Malignant melanoma of the prostate:Primary or metastasis?A case report

BACKGROUND Malignant melanoma of the prostate is rare.Twenty-five studies describing 45 cases have been reported.Prostate melanoma is characterized by an insidious onset and poor prognosis.The prognosis and treatment vary according to primary or secondary melanoma.CASE SUMMARY A 75-year-old man attended the hospital due to low back pain of 2 mo duration.He denied a history of trauma or abnormal urinary symptoms.Digital rectal examination showed indentation in the left lobe of the prostate,1 cm in diameter.His prostate-specific antigen was 5.6 ng/mL and 18F-fluorodeoxyglucose positron emission tomography computed tomography(18F-FDG-PET/CT)showed focal glucose metabolism in the left lobe.Imaging showed bone metastases to T12 and bilateral ribs.Transperineal prostate biopsy was done and three tissue specimens on the left side showed prostate adenocarcinoma(Gleason score 3+3=6),but the specimen on the right side showed malignant melanoma.The patient underwent T12 tumor resection and pathology findings indicated metastatic malignant melanoma.The patient underwent gastroscopy and colonoscopy,and gastroscopy revealed multiple mucosal black spots in the gastric body and fundus.The patient was diagnosed with secondary malignant prostate melanoma and primary gastric disease.CONCLUSION Diagnosis of primary prostate melanoma requires caution and 18F-FDG-PET/CT may result in false-negative detection of melanoma.

Aspiration therapy for acute embolic occlusion of the superior mesenteric artery

BACKGROUND Embolic superior mesenteric artery(SMA) occlusion is associated with high mortality rates. Delayed treatment often leads to serious consequences, including intestinal necrosis, resection, and even patient death. Endovascular repair is being introduced, which can improve clinical symptoms and prognosis and decrease the incidence of exploratory laparotomy. Many reports have described successful endovascular revascularization of embolic SMA occlusion. However,most of those reports are case reports, and there are few reports on Chinese patients. In this paper, we describe the technical and clinical outcomes of aspiration therapy using a guiding catheter and long sheath technique which facilitates the endovascular repair procedure.AIM To evaluate the complications, feasibility, effectiveness, and safety of endovascular treatment for the acute embolic occlusion of the SMA.METHODS This retrospective study reviewed eight patients(six males and two females)from August 2013 to October 2018 at Xuanwu Hospital, Capital Medical University. The patients presented with acute embolic occlusion of the SMA on admission and were initially diagnosed by computed tomography angiography(CTA). The patients who underwent endovascular treatment with a guiding catheter had no obvious evidence of bowel infarct. No intestinal necrosis was identified by gastrointestinal surgeons through peritoneal puncture or CTA. The complications, feasibility, effectiveness, safety, and mortality were assessed.RESULTS Six(75%) patients were male, and the mean patient age was 70.00 ± 8.43 years(range, 60-84 years). The acute embolic occlusion of the SMA was initially diagnosed by CTA. All patients had undertaken anticoagulation primarily, and percutaneous aspiration using a guiding catheter was then undertaken because the emboli had large amounts of thrombus residue. No death occurred among the patients. Complete patency of the suffering artery trunk was achieved in six patients, and defect filling was accomplished in two patients. The in-hospital mortality was 0%. The overall 12-mo survival rate was 100%. All patients survived, and two of the eight patients had complications(the clot broke off during aspiration).CONCLUSION Aspiration therapy is feasible, safe, and beneficial for acute embolic SMA occlusion. Aspiration therapy has many benefits for reducing patients' death,resolving thrombi, and improving symptoms.

A technique of pretightening dorsal vein complex can facilitate laparoscopic radical prostatectomy

The ligation of dorsal venous complex(DVC)is a very important procedure during laparoscopic radical prostatectomy(LRP).Inaccurate DVC ligation may lead to severe bleeding or postoperative incontinence.We,therefore,designed the DVC pretightening technique to facilitate this procedure.The 32 involved patients with localized prostate cancer underwent LRP between July 2017 and October 2018.All of the patients received DVC pretightening technique.A laparoscopic intestinal clamp was used to narrow and strain DVC.The needle passage was limited between the bone and clamp.The ligation time,DVCrelated blood loss,and continence data were recorded.The ligation of DVC in 32 patients was performed with DVC pretightening technique.

Modified technique in treating recurrent priapism： a technique report

Recurrent ischemic priapism is a problem in clinical treatment. Most of the cases require more invasive surgery to shunt the blood stasis. We introduce a modified technique in treating recurrent ischemic priapism. The technique described is applied to acute ischaemic priapic episodes in patients with a history of stuttering priapism. It was carried out by a Winter＇s shunt combined with a continuous cavernosal irrigation system. Priapism was effectively resolved on the patients without recurrence. ]he four patients who received this treatment recovered most sexual function after 6 months follow-up.