Percutaneous antegrade ureteric stent insertion in malignant disease.

Untreated, progressive bilateral ureteric obstruction, or unilateral ureteric obstruction in patients with a solitary functioning kidney, will ultimately lead to uraemia, renal failure and death. This paper describes 34 successful percutaneous antegrade ureteric stent placements from 37 attempts, performed on 25 selected patients with a history of malignant disease, in whom retrograde ureteric stenting was impossible or difficult.     

顺行与逆行输尿管镜技术处理输尿管上段嵌顿性结石的疗效比较

目的 比较顺行与逆行输尿管镜技术处理输尿管上段嵌顿性结石的疗效,并对其安全性与有效性进行评价.方法 采用输尿管镜技术共治疗输尿管上段嵌顿性结石106例,其中顺行经皮肾微造瘘入路50例(顺行组),逆行经尿道入路56例(逆行组).结果 逆行组手术成功52例(92.9%),手术时间(45±5)min,住院时间(6±1)d,一期结石清除率80.4%(45/56),7例需体外冲击波碎石术(ESWL)辅助治疗,出现手术并发症3例(5.4%);顺行组手术成功50例(100.0%),手术时间(55±8)min,住院时间(8±2)d,一期结石清除率100.0%(50/50),无手术并发症发生.两组一期结石清除率和并发症发生率比较差异有统计学意义(P＜0.05).结论 顺行与逆行输尿管镜技术处理输尿管上段嵌顿性结石均有较高的手术成功率,顺行入路的安全性与有效性更好,但手术时间及住院时间稍长.     

Urographic appearances in renal failure due to intraluminal ureteric obstruction.

With reference to a series of 13 patients, the urographic signs seen in the conditions of acute, post-acute, chronic and acute-on-chronic obstruction are described. These are seen in a relatively pure form in patients with renal failure due to ureteric calculi. Patients in renal failure with acute, post-acute or acute-on-chronic obstruction are anuric or oliguric; patients with chronic obstruction due to bilateral ureteric stones are polyuric. After removal of the stones the urine output returns to normal in cases of acute obstruction, is reduced in chronic obstruction but is increased in post-acute obstruction. A further case is described which illustrates the importance of recognizing post-acute obstruction unaccompanied by pain: the kidney may be completely obstructed and so be destroyed. The different types of obstruction are recognized by considering the nephrographic and pyelographic signs together with the presence of pain.     

Intraluminal stenting in the management of adhesional intestinal obstruction.

Intraluminal stenting of the small bowel has been advocated as a method of reducing the risk of recurrent adhesional obstruction in patients requiring adhesolysis. We reviewed the complications and efficacy of this technique in 25 patients undergoing surgery for relief of intestinal obstruction due to complex, extensive and dense adhesions. Five patients developed minor and three patients major complications. Three (13%) of 23 patients alive after mean follow-up of 4 years had had episodes of recurrent intestinal obstruction, but none had required reoperation. Intraluminal stenting remains of unproven efficacy. It may find a place as an adjunct to adhesolysis in patients requiring repeated operations for the relief of obstruction due to extensive and dense adhesions; but, in view of the high rate of complications, careful case selection will be necessary.     

Double-ended pigtail polyethylene stents in management of benign and malignant ureteric obstruction.

Surgical urinary diversion for incurable pelvic malignancy has a high morbidity and mortality, and external drainage provides less than ideal palliation. Six patients with ureteric obstruction caused by cancer have been managed by operative or endoscopic insertion of self-retaining polyethylene tubes. These techniques also have applications in non-malignant disease, and the treatment of two patients with benign ureteric stricture is described.     

输尿管镜治疗输尿管结石梗阻并发急性肾功能衰竭

目的探讨输尿管结石梗阻并发急性肾功能衰竭的治疗方法.方法应用输尿管镜直视下气压弹道碎石治疗输尿管结石梗阻并发急性肾功能衰竭32例.结果术后全部患者血Bun、Cr均不同程度降低或恢复正常,结石清除率为88.2%.结论输尿管镜直视下气压弹道碎石治疗榆尿管结石梗阻并发急性肾功能衰竭具有安全、疗效可靠、损伤小的优点,能同时处理双侧输尿管病变.     

颈动脉超声对颈动脉支架置入术适应证选择的临床价值简

目的：探讨颈动脉超声在颈动脉支架置入术适应证选择中的临床价值。方法：回顾分析62例颈动脉狭窄（≥50％）行颈动脉支架置入术的患者颈动脉超声和数字减影血管造影术（DSA）检查结果。结果：以70％狭窄为切分点。颈动脉超声／DSA对中度狭窄（50％-69％）诊断的吻合比例（32／29）,对重度狭窄（≥70％）诊断的吻合比例（30／33）。颈动脉超声与DSA两种方法的检出率间差异无统计学意义（P〉0．05）。结论：颈动脉超声检查可以用于颈动脉支架置入术患者的筛查并指导临床医生进一步选择最佳治疗方案。     

A study of the value of colonic stenting as a bridge to elective surgery for the management of acute left-sided malignant colonic obstruction: the STENT-IN 2 study

Conventionally, patients with acute left-sided malignant colonic obstruction are treated with emergency surgery to restore luminal patency. These emergency operations have a mortality rate of 15-34% and a morbidity rate of 32-64% despite advances in perioperative care. Since the early 1990s, colonic stenting has been introduced, mainly in the left-sided colon, to restore luminal patency. In uncontrolled studies, stent placement before elective surgery has been suggested to improve the patient's clinical condition, thus decreasing mortality, morbidity, and the number of colostomies. To date, only one randomised controlled trial has been published: this study had several limitations, due to which there is still insufficient evidence. Therefore, a large-scale comparison between these two treatment algorithms has been initiated in a prospective multicentre randomised setting with respect to quality of life, morbidity, mortality, and healthcare costs.     

输尿管中下段微小结石非增强螺旋CT诊断

目的 探讨非增强螺旋CT检查对输尿管中下段小结石的诊断价值.方法 152例输尿管中下段小结石患者均行非增强螺旋CT检查（结合多平面重建和三维重建）和B超检查,其中65例还行X线平片及静脉肾盂造影检查.结果 CT明确诊断输尿管中下段小结石146例,疑诊6例;B超诊断输尿管中下段小结石32例;X线诊断输尿管中下段小结石21例.结论 结合轴位图像和后处理技术,非增强螺旋CT检查较其他影像检查方法具有更高的检出率和诊断价值.     

多层螺旋CT对结肠癌性肠梗阻的诊断价值

目的 探讨多层螺旋CT(MSCT)在结肠癌性肠梗阻诊断中的临床价值.方法 分析40例MSCT诊断为结肠癌性肠梗阻患者的临床资料及MSCT检查资料.结果 40例MSCT诊断结肠癌性肠梗阻患者中,完全性肠梗阻17例,不完全性肠梗阻23例,经手术病理证实39例为结肠癌性肠梗阻,1例证实为肠多发息肉所致套叠性肠梗阻,梗阻原因定性准确率为97.5％(39/40),肠梗阻诊断准确率为100.0％(40/40);梗阻部位:升结肠14例,横结肠4例,结肠脾曲2例,降结肠6例,乙状结肠12例,横结肠与升结肠复合病变1例,结肠及小肠多发病变1例,MSCT对病变部位诊断准确率为100.0％(40/40).结论 MSCT对结肠癌性肠梗阻在确定梗阻存在、梗阻部位、梗阻原因方面具有明显优势,能为临床治疗提供重要诊断价值.     

The value of music for hospitalized infants.

Infants are very responsive to stimuli and may be even more vulnerable to the adverse effects of hospitalization than older children. Play techniques are effective in helping older children cope with the emotional effects of hospitalization; however their potential may be limited with small infants. Music therapy could offer a more direct and effective means of constructive interaction with this easily overlooked and underestimated age group. This paper reviews the results of a three-month trial of music therapy in an infant ward at the Izaak Walton Killam Hospital for Children, Halifax, Nova Scotia.