丝裂霉素对于腺性膀胱炎术后膀胱灌注的疗效分析(附60例报告)

目的:提高腺性膀胱炎综合治疗效果。方法:腺性膀胱炎患者60例,膀胱镜检表现为滤泡状或绒毛状40例、乳头瘤样16例、慢性炎症4例。术前活检病理报告腺性膀胱炎。行经尿道电切加气化术,术后丝裂霉素20mg膀胱灌注,规律治疗2年,方案为每周1次共8次,其后每月1次共2年。定期做膀胱镜检查,并行组织学观察。结果:随访6￣70个月,平均25个月。55例痊愈,膀胱黏膜逐渐恢复为移行上皮覆盖;4例复发;1例腺癌变。结论:经尿道电切加气化,术后丝裂霉素灌注治疗腺性膀胱炎,有助于膀胱上皮的组织学转归。     

不同灌洗液对经尿道前列腺等离子体双极电切术病人血糖、电解质的影响

目的 :观察经尿道前列腺等离子体双极电切 (PKRP)术中 5 %葡萄糖与 0 .9%生理盐水作为灌洗液对病人血糖、电解质的影响。方法 :5 8例ASAⅠ～Ⅱ级 ,术前无糖尿病 ,肝、肾功能无异常患者。 5 %葡萄糖组 (组Ⅰ ) 2 9例 ;0 .9%生理盐水组 (组Ⅱ ) 2 9例。手术均采用英国佳乐等离子体双极电切系统。结果 :组Ⅰ手术 30、6 0min及术后 6 0min血糖均较术前明显增高 (P <0 .0 1) ,且手术 6 0min较 30min亦明显升高 (P <0 .0 5 )。手术 6 0min及术后 6 0min血钠明显低于基础值 (P <0 .0 1)。血氯无显著性差异。术后 6 0min血钾明显低于基础值 (P <0 .0 5 )。组Ⅱ术中及术后血糖 ,血钾、钠、氯变化无统计学意义 (P >0 .0 5 )。结论 :经尿道前列腺等离子体双极电切术 ,灌洗液选用 0 .9%生理盐水是安全可行的 ,较 5 %葡萄糖注射液更有利于机体内环境的稳定和组织代谢。     

Intra- and Retroperitoneal Irrigation Liquid After Arthroscopy of the Hip Joint

The case of intra- and retroperitoneal irrigation solution after hip arthroscopy of a 15-year-old girl is presented. She underwent hip arthroscopy for intra-articular adhesiolysis after previous surgical dislocation of the hip for the treatment of femoroacetabular impingement. Arthroscopy was performed in the lateral decubitus position without traction to debride the peripheral joint compartment. The irrigation pressure was set at 40 mm Hg. There were no intraoperative complications. By the end of surgery, the anesthesiologist reported a drop in the patient's body temperature from 36.3° to 34.5°C. Postoperatively, she complained about abdominal swelling and discomfort. Abdominal sonography revealed approximately 2 to 3 L of intra- and retroperitoneal liquid, which was considered to be irrigation fluid. The irrigation fluid was absorbed within 16 hours without further treatment. The only possible way the irrigation fluid could have flown was a retroperitoneal course along the iliopsoas muscle and the iliac vessels with intraperitoneal perforation along their course. We observed at arthroscopies that irrigation pressure incidentally can rise to 140 mm Hg when leaking of fluid through the portals occurs. Intra-abdominal fluid is a potentially devastating complication. A sudden drop of body temperature has to raise suspicion for intra-abdominal leaking of irrigation fluid.     

HPC-MMC膀胱灌注尿液的药代动力学研究

目的:比较研究粘膜粘附性抗癌药羟丙基纤维素-丝裂霉素C(HPC-MMC)与丝裂霉素C水溶液(S-MMC)膀胱灌注的药代动力学。方法:将16只日本大耳白兔随机平分为两组,分别膀胱灌注4mg/4ml1%HPC-MMC和4mg/4mlS-MMC,于灌注后不同时间点排空膀胱并收集尿样,用高压液相色谱法测量尿液MMC浓度。尿药数据用药代动力学尿药法推算清除速度常数(k)、半衰期〔t(1/2)〕等药代动力学参数。结果:HPC-MMC组尿液中MMC平均t(1/2)为2.61h,而S-MMC组平均t(1/2)为0.556h,前者是后者的4.69倍(t检验,P<0.01)。结论:HPC-MMC比S-MMC在膀胱内的停留时间延长,有望提高MMC化疗疗效,具有较好的临床应用前景。     

Laser-induced shock wave lithotripsy

Summary With a high intensity Q-switched Nd-YAG laser shock waves can be generated in a liquid close to the calculus. Up to 80 mJ single pulse energy with 8 nsec pulse duration can be transmitted through flexible quartz fibers. Energy conversion and enhancement can be accomplished at the fiber tip with optical focussing of the light at the quartz tip, with irrigation solutions and with high pulse energies. Iron-III-dextran solutions (1 mg Fe³⁺/1) and magnesium chloride (50 mmol/l) increased the pressure in the laser induced breakdown up to ten times (8,000–10,000 bar). Smaller stone particles and higher efficacy in stone fragmentation could be achieved.     

洗眼球洗眼法与输液吊瓶洗眼法的对比分析

目的:对比分析洗眼球洗眼法与输液吊瓶洗眼法的洗眼速度和效果。方法:将80例行准分子激光原位角膜磨镶术(LASIK)患者随机分为两组,40例采用洗眼球洗眼法,40例采用输液吊瓶洗眼法。结果:采用洗眼球洗眼者共计历时195m in,平均4.88m in,清洁率为62.5%;采用输液吊瓶洗眼者共计历时130m in,平均3.25m in,清洁率为92.5%,两组比较有显著性差异(P<0.05)。结论:输液吊瓶洗眼法速度快,清洁度高,值得临床推广。     

Irrigation of continent catheterizable ileal pouches: tap water can replace sterile solutions because it is safe, easy, and economical

Background

Continent catheterizable ileal pouches require regular irrigations to reduce the risk of bacteriuria and urinary tract infections (UTIs).

Objective

Our aim was to compare the UTI rate, patient friendliness, and costs of standard sterile irrigation versus irrigation with tap water.

Design, setting, and participants

Twenty-three patients participated in a prospective randomized two-arm crossover single-center trial. Aseptic intermittent self-catheterization (ISC) combined with sterile sodium chloride (NaCl) 0.9% irrigation was compared with clean ISC and irrigation with tap water (H₂O) during two study periods of 90 d each.

Intervention

Patients underwent daily pouch irrigations with NaCl 0.9% solution or tap water.

Measurements

Urine nitrite dipstick tests were evaluated daily; urine culture (UC) and patient friendliness were evaluated monthly. Costs were documented.

Results and limitations

A total of 3916 study days with nitrite testing and irrigation were analyzed, 1876 (48%) in the NaCl arm and 2040 (52%) in the H₂O arm. In the NaCl arm, 418 study days (22%) with nitrite-positive dipsticks were recorded, 219 d (11%) in the H₂O arm, significantly fewer (p = 0.01). Of the 149 UCs, 96 (64%) were positive, 48 in each arm, revealing a total of 16 different germs. All patients preferred the H₂O method. Monthly costs were up to 20 times lower in the H₂O arm.

Conclusions

Pouch irrigation with sterile NaCl 0.9% solution and tap water had comparable rates of positive UC. Irrigation with tap water significantly lowered the incidence of nitrite-positive study days and was substantially less costly and more patient friendly than NaCl irrigation. We therefore recommend the use of tap water (or bottled water) instead of sterile NaCl 0.9% solution for daily irrigation of continent catheterizable ileal pouches.

Trial registration

Australian New Zealand Clinical Trials Registry, ACTRN12610000618055, http://www.ANZCTR.org.au/ACTRN12610000618055.aspx.     

Qualitative analysis of the removal of the smear layer in the apical third of curved roots: conventional irrigation versus activation systems

Introduction

The aim of this study was to evaluate the effectiveness of different irrigant agitation techniques on smear layer removal in curved root canals.

Methods

Mesiobuccal canals of 62 extracted lower molars with a curvature of 33 degrees were used and instrumented up to ProTaper F2. The samples were divided into 3 experimental groups according to the final irrigation: conventional irrigation, ultrasonic irrigation, and sonic irrigation by using the EndoActivator system. The control group was composed of 2 specimens without any final irrigation. In all of the experimental groups, 5 mL of 17% ethylenediaminetetraacetic acid was used for 1 minute, and 5 mL of 2.5% NaOCl was used for 30 seconds. The analysis of the apical region was performed via scanning electron microscopy by 3 examiners. The data were submitted to the Kruskal-Wallis and Dunn tests (P < .05).

Results

The activation systems removed significantly more smear layer than did conventional irrigation.

Conclusions

Sonic and ultrasonic irrigation resulted in better removal of the smear layer in the apical third of curved root canals than did conventional irrigation.     

两种膀胱冲洗液温度对经尿道前列腺电切除术后出血和膀胱痉挛的影响

目的 探讨两种膀胱洗液温度对经尿道前列腺电切除(TURP)术后出血量和膀胱痉挛的影响.方法 采用Excel电子表格程序完成试验分组的随机化,将96例TURP术后患者分为试验组(n=48)和对照组(n=48).手术结束后,所有患者立即行持续膀胱冲洗.冲洗液温度:试验组为(35.50±1.50)℃,对照组为(26.18±0.82)℃.结果 试验组术后膀胱冲洗液量少于对照组(P<0.05),且血块堵管、膀胱痉挛的发生率均低于对照组(P<0.05).结论 将冲洗液加温至(35.50±1.50)℃进行持续膀胱冲洗,可有效减轻TURP术后出血、膀胱痉挛等不良反应.     

肺癌胸腔冲洗液中脱落癌细胞诊断及鉴别诊断的研究

目的探讨免疫细胞化学检查在肺癌胸腔冲洗液中对脱落癌细胞鉴别诊断的价值,确定适用于胸腔冲洗液检查的最佳抗体和检查方法。方法对62例肺癌患者的胸腔冲洗液沉渣涂片行两种常规染色：HE染色、Papanicolaou染色;同时行链霉素菌抗生物素蛋白-过氧化物酶法染色（SP）,单克隆抗体为：癌胚抗原（CEA）、上皮抗原（EA）、间皮细胞（MC）、波形蛋白（Vimentin）。将结果与细胞学诊断进行比较。结果62例肺癌患者胸腔冲洗液细胞学诊断阳性28例（阳性组）,可疑6例（可疑组）,阴性28例（阴性组）。确诊腺癌细胞CEA、EA、MC、Vimentin的阳性表达率分别为：阳性组中92．00％、92．00％、12．00％、44．00％;可疑组75．00％、100．00％、0、25．00％;阴性（细胞学诊断）组66．66％、100．00％、0、33．33％。免疫细胞化学染色检测优于常规细胞学检查,差异有统计学意义（x2=4,P〈0．05）。结论联合应用CEA、EA、MC、Vimentin进行免疫细胞化学检查对鉴别胸腔脱落癌细胞与反应性间皮细胞具有一定的临床价值。