Efficacy of atropine,orthokeratology, and combined atropine with orthokeratology for childhood myopia: A systematic review and network meta-analysis

Background/PurposeOrthokeratology (Ortho-K), atropine eye drops and combined atropine with Ortho-K are proven to be effective ways to prevent myopic progression in many studies, but there is scarce evidence regarding the comparative efficacy of different dosages of atropine,Ortho-K, and combined atropine with Ortho-K for childhood myopia.MethodsWe performed a network meta-analysis (NMA) to assess the relative efficacy of the aforementioned interventions for myopic progression; moreover, we calculated the surface under cumulative ranking area (SUCRA) to determine the relative ranking of treatments.ResultsWe identified 19 randomized controlled trials (3435 patients). NMA revealed that 0.01%–1% atropine, Ortho-K, and 0.01% atropine combined with Ortho-K inhibited axial elongation (AL) over one year. For refractive change, SUCRA analysis revealed that the hierarchy was high-dose (0.5%–1%), moderate-dose (0.1%–0.25%), and low-dose (0.01%–0.05%) atropine. Regarding AL, SUCRA analysis revealed the following hierarchy: Ortho-K combined with 0.01% atropine, high-dose atropine, moderate-dose atropine, Ortho-K, and low-dose atropine.ConclusionIn conclusion, we found that atropine (0.01%–1%), Ortho-K, and 0.01% atropine combined with Ortho-K could significantly slow down myopia progression. The atropine efficacy followed a dose-related pattern; moreover, Ortho-K and low-dose atropine showed similar efficacy. There was a synergistic effect of using 0.01% atropine combined with Ortho-K, and it showed comparable efficacy to that of high-dose atropine.     

Prevalence of anisometropia in Taiwanese schoolchildren.

BACKGROUND AND PURPOSE: This study investigated the prevalence and distribution of anisometropia in Taiwanese schoolchildren using nationwide data from refractive surveys performed in 1995 and 2000. METHODS: Complete survey data was obtained for 11,175 students in 1995 and 10,878 students in 2000. The refractive status of each student was measured using an autorefractometer under cycloplegia and rechecked with retinoscopy. The difference in refractive status between each participant's eyes was determined. Chi-squared statistic was used to assess the difference between the 2 surveys. Multiple linear regression was used to determine the trend and effects of covariates. RESULTS: Most of the schoolchildren (77.6% in 1995, 71.9% in 2000) were not anisometropic. Most of the anisometropic differences were in the range 0.5 to 1.0 D (14.1% in 1995 vs 17.9% in 2000). About 6% of schoolchildren in 1995 and 7.0% in 2000 had anisometropic differences in the range from -1.0 to -2.0 D. Fewer than 4% of students had a level of anisometropia greater than 2.0 D (2.7% vs 3.2%, respectively). The prevalence of anisometropia and the extent of anisometropic difference both increased with age and with maximal myopic refraction (both p < 0.0001). Both the prevalence and extent of anisometropia showed significant differences between the 2 surveys (both p < 0.0001). CONCLUSIONS: Most of the Taiwanese schoolchildren surveyed were non-anisometropic. The prevalence and amount of anisometropia were significantly increased from 1995 to 2000. The mechanisms responsible for these increases have not been determined, but may be related to increase of myopic refraction.     

Survivin在儿童急性白血病中的表达和P53的相关性及其临床意义

目的探讨Survivin在儿童急性白血病(AL)中的表达及其与抑癌基因P53的相关性，同时观察Survivin与急性淋巴细胞白血病(ALL)临床分型的关系。方法应用免疫组织化学链霉亲和素-生物素-过氧化物酶复合物(SABC)方法，检测华中科技大学同济医学院附属同济医院儿科2004年1~7月收治的37例儿童AL骨髓细胞Survivin和P53的表达，对照组为10例非恶性血液病且骨髓正常患儿。结果在37例AL患儿中，Survivin蛋白表达阳性率为35.14%，P53表达阳性率为32.43%，显著高于正常骨髓组织(P均<0.05)，Survivin和P53表达呈强相关性(P<0.05)，Survivin在高危(HR)ALL患儿的表达为46.15%，在标危(SR)ALL患儿的表达为0，差异有显著性意义(P<0.05)。结论(1)Survivin在儿童AL中异常表达，且与ALL的临床分型有关，提示其在判定儿童ALL预后中有意义；(2)抑癌基因Ｐ53的失活与Survivin的表达可能在AL发生中起协同作用。 Abstract Objective To investigate the expression of Survivin in pediatric acute leukemia and its relationship with expression of P53 and clinical significance.Methods The expression of Survivin and P53 proteins were detected by immunohistochemical assay in 37 acute leukemia children.The control included 10 children with normal bone marrow.Results Survivin protein expression rate was 35.14% and P53 protein expression rate was 32.43% in 37 AL children.Both of them were significantly higher than that in control group (P<0.05).The expression of Survivin and P53 being strongly related (P<0.05).The expression rate of Survivin was 46.15% in HR ALL and 0% in SR ALL,the difference was statistically significant(P<0.05).Conclusion (1)Survivin protein expression rate is abnormal and is associated with the clinical typing of ALL.It may play an important role in the prognosis of ALL.(2)Expression of Survivin and de activation of anti oncogene P53 might play synergetic roles in the process of genesis of AL. Key words Survivin;P53;Children;Acute leukemia     

Evaluation of optic disc changes in severe myopia.

PURPOSE: To evaluate the changes in the optic nerve head in highly myopic subjects by means of confocal laser scanning opthalmoscope. METHODS: Using laser scanning and a three-dimensional image analysis system, we studied 114 young (21.4 +/- 1.4 years), highly myopic subjects with refractive errors greater than -8.0 D and a control group of 29 subjects (18.9 +/- 1.2 years) with myopia of -3.0 D or less. Measurements included cycloplegic refraction, corneal curvature, biometric axial length, and morphometric values of the optic disc obtained with a laser scanning disc analyzer. RESULTS: The optic disc area in highly myopic eyes was similar to that in mildly myopic eyes. However, regression analysis revealed that the optic disc area increased with axial length in subjects with severe myopia. The cup/disc ratio, the disc depth, the neuroretinal rim area, and the tilting of the disc were not significantly different between the severe and mild myopia groups. CONCLUSIONS: These findings may be useful in further investigations of myopic progression and of the mechanisms responsible for the development of myopic complications.     

儿童急性白血病细胞周期蛋白D3、E的表达

目的 探讨细胞周期蛋白D3、E的表达与儿童急性白血病(AL)的关系。方法 采用免疫组织化学法，对广西医科大学第一附属医院儿科2002年1月至2004年5月收治的50例初发或复发儿童AL，其中急性淋巴细胞白血病(ALL)30例(高危ALL 12例，标危ALL 18例)，急性非淋巴细胞白血病(ANLL)20例，和26例完全缓解AL(AL CR)患儿，以及23例同期住院的非恶性疾病患儿(对照组)，检测其骨髓细胞中细胞周期蛋白D3、E的表达情况。结果 AL组中细胞周期蛋白D3、E阳性率分别为54%和46%，高于AL-CR组和对照组(P<0.01)；在ALL和ANLL间差异无显著性(P>0.05)。高危ALL细胞周期蛋白D3阳性率明显高于标危ALL(P<0.01)。化疗前细胞周期蛋白D3、E表达阳性率明显高于化疗缓解后(P<0.01)。细胞周期蛋白D3、E在AL组中的表达呈正相关(r=0.298，P<0.01)。结论 细胞周期蛋白D3、E与儿童AL发病有关，它们的表达存在相关性，可作为疗效观察的指标；细胞周期蛋白D3可能与患儿不良预后有关。 Abstract Objective To investigate the relationship between the expression of cyclin D3，cyclin E and childhood acute leukemia(AL).Methods The expression of cyclin D3 and cyclin E was detected in bone marrow cells from 50 cases of newly diagnosed or relapsing AL，in whom there were 30 cases of acute lymphoblastic leukemia(ALL，including 12 cases of high risk ALL and 18 cases of standard risk ALL ) and 20 cases of acute non lymphocytic leukemia(ANLL)，26 cases of complete remission AL(AL CR) patients and 23 cases of control group(no malignant disease) using immunohistochemical assay.Results 54% AL cases were positive for cyclin D3，and 46% for cyclin E，both being remarkably higher than that of AL CR group and control group(P<0.01).There was no difference between ALL and ANLL in the expression of cyclin D3 and cyclin E(P>0.05).The positive expression of cyclin D3 was higher in high risk ALL than that in standard risk ALL(P<0.01).The expressions of cyclin D3 and cyclin E before chemotherapy were significantly higher than that after remission using chemotherapy(P<0.01).There was significantly positive correlation between the expression of cyclin D3 and cyclin E in AL (r=0.5298，P<0.01).Conclusion In childhood AL，the expression of cyclin D3 and cyclin E is quite high，which is related to the development of AL and might be index of treatment effect.There is positive relation between cyclin D3 and cyclin E.Cyclin D3 might be related to poor prognosis. Key words Acute leukemia;Cyclin;Immunohistochemistry     

儿童白内障手术植入人工晶体度数的选择

目的探讨儿童先天性白内障手术时如何依据视觉发育的特点合理地选择植入人工晶体的度数。方法收集2003-01-2006-10辽宁省友谊医院眼科施行白内障人工晶体手术患儿136例178眼，按手术时年龄分为2组sA组2～5岁70例102眼，B组6～14岁66例76眼，观察术后1周至1年患儿的眼轴长度和屈光度变化。结果A组眼轴长度变化为（3．08±1．89）mm，屈光度变化为（4．12±2．92）D，B组眼轴长度变化为（O．84±0．76）mm，屈光度变化为（2．07±1．36）D。结论儿童人工晶体眼仍存在视觉发育的近视趋向，故较小年龄患儿人工晶体度数应以低度欠矫为原则。     

Down syndrome and precocious menopause

Purpose: To determine whether women who had children with Down syndrome (DS) had precocious menopause.Methods: We selected 104 mothers of children with DS and 121 normal women who had children with no genetic problems. We conducted an interview and compared their mean age at menopause.Results: We did not detect a statistically significant difference in mean age at menopause. When we stratified into women who had conceived when younger or older than 35 years of age, we found a statistically significant difference only for women who had conceived at the age of 35 years or older. We observed three cases of previous unilateral ovarian surgery in the study group and one case in the control group.Conclusions: We cannot conclude that mothers of children with DS will have precocious menopause. Nevertheless, our findings do not exclude the theory of reduced ovarian reserve as a primordial factor in the genesis of DS.     

Metformin versus laparoscopic unilateral ovarian drilling in clomiphene resistant women with polycystic ovary syndrome

ObjectivesTo compare the hormonal-metabolic profiles and reproductive outcomes between women receiving metformin and women undergoing unilateral ovarian drilling in clomiphene citrate(CC) resistant patients with polycystic ovary syndrome (PCOS)DesignNon randomized controlled trial.SettingObstetrics and Gynecology department, Faculty of medicine, Zagazig University, Egypt.MethodsA total of 120 patients were divided into group 1(n=58) who received metformin therapy and group 2 (n=62) who underwent unilateral ovarian drilling. Hormonal-metabolic profiles changes after treatment were reported and reproductive outcomes were compared between both groups.Main outcomeFSH and LH were reduced significantly in unilateral drilling group (P=<0.001and 0.001), while there was significant improvement in testosterone level , fasting insulin, fasting glucose to insulin ratio and homeostasis model assessment index in metformin therapy group. Pregnancy and ovulation rates were higher after unilateral drilling with significant difference (P=0.048 and 0.004). No significant difference in early miscarriage rate between both groups (P=0.51).ConclusionUnilateral LOD was associated with greater ovulation and pregnancy rates than metformin in women with PCOS who did not conceive with CC.     

Treatment of infertile women with unilateral tubal occlusion by intrauterine insemination and ovarian stimulation

ObjectiveThe aim of this study was to evaluate the value of intrauterine insemination (IUI) combined with ovarian stimulation in women with unilateral tubal occlusion detected on hysterosalpingography (HSG).Materials and MethodsA total of 703 patients undergoing IUI and controlled ovarian hyperstimulation were enrolled in this study. The study group consisted of 133 patients treated for unilateral tubal occlusion diagnosed by HSG during 2005–2011. The control group consisted of 570 patients with unexplained infertility treated during the same period. In all cases of the retrospective study, menstrual cycles were regular, basal serum follicle-stimulating hormone levels and sperm parameters were normal.ResultsThere were no significant differences in pregnancy rate per cycle between the study (17.3%) and control groups (18.9%). The pregnancy rate was higher in patients with proximal tubal occlusion (21.7%) compared with mid-distal tubal occlusion (12.5%) or unexplained infertility (18.9%), but the difference was not statistically significant.ConclusionsInfertile patients with only unilateral proximal tubal occlusion detected on HSG can be treated initially by IUI combined with ovarian stimulation. The cycle outcomes in patients with proximal tubal occlusion are similar to patients with unexplained infertility. However, the stimulated IUI might not be a good choice for patients with unilateral mid-distal tubal occlusion because of a lower success rate, although further evidence is needed.     

Labor length among overweight and obese women undergoing induction of labor

Abstract

Objective: Maternal weight is thought to impact labor. With rising rates of obesity and inductions, we sought to evaluate labor times among induced women by body mass index (BMI) category.

Methods: Retrospective cohort study of term inductions from 2005 to 2010. BMI categories were: normal weight (NW), overweight (OW), and obese (Ob) (18.5–24.9, 25–29.9, ≥30?kg/m²). Kruskal–Wallis tests compared median latent labor (LL) length and active labor (AL) length. Chi-square determined associations. Multivariable logistic regression controlled for confounders. Analyses were stratified by parity.

Results: A total of 448 inductions were analyzed. For nulliparas, there was no difference in LL by BMI category (p?=?0.22). However, OW nulliparas had a longer AL compared to NW and Ob nulliparas (3.2, 1.7, 2.0?h, p?=?0.005). For multiparas, NW had the shortest LL (5.5?h, p?=?0.025) with no difference in AL among BMI categories (p?=?0.42). The overall cesarean rate was 23% with no difference by BMI category (p?=?0.95). However, Ob women had a greater percentage of first stage cesareans (41%) and NW had a greater percentage of second stage cesareans (55%), p?=?0.06.

Conclusion: The association between BMI and labor length among inductions differs by phase of labor and parity. BMI also influences the stage of labor in which a cesarean occurs.     

Epidemiologic study of the prevalence and severity of myopia among schoolchildren in Taiwan in 2000.

BACKGROUND AND PURPOSE: A nationwide survey was performed in 2000 to determine the prevalence and severity of myopia among schoolchildren in Taiwan and to compare these findings with the results of the last survey performed in 1995. METHODS: We first divided the whole island into regions according to developmental grade scores and then sampled with the probability proportional to the size of the population within each stratum. A total of 10,889 students were enrolled, including 5,664 boys and 5,225 girls, with ages ranging from 7 to 18 years. The refractive status and corneal radius of each student were measured with an autorefractometer under cycloplegia and checked with retinoscopy. Axial length was measured using biometric ultrasound. RESULTS: The myopia rate increased from 20% at 7 years, to 61% at 12 years, and 81% at 15 years. A myopic rate of 84% was found for schoolchildren aged 16 years through 18 years. The mean refractive index reached myopic status at the age of 8, and increased to -4.12 D in girls and -3.15 D in boys at the age of 18 years. The prevalence of high myopia (> -6.0 D) at the age of 18 years was 24% in girls and 18% in boys. The increase in axial length corresponded with the progression of myopia. The anterior chamber depth was slightly deeper from 7 years to 13 years and then remained stable. The lens thickness decreased from 7 years to 11 years. After age 15, further thickening of the lens was correlated with both age and severity of myopia. However, the corneal curvature was not related to age or severity of myopia. Girls had a higher prevalence and more severe degree of myopia than boys. Children in urban areas had a higher prevalence and more severe degree of myopia than children in rural areas. CONCLUSION: The prevalence and severity of myopia in schoolchildren in Taiwan in 2000 increased compared to 1995, with the most severe increases occurring in younger age groups. Thus, preventing schoolchildren developing myopia at a young age may slow down the increase in severity of myopia in Taiwan.     

Reproductive motivation in Russian women in the family context

Objective: This article presents an investigation of characteristics of reproductive motivation, reasons for not having children, and the propensity towards attempting a premeditated abortion in Russian women in early and middle adulthood. Method: Sixty-eight married women (34 childless women (20–25 years old) and 34 women with children (26–35 years)) were assessed on a number of measures. Results: There was no difference in reproductive motives between the two groups of women. The most significant difference is that, unlike younger women’s, middle-aged women’s reproductive motives correlate with life goals and locus of control. However, a large difference was found across two groups in the reasons for not having a baby. Younger women give more reasons for not having children. They specify that a child interferes with self-actualisation, limits social contacts and creates marital problems. In middle adulthood women tend to specify material (financial) difficulties as a reason for not having baby. Regarding premeditated abortion, there is no big difference between groups in attitudes towards it, but the reasons differ from a conflict between children and career in younger women to problems in the wider family system for more mature women. Conclusion: Although there is no significant difference in direct reproductive motivations between both groups, each age has its own specific instrumental reproductive and reproductive refusal motives.     

Comparison of periodontal health of primary teeth restored with zirconia and stainless steel crowns: A systemic review and meta-analysis

Background/PurposeIn children, the use of stainless steel crowns to treat caries has a high success rate. However, due to the unnatural color of stainless steel crowns, it still needs to modify crown types. The present meta-analysis study aims to explore the previous articles on the comparison of stainless steel crowns and zirconia crowns.MethodsThe systematic search of studies on the comparison of zirconia crowns and stainless steel crowns for primary teeth was mainly in PubMed and Cochrane database. The standardized mean differences (SMDs) of gingival health between zirconia crowns and stainless steel crowns comprised the primary outcome, and the SMDs of plaque index compared two crown treatments was treated as the secondary outcome.ResultsThe meta-analysis extracted 187 papers from various databases and collected five randomized controlled trials, four comparisons on deciduous molars and one comparison on deciduous incisors. 160 children were included, ranging in age from 3-9 years old. The quantitative analysis showed a significantly lower gingival index of zirconia crowns in the primary molar group and the primary incisor group. The plaque index between two crown treatments groups was -4.51, indicating less accumulation of plaque on zirconia crown. However, the heterogeneity of included trials still need to be considered.ConclusionZirconia crowns for deciduous teeth had its advantages for gingival health. Although stainless steel crowns were more likely to have plaque deposition and gingival inflammation, zirconia crowns relatively caused the opposite tooth wearing and chipping. Therefore, the comprehensive consideration is important to choose deciduous tooth crown.     

Juvenile Papillomatosis in a Young Child: A Case of Infantile Bloody Nipple Discharge

BackgroundBloody nipple discharge (BND) is a rare and distressing finding in infants, although its etiology is usually benign. Diagnostic management of BND and breast lesions in children calls for an adapted approach.CaseWe present the case of an 11-month-old girl with unilateral BND and a painless breast mass. Sonographic and histologic examination identified juvenile papillomatosis of the breast.Summary and ConclusionJuvenile papillomatosis of the breast is a rare cause of breast lesions in young patients with specific sonographic and histologic characteristics. Because of the associated risk of malignancy, surgical excision is the preferred therapy.     

儿童急性白血病SODD和P65蛋白的表达及临床意义

目的 探讨儿童急性白血病SODD和P65蛋白的表达及其临床意义。 方法 2004年3~11月采用免疫组化SABC法，检测华中科技大学同济医学院附属同济医院儿科住院急性白血病(AL)患儿骨髓涂片中SODD、P65蛋白表达。 结果 33例AL中，SODD和P65表达阳性率分别为54.5%(18/33)和45.5%(15/33)，与正常对照组相比差异有显著性(P<0.05)；25例急性淋巴细胞白血病(ALL)中，SODD和P65表达的阳性率分别为56.0%(14/25)和48.0%(12/25)，与正常对照组相比差异有显著性(P<0.05)。ALL高危病例组中SODD阳性表达率为75.0%(12/16)，较标危病例组阳性率高，差异有显著性(P<0.05)。33例AL患儿中SODD和P65均为阳性12例，均阴性16例，表达一致符合率为84.8%(28/33)，两者的表达呈正相关(P<0.01,r=0.69)。 结论 SODD和P65均参与了AL的发生发展；SODD过表达与儿童ALL的发生、临床分型以及预后均有密切关系。     

急性淋巴细胞白血病患儿化疗时脑脊液神经元特异性烯醇化酶的变化及意义

目的 探讨大剂量甲氨蝶呤静滴+鞘内注射治疗急性淋巴细胞白血病(ALL)患儿时中枢神经系统损伤的监测指标。方法 2003年1~12月在青岛大学医学院附属医院收治的42例标危ALL患儿中。在行大剂量甲氨蝶呤静滴+鞘内注射化疗前及化疗后15、30、45d腰穿留取脑脊液(CSF)各1mL,用双抗体夹心酶联免疫法测定CSF中神经元特异性烯醇化酶(NSE)的质量浓度。结果 化疗后，CSF中NSE质量浓度升高,于第15天达峰值,化疗30d NSE质量浓度下降，与化疗前比较差异有统计学意义；化疗45d后NSE质量浓度与化疗前比较差异无统计学意义。结论 CSF中NSE是ALL患儿行大剂量甲氨蝶呤静滴+鞘内注射化疗时，神经细胞急性损伤的一个有价值的预报因子。 Abstract Objective To investigate the monitoring factors for the central nervous system from intrathecal injections and high dose methotrexate therapy (HDMTX+IT) given during treatment for acute lymphoblastic leukemia in children.Methods Forty two children aged from 5 to 11 years with ALL participated in the study.children had the history of ALL less than one year,while twenty two children had ALL more than one year.CSF was sampled for analyses of NSE on four occasions.Results No difference was found between the NSE concentration of the children who had ALL more or less than one year.The NSE content in the CSF samples increased from (3.9±0.5) ng/mL before the start of treatment to (6.5±1.1) ng/mL at day 15 and then gradually decreased to (4.3±0.9) ng/mL at day 30 and to (4.0 0.7) ng/mL at day 45.Conclusion NSE is a useful marker for acute brain damage in acute lymphoblastic leukemia children. Key words Leukemia,lymphoblastic,acute;Children;Methotrexate;Neuron-specific enolase     

Daxx和NF-κB在儿童急性白血病中的表达及其相关性

目的探讨Daxx在儿童急性白血病(AL)骨髓细胞中的表达及其与NF-κB的相关性，同时观察其与AL临床分型和预后的关系。 方法骨髓涂片取自华中科技大学同济医学院附属同济医院2005—2006年收治的AL患儿和骨髓正常的非恶性血液病患儿,应用免疫组织化学链霉素 亲和素-生物素-过氧化酶复合物(SABC)方法检测50例儿童AL骨髓细胞Daxx和NF-κB的表达，对照组为20例非恶性血液病且骨髓正常患儿。 结果在50例AL患儿中，Daxx和NF-κB蛋白阳性表达率分别为38.0%和56.0%，显著高于正常骨髓组织中的表达(P<0.05)；Daxx与NF-κB表达呈强 相关(P<0.05)；急性淋巴细胞白血病(ALL)患儿高危组Daxx和NF-κB的表达率分别为55.6%和77.8%，标危组分别为0和16.7%，两组之间差异均有 显著性(P<0.05)。 结论Daxx、NF-κB在儿童AL中过度表达，在白血病细胞凋亡和增殖的调控过程中可能起协同作用，且与AL的某些临床特征、疗效和预后密切相 关。     

Compensatory Ovarian Hypertrophy after Unilateral Oophorectomy: Evaluation of Ovarian Volumes in Pediatric and Adolescent Populations

Study ObjectiveLimited data exist on the morphologic and physiologic effect on the remaining ovary after unilateral oophorectomy, especially in the pediatric population. Our aim is to evaluate ovarian volumes following unilateral oophorectomy to determine whether compensatory ovarian hypertrophy occurs in the remaining contralateral ovary.DesignThis was a retrospective chart review of ovarian volume measured on ultrasounds that were completed after unilateral oophorectomy. Postoperative ovarian volumes were compared to established radiologic standards.SettingLarge tertiary care academic children's hospital in Atlanta, GA.ParticipantsFemale patients less than 21 years old who underwent unilateral oophorectomy.Main Outcome MeasuresOvarian volumes measured on postoperative ultrasounds.ResultsA total of 93 patients met inclusion criteria for this study. Serial ultrasounds were performed in slightly more than half of the patients (n = 48, 51.6%), totaling 193 postoperative ovarian volumes. The average age of oophorectomy was 10.8 years. Prior to surgery, the majority of patients presented with abdominal pain (n = 51, 54.8%) or pelvic mass (n = 51, 54.8%), and most (n = 77, 82.8%) had benign final pathology. Ovarian volumes were compared to 4 published radiologic ultrasound standards. More than 62.2% of ovarian volumes from girls who had previously had unilateral oophorectomy were larger than age-matched standard ovarian volumes.ConclusionOvarian enlargement occurs in the contralateral ovary following unilateral oophorectomy in the pediatric and adolescent population. This supports the concept of compensatory ovarian hypertrophy. This knowledge provides valuable information for interpretation of radiologic images in young female individuals who have undergone oophorectomy, and can assist with counseling on the risk of adnexal complications due to ovarian hypertrophy after unilateral oophorectomy.     

An Innovative Strategy for Non-Grafting Penile Enlargement: A Novel Paradigm for Tunica Expansion Procedures

BackgroundPeyronie’s disease, diabetes, trauma, pelvic surgeries, and aging are conditions that promote penile fibrosis and trigger erectile dysfunction associated with penile reduction. These pathologies require an objective preoperative diagnosis and intraoperative management of penile shrinkage.AimThe goal is to develop a non-grafting procedure to promote lengthening using geometric patterns of multiple staggered small cuts on the tunica albuginea with an optimal ratio between tissue expansion and resistance to confine the cylinders inside the corpora cavernosa.MethodsBetween February 2016 and February 2019, 416 patients suffering penile shortening with or without Peyronie’s disease received implants using the tunica expansion procedures (TEP). Incisions were distributed in respective areas of the tunica to allow maximum expansion while maintaining strength to confine prosthetic cylinders within the corpora cavernosa to prevent bulges and denting.OutcomesIn accordance with these principles, surgical objectives and patient satisfaction were achieved in length and girth restoration regardless of the type of implant used to obtain adequate axial rigidity.ResultsThe sample of 416 patients included 287 cases of Peyronie’s disease having a mean axial deviation of 51° (0–90°) whose curvature was corrected in surgery, with pressure from the cylinders maintaining straightness for malleable and inflatable devices. Tunica constriction in 40.86% of cases was corrected with vertical relaxing incisions. Ventral glanspexy was performed intraoperatively in 92.8% of patients to prevent hypermobility. A penile gain of 3.3 cm (2–6) was measured intraoperatively.Clinical ImplicationsDiagnosis of penile shortening was performed by a stretch length test and pharmacologically induced erection together with the patient’s subjective opinion of penile loss. Lengthening procedure depends on the limit of the dissected neurovascular bundle. The patient and surgeon select the type of implant in accordance with his individual anatomic characteristics.Strengths and LimitationsThe TEP strategy is a non-grafting procedure based on tissue restitution by expansion instead of substitution, which provides surgeons a solution for penile enlargement to the limit of the dissected neurovascular bundle.ConclusionsThe TEP strategy has been demonstrated to be safe and effective to resolve problems of penile size reduction independently of penile curvature. It eliminates grafting and improves penile lengthening techniques using small, staggered cuts on the tunica albuginea, while maintaining tunica structural resistance to contain cylinders inside the corpora, preventing bulges and denting, facilitating tissue regeneration, and improving axial rigidity.Paulo H. Egydio, An Innovative Strategy for Non-Grafting Penile Enlargement: A Novel Paradigm for Tunica Expansion Procedures. J Sex Med 2020;17:2093–2103.