adverse cutaneous drug reaction among Asians, a review
". Neurotogy Asia, 13, pp. 15-21.
6. Lv Y. D., Min F. L., Liao W. P.. He N., Zeng T., et al.
(2013), "The association between oxcartoazepine-induced maeulopapular eaiption and HLA-B alleles in a northem Han Chinese population". SMC Neurol, 13, pp. 75.
7. Zeng T.. Long Y. S., Min F. L . Liao W. P., ShiY.%
(2014), "Association of HLA-B'1502 allele w^
lamotrigine-induced Stevens-Johnson syndrome and t ^ epidermal necrolysis in Han Chinese subjects: a mab' analysis". Int J Dermatol.
DIEU TRj CONG DimNG VAT NANG TRONG MIENG NIEU DAO DONG THAP VflTl MANH GHEP BJ
TOM TAT
Muc dich: Chung tdi gidi thieu ky thuat dieu trj di tit cong duang vat nBng trong mieng nieu dao ddng thap bing manh ghip bi di md ring can tring vung bung duang vat.
Sd lieu & phuang phap: 44 trudng hpp cong duang v$t nBng kem mieng nieu dao ddng tha'p dupe dieu tri tUthing 3 - 201 idin thing 9 - 2013, tuii tU 1 din 14 Phin loai dua vio thuang tin giai phiu hpc cOa cong duang vat, diiu tri theo tiiu chuan phan loai va xac nhan dUdng vat th^ng sau mi.
Kit qua: Bin muo/ ddn trudng hap cong duang vat nBng dupc dung ky thuat md ring can tring vdi manh ghip bi, sau dd tao hinh nieu dao thi 2 vdi ky thuat cudn dng tai chd. Vidi gian theo ddi tU 6 thang din 2 nBm.
Kdt luin: Chung tdi tin ring viec diiu tri_ cong duang vat nBng vdi ky thuat md ring can tring vdi minh ghip bi la ky thuat chon lua nhim dem lai hinh ding dUdng vat thing han so vdi phuang phap khac.
Tifkhda: Manh ghep bi, duang vit.
SUMMARY
DERMAL GRAFT FOR SEVERE CHORDEE WITH HYPOSPADIAS
Purpose: We present the technique of using a small dermal graft to augment the ventral tunica albuginea in the patient with severe chordee.
Materials & methods: We reviewed the records of 44 patients who underwent severe chordee correction between March 2011 and September 2013. The age ranged from 1 to 14. Dermis was used in 44 patients We grouped cases according to the etiology of chordee and we treated in the standard and a straight phallus was confirmed in all postoperatively.
Results: One dermal graff was placed in 44 patients. Second stage urethral.
reconstruction was done 6 months later with a Thiersch Duplay tube. Patient age ranged from 1 to 14 years. All patients have been followed for a minimum of 6 months and a maximum of 2 years.
Conclusions: We bilieve that the additional penile length achieved with dermal graft results In a depent phallus and cosmetic preferable to that of plication only.
Keywords: H^xispadias, chordee.
DATVANB^
Cong duang vat l i bien dang b i m sinh cd hay khdng di kem vdi mieng nieu dao ddng thap, 16 tieu cao [4][6][9]. Cd nhieu ky thuat trong viic dieu tn eong
LE THANH HUNG, LE CONG T H A N G LE TAN SON, VU Lg CHUYEN
dUdng v i t tuy thuoc vao tUng loai thuang tdn giai phlu [11,[8]. Trong cong duang vat nhe v i tnjng binh viec cat bd md xd vCing bung duang v i t hay khiu gap the hang (Nesbit plication) thudng cho ket qua tuyet v^
[1],[4],[8]. Tuy nhien vdi cong duang v i t nang (hon 30 do) do mi't can ddi cOa bao trang duang vat (tunica albuginea) viee dieu tri bang c i c h khiu gap the hang td ra khdng hiiu qua do lam ngan duang vat. gap cudng mach mau than kinh vung luhg dUdng vat va cong tai phat [1],[2],[3],[7]- Chung tdi gidi thieu kyihuilt md ring c i n trang vung bung duang v i t bang manh ghep bi (dennal graft) lay tU ben trong dieu tq cac trudng hpp cong duang vat nang dua v i o su hllu tHet ve mo hpc cQa manh ghep bi.
SO LIEU & PHL/ONG PHAP
TUthing 3 - 2 0 1 1 den thing 9-2013cd44tm6n9 hpp eong duang vat n i n g kem mieng nieu dao ding thap dupc dieu tri tai khoa Ngoai Benh vien Nhi Ddng I, Phuang phap nghiin cUu: Tien cUu md ta co can thiep l i m sang.
Tat ca benh nhi mieng nieu dao ddng thap cd cong duang v i t hdn 30 dp khi l i m test cuang duang vat (sau khi d i cat san nieu dao).
Tudi benh nhan tU2 den 14.
Trong sd 44 trudng hpp eong dUdng vat ning nft/
Chung tdi phai ap dung ky thuat md ring can trang vi ghep manh bi. Tao hinh n i i u dao dupe tien hanh thi 2 sau 6 thing.
Ky thuat: Sau khi sat trung da duang vat ha vj vi vung ben ndi dU djnh lay da ghep tien hanh dat tti6nfl nuoi an (feeding tube) thfch hdp v i o niiu dao. Dung Viet vd trung ve vong trdn quanh da quy dau each Vnk quy dau cd 0,5cm. chich thudc te Lidocaine (0,1?i adrenaline) vdng theo dudng ve vong trdn. Phliu tidi tach da dUdng vat ra khoi t h i n duang v i t (deglove) eho tdi t i n bd xuang mu. Sau do chUng tdi lam ted cUdng duang v i t (artificial erection) bang each buoc gan-ot gdc duBng v i t v i bam nudc mudi sinh ly vao 0 hang qua kim budm de danh gia mUc dp cong ciliB dUdng vat va tuy theo mUc dp cong ma dUa ra cac each sCr tri khac nhau de lam thang duang v i t nhSm dua dUdng vat trd ve hinh dang binh thudng. Vdi cong dUdng v i t ning dp eong hdn 30 dd chiing tdi cat tuf) trang (tunica albuginea) chd cong vung bung duanfl vat tu VI tri 3 gid den 9 gid trinh l i m tdn thuang W hang ndi cd dpng mach s i u dUdng vit, luc nay dUtJnB
Y HOC THUC HANH (953) - SO 3/2*
vat se thing bao trang vung bung duang v i t ed hinh khuyet ellip. Vung ben dung viet mau danh dau hinh ej^lip tiep theo dCing dao md cat bo Idp thUdng bi ed sac td da sau dd lay tron Idp da ya cat tid Idp md dUdi da.
Lay manh da bi ghep vao chd khuyet bao trang vdi mui khau 6.0 Vicryl lien tuc, thao garott, l i m lai test eUdng duang v i t kiem tra. Khau phu da duang v i t lai, bang ep cam mau. Thdng foley sd 8F luu trong vong 7 ngay.
KET QUA Trong sd 44 tnidng hpp Tudi nho nhi't 1 tudi.
Tudi Idn nhat 14 tudi.
Phin t)dtheo nhdm tudi.
+ Nhdm 1 (< 3 tuoi), 24 tnJdng hpp (54,5%), + N h 6 m 2 ( t U 4 - 6 t u d i ) - 13 trudng hop (29,5%), + Nhdm 3 (tU7 den 14 tuoi); 7 tnJdng hop (15,9%).
Lien quan giUa do d i i them dUdng vat va nhdm tuoi (Bangi)
Bang 1: Lien quan giiJa dp dai them dUdng vat va nhdm tudi
Nh6mIm 1-3
«
7-15 T^ng cflng
Dai tmng binh 1.33 cm 1,923 cm 2,442 cm 1.762 cm
SD (36 I W i chuan}
0,271 0.189 0,243 0,185
Soca 24 13 7 44 B i e n e h U n g s 6 m :
- Phu' 7 trudng hdp, da sd cd phu sau khi thao bang rut thdng xui't vien, (ehie'm ty l i 16%) chu yeu trong nhdm 2: 10 trudng hap, nhom 3 5 trudng hop.
- Chay mau: 3 tnJdng hpp (6,8%) trong dd da sd nam trong nhdm tudi nhd 2 trudng hdp trong nhdm 1-3 tudi va 1 ]rong nhdm 4-7 tudi.
- Nhiem trung nhe. 2 trUdng hdp vdi do da vung bung dUOng vat (4.5%),
- Nghet thdng: 2 trUdng hpp (4,5%). tai kham sau xui't vien 1 tuan, 1 thing, 3 thing. 6 thang va 1 nam.
Thdi gian theo doi trung binh 6 thing di'n 1 nam KfiT QUA
- Tme dUong vat DUdng v i t thing true, khong xoay ca 44 trudng hdp. danh gia qua tai kham va hdi qua thin nhan benh nhi.
- Seo da dUdng v i t Da dUdng vat mem mai khong CO rut hay md xd bung dUdng vat, san nieu dao mem mai.
- Cong dUdng v i t Khong cd trudng hdp nao eong tai phat
- Seo vung ben. Seo ndi li'y da ghep d ben lanh tdt, Thdi gian nam vien 5 nga^, tai kham ft nhi't tU 6 thing den 2 nam. Duong vat thang, khong xoay, khong rdi loan cuang duang v i t . Tao hinh nieu dao thi 2 sau 6 thing. NgUdi n h i binh nhi rat hai long vdi hinh dang duang v i t sau mo.
BAN LUAN
Tn/de day ngudi ta khdng eo cung quan diem ve benh nguyen cung nhu viee dieu tri di tat nay [6],[8], Ddi vdi cong dUdng v i t nhe va trung binh viec dieu tri bang cich cat bd md xo hay khiu gi'p the hang (Nesbit plication) to ra thich hdp, duang vat th^ng dat yeu td t h i m my [4],[5]. Vdi cong dUOng vat nang do
khdng tUdng xUng ve chieu d i i cCia can trang (tunica albuginea) ciLa the hang nen dUdng vat v i n eon eong neu ehi cat bd md xd, p h i u tich nieu dao hay khiu gi'p the hang.trong trudng hdp nay su" dung manh ghep bi da la chon lua duy nhi't nham lam dUdng vat thing [6],[9].
That ra viee dung manh ghep bi trong dieu tri cong dUdng v i t khdng phai la mdi. Nam 1974 [9] Devin va Horton dung manh ghep bi dau tien trong dieu tn eong duang vat d benh nhan bj benh Peyroni khi thU nghiem thanh cdng tren chd sau do hai tac gia nay tie'p tuc ap dung manh ghep bl cho benh nhan bi mieng nieu dao ddng tha'p v i 16 tieu cao tie'p theo nhieu eong trinh duoc cong bd trong viec sd dung manh ghep bi trong dieu tri cong duang vat nang cd hay khdng kem vdi mieng nieu dao ddng thap [4], Nam 1983 Kogan va cdng sU bao cao kinh nghiem ve viec sCr dung manh ghep bi, nam 1988 Hendren va Keating cong bdcdng tmh silf dung manh ghep bi va tao hinh nieu dao bang mem mac bang quang trong cung mot thi p h i u thuat cong dUong vat nang va khong ghi nhan bien ehUng nao. Ngoii manh ghep bi cac chat lieu khac cung dupe neu ra nhu mang tinh mac, mang cUng, c i n cd, md tuy nhien mang tinh mac dUOc cac nha nieu nhi chap nhan hdn [9], Soergel TM va Kaefer M da dung manh ghep la Idp dUdi mem mac ruot non va cung nhin nhan sU that bai eua phUdng phap nay trong bao cao n i m 2003 [7].
M^
lay manh ghep bi tCi ben da loai bo Idp sic
test cuang di/ong vat kiem tra sau khi ghep manh bi vS may da djong vat
Manh ghep bi (dermal graft)vung bung ben la mo hen ket gidng vdi can trang (tunica albuginea) ve mat mo hoc, Trong manh ghep bi md tang sinh sdi chiem Uu the vdi 90% chat gan ket ngoai bao vdi collagen va 10% la mo dan hdi. Ve mat ly thuyet manh ghep bi chac va dan hdi nen thfch hpp nhi't trong viec sd dung de md rpng can trang so vdi mang tinh mac hay can ed, Hdn niJa ky thuat li'y manh ghep bi cung ddn gian khong doi hdi dung cu dac biet va v| tn vung ben li'y da ghep cung de lai seo tham my |3],|4],[5].
Viec dieu tn eong dUdng vat nang vdi manh ghep va tao hinh nieu dao cung mot thi mo hay tao hinh meu dao thi 2 tuy thuoc vao quan diem cCia tUng p h i u thuat vien.
Y HOC THirC HANH (953) - SO 3/2015
Hendren v i Keating t e n hanh p h i u thuat mot thi khi dua theo nguyen ly manh ghep tren manh g h i p (the principle of "graft on graft") [9]. Lindgrenva E Reda lai chon lUa phlu thuat theo 2 thi (chQa eong duang v i t tn;dc va tao hinh nieu dao sau dd 6 thing) [4]. Tai khoa Ngoai BV Nhi Odng I siJf dung phuang phap manh ghep bi v i tao hinh n i i u dao theo 2 thi phlu thuat.
K^T L U A N
Vdi t i t cong duang vat ning ed hay khdng kem theo mieng niiu dao ddng thap do bat thudng the hang va can trang cd nhieu kieu phiu thuat de chon lUa, tuy nhiin dua v i o sU hiiu biet ve md hpe cOa manh ghip chung tot thay rang sCf dung manh ghep bi de md rong can trang trong dieu tri cong duang v i t nang la chpn lua duy nhdt do tinh hieu qua cao mang lai, duang vat thing, khdng cong tai phat ma ky thuat khdng q u i phUc tap.
T A I L I $ U THAM K H A O
1. Le Thanh HiJng, Le Cdng Thang, Le Tan Sdn (2003) Oilu 111 tat cong dUUng vat khong kem mieng nieu dao ddng thap. Yhoc TP H6 Chi Minh Tap 7, phu ban sd 1 trang 289 - 292
2. Le Thanh Hung, Le Cong Thang. Le Tan Son (2005) Oieu tn tat cong duang vat ndng vdi manh ghep bi
YhpcTPHd ChiMinhTap 9. phu ban sd 1 trang 18-21, 3. Le Tan Son, Le Thanh Hung, Le Cong Tha^
Nguyen TTii Tmc Linh (2015). The use of denna! grag ki severe chordee hypospadias repair expiriwice ftom Vietnam. Pediatric Surgery Intemathnal. DOI 10 1070/s00383-6656-5. Accepted: 2 January 2015.
4. Bruce W Lindgren and E Reda (1998). Single and multiple dermal graft for the management of severe penil cun/ature. Joumal of Urc^ogy, September Vol 160, P 1128-1130.
5. Horton CE and Gearhart (1993). Demal graft for con-ection of severe chordee assodated with hypospadias.
Joumal of UrologyVo\ 150 Aug, P 452-455.
6. Kirstan K. Donnahoo, Mark P Cain (1998). Etiology, Management and surgical complication of congenital chordee without hypospadias. Joumal of Umlogy Vol 160 Sept. P1120-1122.
7. Soergel TM, Kaefer M (2003). Complications of small intestinal submucosa for corporal body graftting for proximal hypospadias. Joumal of Umlogy Vol 170 Oct, P 1577-1579.
8. W. Hardy Hendren and Richard E. Caesar (1992).
Chordee without hypospadias: Expenence with 33 cases.
Joumal of Umlogy Vo\ 147 Jan, P 107 - 109.
9. W. Hardy Haidren and M Keating (1988). Use of dermal graft and free urethral graft in penile reconstructon.
Joumal of Urok}gyVo\ 140 Nov, P 1265-1268.
NGHIEN COU MOT SO DAC DIEM DjCH T I VA LAM SANG CUA D | N H ZONA TAI BENH VIEN TRUNG UUNG QUAN DO1108
TOM T A T
Muc tiiu: Khio sBt dBc diim dich ti vi lim sing binh Zona diiu tn ndi tru tai khoa Da tiiu-Di Ung tU 6/2010-6/2012. Ddi tuang vi phuang phip nghiin eUu: Md ti cit ngang dua trin 193 binh nhin zona.
Kit qui- Tuii trin 50 ehiem 80,8%; nam gidi 67,9%
nUgidi 32,1%. Dau cd trudc la 81,9%, trong dd dau trudc 1-3 ngiy la 72,5%; dau nhUc gBp 81,9%, rat 12,9% va ngUa 3,1%; tdn thuang vung liin sudn 55,96%, vung diu. mBt. cd 23,32%; 98.97% benh nhin zona cd dau va chi sd Likert tU 5 trd lin la 94,1%; binh nBng 55,4%. vUa 24.4%; sot 23,3%, sung hach lin cin 24,9%.
TCrkhoa: Heipes zoster, dich te, lam sang.
SUMMARY
INVESTIGATION OF EPIDEMIOLOGICAL AND CLINICAL FEATURES OF HERPES ZOSTER AT THE MILITARY CENTRAL HOSPITAL 108
Objective: To investigate the epidemiological and clinical features of herpes zoster at the military central hospital 108 from June, 2010 to June, 2012.
Materials and methods: The cross-sectional study was based on data of all patients with herpes zoster Results: 193 patients with herpes zoster were investigated. The epidemiological factors of patients were age >50: 80.8%; male 67.9%, female 32.1%.
Clinical features were pain portends zona 81.9%
N G U Y £ N LAN ANH, D A N G V A N EM Benh vien Trung uang Quin ddi 108 with pain portended 1-3 day 72.5%, aches-pains 81.9%,, burning 12.9%, itch 3.1%; chest-back 55.96%,, head-face 23.32%; severy disease 55.4%, moderate 24.4%,; fever 23.3%, bubo 24.9%.
Keywords: Herpes zoster, epidemiology, clinical DATVA'NOi
Benh Zona l i mot benh hay gap trong sd cae b€nh da do virus, do Varicella Zoster Virus (VZV) giy nin.
Binh Zona cd the g i p d moi l i ^ hidi, d ca hai gidi ntiung thudng g i p d ngUdi tren 50 tudi [5], [6]. NhQT^
ngudi bj suy giam m i i n djch nhu dang dieu tri hoa tri lieu chdng ung thu. dung corticoid keo dai, ngu'S nhiim HIV/AIDS... thi t j l i mac binh se cao hon va benh cung diin bie'n nSng han.
Chan doan benh Zona chfl yeu dUa vao cac tneu chCing l i m sing. Bieu hiin l i m sang cda benh Zona la mun nude hoic v i bong nudc moc thanh chCim tren nen da viem do doe theo day than kinh ngoai bien vS khu tnl d mot ben cd thd. d benh nhin bi suy giam miin dich, cac thuong tdn cfla Zona ed the xuat hiin 3 ca hai ben hoic ral rac khap ed thd, Dau la mdt ^§u chUng ciia Zona va dau cd thd xuat hien trudc hoSc cung luc tdn thudng ngoii da va keo d i i ke ca khi t5n thUdng ngoai da da lien seo.
Tim hidu ve mdt sd ydu td lien quan den sU phM
Y HOC THirc HANH (953) - S6 3/20^
