Robotic Trans‐Abdominal Transplant Nephrectomy for a Failed Renal Allograft

Minimally invasive surgery for removal of a failed renal allograft has not previously been reported. Herein, we report the first robotic trans‐abdominal transplant nephrectomy (TN). A 34‐year‐old male with Alport's syndrome lost function of his deceased donor allograft after 12 years and presented with fever, pain over his allograft and hematuria. The operation was performed intra‐abdominally using the Da Vinci Robotic Surgical System with four trocars. The total operative time was 235 min and the estimated blood loss was less than 25 cm³. There were no peri‐operative complications observed and the patient was discharged to home less than 24 h postoperatively. The utilization of robotic technology facilitated the successful performance of a minimally invasive, trans‐abdominal TN.     

Serology and ultrasound for diagnosis of choledocholithiasis

Introduction

Magnetic resonance cholangiopancreatography (MRCP) is not a routine investigation to exclude choledocholithiasis unless there is clinical or biochemical suspicion of common bile duct (CBD) stones. This study attempted to determine which radiological or serological parameters best predicted CBD stones.

Methods

All patients undergoing MRCP from 2005 to 2011 were selected. Patients with pancreatitis were excluded. Liver function tests (LFTs) at admission and prior to MRCP were recorded, as was abdominal ultrasonography and MRCP results. Parameters measured routinely on LFTs included alkaline phosphatase (ALP), alanine transaminase (ALT) and bilirubin. Receiver operating characteristic curve area analysis (area under the curve [AUC]) and chi-squared analysis were undertaken.

Results

Overall, 195 patients were identified, 71 of whom had CBD stones on MRCP. Raised ALP levels on admission demonstrated a correlation with CBD stones (AUC: 0.619, odds ratio [OR]: 3.16, p=0.06). At ultrasonography, a dilated CBD (OR: 3.76, p<0.001) and intrahepatic duct dilation (OR: 5.56, p<0.001) were highly significant predictors. However, only 37% of patients had a dilated CBD on ultrasonography. Ongoing elevation of LFT parameters, particularly ALP (AUC: 0.707, OR: 4.64, p<0.001) and ALT (AUC: 0.646, OR: 5.40, p<0.001), displayed a significant correlation with CBD stones.

Conclusions

Ongoing (even if minor) elevations of liver function test parameters should prompt the need to exclude CBD stones even in the presence of a normal CBD diameter on ultrasonography.     

Changes in motor function in the unaffected hand ol stroke patients should not be ignored

Motor function changes in the unaffected hand of stroke patients with hemiplegia. These changes are often ignored by clinicians owing to the extent of motor disability of the affected hand. Finger tapping frequency and Lind-mark hand function score showed that the motor function of unaffected hands in stroke patients was poorer than that of a healthy control hand. After 2 weeks of rehabilitation treatment, motor function of the unaffected hand of stroke patients was obviously improved. Therefore, attention should also be paid to motor function in the unaffected hand of stroke patients with hemiplegia during rehabilitation.     

手术病人麻醉后恢复的特点

分析１９９５年８月至１９９６年１１月麻醉恢复室接收４３３例病人的情况，以期了解手术后麻醉恢复期护理的特点。其中男性４０．６％，女性５９．４％，平均年龄５４．１±１４．７岁（６～８２岁），平均停留时间４４ｍｉｎ（５～２６５ｍｉｎ），９８．８％的病人平稳恢复后送回病房，１．２％的病人转入ＳＩＣＵ。实施麻醉方法除６例为连续硬膜外麻醉或腰麻外，余为全麻或强化麻醉。根据Ｒａｍｓａｙ评分法，入室时９５％以上病人５～６分，出室时９２％的病人是４分以下，所有病人血压、心率无显著变化，没有给予任何血管活性药物。入室时６３．３％的病人自主呼吸已经恢复。由于麻醉药和肌肉松弛药对中枢和呼吸肌的残留抑制作用，术后早期病人最易出现缺氧。因此全麻术后必须认真监测病人呼吸功能恢复情况，提高吸入氧浓度，根据病情需要保留气管导管，或短时间的机械通气，提高吸入氧浓度，以保证病人呼吸道通畅，避免ＣＯ２的潴留，特别是缺氧的发生。从观察病例可以看出，全麻术后未能立即清醒，平均约４５ｍｉｎ后意识方能满意恢复。     

The effect of training in an interactive dynamic stander on ankle dorsiflexion and gross motor function in children with cerebral palsy

Objective: To study the effect of active stretching of ankle plantarflexors using an interactive dynamic stander in children with cerebral palsy (CP).

Methods: Six children in Gross Motor Function Classification System classes I–III, aged 4–10 years, trained intensive active dorsiflexion in an interactive dynamic stander using ankle movement to play custom computer games following a 10-week control period. Gross Motor Function Measure Item Set, gait performance and passive and active dorsiflexion with extended and flexed knee were chosen as outcome parameters.

Results: Median active and passive ankle dorsiflexion increased significantly (5 and 10 degrees, respectively) with extended knee. There was a small but clinically significant increase in gross motor function. The intervention had no effect on temporospatial gait parameters.

Conclusion: In spite of the low number of participants, these results may indicate that intensive active stretching in an interactive dynamic stander could be an effective new conservative clinical treatment of ankle plantarflexor contracture in children with CP.     

Circumcision during the phallic period: does it affect the psychosexual functions in adulthood?

The aim of this study was to elucidate whether circumcision during the phallic period (3‐to 6‐year old) has a negative impact on psychosexual functions in adulthood. Over a 6‐month period, healthy and sexually active men between 30 and 40 years without any comorbidities were involved. Participants were evaluated with detailed history, physical examination, International Index of Erectile Function (IIEF), Premature Ejaculation Diagnostic Tool (PEDT) and Beck Depression Inventory. Cases were divided into two groups according to the age at circumcision (group‐1: phallic period, group‐2: nonphallic period). Student's t‐test and Kruskall–Wallis were used for statistical analysis. Of the 321 participants, a total of 302 men were eligible for the study (group‐1: n = 135, group‐2: n = 167). No statistical difference was found between the mean total IIEF scores (group‐1: 25.1 ± 4.8, group‐2: 25.4 ± 4.6, P > 0.05). The subdomains of IIEF; erectile function, orgasm, sexual desire, intercourse satisfaction, overall satisfaction were also found to be comparable. Additionally, the PEDT scores were similar between the two groups (group‐1: 8.2 ± 4.8, group‐2: 8.7 ± 5.4, P > 0.05). Finally, Beck depression scores were also found to be comparable between the groups (group‐1: 10.8 ± 10.4, group‐2: 9.8 ± 8.9, P > 0.05). Our results suggest that circumcision during the phallic period does not negatively affect the psychosexual functions in adulthood.     

成人分泌性中耳炎预后相关因素及临床疗效研究

目的分析成人分泌性中耳炎(OME)临床因素与预后的关系,找出影响成人OME治疗疗效的相关因素。方法收集291例(342耳)成人OME患者的基本资料,了解患者30 d内上呼吸道感染史、变应性疾病史、鼻及鼻窦疾病病史,评估患者咽鼓管功能。统计各临床因素与治疗有效率的相关性。比较上呼吸道感染是否合并咽鼓管功能不良与鼻及鼻窦疾病病史是否合并咽鼓管功能不良疗效的差异。结果①单因素分析显示,患者的性别(P=0.974)、单双侧发病情况(P=0.296)差异无统计学意义,与疾病疗效无明显相关性。而上呼吸道感染病史(P=0.049)与患者的疗效及预后呈正相关;鼻及鼻窦疾病病史(P=0.005)、咽鼓管功能状况(P=0.001)与患者的疗效及预后呈负相关,差异均有统计学意义。②多因素分析显示,上呼吸道感染病史(P=0.019,RR=1.692)、鼻及鼻窦疾病病史(P<0.001,RR=0.392)、咽鼓管功能不良(P<0.001,RR=0.248)仍与患者治疗疗效及预后相关。③鼻-鼻窦疾病病史合并咽鼓管功能不良治疗有效率明显降低(与鼻及鼻窦疾病病史且咽鼓管功能正常、上呼吸道感染合并或不合并咽鼓管功能不良相比,差异有统计学意义;慢性中耳炎发生率及鼓膜置管率明显升高,差异有统计学意义)。结论成人OME的危险因素为上呼吸道感染、鼻-鼻窦疾病、咽鼓管功能不良。鼻-鼻窦疾病合并咽鼓管功能不良是成人OME保守治疗效果欠佳的重要因素。