Objective Although the correlation between high risk human papilloma virus (hrHPV) infection and cervical cancer ( CC ) or cervical intraepithelial neoplasia ( CIN ) is well known , vaginal cancer ( VC ) or vaginal intraepithelial neoplasia ( VAIN) also caused by hrHPV has not received enough attention .This article aims to explore the clinical characteristics of VC or VAIN after operations of CC or CIN in order to provide evidence for the treatment of these diseases . Methods The clinical charac-teristics and treatment of 15 cases with VC or VAIN after operations of CC or CIN were reviewed from Jan 2010 to May 2013 in our hos-pital. Results The mean age was (53.6 ±10.82) years, ranged from 39 to 73 years.The duration from the first operation to devel-oped VAIN or VC was (25.07 ±18.31) months, ranged from 1 to 60 months.There are 4 cases developed VC, 4 cases VAINⅢand 2 cases VINⅡfrom 10 CC patients;and 3 cases developed VC , 2 cases VAINⅢfrom 5 CINⅢpatients.hrHPV test were positive in all 15 patients.Treatment in these series were performed including total vaginectomy in 8 patients (3 VC, 4 VAINⅢ and 1 VAINⅡpatients), pelvic lymphonectomy in 1;upper vaginectomy in 2 patients (1 VC, 1 VAINⅢ), radiation or chemo-radiation therapy in 3 (3 VC), interferon muscle injection combined with topical application of estrogen and acyclovir gel in 2 (1 VC, 1 VAINⅡ). Conclusion Careful follow-up after CC or CIN operations are very important because continued hrHPV infection may result VC and VAIN lesions.Vaginectomy may be the best therapy .Interferon muscle injection combined with topical application of estrogen and acyclovir gel are also alternatively therapy , especially for hard to operate patients . Radiation therapy seems to be not very adaptable for VAIN patients .

Purpose To investigate the clinicopathlogical characteristics, diagnosis and differential diagnosis of ovarian small cell car-cinoma hypercalcemic type ( OSCCHT) associated with acute renal dysfunction. Methods A case of OSCCHT associated with acute renal dysfunction was reported. The clinical and pathologic data, treatment and pathological examinations were analyzed and the related literatures were reviewed. Results A 29-year-olds women was presented to hospital with inappetence and significant weight loss for 2 months. The laboratory examination showed abnormal renal function, and pelvic cavity mass, possibly coming from adnexa of the uterus was seen by radiography. Serum levels showed significantly increased serum calcium with acute renal dysfunction. An emergency opera-tion was performed just after renal function partially recovered by 2 times hemodialysis. During surgery, right ovary tumor with a size of 12 cm × 10 cm × 10 cm was inspected. Microscopically, the tumor cells were arranged in a diffuse solid pattern, mutiple nodules were separated by fibrous tissue. some small folliculars and pseudoglandular cavities with acidophilia secretion within nodules could been ob-served. Tumor cells were medium to large with eosinophilic cytoplasm, round or oval vesicular nucleus, increased karyoplasmic ratio and pathologic mitosis. Immunohistochemistry revealed that the tumor cells expressed EMA, CKpan, C-erbB-2 ( +) , CA125 ( focal+) and Ki-67 proliferation index was about 60%, while ER, PR, Syn, CgA, PTH, Inhibin, CD99, AFP, PLAP, CD30 and CD20 were not expressed. Conclusion Ovarian small cell carcinoma hypercalcemic type with acute renal dysfunction is a very rare with a rapidly progressive and highly malignant tumor. The final diagnosis mainly lies on clinical information ( hypercalcaemia) , morphology and immunohistochemistry, combined with electron microscopy and molecular biological detection when necessary.

Objective To investigate the clinical effect of posterior femoral composite tissue flap pedicled with inferior gluteal artery for repair of huge sacrococcygeal pressure injuries.Methods The clinical data of 11 patients with huge sacrococcygeal pressure injuries admitted to our hospital were retrospectively analyzed,with a mean wounds area of(205.3±15.3)cm2,and the depth of the wounds all reached the sacrococcygeal bone surface with partial sacrococcygeal necrosis.The inferior gluteal artery and its perforating branch were investigated with ultrasonic Doppler flow detector before operation,the posterior femoral composite tissue flap pedicled with inferior gluteal artery was designed according to the wound surface,and then the chronic sacrococcygeal wound was repaired.The operation time,intraoperative blood loss,wound healing,postoperative skin flap survival and occurrence of complications were recorded.The skin flap color,temperature and two-point discernability were monitored to evaluate skin flap sensory sensitivity.The visual analog scale(VAS)was used to evaluate the satisfaction of appearance.Results The operation time of patients was(2.8±0.1)hours and the intraoperative blood loss was(235.4±10.2)mL.The posterior femoral composite tissue flap pedicled with inferior gluteal artery of all the 11 patients survived.The distal part of the flap was necrotic in 1 case,which healed well after local debridement and suturing by amplification;other wounds healed well in the first stage without complications such as infection,fat liquefaction or hematoma.The skin flap has good color,soft texture,and good elasticity,with good healing in the donor area.There were significant differences in the skin flap temperature,two-point discernability and VAS score of appearance satisfaction between 12 months after operation and other time points(P＜0.05).Conclusion The posterior femoral composite tissue flap pedicled with inferior gluteal artery has a constant blood supply,without damage to the main blood vessels.It can be transposed at anterograde or retrograde direction,with simple operation and less damage,which can reconstruct flap sense,and has significant clinical efficacy in repairing huge sacrococcygeal pressure injuries.