Objective To investigate the pathogen distribution and risk factors of pulmonary infection after acute cervical spinal cord injury (ACSCI) in an attempt to offer reference for early antiinfection therapy.Methods The study comprised 223 cases who were admitted from October 2011 to October 2014.There were 149 males and 74 females,at (43.3 ± 13.5) years of age.Species of pathogens identified were gram-positive,gram-negative and mixed.Effects of age,gender,injury types and tracheotomy on pathogen distribution were analyzed.Results Gram-negative infection was found in 114 cases (51.1％),with tracheotomy accounting for 7.0％ of the cases and death accounting for 1.8％ of the cases,and the main causative pathogens were Klebsiella pneumonia,Escherichia coli,Pseudomonas aeruginosa and Acinetobacter baumannii.Gram-positive infection was found in 41 cases (18.4％),with tracheotomy accounting for 12.2％ of the cases and death accounting for 7.3％ of the cases,and the main causative pathogens were Staphylococcus aureus and Streptococcus pneumonia.Mixed infection was found in 68 cases (30.5％),with tracheotomy accounting for 22.1％ of the cases and death accounting for 13.2％ of the cases.Gender had no significant correlation with pathogen distribution.For the cases of complete spinal cord injury and tracheotomy,the ratio of mixed infection increased significantly (P ＜ 0.05).For the cases younger than 30 years,the pathogens were mainly gram-positive bacteria (P ＜ 0.05).Conclusions Main pathogens of pulmonary infection after ACSCI are gram-negative bacteria.The cases younger than 30 years are associated with higher risk of grampositive infection,while the cases with complete injury or tracheotomy are associated with higher risk of mixed infection.

Objective To analyze the effect of mesporous calcium silicate (m-CS)/calcium sulfate cement (CSC),m-CSC for short,in bone defect repair.Methods Setting time and compressive strength of the m-CSC (15 m-CSC as group Ⅰ and 30 m-CSC as group Ⅱ) were tested.CSC was used as the control.Cement samples were immersed in Tris-HCl solution,andin vitro degradation of the m-CSC was measured.Cell morphology and cell proliferation as well as differentiation on the samples were assessed.The cements were implanted into the traumatic femoral defects in rabbits,and the in vivo degradability and osteogenesis of the cements were investigated by histological evaluation after implantation for 4,8 and 12 weeks.Results Addition of m-CS into CSC prolonged the setting time (7.8 min in group Ⅰ and 10.5 min in group Ⅱ),obviously longer than 3.7 min in control group and did not have obvious effect on compressive strength of the cements.Weight loss of m-CSC solution was obviously lower (61.8 wt％ in group Ⅰ and50.3 wt％ in group Ⅱ),compared to70.4 wt％ in control group,pH value in group Ⅱ decreased from 7.40 to 7.26,while decreased from 7.40 to 6.86 in control group,m-CSC could promote cell proliferation and differentiation compared to CSC.At postoperative 12 weeks,histological sections showed massive new bony tissue (55.2％) in group Ⅱ,obviously higher than 25.6％ in control group.Conclusion m-CSC exhibits good biocompatibility,degradability and osteogenesis,and can promote bone regeneration in bone defect repair.

OBJECTIVETo summarize our experience with extraperitoneal robot-assisted laparoscopic radical prostatectomy (RLRP).

METHODSTwenty patients with confirmed prostate cancer by transrectal needle biopsy but no metastasis detected by radiographic examination underwent extraperitoneal RLRP, including 7 with Gleason score of less than 6, 10 with a score of 7, 2 with a score of 8, and 1 with a score of 9.

RESULTSThe procedures were performed successfully in all the patients. In 4 cases, a postoperative PSA value of more than 0.2 ng/ml at 4 weeks suggested residual tumor, for which maximal androgen block therapy was administered before elective radiotherapy. Sixteen patients were followed up for 10 to 37 months (mean 15.5 months). In the 20 cases, the operation was completed in a mean of 180 min (range 150-230 min), with the mean installation time of 48.5 min (range 40-60 min) and average blood loss of 298 ml (range 80-800 ml). The mean postoperative eating time was 1.7 days (1 to 3 days), the mean bladder catheter time was 10.7 days (7 to 14 days), and the mean hospital stay was 10.7 days (range 7-14 days). No postoperative complications occurred in these cases. Postoperative pathology showed a Gleason score no higher than 6 in 6 cases, 7 in 5 cases, and no less than 8 in 9 cases.

CONCLUSIONThe technique of extraperitoneal RLRP can be easily mastered by the surgeons and is especially advantageous for complicated pelvic operations.

Aged ; Humans ; Laparoscopy ; methods ; Male ; Middle Aged ; Prostatectomy ; methods ; Prostatic Neoplasms ; surgery ; Robotics

Objective To assess the value of percutaneous balloon catheter occlusion technique for tumor thrombectomy in renal or adrenal neoplasm extending into the inferior vena cava(IVC). Methods Twelve patients with renal or adrenal neoplasm extending into retrohepatic or subhepatic IVC were diagnosed by the investigations of CT, MR1, and Doppler ultrasound. There were 7 men and 5 women with a mean age of 51 years (range, 20 to 76 years). Of these patients, 11 had renal ne-oplasm and 1 had adrenal tumor; 11 in the right and 1 in the left; 11 with retrohepatic caval thrombus (level 2a) extension and 1 with extension into the subhepatic vena cava (level 1). On the operation day, all patients had a pereutaneous preset of the balloon catheter into the IVC, at the position be-tween hepatic vein and the tip of tumor thrombus. During surgical resection, the balloon was filled via the catheter to occlude the IVC prior to vena cavotomy. Results Radical nephrectomy and resection of vena cava thrombus was successfully performed with this technique on 12 patients. There were no operative or perioperative pulmonary embolisms or deaths, no any complication. The mean postopera-tive hospital stay was 12 d (range, 9 to 15 d). Pathological investigation revealed clear cell carcinoma in 6 patients, papillary renal cell carcinoma (RCC) in 3, metastatic hepatocellular carcinoma in 1, an-gioleiomyolipoma in 1 and adrenal leiomyosarcoma in 1. The pTNM stage in 9 patients with RCC was T3b N0 M0 in 8 patients, T3b Nx M1 in I patient. The mean followup was 21±10 months (median follow-up 24 months). Four patients died of lung or liver metastasis, and the recurrence of liver cancer at 6, 9, 15, and 22 months postoperatively. Eight patients have survived for 6 to 35 months (mean 26 months). The postoperative 1-, and 3-year cancer-specific survival rates in 9 patients with RCC were 78% and 67%. Conclusions Percutaneous balloon catheter occlusion technique is a feasible, safe, and effective method for tumor thrombectomy of low retrohepatic (level 2a) or subhepatic (level 1) type in patients with renal or adrenal neoplasm extending into the IVC. Additional experience and con-tinued investigation are warranted.

Objective:To summarize our clinical experience of robot-assisted laparoscopic partial nephrectomy (RALPN), and to discuss its efficacy and safety. Methods:Between December 2007 and October 2008, 6 patients with small exophytie renal masses underwent intraperitoneal robotic partial nephrectomy utilizing the Da Vinci sur-gical system. The perioperative data were collected, and were compared with those performed the same operation in abroad and those performed laparoseopic partial nephrectomy(LPN) with the same team in internal. Results: All the operations were accomplished successfully except the one which required conversion to open nephron-sparing surgery (NSS) due to bleeding occured after the renal artery had been clamped. The mean lesion diameter was 3.2 (2.2-3.6)cm; the mean operative time (not including preoperative set-up time of the Da Vinci surgical system) was 130 (110-160) minutes; the mean warm ischemia time were 40(33-50)minutes; the mean estimated blood loss was 188 (100-380) ml. The patients were ambulant in the 7th postoperative days, and tubes were removaled in 3 days, and mean hospital stay was 9 (8-12)days. Renal function of all patients was in the normal range. Pathology revealed renal cell carcinoma in five, papillary renal cell carcinoma in one. All resection margins were negative. Follow-up ranged from 4 to t5 months, no local residual lesions, local recurrence, incision implantation and dis-tant metastasis were found in all patients. Conclusions.. Robot-assisted laparoscopic partial nephrectomy can be safe-ly performed in selected patients, and it is a feasible approach and a minimally invasive operation for small renal tumors.

Objective To investigate the efficacy and safety of the hemostatic techniques applied during the laparoscopic nephron-spring surgery in the treatment of renal tumor. Methods Twentytwo male and 8 female patients with renal tumors underwent laparoscopic nephron-sparing surgery by using the hemostatic techniques of harmonic scalpel, bipolar cautery and renal parenchyma defect suturing over surgical bolsters. Among them, 4 cases have been done transperitoneally and others have been done retroperitoneally. The mean patient age was 50 years. Of the 30 cases, 20 had renal cell cancers with a mean diameter of 2.5 cm, and 10 had renal angiomyolioma with a mean diameter of 2.4 cm. The operating time, estimated blood loss, length of postoperative hospital stay, complications and surgical results were recorded. Results All procedures were successfully completed. No case had converted to open surgery. The mean operating time was 169min and mean estimated blood loss was 100 ml. Major complications happened in 2 patients. One of them had accepted transfusion during surgery. Another case had retroperitoneal hemorrhage three days after surgery and had been treated with 800 ml blood transfusion. The mean post-operative hospital stay was 9 days. During the mean 9 month follow-up, no patient had local or trocar port site recurrence.Conclusion The hemostatic techniques of harmonic scalpel, bipolar cautery, renal parenchyma defect suturing over surgical bolsters could be effectively and safely applied in the laparoscopic nephron-sparing surgery.

Objective To present the preliminary experience with laparoscopic ureteral reimp1ant for distal ureteral stricture without everted ureteral nipple or submucosal tunneling. Methods Six patients with distal ureteral stricture underwent transperitoneal laparoscopic ureteral reimplantation.The ureteral was reimplanted into the bladder without everting the ureter or without a tunnel.The seromuscular wall of the ureter was anastomosed eircumferentially to the bladder muscle layer by continuous suture. Results All procedures were successfully performed without any intraoperative complications or need for open conversion.Intravenous urography showed normal drainage without obstruction or reflux during follow-up. Conclusion Laparoscopic ureteral reimplantation might be technically simple and feasible.

Objective To evaluate the feasibility and clinical efficacy of laparoscopic nephron-spring surgery for renal tumor.Methods From September 2004 to November 2006,29 patients with renal tumor underwent laparoscopic nephron-sparing surgery without hilar clamping or with temporary hilar control in our hospital.The retroperitoneal approach was used in 25 patients with 4 trocars.During the operation,the renal artery was exposed and then the vessel bundles were pulled out of the abdominal cavity through one of the trocars,passing by the renal artery without clamping it.Afterwards,fatty cysts surrounding or on the surface of the tumor were resected.Tumor excision was then performed using ultrasonic shears.An incision was made at the point 0.5 cm away from the margin of the tumor,and was extended deeply to completely cut the tumor.Meanwhile,bleeding was controlled with bipolar diathermy.The renal artery was occluded when necessary so that the tumor could be cut within a limited time duration.And the occlusion could be re-opened after controlling the bleeding.After the procedure,the renal incision was compressed with gauze,sutured with 2-0 absorbable sutures,and covered with fibrin sealant.In the other 4 patients,trans-peritoneal approach was used.The ureter was exposed near the lower pole of the kidney and separated towards the renal hilum to find out the renal artery.The following steps were similar to the above mentioned. Results In all the patients,the procedures were done without conversion to open surgeries.In this series,20 operations were completed without clamping the renal artery;and in the other 9,the mean time of renal artery occlusion was 14 min(5-20 min).In our patients,the mean operation time was 165 min(105-240 min),and the mean blood loss was 90 ml(20-800 ml).Two of the patients received blood transfusion during the surgery.The mean postoperative hospital stay was 9 d(7-17 d).No complications,such as urine leakage,occurred after the operation.Eighteen patients were followed up for a mean of 9 months(1-26 month),no recurrence of tumor was found.Conclusion Laparoscopic nephron-sparing surgery without hilar clamping or with contemporary hilar control is feasible and safe for patients with peripheral renal tumor not involving the renal collecting system.

Objective To explore the value and efficacy of retroperitoneal laparoscopic adrenalectomy.Methods From August 2002 to December 2007,a total of 401 cases of retroperitoneal laparoscopic adrenalectomy were performed in our hospital.Among the cases,nonfunctioning adenoma was diagnosed in 151 patients;hyperaldosteronism was detected in 139,Cushing’s syndrome in 37,pheochromocytoma in 19,myelolipoma in 13,and other diseases were found in 42.Results Among the cases,5 were converted to open surgery because of difficulties in the operation due to a huge tumor(1),extensive adhesion between the tumor and the inferior vena cava(2),or massive bleeding(2).The other 396 cases of retroperitoneal laparoscopic adrenalectomy were completed successfully with a mean operation time of 105 minutes(30 to 270 minutes),and a median blood loss of 45 ml(20 to 1000 ml).Two of these patients had massive hemorrhage(1000 and 800 ml respectively),and received red blood cells transfusion(2 U) during the surgery.The rupture of the inferior vena cava or diaphragm occurred in two cases,and was repaired under a laparoscope.Follow-up was available for up to 1 to 64 months(mean 23.9) in 364 patients;none of them had long-term complications or recurrent benign tumors.Conclusions Retroperitoneal laparoscopic adrenalectomy should be used as the first choice for benign adrenal neoplasms,since the procedure is safe,effective,and minimally invasive,and the patients recovery quickly after the surgery.

Objective To discuss three managements of bladder tumors under cystoscopy.Methods Of all the patients,1174 were injected compound aluminum sulphate in tumor pedicle,and 700 cases were treated with transurethral resection of bladder tumor (TURBT) and 34 cases were treated with holmium laser.Results The first management,without obturator nerve reflex and tumor recurrence in situ,was easy and economical but not fit for big tumors without pedicles.With the requirements for related techniques and equipments,TURBT might be accompanied by bleeding,obturator nerve reflex and tumor recurrence in situ.Of the 34 cases treated with holmium laser,there were 3 ones with ectopic recurrence and no one with recurrence in situ.With the requirement for holmium laser equipment,the third management was the most expensive one.Conclusion All of the three managements have their advantages and disadvantages.The doctor should select the right management or perform cross application according to the condition of the patient.