Linfoma de células T/natural killer extranodal de tipo nasal enmascarado en una sinusopatia

Introducción: El linfoma de células T citotóxico/natural killer extranodal de tipo nasal es poco frecuente, pero con alta tasa de mortalidad. Las manifestaciones clínicas de la enfermedad pueden simular una infección de senos paranasales. Objetivo: Presentar las manifestaciones clínicas de un paciente de 34 años de edad con diagnóstico de linfoma de células T citotóxico/natural killer extranodal de tipo nasal. Caso clínico: Se presenta un paciente masculino de 34 años de edad con rinorrea verdosa fétida recurrente y obstrucción en fosa nasal derecha. En la evaluación inicial sugiere sinusitis crónica, sin embargo, debido al empeoramiento de las manifestaciones clínicas se realiza una tomografía computarizada que muestra lesiones sugestivas de infiltración neoplásica, una biopsia de la lesión confirma el diagnóstico de linfoma de células T/natural killer extranodal de tipo nasal. Conclusiones: Los linfomas de células T citotóxico/natural killer extranodal de tipo nasal son considerados neoplasias poco frecuentes, caracterizadas por el patrón rápidamente progresivo con afectación ósea; en su etapa inicial presenta manifestaciones clínicas similares a una sinusitis. La tomografía computarizada y la histopatología, son indispensables en el diagnóstico de la enfermedad.

Introduction: Nasal-type extranodal natural killer/cytotoxic T-cell lymphoma is rare but has a high mortality rate. The clinical manifestations of the disease can mimic a paranasal sinus infection. Objective: To present the clinical manifestations of a 34-year-old patient diagnosed with nasal-type extranodal natural killer/cytotoxic T-cell lymphoma. Clinical case: A 34-year-old male patient with recurrent greenish fetid rhinorrhea and obstruction in the right nostril is presented. In the initial evaluation, it suggests chronic sinusitis, however, due to the worsening of the clinical manifestations, a computed tomography is performed that shows lesions suggestive of neoplastic infiltration, a biopsy of the lesion confirms the diagnosis of T-cell lymphoma/extranodal natural killer. Conclusions: Nasal-type extranodal natural killer/cytotoxic T-cell lymphomas are considered rare neoplasms characterized by a rapidly progressive pattern with bone involvement; in its initial stage it presents clinical manifestations similar to sinusitis. Computed tomography and histopathology are essential in the diagnosis of the disease.

Comparison of early complications of midline catheter and peripherally inserted central catheter in intravenous infusion: a Meta-analysis / 中国实用护理杂志

Objective:To analyze and compare the incidence of catheter related complications between midline catheter (MC) and peripherally inserted central catheter(PICC) within 30 days. Provide guidance and basis for medical staff to choose appropriate intravenous infusion tools to prevent catheter related complications.Methods:The randomized controlled trials, clinical controlled trials and cohort studies about MC and PICC related complications were searched in PubMed, Web of Science, Cochrane Library, Embase, EBSCO, Ovid, CNKI, VIP, Wanfang database and CBM, which were published at home and abroad up to December 31, 2021. After screening the literatures, extracting data and quality evaluation according to the inclusion and exclusion criteria, RevMan5.4 software was used for statistical analysis.Results:A total of ten articles were included in this study, including two randomized controlled trials, a clinical controlled trials, a prospective cohort study and six retrospective cohort studies, with 12 765 cases in MC group and 33 783 cases in PICC group. The results of Meta-analysis showed that the incidences of catheter-related bloodstream infection and catheter displacement in MC group were significantly lower than those in PICC group ( RR=0.37, 95% CI 0.18-0.76, P<0.05; RR=0.49, 95% CI 0.25-0.97, P<0.05). Conclusions:Compared with PICC in the early stage of intravenous infusion, MC is safer and more effective. When continuous infusion of isotonic or near-isotonic medications is required, and there is no need for continuous vesicant medications, MC can be preferred. However, more large-sample and high-quality studies are still needed to provide a basis for the popularization of MC in China.

Panhypopituitarism and bifid uvula / Journal of the ASEAN Federation of Endocrine Societies

@#A 20-year-old male was referred to the Endocrinology Clinic in view of abnormal thyroid function test result and poor development of secondary sexual characteristics. He was born out of non-consanguineous marriage and had a history of breech delivery at term. He had perinatal complications in the form of delayed cry and lower respiratory tract infection. Developmental delay was also present (delayed motor, speech and social milestones). His scholastic performance was below average and he reported being the shortest child in class from kindergarten.

Revisión bibliográfica: ecografía intraparto / Review: intrapartum ultrasound

The evaluation of labor is the clinical process by which variables are analyzed in order to determine whether the patient is in labor, which by definition includes regular uterine contractions that increase in frequency and intensity, associated with dilation cervical. This is done through the anamnesis and physical examination, specifically through the evaluation of contractions and vaginal examination, the latter is intended to specify the degree of dilation, cervical effacement that the patient presents and also allows to a certain degree, establish the presentation, attitude and variety of position in which the fetus is located. From this premise, it is proposed that vaginal examination, since it is operator dependent, is not an objective evaluation, therefore, there is a need to reach consensus on the evaluation, and in order to carry it out, evaluation with ultrasound is proposed, which has as a purpose to objectify the variety of position and presentation of the fetus. Due to the above, this article aims to capture the knowledge that is currently possessed about the uses and methodology that intrapartum ultrasound presents.

Midline diastema closure using a lithium disilicate glass ceramic fragment: increased long-term color stability"

ABSTRACT: Nowadays, maxillary midline diastema (MMD) can be treated with different multidisciplinary approaches. When restorative dentistry is needed, glass-matrix ceramic materials is one of the best choices, since they present good optical behavior and high survival rates in the anterior dentition. To obtain an adequate interphase, and color integration are one of the main restorative goals, and for that purpose, specific finishing and polishing procedures must be employed to avoid staining and ensure the restoration's color stability. In the case report presented in this article, a single lithium disilicate ceramic fragment was performed to close a MMD produced by the shape alteration of one of the maxillary central incisors. Also, the finishing and polishing procedure is discussed.

Imaging and clinical features of NUT gene-related carcinoma in the nasal cavity and sinus / 中华放射学杂志

Objective:To assess the clinical and imaging features of NUT gene-related sinonasal carcinomas (NUT midline carcinome).Methods:The clinical data and pretreatment imaging findings of 5 cases with pathologically proven NUT sinonasal carcinomas were analyzed retrospectively in Beijing Tongren Hospital, Capital Medical University from January 2016 to December 2020. Of 5 cases, the tumors affected 4 females and 1 male with an age range of 15 to 48 years (median 19 years). Clinical data of all cases were available before surgery with both CT and MR examination. Tumor location, CT density, boney change, calcification, tumor size, T 1WI, T 2WI and diffusion weighted imaging (DWI) signal intensity, appearance diffusion coefficient (ADC), type of time intensity curve (TIC) of dynamic contrast-enhanced (DCE)-MRI were evaluated. Results:All five cases belonged to T4 stage of the clinic TNM system. The locations were nasal cavity ethmoid, sphenoid and maxillary sinus ( n=1), nasal and maxillary sinus ( n=1), nasal cavity and ethmoid sinus ( n=3). Iso-attenuated in 3 cases, heterogeneous with local necrosis in 2 cases, and heterogeneous with calcification in 3 cases on CT imaging. Bone erosion was found in 4 cases, and bone erosion with destruction in 1 case. The tumor sizes ranged from 4.2 to 4.9 cm (median 4.5 cm) on MR axial imaging. On T 1WI, 5 cases showed isointense compared with adjacent temporal muscles, with focal hypointense in 2 cases. On T 2WI, the tumor was graded as isointense in 3 cases, and hyperintense in 2 cases. Heterogeneous enhancement in all cases with mild in 3 cases, and moderate in 2 cases on postcontrast MR imaging. On DCE-MRI of 5 cases, there were 3 cases of type Ⅲ (washout-shaped curves), and 2 cases of type Ⅱ of the TIC (plateau-shaped curves). The range of ADC values was from 0.63×10 -3 to 1.17×10 -3 mm 2/s, and median ADC value was 0.84×10 -3 mm 2/s, of 5 cases with varying degrees of high signal on DWI. The Ki-67 index ranged from 30% to 80% of the tumor. An immunohistochemical study showed that the tumor cells of 5 cases were all positive for both NUT and INI-1 genes. One case was performed with biopsy and followed by chemotherapy, four cases were performed with surgery, combined with the following chemotherapy, and one also was implemented with radiation therapy. The follow-up time was 7-16 months. Five cases were all alive during the follow-up. Conclusions:The NUT midline sinonasal tract carcinoma is a rare, gene-related solid malignant tumor. The tumor is more commonly seen in young patients, mostly centered in the nasal and ethmoid region with invasive growth, more calcification on CT, and heterogeneous enhancement on MRI. These findings are some characteristics of the tumor.

Clinical efficacy of off-midline closure techniques for treatment of chronic pilonidal sinus / 中华医学美学美容杂志

Objective:To evaluate the clinical efficacy of off-midline closure technique in the treatment of chronic pilonidal sinus.Methods:From July 2014 to July 2018, 59 patients suffered from chronic pilonidal sinus treated by off-midline closure were admitted to the Department of Proctology, Linyi Central Hospital, including 34 males and 25 females. According to the size and scope of the chronic pilonidal sinus, the off-midline flap was designed and sutured.Results:In this group of 59 patients, there were 52 cases of primary healing and 7 cases of incision complications, such as partial incision dehiscence and subcutaneous effusion. After follow-up for 2 years, no recurrence was observed. The scar was not obvious after wound healing. The patient was satisfied with the postoperative appearance.Conclusions:Using the off-midline closure technique to treat chronic pilonidal sinus can deviate from the midline to make the suture tension-free and the gluteal groove elevated. It not only effectively reduce the complication rate in patients, but also has high cure rate, low recurrence rate and does not affect appearance.

El reto del aneurisma de la aorta abdominal para especialistas en medicina general integral e internistas / The challenge of abdominal aortic aneurysm for general practitioners and internists

El aneurisma de la aorta abdominal es una enfermedad asintomática, frecuente en los adultos mayores del sexo masculino. Su aparición está asociada a enfermedades crónicas no transmisibles como la hipertensión arterial, la enfermedad arterial periférica, la diabetes mellitus, entre otras. A nivel comunitario constituye un problema de salud el diagnóstico tardío de la entidad en pacientes con factores de riesgo, por lo que se decide realizar el artículo de revisión con el objetivo de actualizar los aspectos de diagnóstico clínico, imagenológico, terapéutico y la conducta a seguir ante un paciente con sospecha de aneurisma de la aorta. Se realizó una revisión exhaustiva del tema en bases de datos como SciELO, MEDISAN, Revistas de Angiología y Cirugía Cardiovascular. Para lograr mejores resultados en el diagnóstico precoz y la atención a los pacientes con aneurisma de la aorta abdominal, es necesario mantener la actualización del tema, el uso del método clínico y el trabajo en conjunto de la atención primaria con el nivel secundario(AU)

Abdominal aortic aneurysm is an asymptomatic disease, common in older males. Its appearance is associated with chronic non-communicable diseases such as arterial hypertension, peripheral arterial disease, diabetes mellitus, among others. At the community level, the late diagnosis of the entity in patients with risk factors constitutes a health problem, so it was decided to carry out the review article with the aim of updating the clinical, imaging and therapeutic aspects of diagnosis and the behavior to be followed in a patient with suspected aortic aneurysm. We conducted an exhaustive review of the subject in databases such as SciELO, Medisan, Magazines of Angiology and Cardiovascular Surgery. To achieve better results in the early diagnosis and care of patients with abdominal aortic aneurysm, it is necessary to keep up-to-date on the subject, the use of the clinical method, and the joint work of primary care with the secondary level(AU)

Quiste dermoide nasofrontal: presentación de un caso y revisión narrativa / Nasofrontal dermoid cyst: case presentation

Las lesiones de la región nasofrontal en los niños son un reto diagnóstico debido a su rareza, y su potencial comunicación con el sistema nervioso central también aumenta su complicaciones. Dentro de las principales entidades de esta región se encuentran los quistes dermoides, los gliomas nasales y los encefaloceles. Un abordaje diagnóstico y terapéutico inapropiado podría generar desde simples recurrencias hasta fistulas e infecciones en el sistema nervioso central, que podrían contribuir a mayores complicaciones o incluso, poner en riesgo la vida de los pacientes.

Injuries to the naso-frontal region in children are a diagnostic challenge, associated with their rarity, their complexity also implies their potential communication with the central nervous system. Dermoid cysts, nasal gliomas, and encephaloceles are among the main entities in this region. An inappropriate diagnostic and therapeutic approach could generate from simple recurrences (as in our case), to fistulas and infections of the central nervous system that could contribute to greater complications or even put the lives of patients at risk.

Extensa lesión necrotizante de la línea media inducida por uso de cocaína

Resumen El diagnóstico diferencial de las lesiones destructivas de la línea media es amplio y complejo debido a su presentación clínica poco específica, pudiendo abarcar desde cuadros infecciosos, neoplásicos y patologías autoinmunes. Una entidad a considerar son las lesiones destructivas de la línea media inducidas por cocaína (CIMDL), la que se caracteriza por una extensa destrucción de estructuras a nivel medio-facial. Se presenta el caso de un paciente con antecedentes de consumo de cocaína con una gran lesión destructiva endonasal asociada a una perforación palatal, fiebre, cervicalgia y meningismo. Se realizó un estudio nasofibroscópico y exámenes de laboratorio donde destaca un leve aumento de parámetros inflamatorios y serología positiva para anticuerpos anticitoplasma de neutrófilo (ANCA). Los exámenes imagenológicos destacan una trombosis de carótida interna derecha, osteítis del clivus y paquimeningitis retroclival. Se decide ingresar a pabellón para realizar un aseo y tomar biopsias. Al descartar los diagnósticos diferenciales de CIMDL, el paciente inició terapia antibiótica y antifúngica endovenosa evolucionando en forma satisfactoria. La CIMDL es una condición infrecuente cuyo principal diagnóstico diferencial es la granulomatosis con poliangeitis. Dada similitud en las presentaciones clínicas y la gran diferencia en el manejo de ambas patologías la necesidad de un diagnóstico certero es fundamental.

Abstract Differential diagnosis of destructive midline injuries is complex due to its nonspecific clinical presentation, and the broad variety of conditions that share the same signs and symptoms, such as infections, neoplasms and autoimmune diseases. One of the etiologies that should be considered is cocaine-induced destructive midline lesions (CIMDL), cha- racterized by extensive destruction of midface structures. The following case describes a patient with history of cocaine abuse with a large destructive endonasal lesion asso- ciated with a palatal perforation, fever, cervicalgia and meningism. Clinical assessment included a nasofibroscopy and laboratory tests. Results revealed a slight increase in in- flammatory parameters and positive antineutrophil cytoplasmic antibody serology. Ad- ditionally, imaging revealed a thrombosis of the right internal carotid, clivus osteitis, and retroclival pachymeningitis. Surgical debridement was performed, and biopsies of the nasal cavity were taken. Once the other possible diagnoses were ruled out, the patient was started on intravenous antibiotic and antifungal therapies. The patient showed a positive response to treatment and was successfully discharged after two months. CIMDL is a rare condition whose main differential diagnosis is granulomatosis with polyangiitis. Given the similarity in clinical presentations and the important differences in the management of both pathologies, the need for an accurate diagnosis is essential.

Rehabilitación estética asistida por diseño digital de sonrisa en asimetrías dentofaciales: Reporte de caso / Aesthetic rehabilitation assisted by digital smile design for dentofacial asymmetries: Case report

RESUMEN: Tradicionalmente se ha propuesto una coincidencia entre la línea media facial y dentaria como requisito para transmitir una impresión de simetría, balance y armonía estética. Sin embargo, esta situación puede ser compleja de lograr en rostros asimétricos, impulsando el desarrollo de nuevos protocolos de análisis dentofacial para obtener resultados armónicos y conservadores integrando las estructuras anatómicas que se desvíen de las normas establecidas. Caso: El objetivo de este reporte de caso es presentar una rehabilitación estética integral en base a prótesis fija unitaria libre de metal, asistida por diseño digital de sonrisa, en un paciente con asimetría facial utilizando el concepto de flujo facial (FF) como protocolo de análisis estético dentofacial. Conclusiones: El concepto de FF establece parámetros estéticos dentro de rangos de armonía, permitiendo planificar rehabilitaciones más conservadoras. Sin embargo, faltan estudios para determinar el impacto de este análisis.

ABSTRACT: The traditional aesthetic parameters demand a coincidence between the facial and dental midlines that transmits an impression of symmetry, balance and harmony. However, the complexity of achieving this standard in faces with large asymmetries, has driven to the development of new dentofacial analysis protocols such as the concept of facial flow (FF), in order to obtain harmonic and conservative results integrating the structures that deviate from the norm. Case: The aim of this case report is to present an integral aesthetic rehabilitation based on metal-free fixed prostheses assisted by digital smile design in a patient with facial asymmetry using the concept of FF. Conclusions: The use of dentofacial aesthetic analysis protocols such as FF aids in the development of harmonic and less invasive dental treatments. However, due to the recent appearance of the FF concept, further studies are needed to reveal the implications of this analysis.

Role of Magnetic Resonance Venogram as a Tool in Planning for Various Neurosurgical Operations

Objectives and methodology: Exact localization of superficial cortical veins is very important in planning for avoiding venousinjuries. Cod liver oil capsules were placed on anterior and posterior ends of medial and lateral border of the tumor at scalpaccording to location of tumor and thus tumor boundaries were marked. Then 3DCEMRV and 2DTOF images were taken andthen superficial cortical vein studied in marked area for comparison between both modalities of MRV and planning of surgeryfor avoiding venous injury.Results: Most of the cases were in age group 16-60 years (89%). Most common clinical manifestation was headache (86.2%)and meningioma (58.2%) was found to be most common pathology. Clear depiction and morphology of superficial corticalvein was observed in 58 cases (100%) in 3DCEMRV as compared to 2DTOF 24 cases (41.3%) P <0.001S. Clear depictionand morphology of superior sagittal sinus was observed in 58 cases (100%) in 3DCEMRV as compared to 2DTOF 33 cases(60.3%) P <0.001S. In post operative CT Head, we found 6 (10.3%) cases of venous infarction. 7 patients (12%) developedmotor weakness post operatively. In 3 cases, post operative MRV were done and found no venous injury.Conclusion: This study showed that preoperative marking of tumor area and associated venous anatomy with the help of codliver oil capsule and MRV was very helpful in planning the surgery and to avoid injury of the vein. 3DCEMRV was found to bebetter modality than 2DTOF for delineation of veins.

Lesiones destructivas de la línea media: diagnóstico diferencial con Vasculitis Asociada a ANCA / Destructive lesions of midline: differential diagnosis with ANCA-associated Vasculitis

Presentamos los casos clínicos de tres pacientes adultos jóvenes de origen boliviano, que fueron hospitalizados en salas de clínica médica de un hospital de tercer nivel por manifestaciones de la vía aérea superior y lesiones de las estructuras de la línea media. Reumatología evaluó la posibilidad del diagnóstico de Vasculitis asociada a ANCA, la cual es un diagnóstico diferencial de la entidad conocida como "lesión destructiva de la línea media". En todos los casos se arribó al diagnóstico definitivo de Linfoma T luego de un exhaustivo estudio histopatológico.

We present clinical cases of three Bolivian young adults who were hospitalized in the medical clinic rooms of a third level hospital for upper airway manifestation and lesions of the midline structures. Rheumatology service evaluated the diagnosis of ANCA associated Vasculitis, which is a differential diagnosis of the entity known as midline destructive lesion. In all cases, the final diagnosis of T lymphoma was reached after an exhaustive histopathological study.

Abdominal midline wound closure with small bites versus large bites: a randomized comparative trial

Background: The optimal strategy of abdominal wall closure after midline laparotomy has remained an issue of ongoing debate to minimize incidence of incisional hernia which occurs in 10 to 23% cases postoperatively. The main objective of the study was to evaluate the efficacy of small bites versus large bites suture technique in reduction of incidence of the complications like pain, wound infection, wound dehiscence, seroma formation and incisional hernia by using polydioxanone no.1.Methods: The present study was conducted on 100 patients undergoing elective surgery who were randomly allocated into group A and B. Group A were the patients in which midline abdominal wound closure was done with small bites and group B were the patients in which midline abdominal wound closure was done with large bites. Then the patients were followed up for 6 months to observe any complications.Results: A mean additional closure time of 9 minutes was seen with the small bites technique. The mean suture length was more in small bites group as compared to large bites technique. There was no difference in the visual analog scale score between the two groups. No significant difference was seen in the incidence of major and minor wound infection postoperatively in both the groups. Small bites technique reduced the incidence of suture sinus and incisional hernia compared to conventional large bites technique.Conclusions: It can be concluded that the small bites suture technique is more effective than the traditional large bites technique for prevention of all post-operative complications.

Sinonasal NUT midline carcinoma: A new histological entity

Nuclear protein in testis (NUT) midline carcinoma is poorly differentiated carcinoma defined by rearrangement of NUT gene on 15 to other genes, usually BRD4 on 19. It is first described in 1991. These tumors are most commonly seen in the mediastinum and 35% occur in head and neck. It is a highly aggressive tumor with a median survival of 7 months because of ineffective chemotherapy and undefined treatment. Hence, we must differentiate these tumors from other poorly differentiated tumors. Here, we present a case of NUT midline carcinoma of 44-year male, who presented with headache and dizziness, confirmed by immunohistochemistry of NUT antibody. The aim of this case report is to increase the awareness about this entity in adults with brief review of relevant literature.

Comparison of efficacy of large tissue bites versus small tissue bites for midline abdominal wound closure

Background: Incisional hernia is common complication after median laparotomy, with reported incidence varying between 2% and 20%. For prevention of incisional hernia, many clinical trials and meta-analyses have demonstrated that mass closure technique with simple running suture is good option to close midline incision. An attempt was made in this study to compare efficacy of large tissue bites vs small tissue bites for midline abdominal wound closure.Methods: Three hundred thirty patients admitted for midline laparotomy were randomized into Group A, and Group B. Group A, and Group B patients underwent abdominal closure by small bites technique, and large bites technique respectively. Patients were followed at 7th postoperative day, 1 month, 6 months, and 12 months. Primary outcome measures were incidence of incisional hernia, incidence of postoperative complications like post-operative pain, surgical site infections, wound dehiscence whereas, secondary outcome measure was fascial closure time. Inter-group comparison of categorical, and continuous variables was done using Chi-square test/Fisher’s exact test and unpaired ‘t’ test respectively.Results: Incidence of incisional hernia was significantly higher in large bites suture technique compared to small bites suture technique at 12 months follow up. Mean time required for fascial closure time was significantly higher in small bite group compared to large bite group. There was no statistically significant difference in postoperative pain, surgical site infections, and wound dehiscence among the two groups.Conclusions: The rate of incisional hernia was lower in small bites technique compared with large bites technique in midline abdominal incisions.

Midline cervical cleft: a case report

A 14-year-old boy presented with complaints of a sinus in the middle of neck, with mucoid discharge present since birth. MRI sinogram along with MRI neck was taken which revealed a sinus tract opening in midline, extending posteriorly and traversing inferiorly to end blindly above sternum. Patient was planned for an elective excision of sinus tract, with z-plasty for decreased scarring. Congenital midline cervical cleft is a rare entity that was first described in 1924. Subsequently there have been fewer than 100 cases reported in medical literature. It typically manifests at birth as a cleft at level of suprasternal notch with a pseudonipple above it. Pathogenesis of congenital midline cervical clefts remains speculative. Differential diagnosis includes thyroglossal duct cysts or branchial cleft anomalies.

Selection of perioperative venous access for simultaneous repair and reconstruction of oral cancer after radical resection / 口腔疾病防治

Objective@#To explore the characteristics of perioperative venous therapy in patients undergoing simultaneous repair and reconstruction of oral cancer after radical resection, and prevention of femoral vein catheterization complications, to provide clinical evidence for venous therapy.@*Methods@#A retrospective analysis was perfomed to assess the choice of venous access and its effects in 95 patients undergoing simultaneous reconstruction due to oral cancer during the perioperative period. @*Results @# In total, 95 patients underwent successful indwelling femoral vein catheterization with double lumens, and a midline catheter and peripheral intravenous indwelling needles were used to complete the intravenous therapy after surgery. Among the femoral vein complications, 1 case was complicated with lower extremity venous thrombosis (incidence was 1.1%), and 17 cases were complicated with puncture point bleeding (incidence was17.9%). Two cases of puncture site bleeding were noted among 28 cases using a midline catheter. Local phlebitis and infiltration were the most common complications of peripheral venous catheters. The difference in catheter-related complications among different types of catheters was statistically significant (P < 0.05). The complication rate of the midline catheter was lower than that noted with femoral vein catheterization and peripheral intravenous indwelling needles.@*Conclusion@#Based on the treatment characteristics of patients, proper venous catheters should be established during the perioperative period. The application of a femoral vein catheter during the operation combined with the use of a midline catheter and peripheral venous indwelling needles after the operation can satisfy intravenous therapy needs in patients undergoing simultaneous repair and reconstruction for oral cancer, and the midline catheter can effectively reduce venous catheter-related complications.

Lower Midline Syndrome with Undescended Testes in the Tobacco Agricultural Environment: A Case Report

@#Lower midline syndrome is a rare congenital anomaly associated with omphalocele. Undescended testes is a congenital absence of one or both testes in the scrotum. Both of lower midline syndrome and undescended testes incidence have a positive correlation with exposure of cigarette and pesticide. Tobacco agricultural environment is a vulnerable area exposed by pesticides and cigarettes. This is the case report to associated tobacco agricultural environment’s exposure with lower midline syndrome and undescended testes. We describe a case of lower midline syndrome and undescended testes that occurs in the tobacco agricultural environment. In this case we found the exposures of paternal heavy smoker, second-hand smoker, pesticides from tobacco agricultural environment and daily use of bug spray in the house. As conclusion, the exposures from tobacco agricultural environment may take a contribution to lower midline syndrome and undescended testes incidence.

Clinical study of concealed penis correction surgery based on principle of midline symmetry / 中国修复重建外科杂志

Objective: To investigate the effectiveness of concealed penis correction surgery based on the principle of midline symmetry. Methods: Between January 2016 and September 2018, 18 children with concealed penis were treated with correction surgery based on the principle of midline symmetry. All children were 3-12 years old, with an average age of 8.3 years. Physical examination showed that the penis was short; the penis body could not be exposed or be exposed too limited; the corpus cavernosum developed well. The pressure dressing was removed at 3 days after operation and the urethral tube was removed. The color of the glans, the swelling and congestion of penis and scrotum, and the blood supple of the prepuce flap were observed. Results: The operation time ranged from 47 to 54 minutes, with an average of 50 minutes. All children were followed up 3 months after operation. There was no hemorrhage and necrosis of the glans and no infection or ischemic necrosis of the flap. All patients had different degree of prepuce edema at 3 days after operation, 5 patients still had prepuce edema at 2 weeks, and the prepuce edema in all patients subsided at 3 months. All penises were exposed well after midline symmetric anastomosis with no bulky prepuce and scrotum. Conclusion: The correction surgery based on the principle of midline symmetry can be used to correct the appearance of the concealed penis effectively.