ABSTRACT
Objective To analyze the relevant factors affecting prognosis of pulmonary infection after renal transplantation.Methods The clinical data of 40 patients who suffered from pulmonary infection after renal transplantation at the First Affiliated Hospital of Jinan University from January 2000 to December 2010 were analyzed retrospectively.By Cox risk model,single and multi-analysis were performed on 20 possible factors,including age,gender,time of infection,type of infection,white blood cell count,neutrophil ratio, hemoglobin,blood glucose,serum creatinine (Scr),pulmonary infection complicated with acute respiratory distress syndrome or acute pulmonary injury,rejection,blood transfusion,infusion of albumin,infusion of immune globulin,use of ventilator,way of offering oxygen,immunosuppressive regimen,dosage change of immunosuppressant,anti-infection therapeutic regimen and length of stay.Results and Conclusions Triple immunosuppressive therapy without mycophenolate mofetil (MMF ) and increase of neutrophil ratio were independent risk factors for pulmonary infection after renal transplantation.Triple immunosuppressive therapy with MMF combined with early anti-infection therapeutic regimen may improve patient and graft survival of patients with pulmonary infection after renal transplantation.
ABSTRACT
Objective To evaluate the efficacy and safety of percutaneous nephrolithotomy(PCNL) by middle renal calice used as main access for the treatment of staghorn stones with the combination of pneumatic and ultrasonic lithotrite.Methods Clinical data of 73 patients underwent PCNL by middle renal calices as main access with 57 incomplete staghorn stones and 35 complete staghorn stones.The rate of stone removal and complications were the main points of the analysis.Results Seventy-two cases underwent first session PCNL by single access tract(middle calices),3 cases underwent first session PCNL by double access tracts (2 cases by middle and lower calices,1 case by upper and middle calices).Of these patients,1 case had fragments with no further treatment,16 cases underwent second session PCNL.All were treated by single access tract (middle calices) and 2 cases had extracorporeal shock wave lithotripsy before the second PCNL.Seventy-six cases composed of 27 complete staghorn stones and 49 incomplete staghorn stones had no residual fragments with the stones removal rate 82.6％ (76/92).Hemoglobin dropped 1-4 g/L,11 cases and 3 cases were given blood transfusion in the operation procedure and post operation respectively.One case developed pyelonephritis and 1 case had split renal dysfunction with peri-parenchyma infection.Conclusions By middle calices as a main access to perform PCNL for staghorn stones is effective and safe.Using pneumatic and ultrasonic lithotrite will be very useful with high stones free rate and short procedure time and less complication.
ABSTRACT
ObjectiveTo compare the clinical effects of extracorporeal shock wave lithotripsy (ESWL) and ureteroscope holmium laser lithotripey(URL) in emergency patients with ureteral calculi.MethodsTwo hundred and forty emergency patients with ureteral calculi were retrospectively analyzed,including 110 patients undergoing ESWL (ESWL group) and 130 patients undergoing URL (URL group).Results The success rate of fragmentation and calculi-free rate were 90.0％ (117/130) and 80.8％(105/130) in URL group,of which were 88.2％(97/110) and 75.5％(83/110) in ESWL group with no significant difference between two groups (P ＞ 0.05 ).The success rate of fragmentation and calculi-free rate of upper ureter in ESWL group were much better than those in URL group[93.1％(54/58) vs.84.3％(59/70),77.6％ (45/58) vs.70.0％ (49/70),P ＜ 0.05 ],those of middle-lower ureter in URL group were much better than those in ESWL group[96.7％(58/60) vs.82.7％(43/52),93.3％(56/60) vs.73.1％(38/52),P＜0.05].ConclusionESWL and URL both have good curative effects in emergency patients with ureteral calculi,and ESWL has better effects for upper ureter while URL for middle-lower ureter.