Nueva técnica de fijación de dartos en la reparación de hipospadias / A novel triple dartos fixation in hypospadias repair

Objetivo Este estudio investiga el impacto del uso de la cobertura de dartos para aumentar la neouretra en los resultados funcionales y cosméticos. Evaluar una técnica novedosa que demuestra cómo fijar la cobertura de dartos como cobertura de barrera de la neouretra en la corrección de hipospadias. Pacientes y métodos Este estudio se realizó en 204 pacientes varones, todos con diferentes grados de hipospadias (HPD: 132, hipospadias coronal: 46 y HPM: 26). Sus edades oscilaban entre 1-23 años (edad media: 2 años). Había incurvación ventral (chorda) en (HPD: 45, hipospadias coronal: 33 y HPM: 26). Todos los pacientes tenían un chorro urinario anormal dirigido hacia abajo. La corrección del hipospadias se realizó mediante la técnica TIP clásica, además de nuestra novedosa modificación con cobertura de dartos. El seguimiento se realizó durante 5 años mediante evaluaciones clínicas de los parámetros funcionales y cosméticos. Resultados Se registraron tasas de éxito en 200 pacientes, 3 pacientes tuvieron complicaciones con una fístula uretrocutánea subcoronal y un paciente presentó la pérdida completa de la reparación. Conclusión La fijación triple de dartos es una técnica sencilla con la que todos los hipospadiólogos pueden reducir la fístula uretrocutánea como complicación común de la corrección de hipospadias con unos buenos resultados funcionales y cosméticos (AU)

Objective This study investigates the impact of the use of dartos covering to augment the neourethra on functional and cosmetic results. To evaluate a novel technique demonstrating how to fix dartos flap to cover the neourethra as a barrier in hypospadias repair. Patients and methods This study comprised 204 male patients with different degree of hypospadias (DPH: 132, coronal hypospadias: 46, MPH: 26). Their ages ranged from 1-23 ys (mean age: 2ys). Penile chordee was in (DPH: 45, coronal hypospadias: 33, MPH: 26). All patients had abnormal downward directed urinary stream. Hypospadias repair was performed by the classic TIP technique in addition to our novel modification of dartos covering. Patients were submitted to 5 years of follow-up including clinical examination of the functional and cosmetic parameters. Results Success rates were reported in 200 patients, 3 patients had complications with subcoronal urethrocutaneous fistula and one patient with complete repair disruption. Conclusion Triple dartos fixation is a simple technique for all hypospadiologists to minimize urethrocutaneous fistula as common complication of hypospadias repair with good functional and cosmetic results (AU)

A novel triple dartous fixation in hypospadias repair.

OBJECTIVE: This study investigates the impact of the use of dartos covering to augment the neourethra on functional and cosmetic results. To evaluate a novel technique demonstrating how to fix dartos flap to cover the neourethra as a barrier in hypospadias repair. PATIENTS AND METHODS: This study comprised 204 male patients with different degree of hypospadias (DPH = 132, coronal hypospadias = 46, MPH = 26). Their ages ranged from 1 to 23 ys (mean age = 2 ys). Penile chordee was in (DPH = 45, coronal hypospadias = 33, MPH = 26). All patients had abnormal downward directed urinary stream. Hypospadias repair was performed by the classic TIP technique in addition to our novel modification of dartos covering. Patients were submitted to 5 years of follow-up including clinical examination of the functional and cosmetic parameters. RESULTS: Success rates were reported in 200 patients, 3 patients had complications with subcoronal urethrocutaneous fistula and one patient with complete repair disruption. CONCLUSION: Triple dartos fixation is a simple technique for all hypospadiologists to minimize urethrocutaneous fistula as common complication of hypospadias repair with good functional and cosmetic results.

Anti-inflammatory effect of selenium nanoparticles on the inflammation induced in irradiated rats.

Selenium (Se) has been reported to possess anti-inflammatory properties, but its bioavailability and toxicity are considerable limiting factors. The present study aimed to investigate the possible anti-inflammatory and analgesic effects of selenium nanoparticles (Nano-Se) on inflammation induced in irradiated rats. Paw volume and nociceptive threshold were measured in carrageenan-induced paw edema and hyperalgesia model. Leukocytic count, tumor necrosis factor-α (TNF-α), prostaglandin E2 (PGE2), thiobarbituric acid reactive substances (TBAR), and total nitrate/nitrite (NOx) were estimated in the exudate collected from 6 day old air pouch model. Irradiated rats were exposed to 6 Gy gamma (γ)-irradiation. Nano-Se were administered orally in a dose of 2.55 mg/kg once before carrageenan injection in the first model and twice in the second model. The paw volume but not the nociceptive response produced by carrageenan in irradiated rats was higher than that induced in non-irradiated rats. Nano-Se were effective in reducing the paw volume in non-irradiated and irradiated rats but it did not alter the nociceptive threshold. The inflammation induced in irradiated rats increased all the estimated parameters in the exudate whereas; Nano-Se decreased their elevation in non-irradiated and irradiated rats. Nano-Se possess a potential anti-inflammatory activity on inflammation induced in irradiated rats.

¿Es la glanduloplastia con desepitelización beneficiosa para el hipospadiólogo? / Is approximated de-epithelized glanuloplasty beneficial for hypospadiologist?

Objetivo: Evaluar los resultados estéticos y funcionales de glanuloplastia con desepitelización aproximada en diferente grado de hipospadias. Material y métodos: Este estudio se realizó en 96 pacientes varones (DPH = 68 y MPH = 28). Los pacientes seleccionados para la reparación con la glanuloplastia de aproximación deben tener placa uretral amplia y glande ranurados. Todos los casos fueron reparados con la técnica clásica y la de aproximación glandar. El seguimiento fue de un año, mediante un examen clínico de la forma del meato, tamaño y sitio, forma del glande, cubierta de piel, línea de sutura, sonda uretral, aparición de edema y fístula, además de la satisfacción de los padres. Resultados: El tiempo operatorio promedio fue de 49 ± 9 min. En cuanto a los resultados funcionales y cosméticos el éxito se informó en el 95,8%, mientras que el fracaso fue de 4,16% en forma de interrupción glandar en 2 pacientes y fístula uretrocutánea subcoronal en otros 2 pacientes. Conclusión: La técnica de aproximación glandar tiene muchas ventajas, buenos resultados cosméticos y funcionales, tiempo operatorio corto y menos pérdida de sangre, no habiendo necesidad de torniquete

Objective: Further evaluation of the cosmetic and functional results of approximated de-epithelized glanuloplasty in different degree of hypospadias. Material and methods: This study included 96 male patients (DPH = 68 & MPH = 28). Patients selected for repair with glans approximation should have wide urethral plate & grooved glans. All cases were repaired with the classic TIP and glans approximation technique. Follow up was for one year by clinical examination of the meatal shape, size & site, glans shape, skin covering, suture line, urethral catheter, edema & fistula in addition to parent satisfaction. Results: Mean operative time was 49 ± 9 minutes. As regards the functional and cosmetic outcomes, success was reported in 95.8%, while failure was in 4.16% in the form of glanular disruption in two patients and subcoronal urethrocutaneous fistula in another two patients. Conclusion: Glans approximation has many advantages, good cosmetic and functional results, short operative time, less blood loss, no need for tourniquet. Study of a large number of cases and comparing glans approximation with the classic TIP technique

Is approximated de-epithelized glanuloplasty beneficial for hypospadiologist? / ¿Es la glanduloplastia con desepitelización beneficiosa para el hipospadiólogo?

OBJECTIVE: Further evaluation of the cosmetic and functional results of approximated de-epithelized glanuloplasty in different degree of hypospadias. MATERIAL AND METHODS: This study included 96 male patients (DPH=68 & MPH=28). Patients selected for repair with glans approximation should have wide urethral plate & grooved glans. All cases were repaired with the classic TIP and glans approximation technique. Follow up was for one year by clinical examination of the meatal shape, size & site, glans shape, skin covering, suture line, urethral catheter, edema & fistula in addition to parent satisfaction. RESULTS: Mean operative time was 49±9minutes. As regards the functional and cosmetic outcomes, success was reported in 95.8%, while failure was in 4.16% in the form of glanular disruption in two patients and subcoronal urethrocutaneous fistula in another two patients. CONCLUSION: Glans approximation has many advantages, good cosmetic and functional results, short operative time, less blood loss, no need for tourniquet. Study of a large number of cases and comparing glans approximation with the classic TIP technique.

Direct cord implantation in brachial plexus avulsions: revised technique using a single stage combined anterior (first) posterior (second) approach and end-to-side side-to-side grafting neurorrhaphy.

BACKGROUND: The superiority of a single stage combined anterior (first) posterior (second) approach and end-to-side side-to-side grafting neurorrhaphy in direct cord implantation was investigated as to providing adequate exposure to both the cervical cord and the brachial plexus, as to causing less tissue damage and as to being more extensible than current surgical approaches. METHODS: The front and back of the neck, the front and back of the chest up to the midline and the whole affected upper limb were sterilized while the patient was in the lateral position; the patient was next turned into the supine position, the plexus explored anteriorly and the grafts were placed; the patient was then turned again into the lateral position, and a posterior cervical laminectomy was done. The grafts were retrieved posteriorly and side grafted to the anterior cord. Using this approach, 5 patients suffering from complete traumatic brachial plexus palsy, 4 adults and 1 obstetric case were operated upon and followed up for 2 years. 2 were C5,6 ruptures and C7,8T1 avulsions. 3 were C5,6,7,8T1 avulsions. C5,6 ruptures were grafted and all avulsions were cord implanted. RESULTS: Surgery in complete avulsions led to Grade 4 improvement in shoulder abduction/flexion and elbow flexion. Cocontractions occurred between the lateral deltoid and biceps on active shoulder abduction. No cocontractions occurred after surgery in C5,6 ruptures and C7,8T1 avulsions, muscle power improvement extended into the forearm and hand; pain disappeared. LIMITATIONS INCLUDE: spontaneous recovery despite MRI appearance of avulsions, fallacies in determining intraoperative avulsions (wrong diagnosis, wrong level); small sample size; no controls rule out superiority of this technique versus other direct cord reimplantation techniques or other neurotization procedures; intra- and interobserver variability in testing muscle power and cocontractions. CONCLUSION: Through providing proper exposure to the brachial plexus and to the cervical cord, the single stage combined anterior (first) and posterior (second) approach might stimulate brachial plexus surgeons to go more for direct cord implantation. In this study, it allowed for placing side grafts along an extensive donor recipient area by end-to-side, side-to-side grafting neurorrhaphy and thus improved results. LEVEL OF EVIDENCE: Level IV, prospective case series.

Cardiac cell survival and reversibility of myocardial ischemia.

Because of a limited capacity for cell regeneration, the cardiac tissue, when submitted to ischemic stress, may activate endogenous mechanisms of cell survival resulting in physiological conditions of adaptation to ischemia, known as myocardial stunning, ischemic preconditioning and myocardial hibernation. These conditions result from a switch in gene and protein expression, which sustains cardiac cell survival in a context of oxygen deprivation and during the stress of reperfusion. Understanding how the molecular adaptation of the cardiac myocyte during stress sustains its survival in these conditions might help to define novel mechanisms of endogenous myocardial salvage, in order to expand the conditions of maintained cellular viability and functional salvage of the ischemic myocardium. This review summarizes recent progress made in the study of the molecular pathways controlling reversible ischemic dysfunction, and the unraveling of novel genomic paradigms. We also focus on the discovery and characterization of novel genes, which further increase our knowledge of myocardial ischemia and open novel therapeutic possibilities for ischemic heart disease.