ObjectiveTo investigate the cause, treatment and prevention of splenic injury in radical nephrectomy for left renal cell carcinoma.MethodsThe clinical data of 27 cases of splenic injury in 458 cases of radical nephrectomy for renal cell carcinoma were retrospectively analyzed.ResultsThe injured spleen was saved in 21 cases (18 gradeⅠ injury,3 grade Ⅱ).The injured spleen was sewed up and pressed with hemostatic ganze in 7,pressed with medical sponge laid with spurting argon on biological glue in 11 and the same was carried out in 3 grade Ⅱ injury.Spleenectomy was conducted in the other 6 cases (4 grade Ⅱ injury,2 grade Ⅲ).The patients have been followed up for 6 months to 5 years.The outcome has been good in all except 1 patient died of tumor recurrence 1 month after operation.No late bleeding or adverse side effects has been noted.Conclusionssplenic injury may occur in radical nephrectomy for renal cell carcinoma especially the tumor is lasge or adhered to spleen in the upper past of left kidney.The occurrence of splenic injury is also related to the tumor stage.Attention should be called to the mentioned surgical complication.

Objective To explore the mechanism of six-segment classification of femur intertrochanteric fracture in a three-dimensional finite element model of upper thigh-bone and its clinical relevance.Methods The left upper thigh-bone of a normal male volunteer of 60 years old was scanned using 64-slice CT.After the images were stored in the format of JPG,they were input into photoshop 7.0 for three-dimensional creation.The three-dimensional images were used to make a three-dimensional finite element model of upper thigh-bone using software Super 93.The model consisted of 764 nodes and 531 units (including 306 compact bone units and 225 cancellous bone units).In this model,the stress distribution at the trochanter during human tumbling was analyzed by imitating adduction,abduction,adduction-intemal rotation and abduction-external rotation of the hip,as well as intense muscular contraction of gluteus medius,piriformis and iliopsoas during adduction-internal rotation of the hip.Results Analysis of stress nephogram showed that the stress was distributed mainly at the exterior cortical bone and spread to the inter-trochanteric part in simple hip adduction (two-part fracture) and distributed mainly at the interior cortical bone and spread to the inter-trochanteric part in simple hip abduction (two-part fracture).In adduction-internal rotation or abduction-external rotation of the hip,the stress was focused on the anterior and posterior walls of the greater trochanter and trochanteric part and spread to the exterior and interior cortical bone and the inter-trochanteric part (three-or four-part fracture).During intense muscular contraction of gluteus medius,piriformis and iliopsoas during adduction-internal rotation of the hip,the stress was focused on the anterior and posterior walls of the greater trochanter,lesser trochanter and trochanteric part and spread to the exterior and interior cortical bone and the inter-trochanteric part (five-or six-part fracture).Conclusions The six-segment classification of femur intertrochanteric fracture explains complex stress distributions after human falling.When combined with three-dimensional CT reconstruction,it is more intuitive than other classifications so that it can provide more definite surgical advice for different types of fracture.

Objective To assess the clinical value of gasless laparoscopy-assisted radical nephrectomy in the treatment of renal cell carcinoma.Methods The clinical data of 47 patients who underwent gasless laparoscopy-assisted radical nephrectomy from May 2003 to June 2005 were retrospectively analyzed.The surgical technique and its advantages and disadvantages were evaluated.Results The operative time was 75 to 135 min;and the mean blood loss was 120 to 220 ml.Postoperatively,analgesic at the dose of 5 to 35 mg(morphine sulfate equivalents) was given for pain control.The average time of indwelling drain was 2 to 3 d;the time to oral intake was 6 to 18 h;and the average hospitalization time was 5 to 7 d.Follow-up ranged from 1 month to 1 year,and all the 10 patients survived disease-free.Conclusions Gasless laparoscopy-assisted radical nephrectomy is of the advantages of both open surgery and laparoscopic surgery,and may become a good choice for the treatment of renal cell carcinoma.

Objective To investigate the methods for preventing bladder cancer recurrence after surgical treatment for upper tract urothelial carcinoma.Methods Of the 156 patients who underwent total nephroureterectomy for clinically localized transitional cell carcinoma of the upper urinary trace,139 were followed up and their data were retrospectively analyzed.Of the 139 cases,78 had pyelic carcinoma and 61 had ureteral carcinoma.The tumor cell grading showed G_1 in 19 cases,G_2 in 88 and G_3 in 32.The tumor staging showed T_a-T_1 in 38 cases,T_2 in 80 and T_3-T_4 in 21.The tumor diameter ranged from 0.8 to 6.0 cm.Results Radical nephroureterectomy and resection of partial bladder wall around the ureteral orifice(1.5-2.0 cm) were performed in all the 139 patients;of whom 55(39.6%) experienced subsequent bladder cancer recurrence during a mean follow-up of 52 months(range,1-10 years).The bladder cancer recurrence rate was 18.5%(5/27) in patients whose ureter had been ligated before the kidney was dissociated;and the recurrence rate was 27.5%(14/51) in patients whose ureter had not been firstly ligated.The recurrence rates in those who had prophylactic intravesical instillation immediately after surgery and in those who had the instillation 3 weeks after surgery were 32.3%(10/31) and 34.9%(30/86),respectively.The recurrence rate was 20.0%(4/20) in those who had intravesical instillation on the surgical day and 3 weeks after surgery sequentially,which was significantly lower than that(39.3%,26/66) in those who had the instillation simply 3 weeks after surgery(P

【Objective】To observe the morphologic changes of organs in mice with spleen deficiency and the effect of Qiangji Jianli Oral Liquid(QJOL).【Methods】Forty healthy male NIH mice were randomized into 4 groups:A(normal),B(model),C(treated with QJOL)and D(treated with Si Junzi Decoction).Except group A,the mice in other 3 groups received intraperitoneal injection of reserpine to induce spleen deficiency.Meanwhile,groups C and D received QJOL and Si Junzi Decoction in the dosage of 26?g?kg~(-1)?d~(-1) by gastric gavage respectively,and groups A and B received the same volume of distilled water for 21 days.Twelve hours after last administration,the body weight and pathological changes of liver,kidney,spleen and thymus were examined.【Results】In group A,the body weight decreased,and liver,kidney,spleen and thymus gland showed different degrees of damage.QJOL and Si Junzi Decoction could increase the body weight and promote the repair of the organs.【Conclusion】Different degrees of damage can be found in liver,kidney,spleen and thymus gland of mice with spleen deficiency,and spleen-strengthening medicinal herbs can promote their repair,indicating that the theory of spleen controlling the muscles,being the solitude organ and localized the center to cultivate the surroundings organs like the earth,which is described in Huangdi's Canon of Medicine,has the morphologic evidence.

【Objective】To observe the effect of Buzhong Yiqi Wan(BYW)on thyroid hormones in rat model of spleen-asthenia.【Methods】Thirty-four SD male rats were randomized into 3 groups:normal control group(N=10),spleen-asthenia model group(N=12),BYW group(N=12).Except the normal control group,the rats in other groups were given the decoction of Radix et Rhizoma Rhei(4 g?d-1 for each rat)to induce spleen asthenia,and meanwhile,BYW group reveived BYW(3.9 g?kg-1?d-1).The treatment lasted 20 days.Radioimmunoassay was used to detect serum levels of triiodothyronine(T3),thyroxine(T4),reverse triiodothyronine(rT3)and thyroid stimulating hormone(TSH).Meanwhile,the body weight,spleen and thymus weight as well as their ratio with the body weight were also observed.【Results】Serum T3 and T4 levels,spleen and thymus weight as well as their ratio with the body weight were decreased in the model group as compared with those in the normal control group(P

Objective To investigate the effects of Huangqi Sijun Decoction on the levels of thyroxin and cAMP and cGMP in model rats with spleen deficiency syndrome and to explore its therapeutic mechanism.Methods Male SD rats aged three months were randomly divided into 3 groups:normal control group,spleen deficiency model group and Huangqi Sijun Decoction group.The rat models of spleen deficiency syndrome were established by gavage with the decoction of Rhubarb.The serum levels of thyroxin(T4),3,5,3'-triiodothyronine(T3),thyrotropin(TSH)and plasma levels of cAMP,cGMP were determined.Results T3 and T4 were significantly lower but the levels of cAMP and cAMP/cGMP were significantly higher in the spleen deficiency models than those in the normal control group(P

Objective The changes of thyroid hormone and cyclic nucleotides levels in rats with spleen-kidney deficiency syndrome were observed to evaluate the preventive and therapeutic effect of Yougui Wan(YW) for spleen-kidney deficiency syndrome,and to explore the relationship between the spleen and the kidney at microscopic level.Methods Male SD rats were randomly divided into normal control group,model group,and YW group.Rat models of spleen-kidney deficiency syndrome were established by gavage firstly with rhubarb(4g for each rat) decoction and then with hydrocortisone(25 mg?kg-1?d-1,im).The model group and YW group were treated with distilled water and YW(5.8 g?kg-1?d-1) respectively.The general status of rats was observed,and the plasma cyclic adenosine monophosphate(cAMP) and cyclic guanosine monophosphate(cGMP) levels as well as serum thyroid hormones(T3,T4 and rT3) and thyroid-stimulating hormone(TSH) contents were determined in all rats by radioimmunoassay(RIA).Results Compared with the normal control group,the serum contents of T3,T4,rT3 were decreased significantly(P

Objective To investigate the effect of the rehabilitative therapy on functional recovery of patients with cervical cord injury.Methods 92 cases with spinal cord injury(SCI),including cervical,thoracic and lumbar cord injury,accepted normal rehabilitation.They were assessed with the Barthel Index and Functional Independence Measure(FIM)before and after treatment.Results After rehabilitation of 60~426 d,the scores of the Barthel Index and FIM were significantly improved(P<0.001)in all the patients,but it was the worst in the cervical cord injured ones,and the best in lumbar ones(P<0.05).Conclusion Rehabilitation can promote the functional recovery of patients with cervical spinal cord injury,but it is not as effective as on the thoracic and lumbar cord injury.

Objective To study effects of baicalin(Bai) on AngⅡ in diabetic nephropathy(DN) rats and to explore its preventive and therapeutic effect on treating DN from the non-hemodynamic mechanism of AngⅡ.Methods Nineteen specific pathogen-free male rats were randomly divided into three groups:normal control group(5 rats),diabetic nephropathy model control group(7 rats),baicalin treated group(7 rats).DN rat model was established by one-dose intraperitoneal injection of streptozotocin.Seven weeks after the modeling,rats in baicalin group recieved intraperitoneal injection of baicalin solution(40 mg/kg),rats in DN model group received intraperitoneal injection of normal saline(1 mL for each rats),and the normal control group did not receive any intraperitoneal injection.After treatment for 6 weeks,orbital blood from all rats was collected to determine plasma AngⅡ by radioimmunoassay.Unilateral kidney was processed by 4 % paraformaldehyde fixation and then was used for the determination of TGF-? by immunohistochemical assay.The other unilateral kidney was got out to prepare for renal cortex homogenate,and then was used for the determination of renal tissue AngⅡ by radioimmuno assay.Results The quantity and degree of TGF-? expression in baicalin group was decreased,and there was statistical significance between baicalin group and the model group(P