Objective To study the pathogenetic characteristics of tertiary hyperparathyroidism. Methods The diagnosis and treatment of a male patient with tertiary hyperparathyroidism were reviwed. Results The patient who had had chronic renal failure underwent excision of the adenoma of parathyroid gland 5 year ago.After that,the total parathyroidectomy and autografting were performed because of his recurrent hyperparathyroidism.The patient began hemodialysis therapy 3 years ago and then underwent allogeneic kidney transplantation 2 years ago.Two months after the operation,symptomatic hyperparathyroidism relapsed.The autonomic parathyroid grafts were removed three times (one part of the grafts resected each time) with relapse occurring three times.Later the hyperparathyroidism was cured by itself after the patient was mentally irritated. Conclusions Tertiary hyperparathyroidism may have already developed before kidney transplantation.

Objective To study the bladder function after internal iliac artery chemotherapy for bladder carcinoma. Methods Internal iliac artery chemotherapy was undertaken for 38 cases of bladder carcinoma comprehensively treated by TURBt,partial cystectomy or paliative TURBt.12 were T 1 carcinoma,14 T 2 and 12 T 3. Results The urinary bladder has been preserved in 33 patients.Of the 12 T 1 carcinoma,repeated recurrence occurred in 4.TURBt was undertaken on each occasion whereas total cystectomy was finally carried out in 2 of them.The bladder has been preserved in 10 of 14 and the 10 are still alive;of 14 T 2 (regional infiltrating carcinoma)patients,1 died of metastasis 2 years after surgery and another complicated by renal failure due to chemotherapy and has been on hemodialysis.The bladder has been preserved in 13 of the 14 and the 13 patients are still alive;of the 12 T 3 patients,8 were high risk patients,2 of them died of the cancer 2～3 years after the operation.Tumors vanished in 3 patients with negative multiple randomized biopsy.Tumors became smaller in 7 and partial cystectomy was performed for 3 of them.Of another 4 with shrunken tumors,hematuria has been controlled,the bladder capacity increased and the general condition of the patients improved.The bladder has been preserved in 10 of the 12.The mean survival time has been 58 months. Conclusions Internal iliac artery chemotherapy is effective and useful for some bladder cancer with the bladder function preserved.

Purpose To analyze the clinicopathologic and immunohistochemical features, differential diagnosis and prognosis of papil-lary renal cell carcinoma (PRCC). Methods Thirty-two cases of PRCC diagnosed were reviewed. A retrospective study was per-formed including reviewing the clinical documents, pathological sections and immunohistochemical stainning and follow-up was made of 32 cases of PRCC. Twenty-one patients were treated with radical nephrectomy, eleven patients were treated with partial nephrectomy. Results Among 770 cases of renal epithelial tumors 32(4. 2%) cases of PRCC were detected. Histologically, the PRCC were charac-terized by varying proportions of papillary and tubular architecture covered by single or multiple layer of tumor cells with scanty or volu-minous basophilic or eosinophilic cytoplasm. Foam cells and psammoma bodies were seen in some papillary cores and stroma, and the cytoplasm of some tumor cells contained hemosiderin. Of these 32 patients, 18 and 14 were diagnosed type-Ⅰand type-IIPRCC, re-spectively. Type-I, with small cuboid cell and pale cytoplasm, 16 of them were low in Fuhrman grading, Type-II, with large colunmar cells, rich in eosinophilic cytoplasm, 12 of them were high in Fuhrman grading. Immunohistochemically, the PRCC showed positive immunostaining for vimentin, EMA, CK(AE1/AE3), CK7, CD10 and AMACR. All the tumors studied were negative for CK (34βE12) and TFE-3. Follow-up data were available for 31 cases, 4 patients died of cancer specific causes, 1 with type-Ⅰand 3 with type-II tumors after surgery. The other 27 patients were alive without recurrence or metastasis. High Fuhrman grading, intravascular tumor emboli, lymph node metastasis and high clinical stage were prognostic indicators in PRCC. Conclusions PRCC with unique pathological features is not a common subtype of renal cell carcinoma in China. The presence of higher nuclear grade, sarcomatoid ele-ments or clear cell carcinoma structure may indicate an aggressive biologic behavior and poor prognosis. Close attention to the cytologic and growth pattern characteristics will allow us to arrive at the proper diagnosis in most cases, although sometimes immunohistochemis-try and rarely molecular genetic evaluation may be needed.

Objective To investigate the clinical significance of contrast-enhanced transrectal ultrasound(CE-TRUS) in the perineal prostate biopsy. Methods A total of 116 patients was undergone prostate biopsy through the perineum under the direction of tansrectal ultrasound. Prostate biopsy standard was based on 2007 CUA revised guidelines for diagnosis and treatment of urological diseases.Color Doppler ultrasonography was used to check the prostate and to learn the prostate focal lesion,size, number and echo color Doppler flow characteristics. Of the 116 cases, 43 patients was undergone contrast-enhanced transrectal ultrasound. Results The biopsy results confirmed the diagnosis of prostate cancer was 64 cases, Benign prostatic hyperplasia was 52 cases. Of 43 cases who undergone contrast-enhanced transrectal ultrasound, Prostate cancer and Benign prostatic hyperplasia were 25 and 18 cases, respectively. CE-TRUS group and TRUS group showed no statistical difference between two groups. Analyzed the cases with PSA≤30 ng/ml, CE-TRUS group had a higher positive rate of biopsy (P=0.046). Conclusion TRUS guided transperineal biopsy of prostate might be an method for the diagnosis of prostate cancer with a higher accuracy rate. CE-TRUS can improve the biopsy positive rate of prostate cancer.

Objective: To analyze the longitudinal change of serum total cholesterol concentration in 733 rural residents in Shanxi province. Methods: Based on the residents of five rural areas in Shanxi province who participated in China nutrition and health survey in 2002, a follow-up survey was conducted in 2015. Fasting venous blood of the participants was collected and serum TC concentration was tested by cholesterol oxidase method. Results: Of 733 participants, 332 were male and 401 were female. In 2002 baseline survey, the age of the participants was (42.6±9.5) years old, 76.2% of male and 83.8% of female had junior middle school education or below. Proportion of smoking were 65.7% and 1.2%, drinking were 26.8% and 4.0%, obesity were 6.3% and 12.0%, and central obesity were 27.1% and 31.9%, respectively in male and female. The follow-up age of participants in 2015 was (55.8±9.5) years old, proportion of smoking changed to 48.2% and 1.5%, drinking were 49.7% and 3.0%, obesity increased to 11.8% and 18.2% and central obesity increased to 41.6% and 53.6%, respectively in male and female. The overall serum TC level increased from (3.82±0.89) mmol/L to (4.72±0.97) mmol/L with an average increase of 27.2%, which increased from (3.84±0.94) mmol/L to (4.54±0.93) mmol/L in male with an average increase of 22.7%, and increased from (3.81±0.84) mmol/L to (4.86±0.98) mmol/L in female with an average increase of 30.9%. The serum TC levels in 18-, 30-, 40-, and 50-59 years old group increased from (3.42±0.83), (3.72±0.77), (3.90±0.83) and (4.00±1.03) mmol/L to (4.38±1.01), (4.79±0.92), (4.73±0.99) and (4.76±0.96) mmol/L, with average increase range of 31.4%, 32.1%, 25.2% and 22.6%, respectively. The mean serum TC levels between two years all had statistically significant difference among groups of gender, age, education, marital status, family history of cardiovascular disease, smoking, drinking, BMI and waist circumference after paired t-test and ANOVA analysis (P<0.01). Conclusion The longitudinal serum TC level of rural residents in Shanxi province increased rapidly.