Objective To improve the diagnosis and treatment of renal oncocytoma. Methods The clinical data of 3 cases with renal oncocytoma treated from 1999 to 2002 were retrospectively analyzed and discussed with literature reviewed. The 3 tumors’size was 7.6 cm?8.5 cm?6.8 cm,10.0 cm?11.5 cm?9.8 cm,10.0 cm?8.0 cm?6.8 cm,respectively.The clinical features were atypical.Renal oncocytoma was characterized by homogeneous attenuation with a central, margined stellate area on CT scan. Results The 3 cases underwent nephrectomy,and the resected tumors were examined by pathology.On light microscopy,there was strong eosinophilic cytoplasm with granules,the tumor cells being tubular or adenoid in pattern with no necrosis and very rare or no mitosis.Enormous mitochondria were noted on electron microscopy.The immunohistochemical staining was positive for cytokeratin and EMA,whereas it was negative for vimentin.The follow-up lasted for 16 to 30 months without recurrence or metastasis. Conclusions Renal oncocytoma is a type of benign,parenchymatous tumor,and it has no specific clinical feature.The diagnosis can be established on histopathologic,immunohistochemical and electron microscopic studies.

Objective To investigate the hemodynamic effects and mechanisms of aerosolized iloprost in children with pulmonary hypertension(PAH)after congenital heart surgery,in the setting of early ventilation and continuous nitric oxide(NO)inhalation were administered.To observe the outcomes of the patients after iloprnst therapy.Methods From April 2008 to April 2009,all postoperative children with PAH in ICU,Fuwai hospital had regularly been given ventilation and NO inhalation at a dose of 10 ppm for 2 hours since they were leaving the operation room,and then ultrasonic cardiography was used to evaluate the systolic pulmonary arterial pressure(sPAP=4×TIVmax+RAP).Thirty children were diagnosed as having postoperative PAH for sPAP/sBP≥0.5.They were divided into two groups(group T and group C)randomly,with ventilation and NO inhalation administered continuously,and were given inhaled iloprost at a dose of 100 ng·kg-1·min-1*10 min and inhaled 0.9% NaCl 4ml respectively,once every 4 hours for 48 hours.We used the 24-hour cardiac monitors and ultrasonic cardiography for hemodynamic monitoring in the patients of two groups at the six time points:baseline(t1),20 min later after the first inhalation(t2),120 min later after the first inhalation(t3),24 hours later after the treatment(t4),48 hours later after the treatment(t5) and 24 hours after ceasing the last inhalation(t6).We examine the blood cAMP and cGMP by ELISA assay before and after the first inhalation.We observed the blood coagulation,the liver and kidney function of these patients.The outcomes of these patients were also investigated.Results At t1,the sPAP and sPAP/sBP had no differences between the two groups.At t2,the sPAP(43.23±11.72)mmHg and sPAP/sBP(0.48±0.13)in group T were both lower than the sPAP(53.13±13.60)mmHg and sPAP/sBP(0.60±O.15)in group C(P<0.05).At t3,the sPAP/sBP of group T was also lower than that of group C(0.48±0.09 vs 0.59±0.14,P<0.05).At t4 and t5,the sPAP in group T were (39.84±12.87)and(34.99±12.98)mm Hg,with sPAP/sBP(0.42±0.15)and(0.36±0.14),were much lower than those in group C(P<0.01).From t1 to t2,the cAMP level increased sharply from(406.64±179.18)to(578.68±193.05)pg/dl in group T(P<0.01),and was also obviously higher than that in group C at t2(392.26±94.46)pg/dl(P<0.01).HR,BP and RAP showed no notable difference between two groups at every time point.So did the PIP.There were no differences in coagulation,liver and kidney function at t6.2 patients died from pulmonary hypertension crisis(PAH)in group C and no one in group T.One patient showed flush during the treatment in group T and recovered spontaneously after the inhalation.Nevertheless,none in group C.Conclusiou Inhaled iloprost significantly improved pulmonary hemodynamics in children with PAH after congenital heart operation even thongh they were ventilated and inhaling NO.Increased blood cAMP level was considered to be a contributing factor.Howeve,systemic BP remain unaffected after iloprost inhalation.Aerosolized iloprost may be associated with improvement in the survival and deczeased PHC.

Objective To study the therapeutic effects of inhaled iloprost on pediatric pulmonary hypertension after congenital heart disease operation and to investigate the mechanisms of iloprost.Methods Thirteen 10 min every time,every 4 hours for 48 h after the surgery.We used the 24 h cardiac monitoring and ultrasonic cardiography for hemodynamical monitoring.We examined the blood cAMP and cGMP by ELISA assay.Results The patients were(17.88±12.56) months old with average weight of(9.29±3.59) kg.The right atrial pressure,systolic pulmonary arterial pressure,systolic pulmonary arterial pressure/systolic blood pressure were(11.5±1.41)mm Hg,(61.64±13.6) mm Hg and 0.66±0.16 before the treatment and they were(9.88±1.88) mm Hg,(47.67±12.18) mm Hg and 0.52±0.15 at the time point of 20 min after the treatment.For all the three parameters,there were significant differences before and after treatment.The effect of iloprost continues to 120 min later.The cAMP level was(335.75±127.31) μg/L before iloprost inhalation and increased to(519.68±148.54)μg/L at the time point of 20 min after inhaling iloprost,showing a significant difference(P＜0.01).Blood pressure,cGMP level and ventilator parameters showed no notable difference before and after the treatment.Conclusion Inhaled iloprost significantly improves pulmonary hemodynamics in children with pulmonary hypertension after congenital heart disease operation,which might be achieved by increasing the blood cAMP.However,systemic blood pressure and respiratory function keep unaffected after iloprost inhalation.

10 ng/ml). Results The diagnost ic rate of 3 groups was 44.5%,29.8%,57.4% respectivly. Conclusions The advantages of the procedure were correct acquiring of prastate ti ssue,more accurate approach and depth of the puncturing needle,avoiding injury t o the nearby tissue and raising the diagnosis rate of prostatic carcinoma.

Objective To evaluate bulbourethral sling procedure in the treatment of post prostatectomy incontinence. Methods 5 patients with post prostatectomy incontinence underwent the bulbourethral sling procedure.Preoperatively 1 patient was completely incontinent and 4 patients required a mean of 3.5 pads per day.The mean duration of incontinence was 4.5 years. A sling tension of a mean of 500 g was used to correct incontinence. Results 4 patients have been completely dry,whereas postoperative difficulty in voiding occurred in the other patient and was corrected by subsequent transurethral bladder neck revision resulting in free passage of urine and continence. Conclusions The bulbourethral sling procedure is an effective means in the treatment of post prostatectomy incontinence.

Objective To elucidate the clinical features of nonspecific granulomatous prostatitis(NSGP). Methods From February 1994 to February 2002,26 cases of NSGP confirmed histologically were retrospectively analysed.Of them 20 cases were treated with anti-inflammatory therapy alone;4 cases with anti-inflammatory therapy plus ?-receptor blocker,and 2 cases who concomitantly had retention of urine underwent TURP. Results All the 26 patients were followed up for 6 to 42 months.The therapeutic results were satisfactory.The Qmax increased from 4.6～12.8 ml/s to 16～28 ml/s,and the hard prostate mass became soft,with reduction from 2.5 cm?3.5 cm to 0.5 cm?1.0 cm.The serum PSA decreased from 15.5～60.8 ng/ml to 1.5～10.6 ng/ml. Conclusions In clinical practice NSGP is often mistaken for prostatic carcinoma,so special attention should be paid to the differential diagnosis.The definite diagnosis depends on histopathological examination.

Objective To summarize the experience and evaluate the efficacy of treatment of urethral stricture using direct visual internal urethrotomy (DVIU).Methods The clinical data of 361 patients (age range 16 -72 years, mean age 38 years) with urethral stricture who underwent urethrotomy from 1990 to 2010 was retrospectively analyzed.The disease course ranged from three months to 78 months with a mean of 16 months.The stricture length ranged from 0.2 to 2.0 cm (mean 1.1 cm).Stricture length was split into four main groups:stricture length≤0.5 cm in 63 (group 1 ), stricture length ranging between 0.6 and 1.0 cm in 175 ( group 2), stricture length ranging between 1.0 and 1.5 cm in 85 ( group 3 ) , and stricture length ranging between 1.6 and 2.0 cm in 38 ( Group 4).Of the 238 patients with length less than 1.0 cm there were 148 who's scar thickness were less than 1.0 cm, and 90 who's scar thickness were greater than 1.0 cm.Of the 123 patients with length less than 2.0 cm there were 69 who's scar thickness was less than 1.0 cm, and 54 who's scar thickness was greater than 1.0 cm.Results Three patients with DVIU failed because of long occlusion and false passage.Three hundred and twenty patients were followed-up from 12 to 120 months (mean:42).Re-openiag procedures were performed on 174 patients (54.4%) due to recurrence.The re-openiag procedure rate was 3.3%, 49.7%, 83.3% and 97.1% in Group1, Group2,Group3 and Group4, respectively.On the basis of scar thickness, of the 207 patients with stricture length less than 1.0 cm, 38 of 136 patients (27.9%) with scar thickness less than 1.0 cm underwent opening operation, and 43 of 71 patients (60.6%) with scar thickness more than 1.0 cm underwent opening operation.One hundred and thirteen patients with stricture length more than 1.0 cm, 33 of 42 patients (78.6%) with scar thickness less than 1.0 cm underwent opening operation, and 60 of 71 patients (84.5%) with scar thickness more than 1.0 cm underwent opening operation.Conclusions Good efficacy can be achieved in patients whose urethral stricture length is less than 0.5cm or whose stricture length and scar thickness is less than 1.0 cm using DVIU.

BACKGROUND: Hyperpolarization-activated cyclic nucleotide-gated (HCN) current plays an important role in regulating heart spontaneous pulsation.OBJECTIVE: To observe target gene expression and electrophysiological characteristics of pig bone marrow mesenchymal stem cells (BMSCs) transfected with hyperpolarization-activated cyclic nucleotide-gated channel 2 (HCN2) gene recombinant adenovirus.DESIGN, TIME AND SETTING: Cell-gene in vitro study was performed at the Laboratory of Thoracic and Cardiovascular Surgery,Second Military Medical University of Chinese PLA from July 2007 to March 2008.MATERIALS: Yorkshire pig was supplied by Animal Institute, Second Military Medical University of Chinese PLA. HCN2 plasmid was presented by Professor Dario DiFrancesco from Italy. Recombinant adenovirus Ad.HCN2 was constructed and stored using Ad5 in this laboratory.METHODS: Pig BMSCs were isolated with combination of gradient centrifugation of Percoll and adherent treatment in vitro.Ad.HCN2 was transfected at multiplicity of infection=50. We also set non-transfection and transfected Ad.Null groups.MAIN OUTCOME MEASURES: Expression of HCN2 mRNA was detected with RT-PCR, and expression of HCN2 channel protein was examined with immunofluorescent staining. Electrophysiology of HCN2 channel protein was measured with whole-cell patch clamp.RESULTS: No amplified fragments were found in the non-transfection and transfected Ad.Null groups, but amplified fragments were determined at 250-500 bp following Ad.HCN2 amplification, which was the same as plasmid carrying HCN2 gene. Staining strength of cell nuclei following transfection was significantly weaken compared with cell membrane and plasma, which showed identical distribution as HCN2 protein. No HCN2 protein was detected in the non-transfection and transfected Ad.Null groups.Pacemaker current could be recorded with a whole-cell patch clamp. It was fully activated around -140 mV with an activation threshold of -60 mV, presenting voltage dependence. CsCI (4 mmol/L) reversibly blocked the inward currents. No pacemaker current was detected in the non-transfection and transfected Ad.Null groups.CONCLUSION: The HCN2 recombinant adenovirus carrier was transferred into serial subcultivation porcine bone marrow mesenchymal stem cells. HCN2 channel protein has been expressing. Pacemaker current could be recorded with a whole-cell patch clamp.

Objective To study the diagnostic value of 3-dimensional CT reconstruction in posterior urethral strictures or ankylurethria.Methods Thirty patients with strictures or ankylurethria of posterior urethra caused by pelvic fracture underwent helical CT scan and 3-dimensional reconstruction of the urethral canal as well as radiographic urethrography before and post open urethral reconstruction to observe the urethral anatomy,the length and position of the urethral strictures,the depth of periurethral scar.Results The mean stricture or ankylurethria length measured by radiographic urethrography was 4.0 cm (range from 1.0 cm to 7.0 cm),and the correlation coefficient of stricture or ankylurethria length was 0.92,21 (70%) patients were diagnosed accurately by radiographic urethrography.The mean stricture or ankylurethria length measured by 3-dimensional CT reconstruction was 4.3 cm (range from 1.2 cm to 7.6 cm),and the correlation coefficient of stricture or ankylurethria length was 0.96,there were 28(93%) patients diagnosed accurately by 3-dimensional CT reconstruction.The mean stricture or ankylurethria length measured by open urethral reconstruction was 4.2 cm (range from 1.5 cm to 7.5 cm).Five patients with urethrorectal fistula were also diagnosed accurately by 3-dimensional CT reconstruction rather than by radiographic urethrography.Conclusions 3-dimensional CT reconstruction of the urethral canal can accurately evaluate the urethral anatomy,the length and position of the urethral strictures,as well as the depth of periurethral scar after crush injury and provide useful information for operation that may not be provided by radiographic urethrography.3-dimensional CT reconstruction may become the most valuable means for detecting posterior urethra strictures or ankylurethria with urethrorectal fistula.

Objective To evaluate the efficacy of transpubie access using pedicle tabularized la-bial urethroplasty for urethral reconstruction in female patients with urethral strictures associated with urethrovaginal fistulas.Methods Eight cases of urethral strictures were treated using pedicle labial skin flaps for urethral reconstructions.All cases were the mid-urethral strictures associated with ure-throvaginal fistulas.A single face pedicle flap was obtained from the labia minus or majus in 5 women,and double face pedicle labial flaps were used in 3 patients.Results There were no serious complica-tions.Two patients complained of dysuria symptoms for 2 weeks and one patient experienced stress incontinence which resolved after 4 weeks.The patients were followed up for 6 to 130 months (mean 52) postoperatively.All patients had normal micturition following catheter removal with urinary peak flow greater than 15 ml/s(17.4-42.0 ml/s).Conclusion Pedicle labial urethroplasty might be a reliable technique for the management of complex urethral strictures associated with urethrovaginal fis-tulas.