骨调素和单核细胞趋化蛋白在大鼠梗阻性肾病中的表达及可能作用

目的:探讨骨调素(OPN)和单核细胞趋化蛋白(MCP-1)在大鼠梗阻性模型中的表达及其在肾脏纤维化发病机制中的作用.方法:采用-单侧输尿管结扎制造梗阻性肾病模型,分别于造模后7 d、14 d取肾组织,应用HE染色观察肾脏病理改变,免疫组化方法检测肾组织畔OPN和MCP-1蛋白的表达,应用逆转录-聚合酶链式反应(RT-PCR)法观察肾组织中OPN mRNA和MCP-1 mRNA的变化.结果:OPN、MCP-1表达主要位于肾小管上皮细胞,随着梗阻时间的延长,肾组织中OPN、MCP-1蛋白和mRNA表达明显增加.结论:OPN、MCP-1蛋白和mRNA在梗阻性肾病大鼠肾组织表达明显增加介导炎症过程,参与肾间质纤维化.     

左肝内胆管结石患者的64排CT数据集的三维重建和左肝切除可视化仿真手术的研究

目的 探讨64排螺旋cT的左肝内胆管结石的扫描数据,进行图像程序分割、三维重建和左肝切除术的可视化仿真手术.方法 利用64排cT扫描采集肝内胆管结石的数据集.运用医学图像处理系统(MIPS)对CT序列图像进行程序分割和三维重建,得到肝胆三维模型的数据以标准模板库STL格式输出,然后导入FreeForm Modeling System(FreeForm)利用自行开发的虚拟手术器械进行左肝切除的可视化仿真手术.结果 利用MIPS软件进行肝内胆管结石二维的CT图像程序分割速度快、效果满意.将分割的数据进行三维重建所获得的肝胆模型结构清晰、立体感强,形态逼真,可完成左肝切除的可视化仿真手术.结论 MIPS可以有效、快速地完成肝内胆管结石的64排螺旋CT的二维图像数据的程序分割、三维重建及在FreeForm进行左肝切除可视化仿真手术,为仿真的胆道外科手术提供思路.     

小儿输尿管开口异位的诊断和治疗(附22例报告)

目的 提高小儿输尿管开口异位的诊治效果。方法 总结22例输尿管开口异位患儿临床资料。男1例，女21例。年龄1个月～12岁，平均4岁。单侧17例，双侧5例。21例女童中，有正常分次排尿伴异常漏尿18例，完全持续性漏尿3例；1例男童有上尿路梗阻及泌尿系感染。异位开口于阴道14例、尿道4例、前庭3例、膀胱颈1例。结果 手术治疗20例，其中肾切除者11例、半肾切除者7例，术后漏尿症状消失，3例合并输尿管残端综合征；1例双输尿管膀胱再植术后仍有尿失禁；1例直肠化膀胱术无漏尿症状。结论 明确诊断，选择合理手术是小儿异位输尿管口治疗成功的关键。     

输尿管上段结石的微创手术治疗

目的：探讨输尿管上段结石的治疗方法。方法：回顾性分析输尿管镜下气压弹道碎石(URSL），后腹腔镜输尿管切开取石(RLU)、经皮肾穿刺取石(PCNL)治疗输尿管上段结石患者的临床资料。其中URSL组25例，RLU组20例。PCNL组9例。结果：URSL组碎石成功18例；7例不成功，其中3例改为开放手术，1例改为后腹腔镜取石。2例行ESWL术，1例仅留置双J管。术后1个月拔管后自行排出。2例并发输尿管穿孔。RLU组取石成功18例，2例滑入肾内，经配合输尿管镜和腹腔镜直视下经皮肾穿刺取石成功，术后15例有伤口漏尿。PCNL组成功9例，无并发症。结论：USRL创伤小。术后恢复快。是治疗输尿管上段结石的较为满意的治疗方法。PCNL创伤小，取石成功率高，在结石靠近肾盂、儿童输尿管上段结石并同侧肾结石和结石以下输尿管狭窄时应优先考虑。但技术难度较大。RLU可作为URSL不成功后的辅助治疗方法。     

后腹腔镜下离断式肾盂成形术

目的探讨后腹腔镜下肾盂成形术的临床疗效. 方法腹腔镜下通过后腹腔途径对9例肾盂输尿管连接部狭窄行离断式肾盂成形术并对技术进行改进. 结果 9例手术均获成功,手术时间110～240 min,平均160 min.术中出血量30～80 ml,平均50 ml.术后住院8～18 d,平均11.2 d.术后并发症:皮下气肿(合并阴囊气肿)1例,漏尿2例.术后1～10个月B超示术侧肾盂无积水5例,轻度积水2例,中度积水2例.3例术后5个月IVU显示吻合口通畅. 结论后腹腔镜肾盂成形术微创、效果好,值得推广.     

钬激光输尿管镜下碎石与经皮肾取石治疗嵌顿性输尿管上段结石的比较

目的比较钬激光输尿管硬镜碎石与经皮肾取石术治疗嵌顿性输尿管上段结石的疗效。方法106例单侧伴有肾积水的嵌顿性输尿管上段结石,48例采用URL治疗（URL组）,58例采用PCNL治疗（PCNL组）,统计分析2组的结石清除率及手术并发症。结果术后1 d结石清除率URL组25.0%（12/48）显著低于PCNL组98.3%（57/58）（χ^2=62.065,P=0.000）;术后3个月结石清除率URL组77.1%（37/48）显著低于PCNL组100%（58/58）（χ^2=14.831,P=0.000）;术后高热（T〉38.5℃）率URL组8.3%（4/48）与PCNL组6.9%（4/58）无统计学差异（χ^2=0.000,P=1.000）。结论对于嵌顿性输尿管上段结石,在有条件且技术成熟的医院PCNL可作为治疗的首选方法。     

Ureteral obstruction in the neonatal rat: Renal nerves modulate hemodynamic effects

In the neonate, chronic unilateral ureteral obstruction (UUO) reduces renal blood flow (RBF) of the ipsilateral kidney and increases RBF of the opposite kidney. To determine whether renal nerves mediate or modulate these responses complete left UUO in the neonatal rat was used as a model of severe obstructive uropathy, and was compared with sham-operated controls. At 24–28 days of age, animals underwent left or right mechanical renal denervation or left sham renal denervation. One week after denervation, animals were anesthetized and blood pressure and heart reate were measured. Cardiac output and RBF were determined by the radioactive microsphere technique. UUO increased blood pressure and heart rate, and decreased RBF in the obstructed kidney, regardless of denervation. While left UUO increased RBF to the intact opposite kidney in rats with left renal denervation, this was attenuated by right renal denervation. Thus, in the neonatal rat, UUO modulates systemic renal hemodynamics, possibly through activation of the renin-angiotensin system. While renal nerves do not mediate the vasoconstriction of the obstructed kidney, renal nerves modulate vascular tone of the kidney contralateral to UUO.     

The effect of indomethacin and metamizole on ureteral motility and urine flow in sheep

Summary The objective of this study was to evaluate the effect of two non-steroid anti-inflammatory drugs, indomethacin and metamizole, on ureteral peristalsis during acute occlusion similar to the situation in renal colic. In 12 pentobarbital anesthetized sheep, both ureters were cannulated and the frequency of ureteral contractions, urine flow, mean ureteral pressure and blood pressure were recorded during 10-min control and i.v. drug administration periods. Both indomethacin (1–2 mg/kg) and metamizole (60–120 mg/kg) showed a dose dependent reduction in peristaltic frequency without reduction of the mean pressure. In addition, the pressure amplitude of the peristaltic waves was also lowered, particularly with indomethacin. Only indomethacin reduced the urine flow. Arterial blood pressure was elevated by both drugs, particularly after the first dose of indomethacin. It can be concluded that indomethacin and metamizole reduce ureteral peristaltic frequency, probably blocking the impulse transmission at the ureteropelvic junction.For the partial fulfillment of a Master's degree in Pharmacology     

Is cytomegalovirus a cause of ureteral stricture in renal transplant recipients?

Cytomegalovirus (CMV) is regarded as a predominant infectious agent in solid organ transplants. CMV disease has highly protean clinical manifestations. Nevertheless, urinary tract involvement seems to be very rare during CMV infection. We report two cases of renal transplant recipients in whom ureteral stricture developed in the course of CMV disease. Histologic data were available for them and were consistent with CMV infection. We discuss previous case reports and propose physiopathologic mechanisms. Received: 3 October 1996 Received after revision: 13 February 1997 Accepted: 17 February 1997