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 investigate the results and effects of freezing phrenic nerves for the patients of pulmonary lobectomy.To optimize the best freezing time by studying the effects of different time at-65 ℃.Methods 50 patients of pulmonary lobectomy were randomly entered into 5 groups,including control group,30 seconds group,60 seconds group,90 seconds group,120 seconds group.After operation,the patients' cardiotach,blood pressure,SaO2,breath rate,time period of pulling out drainage tube and VAS about referred pain of scapular region were noted.After pulling out the intrathoracic drain tube,the routine chest normal X ray film and chest ultrasonic inspection were processed and the post-operation remnant cavity were observed.The chest normal fluoroscopy was inspected in 90 days after operation in order to observe the motion information of trouble side diaphragmatic muscle.Results The chest fluid [first day (329±178) ml,(345±150)ml,(268±51) ml,(227±36) ml,second day (251±131) ml,(269±112) ml,(208±61) ml,(158±110) ml,time of pulling out intrathoracic drain tube (5.8±1.75) days,(4.6±1.77) days,(3.9±0.74) days,(3.6±1.07) days] and VAS [(3.6±2.9) scores,(2.2±2.4) scores,(1.0±1.3) scores,(0.7±1.2) scores] about referred pain of scapular region of freezing groups were obviously lower than those in the control group [(375±136) ml,(309±132) ml,(5.7±2.36) days,(4.0±3.3) scores].90 s and 120 s freezing groups were lower than that of 30 s and 60 s groups,andthe 90 s freezing group did not significantly different from the 120 s group.The heart rate,blood pressure,saturation of blood oxygen and breathing rate of each group also had no difference.The remnant cavity sizes were larger in the control group (＞200 ml),they also had more fluidity (＞200 ml),and one case had been taken punctuation.The remnant cavity sizes of freezing groups were small and didn' t need special treatment.The diaphragmatic muscle' s movement of each group were fine after 3 months of operation.Conclusion The freezing phrenic nerves can effectively reduce the chest fluid,the post-operation remnant cavity and the time of pulling out intrathoracic drain tube.The freezing phrenic nerves can reduce the pain of referred pain of scapular region.The best freezing time should be 90 s.The freezing phrenic nerves do not influence the respiration function,and should be advantages of for the clinic researches and applications.

OBJECTIVETo explore the correlation between Chinese medical (CM) syndrome types of chronic atrophic gastritis (CAG) patients and Helicobacter pylori (Hp) infection, polymorphisms of IL-1B, and IL-1β.

METHODSTotally 192 CAG patients and 202 healthy subjects (as the healthy control group) were recruited in this case-control study. The Hp infection was tested by 13C-urea breath test and colloidal gold-labeled assay (GICA). The concentration of peripheral blood IL-1β was measured by ELISA. The polymorphisms of IL-1B gene in the promoter region were analyzed using polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP).

RESULTSPi-Wei weakness syndrome (PWWS) was dominant in CAG patients (31.77%, 61/192 cases). The Hp infection ratio in CAG patients was 53.65% (103/192 cases), of which, Pi-Wei damp-heat syndrome(PWDHS, 64.86%, 24/37 cases) and Gan-Wei disharmony syndrome (GWDS, 66.67%, 24/36 cases) were dominant. Compared with the health control group, the plasma concentration of IL-1β was obviously elevated in CAG patients with PWDHS, GWDS, and static blood obstructing collaterals syndrome (SBOCS) (all P < 0.05). Additionally, there was no difference in the distribution of polymorphisms in the promoter region of IL-1 B gene between the CAG patients and the healthy control group (P > 0.05).

CONCLUSIONSThe incidence risk of CAG was not associated with IL-1B polymorphism. But CM syndrome types of CAG patients was associated with Hp infection and peripheral blood IL-1β levels.

Case-Control Studies ; Gastritis ; Gastritis, Atrophic ; genetics ; Helicobacter Infections ; genetics ; metabolism ; Humans ; Incidence ; Interleukin-1beta ; genetics ; Medicine, Chinese Traditional ; Polymorphism, Genetic

OBJECTIVETo assess the outcome of childhood hepatoblastoma after a combination therapy of resection and chemotherapy.

METHODSThe clinical data of 14 children with hepatoblastoma was retrospectively reviewed. Their long-term survival was followed-up.

RESULTSTwelve cases received surgery and planned chemotherapy. The follow-up duration averaged 18 months (range 1.5-74 months). Nine survived free of events, 1 died, 1 survived with multiple lung metastases, and 1 with increased alpha-fetoprotein (AFP) content but without residual tumor.

CONCLUSIONSSurgery assisted with chemotherapy can improve the outcome of hepatoblastoma.

Chemoembolization, Therapeutic ; Child ; Child, Preschool ; Combined Modality Therapy ; Female ; Hepatoblastoma ; blood ; therapy ; Humans ; Infant ; Lung Neoplasms ; blood ; therapy ; Male ; Retrospective Studies ; Treatment Outcome ; alpha-Fetoproteins ; analysis

Objective To explore the expressions ofhypoxia-inducible factor-1α(HIF-1α) and angiopoietin-2 (Ang-2) in children with nephroblastoma (NB) and its correlation with clinicopathology,prognosis and microvessel density(MVD).Methods Forty-five cases of NB treated by Pediatric Surgery Department of the First Affiliated Hospital of Guangxi Medical University,with NB resected from Jan.2008 to Jan.2012,were divided into groups according to histopathological type,clinical stage and National Wilm's Tumor Study-5 risk factors.The expressions of HIF-1α,Ang-2 and CD34/MVD in NB tissues and adjacent tissues were tested by immunohistochemical method,and the findings were analyzed with the combination of the clinical data and results of the follow-up.Results The ratio of HIF-1α and Ang-2 expressions in NB group was higher than that in the normal adjacent tissues(95.6％ vs 40％ and 86％ vs31.0％,respectively,P ＜ 0.05).HIF-1α and Ang-2 expressions were positively correlated with clinic stage and risk factors,and the postoperative cumulated survival rate was higher in low expression group of HIF-1α,Ang-2 compared with the higher expression group of HIF-1α,Ang-2 (P ＜ 0.05).MVD was higher in NB group than in normal adjacent tissue groups (58.22 ± 10.009 vs 49.43 ±-8.114,P＜0.05) and had a positive correlation with HIF-1α(r =0.442,P＜0.05) and Ang-2 (r =0.590,P ＜ 0.05).HIF-1α had a positive correlation with Ang-2 (r =0.442,P ＜ 0.05).Conclusion HIF-1α and Ang-2 could promote angiogenesis and proliferation in NB,which affects the prognosis.

Objective To explore the relation of matrix metalloproteinase-2(MMP-2) expressed in liver tissue of biliary atresia(BA) and liver fibrosis,jaundice free,cholangitis onset and survival time with native liver after Kasai hepatoenterostomy (KH).Methods Clinical and pathological data were collected in 65 cases of BA,with a completely 2 years' follow-up after KH(BA group) from Jan.2009 to Dec.2010 and 15 cases of children without hepatobiliary disease (control group) were compared at the same time,while expression of MMP-2 in liver tissue was measured by adopting immunohistochemistry.Results Ohkuma's score of liver fibrosis was higher in BA group than that in control group(Z =-4.02,P ＜ 0.001).The staining positive rate and the expression of MMP-2 were higher in BA group than those in control group(x2 =33.88,P ＜ 0.001 ;Z =-5.14,P ＜ 0.001,respectively).With the increase of Ohkuma's score and the age at KH,the expression of MMP-2 was higher(r =0.686,0.465,P ＜ 0.001,respectively).With the higher expression of MMP-2,the rate of jaundice free was lower(r =-0.687,P ＜ 0.001) and the incidence of cholangitis was increased (r =0.361,P =0.003).Those with lower expression of MMP-2 increased 2 year's survival time of native liver 2 years after operation (x2 =64.000,P ＜ 0.001).Conclusions In BA,the expression of M MP-2 in liver is related to the development of liver fibrosis,jaundice clearawe,cholangitis occurrence and survival time of native liver and it can be used as an index to evaluate therapeutic effect and prognosis after KH.

Objective To describe the epidemical characteristics of A (H1N1) influenza identified in the early stage (from May 11 to June 22, 2009) of the epidemic, in mainland China. Methods Epidemical characteristics of 420 confirmed A (H1N1) influenza cases reported from May 11 to June 22, 2009 were analyzed descriptively, including the distribution of age, sex, source of infection, main symptoms and incubation period. Results A total of 77.8% early cases in mainland China were imported from other countries. Three countries including America, Canada and Australia were attributed to 90% of the imported cases. Most of the cases were from 6 months to 73 years old, with 94% of them under 50 years. Most of the symptoms would include fever (81%), cough (40%) and sore throat (35%). The mean incubation period of second-generation cases was 4.3 (4.2±1.5) days. Conclusion Imported cases dominated the total cases in the early stage of the epidemic had similar gender distribution of those from exporting countries. Fever, cough and sore throat were the three main symptoms manifested in influenza cases. 2.5±1.9(1-11)days was found in imported cases between the day of off-board and the onset of symptoms. The incubation period was 4.3±1.7 (1-8) days among the secondary cases.

OBJECTIVETo review the indications, techniques and complications of reoperation for failed hypospadias repair using modified Mathieu urethroplasty.

METHODSUsing modified Mathieu urethroplasty, we treated 24 hypospadias patients aged 3-12 (mean 4.5) years for whom the first (n = 20) or the second hypospadias repair (n = 4) had failed, including 13 cases of large coronary sulcus urethrocutaneous fistula, 5 cases of urethral meatus retraction and 6 cases of anterior urethra dehiscence. The modified procedure involved median longitudinal incision of the urethral posterior wall, dorsal tunica albuginea plication under the vascular and nerve bundle, and double dartos flap protection of the neourethra.

RESULTSOf the 24 patients, 19 (79.2%) were successfully treated by the first operation, which achieved desirable straightness, good cosmetic appearance and normal urethral meatus of the penis, without postoperative complications. Small urethrocutaneous fistula developed in 4 cases, of which 3 were cured by fistula repair and 1 self-healed. Urethral meatus stenosis occurred in 1 case, which was restored by meatal dilation. Urethrocele and urethrostenosis were not found in any of the cases. Two cases received urethroscopy postoperatively, which revealed no hypertrophic cicatrix at the site of median longitudinal incision in the urethral posterior wall.

CONCLUSIONModified Mathieu urethroplasty can be applied to hypospadias reoperation, particularly in such cases as large coronary sulcus urethrocutaneous fistula, urethral meatus retraction and anterior urethra dehiscence. The modified procedure includes median longitudinal incision of the urethral posterior wall, dorsal tunica albuginea plication under the vascular and nerve bundle, and double dartos flap protection of the neourethra.

Child ; Child, Preschool ; Humans ; Hypospadias ; surgery ; Male ; Reconstructive Surgical Procedures ; methods ; Reoperation ; Treatment Outcome ; Urethra ; surgery ; Urologic Surgical Procedures, Male ; methods

Objective To investigate the value and strategy of staged repair in hypospadias surgery.Methods One hundred and sixty-three cases of severe proximal and complex hypospadias were retrospectively analyzed.According to the operation process,all the cases were divided into 2 groups.Staged repair group:there were 46 cases in all,included 31 cases of severe proximal hypospadias and 15 cases cases of complex hypospadias,the diorthosis for penis curvature and urethral reconstruction were completed by staged.One-stage repair group:there were 117 cases as control group,included 108 cases of severe proximal hypospadias and 9 cases of complex hypospadias,their diorthosis for penis curvature and urethral reconstruction were completed in single stage.Results The adverse factors such as a serious deformity in penis or limited local tissue were more common in staged repair group,and the conditions of repair were worse than one-stage repair group.In severe proximal hypospadias,the incidence of penis curvature in staged repair group was obvious lower than one-stage repair group (P ＜ 0.05),within the period of follow up,which only 1 case (3.2％) showed a slight penis curvature.However,there were 23 cases (21.3％) with penis curvature in one-stage repair group,in which 7 cases showed up penis torsion,20 cases with a bowstring shape of breviate urethra in penile ventral,and 19 cases(17.6％) needed reoperation.Compared of 2 groups,the incidences of urinary fistula,urethral stricture and urethral diverticulum showed no difference in statistics (all P ＞ 0.05).In complex hypospadias,the incidence of urinary fistula in staged repair group was significantly lower than one-stage repair group,and then the rate of urinary fistula was 20.0％ vs 66.7％ (P ＜ 0.05).The incidence of penis curvature,urethral stricture and urethral diverticulum showed no difference in statistics (all P ＞ 0.05).Conclusions Staged repair is relatively simple and effective,can be used in the treatment of severe proximal or complex hypospadias,especially in the cases with a worse condition.The mode of operation should be chosen not only according to the penial state and tissue conditions,but also combined with the technology and experience of the surgeon,and avoid the forced of one-staged repair for hypospadias.