[Application of mini-flank open nephron sparing surgery via retroperitoneal route for centrally located renal tumor treatment: a single center experience]

Objective: To investigate the safety and feasibility of mini-flank open nephron sparing surgery (MI-OPN) via retroperitoneal route for the treatment of centrally located renal tumor. Methods: From May 2013 to April 2015, twenty-four cases of centrally located renal tumor were treated with MI-OPN via retroperitoneal route in Zhongshan Hospital. All cases were included in this study with whose clinical data and long term follow-up information retrospectively analyzed. Results: With the assistance of intraoperative ultrasonography to confirm tumor location and boundary, MI-OPN was successfully performed in all cases. Mean tumor maximum diameter was 3.3±0.6 cm, mean operation time was 113±16 minutes, mean ischemia time was 31±6 min, and mean estimated blood loss was 102±46 ml. Mean postoperative hospital stay was 5.0±0.8 days, postoperative complication was found in one patient (4%). The mean pre- and postoperative serum creatinine were 77.1±20.1 μmol/L and 90.3±20.0 μmol/L. Pathological examination confirmed negative surgical margin in all cases, with 18 cases of clear cell renal cell carcinoma, 2 cases of papillary renal cell carcinoma, 2 cases of chromophobe renal carcinoma, 1 case of renal oncocytoma and 1 case of renal angiomyolipoma. In up to 12-36 months postoperative follow-up, no local recurrence or systemic progression was witnessed. Conclusions: For the treatment of centrally localized renal tumor, MI-OPN via retroperitoneal route is a safe and feasible operation method. Importantly, rupture of the tumor capsule was effectively avoided during tumor resection with the assistance of ultrasonic position-setting. Furthermore, incidence of severe postoperative complications such as bleeding and damage of collection system were not found since surgical wound of kidney sewn tightly and finely. The last but not the least, by placing ice slush in retroperitoneal cavity, impairment of renal function caused by renal artery clamping can be alleviated due to decreased metabolism.

Study on the levels of uric acid and high-sensitivity C-reactive protein in ACS patients and their relationships with the extent of the coronary artery lesion

OBJECTIVE

We evaluated uric acid (UA) and high-sensitivity C-reactive protein (hs-CRP) levels in different clinical types of acute coronary syndromes (ACS) and in relationship with the severity of coronary artery lesions. Furthermore, we explored its clinical significance.

PATIENTS AND METHODS

From June 2013 to January 2015, we studied patients in their first onset of symptoms and hospitalization for coronary angiography. According to coronary angiography results, we divided patients into two groups: 93 patients with ACS and 30 patients with normal coronary arteries as the control group. ACS patients were divided further into three subgroups: patients with ST-segment elevation myocardial infarction (STEMI) (n=34); patients with non-ST segment elevation myocardial infarction (NSTEMI) (n=29); and patients with unstable angina (n=30). According to their Gensini scores, patients were divided into mild, moderate and severe groups. We compared UA and hs-CRP levels and the relationship with Gensini scores between different groups.

RESULTS

UA and hs-CRP levels in the ACS group were higher than those in the control group (p < 0.05). UA and hs-CRP levels in the STEMI group were higher than those in the NSTEMI, unstable angina and control groups (p < 0.05). UA and hs-CRP levels in the NSTEMI patients were higher than those in the unstable angina and control groups (p < 0.05). UA and hs-CRP levels in the unstable angina patients were higher than those in the control group (p < 0.05). hs-CRP levels in the STEMI patients were higher than the other groups (p < 0.05). hs-CRP levels in the NSTEMI patients were higher than the unstable angina and the control groups (p < 0.05) while hs-CRP levels in the unstable angina patients were higher than the control group (p < 0.05). Additionally, according to the Gensini score group, we discovered that ACS patients in the severe group had higher hs-CRP levels than the other three groups (p < 0.05) while the moderate group had higher levels than the other two groups (p < 0.05). The mild group had higher levels than the control group (p < 0.05). Correlation analysis suggested that UA levels and Gensini scores had a positive correlation (p < 0.05). hs-CRP levels and Gensini scores also showed a positive correlation (p < 0.05).

CONCLUSIONS

UA and hs-CRP levels should be considered as factors to use in the risk stratification in ACS patients.