Objective To evaluate the two-stage repair in hypospadias cripples.Methods 35 patients with hypospadias cripples underwent two-stage repair.At the first stage,a full-thickness graft of skin or buccal mucosa was used for urethral plate reconstruction after the release of chordee.The second stage was performed 6 months after completion of the first stage.Tubularization of the replaced urethral plate was the preferred technique.Results There was no urethra stricture or “preplaced urethral plate ” atrophy.Fistula developed in 2 of 35 cases.Conclusion The twostaged technique was a useful strategy to deal with the myriad abnormalities encountered in crippled hypospadias.This technique could not only create a neourethra successfully,but also give the penis a near-normal shape and appearance.

OBJECTIVETo study the long-term curative effects of suture plus proximal gastric vagotomy (PGV) and suture plus triad-therapy (omeprazole, amoxycillin and flagyl taken orally) for the treatment of duodenal ulcer with acute perforation.

METHODSThree hundred and twenty-nine patients with duodenal ulcer and acute perforation were treated with 2 different methods, respectively. Method A was suture plus PGV (group A, 153 cases), and method B was suture plus triad-therapy (group B, 176 cases). Follow-up was made by means of correspondence, outpatient reexamination and cooperation with local hospitals in 5 to 8 years after operation. The contents of follow-up included symptom acquisition (such as upper abdominal pain or distention, pyrosis, belch, acid regurgitation, vomiting, diarrhea and conditions of living or working), gastroscopy and Helicobacter pylori (HP) detection. The curative effects were evaluated by the Visick scale.

RESULTSThree hundred and one patients were followed up (group A 142 and group B 159). According to the Visick scale, 97 (68.3%), 19 (13.4%), 13 (9.15%) and 13 (9.15%) patients in group A, and 31 (19.5%), 28 (17.6%), 24 (15.1%) and 76 (47.8%) in group B were classified as Visick I, II, III and IV respectively (Z = -9.818, P < 0.01). As for HP detection, there were 130 (91.5%) patients in group A and 94 (59.1%) in group B (chi(2) = 41.438, P < 0.01).

CONCLUSIONSThe long-term curative effects of suture plus PGV were superior to those of suture plus triad-therapy for duodenal ulcer with acute perforation although HP positive rate was higher in group A than in group B. HP infection is one of the etiological factors of duodenal ulcer. The increased excitability of the vagus nerve remains to play an important role in duodenal ulcer.

Acute Disease ; Adolescent ; Adult ; Aged ; Amoxicillin ; administration & dosage ; Drug Therapy, Combination ; Duodenal Ulcer ; drug therapy ; etiology ; surgery ; Female ; Follow-Up Studies ; Humans ; Male ; Metronidazole ; administration & dosage ; Middle Aged ; Omeprazole ; administration & dosage ; Peptic Ulcer Perforation ; drug therapy ; surgery ; Suture Techniques ; Vagotomy, Proximal Gastric ; methods

Objective To explore the feasibility of applying fractional flow reserve (FFR) into the assessment of carotid stenosis, and analyze the effects from elastic modulus of vessel wall on hemodynamic parameters of carotid artery stenosis model and FFR calculation results. Methods The standard models of carotid bifurcation and stenosis models with different stenosis rates were established by computer-aided design software. Assuming that the vessel wall was linear elastic material and the blood was incompressible Newtonian fluid, the fluid-structure coupling simulation of blood flow in carotid artery stenosis model under the pulsating flow was carried out by finite element analysis, and the relevant hemodynamic parameters were obtained, and the corresponding FFR was calculated. Results When the elastic modulus was fixed, the FFR for narrow part of the model decreased gradually with the increase of the stenosis rate, and the relative difference between the FFR of elastic wall and rigid wall increased with the increase of the stenosis rate; when the stenosis rate was fixed at 70%, the FFR decreased gradually with the increase of elastic modulus. Conclusions The effect of vascular wall elasticity should be considered in the process of functional assessment on carotid stenosis with FFR; the larger stenosis rate will lead to the greater influence from elastic modulus of vessel wall on FFR.