Objective To improve the capability of diagnosing and treating renal chromophobe cell carcinoma (RCCC) and the recognition of this subtype of renal cell carcinoma (RCC). Methods The clinical data of 15 cases of RCCC (10 men and 5 women) were analyzed.Their age ranged from 47 to 74 years,with a mean of 57 years. Radical nephrectomy was performed in all these cases. Results Postoperative pathological findings confirmed the diagnosis of RCCC.The pathologic TNM stage of RCCC was as follows:pT 1N 0M 0 in 6 cases,pT 2N 0M 0 in 5,pT 3bN 0M 0 in 2,pT 1N 2M 0 in 1 and pT 2N 2M 0 in 1.The pathologic grade of RCCC was G 2 in 10 cases and G 3 in 5.Eleven cases were followed up.During the follow-up of 2 to 31 months (mean, 19 months),1 died of heart attack,1 had local recurrence and 9 were surviving tumor free. Conclusions RCCC is a morphologically distinctive uncommon subtype of RCC.Radical nephrectomy is the first choice for the treatment of RCCC.Compared with other types of RCC at the same stage and of the same grade,RCCC has a better prognosis.

Objective To introduce and evaluate the procedure of suprapubic tensionless Sparc TM sling system in treating female stress urinary incontinence (SUI). Methods A total of 42 patients (mean age,54 years) diagnosed with SUI (a mean course of 12 years) were treated by Sparc TM sling method.Of them 4 cases had detrusor instability.Under local anesthesia,this procedure took about a mean of 20 min.The urinary catheters were removed the next morning after the procedure.The patients were counseled on abstaining from heavy lifting,exercises and intercourse for 4 weeks. Results After removal of catheters,all the 42 patients successfully voided without incontinence.Detrusor instability to various degrees developed in 7 patients and was relieved by expectant treatment.All the patients were followed up for 3 to 12 months (mean,6 months).Neither recurrence of SUI nor lower urinary tract obstruction was found.No implant related complications such as local irritation,extrusion,erosion through the urethra,migration from the desired location,fistula formation and inflammation occurred. Conclusions Sparc TM sling system is a simple,safe and efficacious method of treating SUI under local anesthesia.

Thoracic vascular ultrasound was used to evaluate left internal mammary artery to left anterior descending artery (LAD) bypass (LIMA) blood flow pattern in CABG patients. A transthoracic vascular transducer (5～10 MHz) was placed in the second rib space left to the sternum. Doppler spectrum was obtained under 2 D color Doppler image guide. Systolic and diastolic flow was analysed as systolic peak velocity (SPV), systolic velocity time integrate (SVTI), diastolic peak velocity (DPV) and diastolic velocity time integrate (DVTI). Successful examination was done in 106 patients ( 106/110, 94% ) , In patients with patent LIMA, Doppler spectrum showed a notable diastolic flow spectrum. The results of this study suggested that trans thoracic echocardiographic examination could provide avaluable blood flow information. A notable diastolic flow spectrum can be taken as a sign of satisfactory LIMA coronary diastolic myocardium perfusion.

Objective To measure Tei index in patients with idiopathic or ischemia dilated cardiomyopathy, and to evaluate its correlation with other conventional indexes of echocardiography of left ventricular(LV) function,and its applicability in assessing cardiopulmonary exercise capacity in those patients.Methods Seventy consecutive patients (53?14 years) with heart failure(New York Heart Association [NYHA] class, Ⅱ to IV) who had received echocardiographic diagnosis, and believed to be suffering from dilated or ischemia cardiomyopathy were studied. Echocardiography were performed; LV volume as well as ejection fraction were measured from the apical view of the two-dimensional echocardiogram using a modified Simpson’s rule algorithm in all patients. The following variables: peak early transmitral filling velocity (E), late transmitral filling velocity (A), their ratio (E/A), the deceleration time of E (DT), and Tei index were measured by spectral Doppler echocardiography. Furthermore, all patients underwent a cardiopulmonary exercise using 6min walk test. Results Advanced NYHA class was associated with higher Tei index values. A positive correlation was found between Tei index and early /late filling velocity ratio, while a negative correlation was found between Tei index and A wave, E wave, DT, and LV EF. Tei index showed no correlation with heart rate, blood pressure or age. Compared with the parameters of left ventricular function Tei index had a closer relation to the distance of 6min walk. Stepwise regression analysis revealed that the Tei index and the late LV filling velocity were the only independent predictors for cardiopulmonary exercise capacity.Conclusion Tei index correlates inversely with LV performance and reflects disease severity, which is a useful complimentary variable in the assessment of cardiopulmonary exercise performance in patients with heart failure.

Objective To study the value of leptin,adiponeetin and interleukin (IL-1,IL-6,IL-8) in diagnosis,treatment,and prognosis of cerebral infarction.Method The levels of serum leptin ,adiponectin and IL-1,IL-6,IL-8 in acute cerebral infarction before and after treatment were determined with ELISA as well as in the healthy controls.The relationship between these indices and nerve function injury was studied.Results The levels of serum leptin and IL-1,IL-6,IL-8 in the patients increased significantly,but the controls didn't (P

Objective To characterize the systolic torsion in dilated cardiomyopathy (DCM) by velocity vector imaging(VVI).Methods Eighty-seven subjects were studied using VVI:27 patients with DCM and 60 healthy control subjects.Left ventricular short-axis acoustic images were acquired at base and apex levels.The rotation angle and rotation velocity of endocardium and epicardium were measured.Results LVEF of DCM group was significantly lower than that of control group ( P＜0.01).The basal and apical rotation angle, rotation velocity were significantly lower in DCM group.The endocardial and epicardial rotation angle, rotation velocity were also significantly lower in DCM group than those in control group (P＜0.01).Conclusions VVI is a rapid and noninvasive tool to quantitatively assess cardiac torsional deformation in DCM patients,which providing another useful modality for evaluating cardiac function.

Objective To investigate strain and strain rate of right ventricular(RV)based on twodimensional image by velocity vector imaging in normal subjects.Methods Thirty-two healthy adults were rolled in this study.Echocardiographic images in 4 chamber view were analyzed by conventional manual tracing for volumes and ejection fractions,which were also measured by velocity vector imaging.Myocardial velocity,strain rate,and strain were determined at the basal,mid,and apical segments of the RV free wall and ventricular septum by velocity vector imaging.Results RV ejection fractions obtained with manual tracing correlated strongly with the same indexes obtained by velocity vector imaging method in all subjects(r=0.91,P＜0.01).The strain and strain rate value of middle segment and basal segment in RV free wall were higher than those of apical segment.There were same trend in ventricular septal.The strain and strain rate of middle segment and basal segment in RV free wall were higher than those of homologous segments in ventricular septal,but the indexes of apical segment in free wail and septal had no difference.The strain and strain rate in RV were not correlated with age.Conclusions Velocity vector imaging could accurately and quantitatively assess the strain and strain rate of RV.

Objective To study the diagnosis and treatment of retroperitoneal schwannoma.Methods Clinical data of 11 cases of primary retroperitoneal schwannomas were analyzed retrospectively from February 1990 to September 2014.There were 6 males and 5 females,with a median age of 46 years,and the median tumor size was 9.6 cm (4.5-12.3 cm).Seven cases were revealled due to physical examination,3 cases were revealled due to ipsilateral lower back pain or discomfort,and 1 case was revealled due to right lower extremity numbness.There were no clinical manifestations of hypertension or appearance shape change,and there were no abnormal findings in routine laboratory and endocrine examinations.Radiological examination showed a retroperitoneal mass.There were 3 cases in the left adrenal gland,1 case in the right adrenal gland,3 cases in the lower pole of left kidney and 4 cases in the lower pole of right kidney.Four patients were initially diagnosed as adrenal tumors,and 7 patients were diagnosed as kidney tumors.Results All the 11 cases underwent surgical resection,with 7 cases of complete resection,1 case of capsule resection,2 cases of partial resection and 1 case of biopsy.The pathology of immunohistochemical staining showed S-100 positive in 10 cases of benign retroperitoneal schwannomas.During the follow-up period for 1.5-24 years (median 14 years),no recurrence and malignance was observed.One case of malignant retroperitoneal schwannoma died of multiple metastases in 17 months after opreation.Conclusions Primary retroperitoneal schwannoma is rare and preoperative diagnosis is difficult.Clinical manifestations and radiological findings are usually nondiagnostic,and histopathology is the only way for final diagnosis.Complete surgical resection is proved to be the best choice.

Objective To evaluate the efficiency and safety of transurethral plasmakinetic enucleation of prostate(PKEP) in the treatment of patients with benign prostate hyperplasia(BPH) after transrectal prostate biopsy(TRPB).Methods A total of 88 BPH patients who underwent PKEP in our hospital during Jan.2012 to May 2015 were retrospectively analyzed and followedup.38 patients underwent TRPB before PKEP were defined as TRPB group,and 50 patients underwent PKEP with no TRPB were defined as control group.The baseline data,perioperative data and postoperative follow-up outcomes were recorded and compared between the two groups.Results The mean age of the 88 patients were 69.7 years.Compared with control group,TRPB group showed that age was younger(t=2.62,P＜ 0.05)and prostate specific antigen(PSA) level was higher(t=13.64,P＜0.01).Operation duration was longer in TRPB group than in control group (93.6 ± 31.0) min vs.(77.9 ± 17.3) min (t =2.6 4,P ＜ 0.05).There were no significant differences in the preoperative data,blood loss,continuous bladder irrigation duration after operation and period of catheterization between two groups (all P ＞ 0.05).Trans-operative time was significantly shortened when the time interval between TRPB and PKEP is more than 4 weeks(P＜ 0.01),while blood loss was similar in the two groups(P＞ 0.0 5).There were no adverse events of blood transfusion,transurethral resection syndrome and injury of bladder or rectal in both two groups.There were no significant differences in maximum flow rate(Qmax),international prostate symptom score(IPSS) or quality of life(QOL) scores between the two groups at 3,6 and 12 months of follow up(all P＞ 0.05).Conclusions PKEP after TRPB is a safe and effective treatment for BPH patient.When the time interval between TRPB and PKEP is more than 4 weeks,the performing of PKEP operation would reduce the difficulty of operative procedure and increase the safety.

OBJECTIVETo investigate the applications of percutaneous screw fixation for the treatment of pelvic fractures and its related surgical considerations.

METHODSFrom June 2010 to June 2012,19 patients with pelvic fractures were treated with percutaneous hollow screws. There were 13 males and 6 females, with an average age of 41 years (ranged from 22 to 58 years). Fractures were caused by traffic accidents in 11 cases, by falling down from high place in 8 cases. Based on the Tile classification, there were 15 cases of Tile C type and 4 case of Tile B type. The indexes such as screw inserting time, intraoperative blood loss, complications, functional recovery and reduction conditions were observed. Fixation methods included sacroiliac screws, cannulated screw fixation of the pubic ramus and cannulated screw fixation of the pubic symphysis separation.

RESULTSAnatomical reduction achieved in 7 cases, satisfactory reduction 11 cases, and unsatisfactory reduction 1 case. Union time of fracture union ranged from 8 to 12 weeks (mean 10 weeks). Wound infection,ununion of fracture and nerve injuries were not found. According to the Majeed standards, 12 patients obtained an excellent results, 6 good and 1 fair.

CONCLUSIONPercutaneous screw fixation for the treatment of pelvic fractures under fluoroscopy has several advantages such as less trauma, less blood loss, fewer rates of complications, reliable fixation and no blood transfusion, which can reconstruct the stability of the pelvic ring, but it needs adequate preoperative preparation and high requirements for the surgeon.

Adult ; Bone Screws ; Female ; Fracture Fixation, Internal ; Fractures, Bone ; diagnostic imaging ; surgery ; Humans ; Male ; Middle Aged ; Pelvic Bones ; diagnostic imaging ; injuries ; surgery ; Radiography ; Young Adult