Objective To discuss the imaging characteristics of renal cyst of high density.Methods Nine cases (5 women and 4 men; mean age,48 years; age range,31-79 years) with high density renal mass(>30 HU) were reviewed.For all patients,the symptom was intermittent lumbar pain in 2 patients,gross hematuria with lumbar pain in 1 patient,gross hematuria without pain in 1 patient.The other 5 patients were detected during routine physical examination without symptom.Preoperative examination included CT,MRI and DSA.Results All the patients had solitary and unilateral high density renal cysts,which size ranged from 2 to 5 cm in diameter.The cysts displayed predominantly hypoechoic or irregular internal echoes on sonography.Excretory urography showed an unenhanced round mass without further distinguishing characteristics.Their cystic features were con-firmed on nonenhanced and contrast-enhanced CT scans.MRI showed a round mass with long T1 and long T2 signal.Angiography revealed lack of vessels around the mass.All patients were operated by partial nephreetomy.There was no recurrence in all patients during the follow-up for 1-5 years.Conclusion Renal cyst of high density has many special features of imageology.

Objective To explore the viral pathogen spectrum characteristics of acute intestinal infection in Hanzhong from 2019 to 2022. Methods Fecal samples from patients with acute intestinal infection in the outpatient clinic of 3201 Hospital from January 2019 to December 2022 were collected. Common enteroviruses such as enterovirus 71 (EV-A71), coxsackievirus 16 (CV-A16), CV-A10, CV-A6, CV-A2, CV-A4, and CV-B3 were detected and analyzed by real-time fluorescence quantitative PCR. Results A total of 5 194 fecal samples were collected, and the positive rate of nucleic acid detection was 23.95%. In terms of the enteroviruses, the highest detection rate was 9.82% for EV-A71, followed by 4.58% for CV-A16 and 3.37% for CV-A6. The positive detection rate of common enteroviruses showed statistical difference among different age groups (P<0.05), with the highest detection rate of 41.49% in 0-4 years old group. There was no significant difference in the positive virus detection rate between different genders (P>0.05). EV-A71 infection showed no seasonal characteristics, whereas the detection of CV-A16 and CV-A6 infections was concentrated in summer and autumn. There were 106 cases of mixed infection, and the prevalence rate was 2.04%, with EV-A71 and CV-A6 mixed infections accounting for the majority of cases. Conclusion The main pathogens of acute intestinal infections in the Hanzhong area from 2019 to 2022 are EV-A71, CV-A16, and CV-A6. It is necessary to strengthen the monitoring of acute intestinal infections in children aged 4 years and below.

Objective To investigate the risk factors of gastric cancer in Hanzhong area and establish a gastric cancer risk prediction model based on gastric function indexes. Methods A questionnaire survey was conducted on 227 patients with gastric and non-gastric cancer admitted to the Department of Gastroenterology of Hanzhong Central Hospital from January 2018 to January 2019. The diet, lifestyle habits, family history, and past history of the subjects were collected. Serological tests (including serum PGⅠ,Ⅱ, and G-17), gastroscopy and pathological examination of the samples were carried out. Multi-factor Logistic regression analysis was performed to analyze the high risk factors. The efficacy of serum gastric function for gastric cancer screening was assessed through ROC curve. Results There were no significant differences in the distribution of age (χ²=0.054, P=0.816), gender (χ²=3.823, P=0.051) and BMI (χ²=5.569, P=0.135) between the gastric cancer and non-gastric cancer groups, suggesting that the clinical data between the two groups was comparable. Multivariate logistic regression analysis showed that smoked food intake (P=0.031, 95% CI: 1.150 ~ 17.545) and hyperlipidemia (P=0.039, 95% CI:0.216~0.960) were high risk factors for gastric precancerous lesions, other factors did not show significant high risk (P>0.05). The results of ROC curve showed that the diagnostic efficacy of combined PG I, PG II, and G-17 was significantly higher than that of PG I, PGⅡ, or G-17 alone (P<0.05). Conclusion The risk factors of gastric cancer in Hanzhong area mainly included the intake of smoked food and hyperlipidemia. Patients can be advised to pay attention to diet during clinical treatment. Based on gastric function indexes PG, PGⅡ and G-17, the diagnosis of gastric precancerous lesions had a good prediction. The combined diagnosis is more effective, which provided a theoretical basis for the early diagnosis of clinical gastric cancer.

Objective To analyze the VP1-VP4 genetic region of enterovirus 71 ( EV71 ) strains isolated from children with severe or mild hand, foot and mouth disease ( HFMD) in Shenzhen in 2012. Methods EV71 strains were isolated from five children with mild HFMD and five children with severe HFMD in Shenzhen in 2012.Reverse transcription-polymerase chain reaction ( RT-PCR) method was used to amplify the sequence of VP1-VP4 genes of EV71 strains.The sequences of the amplified products were analyzed by comparing with those of the EV71 reference strains ( A, B and C genotypes) published in Gen-Bank using nucleotide alignment, amino acid alignment and phylogenetic tree analysis.Results The homo-geneity between the EV71 strains isolated from severe and mild cases was 95.1%-98.2% in nucleotides and 99.2%-100% in amino acids.The VP1-VP4 nucleotide sequences of 5 strains isolated from severe cases and 5 strains from mild cases in Shenzhen shared 87.9%-97.8% homologies in nucleotides and 97.3%-99.9% homologies in amino acids with the genotype C EV71 reference strain.The EV71 strains isolated from children in Shenzhen were highly similar with the EV71 strain (FJ439769) isolated in Fuyang in 2008 and the one isolated in Jingdezhen in 2011 (JQ806378, C4a subtype) in nucleotide sequences.Mutations at the residue 31 in the VP1 region ( N→D ) were detected in 3 strains isolated from children with severe HFMD.Conclusion All of the 10 EV71 strains isolated in Shenzhen in 2012 belonged to the sub-genotype C4a.The mutation ( aa31 N→D) in the VP1 region of EV71 might be related to the different clinical mani-festations of HFMD cases in Shenzhen area.

Objective To discuss the clinical features and treatment of ureteral obstruction resulted from vena genitalis compression.Methods 2 cases of hydronephrosis resulted from vena genitalis compression were discussed retrospectively,and relevant literatures were reviewed.Both of the 2 patients presenting with mild loin pain,and imaging studies showed hydronephrosis.One patients presenting with left hydronephrosis,and the other showed bilateral hydronephrosis.Imaging study showed ureter obstruction at L3-L4 level.Laparoscopic surgery found vena genitalis crossing and compressing the upper part of the ureter,resulted the upper ureter and pelvis dilation.Laparoscopic excision of vena genitalis were performed on these two cases.Results These patients'symptoms were relieved and hydronephrosis alleviated evidently 3 month after surgery in follow-up.Conclusions Hydronephrosis resulted from vena genitalis compression is a rare clinical manifestation.Classical imaging presents with ureter obstruction at L3-L5 level,at which the vena genitalis crossing the musculi psoas major.Ureter migrates outwards and the upper ureter and pelvis dilate.Pre-operative diagnosis is difficulty,but laparoscopic resection of the vena genitalis to relieve the obstruction of the ureter is recommended.

OBJECTIVE: To investigate the feasibility and effectiveness of bilateral facial perforator artery flap in repairing large area defect in middle and lower part of nose. METHODS: The clinical data of 18 patients with large area defect in middle and lower part of nose repaired by bilateral facial perforator artery flap between January 2019 and December 2022 were retrospectively analyzed. Among them, there were 13 males and 5 females, the age ranged from 43 to 81 years, with an average of 63 years. There were 3 cases of nasal trauma, 4 cases of basal cell carcinoma, 8 cases of squamous cell carcinoma, 1 case of lymphoma, and 2 cases of large area solar keratosis. The size of the defect ranged from 3.0 cm×3.0 cm to 4.5 cm×4.0 cm; the size of unilateral flap ranged from 3.0 cm×1.3 cm to 3.5 cm×2.0 cm, and the size of bilateral flaps ranged from 3.3 cm×2.6 cm to 4.5 cm×4.0 cm. RESULTS: One patient developed skin flap necrosis after operation, and a frontal skin flap was used to repair the wound; 1 case gradually improved after removing some sutures due to venous congestion in the skin flap, and the wound healing was delayed after dressing change; the remaining 16 cases of bilateral facial perforator artery flaps survived well and all wounds healed by first intention, without any "cat ear" malformation. All 18 patients had first intention healing in the donor area, leaving linear scars without obvious scar hyperplasia, and no facial organ displacement. All patients were followed up 3-12 months, with an average of 6 months. Due to the appropriate thickness of the flap, none of the 18 patients underwent secondary flap thinning surgery. All flaps had good blood circulation, similar texture and color to surrounding tissues, symmetrical bilateral nasolabial sulcus, and high patient satisfaction. CONCLUSION The bilateral facial perforator artery flaps for repairing large area defect in middle and lower part of nose can achieve good appearance and function, and the operation is relatively simple, with high patient satisfaction.
Male ; Female ; Humans ; Adult ; Middle Aged ; Aged ; Aged, 80 and over ; Plastic Surgery Procedures ; Skin Transplantation ; Retrospective Studies ; Soft Tissue Injuries/surgery* ; Perforator Flap/blood supply* ; Arteries/surgery* ; Cicatrix/surgery* ; Treatment Outcome ; Skin Neoplasms/surgery*

Objective To improve the diagnosis and treatment quality of juxtaglomerular cell tumor of the kidney. Methods Three patients(2 females, 1 male) were diagnosed with juxtaglomerular cell tumor of kidney and underwent nephron-sparing surgery. Case 1 was female, 15 years old. She presented with hypertention of 245/135 mm Hg. The serum kalium was 2.5--3.0 mmol/L. Thelaboratory examination suggested that in decubitus and standing position, the plasma renin activity (PRA) was 2.2 and 3.5 μg · L-1 · h-1 , angiotensin Ⅱ (ATⅡ) was 181.2 and 481.4 ng/L; aldosterone(ALD) was 332.4 and 747.9 pmol/L, respectively. Dynamic enhanced CT scanning demonstrated a tumor with the diameter of 1.3 cm in right kidney. Case 2 was male, 39 years old. He presented with hypertention of 180/120 mm Hg. The serum kalium was 2. 7--3.0 mmol/L. In decubitus and standing position, PRAwas8.1 and 9.2 μg·L-1 · h-1, ATⅡ was 198.3 and 279.1 ng/L, ALD was 285.3 and 761.7 pmol/L, respectively. Dynamic enhanced CT scanning showed a tumor with the diameter of 1.2 cm in right kidney. Case 3 was female, 26 years old. She presented with hypertention of 210/120 mm Hg. The serum kalium was 4. 1 mmol/L. In decubitus and standing position, PRA was 0.1 and 0.3 μg · L-1·h-1 , ATⅡ 56.2 and 71.5 ng/L, ALD 321.3 and 421.1 pmol/L, respec tively. On dynamic enhanced CT scanning, a tumor with a diameter of 3.0era was located in left kidney. Results Partial nephrectomy was successfully performed in 3 patients, including 1 (case 2) retroperitoneal laparoscopic surgery. Pathologic examination revealed encapsulated tumors in all cases. Light microscopically, the tumor consisted of clusters of polygonal cells, and the cell had centrally located nuclei and slightly eosinophilic cytoplasm. Thick walled vessels were usually present. The tumors showed positive immunostaining for actin and CD34. Three patients were followed up for 23,4, 26 months respectively and all remained normotensive without any treatment. No recurrence or metastasis occurred. Conclusions Hypertention, increased PRA, secondary aldosteronism, hypokalemia are characteristics for juxtaglomerular cell tumor of the kidney. Dynamic enhanced CT scanning has high sensitivity. Partial nephrectomy or enucleation of tumor are both effective surgical treatment. Retroperitoneal laparoscopic surgery is safe and effective as well.

Objective To analyze the clinical and pathological features of the adrenal primitive neuroectodermal tumors(PNET). Methods Four cases of PNET were analyzed.Of them,2 were males and 2 females,aged from 21 to 30 years old with a mean age of 24.No significant abnormal data was found in routine laboratory and endocrine examinations.The CT scan showed a soft tissue mass with unclear boundary and cystic changes in adrenal area.The tumor diameter was 8-17 cm. Results One patient refused treatment alter diagnosed by biopsy and died 6 months later.Another one received palliative operationand died after 8 months.The third patient was found distant metastasis 1 month after operation and had radiotherapy and chemotherapy.The fourth patient was found local tumor recurrence 1 month after operation,and started chemotherapy.All patients were diagnosed by pathology.At HE staining,tumor was consisted of even,uniform small round cells;the cells distributed diffusively or formed lobulated structures (Homer-Wright rosette).Immunohistochemical staining showed CD99 positive in all 4 patients. Canclusion The adrenal PNET is a rare disease originated from primitive neuroectodermal,mostly occurs between 20 and 30 years old,and has non-specific clinical and imaging findings.Histopathologieal examination is the key point for diagnosis.Rapid progression,highly malignant,poor prognosis are the characteristics of this disease.

Objective To compare the clinical efficacy of laparoscopic radical nephrectomy for large renal cell carcinoma (＞7 cm) between retroperitoneal approach and transperitoneal approach.Methods From Jan 2008 to Dec 2013,the data of 68 patients who underwent laparoscopic radical nephrectomy for large renal tumor(＞7 cm) in our hospital were reviewed.There were 41 male patients and 27 female patients,whose age ranged from 43 to 73 (mean 58.4t6.9) years old.The size of tumor was between 7.0 to 12.5 cm (mean 8.9± 1.1 cm).Left renal tumor was found in 37 patients and right renal tumor in 31 patients.Clinical stages of the tumors were T2 to T3.All patients were undergone the laparoscopic radical nephrectomy,including retroperitoneal approach in 42 cases (observation group)and transperitoneal approach in 26 cases (control group).The exclusive criteria included inferior vena cava tumor thrombus,lymphatic or distant metastasis,previous operation history in the same region,multiple tumors.There were no significant differences in the age,gender,tumor size and location within two groups (P＞0.05).The perioperative indexes and oncological outcomes,such as operation time,blood loss,incidence of blood transfusion,incidence of SIRS,postoperative hospital stay,complications and follow-up results,were collected and compared between two groups.Results Conversion occurred in two cases from observation group and one case from control group.Operative time in observation group was significantly shorter than that in control group (114.9±24.4 min vs.131.2±29.9 min,P＜0.05).Bowel function recovered more rapidly in observation group than in control group (1.7±0.6 d vs.2.2±0.6 d,P＜0.05).However,the estimated blood loss,the incidence of blood transfusion,the postoperative hospital stay,the incidence of SIRS and perioperative complications showed similar results in the 2 groups (P＞0.05).The histopathological examination confirmed renal cell carcinoma in all cases.Observation group included 35 pT2 stage and 7 pT3a stage cases,while control group consisted of 21 pT2 stageand 5 pT3a stage cases.The follow-up duration ranged from 4 to 38 months (mean 17 months).Mean overall survival were 17.1 months in observation group and 18.7 months in control group.Progression free survival time was 15.7 months in observation group and 17.1 months in control group.Cox survival analysis showed that only pre-operative stage of the tumor were independent risk factor for the survival time (P=0.018) and progression free survival time (P=0.020),while the operative approach was not the independent risk factor (P=0.298,0.314).Conclusions For large renal tumors (＞7 cm),laparoscopic radical nephrectomy was safe and feasible.Compared to the transperitoneal approach,retroperitoneal approach cost less operative time and faster bowel recovery.But the operation approach is not an independent risk factor for the survival time and progression free survival time.

Objective To evaluate the feasibility of laparoscopic nephroureterectomy with bladder-cuff resection by TUR for upper urinary tract carcinoma. Methods Eighty-two patients with upper urinary tract transitional cell carcinoma(69 cases in renal pelvis and 13 in ureter)underwent retroperitoneal laparoscopic nephroureterectomy and bladder-cuff resection by TUR. This group of cases was retrospectively summarized including operative time, blood loss, drainage mounting days, catheterizing days, post-operative complications and hospital stays. Results All 82 operation procedures were successfully performed without severe complication. The mean operative time was 135 minutes.The mean length of hospital stay was 7 days postoperatively. The mean time with drainage and Foley catheter were 3 days and 6 days respectively. Follow-up time ranged from 6 to 76 months for 74 patients. The 3-year carcinoma recurrence was 10.6% (5/47). Only 1 patient was found incision tumor recurrence in 8 month after the procedure. Conclusion Retroperitoneoscopic nephroureterectomy with bladder cuff resection by TUR could be a feasible procedure to treat upper urinary tract transitional cell carcinoma.