Fifty strip preparations of human gall bladder from 25 specimens removed at operation were studied. Immedia tely after removal the unopened gall bladder was placed in Ringer lactate solution chilled to 4°C and gassed with 95% 02 and 5% CO2. Strips of the wall of the organ, containing muscle and mucosa, and about 20 mm by 2 mm, were cut within two hours of removal. In the majority of experiments a pair of strips were set up to gether in the same organ bath giving a simultaneous record of the circular and longitudinal muscle. The preparation was suspended in modified Krebs solution at 37°C equilibrated with the 95% 02 and 5 % CO2 mixture. Recordings were made on a smoked drum using an isotonic system with a load of IG. A vibrator was used to reduce friction.

SPONTANEOUS ACTIVITY Human gall bladder muscle strips show rhythmic spontaneous contraction and relaxation. Sustained tone is also shown. Slow but considerable changes in tone may also occur, as for example, during the period of 30 minutes after the preparation has been set up when a gradual rise in tone is often seen (Fig. 1). In any preparation there is a general correspondence between the degree of spontaneous activity, the sensitivity to added drugs, and the absence of fibrosis. In general, circular muscle strips are more active and more sensitive than are longitudinal.

The gall bladder acts as a reservoir for bile and plays a part in the regulation of biliary pressure. There has been argument in the past as to whether the muscle tissue in the wall plays an active role in the expulsion ofstored bile or simply aids in prevent ing distension and in adjusting to variations in the volume of the contents as suggested by Halpert and Lewis (1930).

Objectives Heister valves are mucosal folds located on the endoluminal surface of the cystic duct (CD) and were first described by Lorenz Heister in 1732. Their presence could represent an obstacle that impedes transcystic exploration. It has been suggested that the distribution of Heister valves follows a steady rhythmic pattern in a spiral disposition; however, there is no conclusive data to support this claim. The aim of this study was to describe the main characteristics of the CD and Heister valves in adult human cadavers. Methods A descriptive cross-sectional study was performed on 46 extrahepatic biliary tracts. Results The CD has an average length of 25.37 mm and diameter of 4.53 mm. The most frequent level of junction was the middle union. Heister valves were present on 32 CDs; in most cases, they were distributed uniformly on the duct and presented an oblique disposition. A nonreticular pattern was the most frequent reticular pattern. The most frequent type of the nonreticular type was the B1 subtype. The most frequent type of distribution was the nonreticular type, particularly the B1 type. Conclusions The cystic fold could hinder transcystic exploration. The cysticotomy incision should not be determined by the distribution of the fold on the CD. The morphology of the Heister valves does not show evidence of a steady systematic pattern.

Eponyms are very commonly used in medicine. Eponyms serve the goal of honoring scientists who have made important contribution to medicine. The article describes widespread and seldom used eponyms found in biliary structures. Priority of discovery of the "Heister's valve", "Luschka's ducts", "sphincter of Odd", "Vater's papilla" was established. An author provides biographical sketches of physicians in whose honor some anatomic entities were named.

The most detailed description of these ureteral folds was published in 1942 by Ostling [1] in a scholarly paper on the genesis of hydronephrosis, particularly with regard to changes at the ureteropelvic junction. He studied the ureters of 250 fetuses in various stages of development, as well as specimens from a number of newborns and infants, by means of microscopic sections, retrograde thorotrast injections, and ureteral cast techniques. Ureteral folds identical both grossly and histologically to the ones we describe were found in all fetuses as early as the fourth month of gestation, in 37 of 40 newborns, and in all of 10 infants less than 1 year old. Ostling concluded that these folds were normal developmental structures and postulated that they were due to a length reserve of the ureter which was used during growth of the spine and the retroperitoneum after birth. He also hypothesized that disturbances in the development of these fetal folds might be an important factor in the genesis of hydronephrosis. In his paper, Ostling [1] referred to previous similar observations by W#{244}lfler (1877) and Englisch (1879). Our review of normal excretory urograms in infants confirms the high frequency of upper ureteral folds. The radiology and anatomy of folds in our patients are identical to those described by Ostling. Transverse upper ureteral folds are felt to represent a persistence of normal fetal structures. They have no postnatal clinical significance.

Trarisverse folds in the proximal ureter. A normal variant in infants

THE diagnosis of varicose veins of the ureter as a cause of haematuria will rarely be made preoperatively. Usually exploration is carried out to exclude more serious disease, although occasionally the bleeding itself has been so profuse as to endanger life. Since the first reported case in 1922 there have been 14 cases reported, I in the British literature. I would like to add a further case, discuss the pathology and anatomy, and suggest an aid to diagnosis in the future.

Ureteric varicosities usually present with painless haematuria. The condition is commoner in the male (12 : 3) and on the left side (12 : 3). Although portal hypertension or other intraperitoneal disease may predispose to their formation this is unusual-on the other hand, varicocoele and varicose veins of the lower limb are commonly associated. It may have been surmised that the gonadal vessels would have been always involved, but this is not so. Ahlberg, Bartley, and Chidekel (1966), in cadaver studies, have shown that the valves at the upper end of the gonadal vessels are more commonly incom- petent on the left than on the right, and in men than in women. Arey (1944) showed that the develop- ment of the left renal vein is more complicated than that of the right and that potential embryological portacaval anastomoses are common here. Doehner, Ruzicka, Rousselot, and Hoffman (1956), also working on cadavers, have confirmed connexions between the splenic and renal veins on the left side.

Folsum, in I 922, during a discussion on haematuria of obscure cause, described a man with bleeding seen cystoscopically to be coming from the right ureteric orifice. 'The patient had marked varicose veins of the lower limbs, scrotum, and penis. An intravenous pyelogram was not carried out, but at operation large veins were found over the ureter and pelvis of the kidney, one of which had ruptured into the urinary tract. Unfortunately he does not describe the outcome. Sporer and Pollock, in 1947, carried out a left nephrectomy in a 62-year-old man for profuse haematuria. In this case the intravenous pyelogram was normal and the side was determined by cysto- scopy. ,4t operation marked caval and portal veins were present, one large varix having ruptured at the pelvi-ureteric junction. Subsequently the patient died from a carcinoma of the stomach and it is probable that this lesion was the prime cause of the prominent veins. Maslow and Aron (1949) similarly performed a right nephrectomy for a ruptured varix at the pelvi- ureteric junction. The intravenous pyelogram suggested an irregularity at this spot preoperatively. The patient was only 33 years old and he had required bilateral varicose-vein operations in the past. Berman and Copeland (1953) appear to be the first to describe the scalloped ureteric appearance typically seen on the intravenous pyelogram in the majority of these patients. Their 57-year-old male had haematuria, and the intravenous pyelogram showed multiple filling defects of the upper two- thirds of the ureter. Cystoscopically, multiple 'benign polyps' were seen in the bladder. These were dealt with endoscopically and subsequently a left retrograde pyelogram confirmed the persistence of the ureteric defects. The ureter was explored and large veins were found emptying into a vein on the anterior surface of the pelvis of the kidney. The spermatic vein was reported as normal.

SUMMARY I. Fifteen cases of ureteric varicose veins are discussed. They nearly all (a) present with haematuria or (b) show a scalloped corkscrew-like appearance to the ureter on the intravenous pyelogram without evidence of proximal obstruction. 2. Varicose veins of the lower limbs and varicocoele are commonly present. 3. It is suggested that there are two main types: those draining vertically via the renal pedicle and those draining via a ‘communicating’ vein in the gonadal vessels. 4. Spermatic phlebography is suggested as a possible aid to differential diagnosis in the future.

“Corkscrew ureter” has previously been de- scribed as occurring in the upper ureter, result- ing from either ureter-al varices which occur at any age, or transverse folds in the proximal ureter as a normal finding in neonates. 1-4 Herein we report 3 cases of a corkscrew appearance of the distal ureter, all of which were secondary to extrinsic compression.

’ A review of the literature reveals that terms such as corkscrew ureter, UROIOGY / AUGUST 1982 / VOLUME XX, NUMBER 2 scalloped ureter, and notched ureter have all been used to describe the effects on the ureter secondary to varices in the proximal ureterSS7 The term “corkscrew ureter” has also been applied to the appearance on intravenous urog- raphy of transverse upper ureteral folds which are prominent in the neonatal period. These are postulated to be of no clinical importance.2-4 We have seen a typical corkscrew appearance of the distal ureter which has not been previously described. In all 3 cases the original radio- graphic appearance of these lesions on. retro- grade pyelography suggested intrinsic ureteral disease. All 3 patients ultimately were proved to have extrinsic ureteral compression.

Abstract A "corkscrew deformity" of the proximal ureter is a rare congenital anomaly that typically lacks any postnatal clinical significance. The rarity of this entity, however, has not allowed the clarification of its natural history and the ideal approach to its management. We herein present a case of a 27-year-old female patient who presented with right flank pain and significant hydronephrosis. On retrograde ureterography, a typical spiral configuration of the proximal ureter was noted. The patient underwent successful reconstruction by laparoscopic transperitoneal dismembered pyeloplasty. We report the first use of laparoscopic reconstruction for the management of "corkscrew deformity" of the proximal ureter and we focus on the imaging findings, technical details, advantages and limitations of this technique.

Then, the patient was admitted. The following day he developed a septic shock with urinary cultures positive for multi-drug resistant Klebsiella pneumoniae. A new abdominal bedside ultrasound showed a hydronephrosis of the right kidney with an unusual ureteral dilatation. An emergency percutaneous pielostomy was performed and anterograde urethrography showed that the right ureter was twisted along its long axis with a characteristic corkscrew appearance (Figure 1). A ‘‘corkscrew deformity’’ of the proximal ureter is mainly due to a rare congenital anomaly that typically lacks any postnatal clinical significance (1). We probably report a rare case of secondary corkscrew deformity due to the chronic inflammation/ infection and obstruction (2–4). The rarity of this entity has not allowed the clarification of its natural history and the ideal approach to its management.

肠道多发息肉病，高级别上皮内瘤变，不排除已经癌变

肝硬化，转科到肝疾病内科。最佳治疗方案肝移植，50万人民币

肝功能异常，黄疸。肝功能分级child B

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