动脉性阳痿显微重建37例

目的：动永陆阳痿主要是阴茎动脉供血不足或缺乏所致。由于缺血、缺氧对阴茎输入、输出血管壁肉垫易纤维化,失去正常开放与舒张功能,进而加重了阳痿。通过动脉重建以改善阴茎供血、供氧,促使受损组织得以康复。方法：运用显微外科技术作腹壁下动脉-海绵体吻合2例;与阴茎背动脉端端、端侧吻合10例;与阴茎背深静脉端端吻合25例。本组采取端端、端侧、套入、血管移植等方法,全部作阴茎背深、脚静脉结扎。结果：术后随访5—60个月显效20例,占54．05％;满意12例,占32.34％;无效5例,占13．51％。结论：动脉性阳痿,不仅阴茎供血不足造成损害,而且影响或加重静脉系统关闭不全,一旦发生器质性改变,手术效果将不够理想。笔者主张动脉性阳痿尽早作动脉重建是较为理想的选择。     

肾移植受体皮肤黏膜感染的类型

据报告,75 %～10 0 %的肾移植受者患有感染、癌前病变、癌症和药疹等皮肤损害,其中绝大多数为感染。由机会性生物和原发病原体导致的感染是器官移植受者最常见的死因,皮肤表现可作为上述播散疾病存在的重要线索。该研究旨在确定肾移植受者皮肤黏膜感染的病原谱和流行状况。肾移植受者共10 4例,其中男84例,女2 0例,年龄15～6 5岁,移植后病程1～175个月。2 7例应用泼尼龙和硫唑嘌呤2种药物治疗,77例还加用环孢素共3种药物治疗。患者被分为6组:A组,移植肾存活不足2个月;B组,移植肾存活2～6个月;C组,移植肾存活6～12个月;D组,移植肾存活12～2 …     

彩超在男性阴茎勃起功能障碍中的应用

目的：探讨彩超在男性阴茎勃起功能障碍（ED）临床治疗中的作用,以期提高治疗水平。方法：随机选取2010年4月至2013年4月309例ED患者为研究对象,分成两组,均予以彩超检查;观察组予以他达拉非10mg口服,对照组服用安慰剂,观察用药前后在阴茎深动脉收缩期峰值流速（PSV）、舒张期末期最小流速（EDV）、阻力指数（RI）和直径（D）的变化情况和阴茎深动脉D增大率变化情况。结果：在ED构成比率上两者比较无明显差异性（P＞0.05）,而从组间PSV情况看,动脉性ED组最小、复合性ED其次,静脉性ED组再次,非血管性ED组最大;从EDV情况看,静脉性ED组和复合性ED组明显高于其他两组（P＜0.05）;从RI情况看,非血管性 ED 组明显高于其他3者（P＜0.05）,组间比较有明显差异性（P＜0.05）。结论：彩超能为临床上ED的诊断提供良好客观依据。     

盆底肌锻炼对子宫全切术后性生活质量的影响

目的：探讨盆底肌锻炼对子宫全切术后性生活质量的影响。方法：选择子宫全切患者40例,采用本组盆底肌锻炼方法,比较干预前后盆底肌收缩时间和阴道内收缩压力,统计干预前后每周性生活频率,以及性唤起时间、获得高潮时间和性交时疼痛情况。结果：干预后患者盆底肌收缩时间显著长于干预前（P〈0．05）,阴道内压力显著高于干预前（P〈0．05）,干预后患者每周性生活频率超过2次者显著多于干预前（P〈0．05）,且每周性生活频率少于1次者显著少于干预前（P〈0．05）,干预后患者性唤起时间显著快于干预前（P〈0．05）,性交疼痛评分显著低于干预前（P〈0．05）,获得高潮时间显著快于干预前（P〈0．05）。结论：盆底肌功能锻炼能显著减少子宫切除术后患者性交不适,提高女性对性生活的渴望,提高性生活质量。     

男性阴茎附属腺和皮肤淋球菌感染皮损的高频超声研究

【摘要】 目的 了解男性阴茎皮肤和附属腺淋球菌感染皮损的超声影像学表现及其临床意义。方法 2014年1月至2021年1月在常熟市第一人民医院皮肤科纳入经实验室检查确诊且既往未接受过相关治疗的男性阴茎皮肤和附属腺淋球菌感染患者。使用SIEMENS ACUSON X300实时超声显像仪检测阴茎体表淋球菌感染皮损,探头频率7.5 ~ 15 MHz。高频超声影像表现为管状液性暗区者仅予头孢曲松1 g单剂肌内注射;椭圆形液性暗区者,切开引流同时予头孢曲松1 g肌内注射,每天1次,共5 d;低回声区、混合回声区者予头孢曲松1 g肌内注射,每天1次,共5 d,治疗后1个月结节仍不消退者,局部切除结节。治疗后1个月复诊并观察疗效。结果 共收集32例男性阴茎皮肤和附属腺淋球菌感染患者,年龄（28.54 ± 3.27）岁,均有非婚性接触史,非婚性接触至症状出现时间为（4.45 ± 1.03） d,病程（8.64 ± 1.87） d。皮损均单发,位于尿道外口16例（50.00%）,龟头7例（21.88%）,包皮系带旁5例（15.62%）,阴茎缝4例（12.50%）。皮损表现：窦道样损害16例（50.00%）,脓肿9例（28.13%）,结节7例（21.87%）,皮损处均有触痛。高频超声检查：16例（50.00%）表现为管状液性暗区,7例（21.88%）为椭圆形液性暗区,5例（15.62%）为低回声区,4例（12.50%）为混合回声区。16例（50.00%）淋球菌感染累及尿道海绵体,5例（15.62%）累及阴茎海绵体,11例（34.38%）累及阴茎皮下。经治疗,32例均痊愈。结论 高频超声可用于男性阴茎皮肤和附属腺淋球菌感染患者的皮损评估和治疗方案的选择。     

浅表性阴茎癌保留阴茎完整性切除术的可行性以及对患者及配偶性心理影响(附3例报告)

目的:探讨浅表性阴茎癌保留阴茎完整性手术的可行性以及术后对患者及配偶的心理生理学影响。方法:3例患者术前均行必要体检确定肿瘤未侵及白膜,常规术前病理活检证实为阴茎鳞癌,常规检查胸片、髂血管走行区超声及盆腔CT未发现局部淋巴结转移及远处转移。切除肿瘤组织及远端0.5cm包皮组织,深达白膜层,近端切除多余包皮内板及适当外板包皮组织连同阴茎筋膜达白膜层,术中冰冻病例证实切缘阴性。术后1周预防性加用双侧腹股沟区放疗治疗。结果:3例患者均按时复诊,随诊18个月~3年,局部无肿瘤复发,腹股沟区及腹膜后淋巴结未见转移。术后生殖器外观满意,排尿正常,性欲及性生活满意度为满意。结论:浅表性阴茎肿瘤保留阴茎完整性阴茎切除术从手术方案方面是可行的,从手术效果上看,可使患者更好的保持良好的性自信、性功能和性生活满意度,使患者夫妇对生活充满希望及保持幸福。     

动态超声观察血管性勃起功能障碍患者阴茎血流动力学的应用

目的:探究动态超声在观察血管性勃起功能障碍(ED)患者阴茎血流动力学上的临床应用效果。方法:将我院2013年1月至2016年1月接治的220例疑似血管性ED患者纳入研究,并选取100例心理性ED患者进行对照。应用阴茎海绵体注射血管活性药物试验(ICI)及多普勒超声对所有入选患者的阴茎海绵体进行血流动力学检测,分析不同类型ED患者在ICI前后阴茎长度、周长的变化以及收缩期峰值流速、舒张末期峰值流速、血流阻力指数的变化。结果:在220例疑似血管性ED患者中,动脉性ED患者74例,静脉性ED患者65例,混合血管性ED患者81例。动脉性ED、混合血管性ED患者的阴茎海绵体内径、PSV和EDV上均小于静脉性ED和心理性ED患者,而动脉性ED和心理性ED在RI上明显高于静脉性ED和混合血管性ED,差异具有统计学意义(P0.05)。ICI试验之前,动脉性ED、静脉性ED、混合血管性ED、心理性ED四组患者在阴茎周长、长度上比较并无显著性差异(P0.05);ICI试验后,动脉性ED患者的阴茎周长、阴茎长度明显短于静脉性ED、混合血管性ED、心理性ED患者,差异具有统计学意义(P0.05)。结论:彩色多普勒超声能够极为清晰地反映出血管性ED患者的阴茎血流动力学状态,为准确有效地判断血管性ED分型提供有力的诊断依据,在临床鉴别上值得推广使用。     

联合药物治疗糖尿病型勃起功能障碍的临床效果观察

目的：观察应用睾酮补充疗法联合间断剂量他达拉非治疗糖尿病型勃起功能障碍的临床疗效,为糖尿病型勃起功能障碍的临床治疗提供新的有效途径.方法：本组患者43例,平均年龄46.3岁（32 ～57）岁,糖尿病史5年以上,勃起功能障碍病史2年以上,血糖控制良好,有改善性生活的要求.所有患者均进行国际勃起功能问卷表-5（IIEF-5）评分及睾酮缺乏症状（Padam）问卷评分,并测定血睾酮水平,本组患者睾酮水平均＜3ng/ml.按在性生活中阴茎勃起后能否插入阴道将患者分为两组,可插入者（Ⅰ组）26例,插入困难者（Ⅱ组）17例.治疗方法为：睾酮补充治疗均为口服十一酸睾酮制剂120mg/d,Ⅰ组患者给予他达拉非10mg口服,2次/周;Ⅱ组患者给予他达拉非20mg口服,2次/周,疗程为3个月.治疗期间规律性生活,治疗结束后再次填写上述问卷并复查血睾酮水平.结果：治疗后IIEF-5评分平均为（18.25±7.38）分,与治疗前平均（12.36±5.73）分相比有显著统计学差异（P＜0.01）.Padam评分分值由治疗前的平均（31.73±4.36）分下降至治疗后的平均（18.41±2.75）分,二者相比有显著的统计学差异（P＜0.01）.睾酮水平治疗前平均（2.87±0.54） ng/ml[正常对照组为（5.23±2.42） ng/ml,参考范围2～ 10 ng/ml].治疗后复查血睾酮水平平均为（3.26±0.62） ng/ml,与治疗前相比有所上升,但无统计学差异（P＞0.05）.治疗后38例患者性生活质量有明显改善,Ⅰ组26例可插入的患者性生活满意度明显增加,Ⅱ组17例插入困难者有12例可完成插入,性生活质量明显改善.但其余5例仍不能插入,需要进一步治疗.结论：睾酮补充疗法联合间断剂量他达拉非是治疗糖尿病型勃起功能障碍的有效方法.     

心理干预对子宫全切与次全切术患者性生活及生活质量的影响研究

目的：通过临床观察探讨心理干预对子宫全切与次全切术患者性生活及生活质量的影响。方法：选取在我院接受治疗的96例子宫全切与次全切术患者,将患者平均分成对照组和实验组,每组48名患者。对照组患者进行常规护理。实验组患者在常规护理的同时进行心理干预。通过性调查问卷和生活质量问卷,比较并观察半年后两组患者的性生活状况及生活质量情况。结果：两组患者经护理后,实验组性生活频率、性欲能力明显高于对照组;实验组性生活不适感明显低于对照组,统计学上有意义（P〈0．05）。实验组物质生活、心理功能、社会功能方面明显优于对照组;而实验组疲惫疼痛、失眠虚弱方面明显低于对照组,统计学上有意义（P〈0．05）。结论：对子宫全切与次全切术患者进行心理干预后,患者的性生活质量及生活质量明显提高,在临床上可以广泛运用。     

泼尼松龙联合自体表皮移植治疗白癜风的临床疗效观察

目的：探讨泼尼松龙联合自体表皮移植治疗白癜风的临床疗效。方法：采用门诊病历统计法,将患者分3组：A组55例（为试验组）泼尼松龙皮损内注射加皮肤磨削后,自体表皮移植联合治疗。B组80例,用泼尼松龙皮损内注射加白灵内服和外擦治疗,C组65例,用白灵内,外用药加皮肤磨削术治疗。结果：3组疗效比较,以A组疗效最好,结论：先用泼尼松龙皮损内注射,稳定病情发展,再进行皮肤磨削加自体表皮移植术,疗效肯定,又无任何不良反应。     

Older candidates for kidney transplantation: Who to refer and what to expect?

The number of older end-stage renal disease patients being referred for kidney transplantation continues to increase. This rise is occurring alongside the continually increasing prevalence of older end-stage renal disease patients. Although older kidney transplant recipients have decreased patient and graft survival compared to younger patients, transplantation in this patient population is pursued due to the survival advantage that it confers over remaining on the deceased donor waiting list. The upper limit of age and the extent of comorbidity and frailty at which transplantation ceases to be advantageous is not known. Transplant physicians are therefore faced with the challenge of determining who among older patients are appropriate candidates for kidney transplantation. This is usually achieved by means of an organ systems-based medical evaluation with particular focus given to cardiovascular health. More recently, global measures of health such as functional status and frailty are increasingly being recognized as potential tools in risk stratifying kidney transplant candidates. For those candidates who are deemed eligible, living donor transplantation should be pursued. This may mean accepting a kidney from an older living donor. In the absence of any living donor, the choice to accept lesser quality kidneys should be made while taking into account the organ shortage and expected waiting times on the deceased donor list. Appropriate counseling of patients should be a cornerstone in the evaluation process and includes a discussion regarding expected outcomes, expected waiting times in the setting of the new Kidney Allocation System, benefits of living donor transplantation and the acceptance of lesser quality kidneys.     

Renal transplantation with expanded criteria donors: Which is the optimal immunosuppression?

The growing gap between demand and supply for kidney transplants has led to renewed interest in the use of expanded criteria donor (ECD) kidneys in an effort to increase the donor pool. Although most studies of ECD kidney transplantation confirm lower allograft survival rates and, generally, worse outcomes than standard criteria donor kidneys, recipients of ECD kidneys generally have improved survival compared with wait-listed dialysis patients, thus encouraging the pursuit of this type of kidney transplantation. The relative benefits of transplantation using kidneys from ECDs are dependent on patient characteristics and the waiting time on dialysis. Because of the increased risk of poor graft function, calcineurin inhibitor (CNI)-induced nephrotoxicity, increased incidence of infections, cardiovascular risk, and malignancies, elderly recipients of an ECD kidney transplant are a special population that requires a tailored immunosuppressive regimen. Recipients of ECD kidneys often are excluded from transplant trials and, therefore, the optimal induction and maintenance immunosuppressive regimen for them is not known. Approaches are largely center specific and based upon expert opinion. Some data suggest that antithymocyte globulin might be the preferred induction agent for elderly recipients of ECD kidneys. Maintenance regimens that spare CNIs have been advocated, especially for older recipients of ECD kidneys. CNI-free regimens are not universally accepted due to occasionally high rejection rates. However, reduced CNI exposure and CNI-free regimens based on mammalian target of rapamycin inhibitors have shown acceptable outcomes in appropriately selected ECD transplant recipients.     

HLA alleles in renal transplant recipients with nonmelanoma skin cancer in southeastern Brazil

Background: Renal transplant recipients are submitted to immunosuppression to avoid graft rejection, which makes them susceptible to various conditions. Furthermore, these individuals present malignant tumors more frequently than the general population, including nonmelanoma skin cancer. The individual genetic basis that acts in the pathogenesis of cutaneous cancer may present a protection or susceptibility factor for disease development. One of these factors is the HLA complex.Objective: To investigate HLA alleles association to the occurrence of nonmelanoma skin cancer in renal transplant recipients from Sao Paulo State.Methods: A total of 213 patients (93 renal transplant recipients with nonmelanoma skin cancer and 120 renal transplant recipients without nonmelanoma skin cancer) were evaluated by retrospective and cross-sectional study. Epidemiological, clinical and HLA typing data were found in databases. HLA class I (A, B) and class II (DR) alleles were compared to establish their association with nonmelanoma skin cancer.Results: Comparing renal transplant recipients with and without nonmelanoma skin cancer, the HLA-B*13 allele was associated with higher risk of developing nonmelanoma skin cancer while B*45 and B*50 alleles were associated with protection.Study limitations: The HLA A, B and DR alleles identification for the kidney transplantation routine is done by low and medium resolution techniques that do not allow discrimination of specific alleles.Conclusion: The involvement of HLA alleles in nonmelanoma skin cancer in renal transplant recipients was confirmed in this study. Renal transplant recipients with HLA-B*13 showed higher risk for developing a skin cancer (OR= 7.29) and should be monitored for a long period of time after transplantation.     

Immunosuppressive regimens and outcomes of inflammatory bowel disease patients requiring kidney transplantation

Patients with inflammatory bowel disease (IBD) can develop extra-renal complications and as a result, suffer from end stage renal failure requiring kidney transplantation (KT). A brief review of available literature revealed that IBD patients undergoing KT have shorter overall survival rates compared to their controls. Literature reporting steroid regimens and survival outcomes specific to IBD and post kidney transplant are scarce and these studies have small sample sizes thus making it difficult to draw accurate conclusions. Further research is required in the form of a randomized controlled study to clarify the effect and mechanism of steroid immunosuppression on the prognosis of renal transplant recipients and explore new treatment schemes.     

Update on the pathogenesis of post-transplant skin cancer in renal transplant recipients

Remarkable advances in the field of transplantation over the last several decades have benefited many thousands of patients. Five-year survival ranges from 90% for a live donor renal transplant to 85% for a cadaveric renal transplant. However, with this success come the complications of chronic immunosuppression. Lifelong immunosuppressive treatment for adequate graft function results in reduction of immunosurveillance, with increased risk of various cancers leading to substantial morbidity and mortality in these patients. This review discusses multifactorial intrinsic and extrinsic factors contributing to the pathogenesis of skin cancers in renal transplant recipients and reviews potential solutions.     

便携式加压舱治疗急性一氧化碳中毒大鼠的疗效研究

目的 评价便携式加压舱在治疗大鼠急性一氧化碳中毒中的疗效.方法 72只大鼠分成5组：A组（空门组）、B组（对照组）、C组（常压高氧组）、D组（加压高氧组）和E组（加压纯氧组）.除对照组外,其余各组均给予腹腔注射纯品CO气体（体积分数99.95%）,剂量0.15 ml/g,达到染毒状态后放入加压舱中给予不同条件的氧疗.治疗后应用血气分析仪行血气分析,测定动脉血氧分压（PO2）、碳氧血红蛋白（COHb）.结果 实验各组的PO2值均显著低于空白组（A组）,且相比较有显著差异（P〈0.0001）.E组有效的恢复了PO2值,其中E2组最有效,将PO2值恢复至正常值的74%（P〈0.05）;实验各组的COHb值均显著高于空白组（A组）,且相比较有显著差异（P〈0.001）.E组、D组和C组均有效的减低了COHb值,其中E2最有效,将COHb值减低了19%（P〈0.05）.结论 应用便携式加压舱并给予纯氧治疗,能够很好的提高ACMP大鼠的PO2值,并降低COHb值,疗效优于常规氧疗方式.     

Nail disorders in hemodialysis patients and renal transplant recipients: a case-control study

BACKGROUND: There is one published case-control study of nail disorders in hemodialysis patients. The nail changes that occur in renal transplant recipients have not been investigated specifically. OBJECTIVE: The aim of this study was to determine prevalence rates of nail disorders in hemodialysis patients and renal transplant recipients, and to investigate whether these nail pathologies are related to hemodialysis and renal transplantation. METHODS: One hundred and eighty-two hemodialysis patients and 205 renal transplant recipients were screened for the presence of nail disorders. The findings in these groups were compared with findings in 143 healthy individuals. RESULTS: One hundred and twenty-seven patients (69.8%) in the hemodialysis group and 116 patients (56.6%) in the renal transplant recipients had at least one type of nail pathology. Absence of lunula, splinter hemorrhage, and half-and-half nails were significantly more common in the hemodialysis patients than in the renal transplant recipients. Leukonychia was significantly more frequent in the renal transplant recipients than in the hemodialysis patients and controls. CONCLUSION: Hemodialysis patients and renal transplant recipients have higher rates of nail disease than the healthy population. Renal transplantation may reduce the frequencies of splinter hemorrhage and half-and-half nails. Interestingly, leukonychia increases significantly after renal transplantation.     

Basal cell carcinomas developing in solid organ transplant recipients: clinicopathologic study of 176 cases

OBJECTIVE: To assess the clinicopathologic features of basal cell carcinomas developing in organ transplant recipients. DESIGN: Case series. SETTING: University department of dermatology. PATIENTS: One hundred forty-six (7.2%) of 2029 transplant recipients followed up in our department who developed 176 histologically proven basal cell carcinomas. One hundred fifty-three random samples of basal cell carcinomas excised from nonimmunosuppressed patients served as controls. MAIN OUTCOME MEASURES: Clinical data were gathered from the medical records. Histologic slides were retrospectively reexamined. RESULTS: Basal cell carcinomas developed an average of 6.9 years after transplantation, sooner after heart than kidney transplantation, and showed a relative predilection for heart allograft recipients. The mean age of transplant recipients with basal cell carcinomas was significantly lower than that of controls (54.6 vs 69.8 years), especially for recipients of renal transplants, and a male preponderance was found (male-female ratio, 4.8:1 vs 1.3:1). In both groups, basal cell carcinomas were predominantly found on the head and neck, but extracephalic locations were significantly more frequent in transplant recipients (37.5%) than controls (24.5%). Histologically, superficial basal cell carcinomas were more frequent in transplant recipients than controls (33.6% vs 14.4%). The density of the peritumoral cell infiltrate was lower in tumors from transplant recipients compared with controls. The tumor thickness and the presence of epidermal ulceration did not differ significantly between the 2 groups. CONCLUSIONS: Basal cell carcinomas in transplant recipients show some clinicopathologic differences from their "ordinary" counterparts, namely, a younger age at development, male preponderance, more frequent distribution in extracephalic sites, and higher frequency of superficial subtypes.     

Key issues in transplant tourism

Access to organ transplantation depends on national circumstances, and is partly determined by the cost of health care, availability of transplant services, the level of technical capacity and the availability of organs. Commercial transplantation is estimated to account for 5%-10% (3500-7000) of kidney transplants performed annually throughout the world. This review is to determine the state and outcome of renal transplantation associated with transplant tourism (TT) and the key challenges with such transplantation. The stakeholders of commercial transplantation include: patients on the waiting lists in developed countries or not on any list in developing countries; dialysis funding bodies; middlemen, hosting transplant centres; organ-exporting countries; and organ vendors. TT and commercial kidney transplants are associated with a high incidence of surgical complications, acute rejection and invasive infection which cause major morbidity and mortality. There are ethical and medical concerns regarding the management of recipients of organs from vendors. The growing demand for transplantation, the perceived failure of altruistic donation in providing enough organs has led to calls for a legalised market in organ procurement or regulated trial in incentives for donation. Developing transplant services worldwide has many benefits - improving results of transplantation as they would be performed legally, increasing the donor pool and making TT unnecessary. Meanwhile there is a need to re-examine intrinsic attitudes to TT bearing in mind the cultural and economic realities of globalisation. Perhaps the World Health Organization in conjunction with The Transplantation Society would set up a working party of stakeholders to study this matter in greater detail and make recommendations.