Transvesicoscopic Cohen ureteric reimplantation for vesicoureteral reflux in children: A single-centre 5-year experience

PurposeTo evaluate our results with a new method of intravesical ureteric reimplantation using laparoscopic pneumovesicum in children.Materials and methodsSeventy-two patients (mean age 4.2 years, range 0.5–20 years) with primary vesicoureteral reflux (VUR) underwent a laparoscopic transtrigonal ureteric reimplantation with CO₂ pneumovesicum. Ports were inserted suprapubically – 5 mm for the camera and two 3–5-mm working ports. Having mobilized the ureter(s) intravesically, a submucosal tunnel is created and ureteric reimplantation performed with 5/0 and 6/0 absorbable sutures. Bladder drainage was maintained for 2–3 days postoperatively. Patients were followed up with clinical assessment and renal ultrasonography ± voiding cystourethrogram.ResultsNinety percent had VUR grade ≥3. A total of 113 ureters were reimplanted. The mean operative time was 82 min for unilateral and 130 min for bilateral reimplantation. Four cases (6%) were converted. Three patients presented with temporary ureteric dilatation without symptoms on follow-up renal ultrasound. Seven patients had postoperative urinary tract infection without persistent reflux on cystography. Follow-up cystogram was performed in 50 patients (81 ureters). Reflux persisted in four patients (8%).ConclusionsLaparoscopic ureteric reimplantation with CO₂ pneumovesicum is technically feasible with a high success rate (92%). The role of this new technique in the treatment of VUR remains to be determined.     

Interleukin‐6 and chemokines in the neuropsychiatric manifestations of systemic lupus erythematosus

Objective

To define the cytokine and chemokine profile in cerebrospinal fluid (CSF) from patients with neuropsychiatric systemic lupus erythematosus (NPSLE).

Methods

Forty‐two SLE patients who had been hospitalized because of NP manifestations were studied. Patients were evaluated at hospitalization and 6 months later; a CSF sample was obtained at each evaluation. As controls, CSF from 6 SLE patients with septic meningitis, 16 SLE patients with no history of NP manifestations (non‐NPSLE), and 25 patients with nonautoimmune diseases were also studied. Soluble molecules, including cytokines (interleukin‐2 [IL‐2], IL‐4, IL‐6, IL‐10, tumor necrosis factor α [TNFα], and interferon‐γ [IFNγ]) and chemokines (monocyte chemotactic protein 1 [MCP‐1], RANTES, IL‐8, monokine induced by IFNγ [MIG], and interferon‐γ–inducible 10‐kd protein [IP‐10]), were measured with the use of cytometric bead array kits.

Results

CSF levels of the following molecules were significantly increased in NPSLE patients as compared with non‐NPSLE and nonautoimmune diseases control patients, respectively: IL‐6 (32.7 versus 3.0 and 2.96 pg/ml), IL‐8 (102.8 versus 29.97 and 19.7 pg/ml), IP‐10 (888.2 versus 329.7 [P not significant] and 133.6 pg/ml), RANTES (3.8 versus 2.5 and 2.2 pg/ml), MCP‐1 (401.7 versus 257.9 [P not significant] and 136.9 pg/ml), and MIG (35.4 versus 11.4 and 3.5 pg/ml). Low levels of IL‐2, IL‐4, IL‐10, TNFα, and IFNγ were found in all groups. All cytokines and chemokines, except TNFα, were significantly higher among the SLE patients with septic meningitis than among the NPSLE patients. Six months later and in the absence of NP manifestations, all elevated molecule levels, except RANTES, in patients with NPSLE had decreased significantly, and no differences were noted between the NPSLE and non‐NPSLE groups.

Conclusion

A central nervous system response composed of IL‐6 and chemokines, but not Th1/Th2 cytokines, is associated with NP manifestations in SLE patients.

     

黄芪皂苷抗实验性肝损伤作用

两种黄芪苷ASI和SK能对抗D-半乳糖胺,醋氨酚引起的肝损伤。表现为减轻肝毒引起的病变,SGPT降低,肝MDA下降,GSH升高;且三项指标变化呈明显相关。从离体大鼠肝细胞制备法也证明ASI和SK在0.75μmol/L～0.18 nmol/L浓度范围内,可对抗CCl₄引起的GPT升高。给小鼠连续灌服ASI 12,50 mg/kg或SK 6,20 mg/kg能提高肝微粒体细胞色素P—450活性。此结果表明,黄芪苷是黄芪抗肝毒损伤的有效成分。其机理除抗生物氧化外,尚与代谢调节作用有关。     

The natural history of intimal flaps caused by angioscopy

This study tried to determine the natural history of angioscopy-induced arterial intimal flaps as assessed by video angioscopy, light and transmission electron microscopy. Eight mongrel dogs were anesthetized and bilateral femoral and carotid arteries surgically exposed. A 3.0 mm American Edwards angioscope was inserted into each artery and passed vigorously until an intimal flap was visualized by angioscopy. The location of intimal flaps was externally marked with 6–0 polypropylene adventitial sutures. Animals were then recovered and follow-up angioscopy performed at one, two, three, and four week intervals. Following repeat angioscopy, all animals were sacrificed and vessels perfusion-fixed in situ with 2.5% glutaraldehyde in 0.1 M sodium cacodylate. A total of 37 intimal injuries were created (immediate, n=10; one week, n=8; two weeks, n=4; three weeks, n=8; four weeks, n=7). No arterial thrombosis occurred following intimal flap formation. Only one of 37 (2.7%) lesions progressed to a hemodynamically significant stenosis. Histology of immediate lesions demonstrated deep intimal fractures extending into the tunica media. Complete healing of intimal flaps was observed by follow-up angioscopy in zero of eight lesions by one week, zero of four lesions by two weeks, one of eight lesions by three weeks, and four of seven lesions by four weeks (p=0.02). Light and electron microscopy confirmed the angioscopic intimal fractures and regrowth of denuded endothelium. Conclusion: follow-up angioscopy and microscopy one month after angioscopy-induced arterial intimal trauma demonstrated a significant trend towards complete endothelial healing.Presented at the 16th Annual Meeting of the Peripheral Vascular Surgery Society, June 2, 1991, Boston, Massachusetts.     

美托洛尔光学异构体在犬体内的药动学-药效学结合模型

用麻醉犬研究美托洛尔（Ｍｅｔ）光学异构体药动学—药效学结合模型。结果表明，ｉｇ（＋）Ｍｅｔ或（－）Ｍｅｔ后，其药动学符合二室模型，药动学参数Ｖｄ／Ｆ，ＣＬｓ／Ｆ和ＡＵＣ在两种Ｍｅｔ之间有显著性差异。（＋）Ｍｅｔ和（－）Ｍｅｔ的效应和血药浓度关系呈逆时针滞后环。引入效应室理论后，药效和效应室浓度之间的关系符合ＳｉｇｍｏｉｄＥｍａｘ模型。应用ＣＡＰＰ软件进行模型拟合，血药浓度的预测值和药效的预测值皆与其实测值较为接近。（＋）Ｍｅｔ抑制Ｖｍａｘ，ｄｐ／ｄｔｍａｘ及ＨＲ效应的Ｃｅ５０分别是（－）Ｍｅｔ的３７，６８，６３倍，证实（－）Ｍｅｔ对犬心脏的抑制作用强于（＋）Ｍｅｔ。