Kala-azar

Leishmaniasis (Kala - azar) also known as visceral leishmaniasis (Visceral Leishmaniasis), is caused by Du Leishmania, Bai Ling as the spread of chronic endemic infectious diseases. To long-term clinical irregular fever, swelling of the spleen, suffering from weight loss, anemia, leukopenia and characterized by increased plasma globulin.

[Pathogen]

Du leishmaniasis parasite (Leishmania donovani) is a parasite Trypanosoma Kelishenman, the parasite cells lamblia. And the four types of human pathogens is in the form of Leishmania there is no difference in disease and immunological characteristics are different, tropical Leishmania and Mexico Leishmania cause the skin disease leishmaniasis ( “Oriental boil”);nasopharyngeal mucosa leishmaniasis parasite caused the disease; Du Leishmania parasites in the main network offal - endothelial system, from kala-azar.

Du Leishmania before the flagellin-life history of flagella and no body. The former is seen at Bai Ling digestive tract, in the 22 ~ 25 ℃ medium, a spindle, a front-end free flagellum, and the length of its body length is similar, about 11 × 16 μ m. Li Du and the body found in mammalian cells, tissue culture at 37 ℃, was egg-shaped park, the size of about 4.4 × 2.8 μ m.

When the female Bai Ling bites of infected animals and, to inhalation of blood Li Du Bai Ling stomach, 2 to 3 ripe for the future development of the former flagellum, parallel rapid propagation separatist dichotomy, one week ago after gathering a large number of flagella Bailing on the oral and mouth parts, when it bites human or animal body before flagella that penetrated the body, the flagella of falling into a flagellum (Lidu body).

[Epidemiological]

(A) source of infection patients and Bingquan as the main source of infection. North east of Henan and northern Anhui in the plain areas of the main mountain plateau to the northwest mainly Bingquan.

(B) transmission Bai Ling of China is China’s major mass media kala-azar, transmitted mainly through bites Bai Ling, the dual may be damaged skin and mucous membranes, placenta or blood transfusion.

(C) susceptibility to the crowd generally susceptible population, the disease after lasting immunity. Healthy people can have different levels of natural immunity.

(D) popular features of a wider distribution of the disease, China, India, Bangladesh, West Asia, the Mediterranean region, East Africa and Latin America have found. North of the Yangtze River of China’s popular 17 provinces. Because of the slow onset, no significant seasonal incidence. 10-year-old children within Most of male than female. The more rural than urban.

[Pathogenesis and pathological changes]

When Bai Ling bites affected people, it will be before the flagella of subcutaneous injection, a small number of neutrophils slope was bad, most of the reticuloendothelial system macrophages and swallowed up by breeding them in, hyperplasia, with the flow To the body, the destruction of macrophages, the other being a single nuclear swallowed up by macrophages, so repeatedly, leading to the body-nuclear proliferation macrophages to the liver, spleen, bone marrow and lymph node-based damage. Cell proliferation and the secondary is the obstruction of congestive liver and spleen, lymph nodes of the basic reasons. Because of hypersplenism and cell toxicity caused by autoimmune hemolytic allergy, can cause decreased blood cells, platelets significantly lower patients prone epistaxis, gingival bleeding. Since tablets of immune cells and reduce the activity of the cells, due to the lower immune function and easy to cause secondary infection. Reticuloendothelial system because of the proliferation of plasma cells increased substantially, due to increased plasma globulin, coupled with liver damage reduction of albumin, resulting in the ratio of plasma inverted egg white ball. If kidney damage can produce proteinuria.

Major diseases found in the following organs: the spleen significant swelling, weight up to 4-5 kg, capsule thickening and proliferation of macrophages containing a large number of Lidu, the plasma cell proliferation, the spleen may be due to blocked blood flow in congestive small artery Compression, a splenic infarction and spleen Gong hyperthyroidism. Late because of fibrous tissue proliferation swollen spleen hardens. Gall liver were mild to moderate swelling, thickening capsule, the District, sinusoidal, and Kupffer cells, Li Du of a large number of plasma cells and lymphocytes. Gan Xiaoye Centre liver cells and shrink under pressure, liver cells around the muddy swollen, or because of ischemia in fatty liver degeneration, or connective tissue proliferation lead to cirrhosis. Hyperplasia Chenganhongse extreme bone marrow, fat tissue significantly reduced macrophage proliferation obviously, that a large number Lidu; David tablets in the abnormal cells increased, and the late David tablets tablets of the cells, eosinophils decreased significantly; Nucleated red blood cells increase megakaryocyte normal or reduced, and significant reduction in platelets. Swollen lymph nodes, the cortex, medulla and can be found in the sinus with Li Du of macrophages, plasma cells increased. In addition, the tonsils, lung, kidney, pancreas, testes, and other organizations also macrophage proliferation, and to find Li Du of guitar. Glomerular basement membrane on the blood vessels that immune complex (IgG, M and C3) deposition, tips can be caused by immune complex nephropathy.

[Clinical]

The incubation period vary in length and an average of three to six months (10 to 9).

Early symptoms of fever, slow onset, and symptoms rather than the typical light, long-term irregular fever, about 1 / 2 to 1 / 3 cases were bimodal heat, a day temperature has increased 2 (movements of more than 1 ℃ ). Other heat can be similar to typhoid, tuberculosis, malaria or heat wave (that is, Bruton’s disease bacilli). Early fever for three to five more weeks dissipated, a few weeks after the rise again, with intermittent recurrence of such alternative, sustainable more than one year. Can be associated with chills, fever, night sweats loss of appetite, fatigue, dizziness and other symptoms. Although the fever continued over a long time, but still persist in the general labor, its characteristics.

Disease after 3 to June typical symptoms gradually clear, long-term irregular fever, fatigue, Nacha, suffering from weight loss and coughing. Anemia can hemorrhage palpitations, shortness of breath and anemia Maung, severe heart can be expanded and heart failure. Due to factors such as small board will have to reduce epistaxis, bleeding gums, and other bleeding tendencies. Enlargement of the spleen was carried out, since the disease two or three weeks to reach techniques, such as after the swollen spleen extended period of clear and gradually hardens, six months can-umbilical, while up to the pelvic, if the spleen, suppository or cold Bleeding, spleen may cause pain and tenderness, and friction can sometimes hear the sound. Later enlarged liver, spleen swollen than light, occasionally jaundice and ascites, lymph nodes were mild to moderate swelling, no tenderness.

Late patients (incidence 1 to 2 years) due to chronic malnutrition fever, extreme weight loss, resulting in children with developmental disorders. After a skin condition aggravated pigmentation, even to cirrhosis. Gong also because of hyperthyroidism spleen, reducing resistance, often complicated by pneumonia, tablets cell deficiency, such as sepsis.

In addition, lymph nodes and skin type of kala-azar, can be found in the lesions of Lidu.

[Complications]

(A) easy to secondary bacterial infections with lung inflammation, bacillary dysentery, gingival fester, Zouma Malnutrition, and so on.

(B) of agranulocytosis for the performance of high fever, extreme exhaustion, oropharyngeal ulcers and necrosis, regional lymph node swelling and blood cells as tablets in a significant reduction, or even disappear.

[Diagnosis and differential diagnosis]

(A) diagnosis

1. Epidemiological data pandemic stay or living history, Bai Ling activities for the season.

2. Clinical performance of the slow onset, long-term, repeated irregular fever, swelling of the spleen, anemia, weight loss, such as leukocyte reduction, and relatively less serious symptoms of systemic poisoning.

3. Laboratory

(1) reduce blood cells, WBC and more in the 1.5 ~ 3.0 × 108 / L, or even the lack of neutrophil; was moderate anemia, thrombocytopenia.

(2) plasma globulin was significantly higher, globulin precipitation test (water test), aldehyde coagulation tests, tests of antimony Duocheng positive albumin reduction, A / G can be inverted.

(3) serum antibodies specific antigen test positive will help diagnosis. Bone marrow, lymph nodes or spleen, liver pinning smears, found in Lidu or puncture See previous investigations of training can be confirmed in flagellum.

(4) in the treatment of diagnosis: antimony sodium gluconate available for trial, if the effect of significantly contribute to the disease diagnosis.

(B) the differential diagnosis

Application of this disease, tuberculosis, typhoid fever, malaria, Bruton’s disease bacilli, white hyperlipidemia and malignant cell disease, Hodgkin’s disease, schistosomiasis and other causes of chronic liver cirrhosis caused by, the evil of acute bacterial disease of the heart, such as periostitis Identification.

[Prognosis]

The prognosis depends on early diagnosis and early treatment. If not treated, the patient can be two or three years because of the incidence and deaths. Since the use of sodium gluconate antimony, the mortality reduction, the cure rate was 95%. A few may relapse. There are complications and poor prognosis.

[Treatment]

(A) General symptomatic treatment rest and nutrition, and complications to give blood for transfusion or tablets of cells, such as anti-infection.

(B) the preferred treatment of pathogenic antimony sodium gluconate, the total dose of adult <90 ~ 130 mg / kg, children 150 ~ 200 mg / kg, at 6, a day, or intravenous injection. Rapid and significant effect, fewer side effects. Disease-risk patients with anti-Ganji or want to switch to three weeks or therapy. Antimony of the invalid or taboo to the following non-optional antimony drugs:

1. Pentane acetamiprid (pentamidine): dose of 4 mg / kg / times, preparation of a fresh injection of 10% solution, daily, or between 1 and 10 to 15 for a course of treatment. Cure rate of around 70%.

2. The amphotericin B: antimony and pentane Acetamiprid effects of poor Shi Kejia with a daily dose from 0.1 mg / kg, gradually increased to 1.0 mg / kg, or between the intravenous drip ease, the total dose of 2.0 adults . The drug toxic to the kidneys and other organs, and to use adrenal cortex hormones, if there should be withdrawal proteinuria.

(C) splenectomy Splenectomy or spleen work with hyperthyroidism, or a variety of treatment should be considered invalid splenectomy. After treatment for pathogens, one year after treatment without recurrence, as cured.

[Prevention]

Is the main preventive measures and treatment of patients with killing Bingquan. At the same time the spraying season Bailing activities DDV, trichlorfon and other drugs to kill Bai Ling and to prevent breeding.

Other special type of leukemia outlined

1. Sarcoma lymphatic leukemia means the lymph sarcoma occurred in the course of extensive bone marrow transfer. Children period lymphoma about 30% of acute lymphoblastic leukemia, the incidence rate is higher than adults. Patients often have lower jaw, neck, mediastinum, such as swollen lymph nodes, and hepatosplenomegaly. The performance of a lymphoma, have ALL the blood and bone marrow examination findings. ALL often by the general treatment, but the prognosis worse than ALL, easy to relapse.

2. Green means of leukemia and other sites in the course of a bone tumor disease, for the performance of local nodular or massive uplift. More common in orbital bone, temporal bone, nose, sternum, ribs and pelvic bones and other flat bone periosteum, the entire body of the lymph nodes, liver, spleen, kidney, lung, muscle, breast and the dura mater, other offal are also violations . And the appearance of tumor biopsy showed Green Green, Gu Ming of the green. Slice contact with air and sunshine can quickly disappear after the green, after hydrogen peroxide treatment of sodium or green can now resume. More common in acute myeloid leukemia, very few mergers in other types of leukemia. In addition to the general symptoms of leukemia, according to different sites involved, there can be corresponding symptoms. If violations can cause eye protruding eyes, swollen eyelids, conjunctiva valgus, double vision or blindness, and other symptoms. X-ray examination showed thickening of the outer plate, bone destruction, such as osteoporosis. In accordance with the type of leukemia may be, the general combined with chemotherapy, many local mass may disappear in the near future. Can also increase local radiotherapy.

3. Congenital leukemia that neonatal period (less than four weeks), the incidence. The vast majority of acute myeloid leukemia. In addition to their clinical performance of the common characteristic of acute leukemia, the most prominent skin damage, even as the first symptom. For more invasive skin nodules, hard nodules, can be mobile, surface skin Changcheng blue or gray. Diameter of about 0.2 ~ 0.3 cm, more common in the head, face, ears, nose or flooding cadres, and even the surface can form ulcers. Skin damage can be expressed as papules, erythema multiforme, bleeding spots, eczema-like herpes or damage. Anemia often not obvious at birth, but soon after birth hemoglobin often drop in anemia. Thrombocytopenia. WBC general increase, or even up to 1000 × 109 / L. Acute myeloid leukemia cells when the original tablets of about 10% to 80%. And other bone marrow seen the same period of leukemia. The disease can be combined other congenital malformations. Diagnosis of the disease should be and neonatal sepsis, neonatal and other hemolytic diseases like leukemia caused by reaction of identification. A shorter course of the disease in general, more than two to three months died, is not sensitive to chemotherapy drugs.

4. More hairy cell leukemia (hairy cell leukemia, HCL) formerly of leukemia reticuloendothelial hyperplasia. Morphology of the disease to appear on the specific characteristics for more hair cells. Such cells in the light microscope for the round, oval or polygon, irregular edge of the cytoplasm, or a hairy Ju Chizhuang processes, thus the name. Nuclear often irregular, often nuclear-lap 5700, occasionally nucleolus, the cytoplasm of the middle, Wright was stained blue. Scanning electron microscope that there are more cell surface scattering of slender-like hairy processes, part of a fold-cell processes. Their cell phenotype is a monoclonal antibody mature B cells, the membrane surface immunoglobulin (SmIg) for the most part positive. Acid phosphatase positive and do not be tartaric acid suppression.

Clinical manifestations in adults with chronic diseases who-Most of 70% to 90% of cases marked splenomegaly, some patients due to medical diagnosis and found splenomegaly, hepatomegaly have about half of cases, swollen lymph nodes and more not significant . Peripheral blood as often reduce the performance of whole blood cells, the majority of cases have decreased significantly tablets. Bone marrow examination is difficult, often with \ “pumped dry \” phenomenon, bone marrow biopsy to be done. Bone marrow hyperplasia reduce the performance of the tablets, increased fiber network, a moderate to extensive infiltration of the hair cells. Period of the disease rare in children, more acute disease, usually three to 10 months.

Find a diagnosis based on a typical hair cells. The disease of the current commonly used chemotherapy to perform well. Splenectomy can significantly prolong survival, and to correct blood cells decreased. Reported in the literature of α-interferon therapy have a certain effect.

5. Eosinophilic leukemia this rare disease. With the exception of the common symptoms of acute leukemia, often the heart, lung and central nervous system and other organs of the invasion symptoms. Invasive cardiac ventricular wall can occur thrombosis, endocardium, myocardial fibrosis and necrosis, the performance for congestive heart failure and abnormal electrocardiogram. Still visible drowsiness, coma, convulsions, central nervous system symptoms, such as hemiplegia. Pulmonary infiltration can be a chronic cough, difficulty in breathing, cyanosis, such as audio-lung.

Blood in the eosinophil continued to increase significantly, the majority of up to 60 percent or more, and often naive of eosinophils. Bone marrow of eosinophilia, abnormal shape, nuclear the left, there are various stages naive eosinophils, the original tablets of> 5%.

Diagnosis to be ruled out other causes of eosinophilia. The bad effects of chemotherapy.

6. Of Alkaliphilic myeloid leukemia this disease is also rare. Clinical symptoms to anemia, bleeding more prominent, liver, spleen, lymph nodes rare.

As in the blood cells of Alkaliphilic tablets increased significantly, and naive type of Alkaliphilic tablets cells. This shows that a large number in the bone marrow cells of Alkaliphilic tablets, the original tablets of cells increased, the various stages of Alkaliphilic tablets of cells increased, the the left. Coarse particles in the cytoplasm, toluidine blue or flashing blue flowers (Astia Blue) were positive, this can be neutral particles and cells of the distinction.

Diagnosis should rule out other causes of Alkaliphilic tablets of the cells increased. Chemotherapy ineffective, and often trigger DIC, and more in the short term and died of intracranial hemorrhage visceral bleeding.

Ureteral stones

[Summary]
The vast majority of ureteral stones from the kidney, including kidney stones or stones after extracorporeal shock wave caused by fragments landed. As more urine salt crystals into the urine of bladder, the primary ureteral stones rarely see. A ureteral strictures, diverticula, foreign bodies, such as predisposing factor, urinary retention and infection will lead to a ureteral stones. Ureteral stones are mostly single, the left side of the incidence broadly similar bilateral ureteral stones about 2 ~ 6%. Clinical more common in young adults, 20 to 40 years old the highest incidence of male and female ratio of 4.5:1, lower ureteral stones at the most, accounting for about 50 to 60 per cent. Ureteral stones on the urinary obstruction and expansion can cause stagnant water, and threaten suffering from kidney, serious renal function can gradually lose.

[Diagnosis]
The correct diagnosis of ureteral stones is not only sure whether stones, stones to determine the size, location, both sides of kidney function and the degree of hydronephrosis, whether infection. Typical of renal colic and hematuria is an important clue to the diagnosis. Pain in the ribs attack ridge area tenderness, Kouji pain. Women greater distal ureteral stones in the vaginal fornix to the touch. More than 90% of ureteral stones in the urinary tract film can be displayed, showed that calcium oxalate best, and subject to the abdominal lymph node calcification, pelvic vein stone, and appendectomy, bezoar differential phase angle of the island. Intravenous urography is mainly aimed at understanding the site of stones and renal function with the availability of stagnant water, if necessary, to large dose urography and radionuclide renography inspection, renal function can be further understand the situation. Cystoscopy and ureteral stones intubation in the disruption, and plain film shoot in the shadow of calcification catheter in the same plane, which can be sure that the diagnosis of ureteral stones. Air stone for the negative contrast agent for retrograde contrast radiography may show that the existence of stone. Another B-mode ultrasonography and CT examinations were helpful for the X-ray image is not stone diagnosis.

[Treatment]
Treatment of ureteral stones including symptomatic treatment, Chinese medicine treatment, extracorporeal shock wave lithotripsy and stone extraction by endoscopy, surgery and other stones.
(1) symptomatic treatment is mainly for controlling the renal colic, and can be used in the diagnosis after 0.5 mg atropine and dolantin 50 mg intramuscular injection, the pain can heat or district to acupuncture, waist sensitive areas can be closed for subcutaneous procaine (produced skin test). Can also be used nifedipine or indomethacin Cypriot anal suppositories.
(2) TCM Paishi suitable for the treatment within 1 cm in diameter, oval shape, smooth surface of the stone, pyelography were without water. Governance and administration are: Qingre Lishi, such as Lysimachia christinae Hance, such as the Jinsha. Qingrejiedu, such as Mr Wong, Yinhua, such as Hypericum perforatum. Blood Circulation, Ruanjian Huashi, such as Spartina, Ezhu such. Bushen such as cinnamon, Aconite, Cistanche, etc.. Air Dangshen such as blood, such as astragalus. There are various kinds of Paishi granules, and convenient.
(C) The use of extracorporeal shock wave lithotripsy Dornier X-ray positioning of the treatment has been expanded upper ureteral stones in the ureter, the calculi. Upper ureteral stones should adopt the semi-supine Chace, the iliac wing overlapping parts of stones should be used prone position under half of the available seats, the upgrade can be made certain of success. Although the total length of the various parts of ureteral stones can be crushed Extracorporeal Shock Wave, but in smaller stones, body fat patients sometimes difficult existence location, location deep, and so more energy, and crush kidney stones compared to the difficulty of ureteral stones to smash the relatively higher , the overall effect worse than kidney stones. Therefore, we must strengthen the positioning accuracy of the shock wave, there are difficulties, at the same time for excretion of urinary bladder angiography or do endoscopic retrograde catheterization and angiography, to help positioning. If stones can be pushed into the renal pelvis waves again, the most ideal. Contrast agent can often easily shattered stones, which emit. On the contrary, even if not stones, and significantly above water, especially with ureteral periimplantitis, retrograde intubation or inaccessible beneath stones, shock wave lithotripsy effects often poor.
The Lower Ureteral smaller stones, can be carried out by cystoscopy ureter expansion sets of stone, cut the mouth. In recent years, under the application of ureteroscopy peep stones or laser, ultrasonic lithotripsy, although there are reports of 40 to 78 per cent success rate, but it is worth noting that operation can cause perforation, tearing, and other serious complications.
(D) Operation and stone removal indications: ① there ureter stenosis; ② bilateral or unilateral ureteral stones incarcerated with urinary infection caused closure; ③ larger stones, hydronephrosis serious, poor renal function; ④ extracorporeal shock wave or waves can not positioning losers; ⑤ clinical tumor or not, except tuberculosis; ⑥ economic factors. Two hours before surgery urinary-ray film to be positioning.

As for the larger female Lower Ureteral stones, and sometimes touched by transvaginal Konglongbu inspection stone, the stone from the massage.

[Clinical]
Ureteral stones and kidney stones similar symptoms. Stones and the size of obstruction, hematuria and not necessarily proportional to the degree of pain. In the ureter, on the site of the stone or stones plug incarcerated in the downward course of a typical side often caused renal colic and microscopic hematuria. To the thigh pain, testicular or labia minora radiotherapy. Accompanied nausea, vomiting, and sometimes for hematuria visible to the naked eye. Ureter and bladder intramural most of the narrow, stone easy to stay. Because the muscles of the lower ureter and bladder linked triangle, and directly attached to the posterior urethra, it accompanied the frequency, urgency and the unique Niaotong symptoms. Not be affected by the larger urinary calculi, only pain, hematuria also light. In the solitary kidney or ureter stones blocking bilateral ureteral obstruction or obstructive ureteral calculi side contralateral to a reflex anuria, and so on, can be acute anuria, and even renal failure.

Hydronephrosis

Since the beginning of urinary tract kidney until urethra, is a continuous pipeline system. Urine from the urinary tract depends on the pipeline open, and normal urinary function. Urinary any part of the pipeline, as well as stenosis or obstruction of the normal neuromuscular dysfunction, urine through obstacles can arise, causing urinary obstruction, urinary obstruction due to the above location from the sluggish pressure gradually increased lumen expansion, which eventually led to Renal water, and expansion of renal parenchymal thinning, renal dysfunction, if bilateral obstruction, a uremia serious consequences. Lead to urinary obstruction has many causes, can be congenital, such as the kidney, ureteropelvic junction stenosis, urethral valve, horseshoe kidney, acquired diseases such as stones, tumors, benign prostatic hyperplasia, such as bladder neck contracture. It can also be a urinary tract, or the fiber with obstruction caused mass oppression, such as retroperitoneal fibrosis, such as lymphoma. It can also be a urinary tract neuromuscular obstacles, such as megaureter disease. Obstruction and the acute and chronic, acute renal obstruction to complete loss of function in a short period of time, and hydronephrosis not very obvious. Chronic obstructive hydrocephalus can kidneys than 1000 ml. Once infected with hydronephrosis, obstruction if not promptly removed and difficult to cure infection, kidney infection and speed up the destruction of a vicious circle, and even renal abscess formation.

Complications of renal tuberculosis

(1) of bladder contraction

1. Bladder contraction and the cause pathological changes come from renal tuberculosis mycobacterium tuberculosis often repeated invasive bladder, causing serious TB cystitis, the bladder muscle of the bladder mucosa have congestion and edema, Tuberculosis sarcoidosis, tuberculosis ulcer, tuberculosis granulation, a large number of lymphocyte infiltration and formation of fibrous tissue, which causes bladder contraction. Contracture in the bladder, the loss of normal bladder wall flexibility, capacity significantly reduced. Generally believed that the capacity of the bladder contraction in the following 50 ml. Serious bladder can shrink to a few ml capacity. The bladder often repeated by Mycobacterium tuberculosis infection, the bladder is the pathological changes of acute and chronic inflammation and fibrosis of the repeated reference to both miscellaneous process. The incidence of bladder contraction According to the Shanghai Zhongshan Hospital 837 cases of renal tuberculosis statistics to 9.67 percent.

2. Symptoms of bladder contraction of the bladder contraction caused bladder capacity significantly reduced in frequency in patients. Contracture due to the process of gradual, it will gradually increase the frequency. Voiding frequency can be Shituci to dozens of times every day, or even a few minutes, that voiding so that the patients are extremely painful. Contracture due to the regular inclusion of acute tuberculosis bladder inflammation, and even non-specific merger mixed bacterial infection, so evident in the frequency of patients should be non-specific acute TB infection and inflammation in the anti-inflammatory and anti-TB drugs is the only real control Bladder capacity and voiding symptoms. Another bladder contraction often can be ureteral orifice, Zhou TB intramural ureteral change impacts, including about the ureteral orifice role destruction, a “dysraphism” phenomenon, resulting in voiding the result of ureteral expansion ureteral reflux, hydronephrosis. During this period the patient urination, can occur in the urine of bladder emptying after Ureteropelvic immediately in the urine of bladder filling and voiding again, it is the first urine from the urinary or intermittent phenomenon should also consider the bladder contraction symptoms, we must further clarify inspection. Another bladder contraction can produce ureteral orifice and / or intramural ureteral obstruction caused ipsilateral renal pelvis and ureter water.

3. Diagnosis of bladder contraction in the above-mentioned symptoms, the need to rely on X-ray examination. Bladder contrast to the appearance of the bladder can show significantly reduced. Especially the delay in bladder angiography can be observed that the anti-ureteral orifice flow and contralateral renal pelvis and ureter the expansion of water (Figure 4). At that time, the inspection should pay attention to the availability of acute bladder inflammation there. Bladder with the presence of acute inflammation, while not suitable for bladder imaging, contrast agent on the other hand can be stimulated to bladder contraction, resulting in the false impression of bladder contraction, it should be taken to avoid misdiagnosis.

(B) contralateral hydronephrosis contralateral renal tuberculosis hydronephrosis is the late complications from bladder caused by tuberculosis. According to Wu (1954) reported that the incidence rate of 13 per cent; 1963 Comprehensive 4,748 cases of renal tuberculosis patients, the contralateral hydronephrosis secondary to 13.4 per cent.

1. Contralateral hydronephrosis and pathology reasons for the occurrence of tuberculosis caused by bladder following pathological changes affecting the contralateral kidney urine drainage, resulting expansion of the contralateral renal pelvis and ureter water.

(1) contralateral ureter stenosis: Tuberculosis of cystitis side from the disease around the ureteral orifice spread to the entire bladder violations to the contralateral ureteral orifice, the extent of the inflammatory lesions, ulcers and to fibrosis, helps contralateral ureteral I happen narrow, from the impact of urine to the contralateral renal pelvis and ureter expansion in stagnant water.

(2) contralateral ureteral orifice tricuspid regurgitation: normal ureter through the bladder to the ureter of the intramural Although there is no formal opening sphincter exists, but is included with the sphincter about the same role. If the side of TB spread to the bladder and ureter contralateral to the affected population, including about the role of causing damage to the contralateral ureteral orifice formed the tricuspid regurgitation, so when bladder-voiding the bladder contraction pressure, urine from the contralateral tricuspid regurgitation ureteral reflux mouth to the renal pelvis and ureter, resulting in the contralateral kidney, ureter expansion of stagnant water.

(3) contralateral Lower Ureteral stricture: urinary side after suffering from tuberculosis, Mycobacterium tuberculosis returning upward from lower urinary tract, urinary tract infection the other side of the lower ureter and bladder or ureter contralateral near the mouth of tuberculosis directly change the mucosal surface spread or submucosal invasion, the ureteral orifice over a period of ureteral have tuberculosis change, and then by a narrow scar formation caused the contralateral kidney and ureter expansion of stagnant water.

(4) bladder contraction: Serious cases of tuberculosis last cystitis caused bladder contraction, and urine in the bladder filling contracture, bladder pressure increased. Bladder with a long-term high pressure can block the contralateral renal pelvis and ureter from the urine. Contracture or in the urinary bladder voiding the contralateral reflux caused contralateral renal pelvis and ureter expansion of stagnant water.

2. Contralateral hydronephrosis symptoms contralateral hydronephrosis is the late complications of renal tuberculosis, renal tuberculosis patients in general presentation of the clinical symptoms. Hydronephrosis and contralateral to the symptoms hydronephrosis as the extent to which, the less water can be asymptomatic, signs, water clear and serious, there will be full abdominal pain, or low back pain, as well as abdominal or There are mass waist.

3. Contralateral hydronephrosis diagnosis

(1) Analysis of history: while the contralateral renal tuberculosis patients with hydronephrosis, basically tuberculosis side of serious kidney damage, loss of function completely, the patient’s life depends on the maintenance of the contralateral kidney. If the contralateral hydronephrosis a lesser extent, the clinical symptoms is not clear if the contralateral severe hydronephrosis, renal dysfunction can arise, the symptoms of uremia. Often the occurrence of contralateral hydronephrosis in the application of anti-TB drugs after a considerable period of time. Bladder and ureter TB lesions in the control of anti-TB drugs are in the TB lesions in the process of healing fibrosis gradually emerging distal ureter or ureteral orifice of the narrow ureter and renal secondary water, if narrow gradually increased, the water level would gradually development. Thus the total renal dysfunction in patients with renal tuberculosis suggested that water may have contralateral kidney should be further checks.

(2) phenol red (PSP) test: conventional phenol red test: in four of their urine specimens (15,30,60,120 minutes) the concentration of phenol red. When hydronephrosis mildly affected, phenol red from the delay, the first two samples from the small, and the latter two specimens from higher. If serious side hydronephrosis is not discharged phenol red, four are rare specimens from phenol red.

(3) radionuclide renography: hydronephrosis that contralateral renal excretion was delayed plans curve curve or function curve.

(4) Ultrasonography: ultrasonic inspection method is simple, the patients had no pain, detectors the size of the contralateral kidney, water and the extent of the renal parenchyma thickness to provide reference information.

(5) X-ray inspection: X-ray examination is essential in the diagnosis of the contralateral kidney stagnant water will have a decisive role in any of the following methods used several:

1) delay IVP: general methods of intravenous pyelography water pelvis expansion of the renal dysfunction patients can not be satisfied with the show pelvis forms. If suspected water in the contralateral kidney should be intravenous pyelography in radiography time in accordance with phenol red excretion extension of the time to 45 minutes, 90 minutes or even 120 minutes so that the contrast agent pelvis accumulated more when the number of intake X-ray, can renal pelvis and ureter lights show clear patterns. If renal SHANG Jia, in the injection of contrast agent used in the high-dose intravenous pyelography way, the images show more clearly.

2) Delayed bladder angiography: Bladder angiography can show bladder forms. If the ureter is tricuspid regurgitation, the contrast agent can be reflux from the bladder to the ureter and even renal pelvis and ureter and renal pelvis revealed that the morphology. In contrast, if the bladder so that the contrast agent injected into the bladder in the bladder in a short period of time delay so that anti-contrast agent into the kidneys of some more after the X-ray film, the water will form ureteropelvic show more clearly. For the prevention of contrast agent reflux caused retrograde infection, in contrast agents need to add the appropriate antibiotics.

3) puncture renal angiography (anterograde IVP): If poor renal function, intravenous pyelography not that serious and bladder diseases, retrograde renal pelvis angiography can not succeed, no bladder reflux contrast, renal angiography is the only puncture understanding of the renal pelvis and reliable method. Under the guidance of ultrasound in the rib section 12 under the sacral spinal muscular puncture the lateral edge of the renal pelvis, puncture after the success of urine specimens can draw all the necessary checks and from the needle into the appropriate amount of contrast agent uptake after X-ray, clearly the nature of kidney disease.

(C) TB spontaneous rupture of the bladder less spontaneous rupture of the bladder see, but in the breakdown of TB cases to the maximum. 80 cases reported in the literature abroad in 10 cases (12.5%), domestic reported 23 cases in 15 cases of tuberculosis for the spontaneous rupture of the bladder, it should be on the clinical importance.

1. Tuberculosis spontaneous rupture of the bladder etiology and pathology of bladder TB spontaneous rupture of the bladder, is the main reason for the change serious and widespread tuberculosis, TB depth of myometrial ulcer inflammation involving the whole of the bladder wall, if at lower urinary tract obstruction , bladder contraction, or a sudden increase intra-abdominal pressure and other factors can cause spontaneous rupture. More than the site of rupture or posterior wall at the top, almost all of the peritoneum.

2. Tuberculosis bladder symptoms of spontaneous rupture of the bladder is often a spontaneous rupture of acute onset of the disease process. Trauma patients in the absence of a sudden pain in the lower abdomen, and no voiding or attack from a small number of hematuria, peritoneal irritation of the abdomen. However, as is the tuberculosis patients with bladder, in the event of breakdown of the past, the history of the existence of tuberculosis, urinary symptoms of TB, as well as the diagnosis of urinary tuberculosis basis.

Nuclear emergency patients and symptoms of acute abdomen, and the abdomen is obvious. Because bladder rupture, abdominal urine flows continuously, it often ascites. Diagnostic Laparoscopies can extract more yellow liquid. No regular inspection catheterization urine outflow, or only a small amount of bloody urine. If the Bank of China in the bladder catheter perfusion test, the injection volume of the liquid and remove the liquid can be compared to a significant difference, or significantly reduced (liquid into the abdominal cavity) or increased (by intraperitoneal urine extract). If the catheter from a ruptured abdominal may have entered the mouth of urine derived. When necessary, feasible in the X-ray imaging diagnosis of bladder.

Renal tuberculosis treatment

Renal tuberculosis secondary to systemic disease, it must attach importance to the treatment of local and systemic treatment of lesions comprehensive consideration, if it is satisfied with the results.

(1) systemic treatment of systemic therapy including proper rest and full medical and sports nutrition and necessary medication (including renal tuberculosis of the body other than the treatment of TB lesions).

(2) drug treatment as local lesion of renal tuberculosis and the scope of the extent of the damage are very different, for the treatment of localized lesion in all cases are also different. In the discovery of streptomycin and other anti-TB drugs before clinical diagnosis of renal tuberculosis Once established, the only treatment is nephrectomy. In the 1940s, the streptomycin, Liu ammonia acid have been transformed, many clinical cases of renal tuberculosis drug treatment alone can be cured. After the 1950s, high efficiency, low toxicity and low cost of isoniazid there has taken a combination, the efficacy of renal tuberculosis has greatly improved, almost all early TB can be cured change. 1966 rifampicin to clinical application because the results significantly, and fewer side effects, and the shared use of other drugs, the efficacy of renal tuberculosis raise more. At present due to renal tuberculosis and the need to nephrectomy cases has been greatly reduced. But in some poor sanitary conditions, inadequate medical conditions, there are still the occurrence of renal tuberculosis, and even some advanced patients found. The diagnosis of renal tuberculosis patients, regardless of their degree of disease, whether or not they will need surgery, anti-TB drugs must be taken by certain programmes.

1. Indication of the anti-tuberculosis drug

(1) clinical stage renal tuberculosis.

(2) limitations in a large group within the renal calyceal unilateral or bilateral renal tuberculosis.

(3) isolated renal tuberculosis.

(4) with the activities of other parts of the body tuberculosis temporarily unfit renal tuberculosis surgery.

(5) double focus of renal tuberculosis is not the surgery.

(6) both renal tuberculosis other parts of the serious illness temporarily unfit surgery.

(7) with surgical treatment, as a pre-operative medication.

(8) the post-operative renal tuberculosis conventional medication.

2. Commonly used anti-TB drugs for a variety of types of anti-tuberculosis drugs has its pharmacological characteristics of the drug application requirements and also pay attention to different points. Is a brief introduction commonly used anti-TB drugs is as follows:

(1) Streptomycin: Mycobacterium tuberculosis have bactericidal effect, the concentration in the range of 1.0 μ g / ml effective. Intramuscularly one hour after the largest concentration of the serum, three hours after a decrease of 50 percent, about 60 ~ 90% of the urine from the kidney. PH7.7 role in the system of ~ 7.8, the strongest, lower than the 5.5 ~ 6.0 role decreased significantly. At the same time as the urine alkaline sodium bicarbonate can be taken to enhance its efficacy. Ordinary daily adult dose of 1.0 g, intramuscular injection at 2 with other anti-TB drugs combined, 2 g weekly injection, or every 1 g on the 3rd injection. The treatment allows TB lesions streptomycin fibrosis. If Baixiejitong lesions in the urinary tract, such as the ureter, etc., it could easily lead to shrinkage local fibrosis, the formation of obstruction, should be noted. Streptomycin injection after weeks of mouth numbness, if not serious continue to apply, and often in use gradually disappear. The main side effects of the eighth cranial nerve vestibular-effects. A few cases, there may be allergic shock.

(2), isoniazid (1 NH, Jérémie letters): Mycobacterium tuberculosis suppress and kill role. Daily serving 200 to 300 mg can be satisfactory bactericidal concentration. Oral 1 ~ 2 hours of peak serum concentration. Half-life of six hours, 24 hours can be measured in blood effective inhibitory concentration. General dose to 300 mg daily, a suitable use. This little dose of adverse reactions, it may take a long time, even several years. After taking isoniazid rapid absorption infiltration, fibrosis and cheese of the lesions also easy to infiltrate through the TB lesions promote angiogenesis will enable easier access to anti-TB drugs lesions. The main side effects of the spirit of excitement and multiple peripheral neuritis, it is believed that with increased vitamin B6 or interference from Pyridoxine metabolism and therefore should be combined with isoniazid served vitamin B65 ~ 10mg, to prevent the occurrence of side effects. Serum transaminase medication can be increased, but not to cause liver damage.

(3) ammonia Liu acid (PAS, ammonia acid): Mycobacterium tuberculosis have antimicrobial effect. Medication after 1 to 2 hours up to the peak plasma concentration, 4 to 6 hours after the last trace of blood. Daily dose of 8 ~ 12 g, three to four times taking. The drug less effective alone, but to strengthen isoniazid and streptomycin resistance of Mycobacterium tuberculosis, drug-resistant and can delay occurred. Therefore, in clinical use two or three anti-TB drugs combined to play a role in its treatment. Main side effects are nausea, vomiting, diarrhea and gastrointestinal reactions, it now has been rifampicin, ethambutol replace trend. The goods should not be combined with rifampicin.

(4) rifampicin (RifamPin, RFP): Semi-synthetic broad-spectrum oral antibiotics, the strong growth of cells inside and outside there are strong Killing of Mycobacterium tuberculosis, streptomycin than the ammonia Liu acid, the role of ethambutol stronger, resistant Mycobacterium tuberculosis also effective. Medication 2 ~ 4 hours after drug concentration peak, 12 hours after the serum concentration remains high. Daily dosage of 600 to 900 mg, 1 to 2 minutes, taking fasting. And other non-cross-resistance to anti-TB drugs, isoniazid and ethambutol or combination can be mutually reinforcing role. Few side effects, gastrointestinal reactions and the occasional rash. In recent years have found a few cases of liver damage, increased serum transaminase, such as jaundice.

(5) ethambutol (Ethambutol, EMB): For all types of Mycobacterium tuberculosis have antimicrobial effect. Oral 2 to 4 hours after the peak plasma concentration, and 24 hours after kidney from 50 percent, a small portion of the stool from. Normal renal function had no role in stock. Drug absorption and tissue penetration better, the cheese fiber lesions can also penetrating. Its toxicity is the major role of the ball after optic neuritis, a blurred vision and can not distinguish colors (especially on the green) or a narrow field of vision, severe cases can cause blindness. Optic neuritis is reversible, and more can resume after treatment. The incidence of toxicity and dose. General daily dosage of 600 mg, three times or an oral dose, in this context, less toxic reaction. In the course of treatment should be regularly checked and colour recognition of the vision.

(6) kanamycin: Department of broad-spectrum antibiotics is the main inhibitory effect of Mycobacterium tuberculosis. Oral not absorbed by the gastrointestinal tract, the general amount of 0.75 to 1.0 g daily intramuscular injection. After injection of 30 to 60 minutes of peak blood concentration can maintain about six hours, from the urine within 24 hours from about 90%. Of streptomycin, isoniazid and ammonia Liu acid-resistant Mycobacterium tuberculosis application kanamycin still inhibited. Individual use of easily generate resistance. Streptomycin between unidirectional and cross-resistance, that is, streptomycin-resistant strains can be sensitive to kanamycin, and kanamycin-resistant strains of streptomycin is not sensitive. Therefore, not only with streptomycin or resistant Mycobacterium tuberculosis has been and will be considering applications. Its toxicity is the eighth cranial nerve damage, to permanent deafness may also degeneration of nerve fibers. Slight damage to the kidneys, urine may be a type of protein.

(7), Cycloserine (Cycloserine, Seromycim): broad antibacterial spectrum, a system of Mycobacterium tuberculosis bacteria. But only effective human tuberculosis, TB and to the animals in the test tube tuberculosis is very limited. Of isoniazid, streptomycin, Liu ammonia acid-resistant Mycobacterium tuberculosis by Cycloserine effective. Its role equivalent to ammonia Liu acid, worse than streptomycin. A daily oral dose of not more than 500 mg, general and isoniazid, streptomycin combination. More serious side effects, mainly affecting the central nervous system, such as dizziness, depression, seizures, such as epileptic seizures.

(8) pyrazinamide (Pyrazinamide, PZA): is a new use of old drugs. 1970s found after the oral absorption Pyrazine acid, the effective man-TB can be hidden in the cell to kill the stubborn bacteria. Resistance is expressed very quickly, usually in the medication after one to three months can happen. And rifampin, isoniazid combination treatment can be shortened. For the toxic side effects on the liver, can cause serious acute liver yellow atrophy. Commonly used dose of 1.5 to 2.0 g per day.

In addition to the drugs, there are purple adriamycin (viomycin), B sulfur Isonicotinic amine (ethionamide, 1314), the amount of 0.5 to 0.8 g per day, at 2 to 3 times taking. Ammonia thiourea (P-acetyl aminobenzaldebyde, thiosemica-rbazone, TB1) daily dosage of 500 mg oral dose of 2 points. Tendril adriamycin (capromycin). TB release actinomycin, and other anti-TB drugs and, if necessary, could consider selection.

3. Use of anti-tuberculosis drugs in the clinical application of anti-TB drugs early, generally a single-drug treatment, and now that two or more anti-TB drugs combined. Alone in the treatment of the biggest drawbacks is easy to become drug resistant, but also prone to toxicity. If the combination of two drugs, the emergence of drug resistance time can be extended twice, and can be extended by three drugs three to four times.

(1) anti-TB drugs combined with the choice: a wide range of anti-tuberculosis drug, the ideal should be sensitive to Mycobacterium tuberculosis, in the blood or to be a system of the concentration of sterilization, and the body can endure. The past will streptomycin, isoniazid, as the first-line drugs, ammonia Liu acid as a second-line drugs, others as a third-line drugs. When medication is the preferred first and second-line drugs, and only three drugs in the first line, second-line drugs ineffective or some of them resistant to drugs, before considering the use of. But now the various anti-tuberculosis drugs in-depth study of effect of that isoniazid, rifampin, pyrazinamide, and streptomycin is the first line anti-tuberculosis drugs. Isoniazid strong kill Mycobacterium tuberculosis, Mycobacterium tuberculosis cells both inside and outside the breeding kill, and to thoroughly dry acid into the lesions and macrophages. Rifampin can be split in the short term in the killing of Mycobacterium tuberculosis, and access to renal empty cells and macrophages. Pyrazinamide in the acidic environment of a stronger bactericidal effect can thoroughly into macrophages. Macrophages in the low pH, which is pyrazine amine kill bacteria play a role of the establishments. Streptomycin on tuberculosis split exuberant have a good kill, it thoroughly into TB Vomica.

On the specific application of anti-TB drugs, are now using two or three anti-TB drugs combined. Application abroad streptomycin, isoniazid, Liu acid ammonia three important anti-TB drugs gradually the era of the past, replaced by the new drugs, the new joint. These three drugs in the country is still often used, but also the trend was replaced by rifampin, isoniazid, however in the position of anti-tuberculosis drugs did not change. Now the general isoniazid and rifampicin the two joint, or combined with rifampicin and ethambutol. And streptomycin, rifampicin, pyrazinamide or isoniazid, streptomycin, rifampicin, or isoniazid, streptomycin, ethambutol or isoniazid, rifampicin, ethambutol, etc. the three combined are usually chosen for the clinical.

(2) the application of anti-TB drug treatment: With new and effective anti-TB drugs continue to emerge. Clinical anti-tuberculosis drug treatment has also noticeably changed. In the treatment must adhere to the early, combination, adequate, and adequate period of the Five Principles of medication to obtain the best therapeutic effect. Now used in treatment programmes are as follows:

Long-term therapy: on the application of anti-TB drugs, domestic and international long-term therapy were powered by continued use 18 to 24 months. At least in more than a year. Recognized the efficacy of this method reliable, less opportunity recurrence. Lattimer renal tuberculosis in accordance with the classification of anti-tuberculosis drug treatment, in clinical stage renal tuberculosis medication treatment 1, the lights in a single renal lesions typical of TB medication to two years, and three or more renal calyceal changes to a wide range of tuberculosis require medication for more than three years. Petkovio advocated unilateral renal tuberculosis treatment should last for two years, bilateral renal tuberculosis drug efficacy and the longer the better, it was recommended to last for four to five years, or even more than six years. Now Toman that rifampin and ethambutol composed of “two therapy programme,” and to strengthen the pre-start phase 1 ~ 3, the application of isoniazid, rifampicin and ethambutol or streptomycin three - Joint TB drug use later to continue to stage every four to 12 months of isoniazid and rifampicin, ethambutol or two between the use of anti-tuberculosis drugs, such use, the effects can be significantly enhanced, even if delivery period of 12 months can be achieved within a good effect. Long-term therapy is the main shortcomings of medication for too long, which patients can not adhere to the rules of medication, and often Youlou clothes, and clothes, clothes, and other phenomena of chaos, resulting in bacterial resistance, reduced drug efficacy, positive or urine Mycobacterium tuberculosis sustained TB control After another relapse. According to reports the rules of anti-TB treatment success rate was 90.3%, instead of the rules of treatment success rate of 43.7%.

Short-term therapy: short course’s basic aim is to kill as soon as possible TB lesions in Mycobacterium tuberculosis, a disease tissue repair lasting clinical cure. In recent years the emergence of a new anti-tuberculosis drug sterilization, a range of anti-TB treatment can be. Short-term drug treatment of renal tuberculosis research began in 1970, to 1977 Gow, and other studies to determine short-term drug treatment programme laid the foundation. Now a short course of treatment for four months, two months early for pyrazinamide 25 mg / (kg d) (maximum daily dose of 2 g), isoniazid 300 mg / d, rifampicin 450 mg / d, such as serious kidney and bladder disease Streptomycin may increase by intramuscular injection, 1 g daily; after two months as isoniazid 600 mg three times a week, rifampicin 900 mg three times a week. Gow, in addition to the 140 cases, not one case of medication and relapse, have been cured, in the two months when the medication urinary tuberculosis are to negative, minor drug toxicity. It should be noted, isoniazid, rifampicin and pyrazinamide have liver toxicity, when there are jaundice and elevated liver transaminases should stop until the return to normal again after treatment. Dutt and Sfead application of short-term programme for September, the use of isoniazid and rifampin. For the first month of 300 mg isoniazid, rifampicin 600 mg daily for 1; after eight months to isoniazid and rifampicin 900 mg 600 mg, 2 times a week, results were very good. In short short-term therapy to be successful, needs at least two application modules bactericidal drugs, such as isoniazid, rifampicin, coupled with a semi-sterilization unit drugs, such as pyrazinamide, streptomycin and other. Broad range therapy has the following advantages: ① longer-therapy treatment cut by half or more the time. ② reduce total drug. ③ reduce the chance of chronic poisoning. ④ cost savings. ⑤ easy access to the patients, medication may be rules.

As Mycobacterium tuberculosis growth of a certain degree of regularity, and to 13 / 4 to 31 / 2 days, and Mycobacterium tuberculosis in contact with anti-tuberculosis drugs inhibited their growth, such as contact with streptomycin, pyrazinamide, rifamycin equality, After could delay were growing 8 to 10 days, 5 to 10 days, and 2 to 3 days, the application of anti-TB drugs under intermittent use these features will be intermittent administration in time more than one day, can be achieved Continuous long-term therapy with the same effect. General in the country in the first three months of therapy on long-term medication, later switching to intermittent drug treatment, but the amount of drug therapy with the same long-range, fewer side effects, as well as better efficacy.

(3) the withdrawal of anti-tuberculosis drugs in the standard anti-TB drugs in the course of treatment, must pay close attention to changes in condition, all regular inspection to disease has been cured, they may consider to stop medication. Think we can stop the current standards are as follows:

A. general condition improved significantly, the normal erythrocyte sedimentation rate, body temperature normal.

B. voiding symptoms completely disappear.

C. repeated urine routine examination normal.

D.24-hour urine concentration investigation AFB, long-term inspections are negative.

E. Training urinary tuberculosis, urinary animal inoculation View Mycobacterium tuberculosis were negative.

FX line of urinary performed stability or healed lesions.

G. thorough medical check-no other TB lesions.

After the cessation of medication, the sick need to continue to stress long-term follow-up study, regular urine and urinary inspection performed at least 3 to 5 years.

(C) Although the anti-tuberculosis drug treatment can now be treated in the majority of renal tuberculosis can be cured control, but there is still not part of the patient drug to be effective, and treatment remains to be done. Including full nephrectomy surgery, and some nephrectomy, such as removal of kidney lesions in several ways, depending on the scope of diseases, the extent of damage and the effects of drug therapy chosen.

1. Whole nephrectomy

(1) Full-nephrectomy indications: ① unilateral renal lesions of tuberculosis in the destruction of more than 50 per cent larger. ② destruction of the entire renal tuberculosis renal function has been lost. ③ tuberculosis renal abscess. ④ bilateral renal tuberculosis, and severely damaged the side and the other side for the very mild tuberculosis, with a need to serious side, mild lesions side by drug treatment. Since the cut-off plaster ⑤ renal calcification.

(2) nephrectomy before and after the application of anti-tuberculosis drugs: As the body of renal tuberculosis is part of tuberculosis, TB is the secondary, urinary tuberculosis is a part of the period when nephrectomy can be a result of surgery Damage to reduce the resistance of the body, other than the result of renal tuberculosis or TB lesions caused Disseminated, in nephrectomy before and after the application of anti-TB drugs must be controlled.

1) nephrectomy before antituberculotics preoperative preparation: antituberculosis drugs before surgery by the preparations for the selection of varieties and medicinal doses, with the same general anti-tuberculosis treatment. But in the use of methods and the use of the time to be different. Such as isoniazid 100 mg three times daily oral, streptomycin 0.5 g, 2 times a day intramuscular injection, rifampicin 300 mg orally twice a day, every day for the application of application, sustained two weeks, and reoperation. If patients with systemic poor, or any other organ tuberculosis, as appropriate, should extend the preoperative preparation of anti-tuberculosis drugs, and sometimes preoperative medication may be extended to three to four months. Needed after such application until after physical rehabilitation, about two weeks after the turn around conventional anti-TB treatment.

2) nephrectomy after the application of anti-tuberculosis drugs: the urinary tuberculosis, renal tuberculosis is the primary lesion, when after resection of renal disease, urinary system will be only the original lesion resection, there are still remnants of tuberculosis after Variable presence of these residues ureter and bladder Tuberculosis Tuberculosis Tuberculosis other organs or body still needs the light of the choice of anti-TB drugs and long-term or short-term treatment of schedule until the complete urinary tuberculosis control and stop.

2. Part nephrectomy

(1) of nephrectomy indications: ① confined to the kidney to a pole in the 1 to 2 small renal calyceal the devastating disease, the long-term anti-tuberculosis drug treatment was ineffective. ② 1,2 small renal calyceal TB Department narrow funnel to poor drainage. ③ bilateral renal tuberculosis destruction轻而long-term drug therapy ineffective. If kidney function is the only required part of renal surgery, should be retained at least 2 / 3 of the renal tissue, so as to avoid postoperative renal insufficiency caused.

(2) of nephrectomy before and after the application of anti-tuberculosis drugs: As the anti-tuberculosis drug treatment often received good results, some less nephrectomy, the patients suitable for this operation should be a longer period of time antituberculotics prepared before implementation. General preoperative preparation to use 3 to 6 months. Preoperative angiography yet again, the decision to establish lesions after surgery.

I left after surgery because of the kidney and urinary organs TB, it will continue to use anti-TB drugs for at least one year to consolidate the effect.

3. Removal of kidney lesions

(1) removal of the kidney lesions indication: the essence of the kidney in renal calyceal confined formed by tuberculosis empty, and often filled with cheese - like substance. Antituberculosis drugs can not enter the hollow, empty and there are still activities in the presence of Mycobacterium tuberculosis. It is necessary to open empty, remove cheese - like tuberculosis, reuse antituberculotics cavity.

(2) before and after operation also required a longer period of application of anti-TB drugs, and to prevent disseminated tuberculosis treatment after the consolidation.

(D) the treatment of bladder contraction TB bladder contraction of cystitis serious consequences, often in serious bladder tuberculosis healing process gradually taking shape. Treatment methods as follows:

1. By nephrectomy in the treatment of tuberculosis, or TB control variable, seeking to expand the bladder. Contracture in a lesser individual cases, the patient gradually extended training time between urination, bladder capacity is gradually increasing. Can use this method of cases less serious contracture is not used.

2. Drug treatment due to serious inflammation of the bladder tuberculosis alternating with the healing process, in the urinary tract treatment of primary lesion, it should proceed with the treatment. The author has introduced a more Yu (guaiazulene), pyrazinamide (ZA), oxygen chlorine acid (clorpactin XCB), the treatment of bladder tuberculosis, and expand the capacity of the bladder to prevent the occurrence of contracture. Oxygen chlorine acid is an effective fungicide for use in the bladder irrigation water can be released from hypochlorite (hypochlorous acid) to achieve sterilization purposes, removal of bladder lesions in the necrotic tissue from expanding creative use of the normal mucosa without any damage, lesions can heal, bladder capacity increased. But now bladder scar contraction, despite washing can not increase capacity. Lattimer highlighted in the local irrigation, yet at the same time application in the treatment of systemic anti-tuberculosis.

3. Surgery for a clear diagnosis of bladder contraction, in 50 ml capacity below, and not the conservative treatment of bladder capacity to expand, it should consider expanding bladder surgery. Bladder approach is to expand the use of free-intestinal and bladder anastomosis, free of the past is the application of the ileum, although free of the ileum of the activities of large, easy and bladder contraction for anastomosis, but because many of the ileum after expanding bladder patients will ileum of the expansion, loss of tension, to pass urine retention in the expanded bladder not emptying, so now basically have not adopted. Applications currently are generally free of the colon to expand the bladder. Colon to the merits of strong contraction. Colon applications within 12 cm in length. Bladder coincide with the approach adopted cat-tail anastomosis. If patients in bladder contraction while tuberculosis ureter stenosis or Lower Ureteral stricture tuberculosis, should be expanded in the bladder, ureter will narrow over the cut, top ureteral re-anastomosis with a free colonoscopy. If the bladder contraction of the urethral stricture of tuberculosis exist unless it can urethral stricture expansion to be resolved, otherwise it is not appropriate to expand the contracture bladder surgery, only to abandon the purposes of the bladder and urinary diversion suitable.

(5) the treatment of contralateral hydronephrosis contralateral hydronephrosis need to be addressed, the urinary system must have a comprehensive understanding of, such as the degree of hydronephrosis and ureter expansion of the state, lower ureter, the narrow whether ureteral orifice, bladder whether contracture, and the extent of contracture. Finally choose the right treatment options. General treatment options have the following categories:

1. Contralateral kidney ureter mild to moderate expansion of the merger water bladder contraction: in the treatment of bladder contraction in accordance with the surgical treatment of sigmoid colon and bladder, ureter and expand the colon for anastomosis.

2. Contralateral kidney ureter mild to moderate expansion without water bladder contraction (by water or ureteral orifice by the Lower Ureteral stricture): treatment for a cut or ureteral dilatation of the stricture of the distal ureter or expansion . If expansion can not succeed, they may consider a cut after the ureter and bladder re-anastomosis.

3. Contralateral kidney ureter expansion of water caused severe renal dysfunction: kidney should be held water drainage operation. There are two methods of operation:

(1) temporary kidney stoma surgery: kidney, ureter severe water can be used for renal stoma surgery. Stoma in the urine drainage for a considerable period of time, if the expansion narrow, water change or disappear, renal function returned to normal, can only expand further bladder surgery in the transplant ureter bladder wall in the expansion. Subsequent removal of the kidney stoma catheter.

(2) permanent drainage: If renal stoma after water has not changed, nor narrow the ureteropelvic expansion can be renal catheter permanent stoma remain in the pelvis, long-term drainage. If the renal pelvis and ureter expansion of water and there is no serious chance of urinary repair the original channel can be directly ostomy permanent kidney or ureter expansion of the purposes of the skin graft or bladder with ileum (Bricker surgery). Consider drainage and difficult to restore permanent normal urinary voiding following several conditions: ① urethra with severe tuberculosis, it is estimated that difficult to repair the urinary patency. ② bladder contraction extremely serious, it is estimated that difficult to expand the bladder. ③ merger intestinal tuberculosis, peritoneal tuberculosis or other gastro-intestinal diseases. ④ water renal serious obstacle to the resumption of operation is estimated to be competent minor electrolyte disordered. ⑤ The patient is in very poor and can no longer implement molding surgery.

(6) TB spontaneous rupture of the bladder because of the treatment of bladder tuberculosis spontaneous rupture of renal tuberculosis is a serious late complications. Often in the bladder rupture patients before symptoms of urinary tuberculosis, and often rupture after acute abdomen cases. If not diagnosed early exploratory laparotomy should be clear to avoid bungled rescue time. For TB spontaneous rupture of the bladder should be implemented as soon as possible surgery to repair the bladder perforation, and bladder ostomy. Before and after surgery should be routinely taking anti-TB drugs. According to subsequent renal tuberculosis lesions for further processing.

Renal tuberculosis

Urinary Tuberculosis is secondary to other parts of the body TB lesions, which is the main renal tuberculosis. In the urinary tuberculosis in renal tuberculosis is the most common, the first occurred after the spread from the kidney to the urinary system. Therefore renal tuberculosis has actually represent the significance of urinary tuberculosis.

[Diagnosis]

Renal tuberculosis disease process has been very slow, in clinical performance is to stimulate bladder symptoms. So the diagnosis of renal tuberculosis is cystitis symptoms (frequency, urgency, Niaotong) for clues. Apart from the obvious cause cystitis reasons, should consider the possibility of renal tuberculosis, the need for further systematic inspection.

(1) history of chronic medical examination and analysis of the frequency, urgency, Niaotong and hematuria, or the general anti-inflammatory treatment of cystitis prolonged Buyu, should consider changing the existence of renal tuberculosis. Especially young men in urinary tract infection, urine culture nor the general growth of bacteria, should be carried out more inspections of urinary tuberculosis. Caution should be taken when a medical examination in the body the TB lesions, in particular the male reproductive tract check the prostate, vas deferens, epididymis whether nodules. In the urinary tract areas should check whether renal mass, whether a higher angle ridge rib pain.

(2) laboratory inspection

1. Urine routine examination of urine was often acidic reaction, with a small amount of protein, in the majority of patients can be seen under the microscope a small or medium of red or white cells. But in the event of mixed urinary tract infection when alkaline urine can be a reaction, were found a large number of leukocytes, or abscess ball.

2. Urine ordinary bacterial culture renal tuberculosis is the specific urinary tract infection. Urine ordinary bacterial culture should be negative. However, a considerable part of the renal tuberculosis existence of the mixed urinary infection, urine ordinary bacterial culture can be positive, it was reported mixed with renal tuberculosis, urinary tract infection up to 1 / 3 to 1 / 2.

3. Urine checks of Mycobacterium tuberculosis

(1) 24-hour urine acid-fast bacilli Mycobacterium tuberculosis check is in a kind of acid-fast bacilli. 24 hour urine concentration of acid-fast staining for direct smear after AFB inspection method is simple, rapid results, the positive rate of 50 ~ 70%, but Baopigou bacillus, Mycobacterium grass is often in the urine AFB, acid-fast bacilli in the urine does not mean that Mycobacterium tuberculosis. But many times this inspection, the same can find AFB, and the combination of clinical history and characteristics of the reference, in the diagnosis of renal tuberculosis or some reference value.

(2) urinary tuberculosis urine culture of Mycobacterium tuberculosis culture in the diagnosis of renal tuberculosis decisive role. TB-positive urine culture can be sure of the diagnosis of renal tuberculosis. But training for quite a long time to 1 to 2 months to get the results, the positive rate can be as high as 90%.

(3) animal inoculation urinary tuberculosis animal urine tuberculosis vaccination results in diagnosis of renal tuberculosis highly valued and can be used as the basis for the diagnosis of renal tuberculosis, the positive rate is as high as 90 percent. However, a longer time-consuming, long, can be two findings.

4. Urine TB Nassau IgG antibody detection of tuberculosis, and other activities were found in a certain amount of specific antibody. Grauge and other certificates for the specific antibody IgG category. First Affiliated Hospital of Hubei Medical College reported to polymerization OT as antigen using ELISA of IgG antibodies in urine tuberculosis, renal tuberculosis patients with tuberculosis in urine IgG antibody positive rate of 89.1%. Prove that the checks have a certain sensitivity and specificity for the diagnosis of renal tuberculosis considerable clinical significance. But for advanced renal function and renal tuberculosis serious damage does not secrete urine, or renal tuberculosis with ureteral obstruction, and not from urine disease side, seized by the urine from the contralateral kidney, there may be false negative.

5. Tuberculin test tuberculin test is to check whether the body by Mycobacterium tuberculosis infection in a method, the most commonly used TB, but other organs of the body the TB change also be a valuable reference.

(1) tuberculin any of the following categories: ① old tuberculin; ② pure tuberculin; ③ atypical Mycobacterium made of purified protein derivatives; ④ Calgary streptozotocin four. General old tuberculin test.

(2) Old tuberculin (old tuberculin, OT) made: TB-employment training two months, heating inactivated, filtered dead bacteria, evaporation of the original volume to 1 / 10, namely, tuberculin dope. After 1952 by the World Health Organization require each containing 10 ml tuberculin units (TUberculin unit, TU), equivalent to 1000 mg.

(3) Test Method: Using the old tuberculin standardization of the first with 1 / 1000 or 1 / 2000 (each containing 0.1 ml respectively 10.5 TU) dilution of 0.1 ml injection in the left forearm in the medial 1 / 3 Paper within. 48 ~ 72 hours after the observation of reaction, such as negative, then 1 / 100 (0.1 per 100 ml containing TU) dilution repeat test results and determine response.

(4) The positive tuberculin test standards

(5) the significance of positive tuberculin reaction: ① BCG vaccination and the artificial immune. ② infected with Mycobacterium tuberculosis, but need to further confirm or activities except tuberculosis. ③ children positive significance: 8 years of age, active tuberculosis may be greater than 50%. 4 years of age, almost all active TB may be. Under 3 years of age, not only will the active TB, if not treated, the prognosis may be bad. Under 1 year of age, have active tuberculosis, if not treated, the prognosis definitely bad. ④ strong positive tuberculin test, there are active tuberculosis, must be checkups.

6. ESR examination of renal tuberculosis is a long-term chronic disease, a wasting disease, increased erythrocyte sedimentation rate checks to be fast. Li Zhe 300 cases reported in 255 cases of renal tuberculosis have increased erythrocyte sedimentation rate faster phenomenon. But ESR examination of renal tuberculosis disease no specificity, ran on cystitis patients with erythrocyte sedimentation rate by block often suggested that the possibility of a renal tuberculosis, they can be used as a reference check.

7. Renal function tests

(1) urea nitrogen, creatinine, uric acid determination: the side of renal tuberculosis does not affect renal function tests, if the serious side of renal tuberculosis and involvement from the contralateral kidney or renal function caused by water while the renal function checks can display higher. Kidney function te