OBJECTIVETo compare the effectiveness and safety of transurethral resection of the prostate (TURP) and transurethral enucleative resection of the prostate (TUERP) in the treatment of benign prostate hyperplasia (BPH).

METHODSA total of 630 BPH patients with indication of surgery were randomly assigned to receive TURP (n = 305) and TUERP (n = 325), respectively. There were no significant differences preoperatively in age, prostate volume, International Prostate Symptom Score (IPSS), and Qmax between the two groups (P > 0.05). The prostate resection rate, operation time, postoperative complications, and quality of life (QOL) of the patients were recorded and statistically analyzed.

RESULTSCompared with TURP, TUERP showed a significantly higher rate of prostate resection ([47.0 +/- 13.3] vs [60.1 +/- 12.3]%, P < 0.05), shorter operation time ([57.9 +/- 15.9] vs [40.4 +/- 14.2] min, P < 0.05), and shorter bladder irrigation time ([2.7 +/- 0.6] vs [2.2 + 1.1] d, P < 0.05). Significant differences were found between the pre- and post-operative levels of serum sodium and hemoglobin in the TURP group ([141.2 +/- 3.5 ] vs [136.9 +/- 4.7] mmol/L, P < 0.01; [137.6 +/- 8.8] vs [124.8 +/- 9.6] g/L, P < 0.01), but not in the TUERP group. Three months after operation, IPSS, QOL, and Qmax were all markedly improved in both groups (P < 0.01), but with no significant differences between the two groups (P >0.05).

CONCLUSIONTUERP is better than TURP in the treatment of BPH for its advantages of higher resection rate of the prostate, shorter operation time and bladder irrigation time, less intraoperative blood loss, fewer postoperative complications, and faster recovery.

Aged ; Humans ; Male ; Prostatic Hyperplasia ; surgery ; Transurethral Resection of Prostate ; methods ; Treatment Outcome

OBJECTIVETo explore the value of percutaneous radiofrequency ablation (PRFA) combined with transcatheter arterial chemoembolization (TACE) and percutaneous ethanol injection (PEI) in the management of recurrent small hepatocellular carcinoma.

METHODSBetween March 2001 and March 2005, 52 patients with recurrent hepatocellular carcinoma (tumor size< or =5 cm) underwent PRFA, and 14 of the patients (tumor size 3-5 cm) also received TACE and PEI, and their clinical data were analyzed retrospectively.

RESULTSMRI or CT after PRFA revealed complete coagulative necrosis of the tumor in 38 cases (tumor size <3 cm). In the 14 patients (tumor size 3-5 cm) with also TACE and PEI, complete necrosis occurred in 11 cases (78.6%). In the patients involved in this study, the 1-, 2-, 3- and 4-year survival rates were 96.2%, 69.4%, 45.5% and 30.0%, respectively.

CONCLUSIONSPRFA is an effective modality for local treatment of recurrent small hepatocellular carcinoma, capable of total elimination of tumors <3 cm. For tumors of 3-5 cm, combination with TACE and PEI may help increase the tumor necrosis rate following the ablation and raise the patients' survival rate.

Adult ; Aged ; Antineoplastic Combined Chemotherapy Protocols ; therapeutic use ; Carcinoma, Hepatocellular ; pathology ; therapy ; Catheter Ablation ; Chemoembolization, Therapeutic ; Combined Modality Therapy ; Ethanol ; administration & dosage ; Female ; Humans ; Liver Neoplasms ; pathology ; therapy ; Male ; Middle Aged ; Neoplasm Recurrence, Local ; therapy ; Retrospective Studies ; Treatment Outcome

OBJECTIVETo study the epilepsy patients and their family members on their knowledge of the disease.

METHODSA 34-point questionnaire with 34 questions related to epilepsy knowledge was used for the survey on 170 pairs of epilepsy patients and their family members in Huashan hospital. Characters of the disease on the subjects were recorded.

RESULTSThe mean scores of the epilepsy knowledge of the patients and their family members were 16.5 +/- 8.2 and 16.1 +/- 8.5, respectively. The scores were quite low with no statistical difference between patients and their family members. The rate of correct answer in the urban subjects was obviously higher than those subjects living in the rural areas. All the subjects lacked the knowledge on the "cause of disease" when comparing with items as "diagnosis" and "treatment". Multivariate analysis showed that rural residents (P = 0.0001, OR = 52.963) and low education level (P = 0.0294, OR = 2.266) related to low epilepsy knowledge score among epilepsy patients. However, for family members, the factor related to low score was only living in the rural area (P = 0.0001, OR = 37.229).

CONCLUSIONEducation on the epilepsy knowledge should be strengthened, especially in the rural areas.

Adolescent ; Adult ; Epilepsy ; psychology ; Family Health ; Female ; Health Knowledge, Attitudes, Practice ; Humans ; Male ; Middle Aged ; Rural Health ; Surveys and Questionnaires

OBJECTIVETo study the effects of the extensive resection of the tumor-loading segment and artificial humerus head replacement combined with perioperative rehabilitation for the treatment of stage II to III giant cell tumor of bone in the proximal humerus.

METHODSFrom March 2007 to March 2010, 7 patients with stage II to III giant cell tumor of bone in the proximal humerus were treated. Among the patients, 3 patients were male and 4 patients were female with a mean age of 34.6 years (ranged, 18 to 49 years). The mean course of disease was 19 months (ranged, 6 to 35 months). All the patients were confirmed to suffer stage II to III giant cell tumor of bone in the proximal humerus by pathology and X-ray examinations. Clinical manifestations of the patients included persistence aggravated pain of the shoulder, swelling in the proximate arm with obviously tenderness, activity limited of the joint. All the patients were treated with extensive resection of the tumor-loading segment and artificial humerus head replacement combined with perioperative rehabilitation. CMS and OSIS score system were used to evaluate shoulder function and shoulder stability.

RESULTSAll the patients were followed up, and the duration ranged from 14 to 35 months, with an average of 17 months. There were no serious complications or recurrence in all cases. One year after the surgery CMS and OSIS score system were 70.7 scores (ranged,63 to 82 scores) and 25.1 scores (ranged, 18 to 29 scores) respectively. According to evaluation for shoulder function, 2 patients got an excellent result and 5 good. According to evaluation of shoulder stability, 1 patient got an excellent result and 6 good.

CONCLUSIONExtensive resection of the tumor-loading segment and artificial humerus head replacement combined with perioperative rehabilitation for the treatment of stage II to III giant cell tumor of bone in the proximal humerus would not only preserve the upper extremity but also preserve the function of upper extremity.

Adolescent ; Adult ; Bone Neoplasms ; pathology ; rehabilitation ; surgery ; Female ; Giant Cell Tumor of Bone ; pathology ; rehabilitation ; surgery ; Humans ; Humerus ; surgery ; Limb Salvage ; Male ; Middle Aged ; Neoplasm Staging

Abstract: To analyze the clinical, therapeutic and laboratory characteristics of disseminated cryptococcosis caused by Cryptococcus neoformans invading the blood stream in patient with liver cirrhosis and splenectomy. A 30-year-old male underwent splenectomy plus pericardial devascularization due to "splenomegaly and hypersplenism" in March in 2016. The patient had intermittent fever after operation for many times, and successively accompanied with back pain, left lower limb abscess and right hip pain. The highest body temperature was 39 ℃. CT and MRI revealed the lung lesion and multiple bone destruction. During that period, the effect of antibiotics was not good. On April 19th, 2017, Gram's stain, India ink stain, API 32C, Vitek 2 Compact, ribosomal ITS and IGS sequence analysis were performed to identify the strain isolated from the pus and blood stream. The serum of the patient was detected for cryptococcal antigen. Antifungal susceptibility test was used to determine drug sensitivity and minimum inhibitory concentration (MIC). The Cryptococcus neoformans isolated from fresh pus specimen showed a prominent, thick capsule after India ink stain. The colonies isolated from pus and blood stream were identified Cryptococcus neoformans using API 32C, Vitek 2 Compact, and sequence analysis of rDNA ITS and IGS. Cryptococcal capsule antigen was positive. The minimal inhibitory concentrations of 5-Flucytosine, amphotericin B, fluconazole, itriconazole, voriconazole against the isolate were <4 μg/mL, <0.5 μg/mL, 4 μg/mL, ≤0.25 μg/mL, 0.125 μg/mL respectively. The patient was initially treated with intravenous amphotericin B and flucytosine. After anti-Cryptococcus treatment for two months, the patient clinically improved, and the lesions were reduced on a follow-up CT scan. The patient made a full functional recovery after treatment for six months. Cryptococcosis has hidden onset, atypical clinical symptoms and lack of specificity. Blood stream is the main channel for Cryptococcus to spread and involve many organs of the whole body, including skin, bone and so on. Therefore, early use of blood culture to monitor blood flow dissemination, actively removing the primary focus and cutting off the infection route in time and carrying out effective anti-Cryptococcus treatment are conducive to the patient's early recovery.

OBJECTIVETo evaluate the safety and efficacy of staged hybrid approach in treating ventricular septal defect (VSD) patients combined with patent ductus arteriosus (PDA) and pulmonary artery hypertension (PAH).

METHODSFrom July 2004 to July 2009, 22 VSD patients with PDA and PAH were enrolled and received staged hybrid approach treatment (transcatheter PDA occlusion and elective open surgery for VSD several days after PDA occlusion). All patients were followed up to examine rhythm change, residual shunt, shape of occlude, possible valve regurgitation, and aortic stenosis by echocardiography.

RESULTSAfter transcatheter PDA occlusion, pulmonary arterial systolic pressure decreased from (76.2 ± 25.8) mm Hg (1 mm Hg = 0.133 kPa) to (55.4 ± 20.6) mm Hg (P = 0.005), mean pulmonary artery pressure decreased from (53.5 ± 23.5) mm Hg to (36.2 ± 17.8) mm Hg (P = 0.049), total pulmonary resistance decreased from (8.2 ± 4.9) wood units to (6.9 ± 4.3) wood units (P = 0.037), and pulmonary-to-systemic flow ratio (Qp/Qs) increased from 2.8 ± 2.3 to 3.4 ± 1.7 (P = 0.045) post transcatheter interventional PDA occlusion. After VSD repair, pulmonary arterial systolic pressure decreased from (64.5 ± 22.3) mm Hg to (43.1 ± 18.9) mm Hg (P = 0.001) and mean pulmonary artery pressure decreased from (40.2 ± 18.7) mm Hg to (29.5 ± 15.8) mm Hg (P = 0.040). There was no death or right heart failure during the follow-up.

CONCLUSIONStaged hybrid approach is an effective and safe strategy for treating VSD patients with PDA and PAH.

Adolescent ; Adult ; Cardiac Catheterization ; Cardiac Surgical Procedures ; Child ; Ductus Arteriosus, Patent ; complications ; surgery ; Female ; Heart Septal Defects, Ventricular ; complications ; surgery ; Humans ; Hypertension, Pulmonary ; complications ; surgery ; Male ; Young Adult

OBJECTIVETo investigate and compare therapeutic effects of sphincter-preserving operation and Miles operation for rectal cancer.

METHODSA retrospective analysis was carried out in 572 cases of rectal cancer operations performed from January 1980 to December 2006.

RESULTSSphincter-preserving operation was carried out in 403 cases and Miles procedure in 169 cases. The follow-up rate was 76.2% (436/572) with a period of 0.5 - 25.0 years (median, 9.5 years). Local recurrence occurred in 6.3% (20/317) of sphincter-preserving operation and 7.6% (9/119) of Miles operation, the differences was not significant (chi2 = 1.3942, P > 0.05). Distal metastasis was found in 50 cases (15.7%) of sphincter-preserving operation and 19 cases (16.2%) of the Miles operation with no significant difference (chi2 = 0.6672, P > 0.05). There was no significant difference in five-year survival rate between the two groups, with 67.8% in sphincter-preserving operation and 67.2% in Miles operation.

CONCLUSIONSSphincter-preserving operations can improve the quality of life in rectal cancer although with the same five-year survival rate and recurrence rate as Miles operation. The operation for rectal cancer should be performed individually according to the location, the bionomics and the clinical stage.

Adolescent ; Adult ; Aged ; Aged, 80 and over ; Anal Canal ; Female ; Follow-Up Studies ; Humans ; Kaplan-Meier Estimate ; Male ; Middle Aged ; Quality of Life ; Rectal Neoplasms ; mortality ; surgery ; Retrospective Studies ; Surgical Procedures, Operative ; methods ; Survival Rate ; Treatment Outcome

OBJECTIVETo investigate the clinical efficacy, feasibility and safety of sphincter-preserving procedure by casing anastomosis of colon and rectal mucosa in low rectal cancer.

METHODSA retrospective analysis was carried out in 231 cases of low rectal cancer performed casing anastomosis.

RESULTSOne hundred and ninety-seven (197/231, 85.3%) cases were followed up, the median time of the follow up was 5.9 years (range, 2 months-14 years). Eight (3.4%) cases of stoma leak and 3 (1.2%) cases of stoma stenosis were found post operation. Defecating function recovered normally (1 - 3 times per day) in 12 - 24 weeks after operation in all patients. Local recurrence was found in 5.1% (10/197) of the cases. Hepatic and lung metastasis was found in 15.2% (30/197) and 2.5% (5/197) of the patients, respectively. The five-year survival rate was 71.6% totally.

CONCLUSIONSThe casing anastomosis procedure with sphincter preservation is safe and efficacy for low rectal cancer. With the procedure, the anal function can be preserved well, stoma leak is decreased, and the five-year survival rate is the same as Miles operation.

Adult ; Aged ; Aged, 80 and over ; Anal Canal ; Anastomosis, Surgical ; methods ; Feasibility Studies ; Female ; Follow-Up Studies ; Humans ; Male ; Middle Aged ; Rectal Neoplasms ; surgery ; Retrospective Studies ; Treatment Outcome

Adult ; Aged ; Aged, 80 and over ; Diagnosis, Differential ; Humans ; Middle Aged ; Positron-Emission Tomography ; Retrospective Studies ; Solitary Pulmonary Nodule ; diagnosis ; Tomography, X-Ray Computed

OBJECTIVETo investigate the restoration of erectile function by reconstructing cavernous nerves (CN) with small intestinal submucosa (SIS) grafts.

METHODSWe prepared SIS grafts, established rat models and divided the models into a CN ablation, a sham-operation and an SIS graft group. The CNs at both sides were severed with 1 cm ablated in the first group, and 0.5 cm removed in the third, followed by reconstruction with the SIS grafts. Three months after surgery, the apomorphine test was performed to evaluate the erectile function, and then all the rats were sacrificed to detect the expression of nNOS in the penis.

RESULTSPenile erection was observed in 72.73% (8/11) of the rats for (1.07 +/- 0.89) times within 30 min in the SIS graft group, as compared with 0% (0/11) of the rats for (0.00 +/- 0.00) times in the CN ablation group (P < 0.01), and 90.91% (10/11) of the rats for (2.19 +/- 1.17) times in the sham-operation group (P < 0.01). The number of nNOS nerve fibers was significantly larger in the SIS graft than in the CN ablation group (70.36 +/- 10.09 versus 22.09 +/- 4.76, P < 0.01), but both were significantly smaller than that of the sham-operation group (90.81 +/- 5.69, P < 0.01).

CONCLUSIONThe SIS grafting technique contributes to the recanalization of the severed CN and restoration of erectile function in rats after surgical injury.

Animals ; Erectile Dysfunction ; surgery ; Intestinal Mucosa ; transplantation ; Intestine, Small ; Male ; Nerve Regeneration ; Nerve Tissue ; injuries ; surgery ; Penile Erection ; Penis ; innervation ; Rats ; Rats, Sprague-Dawley