应用前列腺素E1注射治疗勃起功能障碍8年经验

目的观察前列腺素E1(PGE1)注射治疗勃起功能障碍(ED)的长期疗效、副作用及预后。方法使用PGE1行阴茎海绵体注射,阴茎硬度检查仪(Rigiscan)连续记录1h,并根据观察结果,调查PGE1注射剂量,确定每例患者合适的注射量,掌握注射方法后回家自行注射。共筛选出ED患者410例,随访患者阴茎勃起情况、药量调整和副作用。结果410例ED患者中,心理性139例,静脉性83例,动脉性36例,神经性78例,混合性74例。对治疗满意的患者有256例(62.44%),其中21例(5.1%)在使用PGE15次后停用,并能达到满意的性生活而治愈。293例(71.46%)患者自述注射时有胀痛感。171例(43.17%)因疼痛(105例)、操作不便(25例)、副作用顾虑(37例)和其他原因(4例)而于6个月后放弃治疗。204例(49.76%)患者使用时间已超过1年,24例(5.85%)患者使用时间已超过5年,7例(1.7%)使用已有8年。未发现阴茎异常勃起和阴茎海绵体纤维化。注射损伤阴茎表面血管致瘀斑者有20例。有27例患者失访。结论PGE1是治疗ED的一种安全有效的药物,可以长期使用。其最常见的副作用是阴茎疼痛。Rigiscan能帮助确定PGE1的注射剂量。     

骶神经电刺激治疗32例继发性女性膀胱过度活动症

目的观察骶神经电刺激治疗女性膀胱过度活动症的疗效。方法采用经皮穿刺电刺激骶3神经治疗32例女性继发性膀胱过度活动症患者40周,通过排尿日记及患者症状评价疗效,并通过治疗前后抑郁与焦虑的心理评分来分析患者的生活质量有无改善。结果23例尿频尿急综合征的患者症状明显改善,日排尿次数显著减少,平均排尿量增加,尿急程度减轻;9例症状略有改善,疗效不显著。症状明显改善者治疗前后抑郁与焦虑的心理评分也明显改善。结论骶神经电刺激可明显改善女性膀胱过度活动症患者的排尿功能障碍,从而改进患者的生活质量。     

Bone growth patterns in Chinese children and adolescents: a 6-year follow-up study provides evidence for sexual dimorphism and tracking

Summary We prospectively examined bone growth patterns in 894 children aged 6–17 years at the baseline visit, with a 6-year follow-up. Results show bone “tracking” over a six-year interval and sexual dimorphism of bone attained levels and timing of peak bone growth. Our findings underscore childhood and adolescence as critical periods for building bone and developing gender differences. Introduction Bone growth patterns were prospectively examined in 894 Chinese children (496 males), aged 6–17 yrs, from a population-based twin cohort. Whole-body bone area (BA), bone mineral content (BMC), and bone mineral density (BMD) were measured by DEXA at baseline and a 6-yr follow-up. Methods Graphic smoothing plots and generalized estimating equations were used to model bone attained levels, growth, and “tracking”. Results Attained levels of BMC and BA increased curvilinearly with age. Male attained levels were higher than females after age ∼15 yr, but BMD was lower between 13–17 yrs (Tanner stage I to IV). In both genders, peak BMC and BMD growth lagged ∼2 yrs behind peak BA growth, which lagged 2 yrs behind peak height growth. Peak bone growth occurred 1–3 yrs later in males. Over the 6-yr follow-up, all bone measurements “tracked”, but “shifting” across ranks also occurred, and baseline tertile ranking influenced bone growth. Females with early menarche had higher attained levels than females with late menarche at age 12–13 yrs. Conclusion Our findings confirm and expand previous studies on peak bone growth conducted in Caucasian cohorts, particularly sexually dimorphic and maturational effects. The significant “tracking” of bone measurements in this 6-yr follow-up study underscores the importance that osteoporosis prevention should begin in childhood and adolescence. Fengxiu Ouyang and Binyan Wang contributed equally to this article. Source(s) of support: This study is supported in part by grant R01 HD049059, R01 HL0864619 and R01 AR045651 from the National Institute of Health and by the Food Allergy Project.     

Endoclip Closure of Jejunal Perforation after Balloon Dilatation

Endoscopy is commonly used in patients undergoing Roux-en-Y gastric bypass (RYGBP) for diagnosis and intervention. Stomal stricture at the gastrojejunostomy occurs in approximately 3% to 17% of patients after laparoscopic RYGBP. The incidence of iatrogenic perforation during stomal balloon dilatation is reported to be 3% to 12% among these patients. Surgery has typically been required for iatrogenic perforation. With the availability of the endoclip, endoscopists are able to manage iatrogenic perforation non-operatively. We report a patient who had jejunal perforation during balloon dilatation after RYBGP, who was successfully closed with endoclip applications and managed non-operatively.     

The laterally extended medial hemisoleus flap for reconstruction of a tibial wound in the distal third of the leg

A soleus flap as a local reconstructive option for soft-tissue coverage of a tibial wound in the distal third of the leg has never been well recognized. In a 2-year period, seven patients underwent reconstruction of a less extensive tibial wound (4 × 3 to 10 × 4 cm) in the distal third of the leg after orthopedic trauma with the laterally extended medial hemisoleus flap. The flap was elevated with emphasis on the preservation of the most distal perforators from the posterior tibial vessels to the flap as possible while allowing adequate rotation of the flap to cover the exposed tibia and/or hardware and on the possible preservation of foot planter flexion by reconstruction of the proximal Achilles’ tendon. In this series, there was no total or partial flap loss. All patients healed their tibial wounds primarily with reliable soft-tissue coverage, evidenced fracture healing, and good cosmetic outcome during follow-up. Thus, the laterally extended medial hemisoleus flap described by the author can be a reliable option for soft-tissue coverage of a less extensive tibial wound in the distal third of the leg. It offers a more cost-effective approach for managing this unique problem and can be performed by most reconstructive surgeons without microsurgical expertise.     

Laparoscopic Adrenalectomy for Isolated Adrenal Metastasis

Background Use of laparoscopy for isolated adrenal metastases is controversial. The aims of this study were to characterize patients with isolated adrenal metastases; compare operative characteristics of the laparoscopic adrenalectomy (LA) versus open adrenalectomy (OA) approach; and compare long-term oncological and surgical outcomes. Methods Our adrenal resection database (1995–2006) identified 63 OA and 31 LA cases done for isolated adrenal metastases. Subset analysis was performed for all patients from isolated lung metastases (n = 39) and for all tumors smaller than 4.5 cm (n = 49). Results Overall, local recurrence was 17%, median survival 30 months and 5-year estimated survival 31%. The only independent predictor of survival for all (n = 94) was adrenal tumor size less than 4.5 cm (P = 0.01). When comparing LA with OA, no differences in local recurrence, margin status, disease-free interval or overall survival were observed for the entire group, or for patients with metastases only from lung cancer (n = 39) or for those with tumors smaller than 4.5 cm (n = 49). LA provided significantly shorter operative time (175 vs 208 min, P = 0.04), lower estimated blood loss (EBL) (106 vs 749 cc, P < 0.0001), shorter length of hospital stay (2.8 vs 8.0 days, P < 0.0001) and fewer total complications (P < 0.0001). Conclusions LA is equivalent to OA in terms of margin status, local recurrence, disease-free interval and overall survival. LA for metastatic adrenal lesions is safe, with equivalent long-term oncological outcomes providing the additional benefits of a minimally invasive technique. LA can be recommended as an appropriate initial approach for isolated adrenal metastases.     

Low risk of cardiac events during intramedullary instrumentation of lung cancer metastases

Background Instrumentation, particularly reaming, of the long bones carries the risk of embolic phenomenon. Emboli may result in pulmonary injury, which is usually manifested by desaturation. This pulmonary injury may be particularly relevant if there is diminished pulmonary reserve due to pre-existing lung disease such as lung carcinoma. In extreme cases, this can result in cardiac arrest intraoperatively.

Patients and methods We reviewed 34 consecutive operations that involved instrumentation of long bones for metastases of lung carcinoma.

Results Desaturation developed during 1 procedure, and there was hypotension in 5 patients. In addition, cardiac arrest occurred intraoperatively in 1 patient, which was the only fatality.

Interpretation This study has shown that while emboli during femoral instrumentation may be common, significant clinical manifestations of this phenomenon are uncommon.     

Body mass index, percent body fat, and bone mass in a cohort of Chinese twins aged 6 to 18 years

Introduction This report examines the relationship of body mass index (BMI), percent body fat (%BF), and bone mass in a cohort of male and female twins recruited from Anhui province, China, ages 6–18 years—577 male pairs (mean age = 11.4) and 478 female pairs (mean age = 11.6). Methods Whole body bone mineral content (WBMC) in (g), whole body bone area (WBA) in (cm²), and %BF were measured using DEXA (Lunar Prodigy, USA). Regression analysis of within-pair differences was used to assess the strength of the association, and the analysis was stratified by gender and age group, where age cut-offs were based on ages at spermarche or menarche estimated from large population based studies in China. Males were stratified at ages before 14 and age 14–18, and females at ages prior to 12 and age 12–18. Results Univariately, BMI and %BF were associated with WBMC and WBA in the younger males and females, and in older males; %BF was significant only in older females. Multivariate models included both BMI and %BF. Among the younger males, age < 14, BMI and %BF were significantly associated with WBMC and WBA. In the younger females, age < 12, %BF was only significant to WBA. In the older age group, only BMI was significant to WBMC and WBA in females, but in males, BMI was positively associated, and %BF was negatively associated with both bone measures. Discussion These findings show that association between BMI and %BF and bone mass differ across gender and developmental stages, and %BF appears to be beneficial at younger ages, but detrimental or non-beneficial at older ages of development.     

Hepatocellular Glycogen in Alleviation of Liver Ischemia-Reperfusion Injury During Partial Hepatectomy

Background Temporary occlusion of liver blood supply for complex liver operation is common in liver surgery. However, hepatic vascular occlusion will undoubtedly impair liver function. This study was designed to elucidate the effect of hepatocellular glycogen in alleviation of liver ischemia-reperfusion injury during hepatic vascular occlusion for partial hepatectomy. Methods Fifty-seven patients were randomly divided into an experimental group (n = 29) and a control group (n = 28). In the experimental group, patients were given high-concentration glucose intravenously during 24 h before the operation. The hepatic lesion was resected after portal triad clamping in the two groups. Noncancer liver tissue was biopsied to measure hepatic tissue ATP content and change of malondialdehyde (MDA) and superoxide dismutase (SOD). Liver function of all patients was assessed by using an automatic biochemical analysis apparatus before the operation and the first and fifth days after operation. Results The mean hepatic vascular occlusion time in the experimental group was 19.21 ± 4.54 min and in the control group it was 21.04 ± 5.11 min. Hepatic tissue ATP content of the experimental group was significantly higher than that of the control group at the end of hepatic vascular occlusion (2.15 ± 0.39 μmol/g wet tissue vs. 1.33 ± 0.44, p < 0.01) and at the point of 1-h reperfusion (2.19 ± 0.29 μmol/g wet tissue vs. 1.57 ± 0.35, p < 0.01). There was significant difference in SOD activity between the two groups at the end of hepatic vascular occlusion (130.69 ± 30.49 NU/mg pr vs. 97.83 ± 26.23, p < 0.01) and at the point of 1-h reperfusion (139.55 ± 39.88 NU/mg pr vs. 114.74 ± 25.93, p < 0.01). Significant difference was shown in MDA content between the two groups at the end of hepatic vascular occlusion (3.02 ± 0.30 nmol/mg pr vs. 3.99 ± 0.49, p < 0.01) and at the point of 1-h reperfusion (3.81 ± 0.69 nmol/mg pr vs. 5.75 ± 1.17, p < 0.01). In addition, the liver function of the experimental group was significantly better than that of the control group the first and fifth days after the operation (p < 0.01). Conclusions Abundant intracellular glycogen may reduce liver ischemia-reperfusion injury caused by hepatic vascular occlusion. It is beneficial to give a large amount of glucose before a complex liver operation during which temporary occlusion of hepatic blood flow is necessary.