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Objective To evaluate the efficacy and complications of flexible ureteroscopy for the treatment of upper urinary tract calculi in children.Methods The clinical data of upper urinary tract calculi in 20 children including 16 male and 4 female,treated by using flexible ureteroscopy,were collected from January 2014 to May 2015 in the First Affiliated Hospital of Zhengzhou University.The mean age was 6.4 years (ranging from 2.7-15.0 years old).Among them,6 cases had upper ureteral calculi and 14 cases had renal calculi.All the calculi was found unilaterally with on the left side in 12 cases and on the right side in 8 cases.Ipsilateral mild to moderate hydronephrosis were found in all of the cases.The mean stone size was 1.2 cm (ranging from 0.5-1.8 cm).All the cases were treated through retrograde flexible ureteroscopy holmium laser lithotripsy after the invalid conservative through conservative treatment.Double J tube was left routinely in the sick side 1 week before operation to expand the internal diameter of the ureter.A double J stent was left in place for 1 month after operation as a routine.Results The flexible ureteral access sheath failed to insert into the upper ureter in 2 cases because of the narrow ureter,then the flexible ureteroscopy was inserted into ureter through wire directly.The flexible ureteral access sheath was successfully inserted into the ureter for the others and flexible ureteroscopy were inserted through flexible sheath.The mean operative time was 38 min (ranging from 20-60 min).The patients were discharged from hospital after a mean of 4.5 days (ranging from 3-7 days).The rate of stone-free in one-stage was more than 90％.There were residual small stones in the lower calices of kidney in 2 cases.The perfusion liquid volume during the operation was 500 mL(ranging from 200-1 000 mL).There was no major perioperative complication,while transient macroscopic hematuria and fever were common complications after operation.The stone search was performed successfully in the whole 14 cases.NO residual stone could be found through ultrasound and kidney ureter bladder plain and Double-J stent was removed 1 month after operation.Conclusions Flexible ureteroscopy produces high stone-free rate and clinical safety for upper urinary calculi in children.However,the complications of flexible ureteroscopy lithotripsy cannot be ignored and sufficient preoperative preparation and careful perioperative safety control should be required.
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Objective To report our experience of retroperitoneal laparoscopic extravascular stent placement for nutcracker syndrome.Methods The clinical data of 12 nutcracker syndrome patients (10 males and 2 females;mean age 26 years) who underwent retroperitoneal laparoscopic extravascular stent placement from March 2014 to Febuary 2016 were retrospectively reviewed.The main symptoms were gross hematuria in 8 patients(one with proteinuria)and flank pain was noted in 1 patient.Three male patients had left-sided secondary varicoceles.Ultrasonography and computed tomography showed the left renal vein clamped by the superior mesenteric artery and the aorta.The anteroposterior diameter of the left renal vein in the renal hilum was three-fold than the aortomesenteric area,and the peak velocity ratio of the aortomesenteric area was much faster than the renal hilum.Twelve patients underwent laparoscopic extravascular stent placement under general anesthesia.The preaortic fibrous tissue between the aorta and the superior mesenteric artery was released intraoperatively.Renal vein became fiat when the superior mesenteric artery was elevated.The 6-8 cm extravascular stent was set on the surface of the renal vein to prevent the compression.Results Stenting was successfully accomplished in all 12 patients.Mean operative time was 62 min (50-125 min),estimated blood loss was 35 ml(20-100 ml),and the hospital stay after operation was 8 days (6-12 days).Three patients had a transient orthostatic intolerance,and they were cured by conservative treatment.With a mean follow up of 14 months (5-30 months),symptoms of hematuria and flank pain resolved in 7/8 and 1/1,respectively.Varicoceles were cured in all three patients.One case got partial relief because of recurrent hematuria due to excessive exercise.Ultrasonography showed that extravascular stent was in the right place,and the angle between abdominal aorta and superior mesenteric artery became normal.The inner diameter of left renal vein was decreased,and the narrow segment was diminished in diameter meanwhile the blood outflow was smooth.Conclusions Retroperitoneal laparoscopic extravascular stent placement in the renal vein is a safe and effective approach for nutcracker syndrome.
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Objective To explore the expression of Tiaml in clear cell renal cell carcinoma and analyze its correlations to pathology of disease and prognosis.Methods The expressions of Tiam1 protein in 107 specimens of human clear cell renal cell carcinoma and 20 specimens of normal renal tissues were detected by immunohistochemical staining and its clinical significance was then analyzed.Results The expression of Tiam1 protein was higher in renal cancers than in the adjacent normal tissues ( P ＜ 0.01 ).Tiam1 protein expression rates were 47.6％ and 72.7％ in Ⅰ - Ⅱ and Ⅲ - Ⅳ tumors,while 49.3％ and 76.5％ in T1 - T2 and T3 - T4 tumors,respectively ( P ＜ 0.01 ).Expression of Tiam1 protein was higher in lymph node positive renal carcinoma tissues than in lymph node negative renal carcinoma tissues ( 71.7％ versus 47.5％,P ＜ 0.05 ).The expression of Tiam1 in carcinoma tissues showed a positive relationship with tumor vascular invasion (81.3％ versus 48.0％,P ＜ 0.01 ).In patients followed-up 5 - 8 years,Kaplan-meier analysis and the log-rank test showed that the 5-year survival was significantly different between the group of lower and higher Tiaml expression groups ( 84.4％ versus 46.8％,P ＜ 0.05 ).Conclusions The expression of Tiaml protein was higher in human primary renal carcinoma than in normal renal tissues.The positive rate of Tiam1 protein expression was related to classification,TNM stage,lymph node metastasis and vascular invasion.The detection of the expression of Tiaml protein may be helpful in the diagnosis and prognosis of renal carcinoma.
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Objective To investigate the effects of solifenacin on the detrusor instability of patients with overactive bladder (OAB).Methods A total of 20 outpatients with OAB of.1 - 20 ( mean, 8 )years, 12 males and 8 females, aged 21 - 83 ( mean, 43) years were included in this study.Five mg solifenacin was given orally once daily for 12 weeks.Before and after treatment, overactive bladder symptom score (OABSS), patient perception of bladder condition symptoms rating scale (PPBC), and filling cystometry was performed.Results Before and after solifenacin administration, significant decrease were detected in term of unstable detrusor waves ( 2.3 ± 2.4) vs (0.6 ± 1.3 ) ( P ＜ 0.05 ), and detrusor overactivity ( DO ) disappeared in 6 patients.Bladder capacities at first desire to void and maximum bladder capacity were significantly increased (P ＜0.01 ).Bladder compliance and detrusor pressure at maximum urine flow had no significant difference (P ＞ 0.05 ).All patients had significant improvement in OAB symptoms evaluating by OABSS and PPBC ( P ＜ 0.05 ).Six patients had mild side effect of dry mouth and could be relieved by drinking more water.Conclusion Urodynamically, solifenacin decreases the detrusor overactivity, increases the bladder capacity and improves the quality of life of OAB patients.
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Objective To explore the expression of the nerve growth factor receptors p75 (p75NGFR) in human bladder carcinoma samples, and the effects of hypoxia on the expression of p75NGFR in human bladder cancer ceils. Methods The expression of p75NGFR in 107 bladder cancer and lymph node specimens were immunohistochemically investigated. The expression of p75NGFR in bladder cancer cell line (T24) was assessed by immunocytochemistry, and reverse tran-scription-PCR in the Normoxic Condition (air, 5%CO2) and in hypoxia condition(10%O2, 5%CO2, 85%N2). Results p75NGFR expressed in 46 of 107(43.0%) tumor samples. There was no signifi-cant correlation between p75NGFR and the factors such as gender, age, extent of the tumors, and pathologic grading(P0.05), p75NGFR was expressed in examined cell line T24, and also expressed in 5 of 24 bladder tumors in metastasized lymph node specimens. Hypoxia markedly down-regulated the expression of p75NGFR of T24 cell line at third day. Conclusions It is suggested that p75NGFR is expressed less in lymph node metastasis. Hypoxia markedly inhibited expression of p75NGFR of T24 cell lines.
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Objective To investigate the antitumor effect of specific cytotoxic T lymphocytes induced by renal cell carcinoma multiple antigen peptide dendritic cell (DC) vaccine in vitro. Methods Dendritic cells were induced by hGM-CSF,hIL-4 from blood.Peptide of renal cell carcinoma cell line (RCC786-0)was got by citrate-phosphate buffer elution.Peripheral blood mononuclear cell was cultured.Multiple antigen peptide DC cell vaccine was obtained by acid-eluted peptide pulsed DC.The tumor antigen specific CTL was generated from activated T cell by vaccine.Killing activity of the tumor antigen specific CTL was activated by vaccine. Results Antigen peptide DC cell vaccine could show a strong cytotoxic activity of CTLs(31.93±5.05%),which was much higher than control groups(5.88±2.26%,8.03±6.70%,9.70±2.09%,9.35±3.58%). Conclusion Renal cell carcinoma antigen peptide DC vaccine could show a high antitumor effect in vitro.
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Objective To explore the clinical efficacy of renal lymphatic stripping with laparo scope.Methods Twenty cases of chyluria (12 men and 8 women; mean age,52 years) were treatedwith laparoscopic renal lymphatic stripping.The diagnosis of chyluria was setup by chylous tests andcystoscopy.The ultrasonic harmonic scalpel was used during the dissociation and ligation.ResultsThe average operation time was 100 min.The average blood loss was 50 ml and the average hospitalstay after operation was 6 d.No surgical complications occurred.The urine was clear and the chyloustests were negative in 19 patients when the patents discharged Irom the hospital.No recurrence ofchyluria was found during the follow up of 6-24 months.One patient with bilateral chyluria occation ally showed chyluria during follow up.Conclusion Laparoscopic stripping of renal lymphatic vesselsfor the treatment of chyluria could be an efficient method with the advantages of simple operating,mini invasion and rapid recovery.
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Objective To explore the mechanisms of cyclosporin induced chronic nephrotoxicity. Methods Radioimmunoassay was used to study the changes of plasma renin activity (PRA), plasma angiotensin Ⅱ (AngⅡ), and Aldosterone after rats were given low salt diet and 30 mg?kg -1 ?d -1 of CsA for 28 days. The protective effects of Radix Salviae Miltiorrhizae or benazepril on these changes were also studied. Results In CsA treated rats, PRA and AngⅡlevels were significantly elevated as compared with control groups. The elevation was not influenced by injection of Radix Salviae Miltiorrhizae, but could be blocked markedly by benazepril. There was significant difference in Aldosterone levels among the groups except benazepril treated group showing a decreased Aldosterone level.Conclusion Chronic cyclosporone nephropathy may be related to activation of renin angiotensin system, especially to the elevation of AngⅡlevels. The different effects of Radix Salviae Miltiorrhizae or benazepril on RAS suggest the different preventive mechanisms of the two drugs to chronic cyclosporine nephropathy. The plasma Aldosterone levels were not elevated in CsA treated rats, suggesting that CsA may induce relative adrenal resistance to AngⅡ.
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Objective To explore the mechanisms of protective effect of benazepril in the treatment of experimental cyclosporin- induced chronic nephrotoxicity. Methods Rats were on low-salt diet and cyclosporine A (CsA) was administered by gastric gavage at a dose of 30?mg/kg once daily for 28 days. The expression of mRNA for intrarenal transforming growth factor-?1 (TGF-?1) and renin was detected by reverse transcription-polymerase chain reaction (RT-PCR). Intrarenal expression of TGF-?1 and Collagen Ⅳ was determined by immunohistochemistry. The effects of benazepril on these changes were also evaluated. Results Chronic cyclosporine-induced nephropathy may be related to TGF-?1 and renin mRNA up-regulation as well as matrix proteins accumulation in interstitium. Benazepril could reduce TGF-?1 mRNA up- regulation and decrease intrarenal matrix proteins accumulation. Conclusion Decreased CsA-related TGF-?1 up-regulation expression and accumulation of matrix proteins in the kidney may be related to mechanisms of protective effect of benazepril in the treatment of cyclosporin-induced chronic nephrotoxicity.