Volume 92  ·   Issue 39  ·  2012

Pituitary adenoma is a common intracranial benign tumor derived from adenopituitary cells, accounting for about 15% of nervous system tumors, second only to glioma and meningioma [1-2]. In recent years, with the development and popularization of minimally invasive neurosurgical techniques, imaging techniques and endocrine hormone detection methods, most provincial hospitals and some regional hospitals have carried out surgical treatment of pituitary adenoma. However, due to the lack of experience and irregular treatment of some doctors, the residual pituitary function of patients is damaged or destroyed to some extent, which affects the quality of life of patients and brings various adverse effects to individuals, families and society. Therefore, it is particularly important to make individualized, standardized and appropriate treatment plans according to the specific condition of patients, protect their residual pituitary gland and pituitary function as much as possible and improve their quality of life during the treatment process. The overall treatment goals of pituitary adenoma are: remove or reduce the compressive effect of tumor and prevent its recurrence; Controlling abnormally elevated hormone levels within the normal range; Restore and preserve pituitary function; Improve local and systemic complications caused by tumor compression or excessive hormone secretion level [3]. This article focuses on how to protect pituitary function from the following aspects.

Objective To explore the surgical efficacy of transforminal lumbar interbody fusion (TLIF) technique in the treatment of lumbar intervertebral disc herniation with lumbar instability.Methods From November 2008 to August 2011,47 patients of lumbar intervertebral disc herniation underwent TLIF.There were 25 males and 22 females with an average age of 52 years (range:30-68).The preoperative diagnoses included lumber intervertebral disc herniation plus lumbar instability (n =16);lumbar degenerative spondylolisthesis (n =9) ; lumbar spinal stenosis (n =15) and degenerative lumbar scoliosis (n =7).A total of 63 levels were fused,including single level (n =31) and double levels (n =16).Posterolateral fixation was secured with pedicle screw.Unilateral resections of inferior articular facet of superior vertebra and superior articular facet of inferior vertebra were performed to expose unilateral intervertebral vertebral foramen.Decompression of vertebral canal was expanded to the opposite side if symptoms recurred when never root was decompressed satisfactorily.Finally TLIF was performed routinely.The standard criteria of JOA (Japanese Orthopedic Association) and ODI (Oswestry disability index) were applied for efficacy evaluations.And the intervertebral height and bone fusion were observed radiologically.Results All patients underwent surgery smoothly without severe complications.The average follow-up period was 19.6 months (range:6-36).Significant differences existed in JOA score between preoperation (11.0 ± 2.8) and postoperation (15.4 ± 3.4) (P =0.0l) and ODI score between preoperation (37.8 ±4.6) and postoperation (18.8 ± 3.8).At 6.5 months postoperatively,all operated segments achieved fusion and there was no broken screw.There was 1 case of cage dislocation.Conclusion In select patients of lumbar intervertebral disc herniation with spinal instability,TLIF may be performedeasily and safely with fewer complications and total root decompression.

Objective The study of blood flow improvement of local estrogen on the low genitourinary tract and its safety.Methods The color Doppler flow imaging technique was employed to observe the flow spectrum of genitourinary tract.During the period of February 2007 to December 2010,there were 78 cases of postmenopausal females on local estrogen.The Doppler parameters included vaginal wall,urethra resistance index (RI) and systolic/diastolic ratio and others.And the lower genital urinary tract symptoms,such as sexual satisfaction,vulvovaginitis,urinary frequency,nocturia and other improvements,as well as adverse drug reactions before treatment and after 1 month,3 months were recorded and analyzed.Results The results before treatment and after 1 month,3 months,vaginal wall artery RI were 0.9 ±0.2,0.6±0.2 and 0.7 ±0.3; S/D 8.6 ±3.7,6.0 ±2.9 and 6.4 ±2.1; urethral artery RI 0.7±0.2,0.6±0.2 and 0.6±0.2,S/D6.6± 1.9,3.5±0.7 and 3.4±0.5 respectively.When the pre-and post-treatment indices were compared,the differences were statistically significant (P ＜ 0.01).After using local estrogen in postmenopausal women,the resistance of lower genital urinary tract vasodilation decreased.Sexual satisfaction increased while the morbidities of vulvovaginitis,urinary frequency and nocturia decreased.The difference was statistically significant (P ＜ 0.01).Conclusion Postmenopausal females on topical estrogen may promote the blood circulation of lower genitourinary tract,red.

Objective To detect the expression of B7-H4 in salivary gland and sera in paticnts with primary Sjogren's syndrome (pSS).Methods A total of 40 pSS patients were referred to our department from June 2009 to January 2011.Immunohistochemistry and flow cytometry were used to detect the expression of B7-H4 in salivary gland from pSS patients and disease controls.Enzyme-linked immunosorbent assay (ELISA) was used to detect soluble B7-H4 of serum from pSS patients and healthy donors.Results Immunohistological staining revealed that B7-H4 antigen was restricted to tubular epithelium.The B7-H4 positive expression of tubules in salivary gland biopsies from pSS patients (18 ± 14)％ were lower than that of controls (85 ± 13)％ (P ＜ 0.05).Flow cytometry revealed that the B7-H4 expression of cell suspensions from salivary gland from pSS patients (42 ± 21)％ were lower than that of controls (48 ± 22)％(P ＜0.01).And the serum level of soluble B7-H4 detected in pSS patients (49 ± 31)μg/L significantly decreased than that in healthy donors (71 ± 27)μg/L (P ＜ 0.05)and positively correlated with saliva and tear flow rates (P ＜ 0.01) respectively.Conclusion The expression of B7-H4 molecule may play some roles in the progression of pSS.And a further understanding of its mechanism helps to elucidate the pathogenesis of pSS.

Objective To explore the diffusion tensor imaging (DTI) features of white matter in healthy siblings of schizophrenics. Methods Twenty healthy siblings of schizophrenics and 45 healthy controls without a family history of mental disorder. They responded to advertised recruitment during December 2009 and March 2012. All participants underwent diffusion weighted magnetic resonance images with a single-shot echo planar imaging (EPI)sequence aligned to straight axial plane. The fractionalanisotropy (FA)images of two groups underwent two-sample t-test with SPM5 software. Results The healthy siblings of schizophrenics demonstrated a significant decrease of regional white matter FA values in right anterior cingulated (MNI:x =9, y = 43,z = 4;cluster = 106) . Conclusion Reduced white matter integrity in right anterior cingulated may be a risk actor of schizophrenia.

Objective To explore the incidence of postoperative venous thromboemolism (VTE) in adult patients with primary bone tumor undergoing knee operation and evaluate its efficacy and safety in the prevention of VTE.Methods For this prospective,randomized and negative-control single-center trial,a total of 100 eligible patients were selected and randomly divided into observation and control groups.Observation group (rivaroxaban):the first rivaroxaban tablet was taken in the first 24 hours after operation.Rivaroxaban was administered daily every 24 hours up to Day 14.Control group:no anticoagulant was taken postoperatively.Results Efficacy indictors:6 cases of DVT (an incidence of 12％) occurred in the observation group versus 15 (30％) in the control group.Significant statistical difference existed between two groups (P ＜ 0.05).Furthermore,neither pulmonary embolism nor death was found in either group,Safety indicators:a total of 3 bleeding (1 major and 2 non-major) cases occurred in observation group versus a total of 2 bleeding (no major and 2 non-major) cases in control group.No significant statistical difference existed in bleeding events (P ＞ 0.05).The total incidence of adverse effect was 6％ (3/50) in the observation group.The drainage volume of the observation group was a little more than that of the control group.But no significant statistical difference existed in drainage duration (P ＞ 0.05).And there was almost no change in the coagulation system by laboratory examination after oral administration.Conclusion With an excellent safety profile and a low incidence of adverse effects,Rivaroxaban is effective and safe in the prevention of VTE in adult patients with primary bone tumor undergoing knee operation.

Objectives This study is designed to determine the impact of the short-time usage of prophylactic antibiotics to prevent postoperative wound infection in spinal surgery.Methods The medical records of 965 patients who underwent cervical spinal operation between 2009 and 2011 were collected for the assessment.These patients were divided into two groups based on antibiotic selection and duration of prophylactic antibiotic treatment:234 patients treated with prophylactic antibiotics for a short period of time were set as Group A,whereas Group B included 731 patients treated with prophylactic antibiotics for experience-based length of time.All the patients' records,including personal information,preoperational medical records,surgical records,postoperative medical information and the development of surgical site infections,were collected for analysis.Results In Group A,153 patients were treated by second generation cephalosporins and 81 patients were treated by clindamycin.The duration of treatment was 1.17 ± 0.38days.In Group B,41 patients were treated by penicillin,375 and 2 patients were treated by second and third generation cephalosporins,respectively,128 patients were treated by clindamycin,42 patients were treated by cephamycin,128 patients were treated by quinolone,other antibiotic was used by 1 patient and other 14 patients were treated by combinations of antibiotics.The duration of the treatment in Group B was 5.72 ±1.63 days.The significant differences between the length of treatment time in Group A and B were observed (P ＜ 0.001).There were no statistical differences of pre-/post-operational leukocytes number compared between Group A and B.In addition,although the neutrophils in Group A and B are 70.70％ ±9.71％ and 67.09％ ± 9.78％ respectively,indicating a subtle difference (t =2.921,P =0.004),however,these numbers were in normal range; therefore,no clinical significance was found from the comparison of neutrophils in groups.A total of 7 cases (0.73％) of surgical site infection were recorded,including 4 cases (1,71％) in Group A and 3 cases (0.41％) in Group B,all of which were posterior laminoplasty.With Fisher analysis (P =0.063),these infection rates were not statistically significant.Conclusions An appropriate usage of prophylactic antibiotics in a short period of time in cervical spinal surgery did not increase the rate of surgical site infection.

Objective To explore the feasibility,short-term efficacies and complications of computed tomography (CT)-guided 125Ⅰ interstitial implant therapy for recurrent ovarian cancer.Methods From October 2009 to November 2010,a total of 25 lesions for 12 patients were diagnosed as recurrent ovarian cancer by positron emission tomography/computed tomography (PET/CT).Among 25 lesions,21 underwent 125Ⅰ seed implantation.And 4 lesions of liver and spleen in one patient were treated with microwave ablation.Nine patients underwent 2-6 cycles of chemotherapy after seeding.There were 11 lesions with diameter ＞ 2 cm and 10 ≤2 cm.According to the area of physiologic 18FDG uptake in lesions,the treatment plans were formulated by computerized treatment planning system (TPS) and Memorial Sloan-Ketterin nomograph.The matched peripheral dose (MPD) was 145 Gy in target mass.A median of 20.5 seeds per patient (range:9-45) were implanted.The efficacies were evaluated by CT and 18F-FDG PET/CT findings.Results One patient died of renal failure while the other patients survived during a median followup of 15 mouths (range:9-19).Ten lesions showed complete remission,6 partial remission and 5 progressive disease.The effective rate was 76.2％ (16/21).Compared with those ＞ 2 cm,the lesions ≤2 cm in diameter had a better local control rate by Fisher's exact test (P =0.035).The hepatic and renallesions treated by microwave ablation showed inactivation on PET/CT.Only one patient suffered from sciatic nerve injury caused by punctuation and numbness and pain of right lower extremity were persistent.There was no onset of the complications of radiation injury,such as intestinal fistula and proctitis.Conclusion The CT-guided 125Ⅰ interstitial implant therapy for recurrent ovarian cancer yields excellent short-term efficacies with fewer complications.The combined modality of 125I interstitial implant and chemotherapy may further improve the patient outcomes.

Objective To explore the clinical features of Chinese patients with congenital stationary night blindness (CSNB).Methods An observational serial case study was conducted for 22 patients diagnosed as CSNB at Department of Ophthalmology,Peking Union Medical College Hospital from December 2003 through December 2011.Sixteen patients (72.7％) were males and 6 patients (27.3％) were females.Their age range was 4-73 years old.All of them underwent detailed ocular examinations including electroretinogram (ERG).Thirteen patients underwent optical coherence tomography (OCT) while 9 had visual field (VF) testing.Medical and family history was recorded.Results Seven patients had a positive family history.Thirteen patients (59.1％) complained of a poor night vision.Best corrected visual acuity was ＜ 0.8 in both eyes for 16 patients (72.7％).There were nystagmus (n =4) and strabismus (n =4).Except for 1 complicated with background diabetic retinopathy,all other patients showed normal or myopic fundi.Nine patients revealed peripheral visual field defects.Twenty-one (95.5％) patients had Schubert-Bornstein type negative ERG while another one had Riggs type ERG.Among 21 Schubert-Bornstein type patients,13 (61.9％) patients showed complete type CSNB and 8 (38.1％) were of incomplete CSNB.Before referral to our tertiary hospital,only 2 patients were suspected as CSNB.The common primary diagnoses included pathogenic myopia,amblyopia and retinitis pigmentosa.Conclusion CSNB is frequently misdiagnosed in China.Poor visual acuity is one of the major complaints.And around 50％ CSNB patients experience night vision problem.Complete CSNB is more common than incomplete type in China.

Objective To evaluate the effects of using longer endografts in conjunctions with the location of Adamkiewicz artery (AKA) on midterm outcomes of endovascular treatment for thoracic aortic dissection.Methods From March 2005 to September 2011,217 patients with type B dissection were recruited.There were 143 males and 74 females with a mean age of 65 ± 11 years.Among them,43 patients were from Fifth Affiliated Hospital of Sun Yat-Sen University while another 174 patients from Affiliated Zhongshan Hospital of Fudan University.They were divided into 2 groups according to whether AKA was identified or not pre-operatively.Endovascular repairs were performed for all patients.Distal landing levels of endograft were recorded.The thrombosis of false lumen and the complications of spinal cord injury and endoleak were analyzed.Results AKA was detected in 121 (55.8％) patients (group A) but not in 96 (44.2％) patients (group B).According to the levels of AKA,the patients of group A obtained the stabilization of affected thoracic aorta over a longer distance.And the ratio of patients with distal landing levels at T8-T10 was significantly higher than in group B (59.5％ vs 12.5％,x2 =49.85,P ＜0.01).Also,during the follow-up period of 7.3 months,the ratio of patients with total thrombosis of false lumen in group A was significantly higher than that in group B (32.1％ vs 19.1％,x2 =4.34,P ＜0.05).Conclusion During the endovascular repair of thoracic aortic dissection,selecting a longer device may provide a better structural stability of affected aorta and promote false lumen thrombosis.

Objective To evaluate the efficacy and safety of real-time three-dimensional dobutamine stress echocardiography for coronary artery disease assessment.Methods A total of 14 patients suspected of coronary artery disease (CAD) underwent real-time three-dimensional dobutamine stress echocardiography.The initial infusion rate of dobutamine was 5 μg · kg-1 · min-1,followed by 10 μg · kg-1 · min-1 and peak infusion 20 μg · kg-1 · min-1 in 3 min stages.At baseline state,stress stages and after the study,the real-time three-dimensional (RT3D) images were captured and assessed by wall motion score index (WMSI) and regional ejection fraction (rEF).And the parameters of these two modalities versus coronary angiography (CAG) were compared and analyzed.Adverse reactions were also observed.Results All patients completed the stress study uneventfully.As compared with CAG,these two modalities showed no significant difference (P ＞ 0.05) and satisfactory agreement (κ values of 0.704 and 0.759 respectively).The diagnostic parameters of these modalities were:sensitivity (78％ vs 89％),specificity (92％ vs 88％),positive predictive value (PPV) (88％ vs 84％),negative predictive value (NPV) (85％ vs 91％) and overall accuracy (86％ vs 88％).Conclusion Real-time three-dimensional dobutamine stress echocardiography is an effective,rapid and safe technique of assessing coronary artery disease.It is worthy of wider clinical applications.

Objective To investigate the role of P2Y12 receptor in rat bone cancer pain model and its influence on p38MAPK (Mitogen-activated protein kinase).Method A total of forty female SD rats,weighting 200-250 g,were randomly divided into 5 groups (n =8):normal group (group N),sham group (group S),vehicle group (group DA),cancer group (group A),and analgesia group (group MA).Rats in group N were untreated,rats in group S were injected with Hank's solution 10 μl into the left tibal metaphysis; rats in group DA,group A and group MA were injected with Walker256 cancer cells (10 μl,2 × 107 cells/ml) into the left tibal metaphysic to establish the model of bone cancer pain.Catheterization was simultaneously made in four groups between L3 and L4 vertebra except group N.Saline (0.9％,15 μl)was injected in group S and group A,DMSO (5％,15 μl) was injected in group DA,and MRS2395 (400 pmol/μl,15 μl) was injected in group MA on day 9 to 12 post-inoculation.Mechanical withdrawal thresholds were measured on left hind paw before and every 10 min after intrathecal injection.Rats were euthanized after measuring mechanical withdrawal threshold at day 12 post-inoculation.L4-6 sections of spinal cord were collected to determine the expression of p-p38MAPK by immunohistochemistry and immunofluorescent.Result Compared to that in group N (36.1 g ± 4.0 g) and group S (38.9 g± 5.2 g),mechanical withdrawalthresholds in group MA (19.8 g±5.0 g) were decreased ou day 9 post-inoculation (P ＜ 0.01),and the expression of p-p38MAPK in spinal cord was increased on day 12 (P ＜ 0.01).Compared to that in group DA (17.7 g ± 3.0 g) and group A (19.1 g ± 2.5 g),mechanical withdrawal threshold in group MA was obviously increased after intrathecal injection,peaked at (26.5 g ± 4.7 g) (P ＜ 0.05) ; compared with group DA (number 43.4 ± 3.8,IOD 569 ± 27) and group A (number 45.0 ± 2.6,IOD 594 ± 22),the expression level of p-p38MAPK in spinal cord in group MA at day 12 was significantly decreased (number 20.9 ± 2.2,IOD 246 ± 25) (P ＜ 0.01) ; Mechanical withdrawal threshold in group MA was still lower than group N and group S,while the expression of p-p38MAPK was higher than group N (number 9.9 ± 2.4,IOD 82 ± 28) and group S (number 10.9 ± 2.2,IOD 109 ± 25) (P ＜ 0.01).Immunofluorescent showed that p-p38MAPK was colocalized with microglia in spinal dorsal horn,but not with neurons and astrocytes.Conclusions These results demonstrate rat bone cancer pain could partially relieved after intrathecal injection of P2Y12 receptor inhibitor MRS2395 through inhibiting the phosphorylation of p38MAPK in spinal dorsal horn.

Metastatic epidural cord compression (MESCC) refers to the syndrome of spinal cord or cauda equina nerve compression damage caused by various epidural metastases. It has an acute onset, rapid progression, and causes serious neurological damage in a short period of time. It is one of the more harmful complications for tumor patients [1]. With the continuous progress of tumor diagnosis and treatment technology, the survival time and quality of life of tumor patients are constantly improved.The incidence of epidural cord compression (ESCC) is also constantly increasing.This article summarizes the clinical situation and treatment experience of 29 patients with metastatic ESCC admitted to Peking Union Medical College Hospital from 1995 to 2011, and is reported as follows.

Amyotrophic lateral sclerosis (ALS), also known as motor neuron disease (MND), is a heterogeneous clinical syndrome involving anterior horn cells of the spinal cord, motor nucleus of the brainstem and pyramidal tract, with damage to upper and lower motor neurons. The main clinical features are selective invasion of upper and lower motor neurons (MN), progressive aggravation of muscle atrophy, muscle weakness and pyramidal tract signs, and its sensory system is generally not invaded. ALS is fatal, because there is no effective treatment, 80% ~90% of patients die of bulbar paralysis, respiratory muscle paralysis or pulmonary infection 3~5 years after the onset of ALS. ALS is distributed worldwide, 90% ~95% of patients are sporadic ALS (SALS), 5% ~10% are familial ALS (FALS). The average onset age of SALS is 50 years old, and FALS is usually 10 years later than SALS. The incidence ratio of male to female is 1.5:1. The incidence rate of this disease is about 1~2/100,000, and the prevalence rate is 4~6/100,000 [1].

Lung cancer is the most common malignant tumor in the world, and its morbidity and mortality rank first. Lung cancer is a systemic disease, and many patients are in advanced stage when lung cancer is discovered. Early diagnosis and early resection can undoubtedly improve the cure rate and survival rate of patients. At present, there is no effective means for early screening of lung cancer. With the continuous deepening of research on peripheral blood circulation DNA, blood circulation DNA detection as a means of early screening of lung cancer has gradually entered the field of vision of researchers.

A 43-year-old male developed hoarseness, no sore throat, and no blood in sputum 3 years ago without obvious trigger, but the patient did not pay attention to it. Later, the hoarseness progressively worsened, and 1 year ago, cough, sputum and blood in sputum appeared without obvious trigger, 5 to 6 times before and after, with a small amount and bright red. The patient took anti-inflammatory drugs for nothing (details are unknown), and the blood in sputum disappeared, but the hoarseness did not improve significantly. Six months ago, the patient experienced sore throat again without obvious trigger, cough, sputum with a little blood in sputum, but there was no shortness of breath and chest tightness. The patient came to Hangzhou Third People's Hospital for treatment. After video laryngoscopy examination in the outpatient clinic, he was diagnosed as "laryngeal neoplasm", and was given oral anti-inflammatory treatment, and he was recommended to be hospitalized. After taking the medicine, the sore throat disappeared, and the hoarseness improved slightly, but the treatment was not continued.

Alteplase (recombinant plasminogen activator) is the only thrombolytic drug approved by the National Food and Drug Administration for the treatment of acute ischemic stroke. After recanalization of blocked blood vessels induced by alteplase after stroke, reocclusion will occur in 14% ~34% of patients, which may be caused by platelet activation. Therefore, many scholars in neurology believe that antiplatelet therapy should be given early, but stroke guidelines in various countries do not recommend aspirin antiplatelet therapy 24 hours after thrombolysis. Therefore, Dutch scholars led by Professor Zinkstok observed patients who were given early intravenous aspirin 300 mg within 90 minutes after thrombolytic therapy with alteplase within the time window of acute ischemic stroke. The results of the study were published in Lancet, published online June 28, 2012.

Depression affects approximately 5% of the population every year, is the fourth leading cause of global disease burden and the leading cause of disability worldwide.Depression severely reduces the quality of life of individuals and families,is a risk factor for suicide,and often leads to the worsening of other physical health problems [1]. At present, antidepressants usually take several weeks to produce beneficial clinical effects,and only close to 50% of patients are cured after acute phase treatment.In the STAR*D study, a 50% reduction rate of HAMD-17 scores was defined as effective, and the results showed that antidepressant treatment was effective only in half of patients [2].

Recently, Yang Pu et al. [1] published a paper "Expression of heat shock protein 27 in hippocampal CA1 region of rats with temporal lobe epilepsy" in Chinese medical journal, which provided very useful information. The article emphasized the importance of heat shock protein 27 gene (HSP27 gene) in neuronal protection and pathological mechanisms. For example, the prominent expression of HSP27 in the development of neuropathy can play a role in protecting sensory neurons in diabetic patients [2]. Similarly, the transduction of PEP-1-HSP27 gene is related to the attenuation of a large number of substantia nigra cells in Parkinson's disease model [3], and its role is achieved by attenuating the apoptosis process of dopaminergic nerve tissues. Intermediates such as FLZ play a cytoprotective role by inducing HSP27 in Parkinson's disease [4]; For another example, HSP27 plays a role in preventing cerebral ischemia by phosphorylating protein kinase D [5]. HSP27 also plays a neuroprotective role in acute and chronic alcohol intake [6]. HSP27 plays a role in protecting and helping brain repair in encephalomyelitis [7]. HSP27 plays a role in protecting neurons by increasing amyloid precipitation [8].

aggressive angiomyxoma (AAM) is a rare mesenchymal mucinous cell tumor, which occurs in female perineum and is more common in childbearing age. In 1983, Steeper et al. first proposed the name of AAM according to the characteristics of aggressive growth and recurrence but no distant metastasis after surgery. Invasion refers to the tumor that often invades and recurs locally and is invasive [1]. In 2003, WHO classified it as deep angiomyxoma.

The patient was an 81-year-old male with abdominal distension and anorexia for more than 1 month. Abdominal CT showed space-occupying lesions in gastric antrum, which was consistent with the changes of gastric cancer (Figure 1). Biopsy pathology: (gastric antrum) moderately differentiated carcinoma; The patient was diagnosed with gastric cancer and planned to undergo surgical treatment in the basic surgery department of Peking Union Medical College Hospital. The patient had a history of cerebral infarction and left limb mobility impairment. Cervical CT angiography (CTA) showed that the right internal carotid artery was occluded and the opening of the left internal carotid artery was severe stenosis (Figure 2). The patient had a history of hypertension and had good blood pressure control.

A 76-year-old female patient developed macroscopic hematuria one month ago, without urgency, frequency and pain in urination, accompanied by distension in the lower abdomen. After local symptomatic and supportive treatment, she was transferred to the Provincial Hospital affiliated to Anhui Medical University for treatment. During the course of the disease, she had no fever, nausea and vomiting, and normal stool. B-ultrasound showed a 31mm ×34mm slightly hyperechoic mass in the left renal collection system, with clear and irregular boundaries.