用人工合成材料的吊带经耻骨固定或经腹壁固定治疗真性女性压力性尿失禁

目的总结用人工合成材料的吊带经不同的途径治疗女性压力性尿失禁的方法和结果。方法采用人工合成材料的吊带经耻骨固定（In—Fast）技术治疗3例，用经腹壁固定（TVT和IVS）技术治疗13例。结果绝大多数病人均排尿通畅．无尿失禁复发。但TVT组有1例排尿不畅，3个月后剪断吊带后变为轻度尿失禁。In-fast组有1例性交不适伴阴道分泌物增加。结论用人工合成材料的吊带进行悬吊技术治疗女性真性压力性尿失禁是安全、微创和有效的手术方式。经耻骨固定技术和用经腹壁固定技术这两种方法各有自己的优缺点。应根据病人的具体情况去选择使用。     

脑卒中与排尿障碍的研究进展

排尿障碍是脑卒中患者的常见症状,严重影响患者的生活质量,分析排尿障碍与脑卒中的关系对指导脑卒中治疗具有重要意义。本文通过查阅大量国内外文献,综合论述近年有关脑卒中与排尿障碍的研究及其进展。     

正位可控性去带盲结肠膀胱术的疗效观察

目的:探讨正位可控性去带盲结肠膀胱术的临床疗效.方法:对17例膀胱肿瘤患者行膀胱全切除术后,应用末段回肠及盲升结肠作贮尿囊行正位膀胱重建术.结果:17例中15例获随访6～24个月,平均14.5个月.全组无严重并发症,均无瘤生存;术后3周自主可控性排尿,日间排尿可控率为93.3%,1年夜间尿失禁22.2%.术后6个月尿动力学检查,膀胱容量336 ml、最大尿流率13.7 ml/s、剩余尿量42 ml,而充盈期膀胱压力明显低于尿道闭合压.输尿管反流1例,但无尿道、输尿管狭窄,肾功能正常.结论:正位可控性去带盲结肠膀胱术具有膀胱容量大、内压低,正位排尿,可控性好,且手术操作简单、并发症少等优点,患者易于接受,是一种较理想的尿流改道方式.     

Variation in the diagnosis of vesicoureteric reflux using micturating cystourethrography

  Variability in the interpretation of micturating cystourethrography by paediatric radiologists for the diagnosis of vesicoureteric reflux in children was evaluated. All 265 micturating cystourethrograms (MCUs) that were available from 304 consecutive children aged 0.5 – 61 months  –  who were investigated after their first urine infection between 1993 and 1995 as part of a prospective cohort study  –  were selected for interpretation. Three experienced paediatric radiologists from the same department independently interpreted the MCUs according to the grading system of the International Reflux Study in Children, from grades 0 to V, with the presence of intrarenal reflux also noted. Apart from being informed that urine infection was the indication for the MCU, no other clinical information was given to the radiologists. The indices of variability used were the percentage of agreement and the kappa statistic, expressed as a percentage. Both measures were weighted with integers representing the number of categories from perfect agreement. Disagreement was analysed for children and kidneys. For the diagnosis of vesicoureteric reflux in individual patients, including grade, the percentage of agreement was 96% – 97% (kappa 90% – 91%) and the weighted percentage of agreement was 96% – 98% (weighted kappa 93% – 94%). The same high level of agreement was present for individual kidneys, with a percentage of agreement of 97% – 98% (kappa 89% – 92%) and a weighted percentage of agreement of 98% – 99% (kappa 94% – 95%). There was near perfect agreement in the interpretation of radiological micturating cystourethrography among three experienced paediatric radiologists for the diagnosis and grade of vesicoureteric reflux. Any variations in the medical care of children suspected of having vesicoureteric reflux are not explained by differences in the reporting of this diagnostic test. Received June 19, 1996; received in revised form November 1, 1996; accepted December 6, 1996     

改良Indiana膀胱术的远期疗效观察

目的:评价改良Indiana膀胱术的远期疗效.方法:对26例改良Indiana膀胱术术后患者的膀胱可控性、尿动力学、肾盂输尿管扩张、上尿路感染情况、血清电解质和肾功能进行随访.结果:26例随访1～7年,平均3年.白天可控率96.2%;贮尿囊容量为380～640 ml,平均542 ml;贮尿囊内压力为1.215～3.224 kPa,平均1.921 kPa.B超、IVP造影示3 例输尿管扩张,经随访无加重.血清电解质及肾功能正常.结论:改良Indiana膀胱术远期疗效可靠,并发症少,是一种较理想的尿路分流术式.     

尿液分析标准化在临床上的应用

目的：建立尿液分析的标准化。方法：NCCLS和CCCLS推荐方法。结果：按标准化的要求进行尿液分析，以获得有临床价值的结果。结论：尿液分析是临床最常用的化验指标之一，在临床诊治疾病中起着非常重要的作用，因此在实际工作中必须遵照标准化的操作规程进行操作，更好地为临床服务。     

Infection of catheterised patients: bacterial colonisation of encrusted Foley catheters shown by scanning electron microscopy

Summary The surfaces of 32 encrusted urinary catheters were examined by scanning electron microscopy to investigate the association of bacteria with the encrusting deposits. Deposits consisted of struvite crystals surrounded by aggregates of very small crystallites of hydroxyapatite. Underneath these minerals there was a layer of closely packed bacteria. Impressions of bacteria were also observed in hydroxyapatite. Crystals were often engulfed by the bacterial layer, which thus appeared to bind the crystals to each other and to the catheter surface. This thick layer of bacteria associated with crystals may protect both the bacteria from antibiotics and the crystals from acidic bladder washout solutions intended to dissolve them. Furthermore, the existence of this sessile population explains why urease-producing bacteria are not invariably detected in the urine of patients with encrusted catheters. The observation of this bacterial layer (or biofilm) by scanning electron microscopy provided direct evidence for infection being implicated in catheter encrustation.     

Connective tissue metabolism in children with chronic renal failure

To assess the characteristics of connective tissue metabolism in chronic renal failure (CRF), urinary excretion of glycosaminoglycan (GAG) fractions and hydroxyproline (HYP) was determined in ten patients with CRF and in ten age-matched healthy children. CRF was found to be associated with elevated free HYP (19.9±6.1 vs 9.8±3.6 mol/day,P<0.05) and depressed peptide HYP excretion (33.1±13.5 vs 225.2±17.7 mol/day,P<0.01), a low rate of total GAG excretion (7.0±2.4 vs 16.1±1.9 mol uronic acid/day,P<0.05) with low chondroitin 4 — sulphate + chondroitin 6 — sulphate (Ch-Ss) (14.0±9.9 vs 65.0±22.1%) and a high proportion of non-sulphated or under-sulphated fractions, i.e. hyaluronic acid + chondroitin + heparan sulphate (HA+Ch+HS) (75.3±11.4 vs 31.5±5.7%). Urinary 3-methyl-histidine (3-met-HIS) excretion and plasma essential free amino acids did not differ in the two groups. In response to haemodialysis no consistent change occurred in urinary excretion of 3-met-HIS, peptide-bound HYP, total GAG or percentage distribution of individual GAG fractions. After haemodialysis all plasma amino acids decreased significantly, and there was a significant increase in urinary excretion of free HYP (P<0.05). We conclude that the alterations in urinary excretion of total and individual GAGs observed in CRF may reflect disturbed connective tissue metabolism which does not appear to be accounted for by protein malnutrition or enhanced protein breakdown and remains uninfluenced by haemodialysis therapy.     

Cardiovascular reflexes and low long-term exposure to mercury vapour

Summary Subjective symptoms related to autonomic dysfunction and quantitative non invasive tests measuring both sympathetic and parasympathetic functions of the autonomic nervous system were studied among a group of 41 chlorine-alkali workers with low long-term exposure to mercury (Hg') vapour and their matched referents. The test battery included measurements of pulse rate variation in normal and deep breathing, in the Valsalva manoeuvre and in vertical tilt as well as blood pressure responses during standing and isometric work. The exposure time had been 16 years on average, and the mean exposure to Hg vapour was estimated to have been about 30 g/m³ of air. Only a tendency for a subtle reduction of cardiovascular reflex responses and a slight increase of subjective symptoms were seen in the exposed group, but no significant autonomic dysfunction was associated with the low level of exposure.     

Biochemical characterisation of para-aminophenol-induced nephrotoxic lesions in the F344 rat

The acute biochemical effects of the nephrotoxin p-aminophenol (PAP) were studied in detail using a combination of conventional bioanalytical and ¹H-NMR spectroscopic methods. Dosing PAP (25–100 mg/kg) to male F344 rats resulted in a dose-related proximal nephropathy with consequent elevations in urinary enzymes, glucose, and urine total protein as shown by conventional methodology. ¹H-NMR spectroscopy at 400 MHz of urine from PAP-treated rats also revealed a characteristic glycosuria, with concomitant amino aciduria. The increased excretion of these compounds indicates functional defects in the proximal tubule and reduced solute reabsorption efficiency. In addition, ¹H-NMR urinalysis and conventional enzymatic analysis showed a dose-related lactic aciduria. Other changes detected by ¹H-NMR included a dose-related reduction in the excretion of citrate (confirmed by a conventional biochemical method) and an increase in the excretion of acetate. The degree of abnormalities shown by ¹H-NMR urinalysis agreed well with histopathological observations and conventional biochemical indices of nephrotoxicity. ¹H-NMR urinalysis therefore serves to highlight changes in the excretion of low MW urine components not routinely studied by conventional biochemical analysis.Abbreviations ALP alkaline phosphatase - APAP paracetamol - BUN blood urea nitrogen - GFR glomerular filtration rate - GOT glutamate oxaloacetate transaminase - LAP leucine aminopeptidase - LDH lactate dehydrogenase - MW molecular weight - NAG N-acetyl--D-glucosaminidase - PAP p-aminophenol - ppm parts per million - TMAO trimethylamine N-oxide - UFR urine flow rate