Information for Authors

1 General Asian Journal of Andrology (AJA) is the official publication of the Asian Society of Andrology sponsored by the Shanghai Institute of Materia Medica, Chinese Academy of Sciences. The Journal has been included in 11 international indexing systems, including BIOSIS, CAB Abstracts, CAB Health, Chemical Abstracts, Current Contents/ Clinical Medicine, EMBASE, Index Medicus, MEDLINE, PASCAL, Research Alert, and SCI Expanded. The Impact Factor is 0.827 and ranks third among the international andrology journals.     

Information for Authors

1 General Asian Journal ofAndrology (AJA) is the official publication of the Asian Society of Andrology sponsored by the Shanghai Institute of Materia Medica,Chinese Academy of Sciences.The Journal has been included in 11 international indexing systems,including BIOSIS,CAB Abstracts,CAB Health,Chemical Abstracts,Current Contents/     

Information for Authors

1 General Asian Journal of Andrology (AJA) is the official publication of the Asian Society of Andrology sponsored by the Shanghai Institute of Materia Medica, Chinese Academy of Sciences. The Journal invites concise reports of original research on all areas of andrology, both experimental and clinical, including modern, traditional and epidemiological, from any pan of the world. Review articles will be     

Information for Authors

General Asian Journal of Andrology ( AJA ), the official journal of the Asian Society of Andrology, invites reports of original research on all areas of andrology, both experimental and clinical, including modem, traditional, and epidemiological, from any part of the world.Short communications (including clinical practice or case report) and letters to the editor are also welcome. Review articles based primarily     

Mediastinoscopic Subaortic and Tracheobronchial Lymph Node Dissection With a New Cervico-Hiatal Crossover Approach in Thiel-Embalmed Cadavers

The use of mediastinal surgery for minimally invasive esophagectomy (MIE) has been proposed; however, this method is not performed as radical surgery because it has been thought to be impossible to perform complete upper mediastinal dissection, including the left tracheobronchial lymph nodes (106tbL). We herein describe a new method for performing complete dissection of the upper mediastinum. We developed a method for performing complete mediastinoscopic esophagectomy as radical surgery via the bilateral transcervical and transhiatal approach in 6 Thiel-embalmed human cadavers. The lower and middle mediastinal lymph nodes are dissected via the transhiatal approach. The dorsal side of the left recurrent nerve is dissected up to the aortic arch and left recurrent nerve lymph nodes (106recL) are dissected under pneumomediastinum. Next, the right recurrent nerve lymph nodes (106recR) are dissected. The cartilage of the left main bronchus is dissected and pushed downward, thereby obtaining a good view between the aortic arch and left main bronchus via the transhiatal approach. The 106tbL lymph nodes are dissected until the aortic arch is reached. Simultaneously, the lymph nodes are dissected via a right cervical incision. This method is termed the “cross-over technique.” We herein demonstrated that the upper mediastinal lymph nodes, including the 106tbL nodes, can be dissected using the bilateral transcervical and transhiatal approach under pneumomediastinum and named this method “mediastinoscopic esophagectomy with lymph node dissection” (MELD). MELD is therefore considered to be a useful modality based on our experience with Thiel-embalmed human cadavers.Key words: Mediastinoscopic esophagectomy, Esophagectomy, Minimally invasive esophagectomy, MELD, Cross-over technique, ThielMinimally invasive esophagectomy (MIE) has been attempted using thoracoscopic surgery with or without laparoscopic procedures.^1,2 However, the application of MIE with radical lymphadenectomy usually includes a transthoracic procedure; this method mandates the use of 1-lung ventilation and destruction of the thoracic wall. The administration of 1-lung ventilation is reported to induce mechanical damage to both the ventilated and collapsed lung.^3,4 We considered that it is possible to perform radical esophagectomy without the thoracic approach, as the esophagus and regional lymph nodes are located inside the bilateral mediastinal pleura. Therefore, total transhiatal and bilateral transcervical radical lymphadenectomy may well be carried out without thoracic damage. Some reports have described the use of mediastinal esophagectomy; however, this method cannot be used to dissect the 106tbL lymph nodes. To date, no authors have reported the successful dissection of these lymph nodes. We herein developed a novel technique for performing transhiatal and bilateral transcervical dissection of the total esophagus and regional lymph nodes, thereby allowing for the application of completely visualized dissection using a 2-field technique for MIE. We applied the “cross-over technique” consisting of the transhiatal and bilateral transcervical approach, which is suitable for dissection in a narrow operative field. In this article, we report our first experience with the “cross-over technique,” using transhiatal and transcervical radical esophagectomy in 6 Thiel-embalmed human cadavers.     

Changes in Health-Related Quality of Life (HRQOL) of a Specific Group of Adolescent Idiopathic Scoliosis (AIS) Patients Who Came Across Both Bracing and Surgery

Background/Purpose of the StudyChanges in health-related quality of life (HRQOL) of AIS patients coming across both bracing and surgery have not yet reported. These patients received two major clinical interventions and their HRQOL might be different from previous articles. The aim of this study is to evaluate the changes of HRQOL of a specific group of AIS patients who experienced both bracing and surgery.MethodsOne hundred and twenty-eight patients requiring surgery with prior bracing treatment were identified from the electronic record. SRS-22 questionnaire was completed at 7 time points crossing both interventions (namely “Before”, “Bracing ≤ 1 year”, “Bracing > 1 year”, “Pre-op”, “Post-op”, “Post-op ≤ 1 year, and “Post-op 1-2 years”).ResultsSRS-22 “Function”, “Pain” and “Self-image” scores were decreased from “Before” to “Bracing ≤ 1 year” when started bracing and raised at “Bracing > 1 year”. The 3 scores were dropped from “Bracing > 1 year” to “Pre-op”, particularly on “Self-image”. “Function” and “Pain” were significantly dropped from “Pre-op” to “Post-op” and kept raising until “Post-op 1–2 years”. “Self-image” was improving after “Pre-op”. “Mental” was relatively stable along the timeline.ConclusionThis study described the changes in HRQOL of a specific group of AIS patients. Scores were dropped after the two major clinical interventions and recovered afterwards. Medical professionals were able to plan and provide appropriate supports on the expected changes in HRQOL, especially on function, pain and mental.     

Nasal Methicillin-Resistant S. Aureus is a Major Risk for Mediastinitis in Pediatric Cardiac Surgery

Background: Mediastinitis caused by methicillin-resistant Staphylococcus aureus (MRSA) is a serious complication after pediatric cardiac surgery. An outbreak of surgical site infections (SSIs) provided the motivation to implement SSI prevention measures in our institution.Methods: Subjects comprised 174 pediatric patients who underwent open-heart surgery after undergoing preoperative nasal culture screening. The incidence of SSIs and mediastinitis was compared between an early group, who underwent surgery before SSI measures (Group E, n = 73), and a recent group, who underwent surgery after these measures (Group R, n = 101), and factors contributing to the occurrence of mediastinitis were investigated.Results: The incidence of both SSIs and Mediastinitis has significantly decreased after SSI measures. With regard to factors that significantly affected mediastinitis, preoperative factors were “duration of preoperative hospitalization” and “preoperative MRSA colonization,” intraoperative factors were “Aristotle basic complexity score,” “operation time,” “cardiopulmonary bypass circuit volume” and “lowest rectal temperature.” And postoperative factor was “blood transfusion volume.” Patients whose preoperative nasal cultures were MRSA-positive suggested higher risk of MRSA mediastinitis.Conclusions: SSI prevention measures significantly reduced the occurrence of SSIs and mediastinitis. Preoperative MRSA colonization should be a serious risk factor for mediastinitis following pediatric cardiac surgeries.     

Propionibacterium acnes infection after shoulder surgery

Propionibacterium acnes has been implicated as a cause of infection following shoulder surgery, may occur up to 2 years after the index operation and has been shown to be responsible for up to 56% of shoulder infections after orthopedic implant. Male patients within the population undergoing shoulder surgery are particularly at risk, especially if their shoulder surgery involved prosthesis or was posttraumatic. P. acnes infection can be difficult to diagnose clinically and laboratory techniques require prolonged and specialized cultures. Usual inflammatory markers are not raised in infection with this low virulence organism. Delayed diagnosis with P. acnes infection can result in significant morbidity prior to prosthesis failure. Early diagnosis of P. acnes infection and appropriate treatment can improve clinical outcomes. It is important to be aware of P. acnes infection in shoulder surgery, to evaluate risk factors, to recognize the signs of P. acnes infection, and to promptly initiate treatment. The signs and symptoms of P. acnes infection are described and discussed. Data were collected from PubMed™, Web of Science, and the NICE Evidence Healthcare Databases - AMED (Ovid), BNI (Ovid), CINAHL (EBSCO), Embase (Ovid), HMIC: DH-Data and Kings Fund (Ovid), Medline (Ovid), and PsycINFO (Ovid). The search terms used were “P. acnes,” “infection,” “shoulder,” and “surgery.” In this review, we summarize the current understanding of the prevention and management of P. acnes infection following shoulder surgery.     

“Acute postoperative open abdominal wall”: Nosological concept and treatment implications

The so-called “burst abdomen” has been described for many years and is a well-known clinical condition, whereas the concept of the “open abdomen” is relatively new. In clinical practice, both nosological entities are characterized by a complex spectrum of symptoms apparently disconnected, which in many cases poses a great challenge for surgical repair. In order to assess the management of these disorders in a more comprehensive and integral fashion, the concept of “acute postoperative open abdominal wall” (acute POAW) is presented, which in turn can be divided into “intentional” or planned acute POAW and “unintentional” or unplanned POAW. The understanding of the acute POAW as a single clinical process not only allows a better optimization of the therapeutic approach in the surgical repair of abdominal wall-related disorders, but also the stratification and collection of data in different patient subsets, favoring a better knowledge of the wide spectrum of conditions involved in the surgical reconstruction of the abdominal wall.     

Fronto-Orbito Zygomatic Approach: A Technical Modification

The fronto-orbito zygomatic approach is part of the surgical armamentarium of modern skull base surgery. As described in the literature, it requires costly technological tools such as powerful drills and saws, to be performed. In the present communication we describe a technical modification that allows the zygoma to be elevated “en bloc” together with the fronto-orbital bone flap by means of appropriate use of the Gigli's saw. Using this technique, adequate replacement of the craniotomy flap requires only two silk sutures. This technical modification, which was already successfully used in over 20 cases, would also allow this useful approach to be performed in those neurosurgical environments where modern costly technology for cranial base surgery is not available.     

“En-Bloc” Removal of Small- to Medium-Sized Acoustic Neuromas With Retrosigmoid-Transmeatal Approach

Surgery of acoustic neuroma (AN) has significantly refined over the past years due to a series of advances in diagnostics and surgical technique. Electrophysiologic investigation performed during surgery has greatly contributed to this progress, increasing the surgeon''s understanding of the mechanism of damage and suggesting various changes in his or her surgical strategy.In this context, the advantages of the retrosigmoid “en-bloc” removal of small to medium size ANs have been examined in the present study. At the ENT Department of the University of Verona, 103 subjects with AN were operated on, from January 1990 to December 1995, with a retrosigmoid-transmeatal approach. Eighteen subjects (17.4%) presented pure a intracanalar (IC) tumor and 85 (82.6%) had both IC and extracanalar (EC) involvement. All the IC tumors (n = 18) and 70 of the IC-EC neuromas with an EC size less than 25 mm are reported in this paper for a total of 88 patients. The first 48 patients were operated on via the classic procedures described in the literature, characterized by removal of the tumor after “debulking” and limited exposure of the internal auditory canal (IAC). The following 40 subjects were operated on according to the technique of “en-bloc” removal of the tumor and wide exposure of the IAC.In the “en-bloc” group the tumor was first detached from the cerebellar flocculus and the pons, when necessary. The tumor was not debulked to preserve the anatomic relationship with the nerves and to facilitate identification, cleavage and dissection of the tumor from the neural structures. Thereafter, the posterior wall of the IAC was drilled out and opened in a circumferential range from 180 to 270°. The IAC dura was subsequently opened, and the distal end of the AN along with the vestibular nerves were identified. The vestibular nerves were sectioned in the distal portion of the IAC and dissected with the tumor from the underlying facial and cochlear nerves. Dissection continued medially to the IAC porus. The AN was progressively dissected from the cochlear and facial nerves in the cerebellopontine angle (CPA) with multiple direction maneuvers, as required by the characteristics and degree of adherence to the neural structures.The anatomic and functional results obtained with this new procedure (“en-bloc” removal) were compared with the classic “debulking” technique. The statistical analysis shows an improvement in postoperative outcome for both auditory and facial nerve function. The “en-bloc” removal procedure along with the wide exposure of the content of the IAC and electrophysiologic monitoring of the seventh and eighth cranial nerves are, in our experience, the recommended strategies for improving outcomes in small to medium size ANs.     

Single-Port Laparoscopic Parastomal Hernia Repair with Modified Sugarbaker Technique

Introduction:

Laparoscopic parastomal hernia repair with modified Sugarbaker technique has become increasingly the operation of choice because of its low recurrence rates. This study aimed to assess feasibility, safety, and efficiency of performing the same operation with single-incision laparoscopic surgery.

Materials and Methods:

All patients referred from March 2010 to February 2013 were considered for single-port laparoscopic repair with modified Sugarbaker technique. A SILS port (Covidien, Norwalk, Connecticut, USA) was used together with conventional straight dissecting instruments and a 5.5- mm/52-cm/30° laparoscope. Important technical aspects include modified dissection techniques, namely, “inline” and “chopsticks” to overcome loss of triangulation, insertion of a urinary catheter into an ostomy for ostomy limb identification, safe adhesiolysis by avoiding electocautery, saline -jet dissection to demarcate tissue planes, dissection of an entire laparotomy scar to expose incidental incisional hernias, adequate mobilization of an ostomy limb for lateralization, and wide overlapping of defect with antiadhesive mesh.

Results:

Of 6 patients, 5 underwent single-port laparoscopic repair, and 1 (whose body mass index [BMI] of 39.4 kg/m² did not permit SILS port placement) underwent multiport repair. Mean defect size was 10 cm, and mean mesh size was 660 cm² with 4 patients having incidental incisional hernias repaired by the same mesh. Mean operation time was 270 minutes, and mean hospital stay was 4 days. Appliance malfunction ceased immediately, and pain associated with parastomal hernia disappeared. There was no recurrence with a follow-up of 2 to 36 months.

Conclusion:

Compared with multiport repair, single-port laparoscopic parastomal repair with modified Sugarbaker technique is safe and efficient, and it may eventually become the standard of care.     

Coronary transfer in the arterial switch operation: the modified closed technique

Arterial switch operation for transposition of great arteries (TGA) is the choice of surgical treatment for this condition. Conventional “open” coronary transfer technique has been commonly employed with good results in experienced hands. A modified “closed” technique of coronary transfer, with a more accurate coronary artery placement taking into account a distended aorta, along with anterior interrupted sutures to reduce purse stringing and other advantages is described.