Objective To improve the diagnosis and treatment for malignant adrenal tumors. Methods Clinical data of 50 cases of malignant adrenal tumors were retrospectively analyzed.Of them 7 cases of corticoadrenal carcinoma with endocrine function presented with relevant symptoms and endocrine abnormality.Among 23 cases of malignant pheochromocytoma high blood pressure existed in 19 and 18 had a high level of urinary catecholamine.Fifteen cases had corticoadrenal carcinoma without endocrine function and 5 cases developed adrenal metastic carcinoma.All of the patients underwent endocrinological and image examination before operation. Results Among the 27 cases of corticoadrenal carcinoma or metastasis,25 were confirmed by pathology and 2 were confirmed during follow-up.Of the 23 patients who were diagnosed as malignant pheochromocytoma,11 were confirmed to have extensive tumorous infiltration or metastasis by imaging procedures and operations and 12 were detected by follow-up to have metastasis.Tumors were resected in 14 cases of corticoadrenal carcinoma,8 of whom survived for 1～5 years.Twelve cases of malignant pheochromocytoma underwent radical operations with a survival of 1～14 years. Conclusions Most cases of corticoadrenal carcinoma can be diagnosed by pathology or image findings of metastasis.Pheochromocytoma is more likely to be malignant when it recurs,expecially for the extro-adrenal pheochromocytoma.The diagnosis of malignant pheochromocytoma must depend on the evidence of tumorous infiltration or invasion of the tissue without para ganglions found by imaging procedures or pathology.The prognosis of the late-stage corticoadrenal carcinoma is poor.For the cases of late-stage malignant pheochromocytoma dibenzyline or 131 I-MIBG treatment can extend their lives.

Objective To summarize the experience of microsurgery for repair on urethrovaginal and vesicovaginal fistula. Methods Five cases of complex urethrovaginal or vesicovaginal fistula underwent repair procedure with thin suture under surgical magnifier.The defect of vesical neck was sutured in several layers and the urethra was renovated by using vaginal wall tissue. Results The operations were successful in all the 5 cases with no obvious incontinence.Their course of coition was not influenced. Conclusions Suturing the defect of the vesical neck in several layers can restore the function of the sphincter.Microsurgery may align the tissue well and cause less tissue reaction,thus it is beneficial to the concrescence of the fistula.

N. By contraries,the effect of N,P_2O_5,and K_2O fertilizer on output of B.striata could be in the order of K_2O

ObjectiveTo explore the relationship between the duration, MRI characters and prognosis in transient ischemic attack (TIA). Methods36 TIA cases were retrospectively analyzed according to the duration and Magnetic Resonance Imaging Diffusion Weighted Imaging(MRI-DWI). They were divided into two groups, Group A (13 cases) in which TIA continued within 1 h and Group B (23cases) in which TIA continued for 1～24 h. The patients were followed up 3 months and 12 months later. ResultsMRI abnormalities could be found with MRI-DWI in 2 cases in Group A, but 17 cases in group B(χ2=11.416,P=0.001). 1 case in Group A and 14 cases in Group B occurred cerebral infarction within a year(χ2=9.663,P=0.004). ConclusionThe longer TIA duration, the worse the prognosis.

Objective To investigate the clinical features , diagnosis and key technique points of laparoscopic partial adrenalectomy for small adrenal pheochromocytoma . Methods From Oct.2006 to Jun. 2011, clinical data of 32 cases with small adrenal pheochromocytoma (≤3.0 cm) were collected and retro-spectively analyzed .Hypertension was observed in 12 patients, whereas 20 patients presented with adrenal incidentaloma .Thirteen patients had a left adrenal neoplasm , eighteen patients had a right adrenal tumor , while one patients had bilateral tumors .The positive rate of plasma-free metanephrines ( MNs) and 24-hours urinary catecholamine (CA) in diagnosing small renal pheochromocytomas was 92.6%(25/27) and 81.3%(26/32) respectively.The main localization diagnosis included ultrasonography , 131I-MIBG, and CT or MRI, with positive rates of 71.9%(23/32), 93.8%(15/16) and 96.9%(31/32) respectively.All the laparoscopic adrenalectomies were performed retroperitoneally .During the surgery , the internal part of the adrenal gland closing to the retroperitoneum was dissected first , and the whole adrenal gland was resected completely. Results Partial adrenalectomy was performed for 30 cases and radical adrenalectomy for 2 ca-ses.All operations were successful without perioperative or postoperative complications .The maximum diame-ter of tumor was 1.7±0.2 (1.0-3.0) cm.Histopathological results showed that all the cases were benign pheochromocytoma.The operative time was 82 (40-210) min.The estimated blood loss was 57 (20-180) ml.No patient required blood transfusion . Conclusions Plasma-free MNs, 24-hours urinary CA and VMA are important qualitative examinations in detection of adrenal pheochromocytoma .Ultrasonography , CT,MRI, and 131 I-MIBG are important in the localization of adrenal tumors .Retroperitoneal laparascopic partial adrenalectomy is the preferred choice in the management of small adrenal pheochromocytoma .Dissecting the internal part of the adrenal gland closing to the retroperitoneum first and exploring the whole adrenal tissue are the key technique points during the operations .

Objective To compare the quality of prepared slices of Herba Ephedrae from different producing areas and to establish reference quality criterion of Herba Ephedrae.Methods Determined the content of Ephedrine and Pseudoephedrine in Herba Ephedra Prepared Herbal by HPLC.According to Chinese Pharmacopeia of 2000-year edition,extract,ash,water,impurity and foreign substance were detected; accelerated stability test was performed according to experience.Results The content of Ephedrine in Herba Ephedra is 0.995 %～1.589 %,honey-fried HerbaEphedra is 0.855 %～1.557 %;the content of Pseudoephedrine in Herba Ephedra is 0.560 %～2.087 %,honey-fried Herba Ephedra is 0.508 %～1.902 %; water-soluble extract was 8.83 %～18.30 %and 14.81%～27.45 %, alcohol-soluble extract was 7.74 %～18.83 %and 14.15 %～27.34 %, the total ash content was 6.49 %～10.29 %and 6.34 %～10.24 %and acid-insoluble ash was 0.19 %～0.42 %and 0.18 %～0.42 %in Herba Ephedrae and honey-prepared Herba Ephedrae respectively.The average water content was 8.10 %(s=0.3961)and 4.02 %(s=0.4674)and average content of impurity and foreign substance was 2.02 %(s=0.1954)and 2.01 %(s=0.2209)in Herba Ephedrae and honey-prepared Herba Ephedrae respectively.Conclusion This research will provide a reference criterion for the quality control of prepared slices of Herba Ephedrae.

Objective:To evaluate the etiological diagnosis value of soft bronchoscopy in children with laryngeal stridor.Methods:The clinical data of 402 children with laryngeal stridor wheezing were retrospectively analyzed, which examined by soft bronchoscopy in Anhui Provincial Children′s Hospital from January 2016 to January 2019.Results:A total of 402 cases of laryngeal stridor were diagnosed by soft bronchoscopy, 317(78.8%) cases were diagnosed as congenital airway dysplasia, including 200(49.7%)cases of congenital laryngeal chondromalacia, which including 132 cases of single laryngeal chondromalacia and 68 cases with other respiratory tract dysplasia, and 117(29.1%) cases of respiratory dysplasia other than laryngeal chondromalacia; 46(11.5%) cases of laryngitis; 28(7.0%) cases of airway acquired stenosis and 11 (2.7%)cases of foreign body.Among 402 cases of children with laryngeal stridor who were diagnosed according to clinical feature, combined with chest X-ray, chest CT, CT angiography and color Doppler echocardiography as well as other imaging data, 335(83.3%) cases were congenital laryngeal chondromalacia, 16(4.0%) cases were other respiratory tract dysplasia (including six cases of subglottic and tracheal stenosis, five cases of laryngeal space occupying lesions, four cases of tracheobronchial malformation, and one case of subglottic hemangioma), 35 (8.7%)cases of laryngitis, acquired airway stenosis in 15 cases including 13 cases of congenital heart disease, one case of pulmonary artery sling, one case of mediastinal cyst, and one case of foreign body.Congenital laryngeal chondromalacia, other causes of respiratory dysplasia and foreign body detected by flexible bronchoscopy were not consistent with clinical examination( P<0.05). Conclusion:Congenital laryngeal chondromalacia is the main cause of laryngeal stridor, but it is often associated with other airway dysplasia.Soft bronchoscopy can provides etiological diagnosis for children with laryngeal stridor wheezing, especially in the diagnosis of respiratory tract dysplasia and airway foreign body.

Objective:To explore the application effect of training methods based on cross-theoretical model in improving the master of knowledge, compliance and implementation rate of nursing students to standard prevention.Methods:A total of 92 nursing trainees participating clinical practice in Zhangjiagang Traditional Chinese Medicine Hospital and Zhangjiagang First People's Hospital in 2017 were selected as the control group, and 112 trainees were selected as the experimental group; the control group adopted conventional standard prevention training method; the training procedure of the experimental group were divided into five stages according to the behavior of trainees, and training was carried out corresponding to different stages and behavioral transformation processes. Standard prevention knowledge, compliance belief scale score, behavior change stage distribution and standard prevention implementation rate between these two groups were compared.Results:The standard prevention theory and skill assessment scores were 84.41±4.64 and 67.01±4.53 in the experimental group and the control group after intervention, respectively. The difference was statistically significant ( t value was 26.934, P<0.01). Nurse standard prevention compliance belief scale scores were 156.21±6.96 and 119.73±5.77 in the experimental group and the control group after intervention, respectively. The difference was statistically significant ( t value was 40.156, P<0.01). The distribution of behavioral changes was statistically significant ( Z value was 8.173, P<0.01). The standard prevention implementation rate of hand washing and hand disinfection, protective equipment uses, sharp and medical waste disposal, item and environmental treatment after intervention was 78.78%(438/556), 76.69%(385/502), 91.47%(193/211), 88.27%(173/196) in the experimental group, and 62.72%(254/405),62.26%(231/371), 76.22%(141/185), 69.23%(117/169) in the control group, the differences were statistically significant( x 2 values were 17.367-29.987, all P<0.01). Conclusions:The training strategy based on cross-theoretical model can improve the attention of nursing trainees to standard prevention work, change adherence beliefs, working attitudes and behaviors, and thus improve the implementation rate of standard prevention behaviors.

OBJECTIVETo identify the value of lymphography in the location and treatment decision of chyle leakage.

METHODSThe clinic data of 177 patients suffered from chyle leakage admitted in 6 medical centers in Shanghai from February 1998 to December 2014 was analyzed retrospectively. There were 94 male and 83 female patients aging from 9 to 84 years with a mean of 49 years, including 128 cases of chyluria, 34 cases of primary chylothorax and 15 cases of other chyle leakage. All patients had failed to conservative treatment more than 2 weeks. Pedal lymphography was performed in every patient to investigate the site and range of chyle leakage. Effect of surgical or conservative management was compared according to the different results of lymphography.

RESULTSNo serious complication was noticed. For all 177 patients, lymphography showed localized lymphatic diseases in 148 cases (83.6%), including 125 cases of lymphatic renal pelvic leaks, 14 cases of unilateral identified leak within thorax and 9 cases of chyle leakage in neck, heart, abdomen or scrotum. Among these patients, surgical treatment cured 129 and improved 3 patients but failed in 2 patients, while the remaining 14 cases had their leaks decreased after lymphography and cured by conservative management. For those 15 patients having disseminated lymphatic diseases or 14 with no abnormality under lymphography, surgery only cured 2 and improved 1 patient but failed in 8 patients (with 3 death), whereas continuous conservative treatment cured 11 patients, improved 5 patients but only failed in 2 patients (with one death). For localized leakage, surgical treatment showed better efficacy (98.5% vs. 3/11), whereas conservative treatment had significantly higher successful rate than surgical interventions in patients with disseminated lymphatic diseases or no abnormality under lymphography (16/18 vs. 3/11).

CONCLUSIONSLymphography could identify the location and range of complicate chyle leakage failed to primary conservative management. Patients with disseminated lymphatic diseases or no abnormality under lymphography would be better managed by continuous non-operative treatment partly due to therapeutic effect of lymphography, while surgical intervention could be a good option for patients having localized lymphatic etiology.

Abdominal Cavity ; Adolescent ; Adult ; Aged ; Aged, 80 and over ; Child ; Chyle ; Chylothorax ; diagnosis ; surgery ; Female ; Heart ; Humans ; Kidney Pelvis ; Lymphatic Diseases ; Lymphography ; Male ; Middle Aged ; Neck ; Retrospective Studies ; Scrotum ; Young Adult