Objective To consider the clinical significance of retroperitoneal laparoscopic adrenalectomy for adrenal diseases. Methods We analyzed 33 cases of adrenal diseases treated by retroperitoneal laparoscopic adrenalectomy in this hospital from October 1996 to December 2001. Results Retroperitoneal laparoscopy was successfully applied in 31 cases, whereas conversions to open adrenalectomy were required in the other 2 cases. The mean operation time was 158 min (120 min～200 min). The mean intraoperative blood loss was 150 ml, without blood transfusion needed. The mean length of hospital stay was 6.4 days. Conclusions Compared with open surgery, retroperitoneal laparoscopic adrenalectomy has the advantages of minimal invasion, less blood loss, fewer complications, quicker recovery and shorter hospital stay length. This procedure can be applied to in the absence of contraindications (such as tumor size being more than 10cm, metastatic carcinoma and vital organs or blood vessels being involved).

Objective To discuss the techniques and efficacy of Ho:YAG laser incision by using uteroscopy for ureterostenosis.Methods From July 2004 to April 2007,52 patients with ureterostenosis received ureteral incision by using Ho:YAG laser under a endoscope.Two double pigtail stents(F5 or F6) were placed in the ureters after the operation and left indwelling for 8 to 12 weeks.Ultrasonography and excretion urography were performed 3 to 6 months after extubation.Results Follow-up was available for 3 to 24 months(mean,17 months) in 46 patients,of which 40(87%) were cured after the treatment.In the cured patients,hydronephrosis,ureteral dilation,and ureterostenosis were improved,and the pain in the kidney region was relieved;none of them showed signs of infection.In the other 6 patients,4 were improved after the treatment(no deterioration of the symptoms of hydronephrosis,ureteral dilation,and pain in the kidney region,and no infection);and 2 failed(the symptoms of hydronephrosis and ureteral dilation deteriorated,and pain in the kidney region and infection were developed).Conclusion Endoscopic ureteral excision using holmium laser combined with indwelling of two double pigtail stents is effective and safe for ureterostenosis.

ObjectiveTo introduce the progressing history of DO technique,and report the characteristics of the home-made type MS-1 internal mandibular distracter, and the effects of application of it in animal experiment. Methods15 Mongrel dogs were subjected to be lengthened of the unilateral or bilateral mandibles using the home-made type MS-1 mandibular distracter, and the regular X-ray ex aminations were made. ResultsAbout (20±5)mm in length of the andible had been achieved by the DO (distraction of osteogenesis)technique using the device. The accuracy of the distracter on lengthening would be attained to 98 % of the expectancy. The mineralization of the new bone fulfilled the gap zone about 5 weeks after the distraction had been finished during the consolidation period. ConclusionThe MS-1 type internal mandibular lengthening device has its special advantages on ap plication of cranio-maxillofacial surgery with a great expectancy.

Objective The method of bone lengthening by distraction of callus was used on dog mandible as a model to study the capability and changes of membranous bone during distraction osteogenesis. Methods 15 dogs aged 5～7 months were chosen as the subjects. The operation included a unilateral or bilateral periosteal preserving corti cotomy of mandibular bone, and an introral mini lengthening device were fixed to the buccal side of the mandible. After 7d, the mandible was lengthened lmm/d for 20d and then held in internal fixation for 7～ 140d (1 ～ 20 weeks). Results The dogs were killed at 3 times. Anthropometric measurements, X-ray examination and histological observa tion were conducted and conformed that the distracted bone had formed in the expanded zone successfully. Conclu sion The results suggested that we could use the DO technique in the area of craniofacial clinic. The strong ability of generating new bone in membranous skeleton by DO technique should be further demonstrated in the future.

Objective To investigate the clinical features and disease-causing mutations of familial hypomagnesaemia with hypercalciuria and nephrocalcinosis.Methods In February 2016,a 24 year old female patient with left kidney stone and nephrocalcinosis in bilateral kidneys was admitted to our hospital.One month prior to this admission,she had been treated by PCNL to remove the most part of left kidney stone in otherhospital.Mter admission,She was found hypomagnesaemia (serum magnesium 0.65 mmol/ L) and hypercalciuria (24h urine calcium 364.0 mg) but with normal renal function (serum creatinine 101.5μmol/L).And the remained part of left kidney stone was removed by flexible ureteroscope.As she was considered probably with an autosomal recessive FHHNC,an analysis of CLDN16 and CLDN19 gene mutations was performed using her and her parents'peripheral white blood cells.Results Mutation analysis revealed this patient had two heterozygous mutations in the CLDN16.One is an one-base deletion mutation in the 123th codon in exon 2:368delA.The other is a missense mutation in the 139th codon in exon 2:416C →T which resulted in an amino acid change Ala139Val.Her parents respectively had one of each heterozygous mutation.In the six months follow-up,an oral administration with hvdrochlorothiazide,potassium citrate,and calcium magesium supplements significantly reduced her hypomagnesaemia (serum magnesiun 1.0 mmol/L) and hypercalciuria (24-h urine calcium 156.0 mg),and no stone recurrence and aggravation of nephrocalcinosis and renal dysfunction occurred.Conclusions We diagnosed a patient with FHHNC who had a novel compound heterozygous mutation of CLDN16.This rare disease should be suspected if there are three constant clinical features of hypomagnesaemia,hypercalciuria and nephrocalcinosis,and verified with CLDN16 and CLDN19 gene test.Currently the option for treatment of FHHNC is symptomatic treatment until severe deterioration of renal function.The hydrochlorothiazide,potassium citrate,and calcium magesium supplements may have considerable effects on hypomagnesaemia and hypercalciuria.

Objective To observe the efficacy and safety of radiofrequency thermocoagulation of lumbar sympathetic ganglia combined with pregabalin in the treatment of complex regional pain syndrome(CRPS).Methods 26 patients with lower limb CRPS were selected and treated by the radiofrequency thermocoagulation of lumbar sympathetic ganglia combined with oral pregabalin capsule.The visual analogue scale (VAS)and the quality of sleep(QS)were adopted to evaluate the pain change before treatment and on 1,7,14,28,56 d after treatment.The temperature change of lower limb skin and the occurrence situation of adverse reactions were recorded.Results Compared with before treatment,the scores of VAS and QS at different time points after treatment were decreased significantly (P <0.05),the skin temperature of affected lower limb after treatment was increased significantly (P <0.05).The total effective rates on 28,56 d after treatment were 88.46% and 96.15% respectively.The adverse reactions were mainly dizziness and somnolence.No severe complications such as vascular,neural and intra-abdominal organs injury were found in the treatment process.Conclusion The radiofrequency thermocoagulation of lumbar sympathetic ganglia combined with pregabalin in the treatment of CRPS can rapidly alleviate pain,improve the patients′quality of sleep and living.

Background and purpose:It has been demonstrated that radical prostatectomy for patients with oligometastatic prostate cancer may contribute to improving local control of prostate cancer and overall survival by several retrospective studies. Perioperative complications play an important role in determining whether radical prostatectomy is appropriate for patients with oligometastatic prostate cancer. This study aimed to discuss the recurrence rate and the sever-ity of perioperative complications, and the primary curative effect of radical prostatectomy on oligometastatic prostate can-cer patients.Methods:A total number of 247 patients who received radical prostatectomy were recruited in the study from Jul. 2015 to Jan. 2016, including 25 patients with oligometastatic prostate cancer and 222 patients with localized prostate cancer. Patients with perioperative complications in both groups were graded with the Clavien-Dindo grading system. The proportion of PSA decline and the rates and severity of perioperative complications were analyzed in both groups.Results:The cases of prostate specific antigen (PSA) decline in the oligometastatic group were 21 (84.0%), lower than the localized group with 212 cases (95.5%). There were 6 cases (24.0%) with postoperative complications in the oligometastatic group, including serious complications (Ⅲ or above) 1 case (4.0%), and 49 cases (22.1%) with postoperative complications in the localized group, including serious complications (Ⅲ or above) 7 cases (3.2%). The differences between the groups reached no statistical significance (P>0.05).Conclusion:Radical prostatectomy for patients with oligometastatic prostate cancer could be safe, effective, and appropriate, the risk of perioperative complications should not be one of the limiting factors.

OBJECTIVETo investigate the diagnosis and treatment of incidental prostate cancer (IPC) following transurethral plasma kinetic vaporization prostatectomy (TUPVP).

METHODSPathological examinations were conducted on 134 benign prostate hyperplasia specimens by means of series microtomy after TUPVP.

RESULTSFifteen cases of IPC were detected from the total number of TUPVP specimens, with a pick-up rate of 11.2%. Dual testicle resection with endocrine therapy was performed in 4 cases of Stage A2 patients, and endocrine therapy alone was conducted in 9 cases of Stage A1 patients. Thirteen patients were followed up for 7 to 15 months and all lived without cancer (PSA 0.15 - 4.0 microg/L).

CONCLUSIONTUPVP and series microtomy may be helpful to the diagnosis of IPC. Patients at Stage A1 need mere endocrine therapy, while those at Stage A2 warrant dual testicle resection.

Aged ; Aged, 80 and over ; Follow-Up Studies ; Humans ; Male ; Middle Aged ; Neoplasm Staging ; Orchiectomy ; Prostate-Specific Antigen ; blood ; Prostatic Hyperplasia ; pathology ; surgery ; Prostatic Neoplasms ; pathology ; surgery ; Transurethral Resection of Prostate

Objective To investigate the effect of POSTN protein on the proliferation of chondrocytes of tibial plateau in old rats.Methods Cartilage cells collected from the tibial plateau of old rats were cultured in vitro to the third generation.Then the cells were divided into 3 groups:POSTN group,PBS group and POSTN antibody group.The proliferations of the three groups at 24 h,48 h and 72 h were determined by EDU method.The expression of Notch1 protein was detected by immunohistochemistry in all groups at the same time.Female 20-month-old Sprague-Dawley rats were randomly divided into 3 groups:POSTN protein injection group,Phosphate Buffered Saline (PBS) injection group and POSTN antibody injection group.Twelve weeks after the operation,related reagents were injected 3 times consecutively at day 1,day 3,day 5 and EDU was injected into joints at day 1.At 2 weeks after injection,the rats were killed and the knee tibial plateau was taken to observe the proliferation of the cartilage cells.Results At 24 h,there were differences between the three groups O(F=27.32,P=0.017).The proliferation rates of POSTN group [(23±8)％] and PBS group [(21±10)％] were higher than that of POSTN antibody group (16±5)(P=0.003,P=0.011).At 48 h,there were differences between the three groups (F=35.34,P＜0.01).The proliferation rate of POSTN group [(36±11)％] was higher than that of the other groups [(22±6)％],(18±6)％(P=0.021,P＜0.01).At 72h,there were differences between the three groups (F=52.62,P=0.000).The proliferation rate of POSTN group [(56±17)％] was the highest one,the proliferation rate of PBS group [(31±8)％] was the medium,and the POSTN antibody group [(26±7)％] was the lowest one (all P＜0.05).As for Notch1 protein expression in chondrocytes,there were differences between the three groups (F=26.72,P＜0.01).The Notch1 protein was the most frequently expressed in POSTN protein-injection group and the least in the anti-POSTN group.In rats,the proliferation rate of the chondrocytes in the medial tibia plateau of the knee of POSTN protein injection group [(36±14)％],which was the highest,and that of the POSTN antibody injection group [(10 ±4)％] was the lowest (all P＜0.05).Conclusion POSTN protein can promote the proliferation of chondrocytes knee OA rats.POSTN antibody injection has been shown to induce the proliferation of chondrocytes.The POSTN protein may promote the proliferation of chondrocytes by activating the Notch signaling pathway.

Hyperuricemia/gout is a common metabolic disease in China, which is a serious threat to people′s health. In clinical practice, the standardization of prevention and diagnosis and the rate of treat-to-target need to be improved. There is still a lack of education for the patients about the understanding of clinical guidelines, the disease knowledge and the importance of cooperating with doctors to carry out diagnosis and treatment. From the most concerned issues of the patients, we established the hyperuricemia/gout patient practice guideline working group with multidisciplinary physicians and patients. Seventeen opinions, as the hyperuricemia/gout patient practice guidelines, are proposed in accordance with the relevant principles of the "WHO guidelines development manual" , and with the international normative process, aiming to improve the patients compliance, improve the level of health management of the disease.