Objective To evaluate the safety and efficacy of transurethral resection of the prostate(TURP)for high-risk benign prostatic hyperplasia(BPH).Methods Form January 2001 to July 2007,we performed TURP on 303 patients with high-risk BPH.The patients aged form 65 to 89 years with a mean of 76.3.Among them,151 were complicated with cardiovascular diseases,67 had pulmonary diseases,37 had diabetes mellitus,26 had brain disease,16 showed renal inadequacy,and 6 showed abnormal liver function.Results The procedure was completed successfully in all of the 303 cases without death,dysuria,or severe complications.Compared to the examinations carried out before the procedure,the IPSS and QOL scores,and RU decreased significantly,while the Qmax increased 3 months after the prosedure[IPSS:(19.6?7.9)points vs.(6.4?3.3)points,t=26.838,P=0.000;QOL:(4.7?1.5)points vs.(2.3?1.1)points,t=22.459,P=0.000;Qmax:(4.1?2.6)ml/s vs.(13.9?7.1)ml/s,t=-22.561,P=0.000;and RU:(139.0?32.5)ml vs(13.5?8.6)ml,t=55.143,P=0.000].ConclusionsTURP is a safet and effective procedure for high-risk BPH with a low rate of postoperative complications.Proper peri-operative individual management and operation skills are important for the success of the procedure.

Objective To evaluate the clinical effectiveness of ureteroscopic pneumatic ballistic lithotripsy for the treatment of ureteral stones.Methods A total of 185 patients with ureteral stones(accompanying renal colic in 96 patients) were treated with ureteroscopic pneumatic ballistic lithotripsy from February 2004 to March 2005 in this hospital. Results The procedure failed in 12 patients,including conversions to open surgery in 6 patients and to extracorporeal shock wave lithotripsy 3 days later in 6 patients.The single-session success rate was 93.5%(173/185),and was 75.0%(24/32) in the upper segment,95.8%(46/48) in the middle segment,and 98.1%(103/105) in the lower segment.The success rate in patients with renal colic was 100%(96/96).The rate of intraoperative ureteral injury was 2.9%(5/173),with conversions to open surgery required in 3 patients(1.7%).Postoperative renal colic occurred in 1 patient.Follow-up checkups in all the patients for 6~12 months(mean,10.2 months) showed no recurrence. Conclusions Ureteroscopic pneumatic ballistic lithotripsy is safe and effective,being the first choice for patients with middle or lower ureteral stones,especially accompanying renal colic.

Objective To evaluate the methods and efficacy of retroperitoneal laparoscopic nephron-sparing surgery for the treatment of renal tumor. Methods A total of 6 patients with renal tumors underwent retroperitoueal laparoscopie nephron-sparing surgery during warm ischacmia. Among the 6 eases, 2 had malignant tumor with the diameter of 2.5 cm and 2.2 cm,and 4 had renal angiomyolipoma with the diameter from 2.5 cm to 3.5 cm.The renal yes,Is were secured by a self-made equipment. Tumors were excised with a cold Endo-shear. Parenehymal edges were approximated using a absorbable hemostatic gauze. Results All procedures were successfully completed without open conversion. Mean surgical time was 150 minutes (range 120-210 minutes). Mean ischaemia time was 22 minutes (range 18-33 minutes) and the mean blood loss was 170 ml (range 150-200 ml). Surgical margins were negative in all patients.During a follow-up for 6-12 months, no patient had local or port site recurrence. Conclusions Betroperitoneal laparoscopic nephron-sparing surgery for renal tumor by using serf-made equipment is safe and effective. This procedure has the advantages of minimal invasion, less blood loss, good vision, and rapid convalescence and so on.

Objective: To observe the automatic ventricular capture management (VCM) conifrmed by paced depolarization integral (PDI) evoked response detection via the follow-up study in patients with Zephyr5826 pacemaker implantation. Methods: A total of 102 relevant patients were enrolled. In order to conduct PDI calculation, pacemakers were set by bipolar sensing and bipolar pacing at immediately after implantation. VCM functions were observed at 1 day, 7 days and 1 month, 3, 6, 12 months after implantation, the ventricular threshold by VCM test and manual test were compared. The symptoms of pectoralis major stimulus, diaphragm stimulus and palpitation were observed in all follow-up patients. Results: There was 1 patient died by MI at 1 month after Zephyr5826 pacemaker implantation, the rest 101 patients were followed-up for 12 months. VCM function was successfully turned-on at immediately after implantation in all patients, no pectoralis major stimulus and diaphragm stimulus occurred. VCM function was turned-off in 6/101 (5.9%) patients at 7 days after implantation due to intolerable palpitation caused by daily automatic VCM, instead they received manual test at follow-up visit. The coincidence rate of ventricular thresholds between VCM test and manual test were 100%. Ventricular pacing output voltage by VCM was (0.99 ± 0.48) V,n=608. Compared with regular pacing output voltage (2.5V, 0.4ms), VCM function may save 84% of energy consumption; compared to high pacing output voltage (3.5V, 0.4ms), VCM may save 92%. Loss of ventricular capture and poor sensation were not found by ECG and 24 h dynamic monitoring. Conclusion: Zephyr5826 pacemaker may conduct bipolar pacing and scanning with VCM function, it can be effectively and safely operated by low energy output. A few patients may not use VCM function due to intolerable palpitation.

Purpose:To improve the understanding of obstructive anuria of upper urinary tract(OAUUT) and upgrade the diagnosis and treatment level.Methods:Causes and treatments of 45 cases OAUUT were reviewed.Results:34 cases obtained normal renal function and 9 cases with azotemia after three months of operation.Conclusions:The main risk factors of OAUUT is urolithiasis (Stone disease) accounting for 77.8%. Ureter catheterization,double-J tube insertion under cystoscope and operation should be the main measures to relieve obstruction.

Purpose:To further improve the therapeutic results of ESWL and to reduce the complications of ESWL. Methods: Clinical materials of 5 140 cases of patients with urinary calculi underwent ESWL from 1989 to 1999 were analyzed retrospectively. Results: Ignorance of the routine examination in urine, blood, hepatic func tion and specialization etc, the serious complications may be produced by ESWL. Low energy and emergency ESWL have obtained satisfactory results. Conclusions:Every routine examination is essential to secure the patient to get satisfactory therapeutic result from ESWL and prevent the complication from occurring. Complete dis charge rate of stones was affected by the tissue structure and type of the renal pelvis and calyces, beside the site of stones.

Cerebral autosomal dominant arteriopathy with subcortical infarcts and leucoencephalopathy(CADASIL)is a common hereditary disease caused by NOTCH3 gene. The major clinical manifestations includerecurrent small-vessel ischaemic events, migraine, dementia and mood disturbance. Herein, wereport a 32-years-old male presented with right leg weakness and persistent migraine. We carried outneurological exams, genetic testing, blood and cerebrospinal fluid analysis (CSF) as well as magneticresonance imaging (MRI) for the brain and spinal cord. There were no anti-aquaporin-4 antibodiesand oligoclonal bands in the CSF and blood investigations were within the normal range. MRI scansrevealed multiple hyperintense regions in the brain and longitudinally hyperintense signal in spinal cord.Further, we identified a c.383G>A(p.Cys128Tyr) mutation in NOTCH3 gene. Therefore, the patientwas diagnosed with CADASIL concurrent with spinal cord lesion. The patient’s condition slightlyimproved after two weeks treatment with daily dosage of 0.5 g citicoline and 75 mg clopidogrel.

Objective: To observe the perioperative changes of serum thrombomodulin in patients with and without cardiogenic shock undergoing off-pump coronary artery bypass grafting surgery. Methods: A total of 66 patients with coronary artery disease who underwent off-pump coronary artery bypass grafting surgery between June and December 2015 in our hospital were included in this study.The patients were divided into non-cardiogenic shock group (n=51) and shock group (n=15) according to the absence or presence of cardiogenic shock.The clinical data of the two groups were analyzed.Arterial blood samples were collected immediately after anesthesia, and at 4, 8, 16, 24, 48 and 72 hours after surgery.The levels of serum thrombomodulin were tested with enzyme-linked immunosorbent assay. Results: (1)The prevalence of diabetes was significantly higher (64.7%(33/51) vs. 20.0%(3/15), P<0.01), while prevalence of myocardial infarction was significantly lower (41.2%(21/51)vs. 100%(15/15), P<0.01) in non-cardiogenic shock group than in cardiogenic shock group.(2)The peak plasma creatinine level, troponin I level and creatine kinase MB level were significantly lower in the non-cardiogenic shock group than in the cardiogenic shock group ((88.5±36.7) μmol/L vs. (122.6±71.1) μmol/L, 1.3(0.2, 2.7) μg/L vs. 16.4(5.8, 23.4) μg/L and (18.8±4.7) μg/L vs.(49.3±15.9) μg/L, respectively, all P<0.05). (3)Mechanical ventilation time was significantly longer (11.5 (9.0, 18.0) hours vs. 20.0 (8.5, 82.5) hours, P=0.02), and frequency of intra-aortic balloon pump use (0 vs. 100%, P<0.01) was significantly higher in the cardiogenic shock group than in the non-cardiogenic shock group.(4) Prevalence of atrial fibrillation (5.9%(3/51) vs. 80.0%(12/15)) and myocardial infarction (19.6%(10/51)vs. 93.3%(14/15)) that occurred during and after surgery was significantly lower in the non-cardiogenic shock group than in the shock group(all P<0.01). (5)The serum thrombomodulin concentration was similar among various time point in the non-cardiogenic shock group: 3.30(2.68, 7.44), 4.09(2.95, 7.18), 4.35(2.68, 8.22), 3.50(2.95, 8.00), 3.41(2.60, 5.97), 3.30(2.65, 5.42)and 3.94(2.82, 5.60) μg/L, taken immediately after anesthesia, and at 4, 8, 16, 24, 48 and 72 hours after surgery respectively, and was 2.44(1.97, 2.67), 2.21(1.93, 2.83), 2.64(2.29, 2.67), 2.84(2.26, 2.94), 3.35(2.43, 4.05), 2.76(2.73, 2.97) and 3.81(2.96, 5.96)μg/L respectively, in the cardiac shock group (all P>0.05). The serum thrombomodulin levels at 4 and 8 hours after surgery were higher in the non-cardiogenic shock group than cardiogenic shock group(all P<0.05). Conclusion Compared with the non-cardiogenic shock group, the peak serum thrombomodulin level appears later and recovers slower in cardiogenic shock patients who underwent off-pump coronary artery bypass grafting surgery.

Deep vein thrombosis (DVT) refers to a venous reflux disorder caused by abnormal condensation of blood in deep veins,It is detected in cardinal veins of the whole body and often occurred in the lower extremities.Desquamation of thrombus may cause pulmonary embolism (PE).PE and DVT are two clinical manifestations of different stages of the same disease,which are collectively referred to as venous thromboembolism (VTE).Five famous experts in hernia and abdominal wall surgery explored the prevention and treatment of DVT during perioperative period in patients undergoing abdominal wall hernia surgery from different angles based on clinical experiences.Professor Liu Ziwen introduced the epidemiology of DVT during perioperative period in patients undergoing abdominal wall hernia surgery,emphasized its risks,analyzed systematically its mechanisms including slow venous blood flow,vein injury,high blood coagulation state,underlying diseases and specific factors of abdominal wall hernia surgery,focused on mechanisms of inflammation caused by meshes inducing DVT.Professor Zhang Guangyong introduced informatively its diagnosis with clear and careful thinking,from the clinical manifestations to assistant examinations and moreover to Wells quantitative scoring,from general to specific and from qualitative to quantitative,striving to achieve early and precise diagnosis in order to prevent misseddiagnosis or ignoration of its danger level.Professor Li Hangyu emphasized appropriate preventive and treatment measures according to different stages and risk levels by evaluating the risk factors of preoperative,intraoperative and postoperative DVT.Professor Shen Yingmo analyzed special factors of laparoscopic abdominal wall hernia inducing DVT during the perioperative period,and indicated that surgeons should select surgical methods individually after comprehensive evaluation and consideration because of uncertainty of risk degree in laparoscopic and open surgery inducing DVT during perioperative period based on exis-ting evidence-based medicine and related guidelines.Professor Lu Chaoyang introduced three categories of main treatments including anticoagulation therapy,thrombolytic therapy and surgical therapy,and specific drugs,indications,advantages and disadvantages,opportunities,recommended clinicians to select individually and rationally.

The clinical data of patients with chlamydia psitsiti pneumonia confirmed by metagenomic next-generation sequencing (mNGS) who were admitted to the Huizhou Municipal Central Hospital from January 2020 to November 2021 were retrospectively analyzed. Among 21 patients, the serum creatine kinase (CK) was elevated in 10 cases, and 5 cases was complicated with rhabdomyolysis (RM). The symptoms of patients with Chlamydia psittaci pneumonia-induced RM were severe, including high fever, dyspnoea, headache and myalgia; 2 case were complicated by acute kidney injury (AKI) and neurological symptoms. Laboratory testing showed a marked increase in CK, myoglobin (Mb), high sensitivity C-reactive protein (hs-CRP), interleukin-6 (IL-6) and D-dimer levels in all 5 patients. The chest CT revealed large areas of pulmonary consolidation, ground-glass opacity in 1 case and a small amount of pleural effusion in 2 cases. One patient died from multiple organ failure, and the other 4 patients were discharged with considerable improvement. Patients with psittacosis pneumonia are prone to developing rhabdomyolysis, early detection and early treatment can effectively improve the prognosis of patients.