Objective To improve the understanding of ileal conduit urinary diversion stomal varicose bleeding.Methods 3 male cases of ileal conduit urinary diversion stomal varicose bleeding were reported.The pathogenic mechanism,clinical features,diagnosis and treatment of this disease were reviewed and discussed with the relevant literature review.The ages were 59,45 and 68.All of them had ileal conduit urinary diversion because of muscle invasive bladder cancer.Ileal conduit urinary diversion stomal varicose bleeding were found at 6 years,6 months and 2 months after surgery.The bleeding was intermittent.All the stomal varicose were found in physical examination.The laboratory examinations showed abnormities of liver functions in all three cases.Image studies showed one with liver metastasis and two with liver cirrhosis.Portal venous hypertension was considered as the cause of bleeding.Results We controlled the bleeding by suturing the first patient's varicose.The patient was died 3 months later because of the advanced cancer.For the second patient,we controlled the bleeding by compressing the varicose.By the meantime,we reduced the portal venous hypertension with medication.The stomal varicose bleeding stopped when the liver function and the portal venous hypertension improved 2 months later.The third patient's stomal varicose were injected with sclerosants.There was no mnore stomal varicose bleeding within half-year follow-up.Conclusions Ileal conduit urinary diversion stomal varicose bleeding is usually found in the patients who have portal venous hypertension because of liver cirrhosis or liver metastasis.To control the bleeding,we can decrease the patient's portal venous hypertension.To control hemorrhage,we can use suturing,compressing,and sclerotherapy,which is an optional treatment.

Objective To investigate the clinical value of the intervertebral disc morphous in patients with thoracolumbar vertebral compression fracture. Methods The MRI, X-ray and CT data of 75 patients with thoracolumbar vertebral compression fracture were retrospectively analyzed. The intervertebral disc damage degree was observed, and its correlation with vertebral fracture degree and endplate damage degree was studied. The vertebral body leading edge height, intervertebral space height and back convex Cobb angle in patients with different intervertebral disc damage degree were measured. Results The intervertebral disc damage degree height was positively correlated with endplate damage degree (P<0.01), and the intervertebral disc damage degree was positively correlated with fracture degree (P<0.01). With the increase of the intervertebral disc damage degree in patients with Ⅰ - Ⅳtype intervertebral disc damage, the vertebral body leading edge height and intervertebral space height gradually became smaller: (0.68 ± 0.05), (0.61 ± 0.03), (0.58 ± 0.03), (0.42 ± 0.05) mm, and (0.31 ± 0.06), (0.29 ± 0.03), (0.24 ± 0.06), (0.22 ± 0.02) mm, and there were statistical differences (P<0.05). There was no statistical difference in back convex Cobb angle in patients with different intervertebral disc damage degree (P>0.05). Conclusions It is more important to observe the morphological changes of the intervertebral disc in patients with thoracolumbar vertebral compression fracture, and the damage degree is closely related with the vertebral fracture degree and endplate damage degree.

Objective To evaluate urinary nuclear matrix protein(NMP 22) as an adjuvant diagnostic marker for transitional cell carcinoma of the upper urinary tract. Methods 24 patients with transitional cell carcinoma of the upper urinary tract and 20 patients with benign urinary diseass were evaluated with urinary NMP 22(cutoff level 10U/ml) and voided urinary cytology.NMP 22 was determined using a commercial test kit. Results The sensitivity and specificity of NMP 22 were 87.5% and 85.0% respectively whereas these of cytology were 58.3% and 95.0%. Conclusions Urinary NMP 22 might be an useful adjuvant diagnostic marker for transitional carcinoma of the upper urinary tract.

Objective To analyze the cause of re-operation after radical cystectomy and ileal conduit in early follow-up period in order to improve the efficacy of this operation and reduce postoperative complications. Methods 12 cases from 81 cases of re-operation were studied retrospectively after radical cystectomy and ileal conduit for bladder tumor in early follow-up period.Of the 12 cases,there are 4 cases of T 4,8 cases of T 3,7 cases of G 2,5 cases of G 3.They are all transitional cell carcinoma. Results There were 4 cases of adhesive intestinal obstruction,2 necrosis of ileal conduit,2 adhesive folding of sigmoid colon into prostatic fossa,2 internal hernia and 2 avulsed incision due to infection .All the cases were re-operated nearly the first operation.After the second operation,all the cases were followed 6～12 months,average 7.7 months,the outcome was satisfied. Conclusions The ileal conduit is a kind of ideal methods for urinary diversion and its early complications should be avoided affecting the efficacy of this operation and the quality of life patients.

Objective To evaluate the clinical features and treatment of pelvi-ureteric junction obstruction (PUJO) in a duplex kidney. Methods From 1993 to 2010, 752 patients were diagnosed as PUJO in our hospital and 18 patients (2.4%) with PUJO in duplex kidneys. Three patients had obstruction in the complete duplicated systems and 15 in the incomplete duplicated systems. Five patients had obstruction of the upper moiety and 13 of the lower moiety. All of the 18 patients underwent B-ultrasonography, with 15 enhanced CT scan, 11 intravenous urography and 10 retrograde pyelography.All patients had serum creatinine test after admission and during the follow-up. Results Sixteen patients underwent operations and 2 patients were treated conservatively. Nine patients underwent pyeloplasty and 7 patients underwent heminephroureterectomy. Pathology shows derangement of the lamina muscularis at pelvi-ureteric junction and infiltration of inflammatory cells in mesenchymal. They were followed up from 6 months to 3 years with a mean of 24 months. The clinical symptoms of patients who underwent surgery were cured in all cases. B-ultrasound and IVU showed that hydronephrosis was obviously relieved and the levels of serum creatinine remained the same or decreased. The hydronephrosis and serum creatinine of patients who underwent conservative treatment remained stabilized. Conclusions PUJO in duplicated system is a rare condition. Careful preoperative evaluation is needed to reach the final diagnosis and retrograde pyelography has high specificity. Treatment should be individualized according to split and partial renal function.

Objective: To investigate the effects of acupuncture and combined acupuncture and medicine on the quality of life and the genital endocrine level in postmenopausal women. Methods:Forty-seven patients were randomly assigned to acupuncture and acupuncture plus medicine groups,23 cases in the acupuncture group and 24 cases in the acupuncture plus medicine group. The observed course of treatment was 3 months. A Chinese concise SF-36 questionnaire was used to evaluate the quality of life in the different groups of patients before and after treatment.Meanwhile, radioimmunoassay was used to observe the differences in serum genital hormones:follicle stimulating hormone (FSH), luteinizing hormone (LH) and estradiol (E2) contents between pretreatment and posttreatment in both groups. Results: After treatment, there was a significant difference in quality of life between the two groups and it was better in the acupuncture plus medicine group than in the acupuncture group(P＜ 0.01). E2 content increased more markedly in the acupuncture plus medicine group than in the acupuncture group(P＜ 0.05). There were no significant differences in FSH and LH contents between the two groups (P ＞ 0. 05). Conclusion: Both acupuncture and acupuncture plus medicine can improve the quality of life and increase obviously low E2 content in postmenopausal women. Acupuncture plus medicine raises the patients' quality of life and E2 content more markedly than acupuncture. It is suggested that both acupuncture and acupuncture plus medicine can improve the symptoms, signs, and physical and mental health, raise the quality of life and ameliorate genital-endocrine environment in postmenopausal women, but a combination of acupuncture and medicine has a better effect.

BACKGROUND:Fragile bone in senile osteoporosis patients easily weakened pedicle screw fixation capacity. Therefore, bone cement leakage and screw removal cannot be solved during pedicle screw repair in osteoporotic patients with degenerative lumbar spine. OBJECTIVE:To investigate the biomechanical properties of novel pourable pedicle screws and bone cement application effect in osteoporotic patients with degenerative lumbar spine. METHODS:Six lumbar specimens (T11-L5) at the mean age of (72.9±4.2) years were selected, total y 42 vertebrae. The average bone density was 0.696 g/cm2. Any side of al vertebrae was inserted with pourable pedicle screws. 2 mL of bone cement was perfused under the X-ray fluoroscopy with cement push rod and fil ing cylinder. The same number of conventional screws was inserted into the opposite side of the samples. Three-point bending test was performed in two kinds of screws. The maximum vertebral axial pul out force test and the maximum spin torque test were conducted in vertebra to observe the destruction of the vertebral body and implanted effect. RESULTS AND CONCLUSION:(1) The ultimate strength and yield load of novel pourable cement pedicle screws were significantly more than conventional screws (P<0.05). Ultimate displacement and yield displacement were significantly less in novel pourable cement pedicle screws than in conventional screws (P<0.05). (2) The maximum vertebral axial pul out force and the maximum spin torque were significantly higher in novel pourable pedicle screws than in conventional screws (P<0.05). (3) In summary, novel pourable cement pedicle screw is simple to operate, can effectively control bone cement penetration, and improve screw stability in osteoporotic vertebrae. Moreover, after treatment, the removal of screws is convenient, cannot evidently destroy vertebral body or screw channel, and promote early recovery.

According to the course characteristics and teaching outline of medical psychology,problem-based learning (PBL) case about somatoform disorders was compiled based on a typical clinical real case.The PBL case covered a wide range of topics such as basic medicine,clinical medicine and medical psychology.Just as clinical treatment process,teachers gave information and put forward the corresponding questions in successive steps.By self-study and group discussion,students learned knowledge about anxiety,somatoform disorders,therapeutic relationship,sociocultural factors and individual personality.The course survey showed that PBL teaching was appreciated by medical students.The PBL model can improve learning interest and self-study ability,promote the connection of different subjects and combine theory and practice.The PBL model is useful for improving the quality of medical psychology teaching.

Objective To observe the clinical efficacy of minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) by Quadrant channel for grade Ⅱ and Ⅲ spondylolisthesis. Methods Forty-eight patients with grade Ⅱ and Ⅲ spondylolisthesis were treated with MIS-TLIF by Quadrant channel. The patients were followed up for 12 months, The visual analog scale (VAS), Oswestry disability index (ODI), intervertebral height and lose drop of anterior slippage reduction were assessed. Results Surgery was successfully completed in all the patients. The VAS, ODI, intervertebral height and vertebral slippage 1 week after operation were significantly improved compared with that before operation:(4.5 ± 0.8) scores vs. (8.6 ± 1.2) scores, (32.0 ± 1.3) scores vs. (46.0 ± 3.7) scores, (10.5 ± 2.2) mm vs. (4.6 ± 2.1) mm and (2.1 ± 2.0) mm vs. (11.2 ± 1.7) mm, and there were statistical differences (P<0.05). Compared with that of 1 week after operation, there was no significant change in 12 months:(2.1 ± 2.0) scores, (11.0 ± 1.1) scores, (9.8 ± 2.5) mm and (2.2 ± 2.0) mm, P>0.05. Patients did not have the complications such as nerve damage, loosening of internal fixation. Conclusions The MIS-TLIF is a safe and effective minimally invasive treatment for grade Ⅱ and Ⅲ spondylolisthesis by Quadrant channel.

Objective To evaluate the effect on treatment of multiple myeloma complicating femoral neck fracture by surgical intervention combined with drugs.Methods Twelve patients with multiple myeloma complicating femoral neck fracture were treated by cemented total hip arthroplasty femoral head shank.All of patients were received zoledronic acid treatment,at the same time,7 cases of them treated by MPT regimen (melphalan,methylprednisolone and thalidomide),3 by bortezomib combined with dexamethasone,and 1 by autologous peripheral blood stem cell transplantation.Results Twelve patients could tolerate surgery,postoperative pain was significantly reduced.Assessed by using Harris hip function score after 6 months operation,2 cases were excellent,7 cases were good,3 cases were common,excellent and good rate was 75％ (9/12).All patients were followed up for 8 months to 3 years,1 case of local recurrence after 13 months.1-year overall survival rate was 100％,2-year overall survival rate was 83％,and 3-year overall survival rate was 67％.Conclusions Multiple myeloma complicating femoral neck fracture,using bone cement in total hip arthroplasty femoral head shank to clear the local tumor lesions,receive reconstruction capability,rapid postoperative recovery,pain relief,and opportunities for further comprehensive treatments.The bisphosphonate can promote new bone formation and prevent further fractures.The surgical intervention combined with chemotherapy could relieve the symptoms,reduce tumor cell burden,improve quality of life and prolong survival time.