腹膜后纤维化的诊治体会

腹膜后纤维化(retmperitoneal fibmsis,RPF)大多数原因不明,可引起输尿管周围发生纤维化粘连,包绕压迫上尿路引起肾积水和肾功能损坏.回顾性分析36例RPF患者的临床资料,报道如下.     

垂体泌乳素微腺瘤致男性不育二例及文献复习

本文报道2例男性垂体泌乳素微腺瘤并不育患者的临床表现及治疗情况,1例患者为重度少精症仅实施溴隐亭治疗后复查精液及性激素;另1例患者主要表现为性欲低下,给予溴隐亭及十一酸睾酮治疗。2例患者经药物治疗后,症状均有明显改善,性激素复查基本正常,且2例患者妻子均成功受孕。认为溴隐亭在男性泌乳素微腺瘤并不育症治疗中有效,针对不同临床表现可考虑个性化的治疗方案。     

18F-FDG PET/CT诊断腹膜后纤维化

目的探讨~(18 )F-FDG PET/CT诊断腹膜后纤维化(RPF)的价值。方法回顾性分析因RPF接受~(18 )F-FDG PET/CT检查的12例患者,分析其病灶形态、分布范围和葡萄糖代谢活性最大标准摄取比值(SUV_(max))。结果 12例患者中,7例为初诊患者,5例为治疗后患者。7例初诊RPF患者中4例为继发性,病因分别为IgG4相关疾病、乳腺癌和前列腺癌。12例患者均可见腹主动脉和/或髂血管旁软组织密度病灶,91.67%(11/12)患者可见输尿管受累。初诊RPF患者腹膜后病灶SUV_(max)(4.21±1.76)显著高于治疗后患者(1.46±0.25;P0.05)。依据PET/CT检查结果,3例有代谢活性病灶的特发RPF患者接受激素和/或他莫昔芬等免疫抑制治疗,4例具有活性病灶的继发RPF患者接受针对病因治疗;5例治疗后患者,3例继续当前激素维持剂量治疗,2例未接受其他治疗。结论 PET/CT可用于评价RPF病灶活性和分布范围。     

继发性腹膜后纤维化引起的肾积水的诊治

腹膜后纤维化 (retroperitonealfibrosis,RPF)系腹膜后结缔组织广泛纤维化 ,压迫血管、神经、胃肠道和输尿管而出现的临床症状 ,其中输尿管周围发生纤维化粘连 ,包绕压迫上尿路引起肾积水和肾功能衰竭最为常见。有特发性RPF和继发性RPF。我院 1 990年 5月～ 2 0 0 1年 1 2月共收治继发性RPF 8例 ,现报告如下。1　资料与方法本组 8例 ,男 7例 ,女 1例 ,年龄 35～ 67岁 ,平均 43岁。 3例为直肠癌术后 ,1例胃癌术后 ,1例腰大肌纤维肉瘤 ,1例卵巢癌盆腔淋巴结清扫术后 ,2例结核。临床症状 :腰腹痛 2例 ,少尿 4例 ,无尿 2例。实验室检查血肌…     

特发性腹膜后纤维化

腹膜后纤维化 (ｒｅｔｒｏｐｅｒｉｔｏｎｅａｌｆｉｂｒｏ ｓｉｓ,ＲＰＦ)是一种以腹膜后纤维脂肪组织增生为特征的非特异性非化脓性炎症 ,引起腹膜后广泛纤维化 ,使腹膜后空腔脏器受压而发生梗阻。该病累计报道大约 10 0 0例左右 ,以白种人多见 ,我国人相当少见 ,国内公开报道不超过 5 0例。Ｋｏｅｐ等报道大约 1/ 3ＲＰＦ病例的病因与某些药物、肿瘤、外伤等因素有关 ,称为继发性腹膜后纤维化 ;2 / 3的病例病因未明称为特发性腹膜后纤维化(ＩＲＦ)。而ＩＲＦ诊断困难 ,病理上有全身多灶性倾向 ,治疗意见欠一致 ,因此将近年来有关文献作一…     

腹膜后纤维化致上尿路梗阻临床分析

目的 加深对腹膜后纤维化的认识，探讨腹膜后纤维化的病因、诊断及治疗；方法 对9例临床收治的腹膜后纤维化病例临床资料进行回顾性分析，其中原发性6例，继发性3例；所有原发性患者行输尿管松解术手术治疗，3例继发性患者中2例行输尿管支架术，1例行肾穿刺造瘘术：结果随访1～3年，所有病例术后。肾功能均有改善或恢复正常，3例继发性患者2例分别于术后4个月、9个月死于原发病一结论腹膜后纤维化所致上尿路梗阻病例采用静脉肾盂造影或逆行造影、B型超声、CT与X线等检查可明确诊断，治疗以去除病闪、解除尿路梗阻保护肾功能为主要治疗方法     

甲磺酸α-二氢麦角隐亭及甲磺酸溴隐亭治疗高催乳素血症的疗效和副作用的比较

目的探讨甲磺酸溴隐亭及甲磺酸α-二氢麦角隐亭治疗高催乳素血症的疗效及副反应。了解甲磺酸α-二氢麦角隐亭的临床应用价值。方法募集2010年3月至2012年6月在广西钦州市第二人民医院妇产科门诊就诊的高催乳素血症患者96例,随机分为两组:观察组(A组,n=48)服用甲磺酸α-二氢麦角隐亭;对照组(B组,n=48)服用甲磺酸溴隐亭。分别于服用药物后的30、60、90、120、150、180d测定血清催乳素(PRL)下降的情况,并观察月经恢复情况、溢乳控制情况及药物副反应。结果 (1)两组患者使用药物后血清PRL水平均下降,但组间无统计学差异(P0.05)。(2)观察组头晕、恶心和体位性低血压等副反应发生率显著低于对照组(P0.05)。对照组有5例因严重副反应停药,改用甲磺酸α-二氢麦角隐亭治疗。观察组中无因为药物副作用而终止治疗者。结论服用甲磺酸α-二氢麦角隐亭治疗高催乳素血症的临床疗效与甲磺酸溴隐亭相似,但其药物副作用的发生率及严重程度明显低于使用甲磺酸溴隐亭。甲磺酸α-二氢麦角隐亭治疗高催乳素血症是临床用药的一种新选择。     

系统性红斑狼疮并发腹膜后纤维化的临床特征分析

目的分析系统性红斑狼疮(systemic lupus erythematosus,SLE)并发腹膜后纤维化(retroperitoneal fibrosis,RPF)的发病机制、临床表现、实验室检查、影像学检查以及治疗预后,旨在提高临床医师对SLE并发腹膜后纤维化的认识。方法收集整理我科1例SLE并发RPF患者的临床资料并进行分析,同时查阅并复习国内外相关文献,总结SLE并发RPF的临床特征。结果本文报道1例及国外报道7例SLE并发RPF病例,其中6例为女性患者,2例为男性患者,发病年龄17~54岁,中位年龄为26岁,平均年龄(30.9±15.8)岁。8例SLE并发RPF患者中,4例为腰腹痛就诊,3例为水肿,1例为关节痛。实验室检查提示8例患者均出现不同程度的蛋白尿、血尿,除1例未提及,其他7例抗核抗体均阳性。8例患者中,1例因病情恶化而死亡,7例行糖皮质激素或激素联合外科手术,病情好转后出院,随访无复发。结论 SLE并发RPF在临床上属于罕见病,目前发病机制不清,主要认为与自身免疫性疾病有关,临床症状无特异性,主要表现为局部疼痛和下肢水肿,其诊断主要依赖于影像学检查,目前治疗建议使用激素和免疫抑制剂,对于病变累及输尿管引起输尿管梗阻肾积水的患者可行外科输尿管松解术。     

腹膜后纤维化合并食管狭窄的临床分析

腹膜后纤维化(retroperitoneal fibrosis,RPF)为临床少见疾病,国外报道年平均发病率为1/20万～1/50万[1],合并食管狭窄更为少见.本文对1999年至2006年我院3例RFP合并食管狭窄的患者进行回顾性分析,现报道如下.     

腹膜后纤维化诊治体会（附6例报告）

目的：探讨腹膜后纤维化防治方法。方法：回顾分析我院收治的6例腹膜后纤维化患者的治疗方法。结果：6例患者中有4例行输尿管松解术，术后输尿管梗阻解除，肾积水减轻，肾功能恢复良好。结论：输尿管松解术是治疗腹膜后纤维化的效果良好的手术方法。对泌尿系炎症给予积极的治疗，防止诱发腹膜后纤维化。肾损伤保守治疗期间和治疗后定期作必的检查，了解腹膜后血肿的吸收情况，以便及时防止腹膜后纤维化。     

Burdened by training not by anaesthesia

Editor—Larsson and colleagues¹ have investigated importantbut often ignored aspects of anaesthetic practice. However,they imply that specialist anaesthetists experience reducedlevels of stress when compared with trainees because they havedeveloped successful coping mechanisms over the years. Thisconclusion cannot be drawn because the specialists' attitudesto work were identified at a particular time and cannot showa progression in learned coping abilities. To demonstrate thedevelopment of these skills, the specialists would have hadto be interviewed     

Treatment of hemospermia caused by dilated seminal vesicles by direct drug injection guided by ultrasonography

Bilateral seminal vesicle puncture and injection of drugs with ultrasound guidance were performed in patients with hemospermia resistant to conservative therapy and with dilated seminal vesicles. Of 7 patients 6 had resolution of hemospermia for 2 to 3 months and then relapse. No side effect was noted.     

Amplification by hyperoxia of coronary vasodilation induced by propofol

We tested the hypothesis that in vitro coronary and myocardial effects of propofol (10-300 microM) should be significantly modified in an isolated and erythrocyte-perfused rabbit heart model in the absence (PaO(2) = 137 +/- 16 mm Hg, n = 12) or in the presence (PaO(2) = 541 +/- 138 mm Hg, n = 12) of hyperoxia. The induction of hyperoxia provoked a significant coronary vasoconstriction (-13% +/- 7%). Propofol induced increased coronary vasodilation in the presence of hyperoxia. Because high oxygen tension has been reported to induce a coronary vasoconstriction mediated by the closure of adenosine triphosphate-sensitive potassium channels, we studied the effects of propofol in 2 additional groups of hearts (n = 6 in each group) pretreated by glibenclamide (0.6 microM) and cromakalim (0.5 microM) in the absence and presence of hyperoxia, respectively. The pretreatment by glibenclamide induced a coronary vasoconstriction (-16% +/- 7%) which did not affect propofol coronary vasodilation. The pretreatment by cromakalim abolished the amplification of propofol coronary vasodilation in the presence of hyperoxia. Propofol induced a significant decrease in myocardial performance for a concentration >100 micro M both in the absence and presence of hyperoxia. We conclude that propofol coronary vasodilation is amplified in the presence of hyperoxia. This phenomenon is not explained by the previous coronary vasoconstriction induced by glibenclamide. However, the pretreatment of hearts by cromakalim abolished the amplification of propofol coronary vasodilation in the presence of hyperoxia. The myocardial effects of propofol were not affected by the presence of hyperoxia. IMPLICATIONS: Propofol induced a coronary vasodilation that was amplified in the presence of hyperoxia. This phenomenon does not seem to be related to previous coronary vasoconstriction. The myocardial effects of propofol were not significantly modified in the presence of hyperoxia.     

Direct plexus repair by grafts supplemented by nerve transfers

This article reviews the Louisiana State University Health Sciences Center experience with direct repair of brachial plexus lacerations, gunshot wounds, and stretch/contusive/avulsive injuries. In the stretch category, limited outcomes with direct repair have led to addition of nerve transfers rather than their exclusive use. It is important to per-form direct plexus repair in conjunction with nerve transfers in the same patient when-ever possible. The intent of such a "pants-over-vest" approach is to maximize axonal input to denervated structures.     

Lavage by laparoscopy fares better than lavage by laparotomy

Background: Although carbon dioxide (CO2) pneumoperitoneum is proposed increasingly for treatment of secondary peritonitis, associated deleterious effects have been reported in experimental models, with the hypothesis that increased intraperitoneal pressure might facilitate bacterial translocation. The purpose of this study was to compare the outcome (and qualitative microbiologic analysis) from peritonitis in rats after lavage by laparoscopy with the outcome after lavage by laparotomy. Methods: After determination of the standard innoculum for this study in 30 animals, 120 male Wistar rats received 1 ml of Escherichi coli 106 colony-forming unit (CFU), Bacteroides fragilis 107 CFU, Enterococcus faecalis 107 CFU in a sterile rat feces-barium sulfate suspension adjuvant, were anesthetized with intramuscular ketamine, and then underwent peritoneal lavage by either laparotomy (n = 60) or laparoscopy (n = 60). The duration of peritonitis defined two groups: group A: duration less than 3 h (n = 20) and group B: duration 3 h or more (n = 40). Both groups underwent successive lavage with 10-ml aliquots (total, 50 ml) of 0.9% saline solution at 37°C. Five 2-ml samples of liquid lavage were drawn for culture and microbiologic analysis. Blood (0.2 ml) and peritoneal liquid lavage samples were incubated 48 h at 37°C and cultured. Results: All the animals survived. Mean duration of peritoneal lavage was 13.2 min (range, 6-25 min) for laparoscopy and 9.7 min (range, 6-15 min) and for laparotomy. The difference was not statistically significant. The mean duration of operation was significantly longer with laparoscopy than with laparotomy: 44.5 min (range, 35-62 min) and 25 min (range, 16-40 min), respectively (p = 0.0001). The collected lavage volumes were not statistically different: 48.5 ml (range, 40-54 ml) and 46.7 ml (range, 37-56 ml), respectively. No statistically significant differences were found between the laparoscopy and laparotomy groups in terms of E. coli bacteremia, irrespective of peritonitis duration. The rates of positive blood culture for B. fragilis and E. faecalis were signficantly lower after laparoscopy than after laparotomy, both in the overall group (p = 0.025 and p = 0.045, respectively) and when duration of peritonitis exceeded 3 h (p = 0.001 and p = 0.044, respectively). Conclusions: In this animal model of secondary peritonitis, lavage by laparoscopy was associated with less bacteremia for B. fragilis and E. faecalis than peritoneal lavage by laparotomy.     

Tracheal constriction by morphine and by fentanyl in man

The effects of morphine and fentanyl on tracheal smooth muscle tone were studied in 38 patients during induction of anesthesia. Endotracheal tube cuff pressure was used to measure tracheal tone. Anesthesia was maintained with nitrous oxide, 70 per cent in oxygen, and pancuronium and ventilation was controlled with a respirator. Morphine, 0.5 mg/kg, produced a biphasic response, initially causing tracheal dilatation and then tracheal constriction. Ten minutes after morphine injection, cuff pressure increased to significantly (21 +/- 8 per cent) above control. Morphine-induced tracheal constriction could be completely blocked by the prior administration of atropine, 0.5 mg. Fentanyl, 0.006 mg/kg, also produced significant tracheal constriction, cuff pressures increasing to 44 +/- 11 per cent above control at 10 min. Fentanyl-induced tracheal constriction could be blocked by pretreatment with droperidol, 0.25 mg/kg. At equianalgesic doses, morphine and fentanyl produced similar tracheal constriction.