[Pathogenesis, prevention and management of edema after prepuce surgery]

Prepuce diseases are very common conditions in urology and andrology, and quite a few cases need to be treated by surgery. Preputial edema is a common complication after prepuce surgery, with a higher incidence rate in children than in adults. Although preputial edema is just moderate symptom and does not affect urination, it worries or even distresses the patient both physically and psychologically. In recent years, rapid achievements have been made in prepuce surgery, as in prepuce circumcision, preputial neoplasm excision, and penile degloving repair, which can now be accomplished with shorter time and higher efficiency. Despite constant improvement in the methods and techniques for prepuce surgery, postoperative edema remains difficult to be totally prevented. Pathogenic factors for postoperative preputial edema vary from disturbance of blood circulation to inflammatory factor-induced change in capillary permeability, lymphatic circulation disorders, and neurogenic edema. Elimination of the pathogenic factors and precautionary measures after surgery count significantly to the prevention and management of postoperative preputial edema. This review focuses on the pathogenesis, prevention and treatment of edema after prepuce surgery.

Optimising the utility of pleural fluid adenosine deaminase for the diagnosis of adult tuberculous pleural effusion in Hong Kong

INTRODUCTION

Pleural fluid adenosine deaminase level can be applied to rapidly detect tuberculous pleural effusion. We aimed to establish a local diagnostic cut-off value for pleural fluid adenosine deaminase to identify patients with tuberculous pleural effusion, and optimise its utility.

METHODS

We retrospectively reviewed the medical records of consecutive adults with pleural fluid adenosine deaminase level measured by the Diazyme commercial kit (Diazyme Laboratories, San Diego [CA], United States) during 1 January to 31 December 2011 in a cluster of public hospitals in Hong Kong. We considered its level alongside early (within 2 weeks) findings in pleural fluid and pleural biopsy, with and without applying Light's criteria in multiple scenarios. For each scenario, we used the receiver operating characteristic curve to identify a diagnostic cut-off value for pleural fluid adenosine deaminase, and estimated its positive and negative predictive values.

RESULTS

A total of 860 medical records were reviewed. Pleural effusion was caused by congestive heart failure, chronic renal failure, or hypoalbuminaemia caused by liver or kidney diseases in 246 (28.6%) patients, malignancy in 198 (23.0%), non-tuberculous infection in 168 (19.5%), tuberculous pleural effusion in 157 (18.3%), and miscellaneous causes in 91 (10.6%). All those with tuberculous pleural effusion had a pleural fluid adenosine deaminase level of ≤100 U/L. When analysis was restricted to 689 patients with pleural fluid adenosine deaminase level of ≤100 U/L and early negative findings for malignancy and non-tuberculous infection in pleural fluid, the positive predictive value was significantly increased and the negative predictive value non-significantly reduced. Using this approach, neither additionally restricting analysis to exudates by Light's criteria nor adding closed pleural biopsy would further enhance predictive values. As such, the diagnostic cut-off value for pleural fluid adenosine deaminase is 26.5 U/L, with a sensitivity of 87.3%, specificity of 93.2%, positive predictive value of 79.2%, negative predictive value of 96.1%, and accuracy of 91.9%. Sex, age, and co-morbidity did not significantly affect prediction of tuberculous pleural effusion using the cut-off value.

CONCLUSION

We have established a diagnostic cut-off level for pleural fluid adenosine deaminase in the diagnosis of tuberculous pleural effusion by restricting analysis to a level of ≤100 U/L, and considering early pleural fluid findings for malignancy and non-tuberculous infection, but not Light's criteria.

Increased survival rate in patients with massive burns

A review of 113 patients with massive burns treated in our centre from 1970 to 1989 is presented. There were 57 adults patients with massive burns (> or = 50 per cent TBSA) in 1980-89 who were compared with 56 patients with similar massive burns in the period between 1970 and 1979. The results show a significant improvement (P < 0.01) in survival rate of the more recent patients. The increased survival rate is attributed to improvements in the early treatment of inhalation injury, sepsis and multiorgan failure.

[In vitro quantitative study on invasive process of two human nasopharyngeal carcinoma cell lines, CNE-1 and CNE-2Z]

Computer-image processing system was used in the quantitative study on invasion in organ culture of two human nasopharyngeal carcinoma cell lines of different degree of differentiation, CNE-1 and CNE-2Z. For invasion of tumor cells into precultured heart fragments (PHF), observations were done on days 1,3,5 and 7 after organ culture. The results showed that the invasion of both CNE-1 and CNE-2Z cells was progressive. The invasion of CNE-1 tumor cells covered 82.22% of PHF on day 7, but on days 1 to 3 the invasion of CNE-2Z tumor cells covered 80-92% of PHF. This indicates that CNE-2Z cells are more invasive then CNE-1 cells.

[The invasive behavior of two human nasopharyngeal carcinoma (NPC) cell lines CNE-1, CNE-2Z in vitro]

Method of co-culture of tumor cells with precultured heart fragments (PHF) in vitro was used in studying the invasive behavior of human nasopharyngeal carcinoma (NPC) cell lines CNE-land CNE-2Z respectively. This improved method was based on the gyrotory shaker organ culture technique originally established by Mareel in order to show NPC cell invasiveness in a rather identical image. Histopathological sections revealed that the tumor cells might invade into the cell layer of fibroblasts surrounding the heart tissue. This would make the heart muscle cells degenerated, atrophied and necrotic and finally displaced by the fibrotic tissue. Data also pointed out that CNE-2Z cells showed more active invasive ability than that of the CNE-1 cells in the organ culture.

Bilateral visual loss after severe burns in a child

A girl who sustained severe burns was admitted to the hospital 16 h postburn. The patient developed sudden visual loss on day 15 postburn. She responded to treatment with significant return of visual acuity by 5 weeks after injury at the time of discharge from hospital.

[An analytic epidemiologic survey of epilepsy in the Hui and Han nationality districts of Yinchuan]

An analytical epidemiologic survey of epilepsy was made with random sampling in the inhabitants of Han and Hui nationalities of Yinchuan city, Ningxia Autonomous Region. The sample of the population consisted of 10,415 subjects, including 1420 Hui nationality people and 8995 Han nationality people. The sex proportion, age, occupation distribution, and the residential years of Han and Hui nationality groups were essentially the same, rendering them comparable statistically. Through cross sectional comparative studies, it was revealed that the prevalence rates of epilepsy in the Hui nationality people were much higher than those in the Han nationality people. In order to find clues relating to the cause of such a difference between these groups, several possible risk factors were investigated and analyzed, but no definite conclusion could yet be made.