急性肾衰大鼠肾阻抗容积脉波的改变及三种莨菪药的治疗作用

用自己建立的阻抗法描记大鼠肾容积脉波，研究油酸致急性肾衰时肾阻抗容积脉波的改变及樟柳碱、东莨菪碱、山莨菪碱对这些改变的影响。结果表明：左肾动脉注射油酸后１０ｍｉｎ、１ｈ、６ｈ出现低平及平顶波，波高及流入容积速度明显低于注射前及生理盐水对照组。三种莨菪药治疗后，低平及平顶波明显减少或消失，波高及流入容积速度明显提高。结果说明：急性肾衰早期肾内脉动血管弹性降低，紧张度增高，周围阻力增加，肾组织血液灌流量降低；三种莨菪药均可改善肾内脉动血管的功能，提高肾组织血液灌流量     

腹腔镜下左半结肠切除术相关筋膜平面的解剖观察

目的：探讨左半结肠切除术相关筋膜的解剖学特点和外科平面的鉴别方法。临床资料和方法：2003-2004年南方医院普通外科施行的腹腔镜左半结肠切除术15例，病例均为左半结肠癌。对腹腔镜下左半结肠后外侧、中线侧和直肠后外侧相关筋膜的解剖特点和镜下定位标志进行观察和描述。结果：在乙状结肠第一曲外侧缘肠壁与左侧腰大肌筋膜之间存在一个固定的粘连带，它是左侧Toldt’s线的尾侧端点。左半结肠系膜后外侧存在肾前筋膜；中线侧存在主动脉前筋膜；直肠系膜后外侧存在盆筋膜壁层。这三个部位的筋膜相互延续。结论：乙状结肠和左侧腰大肌筋膜之间的粘连带是左半结肠切除术外侧分离的起点。肾前筋膜是衬贴于左半结肠和直肠系膜后面的一层连续筋膜，在不同的解剖位置有不同的表现形式。左半结肠切除术的外科平面统一于结直肠系膜与连续的肾前筋膜之间。     

伴有明显血管平滑肌瘤样增生的肾细胞癌

作者报道了伴有独特的血管平滑肌瘤样增生性间质的肾透明细胞癌。5例均为会诊病例，女性4例，男性1例，年龄37～75岁（平均53岁），4例位于右侧肾脏，1例位于左侧，3例有血尿，除1例因乳腺癌行双侧乳房切除术外无明显过去史，均无结节性硬化的临床症状，4例行部分肾切除术，1例行全肾切除术，1例于肾切除术后3年出现骨转移，活检示转移性乳腺腺癌，2例为新近病例，无随访。大体均为肾脏孤立性肿块，直径1．8～4．0cm，边界清楚，周围包绕厚的不规则包膜，2例可见中央有纤维性疤痕呈白色带状与包膜连续，其间的肿瘤组织呈多彩状，见棕红色、黄色、半透明白色区域，可见囊性变、坏死和局灶钙化。镜下生长方式和细胞学特点相似，特征性改变是两种不同的成分混合：上皮透明细胞肿瘤和明显的血管平滑肌瘤样的间质。     

右前臂炸伤继发肾皮质大面积坏死尸解1例

局部炸伤继发肾皮质大面积坏死罕见。解放军303医院收治1例前臂炸伤、死后经尸解证实肾皮质大面积坏死的病例，现将其病变特点和发生原因报道如下。     

躯干肢体皮肤微循环观测

<正> 皮肤被覆全身,在成人约占体重的16％,面积约为1.5～1.8m~2,是人体中表面积最大的器官。临床活体皮肤微循环观察。不论是对全身疾病还是局部病变,均能提供微循环的变化指标,有助于临床诊断和指导治疗。某些疾病属局部动脉供血不足或静脉梗阻性疾病,微循环障碍可在皮肤微血管管袢构形上出现特殊的变异。     

先天性肾病综合征一例

病例:患儿男,33d.因双下肢、阴囊浮肿26d,腹臀部皮肤发硬15d于2002年12月1日人院. 系第1胎第1产,胎龄38 4w顺产,出生体重1700g,羊水多,胎盘大,重量不详.母乳喂养.生后第7d出现双下肢、阴囊浮肿,渐加重,11d腹部、臀部皮肤发硬.当地医院给予对症治疗无效.患儿叔婆第1胎单指趾畸形,出生时不明原因死亡;第2胎无(足母)趾畸形,双眼脸下垂,现20余岁.     

超声诊断盆腔内异位肾1例

患者,女,51岁,无任何不适.常规取俯卧超声榆查(东芝SSA-530A、B超仪),左肾区未探及肾脏回声,右肾区内可显示右肾大小形态正常.经下腹部探查时位于膀胱后方盆腔内见一大小为76x41mm肾脏回声,边界光整清晰,形态规则,包膜完整,肾内结构清晰,.肾锥体、肾窦部、肾实质比例正常,(如图).嘱患者侧卧位探查,该.该肾脏位置始终较固定.     

一种新的基于MCE的心肌微循环定量分析系统的研制

基于心肌声学造影(MCE)的心肌微循环定量分析系统,对实时MCE图像进行处理,通过非线性回归分析方法计算出心肌供血区内心肌血容量、血流速度、血流量以及三者的心内、外膜层跨壁梯度等冠脉微循环临床诊断指标,能有效满足临床需求,实现了实时MCE的定量分析.     

肾混合性上皮间质肿瘤和成人囊性肾瘤的临床病理学观察

Objective To study the clinicopathologie features,immunophenotype and differential diagnosis of mixed epithelial and stromal tumor of kidney ( MEST) and adult cystic nephroma ( CN).Methods Five cases of MEST and 4 cases of CN were retrospectively analyzed.Immunohistochemical study was carried out and the literature was reviewed.Results All of the five patients with MEST were females.Their median age was 45 years.For CN,there were 3 males and 1 female and their median age was 41 years.All patients presented with loin pain and hematuria.On gross examination,MEST was well-circumscribed but non-encapsulated.There was no evidence of haemorrhage or necrosis.Three of the cases were solid in nature.One was composed of a mixture of solid and cystic elements,while the remaining case showed a multicystic cut surface bridged by thick fibrous septa.On the other hand,CN were well-circumscribed and encapsulated.They were multiloculated cystic in nature.The cystic spaces were separated by thin septa and there was no significant solid or necrotic component.Histologically,MEST consisted of proliferation of cystically dilated glands admixed with spindly stromal cells with various cellularity and growth patterns.Both the glandular and stromal elements were well-differentiated with no cytologic atypia identified.The glandular structures in 2 of the cases were partially lined by endometrial or tubal epithelium.In contrast,the thin-walled cystic spaces in CN were lined by a single layer of epithelium.Immunohistochemical　study showed that the epithelial cells were positive for pan-cytokeratin and epithelial membrane antigen.The spindle cells in MEST expressed vimentin (5/5 ) ,smooth muscle actin (3/5 ),desmin (4/5 ),CD10 (5/5),estrogen receptor (4/5) and progesterone receptor (4/5).They were negative for HMB45,CD34,CD117 and S-100 protein.On the other hand,the spindle cells in CN were variably positive for vimentin (4/4),smooth muscle actin (4/4),desmin (1/4),estrogen receptor (3/4) and progesterone receptor (1/4).They were negative for CD10,HMB45,CD34,CD117 and S-100 protein.Conclusions Both MEST and CN are uncommon renal neoplasm.Most of them run a benign clinical course.The stromal cells in MEST show smooth muscle or myofibroblastic differentiation.Areas demonstrating Miillerian features also existed in some cases.MEST and CN share overlapping histological and immunohistochemical features,and may represent spectrum of the same group of lesions.     

Ⅲ型胶原肾小球病的形态学观察

目的了解Ⅲ型胶原肾小球病的形态学改变,并对Ⅲ型胶原可能的细胞来源进行初步探讨。方法对3例肾活检组织进行光镜、免疫荧光、电镜和Ⅰ、Ⅲ、Ⅳ型胶原及d平滑肌肌动蛋白(α-SMA)的免疫组织化学染色(SP法)观察。结果2例患者临床表现为肾病综合征,其中1例伴高血压,第3例表现为肾功能不全和肾性高血压。3例均无肾病家族史。光镜检查可见肾小球基膜内和系膜区弥漫性过碘酸-希夫反应阳性物质沉积,系膜细胞无明显增生。电镜检查在基膜内疏松层和系膜区可见大量胶原纤维沉积,系膜细胞胞膜下平行排列的束状微丝明显增加。免疫组织化学显示这些胶原纤维为Ⅲ型胶原,Ⅰ型和Ⅳ型胶原阴性,同时系膜区多数系膜细胞α-SMA阳性。结论Ⅲ型胶原肾小球病光镜、电镜及免疫组织化学上都有其特殊的病理改变。肾小球内激活的系膜细胞可能是Ⅲ型胶原的来源。