Urinary tract calculi and thresholds in carcinogenesis.

Numerous chemicals administered to rodents at relatively high doses produce urinary tract calculi, resulting in erosions or ulcerations of the urothelium, consequent regenerative hyperplasia, and ultimately tumors. This is a high-dose (threshold) phenomenon, which appears to occur more readily in rodents than in primates, including humans. Several anatomic and urinary physiologic differences between rodents and humans affect the quantitative extrapolation from results in rodent bioassays to human risk assessment. For most chemicals producing tumors by this mode of action, human exposures are significantly lower than would be expected to be required for production of calculi, and therefore pose no carcinogenic hazard to humans.     

Preputial separation and glans penis changes in normal growing Crj: CD (SD) IGS rats.

This study was designed to detect preputial separation and glans penis changes in normal growing SD rats. We examined the changes until 53 days after birth. The glans penis surface changed from a protruding os penis structure to a W shape, and from a W shape to a flattened surface with age. The protruding os penis structure changed gradually to the W shape from postnatal day (PND) 30, and all rats had the W shape by PND 35. The flattened surface was observed from PND 39, and all rats had this structure by PND 44. In all rats, the day of complete preputial separation exactly corresponded to the day of appearance of the flattened surface.     

关于胆囊结石、胆囊结石合并胆总管结石、胆总管结石抗生素抗性基因的初步研究

目的 了解抗生素抗性基因在胆石病患者中的分布状况,为临床合理使用抗生素提供理论依据。方法 收集胆囊结石30例、胆囊结石合并胆总管结石30例、胆总管结石30例,对采集到的标本进行细菌基因组的提取,并采用qPCR的方法对提取的基因组进行检测。结果 在检测到的ARGs中,胆囊结石患者β-内酰胺类抗生素抗性基因占的比例最低为5.92%,检测到的基因有8种,strB基因检出率最高,为27.1%。blaTEM、cfxA、aacc、aadD、aadA1、tetX和sull的检出率分别为13.9%、5.1%、5.1%、7.7%、20.7%、4.6%和15.6%。胆囊结石合并胆总管结石患者β-内酰胺类抗生素抗性基因占的比例最低为12.94%,检测到的基因有15种,sull基因检出率最高,为17.1%。blaCTX-M、blaTEM、blaSHV、ampC-01、ampC/blaDHA、blaACC-1、blaGES、cfxA、aac、aacc、aadA1、strB和tetX的检出率分别为3.2%、9.4%、4.4%、3.4%、8.9%、4.2%、2.8%、2.5%、8.2%、3.9%、8.1%、6.2%、8.2%和9.4%。胆总管结石患者氨基糖苷类抗生素抗性基因占的比例最低为17.34%,检测到的基因有16种,blaTEM基因检出率最高,为9.1%。blaCTX-M、blaSHV、ampC-01、ampC/blaDHA、bla-ACC-1、blaCMY、blaGES、cfxA、aac、aacc、aadA1、strB、tetX和sull的检出率分别为7.3%、6.5%、7.6%、5.4%、5.6%、3.3%、6.4%、4.0%、4.5%、4.7%、6.9%、6.1%、6.0%、7.8%和8.9%。blaCMY只在胆总管结石被测到,aadD只在胆囊结石中被测到。结论 ARGs不仅广泛存在于公共环境中,也存在于人体胆道系统中;同时,在胆道系统中,胆总管结石携带ARGs最多,胆囊结石合并胆总管结石次之,胆囊结石携带的ARGs最少;胆囊结石患者和胆囊结石合并胆总管结石患者中β-内酰胺类抗生素抗性基因含量最低;胆总管结石患者中氨基糖苷类抗生素抗性基因含量最低。这些发现可以为胆石病患者在抗生素的选择上提供理论依据。     

Pharmacology for renal calculi

Stone disease is as old as recorded history but despite advances in diagnosis and treatment, it continues to cause significant morbidity. This review summarises the current pharmacologic management of urinary calculi based upon the stone type. All patients with stone disease are advised to increase fluid intake, limit dietary protein and limit sodium. Calcium oxalate stones can be managed on a selective or non-selective basis depending on the cause of the hypercalciuria or hyperoxaluria. Agents currently in use include sodium cellulose phosphate, thiazides, orthophosphates, oral calcium supplements, pyridoxine, cholestyramine, citrate, magnesium and allopurinol. Classically, struvite stones occur in the presence of urea splitting organisms and are composed of magnesium, ammonium phosphate and carbonate apatite. The goal of treatment is to make patients stone free as bacteria retained in stone fragments lead to stone growth. Urease inhibitors, aluminium hydroxide gel, hemiacidrin, and Suby G and M solutions are infrequently used in treatment. Cystine stones are the result of an autosomal recessive disorder. D-Penicillamine, captopril and alpha-mercaptopropionylglycine (MPG) are all oral agents that have proven to be efficacious. As more randomised trials are conducted and the understanding of endogenous stone inhibitors progresses, the medical management of stone disease will continue to improve.     

应用Turner-Warwick切口治疗小儿膀胱结石及输尿管结石的体会

目的：探讨Turner-Warwick切口治疗小儿输尿管下段结石合并膀胱结石开放手术的方法。方法：本院在2006～2010年收治的4例输尿管下段结石合并膀胱结石患儿,年龄4～8岁,平均5.8岁,其中3例男孩,1例女孩,输尿管下段结石合并膀胱结石2例,双侧输尿管下段结石1例,一侧输尿管下段结石1例,均采用Turner-Warwick切口,行输尿管切开取石术联合膀胱切开取石术,均行膀胱造瘘术,不放置双＂J＂管,均于输尿管内放置硬膜外导管经膀胱造瘘管引出体外。结果：4例均成功取出结石,7～9d拔除膀胱造瘘管和硬膜外导管,无尿外渗及切口感染,随访无复发。结论：对8岁以下小儿不适合行输尿管镜碎石及ESWL的输尿管下段结石合并膀胱结石的患者,本术式是不错的选择。     

输尿管结石的腔镜手术治疗

目的回顾性总结分析输尿管结石腔镜手术经验。方法2004年9月～2007年11月为100例患者施行榆尿管结石腔镜手术,其中男43例,女57例,18—82岁,平均42．3岁;其中输尿管镜碎石术83例,经皮肾榆尿管镜取石（PCNL）9例,后腹腔镜取石术14例。结果104例完成手术,其中1例因输尿管断裂于手术次日行开放手术;无腹腔内脏器损伤、死亡等并发症发生;中转开放手术2例。PCNL和后腹腔镜组的术中出血量、和手术时间多于输尿管镜组,患者住院时间也较长。结论输尿管镜仍是解决输尿管结石的主要手段,PCNL和后腹腔镜取石术适用于治疗复杂输尿管结石。     

开放手术治疗复杂性肾结石

目的：探讨开放手术治疗复杂性肾结石的疗效。方法：对不宜行体外冲击波碎石治疗的218例复杂性肾结石行开放手术治疗．并采用气压弹道碎石技术及内腔镜技术等协助取石。结果：除1例无效而再行手术切除患肾外,均获满意疗效。结论：采用开放手术配合气压弹道碎石及内腔镜技术治疗复杂性肾结石疗效确切。     

输尿管结石的B型超声诊断价值

腰腹痛是临床急诊常见病,输尿管结石是引起疼痛的主要原因,其引发的绞痛常是患者急诊就医的主原因。本文报道经B型超声检查诊断的输尿管结石108例,全部病例均为临床诊断所证实,通过对输尿管结石B型超声诊断结果进行总结,以提高医师对输尿管结石的诊断水平。     

复杂性肾结石不同手术治疗方法的疗效分析

目的比较、分析微创经皮肾镜取石术与开放手术治疗复杂性肾结石的临床疗效。方法选择2006年3月至2011年3月于我院接受手术治疗的82例复杂性。肾结石患者,按治疗方法分为微创经皮肾镜取石组41例和开放手术组41例。比较两组在手术时间、术中出血量、并发症发生率、术后住院时间、总治疗费用及结石清除率方面的差异。结果微创经皮肾镜取石组手术时间[（110±21）rainVS．f178±33）rainl、术中出血量[（96．25±12．34）mlVS．（176．56士11．35）m1）]、并发症发生率[12．2％（5／41）VS．29．3％（12／41）]及术后住院时间[（7．31±0．94）dVS．（13．32±2．84）d]明显少于开放手术组,总治疗费用[（12636．6±672．37）元VS．（8532．20±350．56）元]及结石清除率f80．49％（33／41）vs．65．85％（27／41）]明显高于开放手术组。结论微创经皮肾镜取石术与开放性肾切开取石术相比,尽管住院总费用稍高,却具有微创、损伤小、出血少、并发症少、结石清除率高等优点,患者恢复快,是治疗复杂性肾结石有效、安全、合理的方法,值得临床推广。     

输尿管镜气压弹道碎石术治疗输尿管结石的临床分析

目的：探讨输尿管镜气压弹道碎石术治疗输尿管结石的临床疗效。方法：应用输尿管镜气压弹道碎石术治疗输尿管结石28例。结果：26例中、下段输尿管结石中24例获得成功,2例失败。2例上段输尿管结石,因推入肾盂内改行ESWL。结论;输尿管镜气压弹道碎石术作为一种新兴技术,具有碎石时间短、效果明显、工作时不产生热、不易损伤组织、手术并发症少等优点,是很值得推广的。     

Dissolution of struvite calculi by hemiacidrin solution

Struvite calculi result from urinary tract infections secondary to urease-producing bacteria. To prevent recurrent infection and stone formation complete removal of struvite calculi is recommended. Two illustrative reports of patients with renal struvite calculi are presented in which 10% hemiacidrin (Renacidin) irrigation was instituted for stone dissolution. After surgical removal of the calculi a nephrostomy tube was placed in the renal pelvis. With confirmation of residual struvite calculi, 10% hemiacidrin irrigation was initiated. Urine cultures, electrolytes and nephrotomograms were performed and adverse effects monitored. Using strict aseptic technique and appropriate precautions, hemiacidrin irrigation safely dissolves struvite calculi.