血管内皮素-1在梗阻性黄疸大鼠冷应激肾损害中的作用

目的　了解血浆内皮素 1 (ET 1 )在梗阻性黄疸大鼠冷应激状态下的水平及与肾功能损害的关系。方法　实验动物随机分为 4组 :①假手术 (SO)组 ;②胆总管结扎 (BDL)组 ;③胆总管结扎应激 (BS)组 ;④BS加ET抗血清 (BAS)组。采用放射免疫的方法测定各组动物的血浆ET 1含量。结果　BS组ET 1 (2 0 6 72ng/ml± 34.31ng/ml)明显高于BDL对照组 (1 68 63ng/ml± 2 6 58ng/ml) (P <0 .0 5)。血尿素氮 (BUN) (1 2 31mmol/L± 3 1 4mmol/L)和肌酐 (Cr) (71 .64mmol/L± 9.1 4mmol/L)也较BDL组升高 (P <0 .0 5) ,BUN和Cr也均下降 ,ET 1与BUN ,Cr均呈正相关 (r=0 .743,r =0 .831 )。结论　梗阻性黄疸大鼠血浆ET 1在应激状态下明显升高 ,与BUN和Cr呈正相关 ,致使梗阻性黄疸大鼠的肾功能损害加重。     

大鼠梗阻性黄疸形成中血及肝组织内皮素的水平及意义

目的　了解梗阻性黄疸 (obstructivejaundice ,OJ)形成过程中内皮素 (endothelin ,ET)在血浆及肝组织中的水平及其在OJ肝损伤中的作用。方法　以大鼠胆总管结扎 (bileductligation ,BDL)为模型 ,采用放射免疫法 (radioimmunassay ,RIA)测定了BDL后 3、6、9、1 2、1 5d时血浆及肝组织中ET的含量 ,同时观测血清谷丙氨酸转氨酶 (ALT)含量变化 ,并与肝组织病理改变进行对照分析。结果　BDL后血清总胆红素 (totalbilirubin ,TBi)迅速升高 ,明显高于NC组和SO组 (P <0 0 1 ) ;BDL组血浆及肝组织中ET水平明显高于对照组 (P <0 0 1 ) ,BDL各时相组差异有显著性意义 (F =1 8 41 ,P <0 0 1和F =40 61 ,P <0 0 1 ) ,随梗阻时间延长呈进行性含量升高 ,1 5dET值最高 ,分别为 (2 94 98± 35 95) pg/ml和 (2 0 1 86± 2 4 45) pg/ 1 0 0mg ;二者与血清ALT均呈正相关 (r =0 8441 ,P <0 0 1和r=0 930 3 ,P <0 0 1 ) ,病理切片见肝细胞从肿胀、空泡变性到灶状片状坏死 ,损伤也呈进行性加重 ,与ET含量变化一致 ;病理切片还显示肝内有大量的小胆管及毛细胆管的增生 ,且随着胆管梗阻时间的延长 ,增生越来越明显。结论　实验结果提示在OJ形成中血及肝组织中ET含量上升 ,并随梗阻时间延长而加重 ;ET可能是参与OJ肝脏     

内毒素血症与梗阻性黄疸病人肾功能损害的关系

目的: 探讨梗阻性黄疸(梗黄)病人血浆内毒素(ET)水平与肾功能的关系.方法: 动态观察30例梗黄(梗黄组)手术前后血浆ET、肌酐(Cr)、尿素氮(BUN)含量及内生肌酐清除率(Ccr)变化,并与21例无黄疸病人(对照组)进行同步比较.结果: 梗黄组外周血ET水平显著升高(P<0.01),Ccr显著降低(P<0.01);门静脉血ET水平又显著高于外周血(P<0.05),术后5 d内ET水平降低不明显;术后第1天ET反而升高(P<0.05),Ccrr更趋下降(P<0.05),并伴有血Cr、BUN升高(P<0.05);5 d后随ET水平逐渐下降,Cor逐步上升,第15天ET、Ccr两项指标接近正常水平;ET与Ccr呈显著负相关(r=-0.55,P<0.05).对照组血浆ET呈低水平,Ccr在100ml/min左右,手术前后变化均不显著(P>0.05).结论: 肠源性内毒素血症是梗黄肾功能损害的重要原因,围手术期以手术后一周内最为严重.     

全腔静脉肺动脉连接术后内皮素分泌的随访研究

目的　通过全腔静脉肺动脉连接术后内皮素 1 (ET 1 )变化情况 ,探讨肺循环无搏动血流对肺内分泌功能的长期影响。方法　试验组为 1 8例行全腔静脉肺动脉连接手术后随访病人 ;对照组选择1 8例房间隔缺损、室间隔缺损心内修复术病人。两组分别于术前、术后第 1、5d、出院前和随访时测定ET 1含量。试验组术前、出院前及随访时还行右心导管检查测量心脏指数 (CI)及肺血管阻力 (PVR)。结果　试验组ET 1含量在术后早期显著高于对照组 ,且下降缓慢 ,随访时才恢复至正常水平。试验组术后ET 1含量与CI呈显著负相关 (r=- 0 92 ,P <0 0 5) ,与PVR呈显著正相关 (r=0 91 ,P <0 0 5)。结论　全腔静脉肺动脉连接术后 ,肺血管内皮细胞能够对肺循环内长期无搏动血流逐渐适应。其术后短期内刺激ET 1分泌增加所引起的肺血管阻力升高 ,可能与一些早期并发症密切相关     

梗阻性黄疸患者围手术期血浆D-乳酸的变化及其临床意义

目的 研究梗阻性黄疸患者围手术期血浆D-乳酸的变化及临床意义.方法 将25例梗阻性黄疸患者作为实验组,10例胆囊结石患者作为对照组,检测实验组和对照组患者术前1d、术后1d、3d、7d、10d、14d血浆D-乳酸含量及血清胆红素水平.结果 对照组术后1d血浆D-乳酸含量明显高于术前(P＜0.05),术后7d血浆D-乳酸含量下降至术前水平(P＞0.05).实验组术前血浆D-乳酸含量高于对照组术前(P＜0.05),实验组术后1d血浆D-乳酸含量高于术前(P＜0.05),术后3d血浆D-乳酸含量呈进行性下降(P＜0.05),术后14d血浆D-乳酸含量低于术前(P＜0.05),但仍高于对照组术前(P＜0.05).结论 血浆D-乳酸可作为评价梗阻性黄疸患者肠黏膜通透性的指标;梗阻性黄疸患者术前肠黏膜通透性增加,解除胆道梗阻有利于肠黏膜功能的恢复,术后14d肠黏膜通透性未恢复至正常水平,梗阻性黄疸患者围手术期应加强肠黏膜功能的保护.     

内毒素引起阻塞性黄疸大鼠肾功能障碍的机制

目的 探讨阻塞性黄疸(obstructive jaundice,OJ)时内毒素引起肾功能障碍的机制.方法 SD大鼠60只,胆总管结扎后,分5 d(B1),10 d(B2),15 d(B3)三组,每组各10只,同时建立相应对照组(A1,A2,A3),另30只胆总管结扎后分3组(SHUD,LAC,NS),每组各10只,分别用2 ml舒胆合剂、乳果糖液、生理盐水灌胃,连用9 d.观察内毒素、血和肾组织中内皮素(endothelin,ET)、一氧化氮(nitric oxide,NO)的含量、一氧化氮合酶(nitric oxide synthase,NOS)活性及肝、肾功能的变化.结果 血内毒素与血、肾组织ET含量,ET/NO比值呈显著正相关(P＜0.05,r=0.630,0.438,0.496,0.453),与肌肝清除率(creatinine clearance,Ccr)和肾皮质血流量(renal cortical blood flow,BCBF)呈显著负相关(P＜0.05,r=-0.600,-0.410).血、肾组织ET/NO比值与Ccr,RCBF呈显著负相关(P＜0.05,r=-0.449,-0.558,-0.626,-0.731).血和肾组织内NO水平与内毒素水平呈负相关(P＜0.05,r=-0.518,-0.441),与Ccr、RCBF呈正相关(P＜0.05,r=0.422,0.496,0.400,0.659).SHUD组与LAC血内毒素、ET水平组明显降低,血和肾组织NO,NOS活性以及Ccr,RCBF较NS组明显升高.结论 OJ时内毒素可通过刺激ET的释放,提高ET/NO比值,使肾内缩血管因子与扩血管因子比例失调而损伤肾功能.     

梗阻性黄疸血浆内皮素含量与胃粘膜病变的关系

目的 探讨梗阻性黄疸时血浆内皮素(ET)含量与胃粘膜病变的关系。方法 本实验以犬为实验对象，根据处理方式的不同设实验组与对照组，实验组7只犬行胆总管结扎术，对照组3只犬行假手术，用特异性放射免疫法检测两组术前及术后l、4及7d血浆ET含量，并于术后7d取胃粘膜行光镜、电镜观察。结果 实验组术后ET含量持续升高，明显高于对照组，光镜下见毛细血管扩张，胃粘膜充血水肿，电镜下见毛细血管扩张、瘀血，粘液细胞间质水肿。结论 梗阻性黄疸时，血浆ET含量增高可能是梗阻性黄疸时胃粘膜病变的发病机理之一。     

梗阻性黄疸大鼠血浆和肾组织内皮素含量的变化及与肾功能关系的研究

目的：了解血浆，肾组织内皮素（ET）在梗阻性黄疸（OJ）大鼠模型上不同梗阻时间的变化情况，探讨循环ET和肾内ET与梗阻性黄疸时肾功能损害的关系。方法：胆总管结扎及假手术组各32只Wistar大鼠分别于术后5，10，15，20d（每小时n=8)采用放射免疫法测定血浆和肾皮质，髓质细胞匀浆ET含量，同时测定血清肌酐（Cr)，尿素氮（BUN）和直接胆红素（DB）浓度，并对肾脏行光镜下病理形态学观察。结果；血浆ET浓度及肾皮质，髓质ET含量在梗阻5d即升高，且随OJ时间延长进一步升高，伴有血清Cr,BUN,DB的升高和肾脏病毒形态的进行性改变。血浆ET，肾皮质ET在大部分或部分时相与Cr,BUN呈明显正相关，血浆ET在大部分时相与DB呈明显正相关。结论：梗阻性黄疸时循环和肾内ET水平持续性升高；血浆和肾皮质ET的升高可能参与了肾脏滤过功能的损害；肾髓质ET的升高可能是导致OJ早期尿浓缩功能异常的介质之一；高胆红素血症可能是血浆ET升高的原因之一。     

高危心脏病患者血浆ET、NPY、CGRP含量变化以及乌拉地尔对其的影响

目的观察乌拉地尔(URA)对高危心脏病人(HRC)患者围术期血浆内皮素(ET)、降钙素基因相关肽(CGRP)、神经肽Y(NPY)含量的影响.方法用放射免疫分析方法测定20例HRC患者血浆ET、NPY、CGRP水平,并以40例健康者作对照;观察HRC患者经URA(0.4mg.kg-1)静脉注射后诸指标变化.结果HRC患者血浆ET明显高于正常对照组(P＜0.01);NPY显著高于正常对照组(P＜0.01);CGRP水平显著低于正常对照组(P＜0.01).经URA治疗后HRC患者ET、NPY水平明显下降(P＜0.01),CGRP水平明显升高(P＜0.01).HRC患者URA治疗前后血浆ET与CGRP水平间呈显著正相关(r=0.5821P＜0.01;r=0.619P＜0.01).结论ET、CGRP、NPY是参与HRC发病的重要体液因素,URA可明显提高HRC患者体内CGRP水平,有效拮抗ET、NPY的缩血管作用,对改善HRC患者血流动力学有重要影响.     

654－2对梗阻性黄疸内毒素致肾脏损害的临床干预

目的 :观察梗阻性黄疸 (梗黄 )患者内毒素 (ET)对肾功能影响以及 6 5 4 2的干预作用。方法 :30例梗黄患者 ,随机分为两组 ,分别给予一般治疗 (A组 )和 6 5 4 2治疗 (B组 ) ,观察手术前后血ET及内生肌酐清除率 (Ccr)变化 ,并与 2 1例无黄疸患者进行同步比较。结果 :(1)入院时A、B两组外周血ET及Ccr水平无显著差异 (P >0 0 5 ) ,但ET水平均显著高于对照组 (P <0 0 1) ,Ccr均显著低于对照组 (P <0 0 1)。 (2 )A组门静脉血ET水平显著高于外周血 (P <0 0 5 ) ,A组术后随ET水平下降 ,Ccr逐渐升高 ,第 15天ET和Ccr两项指标达到正常水平。ET与Ccr呈显著负相关 (r =- 0 5 9,P <0 0 5 )。 (3)B组用药后外周血和术中门静脉血ET水平均显著降低 ,术后保持较低水平 ,而Ccr用药后略有升高 ,术后继续上升 ,第 10天ET、Ccr两项指标达到正常水平。结论 :6 5 4 2可降低梗黄患者肠源性ET水平 ,对肾功能损害具有良好的保护作用。     

Urologist-Acquired Renal Access for Percutaneous Renal Surgery

Objectives. In most endourology programs an interventional radiologist is employed to acquire renal access for percutaneous renal surgery. Over the last 13 years the senior endourologist at Oregon Health Sciences University has acquired access without employing a radiologist. We report our experience with urologist-acquired renal access for percutaneous renal surgery in 522 cases.Methods. We reviewed the records of all patients at our hospital who underwent percutaneous renal surgery between August 1983 and December 1996 with renal access being obtained in the operating room by a urologist.Results. Four hundred fifty-six patients underwent 522 procedures. Indications for percutaneous renal surgery were renal and proximal ureteral calculi (n = 516), retained ureteral stent (n = 3), and intrarenal collecting system tumor (n = 3). We were successful in gaining access to 513 of 522 kidneys (98.3%). Access was obtained via a subcostal approach in 344 procedures, over the 12th rib in 152 procedures, over the 11th rib in 15 procedures, and transabdominally in 2 procedures. Sixty-five patients (12.7%) required a second or multiple sites to facilitate complete removal of calculi. Our overall complication rate was 15.3%. Blood transfusion was required in 5.4% of the cases, ileus developed in 1.9%, pneumothorax in 1.1%, intraoperative hydrothorax in 1.1%, postoperative pleural effusion requiring aspiration in 0.9%, and septic shock in 0.9%. Our overall success rate for stone removal was 94.5%.Conclusions. In our experience, the urologist is able to safely and effectively obtain percutaneous access to the collecting system for percutaneous renal surgery as a one-stage procedure without the aid of interventional radiologists.     

Renal Adenoma Associated with Renal Cyst Formation

We report a renal adenoma associated with renal cyst formation in a 49-year-old male. A small renal mass inside a right renal cyst was discovered incidentally by ultrasonography. A right nephrectomy was performed. A pathologic examination revealed a well-differentiated, benign papillary tumor which was composed of slightly eosinophilic cells. We therefore diagnosed this patient as having a renal adenoma with hemorrhage.     

Renal Imaging in Patients with Renal Impairment

In patients with renal impairment, the incremental benefits from administration of contrast media for imaging studies need to be carefully assessed relative to the potential increased risks of worsening renal dysfunction and systemic adverse effects. This review provides an overview of risk and benefits of iodinated and gadolinium-based contrast agents; examines their relationships to contrast-induced nephropathy (CIN) and nephrogenic systemic fibrosis (NSF), respectively; and discusses various clinical strategies to minimize the risk of CIN and NSF. Specifically, renal imaging strategies aimed to minimize the adverse effects of contrast media as well as alternatives to iodinated and gadolinium-based contrast-enhanced renal imaging are proposed with emphasis on non–contrast-enhanced magnetic resonance imaging.     

Early Assessment of Renal Resistance Index and Long-Term Renal Function in Renal Transplant Recipients

Background. The effect of the intrarenal arterial resistance index (RI) on long-term renal functions is not well known. We examined the predictive value of intrarenal RI on long-term allograft outcomes. Methods. We retrospectively investigated 121 stable renal transplant recipients, followed for a mean of 63.21?±?19.9 months after renal transplant. Patients with complications during the first six months after transplant were not included. Color Doppler ultrasonography was done to calculate the intrarenal RI within the first four weeks after transplant. Results. Older recipient age, high pulse pressure, active smoking, and proteinuria were associated with a higher intrarenal RI. Multivariate analyses revealed that renal RI and donor age were independent predictors of allograft outcome. Kaplan-Meier estimates of cumulative graft survival were significantly worse in patients who had an RI of 0.7 or more than they were in patients who had an RI of less than 0.7 (p?=?.005). Development of chronic allograft nephropathy (CAN) was significantly higher in patients who had an RI of 0.7 or more (p?=?.02). Conclusions. Renal RI determined within the first month after renal transplant predicts long-term allograft function and development of CAN in renal transplant recipients.     

Obesity Affects Short-Term Renal Function After Renal Transplantation

BackgroundThe literature has shown a significant association between body mass index (BMI) and patient and graft outcomes after renal transplantation. The purpose of this study was to reveal the effect of obesity on graft function in a Taiwanese kidney transplant cohort.MethodsTwo hundred consecutive patients who received kidney transplantation were enrolled in our study. Eight pediatric cases were excluded due to differing definitions of BMI among children. According to the national obesity criteria, these patients were divided into underweight, normal, overweight, and obese groups. Their estimated glomerular filtration rate (eGFR) was compared accordingly using t tests. Cumulative graft and patient survivals were calculated using Kaplan-Meier analysis. A P value of ≤ .05 was considered significant.ResultsThe mean age of our cohort (105 men and 87 women) was 45.3 years. There was no significant difference comparing biopsy-proven acute rejection, acute tubular necrosis, and delayed graft function between the obese and nonobese groups (P values: .293, .787, and .304, respectively). Short-term eGFR was inferior in the overweight group, but this effect was insignificant beyond 1 month. The 1-month and 3-month eGFR were found to be correlated with BMI groups (P = .012 and P = .008, respectively) but not significant after 6 months post–kidney transplantation.ConclusionsOur study found that short-term renal function was affected by obesity and being overweight, possibly due to the higher prevalence of diabetes and dyslipidemia in obese patients and the increased surgical difficulty.     

Coexisting Renal Cell Carcinoma and Renal Artery Aneurysm

We report a rare case of a patient with a renal artery aneurysm (RAA) and an ipsilateral renal cell carcinoma (RCC). This patient was treated with simultaneous aneurysmectomy and radical nephrectomy. The indications for surgical intervention for RAA remain controversial. We present a review of the literature on the clinical presentation, classification, etiology, and management of RAA and associated RCC.