Preservation of urine voiding and sexual function after rectal cancer surgery

In order to decrease the urinary and sexual morbidity which follows radical pelvic lymphadenectomy for rectal cancer, we began selective preservation of the pelvic autonomic nerves. Between 1985 and 1987, 134 patients with rectal cancer underwent a curative resection (52 abdominoperineal resections, 82 sphincter-saving resections) with extended pelvic lymphadenectomy and selective pelvic autonomic nerve preservation (PANP). PANP was classified into five degrees depending on the extent of pelvic dissection. First-degree PANP indicates complete preservation of the nerves; second-degree PANP indicates destruction of the hypogastric plexus; thirddegree PANP indicates partial preservation of the pelvic autonomic plexus; fourth-degree PANP indicates bilateral or unilateral preservation of only the fourth pelvic parasympathetic nerve; and fifth-degree PANP indicates complete destruction of the pelvic autonomic nerves. Most patients with first-degree PANP were able to spontaneously void 7–10 days following the operation. However, 78 percent (28/36) of patients with fifth-degree PANP had not regained bladder sensation by the third postoperative week and were discharged with an indwelling catheter; 58 percent (21/36) had not regained bladder sensation by the 60th postoperative day. The cystometric data indicate a progressive decline in bladder sensation and function with increasingly extensive pelvic dissection. However, preservation of only the fourth parasympathetic nerve (fourth-degree PANP) resulted in partial sparing of bladder sensation and voiding function. Evaluation of sexual function in males under 60 years of age revealed that only 31 percent (12/39) recovered erectile function and only 19 percent (6/39) recovered normal ejaculatory function in the first postoperative year. Most of these patients had complete preservation of their pelvic autonomic plexus (i.e., first-degree PANP). Four patients with partial PANP have recovered erectile function. Complete PANP is the best way to prevent urinary and sexual morbidity after rectal resection. The opposing goals of maximizing the chance for cure and minimizing morbidity must be individualized and balanced in each patient. Our data demonstrate that it is now possible to perform radical pelvic lymphadenectomy in the majority of patients with advanced rectal cancer with a minimum of voiding dysfunction. Preservation of sexual function in males is more difficult and depends on complete PANP and, as such, should be restricted to the group of patients with Dukes' A and B carcinomas.Read at the meeting of The American Society of Colon and Rectal Surgeons, St. Louis, Missouri, April 29 to May 4, 1990.Supported in part by a grant of Cancer Research of Health and Welfare Ministry of Japan.     

Popliteal lymphadenectomy on sentinel lymph node melanoma metastasis

Popliteal lymph node dissection is a procedure that surgeons rarely perform and, therefore, scarcely represented in bibliography. In this paper we present the case of a patient with melanoma metastasis to popliteal sentinel lymph nodes showing the surgical procedure and discussing some epidemiological and technical issues.     

分泌性中耳炎所致感音神经性听力损失的高频测听观察

目的 探讨分泌性中耳炎（secretory otitis media，SOM）对扩展高频听力的影响。方法 对31例（32耳）SOM患者治疗前和治疗2周后行纯音测听及扩展高频测听，骨导频率范围为250Hz-8kHz，气导频率范围250Hz-20kHz，并与16例（32耳）健康对照组比较。结果 治疗前有31．3％SOM患者平均骨导阈值〉25dB，平均骨导阈值与对照组相比有显著性差异（P〈0．01），骨导阈值在2、4kHz处差异明显（P〈0．01），治疗后平均骨导阈值与对照组相比无显著差异（P〉0．05）。在扩展高频段，治疗前、后所有频率气导阈值均与对照组有明显差异（P〈0．01），且有随着频率增高，治疗后气导改善逐渐减少的趋势。结论 SOM患者导致的感音神经性聋由低频到扩展高频逐渐加重，治疗后低频区听力恢复较快，扩展高频区改善不明显。     

超声新技术在妇产科的应用

近年来,超声技术发展迅速,三维超声成像、超声对比剂及扩展成像都是目前超声研究和应用领域的热点。本文综述三项新技术的基本原理及其在妇产科的应用和发展前景。     

Donor Factors Predicting Recipient Survival After Liver Retransplantation: The Retransplant Donor Risk Index

The use of extended criteria liver donors (ECD) is controversial, especially in the setting of retransplantation. The aims of this study are to investigate the effects of ECD grafts on retransplantation and to develop a predictive mortality index in liver retransplantation based on the previously established donor risk index. The United Network for Organ Sharing (UNOS) liver transplant dataset was analyzed for all adult, non-status 1, liver retransplantations occurring in the United States since February 2002. All donors were categorized for multiple characteristics of ECD, and using multivariate survival models a retransplant donor risk index (ReTxDRI) was developed. A total of 1327 retransplants were analyzed. There were 611 (46%) recipients who received livers with at least one ECD criterion. The use of ECD grafts in recipients with HCV did not incur worse survival than the non-ECD grafts. The addition of the cause of recipient graft failure to the donor risk index formed the ReTxDRI. After adjusting for multiple recipient factors, the ReTxDRI was predictive of overall recipient survival and was a strongly independent predictor of death after retransplantation (HR 2.49, 95% CI 1.89–3.27, p < 0.0001). The use of the ReTxDRI can improve recipient and donor matching and help to optimize posttransplant survival in liver retransplantation.     

Extended pancreatectomy for pancreatic cancers

Pancreatic cancer carries a poor prognosis. A minority of patients are considered for surgical excision. Local extension, lymph node metastasis, poor prognosis with distal spread and the lack of effectiveness of chemo and radiotherapy, have led to a nihilistic approach to this disease. This review outlines the rationale for and technique of extended resections in pancreatic cancer.     

扩大翼点入路大骨瓣开颅+腰穿置管引流预防重症脑损伤并发脑积水

目的探讨扩大翼点入路大骨瓣开颅+腰穿置管引流术在预防额颞部重症脑挫裂伤后并发脑积水的疗效。方法回顾性分析了1995-05～2005-05行手术救治的GCS3～8分额颞部重型脑挫裂伤260例。其中A组170例,扩大翼点入路大骨瓣开颅手术+腰穿置管持续引流;B组90例,单纯额部或颞部骨瓣开颅手术。结果A组患者脑积水发生率明显低于B组患者,且病死率和致残率亦明显低于B组,二组有显著差异(P<0.05)。结论扩大翼点入路大骨瓣开颅+腰穿置管引流术可降低重症颅脑损伤后脑积水的发生率,改善预后。     

A novel MR angiography technique: SPEED acquisition using half-Fourier RARE

A novel MR angiography (MRA) method, swap phase encode extended data (SPEED), was developed. Two one-shot images with the phase-encode directions swapped were collected within a single breath-hold period and processed with a maximum intensity projection (MIP) to obtain an image. In this study, a long echo train two-dimensional rapid acquisition with relaxation enhancement (RARE) sequence with half-Fourier (half-RARE) was used to obtain the pulmonary MRA images. The MIP image obtained using the SPEED technique presented promising results for pulmonary vessels.