Objective To study the characteristics and diagnosis of renal sinus lipomatosis (RSL) complicated with renal staghorn calculi, and report our preliminary experience on percutaneous nephrolithotripsy for the disease. Methods A total of 547 patients with complex renal calculi were admitted to our hospital from January 2005 to June 2007. In 2 of them, RSL complicated with renal staghorn calculi was diagnosed by B-ultrasonography, CT, and MRI. Both the patients were female, aged 42 and 82 years respectively. B-ultrasonography-guided percutaneous nephrolithotripsy was performed on the two patients without removing the kidneys.Results Totally, 7 ml and 5 ml of stones were removed respectively from the two patients by percutaneous nephrolithotripsy. No retained calculi were found by KUB performed one week postoperation. Biopsy of the submucosal fat obtained from the renal pelvis during the operation showed hyperplasia and fibrosis of fatty tissues and inflammatory effusion. The patients were followed up for half a year, during which no recurrence of renal calculi occurred, and no abnormal fatty tissues were found at the renal sinus or surrounding the kidney. Conclusions Imaging examination is valuable for the diagnosis of RSL. B-ultrasonography-guided percutaneous nephrolithotripsy is safe and effective for RSL complicated with renal calculi.

Objective To evaluate the efficacy and safety of standard percutaneous nephrolithotomy(PCNL)guided by ultrasonography for calculi within horseshoe kidneys.Methods From September 2005 to January 2008,44 patients with calculi within horseshoe kidneys(51 sides)underwent ultrasonography-guided F24-tract PCNL in our hospital.Among the cases,single calculus was found in 24 kidneys,multiple calculi were detected in 18,and staghorn calculi in 9.The stones sized(24.4?5.8)mm in length.Results All the operations were completed in one session,single tract was established in 49 kidneys,while double tracts were used in the other 2;31 of the tracts were made through the upper calyx,20 via the middle calyx,and 2 through the lower calyx.The mean operation time was(48.4?11.9)min.The stone-free rate after one-session operation was 88.2%(45/51),3 cases received a second-session PCNL to remove the residual calculi.After the operation,the hemoglobin decreased by(11.3?3.7)% in the patients,none of them received blood transfusion.Postoperative rate of surgery-related infection was 5.9%(3/51).No pleural or abdominal injury occurred.44 patients were followed up for 11.4 months,during the period one of the 3 patients who received the second-session surgery achieved stone-free.The rate of recurrence at 6 months was 2.0%(1/51),and 6.5% at 1 year(3/46).Conclusions Ultrasonography-guided standard PCNL is effective and safe for calculi within horseshoe kidneys.

Objective:To evaluate the efficacy and morbidity of 24F-tract percutaneous nephrolithotomy(PNL) accessed by two-step dilation.Methods:A total of 3 052 patients with 3 366 kidneys or upper ureter calculi underwent 24F-tract PNL accessed by two-step dilation between Aug.,2003 and Jan.,2008,including 108 patients with solitary kidney,68 with kidney cysts,44 with horseshoe kidney,26 with vertebral column deformity,24 with medullary sponge kidney and 1 transplanted kidney.Stone burdens were(47.2?35.6) mm in length.Results:99.4% of 3 740 operations were successful in one-session access,in which 3 348 PNLs were accessed by single tract(89.5%),366 by double tracts(9.7%) and 26 by triple tracts(0.7%).The mean operating time was(68.4?30.9) min,the mean first accessing time were(17.6?11.1) min.and the mean calculi-dealing time were(35.0?55.3) min.The stone-free rate after one session operation was 100% for single calculus and 72.3% for multiple or staghorn calculi.of all the kidneys,374(11.1%) accepted another PNL to remove the residual calculi,and the last stone-free rate of PNL was 88.6%.During and after operation,52 cases(1.4%)needed transfusion,12(0.3%)underwent selective embolization of renal artery and 1(0.03%)accepted nephrectomy for bleeding control.No injury of organs occurred except for 3 cases with pneumatothorax and 19(0.5%)with urinary extravazation.No septic shock occurred.Conclusion:24F-tract PNL accessed by two-step dilation wtih ultrasound-guided puncture is effective and safe.

-Objective To evaluate the efficacy and morbidity of standard tract percu taneousnephrolithotomy (PCNL) for patients with open surgery history of kidney and upper ureter. Meth odsEleven patients with open surgery history of kidney and upper ureter underwent standard tract (24 F)PCNL. Five patients had open nephrolithotomy,3 had pyeloplasty,2 had open ureterolithotomy and 1had partial nephrectomy. Five calculi were in left kidney and 6 in right side. Two cases had single cal culus,5 had multiple,and 4 had staghorn calculi. The stone burden was 1.7 47.1 cm3. ResultsAll patients were successfully operated in one session procedure. Nine PCNLs were accomplished bysingle and 2 by double accesses. The mean operating time was 86.2±34.2 min,the mean first access ing time was 14.14±11.0 min. The stone free rate after one session operation was 91% (10/11). Nocomplication occurred. Conclusion Standard tract PCNL for patients with open surgery history ofkidney and upper ureter could be effective and safe.

Objective To assess the assistance role of three-dimensional reconstruction of stag-horn calculi by 16-slice spiral CT to percutaneous nephrolithotomy (PCNL). Methods A total of 87 patients with 104 staghorn stones underwent 24 F-tract PCNL. 16-slice spiral CT scan and three-di-mensional (3D) reconstruction by volume rendering technique were carried out before PCNL for tract placement planning, the necessity for multiple tracts and stone burden. Tract placement, tract num-ber, operation time, bleeding requiring transfusion and volume of stone cleared were recorded. KUB was taken to explore residual calculi after operation and thus stone free rate was noted. Results In-traoperative tract placement was according to preoperative planning with 3D reconstruction of calculi. Forty-three calculi were cleared by multiple accesses, while multiple accesses were supposed necessary for 47 caculi. The stone free rate of one-session operation was 87.5%, and the last stone free rate af-ter second-look procedure was 91.7%. The stone burden of 3D reconstruction of CT (19.35 ±19.24 cm3) was significantly correlated with the mean volume of cleared calculi (16.34±13.79 cm3) in oper-ation (r=0. 993, P=0. 000). Conclusion The 3D reconstruction of spiral CT for staghorn calculi could show the precise construction of calculi, which could help to plan tract placement, evaluate the necessity of multiple tracts and stone burden.

Objective To compare the effects of nitinol alloy memorial stent with silastic tube in treating the stenosis of the rabbit.Methods 16 rabbits with external ear canal(EEC) stenosis were randomly divided into two groups.One group was implanted with skin on the EEC wound while the other not.By self-comparison method nitinol alloy memorial stem was implanted in a rabbit's one ear and the silastic tube in the other.After days 5,15,30,and 60 later,the diameters of the external ear canal (with two materials planted) were measured respectively in the skin-planting group.In the naked group scar tissues were harvested and tested separately according to the planting material.HE coloration were used to study fibroblast hyperplasty while RT-PCR were applied to detecting the TGFβ1mRNA expression.The two brackets were compared according to their effect to scar hyperplasty.Results The EEC diameters using nitinol alloy memorial stem were found more spacious than using silastic tube.HE coloration showed the fibroblast hyperplasia was more mitigatory by using the nitinol alloy memorial stent.RT-PCR also found the TGFβ1mRNA expression was low by using same material.Conclusion The nitinol alloy memorial stent shows obvious superiority over silastic tube in external ear canal stenosis therapy.

Objective　To modify the Guy's stone score system and evaluate the validation of the modified score system in grading the complexity of percutaneous nephrolithotomy (PCNL) and predicting the stone-free rate after PCNL.　Methods　The modified system comprises 4 grades:grade Ⅰ,solitary stone in mid/lower pole or solitary stone in the pelvis with simple anatomy; grade Ⅱ,solitary stone in upper pole or multiple stones (located in 2 or more 2 calyces) in a patient with simple anatomy or a solitary stone in a patient with abnormal anatomy; grade Ⅲ,multiple stones in patients with abnormal anatomy or stones in a caliceal diverticulum or partial staghorn calculus; grade Ⅳ,staghorn calculus or any stone in a patient with spinal injury or spine malformation ( e.g.spina bifida,scoliosis,lordosis) ; kidney dysplasia ( e.g.duplex kidney,horseshoe kidney).It was validated on a database of 145 PCNL procedures performed by a single surgeon in a stone center.The clinical outcomes were retrospectively assessed with multivariate analysis.Results Of the 145 PCNL patients,according to Guy's stone score system and the modified score system,there were 22 G1 cases (15.2％) and 22 SFR cases (100.0％) ; 27 G2 cases (18.6％) and 25 SFR cases (92.6％); 36 G3 cases (24.8％) and SFR(31,86.1％); 60 G4 cases (41.4％) and 49 SFR cases ( 81.7％ ).Showing that the modified Guy's stone score was more accurate in predicting stone-free rate after PCNL ( P ＜ 0.05 ).　Conclusions　The modified Guy' s stone score system can accurately predict the stone-free rate after PCNL than the old system.

Objective To investigate the clinical value of modified BI?RADS classification by using the coronal plane of automatic breast volume scaner. Methods The total of 201 BI?RADS 3~5 classification of breast masses were retrospectively analyzed. All masses underwent conventional ultrasound and ABVS examination. Using BI? RADS classification standard terms to describe various information of breast masses, and record the coronal image of the masses on the complete interface echo, convergence sign, angle, burr, which classified BI?RADS ultimately. Results The coronal plane of convergence sign, complete interface echo, angulation and burr were significantly different between benign and malignant tumors (P<0.0001). The sensitivity of ABVS convergent sign in diagnosing breast malignant tumors was 68.2%, specificity was 93.4% and accuracy was 82%. The conventional ultrasound combined with the coronal feature of ABVS modified by BI?RADS classification showed that 3 kinds of malignant rate reduced from 8.5%to 3.2%. The rate of malignant 4a decreased from 25.2%to 12.1%and the rate of malignant 5 increased from 94.2% to 98%. Conclusion The convergence sign of ABVS can be used as a significant independent predictor of breast malignant tumors;ultrasound combined with ABVS is helpful to improve the accuracy of ultrasound BI?RADS classification.

Objective To evaluate the efficacy and safety of oral erythromycin in the prevention and treatment of feeding intolerance in preterm infants. Methods The Cochrane Library,PubMed,EMBASE,CBMdise,VIP,WartFang and CNKl were searched up to the year of 2008.Randomized controlled trials (RCT) of erythmmycin for feeding intolerance in preterm infants were included.According to the dosage (low-dose,3-15 mg/kg and high dose,>15 mg/kg)and gestational age(≤32 weeks vs>32 weeks),all infants were divided into several subgroups.Meta-analysis was performed with the Cochrane Collaboration's software RevMan. Results Nine RCrs involving 542 premature infants were included.(1)In preventive studies,low-dose erythromycin could significantly decrease the duration of total parenteral nutrition compared with the high-dose erythmmycin (WMD=-2.99,95%CI:-3.99--1.98).(2)Intreatment studies,highdose erythromycin could significantly decrease the duration of total parenteral nutrition (WMD=-7.06.95%CI:-7.91--6.20,P<0.01)and hospital stay (WMD=-8.10,95%CI:-14.02--2.18,P=0.007)compared with the placebo when gestational age≤32 weeks. Erythromydn could decrease the incidence of iaundice(RR=0.36,95%CI:0.21-0.63,P=0.0003)which might be the effect of bigh-dose erytromycin. Conclusions Compared with placebo,oral erythromycin of different dosage might help to achieve full enteral feeding,shorten the duration of parenteral nutrition and hospital stay,and reduce the associated cholestasis jaundice of preterm infants with different gestational age respectively.

Objective To discuss the clinical features and significance of the difference between the preoperative plan and the actual procedure of the treatment of staghorn calculi with standard access PCNL under ultrasound guidance.Methods From Feb 2011 to May 2011,56 patients withsimple staghorn calculi after standard PCNL under ultrasound guidance were enrolled.The same urologist made the operation plan preoperatively and performed the procedure.The difference between the preoperative plan and the actual procedure were analyzed.The factors leading to the difference were evaluated.Results First puncture calyx,the number of access and stage were changed in 9 (16.1％),15 (26.8％),and 10 (17.9％) patients,respectively.The factors leading to the changes include:flexible,compliance,local inflammation of calyx and texture of stone,efficiency of fragmentation.Conclusions The factors which cannot be clearly known preoperatively may change the procedure of PCNL,which is important to know the clinical features and significance of these factors.