Angiotensin II and renal prostaglandin release in the dog. Interactions in controlling renal blood flow and glomerular filtration rate

The relationship between angiotensin II and renal prostaglandins, and their interactions in controlling renal blood flow (RBF) and glomerular filtration rate (GFR) were investigated in 18 anaesthetized dogs with acutely denervated kidneys. Intrarenal angiotensin II infusion increased renal PGE₂ release (veno-arterial concentration difference times renal plasma flow) from 1.7 ± 0.9 to 9.1 ±0.4 and 6-keto-PGFja release from 0.1 ±0.1 to 5.3 ± 2.1 pmol min^-1. An angiotensin II induced reduction in RBF of 20% did not measurably change GFR whereas a 30% reduction reduced GFR by 18 ± 8%. Blockade of prostaglandin synthesis approximately doubled the vasocon-strictory action of angiotensin II, and all reductions in RBF were accompanied by parallel reductions in GFR. When prostaglandin release was stimulated by infusion of arachidonic acid (46.8± 13.3 and 15.9± 5.4 pmol min^-1 for PGE₂, and 6-keto-PGFja, respectively), angiotensin II did not change prostaglandin release, but had similar effects on the relationship between RBF and GFR as during control. In an ureteral occlusion model with stopped glomerular filtration measurements of ureteral pressure and intrarenal venous pressure permitted calculations of afferent and efferent vascular resistances. Until RBF was reduced by 25–30% angiotensin II increased both afferent and efferent resistances almost equally, keeping the ureteral pressure constant. At greater reductions in RBF, afferent resistance increased more than the efferent leading to reductions in ureteral pressure. This pattern was not changed by blockade of prostaglandin synthesis indicating no influence of prostaglandins on the distribution of afferent and efferent vascular resistances during angiotensin II infusion. In this ureteral occlusion model glomerular effects of angiotensin II will not be detected, and it might well be that the shift from an effect predominantly on RBF to a combined effect on both RBF and GFR induced by inhibition of prostaglandin synthesis is located to the glomerulus. We therefore postulate that renal prostaglandins attenuate the effects of angiotensin II on glomerular surface area and the filtration barrier, and not on the afferent arterioles as previously suggested.     

妇产科手术泌尿系损伤防治方法的探讨

目的 探讨妇产科手术泌尿系损伤的特点及防治方法，为临床妇产科手术中防止泌尿系损伤提供参考。方法 对我院妇产科手术中发生的泌尿系损伤的10例临床资料进行回顾性分析。结果 10例患者中输尿管损伤3例，均为术中发现，术中行输尿管端端吻合；膀胱损伤7例，其中5例于术中发现，2例术后形成膀胱阴道瘘，行膀胱修补术，所有病例均痊愈出院。妇产科损伤泌尿系的主要原因有输尿管解剖移位，盆腔粘连严重等。结论 绝大多数妇产科手术中的泌尿生殖系损伤是可以防范的，一旦发生，应及时发现，尽早修补预后良好。     

34例鹿角形肾结石手术取石的疗效观察

目的探讨肾下极肾盂肾盏联合切开术治疗复杂性鹿角形肾结石的疗效。方法回顾性分析采用肾下极肾盂肾盏联合切开术式治疗复杂性鹿角形肾结石34例临床资料。手术方法:分离肾窦内肾盂后,用1-0肠线在肾后唇中下1/3连接处紧贴肾盂肾盏表面缝合肾实质2针,中间尖刀切开肾实质,然后弧形切开肾盂及肾下盏,用神经剥离子将结石与肾盂肾盏粘膜粘连分离后,取石钳夹住结石轻轻撬出。盏颈狭窄者必要时先用气压弹道碎石器将其在分支处击断。4-0肠线缝合肾盂及肾下盏,再用2-0肠线间断全层缝合肾实质切口数针,包膜层用4-0肠线缝合。结果34例均一次性取净结石。术中平均出血量约90ml。术后无大出血病例。结论肾下极背侧肾实质与肾盂联合切开取石术具有术中出血少,无须阻断肾蒂,肾功能受损轻,便于一次取尽结石等优点。适合于肾窦内肾盂特别是肾下盏盏颈相对狭窄的复杂性鹿角形肾结石的治疗。     

输尿管狭窄的应用解剖学研究

目的:探讨输尿管生理狭窄的数目、位置及狭窄的程度,为选择性CT分段扫描诊断输尿管结石提供解剖学依据.方法:解剖30例国人成人尸体60条输尿管(男40条,女20条),分段观测输尿管形态、狭窄的数目、位置和管腔内径.结果:各段输尿管形态多样,主要有四类.输尿管生理狭窄的程度依次为膀胱壁内段＞输尿管盆段＞输尿管髂血管段＞输尿管腹段.结论:输尿管生理狭窄的数目不恒定.生理狭窄的部位除膀胱壁内段外其余部位均不恒定,膀胱壁内段狭窄程度最大.     

Differences in gallstone structure in primary common bile duct lithiasis and gallbladder lithiasis

Summary Some differences between gallbladder lithiasis and primary common bile duct lithiasis are described. Microbiological cultures and biochemical analyses were carried out on the bile of two groups of patients: 27 suffering from gallbladder and 5 from primary common duct lithiasis. The microstructure and composition of gallstones were also examined by polarized light microscopy and X-ray diffraction. Women predominated in gallbladder lithiasis but not in primary common duct lithiasis group (P<0.05) and body weight was higher in the former group (P<0.02). Primary common duct lithiasis patients had a higher, although not significant, incidence of duodenal diverticulosis (P=0.15), and a higher incidence ofE. coli-positive cultures in bile (P<0.001). No significant difference in the biochemical composition of the bile was found between the groups. Brown pigment stones predominated in primary common duct lithiasis, while cholesterol stones did in gallbladder and secondary common duct lithiasis (P<0.0001). Stones formed in the gallbladder generally show linear, radial growths of cholesterol crystals, while those from the common duct present a polystratified, concentric deposition of microgranules composed mainly of pigmentary salts.These differences should be taken into account as additional criteria in the differential diagnosis between primary and secondary common duct lithiasis, as the classical criteria for diagnosing of the former greatly underestimate its actual incidence. The distinction between primary and secondary common duct lithiasis is of practical significance, since each entity requires different treatment.Abbreviations CBD common bile duct - CBDL common bile duct lithiasis - ERCP endoscopic retrograde cholangiopancreatography - GBL gallbladder lithiasis - HDL high density lipoproteins - PCBDL primary common bile duct lithiasis - SCBDL secondary common bile duct lithiasis - SGOT serum glutamic-oxalacetic transaminase - SGPT serum glutamic-pyruvic transaminase     

肝切除术治疗区域性肝内胆管结石

目的 探讨肝内区域性胆管结石肝切除术的适应症、方法、效果。方法 对本科2年来14例肝内区域性胆管结石实行肝叶切除术进行系统回顾。结果 肝内胆管结石伴有肝内胆管狭窄、胆管慢性炎症、肝实质受损表现;肝叶切除后,结石清除率达100％,手术后症状很快缓解,围手术期渡过平稳,近期随访无复发。结论 对肝内区域性结石患者采用肝叶或肝段切除是一种有效、安全、彻底的治疗方法;对伴有肝内部分胆管狭窄梗阻的,有胆管炎症状的,有肝组织受损的患者应尽早实施。     

纤维胆管镜治疗术后残余结石320例分析

（1）目的 总结320例胆管术后,经T管窦道纤维胆管镜治疗残余结石的经验。（2）方法 对320例胆管术后残余结石病人行纤维胆管镜取石,分析其临床表现并予以随访。（3）结果 结石取净287例,失败33例,（4）结论 纤维胆管镜对于术后胆管残余结石的治疗起着重要作用。     

输尿管镜直视下气压弹道碎石治疗泌尿系结石（附301例报告）

目的：输尿管镜直视下气压弹道碎石术治疗泌尿系结石的临床疗效。方法：1997年5月－2001年4月期间对276例输尿管结石,25例尿道结石采用输尿管镜直视下气压弹道碎石治疗。结果：输尿管结石碎石成功率97．1％（268／276）,并发症发生率1．45％（4／276）,主要为输尿管穿孔,尿道结石成功率100％,结论：输尿管镜直视下气压弹道碎石术治疗输尿管结石,尿道结石临床疗效确切,尤其适用于泌尿系结石的急诊处理。     

肾盂肾下盏夹角对结石清除率的影响

目的：观察肾盂肾下盏夹角及结石大小对结石排净率的影响。方法：选择68例肾下盏结石患者,通过IVU影像,测量夹角与结石直径,并经ESWL治疗,随访2月,观察结石排空情况。结果：68例患者,结石完全排出42例,总的排石排空率为61．7％。结论：提示肾盂肾下盏夹角,结石直径对结石排净率有重要影响。     

肾盂输尿管癌p53、nm23表达的临床意义

目的：揭示p53、nm23基因表达与肾盂输尿管癌生物学行为的关系。方法：采用免疫组化SABC法和原位杂交技术检测p53、nm23的表达。结果：肾盂输尿管癌p53、nm23阳性表达分别为51．1％（23／45）和46．7％（21／45）。p53阳性表达T2－T3为60％（21／35）,T1为20％（2／10）,P＜0．05;G2－G3为59．0％（23／39）,G1为0％（0／6）。nm23阳性表达T2－T3为48．6％（17／35）,T1为40％（4／10）,P＞0．05,G2－G3为48．7％（19／39）,G1为33．3％（2／6）,P＞0．05。p53阳性表达术后再发膀胱癌与阴性表达相比较P＞0．05。nm23阳性表达术后膀胱癌再发为61．9％（13／21）,阴性表达为20．9％（5／24）,P＜0．05。p53、nm23阳性表达生存率明显低于阴性表达,P＜0．05。结论：p53阳性表达与肾盂输尿管癌病理分期、分级有关,nm23阳性表达与术后再发膀胱癌有关。p53和nm23可能是判断肾盂输尿管癌预后的指标之一。