OBJECTIVETo introduce the location and course of S1, S2 sacral nerve root tunnel and to clarify the significance of the anterior aspect of sacral nerve root tunnel on placement of iliosacral screw on the standard lateral sacral view.

METHODSFirstly the data of 2.0 mm slice pelvic axial CT images were imported into Mimics 10.0, and the sacrum, innominate bones, and sacral nerve root tunnels were reconstructed into 3D views respectively, which were rotated to the standard lateral sacral views, pelvic outlet and inlet views. Then the location and course of the S1, S2 sacral nerve root tunnel on each view were observed.

RESULTSThe sacral nerve root tunnel started from the cranial end and anterior aspect of the vertebral canal of the same segment and ended up to the anterior sacral foramen with a direction from cranial-posterior-medial to caudal-anterior-lateral. The tunnel had a lower density than the iliac cortex and greater sciatic notch on the pelvic X-rays,especially on the standard sacral lateral view, on which it showed up as a disrupted are line and required more careful recognition.

CONCLUSIONIt can prevent the iliosacral screw from penetrating the sacral nerve root tunnel and vertebral canal when recognizing the anterior aspect of sacral nerve root tunnel and choosing it as the caudal-posterior boundary of the "safe zone" on the standard lateral sacral view.

Adult ; Aged ; Bone Screws ; Female ; Fracture Fixation, Internal ; Fractures, Bone ; surgery ; Humans ; Male ; Middle Aged ; Pelvic Bones ; diagnostic imaging ; injuries ; innervation ; surgery ; Radiography ; Sacrococcygeal Region ; diagnostic imaging ; innervation ; surgery ; Sacrum ; diagnostic imaging ; injuries ; innervation ; surgery ; Spinal Nerve Roots ; diagnostic imaging ; surgery ; Young Adult

OBJECTIVESTo introduce a classification system of upper sacral segment and its significance based on the continuous pelvic axial computed tomography scan.

METHODSThe whole pelvis 2.0 mm thick axial scan images of 127 cases were observed, the sacroiliac screw channel of S1 were measured, according to the size of the transverse screw channel the upper sacral segment were classified. Such as transverse screw channel existed and in at least 4 layer scan images its width was > 7.3 mm, it was defined as sacral segment of the normal type. Such as transverse screw channel existed and its maximum width was 7.3 mm or less on scanning level, it was defined as a transitional. Such as transverse channel did not exist, or its width on all scanning level was 0 mm or less, it was defined as dysplastic. Various cases,percentage, and the average of the transverse screw channel were calculated.

RESULTSThere were 58 normal (45.7%),42 transitional (33.1%), and 27 dysplastic (21.2%) upper sacral segments with an averaged width of the tansverse screw channel of 13.9 mm, 5.2 mm, and 0.9 mm, respectively. Each specimen could be defined as one of the three types of upper sacral segment without exceptions.

CONCLUSIONIt is possible to insert a transverse iliosacral screw into a normal upper sacral segment when indicated because of the capacious transverse screw channel. The transverse iliosacral screw placement into the transitional and dysplastic upper sacral segments was contraindicated because of the limited or none transverse screw channel. The transitional upper sacral segment was superior to the dysplastic segment due to its starting point location restriction on the true lateral sacral view.

Adolescent ; Adult ; Aged ; Aged, 80 and over ; Bone Density ; Bone Screws ; Female ; Fracture Fixation, Internal ; Humans ; Male ; Middle Aged ; Pelvic Bones ; diagnostic imaging ; surgery ; Sacrum ; diagnostic imaging ; surgery ; Tomography, X-Ray Computed ; Young Adult

OBJECTIVETo analyze the influence of included angle between the anterior aspects of S2 and S vertebral bodies on pelvic inlet imaging in the pelvic midline sagittal plane.

METHODSTotally 58 axial pelvic CT scans were chosen as study objects including 43 males and 15 females,with an average age of 40.7 years old (ranged,18 to 68 years old). The angles between the anterior aspects of S2 and S1, vertebral bodies and the horizontal plane on midline sagittal CT reconstruction were measured to simulate the optimal S2 and S1 inlet angles. The included angle between the anterior aspects of S2 and S1 vertebral bodies was calculated by subtrocting the S1,inlet angle from the S2 inlet angle defined as a base number. Then, the impact of the calculated included angles on the pelvic inlet imaging was analyzed. Results:The S2 inlet angles averaged (30.5±6.5) degrees; the S inlet angles averaged (25.7±5.9) degrees. The difference between them was significant (t=3.35, P=0.001). Ten patients had zero angle between the anterior aspects of S2 and S1 vertebral bodies; 14 patients had negative angle, averaged-(8.9±8.1) degrees; 34 patients had positive angle,averaged (11.8+6.4) degrees.

CONCLUSIONThe difference of included angle between the anterior aspects of S2 and S1 vertebral bodies leads to the difference between S1 inlet view and S2 inlet view in most cases, complicating the pelvic inlet imaging,and affecting the reliability of the application of pelvic inlet view. Utilizing the angles measured on the preoperative midlihe sagittal CT reconstruction to obatin the patient-customized S1 and S2 inlet views could accurately guide the S1 and S2 iliosacral screw insertion.

Adolescent ; Adult ; Aged ; Animals ; Bone Screws ; Female ; Fracture Fixation, Internal ; methods ; Humans ; Image Processing, Computer-Assisted ; Male ; Middle Aged ; Pelvis ; anatomy & histology ; injuries ; Spine ; anatomy & histology ; Tomography, X-Ray Computed ; Young Adult

OBJECTIVESTo research radiographic anatomy of the main structure of the pelvic Teepee view, including its azimuth direction and view anatomy structure.

METHODSFrom June 2013 to June 2014 adult pelvic CT examination results were filtered, excluding skeletal deformities and pelvic osseous destruction caused by tumors, trauma, etc. The data of 2.0 mm contiguous CT scan of 9 adults' intact pelves was,selected and input into Mimics 10.01 involving 7 males and 2 females with an average age of (41.2±10.3) years old. Utilizing the software, the 3D CT reconstructions of the pelves were completed. Setting the transparency being high,the pelvic 3D reconstructions were manipulated from the pelvic anteroposterior view to the combined obturator oblique outlet view and fine-tuned till the regular Teepee-or teardrop-shaped appearance emerges. Cutting tools of the software were at the moment applied to separate the "Teepee" from the main pelvis for each reconstruction. Then the "Teepee" and the rest (main) part of the pelvis were displayed in different color to facilitate the analysis on the Teepee, iliac-oblique, and anteroposterior views.

RESULTSThe "Teepee" started from the posterolateral aspect of the anterior inferior iliac spine and finished at the cortex between the posterior superior iliac spine and the posterior inferior iliac spine in a direction of being from caudal-anterior-lateral to cranial-posterior-medial. The radiographic anatomical composition of the "Teepee" contained one tip, one base,and two aspects. With the inner and outer iliac tables being the inner and outer aspects of the "Teepee", the tip is consequently formed by their intersection. The base is imaged from the cortex of the greater sciatic notch. The medial-inferior-posterior portion of the "Teepee" contains a small part of sacroiliac joint and its corresponding side of bone of the sacrum.

CONCLUSIONSThe "Teepee" is a zone of ample osseous structures of the pelvis, aside from a small medial-inferior-posterior portion, the main zone of which can be accepted as a safe osseous zone for the anchor of implants stabilizing certain pelvic and acetabular fracture patterns. The Teepee view can be utilized as guidance for the safe percutaneous insertion of such implants.

Adult ; Female ; Fractures, Bone ; diagnostic imaging ; surgery ; Humans ; Male ; Middle Aged ; Pelvic Bones ; anatomy & histology ; diagnostic imaging ; injuries ; surgery ; Sacroiliac Joint ; diagnostic imaging ; Tomography, X-Ray Computed ; Young Adult

OBJECTIVETo study the application of tissue granule of oral mucous in plastic surgery.

METHODSTissue granule of oral mucous was placed on glutin sponge and they were used for urethral (12 cases) and vaginal (14 cases) reconstruction in 26 cases.

RESULTSSatisfactory results were achieved in 24 cases. One case of urethral fistula and one case of urethral meatus stricture were happened. The two cases underwent secondary operation.

CONCLUSIONSTissue granule of oral mucous membrane is good supply for repairing mucous defect. It has the advantages of high growth and survival rate, and less shrinkage. It is useful for urethral or vaginal reconstruction which are covered with mucous membrane.

Child, Preschool ; Female ; Humans ; Hypospadias ; surgery ; Male ; Mouth Mucosa ; transplantation ; Reconstructive Surgical Procedures ; methods ; Urethra ; abnormalities ; surgery ; Vagina ; abnormalities ; surgery ; Young Adult

Objective To evaluate the imaging methods,characteristics,diagnostic value of multi- slice CT urography(MSCTU)in congenital abnormities of urinary system.Methods To collect 33 urinary congenital abnormities cases in three years and to analyses these MSCTU images.All examinations were performed with a multi-slice spiral CT scanner.The patients were intravenously injected with 90 ml of Iohexol 300 with a power injector at the rate of 3 ml/s.Nephrographic-phase images were obtained at 75 s after initiation of the injection of contrast material,the appropriate delay time is according to Kidney's enhancement extent and nephrohydrosis degree.Excretory-phase images were obtained through the abdomen and pelvis from 10 min.to 23 h after initiation of the injection of contrast material without abdominal compression.Excretory-phase images were transferred to the workstation and performed maximun intensity projection(MIP),multiplanar reconstruction(MPR),volume rendering(VR),and virtual cystoscopy (VC).Results The urinary congenital abnormities diagnosed by MSCTU in 33 cases,including 1 ectopic kidney,1 horseshoe kidney,1 renal malrotaion,2 supernumerary kidneys,2 ureteral valves,2 retrocaval ureters,4 congenital megaureters,6 ureteropelvic junction stenosis,9 pelviureteric duplication malformations and 5 bladder diverticula.The displaying rate of ureter was 91%(61/66).The scanning time of excretory-phase was less than 20 seconds in All cases.The average CT value of contrast media in displayed ureter lumens was 520 HU.The postprocessing images had clear,dimensional feature and It was satisfy the diagnosis.Conclusion MSCTU has clear,dimensional feature and has strong ability of displaying total anatomy shape and tiny pathology change of congenital abnormities in the urinary system.It is a very useful method for detecting the congenital abnormities in the urinary system.

OBJECTIVELiteratures on the development and function of prepuce was reviewed. To compare the merit and demerit of treatment for redundant prepuce by conventional circumcision or by removing the root skin of the penis. To investigate the ideal method and time of treatment for redundant prepuce.

METHODSThe extended length of the penis and the extended skin of penis were carefully measured and the excess skin at the root of the penis was removed from the surface of Colle's fascia. Then the remaining distal skin was drew back to suture to the root of the penis. As for the cases complicated with stenosis of prepuce, longitudinal incision was performed along the constricted area to release stenosis, followed by transverse closure of the wound.

RESULTS110 adult cases of simple redundant prepuce and 40 cases complicated with stenosis were treated by this way. Functional and cosmetic results were achieved without any complications in all cases. All patients were satisfied with the result.

CONCLUSIONSRemoval of the excess skin at the root of the penis should be preferred to the conventional circumcision for treatment of redundant prepuce. The ideal time for intervention is at or after adolescence, when the prepuce has developed maturely. Non-operative methods should be taken to treat phimosis and adherent prepuce before adolescence.

Adolescent ; Adult ; Circumcision, Male ; methods ; Humans ; Male ; Middle Aged ; Penis ; surgery ; Young Adult

OBJECTIVETo explore a surgical treatment for obstructive sleep apnea hypopnea syndrome (OSAHS).

METHODS12 cases were treated during the period from Jan 1998 to Aug 2006. Partial soft palate was resected in rhombus shape from the middle to shorten the soft palate and enlarge the pharyngeal cavity. The uvula was reserved.

RESULTSThe patients were followed up for six months to five years. There was no complication. Good results were achieved in 9 patients. 2 cases got some kind of improvement. No improvement happened in one case who received a partial tongue resection later.

CONCLUSIONSA rhombus shape excision of the soft palate from the middle is effective for the treatment of OSAHS with few complication.

Adult ; Female ; Humans ; Male ; Middle Aged ; Palate, Soft ; surgery ; Pharynx ; surgery ; Polysomnography ; Sleep Apnea, Obstructive ; physiopathology ; surgery ; Tongue ; surgery ; Uvula ; surgery

OBJECTIVETo assess the diagnostic value of tumor markers in the cerebrospinal fluid (CSF) for meningeal carcinomatosis (MC).

METHODSTwenty-one MC patients (including 13 adenocarcinoma and 8 non-adenocarcinoma patients), 72 patients with tuberculous meningitis (TBM) and 23 with primary intracerebral tumors (PIT) were enrolled in this study. Blood and CSF tumor markers including CEA, CA125, CA15-3, CA19-9, CA72-4, CYFRA21-1, AFP and NSE were measured by Roche E170 electrochemiluminescence analyzer and sandwich assay.

RESULTSCSF tumor markers CEA, CA125, CA199 and CYFRA21-1 and the serum tumor markers CEA, CA125, CA153, CA199 and AFP were significantly higher in MC group than in the other two groups. CSF CEA and CA15-3 were significantly higher in adenocarcinoma MC than in non-adenocarcinoma MC patients, but no significant differences were found in the serum tumor markers between the two groups (P>0.05). CSF tumor markers including CEA, CA125, CA15-3, CA72-4 and CYFRA21-1 were positively correlated to the serum tumor markers (P<0.05). CA199 was positively correlated to the disease course (P<0.05), and age was not correlated to any of the indexes (P>0.05).

CONCLUSIONDetection of the tumor markers in the CSF, especially CEA, CA125, CA19-9 and CYFRA21-1, may help in the early diagnosis of MC. CEA and CA15-3 can serve as indicators for differential diagnosis of adenocarcinoma and non-adenocarcinoma.

Adenocarcinoma ; cerebrospinal fluid ; diagnosis ; Adult ; Aged ; Antigens, Neoplasm ; cerebrospinal fluid ; Biomarkers, Tumor ; cerebrospinal fluid ; CA-125 Antigen ; cerebrospinal fluid ; CA-19-9 Antigen ; cerebrospinal fluid ; Carcinoembryonic Antigen ; cerebrospinal fluid ; Female ; Humans ; Keratin-19 ; cerebrospinal fluid ; Male ; Membrane Proteins ; cerebrospinal fluid ; Meningeal Neoplasms ; cerebrospinal fluid ; diagnosis ; Middle Aged ; Young Adult

OBJECTIVETo study the clinical efficacy of partial glossectomy assisted with temperature-controlled radiofrequency for treating macroglossia.

METHODSThere were 4 patients performed this procedure. We took a rhombus shape incision in the middle of the tongue and performed a wedge excision.

RESULTSThe mouth can close entirely in all of patients and there weren' t hemorrhage and obviously swollen; Tongue's sensory function hadn't disturbance. Masticate function were normal. One patient still had the symptom that tongue lied outside the oral cavity occasionally after operation. The symptom was disappeared after Temperature-controlled radiofrequency (TCRF) ablation. All of patients' parent were satisfied with the results.

CONCLUSIONSPartial glossectomy assisted with temperature-controlled radiofrequency for treating macroglossia is an effective, much safer and less invasive procedure without obvious adverse reactions. There are better prospects for applying.

Catheter Ablation ; Child ; Child, Preschool ; Female ; Glossectomy ; methods ; Humans ; Macroglossia ; surgery ; Male ; Tongue ; surgery ; Treatment Outcome