Résumé
Objective To study the surgical diagnosis and treatment of renal tuberculosis(TB). Methods The clinical data of 42 cases with renal TB were analyzed retrospectively and the experiences of clinical diagnostic and treatment were summarized. Results Cystic irritation symptoms(78.6% ,33/42)and gross hematuria(64. 3%,27/42)were the most common symptoms in these patients. Abnormal urine were found in 83.3 % cases. Acid-fast stains on urinary sediment were positive in 28.6%(12/42)of cases. The diagnostic accuracy of B-ultrasonicgraphy,IVU,retrograde pyelography and CT examination in these patients were 19.0%(8/42),33.3% (14/42),26.2%(11/42)and 71.4%(30/42)respectively. Among all cases enrolled in the study,6 patients received antiphthisic medicine treatment,3 of them were cured and the other 3 accepted nephrectomy and partial ureterectomy after 6-12 months because of severe renal function impairment 36 cases received surgical treatment. In the 39 cases treated with operation,all of them were proved to carry renal tuberculosis by the postoperative pathological examinations. Conclusions The medical history,urine analysis,image examination should be considered synthetically in the clinical diagnosis of renal tuberculosis. The patients should be followed up closely during antiphthisic treatment period. Seriously damaged or nonfunctioning kidney should be removed promptly.
Résumé
Objective To discuss the diagnosis and management and prevention of spontaneous renal allograft rupture. Methods A retrospective analysis of 12 spontaneous renal allograft rupture was conducted. Clinical presentations were similar in all patients: sudden pain and swelling over the graft and declining blood pressure accompanied by anufia. Color-ultrasound combined with clinical manifestation had higher sensitive in detecting a case. Eleven cases were performed emergency operation, 3 of them lost their kidneys, 8 of them were performed transplant-preserving operation,2 cases lost their allograft because of rerupture of the kidney. Conservative therapy was carried on 1 case. Results Five cases of transplant nephrectomy were given hemodialysis to maintain, 6 eases who had accepted surgery to retain kidney transplantation and 1 case of using conservative treatment were cured and discharged. Conclusions Acute rejection and acute tubular necrosis are the main causes of spontaneous renal allograft rupture. Color-ultrasound combined with clinical manifestation have higher sensitive in detecting a case. As soon as possibly adopting internal medicine, surgery for a joint deal with the breakdown of renal aUograft rupture is important.Prevention should begin with the removal of the kidney, operation of the renal graft, rational use of immunodepressants, and early management of transplant rejection.
Résumé
Objective To establish a colony of genetic idiopathic hypercalciuric rats model which can stablely descend and initially explore the mechanism of idiopathic hypercalciuric development. Methods The male and female rats with the highest 24-h urine Ca excretion and normal serum calcium,phosphorus and 1,25(OH)2D3 were chosen for inbreeding to propagate the colony until the stable hypercalcinuria was achieved in filial generation. Immunohistochemical determination (SP method) was undertaken to determine the VDR expression in model rats duodenum. Results The content of two 24 h urine Ca excretion in 93% male and 92% female generation 7 model rats was double standard deviation more than that in the normal group(2.56?0.86 mg/d vs. 1.12?0.18 mg/d,2.86?1.16 mg/d vs. 1.15?0.12 mg/d respectively)(F=27.10,P*0.05). VDR expression was remarkably increased in model rats duodenum(F=14.23,P