ABSTRACT
Objective:Objectives To investigate the predictive value of color Doppler flow imaging (CDFI) for the proteinuria following pyeloplasty for congenital ureteropelvic junction obstruction (UPJO) in children.Methods:We identified a series of 206 children with a mean age of (20.0±28.8) months (1-132 months), consisted of 171 males and 35 females, diagnosed with congenital UPJO accepted pyeloplasty from January 2014 to September 2018, the preoperative mean urinary Albumin/Creatinine Ratio (ACR) was (17.3±160.1) mg/mmol and the mean β2-microglobulin/Creatinine Ratio (β2-MG/Cr) was (135.6±383.8) μg/mmol, ultrasound showed a mean renal pelvis dilatation of (3.1±1.5) cm and a mean cortical thickness of (0.3±0.1) cm, and classified as grade Ⅰ-Ⅴ according to the blood flow distribution in renal by CDFI, these children were divided into three groups of increased, decreased and unchanged blood flow according to the postoperative CDFI within 1 week, the postoperative urinary protein and renal function indexes within 1 week and 2 years were retrospectively analysed among groups.Results:Within 1 week postoperatively, an increased, decreased and unchanged blood flow occurred in 113 (54.9%), 31(15.0%), 62(30.1%) children, respectively. Urinary ACR in above mentioned groups was (112.3±400.7), (16.1±29.3), (32.7±48.4) mg/mmol, β2-MG/Cr was (887.4±6061.0), (50.2±62.7), (51.9±57.8)μg/mmol, there were significant differences among groups ( P<0.01). Contralateral hydronephrosis occurred in 21(18.6%), 4(12.9%), 8(12.9%) children, urinary N-Acetyl-β-D-glucosaminidase (NAG) was (7.5±5.2), (7.0±5.4)、(5.7±4.5) U/L, these indexes showed no significant differences among groups. There was a positive correlation between the increased blood flow level and the decreased renal pelvis dilatation (Spearman’s correlation coefficient 0.2, P<0.01), ACR (Spearman’s correlation coefficient 0.4, P<0.01) and β2-MG/Cr (Spearman’s correlation coefficient 0.3, P<0.01). After a follow up of 2 years, 67 children were diagnosed with proteinuria in this series, 51 cases of them with an increased blood flow, which had significantly higher percentage than children with a decreased (4 cases, 12.9%) or unchanged blood flow (12 cases, 19.3%). Logistic multivariate analysis indicated that early postoperative (within 1 week) increased blood flow ( OR=1.9, 95% CI 1.5-2.6), contralateral hydronephrosis ( OR=2.2, 95% CI 1.1-4.8) and urinary NAG ( OR=1.1, 95% CI 1.0-1.1) were predictive of proteinuria, the increased blood flow was independent predictor of proteinuria (Ⅰ level increased: OR=1.9, 95% CI 1.5-2.6). Conclusions:The CDFI reveals good predictive value for the postoperative proteinuria, an early marked increased blood flow postoperatively indicated risk of proteinuria in the long term.
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OBJECTIVE To introduce and discuss the quality management system of medical loaner instrumentation and implantables in the US.METHODS With US national standards and industry guidelines on loaner instrumentation and implantables,and the practical problems we encountered in China on this subject,we will discuss their quality management.RESULTS We should apply whole process quality management to loaner instrumentation and implantables.CONCLUSIONS Zero tolerance quality management in loaner instrumentation and implantables is crucial for medical safety.
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Objective To explore the causes of bile duct injury during laparoscopic cholecystectomy and its treatment.Methods From January 1998 to February 2007,totally 8600 cases of LC were performed in our hospital.Bile duct injury occurred in 36 of them,among which,the common hepatic duct was cut in 20 cases,the common bile duct was severed in 4 patients,the common hepatic duct was cut and freed in 4;incomplete clipping of the common hepatic duct or common bile duct occurred in 3 and 1 cases respectively;3 cases had injury to the conjunction of the cystic duct and common hepatic duct;electrical burn injury happened in 1 patient.Thirty one of the injured cases were detected during the laparoscopic surgery,while the other five were found because of jaundice or biliary leakage.The patients received bile duct repair and T tube drainage(24),T tube drainage(4),Roux-en-Y bowel biliary anastomosis(4),bile duct anastomosis(1),or removal of the titanium clips after the accidents.Results One of the patients who received bile duct anastomosis developed biliary stenosis after the T tube was withdrawn in 2 months after the surgery,Roux-en-Y bowel biliary anastomosis was thus performed 3 months later.Two patients who underwent Roux-en-Y anastomosis developed anastomotic stenosis after the operation,and thus received a second anastomosis in 11 months.These 3 patients who received totally 3 operations,were followed up for 2 to 3 years,none of them developed cholangitis or biliary stones.One patient in this series had refractory cholangitis,jaundice,and liver function impairment,and was cured after 1-year anti-inflammation and liver support therapy.In the other 32 patients,an 8-to 36-month follow-up(mean,16 months) was achieved,during which none of them showed any complications.Conclusions Bile duct injury can be due to lacking experience and knowledge of the complications of laparoscopic cholecystectomy,inappropriate enrollment of the patients,inaccurate operation,misuse of the surgical instruments,or being unable to discern the Calot's triangle.Strict indications for the operation,advanced training for young doctors,and appropriate timing for conversion to an open surgery are necessary to decrease the rate of bile duct injury.