Objective To study the efficacy and complications of reconstruction of failed urethro-plasty for hypospadias with pedicle flap , bladder mucosa , buccal mucosa , and biological patch . Methods 23 patients were enrolled from Jul .2005 to Dec.2011.8 patients, with good local skin condition , were performed with pedicle flap urethroplasty .The other 15 patients, with bad local skin condition or with long segment urethral stricture , were performed with free grafts , including 6 bladder mucosa , 7 buccal muco-sal and 2 biological patch. Results Of the 23 cases, 7 cases were cured by one phase operation .There were 16 (16/25) cases had complications.3 (3/16) cases were failed because of serious infection (2 pedi-cle flap, 1 bladder mucosa ) .The failed cases were implemented with urethroplasty 6 months later by the buccal mucosa installments operation .4 (4/16) cases had solitary urethral fistula (1 pedicle flap, 2 bladder mucosa, and 1 buccal mucosal), who were successfully treated with simple fistula repair 3 to 6 months later. 9 ( 9/16) cases had urethral stricture ( 2 pedicle flap , 3 bladder mucosa , 3 buccal mucosal , and 1 biologi-cal patch graft ) , who were treated with urethral sound and got good result .We had reconstructed the urethra using mucosa graft onlay urethroplasty .All of the 23 patients were followed up with an average of 14.5 ( 6-24) months.23 cases were satisfied with the stretched penis , urination and no need to expand the urethra more than 6 months.3 cases were not satisfied with penile appearance .After communication, these patients did not require a further penis orthopedic surgery . Conclusions Pedicle flap, bladder mucosa , buccal mucosa and biological patch can be used in urethral repair and construction of failed urethroplasty for hypos -padias.Urethral sound dilation plays an important role in hypospadias repair .

OBJECTIVETo investigate the clinical effect of modified Koyanagi technique with coverage by tunica vaginalis of testis in severe hypospadias.

METHODS49 cases with severe hypospadias treated from Jan. 2009 to Sep. 2011 were retrospectively studied. 25 patients underwent Koyanagi technique with coverage by tunica vaginalis of testis. 24 cases underwent one-stage Duplay + Duckett technique in the same term. The patients were followed up for 7-24 months.

RESULTSAmong the 25 children treated with Koyanagi procedure, 20 cases were cured, 5 patients had postoperative complications, including urethral fistula in 3 cases,urethral stenosis in 2 cases. At the same time, in the Duplay + Duckett group, 17 cases were cured, 7 children had postoperative complications, including urethral fistula in 4 cases, and urethral stenosis in 3 cases. All the patients with urethral fistula were repaired successfully 6 months after the first surgery; The urethral stenosis were cured by dilatation within 1 to 3 months. The successful rate in the 2 groups had no significant difference(P >0.05).

CONCLUSIONSKoyanagi technique with coverage by tunica vaginalis of testis is relatively simple with similar effect as Duplay + Duckett technique for severe hypospadias.

Child ; Child, Preschool ; Humans ; Hypospadias ; surgery ; Male ; Postoperative Complications ; etiology ; therapy ; Retrospective Studies ; Surgical Flaps ; transplantation ; Testis ; surgery ; Urethral Diseases ; etiology ; therapy ; Urethral Stricture ; etiology ; therapy ; Urinary Fistula ; etiology ; surgery

Objective:To explore the differences and similarities of the neuropsychological functioning defi-cits in children between Tourette syndrome (TS)and attention-deficit/hyperactivity disorder (ADHD). Methods:Thirty boys with TS-only,36 with TS-plus-ADHD,36 with ADHD were selected from out-patient department,and 50 normal boys (NC)matched with gender,age and IQ were recruited as the controls. Patients'diagnosis was made according to the International Statistical Classification of Diseases and Related Health Problems,Tenth Revision (ICD-10). They were assessed with the Stroop Color-Word Interference Test (Stroop)and Purdue Pegboard Test (Purdue)to evaluate the response inhibition and fine-motor coordination respectively. Results:The Stroop scores were higher in children with ADHD than in other groups (P<0. 05 ),there was no difference between children with TS-only and TS-plus-ADHD (P>0. 05 ). All Purdue scores were higher in children with disease than in normal children (P<0. 05 ). Conclusion:The results indicate that the response inhibition deficit may be found in children with ADHD,but not in those with TS-only and TS-plus-ADHD. The neural compensatory mechanism may be re-sponsible for the response inhibition function in children with TS whilst the fine-motor coordination deficit was as-sociated with the disease groups.

Chronic subdural hematoma is one of the common central nervous system diseases in middle-aged and elderly people,and the incidence is increasing year by year.Drill and drain surgery is recognized as one of the effective ways to treat chronic subdural hematoma.However,there still exists a non-negligible recurrence after surgery.In addition,with the aging of the population,senior patients may have many underlying diseases.Therefore,the risk of surgery is high and some patients even have contraindications to surgery due to the long-term use of anticoagulant or antiplatelet drugs.In recent years,some progress has been made in the treatment of chronic subdural hematoma,such as oral atorvastatin can promote the absorption of chronic subdural hematoma,small-dose dexamethasone is used in the treatment of chronic subdural hematoma,neuroendoscopy-assisted treatment of segregated chronic subdural hematoma,and middle meningeal artery embolization surgery to reduce the recurrence of chronic subdural hematoma patients.Meanwhile,with the development of imaging,Computed Tomography(CT)and Magnetic Resonance Imaging(MRI)have made some progress in the diagnosis of chronic subdural hematoma.