Ho:YAG Laser Endopyelotomy is effective for primary and secondary UPJOs

PURPOSE

To assess efficacy of laser endopyelotomy in both primary and secondary ureteropelvic junction obstructions (UPJOs) PATIENTS AND METHODS: Primary category consisted of 10 patients of congenital UPJOs. Secondary category was comprised of UPJOs in 12 status post pyeloplasty, 10 status post lithotomy, 5 status post shock wave lithotripsy, and 10 status post ureteroscopic lithotripsy. Ho:YAG laser endopyelotomy was performed in all subjects. Exclusion criteria included obstructions longer than 2 cm, ipsilateral upper urinary calculi and crossing vasculature.

RESULTS

Mean operation time was 44 min. Average inpatient duration was 1.87 days. No major complication occurred. Follow-ups were at least 12 months. Success rate for single endopyelotomy was 82.5%, leaving 7 patients for a secondary endopyelotomy. Secondary UPJO due to failed pyeloplasty had a predilection of restenosis after endopyelotomy (P = 0.0005) compared to other aetiologies.

CONCLUSIONS

Ho:YAG laser endopyelotomy is a safe and effective approach effective in both primary and secondary UPJO treatments.

[The relationship between arteriolar pathological changes and brain hemorrhage in primary hypertension cases]

This study was intended to elucidate the relationship between arteriolar pathological changes and encephalorrhagia in the cases of primary hypertension. Gross anatomy and histology of brain were observed in autopsy of 45 cases of primary hypertension. Forty cases of arteriolar hyalinization including 26 cases of brain hemorrhage were found in those 45 cases of primary hypertension. The hyalinized arterioles were divided to two types. One is characterized by the narrow lumen of terminal arterioles, the other by the dilatant lumen of proximal arterioles. Hemorrhage always occurred in the latter type. Besides these changes, 3 cases of acute necrosis and 5 cases of atherosclerosis in arterioles were related to hemorrhage. These data suggest that brain hemorrhage of primary hypertension mainly occur in dilated and hyalinized arterioles, and some cases are probably related to acute necrosis or atheroscleromatous atrerioles.

[An analysis of DNA content in 405 cases of human tumor by flow cytometry]

This study was intended to evaluate the relationship between the DNA content of cell cycle and the histology in human tumors. We detected the DNA content in 405 cases of fresh human tumor tissue by means of flow cytometry and observed the histology of tumor with light microscopy. The occurrences of aneuploidy in 22 cases of benign tumor and 383 cases of malignant tumor were 27% and 52% respectively. There were differences in aneuploidy in different histologic types of tumor. The aneuploidy in adenocarcinoma was about 50%, that in sarcoma was more than 37%, and that in squamous carcinoma less than 17%. S > or = 10, G2/m > or = 10 or S > or = 20, G2/m > or = 5 were present in malignant tumors, but were not found in benign tumors. The results suggest that there is obvious difference in the occurrences of aneuploidy in benign and malignant tumors and in different histologic type of tumor(P < 0.05). Benign and malignant tumor may be distinguished when SPF and G2/m reach a higher level (P < 0.01).

[Pathological morphology of arterioles and main visceal organs in primary hypertension--an analysis of 45 autopsies]

The autopsy materials of 45 cases of primary hypertension were studied retrospectively. The arteriolar lesions were reviewed. The arterioles < 100 microns in diameter were defined as distal arterioles; those > or = 100 microns and < 300 microns in diameter were proximal arterioles. The lesions of arteriolar wall were categorized as plasma infiltration and hyaline degeneration, and according to seriousness, the latter was divided into three degrees: I, II and III. The results revealed that (1) the arteriolar lesions in different areas of the body were at different stages of seriousness; (2) the changes in the distal arterioles were earlier than those in the proximal ones; in brain, the proximal arterioles dilated first, and then occurred the hyline degeneration; (3) hyaline degeneration took place early in the abdominal organs such as kidney, liver and pancreas, but relatively late in brain; (4) different parts of an organ were at different stages of seriousness; and (5) the lesions in different organs led to different consequences. The pathogenesis of arteriolar sclerosis in primary hypertension was also discussed.

[Pathological analysis of 180 cases of cerebrovascular disorder in autopsy]

OBJECTIVE

To evaluate the ratio of each kind of causes in 180 cases of cerebrovascular disorder(CVD) in autopsy.

RESULTS

In 180 cases of CVD in autopsy: (1)125 (69%) belong to brain hemorrhage including hypertension 36 cases(20%), vascular malformation 28 cases(16%), hemopoitic diseases and blood coagulation disturbances 23 cases(13%), congenital aneurysm and brain tumor 9 cases(5%) each separately. (2) 55 cases (31%) are due to brain infarction, main of them are caused by embolism 29 cases (16%) and thrombosis 17 cases(10%). Thrombosis related to atherosclerosis has 5 cases(3%).

CONCLUSION

In CVD in autopsy, brain hemorrhage is more than infarction, the ratio of them is 2.3:1. More than 50% of cases is due to hypertension and vascular malformation. In infarction, embolism is more than thrombosis, the ratio of them is 1.7:1. Vascular malformation is more than congenital aneurysm, the ratio of them is 3:1.

[Pathologic grading and differential diagnosis on oligodendroglioma]

To investigate the histological characteristics of oligodendroglioma (ODG), 65 cases of ODG were observed with light microscopy and partially with immunohistochemistry. According to WHO classification of tumors, 65 cases of ODG were graded in degree of differentiation of tumor cells. Of these, 19 cases belonged to grade I, 32 grade II, and 14 grade III.

CONCLUSION

Except the degree of differentiation, some other criterlons as cellular density, mitotic activities, and the presence of focally concentrated apoptotic cells are closely related to grading of ODG.

[Observation on oligodendroglioma with light, electron microscopy and immunohistochemistry]

OBJECTIVE

To investigate the ultrastructural and histological characteristics of oligodendroglioma (ODG).

METHODS

By means of light microscopy and partially electron microscopy and immunohistochemistry, 65 cases of ODG were observed.

RESULTS

According to WHO classification of the tumor, all 65 cases of ODG were graded in the degree of differentiation of tumor cells, showing 19 cases of Grade I, 32 cases of Grade II and 14 cases of Grade III.

CONCLUSIONS

(1) The presence of glial filaments in tumor cells may be explained as a heterogeneity in differentiation. (2) Besides the degree of differentiation, some other criteria such as cellular density and mitotic activity are also closely related to the grading of ODG.

[Histopathologic and immunochemical changes in Sjögren's syndrome]

To research into the causes of sjögren's syndrome, we investigated the lacrimal gland tissues of 6 cases of sjogren's syndriome by using electronmicroscopy and immunochemical methods. The results revealed that at the early stage the lacrimal gland cells showed degeneration, irregular arrangement and many intracellular vacuoles. At the middle stage, some lymphocytes infliltrated into the gland tissues. And at the advanced stage, lymphocytes and collagenous fibers were there in substitution of gland cells.

[Electron microscopic observation of hepato-cellular carcinoma in 15 cases--an ultrastructural comparison with human embryonic liver]

An ultrastructural comparison between 15 cases of hepatocellular carcinoma (HCC) and 5 cases of human embryonic liver (HEL) was performed. There were similarities. Both of them are polygonal in cell shape with a central nucleus and are abundant in RER and mitochondria; both have laminating form of RER and formation of bile capillary and perisinusoid space. These are important evidences for diagnosis of a tumor originating from hepatic cells. On the other hand, obvious differences were present between HCC and HEL. Cancer cells possess certain characteristics; they are pleomorphic and heterogeneitic; the differentiation of their ultrastructural components is not synchronic, and they are invasive in growth. These enable us to suspect the malignancy of a tumor. In addition, single death cancer cells with pyknotic nucleus were seen in HCC; some of them were phagocytozed by adjacent cells. We conside these are apoptosis even no formation of apoptoic bodies was found. In the majority of HCC cases, lymphocyte-mediated cancer cell lyses by both T-lymphocytes and large granular lymphocytes (nature killer cell) were found.

[Aneurysmal bone cyst: imaging diagnosis and evaluation of therapeutic methods]

OBJECTIVE

To determine the imaging features and useful therapeutic methods of aneurysmal bone cyst (ABC).

METHODS

The radiographs, CT, and MR scans of 82 cases of pathologically proved ABC were retrospectively analyzed. Post-therapeutic follow-up of 45 cases was carried out for 3 months to 24 years.

RESULTS

Plain radiographs showed eccentric expansile osteolysis in most cases. Fluid-fluid level was seen in 21/27 cases on CT scans, and calcification or ossification in 11/27 cases. MR images showed a hypointense rim in 7/7 cases, multilocular hyperintense cysts with hypointense septae on T2WI in 6/7 cases, and fluid-fluid levels in 5/7 cases.

CONCLUSION

CT and MR scans are superior to plain radiographs in the diagnosis of ABC in the osteolytic phase and in the axial skeleton. Curettage combined with bone graft surgery is the most effective therapeutic method for ABC of the extremities. Arterial embolization with or without surgery is valuble for the treatment of ABC arising from the axial skeleton.

[A pathological analysis of 180 cases of vascular malformation of brain]

180 cases of vascular malformation in brain (BVM) including 156 cases of brain biopsy and 24 autopsy cases were examined with routine pathological methods. The attempt of this study is to realize the pathological change and incidnce of each type and to find out the main cause of hemorrhage in BVM. According the morphological characteristics, 180 cases of BVM were classified into five types. They are: arteriovenous type 159 cases, venous type 3 cases, cavernous type 6 cases, capillary telangiectasis 1 case, and mixed type 11 cases. Hemorrhage was the most common clinical manifestation and main cause of death in BVM. The mechanism of hemorrhage may be due to either hemodynamic disturbance in local area or changes of the blood vessel wall. Besides these, there are five cases of BVM accompanied with brain tumor. They may be two independent diseases occurred in the same person. No relationship was found between the occurrence of these 2 entities.

[An ultrastructural study of the ependymoma cells and cells of the ventric zone and neural canal of embryonic brain]

In order to make clear the characteristics of cell differentiation in ependymoma, 12 ependymoma cases were studied with light and electronic microscopy, and the tumor cells were compared with cells of the ventric zone and neural canal from 8 embryonic brains. 10 out of 12 ependymoma cases were also studied with immunohistochemistry staining. According to the ultrastructural findings, four types of ependymoma were classified, namely, the primary neuroectodermal tumor with ependymoblast differentiation, the ependymoblastoma, the ependymoma, and the subependymoma. Some ultrastructural features, such as long intermediate junction and microrosette formation were considered as the important criterion for differential diagnosis,. Neuroendocrine granulas were found in one case of 12 ependymomas which is considered to be heterogenic in differentiation.

[A comparison between astrocytoma cells and the developing astrocytes in human embryo brain by electron microscopy]

60 cases of astrocytoma of brain and 8 human embryo brains were studied with light and electron microscopy. The 5 types of tumor cells in astrocytoma include the undifferentiated, pre-astrocyte, astrocyte gemistocyte and tumor giant cells. Some similarities were found between the ultrastructure of astrocytoma and that of the developing astrocyte, the tumor cells somewhat resembling the cells of developing astrocytes. But certain differences were observed, the tumor cells were usually polymorphic with increased chromatin in nucleus, and asynchronism between nucleus and cytoplasm differentiation was sometimes found. The current nomenclature and classification of astrocytoma were evaluated and discussed, the author's opinion on classification was presented.

[Recurrent astrocytoma versus primary astrocytoma: a comparative study of morphological changes of 32 cases]

The pathologic morphological changes of 32 cases of recurrent astrocytoma (RA) and primary astrocytoma were reported. During recurrence, 20 cases (62.5%) of astrocytomas transformed into cases at higher grades. Twelve cases remained at the same grades as primary tumors. Among 21 cases of RA at grades III and IV, 15 cases (71.4%) came from primary astrocytomas, grades I and II. The change from astrocytoma grade I to grade III or IV took time longer than that from grade II to grade III or IV. The recurrent time of astrocytomas with different grades showed no statistical differences. Postoperative radiotherapy/chemotherapy did not play a major role in grading changes and recurrent time.

[The ultrastructural changes of infiltrating gastric carcinoma cells and their surrounding structures]

The ultrastructural changes of infiltrating gastric carcinoma cells and their surrounding structures, including extracellular matrix and tissues of target organ were observed under electron microscope. Foot-like processes with abundant microfilaments extended from one side of the surface of cancer cell were found. The microfilaments were lost with the disappearance of foot-like processes. It hinted that there might be some relationship between the presence of microfilaments and the movement of cancer cells. Around the foot-like processes of infiltrating cancer cell, the local basal lamina always disappeared, and a zone of amorphous matrix was shown. It may result from the action of collagenase. Sometimes the basal lamina may reappear, even on the surface of metastating cancer cell. No direct evidence of destruction of smooth muscle cell by the cancer cell was found. The atrophy and degeneration of smooth muscle cells may be the changes indirectly caused by the infiltrating cancer cells.

[A study on the relationship between pathologic morphology and clinical prognosis of renal cell carcinoma]

One hundred and six cases of renal cell carcinoma (RCC) were studied with an objective to investigate the effects of clinical stages, histological patterns (grading), cell types, nuclear grading and tumor sizes on the postoperative survival time of the patients. The results showed that there were no statistical differences in the postoperative survival time among different histological patterns and among different cellular types, such as clear cell, granular cell and mixed cell. But those with either diffuse sarcomatoid pattern or undifferentiated cell type had poor prognosis. The patients with tumor size greater than 10 cm in diameter had poor prognosis. The prognosis-deciding factors for RCC patients were the clinical staging and nuclear grading. We suggest that the nuclear grading of RCC be noted in every pathological report, so as to provide reference for clinical evaluation of the prognosis and further treatment.

[Ultrastructural study of stromal elements of lung carcinoma]

We studied the fine features of stromal elements in 33 cases of human lung carcinoma by electron microscopy. Cancer cells showed the damages to the basement membrane and matrix. On the other hand, stromal elements showed changes responding to the invasion of cancer cells. Lymphocytes and macrophages showed the activity of killing cancer cells. Most cell directly contacts the myofibroblast and fibroblast. Matured myofibroblast, early myofibroblast, active fibroblast and resting fibroblast were present near the nest of carcinoma. We discussed the roles and significance of stromal reactions.

[Ultrastructural study of the parenchyma of lung carcinoma]

Thirty three cases of human lung carcinoma were studied by both light microscopy and electron microscopy. The diagnoses of 24 cases initially made by light microscopy were changed, extended, or supplemented by electron microscopic observation. Nineteen cases showed heterogeneity. Bidirectional or tripartite differentiation was frequently found in the same case, even in the same cell. The diagnosis and heterogeneity of lung carcinoma were discussed.

[Clinicopathologic and ultrastructural studies of olfactory neuroblastoma]

The clinicopathologic and ultrastructural studies of 12 cases of olfactory neuroblastoma were made. The ages of patients ranged from 2 to 58 years with a mean of 32. Eleven cases occurred in men and 1 case in woman. An acidophilic fibrillary intercytoplasmic background was present in every case. Its amount varied focally. Ultrastructurally, the acidophilic fibrillary background was composed of neuronal cell processes. Homer-Wright rosettes were found in 7 cases, Flexner type rosettes in 4 cases, 3 of which shared both Homer-Wright and Flexner type rosettes. Almost all cases with rosettes also had apparent acidophilic fibrillary intercytoplasmic background. So, we think that acidophilic fibrillary intercytoplasmic background was the most useful diagnostic feature by light microscopic observation. The diagnosis of olfactory neuroblastoma by electron microscopy was mainly based on neuronal processes, neurosecretory granules, microtubules, neurofilaments, synaptic-like junctions and occasionally both microvilli and olfactory vesicles at the luminal borders of Flexner type rosettes.