Is V-Y plasty necessary for penile lengthening？ Girth enhancement and increased length solely through circumcision： description of a novel technique

Our objective is to describe a novel ligamentolysis approach using a subcoronal incision technique and to determine its safety and efficacy. During the last 7 years, 82 consecutive patients had penile augmentation surgery. Ligamentolysis, through a lower abdominal incision （V-Y plasty） in the first 35 males, was performed （Group A）, followed by circumcision ligamentolysis in the next 47 males （Group B）. The operation time, complications, and the preoperative and postoperative values of penile length and girth along with the self-esteem and relations questionnaire score as well as satisfaction score was calculated before and after the surgery, and a comparison was conducted between the groups. The mean age at presentation was 32 years （range： 18-56 years）. Seventy-nine patients suffered from penile dysmorphophobia, and three patients had micropenises （length 〈7.5 cm）. The mean surgical times were 150.7 and 125.2 rain for Groups A and B, respectively （P=0.005）. Postoperatively, four Group A patients and three Group B patients （11% versus 6%, respectively） experienced penile retraction （P=0.453）. Hypertrophic scars were observed in 18 men （51%） in the former group. In the circumcision group, no major wound complications were recorded. The length and girth improvements between the groups were similar. In terms of satisfaction and SEAR improvement, the resulting difference for both variables favored the circumcision group （P=0.007 and 〈0.001, respectively）. With strict selection criteria, the circumcision ligamentolysis procedure compared to the V-Y plasty demonstrated improved results in terms of safety, operation time, retraction rate and cosmetic appearance without any compromise in the gained penile size.

Safety and efficacy of ultrasound ciliary plasty as a primary intervention in glaucoma patients

AIM: To evaluate the safety and the efficacy of the ultrasound ciliary plasty(UCP) on the intraocular pressure(IOP) control in glaucomatous eyes without previous glaucoma surgery.METHODS: A retrospective study included patients with primary and secondary glaucoma who underwent UCP in Dar Al Shifa Hospital, Kuwait between January 2017 to June 2018. High-intensity focused ultrasound procedures were performed under peribulbar anesthesia using the 2^(nd) generation probe with 8 s duration of each of the 6 shots. Complete ophthalmologic examinations were scheduled pre-treatment, and at 1 d, 1 wk, 1, 3, 6 and 12 mo posttreatment. Primary outcomes were the IOP reduction and success rates at 12 mo, while the secondary outcomes were the occurrence of vision threatening complications and visual acuity.RESULTS: The records of 62 eyes of 62 patients were analyzed with mean age of 63.8 y(67.7% males). There was statistically significant reduction in the mean IOP from 35.2±8.3 mm Hg before treatment to 20.6±8.7 mm Hg at 12^(th) month(P<0.0005) with a mean percentage IOP reduction of 42.3% with significant reduction in the mean number of antiglaucomatous drugs from 3.2±0.4 before treatment to 2.1±1.02 at 12 mo(P<0.0005). Qualified success was achieved in 77.4% of eyes at 12 mo. No major intra-or posttreatment complications were reported.CONCLUSION: Second-generation UCP prove to be effective in reducing IOP in naive glaucoma patients with lower success rates in cases of neovascular and uveitic glaucomas.

Intraocular inflammation after Ultrasound Cyclo Plasty for the treatment of glaucoma

This is a prospective interventional clinical study evaluating intraocular inflammation developed after Ultrasound Cyclo Plasty(UCP) for the treatment of glaucoma. Eighteen eyes of 18 patients were treated with UCP second-generation probes(Eye OP1). After treatment, the mean intraocular pressure(IOP) significantly decreased from 26.8±7.2 to 18.8±6.1 mm Hg at day 1 and to 14.7±3.4 mm Hg at month 6(all P<0.001). Mean laser flare-cell photometry value steeply increased after surgery from 12.1±7.5 to 64.1±53.9 ph/ms(P=0.001) at day 1, and then progressively decreased to respectively 60.6±49.7 at day 7, 43.5±38.5 at day 14 and 28.2±18.3 at month 1(all P<0.05), returning at levels similar to baseline ones at month 3 and month 6(respectively 16.7±6.2 and 12.8±10.2, both P>0.05). A significant negative correlation was found between postoperative increase of aqueous flare values and anterior chamber depth(R=-0.568, P=0.014). This timeframe may be considered reasonable for repeating UCP treatment, when required.

Uterus Bicorne Cervical United: A Case of Pregnancy after Uterine Plasty (Review of the Literature)

The uterus bicorne is a uterine malformation whose pathophysiology is known but the etiology remains obscure. Few studies have been interested in this subject. This is the clinical observation of Mrs. X 26-year-old housewife nulliparous who consulted for repeated late spontaneous abortions. The clinical examination was normal. The ultrasound revealed a double uterine cavity in Y, in favor of a unicervical bicorne uterus. At hysterosalpingography, the tubes were permeable and the uterus doubled with a single cervix. The treatment consisted of a uterine plasty. The postoperative course was simple. The patient gave birth to a newborn male 20 months after surgery.

ANALYSIS ON THE CURATIVE EFFECT OF QUADRICEPS PLASTY

Three kinds of operations of quadriceps femoris plasty are disscussed in this article.29cases of operations of quadriceps femoris plasty were performed. 23 cases got excellent result andlimb condition of all cases was improved after operation.We think that the best operation method toperform the quadriceps plasty is transplanting the muscular biceps femoris and semitendinous.Theproper age for the operated patient is over 10 years old.The operative indication and complicationare disscussed too.At last four kinds of methods to fix the transplanted muscles or tendor to thepatella are recomended.

Application of autogenous nasal septal cartilage in the plasty of nasal tip and columella

Objective To evaluate the effect of anlogenous septal cartilage in repair of nasal tip and columella. Methods Nasal septal cartilage was transplanted between medial angles of greater alar cartilage at the nasal columella as a support,and a scutellate cartilage was transplanted to the nasal tip. Results All 108 cases were followed up for 1 ～ 2 years,they were satisfied with

Computed tomography virtual endoscopy with angiographic imaging for the treatment of type Ⅳ-A choledochal cyst

Type Ⅳ-A choledochal cysts (CCs) are a congenital biliary anomaly which involve dilatation of the extrahepatic and intrahepatic bile ducts. We present the case of a 30-year-old woman with type Ⅳ-A CC, on whom threedimensional computed tomography (3D CT) and virtual endoscopy were performed. 3D CT revealed partial dilatation in the posterior branch of the intrahepatic bile duct and a relative stricture between it and the extrahepatic bile duct. Virtual endoscopy showed that this stricture was membrane-like and separated from the surrounding blood vessels. Based on these image findings, complete cyst resection, bile duct plasty for the stricture, and hepaticojejunostomy were safely performed. To the best of our knowledge, there are no reports of imaging by virtual endoscopy of the biliary tract which show the surrounding blood vessels running along the bile duct.

A new technique for the reconstruction of complex portal vein anomalies in right lobe living liver donors

Living donor liver right lobe transplantation using donors with variation of the right sectorial portal vein is considered a challenging procedure in terms of the donor’s safety and the complexity of reconstruction in the recipient.We describe an innovative technique to reconstruct double portal vein orifices via a deceased donor iliac vein graft.The postoperative course of the recipient was uneventful.Doppler ultrasound on the fourth postoperative month revealed equivalent flow in both portal vein branches.Reconstruction of double right portal vein branches using a cryopreserved iliac vein is a valuable technique for utilizing right lobe grafts with challenging portal vein anatomy.

Postburn dorsal and palmar interdigital commissural contractures: Anatomy and treatment—A new approach

Background: Postburn dorsal and palmar interdigital commissural contracture is one of the most common complications of hand burns which restricts finger motion and presents a serious cosmetic defect. Many techniques and flaps have been suggested, and research continues for more effective techniques as the problem has not been solved. Methods: Anatomy of scar interdigital commissural contractures was studied in 760 operated patients aiming to develop a new, more effective surgical technique. Results: There are two anatomic types of scar commissural contractures: edge and total. Dorsal and palmar commissural contractures are identified as the edge type and are caused by the fold located along interdigital fossa’s edge. In the fold, the lateral sheet is scars, and the medial sheet and adjacent interdigital fossa are healthy skin. Total commissural contracture is characterized by interdigital fossa obliteration and phalanges’ fusion. Scar sheets have a trapeze-shaped surface deficiency (contracture cause), which spreads from the fold’s crest to metacarpophalangeal joints. The surgical technique consists of scar surface deficiency compensation and commissural groove and slant restoration which can be optimally achieved with the trapezoid adipose-cutaneous flap. The best donor site is interdigital fossa. The small skin grafts on the lateral surface of proximal phalanges did not present a cosmetic defect. Conclusion: Dorsal and palmar interdigital commissural contractures are of an edge type and can be successfully reconstructed with trapeze-flap plasty.

Regeneration of Mastoid Air Cells <i>in Vivo</i>Using Autologous Cortical Bone

Purpose: This was a preliminary study to assess surgical construction and regeneration of mastoid air cells in the treatment of cholesteatoma. Methods: Two-stage tympanoplasty with mastoidectomy was performed in four cases of unilateral cholesteatoma with sclerotic mastoid. During the first-stage operation, small fragments of autologous cortical bone were inserted into the cavity after mastoidectomy to form a honeycomb-like structure. Reconstruction of the lateral wall of the mastoid cavity was performed using the mastoid cortical bony plate. Pre- and postoperative mastoid volume was evaluated by three-dimensional reconstruction based on high-resolution computed tomography (HR-CT) images. Results: HR-CT images after the first-stage operation showed that mastoid volume had increased in all subjects. Macroscopic inspection during the second-stage operation revealed that the honeycomb-like structure made of bony fragments and covered by thin mucosa in the mastoid cavity was stable, with no evidence of effusion or granulation tissue. No retraction of the eardrum, middle ear effusion or recurrence of cholesteatoma was observed, and the hearing level on a pure-tone audiogram was improved in any subject 60 - 94 months after the second-stage operation. Conclusion: Surgical construction and regeneration of mastoid air cells using autologous cortical bone can be useful in treatment of cholesteatoma with arrested mastoid pneumatization.

Reconstructive Surgery in the Lower Urinary Tract in Children: Can the Complication Rate Be Reduced?

Objective: Reconstructive surgery of the lower urinary tract in children is reported with a high complication rate. The aim was to evaluate the complication rate at our institution. Material and methods: Between 2000 and 2010, 41 boys and 19 girls were consecutively operated on with augmentation with ileum (45), alternative CIC-channel (57) and bladder neck plasty (42) in isolation or as combined procedures in individuals with neurogenic bladder dysfunction NBD (42), bladder exstrophy-epispadias complex BEEC (13), isolated epispadias IE (2) and posterior urethral valves, PUV (3). Median age at surgery was 11 years (range 1.3 -21) and median follow-up time 7 years (1 -10). Complications were consecutively observed at follow-up according to a structured protocol. As first line care, specially trained nurses followed the patients and daily bladder irrigation was included in the CIC follow-up regimen. Results: In individuals with augmentation with ileum, of which all but one performed CIC through an alternative channel, there were stones reported in 3/45 (7%), perforation in 2/45 (4%), reoperation of CIC channel in 5/57 (9%), bowel obstruction in 3/56 (5%) and rupture of BNP in 3/39 (8%). Re-augmentation was not needed and malignancy not found. No significant difference was seen between patients with NBD and BEEC/IE. Conclusion: Complication rates were among the lowest reported for stones, perforation and reoperations of CIC channels and were average for bowel obstruction. Bladder stones and perforation were seen in individuals with bad compliance to recommended CIC-and irrigation regimens.

Papillary Fibroelastoma of the Papillary Muscle of the Tricuspid Valve: Reconstruction of the Papillary Muscle

Cardiac papillary fibroelastoma is the third most frequent primary cardiac tumor, after myxoma and fibroma. A papillary fibroelastoma that arises from the papillary muscle is rare. We removed a papillary fibroelastoma located at the anterior papillary muscle of the tricuspid valve. The papillary muscle needed reconstruction. We used the loop technique to adjust the length of the papillary muscle and performed annuloplasty by using an artificial ring.

Treatment of Neglected Elbow Dislocations by Z-Lengthening of the Triceps Brachii

Introduction: Neglected elbow dislocations are much more common in developing and underdeveloped countries. The main reason for the delay in diagnosis is that patients initially seek treatment from traditional healers. These will immobilize the elbow in extension, which will lead to the retraction of the triceps muscle and collateral ligaments. Patients and Method: We carried out a prospective study over five years (2014-2019). The study involved patients with unreduced elbow dislocation older than 21 days. All patients with a dislocated fracture and those whose x-ray showed joint fusion were not included in the study. We collected 26 patients, 20 men and 6 women with an average age of 27.5 years (17 and 45 years). The average consultation time was 8.9 months (3 - 13). The approach was posterior about 8 cm above the olecranon and 2 cm below the olecranon, the ulnar nerve was identified and isolated. The triceps tendon was cut in a Z from its myotendin junction to the beak of the olecranon, and then lengthened. Results: The patients were reviewed after a mean follow-up of 24 months (12 - 36). The Mayo Clinic’s average elbow performance index was 77.1 (60 - 85), with 19 good and 6 average results. The mean flexion was 114&deg;(100&deg;- 135&deg;) and the mean extension deficit was 31.15&deg;(10&deg;- 55&deg;). The average range of motion was 82.5&deg;(60&deg;- 120&deg;). We did not find a correlation between the duration of the lesion and functional recovery (p > 0.05). The Wilcoxon test showed that surgery significantly improved the overall range of motion of the elbow (p = 0.001). Discussion: Based on this study, open reduction with tendon lengthening should remain a treatment option regardless of the age and chronicity of the dislocation.

Massive Vesical Hernias and Its Management: Case Series and Literature Review

Background: Bladder hernias are infrequent and should be treated by the urologist, or an experienced surgeon. An inguinoscrotal hernia of the bladder should be suspected in male patients with voiding symptoms and a fluctuant mass in the scrotum that changes its volume during urination. The most common characteristics found on the series were patients with advanced age, sedentary, and overweight. Case Presentation: We present a case series of 4 patients with inguinoscrotal herniation of the bladder, the surgical management, and outcome. Conclusion: The surgical technique used was inguinal plasty with Lichtenstein technique and either laparoscopic or open surgery mesh-plug placement. None had surgical complications, and none had recurrence at their follow-up.

PVP与PKP治疗骨质疏松性椎体压缩骨折术后疼痛及生活质量改变的对比研究

目的：探讨和比较经皮椎体成形术与椎体后凸成形术治疗骨质疏松性椎体压缩骨折术后疼痛及生活质量改变的情况。方法：回顾性分析2010年11月～2012年11月我科收治的58例骨质疏松性椎体压缩骨折患者。其中PVP治疗组32例，40椎体；PKP治疗组26例，28椎体。术后随访6个～18个月，平均13个月。结果：手术前后，2组病例的疼痛视觉模拟评分（ VAS）与生活质量评分SF～36的差异较大（P＜0．05），有统计学意义；而2组间的VAS与SF～36的差异不大（P＞0．05），无统计学意义。结论：采用PVP与PKP治疗骨质疏松性椎体压缩骨折，二者均能够迅速在术后缓解患者疼痛及使患者生活质量得到改善；相对而言，PVP操作简单，手术时间短，疗效确切且价格便宜，更利于推广应用。

Study of engine performance, emission and combustion characteristics fueled with diesel-like fuel produced from waste engine oil and waste plastics

Utilizing oil extracted from waste engine oil and waste plastics, by pyrolysis, as a filel for internal combustion engines has been demonstrated to be one of the best available waste management methods. Separate blends of fuel from waste engine oil and waste plastic oil was prepared by mixing with diesel and experimental investigation is conducted to study engine performance, combustion and exhaust emissions. It is observed that carbon monoxide （CO） emission increases by 50% for 50% waste plastic oil （50WPO：50D） and by 58% for 50% waste engine oil （50WEO：50D） at full load as compared to diesel. Unburnt hydrocarbon （HC） emission increases by 16% for 50WPO：50D and by 32% for 50WEO：50D as compared to diesel at maximum load. Smoke is fotmd to decrease at all loading conditions for 50WPO：50D operation, but it is comparatively higher for 50WEO：50D operation. 50WPO：50D operation shows higher brake thermal efficiency for all loads as compared to 50WEO：50D and diesel fuel operation. Exhaust gas temperature is higher at all loads tbr 50WPO：50D and 50WEO：50D as compared to diesel fuel operation.

BlueStar New Materials:Does Its Best

BlueStar New Chemical Materials Co.,Ltd.(SH:600299) was established in 1999 andwas listed on the Shanghai Stock Exchange in2000.The company is headquartered in Beijingwith nine affiliated production bases,spread-ing over Jiangxi,Wuxi,Tianjin and other areas.The main businesses of BlueStar NewChemical Materials include silicone series,phenol,acetone,bisphenol A,epoxy resin,engineering plastics,butene,butadiene,chlo-roprene rubber,titanium dioxide,maleic an-