Obstructive Uropathy Secondary to Ureteral Herniation in a Pediatric En Bloc Renal Graft

Ureteral herniation is a rare entity. We report the first case of extraperitoneal ureteral herniation in a pediatric en bloc renal graft causing obstructive uropathy. A 70-year-old, obese patient with an en bloc renal transplant was found to have ureterohydronephrosis in the right renal graft on magnetic resonance imaging. Nephrostomy with insertion of a double-J catheter confirmed the presence of a ureteral loop within the inguinal tract. Surgery confirmed herniation of the ureter through the internal inguinal ring, crossing over the spermatic cord. We performed release, resection, ureteral reimplantation and hernioplasty. Four months later, renal function was normal and urinary tract dilation had diminished. This case illustrates an unusual cause of obstructive uropathy in a transplanted kidney. Apart from obesity, two other factors may have contributed to its development: presence of a redundant ureter, and the fact that the ureter had been placed over, rather than under, the spermatic cord.     

Chronic obstructive pulmonary disease and asthma General and medical management with special attention to exacerbations

The general management of patients with chronic obstructive pulmonary disease and asthma is discussed. Pathophysiological mechanisms of bronchial obstruction and inflammation are briefly described. The importance of preventive measures is emphasized. Medicine prescribed in chronic obstructive pulmonary disease and asthma, their relative place in treatment schedules and route of administration are reviewed. Finally, the importance of maximal bronchodilatation in exacerbations is stressed and the few indications for antibiotic treatment are discussed.     

小型猪渐进性梗阻性黄疸模型的建立

目的建立小型猪慢性渐进性梗阻性黄疸模型，评价其模拟临床渐进性梗阻性黄疸患者的价值。方法开腹手术，将并行有16G注射器针头的胆总管用5％碘酒溶液浸泡处理的10号丝线捆扎后，抽除针头。使胆总管早期部分狭窄，后期组织受化学物质刺激发生无菌性炎症反应、纤维组织修复等病理改变，引发胆管组织慢性纤维瘢痕狭窄，造成渐进性梗阻性黄疸。结果实验动物术后观察28d无死亡，第5—7天逐渐出现黄疸，之后渐重；第28天时的总胆红素较术前明显升高[（1．22±0．41）μmol／L比（125．90±35．77）μmol／L（P〈0．01）]；4周后病理显示胆总管组织发生慢性纤维瘢痕样变，管腔狭窄阻塞。结论本小型猪动物模型模梗阻性黄疸呈渐进性、慢性过程。可重复性强、耐受性好，是比较理想的梗阻性黄疸动物模型。同时，小型猪肝胆系统的生理及解剖结构与人相近，可为临床胆管狭窄和肝门部癌相关研究提供较可靠实验依据。     

内镜下鼻胆管引流治疗急性梗阻性化脓性胆管炎(附25例报告)

目的探讨急性梗阻性化脓性胆管炎伴多器官衰竭的治疗方法。方法对25例急性梗阻性化脓性胆管炎伴多器官衰竭的患者采取以内镜下鼻胆管引流术、经鼻胆管冲洗及灌注抗生素为主的非手术综合治疗,观察患者治疗前后的血清总胆红素水平、B超下胆总管内径变化,并对患者临床资料进行回顾性分析。结果本组25例患者除2例需转外科急诊手术治疗外,其余23例内镜下胰胆管造影、内镜下鼻胆管引流术成功,胆汁引流通畅,多器官衰竭得以纠正,急性梗阻性化脓性胆管炎伴多器官衰竭治愈率为92.0%。结论对急性梗阻性化脓性胆管炎伴多器官衰竭患者采取内镜下鼻胆管引流术、静脉应用和经鼻胆管冲洗及灌注抗生素为主的综合治疗是有效、安全的。     

National Study of Emergency Department Visits for Acute Exacerbation of Chronic Obstructive Pulmonary Disease, 1993–2005

Objectives: Little is known about recent trends in U.S. emergency department (ED) visits for acute exacerbation of chronic obstructive pulmonary disease (AECOPD) or about ED management of AECOPD. This study aimed to describe the epidemiology of ED visits for AECOPD and to evaluate concordance with guideline‐recommended care. Methods: Data were obtained from National Hospital Ambulatory Medical Care Survey (NHAMCS). ED visits for AECOPD, during 1993 to 2005, were identified using the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD‐9‐CM) codes. Concordance with guideline recommendations was evaluated using process measures. Results: Over the 13‐year study period, there was an average annual 0.6 million ED visits for AECOPD, and the visit rates for AECOPD were consistently high (3.2 per 1,000 U.S. population; P_trend = 0.13). The trends in the use of chest radiograph, pulse oximetry, or bronchodilator remained stable (all P_trend > 0.5). By contrast, the use of systemic corticosteroids increased from 29% in 1993–1994 to 60% in 2005, antibiotics increased from 14% to 42%, and methylxanthines decreased from 15% to <1% (all P_trend < 0.001). Multivariable analysis showed patients in the South (vs. the Northeast) were less likely to receive systemic corticosteroids (odds ratio [OR] = 0.6; 95% confidence interval [CI] = 0.4 to 0.9). Conclusions: The high burden of ED visits for AECOPD persisted. Overall concordance with guideline‐recommended care for AECOPD was moderate, and some emergency treatments had improved over time.     

磁共振胆胰管造影在梗阻性黄疸诊断和治疗中的作用

目的：探讨磁共振胆胰管造影(MRCP)对梗阻性黄疸患梗阻定位和定性的诊断价值及对治疗的指导意义。方法：对48例梗阻性黄疸的患进行MRCP检查，34例(70．8％)行手术治疗，14例(29．2％)行非手术治疗。结果：48例患中45例(93．8％)可通过MRCP明确诊断，并经手术或临床证实；2例(4．1％)硬化性胆管炎需结合其他临床资料做出诊断；1例(2．1％)胆总管结石误诊为胆管癌。结论：MRCP对胆道疾患诊断具有无创性、高灵敏度、高准确率等优点，能为梗阻性黄疸患临床治疗提供有效依据。     

早期新生儿黄疸的动态监测及早期干预治疗效果评价

目的观察出生1周内新生儿黄疸的动态变化、高胆红素血症患儿病因分析及早期干预治疗的效果。方法利用经皮胆红素测定仪对我院产科出生的928例新生儿每日进行同一部位的皮肤测定,根据新生儿不同出生情况对超过胆红素值安全范围的及时给予口服药物或转儿科蓝光治疗。结果928例新生儿因高胆红素血症住院156例,高胆红素血症发生率为15.74%,无1例发生胆红素脑病。结论对新生儿黄疸进行监测和早期干预治疗,可大幅度降低高胆红素血症的发病率,从而防止胆红素脑病的发生。     

应用个体化营养方案对COPD患者病情影响的研究

目的　研究应用个体化营养方案对慢性阻塞性肺疾病 (COPD)患者进行营养治疗后的病情变化 ,评价个体化营养方案对病情的影响 ,阐明个体化营养方案的治疗价值。方法　选择 80例COPD患者 ,随机分为实验组与对照组 ,实验组应用个体化方案进行营养治疗 ,对照组采用普通膳食 ,观察营养状况、临床表现、病情急性发作次数、住院次数、治疗费用、并发症、呼吸衰竭发生率、死亡率、肺通气功能的变化。结果　实验组营养状况显著好于对照组P <0. 0 5 ,实验组病情急性发作次数、住院天数减少 ,治疗费用降低 ,与对照组比 ,差异显著P <0 . 0 5 ,实验组临床表现减轻 ,与对照组比差异显著P <0 . 0 5 ,实验组患者肺功能有所改善 ,差异显著P <0 . 0 5 ,实验组并发症、呼衰发生率、死亡率与对照组比显著降低P <0 . 0 5。结论　个体化营养方案简便易行、科学、经济 ,患者易接受 ,应用该个体化营养方案对COPD患者实施营养支持 ,营养效果明显 ,能确切改善患者病情。     

氨溴索对慢性阻塞性肺疾病大鼠模型肺的保护作用

①目的　探讨氨溴索对肿瘤坏死因子α(TNF α)在慢性阻塞性肺疾病 (COPD)大鼠模型肺内表达与分布的影响以及肺泡Ⅱ型上皮细胞超微结构的影响。②方法　实验大鼠随机分为 3组 :健康对照组 (n =8) ,COPD模型组 (n =1 2 ) ,氨溴索干预组 (n =1 2 )。采用熏吸香烟并气管内注入脂多糖法建立大鼠COPD模型 ,氨溴索干预组于COPD模型开始建立时腹腔注射氨溴索溶液 4 0mg/ (kg·d) ,连续 4 0d。观察各组气道炎症的病理特点、超微结构特点、血气指标、肺泡平均内衬间隔、平均肺泡数。应用原位杂交法检测TNF α基因表达的相对含量。③结果　所建COPD模型的病理以及病理生理学改变符合人类COPD的特点。氨溴索干预组肺泡平均内衬间隔、平均肺泡数、TNF α表达强度与健康对照组、COPD模型组比较差异有显著性 (F =3.2 4～ 1 1 .1 1 ,q =4 .74～ 36 .2 2 ,P <0 .0 1 ) ;动脉血氧分压、二氧化碳分压差异亦有显著性 (F =3.30、8.79,q =3.5 0～ 8.6 9,P <0 .0 5 )。 ④结论　长期应用氨溴索对COPD大鼠模型气道炎症有明显的抑制作用     

COPD机械通气病人下呼吸道感染致病菌分布特点

①目的 探讨慢性阻塞性肺病(COPD)病人机械通气后下呼吸道感染致病菌的特点。②方法 取32例COPD并发呼吸衰竭行机械通气病人下呼吸道分泌物做痰细菌学培养，同时做药物敏感试验。③结果 32例病人共分离出菌株76株，阳性率71．7％，其中混合感染10例次。其中革兰阴性杆菌(GNB)58株，占76．3％；阳性球菌10株，占13．2％；真菌8株，占10．5％。常见致病菌以铜绿假单胞菌、鲍曼不动杆菌和肺炎杆菌为主，GNB中铜绿假单胞菌和不动杆菌的耐药率高。④结论 COPD应用机械通气病人下呼吸道感染以革兰阴性杆菌为主，耐药性高。