Objective To investigate the management and prevention of the complications of sigmoid rectal pouch for urinary division after radical cystectomy. Methods The clinical data of 34 patients who underwent a sigmoid rectal pouch procedure were analyzed retrospectively, and the clinical experience was summarized in the management and prevention of the complications of sigmoid rectal pouch for diversion. Results Twenty-six patients were followed up for 2 months to 11 years, and 10 patients lost in follow-up. The early follow-up results were as follows:3 patients had postoperative high fever with unilateral the kidney water, 1 patient had retropubic bleeding and need to stop bleeding, 3 patients suffered from wound split open and were performed relaxation suture, and 1 patient had sigmoid colon rectum bladder fistula 10d after operation. The late follow-up results were as follows:1 patient had urethral neoplasms recurrence, 5 patients developed distance metastases, and 5 patients developed nocturnal incontinence and worn safety pad. There were no hyperchloremic acidosis requiring clinical treatment, hydronephrosis as well as retrograde pelvis infection. Conclusions The operation of sigmoid rectal pouch for urinary division is fairly simple, with no serious complication. It is a better alternative diversion procedure, and should be accepted gradually by patients and surgeons.

Objective To measure the pressure-volume changes and uroflow rate,and assess the function of upper urinary tract in sigmoidorcctal pouch patients.Methods Between 2007 and 2011,a to-tal of 10 patients who had a radical cystectomy because of muscle-invasive bladder tumor underwent a Mainz pouch Ⅱ procedure were evaluated.The ureters were implanted into the post walls of the detubularized sigmoid segment at least 30 cm in length.In all cases,sigmoidoscopy was done and the anal pressure was measured preoperatively,and video urodynamic study of sigmoidorectal pouch as well as the intravenous pyelography was conducted after 3 to 6 months postoperatively.Results Video urodynamic study of sigmoidorectal pouch revealed that no reflux up to an average volume of 360 ml (270-532 ml) of the descending colon.The sigmoidal colon pressure was 26 cm H2O during the 3 to 6 months post-operative follow-up.The anal sphincter pressure was 90 cm H2O on average preoperatively and did not change postoperatively.The renal function and upper urinary tract were preserved well.The Qmax was 30 ml/s and the average uroflow rate was 8 ml/s under abdominal strain.All the patients suffered slight incontinence in the first two months and became continent since the 3 month postoperatively with nocturnal voiding one to four times.Conclusions The sigmoidorectal pouch provides a reservoir with a higher capacity,lower pressure without reflux to the upper urinary tract and descending colon and lower metabolic acidosis problem.It is also a good alternative diversion procedure that would preserve upper urinary tract and good quality of life.

Objective To observe the immunosuppression function of a novel HLA-derived peptide, RDP1258, after rat renal transplantation in vivo.Methods Peptides were synthesized by Fmoc chemistry method. The rat renal heterotopic transplantation model (n=32) was established. The allograft rats were divided into 4 group: group A (n=8) receiving subtherapeutic CsA+RDP1258 peptide; group B (n=8) receiving RDP1258 alone; group C (n=8) receiving subtherapeutic CsA alone; and group D (n=8) receiving no immunosuppression. The renal allograft survival days of receptor rats were observed. Serum creatinine was measured and color Doppler flow imaging was checked. Renal tissues were harvested for light microscopic examination. The immunologic tolerance status of rat renal allografts was detected by MLR of 60th day receptor rat spleen cells cultured with the donor spleen cells and the third party.Results The allograft survival time in groups A, B, C and D were ( 63.4?30.6)days, (18.3?7.3)days, (16.9?6.4)days and (9.4?2.6)days, with the difference being significant between group A and other three groups. The results of MLR revealed that a hyporesponsiveness to donor occurred while the normal reaction to the third parity was retained.Conclusion A novel HLA derived peptide therapy combined with a sub-therapeutic dose of CsA significantly prolonged allograft survival days, and the mechanism might be that RDP1258 induced a donor-specific immunologic tolerance status in the recipients.

Objective To explore the effect of endovascular treatment on Stanford type B aortic dissection. Methods The clinical data of 12 cases of Stanford type B aortic dissection were analysed retrospectively. Results All the cases were male, the age ranged from 40-68 years with a mean of 52.1 years. Among the 12cases, 10 patients underwent endoluminal treatment, the instant technique was successfully performed in 10 patients. Endoleak happened in 1 case because of the stent-graft deployment, but automatically stopped 3 days later. In other 9 patients, Angiography after the operation showed that all the rupture areas were sealed completely, and the celiac arteries blood supply were recovered via the true lumen and no blood stream was shown in the false cavity. 2 patients received conservative treatment died, one died of failure of respiration and another died of rupture of the dissection. Conclusions In the treatment of Stanford B type aortic dissection, if the selection of the patient is correct, endoluminal technique is much simple, safe, less trauma, and less complications as compared to the traditional operation, and it can also shorten the hospital stay of the patient. Conservative treatment can not control the development of the diseases, and easily results in death of the patient.

Objective To explore the surgical management of aortic diseases. Methods The clinical data of 45 cases of aortic diseases were analysed retrospectively. Results There were 37 males and 8 females.The age ranged from 21 85 years with a mean age of 64.7 years, Among these cases, 11 were thoracic aortic dissection, 2 were ruptured descending aortic local dissection and formed an aneurysm;above and below the renal artery abdominal aortic aneurysms( AAAs) were 3 and 23 respectively; complicated with rupture of the AAA in 2, and with aortojejumal fistula in 1;the other 3 cases were traumatic aortal rupture. Among the 45 cases, 18 underwent endoluminal treatment, 25 underwent AAA resection and artificial vessel implantment, and 3 underwent repair of the ruptured aorta. The operative mortality was 6.67% ( 3/45 ). 36 patients were followed up for 2 months to 4 years, all the 36 patients still alive well. Conclusions In the management of appropriate aortic diseases, endoluminal technique is much simple,safe, less trauma, and less complications, it can also short the hospital stay of the patient . However, with improvement of the surgical skills,the surgical operation is still very important and effective, especially for the cases who can not be treated via endovascular technique.

Objective To investigate the management of external iliac artery mycotic hemorrhage after kidney transplantation. Methods A case of external iliac artery mycotic hemorrhage after kidney transplantation managed by the use of hypogastric artery autograft was reported with review of the literature.The massive blooding occurred 3 times after kidney transplantation in a male patient 25 years of age on the 22nd,24th and 38th day after transplantation.The blooding amounted to 800 ml,2500 ml and 3800 ml respectively.The blood loss was replaced and prompt surgical exploration was carried out with the blooding site at the anastomosis sutured up on the 1st and 2nd episode of bleeding.On the 3rd occurrence of bleeding, the diseased external iliac artery segment, about 2cm in length, was resected and the gap was replaced by a 3cm long hypogastric artery autograft. Results The blood flow through the repaired external iliac artery and the blood supply to the lower extremity was adequate.Periodic hemodialysis had been restored and the patient waited for reimplantation. Conclusions External iliac artery mycotic hemorrhage after kidney transplantation is a serious and fatal complication.Simple arterial repair is usually noneffective.Resection of the diseased mycotic segment of the external iliac artery with repairing of the gap with a hypogastric artery autograft is rational,feasible and simple.The procedure is highly recommended.

Objective To investigate the therapeutic method of metabolic acidosis in long-term sur- vival patients undergoing simultaneous pancreas and kidney transplantation.Methods A 45-year-old fe- male patient,who had undergone simultaneous pancreas and kidney transplantation(due to diabetic ne- phropathy and uremia)with bladder drainage 2 years before,developed severe metabolic acidosis,and thus underwent surgical conversion from bladder to ileal drainage.The procedure was as follows.The stoma of duo- denocystostomy was isolated and resected.The site of cystostomy was closed in two layers.The graft duode- num was then anastomosed to a loop of the recipient's ileum,which was proximal 40 cm from the ileocecum in a side-to-side manner.Results The metabolic acidosis resolved postoperatively.The patient received conventional immunosuppressants.The hospital stay was 30d.Follow-up of 4 years showed normal pancreas and kidney functions.Conclusions Conversion from bladder to ileal drainage is safe and effective for metabolic acidosis related to the exocrine secretions of bladder drained pancreas graft in simultaneous pancre- as and kidney transplant recipients.

Objective To explore the management of abdominal aortic aneurysms (AAAs) .Methods The clinical data of 26 patients with AAAs were reviewed retrospectively. Results In the 26 cases,dissection and true aneurysms were found in 3 and 21 respectively, 1 AAA ruptured followed by a false aneurysm formation,and 1 involved duodenojajunary curve to form an aorto intestinal fistul. The lesions involved the renal artery in 3, below renal artery in 23; AAA extended to both common iliac arteries in 12, to both common iliac arteries and one or both internal iliac artery in 5,to both or one common and ,lexternal.internal arteries in 2; Emergency operation was done on 3 patients, elective operation on 14, endoluminal treatment in 7 and conservative treatment in 2. Three cases developed mild postoperative complications. Operative mortality was 3.8% ( 1 case ). 22 patients were followed up for 3 month to 4 years, and living well. Conclusions Endolumianal treatment is the first choice for the AAAs patients . However, the traditional operation is still very important and effective for the patient who can not be treated by endoluminal treatment,especially with improvement of the surgical skills.

Objective To observe the immunosuppression function of a novel HLA derived peptide, RDP1258, and to investigate the mechanisms. Methods The peptides derived from HLA, RDP1258, and HLA 2702.75 84 was synthesized chemically. The effects of the peptides on alloreactive cytotoxic activities of rat spleen cells were observed using 3H TdR incorporation method. The heme oxygenase 1 activity was detected by the enzyme chemistry method. Result The synthetic HLA derived peptides could obviously inhibit the proliferation of rat spleen cells and HO 1 activity in a dose dependent manner in vitro. Conclusion HO 1 may participate in the process of inhibitory effect of RDP1258 on the proliferation of rat spleen cells induced by mitogen or isoantigen.

Objective To study the effect of synthetic HLA-derived peptide (P), HLA-B*2702.75-84, on the mean survival time (MST) of cardiac allografts in mice.Methods NIH mice cardiac allografts were heterotopically transplanted into the posterior of Balb/c ears. The HLA-derived peptide in combination with a subtherapeutic dose of CsA were perioperatively administrated. The pulsation of the cardiac allograft observed under the operating microscope was considered as the indication of the cardiac allograft surviving time or rejection. Results MST was ( 7.5? 0.5) days in untreated control group, ( 8.5? 1.5) days in CsA group and ( 7.0? 1.5) days in control peptide or P groups respectively, whereas MST was ( 26.5? 3.5) days in experimental group.Conclusion The synthetic HLA-derived peptide combined with subtherapeutic CsA can significantly prolong cardiac allograft survival in mice as compared with control groups.