阴茎折断诊治14例分析

对我科2001-2005年收治的阴茎折断14例分析如下。     

阴茎系带断裂58例分析

目的：探讨阴茎系带断裂的综合治疗。方法：回顾性分析1999／2006年58例阴茎系带断裂患者的临床资料。结果：58例患者均治愈，性生活质量有不同程度的提高，无勃起功能障碍等并发症。结论：阴茎系带断裂患者经临床处理和心理疏导等综合治疗，效果良好。     

儿童隐匿阴茎65例治疗分析

目的探讨不同手术方式对65例先天性隐匿阴茎的治疗效果。方法总结洛阳市妇女儿童医疗保健中心近7 a来对65例隐匿阴茎患儿采用不同手术方法进行治疗的临床经验,其中Devine术16例,脱套式阴茎固定术29例,转移皮瓣法20例。结果平均随诊1.5 a(6个月~2.5 a),无明显肥胖者术后阴茎外形均发育良好。Devine术后5例出现顽固性水肿,且外观不甚满意。结论隐匿阴茎手术方法较多,根据患儿阴茎发育情况可采用不同的手术方式,皮瓣转移法手术阴茎外观接近包茎术后外观,并发症较少,可以作为治疗隐匿阴茎的常规术式。     

单纯性阴茎下弯手术矫直体会

【目的】探讨单纯性阴茎下弯矫直的手术方法和疗效。【方法】8例单纯性阴茎下弯患者采取尿道延伸术,9例重度阴茎下弯患者采取切断尿道矫直阴茎一期尿道成形术。【结果】17例术后外观均满意,无下弯复发,1例发生尿瘘。【结论】根据单纯阴茎下弯的严重程度具体选择矫直术式,并发症少,疗效满意。     

急诊手术治疗阴茎折断26例分析

折断在临床上较为少见,早期诊断和正确治疗对防止阴茎勃起功能障碍的发生非常重要.对我院1988-03～2003-06共收治的26例分析如下.     

环切入路包皮阴茎皮肤成形术治疗隐匿阴茎

目的 探讨环切入路包皮阴茎皮肤成形术治疗隐匿阴茎的疗效。方法 回顾性分析2010～2013年行环切入路包皮阴茎皮肤成形术治疗29例隐匿阴茎患者的临床资料。患儿年龄3～18（9．2±2．7）岁。术前测量阴茎外露长度0．5～3．2（1．8 ± 0．6）cm ,其中重度13例,中度16例。合并包茎者23例,明显肥胖者16例。结果 环切入路包皮阴茎皮肤成形术治疗隐匿阴茎术后阴茎外露增加长度为（2．5 ± 0．3）cm ,龟头外露良好,无术后顽固性阴茎皮肤水肿现象。结论 隐匿阴茎的形成与阴茎皮肤浅筋膜发育异常有关。环切入路,包皮阴茎皮肤成形术是行之有效并能预防术后包皮顽固性水肿的简易方法。     

国内器官移植供体不足的伦理原因分析

器官移植对于挽救晚期脏器功能衰竭患者的生命具有极其重要的意义，但供体器官的严重不足，成为阻碍器官移植临床应用的最棘手问题。器官移植应用中，主要涉及器官来源和器官分配两大方面。从这两个方面分析器官移植中的社会伦理问题，为帮助人们解放思想，冲破传统观念的束缚，以求最大限度地增加器官来源缓解供求矛盾。在器官来源上存在的伦理问题主要是传统伦理观念和死亡标准问题。对于尸体供体及活体供体均应考虑维护供体利益，体现真正意义的“自愿”。从医学伦理学角度来讲器官分配主要考虑患者的剩余寿命、家庭角色、科研价值、历史回顾与对未来的前瞻。但同时更应该遵守器官移植资源分配的原则（尊重生命原则、效用原则、公平公正原则）。     

阴茎癌56例分析

我院1997／2005年共收治阴茎癌患者56例,现报告如下。 1临床资料 1．1一般资料本组年龄22～73岁,其中41～60岁42例,占75．0％。病程3个月1-4a。包茎40例,包皮过长16例,其中10例发病前3个月～5a曾行包皮环切术。临床表现为阴茎头部肿物34例,久治不愈之溃疡9例;阴茎溃烂、疼痛伴恶臭分泌物45例;腹股沟淋巴结肿大41例。均无排尿困难史。     

阴茎离断再植5例分析

目的总结5例阴茎完全离断再植的临床治疗及疗效。方法1990-06-2009-10对5例阴茎完全离断的患者,采用急诊在放大16倍的手术显微镜下按导尿管固定、吻合阴茎背静脉、阴茎背动脉及阴茎背神经的再植顺序。其中1例阴茎连同两侧睾丸离断,吻合输精管及血管。结果本组5例阴茎全部成活,其中1例阴茎连同两侧睾丸离断的患者,一侧睾丸及部分阴囊皮肤坏死,二期行大腿内侧局部转移皮瓣修复后愈合。2例阴茎皮肤部分坏死,换药后瘢痕愈合。术后随访时间为10个月~18 a。再植阴茎无明显尿道狭窄,皮肤感觉恢复良好,阴茎勃起功能恢复良好能完成正常的性生活。结论应用显微外科技术可明显提高阴茎离断再植的成活率,并可恢复阴茎的完整外形和良好的功能。     

弹力绷带在阴茎术后伤口包扎中的应用

阴茎部手术的患者如包皮环切术或尿道下裂阴茎伸直术等,即往用纱布包扎后再利用医用橡皮膏固定。因医用橡皮膏无弹性,不能随阴茎的大小而变化,再加术区的特殊性如包扎过紧,当阴茎充血时,会影响血液循环而导致切口感染引起伤口延期愈合也可能出现排尿不畅。如果阴茎包扎过松可能发生血肿或敷料容易脱落。我科对阴茎部手术的患者利用弹力绷带包绕术区效果满意。现将临床应用体会报告如下     

Organs for transplantation: analysis of 27,000 cadaveric donor organs

Organs from brain-dead cadaveric donors have been increasingly used for saving lives and preserving health. During the 5 calendar years 1984 through 1988, specific organ recovery patterns were reported for 10,488 donors of 27,833 vascular organs. Transplantation of 18,277 kidneys, 3425 hearts, 2957 livers, and 411 pancreatic grafts (as well as smaller numbers of lung, intestine, heart-lung, and multivisceral grafts) represented an organ utilization rate exceeding 90%. Organ sharing was common and had a beneficial effect overall. Renal allografts from multiorgan donors showed better early function and long-term survival. A steady decrease in organ wastage has been accompanied by a substantial increase in numbers of cadaveric multiorgan donors. The resource of life-saving cadaveric organs is effectively and widely dispersed, allowing increasingly common treatment of end-stage organ failure by transplantation.     

Diaphragm needle placement techniques evaluated in cadaveric specimens

Chiodo A, Goodmurphy C, Haig A. Diaphragm needle placement techniques evaluated in cadaveric specimens.

Objective

To evaluate the safest and most accurate method of diaphragm needle placement for electromyography.

Design

Single blinded study.

Setting

University anatomy laboratory.

Cadavers

Five cadavers.

Interventions

Needle placement in the diaphragm by an American Board of Electrodiagnostic Medicine physician, blinded dissection by a doctoral candidate anatomist.

Main Outcome Measures

Accurate needle placement in the diaphragm, proximity or penetration of organs, vessels, or nerves, defined as cautions (proximity) and dangers (penetration).

Results

The anterior axillary approach was most accurate at the above-the-seventh and eighth-rib locations. The risk of dangers of needle placement in the diaphragm was greater on the right than left side.

Conclusions

Needle placement in the diaphragm is safe and most accurate at the anterior axillary line superior to the eighth rib. If the side of needle placement does not matter for the study being done, the left side should be chosen because it leads to a lower risk of danger to the patient.     

亲属活体供肾与同期尸体肾移植40例比较

背景:近年亲属活体问肾移植数量明显增加,供肾者的安全性及亲属活体供肾的移植质量受到日益重视.目的:总结40例亲属活体供肾移植的临床经验,评价其效果及安全性.方法:广西中医学院附属瑞康医院移植泌尿外科在2007-06/2008-08共完成亲属活体供肾移植40例,回顾分析供、受者相关的临床资料.同期随机抽取尸肾移植40例,将亲属活体间肾移植受者与尸肾移植受者在血肌酐水平恢复正常时间、急性排斥反应发生率、肾功能延迟恢复发生率、外科相关并发症发生率等方面进行比较.结果:所有供者手术时间仅1.0～2.0 h,供肾热缺血时间15 S左右,冷缺血时间1.0～2.0 h,围手术期间未发生外科及内科并发症.受者术后肾功能恢复快,前3 d尿量500～1 000 mL/h,1周左右血肌酐水平均可降至正常.随访至今,所有供、受者均正常生存,移植肾功能均保持在正常范围.活体肾移植受者在血肌酐水平恢复正常时间、急性排斥反应发生率、肾功能延迟恢复发生率等方面均显著低于尸肾移植.开放切取供肾手术时间短、热缺血时间短,在手术安全性方面也有一定的优势.     

供肝的不同灌注方法在大鼠肝移植中的应用

目的:探讨大鼠肝移植时供肝的不同灌注方法对大鼠的影响.方法:80只大鼠随机分为供、受体两组(各40只),供体组再随机均分为经腹主动脉灌注组(A组)和经门静脉灌注组(B组)以获取供肝,应用改良二袖套法进行大鼠原位肝移植.检测两组供肝切取时间,热缺血时间,术后第1、4、7、10天的肝功能,术后一般情况及生存率等.结果:A组和B组的供肝切取时间分别为(30.0±3.0)min和(27.0±3.0)min,热缺血时间分别为(2.0±0.5)min和(1.0±0.5)min;A组术后第1天的丙氨酸氨基转移酶、天冬氨酸氨基转移酶、总胆红素等均较B组高,而术后第7天的结果却相反.结论:对于非肝动脉化的大鼠肝移植手术供肝采用经门静脉灌注的方法操作较简单,供肝切取时间较短,热缺血时间短,术后早期肝功能的损害较小,但恢复速度相对较慢.     

Brain perfusion and ultrasonic imaging techniques.

Advances in neurosonology have generated several techniques of ultrasonic perfusion imaging employing ultrasound echo contrast agents (ECAs). Doppler imaging techniques cannot measure the low flow velocities that are associated with parenchymal perfusion. Ultrasonic perfusion imaging, therefore, is a combination of a contrast agent-specific ultrasound imaging technique (CAI) mode and a data acquisition and processing (DAP) technique that is suited to observe and evaluate the perfusion kinetics. The intensity in CAI images is a measure of ECA concentration but also depends on various other parameters, e.g. depth of examination. Moreover, ECAs can be destroyed by ultrasound, which is an artifact but can also be a feature. Thus, many different DAPs have been developed for certain CAI techniques, ECAs and target organs. Although substantial progress in ECA and CAI technology can be foreseen, ultrasound contrast imaging has yet to reliably differentiate between normal and pathological perfusion conditions. Destructive imaging techniques, such as contrast burst imaging (CBI) or time variance imaging (TVI), in combination with new DAP techniques provide sufficient signal-to-noise ratio (SNR) for transcranial applications, and consider contrast agent kinetics and destruction to eliminate depth dependency and to calculate semi-quantitative parameters. Since ultrasound machines are widely accessible and cost-effective, ultrasonic perfusion imaging techniques should become supplementary standard perfusion imaging techniques in acute stroke diagnosis and monitoring. This paper gives an overview on different CAI and DAP techniques with special focus on recent innovations and their clinical potential.     

Intravenous nitroglycerin perfusion techniques — Clinical implications

Two types of intravenous nitroglycerin (NTG) perfusion sets were studied using laboratory techniques. A known concentration of NTG was placed in each of these sets, and an evaluation was made as to the dose of NTG actually received by the patient after passage of the NTG solution through the sets. Set number one consisted of a glass container and polyvinyl chloride (PVC) tubing. After passage through this set, there was a rapid and significant decrease in the NTG concentration, i.e. the dose actually received by the patient is less than the dose theoretically administered. Set number two consisted of a polypropylene syringe and polyethylene tubing. After passage through this set, there was no significant change in the NTG concentration, i.e. the patient receives the full theoretical dose.     

A comparison of two behavioral influence techniques for improving blood donor recruitment

This study was designed to test the viability of two multiple request techniques of behavioral influence for recruiting blood donors by telephone. The first technique utilizes a small antecedent request to encourage behavioral involvement and favorable disposition toward the target activity of the critical request to donate. The second approach frames the critical request as a concession following refusal of a very large request. The two techniques, dubbed the foot-in-the-door (FID) and door-in-the-face (DIF), respectively, were tested against a control condition on three donor groups: active donors, inactive donors, and nondonors. Thus, a three-by-three factorial design was used on 910 adults in a Midwest city. Although the DIF was outperformed by the control across all three donor groups, the authors recommend its continued study in face-to-face donor solicitation. Importantly, the FID approach produced more donations than the control condition among active donors (Z = 4.30; p less than .001), inactives (Z = 7.45; p less than .001), and nondonors (Z = 1.98; p less than .05). For managing the blood supply, the FID is particularly potent for rekindling donations from inactive donors. Additional research on means of penetrating the nondonor segment is recommended.     

Assessment of non-heart-beating donor (NHBD) kidneys for viability on machine perfusion.

The shortage of organs has resulted in renewed interest in organs from non-heart-beating donors (NHBD). Viability assessment of such organs may reduce the incidence of delayed graft function and primary non-function. In Phase III of the NHBD programme, introduction of machine perfusion enabled the assessment of these marginal donors. Since then the graft survival has been 88.4% compared with the previous phase where machine perfusion or viability assessment was not done (45.5%). The parameters used were total glutathione S-transferase (GST) in the perfusate, the intrarenal vascular resistance (IRVR) and flow characteristics over time. METHODS: All NHBD kidneys were machine perfused through a locally developed perfusion system. The viability was assessed by serial measurements of the above-mentioned parameters. RESULTS: Forty-two local NHBD kidneys were retrieved and one kidney was imported, of which 19 donors (i.e. 38 kidneys) were of the uncontrolled (category II) donors. After viability assessment on machine perfusion; two kidneys were discarded due to positive tests for syphilis, four kidneys had high total GST levels, five kidneys due to high IRVR and poor flow characteristics and one did not flush on retrieval. Three kidneys were exported after viability tests. In 28 NHBD kidney recipients, immediate graft function was seen in two kidneys, 22 (84.6%) developed delayed graft function. One kidney had primary non-function, and two recipients lost their grafts, due to chronic rejection and renal vein thrombosis. There were two deaths, unrelated to transplantation. Graft survival was achieved in 88.4% (23/26 graft survival in phase III) of cases. CONCLUSION: Machine perfusion and assessment of NHBD kidneys has been successfully introduced to the Newcastle NHBD programme. This approach, using renal transplants from largely category II donors produced a success rate of 88.4% which was significantly better than the phase II period (45.5%) of the program (p=0.023, Fisher 2 tail test).