Dorsal inlay graft urethroplasty for primary hypospadiac repair

OBJECTIVE: Tubularized incised plate urethroplasty has become a popular technique for repairing distal and proximal hypospadias in many institutions. Dorsal inlay graft urethroplasty has been used in our institution since 2003 to reduce the risk of meatal stenosis. In the present study, we evaluated the results of the dorsal inlay graft procedure. METHODS: A total of 28 patients with no deep groove and no severe curvature underwent one-stage urethroplasty using an inner preputial-based dorsal inlay graft. The medical records of all patients were retrospectively reviewed with regard to complication rate and cosmetic appearance. RESULTS: Mean patient age at surgery was 21 months (range, 14 months to 4.6 years). Preoperatively the urethral meatus was coronal in two cases, distal shaft in 17, proximal shaft in six and penoscrotal in three. Nine patients required testosterone therapy before surgery. Mean operative time was 200 min (range, 154-249 min). Mean length of inlay graft was 20.9 mm (range, 12-30 mm). In all patients, a straight penis was achieved without dorsal plication of the corposa cavernosa, and the neomeatus with a slit-like appearance was positioned at the glans tip. At a mean of 22 months of follow up, a urethrocutaneous fistula developed in only one patient (3.6%), requiring repair surgery 6 months after urethroplasty. No patient had meatal stenosis, neourethral stricture or urethral diverticulum along the inlay graft. CONCLUSION: Dorsal inlay graft urethroplasty is an effective method for hypospadiac repair and leads to good cosmetic outcome with low risk of complications.     

Impact of unilateral interposition sural nerve graft on the recovery of sexual function after radical prostatectomy in Japanese men: A preliminary study

PURPOSE: To determine the effect of an interposition nerve graft on sexual function after radical prostatectomy. METHODS: This study includes 64 patients, without hormonal therapy, who underwent a radical prostatectomy and intraoperative electrophysiological confirmation of cavernous nerve preservation. Twelve patients underwent a unilateral interposition sural nerve graft (UNG) for the resected neurovascular bundle. Twenty-one and 31 patients underwent bilateral nerve-sparing (BNS) and unilateral nerve-sparing (UNS) surgery without a nerve graft, respectively. As the age of patients was significantly younger in the UNG group than in the other groups, age-matched analysis also was conducted. Sexual function, evaluated by a self-administered questionnaire using the University of California Los Angeles-Prostate Cancer Index, was compared statistically among the three groups. RESULTS: In the age-matched analysis, the postoperative sexual function (SXF) score of the UNG group showed an intermediate level of recovery between those of the BNS and UNS groups at 12 months and reached the same level as the score at 12 months of the BNS group at 18 months postoperatively. The difference in the SXF score between the UNG and UNS groups began to appear after 6 months postoperatively and increased steadily with time. However, the background factors, such as the baseline SXF score, the usage rate of phosphodiesterase 5 inhibitors, and the rate of comorbidities were different between the UNG and UNS groups. CONCLUSIONS: The difference of the SXF score between the UNG and UNS groups increased with time after 6 months postoperatively. However, it might be difficult at present to attribute a better recovery of the SXF score to the nerve graft because of the difference in the background factors between the groups.     

血管移植搭桥治疗巨大动脉瘤

目的探讨中、高流量血管搭桥方法对颅内巨大颅内动脉瘤的治疗。方法8例巨大和颅底复杂动脉瘤患者,主要表现头痛发病者5例,视力减退者2例,面部麻木者1例。未破裂动脉瘤6例,2例患者发生动脉瘤破裂,Hunt-Hess分级分别为Ⅰ级和Ⅱ级。血管造影证实：动脉瘤体位于颈内动脉海绵窦段（C4段）4例、床突上段（C1段）2例、大脑中动脉M2～M1段者2例动脉瘤大小为2．5～6．0cm,平均直径3．7cm。其中6例动脉瘤为梭形,2例为宽颈动脉瘤。8例患者均采用额颞开颅,骨瓣要尽可能低到颅底,以缩短搭桥移植血管在颅外走行长度。通常用7-0显微缝线吻合移植血管与颈外动脉,用8-0缝线吻合移植血管与颅内段颈内动脉和大脑中动脉。4例患者利用大隐静脉移植搭桥,4例患者利用桡动脉移植搭桥。颅内、外搭桥完毕后将动脉瘤近心端和远端的供血动脉结扎和夹闭,阻断动脉瘤的全部血供。对3例有压迫脑神经或颅内占位引起颅压高的患者,将动脉瘤切除。结果5例术后头痛消失,1例视力减退者明显改善,1例动眼神经麻痹恢复。5例术后行脑血管造影检查,3例行CT血管造影检查,7例搭桥吻合血管全部畅通,动脉瘤消失。2例术后出现暂时性一侧肢体力弱,肌力在Ⅱ～Ⅲ级之间,术后1个月完全恢复。结论中、高流量颅内外血管搭桥可作为治疗颅内巨大动脉瘤的有效方法。     

Kidney Transplant in Black Recipients: Are African Europeans Different from African Americans?

Despite recent improvement, significant racial disparities in outcome still persist after renal transplantation among African American patients in the United States. This study evaluated the association of race and ethnicity with allograft outcomes in a French population of 952 Caucasian (Cauc) patients and 140 African European (AE) patients who underwent renal transplantation in our center between 1987 and 2003. Demographic characteristics were similar for the two cohorts other than cause of end-stage renal failure (more hypertension among AE and more polycystic kidney disease among Cauc) and cold ischemia time (significantly longer for AE). Immunosuppressive treatment was comparable between groups. There were no significant differences between AE and Cauc in the incidence of acute rejection (31% vs. 30%). At 5 years post-transplant, patient survival (93% vs. 92%), graft survival (83% in both groups) and graft function (creatinine clearance 48 mL/min vs. 45 mL/min) were also similar among the AE and Cauc patients. We demonstrate that ethnic origin does not affect outcome after renal transplantation in France. Therefore, differences observed in the United States cannot be only related to immunologic or pharmacologic factors. The results of renal transplantation in patients of African origin could be improved with universal immunosuppressive drug coverage.     

胎骨移植治疗骨肿瘤缺损：附10例报告

近3年来，用制备的胎骨充填良性骨肿瘤及病样病变术后骨缺损，经观察10例效果良好。胎骨因其自身组织学和生理学特点，具有抗原性小、诱导成骨活性高，利于“爬行各代”等优点。而且来源丰富、采制简单、储存容易、费用低度，是一种良好的植骨材料，特别适于儿童及年老体弱患者自身取骨困难的骨缺损植骨需要。但其为异体骨，有一定免疫原性，抗支撑强度略差，应注意严格无菌操作、消除免疫原性、配合使用内、外固定等措施。     

全厚皮片移植修复颈部瘢痕挛缩畸形

应用全厚皮片移植修复治疗183例颈部烧伤后瘢痕挛缩畸形患者,术后经3～5年随访观察效果确切.并对全厚皮片术后易发生收缩的问题,进行讨论.     

Research review: DNA polymerases as molecular markers of the regenerating capacity of hepatocytes

Hepatocyte regeneration has been widely investigated, with the mitotic index and the incorporation of [³H]thymidine being used as regeneration markers. We focused on the induction of DNA replication enzymes, particularly DNA polymerases (pol) α, δ, and ε. Using rat models, we have shown that the activity of pol α in crude liver extract well represents the regenerating capacity of hepatocytes. Using pol α as an indicator, we analyzed liver regeneration in rat models under various conditions: obstructive jaundice, external or internal biliary drainage, and the obstruction of portal vein branches. It has been revealed that the ligation of the common bile duct alone induces a certain amount of hepatocyte proliferation. It was striking that external biliary drainage suppressed regeneration capacity in cholestatic rat liver after partial hepatectomy. The strong regeneration in nonligated lobes induced by portal branch ligation was similar to the liver regeneration seen after partial hepatectomy with respect to the induction of DNA polymerases. Taken together, the aspects of DNA replication, particularly the induction of DNA polymerases, may contribute to shedding new light on the regeneration of human liver. This work was supported in part by a Grant-in-Aid for General Scientific Research and for Cancer Research from the Ministry of Education, Science and Culture, Japan, and by grants from the Uehara Memorial Foundation     

Electro-oculogram of Retinal Vein Occlusion

Twenty five cases, including 26 eyes with retinal vein occlusion (RVO) were examined by means of the electro-oculogram. The results showed that 23 of the 26 eyes suffering from RVO exhibited abnormalities of the electro-oculogram (EOG). The potential difference and Arden ratio in the RVO eyes were lower than those in the normal eyes (P<0.01). The more the visual acuity of ill eyes was decreased, the higher the abnormal rate of EOG in ill eyes was. 14 eyes had the visual acuity less than 0.1, whose EOGs were abnortmal. Six eyes had the visual acuity from 0. 2 to 0. 4, in which the EOGs of 5 eyes were abnormal. Six eyes had the visual acuity more than 0. 5, a-mong which the EOGs of 4 eyes were abnormal. Based on the above observations, it may be considered that the circulatory disturbance resulting from RVO damages not only the internal layer but also the external layer of the retina. We suggest that EOG is a useful method for distingquishing lesions caused by RVO and may reflect the functional condition     

玻璃体切除术治疗视网膜静脉阻塞所致的玻璃体出血

报告应闭合式玻璃体切除术治疗７例（７眼）因视网膜静脉阻塞所致的玻璃体出血。所有病人术后眼底清晰可见，视力明显提高。术后４例出现再出血，经药物治疗后出血吸收，加用氩离子激光视网膜光凝，无再出血。随访３至１８个月所有病人无新生血管性青光眼及牵引性视网膜脱离出现。认为玻璃体切除术不但能使屈光间质恢复透明，视力提高，预防牵引性视网膜脱离，而且为明确诊断和进一步激光治疗提供条件。     

前列腺素E1对尸体肾移植术后肾功能延迟恢复的影响

目的探讨前列腺素E1(PGE1)应用于尸体肾移植术后肾功能延迟恢复(DGF)患者对移植肾功能恢复的影响.方法回顾性分析因急性排斥(AR)和急性肾小管坏死(ANT)导致DGF的127例临床资料,其中应用PGE1治疗56例(PGE1组),未用PGE1者71例(对照组).比较两组在出现DGF后的透析治疗时间、肾功能恢复情况、彩超的移植肾血流阻力指数(RI)及6个月内AR发生率.结果与对照组比较,PGE1组透析治疗时间明显缩短(P＜0.05),移植肾的血肌酐下降速度快(P＜0.05),RI及6个月内AR发生率低(P＜0.05).结论PGE1有利于尸体肾移植术后DGF患者移植肾功能的早期恢复,并能降低AR的发生率.