Objective To evaluate the role of adrenolectomy in ectopic ACTH syndrome. Methods Clinical data of 23 cases of ectopic ACTH syndrome were analysed.Of them,14 were males and 9 were female,the average age was 38.All of the 23 cases had clinical and biochemical and imaging evidences for the diagnosis of Cushing's syndrome.16 of the 23 cases were treated with total adrenalectomy and the other 7 were treated without surgical intervention. Results Sixteen cases,having no identifiable source of ectopic hormone production, treated with bilateral or unilateral total adrenalectomy,had resolution of their presenting signs and symptoms,1-year survival was 67%,2-year survival was 44% and 5-year survival was 19%.Seven of the patients who were managed without surgical intervention,1-year survival was 0%. Conclusions To most patients with no identifiable source of ectopic hormone production, bilateral adrenolectomy with hormonal replacement is effective.

Objective To assess the feasibility and advantage of systematic transperineal ultrasound guided template prostate biopsy. Methods In a prospective study, a total of 1270 patients(26 -90 year old,mean age 70. 4) who met the inclusion criteria underwent 11 regions systematic transperineal ultrasound guided template prostate biopsy. The median PSA level was 12. 96 ng/ml(range 0. 25000. 0 ng/ml) and the mean prostate volume was 53. 6 ml(range 7-200 ml). Results Prostate cancer was detected in 486 of 1270(38. 3%). The prostate cancer detection rate in group with PSA 0-4.0, 4. 1-10. 0, 10. 1-20. 0, 20. 1-40.0, 40. 1-60.0, 60. 1-100.0、and> 100. 0 ng/ml groups was 21.9%(16/73 )、16.6%(67/ 403)、30.7% (122/397)、46. 7%(77/165)、68. 3%(41/60)、86.2% (46/54) 、99.2% (117/118), respectively . While cancer detection rate in group with prostate volumes less than 20, 21-40, 41-60, 61-80 and great than 80 ml was 72. 1%(49/68 )、55. 6%(234/421) 、32.5%(136/418)、23.3%(48/206)、12. 1%、(19/157). The mean positives for the cancer of regions 1- 10 and region 11 (the apical region) were 35.3% vs. 44.8% in patients whose PSA＜20ng/ml(P＜0. 05). The positives for cancer within the right lobe and left lobe were 70. 8% vs. 74.2%(P>0.05)and the positives for cancer within the anterior and posterior parts were 79. 4% vs. 86. 8%(P>0. 05). No serious complication occurred during the procedure. Conclusions Systematic transperineal ultrasound guided template prostate biopsy could be accurate and safe. Prostate carcinoma foci are more frequently localized in the apical region in patients with PSA ＜20 ng/ml. Special attention should be paid to the apical region during the process of biopsy.

Objective To evaluate the safety and efficacy of adrenal autotransplantation for the treatment of persistent Cushing's disease after transsphenoidal pituitary tumor resection. Methods Four patients were treated by adrenal autotransplantation with attached blood vessels after bilateral adrenalectomy for persistent Cushing's disease from April 1991 to March 2008 in our institute. The four patients were 3 females and 1 male. Their ages ranged from 14 to 36 years, with an average of 30 years. Right adrenalectomy was performed 1 to 3 months before the left adrenalectomy. 30 % ?50 % of the left hyperplastic adrenal was placed in the left inguinal region with the anastomosis of the inferior epigastric artery and the central adrenal vein, and between the left saphenous vein and the incised adrenal envelope with the adrenal middle artery inside. The hormone replacement dosage decreased gradually after operation. They were followed up for 1.0, 1. 5, 8. 0 and 10. 0 years. The patient's symptoms, adrenal hormone (serum cortisol, urinary free cortisol and adrenocorticotroph) levels and the steroid replacement dosages were recorded and analyzed. Results The symptom of the Cushing's disease disappeared completely after operation and there was no Nelson's syndrome except one patient with slight darken skin. Through 4 ways of imaging examination, operation, clinical presentation and endocrine examination, the 4 transplanted adrenals functioned well with less steroid replacement dosage needed after operation. The 4 transplanted adrenal glands functioned steadily 1 year after the auto-transplantation, and no hyperplasia was detected in the transplanted adrenals with the stimulus of high dosage adrenocorticotroph. Conclusions The long-term effects of adrenal autotransplantation with attached blood vessels after bilateral adrenalectomy is effective and safe. Adrenal autotransplantation can be a feasible option for the treatment of persistent Cushing's disease.

Objective To discuss the clinical characteristics and management principles of com-posite pheochromoeytoma of adrenal gland (pheochromocytoma-ganglioneuroma). Methods Four cases of composite tumor of adrenal gland diagnosed pathologically were reviewed. All the cases were male, aged 37 to 62 years;three of them had the history of hypertension, one of them accompanied with paroxysmal palpitation, while one case was asymptomatic. Computerized tomography and ultra-sonography showed single tumor in adrenal, the diameter was about 2.5、3.8、6.3、15cm respectively. Two cases showed positive results in 131Ⅰ-metaiodobenzylguanidine (MIBG) scintigraphy. One case showed positive result in 99Tcm-hydrazinonicotinamide-3trysinoctreotide (HTOC) scintigraphy. Twenty-four hours urinary catecholamine examination revealed the average of norepinephrine, epi-nephrine and dopamine were (196.1±92.2)nmol/24 h, (26.6±8.9)nmol/24 h, (1957.9±913.5) nmol/24 h respectively. Two cases were at a little elevated level and the others with normal. All cases were managed with α-adrenergic receptor blocker preoperatively for 2-4 weeks. Results Tumor re-section was performed in all 4 cases, and 3 cases by retroperitoneal laparoscopy, one by open surgery. All 4 cases were diagnosed as composite pheochromocytoma of adrenal (Pheochromocytoma-gangli-oneuroma) by pathology. All patients had no evidence of recurrence or metastasis during follow-up from 15 to 38 months. Two of three cases with hypertension reverted to normotensive. Conclusions Composite pheochromocytoma of adrenal is rare, difficult to be diagnosed preoperatively. Except mild in eatecholamine secretion, which clinical manifestations are similar to pheochromocytoma. Pheochro-mocytoma-ganglioneuroma is no apparent tendency for aggressive behaviors, the results of surgical management are favorable.

Objective To understand the application of dietary supplements among adult patients with type 2 diabetes mellitus (T2MD) in two areas of China. Methods A total of 615 T2MD patients were recruited from three hospitals in Beijing and Shenyang, with convenience sampling for the study using self-reported questionnaires. Data were statistically analyzed. Results Overall 34. 8% of the participants (22.5% in Beijing and 45.5% in Shenyang, respectively) reported ever use of at least one dietary supplement in the past 12 months. The most commonly used supplement was royal jelly ( 16. 1% ), followed by vitamins ( 10. 1% ), calcium (8. 8% ),fish oil (7. 3% ), spirulina (3.9%), and lecithin (2. 3% ). Except that royal jelly was used for complementary treatment for T2MD, most of the other supplements were used for improving their body defense. In addition, more than 20 other health dietary supplements were also used for diabetes-related conditions in 8. 5% of the participants surveyed. The participants' main sources of information about dietary supplements were from mass media or recommendations by relatives and friends. About half of supplements users perceived that the dietary supplements were effective. The application of dietary supplements was associated with gender, educational background, living area,perceived burden of medical cost, stage of diabetes, comorbidity, and body mass index (BMI) of the patients ( all P ＜0. 05). Conclusions Dietary supplements are widely used among T2MD patients in Beijing and Shenyang.The types of these dietary supplements are diverse and lack professional instructions. It is recommended that information on dietary supplements should be included in diabetes education.

Objective To evaluate the clinical application of a muhiprobe FISH (multicolor fluorescence in situ hy-bridization,M-FISH) assay in voided urine specimens for detection of bladder cancer and compare the results with those afforded by urinary cytology.Methods Voided urine specimens from 100 cancer patients with or without surgery and 10 patients with prostate hyperplasia were obtained for urinary cytology and FISH.FISH was performed using a mixture of fluorescent labeler DNA probes for the centromeric regions of chromosomes 3,7,and 17 and 9p21 region.Cystoscopy with biopsy or tumor resection was performed in all patients and compared the pathological results with the cytological and FISH findings.Results The sensitivity of M-FISH were 75.6% for low grade tumors,100% for high grade tumors,with overall sensitivity of 85.5%.Urinary cytology affords an overall sensitivity of 62.9% (33.3% for low grade tumors,96.0% for high grade tumors).Significant difference in overall sensitivity was observed between M-FISH and urinary cytology (P＜0.05).The specificity of M-FISH and urinary cytology was 84.6% and 87.8% respectively.No significant difference in specificity was observed between M-FISH and urinary cytology.Conclusion M-FISH improves the sensitivity obtained with urinary cytology for bladder cancer detection with similar specificity,so can detect all high grade infiltrating tumors patients.

Objective:To investigate colonic motility effect and mechanism of Ghrelin in diabetic mice.Methods:In vivo,the effects of Ghrelin(50,100,200 ?g/kg)on colonic transit of diabetic mice were measured by charcoal suspension pushing test.The effects of Atropine,N?-nitro-L-arginine methylester hydrochloride(L-NAME)and D-Lys3-GHRP-6(GHS-R antagonist)on the colonic transit of Ghrelin(200 ?g/kg)were also investigated.In vitro,the effects of Ghrelin on spontaneous contraction of proximal colonic circular muscle strips of diabetic mice were studied.Results:Ghrelin accelerated colonic transit of diabetic mice with significant dose-response relationship(P

Objective To discuss the clinical and pathological manifestations of paragangliomas of the urinary bladder (PUB) and improve the preoperative diagnosis and surgical treatment of PUB.Methods Clinical data of 11 patients treated for PUB from June 1985 to March 2010 were analyzed.All cases had mild-paroxysmal hypertension, palpitation, sweating, and 9 cases occasionally showed headache and micturition syncope during straining urination. Twenty-four hour urine catecholamine (CA) levels were estimated in all cases. B-ultrasound and CT and/or MRI scanning were used in the imaging of all cases. Nailfola microcirculation inspection was carried out in 5 cases. Scintigraphy 131I-MIBG in 4 patients was positive expression, 7 of 111 In-DTPA-Octreotide scintigraphy and I of PETCT were also positive expression. UICC bladder tumor classification was T1 (1 case), T2 (5 cases), T3(4 cases), T4 (1 case). Results All the patients underwent partial cystectomy, laparoscopy or TURBT. One patient received 131 I-MIBG therapy. Histopathological diagnosis was confirmed by HE staining in all of the removed tumors. The tumors consisted of discrete aggregates of zellballen cells separated by a network of vascular channels. Follow-up ranged from 3 to 291 months (mean, 45 months). There were 3 recurrences following surgery. One patient died after developing pelvic lymph nodes, liver and colon metastasis. Conclusions PUB should be suspected in patients below 40 years of age if the clinical manifestations of typical tetrad symptoms: headache and micturition syncope,sweating, palpitation and hematuria are present. Advanced classification, multifocal tumors and CgA (+) are risks of recurrence and metastasis. In those patients with unresectable multiple or recurrent tumors, chemotherapy and 131I-MIBG therapy may be helpful for controling hypertension and delaying progress.

Objective To evaluate the efficacy of laparoscopic adrenalectomy and open adrenalectomy in treating recurrent Cushing′s disease. Methods Forty-three patients (29 females and 14 males) with recurrent Cushing′s disease treated with laparoscopic adrenalectomy (LA, n=32) or open (OA, n=11) adrenalectomy from 2000 to 2008 were retrospectively analyzed. Patients completed the follow-up survey including a 36 item short-form (SF-36) health survey. Results All 43 patients achieved successful adrenalectomies without intraoperative complication. The duration of the LA was significantly shorter than that for the OA. Intraoperative blood loss was low in both groups. Median length of hospital stay was shorter in the laparoscopic adrenalectomy group, P<0.05. The median follow-up was 48.5 mon. Of the 34 (79.1%) patients available for follow-up, 22 (64.7%) had an adrenocorticotropic hormone levels >200 ng/ml and six (27.3%) had clinical Nelson syndrome. Thirty-four patients who completed the SF-36 survey reported that they felt their health status had changed from good to excellent after adrenalectomy. However, except for social activity, they showed significantly lower SF-36 scores compared with the general population, P<0.05. No statistical difference was found in SF-36 scores between the laparoscopic and open groups. Conclusions Adrenalectomy is safe and an effective option in the treatment of recurrent Cushing′s disease. It can help patients to improve both survival rate and quality of life.

ObjectiveTo discuss the safety and feasibility of transumbilical laparoendoscopic single-site resection of postperitoneal paraganglioma. MethodsFive patients with postperitoneal paraganglioma accepted transumbilical laparoendoscopic single-site surgery from October 2010 to October 2011.Four patients were male and 1 patient was female aged from 24 to 52 years with the average age of 38 years.Three patients presented with paroxysmal hypertension,1 patient with persistent hypertension,and the other with no symptom.The tumors were located on left postperitoneum in 3 cases (2 adjacent to left renal vessels,the other para-aortic),and right postperitoneum in 2 cases (1 adjacent to right renal vessels,the other between inferior vena cava and aorta).The diameter of tumors ranged from 2.5 cm to 6.0 cm.or-blocker was given for preoperational preparation.After 2 -4 weeks,transumbilical laparoendoscopic single-site resection of tumors were administered.Transparacolic route was selected in 4 cases and the other was operated through mesentery. ResultsAll the operations were successful.None was converted to conventional laparoscopic surgery or open surgery.The operative time ranged from 80 to 190 min,the mean was 150 min.The blood loss ranged from 50 to 150 ml,the average blood loss was 85 ml. No operation-related complications ocurred.Four cases with hypertension returned to normal blood pressure.All cases recovered uneventfully and discharged in 3 to 6 d after operation.Postoperational pathologic result proved the diagnosis of paraganglioma.The wound healed very well and the scars were occult.Follow-up was performed in all cases for 3 to 15 months.No recurrence was found.ConclusionTransumbilical laparoendoscopic single-site resection of postperitoneal paraganglioma could be safe and effective,and has good cosmetic effect.