Objective To summarize the experience of diagnosis and treatment of iatrogenic injury by ureteroscopic surgery.Methods Retrospective analysis of 13 cases with iatrogenic injury by ureteroscopy from December 2008 to December 2011,including 8 men and 3 women,aged 15 to 75 years.Among the 13 cases (Holmium laser lithotripsy under ureteroscope),there were 5 cases of ureterostoma severe disruption,4 cases of submucosa injury,2 cases of perforation,1 case of disruption,and 1 case of sleeve exfoliation of mucosa.Results Among these 13 cases with iatrogenic injury by ureteroscopy,10 cases underwent double J drainage (drainage duration:60 days),and 3 cases underwent open surgery immediately.There was no hydronephrosis when examined by IVU after six months to two years follow-up.Conclusions The skills and techniques of surgical operation should be improved when performing ureteroscopic operation,and it is essential to be familiar with ureteric dissection and alignment,which can avoid ureteric injury.Indwelling D-J tube is very important in dealing with mild ureteral injury secondary to ureteroscopes.Surgical intervention should be given to severe cases of ureteric injury in time.

Adult ; Female ; Humans ; Hyperparathyroidism, Primary ; complications ; diagnosis ; surgery ; Male ; Middle Aged ; Thyroid Crisis ; diagnosis ; etiology ; surgery

AIM:To study the relation between expression of uPAR and annexinⅡ and fibrinolytic activity in various leukemic cell lines.METHODS: The plasma activity was measured under the reaction between cells of NB4,SHI-1,K562,Jurkat,Raji and plaminogen by chromogenic assay.The protein expressions of uPAR and annexinⅡin cells of NB4,SHI-1,K562,Jurkat,Raji were detected by flow cytometry method.The mRNA expressions of uPAR and annexinⅡin cells of NB4,SHI-1,K562,Jurkat,Raji were detected by RT-PCR.RESULTS: The plasma activity in SHI-1 cells and NB4 cells were higher obviously than that in Raji,K562 and Jurkat cells.The protein expression ratio of uPAR and annexinⅡ in NB4 cells were(13.15?1.61)% and(95.97?1.19)%,respectively,they were(99.00?0.26)%,(90.35?2.15)% respectively in SHI-1 cells,and they were lower in K562,Jurkat,Raji cells.The expression of annexinⅡ mRNA in NB4 cells was higher than that in SHI-1 cells,and they were undectectable in K562 and Jurkat cells.The expression of uPAR mRNA in NB4 and SHI-1 cells were higher than that in Jurkat and K562 cells.The expression of uPAR mRNA in Raji cells was undectectable.CONCLUSION: The primary hyperfibrinolysis in leucocythemia cells was observed,and relation was closely with the expression of annexinⅡ.It might be the main reason for bleeding and disseminated intravascular coagulation in patients with acute promyelocytic leukemia and acute monocytic leukemia.

0.05) ,but the differences reached statistical significance compared the positive ratios of two index together to urine NAG and ?2 - MG (X2 = 4.41,7.28 P

Objective To investigate the clinical characteristics and its prognostic factors for hilar cholangiocarcinoma with exairesis .Methods The clinical data of 58 cases of hilar cholangiocarcinoma were ret-rospectively analyzed .The Kaplan-Meier method was used to estimate the overall survival and disease specific survival rates for these patients .And the factors that may influence the prognosis and survival of patients were an -alyzed using univariate(log-rank test)and multivariate Cox proportional hazard models .Results The median survival time was 22 months for all patients .The 1-,3-and 5-year survival rates were 76%,40%and 21%, respectively.Univariate analysis showed that preoperative albumin (P=0.002),intraoperative blood loss (P=0.039),surgical method(P =0.006),histologic differentiation(P =0.001),portal vein encroached(P =0.014),surgical margin(P=0.020)were correlated factors for postoperative survival duration .Multivariate analy-sis by Cox Proportional Hazard Model showed that surgical method (P=0.022),histologic differentiation(P=0.020)were independent prognostic factors for patients with Hilar cholangiocarcinoma excised .Conclusion Low albumin leve,intraoperative blood loss more than 500 mL,low degree of tumor differentiation,portal vein en-croached ,radical surgery ,positive surgical margin are risk factors for total survival of Hilar cholangiocarcinoma .

Objective To discuss the cause,treatment and prevention of splenic injury during the urological surgery.Methods The clinical data of 16 cases with splenic injury in operation for renal and adrenal tumors in 496 cases were retrospectively analyzed.Nine cases were left radical nephrectomy,3 cases were left renal hamartoma enucleation,4 cases were left adrenal tumor resection.Damage located at outer edge of the spleen in 8 cases,the splenorenal ligament in 6 cases,and the splenic hilum in 2 cases.In these 16 cases,14 patients spared the spleen (Ⅰ Grade injury 8 cases,Ⅱ grade 6 cases).The injuryed spleen was directly pressed with hemostatic gauze in 3 cases; 5 patients used coagulation,bonding,hemostatic gauze to stop bleeding; 2 cases of grade Ⅱ injury used U-shaped suture and coated with fibrin glue,then compressed with hemostatic gauze to stop bleeding; 2 cases of grade Ⅱ injuries with the greater omentum stitched into the seam,sprayed biological glue,were compressed with gelatin sponge; 2 cases of grade Ⅱ injury underwent splenic artery branch ligation.The other 2 cases (1 Ⅱ grade and 1 Ⅲ grade) underwent splenectomy.Results All of the 16 patients were cured and followed up for 6 months to 5 years.There was no delayed bleeding of spleen and splenic dysfunction.One patient died of tumor recurrence 6 months after operation.Conclusions Splenic injury is a common complication during urological surgery,especially the tumor is large or adhered to spleen in the upper pole of left kidney.Once spenic injury occurs,doctors should choose the right treatment plan according to surgical injury,and try to save the spleen.

Objective To investigate the therapeutic efficacy of castration with 125I brachtherapy in middle and late stage prostate cancer. Methods Sixty-six patients with prostate cancer from 2004 to 2009 were analyzed, 40 were at clinical stage C and 26 were at clinical stage D, 42 had a pathologic grade G2 and 24 had a pathologic grade G3. The first endocrinal therapy used was total androgen blockade (chemical castration and anti-androgen drugs). The therapeutic time was three months before bilateral orchidectomy and brachtherapy. A 3D radiotherapy planning system was used for brachtherapy with transrectal ultrasound-guided radioactive 125I seed uniform implantation. Follow-up endocrinal therapy was decided according to a monthly check of serum PSA (prostate specific antigen) levels. After six months, serum PSA, IPSS and volume of the prostate before and after treatment were compared. Results The operations were completed successfully in all cases. The mean number of 125I seeds implanted was 55. The mean follow-up was 10 to 62 months, with an average of 49 months. Serum PSA, IPSS and the volume of the prostate was reduced significantly six months after operation (P<0.05). Conclusions Castration with 125I brachtherapy is an effective approach in combination therapy for treating middle and late stage prostate cancer.

Objective To investigate the relationship and mechanism between the serum level of high mobility group box protein-1(HMGB1)and the mortality rate in patients with sepsis.Methods The serum levels of HMGB1,superoxide dismutase(SOD)and malondialdehyde(MDA)in 48 patients with sepsis were determined.The clinical outcomes in those patients were recorded and anlyzed.Results After the onset of sepsis,the serum HMGB1 levels of both death group and survival group were increased gradually and peaked at 72h after the onset of the disease.The semm HMGB1 levels of death group were much higher than those of survival group except at 24h(t=6.07,6.20,24.43,all P＜0.05).The activity of serum SOD of death group was markedly lower than that of survival group at 12h,24h,48h and 72h(t=10.24,20.61,11.67,33.33,all P＜0.05),and the level of serum MDA of death group was significantly higher than those of survival group at all time points(t=26.06,22.17,23.86,9.49,5.95,all P＜0.05).There was a significantly positive correlation between the serum HMGB1 and MDA level.Conlusioa The increase in serum HMGB1 level may be the important reasoll for the increased mortality rate in patients with sepsis;Oxidant/antioxidant imbalance may be olle reason for the increase in serum HMGB1 level.

Objective To measure the range of motion (ROM) of the lumbar pedicle screw entrance point (LPSEP) in vivo during unrestricted motion under physiological weight bearing.Methods Eleven healthy volunteers aged 45-60 years underwent MRI scans in a supine position.Three-dimensional (3D) models of L2-5 were constructed.Next,each volunteer was asked to stand and was positioned in the following sequence:standing,45° flexion,maximal extension,maximal left-right twisting,while two orthogonal fluoroscopic images were taken simultaneously at each position.The MRI models were matched to the osseous outlines of the images from the two orthogonal views to determine the position of the vertebrae in 3D at each position.Coordinate systems were established to study the ROM of the LPSEP.Results The predominant translations were along anteroposterior and craniocaudal axis from supine to standing position (average,2.44mm and 2.35 mm).Rotation of the LPSEP occurred mainly around the mediolateral axis(average,3.91 °).During flexion-extension movements of the trunk,the predominant translation were along anteroposterior and craniocaudal axis and rotation were around mediolateral axis.During lateral bending and twisting,ROM of LPSEP did not rotate or translate in one dominant direction.Instead,the resulting motion represented a combination of rotation and translation in different directions.There was no significantly difference in translation and rotation between the three axis in L4,5segment (P＞0.05).Conclusion The kinematic behaviors of the LPSEP of the upper lumbar spine (L2,3 and L3,4) are similar which are different from that of the lower lumbar spine (L4,5).

Objective To evaluate the diagnosis and treatment of urinary tract endometriosis.Methods Retrospective review of 10 female cases of urinary tract endometriosis was carried out. All cases age was from 28-49, and the average age was 39-year-old. The course of this disease was from 6 months to 3 years. Four of 10 cases were bladder endometriosis. The clinical presentations included the urgency, frequency, pain at micturition and lower abdomen pain during menstruation, gross hematuria coinciding with menstruation 1 case. B-ultrasound and CT showed the mass of bladder from 2. 0 -3.5 cm but were not specific. Four of 6 cases ureteral endometriosis were the left side and 2 cases were the right side. This clinical presentation included non-specific flank or abdomenal discomfort in 4 cases, intermittent gross hematuria in 1 case and 1 case renal hydronephrosis was found incidentally by B-ultrasound. B-ultrasound indicated unilateral upper urinary tract dilation and hydrops in all cases,with pyelic separation from 2.0-4.5 cm and ureteral separation from 1-2 cm. CT indicated stenosis of the lower ureter in 5 cases, ureter tumor in 1 case. Results All cases were treated surgically.Partial cystectomy were performed in 4 cases of bladder endometriosis, of which, 1 case bilateral oophorectomy and hysterectomy. Five cases were performed ureteral segmental resection, of which, 3 ureterocystostomy and 2 terminoterminal anastomosis. 1 case was performed radical nephrectomy and ureterectomy. Postoperative pathological findings confirmed the diagnosis of endometriosis. Postoperative oral hormone therapy was given to 9 cases for 6-12 months. All cases were followed for 12-60months. 2 cases ureteral endometriosis had recurrent hydronephrosis in 18-24 months. The 2 cases received ureteral stent and cured by oral hormone therapy or goserelin subcutaneous injection for 3 months. Conclusions Urinary tract endometriosis usually shows non-specific symptoms. The diagnosis can be missed on both clinical examination and preoperative work-up. Surgical treatment is effective and adjuvant hormone therapy is often recommended to prevent the recurrence.