2008年泌尿外科热点问题

随着科学技术的飞速发展,随着世界逐渐进入老龄化社会,泌尿外科疾病发病率日益增高,泌尿外科逐渐发展成为临床医学的一门重要学科.2008年泌尿外科有许多热点问题.     

Flexion compromises ventilation with the laryngeal tube suction II in children

Background: There are insufficient data as to the influence of the head and neck flexion, extension, and rotation on the ventilation with laryngeal tube suction II^® (LTS II). The purpose of this study was to investigate the influence of the head and neck position on oropharyngeal sealing pressure (primary outcome) and ventilation score (secondary outcome) during ventilation with the LTS II in children. Methods: We studied 33 children scheduled for elective surgery. Oropharyngeal sealing pressure and ventilation score were measured with the head and neck in a neutral position, flexed, extended and rotated to the right. The ventilation score was scored from 0 to 3 based on three items (no leakage with an airway pressure of 15 cmH₂O, bilateral chest excursion, and a square wave capnogram; each item scored 0 or 1 point). Peak inspiratory pressure (PIP) at a tidal volume of 10 ml·kg^?1 and fiberoptic laryngeal views were also assessed in each position. Results: Although the sealing pressure was lower in the extended position [22 (8) cmH₂O] than that in the neutral position [25 (7) cmH₂O], there was no significant leakage during ventilation with a tidal volume of 10 ml·kg^?1. In the neutral, extended and rotated positions, the median ventilation scores were better (3 point respectively) than that with the head and neck flexed (1 point). PIP was decreased with the head and neck extended or rotated but was significantly increased in flexion position. During fibreoptic examination, the vocal cords were more easily seen in extension and right rotation, compared with the neutral position and flexion. Conclusions: Although oropharyngeal sealing pressure is decreased with the head and neck extended, effective ventilation with LTS II can be performed like in the neutral position or the rotated position. While the sealing pressure is maintained with the head and neck flexed, flexion compromises the ventilation with LTS II in children.     

Congenital hypoplastic anemia inhibition of erythropoiesis by sera from patients with congenital hypoplastic anemia

An in vitro marrow culture assay designed to measure erythropoietic capability was used to ascertain the presence of an inhibitor in the sera of patients with congenital hypoplastic anemia (CHA). Marrow cells from nine anemic CHA patients responded to the stimulatory effect of exogenous erythropoietin (EPO) by an increase in heme synthesis in the presence of normal serum. The effect on heme synthesis was less than that observed with normal marrow cells. CHA serum inhibited heme synthesis by both normal and CHA marrow cells. It is concluded that an in-inhibitor of erythropoiesis is present in serum from CHA patients. This inhibitor most likely blocks the EPO-sensitive stem cell receptor sites, causing decreased response to the hormone.     

大豆异黄酮对大鼠骨密度及骨代谢生化指标的影响

目的 研究植物雌激素-大豆异黄酮对大鼠骨密度及骨代谢生化指标的影响。方法 将断乳Wister大鼠按体重随机分为4组，分别给予基础饲料和不同剂量的大豆异黄酮。每周称体重，调整给食量。12周后处死大鼠，取脏器称重，计算脏体比值；剥离股骨，测骨矿物质含量(BMC)、骨密度(BMD)和骨钙、骨磷的含量；对血清中骨形成生化指标碱性磷酸酶、骨钙素和骨吸收生化指标抗酒石酸酸性磷酸酶进行检测，同时测定雌激素-雌二醇(E2)的含量。结果 具有弱雌激素样作用的大豆异黄酮对实验大鼠的子宫、卵巢无刺激作用。与对照组相比，给予大豆异黄酮能提高BMC、BMD及骨钙含量，并随剂量的增加而增大。大豆异黄酮可影响骨代谢，高剂量的大豆异黄酮(41．6mg／kg)同时抑制骨形成和骨吸收，使骨转化率降低，但对骨吸收的作用大于骨形成。给予大豆异黄酮组血清雌激素水平大于对照组。结论 大豆异黄酮通过调整骨代谢生化指标的活性，提高大鼠的骨钙含量和骨密度，可预防骨质疏松的发生。     

Extracts of Monascusus Purpureus beyond Statins——Profile of Efficacy and Safety of the Use of Extracts of Monascus Purpureus

Monascus purpureus is a fungus that has been tradi-tionally used in China for thousands of years to produce ricewine . Traditionally the fungus is used to ferment non-gluti-nous cooking of rice ,to produce a kind of famous red ricewine .Its main traditional indications consist of disordersdue to the accumulation of fats (nosologically linked withthe problems of stasis of circulation in traditional Chinesemedicine) ,liver disorders and some forms of tumor as ithelps i mprove the circulation of …     

Sexual precocity: sex incidence and aetiology

The aetiology of 197 girls and 16 boys presenting with sexual precocity was reviewed. Ninety one girls and four boys had central precocious puberty (M:F 23:1); a cause was identified in all the boys but in only six girls. All boys with precocious puberty need detailed investigation; in girls investigation should be based on clinical findings, particularly the consonance of puberty.     

显微注射后家兔转基因受精卵的体外培养和移植成活率的观察研究

目的：研究家兔受精卵经显微注射转基因过程的耐受性，建立转基因动物技术平台。方法：(1)家兔超数排卵诱导；(2)对2000个家兔受精卵进行显微注射技术操作；(3)对1280个受精卵进行显微注射后体外培养观察；(4)216个注射后受精卵向13只受体母兔输卵管进行移植．结果：(1)经显微注射后受精卵进行体外培养有68％的受精卵能够发育至桑椹胚和囊胚；(2)目前有7只受体母兔经输卵管转基因受精卵移植分别产下3，4，5，2，6，13，7只仔兔。结论：(1)受精卵能够在体外经受显微注射转基因过程的损伤，但暴露于体外的操作时间应尽可能的缩短；(2)显微注射操作技术的熟练程度是实验成功的关键。     

Partial scapholunate ligament injuries treated with arthroscopic debridement and thermal shrinkage

PURPOSE: To present the early results of arthroscopic debridement and thermal shrinkage using radiofrequency probes for partial (Geissler grades I and II) scapholunate (SL) interosseous ligament injuries of the wrist. METHODS: Sixteen patients with a mean age of 34 years (range, 18-54 y) presenting with chronic dorsoradial wrist pain unresponsive to initial conservative treatment for a mean period of 12 weeks were included in this study. No patient showed radiologic signs of static dissociation (SL interval, <3.5 mm; mean SL angle, 49 degrees ) before surgery. Diagnostic arthroscopy showed a partial SL tear in 14 patients and redundancy of the ligament in 2. Partial SL tears involved the membranous (proximal) and volar part of the ligament. All lesions were debrided and treated with thermal shrinkage using a bipolar radiofrequency probe. RESULTS: The mean follow-up period was 19 months (range, 9-34 mo). Fourteen patients experienced substantial pain relief whereas in 2 the pain remained unchanged. Eight patients were completely pain free. The mean flexion-extension arc was 142 degrees and the mean grip strength was 78% that of the unaffected side. No patient showed radiologic signs of arthritis or static or dynamic instability after surgery (SL interval remained <3.5 mm; mean SL angle, 53 degrees ). Based on the modified Mayo wrist score there were 8 excellent, 6 good, 1 fair, and 1 poor result. CONCLUSIONS: Partial SL ligament tears can be a source of radial-sided wrist pain. Scapholunate ligament debridement and thermal shrinkage effectively provided pain relief for most of the patients treated. Stability was maintained radiographically. No complications were noted from the use of radiofrequency probes. These reasonably favorable short-term results should be viewed cautiously. A longer follow-up study is necessary to determine the ultimate efficacy of this procedure.     

尿微量蛋白与老年2型糖尿病合并缺血性心脏病关系的研究

目的探讨在老年2型糖尿病合并缺血性心脏病患者中尿微量蛋白在加重缺血性心脏病进展方面的作用。方法将66例老年2型糖尿病合并缺血性心脏病患者按24h尿微量蛋白排泄量分为:尿微量蛋白正常组及尿微量蛋白阳性组,分别对血脂、空腹血糖、血清胰岛素、胰岛素敏感指数、纤维蛋白原、颈动脉内-中膜厚度、颈总动脉粥样硬化等级积分、硬化斑块指数、心脏彩超室间隔厚度及射血分数等加重缺血性心脏病进展等指标进行比较分析。结果66例老年2型糖尿病合并缺血性心脏病患者尿微量蛋白阳性组高密度脂蛋白、载脂蛋白A、胰岛素敏感指数、年龄、纤维蛋白原、硬化斑块指数、颈总动脉粥样硬化等级积分、室间隔厚度及射血分数显著高于尿微量蛋白阴性组(P<0.05,P<0.01)。结论尿微量蛋白的出现能够加速糖尿病合并缺血性心脏病的发展进程,它的出现预示着缺血性心脏病的预后不良。