[Endoscopic realignment with drainage via a peel-away sheath for the treatment of urethral rupture: A report of 21 cases].

OBJECTIVE: To study the clinical effect endoscopic realignment with drainage via a peel-away sheath in the treatment of urethral rupture. METHODS: We treated 21 urethral rupture patients by endoscopic realignment with drainage via a peel-away sheath using normal saline for irrigation under the normal nephroscope or Li Xun nephroscope, followed by analysis of the clinical results. RESULTS: The operation was successfully accomplished in 20 cases but failed in 1 and none experienced urinary extravasation. In the 14 cases of bulbar urethral rupture, the mean operation time was (5.1±1.6) min and the mean Foley catheter indwelling time was (26.0±5.1) d. Urethral stricture developed in 57.1% (8/14) of the cases after catheter removal, of which 1 was cured by internal urethrotomy and the other 7 by urethral sound dilation, with an average maximum urinary flow rate of (18.8±1.8) ml/s at 12 months after operation. In the 6 cases of posterior urethral rupture, the mean operation time was (15.8±7.5) min and the mean Foley catheter indwelling time was 8 weeks. Urethral stricture developed in all the 6 cases after catheter removal, of which 3 cases were cured by urethral dilation, 1 by internal urethrotomy, and 2 by open urethroplasty. The average maxium urinary flow rate of the 4 cases exempt from open surgery was (17.9±1.9) ml/s at 12 months after operation. CONCLUSIONS: Endoscopic realignment with drainage via a peel-away sheath can keep the operative field clear, avoid intraoperative rinse extravasation, shorten the operation time, improve the operation success rate, and achieve satisfactory early clinical outcomes in the treatment of either bulbar or posterior urethral rupture.

[Relationship between donor renal graft quality and graft rejection].

OBJECTIVE: To evaluate the correlation between the quality of donor renal grafts and graft rejection. METHODS: The cold ischemia time and the pathological findings by biopsies of the donor grafts in 87 cases were analyzed in conjunction with the occurrence of acute or chronic graft rejection after transplantation. RESULTS: After transplantation, acute rejection occurred in 28 cases, in which 5 (17.8%) had adverse changes in the donor grafts; chronic allograft nephropathy developed in 13 cases, in which 6 (46.1%) had adverse changes in the donor grafts. By binary logistic regression analysis, the cold ischemia time and acute renal tubular injury were identified as the factors affecting acute graft rejection, and cold ischemia time and glomeruloserosis as the risk factors for chronic rejection. CONCLUSION: High-quality donor kidney and minimization of the risk factors help reduce the occurrence of graft rejection after kidney transplantation.

[Expressions of transforming growth factor-beta1 and collagen IV in renal tissues of patients with chronic allograft nephropathy].

OBJECTIVE: To investigate the expressions of transforming growth factor (TGF)-beta1 and collagen IV in the renal tissues of patients with chronic allograft nephropathy (CAN). METHODS: Immunohistochemical method and computer-assisted image analysis system were used to detect the expressions of TGF-beta1 and collagen IV in the renal tissues of patients with CAN, and the association between TGF-beta1 and collagen IV expressions as well as that between their expressions and the pathological grading of CAN were analyzed. RESULTS: The expressions of TGF-beta1 and collagen IV were significantly higher in the renal tissues of the patients than in normal renal tissues (P<0.001), and the expressions tended to increase with the pathological grades of CAN; TGF-beta1 and collagen IV expressions in both the renal glomeruli and the tubulointerstitium were in patients with CAN positively correlated with normal renal tissues (r=0.943, P<0.001; r=0.910, P<0.001). CONCLUSIONS: Abnormal collagen IV deposition is one of the major factors associated with renal fibrosis in CAN, and TGF-beta1 might play an important role in renal fibrosis in CAN through up-regulation of collagen IV in the renal tissues.

[Expression of IGF-I and IGF-IR in bladder cancer].

BACKGROUND & OBJECTIVE: Insulin-like growth factors (IGF) is one of polypeptide growth factors that stimulate proliferation, survival, and differentiation in many cell types; their signal pathways implicate development and progression of many kinds of malignant tumor, while less study were undergone on the roles of IGF-I and IGF-IR in bladder cancer genesis. This study was designed to investigate the expression of IGF-I and IGF-IR and proliferation cell nuclear antigen (PCNA) in human normal and carcinomatous bladder cancer, and to explore the mechanism of IGF-I and IGF-IR in cellular proliferation and tumorigenesis of bladder cancer. METHODS: Immunohistochemical methods were adopted to examine expression of IGF-I, IGF-IR, and PCNA in 88 cases with bladder cancer and 12 cases with normal bladder tissues. The relationship of expression of IGF-I and IGF-IR with various clinicopathological parameters and PCNA were analyzed. RESULTS: The protein expression rates of IGF-I and IGF-IR in bladder cancer were 73.9% and 59.1%, significantly higher than 33.3% and 16.7% in normal tissues, respectively(P< 0.05). Both two protein expression were association with PCNA indexes in bladder cancer (P< 0.05). There were close relationship among IGF-I expression and tumor recurrence (P< 0.05), IGF-IR and tumor grade, stage and recurrence (P< 0.05). CONCLUSION: Abnormality of IGF-I-IGF-IR autocrine loop play an important role in development and progression of bladder cancer by promoting abnormal cellular proliferation. IGF-IR may be a marker for evaluating tumor biological behaviors.

[Simultaneous orthotopic liver and heterotopic pancreas-duodenum transplantation in a diabetic patient with end-stage liver disease].

OBJECTIVE: To study the effect of combined transplantation of the liver and the pancreas in diabetic patients with end-stage liver disease, and explore the optimal surgical procedure. METHODS: Simultaneous orthotopic liver and heterotopic pancreas-duodenum transplantations were performed in a patient diagnosed as having chronic hepatitis B, hepatocirrhosis, hepatic cellular cancer, and insulin-dependent diabetes. Immunosuppression therapy utilized prednisone, tacrolimus (FK506), mycophenolate mofetil (MMF), and simulect. The function of the liver graft, serum amylase and lipase, blood glucose, and C-peptide were monitored after transplantation. RESULTS: Insulin was withdrawn at the 6th day after operation, good liver allograft functional recovery was achieved, without such complications as pancreatitis, thrombosis, and localized infections. CONCLUSION: End-stage liver disease with concomitant insulin-dependent diabetes is the indication for combined liver-pancreas transplantations, for which simultaneous orthotopic liver and heterotopic pancreas-duodenum transplantations may constitute the optimal surgical approaches as the primary choice.