特发性腹膜后纤维化误诊为输尿管癌1 例报告并文献复习

目的:分析并掌握腹膜后纤维化的诊疗特点,避免对该病的误诊误治。方法:回顾性分析1例腹膜后纤维化患者分别因两侧肾积水先后两次住院并最终确诊的诊疗过程中的临床资料,包括临床表现、影像特点、病理结果、治疗方法及预后等,并结合相关文献进行复习。结果:患者因右肾积水首次入院诊断为右输尿管癌而行右侧肾输尿管切除术,后患者因左肾积水来我院住院诊断为腹膜后纤维化,行腹腔镜输尿管松解+腹腔内置术,术后长期随访疗效满意。结论:腹膜后纤维化作为一种少见病,缺乏对其认识极易导致误诊误治,掌握该疾病的临床特点及选择适宜的治疗方案,对本病的诊疗具有重要意义。     

Minimally invasive surgery via laparoscopy for intra-abdominal biopsy in obese rhesus macaques (Macaca mulatta)

PURPOSE: To determine the safety and effectiveness of laparoscopy for repeated intra-abdominal biopsy of liver and omental adipose tissue (AT) in obese rhesus monkeys (Macaca mulatta). METHODS: Nine obese rhesus monkeys were studied by use of 18 laparoscopic procedures (two procedures each, approx. six weeks apart). Time-sensitive liver and omental AT specimens were obtained from monkeys under general anesthesia, using a three-port approach with a roticulating endoscopic stapler/divider and a monopolar electrosurgery for hemostasis. RESULTS: All subjects tolerated the initial and repeat laparoscopic procedures well. Liver specimens weighed a mean +/- SEM of 3.8 +/- 0.5 g, and omental AT specimens weighed 16.6 +/- 0.8 g. Compared with previous studies of conventional laparotomy with liver wedge resection, the monkeys experienced faster postoperative recovery via laparoscopy, with rapid return to normal food intake and activity. Minimal to no adhesions were observed by use of the repeat procedure in all monkeys, with no major complications. CONCLUSIONS: Laparoscopy in obese rhesus monkey (ranging from young to older-aged), with repeated intra-abdominal liver and omental AT biopsy, was an excellent minimally invasive surgical method. In contrast to laparotomy with wedge resection, this approach greatly decreases operative time and stress, provides generous tissue specimens in a time-efficient manner, and facilitates rapid and full recovery of the nonhuman primate.     

Effect of acute and chronic renal denervation on renal function after release of unilateral ureteral obstruction in the rat.

The role of the renal nerves in determining renal function after relief of 24-h unilateral ureteral obstruction (UUO) was studied using clearance techniques in anaesthetized rats. Acute renal denervation during the first 1--2 h after relief of UUO resulted in a significant increase in glomerular filtration rate (GFR), renal plasma flow (RPF), urine flow, and sodium and potassium excretion, changes which were not seen in the sham-denervated postobstructive kidney. Acute denervation of sham-operated normal kidneys caused a similar natriuresis and diuresis but with no change in GFR or RPF. Chronic renal denervation 4--5 days before UUO denervated postobstructive controls, while chronic denervation alone was associated with a significantly higher urine flow and sodium excretion rate from the denervated kidney. The effectiveness of renal denervation was confirmed by demonstrating marked depletion of tissue catecholamines in the denervated kidney. It was concluded that renal nerve activity plays a significant but not a major role in the functional changes present after relief of UUO. Chronic renal denervation did not protect against the functional effects of unilateral ureteral obstruction.     

Free omental flap for partial breast reconstruction after breast-conserving surgery

Recent advances in endoscopic surgery have allowed laparoscopic harvesting of the omental flap with reduced donor-site morbidity and deformity. Between August of 2004 and May of 2010, the authors performed immediate breast reconstruction with the free omental flap in 10 breast cancer patients, employing it either as a pedicle flap or as a free flap for volume replacement. Only one complication occurred during the follow-up. Cosmetic results were mostly satisfactory. The free omental flap is a safe procedure with minimal donor-site morbidity and deformity and can be an additional option for immediate partial breast reconstruction after breast-conserving surgery. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.     

Changing patterns in iatrogenic ureteral injuries

Advances in laparoscopic and endoscopic surgery over the past 25 years have changed the preferred methods for performing many operations. We previously reported an increase in the number of patients treated for ureteral injury at our institution that paralleled the introduction of minimally invasive techniques. Since that report, more advanced endoscopic procedures have been introduced. We sought to determine whether the latter influenced the number of ureteral injuries managed at our institution. Reported here are the results of our retrospective study, which sought to determine if the rate of treatment of major iatrogenic ureteral injuries has changed.     

Metastatic transitional cell carcinoma causing a unilateral pleural effusion: a case report

BACKGROUND: Transitional cell carcinoma (TCC) is a common neoplasm, but it is only rarely associated with serous effusions. The cytologic features of metastatic TCC in pleural effusions have been described only in occasional studies. One feature that raises the possibility of metastatic TCC in this setting is the presence of eosinophilic cytoplasmic inclusions (ECIs). CASE: Metastatic TCC was diagnosed in a pleural fluid from a 50-year-old man with a unilateral effusion. Two years previously he had been diagnosed with a poorly differentiated TCC of the urinary bladder (WHO grade 3, stage pT2 at least), and more recently he had also been diagnosed with an omental metastasis. Cytologic examination of the pleural fluid sample revealed numerous pleomorphic malignant cells, many of which were vacuolated. Numerous eosinophilic inclusions were identified within the malignant cells in the liquid based cytology (ThinPrep) preparation. Examination of the omental cake biopsy revealed similar appearances. CONCLUSION: ECIs within malignant pleural effusion fluid specimens should, if detected, raise the possibility of metastatic transitional cell carcinoma.     

Captopril effect on prostaglandin E2, thromboxane B2 and proteinuria in lupus nephritis patients

OBJECTIVE: High urinary Prostaglandin E2 (PGE2) and thromboxane B2 (TxB2) levels have been reported in lupus nephritis (LN). Captopril diminishes proteinuria and improves glomerular filtration rate (GFR), and may have effect on immune function. We evaluate captopril effect on urinary PGE2, and TxB2. METHODS: Eighteen LN patients were randomly assigned to two groups. Group 1 received only prednisone plus cyclophosphamide. Group 2 received also captopril. Serum creatinine, GFR, RPF, urinary proteins, PGE2 and TxB2, were assessed. RESULTS: There were no differences between the initial and final assessments in Group 1. Group 2 showed a significant decrement in proteinuria (p=0.003) and serum creatinine (p=0.01) at the end of the study. PGE2 decreased significantly when compared with the initial value (p=0.02). CONCLUSION: Captopril plus usual treatment, improved serum creatinine and decreased proteinuria in parallel with prostaglandin E2 reduction. This effect is not related to changes in GFR or RPF. Captopril may have an immunomodulatory effect on local inflammatory processes in lupus nephritis.     

Use of laparoscopy in pediatric urology

The goal of laparoscopy is to minimize patient morbidity while maintaining successful outcomes. The use of laparoscopy in urology has grown significantly over the past 30 years. Its use has been slower to gain acceptance in pediatrics than in the adult population. Laparoscopic orchidopexies and nephrectomies are commonly performed and have become widely accepted as alternatives to open surgery, if not the gold standard. The more technically demanding procedures, such as laparoscopic pyeloplasty, laparoscopic-assisted bladder reconstruction, and laparoscopic ureteral reimplantation, tend to be performed at selected centers and have yet to achieve widespread acceptance. As laparoscopy is applied more widely in pediatric urology, its potential benefits and drawbacks will be clarified.     

Endothelial vasodilator production by uterine and systemic arteries. V. Effects of ovariectomy, the ovarian cycle, and pregnancy on prostacyclin synthase expression

Prostacyclin (PGI(2)) is a potent vasodilator, the level of which is increased during pregnancy, and is the main eicosanoid of which production is elevated in the endothelium and vascular smooth muscle (VSM) of both uterine and omental (systemic) arteries. We tested the hypothesis that during physiologic states that have high uterine blood flow, such as pregnancy and the follicular phase of the ovarian cycle (versus luteal phase and ovariectomized ewes), there is an increased level of prostacyclin synthase (PGIS) expression in ovine uterine and omental artery endothelium and VSM. To investigate this, the cellular localization and PGIS protein expression level in uterine and systemic arteries was examined by immunohistochemistry as well as by Western immunoblot analysis of endothelial-isolated protein and denuded vessels (VSM). Whole uterine, but not omental (systemic), arteries from the pregnant ewes showed an increase (P < 0.001) in PGIS expression. Further localization of PGIS protein by immunohistochemistry and quantification by Western analysis showed PGIS to be somewhat higher in the uterine artery VSM (69 +/- 7%) than endothelium (31 +/- 7%). PGIS protein levels in uterine and omental artery endothelial isolated protein were not altered by ovariectomy or the ovarian cycle, although they were both significantly elevated by pregnancy. Uterine and omental artery VSM PGIS expression levels also were not altered by ovariectomy or the ovarian cycle, whereas PGIS expression, in uterine but not omental artery VSM showed a significant elevation during pregnancy. Thus, the rise in PGI(2) production by uterine arteries observed in ovine pregnancy is paralleled by an elevation in PGIS expression in both endothelium and VSM, whereas those seen in omental arteries is associated with increases in endothelial PGIS.     

多层螺旋CT 对腹膜后纤维化的诊断价值

目的:评价MSCT对腹膜后纤维化的诊断价值。方法:回顾性分析经临床及手术、活检病理证实9例腹膜后纤维化患者的MSCT影像资料,分别由两名副主任医师采用盲法对RPF病变发生部位、病变范围、病灶形态、密度及与周围组织的解剖关系显示情况进行分析,所有病例均进行平扫及三期增强扫描,并进行平扫及增强后病变CT值测定。采用多平面重建(MPR)、曲面重建(CMPR)、容积重建(VR)及CT尿路造影(CTU)技术进行分析。结果:所有患者CT平扫表现为腹膜后不规则近似于肌肉密度的软组织病变,6例病灶边界清晰,3例边界不清。9例均不同程度包绕腹膜后大血管,8例始于肾门下方,一例累及十二指肠上动脉。9例均不同程度累及一侧或双侧输尿管,造成输尿管及肾盂扩张积水,输尿管管壁增厚。增强扫描7例有轻中度强化,2例强化不明显。结论:MSCT可以显示腹膜后纤维化的特征,MPR、CMPR、VR及CTU技术综合应用有利于明确病变部位、形态、范围及与周围组织的解剖关系,有利于提高该病的诊断准确率。     

The effect of nanoparticle size on endocytosis dynamics depends on membrane–nanoparticle interaction

Molecular simulation studies on the interaction between nanoparticles (NPs) and cell membranes have been limited by small NP size of several nanometres. In this work, by using a simplified lipid model, we study the endocytosis of large NPs with a size being enlarged to 37.5 nm. It is found that the effect of NP size on endocytosis dynamics depends on the membrane–NP interaction. As the interaction strength between NP and lipid changes, different wrapping modes are observed. For the system with weak membrane–NP attraction, the wrapping process is controlled by the membrane bending, and thus large size of NPs (within the range of NP size we studied) would promote the wrapping dynamics. While for the case with strong membrane–NP adhesion, the wrapping process is dominated by lipid diffusion and small NPs show a larger wrapping rate. In this wrapping mode, the membrane–NP adhesion drives small NPs to move towards the membrane as the wrapping process proceeds. For relatively larger NPs, however, the membrane moves towards the NPs instead. We also find that for the second wrapping mode, the rapid wrapping rate, especially with the hydrophobic ligands on the hydrophilic NP would impose significant perturbations on membrane stability, and consequently, membrane pores may be induced during the process of NP endocytosis.     

Technical modifications of double-J stenting for retroperitoneal laparoscopic dismembered pyeloplasty in children under 5 years old

Both antegrade stenting and retrograde stenting for retroperitoneal laparoscopic dismembered pyeloplasty in children have many disadvantages. In this work, we tried using an alternative technique of modified antegrade (MAG) double-J stenting for retroperitoneal laparoscopic dismembered pyeloplasty in children under 5 years old, analyzed our results using the conventional antegrade (CAG) and the MAG techniques of stent insertion for this procedure, and reported our experience with these techniques. Between December 2002 and July 2010, 77 children under 5 years old with ureteropelvic junction obstruction underwent retroperitoneal laparoscopic dismembered pyeloplasty. CAG and MAG double-J stenting were attempted, in the first 36 cases (mean age 27.1 months) and the following 41 cases (mean age 25.4 months), respectively. The stents were removed 4-6 weeks later via cystoscopy. Follow-up studies were performed with ultrasonography and intravenous urography at 3 and 12 months postoperatively. The results showed that successful stent placement without malpositioning was achieved in 31 of 36 (86%) and all 41 (100%) cases, in the CAG and MAG groups, respectively. The common factor of unsuccessful stent was the inability to across the ureterovesical junction. The mean stent insertion time was 10 min 54 s and 12 min 46 s in the CAG and MAG groups, respectively. The mean operating time was 176 min and 185 min in the CAG and MAG groups, respectively. No stent malpositioning occurred in the MAG group; in the CAG group, two children had a malpositioned stent in the distal ureter and one child presented with a severe hematuria. Twelve months follow-up showed no new onset of hydroureteronephrosis and hydronephrosis. Thus we concluded that the MAG double-J stenting seems more reliable than CAG stenting for retroperitoneal laparoscopic dismembered pyeloplasty in children under 5 years old, with greater success and lower complication rates.     

结核分枝杆菌Rv1009的生物信息学分析及克隆、表达

以往在对藤黄微球菌的研究中发现了促进复活因子(RPF),该因子可以有效促进休眠期的多种革兰氏阳性细菌复活和生长。生物信息学分析表明在多种革兰氏阳性细菌的基因组中均存在编码RPF样蛋白的基因。从GeneBank中获得了结核分枝杆菌、麻风分枝杆菌、谷氨酸棒杆菌和微链霉菌等革兰氏阳性细菌的多种RPF样蛋白相关信息,通过同源性分析发现这些蛋白均含有一个由75个氨基酸残基构成的高度保守序列,即RPF作用域。进一步对结核分枝杆菌H37Rv株的Rv1009进行了分析,并用PCR法克隆了其编码基因全长,定向克隆至pGEX 4T-2,在大肠杆菌BL21 (DE3)中获得了Rv1009-GST融合蛋白的高效表达,为深入探讨其生物学功能奠定了基础。     

Reverse plaque formation method for titration of non-cytopathogenic bovine viral diarrhea-mucosal disease virus

The reverse plaque formation (RPF) method with a semi-micro plate was applied to the titration of a non-cytopathogenic (non-CP) strain of bovine viral diarrhea-mucosal disease (BVD-MD) virus. All the five non-CP strains used in this experiment formed reverse plaques (RP) on bovine testicle cell culture under methyl cellulose overlay. The RPF was inhibited by the pretreatment of a non-CP virus strain with immune rabbit serum to a reference strain. The specificity of the RPF method was demonstrated by the linear test and Poisson distribution test. Comparative titration of commercial BVD-MD vaccines was carried out by the semi-micro RPF method and the tube method based on the exaltation on Newcastle disease virus. The virus titer obtained by the former was slightly higher than that obtained by the latter. The former was proved to be a method of high sensitivity for determining non-CP virus.     

Evaluation of a pour-plate system with a rabbit plasma-bovine fibrinogen agar for the enumeration of Staphylococcus aureus in food

Investigations were carried out concerning the selectivity and productivity of rabbit plasma fibrinogen (RPF) agar according to Beckers et al. (H. J. Beckers, F. M. van Leusden, W. M. Hogeboom, and E. H. M. Delfgou-van Asch. 1980. De Ware(n)-Chemicus, 10: 125-130). Its selectivity was compared with pork plasma fibrinogen (PPF) medium according to Hauschild et al. (A. H. W. Hauschild, C. E. Park, and R. Hilsheimer. 1979. Can. J. Microbiol. 25: 1052-1057) and its productivity was compared with PPF medium and Baird-Parker's egg yolk tellurite glycine pyruvate (ETGP) agar. In total 139 samples of naturally contaminated foodstuffs were examined. RPF agar scored higher than ETGP agar; although only small (mean value of differences 0.09 log units), the differences were statistically significant. While no significant differences in sensitivity between RPF agar and PPF medium were encountered, RPF agar was statistically more selective than PPF medium. It is concluded that RPF agar is very suitable for the enumeration of Staphyloccus aureus in foods.     

Innervation of human omental arteries and veins and vasomotor response to noradrenaline, neuropeptide Y, substance P and vasoactive intestinal peptide

Human omental arteries and veins are supplied with nerve fibers containing noradrenaline (NA) and neuropeptide Y (NPY); these two agents probably co-exist in perivascular sympathetic nerve fibers. Substance P (SP)- or vasoactive intestinal peptide (VIP)-containing fibers could not be detected. In studies on isolated omental vessels NA produced constriction. The results of blockade experiments suggest that human omental arteries are equipped predominantly with alpha 1-adrenoceptors and omental veins with a mixture of alpha 1- and alpha 2-adrenoceptors. NPY at a concentration of 10(-7) M or higher had a weak contractile effect on veins and virtually no effect on arteries. NPY at a concentration of 3 X 10(-8) M shifted the NA concentration response curve to the left in arteries (pD2 = 5.8 for NA versus 6.6. for NA in the presence of NPY; P less than 0.001) but not in veins. Both SP and VIP relaxed arteries precontracted with NA or prostaglandin F2 alpha (PGF2 alpha). The potency of SP as a relaxant agent was similar in arteries and veins; the effect of VIP was elicited at lower concentrations in veins than in arteries.     

Primary retroperitoneal carcinosarcoma in a child: a case report

Background

Lymphadenectomy is an integral part of the staging system of epithelial ovarian cancer. However, the extent of lymphadenectomy in the early stages of ovarian cancer is controversial. The objective of this study was to identify the lymph node involvement in unilateral epithelial ovarian cancer apparently confined to the one ovary (clinical stage Ia).

Methods

A prospective study of clinical stage I ovarian cancer patients is presented. Patient's characteristics and tumor histopathology were the variables evaluated.

Results

Thirty three ovarian cancer patients with intact ovarian capsule were evaluated. Intraoperatively, neither of the patients had surface involvement, adhesions, ascites or palpable lymph nodes (supposed to be clinical stage Ia). The mean age of the study group was 55.3 ± 11.8. All patients were surgically staged and have undergone a systematic pelvic and paraaortic lymphadenectomy. Final surgicopathologic reports revealed capsular involvement in seven patients (21.2%), contralateral ovarian involvement in two (6%) and omental metastasis in one (3%) patient. There were two patients (6%) with lymph node involvement. One of the two lymph node metastasis was solely in paraaortic node and the other metastasis was in ipsilateral pelvic lymph node. Ovarian capsule was intact in all of the patients with lymph node involvement and the tumor was grade 3.

Conclusion

In clinical stage Ia ovarian cancer patients, there may be a risk of paraaortic and pelvic lymph node metastasis. Further studies with larger sample size are needed for an exact conclusion.     

Effects of taurolidine and octreotide on tumor growth and lipid peroxidation after staging-laparoscopy in ductal pancreatic cancer

Irrigation with taurolidine after laparoscopy decreases tumor growth in colon carcinoma. In pancreatic cancer subcutaneous therapy with octreotide decreases oxidative stress and carcinogenesis as well. However, it is still unclear, whether irrigation with taurolidine or octreotide after laparoscopic pancreatic biopsy reduces tumor growth in pancreatic cancer as well. In 60 Syrian hamsters ductal pancreatic adenocarcinoma was induced by weekly injection of 10mg/kg body weight N-nitrosobis-2-oxopropylamine s.c. for 10 weeks. In week 16 laparoscopic pancreatic biopsy by use of carbon dioxide was performed (gr. 1, n = 20) with subsequent laparoscopic irrigation with taurolidine (gr. 2, n = 20) or octreotide (gr. 3, n = 20). In week 25 hamsters were sacrificed. Our results show that macroscopic visible primary tumors were found in only one animal of the taurolidine group (5.9%), compared to 42.1% in the saline and 62.5% in the octreotide group (P<0.05). Carcinomas were smaller after saline (6+/-23 mm(2)) than after octreotide irrigation (70+/-120 mm(2), P<0.05). In conclusion this study showed that laparoscopic irrigation with taurolidine after pancreatic biopsy inhibited tumor growth in ductal pancreatic adenocarcinoma.     

Ca2+ antagonists and db-cAMP sustain a rise in renal blood flow induced by acetylcholine in indomethacin-treated dogs

Renal arterial infusion of acetylcholine (ACh) in the dog normally produces a sustained rise in sodium excretion (UNaV) and in renal plasma flow (RPF). When prostaglandin (PG) synthesis is inhibited, ACh induces only a transient increase in UNaV and RPF followed by a progressive decline in UNaV and RPF, and a rise in renin secretory rate (RSR). Renal arterial infusion of PGE2 but not a vasodilator such as bradykinin restored the response to ACh to normal in indomethacin (Indo)-treated dogs. During renal arterial infusion of dibutyryl cyclic AMP (6 mg/min), ACh also produced a sustained increase in UNaV and RPF despite an inhibition of PG synthesis by Indo. Renal arterial infusion of verapamil (60 micrograms/min) or diltiazem (60 micrograms/min) also prevented the subsequent fall in RPF when ACh was infused; RSR, however, did not show a rise. The results suggest that synthesis of PGE2 with stimulation of cAMP is required for sustained ACh action. When PGE synthesis is inhibited, ACh may produce renal vasoconstriction by increasing intracellular Ca2+ concentration. The partial effect of calcium channel blockers suggests that release of calcium from intracellular stores as well as calcium entry may mediate the response.