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

Different doses of oral folic acid for homocysteine-lowering therapy in patients on hemodialysis a randomized controlled trial

We compared the effect of higher and lower doses of folic acid compared to our routine daily dose on plasma homocysteine levels, in our hemodialysis patients. Eighty patients on hemodialysis receiving oral folic acid, 10 mg/d, were randomized to receive folic acid at either doses of 5 mg/d [group 1] or 15 mg/d [group 2] for 2 months. Plasma levels of total homocysteine were measured before and after the study period. Hyperhomocysteinemia was seen in 75 patients [93.8%] before, and in 37 patients of group 1 [92.5%] and 39 of group 2 [97.5%] after the study period. In group 1, a nonsignificant decrease occurred in plasma homocysteine level [29.67 +/- 12.26 micro mol/L to 27.78 +/- 9.94 micro mol/L, P = .30], while in group 2, there was a significant decrease in homocysteine level [32.40 +/- 9.76 micro mol/L to 29.58 +/- 9.62 micro mol/L, P = .01]. Changes in homocysteine level correlated with its baseline level [r = -0.42, P < .001]. In both groups, significant reductions in homocysteine level were seen mostly in those patients with high baseline homocysteines. Routine folic acid supplementation of 10 mg/d could not normalize plasma homocysteine levels in most of our patients. Increasing folic acid dose made a statistically significant but clinically trivial decrease in homocysteine levels, and could not normalize homocysteine level in most patients. Patients with a higher baseline homocysteine level achieved a greater reduction, which may be explained by primary noncompliance of some patient. Further investigation of folic acid dosage is suggested

Burden of chronic kidney disease in Iran. A screening program is of essential need

The latent nature of chronic kidney disease [CKD] in primary stages precludes early diagnosis. This necessitates plans such as screening, but we should first introduce CKD as a public health problem. This study was designed to define the burden of CKD in Iran. We calculated disability-adjusted life years [DALYs] according to the World Health Organization's practical guidelines for national burden of disease studies. The sum of years of life lost and years lived with disability were estimated for CKD stages 1 to 4 and end-stage renal disease [ESRD] based on the national registry data and the published reports about CKD in Iran in 2004. Over 700 000 people were estimated to have CKD in Iran in 2004 and 61 000 new cases of CKD were anticipated. The prevalence rate of CKD was estimated to be 1083 and its incidence rate was 173.5 per 100 000 population. Chronic kidney disease was responsible for 1 145 654 DALYs. The highest DALYs for stages 1 to 4 of CKD were due to unknown etiology, diabetes mellitus, and hypertension [382 000 years, 347 400 years, and 311 800 years, respectively]. The DALY for ESRD and CKD stages 1 to 4 were 21 490 years and 1 124 164 years, respectively. The present study provides an estimate of the burden of CKD in Iran. As CKD can be controlled by practical cost-effective plans, we strongly recommend the information given by this study be considered for future action plans

Low dose doxepin for treatment of pruritus in patients on hemodialysis

Pruritus is one of the frequent discomforting complications in patients with end-stage renal disease. We prospectively evaluated the effectiveness of doxepin, an H1-receptor antagonist of histamine, in patients with pruritus resistant to conventional treatment. A randomized controlled trial with a crossover design was performed on 24 patients in whom other etiologic factors of pruritus had been ruled out. They were assigned into 2 groups and received either placebo or oral doxepin, 10 mg, twice a day for 1 week. After a 1-week washout period, the 2 groups were treated conversely. Subjective outcome was determined by asking the patients described their pruritis as completely improved, relatively improved, or remained unchanged/worsened. Complete resolution of pruritus was reported in 14 patients [58.3%] with doxepin and 2 [8.3%] with placebo [P < .001]. Relative improvement was observed in 7 [29.2%] and 4 [16.7%], respectively. Overall, the improving effect of doxepin on pruritus was seen in 87.5% of the patients. Twelve patients [50.0%] complained of drowsiness that alleviated in all cases after 2 days in average. One patient refused to continue the treatment due to its sedative effect. We suggest that doxepin, a tricyclic antidepressant with anti-H1 receptor effect, can help improve pruritus resistant to antihistamines in end-stage renal disease patients who undergo hemodialysis. A low dose of doxepin is safe while effective and its main adverse effect, drowsiness, is temporary and can be easily tolerated by the patients

Successful treatment of infective endocarditis in four kidney transplant recipients

Infective endocarditis [IE] is a serious complication in kidney transplantation, leading to graft loss and a high mortality rate. We report 4 successfully managed cases of IE in kidney transplant recipients. Blood culture revealed Enterococcus in 2 patients, group D Streptococcus in 1, and no bacteria in 1. All of the patients were diagnosed based on at least 2 major Duke criteria for diagnosis of IE. Although a mild increase in the serum creatinine level was observed in 3 out of 4 patients, no graft rejection occurred during the follow-up. Early diagnostic and therapeutic intervention, particularly intensive antibiotic therapy and surgical management can preserve the patient and the kidney allograft. Studies on previous recurrent infections and simultaneous diseases such as cytomegalovirus in these patients are warranted

Genetics of azoospermia: current knowledge, clinical implications, and future directions Part I

We reviewed the most recent advances in the genetics of male infertility focusing on karyotypic abnormalities, obstructive azoospermia, and idiopathic hypogonadotropic hypogonadism. To update our previous review, we searched the literature using PubMed and skimmed articles published from January 1998 to November 2006. There were 52, 30, and 41 relevant articles to our subject on karyotypic abnormalities, obstructive azoospermia, and idiopathic hypogonadotropic hypogonadism. The full texts of these articles and their bibliographic information were reviewed and a total of 93 were used to contribute this review. The frequency of sperm aneulpoidy in karyotypic abnormalities such as 47,XXY and 47,XYY is higher than that in the healthy individuals, but transmission of the abnormalities to the offspring is rare and the outcomes of assisted reproductive techniques are encouraging. Mutations in the cystic fibrosis gene are detectable in up to 80% of men with congenital bilateral absence of the vas deferens. However, there is a considerable diversity among different populations and the role of other potential causes is not ruled out yet. Autosomal and X-linked genetic aberrations in men with idiopathic hypogonadotropic hypogonadism are now well known. As hormone replacement therapy can provide the chance of fathering in these patients, the risk of mutations' transmission, especially the autosomal dominant ones, is high. In the recent decade, a parallel progress has been made in the genetics of men with azoospermia and the treatment modalities for these patients. Assisted reproductive techniques can help most of the patients, but there are several genetic abnormalities that must be considered before decision making for treatment of their infertility