Insights into enlarged prostatic utricles and Müllerian duct system remnants associated with posterior hypospadias.

INTRODUCTION: The prostatic utricle (PU) consists of the caudal remnant of the Müllerian duct and the urogenital sinus. The term "vagina masculina" is used if other Müllerian structures are associated with the PU. This work aims to investigate the incidence, management, and follow up of enlarged PUs and Müllerian remnants in males with posterior hypospadias. PATIENTS AND METHODS: This study presents a retrospective review of cases presented with posterior hypospadias over a 5-year period. Prior to hypospadias repair, retrograde urethrograms were used to investigate enlarged PU. Subsequently, they were classified according to the Ikoma score and further assessed by karyotyping and cystoscope. Surgical excision was indicated in cases with symptomatic utricles or vagina masculina. RESULTS: Thirty patients were included in the study in the period between 2015 and 2020 (Table). All cases were asymptomatic initially. Twelve patients were diagnosed with enlarged PU; three of them had vagina masculina. One case with perineal hypospadias had a separate perineal opening for PU. Following hypospadias repair, three of the eight cases treated conservatively turned symptomatic. DISCUSSION: The incidence of enlarged PU and Müllerian remnants varied among different studies. However, it increased as the severity of hypospadias increased. Preoperative urethrogram was helpful in the diagnosis and classification of PU, but it had its limitations. Cystoscope was more advantageous in diagnosing vagina masculina. Although most cases were asymptomatic, some turned symptomatic after hypospadias repair. Some cases with perineal hypospadias had PU with a separate perineal opening. CONCLUSION: The incidence of enlarged PUs or Müllerian remnants was 40%. Although cases were asymptomatic before hypospadias surgery, some cases turned into symptomatic after hypospadias repair. In some cases, the PU or Müllerian remnants had a separate perineal opening. They can be classified as a particular form of Ikoma grade III necessitating surgical intervention.

Iris recognition approach for identity verification with DWT and multiclass SVM.

The iris has been proven to be one of the most stable and accurate biometrics. It has been widely used in recognition systems to determine the identity of the individual who attempts to access secured or restricted areas (e.g., airports, ATM, datacenters). An iris recognition (IR) technique for identity authentication/verification is proposed in this research. Iris image pre-processing, which includes iris segmentation, normalization, and enhancement, is followed by feature extraction, and matching. First, the iris image is segmented using the Hough Transform technique. The Daugman's rubber sheet model is the used to normalize the segmented iris area. Then, using enhancing techniques (such as histogram equalization), Gabor wavelets and Discrete Wavelets Transform should be used to precisely extract the prominent characteristics. A multiclass Support Vector Machine (SVM) is used to assess the similarity of the images. The suggested method is evaluated using the IITD iris dataset, which is one of the most often used iris datasets. The benefit of the suggested method is that it reduces the number of features in each image to only 88. Experiments revealed that the proposed method was capable of collecting a moderate quantity of useful features and outperformed other methods. Furthermore, the proposed method's recognition accuracy was found to be 98.92% on tested data.

Vesico-cutaneous fistula: A modified technique for intermittent catheterization in children with impaired bladder function.

BACKGROUND: Clean intermittent catheterization (CIC) is fundamental in managing children with impaired bladder function. However, it is not always feasible via the native urethra predominately males with intact sensation. AIM: In the current study, the experience regarding a modified vesico-cutaneous fistula (VCF) technique for CIC in children is reported. PATIENTS AND METHODS: From January 2018 to January 2020, the modified VCF was performed to cases with impaired bladder function for CIC. Before surgery, patients were evaluated thoroughly. The anteroposterior diameter (APD) of the renal pelvis was considered as an indicator of the degree of affection of the upper urinary tract. Postoperative attacks of UTIs, leakage from the fistula, fistula stenosis, and the need for revision were recorded. The technique was accomplished relying on the principles of open Stamm gastrostomy (Fig. 1). RESULTS: Eight cases underwent a modified VCF due to different pathologies. Their ages, at time of the surgery, ranged from 1 month to 144/12 years. The median postoperative follow up period was 12 months. A leakage between catheterizations was experienced in 1 case. Stenosis of the fistula occurred in 1 case and it required surgical revision. No symptoms or signs of urinary tract infection were encountered. The mean APD of the renal pelvis was reduced from 29.8 mm (SD: ±14.6 mm), in the preoperative evaluation, to 17.6 mm (SD: ±10.85 mm) in the postoperative follow up. DISCUSSION: Vesico-cutaneous fistula is a new technique that provides easy and direct way for CIC. In the current study, a modified VCF technique was introduced to the enrolled patients as a simple maneuver, to make easy self-catheterization. Despite the limitations of this study due to the lack of a control group, the small number of cases, and the short follow up period, this modified technique was able to create a short and straightforward channel to access the bladder for intermittent catheterization. It could be done in redo cases. Results showed an acceptable degree of continence and low rate of complications. Moreover, it was socially accepted among our patients. CONCLUSION: Intermittent catheterization in children, with abnormal bladder function, can be done easily and efficiently via a modified VCF.

Closed Gastroschisis.

Closed gastroschisis is a rare entity usually associated with intestinal atresia and short bowel syndrome. We report two cases of closed gastroschisis presenting with neonatal intestinal obstruction and para-umbilical evisceration without an abdominal defect.

Colonic Atresia: Association with Other Anomalies.

BACKGROUND: Colonic atresia (CA) is a rare form of congenital intestinal atresia. Although CA may be isolated, it is more commonly reported in literature in association with other congenital anomalies. MATERIALS AND METHODS: This study is a review of prospectively collected data of all the patients with colonic atresia presented to our center (Ain Shams University) during 2008 to 2016. RESULTS: Twelve patients were enrolled in this study. The atresia was of type I in one case, type II in four cases, type IIIa in six cases, type IV in one case. These cases accounted for 4.9 % of intestinal atresias managed in our center during the same period. Five cases were isolated CA, while the other seven cases had associated abdominal congenital anomalies (exomphalos, Hirschsprung's disease, imperforate anus, closing gastroschisis, colonic duplication, and multiple small bowel atresia in two cases). The management in ten cases was by staged procedure with creation of a temporary stoma initially, while primary anastomosis was established in two cases. We had two cases with delayed presentations, one missed diagnosis, and three mortalities in this series. CONCLUSIONS: The low incidence of CA may result in delay in the diagnosis and management. Hirschsprung's disease should be excluded in every case of colonic atresia. Early diagnosis and proper surgical management is essential for good prognosis.

Surgical aspects of inflammatory bowel diseases in pediatric and adolescent age groups.

BACKGROUND: Inflammatory bowel disease (IBD) is increasingly encountered in children. Early disease is associated with higher complication rate with increased incidence of surgical intervention. PATIENTS AND METHODS: From January 2010 to June 2015, 25 patients in the pediatric and adolescent age groups with IBD underwent surgical intervention in our center. They were classified into two groups. Group I included 15 patients with ulcerative colitis where 5 cases had left colon disease underwent left colectomy, while 10 cases had pancolonic disease underwent total colectomy and anal mucosectomy with ileo-anal or ileal pouch-anal anastomosis with covering ileostomy. Group II included 10 cases with Crohn's disease where the indications for surgery were intestinal obstruction in seven cases, fulminant perianal infection with septic shock in one, perianal fistula and ulcers in one, and growth failure due to resistant intestinal fistula in one. RESULTS: Group I included eight males and seven females; mean age at surgery was 10.6 years. There were postoperative complications in seven cases in the form of pelvic abscess and wound infection in one, wound infection in two, and recurrent pouchitis in four cases. Group II contained eight males and two females; mean age at surgery was 6.6 years. Two cases had recurrent symptoms after stricturoplasty. The mean length of time from diagnosis to surgery was 2.4 years (ranging from 6 to 36 months). CONCLUSION: A multidisciplinary team is mandatory for proper management of IBD cases. The risk of the disease and the expected surgical complications determine the timing of surgical interference.

Low pH induces co-ordinate regulation of gene expression in oesophageal cells.

The development of gastro-oesophageal reflux disease (GORD) is known to be a causative risk factor in the evolution of adenocarcinoma of the oesophagus. The major component of this reflux is gastric acid. However, the impact of low pH on gene expression has not been extensively studied in oesophageal cells. This study utilizes a transcriptomic and bioinformatic approach to assess regulation of gene expression in response to low pH. In more detail, oesophageal adenocarcinoma cell lines were exposed to a range of pH environments. Affymetrix microarrays were used for gene-expression analysis and results were validated using cycle limitation and real-time RT-PCR analysis, as well as northern and western blotting. Comparative promoter transcription factor binding site (TFBS) analysis (MatInspector) of hierarchically clustered gene-expression data was employed to identify the elements which may co-ordinately regulate individual gene clusters. Initial experiments demonstrated maximal induction of EGR1 gene expression at pH 6.5. Subsequent array experimentation revealed significant induction of gene expression from such functional categories as DNA damage response (EGR1-4, ATF3) and cell-cycle control (GADD34, GADD45, p57). Changes in expression of EGR1, EGR3, ATF3, MKP-1, FOSB, CTGF and CYR61 were verified in separate experiments and in a variety of oesophageal cell lines. TFBS analysis of promoters identified transcription factors that may co-ordinately regulate gene-expression clusters, Cluster 1: Oct-1, AP4R; Cluster 2: NF-kB, EGRF; Cluster 3: IKRS, AP-1F. Low pH has the ability to induce genes and pathways which can provide an environment suitable for the progression of malignancy. Further functional analysis of the genes and clusters identified in this low pH study is likely to lead to new insights into the pathogenesis and therapeutics of GORD and oesophageal cancer.