Objective To discuss the relevance between the serum prostate specific antigen (PSA) level and the prostatic cancer biopsy detection rate after tamsulosin treatment for patients with lower urinary tract symptoms and elevated PSA level.Methods 168 patients with lower urinary tract symptoms and elevated PSA level were divided into two groups according to the serum PSA level change after tamsulosin treatment:in the first group,serum PSA level decreased slightly (PSA≥4.0 ng/ml and PSA decrease＜20％);in the second group,serum PSA level decreased obviously (PSA＜4.0 ng/ml or PSA decrease≥20％).Tamsulosin treatment was given in 0.2 mg/d for two months.Prostate gland aspiration biopsy was performed at the end of tamsulosin treatment.Result For the 68 patients of the first group,after tamsulosin treatment,the tPSA level increased from (8.11 ±2.09)ng/ml to (9.05±3.13)ng/ml,in which 38 patients (55.88％,38/68) were confirmed as the prostatic cancer by pathology.For the 100 patients of the second group,after tamsulosin treatment,the tPSA level decreased from(7.80±3.79)ng/ml to (5.19±2.32)ng/ml,in which 6 patients (6％,6/100) was confirmed as the prostatic cancer by pathology.There was significant statistical differences of prostate aspiration biopsy detection rate between the two groups(x2=23.53,P＜0.05).For patients with lower urinary tract symptoms who received tamsulosin treatment,the sensibility of PSA increased to 86.4％,specificity increased to 75.8％,the rate of avoiding aspiration was 55.9％,and the rate of correct diagnosis was 78.5％.Conclusion Tamsulosin treatment can increase the prostatic cancer diagnostic positive rate and decrease the aspiration rate in patients with lower urinary tract symptoms and elevated serum PSA level in a certain extent.

Objective To review clinical characteristics and treatment of multiple endocrine neoplasia type 2A (MEN-2A).Methods The clinical data of 13 patients with MEN-2A admitted to our hospital between 1988 and 2011 were retrospectively reviewed.All 13 cases were diagnosed as pheochromocytoma with medullary thyroid carcinoma,presenting no hyperparathyroidism,including 8 cases who had medullary thyroid carcinoma before pheochromocytoma and 5 cases who had medullary thyroid carcinoma and pheochromocytoma simultaneously.All 13 cases underwent resection for pheochromocytoma; 9 cases had bilateral adrenal resection,including 4 cases undergoing laparoscopic resection for pheochromocytoma.Thyroidectomy with bilateral dissection of regional lymph nodes was performed in 10 patients,and nodule enucleation was performed in 3 remaining patients.Results Adrenal pathology reported pheochromocytoma in all cases,including 3 malignant cases.Thyroid pathology reported medullary thyroid carcinoma in all cases.All 13 patients were followed-up visit,10 cases survived and 3 died from distant metastasis of medullary thyroid carcinoma.Conclusions MEN-2A is a rare disease.Surgery is the only treatment for this disease ; when patients have both pheochromocytoma and medullary thyroid carcinoma,to first remove the pheochromocytoma is preferable.

Two hundred and five patients with a confirmed diagnosis of aldosterone-producing adenomas underwent retroperitoneal laparoscopic operation from January 1999 to December 2009 in our hospital. All cases had hypokalemia and hypertension preoperatively. Of all the cases, 80 received total adrenalectomy and 125 received partial adrenalectomy. Operations were successfully performed in all cases. The time of operation ranged from 15 to 150 min [mean(45 ±13) min] and the volume of bleeding during operation ranged from 10 to 200 ml [mean(25 ±10) ml]. The length of hospital stay ranged from 4 to 9 d [mean(6. 8 ± 1. 2) d]. All patients were followed up for 0. 5 - 2 years (mean 1. 2 years). After operations blood potassium levels returned to normal in all cases, blood pressure returned to normal in 168 cases (82.0% ) . Results indicated that partial or total adrenalectomy with retroperitoneal laparoscopy for aldosterone-producing adenomas was safe and feasible technique.

Objective To evaluate clinical significance of laparoscopic adrenalectomy for treatment of primary aldosteronism.Methods From Jan.1999 to Dec.2009,227 patients(92 males and 135 females)with a confirmed diagnosis of primary aldosteronism underwent laparoscopic adrenalectomy.The median age was 42years old,ranging from 22 to 69 years old.The median disease duration was 4.6 yeas,ranging from 2 months to 15 years.5 cases underwent peritoneal laparoscopic adrenalectomy and 222 cases underwent retropefitoneal laparoscopic adrenalectomy.All cases had hypokalemia,hpertension,high plasma aldosterone and low plasma rennin preoperatively.Of all the cases,there were 205 cases with aldosterone-producing adenomas among whom 80 cases underwent total adrenalectomy and 125 cases underwent partial adrenalectomy.There were 22 cases with unilateral adrenal hyperplasia and all of them underwent total unilateral adrenalectomy.Results Procedures were successfully performed in all the 227 cases.The operation duration ranged from 15 to 156 min(39 min as the median)and the blood loss ranged from 5 to 220 ml(20 ml as the median).The hospitalization time ranged from 5 to 9 days (6.9±1.2 days as the median).All the cases were followed up from 6 months to 2 years(1.2 years as the median).Postoperative potassium level resumed normal in all cases.Blood pressure resumed normal in 180 cases(80%).No adrenocortieal insufficiency and any other complication occurred.Conclusion Retropreitoneal laparoscopic partial or total adrenalectomy for treatment of primary aldosteronism is a safe and feasible procedure.

Objective To summarize clinical characteristics of ectopie pheochromocytoma in order to improve the diagnosis and treatment of this disease.Methods Clinical data of 36 cases of pathologically proved ectopic pheochromocytoma treated in Tianjin Medical University General Hospital from 1990 to 2010 were retrospectively analyzed.Hypertension was observed in 28 cases.5 cases had hypertension at the end of urination. 1 case was proved to have ectopic pheochromocytoma by physical examination.Abdominal pain occulted in 2 patients.Urinary VMA was measured in all the 36 cases,and 32 esges had an elevation of VMA(88.9%).The lesions were localized mainly by abdominal ultrosonggraphy,CT,MRI and 131 I-MIBG.All cages underwent operation,including 4 laparoscopic surgery.Results Of the 36 patients with ectopic pheochromocytoma,34 cases had sinsle tumor,and 2 cases had multiple tumors.The diameter of the lesions was from 3.4 cm to 18.2 cm in size.Postoperative pathological examination showed 27 cases of ectopic pheochromocytoma were benign and 9 cases were malignant.Conclusions VMA level is an important marker to detect ectopic pheochromocytoma.Tumor localization is difficult.131 I-MIBG is of great value for localization of the lesion.Meticulous preoperative preparation is extremely important.Surgical resection of the tumor is the best therapy.Laparoscopic surgery can be the new choice for treatment of ectopic pheochromocytoma.Patients with malignant ectopic pheochromocytoma may be treated with 131 I-MIBG after surgery.

Objective To investigate the application and effect of hydrocortisone during perioperation of retroperitoneum laparoscopic surgery for Cushing's syndrome.Methods Data of 56 cases of Cushings's syndrome treated by hormone replacement therapy of hydrocortisone were retrospectively analyzed .The hormone replacement therapy was as the following:no hormone before surgery, intravenous drip of hydrocortisone during and the 1st and 2nd day after surgery, oral intake of hydrocortisone from the 2nd after surgery.Clinical symptoms were observed and plasma,24h urine cortisol levels were intermittently measured after the surgery to evaluate the effects of treatment . Results 2 cases had slight cortical dysfunction symptoms, then back to normal after receiving larger dose of hydro-cortisone.6 cases had blood cortisol levels below the normal range , but they did not have cortical dysfunction symp-toms, and at the same time their 24h urine cortisol levels were normal .Urine cortisol concentration significantly de-creased on the 7th day after surgery, and had significant difference compared with that before surgery .Plasma cortisol concentration significantly decreased on the 6th, 7th day after surgery, and had significant difference compared with that before operation.All the cases recovered well.Conclusion Perioperative hydrocortisone replacement in retroper-itoneum laparoscopic surgery for Cushing's syndrome is safe.

Objective To discuss the feature,diagnosis and treatment,and proguosis of adrenal teratoma.Methods Clinical data of 5 patients with confirmed adrenal teratoma were retrospectively reviewed.There were 2 males and 3 females,with a median age of 57 years (35-64).The mean tumor size was 5-8.5 cm.The tumors were located on the right side in 3 cases and the left side in 2.Two cases were detected by routine health check up,and 2 were detected with the complains of fatigue and 1 with complains of back pain.All cases had normal value of endocrinology and biochemistry tests.Ultrasound examination showed cystic tumor on adrenal gland with uneven echo.CT showed irregular,inhomogeneous adrenal neoplasms in adrenal gland.The tumor presented as inhomogenous high signal intensity on MRI T1 and T2.Results Five patients underwent laparoscopic adrenalectomy,and histopathology showed adrenal mature teratoma.No recurrence occurred after operation in all patients.Conclusions These cases combined with literature review indicate that adrenal teratoma is extremely rare which has no characteristic clinical manifestations; and laparoscopic adrenalectomy is a feasible,effective technique with excellent results.

Clinical characteristics were retrospectively analyzed in a patient with parathyroid crisis as the main symptoms of parathyroid adenoma and asymptomatic pheochromocytoma.This analysis was aimed to implement specific diagnosis and treatment and to accumulate experience in managing these diseases.

Objective To investigate the clinical characteristics , treatment and prognosis of primary ad-renal lymphoma ( PAL) .Methods Clinical data of 8 cases of PAL admitted from Jan .2007 to May.2014 were analyzed retrospectively .Results Of all the cases , 6 patients underwent adrenalectomy , and 2 patients under-went adrenal biopsy .Pathology revealed all the 8 cases had non-hodgkin's lymphoma , 6 cases were B cell type , 1 case was T cell type , and 1 case was NK cell type .One case was followed up for 2 years and was still alive .The other 7 cases died 2 to 9 months after the treatment .Conclusions PAL is extremely rare which has no special imaging characteristics .PET-CT is of great value in diagnosis of the disease .The disease has a high malignant behavior and poor prognosis .The comprehensive therapy has better effects than single therapy .

Objective To evaluate the value of using fluorescence in situ hybridization (FISH)technique for the detection of chromosome aberration of urine exfoliated cells for the diagnosis of bladder tumor.MethodsFISH technique were used to detect the abnormalities of chromosome 3,7,17 and 9p16 site from 20 normal people, and to establish the threshold.The morning's first urinations were available from 75 patients with bladder cancer and 25 patients without urothelial tumor, then were detected using FISH technique and urine cytology respectively.The sample was considered positive if two or more probes results higher than the criteria,or one probe has two or more abnormal results.Results The sensitivity of single using were 73.3％ (55/75),76.0％ (57/75),62.7％ (47/75) and 62.7％ (47/75) for the 4 probes (3,7, 17 and 9p16)respectively.The sensitivity of combined detection was 85.3％ (64/75) and specificity was 96.0％ (24/25) The sensitivity and specificity of urine cytology examination was 9.3％ (7/75) and 100％ (25/25) .The sensitivity of FISH examination was significantly higher than that of urine cytology examination (85.3％ vs 9.3％ ,x2 = 57.00, P ＜ 0.001) .Sensitivity of FISH examination was not correlated with cancer pathologic grading(low vs high : 84.2％ vs 86.5％, x2 = 0.08, P ＞ 0.05)and clinical stage (ta-tl : 82.9％, t2-t4 :87.5％, x2 = 0.32 ,P ＞ 0.05) .ConclusionFISH technique is a non-invasive and effective method for the early diagnosis of bladder tumor and is more sensitive than urine cytology.Furthermore, FISH technique can be used to predict the tumor's biological behavivor and prognosis.