螺旋CT扫描在复杂肾结石经皮肾镜碎石术中的应用

目的探讨螺旋CT扫描在复杂肾结石微创治疗中的应用价值。方法对15例复杂肾结石患者在行经皮肾镜取石治疗前先行俯卧位螺旋CT扫描,确定穿刺点、穿刺角度和深度,然后进行结石的二维和三维重建,确定主体结石的部位、形状、结石分支的部位或方向以及有无肾盏积水等情况。结果15例中13例一次穿刺成功,2例经微调穿刺角度二次成功。其中肾多发结石10例,其中7例伴部分肾盂铸型结石;完全肾盂铸型结石5例。手术历时50～150min,平均90min;除3例存在结石残留外,余者均一期粉碎、排净。结论螺旋CT扫描及三维重建有助于复杂肾结石微创经皮肾镜碎石用通道建立的穿刺定位以及碎石过程中目标结石的定向搜寻和结石的一期清除。     

多层螺旋CT增强扫描对慢性肾盂肾炎的诊断价值

目的：探讨多层螺旋CT增强扫描在诊断慢性肾盂肾炎的应用价值。方法：回顾分析16例慢性肾盂肾炎患者的螺旋CT增强扫描图像。结果：本组16例中肾盂积水扩张10例,占62.5%;肾盂壁增厚、强化8例,占50.0%;肾盏变形10例,占62.5%;肾盏裸露征9例,占56.3%;肾实质凹陷征16例,占100.0%;肾功能减退13例,占81.3%;肾盂肾盏结石5例,占31.3%。肾盂肾盏形态改变、肾实质凹陷征、肾盏裸露征、肾功能减退和肾盂积水,肾盂壁增厚是慢性肾盂肾炎的特征性的CT表现。结论：多层螺旋CT增强扫描能准确显示慢性肾盂肾炎的影像特征,为临床的诊断和治疗提供依据。     

泌尿系结石的螺旋CT诊断

目的 探讨泌尿系结石的CT表现及其诊断价值.方法 分析60个临床及其他检查怀疑泌尿系结石患者的CT图像.结果 单纯肾结石27例、单纯输尿管结石14例、两者均有结石12例;单纯膀胱结石5例,2例未发现结石.其中,40例有肾盏肾盂扩张和输尿管扩张,10例可见环形征.结论 泌尿系结石的CT表现具有特征性,有重要的诊断价值.     

64层螺旋CT三维重建技术在泌尿系疾病诊断中的应用价值

目的:探讨64层螺旋CT三维重建技术在泌尿系疾病诊断中的应用价值.方法:对36例泌尿系疾病患者行64层螺旋CT平扫、双期增强以及延时扫描.利用后处理技术对图像数据进行三维重建,得到包括肾盏、肾盂、输尿管及膀胱在内的完整泌尿系三维图像.结果:64层螺旋CT三维重建图像清晰显示了泌尿系的解剖结构以及病变和尿路之间的空间关系.诊断泌尿系结石19例,肾输尿管肿瘤7例,肾盂输尿管重复畸形7例,肾位置异常2例,腔静脉后输尿管1例.肿瘤病例均经手术病理证实,其余病例与超声检查结果相符.CT诊断与临床诊断符合率100%.结论:64层螺旋CT三维重建技术对显示泌尿系病变部位、病因和尿路梗阻的程度具有高速快捷、安全可靠的特点,可提供高分辨率全尿路三维图像,是诊断泌尿系疾病的一种无创影像学方法.     

多层螺旋CT泌尿系统成像对肾盂旁囊肿的诊断价值

目的探讨多层螺旋CT泌尿系统成像对肾盂旁囊肿的应用价值。方法对15例肾盂旁囊肿患者的螺旋CT平扫、增强多期扫描及多平面重建表现资料进行回顾性分析总结。结果肾盂旁囊肿表现为肾窦内无强化的囊性病灶,延迟期扫描无对比剂进入,而周围受压变形的肾盏及肾盂内可见对比剂进入。MPR图像对肾盂、肾盏及部分输尿管受压变形情况显示良好,可以不同方位显示病变本身及周围情况,有助于病变的定性定位诊断。结论螺旋CT增强多期扫描结合多平面重建对肾盂旁囊肿的诊断和鉴别诊断具有重要应用价值。     

64层螺旋CT三维重建技术在泌尿系疾病诊断中的应用价值

目的:探讨64层螺旋CT三维重建技术在泌尿系疾病诊断中的应用价值.方法:对36例泌尿系疾病患者行64层螺旋CT平扫、双期增强以及延时扫描.利用后处理技术对图像数据进行三维重建,得到包括肾盏、肾盂、输尿管及膀胱在内的完整泌尿系三维图像.结果:64层螺旋CT三维重建图像清晰显示了泌尿系的解剖结构以及病变和尿路之间的空间关系.诊断泌尿系结石19例,肾输尿管肿瘤7例,肾盂输尿管重复畸形7例,肾位置异常2例,腔静脉后输尿管1例.肿瘤病例均经手术病理证实,其余病例与超声检查结果相符.CT诊断与临床诊断符合率100%.结论:64层螺旋CT三维重建技术对显示泌尿系病变部位、病因和尿路梗阻的程度具有高速快捷、安全可靠的特点,可提供高分辨率全尿路三维图像,是诊断泌尿系疾病的一种无创影像学方法.     

肾结构异常与肾结石形成关系的探讨

目的 探讨肾结构异常与结石形成的关系.方法 观察分析两医院2013年7月至10月345例肾结石患者的静脉肾盂造影X线片,统计单侧肾结石的发生率,观察比较结石患肾和健肾间的肾盂轴线与输尿管夹角、输尿管与肾下盏夹角、肾盂输尿管连接部狭窄、结石肾盏出口狭窄、结石肾盏长度、肾小盏的数量等多项指标.结果 单侧肾结石发生率为78.8％,结石患肾的结构存在一些异常,虽然单个异常比例不太高,但总计异常的比例较高.结论 在同一内环境的人体中单侧肾结石发生率高,这一现象值得关注,肾结构异常可能与肾结石的形成有显著的相关性.     

经皮肾镜与微创经皮肾取石术治疗肾结石的效果对比分析

目的 对比经皮肾镜和微创经皮肾取石术治疗肾结石的效果.方法 选取本院2008年1月至2012年1月期间行PCNL术的患者45例和行MPCNL术的患者48例.观察两组患者各项指标及并发症发生情况、结石清除率.结果 PCNL组鹿角形结石清除49.0％,单纯肾盂结石清除90.1％,肾盏多发结石清除62.3％; MPCNL组鹿角形结石清除60.8％,单纯肾盂结石清除61.1％,肾盏多发结石清除89.2％.两组鹿角形结石清除率、单纯肾盂结石清除率、肾盏多发结石清除率对比,差异有显著性(P＜0.05).结论 PCNL术适合治疗较大的肾盂结石,MPCNL术适合治疗较小的肾盂和肾盏结石.     

探讨经皮肾镜联合电子输尿管软镜治疗复杂肾结石的疗效

目的研究分析经皮肾镜联合电子输尿管软镜治疗复杂肾结石的临床效果。方法 61例复杂肾结石患者,采用经皮肾镜联合输尿管软镜碎石术进行治疗,对患者的治疗效果进行回顾性总结与分析。结果 61例复杂肾结石患者中59例患者肾盂及主要肾盏结石均成功取出,2例残留较大结石需要再次处理,患者结石清除率为96.7%,平均手术时间(110.2±23.6)min,且无一例患者出现严重并发症状及不良反应。结论经皮肾镜联合电子输尿管软镜进行复杂肾结石的治疗具有较好效果,且不良反应与并发症少、安全性高,值得临床推广和应用。     

鹿角形肾结石的微创治疗进展

鹿角形肾结石是位于肾盂、其分支进入肾盏的一类特殊类型的肾结石,临床上具有结石复杂、取石困难、手术中难以取尽结石和术后结石复发的特点,是泌尿外科临床上的治疗难点之一.当前,随着泌尿腔内技术的不断发展和碎石设备的日趋完善,体外冲击波碎石（ESWL）、经皮肾镜碎石（PCNL）、输尿管软镜技术、ESWL联合PCNL、PCNL联合输尿管软镜技术及腹腔镜等微创治疗正越来越多地应用于肾鹿角形肾结石的治疗,传统开放性手术在该类型肾结石的治疗中的使用率逐步下降.本文就微创治疗在鹿角形肾结石治疗中的应用现状与进展进行综述.     

Role of glutathione in reduction of arsenate and of gamma-glutamyltranspeptidase in disposition of arsenite in rats

Arsenate (AsV), the environmentally prevalent form of arsenic, is converted sequentially in the body to arsenite (AsIII), monomethylarsonic acid (MMAsV), monomethylarsonous acid (MMAsIII), and dimethylarsinic acid (DMAsV) and some trimethylated metabolites. Although the biliary excretion of arsenic in rats is known to be glutathione (GSH)-dependent, involving transport of arsenic-GSH conjugates, the role of GSH in the reduction of AsV to the more toxic AsIII in vivo has not been defined. Therefore, we studied how the fate of AsV is influenced by buthionine sulfoximine (BSO), which depletes GSH in tissues. Control and BSO-treated rats were given AsV (50 micromol/kg, i.v.) and arsenic metabolites in bile, urine, blood and tissues were analysed by HPLC-HG-AFS. BSO increased retention of AsV in blood and tissues and decreased appearance of AsIII in blood, bile (by 96%) and urine (by 63%). The biliary excretion of MMAsIII was also nearly abolished, the appearance of MMAsIII and MMAsV in the blood was delayed and the renal concentrations of these monomethylated arsenicals were decreased by BSO. Interestingly, appearance of DMAsV in blood and urine remained unchanged and the concentrations of this metabolite in the kidneys and muscle were even increased in response to BSO. To test the role of gamma-glutamyltranspeptidase (GGT) in arsenic disposition, the effect of the of the GGT inhibitor acivicin was investigated in rats injected with AsIII (50 micromol/kg, i.v.). Acivicin lowered the hepatic and renal GGT activities and increased the biliary as well as urinary excretion of GSH, but failed to alter the disposition (i.e. blood and tissue concentrations, biliary and urinary excretion) of AsIII and its metabolites. In conclusion, shortage of GSH decreases not only the hepatobiliary transport of arsenic, but also reduction of AsV and the formation of monomethylated arsenic, while not hindering the production of dimethylated arsenic. While GSH plays an important role in the disposition and toxicity of arsenic, GGT, which hydrolyses GSH and GSH conjugates, apparently does not influence the fate of the GSH-reactive trivalent arsenicals in rats.     

微透析取样技术在中药体内分析中的应用研究进展

本文综述了微透析取样技术在中药体内分析中的应用,介绍微透析取样技术的原理、组成、探针类型、特点,重点阐述了微透析取样技术在测定脑、血液、皮肤等组织器官中中药有效成分浓度的应用实例。表明微透析取样技术在中药药效研究中具有广阔的前景。     

应用PASS系统分析我院2010年住院医嘱

目的:了解我院2010年住院患者的合理用药情况,探讨如何利用合理用药监测系统( PASS)提高合理用药水平.方法:利用PASS对我院2010年15 966例住院患者的1 184 997条用药医嘱进行监测,以黑色警示医嘱为依据,收集不合理用药信息,并对监测结果进行统计、分析.结果:不合理用药医嘱50 261条,发生率为4.24％.绝对禁止黑色医嘱5441条,主要为药物相互作用(66.54％)、注射液体外配伍(17.86％)、用法用量(15.46％)、儿童警告(1.14％).结论:应用PASS系统能有效监测医嘱中的不合理用药情况,有利于提高临床合理用药水平,但PASS系统尚存在局限性,有待进一步完善.     

Changes in levels of dependency and predictors of mortality in elderly people in institutional care in Dunedin

The 1983 study of dependency of subjects in institutional care in Dunedin was repeated two years later. A significant increase in levels of dependency in residential homes, particularly in the Religious and Welfare sector was found. In 1983 there were 29 high dependency residents and 73 medium dependency residents in residential homes. In 1985 these numbers had increased to 55 and 86 respectively. There was no change in the number of low dependency residents. In 1983, 6 high dependency residents had been admitted to residential home care in the year prior to the study. In 1985 the number of high dependency residents recently admitted had increased to 23. There had also been a significant increase in the dependency of patients in Religious and Welfare continuing care hospitals. Of the 933 subjects in institutional care in 1983 who were able to be followed, 354 (37.9%) died in the following 2 years. Mortality rate was higher for those in hospital care (48.1%) than for those in residential home care (29.6%). Mortality rates were higher in more dependent subjects and this was evident for each measure of dependency.     

应用PASS系统对我院2008年住院医嘱的分析

目的监测分析2008年我院住院患者用药情况。方法将PASS系统嵌入医生工作站、临床药学工作站等子系统,构建合理用药计算机网络系统,对住院医嘱进行及时监测,将监测结果向医生反馈,并对其进行统计、分析。结果2008年共监测医嘱3 620 241条,不合理医嘱908条,占0.02%。不合理医嘱中,配伍禁忌(381条)占41.96%,用法用量(381条)占41.96%,药物相互作用(108条)占11.89%,儿童用药(38条)占4.19%。经与医生沟通后,更改不合理医嘱856条,占94.27%。结论PASS系统可有效监测医嘱中的不合理用药,通过与医生交流,大大减少药物不良事件的发生,值得临床推广应用,也为临床药师开展工作带来了极大的便利。但PASS系统尚存在局限性,有待进一步完善。     

Role of desacetylation in the detoxification of cephalothin in renal cells in culture

The toxicity of three cephalosporin antibiotics to rabbit kidney cells in culture was compared to their known nephrotoxic potential in vivo (cephaloridine greater than cefazolin greater than cephalothin). While cephalothin is considered to be a relatively nonnephrotoxic cephalosporin when administered to many species including humans and rabbits, in several in vitro systems involving rabbit renal tissue, cephalothin was comparatively more toxic than anticipated based on in vivo data. Cephalothin is extensively desacetylated in rabbits to a less microbiologically active metabolite, desacetylcephalothin. When a microsomal S9 fraction from rabbit kidney was added to the in vitro assay in cultured rabbit renal cells, cephalothin was desacetylated and its toxicity to kidney cells was reduced. The addition of S9 in vitro provided a toxicity ranking of the cephalosporins that correlated with their known in vivo nephrotoxic potentials (cephaloridine greater than cefazolin greater than cephalothin). The in vitro detoxification of cephalothin by S9 was blocked by the coadministration of the esterase inhibitor, aminocarb. Desacetylcephalothin was relatively nontoxic to rabbit renal tissue in vitro. These results suggest that the desacetylation of cephalothin in vivo represents a previously unrecognized mechanism of detoxification of this cephalosporin antibiotic. Furthermore, this mechanism of detoxification may be applicable to other acetylated cephalosporins.     

2009年某院住院患者抗真菌药用药调查

目的:分析讨论某院抗真菌药使用的合理性,为临床安全有效地使用抗真菌药提供参考。方法:回顾性统计分析某院2009年住院患者抗真菌药用药信息。结果:2009年某院住院患者抗真菌药DDDs排名前3名分别为:氟康唑、制霉菌素和伊曲康唑;使用金额排名前3名分别为:氟康唑、米卡芬净及卡泊芬净;更换一种抗真菌药进行治疗的患者数为176人,在全部患者中占13.4%。结论:应进一步强化用药指征的意识,提高标本送检率,同时改善某些抗真菌用药不合理更换的现象,以避免耐药性发生,从而更好更长远地体现抗真菌药的治疗价值。     

Kinetics of in vitro metabolism of methoxyphenamine in rats

1. Methoxyphenamine (MP) was metabolized in vitro by rat liver preparations to O-desmethylmethoxyphenamine (O-desmethyl-MP), N-desmethylmethoxyphenamine (N-desmethyl-MP) and 5-hydroxymethoxyphenamine (5-hydroxy-MP). These metabolic pathways were inhibited by SKF 525-A and carbon monoxide, which indicates that these reactions were mediated at least partly by an NADPH-dependent cytochrome P-450 system. 2. Strain differences in the metabolism of this drug in vitro were observed in female Lewis and Dark Agouti (DA) rats, which are proposed models for human debrisoquine phenotypes. Methoxyphenamine O-demethylase and 5-hydroxylase activity in DA rats were lower than those in Lewis rats. 3. The metabolic transformation of methoxyphenamine in vitro to O-desmethyl-MP was inhibited competitively by debrisoquine and sparteine. This indicates that the cytochrome P-450 isoenzyme mediating the metabolism of MP to O-desmethyl-MP is similar to that mediating metabolism of debrisoquine and sparteine. However, no inhibition was observed with methenytoin.     

Comparison of in vitro cell models in predicting in vivo brain entry of drugs

Although several in vitro models have been reported to predict the ability of drug candidates to cross the blood-brain barrier, their real in vivo relevance has rarely been evaluated. The present study demonstrates the in vivo relevance of simple unidirectional permeability coefficient (P(app)) determined in three in vitro cell models (BBMEC, Caco-2 and MDCKII-MDR1) for nine model drugs (alprenolol, atenolol, metoprolol, pindolol, entacapone, tolcapone, baclofen, midazolam and ondansetron) by using dual probe microdialysis in the rat brain and blood as an in vivo measure. There was a clear correlation between the P(app) and the unbound brain/blood ratios determined by in vivo microdialysis (BBMEC r=0.99, Caco-2 r=0.91 and MDCKII-MDR1 r=0.85). Despite of the substantial differences in the absolute in vitro P(app) values and regardless of the method used (side-by-side vs. filter insert system), the capability of the in vitro models to rank order drugs was similar. By this approach, thus, the additional value offered by the true endothelial cell model (BBMEC) remains obscure. The present results also highlight the need of both in vitro as well as in vivo methods in characterization of blood-brain barrier passage of new drug candidates.