Expert consensus for PVCR in severe, rigid and angular spinal deformity treatment: The Kunming consensus.

In the past decades, an increasing number of surgeons started using posterior vertebral column resection (PVCR) to treat severe, rigid and angular spinal deformities. Little high-level evidence is available to guide surgical treatment. The aims of our study were to identify important surgical strategies and key technical points of Chinese experts who have extensive experience in the management of severe, rigid and angular spinal deformities using PVCR, and to standardize and unify the current core concepts. Workgroups of consensus were formed by selecting nationwide representing experts and comprehensive consultations. Eight task forces for major issues were established, then retrieval of literature, collection of expert opinions and writing of review articles were carried out. A modified Delphi process was chosen in round-table forum with three face-to-face meetings. Consensus was reached with items graded more than seven points including: indications and contraindications of PVCR; review PVCR in the evolution of spinal osteotomies; The corrective mechanism and safety of spinal cord; monitoring and responses of spinal cord crisis; characteristics and therapeutic outcome of pulmonary function; management of bleeding during PVCR; relationship of pedicle screw insertion and spinal cord safety; and analysis of non-neurologic complications and prevention strategies. In conclusion, The essential properties regarding PVCR procedure are tightly linked with various factors such as medical and surgical indication, range and level of vertebral column resection, strategies of correction, corrective efficiency and control of neurological risk. PVCR is used mainly for severe, rigid spinal deformity that is not manageable by other osteotomy techniques.

[Feasibility of transurethral electro-resection as sole modality for the treatment of cystitis glandularis].

OBJECTIVE: To evaluate the efficacy and necessity of transurethral electro-resection as sole modality for the treatment of cystitis glandularis. METHODS: The clinical data of 48 cases were reviewed. The patients were divided into two groups. One control group of 25 cases was treated by transurethral electro-resection or electric coagulation combined with bladder instillation of anti-tumor drugs. The other investigation group of 23 cases was treated by transurethral electro-resection as sole modality. The cystoscopy was performed at 3 months post-operatively to judge if the disease recurred. And the efficacy of two groups was compared. RESULTS: In the control group, 21 cases had normal cystoscopic finding and the rate of lesion removal was 84%, cure rate 72% and efficacy rate 92%. In the investigation group, 19 cases had normal cystoscopic finding and the rate of lesion removal was 83%, cure rate 74% and efficacy rate 87%. There was no statistical significance between these two groups. CONCLUSION: Using transurethral electro-resection as a major therapy without bladder instillation of anti-tumor drugs is feasible. It can reduce the hospitalization cost and economize the social resources.

[Submucosal injection of anti-tumor drug on the prevention of Post-TUR-Bt recurrence].

OBJECTIVE: To study a new and practical method to prevent the superficial bladder tumor recurrence after transurethral resection of bladder tumor (TUR-Bt). METHODS: We had chosen 68 patients with superficial bladder tumor randomly. After TUR-Bt, we inserted special stainless steel injection needle through the operation hole, and then injected anti-tumor drugs (pirarubicin) submucously; in the control group, 74 patients were given traditional perfusion therapy for carcinoma in bladder with the same anti-tumor drug (pirarubicin) after TUR-Bt. The effects were evaluated according to recurrence ratio. RESULTS: The recurrence rate of injection group was 11.8% (8/68), and that of the control group was 29.7% (22/74). There is a very significant difference between the two groups (chi(2) = 0.013, P < 0.01). The overall median recurrence interval period of injection group was obviously longer than that of the control group, but there was no significant difference about single and multiple occurrences between the two groups (chi(2) = 0.719, P > 0.05). CONCLUSIONS: The injection method used to prevent tumor recurrence after TUR-Bt has the following virtues: simple and safe, less side effect, more economical. We demonstrated that submucosal injection is a practical method to prevent tumor recurrence and is worth popularizing.