重庆地区蛇咬伤后急救处理

目的：探讨重庆地区蛇咬伤的急救处理及分析治疗过程中凝血功能变化。方法回顾性分析我院2003年1月～2013年9月收治的1191例蛇咬伤患者（男性696例,女性495例;年龄16～81岁,平均45.2岁）临床表现、治疗情况、凝血功能变化及分泌物细菌培养等。结果重庆地区蛇咬伤以蝮蛇为主,轻型患者830例（69.69％）,就诊时临床表现以患肢肿胀常见,占92.35％。五步蛇及眼镜蛇较蝮蛇导致凝血系统异常具有显著性差异（ P＜0.05）。咬伤溃疡创面分泌物行细菌加药敏试验培养率49.5％,细菌培养阳性率21.3％。结论我院蛇咬伤以蝮蛇咬伤常见,五步蛇及眼镜蛇等咬伤较少,但对凝血功能影响显著,需及早综合处理蛇伤,合理运用抗菌药物,提高防治水平。     

Cyclosporine-induced renal injury induces toll-like receptor and maturation of dendritic cells

BACKGROUND: The toll-like receptor (TLR) is stimulated by not only pathogen-associated molecular patterns but also endogenous TLR ligands provided by injured cells. The influence of cyclosporine A (CsA)-induced renal injury on TLR expression and subsequent signaling pathway was evaluated. METHODS: Induction of chronic CsA nephropathy was made by administering CsA (15 mg/kg/day) for 28 days in rats. The TLR2 and TLR4 mRNA and protein expression, TLR-signaling pathway (MYD88, NF-kappaB and AP-1), putative TLR ligand (heat shock protein 70 [HSP70]), and maturation of dendritic cells were evaluated in CsA-treated rat kidneys. RESULTS: Long-term CsA treatment upregulated TLR2 and TLR4 mRNA and protein expression on renal tubular cells, and these were accompanied by increased MYD88, NF-kappaB and AP-1 expression. Putative TLR ligand (HSP70) was also significantly increased in CsA-treated rat kidney compared with vehicle-treated rat kidney. CsA-treatment increased expression of TNF-alpha mRNA, the number of dendritic cells, and expression of MHC class II antigen. Double-labeling of markers of dendritic cells and MHC class II antigen revealed that matured dendritic cells increased in CsA-treated rat kidney. CONCLUSIONS: CsA-induced renal injury stimulates components of innate immunity, and this finding suggests close association between CsA-induced renal injury and activation of innate immunity.     

Perfusion computed tomography could be a new tool for single-session imaging of ureteric obstructive pathology: an experimental study in rats

Background/Purpose

Perfusion imaging redefines computed tomography (CT) as a technique that can now depict vascular physiology in addition to detailed anatomy. The major clinical applications of perfusion CT are in acute stroke and oncology. Currently, there are very limited data on the application of perfusion CT in urology. The aim of the present study is to investigate the potential value of perfusion CT in anatomic and functional evaluation of obstruction in a single session on experimental hydronephrosis model in rats. Thus, we evaluate the perfusion CT in a new clinical application.

Methods

Twenty-eight rats were randomly allocated into 4 groups each consisting of 7 rats. At the third week of experimental intervention, postoperative renogram curves and perfusion parameters of the right kidneys' cortex and pelvis were assessed by CT. The right ureter was sutured as proximal complete obstruction in group 1, as distal complete obstruction in group 2, and as proximal partial obstruction in group 3. Group 4 served as the sham control group. Computed tomography was performed with single-slice tomography. Dynamic examination was performed with the help of perfusion software through contrast-enhanced tomography examination.

Results

In all study groups, the aorta time/density curves showed a rapid increase after a rapid decrease, and the duration to reach peak concentration in the normal kidney cortex was observed to be later than the aorta as expected. In groups 1, 2, and 3, the duration to reach peak concentration lengthened and the peak concentration values decreased. The time/density curves gradually increased as a result of the accumulation of the contrast agent in the pelvis, and a peak was observed at the end of the procedure in all study groups. In groups 1, 2, and 3, a statistically significant decrease (P = .01, P = .01, and P = .01, respectively) was observed in the peak concentration values of the contrast agent in comparison to group 4. The flow and blood volume values gradually decreased as the grade of the obstruction increased and the localization of the obstruction or grade of obstruction moved closer to the kidney.

Conclusion

In conclusion, perfusion CT technique, performed in a single session, is a useful method for anatomic visualization, together with functional evaluation, in the diagnosis of ureteric obstructive pathology of experimental hydronephrosis model.     

Distal unlocked proximal femoral intramedullary nailing for intertrochanteric femur fractures

We investigated whether a proximal femoral nail (PFN) having two lag screws can be implanted without distal locking screws in AO/OTA 31-A1 and 31-A2 intertrochanteric femur fractures. Twenty-four patients with AO/OTA 31-A1 and 31-A2 fractures were treated with a PFN without distal interlocking by a single surgeon. The mean follow-up was 12 months (range: 7–23). Clinical and functional outcome was assessed according to the Harris hip score and Barthel’s activity score. The fractures healed in all patients; the average consolidation time was 14 weeks (range: 9–28). Fourteen patients had excellent and good results, nine patients had fair results, and one patient had a poor result according to the Harris hip score; 17 patients had a high range of mobility according to the Barthel activity score. Our results suggested that the PFN can be successfully implanted without distal interlocking in 31-A1 and 31-A2 fractures.     

Cauda-filar paraganglioma with 'silk cocoon' appearance on spinal angiography

'Silk cocoon' appearance on spinal angiography is pathognomonic to differentiate paragangliomas from several vascular tumors and malformations of cauda-filar region.     

Minimizing Ports During Robotic Partial Nephrectomy

Methods:Data on 11 robot-assisted laparoscopic partial nephrectomies performed by using our technique from February 2015 through June 2015 were retrospectively analyzed. The robotic platform used was DaVinci Xi (Intuitive Surgical, Inc., Sunnyvale, California, USA) with a 3-arm setup. The AirSeal system (SurgiQuest, Milford, Connecticut, USA) was used as a port allowing simultaneous introduction of 2 instruments for the bedside surgeon, obviating the need for an additional (fourth) robotic arm. A long suction-and-irrigation device and atraumatic grasping forceps were used. Both instruments were introduced through the trocar of the AirSeal system, making simultaneous introduction and use possible. We preferred the long suction-and-irrigation device, because it minimizes collision of the instruments.Results:Mean age and BMI of the patients were 55 ±14.6 y and 29.18 ± 6.85, respectively. Seven tumors were on the right side and 4 were on the left. The mean size of the tumors was 32.45 mm (± 11.31). Surgical time was 132.2 minutes (±37.17), with an estimated blood loss and ischemia time of 103.63 mL (±65.92) and 16.72 minutes (±9.52), respectively. One patient had postoperative bleeding that was resolved without transfusion. The median hospitalization period was 3.9 d (±0.53). Loss of intra-abdominal pressure was not observed, and pressure was stable at 10 mm Hg.Conclusion:The AirSeal System and its valveless trocar eliminated the need for an additional port placement in our series. The technique is feasible, safe, and reproducible; therefore, it may be implemented in selected cases of robot-assisted partial nephrectomies.     

Immediate Continence Rates in RALRP: A Comparison of Three Techniques

Methods:We retrospectively analyzed the patients who underwent RALRP for localized prostate cancer by a single surgeon in our clinic from January 1, 2009–February 1, 2016. Continence was defined as no leakage or use of a safety pad for minimal leakage. The main outcome measure was continence at postoperative week 1 and months 1, 6, and 12.Results:Between 2009 and 2016, 239 patients underwent RALRP for localized prostate disease. Seventy-four patients underwent a standard approach (group 1), 88 had posterior reconstruction (group 2), and 77 had posterior reconstruction with total anatomic restoration (group 3). After 1 week, 24.3% of the patients in group 1 (18/74), 31.8% in group 2 (28/88), and 45.8% in group 3 (33/72) were continent (P = .02). One month after the surgery, continence rates for groups 1, 2, and 3 were 56.7, 67, and 75%, respectively (0.065). After 6 and 12 months, continence rates for groups 1, 2, and 3 were 72.9 and 87.8%, 81.8 and 89.7%, and 84.7 and 91.6%, respectively (P = .178 and .7484).Conclusion:Anatomic restoration improves continence rates in the early period after RALRP. Even though other parameters were higher in the total restoration group, immediate continence (at 1 week) was significantly better.     

细胞因子白细胞介素-6及胰岛素生长样因子-1与类风湿关节炎临床表现的关联性研究

目的研究白细胞介素-6(interleukin-6,IL-6)及胰岛素样生长因子-1(insulin-like growth factor-1,IGF-1)与类风湿关节炎(rheumatoid arthritis,RA)临床表现的关联性。方法采用酶联吸附免疫法(enzyme linked immunosorbent assay,ELISA)测定RA患者血清IL-6及IGF-1浓度,分析其于RA临床表现的关联性。结果1.骨质疏松组IGF-1水平明显低于无骨质疏松组(P0.05)。而男性组与女性组、RF阳性组与阴性组、ACCP阳性组与阴性组、无+轻度贫血与中度+重度贫血、白细胞减少与白细胞不减少、血小板升高与无血小板升高之间均无显著性差异(P0.05)。2.IGF-1与ACCP滴度、RF滴度、病程、ESR、年龄、CRP均无相关性(P0.05),与疼痛关节数及肿胀关节数呈负相关(P0.05)。3.男性RA患者IL-6水平明显比女性RA患者水平低(P0.05),ACCP阴性组明显比阳性组低(P0.05),骨质疏松组明显比无骨质疏松组低(P0.05)。而RF阳性组与阴性组、无+轻度贫血与中度+重度贫血、白细胞减少与白细胞不减少、血小板升高与无血小板升高之间均无显著性差异。(P0.05)。4.IL-6水平与ACCP滴度、疼痛关节数及肿胀关节数呈正相关(P0.05),与IGF-1水平呈负相关(P0.05),与RF滴度、病程、ESR、年龄、CRP均无相关性(P0.05)。结论IL-6及IGF-1与RA病情活动有关。女性患者Il-6高,易于发生骨质疏松     

Evaluation of genitofemoral nerve motor conduction in inguinoscrotal pathologies

Aim

Inguinoscrotal pathologies are commonly seen in childhood. The genitofemoral nerve (GFN) is responsible for sensitive innervations of scrotal region and the motor innervations of cremasteric muscle. GFN also innervates the afferent and efferent pathways of cremasteric reflex. A prospective study was performed to evaluate the possible relation between inguinoscrotal pathologies and GFN motor functions.

Methods

Patients with inguinal hernia, hydrocele, undescended or retractile testicles, aged between 2-12 years were enrolled in the study. Bilateral latency and duration of GFN motor conductions (GFNMC) were obtained electrophysiologically by surface electrodes. GFNMC recordings of non-pathological sides were assessed as control group. Latency and duration of each group were compared with control group (Mann-Whitney U test). P values lower than .05 were considered significant.

Results

Seventy-three electrophysiologic evaluations were investigated in inguinal hernia (n:18), hydrocele (n:9), undescended testicle (n:14), retractile testicle (n:12) and control (n:20) groups. There was no age difference between groups and controls. Latency was significantly prolonged in inguinal hernia group when compared with control group (P = .028). Although the latencies were shortened in undescended testicle group, no significant difference detected (P > .05).

Conclusion

Prolonged latencies in inguinal hernia may be a result of nerve trap caused by hernia sac. GFN motor functions showed no causative role in other inguinoscrotal pathologies. It can be also suggested that clinical features of other inguinoscrotal pathologies were not affected by GFN motor functions. Electrophysiological studies in younger age groups with large number of patients are needed to support our suggestions.