Objective To report the experiertce of management of complicated renal stones by percu taneous nephrolithotripsy (PCNL) with pneumatic and ultrasonic power by ultrasound guidance. MethodsThree hundred and eighty two cases(218 males,164 females,4 74 years) who underwent PCNL by u sing the third generation Swiss LithoClast Master for kidney stones from 2004 to 2007 were retrospectivelyreviewed. Clinical data including operation time,stone free rate and complications were analyzed. ResultsPhaseⅠlithotripsy was performed in 397 sides and delayed phaseⅡlithotripsy in 8 sides. Twenty three casesunderwent simultaneous bilateral PCNL. The operation time ranged from 70 to 190 min,average time was(93±11)min. Nine cases needed blood transfusion. Severe complications did not occur during operations.Stone free rate was 91.8% (372/405). Residual stone fragment was found in 33 cases after delayed phase Ⅱlithotripsy and 14 cases received adjuvant extracorporeal shock wave lithotripsy. One hundred and forty sixcases were followed up for 3 to 24 months and showed no recurrence. Conclusion PCNL with pneumaticand ultrasonic power could be an efficient treatment for complicated kidney stones.

Objective To investigate the epidemiology,clinical features,etiology and treatment of Kaposi sarcoma after kidney transplantation through the diagnosis and treatment of a patient with Kaposi sarcoma after kidney transplantation.Methods The clinical data of a 61-year-old man with Kaposi sarcoma who had kidney transplantation in 2015 were retrospectively analyzed,and the relevant leteratures at home and abroad were reviewed.The patient was an elderly male who underwent renal allograft transplantation for end-stage uremia,and the operation was successful.Preoperative detection of antibodies such as EB virus were negative.Besides,the donor donated organs after the death of the citizen (donation after cardiac death).The man developed dark brown plaques on the outside of his right lower leg and had a roundish-purple tumor on his left ear at the end of 3 months after kidney transplantation,gradually increasing without any other special discomfort.After admission,relevant examinations showed that the function of the transplanted kidney was stable and no other related lesions were found.HIV confirmatory test was negative and the pathology was consistent with Kaposi sarcoma.Therefore,the diagnosis was Kaposi sarcoma and kidney transplantation status.Results Then,the treatment was modified.The cyclosporine +mycophenolate mofetil + prednisone triple immunosuppressive regimen was discontinued and the immunosuppressive drug was changed to sirolimus at a concentration of about 5.69 ng/mL.After treatment for half a year,the Kaposi sarcoma disappeared gradually.Furthermore,the graft function was still stable and up to now,no recurrence of Kaposi sarcoma has been observed.Conclusion Though characteristics of skin lesion are helpful,confirmed diagnosis relies on pathology.And sirolimus may be effective in the treatment of Kaposi sarcoma after kidney transplantation.

Objective:To observe the occurrence and closure of iatrogenic atrial septal defect (IASD) after left atrial appendage occlusion (LAAo) and atrial fibrillation cryoballoon ablation (CBA), and to identify potential factors that may affect the occurrence of IASD.Methods:A total of 383 patients who underwent successful LAAo surgery in the Department of Cardiology at the Nanjing Hospital Affiliated to Nanjing Medical University from June 7, 2016 to December 2, 2020, and atrial fibrillation CBA surgery from December 29, 2016 to September 10, 2020 were retrospectively selected. Patients were followed up with echocardiography at 1 month, 3 months, 6 months, 1 year, and>1 year after surgery to determine the occurrence of IASD. The incidence of IASD between the two groups was compared, and clinical data between the two groups with and without IASD were analyzed to identify the relevant factors for the occurrence of IASD.Results:One month after CBA surgery for atrial fibrillation [73.8%(138/187) vs 47.9%(67/140), P<0.001], 3 months [39.0%(57/146) vs 13.6%(16/118), P<0.001], 6 months [17.7%(22/124) vs 3.6%(4/110), P=0.001], 1 year [11.8%(15/127) vs 1.8%(2/112), P=0.003], and one year later [9.8%(13/133) vs 0.9%(1/116), P=0.002], the incidence of IASD was significantly higher than those in LAAo. Compared with the non IASD group, the IASD group had a lower proportion of males [59.0%(121/205) vs 83.6%(102/122), P<0.001], and a higher proportion of paroxysmal atrial fibrillation [61.5%(126/205) vs 45.9%(56/122), P=0.006]. Logistic regression analysis found a significant correlation between women and CBA with postoperative IASD. Conclusions:Compared with LAAo, the incidence of IASD after CBA for atrial fibrillation is higher, and some IASD persist for more than 1 year after surgery. Women are significantly associated with IASD.