Cryptorchidism and the value of ultrasonography.

INTRODUCTION: The aim of this study was to evaluate the usefulness and accuracy of ultrasonography in investigating cryptorchidism. METHODS: Case notes were reviewed of all children with cryptorchidism who had undergone ultrasonography for their testes between February and October 2010. Preoperative ultrasonography findings for presence or absence and position of testes were noted and compared with the operative findings. The sensitivity and specificity of ultrasonography were calculated. RESULTS: A total of 50 testes in 42 boys were examined by ultrasonography preoperatively during the study period. The median age was 6 years. All had single B-mode greyscale ultrasonography using greyscale and Doppler imaging. Of the 50 testes, 42 were visualised intracanalicularly or in the superficial inguinal pouch, 2 were intra-abdominal and 6 could not be detected. However, on examination under anaesthesia, 37 out of the 50 testes were palpable in the groin and 13 were impalpable. Two out of the remaining thirteen were found to be atrophic on diagnostic laparoscopy. The sensitivity and specificity of ultrasonography in determining the presence of testes was 85% and 25% respectively. CONCLUSIONS: Ultrasonography has low sensitivity and specificity in determining the presence of testes and localisation of their position. When performing an examination under anaesthesia and using a laparoscopic technique, ultrasonography is not recommended in cases of cryptorchidism.

A review of decellularized stem cell matrix: a novel cell expansion system for cartilage tissue engineering.

Cell-based therapy is a promising biological approach for the treatment of cartilage defects. Due to the small size of autologous cartilage samples available for cell transplantation in patients, cells need to be expanded to yield a sufficient cell number for cartilage repair. However, chondrocytes and adult stem cells tend to become replicatively senescent once they are expanded on conventional plastic flasks. Many studies demonstrate that the loss of cell properties is concomitant with the decreased cell proliferation capacity. This is a significant challenge for cartilage tissue engineering and regeneration. Despite much progress having been made in cell expansion, there are still concerns over expanded cell size and quality for cell transplantation applications. Recently, in vivo investigations in stem cell niches have suggested the importance of developing an in vitro stem cell microenvironment for cell expansion and tissue-specific differentiation. Our and other investigators' work indicates that a decellularized stem cell matrix (DSCM) may provide such an expansion system to yield large-quantity and high-quality cells for cartilage tissue engineering and regeneration. This review briefly introduces key parameters in an in vivo stem cell niche and focuses on our recent work on DSCM for its rejuvenating or reprograming effect on various adult stem cells and chondrocytes. Since research in DSCM is still in its infancy, we are only able to discuss some potential mechanisms of DSCM on cell proliferation and chondrogenic potential. Further investigations of the underlying mechanism and in vivo regeneration capacity will allow this approach to be used in clinics.

Rolled Vaginal Wall Flap for the Treatment of Stress Urinary Incontinence

Objectives: Anterior vaginal wall slings (AVWS) have been used for decades in the treatment of female stress urinary incontinence (SUI). The main drawback of using the vaginal wall as a sling is its tendency to weaken and stretch over the course of years. The use of synthetic tapes for the treatment of SUI is effective but costly. For patients who cannot afford synthetic tapes; we describe the preliminary results of a modified AVWS technique for the treatment of SUI types II and III. Patients and Methods: In this series; a modification of the AVWS was applied in 35 female patients with SUI. A fortified and rolled flap is used to provide compression and support of the urethra. The vaginal mucosal surface of the flap is cauterized and two diagonal sutures are placed across it. The flap is then rolled on itself with a running 2/0 vicryl suture. Two sutures attached to both ends are passed retropubically to the anterior abdominal wall and tied over the rectus sheath. Results: All 35 female patients had type II/III SUI. After a median follow up of 43 months; 91of the patients were dry or used 0-1 pad per day. Only one patient suffered from transient retention for one week post-operatively. Conclusion: This is a simple method to reinforce vaginal wall flaps. It could offer a durable and effective option for the treatment of SUI in patients who can not afford synthetic tapes. Long-term follow up is required to evaluate the durability of the procedure

Rectus Fascia Sling for the Treatment of Total Urethral Incontinence in Males

Objectives: Urinary incontinence in patients with neurological disease is a major health problem. A modified rectus fascial sling has been assessed in incontinent male patients. Patients and Methods: Fourteen adult male patients with total incontinence due to neurogenic or post-traumatic and etiology were included in this study. A rectangular rectus sheath flap was harvested and defatted.The flap was placed around the bulbar urethra and sutures were passed both in front of and behindthe pubic bone. Both sutures on each side were tied to each other over the pubic bone. Results: Of the 14 patients; 9 (64.3) were completely dry; 3 (21.4) reported improved continence; while 2 (14.3) were a failure. In total; 71.4of the patients showed significant improvement using the Incontinence Quality of Life (IQoL) questionnaire. A significant decrease in the number of pads used per day of 61.3(p

Nissen fundoplication, robotic-assisted versus laparoscopic procedure: a comparative study in children.

BACKGROUND/PURPOSE: Many reports have addressed the feasibility and safety of robotic-assisted surgery. However, few have compared the use of robots with the standard laparoscopic approach in various procedures. The aim of this study was to compare robotic-assisted Nissen fundoplication (RNF) with laparoscopic Nissen fundoplication (LNF). METHODS: Children who underwent RNF were compared with those who underwent LNF during the same period at the same institution. Data collected included patient demographics, surgical indications, operative times, intraoperative and postoperative complications and clinical outcomes. RESULTS: Between January 2005 and July 2008, 25 patients underwent RNF and 25 underwent LNF. Both groups were similar with regard to age, male/female ratio, and body weight. The total operative time was comparable in both groups. There were no deaths, intraoperative complications or untoward events. There were no significant differences in postoperative complication rates, postoperative analgesic requirements or lengths of hospital stay between the groups. Short-term clinical results with respect to gastroesophageal reflux symptoms were comparable in both groups after 14 months of follow-up. CONCLUSION: RNF is a safe and feasible alternative to LNF. There were no significant differences in outcomes measured between groups. In view of the high cost of robotic devices, no clear benefits of using robotics in Nissen fundoplication were observed.

Repair of experimental plaque-induced periodontal disease in dogs.

Forty mongrel dogs were used in this study for induction of periodontal disease by placing subgingival silk ligatures affecting maxillary and mandibular premolar teeth during a 12-month period. Experimental premolar teeth received monthly clinical, radiographic, and histometric/pathologic assessments. The results demonstrated significant increases in scores and values of periodontal disease parameters associated with variable degrees of alveolar bone loss. The experimental maxillary premolar teeth exhibited more severe and rapid rates of periodontal disease compared with mandibular premolar teeth. Histometric analysis showed significant reduction in free and attached gingiva of the experimental teeth. Histopathological examination of buccolingual sections from experimental premolar teeth showed the presence of rete pegs within the sulcular epithelium with acanthosis and erosive changes, widening of the periodontal ligament, and alveolar bone resorption. Various methods for periodontal repair were studied in 194 experimental premolar teeth exhibiting different degrees of periodontal disease. The treatment plan comprised non-surgical (teeth scaling, root planing, and oral hygiene) and surgical methods (closed gingival curettage, modified Widman flap, and reconstructive surgery using autogenous bone marrow graft and canine amniotic membrane). The initial non-surgical treatment resulted in a periodontal recovery rate of 37.6% and was found effective for treatment of early periodontal disease based on resolution of gingivitis and reduction of periodontal probing depths. Surgical treatment by closed gingival curettage to eliminate the diseased pocket lining resulted in a recovery rate of 48.8% and proved effective in substantially reducing deep periodontal pockets. Open root planing following flap elevation resulted in a recovery rate of 85.4% and was effective for deep and refractory periodontal pockets. Autogenous bone graft implantation combined with canine amniotic membrane as a biodegradable membrane was used in 18 premolar teeth and failed to improve advanced furcation defects in most teeth.

Doxazosin versus finasteride for the treatment of large symptomatizing benign prostatic hyperplasia : a questionnaire and urodynamic-based study

Objectives: To evaluate and compare the efficacy of both Finasteride and Doxazosin in the treatment of moderately symptomatizing large-sized benign prostatic hyperplasia and to correlate symptomatic changes with alterations in urodynamic values using the OCO values (Schafer nomogram). Patients and Methods: Fifty male patients with moderately symptomatizing BPH ( 40 cc) as assessed by ultrasound; were randomized to receive either Finasteride (5 mg/day)or Doxazosin (1-4 mg/ day) for 12 months. Results: Both Finasteride and Doxazosin significantly improved the urinary flow rates. Pressure-flow studies confirmed that both Doxazosin and Finasteride were effective in decreasing the opening detrusor pressure; the detrusor pressure at maximum flow (PdetQmax) and the detrusor pressure at least flow (Pdet least). When applying the Schafer nomogram; the OCO values were found to have improved in both treatment groups. There was; however; a significant difference between both groups with respect to the OCO values denoting a better improvement of the degree of obstruction in patients treated with Finasteride. Conclusion: The use of a compatible numerical format for grading the degree of bladder outlet obstruction would maximize the usefulness of pressure-flow studies in the evaluation of obstructed patients. Using the OCO value revealed that Finasteride was superior to Doxazosin regarding the degree of improvement in obstruction caused by benign prostatic hyperplasia

Brain imaging and urodynamic correlation in patients with cerebrovascular stroke

Objective: To identify urodynamic abnormalities in patients with cerebrovascular accidents and correlate both with CT or MRI findings. Patients and Methods: From September 2001 to March 2003; a total of 44 males and 16 females were prospectively examined urodynamically in different phases after cerebrovascular accidents; and as early as two days after stroke. Results: In most cases; the urodynamic findings could be correlated with CT or MRI findings. The most determining factor was the site of the lesion followed by the size. Small lesions were frequently silent unless located in critical sites. It was found that frontal; frontoparietal; parietal; basal ganglia and internal capsular ischemic lesions were associated in most cases with detrusor hyperreflexia; whereas thalamic; pontine and cerebellar infarcts were linked to detrusor hyporeflexia. Multiple lesions within the same group produced the same effect; while mixed lesions produced variable ef-fects. There was no effect of laterality or dominance and an initial shock phase could not be identified. Detrusor-sphincter-dys-synergia (DSD) and hence upper tract deterioration were not observed. The effect of stroke was also modified by already present or predominant conditions such as BPH. Conclusion: Correlating urodynamic and CT findings is very difficult in stroke patients because of the diffuse nature of the lesions; the unknown function of many brain centers in micturition control; the innumerable connections between the different brain regions and the extremely complicated influences that the brain regions exert upon each other and upon the bladder. The optimal understanding of the problem is dependent upon the better understanding of the function of each part of the brain. Further studies in this direction are recommended

Repeated transurethral resection of recurrent superficial bladder tumors--does it affect the spread and stage of the tumor?

OBJECTIVES: This prospective study was done to demonstrate the effect of repeated resection of superficial bladder tumors (TURT) on deep malignant cell infiltration in bladder wall. MATERIAL AND METHODS: Thirty-six patients underwent radical cystectomy for invasive bladder cancer, 16 patients originally had superficial cancer that became invasive after repeated TURT (group I) and the other 20 patients (group II) presented with invasive bladder cancer from the start. Each cystectomy specimen was subjected to a thorough histopathological study. RESULTS: There was a statistically significant difference in pattern of local spread of malignant cells between the two groups. Isolated clusters of malignant cells in-between normal bladder muscle fibers, isolated subserosal malignant deposits as well as cells reaching the adjacent cervix uteri were found only in group I. Intravesical pressure was measured in another 10 patients during TURT and was found to be high reaching up to 80 cm H2O. CONCLUSIONS: We conclude that some malignant cells penetrate through the denuded urothelium during TURT by the effect of high intravesical pressure. This may be responsible, among other factors, for tumor recurrence with deeper stages.

Interaction of diphenyltin(IV) dichloride with some selected bioligands.

The interaction of diphenyltin(IV) with selected bioligands having a variety of model functional groups were investigated using the potentiometric technique. The hydrolysis constants of diphenyltin(IV) cation and the step-wise formation constants of the complexes formed in solution were calculated using the non linear least-squares program MINIQUAD-75. The participation of different ligand functional groups in binding to organotin is discussed. The concentration distribution of the various complex species was evaluated as a function of pH.

Effects of permethrin on the salivary glands and neuroendocrine organs of unfed female Hyalomma (Hyalomma) dromedarii (Ixodoidea: Ixodidae).

Permethrin-impregnated fabric has been shown to be an effective repellent against various tick species. However, some tick species are not repelled by this chemical. In Hyalomma dromedarii (Koch), permethrin exposure is reported to actually enhance the tick's attachment behavior. This study evaluated the histological effects of permethrin exposure on the salivary glands and neuroendocrine organs of unfed, virgin H. dromedarii ticks of uniform age. Three fabric treatments consisting of unwashed-untreated (control), washed after treatment (0.125 mg [AI] / cm2) and unwashed-treated were used after 5- and 10-min exposure times for unfed, unmated females. For all of the organs examined, the cellular structure of treated ticks differed from controls as evidenced by increases in cellular activity, as well as significant increases in the size of the cells of the organs under study (P < 0.05). These data conclusively demonstrate that an unexpected enhanced attachment response observed in this tick species after permethrin exposure is the direct result of increased neurosecretory and salivary gland activity induced by that exposure.

Induction of some digestive enzymes in the midgut of the sandfly Phlebotomus langeroni after sugar and blood meals.

Changes associated with blood and sugar meal digestion in the sandfly, Phlebotomus langeroni were characterized. Different types of sugars: sucrose, glucose, melibiose, cellobiose, lactose, starch, fig fruits, honey dew and a mixture of sucrose and sugar sources were used for the sandfly feeding. Activities of glycosidases and proteases in the sandfly guts after blood and sugar meals were determined using the endpoint method. The results showed that glycosidases (alpha-glycosidase, beta-glycosidase, alpha-galactosidase, and beta-galactosidase) are present in the sandfly midguts. No activities of the glycosidases (alpha-mannosidase and alpha-amylase) were detected in the sandfly gut. Proteases: trypsin and aminopeptidase showed activities in the sandfly midguts. It is concluded that the midgut glycosidase may play an important role in the vector-parasite interaction. Trypsin and aminopeptidase induction after a blood meal is controlled by a secretogogue mechanism which indirectly influences the outcome of the Leishmania parasite infection.

Equilibrium studies of the binary and ternary complexes involving tetracycline and amino acid or DNA constituents.

The acid-base equilibria of tetracycline and its copper(II) complex formation equilibria are investigated in dioxane-water mixtures. The ternary complexes of copper(II) with tetracycline as primary ligand and amino acid or DNA constituent as secondary ligand are studied in 50% dioxane-water solution. The formation constants of the ternary and binary complexes with amino acids or DNA constituents are determined. The concentration distribution of the various complex species are evaluated. Probable mode of chelation with tetracycline and DNA constituents is discussed.

Contact toxicity of permethrin-impregnated fabric to Hyalomma anatolicum excavatum (Acari: Ixodidae): effects of laundering and exposure and recovery times.

A previous study that documented enhanced host attachment by the camel ticks Hyalomma dromedarii Koch after permethrin exposure prompted a similar investigation of permethrin effects in H. anatolicum excavatum Koch, an Old World hardbacked tick suspected of vectoring human pathogens. Contact toxicity tests were conducted with laboratory-colonized male and female H. a. excavatum of the same age exposed for periods of 5, 10, 30, and 60 min to each of 5 fabric treatments: unwashed/untreated; unwashed and treated; and treated fabric given 1, 2, or 3 laundry cycles of warm-water detergent machine washing, followed by hot-air drying. Fabric was tropical weight 100% cotton military uniform. Treated fabric was impregnated with permethrin at 0.125 mg (AI)/cm2. Contact toxicity was measured immediately after and 24 h after fabric contact as proportion of ticks that attached mouthparts to the skin of a host (rabbit) within a 60-min quest period and time lapse (minutes) between contact with the host and attachment. Attachment response immediately after permethrin contact was exposure time- and wash-dependent in both sexes. Proportion of attaching ticks and times to attachment were comparable in controls and in groups exposed to all permethrin-treated fabrics for 5 or 10 min. Contact periods of 30 and 60 min with 0-wash/treated or 1-wash and treated fabric significantly reduced the frequency of attachment and significantly prolonged mean times to attachment. Compared with low levels of attachment response observed immediately after fabric contact, recovery of attachment response was observed 24 h after exposure in these wash/treatment groups, but inhibition was still evident. Permethrin-induced intoxication was more pronounced in males than females. Mortality 24 h after exposure was only significant among females exposed to 0-wash/treated fabric for 60 min. There was no evidence of permethrin-mediated stimulation of the attachment response in H. a. excavatum.

Urodynamic predictors of upper tract deterioration in children with myelodysplasia.

The clinical and urodynamic data of 62 children with myelodysplasia without previous urological treatment were tested statistically for the ability to predict upper tract deterioration. This was done by comparing these data among 26 children with dilated upper tracts and 36 children with normal upper tracts. Vesicoureteric reflux had a strong positive correlation with upper tract dilation but the maximum cystometric capacity, detrusor instability, compliance, maximum urethral closure pressure and peak flow rate all had no predictive value. Residual urine is sensitive and negatively predictive and leak pressure is specific and positively predictive; detrusor pressure at peak flow, opening pressure, pressure at least flow and the detrusor-adjusted mean passive urethral resistance relation factor (DAMPF) are sensitive and specific with high positive and negative predictive values.

Detrusor properties in myelomeningocele patients: in vitro study.

PURPOSE: To characterize detrusor properties of myelomeningocele (MMC) bladders which failed conventional therapy. MATERIALS AND METHODS: Bladder strips from five end-stage MMC patients were compared with those from five patients with vesicoureteric reflux. The active and passive properties of the detrusor muscles and the effect of different blocking agents on the transmural nerve stimulation were studied. RESULTS: A significant decrease in contractility (p = 0.003) and increased rigidity (p = 0.019) was found in MMC group. In the control group, atropine blocked 77.7% of the detrusor contractility and tetrodotoxin demonstrated an equal blocking effect. In MMC group, atropine blocked 58.2% and tetrodotoxin blocked 77.4% of the detrusor contractility. CONCLUSION: MMC bladders showed decreased contractility and increased rigidity. In MMC group, the atropine-resistant component which is blocked by tetrodotoxin signifies the possible existence of non-adrenergic, non-cholinergic neurotransmitters (NANC). Further studies are needed to possibly improve the pharmacological therapy of the myelomeningocele detrusor.

Equilibrium studies of organotin(IV) complexes with vitamin B(6).

The complex-formation equilibria of dimethyltin(IV), trimethyltin(IV) and tributyltin(IV) with pyridoxamine were investigated in dioxane-water mixtures and at different temperatures using a potentiometric technique. The stepwise formation constants of the complexes formed in solution were calculated using the non-linear least-square program MINIQUAD-75. The effect of dioxane as a solvent on the protonation constants of pyridoxamine and the formation constants of organotin(IV) complexes was discussed. The thermodynamic parameters DeltaH degrees and DeltaS degrees calculated from the temperature dependence of the equilibrium constants were investigated. The concentration distribution of the various complex species was evaluated as a function of pH.

Urethral needle suspension for male urinary incontinence.

A rectus fascia sling was used to suspend the bulbous urethra in 12 males with total sphincteric incontinence. Incontinence was related to prostatectomy in 3 patients, to spinal trauma in 3, and to myelodysplasia in 6 patients. In 3 patients augmentation ileocystoplasty was added to the procedure because of reduced bladder capacity and compliance. Needle suspension of the sling simplified the procedure and obviated difficult retroprostatic dissection. After an average of 13 months 10 out of 11 patients were totally dry, 2 of these are voiding spontaneously with little residual while the rest are on intermittent catheterization. One patient is still wet because of severe postoperative detrusor instability. Urethral erosion occurred in one patient in whom the sling was removed. No upper tract deterioration was found until the last follow-up. In conclusion, a rectus fascia sling is a readily available alternative to the artificial urinary sphincter with comparable success and less reoperation rates. Needle suspension of the sling simplified its application in male patients.

A telemetric multichannel computer-based system for monitoring urodynamic parameters in awake rhesus monkeys.

For comprehensive telemetric monitoring of bladder function in monkeys, transducers were implanted in the bladder wall and abdominal cavity. The EMG lead was buried in the external sphincter. All wires terminated in a subcutaneous transmitter. Conventional urodynamics were performed for comparison. Excellent reproducibility with conventional urodynamics was found. Implantation caused detrusor instability, which subsided in 6 to 8 weeks. Real-time computer-based multichannel telemetric studies of voiding are feasible and reliable. Telemetric studies monitor for long periods without stress or anesthesia and provide an excellent model for lower urinary tract studies.