Surgical outcome of different types of primary hypospadias repair during three decades in a single center.

OBJECTIVE: To evaluate the surgical outcome of different techniques of primary hypospadias repair in a single department. METHODS: We retrospectively evaluated the medical files of all patients who had undergone primary hypospadias repair at our department during the past 3 decades (1978-2009). RESULTS: A total of 820 patients were divided into 3 groups. The first group of 309 patients (37.7%) had glanular hypospadias, the second group of 398 patients (48.5%) had distal hypospadias, and the third group of 113 patients (13.8%) had proximal hypospadias. Of these 820 patients, 67 (8.2%) required corpoplasty to straighten the penis. In the first group, 67 (21.7%) children underwent meatal advancement or meatoplasty, 211 (68.3%) underwent meatal advancement and glanduloplasty, 8 (2.6%) underwent tubularized incised plate hypospadias repair, and 23 (7.4%) underwent Mathieu flap hypospadias repair. In the second group, 196 (49.2%) underwent Mathieu hypospadias repair, 38 (9.5%) underwent tubularized incised plate repair, 142 (35.7%) underwent meatal advancement and glanduloplasty, and 22 (5.5%) underwent onlay-type hypospadias repair. In the third group, 28 (24.8%) underwent 2-stage hypospadias repair, 85 (75.2%) underwent single-stage surgery (including 68 [60.2%] onlay and 11 [9.7%] tubularized island flap), and 6 (5.3%) underwent tubularized incised plate hypospadias repair. Immediate complications developed in 46 (14.9%) in the first, 123 (30.9%) in the second, and 66 (58.4%) in the third group; 38 (4.6%) required additional surgery during or after adolescence. CONCLUSION: Our data have shown that despite the numerous techniques used for hypospadias surgery, the incidence of complications is still high in patients who undergo hypospadias repair.

Cross-language tests of hemispheric strategies in reading nonwords.

Four experiments explored the effects of specific language characteristics on hemispheric functioning in reading nonwords using a lateralized trigram identification task. Previous research using nonsense consonant-vowel-consonant (CVC) trigrams has shown that total error scores reveal a right visual field (RVF) advantage in Hebrew, Japanese, and English. Qualitative error patterns have shown that the right hemisphere uses a sequential strategy, whereas the left hemisphere uses a more parallel strategy in English but shows the opposite pattern in Hebrew. Experiment 1 tested whether this is due to the test language or to the native language of the participants. Results showed that native language had a stronger effect on hemispheric strategies than test language. Experiment 2 showed that latency to target letters in the CVCs revealed the same asymmetry as qualitative errors for Hebrew speakers but not for English speakers and that exposure duration of the stimuli affected misses differentially according to letter position. Experiment 3 used number trigrams to equate reading conventions in the 2 languages. Qualitative error scores still revealed opposing asymmetry patterns. Experiments 1-3 used vertical presentations. Experiment 4 used horizontal presentation, which eliminated sequential processing in both hemispheres in Hebrew speakers, whereas English speakers still showed sequential processing in both hemispheres. Comparison of the 2 presentations suggests that stimulus arrangement affected qualitative errors in the left visual field but not the RVF for English speakers and in both visual fields for Hebrew speakers. It is suggested that these differences result from orthographic and morphological differences between the languages: Reading Hebrew requires attention to be deployed to all the constituents of the stimulus in parallel, whereas reading English allows sequential processing of the letters in both hemispheres. Implications of cross-language studies for models of hemispheric function are discussed.

Individual differences in lateralization: effects of gender and handedness.

Male and female left- and right-handers participated in 3 experiments designed to investigate 3 components of performance asymmetry in lateralized tasks. Experiment 1 used a consonant-vowel-consonant (CVC) identification task measuring quantitative differences in hemispheric abilities and hemispheric control and qualitative differences in hemispheric strategies. The quantitative data revealed that left-handers have a smaller performance asymmetry than do right-handers and that both groups have the same degree of increased accuracy when stimuli are presented bilaterally. Handedness affected the qualitative measures of men, not of women. Experiment 2 used nominal and physical letter-matching tasks with bilateral presentations and measured the flexibility of callosal function. The results suggest that left-handers have less flexible interhemispheric communication than do right-handers and show no effect of gender. Experiment 3 used a chair identification task indexing hemispheric arousal bias. Left-handers tended to have more aroused right than left hemispheres, whereas the distribution of right-handers was centered around 0 arousal bias. Intertask analyses revealed a relationship between arousal bias and metacontrol, where individuals with more aroused right hemispheres tended to use a right-hemisphere strategy in the bilateral condition of the CVC experiment. Intercorrelations between measures from the experiments revealed only a limited relationship between metacontrol patterns in the CVC task and a measure of callosal flexibility in the physical letter-matching task. The results are discussed in the context of the relationships between dimensions of hemispheric asymmetry.

Language experience and right hemisphere tasks: the effects of scanning habits and multilingualism.

This study explores the effects of multilingualism and reading scanning habits on right hemisphere (RH) abilities. Native Hebrew speakers and Arabic-Hebrew bilinguals performed three tasks. Experiment 1 employed an odd/even decision paradigm on lateralized displays of bar graphs. Both groups of subjects displayed the expected LVFA within the range previously reported for readers of English. Experiment 2 consisted of a chair identification task designed to tap asymmetry of hemispheric arousal and a chimeric face task designed to tap RH specialization for facial emotion. Neither scanning habits nor language experience affected performance on the chair task. Scanning habits seem to have affected performance on the chimeric faces task: there was no preference for the left smile in these right-to-left readers, as opposed to previous results in the literature using left-to-right readers. Correlations between measures from the three tasks and all the subject's scores on an English proficiency test and on a Hebrew test for the bilinguals reveal tentative relationships between proficiency in a second language and RH abilities. The results do not support the hypothesis that multilingualism can affect the manner in which these nonlanguage tasks are subserved by the RH. They do support the hypothesis that scanning habits particular to specific languages can affect performance asymmetries on some nonlanguage tasks that have been posited to reflect RH specialization.

Reading direction and attention: effects on lateralized ignoring.

The effects of the scan for the first element in reading (leftmost in English, rightmost in Hebrew) on the ability of subjects to ignore irrelevant stimuli in one visual field more than in the other were investigated. The hypothesis tested was that English readers would have a harder time ignoring irrelevant stimuli in the left visual field than in the right visual field, with the opposite pattern predicted for readers of Hebrew. The paradigm employed by Banich (Banich & Belger, 1990) was used with two letter matching tasks. The results showed that when an irrelevant letter was present, English readers responded more slowly in the right than in the left visual field, and Hebrew readers showed the opposite pattern (Experiment 1). This interaction did not occur when the irrelevant letter was deleted (Experiment 2). These findings are discussed in terms of their relation to eye movements and covert attention and to the use of bilateral displays in neuropsychological experiments.

Individual variation in hemispheric asymmetry: multitask study of effects related to handedness and sex.

Functional hemispheric asymmetries were examined for right- or left-handed men and women. Tasks involved (a) auditory processing of verbal material, (b) processing of emotions shown on faces, (c) processing of visual categorical and coordinate spatial relations, and (d) visual processing of verbal material. Similar performance asymmetries were found for the right-handed and left-handed groups, but the average asymmetries tended to be smaller for the left-handed group. For the most part, measures of performance asymmetry obtained from the different tasks did not correlate with each other, suggesting that individual subjects cannot be simply characterized as strongly or weakly lateralized. However, ear differences obtained in Task 1 did correlate significantly with certain visual field differences obtained in Task 4, suggesting that both tasks are sensitive to hemispheric asymmetry in similar phonetic or language-related processes.

Nominal and physical decision criteria in same-different judgments.

We propose a model in which the physical and nominal dimensions of letter pairs are compared independently of whether subjects use physical (shape task) or nominal (name task) identity as the decision criterion. We attempt to explain the fast-same effect, the preponderance of false-different errors, and the nominal-physical disparity as results of congruent and incongruent outputs of physical and nominal comparison devices that function in both tasks. Subjects performed both tasks with and without response deadlines. The stimuli were presented foveally or unilaterally to one or the other hemisphere. With foveal presentations, the nominal-physical disparity disappeared when congruent and incongruent cells were compared, the fast-same effect occurred only in the shape task, and there was a preponderance of false-different errors only in the name task. Response times and error patterns from centrally presented trials conformed to the predictions of the model. Performance patterns from the lateralized trials conformed only partially. The implications of the data are discussed in the context of several theoretical models of same/different judgments.

Letter matching within and between the disconnected hemispheres.

Three patients with complete cerebral commissurotomy from the California series were given two letter-matching tasks, one requiring physical identity and the other requiring nominal identity. The pairs of letters were presented unilaterally to each disconnected hemisphere or bilaterally, with each hemisphere receiving one of the letters to be compared. The disconnected hemispheres of all three patients showed good performance in the unilateral conditions, even when visual field and response hand were crossed. The crossed visual field-hand conditions resulted in both slower and less accurate responses. Only N.G. was able to cross-compare letters in the bilateral condition and only for physical identity. The results qualify previous reports that higher-level information can transfer subcallosally while visual information cannot.

Letter matching in the hemispheres: speed-accuracy trade-offs.

Eight subjects performed physical and nominal letter-matching tasks for pairs of letters presented in the left, right, or central visual fields, using a unimanual two-choice response-time paradigm. Latencies were manipulated by using a cued response procedure, and speed-sensitivity and speed-bias functions were calculated separately for each of the peripheral visual field by response hand conditions. Hemispheric contributions to these tasks were investigated by looking for evidence of exclusive specialization and callosal transfer. The results suggest that both hemispheres are able to perform the tasks and that they do so using similar processing strategies, but they differ in the response-choice stage of the nominal identity task.

The effects of word length and emotionality on hemispheric contribution to lexical decision.

The effects of emotionality and length on lateralized lexical decision of abstract nouns were investigated in 41 normal and three commissurotomized subjects. Emotionality had the same effect in both visual fields: Emotional words were responded to more accurately than neutral words. Length had different effects in the two visual fields: The accuracy of lexical decisions in the left visual field was selectively higher for four-letter words and in the right visual field it was selectively lower for six-letter words. The latency of lexical decisions revealed equivalent length effects in both visual fields. Of the commissurotomy patients, only L.B.'s left hemisphere performed above chance and revealed a length effect. Length effects are interpreted to reflect a change from a parallel graphic analysis to a sequential parsing strategy when resources are limited. Such a change can occur for words or nonwords in either visual hemifield.

Concreteness: nouns, verbs, and hemispheres.

The preferential processing of concrete versus abstract nouns, and of active versus static or "quiet" verbs, was investigated using a lateralized lexical decision task in 32 normal and 4 commissurotomized subjects. Both groups of subjects showed the concreteness effect for nouns in both visual fields. The disconnected right hemisphere of two commissurotomized subjects responded with above chance performance only to concrete nouns. Neither group showed an activeness effect for verbs in either visual field. This supports an imageability rather than a multisensory representation interpretation of the concreteness effect. A comparison of responses to words and to nonwords revealed that males had a "no" bias to stimuli in the left visual field, and both males and females showed a slight "yes" bias for stimuli in the right visual field. These data suggest that the lexical decision task is complex and that word and nonword decisions constitute partly independent functional components. We interpret the sex differences as an indication of strategic rather than functional differences in lateralization patterns between males and females.