Single-stage repair of severe hypospadias using bladder mucosa graft

Our experience of single-stage repair of severe hypospadias (penoscrotal, scrotal, and perineal) in 30 children using urinary bladder mucosa for urethroplasty is reported. These children had severe chordee, small prepuce, and often ventral transposition of the penis with bifid scrotum where Devine and Horton, Asopa, or Duckett techniques are not so suitable. The graft uptake was uniformly satisfactory. Ten patients had complications; most of the fistulae healed spontaneously. Surgical intervention was required in 2 cases only: 1 for a fistula and another for a stricture with fistula. Meatal stenosis, seen in 4 cases, led to delayed distal fistulae in 2, which healed spontaneously with meatal dilatation. Regular dilatation of the external meatus is recommended to prevent this problem.     

大鼠壁细胞的黏膜刮取式分离方法

采用黏膜刮取式方法，分离大鼠胃黏膜细胞。用相差显微镜、HE染色、电镜、荧光显微镜、免疫细胞化学染色等方法，对壁细胞进行观察和鉴定，并测定了壁细胞直径。结果成功地分离了大鼠胃黏膜细胞，同时证实，壁细胞在所分离的细胞中直径最大。     

老年病人鼻饲方法的改进

目的探讨增加置管深度并抬高床头对预防老年鼻饲病人食物反流的效果。方法将 5 75例需鼻饲的卧床老年病人按鼻饲医嘱时间顺序及不平衡指数最小原则分成三组 ,分别给予教科书中的常规置管深度置管 (对照组 )、置管深度延长 10cm(观察 1组 )、置管深度延长 10cm并抬高床头 30～ 45°(观察 2组 )进行鼻饲。结果三组病人食物反流率比较 ,P <0 .0 1;观察 1、2组分别与对照组比较 ,P <0 .0 5、P <0 .0 1;观察 1组与观察 2组比较 ,P <0 .0 1。增加置管深度并抬高床头其食物反流率最低 ,仅增加置管深度次之 ,常规置管最高。结论增加置管深度并抬高床头可显著降低老年鼻饲病人食物反流发生率。     

乳凝集素对新生仔兔小肠粘膜及小肠CD4~+,CD8~+,CD25~+淋巴细胞发育的影响

目的探讨乳凝集素(lactadherin)对新生仔兔在吮乳期及断奶期小肠粘膜发育以及小肠淋巴细胞发育的影响。方法新生仔兔共45只,随机分为母乳组(GB),配方奶组(GF)及配方奶加乳凝集素组(GL,100μg/ml),每组15只,在3w和5w应用图像分析技术检测新生仔兔小肠粘膜发育情况,分别在1、2、3、4和5w时,应用流式细胞技术测定小肠CD4+,CD8+,CD25+淋巴细胞发育情况。结果(1)GL组3w空肠绒毛周长、绒毛面积、绒毛高度及隐窝深度均超过GF组,GB组3w空肠绒毛周长及绒毛高度超过GF组;GL组5w空肠和回肠绒毛周长、绒毛面积、绒毛高度及隐窝深度均超过GF组和GB组。(2)5w各组小肠绒毛发生变化,绒毛表面由高密度的手指状变为平滑叶状或舌状,GL组绒毛面积和高度恢复较GB和GF组好。(3)GL组回肠CD4+淋巴细胞发育较GF组好,GB组较GL组好;GL组回肠CD25+淋巴细胞发育较GF组好(P<0.05)。结论乳凝集素对近端空肠粘膜形态发育和小肠CD4+和CD25+淋巴细胞发育有促进作用,并且可能帮助断奶期绒毛的恢复。     

Pressure stability of nasal CPAP and bilevel devices

Summary Question of the study   Nasal continuous positive airway pressure (CPAP) prevents collapse of the upper airway during sleep in patients with obstructive sleep apnea provided that a positive transmural pressure can be maintained during inspiration. We examined pressure-flow characteristics in seven CPAP and bilevel devices during spontaneous breathing.
Methods   The CPAP devices were set to a pressure level of 9.8  hPa (10  cm H₂O) and adapted to a pneumotachograph using a standard CPAP hose and an outlet valve. We continuously measured flow, volume and pressure during resting ventilation and increasing voluntary hyperventilation and analysed the dependence of the variables on a breath-to-breath basis.
Results   Mean CPAP pressures differed between the devices (9.9 – 10.6  hPa) despite the same settings. In all machines pressure fell during inspiration to 8.4 – 9.8  hPa and increased during expiration to 11.1 – 11.7  hPa. This effect increased with higher flow rates. Maximum expiratory pressures rose to 12 – 19  hPa at peak flow rates of 2 l/s, mean expiratory pressures to 9.5 – 16  hPa. Inspiratory pressures dropped to 8.5 – 4.5  hPa (minimum) and 10.5 – 6.0 (mean). Bilevel devices showed a higher stability than CPAP devices. Pressure swings during the respiratory cycle increased the additional work of breathing.
Conclusions   Due to differences in mean and effective CPAP levels CPAP devices are not simply exchangeable but should be individually adapted. Patients with higher minute ventilation might benefit from more stable CPAP machines. The impact on patients' compliance remains to be evaluated.     

鼻眶筛骨折手术治疗的临床评价

目的　探讨鼻眶筛骨折的手术入路、骨折复位与坚固内固定及合并眼球内陷的处理方法。方法　对 17例鼻眶筛骨折患者进行回顾性研究 ,根据CT结果与Fedor骨折分型分为三型 ,其中Ⅰ型 1例 ,Ⅱ型 7例 ,Ⅲ型 9例 ;13例选用鼻根正中入路 ,3例鼻旁入路 ,7例需同时附加眶下切口。 8例合并眼球内陷者采用眼球赤道后方碘仿纱条填塞与植骨矫正法。结果　①本组病例平均内眦宽度和内眦宽度 /外眦宽度比例从 ( 35± 7)mm、( 37± 8) %恢复到 ( 32± 4 )mm、( 35± 7) %比较正常水平 ;②面部外形全部恢复到正常或接近正常 ;③ 8例眼球内陷患者术后 6例恢复到基本正常 ,2例术后仍有轻度凹陷 ,5例复视术后全部消失。结论　鼻根正中入路附加眶下切口可充分显露骨折片 ,结合坚固内固定技术可使骨折片解剖复位 ;内眦韧带复位固定是本手术关键所在 ,重建正常眶内容积和眶内容物准确复位 ,以解决眼球内陷和眼球运动受限问题     

Esthesioneuroblastoma in a young child. Case report

Esthesioneuroblastoma is an uncommon malignant neoplasm that arises from olfactory mucosa, often with intracranial extension.A case report of the youngest victim in the literature (2-year-old boy) is presented.     

Personal exposure to house dust mite allergen in bed: nasal air sampling and reservoir allergen levels

BACKGROUND: Assessment of personal exposure to dust mite allergen has relied on proxy measures. Only recently has a means to directly measure inhaled allergen particle number become available (the intra-nasal air sampler). OBJECTIVE: To quantify inspired dust mite group 1 and group 2 allergen-bearing particles in bed in undisturbed conditions prior to sleep by nasal air sampling and to investigate the relationship between inhaled particles and reservoir allergen levels. METHODS: Twelve volunteers wore nasal samplers in bed for 6 evenings, nose-breathing in undisturbed conditions. Allergen-bearing particles ('halos') were detected by immunostaining for Der p 1, Der p 2, or Der p 1 and Der p 2 together, and counted by light microscopy. Count data were square root transformed for analysis of variance. Mattress dust samples were assayed for Der p 1 and Der p 2 concentrations. RESULTS: Square root detransformed mean particle counts per 30-min sample were: Der p 1, 4.22; Der p 2, 5.9; Der p 1 + Der p 2, 4.87; and for all samples, 5.01, with no difference between the groups. With replicate samples, halo number correlated significantly with mattress allergen concentrations (Der p 1 r = 0.80, P < 0.01; Der p 2 r = 0.68, P < 0.02). CONCLUSION: Nasal air sampling can be used to quantify nocturnal Der p exposure in undisturbed conditions in an area with moderate exposure to mite allergen and can provide a direct measure of inhaled mite allergen. The choice of either Der p 1 or Der p 2 is appropriate for this purpose.     

Effect of Helicobacter pylori on ectopic gastric mucosa of Meckel's diverticulum in children after meckelectomy

Ninety-two children underwent meckelectomy in our department over the 10-year period 1981–1990. All histologic speciments of Meckel's diverticula were studied, most of them retrospectively, for evidence of active inflammation or ulceration in any ectopic gastric mucosa present and specifically searching for Helicobacter pylori (HP). Thirty-eight (group A) were excised as being responsible for the main clinical symptoms while 54 (group B) were resected incidentally. Ectopic gastric mucosa was found in 19 cases, 18 in the symptomatic group and 1 in the incidental group. In the 18 cases belonging to group A histologic findings indicating gastritis due to HP were present. Combined operative and laboratory findings in all 92 cases indicated that HP colonizes gastric mucosa electively and leads to infection, which seems to be responsible for the clinical symptoms of meckelitis.Presented at the 15th Annual International Meeting of Greek Association of Pediatric Surgeons, Porto Hydra, Greece, 27–30 September 1990