后腹腔镜肾癌根治性切除术52例临床体会

目的探讨后腹腔镜肾癌根治性切除术的手术治疗方法和临床体会。方法回顾研究后腹腔镜肾切除术的临床资料。肾脏肿瘤共52例。结果手术均获成功。所有患者均未输血,无腹腔脏器损伤、膈肌损伤、皮下气肿等并发症。手术时间70～180min,平均100min;术中出血50～200ml,平均90ml;引流管拔除时间24～72h;术后12～24h进流食;术后1～2d下床活动;术后6～8d出院。随访1年,患者无肿瘤种植及复发。结论后腹腔镜肾癌根治性切除术具有创伤小、恢复快、出血少、对腹腔脏器干扰少、住院时间短等优点,在手术器械改进和手术技巧熟练的情况下,疗效优于开放手术。具有良好的临床应用前景。     

经腹途径腹腔镜根治性肾切除术的临床效果

目的 探讨经腹途径腹腔镜根治性肾切除术治疗肾癌的临床效果及休会。方法 2000年10月-2009年8月共收治肾癌85例，男性47例，女性38例，年龄30-80岁（平均57岁），肾上极有25例，肾中极有36例，肾下极有24例；肿瘤平均直径4．8cm，左侧46例，右侧39例，75例肿瘤直径小于8cln，采用经腹腹腔镜肾癌根治术。10例肿瘤直径大于10crn，采用手辅式腹腔镜肾癌根治术。结果 84例腹腔镜肾癌根治手术成功，1例右肾动脉损伤改开放手术，3例胰腺损伤，1月后治愈；手术时间85-360min，平均145min。术中出血量约60-430ml之间，平均125ml。4例穿刺口周围不同程度皮下气肿，3d后自行消失。术后24h下床活动，48h开始进食，术后7d出院。50例随访6-0．5年，无肿瘤复发，无穿刺孔种植转移。结论腹腔镜肾癌根治术具有术中创伤小，术后恢复快，疼痛小的优点，对于T1-T2NOM0期肾肿瘤，效果优于开放手术：是一种安全，有效的治疗方法。     

腹腔镜辅助下进展期胃癌根治术16例临床分析

目的探讨腹腔镜辅助下进展期胃癌根治术的可行性及疗效。方法回顾性分析我院自2009年12月至2010年8月16例腹腔镜辅助下实施进展期胃癌根治术患者的临床资料,其中全胃切除2例、近端胃癌根治8例、远端胃癌根治6例。结果 16例患者顺利完成腹腔镜胃癌根治术,无中转开腹病例。平均手术时间为全胃切除280（230~310）min,近端胃癌根治246（210~276）min,远端胃癌根治230（200~256）min。术中平均出血量为全胃切除280（260~300）mL,近端胃癌根治110（60~180）mL,远端胃癌根治120（70~200）mL。切口长度为5~7 cm。术后患者肛门排气平均3.5（2~4）d,下床活动时间平均为3.5（2~4）d,所有患者随访1~8个月,术后近期恢复良好,无近期并发症,无肿瘤的局部复发,无Trocar种植。结论腹腔镜辅助下行胃癌根治术具有较好的安全性及可靠性,微创手术在胃癌根治中的应用是可行的。     

后腹腔镜肾蒂淋巴管结扎术治疗乳糜尿

目的探讨后腹腔镜肾蒂淋巴管结扎术治疗乳糜尿的手术方法和临床效果。方法回顾性分析12例乳糜尿患者的临床资料，均行后腹腔镜肾蒂淋巴管结扎术，观察手术时间、术中出血量、术后肠道功能恢复、和术中术后并发症及手术效果。结果手术平均时间97min，术中平均出血量86ml，术后肠道功能恢复时间24～48h，术后当日乳糜尿消失，术后平均住院5．8d，术中术后无明显并发症，随访2—36个月，无复发。结论该术式具有创伤小、出血少、恢复快、并发症少等特点，淋巴管结扎较传统开放性手术更加完全，近期效果良好，是一种安全有效的治疗方法。     

腹腔镜结直肠癌根治术的临床分析

目的：探讨腹腔镜结直肠癌根治术的可行性。方法：2007年5月-2008年11月我院完成腹腔镜结直肠癌根治术8例,选取同期开腹手术8例,对其临床资料进行对照分析。结果：手术时间腹腔镜组长于开腹组（210min±56minvs160min±32min,P〈0．05）;术中失血量、清扫淋巴结数目、术后并发症发生率两组间无统计学差异（P〉0．05）;术后肠蠕动恢复时间、镇痛时间及术后住院时间腹腔镜组分别为（2．3±0．8）d、（1．7±0．7）d、（8．8±1．1）d,开腹组分别为（3．4±0．9）d、（2．4±0．6）d、（10．2±1．2）d,腹腔镜组短于开腹组（P〈0．05）;两组术后随访均未出现穿刺孔或切口种植转移。结论：腹腔镜结直肠癌根治术安全可行,疗效可靠;与开放手术相比,具有创伤小、微创、疗效好等优势。     

腹腔镜修补术治疗成人腹股沟疝80例临床观察

分析80例实施腹腔镜股沟疝修补术(1aparoscopie inguinal hernia repair,TAPP)治疗成人腹股沟疝的方法及疗效。结果均获得成功,无转用开放手术,未发生戳孔感染、神经损伤、肠粘连等并发症。平均手术时间40～l60 min,平均住院时间4.5 d。出院后随访3～12个月,无复发病例。腹腔镜治疗腹股沟疝安全可靠,术后疼痛轻、并发症少、恢复快。     

气膀胱腹腔镜手术在膀胱疾病中的应用

目的探讨气膀胱腹腔镜手术治疗膀胱疾病的临床疗效。方法回顾性分析2010年8月至2011年11月期间我科采用气膀胱腹腔镜手术治疗12例膀胱疾病患者的临床资料,其中膀胱结石碎石取石术9例、膀胱肿瘤切除术3例。结果 12例手术均获成功。手术时间35～98 min,平均（57.42±16.54）min。术中出血5～20 mL,平均出血量（10.83±4.76）mL。膀胱造瘘管留置4～5 d,导尿管留置6～7 d。术后住院时间5～8 d,平均（7.00±1.04）d。术后随访2～12个月,未出现并发症。结论气膀胱腹腔镜手术治疗泌尿外科疾病具有微创、操作简单、并发症少、术后恢复快等优势,疗效满意,有较高的应用价值。     

腹腔镜胆囊大部分切除术在复杂型胆囊结石手术中的临床运用

目的探讨腹腔镜胆囊大部分切除术(laparoscopic subtotal cholecystectomy, LSC)的适应证、手术方法及临床应用价值。方法回顾分析总结本科自2012年7月~2013年9月28例腹腔镜胆囊大部分切除术的原因、方法和体会。结果28例手术顺利完成,手术平均时间75.8min,术中平均出血量60.5mL,肠蠕动平均恢复时间34 h,开始进食平均时间16~24 h,腹腔引流管平均留置时间为69.6 h,术后平均住院时间7.6d。术后无出血及肝外胆道损伤,随访6个月~1年,无症状复发,效果满意。结论在复杂型胆囊结石,选择行LSC是一种切实有效、并发症少、术后恢复快的手术方式,既能达切除胆囊之目的,且还能避免临近脏器之损伤(如肝外胆道、右肝管、胃肠道等),不失为复杂型胆囊手术治疗的一种较好的选择。     

超声胃镜联合腹腔镜在胃间质瘤手术中的应用分析

目的探讨超声胃镜联合腹腔镜在胃间质瘤手术中的应用及疗效,分析其可行性和临床价值。方法回顾性分析我院2015年1月至2019年6月78例行超声胃镜联合腹腔镜下胃间质瘤手术患者的临床资料,统计手术时间、恢复时间、住院时间、并发症等临床指标,并总结临床经验。结果本组78例患者均在超声胃镜引导及定位下顺利完成手术,无患者中转开腹。内镜操作时间5~15 min,平均(10.3±4.7)min;手术时间35~120 min,平均(72.8±18.2)min;恢复时间15~37 h,平均(23.2±6.5)h;住院时间6~16 d,平均(8.5±2.3)d。术后均顺利出院,无胃腔出血、梗阻、穿孔、吻合口瘘、严重心脑血管意外等并发症。结论超声胃镜能弥补腹腔镜和影像学检查的不足,双镜联合治疗胃间质瘤具有层次清晰、定位精准、创伤小、术后并发症少的优点,手术安全可行。     

后腹腔镜肾切除治疗结核性无功能肾临床分析

目的总结后腹腔镜结核性无功能肾切除的技术要点和方法,探讨后腹腔镜结核性无功能肾切除术的可行性。方法回顾分析2005年3月至2009年12月收治的46例结核性无功能肾患者临床资料,所有患者均经后腹腔镜行肾切除术,观察手术时间、术中出血量、手术并发症、术后患者恢复时间等指标。结果 46例手术均获得成功,无中转开放。手术时间45～240min,平均（102±36.9）min;出血量10～300 mL,平均（59.8±49.6）mL,术后1～3 d肠道功能恢复,术后住院时间5～9 d,平均6.5 d。术后所有患者未出现切口感染及切口不愈合。术后随访6个月至5年,无结核复发。结论后腹腔镜结核肾切除术创伤小、出血少、恢复快,但由于粘连较重,分离较为困难,因此,对有较好腹腔镜操作经验的医生而言,是一种安全、可靠的手术方法。     

Schizophrenia in a North Swedish geographical isolate, 1900–1977. Epidemiology, genetics and biochemistry

Over 200 schizophrenic patients belonging to three major and interrelated pedigree complexes have been investigated over the past 30 years in a North Swedish geographically isolated population, presently numbering about 6,000. An intensive investigation of a number of biochemical correlates and genetic markers in a few selected families belonging to one of the major pedigrees has indicated new strategies for the current research program.
Schizophrenia, as defined operationally, is significantly associated with decreased activities of two enzymes (1) blood platelet monoamine oxidase, (2) plasma dopamine-β-hydroxylase, and (3) with the genetic marker Gc² (group specific antigen). Both enzymes are subject to genetic variation. A positive score for linkage between schizophrenia and low plasma DBH activity has been calculated, but, so far, available data are insufficient for discrimination between linkage and partial contribution of genetically controlled low plasma DBH to the pathogenesis of the disease. Alternatively, both mechanisms could be involved.
As a model for continued research, schizophrenia is explained as based on a double dominant-recessive genotype (Aabb), representing a vulnerability which in about 50 % of cases develops into clinical schizophrenia. It is suggested that the dominant mutation (A) operates on or affects MAO activity, and that the recessive genotype (bb) is instrumental in low variates of DBH activity and very likely such variates within the normal range of physiological variation. Moreover, it is suggested that the combined effects of MAO- and DBH-reduced efficiency on the metabolism of e.g. dopamine could be an essential pathogenic mechanism for the schizophrenic illness which is segregating in this population.     

The universal muscular chain reaction,muscle spasm,Torsions, ruptures and extravasations. Chameleons of pathology and some manifestations of simple muscular disorders

Most bodily functions require the coordinated actions of complementary and supplementary paired muscle groups. Where this essential muscular cooperation is lacking, hollow organs may burst and others become literally screwed up, giving rise to many similar spastic diseases such as Torticollis, Twisted ovarian cyst, Torsion of the Testis, Volvulus of the intestines, Varicose Veins, Megacolon, Aortamegaly, Scoliosis, Erb's Palsy, Peyronie's Disease, Main-en-Griffe, Undescended Foot (Pes Cavus), Talipes, Strabismus. Spasm is “panenepidemic” and unclassified examples of Torsion Dystonia and Dyskinesia really are as common as debt and taxes.     

The dominant diseases of modernized societies as omega-3 essential fatty acid deficiency syndrome: Substrate beriberi

About 1900, modern food selection and processing caused widespread $\text{epidemics}$ of the B vitamin deficiency diseases of beriberi and pellagra which, for genetic reasons, often expressed as different diseases ranging from bowel and heart disease to dermatoses and psychoses. But the B vitamins merely help convert essential fatty acids (EFA) into the prostaglandin (PG) tissue regulators and it now turns out that, through hydrogenation, milling and selection of w3-poor southern foods, we have also been systematically depleting, by as much as 90%, a newly discovered trace Nordic EFA (w3) of special importance to primates and sole precursor of the PG3(4) series, even as a concurrent fiber deficiency increases body demand for EFA. Since substrate EFA is processed by many B vitamin catalysts, an EFA deficiency will mimic a $\text{panh}$ypovitaminosis B, i.e., a mixture of $\text{substrate}$ beriberi and $\text{substrate}$ pellagra resembling vitamin beriberi and pellagra but exhibiting as even more diverse $\text{endemic}$ disease. This would consitute a second stage of the Modern Malnutrition and explain why some workers now hold the dominant diseases of modermized societies to be new, nutritionally based, pellagraform yet lipid-related and to range, once again, from heart disease to psychosis. It is an assumption that our dominant diseases are unrelated to each other or are merely revealed by our diagnostic acumen and therapeutic success; and that hydrogenating millions of tons of food oils annually, to destroy the rancidity producing w3-EFA, is safe for $\text{primates}$. Extensive beriberiform disease is reported here in 32 typical cases taken from medical practice which responds strikingly to linseed oil supplements (60% w3-EFA) in confirmation of identical results in Capuchins.     

Hypo- und Hypermagnesämie aus kardiologischer Sicht

Zusammenfassung Eine Reihe pathologischer Zustände bedingen Magnesiummangel. Zustände mit Hypermagnesämie sind ebenfalls bekannt, doch wesentlich seltener. Für den Kardiologen beachtenswert ist, daß unter Therapie mit bestimmten Diuretica bei Herzinsuffizienz, bei Herzinfarkt, Kardiomyopathie, Digitalisintoxikation und bestimmten Herzrhythmusstörungen Hypomagnesämie beobachtet wurde. Leider kann in der klinischen Routine nur ein extracelluläres Magnesiumdefizit durch Serumbestimmungen gemessen werden; über Magnesiummangel einzelner Organe kann nichts ausgesagt werden. Hinweise für Magnesiummangel geben aber neben der Messung des Serumspiegels Anamnese, klinischer Befund, bestimmte EKG-Veränderungen wie auch evtl. Hypokalämie, ein Zustand, bei dem sich oft — besonders bei Aldosteronismus — parallele Veränderungen zeigten.Tierexperimente deuten darauf hin, daß infarktähnliche Läsionen unter Magnesiummangel entstehen, doch ob Herzinfarkt beim Menschen durch Magnesiummangel ausgelöst werden kann, ist noch ungeklärt. In Leichenherzen zeigte sich im Infarktgebiet neben Calciumakkumulation signifikanter Magnesiumverlust, wobei unklar blieb, ob sich Ursache oder Folge des Infarktes widerspiegelten. Falls ein ursächlicher Zusammenhang besteht, ist er im Myokardstoffwechsel selbst zu suchen, wie bei der Alkoholkardiomyopathie, wo myokardialer Magnesiummangel zumindest als pathogenetischer Teilfaktor anerkannt wird. Andererseits versucht man aber auch Beziehungen zwischen Atherosklerose, Blutgerinnung und Hypomagnesämie herzustellen, in der Meinung, daß Magnesiummangel auch über den coronaren Pathomechanismus des Herzinfarktes wirken könnte. Sicher scheint, daß gewisse EKG-Veränderungen und Herzrhythmusstörungen durch einen irritierten Magnesiumhaushalt bedingt sein können, da sie bei Gabe bzw. Entzug von Magnesium verschwinden. Daß Magnesiummangel die Glykosidtoleranz verringert, wird tierexperimentell bestätigt. Unter Hypomagnesämie bewirkt Acetylstrophanthidin eher und länger Rhythmusstörungen als ohne, außerdem lassen diese sich durch Magnesiumgaben eliminieren. Da in gewissen Fällen spontane und digitalisinduzierte Herzrythmusstörungen durch Magnesiuminjektionen beseitigt wurden, scheint Magnesium als Therapeuticum angebracht. Einsatz verschiedener Magnesiumsalze bei Angina pectoris, degenerativen Herzerkrankungen und Herzinsuffizienz ohne geprüften und offensichtlich gestörten Magnesiumhaushalt ist fragwürdig, weil keine eindeutigen klinischen Erfolgsbeweise vorliegen. Immerhin mag es aber larvierte, durch Serumbestimmungen nicht erfaßbare Mangelzustände geben. Allgemein erscheint es aus kardiologischer Sicht ratsam, den Magnesiumhaushalt zu überwachen und in entsprechenden Fällen auszugleichen, um möglichen Myokardläsionen oder fatalen Herzrhythmusstörungen entgegenzuwirken.     

Environmental risk factors and their role in the management of atopic dermatitis

Introduction: The etiology of atopic dermatitis (AD) is multifactorial with interaction between genetics, immune and environmental factors.

Areas covered: We review the role of prenatal exposures, irritants and pruritogens, pathogens, climate factors, including temperature, humidity, ultraviolet radiation, outdoor and indoor air pollutants, tobacco smoke exposure, water hardness, urban vs. rural living, diet, breastfeeding, probiotics and prebiotics on AD.

Expert commentary: The increased global prevalence of AD cannot be attributed to genetics alone, suggesting that evolving environmental exposures may trigger and/or flare disease in predisposed individuals. There is a complex interplay between different environmental factors, including individual use of personal care products and exposure to climate, pollution, food and other exogenous factors. Understanding these complex risk factors is crucial to developing targeted interventions to prevent the disease in millions. Moreover, patients require counseling on optimal regimens for minimization of exposure to irritants and pruritogens and other harmful exposures.     

'Very sore nights and days': the child's experience of illness in early modern England, c.1580-1720

Sick children were ubiquitous in early modern England, and yet they have received very little attention from historians. Taking the elusive perspective of the child, this article explores the physical, emotional, and spiritual experience of illness in England between approximately 1580 and 1720. What was it like being ill and suffering pain? How did the young respond emotionally to the anticipation of death? It is argued that children’s experiences were characterised by profound ambivalence: illness could be terrifying and distressing, but also a source of emotional and spiritual fulfilment and joy. This interpretation challenges the common assumption amongst medical historians that the experiences of early modern patients were utterly miserable. It also sheds light on children’s emotional feelings for their parents, a subject often overlooked in the historiography of childhood. The primary sources used in this article include diaries, autobiographies, letters, the biographies of pious children, printed possession cases, doctors’ casebooks, and theological treatises concerning the afterlife.     

Guidelines for the Validation and Use of Immunoassays for Determination of Introduced Proteins in Biotechnology Enhanced Crops and Derived Food Ingredients

Recent advancements in agricultural biotechnology have created a need for analytical techniques to determine introduced proteins in crops enhanced through modern biotechnology techniques. These proteins are expressed in plant tissues and may be present in food ingredients. Immunoassays are ideally suited for protein detection and may be used as both quantitative and threshold methods. Microplate ELISA and lateral flow devices are two of the most commonly used immunoassay formats for agricultural biotechnology applications. This paper provides general background information and a discussion of criteria for the validation and application of immunochemical methods to the analysis of proteins introduced into plants and food ingredients using biotechnology methods. It is the result of a collaborative effort of members of the Analytical Environmental Immunochemical Consortium. This collaborative effort represents the combined expertise of several organizations to reach consensus on establishing guidelines for the validation and use of immunoassays. Further, the paper offers developers and users a consistent approach to adopting the technology as well as aid in producing accurate and meaningful results.     

HLA genes in Amerindians from Mexico San Vicente Tancuayalab Teenek/Huastecos

Huastecos or Teenek Amerindians are presently living at North East Mexico (San Luis Potosi State). They have probably one of the most ancient culture of Mexico and Central America together with Mayas and Olmec groups with which also show close relationships. Proximity to Atlantic Ocean/Mexican Gulf originated that Spaniards had very early contact with them at about 1519 CE or before. In the present paper we have aimed to study HLA gene profile which may be useful for HLA and disease epidemiology and transplant programs in Teeneks. HLA-DRB1*04:07, -DRB1*14:06 and -DRB1*04:11 have been found in high frequency like in other Amerindian groups. High frequency typical Amerindians HLA extended haplotypes have been found, such as A*02-B*35-DRB1*04:07-DQB1*03:02; A*68-B*39-DRB1*04:07-DQB1*03:02 and A*02-B*39-DRB1*04:07-DQB1*03:02; also new haplotypes have been described, like A*02-B*52-DRB1*04:11-DQB1*03:02, A*68-B*35-DRB1*14:02-DQB1*03:01 and A*68-B*40-DRB1*16:02-DQB1*03:01. Genetic proximity is observed not only to linguistically close Mayans, but also to Mazatecans, Mixtecans and Zapotecans, who speak an altogether different languages; it shows once more that genes and languages do not correlate. This population was greatly diminished after European contact between 1500 and 1600 years CE; in fact, North and South America First Inhabitants population was brought from 80 down to 8 million people because of diseases (i.e.: measles, smallpox or influenza), slavery and war.     

Ultracryotomy: development and application (with examples from the yeast cytology) (author's transl)

The preparation steps usually necessary for obtaining ultrathin frozen sections of biological material (chemical prefixation, enclosing, cryoprotective treatment, freezing, sectioning, and post-staining the sections for transmission electron microscopy) are submitted to a critical analysis. The application of cryo-ultramicrotomy, in particularly for cytochemical purposes, is reviewed. Fundamental considerations of chemical prefixation and poststaining are supported by examples from yeast cytology. Furthermore, the efficiency of the cryo-ultramicrotomy (electron optical resolution of ultrastructural details) is demonstrated on yeast cells and protoplasts.