Pedicle patch urethroplasty

The pedicle patch urethroplasty provides an alternative single-stage vascularised graft procedure for the repair of moderately severe hypospadias. Over a 7-year period, 38 primary hypospadias repairs were performed employing this technique. The fistula rate was 18% in the 34 patients reviewed, but there were few other significant complications. The operation is recommended when the urethral plate can be preserved and the penis straightened in boys who are unsuitable for a meatal-based flap.     

Persistent or recurrent acromegaly. Long-term endocrinologic efficacy and neurologic safety of postsurgical radiation therapy.

As in other clinics, pituitary surgery was definitive treatment in less than 50% of cases of acromegaly treated at one institution over several decades. From 1965 to 1989, 24 acromegalic patients who had noncurative pituitary surgery received radiation therapy at the National Institutes of Health, with a basal human growth hormone level of greater than 5 ng/ml as the criterion for active disease. Using megavoltage irradiation, more than 60% of these patients stabilized at a normal hormonal range, and the overwhelming majority had decreasing growth hormone levels with time. No major side effects of irradiation were encountered except panhypopituitarism of varying degrees. The authors evolved a policy of surgery as the first option, followed by irradiation for patients with postoperative growth hormone levels more than 5 ng/ml.     

Bipolar affective disorder. II. EEG, neuropsychological, and clinical correlates of CT abnormality

Since the clinical significance of CT abnormalities found in bipolar patients remains obscure, we studied 26 DSM-III bipolar patients who had specific CT abnormalities (third ventricle enlargement, and hyperdensity of the caudate, thalamus, anterior frontal white matter, and right temporal lobe) on numerous parameters such as EEG, the Halstead-Reitan Neuropsychological Battery, premorbid personality adjustment, family history of affective disorder, positive and negative symptoms, employment history, and response to lithium carbonate treatment. None of these measures could differentiate between the CT abnormal and CT normal subgroups. The implications of these findings are discussed.     

UROLITHIASIS IN AUSTRALIAN ABORIGINAL CHILDREN

Thirty-six Australian Aboriginal children with urolithiasis were reviewed. Males dominated the series. The age distribution ranged from 8 months to 12 years and nearly 70% were 2 years or younger. Thirty-five patients had upper tract stones. Ultrasound was diagnostic in 35 patients and was falsely negative in one. Dietary factors, dehydration and recurrent diarrhoea are incriminated in the aetiology, because ammonium urate and oxalate were the main constituents of the stones. Malformations of the urinary tract were rare and known metabolic disorders were not seen. Chemical dissolution of the stones was found to be a safe and effective adjuvant in the management of urate stones.     

健康教育项目设计PRECEDE诊断评价模式

美国著名健康教育专家Lawrence W.Green 提出的健康教育项目设计PRECEDE 诊断评价模式,站在社会健康的宏观高度,全面规划健康教育内容、方式与作用环节,并从项目设计开始就将监测评价纳入项目内容。由于设计思维的缜密与方法的科学性,保证了健康教育项目能够紧紧抓住重点健康问题,做到有的放矢。因此,在模式的引进和使用过程中,应结合我国妇幼卫生的现状和当地的实际情况,设计出适合我国国情的妇幼卫生健康教育项目规划,为发展我国妇幼卫生事业服务。     

DRFS装置治疗腰椎滑脱症

目的 探讨一种新型脊柱滑脱复位固定装置的临床疗效。方法 对29例腰椎滑脱症患者采用DRFS装置复位固定并脊柱融合术。结果 29例治疗患者获得7～30月随访，平均复位率及脊柱融合率均达100％。结论 DRFS治疗脊柱滑脱复位满意、固定可靠、融合率高，是治疗腰椎滑脱较理想的方法。     

Serotonin-depleting midbrain lesions fail to mitigate hyperphagia and obesity in the Zucker fatty rat

Previous research has shown that damage to the dorsal and median raphe nuclei of rats can impede the subsequent development of hypothalamic hyperphagia and obesity as well as impair the defense of established hypothalamic obesity in response to food deprivation. The present study sought to determine if raphe injury might alter the development of another form of obesity, namely that which occurs spontaneously in the Zucker fatty rat. Subjects were 20 obese females (fafa; mean weight of 200 g) and 20 lean littermate controls (FaFa females; mean weight of 150 g). Following 10 days of baseline intake and weight recordings, half of each group received radio-frequency heat lesions of the dorsal and median raphe nuclei while the other half received sham surgery. Except for a mild suppression of food intake and weight gain during the first few days after lesioning, raphe injury did not alter the hyperphagia or obesity shown by fatties over the 7 week ad lib feeding period studied. Additional 24-hr intake tests of varying sucrose and quinine solutions revealed reduced sucrose acceptance and enhanced quinine rejection by fatties much as has been seen in previous studies of hypothalamic obese rats. Terminal assays of forebrain monoamine levels confirmed that raphe lesions were effective in depleting serotonin (-71% compared to controls) without producing major changes in norepinephrine or dopamine (-14% and +2%, respectively). The inability of raphe lesions to mitigate this form of hyperphagia and obesity suggests that earlier observations of their attenuating effects on hypothalamic obesity were not due to non-specific impairments of behavioral or metabolic factors necessary to permit overeating and weight gain.     

Endoscopic reappraisal of the morphology of congenital obstruction of the posterior urethra.

Congenital obstruction of the posterior urethra was first systematically classified by Young in 1919. Since then, no-one has seriously challenged the presence of both Type I and Type III "valves", although the presence of Type II lesions has often been disputed. A review of Young's papers and more recent anatomical studies, together with endoscopic findings in our own patients, indicates that most congenital posterior urethral obstructions are anatomically similar. Consequently, Young's classification now seems redundant.