Objective To study the mechanism of occurrence of the multifocal bladder cancers. Methods The expressions of p21,p53 and EMA in twenty specimens from 5 cases of multifocal bladder cancers were studied by means of immunohistochemistry. Results In 4 of 5 cases, the expressions of p21 and p53 were correspondent in scattering specimens from the same patient. In all the 5 cases, the expressions of EMA were correspondent in scattering specimens from the same patient. Conclusions Multifocal bladder cancer may originate from the same monocolone.

Objective To evaluate the use of spiral Double J stent in the treatment of complica ted ureteral calculi with extracorporeal shockwave lithotripsy (ESWL). Methods Spiral Double J stent was inserted in 52 patients with complicated ureteral calculi before ESWL,and the conventional Double J stent was inserted in 45 patients as control. Results In the control group,the number of ESWLprocedures was 4.2,while in spiral Double J stent group,it was 3.8( P

Objective To evaluate the clinical effect of Ho:YAG laser with flexible ureteroscope on the treatment of renal calculi. Methods Fifty one cases of renal stone burdens were treated with Versa Pulse Select Ho:YAG lithotriptor through flexible ureteroscope. Results The successful rate of stone fragmentation after single session was 90%(45/51).Mean operation duration was 45 min (30～78 min).Mean duration of post operation in hospital was 2.4 days (1～6 days).Stone free time was 3～6 weeks,with a mean of 4 weeks.No ureteral perforations or pyonephrosis occurred. Conclusions Ho:YAG laser lithotripsy through flexible ureteroscope is a safe, effective treatment for renal calculi.

Objective To evaluate the clinical features,diagnosis and treatment of metastatic adrenal carcinoma. Methods The data of 11 cases of metastatic adrenal carcinoma who were admitted from December 1993 to March 2003 were reviewed,including 4 cases of lung carcinoma,5 cases of hepatocellular carcinoma,1 case of bile duct carcinoma and 1 case of renal cell carcinoma.The main clinical manifestations were waist pain in 3,fatigue and weight loss in 3,hematuria in 1 and no symptom in 4.All the 11 cases underwent B-ultrasonography and CT scan,of whom 2 underwent positron emission tomography (PET).All patients were treated by surgical operation,including 9 cases by total adrenalectomy,1 case by palliative adrenalectomy and 1 bilateral metastatic case by left-adrenalectomy alone. Results In 5 cases by total adrenalectomy the survival time was 6 to 63 months with a mean of 34 months.Two cases were followed up for 2 to 16 months and 2 cases were lost with follow-up.One case by palliative adrenalectomy survived for 3 months.One bilateral metastatic case by left-adrenalectomy survived for 4 months. Conclusions Ultrasonography and CT are important in the diagnosis of metastatic adrenal carcinoma,and PET is of greater value in clinical practice.Complete adrenalectomy may be the best treatment choice to prolong the survival time.

Objective To summarize the CT signs and clinic characteristics to improve the CT diagnoses ability on the lobar bronchial intraluminal cancer and provide a well comprehension for it.Methods To study the clinical symptom and CT presentation in 7 cases with the lobar bronchial intraluminal cancer which had been confirmed by bronchoscopy and pathologic exam.Results 3 cases were in right superior lobaris bronchus,1 case in right middle lobaris bronchus,3 cases in left superior lobaris bronchus.Obstructive pneumonia were found in 7 cases.Obstructive atelestasis in 5 cases.The nodules or emboluses within lobaris bronchus were showed by CT in all cases and the obstructive signs on each patient in its degrees. Conclusion To get the CT diagnosis of the lobar bronchial cancer is easily be delayed. But if pay attention and keep it a close combination with clinic, the early diagnosis will be attained on time.

Objective To study the feasibility of renal hypothermia achieved by retrograde icecold saline infusion with perfusion pump. Methods Twenty-one patients who received the open radical nephreetomy were divided into three groups,A group with ice-slush renal hypothermia,B group with gravitational retrograde ice-cold infusion,C group with retrograde ice-cold infusion by perfusion pump.After the kidney was dissected and the ureter was divided,the renal vasculars were clamped.The kidney was cooled by three methods respectively.The temperature of renal parenchyma was monitored for 15 min. Results Fifteen minutes later,the temperature of renal parenchyma of A group declined from 34.4℃ to 5.4℃,B group from 34.8℃ tO 23.8℃,C group from 35.1℃ to 22.3℃.Coneiusions Renal hypothermia can be achieved by retrograde cold saline infusion and the perfusion pump may accelerate the speed of cooling.

Objective To evaluate the clinical effect o f Ho:YAG laser on the treatment of urinary calculi. Methods 155 cases of urolithiasis were treated via ureteroscope or cystoscope with V ersa Pulse Select Ho:YAG lithotriptor. Results 8 cases with kidney stones and 7 bladder stones were fragmented after a single s ession. The overall successful stone fragmentation rate of ureteral calculi was 95.7%(134/140). The mean stone expectoration time stone-free was 2.5 weeks. The mean operation time and post-operation hospital stay were 25 minutes and 2.5 da ys. No major complications such as perforation were encountered. Co nclusions Ho:YAG lithotripsy is an excellent treatment modality for urolithiasis.

Objective To discuss the safety of nephron sparing surgery for central renal tumors. Methods Thirty-eight cases of partial nephrectomies for central type renal masses were performed.One hundred and seventeen cases of partial nephrectomies with peripheral type renal tumors were compared. Results For the patients with central renal tumors,mean operative time was 118 minutes.Mean isehemic time was 34 minutes.Mean blood loss was 150 ml.The major postoperative complication included leakage of urine(1 case).For the patients with peripheral based tumors,mean operative time was 95 minutes.Mean ischemic time was 21 minutes(only renal artery clamped)and 17 minutes(complete block).Mean blood loss was 250 ml(only renal artery clamped)and 100 ml(complete block).The major postoperative complication included postoperative bleeding(4 cases). Conclusion According to the standard operative procedure,the nephron sparing surgery for central renal tumors is a safe procedure.

Objective To evaluate the effectiveness of a newly designed flexible,deflectable tip ureteroscope for the management of renal calyceal calculi. Methods We designed an actively deflectable tip, flexible ureteroscope for the treatment of renal calyceal calculi.From 2003 to 2004,25 patients with renal calyces calculi underwent deflectable,flexible ureteroscopic lithotripsy with holmium laser.Of them, 7 had concomitantly upper ureteral calculi.The mean diameter of the renal caliceal calculi was 1.3 cm (range,0.8-2.4 cm);and the mean diameter of the upper ureteral calculi was 0.6 cm (range,0.4-0.9 cm).The disease course ranged from 1 to 38 months with a mean of 17 months.Thirty days after the procedure, KUS showed no remnant fragmented calculi≥0.1 cm,suggesting clearance of the calculi.The completion rate of the procedure, lithotripsy rate and operative complications were analyzed. Results The procedure was successful in all the 25 patients with mean operative time of 28 min (range,19-45 min).The mean lithotripsy time was 11 min (range,5-22 min).No severe complication such as perforation of the ureter occurred during operation.The mean hospital stay was 3 d.The overall stone-free rate at 1 month after treatment was 92%(23/25). Conclusions The flexible,deflectable tip ureteroscope has the advantages of both rigid and flexible ureteroscopes,thus it is safe and effective in lithotripsy, especially for renal calyceal calculi of relatively small size.

Objective To explore the feasibility and safety of primary suture in laparoscopic common bile duct exploration(LCBDE) for treating choledocholithiasis.Methods The clinical data in 185 cases of choledocholithiasis underwent LCBDE in Sun Yat-sen Memorial Hospital from March 2010 to October 2015 were retrospectively analyzed.The patients were divided into 1aparoscopic common bile duct exploration and primary suture(LBEPS) group(117 cases) and T tube drainage group(68 cases) according to different processing modes of common bile duct incision.The operative time,intra-operative blood loss amount and postoperative complications were observed in the two groups.Results All operations were successfully performed in both two groups without converting to laparotomy.The operative time,intra-operative blood loss amounts and postoperative complications had no statistically significant differences between the LBEPS group and T tube drainage group(P>0.05).The postoperative hospital stay of the LBEPS group was significantly shorter than that of the T tube drainage group(P<0.01).There was no bile duct stricture or stone recurrence during the follow up period in the two groups.Conclusion Under strictly grasping the operation indication,selecting correct suture material and possessing practiced operating skills,primary suture of laparoscopic choledocholithiasis is safe and feasible,can avoid the risk of T tube placing related complications,has short postoperative hospitalization duration and increases postoperative living quality.