ANATOMICAL AND FUNCTIONAL RESULTS OF PUBOVAGINAL SLING PROCEDURE USING POLYPROPYLENE MESH FOR THE TREATMENT OF STRESS URINARY INCONTINENCE

PURPOSE: The anatomical and functional results of pubovaginal sling procedure using polypropylene mesh were investigated. MATERIALS AND METHODS: A total of 50 women with stress urinary incontinence, including 26 with type 2, 7 with mixed type 2/3 and 17 with type 3 disease, underwent the pubovaginal sling procedure using polypropylene mesh. A self-fashioned 2 cm. polypropylene mesh sling was used in all cases. The slings were fixed without tension at each side of the bladder neck. The sling was further suspended to elevate the bladder neck in patients with type 2 disease and those with a hypermobile bladder base, while it was placed without further tension in those with type 3 disease and those with a nonmobile bladder base. After the operation video urodynamics and transrectal sonography were done to evaluate functional and anatomical results. RESULTS: At a median followup of 24 months 42 women were cured, 6 had improvement and treatment had failed in 2. Although the maximum flow rate increased, no changes were noted in detrusor pressure, post-void residual urine or cystometric capacity at month 3. Transrectal sonography revealed that mean sling width plus or minus standard deviation had decreased to 13.5 +/- 3.3 mm. at 3 months. The endopelvic fascia was thicker in women with type 2 than in those with types 2/3 or 3 disease (mean 5.3 +/- 1.5 versus 3.5 +/- 1.3 mm., p = 0.001). The position of bladder neck on video urodynamics was elevated a mean of 2.01 +/- 2.01 and 3.07 +/- 2.07 cm. compared to baseline elevation during resting and straining, respectively (p = 0). No hypermobility was noted while the patients coughed and no kinking of the urethra was observed while they performed the Valsalva maneuver. Detrusor instability resolved in 6 of 8 women (75%) and new onset detrusor instability was noted in 7 (14%). In 2 women with persistent stress urinary incontinence a repeat sling procedure was necessary to treat type 3 disease and cure incontinence. The overall success rate was 96%. One patient with sling erosion into the vaginal wall was treated with simple revision. CONCLUSIONS: Fixation of a polypropylene mesh sling at the bladder neck and adequate suspension may effectively achieve a hammock effect without creating bladder outlet obstruction in patients with types 2 and 2/3 stress urinary incontinence. The anatomical and functional results of this study show that a well suspended bladder neck did not create bladder outlet obstruction after a pubovaginal sling procedure using polypropylene mesh.     

长强穴埋线治疗痔术后疼痛的临床观察

目的:观察长强穴埋线治疗痔术后疼痛的疗效。方法:将60例患者随机分为治疗组和对照组,每组各30例。治疗组在手术前行长强穴埋线治疗,对照组采用吲哚美辛栓纳肛治疗,1粒/d,连用4天。观察两组患者每天疼痛程度、24h疼痛持续时间及肛缘水肿、睡眠及尿潴留等情况。结果:治疗组每天疼痛程度、24h疼痛持续时间及肛缘水肿、睡眠及尿潴留与相应对照组比较均有显著性意义(P<0.05)。结论:长强穴埋线能明显缓解痔术后疼痛和减少并发症,疗效较吲哚美辛栓好。     

Heat‐Stress Responses Modulate Beta‐Adrenergic Agonist and Angiotensin II Effects on the Arrhythmogenesis of Pulmonary Vein Cardiomyocytes

Effect of Heat Stress on Pulmonary Vein Cardiomyocytes. Introduction: Heat stress‐induced responses reduce the occurrence of atrial fibrillation (AF). Pulmonary vein (PV) cardiomyocytes with pacemaker activity play a critical role in the pathophysiology of AF. In this study, we examined whether heat‐stress responses alter the electrophysiological characteristics of PV cardiomyocytes and protect the PV against angiotensin II‐ or isoproterenol‐induced arrhythmogenesis. Methods and Results: We used whole‐cell patch clamp techniques to investigate the spontaneous activity and ionic currents in single isolated rabbit PV pacemaker cardiomyocytes with or without (control) exposure to heat stress (43°C, 15 minutes) 5 ± 1 hours before the experiments. Compared to control cardiomyocytes, heat‐stressed PV cardiomyocytes had slower beating rates. Heat‐stressed PV cardiomyocytes had larger L‐type calcium currents, transient outward currents, smaller inward rectifier potassium currents, but similar sodium‐calcium exchanger currents_. Additionally, heat‐stressed PV cardiomyocytes had a lower incidence of pacemaker currents than control PV cardiomyocytes. Moreover, isoproterenol increased the beating rate of control cardiomyocytes but not heat‐stressed PV cardiomyocytes. Similarly, angiotensin II also increased the beating rate of control cardiomyocytes, but not heat‐stressed PV cardiomyocytes, in association with decreased expression of the angiotensin II type 1 receptor. Conclusion: Heat‐stress responses altered the electrophysiological characteristics of PV cardiomyocytes and attenuated the effects of isoproterenol and angiotensin II on PV arrhythmogenesis, which may play a role in the protective potential of heat‐stress responses. (J Cardiovasc Electrophysiol, Vol. 22, pp. 183‐190, February 2011)     

Simultaneous occurrence of papulonecrotic tuberculide and erythema induratum and the identification of Mycobacterium tuberculosis DNA by polymerase chain reaction

The simultaneous occurrence of two tuberculides in one patient is rare. We report the case of a 32-year-old man presenting with both papulonecrotic tuberculide and erythema induratum. Mycobacterial DNA was identified from both skin lesions by polymerase chain reaction using formalin-fixed and paraffin-embedded tissues, suggesting that tuberculides are related to tuberculosis. New skin lesions developed after the patient discontinued his medication on his own initiative, 2 months after triple antituberculous therapy had been started. It is important to continue therapy for a prolonged period.     

Mycoplasma pneumonia: Clinical and radiographic features in 39 children

BACKGROUND: The purpose of the present paper was to evaluate the clinical and chest radiographic features of pediatric patients with serologically proven Mycoplasma pneumoniae pneumonia (mycoplasma pneumonia). METHODS: The clinical records and chest radiographs of 39 consecutive patients (19 male, 20 female; age 3-13 years) with serologically positive IgG and IgM mycoplasma pneumonia were reviewed. RESULTS: More than 90% of patients presented with fever and cough and 48% of patients had leukocyte count >10,000/mm(3). A C-reactive protein (CRP) level >0.375 mg/dL was noted in 28 patients (72%). Chest radiographs displayed four different patterns: (i) peribronchial and perivascular interstitial infiltrates (n= 19, 49%); (ii) airspace consolidations (n= 15, 38%); (iii) reticulonodular opacification (n= 3, 8%); and (iv) nodular or mass-like opacification (n= 2, 5%). Bilateral peribronchial perivascular interstitial infiltrations in central and middle lung zones were frequently seen (n= 19, 49%). Other radiological features were bilateral lesions in 51% of patients, pleural effusion in 23%, and hilar lymphadenopathy in 13%. Means of duration for treatment response and hospitalization were 2.5 and 5 days, respectively. CONCLUSION: There are various radiological features of mycoplasma pneumonia in children. Bilateral peribronchial and perivascular interstitial infiltrates were most frequently seen in the present patients.     

Transcatheter arterial embolization for hepatocellular carcinoma with portal vein thrombosis

Abstract In order to evaluate the possible benefits of transcatheter arterial embolization (TAE) in hepatocellular carcinoma (HCC) patients with peripheral portal vein thrombosis, 96 consecutive HCC cases with peripheral portal vein thrombosis were analysed. Of them, 35 cases received TAE and 61 cases did not. Most (77.8%) of the TAE-treated cases showed decreased α-fetoprotein (AFP) levels after treatment, but 57.1% of them suffered another rise in AFP levels and subsequently died. One patient (2.8%) developed progressive jaundice after TAE and died within 1 month, while four of the non-TAE cases died within 1 month after diagnosis. In general, TAE is safe for HCC patients with peripheral portal vein thrombosis. In addition, using Cox's regression model for multivariate survival analysis, serum total bilirubin (≤, > 2 mg/dL; P = 0.0254), AFP (≤ 3155 ng/mL, > 3155 ng/mL; P = 0.0002) and treatments (TAE, non-TAE; P = 0.0059) were found to affect their prognosis. There was significant difference in survival between TAE and non-TAE groups, the 6 month, 1 year and 2 year survival rates were 91.4 versus 62.3%, 51.4 versus 26.2% and 17.1 versus 4.9% ( P = 0.0017). The median survival times of TAE and non-TAE groups were 10.3 versus 3.7 months, respectively. Though TAE only provided palliative treatment, it did prolong survival in HCC patients with peripheral portal vein thrombosis.     

红细胞生成素对骨髓源间充质干细胞迁移的影响

目的 利用Transwell体外迁移体系初步探索EPO在骨髓源间充质干细胞(MSC)迁移中的作用及其信号传递机制.方法 采用经典的全骨髓细胞贴壁法培养MSC,通过成骨、成脂肪等多向诱导分化以及流式细胞术分析其表面标志(CD133、CD34、CD90、CD105)等鉴定MSC特征;以第3代MSC为实验材料,利用Transwell体外迁移体系,先观察不同浓度的rhEPO对MSC迁移的影响,随后在50 nmol/L Wortmannin、50μmol/L PD98059、10μmoL/L U73122、4μg/ml抗EPO-R IsG、30 μmol/LSB203580、10 mmol/L Straurosporine、6 nmol/L G0697、50 μmol/L Pseudo Z等不同的信号转导途径阻断剂的干预下观察EPO对迁移的影响.结果 培养的MSC呈现出CD90、CD105强阳性,具有成骨、成脂肪等多向分化能力;MSC体外迁移能力随着rhEPO浓度(1、10、100、1000 IU/ml)的递增而逐渐增强,并且rhEPO浓度在100 U/ml时,MSC迁移到滤膜上的细胞数接近于峰值;Wortmannin、PD98059、抗EPO-R IgG、Straurosporine、G06976、Pseudo Z对MSC迁移均有影响,其中U73122、抗EPO-R IgG、Straurosporine、Pseudo Z对MSC迁移阻断的效应最显著.结论 EPO-EPO-R所介导的MSC迁移与丝裂原活化蛋白激酶、磷脂酰肌醇特异性磷脂酶C和蛋白激酶C-ζ(PKC-ζ)等信号传递途径有关,且PKC-ζ途径可能处于中心环节.