Characteristics and prognosis of chromophobe non‐metastatic renal cell carcinoma: A multicenter study

Objectives: To analyze the characteristics and the prognostic significance of chromophobe renal cell carcinomas (chRCC). Methods: Data about 2981 patients with non‐metastatic renal cell carcinomas (RCC) at the time of surgery were retrospectively collected from 26 institutions between 1998 and 2008. All patients had undergone partial or radical nephrectomies. Of the 2981 patients, 2602 patients with conventional RCC (cRCC) and 148 with chRCC were studied. Clinical and pathological parameters were determined in all patients. Recurrence‐free survival (RFS) and cancer‐specific survival (CSS) were assessed. Results: Patients with chRCC differed significantly from those with cRCC on the following parameters: younger age (P = 0.026), greater female ratio (P < 0.001), and larger tumor diameter (P < 0.001). Both groups were alike with respect to body mass index (P = 0.943), Eastern Cooperative Oncology Group performance status (P = 0.163), T stage (P = 0.375), and Fuhrman's grade (P = 0.134). The 5‐year RFS rates in patients with chRCC and cRCC were 82.7% and 83.3%, respectively (P = 0.762). The 5‐year CSS rates in patients with chRCC and cRCC were 88.8% and 92.2%, respectively (P = 0.980). Both groups showed equivalent oncological outcomes in terms of RFS and CSS for cases stratified by T stage and Fuhrman's grade. In multivariate analysis, the histological subtype was not retained as an independent prognostic variable (RFS: P = 0.893; CSS: P = 0.729). Conclusions: Despite being significantly different from cRCC in terms of several clinical and pathological parameters, chRCC shows equivalent oncological outcomes.     

微生态疗法治疗128例细菌性阴道病的临床分析

目的：探讨微生态疗法治疗细菌性阴道病的临床应用。方法：将在我校附院门诊就诊的细菌性阴道病患者随机分成两组：A组64例,B组64例;A组给予常规治疗,B组均常规治疗后加用微生态疗法治疗,观察并比较两组治疗结束后的有效率,并于下次月经干净后复查,观察各组的复发率。结果：治疗结束后,细菌性阴道病的治疗有效率,A组92.2%,B组96.9%,P〉0.25;复发率,A组23.7%,B组1.6%,P〈0.005。结论：微生态疗法联合阴道常规治疗的方法治疗细菌性阴道病,疗效好,而且复发率低。     

高通量血液透析与常规血液透析疗效比较

目的比较高通量血液透析与常规血液透析的临床疗效。方法回顾性分析我院近年来收治的45例行维持性血液透析患者的临床资料,根据透析方法及透析器的不同,将患者随机分为两组,高通量血液透析（HPD）组23例,常规血液透析（CHD）组22例,比较两组患者的疗效差异。结果 HPD组各项检测指标透析前后下降率为BUN值为（69.2±5.3）%,SCr值为（63.1±5.4）%,P值为（58.1±15.9）%,β2-MG值为（1.39±0.62）%,PTH值为（71.3±15.3）%;CHD组BUN值为（68.8±4.9）%,SCr值为（62.8±5.9）%,P值为（56.2±14.7）%,β2-MG值为（33.5±8.4）%,PTH值为（16.5±9.4）%;两组患者血液透析前后的BUN、SCr下降率比较无明显差异性,而磷（P）、β2-微球蛋白（β2-MG）,甲状旁腺素（PTH）比较,有显著性差异。结论高通量血液透析治疗终末期肾病患者与常规血液透析比较,疗效更为确切,值得临床推广使用。     

SLIPA喉罩在腹腔镜胆囊切除手术麻醉中的应用

目的:评估SLIPA喉罩在腹腔镜胆囊切除手术麻醉中的应用效果,并探讨其安全性和有效性。方法:随机将行腹腔镜胆囊切除手术的患者分为两组:SLIPA喉罩组(S组)和经典喉罩组(C组)。分别记录喉罩成功置入率、一次放置成功所需时间以及术中需调整喉罩位置病例数;人工气道建立成功时、气腹后5min及气腹后30min时的气道峰压(Ppeak)、呼气末二氧化碳分压(PetCO2)和患者入室时(T1)、置入喉罩即刻(T2)、置入后3min(T3)、拔除喉罩即刻(T4)、拔除后3min(T5)的平均动脉压(MAP)、心率(HR);并观察术中有无胃胀气、返流误吸情况及术后咽喉部并发症,如声嘶或咽痛等。结果:两组患者在人工气道建立成功时、气腹后5min及气腹后30min时的Ppeak和PetCO2比较,差异均无统计学意义(P>0.05);同时两组患者在所选取的各时点的MAP和HR比较,差异无统计学意义(P>0.05);S组在一次放置成功率、一次放置成功所需时间以及术中需调整喉罩位置病例数方面优于C组,差异均有统计学意义(P<0.05)。两组术后各发生7例轻微咽痛,C组有4例患者术中发生胃胀气,两组均未见声音嘶哑及返流误吸。结论:SLIPA喉罩适用于腹腔镜胆囊切除手术,并发症少、操作便捷、安全性和有效性较高。     

针刺穿线胆囊悬吊在经脐单孔腹腔镜胆囊切除术中的临床对照研究

目的观察针刺穿线胆囊悬吊与常规经脐单孔腹腔镜胆囊切除术的治疗效果。方法 60例符合入选标准的胆囊结石、胆囊息肉患者,随机分成30例行针刺穿线胆囊悬吊经脐单孔腹腔镜胆囊切除术的观察组,30例行常规经脐单孔腹腔镜胆囊切除术对照组,采用手术时间、术中出血、住院时间、疼痛指数、肩背疼痛、C反应蛋白(C-reactive protein,CRP)、凝血功能指标评价两种手术方法的治疗效果。结果两组患者手术时间、术中出血、住院时间、疼痛指数、肩背疼痛、CRP比较,有显著的统计学差异(P<0.05,P<0.01,P<0.001)。两组患者手术前后凝血指数PT、APTT、INR,纤维溶解指数FIB、D-D检测结果比较,观察组凝血功能正常,与治疗前比没有统计学差异(P>0.05),对照组凝血功能异常,与治疗前比有显著的统计学差异(P<0.05,P<0.01,P<0.001)。结论针刺穿线胆囊悬吊经脐单孔腹腔镜胆囊切除术胆囊三角显露良好,传统器械处理起来简单方便,切口小术后不易察觉起到了美容效果,患者术后凝血功能正常,避免了腹腔镜术后患者静脉、肺栓塞的问题。     

Computed tomography of renal cell carcinoma in patients with terminal renal impairment

Purpose

An increased incidence of renal tumors has been observed in patients with end-stage-renal-disease (ESRD). The very strong association with acquired renal cystic disease (ACRD) and increased incidence of the renal tumors (conventional renal cell carcinoma (CRCC), papillary renal cell carcinoma (PRCC) or papillary renal cell adenoma (PRCA)) was reported. This study discusses the role of computed tomography (CT) in detecting renal tumors in patients with renal impairment: pre-dialysis, those receiving dialysis or with renal allograft transplants.

Materials and methods

Ten patients (nine male, one female) with renal cell tumors were enrolled into a retrospective study; two were new dialysis patients, three on long-term dialysis, and five were renal transplant recipients with history of dialysis. All patients underwent helical CT, a total of 11 procedures were performed. Sixteen-row detector system was used five times, and a 64-row detector system for the six examinations. All patients underwent nephrectomy of kidney with suspected tumor, 15 nephrectomies were performed, and 1 kidney was assessed during autopsy. CT findings were compared with macroscopic and microscopic assessments of the kidney specimen in 16 cases.

Results

Very advanced renal parenchyma atrophy with small cysts corresponding to ESRD was found in nine patients, chronic pyelonephritis in remained one. A spontaneously ruptured tumor was detected incidentally in one case, patient died 2 years later. In the present study, 6.25% (1/16) were multiple PRCA, 12.5% (2/16) were solitary PRCC, 12.5% tumors (2/16) were solitary conventional renal cell carcinomas (CRCC's), 12.5% tumors (2/16) were multiple conventional renal cell carcinomas (CRCC's), 25% (4/16) were CRCC's combined with multiple papillary renal cell carcinomas with adenomas (PRCC's and PRCA's), and 25% (4/16) of the tumors were multiple PRCC's combined with PRCA's without coexisting CRCC's. Bilateral renal tumors were found in our study in 60% (6/10) confirmed in six cases, one kidney left on follow-up due to the small tumors.

Conclusions

With the use of a multi-detector row system, it is possible to detect smaller foci suspected to originate in multiple tumors, especially when up to 3-mm thin multi-planar reconstructions are used. Two cases demonstrated the possibility the development of RCC in impaired kidneys may start before dialysis initiation.     

Ilizarov methodology for infected non union of the Tibia: Classic circular transfixion wire assembly vs. hybrid assembly

Introduction:

Conventional wire fixation of Ilizarov rings often fails to provide 90-90 configuration because of vital structures, which is essential for optimum stability. Hybrid assembly with half pins is an alternative. The aim of this study is to compare the results of Hybrid assembly with that of conventional classic circular transfixion wire Ilizarov assembly in 50 cases of infected nonunion of tibia between 1994 and 2003.

Materials and Methods:

This study includes two groups with 25 patients in each group: Group (A) conventional Ilizarov assembly and Group (B) hybrid Ilizarov assembly. Thirty-five cases developed infected nonunion following road traffic accidents while others after fall (6) bullet injury (4), infected osteosynthesis (3) and assault (2). There were 45 males and five females with mean age (18 to 56 years). All active cases (n=28) were treated by debridement including removal of implants in infected osteosynthesis. Twenty out of 22 cases in the quiescent group (non draining for last three consecutive months) were treated without open debridement; only two cases required open debridement for various reasons. All the cases were finally treated as atrophic aseptic nonunion with bone defect and were classified according to ASAMI.Type B1: length of the limb maintained with bone gap (14 cases in both Group A and B) and Type B3: combined shortening with defect (five and seven cases in Group A and B respectively), were treated by bifocal osteosynthesis. Only one case in the B3 group was treated by trifocal osteosynthesis to shorten the time. Type B2: segments in contact with limb shortening (total nine cases; five and four cases in Group A and B respectively) with shortening up to 2 cm (total five cases) were treated with monofocal osteosynthesis while shortening up to 5 cm and beyond (total four cases) were treated with bifocal osteosynthesis.

Results:

The cases were followed up for two to six years and the results were evaluated by Paley criteria of bony results (union, infection, deformity and leg-length discrepancy) and Functional Results (significant limp, equinus rigidity of the ankle, soft-tissue dystrophy, pain and inactivity). In both the groups, 24 cases out of 25, had excellent to good bony result with Group B having twice more excellent result than Group A. Functional results were found to be similar in both the groups. Although persistence of infection and Grade III pin tract infection (PTI) were slightly higher in Group B, complications like delayed consolidation of regenerate, refracture, deformity and aneurysm of vessel were less in this group.

Discussion and Conclusion:

Ilizarov methodology produced a satisfactory result in infected nonunion of the tibia. Hybrid assembly was a fruitful advancement in the Ilizarov armamentarium. The results were comparable to Conventional assembly in terms of docking site problems, corticotomy site problems, PTIs and other problems.     

Strongyloides stercoralis in a bronchial washing specimen processed as conventional and Thin‐Prep smears: Report of a case and a review of the literature

Strongyloidiasis is an opportunistic infection which may result in a fatal hyperinfection syndrome in immunocompromised patients. We report the case of a pulmonary infection with Strongyloides stercoralis in a 61‐year‐old male with a history of a long‐term administration of corticosteroids. Cytologic examination of a bronchial washing specimen, processed both as conventional and as Thin‐Prep smears, revealed an abundance of the typical larvae of Strongyloides stercoralis, amidst a cellular population comprising several acute inflammatory cells as well as bronchial epithelial cells with features of basal cell hyperplasia or regenerative atypia. To the best of our knowledge there is only one previous report describing Strongyloides stercoralis in thin‐layer smears, and there are no previous studies comparing its morphology in conventional and thin‐layer preparations. Diagn. Cytopathol. 2009. © 2009 Wiley‐Liss, Inc.     

Interphase fluorescence in situ hybridization analysis detects a much higher rate of thyroid tumors with clonal cytogenetic deviations of the main cytogenetic subgroups than conventional cytogenetics

In benign thyroid lesions, three main cytogenetic subgroups, characterized by trisomy 7 or structural aberrations involving either chromosomal region 19q13.4 or 2p21, can be distinguished by conventional cytogenetics (CC). As a rule, these aberrations seem to be mutually exclusive. Interphase fluorescence in situ hybridization (I-FISH) analysis on benign as well as malignant thyroid neoplasias has been performed in the past, but rarely in combination with CC. In the present paper, we have analyzed 161 benign thyroid lesions both with CC and I-FISH on touch preparations by using a multi-target, triple-color FISH assay as well as dual-color break-apart probes for detection of the main cytogenetic subgroups. Within the samples, I-FISH detected tumors belonging to either of the subgroups more frequently than CC (23 vs. 11.4%), either due to small subpopulations of aberrant cells or to cryptic chromosomal rearrangements (three cases). Thus, I-FISH seems to be more sensitive than CC, particularly in the detection of subpopulations of cells harboring cytogenetic aberrations that may be overlooked by CC. In summary, I-FISH on touch preparations of benign thyroid lesions seems to be a favorable method for cytogenetic subtyping of thyroid lesions.