OBJECTIVE:To study the effects of diltiazem on the blood concentration and the renal toxicity of cyclosporin A(CsA) in patients with renal transplantation.METHODS: 25 patients with renal transplantation were divided into two groups,the therapeutic group were treated with diltiazem plus CsA and control group CsA alone and the valley blood concentration of CsA was detected by FPIA assay.RESULTS:The dosage of CsA in therapeutic group was less than that in control group significantly,the levels of UA,Scr and BUN in patients were decreased by diltiazem.CONCLUSION:The diltiazem therapy can decrease the dosage and toxic effect of CsA,then save the patient's medical costs.

Objectives Hand-assisted laparoscopic nephrectomy in living donors was studied in order to investigate the advantages and disadvantages of this technique as well as the feasibility in clinic use.Methods Hand-assisted laparoscopic live-donor nephrectomy and transplantations were done in 6 canine models,the operating time,warm ischemic time,function of the donor kidney and the recovery of donor were all recorded and analyzed.Results All dogs survival postoperation in our experiment;the mean operating time was 132 minutes,the mean warm ischemic time of kidney was 83 seconds,however,the mean time of micturation after graft reperfusion was 74 seconds.Conclusions Hand-assisted laparoscopic live-donor nephrectomy is feasible with short operating time and warm ischemic time; the grafting function was well and donors recovered quickly postoperation,the minimal trauma;this technique is worth to be widely used in living donor nephrectomy.

Objective: To report our prelimilary experience of laparoscopic radical prostatectomy (LRP) for clinically localized prostatic cancer.Methods:23 cases with localized prostatic cancer underwent LRP in our institution from October 2000 to August 2003. The median age was 64.5 years old, the median PSA was 13 ng/ml and median Gleason score of biopsy specimens was < 7. The operations were performed according to Montsouris technique. Briefly, operations were carried out transperitonealty, combining posterior and anterior approachs to the prostate, transecting the bladder neck, lateral dissection of the prostate, urcthrovesical anastomosis, completing the operation.Results:No death and no conversion rate were observed in this series of 23 cases of LRP. No re-intervention was needed. The median operating time was 325 minutes (range 270 to 660 min) including the lymphadenectomy phase that was considered necessary in the case whose PSA value was 51ng/ml and pathological reading was negative to thoses lymph nodes; The median intraoperative blood loss was 430 ml(rang 200 to 1100 ml). Postoperative bladder catheterization time was 20 days. Surgical positive margin was found in I case of pathlogical stage of pT2b and Casodex 50 mg had been used on this case for 3 mon after the PSA value was < 0.2 ng/ml. Postoperation follow-up of 3 to 24 mo. showed no signs of complications such as urethral stricture or urine incontinence. The PSA concentrations was < 0.3 ng/ml in all cases.Conclusions: LRP provides a clear and magnified anatomical image to allow a more precise and safer dissection.

Objective To describe the surgical technique in reconstructing anterior cruciate ligament (ACL) with six strands harmstring tendon graft fixed by bioabsurbable rigidfix cross pins under arthroseopy and to e-valuate its efficacy. Methods From March 2005 to June 2008,39 patients with ACL injury were treated with ACL reconstruction by transplantation of six strands autogenous harmstring tendon , fixed by bioabsorbable rigidfix cross pins in femoral side. There are 22 male and 17 female,ages from 22 to 55 (the average age is 37). 19 cases were hurt in traffic accident, and another 20 cases in accidental injury. The state of illness is 7 days to 38 months. 13 cases merge the meniscus rupture, and 4 cases of meniscus suture,8 partial meniscectomy, 1 meniscectomy were performed simultaneously ;4 cases associating with the medial collateral ligaments Ⅲ degree injure underwent medial collateral ligament neo-plasty or reconstruction ;no cases merge posterior cruciate ligament injury, the patients were followed up 12 to 51 months , Pre-and post-operative knee joint function and stability were evaluated according to the Lysholm scoring scale system and the results of KT-2000 arthrometer , the clinical results and the reliability of the fixation were analyzed. Results 32 patients were followed-up and there is no limitation of the extention in the knee joints. The flexation of the knee joint is greater than 120°,and the anterior drawer test in 90° of flexation were negative in all patients. The postoperative Lachman test was strong positive in 1 case, negative in 26 cases and positive in 5 cases. The Lysholm scores was (92.6±4.2) points. The results of KT-2000 arthrometer: 31 cases 0-4.5 nun, average 3.2 mm;1 case 6. 5 mm. Conclusions It is a safe and reliable method to reconstruct ACL with six strands harmstring tendon graft fixing by bioabsorbable rigidfix cross pins under arthroscopy, and this procedure can obtain primary stabilization and long term stabilization of the autografts.

16,95% CI 0.074-0.628 ,P<0.05) and diabetes mellitus history(RR=3.023,95% CI 0.998-9.157,P≤0.05).

[Objective] To investigate the incidence and risk factors for posttransplantation anemia (PTA) following kidney transplantation. [Methods] A retrospective cohort study reviewing the medical records of the patients who received a renal transplant at our center from January 2004 to June 2008 was performed. All possible risk factors for PTA were recorded. Outcomes among the patients with PTA were compared with those without PTA using t-test and chi-square analysis methods. Logistic regression analysis was done to rank the relative risk of potential variables and calculate the 95% CI. [Results] Prevalence of PTA in our center was 31.0% (hemoglobin <120 g/L or Hct< 0.38 for males, < 110 g/L or Hct < 0.35 for males). Univariate and Logistic regression analysis revealed that the risk factors for PTA after kidney transplantation were female (RR=8.738; 95%CI 2.558～29.853; P= 0.001), creatinine level (RR=1.035; 95%CI 1.018～1.052; P<0.001) and acute rejection (RR=19.827; 95%CI 2.056～191.19; P=0.01); [Conclusions] PTA is a frequent complication after kidney transplantation. Great attention should be paid to this complication considering its negative effect on graft function. Female, impaired renal function and acute rejection are risk factors of anemia in kidney transplantation recipients.

Objective To evaluate the curative efficacy of multimodality for severe pulmonary infection (SPI) following kidney transplantation (KT).Methods Fifty-seven cases of SPI following KT were treated with multimodality therapy in our hospital between Jan.2014 and Jan.2017.The outcome and data were analyzed and evaluated retrospectively.Results Of these 57 patients,45 cases were cured (41 cases were alive with functioning grafts,and 4 cases had grafts loss).The pulmonary lesions in 4 cases of pulmonary fungal infection were improved and oral anti-fungal drugs were continuously given after discharge.The symptoms in one case of tuberculosis were obviously improved and anti-tuberculosis treatment was given continuously after discharge.There were 5 deaths,including 2 deaths due to functioning grafts loss.Two cases abandoned treatment during therapy because of financial problem.Pathogens could be detected in only 29 cases.Conclusion SPI after KT is an acute important complication with rapid progression.Early and prompt treatment with combined antibiotics,antifungal drugs as well as antivirus is essential.The keys to successful rescue for SPI should also include immunosuppressant reduction,intravenous immunoglobulin and nutrition support.The combined therapy is successful and could reduce mortality of SPI obviously.

Objective To compare the clinical efficacy of robotic low anterior resection (R-LAR) and laparoscopic low anterior resection(L-LAR) for rectal cancer.Methods The case-control studies for comparing the clinical efficacy of R-LAR and LLAR for rectal cancer were retrieved from databases,including PubMed,OVID,Springer,Wanfang and VIP,till June 2016.The studies were selected in accordance with inclusion and exclusion critera,and the data were extracted and evaluated by two researchers.The RevManS.3 software was used for Meta-analysis.Results A total of 7 studies including 1 126 patients with rectal cancer were included,592 cases in the R-LAR group and 534 cases in the L-LAR group.Compared with the L-LAR group,in the R-LAR group the operation time was longer (MD=33.84,95％ CI:4.25-63.43,P =0.03),the conversion rate was lower (OR =0.10,95％CI:0.03-0.36,P=0.000 5),and more lymph nodes were dissected (MD=1.24,95％CI:0.31-2.17,P=0.009).No statistically significant difference was found in length of hospital stay,intraoperative blood loss,distance from distal margin to tumor and incidence rate of postoperative anastomotic leakage between the two groups (P ＞ 0.05).Conclusion Compared with L-LAR,RLAR is characterized by longer operation time,lower conversion rate and more thoroughly removing lymph nodes.And the length of hospital stay,intraoperative blood loss,distance from distal margin to tumor and incidence rate of postoperative anastomotic leakage of R-LAR are similar to those of L-LAR.