超声引导下肾上盏径路经皮肾镜碎石术治疗鹿角形结石疗效及安全性分析

目的总结超声引导下肾上盏径路经皮肾镜取石术(PCNL)的疗效及安全性。方法回顾性分析193例应用超声引导肾上盏径路PCNL治疗鹿角形结石的患者资料。193例均为鹿角形复杂结石(完全鹿角形结石74例,不完全鹿角形结石119例,结石长径2.5~9.0 cm),均完成超声引导下对后组上盏穿刺,其中十二肋下径路70例(36.3%),十一肋间径路123例(63.7%)。统计并分析手术清石时间、清石率及术后并发症。结果一期手术时间平均70 min(45~150 min),采用单一肾上盏通道186例,需另外建立经皮肾通道7例。一期碎石清石率72.0%(139/193),二期清石率88.1%(170/193)。术后输血6例,需选择性肾动脉栓塞止血2例。胸腔积液4例,2例需闭式引流。术后发热20例,无感染性休克及不良预后发生。无肺脏及其他内脏损伤。结论后组肾上盏径路的PCNL视野范围广,输尿管镜活动度大,碎石速度快、清石率高,对于鹿角形结石是一种安全有效的方法,值得临床治疗鹿角形结石选择性使用。     

开放手术与B超引导经皮肾镜气压弹道碎石治疗肾结石的疗效比较

目的 通过开放手术与B超引导经皮肾镜气压弹道碎石治疗肾结石的疗效对比,探讨B超引导经皮肾镜气压弹道碎石治疗肾结石的方法 、疗效和安全性.方法 回顾性分析2007年12月～2008年12月收治的肾结石患者应用肾切开取石术53例(开放组),应用B超引导经皮肾镜气压弹道碎石术57例(微创组)的患者资料进行比对比,比较两种方法 的手术时间、术中出血量、术后引流量、结石清除率、术中及术后并发症等指标.结果 110例手术均获成功,微创组各项指标均低于开放手术组(P＜0.05),结石清除率则明显高于开放手术组(P＜0.05).结论 B超引导经皮肾镜气压弹道碎石术治疗肾结石操作方法 安全可靠,损伤小、出血少,成功率高,并发症少,与传统开放手术相比比较具有一定的优越性,值得推广运用.     

微造瘘经皮肾钬激光碎石取石术治疗复杂性肾结石

目的:探讨微造瘘经皮肾钬激光碎石取石术(MPCNL)治疗复杂性肾结石的疗效.方法:对38例接受MPCNL治疗的复杂性肾结石患者的临床资料进行回顾性分析.结果:本组38例均成功进行了经皮微穿刺肾造瘘,在输尿管镜下完成了钬激光碎石术,无中转行开放手术.行I期取石37例,一次取尽结石34例,3例术后残余结石配合体外冲击波碎石(ESWL)治愈; 1例于术后1周经原造瘘通道行II期经皮肾钬激光碎石取石术治愈.平均手术时间140 min,出血50～100 ml;术后肾造瘘管留置时间5～7 d,住院天数平均9 d.无大出血、尿瘘、动静脉瘘、腹腔脏器损伤等严重的并发症.肾结石总取净率92.1%(35/38).结论:MPCNL联合钬激光碎石取石术具有创伤小、恢复快、出血少、住院时间短、结石清除率高、并发症少等优点,是治疗复杂性肾结石的较好的微创方法.     

超声引导下经皮肾镜取石术在上尿路结石治疗中的应用（附359例报告）

目的探讨超声引导下经皮肾镜取石术（PCNL）在治疗上尿路结石的方法、临床疗效和安全性。方法对我院2009年10月~2012年12月359例上尿路结石患者采用在B超定位引导下PCNL术临床资料回顾性分析。结果本组患者成功施行经皮肾穿刺并建立经皮肾通道行钬激光碎石取石术。297例一期取净结石,62例二期取净结石。术后部分病例出现肉眼血尿、轻度发热;术后随访3～8w,全组无输血及严重并发症。结论超声引导下PCNL治疗上尿路结石微创高效,安全可靠,并发症少,具有临床推广应用推广价值。     

输尿管软镜和经皮肾镜碎石取石术治疗鹿角形肾结石的疗效观察

目的比较输尿管软镜碎石取石术(RIRS)和经皮肾镜碎石取石术(PCNL)治疗鹿角形肾结石的有效性和安全性。方法回顾性分析我院2016年9月至2019年1月收治的89例接受RIRS和PCNL治疗的鹿角形结石患者的临床资料,其中RIRS组42例,PCNL组47例。对比2组患者的手术时间、术中出血量、输血百分比、术后血红蛋白(Hb)下降量、碎石成功率、术后住院时间、住院总费用和并发症情况。结果 RIRS组和PCNL组患者手术时间分别为(140. 3±47. 1) min和(115. 2±43. 6) min;术中出血量分别为(30. 2±6. 7) m L和(39. 6±8. 3) m L;术后血红蛋白下降量分别为(0. 95±0. 67) g/L和(1. 66±1. 07) g/L;住院总费用分别为(21. 3±6. 7)千元和(25. 4±6. 2)千元;术后住院时间分别为(2. 8±1. 3) d和(5. 6±1. 6) d;输血百分比分别为0和4. 25%(2/47);一次性取石成功率分别为78. 6%(33/42)和85. 1%(40/47),以上差异均具有统计学意义(P 0. 05)。2组患者总结石清除率和并发症发生率差异无统计学意义(P 0. 05)。RIRS组7例患者术后行体外冲击波碎石术(EWSL)辅助碎石治疗,PCNL组4例患者术后行EWSL辅助碎石治疗。结论 RIRS和PCNL治疗鹿角形肾结石都是安全、有效的手术方式。与PCNL相比,虽然RIRS手术时间相对较长,但术中出血少,术后恢复快,住院费用少,安全性更高。     

超声引导微创经皮肾镜治疗肾及输尿管上段结石并发症分析

目的探讨超声引导下微创经皮肾镜取石术(mPCNL)治疗肾结石及输尿管上段结石的并发症及预防措施。方法对本院2008年10月至2012年12月开展的超声定位下经皮肾镜取石患者的临床资料进行回顾性分析,其中肾结石428例,输尿管上段结石267例,肾结石合并输尿管上段结石135例。结石直径1.5～3.2 cm,平均直径约2.1 cm。结果所有患者并发症总发生率为28.43%(236例),包括术中peel-away鞘置入失败62例(7.47%),其中改二期手术2例,其余60例经更换穿刺点后完成手术;术中肾集合系统穿孔伤150例(18.07%),均未造成大出血而终止手术;术中大出血需要输血者21例(2.53%),术后迟发性出血37例(4.46%),行高选择性肾动脉介入栓塞术3例(0.36%);胸腔积液1例(0.12%),后经胸腔闭式引流5 d后痊愈;术后发热162例(19.50%),经积极对症处理后痊愈;所有病例均未发生肾静脉等大血管及肝脏等腹腔内脏器损伤。结论超声引导下微创经皮肾镜治疗肾结石及输尿管上段结石临床疗效好,但是应加强术中大出血、术后迟发性出血、术后感染等严重并发症的防治,只有重视并采取预防措施才有利于此项技术的广泛开展。     

B超引导下微创经皮肾镜术治疗无明显积水的肾铸型结石

目的探讨B超引导微创肾穿刺造瘘、经皮肾取石术治疗无积水的铸型肾结石的疗效。方法回顾分析2009年1月至2010年9月采用微创经皮肾镜术（MPCNL）治疗27例无明显积水的铸型肾结石患者的临床资料。结果 27例均成功建立经皮肾镜微创通道,25例患者一期单通道碎石取石,2例因出血和体位不能耐受,留置肾造瘘管后改二期碎石取石。19例患者一期一次手术取净结石;3例患者经2次MPCNL手术;1例患者经过3次MPCNL手术均取净结石;2例患者残留结石配合ESWL治疗,术后1~2个月复查结石排出,总结石清除率为92.6%。2例患者残留结石（单发）位于肾下盏,结石直径小于5 mm。结论 B超引导MPCNL治疗无明显积水的肾铸型结石安全有效。     

经皮肾镜取石术治疗上尿路结石400例报告

目的：探讨经皮肾镜取石术在治疗上尿路结石的临床疗效及安全性。方法选取我院2010年1月~2014年1月内收治的经皮肾镜取石术治疗上尿路结石患者400例的临床资料,进行回顾性分析。结果270例肾结石,130例输尿管上段结石,一期取石356例次,二期取石49例次;单通道经皮肾通道367例次,多通道33例次。手术时间40~270min,平均(90±15)min。并发症主要为大出血(2%)、感染(4%)、结石残留(10%),无周围器官损伤。一期结石清除率85%(340/400),二次肾镜取石49例(12.3%)。结论经皮肾镜取石术具有安全性、疗效确切、创伤小、患者痛苦轻、恢复快、出血少等优点,值得在临床推广和应用。     

B超引导下局麻经皮肾镜取石术治疗上尿路结石的临床应用

目的 探讨B超引导下局麻经皮肾镜取石术(PCNL)治疗上尿路结石的可行性和安全性。方法 回顾性分析2008年3月—2012年10月B超引导下局麻行PCNL 的86例患者的临床资料,其中复杂性肾结石16例、单纯肾盂结石52例、输尿管上段结石18例。在B超定位下选择中盏或结石所在肾盏处作肾穿刺点,用1%盐酸利多卡因10～40 ml自穿刺点向肾脏方向穿刺浸润麻醉,深达肾包膜。然后在B超引导行PCNL。结果 86例患者麻醉效果满意,均顺利完成手术。穿刺成功率100%(86/86),术中未发现肝、脾、胸膜、肠管损伤等严重并发症。单纯肾盂结石患者结石取尽率96.2%(50/52);结石残留2例,予体外冲击波碎石术(ESWL)排出。输尿管上段结石患者结石取尽率100%(18/18)。复杂性肾结石患者结石取尽率81.3%(13/16);术后结石残留3例,行二期PCNL取石2例,予ESWL排出1例。所有患者均获随访3～12个月,平均8.5个月。随访期间未发现结石残余和复发,无继发性上尿路感染。结论 B超引导下局麻行PCNL简单、安全、有效,尤其适用于肾脏及输尿管上段结石患者,值得临床推广应用。     

微通道经皮肾镜碎石取石术治疗结石性脓肾的效果

目的 分析微通道经皮肾镜碎石取石术（PCNL）治疗结石性脓肾的效果。方法 选取2018年1月~12月我院收治的结石性脓肾患者78例,按照随机数字表法分为观察组和对照组,每组39例。对照组行标准通道PCNL治疗,观察组行微通道PCNL治疗,比较两组手术治疗指标（Ⅰ期结石取净率、手术时间、术中出血量、住院时间）和术后并发症总发生率（出血、高热、肾周积液感染、尿培养阳性）。结果 两组Ⅰ期结石取净率比较,差异无统计学意义（P＞0.05）;观察组术中出血量少于对照组,手术时间、住院时间短于对照组,差异有统计学意义（P＜0.05）。观察组术后并发症总发生率为7.69%,低于对照组的20.51%,差异有统计学意义（P＜0.05）。结论 微通道PCNL治疗结石性脓肾疗效显著,能有效减少术中出血量,缩短手术时间、住院时间短,降低术后并发症的发生率,优于标准通道PCNL治疗。     

Renal dysplasia and asplenia in two sibs

A family is reported in which two sibs, one male and the other female, both died within 24 hours of birth with enlarged polycystic kidneys. Postmortem histology in the second child showed gross renal dysplasia. In both children the pancreas was enlarged, nodular and cystic but the liver appeared macroscopically normal. In the second child, histological examination confirmed pancreatic fibrosis with cystic dilation of ducts, but showed portal fibrosis with bile duct proliferation in the liver.
This combination of findings is very reminiscent of those in a girl and her brother reported by Ivemark et al. (1959). The children reported here also showed absence or hypoplasia of the spleen, cardiac anomalies and other features of the Ivemark syndrome (Ivemark 1955), a quite different, usually sporadic, congenital disorder. It is suggested that the children described here have a distinct lethal congenital disorder, probably inherited in an autosomal recessive manner.     

Schizophrenia in a North Swedish geographical isolate, 1900–1977. Epidemiology, genetics and biochemistry

Over 200 schizophrenic patients belonging to three major and interrelated pedigree complexes have been investigated over the past 30 years in a North Swedish geographically isolated population, presently numbering about 6,000. An intensive investigation of a number of biochemical correlates and genetic markers in a few selected families belonging to one of the major pedigrees has indicated new strategies for the current research program.
Schizophrenia, as defined operationally, is significantly associated with decreased activities of two enzymes (1) blood platelet monoamine oxidase, (2) plasma dopamine-β-hydroxylase, and (3) with the genetic marker Gc² (group specific antigen). Both enzymes are subject to genetic variation. A positive score for linkage between schizophrenia and low plasma DBH activity has been calculated, but, so far, available data are insufficient for discrimination between linkage and partial contribution of genetically controlled low plasma DBH to the pathogenesis of the disease. Alternatively, both mechanisms could be involved.
As a model for continued research, schizophrenia is explained as based on a double dominant-recessive genotype (Aabb), representing a vulnerability which in about 50 % of cases develops into clinical schizophrenia. It is suggested that the dominant mutation (A) operates on or affects MAO activity, and that the recessive genotype (bb) is instrumental in low variates of DBH activity and very likely such variates within the normal range of physiological variation. Moreover, it is suggested that the combined effects of MAO- and DBH-reduced efficiency on the metabolism of e.g. dopamine could be an essential pathogenic mechanism for the schizophrenic illness which is segregating in this population.     

The dominant diseases of modernized societies as omega-3 essential fatty acid deficiency syndrome: Substrate beriberi

About 1900, modern food selection and processing caused widespread $\text{epidemics}$ of the B vitamin deficiency diseases of beriberi and pellagra which, for genetic reasons, often expressed as different diseases ranging from bowel and heart disease to dermatoses and psychoses. But the B vitamins merely help convert essential fatty acids (EFA) into the prostaglandin (PG) tissue regulators and it now turns out that, through hydrogenation, milling and selection of w3-poor southern foods, we have also been systematically depleting, by as much as 90%, a newly discovered trace Nordic EFA (w3) of special importance to primates and sole precursor of the PG3(4) series, even as a concurrent fiber deficiency increases body demand for EFA. Since substrate EFA is processed by many B vitamin catalysts, an EFA deficiency will mimic a $\text{panh}$ypovitaminosis B, i.e., a mixture of $\text{substrate}$ beriberi and $\text{substrate}$ pellagra resembling vitamin beriberi and pellagra but exhibiting as even more diverse $\text{endemic}$ disease. This would consitute a second stage of the Modern Malnutrition and explain why some workers now hold the dominant diseases of modermized societies to be new, nutritionally based, pellagraform yet lipid-related and to range, once again, from heart disease to psychosis. It is an assumption that our dominant diseases are unrelated to each other or are merely revealed by our diagnostic acumen and therapeutic success; and that hydrogenating millions of tons of food oils annually, to destroy the rancidity producing w3-EFA, is safe for $\text{primates}$. Extensive beriberiform disease is reported here in 32 typical cases taken from medical practice which responds strikingly to linseed oil supplements (60% w3-EFA) in confirmation of identical results in Capuchins.     

What will studies of Fulani individuals naturally exposed to malaria teach us about protective immunity to malaria?

There are an estimated over 200 million yearly cases of malaria worldwide. Despite concerted international effort to combat the disease, it still causes approximately half a million deaths every year, the majority of which are young children with Plasmodium falciparum infection in sub-Saharan Africa. Successes are largely attributed to malaria prevention strategies, such as insecticide-treated mosquito nets and indoor spraying, as well as improved access to existing treatments. One important hurdle to new approaches for the treatment and prevention of malaria is our limited understanding of the biology of Plasmodium infection and its complex interaction with the immune system of its human host. Therefore, the elimination of malaria in Africa not only relies on existing tools to reduce malaria burden, but also requires fundamental research to develop innovative approaches. Here, we summarize our discoveries from investigations of ethnic groups of West Africa who have different susceptibility to malaria.     

'Very sore nights and days': the child's experience of illness in early modern England, c.1580-1720

Sick children were ubiquitous in early modern England, and yet they have received very little attention from historians. Taking the elusive perspective of the child, this article explores the physical, emotional, and spiritual experience of illness in England between approximately 1580 and 1720. What was it like being ill and suffering pain? How did the young respond emotionally to the anticipation of death? It is argued that children’s experiences were characterised by profound ambivalence: illness could be terrifying and distressing, but also a source of emotional and spiritual fulfilment and joy. This interpretation challenges the common assumption amongst medical historians that the experiences of early modern patients were utterly miserable. It also sheds light on children’s emotional feelings for their parents, a subject often overlooked in the historiography of childhood. The primary sources used in this article include diaries, autobiographies, letters, the biographies of pious children, printed possession cases, doctors’ casebooks, and theological treatises concerning the afterlife.     

Guidelines for the Validation and Use of Immunoassays for Determination of Introduced Proteins in Biotechnology Enhanced Crops and Derived Food Ingredients

Recent advancements in agricultural biotechnology have created a need for analytical techniques to determine introduced proteins in crops enhanced through modern biotechnology techniques. These proteins are expressed in plant tissues and may be present in food ingredients. Immunoassays are ideally suited for protein detection and may be used as both quantitative and threshold methods. Microplate ELISA and lateral flow devices are two of the most commonly used immunoassay formats for agricultural biotechnology applications. This paper provides general background information and a discussion of criteria for the validation and application of immunochemical methods to the analysis of proteins introduced into plants and food ingredients using biotechnology methods. It is the result of a collaborative effort of members of the Analytical Environmental Immunochemical Consortium. This collaborative effort represents the combined expertise of several organizations to reach consensus on establishing guidelines for the validation and use of immunoassays. Further, the paper offers developers and users a consistent approach to adopting the technology as well as aid in producing accurate and meaningful results.     

Ultracryotomy: development and application (with examples from the yeast cytology) (author's transl)

The preparation steps usually necessary for obtaining ultrathin frozen sections of biological material (chemical prefixation, enclosing, cryoprotective treatment, freezing, sectioning, and post-staining the sections for transmission electron microscopy) are submitted to a critical analysis. The application of cryo-ultramicrotomy, in particularly for cytochemical purposes, is reviewed. Fundamental considerations of chemical prefixation and poststaining are supported by examples from yeast cytology. Furthermore, the efficiency of the cryo-ultramicrotomy (electron optical resolution of ultrastructural details) is demonstrated on yeast cells and protoplasts.     

HLA in North Colombia Chimila Amerindians

HLA-A,-B,-C,-DRB1 and -DQB1 alleles have been studied in Chimila Amerindians from Sabana de San Angel (North Colombian Coast) by using high resolution molecular typing. A frequent extended haplotype was found:HLA-A*24:02-B*51:10-C*15:02-BRB1*04:07-DQB1*03:02 (28.7%) which has also been described in Amerinndian Mayos Mexican population (Mexico, California Gulf, Pacific Ocean). Other haplotypes had already been found in Amerindians from Mexico (Pacific and Atlantic Coast), Peru (highlands and Amazon Basin), Bolivia and North USA. A geographic pattern according to HLA allele or haplotype frequencies is lacking in Amerindians, as already known. Also, five new extended haplotypes were found in Chimila Amerindians. Their HLA-A*24:02 high frequencies characteristic is shared with aboriginal populations of Taiwan; also, HLA-C*01:02 high frequencies are found in New Zealand Maoris, New Caledonians and Kimberly Aborigines from Australia. Finally, this study may show a model of evolutionary factors acting and rising one HLA allele frequency (-A*24:02), but not in others that belong to the same or different HLA loci.     

The universal muscular chamber. A basic unit of the genitourinary, cardiovascular, gastro-intestinal, skeletal, cutaneous, respiratory and other systems, endocameral hypertension; and spasm, the key to their idiopathic diseases and arthropathies

Starting with the integument, we see many organs are contractile sacs or multiples thereof, which tubes or bags constitute the major part of the entire body. Recognition of this basic unit and its characteristics sheds new light, individually and collectively, on many disorders previously considered unrelated. Muscular tears and perforations develop in the walls of these chambers, being no way peculiar to those organs, wherein, hydrochloric acid occurs. So, it is not necessary to explain the absence of excessive acid from patients who exhibit holes in the gastric, uterine, aortic, duodenal, rectal, pulmonary, retina, and other walls. Muscle, not acid is the great common factor relating idiopathic disorders in the gastrointestinal tract to each other and to similar diseases in other systems. When the units are linked together, the lesions tend to appear as arthropathies, i.e. at the joints. Rephrasing common-place observations, frees us from conventional, conceptual cul-de-sacs. An observation is only as good as its interpretation, so all possibilities must be considered, otherwise, we will remain blinded by our misconceptions.