Surgical treatment of hermaphroditism: experience with 25 cases.

This article is a summary of our experience with surgical treatment of 25 patients with hermaphroditism. We treated 25 patients with hermaphroditism since 1985, including 12 with male pseudohermaphroditism, 9 with female pseudohermaphroditism and 4 with true hermaphroditism. Decision on sex reassignment for these patients was made according to their genetic sex, gonad sex, social sex, psychologic sex, and the request of the patients and their relatives. Of the 12 male pseudohermaphrodites, 1 was reassigned with the male sex and penile reconstruction was performed, and the other 11 had a female sex assignment and received undescended testis removal, clitoral reduction, labioplasty of the labia minora and labium majus, and vaginoplasty. Nine female pseudohermaphrodites with female sex assignment underwent clitoral reduction, labioplasty of the labia minora and labium majus, and vaginoplasty. The 4 true hermaphrodites also had female sex assignment, and received such procedures as resection of the ovotestes and undescended testes, clitoral reduction, and labioplasty of the labia minora; resection of the uterus and appendices was also performed in 1 case due to the identification of malignant cells. The reconstructed penis in the patient with male sex assignment had good appearance and allowed normal urination. In patients with female sex assignment, the reconstructed external genitalia had also good appearance and good sensation without obvious contraction. No serious complications occurred in these patients, who were satisfactory with the outcome and reported stable gender identity, and 3 married patients reported normal sexual life. Plastic surgery is still the primary option for correction of hermaphroditism after determination of sex assignment, and satisfactory effect can be achieved by surgical intervention with stable gender identity and minimal complications.

Effect of continuous bioartificial kidney therapy on porcine multiple organ dysfunction syndrome with acute renal failure.

The bioartificial kidney (BK) was fabricated with primary culture of human proximal tubular cells growing in a hemofilter. A porcine model with multiple organ dysfunction syndrome, including acute renal failure, was induced by cecal ligation and puncture and bilateral ureteral ligation. The models were treated with BK (group A) or sham BK (group B) or without treatment (group C). Mean arterial pressure (mm Hg) was higher in group A (88.13 +/- 7.62) than in groups B and C (63.50 +/- 11.82, 53.50 +/- 2.52) at 24 hours (p < 0.01). Serum blood urea nitrogen, Cr, K, Pao2, and HCO3 were similar during the treatment periods between groups A and B, which were better than those in group C. In group A, tumor necrosis factor (TNF)-alpha (pg/mL) was 394.42 +/- 35.62 at 24 hours, lower than that of groups B and C (531.76 +/- 30.23, 552.89 +/- 27.81) (p < 0.05). Peak level of interleukin (IL)-10 (pg/mL) was higher in group A (272.36 +/- 48.89) than in groups B and C (106.30 +/- 29.69, 102.59 +/- 10.21) (p < 0.01). There was no difference of serum IL-6 between pretreatment and post-treatment in groups A and B, but serum IL-6 gradually increased in group C. The survival time (hours) was longer in group A than in other groups, which was prolonged by 46.20% and 58.39%. Results indicate that BK can ameliorate mean arterial pressure, decrease serum TNF-alpha, increase serum IL-10, and prolong survival time of pigs with multiple organ dysfunction syndrome and acute renal failure.