慢性前列腺炎合并精索静脉曲张526例总结

Objectives To summarize diagnostic and therapeutic experience of chronic prostatitis combined with varicocele. Methods 526 varicocele patients with chronic prostatitis underwent superselective high ligation of the internal spematic veins. After operation,all the patients had individual treatment in 4-8weeks according to the type of CP and Chronic Prostatitis Symptom Index(CPSI). Results The diameter of spermatic vein＜1.8mm in 468 cases, while the diameter of spermatic vein ＞ 1.8mm in 58 cases in 3 months after operation. The CPSI scor e in 526 patients was decreased from 19.2 ±4.8 before treatment to 4.8 ± 3.4 after treatment. CPSI score decreased by 15.8. Routine examination of the prostatic secretions became normal in 388 cases(73.3% ) ,and bacterial culture became negtive in 146 cases(79.7% ). There was significant difference before and after operation. Conclusions In CP patients combined with VC, the curative effect was improved by superselective high ligation of the internal spematic veins.     

Microsurgical subinguinal varicocelectomy with spermatic cord double traction and vein stripping

We retrospectively reviewed data for 286 patients with varicocele who underwent microsurgical subinguinal varicocelectomy from March 2015 to May 2017 in Shanghai General Hospital(Shanghai,China).In this surgical approach,the testis was delivered,and the gubernacular and external cremasteric veins were stripped.In addition,the spermatic cord was delivered downward with continuous double traction away from the external ring.The remaining procedure was similar to the conventional approach.We followed patients for at least 3 months and evaluated postoperative semen parameters,pain symptoms,and complications.We excluded data for 32 men due to inadequate follow-up(<3 months).Of the remaining 254 patients,73 had oligoasthenospermia,121 had nonobstructive azoospermia,and 60 had symptomatic varicoceles.Total progressive sperm counts increased in the oligoasthenospermic patients from a median preoperative value of 9.15×10^6 ml^?1 to 25.33×10^6 ml^?1(n=34),and 35.6%(26/73)initially oligoasthenospermic men contributed to unassisted pregnancies.Sperm returned to the ejaculate in 12.4%(15/121)azoospermia patients.In patients with scrotal pain(n=60),43(71.7%)reported complete resolution of pain,16(26.7%)reported partial resolution,and 1(1.7%)reported no change.No patients experienced varicocele recurrence.This doubletraction strategy avoids opening the external oblique aponeurosis,and results in less damage and faster recovery.In addition,the stripping strategy eliminates potential damage to the testis caused by the varicose veins.Our results showed that microsurgical subinguinal varicocelectomy using spermatic cord double traction in conjunction with testicular delivery for vein stripping is a safe and effective approach for varicocele repair.     

Initial experience with robot-assisted varicocelectomy

Aim： To determine if robot-assisted varicocelectomy can be safely and effectively performed when compared to microscopic inguinal varicocelectomy. Methods： Eight patients aged 29.1 ± 12.5 years underwent microscopic subinguinal varicocelectomies： seven patients with left-sided repair, and one patient with bilateral repair. Eight patients aged 22.0 ±8.0 years underwent robot-assisted varicocelectomies： seven patients with left-sided repair and one patient with bilateral repair. Results： The average operative time for microscopic inguinal varicocelectomy was 73.9 ±12.2 min, whereas the robot-assisted technique took 71.1± 21.1 min. There were no difficulties in identifying and isolating vessels and the vas deferens with robot-assisted subinguinal varicocelectomy. Hand tremor was eliminated using the robotic procedure. Patients who underwent either microscopic or robot-assisted varicocelectomies were able to resume daily activities on the day of surgery and full activities within 2 weeks. There were no complications or recurrences of varicocele. Conclusion： From our experience, compared to microscopic surgery, robot-assisted varicocelectomy can be safely and effectively performed, with the added benefit of eliminating hand tremor.     

Outpatient varicocelectomy performed under local anesthesia

Aim： To report a series of varicocelectomy performed under pure local anesthesia. Methods： From July 1988 to June 2003, a total of 575 patients, aged between 15 and 73 years, underwent high ligation of the internal spermatic vein for treatment of a varicocele testis under a regional block in which a precise injection of 0.8 % lidocaine solution was delivered to involved tissues after exact anatomical references were made. A 100-mm visual analog scale （VAS） was used to assess whether the pain level was acceptable. Results： The surgeries were bilateral in 52 cases, and unilateral in 523 cases. All were successfully performed on an outpatient basis except in the case of two patients, who were hospitalized because their surgeries required general anesthesia. Overall, 98.6 % （567/575） of men could go back to work by the end of the first post-operative week and only 8 （1.4 %） men reported feeling physical discomfort on the eighth day. The VAS scores varied from 11 mm to 41 mm with an average of （18.5 ± 11.3） mm that was regarded as tolerable. Conclusion： This study has shown varicocelectomy under local anesthesia to be possible, simple, effective, reliable and reproducible, and a safe method with minimal complications. It offers the advantages of more privacy, lower morbidity, with no notable adverse effects resulting from anesthesia, and a more rapid return to regular physical activity with minor complications.     

Induction of spermatogenesis in men with azoospermia or severe oligoteratoasthenospermia after antegrade internal spermatic vein sclerotherapy for the treatment of varicocele

Aim:To evaluate the treatment outcome of antegrade internal spermatic vein sclerotherapy in men with non-obstruc-tive azoospermia or severe oligoteratoasthenospermia(OTA)as a result of varicocele.Methods:Between September1995 and January 2004,47 patients(mean age 33.8±6.3 years)underwent antegrade internal spermatic vein sclero-therapy for the treatment of varicocele with azoospermia(14 patients)or severe OTA(33 patients).Testicular corebiopsy was also performed in complete azoospermic patients who provided informed consent.The outcome wasassessed in terms of improvement in semen parameters and conception rate.Results:Forty-two(89.4%)of 47patients had bilateral varicocele,Serum follicle stimulating hormone(FSH)did not differ between patients withazoospermia and severe OTA.After the follow-up of 24.8±9.2 months,significant improvement was noted in meansperm concentration,motility and morphology in 35 patients(74.5%).Comparison between groups during thefollow-up revealed significantly higher values of sperm concentration,motility and normal morphology in the severeOTA group.Pregnancy was achieved in 14 cases(29.8%).Testicular histopathology of the azoospermic patientswith postoperative induction of spermatogenesis revealed maturation arrest at spermatid stage,Sertoli-cell-only(SCO)with focal spermatogenesis or hypospermatogenesis.None of the patients with pure SCO pattern or maturation arrestat spermatocyte stage achieved spermatogenesis after the treatment.Preoperative serum FSH levels didn't relate totreatment outcome.Conclusion:Antegrade internal spermatic vein sclerotherapy is an easy and effective treatmentfor symptomatic varicocele.It can significantly reverse testicular dysfunction and improve spermatogenesis in menwith severe OTA,as well as induce sperm production in men with azoospermia,improving pregnancy rates insubfertile couples.(Asian J Androl 2006 Sep;8:613-619)     

Immunohistopathology of the contralateral testis of rats undergoing experimental torsion of the spermatic cord

Aim:To evaluate the immunohistopathological changes in the contralateral testis of rats after an experimental sper-matic cord torsion.Methods:Male Sprague-Dawley rats of 45-50 days old were subjected to a 720° unilateralspermatic cord torsion for 10,30 and 80 days(experimental group,E),respectively or sham operation(controlgroup,C).Histopathology of the contralateral testis as well as germ cell apoptosis were studied using the TerminalDeoxynucleotidyl Transferase Biotin-dUTP Nick End Labeling(TUNEL)technique.The number of testicularlymphocytes,mast cells and macrophages,and the expression of tumor necrosis factor-α(TNF-α)and its receptor(TNFR1)in testicular cells of the contralateral testis were quantified by histochemistry and immunohistochemistry.TNF-α concentration in testicular fluid was determined by ELISA.Results:In the contralateral testis of rats fromthe E group,the maximal degree of damage of the germinal epithelium was seen 30 days after torsion.At this time weobserved in the E group vs.the C group increases:(i)the number of testicular T-lymphocytes;(ii)the number oftesticular mast cells and macrophages;(iii)the percentage of macrophages expressing TNF-α:(iv)TNF-α concen-tration in testicular fluid;(v)the number of apoptotic germ cells;and(vi)the number of TNFR1~ germ cells.Conclusion:Experimental spermatic cord torsion induces,in the contralateral testis,a focal damage of seminiferous tubulescharacterized by apoptosis and sloughing of germ cells.Results suggest humoral and cellular immune mediatedtesticular cell damage in which macrophages and mast cells seem to be involved in the induction of germ cell apoptosisthrough the TNF-α/TNFR1 system and in the modulation of the inflammatory process.(Asian J Andro12006 Sep;8:576-583)     

Application of damage control orthopedics in 41 patients with severe multiple injuries

Objective： To probe the feasibility and efficacy of damage control orthopedics （DCO） in treating severe multiple injuries. Methods： A retrospective analysis was made on the clinical data of 41 patients （31 males and 10 females, aged 18-71 years, mean： 36.4） with multiple injuries admitted to our department and treated by DCO from January 1995 to December 2005.
Results： As a first-stage therapy, devascularization of internal iliac arteries was performed in 29 patients with pelvic fractures combined with massive bleeding, including ligation of bilateral internal iliac arteries in 21 patients and embolization of bilateral internal iliac arteries in 8. And early external fixation of pelvis was performed in 10 patients. Ten patients with severe multiple injuries combined with femoral fractures were managed with primary debridement and temporal external fixation and 2 patients with spinal fractures combined with spinal cord compression received simple laminectomy. Thirty-one patients received definite internal fixation after resuscitation in intensive care unit. The overall mortality rate was 12.1% （5/41） with an average injury severity score of 41.4. The main causes of death were hemorrhagic shock and associated injuries. Complications occurred in 7 patients including acute respiratory distress syndrome in 3 cases, thrombosis of right common iliac artery in 1, subphernic abscess in 2 and infection of deep wound in lower extremity in 1. After treatment, all the patients got cured.
Conclusions： Prompt diagnosis and integrated treatment are keys to higher survival rate in patients with severe multiple injuries. In this condition, DCO is an effective and safe option.     

Genetic polymorphisms in glutathione S-transferase T1 affect the surgical outcome of varicocelectomies in infertile patients

Glutathione S-transferases （GSTs）, superoxide dismutase 2 （SOD2） and NAD（P）H：quinone oxidoreductase 1 （NQO1） are anti-oxidant enzyme genes. Polymorphisms of GSTs, SOD2 and NQO1 have been reported to influence individual susceptibility to various diseases. In an earlier study, we obtained preliminary findings that a subset of glutathione S-transferase 7：1 （GSTT1）-wt patients with varicocele may exhibit good response to varicocelectomy. In this study, we extended the earlier study to determine the distribution of genotype of each gene in the infertile population and to evaluate whether polymorphism of these genes affects the results of surgical treatment of varicocele. We analyzed 72 infertile varicocele patients, 202 infertile patients without varicocele and 101 male controls. Genotypes of GSTs were determined by polymerase chain reaction （PCR）. Genotyping of SOD2 and NQO1 was performed using the PCR-restriction fragment length polymorphism （PCR-RFLP） method. A significantly better response to varicocelectomy was found in patients with the GSTTI-wt genotype （63.2%） and NQO1-Ser/Ser genotype （80.0%） than in those with GSTTI-null genotype （35.3%） and NQO1-Pro/Pro or NQO1- Pro/Ser genotype （45.2%）, respectively. The frequencies of glutathione S-transferase M1/T1, SOD2 and NQO1 genotypes did not differ significantly among the varicocele patients, idiopathic infertile patients and male controls. GSTT1 genotype is associated with improvement of semen parameters after varicocelectomy. As the number of patients with NQO1-Ser/Ser genotype was not sufficient to reach definite conclusions, the association of NQO1 genotype with varicocelectomy requires further investigation.     

Studies on plasma endothelin changes in varicocele patients

Aim: To investigate the possible role endothelin may play in the pathogenesis of varicocele and varicocele-induced infer-tility. Methods: In varicocele patients, radioimmunoassay is used to determine the blood endothelin concentration inthe spermatic vein and the antecubital vein separately. Results: The blood endothelin concentration of the spermaticvein (66.8±23.5 pg/mL) was significantly higher (P <0.05) than that of the antecubital vein (55.3±25.3 pg/mL).The endothelin concentration in the spermatic vein in Grade Ⅱ varicocele patients was not significantly different from thatin Grade Ⅲ patients ( P = 0.87). Conclusion: The higher blood endothelin level in the spermatic vein may indicate theinvolvement of endothelin in the pathophysiology of varicocele and varicocele-induced infertility. (Asian J Androl 1999Sep ; 1: 159 - 160)     

Clinical anatomic study of the lower lumbar anterolateral vein: with respect to retroperitoneal endoscopic surgery

Objective： To study the anatomy of veins of the lower lumbar spine and provide the anatomic basement for laparoscopic lumbar surgery. Methods： A total of 15 formaldehyde-preserved cadav- ers were studied with special attention to the variety and surrounding structure of ascending lumbar vein （ALV） and iliolumbar veins （ILV）, and their relationship with lumbar plexus. Results： ALV and ILV can be found on every sides, which have four variants including separate entry and common entry. The ascending vein and iliolumbar vein separately enter common iliac vein in 18 cases, and as a common stem enter the common iliac vein in 12 cases. Retracting common iliac vein medially both the ascending lumbar and the iliolumbar veins are always at risk of avulsion on exposure of the disc space. The injury of obturator nerve and lumbosacral trunk of lumbar plexus should be avoided. Conclusion： Awareness of these anatomic variation can prevent the hemorrhage and be helpful for the surgeon in performing a careful ligation of these veins before medial retraction of the common iliac vein. Our findings emphasize the need for proper dissection of ALV and ILV before ligature during exposure of the lower lumbar spine.     

Effects of epidermal growth factor on sperm content and motility of rats with surgically induced varicoceles

Aim:To investigate the effect of epidermal growth factor(EGF)on the sperm content and motility of the varicocelizedrats.Methods:Forty-eight male Wistar rats were randomly divided into five groups.Experimental varicocele wasinduced by partial ligation of the left renal vein in the varicocele,the varicocele repair,the varicocele with EGF and thevaricocele repair with EGF groups,whereas the control group only received a sham induction of varicocele.Surgicalrepair of varicocele was performed 4 months later in the varicocele repair and varicocele repair with EGF groups.EGF administration was performed daily by s.c.injection in the varicocele with EGF and varicocele repair with EGFgroups at the dose of 10μg/(kg.day)from the next day of the second surgery.One month later,all animals werekilled and bilateral cauda epididymal sperm counts and motility were evaluated.Results:The mean sperm count andpercentage of motile spermatozoa were significantly higher bilaterally in the varicocele with EGF group than in thevaricocele group(P<0.05).They were also significantly higher bilaterally in the varicocele repair with EGF groupthan in the varicocele repair and the varicocele with EGF groups(P<0.05).Conclusion:EGF can improve bilateralepididymal sperm content and motility of the rat with surgically induced varicocele.The administration of EGF incombination with surgical repair is more effective than surgical repair or EGF administration alone.EGF might beuseful for the treatment of infertility induced by varicocele.(Asian JAndrol 2006 Nov;8:713-717)     

Effect of ketotifen fumarate on experimental autoimmune orchitis and torsion of the spermatic cord

The aim of this work was to study effects of ketotifen fumarate(KF)on prevention of tissue damage in testes of rats with experimental autoimmune orchitis(EAO)and on the contralateral testis in a model of prolonged testicular cord torsion(TCT).Rats with EAO or TCT were injected intraperitoneally once daily with KF or saline solution(vehicle group).Incidence and severity of testicular damage were evaluated by histopathology using an EAO score or a Johnsen score.Mast cells(MC)were identified by histochemistry and quantified.In EAO model,KF significantly reduced severity of histopathological testicular damage compared to rats in the vehicle group.KF also reduced the number of testicular MC compared to vehicle group.Similarly,in TCT model,multifocal damage of the contralateral testis was observed 30 days after testicular torsion characterized by sloughing of the germinal epithelium,seminiferous tubule atrophy,and interstitial edema.Focal signs of inflammation and fibrosis of seminiferous tubular walls were also observed.In contrast,sections of contralateral testis of rats injected with KF and killed 30 days after surgery showed normal histological features.A significant decrease in the number of MC was observed in rats treated with KF compared to untreated animals.In conclusion,we demonstrated that treatment with KF reduced testicular inflammatory process and MC infiltrates in both EAO and TCT models.The results suggest a promising treatment for infertile male patients with testicular pathologies associated with inflammation and germ cell loss.     

Potential role of reactive oxygen species on testicular pathology associated with infertility

Aim: To investigate the level of malondialdehyde (MDA), a direct indicator of lipid peroxidation-induced injury by reactive oxygen species (ROS), in testicular biopsy specimens from infertile patients. Methods: Levels of MDA were measured in testicular biopsy specimens from 29 consequent-randomized infertile men, aged 29.58±4.76 (21-45) years. All patients were evaluated by a complete medical and reproductive history, physical examination, semen analysis (at least two), serum follicle-stimulating hormone and free testosterone levels, testicular biopsy and contact imprint. Scrotal colour Doppler ultrasonography was used to confirm suspected varicocele. The testicular MDA level was measured using the thiobarbituric acid test and the results were expressed per unit tissue weight. Results: As a causal factor in infertility, varicocele was identified in 17 (58.6 %) patients, and idiopathic infertility, testicular failure and obstruction in 4 (13.8 %) patients each. The testicular MDA level was 13.56 (6.01),     

The impact of ipsilateral testicular atrophy on semen quality and sperm DNA fragmentation response to varicocele repair

Varicoceles adversely impact semen quality and sperm DNA fragmentation,which typically improve with surgical repair.Some men with varicoceles have ipsilateral testicular atrophy due to damage from the varicocele.This study assessed semen quality and the sperm DNA fragmentation index(DFI)response to varicocele repair in men with ipsilateral testicular atrophy(TA)versus men with no testicular atrophy(NTA).Semen parameter values and DFI in both groups were compared preoperatively and postoperatively.The Mann-Whitney U test and the Wilcoxon signed-rank test were used where appropriate.There were 20 men in the TA group and 121 men in the NTA group with no difference in age,varicocele grade,or preoperative semen parameter values between the two groups.The NTA group had a higher preoperative DFI than the TA group.Both groups showed improvement in semen quality postoperatively,only the TA group showed a significant improvement in DFI,whereas the NTA group showed significant improvements in several parameter values and DFI.The change from preoperative to postoperative parameter values when comparing the two groups revealed a difference in total sperm motile count and DFI,with a larger mean improvement in the NTA group than in the TA group.Both TA and NTA groups showed improved semen quality and DFI after varicocele repair,but the NTA group had more improvement than the TA group.However,only total motile count(TMC)and DFI had a significantly greater mean change in preoperative to postoperative response in the NTA group than in the TA group.     

Implications of the presence of an aberrant right hepatic artery in patients undergoing pancreaticoduodenectomy

AIM:To analyze the differences in outcomes and the clinical impact following pancreatoduodenectomy(PD)in patients with and without aberrant right hepatic artery(aRHA).METHODS:All patients undergoing PD between January 2008 and December 2012 were divided into two groups,one with aRHA and the other without.These groups were compared to identify differences in the intraoperative variables,the oncological clearance and the postoperative morbidity,mortality and hospital stay.RESULTS:A total of 225 patients underwent PD,of which 43(19.1%)patients were found to have eitheraccessory or replaced right hepatic arteries(aRHA group).The aRHA was preserved in 79%of the patients.There was no significant difference in the intraoperative blood loss but operative time was prolonged,reflecting the complexity of the procedure[420±44(240-540)min vs 480±45(300-600)min,P0.05)].There were no differences in the incidence of postoperative complications(pancreatic leak,pancreatic fistula,delayed gastric emptying and mortality)and hospital stay.Oncological clearance in the form of positive resection margins[13(7.1%)vs 3(6.9%)]and lymph node yield were also similar in the two groups.CONCLUSION:An aRHA is found in approximately one fifth of patients undergoing PD.Preservation is technically possible in most patients and can increase the operative complexity but does not negatively affect the safety or oncological outcomes of the procedure.     

The effects of topical L-arginine and Ng-nitro-L-arginine methyl ester after experimental acute spinal cord injury. A light and electron microscopic study

The primary objective of this study was to investigate the effects of topical L-arginine and Ng-nitro-L-arginine methyl ester vs the role of ischemia in contributing to secondary injury after experimental acute spinal cord trauma. Twenty-six rabbits were submitted to spinal cord compression at the T7/8 level. The animals were divided into three groups: no applied drug (n=6), L-arginine (n=10), and Ng-nitro-L-arginine methyl ester (n=10). L-arginine was topically administered at a dose of 10 μmol (1.742 mg) per kg immediately after acute spinal cord injury. Ng-nitro-L-arginine methyl ester was applied topically at a dose of 10 μmol (10 mg/kg) immediately after acute spinal cord injury. Cortical somatosensory evoked potentials were recorded before injury and 1 min, 15 min, 30 min, and 60 min after injury. Physiological parameters were followed before, during, and 1 h post injury. Light and electron microscopic analysis was performed in all of the groups. In contrast to group 1, the edema of perineural, axoplasm, or surrounding tissue, the thickening of walls of the arterioles and venules, and the degeneration in myelinated axons in groups 2 and 3 were well observed. However, no differences between group 2 and group 3 occurred. Electronic Publication     

脊髓线预测颈椎后路开门术后脊髓减压效果的临床研究

Objectives To report a new index (the SC-line) and a new classification for predicting of postoperative spinal cord decompression after cervical laminoplasty. Methods From March 2008 to August 2009, MRI images of 25 patients treated with cervical laminoplasty were retrospectively studied.Using T2-weighted images of the cervical spine, point A was anterior point of the spinal cord at inferior endplate level of cranial compressed vertebra. Point B was anterior point of the spinal cord at superior endplate level of caudal compressed vertebra. The SC-line was defined as a line that connects A and B.Posterior surface of compressor at compression level did not exceed the line in Type Ⅰ , connected the line in Type Ⅱ , and exceeded it in Type Ⅲ . Twenty-five patients who underwent cervical laminoplasty were classified into 3 groups according to the SC-line classification. The posterior shift of the spinal cord after the posterior decompression procedure was evaluated by using a modified gradation of degree of anterior spinal cord compression by MRI finding. The relationship between the degree of anterior spinal cord compression after surgery and the SC-line types were analyzed. Results Preoperative cervical SC-line classification showed high correlations to the degree of spinal cord decompression. There were 3. 82 ± 0. 39 points in Type Ⅰ before surgery, 3. 90 ±0. 32 points in Type Ⅱ , and 4. 00 ±0. 00 points in Type Ⅲ , respectively. After surgery, there were 1. 15 ±0. 50 points in Type Ⅰ , 2. 70 ±0. 48 points in Type Ⅱ , and 3. 50 ±0. 55 points in Type Ⅲ, respectively. Significant differences were found between each Type ( F = 42. 49, P ＜ 0. 01; Type Ⅰ vs. Type Ⅱ : P＜0. 01;Type Ⅰvs. Type Ⅲ: P ＜0. 01;Type Ⅱ vs. Type Ⅲ: P =0.038). Conclusion SC-line can be used to predict the degree of postoperative spinal cord decompression following cervical laminoplasty.     

脊髓线预测颈椎后路开门术后脊髓减压效果的临床研究

Objectives To report a new index (the SC-line) and a new classification for predicting of postoperative spinal cord decompression after cervical laminoplasty. Methods From March 2008 to August 2009, MRI images of 25 patients treated with cervical laminoplasty were retrospectively studied.Using T2-weighted images of the cervical spine, point A was anterior point of the spinal cord at inferior endplate level of cranial compressed vertebra. Point B was anterior point of the spinal cord at superior endplate level of caudal compressed vertebra. The SC-line was defined as a line that connects A and B.Posterior surface of compressor at compression level did not exceed the line in Type Ⅰ , connected the line in Type Ⅱ , and exceeded it in Type Ⅲ . Twenty-five patients who underwent cervical laminoplasty were classified into 3 groups according to the SC-line classification. The posterior shift of the spinal cord after the posterior decompression procedure was evaluated by using a modified gradation of degree of anterior spinal cord compression by MRI finding. The relationship between the degree of anterior spinal cord compression after surgery and the SC-line types were analyzed. Results Preoperative cervical SC-line classification showed high correlations to the degree of spinal cord decompression. There were 3. 82 ± 0. 39 points in Type Ⅰ before surgery, 3. 90 ±0. 32 points in Type Ⅱ , and 4. 00 ±0. 00 points in Type Ⅲ , respectively. After surgery, there were 1. 15 ±0. 50 points in Type Ⅰ , 2. 70 ±0. 48 points in Type Ⅱ , and 3. 50 ±0. 55 points in Type Ⅲ, respectively. Significant differences were found between each Type ( F = 42. 49, P ＜ 0. 01; Type Ⅰ vs. Type Ⅱ : P＜0. 01;Type Ⅰvs. Type Ⅲ: P ＜0. 01;Type Ⅱ vs. Type Ⅲ: P =0.038). Conclusion SC-line can be used to predict the degree of postoperative spinal cord decompression following cervical laminoplasty.     

脊髓线预测颈椎后路开门术后脊髓减压效果的临床研究

Objectives To report a new index (the SC-line) and a new classification for predicting of postoperative spinal cord decompression after cervical laminoplasty. Methods From March 2008 to August 2009, MRI images of 25 patients treated with cervical laminoplasty were retrospectively studied.Using T2-weighted images of the cervical spine, point A was anterior point of the spinal cord at inferior endplate level of cranial compressed vertebra. Point B was anterior point of the spinal cord at superior endplate level of caudal compressed vertebra. The SC-line was defined as a line that connects A and B.Posterior surface of compressor at compression level did not exceed the line in Type Ⅰ , connected the line in Type Ⅱ , and exceeded it in Type Ⅲ . Twenty-five patients who underwent cervical laminoplasty were classified into 3 groups according to the SC-line classification. The posterior shift of the spinal cord after the posterior decompression procedure was evaluated by using a modified gradation of degree of anterior spinal cord compression by MRI finding. The relationship between the degree of anterior spinal cord compression after surgery and the SC-line types were analyzed. Results Preoperative cervical SC-line classification showed high correlations to the degree of spinal cord decompression. There were 3. 82 ± 0. 39 points in Type Ⅰ before surgery, 3. 90 ±0. 32 points in Type Ⅱ , and 4. 00 ±0. 00 points in Type Ⅲ , respectively. After surgery, there were 1. 15 ±0. 50 points in Type Ⅰ , 2. 70 ±0. 48 points in Type Ⅱ , and 3. 50 ±0. 55 points in Type Ⅲ, respectively. Significant differences were found between each Type ( F = 42. 49, P ＜ 0. 01; Type Ⅰ vs. Type Ⅱ : P＜0. 01;Type Ⅰvs. Type Ⅲ: P ＜0. 01;Type Ⅱ vs. Type Ⅲ: P =0.038). Conclusion SC-line can be used to predict the degree of postoperative spinal cord decompression following cervical laminoplasty.     

Antegrade scrotal sclerotherapy and varicocele

Antegrade scrotal sclerotherapy is a simple and easy technique for the treatment of varicocele. The success rate varies between 87% and 95%. The initial reflux grade and the number of collateral vessels of the spermatic vein are the most important factors to predict the outcome of the technique. The postoperative complication rate is about 7% and the common ones are scrotal hematoma and epididymo-orchitis of slight severity. Testicular athrophy is a rare event (0.6%). This technique offers a considerable cost reduction compared to other therapeutic options currently available for varicocele.