DETECTION OF URETHRAL DIVERTICULA IN WOMEN: COMPARISON OF A HIGH RESOLUTION FAST SPIN ECHO TECHNIQUE WITH DOUBLE BALLOON URETHROGRAPHY

Purpose

We compared a rapid high resolution magnetic resonance imaging (MRI) technique to contrast urethrography for the detection of urethral diverticula in women.

Materials and Methods

During a 19-month interval 13 patients with clinically suspected urethral diverticula were evaluated with MRI and contrast urethrography. All patients were referred by a urologist, and had clinical signs and symptoms suggesting the presence of a urethral diverticulum. Double balloon urethrography was performed in 12 patients and voiding cystourethrography was done in 1. MRI was performed using a fast spin echo T2-weighted pulse sequence and a dedicated pelvic multicoil. Following a sagittal localizer sequence 3 mm. thick axial sections were obtained from the bladder base through the entire urethra. Total imaging time was 15 minutes.

Results

In 7 patients MRI and urethrography were negative for urethral diverticula, and in 3 cystourethroscopy was negative. In 1 patient MRI revealed a vaginal inclusion cyst confirmed by surgery. Three patients had no other studies or procedures performed. In 6 patients MRI was positive for urethral diverticula, including 4 in whom the diverticulum was confirmed at surgery, 1 who declined surgery and 1 who was lost to followup. Of the 4 patients (75%) with a surgically confirmed diverticulum double balloon urethrogram was negative in 3.

Conclusions

MRI is a valuable noninvasive technique for determining the presence of urethral diverticula as well as detecting other abnormalities. In our study MRI had a higher sensitivity for detecting diverticula and a much higher negative predictive rate.     

JUGULAR BULB CANNULATION: DESCRIPTION OF A CANNULATION TECHNIQUE AND VALIDATION OF A NEW CONTINUOUS MONITOR

We have compared in vivo oxygen saturation recordings obtainedfrom the Oximetrix 3 with in vitro measurements using the InstrumentationLaboratories 282 Co-Oximeter. The small mean difference (0.85%)and close limits of agreement (—4% to 6%) are close enoughfor clinical purposes, provided in vivo calibration is performedafter insertion of the fibreoptic catheter and repeated at leastevery 12 h. Continuous monitoring of jugular bulb oxygen saturationduring intensive care of brain injured patients is now possibleusing fibreoptic technology. This technique may be of valuein detecting global ischaemia, and as a predictor and monitorof cerebral perfusion pressure therapy.     

A NEW TECHNIQUE OF ANKLE ARTHRODESIS

A new technique of ankle arthrodesis is described and the results of 12 consecutive procedures are assessed. The method described employs three cannulated transfixion screws and an anterior approach to the ankle. Eleven of the 12 ankles proceeded to solid fusion. One patient developed a painless fibrous non-union. There were no other significant complications. This simple technique provides good compression and adequate resistance to rotatory and angulatory stresses about the ankle fusion site.     

HEMIFICAL SPASM: A NEW TECHNIQUE OF FACIAL NERVE BLOCKADE

A new technique of facial nerve blockade using a special needleand a nerve stimulator was introduced. The results in patientssuffering from hemifacial spasm are reported. This techniquereduced the difficulties in identifying the facial nerve anddecreased the suffering associated with the conventional wayof creating these blocks. The technique described may also allowtitration of neurolytic agent which may produce complete relieffrom spasm with much less likelihood of facial paralysis afterthe nerve blockade.     

A NEW TECHNIQUE FOR DOMICILIARY FLYING SQUAD ANAESTHESIA

A technique of domiciliary midwifery anaesthesia using Entonoxon a demand basis and minimal trichloroethylene is described.The method employs apparatus using the drawover principle, andalso includes facilities for neonatal resuscitation. ^*Liverpool Maternity Hospital, Liverpool 7. Department of Anaesthetics, Bristol University. Whiston Hospital, Prescot, Lanes.     

荧光示踪法研究逆行岛状皮瓣静脉回流

目的探讨采用荧光示踪法研究逆行岛状皮瓣静脉回流的可行性，并初步观察静脉回流规律。方法20只新西兰大白兔，每只取耳静脉血0．ImL，分离RBC并用FITC标记。流式细胞仪检测已标记的RBC阳性率及荧光强度，倒置荧光显微镜观察其形态。取20只新西兰大白兔，在动物双侧后肢内侧分别建立4cm×3cm隐动、静脉逆行岛状皮瓣模型（n=10）和顺行岛状皮瓣模型（n=10），血管蒂长3cm。将一侧后肢随机设定为实验组，皮瓣制备后注射已标记的RBC悬液5pL；对侧为对照组，不注射示踪剂。实验组按顺行和逆行皮瓣分成两组，即顺行皮瓣组和逆行皮瓣组，每组10个；再根据注入示踪剂途径不同，分为动脉和静脉2个亚组，每亚组5个皮瓣。注射示踪剂5S后取下皮瓣立即冷冻，取连续的3张冰冻切片（5～7pm），其中2张行HE染色和GENMED染色，另]张不染色直接压片，荧光显微镜观察荧光分布。结果流式细胞仪分析FITC标记的RBC阳性率在99％以上，荧光强度均≥10。；倒置荧光显微镜下标记的RBC呈均匀分布的绿色荧光，荧光强度均匀、稳定。冰冻切片显示实验组皮瓣蒂部均出现荧光，对照组未见荧光。顺行岛状皮瓣组荧光主要分布在静脉腔、静脉壁、动脉内膜和外膜；逆行岛状皮瓣组荧光分布在动脉内膜、外膜和静脉壁。结论荧光示踪剂可用于静脉回流研究，顺行岛状皮瓣静脉主要通过静脉腔、静脉壁、动脉内膜和外膜回流；逆行岛状皮瓣静脉主要通过动脉内膜、外膜和静脉壁的“迷宫式途径”回流。     

A NEW TECHNIQUE FOR TWO-HAND BAG VALVE MASK VENTILATION

A method of bag valve mask ventilation (BVM) in which the resuscitatorcompresses the self-inflating bag between the open palm andbody was compared with both standard single resuscitator andtwo-resuscitator BVM ventilation. Eighteen subjects ventilateda modified recording mannikin using each method in random order.The tidal volume (VT) was greater with the open palm (mean 684(SD 182) ml) than standard single resuscitator ventilation (mean520 (152) ml). The difference was greater in the nine subjectswith small hands (mean 196 (103) ml).VT was less than with tworesuscitatorventilation (mean VT 953 (236) ml).     

THE ADVANTAGES OF A COMBINED T-PIECE AND NON-REBREATHING VALVE: A SIMPLE DEVICE

A combined device is described which is considered to utilizethe advantages of both the T-piece and non-rebreathing valve,while eliminating the disadvantages. The device incorporatesthe reservoir bag and inhalation valve of the non-rebreathingsystem and the expiratory reservoir limb of the T-piece.     

ERCP术后胰腺炎的诊断与治疗

目的探讨ERCP术后并发胰腺炎的诊断与治疗。方法回顾性分析2824例行ERCP患者的有关临床资料。统计高淀粉酶血症与PEP的发生率,观察ERCP后血淀粉酶变化的规律。结果高淀粉酶血症与PEP是ERCP后最常见的并发症,本组总发生率达87．3％。结论ERCP术后并发胰腺炎一般较轻,经保守治疗后均能恢复。重症胰腺炎的发生率较低,但愈后较差。     

LAPAROSCOPIC CHOLECYSTECTOMY AND PREVIOUS ABDOMINAL SURGERY: A SAFE TECHNIQUE

Previous abdominal surgery has been cited as a contraindication to the performance of laparoscopic cholecystectomy. The present paper describes a technique whereby a Hasson cannula was introduced into the right iliac fossa by the open technique, using a method similar to an appendicectomy. The laparoscope was then introduced through this port and the safe introduction of other ports was achieved. Any adhesions were divided at this stage. The laparoscope was then moved to the umbilical port and a conventional laparoscopic cholecystectomy performed. In the series of six patients with upper or upper and lower abdominal scars, no patient suffered a complication or required a conversion to laparotomy. However, the operating time was increased from 75 to 105 min. This method involves open introduction of the primary trocar in an area devoid of adhesions. It was shown to be safe and with this method previous abdominal surgery should not be regarded as a contraindication.     

全膝关节置换术中胫骨假体旋转对线新技术

目的 比较全膝关节置换术中确定胫骨假体旋转对线的参照方法,以提高手术效果,减少术后并发症. 方法 2006 年5月 -2007年4月,对60例膝内翻患者行旋转平台全膝人工关节置换,其中男27例,女33例;年龄55～78岁.随机分为两组,每组30例.术中胫骨假体定位方法:A组采用胫骨结节中内1/3线作为解剖标志;B组膝内翻0～9°患者采用胫骨结节内侧缘作为解剖标志,10～19°患者以胫骨结节内侧缘至胫骨结节中内1/3线区间的中线为准,≥20°的患者以胫骨结节中内1/3 线为准.测量术后两组聚乙烯半月板垫片的旋转角度. 结果 术后聚乙烯半月板垫片旋转角度测量,A 组内旋(5.6±2.8)°,其中膝内翻 0～9°患者为(8.4±3.8)°,10～19°患者为(3.5±2.7)°,≥20°患者为(0±2.4)°;B 组内旋(0±1.9)°,其中膝内翻0～9°患者为(0±2.1)°,10～19°患者为(0±2.0)°,≥20°患者为(0±1.7)°.A 组组内比较及与 B 组比较差异均有统计学意义(P<0.05),B 组组内比较差异无统计学意义(P>0.05). 结论 胫骨结节内侧缘至中内 1/3 线是较理想的胫骨假体旋转定位区间,线性的定位应根据患者膝关节内外翻畸形程度而定.     

肾移植手术输尿管吻合新技术随访评估

目的比较改良的“一针法”技术和传统Lich—Gregoir输尿管吻合技术临床效果。方法2002年1月-2004年12月,对445例慢性肾炎尿毒症患者行肾移植术。121例采用改良的“一针法”技术行膀胱输尿管吻合（新-针法组）。其中男79例,女42例;年龄20～62岁,平均35．7岁。病程2～11年,平均2．7年。324例采用Lich—Gregoir技术（Lich—Gregoir组）。其中男211例,女113例：年龄19～65岁,平均33．9岁。病程1～14年,平均2．3年。两组患者的性别、年龄、原发病、病程差异均无统计学意义（P〉0．05）。对两组患者的手术时间及移植术后输尿管和非输尿管并发症进行比较。结果新一针法组和Lich—Gregoir组手术时间分别为（8．74&#177;1．1）min和（22．44&#177;5．1）min,差异有统计学意义（P〈0．05）。患者获随访3～5年。新一针法组：5例输尿管漏尿、15例肉眼血尿、4例梗阻以及28例泌尿系感染,未见膀胱输尿管系统性返流发生。Lich-Gregoir组：17例输尿管漏尿、12例肉眼血尿、13例梗阻、6例膀胱输尿管系统性返流、86例泌尿系感染和2例泌尿系结石。其中新一针法组术后肉眼血尿并发症的发生率为12．4％,与Lich—Gregoir组3．7％比较,差异有统计学意义（P〈0．05）;Lich．Gregoir组和新一针法组输尿管并发症发生率分别为19．8％及15．4％,差异无统计学意义（P〉0．05）;两组泌尿系感染、移植肾功能延迟恢复和排斥反应的发生率比较,差异无统计学意义（P〉0．05）。结论改良的“一针法”技术和Lich-Gregoir技术其总体输尿管并发症发生率无明显差异,但改良的“一针法”技术较Lich—Gregoir技术简便。     

COLOSTOMY CLOSURE: TECHNIQUE AND MORBIDITY

A personal retrospective series of 100 consecutive colostomy closures performed between 1968 and 1978 is reviewed. Serious intraabdominal complications occurred in three patients. The total complication rate in this series was 29%. There were no deaths and no faecal fistulae. However, wound infection occurred in 22 patients.     

SUBCUTANEOUS MASTECTOMY: INDICATIONS AND TECHNIQUE

For a certain group of patients, carefully selected by criteria which are here discussed, subcutaneous mastectomy offers a real prospect of minimizing the risk of breast cancer developing. It will also relieve pain in most of those for whom it has become intolerable and will usually provide the patient with both comfort and peace of mind. Performed by the technique described, subcutaneous mastectomy can now produce an aesthetically pleasing result. Regular review of all patients is, however, mandatory.     

A DEVICE FOR THE CONTROLLED VENTILATION OF INFANTS AND CHILDREN

A self-filling ventilator attachment which will deliver presetvolumes from 10 ml to 700 ml is described. It can be operatedby most ventilators or by manual inflation. It is a non-rebreathingsystem and patients can be ventilated with ambient air or anaestheticgases. ^* In receipt of a grant from the Wellcome Trust.     

ORTHOTOPIC URINARY DIVERSION WITH PRESERVATION OF ERECTILE AND EJACULATORY FUNCTION IN MEN REQUIRING RADICAL CYSTECTOMY FOR NONUROTHELIAL MALIGNANCY: A NEW TECHNIQUE

PURPOSE: Nerve sparing techniques to preserve sexual function in men undergoing cystoprostatectomy have been well documented. The patient who desires to remain fertile with ejaculatory function poses an additional challenge. We describe a new technique for radical cystectomy and orthotopic diversion with preservation of the vasa deferentia, seminal vesicles, posterior prostate and neurovascular bundles. MATERIALS AND METHODS: Four men with a median age of 26 years presented with bladder pathology necessitating cystectomy, including signet ring carcinoma of the bladder dome, leiomyosarcoma of the anterior bladder wall, leiomyosarcoma of the lateral bladder wall, and extensive polypoid cystitis glandularis of the trigone and posterior wall refractory to conservative and transurethral management. All patients wished to maintain fertility and ejaculatory function. We detail the surgical technique of extirpation of the bladder and anterior proximal prostate en bloc with preservation of the vasa deferentia, seminal vesicles, posterior prostate and neurovascular bundles as well as construction of an orthotopic reservoir. RESULTS: Followup ranges from 4 months to 5 years. All patients remain completely continent and void to completion without difficulty. Erectile function is normal in all cases. Of 3 patients who ejaculate antegrade 1 has fathered a child. The remaining patient ejaculates retrograde. There has been no tumor recurrence. CONCLUSIONS: The technique of cystectomy with preservation of the vasa deferentia, seminal vesicles, posterior prostate and neurovascular bundles is an excellent option in men with nonurothelial malignancy or another pathological condition that necessitates cystectomy, and in whom preservation of fertility and potency is desirable. All of our patients are fully potent and achieve ejaculation. Even the patient with retrograde ejaculation remains fertile. In terms of practicality semen retrieval from urine is much simpler than epididymal sperm aspiration and in vitro fertilization.     

INFERIOR VENA CAVAL RESECTION WITH AUTOGENOUS PERITONEO-FASCIAL PATCH GRAFT CAVAL REPAIR: A NEW TECHNIQUE

Background : In the course of oncological surgery, resection of the inferior vena cava (IVC) may be required to obtain an adequate resection margin and to offer the best opportunity of cure. The remaining defect in the IVC may be managed by: (i) primary repair which may lead to subsequent narrowing of the lumen, possibly leading to turbulent flow and thrombus formation; (ii) patch grafting of the defect, which may prevent narrowing. Several synthetic and biosynthetic materials are available as patch grafts and autologous pericardium has also been used. Methods : The harvesting and use of the autogenous peritoneo-fascial (APF) graft as an alternative caval patch graft material in the management of defects in the caval wall is proposed. Autogenous peritoneo-fascial caval patch graft repair in six patients was undertaken. Results : One patient with leiomyosarcoma secondaries in the liver eventually succumbed to the disease. The other five patients are clinically well with no evidence of IVC obstruction or venous aneurysms. Conclusion : Preliminary results show that this new technique of utilizing an APF patch graft for caval repair is clinically a suitable alternative to current biosynthetic and synthetic materials and may in fact be superior in many aspects.     

CAUDAL ANALGESIA: A SIMPLE AND SAFE TECHNIQUE IN PAEDIATRIC SURGERY

A series of 170 infants and children were operated upon undercaudal analgesia. Lignocaine was used in concentrations from0.5 to 2 per cent. The average dose employed was 10 mg/kg bodyweight. Analgesia was satisfactory in 91.7 per cent of cases.Complete failure occurred in 5.2 per cent of patients. No seriousaccidents or complications were seen due to the anaestheticmethod. In the author's experience this technique representsa safe, reliable and simple way to produce surgical analgesiain infants and children, especially in those needing emergencysurgery who are in poor condition.