The success of organ transplantation depends on the prevetion of acute rejection. T and B lymphocytes, the major components of the cellular and humoral immunization mediating the rejection response, respectively, have been extensively studied. The importance of matural killer(NK) cells in transplantation has become an increasing area of interest as reagents for their study have become available. Basing on this on the killer immunoglobulin-like receptor in the acute rejection response with kidney transplantation.

0. 05) in a year, respectively. Conclusions FK506 was an effective and high safe basic immunosuppressant in long-term application in renal transplant recipients, especially suitable for children and old recipients. To those patients with DM, FK506 had almost the same influence on the glucose metabolism as the CsA.

Objective To study kidney transplantation in the aged and its perioperative management. Methods Scrutinized screening of heart,lung and liver were carried out before renal transplantation for 29 patients,aged 65～84.Color Doppler B type ultrasonic inspection was used to determine the status of arteriae iliaca externa and arteriae iliaca interna.Tissue match included HLA and PRA measurement.Warm ischemia time of donor kidney was within 5 minutes and cold ischemia time 10 hours.The dose of MP was under 2.0 g during the period of operation and the immunosuppressive regimen was CsA or FK506+MMF+Pred.The general condition,blood electrolytes,whole blood CsA or FK506 concentration and immune index were monitored. Results There were 4 cases of AR,1 cases of FK506 toxicity and 1 case of lung infection.All these 6 patients were cured.1 kidney graft was removed because of thrombogenesis of renal artery.Up to now,the other 28 have been surviving with the graft functioning well for 1 to 5 years. Conclusions Abide to the indications of kidney transplantation,donor kidney of good quality and well tissue match were important in the elderly patients.With comprehensive monitoring and adequate management,kidney transplant in old patients can achieve sa tisfying outcome.Rational application of immunosuppressants and effective long term follow up are major factors for long term allograft survival.

Objective To study the diagnosis and treatment of ureteral obstruction caused by endometriosis. Methods Out of 23 patients suffered from endometriosis treated from 1997 to 2000,ureteral obstruction occurred in 2 accompanied by hydronephrosis and dilatation of ureter.Both the 2 underwent sub total hysterectomy, resection of the intumescence in pelvic cavity, and the ureter was freed from the surrounding tissue. Results Ureteral obstruction was relieved in 7～10 days after the procedure. Both the petients were followed up for 2 years without recurrence. Conclusions Attention shoud be called to ureteral obstruction caused by endometriosis.Ultrasonic examination and intravenous pyelogram before operation, close examination of the ureter and adequate freeing of the ureter from it's surrounding tissue during operation, the application of gestrinone for 6 months after the operation, and scheduled following up would yield a satisfactory outcome.

0.05). The body surface area of recipients was positively correlated and the ratio of allograft weight to body surface area negatively correlated with the mean sCr in the 2～7 days after transplantation( P

Objective To study the diagnosis and treatment of multiple-ligament injury to the knee and report the clinical outcomes of the disease.Methods A total of 51 patients with multiple-ligament tear in the knee were enrolled in this study.The lesion involved the ACL and MCL in 21 cases,ACL and PLC in 1,PCL and MCL in 4,PCL and PLC in 6,ACL,PCL,and MCL in 6,ACL,PCL,and PLC in 3,ACL and PCL in 8,and PCL and patella tendon in 2.Among the patients,14 patients had acute Ⅲ grade MCL tear and 3 had acute Ⅲ grade PLC injury;open suture repair were performed on these cases,and then arthroscopic surgery was carried out for other injured ligaments after 3-week immobilization.For 2 patients who had chronic Ⅲ grade MCL injury and 3 cases that were suffering from chronic Ⅲ grade PLC tear,open surgery for ligament reconstruction was employed,arthroscopy were used afterwards to remodel the ACL and PCL.In the 51 patients,totally 39 ACLs were injured,20 of these ligaments were reconstructed under a arthroscope using Hamstring tendon,17 were repaired with BPB by arthroscopy,and 2 were remodelled by implanting allogeneic tendons.In addition,29 PCLs tear were diagnosed,among which arthroscopic PCL reconstruction with autologous Hamstring tendon was performed on 19,allogeneic ligaments were used in 2,and the other 8 injured PCL were not repaied surgically because the lesion was relieved after immobilization(improved from grade Ⅲ to

Objective To evaluate whether serum cystatin C (SCys C) could be used as an ideal index to assess renal function of renal transplant recipients during posttransplant follow-up.Methods Seventy patients who were followed up for at least 6 months after renal transplantation in our centre were recruited in the study. SCys C and serum creatinine (SCr) were determined during the follow-up period, and glomerular filtration rate (GFR) was measured using an isotope Tc99m DTPA.The correlation between SCys C, SCr and GFR was analyzed. The performance of SCys C and SCr in diagnosing the mild impairment of renal allgraft function (GFR ＜ 1 ml/s) was evaluated using ROC curve. Results Both SCys C and SCr had a linear negative correlation with GFR (r = -0. 82 and -0. 66 respectively, P＜0. 01 ). The sensitivity, specificity and positive predictive values (PPV) of SCys C for diagnosing the mild impairment of renal allgraft function were higher than those of SCr,but the AUC of SCys C did not differ from that of SCr significantly (0. 935 vs. 0. 877, P＞0. 05).Conclusion SCys C could be used an ideal index to evaluate the allograft renal function for its better correlation with actual GFR.

Objective To discuss the treatment strategy of knee dislocation and to evaluate its outcome.Methods Thirty-six patients with unilateral knee dislocation treated with individualized protocol were studied retrospectively,including 22 males and 14 females with an average age of 35 years (range,19-72 years).There were 30 acute and 6 chronic knee dislocations.According to the modified Schenck's classification of knee dislocation,there were 7 KD- Ⅰ and 23 KD-Ⅲ cases in the acute category,and all 6 chronic cases were KD-Ⅲ.Seven acute KD- Ⅰ and 6 chronic KD-Ⅲ cases underwent one-stage arthroscopic surgery.In 23 acute KD-Ⅲ cases,2 were treated conservatively with splint or brace due to advanced age,18 with staged surgery,3 with one-stage surgery due to concomitant vascular and nerve injury.Functional and clinical evaluation was conducted at final follow-up.Results All 36 patients were followed up for an average of 27 months (range,18-36 months).The Lysholm score (82.0±11.4),Tegner score (5.5±1.3),and knee range of motion (118.3°±19.2°) at final follow-up showed a statistically significant improvement compared with preoperative results (P＜O.O1).Eight (23.5％) patients had residual knee instability:posterior drawer test and Sag sign were positive (++ or +++) in 8 knees,valgus instability (++) in 1 and varus instability (+++) in 1.The remaining 28 knees were stable.Conclusion Special attention should be paid to rotational knee dislocation with single cruciate ligament rupture.Properly individualized treatment plan is the key to optimal outcome.Arthroscopic surgery can lead to successful outcome.Early one-stage arthroscopic surgery is recommended for acute KD-Ⅰ and chronic KD-Ⅲ dislocation,staged arthroscopic surgery for acute KD-Ⅲ dislocation.

Objective To report our experience in surgical technique of pediatric renal transplantation and administration of immunosuppressive agents for improvement of recipient/graft survival. Methods Twenty six pediatric recipients (less than 18 years) received cadaveric renal allografts between June 1980 and March 2001.A retrospective analysis was made in these 26 cases with respect to the technical consideration of transplant,immunosuppressive regimens and long term survival. Results Two cases (8%)had delayed graft function,11(42%)had acute rejection and 10 (38%)had chronic rejection.One case develo ped recurrent nephritis,which was pathologically confirmed to be focal segment glomerulosclerosis (FSGS).The recipient/graft survival rates of 1,3,5 years were 96%/88%,92%/73% and 88%/62% respectively,with mortality of 12%. Conclusions In pediatric renal transplantations,good tissue matching,appropriate technique of vessel anastomosis,early diagnosis of acute rejection and optimal adjust ment of blood level for immunosuppressants are keys to success.

Objective To summarize the clinical experience of combined liver and kidney transplantation (CLKT). Methods CLKT was performed on 22 patients. The orthotopic liver transplantation (LT) was preceded with the classic fashion in 10 patients and piggyback fashion in 12 patients. The renal allograft was implanted to the iliac fossa routinely. After operation, the patients received an induction therapy with anti-CD25 monoclonal antibody or antithymocyte globulin ( ATG) and a maintenance therapy with tacrolimus (Tac), mycophenolate mofetil and prednisone. Results The CLKT was successfully performed on all 22 patients, and the graft function was restored well postoperation. During the perioperative period, an acute rejection episode of liver occurred in one patient and acute renal allograft rejection episode in 2 patients. The Tac toxicity occurred in one patient. The hemorrhage of digestive tract occurred in one recipient and the hemorrhage of peritoneal cavity in one patient. The pleural effusion occurred in 6 recipients. The pneumonia occurred in 2 cases and the peritoneal infection in one patient During a follow-up period of 6 months to 7 years 11 months, three patients died because of cytomegalovirus pneumonia in 2 patients and acute myocardial infarction in, one patient, The 1-, 3-, 5-year survival rate of recipients was 86,4 %, 81.3 %, 72.7 % respectively. Conclusion The CLKT is an effective method for treatment of patients with end-stage liver djsease and chronic renal failure.