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Objective:To investigate the clinical features of neonatal testicular torsion and to evaluate the effect and necessity of early intervention.Methods:A retrospective analysis was performed on 11 neonates admitted to the Second Hospital of Shandong University with neonatal testicular torsion from June 2017 to June 2022. Clinical data of these cases including clinical manifestations, ultrasonography findings, surgical management and outcomes were reviewed and analyzed with descriptive statistical methods.Results:The median age of the 11 patients on admission was 2.6 d (1-5 d). The median time from finding abnormal scrotum to admission was 12 h (1-120 h). Various degrees of scrotal swelling or scleroma were found in the patients. Among them, seven patients presented with acute inflammatory signs of cyano sis or skin redness, and testis-like tissue induration could be touched. Ultrasound scan showed abnormal blood flow in the affected testicle in all cases. Emergency scrotal exploration under general anesthesia was performed successfully in all cases and ten of them underwent orchiectomy of the affected testicle plus contralateral orchiopexy. The rest one who was admitted within 1 h after birth only underwent orchiopexy of the affected testicle as the parents refused contralateral testicular exploration. During the operation, 12 twisted testis were observed, including seven with extravaginal torsion, three with intravaginal torsion and two adhering to the surrounding tissue without normal testicular tissue or distinguishable torsion direction or degree. In this study, ten patients had unilateral testicular torsion, which affected the left side in seven cases and the right side in three cases, and one had bilateral testicular torsion, which was diagnosed as left testicle torsion before surgery. During scrotal exploration, the left testicle of this bilateral case was resected due to necrosis, while the right testicle twisted about 180 degrees with good blood flow and was subjected to orchidopexy after reduction. In one case, the unaffected testicle was unfixed and dysplastic during contralateral exploration, which was also subjected to orchidopexy. In the 12 testis with torsion, one testicle of the patient admitted within 1 h after birth and the right testicle of the bilateral case were preserved with a salvage rate of 2/12. Pathological examination showed necrosis in the ten excised testis, and fibrosis and calcification foci in two of them. None of the patients had any perioperative complications and the scrotal incision healed well in all neonates. The patients were followed up for 6-12 months with regular ultrasound. The two preserved testis and the contralateral testis subjected to orchidopexy were located in the scrotum with good blood supply, and no torsion, atrophy or other abnormalities occurred.Conclusions:Neonatal testicular torsion is rarely seen in clinical practice and has no specific manifestations. It has a high excision rate due to testicular necrosis. Early diagnosis and bilateral scrotal exploration are crucial to the prognosis and the keys to save the affected testis and avoid anorchidism.
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<p><b>OBJECTIVE</b>To evaluate the application of anal endosonography in the morphology of internal anal sphincter (IAS), external anal sphincter (EAS) and puborectalis (PR) in order to provide necessary information for analysis of the etiology of fecal incontinence and formulation of the therapeutic schedule.</p><p><b>METHODS</b>From December 2010 to November 2012, 18 children of anorectal malformation (n=14) or Hirschsprung's disease(n=4) with fecal incontinence received anal endosonography. The morphology of IAS, EAS and PR was observed. The damage of anal sphincter was classified according to Starck criteria. Anorectal mamometry and anal clinical score were measured simultaneously. Spearman analysis was performed to examine the correlation of anal sphincter damage with anorectal mamometric score and anal clinical score.</p><p><b>RESULTS</b>According to Starck criteria, anal sphincter damage was small in 11 children, moderate in 6, and severe in 1. PR damage was found in 4 cases. Starck score was positively correlated with manometric score(P<0.05), while not correlated with anal clinical score(P>0.05).</p><p><b>CONCLUSIONS</b>Anal endosonography can clearly display the morphology of IAS, EAS and PR, and their integrity and damage degree. It is a very valuable technique to evaluate the anal sphincter of the children with fecal incontinence, which however can not reflect the function of anal sphincter and anal continence thoroughly.</p>
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Child , Humans , Anal Canal , Diagnostic Imaging , Endosonography , Fecal Incontinence , Diagnostic Imaging , ManometryABSTRACT
Objective To observe the effects of olfactory lamina propria (OLP) transplantation and ganglioside GM1 treatment on spinal cord injury (SCI) in rats.Methods Totally 50 healthy pure breed female Sprague-Dawley (SD) rats after spinal cord hemiseetion were randomly divided into 5 groups and were given different treatments: (OLP + GM1) treatment group (group A), GM1 treatment group (group B), OLP treatment group (group C), spinal cord injury but without treatment group (group D) and healthy control group (group E). The recovery of neurological function was evaluated by somatosensory evoked potential (SEP) and pathological examination after surgery. Results In group A, in some rats an escaping response in right hind leg occurred, but in other groups, the motor function was not significantly improved. Histological examination showed that transplanted olfactory lamina propria survived in the transplantation area and expanded on certain routes. NF positive nerve fibers passed through the transplantation area. Compared with group B, C, D, the N1-wave latency was(4.71±0. 72)ms 4 weeks after operation(P<0. 01), and the NF density was(7. 31±0. 26) ×104/mm28 weeks after operation in group A(P<0. 05). Conclusions Olfactory lamina propria (OLP) transplantation and ganglioside GM1 treatment have a synergistic effect on SCI.
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Objective: To evaluate the anal sphincter function of congenital anorectal malforotation retrospectively.Methods: With continuous pull through technique, the manometry of 22 congenital anorectal malforotation patients and 24 controls were studied and the results were analysed with their clinical scores. Results: Anal resting pressure in the children with neurogenic anorectum induced by myelodysplasia(21.3?3.4) mmHg was lower than that in normal children(66.7?24.0) mmHg.The maximum contractive pressure of anus in the patients(22.4?3.3) mmHg was lower than that in normal children(129.0?18.8) mmHg. The length of high pressure zone in the patients(12.3?4.6 mm) was lower than that in normal children(23.6?4.6 mm). Rectoanal inhibitory reflex was identified in both patients and normal children. Conclusion:Anorectal manometry might be an effective parameter to evaluate the anal sphincter function of congenital anorectal malformation.
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Objective:To study the influence of neurogenic anorectum induced by myelodysplasia on function of anorectum.Methods:Twenty-five patients with myelodysplasia were evaluated by anorectal manometry.The function of anal sphincter was evaluated by resting pressure,contractive pressure and the length of high pressure;The sensation of rectum was evaluated by rectal maximum volume threshold;The function of defecation reflex was evaluated by rectoanal inhibitory reflex.Results:Anal resting pressure in the children with neurogenic anorectum induced by myelodysplasia( 25.8?3.4)mmHg was lower than that in normal children(66.7?24)mmHg.The maximum contractive pressure of anus in patients (86.6?20.1)mmHg was lower than that in normal children(129.0?18.8)mmHg.The length of high pressure in patients (17.5?4.5)mm was lower than that in normal children(23.6?4.6)mm.The rectal volume at sensory threshold in patients(62.1?8.5)ml was higher than that in normal children(36.0?12.6)ml.Rectal maximum volume threshold in patients(141.4?22.6)ml was higher than that in normal children (109.5?12.2)ml.Rectoanal inhibitory reflex was identified in both patients and normal children.Conclusions:Anorectal manometry may provide objective assessment of the neurogenic damage of anorectum in myelodysplasia including the damage of sphincter and the decrease of the rectal sensation. Rectoanal inhibitory reflex was identified in both patients and normal children. The major objective of anorectal treatment for patients with myelodysplasia was to strengthen the function of external sphincter, internal sphincter and pelvis floor muscle and to repair the sensation of rectum.