Objective To explore the indication,technique and complications of Snodgrass operation in hypospadias repairment.Methods From Sep.2005 to Nov.2006,22 boys from 2 to 18 years old with hypospadias were treated with Snodgrass modification.The procedure was performed in 16 patients as a primary repairment and in 6 patients as the 2-stage repairment.The entire length of the urethral plate was incised along the midline in primary repairment,and the skin flaps and residual urethral plate were incised in the 2-stage repairment.The length of neourethra was from 1 to 10 cm.The neourethra was tubularized over a F 6 or F 8 catheter.The urethral stent was removed in 10 to 14 days pos-toperatively.Results Of the 22 patients,18(81.8%) required no other surgery as the repairment provided a normal appearing penis(straight,terminal meatus, cosmetics) without complications.Fistul aoccurred in 4 patients(18.2%) and meatal stenosis in 1 patient.Conclusion Snodgrass operation creates a vertical slit-like neomeatus.The procedures restores good function and normal appearance to the penis.

Objective To explore influence of thoracic duct ligation on lipid metabolism after esophagectomy. Methods Seventy-four patients with esophageal cancer received esophagectomy were divided into two groups by their thoracic duct ligation, 39 in ligation group and 35 in non-ligation group. All the patients were fed with nutrients through nasal-duodenal tube placed during operation from the 1 st day to the 8th day after surgery, and started taking liquid diet on the 6th day. Blood specimens were collected from the patients on the 1st day after admission, the 9th day, one month and three months after surgery,respectively for biochemical analysis,including determinations of total cholesterol(TC),triglyeeride(TG),high-density lipoprotein-cholesterol ( HDL-C) and low-density lipoprotein-cholesterol ( LDL-C) . Databetween the two groups were compared with statistical analysis. Results No significant difference in plasma levels of TC, TG and HDI.-C was found between the two groups at varied time points. Plasma level of LDL-C in the ligation group significantly decreased on the 9th day after surgery, as compared with that in the nonligation group ( P ＜ 0. 05), and went down to the lowest level one month after surgery. Conclusions Chylomicron was blocked to enter blood stream and production of LDL-C decreased by thoracic duct ligation,which affect lipid absorption and metabolism leading to poor early nutrition in patients with esophagealsurgery due to slower establishment of collateral circulation.

Objective To analyze the correlationship of ACE I/D gene polymerphisms with the anti-hypertensive efficacy of irbesartan among essential hypertension (EH) patients in Yunnan han people.Methods One hundred EH patients hypertension were treated with irbesartan 150mg once daily for 4 weeks,and anti-hypertensive efficacy were monitored during the treatment.Results There was a significant difference between anti-hypertensive efficacy of irbesartan among different genotype groups,DD group ＞ID group ＞Ⅱ group (P ＜ 0.05) Conclusions There is different therapy responsiveness in diffenent genotypes.ACE I/D polymorphism may be an important hereditary factor that impacts the efficacy of irbesartan.

Objective To evaluate the effecof bilateral ovariectomy combined with hormone injection on the bone mineral density and biomechanical property of sheep proximal femu.Method16 healthy adulsheep were divided into the sham operation group (n=8) and the experimengroup (n=8) randomly .Bilateral ovariewere only exposed in the sham operation group .The ex-perimengroup waperformed bilateral ovariectomy (OVX) and began to conducthe intramusculainjection of methylprednisolone (0 .45 mg · kg -1 · d-1 ) aftepostoperative 1 month fo10 month.The bone density (BD) of all sheep proximal femuwameas-ured before OVX and in postoperative 1 yea.The compression tesand the axial pullouteswere performed to evaluate biome-chanical property of postoperative 1 yeaproximal femu.ResultBD of proximal femubefore surgery had no statistically signifi-candifference between the two group,and which in the sham operation group had no statistically significandifference between before and aftesurgery (P＞0 .05) .BD of proximal femuin postoperative 1 yeain the experimengroup wasignificantly de-creased and significantly lowethan thain the sham operation group (P＜0 .05) .The maximal compression stresand the energy absorption value in the experimengroup were significantly lowethan those in the sham operation group with statistically signifi-candifferences(P＜0 .05);the maximal axial pulling force and the energy absorption value in the experimengroup were signifi-cantly lowethan those in the sham operation group with statistically significandifference (P>0 .05) .Conclusion The method of bilateral ovariectomy combined with hormone injection can significantly decrease BD and biomechanical intensity of sheep proximal femu.

Objective To analyze the characteristics of bone scintigraphy in 117 cases with primary hyperparathyroidism (PHPT).Methods Of these 117 cases (50 males and 67 females),there were 116 parathyroid adenomas and 1 parathyroid cancer.Mean age was 61.1(12-86) years old.All had ~(99)Tc~m-methylene diphosphonate (MDP) bone scintigraphy.The bone images could be classified into 4 categories.Category Ⅰ:normal;category Ⅱ:localized abnormal,which could be subcategorized as Ⅱ A with skull and mandible involvement,and Ⅱ B with Ⅱ A characteristics plus metabolic derangement;category Ⅲ:systemic,whole-body incmased tracer uptake;category Ⅳ:systemic plus localized metabolic derangement.Data were analyzed statistically with X~2 and t-test (isolated samples).Results According to the scintigraphic findings,there were 47 cases(40.17%)of category Ⅰ,35 cases(29.91%) category Ⅱ (21/35cases Ⅱ A and 14/35 cases Ⅱ B),30 cases (25.64%) category Ⅲ,and 5 cases (4.27%) category Ⅳ.Combining categories Ⅱ、Ⅲ and Ⅳ together,there were 70 abnormal cases.These patients had history of abnormal bone images such as bone fracture (39 cases,55.71%),calculus (8 cases,11.43%),bone fracture plus calculus(7 cases,10.00%),osteoporosis (51 cases,72.86%) or ostalgia(26 cases,37.14%);however,in the 47 cases of category Ⅰ,only 1 (2.13%),0,0,10(21.28%)and 10 cases (21.28%),respectively,were found.Therefore.these case history characteristics were statistically significant (X~2=11.152,P=0.01).The tumor size,parathyroid hormone (PTH),blood calcium,blood phosphorus in the patients of abnormal PHPT categories Ⅱ to Ⅲ were(14.52±13.72)cm~3,(731.67±618.40)ng/L,(3.05±0.29) mmol/L and (0.71±0.14) mmol/L,respectively.with statistically significant difference compared to category Ⅰ:(0.78±1.33) cm~3,(112.04±62.98)ng/L,(2.56±0.42) mmol/L and (1.03±0.36)mmol/L(t=-5.724,-5.741,-7.274 and -6.451;all P＜0.01).Conclusions (1)Bone scintigraphy was normal in 40% of PHPT patients.(2)The bone images of PHPT could be classified into 4 categories and each could reflect the duration and severity of the disease status on bone.(3)The bone imaging characteristic could be useful for differential diagnostic purposes.

Objective To assess the feasibility and clinical efficiency of laparoscopic Madigan enucleation of the prostate for the treatment of benign prostatic hyperplasia (BPH) with large prostate.Methods From Nov.2008 to Jan.2010,24 eases of BPH patients with large prostate ( ＞90 g) were treated in our institute by laparoscopic Madigan enucleation.The average patient's age was 65.2 yrs,the average prostate weight were 132.3 ± 21.9 g,preoperative residual urine was 143.2 ± 23.2 ml,average IPSS was 28.6 ± 3.8,average QOL was 5.5 ± 2.4 and average MFR was 5.4 ± 2.3 ml/s.All patients accepted the laparoscopic Madigan enucleation of the prostate.The pre-surgery and three months post-operative IPSS,QOL,and MFR were compared and analyzed.Results All 24 patients successfully completed the surgery.The resected prostate tissue weight was 104.7 ± 23.3 g,blood loss was 112.5 ± 47.8 ml,postoperative hospital stay was 3.5 ± 0.8 d,bladder irrigation time was 1.3 ± 0.9 d,drainage time was 2.3 ± 0.5 d and catheterization time was 3.1 ±0.4 d.Three months after surgery,patient's IPSS was 4.5 ± 1.8,QOL was 19.9 ±3.1,and MFR was 18.5 ±2.9 ml/s.All the parameters significantly improved compared with the pre-surgery data ( P ＜ 0.05 ).Conclusions Laparoscopic Madigan enucleation of the prostate is a safe and effective method in the treatment of BPH with large prostate volume.

Objective To investigate the clinical features,diagnosis and treatment of prostate sarcoma. Methods19 cases of prostate sarcoma had been treated in our hospital from Oct 1995 to Sep 2010,aged from 16 to 48 years (mean,36 years).They were hospitalized due to different degrees of difficulty in urination,6 cases with bladder irritation,3 cases with gross hematuria,3 cases with blood clots in urination,3 cases with difficult defecation,2 cases with urinary tract infection,and 1 case with low back pain.Digital rectal examination showed prostate volume increased significantly in 16 cases,of which 6 cases prominent into bladder,and 3 cases touched hard nodules and tenderness.B ultrasound examination showed prostate neoplasms with internal echo uneven.Pelvic MRI in 12 cases indicated irregular soft tissue density in prostate with unclear edge,a high-low mixed signal inside,and mass protruding outward,among which 7 cases with significantly enlarged prostates and unclear bladder boundaries,6 cases with unclear boundaries with rectum,and 1 case with solid and cystic change. Pelvic CT in 10 cases showed irregular prostate tumors,among which 5 cases with tumor violation of bilateral seminal vesicle,2 cases with tumor invasion of unilateral seminal vesicle,and 3 cases with lymph node enlargement.Chest X-ray in 2 cases showed widespread metastatic lung. Results Different treatments were used according to different conditions:6 cases with full cystoprostatectomy,8 cases with radical prostatectomy,1 case with skin routine ureter fistulization and rectal fistulization,1 case with bladder fistulization,1 case with chemotherapy after prostate biopsy,and 2 cases with prostate biopsy alone. Pathological diagnosis showed 6 cases of leiomyosarcoma,6 cases of rhabdomyosarcoma,2 cases of malignant mesenchymal tumor,1 case of phyllodes sarcoma,1 case of granulocytic sarcoma,1 case of phyllodes sarcoma,1 case of malignant fibrous tissue sarcoma,and 1 case of poorly differentiated muscle induced sarcoma. Immunohistochemical examination in 19 cases of paraffin specimens stained with SP showed vimentin was positive,smooth muscle actin and myoglobin in leiomyosarcoma and rhabdomyosarcoma were positive respectively,and desmin in two kinds of afore-mentioned sarcoma expressed in different level.CD117 and S-100 were weakly positive in 1 patient with undifferentiated component and 1 patient with liposarcoma of the malignant mesenchymoma.Peroxidase was positive in granulocytic sarcoma,p63 was positive in lobulated sarcoma,and CD34 was positive in malignant fibrous histiocytoma.14 patients were given chemotherapy,among which 6 cases were combined with radiotherapy.19 cases were followed up for 4 -30 months (mean 13 months).4 patients survived for 24 -30 months without recurrence,while 15 cases died within 18 months after diagnosis. Conclusions The prostate sarcoma is a clinically rare malignant tumor with high degree of malignancy and unspecific clinical manifestations.The diagnosis relies on biopsy and immunohistochemistry,and early diagnosis and radical surgical excision are helpful for increasing survival rate.

Objective To investigate the feasibility and role of single-dose three-dimensional dynamic contrast-enhanced magnetic resonance angiography(SD 3D DCEMRA)in evaluating soft-tissue hemangioma of limbs.Methods The transit time(TT),signal intensity of peak enhancement(SPE)and duration of peak enhancement(DPE)of the femoral,popliteal and anterior tibial arteries at the level of the middle section were assessed in 30 healthy volunteers after intravenous bolus injection of single-dose contrast media at the rate of 3 ml/s.Forty-five patients with soft-tissue hemangioma and 9 patients with schwannoma of the extremities underwent both conventional MRI and SD 3D DCEMRA.The acquisition time of SD 3D DCEMRA ranged from 10 to 12 s,and early arterial,late arterial and venous phases of SD 3D DCEMRA images were acquired consecutively.The conventional MRI and SD 3D DCEMRA findings of the 45 patients with hemangioma were observed and compared with those of the 9 cases of sehwannoma.Results(1)The TT,SPE and DPE of the femoral,poplitcal and anterior tibial arteries were(15?5)s,(400?50),(11.9? 2.6)s;(19?7)s,(320?45),(16.8?3.6)s and(27?10)s,(270?39),(22.0?6.6)s respectively. The comparison of TT(F=6.91,P0.01).The tumoral feeding artery was visualized in all cases(100%).(3)Two cases of hemangioma missed on conventional MRI were correctly diagnosed on SD 3D DCEMRA owing to the visualization of both the tumoral mass and the feeding artery.(4)For schwannoma,neither the dynamic visualization of tumoral mass nor the feeding artery was demonstrated on SD 3D DCEMRA.Conclusion SD 3D DCEMRA is technically feasible to evaluate the limb soft-tissue hemangioma.Dynamic visualization of tumoral mass and demonstration of the tumoral feeding artery are the characteristic features of the tumor on SD 3D DCEMRA.

Objective Clutching internal fixtor(CIF)loose and the fixed part weakly heal up are often found in orthopedic clinic.In the present paper,biomechanics methods were used to try to explain and analyze these issues,providing a helpful suggestion for the application of CIF in clinic.Method Commerical finite element models(FEM)Program ANSYS was applied to set up the finite element models of orthopedic CIF and bone tissue to analyze and evaluate the biomechanical performances of the NiTi shape memory alloy CIF.Results There is an interaction force between embracing force of CIF and resistant force of bone tissue during the orthopedic clinical treatment.The embracing force along two semi-circular arms of CIF is increasing from the open position and reached the maximum value at the open symmetry position where the deformation of the bone occurred.Conclusion It is the key to choose the force loading position during the practical treatment,as the concentration force is the main force when there is an interactive force between the bone and the CIF.

Objective Clutching internal fixtor(CIF)loose and the fixed part weakly heal up are often found in orthopedic clinic.In the present paper,biomechanics methods were used to try to explain and analyze these issues,providing a helpful suggestion for the application of CIF in clinic.Method Commerical finite element models(FEM)Program ANSYS was applied to set up the finite element models of orthopedic CIF and bone tissue to analyze and evaluate the biomechanical performances of the NiTi shape memory alloy CIF.Results There is an interaction force between embracing force of CIF and resistant force of bone tissue during the orthopedic clinical treatment.The embracing force along two semi-circular arms of CIF is increasing from the open position and reached the maximum value at the open symmetry position where the deformation of the bone occurred.Conclusion It is the key to choose the force loading position during the practical treatment,as the concentration force is the main force when there is an interactive force between the bone and the CIF.