胆石病从肝虚论治探析

认为肝脏自身虚损是胆石病发生发展的重要因素。提出胆石病病发在胆，病源在肝，应无石先防，有石治本。治石当有补肝一法，并从补气益肝、养血柔肝、养阴滋肝。

说“商”

商族自称其国族为“商”,称都邑为“大邑商”。商字从■、■,是其基本构形。■为铜凿类工具的象形,■乃二石叠合之形表多石。则“商”字本义会以凿采石加工石器之意,用指擅长石器制造业的族群。商族使用的青铜工具恰以凿类为主,是殷商文化的一个特征。商族特别喜欢各种大理石制品,是殷商文化与夏、周文化的不同之处。商族擅长玉石加工业,在殷墟分布着众多玉石手工业作坊遗存和玉石手工业者墓葬。甚至在王族居住地,也有大量玉石手工业遗迹遗物,表明玉石加工业是商族的主要生业。

观《削觚庐印存》里的吴昌硕“治邱晓石云圈”

吴昌硕以其融诗书画印于一体的艺术成就矗立于中国近代艺术之林。而吴昌硕的人生经历、交游方式、个人性情,无疑是他取得艺术成就的重要因素。本文以吴昌硕的《削觚庐印存》为例,探究中年吴昌硕的治石交友范围,以期更加全面地了解吴昌硕其人、其事以及他在那个时代的影响。

Influence of Marine Oil Pollution and Countermeasures

In the article, status quo of oil pollution in China＇s offshore area was in- troduced, and the sources of oil pollution in the ocean were analyzed. Furthermore, the possible hazards of marine oil pollution were discussed and related countermea- sures were proposed, including implementation of laws and regulations, enhancing awareness of environment protection, improvement of pollution monitoring and early warning mechanism, physical treatment, chemical treatment and biological treatment. With economy development, the demand of oil is increasing accordingly. Hence, oil pollution has become an urgent issue to be solved for better exploration of oil and protection of marine environment.

Clinical usefulness of transpapillary removal of common bile duct stones by frequency doubled double pulse Nd:YAG laser

AIM: To study the efficacy and the safety of laser lithotripsy without direct visual control by using a balloon catheter in patients with bile duct stones that could not be extracted by standard technique. METHODS: The seventeen patients (7 male and 10 female; mean age 67.8 years) with difficult common bile duct (CBD) stones were not amenable for conventional endoscopic maneuvers such as sphincterotomy and mechanical lithotripsy were included in this study. Laser wavelengths of 532 nm and 1064 nm as a double pulse were applied with pulse energy of 120 mJ. The laser fiber was advanced under fluoroscopic control through the ERCP balloon catheter. Laser lithotripsy was continued until the fragment size seemed to be less than 10 mm. Endoscopic extraction of the stones and fragments was performed with the use of the Dormia basket and balloon catheter. RESULTS: Bile duct clearance was achieved in 15 of 17 patients (88%). The mean number of treatment sessions was 1.7 ± 0.6. Endoscopic stone removal could not be achieved in 2 patients (7%). Adverse effects were noted in three patients (hemobilia, pancreatitis, and cholangitis). CONCLUSION: The Frequency Doubled Double Pulse Nd:YAG (FREDDY) laser may be an effective and safe technique in treatment of difficult bile duct stones.

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.

Giant choledocholithiasis treated by mechanical lithotripsy using a gastric bezoar basket

Mechanical lithotripsy （ML） is usually considered as a standard treatment option for large bile duct stones. However, it is impossible to retrieve oversized stones because the conventional lithotripsy basket may not be able to grasp the stone. However, there is no es- tablished endoscopic extraction method for such gi- ant stone removal. We describe a case of successful extraction of a 4-cm large stone using a gastric bezoar basket. A 78-year-old woman had suffered from upper abdominal pain for 20 d. Contrast-enhanced computed tomogram revealed a 4-cm single stone in the distal common bile duct （CBD）. Endoscopic stone retraction was decided upon and endoscopic papillary balloon dilation was performed using a large balloon. An at- tempt to capture the stone using a standard lithotripsy basket failed due to the large stone size. Subsequently, we used a gastric bezoar basket to successfully capturethe stone. The stone was fragmented into small pieces and extracted. The stone was completely removed after two sessions of endoscopic retrograde cholangio- pancreatography; each of which took 30 rain. No com- plications occurred during or after the procedure. The patient was fully recovered and discharged on day 11 of hospitalization. ML using a gastric bezoar basket is a safe and effective retrieval method in select cases, and is considered as an alternative nonoperative option for the management of difficult CBD stones.

Hepaticojejunostomy for hepatolithiasis: A critical appraisal

AIM： To evaluate the long-term outcome and surgical indications of hepaticojejunostomy （H J） for the treatment of hepatolithiasis. METHODS- Three hundred and fourteen elective cases with hepatolithiasis but without biliary stricture or cystic dilatation treated in the past 10 years were reviewed retrospectively. The patients were divided into HJ group and T tube drainage group according to biliary drainage procedure. Furthermore, four subgroups were subdivided by hepatectomy as a balance factor, group A1： hepatectomy＋HJ; group A2： choledochoctomy＋HJ; group B1： hepatectomy ＋ choledochoctomy T tube drainage; group B2： choledochoctomy ＋ T tube drainage. The stone residual rate, surgical efficacy and long-term outcome were compared among different procedures. RESULTS： There was no surgical mortality among all patients. The total hospital mortality was 1.6%. The overall stone residual rate after surgical clearance was 25.9%. There was no statistical difference between HJ group and T tube drainage group in terms of stone residual rate after surgical clearance, however, after postoperative choledochoscopic lithotripsy, the total stone residual rate of T tube drainage group was significantly lower than that of HJ group （0.5% vs 16.7%, P 〈 0.01）. Hepatectomy ＋ choledochoctomy tube drainage achieved the optimal therapeutic effect, only 8.2% patients suffered from an attack of cholangitis postoperatively, which was significantly lower than that of hepatectomy ＋ HJ （8.2% vs 22.0%, P = 0.034）. The major reason for postoperative cholangitis was stone residual in the HJ group （16/23, 70.0%）, and stone recurrence in the T tube drainage group （34/35, 97.1%）. The operative times were significantly prolonged in those undergoing HJ, and the operative morbidity of HJ was higher than those of T tube drainage. CONCLUSION： The treatment result of HJ for hepatolithiasis is not satisfactory in this retrospective study due to high rate of stone residual and postoperative cholangi- tis. HJ could not drain residual stone effectively. HJ may hinder post-operative choledochoscopic lithotripsy, which is the optimal management for postoperative residual stone. The indications of HJ for hepatolithiasis should be strictly selected.

Ursodeoxycholic acid improves gastrointestinal motility defects in gallstone patients

AIM: To simultaneously evaluate the presence of defects in gallbladder and gastric emptying, as well as in intestinal transit in gallstone patients (GS) and the effect of chronic ursodeoxycholic acid (UDCA) administration on these parameters and on serum bile acids and clinical outcome in GS and controls (CTR). METHODS: After a standard liquid test meal, gallbla-dder and gastric emptying (by ultrasound), oroileal transit time (OITT) (by an immunoenzymatic technique) and serum bile acids (by HPLC) were evaluated before and after 3 mo of UDCA (12 mg/kg bw/d) or placebo administration in 10 symptomatic GS and 10 matched healthy CTR. RESULTS: OITT was longer in GS than in CTR (P < 0.0001); UDCA significantly reduced OITT in GS (P < 0.0001), but not in CTR. GS had longer gastric half-emptying time (t1/2) than CTR (P < 0.0044) at baseline; after UDCA, t1/2 significantly decreased (P < 0.006) in GS but not in CTR. Placebo administration had no effect on gastric emptying and intestinal transit in both GS and CTR. CONCLUSION: The gallstone patient has simultaneous multiple impairments of gallbladder and gastric emptying, as well as of intestinal transit. UDCA administration restores these defects in GS, without any effect in CTR. These results confirm the pathogenetic role of gastrointestinal motility in gallstone disease and suggest an additional mechanism of action for UDCA in reducing bile cholesterol supersaturation.

Appropriate kidney stone size for ureteroscopic lithotripsy:When to switch to a percutaneous approach

Flexible ureteroscopy(f URS) has become a more effective and safer treatment for whole upper urinary tract stones. Percutaneous nephrolithotomy(PNL) is currently the first-line recommended treatment for large kidney stones ≥ 20 mm and it has an excellent stone-free rate for large kidney stones. However, its invasiveness is not negligible considering its major complication rates. Staged f URS is a practical treatmentfor such large kidney stones because f URS has a minimal blood transfusion risk, short hospitalization and few restrictions on daily routines. However, as the stone size becomes larger, the stone-free rate decreases, and the number of operations required increases. Therefore, in our opinion, staged f URS is a practical option for kidney stones 20 to 40 mm. Miniaturized PNL combined with f URS should be considered to be a preferred option for stones larger than 40 mm. Moreover, URS is an effective treatment for multiple upper urinary tract stones. Especially for patients with a stone burden < 20 mm, URS is a favorable option that promises a high stone-free rate after a single session either unilaterally or bilaterally. However, for patients with a stone burden ≥ 20 mm, a staged operation should be considered to achieve stone-free status.

Therapy and Prevention of Postoperative Urosepsis of Ureter Endoscopic Lithotripsy for "Non-infection"

Objective To analyze the risk factors causing postoperative urosepsis in ureter endoscopic lithotripsy without infection preoperatively,in order to make a more effective and safer preventive and therapeutic strategy.Methods From January 2010 to January 2015,5 ureteral calculus patients undergoing ureter endoscopic lithotripsy with holmium laser were retrospectively enrolled in this clinical study.These patients suffered urosepsis postoperatively confirmed by the clinical presentations and laboratory results,while they had no infection in their blood and urine preoperatively.Without delay,5 patients were treated by anti-inflammation and anti-shock.Results The vasopressor drug was stopped gradually after 12-36 hours.The body temperature was recovered to normal in 2 or 3 days,and the blood and urine test results were not abnormal in 7 days.At last,5patients were all cured.Conclusions Stone and operation themselves are potential factors to cause urosepsis after ureter endoscopic lithotripsy.Especially for patients who had not presented infection preoperatively,careful preparation preoperatively,corrective manipulation,low pressure irrigation,drainage and controlling time during operation,and early diagnosis,appropriate treatment postoperatively are the key to cure and prevent urosepsis.

Favorable outcomes of hilar duct oriented hepatic resection for high grade Tsunoda type hepatolithiasis

AIM： To evaluate the efficacy of hilar duct oriented hepatectomy for intractable hepatolithiasis, the ventral hilum exposure （VHE） method that has been applied by the authors. METHODS： From June 1994 to June 2004 for a period of 10 years, 153 patients who had Tsunoda type Ⅲ or Ⅳ hepatolithiasis, received hepatectomy at our institution. Among these patients, 128 who underwent hepatectomy by the VHE method were the subjects for the study. We analyzed the risk of this procedure, residual rate of intrahepatic stones, and stone recurrent rates. RESULTS： The average age was 54.2 years, and the male to female ratio was 1：1.7. The average follow-up period was 25.6 mo （6-114 too）. There was no postoperative severe complication or mortality after the operation. The rate of residual stones was 5.4% and the rate of recurrent stones was 4.2%. CONCLUSION： VHE is a safe surgical procedure and provides favorable treatment results of intractable hepatolithiasis. Especially, this procedure has advantage in that intra-hepatic bile duct stricture may be confirmed and corrected directly during surgery.

Percutaneous nephrolithotomy in pediatric age group:Assessment of effectiveness and complications

Management of kidney stone disease in pediatric population is a challenging condition in urology practice. While the incidence of kidney stone is increasing in those group, technological innovations have conrtibuted to the development of minimally invasive treatment of urinary stone disease such as mini-percutenous nephrolitotomy(mini-PCNL), micro-PCNL, ultra mini-PCNL. In this review we tried to evaluate the effect of new teratment techniques on pediatric kidney stones.

Medical and alternative therapies in urinary tract stone disease

Nephrolithiasis is a serious problem for both patients and the health system. Recurrence stands out as a significant problem in urinary system stone disease, the prevalence of which is increasing gradually. If recurrence is not prevented, patients may go through recurrent operations due to nephrolithiasis. While classical therapeutic options are available for all stone types, the number of randomized controlled studies and extensive meta-analyses focusing on their effciency are inadequate. Various alternative therapeutic options to these medical therapies also stand out in recent years. The etiology of urolithiasis is multifactorial and not always related to nutritional factors. Nutrition therapy seems to be useful, either along with pharmacological therapy or as a monotherapy. General nutrition guide-lines are useful in promoting public health and deve-loping nutrition plans that reduce the risk or attenuate the effects of diseases affected by nutrition. Nutrition therapy involves the evaluation of a patient’s nutritional state and intake, the diagnosis of nutrition risk factors, and the organization and application of a nutrition program. The main target is the reduction or prevention of calculus formation and growth via decreasing litho-genic risk factors and increasing lithogenic inhibitors in urine. This review focuses briefly on classical medical therapy, along with alternative options, related diets, and medical expulsive therapy.

Nephropathy in dietary hyperoxaluria:A potentially preventable acute or chronic kidney disease

Hyperoxaluria can cause not only nephrolithiasis and nephrocalcinosis,but also renal parenchymal disease histologically characterized by deposition of calcium oxalate crystals throughout the renal parenchyma,profound tubular damage and interstitial inflammation and fibrosis.Hyperoxaluric nephropathy presents clinically as acute or chronic renal failure that may progress to endstage renal disease(ESRD).This sequence of events,well recognized in the past in primary and enteric hyperoxalurias,has also been documented in a few cases of dietary hyperoxaluria.Estimates of oxalate intake in patients with chronic dietary hyperoxaluria who developed chronic kidney disease or ESRD were comparable to the reported average oxalate content of the diets of certain populations worldwide,thus raising the question whether dietary hyperoxaluria is a primary cause of ESRD in these regions.Studies addressing this question have the potential of improving population health and should be undertaken,alongside ongoing studies which are yielding fresh insights into the mechanisms of intestinal absorption and renal excretion of oxalate,and into the mechanisms of development of oxalate-induced renal parenchymal disease.Novel preventive and therapeutic strategies for treating all types of hyperoxaluria are expected to develop from these studies.

Urinary stone disease and obesity: Different pathologies sharing common biochemical mechanisms

The prevalence of urolithiasis is increasing in parallel with the escalating rate of obesity worldwide. It has previously been speculated that obesity is a potential risk factor for urinary stone disease. The possibility that common biochemical mechanisms underlie both obesity and urolithiasis is remarkable. Better understanding of possible common mechanisms of these diseases could potentially lead to a better management of urinary stone prevention. The prevention of urinary stone for-mation gives clinicians an acceptable reason to encour-age lifestyle modification and weight loss through a regular diet. In this review, the association of obesity with urinary stone disease, possible common biochemi-cal mechanisms, effects of dietary habits and weight loss on stone formation, as well as diffculties in surgi-cal management of obese individuals with urolithiasis are discussed.

Determination of chemical composition of gall bladder stones:Basis for treatment strategies in patients from Yaounde,Cameroon

AIM:Gallstone disease is increasing in sub-saharan Africa (SSA).In the west, the majority of stones can be dissolved with bile salts,since the major component is cholesterol.This medical therapy is expensive and not readily accessible to poor populations of SSA.It was therefore necessary to analyze the chemical composition of biliary stones in a group of patients,so as to make the case for introducing bile salt therapy in SSA.METHODS: All patients with symptomatic gallstones were recruited in the study. All stones removed during cholecystectomy were sent to Houston for x-ray diffraction analysis.Data on age, sex, serum cholesterol,and thepercentage by weight of cholesterol, calcium carbonate, and amorphous material in each stone was entered into a preestablished proforma. Frequencies of the major components of the stones were determined.RESULTS:Sixteen women and ten men aged between 27 and 73 (mean 44.9) years provided stones for the study.The majority of patients (65.38%) had stones with less than 25% of cholesterol.Amorphous material made up more than 50% and 100% of stones from 16 (61.53%) and 9 (34.61%) patients respectively.CONCLUSION:Cholesterol is present in small amounts in a minority of gallstones in Yaounde. Dissolution of gallstones with bile salts is unlikely to be successful.

Laparoscopic cholecystectomy in a patient with situs inversus totalis

Currently, laparoscopic cholecystectomy is an undoubtfully optimal treatment of cholelithiasis. What about performing this procedure on a patient with situs inversus totalis and what are the difficulties of this operation for a right-handed surgeon? We presented a 35-year-old man with unknown situs inversus totalis who was admitted with epigastric pain and digestive problems. Ultrasonography and computed tomography of the abdomen confirmed the diagnosis of a gallstone. Besides, the liver and gallbladder were on the left side and the spleen was on the right. All systems were left-right reversal as mirror image in all diagnostic studies. Laparoscopic cholecystectomy was safely performed, despite of difficulties of situs inversus. The patient was discharged on postoperative day 1. It should be considered that existence of other anomalies may easily cause uninvited injuries. In the patients with situs inversus, laparoscopic cholecystectomy can be safely managed by an experienced surgeon through laparoscopy, and also hepatobiliary surgery.

How botulinum toxin in neurogenic detrusor overactivity can reduce upper urinary tract damage?

Intradetrusor injections of botulinum toxin are the cornerstone of medical treatment of neurogenic detrusor overactivity. The primary aim of this treatment is to ensure a low pressure regimen in the urinary bladder, but the mechanisms leading to long-term protection of the urinary tract remain poorly understood. In this paper, we highlight the potential benefts of intradetrusor injections of botulinum toxin regarding local effects on the bladder structures, urinary tract infections, stone disease, vesico ureteral refux, hydronephrosis, renal function based on a comprehensive literature review.

Experimental models of renal calcium stones in rodents

In human nephrolithiasis, most stones are containing calcium and are located within urinary cavities; they may contain monohydrate calcium oxalate, dihydrate calcium oxalate and/or calcium phosphates in various proportion. Nephrolithiasis may also be associated with nephrocalcinosis, i.e., crystal depositions in tubular lumen and/or interstitium, an entity which suggests specific pathological processes. Several rodents models have been developed in order to study the pathophysiology of intrarenal crystal formation. We review here calcium rodent models classified upon the presence of nephrolithiasis and/or nephrocalcinosis. As rodents are not prone to nephrolithiasis, models require the induction of a long standing hypercalciuria or hyperoxaluria(thus explaining the very few studies reported), conversely to nephrocalcinosis which may occur within hours or days. Whereas a nephrotoxicity leading to tubular injury and regeneration appears as a critical event for crystal retention in nephrocalcinosis models, surprisingly very little is known about the physiopathology of crystal attachment to urothelium in nephrolithiasis. Creating new models of nephrolithiasis especially in different genetic mice strains appears an important challenge in order to unravel the early mechanisms of urinary stone formation in papilla and fornices.