舌黏膜尿道成形治疗前尿道狭窄（附80例报告）

目的：研究舌黏膜尿道成形治疗尿道狭窄的有效性和安全性。方法：2006年8月～2008年12月采用舌黏膜尿道成形治疗80例前尿道狭窄,尿道狭窄段2．5～18cm,其中30例为长段尿道狭窄（9～18cm）采用双侧舌黏膜或舌黏膜与颊黏膜或与带蒂包皮拼接尿道成形治疗。尿道成形采用两种术式：保留原尿道板的扩大尿道腔37例;埋藏黏膜条43例。结果：术后随访4～30（平均16．8）个月,7例发生并发症,其中尿瘘4例,再次发生尿道狭窄3例,其余患者排尿通畅,最大尿流率从15．2～54．6（平均28．7）ml／s。结论：舌黏膜是一种修复前尿道狭窄较好的尿道替代物,双侧舌黏膜尿道成形能成功治疗长段、复杂性尿道狭窄。     

Ritual Circumcision: No Longer a Problem for Health Services in the British Isles

INTRODUCTION

Primary care trust (PCT) funding of a ritual circumcision service has recently been withdrawn from our unit, raising concerns that this may result in greater morbidity from community circumcision. The aims of this study were to document our circumcision practice before and after the withdrawal of PCT funding and to determine its effect on the morbidity from circumcision. In addition, we wanted to survey all paediatric surgical centres in the British Isles to ascertain how many still offer a ritual circumcision service.

PATIENTS AND METHODS

We retrospectively reviewed our circumcision practice for 1 year prior to the removal of UK Government funding, and then performed a prospective audit of our practice for the 12 months following funding withdrawal. An e-mail survey was also performed of all paediatric surgical units to determine the ritual circumcision service provision throughout the British Isles.

RESULTS

A total of 213 boys underwent circumcision during the 12 months prior to the withdrawal of funding, of which 106 cases (50%) were ritual circumcisions. After funding withdrawal, 99 boys underwent circumcision, of which 98 cases (99%) were for medical reasons. A similar number of boys were re-admitted after a hospital circumcision during the two review periods (5 versus 4 patients), whereas the number admitted following a community circumcision rose after funding withdrawal (6 versus 11 patients). Only a third of British paediatric surgical centres offer a ritual circumcision service, and a significant proportion of these were either providing the service without PCT funding, or were reconsidering their decision to continue.

CONCLUSIONS

PCT funding withdrawal for ritual circumcision had an impact on our unit''s procedural case volume. This represented a cost saving to the trust, despite a higher rate of admissions for postoperative complications. There is an inequality in healthcare provision throughout the British Isles for ritual circumcision, and we feel it is vital to offer support and training to medical and non-medical practitioners who are being asked to perform a greater number of circumcisions in the community.     

Effects of nandrolone decanoate compared with placebo or testosterone on HIV-associated wasting

Objectives Current research is unclear about the most effective pharmacological agents for managing the loss of weight and fat-free mass common in HIV/AIDS. The aim of this study was to compare nandrolone decanoate with placebo and testosterone. Methods The study was a multicentre randomized double-blind placebo-controlled trial. Three hundred and three adult HIV-positive male patients with a weight loss of 5-15% in the last 12 months, or a body mass index of 17-19 kg/m(2), or a body cell mass/height ratio lower than 13.5 kg/m, were randomly assigned to receive nandrolone decanoate (150 mg), testosterone (250 mg) or placebo intramuscularly every 2 weeks for 12 weeks. Fat-free mass, weight, immune markers and perception of treatment were the main outcome measures. Results Treatment with nandrolone resulted in significantly greater increases in fat-free mass [mean increase 1.34 kg; 95% confidence interval (CI) 0.60; 2.08 kg] and in weight (mean increase 1.48 kg; 95% CI 0.82; 2.14 kg) compared with placebo. The mean increase in weight with nandrolone of 1.00 kg (95% CI 0.27; 1.74 kg) when compared with testosterone was significant, although the difference in fat free mass did not reach significance (mean increase 0.69 kg; 95% CI-0.13; 1.51 kg). Patient perception of benefit was significantly greater in the nandrolone group when compared with both the placebo and the testosterone groups. Conclusions Treatment with nandrolone decanoate increased body weight when compared with placebo and testosterone. Nandrolone decanoate treatment resulted in greater increases in fat-free mass than placebo and demonstrated a trend for a significant increase when compared with testosterone.     

Does family history predict the age at onset of new breast cancers in BRCA1 and BRCA2 mutation‐positive families?

Panchal S, Bordeleau L, Poll A, Llacuachaqui M, Shachar O, Ainsworth P, Armel S, Eisen A, Sun P, Narod SA. Does family history predict the age at onset of new breast cancers in BRCA1 and BRCA2 mutation‐positive families? Women who carry BRCA mutations are advised to begin breast cancer screening based on the age‐specific risks of breast cancer development. It is not clear to what extent the family history of breast cancer influences age of onset. We evaluated the use of family history to predict the age of breast cancer onset in BRCA mutation carriers. Pedigrees from an Ontario‐based registry were reviewed to identify the index case of breast cancer (most recent diagnosis) and other family cases of breast cancer. The youngest age of breast cancer diagnosis and mean age at breast cancer diagnosis in the other family cases were compared to the age of onset in the index case. The 260 BRCA1 and 213 BRCA2 pedigrees were reviewed. In BRCA2 families, the index case was diagnosed on average at 44.4 years when the youngest reported family case was less than or equal to 35 years, compared to 51.9 years when the earliest cases were diagnosed after age 50 (p = 0.04). A modest trend was seen for BRCA1 carriers, but this was not statistically significant. To a small extent, the onset of breast cancer in a BRCA2 mutation carrier can be predicted from her family history of cancer, however, the trend is modest and should not alter clinical recommendations regarding initiation of screening.     

螺旋CT尿道三维重建诊断后尿道狭窄或闭锁

目的 探讨螺旋CT尿道三维重建技术在后尿道狭窄或闭锁诊断中的应用价值.方法 对30例创伤性后尿道狭窄或闭锁患者术前行螺旋CT薄层扫描和尿道三维重建、X线尿道造影,观察狭窄或闭锁部位、长度以及尿道周围组织解剖结构的改变,并与开放性手术中发现的结果进行对比研究.结果 X线尿道造影检测狭窄或闭锁段长度为1.0～7.0 cm,平均4.0 cm,狭窄或闭锁长度相关系数为0.92,定位准确率为70%(21/30);螺旋CT尿道三维重建检测狭窄或闭锁段长度为1.2～7.6 cm,平均4.3 cm,狭窄或闭锁长度相关系数为0.96,定位准确率为93%(28/30);术中发现后尿道狭窄或闭锁长度为1.5～7.5 cm,平均4.2 cm.5例合并尿道直肠瘘者螺旋CT尿道三维重建可以清楚显示瘘管位置、长度及大小;X线尿道造影则无法清楚显示.结论 螺旋CT尿道三维重建对了解伤后尿道的解剖结构改变、测量尿道狭窄或闭锁部位和长度、指导手术方式选择有较高价值,尤其对合并尿道直肠瘘者有重要的诊断意义.     

口腔医学专业硕士研究生对艾滋病认知状况及态度的调查研究

为了探寻艾滋病的教育模式,帮助口腔医学专业硕士研究生形成对待艾滋病患者的正确态度,武汉大学口腔医学院对本院硕士研究生进行了问卷调查.调查结果显示,研究生对艾滋病相关知识及防护措施的认知水平总体较高,但仍然需要加强;对艾滋病患者和艾滋病病毒携带者持积极救助态度,但同时心存恐惧.因此,规范、系统的临床操作习惯亟需培养,无菌观念和“普遍预防”的意识亟需建立.     

Treatment of urethral strictures using lingual mucosas urethroplasty: experience of 92 cases

Background Urethroplasty of complex urethral stricture is a difficult procedure, and there is no widely accepted standard approach described in the published literature. We evaluated the efficacy and safety of urethroplasty using lingual mucosa grafts （LMGs） for the repair of urethral strictures. Methods Between August 2006 and April 2009, 92 cases of urethral strictures （length ranging from 2.5 cm to 18 cm, mean 6.5 cm） were treated using LMGs. Of the 92 patients, 38 with long-segment urethral strictures （9-18 cm） underwent dual LMG or LMG combined with foreskin flap or buccal mucosal graft urethroplasty. Results Follow-up was obtained for 3-33 months （mean 17.2 months） postoperatively. Complications occurred in 8 patients, including urinary fistulas in 4 patients; recurrent strictures developed in 4 patients at 3-4 months post-operatively. The remaining patients voided well postoperatively, with peak flows between 14.3 ml/s and 54.6 ml/s （mean 28.4 ml/s）. Conclusions The tongue is an excellent source of graft material for the repair of anterior mucosal strictures. Dual LMG substitution urethroplasty can successfully treat longer, more complex urethral strictures.