ABSTRACT
Urethrocutaneous fistula may complicate hypospadias repair. We noticed that double-layered preputial dartos flaps added to tubularized incised plate urethroplasty can reduce the risk of urethrocutaneous fistula. The aim of this study was to compare the outcomes of tubularized incised plate urethroplasty with double-layered preputial dartos flaps to with single-layered local fascial flaps in preventing urethrocutaneous fistula. A retrospective cohort study was conducted between January 2017 and December 2020 at Jordan University Hospital (Amman, Jordan). Boys who were aged between 6 months and 5 years, diagnosed with distal hypospadias, and not circumcised were included. The primary outcome was the occurrence of urethrocutaneous fistula in patients who underwent tubularized incised plate urethroplasty with a double-layered fascial flap. The results showed a total of 163 boys with distal hypospadias; among them, 116 patients underwent tubularized incised plate urethroplasty with a single-layered fascial flap, and 47 underwent tubularized incised plate urethroplasty with a double-layered fascial flap. The development of urethrocutaneous fistula was higher in the group receiving tubularized incised plate urethroplasty with a single-layered fascial flap than in the group receiving tubularized incised plate urethroplasty with a double-layered fascial flap after 1 month, 6 months, and 12 months (6.9% vs 0, 10.3% vs 0, and 5.2% vs 0, respectively), and the difference after 6 months was statistically significant (P = 0.02).
Subject(s)
Male , Humans , Infant , Hypospadias/surgery , Retrospective Studies , Urologic Surgical Procedures, Male/methods , Urethra/surgery , Fistula/surgery , Treatment OutcomeABSTRACT
Objectives: To describe the prevalence of rheumatoid nodules [RN] in patients with rheumatoid arthritis [RA] and to compare their features with those of patients without RN
Subjects and Methods: Adult RA patients [n = 952] in the Kuwait Registry for Rheumatic Diseases from February 2013 to December 2015 were evaluated for RN. Demographic and serological features and disease activity and severity were obtained from the registry
Results: Of the 952 RA patients, 22 [2.3%] had RN and 930 [97.7%] did not. Age, sex, disease duration, smoking, and family history of an autoimmune rheumatic disease were similar. Obesity was more prevalent in the RN group, i.e. 11 [50%] vs. 326 [35.1%], p = 0.016. There was no difference in rheumatoid factor [RF] or anti-cyclic citrullinated peptide antibody positivity. Patients with RN had more sicca symptoms, i.e. 8 [36.4%] vs. 152 [16.3%], p = 0.025, a higher mean score on the visual analogue scale pain [3 +/- 2.9 vs. 2 +/- 2.7, p < 0.001], more tender joints [6.4 +/- 8.8 vs. 4.2 +/- 7.2, p = 0.001], a higher patient global assessment of disease activity [3.3 +/- 2.7 vs. 2.3 +/- 2.7, p < 0.001], and more deformities, i.e. 3 [13.6%] vs. 74 [8%], p = 0.034. The mean health assessment questionnaire score in RN patients was 1.1 versus 0.9 in patients without RN [p = 0.08]. Patients with RN had a low disease activity [means: disease activity score [DAS-28], 3.02; clinical disease activity index, 7.7; and simple disease activity index, 10.4], similar to the other group. While the rates of methotrexate treatment were comparable, biologic therapy was administered more in patients with RN [i.e. 15 [68.2%] vs. 478 [51.4%], p < 0.001]
Conclusion: In Kuwait, the prevalence of RN is low among RA patients. Patients with and without RN are similar in terms of demographics and serologic features, except for more obesity. However, patients with RN have more sicca symptoms, joint deformities, and painful and tender joints. Disease activity scores are low with more frequent biologic therapy
ABSTRACT
Background: No reflow phenomenon is associated with major adverse cardiac events, prediction of no reflow using laboratory and noninvasive imaging techniques can help in early prevention and management of this phenomenon
Objectives: To investigate the predictive value of serum sP-selectin and endothelial dysfunction assessed by using brachial artery flow mediated dilation [FMD] in patients with STEMI undergoing primary PCI to address patients with high incidence of no reflow
Methods: The prognostic performance, clinical and angiographic correlates of sP-selectin and FMD was assessed in 96 patients admitted in National Heart Institute and Ain Shams University Hospitals by STEMI and underwent primary PCI as a reperfusion strategy. Each patient was subjected to [history taking, clinical examination, laboratory investigations including withdrawal of serum samples for detection of sP-selectin levels, echocardio-graphy, assessment of endothelial dysfunction by measuring the FMD, assessment of the angiographic results using TIMI flow grade and myocardial blush grade. Follow up of the patients during hospital stay and after one month for the incidence of MACE
Results: A significant correlation between patients with high serum sP-selectin and TIMI flow
Conclusions: Serum sP-selectin level in patients with STEMI treated by primary PCI can predict the patients who will develop no reflow phenomenon after PCI, FMD could not predict the incidence of no reflow among those patients
ABSTRACT
One of the potential strategies to increase the efficacy of RFA is to modulate the biologic environment of the treated tissues. Several investigators have studied increasing RFA heating by combining intra-tumoral injections of different concentrations of sodium chloride with RFA. The aim of this study is to assess the enhancing effect of normal saline [NS] on radiofrequency ablation [RFA] of hepatocellular carcinoma [HCC] using a cool-tip needle. This study included 40 patients with HCC [proved by histopathology or combined spiral CT and elevated alpha-fetoprotein]. They were randomly divided into two groups [20 patients in each group]. The first group was treated with RFA preceded by intra-tumoral normal saline injection [RFA + S]; the second group was treated with RFA only [RFA]. The procedure was successful in all patients [100%] of the RFA + S group and in 11 [55%] of the RFA group [as proved by spiral CT or pathology]. This difference between the two procedures was statistically highly significant [P = <0.01]. No major complications occurred in either group. Combined RFA and normal saline is more effective than RFA alone. Considering the reduced cost and wide availability of isotonic saline together with the easy performance of the intra-tumoral injection, the dramatic improvement in therapeutic effect of RFA to 100% could be a breakthrough in future strategies to modernize the RFA technique