A New Technique: Laparoscopic Resection of Fibrous Ring and Placing Extravascular Stent in Patients With Nutcracker Syndrome: A Report of 5 Cases.

OBJECTIVE: To evaluate the feasibility and safety of a new laparoscopic technique for resection of a fibrous ring and extravascular stent implantation in patients with nutcracker syndrome (NCS). MATERIAL AND METHODS: We retrospectively reviewed data of 5 patients diagnosed with NCS between March 2010 and February 2016. The mean age of the patients (4 male and 1 female) was 34 years (range, 28-40 years). All 5 patients underwent laparoscopic resection of the narrow fibrous ring around the left renal venous (LRV) and for extravascular stent implantation in the LRV for management of NCS. RESULTS: The average operating time was104 minutes and the average blood loss during surgery was 59 mL. The average length of the postoperative hospital stay was 6 days (range, 4-8 days). In all 5 patients, the symptoms of macroscopic hematuria started decreasing gradually and resolved after surgery. Postoperative computed tomography showed that the blood outflow from the LRV was smooth. The ratio of the dilated segment's inner diameter to the diameter of the strictured segment decreased from 3.4 to 9.5, preoperatively to 1.1-2.0, postoperatively. The mean follow-up period was 17.6 months (range, 8-24 months).One patient's varicocele was cured and symptoms in all 5 patients resolved after surgery. None of the patients showed symptom recurrence. CONCLUSION: Laparoscopic surgery, for the placement of an extravascular stent and resection of the fibrous ring around the end of the LRV outflow to the inferior vena cava appears feasible and safe and offers an alternative minimally invasive for the management of NCS.

[Influence and distribution of CD133 and CD34 antigen expression in proximal tubule epithelial cells during ischemia/reperfusion injury in rats].

OBJECTIVE: To study the influence and distribution in proximal tubule epithelial cells with the expressions of CD133 and CD34 in a rat model so as to provide a study basis for renal adult stem cell. METHODS: The kidney ischemia/reperfusion model was established by blocking the bilateral renal arteries for about 50 min and recovering the renal perfusion of blood. Then the rat kidneys were extracted at Days 3, 5 and 7 post-modeling. After a series of special treatment, immunohistochemical staining was used to show the distribution and expression intensity of KIM-1, Brdu antigen, CD34 and CD133 antigens in cells with the elapsing of time. RESULTS: As compared with control group, the KIM-1 and CD133 antigens were present in cortex renis while the CD34 and Brdu antigens were distributed in parts of medulla renis and juncture of cortex-medulla renis. The expression density value of KIM-1 and CD133 antigens rose for the first 3 days then declined afterward (40.3% ± 3.2%, 57.5% ± 3.8%, 24.3% ± 1.4%). Otherwise the expression density value of CD 34 antigen declined (56.0% ± 4.8%, 44.2% ± 2.2%, 28.8% ± 1.0%) and Brdu antigen showed an upward trend at post-operation (10.0% ± 1.1%, 36.0% ± 4.2%, 48.8% ± 5.0%). CONCLUSION: After ischemia/reperfusion injury in kidney, the expression rates of CD133 and KIM-1 antigen rise obviously in cortex renis. And the D34 and Brdu antigens show a similar trend in medulla renis. The result indicates that the phenomenon of proliferation and differentiation may appears in kidney proximal tubule and migrate from the region of medulla renis to cortex renis. The participating cells not only possess the strong proliferation and repairing ability of stem/progenitor cells, but also can expresses the CD34 and CD133 antigens. Thus it is may provide a study basis for the tissue reconstruction of nephron and research in the field of kidney adult stem cell.