Objective To evaluate transureteroscopic pneumatic lithotripsy in the treatment of ureteral calculi. Methods 116 cases of ureteral calculi treated with ureteroscopic pneumatic lithotripsy from Dec.1999 to Feb.2002 were studied retrospectively.There were 49 male patietns and 67 female with an average age of 43,3 being upper ureteral stone,24 middle and 68 lower ureteral stone.21 ureteral stone-street. Results The stone fragmentation rate was 90%(104/116),85%(99/116) of which being fragmented on the first treatment session.The main complications were failure to insert the ureteroscope in 3 cases and ureteral perforation in 4.94 cases were follow-up for one to eighteen months and 91 cases were stone free within one month.No ureteral stricture has been observed on intravenous urogram. Conclusions Treatment of ureteral calculi by transureteroscopic pneumatic lithotripsy has been safe, effective and less invasive.

Objective To study the diagnosis and treatment of cystic renal cell carcinoma. Methods 12 cases of cystic renal cell carcinoma have been identified. Imaging studies showed no specific evidence of malignance and the preoperative diagnosis was a complex cystic mass in all but 2.All the 12 cases had been surgically explored,intraoperative pathological examination being undertaken in 9,8 of them demonstrating a malignant cystic renal clear cell carcinoma.Radical nephrectomy was carried out in 7,simple nephrectomy in 3,partial nephrectomy in 1 and one cyst unroofed. Results All the 12 cases were confirmed as cystic renal clear cell carcinoma on pathology.All the patients have been followed up for a mean of 39.5 months and the overall results were excellent with no evidence of cancer recurrence or metastasis. Conclusions Intraoperative pathological examination should be performed in suspected cases of cystic renal cell carcinoma.The prognosis is fair for cystic renal clear cell carcinoma.Nephrectomy or partial nephrectomy is indicated.

Objective To understand the cause of chest pain (precordium indisposition) in children and explore the thread of thought in its analysis.Methods Clinical data of 314 children with chest pain who visited the cardiovascular department for children of our hospital were collected and analyzed to study its causes.Results The cause could be attributed to organic cardiac diseases in 43 of 314 children (13.7%) with chest pain,to non-organic cardiac diseases in 108 (34.4%),to psychiatric-psychological factors in 60 (19.1%) and to unknown cause in 41 (13.1%).Average age of children with organic cardiac diseases was younger than that of children with other causes (P<0.05).Symptoms accompanied simultaneously in children with organic cardiac diseases were much more frequent significantly than those in them with non-organic cardiac chest pain and unknown causes (P<0.05).Conclusions Chest pain in children could be caused by a few causes,which was non-specific symptom for organic cardiac diseases,so, more should be taken into account in analyzing the cause of chest pain in children.

Objective To investigate the level of platelet activating factor (PAF) in acute myocardial infarction (AMI) in minipig model and patients, and to study the relationship between PAF and lethal arrhythmia referring to ventricular fibrillation and ventricular tachycardia. Method ( 1 ) The levels of PAF in minipig models ( n = 20) were measured by using ELISA before and 1h after occlusion of left anterior descending coronary artery with balloon at the junction of 1/3 middle and distal portion. The lethal arrythmia was recorded by using electrocardiography. (2) In patients with AMI (n = 72), the levels of PAF were measured on arrival, and 24 h,48 h and 72 h later. The lethal arrythmia, acute heart failure and cardiogenic shock were documented. Results ( 1 ) In minipigs with occlusion of coronary artery for one hour, the mean level of PAF increased from (4.66± 2.89)ng/mL to (6.00±2.82) ng/mL,and thus the increment in PAF was (1 .34± 1.40) ng/mL (P ＜ 0.05). In 13 minipigs with lethal anythmia after occlusion of coronary artery for one hour, the increment in mean level of PAF was ( 1.92 ± 1 .34) ng/mL, whereas the increment in mean level of PAF in other 7 minipigs without lethal arrythmia after occlusion of coronary artery for one hour was as low as (0.28 ± 0. 74 ) ng/mL ( P ＜ 0. 05 ). ( 2 ) In patients, the mean levels of PAF on arrival, 24 h,48 h,and 72 hous after admission were (0.47 ± 0.05) ng/mL,(2.38±0.12) ng/mL,(3.65±0.15) ng/mL and (3.02±0.10) ng/mL, respectively. Of 72 ACI patients, 40 (55%) had complication of lethal arrythnia, heart failure or cardiogenic shock and their mean level of PAF 48 h after admission was (4.72 ± 0.16) ng/mL, whereas mean level of PAF in other 32 (44.44%) without complications was (2.31 ±0.03) ng/mL ( P ＜0.05). Conclusions The level of PAF increased after acute myocardial infarction, and the minipigs and AMI patients complicated with lethal arrythmia had higher levels of PAF.

ObjectiveTo study the risk factors of renal artery pseudoaneurysm (RAP) following partial nephrectomy.MethodsOpen partial nephrectomy was performed on a total of 464 cases of renal cell cancer from July 2003 to May 2010. Five patients ( 1.1％ ) had postoperative hemorrhage from RAP.The surgery technique of the open partial nephrectomy, the clinical presentation, imaging findings and treatment of RAP were reviewed. The anatomical characteristics of these five renal tumors on enhanced CT were quantified using the R.E.N.A.L. Nephrometry Score System.ResultsAll five cases were male, two had tumors on the left side and three on the right side. Median tumor size was 3.6 cm ( range from 2.5 to 5 cm; Radius score 1 - 2). Four tumors were exophytic of these, three had a major endophytic component (≥50％) deep in the parenchyma (Exophytic/endophytic score 2 ), one was entirely endophytic (score 3 ). The distance of all the tumors to the collecting system was ≤4 mm ( Nearness score 3 ). Four of the five tumors were across the polar line and/or renal axial midline ( Location score 3 ). The other tumor was located under the lower pole ( Location score 1 ) but close to the renal hilar. All patients presented with delayed gross haematuria and decreasing hemoglobin occurred on mean postoperative day 12 (3 -23 day). Four patients complained of flank pain, two of which had signs of hypovolemia requiring blood transfusion. The diagnosis was confirmed by the contrast medium-enhanced CT and selective angiography, and RAP was found most commonly arising from the segmental branch of renal artery. Superselective microcoil angioembolization was successfully performed in four cases, once in three cases and twice in the remaining case. The procedure failed in one patient and a nephrectomy was done. At a mean follow-up of 21 months (12 -30) , all patients had normal renal function without evidence of recurrence.ConclusionsRAP should be considered in all patients who had delayed hematuria after partial nephrectomy. A central, deep tumor and its relationship to the segmental branch of renal artery could be an important risk factor for this complication. Choosing the case properly for partial nephrectomy and suturing the transected vessels and the defect of parenchymal correctly could reduce occurrence of this serious complication. Early use of selective angioembolization could be a primary choice of treatment.

Objective To discuss the treatment of synchronous bilateral renal cell carcinoma.Methods Fourteen cases of synchronous bilateral renal cell carcinoma with 12 males and 2 females were treated from 1994 to 2005.Lumbago occurred in 4 cases and hematuria in 2 cases.All the cases were diagnosed with the CT scan,IVU,US and/or MR.Six cases received bilateral operation simultaneously,8 cases received sequential operations.Radical nephrectomy on one side and partial nephrectomy on the opposite side was conducted in 8 patients.Partial nephrectomy on both sides was performed for 6 patients. Results Twenty-two operations were performed in 14 cases.The average operative time was(263±52)min in simultaneous operation and(155±46)min in others.The length of hospital stay was(11.5±2.1)d in simultaneous operation and(7.4±1.2)d in staging operatiom Ten cases were followed up for 6-41 months.The renal function remained good in 7 patients.The SCr increased in 3 cases with no need for dialysis.One case died 25 months later with metastasis of lung.One case with local recurrence died 38 months later.One case died of cerebral hemorrhage.Conclusions The renal function and treating tumor must be considered in managing synchronous bilateral renal cell carcinoma.The geheral condition of patient and the position of tumor should be evaluated in order to make a treatment plan.

Objective To evaluate the application significance of Bosniak renal cyst classification. Methods The operations of 497 cases of cystic renal masses were performed from 2002 to 2007 in our hospital.The average age of these cases was 42-years old,the average diameter of renal cysts was 5.4 cm. There were 212 left lesions,265 right and 20 bilateral.According to Bosniak classification,there were 339 cases of category I,49 cases of category Ⅱ(including 23 cases of category ⅡF),44 cases of category Ⅲ and 65 cases of category Ⅳ.Renal cystectomy was performed in 372 cases when nephron sparing surgery performed in 51 eases and radical nephrectomy performed in 74 cases.Results Malignant tumors were found in 89 cases and benign lesions were found in 408 cases.The malignant rate was 0.9% in category I,10.2% in category Ⅱ(13.O%in category ⅡF),52.3% in category Ⅲ,89.2% in category Ⅳ.There was significant difference among the 4 groups,but there was no significant difference between category ⅡF and non-Ⅱ F of category Ⅱ.403 cases were followed up for 1-5 years with 75 cases of malignancy and 328 cases of benign lesions.Recurrence or metastasis was found in 9 malignant cases.Conclusions Careful follow-up should be performed in category I and Ⅱ,especially in the cases of Ⅱ F category and the eases with changes of diameter or morphology.It is definite that surgery should be performed in the cases of renal cyst with category Ⅲ or Ⅳ for their high malignant rate.

Objective To discuss the etiology and management of hemorrhage after partial nephrectomy because of renal cancer. Methods Of the 382 cases performed partial nephrectomy during a 10-year period, 5 patients(1.3%) had postoperative hemorrhage because of a renal artery pseudoaneurysm. The ages of these patients were from 42 to 63 years. All the tumors were malignant with an average diameter of 2. 8 cm. The renal pedicle was blocked in 2 cases with tumor size larger than 3 cm. The kidney was reconstructed with interrupted 0 chromic sutures in "8"or "U" style. Delayed postoperative hemorrhage occurred from 6 days to 3 months. The blood loss was from 1000 to 4500mi. Shock or lower blood pressure occurred in 3 patients. Nephrectomy was performed in 1 patient and selective angiographic embolization was performed in other 4 cases. Results Angiography revealed renal artery pseudoaneurysm in all 5 cases at the third (4 cases) or fourth branch(1 patient).Percutaneous embolization was successful in 4 patients. Four cases were followed up for 2 to 9 years without complication. Conclusions Delayed postoperative hemorrhage following partial nephrectomy is an uncommon but potentially life-threatening complication. Super-selective angiographic embolization could be the first choice of treatment.

Objective To investigate the relationship between primary platelet parameters and early acute rejection (AR) after renal transplantation.Methods From October 2015 to June 2017,112 patients with renal failure underwent allograft renal transplantation in the Second People's Hospital of Shanxi Province were selected as the research objects,according to the preoperative and postoperative 30d in platelet parameters based on the occurrence of AR they were classified into the observation group (23 cases),no rejection for the control group (89 cases),analysis the difference of two groups of patients with platelet parameters [peripheral blood platelet count (PLT),platelet hematocrit (PCT),mean platelet volume (MPV) and platelet volume distribution width (PDW),the ratio of large platelet (P-LCR)] at preoperative (T0),postoperative 5 d (T1),10 d (T2) after operation,postoperative 15 d (T3) 15,30 d (T4).The correlation between PLT,PCT,MPV,PDW,P-LCR and acute rejection after renal transplantation was also analyzed.Results Compared with those of preoperative,the PLT [(122.06 ± 49.67) × 109/L vs.(185.26 ± 63.49) × 109/L)],PCT[(0.46 ± 0.28) ％ vs.(0.34 ± 0.06) ％)] in T1,T2 of the two group after surgery declined (P ＜ 0.05).MPV,PDW and P-LCR were increased in both groups after surgery (P ＜0.05),and the observation group were higher than that in the control group MPV[(13.69 ± 0.59) vs.(12.24 ±0.42),(16.08 ±0.61) vs.(12.52 ±0.57)],PDW[(13.26 ± 1.19) vs.(12.13 ±2.14),(15.46±3.15) vs.(12.72 ±2.09)],P-LCR[(30.57 ±7.29) vs.(28.13 ±6.34),(33.01 ±3.98) vs.(29.13 ± 6.91)] at the baseline of T1 and T2 (all P ＜ 0.05).Correlation analysis showed that the level of MPV,PDW,P-LCR and the occurrence of acute rejection after kidney transplantation were positively correlated (r =0.464,0.606,0.512,all P ＜0.05),while the PLT,PCT has nothing to do with the occurrence of acute rejection after kidney transplantation.Conclusion MPV,PDW and P-LCR can indirectly reflect the occurrence of AR after renal transplantation,and the trend of monitoring the three indexes of MPV,PDW and P-LCR after operation is an auxiliary diagnostic method for postoperative AR.