Analysis of spontaneously passed urinary tract stones

Most studies on epidemiology, composition, and recurrence of renal calculi include both spontaneously passed calculi and those retrieved after surgical manipulation or shock wave lithotripsy. The present study exclusively focused on epidemiology, composition, and recurrence of spontaneously expelled stones in patients from North and East Mallorca (Spain) which represents a geographically specific non-urban region of a developed country. The study involved 136 patients who spontaneously passed 205 renal calculi. All calculi were classified and sub-classified according to composition after macroscopic and microscopic examination. We also analyzed prevalence, gender, age, and stone recurrence rate over a period of 3 years. The peak incidence of spontaneously stone passage is within the fourth to sixth decade. Overall male to female ratio was 3/1. Calcium oxalate was the most prevalent composition (64.8%) followed by uric acid (25.3%), mixed stones (5.3%) and calcium phosphate calculi (4.3%). Uric acid stones were the most recurrent (50%) followed by calcium oxalate monohydrate papillary calculi (26.4%), calcium oxalate monohydrate un-attached calculi (19.2%), calcium oxalate dihydrate calculi (18.3%), calcium phosphate calculi (14%), and mixed calculi (12.5%). In conclusion, spontaneously passed stones in Mallorcan population have similar epidemiology, composition, and recurrence rate from that found in other developed countries. Calcium oxalate stones are largely the most spontaneously passed type of calculi and uric acid stones are the most frequently recurred. These findings are also found to be similar to those reported in previous studies examining both spontaneously and non-spontaneously passed stones.     

切开挂线术治疗骨盆直肠间隙脓肿32例临床观察

目的探讨切开挂线术治疗骨盆直肠间隙脓肿的临床应用价值。方法自2008年1月至2009年3月对32例骨盆直肠间隙脓肿患者行切开挂线术。结果 32例均临床治愈,住院l5～26d（平均20d）,其中31例随访1年无复发,1例形成肛瘘,经再次手术治愈。结论切开挂线术治疗骨盆直肠间隙脓肿具有病程短,一次性根治率高等优点,且有效减轻或避免了肛门缺损。     

Apogossypolone, a novel inhibitor of anfiapoptotic Bcl-2 family proteins, induces autophagy of PC-3 and LNCaP prostate cancer cells in vitro

Limited treatment options are available for aggressive prostate cancer. Gossypol has been reported to have a potent anticancer activity in many types of cancer. It can increase the sensitivity of cancer cells to alkylating agents, diminish multidrug resistance and decrease metastasis. Whether or not it can induce autophagy in cancer cells has not yet been determined. Here we investigated the antiproliferative activity of apogossypolone （ApoG2） and （-）-gossypol on the human prostate cancer cell line PC3 and LNCaP in vitro. Exposure of PC-3 and LNCaP cells to ApoG2 resulted in several specific features characteristic of autophagy, including the appearance of membranous vacuoles in the cytoplasm and formation of acidic vesicular organelles. Expression of autophagy-associated LC3-Ⅱ and beclin-1 increased in both cell lines after treatment. Inhibition of autophagy with 3-methyladenine promoted apoptosis of both cell types. Taken together, these data demonstrated that induction of autophagy could represent a defense mechanism against apoptosis in human prostate cancer cells.     

基础护理操作训练中护生人文素质的培养

目的探讨在基础护理操作训练中培养护生人文素质的方法及效果。方法将322名护生分成观察组(163人)和对照组(159人)。对照组采用常规基础护理操作训练法;观察组在基础护理操作训练中加强人文素质的培养,包括塑造白衣天使的美好形象,"真人真做"强化爱伤观念,培养法律意识,提升语言沟通能力,在护理技术操作评分标准中融入人文素质考评项目。结果观察组新标准操作考核成绩显著高于对照组(P0.01),参加省市护理操作技能大赛成绩优于对照组。结论在基础护理操作训练中进行人文素质的培养,将护生的人文素质考评融入到基础护理操作考核中,可提升护生的人文素养。     

Frozen Section Analysis for Intraoperative Margin Assessment During Breast-Conserving Surgery Results in Low Rates of Re-excision and Local Recurrence

Background Negative surgical margins minimize the risk of local recurrence after breast-conserving surgery. Intraoperative frozen section analysis (FSA) is one method for margin evaluation. We retrospectively analyzed records of patients who received breast-conserving therapy with intraoperative FSA of the lumpectomy cavity to assess re-excision rates and local control. Methods Records were retrospectively reviewed for individuals who underwent breast-conserving surgery for ductal carcinoma in situ (DCIS) or invasive carcinoma between 1993 and 2003. Inclusion criteria were a minimum of 2 years follow-up and intact tumor at the time of operation. The major outcome measure was local recurrence. The Kaplan-Meier test was used to evaluate local recurrence rates between groups. Results 290 subjects with an average age of 57.2 years (range 27–89) underwent 292 lumpectomies with FSA. 11.3% had DCIS, 73.3% had infiltrating ductal, 5.8% had infiltrating lobular, and 9.6% exhibited other forms of invasive carcinoma. 70 subjects underwent additional resection at the time of breast surgery, 16 underwent subsequent re-excision, and 17 underwent subsequent mastectomy. At a median follow-up of 53.4 months (range 5.8–137.8), there were six local recurrences (2.74%) in patients who had breast-conserving procedures and two local recurrences in patients who underwent mastectomy. There were no statistically significant associations among local recurrence rate, tumor size, nodal status, or overall stage. Local recurrences were higher in patients with DCIS compared with invasive carcinoma, and tumors >2cm. Conclusions Intraoperative FSA allows resection of suspicious or positive margins at the time of lumpectomy and results in low rates of local recurrence and re-excision. The low local recurrence rate reported here is comparable to those reported with other margin assessment techniques.     

悬吊式、气腹腹腔镜及不同麻醉方法对妇科患者细胞因子水平的影响

目的 比较在不同麻醉方法下妇科悬吊式或气腹腹腔镜患者术中血清细胞因子白介素-6(IL-6)、白介素-10(IL-10)、肿瘤坏死因子-α(TNF-α)和热休克蛋白70(heat shock protein 70,HSP70)水平的变化.方法 选择57例择期行腹腔镜下子宫肌瘤剔除术的患者,手术时间均短于100 min,按手术方式或患者的意愿分成3组(每组19例):Ⅰ组,于静脉全麻下行CO2气体腹腔镜手术;Ⅱ组,于静脉全麻下行悬吊式腹腔镜手术;Ⅲ组,于硬膜外神经阻滞麻醉下行悬吊式腹腔镜手术.监测3组患者麻醉前(T1)、气腹或悬吊建立后30 min(T2)、气腹或悬吊撤除后10 min(T3)和术后第2天晨8时(T4)4个时点的TNF-α、IL-6、IL-10和HSP70浓度.结果 麻醉前患者的血清IL-6、IL-10、TNF-α和HSP70水平差异均无统计学意义(P＞0.05).术后各指标的水平均升高,其中Ⅰ组在T3时达峰值,Ⅱ组和Ⅲ组在T4时达峰值.组间比较,Ⅰ组在T2时点的TNF-α水平[(31±14) pg/L)]高于Ⅱ组[(24±10) pg/L] (P＜0.05);在T3时点,Ⅰ组的IL-6[ (46±8) pg/L]、TNF-α[( 54±18) pg/L]和HSP70[ (3.18±0.58) μg/L]水平分别显著高于Ⅱ组[( 39±6) pg/L,(36±17) pg/L,(2.30±0.29) μg/L](P＜0.叭),且IL-6/IL-10比值也高于Ⅱ组(P＜0.05);此时,Ⅲ组的IL-6[(27±10) pg/L]和TNF-α[(24±7)pg/L]水平低于Ⅱ组(P＜0.05).结论 悬吊式腹腔镜技术免除了CO2气腹对机体的影响,降低了术中应激反应水平,与全身麻醉相比,硬膜外麻醉可进一步减轻此术式引起的应激反应.     

肝血管瘤血流动力学特征与个性化介入治疗的临床研究

目的探讨肝血管瘤血流动力学特征与个性化介入治疗的临床价值。方法 2007年1月～2010年2月,对81例肝血管瘤应用彩色多普勒血流显像（color Doppler flow imaging,CDFI）进行血流动力学评估,根据CDFI将其分为三型：富血供型、少血供型、乏血供型。根据CDFI评估结果采取个性化介入治疗方案：富血供型肝血管瘤行肝动脉栓塞术,采用平阳霉素超液化碘化油乳剂行肝动脉栓塞;乏血供和少血供型肝血管瘤,超声引导下经皮肝穿刺瘤内注入平阳霉素,分3次治疗,间隔10 d（瘤体≤7.0 cm,药物剂量分别为16、24、16 mg;瘤体〉7.0 cm,药物剂量分别为16、24、24 mg）。结果 CDFI示富血供型占25.9%（21/81）,少血供型占54.3%（44/81）,乏血供型占19.8%（16/81）。60例乏血供和少血供型肝血管瘤,采用超声引导下经皮肝穿刺瘤内注入平阳霉素,术后6个月瘤体消失21例（CR）,39例形成1.5～1.0 cm的瘢痕结节（PR）,总有效率100%。21例富血供型肝血管瘤行肝动脉栓塞,术后6个月19例瘤体缩小率〉75%（PR）,2例瘤体缩小50%左右（WR）,总有效率90.5%（19/21）。结论应用CDFI评估肝血管瘤的血流动力学特征,并以此为依据采取个性化介入治疗方案,在肝血管瘤介入治疗中具有重要的临床价值。     

无气腹悬吊与气腹腹腔镜手术对妇科手术患者血清细胞因子和HSP70水平的影响

目的比较妇科无气腹悬吊式与气腹腹腔镜手术对患者术中血清细胞因子白细胞介素-6（IL-6）、白细胞介素-10（IL-10）、肿瘤坏死因子-α（TNF-α）和热休克蛋白70（HSP 70）水平的影响。方法选择2005年7月至2006年2月择期行腹腔镜下子宫肌瘤剜除术的38例患者,手术时间均在100 min内,随机分成两组,每组19例。Ⅰ组于静脉全身麻醉下行CO2气体腹腔镜手术;Ⅱ组于静脉全身麻醉下行无气腹悬吊式腹腔镜手术。监测两组患者麻醉前（T1）、气腹或悬吊建立后30 min（T2）、气腹或悬吊撤除后10 min（T3）和术后次日晨8时（T4）4个时点的TNF-α、IL-6、IL-10和HSP70水平。结果麻醉前患者的血清IL-6、IL-10、TNF-α和HSP70水平差异无统计学意义（P〉0.05）。术后各指标的水平均升高,其中Ⅰ组在T3时达峰值,Ⅱ组在T4时达峰值。组间比较,Ⅰ组在T2时点的TNF-α水平高于Ⅱ组（P〈0.05）;在T3时点,Ⅰ组的IL-6、TNF-α和HSP70水平显著高于Ⅱ组（P〈0.01）,且IL-6/IL-10比值也高于Ⅱ组（P〈0.05）。结论悬吊式腹腔镜技术避免了CO2气腹对机体的影响,降低了术中应激反应水平。     

游离口腔黏膜代尿道治疗尿道下裂及前尿道狭窄50例

目的 探讨口腔黏膜游离移植,治疗严重尿道下裂和长段前尿道狭窄的手术适应证及疗效.方法 2006年5月至2010年4月期间我科共进行口腔黏膜游离代尿道治疗严重尿道下裂及长段前尿道狭窄50例,年龄5-48岁.其中尿道下裂28例,有过一次手术史15例,多次手术史10例.前尿道狭窄22例,狭窄段4～7cm长.结果 28例尿道下裂患者,26例成功;22例尿道狭窄患者,20例成功,手术成功率92.00%(46/50),尿道下裂患者术后阴茎外观满意,尿道开口于阴茎前端,排尿通畅.尿道狭窄患者术后1个月最大尿流率为14～40ml/s,平均29ml/s.所有手术成功患者术后随访1～10个月无尿道狭窄,无尿瘘.尿道下裂和尿道狭窄患者中各有2例失败,术后出现阴茎皮肤切口感染发生尿瘘,6个月行补瘘手术治愈.结论 对于多次手术,局部组织缺乏的尿道下裂及长段前尿道狭窄,应用口腔黏膜游离移植修复尿道,手术疗效好,值得推广.     

Reconstruction of fronto-orbital and nasal defects with compound epoxied maleic acrylate/hydroxyapatite implant prefabricated with a computer design program

The repair of fronto-orbital nasal bone defects may be a troublesome problem to plastic surgeons. This report aims to present the results of reconstruction of fronto-orbital nasal bone defects with the prefabrication of epoxied maleic acrylate/hydroxyapatite compound (EH compound) using 3-dimensional (3D) imaging data and computer-assisted manufacturing techniques, sometimes combined with autogenous bone to repair nasal defect. Helical computed tomography data were used to create a 3D model of the patient's skull. On the basis of these data, the individual shape of the implant was created by a computer-aided design/computer-aided manufacturing program. A rapid prototyping system was applied for production of the physical models. A total of 12 patients with traumatic fronto-orbital nasal defects were included in this study. The patients followed up for 1 to 24 months. The satisfactory results, such as excellent symmetry, stability, and normal fronto-orbital contours were obtained for all patients. The operating time was short without any complications. The depression of the region of fronto-orbital nasal bone defects always achieved an attractive or satisfactory prominence that was in balance and harmony with other facial features of all the patients. This method allows accurate fabrication of the implant. It improves the surgical techniques and reduces the risk of a second intervention, with improved aesthetic outcomes.