Objective To evaluate the effects and complications of percutaneous nephrolithotomy (PCNL) in the treatment of renal stone after repeated extracorporeal shockwave lithotripsy (ESWL).Methods Forty-four patients who had a history of repeated ESWL (treatment group) and 50 patients with-out surgical intervention (control group) were submited to PCNL,and clinical data was documented in details and analyzed.Results The time to establish access in treatment group and control group was (11.8 ± 4.1) min and (10.9 ± 2.5) min,respectively,and there was no significant difference (t =1.308,P =0.194).The time to extract stone in both groups was (92.0 ± 13.5) min and (66.6 ± 17.6) min,respectively,and there was significant difference (t =7.776,P =0.000).The operative time in treatment group was (113.9 ± 12.0) min,which was longer than that in control group with (87.6 ± 13.6) min (t =8.354,P =0.000).The clearance in both groups was 81.8％ and 94.0％,and there was no significant difference (x2 =3.361,P =0.067).The was no death or other severe complication in both groups.Conclusions The operation time in treatment group was longer than that in control group,and there was no significant difference in clearance and complication rate.Thus it was safe and effctive to perform PCNL in these patients with a history of failed repeated ESWL.

Adult ; Angiomatosis ; immunology ; pathology ; surgery ; Antigens, CD ; metabolism ; Diagnosis, Differential ; Female ; Hemangioma ; immunology ; pathology ; Humans ; Hyperplasia ; Spleen ; immunology ; pathology ; Splenectomy ; Splenic Diseases ; immunology ; pathology ; surgery ; Splenic Neoplasms ; immunology ; pathology

Objective To evaluate the therapeutic effects and to summarize the clinical experience of benign prostatic hypertrophy(BPH) with inguinal hernia in the elderly 70-89 years. Methods Clinical data of 32 patients 70-89 years old simultaneously undergone transurethral resection of prostate (TURP) and plug-mesh tension-free hernia repair from July 2000 to May 2005 were retrospectively analyzed and followed up. Results The average operating time was (85.0?12.8)minutes, the average blood loss was (90.0? 18.7 )ml. No postoperative death or life threatening complications were revealed. By 7-40 months of following up reported that there were no recurrence of hernia as well as no incontinence and urethral stenosis or other complications. IPSS,maximal flow rate and residual urine were evidently improved after operation. Conclusion Combined TURP and plug-mesh tension-free hernia repair is a safe and effective procedure for the elderly patients.

Objective To investigate the CT and MRI findings of primary hepatic neuroendocrine carcinomas.Methods Imaging findings of 6 patients with pathologically confirmed hepatic neuroendocrine carcinomas were retrospectively analyzed.Four patients underwent plain CT and contrast enhanced CT examinations.The other 2 patients underwent plain MRI and contrast enhanced MRI.Results One out of the 6 cases manifested multicentric tumor which appeared as one large tumor surrounded with multiple small nodules peripherally,and the tumors of the other 5 cases were solitary.On plain CT images,all lesions were well-defined and hypoattenuating with central areas of even lower density except punctuate calcifications at tumor periphery in 1 case.On pre-contrast MRI,the cases manifested heterogeneous low signal intensity on T1 wI and slightly high intensity on T2 WI.On dynamic contrast enhanced CT and MRI,Tumors manifested slight to mild enhancement in arterial phase,slight enhancement in portal venous phase or delayed phase with no enhancement in the center,accompanied by dislocation of surrounding vessels.There Was no lymphadenopathy in peritoneal cavity and retroperitoniurm. Conclusion CT and MRI scanning can demonstrate specific features of primary hepatic neuroendocrine carcinoma,which may help the diagnosis and differential diagnosis of the tumor.

Objective To investigate the feasibility, safety and clinical efficacy of staged endo-scopic treatment for refractory ureteral calculus. Methods Eighteen refractory ureteral calculus ea-ses (11 males and 7 females) treated with staged endoscopic treatment were retrospectively analyzed. The mean age of the patients was 32 years (range 2-65 years). Of the 18 cases, 2 had bilateral ure-teral calculi. Of the 20 ureteral calculi, 11 were in the upper, 6 were in the middle and 3 in the lower part of ureter. The mean diameter of the calculi was 0.9 cm (range 0.4-1.6 cm). Staged endoscopic treatment was offered to patients because of failure of ureterscopic lithotripsy or extracoporeal shock-wave lithotrispy caused by uretreal twist or eongential narrow. For all the cases, it was hard to com-pletely clear all the stone load and ureteral stents or percutaneous nephrostomy were performed to drain the kidney in the first session. Then, the calculi were removed by endoscopic manipulations in the second or third session. Results Thirteen patient's calculi were completely cleared in the second sessions 40-50 d after the first operation. The other 5 cases had to accept the third session 50-60 d after the second operations. There was no intra- or post-operative complication in all cases. During the 6 months' follow-up, there was no sign of recurrence. Conclusion Staged endoscopic treatment is a feasible and safe method and has high efficiency in the management of refractory ureteral calculi.

On the basis of an outline on Governor Vessel acupoints electroacupuncture ,endogenous neurotrophic factor expres?sion,grafted adult stem cell-derived neurons integrating to spinal host neuron circuit for repairing spinal cord injury ,it is summa?rized that mechanism of a combination of Governor Vessel acupoints electroacupuncture and grafted adult stem cells improving the tis?sue microenvironment of spinal cord injury to reestablish neuron conduction pathway. Governor Vessel acupoints electroacupuncture stimulate meningeal branch of spinal nerve in rat spinal cord transected or demyelinated. The stimulation message is input into spinal cord through afferent nerve,which activates spinal cord cells synthesizing and secreting neurotrophin-3(NT-3). The NT-3 can pro?mote the survival,differentiation and migration of exogenous neural stem cells(NSC)and bone marrow mesenchymal stem cells (MSC)expressing tyrosine kinase receptor C(TrkC)at the injury/graft site or demyelination/graft site in the spinal cord transected or demyelinated. The combined therapeutic strategy may replace and protect host neurons injured ,perfect tissue microenvironment in?jured,promote nerve fiber regenerating,and improve motor evoked potential of cerebral cortex and motor function of paralysis limbs.

The effect of magnetic Fe3O4 particles on cellulase in the enzymatic hydrolysis of sunflower seed hull was studied in different adding ways and additive amount. In the process of enzymatic hydrolysis of sunflower seed hull, the variations of cellulase activity, reducing sugar concentration and cellulose conversion were evaluated. After the reaction, the analysis of pH and surface tension of hydrolysate were also used to determine the mechanisms of cellulase by the magnetic effect. The results indicated that after adding magnetic Fe3O4, the cellulase activity, reducing sugar concentration and conversion of cellulose had an increased between the 0.5 g/L and 2.0 g/L cases after 48 h. When the additive amount of magnetic Fe3O4 was 2 g/L, the cellulase activity at 60 h was improved significantly by 25.9%. It was found that the concentration of reducing sugar was increased from 6.950 mg/mL to 8.775 mg/mL with magnetic Fe3O4 1.5 g/L. Simultaneously, compared with the blank, which the conversion of cellulose was 47.932%, the maximum celluloseconversion of samples with adding magnetic Fe3O4 was 60.531%. Besides, the stability of cellulase activity adding in times was better than in one time. After the reaction, the final surface tension of hydrolysate with 1.5 g/L magnetic Fe3O4 was the lowest in comparison with the blank. However, no significant differences were observed in the final pH of the hydrolysate.

Objective To investigate the clinical outcomes of minimally invasive percutaneous nephrolithotomy(MPCNL)in the treatment of lower caliceal calculi.Methods We retrospectively re- viewed the clinical outcomes and complications of 33 patients who underwent MPCNL for lower caliceal cal- culi from March 2001 to April 2005.The average diameter of the calculi was 2.8 cm.Single tract nephrosto- my was performed in all 33 cases;among them renal access was obtained through a middle calyx in 10 cases and a lower calyx in 23.Nine cases had F14 renal access;and 24 cases,F16.Results Of 33 cases,28 (85%)achieved stone-free at 1 session.A second-look was needed in 3 cases due to intraoperative bleed- ing;ESWL,in 1 case with residual,calculi;no treatment,in 1 case with residual calculi＜4 ram.The mean operative time was 93 min;mean blood loss was 113 ml;mean hospital stay was 11 d.Blood transfusion was needed in 1 patient who suffered from hepatic cirrhosis preoperatively;another experienced severe bleeding 7 d after operation and was cured with hyperselective spongia gelatinosa embolization of the renal artery.Fol- low-up was available in 19 cases for 2-48 months,and no recurrence of renal calculi was noted.Conclu- sions Minimally invasive percutaneous nepbrolithotomy has advantages of safety,less invasion,and easy re- covery for the treatment of lower caliceal calculi.

OBJECTIVETo study the clinicopathologic features of intraductal papillary mucinous neoplasm (IPMN) and its distinction from mucinous cystic neoplasm of pancreas.

METHODSThe clinical, radiologic and histologic features of 17 cases of IPMN and 13 cases of mucinous cystic neoplasm (MCN) were reviewed. Mucin profiles (MUC1, MUC2 and MUC5AC) were studied by histology (HE) and immunohistochemistry (EnVision).

RESULTS10 of the 17 cases of IPMN were males. 13 cases of the IPMN were located in head of pancreas. Communication with the main pancreatic duct was demonstrated in 15 cases. Histologically, there were mild to severe papillary ingrowths of dysplastic epithelial cells, associated with intervening normal or atrophic pancreatic parenchyma. Ovarian-like stroma was not seen. Ancillary investigations showed that MUC2 and MUC5AC were detected in tumor cells of 9 and 4 cases respectively. The 4 cases with invasive component showed MUC1 positivity. On the other hand, 11 of the 13 cases of MCN occurred in middle-aged to elderly females and were located in the body and tail of pancreas. Ovarian-like stroma was commonly seen and there was no connection with the main pancreatic duct. All non-invasive MCN, regardless of the degree of cytologic atypia, were positive for MUC5AC (but not MUC2). In the 2 cases with invasive component, MUC1 expression was observed, as in IPMN.

CONCLUSIONSThe age and sex of patients, tumor location, absence of ovarian-like stroma, communication with main pancreatic duct and characteristic mucin profiles represent useful parameters in distinguishing IPMN from MCN of pancreas. The tumor cells of IPMN express mainly MUC2, while those of MCN express MUC5AC. MUC1 may also be a useful marker in demonstration of stromal invasion in these tumors.

Adult ; Age Factors ; Aged ; Antigens, Neoplasm ; metabolism ; Biomarkers, Tumor ; metabolism ; Carcinoma, Pancreatic Ductal ; diagnosis ; metabolism ; pathology ; Carcinoma, Papillary ; diagnosis ; metabolism ; pathology ; Cystadenocarcinoma, Mucinous ; diagnosis ; metabolism ; pathology ; Cystadenoma, Mucinous ; diagnosis ; metabolism ; pathology ; Diagnosis, Differential ; Female ; Follow-Up Studies ; Humans ; Male ; Middle Aged ; Mucin 5AC ; Mucin-1 ; Mucin-2 ; Mucins ; metabolism ; Pancreas ; metabolism ; Pancreatic Neoplasms ; diagnosis ; metabolism ; pathology ; Precancerous Conditions ; diagnosis ; metabolism ; pathology ; Sex Factors

OBJECTIVETo study the clinicopathologic features and metastasizing potential of solid pseudopapillary tumor of the pancreas (SPT).

METHODSForty-five cases of SPT were retrieved from the archival file and subdivided into metastasizing group (MG, n = 4), and non-metastasizing group (NMG, n = 41), according to the follow-up clinical information. The histological features were reviewed and immunohistochemical study for vimentin, alpha 1-antitrypsin, alpha 1-antichymotrypsin, CD10, neuron-specific enolase, progesterone receptor, chromogranin A, synaptophysin, AE1/AE3, beta-catenin, p53, cyclin D1, CD34 and Ki-67 was carried out. The results were correlated with follow-up data.

RESULTSThere was no statistically significant difference between MG and NMG, in terms of age and gender of the patients, site, size and capsular status of the tumor. No single morphologic parameter could distinguish MG from NMG. In general, increased mitotic activity, tumor emboli in vessels and necrotic foci were more conspicuous in MG than in NMG. According to a morphologic scoring system, all cases of MG had score ≥ 5, in contrast to < 5 in 95.1% (39 cases) of NMG. Immunohistochemically, there was no statistically significant difference between MG and NMG for beta-catenin, p53, cyclin D1 and CD34 staining. Ki-67 positivity however was significantly higher in MG. Amongst the 37 cases with follow-up information available, the average duration of follow up was 37.4 months. Thirty-three patients were alive and disease-free.Four suffered from liver metastases; and none of them died of the tumor.

CONCLUSIONSMitotic activity, presence of tumor emboli and necrotic foci represent as the useful parameters in predicting metastasizing potential of SPT, especially with application of morphologic scoring system. Immunostaining for Ki-67 can also serve as an additional prognostic indicator.

Adolescent ; Adult ; Carcinoma, Papillary ; metabolism ; pathology ; secondary ; surgery ; Disease-Free Survival ; Female ; Follow-Up Studies ; Humans ; Ki-67 Antigen ; metabolism ; Liver Neoplasms ; secondary ; surgery ; Male ; Middle Aged ; Mitosis ; Necrosis ; Pancreas ; pathology ; Pancreatectomy ; methods ; Pancreatic Neoplasms ; metabolism ; pathology ; surgery ; Survival Rate ; Tumor Suppressor Protein p53 ; metabolism ; Young Adult ; beta Catenin ; metabolism