Lesions produced by the extravasation of urine from the upper urinary tract

We present six cases which illustrate the spectrum of clinical features, macroscopic findings and light microscopic findings of urine extravasation from the upper urinary tract. The early lesions are characterized macroscopically by an oedematous, glistening or gelatinous appearance to the renal perihilar and peripelvic fat. Light microscopically there is lipolysis with associated foamy macrophages, multinucleate giant cells and lymphocytes. Immunohistochemical staining for Tamm–Horsfall protein is strongly positive in the extracellular space and in the foamy macrophages confirming urine extravazation. Later lesions are characterized by cicatrization of fibrous tissue around the renal pelvis and hydronephrosis. Microscopically there is relatively bland fibrosis with occasional lymphocytes and histiocytic cells. The late lesions are also characterized by extracellular deposits of weakly eosinophilic, granular or hyaline material, the so called 'urinary precipitates'. These deposits stain strongly with diastase PAS and weakly positive for Tamm–Horsfall protein. The staining of these urinary precipitates is analogous to renal tubular hyaline casts, thus supporting the theory that they are derived from uroproteins. We consider that these deposits are pathognomic of past urine extravasation.     

全喉切除发音重建术后喉咽部颈段食管影像学研究

目的:研究全喉切除发音重建术后患者咽部、食管在发音时的作用机制、影像学表现。方法:采用全喉切除发音重建术后1年以上随访病人,利用频闪动态喉镜、纤维喉镜、食道钡餐透视下观察发音时分流口及食管粘膜振动情况并照像记录。结果:发音时喉刚部及食管粘膜均振动,参与发音,发不同音时食管振动及扩张方式不一,但声源位于我们设计的分流口。结论:本发音方法设计合理,发音流畅,进食时无明显病人不能耐受之呛咳。     

大鼠食管颈段神经形态的组化研究

本文采用多种组化方法结合神经银染技术,对大鼠的食管颈段神经形态观察发现:延髓内双侧疑核的咀侧端及迷走神经背核闩平而附近,分别见散在的多极和梭形标记细胞;颈前、中节、颈胸节和胸交感节(T_2-T_4),结状节,脊神经节(C_2-C_8)内均见标记细胞。 食管壁内的神经束及分支,由粗、细两类神经纤维组成。其中AchE阳性的胆碱能纤维占优势,分别见于外膜丛、肌内丛、粘膜下丛,腺体血管周围和粘膜肌内,粗纤维末梢伸向上皮基部和上皮之间,肌内的神经末梢呈结状膨大。外膜和肌肉见有神经节和散在的神经细胞。而食管壁内肾上腺素能纤维稀少,仅见于神经束和分支内及血管壁周围。     

Relations between upper limb soft tissue disorders and repetitive movements at work

To make a preliminary assessment of whether upper limb soft tissue disorders might be associated with activities at work, we have conducted a case-control study of subjects attending orthopedic clinics in three cities. All subjects between the ages of 16 and 65 years, in whom defined soft tissue conditions of the upper limb were diagnosed by the participating orthopedic surgeons, were invited to take part. Controls were subjects attending the same clinics within the same age range whose clinical diagnosis did not include disease of the upper limb, cervical or thoracic spine. Information concerning repetitive movements of the upper limbs at work was elicited by questionnaire. Five hundred eighty cases and 996 controls were studied, representing 96% and 93%, respectively, of those invited to participate. The diagnoses of the cases included soft tissue conditions affecting the shoulder, elbow, forearm, wrist, thumb, hand, and fingers. The diagnoses of the controls included traumatic, degenerative, and inflammatory conditions, mostly of the legs and lower back. Women predominated among the cases (70%) and men among the controls (56%). Of 221 female cases with injury to the wrist and forearm, 32 were cleaner/domestics (14.5%) compared to 35 of 439 controls (8%), a difference statistically significant at the 2 1/2% level. Other jobs significantly overrepresented (5% level) among female cases with injuries at various anatomical sites included hairdressers, secretary/temps, assembly line workers, and machine operators (type unspecified). Among male cases, electricians were significantly overrepresented (5% level). Jobs for which there was a suggestion (p < 0.1) of overrepresentation among cases included butchers and teacher/ lecturers (both males only) and the combined job groups (chosen a priori for analysis) of keyboard operators, machine operators, and music teachers (all three jobs, females only).     

Detecting cumulative trauma disorders in workers performing repetitive tasks

On-site testing of 157 poultry processors disclosed that 50% had three or more abnormal upper extremity findings out of a total of 22 possibles. The average worker had five to six abnormal findings. Impaired pinch strength, decreased vibration sensitivity in the fingertips, and reports of current numbness were the most prevalent. Of workers with signs, 25% reported no symptoms, whereas only 8% of workers reported symptoms but had no signs. The investigators concluded that this measurement method has utility for assessments of worker populations to determine prevalence of CTDs and, potentially, for preclinical detection of these disorders to permit early intervention, reduce medical costs, and minimize disability. The need for accurate measurement to enhance early detection and prevention is discussed.     

人食管癌组织中热休克蛋白70和糖调节蛋白94的表达

为探讨人食管癌组织中热休克蛋白 70 (HSP70 )和糖调节蛋白 94( grp94)的表达及意义 ,采用SABC法检测人食管癌组织HSP70和grp94的表达 ,镜下观察HSP70和 grp94在癌组织及癌旁组织中的表达特点。结果 :92 .6%( 5 0 /5 4)食管癌组织中存在HSP70的表达 ,癌细胞存在胞质、胞核表达强度及部位的差异 ;而 grp94的表达阳性率为70 .4% ( 3 8/5 4) ,以胞质表达为主 ,而癌旁组织表达较少。提示 :人食管癌组织存在HSP70和 grp94的表达异质性 ,呈现了胞质、胞核的表达差异 ,HSP70和 grp94在人食管癌组织的表达特点为以后肿瘤抗原肽肿瘤疫苗的提取和实验奠定了基础。     

食管癌加速超分割放疗的临床研究

目的：评价加速超分割放射治疗食管癌的疗效。方法：食管鳞癌９８例随机分为常规组和加速超分割组。常规组：１８０～２００ｃＧｙ／次，５次／周，总量６０００～７０００ｃＧｙ／６～７周；加速超分割组：１５０ｃＧｙ／次，２次／日，间隔６小时，总量５４００ｃＧｙ／３５周。两组病人均采用６０Ｃｏ远距离外照射。结果：常规组１，３，５年生存率分别为４６％（２３／５０）、２０％（１０／５０）、１２％（６／５０）；加速超分割组１，３，５年生存率分别为７０８％（３４／４８）、３９６％（１９／４８）、２９２％（１４／４８），加速超分割组明显优于常规组（Ｐ＜００５），而两组放疗反应和并发症无明显差异。结论：加速超分割放疗能明显提高食管癌病人的生存率，但不增加放疗反应及并发症。     

食管癌高低发区人群食管粘膜组织病理学研究

目的探讨食管癌高、低发区人群食管粘膜上皮组织学改变，为癌前病变防治提供依据。方法高（林州市）、低发区（范县、清丰县）分别取无症状居民食管活检２２９人和１８７人，均分为４组，２５岁～３４岁、３５岁～４４岁、４５岁～５４岁及≥５５岁，常规石蜡ＨＥ制片，按标准诊断归类。结果高、低发区食管上皮萎缩、棘层肥厚、炎细胞浸润相应年龄组比较无显著差异，基底细胞增生高发区３５岁～４４岁、４５岁～５４岁组显著大于低发区相应组（Ｐ＝０．０３１２，Ｐ＝０．０２７３），非典型增生４５岁～５４岁、≥５５岁组高发区显著大于低发区相应组（Ｐ＝０．０１９６，Ｐ＝０．０２６３）。高、低发区总体人群比较除棘层肥厚、炎细胞浸润无差异外，余各病变间均有极显著差异（Ｐ＜０．０１）。结论食管上皮萎缩、基底细胞增生应作为较狭义的癌前病变对待，食管上皮棘层肥厚、炎细胞浸润似与食管癌变无关。     

Retrograde endoscopic laser therapy for transitional cell carcinoma of the upper urinary tract

AIM: The aim of the present study was to investigate the safety and efficacy of endoscopic laser therapy for transitional cell carcinoma (TCC) of the upper urinary tract. METHODS: Tumors of the renal pelvis and ureteropelvic junction were detected by ureteroscopy. The tumors were subjected to biopsy, and after TCC was diagnosed, endoscopic laser therapy (Neodymium-YAG and Holmium-YAG) was conducted using a 6.9 Fr. flexible ureterorenoscope. RESULTS: From January 1997 to April 2002, six patients underwent ureteroscopic treatment. Tumor grade was 1 in four patients and 2 in two patients. Average tumor size was 1.45 cm. Endoscopic treatment was chosen for two patients because of the high medical risk associated with open surgery. Another patient underwent diagnostic ureteroscopy, followed immediately by endoscopic treatment. A further three patients elected to undergo ureteroscopic treatment. One patient with large (3 cm), multifocal and incompletely treated tumors died of metastatic disease 22 months after the initial operation. One patient requested nephroureterectomy one month after endoscopic treatment, and pathological examination of the resected specimen revealed no tumor. The other four patients have been followed up for a mean period of 14 months after initial treatment. Recurrence occurred in one patient, and was successfully treated by repeat endoscopic resection. None of the patients required blood transfusion or emergency open surgery. CONCLUSION: Ureteroscopic treatment of small, localized, low-grade TCC of the upper urinary tract is now a safe and feasible alternative to nephroureterectomy in selected patients.     

207例预激综合征的心律失常

对207例预激综合征行电生理检查.检出心律失常171例.占82.6%。房室折返性心动过速占所有心律失常的80.4%,心房颤动13.1%,其他6.5%.房室折返性心动过速占我院同期室上速的56.5%.远较房室结折返性心动过速(24.4%)多见。隐性旁路在室上速中占29%,居首位。上述情况反映我国人室上速的构成比可能与西方国家不同。