Sarafoff's anoplasty for incontincence following Whitehead's haemorrhoidectomy

The purpose of our study was to ascertain whether Sarafoff's anoplasty is a valid option for anal ectropion (eversion), in which mucosal prolapse causes continuous mucus discharge and faecal incontinence from loss of sensitivity due to anal skin removal. A retrospective evaluation was made of 12 patients (8 female and 4 male, mean follow-up time 8.3 years, range 2–12 years) who, from 1984 through 1997, underwent Sarafoff's anoplasty for anal ectropion following Whitehead's haemorroidectomy, which in 5 cases had been combined with prolapsectomy. Eight patients complained of incontinence to solid faeces (Miller's score 7–9), and the remaining 4 of incontinence to liquid faeces and gas (Miller's score 1–6). The median score for preoperative incontincence was 7. All patients underwent pre- and postoperative manometric evaluation. Sarafoff's anoplasty consists of a cutaneous and subcutaneous circular incision to a depth equal to that of the sphincteric apparatus (1–4 cm), and at a distance of 1–2 cm from the everted anal or rectal mucosa, with analcoccygeal ligament sectioning. The wound created is made to heal without sutures. Scar retraction, together perhaps with the action of the levator ani muscle, raises the eversion, thus restoring the anoderm of the distal anal canal. On comparing values before and after Sarafoff's anoplasty, a significant improvement was found in: mucus secretion (P < 0.01), ectropion (P < 0.01), and degree of postoperative continence, with a median score of 2 (P < 0.01). No statistical difference was found between mean manometric parameters before and after surgery. Sarafoff's anoplasty in selected patients with ectropion combined with faecal incontinence due to loss of anal sensitivity, is a simple procedure with good long-term results, and without important complications. Received: 19 January 1999 / Accepted in revised form: 13 May 1999     

低位直肠癌保肛术后阴道瘘治疗体会

目的探讨低位直肠癌保肛术后阴道瘘治疗预防措施。方法3例直肠阴道瘘患者行结肠造瘘术，并对一例典型病例的治疗效果进行分析。结果经过结肠造口术、阴道瘘口修补术、结肠造瘘口还纳术，3例均已治愈。结论对直肠阴道瘘患者行规范治疗，效果满意。     

外伤性颈内动脉海绵窦瘘——附三例报告

本文报告3例外伤性颈内动脉海绵窦瘘并复习文献讨论其血管造影检查和治疗问题。3例均采用经颞入路,手术暴露海绵窦,向海绵窦内插入铜丝铜针填塞。术后血管造影显示3例瘘口均闭塞,2例颈内动脉通畅,1例颈内动脉闭塞。出院时主要临床症状均消失。     

Endoscopic aspects of aortointestinal fistula

Summary The etiology, diagnostic difficulties and treatment of five cases of aortointestinal fistulas are presented. In all of them, endoscopy played a major diagnostic role. Early diagnosis is essential for elective surgery since reconstruction in the massive bleeding stage has a mortality of up to 80%.     

Congestive heart failure secondary to cerebral arterio-venous fistula

Arteriovenous fistula is a relatively rare cause of severe congestive heart failure in the newborn. An intracranial arteriovenous malformation associated with an aneurysm of the great vein of Galen is the most frequent of such malformations and, although well known, it remains a difficult diagnosis in the neonate because the clinical picture first presents with findings suggesting cardiac disease. The newborn with a vein of Galen aneurysm has volume and pressure overload on his myocardium; cyanosis is often present due to persistent fetal circulation; peripheral pulses are generally decreased in amplitude except in those arteries near the fistula where they are bounding, as an expression of a hyperdynamic status. A continuous murmur may be heard over the scalp, but this highly suggestive sign is often not present. The majority of newborns with intracranial arteriovenous fistula die very soon. Unfortunately, most of these infants are at first considered to have congenital heart disease and are, therefore, subjected to cardiac catheterization and angiography, with their well-known risks, before a correct diagnosis is made. Cross-sectional echocardiography, by demonstrating normal intracardiac anatomy, eliminates the need for an invasive investigation in a very sick neonate. Ultrasonography of the head will then provide a rapid and accurate demonstration of the aneurysm of vein of Galen. Cerebral angiography will complete the diagnosis in those cases in which a neurosurgical intervention is contemplated.     

应用Sigma覆膜支架治疗食管气管瘘22例临床分析

目的 探讨Sigma覆膜支架治疗食管气管瘘的优点和使用方法.方法 对采用Sigma支架治疗的22例食管气管痿患者的临床资料进行分析.其中,食管癌17例,食管良性病5例,病史4 d～2个月.放置1个气管支架5例,气管食管双支架15例,3个支架2例;直管形气管支架18例,钝角L形气管支架3例,Y形气管支架1例.支架置入分为介入法和内镜法两种.结果 22例成功放置41个支架,无手术死亡.除了1例良性患者迁延不愈、1年后行手术治疗,1例气管支架封堵不完全,再次放置食管支架外,其余均一次治疗成功,2～4 d后可正常经口进食.成功率91%(20/22),未完全成功率9%(2/22).结论 食管和(或)气管放置Sigma支架可有效封堵食管气管瘘,患者术后均可正常进食.此支架优点是可以回收并能有效防止继发食管气管瘘.     

Pericardium Plug in the Repair of the Corneoscleral Fistula After Ahmed Glaucoma Valve Explantation

We report four cases in which a pericardium (Tutoplast®) plug was used to repair a corneoscleral fistula after Ahmed Glaucoma Valve (AGV) explantation. In four cases in which the AGV tube had been exposed, AGV explantation was performed using a pericardium (Tutoplast®) plug to seal the defect previously occupied by the tube. After debridement of the fistula, a piece of processed pericardium (Tutoplast®), measured 1 mm in width, was plugged into the fistula and secured with two interrupted 10-0 nylon sutures. To control intraocular pressure, a new AGV was implanted elsewhere in case 1, phaco-trabeculectomy was performed concurrently in case 2, cyclophotocoagulation was performed postoperatively in case 3 and anti-glaucomatous medication was added in case 4. No complication related to the fistula developed at the latest follow-up (range: 12~26 months). The pericardium (Tutoplast®) plug seems to be an effective method in the repair of corneoscleral fistulas resulting from explantation of glaucoma drainage implants.     

Fistula advancement operation in the treatment of selected cases of persistently recurrent urethrocutaneous fistula following distal penile hypospadias repair

BACKGROUND: Hypospadias fistula may be a persistently recurrent problem in some cases. The present paper describes a urethral mobilization procedure as a new way to solve this problem. METHODS: The procedure was performed on seven children suffering from recurrent hypospadias fistula that had failed more than once to be repaired by the classic ways of closure. Selection of suitable cases should be done intra-operatively, when urethral mobilization has successfully allowed the fistula opening to easily reach the glans top. The described procedure is an extensive urethral mobilization that advances the fistula opening to the neomeatus at the glans top through a glanular tunnel. RESULTS: The operation resulted in a straight penis with the neomeatus at the glans top in all seven children, without complications, over a period of 6-18 months follow up. CONCLUSIONS: The fistula advancement operation, as it is called by the author, can, in selected cases, solve the problem of persistently recurrent hypospadias fistula with a high success rate. Thus, the author recommends that this technique is added to urologists' armamentarium.     

不同尿液引流方法的尿液检查分析及护理

目的分析应用不同尿液引流方法引起菌尿的机率。方法对①留置导尿管持续引流组30例、②留置尿管膀胱冲洗组30例、③膀胱造瘘管持续引流组30例、④膀胱造瘘管膀胱冲洗组30例的患者尿液在即时、2d、5d、7d、10d、14d进行取尿样后进行细菌培养。结果①组与②组,③组与④组相比较,无明显差异（P〉0.05）,无统计学意义（①＋②）组和（③＋④）组比较,（P〈0.05）,有显著差异,后者比前者效果明显。结论留置引流管应用膀胱冲洗法不能明显降低菌尿的发生,膀胱造瘘管比留置导尿管效果好,菌尿发生率低。合理的护理可有效降低菌尿的发生。