most sensitive double-marker method of cardiac isoenzymes of creatinine kinase, troponin I, and myoglobin in different time periods for diagnosing acute myocardial infarction

Myocardial infarction is among the most common diagnoses in patients admitted to hospitals in western countries, and its rapid diagnosis is of utmost importance. This study was conducted to determine the most sensitive double-marker cardiac isoenzyme of creatinine kinase, troponin I, and myoglobin for diagnosing acute myocardial infarction. This was an observational-analytic research on a diagnostic test conducted on 256 patients who had referred to the emergency department with chest pain from 4 to 24 hours before their referral. They were sorted equally into two groups of 4-14 hours and 15-24 hours from onset of pain, each group including 128 patients. In the first time period, the combination of troponin and myoglobin had the highest sensitivity [sensitivity = 97.3%, specificity = 98.1%], whereas the combination of double-marker and troponin proved the most sensitive [sensitivity = 100%, specificity = 96.3%].The double-marker combination of troponin and myoglobin is more appropriate for the first time period [i.e. during the first 24 hours from the onset of chest pain],while it would be more helpful to use the combination of troponin during the second period of time.

Penile reconstruction. Evaluation of the most accepted techniques

Loss of the penis can have a devastating effect on the lives of sufferers with significant psychogenic implications. Penile reconstruction or phallus construction poses a difficult challenge and a demanding problem to the urologists and plastic surgeons. Different techniques have been used for construction of a total penis and reconstruction of severely injured penis. The objective of this review was to determine the efficacy, advantages and disadvantages of the most popular penile reconstruction [PR] and phallus construction techniques. We searched without language restriction MEDLINE, Pre-MEDLINE EMBASE, and the Cochrane Central Register of Controlled Trials [CENTRAL] from January 1960 to January 2009. In addition, we searched the citation lists of relevant articles and book chapters. Studies evaluating the functional and cosmetic results of different techniques of total phallus construction [TPC] and penile reconstruction [PR] were identified. Two authors independently evaluated studies for selection, study quality, and extracted data. The primary outcome was creation of a sensate and cosmetically acceptable phallus. The secondary outcomes were competent neourethra that allows voiding in comfortable position, sexual intercourse, and the rate of complications. One hundred and forty-six studies with a total of 1622 patients were included in this review. Data from the available studies are insufficient to recommend any technique for TPC or PR. In the absence of evidence to support any method, the review authors recommend the one-stage TPC or PR. Further studies are warranted, preferably multi-centered studies

Penile replantation, science or myth? a systematic review

Penile amputation is a rare urologic condition for which immediate surgical replantation is warranted. The surgical technique used for repair has been modified and refined. Our aim was to assess the effects of several interventions and management for amputated penis after replantation. We searched the MEDLINE [January 1966 to May 2007], EMBASE [January 1988 to January 2007], CINAHL [January 1982 to January 2007], PsycLIT [January 1984 to January 2007], ERIC [January 1984 to January 2007], and the bibliographic data of relevant articles; hand-searched conference proceedings; and contacted investigators to locate studies. All reported cases of penile replantation were studied. We assessed all titles, abstracts, and extracted data from the articles identified for inclusion. Outcome measures included cosmetic outcomes, acceptability, operative time, restoration of erectile function, sensibility of the glans, and long-term outcomes. Eighty patients had undergone penile replantation. There was considerable variation in the interventions, patients, and outcome measure. The majority of the reported cases in this area continue to be of moderate quality, although more recent cases have been of higher quality in terms of both patients' demographics and surgical techniques. Data were not available in all of the cases for many of the outcomes expected to be reported. There were several important variations in the cases studied. The value of the various microsurgical techniques for replantation of the penis remains uncertain. Meticulous microsurgical techniques by experienced surgeons can reduce skin, urethra, and graft loss complications and produce a functional organ; nonetheless, such complications are still highly prevalent

Early versus delayed internal urethrotomy for recurrent urethral stricture after urethroplasty in children

Our aim was to evaluate the results of early versus delayed internal urethrotomy for management of recurrent urethral strictures after posterior urethroplasty in children. Twenty boys with proven posterior urethral strictures were treated by perineal posterior urethroplasty. Of these, 12 required internal urethrotomy. Each radiograph demonstrated a patent but irregular urethra with a decrease in diameter at the point of repair [fair results]. Patients were then divided into 2 groups: 6 underwent early [within 6 weeks from urethroplasty], and 6 underwent delayed [after 12 weeks from urethroplasty], internal urethrotomy with the cold knife as a complementary treatment. The groups were comparable in terms of patient age, etiology of the primary urethral stricture, number of recurrences, length and site of the actual stricture, and preoperative maximum flow rate. Mean follow-up was 5 years. Kaplan-Meier analyses showed that the stricture-free rate was 66.6% after early, and 33.3% after delayed, internal urethrotomy [P=.03]. Early internal urethrotomy should be considered in boys with recurrent urethral stricture after urethroplasty