Success of de novo reimplantation of the artificial genitourinary sphincter

PURPOSE: We evaluate our experience with de novo reimplantation of the artificial genitourinary sphincter with a particular emphasis on mechanical and nonmechanical failure rates. De novo reimplantation is defined as implantation of an artificial sphincter following removal of a previously placed sphincter for erosion and/or infection and a waiting period of several months. MATERIALS AND METHODS: A retrospective analysis of more than 400 patients with an artificial sphincter revealed 23 who underwent de novo reimplantation between January 1983 and October 1998. All patients were men with a mean age of 66.5 years (range 16 to 88) and all had a urethral cuff. Reasons for cuff removal were erosion in 12 cases (52.2%), infection in 10 (43.5%) and intraoperative urethral injury in 1 (4.3%). Mean waiting period was 6.8 months (range 1.5 to 32) between explantation and de novo reimplantation. Mean followup was 32.6 months (range 1 to 108). RESULTS: Of the 23 patients 20 (87%) had no mechanical or nonmechanical failures and 3 (13%) had nonmechanical failures, including 2 patients (8.7%) whose cuff eroded into the urethra and 1 (4.3%) who had recurrent urinary incontinence which was successfully treated with implantation of a tandem cuff. There were no mechanical failures or infections in this group of patients. CONCLUSIONS: Our study suggests that de novo artificial sphincter reimplantation is an excellent treatment option. It is safe and associated with complication rates that are comparable to those of primary implantation.     

带状疱疹节段性轻瘫的电生理特点分析

目的 分析带状疱疹节段性轻瘫的电生理特点。方法 回顾分析2017年10月至2022年10月肌电图室接诊的11例带状疱疹节段性轻瘫患者神经电生理检查结果。结果 11例患者的电生理结果均异常,神经传导异常率为20.9%（41/196）。运动神经异常率为26.0%（26/100）,感觉神经异常率为15.6%（15/96）,以受累神经波幅降低为主。与健侧对比,神经传导波幅异常率为18.4%（36/196）,其中运动传导波幅异常率为23.0%（23/100）,感觉传导波幅异常率为13.5%（13/96）。炎性神经病病因和治疗量表（Inflammatory Neuropathy Cause and Treatment,INCAT）评分与复合肌肉动作电位（compound muscle action potential,CMAP）波幅下降比例最大值呈正相关（P<0.05）。针极肌电图显示受累肌肉呈神经源性损害改变。结论 带状疱疹节段性轻瘫患者的电生理结果分为神经丛型、神经根型、单神经型,以轴索损害为主。神经传导联合针极肌电图检测对带状疱疹节段性轻瘫的早期诊断、肌肉定位、病情的严重程度评估有重要价值。     

儿童局灶节段性肾小球硬化

局灶节段性肾小球硬化（FSGS）近年来有增多趋势,FSGS不仅是一种形态学描述,而被视为一种临床病理综合征,表现为蛋白尿,常为肾病水平蛋白尿,并有局灶节段分布的肾小球硬化和足突融合。FSGS可为原发性（特发性）、继发性和遗传家族性。最近FSGS被区分为5种变异型,提示其不同的发病机制和预后,这5型包括特异FSGS、门周型、细胞型、顶端病变和塌陷型。该文还就FSCS的治疗和预后进行了讨论。     

家族性局灶节段性肾小球硬化一家系报告及文献复习

目的 探讨家族性局灶节段性肾小球硬化（FFSGS）的临床特点、诊断、治疗及预后。方法 结合1个FFSGS家系临床资料进行文献复习,分析该病临床特点、诊断、鉴别诊断、发病机制、治疗及预后。结果 家谱分析可提示遗传类型;诊断主要依据病理,病理早期为局灶性、节段性改变,晚期为弥漫性、球性改变;免疫抑制治疗效果差。结论 FFSGS是一种罕见的遗传性疾病,预后差。     

白色萎缩7例报告与文献复习

目的：提高对白色萎缩的认识,探讨其诊断依据和有效的治疗方法。方法：对2002年以来我院住院的7例本病患者的临床资料进行回顾性分析。结果：本病发病年龄以中年以上女性居多,皮损表现为双小腿、踝部、足部散在淡红色和紫红色斑疹、斑片,逐渐破溃、渗液、溃疡、结痂、萎缩形成象牙白色瘢痕,夏重冬轻。实验室检查无特异性;组织病理改变为真皮浅层小血管数量增多,血管内皮细胞显著增生,管腔狭窄,少数血管壁有纤维蛋白样物质沉积及玻璃样变、透明血栓形成,血管周围有少量淋巴细胞和组织细胞浸润。结论：本病主要根据临床特点和组织病理诊断。目前,以大剂量双嘧达莫、小剂量阿司匹林联合治疗为首选;其他还可选用纤维蛋白溶解药、抑制血小板聚集药,以及中药生地、山药;重症患者采用血浆置换术可获得近期良好的疗效。     

单孔胸腔镜肺段切除术在治疗Ⅰa期非小细胞肺癌中的应用效果

目的 研究单孔胸腔镜肺段切除术在Ⅰa期非小细胞肺癌患者治疗中的应用效果.方法 采用回顾性分析方法,研究对象为2017年1月至2020年1月阜阳市第五人民医院收治的70例Ⅰa期非小细胞肺癌患者,根据不同手术方式分为对照组与研究组,各35例.对照组选用单孔胸腔镜肺叶切除术治疗,研究组选用单孔胸腔镜肺段切除术治疗.比较2组手...     

Successful Treatment of Nephrotic Syndrome Due to Collapsing Focal Segmental Glomerulosclerosis Accompanied by Acute Interstitial Nephritis

A 39-year-old woman was hospitalized for nephrotic syndrome. Laboratory test results showed increased serum creatinine levels and urinary excretions of beta-2-microglobulin, and N-acetyl-beta-D-glucosaminidase. A renal biopsy revealed collapsing focal segmental glomerulosclerosis (FSGS) and acute interstitial nephritis. Despite treatment with pulse steroid followed by oral high-dose glucocorticoids and cyclosporines, heavy proteinuria persisted. After low-density lipoprotein apheresis (LDL-A) therapy was initiated, her proteinuria gradually decreased, leading to complete remission. A repeat renal biopsy after treatment revealed no collapsing glomeruli. Immediate LDL-A should be performed to treat cases of collapsing FSGS poorly responding to other treatments.     

The Effect of Customized and Silicon Insoles on Mid- and Hindfoot in Adult Flexible Pes Planovalgus

BackgroundFlexible flat foot or pes planovalgus is a common foot deformity, and silicone and customized insole are commonly used as a non-operative treatment modality of flexible planovalgus. However, there are inadequate data and limited evidence available regarding the immediate effects of their use in midfoot and hindfoot of adults. The aim of this study is to quantify and compare the radiological parameters immediately on weightbearing with silicon and customized insoles and without them to assess the effect on midfoot and hindfoot of the flexible planovalgus in adults.MethodsA total number of 11 (8 females and 3 males) subjects with flexible pes planovalgus deformity without any other foot deformity were included in the study. Each patient was assessed three times in a random sequence without and with use of either silicon insoles or customized insole. The radiographic parameters without insole, with silicon insole, and with customized insole conditions were calculated using online available computer software Kinovea.ResultsOne-way ANOVA analysis was performed between groups (without insole, with silicone insole and with customized insole). The hindfoot parameters depicted that calcaneal inclination angle (CIA) was significant increased (P = 0.000) and talar declination angle (TDA) was significantly decreased (P = 0.003) only with the use of customized insole compared to without insole. The midfoot parameters depicted that the first metatarsal angle (FMA) and talonavicular coverage angle (TCA) were significantly lower with customized insole (P = 0.00) as compared to other two groups and significantly lower with silicone insole (P = 0.00) as compared to without insole group.ConclusionThe results imply that the compressibility of the insole material affects the forefoot and hindfoot biomechanics differently. This study concludes that silicone insole affects only the midfoot which bears 45% of bodyweight and customized insole affects both midfoot and more importantly the hindfoot which bears 55% of bodyweight.     

Four Pins Assisted Reduction of Complex Segmental Femoral Fractures： a Technique for Closed Reduction

Complex segmental femoral fractures are usually not amenable to closed reduction. The purpose of this study was to evaluate a series of patients who had undergone four pins assisted reduc- tion and intramedullary nail fixation to determine the therapeutic effect of this closed reduction tech- nique. Between December 2010 and January 2013, 15 consecutive patients with segmental femoral fractures were treated with four pins assisted reduction at our hospital. The patient was placed in a supine position on a radiolucent fracture table and a. gentle traction was attempted on the limb. Usu- ally, the proximal fracture segment exhibited the typical deformity of flexion, external rotation, and abduction, the middle segment exhibited adduction and distal fracture segment exhibited flexion. Four Schanz pins were placed percutaneously to fix one cortex and did not penetrate into the me- dullary cavity, and the ＂T＂ sharp handles were fixed on the Schanz pins. The fragments were then re- duced by reversing the deforming forces for segmental fractures by two assistants~ And then, the re- duction could be easily achieved and intramedullary nail fixation was performed. Radiographs were evaluated for the quality of the reduction and fracture union. Closed reduction was achieved in all pa- tients using the four pins technology. All 15 fractures united uneventfully. No patient had a rotational malunion or limb length discrepancy at the time of the last follow-up. Thirteen of the fifteen （86.7%） patients had anatomic reduction and two of them （13.3%） had minor varus alignment of 3° and 5°. Knee stiffness was Observed in 2 patients and no implant failure was observed. Surgical treatment of complex segmental femoral fractures With four pins assisted reduction and intramedullary nail fixation techniques can result in excellent reductions and a high union rate.