Perioperative Techniques and Long-term Outcomes in Hypospadias: A Systematic Review

@#Introduction: Hypospadias is a condition when the urethra distal opens on the bottom of the penis and has a ventral penile curvature. Hypospadias is the second most frequent genital birth abnormality in boys after cryptorchidism. Surgery is the standard treatment of choice and has a significant risk problem. There are many surgical procedure complications, especially in appearance and function. This article discusses the appropriate operative management and the best long-term outcome. Methods: The data was culled and selected from the ten years of full-text English publication (2012-2022) utilizing the PubMed and Google Scholar databases. Meta-analyses (PRISMA) paradigm and PICO investigation of management techniques and long-term outcomes in clinical and randomized clinical trials. Result: From 149 search articles, 7 met the inclusion criteria. The gland penis size and the meatal location did not affect the outcome of the surgical technique. However, 58/432 patients required reoperation, and 61(13%) had urethroplasty complications (UC), although not statistically significant (OR 0.8, 95% CI: 0.7-0.9). Testosterone is advised for small penises, narrow glands, thin urethral plates, and proximal hypospadias (67 vs. 87%). Preoperative antibiotics reduce the incidence of infection (17/150 repairs), tubularized incised plate (TIP), and the stent is recommended. Conclusion: The recommended strategies are good perioperative treatment, including antibiotics, testosterone treatment, surgery ages (6-18 months), tubularized incised plate (TIP) technique, and stent postoperative.

Efficacy of noninvasive correction on congenital auricle deformities at different time points: a meta analysis / 中华医学美学美容杂志

Objective:To evaluate the efficacy and safety of nonsurgical methods in early postnatal correction of congenital auricle malformation.Methods:The clinical trials regarding non-surgical treatment for congenital ear deformity published before May 2021 were searched in databases of Cochrane Library, PubMed, Medline, CNKI, VIP and Wanfang. The information of included studies was extracted. The Meta-analysis was performed by using RevMan 5.3 software.Results:A total of 15 trials were included, involving 1 349 patients. The Meta-analysis results showed that the effect of the group <6 weeks was better than the group over 6 weeks ( OR=4.67, 95% CI: 3.21, 6.78, Z=8.09, P<0.001); The complications incidence of the group < 6 weeks was lower than the group over 6 weeks ( OR=0.27, 95% CI: 0.08, 0.88, Z=2.18, P=0.03); The correction time required of the group <6 weeks was shorter than the group over 6 weeks ( MD=-11.81, 95% CI: -18.36, -5.26, Z=3.54, P=0.001). Conclusions:Non-surgical correction of congenital ear malformation within 6 weeks after birth has better efficacy and safety.

Modified single-patch technique for children with complete atrioventricular septal defect in a single center / 中国胸心血管外科临床杂志

@#Objective    To sum up the experience of the primary modified single-patch (MSP) technique applied in our hospital for children with complete atrioventricular septal defect (CAVSD). Methods    The clinical data of 141 children who underwent primary MSP technique for CAVSD between June 2009 and December 2017 were retrospectively analyzed, including 62 males and 79 females with a median age of 6 (3, 11) months and a median weight of 5.8 (4.5, 7.0) kg. According to Rastelli classification, there were 116 patients in type A, 14 in type B and 11 in type C. Among them, 15 patients were diagnosed with Down’s syndrome. Cardiopulmonary bypass time, aortic cross clamp time, atrioventricular valve regurgitation and other clinical data were recorded during and after operation. Results    Postoperatively, 17 patients suffered from severe left atrioventricular valve regurgitation (LAVVR) and 6 patients severe right atrioventricular valve regurgitation (RAVVR). In the follow-up period, 5 patients suffered from severe LAVVR and 1 patient severe RAVVR. Left ventricular outflow tract obstruction (LVOTO) appeared in 1 patient during follow-up period and none at the end of follow-up. There were 5 early deaths and 2 late deaths. Twelve patients underwent reoperation with a median interval time of 268 (8, 1 270) days. Conclusion    MSP technique is a wise surgical strategy for CAVSD children with good outcomes, improved postoperative mortality and decreased atrioventricular valve regurgitation.

Surgical correction of concomitant exotropia combined with inferior oblique weakening procedures for the treatment of children with complex strabismus / 国际眼科杂志(Guoji Yanke Zazhi)

@#AIM: To observe the clinical curative effect of surgical correction of concomitant exotropia combined with weakening procedures in the treatment of children with complex strabismus. <p>METHODS: Totally 68 children(80 eyes)with complex strabismus who were admitted to the hospital from January 2015 to February 2017 were selected. All of them were treated by surgical correction of concomitant exotropia. The clinical diagnosis and treatment were retrospectively analyzed. They were divided into the combined group(<i>n</i>=30, 35 eyes)and the non-combined group(<i>n</i>=38, 45 eyes)according to the implementation of inferior oblique weakening procedures. The visual function, 5m exotropia deviation, degree of inferior oblique muscle overreaction and results of Titmus stereoscopic experiment were compared between the two groups before and after surgery. The postoperative curative effect of both groups was observed.<p>RESULTS: The proportions of patients with simultaneous vision, patients with certain fusion range, patients with distant stereoscopic vision and normal patients with near stereoscopic vision(40-60s)in both groups were significantly increased surgery at 6mo after surgery(<i>P</i><0.05), without significant differences between groups(<i>P</i>>0.05). The degree of inferior oblique muscle overreaction and 5m exotropia deviation in both groups were significantly improved at 6mo after surgery(<i>P</i><0.05), but there was no significant difference between groups(<i>P</i>>0.05). Follow-up of 1-3d, 1a after operation showed there were no significant differences between the two groups in the orthophoria rate, over-correction rate or under-correction rate(<i>P</i>>0.05).<p>CONCLUSION: In the treatment of children with complex strabismus by surgical correction of concomitant exotropia, the combined use of inferior oblique weakening procedures may not affect the correction effects of exotropia. When the surgery is designed, the impact of inferior oblique weakening procedures can be ignored.

Síndrome de cimitarra, valoración con ecocardiografía transesofágica intraoperatoria. Informe de caso / Scimitar syndrome; intraoperative transesophageal echocardiography assessment. Case report

9-year-old patient diagnosed with scimitar syndrome through transthoracic echocardiogram and cardiac catheterization. Surgical correction is performed by anastomosing the collector of the pulmonary right vein to AI through the interatrial septum, tunneling it with a pericardic patch. The study findings and echocardiographic images of such surgical repair and the spectrum of pulsed Doppler differentiating between right and left pulmonary veins will be shown below. The connection through the septum was evidenced, simulating an interatrial communication. A difference was found among the measured points S, D, A and between the left and right pulmonary veins, without this resulting in a stenosis during the repair.

Paciente de 9 años de edad el cual es diagnosticado con síndrome de cimitarra a través de ecografía transtorácica y cateterismo cardiaco. Se realiza cirugía correctora la cual se anastomosa el colector de vena pulmonar derecha hacia AI a través del septum interauricular, tunelizándolo con parche pericárdico. A continuación se muestran los hallazgos e imágenes ecocardiográficas de tal reparación y el espectro doppler pulsado diferenciado entre las venas pulmonares derechas e izquierdas. Se pudo evidenciar la conexión a través del septum, simulando una comunicación interauricular. Se halló una diferencia entre los puntos medidos S, D, A entre las venas pulmonares izquierdas y derechas, sin que esto significara una estenosis en la reparación.

A Comparative Study of Sagittal Balance in Patients with Neuromuscular Scoliosis

OBJECTIVES: Spinopelvic alignment has been associated with improved quality of life in patients with vertebral deformities, and it helps to compensate for imbalances in gait. Although surgical treatment of scoliosis in patients with neuromuscular spinal deformities promotes correction of coronal scoliotic deformities, it remains poorly established whether this results in large changes in sagittal balance parameters in this specific population. The objective of this study is to compare these parameters before and after the current procedure under the hypothesis is that there is no significant modification. METHODS: Sampling included all records of patients with neuromuscular scoliosis with adequate radiographic records treated at Institute of Orthopedics and Traumatology of Clinics Hospital of University of São Paulo (IOT-HCFMUSP) from January 2009 to December 2013. Parameters analyzed were incidence, sacral inclination, pelvic tilt, lumbar lordosis, thoracic kyphosis, spinosacral angle, spinal inclination and spinopelvic inclination obtained using the iSite-Philips digital display system with Surgimap and a validated method for digital measurements of scoliosis radiographs. Comparison between the pre- and post-operative conditions involved means and standard deviations and the t-test. RESULTS: Based on 101 medical records only, 16 patients met the inclusion criteria for this study, including 7 males and 9 females, with an age range of 9-20 and a mean age of 12.9±3.06; 14 were diagnosed with cerebral palsy. No significant differences were found between pre and postoperative parameters. CONCLUSIONS: Despite correction of coronal scoliotic deformity in patients with neuromuscular deformities, there were no changes in spinopelvic alignment parameters in the group studied.

Surgical Correction Of Pincer-Nail Deformity Using Autologous Full Thickness Skin Graft: A Case Report

Pincer nail deformity is often undertreated although it is a cause of pain and disfigurement.This may be attributed to underdiagnosis and lack of awareness of the available treatmentoptions especially surgical options. Not many centres offer surgical correction of pincer naildeformity in Malaysia. We would like to describe a surgical method of correcting this deformity.

Surgical Correction of Adult Spinal Deformity / 대한정형외과학회잡지

Surgical correction of adult spinal deformity is a challenge, and is physically and mentally demanding for spinal surgeons. For satisfactory surgical outcomes, proper patient selection is fundamental and preoperative detailed physical examination, intra-operative neuromonitoring, and collaboration with anesthesiology or internal medicine department are critical for prevention of peri-operative complications associated with surgical treatments. A posterior-only or anterior-posterior combined approach can be used. Considering the patients' hemodynamic status or long-time anesthesia, surgeons can decide whether to operate by stage or one stage. Deformity correction can be performed using spinal osteotomy or anterior interbody fusion. Decision regarding correction method depends on the patient's condition and correction degree or level. In this review, the authors try to help in decision making with regard to deformity correction methods for ideal surgical technique, correction angle, fusion length etc. in reference to previous literature.

Correction of Prominent Ears / 대한이비인후과학회지

External ear anomaly was not uncommon disease. The spectrum of anomaly is wide, from mild anomalies including prominent ears, cryptotia to absence of external ear. In western countries, prominent ears were common and surgical correction was usually performed in their childhood period. However in Asian countries, including Korea, prominent ears were not considered correcting condition. Many techniques and skills were introduced to perform otoplasty since 19th century. For improving surgical result of otoplasty, operator should choose suitable surgical techniques considering patient's condition in these techniques and can read demands of patients.

The Effectiveness of Surgical Correction of Pincer Nails Using Nail Bed Flap and Bilateral Partial Matrixectomy, with or without Osteophyte Removal / 대한피부과학회지

BACKGROUND: A pincer nail is characterized by the presence of an excessively curved and distorted nail across the transverse dimension. A multitude of therapeutic modalities have been implemented to treat this condition with limited efficacy. OBJECTIVE: We sought to evaluate the efficacy of surgery for pincer nail deformity with the use of the nail bed flap and bilateral partial matrixectomy, with or without osteophyte removal. METHODS: Nine patients (four patients: both great toe nails, five patients: single toe nail) with pincer nail deformities were treated with nail bed flap and bilateral partial matrixectomy, with or without osteophyte removal. Objective assessment was evaluated by use of the width index (width of the nail tip/width of the nail root) and height index (height of the nail tip/width of the nail tip). Subjective assessment was evaluated through patient global assessment (PGA) and use of the pain visual analogue scale as declared by patients. In addition, wound complications and recurrences were described. RESULTS: The width index and height index were improved (width index: 85.5%-->97%, height index: 54.3%-->3.4%). All of the patients claimed 'good' or higher in the PGA score. Relief of pain was shown in 100% of the cases. There was no recurrence during a 6- to 20-month period (mean time: 11.8 months) and no complications. CONCLUSION: Nail bed flap and bilateral partial matrixectomy with or without osteophyte removal as a surgical approach might be an effective and curative method of treatment for pincer nail deformity.

Tratamiento quirúrgico del frenillo lingual corto en niños / Surgical treatment of short lingual frenulum in children

La anquiloglosia es una anomalía congénita que se caracteriza por un frenillo lingual anormalmente corto, que resulta en grados variables de dificultad de la movilidad lingual. Puede ser asintomática o manifestarse con dificultades en la lactancia, trastornos en el habla y en la dentición, y problemas sociales relacionados con la limitación funcional de la lengua. Si bien es una patología frecuente y conocida, persisten controversias y diversidad de opiniones relacionadas con la indicación, el momento y el método de la corrección quirúrgica. Describimos nuestra experiencia con 35 niños que presentaban esta afección, tratados quirúrgicamente de forma exitosa.

Ankyloglossia is a congenital anomaly characterized by an abnormally short lingual frenulum resulting in varying degrees of difficulty of tongue mobility. It may be asymptomatic or it may present with breastfeeding difficulties, speech and dentition disorders, and social problems related to the functional limitation of the tongue. While it is a common and known pathology, controversies and diversity of opinions persist regarding the indication, timing and method of surgical correction. We describe our experience with 35 children presenting this condition; they underwent successful surgical treatment.

Enfoque filosófico del impacto de la cirugía refractiva ocular / Phylosophical approach to the impact of the ocular refractive surgery

La cirugía oftalmológica mundial ha experimentado enormes avances, tanto en sus técnicas como en el impacto social que representa. Temas como la cirugía de catarata y la corrección quirúrgica de los defectos refractivos han sufrido grandes cambios en los últimos años. En esta especialidad como en cualquier rama de la ciencia los científicos necesitan acudir a la Filosofía, ya que también tiene su impacto en el desarrollo de esta ciencia. Esto está dado principalmente porque los conocimientos deben verse interrelacionados con otras ciencias y por lo que significa la pérdida visual o un tratamiento inadecuado para los pacientes y, por tanto, para la sociedad. El colectivo de autores está empeñado en la profundización de esta problemática sin la cual las metas de salud en el milenio serán de difícil cumplimiento.

Eye surgery has made great advances worldwide in terms of its techniques and social impact. Some issues like cataract surgery and surgical correction of refractive defects have undergone big changes in the last few years. As it happens in any branch of science, the scientific need to resort to philosophy within this specialty since the former has its own impact on the development of eye surgery. This is mainly due to the fact that knowledge should be interrelated with other sciences and that the significance of visual loss or inadequate treatment for both the patients and the society. The group of authors of this paper is committed to delve into this issue, because it will be difficult to meet the health goals of the millennium if this topic is not given due consideration.

Morfina intratecal como analgésico postoperatorio en la corrección quirúrgica de escoliosis / Intratecal morphine as a preoperative analgesic in the surgical correction of scoliosis

Introducción: la escoliosis, entidad frecuente en Cuba, es fuente de preocupación e investigación por su repercusión estética y afecciones funcionales que produce. Su tratamiento definitivo es quirúrgico y el dolor es una molestia significativa para estos pacientes en el postoperatorio. Objetivos: caracterizar el desempeño de la morfina intratecal como analgésico postoperatorio en la corrección quirúrgica de escoliosis. Métodos: análisis del dolor postoperatorio de 24 pacientes portadores de escoliosis idiopática con curvaturas mayores o iguales a 40 grados divididos en un grupo «Estudio¼ receptor de morfina intratecal y un grupo «Control¼ con tratamiento convencional. Análisis estadístico con la prueba t, ANOVA, Chi-cuadrado, Odds Ratio y Correlación Lineal de Spearman con un nivel de significación de 5 %. Resultados: ambos grupos no exhibieron diferencias estadísticamente significativas respecto a edad, sexo, peso corporal, estado físico ASA, grado de escoliosis y tiempo quirúrgico pero difirieron significativamente en la analgesia de rescate requerida en la totalidad de los controles y en menos de la mitad del grupo Estudio. Solo un paciente del grupo Estudio no presentó efectos adversos atribuibles a la morfina. Los dos grupos revelaron diferencias estadísticamente significativas en relación al dolor postoperatorio a las 3, 6, 12 y 48 horas, no así a las 24 horas. Conclusiones la morfina intratecal fue altamente efectiva para disminuir el dolor postoperatorio con desempeño superior al tratamiento convencional. La incidencia y severidad de los efectos colaterales fueron aceptables y fácilmente controlables, no se presentó ninguna complicación.

Introduction: scoliosis, a frequent entity in Cuba, is a source of concern and research due to the esthetic repercussion and functional affections that produces. Surgery is the definite treatment and the pain is a significant bother for patients in postoperative. Objective: to characterize the behavior of intratecal morphine as a postoperative analgesic in the surgical correction of scoliosis. . Methods: analysis of postoperative pain in 24 patients who suffer from idiopathic scoliosis with main curvatures or equal to 40 degrees divided into a study group as a receptor of intratecal morphine and a control group with a conventional treatment. Statistical analysis with the T test , ANOVA, Chi-squared, Odds Ratio and Linear Correlation of Spearman with a level of significance of 5 %. . Results: both groups did not show significant statistical differences as to age, sex. body weight, ASA physical conditions, degree of scoliosis and surgical time but they differed significantly in the rescue analgesia in all controls and in less than the half of the study group. Only one patient of the group study did not show side effects attributed to morphine. Both groups revealed statistical differences in relation to postoperative pain at 3, 6, 12 y 48 hours, but not at 24 hours. Conclusions: intratecal morphine was effective to reduce postoperative pain with a higher behavior to conventional treatment. Incidence and severity of side effects were acceptable and easily controllable, there was no complication.

Changes of Spinopelvic Parameter using Iliac Screw In Surgical Correction of Sagittal Imbalance Patients

STUDY DESIGN: A retrospective-based study. OBJECTIVES: To evaluate the usefulness of iliac screws in the surgical correction of sagittal imbalance by changes of spinopelvic parameters. SUMMARY OF LITERATURE REVIEW: Although reports exist regarding the fusion rates on lumbosacral fusion by iliac screws, no previous studies address the issue of changes of spinopelvic parameters on surgical correction of sagittal imbalance by iliac screws. MATERIALS AND METHODS: We analyzed a total of 23 patients who were operated on by pedicle subtraction osteotomy and posterior fusion on sagittal imbalance. Patients were divided into two groups: 1) non-iliac screw fixation and; 2) iliac screw fixation. The two groups were compared during the preoperative and postoperative stages, and the last follow-up spinopelvic parameters of two groups. RESULTS: Spinopelvic parameters, except for pelvic incidence, were corrected after surgery; some corrected values of spinopelvic parameters were lost during follow-up. There was a statistically significant difference in the last follow-up period between lumbar lordosis and pelvic tilt. Values of postoperative lumbar lordosis and pelvic tilt was similar to each other; however, during the follow-up period corrected values of spinopelvic parameters of non-iliac screw fixation group were more lost. There were no statistically significant changes in postoperative and last follow-up sacral slope and pelvic incidence. CONCLUSIONS: Sagittal imbalance could be corrected by pedicle subtraction osteotomy, and corrected values of lumbar lordosis and pelvic tilt of iliac screw fixation group could be maintained well compared to non-iliac screw fixation. Iliac screw fixation could be useful for maintenance of corrected values of spinopelvic parameters in surgical correction of sagittal imbalance.

Application of femoral neck anteversion′s correction in the treatment of children′s developmental dysplasia of the hip / 重庆医学

Objective To discuss application of femoral neck anteversion′s correction in the treatment of children′s developmen-tal dysplasia of the hip .Methods 98 children diagnosed DDH from Jan 2006 to Jan 2010 were treated and followed up ranging from 12 to 48 months ,average 32 months .Before the operations ,FNA index were evaluated by X-ray and thin slice hip joint scan and 3D reconstruction to guide the rotary osteotomy .After the operations ,FNA index were rechecked .Results According to Mckay′s clas-sification ,clinical assessment was performed .84 hips were evaluated as excellent (73 .68% ) ,20 hips as good(17 .55% ) ,10 hips as acceptable(8 .77% ) ,and no poor hip (0% ) was reported .FNA decreased averagely 16 .3° ± 2 .0° .FNA had significant difference with themselves before the operations(P0 .05) .Conclusion The change of FNA is one of the most important pathological changes .FNA′s correction is one of the most valuable to guarantee success operation .

Surgical Correction of Hallermann-Streiff Syndrome: A Case Report of Esotropia, Entropion, and Blepharoptosis

We report a case of surgical treatment for Hallermann-Streiff syndrome in a patient with ocular manifestations of esotropia, entropion, and blepharoptosis. A 54-year-old man visited Yeouido St. Mary's Hospital complaining of ocular discomfort due to cilia touching the corneas of both eyes for several years. He had a bird-like face, pinched nose, hypotrichosis of the scalp, mandibular hypoplasia with forward displacement of the temporomandibular joints, a small mouth, and proportional short stature. His ophthalmic features included sparse eyelashes and eyebrows, microphthalmia, nystagmus, lower lid entropion in the right eye, and upper lid entropion with blepharoptosis in both eyes. There was esodeviation of the eyeball of more than 100 prism diopters at near and distance, and there were limitations in ocular movement on lateral gaze. The capsulopalpebral fascia was repaired to treat the right lower lid entropion, but an additional Quickert suture was required to prevent recurrence. Blepharoplasty and levator palpebrae repair were performed for blepharoptosis and dermatochalasis. Three months after lid surgery, the right medial rectus muscle was recessed 7.5 mm, the left medial rectus was recessed 7.25 mm, and the left lateral rectus muscle was resected 8.0 mm.

Cornaje del recién nacido por estenosis congénita de la apertura piriforme: serie de casos / Stertor in the newborn due to congenital nasal pyriform aperture estenosis: case series

El cornaje es un ruido generado por la alteración del flujo de aire al pasar por las fosas nasales. La principal causa en recién nacidos y lactantes es la rinitis inflamatoria o infecciosa. Con menor frecuencia, puede ser de origen congénito, neoplásico, traumático o iatrogénico.La estenosis congénita de la apertura piriforme es una etiología infrecuente de obstrucción nasal en el neonato. El diagnóstico precoz y el tratamiento apropiado son esenciales debido a surespiración nasal obligada. La dificultad o la imposibilidad de hacer progresar una sonda de 2,8 mm (sonda K30) a través de la región anterior de las fosas nasales, permiten sospecharla.El diagnóstico debe ser confirmado por una tomografía computada del macizo craneofacial. La conducta terapéutica dependerá de la gravedad de los síntomas.Describimos nuestra experiencia con 9 pacientes que presentaban esta patología cuya corrección quirúrgica fue exitosa.

Stertor is a noise generated by the disturbance of the air flow passing through the nose. Its main cause –in newborns and infants– is inflammatory or infectious rhinitis. Congenital,neoplastic, traumatic or iatrogenic causes are less frequent. Congenital stenosis of the pyriform aperture is a rare etiology of nasal obstruction in the neonates. Early diagnosis and appropriate treatment are essential because of their exclusive nasal breathing. Suspicion might arise when a difficulty or even an impossibility to pass a probe of 2.8 mm (K30 tube) through anterior nares, exists. Diagnosis should be confirmed by a computed tomography of the craniofacial massif. The therapeutic behavior will depend on the severity of symptoms. We describe our experience with nine patients with this conditionwhose surgical correction was successful.

Comparison between Operated Muscular Dystrophy and Spinal Muscular Atrophy Patients in terms of Radiological, Pulmonary and Functional Outcomes

STUDY DESIGN: Retrospective comparative study. PURPOSE: To study and compare the surgical outcomes of muscular dystrophy (MD) and spinal muscle atrophy (SMA). OVERVIEW OF LITERATURE: There are few reports that have evaluated and compared the surgical outcomes of MD and SMA patients. METHODS: The patients (n = 35) were divided into two groups: a MD group with 24 patients and a SMA group with 11 patients. The average follow-up period was 21 months. All patients were operated for scoliosis correction using posterior instrumentation and fusion. In the immediate postoperative period, all efforts were made to reduce the pulmonary complications using non-invasive positive pressure ventilation and a coughing assist devices. The patients were evaluated by radiograph in terms of the Cobb's angle, pelvic obliquity, T1 translation, thoracic kyphosis and lumbar lordosis. The pulmonary function and self-image satisfaction were also assessed. RESULTS: There was a lower correction rate in the MD group (41.5%) than in the SMA group (48.3%), even though the curves were smaller in the MD group. The correction in the pelvic obliquity was significantly better in the SMA group (p = 0.03). The predicted vital capacity showed a 4% reduction in the MD group 1 year after surgery, while the SMA group showed a 10% reduction. The peak cough flow and end tidal PCO2 did not deteriorate and were well maintained. The average score for the improvement in self-image satisfaction postoperatively was 3.96 and 4.64 for the MD and SMA groups, respectively. The total complication rate was 45.7%; 14.3% of which were respiratory-related. CONCLUSIONS: Surgical intervention for MD and SMA may be performed safely in patients with a very low forced vital capacity (< 30%) through aggressive preoperative and postoperative rehabilitation efforts.

Correction of complete bilateral cleft lip by using post nasal septal arterie's flap / 中华医学美学美容杂志

Objective To develop a new method for correction of the deformity of the complete bilateral cleft lip with short pre-lip. Methods Two specimens with the complete bilateral cleft lip was chosen to investigate the arterial supply to the pre-lip. The arteries were observed by radiography when the specimen was infused with lead oxide. 16 patients with the complete bilateral cleft lip and shortage in the length of pre-lip were enrolled in this study. Taking advantage of the unique character of arterial supply of complete bilateral cleft lip, those with short pre-lip were corrected. Photos of them were taken when preand post-operation for further measurement. And more than 1 year following-up was conducted to judge if the results were good enough or not. 30 babies were chosen as a control group to confirm the results of surgury objectively. Results Post nasal septal arteries were found to supply the pre-lip of the bilateral complete cleft lip. Appearance of 16 patients was good after surgery or 1 years later. There was no statistical significant difference between the patients and control group in the measurement data but nasal-lip angle. Conclusion It is an effective way to correct deformity of the bilateral cleft lip with short pre-lip by taking advantage of post nasal septal arterie's flap.

Pênis curvo congênito chordee / Congenital penile curvature chordee

O chordee é a causa mais comum de curvatura ventral na hipospadia e também em muitos casos de curvatura ventral sem hipospadia esta última não é muito assinalada. A curvatura ventral sem hipospadia é um defeito congênito decorrente da ação insuficiente dos hormônios produzidos pelos testículos, os quais estimulam o desenvolvimento masculino. Clinicamente, chordee sem hipospadia é uma curvatura ventral entretanto, o meato da uretra está localizado em sua posição normal na glande e o tecido fibroso é o principal responsável pelo encurvamento. Para a correção da angulação do pênis, várias técnicas cirúrgicas têm sido descritas. Todavia, adotando um conceito diferente sobre a curvatura ventral, tenho utilizado o método progressivo para corrigir a deformidade. Acredito que, em princípio, a clássica excisão do tecido fibroso da face ventral até o meato uretral é o procedimento mais apropriado e frequentemente será suficiente para conseguir a adequada retificação do falo.