Synchronous bilateral laparoendoscopic single-site urological surgeries via the umbilicus:a report of 2 cases

Objective： To describe two cases of bilateral transumbilical laparoendoscopic single-site（LESS） surgeries in a single operative session and assess the safety, feasibility and efficacy. Methods： One patient underwent right ureterolithotomy and left varicocelectomy, and the patient was performed with right simple nephrectomy for nonfunctioning kidney due to ureteral calculus and left ureterolithotomy using a novel multichannel TriPortTM via a single 2-3 cm transumbilical incision Results： The right-side ureterolithotomy and left-side varicocelectomy were finished in 229 minutes, with a total estimated blood loss of 50 hal. The right-side simple nephrectomy and left-side ureterolithotomy in the other patient were finished in 340 minutes, with a total estimated blood loss of 100 ml. There were no major complications. At the latest follow-up, both patients remained symptom-free and there were no evidences of recurrence. Both of them were delighted for the single scarConclusion： Synchronous LESS urologic procedure via a single umbilical incision is technically feasible, safe and efficacious with a promising potential

Congenital Epidermal Cyst of the Umbilicus: A Case Report

Epidermal cysts are one of the most common benign skin tumors, although they are rarely found in the umbilicus of a child. Herein we report the case of a 13-year-old girl with a congenital umbilical mass. This mass had been misdiagnosed as a lipoma at birth. Awareness of this lesion can avoid its misdiagnosis and inappropriate treatment.

Observation on therapeutic effects of simple obesity treated with needling and quick cupping therapy at the selected eight points around umbilicus

Objective To observe the clinical effects of simple obesity treated with needling and quick cupping therapy at the selected eight points around umbilicus. Methods Ninety-five cases were randomly allocated into an observation group and a control group. In observation group （n=50） patients were treated with acupuncture and quick cupping therapy at the selected eight points around umbilicus, namely Huaroumen （滑肉门 ST 24）, Tianshu （天枢 ST 25）,Wailing （外陵 ST 26）,Shuifen （水分 CV 9）, and Yinjiao（阴交 CV 7）.In control group （n=45） patients were advised to take Sibutramine, an oral administration to suppress appetite. Relevant data concerning one＇s weight, body mass index （BMI）, waist hip ratio （WHR） and distribution rate of body fat （F%） before treatment and after eight weeks＇ of treatment were collected to observe the effects. Results The total effective rate was 98.0%（49/50） in the observation group and 97.8%（44/45） in the control group. There was no significant difference on body weight and BMI between the two groups （P〉0.05）, however the therapeutic effects on WHR and F% in the observation group were more satisfactory than those of the control group （P〈0.05）. Conclusion Acupuncture and quick cupping therapy at the selected eight points around umbilicus have a good therapeutic effect on simple obesity, moreover acupuncture and quick cupping therapy can greatly improve the condition of WHR and F% for obesity patients, which is also safe and without any side effect.

Anatomy and embryology of umbilicus in newborns： a review and clinical correlations

Umbilicus is considered a mirror of the abdomen in newborns. Despite its importance, the umbilicus has been stated in literature and textbooks as discrete subjects with many body systems, such as the urinary, digestive, and cardiovascular ones. This article aimed to address the basic knowledge of the umbilicus in relation to clinical disorders under one integrated topic to aid physicians and surgeons in assessing newborns and infants. The umbilicus appears as early as the fourth week of fetal life when the folding of the embryonic plate occurs. The umbilicus appears initially as a primitive umbilical ring on the ventral aspect of the body. The primitive umbilicus contains the connecting stalk, umbilical vessels, vitelline duct and vessels, allantois, and loop of the intestine. Changes occur to form the definitive cord, which contains three umbilical vessels, namely, ＂one vein and two arteries,＂ embedded in Wharton＇s jelly. After birth, the umbilical vessels inside the body obliterate and gradually form ligaments. Congenital disorders at the umbilicus include herniation, bleeding, and discharge of mucous, urine, or feces. Some of these disorders necessitate emergent surgical interference, whereas others may be managed conservatively. The umbilicus has many embryological remnants. Thus, the umbilicus is prone to various clinical disorders. Detecting these disorders as early as possible is essential to prevent or minimize possible complications.

Umbilicus application with Chinese medicine for chronic diarrhea due to food intolerance in kids:a multicenter randomized trial

Objective： To observe the clinical efficacy of umbilicus application with Chinese medicine in treating children＇s chronic diarrhea due to food intolerance and the value of healthy diet education. Methods： Eighty kids with chronic diarrhea due to food intolerance were recruited from multiple centers and divided by using the random number table into a treatment group of 40 cases and a control group of 40 cases. For both groups, based on the level of serum food-specific immunoglobulin G（Ig-G）, the patients were given unified diet following the healthy diet guidance： safe, alternate, and forbidden, while the treatment group was additionally given umbilicus application with Chinese medicine. The therapeutic efficacy and symptom score of traditional Chinese medicine（TCM） were observed and compared respectively after 1-week, 2-week, 4-week, and 12-week treatment. Results： The diarrhea symptoms and coupled symptoms scores dropped significantly in the two groups after treatment（ all P〈0.05）, and the inter-group comparisons also showed statistical significances（P〈0.05）. The total effective rate was 97.5% in the treatment group versus 77.5% in the control group, and the inter-group difference was statistically significant（P〈0.05）. Conclusion： The healthy diet guidance based on the food intolerance test is effective in helping treat diarrhea, while umbilicus application with Chinese medicine works better in treating diarrhea for kids with chronic diarrhea due to food intolerance and can significantly enhance the therapeutic efficacy.

Effectiveness and Safety of Umbilicus Treatment with Modified Dinggui Powder(加味丁桂散)in Patients with Chronic Nonbacterial Prostatitis:A Randomized,Double-Blind,Placebo-Controlled Clinical Trial

Objective:To evaluate the effectiveness and safety of Chinese herbal external umbilicus treatment with Modified Dinggui Powder(加味丁桂散,MDGP)in patients with chronic nonbacterial prostatitis(CNP).Methods:A randomized,double-blind,placebo-controlled clinical trial was conducted among 72 patients with CNP.Participants were randomly allocated to a treatment group and a placebo group using computer software in a 1:1 ratio,and received either MDGP external umbilicus treatment(MDGP group,36 cases)or placebo(control group,36 cases)at acupoints Shenque(CV 8),twice a week for 4 weeks.In addtion,patients all received herbal medicine treatment twice a day for 4 weeks.The primary outcome was the US National Institutes of Health Chronic Prostatitis Symptom Scores Index(NIH-CPSI)with a questionnaire at weeks 2 and 4.The secondary outcomes including prostatic fluid examination(white blood cells and lecithin bodies),the clinical efficacy evaluation,and the adverse events were also assessed during the entire trial.Results:The NIH-CPSI scores regarding pain or discomfort scores showed greater improvement in the MDGP group than placebo control group at weeks 2(P=0.001)and week 4(P=0.004),respectively.NIH-CPSI scores of symptom severity,total scores and leukocytes number in the prostatic fluid in the MDGP group were significantly improved(P<0.05).There was no statistical difference in the urinary symptoms,quality of life,lecithin and other scores between two groups(P>0.05).The clinical effective rate was 73.53%(25/34)in the MDGP group,which was significally higher than the placebo control group with 48.39%(25/31,P<0.05).Patients were blinded successfully,and no serious adverse effects were found during the trial.Conclusion:A 4-week course of umbilicus treatment with modified Dinggui Powder seems to relieve pain and symptom severity effectively and increase the amount of leukocytes number in patients with CNP(Trial registration No.ChiCTRI 800014687).

Hormone-dependent high fever treated with umbilicus moxibustion and acupuncture

The combined treatment with umbilicus moxibustion and acupuncture achieves the significant effect on hormone-dependent high fever.The medical case was recorded so as to provide the approach to the clinical treatment or the reoccurrence control of this disease.

Thirty-eight cases of uterine bleeding of spleen deficiency treated with wheat-grain size cone moxibustion and herbal plaster on the umbilicus

Objective:To introduce an effective method in treatment of uterine bleeding of spleen deficiency.Methods:A total of 38 patients were treated with wheat-grain size cone moxibustion and herbal plaster on the umbilicus.The wheat-grain size cone moxibustion was used at Guānyuán(关元 CV 4)and Yǐn bái(隐白 SP 1),20 moxa cones at each acupoint were required in each treatment.The treatment was given once every two days and three treatments made 1 course.Additionally,the herbal plaster was dressed on the umbilicus.The dressing changed once every day.After 2 courses of treatment,the therapeutic effect was observed.Results:Regarding the effects of uterine bleeding,of 38 cases,12 cases were cured,accounting for 31.58%,17 cases effective remarkably,accounting for 44.74%,4 cases effective,accounting for 10.53% and 5 cases failed,accounting for 13.16%.The total effective rate was 86.84%.The symptoms of spleen deficiency were relieved in 38 patients,such as sallow complexion,lassitude,short breathing,dislike of speaking,no appetite and cold limbs.Conclusion:The combined treatment with wheat-grain size cone moxibustion and herbal plaster on the umbilicus achieves significant effects on uterine bleeding of spleen deficiency.

Stenosing tenosynovitis of styloid process of radius treated by umbilicus acupuncture

The gen and mao areas,and the responding area of hand were punctured in umbilicus acupuncture,reperfusion activities were also done for a stenosing tenosynovitis of styloid process of radius patient in lactation period,sound effect were obtained.

Hematogenous umbilical metastasis from colon cancer treated by palliative single-incision laparoscopic surgery

Sister Mary Joseph’s nodule(SMJN)is a rare umbilical nodule that develops secondary to metastatic cancer.Primary malignancies are located in the abdomen or pelvis.Patients with SMJN have a poor prognosis.An 83-year-old woman presented to our hospital with a1-month history of a rapidly enlarging umbilical mass.Endoscopic findings revealed advanced transverse colon cancer.computer tomography and fluorodeoxyglucose-positron emission tomography revealed tumors of the transverse colon,umbilicus,right inguinal lymph nodes,and left lung.The feeding arteries and drainage veins for the SMJN were the inferior epigastric vessels.Imaging findings of the left lung tumor allowed for identification of the primary lung cancer,and a diagnosis of advanced transverse colon cancer with SMJN and primary lung cancer was made.The patient underwent local resection of the SMNJ and subsequent single-site laparoscopic surgery involving right hemicolectomy and paracolic lymph node dissection.Intra-abdominal dissemination to the mesocolon was confirmed during surgery.Histopathologically,the transverse colon cancer was confirmed to be moderately differentiated tubular adenocarcinoma.We suspect that SMJN may occur via a hematogenous pathway.Although chemotherapy for colon cancer and thoracoscopic surgery for the primary lung cancer were scheduled,the patient and her family desired home hospice.Seven months after surgery,she died of rapidly growing lung cancer.

Outpatient varicocelectomy performed under local anesthesia

Aim： To report a series of varicocelectomy performed under pure local anesthesia. Methods： From July 1988 to June 2003, a total of 575 patients, aged between 15 and 73 years, underwent high ligation of the internal spermatic vein for treatment of a varicocele testis under a regional block in which a precise injection of 0.8 % lidocaine solution was delivered to involved tissues after exact anatomical references were made. A 100-mm visual analog scale （VAS） was used to assess whether the pain level was acceptable. Results： The surgeries were bilateral in 52 cases, and unilateral in 523 cases. All were successfully performed on an outpatient basis except in the case of two patients, who were hospitalized because their surgeries required general anesthesia. Overall, 98.6 % （567/575） of men could go back to work by the end of the first post-operative week and only 8 （1.4 %） men reported feeling physical discomfort on the eighth day. The VAS scores varied from 11 mm to 41 mm with an average of （18.5 ± 11.3） mm that was regarded as tolerable. Conclusion： This study has shown varicocelectomy under local anesthesia to be possible, simple, effective, reliable and reproducible, and a safe method with minimal complications. It offers the advantages of more privacy, lower morbidity, with no notable adverse effects resulting from anesthesia, and a more rapid return to regular physical activity with minor complications.

Cloning and Functional Analysis of Porcine Cycling A

Cyclin A is a key regulator of the cell cycle. Its expression may become disrupted in virusinfected cells, leading to deregulation of the cell cycle and increased cell proliferation. Here, we cloned the porcine cyclin A gene and verified its functionality in swine umbilicus vein endothelial cells （SUVEC）. The human cyclin A gene was used to probe databases to clone the pig cyclin A gene electronically. The identified porcine cDNA contained an open reading frame of 1,299 bp, encoding 432 amino acids, the same length as the human cyclin A protein. The porcine cyclin A gene comprises eight exons on chromosome 8. The sequence of the in silico clone and expression of this novel gene were confirmed in SUVEC by reverse transcription PCR. Western blotting of cell lysates from SUVEC transfected with a cyclin A enhanced green fluorescent protein （EGFP） fusion construct revealed a band at approximately 40 kDa. Confocal microscopy of CycA-EGFP-expressing cells showed that the fusion protein was expressed in the nucleus. Flow cytometry demonstrated that more stably expressing SUVEC-CycA-EGFP were in G1 phase （15% to 20% increase） and fewer were in S phase （18% decrease） compared with control ceils. MTS assays showed that the proliferative activity of SUVEC-Cy- cAG-EGFP was significantly higher than that of the control cells. In conclusion, we have cloned the pig cyclin A gene and demonstrated that its biological function is consistent with cyclin A in other mammali- an species. This provides a foundation for future research on the impact of virus infection on cyclin A.

UMBILICAL METASTASIS FROM GYNECOLOGIC MALIGNANCIES──A CLINICAL STUDY OF 15 CASES

Umbilical metastasis from gynecologic malignancies is very rare. We report 15 patients with primary gynecologic malignant tumours associated with umbilical metastases treated in this hospital from 1958 to Jan.1991, including 10 epithelial ovarian cancer, 1 malignant teratoma of the ovary, 2 endometrial carcinoma and 2 squamous cell carcinoma of the cervix. Excepting l patient initially diagnosed as stage I endometrial carcinoma, all patients had advanced tumours. Umbilical lesions were discovered at the time of initial diagnosis of the primary tumour in 6 cases.The main clinical finding is an umbilical nodule or an ulcerated nodule in a diameter less than 2 cm.Usually the prognosis was poor. The average survival from initial diagnosis of umbilical metastasis to death was 14 months in 12 patients. There were 4 cases with longer survival, including 1 patient with endometrial carcinoma who survived for 40 months, and 3 Patients with ovarian carcinoma who survived for 54, 52, 31 months, respectively. Two cases are surviving with tumour. It indicates that aggressive therapy may prolong survival time, especially in patient with ovarian cancer.

Urachus Fistula about Two Cases in Yalgado Ouedraogo Teaching Hospital, Ouagadougou (Burkina-Faso)

The purpose of these serial cases was to report the diagnostic and therapeutic features of urachal fistulas at Yalgado Ouedraogo teaching Hospital. We have reported retrospectively two cases of urachus fistula at the Surgery Department of Yalgado Ouedraogo Teaching Hospital in Ouagadougou. The parameters studied were sex, age, reason for consultation, clinical and paraclinical signs, treatment, length of hospital stay, delay of urinary catheterisation and evolution. Two serial cases of urachal fistula were reported, one 14 years old female patient and a 32 years old male patient. Clinical signs were marked by urine flow through the umbilicus. The diagnosis was made by fistulography in one case and during surgery for the second case. The treatment was surgical and consisted of laparotomy followed by removal of the urachal fistula from bladder. The urinary catheter was removed after 10 days. The postoperative course for the two patients was uneventful.

Umbilical Endometriosis without Pelvic Surgery

We report a recently observed case of primary umbilical endometriosis without previous pelvic surgery. A 41-year-old Japanese woman complained of umbilical nodular tumor. Histopathology revealed endometriosis of an approximate 10 mm resected mass. The stromal cells in endometriosis were immunohistochemically positive for CD10. Two months later the first umbilical surgery, she underwent a left salpingo-oophorectomy and release of adhesion around the left adnexa under a laparoscope. She was treated with dienogest (2 mg/day) for six months after four injections of GnRH analogue for four months. After three years of the follow-up, there were no signs of local relapse and no clinical and ultrasonographic abnormalities due to endometriosis.

Observation on the Effect of Umbilical Therapy of Herbal Medicine Combined with Self-Made Dysmenorrhea Paste on Primary Dysmenorrhea

Objective:To investigate the clinical effect of self-made dysmenorrhea paste combined with umbilical therapy of herbal medicine on primary dysmenorrhea.Methods:160 patients with primary dysmenorrhea were recruited from Changle People’s Hospital.Participants were randomly divided into control group and treatment group,with 80 cases in each group.The control group were administered the dysmenorrhea paste sold on the market for 5 days during three menstruation cycles,and the treatment group was given the umbilical therapy of herbal medicine combined with self-made dysmenorrhea paste.The outcome was the intensity of menstrual pain measured by using the visual analogue scale,TCM symptom score and dysmenorrhea symptom score of patients,responder rate.The clinical outcomes were measured on each menstrual cycle at baseline,treatment course(3 cycles),and follow-up period.Results:In this study,there was no significant difference in age and severity of disease between the two groups before treatment.After treatment,VAS score,TCM symptom score and dysmenorrhea symptom score of patients in both groups decreased.The total effective rate was 90.75%in the treatment group and 81.25%in the control group.Conclusion:The treatment of primary dysmenorrhea patients with self-made dysmenorrhea paste combined with application of drugs and moxibustion naval-button method has a significant clinical effect.This method can reduce the pain of patients,improve the quality of life of patients,and homemade dysmenorrhea paste has a good taste,long shelf life,easy to carry,and is worthy of promotion and application.

Therapeutic observation of acupuncture plus navel acupuncture for urinary retention after radical hysterectomy for cervical cancer

Objective: To observe the clinical efficacy of acupuncture plus navel acupuncture for patients with urinary retention after radical hysterectomy for cervical cancer. Methods: A total of 64 patients with urinary retention after radical hysterectomy for cervical cancer was divided into a navel acupuncture group (22 cases), an acupuncture group (18 cases) and an acupuncture plus navel acupuncture group (24 cases). All three groups received bladder function training and neuromuscular electrical stimulation. In addition, navel points were combined in the navel acupuncture group. Electroacupuncture was conducted to Qihai (CV 6), Zhongji (CV 3), Dahe (KI 12), Shuidao (ST 28), Ciliao (BL 32) and Huiyang (BL 35) in the acupuncture group. The acupuncture plus navel acupuncture group received both treatments. The catheter was removed after 3 d of treatment. Spontaneous urination, residual urine volume, urinary catheter dependence and recurrence after 3 d, 6 d and 9 d of treatment in each group were observed, respectively. Results: In the acupuncture plus navel acupuncture group, the markedly effective rates after 3 d, 6 d and 9 d of treatment were significantly higher than those in the navel acupuncture group and the acupuncture group;the urinary catheter dependence was lower than that of the other two groups, and the differences were statistically significant (P<0.05, P<0.01);the spontaneous urination time was shorter than that of the navel acupuncture group and the acupuncture group, and the differences were statistically significant (P<0.05, P<0.01);the residual urine volume was significantly less than that of the navel acupuncture group and the acupuncture group, and the differences were statistically significant (both P<0.01). After the catheter was removed, recurrence was observed from the next day after spontaneous urination was resumed. There were 2 cases of recurrence in the navel acupuncture group, 2 cases in the acupuncture group and 1 case in the acupuncture plus navel acupuncture group. The recurrence rate of the acupuncture plus navel acupuncture group was significantly lower than that of the navel acupuncture group and the acupuncture group (both P<0.01). Conclusion: Acupuncture plus navel acupuncture has satisfactory efficacy for urinary retention after radical hysterectomy for cervical cancer. It can significantly shorten the urinary retention time, reduce the patient's dependence on urinary catheter, and reduce the residual urine volume.

Prospective randomized comparison of transumbilical two-port laparoscopic and conventional laparoscopic varicocele ligation

We have established a novel method named transumbilical two-port laparoscopic varicocele ligation （TTLVL） for varicocele, which is still needed to evaluate. In this study, 90 patients with left idiopathic symptomatic varicoceles of grades Ⅱ-Ⅲ according to the Dubin grading system were randomly assigned to TTLVL （n = 45） and conventional laparoscopic varicocele ligation （CLVL） （n = 45）. The demographic, intraoperative, postoperative, and follow-up data were recorded and compared between the two groups. All the procedures in the two groups were completed successfully with no intraoperative complications and no conversions to open surgery. No significant difference was found in the operative time, resuming ambulation, bowel recovery, postoperative hospital stay, and postoperative resolution of scrotal pain between the two groups （P 〉 0.05）. However, the postoperative mean visual analog pain scale scores for TTLVL group were all less at 24 h, 48 h, 72 h, and 7 days postoperatively compared to CLVL （P= 0.001, 0.010, 0.006, and 0.027, respectively）. The mean patient scar assessment questionnaire score in postoperative month 3 was 29.7 for TTLVL group compared with 32.1 for CLVL group （P 〈 0.001）. There was no testicular atrophy observed in both groups during the follow-up period. The study shows that TTLVL is a safe, feasible, and effective minimally invasive surgical alternative to CLVL for the treatment of varicocele. Compared with CLVL, TTLVL may decrease postoperative pain and improve the cosmetic outcomes.

Clinical efficacy of umbilical therapy with herbal cakes of different dosages for damp-heat diarrhea in young children

Objective:To observe the clinical efficacy of umbilical therapy with herbal cakes made of Ge Gen Qin Lian Tang prescription of different dosages in treating damp-heat diarrhea in young children.Methods:Seventy-two kids with diarrhea of damp-heat pattern were recruited and divided into a high-dosage group and a low-dosage group using the random number table method,with 36 cases in each group.They all received conventional antidiarrheal treatment and umbilical application with herbal cakes.However,the herbal cakes for the high-dosage group were made of the mixture of Ge Gen Qin Lian Tang powder and water,and those for the low-dosage group consisted of 10%Ge Gen Qin Lian Tang powder and 90%auxiliary materials(corn starch)plus water.The treatment duration was 3 d.The clinical efficacy,antidiarrheal rate,effective rate for symptoms and signs of traditional Chinese medicine(TCM),TCM symptoms score,and safety indicators were compared between the two groups.Results:After the treatment,the TCM symptoms scores dropped significantly in both groups(P<0.01)and were lower in the high-dosage group than in the low-dosage group(P<0.05).The clinical efficacy was more significant in the high-dosage group than in the low-dosage group after the treatment,and the between-group difference was statistically significant(P<0.05);the antidiarrheal rate was markedly higher in the high-dosage group than in the low-dosage group(P<0.05).Regarding the TCM symptoms and signs,the high-dosage group showed better results in improving the greasy and yellowish tongue coating,bowel movement frequency,watery excrement,short and dark urine,red tongue body,red anus,vomiting,bowel sounds,and abdominal bloating compared with the low-dosage group,and the between-group differences were statistically significant(P<0.01).Conclusion:Umbilical therapy with herbal cakes made of Ge Gen Qin Lian Tang is safe,reliable,and effective in treating damp-heat diarrhea in young children;the high-dosage herbal cakes produce more significant efficacy than the low-dosage ones and are worth further investigation.

Clinical study on Tuina plus umbilical therapy for senile functional constipation

Objective To observe the clinical efficacy of Tuina(Chinese therapeutic massage)plus umbilical therapy for senile functional constipation due to Qi deficiency of lung and spleen.Methods A total of 60 patients who met the inclusion criteria were randomly divided into a control group and an observation group by the random number table method,with 30 cases in each group.The patients in the control group were given lactulose oral solution,while the patients in the observation group were treated with Tuina and umbilical therapy.After two weeks of treatment,the scores of the Wexner continence grading scale(WCGS)and patient assessment of constipation-quality of life questionnaire(PAC-QOL)were observed.The effective rates in the two groups were compared.Results After two weeks of treatment,the total effective rate in the observation group was 90.0%,while that in the control group was 76.7%,presenting a significant difference between the two groups(P<0.05).There were no significant differences in the WCGS and PAC-QOL scores between the two groups before treatment(P>0.05).After two weeks of treatment,the WCGS and PAC-QOL scores of both groups decreased significantly compared with those before treatment(P<0.05),and the two scores in the observation group were lower than those in the control group(P<0.05).Conclusion The efficacy of Tuina plus umbilical therapy for senile functional constipation is confirmed.This method can improve patients’quality of life.Its efficacy is better than that of taking lactulose oral solution.