犬尿石症的诊治

犬作为宠物,随着经济的发展,其饮食水准也越来越高,但是由于饮食结构的不很合理导致犬的泌尿道疾病尤其尿石症发病率大幅提高.患犬常表现尿急、尿频、血尿、排尿困难或尿闭,若不出现症状,尿石症可长期存在而不被发现.本病多发于5岁以上的中老年犬.在南京某宠物医院2005年1～3月间有6例患犬接受治疗,2例尿结石,1例肾结石及3例膀胱结石.现就该6例尿石症患犬的症状、诊断、治疗以及预后进行分析总结.

益肾通淋溶石排石法治疗尿石症137例

尿石症是临床上多发病和常见病。我们从1989年以来,应用益肾通淋、溶石排石的方法治疗尿石症137例,收到较好效果,报道如下。临床资料1、一般情况:男性92例,女性45例;最大年龄63岁,最小21岁,其中26岁～45岁106例。肾结石44例,输尿管结石93例;

Preoperative CT radiomics models for predicting composition of in vivo urinary calculi

Objective To observe the value of preoperative CT radiomics models for predicting composition of in vivo urinary calculi.Methods Totally 543 urolithiasis patients were retrospectively enrolled and divided into calcium oxalate monohydrate stone group(group A,n=373),anhydrous uric acid stone group(group B,n=86),carbonate apatite group(group C,n=30),ammonium urate stone group(group D,n=28)and ammonium magnesium phosphate hexahydrate stone group(group E,n=26)according to the composition of calculi,also divided into training set and test set at the ratio of 7∶3.Radiomics features were extracted and screened based on plain CT images of urinary system.Five binary task models(model A—E corresponding to group A—E)and a quinary task model were constructed using least absolute shrinkage and selection operator algorithm for predicting the composition of calculi in vivo.Then receiver operating characteristic curves were drawn,and the area under the curves(AUC)were calculated to evaluate the predictive efficacy of binary task models,while the accuracy,precision,recall and F1 score were used to evaluate the predictive efficacy of the quinary task model.Results All binary task models had good efficacy for predicting the composition of urinary calculi in vivo,with AUC of 0.860—0.948 in training set and of 0.856—0.933 in test set.The accuracy,precision,recall and F1 score of the quinary task model for predicting the composition of in vivo urinary calculi was 82.25%,83.79%,46.23%and 0.596 in training set,respectively,while was 80.63%,75.26%,43.48%and 0.551 in test set,respectively.Conclusion Binary task radiomics models based on preoperative plain CT had good efficacy for predicting the composition of in vivo urinary calculi,while the quinary task radiomics model had high accuracy but relatively poor stability.

Progress on the Causes and Current Status of Canine Urolithiasis

Canine urolithiasis is a common disease of the urinary system, referring to the hemorrhage, inflammation and stagnation of the urinary tract caused by the mineral congelation centered with the dediduous epithelial cel s and other foreign matters surrounded by the salt crystal ization from the urine when the in the case of mineral metabolism disorder of canine. ln this paper, the causes, classification, treatment and prevention of canine urolithiasis were reviewed.

A population-based follow-up study on gallstone disease among type 2 diabetics in Kinmen,Taiwan

AIM： To assess the incidence of and risk factors for gallstone disease （GSD） among type 2 diabetics in Kinmen, Taiwan. METHODS： A screening program for GSD was performed by two specialists who employed real-time abdominal ultrasound to examine the abdominal region after patients had fasted for at least eight hours. Screening, which was conducted in 2001, involved 848 patients diagnosed with type 2 diabetes. After exclusion of 63 subjects with prevalent GSD, 377 participants without GSD were invited in 2002 for a second round of screening. A total of 281 （74.5%） subjects were re-examined. RESULTS： Among the 281 type 2 diabetics who had no GSD at the first screening, 10 had developed GSD by 2002. The incidence was 3.56% per year （95%CI： 1.78% per year-6.24% per year）. Using a Cox regression model, age （RR = 1.07, 95% CI： 1.00-1.14）, waist circumference （RR = 1.12, 95% CI： 1.01-1.29）, and ALT （RR = 1.13, 95%CI： 1.01-1.26） appeared to be significantly correlated with development of GSD. CONCLUSION： Older age is a known risk factor for the development of GSD. Our study shows that greater waist circumference and elevated ALT levels are also associated with the development of GSD among type 2 diabetics in Kinmen.

Urolithiasis in inflammatory bowel disease and bariatric surgery

AIM To analyse current literature focusing on pathogenesis and therapeutic aspects of urolithiasis with inflammatory bowel disease(IBD) and following bariatric surgery. METHODS A systematic literature search was performed using PubMed, supplemented with additional references. Studies assessing the association of IBD or bariatric surgery with renal stones in both paediatric and adulthood were included. RESULTS Certain types of stones are seen more frequently with IBD. Hyperoxaluria and hypocitraturia are the main metabolic changes responsible for urolithiasis. The incidence of renal stones in malabsorptive types of bariatric surgery such as gastric bypass is high; this is not as common in modern restrictive surgical methods. Preventative methods and urine alkalinisation have been shown to be beneficial.CONCLUSION Both conditions are associated with renal stones. Patients' counselling and prevention strategies are the mainstay of urolithiasis management in these patients.

Cholelithiasis associated with haemolytic-uraemic syndrome

Cholelithiasis occurs infrequently in the paediatric age group. Hereditary spherocytosis, sickle cell anaemia and thalassemia are the haemolytic disorders most commonly associated with development of gall stones in paediatric age group. The question is whether an isolated episode of haemolysis can cause gallstones.

Bone disease in pediatric idiopathic hypercalciuria

Idiopathic hypercalciuria （IH） is the leading metabolic risk factor for urolithiasis and affects all age groups without gender or race predominance. IH has a high morbidity with or without lithiasis and reduced bone mineral density （BMD）, as described previously in pe-diatric patients as well as in adults. The pathogenesis of IH is complex and not completely understood, given that urinary excretion of calcium is the end result of an interplay between three organs （gut, bone and kidney）, which is further orchestrated by hormones, such as 1,25 dihydroxyvitamin D, parathyroid hormone, calcitonin and fosfatonins （i.e., fbroblast growth-factor-23）. Usu-ally, a primary defect in one organ induces compensa-tory mechanisms in the remaining two organs, such as increased absorption of calcium in the gut secondary toa primary renal loss. Thus, IH is a systemic abnormality of calcium homeostasis with changes in cellular trans-port of this ion in intestines, kidneys and bones. Re-duced BMD has been demonstrated in pediatric patients diagnosed with IH. However, the precise mechanisms of bone loss or failure of adequate bone mass gain are still unknown. The largest accumulation of bone mass occurs during childhood and adolescence, peaking atthe end of the second decade of life. This accumulation should occur without interference to achieve the peak of optimal bone mass. Any interference may be a risk factor for the reduction of bone mass with increased risk of fractures in adulthood. This review will address the pathogenesis of IH and its consequence in bone mass.

Anterior myocardial pseudoinfarction in a patient with diabetic ketoacidosis

Diabetic ketoacidosis remains one of the most serious complications of diabetes mellitus. Among its precipitating factors is myocardial ischemia, responsible for 1% of the cases of diabetic ketoacidosis.Ell Diabetic ketoacidosis both with and without hyperkalemia has been reported to mimic a myocardial infarction pattem on ECG with ST segment elevation, described as pseudoinfarction pattern. Thus, it is important to raise awareness among physicians, as subjecting patients to invasive medical management can be avoided. We present a case of a 47-year-old female with diabetic ketoacidosis and hyperkalemia with initial ECG findings of ST segment elevation, but an urgent left heart catheterization revealed non-obstructive coronary disease.

Risk factors for anastomotic leakage after low anterior resection without diversional stomas

Objective The most important complication after low anterior resection(LAR) for mid-low rectal cancer is symptomatic anastomotic leakage(AL). More than one-third of patients with rectal cancer who underwent LAR will have functional stomas during primary operation. The aim of this retrospective study was to evaluate the risk factors associated with clinical AL following LAR without diversional stomas.Methods Between 2012 and 2017, information about 578 consecutive patients with rectal tumors less than 12 cm from the anal verge who underwent LAR without diversional stomas by the same surgical team was collected retrospectively. A standardized extraperitonealized anastomosis and pelvic drainage were conducted for all patients during primary operations, and the outcome of interest was clinical AL. The associations between AL and 14 patient-related and surgical variables were examined by both univariate chi-square test and multivariate logistic regression analysis.Results The AL rate was 7.27%(42 of 578). Univariate and multivariate analyses showed that male sex(P = 0.018), mid-low rectal cancer(located 10 cm or less above the anal verge)(P = 0.041), presence of diabetes(odds ratio = 2.117), longer duration of operation(odds ratio = 1.890), and intraoperative contamination(odds ratio = 2.163) were risk factors of AL for LAR without diversional stoma and independently predictive of clinical AL. Nearly 83.3%(35 of 42) of leakage could be cured by persistent pelvic irrigation-suction-drainage without surgical intervention. Only 7 patients(16.7%) with severe complications, such as peritonitis, and fistula, required reoperation, and functional stoma was used as a salvage treatment.Conclusion From the findings of this retrospective survey, we identified that mid-low rectal cancer and male sex were independent risk factors for developing clinical AL after LAR without diversional stomas, as well as longer duration of operation, presence of diabetes, and contamination of the operative field. Moreover, we deemed that LAR without diversional stomas for mid-low rectal cancers was safe, effective, and feasible. Extraperitonealized anastomosis and pelvic drainage obtained a relatively low rate of AL and avoided unnecessary functional stomas. Pelvic irrigation-suction-drainage was an effective procedure to resolve AL, and functional stoma was potentially used as a salvage modality for serious leakage.