[Anthropometric assessment on prepubertal boys with hypospadias: a multicenter case series].

Objective: Anthropometric variants in prepubertal boys with hypospadias were assigned and assessed to illustrate anatomical malformation. Methods: A total of 516 prepubertal (Tanner grade Ⅰ) boys with hypospadias who were admitted to three medical centers between March 2021 and December 2021 and met the selection criteria for primary surgery were selected. The age of the boys ranged from 10 to 111 months, with an average of 32.6 months. Hypospadias were classified according to the location of the urethral defect, 47 cases (9.11%) of the distal type (the urethral defect is in the coronal groove or beyond), 208 cases (40.31%) of the middle type (the urethral defect is in the penis body), and 261 cases (50.58%) of the proximal type (the urethral defect is at the junction or proximal side of the penis and scrotum). The following indexes were measured: penis length before and immediately after operation, reconstructed urethral length, and total urethral length. Morphological indicators of the glans area, including preoperative height and width of glans, AB, BC, AE, AD, effective AD, CC, BB, the urethral plate width of the coronal sulcus, and postoperative height and width of glans, AB, BE, and AD. In which point A is the distal endpoint of navicular groove, point B is the protuberance lateral to the navicular groove, point C is the ventrolateral protuberance of the glans corona, point D is the dorsal midline point of the glans corona, and point E is the ventral midline point of the coronal sulcus. The foreskin morphological indicators, including the foreskin width, inner foreskin length, and outer foreskin length. The scrotal morphological indicators, including the left, right, and front penile to scrotum distance. The anogenital distances, including anoscrotal distance 1 (ASD1), ASD2, anogenital distance 1 (AGD1), and AGD2. Results: The penis length of the distal, middle, and proximal types decreased successively before operation, the reconstructed urethral length increased successively and the total urethral length decreased successively, these differences were all significant ( P<0.05). The height and width of the glans of the distal, middle, and proximal types significantly decreased successively ( P<0.05), but the height/width of the glans was generally close; AB value, AD value, and effective AD value significantly decreased successively ( P<0.05); there was no significant difference in BB value, urethral plate width of the coronary sulcus, and (AB+BC)/AD value between the groups ( P>0.05). There was no significant difference in the width of glans between the groups after operation ( P>0.05); AB value and AB/BE value increased successively, and AD value decreased successively, these differences were all significant ( P<0.05). The inner foreskin length in the 3 groups significantly decreased successively ( P<0.05), while the outer foreskin length had no significant difference ( P>0.05). The left penile to scrotum distance of middle, distal, and proximal types significantly increased successively ( P<0.05). ASD1, AGD1, and AGD2 significantly decreased from distal type to proximal type successively ( P<0.05). The other indicators' differences were significant only between some groups ( P<0.05). Conclusion: The anatomic abnormalities of hypospadias can be described by anthropometric indicators, which can be used as the basis for further standardized surgical guidance.

Using of Single-Layer Porcine Small Intestinal Submucosa in Urethroplasty on a Beagle Model.

Purpose: To evaluate the role of porcine small intestinal submucosa (SIS) in reducing fistula during urethroplasty and to observe its degradation process in beagle models. Methods: 22 male beagles were divided into the SIS group and control group. All animals received surgical operation to establish the hypospadias model. Urethroplasty was followed. In the SIS group, the urethra was covered with a single-layer SIS material while no SIS material covered in the control group. At the 2nd, 4th, and 12th weeks after the operation, there were 3, 3, and 5 animals in each group, respectively, sacrificed for surgical site histological examinations. The inflammation reaction and collagen hyperplasia levels were assessed. The fistula was identified by retrograde cystourethrography at the 4th and 12th weeks after the operation. Results: the incidence of urethral fistula was 25% (2/8) in the SIS group and 75% (6/8) in the control group. The inflammation reaction of SIS and control groups had no significant difference (U = 52.50, P = 0.58). The collagen fiber increased in both groups; however, the SIS group had a much more gentle increase compared to the control group (U = -0.00, P < 0.001). In the SIS group, the SIS material was roughly complete on the specimens 2 w after surgery but became loose and discontinuous 4 w after surgery and could not be found 12 w after surgery. Conclusion: The material can decrease the incidence of urethral fistula in the animal models, when used as a coverage layer. The SIS degradation process started 2 w-4 w after the operation and finished before 12 w in the animal model.

[Effect of surgical steps in primary hypospadias repair on penile length].

OBJECTIVE: To document the effect of surgical steps, including penile degloving, plate transection, dorsal plication, and fasciocutaneous coverage, in primary hypospadias repair on penile length. METHODS: A consecutive series of 209 prepubertal boys with primary hypospadias repair was included with the age ranged from 10 to 97 months (mean, 31.7 months). Intraoperative stretched penile length (SPL) was measured before operation ( n=209), and after each step, namely penile degloving ( n=152), plate transection ( n=139), dorsal plication ( n=170), and fasciocutaneous coverage ( n=209). SPLs before and after each steps or the entire operation were analyzed. The SPL was compared between plate transection group and plate preservation group, dorsal plication group and non-plication group, and plate preservation with plication group and plate preservation without plication group, respectively. Differences of SPL between before and after each steps were analyzed with factors including neourethra length, rest dorsal penile length, rest ventral penile length, preoperative SPL, and the degree of penile curvature after penile degloving, with multivariate linear regression analysis. RESULTS: All the four steps resulted in SPL difference. The SPL increased after penile degloving and plate transection ( P<0.05), and decreased after dorsal plication and fasciocutaneous coverage ( P<0.05). The SPL increased after all steps were completed ( P<0.05). In patients with plate transection, postoperative SPL increased when compared with that before operation ( P<0.05). No significant difference was noted in patients without plate transection ( P>0.05). And there was significant difference in the increased length of SPL between patients with and without plate transection ( P<0.05). In patients with dorsal plication, a significant increase of postoperative SPL ( P<0.05) was noted. No significant difference was noted in patients without dorsal plication ( P>0.05). And there was no significant difference in increased length between patients with and without dorsal plication ( P>0.05). When patients with plate transection were excluded, dorsal plication resulted in no significant difference on postoperative SPL ( P>0.05). The increased length of SPL after penile degloving, dorsal plication, or cutanofascial coverage was not related to the neourethra length, the rest dorsal penile length, the rest ventral penile length, the preoperative SPL, and the degree of penile curvature ( P>0.05). However, the neourethra length and preoperative SPL were the influencing factors for the increased length of SPL after plate transection ( P<0.05). CONCLUSION: The main steps in primary hypospadias repair can change SPL. The lengthening effect of plate transection would not be counteracted by dorsal plication. Dorsal plication makes no significant difference on postoperative SPL.

Robot Surgery for Midline Cysts of the Prostate With Hypospadias in the Pediatric Population.

OBJECTIVE: To summarize the experience of using robotic surgery to treat midline cysts (MLC) of the prostate in pediatric patients with hypospadias, and to introduce and evaluate the initial outcome of seminal passage reconstruction via robot-assisted laparoscopy during the removal of symptomatic MLCs. PATIENTS AND METHODS: We included a case series of 17 symptomatic MLCs with hypospadias. All patients received both genetic and fertility evaluation. MLCs were removed via robot-assisted laparoscopy and the seminal passage was reconstructed in 7 patients. RESULTS: Five patients were assessed as fertile as adults, while the other 12 were assessed as infertile. All 17 patients received robot-assisted laparoscopic surgery to remove MLCs, and 7 patients received reconstruction of the seminal passage. Patients were followed-up for 5-24 months; there were no serious adverse events except for 1 patient who experienced a single occurrence of epididymitis 7 months after reconstruction of the seminal passage. There were no significant cystic remnants in any of the patients upon ultrasonography and/or urethrography after surgery. Urethroscopy and vasography were performed in 2 patients after reconstruction; in both cases, unobstructed seminal passages were indicated. CONCLUSION: Reconstruction of the seminal passage is practical when carried out by robot-assisted techniques. Initial results indicated that the reconstruction operations were able to restore patency in the seminal duct in some of the patients. Fertility is the goal of this technique, and long-term follow-up is needed.

Oncocytic adrenocortical tumor with uncertain malignant potential in pediatric population: A case report and review of literature.

BACKGROUND: Oncocytic adrenocortical tumor (OACT) is rare, with few cases reported in the literature. No more than 20 cases in children have been reported. The clinical characteristics, diagnosis, treatment and prognosis of children with OACT are summarized based on a literature review, in order to improve the understanding of OACT in children. CASE SUMMARY: We report a case of a 17-mo-old patient who was admitted to our hospital due to symptoms of odynuria and fever, which are clinical features consistent with a functional adrenocortical tumor. The patient was diagnosed with OACT of uncertain malignant potential. Computed tomography indicated a soft tissue giant tumor in the right adrenal region, approximately 4.3 cm × 5.5 cm in size. Multiple nodular and speckled calcifications were observed in the lesion. The patient received robot-assisted laparoscopic right adrenal tumor resection. Postoperative pathological results were consistent with OACT, and immunohistochemical results showed cytokeratin+/-, chromogranin A+, synaptophysin-, neuron-specific enolase-, S100-, Ki67 about 10%, CD34- and D2-40-. After surgery, urinary tract ultrasonography was reviewed monthly, catecholamine hormone and sex hormone levels were examined every 2 mo and computed tomography was performed every 6 mo. To date, no tumor metastasis or recurrence has been identified in this patient. The levels of sex hormones and catecholamine hormones decreased to normal 1 mo after surgery. CONCLUSION: OACT is rare in the pediatric population, with few cases reported in the literature. Although most pediatric OACTs are benign, malignant cases have been reported. Surgical resection is the preferred option in most patients.

Combined Laparoscope and Flexible Ureteroscope Pyelolithotomy Dealing with Large-Burden Complex Renal Calculi in Children Less Than 1 Year Old.

Objective: To evaluate the experience and result of combined laparoscope and flexible ureteroscope (f-URS) pyelolithotomy in dealing with large-burden complex renal calculi in children <1 year old. Methods: Eleven patients (7 males and 4 females) <1 year old were retrospectively reviewed between December 2015 and May 2017, who had been diagnosed with renal calculi and received combined laparoscope and f-URS pyelolithotomy. The operations were carried out under general anesthesia. Patient' characteristics, presenting symptoms, operative times, and blood loss, stone-free rate, and postoperative complications were all collected retrospectively. Results: All 11 patients received combined laparoscope and f-URS pyelolithotomy. All operations went smoothly without conversion record and blood transfusion. Average time consumed was 109 minutes (55-187 minutes), and blood loss reported was 16 mL (10-25 mL). Average hospital stay after operation was 7 days (5-11 days). On mean follow-up of 6-12 months, no symptomatic urinary tract infections and urinary calculi were detected. Conclusion: Laparoscope combined f-URS pyelolithotomy is considered safe in the treatment of large-burden multiple renal calculi in infant patients with a high stone clearance rate. It has certain advantages in the treatment of renal calculi in infants <1 year old, and it could be an alternative treatment when other treatments fail or are unavailable.

Antagonistic Effect of Cuscuta chinensis on a Rat Model with Unilateral Cryptorchidism.

BACKGROUND The aim of this study was to investigate the effect of Cuscuta chinensis Lam. on germ cell apoptosis in a rat model of unilateral cryptorchidism. MATERIAL AND METHODS Thirty male SD rats were randomly and equally divided into a control group, a model group, and a Cuscuta group (5.0 g/kg/d) (n=10). The rat model of unilateral cryptorchidism in the model and Cuscuta groups was established by removal of the right gubernaculum, while rats in the control group received no treatment. After modeling, rats in the Cuscuta chinensis group were intragastrically administered Cuscuta chinensis extract (5.0 g/kg/d), while rats in the control group and model group were administered an equal volume of normal saline. After 90 days, all the rats were sacrificed and the testicles were separated and weighed, followed by TUNEL staining to detect germ cell apoptosis, flow cytometry to measure JC-1, ROS, and MDA, and Western blot analysis to evaluate the expression of Bax, Bcl-2, and cleaved caspase3. RESULTS Ninety days after the operation, Cuscuta chinensis Lam significantly minimized the damage caused by modeling by increasing weight of testis, reducing the germ cell apoptosis, and enhancing the mitochondrial membrane potential of testicles, as shown by levels of JC-1, ROS, and MDA, as well as elevating the level of Bcl-2/Bax and reducing the level of cleaved caspase3 (P<0.05). CONCLUSIONS Treatment with Cuscuta chinensis Lam reduced the germ cell apoptosis in rats with unilateral cryptorchidism, which provides new insight for the development of cryptorchidism therapy in the future.

[Reoperation methods and effectiveness of urethral stricture after urethroplasty of hypospadias].

Objective: To discuss the reoperation methods of urethral stricture after urethroplasty of hypospadias and their effectiveness. Methods: Between September 2010 and April 2018, 169 patients with urethral stricture after urethroplasty of hypospadias, who underwent ineffective conservative treatments first, were accepted. The age ranged from 1 year and 7 months to 41years with a median age of 5 years and 8 months. The stricture located at the external urethral orifice in 80 cases, internal anastomosis connection in 87 cases, and constructed urethra in 2 cases. The symptoms of urethral stricture occurred at 2 weeks to 52 months after urethroplasty, with a median time of 4.5 months. The patients with external urethral orifice stenosis were treated with urethral meatus augmentation (74 cases) and urethral advancement (6 cases). The patients with internal anastomosis connection stenosis were treated with internal urethrotomy with urethroscopy (10 cases), urethrotomy and one-stage urethroplasty (26 cases), and urethrostomy (51 cases) including 43 cases of two-stage urethroplasty. The patients with constructed urethral stricture were treated with urethrolysis. Results: One hundred and fifty-four patients were followed up 6-86 months with an average of 47 months. The stenosis was relieved in 137 cases, and re-stenosis in 12 cases, urethral fistula in 4 cases, all of which were treated successfully. In addition, 1 case with mild urethral diverticulum did not need to be treated. Conclusion: If it is ineffective for the conservative treatment of urethral stricture after urethroplasty of hypospadias, appropriate surgical treatments could be selected according to the location and length of the stricture, local tissue conditions, complications, and so on.

[Application of cavernosum reduction technology in glanuloplasty during repair of moderate-severe hypospadias].

Objective: To investigate the application of cavernosum reduction technology in glanuloplasty during the repair of moderate-severe hypospadias and evaluate the effectiveness. Methods: The clinical data of 192 patients with moderate-severe hypospadias between November 2015 and May 2017 were retrospectively analyzed. Among them, 103 patients were treated with the cavernosum reduction technology in glanuloplasty during the repair (observation group), 88 patients were treated with repair and glanuloplasty without the cavernosum reduction technology (control group). There was no significant difference in maximum transverse diameter of glans and the height of glans between 2 groups ( t=1.652, P=0.152; t=1.653, P=0.077). The length of reconstructed urethra, complications (e.g. glans dehiscence and fistula), and the maximum flow rate at 3 months after operation in 2 groups were recorded. Results: The length of reconstructed urethra were (35.51±7.79) mm in observation group and (32.17±6.37) mm in control group. In observation group, the meatus location after the correction of chordee was proximal in 24 cases and scrotum-perineum in 79 cases. In control group, the meatus location after the correction of chordee was proximal in 21 cases and scrotum-perineum in 67 cases. There was no significant difference in the meatus location between 2 groups ( χ2=0.008， P=0.920). All patients were followed up 6-12 months after operation (mean, 9 months). There were 3 cases of urethral fistula, 2 cases of glans dehiscence, and 3 cases of urethral orifice stricture in observation group, with the incidence of complications of 7.8%. There were 7 cases of urethral fistula, 3 cases of glans dehiscence, and 4 cases of urethral orifice stricture in control group, with the incidence of complications of 15.9%. There was a significant difference in the incidence of complications between 2 groups ( χ2=4.027, P=0.040). The appearance of the penis was satisfactory, and the urethral orifice was fissured, which was close to the appearance of the normal urethral orifice. At 3 months after operation, the maximal flow rates were (6.23 ± 0.54) mL/s in observation group and (5.44±0.92) mL/s in control group. There was significant difference in the maximum flow rate between 2 groups ( t=1.653, P=0.000). Conclusion: Cavernosum reduction technology being applied in the repair of moderate-severe hypospadias can reduce the probability of glans dehiscence, urethral fistula, urethrostenosis, and other postoperative complications, and improve the success and satisfaction of surgery.

[Free grafting of internal preputial lamina for penile divided nevus in children].

OBJECTIVE: To evaluate the effect of free grafting of internal preputial lamina in the treatment of penile divided nevus in children. METHODS: This retrospective study included 5 children with penile divided nevus, 4 complicated by redundant prepuce and the other 1 by concealed penis, all treated by free grafting of internal preputial lamina from October 2015 to November 2017. The patients ranged in age from 6 years and 8 months to 10 years and 4 months, averaging 8 years and 6 months. The surgical procedure involved complete excision of the lesions underneath the foreskin with a safety margin of 2 mm, collection of healthy internal preputial lamina for free grafting onto the defected glans, and simultaneously circumcision or concealed penis correction. The removed tissue of the divided nevus was subjected to pathological examination. The patients were followed up for 4－29 (mean 18) months postoperatively. RESULTS: All incisions healed primarily and the free grafts of internal preputial lamina survived well, similar to the glans in color and with a desirable appearance. The patients lost no protopathic sensibility of the glans and experienced no recurrence. Pathological examination confirmed 1 case of intradermal nevus and 4 cases of compound nevus. CONCLUSIONS: Free grafting of internal preputial lamina is an ideal method for the treatment of penile divided nevus in children, with the advantages of easy graft collection, little color difference between the graft and surrounding skin, desirable external appearance, and definite clinical effect.

Evaluation and treatment for ovotesticular disorder of sex development (OT-DSD) - experience based on a Chinese series.

BACKGROUND: The aim of this study is to review and present the clinical features and process of evaluation and treatment for OT-DSD in a single center in recent years in China. METHODS: Sixteen patients with OT-DSD during the past 4 years underwent the evaluation and treatment in a single center. The clinical characteristics and outcomes of surgery were analyzed. RESULTS: The surgical age ranged from 17 months to 66 months with a mean age of 20 months, and the mean follow-up was 30 months (4 months to 56 months). The presentation in 11 patients was ambiguous genitalia, and the rest 5 patients were suspected to have DSD in preoperative examination before hypospadias repair. The karyotypes were 46, XX in 11 patients, 46, XX/46, XY in 3, 46, XX/47, XXY in 1, and 46, XY in 1. Initial reared sex was male in 14 patients, female in 1, and undetermined in 1. After surgery, genders were reassigned in 3 patients, while 15 patients were raised as male with testicular tissue left. Only 1 patient with ovarian tissue left was raised as female. Repair was completed in 11 males and 1 female, and stage I urethroplasty was done in 4 males. No further surgery to remove the gonads was needed for inconsonance of gender assignment. No gonadal tumors were detected. CONCLUSIONS: OT-DSD is a rare and complex deformity with few systematic reports in China. It's important to establish a regular algorithm for evaluation and treatment of OT-DSD.

[Evaluation of urogenital sinus surgery in disorder of sex development].

Objective: To explore the indication and effectiveness of urogenital sinus surgery in feminizing genitoplasty of disorder of sex development (DSD). Methods: A retrospective analysis was made on clinical data from 22 patients with DSD who underwent one stage feminizing genitoplasty between October 2010 and December 2015. The patients' age ranged from 1 year and 2 months to 21 years, with the median age of 2 years and 1 month. According to the Prader classification criteria, the appearance of vulvas were rated as grade Ⅰ in 7 cases, grade Ⅱ in 6 cases, grade Ⅲ in 8 cases, and grade Ⅳ in 1 case. Cystoscopy was applied before feminizing genitoplasty in all patients. Low confluence of vagina and urethra was found in 19 patients, while high confluence was found in 3 patients. The mean length of urogenital sinus was 1.6 cm (range, 0.5-3.0 cm). The mean length of water-filled vagina was 4.4 cm (range, 3.5-5.5 cm). Cervix was detected at the end of vagina in 16 patients, meanwhile absence of cervix was detected in 6 patients. The same procedures of clitoroplasty and labioplasty were used in all patients. Three procedures of urogenital sinus surgery were applied, as the "cut-back" vaginoplasty in 6 patients, the "flap" vaginoplasty in 11 patients, and the partial urogenital sinus mobilization (PUM) in 5 patients. Results: All procedures were completed successfully and the incisions healed by stage Ⅰ. All patients were followed up 12-74 months, with the average of 30.5 months. The outcome of appearance evaluation was excellent in 13 patients (59.1%), good in 6 patients (27.3%), and poor in 3 patients (13.6%). Urinary incontinence, post-void residual, urinary infection, and urethrovaginal fistula were not found in 17 toilet trained patients. Conclusion: Urogenital sinus surgery is the most critical step in feminizing genitoplasty of DSD. It can be finished in one stage procedure with clitoroplasty and labioplasty before puberty. If thoroughly evaluation before surgery is completed and the principle of different procedures is handled, the outcome will be satisfactory.

Littre's hernia in a paediatric patient.

Meckel's diverticulum (MD) is the most common congenital abnormality of the gastrointestinal tract that is generally asymptomatic and manifests only in a specific way when complications exist. Littre's hernia is a rare complication of MD . The definition of Littre's hernia is based upon the protrusion of a MD through a potential abdominal opening accompanied in some cases by incarceration, inflammation, or necrosis. The most common site of Littre's hernia is the inguinal canal, usually on the right. It is difficult to diagnose before surgery. We report a 4-month-old boy with Littre's hernia, including join with incarcerated hernia in the left side.

[A preliminary study on clinical feature of infantile hemangioma and vascular malformation].

OBJECTIVE: To study the clinical features of infantile hemangioma and vascular malformation, to find out a proper strategy of dealing with them. METHODS: From March 2000 to August 2007, 2957 cases of infantile hemangioma and vascular malformation were treated, including 860 operative cases and 2097 non-operative cases. There were 441 male and 419 female patients in operation group, aging 6 months to 18 years (median 5 years). In 1950 hemangioma patients of non-operation group, there were 575 male and 1 375 female patients, aging 1 month to 14 years (median 6 months); in 147 vascular malformation patients of non-operation group, there 67 male and 80 female patients, aging 2 years to 17 years (median 7 years). In non-operative group, 147 vascular malformation patients and 1 525 infantile hemangioma patients were followed up without any medical intervention, while other 425 hemangioma patients received triamcinolone plus dexamethasone intralesional injection treatment. All the treatments and outcomes were recorded. RESULTS: Vascular malformation cases and infantile hemangioma cases presented totally different clinical features. To the deadline of this study, 522 (34%) of 1 525 un-intervened hemangioma cases turned into involuted phase and 383 (90%) of 425 cases receiving triamcinolone plus dexamethasone intralesional injection treatment turned into involuted phase after injection treatment; no regression was noted in 147 cases of vascular malformation. The constituent ratio of infantile hemangioma in 860 operative cases was decreased gradually and the constituent ratio of vascular malformation was increased gradually as the age increasing. CONCLUSION: Infantile hemangioma has a distinct life pattern. Except several specific cases need medical intervention for their special location or large ambit and unacceptable growth, most infantile hemangioma need no medical intervention. Most vascular malformations can not regress spontaneously, proper intervention is in need.

[Non-thoracoscopic minimally invasive Nuss procedure for correction of recurrent pectus excavatum].

OBJECTIVE: To assess the efficacy and summarize the treatment experience in correction of recurrent pectus excavatum by the non-thoracoscopic minimally invasive Nuss procedure. METHODS: From July 2003 to November 2007, 21 patients with recurrent pectus excavatum were treated with surgical repairs. Among them, there were 15 patients who underwent a Nuss procedure (the recurrent Nuss group), 13 males and 2 females, aged (13.31 +/- 4.21) years old, and the preoperative CT scan showed the mean Haller index was 3.98 +/- 0.94. The recurrence time of the depression after the primary operation was different: 2 patients with less than 1 year, 4 with 1-3 years, 7 with 3-5 years and 2 with over 5 years. There were 6 patients who underwent a modified Ravitch procedure (the recurrent Ravitch group), 5 males and 1 female, aged (13.67 +/- 2.23) years old, and the mean Haller index was 3.92 +/- 1.01. The recurrence time of the depression after the primary operation was as follows: 2 patients with less than 1 year, 1 with 1-3 years and 3 with 3-5 years. Another 119 patients had a primary Nuss procedure in the same period (the primary Nuss group), 95 males and 24 females, aged (7.79 +/- 3.59) years old, and the mean Haller index was 4.61 +/- 1.36. In terms of the age and the Haller index, there was significant difference between the recurrent Nuss group as well as the recurrent Ravitch group and the primary Nuss group (P < 0.05), but there was no significant difference between the recurrent Nuss group and the recurrent Ravitch group (P > 0.05). RESULT: s All the patients were performed with the surgery successfully without any severe complications. The operation time, blood loss and postoperative hospitalization time of the recurrent Nuss group and the primary Nuss group were significantly less than those of the recurrent Ravitch group (P < 0.05), but there was no significant difference between the recurrent Nuss group and the primary Nuss group (P > 0.05). All the patients were followed up for 1.5-37.0 months (11.2 months on average). Except for 1 with plate displacement and 2 with suture reaction in the primary Nuss group who were readmitted to hospital, the other patients recovered well. The patients had perfect thoracic appearances with increased exercise tolerance and had a significantly improved psychological condition and an active social participation because of their improved appearances. The postoperative mean Haller index was 2.58 +/- 0.31, 2.77 +/- 0.48 and 2.52 +/- 0.34 in the recurrent Nuss group, the recurrent Ravitch group and the primary Nuss group, respectively, with significant difference compared with the preoperative mean Haller index in each group (P < 0.05). CONCLUSION: Although the recurrent pectus excavatum repairs are technically more challenging than the primary surgery, the non-thoracoscopic Nuss procedure for reoperative correction is a safe, effective and reliable method.

[Non-thoracoscopic Nuss procedure for correction operation of pectus excavatum ].

OBJECTIVE: To review the experience in correction operation of pectus excavatum with non-thoracoscopic Nuss procedure. METHODS: From September 2005 to August 2007, 108 patients with pectus excavatum were surgically corrected by non-thoracoscopic Nuss procedure. There were 91 male patients and 17 female patients. The age was from 2 years and 10 months old to 25 years old with an average of 7 years and 9 months old. The Haller indexes were from 3.6 to 10.1 before the operation. RESULTS: The operation in all patients had been performed successfully without any severe complications. The average time of operation was 40 minutes. The average bleeding volume during procedure was 10 ml. Uneventful recovery was achieved in all the cases. Excellent outcome was obtained in the follow-up of 2 months to 21 months in 92 patients. CONCLUSIONS: Non-thoracoscopic Nuss procedure for correction of pectus excavatum is safe and effective. It is unnecessary to perform the procedure into thoracic cavity so that there is less trauma and shorter time for the operation.

[Effect of hemin on the lung development and pulmonary arterial structural remodeling in congenital diaphragmatic hernia: experiment with rats].

OBJECTIVE: To assay the effects of prenatal hemin therapy on pulmonary hypoplasia (PH) and pulmonary arterial structural remodeling in congenital diaphragmatic hernia (CDH). METHODS: Six pregnant female SD rats were randomly divided into 3 equal groups: control group, undergoing gastric perfusion of olive oil once on day 9.5 and intraperitoneal injection of normal saline on days 11-14; CDH group, undergoing gastric perfusion of nitrofen 125 mg once on day 9.5 and intraperitoneal injection of normal saline on days 11-14; and hemin group, undergoing gastric perfusion of nitrofen 125 mg once on day 9.5 and intraperitoneal injection of hemin 15 mg x kg(-1) x d(-1) on days 11-14. On the gestational day 21 caesarean section was performed to take out the fetuses to undergo histological examination and image analysis. RESULTS: CDH were detected in 28 of the 44 (63.6%) fetuses from the 2 groups receiving nitrofen. The lungs of all CDH group fetuses were hypoplastic, and the fetuses of the hemin group showed improved lung development. The right lung/body weight ratio and pulmonary alveolar area ratio (PAA%) of the hemin group were (16.6 +/- 1.0) mg/g and (45 +/- 6)% respectively, both significantly higher than those of the CDH group [(14.6 +/- 1.7) mg/g and (28 +/- 6)% respectively, P = 0.03 and P < 0.01]. The alveolar septum area ratio (ASA%) of the hemin group was (44 +/- 6)%, significantly lower than that of the CDH group [(64 +/- 8)%, P < 0. 01]. The media thickness percentages (MT%) of pre-acinar artery (PAPA) and intra-acinar artery (IAPA) of the fetuses of the hemin group were (21.2 +/- 2.2)% and (18.2 +/- 2.1)% respectively, both significantly lower than those of the CDH group [(24.3 +/- 4.0)% and (21.9 +/- 3.9)% respectively, both P < 0.05], which were significantly higher than those of the control group [(20.0 +/- 2.4)% and (17.2 +/- 2.3)% respectively, both P < 0.01]. The component ratio of nonmuscularized artery (NMA) in the IAPA level of the hemin group was (78.2 +/- 3.0)%, significantly higher than that of the CDH group [(72.8 +/- 3.2)%, P = 0.001]. CONCLUSION: PH and pulmonary arterial structural remodeling are present in CDH. Although prenatal administration of hemin cannot prevent the genesis of CDH in rats, it may improve the pulmonary development, inhibit medial hypertrophy, and reduce the percentage of muscularized IAPA.