Risk factors in the failure of surgical repair of pelvic organ prolapse

IntroductionPelvic organ prolapse (POP) surgery has variable results of recurrence and complications. We have aimed to analyze our outcomes in order to know the factors associated with anatomical and functional failure in POP surgery.Material and methodsA retrospective study of 69 patients who underwent POP surgery at our hospital was performed. Registered variables were: Age, BMI, number of deliveries, previous pelvic surgery, menopause, quality of life, urinary incontinence, associated frequency-urgency symptoms, high POP stage, vaginal compartments repaired, type of mesh, urethro-suspension and vaginal hysterectomy during POP surgery and its complications. Patients were evaluated at 1, 6 and 12 months post-surgery. The technique was considered as failed when relapse or mesh erosion occurred and when the patient is not satisfied or there was relapse. The sample is described, analyzing the relationship of the variables studied by univariate analysis (Chi square and Mann-Whitney U test) and a study was made of which variables may have predictive value in the failure of the repair (multiple logistic regression).ResultsSurgery failed in 17 patients during the follow-up at one year. BMI (29.6 ± 2.03 vs 27.1 ± 3.32), delivery number (3.4 ± 0.71 vs. 2.8 ± 1.88), menopause, frequency- urgency symptoms and number of vaginal compartments repaired were associated with treatment failure although only BMI, delivery number and frequency-urgency symptoms were defined as independent predictive variables when the logistic regression was carried out.ConclusionsOverweightness-obesity, previous delivery number and frequency-urgency symptoms before surgery are factors associated to anatomical and functional failure after POP repair.     

大黄素诱导人胃癌细胞MKN45凋亡及其分子机制的研究

目前国内外一些学者的研究成果表明:大黄素具有诱导多种肿瘤细胞的凋亡效应,具有细胞毒潜能,其诱导凋亡的信号转导途径主要有Bax-caspase途径、PKC途径、Fas途径及ROS途径等[1-3].本研究旨在观察大黄素对人胃癌细胞MKN45的抑制作用并探讨其作用机制.     

局部双易位皮瓣修复高位穿耳洞所致耳轮部瘢痕疙瘩

随着高位穿耳洞需求的增多,由此所致的并发症也越来越多,治疗上也较为棘手,因为通常合并有软骨炎的存在[1-2],故形成的瘢痕疙瘩往往较大,增生更加明显,且累及耳廓的前、后两面,形成独特的"哑铃型"外观,给治疗带来很大困难.     

Renin angiotensin system-regulating aminopeptidase activities in serum of pre- and postmenopausal women with breast cancer

Angiotensin peptides regulate vascular tone and natriohydric balance through the renin angiotensin system (RAS) and are related with the angiogenesis which plays an important role in the metastatic pathway. Estrogen influences the aminopeptidases (APs) involved in the metabolism of bioactive peptides of RAS through several pathways. We analyze RAS-regulating AP activities in serum of pre- and postmenopausal women with breast cancer to evaluate the putative value of these activities as biological markers of the development of breast cancer. We observed an increase in aminopeptidase N (APN) and aminopeptidase B (APB) activities in women with breast cancer; however, a decrease in aspartyl-aminopeptidase (AspAP) activity in premenopausal women. These results suggest a slow metabolism of angiotensin II (Ang II) to angiotensin III (Ang III) in premenopausal women and a rapid metabolism of Ang III to angiotensin IV (Ang IV) in pre- and postmenopausal women with breast cancer. An imbalance in the signals activated by Ang II may produce abnormal vascular growth with different response between pre- and postmenopausal women depending on the hormonal profile and the development of the disease.     

近红外自体荧光显像技术在甲状腺癌根治性手术中辅助甲状旁腺识别应用1例报告并文献复习

甲状腺癌(thyroid carcinoma)是一种起于甲状腺滤泡上皮或滤泡旁上皮细胞的恶性肿瘤,女性高发,发病率居女性恶性肿瘤的第4位[1],我国的发病人群以每年20%的速度持续增长,而根治性手术是治疗甲状腺癌疾病的主要手段。甲状旁腺体积小,位置较深,而且数目和位置常存在解剖学变异,给甲状腺和甲状旁腺手术术中探查并保护甲状旁腺造成了一定困难。尤其是在甲状腺癌根治术中,往往在中央区淋巴结的清扫容易误损伤甲状旁腺,致使术后暂时性或永久性低钙血症,极大地降低了病人的生活质量。因此,如何在甲状腺癌根治术中快速准确的识别甲状旁腺并予以保护,已经成外甲状腺外科医生重点关心的问题。     

孤立性髂动脉瘤介入治疗39例临床分析

目的 探讨孤立性髂动脉瘤介入治疗的临床经验。方法 回顾性分析2010年1月至2018年9月昆明医科大学附属延安医院血管介入科采用覆膜支架介入治疗孤立性髂动脉瘤39例,术后3个月、6个月及之后的每年对病人进行随访,探讨相关治疗方法。结果 39例病人分型有1A：Ⅰ型1例,1B：Ⅱ型8例,1D：Ⅳ型17例,2B：Ⅱ型2例,2D：Ⅳ型1例,2E：V型10例。平均瘤体最大直径为（42.4±11.2）mm（23.0～77.0 mm）。39例病人均顺利完成介入手术治疗,技术成功率100%,术中保留双侧髂内动脉1例,保留一侧髂内动脉29例,双侧髂内动脉均封闭9例,术中行一侧髂内动脉栓塞9例,行双侧髂内动脉均栓塞1例,手术时间为（49.0±17.0）min（35.0～87.0 min）,术后随访（31.9±17.7）个月（5～69个月）,术后除1例左髂动脉瘤破裂且合并肾衰竭的病人死亡,其余病人均好转出院,复查CTA示髂动脉瘤被完全封闭,支架形态位置良好,无内漏及其他并发症。结论 孤立性髂动脉瘤起病隐匿,早期多无症状,CT等检查能够早期诊断。介入治疗是安全有效的方法。应注意在术前根据髂动脉瘤的累及范围,近远端有无足够的锚定区进行分型,并对不同分型进行有差别的个体化治疗。     

Traumatic rupture of a horseshoe kidney

One-third to one-half of all patients with horseshoe kidney are asymptomatic and the condition is found incidentally. This congenital renal anomaly has shown as a predisponent condition for renal injury in blunt abdominal trauma, but often the degree of injury has a nonoperative therapy. Horseshoe kidney rupture is an exceptional pathology that require a complete diagnostic study to make an adequate management when surgical therapy is indicated. We present a fifteen-year-old male with previously unsuspected horseshoe kidney that suffered an atypical right upper-pole and mesorrenal kidney rupture after low-velocity-impact blunt abdominal trauma. A correct presurgical diagnose let a deferred surgical approach with right lower pole and horseshoe renal isthmus preservation. The trauma conditions, an excesive clinic manifestation, a clinical investigation about known congenital simultaneous anomallies and typical radiological signs, can suggest this infrequent patology. Computed tomography provides the best radiological information.     

Synchronous bilateral urothelial carcinoma of the upper urinary tract

ObjectiveReport a case of a synchronous bilateral urothelial carcinoma of the upper urinary tract without bladder affectation.MethodsWe describe the diagnosis and treatment of a case of a bilateral upper urothelial carcinoma.ConclusionsSynchronous bilateral urithelial carcinoma of the upper urinary tract without bladder affectation in an unusual occurance (1-5% of urothelial tumors) and radical surgery continues to be the treatment of choice, although it is possible to take a less aggressive approuch with selected groups of patient, in which we can achiese a survival rate similar to that which we obtain with radical surgery.     

Evaluation of pT3a stage in the current classification for renal cancer

ObjectiveWe assessed the prognostic value of a stage pT3a diagnosis based on perirrenal fat infiltration.Material And MethodsA series of 300 patients diagnosed of renal cell carcinoma (ccr) between 1992 and 2001 were retrospectively analyzed. focusing on pt3a tumors as defined by perirrenal fat infiltration, a group of 92 patients (91,08%) regardless lymph node involvement (nall) were included. patients with distant metastases were excluded. in patients with pt3a nall m0 tumors, tumour size was a significant parameter predicting survival. the most significant cut-off value for tumor size based on roc curve was 5,5 cm. therefore two groups were defined (up to 5,5 cm or greater than 5,5 cm) and actuarial survival were compared between both groups.ResultsNo significant differences were found comparing actuarial survival of selected pT3a and tumour size less than 5,5 cm with pT1 and pT2 tumors. After classifying selected pT3a less than 5,5 cm as pT1, multivariate analysis showed no differences regarding to prognostic variables before and after classification. Subsequently multivariate analysis showed that modified T stage was an independent significant predictor of cancer specific actuarial survival.ConclusionsPerirrenal fat infiltration in renal cell carcinoma should not be used to assign T category. In our series grading tumors pT3a lesser than 5,5 cm as pT1/pT2 TNM stage does not affect their prognostic value.