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We treated 100 consecutive ureteral calculi requiring intervention with a previously described algorithm. There were 16 ureteropelvic junction, and 18 upper, 22 mid and 44 lower ureteral calculi. Treatment was by a stent and extracorporeal shock wave lithotripsy in 10 ureteropelvic junction, 10 upper ureteral and 3 mid ureteral calculi, ureteroscopy and extracorporeal shock wave lithotripsy in 6 upper and 6 mid ureteral calculi, and ureteroscopy alone in 5 ureteropelvic junction, 2 upper and 12 mid ureteral calculi. All 44 lower ureteral calculi were treated successfully by ureteroscopy. Of the 100 patients studied 98 were treated by endourological methods (extracorporeal shock wave lithotripsy or ureteroscopy), while 2 required an operation (1 with a ureteropelvic junction calculus and 1 with a mid ureteral calculus). Over-all, 100 patients required a total of 125 procedures to accomplish successful stone removal. An algorithm is developed in which lower ureteral calculi are treated by ureteroscopy, mid ureteral calculi (large and dense) by stent bypass and extracorporeal shock wave lithotripsy or (lucent and fragile) by ureteroscopy, upper ureteral calculi by stent bypass and extracorporeal shock wave lithotripsy without manipulation, and impacted ureteral stones initially by ureteroscopy and, if necessary, then by extracorporeal shock wave lithotripsy. 相似文献
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R Shirane H Shimizu M Kameyama P R Weinstein 《Journal of cerebral blood flow and metabolism》1991,11(6):949-956
A new model of temporary complete cerebral ischemia was developed and tested in 64 rats. With use of microsurgical techniques, both pterygopalatine and external carotid arteries were occluded and the basilar artery was coagulated to reduce potential collateral CBF during ischemia. After this preliminary five-vessel occlusion, temporary global ischemia was induced by occluding the common carotid arteries (CCAs) with microclips. To validate the method, CBF was measured autoradiographically in 24 anatomical regions at death after 5 min of ischemia or after 15 min of ischemia followed by 5 min of reperfusion. Mean arterial blood pressure and arterial blood gases remained stable under controlled endotracheal ventilation and anesthesia (halothane, 70% N2O, and 30% O2) throughout the CBF experiments, except for a 10-15% increase in mean arterial blood pressure for 1-5 min after bilateral CCA occlusion. After the initial five-vessel occlusion, the EEG did not change, and local CBF levels were comparable to those in anesthetized non-surgical controls. When the CCAs were occluded, the EEG flattened rapidly; after 5 min of ischemia, autoradiography showed no detectable blood flow in the forebrain and cerebellum. The local CBF levels measured after 15 min of temporary global ischemia and 5 min of reperfusion demonstrated relatively homogeneous postischemic hyperperfusion; only two of eight rats had several 1- to 3-mm areas of no-reflow. Survival studies showed increasing motor impairment after 10, 15, 30, and 60 min of temporary CCA occlusion. Ischemic neuronal damage was observed histologically in the hippocampus and basal ganglia 24 h after 10 min of temporary ischemia.(ABSTRACT TRUNCATED AT 250 WORDS) 相似文献
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Both cyproterone acetate (CPA) and the gonadotrophin-releasing hormone
agonist (GnRHa) have been shown to be effective for the treatment of
hirsutism. We wished to compare the effectiveness of CPA in two standard
doses with GnRHa and add-back therapy and to compare the length of
remission after these treatments. A total of 60 hirsute hyperandrogenic
women was assigned to the following treatment groups: CPA 2 mg with 35
microg of ethinylestradiol for 21 days each month (Diane group), CPA 50 mg,
days 5-15, and ethinylestradiol 50 microg, days 5-25, each month (CPA
group) or Decapeptyl 3.75 mg i.m. every 28 days with the addition of
conjugated oestrogen 0.625 mg, days 1-21, and medroxyprogesterone acetate
10 mg, days 12-21 (GnRHa group). Hirsutism was graded by the
Ferriman-Gallwey-Lorenzo (FGL) index and anagen hair shaft diameters and
serum luteinizing hormone (LH) and testosterone were assessed before and
every 3 months during and after treatment. All women were treated for 1
year with 1 year follow-up. At baseline hirsutism and endocrine patterns
were similar in all groups. After one year of treatment, hirsutism
decreased in all groups but the changes were greater (P <0.05) in the
CPA and GnRHa groups than in the Diane group. Serum LH and testosterone
were lowest in the GnRHa group. After withdrawal, hirsutism increased
rapidly in the Diane and CPA groups and after 6 months, FGL scores and hair
shaft diameters were similar to pretreatment values. In the GnRHa group,
hirsutism increased more gradually and after 1 year of withdrawal, FGL
scores and hair diameters were significantly (P <0.05) less than
pretreatment values. Serum LH and testosterone increased rapidly in all
three groups reaching pretreatment values by 6 months. These data suggest
equal efficacy of the GnRHa and the high dose CPA regimen for the treatment
of hirsutism in hyperandrogenic women. GnRHa with add-back treatment
appears to result in a longer remission of hirsutism in comparison with
CPA.
相似文献
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Multicystic dysplastic kidney is a common renal anomaly in the newborn. Long-term problems, such as pain, infection, hypertension and neoplasm, although infrequent, have been reported. Acute, life-threatening complications resulting from the size of the affected kidney are rare and emergency nephrectomy has been the only reported effective therapy. We present a case of ultrasound-guided percutaneous cyst decompression used as definitive treatment of respiratory failure associated with multicystic dysplastic kidney. 相似文献