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Objective: To explore the evaluation effect of ultrasonography and Pirani score on tarsal deformity, treatment effect and pseudo-correction of congenital clubfoot in infants and young children, and the correlation between the two methods. Methods: This is a retrospective case series study. The clinical data of 26 children (40 feet) with congenital clubfoot who were evaluated by ultrasonography in the Third Affiliated Hospital of Zhengzhou University from January 2020 to January 2023 were retrospectively collected. There were 16 males and 10 females. The age at the first ultrasound examination was ( M (IQR)) 9.0 (18.0) days (range: 1 to 46 days). All patients were treated with Ponseti method by the same physician. The Pirani scores before and after treatment and at the last examination, and the talonavicular angle, calcaneocuboid angle and tibiocalcaneal angle measured by ultrasound were collected, and the treatment and follow-up were recorded. Paired sample t test, repeated measures analysis of variance or Kruskal-Wallis test were used for data comparison, and Spearman correlation analysis was used for correlation analysis. The receiver operating characteristic curve was used to calculate the efficacy of ultrasound in evaluating different Pirani scores. Results: The number of plaster fixation in 26 children was 4.0 (1.0) times (range: 2 to 8 times). The medial talonavicular angle and posterior tibiocalcaneal angle were significantly improved after treatment and at the last follow-up compared with those before treatment, and the differences were statistically significant (all P <0.01). There was no difference in lateral calcaneocuboid angle before and after treatment and at the last follow-up ( F =1.971, P >0.05). Pseudo-correction occurred in 2 cases (2 feet) during the treatment, with an incidence of 5%. Correlation analysis showed that there was a moderate positive correlation between talonavicular angle and Pirani midfoot score ( r =0.480, P <0.01). There was no correlation between calcaneocuboid angle and Pirani midfoot score ( r =0.114, P =0.105). There was a moderate negative correlation between tibial heel angle and Pirani hindfoot score ( r =-0.566, P <0.01). The cut-off point of Pirani midfoot score of 1.5 was 38.78°, the sensitivity was 0.90, the specificity was 0.56, and the area under the curve was 0.75. The cut-off value of angle was 27.51 °, the sensitivity was 0.16, the specificity was 0.92, and the area under the curve was 0.44.The cut-off points of Pirani midfoot score of 3.0 were 45.08°and 9.96°, the sensitivity was 0.94 and 0.91, the specificity was 0.37 and 0.42, and the area under the curve was 0.59 and 0.62, respectively. The cut-off values of Pirani hindfoot score of 2.0 and 3.0 were 167.46° and 160.15°, respectively. The sensitivity was 0.75 and 0.67, the specificity was 0.81 and 0.83, and the area under the curve was 0.78 and 0.71, respectively. Conclusion: Ultrasound can complement with Pirani score, visually and dynamically observe the morphology and position changes of talonavicular joint, calcaneocuboid joint and tibiotalocalcaneal joint, monitor the recovery and pseudo-correction of tarsal bones, and better evaluate the therapeutic effect.

Telesurgery, which utilizes remote communication technology and surgical robots for operations, is an emerging method that breaks the constraints of space on surgical procedures and is an important development direction for future surgery. With a vast territory, telesurgery has the potential to become a candidate method to improve the uneven distribution of regional medical resources. In recent years, with the development and maturity of China's domestic surgical robot technology and communication technology, China has made rapid progress in the field of telesurgery, but is still in the primary stage of development, facing many challenges and also taking advantage of opportunities. The next 20 years will be a golden opportunity for the development of telesurgery worldwide, and it is a hopeful view that Chinese surgeons will seize the opportunity and face the challenges to lead the development of telesurgery.

Objective: To review and discuss the experience of diagnosis and treatment of adrenal ganglioneuroma. Methods: Clinical data of 80 cases of adrenal ganglioneuroma undergoing surgery during January 1982 to May 2017 at Peking Union Medical College Hospital were retrospectively analyzed. There were 36 male and 44 female patients. Age ranged from 8 to 69 years old (mean 37.7 years old). The tumor diameter were 1.5 to 18.0 cm (mean 4.3 cm). There were 61 cases of adrenal ganglioneuroma diagnosed by imaging examination. All patients underwent adrenalectomy. Results: All procedures were performed successfully without serious complication. Including 15 open surgery and 64 retroperitoneal laparoscopic surgery. One laparoscopic case conversion to open surgery. The pathological diagnosis was adrenal ganglioneuroma. Fifteen cases were mixed with other tumor components. No recurrence or metastasis was observed during the follow-up of 2 months to 35 years. Conclusions: The diagnostic techniques for adrenal ganglioneuroma are helpful to judge the tumor property before operation. The laparoscopic surgery has become the current method for resecting tumors. It shows advantages of small trauma and speedy recovery. The relationship between tumor and surrounding tissues should be understand clearly before operation. Full preparation must be made before operation if adrenal ganglioneuroma mixed with other tumor components.

Tuberous sclerosis complex is an autosomal dominant disease involving multiple organs and multiple systems. The main manifestation is renal angiomyolipoma in the kidney. It is the most common cause of death in adults, because of its high incidence, rapid growth and bleeding. The incidence of this disease is low and the cognition is not enough, so the diagnosis and treatment are lack of standardization. Recently, the expert consensus of the diagnosis and treatment of tuberous sclerosis related renal angiomyolipoma has been established in China. This content fills the gap in this field in China. With the development of precision medicine, the diagnosis and treatment of such diseases are also progressing.

With the aging of the population, changes in diet and medical examination popular, the incidence and mortality of prostate cancer in China are increasing year by year. Over the past year, a large number of clinical and basic researchers focus on various perspectives of prostate cancer, which may provide new direction for the clinical diagnosis and treatment of prostate cancer. In this paper, the near year important progress in the forefront of prostate cancer has been reviewed and summed up in two major aspects: diagnosis and treatment.

Prostate cancer is currently diagnosed by prostate biopsy performed by the transrectal ultrasound-guided technique. However, overdetection of clinical insignificant tumours and missed detection of clinical significant tumours have become problematic. MRI of the prostate, particularly if performed with multiparametric imaging, is capable of detecting clinical significant prostate cancer, which has brought the opportunity to use those images as targets for needle biopsy. Three methods of fusing MRI for targeted biopsy have been recently described: MRI-ultrasound fusion, MRI-MRI fusion ('in-bore' biopsy) and cognitive fusion. Fusion of MRI with ultrasound allows urologists to progress from blind, systematic biopsies to biopsies, which are mapped, targeted and tracked. In the future, MRI-ultrasound fusion for lesion targeting is likely to result in fewer and more accurate prostate biopsies than the present use of systematic biopsies with ultrasound guidance alone.

Objective: To explore how clinical features of renal cell carcinoma (RCC) relate to cancer patients' prognosis and survival., Methods: A total of 1 497 renal cell carcinoma patients received surgical treatments in Department of Urology, Peking Union Medical College were admitted between January 2002 and December 2012. Telephone interviews and complimentary medical records review were carried out to acquire follow-up data, including post-surgery adjuvant therapy, disease progression and survival., Results: There were 1 326 of all 1 497 RCC cases successfully followed up, including 899 male and 427 female cases. The median age was 54(18) years (M(QR)). There were 1 049 T1 cases (79.11%), 139 T2 cases (10.48%), 125 T3 cases (9.43%), and 13 T4 cases (0.98%). As for types of surgery, there were 584 (44.04%) nephron-sparing surgery cases, and 742 (55.96%) radical nephrectomy cases. As for pathological subtypes, it included 1 153 (86.95%) clear cell renal cell carcinoma cases, and 173 (13.05%) non-clear cell renal cell carcinoma cases. Median length of follow-up was 43.6 months. During follow-up, 147 patients developed RCC related progression, with a median progression free survival of 18.2 months.Sixty-four patients died from RCC related progression, with a median cancer specific survival (CSS) of 27.7 months. RESULTS of data analysis showed that CSS rates of 1-, 5-, 10-year of T1 stage post-surgical RCC were 99.61%, 97.24%, 92.08%, respectively; CSS rates of 1-, 5-, 10-year of T2 stage were 98.51%, 92.01%, 85.08%, respectively; and CSS rates of 1-, 5-, 10-year of T3-4 stage were 92.40%, 77.99%, 42.56%, respectively. Multivariable Cox regression analysis showed that signs of lung metastasis, signs of bone metastasis, tumor N stage, pathological subtype, microscopic sarcomatoid changing, and types of progression were major risk factors for RCC cancer specific survival (P<0.05)., Conclusions: Surgery is the primary choice of treatment in RCC. The survival is not same with different T stage. T stage affects the progression of renal cell carcinoma. N stage, lung and bone symptoms, pathological type, sarcomatoid changes and postoperative metastasis of renal cell carcinoma will affect the mortality of patients.

Objective: To evaluate the effectiveness and safety of the combined therapy of doxazosin and tolterodine for BPH patients with dominant storage symptoms., Methods: From May 2009 to April 2010, 76 patients diagnosed as benign prostatic hyperplasia (BPH) by International Prostate Symptom Score (IPSS), flowmetry, ultrasound for prostate volume, residual urine and other methods were included in the study, all of them fulfilled the study's inclusive/exclusive criteria. The principal exclusive criteria were prostate volume > 50 ml, maximum flow rate (Qmax) < 10 ml/s and residual urine > 100 ml. All 76 patients had bothering storage symptoms and divided randomly into two groups:doxazosin group (n = 36) in which patients were treated with doxazosin 2 mg once daily for 8 weeks, and combination group (n = 40) in which patients were treated with doxazosin 2 mg once daily and tolterodine 2 mg twice daily for 8 weeks., Results: At baseline, there was no significant differences. The IPSS was significantly improved in the two groups after treatment, but the reduction of IPSS in combination group was significantly greater (18.7 ± 2.2 vs 12.7 ± 3.9) than that in doxazosin group (18.6 ± 3.0 vs 15.2 ± 3.8) (P < 0.05), and the decreased storage IPSS was the main contribution to the reduction of IPSS in combination group. There was no difference between the groups for Qmax and residual urine., Conclusions: Combined therapy with doxazosin plus tolterodine for BPH patients with dominant storage symptoms can improve the IPSS, especially the storage IPSS, without any negative effects on uroflow rate and residual urine.

Objective: To evaluate the safety and efficacy of retroperitoneal laparoscopic resection for pheochromocytoma., Methods: The clinical data of 107 cases of pheochromocytoma in PUMCH from 2003 to 2008 were analyzed retrospectively. There were 58 males and 49 females with an age range from 8 to 77 years (mean 44 years) in this cohort. One hundred and two cases were intra-adrenal and 5 extra-adrenal. Of the 102 intra-adrenal tumors, 43 tumors were located in left adrenal, 51 in right adrenal and 8 in both sides. All of the 5 extra-adrenal tumors were at para-abdominal aorta. Retroperitoneal laparoscopic resection was performed for the 107 cases. This period was separated to 3 stages based on the degrees of the practical ability for retroperitoneal laparoscopic resection, such as tentative and exploratory stage, accumulative stage, and mature stage., Results: At tentative and exploratory stage from June 2003 to December 2003, 10 cases underwent retroperitoneal laparoscopic surgery, of which 3 cases were converted to open surgery. The mean diameter was 4.2 cm (range in diameter from 2.5 cm to 6.0 cm). The mean operation time was 105 min (range from 60 min to 230 min). The mean volume of blood loss during operation was 620 ml (range from 150 ml to 1800 ml). At accumulative stage from January 2004 to December 2006, 66 cases underwent retroperitoneal laparoscopic surgery with none converted to open surgery. The mean diameter was 5.7 cm (range in diameter from 2.1 cm to 8.7 cm), and the diameter was above 6.0 cm in 19 cases. The mean operation time was 95 min (range from 40 min to 210 min). The mean volume of blood loss during operation was 350 ml (range from 50 ml to 1800 ml). At mature stage from January 2007 to June 2008, 31 cases, including 5 extra-adrenal pheochromocytomas, underwent retroperitoneal laparoscopic surgery. The mean diameter was 6.5 (range in diameter from 1.5 cm to 12.3 cm). The mean operation time was 75 min (range from 40 min to 160 min). The mean volume of blood loss during operation was 180 ml (range from 50 ml to 800 ml). No peri-operative death occurred. Follow up period was ranging from 1 to 62 months (the mean was 34 months), and 7 failed to be followed up, 3 cases recurred. And there was no distant metastases and death case., Conclusions: Retroperitoneal laparoscopic surgery for pheochromocytoma is feasible and safe. This procedure will be more and more performed as the advancement of the skill and accumulation of experience. The dimension, recurrence and location of tumor are not the absolute contraindication of retroperitoneal laparoscopic surgery for pheochromocytoma.

Objectives: To investigate the expression of Ki-67 antigen in benign and malignant pheochromocytomas, and to evaluate whether the expression of Ki-67 antigen could serve as a diagnostic marker for predicting the biological behaviour of these tumors., Methods: Ki-67 antigen were detected by immunohistochemical technique and image analysis in 57 cases of clinically documented benign and malignant pheochromocytomas were analyzed. Aside from histological study, Ki-67 immunohistochemistry studies were performed to get the Ki-67 index. Statistical analysis was performed between these groups., Results: Ki-67 index was low in benign pheochromocytomas (average 0.98%), and high in malignant pheochromocytomas (average 3.78%). There was statistically significant difference in expressions of Ki-67 antigen between benign and malignant pheochromocytomas. The Ki-67 index of 2 cases in benign pheochromocytomas (5.1%, 2/39) and 10 cases in malignant pheochromocytomas (55.6%, 10/18) was higher than 3%. The accuracy, sensitivity, specificity, positive predictive value and negative predictive value of Ki-67 index higher than 3% to diagnosis malignant pheochromocytomas was 82.5%, 55.6%, 94.9%, 83.3% and 82.2%. The follow-ups indicated the survival rate of patients with higher Ki-67 index was lower than those with lower Ki-67 index., Conclusions: Ki-67 may serve as a useful marker of the biological behavior of tumors, and can provide useful information for prognosis of tumor patients. Immunohistochemical assessment of Ki-67 antigen can be useful in the differential diagnosis of malignant from benign pheochromocytomas. Ki-67 index (> 3%) is a useful marker for distinguishing benign from malignant tumors or for predicting the malignant potential of pheochromocytomas.

Objective: To improve the diagnostic and therapeutic ability on subclinical Cushing's syndrome., Methods: Retrospective analysis for the clinical data of 24 cases of subclinical Cushing's syndrome, the clinical and biological characters pre and post operation were compared., Results: None of the 24 cases of subclinical Cushing's syndrome had the classic symptoms and signs of Cushing's syndrome. The common symptoms of these patients were hypertension in 17 cases, diabetes mellitus in 11 cases, hyperlipidemia in 9 cases, high plasma cortisol value in 13 cases and high 24 h UFC value in 9 cases. None of patients did respond to low dose dexamethasone suppression test, but 16 cases of them did not respond to high dose dexamethasone suppression test. All the cases were found adrenal tumors by CT scan, 10 cases in left adrenal and 14 cases in right adrenal. All the patients underwent retroperitoneal laparoscopic operation and were pathologic diagnosed to adrenal adenomas. During follow-up, the symptoms of 20 cases (83.3%) were cured after surgery, and hormone supplement was required in 8 cases., Conclusions: Subclinical Cushing's syndrome may be incidentally detected on clinical manifestations, laboratory findings and imaging examinations. CT scan, assays of plasma cortisol, urinary free cortisol and dexamethasone suppression test are most useful in the diagnosis. The potential benefit of surgery should be considered in those who have a definite diagnosis of subclinical Cushing's syndrome. Hormone supplement is required in some patients. It is safe and practical to perform retroperitoneal laparoscopic surgery on the patients with subclinical Cushing's syndrome.

Objectives: To introduce a new arthroscopic Bankart repair by vertical mattress suture with anchors, and to evaluate its clinical effectiveness., Methods: A new arthroscopic Bankart repair by vertical mattress suture with anchors was performed, including to insert only 2 anchors at 3 o'clock and 5 o'clock position and make vertical mattress suture of labrum-ligament complex at 2, 4 and 6 o'clock of labrum, and to shift up the anterior-inferior capsule. Nine cases of anterior glenohumeral instability without severe glenoid bone defect were followed-up for an average period of 14 months (range from 6 to 26 months). The average surgery age was 28 years (range from 21 to 46 years)., Results: The average surgery time was 51 min (40 - 75 min). Clinical scores as evaluated by the modified Rowe score advanced from 40 +/- 16 points to 92 +/- 19 points (75 - 94). There was no any recurrence and complication. External rotation was reduced by 5 degrees at 0 degrees adduction and by 3 degrees at 90 degrees of abduction., Conclusions: The arthroscopic Bankart repair by vertical mattress suture with anchors for anteroinferior glenohumeral instability is favorable as an easy, short-time surgery with excellent clinical results in short-term follow-up.

Objective: To investigate the changes and its clinical significance of ultrasound evaluated bladder wall weight (UEBW) pre and after surgery in patients with benign prostatic hyperplasia (BPH)., Methods: The clinical data of 63 patients of benign prostatic hyperplasia and 30 of contrast control were studied. The bladder wall weight was calculated by subtracting the volume of sphere represented by the urine volume inside the bladder from the volume of the sphere representing the whole bladder (sphere with a radius = internal radius + bladder wall thickness). Bladder outlet obstruction (BOO) and bladder function was evaluated by urodynamic studies. Of the 63 patients with BPH, UEBW was (97 +/- 54) g, while the control group was only (41 +/- 14) g. UEBW was found to be significantly correlated with LinPURR grade (R = 0.47, P < 0.01) and positive residual urine volume (R = 0.48, P < 0.01), and it was negatively correlated with Qmax (R = -0.52, P < 0.01) and detrusor contraction strength (presented as WF, R = -0.4, P < 0.05)., Results: A significant difference was found between the UEBW pre and after surgery [(99 +/- 50) g vs. (56 +/- 21) g, t = 5.05, P < 0.01)]. UEBW decreased 43.68%, and IPSS score decreased 16.81 point, while Qmax increased 8.38 ml/s., Conclusion: As an non-invasive methods, measurement of bladder wall weight appears to be a useful marker in evaluating status before operation and in monitoring the effect of surgery for patients with BPH.

Objective: To evaluate the diagnostic usefulness of serum osteoprotegerin (OPG) in prostate cancer bone metastasis., Methods: Serum osteoprotegerin were measured by ELISA assay in 30 healthy men, 30 patients with benign prostatic hyperplasia, 66 patients with prostate cancer including 36 without bone metastasis (30 with localized cancer, 6 with lymph node metastasis) and 30 with bone metastasis. The results associated with clinical data were calculated statistically., Results: Serum osteoprotegerin were significantly increased in patients with bone metastasis compared with others (P<0.001). OPG level had a positive correlation with either prostate specific antigen (PSA) or Alkaline phosphatase (ALP) level (r=0.427, 0.277; P<0.001); and a positive correlation with either Gleason score or grade (r=0.427, 0.277; P<0.001). ROC analysis proved that OPG had better diagnostic accuracy than ALP for detecting bone metastasis in prostate cancer., Conclusion: Serum osteoprotegerin could be used as a marker for diagnosis of bone metastasis in prostate cancer.

Objective: To investigate the anesthetic management features of laparoscopic adrenalectomy for pheochromocytoma., Methods: Twelve patients scheduled for laparoscopic adrenalectomy for pheochromocytoma under general anesthesia were allocated into group 1, while another 12 patients who received transabdominal adrenalectomy for pheochromocytoma under general anesthesia were selected as group 2. The hemodynamic changes and the postoperative recovery profiles between the two groups were compared., Results: Hemodynamic fluctuation occurred during carbon dioxide insufflation and tumor manipulation in group 1. However, there were no differences between the two groups. Duration of post operative recovery and hospital stay as well as requirement of analgesics in group 1 were significantly lower than those in group 2 (P < 0.05)., Conclusion: Hemodynamic fluctuation still exists during laparoscopic adrenalectomy for pheochromacytoma. However, patients undergoing such surgical procedure recover faster as compared with open surgery.

Objective: To discuss the standards for clinical functional gradation and preoperative preparation of pheochromocytoma., Methods: According to the preoperative clinical manifestations and 24 hr urine catecholamine, 172 cases of pheochromocytomas were divided into 4 grades. Functionary grade 0 including 22 patients was given no volume expansion. Functionary Grade 1 consisted of 17 cases, 10 of which were given phenoxybenzamine orally 5 - 10 mg/d for 1 week (therapeutic group), the rest were control group; the results were analyzed by the chi(2) test. Functionary Grade 2 including 120 patients had phenoxybenzamine orally 30 - 240 mg/d for 4 weeks, hemodynamics and microcirculation image were standards for evaluating volume expansion. Functionary Grade 3 consisted of 13 patients including 1 with acute heart failure, 2 and 10 patients with past history of cerebral hemorrhage and hypertensive crisis respectively, they were treated with enough phenoxybenzamine and other emergent measures., Results: The perioperative blood pressure of Functionary Grade 0 had no fluctuation. The blood pressure of therapeutic group of Functionary Grade 1 had small range fluctuation (< 20 mm Hg), that of the control group was large (> 40 mm Hg). Chi(2) = 13.12, P < 0.01. The hemodynamics of Functionary Grade 2 and Grade 3 recovered within 24 hours postoperatively and no complications occurred., Conclusion: According to the function of pheochromocytoma, it is safe and efficient to use different preoperative preparations. Hemodynamics and microcirculation image are golden standards for evaluating preoperative preparations.

Objective: To study the clinical characteristics and treatment of multiple endocrine neoplasia (MEN) type 2., Methods: The clinical features, diagnosis and treatment of from 1980 to 2002 8 cases of multiple endocrine neoplasia type 2 from Peking Union Medical College Hospital were reviewed and analyzed in clinical features, diagnosis and treatment retrospectively., Results: Seven cases were with paroxysmal hypertension, the highest blood pressure was over 200 mm Hg (1 mm Hg = 0.133 kPa). Tumor was found in 3 cases. The diagnosis was confirmed by B-ultrasonography, CT and urine catecholamine test: six cases with MEN 2a 2 with MEN 2b. Six cases were medullary carcinoma of thyroid with or without parathyroidoma or hyperplasia, 1 with multiple mucosal neuromata. One case was pheochromocytoma with marfan's syndrome; 7 cases were with bilateral adrenal tumor. Total resection or resection ectomy was performed on different stages on adrenal gland, parathyroid tubercle. Average follow-up was 9 years. And the feedback was good., Conclusion: The diagnosis of multiple endocrine neoplasia type 2 depends on endocrine biochemical tests, B-ultrasonography and CT. When the pheochromocytoma and the other tumor exists at the same time, operation is the primary treatment, and it is better to remove the pheochromocytoma at the first.

Objective: To evaluate retroperitoneal laparoscopic partial or total adrenalectomy for primary aldosteronism., Methods: From February 2000 to September 2003, 130 patients (76 women and 54 men) with a confirmed diagnosis of primary aldosteronism underwent retroperitoneal laparoscopic operation. Of the 130 cases, there were 119 cases with Aldosterone-producing Adenoma and 11 cases with Idiopathic Adrenal Hyperplasia (unilateral of 2 cases). Eleven cases with Idiopathic Adrenal Hyperplasia underwent unilateral adrenalectomy. Of the 119 cases with Aldosterone-producing Adenoma, 61 cases underwent total adrenalectomy, and 58 cases underwent partial adrenalectomy. All cases were with preoperatively high plasma aldosterone, low plasma rennin and hypokalemia and arterial hypertension., Results: Operations were successfully performed in all cases. The operative time ranged from 15 to 225 min (mean 52 +/- 40 min, Md = 43 min) and the operative bleeding ranged from 0 to 200 ml (mean 23 +/- 34 ml, Md = 20 ml, zero bleeding means that less than 5 ml) without blood transfusion. The hospital length of stay was ranged from 3 to 9 d (mean 5.1 +/- 1.3 d). No major complication occurred. Kalemia was normalized within one month and aldosterone/PRA ratio was decreased obviously in all cases. Postoperatively blood pressure was normalized within 2 month in 88 cases without using any drug., Conclusion: It is safe and practical to perform retroperitoneal laparoscopic partial on total adrenalectomy on the patients with primary aldosteronism.

Objective: To investigate and discuss the diagnosis and treatment of ectopic ACTH syndrome., Methods: Clinical data of 32 cases of ectopic ACTH syndrome, recruited from January 1990 to April 2003 in our hospital, was analyzed., Results: All of the 32 cases presented with clinical and biochemical evidences of Cushing's syndrome. Ten cases were definitively diagnosed as ectopic ACTH syndrome by finding ectopic tumors; 4 cases were highly suspected as ectopic ACTH by blood sampling from femoral vein and infra-petrosal vein and 18 cases were suspected as ectopic ACTH by imaging examinations. Fifteen cases (47%), without identified source of ectopic hormone, were treated with bilateral or unilateral total adrenalectomy, with 1-year survival rate of 60%. Seven cases (22%), with possible source of ectopic hormone, underwent no intervention, with 1-year survival rate of 0. Ten cases underwent radical resection of tumor, 6 of which were bronchial carcinoids and 4 of which were thymic carcinoids, with 1-year survival rate of 60%., Conclusion: It is very difficult to localize the tumor of ectopic ACTH syndrome patients. Bilateral adrenalectomy followed by hormonal replacement is effective for most of the patients without identifying source of ectopic hormone.

Objective: To determine the efficacy of IL-2, IFN and Furtulon in patients with metastatic renal cell carcinoma., Methods: During the induction phase of the treatment of 28 patients, which lasted 3 months, IL-2 and IFN were administered subcutaneously three times a week at doses of 5 - 20 MU/m(2) and 6 - 9 MU/m(2), Furtulon was administered at doses of 800 - 1,200 mg daily by oral during 28 days a month., Results: The response rate was 46.4%, including 4 complete response (CR), 9 presented with partial response (PR)., Conclusion: The three-drugs combination described in this study demonstrates activity. Based on the present data, combined biochemotherapy may be a promising new approach to the therapy of the metastatic renal cell carcinoma.

Objective: To evaluate the diagnosis and treatment of adrenal incidentalomas., Methods: One hundred and twenty-six patients were analyzed, in which 98 patients underwent operation., Results: Of all types of the adrenal incidentalomas, 52 (41.3%) of them were adenomas and they were the most often; 43 (34.1%) of them were hypersecretory adrenal tumors, most of them were pheochromocytomas and Conn adenomas; all nonhypersecretory adrenal adenomas were under 6 cm, and all adrenal carcinomas were above 6 cm., Conclusions: It is important to search for hypersecretory adrenal tumors and to detect malignant adrenal tumors. To nonhypersecretory adrenal adenomas, the sizes of tumors are the most important indexes in determining weather the tumors are benign or malignant and weather the tumors need to be treated with operation or not.

Laparoscopic resection of the adrenal tumor was carried out in 8 patients since January 1993. The age of the patients was 22 to 45 years, 6 with aldosteronism and 2 with Cushing's syndrome. The tumors were located in righ adrenal in 5 cases and left adrenal in 3. The tumor size was 1.0-3.6 cm. All laparoscopic procedures were performed under general edothacheal anesthesia. The operative time ranged from 90 minutes to 4 hours. Bleeding volume during the operation was 20-90 ml. We developed a reliable technique for adrenal tumor using a laparoscopic approach. The anatomy of adrenal glands, operative indications and complications are discussed. Laparoscopic resection of the adrenal tecmos is a valuable method.