电视腹腔镜—膀胱尿道镜联合应用行Gil—Vernet法抗返流术的？…

目的 探讨电视腹腔镜－膀胱尿道镜联合应用行Ｇｉｌ－Ｖｅｒｎｅｔ手术的可行性。方法 以家兔建立光输尿管反流（ＶＵＲ）动物模型,并在返流模型上,联合应用腹腔镜－膀膛饮水 道镜行Ｇｉｌ－Ｖｅｒｎｅｔ手术。结果 １３只家兔均成功建立了ＶＵＲ模型,并用电视腹腔镜０膀胱尿道镜行Ｇｉｌ－Ｖｅｒｎｅｔ手术,１００％抗返流成功。结论 该术式综合了电视腹腔镜、膀胱尿道镜和Ｇｉｌ－Ｖｅｒｎｅｔ术式的优点,具不不必解剖输     

膀胱输尿管返流应强调个体化治疗

<正>膀胱输尿管返流(esicoureteral reflux,VUR)是指尿液从膀胱返流至输尿管或/和肾脏,包括原发性和继发性两种类型。原发性VUR由先天性的输尿管膀胱连接部解剖异常所致。继发性VUR是返流继发于膀胱尿道病变,如神经性膀胱、膀胱出口梗阻、尿道瓣膜等。如何选择VUR治疗方案,保守治疗还是手术治疗,有时很难抉择。笔者认为应该根据VUR类型和病情选择保守治疗或手术治疗,即强调个体化治疗。欧洲及美国泌尿协会VUR相关的指南也强调了根据VUR潜在风险和实际情况选择不     

改良膀胱外输尿管隧道延长术治疗小儿巨输尿管（附10例报告）

目的观察改良膀胱外输尿管隧道延长术（Lich—Gregoir法）治疗小儿巨输尿管的疗效。方法改良膀胱外输尿管隧道延长术（Lich—Gregoir法）治疗巨输尿管症10例，男8例、女2例。结果全组10例，术后恢复顺利。原发性膀胱输尿管返流（VUR）2例及输尿管囊肿1例，行排尿性膀胱尿道造影（VCU）检查，返流消失。输尿管末端狭窄3例经肾造瘘管造影，其余4例行静脉尿路造影（IVU）检查，7例输尿管均显影，VCU检查无VUR发生。结论改良膀胱外输尿管隧道延长术既能对巨输尿管做游离、松解、裁剪整形，又保留了原术式仅在膀胱外手术，不切开膀胱，延长膀胱黏膜下输尿管长度，达到抗VUR的目的，是一种适合治疗小儿巨输尿管症的手术方法。     

气膀胱腹腔镜输尿管前移术

目的:探讨气膀胱腹腔镜输尿管前移术的安全性及有效性。方法:分析6例建立气膀胱行腹腔镜输尿管前移术患者的临术资料。结果:手术均获成功,手术时间70~140m in,平均95m in,出血量30~50m l,术后2d下床活动,术后1周拔导尿管,住院7~10d,平均7.8d,术后1个月膀胱镜下拔双“J”管,无尿漏发生。随访3~8个月,症状消失,B-us肾积水减轻,IVU吻合口无狭窄,膀胱造影无返流。结论:气膀胱腹腔镜输尿管前移术是治疗输尿管下段狭窄、输尿管返流、输尿管囊肿、巨输尿管症安全有效的微创手术方式。     

经尿道电切联合后腹腔镜在上尿路肿瘤手术中的应用体会

目的:探讨应用经尿道等离子电切镜联合后腹腔镜行膀胱输尿管口袖套状切除加肾输尿管全长切除术治疗上尿路移行细胞癌的可行性及安全性。方法:选取12例上尿路移行细胞癌患者,首先取截石位,应用经尿道等离子电切镜行膀胱输尿管口袖套状切除术,再改为健侧卧位采用后腹腔镜行肾输尿管切除,术中游离出输尿管中上段,最后采取麦氏点或反麦氏点切口游离输尿管下段并取出标本。术后常规行膀胱灌注化疗。结果:手术均获成功,手术时间平均(155.3±13.3)min,出血量平均(81.3±20.8)ml,术后平均(9.1±0.9)d出院,无严重并发症发生。术后随访1.5年,1例发生膀胱移行细胞癌。结论:经尿道等离子电切镜联合后腹腔镜手术治疗肾盂输尿管上尿路移行细胞癌安全、可行,具有术后康复快、手术创伤小及并发症少等优点,具有良好的应用前景。     

外科手术是膀胱输尿管返流治疗的最佳选择

<正>膀胱输尿管返流(vesicoureteral reflux,VUR)是指由于输尿管膀胱连接部位的解剖异常导致膀胱中的尿液返流至输尿管和肾。VUR是引起尿路感染和肾功能衰竭的重要因素之一。目前VUR的治疗主要包括抗生素药物保守治疗、内镜下输尿管口旁注射治疗和手术治疗等。但关于如何选择治疗方案目     

经尿道腔镜下囊肿内切开术治疗单纯输尿管囊肿

目的探讨经尿道腔镜下囊肿内切开术治疗单纯输尿管囊肿的疗效。方法回顾总结12例行经尿道输尿管囊肿内切开术治疗的单纯输尿管囊肿患者临床资料，所有患者均经IVP、超声、膀胱镜检查确诊，手术方法包括行囊肿切开术4例及部分囊肿壁切除术8例。结果所有手术均取得成功，无一例转为开放手术，术后随访5～21个月，临床症状消失，肾积水减轻，无膀胱输尿管反流发生。结论经尿道电切术治疗单纯输尿管囊肿，具有创伤小，患者痛苦小，术后恢复快，并发症少等优点，可作为单纯输尿管囊肿治疗的首选方法。     

腹膜后两镜联合治疗中上段输尿管结石的体会

目的：总结经腹膜后途径应用腹腔镜联合膀胱镜治疗中上段输尿管结石的体会。方法：为9例中上段输尿管结石患者应用腹腔镜联合膀胱镜经腹膜后途径行输尿管切开取石术，逆行置双“J”管。结果：手术均获成功。手术时间50～100min，平均80min。术中失血40—90ml。结论：经腹膜后途径用腹腔镜^[1]联合膀胱镜行输尿管切开取石术治疗中上段输尿管结石简易，安全有效。     

膀胱粘膜肌瓣翻转术在抗膀胱输尿管返流术中的应用(附四例报告)

目的　提高治疗膀胱输尿管返流的手术疗效。　方法　采用膀胱粘膜肌瓣翻转抗返流术治疗膀胱输尿管返流 4例 ,其中因输尿管壁段结石行经尿道输尿管口切开致膀胱输尿管返流 2例 ,原发性膀胱输尿管返流 2例。Ⅲ°1例 ,Ⅳ°3例。　结果　术后 2例出现膀胱刺激症状及膀胱痉挛 ,1个月后症状明显改善 ,3个月后症状完全消失。 4例平均随访 2 2个月 ,患者症状消失 ;IVU示患侧肾功能良好 ,3例肾积水及输尿管扩张完全消失 ,1例改善 ;膀胱造影均未见膀胱输尿管返流 ;膀胱镜可见再造输尿管口呈唇状。　结论　膀胱粘膜肌瓣翻转抗返流术治疗膀胱输尿管返流简便、有效 ,但存在术后膀胱刺激症状重的缺点。     

后腹腔镜肾输尿管全长与膀胱袖状切除术的三种术式比较（附110例报告）

目的：探讨后腹腔镜肾输尿管全长与膀胱袖状切除的最佳手术方式.方法：对110例肾盂或输尿管癌伴膀胱癌患者采用三种不同术式行肾输尿管全长及膀胱袖状切除术：A术式即后腹腔镜肾输尿管全长切除＋下腹部切口膀胱壁内段袖状切除术,共行32例 B术式即后腹腔镜肾输尿管全长切除＋经尿道电切膀胱袖状切除＋经腹部切口取肾术,共行19例 C术式即经尿道电切膀胱袖状切除＋后腹腔镜肾输尿管全长切除＋经腹部切口取肾术,共行59例.结果：手术经过均顺利.三种术式的手术时间、术中出血量、平均住院时间差异无统计学意义.围手术期死亡3例.出院后获定期随访58例,随访8～85个月,平均38.3个月,46例失访.因肿瘤转移死亡4例,因气胸、脑血管病死亡各1例.三种术式术后早期并发症、对侧病变、膀胱痛复发情况差异无统计学意义 但C术式术后死亡及转移例数较少.结论：肾盂或输尿管癌伴膀胱癌者可优先选择经尿道电切膀胱袖状切除＋后腹腔镜肾输尿管全长切除＋经腹部切口取肾术,而仅有肾盂或输尿管癌者可考虑行后腹腔镜肾输尿管全长切除＋下腹部切口膀胱壁内段袖状切除术.     

Influence of religious and spiritual values on the willingness of Chinese-Americans to donate organs for transplantation

The rate of organ donation among minority groups in the United States, including Chinese-Americans, is very low. There is currently very little data in the biomedical literature that builds on qualitative research to quantify the attitudes of Chinese Americans toward organ donation. The present study quantitatively assesses the religious and cultural reasons that Chinese-Americans appear to be less willing to donate their organs than other populations. It also seeks to determine whether Confucian, Buddhist, or Daoist ideals are a significant factor in their overall reluctance to donate organs among respondents in this sample. A questionnaire distributed to Chinese American adults asked about general feelings toward organ donation and Buddhist, Confucian, Christian, Daoist, and other spiritual objections. The results suggest that Chinese-Americans are indeed influenced by Confucian values, and to a lesser extent, Buddhist, Daoist, and other spiritual beliefs, that associate an intact body with respect for ancestors or nature. Another significant finding is that the subjects were most willing to donate their organs after their deaths, to close relatives, and then in descending order, distant relatives, people from their home country, and strangers. This 'negotiable' willingness has enormous implications for clinicians, who may be able to increase organ donation rates among Chinese-Americans by, first, recognizing their diverse spiritual beliefs, and, second, offering a variety of possibilities for the organ procurement and allocation.     

胃去动脉术治疗急性胃粘膜病变大出血

作者采用胃去动脉术治疗各种原因引起的急性胃粘膜病变（ＡＧＭＬ）大出血１３例，１１例即刻止血，２例无效，１例再出血，３例死亡。临床分析提示，低血压、肝功能损害、严重感染、酸中毒、尿毒症等是ＡＧＭＬ的危险因素；对门静脉高压性ＡＧＭＬ，本手术疗效较差，应慎重选用。作者还就ＡＧＭＬ的病因和发病机理、胃去动脉术的解剖学和生理学依据以及ＡＧＭＬ的术式选择等问题进行了讨论     

Laparoscopic surgery in Europe. Where are we going?

The most important factors that have facilitated the development of laparoscopic surgery (LS) are technological innovations and the vision of a small number of surgeons who took advantage of these advances. There are few surgical innovations that have stimulated such controversies and concerns and have raised so many medico-legal issues as LS. Although much progress has been made in LS, some important controversies remain unresolved, which are reviewed in the present article: 1. Evolution of the laparoscopic approach: total laparoscopic approach through positive-pressure capnoperitoneum, gasless laparoscopy, hand-assisted laparoscopy, and laparoscopy-assisted surgery. 2. Classification of current instrumental technology in laparoscopic surgery: a) facilitating instruments (high-power ultrasonic dissection systems); b) enabling instruments (endostapling and linear dissection devices), and c) complementary instruments: the Da Vinci robotic system. 3. Current laparoscopic surgical practice: a) interventions that definitively improve the patient's outcome (diagnostic and staging laparoscopy, cholecystectomy, adrenalectomy, splenectomy, antireflux surgery, cardiomyotomy, bariatric surgery, laparoscopic colon surgery, living donor nephrectomy); b) interventions that seem to be useful to the patient (distal pancreatic surgery, laparoscopic left hepatic resection, gastric and esophageal resections, hernioplasty), and c) interventions with uncertain benefit (right hepatectomy, pancreatoduodenectomy). 4. Future lines of development: video monitors in laparoscopic surgery, endoluminal surgery, robotic surgery, and finally, 5. Problems faced by laparoscopic surgery: quality guarantees in laparoscopic surgery, training the future laparoscopic generation, and allocation of sufficient material and human resources to laparoscopic surgery and its subspecialties.     

Pancreatic Anastomotic Leakage After Pancreaticoduodenectomy in 1,507 Patients: A Report from the Pancreatic Anastomotic Leak Study Group

Several definitions for pancreatic leakage after pancreaticodoudenectomy exist, and the reported range of 2–50% underscores this variation. The goal was to determine if drain data alone was predictive of a leak and validate International Study Group on Pancreatic Fistula (ISGPF) leak criteria. Participating surgeons entered de-identified data into a web-based database designed to collect Whipple-related data. Definitions used were the ISGPF definition, ≥3 days, amylase 3× normal; and Sarr’s definition, ≥5 days, amylase 5× normal, >30 ml. We compared how well these two definitions were at detecting a leak and its complications. There were 1,507 cases submitted from 16 international institutions. A pancreaticoduodenectomy (PPPD) was performed in 76.2%. Drain placement occurred in 98.0%. Using the ISGPF definition, the pancreatic leak rate was 26.7 and 14.3% with the Sarr definition. There were more grades A and B leaks detected by the ISGPF definition. Both determined grade C leaks equally. Both definitions correlated with an increased length of stay (LOS), need for percutaneous drains, reoperation, and delayed gastric emptying (DGE). Neither was associated with an increased risk of intensive care unit (ICU) stay or 30-day mortality. The ISGPF was able to capture more patients with clinically relevant leaks than Sarr’s criteria; however, the ability to detect a leak by drain data alone is imperfect. This paper was presented at the 48th annual meeting of the Society for Surgery of the Alimentary Tract, Washington, DC, May 19–24, 2007. Members of the Pancreatic Anastomotic Leak Study Group: David Adams, M.D., Charleston, South Carolina; Gerard Aranha, M.D., Chicago, IL; Mark Callery, M.D., Boston, MA; Roberto Coppola, M.D., Rome, Italy; Elijah Dixon, M.D., Calgary, Alberta, Canada; Massimo Falconi, M.D., Verona, Italy; John Hoffman, M.D., Philadelphia, PA; Thomas Howard, M.D., Indianapolis, Indiana; Frank Makowiec, M.D., Freiberg, Germany; Franco Mosca, M.D., Pisa, Italy; Thomas Neufang, M.D., Mannheim, Germany; Marco Niedergethmann, Mannheim, Germany; Paolo Pederzoli, Verona, Italy; Sergio Pedrazzoli, Padua, Italy; Stefan Post, M.D., Mannheim, Germany; Roberto Salvia, M.D., Verona, Italy; Hiroyuki Shinchi, M.D., Kagoshima, Japan; Margo Shoup, M.D., Chicago, IL; Charles Vollmer, M.D., Boston, MA; Frank Willeke, M.D., Mannheim, Germany; Hiroki Yamaue, M.D., Wakayama, Japan.     

42 例耐多药肺结核肺切除术治疗效果分析

目的 分析耐多药肺结核的手术治疗效果。方法 回顾性分析我院2009年1月至2016年6月行单肺叶切除术17例、复合肺叶切除术15例、全肺切除术5例、余肺切除术3例、肺段切除术2例等共计42例耐多药肺结核肺切除术患者的临床资料和随访结果 。结果 42例患者随访1～84月（26±24.8月）,单肺叶切除术、肺段切除术各1例患者随访1月后丢失。40例随访资料完整的患者的治疗成功率、病情缓解率、失败率分别为80.0%（32/40）、7.5%（3/40）、12.5%（5/40,其中3例死亡）,其中：单肺叶切除术分别为16/16、0、0,复合肺叶切除术分别为11/15、2/15、2/15,全肺切除术分别为3/5、1/5、1/5,余肺切除术分别为2/3、0、1/3,肺段切除术分别为1/1、0、0;手术并发症发生率35.0%（14/40）,包括顽固性空腔（12.5%,5/40）、支气管胸膜瘘（12.5%,5/40）,胸腔感染（5.0%,2/40）,胸腔内出血（2.5%,1/40）和伤口感染（2.5%,1/40）,5种手术方式的并发症发生比例分别为2/16、8/15、2/5、2/3、0。结论 手术治疗有助于提高耐多药肺结核患者的治疗成功率,对于单肺叶内局限性病灶患者,建议首选单肺叶切除术;对于多肺叶切除的手术,则应积极防范手术并发症。     

Ptosis: Causes,Presentation, and Management

Drooping of the upper eyelid (upper eyelid ptosis) may be minimal (1–2 mm), moderate (3–4 mm), or severe (>4 mm), covering the pupil entirely. Ptosis can affect one or both eyes. Ptosis can be present at birth (congenital) or develop later in life (acquired). Ptosis may be due to a myogenic, neurogenic, aponeurotic, mechanical or traumatic cause. Usually, ptosis occurs isolated, but may be associated with various other conditions, like immunological, degenerative, or hereditary disorders, tumors, or infections. Besides drooping, patients with ptosis complain about tired appearance, blurred vision, and increased tearing. Patients with significant ptosis may need to tilt their head back into a chin-up position, lift their eyelid with a finger, or raise their eyebrows. Continuous activation of the forehead and scalp muscles may additionally cause tension headache and eyestrain. If congenital ptosis is not corrected, amblyopia, leading to permanently poor vision, may develop. Patients with ptosis should be investigated clinically by an ophthalmologist and neurologist, for blood tests, X-rays, and CT/MRI scans of the brain, orbita, and thorax. Treatment of ptosis depends on age, etiology, whether one or both eyelids are involved, the severity of ptosis, the levator function, and presence of additional ophthalmologic or neurologic abnormalities. Generally, treatment of ptosis comprises a watch-and-wait policy, prosthesis, medication, or surgery. For minimal ptosis, Müller's muscle conjunctival resection or the Fasanella Servat procedure are proposed. For moderate ptosis with a levator function of 5–10 mm, shortening of the levator palpebrae or levator muscle advancement are proposed. For severe ptosis with a levator function <5 mm, a brow/frontalis suspension is indicated. Risks of ptosis surgery infrequently include infection, bleeding, over- or undercorrection, and reduced vision. Immediately after surgery, there may be temporary difficulties in completely closing the eye. Although improvement of the lid height is usually achieved, the eyelids may not appear perfectly symmetrical. In rare cases, full eyelid movement does not return. In some cases, more than one operation is required.     

不同生殖生理状态下6种精浆元素的检测分析

本文研究了不育及两种男性节育术后精浆中锌、铜、钙、镁、钾、钠（仅节育组未测钠）６种元素的含量，通过与正常组对比分析，发现３组均出现精浆Ｃｕ的显著增高，两种节育组还有Ｃａ的降低；随着元素水平的改变，存在于正常生育男性精浆中元素之间的相关关系部分消失，从这３种不同生殖状态下精浆元素的改变，推测精浆中Ｚｎ、Ｍｇ源自前列腺，Ｃａ和Ｃｕ分别源自附睾及精囊，除Ｃｕ对精子功能为负性影响外，其余各元素均为积极的作用。     

Ten-year results of randomized treatment of children with severe vesicoureteral reflux. Final report of the International Reflux Study in Children

For the comparison of long-term outcome of the management of medical or surgical treatment of children with severe vesicoureteral reflux (VUR), children aged <11 years with non-obstructive grade III/IV reflux, previous urinary tract infection (UTI) and glomerular filtration rate (GFR) ≥70 ml/min per 1.73 m² body surface area were recruited, and 306 were randomly allocated to receive antimicrobial prophylaxis or ureteral reimplantation. Primary endpoints were new renal scars and renal growth. Follow up, originally planned for 5 years, was extended to 10 years for 252 children, 223 of whom had follow-up imaging. Up to 5 years, 40 new urographic scars (medical 19, surgical 21) were seen. Between 5 years and 10 years, only two further scars were observed. Renal growth and UTI recurrence rate were similar, except that medically treated patients had more febrile infections. There was no difference in somatic growth, radionuclide imaging or renal function. A GFR <70 ml/min per 1.73 m² was found in only one patient. Three patients developed hypertension requiring treatment. We conclude that, with close supervision and prompt treatment of recurrences, children entering the study with GFR ≥70 ml/min per 1.73 m² progressed remarkably well under either medical or surgical management, emphasizing the importance of continued supervision and the entry level of renal function.The authors are the writing committee of the European arm of the International Reflux Study in Children. Co-ordinating centre, Essen, Germany: chairman H. Olbing (deceased), scientific coordinator T. Tamminen-Möbius, statistics H. Hirche, documentation H. Lax.Participating university hospitals and investigators were Bonn, Germany: R. Mallmann, D. Emons; Brussels, Belgium: M. Hall, A. Piepsz, C. Schulmann; Essen, Germany: H.J. Bachmann, W. Rascher, E. Brunier, C. Reiners, J. Behrendt, P. Mellin (deceased); Göteborg, Sweden: U. Jodal, K. Hjälmås (deceased), E. Hanson, N. Nilsson, J. Bjure (deceased), R. Sixt; Hamburg, Germany: R. Busch, C. Montz; Helsinki, Finland: O. Koskimies, S. Wikström, E. Marttinen, A. Kivisaari, T. Korppi-Tommola; Oulu, Finland: J. Seppänen (deceased), N.P. Huttunen, U. Seppänen, J. Heikkilä; Stockholm, Sweden: A. Aperia, G. Löhr, P. Herin, U. Freyschuss, L. Blom, U. Erasmi, B. Söderborg. Consultants: I. Claesson, K.-D. Ebel, R.A. Lebowitz, K. Parkkulainen (deceased), J.M. Smellie, I. Wikstad, and J. Winberg (deceased). External Monitoring Committee: C. Meinert (chairman), H.-K. Selbmann, J.M. Smellie, J. Gillenwater, and H.J. Jesdinski (deceased).This paper is presented as a tribute to the late Professors Hermann Olbing and Paul Mellin of Essen, who conceived this study in 1978; to the late Dr. John Duckett of Philadelphia, who, with Professor Adrian Spitzer and Dr. Robert Weiss of New York, promoted and maintained the American limb; to Dr. Tytti Tamminen-Möbius, who coordinated the study, and to Herbert Hirche, statistician. Finally, we wish to acknowledge and thank all the children and their parents who agreed to participate in the study and adhere to the follow-up protocol, 252 of them for 10 years.     

Severe skeletal toxicity from protracted etidronate therapy for generalized arterial calcification of infancy

Generalized arterial calcification (AC) of infancy (GACI) is an autosomal recessive disorder that features hydroxyapatite deposition within arterial elastic fibers. Untreated, approximately 85% of GACI patients die by 6 months of age from cardiac ischemia and congestive heart failure. The first‐generation bisphosphonate etidronate (EHDP; ethane‐1‐hydroxy‐1,1‐diphosphonic acid, also known as 1‐hydroxyethylidene‐bisphosphonate) inhibits bone resorption and can mimic endogenous inorganic pyrophosphate by blocking mineralization. With EHDP therapy for GACI, AC may resolve without recurrence upon treatment cessation. Skeletal disease is not an early characteristic of GACI, but rickets can appear from acquired hypophosphatemia or prolonged EHDP therapy. We report a 7‐year‐old boy with GACI referred for profound, acquired, skeletal disease. AC was gone after 5 months of EHDP therapy during infancy, but GACI‐related joint calcifications progressed. He was receiving EHDP, 200 mg/day orally, and had odynodysphagia, diffuse opioid‐controlled pain, plagiocephaly, facial dysmorphism, joint calcifications, contractures, and was wheelchair bound. Biochemical parameters of mineral homeostasis were essentially normal. Serum osteocalcin was low and the brain isoform of creatine kinase and tartrate‐resistant acid phosphatase 5b (TRAP‐5b) were elevated as in osteopetrosis. Skeletal radiographic findings resembled pediatric hypophosphatasia with pancranial synostosis, long‐bone bowing, widened physes, as well as metaphyseal osteosclerosis, cupping and fraying, and “tongues” of radiolucency. Radiographic features of osteopetrosis included osteosclerosis and femoral Erlenmeyer flask deformity. After stopping EHDP, he improved rapidly, including remarkable skeletal healing and decreased joint calcifications. Profound, but rapidly reversible, inhibition of skeletal mineralization with paradoxical calcifications near joints can occur in GACI from protracted EHDP therapy. Although EHDP treatment is lifesaving in GACI, surveillance for toxicity is crucial. © 2013 American Society for Bone and Mineral Research     

Daily hassles and symptoms: Their relationship to enumerative immunologic measures

Two studies are presented, both of which aimed to establish the effects of psychosocial load and symptoms on the following enumerative immunologic parameters: leucocytes, granulocytes, monocytes, lymphocytes, lymphocyte subsets, and plasma levels of IgG, IgA, and IgM. In study I, 83 and in study II, 95 subjects participated, who were selected based on their scores on questionnaires measuring daily hassles, and psychoneurotic symptoms. The following four groups were composed: (1) low load, few symptoms; (2) high load, few symptoms; (3) low load, many symptoms; (4) high load, many symptoms. The influences of the psychological variables were assessed using regression analyses, while controlling for age (study I), gender (study 2), smoking cigarettes, alcohol consumption, and plasma levels of adrenaline and cortisol. The psychological factors did not explain any of the variance in the dependent variables in either study. It is concluded that there is no relationship between the immunologic parameters under investigation and self-reports of daily hassles and symptoms.