Long-term follow up to determine the prognostic value of imaging after urinary tract infections. Part 1: Reflux

In 3646 children with at least one confirmed urinary tract infection the prevalence of vesicoureteric reflux at presentation was correlated with progressive renal damage during follow up of not less than two and up to 16 years. Reflux was not demonstrated either at presentation or at any subsequent time in almost one half of the children who suffered progressive renal damage and was not a risk factor for progressive renal damage in boys under 1 year. It was an important risk factor in boys over 1 year and in girls of any age. The risk of progressive renal damage in children in whom micturating cystourethrography (MCU) did not reveal vesicoureteric reflux was substantially greater than in those who indirect isotope voiding study (IVS) did not show reflux. The risk of deterioration for those in whom reflux was demonstrated was similar for both techniques. This discrepancy indicates an appreciably higher false negative rate for the MCU than the IVS. Dilatation of the renal pelvis detected by ultrasound was associated with a significantly increased risk of progressive damage only when associated with reflux, but most children with progressive damage did not have a dilated collecting system at presentation.     

经腹腔镜开窗减压术治疗巨大非寄生虫性脾囊肿是有效的保脾术式

原发性脾囊肿是一种罕见的疾病,目前尚缺乏对该疾病的理想治疗方法的相关研究.大多数原发性脾囊肿是上皮性囊肿.近几年,腹腔镜脾脏外科手术普及率不断提高.该研究报告了关于经腹腔镜保脾手术治疗脾囊肿的相关经验.1996年至2006年间,作者治疗了11例有症状的非寄生虫性脾脏巨大囊肿病人.病人均诉左上腹涨满症状,触诊可扪及腹部包块.术前腹部超声及CT均已明确诊断.病人接受经腹腔镜脾脏囊肿部分切除术或脾脏囊肿开窗减压术.结果发现,7例病人为脾脏间皮囊肿,2例为脾脏表皮样囊肿,2例为脾脏假性囊肿,没有发现囊肿癌变.手术操作时间为62～85 min,无中转开腹.     

The effect of cartilage and bone density of mushroom-shaped,photooxidized, osteochondral transplants: an experimental study on graft performance in sheep using transplants originating from different species

Background  

Differences in overall performance of osteochondral photooxidized grafts were studied in accordance of their species origin and a new, more rigorous cleansing procedure using alcohol during preparation.     

Mycotic aneurysms of the aorta: radiologic features

Four patients with a total of six mycotic aneurysms of the aorta were examined with computed tomography (CT) after intravenous contrast material enhancement, and with abdominal or thoracic aortography. In the three patients with mycotic aneurysms involving the abdominal aorta, CT scans showed a vascular paraaortic structure without calcified walls adjacent to a nondilated aorta, and a large non-contrast-enhanced retroperitoneal mass representing inflammatory tissue and blood from a contained aortic rupture. A CT scan of one aneurysm of the thoracic aorta demonstrated an enhanced saccular mass originating from the aorta without paraspinal component. In three of four patients, the CT findings were corroborated by aortographic evidence of an eccentric aneurysmal sac in an atypical location for atheromatous disease. In four patients with clinical manifestations suggesting mycotic aneurysm of the aorta, a combination of CT and angiographic imaging provided accurate diagnostic information for planning adequate and early surgical treatment.     

Doppler Ultrasound in Canine Pregnancy

Objective. The aim of this article is to review the current knowledge of Doppler ultrasound in canine pregnancy. A brief introduction of Doppler principles and their applications in human obstetrics is also included. Methods. A review of the peer‐reviewed published literature was conducted of the articles pertaining to the use of Doppler ultrasound in canine pregnancy, general Doppler principles, and Doppler applications in human obstetrics. Results. In bitches, Doppler ultrasound has been used to assess ovarian, uterine, umbilical, fetal aorta, common carotid artery, and fetal caudal vena cava blood flow during normal gestation. Most of these vessels increase their blood flow during normal pregnancy. The resistive index and systolic/diastolic ratio of the uterine arteries have been recently described in an experimental pharmacologically induced model of abnormal canine gestation. Both indices progressively increase up to abortion, probably because of progesterone deprivation. Moreover, resistive index abnormalities have been found in canine cases of spontaneous abnormal gestations as described in human medicine. Conclusions. Doppler ultrasound is a useful method for assessing development of the placental and fetal circulation during normal and abnormal canine pregnancy. Further studies are still necessary to widely use this technique in clinical practice.     

Hemodilution and intravenous perflubron emulsion as an alternative to blood transfusion: effects on tissue oxygenation during profound hemodilution in anesthetized dogs

BACKGROUND: Intravenously administered perfluorocarbon (PFC) emulsions increase oxygen solubility in plasma. PFC might therefore temporarily replace red cells (RBCs) lost during intraoperative hemorrhage. In patients who have undergone hemodilution, the return of autologous blood may be delayed by the administration of PFC, and autologous RBCs may be saved for transfusion after surgical bleeding is stopped and PFC is cleared by the reticuloendothelial system. STUDY DESIGN AND METHODS: In 22 anesthetized, hemodiluted dogs (hemoglobin [Hb] 7 g/dL) breathing 100-percent O2, an intraoperative volume-compensated blood loss was simulated. The efficacy of three therapeutic regimens in maintaining tissue oxygenation was compared: 1) RBC group (n = 7): maintenance of a Hb > 7 g per dL by transfusion of autologous RBCs; 2) PFC group (n = 7): bolus application of a second-generation PFC emulsion (60% wt/vol perflubron) and further acute normovolemic hemodilution (ANH) to a Hb of 3 g per dL; and 3) control group (n = 7): further ANH alone to a Hb of 3 g per dL. Systemic and myocardial oxygenation status and tissue oxygenation were assessed. RESULTS: Autologous RBCs transfused to maintain a Hb of 7 g per dL preserved hemodynamics and tissue oxygenation during blood loss. In the PFC and control groups, heart rate and cardiac index increased significantly in response to further ANH. Tissue oxygenation was not different in the PFC and the RBC groups. Direct comparison of the PFC and control groups revealed better tissue oxygenation in the PFC group, as reflected by significantly higher mixed venous, coronary venous, and local tissue pO2 on liver and skeletal muscle. CONCLUSION: Bolus intravenous administration of 60- percent (wt/vol) perflubron emulsion and further hemodilution from a Hb of 7 g per dL to one of 3 g per dL were as effective as autologous RBC transfusion in maintaining tissue oxygenation during volume-compensated blood loss designed to mimic surgical bleeding.