Imaging evaluation of kidney using multidetector computerized tomography in living-related renal transplantation

Background

Multidetector computerized tomography (MDCT) is lesser invasive than conventional angiography and has the advantage of assessment of vessels and surrounding anatomic variants before laparoscopic nephrectomy.

Methods

From May 2005 to March 2011, 62 consecutive living kidney donors of mean age 45.3 ± 12.7 years (range 24-70 y, male:female 26:36) underwent laparoscopic nephrectomy to paired recipients of mean age 44.8 ± 14.0 years (range 17-74 y, male:female 38:24). The clinical characteristics and laboratory data of donors and recipients were collected for analysis. Graft function as indicated by estimated glomerular filtration rate (eGFR) was obtained from the last stable visit of the donors and the best value displayed by the recipients.

Results

There was no significant correlation between CT kidney volume and and eGFR. By univariate analysis, donor age was associated with worse graft function (−0.51 mL/min lower eGFR per 1 year of donor age; P < .0001). Female sex and higher effective renal plasma flow/body mass index ratio were associated with better graft function; conversely, body weight and BMI were associated with poor graft function upon univariate and multivariate analysis. An ERPF of <220 mL/min and a donor age >45 y showed significantly lower eGFR. There was no effect of CT kidney volume <100 mL.

Conclusions

Our preliminary data suggest that CT kidney volume does not predict posttransplantation graft function, but MDCT is still important for analysis of anatomy before laparoscopic nephrectomy among living donors.     

Long-term outcomes of living kidney donors over the past 28 years in a single center in Taiwan

Background

The chronic shortage of kidneys for transplantation has increased the number of living donations, but demand remains high, which has created a long waiting list of end-stage kidney disease patients. Donors with decreased renal mass may suffer a higher risk of developing proteinuria, hypertension (HTN), and chronic renal disease (CKD) during long-term follow-up.

Methods

We retrospectively retrieved medical data of living kidney donors at our hospital over the past 28 years.

Results

There were 45 male and 60 female donors with a mean donation age of 46.34 ± 12.47 years (range = 20-70y). The mean follow-up duration was 4.67 ± 4.78 years. The serum creatinine (Cr) at donation was 0.93 ± 0.22 mg/dL, while the latest Cr was 1.26 ± 0.45 mg/dL (P < .001). The mean age at follow-up was 50.95 ± 14.57 years. At last follow-up, eight subjects (7.6%) displayed HTN requiring treatment, 10 (9.5%), proteinuria and 55.4%, an estimated glomerular filtration rate (eGFR) of less than 60 mL/min, including one with diabetic nephropathy at 10 years after donation who required long-term hemodialysis. Although gender did not correlate with occurrence of HTN, proteinuria, and CKD, the occurrence of CKD was associated with age at donation (P < .001, odds ratio [OR] = 1.076), and age at follow-up (P < .001, OR = 1.071). HTN donors were older (P = .036, OR = 1.057) with longer follow-up durations (P = .007, OR = 1.166) and had higher Cr values at donation (P = .044, OR = 94.4). Donors with proteinuria were not related to gender, follow-up duration, initial Cr, warm ischemic time, or duration of admission. eGFR was indeed worse after donation (P = .002).

Conclusions

Our results indicated a significant proportion of living donors may develop CKD upon long-term follow-up. The factors affecting donor risk of CKD were baseline renal function, older age, and duration after kidney donation.     

Application of the Calgary-Cambridge guideline to communication skills training for nursing students practising in emergency room

目的 探讨卡尔加里-剑桥指南(下称指南)在急诊实习护生沟通技巧培训中的应用效果.方法 将急诊科实习护生63名按入科实习时间分为观察组(32例)和对照组(31例),观察组接受指南进行沟通技巧的培训,对照组接受常规沟通指导;采用护患沟通满意度调查问卷A、B卷调查两组护生所服务的患者和两组护生的沟通满意度情况.结果 观察组患者护患沟通总体满意度和11个条目(除外“保护隐私”)显著优于对照组(P＜0.05,P＜0.01);观察组护生沟通总体满意度及沟通过程中的8个条目(除外“有礼貌、尊重患者”及“保护隐私”等4个条目)显著优于对照组(P＜0.05,P＜0.01).结论 指南可有效提高急诊患者及实习护生对沟通过程的满意度.     

Extrapulmonary tuberculosis in chronic hemodialysis patients

BACKGROUND: The incidence of extrapulmonary tuberculosis is higher in dialysis than general population. The aim of the study was to characterize clinical picture in dialysis patients, who developed extrapulmonary tuberculosis. METHODS: We retrospectively investigated the hemodialysis patients with extrapulmonary tuberculosis. 2208 hemodialysis patients were reviewed for extrapulmonary tuberculosis from October 1986 to January 2001. RESULTS: Seventeen patients (10 male, 7 female) were enrolled. The mean age was 57.4 +/- 12.4 years. The sites for extrapulmonary tuberculosis were peritoneum (35.3%, 6/17), cervical lymph node (17.6%. 3/17), bone marrow (5.9%, 1/17), spine (5.9%, 1/17), knee (5.9%, 1/17), brain (5.9%, 1/17), pericardium (5.9%, 1/17), cutaneous tissue (5.9%, 1/17) and genitourinary system (5.9%, 1/17). Fourteen of 15 tissue-biopsy specimens from suspicious sites revealed granulomatous inflammation. There were low yield in mycobacteria culture (11.1%, 1/9) and PCR (33.3%, 2/6). Three patients died during the treatment of the disease. CONCLUSION: Extrapulmonary tuberculosis constitutes a major part of tuberculosis in dialysis patients. Tissue biopsy with invasive procedures, such as laparoscopy or laparotomy, may be necessary if clinical presentations are suspicious.     

腰椎手术中的移行椎问题

目的：探讨移位椎的定位方法和移行椎对腰椎手术的影响。方法：回顾性分析了52例腰椎疾患手术治疗的病例，其中腰椎间盘突出症26例，腰椎骨折15例，腰椎滑脱9例，腰椎结核2例，术前均经过X线摄片、CT或MRI检杳。结果：腰部疾患合并移行椎的病例并不少见，本组病例占同期腰椎手术病人的5．3％。腰椎出现移行椎，其定位则石L4—S1，L5—L6，L6—S1。结论：腰部疾患合并移行椎时，腰椎数量发生改变，定位诊断非常重要。要确定手术部位，X线定位片(包括术中X线透视定位)、CT或MRI片缺一不可，但必须注意的是，腰椎CT和MRI检查结果是以骶椎为基准定位，也就是从下往上定位，普通X线片是从上往下序列，两定位诊断的差异，手术时必须高度重视。     

Stereotactic radiosurgery for locally recurrent nasopharyngeal carcinoma

BACKGROUND: Stereotactic radiosurgery has been used to treat intracranial tumors. Recently, it has also been used for the treatment of head and neck tumors involving the base of skull, including recurrent NPC. METHODS: From October 1994 to April 1999, 36 patients with recurrent NPC, were retreated by stereotactic radiosurgery. These patients received radiosurgery as a boost treatment after reirradiation for recurrence. The external RT dose ranged from 20 to 60 Gy. The tumor volume ranged from 3.58 to 24.6 cc. The target surface dose ranged from 8 to 20 Gy. The median follow-up was 22.1 months. RESULTS: The 3-year local control rate was 56%. The 5-year overall survival was 49%. Persistence after radiosurgery had a worse survival than those who had secondary recurrence. Age and gender were marginally significant. No patient had new severe complications after retreatment. Four patients (11%) had nasopharyngeal necrosis after radiosurgery, none had nasal bleeding or headache, but a foul odor was present in one patient. CONCLUSIONS: Conformal radiotherapy and stereotactic radiotherapy provide good local control and survival without severe complications for patients with recurrent NPC.     

Experience in the use of the long Gamma nail for 16 femoral shaft fracture that have occurred following initial Asian Pacific Gamma nail fixation for pertrochanteric fractures

From January 1993 to September 2002, 931 patients suffered from intertrochanteric fracture and subrochanteric fracture received open reduction and internal fixation with APGN in our institute. Among these patients, 16 patients (1.7%) developed a femoral shaft fracture after the initial fixation with APGN. Removal of the APGN, closed reduction and fixation with long Gamma nail (LGN) was performed in all the 16 patients. The patients were followed for 12-60 months (average, 39.8 months). The union time of fracture was 12-24 weeks (average, 18.5 weeks) for femoral shaft fractures and 12-20 weeks (average, 16 weeks) for peritrochanteric fractures. Two early complications were noted, including one superficial (6%) infection and one deep (6%) infection. Two malunions (12.5%) developed with no definite functional impairment. The functional results using the Harris hip score were good to excellent. In conclusion, closed reduction and internal fixation with a LGN is very effective in the management of a femoral shaft fracture, a complication of a previous APGN that had been initially used for stabilisation of a pertrochanteric fracture.     

反义CD147分子对人胆管癌细胞株侵袭性影响的实验研究

目的探讨反义CD147分子对人胆管癌细胞株QBC939侵袭性的影响。方法构建含反义CD147分子片段的重组真核表达质粒,将人胆管癌细胞株QBC939分为三组:(1)反义CD147组,运用重组真核表达质粒as CD147-pc DNA3.1(-)转染QBC939细胞;(2)空质粒组,运用pc DNA3.1(-)空质粒转染QBC939细胞;(3)对照组,运用DMEM常规处理细胞。采用MTT法检测各组QBC939细胞的生长情况,RT-PCR和Western blotting法分别对三组QBC939细胞中的CD147、MMP-2、MMP-9、TIMP-2的m RNA表达水平及其对应蛋白的表达水平进行检测。结果成功构建了携带反义CD147分子片段的重组真核表达质粒。MTT法检测显示:三组QBC939细胞的生长曲线及对数生长期情况无统计学差异(P0.05)。RT-PCR法检测显示:反义CD147组QBC939细胞中CD147和MMP-2分子的m RNA表达均低于空质粒组和对照组(P0.05),且空质粒组与对照组相比无统计学差异(P0.05);反义CD147组QBC939细胞中MMP-9和TIMP-2分子的m RNA表达与空质粒组和对照组相比无统计学差异(P0.05)。Western blotting检测发现:与空质粒组和对照组相比,反义CD147组QBC939细胞中CD147和MMP-2分子的蛋白表达明显降低(P0.05),空质粒组与对照组相比无统计学差异(P0.05);与空质粒组和对照组相比,反义CD147组QBC939细胞株中MMP-9和TIMP-2分子的蛋白表达无统计学差异(P0.05)。结论 (1)反义CD147对胆管癌细胞株QBC939的生长无影响;(2)反义CD147对胆管癌细胞株QBC939中MMP-9和TIMP-2的m RNA表达及对应蛋白表达无影响;(3)反义CD147降低胆管癌细胞株QBC939中CD147和MMP-2的m RNA表达及对应蛋白表达,可能会降低胆管癌细胞株的侵袭性。     

乳腺癌患者化疗相关认知障碍与自我效能的相关性研究

目的探讨乳腺癌患者化疗相关认知障碍发生情况及与自我效能的相关性。方法采用中文版癌症治疗功能评估-认知功能量表(FACT-Cog)、健康促进策略量表(SUPPH)对106例乳腺癌术后患者化疗前后进行调查。结果化疗前患者认知障碍得分为92.18±17.09,显著低于化疗后(得分101.02±24.58,P0.01);化疗前认知障碍发生率为68.9%,化疗后为92.5%;化疗前自我效能得分为82.79±26.64,化疗后为73.08±18.90,差异有统计学意义(P0.01)。化疗后自我效能与认知障碍总分及各维度得分呈负相关(r=-0.232~-0.533,P0.05,P0.01)。结论乳腺癌术后化疗患者认知障碍发生率高,且与自我效能呈负相关。护理人员可采取有效措施提高患者自我效能水平,从而减轻化疗相关认知障碍,改善生活质量。     

难治性胆石病的外科手术经验-附521例报告

目的 探讨难治性胆石病的手术方式与技巧.方法 回顾性分析1990年1月至2007年12月湖南省人民医院肝胆医院收治的521例难治性胆石病患者的临床资料.结果 全组均行手术治疗,除3例术后围手术期并发肝肾功能衰竭死亡,其余518例无严重并发症、痊愈出院.经影像学检查有残石者78例,占15.0%.423例获随访,随访率为81.7%,平均随访时间7年6个月(5个月～17年).效果良好率达90.1%.结论 大部分难治性胆石病可以根治,个体化的手术方案、精细规范的手术操作是保证疗效的关键.

Abstract：

Objective To summarize the experience in operation manner and surgical technique of refractory cholelithiasis.Methods A total of five hundred and twenty one patients with refractory cholelithiasis admitted to Hunan Provincial People's Hospital from Jan.1990 to Dec.2007 were involved in this study for retrospective analysis.Results All patients in this group accepted surgery.Apart from three cases of perioperative death with liver and kidney failure,the remaining five hundred and eighteen cases had no serious complications,were cured and discharged.The imaging examination showed residual stone in seventy cases,accounting for fifteen percent.Four hundred and twenty one patients were followed up.The mean time of follow-up was seven years and six months (range 5 months - 17 years).Good result rate was 90.1%(381/423).Conclusions Most intractable cholelithiasis can be cured radically.Individual surgery programme,fine and standard surgical procedure are the key to treatment effect.