肝胆管囊腺瘤及囊腺癌的CT、MRI诊断

目的总结肝胆管囊腺瘤和囊腺癌的CT、MRI表现,探讨CT、MRI诊断该肿瘤的价值。方法回顾性分析经手术病理证实为肝胆管囊腺瘤(3例)和囊腺癌(5例)的CT和(或)MRI表现、术前诊断,并与病理所见进行对照分析。结果3例囊腺瘤均为单房或多房的囊性肿物,无壁结节,术前均误诊为肝包虫或肝囊肿;5例恶性者中囊腺癌3例,囊腺瘤伴局部癌变2例。5例均为单房或多房的囊实性肿物,有壁结节。CT扫描囊性部分呈均匀液性密度,囊壁、分隔厚薄不均,壁结节大小不一,增强扫描囊壁、分隔及壁结节强化。MR示囊性部分呈均匀液性信号,增强扫描囊壁、分隔及壁结节强化。5例恶性者术前4例诊断为囊腺瘤或囊腺癌,1例诊为胆管癌。CT、MRI表现与病理所见对应良好。结论胆管囊腺癌在CT、MRI上具有特征性表现,可以做到术前正确诊断;但胆管囊腺瘤如果无壁结节则缺乏特征性表现,需要和肝复杂性囊肿或肝包虫病等鉴别。     

Back and neck pain in seniors—prevalence and impact

Neck pain (NP) and back pain (BP) are common complaints in seniors yet specific information on these complaints is lacking in the scientific literature. We present cross-sectional interview data from the 2003 data collection within the population based Longitudinal Study of Aging Danish Twins dealing with the 1-month prevalence of NP and BP and the intensity of possible pain. Further, we present the 1-year prevalence of NP and BP, duration of pain, influence of NP and BP on daily activities and care seeking for NP and BP. 84.4% of invited twins aged 70–102 years participated in the study. The 1-month prevalence of NP and BP was similar to previously reported results. 7% of men and 13% of women reported moderate or severe NP and 12% of men and 19% of women reported moderate or severe BP on a monthly basis. 10% of men and 12% of women reported more than 30 days of NP within the past year and 13% of men and 21% of women reported more than 30 days of BP within the past year. 5% of men and 8% of women had altered or diminished their physical activities due to NP and 9% of men and 16% of women had diminished their physical activities due to BP within the past year. 10% of men and 12% of women had had treatment for NP within the past year and 13% of men and 19% of women had had treatment for BP within the past year, most commonly from general medical practitioners and physical therapists. Altering or diminishing physical activities and care seeking were associated with both pain intensity and duration of pain. NP and BP of longer duration were associated with significantly lower physical performance scores when compared to no NP or BP during the past year. NP and BP in seniors are probably associated with difficulty but not inability to perform daily activities.     

Hormonal and cholinergic effects on amylase and lysosomal enzyme activities in pancreatic tissue and ascites of rats with acute experimental pancreatitis

The effects of hormonal or cholinergic stimulation on survival and on activities of lysosomal enzymes and amylase in pancreatic tissue and ascites were studied in rats with induced pancreatitis. Pancreatitis per se caused an increase of the activities of cathepsin D, N-acetyl-beta-D-glucosaminidase and amylase, and a decrease of acid phosphatase in pancreatic tissue. Pancreatic protein concentration was not influenced. In pancreatitic rats administration of cerulein or carbachol markedly decreased survival rate. Cerulein increased the activities of cathepsin D and amylase in ascites and cathepsin D and acid phosphatase in pancreatic tissue. Carbachol increased the activities of cathepsin D and amylase in ascites and acid phosphatase in pancreatic tissue. Both cerulein and carbachol decreased the activity of amylase in pancreatic tissue. Administration of secretin or the anticholinergic drug Pro-Banthine did not influence survival rate or the activities of lysosomal enzymes and amylase in ascites. In pancreatic tissue the activity of acid phosphatase was slightly increased by secretin or Pro-Banthine. In conclusion, the results show a nonparallel alteration of lysosomal enzyme activities in pancreatic tissue in rats with pancreatitis. Cerulein and cholinergic stimulation decreased survival rate and brought about a marked increase of cathepsin D activity in ascites and, in the case of cerulein, also in pancreatic tissue. The implication of lysosomes and especially the catheptic proteases in the pathogenesis and outcome of acute pancreatitis deserves further attention.     

Regulation of bone remodeling: impact of novel therapies

The kidneys serve as both an endocrine organ and as a target of endocrine action, with the aim of controlling mineral and water balance. Hormones and other key metabolites regulate mineral homeostasis by altering gene function directly or by initiating a sequence of events, leading ultimately to a change in enzyme function. Two of these hormones, parathyroid hormone (PTH) and calcitriol (the active form of vitamin D), interact in multiple tissues in the body to regulate the flux of calcium and phosphorus between extra- and intracellular compartments. Changes in the concentration of PTH and vitamin D, or the interaction of these with other factors, lead to the aberrant regulation of calcium and phosphorus. Among other effects, this aberrant regulation leads to pathologic changes in bone metabolism. The pathology of renal bone disease varies along a spectrum from disorders of low turnover to those of high turnover. This spectrum reflects the results of therapeutic intervention, hormone balances, and other causes. Effective management of renal bone disease therefore requires thorough evaluation of relevant risk factors, measurement of biochemical markers of bone remodeling, and determination of the physical status of bone tissue either by bone mineral density or bone biopsy. Subsequent therapeutic intervention with newer vitamin D compounds, novel phosphate binders, calcimimetics, and the use of alternative dialysis modalities offer hope in normalizing bone remodeling and mineral balance. The human skeleton functions in two capacities: the storage of minerals and structural support of the body. It is the only tissue that behaves as both a major source and a sink of calcium (Ca) and phosphorus (P). Healthy bone is a composite of a collagenous matrix embedded with crystals of hydroxyapatite. On the surface of bone and within the calcified matrix are specialized cells that build and maintain the tissue, and facilitate the movement of Ca and P into and out of serum. Bone undergoes remodeling in response to either damage from mechanical strain or as part of the normal cycle of bone renewal. The process involves distinct steps of cellular activation, bone resorption, and subsequent bone formation. It is a relatively slow process that takes several months, and at any one time occurs at many different sites along the bone surface. Systemic factors, such as PTH and vitamin D, regulate the resorption and formation of bone, and thus the systemic movement of Ca and P. However, during conditions of stress and disease, other factors may also play a role. In patients with chronic renal disease, the balance of Ca and P is profoundly disturbed. This disruption and the compensatory changes that occur in response alter the normal processes of bone metabolism.     

Gaucher Disease in Bone: From Pathophysiology to Practice

Gaucher disease (GD) is a rare, genetic lysosomal disorder leading to lipid accumulation and dysfunction in multiple organs. Involvement of the skeleton is one of the most prevalent aspects of GD and a major cause of pain, disability, and reduced quality of life. Uniform recommendations for contemporary evaluation and management are needed. To develop practical clinical recommendations, an international group of experienced physicians conducted a comprehensive review of 20 years’ of the literature, defining terms according to pathophysiological understanding and pointing out best practice and unmet needs related to the skeletal features of this disorder. Abnormalities of bone modeling, reduced bone density, bone infarction, and plasma cell dyscrasias accompany the displacement of healthy adipocytes in adult marrow. Exposure to excess bioactive glycosphingolipids appears to affect hematopoiesis and the balance of osteoblast and osteoclast numbers and activity. Imbalance between bone formation and breakdown induces disordered trabecular and cortical bone modeling, cortical bone thinning, fragility fractures, and osteolytic lesions. Regular assessment of bone mineral density, marrow infiltration, the axial skeleton and searching for potential malignancy are recommended. MRI is valuable for monitoring skeletal involvement: It provides semiquantitative assessment of marrow infiltration and the degree of bone infarction. When MRI is not available, monitoring of painful acute bone crises and osteonecrosis by plain X-ray has limited value. In adult patients, we recommend DXA of the lumbar spine and left and right hips, with careful protocols designed to exclude focal disease; serial follow-up should be done using the same standardized instrument. Skeletal health may be improved by common measures, including adequate calcium and vitamin D and management of pain and orthopedic complications. Prompt initiation of specific therapy for GD is crucial to optimizing outcomes and preventing irreversible skeletal complications. Investing in safe, clinically useful, and better predictive methods for determining bone integrity and fracture risk remains a need. © 2019 The Authors. Journal of Bone and Mineral Research Published by Wiley Periodicals Inc.     

Asymptomatic bacteriuria in spinal cord patients and the elderly

The prevalence and incidence of symptomatic and asymptomatic bacteriuria will remain high for many years to come. Antimicrobial agents are necessary to treat symptomatic UTI because no natural methods have been shown to be effective. Treatment of ABU is not appropriate. There is growing resistance to antibiotics, biocides, and antiseptics and, simultaneously, a decreasing rate of introduction of new antibacterial agents; thus the problem of resistance is magnified and potentially complicates the management of patients with SCI and elderly persons. New options of managing health and of preventing ABU and UTI and the complications arising from these diseases must be investigated vigorously and urgently. In particular, further study of the role of bacterial biofilms, the normal microflora, the influence of diet and hygiene, and the importance of the host immune response in the process of urinary tract colonization and infection is relevant and necessary.     

雄性2型糖尿病大鼠血清、生殖器官中NO、NOS、ET与CGRP变化的实验研究

目的 观察和探讨2型糖尿病大鼠血清及生殖器官中各指标含量的变化和相互关系，及其对雄性大鼠生殖器官的影响。方法 雄性Wistar大鼠30只，其中20只制备2型糖尿病模型，余为对照组。实验结束时，观察组织的病理改变，并测定各指标的变化。结果 2型糖尿病大鼠模型制备成功；与对照鼠比较：电镜显示睾丸精原细胞线粒体呈空泡样变；附睾管腔内精子数量减少或缺如。光镜下见阴茎海绵体平滑肌数量减少，纤维结缔组织增生。NO含量和NOS活性均显著低于对照组，ET浓度明显高于对照组。血清、阴茎中CGRP含量均低于对照组，但睾丸、附睾中CGRP含量与对照组比较无显著差异。睾丸中ET与CGRP含量、ET与NO含量呈负相关。结论 2型糖尿病时大鼠生殖器官均受到不同程度的损害；糖尿病时上述指标的变化结果可能是导致其功能紊乱，进而造成不育症的原因。     

Werner syndrome in an Iranian family

A 49-year-old man was first seen in our department for the evaluation of scleroderma-like skin changes and a nonhealing ulcer on his leg from years before referral. His medical history was of long duration. His growth was stunted at the age of 12. At 21 years of age, the patient noted graying of the scalp hair, most prominent on his temples, and the process was progressively completed by the age of 23. At the same age, atrophy and thinning of the skin and loss of subcutaneous fat resulted in a tense, shining, and adherent appearance of his skin, most obvious on his face and extremities. Soon after, he developed a high-pitched, hoarse voice. He had undergone bilateral cataract surgery at the age of 30. Around the age of 46, he developed a unilateral nonhealing chronic leg ulcer (Figure 1). He had separated from his wife because of infertility. He was the first offspring of his second-degree healthy relative parents. The other 3 siblings had similar signs and symptoms. Our patient gave the history of premature graying of the hair of his younger brother at the age of 18 and his 2 younger sisters at the age of 12 and 16. His brother had recently received diagnoses of bilateral cataract and diabetes mellitus. All of the siblings had ceased growth from early adolescence. On physical examination, our patient's weight was 48 kg and his height was 150 cm. He had normal intelligence. He was speaking with a high-pitched and childish voice. He had a bird-like appearance with a beak-shaped nose. Mottled and diffuse pigmentation and poikiloderma appearance was conspicuous on his neck (Figure 2). The entire skin was smooth, shiny, and scleroderma-like, and a marked decrease in the subcutaneous fat was noted over the extremities. A deep cutaneous ulcer was evident on his slimmed leg. Digital ulcers were not found, and radial and dorsalis pedis pulses were palpable. Clinodactyly of the toes were conspicuous. His nails were dystrophic and he had used dentures from the age of 20. On examination of the external genitalia, his testes were smaller than normal. In the biopsy taken from the leg ulcer, there were no signs of malignancy. There were no signs ofosteomyelitis on x-ray. Biopsy of the normal skin revealed atrophic epidermis and thick dermis with hyalinization of the collagen fibers and absence of pilosebaceous structures (Figure 3). The patient's scalp hair was thin and sparse and there were few axillary and pubic hairs. His fasting plasma glucose level was normal.     

正常人颈脊髓矢状径MRI测量

目的 提供颈脊髓矢状径、颈椎管有效矢状径(脑脊液柱矢状径)正常参考值,筛选出较科学的评估颈脊髓病的影像学标准.方法 在120例正常人颈椎MRI片上,对各节段颈脊髓矢状径、颈椎管有效矢状径、M值(桥脑-延髓交界处矢状径)进行测量,计算脊髓矢状径与椎管有效矢状径比值,以及脊髓矢状径和M值的比值(C/M值),研究它们与性别、年龄和颈椎长度的相关性.评估脊髓矢状径与椎管有效矢状径比值和C/M值的临床应用价值.结果 脊髓矢状径、椎管有效矢状径、M值男性大于女性(P<0.05),脊髓矢状径和椎管有效矢状径比值和C/M值男女无差别(P>0.05).颈脊髓矢状径和M值随着颈椎长度的增加而增加(r=0.215,P=0.010;r=0.151,P=0.020).颈脊髓矢状径和颈椎管有效矢状径比值与年龄成呈相关(r=0.242,P<0.01),与颈椎长度无明显相关(r=0.082,P=0.200).C/M值与年龄和颈椎长度均无相关性(r=0.06,P=0.359;r=0.003,P=0.900).结论 C/M值能够很好评价颈脊髓萎缩、受压、损害的状况,它很少受到个体差异的影响,是临床评估颈脊髓疾病的良好标准之一.     

舟月骨间韧带在腕尺桡偏时舟月骨三维运动中的作用

目的 观察在腕关节尺桡偏运动时,舟月骨间韧带(scapholunate interosseous ligament,SLIL)及其各亚区分级切断后对舟骨与月骨三维运动的影响,从亚区水平对SLIL在舟月骨三维运动中的作用进行研究.方法 取12例新鲜冰冻成人上肢标本(左、右侧各6例),共分为正常对照组、断SLIL近侧组、断SLIL近+背侧组、断SLIL近+掌侧组、SLIL全断组(每组6例).采用三维激光扫描及图像重建技术,测定在腕关节尺桡偏时舟骨与月骨的三维运动数据,并进行统计学处理.结果 在正常腕关节做尺桡偏运动时,舟、月骨同时也做尺桡偏运动,但还伴有明显的屈伸方向上的运动;与此同时,舟、月骨还做一定的旋前、旋后活动.在切断近+掌和近+背侧亚区组,舟月骨的活动受到影响.全切断SLIL会导致舟骨掌屈度增加,月骨掌屈活动减弱.结论 采用三维激光扫描及图像重建技术可准确测定腕舟月骨的三维活动度,从SLIL亚区水平上进行的研究表明,部分或全部切断SLIL后会对舟月骨的掌屈程度产生明显影响,但SLIL近侧亚区在控制舟、月骨的活动上不起主要作用.     

舟月骨间韧带在腕尺桡偏时舟月骨三维运动中的作用

目的 观察在腕关节尺桡偏运动时,舟月骨间韧带(scapholunate interosseous ligament,SLIL)及其各亚区分级切断后对舟骨与月骨三维运动的影响,从亚区水平对SLIL在舟月骨三维运动中的作用进行研究.方法 取12例新鲜冰冻成人上肢标本(左、右侧各6例),共分为正常对照组、断SLIL近侧组、断SLIL近+背侧组、断SLIL近+掌侧组、SLIL全断组(每组6例).采用三维激光扫描及图像重建技术,测定在腕关节尺桡偏时舟骨与月骨的三维运动数据,并进行统计学处理.结果 在正常腕关节做尺桡偏运动时,舟、月骨同时也做尺桡偏运动,但还伴有明显的屈伸方向上的运动;与此同时,舟、月骨还做一定的旋前、旋后活动.在切断近+掌和近+背侧亚区组,舟月骨的活动受到影响.全切断SLIL会导致舟骨掌屈度增加,月骨掌屈活动减弱.结论 采用三维激光扫描及图像重建技术可准确测定腕舟月骨的三维活动度,从SLIL亚区水平上进行的研究表明,部分或全部切断SLIL后会对舟月骨的掌屈程度产生明显影响,但SLIL近侧亚区在控制舟、月骨的活动上不起主要作用.     

舟月骨间韧带在腕尺桡偏时舟月骨三维运动中的作用

目的 观察在腕关节尺桡偏运动时,舟月骨间韧带(scapholunate interosseous ligament,SLIL)及其各亚区分级切断后对舟骨与月骨三维运动的影响,从亚区水平对SLIL在舟月骨三维运动中的作用进行研究.方法 取12例新鲜冰冻成人上肢标本(左、右侧各6例),共分为正常对照组、断SLIL近侧组、断SLIL近+背侧组、断SLIL近+掌侧组、SLIL全断组(每组6例).采用三维激光扫描及图像重建技术,测定在腕关节尺桡偏时舟骨与月骨的三维运动数据,并进行统计学处理.结果 在正常腕关节做尺桡偏运动时,舟、月骨同时也做尺桡偏运动,但还伴有明显的屈伸方向上的运动;与此同时,舟、月骨还做一定的旋前、旋后活动.在切断近+掌和近+背侧亚区组,舟月骨的活动受到影响.全切断SLIL会导致舟骨掌屈度增加,月骨掌屈活动减弱.结论 采用三维激光扫描及图像重建技术可准确测定腕舟月骨的三维活动度,从SLIL亚区水平上进行的研究表明,部分或全部切断SLIL后会对舟月骨的掌屈程度产生明显影响,但SLIL近侧亚区在控制舟、月骨的活动上不起主要作用.     

脊柱手术中TES-MEP和CSEP联合监测脊髓功能的作用评价

目的 探讨脊柱手术中经颅电刺激运动诱发电位(TES-MEP)和皮层体感诱发电位(CSEP)联合监测脊髓功能的临床应用价值.方法 分析2006年7月至2009年4月脊柱手术中同时记录双侧胫前肌、足足母短屈肌(颈椎病变增加鱼际肌)TES-MEP和双侧胫后神经(颈椎病变增加尺神经)CSEP共293例患者的临床资料.术中全静脉麻醉维持,部分患者辅助使用小剂量七氟烷吸入或小剂量肌肉松弛药.将TES-MEP、CSEP、联合监测的结果与术后脊髓运动和感觉功能进行比较及相关分析.结果 术中TES-MEP、CSEP、联合监测的成功检出率分别为90.8%、96.9%和100%.术中TES-MEP、CSEP判断脊髓运动功能的灵敏度分别为100%和89.3%,特异度分别为98.4%和96.9%,约登指数分别为0.984和0.862;而判断脊髓感觉功能的灵敏度分别为76.7%和93.3%,特异度分别为98.7%和98.0%,约登指数分别为0.754和0.913;联合监测的灵敏度为100%,特异度96.9%,约登指数0.969.结论 TES-MEP监测脊髓运动功能的准确性高于CSEP,而CSEP监测脊髓感觉功能的准确性高于TES-MEP;联合监测对脊髓功能监测的灵敏度和准确性又高于单一的TES-MEP或CSEP监测,它是目前脊柱脊髓手术中较为理想的监测方法.     

Social Network Analysis of Equidae Movements and Its Application to Risk‐Based Surveillance and to Control of Spread of Potential Equidae Diseases

Movements of animals and animal products are one of the most important ways of disease introduction and spread between regions and countries. Maybe one of the most complex animal species in terms of diversity of uses, nature and extent of movements are equidae, for which animal movement records are usually not available. The study presented here is the first characterization of a complete and reliable network of equidae movements in Castile and Leon, which is one of the most important equidae production regions of Spain. Social network analysis and space–time cluster analysis were used to describe the contact patterns of the equidae network and to identify the most important premises, areas and time periods for potential disease introduction or spread into the region. The studied network was complex, with very heterogeneous types of premises and diverse nature and extent of the movements compared with other livestock species, which have important implications for prevention and control of equidae diseases. Centrality measures revealed that production and reproduction farms and centres of livestock competition were the most important type of premises in the studied network. Cluster analyses allowed to identify seventeen significant spatio‐temporal clusters of premises at high risk of dispatching or receiving equidae, which formed four interconnected compartments. These clusters were mainly located in the north‐west region and in the second part of the year. The results of this study may be useful to design risk‐based surveillance and control programmes of equidae diseases and increase the speed of detection and control of potential secondary outbreaks in future epidemics. Consequently, these results will help to minimize the great economic and sanitary impact of equidae diseases. The analytical approach used here may be easily extended to characterize the equidae movement patterns in other countries and regions of the world.     

Measuring depression and PTSD after trauma: common scales and checklists

Traumatic injury is an important public health problem secondary to high levels of morbidity and mortality. Injured survivors face several physical, emotional, and financial repercussions that can significantly impact their lives as well as their family. Depression and posttraumatic stress disorder (PTSD) are the most common psychiatric sequelae associated with traumatic injury. Factors affecting the prevalence of these psychiatric symptoms include: concomitant TBI, the timing of assessment of depression and PTSD, the type of injury, premorbid, sociodemographic, and cultural factors, and co-morbid medical conditions and medication side effects. The appropriate assessment of depression and PTSD is critical to an understanding of the potential consequences of these disorders as well as the development of appropriate behavioural and pharmacological treatments. The reliability and validity of screening instruments and structured clinical interviews used to assess depression and PTSD must be considered. Common self-report instruments and structured clinical interviews used to assess depression and PTSD and their reliability and validity are described. Future changes in diagnostic criteria for depression and PTSD and recent initiatives by the National Institute of Health regarding patient-reported outcomes may result in new methods of assessing these psychiatric sequelae of traumatic injury.     

Publication ethics

The editor of any medical journal has to be aware of the ethical and legal framework within which medical research is conducted. When research and publications relate to children, then particularly high standards are required in the design, conduct, and reporting of research in order to protect the rights of children and their families. Authors have a number of duties and responsibilities that are mirrored by those of editors and publishers. Of particular importance are the principles of transparency and integrity. Authors should be explicit about who carried out the work and who funded the study. They should declare whether the work has been published before and is not being considered for publication elsewhere. The authors must protect the rights of research participants including their anonymity. Editors and publishers have a duty to ensure high editorial standards and efficient and effective peer review systems. They should follow ethical and responsible publication practices and should safeguard the intellectual property of the authors. This review discusses in detail the duties and responsibilities of authors, editors, and publishers in modern medical publishing.     

Continuous infusion of ketamine and midazolam for prolonged sedation in the intensive care unit]

The clinical effects and pharmacokinetics of ketamine and midazolam, administered continuously for prolonged sedation were studied in 7 critically ill patients under mechanical ventilation. Initially ketamine 1 mg.kg-1 and midazolam 0.1 mg.kg-1 were administered intravenously and these were followed by infusion at a rate of 1.0 mg.kg-1.hr-1 of ketamine and 0.05 mg.kg-1.hr-1 of midazolam. The infusion rate was changed every 30 minute with increments of 0.5 mg.kg-1.hr-1 of ketamine and 0.05 mg.kg-1.hr-1 of midazolam until the sedative score by Ramsy RAE reached rank 4 (i.e. slow response to loud verbal commands). The plasma concentrations of ketamine were analyzed using high performance liquid chromatography and those of midazolam using gas chromatography. The mean maintenance doses of ketamine and midazolam were 2.25 +/- 0.61 mg.kg-1.hr-1 and 0.11 +/- 0.05 mg.kg-1.hr-1 (mean +/- SD), respectively. There were no significant changes in blood pressure or heart rate before and after the injection of ketamine and midazolam in all the patients. The plasma concentrations of ketamine and midazolam were 2.98 +/- 0.20 micrograms.ml-1 and 494.1 +/- 66.7 ng.ml-1, respectively. The time to clear response to verbal commands after cessation of the continuous infusion was 168 +/- 109 min. The plasma concentrations of ketamine and midazolam decreased rapidly, and plasma half-life of ketamine was about 1 hour and for midazolam less than 2 hours. In conclusion, continuous infusion of ketamine and midazolam was very useful to sedate critically ill patients under mechanical ventilation, with minimal effect on the cardiovascular system and rapid recovery of consciousness.     

Scaling of disfigurement and dysfunction in postoperative head and neck patients

The primary purpose of this investigation was to construct a quantitative scale to measure the perception of severity of visible disfigurement and dysfunction following ablative head and neck cancer surgery. Facial disfigurement and disruption of physical function induced by head and neck surgery pose formidable obstacles to the medical and psychosocial adaptation of cancer patients. Although this problem is widely acknowledged, virtually no research has attempted reliable and valid measurement of such concepts. Consequently, the present study investigated the psychological perceptions of 100 registered nurses regarding 11 disfiguring surgical procedures and loss of associated functions. Results indicated that the nurses' judgments of disfigurement and dysfunction were highly consistent and not a function of patient gender. Judgments of the severity of disfigurement, moreover, were independent of the perceived severity of associated dysfunction. It was concluded that this is a reliable method for measuring the relative degree of disfigurement and dysfunction and represents a critical precursor to prediction of a patient's psychological rehabilitation and compliance with medical care after surgery.     

Robotische Chirurgie in der Kinderurologie

The increasing experience obtained through laparoscopy has resulted in the evolution of ablative and reconstructive procedures in the field of paediatric urology. Apart from the established methods of laparoscopic nephrectomy and orchidopexy, nowadays laparoscopic hemi-nephrectomy and pyeloplasty have become standard therapeutic surgical alternatives. Nevertheless, many of these procedures require a high level of experience in laparoscopic preparation and stitching techniques and are thus performed in institutions with greater laparoscopic experience. With the introduction and evolution of the robotic-assisted technique and the availability of smaller instruments and ports (8 and 5 mm), there has been an evolution in the spectrum of complex ablative and reconstructive procedures in the field of paediatric urology as well. Nevertheless, there is a lack of randomised trails and the literature available in this area consists manly of case reports. The purpose of this article is to present the current status and perspectives of robotic-assisted surgery in the field of paediatric urology.