The effect of complete and incomplete Pelvic Autonomic nerves Preservation on Urination Function in Patient With Resection of Rectal Carcinoma

Objective： To evaluate the influence of complete and incomplete pelvic autonomic nerve preservation （PANP） on urination function in patients with resection of rectal carcinoma. Methods： The changes of pre-and post-operative residual urine volume （RUV） in patient undergoing complete PANP （n = 15） and incomplete PANP （n = 17） were observed. Results： In fifteen cases with complete PANP, preoperative RUV was 4.09 ml, 14 days and 3 months after operation RUV were 8.00 ml and 7.02 ml （P 〉 0.05）. In seventeen cases with incomplete PANP, preoperative RUV was 3.90 ml, 14 days and 3 months after operation RUV were 36.55 ml and 22.64 ml （P 〈 0.001 ）. Conclusion： Complete and incomplete pelvic autonomic preservation may affect urination function in patients with resection of rectal carcinoma and RUV is an effective indicator if the pelvic autonomic nerves are preserved completely.     

Expression of hNav1.8 sodium channel protein in affected nerves of patientswith trigeminal neuralgia

Objective: To explore the pathogenesis of trigeminal neuralgia (TN) and to provide a new target for the drug treatment of TN by studying the expression of tetrodotoxin-resistant hNavl. 8 sodium channel protein in affected nerves of patients with TN. Methods: Twelve affected inferior alveolar nerves were obtained from patients with idiopathic TN, to whom the drug therapy was not effective. As negative control, one normal inferior alveolar nerve was obtained from patients who accepted the combined radical neck dissection with glessectomy and mandibulectomy. One muscle sample was obtained as normal control. One dorsal root ganglion from rat was as positive control. These tissues and prepared hNav1.8 antibody were conducted immunohistochemistry response. Results: hNavl. 8 channel protein was expresses in all the 12 specimens of the affected nerves of patients with TN, but not in the muscle sample and the normal inferior alveolar nerve. Conclusion: The abnormal expression of hNavl. 8 channel protein in the affected nerves of patients with TN may play an important role in the pathogenesis of TN.     

Prevalence of nerve-vessel contact at cisternal segments of the oculomotor nerve in asymptomatic patients evaluated with magnetic resonance images

Background Some studies indicated that cases of idiopathic oculomotor nerve palsy can be explained by vascular compression of the oculomotor nerve. Vascular contact with or compression to the cisternal segment of the oculomotor nerve has been reported frequently in asymptomatic individuals. In this study, we retrospectively analyzed the relationship between the oculomotor nerve＇s cisternal segment and adjacent arteries in asymptomatic patients and the prevalence of this occurrence via magnetic resonance imaging （MRI）. Method MRI of bilateral oculomotor nerves in 93 asymptomatic patients were reviewed. The oculomotor nerve-artery relationship was evaluated and classified from levels 1 to 3, representing the degrees of contact on oblique transverse and oblique sagittal reconstructed MRI. Prevalence of the nerve-artery relationship at each level was described. The correlation between the nerve-vessel relationship （levels） and the age was analyzed by Spearman＇s rank correlation analysis. Results Cisternal segment of the oculomotor nerve did not have contact with any artery （level 1） in 27.4% （51/186） nerves. One hundred nerves made contact with at least one artery （level 2）, but their shapes or configurations were not changed; 35 nerves （18.8%） were displaced or distorted due to artery compression （level 3）. The posterior cerebral artery had the greatest incidence of making contact with or compressing the cisternal segment of the oculomotor nerve （58.1%）. No significant correlation between nerve-vessel relationship （levels） and the age was found in this study. Conclusions Whether oculomotor nerve contact with or compression by one or more arteries is of high prevalence in asymptomatic individuals as evidenced by MRI examination. There is no correlation with individual age. Discretion should be used when making an etiological diagnosis of vascular compression for patients with oculomotor nerve palsy. Further investigation of other causes is warranted.     

ELECTRO-ACUPUNCTURE ANESTHESIA IN PITUITARY ADENOMA EXTIRPATION

It is clinically shown that the analgesic effect of electro-acupuncture anesthesia (EAA) for cranial operations is more effective than for other parts of the botly. Among all cranial operations the analgesic effect of prefrontal craniotomy is best. Since 1975, 43 patient.s with pituitary adenoma operated on under EAA had good or excellent results in 41/43. In this series the patients' general conditions and mental status were similar. The OPeration was carried out as a small osteoplastic flap craniotomy in the right frontal region. All acupuncture points used were close to the sensory nerve branches around the operative field. According to the puncture locations the cases are divided int0 2 groups. In Group A the points were very close to the nerves distributed in the frontal operative field includ- ing Zanzhu 攒竹, Yuyao 鱼腰, Ermen 耳门 and Shangguan 上关 In Group B point Chuan- liao 颧鼹 was located near the infraorbital nerve with another point at the ipsilateral ear lobe as a coupling point, both were a little farther away from the operative field. The good and excellent results in Group A and B included all patients except l in each group (statistically insignificant). Although a few patients com- plained or groaned slightly, they could tolerate the ent.ire operation. All points used in Groups A and B are close to sensory branches of trigeminal nerve and/or the analgesia is connected with changes of some neurochemical elements within the central ner- vous system (e.g. endorphine, 5HT). The authors' experience is that points close to sensory branches near the central nervous system have better EAA analgesic effect.     

Clinical course and cause of death in elderly patients with idiopathic Parkins on’s disease

Objective To improve the therapeutic and preventive measure for elderly patients (75 years and over) with idiopathic Parkinson’s disease (OEIPD). Methods Fifteen OEIPD patients were observed prospectively over a long period of time. Their diagnosis was confirmed by autopsy. Based on clinical and pathological data, the causes of death were analyzed.Results The mean clinical course in OEIPD patients was 6.2±3.6 years. The majority of the 15 patients were the akinetic type and the akinetic type with tremor (80.0%). In the late stages of disease (4.8±3.5 year), choking occurred in 12 OEIPD patients who received nasal feeding for an average of 4 months after the occurrence of choking. The most common complication in 12 patients was repeated pulmonary infections with an average rate of 2.9±1.9. The causes of death were bronchial pneumonia and shock induced by pulmonary infection (11 cases, accounted for 73.3%), acute myocardial infarction (2 cases), one case with cardiac rupture and one case with rupture of aortic aneurysm. Conclusions The clinical course was shorter in OEIPD patients. Levodopa therapy should be started early in OEIPD patients. Bronchial pneumonia and infectious shock constitute the major cause of death and choking was one of the main causes of aspiration pneumonia. Nasal feeding should be started as early as possible after the appearance of choking. Silent aspiration can be reduced by teaching the patient to protect the airway by ’supraglottic swallowing’.     

Repair of brachial plexus lower trunk injury by transferring brachialis muscle branch of musculocutaneous nerve: anatomic feasibility and clinical trials

Background There are few effective methods for treating injuries to the lower trunk of brachial plexus, and the curative effect is usually poor. The purpose of this study was to provide anatomic references for transferring the brachialis muscle branch of musculocutaneous nerve （BMBMCN） for selective neurotization of finger flexion in brachial plexus lower trunk injury, and to evaluate its clinical curative effects.
Methods Microanatomy and measurement were done on 50 limbs from 25 adult human cadavers to observe the origin, branch, type of the BMBMCN and median nerve, as well as their adjacent structures. Internal topographic features of the fascicular groups of the median nerve at the level of the BMBMCN were observed. In addition, the technique of BMBMCN transfer for selective neurotization of finger flexion of the median nerve was designed and tested in 6 fresh adult human cadavers. Acetylcholinesterase （AchE） staining of the BMBMCN and median nerve was done to observe the features of the nerve fibers. This technique was clinically tried to restore digital flexion in 6 cases of adult brachial plexus lower trunk injury. These cases were followed up for 3, 6, 9 and 12 months postoperatively. Recovery of function, grip strength, nerve electrophysiology and muscle power of the affected limbs were observed and measured.
Results The brachialis muscle was totally innervated by the musculocutaneous nerve （MCN）. Based on the Hunter＇s line, the level of the origin of the BMBMCN was （13.18±.2.77）cm. Ache histochemical staining indicated that the BMBMCN were totally made up of medullated nerve fibers. At the level of the BMBMCN, the median nerve consistently collected into three fascicular groups as shown by microanatomy in combination with Ache stain. The posterior fascicular group was mainly composed of anterior interosseous nerves and branches to the palmaris Iongus. The technique was tested in six fresh cadavers successfully, except that stoma split occurred in one case. Five of the six cases reco     

Y-V vascular pedicle elongation technique in island flap transplantation

Objective To introduce a new technique for vascular pedicle elongation in island flap transplantation, and evaluate its clinical results. Methods From February 1994 to October 2001,16 cases were treated with island flap transplantation with Y-V vascular pedicle elongation technique. There were 10 males and 6 females with the age ranging from 19 to 45 years (average 26. 8 years). The locations of the primary injury were as follows: the fingers in 6 cases, the great toe in 2 cases, the other toes in 2 cases, the knee joint in 3 cases and the proximal tibia in 1 case. The flaps vascularized by a branch of "Y" pattern bifurcation were used. Both branches of "Y" shaped vascular pedicle arising form the same main vessel trink were dissected, then the main vessel trunk was severed at the division of the branches, the arc of "Y" bifurcations was then turned into "V" pattern, the length of pedicle was significantly elongated than the original pedicle. Results The operative procedures were smooth in the patients,     

Ultrastructural Observation of Fallopian Tubes in Patients with Pelvic Congestion Syndrome after Oviductal Ligation

The morphological basis of bilateral lower abdominal pain was studied by means of ultrastructural observation in patients with pelvic congestion syndrome after oviductal Iigation. Fallopian tubes of 14 cases were collected during opera tion. Of them, 10 patients suffered from pelvic congestion syndrome, 4 cases were normal used as control, the 8 small segments from the tubal isthmus were removed during tigation. The essential changes of the fallopian tubes in patients with this syndrome were the marked swelling of the C type unmyeIinated nerve fibers, the decrease in density of axoplasm and in number of microtutbules and microfitaments. The Schwann‘s cells were swollen as welt. Furthermore, the mitochondria revealed mild to moderate swelling, their cristae decreased and shortened. However, the changes of the endings of efferent nerve fibers were not obvious.The ultrastructural changes of C-type unmyeIinated nerve fibers except the endings of efferent nerve fibers were closely related to the bilateral lower abdominal pain in patients with this syndrome.     

Selective percutaneous radiofrequency thermocoagulation in the treatment of trigeminal neuralgia:report on 1860 cases

Trigeminal neuralgia (TN) is defined by the International Association for the Study of Pain as "a sudden, usually unilateral, severe, brief, stabbing, recurrent pain in the distribution of one or more branches of the fifth cranial nerve".1 The incidence rate is about three to five cases per year per 100000 persons and increases with age.2 In our hospital, percutaneous radiofrequency therapy was performed on 1860 patients with TN from June 1986 to April 2003, and percutaneous trigeminal ganglion radiofrequency therapy on 579 cases. Among this group of patients, X-ray, 3-D CT, and navigational localization of the oval foramen were performed on 42 cases. The indications, techniques, and results are reported here.     

Acupuncture Treatment for 15 Cases of Post-traumatic Coma

In order to observe the effects of acupuncture combined with point-injection therapy on post-traumatic coma, 30 such cases were randomly divided into the following two groups. The patients in the control group were simply treated with the basic neural medical treatment; while patients in the treatment group were treated by acupuncture and point-injection therapy in addition to the above treatment. Comparisons were made between the two groups in the therapeutic effects by GCS evaluations as well as in the changes of main symptoms. The results showed that the GCS value in the treatment group was higher than that of the control group, but with no statistical significance （P〉0.05）. However, the main symptoms of the patients in treatment group, such as aphasia, hemiplegia, and injuries of cranial nerves （including injuries of the facial, oculomotor and abducent nerves） were obviously improved, showing significant differences as compared with the control group （P〈0.05）. Conclusion can be made that acupuncture combined with point-injection has the consciousness-inducing effect for post-traumatic coma, and shows good effects for the cranial nerve iniuries and aohasia.     

阴茎背神经局部解剖学研究

目的 观察正常人群阴茎背神经数量及分布.方法 采用38具成年男性(20-50岁)尸体的阴茎,对阴茎背神经、阴茎背深静脉和阴茎背动脉进行解剖观察,探查阴茎背神经的走形、分布及数量.结果 阴茎背神经大多分布于阴茎背侧,其中各支大多平行分布.其数量为:7支1例,6支1例,5支6例,4支9例,3支14例,2支7例.38具尸体阴茎背神经数目平均值为(3.55±1.2)支.结论 正常人阴茎背神经多为2支以上,呈平行分布.确定正常人群阴茎背神经数目和分布对原发性早泄患者术中保留阴茎背神经数目有指导意义.     

人阴茎背动脉与阴茎海绵体血供关系的研究

目的探讨人阴茎背动脉与阴茎海绵体血液供应的关系。方法对15例成年男性尸体阴茎采用血管铸型(8例)和直接解剖(7例)以观察阴茎背动脉、阴茎海绵体及深动脉之间的关系。结果阴茎背动脉发出1～2条分支直接进入阴茎海绵体,而深动脉发出分支进入阴茎海绵体脚。结论阴茎背动脉为供应阴茎海绵体的主要动脉。     

Schwannoma of the penis: a report of two cases

Schwannomas are benign nerve sheath tumors, which can occur sporadically or in patients with neurofibromatosis. Schwannomas of the penis are extremely rare. To our knowledge, only 18 cases of penile schwannomas have been reported previously in the English-language literature. Here we report two additional cases of penile schwannomas, including one case of multiple penile schwannomas. The first patient was a 26-year-old man presenting with a 2 x 2 cm, slowly growing, painless tumor on the dorsal penile shaft. The second patient was a 41-year-old man presenting with three painless nodules measuring up to 0.9 cm on the dorsal penile shaft. Neither patient had evidence of neurofibromatosis. Both patients received simple tumor excision, and neither experienced tumor recurrence. Penile schwannomas tend to occur on the dorsal penile shaft, the location of the penile dorsal nerves. Notably, multiple tumors are present in 30% of penile schwannoma cases, whereas most schwannomas at other locations present as a single tumor. Most penile schwannomas present as painless nodules. No reported patients had malignant transformation, but two had tumor recurrence 4 months and 7 years after excision. Despite its rarity, schwannomas should be included in the differential diagnoses of penile tumors. Simple excision with follow up should be the treatment of choice.     

显微外科技术辅助比格犬阴茎离断再植对照研究

目的 探讨显微外科技术在阴茎离断再植术中的作用.方法 20只成年比格犬进行阴茎海绵体离断后再植术;随机分成2组,观察组10例采用10倍放大镜显微外科技术辅助手术,对照组10例采用在肉眼直视条件下手术、手术方式均采用同一组手术成员及统一术式,缝合阴茎海绵体、尿道海绵体,两侧阴茎背血管;比较两组手术时间,术中失血量、血管吻合时间、阴茎背血管吻合成功例数、术后远端阴茎颜色、温度、术后远端阴茎坏死例数等各项指标.结果 观察组10例血管吻合一次成功例数高达38根(其中静脉20根、动脉18根),而对照组10例血管吻合一次成功例数达22根(其中静脉14根,动脉8根),两者比较有显著性差异(P＜0.05);观察组平均手术时间120 min、平均血管吻合时间68 min、平均失血量80 mL,而对照组平均手术时间106min、平均血管吻合时间50 min、平均失血量70 mL.观察组术后阴茎坏死例数为0例,而对照组阴茎坏死例数为3例.结论 显微外科技术辅助阴茎离断再植可明显提高血管吻合成功率,显著改善远端阴茎血流供应,缩短远端阴茎恢复时间.     

选择性阴茎背神经离断术手术编码的探讨

目的 探讨选择性阴茎背神经离断术手术编码.方法 采用ICD-10以F52.4（早泄）为检索词,在病案统计管理系统检索出2009-2013年病例277份,其中操作210例手术,以ICD-9-CM-3 2008版为工具书,回顾性分析选择性阴茎背神经离断术手术编码的质量.结果 发现错误编码64.2阴茎病损的局部切除术或破坏术124例,误编64.4阴茎修补术和整形术51例;03.1脊髓内神经根切断或脊神经根切断术35例,错误率16.66％,正确编码应为04.03其他颅的和周围神经切断术或压轧术,延拓细化尾码04.0301.结论 编码员对手术范围,术式以及解剖部位的错误判断导致选择性阴茎背神经离断术编码错误.手术确定阴茎背神经的解剖位置是编码的关键,编码员必须认真阅读手术记录,熟练掌握解剖知识,提高医学知识和国际疾病分类专业技能,才能确保编码准确.     

再造阴茎感觉功能重建动物模型的建立

目的:建立再造阴茎感觉功能重建的动物模型,为临床上改善阴茎再造术后感觉功能探索新术式.方法:以成年新西兰雄兔为实验对象,采用腹壁浅血管筋膜蒂岛状皮瓣行阴茎再造术,切取一段隐神经游离移植,与阴茎背神经端端吻合植入皮瓣后阴茎成形.术后不同时间对再造阴茎进行组织形态学观察和感觉神经肽(calcitonin gene related peptide,CGRP)免疫组化标记.结果:再造阴茎术后1个月时少量CGRP阳性神经纤维仅见于真皮深层,术后3个月数量明显增多,并开始出现在真皮浅层以及真皮乳头内,术后6个月真皮与表皮交界层以及皮肤附属器周围也可见CGRP阳性纤维.结论:隐神经游离移植与阴茎背神经吻接植入再造阴茎皮瓣内可以获得良好的神经再生,这一动物模型可为临床应用该术式重建再造阴茎感觉功能提供实验依据.     

桡神经浅支掌背部的临床应用解剖学研究

目的：观察桡神经浅支掌背部的解剖结构,为临床掌背部筋膜皮瓣、掌指骨骨折的微创治疗及外科神经修复提供形态学基础。方法：选用福尔马林固定上肢标本42例,应用解剖剥离法,解剖出桡神经浅支及其各分支,观测了桡神经浅支分为内、外侧支的分支点（A点）与桡骨茎突（O点）的距离（AO）和角度（∠A）,并测量了其各分支点之间的长度及相应分支点的角度。外侧支分为拇指尺背侧皮神经和第一掌背皮神经处记为B点;桡神经内侧支分为第二、三掌背皮神经处记为C点,第二、三掌背皮神经的夹角记为∠C;第二、三掌背皮神经分为指背皮神经处分别记为D点和E点。结果：42例标本中,38例标本桡神经浅支在桡骨茎突远侧约（3.8±0.6）cm分为内、外侧支,外侧支前行约（1.2±0.3）cm分为拇指尺背侧皮神经和第一掌背皮神经,桡神经内侧支前行（1.1±0.2）cm分为第二、三掌背皮神经,分布于手背部。结论：临床工作中要充分的掌握皮神经的走行数据和体表投影,从而减少损伤和提高手术成功率。     

隐匿型阴茎两种新的手术治疗--附63例分析

目的 :探讨隐匿型阴茎的病因、分类及外科治疗原则。方法 :回顾性分析 1999年 1月～ 2 0 0 2年 12月我院收治的 6 3例隐匿型阴茎患者 ,年龄 1岁 6个月～ 19岁 ,平均 7岁 2个月。根据患者的肥胖程度、是否合并阴茎发育不良而将其分为 37例及 2 6例两组 ,肥胖及阴茎发育不良组 (37例 )采用一种手术方式 ,称为手术Ⅰ式 ,另一组采用手术Ⅱ式治疗。结果 :术后随访 6月 ,手术Ⅰ式组 37例阴茎显露均满意 ,7例发生较重阴茎包皮水肿 ,3例出现耻骨联合下切口脂肪液化 ,3例耻骨联合下切口凹陷恢复不满意 ,1例出现龟头片状麻木感 ;手术Ⅱ式组 2 6例有 1例术后 7d阴茎回缩 ,余各例阴茎显露满意 ,包皮无明显水肿。结论 :隐匿型阴茎是多因素的结果 ;手术治疗方式多样化 ,阴茎根部被膜的复位与固定是提高手术疗效的关键 ,其自然病程和手术时机有待进一步研究。     

改良横裁岛状包皮瓣尿道成形术Ⅰ期修复阴茎型尿道下裂27例分析

对27例阴茎型尿道下裂患儿，横行裁取阴茎背侧岛状带蒂包皮瓣制成皮管，于血管蒂中部无血管区戳孔，穿过阴茎翻转至腹侧，与原尿道远端吻合。27例均Ⅰ期修复成功，术后并发尿瘘2例及尿道外口狭窄1例，阴茎外观满意。提示应用改良横裁岛状包皮瓣尿道成形术（Duckett术）Ⅰ期修复阴茎型尿道下裂，皮管缝合处紧贴阴茎腹侧白膜，两侧被血管蒂覆盖，极大地减少了尿瘘发生。     

阴茎背神经切断术联合包皮系带埋线术治疗原发性早泄330例

目的探讨选择性阴茎背神经切断术联合包皮系带埋线术治疗原发性早泄的临床效果。方法 330例早泄患者,局部麻醉下实施选择性阴茎背神经切断术联合包皮系带埋线术,术后1个月开始性生活,观察手术治疗前后性交时射精时间、患者及配偶性交满意度的变化。结果 330例早泄患者中,早泄治愈242例,有效72例,无效16例,总有效率达95.2%。手术治疗后患者的射精潜伏期由术前的平均0.75 min延长到术后的4.75 min;患者及配偶性交满意度由术前的47%提高到术后的93%。结论选择性阴茎背神经切断术联合包皮系带埋线术治疗原发性早泄,方法简单,恢复快,并发症少,疗效确切,是治疗原发性早泄的有效方法之一。