Tubularized incised-plate urethroplasty for secondary hypospadias repair

Reoperation for failed hypospadias has been considered to be seriously bothersome because abundant penile skin does not tend to remain for urethroplasty or for penile shaft skin coverage. In this study we evaluated the results of tubularized incised plate [TIP] urethroplasty [Snodgrass technique] in a series of secondary hypospadias repair in children. From March 2003 to September 2004, a total of 28 patients with hypospadias in whom repair had failed, underwent a re-operative TIP urethroplasty. The patients age ranged from 2 to 14 years. The number of prior repairs ranged from one to five repairs. Before this treatment the meatus was at the distal shaft in 16 cases, mid shaft in 9 and proximal shaft in 3. Preoperatively, the associated complications were fistulas in 7 patients and residual chordee in 4. In 5 cases the fistulas were incorporated into the hypospadiac openings and treated as a longer defect. The urethral plates were subjectively, surgically altered or unaltered in 8 and 20 respectively. In 17 patients [group A] the previous repair[s] did not involve dissection of the urethral plate [unaltered] nor was there a fistula. The remaining 11 patients were classified as group B. The neourethra was then reconstructed as the Snodgrass technique. The mean follow up period was 10 months. There were 11 complications in 7 patients [25%], including a small fistula in 4 [14%] and meatal stenosis in 7 [25%]. All complications occurred in group B except for 2 cases of meatal stenosis which occurred in group A and treated with simple dilatation. We conclude that TIP urethroplasty is a viable option for the treatment of previously failed hypospadias repair. It was highly effective in patients with a surgically unaltered urethral plate

Stress among young Egyptian anesthesiologists

The practice of medicine offers many satisfactions, but there have been increasing sources of stress in the profession and increasing signs of stress- related problems among physicians. Aim of the work: was to explore the main causes of stress among young Egyptian anesthetists and to encourage them to incorporate stress management into their lives. This study was conducted on a sample of 120 anesthetists. They were chosen from both sexes with age range from 25-45 years. Anesthetists were divided into two main groups. Group A included 60 anesthetists working in Alexandria University Hospitals and group B included 60 anesthetists working in Ministry of Health Hospitals. Each main group was subdivided into three subgroups including 20 junior residents, 20 senior residents and 20 specialists. Each participant was allowed to answer a questionnaire booklet of 40 items. The most frequent source of stress among the whole studied sample was available resources and poor management [severely stressful for 76.6%]. This was significantly stressful for residents than specialists. Fallowed by stressful nature of anesthesia [severely stressful for 71.7%], and work overload and its effects on all aspects of life [severely stressful for 71.7%]. Work overload was significantly higher in group A than group B. Interpersonal relationships [severely stressful for 43.3%] was significantly higher in group A than group B and in senior residents than other subgroups. Finally, sources of dissatisfaction [moderately stressful for [99.2%]. Six anesthetists became smokers and 28 increased the rate of smoking after becoming anesthetists. Two anesthetists in the present study used to take psychoactive substances daily, one weekly and four monthly. The other 113 anesthetists never took but 13 of them thought in taking these substances. Two anesthetists claim that they thought in committing suicide weekly and another two monthly. Anesthesia is a stressful branch. Treatment of stress problems when they occur is not enough; prevention should be our aim. So, appropriate stress management skills should be included in the training program for all junior anesthetists

Microscopic testicular changes following Fowler - Stephens and testicular revascularization: an experimental study

A study of 15 adult male dogs with 30 bilateral testes and compare the Fowler-Stephens procedure with microvascular transfers in a comparative study. The Fowler-Stephens operation was used for 12 left testes and microvascular transfer was used for 12 right testes, and three dogs were used as a control group. One month postoperatively, histological study was done using hematoxylin and eosin and PAS stains after Indian ink injection above the level of anastomosis in some dogs and using a corrosion cast of the testes after injection of plastoid material above the anastomosis in the remaining dogs. Seven testes treated by the Fowler-Stephens procedure and eight testes treated by microvascular procedures were viable after an average follow up for one month. The procedure of testicular auto-transplantation with microvascular anastomosis was feasible and, while the immediate results appeared to be good, the long-term results were still awaited. In this study, the procedure has a greater potential for success than Fowler-Stephens procedure. Microvascular techniques require considerable training and expertise

study of histopathologic changes in soft tissues associated with asymptomatic impacted mandibular third molar

Forty eight patients participated in the present study. They were divided according to the width of non-pathological radiographic pericoronal radiolucency into group one with pericoronal radiolucencies having width of less than 1mm, and group two with pericoronal radiolucency less than 2.5 mm but more than 1 mm. The present study was designed to find out firstly; the possible incidence of histopathological changes in the soft tissues adjacent to impacted mandibular third molar that were asymptomatic and not associated with pathological pericoronal radiographic radiolucency. Secondly, to examine if the pathological changes, in the soft tissue around the asymptomatic impacted third molars; parallel those noted in the radiographic radiolucency. The pericoronal soft tissue were removed after the extraction of teeth, fixed in 10% formaline. and processed to be submitted for the histological study. The examination revealed firstly; mild variable tissue changes in the different tissue specimens which dose not encourage the prophylactic removal of impacted third molars because the histological changes were not conclusive for cystic degeneration. Secondly; no significant histopathological differences had been recorded between the two groups of different radiolucencies

Stress mechanism - an emerging role for furosemide

The beneficial effect of furosemide in emergency treatment of acute left ventricular failure starts immediately with the intravenous administration before the occurrence of diuresis. Pulmonary-systemic redistribution of blood volume had been suggested in relieving the left ventricular strain. A central mechanism for furosemide could be suggested because; recent data point to furosemide high specificity and selectivity in antagonizing cerebral GABA neurotransmission and a state of neurohumoral imbalance was suggested in these patients. So this study was conducted to evaluate the potential role of furosemide in the physiological stress mechanism. The effect of a single intraperitoneal dose of furosemide [4mg/kg. of body weight] was tested in a model of emotional stress induced by ultrasound noise, on rat behavioral activity, serum corticosterone level together with the volume of diuresis. Ultrasound noise exposure in a frequency range of 30,000 Hz to 65,000 Hz led to a significant limitation of its activity [freezing reaction]. Serum corticosterone level and behavioral activity are increased significantly in furosemide treated non-stressed and stressed rats compared with both control or stressed group. The increase was marked in furosemide treated-stressed rats. The increase in serum corticosterone and behavioral activity by furosemide in stressed rats indicate a transformation of the stress state from [freezing reaction] to a state of a [defense reaction]. In conclusion; furosemide stimulates the central stress mechanism. This stimulation may be in favor of rapid and potent beneficial effect of furosemide inrecovery of neurohumoral imbalance in stress conditions which probably mediates the pituitary hypothalamic axis

Effect of vitamin - E on methotrexate hepatotoxicity in rats

The aim of this study was to elucidate the possible role of free radicals in methotrexate [MTX] hepatotoxicity and the protective effect of antioxidant [vitamin E] against MTX hepatotoxicity. Experimental MTX hepatotoxicity was induced by a daily oral administration of 15 mg/kg MTX for four days to Sprague-Dawley rats. The oral co-administration of vitamin E 450 mg/kg with MTX for the same period produced a significant improvement in both the functional parameters and the histopathological picture in the liver of the treated rats. Also, the concomitant administration produced a significant decrease in serum malondialdehyde [MDA] which was significantly increased by MTX alone

Hepatoprotective effect of vitamins C and E on paracetamol toxicity in rats

It has been reported that the reactive metabolites of paracetamol is responsible for initiating liver cell injury. Furthermore, the involvement of free radicals and lipid peroxidation in the pathogenesis of reversible liver injury by various xenobiotics including paracetamol has been postulated for several years in animal models. The cytoprotective effects of currently used antioxidants, vitamin E and vitamin C, against various types of hepatotoxicity have been reported in previous studies. A model of paracetamol-induced hepatotoxicity was used in this study to investigate the possible prophylactic hepatoprotective role of vitamin E and/or vitamin C and their possible mechanism of protection

Ureteroscopic manipulations in bilharzial ureter: difficulties and precautions

Ninty two bilharzial patients were subjected to different ureteroscopic manipulations for primary ureteric stones [5 7 patients], ureteric stricture with secondary stones [13 patients] and ureteric stricture [22 patients]. Difficulties of the technique included: failure to identify the ureteric orifice, shredding and cracking of the mucosa during dilatation, upward migration of stones in dilated ureters, restricturing after dilation and vesico-ureteral reflux. Different precautions had been used to avoid these difficulties. He concluded that although bilharzial affection of the ureter is not a contra-indication for ureteroscopy yet it imposes certain difficulties upon the procedure and must be cautiously handled

TB epididymitis is not uncommon incident

100 cases of epididymitis were randomly chosen provided that they didn't receive antibiotics in the last 48 hours. We categorized the patients into two groups: those presenting with acute painfull scrotal swelling and fever into group A [5 6 patient] and those presenting with painless scrotal lumb of more than 3 months duration into group B [44 patients]. - Full clinical assessment including careful history taking and clinical examination was done to all patients. - Urine smears stained with Z.N. -staining were examined for alcohol and acid fast bacilli for all patients, and similar semen smears for group [B] patients were also done. - Urine culturing on Lowenstein-Jensen medium was done for all patients. - Semenogram was done for group [B] patients. - Semen of group [B] patients was cultured also on Lewenstein-Jensen medium. Abdominal ultrasound together with chest x-ray and plain x-ray abdomen had been performed to all cases. In Group [B] patients, I V.U was routinely done. It is clear that chronic epedidymitis is highly suspecious for T.B. It had been found that semen culturing or smearing by Z-N-Stain gave a better chance-than urine to isolate the T-B bacillus [semen smearing and culturing proved that 15.9% and 29% of patients respectively were positive for T.B. bacilli compared to 13.6% and 25% of patients in case of urine]. Semen parameters had been variably affected in tuberculous involvement of the epididymitis specially in bilateral cases [all bilateral cases and 3 out of 8 unilateral involvement were infertile]. In conclusion, T.B. bacillus is a relatively common causative organism in cases of chronic epididymitis [13% of total cases of epididymitis and 29% of chronic cases]

Extra corporeal shock wave lithotripsy using the domier MPL 9000 in treatment of nephrolithiasis

After the installation of the third generation Dornier MPL 9000 multipurpose lithotripter in Assiut University Hospital and within one year 460 patients suffering from renal calculi were treated using a modified ellipsoid with a larger skin to focus distance with increased coupling surface area. Single stone was encountered in [214 patients], two stones [91 patients], branched stones [39 patients], multiple stones [116 patients] Succesful disintegration was achieved in 94% with an average number of sessions 2.28. The great majority of cases were premedicated by morphia or pithidine and one of the non steroidal anti-inflammatory drugs [NSAID]. Our preliminary reports concerning the use of Dornier MPL 9000 for treatment of nephrolithiasis indicated that the technique was easy, safe, effective and provided a maximal range of indications

Evalution of post operative radiotherapy in bladder cancer after total cystectomy

Fifty patients with carcinoma of the urinary bladder who undergone total cystectomies were reviewed for evaluation of the effect of post-operative radiotherapy. Those patients were classified into two groups, 25 patients each. One group had recievid post-operative radiotherapy and the other not. The age of patients, sex, occupation, history of B infestation, pathological type, histopathological grading, duration of the disease before surgery and duration and type of recurrence after operation were all reviewed. The results showed that the use of post operative radiotherapy has improved the outcome of these cases after surgery

Serum gonadotropins, testosterone and prolactin in azoospermic men in relation to the histopathological changes

Serum follicle stimulating hormone [FSH], luteinizing hormone [LH], testosterone and prolactin levels in relation to histopathological appearance were studied in 32 azoospermic men. Histologically, they were classified into four groups; normal[25%], sertoli-cell-only syndrome [28.1%], maturation arrest [25%] and focal tubular atrophy [21.8%]. In azoospermic men with normal histological findings, gonadotropins and testosterone levels were within the normal values. In other groups associated with histological changes, gonadotropins were significantly raised. Testosterone had a significant lower levels than normal in cases of maturation arrest. Prolactin levels were normal in all azoospermic men. These findings suggested the importance of hormonal determination for evaluation and management of male infertility

experience with the transverse preputial tubularised flap for hypospadius repair [Duckett's procedure]

Advances in the field of hypospadius surgery [including the use of refined microsurgical techniques, the use of fine suture material and soft indwelling silastic stents] had allowed selective reduction in hospital stay, decreased the need for secondary procedures and had resulted in improvement in the cosmetic and functional outcome of these patients. A transverse preputial tubularized flap was applied as a one stage technique for hypospadius repair in eighteen male children with different ages and had different degrees of hypospadius. Good results were obtained in ten patients regarding the functional and the cosmetic outcome [straight penis, nearly normal appearance of the external meatus situated at the apex of the glands with forward projection of the urinary stream and no penile curvature on erection]. Eight postoperative complications were reported [urethral fistulae, stricture urethra and external meatal stenosis]