影像学及腔内技术在输尿管癌诊断中的应用

目的：提高输尿管癌术前及时诊断水平。方法：结合有关文献对32例输尿管癌采用影像学及腔内技术检查的选择及其临床特点进行分析。结果：输尿管癌的首发症状以肉眼血尿最常见,32例术后经病理检查证实。与术前影像学腔内技术检查诊断符合率为100％。结论：输尿管癌有时缺乏典型症状,凡原因不明血尿患者,影像学及腔内技术检查有极其重要作用。经B型超声波或静脉尿路造影影检查发现肾积水或肾不显影时,应考虑到输尿管癌的可能。在各种检查中,逆行肾盂造影和输尿管镜检查是最重要的诊断方法。     

贵阳市10039名无症状小儿泌尿系疾病普查结果分析

对贵阳市10039名无症状的中、小学生和托幼儿进行了蛋白尿、潜血和细菌尿的普查。先用尿试纸进行初筛;任一项阳性者再用试纸法进行复查,同时加用磺硫酸法进行蛋白定性及玻片法计数尿中红细胞;对第二次检查中任一项阳性者,进行体检及特殊检查、化验。结果查出阳性人数77人,阳性率为0.77%,其中急性肾炎及肾炎可疑者28例,占普查总数的0.28%,泌尿系感染共27例,占0.27%;另有无症状血尿、泌尿系结石等,提示在儿童中进行尿普查是有意义的。     

隐匿性肾小球疾病83例治疗观察

中医辨治隐匿性肾小球疾病83例,其中属脾肾气虚者58例,肾阴不足者16例,外感表证为主者7例,湿热阻滞者2例,分别治以补气健脾益肾、滋阴清火、疏解外邪等法,并根据兼证不同随时加减。结果缓解37例,好转46例。随访61例,仍维持缓解者28例,尿中尚有少量蛋白或红细胞者26例,加重者7例。随访时间最长11年。     

血尿1000例临床分析

本文对1000例血尿进行了临床分析。本组除40例原因不明血尿外,约99％为泌尿系本身疾病所致。主要疾病有结石(46.2％)、结核(12.8％)、乳糜尿(10.7％)、损伤(7.6％)、非特异性感染(6.9％)及肿瘤(5.9％)等。文中温习文献对未发现原因血尿、归纳可能的肾性病因。根据资料,二种病因血尿60例,提示当一种疾病作出诊断后,不应忽视另一疾病的存在,致使治疗欠妥。     

Utility of ultrasound in evaluating hematuria

Hematuria is a common clinical problem. Ultrasound is an effective first line screen for pathology of the kidneys and bladder. Its use in older male patients is apt to yield a cause of hematuria in about 15%.     

Differentiation of hematuria by quantitative determination of urinary marker proteins

Summary Hematuria caused by prerenal, glomerular, postglomerular, and postrenal causes is usually differentiated by a number of noninvasive and invasive diagnostic procedures. In the present study we have applied a new analytical strategy based on observations that the various forms of hematuria can be classified by their typical protein pattern. When analyzed by quantitative turbidimetric assays, urines from postrenal hematurias contained high-molecular-weight proteins ( ₂-macroglobulin and IgG) in proportions found in plasma. Relating excretion rates (mg/mg) of these proteins to those of albumin, ratios for ₂-macroglobulin/albumin and IgG/albumin were 2.0–31×10^–2 and 20.0 –180×10^–2, respectively. In contrast, glomerular hematurias exhibited ratios of 0.01–2.0×10^–2 ( ₂macroglobulin/albumin) and 2.0–20×10^–2 (IgG/albumin). Additional determination of ₁-microglobulin allowed us to differentiate postglomerular hematurias caused by interstitial nephropathies from glomerular and postrenal diseases. Critical evaluation of 93 cases diagnosed by independent clinical examination including histology, sonography, and cystoscopy revealed that the criteria derived from protein measurements resulted in correct classification when urine albumin exceeds 100 mg/l. This noninvasive procedure is expected to be of considerable help in the primary care of patients with unexplained hematuria.     

Protracted,gross hematuria in sickle cell trait: response to multiple doses of 1-desamino-8-D-arginine vasopressin

Gross and microscopic hematuria are well-known complications in patients with sickle cell hemoglobinopathy. Most of these episodes of gross hematuria are self limiting, but rarely may be severe and persistent requiring definitive intervention. Before subjecting these patients to surgical management such as partial or total nephrectomy, several medical therapies of variable benefit have been suggested. We report a patient with sickle cell trait who experienced severe, intractable gross hematuria for 5 months and showed a dramatic response to multiple doses of 1-desamino-8-D-arginine vasopressin (DDAVP) infusion. The remarkable response observed in this patient suggests that treatment with DDAVP infusion may be considered in patients with unremitting gross hematuria associated with sickle cell trait.