Disorders of sex development

Disorders of sex development (DSD) occur in 1–2/10,000 live births, with a specific molecular diagnosis only possible in 20% of cases. Presentation is usually at birth, and gender assignment must be avoided before review by an expert multidisciplinary team. Initial investigations allow a working diagnosis to be made within 48 hr. In 46,XY DSD, surgery may be necessary to correct hypospadias, reposition or remove undescended testes, and remove symptomatic Müllerian remnants. In 46,XX DSD, feminizing surgery is performed less frequently than in the past, but genitoplasty may still be indicated. Psychosocial support is required to promote positive adaptation as gender dissatisfaction can occur in certain conditions. Long-term outcome data are sparse.     

Factors Affecting Recurrent Deep Vein Thrombosis after Pharmacomechanical Thrombolysis and Left Iliac Vein Stent Placement in Patients with Iliac Vein Compression Syndrome

PurposeThis study evaluated the factors affecting contralateral and ipsilateral recurrent deep vein thrombosis (DVT) after iliac vein stent placement in patients with iliac vein compression syndrome (IVCS).Materials and MethodsData from 130 patients (95 female patients) who underwent catheter-directed thrombolysis and stent placement for IVCS with left lower leg thrombosis at a single institution were retrospectively analyzed. Mean patient age was 69.0 ± 14.0 years old. Median follow-up was 14 months (range, 3–164 months). Anticoagulation therapy was prescribed for 6 months, followed by lifelong antiplatelet therapy. Multivariate logistic regression analysis was performed to evaluate the factors affecting the development of contralateral and ipsilateral recurrent DVT.ResultsSeven patients (5.4%) developed contralateral DVT (median, 26 months; range, 2–61 months), and 11 patients (8.5%) developed ipsilateral DVT (median, 1 month; range, 0–53 months). Stent location (odds ratio [OR], 11.564; 95% confidence interval [CI], 1.159–115.417) and in-stent thrombosis during follow-up (OR, 15.142; 95% CI, 1.406–163.119) were predictors of recurrent contralateral DVT. Thrombophilia (OR, 47.560; 95% CI, 2.369–954.711), remaining inferior vena cava filter (OR, 30.552; 95% CI, 3.495–267.122), and in-stent thrombosis during follow-up (OR, 82.057; 95% CI, 2.915–2309.848) were predictors of ipsilateral DVT.ConclusionsContralateral DVT occurs late and is associated with extension of the iliac vein stent to the inferior vena cava and in-stent thrombosis. Ipsilateral DVT occurs relatively early and is associated with thrombophilia, remaining inferior vena cava filter, and in-stent thrombosis.     

CT动态增强鉴别肾上腺乏脂肪腺瘤与肾上腺结节样增生的价值

目的探讨CT动态增强对鉴别肾上腺乏脂肪腺瘤与肾上腺结节样增生的价值。方法回顾性分析经手术病理证实的12例肾上腺乏脂肪腺瘤和27例肾上腺结节样增生患者的病例资料,统计两组病例各期增强CT值,利用公式灌注值P=CT静脉期-CT平扫期、廓清值C=CT静脉期-CT延迟期、绝对廓清灌注指数APC=(C/P)×100%及相对廓清灌注指数RAPC=(C/CT静脉期)×100%得到相关参数,并通过绘制受试者工作特征曲线,鉴别两者的最佳价值。结果肾上腺乏脂肪腺瘤直径较结节样增生更大;肾上腺乏脂肪腺瘤病灶各期CT值均明显高于结节样增生,且两者灌注值P、廓清值C、APC及RAPC有明显的统计学差异。年龄、性别、高血压、病灶位置、对侧肾上腺萎缩及动脉期CT值对鉴别两者无显著意义。结论CT动态增强扫描有助于鉴别肾上腺乏脂肪腺瘤和肾上腺结节样增生。     

尿动力学检查在前列腺增生症术前评估中的临床意义

目的探讨前列腺增生症(BPH)手术治疗前尿动力学检查的必要性。方法对166例拟行手术治疗的BPH患者的尿动力学检查结果进行分析。结果在166例患者中,125例(75.3%)证实存在膀胱出口梗阻(BOO ),25例(15.1%)为可疑BOO(BOO±),16例(9.6%)无BOO(BOO-),3组之间在最大尿流率(Qmax)、残余尿量(PVRV)、逼尿肌/外括约肌协同失调(DSD)上差异无统计意义,BOO( )组的逼尿肌不稳定(DI)、低顺应性膀胱的发生率明显高于其他两组,逼尿肌收缩力减弱(DUA)的发生率明显低于其他两组。结论尿动力学检查对诊断BPH、选择治疗方法和预测疗效有重要意义,手术治疗前应常规检查。     

蛋白质组学及其在前列腺癌研究中的应用

随着蛋白质组学技术的发展,越来越多的肿瘤标记物被发现,并逐渐应用于临床,这将为肿瘤的早期诊断和预后监测提供可靠的依据。现综述蛋白质组学的研究策略及其在前列腺癌研究中的应用。     

中老年男性下尿路症状的流行病学调查

为了了解下尿路症状在中、老年男性中的流行情况，用附加了二个症状问题的ＳＬ问卷对８７１名５２～７４岁的男子作回顾性调查，对调查结果作了年龄分组分析。结果发现：平均ＩＰＳＳ总分为４．９３分，无症状者为１２．２％，轻症者为６４．７％，中度症状者为１９．６％，重症者为３．５％。夜尿者占７２．３％，尿终滴沥占５４．４％，而症状中分值＞３分者尿终滴沥占２５．６％，夜尿占１４．６％，平均ＱＯＬ为１．７４，ＱＯＬ为０～２、３、４～６的比例分别为５２．７％、４６．０％、１．３％。ＱＯＬ与ＩＰＳＳ的相关性较好（ｒ＝０．６２），与梗阻症状群的相关性（ｒ＝０．５７）优于与刺激症状的相关性（ｒ＝０．４４）。中重度症状者中有７２．０％的人未进行治疗。     

诱导型一氧化氮合酶与移植血管平滑肌细胞增生的关系

目的　探讨诱导型一氧化氮合酶 (iNOS)与移植血管平滑肌细胞增生的关系。方法　新西兰大白兔 15只随机分成 3组 ,建立双侧颈动脉间置移植颈外静脉的动物模型。高剂量组每日喂食L 精氨酸 (L Arg) 2 5 0mg/kg ,低剂量组每日喂食L Arg 12 5mg/kg ;对照组不喂食L Arg ,持续 2周。检测血浆和组织匀浆一氧化氮(NO)水平 ,移植血管iNOSmRNA表达。观察术后 3和 6周移植血管平滑肌细胞增生。结果　 1.iNOS活性 :(1)血浆NO水平 :实验组血浆NO水平显著高于对照组 ,高剂量组血浆NO水平高于低剂量组 ;(2 )组织匀浆一氧化氮合酶 (NOS)活性 :实验组组织匀浆NOS活性显著高于对照组 ;(3)组织匀浆iNOSmRNA表达 :术后 3周实验组iNOSmRNA表达 ,对照组无表达 ;术后 6周实验组iNOSmRNA表达高于对照组 ,高剂量组高于低剂量组。 2 .移植血管平滑肌细胞形态学变化 :(1)SMA免疫组化染色 :实验组移植血管平滑肌细胞厚度低于对照组 ;术后 6周低剂量组移植血管平滑肌细胞厚度低于高剂量组 ;(2 )PCNA免疫组化染色 :术后 3周实验组平滑肌细胞增殖低于对照组 ;术后 6周低剂量组平滑肌细胞增殖低于对照组和高剂量组。结论　iNOS表达致体内NO水平增高可抑制移植血管平滑肌细胞增生 ;NO浓度与平滑肌细胞增生关系密切     

经尿道前列腺电切气化术治疗前列腺增生568例报告

目的 :进一步探讨前列腺增生 (BPH)的有效手术新方法。方法 :采用经尿道前列腺电切术和气化术治疗BPH患者 5 6 8例。结果 :疗效满意 ,术后 3～ 6个月随访 ,国际前列腺症状评分 (IPSS) 8.5± 1.5分 ;最大尿流率 (Q max) 2 0 .5± 4 .5ml s,剩余尿量 2 9.1± 14 .2ml,未出现严重并发症。结论 :将电切和气化相结合行经尿道前列腺切除术是一种安全性高、并发症少、疗效确切的新手术方法 ,具有操作易掌握、出血少、速度快、安全可靠等优点。     

Castleman disease: surgical cure in pediatric patients

Castleman disease is a rare disorder characterized by lymphoid hyperplasia which rarely manifests in children. We present 2 cases which highlight both histologic variants of this disease, and provide suggestions regarding workup and treatment with the goal of making practitioners aware of Castleman disease in the differential diagnosis of a child presenting with vague symptoms.