后腹腔镜下离断式肾盂成形术(附19例报告)

目的 评价后腹腔镜下离断式肾盂成形术治疗肾盂输尿管连接部梗阻(UPJO)的临床疗效及其可行性.方法 采用后腹腔镜下离断式肾盂成形术对19例诊断为动力性梗阻的肾盂输尿管连接部(UPJ)狭窄患者(不包括因外在纤维索及异位血管压迫所致者)进行治疗.结果 19例手术均获成功,无1例中转改开放手术,平均手术时间165 min( 125～245 min);出血量78 mL(55～165 mL),均无输血.术后平均住院时间7.5d.2例出现尿漏,分别于术后11、12d消失.术后随访6～36个月(平均26个月),IVP检查UPJ吻合口未见狭窄,手术侧肾盂积水明显减轻或基本消失(中度积水3例、轻度积水5例、肾积水消失11例).结论 后腹腔镜下离断式肾盂成形术具有术中创伤小、术后恢复快、疼痛减轻的优点,效果优于开放手术,是既安全又有效的微创手术方法.     

腹腔镜肾盂成形术中联合输尿管镜取石术

目的 评价腹腔镜肾盂成形术中联合输尿管镜取石术的可行性及临床价值。方法 采用经腹途径施行腹腔镜离断式肾盂成形术联合输尿管镜取石术治疗输尿管肾盂连接部梗阻（UPJO）合并肾盏结石9例。男7例,女2例。重度积水6例,中度积水3例,上盏结石3例,中盏结石4例,下盏结石2例。结果 9例手术均获成功。手术时间120～200 min,平均140 min;出血量40～150 mL,平均70 mL。术后住院时间7～10 d,平均8.2 d。术后无漏尿,无结石残留。随访6～12个月,UPJ吻合口无狭窄,肾积水减轻,其中,中度积水2例,轻度5例,肾积水消失2例。肾功能均有明显改善。结论 经腹途径施行腹腔镜肾盂成形术中联合输尿管镜取石术疗效确切,有一定临床应用价值。     

Anderson-Hynes离断式肾盂成形术治疗肾盂输尿管连接部狭窄

目的:探讨肾盂输尿管连接部(UPJ)狭窄的手术治疗方法。方法:采用Anderson-Hynes离断式肾盂成形术治疗肾盂输尿管连接部(UPJ)狭窄36例。成人留置D-J管,患儿放外引流。结果:36例手术均获成功,肾盂积水好转,狭窄解除,吻合口通畅。随访6个月~2年,未出现吻合口再狭窄、肾积水加重等并发症。结论Anderson-Hynes离断式肾盂成形术是治疗肾盂输尿管连接部(UPJ)狭窄的首选术式。     

肾盂输尿管连接处狭窄所致肾积水围手术期的护理

总结19例肾盂输尿管连接处狭窄所致肾积水围手术期的护理经验.对肾盂输尿管连接处狭窄所致肾积水患儿于围手术期实施全面的身心整体护理.19例患儿均恢复顺利,于术后15d左右痊愈出院,无1例出现护理并发症.认为肾盂输尿管连接处狭窄所致肾积水围手术期护理是决定手术成功的保障.     

小儿先天性肾积水30例的手术治疗

目的:探讨小儿先天性肾盂输尿管连接部狭窄所致肾积水的手术治疗方法.方法:对25例轻、中度肾积水,肾功能未见明显损害者行离断性肾盂成形术;对3例重度肾积水伴肾功能损害者,先行肾造瘘术3个月后再行离断性肾盂成形术;对2例重度肾积水、广泛肾实质菲薄,术前检查提示无肾功能者行肾切除术.结果:行离断性肾盂成形术的25例及先行肾造瘘术3个月后再行离断性肾盂成形术的3例手术均成功;行肾切除术的2例术后恢复良好.结论:先天性肾盂输尿管连接部狭窄致肾积水患儿可根据肾积水及肾功能情况分别选用离断性肾盂成形术、先行肾造瘘术再行离断性肾盂成形术、肾切除术治疗.     

后腹腔镜肾盂成形术13例临床分析

目的探讨后腹腔镜肾盂成形术的适应证选择、手术技巧及临床应用价值。方法回顾性分析后腹腔镜肾盂成形术治疗13例输尿管肾盂连接部梗阻(UPJO)的临床资料。男7例,女6例。钬激光腔内切开失败1例;高位输尿管开口1例;狭窄段>2cm或UPJ完全闭锁3例;单纯重度肾积水4例;异位血管压迫2例;合并肾盂结石2例。结果13例手术均获成功。手术时间120￣200min,平均175min;出血量60￣110mL。术后平均住院时间7.5d。围手术期无并发症。随访3￣19个月,UPJ吻合口无狭窄,肾积水、肾功能均得到改善。结论后腹腔镜肾盂成形术是治疗UPJ梗阻的有效、可行的微创手术,可替代开放手术,成为腔内切开治疗失败、高位输尿管开口、异位血管压迫或伴有重度肾积水、结石的肾盂输尿管连接部梗阻患者的首选术式。     

腹腔镜下离断式肾盂成形术治疗肾盂输尿管连接处梗阻

目的 评价腹腔镜下离断式肾盂输尿管成形术治疗肾盏输尿管连接处梗阻的临床疗效及其可行性.方法 采用腹腔镜下离断式肾盂输尿管成形术治疗肾盂输尿管连接处梗阻29例,其中采用经腹路径6例,腹腔后路径23例.结果 29例患者手术全部成功,手术时间70～130 min,平均110 min;术中出血量50～100 ml,平均80 ml;无严重并发症发生;术后住院6～11 d,平均7.6 d.29例随访3～15个月,平均6个月,肾积水均有不同程度好转,静脉尿路造影无吻合口狭窄.结论 腹腔镜下离断式肾孟输尿管成形术治疗肾孟输尿管连接处梗阻有效、可行,可以替代开放手术.     

微创硬性膀胱镜下肾盂离断成形术治疗肾盂输尿管连接处梗阻的临床疗效——附48例报告

目的:探讨微创硬性膀胱镜下肾盂离断成形术治疗肾盂输尿管连接处梗阻的临床疗效。方法:采用微创硬性膀胱镜下肾盂离断成形术治疗48例盂输尿管连接部梗阻患者,观察治疗效果。结果:本组48例手术均获成功,无发生周围器官损伤,手术时间60～140 min,平均90 min,术中出血量20～40 ml,平均28 ml。术后均未用镇痛药,术后第1日下床活动,第2～3日拔出肾周引流管,进食,第5～7日拔除导尿管,改半坡卧位,第7日拆线出院,术后5～6周膀胱镜下拔除双J管,小儿患者输尿管镜下拔除双J管。随访6～36个月,B超和静脉肾盂造影检查示无一例出现吻合口狭窄,肾积水均减轻,其中19例肾积水消失,肾功能均改善,静脉肾盂造影显影良好31例,显影改善11例。结论:微创硬性膀胱镜下肾盂离断成形术具有简便、微创、并发症少、疗效确切等优点,是尚无条件开展腹腔镜手术的基层医院治疗肾盂输尿管连接处梗阻的可选方法之一。     

腹腔镜离断性肾盂成形术+肾脏折叠术治疗巨大肾积水的临床研究

目的探讨腹腔镜离断性肾盂成形术+肾脏折叠术治疗巨大肾积水的方法、适应症及临床疗效。方法采用腹腔镜离断性肾盂成形术+肾脏折叠术治疗巨大肾积水29例患者,其中左侧18例,右侧11例。29例均为肾盂输尿管连接部狭窄所致巨大肾积水,其中2例合并肾盂及输尿管上端结石、1例合并输尿管末端狭窄,5例为外院肾盂成形术后积水复发。结果 29例手术均获得成功。手术时间130～200min,平均150min;术中出血50～160ml,平均90ml;术后住院7～15d,平均9d。术后5个月及12个月复查提示患侧肾脏形态及功能较术前明显恢复。结论肾脏功能严重受损的巨大肾积水患者,手术切除患肾不是惟一的选择;解除病因的同时行腹腔镜离断性肾盂成形术+肾脏折叠术,对于患肾形态功能恢复以及人文医学等层面均有积极的意义。     

后腹腔镜技术治疗肾盂输尿管连接部梗阻疗效分析

目的 探讨后腹腔镜治疗肾盂输尿管连接部(UPJ)梗阻的手术方式及疗效.方法 回顾性分析应用后腹腔镜技术治疗UPJ梗阻23例患者的临床资料.术前行B型超声、静脉尿路造影(IVU)、肾盂输尿管逆行造影或MRI、多层CT泌尿系统成像(CTU)检查.20例为连接部狭窄,其中2例狭窄段<0.5 cm,做狭窄段纵形切开,横向缝合;18例做肾盂成形术;3例迷走血管致梗阻,其中2例移植输尿管后做肾盂成形,1例结扎迷走血管,肾盂造口.23例均置双J管引流.结果 23例均手术成功,平均手术时间160 min(120～210min),术中出血平均80 ml(50～120 ml).术后住院平均7.5 d(6.0～10.0 d).症状消失或明显减轻,术后随访平均13个月(6～24个月).经B型超声、IVU检查,肾积水明显减少,连接部无狭窄.结论 后腹腔镜技术治疗UPJ梗阻安全有效,较开放式手术创伤小,康复时间短.     

Guns and Knives in New Mexico: Patterns of Penetrating Trauma, 1978–1993

Objective: To identify patterns of nonfatal and fatal penetrating trauma among children and adults in New Mexico using ED and medical examiner data.
Methods: The authors retrospectively sampled in 5-year intervals all victims of penetrating trauma who presented to either the state Level-1 trauma center or the state medical examiner from a 16-year period (1978–1993). Rates of nonfatal and fatal firearm and stabbing injury were compared for children and adults.
Results: Rates of nonfatal injury were similar (firearm, 34.3 per 100,000 person-years; stabbing, 35.1). However, rates of fatal injury were significantly different (firearm, 21.9; stabbing, 2.7; relative risk: 8.2; 95% confidence interval: 5.4, 12.5). From 1978 to 1993, nonfatal injury rates increased for children (p = 0.0043) and adults (p < 0.0001), while fatal penetrating injury remained constant. The increase in nonfatal injury in children resulted from increased firearm injury rates. In adults, both stabbing and firearm nonfatal injury rates increased.
Conclusions: Nonfatal injury data suggest that nonfatal violence has increased; fatal injury data suggest that violent death rates have remained constant. Injury patterns vary by age, mechanism of trauma, and data source. These results suggest that ED and medical examiner data differ and that both are needed to guide injury prevention programs.     

Dissociable correlates of two classes of retrieval processing in prefrontal cortex

Although substantial evidence suggests that the prefrontal cortex (PFC) implements processes that are critical for accurate episodic memory judgments, the specific roles of different PFC subregions remain unclear. Here, we used event-related functional magnetic resonance imaging to distinguish between prefrontal activity related to operations that (1) influence processing of retrieval cues based on current task demands, or (2) are involved in monitoring the outputs of retrieval. Fourteen participants studied auditory words spoken by a male or female speaker and completed memory tests in which the stimuli were unstudied foil words and studied words spoken by either the same speaker at study, or the alternate speaker. On "general" test trials, participants were to determine whether each word was studied, regardless of the voice of the speaker, whereas on "specific" test trials, participants were to additionally distinguish between studied words that were spoken in the same voice or a different voice at study. Thus, on specific test trials, participants were explicitly required to attend to voice information in order to evaluate each test item. Anterior (right BA 10), dorsolateral prefrontal (right BA 46), and inferior frontal (bilateral BA 47/12) regions were more active during specific than during general trials. Activation in anterior and dorsolateral PFC was enhanced during specific test trials even in response to unstudied items, suggesting that activation in these regions was related to the differential processing of retrieval cues in the two tasks. In contrast, differences between specific and general test trials in inferior frontal regions (bilateral BA 47/12) were seen only for studied items, suggesting a role for these regions in post-retrieval monitoring processes. Results from this study are consistent with the idea that different PFC subregions implement distinct, but complementary processes that collectively support accurate episodic memory judgments.     

Interprofessional approaches to creating safe,high quality health care

Three supplementary perspectives are presented arguing that interprofessional collaboration is both necessary and desirable. Nonetheless, there are often too many serious intra-professional barriers and obstacles to interprofessional collaboration to make it successful. Some of these barriers, it is argued and illustrated, are found in the multiple ways in which professional identity is tacitly acquired and embodied in the practitioners' habitual, everyday practice. The paper then explores ways in which reflection, especially Second order reflection, can help to elucidate and overcome these obstacles, as well as increasing professional adaptability and competence.     

Systematic Reviews Published in the January 2011 Issue of The Cochrane Library

ABSTRACT

The Cochrane Library of Systematic Reviews is published quarterly as a DVD and monthly online. The January 2011 issue (first quarterly DVD for 2011) contains 4515 complete reviews, 1985 protocols for reviews in production, and 13,521 one-page summaries of systematic reviews published in the general medical literature. In addition, there are citations of 641,000 randomized controlled trials, and 14,018 cited papers in the Cochrane methodology register. The health technology assessment database contains over 9300 citations. One hundred and seven new reviews have been published in the last 3 months, of which five have potential relevance for practitioners in pain and palliative medicine.     

Modified micro-superior percutaneously-assisted total hip: early experiences & case reports

Because of the extensile nature and familiarity of the standard posterior-lateral approach to the hip, a family of "micro-posterior" approaches has been developed. This family includes the Percutaneously-Assisted Total Hip (PATH) approach, the Supercapsular (SuperCap) approach and a newer hybrid approach, the Supercapsular Percutaneously-Assisted Total Hip (SuperPATH) approach. Such approaches should ideally provide a continuum for the surgeon: from a "micro" (external rotator sparing) posterior approach, to a "mini" (external rotator sacrificing) posterior approach, to a standard posterior approach. This could keep a surgeon within his comfort zone during the learning curve of the procedure, while leaving options for complicated reconstructions for the more practiced micro-posterior surgeons. This paper details one author's experiences utilizing this combined approach, as well as permutations of this entire micro-posterior family of approaches as applied to more complex hip reconstructions.     

Determination of creatine kinase isoenzyme MB activity in serum using immunological inhibition of creatine kinase M subunit activity. Activity kinetics and diagnostic significance in myocardial infarction.

This is a new method for the determination of creatine kinase isoenzyme MB activity in serum. The method uses direct activity measurement of creatine kinase B subunit activity after blocking of CK-M subunit activity by inhibiting antibodies. The test takes no longer than 15 min. The method yields an intra-serial C.V. of 2.0-12.9%, and a C.V. from day to day of 5.5%. The detection limit is 3.4 U/l creatine kinase MB. In the 95 cases with proven myocardial infarction several types of creatine kinase MB activity kinetics could be determined. The percentage of creatine kinase MB of peak CK-total is 6-25%, with a mean of 11.1%. The amount of creatine kinase MB with respect to total CK activity after reinfarction is higher than the amount after initial infarction.     

Structure and function of "metalloantibiotics"

Although most antibiotics do not need metal ions for their biological activities, there are a number of antibiotics that require metal ions to function properly, such as bleomycin (BLM), streptonigrin (SN), and bacitracin. The coordinated metal ions in these antibiotics play an important role in maintaining proper structure and/or function of these antibiotics. Removal of the metal ions from these antibiotics can cause changes in structure and/or function of these antibiotics. Similar to the case of "metalloproteins," these antibiotics are dubbed "metalloantibiotics" which are the title subjects of this review. Metalloantibiotics can interact with several different kinds of biomolecules, including DNA, RNA, proteins, receptors, and lipids, rendering their unique and specific bioactivities. In addition to the microbial-originated metalloantibiotics, many metalloantibiotic derivatives and metal complexes of synthetic ligands also show antibacterial, antiviral, and anti-neoplastic activities which are also briefly discussed to provide a broad sense of the term "metalloantibiotics."