Bronchial Arteries ; diagnostic imaging ; Embolization, Therapeutic ; methods ; Hemoptysis ; therapy ; Humans ; Male ; Middle Aged ; Myocardial Infarction ; etiology ; Radiography

Objective To report a retroperitoneal laparoscopic surgery for ureteropelvic junction obstruction (UPJO) by double renal veins.Methods A 28-year-old male patient with left low back pain for 6 months was diagnosed as left hydronephrosis and UPJO.A ureteral stent had been placed 3 months before and failed to improve hydronephrosis,so the ureteral stent was pulled out.CT scan showed that left UPJ went through the two renal veins,suggesting UPJO.Nephrogram showed that left GFR and right GFR were 35 ml/min and 34 ml/min,respectively.These results indicated mechanical obstruction of left upper urinary tract.The patient underwent retroperitoneal laparoscopic Anderson-Hynes dismembered pyeloplasty.Results The surgical procedure was successful.Two left renal veins were found,and the ventral one was in front of ureter,compressing the ureter.An aberrant renal artery went into left kidney with the ureter.0.5 cm stenosis of ureteropelvic junction was excised,and pyeloplasty was performed.A ureteral stent was placed into the ureter,then the pelvis and the ureter were sew up in front of the ventral renal vein.The surgical time was 240 min,and blood loss was 50 ml.Postoperative hospital stay time was 4 d.During 4 months' follow up,hydronephrosis was attenuated significantly.Conclusion Retroperitoneal laparoscopic surgery for UPJO with aberrant two renal vein might be a minimally-invasive and effective procedure.

@@

Objective:To explore the association between dopamine-β-hydroxylase (DβH), norepinephrine transporter (NET) gene polymorphisms and panic disorder(PD).Methods:The structured clinical interview for the diagnostic and statistical manual of mental disorders fourth edition (DSM-Ⅳ) axis Ⅰ disorders was administered by trained clinical psychiatrist, 139 patients with PD(PD group) and 196 healthy controls(control group) were enrolled in the study.Single nucleotide polymorphism(SNP) genotyping was performed using an improved multiplex ligation detection reaction technique.SPSS 16.0 and PLINK softwares were used to compare the allele frequency and genotype distribution.Results:(1)Compared with control group, PD group carried more G allele(76.3% vs 68.4%) and fewer A allele(23.7% vs 31.6%) in NET rs5569, and the difference was significant(χ 2=4.986, OR=0.67, 95% CI: 0.47-0.95, P<0.05). However, the correlation was no longer significant after adjusting for Bonferroni’s multiple testing( P>0.05). (2)The additive model of NET rs5569 showed a association with PD ( OR=0.68, 95% CI: 0.48-0.96, P<0.05). And the recessive model of DβH rs1611114 showed a association with PD( OR=0.42, 95% CI: 0.18-0.96, P<0.05). However, these correlations were no longer significant after adjusting for Bonferroni's multiple testing( P>0.05). (3)No matter allele or genotype, there were no significant differences in DβH (rs129882, rs1611114, rs1611115) and NET (rs2242446, rs28386840) gene polymorphisms between panic disorder group and control group(all P>0.05). Conclusion:The present study indicates that there is no significant association of DβH and NET gene polymorphisms with PD.

SUMMARY Anaphylaxis is an acute and fatal systemic allergic reaction to an allergen , and it could be an unpre-dictable and life-threatening cause during anesthesia .The main purpose of this paper is to report a case of anaphy-lactic shock during the anesthesia induction and to review the prophylaxis and treatment of anaphylactic reactions and anaphylactoid reactions during the anesthesia period .A 63-year-old man, with a mass on his adrenal , was scheduled to a laparoscopic adrenal tumor excision .During the anesthesia induction period , after administrated sul-fentanil, propofol and rocuronium , the blood pressure was decreased and the heart rate was increased .Then, the patient had rash on his whole body and developed an anaphylactic shock .After being treated with the anti-allergic agents and norepinephrine , the rash disappeared and the vital sign become stable .The patient felt nothing uncom-fortable during the two weeks ’ follow-up.Anaphylactic reactions and anaphylactoid reactions are not rare during the anesthesia period .The most common inducements are muscle relaxant , latex and antibiotics .Anaphylactic reac-tions in the perioperative period are often serious and potentially life-threatening conditions , involving multiple or-gan systems in which the clinical manifestations are the consequence of the release of preformed mediators from mast cells and basophils .Before anesthesia , we should acquire the allergic history .During the anesthesia period , the vi-tal sign and the skin should be observed carefully .

Objective To investigate the clinical effect of vagus nerve preserving pericardial devascularization plus subtotal splenectomy in treating portal hypertension with a history of variceal bleeding.Methods The clinical data of 33 cases of portal hypertension with variceal hemorrhage treated with vagus nerve preserving selective pericardial devascularization plus subtotal splenectomy from April 2004 to December 2013 (study group) were compared with that of 34 cases treated with pericardial devascularization plus splenectomy (control group).Results There was no mortality in two groups.The postoperative gastric drainage during the first 72 h were(1 525 ±30) ml in the study group and (2 130 ±40) ml in control group(P ＜0.05).Portal vein thrombosis developed in one case in the study group and 15 cases in the control group(P ＜ 0.05).Postoperative 3-year recurrent gastroesophageal varices hemorrhage was 15％ in the study group and 25％ in the control group (P ＜ 0.05).Postoperative 5-year variceal hemorrhage recurrence rate were 28％ in the study group and 30％ in the control group (P ＞ 0.05).Conclusions Maitaining vagus nerve selective pericardial devascularization plus subtotal splenectomy is of less postoperative complication and lower portal vein thrombosis rate and better patients' survival compared with pericardial devascularizatim plus total splenectomy.

Objective To investigate the characteristic of ?-amyloid precursor protein (A?) processing in activated platelet in AD.Methods Thirty-six sporadic AD patients and 30 control subjects were included in this study.Blood was collected from the subjects to separate platelets.After treated by thrombin,the soluble amyloid precursor protein (APP) level in the snpernatants of platelets from 36 were analyzed by means of western blot with a specific antibody recognizing soluble APP.Meanwhile A? level was measured by radioimmunoassay.Results After treated with thrombin,the level of soluble APP in the supernatants of platelets in patients with AD decreased by 31.0% (P

Objective To investigate the correlation between specific features on contrast-enhanced CT and its clinical findings of adrenal tuberculosis so as to improve the diagnostic accuracy of the disease. Methods Contrast-enhanced CT features in 30 patients with documented adrenal tuberculosis were retrospectively evaluated blindly for the features of location,size,morphology,attenuation and enhancement patterns on CT images,and compared with clinical and pathological materials.Results The common CT manifestations were as follows:enlargement of the adrenal glands in all 30 cases(bilateral 90%,mfilateral 10%)including mass-like enlargement in 13 cases and enlargement but the contours preserved in 17 cases, heterogeneity(28 cases,93.3%),calcification(17 cases,56.7%),and low attenuation in the center with peripheral enhancement(16 cases,53.3%)of the lesions.After antituberculosis chemotherapy, 5 cases of enlarged adrenal glands decreased in size or returned to normal size and configuration,with disappearance of the central low attenuation and new appearance of dot-like calcification in 2 cases.Cochran Armitage trend test showed there was an increasing tendency of calcification rate with clinical duration(X~2= 7.47,P

Objective To discuss the clinic characters of clear cell papillary renal cell carcinoma ( CCPRCC) and the efficacy of related laparoscopic surgery.Methods From October 2013 to December 2015, 4 cases were treated as CCPRCC including 3 male and 1 female.Their age ranged from 34 to 67 years old ( mean 53 years old) .The duration of illness ranged from 7 days to 3 months, which the average duration was 1.5 months.The location of tumor included left side in 2 cases and right side in other 2 cases.All tumors were found incidentally, without symptoms or positive sign.Ultrasound showed that 2 cases were solid, and the other 2 cases were cystic solid with low, high or mixed echo and rich blood flow signals.The tumors were enhanced in CT arterial phase, and calcification showed in one case.MRI showed heterogeneous signal.The mean size of tumor was 3.0 cm,ranging 2.3 to 4.5 cm.After preoperative examination, all cases underwent retroperitoneal laparoscopic partial nephrectomy.During the operation, 2 cases were confirmed as cystic solid tumors, and the other 2 cases were solid tumors.Renal artery and renal mass were dissociated , then the artery was blocked.The tumor was complete resected, and kidney was sutured. Results All surgery was performed successfully without conversion.The operation time was 137-191 min (average 157 min).The blood loss was 10-100 ml (average 45 ml) without blood transfusion.The warm ischemia time was 15-35 min ( mean 22 min) .The postoperative hospitalization time stay 6-8 d ( average 7 d).Pathologic report was CCPRCC, including 3 cases of WHO/ISUP grade 1, and 1 case of WHO/ISUP grade 2.2 cases were cystic solid tumor, and other 2 cases were solid tumor.Bland-appearing tubules and occasional small papillae, and uniform small nuclei are arranged in a linear manner away from the basal aspect of the tubules in microscope.Immunohistochemistry showed that CA IX, CK7, 34 E12 were positive, but CD10 , P504S and CD117 were negative.The mean duration of postoperative follow-up was 14 months, ranging 4 to 30 months.No recurrence was found in those patients.Patients were followed up for 4-30 months ( average 14 months) without recurrence or metastasis.Conclusions CCPRCC is a rare subtype of renal tumor, which mainly diagnosed by pathological diagnosis . Retroperitoneal laparoscopic partial nephrectomy is an effective method for the treatment with good prognosis.

Objective: To analyze the efficiency of ureteroscope and biopsy in the diagnosis of tumor grade, muscle-invasiveness and multifocality in suspected upper tract urinary carcinoma (UTUC) patients in order to find out whether it can be used in the risk stratification of UTUC patients.Methods: A retrospective study of 76 UTUC patients who underwent preoperative ureteroscope and/or biopsy and received radical nephroureterectomy in Peking University Third Hospital during January 2014 to December 2016 was undertaken.Results: In this study, 76 patients were included.There were 31 males (40.8%), and 45 females (59.2%).The median age was 64.5 years (31-88), and 51 patients had the symptom of hematuresis.The tumor was located in renal pelvis in 39 patients, and in ureter in 37 patients.Post-operative pathology confirmed that all the 76 patients included in this study suffered from UTUC, of whom 21 (21.6%) were of low-grade, 51 (67.1%) were of high-grade, 4 (5.3%) were undetermined, and 47 (61.9%) patients were muscle-invasive, and 27 (35.5%) were not, and 2 (2.6%) were undetermined.Among the 50 patients, in whom the grade of the tumor could be diagnosed by biopsy, the sensitivity, specificity, accuracy, positive predictive value and negative predictive value for low-grade tumor was 88.2%, 69.7%, 76.0%, 60.0% and 92.0%, respectively.Among the 27 patients, in whom the muscle-invasiveness could be diagnosed by biopsy, 5 patients were diagnosed with muscle-invasiveness, all confirmed by pathology after surgery and 22 patients were diagnosed with none muscle-invasiveness, turned out to be 50% muscle-invasive and 50% none-muscle invasive after surgery.The accuracy was 59.3%.The accuracy of ureteroscopic biopsy to diagnosis multifocality was 61.0%.On univariate ana-lysis, biopsy grade was associated with postoperative pathology (P=0.001), while gender, age, side, body mass index (BMI), hematuresis, preoperative estimated glomerular filtration rate (eGFR), hydronephrosis, tumor size, location, multifocality and sessile were not associated with postoperative pathology grade.Biopsy grade (P=0.02), preoperative eGFR<90 mL/(min·1.73 m2)(P=0.025) and tumor located in pelvis (P=0.049) were associated with muscle invasiveness.Gender, age, side, BMI, hematuresis, hydronephrosis, tumor size, multifocality and sessile were not significantly associated with muscle invasiveness.Conclusion: Ureteroscope and biopsy can assist risk stratification in upper tract urothelial carcinoma patients.