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Objective To evaluate the of the decision process to perform staged or synchronous bilateral percutaneous nephrolithotripsy (PCNL) in the treatment of bilateral upper urinary tract calculi. Methods Patients with an indication for bilateral PCNL were enrolled in the study from Jan. 2008 to Dec. 2008. The decision to perform staged or synchronous bilateral PCNL was based on the initial side operative time, the changes of hemoglobin level and systolic arterial pressure, the results of blood gas analysis and the patient′s tolerance at the end of initial side operation. The patients were divided into two groups, patients who underwent synchronous bilateral PCNL were in group one. Patients where the PCNL procedure was stopped after the initial side and subsequently underwent staged bilateral PCNL three to six weeks later were placed in group two. The success and complication rates of two groups were compared and analyzed. Results Of 60 planned simultaneous bilateral PCNLs, nine were stopped after the initial side, due to prolonged operative time in four cases, a hemoglobin level ＜100 g/L or the decrease of more than 30 g/L in three cases, a systolic arterial pressure lower than 90 mm Hg or the decrease more than 30 mm Hg in two cases, an arterial blood pH lower than 7.35 or the arterial oxygen saturation lower than 95% in two cases or the patients were intolerant to the surgery in three cases. Between the two groups, the differences of patient gender, age, BMI, preoperative hemoglobin level, the total hemoglobin decrease, the side initiated operation, stone number and second side stone burden were insignificant. However, there were significant differences in the first operative side stone burden, total stone burden, the first operative side operative time and total operative time. The stone-clearance rate was 87.3% in group one and 88.9% in group two. There was no difference in complication rate of two groups. Conclusions Prolonged operative time, large blood loss during the first operation side and patient intolerance are the main causes of staged bilateral PCNL.
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BACKGROUND: There are numerous inducers used in inducing bone marrow mesenchymal stem cells (BMMSCs) differentiate into neuron-like cells, however, due to poisonous, most chemical inducers can not be used in human.OBJECTIVE: To investigate the effect of ligustrazine on differentiation of rat BMMSCs into neuron-like cells in vitro, and to search for the optimal inductive concentration.METHODS: After SD rats were anesthetized, bone marrow was obtained from the femoral and tibial bones, centrifuged, and the supernatant was discarded. The extracted cells were cultured in L-DMEM supplemented with 15% fetal bovine serum. The expression of CD44 and CD45 of the 5~(th) passage of BMMSCs were identified by immunocytochemical technique. Serum-free L-DMEM medium contains 1.00, 1.25 and 1.50 g/L ligustrazine concentrations were used to induce the 5~(th) passage of BMMSCs in vitro. Morphology changes of BMMSCs were observed under an inverted phase microscope. Expression of nestin, neuron-specific enolase and glial fibrillary acidic protein were identified by immunocytochemical technique, and the expression ratio of neuron-like cells' surface antigens induced by different concentrations of ligustrazine were compared.RESULTS AND CONCLUSION: ①Most primarily cultured BMMSCs adhered to the wall at 3 days after culture, which proliferated faster after passaged, and the 5~(th) passage of cells were mostly purified into BMMSCs, spread radially or vortex-likely. ②The 5~(th) passage of BMMSCs was positive expressed (98.02±0.81)% CD44, but negative for CD45. ③Neuron-like cells with prominence and bifurcation could be seen after induction. The immunocytochemical method showed that nestin and neuron-specific enolase in most induced cells were positive expressed, especially received a highest ration of neuron-specific enolase expressing in the induced group with 1.25 g/L concentration of ligustrazine. It revealed that ligustrazine can induce BMMSCs differentiated into neuron-like cells, and 1.25 g/L is the optimal inductive concentration.
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Objective To explore the safety of the elderly donors in living related donor kidney transplantation. Methods Forty-five elderly donors (51 - 78 years,study group) who underwent ne-phrectomy for living related donor kidney transplantation from April 1993 to December 2007 were retrospectively investigated. Clinical data including serum creatinine (SCr), glomerular filtration rate (GFR) in pre-and post-operation, operation complications and hospital stay time were analyzed and compared with the control group(62 cases, the donors age were younger than 50 years). Results The operations of all living donors were successful. The SCr and GFR in pre-operation were (82.16 ± 10.86)μmol/L, (85. 82±6.26)ml/min(study group)and (78. 66±10. 41)μmol/L, (88. 74±9. 44) ml/min (control group) respectively. There were no significant differences in SCr and GFR between the groups at different time points (P>0. 05). The average hospitalization time was 9 days in study group and 8 days in control group. There were no severe perioperative complications and no renal function failure was found in long-term following-up in study group. Conclusions Age is not the absolute contraindication of donor for living related donor kidney transplantation. The preoperative evaluation and careful operation can ensure the safety of elderly donors.
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Objective To discuss the safety and efficacy of simultaneous bilateral percutaneous nephrolithotomy (SBPCNL) for bilateral renal or upper ureteral calculi. Methods Forty-eight cases (26 males, 22 females, 24-57 years )who underwent SBPCNL with pneumatic and ultrasonic power for bilateral renal or upper ureteral calculi were retrospectively reviewed. Clinical data including opera-tion time, blood loss, transfusion rates, length of hospital stay, stone free rate and complications were analyzed. Results The percutaneous renal access was successfully established under ultrasonic guid-ance in all patients. The average operation time was(105±18) rain(range 80-190 min). The average drop in hemoglobin was 21 g/L (range 5-54 g/L), with 5 patients requiring blood transfusion. In 43 patients, a single stage was performed on both sides, while 5 required the second stage PCNL on one side. A single tract was adopted on both sides in 44 patients, while 4 cases of the patients required two tracts on one side. No one required two tracts on both sides or more than one stage on both sides. The stone-clearance rate was 87.5 %. The average hospital stay was 6.5 d. There was no severe complica-tion occurred. Conclusion SBPCNL might be safe and effective for bilateral renal or upper ureteral calculi for selected patients.
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Objective To report the experiertce of management of complicated renal stones by percu taneous nephrolithotripsy (PCNL) with pneumatic and ultrasonic power by ultrasound guidance. MethodsThree hundred and eighty two cases(218 males,164 females,4 74 years) who underwent PCNL by u sing the third generation Swiss LithoClast Master for kidney stones from 2004 to 2007 were retrospectivelyreviewed. Clinical data including operation time,stone free rate and complications were analyzed. ResultsPhaseⅠlithotripsy was performed in 397 sides and delayed phaseⅡlithotripsy in 8 sides. Twenty three casesunderwent simultaneous bilateral PCNL. The operation time ranged from 70 to 190 min,average time was(93±11)min. Nine cases needed blood transfusion. Severe complications did not occur during operations.Stone free rate was 91.8% (372/405). Residual stone fragment was found in 33 cases after delayed phase Ⅱlithotripsy and 14 cases received adjuvant extracorporeal shock wave lithotripsy. One hundred and forty sixcases were followed up for 3 to 24 months and showed no recurrence. Conclusion PCNL with pneumaticand ultrasonic power could be an efficient treatment for complicated kidney stones.
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Objective To evaluate the role of detecting circulating UP Ⅱ mRNA positive cells in patients with transitional cell carcinoma (TCC). Methods Expression of UP Ⅱ mRNA was examined with nested reverse transcriptase polymerase chain reaction (RT PCR) assay. Results UP Ⅱ mRNA positive cells were detected in 0% (0/26) of patients with superficial urothelial cancers (pT a～1 N 0M 0), 20.8% (5/24) of patients with invasive cancers (pT 2～4 N 0M 0), 50.0% (1/2) of regional node positive patients (pN 1～2 M 0),and 100.0% (2/2) of patients with distant metastases. Positive rates increased with tumor extension ( P