Our tubularized incised plate urethroplasty Repair. Results for Hypospadias Surgery

Background: The Tubularized Incised Urethral Plate (TIP) urethroplasty is a widely accepted technique among urologists and heavily used in their centers. This technique was developed by Snodgrass in 1994 for repairing varied degrees of hypospadias. Aim: This paper aims at analyzing and evaluating our early experience and the outcomes of using TIP urethroplasty technique. Therefore, the results have to be assessed in a large series. Methods: In this prospective study, 95 patients with varying hypospadiac meatus levels who experienced the procedure of TIP. During the entire sampling period, patients had varying degrees of hypospadias ranging from glanular to penoscrotal (glanular 2, coronal/subcoronal 37, distal shaft 30, mid-shaft 10, proximal shaft 5 and penoscrotal 11). Results: The overall success rate of TIP procedure repair of hypospadias was 87.4%; whereas the overall reoperation rate was 12.6%. The highest percentage was for those with failed previous repair (secondary). The average duration of the procedure was 58.6±18.4 minutes. Nearly a third of the patients developed one or more postoperative major complication. The total rate of fistula was 12.6%, with "10.6% in primary distal, 15.9% in primary proximal and 20% in secondary repair". Sixteen cases had a mild degree of "meatal stenosis" (16.8%), but all were managed by simple dilatation at the office or at home using 8 F feedingtube. Conclusion: The outcomes demonstrated that the TIP procedure is a quick, safe and reliable technique. Additionally, it can provide excellent cosmoses and function with few complications and acceptable reoperation rate.

Alignment of teeth using different aesthetic orthodontic techniques [conventional buccal technique, lingual technique and inman aligner]: In vitro study

Background and objective: An expectation of beautiful smiles at the end of orthodontic treatment is a primary concern to each patient, but is also equally concerned with appearance while undergoing treatment. The development of appliances that combine both acceptable aesthetics for the patient and adequate technical performance for the clinician is the ultimate goal. The aim of this study was to compare three different aesthetic orthodontic techniques with different biomechanics in order to quantify the efficiency of these techniques in alignment of displaced upper right central incisor and investigating the effects of these variables on alignment considering its tipping and rotation

Methods: The sample consisted of three groups with each group including 15 samples; [1] conventional buccal technique group, [2] lingual technique group and [3] Inman Aligner group, all on a typodont simulation system [dentsply]. Preoperative and postoperative digital images were taken and analyzed using Autodesk AutoCAD software

Results: The conventional buccal technique gave rise to the highest mean of tooth tipping and rotation followed by the lingual technique. The Inman Aligner produced the least level of tooth tipping and rotation

Conclusion: The best method of alignment is the conventional buccal technique followed by the lingual technique. The least favourable one is the Inman Aligner

Comparison of low-dose versus conventional-dose prednisolone in the treatment of Idiopathic Thrombocytopenic Purpura [ITP]

Objective: To assess the efficacy of low-dose prednisolone in patients with ITP

Design: A Prospective Randomized Controlled Trial

Setting: Salmaniya Medical Complex, Kingdom of Bahrain

Method: A randomized controlled trial was conducted comparing the conventional-dose to a lowdose of prednisolone [0.25 mg/kg/day]. Forty-one patients with ITP were enrolled in the study; 21 patients were randomized to low-dose prednisolone [group I] and 20 patients received the conventional-dose [group II]

Result: The overall remission rate [OR] for both groups was 78.05%. There was no statistically significant difference between both groups in terms of group overall remission 17 [81%] versus 15 [75%], group complete remission 11 [52.4%] versus 10 [50%] or partial remission rate 6 [28.6%] versus 6 [25%]. In addition, failure rate, relapse rate, and splenectomy rate were similar and not statistically significant. Two [10%] patients developed complications related to steroids therapy, both were in group II, but were not statistically significant

Conclusion: Although the study had a small number of patients, it revealed that low-dose of prednisolone [0.25 mg/kg/day] is as effective as the conventional-dose [1 mg/kg/day] and probably, safer. Accordingly, we recommend the use of low-dose prednisolone as initial therapy for ITP rather than the high-dose

Surgical treatment of volarly displaced intra - articular fractures of the distal end of the radius

Intra-articular fractures of the distal end of radius that are characterized by volar displacement of part of the articular surface are uncommon and tend to be associated with high velocity trauma. In this study, the results of operative treatment of 30 volar intra- articular fractures of the distal end of the radius were evaluated. According to the comprehensive classification of fractures of the long bones [Mueller et al., 1990], there were 6 cases type B 3-1, 14 patients type B 3-2 and 10 patients type B3-3. All cases were treated operatively by open reduction and internal fixation by small T plate. In ten comminuted cases of type B 3-3, external fixator and iliac graft were added. In five cases, K-wires were used. After an average follow up period of one year, there were seven excellent cases, nine good, nine fair and five with poor results according to the modified system of Green and O'Brien 1978. Accurate articular surface restoration was the most critical factor in achieving a successful outcome. Fair or poor results mainly occurred in type B 3-3 fractures characterized by comminution of the volar fragment