Objective To discuss anatomic landmarks during retroperitoneoscopic radical nephrectomy. Methods A total of 46 patients underwent retroperitoneoscopic radical nephrectomies from November 2002 to July 2004.The first trocar was introduced at the union of the site 2 cm below the 12 th costal margin with the lateral side of the musculus sacrospinalis.The second trocar was placed at the midpoint of the upper border of the iliac crest,or at the location above and medial to the anterior superior iliac spine.And the third one was inserted at the union of the anterior axillary line with the costal margin.In the first place,the greater psoas muscle was identified as the dorsal marker.Then the diaphragmatic muscle was identified as the posterior marker of the upper pole of the kidney,and the adrenal gland as the medial marker of the upper pole of the kidney,and the peritoneum as the ventral marker.The renal vein lay below and anterior to the renal artery.The right renal vein was routinely sperated right up to the joining site with the inferior vena cava.A linear cutter was used to resect the renal vein and artery respectively. Results The mean operation time was 145 min (range, 60~ 255 min) and the mean intraoperative blood loss was 133 ml (range, 20~1 000 ml). Adrenalectomy was performed in 32 patients (69 6%). A conversion to open surgery was required in 1 patient because anatomic landmarks could not be well seen. The inferior vena cava was wrongly closed off by 1/2 cross-section when using a linear cutter to sever the right renal vein in 1 patient. Peritoneal injuries happened in 4 patients.Follow-up was carried out for 1~20 months (mean,9 months) in all the 46 patients.One patient died of liver metastasis 1 year after the surgery, while the remaining 45 patients survived without recurrence. Conclusions Proper identification of anatomic landmarks is crucial to a successful retroperitoneoscopic nephrectomy.

Objective To evaluate the safety and efficacy of retroperitoneoscopic radical nephrectomy. Methods A total of 46 patients (24 males and 22 females;age range,23-86 years;mean age,58 years) underwent retroperitoneoscopic radical nephrectomy from November 2002 to July 2004.Of the 46 cases,43 were detected by B-ultrasound during physical examination and the rest 3,when visiting doctors due to painless hematuria.The masses by B-ultrasound was on average 4.5 cm (range,1.5-8.0 cm) in diameter, with 17 masses at the upper pole of the kidney,13 at the middle and 16 at the inferior pole.CT scan was performed on all the 46 cases and MRI,on 41.The tumor size detected by CT and MRI was consistent with that by B-ultrasound.Preoperatively,3 cases had the tumors of clinical stage T 1N 0M 0,38 of T 2N 0M 0 and 5 of T 3aN 0M 0. Results The operative time was 60-255 min (mean,145 min),and blood loss was 20-1000 ml (mean,133 ml).Adrenalectomy was performed on 32 patients (70%).Complications occurred in 3 cases,of whom only 1 required conversion to open surgery due to injury of genital gland vein,with blood loss of 1000 ml.Pathology showed that 41 cases were of renal clear cell carcinoma,2 of cystic renal cell carcinoma,1 of chromophobe carcinoma,1 of hamartoma and 1 of oxyphil cell tumor.During the follow-up of 1-20 months (mean,9 months),45 patients survived;only 1 died of liver metastasis. Conclusions Retroperitoneoscopy radical nephrectomy is safe and effective.

Animals ; Antibiotics, Antineoplastic ; administration & dosage ; toxicity ; Apoptosis ; drug effects ; Daunorubicin ; administration & dosage ; toxicity ; Disease Models, Animal ; Female ; In Situ Nick-End Labeling ; Male ; Myocardium ; cytology ; metabolism ; pathology ; ultrastructure ; Neuregulins ; metabolism ; pharmacology ; RNA, Messenger ; metabolism ; Rats ; Rats, Wistar ; Receptor, ErbB-2 ; genetics ; metabolism ; Reverse Transcriptase Polymerase Chain Reaction

Objective To detect the levels of plasma N-terminal pro-brain natriuretic peptide (NT-proBNP) and investigate its relationship with liver function, ascites and heart structure in patients with liver cirrhosis. Methods The levels of plasma NT-proBNP and various clinical and biochemical parameters were determined in 60 patients with liver cirrhosis and 30 healthy controls. Meanwhile Child-Pugh liver function was classified. All people underwent color Doppler echocardiography. Results The level of plasma NT-proBNP was significantly elevated in patients with liver cirrhosis [(38.63±36.05)pmol/L], compared with that of the controls [(7.50±8.25)pmol/L],P<0.01. There was no significant difference in different Child-Pugh class and aseites amount of liver cirrhosis. E/A < 1 and E wave decelerate time (EDT) was in-creased in liver cirrhosis. Conclusion The levels of plasma NT-proBNP in liver cirrhosis are significantly elevated, and related to early impairment of diastolic function. But it does not correlate with liver function and aseites.

Adolescent ; Adult ; Aged ; Aged, 80 and over ; Child ; Female ; Humans ; Male ; Middle Aged ; Paraquat ; poisoning ; urine ; Prognosis ; Young Adult

Adrenal Gland Neoplasms ; surgery ; Adult ; Cystectomy ; methods ; Humans ; Laparoscopy ; methods ; Male ; Pheochromocytoma ; surgery ; Urinary Bladder Neoplasms ; surgery

Objective To investigate the levels of adiponectin and the relation with insulin and tumor necrosis factor(TNF)- ? in patients with cirrhosis. Methods Adiponectin,insulin and TNF-? levels were determined in 73 patients with cirrhosis and 30 healthy controls, and were correlated with various clinical and biochemical parameters. Meanwhile Child-Pugh liver function was classified. Results Adiponectin was significantly elevated in patients with cirrhosis compared with the control. Adiponectin levels in cirrhosis was correlated positively with insulin and negatively with insulin sensitively index,and did not correlate with TNF-? and liver function.Conclusion Serum adiponectin levels in cirrhosis are significantly elevated. Adiponectin levels do not correlate with TNF-? and liver function, but exclusively insulin and insulin sensitivity index.

Objective To evaluate the feasibility and clinical efficacy of laparoscopic nephron-sparing surgery without renal wound suturing.Methods From December 2012 to February 2014,9 patients (4 male,5 female) with renal tumor underwent laparoscopic nephron-sparing surgery without suturing in our hospital.The mean age in those patients was 56 years (range 42-72 years).The mass size ranged from 1.1to 3.8 cm (mean 2.4 cm).The location of tumor included 2 in left kidney,7 in right kidney.Meanwhile,6 tumors were found in the middle part of kidney,2 tumors were demonstrated in the lower part of kidney,and 1 tumor located in the upper part of kidney.The imaging examination confirmed that all tumors protruded the renal surface and infiltrated into the renal parenchyma about 0.1-1.2 cm,which could be defined as the peripheral renal tumor without the invasion of collective system.The retroperitoneal approach was used in all patients with 3 trocars.During the operation,the renal artery was exposed and fats surrounding or on the surface of the tumor were resected.The renal artery was occluded.Tumor excision was then performed using scissors.An incision was made at the point 0.5 cm away from the margin of the tumor,extending deeply to completely cut the tumor.Meanwhile,bleeding was controlled with bipolar diathermy.Then,the clamping of the renal artery was removed and the retroperitoneal pressure was reduced in order to check the site of bleeding.If the bleeding occurred severely,the kidney wound was sutured with 2-0 absorbable sutures.Otherwise,the coagulative glue was sprayed on the wound surface.Results In all the patients,the procedures were done without conversion to open surgeries.The renal wound suturing appeared in one case because the tumor infiltrated into the deep of the kidney and the bleeding could not be completely controlled by bipolar diathermy.Eight of 9 cases were successfully performed without suturing.The mean time of renal artery occlusion was 8 min (range 3-18 min).In our patients,the mean operation time was 120 min (90-180 min),and the mean blood loss was 60 ml (10-200 ml).None of the patients received blood transfusion during the surgery.The mean postoperative hospital stay was 7 days (5-9 days).No complications,such as urine leakage,bleeding occurred after the operation.All the patients were followed up with no recurrence of tumor.Conclusions Laparoscopic nephron-sparing surgery without renal wound suturing is feasible and safe for patients with the small and the depth of infiltration less than 0.5 cm tumor in the kidney.

Objective To evaluate the surgical treatment,effect and follow-up for renal cell carcinoma with tumor thrombus (T T) in inferior vena cava (IVC) and right atrium (RA).Methods Three cases of renal cell carcinoma with TT in IVC and RA diagnosed by Doppler ultrasonography,CT,MRI and transesophageal echocardiography were included in this retrospective analysis from January 2014 to March 2015 in our hospital.They were all male patients,aged from 50-64 years,and all patients presented painless gross hematuria.All patients underwent radical nephrectomy,inferior caval venous and atrial thrombectomy under general anesthesia,using abdomen inverted Y shaped incision and median sternal incision.Firstly,we dissected and ligated renal artery,then the vena cava was dissected;then hepatobiliary surgeons help to dissect the liver that can expose suprahepatic vena cava and inferior vena cava,and hepatic artery,hepatic portal vein;cardiothoracic surgeons help to perform sternotomy and establish cardiopulmonary bypass.Finally,TT in renal vein and IVC were extracted.Results All patients underwent radical nephrectomy,caval and atrial thrombectomy successfully.The operation time was 480-589 min,the extracorporeal circulation time was 40-110 min,the intraoperative blood loss was 1 200-4 400 ml,and the blood transfusion amount was 1 800-3 200 ml.Of the 3 patients,1 patient died on the 17th day of sepsis,respiratory failure,renal failure and coagulation disorders.One patient developed adrenal gland,lung and brain metastases in 5 months after surgery and died in 7 months after surgery.The remaining one is alive (follow-up:12 months) and without evidence of tumor recurrence or metastases.Conclusion For patients with renal cell carcinoma and TT in IVC and RA,although the overall prognosis is poor,radical nephrectomy plus caval and atrial thrombectomy is the only safe and effective therapeutic method.

Objective:To analyze the clinical efficacy of compound honeysuckle decoction hot and humid joint fusidic acid cream in the treatment of targeted drugs-induced rash.Methods:80 cases of patients with targeted drugs-induced rash admitted in our hospitalfrom August 2014 to August 2016 were selected and divided into two groups with 40 cases in each group according to the drawing method.The control group was treated by fusidic acid cream,while the observation group was treated by compound honeysuckle decoction hot and humid joint fusidic acid cream,the changes of symptom score,quality of life after treatment,clinical efficacy and incidence of adverse reactions were compared between two groups.Results:After treatment,the symptoms score of observation group ((6.87± 1.25) points) was lower than that of the control group ((10.29± 2.74) points)(P＜0.05),the quality of life score ((3.15± 0.57)points) of observation group was lower than that of the control group ((6.42± 1.20) points)(P＜0.05).The effective rate of observation group(95.00％) was higher than that of the control group(77.50％)(P＜0.05),no statistical difference was found in the incidence of adverse reactions was observed between two groups (P＞0.05).Conclusion:Compound honeysuckle decoction hot and humid joint fusidic acid cream was effective in the treatment of targeted drugs-induced rash,it could effectively relieve the clinical symptoms,improve the quality of life.