Percutaneous microwave coagulation therapy for patients with primary and metastatic hepatic tumors during interruption of hepatic blood flow

BACKGROUND: Although percutaneous microwave coagulation is relatively noninvasive therapy for patients with hepatic tumors, coagulation of tumors is sometimes incomplete and local recurrence occurs. The authors hypothesized that the cause of incomplete coagulation was a cooling effect in surrounding hepatic blood flow. To prove this hypothesis and to improve the efficacy of this therapy, they interrupted hepatic blood flow during the treatment and measured the amount of tumor tissue coagulated by microwave. METHODS: The authors first performed an animal experiment on pigs. After laparotomy, the liver of an anesthetized pig was coagulated by microwave with or without interruption of hepatic blood flow; the interruption was achieved by squeezing hepatic blood vessels. Next, the authors applied the microwave coagulation percutaneously to 25 human patients with primary or metastatic carcinoma in the liver with or without intraoperative temporary interruption of hepatic blood flow; the interruption was achieved by inflating balloon catheters inserted in the hepatic blood vessels through femoral vessels. RESULTS: The greatest dimension of area of normal liver tissue coagulated by microwave with blood flow interruption was significantly (P < 0.001) larger (18.8 +/- 1.0 mm, n = 4) than without it (9.8 +/- 1.7 mm, n = 4) in the experiment with pigs. In human hepatic tumors, the greatest dimension of the area coagulated by microwave with blood flow interruption was also significantly (P < 0.001) larger (41.1 +/- 9.3 mm, n = 14) than without it (26.9 +/- 8.5 mm, n = 11). The local recurrence rate of the tumor during a period of 6 months after the treatment was lower (P < 0.05) with blood flow interruption (7%) than without it (45%). CONCLUSIONS: Intraoperative interruption of hepatic blood flow increases the areas of primary and metastatic hepatic tumors coagulated by microwave. It is expected to increase the efficacy of percutaneous microwave coagulation therapy for patients with hepatic tumors.     

Nephron-sparing surgery of a low grade renal cell carcinoma in a renal allograft 12 years after transplantation

Renal cell carcinoma (RCC) occurring in renal allografts after cadaveric kidney transplantation has rarely been observed. RCC accounts for 2.3% of all malignancies in the general population, but up to 4.8% of malignancies in renal transplant recipients. Most have been reported in the patient's own diseased kidneys, whereas RCC in the renal allograft occur in only 10%. Here, we describe an organ-preserving surgical technique of a malignant renal tumor in a kidney allograft using a harmonic scalpel (Ultracision) for tumor enucleation. Furthermore we demonstrate by DNA microsatellite analysis the tumor's genetic origin as donor related. Collectively, we suggest that patients with a well defined low grade RCC in the kidney allograft and altogether low malignancy and good allograft function should only undergo an organ-preserving procedure and short-term postoperative screening.     

Serum ferritin in renal cell carcinoma: effect of tumor size, volume grade, and stage

AIM: To study the levels of serum ferritin in patients of renal cell carcinoma (RCC). PATIENTS AND METHODS: Serum ferritin levels were measured preoperatively in 32 patients with radiological evidence of RCC using an enzyme immunoassay. The largest diameter of the primary tumor was measured in the pathological specimens in patients undergoing radical nephrectomy while in patients with non-operable tumor maximum tumor dimension was taken from CT scan. Pathological staging was done according TNM-1997. RESULTS: Mean serum ferritin value in patients of RCC was 283.23+/-77.38 ng/ml while in controls the mean value was 79.98+/-32.96 ng/ml (P CONCLUSIONS: Serum ferritin levels are elevated in patients with RCC although its actual source is unclear. Further studies are needed to establish the role of ferritin in RCC.     

Comparative analysis of modern combined methods in diagnosis of renal cell carcinoma

To ascertain the role of multispiral computed tomography (MSCT) in diagnosis of renal cell carcinoma (RCC) and to propose optimal diagnostic policy in RCC patients, we examined 63 patients with suspected renal tumor: 37 (59%) males and 26 (41%) females, age 47-77 ages, mean age 54.2+/-1.5 years, duration of the disease from 1 month to 7 years. The following diagnostic methods were imployed: ultrasonography of the kidneys, plain and excretory urography, spiral computed tomography, angiography, MSCT, MRT, thin-needle aspiration biopsy. By the results of a combined examination and operation on the kidney lesion, the diagnosis of RCC was made in 45 (80.3%) patients including stage I in 21 (46.7%), stage II in 9 (20%), stage III in 13 (28.9%), stage IV in 2 (4.5%) patients. Benign renal tumors were detected in 8 (14.2%) patients, giant cysts of the kidneys--in 5 cases, benign renal tumors--in 3 cases, adenoma--in 2 cases, angiomyolipoma--in 1 case. Detected were also renal malformations in 3 cases, a distant retroperitoneal metastasis of RCC in 1 case, adrenal tumors in 6 (9.5%) cases. We suppose that MSCT enables multiplanar and 3-dimentional reconstruction of the images, staging of RCC, planning of surgical treatment. MSCT should be conducted after standard ultrasound examination.     

Increased serum levels of vascular endothelial growth factor in patients with renal cell carcinoma.

Neovascularization, an essential event for the growth of solid tumors, is regulated by a number of angiogenic factors. One such factor, vascular endothelial growth factor (VEGF), is considered to exert a potent angiogenic activity, as indicated by immunohistochemical and molecular evidence. In this study we investigated the serum VEGF level (s-VEGF) in patients with renal cell carcinoma (RCC). s-VEGF in peripheral blood samples was analyzed in 40 RCC patients and 40 patients without cancer (controls) using a sandwich enzyme-linked immunoassay. In 20 RCC patients, serum samples were obtained separately from the bilateral renal veins. s-VEGF was also measured before, 4 and 8 weeks after nephrectomy in 11 patients. There were significant differences in s-VEGF between the RCC patients and the controls (207.3+/-32.9 vs. 71.5+/-9.1 pg/ml, mean+/-SE) (P<0.005), between the tumor-bearing renal veins and the contralateral ones (P<0.01), between the pre- and post-nephrectomy situations (P<0.01) and among the various parameters of tumor status such as tumor extent (P<0.001) and existence of metastasis (P<0.001). s-VEGF significantly correlated with the tumor volume obtained by a three-dimensional measurement (r=0.802, P<0.0001). The sensitivity and specificity of s-VEGF at the cut-off level of 100 pg/ml, as determined by the receiver-operating-characteristics curve, were 80.0% and 72.5%, respectively. The results indicate that tumor tissue of RCC liberates VEGF into the systemic blood flow and that s-VEGF is a possible marker for RCC.     

Short Term Clinical Outcome after Laparoscopic Cryoablation of the Renal Tumor < or = 3.5 cm

Between September 2000 and September 2006, 26 patients underwent primary laparoscopic cryosurgical procedures (28) for an organ-confined renal tumor(s). In one case, cryosurgery was done sequentially on both kidneys. All patients had been carefully selected based on the following criteria: tumor size < or = 3.5 cm, the absence of local and systemic spread on cross-sectional computed tomography (CT) or magnetic resonance imaging (MRI), and the ability to tolerate general anesthesia. A pure laparoscopic approach was employed using third generation cryotechnology (Galil Medical Inc., Plymouth Meeting, USA). Patients were followed by serial CT or MRI scan, creatinine level, and physical examination at least every six months after cryotherapy. The mean patient age was 64 years (range: 44-79) and the mean follow-up was 20.9 +/- 17.2 months. The median tumor size was 2.0 cm (range: 1-3.5 cm). Only one patient required a blood transfusion and one patient developed a transient ileus. The median length of stay was 2.0 days (range: 0-9 days). The median change in creatinine was 0.1 mg/dl (range:-0.4 to 1.8). No patient was converted to open surgery. No evidence of recurrence or progression was found in all patients, and overall survival rate was 100%. Laparoscopic renal cryoablation of the small renal tumor is a safe procedure with minimal complications. Although there were no recurrences with short term follow-up, further long term study is needed to verify its efficacy.     

腹腔镜下肾脏部分切除术（附58 例报告）

目的:探讨腹腔镜下肾脏部分切除术的临床疗效。方法:肾肿瘤患者58例,包括肾癌43例,血管平滑肌脂肪瘤14例,肾素瘤1 例。瘤体直径1~6cm,平均2.5 ± 1.5cm,均采用后腹腔镜下肾肿瘤剜除术。手术过程:分离暴露肾动脉和瘤体,血管阻断夹阻断肾动脉,距离瘤体1cm用超声刀剜除完整瘤体,1-0 可吸收线间断缝合创面,解除血管阻断,观察出血情况,对出血点予以缝合止血,取出肿瘤,完成手术。结果:3 例因瘤体较大,或多支动脉仅夹闭1 支而出血较多中转开放。手术时间65~200min,平均95± 43min;术中出血20~1 500mL,平均140 ± 60mL。血管阻断时间最初10例30～45min,后48例仅为8～28min;肠道功能12~36h恢复,绝对卧床3～5d 后下床活动,术后住院7～10d。随访6~48个月。术后肾图显示患侧肾脏血流良好,功能无明显异常;1 例切口种植转移,1 例肾门淋巴结转移,2 例因术后病理报告切缘阳性而再次开放手术行根治性切除。结论:后腹腔镜下保留肾单位的肾肿瘤切除术除具有创伤小,康复快等优点外,还可以有效保留肾脏功能,适合于处理外生性生长、直径<4cm的恶性肿瘤或者稍大良性肿瘤。手术对术者腔镜下缝合打结技巧要求较高,血管控制时间一般不超过30min,需要有一定经验的医师操作。      

Direct amifostine effect on renal tubule cells in rats.

Clinical trials indicate that amifostine offers protection against cisplatin-induced nephrotoxicity. It is unclear whether a direct pharmacological t on renal tubular cells is involved. We investigated the effect of amifostine pretreatment on the tubular apparatus and evaluated its nephroprotective potential. A total of 32 rats were treated by i.p. administration of 0.9% saline solution (group 1), 5 mg/kg cisplatin (group 2), 25 mg/kg amifostine (group 3), and 25 mg/kg amifostine followed by 5 mg/kg cisplatin (group 4) after 30 min. We recorded elevation of N-acetyl-beta-D-glucosaminidase (NAG) in 24 h pooled urine as a specific marker for tubular lesions, renal leakage of magnesium as an unspecific nephrotoxicity marker, and survival over a 10-day observation period. A significant (P < 0.002) increase in urinary NAG after treatment was documented only in cisplatin-treated group 2 [day 2 (mean+/-SE), 93+/-2.1 units/gram creatinine; day 4, 70.6+/-16 units/gram creatinine; normalization at day 8]. Treatment with amifostine before cisplatin administration resulted in a slight urinary NAG leakage (day 2, 2.8+/-1.8 units/gram creatinine; day 4, 13.8+/-13 units/gram creatinine; normalization at day 6). No increase in urinary enzyme levels was seen in the other groups, and there were no significant differences in urinary magnesium between all groups. Four of eight rats in the cisplatin-treated group and one of eight rats in the amifostine plus cisplatin-treated group died.     

Comparison of microwave coagulation using a new type electrode with radiofrequency ablation in the liver of living animals]

In the present study, we compared microwave coagulation using a new type of electrode, a teflon-coated electrode that was developed in order to increase the area of coagulation, with radiofrequency ablation using a Radionics Cool-tip electrode inserted into the pig liver. Two Landrace male pig were put under general anesthesia. A microwave electrode (insulated area: 6 mm, teflon-coated electrode 16 G) and a radiofreqency (RF) electrode (Cool-tip RF single electrode 17 G) were passed through the surface of the livers of the pig. A thermometer was placed 1 cm from the tip of the electrode in order to measure the changes in the temperature of the area surrounding the electrode. In this study, the microwave setting was 80 W, and the RF pulse was set automatically. The coagulated and ablated areas of the liver were measured after 2.5, 5, and 10 minutes of energy delivery (n = 4). The diameter of the coagulated area of the liver following 2.5, 5 and 10 minutes of microwave exposure was 23.5 +/- 4.8 mm, 29.5 +/- 5.2 mm and 32.5 +/- 6.4 mm, respectively. On the other hand, the diameter of the ablated area of the liver following 2.5, 5 and 10 minutes of RF exposure was 18.5 +/- 4.1 mm, 24 +/- 7.8 mm and 28 +/- 4.9 mm, respectively. The mean temperature of the liver 1 cm from the microwave and RF electrodes (measured time: 2 minutes) was 69.6 degrees C and 56.3 degrees C. respectively (n = 12). Thus, the temperature of the area surrounding the microwave electrode was significantly higher than the temperature of the area surrounding the RF electrode (p = 0.0065). The teflon-coated microwave electrode achieved superior results to the Radionics Cool-tip electrode with respect to the diameter of the coagulated area and the temperature of the area in which the electrode was inserted, at the specified times.     

多层螺旋CT灌注成像在肾肿瘤中的应用及与分子病理学的相关性

[目的]探讨多层螺旋CT（MSCT）灌注成像在肾肿瘤诊断中的价值。[方法]59例肾肿瘤行MSCT灌注扫描．应用perfusion2软件包计算血流量（BF）、血容量（BV）、表面通透性fPS）及平均通过时间（MTT）．同时检测肾肿瘤及肿瘤旁正常组织中血管内皮生长因子（VEGF）的表达及微血管密度（MVD）,[结果]59例肾肿瘤术后病理证实为。肾癌48例,肾盂癌6例,肾血管平滑肌脂肪瘤5例。在不同级别的肾细胞癌中．其灌注参数BF、BV和PS均明显低于正常肾皮质（P〈0．01）,且高级别的肾癌灌注参数BF、BV和PS均明显高于低级别的肾癌（P〈0．01）。肾血管平滑肌脂肪瘤和肾盂癌的灌注值均明显低于肾癌,有显著性差异（P〈0．01）。肾癌的BF、BV、PS值与肿瘤的VEGF表达呈显著正相关（P〈0．01）,MTT、值与VEGF表达呈显著负相关（P〈0．01）。[结论]MSCT灌注成像能定量评价肿瘤血管生成,血管灌注及血管通透性改变,有助于肾细胞癌的术前分级．并在肾肿瘤的鉴别诊断方面具有一定的临床应用价值。     

微波固化治疗在口腔癌中的临床应用--附96例临床总结

背景与目的：微波固化治疗口底癌在保护口腔功能方面的研究较少。本研究旨在探讨微波固化治疗过程中的两种特殊处理方式的意义及出血的预防。方法：回顾性分析经微波固化治疗的96例口腔癌病例,比较清除的固化组织病理学检查阴性组和阳性组生存曲线和复发率,比较手术切缘组织病理学阴性组和阳性组的生存曲线和复发率,分析微波固化的并发症及其防治。结果：固化组织病理学检查阴性组和阳性组生存曲线的差异无统计学意义（Log-rank=0.70,P=0.4033）,原发灶、继发灶和复发灶不明者复发率的差异也无统计学意义（X^2=1.650,0.837,0.003;P=0.684,0.360,0.959）;手术切缘组织病理学阴性组的总体生存时间高于阳性组（Log-rank=6.08,P=0.0136）,但复发率的差异则无统计学意义（X^2=0.327,P=0.567）;96例患者的总体并发症发生率为9.6％,都是可以接受的,微波固化组织清除组的出血发生率较微波固化组织未清除组的低（P=0.013）。结论：舌动脉结扎、固化组织清除、创缘缝扎碘仿纱压迫是防止术后出血的有效方法,但微波固化组织的病理学检查结果对预后没有预测作用。术中宜确保足够的固化治疗范围。微波固化治疗口癌时并发症少且较轻微。     

Enzymuria following amphotericin B application in the rat

The effect of amphotericin B application on urinary renal tubule enzyme excretion was investigated in rats treated with amphotericin B (1.5 mg kg-1 b.i.d., i.v.) for 4 days. Application of amphotericin B induced a significant higher daily urinary enzyme activity of the renal tubular enzymes N-acetyl-beta-glucosaminidase (NAG), beta-glucuronidase (GRS), alanine-aminopeptidase (AAP) and gamma-glutamyltransferase (GGT) in comparison with controls and sodium deoxycholate treated animals as well. A significant increase in the renal excretion of NAG, GRS, AAP and GGT occurred after the first day of amphotericin B treatment and continued until the fourth day. Following treatment for 4 days with amphotericin B urine AAP activity amounted to 69 +/- 19 U g-1 creatinine, control: 39 +/- 7 U g-1 creatinine (P < 0.05). After 4 days GGT excretion increased to 803 +/- 238 U g-1 creatinine, control: 445 +/- 106 U g-1 creatinine (P < 0.05). At the fourth day NAG excretion was 80 +/- 39 U g-1 creatinine, control: 23 +/- 5 U g-1 creatinine (P < 0.05) and GRS 724 +/- 604 U g-1 creatinine (amphotericin B), control: 276 +/- 158 U g-1 creatinine (P < 0.05). Treatment with amphotericin B decreased the creatinine clearance significantly: 0.94 +/- 0.16 ml-1 min-1 vs. control 1.35 +/- 0.29 ml-1min-1 (P < 0.05). Fractional sodium and potassium excretion was not influenced by amphotericin B. The application of sodium deoxycholate had no influence on urinary renal tubular enzyme activity. The results show that amphotericin B application induces early enzymuria of renal tubule enzymes suggesting damage of proximal renal tubules.     

Effect of flueytosine on renal function in the rat

Flucytosine (5-fluorocytosine), a potent antimycotic drug against various systemic infections such as candidosis, aspergillosis and cryptococcosis, is extensively excreted by the kidneys, yet its possible role in renal function is not known. In the present study flucytosine, administered intravenously, increased significantly renal blood flow (RBF) by 26% from 5.06 +/- 0.9 ml/min/kidney. The renal vasodilation was combined with an elevation of creatinine clearance of 140% from a baseline value of 0.23 +/- 0.11 ml/min/kidney. This improvement in renal function was accompanied by an increase in filtration fraction, urine volume and potassium excretion. In comparison, rats administered an equal amount of 5% glucose only showed no changes in the values of these parameters.     

微波组织凝固对荷瘤小鼠肿瘤浸润淋巴细胞影响

[目的]探讨微波组织凝固肝癌的免疫效应.[方法]采用昆明小鼠一侧腋窝下接种Hepa瘤细胞建立小鼠肝癌模型,将30只荷瘤小鼠随机分2组:微波组织凝固组和对照组,微波组织凝固后第3、7、14d,应用免疫组织化学和图像分析技术定量观察癌旁组织的CD 4和CD 8细胞浸润密度.[结果]微波组织凝固后第3、7、14d后,微波组织凝固组癌旁组织内CD4 和CD 8细胞数量明显高于对照组.[结论]微波组织凝固小鼠移植性肝癌可促进固化灶周围组织的细胞免疫反应.     

Change in anatomo-functional state of the parenchyma in early unilateral renal cell carcinoma before and after surgical treatment

The aim of the trial was to study compensatory potential of renal parenchyma in the presence of renal cell carcinoma (RCC) and after organ-saving and radical surgical treatment as shown by one-photon emission computed tomography (OPECT). OPECT before the treatment and 6 and 12 months after it evidences that in unilateral RCC, irrespective of the focus location, both kidneys as a single organ respond to tumor growth with compensatory hypertrophy. Compensatory reserve is limited. In tumor size more than 6 cm the affected kidney starts losing the volume of the functional tissue while infiltrative growth is most likely. Assessment of the compensatory potential of the kidneys provides additional information. If the volumes of the kidneys differ by more than 30%, RCC growth is infiltrative. In this case only radical nephrectomy is recommended. If the size of the kidneys is by 60% more than normal one and parenchymas of the affected and contralateral kidney reach their compensatory limit but are equal, indications to organ-saving surgery extend as greater hypertrophy of the remaining kidney is excluded. After organ-saving surgery, a compensatory increase was observed in the contralateral kidney. This is explained by effective distribution of protein material and separate processes of proliferation (healing) and hypertrophy (compensation). Assessment of anatomo-functional condition of renal parenchyma helps better selection of patients for organ-saving surgery.     

抑癌基因PTEN/MMAC1/TEP1在肾癌组织中的表达及其与细胞增殖和凋亡的关系

背景与目的:PTEN/MMAC1/TEP1是近来新发现的具有磷酸酯酶活性的抑癌基因,有研究证实PTEN在人类多种肿瘤中存在丢失或突变,与肿瘤的发生、发展密切相关,但在肾癌中研究较少。本研究拟探讨肾细胞癌(renalcellcarcinoma,RCC)中抑癌基因PTEN的蛋白表达及其与肾癌生物学行为的关系。方法:收集44例手术后并经病理学检查证实的RCC组织、15例癌旁非癌肾组织及10例非瘤正常肾组织,采用免疫组化SP法进行PTEN蛋白检测,按PTEN蛋白阴、阳性各选15例RCC组织和10例正常肾组织,用流式细胞仪检测细胞的增殖指数和凋亡率,从而分析PTEN蛋白与肾细胞增殖和凋亡的关系。结果:PTEN蛋白在肾组织中表达主要位于胞浆,RCC组织中PTEN阳性表达率为36.36%,显著低于癌旁非癌肾组织(73.33%)及正常肾组织(100%)(P<0.01),在不同组织类型中无统计学差异(P>0.05)。PTEN蛋白在Ⅰ、Ⅱ期RCC组织中表达显著高于Ⅲ、Ⅳ期RCC组织(P<0.05),PTEN蛋白阳性RCC细胞的增殖指数为(5.6±0.8)%,显著低于PTEN蛋白阴性者的(15.6±1.6)%(P<0.01),而PTEN蛋白阳性者的细胞凋亡率为(6.5±1.9)%,显著高于PTEN蛋白阴性者的(2.8±1.6)%(P<0.01)。结论:PTEN蛋白在RCC组织中的阳性表达明显下降,其抑癌作用机制可能是诱导细胞周期阻滞在G1期和增加细胞凋亡率,提示检测PT     

Investigation of the thermal and tissue injury behaviour in microwave thermal therapy using a porcine kidney model.

Minimally invasive microwave thermal therapies are being developed for the treatment of small renal cell carcinomas (RCC, d<3 cm). This study assessed the thermal history and corresponding tissue injury patterns resulting from microwave treatment of the porcine renal cortex. Three groups of kidneys were evaluated: (1) in vitro treated, (2) in vivo with 2-h post-treatment perfusion (acute) and (3) in vivo with 7-day post-treatment perfusion (chronic). The kidneys were treated with an interstitial water-cooled microwave probe (Urologix, Plymouth, MN) that created a lesion centered in the renal cortex (50 W for 10 min). The thermal histories were recorded at 0.5 cm radial intervals from the probe axis for correlation with the histologic cellular and vascular injury. The kidneys showed a reproducible 2 cm chronic lesion with distinct histologic injury zones identified. The thermal histories at the edge of these zones were found using Lagrangian interpolation. The threshold thermal histories for microvascular injury and stasis appeared to be lower than that for renal epithelial cell injury. The Arrhenius kinetic injury models were fit to the thermal histories and injury data to determine the kinetic parameters (i.e. activation energy and frequency factor) for the thermal injury processes. The resultant activation energies are consistent in magnitude with those for thermally induced protein denaturation. A 3-D finite element thermal model based on the Pennes bioheat equation was developed and solved using ANSYS (V7.0). The real geometry of the kidneys studied and temperature dependent thermal properties were used in this model. The specific absorption rate (SAR) of the microwave probe required for the thermal modelling was experimentally determined. The results from the thermal modelling suggest that the complicated change of local renal blood perfusion with temperature and time during microwave thermal therapy can be predicted, although a first order kinetic model may be insufficient to capture blood flow changes. The local blood perfusion was found to be a complicated function of temperature and time. A non-linear model based on the degree of vascular stasis was introduced to predict the blood perfusion. In conclusion, interstitial microwave thermal therapy in the normal porcine kidney results in predictable thermal and tissue injury behaviour. Future work in human kidney tissue will be necessary to confirm the clinical significance of these results.     

Perfusion-CT monitoring of cryo-ablated renal cells tumors

Background

No single and thoroughly validated imaging method in monitoring of cryoablated renal cell carcinoma (RCC) is available. The purpose of our study was to determine the feasibility of dynamic contrast-enhanced perfusion CT (pCT) in evaluating the hemodynamic response of RCC.

Methods

15 patients (14 male, 1 female; age range, 43-81 years; mean age, 62 years) with cryoablated RCC via a transperitoneal approach, underwent to pCT 6-8 months after cryo-therapy. pCT was performed for 65 seconds after intravenous injection of contrast medium (80 mL, 370 mg iodine per millilitre, 4 mL/sec). Perfusion parameters (Time/Density curve; Blood flow, BF; Blood Volume, BV; Mean Transit Time, MTT; Permeability-Surface Area Product, PS) were sampled in the cryoablated tumor area and in ipsilateral renal cortex using deconvolution-based method. A tumor was considered to be not responsive to treatment by CT evidence of pathological contrast enhancement in the cryoablated area or renal mass persistence compared with the preoperative CT control. Written informed consent was obtained from all participants before the study.

Results

After cryotherapy, successfully ablated tumor (n = 13) showed decrease in BV (5,39 +/- 1,28 mL/100 g), BF (69,92 +/- 20,12 mL/100 g/min) and PS (16,66 +/- 5,67 mL/100 g/min) value and increased value of MTT (25,35 +/- 4,3 sec) compared with those of normal renal cortex (BV: 117,86 +/- 31,87 mL/100 g/min; BF: 392,39 +/- 117,32 mL/100 g/min; MTT: 18,02 +/- 3,6 sec; PS: 81,68 +/- 22,75 mL/100 g/min). In one patient, assessment of perfusion parameters was not feasible for breathing artifacts. One tumor showed poor response to treatment by the evidence of nodular contrast enhancement in the region encompassing the original lesion. Two typical enhancement patterns were obtained comparing the Time-Density curves of responsive and not responsive ablated tumors.

Conclusion

Perfusion CT seems to be a feasible and promising technique in monitoring the effects of cryoablation therapy.     

Tumor enucleation: a safe treatment alternative for renal cell carcinoma

The treatment of renal cell carcinoma has evolved tremendously over the years. Initially the entire kidney was removed along with the renal tumor despite the size or extent of the mass. Early attempts to remove tumors with a normal surrounding parenchymal margin showed equivalent oncologic results in small renal masses. Attempts to preserve more renal parenchyma in patients with compromised renal function led to the enucleation of renal masses by blunt dissection following the natural plane between the peritumor pseudocapsule and the renal parenchyma. Enucleation of renal tumors has been especially useful for renal preservation in patients with preoperative renal insufficiency, solitary kidneys, multiple renal lesions and hereditary renal cell carcinoma syndromes. Comparable long-term progression and cancer-specific survival has been shown with tumor enucleation and standard partial nephrectomy. However, there has been considerable controversy regarding the safety of renal tumor enucleation due to histopathologic findings of pseudocapsule tumor invasion. Current data suggest that tumor enucleation is a safe alternative for small renal masses that are locally confined on preoperative imaging, easily delineated intraoperatively and do not appear to grossly invade beyond the pseudocapsule.     

Shank1 在肾细胞癌组织中的表达及临床意义

目的:检测Shank 家族成员Shank1 在肾细胞癌（renal cell carcinoma,RCC ）中的表达,探讨在RCC 癌组织与癌旁组织中Shank1 的表达差异,分析其与RCC 临床病理特征的关系。方法:收集2008年5 月至2014年12月沧州市中心医院与济南市中心医院120 例RCC 术后患者的癌组织与癌旁组织标本,采用免疫组织化学染色及Westernblot检测Shank1 的蛋白表达水平,分析Shank1 表达与RCC 临床病理特征的关系。结果:免疫组织化学结果显示,RCC 的癌组织中Shank1 表达较癌旁组织明显上调,差异具有统计学意义（P < 0.05）。 Westernblot检测发现RCC 的癌组织中Shank1 蛋白表达水平明显高于癌旁组织。对Shank1 表达上调RCC 患者的临床病理特征分析发现,Shank1 在癌组织中的高表达与患者的性别、年龄、肿瘤的大小、TNM 分期无显著性相关（P > 0.05）,但与RCC 的不同病理类型显著性相关（P < 0.05）。 结论:Shank1 在RCC 的癌组织中异常表达,并与RCC 的病理类型相关。