Objective To compare the clinical effect of video-assisted thoracoscopic surgery (VATS) and chest tube drainage combined with urokinase for the treatment of empyema after fibropurulent pneumonia, and to determine the best therapy for patients. Methods Patients were randomly divided into two groups according to inclusion and exclusion crite?ria:55 patients were selected as group VATS performed VATS;46 patients were selected as drainage group performed 12F catheter chest closed drainage by Seldinger technique under B ultrasound guidance. The 100 000 unit urokinase was inject?ed into chest, and open after 4-hour closed, once a day for three days. Values of white blood cell (WBC), pH, glucose, lactate dehydrogenase (LDH) and C reactive protein (CRP) of pleural effusion before treatment were recorded, and the duration of fe?ver after treatment, duration of chest-tube placement, antibiotic use, hospital stay, cure rate, complication and hospitaliza?tion expenses were also recorded. Results The duration of fever after treatment,, duration of chest-tube placement, antibiot?ic use and hospital stay were significantly lower in VATS group than those in drainage group. The cure rate was significantly higher in VATS group than that of drainage group (P<0.05). There were no significant differences in complication rates and hospitalization expenses between two groups. There was no death in both two groups. Conclusion VATS is more suitable for the treatment of empyema after fibropurulent pneumonia than chest tube drainage combined with urokinase, and which is worthy of clinical promotion for not adding complication rates and hospitalization expenses.

Objective To report the experience in the use of laparoscopic extravascular stent for the treatment of the nutcracker syndrome. Methods Five patients (4 men and 1 woman) aged 20 to 35 years (mean 25) underwent laparoscopic extravascular stent of the left renal vein (LRV) for treatment of nutcracker syndrome associated with severe recurrent gross hematuria and left gonadal vein varices. All patients met the criteria for establishing the diagnosis of nutcracker syndrome. Ultrasonography, computed tomography, and magnetic resonance imaging revealed visible entrapment of the LRV between the superior mesenteric artery and aorta. Bleeding from the left ureteral orifice was detected by cystoscopy in 3 cases. An externally reinforced graft was selected to form an external stent around the LRV to relieve the compression. Results The mean operation time was 67 min (65-70min). No complications occurred during surgery. The postoperative follow-up was 9 to 39 months (mean 28). Total relief was achieved in 4 men without a relapse of symptoms and abnormalities were not found in urine tests. There was partial relief for the female patient due to microscopic hematuria after the operation. In all the 5 cases, Color Doppler ultrasonography showed that the blood outflow was smooth, the inner diameter and flow velocity of the aortomesenteric portion of the LRV were both decreased, and the gonadal vein varices had diminished in diameter. Conclusions The laparoscopic extravgscular stent of the renal vein could be a feasible approach for re-establishing free renal venous outflow in patients with nutcracker syndrome. This slightly invasive treatment could eliminate the symptoms of the condition.

Objective To compare the effect of ibuprofen and glucosamine on synoviocyte proliferation and cartilage oligomeric matrix protein (COMP) expression in human knee osteoarthritis. Methods Human synoviocytes were isolated from synovium (earlier stage and late stage of OA) by tissue culture and were cocultured with ibuprofen and glucosamine. The concentration of COMP was determined by MTS/PMS method and hCOMP kit. Two-tailed t-test was used for statistical analysis. Results The observation time of tissue culture was determined at 5～7 day by the MTS/PMS method. The A values of glucosamine [ late stage group (0.054±0.021), early stage group (0.777±0.034)] were less than the normal serum control group (P＜0.05).Both ibuprofen [late stage group (35.4±1.9), early stage group (46.0±2.2)] and glucosamine [late stagegroup (36.6±1.3), early stage group (48.8±1.3) ] could decrease the concentration of COMP in synoviocyte secretion in vitro (P＜0.05). Conclusion Glucosamine can inhibit the synoviocyte proliferation of human knee osteoarthritis (both early stage and late stage) in vitro. Both ibuprofen and glucosamine can inhibit the COMP secretion of synoviocyte in vitro.

Objectives:To compare the susceptibility of serum lipoproteins to oxidation and the effects of high-density lipoprotein on oxidative stress in patients with lipid turbulence.　Methods:VLDL, LDL and HDL were isolated using sequential ultracentrifugation from serum of patients with chronic renal failure (CRF) (n=45), myocardial infarction survivor (MIS) (n=33) , cerebral infarction(CI)(n=33) ,type 2 diabetes mellitus(DM)(n=53) and normal individuals (n=44). The degree of lipid peroxidation was estimated using the thiobarbituric acid-reactive substances (TBARS) value and the susceptibilities of lipoproteins to oxidation were assessed by measuring the increased absorbance value at 234 nm due to the conjugated dinene formation. Lipid levels and lipoprotein fractions were measured using standard methods.　Results: VLDL obtained from the patient groups showed significant increase in TBARS values, especially from the patients with MIS (compared with control group, P<0.001). In addition, LDL from MIS and DM groups and HDL from CI and DM groups also showed markedly increase in TBARS content. Significant decrease in lag time was observed in both VLDL and LDL fractions from the four patient groups. However, no change was found in the lag time in HDL fraction from the patient group compared with control group. In addition, HDL from the four patients exhibited significantly decreased inhibitory effects on in vitro oxidation of LDL, with the most significant decrease in HDL from CRF and MIS groups.　 Conclusions:The oxidative modification of lipoproteins in vivo in patients with serum lipid turbulence might be involved in the development of atherosclerosis in these patients.

0. 05) and the specificity is higher than that of the SEA-ELISA (P

ObjectiveTo investigate the feasibility,technique and clinical effect of applying laparoscopic plastic surgery in the treatment of horseshoe kidney.Methods Eleven patients with horseshoe kidney were admitted from Mar.2006 to Mar.2011.There were 5 males and 6 females with mean age of 27years (14 to 46 years).Clinical manifestations included lower-back pain in 8 cases,lower-back pain and hematuria in 2 cases,lower-back pain and fever in 1 case.There were 6 cases accompanied with kidney calculi.All the cases with calculus were in left kidney and there was 1 case with multiple calculi.There were 11 cases accompanied with left hydronephrosis.Of which,there were moderate hydronephrosis in 6 cases,severe hydronephrosis in 5 cases.There were 3 cases accompanied with mild right hydronephrosis.There were 2 patients with renal insufficiency,1 patient with urinary tract infection.The surgery procedures included laparoscopic isthmectomy and plastic surgery in 3 cases,isthmectomy and plastic surgery and pelviolithotomy in 6 cases,isthmectomy and vascular compression release in 2 cases.ResultsAll patients had successful surgeries with the mean operative time of 145 min (95 - 190 min).The average blood loss was 250 ml ( 100 -400 ml).Average postoperative hospital stay was 10 d (7 - 15 d).One patient suffered from urinary leakage after surgery and recovered after anti-inflammatory therapy and local drainage.One patient suffered from secondary hemorrhage controlled with DSA.All the patients were followed up with a mean of 17 months (6 -28 months).In 6 cases with moderate hydronephrosis,5 patients recovered to mild hydronephrosis and 1 case improved from preoperative renal hydronephrosis 3.5 cm to postoperative 3.0 cm.In 5 cases with severe hydronephrosis,3 patients improved to moderate hydronephrosis,2 patients to mild hydronephrosis.One patient with kidney stone had 0.4 cm residual stone.Three patients complained of occasional mild backache.One patient suffered from hematuria and urinary tract infection,recovered after antiinflammatory therapy for 2 weeks.The remaining 6 patients were in good conditions during the follow-up.ConclusionTransperitoneal laparoscopic plastic surgery is able to deal with horseshoe kidney isthmus malformation and comorbidities,and is another alternative for the treatment of horseshoe kidney.

Objective To compare the effects of laparoscopic surgery and open surgery of inguinal lymphadenectomy in patients with penis carcinoma.Methods A retrospective case-control study was carried out.The retrospective analysis of clinic data of 10 patients with penis carcinoma who had laparoscopic inguinal lymphadenectomy and 13 who had open inguinal lymphadeneetomy were collected from June 2007 to June 2011,with an average age of 57 (40-75 years),and the average follow-up of 18.6 months (7 days to 9 years).Preoperative clinical stage were T1 in 10 cases,T2 in 7 cases,T3 in 6 cases,with 10 patients detecting inguinal lymph nodes enlargement,while three of which have two enlarged lymph nodes.The age of patients,duration of disease,tumor stage and lymph node enlargement have no statistically significant difference between laparoscopic surgery (LS) group and open surgery (OS) group.The mean operation time,intraoperative blood loss,time of postoperative drainage,hospitalization duration,mean number of excised lymph nodes and postoperative complications were analyzed.Results The mean operative time,intraoperative blood loss,time of postoperative drainage,and hospitalization duration of LS group and OS group were (103.6 ± 15.2) min,(56.5 ±6.8) ml,(5.8±0.8) d,(8.5±1.1) d versus (156.8±18.3) min,(88.5±9.5) ml,(12.5±1.3) d,(15.7±1.9) d,respectively.There was significantly different between the two groups (P＜0.05).However,the mean number of lymph nodes and the mean number of positive lymph nodes excised were not statistically different between the two groups (P＞0.05).There was no transfusion,and no severe complications occurred in either group.With the follow-up of 12-48 months,only one case of lung metastasis detected in OS group.Conclusions Compared with the open inguinal lymphadenectomy,laparoscopic inguinal lymphadenectomy is more safe and effective.It leads to less intraoperative blood loss,less hospitalization duration,less postoperative complications and quick postoperative recovery.

Objective To summarize the causes and treatment strategies for laparoscopic vascular injuries.Methods We had retrospectively reviewed 1858 cases of laparoscopic surgeries from March 2006 to February 2011.There were 10 cases (6 males and 4 females) had intraoperative vascular injuries.The mean age of these 10 patients was 49 years (ranged from 21 to 78 years).2 cases were aortic injuries,2 cases were vena cava injuries,4 cases were renal vein injuries,1 case was iliac vein injury and 1 case was iliac artery injury.The causes of vascular injuries included 2 cases caused by lack of anatomical understanding; 1 cases occurred during establishment of the first puncture site ; 2 cases caused by forced operation during the procedure; 2 cases caused due to ectopic anatomy; 3 cases caused due to adhesions and difficulties in dissection.Treatment strategies were maintaining pneumoperitoneum pressure and rapidly increasing the pressure to 2.6Kpa if a large amount of bleeding in a short time.With the help of suction,the bleeding sites could be identified.If necessary,an additional trocar was added to help exposure.The bleeding was closed with 4-0 vessel sutures.For arterial bleeding,the upper and lower ends of blood vessel ruptures were clipped with bulldog clamp,then follow the same procedures of variceal bleeding sutures if the bleeding were controlled.Results In 7 of the 10 cases,the bleedings were successfully controlled by laparoscopic technique,while the other 3 were converted to open surgery for bleeding control.The average laparoscopic hemostasis time in the 7 cases was 14 min (range from 8 to 25 min),the average blood loss was 530 ml (range from 150 to 1600 ml).Rupture size were 0.2-1.0 cm.One aortic injury case had complication of big post operative local hematoma which was spontaneously absorbed 3 months after surgery.And the other 9 patients did not have air embolism,hemorrhage and other complications.Conclusions Laparoscopic vascular injuries can be caused by a variety of causes.The strategies of controlling the bleeding are calmness and the fine suturing to control bleeding.A skillful assistant also plays an important role in dealing with this complication.

Objective To evaluate the clinical application of superselective renal artery embolization in the treatment of iatrogenic renal hemorrhage. Methods The iatrogenic renal hemorrhage in fifteen patients was first demonstrated by renal arterigraphy to diagnose the rupture site and degree of injury. And then they were treated by percutaneous catheterized superselective renal arterial embolization through guidance of guide wire. Results In all 15 patients, the occlusive ruption of bleeding arteries and disappearance of extravasation staining were found after the superselective catheterized renal arterial embolization. Clinically, the bloody urine turned clear without macroscopic hematuria during 1-3 days in all patients after the procedure. Conclusions Superseclective renal arterial embolization treatment signified a less invasion, less complications, good hemostatic efficacy, and maximal preservation of renal tissue and function for iatrogenic renal hemorrhage. The treatment is worthy to be recommended.

Objective To study the efficacy and safety of transurethral plasmakinetic resection of prostate (PKRP) in treatment of benign prostate hyperplasia in elderly patients aged 80 years and over. Methods Retrospective clinical analysis of 180 case of high risk of benign prostate hyperplasia treated by PKRP in patients aged 80 years and over. Results All the 180 patients underwent the operation successfully. The average time for operation was (45.5±23.3) min and the resected prostate was in an average of (60.3±23.3) g. Neither of blood transfusion during the operation nor aductor reflex and transurethral resection syndrome occurred. International prostate symptom score,residual urine and quality of life decreased from (29.5±5.3) to (10.2±2.8),from (130.5±45.5) ml to (13.5±7.1)ml and from (7.2±1.1) to (1.0±0.5) respectively. The maximum flow rate elevated from (6.2±1.8) ml/s to (24.5±3.1) ml/s. The differences in the above indicators were statistically significant between pre- and post- operation (P＜0.05). Conclusions Transurethral plasmakinetic prostatectomy is a reliable and effective surgical method, especially for the aged patients with benign prostate hyperplasia.