用包皮去除环进行成人包皮环切术

目的探讨用一种新器械-包皮去除环进行包皮环切术的方法和效果。方法对2组各100例患者分别施行该手术和经典的包皮环切术,随访3～6个月,对比手术时间、手术失血,前瞻性对比术后疼痛、不适及术后失血、水肿等并发症和术后包皮形状、勃起功能。结果该术的切除范围标准,并发症少,痛苦小,患者的满意度高。结论用该器械进行包皮环切术是一种新的有效的包皮环切方法。     

已行和未行包皮环切术的青年男性对包皮及包皮环切术认识和态度的比较研究

目的:探讨青年男性对包皮及包皮环切术知识的掌握程度以及他们是否接受包皮环切术的影响因素。方法:采用自行设计的问卷对泌尿外科门诊已行和未行包皮环切术的青年男性各100名进行调查研究。统计学方法采用SPSS 11.0软件包中χ2检验。结果:已行包皮环切术的青年男性接受该手术的原因依次为:使阴茎更卫生、为预防阴茎癌和期望提高性功能,分别占63%、27%和26%;青年男性未行包皮环切术的主要原因是不清楚包皮环切术的益处和担心术后并发症,分别占47%和24%。同时,周围同龄人的影响也是决定是否接受包皮环切术的重要因素。已行包皮环切术的青年男性对何时进行该手术并不十分清楚。结论:青年男性接受包皮环切术的主要因素是认为术后可改善阴茎局部卫生和期待提高性功能;而拒绝该手术者则不清楚包皮环切术的益处和担心术后并发症。故应加强对包皮和包皮环切术相关知识的宣教工作。     

对包皮环切术的新认识

１　对包皮的认识包皮是灵长类和人类外生殖器普通的解剖结构，已知在灵长类包皮有６５００万年以上。包皮是外生殖器的正常部分，在男性覆盖阴茎，在女性遮盖阴蒂。包皮酷似眼睑、小阴唇、口唇。包皮的胚胎发生源自外胚层、神经板和间充质。Ｃｏｌｄ［１］研究认为，包皮由五层组织构成，各有其特殊功能。包皮由包皮皱襞和一层细胞膜向内生长结合而成。由这一层向内生长形成包皮、阴茎头、阴茎冠和冠状沟粘膜，从而形成共同的粘膜上皮，包绕阴茎头和包皮最内层粘膜。阴茎头粘膜、冠状沟和包皮均为一种具有同样细胞角蛋白多肽型的组织隔。因…     

包皮切环圈行包皮环压术328例

我院应用作者自行设计的包皮环切圈行包皮环压术 32 8例 ,效果满意 ,现报告如下。1　资料与方法1.1　临床资料　本文 32 8例 ,年龄 1～ 38岁 ,平均2 0 .2岁。其中包茎 12 7例 ,包皮过长 2 0 1例。1.2　包皮环切圈　即内外径均相同的 2个圆形板圈样结构 ,分别称为底圈和垫圈 ,对应有 3个等分对称的螺孔和圆孔 ,2ｍｍ的螺钉刚能通过圆孔旋入螺孔使两圈紧密嵌合 (见图 1)。　　 图 1　包皮环切圈行包皮环压术(ａ) :包皮背侧正中剪开后将包皮绕底圈翻转 ;(ｂ) :用输精管固定钳 (或用磨尖钳嘴的皮钳 )穿入两圈的螺 (圆 )孔 ,夹住两孔的外缘固定 ;…     

包皮扎切环与包皮扎切术

包皮扎切环与包皮扎切术高民信＊刘明利＊张德华＊包皮环切术是治疗包茎和包皮过长的常用术式。但有术后系带过短、出血、感染及切缘不整齐等不足。为此，我们研制了包皮扎切环施行包皮扎切术９４例，效果满意。此包皮扎切环已取得国家专利权。专利号为８６３７０。１临床...     

电刀包皮环切术

包皮环切术是一种常见的小手术 ,按常规使用的手术方法 ,病人对术中的出血 ,术后血肿及拆线时的疼痛有诸多埋怨。本组从 93年 4月～ 97年 5月改良使用电刀切割及肠线缝合手术共 96例 ,病人反应良好 ,效果满意。临床资料本组年龄 2 5个月～ 75岁 ,平均 18岁 ,其中包茎 2 5例 ,包皮过长 6 5例 ,包皮嵌顿经复位抗炎治疗后手术者 6例。一般 10岁以上者用阴茎根部局麻 ,而 10岁以下者采用基础麻醉 ,备常用的高频电刀及5～ 0肠线。操作步骤1.在包皮的背腹侧边缘中旁各用一对直止血钳夹住皮肤 ,每对间距约 0 .5ｃｍ左右。2 .先提起腹侧两把止血钳 ,…     

包皮环切圈行包皮环压术328例

我院应用作者自行设计的包皮环切圈行包皮环压术328例,效果满意,现报告如下. 1 资料与方法 1.1 临床资料本文328例,年龄1～38岁,平均20.2岁.其中包茎127例,包皮过长201例.     

Normal ranges of scapholunate distance in children 6 to 14 years old.

SUMMARY: The purpose of this study was to determine the normal ranges of scapholunate distance (SLD) applicable to children. Bone age radiographs of 85 children (36 boys, 49 girls) 6 to 14 years of age were used to establish the normal ranges. Repeated-measures analysis of variance revealed significant age and gender differences. Therefore, linear regression was used to determine normal SLD ranges separately for girls and boys based on chronologic age and bone age. SLD normal ranges were similar for chronologic age and bone age. Interobserver and intraobserver agreement was excellent. There was no significant age by gender interaction found, indicating that although boys had significantly longer distances than girls, both showed a similar rate of decreasing SLD distance with age. These results provide age-and gender-based normal ranges of SLD in young children. These results may be useful in assessing traumatic soft tissue injuries about the pediatric wrist. Of note, only three girls and two boys (all 12 years or older) met the adult criterion of normal SLD of < or = 2 mm.     

Patient satisfaction with burn care 1-6 years after injury

Patient satisfaction is an important outcome in health care but has not been studied in relation to burn care. The aim was to explore factors related to satisfaction with care 1–6 years after a burn. Participants were 86 adult burn patients, injured on average 3.6 years previously. The Patient Satisfaction-Results and Quality (PS-RESKVA) was used to assess satisfaction. It has four subscales: Quality of contact with the nursing staff (QCN), Quality of contact with the medical staff (QCM), Adequate treatment information (INF) and Global satisfaction with treatment (GS). Further, data were gathered regarding personality traits and health. Average scores for QCN were significantly higher than scores for the other subscales, and INF received the lowest mean score. In multiple regressions, the PS-RESKVA subscales were associated with better interpersonal relationships (all PS-RESKVA subscales), more sensation seeking (QCM, INF, and GS) and less aggressiveness (QCM and GS). Other variables contributed to a lesser degree. Total amount of explained variance ranged between 18% and 25% for the PS-RESKVA subscales. In summary, satisfaction with burn care was only moderately explained by health and personality characteristics. Further, former patients rated satisfaction with nursing staff higher than other aspects of care, especially information routines.     

Renal transplantation in children younger than 6 years old

Herein we report our experience in renal transplantation in 38 children (40 transplants), ages 1 to 5 years, between 1989 and 2005. Demographics as well as patient and graft survivals are reported. Mean age at transplantation was 3.3 ± 1.3 years, and mean weight was 14 kg (range, 5.7-25 kg); 92.5% were Caucasian, 7.5% African-Brazilian. The main etiology for end-stage renal disease (ESRD) was uropathic/vesicoureteral reflux (45%) followed by glomerulopathy (25%), congenital/hereditary diseases (10%), and hemolytic uremic syndrome (12.5%). Prior to transplantation, 5% were on hemodialysis, 85% on peritoneal dialysis, and 10% preemptive. All children were followed for at least 6 months posttransplantation, except 2 who died in the first month. In 75% of cases, kidneys were obtained from living-related donors, and in 25% from deceased donors. Thirty-nine kidneys were extraperitoneally placed. Primary immunosuppressant therapy consisted of cyclosporine (61%), tacrolimus (39%), mycophenolate (49%), and azathioprine (51%). A steroid-free protocol was used in 17% of patients. In the last 21 cases, basiliximab or daclizumab was added. There were 13 (32.5%) graft losses (4 artery/vein thromboses, 3 chronic rejections, 3 deaths, 3 other causes). The 5-year patient and graft survival rates were 89.6% and 72.2%. We have concluded that renal transplantation can be performed with good long-term results in children younger than 6 years old.     

Intermittent catheterization in children less than 6 years old.

Neurogenic bladder dysfunction often requires treatment early in life. Intermittent catheterization is an accepted means of treatment in older children and adults but its use in young children and infants has been limited because of fear of urethral injury. The results of managing 42 patients less than 6 years old by intermittent catheterization are presented. Excellent results were achieved even in small infants.     

Renal cell carcinoma in children under 14 years old: long-term survival

OBJECTIVES: To assess the treatment and long-term survival of children under 14 years old operated upon for renal cell carcinoma (RCC). PATIENTS AND METHODS: The records of five patients (aged 2, 4, 6, 9 and 13 years) who had been treated for RCC between 1982 and 1993 were reviewed. All had undergone nephrectomy with (two) or without (three) regional lymphadenectomy. After surgery four patients received chemotherapy (vincristine with actinomycin-D, three, vinblastine, one), and two with advanced-stage disease received other agents (interferon alpha, interleukin-2). They were followed for 5 to 15 years. RESULTS: Three patients with stage I-II RCC were well at 13, 15 and 15 years after treatment. Of the two patients with regional lymph node involvement (stage III), one was well 5 years after surgery while the other developed hepatic, lung and bone metastases, and died 2 years after presentation. CONCLUSION: The prognosis and long-term survival of children under 14 years old with RCC is very good for those with low-stage tumours. Nephrectomy with complete tumour extirpation is the main mode of treatment. For advanced-stage tumours, the role of adjuvant chemotherapy and/or biological agents must be defined more clearly.     

Ankle joint complex mobility of children 7 to 14 years old.

The ranges of motions of the ankle have been studied only rarely in children. The authors examined the mobility of the ankle joint complex of 245 healthy children. The mean age was 10.2 years. In healthy children ages 7 to 14 years, the variation of the ankle joint complex range of motion was wide. The largest gender-related difference was recorded for passive plantarflexion, which was greater in girls. Other statistically significant gender differences do exist, but they are small and probably lack clinical meaning. Some of the children had remarkable left-right difference in the range of motions of the ankle joint complex. This means that the "healthy ankle" cannot necessarily be used in clinical practice as a reference when evaluating, for example, treatments of foot and ankle injuries in children.     

Comparison of parents' and caregivers' satisfaction after spinal fusion in children with cerebral palsy

The purpose of this study was to delineate parents' and professional caretakers' satisfaction after spinal fusion in children with spasticity and to determine differences in their perceptions. A questionnaire assessing patients' functional improvement after spinal arthrodesis for correcting scoliosis was addressed to 190 parents. An expanded questionnaire was also addressed to 122 educators and therapists working in the care of children with cerebral palsy. Caretakers did not recognize effects of the scoliotic deformity on patients' head control, hand use, and feeding ability. Most of parents and caregivers reported a very positive impact of the surgery on patients' overall function, quality of life, and ease of care. Parents had more appreciation of the benefits in the children's appearance, whereas educators and therapists acknowledged more improvement in gross and oral motor function. Considering that the benefits from scoliosis correction clearly outweigh the increased risk of surgical complications, most parents (95.8%) and caretakers (84.3%) would recommend spine surgery.     

Visuospatial deficits in children 3-7 years old with shunted hydrocephalus.

OBJECTIVE: To define non-verbal intelligence deficits in children 3-7 years of age following shunted hydrocephalus (HCP). DESIGN: Prospective randomised single-blinded study. Thirty shunted HCP (study) and 30 cardiac (control) patients between the ages of 3 and 7 years were compared on eight non-verbal subtests of the Junior South African Individual Scales (JSAIS). SETTING: Department of Neurosurgery at Wentworth Hospital, Durban, South Africa. RESULTS: Significant differences between the HCP and cardiac groups were recorded on all eight subtests of the JSAIS. The HCP group experienced problems with spatial orientation, perceptual planning and organisation, emotive deficits, abstract thinking and visual concepts. CONCLUSION: All patients with shunted HCP had specific deficiencies in defined cognitive areas of non-verbal intelligence when compared with the controls. Further studies are warranted to determine the effects of ventriculoperitoneal shunting on non-verbal intelligence so that the special educational needs of HCP children may be met.     

Results of decompression and rotator cuff repair in patients 65 years old and older: 6- to 14-year follow-up

At an average of 9.2 years after surgery, 47 patients with 51 shoulders who had undergone rotator cuff repair and subacromial decompression through an open Rockwood 2-stage acromioplasty-type approach were reviewed. All patients were 65 years or older at the time of their initial index procedure. Results were rated by patient satisfaction, the Constant's score, American Shoulder and Elbow Surgeons (ASES) Evaluation, and Neer rating. Subjectively, the patients were highly satisfied, with a 94.1 overall satisfaction rate. Objectively, the average Constant's score was 82 when normalized to the opposite shoulder and age. According to the Neer rating scale, there were 20 (39%) excellent, 26 (51%) satisfactory, and 5 (10%) unsatisfactory results. When assessing the ASES Evaluation, the patients who had undergone an extensile deltotrapezial takedown had increased strength in their lateral deltoid as compared with a cohort of individuals who had undergone the VY exposure. There was no statistically significant difference in subjective or objective results. For the most part, open rotator cuff repair and subacromial decompression in older patients has a high level of success with respect to pain relief, independent living, and when desired, reasonable sports participation.