Superficial Venous Pathology in the Asian Population of South West London – A Prospective Study

OBJECTIVES: The Asian population of our hospital catchment area represents 6.2% of the total, which is 3.2% higher than the national average, compared to the Caucasian population which comprises 70.2% and is 21.9% lower than the national average. This study aimed to analyse the prevalence and presentation of superficial venous disease (SVD) in the Asian population of South West London. METHODS: A prospectively gathered database of all 481 patients referred by local general practitioners (GP) to the varicose veins nurse specialist over a 24 month period was analyzed. Information was collected on demographics, presenting features, clinical signs, and whether surgical referral was made. RESULTS: Asians presented significantly younger than Caucasians (p<0.0001; unpaired t-test). Caucasians had a significantly higher positive family history than Asians (p相似文献   

Management of Symptomatic Urethral Diverticula in Women: A Single-centre Experience

Background

Urethral diverticula (UDs) affect between 1% and 6% of adult women. A total of 1.4% of women with stress urinary incontinence (SUI) have a UD. Clinically significant diverticula are rare and can be challenging to manage.

Objective

To review results of surgery on UDs in a single surgical centre.

Design, setting, and participants

We retrospectively evaluated a group of 89 patients with symptomatic UDs referred for surgical intervention to one teaching hospital. Data were from two surgeons over an 8-yr period between October 2004 and November 2012. Follow-up period ranged from 3 mo to 20 mo, and all patients were physically reviewed postoperatively in an outpatient setting.

Intervention

The surgical technique involved placing the patient prone, ureteric catheterisation, dissection and removal of the diverticulum, and layered closure. Where a large defect was present following excision, a Martius flap was interposed.

Outcome measurements and statistical analysis

Outcome data collected included symptomatic cure, continence, de novo SUI, early versus late complications, and recurrence.

Results and limitations

Early complications included one urinary tract infection and one Martius graft infection, both requiring intravenous antibiotics. Overall, 72% of patients were dry and cured postoperatively; 13 patients had de novo SUI following surgery. Those with bothersome SUI went on to have an autologous sling at 6 mo. All were dry; three (23%) required clean intermittent self-catheterisation. Three patients had a recurrent residual diverticulum (3.4%) following surgery. One chose conservative management. The other two had a redo diverticulectomy performed via a dorsal approach. They have recovered well and are dry. Two (2.2%) diverticula revealed unexpected abnormal pathology. The first was a leiomyoma; the second was a squamous cell carcinoma requiring further surgery.

Conclusions

The recommended preoperative imaging is postvoid sagittal magnetic resonance imaging and appropriate use of urodynamic assessment at baseline. The 72% dry rate (including a number with preoperative incontinence) is comparable with the literature as is the development of de novo SUI in 15% of patients. There is a small risk of unexpected tumours (2%).

Patient summary

A urethral diverticulum should be excluded as a diagnosis in anyone troubled by symptoms of a swelling of the urethra often associated with discomfort, pain on intercourse, urinary dribbling after passing urine, and/or recurrent urinary infections. In these circumstances patients should seek advice from their doctors and consider referral for a specialist assessment. If the diagnosis is made and the problem is symptomatic, surgery is likely to resolve the problem but should be carried out in a specialist centre with expertise in the management of this condition.     

A New Option for the Management of Urethral Trauma: Primary Reconstruction of Posterior Urethral Disruption with a Buccal Mucosa Transplant

Up to now, the management of traumatic posterior urethral disruption ranges from primary realignment to delayed urethroplasty. However, we reconstructed the membranous part of the urethra with an onlay graft of buccal mucosa after traumatic complete disruption as a first line therapy. After 7 months followup, the clinical outcome is very good. Because primary reconstruction of the urethra with a buccal mucosa graft after traumatic disruption has not yet been reported, the question arises whether this technique should be routinely included as an option for primary urethral reconstruction after trauma of the posterior urethra.     

Neurofibromatosis: An Unusual Cause of Cervical Myopathy

Abstract

Generalized neurofibromatosis (NF) is characterized by café au lait spots, deformity of the skeleton and tumors involving the skin as well as spinal, peripheral and cranial nerves. The spine is that part of the skeleton most commonly affected in NF, although involvement of the cervical spine in NF has only rarely been reported. The majority of neurofibromas involving spinal nerves are asymptomatic or present with symptoms consistent with nerve root involvement. Classic symptoms of myelopathy secondary to spinal cord compression in NF are rare. We describe a 35-year-old male with generalized NF who presented with worsening gait instability. Magnetic resonance imaging (MRI) revealed enhancing masses producing spinal cord compression at the C1-C2 and C4 levels. The patient underwent decompressive laminectomy and, at eight weeks after surgery, was once again ambulatory. The literature discussing the sequelae and treatment of NF when it produces myelopathy is reviewed.     

结肠粘膜重建尿道治疗复杂性尿道狭窄的探讨

目的 探讨结肠粘膜替代尿道治疗复杂性较长段尿道狭窄或闭锁的可能性。方法 采用结肠粘膜重建尿道一期尿道成形术治疗6例复杂性较长段尿道狭窄，患者术前有平均3次不成功的尿道修复史，用结肠粘膜重建的尿道长10－15cm，平均12.7cm。术后随访时分别行逆行尿道造影，尿道镜和尿流率检查。结果 术后随访3－14个月，平均7.8个月。1例在术后3个月并发尿道外口狭窄性，经手术矫正后排尿通畅，术后1年随访时最大尿流率28.7ml/s。余5例术后排尿通畅，最大尿流率大于15ml/s。术后6个月4例经尿道镜检查，肉眼较难将尿道的结肠粘膜与正常的尿道粘膜相区别。结论 结肠粘膜重建尿道治疗较长段尿道狭窄或闭锁是一种可行而有效的方法，适合阴茎皮肤或膀胱粘膜利用有困难时的尿道重建。     

Treatment of failed Adult Chiari Malformation decompression with CSF drainage: observations in six patients

OBJECTIVE: We report the use of CSF drainage for the management of failed Adult Chiari Malformation (ACM) decompression. METHODS: All patients with more than one year follow-up after treatment of their failed ACM were included in this study. They underwent initial decompression between September 1998 and April 2000. Clinical and radiological data were collected initially and at recurrence. Lumbar punctures (LP) were done at recurrence for diagnostic and therapeutic purposes. Opening pressures and symptomatic relief were recorded. Therapeutic options included intermittent LP and ventriculo-peritoneal shunting (VPS). RESULTS: There were 6 patients (5 females and one male). Their age ranged from 19 to 43 years. Tonsillar descent ranged from 5 to 21 mm. The symptoms recurred 1.5 to 9 months postoperatively (average 5.6 months). Postoperative imaging revealed the presence of CSF flow behind the tonsils and the formation of a retrotonsillar neocistern in all patients. On LP, the opening pressure ranged from 17 to 31 cm of water (average 23 cm). All patients improved after CSF drainage, and four patients underwent VPS. The other patients were treated with repeat LP+/-Acetazolamide. There was significant improvement in all patients, with 18 months follow-up after CSF drainage (range 16-21 months). CONCLUSIONS: Our results suggest a role for CSF drainage in the treatment of some patients with failed ACM surgery. Possible explanations for the failure of ACM surgery in this subgroup include: surgical complications leading to neural hydrodynamic alteration, inadequate initial surgery, and coexistence with another pathology, possibly a mild form of intracranial hypertension. More prospective and hydrodynamic studies are needed to further clarify these issues.     

按《指南》预防人工髋关节置换术后静脉血栓栓塞症的有效性与安全性

目的 探讨按<中国骨科大手术静脉血栓栓塞症预防指南>(简称<指南>)预防人工髋关节置换术后静脉血栓栓塞症(VTE)的有效性和出血并发症的风险. 方法 2001年1月至2005年1月对402例患者行人工髋关节置换术,男119例,女283例;平均年龄63.2岁;其中股骨颈骨折278例,股骨头缺血性坏死78例,骨关节炎46例,没有按<指南>进行规范预防(A组);2009年1月至2010年1月对120例患者行人工髋关节置换术,男36例,女84例;平均年龄62.9岁;其中股骨颈骨折83例,股骨头缺血性坏死23例,骨关节炎14例,按<指南>实施基本预防措施和物理预防措施,药物预防于术后12 h开始皮下注射低分子量肝素至术后10 d,之后改用口服利伐沙班至术后21 d(B组).比较两组患者发生症状性VTE和出血并发症的比例. 结果 A组出现下肢深静脉血栓形成(DVT)83例,发生率为20.6%(83/402);出血并发症28例(7.0%,28/402).B组15例出现DVT,发生率为12.5%(15/120);出血并发症8例,发生率为6.7%(8/120).B组DVT的发生率低于A组,差异有统计学意义(χ2=4.022,P=0.045).两组出血并发症发生率差异无统计学意义(χ2=0.002,P=0.960). 结论按照<指南>对人工髋关节置换术患者术后VTE进行预防,提高了预防效果,同时不会增加出血的风险.     

Urethral hydrodistension for management of urethral hypoplasia in prune belly syndrome: long-term results

Purpose

The aim of the study was to evaluate the efficacy and safety of urethral hydrodistension for management of urethral hypoplasia in prune belly syndrome (PBS).

Methods

During a 10-year period, 7 infants with PBS and urethral hypoplasia presented either with open urachus or surgically created urinary diversion referred to our hospital. Five milliliters of normal saline was pushed via a 22-gauge plastic angiocatheter into the urethra with simultaneous finger pressure on the perineum to occlude the proximal urethra that was repeated with higher volumes of the solution (up to 20 mL). The procedure was continued until a 6F or 8F feeding tube catheter confirmed the urethral patency. Hydrodistension was repeated in 3-month intervals till complete patency was confirmed by imaging.

Results

Median age of the infants was 6 (1-8) months. All urethral hydrodistension were successful after 1 to 3 sessions. Follow-up imaging studies showed significant improvement in all patients except one. Natural and surgically created urinary diversions were closed in 6 infants.

Conclusions

The hydrodistension create an equal and constant pressure into the urethral wall without any urethral damage. This technique can be considered along with the other available methods for management of urethral hypoplasia in selected cases of PBS.     

An Obstructed Venous Aneurysm Presenting as an Abdominal Mass: Report of a Case

We report herein the case of a 32-year-old woman found to have a venous aneurysm originating from the ovarian vein. The patient presented with a 9-cm abdominal tumor, and surgery was performed under the preoperative diagnosis of a mesenteric cyst. The tumor was easily ablated from the mesentery and resected with the right ovarian artery and vein. His-tologically, the wall of the cyst showed the structure of a vein, and the diagnosis of a venous aneurysm was made. This disease is difficult to diagnose preoperatively when a patient presents with no symptoms other than a palpable mass, or when the lumen is obstructed by thrombus. This report serves to demonstrate that a venous aneurysm should be considered in the differential diagnosis of an asymptomatic abdominal mass. Received: December 20, 1999 / Accepted: November 20, 2000     

浅静脉剥脱术治疗合并深浅静脉反流的下肢静脉曲张

目的 探讨下肢浅静脉剥脱术对合并深、浅静脉反流的静脉曲张的疗效.方法 2004年1月至2006年12月选取合并深浅静脉反流患者20例共22条下肢,以单纯浅静脉反流患者22例共27条下肢为对照,采用传统静脉剥脱手术方法治疗.以静脉临床严重程度评分(venous clinical severity score,VCSS)临床评分体系以及彩色多普勒超声检查观察二组术前以及术后2年临床症状改善以及深静脉反流程度的变化.结果 深浅静脉反流组和单纯浅静脉反流组术前VCSS分别为(7.1±2.9)分和(6.6±2.0)分,差异无统计学意义(P=0.44).术后两组VCSS分别为(2.3±1.2)分和(1.8±0.8)分,差异无统计学意义(P=0.13).随访两年各组手术前后VCSS评分差异均有统计学意义(P<0.01),2年后超声检查深浅静脉反流组中深静脉反流程度无改变肢体11条,改善7条,加重4条,单纯浅静脉反流组4个肢体出现深静脉反流.结论 浅静脉剥脱术可改善合并深静脉反流患者的临床症状,对深静脉反流总体无影响.     

下肢静脉曲张患者左髂总静脉的血流动力学改变及其意义

目的 检测下肢静脉曲张患者左髂总静脉（left common iliac vein，LCIV）受压情况，以及对深静脉逆流和浅静脉曲张的影响。方法 2004年10月至2005年3月对24例下肢静脉曲张患者行双下肢深静脉逆行造影，同时行LCIV顺行造影，并测量活动前后双髂总静脉压力。结果 下肢静脉曲张患者双下肢深静脉逆行造影显示LCIV造影受压发生率为54．17％。运动前，LCIV造影受压患者的左右髂总静脉压差值高于造影正常患者（t=2．833，P=0．010）；运动后，LCIV造影受压患者的左右髂总静脉压差值明显高于造影正常患者（t=4．364，P=0．000）。LCIV造影受压患者的左下肢深静脉逆流程度重于造影正常患者（Fisher’s Exacttest，P=0．017），左下肢浅静脉曲张程度两者间无明显差异（χ^2=3．333，P=0．343）。结论 下肢静脉曲张患者伴有LCIV造影受压时，LCIV压力明显升高，左下肢深静脉逆流程度加重，但左下肢浅静脉曲张程度没有明显加重。     

Urethral duplication in boys: report of 4 cases

Urethral duplication is a rare anomaly, affecting mainly boys. The clinical presentation varies because of the different anatomical patterns of this abnormality. We report 4 cases of urethral duplication in children. An epispadiac duplication was present in 1 case, hypospadiac duplication in 1 case, Y-duplication in 1 case and a congenital prepubic sinus in the last case. The pre-operative probe was based on urethrocystography and fistulography. The surgical management included excision of the duplicated urethra in 3 cases. Transurethral incision of the intra-urethral septum was performed in the case of hypospadiac duplication. The characteristics of male urethral duplication are reviewed.     

腹腔镜术后下肢静脉血栓形成分析

目的：探讨腹腔镜术后下肢静脉血栓发生的原因和预防措施。方法：回顾分析2000年5月至2006年5月2 000余例各种腹腔镜术后出现的26例下肢静脉血栓患者的临床资料。结果：手术时间20-200min,15例下肢浅静脉血栓治疗5-7d后症状消失,复查彩色多普勒血栓消失,随访3-12个月无复发。11例髂—股及股深静脉、血栓,经抗凝治疗14-21d症状消失,随访12个月无复发。结论：腹腔镜术后下肢静脉血栓的发生与患者高危因素、CO2气腹、体位等密切相关,在围手术期应积极采取措施予以预防。     

多种超脉冲等离子体电极联合腔内治疗男性尿道狭窄34例报告

目的探讨多种超脉冲等离子体电极联合腔内治疗男性尿道狭窄的临床疗效。方法 2007年11月～2011年11月,采用多种超脉冲等离子体电极联合使用腔内治疗男性尿道狭窄34例。输尿管镜直视下用长超脉冲等离子体柱状电极多点少量切开狭窄环,电切镜直视下用短超脉冲等离子体柱状电极多点彻底切开狭窄环,使其能通过电切镜内鞘,最后用超脉冲等离子体电切襻切除狭窄段尿道瘢痕。结果手术时间20～125 min,平均49.8 min。术后3个月最大尿流率(Qmax)由(4.8±2.5)ml/s上升至(18.3±8.8)ml/s(t=-6.911,P=0.000),膀胱残余尿量(residual urine,RU)由(82.8±33.6)ml减少至(25.8±10.1)ml(t=5.671,P=0.000)。34例随访3～51个月,平均12.9月,8例术后出现再狭窄,其中6例再次腔内手术处理,另2例行膀胱造瘘术;余22例排尿通畅。结论多种超脉冲等离子体电极联合腔内治疗男性尿道狭窄,具有安全、并发症少、疗效确切等优点。