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 values of combined detection of serum pancreas autoantibodies (PAB),anti-saccharomyces cerevisiae antibodies(ASCA),goblet cell autoantibodies(GAB) and antineutrophil cytoplasmic antibodies(PANCA) and fecal calprotectin(FC) in the diagnosis and differential diagnosis of inflammatory bowel diseases(IBD).Methods The serum and feces samples from IBD patients,including 107 with definite Crohn's disease(CD) and 98 with definite ulcerative colitis(UC),and 79 non-IBD patients as the control were collected.Serum PANCA,ASCA,GAB and PAB were detected by an indirect immunofluorescence assay,and FC concentration by double-antibody sandwich ELISA.The results from different patients were compared and analyzed.Results The positive rates of serum PANCA,GAB,PAB and ASCA in 205 IBD patients were 36.1％,29.8％,38.0％ and 4.9％,respectively.The FC concentrations in IBD,CD and UC patients were significantly higher than that in the control(P ＜ 0.01),while there was no statistical difference between CD and UC patients (P ＞ 0.05).The positive rates of PANCA in CD and UC patients were 8.4％ and 66.3％,respectively,while those of PAB in CD and UC patients were 65.4％ and 8.2％,respectively.The sensitivity and specificity of PAB,PANCA,GAB,ASCA,FC and their combination in the differential diagnosis of IBD and non-IBD were 38.0％,36.1％,29.8％,4.9％,54.1％,63.4％ and 98.7％,96.2％,94.9％,100％,68.4％,93.7％,respectively.The area under the ROC of the combination of 5 markers was 0.819 in differentially diagnosing IBD and non-IBD.The area under the ROC of PANCA for the differential diagnosis of UC was 0.816,while that of PAB for the differential diagnosis of CD was 0.823.Conclusion GAB is an autoantibody associated with IBD,which may be helpful for the auxiliary diagnosis of IBD.PAB and PANCA are the important serological markers for the diagnosis of CD and UC,respectively.The combination of FC with PAB,PANCA,GAB and ASCA may be used for the differential diagnosis of IBD and non-IBD,but has little value in distinguishing CD and UC.

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 analyze the epidemiological features and influencing factors of human brucellosis in Qinghai province,and to provide scientific basis for prevention and control of brucellosis.Methods From 2006 to 2010,select the high incidence areas of brucellosis in Qinghai province and five counties(Henan,Dari,Tianjun,Ping'an and Haiyan counties) included in the “Central Subsidies to Local Public Health Special Fund Human Brucellosis Prevention and Control Projects” for the survey point,as well as high-risk employees from Qinghai Biological Pharmaceutical Factory were investigated.Combined with epidemiological questionnaire investigation [done according to the “National Human Brucellosis Surveillance Program(Trial)”],clinical symptoms and signs,confirmed human brucellosis patient were tested by intradermal allergy test,rose bengal plate agglutination test(RBPT) and standard tube agglutination test (SAT),in accordance with “Diagnostic Criteria and Principles of Management of Brucellosis” (GB 15988-1995) and“Diagnostic Criteria for Brucellosis” (WS 269-2007).Results Of 8368 serum samples detected,347 were RBPT positive,and the positive rate was 4.15％;5346 serum samples were tested by SAT,180 were positive,and the positive rate was 3.37％.In June 2009,112 employees in Qinghai Biological Pharmaceutical Factory were investigated on a follow-up survey,83 were RBPT positive,the positive rate was 74.11％; 58 were SAT positive,the positive rate was 51.79％.Eight of them were new cases and 4 were chronic brucellosis.Twenty five new cases were reported between 2006 and 2010.The peak incidence was from March to July.Most of the cases were herdsmen.ConclusionStrengthening animal quarantine,strengthening public education,and improving protection awareness,can effectively control the disease brucellosis.

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.