Novel technique for the treatment of large subcapsular renal hematoma: combined use of percutaneous drainage and urokinase injection

Purpose

To evaluate the efficacy and safety of combined use of percutaneous drainage and urokinase injection to treat patients with large subcapsular renal hematoma.

Methods

We retrospectively analyzed the data of 20 patients with large subcapsular renal hematoma who were treated with percutaneous drainage and urokinase at our institutes between 2002 and 2010. Percutaneous drainage of the hematoma was performed after bleeding stopped. Then, urokinase was injected into the hematoma cavity per our protocol every 3 days. During the treatment and follow-up period, the diameter of hematoma was assessed by ultrasonography and enhanced computed tomography (CT) in all cases. Complete blood count, serum creatinine and blood pressure were evaluated as well. Follow-up periods ranged from 12 to 60 months (mean 24.1 ± 11.5 months).

Results

Percutaneous renal hematoma drainage combined with urokinase injection was successfully performed in all the patients. After sufficient drainage, all of the patients were free from their symptoms. The average time to pain relief was 10.8 ± 2.1 days after percutaneous drainage, and the total duration of drainage was 28 ± 5.1 days. Relative to baseline, there was reduction in the diameter of hematoma evaluated by the enhanced CT scan after treatment (from 11.7 ± 3.1 to 2.8 ± 1.0 cm). During long-term follow-up, active bleeding, hypertension, renal function impairment or infectious complications were not found.

Conclusions

This study revealed that combined use of percutaneous drainage and urokinase injection was a safe and effective treatment for patient with large subcapsular renal hematoma.     

New clues to identify proteins correlated with Attractin

In our previous study, the age‐dependent testis vacuolisation and sperm dysfunction were found in Attractin (Atrn)‐deficient mice, Atrn^mg‐3J, which is a null or nearly null allele. To explore the potential mechanism involved in these pathological changes, Attractin knock‐down in mouse Sertoli cells TM4 (psiAtrn‐TM4) was successfully established by stable RNA interference. The TM4 transfected by psiRNA‐hH1 (psiRNA‐TM4) was the control group, in which the expression of Atrn was not affected. The proteomic changes among the psiAtrn‐TM4, primary cultures of Sertoli cells of Atrn^mg‐3J (mu‐Sc) and control cells (psiRNA‐TM4) were compared by two‐dimensional gel electrophoresis. Fifteen differentially expressed protein spots of those cells were identified by matrix‐assisted laser desorption/ionisation time‐of‐flight mass spectrometry and the NCBI proteins database. Except the decreased expression of superoxide dismutase (SOD), there were several novel proteins associated with Atrn function, including downregulated ATP synthase, peroxiredoxin 2 and upregulated caspase 6, ketohexokinase, etc., in psiAtrn‐TM4 and mu‐Sc. These data suggest that these differentially expressed proteins may be associated with the function of Atrn in Sertoli cells, thus providing a new clue to interpret the mechanism of testis degeneration in Atrn mutants.     

Is the supine position superior to the prone position for percutaneous nephrolithotomy (PCNL)?

The objective of this study is to update the two previous meta-analyses in order to evaluate the efficacy and safety of percutaneous nephrolithotomy (PCNL) for patients in the prone position versus supine position. An electronic database search of MEDLINE, EMBASE, google scholar, and the Cochrane library was performed up to June, 2013. All studies comparing prone with supine position for PCNL were included. The outcome measures were stone-free rate, operative time, complication and hospital stay. Two randomized controlled trials (RCTs) and 7 non-RCTs, including 6,413 patients (4,956 patients in the prone position group and 1,457 patients in the supine position group), met the inclusion criteria. Meta-analysis of extractable data showed that PCNL in the supine position was associated with a significantly shorter operative time (WMD: 21.7; 95 % CI 2.46–40.94; p = 0.03) but lower stone-free rate (OR: 1.36; 95 % CI 1.19–1.56; p < 0.0001) than PCNL in the prone position. There was no difference between the two positions regarding hospital stay (WMD = 0.05; 95 % CI ?0.16–0.25; p = 0.66) and complication rate (OR: 1.1; 95 % CI 0.94–1.28; p = 0.24). In conclusion, the present study found different results from the two previous meta-analyses results regarding stone-free rate; PCNL in the supine position had a significantly lower stone-free rate than that in prone position.     

Tracking postoperative head positioning in endothelial keratoplasty using a head positioning sensor

Graefe's Archive for Clinical and Experimental Ophthalmology -     

Complement and HIV-I infection/HIV-associated neurocognitive disorders

The various neurological complications associated with HIV-1 infection, specifically HIV-associated neurocognitive disorders (HAND) persist as a major public health burden worldwide. Despite the widespread use of anti-retroviral therapy, the prevalence of HAND is significantly high. HAND results from the direct effects of an HIV-1 infection as well as secondary effects of HIV-1-induced immune reaction and inflammatory response. Complement, a critical mediator of innate and acquired immunity, plays important roles in defeating many viral infections by the formation of a lytic pore or indirectly by opsonization and recruitment of phagocytes. While the role of complement in the pathogenesis of HIV-1 infection and HAND has been previously recognized for over 15 years, it has been largely underestimated thus far. Complement can be activated through HIV-1 envelope proteins, mannose-binding lectins (MBL), and anti-HIV-1 antibodies. Complement not only fights against HIV-1 infection but also enhances HIV-1 infection. In addition, HIV-1 can hijack complement regulators such as CD59 and CD55 and can utilize these regulators and factor H to escape from complement attack. Normally, complement levels in brain are much lower than plasma levels and there is no or little complement deposition in brain cells. Interestingly, local production and deposition of complement are dramatically increased in HIV-1-infected brain, indicating that complement may contribute to the pathogenesis of HAND. Here, we review the current understanding of the role of complement in HIV-1 infection and HAND, as well as potential therapeutic approaches targeting the complement system for the treatment and eradications of HIV-1 infection.     

Proteomic analysis of cerebrospinal fluid: toward the identification of biomarkers for gliomas

Gliomas are the most common primary brain tumors in adults and, despite advances in the understandings of glioma pathogenesis in the genetic era, they are still ineradicable, justifying the need to develop more reliable diagnostic and prognostic biomarkers for this malignancy. Because changes in cerebrospinal fluid (CSF) are suggested to be capable of sensitively reflecting pathological processes, e.g., neoplastic conditions, in the central nervous system, CSF has been deemed a valuable source for potential biomarkers screening in this era of proteomics. This systematic review focused on the proteomic analysis of glioma CSF that has been published to date and identified a total of 19 differentially expressed proteins. Further functional and protein-protein interaction assessments were performed by using Protein Analysis Through Evolutionary Relationships (PANTHER) website and Ingenuity Pathway Analysis (IPA) software, which revealed several important protein networks (e.g., IL-6/STAT-3) and four novel focus proteins (IL-6, galanin (GAL), HSPA5, and WNT4) that might be involved in glioma pathogenesis. The concentrations of these focus proteins were subsequently determined by enzyme-linked immunosorbent assay (ELISA) in an independent set of CSF and tumor cyst fluid (CF) samples. Specifically, glioblastoma (GBM) CF had significantly lower GAL, HSPA5, and WNT4 levels than CSF from different grades of glioma. In contrast, IL-6 level was significantly higher in GBM CF when compared with CSF and, among different CSF groups, was highest in GBM CSF. Therefore, these candidate protein biomarkers, identified from both the literatures and in silico analysis, may have potentials in clinical diagnosis, prognosis evaluation, treatment response monitoring, and novel therapeutic targets identification for patients with glioma.     

Pyogenic Liver Abscess Following Pancreaticoduodenectomy: Risk Factors,Treatment, and Long-Term Outcome

Background

Pancreaticoduodenectomy (PD) remains a challenging operation with a 40 % postoperative complication rate. Pyogenic liver abscess (PLA) is an uncommon complication following PD with little information on its incidence or treatment. This study was done to examine the incidence, risk factors, treatment, and long-term outcome of PLA after PD.

Methods

We retrospectively reviewed 1,189 patients undergoing PD (N?=?839) or distal pancreatectomy (DP) (N?=?350) at a single institution over a 14-year period (January 1, 1994–January 1, 2008). Pancreatic databases (PD and DP) were queried for postoperative complications and cross-checked through a hospital-wide database using ICD-9 codes 572.0 (PLA) and 006.3 (amebic liver abscess) as primary or secondary diagnoses. No PLA occurred following DP. Twenty-two patients (2.6 %) developed PLA following PD. These 22 patients were matched (1:3) for age, gender, year of operation, and indication for surgery with 66 patients without PLA following PD.

Results

PLA occurred in 2.6 % (22/839) of patients following PD, with 13 patients (59.1 %) having a solitary abscess and 9 (40.9 %) multiple abscesses. Treatment involved antibiotics and percutaneous drainage (N?=?15, 68.2 %) or antibiotics alone (N?=?7, 31.8 %) with a mean hospital stay of 12 days. No patient required surgical drainage, two abscesses recurred, and all subsequently resolved. Three patients (14 %) died related to PLA. Postoperatively, patients with biliary fistula (13.6 vs. 0 %, p?=?0.014) or who required reoperation (18.2 vs. 1.5 %, p?=?0.013) had a significantly higher rate of PLA than matched controls. Long-term follow-up showed equivalent 1-year (79 vs.74 %), 2-year (50 vs. 57 %), and 3-year (38 vs. 33 %) survival rates and hepatic function between patients with PLA and matched controls.

Conclusions

Postoperative biliary fistula and need for reoperation are risk factors for PLA following PD. Antibiotics and selective percutaneous drainage was effective in 86 % of patients with no adverse effects on long-term hepatic function or survival.