RESUMO
Objective To investigate the epidemiology,clinical features,etiology and treatment of Kaposi sarcoma after kidney transplantation through the diagnosis and treatment of a patient with Kaposi sarcoma after kidney transplantation.Methods The clinical data of a 61-year-old man with Kaposi sarcoma who had kidney transplantation in 2015 were retrospectively analyzed,and the relevant leteratures at home and abroad were reviewed.The patient was an elderly male who underwent renal allograft transplantation for end-stage uremia,and the operation was successful.Preoperative detection of antibodies such as EB virus were negative.Besides,the donor donated organs after the death of the citizen (donation after cardiac death).The man developed dark brown plaques on the outside of his right lower leg and had a roundish-purple tumor on his left ear at the end of 3 months after kidney transplantation,gradually increasing without any other special discomfort.After admission,relevant examinations showed that the function of the transplanted kidney was stable and no other related lesions were found.HIV confirmatory test was negative and the pathology was consistent with Kaposi sarcoma.Therefore,the diagnosis was Kaposi sarcoma and kidney transplantation status.Results Then,the treatment was modified.The cyclosporine +mycophenolate mofetil + prednisone triple immunosuppressive regimen was discontinued and the immunosuppressive drug was changed to sirolimus at a concentration of about 5.69 ng/mL.After treatment for half a year,the Kaposi sarcoma disappeared gradually.Furthermore,the graft function was still stable and up to now,no recurrence of Kaposi sarcoma has been observed.Conclusion Though characteristics of skin lesion are helpful,confirmed diagnosis relies on pathology.And sirolimus may be effective in the treatment of Kaposi sarcoma after kidney transplantation.
RESUMO
Objective To evaluate the clinical significance of using B-ultrasound combined with color Doppler ultrasonography guidance in percutaneous nephrolithotomy ( PCNL) to decease the incidence of hemorrhagic complication.Methods A total of 323 patients with renal or urethral stones who had undergone PCNL were retrospectively categorized into 2 groups.Group 1 (147 patients) underwent PCNL with single B-ultrasound guidance while group 2 (176 patients) underwent PCNL with combined B-ultrasound and color Doppler ultrasound guidance. The clinical characteristics and complications, especially hemorrhagic complications in the two groups were recorded and compared.Results There were no statistical significances in age [ ( 53.2 ±12.9 ) years vs.( 54.7 ±9.1 ) years ] , hight [ ( 165.1 ±8.5 ) cm vs.( 164.6 ± 6.9) cm], weight[ (66.1 ±19.2) kg vs.(64.9 ±16.3) kg], stone burden [(680.5 ±56.4) mm2 vs. (654.0 ±76.9) mm2], operative time[(117.6 ±55.1) min vs.(121.4 ±54.3) min], stone-free rate (90.7%vs.91.3%), or postoperative hospital stay [(4.9 ±2.2)d vs.( 4.7 ±1.7 )d] between the two groups.In the B-ultrasound combined color Doppler ultrasound guidance group, the rate of blood transfusion (1.1%vs.3.4%) and super-selective embolization (0 vs.3.4%) was significantly lower than that of the single B-ultrasound guidance group.Besides, the incidents of renal arteriovenous fistula (0 vs.2.0%), pseudoaneurysm (0 vs.2.0%), and perirenal hematoma (0 vs.1.4%) were significantly lower in the B-ultrasound combined color Doppler ultrasound guidance group than that of the single B-ultrasound guidance group.Conclusion Using B-ultrasound combined color Doppler ultrasound guidance during PCNL resulted in the real-time detection and avoidance of the renal blood vessels during puncture and decreased the incidence of hemorrhagic complications.
RESUMO
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.
RESUMO
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.
RESUMO
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.
RESUMO
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.
RESUMO
Objective To assess the clinical efficacy of patient controlled intravenous analgesia (PCIA) with mixture of fentanyl and droperidol for post-prostatectomy pain. Methods 104 patients undergone prostatectomy were randomly divided into two groups. In group A, the patients received PCIA.In group B, they received routine analgesia.The pain scores of visual analogue pain scale (VAS) and control of bladder spasm were recorded at various time postoperatively, and the time of continuous infusion of bladder, the time of indwelling catheter and the mean hospitalization time were also recorded. Results Compared with those of group B,the VAS,continuous time and ratio of bladder spasm decreased markedly in group A ( P
RESUMO
Objective To study the diagnosis and treatment of aldosterone producing adenoma of the adrenal gland. Methods From January 1988 to January 2000,69 cases of aldosterone producing adenoma of the adrenal gland were diagnosed and treated.The diagnosis was all confirmed on open surgery and pathological studies. Results In all the patients,serum potassium level resumed to normal range in a week postoperatively.48 patients have been followed up for 3 months to 10 years,in 45 of them the blood pressure dropped to normal.In the other 3, drugs are still needed to control blood pressure after operation. Conclusions Spironolactonum test and serum aldosterone assay were the main methods of qualitative diagnosis of aldosterone producing adenoma.The location of the growth was mainly assessed on B ultrasono graphy and CT, the diagnostic accuracy being 81.2 percent and 100 percent respectively.Operation was the effective treatment method for aldosterone producing adenoma.