单纯性隐匿阴茎诊断与改良Devine矫正术治疗体会

目的 探讨单纯性隐匿阴茎诊断方法,观察改良Devine矫正术治疗效果.方法 明确诊断为单纯性隐匿阴茎58例进行改良Devine矫正术.手术方法为冠状沟下方环形切开包皮,于阴茎深筋膜浅层向阴茎根部游离脱套,充分切除阴茎体与皮肤之间发育不良的肉膜组织以及纤维索带.充分伸直阴茎,于阴茎皮肤与会阴皮肤延续处,2、10点分别切取5mm切口,通过此切口固定阴茎白膜与阴茎皮肤真皮层.结果 平均手术时间40min,术后平均住院时间4～4.5d.所有患者术后阴茎显露较术前改善明显,较术前阴茎外形延长2.0～2.5cm;加压包扎3～4d,有不同程度包皮水肿,以内板水肿明显,于术后2～4周消退.伤口边缘皮肤坏死1例,清创换药两周后愈合.结论 诊断隐匿性阴茎从严掌握标准,充分的阴茎皮肤脱套松解、切除异常组织以及阴茎根部白膜固定为手术治疗的关键.采用Devine矫正术,结合阴茎根部两点直视下固定,具有手术操作简单、固定点明确可靠、创伤小、外观满意的特点,是治疗单纯性隐匿阴茎的有效术式.     

包皮脱套阴茎根部固定术治疗隐匿阴茎

目的 探讨包皮脱套阴茎根部固定术治疗隐匿阴茎的疗效。方法 本组38例，年龄1—20岁，27例为肥胖患儿，3例曾用绒毛膜促性腺激素治疗无效。均采用包皮脱套阴茎根部固定术治疗。结果 本组手术后阴茎均显著外露，凸出2—3cm；随访2月-3年，阴茎无明显回缩，勃起功能正常。结论 采用包皮脱套阴茎根部固定术充分切除失去弹性的肉膜层，松解阴茎，是一种治疗单纯性隐匿阴茎的理想术式。     

青春期前隐匿性阴茎肉膜组织病理学分析及临床意义

目的:评估青春期前隐匿性阴茎肉膜组织病理学特点及其临床意义。方法:10例青春期前隐匿性阴茎患儿作治疗组,予以改良Devine术治疗。10例正常青春期前儿童作对照组,予以包皮环切术治疗。分别于术前行阴茎长度测量;通过术中解剖学观察,以及用Masson三色染色法检测阴茎肉膜组织纤维化程度。结果:治疗组患儿术前阴茎长度为(1.49±0.17)cm,较对照组[(4.26±0.23)cm]明显短(P<0.01)。术中发现阴茎的隐匿程度与其阴茎肉膜纤维条索状组织远端附着部位有关,其远端附着点越靠近冠状沟,阴茎的隐匿程度越严重。Masson三色染色示治疗组阴茎肉膜组织胶原纤维阳性面积比为(65.6±6.9)%,明显高于对照组的(37.1±4.7)%(P<0.01)。结论:隐匿性阴茎的肉膜组织明显呈纤维化改变,其手术关键是彻底切除纤维化的阴茎肉膜组织。     

改良Devine治疗小儿隐匿性阴茎158例分析

目的总结改良Devine治疗小儿隐匿性阴茎的效果。方法对158例小儿隐匿性阴茎患者采用改良Devine术式治疗,阴茎皮肤完全脱套后,切除发育异常的纤维肉膜组织,阴茎根部皮肤固定成角。结果 158例患儿术后阴茎均显露良好。随访105例,随访2~38个月,105例患儿阴茎均发育正常,效果满意。结论改良Devine术式是治疗小儿隐匿性阴茎的理想术式。该术式操作简单,术后恢复快,并发症少,治疗效果满意。     

改良Devine术治疗小儿隐匿阴茎27例分析

目的 探讨改良Devine术式治疗小儿隐匿阴茎的疗效.方法 采用改良Devine术式,切除阴茎皮下异常的纤维条索状组织,将阴茎根部白膜固定在阴茎皮下筋膜上.结果 术后6个月至5年随访,疗效满意,未见阴茎回缩.结论 改良Devine术式操作简单,外观满意,是实用的手术方法.     

Devine矫正术治疗小儿隐匿性阴茎

目的：探讨小儿隐匿性阴茎的诊断方法,观察Devi ne矫正术治疗小儿隐匿性阴茎的疗效。方法：2008年10月～2010年2月采用Devi ne术治疗小儿隐匿性阴茎14例。结果：本组所有病例术后切口均Ⅰ期愈合,术后阴茎延长长度为2.1～2.8cm,平均延长2.46cm。经9个月～2年随访,14例患儿均阴茎显露及外观正常,无阴茎水肿、皮肤缺血、勃起疼痛等并发症。结论：Devi ne矫正术治疗小儿隐匿性阴茎疗效确切,是一种治疗小儿单纯性隐匿阴茎的有效方法。     

隐匿阴茎不同术式的疗效比较

目的 探讨隐匿阴茎不同术式的疗效.方法 回顾性分析1986-2007年手术治疗219例隐匿阴茎患儿临床资料.年龄3～15(10.3±2.4)岁.术前测量阴茎外露长度0.5～3.0(1.9±0.5)cm,其中重度93例,中度126例.采用Johnston术34例,Devine术42例,改良Devine术125例,Brisson术18例.比较4种术式患儿术后阴茎长度增加的差异. 结果 Johnston术、Devine术、改良Devine术和Brisson术患儿术后阴茎外露增加长度分别为(1.8±0.4)、(2.0±0.5)、(2.1±0.4)和(2.3±0.4)cm,组间差异有统计学意义(F=13.1,P<0.001).Devine术、改良Devine术和Brisson术效果优于Johnston术.4种术式术后发生顽固性阴茎皮肤水肿患儿分别为8、5、6和2例. 结论 隐匿阴茎的形成与阴茎皮肤浅筋膜发育异常有关.改良Devine术式疗效良好,术后并发症少.     

改良Devine术治疗隐匿阴茎的临床应用

目的通过对32例隐匿阴茎患者临床资料,探讨改良Devine术治疗隐匿阴茎的临床应用。方法 2012年8月至2014年5月,应用改良Devine术治疗隐匿阴茎患者32例,年龄6~13岁,阴茎长度0.9~2.5cm,诊断标准均符合隐匿阴茎。结果 32例患者均手术顺利,无血管、神经及尿道损伤,术中无明显出血,均一期愈合,术后阴茎外观长度平均(3.6士1.2)cm,较术前改善明显(P0.01),术后随访3~20月,阴茎外观满意,阴茎头显露,包皮无狭窄环,无明显顽固性水肿,排尿通畅。结论改良Devine术具备操作简便、创伤小、术后并发症少、外观恢复满意等优点,是一种治疗隐匿阴茎的理想术式。     

改良Devine术治疗隐匿阴茎40例分析

目的:探讨简单有效的隐匿阴茎手术方式。方法:采用改良Devine术式,切除阴茎皮下异常的纤维条索状组织,将阴茎根部白膜和真皮固定于耻骨筋膜上。结果:所有手术均获成功,平均手术时间50min,随访6个月～6年,阴茎发育满意,外观效果好,未见阴茎回缩,无并发症。结论:改良Devine术式操作简单,术野好,手术效果满意,是治疗隐匿阴茎实用有效的手术方法。     

隐匿阴茎212例诊治分析

目的探讨隐匿阴茎的最佳手术方法。方法总结212例隐匿阴茎诊断和治疗的经验,介绍三点式阴茎固定术、改良的Devine术和改良的阴茎脱套固定术的手术方法与指征。结果三点式阴茎固定术64例术后3个月龟头显露,阴茎回缩,外观短小。改良的Devine术68例,术后阴茎显著外露,阴茎较术前延长2～3cm。改良的阴茎脱套固定术80例,术后阴茎显著外露,阴茎较术前延长3～4cm,阴茎外形矫正良好。三种术式术后阴茎勃起功能均正常。结论隐匿阴茎手术方法应根据患者的年龄、病理特点和严重程度设计,重度或完全型隐匿阴茎行改良的阴茎脱套固定术为宜,该术式方法简单,术后阴茎外观好。     

Vasopressor hormone response following mesenteric traction during major abdominal surgery

Background : We investigated the vasopressor hormone response following mesenteric traction (MT) with hypotension due to prostacyclin (PGI₂) release in patients undergoing abdominal surgery with a combined general and epidural anesthesia. Methods : In a prospective, randomized, placebo-controlled study we administered 400 mg ibuprofen (i.v.) in 42 patients scheduled for abdominal surgery. General anesthesia was combined with epidural anesthesia (T4-L1). Before as well as 5, 15, 30, 45, and 90 min after MT we recorded plasma osmolality, hemodynamics and measured 6-keto-PGFlα (stabile metabolite of PGI₂), TXB₂ (stabile metabolite of thromboxane A₂) active renin, and arginine vasopressin (AVP) plasma concentrations by radioimmunoassay. Catecholamine levels were assessed by high-pressure liquid chromatography (HPLC) with electrochemical detection. Results : Following MT, arterial hypotension occurred along with a substantial PGI₂ release. This was completely abolished by ibuprofen administration. Although plasma levels of 6-keto-PGF_1α (1133 (708) vs. 60 (3) ng/L, median (median absolute deviation), P=0.0001, placebo vs. ibuprofen) remained significantly elevated, blood pressure was restored within 30 min after MT in the placebo group. At the same point in time plasma concentrations of TXB² (164 (87) vs. 58 (1) ng/L, P=0.0001), epinephrine (46 (33) vs. 14 (6) ng/L, P=0.001), AVP (41 ± (18) vs. 12 (7) ng/L, P=0.0004), and active renin (27 (12) vs. 12 (4) ng/L, P = 0.001) were significantly higher in placebo-treated patients. Conclusion : Under combined general and epidural anesthesia arterial hypotension following MT due to endogenous PGI₂ release is associated with enhanced release of AVP, active renin, epinephrine and thromboxane A₂, presumably contributing to hemodynamic stability within 30 min after MT.     

A Teaspoon Pump for Pumping Blood with High Hydraulic Efficiency and Low Hemolysis Potential

Abstract: Virtually all blood pumps contain some kind of rubbing, sliding, closely moving machinery surfaces that are exposed to the blood being pumped. These valves, internal bearings, magnetic bearing position sensors, and shaft seals cause most of the problems with blood pumps. The original teaspoon pump design prevented the rubbing, sliding machinery surfaces from contacting the blood. However, the hydraulic efficiency was low because the blood was able to "slip around" the rotating impeller so that the blood itself never rotated fast enough to develop adequate pressure. An improved teaspoon blood pump has been designed and tested and has shown acceptable hydraulic performance and low hemolysis potential. The new pump uses a nonrotating "swinging" hose as the pump impeller. The fluid enters the pump through the center of the swinging hose; therefore, there can be no fluid slip between the revolving blood and the revolving impeller. The new pump uses an impeller that is comparable to a flexible garden hose. If the free end of the hose were swung around in a circle like half of a jump rope, the fluid inside the hose would rotate and develop pressure even though the hose impeller itself did not "rotate"; therefore, no rotating shaft seal or internal bearings are required.     

Microspheres Based Detoxification System: A New Method in Convective Blood Purification

Abstract: A variety of protein-bound or hydrophobic substances, accumulating as a result of pathologic conditions such as exogenous or endogenous intoxications, are removed poorly by conventional detoxification methods because of low accessibility (hemodialysis), insufficient adsorption capabilities (hemosorption), low efficiency (peritoneal dialysis), or economic limitations (high-volume plasmapheresis). Combining advantages of existing methods with microspheric technology, a module-based system was designed. Major operating parameters of the latter can be modified to allow for adjustment to individual clinical situations. An extracorporeal blood circuit including a plasmafilter is combined with a secondary high-velocity plasma circuit driven by a centrifugal pump. Different microspheric adsorbers can be combined in one circuit or applied in sequence. Thus, a prolonged treatment can be tailored using specially designed selective adsorber materials. Comparing this system with existing methods (high-flux hemodialysis, molecular adsorbent recycling system), results from our in vitro studies and animal experiments demonstrate the superior efficiency of substance removal.     

A comparison of the inhibitory effects of four volatile anaesthetics on the metabolism of chlorzoxazone, a substrate for CYP2E1, in rabbits

Background: Halothane inhibits in vitro and in vivo activity of cytochrome P-450 (CYP) 2E1. There are several fluorinated volatile anaesthetics besides halothane, and most of them are defluorinated by CYP2E1. It is unclear whether other fluorinated anaesthetics inhibit the in vivo activity of CYP2E1.
Methods: We compared the inhibitory effects of therapeutic concentrations of four inhalational anaesthetics, halothane, enflurane, isoflurane, and sevoflurane, on chlorzoxazone metabolism in rabbits receiving artificial ventilation.
Results: All four inhalational anaesthetics decreased arterial blood pressure and increased plasma chlorzoxazone concentration. However, no significant differences in the plasma chlorzoxazone concentration were found between the four anaesthetics. The estimated chlorzoxazone clearance increased after beginning inhalation with all four agents, but no significant difference in clearance was noted between agents.
Conclusions: At therapeutic concentrations, the in vivo inhibitory effect on chlorzoxazone metabolism was similar for all four inhalational anaesthetics examined, even though their chemical characteristics and extent of hepatic metabolism differ considerably.     

Tissue perfusion in relation to cardiac output during continuous positive-pressure ventilation and administration of propranolol or verapamil

Background : Our objective was to determine whether administration of propranolol or verapamil modifies the hemodynamic adaptation to continuous positive-pressure ventilation (CPPV), in particular the regional distribution of cardiac output (CO).
Methods : General hemodynamics and regional blood flows assessed by microsphere technique (15 (μm) were recorded in 16 anesthetized pigs during spontaneous breathing (SB) and CPPV with 8 cm H₂O end-expiratory pressure (CPPV8) before and after intravenous administration of propranolol (0.3 mg · kg⁻¹ followed by 0.15 mg · kg⁻¹ · h⁻¹, n=8) or verapamil (0.1 mg · kg⁻¹ followed by 0.3 mg · kg⁻¹ · h⁻¹, n=8).
Results : CPPV8 depressed CO by 25% without shifts in its relative distribution with the exception of a noteworthy increase in adrenal perfusion. Propranolol increased arterial blood pressure, and due to a fall in heart rate, CO dropped by 25%. The kidneys and, to a lesser extent, the splanchic region and central nervous system received increased fractions of the remaining CO at the expense of skeletal muscle flow. Similar patterns were seen during SB and CPPV8 such that the combination of propranolol and CPPV8 depressed CO by 50%. The circulatory effects of verapamil were less evident but myocardial perfusion tended to increase.
Conclusions : The combination of propranolol or verapamil with CPPV does not result in any specific hemodynamic interaction in anesthetized pigs, except that the combined effect of propranolol and CPPV may severely reduce CO.     

Bariatric Surgery in Some "Central and East-European (former Eastern bloc)"Countries - Current Status and Prediction for the Next Millennium

Background: Obesity is increasing globallly, including in the formerly "Eastern Bloc" countries. Methods: A survey was made of obesity and bariatric surgery. Results: In the 8 East and Central European countries studied, with total population 300 million, roughly 43% of the population was overweight (BMI 25-30), 23% obese (BMI > 30), with about 15 million people morbidly obese (BMI > 40). From 0-10 morbidly obese individuals/100,000/year undergo bariatric surgery. Conclusion: Most countries were found to provide inadequate treatment for obesity.The majority of the morbidly obese are not treated effectively. However, health-care awareness of obesity and bariatric surgeons are slowly increasing.     

Volatile anaesthetics reduce adhesion of blood platelets under low-flow conditions in the coronary system of isolated guinea pig hearts

Background : Inhibitory effects of volatile anaesthetics on platelet aggregation have been demonstrated in several studies. However, the influence of volatile anaesthetics on intracoronary platelet adhesion has not been elucidated so far.
Methods : Isolated hearts of guinea pigs were perfused with buffer in the absence or presence of volatile anaesthetics (0.5 and 1 MAC) at constant coronary flow rates of 5 ml/min for 25 min, then 1 ml/min for 30 min and again 5 ml/min for 10 min. Before, during and after low-flow perfusion, a bolus of human platelets was applied into the coronary system. To simulate thrombogenic conditions, 0.3 U/ml human thrombin was infused during low-flow perfusion and reperfusion. The number of platelets sequestered to the endothelium was calculated from the difference between coronary in- and output of platelets. The myocardial production of lactate and consumption of pyruvate and coronary perfusion pressure were also determined.
Results : At a flow rate of 5 ml/min only about 3% of the applied platelets did not emerge from the coronary system, in any group. In contrast, 13.1±1.2% (mean±SEM) of infused platelets became adherent in low-flow perfusion in the control group without anaesthetic. The adherence was reduced with each 1 MAC isoflurane (to 6.2±1.2%), sevoflurane (to 4.4±0.9%) or halothane (to 3.2±1.5%) (each P <0.05 vs. control). Volatile anaesthetic, 0.5 MAC, did not inhibit platelet adhesion to a statistically significant extent in any case. Perfusion pressure and metabolic parameters were not statistically different between the control and the hearts exposed to anaesthetics.
Conclusion : Volatile anaesthetics in a concentration of 1 MAC can reduce the adhesion of platelets in the coronary system under reduced flow conditions. This action does not arise from vasodilation or inhibition of ischaemic stress.     

Synergistic interaction between the effects of propofol and midazolam with fentanyl on phrenic nerve activity in rabbits

Background: It has been shown that the depressive effects of both propofol and midazolam on consciousness are synergistic with opioids, but the nature of their interactions on other physiological systems, e. g. respiration, has not been fully investigated. The present study examined the effect of propofol and midazolam alone and in combination with fentanyl on phrenic nerve activity (PNA) and whether such interactions are additive or synergistic. Methods: PNA was recorded in 27 anaesthetised and artificially ventilated rabbits. In three groups, propofol, fentanyl and midazolam were administered intravenously in incremental doses to construct dose-response curves for the depressant effects of each one on PNA. In another two groups, the effect of pretreatment with either fentanyl 1 μg · kg^?1 i. v. or midazolam 0.05 mg · kg^?1 i. v. on the effects of propofol and fentanyl respectively on PNA were studied. Results: Propofol and fentanyl caused a dose-dependent depression of PNA with complete abolition at the highest total doses of 16 mg · kg^?1 i. v. and 32 μg · kg^?1 i. v., respectively. In contrast, midazolam in incremental doses to a total of 0.8 mg · kg^?1 reduced mean PNA by 63%, but approximately 12% of PNA remained at a total dose as high as 6.4 mg · kg^?1. The mean ED₅₀s, calculated from dose-response curves, were 5.4 mg · kg^?1, 3.9 μg · kg^?1 and 0.4 mg · kg^?1 for propofol, fentanyl and midazolam, respectively. Initial doses of either fentanyl 1 μg · kg^?1 i. v. or midazolam 0.05 mg · kg^?1 i. v. acted synergistically with subsequent doses of either propofol or fentanyl to abolish PNA at total doses of 8 mg · kg^?1 and 8 μg · kg^?1, respectively. Conclusion: Fentanyl has a synergistic interaction with both propofol and midazolam on PNA and hence potentially on respiration.     

Influence of dopexamine hydrochloride on haemodynamics and regulators of circulation in patients undergoing major abdominal surgery

Background: Catecholaminergic support is often used to improve haemodynamics in patients undergoing major abdominal surgery. Dopexamine is a synthetic vasoactive catecholamine with beneficial microcirculatory properties. Methods: The influence of perioperative administration of dopexamine on cardiorespiratory data and important regulators of macro- and microcirculation were studied in 30 patients undergoing Whipple pancreaticduodenectomy. The patients received randomized and blinded either 2 μg · kg^?1 · min^?1 of dopexamine (n=15) or placebo (n=15, control group). The infusion was started after induction of anaesthesia and continued until the morning of the first postoperative day. Endothelin-1 (ET-1), vasopressin, atrial natriuretic peptide (ANP), and catecholamine plasma levels were measured from arterial blood samples. Measurements were carried out after induction of anaesthesia, 2 h after onset of surgery, at the end of surgery, 2 h after surgery, and on the morning of the first postoperative day. Results: Cardiac index (CI) increased significantly in the dopexamine group (from 2.61±0.41 to 4.57±0.78 1 · min^?1 · m^?2) and remained elevated until the morning of the first postoperative day. Oxygen delivery index (DO₂I) and oxygen consumption index (VO₂I) were also significantly increased in the dopexamine group (DO₂I: from 416±91 to 717±110 ml/m² · m²; VO₂I: from 98±25 to 157±22 ml/m² · m²), being significantly higher than in the control group. pHi remained stable only in the dopexamine patients, indicating adequate splanchnic perfusion. Vasopressive regulators of circulation increased significantly only in the untreated control patients (vasopressin: from 4.37±1.1 to 35.9±12.1 pg/ml; ET-1: from 2.88±0.91 to 6.91±1.20 pg/ml). Conclusion: Patients undergoing major abdominal surgery may profit from prophylactic perioperative administration of dopexamine hydrochloride in the form of improved haemodynamics and oxygenation as well as beneficial influence on important regulators of organ blood flow.     

Systemic analgesia adapted to the children's condition

A concept of balanced analgesia using nonsteroidal anti-inflammatory drugs (NSAIDs), paracetamol (acetaminophen), opioids, and corticosteroids can also be used in patients with pre-existing illnesses. NSAIDs are the most effective treatment for acute pain of moderate intensity in children; however, these drugs should be avoided in patients at increased risk for serious side effects, e.g. patients with renal impairment, bleeding tendency, or extreme prematurity. NSAIDs can be given with minimal risks to the younger child with mild to moderate asthma, and, in these patients, the use of steroids can be encouraged; in addition to their antiemetic and analgesic action, a beneficial effect on asthma symptoms can be expected. In the non-intubated child with cerebral trauma, exaggerated sedation caused by opioids and increased bleeding tendency caused by NSAIDs must be avoided. In neonates and small infants, the oral administration of sucrose or glucose is helpful to minimize pain reaction during short uncomfortable interventions.