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1. Surgical Treatment and Analysis of Prognosis for Renal Tumor with Vena Cava Tumour Thrombus and Establishment of Cox Model 2. Clinical Genetics Investigation in Chinese Kindred with ACTH-independent Macronodular Bilateral Adrenal Hyperplasia 3. Design

Author: CuiLiang
Tutor: XiaoXuRen;GaoJiangPing
School: PLA Postgraduate Medical School
Course: Department of Urology
Keywords: Renal tumors Renal cell carcinoma Inferior vena cava tumor thrombus Free survival Survival analysis Prognosis Cox proportional hazards regression model ACTH -independent adrenal cortex greater tuberosity Hyperplasia ( AIMAH ) Autosomal dominant Delay dominant Family survey Phenotypic Subclinical Cushing's syndrome Genetics Gene Karyotype analysis
CLC: R737.11
Type: Master's thesis
Year: 2008
Downloads: 251
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Abstract


[Objective] To explore the inferior vena cava tumor thrombus typing methods and their choice of surgical approach to screening renal tumor with vena cava tumor thrombus of prognostic factors and survival analysis, the establishment of the surgical treatment of renal tumor with vena cava tumor thrombus prognosis Cox model . [Methods] our hospital from January 1993 to April 2008 retrospective of renal tumor with vena cava tumor thrombus in patients with complete follow-up data included in the study, univariate and multivariate analysis of prognostic factors, the Kaplan-Meier method draw survival curves, and build a Cox proportional hazards model. [Results] The patients for the surgical treatment of the the renal malignancies merger vena cava tumor thrombus, the median survival time of 30.8 months, the 1-year survival rate is about 77%, the 5-year survival rate is about 43%. Professor Xiao Xuren establishment of the inferior vena cava tumor thrombus new classification system application is reliable, has a clear role in guiding the choice of surgical approach, good surgical results. Tumor invasion and the vein wall and tumor size (maximum diameter of the tumor), the range of tumor-infiltrating tumor central necrosis and lymph node metastasis is an important factor affecting the renal tumor with vena cava tumor thrombus in the surgical treatment prognosis independent factors. Construction of the surgical treatment of renal tumor with vena cava tumor thrombus prognosis Cox model, prognostic index high points, the low-risk group. [Conclusion] (1) the surgical treatment of renal tumor with vena cava tumor thrombus is an effective method to prolong survival, which the renal malignancies merge vena cava tumor thrombus surgical treatment group median survival of 30.8 months, the 5-year survival rate of 43 %, non-surgical treatment group the median survival of September, the 2-year survival rate of 10%. (2) new the tumor thrombus typing system for renal tumor with vena cava tumor thrombus surgical approach choice. (3) tumor thrombus invading the vein wall, as well as the size of the renal tumor \(4) through the establishment of impact survival prognosis Cox proportional hazards model and prognostic index calculated as postoperative treatment mode selection parameter. [Objective] To discover and explore the the Chinese crowd ACTH-independent adrenal cortical nodular hyperplasia (AIMAH) clinical phenotype and genetic characteristics of the family. [Methods] not yet a AIMAH pedigrees reported no underlying etiology and genetics research, only a small number of the smaller AIMAH home abroad Department reported. 2004 to 2007, our department has treated of two AIMAH patients, their sibling siblings relationship, we get a Five Dynasties the legend AIMAH home department by tracking survey. This study is based on the first domestic AIMAH pedigree, is currently the largest international known AIMAH pedigree. Of the clinical findings AIMAH pedigree information collection, collation and analysis of clinical genetics. Investigate and draw the family tree of the proband and his family members. History taking, physical examination, endocrine laboratory tests and imaging studies, karyotype analysis investigation of family members. 【Results】 The AIMAH2004001 pedigrees Five Dynasties, the existing family members of 28 people, including nine people AIMAH patients first, second and third generations have the disease. First-generation and second-generation are dead, the third generation of a total of 8 people (including the proband), age 73 to 49 years, an average of 60.625 years, the male to female ratio of 3:5, 6 of whom underwent CT examinations were diagnostic for bilateral adrenal nodular hyperplasia, one had received ultrasound examinations showed bilateral adrenal nodules hyperplasia, a person refuses to be examined. There are three people in the third-generation performance has obvious Cushing's syndrome, two cases treated by surgery, and the remaining members were no obvious clinical manifestations. Fourth-generation aged 48 to 24 years old, with an average of 32.8 years of age, no abnormal adrenal CT examination, no obvious clinical manifestations. The fifth-generation aged 18 to 50 years, mean 13.3 years, no obvious clinical manifestations. The survey of members of the family of the spouse's pedigree is not found to have a similar illness. In this family, the proband and his brother by the endocrine examination and post-operative pathological diagnosis of AIMAH. Karyotype analysis confirmed the chromosomal level exception. Pedigree genetics analysis gave the following results: (1) AIMAH2004001 home system for single-gene genetic diseases, the dominant mode of inheritance consistent with autosomal delay; (2) phenotype is characterized by clinical AIMAH patients 50-60 years the incidence of , Cushing's syndrome as the main clinical manifestations, imaging examination revealed bilateral adrenal nodular hyperplasia; (3) the lack of subclinical AIMAH typical Cushing syndrome, basically normal plasma cortisol levels, imaging studies prompted double side adrenal nodular hyperplasia. Conclusion] this AIMAH pedigrees consistent with autosomal the delay dominant mode of inheritance for single gene disorders, through the study of the family can provide clues as to clarify the cause of the AIMAH.

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CLC: > Medicine, health > Oncology > Genitourinary tumors > Urinary tumors > Kidney,renal pelvis tumor
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