ESWL: stone-free efficacy based upon stone size and location

Summary Extracorporeal shock wave lithotripsy was used for the treatment of 1060 patients or 1128 kidneys with solitary stones. There were 528 pelvic stones, 82 upper caliceal stones, 120 middle caliceal stones and 398 lower caliceal stones. These groups were divided into two subgroups of large (>15 mm) and small (15 mm) stones. A total of 1232 treatments were carried out (1.16/patient or 1.09/kidney) and 91% of the patients underwent a single treatment. Auxiliary procedures were required in 5% of the patients and the complication rate was 3%. Overall, 74% of the patients were stone-free after 3 months of follow-up. Of the 26% with residual stones, 18% had sand (2 mm fragments) or match-heads (4 mm), 6% had fragments (5 mm) and 2% had no fragmentation at all. A stone-free result occurred in approximately 87% with small pelvic and upper caliceal stones, whereas large stones in these locations became stone-free in approximately 70% of cases. Both large and small stones in the lower half of the kidney (mid and lower calices) become stone-free less frequently (to a statistically significant degree) than do similar stones located in the pelvis or upper calices.     

A morphologic study of childhood lymphoma of the diffuse "histiocytic" type. The Pediatric Oncology Group experience

Of 227 cases of pediatric non-Hodgkin's lymphoma with adequate histopathologic material for review, 72 (32%) were classified as diffuse "histiocytic" lymphoma (DHL). These cases were further divided into different morphologic subtypes according to the Lukes-Collins classification, and the National Cancer Institute Working Formulation, to ascertain whether there were any significant prognostic differences among the different subtypes. The results of our study showed that 40 patients were classified as immunoblastic lymphomas, and 32 were called large follicular center cell (FCC) tumors. Of the 40 patients with immunoblastic histology, 19 had morphologic features of the clear cell type and were interpreted as consistent with T-immunoblastic lymphomas; an additional two had polymorphous features also consistent with T-cell type: 17 had plasmacytoid features, and were morphologically classified as B-immunoblastic lymphomas; two could not be subtyped. Of the 32 patients with morphologic features of FCC lymphomas, 29 were classified as large noncleaved type, and three as large cleaved type. A clinicopathologic analysis showed that 90% of the patients obtained complete remission, and there were no significant differences in complete remission rate among the different morphologic subtypes of DHL. The estimated five year disease-free survival for all patients was over 70%, with no failure after the second year; and there were no significant differences in the disease-free survival among the different subtypes. The only clinical differences that we found, were that patients with lymphomas of FCC (large noncleaved) type were younger (P = 0.01); had less nodal involvement (P = 0.03); and had more organ involvement (P less than 0.01). We conclude that the morphologic subclassification of DHL in children currently has limited clinical prognostic significance.     

Priapism--a complication of home parenteral nutrition?

A case of priapism in a patient receiving home parenteral nutrition is reported. To our knowledge this is the first such case to occur in a patient receiving home parenteral nutrition. The literature is reviewed and the possible aetiology discussed.     

Gallstones: advantages and disadvantages of five treatment alternatives

Cholecystectomy is the gold standard treatment for symptomatic gallstones. However, within the last decade peroral drug chemolysis, methyl-tert-butyl ether lavage, shock wave lithotripsy, and percutaneous cholecystolithotomy have been introduced. This article compares and contrasts the presently available therapeutic modalities for gallstones and highlights the limitations of each treatment option.     

急性髓细胞白血病血型变异1例

1　临床资料　患者 ,女 ,6 1岁 ,1999- 0 6 - 0 3日确诊为急性红白血病 (M6 ) .先后 4次住院 ,鉴定血型均为 O型 . 2 0 0 0 - 0 1- 2 2日复诊 ,正反鉴定表明 ,患者红细胞与抗 - B不凝集 ,与抗 - A凝集 ,血清中有抗 - B抗体 (表 1) ,吸收释放试验证实为 A型 (表2 ) .输 A型浓缩红细胞 2 μ,无不良反应 .表 1　血型正反鉴定试剂血清试剂红细胞标本抗 A 抗 B 抗 A+ B Ac Bc Oc被检红细胞 2 + -3+ ---自身血清 -3+ -表 2　吸收、放散试验被检 RBC吸收抗血清后上清被检 RBC吸收抗血清后释放液试剂细胞抗 A修正液抗 B修正液抗 A修正液抗…     

综合疗法治愈狼疮性急性肾衰1例

1　病例报告　患者 ,女 ,6 0岁 ,因反复发热 2 5 a、全身性关节疼痛 2 3 a,双下肢水肿 2 mo,腹胀、尿少 1mo,于 1998- 10 - 2 0入院 .1975年患者出现发热 ,全身关节疼痛 ,四肢关节周围皮肤出现结节性红斑 ,触之疼痛 ,多次化验血沉 115 mm· h- 1 ,抗核抗体阴性 ,类风湿因子阳性 ,未找到狼疮细胞 ,诊断为“类风湿性关节炎”.1986年因上述症状复发再次入我院 ,多次检查后发现血抗核抗体 ( ) ,抗双链 DNA抗体 ( ) ,临床确诊为系统性红斑狼疮 (SL E) ,狼疮性肝炎 ,狼疮性胸膜炎 ,狼疮性肺炎 .经治疗好转 ,但上述症状反复发作 .此次上述症状复…     

Eye injury and eye protection: a survey of the chemical industry

A population-based study of chemical eye injury in the chemicalindustry is reported. In a population of 62839 workers studiedfor one month (approximately 10 million man-hours), 60 eye injuries(45.1 per cent of all eye injuries) were caused by chemicals(eye injury incidence 11.4 per 1000 employees per year). Sixpatients (10 per cent) required hospital attention. No sight-threateninginjuries occurred. Health workers within the industry have recognizedthat most of these injuries are avoidable. Eye protectors werenot a requirement in some situations where injury occurred (one-thirdof injuries), were not used where specified in some cases, andin others failed to prevent injury even when worn. This lowincidence of injury can be reduced further by appropriate selectionand wear of protectors, by education and by legislation.