Congenital megaprepuce: an emerging condition--how to recognize and treat it

OBJECTIVE: To highlight the clinical presentation, pathological anatomy and surgical management of an emerging condition, the congenital megaprepuce (CM). PATIENTS AND METHODS: All patients with CM treated at Southampton between 1994 and 1998 were reviewed retrospectively; 20 patients underwent surgery (mean age at operation 16 months, range 6-43). Surgical correction developed over this period and variations on a basic technique are now used, depending on the precise pathological anatomy. These techniques are described and illustrated. Cosmetic and functional success, and parental satisfaction, were assessed by a review of the case-notes. RESULTS: After a follow-up of >/= 6 months, the cosmetic and functional outcome was very successful, with the parents of 19 of the 20 patients satisfied. Five patients underwent re-operation, all requiring excision of redundant penile skin. CONCLUSIONS: CM is a striking condition which cannot be easily missed or hidden; we propose that it is a newly emerging and distinct condition which should not be confused with a buried, concealed, webbed, trapped or micropenis. Early surgical correction is recommended and circumcision should be avoided.     

如何治疗(足母)外翻

本期有三篇分析(足母)外翻外科治疗效果的文 章.(足母)外翻(hallux abducto valgus,HAV)是足外科最常见的疾病,门诊患者几乎占2/3以上.HAV的治疗目的是矫正畸形,但曾有规定将(足母)外翻的治疗归为美容学范等,因而许多医院将(足母)外翻改称为(足母)囊炎(bunion,bursitis),实际上二者是并存的.(足母)外翻的病因有两种说法:遗传及鞋.北京足踝外科研究所的调查显示,20%的患者有家族史,但主要的原因还是"鞋".不穿鞋时,(足母)趾与跖骨在同一顺列,穿鞋后产生外翻角.     

How to avoid and treat endoscopic complications

Colonoscopy is a common procedure performed for screening, diagnostic, or therapeutic indications; nevertheless, it is an invasive procedure that has associated risks. Complications of colonoscopy can be divided into four main categories: (1) bleeding, (2) postpolypectomy syndrome, (3) perforation, and (4) rarely, solid organ injury. In this review, we discuss strategies to avoid and treat complications of colonoscopy. Diligent biopsy and use of electrocautery and avoiding looping and blind advancement of the colonoscope minimize the risk of these complications. Management of complications ranges from non-operative conservative management, to minimally invasive endoscopic or laparoscopic techniques, to operative exploration.     

肘管综合征如何治疗

查阅文献,对肘管综合征的治疗有两种意见.一种强调一旦诊断确定应及早进行手术探查,理由是肘部压迫与牵拉因素的存在影响局部神经内循环,造成充血、水肿,随后成纤维细胞浸润,当神经内形成纤维化再作神经松解或前移,不能使症状消失,所以延迟手术效果不良.     

How to treat male breast cancer

The prevalence for breast cancer in males in Europe is estimated to be 1 or less per 100,000. Male breast cancer has a peak incidence at the age of 71 years. There are no randomized data giving information on the optimal therapy for male breast cancer patients, thereby limiting firmer conclusions. The preferred primary surgical therapy is modified radical/simple mastectomy, but breast-conserving surgery has also been used in males. Post-operative radiotherapy should be used on a more routine basis; as males have shorter breast-anatomical distances and males are diagnosed at a later stage compared with females. The so far preferred adjuvant therapy modality has been tamoxifen for patients with endocrine responsive disease. The use of aromatase inhibitors in males is more controversial, since they may not deplete the estradiol levels sufficiently. Different chemotherapy regimens have been used in the adjuvant and metastatic setting. The use of adjuvant therapy has in institutional and review comparisons been demonstrated to result in an improved outcome.     

How to grow bone to treat osteoporosis and mend fractures

The growing number of patients with osteoporosis in our aging population need "anabolic" drugs to stimulate bone growth, improve bone microarchitecture, and accelerate fracture healing. Potent anabolic agents such as parathyroid hormone (PTH) and some of its adenylyl cyclase-stimulating fragments are either on their way, or have just now reached the clinic. This article discusses how PTHs might stimulate bone growth. The controversial bone anabolic activities of the widely used cholesterol-lowering lipophilic statins and how they might stimulate bone growth are also probed. Also, evidence is presented for leptin, a controller of body fat stores and the ovarian cycle. It has the remarkable property of being an anabolic and antianabolic that uses a hypothalamic factor to restrain osteoblast activity but by itself stimulates osteoblasts and inhibits osteoclasts.     

如何看待微创与传统开放TLIF手术

腰椎的椎体间融合手术是目前临床脊柱外科的常用术式,根据手术入路不同一般分为经后路的腰椎椎体间融合和经椎间孔的腰椎椎体间融合,即常说的PLIF和TLIF。PLIF术式起于1952年（Cloward等[1]）,而TLIF术式起源于1982年（Harms等[2]）。两种术式均经历了几十年的临床应用,成为经典术式。而微创的腰椎椎体间融合术（MIS）起于2003年（Foley等[3]）。近十年来“开放”与“微创”的优劣势成为国内外学者的热议话题,笔者认为目前微创椎间融合在许多方面仍不可完全取代开放腰椎椎体间融合。     

Hypertonia in children: How and when to treat

Opinion statement Hypertonia in children can be caused by many different diseases. The most common etiology is cerebral palsy. Spasticity and dystonia are the most common types of hypertonia. There are few options for treatment, and usually treatment has an incomplete effect. Therefore, it is necessary to prioritize goals in order to improve overall functional outcome. The use of any intervention will require the ability to verify the magnitude and importance of the outcome in order to ensure that therapy is efficacious. In general, a complex, flexible, and multifaceted approach will be necessary to improve the motor abilities of children with hypertonia.     

Hyperfunctional parathyroid carcinoma

The parathyroid cancer is mentioned in literature with an incidence of 0.5-5% in the etiology of the primary hyperparathyroidism. The authors present the case of a 45 year old female with diagnosis of "primary hyperparathyroidism" based on clinical, ultrasonographic and biochemical investigations. A right superior adenoma of 3 x 2 x 1 cm (150 mg) has been found and extirpated. The histological examination showed an adenoma with predominant "chief" cells. Three years after surgery the patient had a recurrence of the clinical and hypercalcemie syndrome (with more severe damages). The surgical reexploration showed the right thyroid lobe with a nodular aspect and in its inferior pole a enlarged parathyroid gland of one cm size was found. An en-block exeresis including the right thyroid lobe with isthmus as well as the mentioned lesion and the half of left superior parathyroid, the left inferior one together with retrosternal fat tissue have been performed. Frozen sections completed by paraffin examination established the diagnosis of hyperfunctioning parathyroid carcinoma. We have emphasize the issues that could suggest the initially preoperative true diagnosis: the large size of excised adenoma and the relatively quick recurrence of the phenomena of parathyroid hyperfunction. The surgical principles and strategies in the treatment of parathyroid cancer are also discussed.     

How to recognize patients at risk or infected with HIV.

This monthly series was developed from the AOA Task Force on AIDS Writers' Workshop, held August 16 to 18, 1991, in New York. The workshop was sponsored by an educational grant from Burroughs Wellcome. It will provide brief clinical updates and perspectives on the human immunodeficiency virus (HIV). Readers may request tear sheets from the AOA editorial offices.     

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目的 研究射频技术肝癌原位灭活治疗的方法及疗效。方法 在Ｂ超引导下将中空金属钛多极穿刺针经皮直接穿刺置入瘤体,分点１次或多次对瘤体进行射频热毁损治疗。射频输出功率由２０Ｗ每隔一分钟增加２０Ｗ,直到９０Ｗ,治疗时间设定了１５分钟,术后观察病人的ＡＦＰ、Ｂ超（瘤体大小、回声、血流）、ＣＴ图像及病理变化。结果 １８０例病人中ＡＦＰ高于正常者（１５３例）射频治疗１周后复查１１９／１５３（７７．８％）下降为