经皮肾镜气压弹道联合超声碎石术治疗复杂性肾结石150例报告

目的探讨经皮肾镜气压弹道联合超声碎石取石术治疗复杂性肾结石的疗效。方法全麻下经膀胱镜先向患侧逆行插入输尿管导管,俯卧位,在B超或X线引导下,向目标肾盏穿刺,建立皮肾通道,肾镜下用气压弹道联合超声腔内碎石机碎石取石。结果单通道取石137例,双通道取石11例,三通道取石2例;一次取石119例,二次取石27例,三次取石4例。手术时间（88±34）min。1例术后当晚发生感染性休克,经抗休克治疗后缓解;2例术后2周继发出血,保守治疗后缓解。术后3个月结石取净率为84.7%（127/150）;23例残余结石中,术后10例行ESWL治疗,其中7例结石排净,余13例口服排石药,术后6个月随访结石排净率为89.3%（134/150）。结论经皮肾镜气压弹道联合超声碎石取石术治疗复杂性肾结石效率高,安全有效,损伤小,可以解决开放手术难以处理的复杂性肾结石。     

The "all-seeing needle": initial results of an optical puncture system confirming access in percutaneous nephrolithotomy

Background

In percutaneous nephrolithotomy (PNL), the best possible way to access the collecting system is still a matter of debate. There is little possibility of correcting a suboptimal access.

Objective

To describe our initial experience using a micro-optical system through a specific puncture needle to confirm the quality of the chosen access prior to dilatation of the operating tract.

Design, setting and participants

Micro-optics of 0.9- and 0.6-mm diameter were used. The micro-optic with integrated light lead was inserted through the working sheath of the puncture needle. The modified needle had a 1.6-mm (4.85-Fr) outer diameter. The optical fiber was connected via a zoom ocular and light adapter to a standard endoscopic camera system. For sufficient intraoperative sight, an irrigation system was connected.

Intervention

The optical puncture needle was used in 15 patients for renal access prior to standard PNL procedures.

Measurements

The optical assessment included determination of the distortion, resolution, angle, and field of view. The irrigation flow was assessed in an ex vivo setting, with the puncture stylet or the needle shaft either empty or with a 0.018-in guidewire inserted.

Results and limitations

In all cases, visualization of the punctured kidney calyces was successful and the presence of the target calculi could be confirmed prior to guidewire placement and tract dilation. The 0.9-mm optic was found to be significantly superior in all optical parameters in contrast to the 0.6-mm optic. No significant complications were observed.

Conclusions

The optical puncture needle for PNL appears to be most helpful for confirming the optimal percutaneous access to the kidney prior to dilation of the nephrostomy tract, improving the safety of the technique.     

Vitamin A and beta-carotene inhibitory effect during 1,2-dimethylhydrazine induced hepatocarcinogenesis potentiated by 5-azacytidine.

5-Azacytidine is being used for reactivation of tumor suppressor genes. However, its administration during DNA repair pontentiates hepatocarcinogenesis. We observed chemopreventive activities by vitamin A and beta-carotene during early hepatocarcinogenesis. Thus, in the present study we evaluated vitamin A and beta-carotene chemopreventive potential during early hepatocarcinogenesis potentiated by 5-azacytidine. Wistar rats received vitamin A (VAA group), beta-carotene (betaCA group) or corn oil (CO and COA groups). After three weeks of treatment, all animals were initiated with 1,2-dimethylhydrazine. Twelve hours later VAA, betaCA and COA groups received a single dose of 5-Azc. Hepatocytes were selected/promoted by 2-acetylaminofluorene and 70% partial hepatectomy. All animals were sacrificed six weeks after initiation. Compared to CO group (without 5-azacytidine), COA group presented higher (p<0.05) nodule multiplicity, larger (p<0.05) gamma-GT positive lesions that occupied a larger (p<0.05) area of liver section. Compared to COA group, VAA group presented decreased (p<0.05) nodule multiplicity while betaCA group tended to present smaller gamma-GT positive lesions and to decrease occupied liver section. These results reinforce vitamin A and beta-carotene chemopreventive potential. Considering that 5-azacytidine potentiates hepatocarcinogenesis, more studies are needed to elucidate the efficacy and safety of this drug for cancer control.     

Protective effect of t-type calcium channel blocker in histamine-induced paw inflammation in rat

The aim of this paper was to investigate the protective effect of the T-type calcium channel blocker in a model of acute local inflammation (histamine-induced). The intraplantar injection of histamine elicited an inflammatory response that was characterized by a time-dependent increase in paw oedema and neutrophil infiltration in paw tissue. The maximal increase in paw volume was observed at 90 min after histamine administration (maximal paw volume: 0.97 +/- 0.07). In addition, polymorphonuclear leucocyte (PNL) number was markedly increased in the histamine-treated paw tissue (144 +/- 25.56). However, histamine-induced paw oedema was significantly reduced in a dose-dependent manner by treatment with mibefradil (given at 10, 25, 50, and 100 mg x kg(-1)) at 30, 60, 90, 120, 150, 180 min after injection of histamine. Mibefradil treatment also caused a significant reduction of the polymorphonuclear leucocyte number in the paw tissue. Our findings support the view that mibefradil exerts antiinflammatory effects.     

基于PET影像组学鉴别鼻咽癌及原发鼻咽淋巴瘤

目的：探讨PET影像组学方法对鼻咽癌及原发鼻咽淋巴瘤鉴别诊断的意义。方法：回顾性分析89例鼻咽癌（NPC）原发鼻咽淋巴瘤（PNL）患者,提取PET影像组学特征,进行Logistic回归建模,得到模型参数,并建立模型方程。结果：NPC患者58例,PNL患者31例（NK/T细胞淋巴瘤10例,弥漫大B细胞淋巴瘤21例）,采用低方差滤波法及LASSO法,将PET影像组学特征缩减到12个,共有4个特征（Small Dependence High Gray Level Emphasis、Run Percentage、Short Run Low Gray Level Emphasis、Short Run Low Gray Level Emphasis）的系数具有统计学意义（P<0.05）。模型AUC为0.913(95%CI:0.857～0.969),灵敏度0.935,特异度0.724,准确度0.798。结论：PET影像组学方法可以作为鉴别NPC和PNL的可用方法。     

Potential biomarkers for the early detection of acute kidney injury after percutaneous nephrolithotripsy

This study aims to investigate the role of urinary biomarkers in the determination of the potential risks of renal parenchymal tubular damage in adult patients who underwent percutaneous nephrolithotomy (PNL) with the indication of renal stone. A randomized and prospective controlled study was performed between June and December 2013. We enrolled 29 consecutive patients with renal calculi?>?2?cm and who underwent PNL, as well as 47 healthy control subjects. Urine samples, including 2 h before surgery, 2 and 24 h after surgery were collected from the patient group. Freshly voided urine samples were collected from the control group. Kidney injury molecule-1 (KIM-1), neutrophil gelatinase-associated lipocalin (NGAL), N-acetyl-glucosaminidase (NAG), and liver-type fatty acid binding protein (LFABP) levels were measured from these urine samples. The mean KIM-1/Cr value that measured 24 h after the operation was statistically significant, higher than its preoperative (preop) level (p?= 0.045). A significant difference was detected between the mean preop and postoperative (postop) 24 h NAG/Cr values (p?< 0.001). Also, postop 24 h NGAL/Cr levels were statistically significant, higher than its preop levels (p?= 0.013). According to the comparison of preop and postop levels, an increase in LFABP/Cr values secondary to surgical intervention was observed without any statistically significant difference. Besides the LFABP/Cr levels do not change after percutaneous kidney surgery, KIM-1/Cr, NAG/Cr, and NGAL/Cr levels increase postop period, especially at 24 h. Further studies with a larger series and repeated measurements should be performed to clarify if they can be used to demonstrate renal damage after percutaneous surgery or not.     

Direct pelvic access percutaneous nephrolithotomy in management of ectopic kidney stone: a case report and literature review

Abstract

Percutaneous nephrolithotomy (PNL) is an effective procedure for the treatment of patients with large or complex stones. PNL is challenging in anomalous kidneys, certain patients, such as those with renal ectopia. It is unable to undergo PNL in conventional technique safely in these cases. We presented a case report of laparoscopic-assisted PNL via direct pelvic puncture in a pelvic kidney stone and discussed previous published literature. A 49-year-old man presented with right lower quadrant pain and hematuria. Intravenous pyelography and three-dimensional computerized tomography revealed an opaque 2.7?×?1.7?cm pelvis renalis stone in a right side ectopic pelvic kidney with grade III hydronephrosis. Laparoscopic-assisted tubeless PNL was performed to remove the calculus. Laparoscopic-assisted PNL as a minimally invasive therapy in ectopic kidney has many advantages. Our case showed that, in pelvic ectopic kidney with pelvic stones greater than 1.5?cm in size, laparoscopic-assisted PNL via direct pelvis puncture is a safe and effective technique.