猪腰段脊髓火器伤对肾脏及其功能的影响

[目的]建立猪腰段脊髓火器伤模型和改良Allen＇s打击伤后全瘫模型，观察伤后肾脏病理和肾功能的早期变化。[方法]动物随机分为两组，火器伤组（G）6只，在全麻状态下做L1-2脊髓火器伤模型；打击伤组（A）6只，L1节段脊髓行改良Allen＇s打击。两组动物分别于伤前（0h）、伤后0．5h、1h、2h、4h检测血肌酐和血尿素氮（BUN）。死亡动物行肾脏病理检查。[结果]A组BUN值在伤后4h升高，G组BUN值在伤后1h升高。两组肌酐在伤后0．5h升高，各点监测G组明显高于A组。G组动物伤后5．2h-7．5h死亡，死亡率为100％。病理检查示G组肾包膜及肾实质广泛充血、出血。[结论]G组火器伤较A组肾脏损伤及组织破坏严重，在伤后早期出现肾功能变化。脊髓火器伤后肾功能变化早期应给予积极处理，以降低早期死亡率。     

肾功能损伤分级系统在成人心脏术后的应用

Objective The aim of this study was to evaluate of adilty of two acute renal failure-specific scoring systenms (the classification by Bellome et al and the AKIN criteria) for predicting hospital mortality after cardiac surgery in adult patients. Methods Between October 1 st 2006 to Decemjber 31 st 2006, 509 adult patients who ungerwent coronary artery bypass grafting (CABG) and/ or valve operation were enrolled in this study. The medical data collection included gender, age, types of operation, perioperative he- modynamic parameters, urine output, biochemical parameters and outcome. Renal function was assessed daily according to the classi- ficatinn by Bellomo and the AKIN criteria, respectively. As references, Acure Physiology and Chronic Health Evaluation(APACHE) Ⅱ and Sepsis-related Organ Failure Assessment (SOFA) score were also calculated. Resuits Three hundred and forty-one patients were male (67.0%), and 168 were female (33.0%), mean age was (56.2±12.0) years old. Tnree hundred and nine patieats un- derwent CABG, 182 underwent valve operation and 18 underwent CABG plus valve operation, Mean duration of ventilation support was (20.4±17.7) houra, and the ICU stay was (1.4±1.0) days. Postoperative hospital stay was (13.8±9.1) days. According to the classification by Bellomo., the highest in-hospital mortality was 52.9% in ARFS group. Mahiplicatinn of in-hospital morality rate was abserved (X2 for trend, P<0.01) in 0.4% (non-ARF), 1.2% (stage 1), 12.0% (stal～ 2) and 32.4% (stage 3) of pa- tients based on the AKIN criteria. By applying the area under the receiver operating characteristic ourve, the classification by Bellomo and the AKIN criteria had good discriminative power. Furthering, multivariate logistic regression analysis verified that the Odds Ratio of the AKIN criteria was 5.478 (P =0.028, 95% Confidence Interval 1.027- 24.856), after adjusting for gender and age. Con- clusion Analytical data confinned good discriminative power of both the AKIN criteria and the classification by Bellomo for predicting hospital mortality of adult postoperative patient with ARF.     

微创经皮肾取石术治疗无积水肾结石

目的探讨微创经皮肾穿刺气压弹道碎石取石(minipercutaneous nephrolithotripsy,MPCNL)治疗无积水肾结石的效果。方法对无积水肾结石47例,经输尿管导管注入生理盐水,制造"人工肾积水",C形臂X线机定位穿刺,扩张至F16,建立经皮肾取石通道,使用WolfEMS气压弹道碎石机击碎结石。结果手术时间(120±35)min。单通道取石38例,双通道取石6例,三通道取石3例。一次取石35例,二次取石12例。结石手术取净率83.0%(39/47),最终排净率93.6%(44/47)。无严重并发症。结论对于无积水肾结石,MPCNL技术要求较高,掌握无积水肾结石的解剖特点和PCNL的技巧,可以达到积水肾结石相类似的疗效,同样具有创伤小、结石残留率低、并发症少、康复快等优点,是一种安全、微创、有效的治疗方法。     

对原发性骨质疏松诊断的一些看法

原发性骨质疏松的诊断首先要除外继发性骨质疏松。后者包括的范围很广，内容也很多，需要广博的内科学基础和辨证的逻辑思维才能予以正确鉴别。骨密度检查只能作为一种参考，而不能作为诊断原发性骨质疏松的唯一依据。     

肾脏疾病患者治疗前后血浆内皮素水平动态变化及其意义

目的 为了探讨肾脏疾病患者血浆内皮素水平与肾脏疾病病情程度的关系,为肾脏疾病治疗效果的评价提供依据.方法 采用放射免疫分析(RIA)观察了77例肾脏疾病患者治疗前后血浆内皮素水平的动态变化,并与60例正常对照组比较.结果 正常对照组血浆内皮素浓度为43.1±15.2ng/L,肾脏疾病患者治疗前血浆内皮素水平为161±83.8ng/L,治疗后为97.4±52.7ng/L,均高于正常对照组(P值均<0.001).肾脏疾病治疗后内皮素水平明显下降(P<0.001),与BUN,Cr水平的下降具有一定的相关性(相关系过分别为0.54,0.55).结论血浆内皮素水平随着肾脏疾病严重程度的增加而升高,血浆内皮素水平可作为肾脏疾病治疗效果评定的指标之一     

Chronic anemia as a complication of parvovirus B19 infection in a pediatric kidney transplant patient

. This is a report of unexplained anemia that persisted for 4 months in an adolescent renal transplant patient receiving immunosuppression that included prednisone, tacrolimus, and mycophenolate mofetil. This patient required monthly blood transfusions for fatigue, palpitations, and hematocrit levels between 15% and 17%. In addition, his posttransplant course was notable for the development of insulin-dependent diabetes mellitus. While receiving low-dose prednisone, he was switched from tacrolimus to cyclosporin and tapered off insulin injections over the next 2 months. At 4.5 months post-transplantation, further diagnostic evaluation was suggestive of parvovirus B19 infection as the cause for our patient’s chronic anemia. After testing negative for serum-specific parvovirus B19 IgM and IgG antibodies, parvovirus B19 infection was detected in blood by the polymerase chain reaction. Treatment with intravenous immunoglobulin (1 g/kg per day × 2 days) resulted in normalization of both his reticulocyte count and hematocrit within 6 weeks. At 4 months after receiving the immunoglobulin infusion, he has maintained a normal hematocrit level and stable renal function without requiring further blood transfusions. Received August 23, 1996; received in revised form and accepted November 20, 1996     

Comparison of CT-guided sclerotherapy with using 95% ethanol and 20% hypertonic saline for managing simple renal cyst.

OBJECTIVE: We wanted to compare the efficacies of 95% ethanol and 20% hypertonic saline (HS) sclerotherapies that were performed in a single session under CT guidance for the management of simple renal cysts. MATERIALS AND METHODS: A prospective series of 74 consecutive patients (average age: 57.6 +/- 8.1 years) with simple renal cysts were enrolled in this study. They were randomized into two groups and 95% ethanol or 20% HS, respectively, corresponding to 25% of the aspiration volume, was injected. Treatment success was determined six months later with follow-up clinical evaluation and performing ultrasonography. RESULTS: The sclerotherapy was accepted as technically successful without major complications in all except two patients who were excluded because of a communication between the simple renal cyst and the pelvicalyceal collecting system. Thirty-six patients in the ethanol group received sclerotherapy with 95% ethanol and 36 patients in the HS group underwent sclerotherapy with 20% HS. The complete regression ratio of the ethanol group was significantly higher (94% versus 72%, respectively) than that of the HS group. There was one patient with partial regression in each group. The failure ratio of the ethanol group was significantly lower (3% versus 25%, respectively) than that of the HS group. CONCLUSION: Ethanol sclerotherapy under CT guidance is a successful and safe procedure and it can be used for the treatment of simple renal cysts. Sclerotherapy with 95% ethanol is more effective than 20% HS sclerotherapy. Sclerotherapy with HS may be an option for patients preferring to undergo a less painful treatment procedure.     

缺血再灌流肾组织内皮素—1动态变化的实验研究

在大鼠肾缺血６０分钟再灌注的模型上观察不同时相肾静脉血、肾皮质、外髓和内髓的内皮素１（ＥＴ１）浓度变化，肾组织ＥＴ１光镜和电镜免疫组织化学变化。结果发现：缺血再灌流肾组织ＥＴ１基因表达及分泌明显增强，主要分布在血管内皮细胞及平滑肌细胞、系膜细胞、肾小管上皮细胞。其分布特点与细胞类型和活性有关。本实验结果提示了缺血再灌注肾内ＥＴ１的变化规律。     

肾移植患者术前抗体水平的分析

对肾移植术前患者血清４５９份进行了抗体水平的分析。发现４０７例首次移植前的患者血清中８４例（２０．６％）有抗淋巴细胞抗体。再次移植前５２例中３９例（７５％）有抗淋巴细胞抗体。在阳性患者血清中对全淋巴细胞有抗体的占６８．３％，而仅对Ｂ淋巴细胞有抗体的占３１．７％。在性别上，女性产生抗体阳性率均高于男性。结果表明，初次移植肾患者输血和妊娠是致敏的重要因素，再次移植的患者移植物刺激是致敏的重要因素之一。Ｂ淋巴细胞抗体在移植物排斥的关系中可能具有保护移植物的作用。     

肾移植前后男性性生活状况比较

目的 :探讨肾移植前后男性性生活质量的变化。　方法 :将 86例男性肾移植病人分为低年龄组 (2 5～ 35岁 ,35例 )、中年龄组 (36～ 45岁 ,2 9例 )、高年龄组 (46～ 5 5岁 ,2 2例 ) 3组 ,分别调查病人患病前后、肾移植术后性生活能力、频率、性生活满意程度等性生活状况。　结果 :86例病人患病前均有性生活能力 ,患病后有性生活能力的 :低年龄组、中年龄组、高年龄组分别为 2 8.6 %,13.8和 9.1%。肾移植术后有性生活能力的 :低年龄组、中年龄组、高年龄组分别为 88.6 %、75 .9%和 6 3.6 %。　结论 :肾移植术后的性生活质量明显好于患病后 ,年龄越轻、恢复的越理想。