Uterine artery atherosclerotic disease: histologic features and clinical correlation.

OBJECTIVE: To determine whether uterine artery atherosclerosis is associated with known cardiovascular risk factors in women undergoing hysterectomy. METHODS: Seventy-four women undergoing hysterectomy between September 1995 and March 1996 were evaluated. Following hysterectomy, samples of the uterine artery were collected for histologic evaluation. Plaque complexity and histologic measurements were compared with regard to known cardiovascular risk factors. RESULTS: Among the 59 premenopausal women, 55.9% had intimal thickening 40.7% had simple plaques, and 3.7% had complex lesions in the uterine artery samples. Among postmenopausal women, 40% had intimal fibrosis, 20% had simple plaques, and 40% had complex lesions. Postmenopausal status was correlated strongly with the presence of advanced atherosclerotic disease (P < .001). Postmenopausal women had significantly greater intimal area (P = .01), intimal area/medial area (P = .002), intimal area/vessel area (P = .002), maximal intimal thickness/medial thickness (P = .01), and significantly less medial thickness (P < .001). A significant linear correlation existed between age and the intimal/medial ratio among premenopausal women (P = .04) and postmenopausal women (P = .01). Patients with electrocardiogram (ECG) abnormalities had significantly greater intimal/medial area as well (P = .02). Hypertension was associated with complex lesions among the postmenopausal patients (P = .01). Preoperative cholesterol levels greater than 200 mg/dL were associated with greater intimal thickness (P = .05) and intimal thickness/medial thickness (P = .03). CONCLUSION: The severity of uterine artery atherosclerosis is significantly correlated with known risk factors for cardiovascular disease: increasing age, postmenopausal status, ECG abnormalities, and hypertension. Uterine artery histologic analysis may provide a means of assessing the degree of atherosclerosis in other, critical, vascular beds.

The treatment of hypospadias by a modified one-stage van der Meulen dorsal axial flap repair.

A modified van der Meulen operation has been designed to reduce even further the low complication rate associated with this method of hypospadias repair. Our experiences with the first 20 cases are reported.

A supero-medial thigh flap for urethral reconstruction in epispadias and hypospadias.

A reliable axial flap from the adductor region has been used for many years to repair a series of urethral defects formerly regarded as difficult problems. In particular the flap has proved invaluable in the treatment of epispadias "cripples". Suggestions are also made for correcting the reverse chordee deformity due to the shortage of skin on the dorsum which, if untreated, spoils the functional result. The use of a supero-medial thigh flap was reported by Hirshowitz et al. (1980, 1982) for repair of the scrotum and vulva. The same flap had been discovered independently in 1978 in this department and used for the repair of epispadias and hypospadias "cripples". Its reliability was soon recognised and the presence of axial vessels from the medial femoral circumflex artery and vein were demonstrated by transillumination at the time of surgery and by study in the post-mortem room. Some patients with epispadias are referred at puberty with an unrepaired scarred penis and a reverse chordee deformity. The defect cannot be repaired with local tissue alone and the same difficulty is encountered with some hypospadias "cripples". Occasionally untreated cases of perineal hypospadias are seen with a marked shortage of local tissue. In our experience scrotal flaps may fail to heal and orthodox groin flaps may have difficulty in reaching the target. Although the superomedial thigh flap will require at least two stages it is a reliable technique and it provides a generous amount of tissue with which to solve what may at first sight seem to be an insuperable problem.(ABSTRACT TRUNCATED AT 250 WORDS)

Inflammatory fibrous histiocytoma.

The name inflammatory fibrous histiocytoma (FH) is applied to a rare group of disorders which is not well known to surgeons but which may require surgical treatment. The name is misleading in that although there may be features of inflammation, the clinical progress, absence of causative organism and fatal outcome seem to place it within the sphere of malignancy. The condition is fully described by Kyriakos and Kempson (1976) and a case with a periorbital lesion managed by multiple surgical excisions, the "berry-picking" technique, is documented by Jones et al., (1979). The average age is over 50 years and the sex distribution about equal. In this paper a patient much younger than average is presented to illustrate the problems of diagnosis and management. During the course of treatment an observation was made on the "take" of a free graft on the cortex of the sternum.

Cross-leg flap repair: a suggested change of routine.

A change in the accepted routine of cross-leg repair is suggested in the interest of safety. In order to avoid infection in the donor site the skin graft is cut first. The flap is raised before the defect is prepared so that the problems of tension and 'tenting' are eliminated. This enables the flap to be sutured under less than normal skin tension.

Buried penis.

Six cases of buried penis in childhood are recorded. An attempt has been made to clarify the nomenclature of a number of penile deformities over which there has been some confusion. The treatment of buried penis, which should be completed before school age, depends upon freeing the penile shaft from abnormal attachments and correcting the skin defect. The importance of the tethering fibromuscular bands between the penile shaft and abdominal wall has not previously been stressed.