腹腔镜小儿阑尾切除术52例报告

目的探讨腹腔镜在小儿阑尾切除术中的应用价值. 方法 2002年10月～2004年12月应用腹腔镜三孔法行小儿阑尾切除术52例. 结果 52例均顺利完成手术,手术时间20～50 min,平均30 min.术后2～4 d出院.2例穿刺孔周围发生皮下气肿,无其它并发症.49例随访3～29个月,平均14个月,无肠梗阻、腹腔内残余感染等发生. 结论腹腔镜小儿阑尾切除术创伤小,并发症少,安全,疗效确切.     

Urolithiasis in pregnancy. A case report

Urolithiasis in pregnancy is relatively rare and management requires slight modification. A case is presented and treatment discussed.     

Urolithiasis in children.

A 10-year review of stones in children at the St. Louis University Hospitals is presented. Stones related to infection were seen most often and urinary diversion secondary to congenital abnormalities of the urinary tract was the most frequent predisposing cause. The morbidity of stones in children is high.     

Urolithiasis in children

Relying on experiences made in connection with 103 paediatric cases, urolithiasis is discussed with reference to age, sex, and site; the significance of obstructions to urine flow and their lithogenic effect is emphasized and also urogenital infections are discussed. Surgical treatment of these anomalies is dealt with in detail. Results of stone operations are compared and the incidence of recurrences is examined. Conclusions based on clinical observations are presented.     

Urolithiasis in children

Urinary tract calculi in children are rare in the United States, with an incidence of 1 to 4 per 1000 pediatric admissions. Primary and secondary calculi are different in causation, chemical composition, and prognosis, and must be considered separately. Review of the literature in the United States and England suggests that in 60 per cent of children, as in adults, no causation will be found. Our experience with twenty-five primary and twenty-five secondary calculi in a nonendemic area, however, shows only six truly idiopathic stones. Thorough urologic and metabolic evaluation has been rewarded with an appreciable yield of metabolic or structural abnormalities. Treatment consists of standard urologic management of stones, as well as specific therapy directed at the underlying causes.     

Urolithiasis in children

In general, the criteria for the treatment of urolithiasis in children are the same as those for adults. Today, extracorporeal shock wave lithotripsy (ESWL) is the method of choice in the treatment of most pediatric urinary stones. Stone-free rates between 67% and 93% at short-term follow-up, and 57% to 92% at long-term follow-up, have proven the efficacy of ESWL treatment in children. Nevertheless, the demand for auxiliary measures still remains. In order to achieve the most beneficial success rates under low complications, it is advisable to perform this type of ESWL in centers that claim the experience necessary for ESWL and endourological measures in children.     

微创经皮肾穿刺取石术52例报告

目的探讨微创经皮肾穿刺取石术 (minimally invasive percutaneous nephrolithotomy,MPCNL)的疗效.方法 52例肾或输尿管结石患者,在C形臂机和(或)B超定位下行MPCNL.结果除1例术中因肾盂穿孔转开放性手术外,Ⅰ期取净结石33例,l周后经造瘘管再行MPCNL取净结石15例,两次手术结石总取净率为92.3%,手术时间1.5～4 h,平均2.5 h.术中无输血.结论 MPCNL安全、疗效好,易在基层医院推广.     

Hypertension in Jordanian children: a retrospective analysis of 70 cases

Seventy patients, aged 1–20 years, were seen at Jordan University Hospital with high blood pressure (BP) over a 3-year period. BP values ranged from 140 to 230 mmHg for systolic pressure and from 90 to 130 mmHg for diastolic pressure. Essential hypertension was seen in only 6 patients (8.6%); secondary hypertension (n=64 or 91.4%) was due to renal parenchymal diseases (RPD) in 46 patients (65.7%), reno-vascular lesions in 8 (11.4%), renal transplantation in 5 (7.2%), teenage pregnancy in 4 (5.7%), and phaeochromocytoma in 1 patient (1.4%). The aetiologies of RPD were as follows: end-stage renal disease requiring dialysis in 14 patients, acute glomerulonephritis in 14, idiopathic nephrotic syndrome in 10, chronic renal insufficiency in 5, and polycystic kidney in 3 patients. Surgical cure of hypertension was achieved in 5 of the children with reno-vascular lesions and in the patient with phaeochromocytoma.     

睾丸微结石症52例报告

目的 探讨睾丸微结石症(testicular microlithiasis,TM)的临床特点.方法 对泌尿男科门诊患者行睾丸超声检查诊断TM 52例,患者主诉依次为不育24例(46.2%)、阴囊睾丸疼痛不适22例(42.3%)、性腺发育不良4例(7.7%)、性功能障碍和男性更年期综合征各1例;相关系统的疾病史依次为隐睾症、睾丸附睾炎、腮腺炎、肺结核病各4例(各占7.7%),睾丸外伤2例(3.8%),糖尿病、淋病各1例.结果 微结石表现为双侧睾丸同时发生者40例(76.9%),单侧者12例(23.1%)(右4、左8);结石数量5～10个17例(32.7%)、11～50个19例(36.5%)、≥51个16例(30.8%);结石呈均匀散在分布者46例(88.5%),不均匀分布者6例(11.5%);睾丸发育基本正常者32例(61.5%),伴发睾丸发育异常者20例(38.5%).精液分析42例,其中存在质量异常者37例(88.1%).37例测定生殖激素,5项指标中至少1项异常者19例(51.4%);其中11例行睾丸瘤标(β-HCG和AFP)检测均正常.对3例高度怀疑肿瘤患者进行活检病理诊断,确诊精原细胞瘤1例.结论 TM患者多因不育、阴囊睾丸疼痛不适、性腺发育不良或睾丸发育异常等就医,并经超声检查偶然获得诊断.结石特点多为双侧发生、分布均匀、数量有较大波动,对精液质量和内分泌激素水平有一定的不良影响,甚至可发生肿瘤.感染和损伤可能是其潜在病因.     

输尿管异位开口52例报告

目的　总结输尿管异位开口的诊治经验。　方法　对 5 2例输尿管异位开口患者临床表现、诊治方法进行回顾性分析。　结果　 5 2例患者B超检查 37例 ,IVU检查 4 5例 ,CT检查 8例 ,膀胱镜检逆行插管造影检查 18例。联合以上方法于术前确诊 4 9例 (94 .0 % )。 2 8例 (5 3.8% )患者行输尿管膀胱再植术 ,12例 (2 3.0 % )行单侧肾脏切除术 ,9例 (17.3% )行上半肾及输尿管切除术 ,1例行异位输尿管口囊肿单纯切开术。 4 2例随访 6个月～ 10年 (平均 3年 ) ,疗效满意。　结论　结合病史、体格检查和联合影像学检查 ,大多数输尿管异位开口可于术前确诊。输尿管膀胱再植术 ,上半肾和输尿管切除术及单侧肾脏切除术为有效的外科治疗方法     

Pilomatricoma: report of two cases in children.

Two children with pilomatricoma are reported. The characteristics of this benign tumor and general principles of treatment (surgical excision) are described.     

Systemic lupus erythematosus with nephritis in children. A report of 6 cases

Six children with systemic lupus erythematosus treated over the last 10 years are described. There are 3 boys and 3 girls and their ages at presentation ranged from 9.25 to 15 years; follow-up ranges from 11 months to 12 years. The modalities of treatment, methods of follow-up, and regular assessment of lupus activity are discussed with a brief review of the relevant literature. One patient has progressed to end-stage renal failure and is awaiting renal transplantation. Of the others, 2 have mild renal impairment and 3 have normal renal function. We believe that an aggressive therapeutic approach with meticulous follow-up can improve the outlook in children with this condition.     

Vertically transmitted HIV-1 infection in children. A report of 23 cases

Twenty-three children with vertically transmitted human immunodeficiency virus type 1 (HIV-1) infection were seen at Baragwanath Hospital between May 1989 and April 1990. There was a marked increase in the number of cases in 1990. Infected children presented at a median age of 6 months; most commonly with lymphadenopathy, failure to thrive and respiratory complications. Serious bacterial infections occurred in 39%. Reversed helper T- to suppressor T-cell ratios were present in all but 1 of 16 children tested and hypergammaglobulinaemia and anaemia (usually normocytic) were frequently present. Some of the children have already died and the outlook for the others is bleak. With the increase of HIV infection in the heterosexual population, increasing numbers of infected children can be expected.     

Pleuropericardial effusions in children with non-Hodgkin's lymphoma. A report of 2 cases

Two children with non-Hodgkin's lymphoma (NHL) who presented with pleuropericardial effusions are reported on. Pericardial effusions are very unusual in children with mediastinal nodal NHL. In the first patient, who presented with a pleural effusion and pericardial tamponade, the diagnosis of NHL was obscured by a false-positive report of acid-fast bacilli in the pleural fluid. The second patient presented with a pleural effusion and a pericardial effusion with superior vena cava obstruction. Rapid filling of the serous cavities was a striking feature in both cases. Cytological and biochemical investigation of the pleural fluid and pleural biopsy are of limited diagnostic value. Pleuropericardial effusions in NHL are reviewed. The patients have been in disease-free remission for 18 and 16 months respectively.     

Carotid body tumours. A review of 52 cases

During a 22-year period (1962-1984) 52 carotid body tumours were encountered in 50 patients. In addition, 2 of the patients had tumours of the glomus intravagale. One patient had a recurrent tumour, the first one having been removed 23 years previously. The ages ranged from 23 to 80 years, the female/male ratio was 2:1, and the right side was affected twice as often as the left. Four patients were treated non-surgically; 3 were too elderly and frail to undergo the operation and in the 4th case the tumour was considered inoperable. In 2 cases excision was attempted but abandoned for technical reasons. In the remaining 44 patients 46 tumours were excised, with grafting of the internal carotid artery in 6 cases. There were 2 deaths (4.5%), 1 after hemiplegia and 1 a pulmonary embolus. Eight patients were left with cranial nerve palsy, which had been present preoperatively in 5 cases. Of the tumours 7 (13.5%) were found to be malignant. The results of endocrine studies when undertaken were normal. Although ultrasonography and computed tomography were used in some cases, arteriography was the definitive mode of investigation.     

Urolithiasis in Tunisian children: a study of 120 cases based on stone composition

The composition of urinary stones in children depends on socioeconomic conditions and hygiene, geographical area, and dietary habits. We analyzed urinary stones from 120 consecutive Tunisian children (81 males, 39 females) aged 5 months to 15 years. The stone was located in the upper urinary tract in 91 cases (76%). Stone analysis included both a morphological examination and an infrared analysis of the nucleus and the inner and peripheral layers. The main components of bladder calculi were whewellite (69%) and struvite (22%), whereas the main component of upper urinary tract calculi was whewellite (67%). The nucleus of bladder stones was composed of ammonium urate (45%), struvite (28%), cystine (10%), and carbapatite (7%). The nucleus of kidney and ureteral calculi was mainly composed of ammonium urate (38%), whewellite (24%), carbapatite (13%), or struvite (11%). Based on stone composition, urinary tract infection was involved in the nucleation or growth of a third of calculi. Endemic urolithiasis involving simultaneous nutritional, metabolic, and infectious factors, and defined by its nucleus composed of ammonium urate without struvite, represented 40% of cases. Exclusive metabolic factors – including genetic diseases such as primary hyperoxaluria, cystinuria, and hypercalciuria – were responsible for less than 25% of cases. Received: 6 March 1998 / Revised: 22 March 1999 / Accepted: 22 March 1999