尿道中段吊带术临床解剖学的研究进展

<正>压力性尿失禁的特征为正常状态下无遗尿但在腹压突然增加时会有尿液不自主流出,是一种产后以及绝经后女性的常见疾病,严重影响了患者的正常生活。基于盆底支持系统的"吊床理论",Ulmsten等~([1])在1995年首次介绍了经耻骨途径无张力阴道悬吊术(tension-free vaginal tape,TVT),得到临床医师广泛认可,成为治疗压力性尿失禁的金标准,但该术式易引起诸如膀胱损伤、腹股沟痛等并发症。同样采用耻骨后穿刺入路的还     

经闭孔中段尿道无张力吊带术（TOT）治疗女性压力性尿失禁的中远期疗效及安全性分析

目的：探讨经闭孔中段尿道无张力吊带术(TOT)治疗女性压力性尿失禁的中远期疗效及安全性。方法将60例女性压力性尿失禁患者按照奇偶数字法随机地均分为对照组与观察组，每组均为30例。对照组采用经趾骨后吊带术(SPARC)治疗，观察组采用TOT治疗。比较两组临床疗效、治疗前后生存质量评分及并发症发生率。结果对照组临床总有效率为66.67%，显著小于观察组(93.33%)(P<0.05)；两组手术前后各评分(包括：ICI-Q-SF症状评分、ICI-SF QOL评分、UDI-6评分、I Q-7评分及PISQ-12评分)差异均具有统计学意义(P<0.05~0.01)，且观察组术后上述评分差异也均具有统计学意义(P<0.05)；对照组并发症发生率为23.33%，观察组为16.67%，两组并发症发生率差异无统计学意义(P>0.05)。结论经闭孔中段尿道无张力吊带术(TOT)治疗女性压力性尿失禁的疗效显著，安全性尚可，应加以推广及应用。     

尿道悬吊术吊带材料的研究进展

目前临床侵入性治疗压力性尿失禁存在多种手术方式,文献对无张力阴道吊带术及其繁多的植入材料报道甚多。文章就目前流行的控尿机制、吊带术历史和临床使用吊带材料的最新进展做系统综述。     

TOT治疗女性压力性尿失禁临床分析（附39例报道）

目的：探讨经闭孔无张力尿道悬吊术（TOT）治疗女性压力性尿失禁（SUI）的安全性和有效性。方法：2007年10月至2010年10月采用TOT术治疗女性SUI患者39例,其中轻度10例（26％）,中度20例（51％）,重度9例（23％）。结果：手术时间（16±3）min,术中出血量（10±3）ml,术后平均住院时间3．5d;39例均临床治愈,无严重并发症。1例排尿姿势改变;2例尿潴留,予以尿道扩张2次后好转。术后随访3～36个月,无尿失禁复发。结论：TOT治疗女性SUI是一种安全、有效的术式,并且具有微创、操作简单、并发症少等优点。     

经闭孔无张力尿道中段悬吊术治疗压力性尿失禁的护理

压力性尿失禁（stress urinary incontinence SUI）是中老年女性常见疾病，发病率为15％～30％，病程长，严重影响了患者生活质量。经闭孔无张力尿道中段悬吊术（TVT-O）是目前经阴道无张力尿道中段悬吊术（TVT）的改进术式。我科从2008年5月至2010年1月，采用TVT-O方法治疗女性压力性尿失禁26例，经过精心护理，效果满意。现将围手术期护理体会报告如下。     

腹腔镜下经腹膜前疝修补术治疗腹股沟复发疝58例临床体会

目的：探讨腹腔镜下经腹膜前无张力疝修补术(TAPP)治疗腹股沟复发疝58例的临床经验及效果。方法回顾分析2011年3月~2013年1月我院58例腹股沟复发疝患者行腹腔镜TAPP的临床资料,其中原位复发疝12例,再发疝46例。结果57例顺利完成手术,1例中转开放手术。手术时间平均(60.5±17.5)min,平均住院(4.56±1.6)d。5例术后腹股沟区轻微疼痛不适;6例血清肿,3例自行吸收,3例经多次穿刺抽液后治愈。无切口感染及其他严重并发症发生。术后随访6~18个月,无再次复发。结论腹腔镜TAPP治疗腹股沟复发疝具有患者创伤小、并发症少等优势,手术效果切实、可靠。     

无张力疝修补术在治疗复发腹股沟疝中的疗效观察

目的探讨无张力疝修补术对于复发腹股沟疝手术治疗的临床效果和并发症。方法选取2013年5月~2014年2月复发腹股沟疝患者120例,随机分为两组,各60例,观察组予以无张力疝修补术,对照组予以传统修补术,比较两组手术效果以及并发症。结果观察组术中平均出血量(18.2±5.1)ml、平均手术时间(39.6±4.3)min、术后平均下床活动时间(18.4±5.4)h、平均出院时间(4.6±1.3)d均少于对照组;观察组伤口感染、阴囊水肿、脂肪液化、随访6个月复发、尿潴留和总并发症均少于对照组;所有差异均具有统计学意义(P<0.05)。结论无张力疝修补术手术效果好,术后住院时间短,并发症少,适合临床推广。     

女性压力性尿失禁患者盆底肌形态改变的磁共振成像评价

目的 磁共振成像(MRI)技术探讨女性压力性尿失禁(SUI)患者盆底肌形态的改变.方法 自2006年1月至2008年6月间,21例SUI患者(尿失禁组)以及10例正常控尿成年女性(对照组)入组研究.所有对象均分别在平静状态以及屏气用力状态下行盆腔MRI扫描.分析尿失禁组和对照组两种状态下耻骨直肠肌厚度以及肛提肌裂隙面积的变化情况与SUI之间的关系.结果 无论在平静或屏气用力状态下,尿失禁组左、右侧耻骨直肠肌厚度均较对照组薄(均P<0.05).尿失禁组肛提肌裂隙多呈横径增宽的纵向椭圆形,平静状态下裂隙面积较对照组大[(1893.44±218.44)mm2比(1661.86±206.62)mm2,P<0.05].尿失禁组阴道呈"H"形占33.3%(7/21),提示存在阴道侧壁损伤占66.7%(14/21);对照组阴道呈"H"形占80.0%(8/10).尿失禁组阴道侧壁损伤明显高于对照组(P<0.05).结论 女性压力性尿失禁患者左、右侧耻骨直肠肌厚度变薄,肛提肌裂隙明显增大.MRI在评价女性SUI患者的肛提肌形态改变的检测中结果可信,能为临床治疗提供明确信息.     

盆腔器官脱垂患者盆底重建手术后新发压力性尿失禁相关影响因素分析

目的探讨盆底重建手术后新发压力性尿失禁的相关因素。方法回顾性分析2005年11月30日至2015年11月30日第三军医大学西南医院妇产科714例接受盆底重建手术患者的临床资料,其中术前无尿失禁的患者共544例,对可能引起患者术后新发压力性尿失禁的相关影响因素进行统计学分析。结果术后新发压力性尿失禁患者有151例,发生率30.5%。其中有糖尿病史、巨大胎儿分娩史、盆腔手术史、盆腔器官脱垂(POP)、手术方式(经腹腔镜阴道顶端骶骨固定术)是术后新发压力性尿失禁的危险因素,其OR值分别为2.575、5.286、1.671和1,而患者其他一般资料和POP分期与之无相关性(P0.05)。结论盆腔器官脱垂有高危因素的患者盆底重建手术时,可根据患者个体情况及意愿考虑同时实施抗尿失禁手术。     

骶韧带耻骨阴道肌筋膜交叉缝合术联合骶棘韧带悬吊术治疗盆腔器官脱垂

目的探讨骶韧带耻骨阴道肌筋膜交叉缝合术联合骶棘韧带悬吊术治疗中、重度盆腔器官脱垂的临床应用价值。方法回顾分析我院应用骶韧带耻骨阴道肌筋膜交叉缝合术联合骶棘韧带悬吊术治疗32例中、重度盆腔器官脱垂患者的临床资料。结果 32例盆腔器官脱垂患者均以中盆腔、前盆腔缺陷为主,子宫脱垂程度均为Ⅲ度以上,都合并不同程度的阴道前后壁脱垂。行经阴道全子宫切除术+阴道前后壁修补术+骶棘韧带悬吊术+骶韧带耻骨阴道肌筋膜交叉缝合术(有压力性尿失禁患者加行尿道后韧带折叠术)。手术时间60~120 min,失血量100~300 m L,无严重并发症发生。32例术后无1例复发。结论骶韧带耻骨阴道肌筋膜交叉缝合术可显著减少骶棘韧带悬吊术治疗盆腔器官脱垂术后前盆腔缺陷复发概率,可显著加固前盆腔,且简单、安全、有效,值得在临床推广运用。     

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.     

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.     

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.     

'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.     

Der Einfluß von Nahrungsmitteln und Rauchen auf die klinisch-chemische Diagnostik von Phäochromozytom,Neuroblastom und Karzinoid-Syndrom

Zusammenfassung Der Einfluß von verschiedenen Nahrungsmitteln auf Methoden zur Bestimmung von Adrenalin (AD), Noradrenalin (NA), Vanillinmandelsäure (VMS), Metanephrinen (MN), Homovanillinsäure (HVS) und 5-Hydroxyindolessigsäure (5-HIE) im 24 h-Harn zur Diagnose des Phäochromozytoms bzw. Karzinoid-Syndroms wurde untersucht. Die in die Untersuchung einbezogenen Nahrungsmittel waren: Tee, Kaffee, Mandeln, Ananas, Käse, Walnüsse, Vanillepudding, Bananen, Tomaten und Milchschokolade. Außerdem wurde der Einfluß des Zigarettenrauchens auf die Bestimmung von AD, NA, VMS und MN untersucht.Walnüsse führten zu einer starken Erhöhung der 5-HIE-Ausscheidung. Bananen erhöhten die Ausscheidung von AD, NA, VMS, MN und 5-HIE. Kaffee und Ananas bewirkten eine geringe Zunahme der MN-Werte. Rauchen von 20–30 Zigaretten/Tag beeinflußte keine der vier Variablen.Wenn die beschriebenen Methoden benutzt werden, sollte lediglich auf den Verzehr von Bananen und Walnüssen vor und während der Harnsammelperioden verzichtet werden, da die oberen Normgrenzen im Harn überschritten werden könnten. Ein Verzicht auf Kaffee und Ananas in normalen Mengen ist nicht erforderlich. Es besteht kein Anlaß, weiterhin die bisherigen umfangreichen Restriktionen der übrigen Nahrungsmittel beizubehalten.