肾盂输尿管连接部梗阻的开放手术治疗

目的 探讨肾盂输尿管连接部梗阻(UPJO)的手术治疗效果.方法 UPJO患者64例,其中肾盂输尿管连接部狭窄引起梗阻的46例,输尿管肾盂高位连接10例,纤维索带或异位血管压迫者8例.64例均手术,其中Anderson-Hynes离断式肾盂成形术52例,异位血管切断及纤维索条松解术10例,肾切除术2例.结果 52例离断式肾盂成形术患者随访3～60个月,平均24个月.B超及IVU检查提示患肾实质明显增厚,肾积水消失42例,轻度积水18例,2例中度积水,患者肾功能术后复查均正常.结论 Anderson-Hynes离断式肾盂成形术是治疗肾盂输尿管连接部梗阻的首选手术方法,疗效确切.     

成人肾盂输尿管连接部梗阻的手术治疗

目的 总结成人肾盂输尿管连接部梗阻的诊治经验。方法 对我院1990年7月至2003年6月收治的56例成人肾盂输尿管连接部梗阻患者的病因、诊断及治疗结果进行回顾性分析。结果 肾盂输尿管连接部狭窄引起梗阻者46例(82．1％)，其中3例为双侧；粘连带压迫者3例(5．3％)，输尿管肾盂高位连接者4例次(7．3％)，异位血管压迫者3例次(5．3％)。共行手术59例次，Anderson—Hynes离断式肾盂成形术47例次，肾盂Y—V成形术4例，纤维条索松解3例，异位血管切断3例，肾切除术2例。本组病例除2例肾切除者外，余54例均于术后3个月至1年进行复查随访，50例痊愈。总治愈率92．8％。4例(7．2％)发生再狭窄，二次行肾盂成形术后均痊愈。结论 IVU和RU是诊断成人肾盂输尿管连接部梗阻的主要方法，Anderson-Hynes离断式肾盂成形术是治疗成人肾盂输尿管连接部梗阻的首选术式。     

离断性肾盂成形术在肾盂输尿管连接部梗阻治疗中的应用

目的：探讨肾盂输尿管连接部(UPJ)梗阻的治疗方法。方法：本组10例病人均采用“Anderson——Hynes”肾盂成形术，并放置双“J”管引流；对2例重度肾积水病人加作肾内翻折叠及肾固定术。结果：术后复查IVU均显示肾盂缩小，肾功能改善，UPJ处蠕动良好。结论：“Anderson--Hynes”肾盂成形术是治疗UPJ梗阻的有效方法。重度肾积水加做肾内翻折叠缝合及固定术有利于引流及肾功能恢复。     

肾盂输尿管连接部梗阻42例报告

目的 探讨肾盂输尿管连接部梗阻(UPJO)的诊断和治疗.方法 对42例UPJO患者的40例行开放手术,1例行输尿管镜下狭窄部扩张术,1例行输尿管镜肿瘤激光切除术.术毕均植入双"J"管.回顾性分析42例UPJO患者的诊断和治疗经验.结果 随诊42倒患者,随诊时间6个月～3年.42例患者解除梗阻后无复发,全部治愈.结论 UPJO的诊断主要依靠B超、肾分泌造影、逆行尿路造影及MRI检查,手术是有效的治疗手段,但对孤立肾患者需慎重.术式选择需根据梗阻病因而定.     

迷走血管与小儿先天性肾积水因果关系分析

目的探讨肾盂输尿管连接部(UPJ)迷走血管与该处梗阻引起的小儿先天性肾积水的因果关系、选择合理手术方式,提高迷走血管存在的小儿先天性肾积水临床诊治水平.方法回顾性分析了我科1998-2003年收治12例迷走血管存在的小儿肾积水诊断治疗随访情况.结果全部病人经开放手术证实,术后随访无复发.肾盂输尿管连接处管壁病理检查结果显示在有迷走血管存在与无迷走血管存在的小儿先天性肾积水中病理改变基本相同.结论该病中迷走血管存在可能不是引起肾盂输尿管连接部梗阻的始动因素.手术必须在转换盂管交界与迷走血管位置同时行肾盂输尿管成形术,切除病变的肾盂输尿管连接部,病理检查的结果为术式的选择提供了依据.     

肾盂输尿管连接部梗阻诊断及治疗进展

肾盂输尿管连接部梗阻(ureteropelvic junction obstruction,UPJO)为原发性肾积水最常见原因.UPJO的术前诊断依赖于影像学检查,治疗选择取决于梗阻严重程度和患者身体状况.近年来影像和医疗设备技术的进步,特别是B超的广泛普及和CT的升级换代以及腔镜技术的开展,极大促进了肾盂输尿管连接部梗阻诊断及治疗水平的提高.UPJO的治疗方法多样,包括开放肾盂成形术、腹腔镜肾盂成形术、顺行及逆行肾盂内切开术或扩张术.     

小儿先天性双肾积水35例临床分析

目的探讨小儿先天性双肾积水的发病机制及治疗策略。方法回顾分析35例小儿先天性双肾积水的尿动力学、泌尿影像、肾脏功能检查及外科治疗的临床资料。结果下尿路排尿功能障碍32例,上尿路梗阻3例;25例残余尿量超过100mL,28例膀胱储尿期压力大于40 cmH2O。16例行后尿道瓣膜切除术;10例神经源性膀胱行自身清洁导尿及骶神经电刺激治疗,4例行精阜切除术,2例行包皮环切术,1例双侧肾盂输尿管交界部狭窄行离断成形术,2例行输尿管膀胱再植术。术后随访6个月以上,双肾积水均明显好转。结论下尿路排尿障碍致膀胱压力超过安全压力仍继续储尿导致双肾积水主因,将膀胱压降至安全压以下是治疗和预防双肾积水的根本措施。     

十年同一单位1160例肾移植输尿管并发症23例回顾性分析

背景:输尿管梗阻的发生原因有外科技术性、缺血性、周围病变压迫和排斥反应等,其中外科因素最为重要。如何有效降低肾移植后输尿管并发症的发生,并对其作出及时诊断、处理对临床有重要的指导意义。目的:回顾解放军济南军区总医院23例肾移植后输尿管并发症的诊治情况,分析总结肾移植后输尿管并发症的发病原因及防治经验。方法:回顾分析解放军济南军区总医院1998-01/2008-12肾移植患者1160例的临床资料,肾移植后发生输尿管并发症23例,占1.98%。其中尸体供肾移植共924例,发生移植肾输尿管并发症18例,占1.95%;活体供肾移植236例,发生移植肾输尿管并发症5例,占2.12%。17例行移植肾输尿管膀胱重新吻合术;2例行移植肾输尿管-自体输尿管吻合术;1例行输尿管皮肤造瘘术;1例行移植肾输尿管游离,重新放置输尿管支架管;1例行球囊扩张术;1例行软膀胱镜下逆行输尿管支架管插管治疗。输尿管并发症治疗后复查B超明确肾盂输尿管扩张恢复情况。结果与结论:23例患者中19例为输尿管膀胱吻合口狭窄,2例输尿管坏死,2例输尿管扭曲。治疗后随访3~98个月,其中20例患者经手术治疗,恢复了移植肾肾盂与膀胱的通畅,移植肾功能均有明显的改善,术后4d内血肌酐浓度下降,术后无复发。1例皮肤造瘘患者术后8年余,移植肾功能正常,定期更换造瘘管。1例扩张及1例留置输尿管支架管患者治疗后效果欠佳,仍输尿管狭窄,后行手术治疗。提示肾移植后输尿管梗阻病因复杂,以输尿管膀胱吻合口狭窄最常见;外科手术是解除梗阻的主要方法,经及时恰当的外科处理,对移植肾功能的恢复及长期存活无明显影响。     

微创经皮肾输尿管镜下电切扩张治疗继发性肾盂输尿管连接部梗阻并发症的预防与分析

目的:探讨微创技术治疗继发性肾盂输尿管连接部梗阻(UPJO)并发症产生的原因和防范措施。方法:采用经皮肾微造瘘输尿管镜下电切扩张治疗继发性UPJO 34例患者。结果:34例中一次性行肾盂输尿管连接部狭窄切开取得成功的有31例,3例行二次手术取得成功。其中肾周尿外渗的发生率为5.9%,大出血的发生率为5.9%。结论:微创经皮肾输尿管镜下电切扩张治疗继发性UPJO,手术创伤小,疗效好;熟悉局部解剖,熟练掌握手术和腔镜操作技巧,术中精细操作,可以最大限度的减少手术并发症的发生。     

肾盂加肾后唇实质段间线切开治疗巨大鹿角形肾结石(附24例报告)

目的：探讨。肾内型。肾盂并发巨大鹿角型。肾结石的手术疗效。方法：采用。肾盂加。肾后唇实质段间线切开取石术治疗24例25侧巨大鹿角型。肾结石。结果：本组手术顺利取尽结石者22例23侧。肾，术后。肾内残留小结石（直径〈5mm）2例，经ESWL治愈。随访3个月，25侧术。肾功能良好。结论：该术式不阻断。肾蒂，操作简单，出血少，取石干净，对肾功能影响小，是治疗巨大鹿角型。肾结石较理想的手术方法之一。     

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 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.     

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.     

'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.     

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.     

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.     

Renal dysplasia and asplenia in two sibs

A family is reported in which two sibs, one male and the other female, both died within 24 hours of birth with enlarged polycystic kidneys. Postmortem histology in the second child showed gross renal dysplasia. In both children the pancreas was enlarged, nodular and cystic but the liver appeared macroscopically normal. In the second child, histological examination confirmed pancreatic fibrosis with cystic dilation of ducts, but showed portal fibrosis with bile duct proliferation in the liver.
This combination of findings is very reminiscent of those in a girl and her brother reported by Ivemark et al. (1959). The children reported here also showed absence or hypoplasia of the spleen, cardiac anomalies and other features of the Ivemark syndrome (Ivemark 1955), a quite different, usually sporadic, congenital disorder. It is suggested that the children described here have a distinct lethal congenital disorder, probably inherited in an autosomal recessive manner.     

HLA in North Colombia Chimila Amerindians

HLA-A,-B,-C,-DRB1 and -DQB1 alleles have been studied in Chimila Amerindians from Sabana de San Angel (North Colombian Coast) by using high resolution molecular typing. A frequent extended haplotype was found:HLA-A*24:02-B*51:10-C*15:02-BRB1*04:07-DQB1*03:02 (28.7%) which has also been described in Amerinndian Mayos Mexican population (Mexico, California Gulf, Pacific Ocean). Other haplotypes had already been found in Amerindians from Mexico (Pacific and Atlantic Coast), Peru (highlands and Amazon Basin), Bolivia and North USA. A geographic pattern according to HLA allele or haplotype frequencies is lacking in Amerindians, as already known. Also, five new extended haplotypes were found in Chimila Amerindians. Their HLA-A*24:02 high frequencies characteristic is shared with aboriginal populations of Taiwan; also, HLA-C*01:02 high frequencies are found in New Zealand Maoris, New Caledonians and Kimberly Aborigines from Australia. Finally, this study may show a model of evolutionary factors acting and rising one HLA allele frequency (-A*24:02), but not in others that belong to the same or different HLA loci.