Objective To study the clinical valne of color Doppler ultrasound for the diagnosis of primary ureteral carcinoma. Methods 15 patients with pathologically confirmed primary ureteral carcinoma by color Doppler ultrasound were retrospectively analyzed. Results 15 patients with lesions above the ureter and renal pelvis and varying degrees of expansion,water, of which 11 cases of solid mass within the probe and ureter. Color Doppler showed lesions could be detected, and dot, stripe and dendritic arterial blood flow signal, resistance index (RI) 0. 58 ～ 0. 67.Conclusion Color Doppler ultrasound screening of primary ureteral carcinoma has important diagnostic value, can increase the rate of preoperative diagnosis,and can provide reference for clinical staging.

Objective To explore the Diagnostic value of real-time three-dimensional ultrasound for urethral vaginal fistulas.Methods 5 patients with urethral vaginal fistulas were checked using real-time three-dimensional ul-trasound ,respectively by the abdomen and the sonographic appearance of pudendal observation of female urethral vagi -nal interval sagittal and transverse ,sagittal and transverse section by measuring the size of the fistula ,and voiding trial or colored liquid test injection from urethral to confirm .Results 5 cases of urethra,vagina ultrasonography can dis-play and urethral vaginal interval throughout the sagittal plane and different levels of cross section ,urethral vaginal in-terval by low echo-band-low echo constitute the sandwichsign in the fistula showed partial loss ,local band echo in-terruption,urethral and vaginal local fusion ,voiding trial or from the urethra into the colored liquid test further con-firmed the fistula,fistula and verify the existence of fistula after the operation the size .Conclusion Real time three-dimensional echocardiography by urethral vaginal interval in the axial and sagittal plane ultrasound at different levels , combining with the history and voiding trial or injected with colored liquid test from the urethra ,can provide a new i-dea for diagnosis of urethral vaginal fistula .

Objective To improve the diagnosis and treatment of ureteral cancer. Methods A retrospective analysis of 24 cases of primary ureteral cancer treated from January 1990 to March 2005 was performed.The diagnostic value of ultrasound,IVU,CT,MRU and the patients' outcomes were reviewed. There were 19 males and 5 females aged 38-72 years(mean,59 years).The tumors were on the left side in 16 cases and on the right in 8.Of the 24 cases,17(71%)had gross hematuria and 7(29%)had micro- scopic hematuria.Urine cytology was performed in 16 cases with a positive rate of 6.3%.B-ultrasonic exami- nation showed hydronephrosis in 19 cases(79%)and low-echo space-occupying disease of middle-inferior ureter in 3(12%).IVU demonstrated hydronephrosis in 20 cases(83%)and filling defect of the diseased ureter in 3(12%).Retrograde pyelography showed filling defect of the diseased ureter in 16(76%)of 21 cases(5 cases had failure of intubation).CT scan was performed in 20 cases,indicating thickening of the ureteral wall and infiltration of the cancer in 14(70%).In 3 cases who had undergone spiral CT thin layer scan and 1 of 3 cases who had undergone MRU,the definite diagnosis was made.Results All the 24 pa- tients underwent surgical treatment.Among them,nephroureterectomy and bladder cuff or partial resection were performed in 18 cases,and nephrectomy and partial ureterectomy in 6 cases.Postoperative pathology showed transitional cell carcinoma in 23 cases,and adenoma in 1.Of the 14 cases during 1990-1999 peri- od,1,5,3,2,2 and 1 cases had survival time of 1,2,3,4,5 and 6 years,respectively.Of the 10 cases during 2000-2005 period,3 were lost to follow-up;2 survived for 3 years and 2,for 1 year;the other 3 who have survived near 5 years have been followed till now.Conclusions IVU and retrograde urography are the most common diagnostic measures for primary ureteral cancer.They can be used in combination with other imaging study to reduce missed diagnosis rate.The 5-year survival rate was lower because of late pathologic stage of the tumors in the patients of this series.

Objective To evaluate the choice of early diagnosis method of primary ureteral neoplasms in or-der to improve the ratio of clinical diagnosis. Methods 28 cases with primary ureteral neoplasms were retrospectively analyzed. Ultrasonic examination, IVU, retrograde urogram, spiral CT, MRI, ureteroscopy and exfoliative cell examina-tion of urine were compared in this study. Results The most useful methods of detecting tumors preoperation were retrograde urogram, spiral CT, MRI, ureteroseopy. All the 28 patients underwent surgical treatment. Among them, nephroureterectomy and bladder cuff or partial resection were performed in 19 cases. Postoperative pathology showed transitional cell carcinoma in 27 cases,and adenoma in 1 case. 8 cases were T1-2 tumours. Of the 14 cases during 1990 ～1999 period, 1,5,3,2,2 and 1 cases had survival time of 1,2,3,4,5 and 6 years ,respectively. Of the 14 cases during 2000～2007,4 were lost to follow-up;2 survived for 3 years and 2 for 1 year;the other 6 who have survived near 5 years have been followed till now. Conclusions To improve the early diagnosis rate,B-ultrasonic examination, IVU,retrograde urogram,3D spiral CT and MRI examination were necessary in the early stage. The patients should be opeiated as early as possible after diagnosis.

Objective: To investigate the clinical effect of modified three minimally invasive blepharoplasty of double-fixation method. Methods: From April 2015 to December 2016, 82 patients were included, all received minimally invasive blepharoplasty. Three 3 mm-long small incision (at medial, middle and lateral) were designed, then part of the orbicularis oculi muscle and pretarsal fat were removed. Pretarsal fascia was then sutured with orbicularis oculi muscle and skin with two-layer-suture to form double eyelid respectively. Results: With up to 18 months follow-up, all patients had short period of detumescence within 7-12 days, high satisfaction rate with long lasting and natural double eyelid shape were achieved, no obvious scarring was noted. Conclusions Modified three minimally invasive blepharoplasty of double-fixation method has presented the merits of accurate presentation, natural shape, quicker recovery and less trauma, which makes it worthy of clinical presentation.

The concept of depressor orbicularis lateralis arises through anatomy of brow ptosis and innovations of its correction. This vertical muscle band is usually found running inferiorly from the lateral brow down along the lateral orbital rim, adjacent to the orbicularis oculi. The muscle segment is a powerful depressor of the brow and may lead to recurrent lateral eyebrow ptosis, if it is not addressed at the time of the facelift. In this review, the anatomical evidence, basic functions of depressor orbicularis lateralis, as well as its clinical relevance and the proper measures in handling this structure as part of brow ptosis and crow′s feet surgery will be discussed.

Objective:To discuss a surgical method that reduces the notch tension and assists in suspending and lifting the skin after reposition so as to relieve scar and to prevent alopecia and maintain long-term lifting effect.Methods:After forehead or temporal open incision rhytidectomy, 2-0 absorbable sutures were used to pass through the intradermal at the hairline and skin junction in front of the incision. After that, the sewing needle passed through the whole skin flap vertically from the two points of the suture inlet and outlet, and then sutured on the deep temporal fascia or galea aponeurotica, in order to reduce tension of the main anchor point of the incision and to assist suspending the elevated flap. Afterwards, the width of the skin excision was determined according to the skin relaxation, the subcutaneous relaxation suture of scalp incision was conducted and the incision closed with nailing device.Results:From June 2016 to October 2018, this method was applied in 33 cases of rhytidectomy. In the early postoperative period, the skin around the hairline had a slight appearance of accumulation due to the traction of sutures, which gradually disappeared with time. During the long-term follow-up, 2 patients had hair loss near the incision, and the hair density decreased. The remaining patients had no obvious scar hyperplasia and alopecia, and no long-term skin accumulation. The facial rejuvenation effect was good, and the satisfactory rate of patients was high.Conclusions:The technique of intradermal tension reduction combined with suspension suture redistributes the tension and significantly reduces the scar hyperplasia and baldness at the incision. Meanwhile, the suture also plays the role of accessory suspension, which helps to increase the stability and durability of facial tissue; the whole procedure is simple, safe, and long lasting.

Facial rhytidectomy is one of the most complex and unpredictable procedures in the field of cosmetic and plastic surgery, aiming to rejuvenate the face. The facial rejuvenation surgery began in the early 20th century. The purpose of the surgery is to alleviate the aging characteristics of the skin, fascia, fat and other tissues of the face and neck by surgical means. In China, due to historical development and other factors, it started late. From the late 1980s to the early 1990s, Song Yeguang and other pioneers took the lead in venturing into this field. With the significant growth of the economy and the increasing attention from both medical professionals and marketing to cosmetic surgery, surgeons in this era have made substantial contributions to the systematic and standardized advancement of rhytidectomy surgery. However, with the understanding of the aging process of the face and the in-depth study of the changes in the anatomy and tissue structure of the face and neck, surgical techniques have evolved from simple to complex, and gradually improving over time. Through long-term observation of the surgical outcomes, the surgical technique has evolved from complex to simple. The purpose of this paper is to summarize the evolution of rhytidectomy in China by reviewing the literature from previous years.

Objective:To investigate the clinical effect of middle and lower facial rhytidectomy by lifting the prolapsed buccal fat pad using a consecutive suspensions in a dragnet fashion.Methods:from December 2016 to October 2019, 42 female patients aged 46 to 65 with aging faces and prolapsed buccal fat pads were treated with multiple suspension method. The incision was the classic temporal to peri-auricular incions. After the skin flap and superficial musculoaponeurotic system(SMAS) flap was elevated. The suspending stitches were arranged with 5 lines from the lateral edge of orbicularis oris muscle to the level of zygomatic process to lift the sagging buccal fat pad and achieve facial rejuvenation. The short and long term complicationsas well as post-operative satisfaction rate were also investigated.Results:After 9-12 months of follow-up, the facial aging characteristics were significantly improved, especially sagging mandibular bag and loose perioral skin. The volume of middle face was restored with natural contour. Post-operative complications included local facial depression (2 patients), slight asymmetry (1 patient) and mild tactile abnormalities (1 patient). Satisfaction survey showed that 28 patients were very satisfied, 12 were satisfied and 2 were dissatisfied. The subjective satisfaction rate was 95.2% (40/42). There were no serious complications such as facial nerve injury or flap necrosis.Conclusions:This technique has a good outcome combined with conventional rhytidectomy, as it can achieve good effect of rejuvenationin the middle and lower face.

Objective:To introduce the clinical experiences in multilevel suspension rhytidectomy with limited dissection of the immobile zone in superficial musculoaponeurotic system(SMAS).Methods:From January 2014 to December 2019, at total of 110(1 male and 109 females, 46-72 years old)cases of facial rhytidectomy were performed in our institution. During the operation, the area of skin flap elevation is similar to the classic rhytidectomy. SMAS layer dissection is contained within the immobile area.Dynamic evaluation was conducted every 1 cm of SMAS flap elevation, by gently pulling the SMAS flap.The change of depth of the nasolabial fold, the change of lips elevation were the parameters for which the degree of dissection is determined.The subjective satisfaction and overall improvement were investigated and the complications were recorded.Results:All 110 patients were followed up for 6-30 months, with an average of 12 months. The subjective satisfaction rate was 94.5%(104/110). Among them , 61 cases rated "very satisfied" , 43 cases were "satisfied" , 2 cases were "acceptable" and 4 cases were "unsatisfactory" . All patients had significant improvement on brow sagging, nasolabial fold, mouth sagging, and skin texture. The early postoperative complications were local hematoma in 4 cases (3.6%). The long-term complications included 3 cases (2.7%) of periauricular scar hyperplasia , 2 cases (1.8%) of earlobe displacement and 1 case (0.9%) of hair loss at temporal incision (0.9%).Conclusions:Limited dissection of the immobile zone in SMAS flap has no significantly negative impact on the overal outcomes. By such contained surgical dissection, facial rejuvenation can be achieved, and the risks of complications were reduced.