肾癌多中心病灶发生机理的探讨

目的　探讨肾癌多中心病灶的发生机理。　方法　肾癌根治术标本 10 2例 ,间隔 3mm切开检查切面 ,原发灶外可疑处取材证实肾癌者为多中心灶阳性。免疫组化法检查肾癌原发灶及多中心灶p5 3、PCNA、c erbB2 、CD44 v6、bcl 2、nm2 3 H1 蛋白表达情况。　结果　多中心灶发生率为 15 .7%( 16 10 2 ) ,16例多中心性肾癌中 ,原发灶与多中心灶p5 3、PCNA、c erbB2 、CD44 v6、bcl 2、nm2 3 H1 蛋白表达情况均相近 ,统计学处理差异无显著性意义 (P均 >0 .4)。　结论　肾癌多中心灶具有与原发灶相似的生物学特征 ,其发生以原发灶肾内转移可能性大。     

膀胱癌膀胱全切术后尿道复发的风险评估及对策

目的 探讨膀胱癌膀胱全切术后尿道复发的危险因素及处理方法。方法 回顾分析278例膀胱癌膀胱全切患者的临床资料，其中24例发生了尿道复发。运用cox’s多因素回归模型对影响复发的危险因素进行评价。结果 6例选择性尿道切除者无1例死于肿瘤；24例尿道复发者10例死于肿瘤转移。多因素分析表明前列腺受累、膀胱颈受累、三角区肿瘤、多发肿瘤和原位癌是影响尿道复发的危险因素，相对危险度分别为1．573，1．532，1．360，1.337和1．213。结论 前列腺受累、膀胱颈受累、三角区肿瘤、多发肿瘤或原位癌是预防性尿道切除术的指征。保留尿道的患者宜尽量行正位排尿的尿流改道术。     

Training and assessment of laparoscopic skills.

Laparoscopic surgery is gaining popularity among the surgical community. While its prevalence expands, the need for reliable training and assessment tools is becoming increasingly important. Laparoscopic skills are not an innate behavior, nor can they be easily mimicked, and can only be acquired through hands-on training. A consensus exists among physicians that establishment and evaluation of technical skill in surgical training programs are inadequate and in need of improvement. A validated, reliable bench model that could train and assess could be standardized and provide numerous benefits including determination of which medical students should consider a career in surgery, valuable feedback to residents, a tracking mechanism of resident performance, a possible certification and recertification tool, and to allow for interinstitutional comparison. To this end, several potentially successful bench models testing dexterity, hand-eye coordination, and depth perception have been developed. A few models have been proven to be both valid and reliable indicators of technical skill. Although the future remains uncertain, enough groundwork has been laid to begin incorporating technical skill training and assessment into surgical training programs.     

腹腔镜改良性腹膜后淋巴清除术治疗临床Ⅰ期睾丸非精原细胞瘤

目的:探讨腹腔镜改良性腹膜后淋巴清除术初步经验,评估其手术可行性和近期临床疗效。方法:2004年10月~2006年7月,对7例临床诊断为Ⅰ期睾丸非精原细胞瘤患者,施行了经腹腔途径腹腔镜改良性腹膜后淋巴清除术,年龄26~36岁,平均年龄为30岁,睾丸肿瘤大小为3.0 cm×2.5 cm×2.0 cm~6.5 cm×4.5 cm×3.0 cm,左侧3例,右侧4例,均通过B超、腹膜后CT、胸片检查,并施行了根治性睾丸切除和病理证实。术后淋巴结阳性患者施行了3个疗程的化疗。结果:7例均获得成功,无1例改开放手术。手术时间为120~210 min,平均160 min,手术失血量50~200 ml,平均150 ml,均未输血。术后1~3 d肛门排气,于1~2 d拔除引流管;术后平均住院时间5.5 d。病理报告6例均无转移性淋巴结,其中1例为1/18淋巴结转移,术后无明显并发症。随访6~32个月,平均14个月,阴茎勃起功能良好,射精功能正常。定期复查血hCG、AFP均阴性,B超复查均未发现腹膜后淋巴结,胸片表现均正常。其中淋巴结阳性1例患者术后接受3个疗程的辅助化疗,随访6个月,无瘤存活。结论:腹腔镜改良性腹膜后淋巴清除术具有损伤小、并发症少、术后恢复快等特点,可以代替传统开放手术。     

69例睾丸扭转诊断与治疗

目的提高睾丸扭转诊断及治疗水平。方法对69例睾丸扭转患者的临床资料进行回顾性分析。结果8例12h内手术者，睾丸均存活；6例12—24h手术者，3例睾丸存活；39例超过24h手术者仅7例睾丸存活。未手术者16例，随访7例扭转睾丸均发生不同程度萎缩，尚未发现生育能力受影响者。结论早期诊断、及时治疗是提高疗效的关键。睾丸移植是治疗双侧睾丸扭转后功能性无睾症的一种有效方法。     

Critical Evaluation of the Efficacy and Safety of Anticholinergics in Overactive Bladder

Antimuscarinic agents are the primary pharmacologic treatment of overactive bladder (OAB), and objective clinical data are available in a range of formats including head-to-head studies, systematic reviews and adjusted indirect comparisons. This paper reexamines the various data available on the safety and efficacy of the antimuscarinics. Clinical studies determine whether one treatment is better than another, rather than examining which treatment is best for the individual patient. Favourable treatment outcome may not be attained because of unrealistic expectations of the patient, who may also be dissatisfied with the complications of the treatment. Comparisons between clinical studies on drug therapy for OAB may be complicated by the high placebo response rates. Variations exist in the study populations in terms of symptom severity and tolerance of adverse events, and the diverse methods of assessment employed. Apart from head-to-head studies, meta-analyses can be employed to compare different classes of drugs (lumping method) or individual drugs (splitting method) by pooling of clinical data. The adjusted indirect comparison method has been developed as a method to allow the outcome of two different trials to be compared. Overall, data from clinical trials indicate that the commonly used antimuscarinics have different tolerability and safety profiles but broadly similar efficacy profiles. Consequently, therapy should be tailored to individual patient needs rather than one drug fits all.     

Bladder Cancer: Highlights from 2006

ObjectivesThis paper provides an overview of the most relevant findings on bladder cancer (BCa) presented at the 2006 annual meetings of the European Association of Urology, American Urological Association, and the American Society of Clinical Oncology.MethodsExperts in the field of BCa selected and discussed relevant new findings in BCa during a closed meeting in Marbella, Spain. Furthermore, the participants’ opinions on representative clinical cases were assessed via interactive voting. Voting results were commented on by an expert panel.ResultsMany studies examined the diagnostic and prognostic value of the biomarkers survivin and nuclear matrix protein-22, but results were not consistent. With respect to superficial BCa, a major revelation was the introduction of the European Organisation for Research and Treatment of Cancer tables to calculate the risk for recurrence and progression of superficial BCa patients. In addition, one study showed that Bacillus Calmette-Guérin + interferon-alpha might be a good alternative treatment for patients with recurrent superficial BCa. For patients with minimally invasive BCa who had undergone radical transurethral resection, a bladder-sparing treatment was cautiously suggested. For those with recurrent urothelial cancer, one study presented a new salvage chemotherapy consisting of paclitaxel, ifosfamide, and nedaplatin. Finally, two studies demonstrated that there was no difference in oncologic outcome between patients who underwent open or laparoscopic radical cystectomy or nephroureterectomy.ConclusionsMany interesting new findings in the field of BCa have been presented at 2006 urologic/oncologic meetings, which aim to improve the diagnosis and treatment of patients with BCa.     

Eligard® 6: Achieving Optimal Testosterone Control with the Convenience of a Twice-a-Year Formulation

ObjectivesThe primary objective of androgen-deprivation therapy for advanced prostate cancer (PCa) is to induce a rapid, profound, and sustained suppression of testosterone.MethodsThis review discusses the efficacy of a new leuprolide formulation, Eligard^®, available in 1-, 3-, and 6-mo depots, as androgen-deprivation therapy for PCa and highlights the potential advantages of the 6-mo (45-mg) formulation of Eligard.ResultsThe 6-mo depot formulation of Eligard has a comparable efficacy profile in achieving and maintaining testosterone castration levels as the 1- and 3-mo depots. The mean testosterone level 12 mo after PCa diagnosis was 12.3 ng/dl, far below the testosterone castration level of 20 ng/dl. Breakthrough and injection-related testosterone escapes were rarely observed. A patient survey confirmed that follow-up visits are associated with anxiety and fear for recurrence of PCa. Eligard 6 can offer patients a full year of therapy with just two injections. This removes the need for visits purely to administer injections and allows the patient and physician more liberty during the follow-up period.ConclusionsEligard 6 elicits a rapid, profound, and sustained testosterone suppression. The availability of 1-, 3-, and 6-mo depot formulations of Eligard enables physicians to tailor the management of PCa to the individual needs of their patients.