后腹腔镜手术在泌尿外科的应用

目的　探讨后腹腔镜手术治疗泌尿系疾病的方法及疗效。方法　采用后腹腔镜手术治疗泌尿系疾病3 5例 ,其中肾上腺肿瘤及肾上腺囊肿切除 13例 ,肾囊肿去顶术 15例 ,精索静脉曲张高位结扎术 4例 ,UPJ成形术 1例 ,乳糜尿行肾蒂淋巴管结扎术 1例 ,肾切除 1例。结果　 3 5例手术全部成功。手术时间 3 0～ 13 0分钟 ,术中平均出血 2 0ml。术后住院时间 1.5～ 14天 ,平均 4.5天。结论　腹腔镜手术治疗泌尿系疾病 ,具有损伤小 ,住院时间短 ,恢复快 ,并发症少等优点 ,值得临床推广应用     

力学刺激对3月龄骨质疏松大鼠成骨细胞增殖与合成功能的影响

探讨周期性双轴力学应变对成骨细胞增殖与分化合成功能的影响。将正常 3月龄雌性 SD大鼠和骨质疏松大鼠颅顶骨分离的成骨细胞分别在含 10 %胎牛血清的 F- 12培养液中培养 ,并接种在双轴力学应变装置中。当细胞生长至亚融合状态 (Subconfluence) ,给细胞施加力学刺激 ,频率为 1Hz,力学刺激分别为 4 0 0、10 0 0、4 0 0 0μ strain;作用时间分别为每天 30 m in,2、4、8h,共加载两天。以未受力学刺激的细胞为对照组 ,受力学刺激的细胞为实验组 ,并进行比较。采用流式细胞技术测定细胞增殖变化 ;采用同位素标记方法检测成骨细胞骨钙素、I型胶原 C端前肽 (PICP)和总蛋白的分泌量。结果表明 :1)在静态培养条件下 ,3ovx组与 3control组比较 ,其细胞功能活性无明显变化 ,但 3ovx组大鼠成骨细胞增殖活性明显增高 ,这与绝经后骨质疏松骨代谢的高转换率相一致。 2 )4 0 0、10 0 0 μstrain力学刺激可以促进 3control组成骨细胞 I型胶原、骨钙素和总蛋白的分泌量增加 ,促进成骨细胞的分化成熟 ;在 10 0 0μstrain力学刺激下 ,成骨细胞合成骨基质的能力增加最为明显。同时 ,在 4 0 0、10 0 0μstrain力学刺激的初期也可以促进成骨细胞的增殖 ,而促进成骨细胞的分化成熟的作用大于促进细胞增殖的作用。 3)在4 0 0 0 μ     

Gains of chromosomes 7, 17, 12, 16, and 20 and loss of Y occur early in the evolution of papillary renal cell neoplasia: a fluorescent in situ hybridization study.

It has been suggested that gains of chromosomes 7 and 17 and loss of Y occur in renal papillary adenoma and that progression to papillary renal cell carcinoma is marked by gains of additional chromosomes, most frequently 12, 16, and 20. Previous studies have included very few lesions of <5 mm in diameter, a requirement of the present definition of papillary adenoma. Ten papillary adenomas (ranging from 1 to 5 mm in diameter) from autopsy material and 10 surgically resected papillary renal cell carcinomas were studied with fluorescence in situ hybridization in paraffin sections using centromeric probes for chromosomes 7, 12, 16, 17, 20, and Y diluted 1:100 with tDenHyb1 buffer. The signals in 50 to 150 nuclei were counted in each tumor. Controls for all the probes were normal renal tissues from the same patients. Three or more signals per nucleus were frequently observed in papillary adenomas: chromosome 7 (range, 10 to 50%; > or = 30% in 9 of 10), 17 (range, 10 to 47%; > or = 30% in 7), 16 (range, 1 to 63%; > or = 10% in 5), 12 (range, 0 to 32%; > or =10% in 4), and 20 (range, 5 to 49%; > or = 10% in 5). Loss of the Y chromosome was observed in 80 to 90% of nuclei in 9 adenomas from males. Three or more signals were frequent in papillary renal cell carcinomas: chromosome 7 (range, 32 to 63%; > or =30% in 10 of 10), 17 (range, 28 to 61%; > or = 30% in 7), 16 (range, 0 to 45%; > or = 10% in 6), 12 (range, 1 to 37, > or = 10% in 5), 20 (range, 2 to 44%; > or = 10% in 4). No signal for Y was observed in 12 to 88% (> or = 81% in 6) of nuclei in 7 carcinomas from males. Statistical analysis showed no difference between adenomas and carcinomas. Gains of chromosomes 7, 17, 16, 12, and 20 and loss of the Y chromosome occur early in the evolution of papillary renal cell neoplasia in tumors that are only a few millimeters in diameter. Progressive gains of these chromosomes do not appear to correlate with the transition from adenoma to carcinoma.     

Percutaneous transluminal coronary angioplasty in a patient with paroxysmal nocturnal hemoglobinuria

Paroxysmal nocturnal hemoglobinuria (PNH) is an acquired chronic hemolytic anemia associated with an unusual susceptibility to hemolytic crisis, infection, and venous thrombosis which would be aggravated by a number of factors including surgery. We report a case of PNH undergoing percutaneous transluminal coronary angioplasty and discuss the corresponding perioperative management.     

Diagnosis and management of obstetric acute disseminated intravascular coagulation]

Twenty-seven in-patients with obstetric DIC in our hospital from Jan. 1971 to Dec. 1990 were analysed retrospectively. The incidence was 0.12% in the first decade and 0.02%, in the second, showing a difference of significance between them. The most common predisposing factors included amniotic fluid embolism, abruptio placenta and hemorrhagic shock. Bleeding from multi-organs in various extent and coagulation disorders occurred in all those 27 cases. [Besides anti-shock treatment, heparin was employed together with fibrinogen in 4 postpartum and 1 antepartum DIC patients, fibrinogen alone in 8 cases, and hysterectomy in 11 cases. 17 patients were saved and 9 died. It is important that early diagnosis and much attention paid to clinical characteristics together with serial laboratory tests. Key management should include prompt treatment and eradication of predisposing factors. Quick decision spite of to terminate the pregnancy and even hysterectomy should be done in some risks.     

严重烫伤对睾丸间质细胞影响的实验研究

采用大鼠３０％Ⅲ度烫伤模型，应用光镜、电镜、３β－羟甾脱氢酶（３β－ＨＳＤ）组织化学染色及其相对活性的测定和血清睾酮及黄体生成素（ＬＨ）浓度的检测，分不同时相对严重烫伤后３０天内大鼠睾丸间质细胞的改变进行了动态观察。结果表明，烫伤后睾丸间质细胞有不同程度的变性、坏死；间质细胞内３β－ＨＳＤ活性迅速降低，伤后３０天仍保持较低水平；血清睾酮水平迅速下降，并持续维持较低水平，伤后３０天仍不回升，而血清ＬＨ浓度无明显改变。提示烫伤后血清睾酮下降的机理可能与睾丸间质细胞的受损及糖皮质激素升高有关。     

Effect of ibopamine and the active metabolite epinine on the catecholamine content of rat hypothalamus and brainstem in vitro

The effect of ibopamine (IBO) (SB 7505, SK&F 100168-A), a new drug for the treatment of congestive heart failure, and its active metabolite epinine (EPN) (N-methyldopamine), on the catecholamine content of hypothalamus and brainstem was studied in vitro after monoamine oxidase inhibition with pargyline. IBO and EPN increased levels of epinephrine (EPI) in a concentration- and time-dependent manner in both brain areas without significantly affecting the concentration of other catecholamines. Inhibition of either dopamine beta-hydroxylase, the neuronal EPI and norepinephrine uptake system, or esterase hydrolysis of IBO prevented the increase of EPI, whereas inhibition of phenylethanolamine N-methyltransferase, enzymatic dealkylation or the neuronal dopamine or serotonin uptake system had no influence on the increase of EPI levels. These results suggest that IBO after hydrolysis to EPN can be converted enzymatically to EPI by dopamine beta-hydroxylase in hypothalamus and brainstem. EPN seems to be accumulated into adrenergic and noradrenergic neurons by the high affinity uptake system. Changes in the EPI content of the central nervous system neurons might be responsible for some of the pharmacologic effects of IBO.     

中药治疗激素依赖性肾病综合征98例

肾病综合征是由多种病因引起的以大量蛋白尿、低蛋白血症、高度浮肿、高脂血症为临床特点的一组症状群，其基本病理缺陷是肾小球毛细血管基底膜通透性增加，属于中医“水肿”范畴。     

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目的　探讨医用创面封闭胶在减少肝切除术后肝断面渗血中的价值。方法　 2 0 0 2年 5～ 11月采用信封法将 60例接受肝切除术的病人随机分为医用胶组 (A组 ,n =3 0 )和对照组 (B组 ,n =3 0 )。A组在肝断面彻底止血后滴注医用创面封闭胶 ,B组则不用。测定术后第 1、2、3d腹腔引流液中红细胞 (RBC)数和血红蛋白 (Hb)量。结果　A、B两组术后腹腔引流液中的RBC数和Hb量均以第 1d为高峰 ,显著高于第 2、3d(P <0 0 5) ,其中A组术后第 1d腹腔引流液中RBC数及Hb量均显著低于B组 (P <0 0 5) ,只相当于B组第 2d的水平。A组主要并发症发生率低于B组 ,但差异无统计学意义 (P =0 0 7)。结论　医用创面封闭胶可有效抑制肝切除术后早期的肝断面渗血 ,有助于降低术后并发症的发生率