Paravaginal defect: A new classification of fascial and muscle tears in the paravaginal region

The lateral support of the vaginal wall depends on the integrity of the paravaginal section of the visceral pelvic fascia, levator ani, and their connection. Various defects of the muscle and fascia can result in identical clinical findings—ie, the descent of the lateral vaginal sulcus. In this study, we created a realistic scheme for classifying paravaginal defects, based on the complex relationship of the pelvic fascia with the levator ani. Surgical observations, cadaver examinations, and a complex magnetic resonance imaging (MRI)‐based 3‐dimensional (3D) model were used to analyze the spatial relationships of normal and defective anatomy of the female pelvic floor. Descent of the lateral vaginal sulcus can result from a defect in the paravaginal visceral pelvic fascia, levator ani, or both. The fascial defect can be partial or complete, and the muscle defect can vary in location. A detailed illustrated classification is presented. We present a new model of the pathology that underlies a common clinical finding. Clin. Anat. 29:524–529, 2016. © 2016 Wiley Periodicals, Inc.     

经腹腹腔镜下右肾周筋膜解剖研究及其在腹腔镜右肾切除中应用价值

目的通过研究经腹途径腹腔镜下右肾肾周筋膜的分层结构,为腹腔镜筋膜入路右肾切除手术的可行性及安全性提供解剖学依据。方法在国内外学者对肾周筋膜研究的基础上结合CT肾周筋膜的呈现,对经腹途径腹腔镜下肾周筋膜分层结构进行研究,并以此为基础设计好手术的筋膜入路及分离途径并应用于指导经腹腹腔镜下右肾切除术,记录2015年1月至2019年6月来自阳江市中医医院和人民医院的45例患者的术中肾周筋膜观察结果及手术时间、出血及术中术后并发症等。结果经腹途径腹腔镜下肾周间隙周围存在一个潜在连续的由疏松纤维条索填充的无血管层面,这个无血管层面存在于相邻的两层肾周筋膜之间,45例患者均按术前设计的手术路径顺利完成手术,其中42例患者可以很好或较好的保持筋膜完整性的情况下完成分离,2例脓肾患者及1例无功能肾患者由于粘连明显未能保持分离面筋膜完整性,平均手术时间73 min,平均出血50 ml,术后引流管时间2.7 d,术中无肠管及下腔静脉损伤病例,术后无肠漏及严重的继发出血病例,无围手术期死亡病例。结论肾周筋膜的分层结构及肾周间隙周围存在的连续的潜在无血管层面为经腹途径腹腔镜筋膜入路右肾切除有效的解剖依据,经腹腹腔镜下筋膜入路右肾切除是安全可行的,可以让手术更加安全及出血更少。     

Preservation of Denonvilliers' fascia for nerve‐sparing laparoscopic total mesorectal excision: A neuro‐histological study

Urogenital complications due to pelvic autonomic nerve damage frequently occur following rectal surgery. We investigated whether total mesorectal excision (TME) with preservation of the Denonvilliers' fascia (DVF) can effectively prevent the removal of pelvic autonomic nerves through microscopy. Twenty consecutive male patients with mid‐low rectal cancer who received TME with preservation or resection of the Denonvilliers' fascia (P and R groups, respectively) were included. Serial transverse sections from surgical specimens were studied histologically. Nerve fibers at the surfaces of the mesorectum were counted. Clinical correlation between the amount of nerve fibers removed and post‐operative sexual function was analyzed. Nerve fibers closely localized to the DVF in the R group displaying rich erectile activity (positive anti‐nNOS immunostaining). At the anterior surface of the mesorectum, the mean numbers of nNOS‐positive nerve fibers per specimen in the P group were significantly lower than the R group (3.0 ± 1.8 vs. 5.0 ± 2.3, P < 0.05). Compared to the R group, patients in the P group had higher IIEF scores and better erectile function at 3 and 6 months post‐operatively. The DVF is a key risk zone for pelvic denervation during laparoscopic TME. Preservation of the DVF can prevent the removal of autonomic nerves and protect post‐operative erectile function. Clin. Anat. 32:439–445, 2019. © 2019 Wiley Periodicals, Inc.     

平阳霉素治疗跖疣的疗效观察

目的 评价平阳霉素治疗跖疣的临床疗效和安全性.方法 120例跖疣患者随机分为A组、B组和C组各40例,A组患者采用局部注射平阳霉素,每月1次,连续1～2次；B组患者采用CO2激光治疗,每月1次,连续1～2次；C组患者采用液氮冷冻,每月1次,连续1～2次.结果 A组患者治疗后基愈率为75.00％、显效率为17.50％、进步率为7.50％、无效率为0％,总有效率为92.50％；B组患者治疗后基愈率为52.50％、显效率为22.50％、进步率为17.50％、无效率为7.50％,总有效率为75.00％;C组患者治疗后基愈率为50.00％、显效率为22.50％、进步率为22.50％、无效率为5.00％,总有效率为72.50％.A组与B、C组疗效比较差异均有显著的统计学意义(Uc=5.3750,P=0.0204；Uc=6.4645,P=0.0110);B与C组疗效比较差异无显著的统计学意义(Uc=0.0355,P=0.8506).三组患者均无明显不良反应.结论 平阳霉素治疗跖疣是安全的、有效的.     

Photodynamic therapy: An option in mycosis fungoides

BackgroundPhotodynamic therapy (PDT) is a well-known and effective treatment for non-melanoma skin-cancer. Numerous studies have also shown its effectiveness in mycosis fungoides. The aim of the study was to analyse MF patients treated with PDT at the Dermatology Unit of Bologna University.MethodsWe retrospectively analysed MF patients treated with PDT over the last ten years. Each PDT protocol consisted of the appliance for 3 h under an occlusive film dressing on each lesion of a one-mm-thick layer of 16% methyl aminolaevulinate (MAL) 160 mg/g cream (Metvix^®, Galderma, Paris, France). The cream was then removed and the skin was exposed to 630 nm red light from a diode lamp (Aktilite^®, Galderma Benelux, Rotterdam, the Netherlands), with a total radiation dose of 37 J/cm2 for 9 mins. A protocol of one session every month was scheduled. The treated lesions were clinically examined, before each treatment.ResultsFour cases, three male and one female, had been treated with PDT. Two patch lesions on the plantar area, one leg and the pubic area were treated. The number of PDT sessions ranged from 4 to 9. Two complete remissions and two partial remissions were observed. A low-to-mild burning sensation was reported during the treatment, and persisted over the next day; no further side effects were observed.ConclusionsOur series shows that PDT can be considered an effective second-line treatment in patients characterised by a disease located in difficult-to-treat anatomical areas such as the feet and the pubic area.     

A new space of the face: The bucco‐mandibular space

Our previous studies based on intraoral dissection of fresh cadavers demonstrated the fissure and loose connective tissues behind the mucosa between the incisivus labii inferioris (ILI) and buccinator (BM) muscles. However, this raised new questions about the relationship among these muscles, the fissure and the buccal space. To our knowledge, no pathway to the oral cavity from the buccal space has been previously demonstrated, although such a pathway would better explain some routes of infection. Therefore, the aim of this study was to clarify the relationship among the mimetic muscles attached to the mandible, the fissure, and the buccal space. Twenty sides from 10 fresh frozen adult cadaveric Caucasian heads were used. The relationships among the ILI, BM, mandible, and buccal space were investigated with dissection and fluoroscopy. In all specimens, the fissure between the lateral border of the ILI and the anterior border of the BM formed the entrance of a space (here termed the bucco‐mandibular space), which corresponded to the buccal mucosa in the premolar region. The superior border of this space was formed by the platysma and associated fascia, which was continuous with the masseteric fascia. This fascia clearly separated this space from the buccal space, which was located lateral to the BM and superior to this space. Clin. Anat. 30:958–962, 2017. © 2017 Wiley Periodicals, Inc.     

关节镜下跟骨骨刺去除联合带线锚钉固定跖筋膜的研究（附17例报告）

目的探讨关节镜下跟骨骨刺去除联合带线锚钉固定跖筋膜的临床疗效。方法通过对17例符合跟骨骨刺的病例行关节镜下跟骨骨刺去除联合带线锚钉固定跖筋膜进行疗效观察。结果所有病例均得到有效随访,所有患者疼痛均得到有效缓解,X片显示骨刺消除未再生。无切口感染病例,其中5例患者伤口延迟愈合,2例患者切口愈合后负重行走再裂开,细菌培养均阴性。总有效率100.00%,切口正常愈合率70.58%。结论关节镜下跟骨骨刺去除联合带线锚钉固定跖筋膜:(1)创伤小,切口小,2.0 cm左右,出血少;(2)关节镜视野清晰,有效彻底清除病灶,缩短手术时间;(3)缝合跖筋膜,维持、修复了足弓的稳定性;(4)术后恢复快,切口美观,住院时间短。     

Foot disorders in the elderly: A mini-review

Ageing process is associated with changes to the aspect, biomechanics, structure and function of the foot, it may be related with a marked presence of foot conditions, pain, disability and other overall health problems that constitute a major public health concern.Also, the prevalence of epidemiologic research found an incidence of foot problems which is even higher as a consequence of increasing life expectation. Several studies have also suggested that such foot disorders currently affect between 71 and 87% of older patients and are a frequent cause of medical and foot care.Thus, these kind problems are extremely common conditions in the general population, especially in the elderly who are associated with poor quality of life, balance impairment, increase the risk of falls, dificulty on putting shoes, fractures, restrict mobility and performance of activities of daily living that turn can produce serious physical, mental and social consequences in the older people.The role of the physician in the assessment, evaluation, and examination of foot problems is very important, yet it is often an overlooked and undervalued component of geriatric health care.The purpose of this article is to review and to provide an overview of the most common foot deformities precipitating factors, clinical presentation, evidence-based diagnostic evaluation, and treatment recommendations with a view to preventing medical conditions or deformities affecting the feet that may alter foot condition and general health amongst the elderly.