The clinical data of 39 cases of idiopathic hyperaldosteronism (IHA) confirmed by operation were analyzed. The indications of operation consisted of (1) unable controlled the patients′ conditions by pharmacotherapy, (2) severe side effects due to high doses of medication and (3) difficulty in distinguishing between adenoma and nodule hyperplasia. The unilateral total adrenalectomy was suggested.

Objective To probe into the diagnosis and treatment of pheochromocytoma of high risk. Methods The clinical data of 35 cases of pheochromocytoma of high risk underwent surgical extirpation from 1990 to 2000 were reviewed. Results The tumors were intraadrenal in 27 and extraadrenal in 8.The average diameter of the growth which could be successfully resected was 10 cm and the weight 350 g.Biopsy was undertaken in 2 because of the difficulty in extirpation of the tumor.Recurrence occurred in 4 and there were 3 cases being comfirmed to be malignant. Conclusions Adequate preoperative preparation and definite location of the tumor are the most important before surgery.Fluctuation of blood pressure have to be monitored during surgery and to be treated carefully and promptly.Hypoglycemia have to be awared of after the surgery.

Objective To study the diagnosis and treatment of adrenal tumors. Methods 1 006 cases of adrenal tumors treated from 1957 to 2000 were reviewed. Results Of the 1 006 cases of adrenal tumors,845(84.0%) were functional with 12(1.4%) malignant and 161(16%) nonfunctional with 11( 6.8%) malignant.There were 180 incidentaloma including 19 pheochromocytoma.A total of 996 tumors have been surgically removed and 10 cases underwent surgical exploration only.The total mortality rate was 0.3%. Conclusions Adrenal tumors occurred mostly in patients of 30～50 years of age.The prevalence of Cushing syndrome was more in females than in males.Ultrasonography and CT are the method of choice for the localization of the tumor whereas hormone levels should be determined both in the symtomatic and asymtomatic patients with adrenal tumors.Functional adrenal tumors and solid incidentaloma of large size should be surgically removed while asymtomatic incidentaloma less than 3 cm in size could be observed and followed up and surgery might be undertaken when indicated.

Objective To detect plasma renin activity(PRA) and kidney damage in primary hyperaldosteronism(PA). Methods The duration of hypertension,serum creatinine and aldosterone levels,recumbent and upright PRA levels were detected and studied in 76 PA patients.Correlation was measured between creatinine and other parameters. Results Serum creatinine level correlates closely with upright PRA ( P

Objective To investigate the influence of multi-drug resistant mycobacterium strain tuberculosis (MDR-TB) on the clinical outcomes and its countermeasures in the treatment of bone and joint tuberculosis. Methods From December 1993 to June 1999, 250 revised cases were admitted in our hospital, which were 143 males and 107 females aging from 2 to 72 years with an average of 25.44 years. The most of lesions were located at spine, then the hip, knee and small joints. The specimens were harvested via need biopsy or operation from the lesion. Specimens were examined by Bactec TB 460 to identify tuberculosis mycobacterium and non tuberculosis mycobacterium strain, and drugs-sensibility test to INH(0.2 ?g/ml), SM (6.0 ?g/ml), RFP (2.0 ?g/ml) and EMB (7.5 ?g/ml) respectively. Results Of 250 patients, Mycobacterium were positive in 48 by Bactec measurement, which were tuberculosis mycobacterium strain in 46 with 18.4% positive rate, and non tuberculosis mycobacterium strain in 2(1 mycobacterium avium intracellulare complex, the other unkown). Of the 46 positive specimens, 27 were sensitive to all of 4 drugs(58.7%), however, 3 were resistant to 1 drug(6.5%), 1 was resistant to 2 drugs(2.1%), 4 were resistant to 3 drugs (8.7%), and 11 were resistant to 4 drugs(24%). In 11 patients resistant to 4 drugs and 2 patients with non tuberculosis mycobacterium strain, 8 were complicated with sinuses after the first operation, in which 7 healed after 2 to 3 re-operations and 1 died of secondary infection. 1 M. avium intracellulare complex and 1 unidentified mycobacterium were multi-drug resistant strains( INH,RFP, SM, EMB) and found with poor clinical results.Conclusion Those cases with MDR-TB in lesions can influence the curative effect of bone and joint tuberculosis significantly. Based on the drug-sensibility, the chemotherapy regimen should be modified and individualized, and requires several operations to cure.

Objective To evaluate the value of 3-dimensional dynamic contrast-enhanced magnetic resonance angiography (3D DCE MRA) in the diagnosis of adrenal and renal diseases.Methods 3D DCE MRA was performed on 22 patients with adrenal neoplasm,23 patients with renal neoplasm and 2 patients with stenosis of renal artery. Comparison with surgical findings or DSA was made.Results 3D DCE MRA clearly reflected the vascular anatomy,satisfied diagnostic demands.Simultaneously,The extravascular lesions were also detected.Conclusion The 3D DCE MRA is a reliable non-damaged imaging diagnostic method.

Objective To evaluate the comprehensive treatment results of cystitis glandularis. Methods A total of 65 cases of cystitis glandularis underwent cystoscopy.The results showed follicular or villous changes in 39 cases,papillomatous in 15,chronic inflammation in 8 and no obvious change in 3.Transurethral electric resection or partial cystectomy were performed.After surgery all the cases received mitomycin-c bladder irrigation at high dose (40 mg once) regularly for 2 years.During the follow-up cystoscopy was periodically performed and the biopsy samples were pathologically examined with all the cases. Results The mean follow-up was 29 months (range,7 to 72 months).Of the 65 cases,60 fully recovered with transitional cell surface covering the bladder musoca gradually;4 had relapse;and 1 developed canceration (adenocarcinoma). Conclusions Transurethral resection of bladder tumors or galvanocautery is the essential therapy for cystitis glandularis.After surgery the bladder irrigation with mitomycin-c at high dose can be helpful for urothelium recover in histology.

Objective To compare the effects of two positions in the infant megacolon radical operation.Methods Sixty infants undergoing abdominal perineal megacolon radical operation were randomly divided into the control group and the observation group in equal number.The former took the traditional lithotomy position and the latter modified suspended lithotomy position.Results The operative exposures in the observation group were much more sufficient than that of the control group(P<0.05).While adverse skin reactions in the observation group were more uncommon than those of the control group(P<0.05).Conclusion The suspended lithotomy position may provide a better exposure and result in fewer adverse skin reactions during the abdominal perineal megacolon radical operation.

Objective To investigate the nursing points and the effect of the conjoint liver and kindey transplantation. Methods To review the concreted nursing experience among 13 patients who have accepted the conjoint liver and kidney transplantation from 1996 to 2004 in the First Affiliated Hospital of Sun Yat-Sen University,and then summarized the nursing key points of the operation. Results All the nursing measures during the course of operation were properly,the means time of operation was 9.5 hours,the means time of liverless was 65 minutes,the blood loss volume was 7 000 ml. Conclusion The nursing key points of conjoint liver and kidney transplantation include sufficient nursing prepare,homoiothermism during the operation,proper using drugs, proper blood-transfusion and fluid infusion.

Objective To improve the diagnosis and treatment ot adrenocorticotropin-independent macornodular adrenal hyperplasia (AIMAH).Methods The clinical data of 17 cases with AIMAH from 2000 to 2011 were analyzed retrospectively,including 3 subclinical AIMAH,10 clinical AIMAH and 4 highrisk AIMAH patient,with common radiological characteristic of bilaterally enlarged adrenal glands with multiple nodules like ginger.The 3 cases of subclinical AIMAH patients presented with decreased serum ACTH,normal or slightly elevated plasma cortisol and urinary free cortisol level,no suppression following 1 mg overnight dexamethasone suppression test and absence of clinical signs of Cushing syndrome (CS).While clinical AIMAH and high-risk AIMAH presented with clinical signs of CS,elevated plasma cortisol and urinary free cortisol level,suppressed serum ACTH,loss of normal circadian rhythm in cortisol secretion and no suppression following the low-dose and high-dose overnight dexamethasone suppression test.Among the 4 cases of high-risk AIMAH,2 cases presented with osteoporosis,2 cases with hepatic dysfunction,3 cases with cardiopulmonary dysfunction,and 4 cases with severe hypertension.Three cases of subclinical AIMAH were treated with symptomatic treatment,10 cases of clinical AIMAH patients with surgical operation,4 cases of high-risk AIMAH patients with ketoconazole and surgical operation.Results Three subclinical AIMAH patients received symptomatic treatment and discharged from hospital with normal blood pressure and blood glucose.During the period of follow-up from 3 months to 3 years,endocrine results were normal.Seven clinical AIM AH patients underwent unilateral adrenal tumor resection plus ipsilateral partial adrenalectomy or total adrenalectomy.CS disappeared completely after 6 to 9 months.Two clinical AIMAH patients underwent simultaneous bilateral adrenalectomy.One case died of adrenal crisis after operation,and the other case presented with adrenal insufficiency but returned to normal after glucocorticoid replacement therapy,no Nelson's syndrome happened during the follow-up for 5 years.One clinical AIMAH patient undertook unilateral adrenalectomy twice by interval,followed by routine corticosteroid replacement therapy.Followed up for 10 years,no Nelson's syndrome happened.Four high-risk AIMAH patients received ketoconazole and then underwent right total adrenalectomy.Cortisol levels returned to normal after 1 to 2 months and during the follow-up for 1 to 3 years,the laboratory examinations maintained normal.Conclusions Different treatment methods should be adapted to different subtypes of AIMAH.For subclinical AIMAH,the principal treatment is symptomatic,and close follow-up with regular adrenal imaging and endocrine examination is required.Surgical operation should be performed when clinical symptoms of AIMAH appear.Medical management is essential for high-risk AIMAH to inhibit the production of cortisol at first.Once these patients could stand the stimulation caused by operation,the adrenal glands should be resected as soon as possible.The unilateral adrenalectomy is an effective treatment for clinical AIMAH.