ABSTRACT
Objective To investigate the value of heparin-binding protein(HBP) in predicting urosepsis after endoscopic lithotripsy for upper urinary tract stones.Methods From January to November 2018,635 cases of upper urinary tract stones treated by endoscopic lithotripsy in our hospital was analyzed.According to the 2014 edition Chinese Guidelines of the diagnosis and treatment of urosepsis,all patients were divided into two groups,the definite urosepsis group (n =53,8.3％) and the no urosepsis group (n =582,91.7％).The serum of HBP level was detected by fluorescence immunoassay technology.The serum of procalcitonin (PCT) level was detected by cyclic enhanced immunofluorescent assay.C-reactive protein (CRP) level was detected by automatic chemiluminescence immunoassay analyzer.White blood cells (WBC) count was performed by hematology analyzer.Receiver operating characteristic(ROC) curves were constructed by SPSS 22 and MedCale,and areas under curves (AUC) were calculated and compared to illustrate the diagnostic power of HBP,PCT,CRP and WBC.The correlation between HBP and WBC was also significant (r =0.68,P ＜ 0.05).Results The level of HBP,PCT,CRP and WBC were significantly higher in the definite urosepsis group compared to the no urosepsis group.AUC of HBP,PCT,CRP and WBC were 0.930,0.878,0.727 and 0.617.When the cutoff of HBP,PCT,CRP and WBC were set as 51.5 ng/ml,0.41 ng/ml,64.2 mg/L and 11.7 × 109/L,the sensitivities were 89.2％,83.3％,83.5％ and 44.7％,and the specificity were 95.9％,75.6％,64.3％ and 77.1％,respectively.Conclusions The value of heparin-binding protein was superior to that of PCT,CRP and WBC in predicting urosepsis after endoscopic lithotripsy for upper urinary tract stones.Heparin-binding protein could be acted as a diagnostic marker for urosepsis.
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Objective To investigate whether initial intervention based on WBC measured within 2 hours postoperatively can reverse the uroseptic shock induced by UUTEL.Methods From May,2015 to July 2015,24 female New Zealand rabbits,weighing 2.0-2.5 kg,born 2-3 months,used as uroseptic shock model.Their ureters were ligated and followed by injection of Escherichia coli solution into the renal pelvis.Then,those animals were randomly assigned into control group(the first group)and experimental groups (the second group,the third group).Each group had 8 rabbits initially.The first group did not receive sensitive antibiotic or fluid resuscitation.The second group received imipenem and cilastatin sodium 15mg/kg and normal saline 5 ml/kg 2 hours postoperatively.The third group received sensitive antibiotic and fluid resuscitation the same dosage as the second group 6 hours postoperatively.Mean arterial pressure(MAP) was recorded for 10 hours and survival rate of all groups for 72h postoperatively was recorded..The clinical data of 46 patients whose WBC count less than 2.85 × 109/L within two hours after UUTEL were analyzed retrospectively.These patients were divided into two groups based on the time of intervention.Group A including 19 patients received routine antibiotic,fluid therapy,low-dose corticosteroids when there was symptom of shock.Group B including 27 patients immediately received resuscitation bundle protocol when there was a drastic decrease in WBC.The incidence of septic shock,the rate of intubation,length of stay in ICU,length of stay in hospital postoperatively,hospitalization cost and survival rate of these two groups were compared.Results All 8 rabbits of the first group died within 72 h,postoperatively and the median time of survival was 11 h.None of the second group rabbits developed shock and all rabbits survived 72 h after operation.6/8 rabbits of the third group survived 72 h after operation.15 patients in Group A and 3 patients in Group B experienced acute uroseptic shock (P ＜ 0.05).11 patients in Group A and one patients in Group B underwent tracheal intubation (P ＜ 0.05).18 patients in Group A and 6 patients in Group B were transferred to ICU(P ＜ 0.05),and their length of stay in ICU was (10.8 ± 5.4) d and (7.5 ± 2.8) d,respectively(P ＞ 0.05).The length of stay in hospital and hospitalization cost of Group A and B were (19 ± 9.8)d vs.(7 ±4.7)d(P ＜0.05),(94 583 ±51 623) RMB vs.(35 389 ± 16 342) RMB respectively (P ＜ 0.05).One patient in Group A died due to acute uroseptic shock and none of Group B died.Conclusions Our animal model and clinical cohort study showed that initial intervention based on WBC mneasured within 2 hours postoperatively can reverse the uroseptic shock induced by UUTEL and improve the prognosis.
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BACKGROUND AND AIMS: Nowadays, common bile duct stones are predominantly extracted endoscopically, after endoscopic papillotomy. Nearly 90% of stones can be removed with a Dormia basket or mechanical lithotripter. In the remaining patients several nonoperative procedures serve as alternatives to surgery. Once extracorporeal lithotripsy had been successfully used for gallbladder stones, this technique was extended to bile duct stones. An experience of endoscopic removal of difficult bile duct stones combined with extracorporeal shock wave lithotripsy (ESWL) is reported. METHODS: 82 patients were selected for this treatment because conventional stone extraction had failed. The Biolithos Mark III was used for extracorporeal spark-gap lithotripsy and the shock wave number was 2,000 waves (average) at one session. The stones were detected through a fluoroscopy with dye injection through an endoscopic naso-biliary drainage tube. After the fragmentation of bile duct stones, endoscopic removal of stones was performed for the facilitation of the complete removal of the stones, and to decrease the discomfort of the patients for the duration of their stay. RESULTS: Visualization of the stones using a fluoroscopy with dye injection was possible in all patients. On average, these patients had 3.1 (1-7) sessions of treatment with ESWL. Fragmentation was achieved in 74 (90.2%) patients and complete stone removal occurred in 71 (86.5%) patients. Complete stone clearance was achieved without further intervention in 8 (11.3%) patients, and in 63 (88.7%) patients after endoscopic extraction of the fragments. Thirty-seven (58.7%) patients underwent one endoscopic intervention to extract the remaining fragments. In 54 (81.8%) patients, a balloon catheter or Dormia basket was sufficient to extract the remaining fragments and an additional mechanical lithotripsy was necessary to break down larger fragments in 12 (18.2%) patients. There were no serious adverse effects from ESWL. CONCLUSIONS: Endoscopic removal combined with ESWL is also a useful method for the treatment of difficult bile duct stones to facilitate the complete removal of the stones and to decrease the discomfort of the patients, as well as the duration of their hospitalization.