[Objective]To explore the advantages and disadvantages of minimal incision surgery(MIS) for total hip replacement.[Methods]Thirty-two patients(37 hips) who had undergone a MIS were compared with 32 patients(37hips) who had undergone conventional incision surgery with similar condictions.The length of incision,operation time,intraoperative blood loss,postoperative drainage,hospitalized days and complications were observed.[Results]The average incision length was 7.7 cm for MIS group and 11.5 cm for conventional incision group(P0.05).In MIS group,greater trochanter fracture occured in 1 patient during operation.Dislocation occurred in another patient with anterolateral approach 3 days postoperatively because of malposition of the cup,the cup was then adjusted to proper position by re-operation with extended incision length.In conventional incision group,no complication occured during or after operations.[Conclusion]Total hip replacement with the incision length of 6～8.5 cm is a very demanding technique.There were no much advantages of MIS for total hip replacement concerning surgical time,blood loss or trauma compare with a conventional incision surgery.The incision length for total hip replacement should not be stressed.The most important thing for total hip replacement is not the length of the incision and the length of incision should not be reduced at the price of more soft tissue injury.

Objective To discuss the clinicopathologic and imaging features of multilocular cystic renal eell carcinoma(MCRCC). Methods The data of 8 cases(5 men and 3 women)MCRCC classified according to 2004 WHO criteria were reviewed retrospectively.The tumor was incidentally found in 5 out of 8 cases.Renal ultrasound and CT scans were available in all 8 cases.CT or enhanced CT scans showed a well-defined cystid mass with irregular thickening wall or septa in 7 cases,without visible nodules found.For treatment,open or laparoscopic radical and partial nephrectomy was done in those cases. Results Postoperative pathological findings confirmed the diagnosis of MCRCC.The mean greatest diameter of the tumors was 5.6 cm.Microscopically,the wall and septa lined by one or several layers of clear cells were observed in all cases.The TNM stage of all 8 cases was T1 N0 M0.For pathologic grade,7 cases were G1 and 1 case was G2.Seven patients were followed up and remained tumor free during the average time of 8 months. Conclusions MCRCC is an uncommon subtype of RCC,it has a lower malignant potential and a better prognosis compared with other types of RCC according to the literature.Nephron-sparing surgery may be an appropriate treatment option for MCRCC.

Objective To investigate the accumulation of mutations and single nucleotide polymorphisms ( SNPs) in the displacement loop ( D-loop ) of mitochondrial DNA ( mtDNA ) might be associated with cancer risk and disease outcome.Methods We obtained cancerous and noncancerous liver tissues from 49 HBV-related HCC patients at the Fourth Hospital of Hebei Medical University.mtDNA of the liver tissues was extracted with Mitochondrial DNA Extraction Kit.Mutation and polymorphism were confirmed by repeated analysis.We assessed the prediction power of D-loop SNPs in hepatocellular carcinoma ( HCC) patients.Results No mutation in these HCC patients had prediction power for post-operational survival, whereas one SNP site ( nucleotide 150 C/T ) was identified by the log-rank test for statistically significant prediction of HCC survival.In an overall multivariate analysis, allele 150 was identified as an independent predictor of HCC outcome.The length of survival of patients with allele 150C was significantly shorter than that of patients with allele 150T (relative risk, 0.246;95% CI, 0.070–0.861; P=0.028).Conclusions The analysis of genetic polymorphisms in the mitochondrial D-loop helps to identify patient subgroups at high risk of a poor disease outcome.

Objective To summarize the pathological and imaging features and treatment of retroperitoneal bronchogenic cyst.Methods The clinical data of 2 cases treated from October 2001 to November 2009 were summarized.The first patient was a 55-year-old woman with the chief complaint of lumbago in the left flank for 10 d.B-ultrasound showed mixed solid and cystic mass in spleen space with a diameter of 3.9 cm with thin wall and without rich blood supply.CT showed the lesion in the left adrenal gland region measured about 4 cm ×4 cm with low density with CT value of 10 HU,and enhanced scan was not obvious with CT value of 20 HU.It was diagnosed as left adrenal tumor and tumor resection was performed.The second case was a 17-year-old young man with the chief complaint of gross hematuria for 3 weeks after strenuous exercise.Ultrasonography found a 8.4 cm × 7.7 cm × 9.0 cm anechoic area surrounding the bladder.CT showed about 9.0 cm × 7.2 cm × 9.0 cm cystic lesion with thin wall,and the center density was uniformity in presacral space with CT value of8 HU.IVU showed visible semi-circular lower edge on the right edge of the bladder.The patient was diagnosed of presacral cyst and cystectomy was performed successfully.Results The pathology report of the first case:organizing wall with fibrous connective tissue,with most of the lining overlying pseudostratified ciliated columnar epithelium,goblet cells and subepithelial basement membrane.Pathological diagnosis was bronchogenic cyst,and the patient was followed up for 9 months without recurrence.The pathology report of the second case:pathological tissue fibers false wall tissue lining ciliated columnar epithelium,goblet cells seen in epithelium,fibrous tissue in the visible structure of mixed glands,a small amount of cartilage and muscle tissue.The diagnosis was bronchogenic cyst,and the patient was followed up for 2 years without recurrence.Conclusions Retroperitoneal bronchogenic cyst is rare and easily misdiagnosed.Radiology imaging can identify cystic features,while a few may be with high density without specificity.Surgical removal of retroperitoneal bronchogenic cyst with symptoms has good prognosis and may prevent malignant transformation and secondary infection.

Objective To discuss the clinical and pathological features of urachal carcinoma.Methods The clinical and pathological data of 7 patients diagnosed as urachal carcinoma were retrospectively analyzed,and the cIinicopathologic features,diagnosis and treatment,surgical characteristics and surgical outcomes were reviewed.There were 6 males and 1 female.Patient's age ranged from 26-75 years,with average of 52 years.Examinations before surgery included ultrasound,cystoscopy,urine cytology,CT and IVU.Six patients underwent extensive partial cystectomy and 1 patient underwent conventional partial cystectomy. Results Pathological diagnosis were 5 cases of mucinous adenocarcinoma,1 case of not classified adenocarcinoma,1 case of small cell neuroendocrine carcinoma.Clinical stages according to Sheldon staging system were 6 cases of stage ⅢA and 1 case of ⅢC.One patient died of bone metastasis 3 months after operation,1 patient experienced recurrence in bladder neck and urethra in 15 months and 24 months after operation and received TUR-Bt,the other 5 patients were alive without recurrence and metastasis with follow-up of 2-30 months. Conclusion Urachal carcinoma is a rare malignancy,and patients with this disease haye a poor prognosis.

Objective To summarize the relationship between metabolic syndrome (MS),its components and T1 stage with high grade urothelial carcinoma (HGUC) of the Bladder.Methods The clinical data of 200 patients with T1 high grade bladder cancer who were admitted to our hospital from January 2010 to June 2014 were retrospectively analyzed,including 155 males and 45 females.Ages were 24 to 86 years old,average 66 years old.Based on the history or blood glucose levels,patients were divided into diabetic group (n =41) (20.5％) and non diabetes group 159 cases (79.5％);According to the body mass index (BMI) were divided into obese group (≥25 kg / m2) of 98 cases (49.0％) and non obese group (＜ 25 kg / m2) of 102 cases (51.0％).According to the blood pressure level,71 cases (35.5％) were divided into hypertension group and 129 cases of non hypertension group (64.5％).MS and its components and the relationship between the recurrence and progress of bladder cancer were analyzed.The Kaplan Meier method was used to assess MS and its components division of tumor progression free survival (progress-free survival,PFS) and recurrence free survival (recurrence-free survival,RFS) influence.Cox regression model of multi factor analysis were used to evaluate the PFS and RFs of MS and its components with bladder cancer.Results Of the 200 cases,16 cases (8.0％) were MS.Tumor recurrence occurred in 121 cases (60.5％),and 84 patients (42.0％) were in progress.Diabetes and non diabetes groups the average RFs were 21.7 and 29.3 months respectively,and the difference was statistically significant (x2 =10.115,P =0.001);The median PFS were 32.8 and 39.8 months respectively,the difference has statistical significance (x2 =14.760,P ＜0.001).Obese group and non obese group average RFs were 34.7 and 42.0 months respectively,and the difference were statistically significant (x2 =16.077,P ＜ 0.001);The median PFS were 22.8 and 32.6 months respectively,the difference was statistically significant (x2 =16.174,P＜0.001).The average RFS of MS group and non MS group were 21.5 and 28.4 months respectively,the difference was statistically significant (x2 =5.429,P =0.02);the average PFS was 35.1 and 38.7 months respectively,and the difference was statistically significant (x2 =3.854,P ＜ 0.05).Cox multivariate survival analysis showed that diabetes and obesity can increase the risk of recurrence and progression of T1 advanced stage bladder cancer (HR =1.792,P =0.013,HR =2.498,P ＜ 0.001;HR =0.559,P ＜ 0.001;HR =0.492,P ＜ 0.001).Conclusions Diabetes mellitus and obesity are high risk factors for the recurrence and progression of T1 advanced stage bladder cancer,but MS is not related to the prognosis of T1 patients with advanced bladder cancer.

Objective To investigate the clinicopathological features, treatment modalities, and prognostic factors for survival in patients with urinary tract small cell carcinoma (UT-SCC).Methods A total of 25 patients treated from June 2000 to December 2014 were included in the retrospective study.The data included age, gender, primary tumors origins, stage, treatment modalities, progression-free survival (PFS), overall survival (OS), pathology and immunohistochemistry.Of these cases, 22 were male, and the other was female, whose age was 45-79 years (mean age 67).20 cases small cell carcinoma of bladder patients and 2 small cell carcinoma of prostate cancer patients were included.The number of small cell carcinoma in pelvis,ureter and retroperitoneal was 1 respectively.The patients with small cell carcinoma of the urinary tract were classified as disease and extensive disease.17 bladder small cell carcinomas were limited disease and 3 cases were extensive disease;Prostate small cell carcinomas were both extensive disease;The small cell carcinomas in pelvis, ureter were limited disease;The small cell carcinoma in retroperitoneal was extensive disease.10 bladder small cell carcinomas which were limited disease received radical cystectomy.6 of 10 patients received etoposide and cisplatnum (EC).4 of 10 patients received gemcitabine and cisplatnum (GC).7 bladder small cell carcinomas patients who with limited disease refused to receive radical cystectomy in which 2 patients received TURBT and 5 patients received TURBT followed chemotherapy.Both prostate small cell carcinomas received chemoradiotherapy.2 small cell carcinomas in upper urinary tract (pelvis and ureter) received radical nephroureterectomy with bladder cuff resection.The patient of retroperitoneal small cell carcinoma received percutaneous nephrostomy after biopsy.The progression-free survival (PFS) and overall survival (OS) of these patients are analyzed;the influence of TURBT with adjuvant chemotherapy and clinicopathologic characteristics were analyzed in median PFS and OS.PFS and OS were compared between groups as a function of time, using a Kaplan-Meier survival curve analysis and the log-rank significance test.All statistical tests were two-sided, and P values ＜ 0.05 were considered statistically significant.Results 25 patients with a pathologic confirmation of UT-SCC,either by biopsy or surgery,were finally included.These patients were classified as pure UT-SCC (14) and Mixed UT-SCC (11).Mixed UT-SCC was defined as tumors containing both SCC and non-SCC components,regardless of the proportion of the latter.13 cases were strongly positive and 3 cases were weakly positive in neuron specific enolase (NSE) level.8 cases were strongly positive and 2 cases were weakly positive in CgA level.Patients with limited disease experienced a significant longer PFS and OS compared with extensive disease subjects (PFS 13.2 vs.7.8 x2=13.53 P＜0.01;OS27.2 vs.12.7x2=19.88 P＜0.01).Patients with bladder SCC showed a significantly higher median PFS and OS compared with patients with SCC of other parts of urinary tract (PFS 12.8 vs.8.2 x2 =12.00, P =0.001;OS 26.3 vs.13.2 x2 =14.45,P ＜0.01) .The two different chemotherapy regimens (GC and EC) have no influence on survival (PFS: 16.3 vs.12.5,x2 =3.34, P =0.07;OS 29.5 vs.22.8, x2 =1.66, P =0.198).TURBT followed by adjuvant therapy have no influence on survival (PFS 14.5 vs.12.0 t =1.30 P =0.251;OS 24.5 vs.28.4 t =0.50,P =0.636).Conclusions The primary tumors origins and stage may have influence on survival in patients with UT-SCC.Patients with bladder small cell carcinoma and limited disease experienced a longer survival.

Objective To evaluate the relationship between metabolic syndrome , its components and the histopathological findings in bladder cancer patients .Methods The data of 326 patients in our department between October 2010 and October 2013 were retrospectively analyzed.Age, gender, stature, weight, histologic stage, grade, and the presence of hypertension , diabetes mellitus, body mass index ( BMI) were evaluated.There were 64 females, 262 males, aged 23-89 years, including 241 low stage, 85 high stage, 155 low grade, and 171 high grade, respectively.There were 117 cases with hypertension, 95 cases with diabetes mellitus , 139 cases with BMI ≥25 kg/m2 and 49 cases with metabolic syndrome.The TNM classification was used , with Ta and T1 tumor accepted as low stage , T2 , T3 and T4 tumor as high stage bladder cancer.In addition, the pathological grading system adopted by the 2004 World Health Organization was applied.Non-invasive papillary urothelial neoplasms of low malignant potential were regarded as low grade.Analyses were completed using Chi-square tests to evaluate the correlation of diabetes mellitus , hypertension and obesity with the pathologic stage and grade .Moreover , the pathologic stage , grade and recurrence were compared between metabolic syndrome and non-metabolic syndrome groups . Results Metabolic syndrome was significantly associated with histological grade and stage (P=0.001, P=0.011). Diabetes mellitus and obesity were also associated with histological grade and stage (P=0.006, P<0.01). Conclusions Patients with metabolic syndrome were found to have significant higher T stage and grade of bladder cancer .Diabetes mellitus and obesity may promote the grading and staging of bladder cancer .

Objective To discuss the indication for kidney-sparing surgery (KSS) on primary urothelial carcinoma of the distal ureter.MethodsClinical data of 108 patients with primary urothelial carcinoma of the distal ureter in our hospital from 2001 to 2009 were analyzed retrospectively.There were 75 males and 33 females with mean age of 62 ( range from 42 to 85 ) years old in this study.The patients were divided into KSS group and RNU group according to the operation methods.The recurrence rate of radical nephroureterectomy (RNU) and KSS were evaluated.Results The recurrence was seen none with T,stage,1 (12.5％) with T1 stage,4 (36.4％) with T2 stage and 4 (80％) with T3 stage in KSS group.In RNU group,there was none with Ta stage,4 ( 15.4％ ) with T1 stage,10 (33.3％) with T2 stage and 7 (36.8％) with T3 stage recurred.There was no difference between patients with Ta to T2 stages in KSS and RNU group (P ＞0.05 ) on recurrence,but there was a significant difference between patients with T3 stage (P＜0.05).There was 1 (33.3％) case with G1 grade,3 (18.8％) with G2 grade and 5 (62.5％) with G3 grade recurred in KSS group,while 2 (22.2％) cases with G1 grade,9 (20％) with G2 grade and 10 (37.0％) with G3 grade recurred in RNU group.There was no difference between patients with G1 to G2 grades in KSS and RNU group (P＞0.05),but there was a significant difference between patients with G3 stage in the two groups ( P ＜ 0.05 ).Conclusion KSS seems to be safe for patients with low stage and low grade primary urothelial carcinoma of the distal ureter.

Objective To investigate the clinical feature,diagnosis,treatment and prognosis of endometriosis of the bladder.Methods A retrospective study was conducted to review the clinical data of 10 patients with bladder endometriosis.Patient's age ranged from 30 to 48 years (with mean age of 38 years).Eight cases were admitted to hospital with urinary tract irritating symptoms during the menstrual period and 6 cases with hematuria; 2 patients without any symptoms were found through examination.The course of disease was 1-36 months (with mean of18 months).Ultrasound shows with low echo,single,wide base and no significant blood flow mass whose boundaries are less clear within the bladder wall.CT reveals soft-mass protruding into the bladder.Results Eight of the 10 patients were undergone partial cystectomy.And 2 cases was treated with transurethral resection.All cases were pathologically confirmed to be bladder endometriosis.Recurrence and ectopic lesion had not be found during follow-up period from 10 to 72 months (with mean of 30 ± 5.6 mon).Conclusions Endometriosis is a common disease in females in their reproductive years,but thebladder endometriosis is rare.The initial diagnosis needs to be made combining with imaging studies.It is confirmed by cystoscopy and pathological biopsy.Surgery is the option for the treatment of bladder endometriosis.