Objective To compare and analyse the esthetic effect of four kinds of the porcelain fused to metal crowns (PFMs) in restoring anterior teeth. Methods Based on single standard, a total of 371 anterior teeth from 110 patients were restored by PFM, in which 206 teeth of 59 patients were restored with Ni-Cr alloy PFM, 105 teeth of 29 patients with full circular procelain shoulder PFM, 35 teeth of 16 patients with titanium metal PFM, and 25 teeth of 6 patients with noble metal PFM. The esthetic effect was examined and analysed by single-blind method in one week and after one year. Results Between three days and one week, there was no difference among four PFMs in shapes and colors, which corresponded with adjacent teeth. The edge suitability was good and no significance was found in them. After one year, there was no difference of four PFMs in shapes and colors, which corresponded with adjacent teeth. The edge suitability of noble metal PFM was better than the other three, and the difference was statistically significant. Conclusion The esthetic effect is the best when noble metal PFM is used to restore anterior teeth and better with full circular procelain shoulder PFM.

Objective To report on our experience with laparoscopic nephron-sparing surgery forthe treatment of renal tumors,and to seek the safe and effective techniques and methods. Methods FromJune 2003 to June 2005,16 patients (5 men and 11 women) with small exophytic solid renal masses weretreated by transperitoneal laparoscopic wedge resection in our hospital.The mean age was 46 years (range,29 -56 years).The mean tumor size of renal cell carcinoma (5 cases) and hamartoma (11 cases) was2.0 -3.5 cm and 3.0 -5.5 cm,respectively, in diameter. One case of hamartoma had secondary bleeding.Wedge resection of the tumors was performed quickly with scissor,and hemostasis was achieved by intra-ab-domen suturing and knotting. Results All the procedures were finished laparoscopically with no conver-sion to open surgery.The mean operative time was 104 min (range,70 -150 min);mean hot bloodless timewas 21 min(range,14 -32 min);mean blood loss was 158 ml (range,50 -700 ml).The pathologic exami-nation showed negative surgical margin in 5 cases of renal cell carcinoma.Postoperatively,no urinary leakageand secondary bleeding occurred,and the renal function was normal in all the 16 cases.The patients weredischarged 7 d after operation.Follow-up was 1 month to 1 year.Neither distant nor local recurrences wereobserved by the last follow-up date on B-ultrasound,IVUand CTat follow-up. Conclusions Laparoscopicnephron-sparing surgery for renal tumors is a minimally invasive procedure with less blood loss,less pain andfewer complications.Reliable non-traumatic kidney vessel control is the basic method of this operation.Sharpresection without smog and rapid renal incision suturing can reduce the renal hot bloodless time.

Objective To investigate the relationship between the plasma cytokines and the translocation of intestinal bacteria and endotoxin after gut barrier injury in severe acute pancreatitis (SAP) rats. Methods SD rats were divided randomly into sham operation group(n=36) and SAP group (n=36). The rat model of SAP was set up by retrograde injection of 4% sodium taurocholate in biliopancreatic duct. Morphological changes of pancreas and ileum were observed. The plasma levels of TNF-a,IL-6 and IL-10 were determined by ELISA. The plasma levels of DAO activities and LPS were measured at various time points. The rates of bacterial translocation to abdominal organs were also calculated. Results The plasma levels of TNF-a and IL-6 obviously elevated immediately after SAP induction and reached peak value at 48 hours, and the plasma IL-10 level significantly increased only 6 hours after SAP induction. Plasma DAO activities increased at the early stage of SAP and obviously decreased at 24 hours. Plasma LPS levels also increased significantly at the early stage of SAP and reached peak value at 48 hours. The rates of bacterial translocation to organs sharply increased 24 hours after SAP induction and reached 58.3% at 72 hours. Conclusion The levels of cytokines increased and gut barrier function was injured in the early stage of SAP. Cytokines may impair the intestinal microcirculation and gut barrier function, which could promote the intestinal bacteria and endotoxin translocation. Simultaneously, intestinal bacteria-endotoxin translocation could also induce excessive release of cytokines and aggravate the gut barrier damage, which might cause systemic inflammatory response syndrome and multiple organ disfunction syndrome. There was a close relationship beween cytokines and the translocation of intestinal bacteria and endotoxin in SAP.

Objective To evaluate the value of photodynamic diagnosis for early detection of bladder cancer using narrow band imaging fluorescence cystoscopy. Methods A total of 28 cases of painless hematuria underwent narrow band imaging(NBI) endoscopy and biopsy. The procedure was as follows: biopsies were taken from lesions that were either fluorescing or nonfluorescing using endoscopy by NBI system) and then TUR was performed on them. Results Of the 28 cases, 79 biopsies were taken. Histopathologic examination showed that 32 of them were of urothelial cell carcinoma. Compared with white light cystoscopy, NBI had a sensitivity of 100% (32/32) ,flat small fluorescence positive lesions were found in peritumoral or other regions, which could not be detected by white light cystoscopy. Conclusion Photodynamic diagnosis using NBI fluorescence cystoscopy is useful for detection of early bladder cancer.

asty without increasing morbidity, especially for slim patients or patients with a large renal pelvis.

Objective To introduce a better and quicker technique of transperitoneal laparoscopic ureterolithotomy. Methods 42 cases of ureterolithiasis (23 males and 19 females;mean age of 42.4 years,range from 16 to 63 years) were included.Of them 26 cases had calculi on the left side and 16 cases,on the right side.All the cases underwent laparoscopy through 3-port technique. Results The operations were successful in all of 42 cases.The mean operative time was 43 min (range,33 to 56 min).Blood loss was 20 to 50 ml.The postoperative hospital stay was 3 to 5 days.None experienced urinary leakage.During the follow-up of 12～18 months no ureteral stricture was found.The renal functions were improved. Conclusions Our experience indicates that appropriate trocar location,exactly checking of calculi,good D-J tube drainage and skillful intra-abdomenal suturing are the keys to perform laparoscopic ureterolithotomy quickly.

Objective To describe the new technique of transperitoneal laparoscopic dismembered pyeloplasty and to evaluate its clinical effect. Methods Of the 18 cases of ureteropelvic junction (UPJ) obstruction who underwent transperitoneal laparoscopic dismembered pyeloplasty,8 cases had severe hydronephrosis;7,intermediate;3,mild. Results Operations were all successful in 18 cases with the operating time being 100 to 210 min (mean,142 min) and the blood loss,40 to 200 ml.All the pores of puncture healed at phase 1;mean hospitalization was 7.4 d.Only 1 case had postoperative urine leakage.Follow-up of 3 to 12 months showed there was no stricture at UPJ and hydronephrosis was remitted (intermediate hydrops in 4 cases,mild in 7 and resolution in 7).The renal functions were improved. Conclusions Laparoscopic dismembered pyeloplasty is an effective and minimally invasive approach and can be used as an alternative to open surgery for UPJ obstruction.

Objective To describe the initial experience of transperitoneal laparoscopic renal plication for giant hydronephrosis,and to evaluate the clinical feasibility of the procedure. Methods This series included 12 cases of giant hydronephrosis (5 men and 7 women;age ranged from 19 to 64 years with a mean of 42.6 years).Of them 4 cases had upper ureter calculi;2 had ureteropelvic junction(UPJ) obstruction;2,middle ureter calculi;3,nephrolithiasis and 1,middle ureter stricture. The upper urinary tract obstruction was relieved and plication was performed via laparoscope. Results All the 12 operations were completed successfully.The intraoperative blood loss was 50 to 200 ml,operative time was 75 to 210 min.The postoperative follow-up lasted 3 to 18 months.In all these cases,hydronephrosis was relieved and renal function was improved. Conclusions Laparoscopic renal plication is an effective and minimally invasive method and can be considered as an alternative for treatment of giant hydronephrosis.

Objective To introduce the new technique of transperitoneal laparoscopic ureterovesical reimplantation and to evaluate its feasibility and clinical significance. Methods Overall,17 cases (5 men and 12 women) of ureterovesical obstruction (left,7 and right,10) were included.Of them,10 cases were diagnosed with simple congenital ureter outlet stricture;1 had calculi and polyp formation at right ureter outlet;2 had recurrent ureter outlet stricture after open ureterovesical reimplantation (1 of them had 2 calculi at lower part of the ureter);1 had double nephroureteral upper unit ureter outlet stricture with 2 calculi;2 had recurrent ureter outlet stricture after holmium laser section;1 with urinary TB had right ureter outlet stricture after left nephrectomy.Among the 17 cases,severe hydronephrosis occurred in 12,and moderate,in 5.Transperitoneal laparoscopic ureterovesical reimplantation was performed in the 17 cases (ureterovesical anastomosis in 15 and bladder flap ureterovesical reimplantation in 2). Results The operations were all successful in 17 cases with operating time of 90～160 min (mean, 112 min) and blood loss of 60～100 ml.The drainage tubes were removed 1～3 days after surgery without urine leakage.The urinary catheters were removed 1 week after surgery and double J stents,1 month after surgery. Six months after surgery cystography showed Ⅲ?urine reflux in 6 cases, Ⅰ?-Ⅱ? urine reflux in 5 and no reflux in 6.One year after surgery cystography showed Ⅲ? urine reflux in 3 cases, Ⅰ?～Ⅱ? urine reflux in 4 and no reflux in 10.During 3～24 months' follow-up, ultrasound B and IVU showed moderate hydronephrosis in 4 cases,mild,in 5 and no obvious hydronephrosis in 8. Conclusions Laparoscopic ureterovesical reimplantation is a feasible,less painful and minimally invasive alternative method for treatment of ureterovesical diseases.By comparison,bladder flap ureterovesical reimplantation has better anti-urine reflux effect but more complicated than ureterovesical anastomosis does.Long term efficacies of the methods need further observation.

Objective To report the experience in the use of laparoscopic extravascular stent for the treatment of the nutcracker syndrome. Methods Five patients (4 men and 1 woman) aged 20 to 35 years (mean 25) underwent laparoscopic extravascular stent of the left renal vein (LRV) for treatment of nutcracker syndrome associated with severe recurrent gross hematuria and left gonadal vein varices. All patients met the criteria for establishing the diagnosis of nutcracker syndrome. Ultrasonography, computed tomography, and magnetic resonance imaging revealed visible entrapment of the LRV between the superior mesenteric artery and aorta. Bleeding from the left ureteral orifice was detected by cystoscopy in 3 cases. An externally reinforced graft was selected to form an external stent around the LRV to relieve the compression. Results The mean operation time was 67 min (65-70min). No complications occurred during surgery. The postoperative follow-up was 9 to 39 months (mean 28). Total relief was achieved in 4 men without a relapse of symptoms and abnormalities were not found in urine tests. There was partial relief for the female patient due to microscopic hematuria after the operation. In all the 5 cases, Color Doppler ultrasonography showed that the blood outflow was smooth, the inner diameter and flow velocity of the aortomesenteric portion of the LRV were both decreased, and the gonadal vein varices had diminished in diameter. Conclusions The laparoscopic extravgscular stent of the renal vein could be a feasible approach for re-establishing free renal venous outflow in patients with nutcracker syndrome. This slightly invasive treatment could eliminate the symptoms of the condition.