Grade of hypospadias is the only factor predicting for re-intervention after primary hypospadias repair: a multivariate analysis from a cohort of 474 patients.

PubMed

Spinoit, Anne-Françoise; Poelaert, Filip; Van Praet, Charles; Groen, Luitzen-Albert; Van Laecke, Erik; Hoebeke, Piet

2015-04-01

There is an ongoing quest on how to minimize complications in hypospadias surgery. There is however a lack of high-quality data on the following parameters that might influence the outcome of primary hypospadias repair: age at initial surgery, the type of suture material, the initial technique, and the type of hypospadias. The objective of this study was to identify independent predictors for re-intervention in primary hypospadias repair. We retrospectively analyzed our database of 474 children undergoing primary hypospadias surgery. Univariate and multivariate logistic regression was performed to identify variables associated with re-intervention. A p-value <0.05 was considered statistically significant and therefore considered as a prognostic factor for re-intervention. Distal penile hypospadias was reported in 77.2% (n = 366), midpenile in 11.4% (n = 54) and proximal in 11.4% (n = 54) of children. Initial repair was based on an incised plate technique in 39.9% (n = 189), meatal advancement in 36.0% (n = 171), an onlay flap in 17.3% (n = 82) and other or combined techniques in 5.3% (n = 25). In 114 patients (24.1%) re-intervention was required (n = 114) of which 54 re-interventions (47.4%) were performed within the first year post-surgery, 17 (14.9%) in the second year and 43 (37.7%) later than 2 years after initial surgery. The reason for the first re-intervention was fistula in 52 patients (46.4%), meatal stenosis in 32 (28.6%), cosmesis in 35 (31.3%) and other in 14 (12.5%). The median time for re-intervention was 14 months after surgery [range 0-114]. Significant predictors for re-intervention on univariate logistic regression (polyglactin suture material versus poliglecaprone, proximal hypospadias, lower age at operation and other than meatal advancement repair) were put in a multivariate logistic regression model. Of all significant variables, only proximal hypospadias remained an independent predictor for re-intervention (OR 3.27; p = 0.012). The grade of hypospadias remains according to our retrospective analysis the only objective independent predicting factor for re-intervention in hypospadias surgery. This finding is rather obvious for everyone operating hypospadias. Curiously midpenile hypospadias cases were doing slightly better than distal hypospadias in terms of re-intervention rates. Our study however has also some shortcomings. First of all, data was gathered retrospectively and follow-up time was ill-balanced for several variables. We tried to correct this by applying sensitivity analysis, but possible associations between some variables and re-intervention might still be obscured by this. Standard questionnaires to analyze surgical outcome were not available. Therefore, we focused our analysis on re-intervention rate as this is a hard and clinically relevant end point. This retrospective analysis of a large hypospadias database with long-term follow-up indicates that the long-lasting debate about factors influencing the reoperation rate in hypospadias surgery might be futile: in experienced hands, the only variable that independently predicts for re-intervention is the severity of hypospadias, the only factor we cannot modify. This retrospective multivariate analysis of a large hypospadias database with long-term follow-up suggests that the only significant independent predictive factor for re-intervention is proximal hypospadias. In our series, technique did not influence the re-intervention rate. Copyright © 2015 Journal of Pediatric Urology Company. Published by Elsevier Ltd. All rights reserved.

Technical refinements to improve outcomes following distal hypospadias repair.

PubMed

Lacy, John M; Hendrix, Lauren N; Bole, Raevti; Habib, Enmar; Wootton, Cole W; Ziada, Ali M

2016-02-01

Hypospadias complications, most notably meatal stenosis, are commonly reported to occur after tubularized incised plate (TIP) hypospadias repair. We focus on a point of technique in TIP repair and its effect on outcome of this possible complication, as well as other commonly reported complications. Meatal stenosis after TIP can be avoided if the urethra and overlying glans are dissected and sutured separately with no attempt at cross suturing whether the urethra ends below, behind, or above the glans sutures. This hypothesis was evaluated by a prospective data collection before and after implementation to evaluate the effect of a technical refinement on rates of meatal stenosis in TIP hypospadias repair. All cases of coronal to midpenile hypospadias repair during two periods were included in our study. Group 1 included 140 consecutive patients over a 30 month period. Group 2 included 122 consecutive patients over a 36 month period during which the above mentioned technical changes were implemented by all participating pediatric urologists. Rates of complications between the two groups were compared with special emphasis on meatal stenosis. Median follow up for both groups was > 1 year. Overall complication rate in Group 1 was 31.5% compared to 9.8% in Group 2. Meatal stenosis was significantly reduced from 13 patients (9.3%) in Group 1 to 2 patients (1.6%) in Group 2, p = 0.008. The technical refinements described resulted in reduction of complication rates and a decrease in incidence of meatal stenosis.

Factors associated with reoperation in hypospadias surgery - A nationwide, population-based study.

PubMed

Lu, Yu-Chuan; Huang, Wei-Yi; Chen, Yu-Fen; Chang, Hong-Chiang; Pong, Yuan-Hung; Shih, Tsung-Hsien; Huang, Kuo-How

2017-04-01

To analyze the preoperative factors associated with the need for secondary surgery following primary urethroplasty. This study utilized a subset of the National Health Insurance Research Database, which includes the data on all paid medical benefit claims from 1997 to 2007, for 1 million beneficiaries in 2005. We analyzed the claims data for all patients with hypospadias who had undergone primary urethroplasty. The characteristics of the patients, surgeons, and hospitals associated with surgical outcomes were analyzed to investigate possible associations with the need for secondary surgery. Among 52,705 live male newborn babies, 218 were diagnosed with hypospadias, of whom 89 received repair surgery. A total of 75 (84.3%) male newborn babies received single hypospadias surgery, and 14 (15.7%) underwent more than two surgical procedures. Univariate analysis demonstrated that the type of hypospadias and the surgeon caseload volume were significantly associated with the need for additional hypospadias surgery (p = 0.02 and p = 0.03, respectively). In multivariate analysis, the type of hypospadias (distal vs. proximal, odds ratio, 0.25; p = 0.03) and the surgeon caseload volume (high vs. low, odds ratio, 0.04; p = 0.05) were significantly correlated with secondary operation. The type of hypospadias and the surgeon caseload volume were significantly associated with the need for secondary hypospadias surgery. The findings of this study provide important information on the outcomes of hypospadias repair for parents and specialists. Copyright © 2017. Published by Elsevier Taiwan.

Meatal Mobilization and Glanuloplasty: A Viable Option for Coronal and Glanular Hypospadias Repair.

PubMed

Moradi, Mahmoudreza; Kazemzadeh, Babak; Hood, Brandy; Rezaee, Haress; Kaseb, Kaveh

2016-08-01

To present the meatal mobilization with glanuloplasty inclusive (MMGPI) modification of meatal advancement and glanuloplasty inclusive. A total of 120 patients with anterior hypospadias underwent MMGPI between September 2008 and October 2014 at Kermanshah University of Medical Sciences. Satisfactory outcomes were defined as continuous straight urinary flow and catheterization of new meatus without difficulty. Cosmetic outcomes were considered acceptable if patients maintained a slit-like meatus at the glanular tip. Patients were examined at 1 week, 1, 3, 6, 12, and 24 months. The 120 patients with anterior hypospadias underwent MMGPI. There were no hematoma, meatal necrosis, or other early complications. In patients with glanular hypospadias, there were no meatal regressions or stenosis, all voiding patterns were normal, and all patients maintained a slit-like meatus at the glanular tip. Two patients with coronal hypospadias had meatal stenosis and 2 patients had meatal regression. Five patients with sub-coronal hypospadias had 2-mm meatal regression with downward sloping urinary stream, and 2 patients had meatal stenosis. In all, meatus remained distal to the preoperative meatus with no necrosis. Small sample size was the major limitation of this study. MMGPI represents a viable option for glanular and coronal hypospadias repair. Copyright © 2016 Elsevier Inc. All rights reserved.

Hypospadias, all there is to know.

PubMed

van der Horst, H J R; de Wall, L L

2017-04-01

Hypospadias is one of the most common congenital anomalies in men. The condition is typically characterized by proximal displacement of the urethral opening, penile curvature, and a ventrally deficient hooded foreskin. In about 70%, the urethral meatus is located distally on the penile shaft; this is considered a mild form that is not associated with other urogenital deformities. The remaining 30% are proximal and often more complex. In these cases, endocrinological evaluation is advised to exclude disorders of sexual differentiation, especially in case of concomitant unilateral or bilateral undescended testis. Although the etiology of hypospadias is largely unknown, many hypotheses exist about genetic predisposition and hormonal influences. The goal of hypospadias repair is to achieve cosmetic and functional normality, and currently, surgery is recommended between 6 and 18 months of age. Hypospadias can be corrected at any age with comparable complication risk, functional, and cosmetic outcome; however, the optimal age of repair remains conclusive. Although long-term overall outcome concerning cosmetic appearance and sexual function is fairly good, after correction, men may more often be inhibited in seeking sexual contact. Moreover, lower urinary tract symptoms occur twice as often in patients undergoing hypospadias repair and can still occur many years after the initial repair. This study explores the most recent insights into the management of hypospadias. What is Known: • Guidelines advise referral for treatment between 6 and 18 months of age. • Cosmetic outcome is considered satisfactory in over 70% of all patients. What is New: • Long-term complications include urinary tract symptoms and sexual and cosmetic issues. • New developments allow a more individualized approach, hopefully leading to less complications and more patient satisfaction.

Re-operative urethroplasty after failed hypospadias repair: how prior surgery impacts risk for additional complications.

PubMed

Snodgrass, W; Bush, N C

2017-06-01

The primary aim of this report was to compare urethroplasty complications for primary distal and proximal repairs with those after 1, 2, 3, and 4 or more re-operations. Prospectively collected data on consecutive hypospadias repairs (tubularized incised plate (TIP), inlay, two-stage graft) from 2000 to 2015 were reviewed. Isolated fistula closures were excluded. Extracted information included patient age, meatal location, repair type, primary vs. re-operative surgery, number of prior operations, any testosterone use, glans width, and urethroplasty complications. Pre-operative testosterone stimulation was used during the study period until 2012. Initially, it was given for a subjectively small-appearing glans, but from 2008 to 2012 use was determined by glans width <14 mm. Patients initially managed elsewhere were queried for any testosterone treatment. The number of prior operations was determined by patient history and confirmed by review of records. Calibrations, dilations, cystoscopies, and/or isolated skin revisions were not considered as prior urethroplasty operations. Multiple logistic regression was performed for all patients, and for the subset of patients undergoing re-operation, using stepwise regression for the following potential risk factors: meatal location (distal vs. midshaft/proximal), number of prior surgeries (0, 1, 2, 3, ≥4), pre-operative testosterone use (yes/no), small glans (<14 vs. ≥14), surgery type (TIP, inlay and two-stage graft), and age (continuous in months), with P-values <0.05 considered statistically significant. In contrast to the 135/1085 (12%) complication rate in patients undergoing primary distal and proximal TIP repair, re-operative urethroplasty complications occurred in 61/191 (32%) TIP, 16/46 (35%) inlay, and 49/124 (40%) two-stage repairs, P<0.0001. Data regarding testosterone use was available for 1490 (96%) patients. A total of 139 received therapy, of which 65 (46%) had urethroplasty complications vs. 229 of 1351 (16%) without treatment, P = 0.0001. Logistic regression in 1536 patients demonstrated that each prior surgery increased the odds of subsequent urethroplasty complications 1.5-fold (OR 1.51, 95% CI 1.25-1.83), along with small glans <14 mm (OR 2.40, 95% CI 1.48-3.87), mid/proximal meatal location (OR 2.54, 95% CI 1.65-3.92), and use of pre-operative testosterone (OR 2.57, 95% CI 1.53-4.31); age and surgery type did not increase odds (AUC = 0.739). Urethroplasty complications doubled in people undergoing a second hypospadias urethroplasty compared with those undergoing primary repair. This risk increased to 40% with three or more re-operations. Logistic regression demonstrates that each surgery increases the odds for additional complications 1.5-fold. Mid/proximal meatal location, small glans <14 mm, and use of pre-operative testosterone also significantly increase odds for complications. These observations support the theory that previously operated tissues have less robust vascularity than assumed in a primary repair, and suggest additional adjunctive therapies are needed to improve wound healing in re-operations. The finding that even a single re-operative urethroplasty has twice the risk for additional complications vs. a primary repair emphasizes the need for hypospadias surgeons to 'get it right the first time'. The fact that 40% of the re-operative urethroplasties in this series followed distal repairs emphasizes that there is no 'minor' hypospadias. A single re-operative hypospadias urethroplasty has twice the risk for additional complications vs. the primary repair, which increases to 40% with three or more re-operations. These results support a theory that vascularity of penile tissues decreases with successive operations, and suggest the need for treatments to improve vascularity. The higher risk for complications during re-operative urethroplasties also emphasizes the need to get the initial repair correct. Copyright © 2016 Journal of Pediatric Urology Company. Published by Elsevier Ltd. All rights reserved.

Appraisal of adult genitalia after hypospadias repair: Do laypersons mind the difference?

PubMed

Ruppen-Greeff, Norma K; Landolt, Markus A; Gobet, Rita; Weber, Daniel M

2016-02-01

Men with corrected hypospadias often suffer from sexual inhibition and fear of being ridiculed by others because of their penile appearance. However, no investigation has thus far been made of the perception of hypospadias-affected surgically repaired genitals by laypersons unacquainted with hypospadias. Therefore, the aim of this study was to find out whether laypersons notice a difference between genitals of men with corrected hypospadias in comparison with circumcised genitals. Furthermore, the most relevant predictors of laypersons' perception of hypospadias-affected genitals were examined. A cross-sectional study was performed in which a questionnaire with 10 standardized photographs of non-erect hypospadias-affected genitals and 10 circumcised genitals was presented to laypersons unacquainted with hypospadias to measure how they rated these genitals. Laypersons were 105 women and 70 men of three different age groups (age ranges 16-20, 25-30, and 40-45 years). Furthermore, laypersons were asked about demographic characteristics, their sexuality and their genital self-perception. The results showed that genitals with distal forms of hypospadias were rated similarly to circumcised genitals. In contrast, genitals with more proximal types were perceived as significantly less positive than circumcised genitals. However, the effect size was small. Higher age, being in an intimate relationship, higher socio-economic status, and a higher sexual interest predicted a better layperson's perception of hypospadias-affected genitals. These findings do not support the fear of some men with corrected hypospadias of being ridiculed by others because of their penile appearance. The results indicate that laypersons do not notice a difference between corrected distal types of hypospadias (which represent the majority of hypospadias) and circumcised genitals. Although the findings showed that laypersons perceive more proximal forms of hypospadias less positively than circumcised genitals, the difference does not appear to be clinically relevant as the effect size was small. A major strength of this study is its comprehensive study design. However, the low response rate of hypospadias patients and control individuals for photo documentation and of laypersons who rated these photosets is a limitation of the study. Therefore, generalization from the results must be made carefully. The results are relevant for patient counseling. Knowing that the penile appearance would not trouble laypersons may prevent the development of a negative genital self-perception and feelings of shame. The findings also suggest that hypospadias-affected genitals seem to be rated more positively when laypersons know more about the "normal" variation of penile appearance (e.g. with increasing sexual experience at a higher age). Copyright © 2015 Journal of Pediatric Urology Company. Published by Elsevier Ltd. All rights reserved.

Hypospadias repair: Byar's two stage operation revisited.

PubMed

Arshad, A R

2005-06-01

Hypospadias is a congenital deformity characterised by an abnormally located urethral opening, that could occur anywhere proximal to its normal location on the ventral surface of glans penis to the perineum. Many operations had been described for the management of this deformity. One hundred and fifteen patients with hypospadias were treated at the Department of Plastic Surgery, Hospital Kuala Lumpur, Malaysia between September 1987 and December 2002, of which 100 had Byar's procedure performed on them. The age of the patients ranged from neonates to 26 years old. Sixty-seven patients had penoscrotal (58%), 20 had proximal penile (18%), 13 had distal penile (11%) and 15 had subcoronal hypospadias (13%). Operations performed were Byar's two-staged (100), Bracka's two-staged (11), flip-flap (2) and MAGPI operation (2). The most common complication encountered following hypospadias surgery was urethral fistula at a rate of 18%. There is a higher incidence of proximal hypospadias in the Malaysian community. Byar's procedure is a very versatile technique and can be used for all types of hypospadias. Fistula rate is 18% in this series.

Two-stage repair with long channel technique for primary severe hypospadias.

PubMed

Yang, Tianyou; Xie, Qigen; Liang, Qifeng; Xu, Yeqing; Su, Cheng

2014-07-01

To introduce a 2-stage repair with long channel technique for primary severe hypospadias. Between March 2010 and November 2013, 16 children with primary severe hypospadias underwent 2-stage repair with long channel technique. The technique applied in the first stage was almost the same as Bracka 2-stage repair. The second stage was usually performed 6 months later. A small transverse skin incision, distal to the meatal opening and about 1 cm in length, was made. Dissection was carried out deep into the surface of corpora cavernosa and a plane between the subcutaneous tissue and corpora cavernosa was reached. A long channel between the subcutaneous tissue and corpora cavernosa was created from the para-meatus incision to the apex of glans. A rectangle, pedicle scrotal septal skin flap was elevated and tubularized into neourethra around a stenting tube. The neourethra was delivered through the subcutaneous channel and fixed at the apex of glans. The mean operation time of the first and second stages was 65 and 55 minutes, respectively. The mean age at the first and second operation was 28 and 36 months, respectively. The mean follow-up was 10 months. No fistula, glans dehiscence, urethral stricture, and meatal stenosis were recorded. One scrotal surgical wound infection occurred after second stage and healed successfully with antibiotics treatment. The overall cosmetic and functional outcomes after second stage were excellent. Two-stage repair with long channel technique was applicable for primary severe hypospadias, with excellent short-term outcomes. Copyright © 2014 Elsevier Inc. All rights reserved.

Glans size is an independent risk factor for urethroplasty complications after hypospadias repair.

PubMed

Bush, Nicol C; Villanueva, Carlos; Snodgrass, Warren

2015-12-01

We hypothesized small glans size could increase urethroplasty complications (UC) following hypospadias repair. To test this, we measured glans width at its widest point in consecutive patients with hypospadias, and following a protocol for surgical decision-making, we then assessed post-operative UC using pre-determined definitions. We now report analysis of glans size as a potential additional independent risk factor for UC after hypospadias repair. Consecutive prepubertal patients undergoing hypospadias repair (2009-2013) had maximum glans width measured using calipers (Fig. 1). There were no differences in surgical technique for urethroplasty or glansplasty in this series based on the measured size of the glans. Multivariate logistic regression analyzed UC (fistula, glans dehiscence, diverticulum, stricture and/or meatal stenosis) based on glans size while adjusting for patient age, meatus (distal or midshaft/proximal), type of repair (TIP, inlay, 2-stage), surgeon, and primary or reoperative repair. Glans size was analyzed as both a continuous and dichotomous variable, with small glans defined as <14 mm. Mean glans size was 15 mm (10-27 mm) in 490 boys (mean 1.5 years) undergoing 432 primary repairs (380d/19mid/33prox), and 58 reoperations (28d/7mid/23prox). Increasing age between 3 months and 10 years did not correlate with increasing glans size (R = 0.01, p = 0.18). 17% had small glans <14 mm. UC occurred in 61 (13%) primary TIP, 2-stage, and reoperative repairs, including 20/81 (25%) patients with small glans <14 mm, versus 41/409 (10%) in patients with glans width ≥14 mm (p = 0.0003). On multivariate analysis, small glans size (OR 3.5, 95% CI 1.8-6.8), reoperations (OR 3.0, 95% CI 1.4-6.5) and mid/proximal meatus (OR 3.1, 95% CI 1.6-6.2) were independent risk factors for UC. Surgeon, repair type, and patient age did not impact risk for UC. Analysis with glans size as a continuous variable demonstrated each 1 mm increase in size decreased odds of UC (OR 0.8, 95% CI 0.7-0.9). Our analysis of prospectively-collected data from a standardized management protocol in 490 consecutive boys undergoing hypospadias repair adds small glans size, defined as width <14 mm, to proximal meatal location and reoperation as an independent risk factor for UC. Best means to modify this factor remain to be determined. Our data suggest that others analyzing potential risks for hypospadias UC should similarly measure and report glans width. Copyright © 2015 Journal of Pediatric Urology Company. Published by Elsevier Ltd. All rights reserved.

Tubularized proximally-incised plate in distal/midshaft hypospadias repair.

PubMed

Marte, Antonio; Pintozzi, Lucia

2017-06-23

The aim of this study was to verify the validity, feasibility, and the functional results, by uroflowmetry, of Tubularized proximallyincised plate technique in selected case of distal/midshaft hypospadias. Out of 120 patients scheduled to undergo TIP (or Snodgrass) procedure, 23 were selected between January 2013 and January 2016 (19.1%). This case series comprised 16 patients with distal and 7 with midshaft hypospadias. Mean age at surgery was 2.9 years. The inclusion criteria were a deep and wide glandular groove and a proximal narrow urethral plate. The procedure was carried out as described by Snodgrass but the incision of the urethral plate, including the mucosal and submucosal tissue, was made only proximally, between the original meatus and the glandular groove in no case extending to the entire length of the plate. Postoperatively a foley catheter was left in place from 4 to 7 days. Uroflowmetry was performed when the patients age ranged from 2.5 to 5.7 years (mean age 3.11 years and mean follow-up 1.8 years, body surface 2). No patient presented fistulas nor perioperative complications. At uroflowmetry, eighteen patients presented values above the 25th percentile and 5 showed a borderline flow. All patients in this group remained stable without urinary symptoms. In selected cases, the tubularized proximally-incised plate yields satisfactory cosmetic and functional results for the treatment of midshaft proximal hypospadias. A long-term follow-up study is needed for further evaluation. Patient selection is crucial for the success of this technique.

Hypospadias repair with the glanular-frenular collar (GFC) technique.

PubMed

Özbey, Hüseyin; Etker, Şeref

2017-02-01

In the normal human penis, the glans wings merge in the midline ventrally, but are separated by the 'septum glandis' in conjunction with the frenulum. The frenulum is also included in the formation of the distal (glanular and subcoronal) urethra, which has a special part known as the 'fossa navicularis'. This has inspired a hypospadias repair technique that simulates the development of the glanular and subcoronal urethra, which can be incorporated into the repair of all cases of hypospadias. A total of 121 patients with varying degrees of hypospadias underwent surgery with the described technique: a Y-V plasty was used to dissect the inner foreskin, in a fashion that allowed for its ventral mobilization as a frenular mucosal collar. After tubularization of the proximal urethra, a partial spongioplasty was performed that extended up to the subcoronal level. The glans wings were approximated only at their outermost convexities, with a couple of subepithelial sutures, leaving a slit for the meatus. The cleft-like area between the split wings of the glans penis was filled with the terminal ends of the spongiosum and the dartos of the mucosal collar, which converged to form a septum and a neo-frenulum (glanular-frenular collar, GFC). The midline skin closure of the ventral collar and the circumferential foreskin closure was completed as usual. At a mean follow-up of 10 months, two patients developed urethral fistula (2%), six had meatal stenosis (5%), and two had glans dehiscence (2%) that resulted in meatal retraction. Overall, patients had a cosmetically satisfying appearance (Figure). Forty-one received secondary circumcision; the parents of 80 (66%) patients were satisfied with the final foreskin appearance obtained with this method. The split wings of the glans penis or so-called ventral cleft between the glans wings that accommodate the frenulum is part of normal anatomy. Hence, in hypospadias surgery, the approximated glans wings should allow for ventral support of the glanular and subcoronal urethra through a reconstructed neo-frenulum. Neither glanular surface enhancement nor extensive dissection of the glans wings and their full-length approximation are necessary, and may in fact be counter-productive. The employment of a GFC provided: 1) an anatomical restoration of the distal (glanular and subcoronal) urethra, supported by a frenulum; 2) a protective (undissected) dartos layer over the distal part of the tubularized neourethra; and 3) a space for the re-formation of the fossa navicularis. Copyright © 2016 Journal of Pediatric Urology Company. Published by Elsevier Ltd. All rights reserved.

What is a Good Looking Penis? How Women Rate the Penile Appearance of Men with Surgically Corrected Hypospadias.

PubMed

Ruppen-Greeff, Norma Katharina; Weber, Daniel M; Gobet, Rita; Landolt, Markus A

2015-08-01

Some men with corrected hypospadias perceive their penile appearance to be abnormal, although health professionals consider these results satisfactory. The aim of this study was to investigate how relevant women consider single aspects of penile appearance to be. Moreover, we studied whether women perceive hypospadias-affected surgically repaired genitals (HASRGs) to be as normal-looking as circumcised genitals and identified the most relevant predictors that influence whether a penis is perceived as normal. In this cross-sectional study, 105 women in different age groups (age range: 16-20, 25-30, and 40-45 years) completed a standardized questionnaire. Participants had to rate the importance of eight penile aspects and to indicate how normal they found the appearance of standardized photos of 10 HASRGs and of 10 circumcised genitals. Furthermore, they were asked about demographic characteristics and their sexuality. Results showed that women considered the position and shape of the meatus as the least important penile aspect. Furthermore, results showed that HASRGs with distal hypospadias were perceived to be as normal-looking as circumcised genitals, whereas genitals with more proximal hypospadias were perceived as significantly less normal. However, the difference need not be considered clinically relevant, as the effect size was small. Observer-related predictors of a more positive perception of HASRGs were higher age, higher sexual interest, and perceiving the general cosmetic penile appearance as more important and penile length as less important. Overall, women were found to consider the "position and shape of the meatus" as the least important penile aspect. These findings may stimulate reflections regarding the relevance of surgical correction of the meatus in minor forms of hypospadias. In addition, this study indicates that women perceived genitals of men with distal operated hypospadias (which represents the majority of hypospadias) to be as normal as nonaffected, circumcised genitals. © 2015 International Society for Sexual Medicine.

Urinary, sexual, and cosmetic results after puberty in hypospadias repair: current results and trends.

PubMed

Rynja, Sybren P; de Kort, Laetitia M O; de Jong, Tom P V M

2012-11-01

To give an overview of the recently published long-term outcomes of hypospadias surgery performed at childhood, of patients who have had multiple previous repairs, and results of surgery done to treat late complications following hypospadias repair. Urethral function after hypospadias repair is good, but cosmesis based on the patients' opinion, on the long term, was disappointing. Also erectile function was reported to be good, although persisting curvature and ejaculation disorders were mentioned, more evidently in patients with proximal hypospadias. Long-term results using buccal mucosa repairs in hypospadias cripples are good, but the use of tissue expanders may be a good alternative. Late complications of hypospadias repair, such as urethral strictures, are difficult to treat, and have a high failure rate compared to urethroplasty for other reasons. Functional results of hypospadias repair are generally satisfactory in the long term, although improvement must be pursued. Most adult men with a history of hypospadias present themselves with urinary tract symptoms. Cosmesis judged by patients remains rather poor in the long run and better techniques should be found. Preferably, assessment of long-term results should be done by validated test methods for better comparison.

Voiding patterns of adult patients who underwent hypospadias repair in childhood.

PubMed

Jaber, Jawdat; Kocherov, Stanislav; Chertin, Leonid; Farkas, Amicur; Chertin, Boris

2017-02-01

This study aimed at evaluating the voiding patterns of adult patients who underwent hypospadias repair in childhood. Following IRB approval 103 (22.7%) of 449 adult patients who underwent hypospadias repair between 1978 and 1993 responded to the following questionnaires: International Prostate Symptom Score (I-PSS) and Short Form 12 questionnaire (SF-12). Uroflowmetry (UF) was performed for all patients. The patients were divided into three groups according to the primary meatus localization. Group I had 63 patients (61.5%) treated for glanular hypospadias, group II had 19 patients (18.4%) treated for distal hypospadias, and group III comprised the remaining 21 patients (20.4%) treated for proximal hypospadias. The mean ± SD I-PSS score for all patients who responded to the questionnaire was 2.3 ± 2.4, and UF was 21.1 ± 4.3 mL/s. The patients from groups I and III had fewer urinary symptoms compared with those of the group II: 1.3 ± 1.5, 5.5 ± 2.4, and 1.6 ± 1.4, respectively (p < 0.0001). With regards to UF, the patients from the groups I and III did better compared with those from the group II: 22.1 ± 4.1 mL/s, 18.91 ± 4.2 mL/s, and 20.11 ± 3.42 mL/s, respectively (p = 0.021) (Figure). The UF was better in patients with normal vs. abnormal IPSS (p = 0.0064). The physical component summary was 49.8 ± 10.3, 51.1 ± 3.6, and 46.4 ± 0.3 in groups I, II, and III, respectively. The mental summary component was 42.64 ± 4.1, 42.2 ± 2.4, and 39.89 ± 2.9 in groups I, II, and III, respectively. Most of the adult patients who underwent hypospadias repair in childhood had normal or mild voiding disturbance, with no effects on their physical or mental status. Copyright © 2016 Journal of Pediatric Urology Company. Published by Elsevier Ltd. All rights reserved.

Hypospadias repair - discharge

MedlinePlus

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Assessment of postoperative outcomes of hypospadias repair with validated questionnaires.

PubMed

Liu, Mona M Y; Holland, Andrew J A; Cass, Danny T

2015-12-01

A standardized assessment for the optimal repair of hypospadias remains elusive. This study utilized validated questionnaires to assess the postoperative functional, cosmetic, and psychosocial outcomes of hypospadias repair. 172 patients who underwent hypospadias repair under the care of a single surgeon were identified. 25 agreed for follow-up using the validated questionnaires of Hypospadias Objective Scoring Evaluation (HOSE), Pediatric Penile Perception Scale (PPPS), and Pediatric Quality of Life Inventory (PedsQL™4.0). Mean follow-up was 59months postoperatively (range 7-113months). Techniques used included tubularized incised plate urethroplasty, meatal advancement and glanuloplasty, and a 2-stage repair. 23 of 25 patients achieved a HOSE score of 14 or more (maximum of 16). The PPPS scores correlated with severity of the hypospadias. Those with glanular hypospadias (mean score=10) scored higher than those with coronal (mean score=9) and penile/penoscrotal hypospadias (mean score=7). There was no correlation between PedsQL™4.0 scores and the severity of hypospadias or procedure used. Validated questionnaires revealed generally good functional, cosmetic, and early psychosocial outcomes after hypospadias repair. The use of validated questionnaires in routine follow-up sessions may facilitate objective assessment of both functional outcomes and patient satisfaction. Copyright © 2015 Elsevier Inc. All rights reserved.

A prospective randomized clinical trial to evaluate methods of postoperative care of hypospadias.

PubMed

McLorie, G; Joyner, B; Herz, D; McCallum, J; Bagli, D; Merguerian, P; Khoury, A

2001-05-01

Hypospadias repair is a common operation performed by pediatric urologists. Perhaps the greatest variable and source of controversy of postoperative care is the surgical dressing. We hypothesized that using no dressing would achieve surgically comparable results to those traditionally achieved by a postoperative dressing and it would also simplify postoperative parent delivered home care. Accordingly we designed a prospective randomized clinical trial to compare surgical outcome and postoperative care after hypospadias repair in boys with no dressing and those who received 1 of the 2 most common types of dressing. In a 12-month period 120 boys with an average age of 2.2 years underwent primary 1-stage hypospadias repair at a single center with 4 participating surgeons. Repair was performed in 60 boys with proximal and 60 with distal hypospadias on an outpatient basis. Ethics and Internal Review Board approval, and informed consent were obtained. Boys were then prospectively randomized to receive no dressing, an adhesive biomembrane dressing or a compressive wrap dressing. Comprehensive instructions on postoperative care were distributed to all families and a questionnaire was distributed to the parents at the initial followup. Surgical outcome was evaluated and questionnaire responses were analyzed. Fisher's exact test was done to test the significance of differences in surgical outcomes and questionnaire responses. A total of 117 boys completed the prospective randomized trial. Surgical staff withdrew 3 cases from randomized selection to place a dressing for postoperative hemostasis. We obtained 101 questionnaires for response analysis. The type or absence of the dressing did not correlate with the need for repeat procedures, urethrocutaneous fistula, or meatal stenosis or regression. Analysis revealed less narcotic use in the no dressing group and fewer telephone calls to the urology nurse, or on-call resident and/or fellow. These findings were statistically significant. In addition, there were more unscheduled visits to the urology clinic, emergency room or primary physician office by boys with than without a dressing. Furthermore, 29% of the parents were not psychologically prepared to remove the dressing and 12% were so reluctant that the dressing was removed at the urology outpatient clinic. The surgical outcome and rate of adverse events or complications were not compromised without a postoperative dressing. An absent dressing simplified postoperative ambulatory parent delivered home care. We recommend that dressings should be omitted from routine use after hypospadias repair.

Management of Urethral Strictures After Hypospadias Repair.

PubMed

Snodgrass, Warren T; Bush, Nicol C

2017-02-01

Strictures of the neourethra after hypospadias surgery are more common after skin flap repairs than urethral plate or neo-plate tubularizations. The diagnosis of stricture after hypospadias repair is suspected based on symptoms of stranguria, urinary retention, and/or urinary tract infection. It is confirmed by urethroscopy during anticipated repair, without preoperative urethrography. The most common repairs for neourethra stricture after hypospadias surgery are single-stage dorsal inlay graft and 2-stage labial mucosa replacement urethroplasty. Copyright © 2016 Elsevier Inc. All rights reserved.

Transverse preputial onlay island flap urethroplasty for single-stage correction of proximal hypospadias.

PubMed

Singal, Arbinder Kumar; Dubey, Manish; Jain, Viral

2016-07-01

Transverse preputial onlay island flap urethroplasty (TPOIF) was described initially for distal hypospadias, but has seen extended application for proximal hypospadias. We describe a set of modifications in the technique and results in a large series of proximal hypospadias. All children who underwent TPOIF repair for proximal hypospadias (proximal penile, penoscrotal and scrotal) from June 2006 to June 2013 by a single surgeon were prospectively followed till June, 2014. A standard technique and postoperative protocol were followed. Salient points to be emphasized in the technique: (1) dissection of the dartos pedicle till penopubic junction to prevent penile torsion, (2) incorporation of the spongiosum in the urethroplasty, (3) midline urethral plate incision in glans (hinging the plate), (4) Dartos blanket cover on whole urethroplasty. Out of 136 children with proximal hypospadias, 92 children who underwent TPOIF formed the study group. Out of 92 children, 48 (52 %) children required a tunica albuginea plication for chordee correction. In total, 16 (17 %) patients developed 24 complications and 11 children (12 %) required second surgeries: fistula closure in 7 (with meatoplasty in 5), glansplasty for glans dehiscence in 2 and excision of diverticulum in 2. Two children required a third surgery. Only 5 children had a noticeable penile torsion (less than 30 degree), and 7 had a patulous meatus. Transverse preputial onlay island flap urethroplasty can deliver reliable cosmetic and functional outcomes in proximal hypospadias.

The effect of parenteral testosterone administration prior to hypospadias surgery: A prospective, randomized and controlled study.

PubMed

Asgari, S A; Safarinejad, M R; Poorreza, F; Asl, A Safaei; Ghanaie, M Mansour; Shahab, E

2015-06-01

The goal of hypospadias surgery is to provide a functionally and cosmetically normal penis. Whether this goal will be to the patient's satisfaction depends largely on the original anatomy, surgical technique and surgeon's experience. It has been suggested that androgen administration is associated with better outcomes in hypospadias repair; however, few studies have included control groups and the issue is still controversial. To evaluate the effects of parenteral testosterone administration on the results of hypospadias repair in children with untreated hypospadias. A total of 182 children with midshaft or distal hypospadias and a mean age of 30 months (range 18-52 months) were enrolled in this study. Consecutive children were randomly allocated to the study group (testosterone administration) (Group 1, n = 91) or control group (Group 2, n = 91). Only children with a flat urethral plate were included in this study. The control group did not receive any pre-operative treatment. Children with a previous history of hypospadias repair and any proven endocrine disorder were excluded. The study children received 2 mg/kg testosterone enanthate monthly for two months before surgery. Tubularized incised plate (TIP) urethroplasty, with or without chordee correction, was performed for all children in both groups by the same urologist. Hypospadias repair was performed 4 weeks after the second dose of testosterone administration. Postoperative complications were recorded, including: urethrocutaneous fistulas, urethral diverticula, meatal stenosis, and glanular dehiscence. The mean stretched penile length and circumference were measured at baseline and at 1 month and 2 months post operation. All children were examined every month for any adverse affects to testosterone treatment, like pubic and axillary hair, and height acceleration, up to 3 months post operation. An increase in penile length (from 28.1 ± 2.2 mm to 38.5 ± 2.6 mm) (P = 0.001) and penile circumference (from 35.1 ± 1.6 mm to 45.5 ± 2.2 mm) (P = 0.001) were noticed in all but four children in Group 1. The actual values for increase in penile length in the study group were, 22.0%, 35.0% and 36.0%, at postinjection months 1, 2 and 3, respectively (P = 0.01, P = 0.001 and P = 0.001, respectively) (Figure). The actual values for increase in penile circumference in the study group were, 16.0%, 27.0% and 29.0%, at postinjection months 1, 2 and 3, respectively (P=0.01, P=0.001 and P =0.001, respectively). The overall complication rates were significantly higher in Group 2 [12 children, 13.18%) compared to Group 1 (five children, 5.45%) (P=0.03). Urethrocutaneous fistula was the most common complication in both groups (four children [4.39%] in Group 1 and seven children [7.69%] in Group 2) (P=0.02), followed by meatal stenosis (one child [1.09%] in Group 1 and three children [3.29%] in Group 2) (P=0.03). All children in Group 1 developed pigmentation of the genitalia, and scant pubic hair appeared in 14 of them. These side effects disappeared by the 3 months postoperation follow-up visit. Tubularized incised plate urethroplasty is a popular reconstructive method for hypospadias repair and is widely accepted by pediatric urologists. It is a reliable and simple technique with low complication rates. Testosterone administration before hypospadias repair decreases complication rates, reduces the need for reoperation and results in better cosmetic outcomes. Some studies have demonstrated temporary side effects like pubic hair growth and aggressive behavior, which gradually became normalized after treatment cessation. Nowadays, many pediatric urologists administer testosterone prior to hypospadias surgery; however, this can be variable. Parenteral testosterone administration before hypospadias repair is beneficial in decreasing complication rates. Copyright © 2015 Journal of Pediatric Urology Company. Published by Elsevier Ltd. All rights reserved.

Patient Reported Outcomes in Preoperative and Postoperative Patients with Hypospadias.

PubMed

Keays, Melise A; Starke, Nathan; Lee, Simon C; Bernstein, Ira; Snodgrass, Warren T; Bush, Nicol C

2016-04-01

Current outcome tools for hypospadias have limited focus on the caregiver or patient perspective of important patient centered outcomes. In this study we collaborated with patients, caregivers, and lay and medical experts to develop and pilot a patient reported outcome measure for hypospadias. We developed a patient reported outcome measure based on systematic review of the literature and focus group input. The patient reported outcome measure was piloted in caregivers for boys younger than 8 years and in patients older than 8 years who presented for urology consultation before meeting with the surgeon. Patients were classified with uncorrected hypospadias, successful repair or failed repair based on the presence or absence of complications (fistula, diverticulum, meatal stenosis/stricture, greater than 30-degree recurrent curvature, glans dehiscence and/or skin reoperation). A patient reported outcome measure was developed and administered to 347 patients and/or caregivers-proxies, including 105 uncorrected cases, 162 successful repair cases and 80 failed cases. Satisfaction with appearance was highest in those with successful hypospadias repair compared to failed repair and uncorrected hypospadias (93% vs 77% and 67%, respectively). Voiding symptoms such as spraying or a deviated stream were highest in failed and uncorrected cases (39% and 37%, respectively). Overall dissatisfaction with voiding was highest for uncorrected hypospadias and failed repair compared to successful cases (54% and 47%, respectively, vs 15%). The evaluation of patient and caregiver-proxy reported outcomes in preoperative and postoperative patients with hypospadias allows for the quantification of benefits derived from hypospadias repair and may ultimately represent the gold standard outcome measure for hypospadias. This pilot study identified preliminary patient centered themes and demonstrated the feasibility of administering hypospadias patient reported outcome measures in clinical practice. Copyright © 2016 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.

[Effect of epidermal growth factor and testosterone on androgen receptor activation in urethral plate fibroblasts in hypospadias].

PubMed

Lin, Junshan; Xie, Cheng; Chen, Ruiqing; Li, Dumiao

2016-05-01

To investigate androgen receptor (AR) expression and the effect of epidermal growth factor (EGF) and testosterone on AR expression level.
 EGF or different concentrations of testosterone were incubated with the primary urethral plate fibroblasts from patients with hypospadias. The levels of AR expression in the fibroblasts were detected by immunocytochemical assays and graphical analysis.
 There was no significant difference in AR activation under physiological concentrations (3×10(-8) mol/L) of testosterone between the control and the distal hypospadias group (P>0.05). However, there was a significant decrease in AR activation in the proximal hypospadias group compared to that in the control group (P<0.001). Under the concentration of 3×10(-6) mol/L, the effects of testosterone on AR activation were dramatically different in the three groups (control group>distal hypospadias group>proximal hypospadias group, P<0.001). AR activation level in the group of proximal hypospadias was improved most obviously when EGF and physiological concentration of testosterone were employed in the urethral plate fibroblasts from hypospadias patients (P<0.001), and it was improved more in the distal hypospadias group than that in the control group (P=0.02).
 AR expression and activation in the urethral plate fibroblasts from hypospadias patients are abnormal. EGF can be used to improve AR activation in fibroblasts from different types of hypospadias, especially in the proximal type.

Hypospadias repair - series (image)

MedlinePlus

... penis. Hypospadias is usually associated with an abnormal curvature of the penis, called "chordee". Hypospadias is one ... of the surgery are to repair the abnormal curvature of the penis, and to create a new ...

Hypospadias: Are we as good as we think when we correct proximal hypospadias?

PubMed

Long, C J; Canning, D A

2016-08-01

Hypospadias surgery is a humbling art form. Although outcomes with distal hypospadias are favorable, recent publications have suggested that the complication rates are much higher than previously anticipated for proximal hypospadias. The present review examined the literature concerning proximal hypospadias, to explore some of the inadequacies and identify some of the reasons behind these shortfalls in the reported data. A systematic review of the published literature was conducted using keywords relevant to proximal hypospadias and long-term outcomes. The literature for hypospadias was reviewed, and outcomes for distal vs proximal variants were compared. The quality of the literature for proximal hypospadias was examined, and the shortcomings that led to underreporting of the surgical outcomes were identified. Special focus was on the lack of standardized documentation, the subsequent inability to objectify the severity of the phenotype, and the underestimation of complications due to lack of long-term follow-up. There was also a great deal of variability in the utilized techniques, and the literature was filled with small case series from single institutions. To enable scientific assessment of outcomes, it is proposed that the following be implemented: acceptance and incorporation of standardized phenotype assessment scores in the pre-operative period, objective intraoperative hypospadias characterization, and postoperative score assessment. Treatment of proximal hypospadias is much less successful than the distal variant. A specialty wide commitment to standardize the hypospadias language is required to make advancement in surgical outcomes. Boys need to be followed through puberty into adulthood, and honest reporting of outcomes must be discussed so that surgical techniques for this complicated disease process can be advanced. Copyright © 2016 Journal of Pediatric Urology Company. Published by Elsevier Ltd. All rights reserved.

Inpatients hypospadias care: trends and outcomes from the American nationwide inpatient sample.

PubMed

Meyer, Christian; Sukumar, Shyam; Sood, Akshay; Hanske, Julian; Vetterlein, Malte; Elder, Jack S; Fisch, Margit; Trinh, Quoc-Dien; Friedman, Ariella A

2015-08-01

Hypospadias is the most common congenital penile anomaly. Information about current utilization patterns of inpatient hypospadias repair as well as complication rates remain poorly evaluated. The Nationwide Inpatient Sample was used to identify all patients undergoing inpatient hypospadias repair between 1998 and 2010. Patient and hospital characteristics were attained and outcomes of interest included intra- and immediate postoperative complications. Utilization was evaluated temporally and also according to patient and hospital characteristics. Predictors of complications and excess length of stay were evaluated by logistic regression models. A weighted 10,201 patients underwent inpatient hypospadias repair between 1998 and 2010. Half were infants (52.2%), and were operated in urban and teaching hospitals. Trend analyses demonstrated a decline in incidence of inpatient hypospadias repair (estimated annual percentage change, -6.80%; range, -0.51% to -12.69%; p=0.037). Postoperative complication rate was 4.9% and most commonly wound-related. Hospital volume was inversely related to complication rates. Specifically, higher hospital volume (>31 cases annually) was the only variable associated with decreased postoperative complications. Inpatient hypospadias repair have substantially decreased since the late 1990's. Older age groups and presumably more complex procedures constitute most of the inpatient procedures nowadays.

Prevalence, repairs and complications of hypospadias: an Australian population-based study.

PubMed

Schneuer, Francisco Javier; Holland, Andrew J A; Pereira, Gavin; Bower, Carol; Nassar, Natasha

2015-11-01

To investigate hypospadias' prevalence and trends, rate of surgical repairs and post-repair complications in an Australian population. Hypospadias cases were identified from all live-born infants in New South Wales, Australia, during the period 2001-2010, using routinely collected birth and hospital data. Prevalence, trends, surgical procedures or repairs, hospital admissions and complications following surgery were evaluated. Risk factors for reoperation and complications were assessed using multivariate logistic regression. There were 3186 boys with hypospadias in 2001-2010. Overall prevalence was 35.1 per 10,000 live births and remained constant during the study period. Proportions of anterior, middle, proximal and unspecified hypospadias were 41.3%, 26.2%, 5.8% and 26.6%, respectively. Surgical procedures were performed in 1945 boys (61%), with 1718 primary repairs. The overall post-surgery complication rate involving fistulas or strictures was 13%, but higher (33%) for proximal cases. Complications occurred after 1 year post-repair in 52.3% of cases and up to 5 years. Boys with proximal or middle hypospadias were at increased risk of reoperation or complications, but age at primary repair did not affect the outcome. One in 285 infants were affected with hypospadias, 60% required surgical repair or correction and one in eight experienced complications. The frequency of late complications would suggest that clinical review should be maintained for >1 year post-repair. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

Inpatients hypospadias care: Trends and outcomes from the American nationwide inpatient sample

PubMed Central

Sukumar, Shyam; Sood, Akshay; Hanske, Julian; Vetterlein, Malte; Elder, Jack S.; Fisch, Margit; Trinh, Quoc-Dien; Friedman, Ariella A.

2015-01-01

Purpose Hypospadias is the most common congenital penile anomaly. Information about current utilization patterns of inpatient hypospadias repair as well as complication rates remain poorly evaluated. Materials and Methods The Nationwide Inpatient Sample was used to identify all patients undergoing inpatient hypospadias repair between 1998 and 2010. Patient and hospital characteristics were attained and outcomes of interest included intra- and immediate postoperative complications. Utilization was evaluated temporally and also according to patient and hospital characteristics. Predictors of complications and excess length of stay were evaluated by logistic regression models. Results A weighted 10,201 patients underwent inpatient hypospadias repair between 1998 and 2010. Half were infants (52.2%), and were operated in urban and teaching hospitals. Trend analyses demonstrated a decline in incidence of inpatient hypospadias repair (estimated annual percentage change, -6.80%; range, -0.51% to -12.69%; p=0.037). Postoperative complication rate was 4.9% and most commonly wound-related. Hospital volume was inversely related to complication rates. Specifically, higher hospital volume (>31 cases annually) was the only variable associated with decreased postoperative complications. Conclusions Inpatient hypospadias repair have substantially decreased since the late 1990's. Older age groups and presumably more complex procedures constitute most of the inpatient procedures nowadays. PMID:26279829

Comparison of variables affecting the surgical outcomes of tubularized incised plate urethroplasty in adult and pediatric hypospadias.

PubMed

Bhat, A; Bhat, M; Kumar, V; Kumar, R; Mittal, R; Saksena, G

2016-04-01

The American Academy of Pediatrics recommends operating on hypospadias between the ages of 6-12 months. Since most births in developed countries are conducted in a hospital, parents are likely to be well informed and counseled about the hypospadias. However, significant numbers of births in developing countries are still conducted at home, with illiteracy, poverty and ignorance often leading to late presentation at the hospital. Reported hypospadias-repair complication rates are higher in adults compared with those having surgery in childhood. The present study's objective was to evaluate the factors affecting surgical outcome in hypospadias patients undergoing tubularized and tubularized incised plate urethroplasty (TIPU) in adulthood compared with childhood. A prospective study of 60 adult patients >16 years, and 60 pediatric patients <5 years who underwent TIPU for primary hypospadias between May 2008 and May 2012. Patients were operated on by a single surgeon, under similar circumstances, and were pre-operatively examined to assess meatal location, chordee, and torsion; they were also examined intra-operatively for quality of spongiosum and urethral plate width. The outcomes were assessed by patient/parents for satisfaction regarding cosmesis, urinary stream and complications. The age of the patients varied from 16 to 27 years, with a mean of 20.8 years in adults, and 6 months to 5 years, with a mean of 2.1 years, in children. The type of hypospadias, degree of curvature, quality of spongiosum and urethral plate width were comparable in both groups, but complication rates were higher in adults (16.7%) than in the pediatric (6.7%) group (Figure 1A-D). Meatal stenosis responded well to dilatation, but fistulae required revision surgery and had a cure rate of 100%. The median follow-up was 37 months in adults, and 39 months in children. The higher complication rates in adults may be due to more frequent erections; increased susceptibility to infection along with relatively reduced vascularity lead to poor wound healing and increased complication rates. The limitation of the study was the small number of patients with mid and proximal hypospadias having lesser incidences in comparison with distal hypospadias. Adequate number of patients in these subgroups could have further strengthened the statistical correlation. Secondly, there was no objective criterion like uroflowmetry to assess urinary stream. Complication rates were higher in adults undergoing TIPU compared with pediatric patients, which was also statistically significant in distal hypospadias. The important factors in surgical outcome were: severity of hypospadias, degree of curvature, quality of spongiosum, and urethral plate width. Copyright © 2015 Journal of Pediatric Urology Company. Published by Elsevier Ltd. All rights reserved.

Fistula repair after hypospadias surgery using buccal mucosal graft.

PubMed

Hosseini, Jalil; Kaviani, Ali; Mohammadhosseini, Mojtaba; Rezaei, Alireza; Rezaei, Iraj; Javanmard, Babak

2009-01-01

The aim of this study was to evaluate the success rate of urethrocutaneous fistula repair using buccal mucosal graft in patients with a previous hypospadias repair. We reviewed records of our patients with urethrocutaneous fistula developed after hypospadias repair in whom buccal mucosal graft fistula repair had been performed. All of the patients had been followed up for 24 postoperative months. A successful surgical operation was defined as no fistula recurrence or urethral stricture. Retrograde urethrography and urethrocystoscopy would be performed in patients who had any history of decreased force and caliber of urine or any difficulty in urination. Fistula repair using buccal mucosa patch graft had been done in 14 children with urethrocutaneous fistula developing after hypospadias reconstruction. The mean age of the children was 8.70 +/- 1.99 years old (range, 4 to 11 years). Seven fistulas were in the midshaft, 4 were in the penoscrotal region, and 3 were in the coronal region. Repair of the fistulas was successful in 11 of 14 patients (78.6%). In the remaining children, the diameter of the fistula was smaller than that before the operation, offering a good opportunity for subsequent closure. Our findings showed that fistula repair using buccal mucosal graft can be one of the acceptable techniques for repairing fistulas developed after hypospadias repair.

Salvage hypospadias repairs

PubMed Central

Sripathi, V.; Satheesh, M.; Shubha, K.

2008-01-01

Aim: Review of our experience and to develop an algorithm for salvage procedures in the management of hypospadias cripples and treatment of urethral strictures following hypospadias repair. Methods: This is a retrospective review of hypospadias surgeries over a 41-month period. Out of a total 168 surgeries, 20 were salvage/re-operative repairs. In three children a Duplay repair was feasible, while in four others a variety of single-stage repairs could be done. The repair was staged in seven children – buccal mucosal grafts (BMGs) in five, buccal mucosal tube in one, and skin graft in one. Five children with dense strictures were managed by dorsal BMG inlay grafting in one, vascularized tunical onlay grafting on the ventrum in one, and a free tunical patch in one. Three children were treated by internal urethrotomy and stenting for four weeks with a poor outcome. Results: The age of children ranged from 1.5–15 years (mean 4.5). Follow-up ranged from 3 months to 3.5 years. Excellent results were obtained in 10 children (50%) with a well-surfaced erect penis and a slit-like meatus. Glans closure could not be achieved and meatus was coronal in three. Two children developed fistulae following a Duplay repair and following a staged BMG. Three repairs failed completely – a composite repair broke down, a BMG tube stenosed with a proximal leak, and a stricture recurred with loss of a ventral free tunical graft. Conclusions: In salvage procedures performed on hypospadias cripples, a staged repair with buccal mucosa as an inlay in the first stage followed by tubularization 4–6 months later provides good results. A simple algorithm to plan corrective surgery in failed hypospadias cases and obtain satisfactory results is devised. PMID:20011495

Salvage hypospadias repairs.

PubMed

Sripathi, V; Satheesh, M; Shubha, K

2008-10-01

Review of our experience and to develop an algorithm for salvage procedures in the management of hypospadias cripples and treatment of urethral strictures following hypospadias repair. This is a retrospective review of hypospadias surgeries over a 41-month period. Out of a total 168 surgeries, 20 were salvage/re-operative repairs. In three children a Duplay repair was feasible, while in four others a variety of single-stage repairs could be done. The repair was staged in seven children - buccal mucosal grafts (BMGs) in five, buccal mucosal tube in one, and skin graft in one. Five children with dense strictures were managed by dorsal BMG inlay grafting in one, vascularized tunical onlay grafting on the ventrum in one, and a free tunical patch in one. Three children were treated by internal urethrotomy and stenting for four weeks with a poor outcome. The age of children ranged from 1.5-15 years (mean 4.5). Follow-up ranged from 3 months to 3.5 years. Excellent results were obtained in 10 children (50%) with a well-surfaced erect penis and a slit-like meatus. Glans closure could not be achieved and meatus was coronal in three. Two children developed fistulae following a Duplay repair and following a staged BMG. Three repairs failed completely - a composite repair broke down, a BMG tube stenosed with a proximal leak, and a stricture recurred with loss of a ventral free tunical graft. In salvage procedures performed on hypospadias cripples, a staged repair with buccal mucosa as an inlay in the first stage followed by tubularization 4-6 months later provides good results. A simple algorithm to plan corrective surgery in failed hypospadias cases and obtain satisfactory results is devised.

Comparison between tubularised incised plate urethroplasty and onlay island flap repair in mid and proximal penile hypospadias.

PubMed

Javid, Latif; Pansota, Mudassar Saeed; Ahmad, Iftikhar; Tariq, Muhammad; Tabassum, Shafqat Ali

2014-04-01

To evaluate the surgical outcome of tubularised incised plate urethroplasty and onlay island flap repair for mid and proximal penile hypospadias. The prospective study was conducted at the Bahawal Victoria Hospital, Bahawalpur from June 2011 to May 2013. A total of 60 patients with mid and proximal penile hypospadias in the age range of 02 to 06 years were included. Patients with hypospadias other than mid and proximal penile, with chordee and history of previous hypospadias repair were excluded. Patients were divided into two equal groups. Urethroplasty was done for group I and flap repair for group II. The follow-up period was 12-24 months. SPSS 16 was used for statistical analysis. The mean duration of surgery was 62 +/- 8.72 minutes for group I and 90 +/- 11.25 minutes for group II (p < 0.0001). In group I, only 03 (10.0%) patients had complications, while in group II, 09 (30.0%) patients developed complications (p = 0.02). Cosmetic results were also excellent in group I compared to group II. Tubularised incised plate urethroplasty was better and superior than onlay island flap repair in terms of less operative time, complication rate and satisfactory cosmetic results for mid and proximal penile hypospadias.

A Simple Method for Closure of Urethrocutaneous Fistula after Tubularized Incised Plate Repair: Preliminary Results.

PubMed

Shirazi, Mehdi; Ariafar, Ali; Babaei, Amir Hossein; Ashrafzadeh, Abdosamad; Adib, Ali

2016-11-01

Urethrocutaneous fistula (UCF) is the most prevalent complication after hypospadias repair surgery. Many methods have been developed for UCF correction, and the best technique for UCF repair is determined based on the size, location, and number of fistulas, as well as the status of the surrounding skin. In this study, we introduced and evaluated a simple method for UCF correction after tubularized incised plate (TIP) repair. This clinical study was conducted on children with UCFs ≤ 4 mm that developed after TIP surgery for hypospadias repair. The skin was incised around the fistula and the tract was released from the surrounding tissues and the dartos fascia, then ligated with 5 - 0 polydioxanone (PDS) sutures. The dartos fascia, as the second layer, was covered on the fistula tract with PDS thread (gauge 5 - 0) by the continuous suture method. The skin was closed with 6 - 0 Vicryl sutures. After six months of follow-up, surgical outcomes were evaluated based on fistula relapse and other complications. After six months, relapse occurred in only one patient, a six-year-old boy with a single 4-mm distal opening, who had undergone no previous fistula repairs. Therefore, in 97.5% of the cases, relapse was non-existent. Other complications, such as urethral stenosis, intraurethral obstruction, and epidermal inclusion cysts, were not seen in the other patients during the six-month follow-up period. This repair method, which is simple, rapid, and easily learned, is highly applicable, with a high success rate for the closure of UCFs measuring up to 4 mm in any location.

Proximal hypospadias repair with bladder mucosal graft: Our 10 years experience.

PubMed

Lanciotti, Michele; Betti, Marta; Elia, Antonio; Landi, Luca; Taverna, Maria; Cini, Chiara; Masieri, Lorenzo

2017-06-01

A great variety of different surgical techniques has been described for proximal hypospadias repair and an ideal tissue has not been determined yet. We present our 10 years of surgical experience using a bladder mucosal graft for urethroplasty. Bladder mucosal graft urethroplasty was performed between 2005 and 2015 in 50 patients with severe proximal hypospadias. The mean age of patients was 45.1 months (range 24-164 months). Hypospadias were perineal in 18 patients, scrotal in 22, and penoscrotal in 10. In all cases a chordee correction was performed and median time between the first and the second stages was 12 months (mean 17 months, range 4-68 months). Both foley catheter and a suprapubic cystostomy were positioned and maintained for 2-4 weeks. Follow-up was performed at 1-3 and 6-12 months after surgery, and afterwards annually with clinical examination and flowmetry test. Mean follow-up was 5.3 years (median 5, range 1-10 years). Mean graft length was 57.4 mm (median 55 mm, range 35-85 mm). Among all the only early complication registered was a postoperative infection in one patient (2%) at the site of anastomosis. The long-term complications observed were urethrocutaneous fistula in nine patients (18%), urethral stricture in 15 patients (30%), meatal stricture in four patients (8%), and prolapse of meatus in seven patients (14%). The mean time of complication occurrence was 15 months (median 15.5 months, range 1-96 months). The functional and cosmetic appearance after surgery was satisfactory in 42/50 patients (84%) during the follow-up period. There is still an open debate regarding the optimal surgical approach for management of severe proximal hypospadias. Compared with other approaches, our technique showed acceptable results even though encumbered by slightly higher complication rates. Our results show that bladder mucosal graft for primary severe proximal hypospadias in selected patients is a possible alternative to other commonly used techniques, with the aim of restoring recovery of the normal continuity of the distal urinary tract see figure below. Copyright © 2017 Journal of Pediatric Urology Company. Published by Elsevier Ltd. All rights reserved.

Urethrocutaneous fistulae after hypospadias repair: When do they occur?

PubMed

Liao, Adelene Y; Smith, Grahame Hh

2016-05-01

The aim is to determine the incidence and timing of urethrocutaneous fistula diagnosis after hypospadias surgery. A retrospective review of all patients who had both initial hypospadias surgery and subsequent fistula repair from 1995 to 2012. A comparison was made between patients who had an initial onlay island flap procedure and those who had a tubularised incised plate repair. Patient age at initial surgery ranged from 6 months to 16 years of age. The median time to fistula presentation was 8.5 months with a range of less than 1 month to 13.9 years post-hypospadias surgery. The median time to fistula repair was 17 months. The overall fistula rate was 8%. There was no significant difference between the rates of fistulae for onlay island flap (9%) versus tubularised incised plate procedure (7%). Urethrocutaneous fistulae can present many years after the original hypospadias repair. The majority are diagnosed within the first year after surgery. Rates of fistulae are probably underreported due to short follow-up, but more importantly, due to patients transferring to other surgeons for fistula repair. © 2016 The Author Journal of Paediatrics and Child Health © 2016 Paediatrics and Child Health Division (Royal Australasian College of Physicians).

Two-stage repair for severe proximal hypospadias using oral mucosal grafts: combination of a modified Bracka method and a modified Byars flap method.

PubMed

Mitsukawa, Nobuyuki; Saiga, Atsuomi; Akita, Shinsuke; Kubota, Yoshitaka; Kuriyama, Motone; Satoh, Kaneshige

2015-02-01

One-stage repair is a conventional treatment of hypospadias. If hypospadias is severe as in the scrotal type and perineal type, penile curvature sometimes cannot be corrected by dorsal midline plication alone. In addition to resection of the urethral plate, ventral grafting becomes necessary for insufficient skin and subcutaneous tissue. In recent years, there has been renewed interest in 2-stage repair for such severe cases and salvage of failed cases with scarring. In the present study, novel 2-stage urethroplasty was performed in 6 cases to repair severe proximal hypospadias which required resection of the urethral plate. This novel method consisted of a combination of a modified Bracka method using oral mucosal grafts and a modified Byars flap of the dorsal foreskin. Good results were obtained using this novel method.

One-stage dorsal lingual mucosal graft urethroplasty for the treatment of failed hypospadias repair.

PubMed

Li, Hong-Bin; Xu, Yue-Min; Fu, Qiang; Sa, Ying-Long; Zhang, Jiong; Xie, Hong

2016-01-01

The aim of this study was to retrospectively investigate the outcomes of patients who underwent one-stage onlay or inlay urethroplasty using a lingual mucosal graft (LMG) after failed hypospadias repairs. Inclusion criteria included a history of failed hypospadias repair, insufficiency of the local skin that made a reoperation with skin flaps difficult, and necessity of an oral mucosal graft urethroplasty. Patients were excluded if they had undergone a failed hypospadias repair using the foreskin or a multistage repair urethroplasty. Between January 2008 and December 2012, 110 patients with failed hypospadias repairs were treated in our center. Of these patients, 56 underwent a one-stage onlay or inlay urethroplasty using LMG. The median age was 21.8 years (range: 4-45 years). Of the 56 patients, one-stage onlay LMG urethroplasty was performed in 42 patients (group 1), and a modified Snodgrass technique using one-stage inlay LMG urethroplasty was performed in 14 (group 2). The median LMG urethroplasty length was 5.6 ± 1.6 cm (range: 4-13 cm). The mean follow-up was 34.7 months (range: 10-58 months), and complications developed in 12 of 56 patients (21.4%), including urethrocutaneous fistulas in 7 (6 in group 1, 1 in group 2) and neourethral strictures in 5 (4 in group 1, 1 in group 2). The total success rate was 78.6%. Our survey suggests that one-stage onlay or inlay urethroplasty with LMG may be an effective option to treat the patients with less available skin after failed hypospadias repairs; LMG harvesting is easy and safe, irrespective of the patient's age.

Urinary tract abnormalities in boys with recurrent urinary tract infections after hypospadias repair.

PubMed

Wehbi, Elias; Patel, Premal; Kanaroglou, Niki; Tam, Stephanie; Weber, Bryce; Lorenzo, Armando; Pippi Salle, Joao Luiz; Bagli, Darius; Koyle, Martin; Farhat, Walid A

2014-02-01

To examine the development of recurrent urinary tract infections (UTIs) in boys who have undergone hypospadias repair. We retrospectively reviewed the records of all boys who had recurrent UTIs after primary or redo tubularized incised plate (TIP) or transverse island flap (TVIF) repairs, between 1998 and 2009. Data on age, operating details, postoperative complications and imaging studies were collected. We attempted to identify risk factors for recurrent UTIs after hypospadias repair. During the study period, 43/2249 boys (1.91%) were diagnosed with recurrent UTIs after hypospadias repair. The boys' mean (range) age at repair was 14 (6-24) months and the median (range) follow-up was 6.5 (1.5-11) years. Primary TIP and TVIF were performed in 47% (20/43) and 35% (15/43) of the boys, respectively. Redo surgeries were performed in 18% of the boys (8/43). The initial meatal location was proximal in all TVIF and redo repairs, and in one of the TIP repairs. Postoperative voiding cysto-urethrography, ultrasonography and dimercapto-succinic acid (DMSA) scans were performed in 58% (25/43), 90% (39/43) and 19% (8/43) of the boys, respectively. Abnormalities were noted. Of those boys who underwent a TVIF repair, urethral diverticula were seen in 47% (7/15) and urethral fistulae were also seen in 47% (7/15). Conversely, in those who had a TIP repair, an elevated PVR and vesico-ureteric reflux were more common; they were found in 40% (8/20) and 50% (10/20) of patients, respectively. The pathophysiology of recurrent UTI is multifactorial, but postoperative complications seem to vary with type of procedure. Recurrent UTIs after hypospadias surgery should prompt a specific assessment for potentially functionally relevant and correctable anatomical abnormalities. © 2013 The Authors. BJU International © 2013 BJU International.

Shorter anogenital and anoscrotal distances correlate with the severity of hypospadias: A prospective study.

PubMed

Cox, K; Kyriakou, A; Amjad, B; O'Toole, S; Flett, M E; Welsh, M; Ahmed, S F; Cascio, S

2017-02-01

Anogenital distance (AGD) is a recognised marker of in utero androgen action. This study aimed to evaluate the relationship between severity of hypospadias and AGD. Boys undergoing hypospadias repair in a single tertiary centre between May 2012 and February 16 were included in the study. Anogenital distance was measured from the centre of the anus to the base of the penis, and anoscrotal distance (ASD) from the centre of the anus to the junction between the smooth perineal skin and scrotal skin. Trained paediatric urologists made all measurements using digital callipers. Fifty-nine boys with hypospadias and 31 age-matched controls undergoing circumcision (median age 1.37 years, range 1.01-1.96) had AGD and ASD measured under anaesthetic. The patients were divided into two groups, according to hypospadias severity: group 1 - distal penile/subcoronal/glandular (n = 40); and group 2 - perineal/penoscrotal/midshaft (n = 19). The median AGD for controls was 74.0 mm (range 53.2-87.8) and for hypospadias it was 72.3 mm (range 50.7-90.0) (P = 0.816). The median ASD for controls was 42.3 mm (range 31.0-56.1) and for hypospadias it was 39.4 mm (range 20.7-77.0) (P = 0.224). Considering severity of hypospadias, the median AGD for group 1 and group 2 was 73.7 mm (range 50.7-90.0) and 63.3 mm (range 53.6-77.0), respectively (P < 0.001). The median ASD was also higher in group 1, at 41.3 mm (range 20.7-65.0), compared to 35.2 mm (range 23.5-77.0) in group 2 (P = 0.119) (Summary Fig.). This study showed that more severe forms of hypospadias are associated with shorter AGD and ASD. These findings agree with two previous studies that identified reduced AGD in boys with hypospadias. However, these studies did not investigate an association with severity of hypospadias. As hypospadias is multifactorial, only a small proportion of cases are thought to be associated with impaired in utero androgen exposure. The shorter AGD in boys with severe hypospadias compared with mild hypospadias would indicate that AGD is a marker of the severity of androgen production. This may also suggest that less severe forms of hypospadias have a different aetiology involving a later stage of development, and that they are not the result of reduced androgen exposure in the male programming window between the 8-14 weeks gestation. This study identified that boys with more severe hypospadias are more likely to have a shorter AGD and ASD than boys with mild hypospadias. This may indicate that there is a more profound impairment of in utero androgen action in severe hypospadias. Copyright © 2016 Journal of Pediatric Urology Company. All rights reserved.

TIP hypospadias repair: A pediatric urology indicator operation.

PubMed

Snodgrass, Warren; Bush, Nicol

2016-02-01

We review development and evolution of TIP hypospadias repair, including technical changes made to improve its results. We also discuss general risk factors for hypospadias surgical complications. We describe use of a database with prospective data entry to first identify our most common complications and their frequency, and then to monitor results of technical modifications made to reduce their occurrence. Multiple logistic regression of various factors recorded in the database was done to identify those predicting increased risk for urethroplasty complications. Fistula and glans dehiscence are the two most common complications we encountered after TIP repair. Changes in urethral plate tubularization and barrier layers covering the neourethra resulted in a significant reduction in fistulas after proximal TIP. Changes in glansplasty sutures and use of preoperative testosterone to increase glans size did not reduce likelihood for dehiscence, whereas increasing the extent of glans wings dissection did. Logistic regression analysis confirmed proximal meatal location and reoperation predicted increased complications, but also identified glans width ≤ 14 mm as an independent risk factor for hypospadias urethroplasty complications. Systematic, prospective data collection facilitated identification of complications and their risk factors, and provided a means to assess results of modifications made to address them. Limiting the algorithm used for hypospadias repair increases expertise in those techniques used. Reported low surgical volumes for proximal hypospadias repair suggest subspecialization of these cases be carried out so that designated surgeons can achieve sufficient volume to analyze their results and make improvements. Copyright © 2015 Journal of Pediatric Urology Company. Published by Elsevier Ltd. All rights reserved.

Long-term follow-up of children who underwent severe hypospadias repair using an online survey with validated questionnaires.

PubMed

Fraumann, Sarah A; Stephany, Heidi A; Clayton, Douglass B; Thomas, John C; Pope, John C; Adams, Mark C; Brock, John W; Tanaka, Stacy T

2014-06-01

Few studies of hypospadias repair in childhood have used validated questionnaires to investigate outcomes of cosmesis, urinary function, and sexual function in adulthood. We sought to investigate long-term outcomes in adult patients who had undergone severe hypospadias repair as children using an existing web-based application available to multiple institutions in order to develop an online patient survey of previously validated questionnaires. Patients aged 18 years or older who underwent severe hypospadias repair between 1992 and 1997 at our institution were contacted to complete an online survey. Through medical chart reviews, we analyzed the location of meatus, type of repair, and complications. The online survey included questions about penile appearance, and validated questionnaires to assess urinary and sexual function. Of 58 patients who met the inclusion criteria, we contacted 19, and 13 completed the survey. Fifty-nine percent had complications, with an average of 2.2 procedures per patient. Most (85.0%) were satisfied with penile appearance, although 38.0% had residual penile curvature. Hypospadias patients had mean lower orgasmic function than normal controls. Mean scores for urinary function and other domains of sexual function were similar to normal controls. Although the majority of adult patients were satisfied with the outcomes of penile appearance, urinary function, and sexual function, our online survey suggests decreased lower orgasmic function as measured by validated questionnaire. An online survey accessible to multiple institutions with validated questionnaires may facilitate assessment of long-term hypospadias results. Copyright © 2014 Journal of Pediatric Urology Company. Published by Elsevier Ltd. All rights reserved.

Further analysis of the Glans-Urethral Meatus-Shaft (GMS) hypospadias score: correlation with postoperative complications.

PubMed

Arlen, Angela M; Kirsch, Andrew J; Leong, Traci; Broecker, Bruce H; Smith, Edwin A; Elmore, James M

2015-04-01

The Glans-Urethral Meatus-Shaft (GMS) score is a concise and reproducible way to describe hypospadias severity. We classified boys undergoing primary hypospadias repair to determine the correlation between GMS score and postoperative complications. Between February 2011 and August 2013, patients undergoing primary hypospadias repair were prospectively scored using the GMS classification. GMS scoring included a 1-4 scale for each component: G - glans size/urethral plate quality, M - meatal location, and S - degree of shaft curvature, with more unfavorable characteristics assigned higher scores [Figure]. Demographics, repair type, and complications (urethrocutaneous fistula, meatal stenosis, glans dehiscence, phimosis, recurrent chordee and stricture) were assessed. Total and individual component scores were tested in uni- and multivariate analysis. Two-hundred and sixty-two boys (mean age 12.3 ± 13.7 months) undergoing primary hypospadias repair had a GMS score assigned. Mean GMS score was 7 ± 2.5 (G 2.1 ± 0.9, M 2.4 ± 1, S 2.4 ± 1). Mean clinical follow-up was 17.7 ± 9.3 months. Thirty-seven children (14.1%) had 45 complications. A significant relationship between the total GMS score and presence of any complication (p < 0.001) was observed; for every unit increase in GMS score the odds of any postoperative complication increased 1.44 times (95% CI, 1.24-1.68). Urethrocutaneuous fistula was the most common complication, occurring in 21 of 239 (8.8%) of single-stage repairs. Patients with mild hypospadias (GMS 3-6) had a 2.4% fistula rate vs. 11.1% for moderate (GMS 7-9) and 22.6% for severe (GMS 10-12) hypospadias (p < 0.001). Degree of chordee was an independent predictor of fistula on multivariate analysis; S4 (>60° ventral curvature) patients were 27 times more likely to develop a fistula than S1 (no curvature) boys (95% CI, 3.2-229). The GMS score is based on anatomic features (i.e. glans size/urethral plate quality, location of meatus, and degree of chordee) felt to most likely impact functional and cosmetic outcomes following hypospadias repair. We demonstrated a statistically significant increase in the likelihood of any postoperative complication with every unit increase in total GMS score. The concept that factors aside from meatal location affect hypospadias repair and outcomes is not novel, and degree of ventral curvature and urethral plate quality are often cited as important factors. In our series, boys with greater than 60° of ventral curvature undergoing a single-stage repair were 27 times more likely to develop a fistula than those without chordee on multivariate analysis, making severe curvature an independent predictor of urethrocutaneous fistula formation. That meatal location did not retain significance on multivariate analysis highlights the importance of considering the entire hypospadias complex when determining severity, rather than just evaluating the position of the meatus. Our study has several limitations that warrant consideration. While GMS scores were assigned prospectively, the data was collected retrospectively, subjecting it to flaws inherent with such study design. Furthermore, type of repair is influenced by surgeon preference and subjective assessment of hypospadias characteristics not incorporated in our scoring system (i.e. tissue quality, urethral hypoplasia, penoscrotal transposition). Despite these limitations, our study demonstrates a strong correlation between the GMS classification and surgical complications, furthering supporting its potential as a tool to standardize hypospadias severity and gauge postoperative complications. The Glans-Urethral Meatus-Shaft (GMS) classification provides a means by which hypospadias severity and reporting can be standardized, which may improve inter-study comparison of reconstructive outcomes. There is a strong correlation between complication risk and total GMS score. Degree of chordee (S score) is independently predictive of fistula rate. Copyright © 2015 Journal of Pediatric Urology Company. Published by Elsevier Ltd. All rights reserved.

Salvaging the dehisced glans penis.

PubMed

White, C M; Hanna, M K

2018-05-30

The glans penis may show a deep groove (surgically favorable), or may appear flat with an absent sulcus (unfavorable). Glans dehiscence following hypospadias repair, especially after multiple surgeries, frequently results in a scarred, obliterated, or absent urethral plate. The glans penis appears to be flat and grooveless. This study reported on the outcome of a two-stage salvage repair for glans dehiscence in 49 consecutive patients. Retrospective chart review was performed for all patients who underwent repair for glans dehiscence following hypospadias repair. Between January 2009 and April 2015, 49 children aged 16 months to 18 years presented with glans dehiscence following hypospadias repair. The prior number of operations ranged from one to six. Eleven children had urethral fistulas, and seven had chordee. In the first stage, the flat glans was incised deeply to visualize, but spare, the corpora. Thereafter, a free graft of oral mucosa harvested either from the lower lip or cheek, or the residual preputial skin, was sutured to the glans cleft. The grafts were fenestrated, quilted in the midline, and a tie-over dressing was applied. Any fistula or chordee was repaired during the first stage. The neo-plate was tubularized 6-12 months later, and urine drainage with a catheter was maintained for 10-14 days. In 11 patients, skin flaps appeared dusky, and nitroglycerine ointment 2% was applied for 24 h to enhance the blood supply of the tissues. Subsequently, six of these children received nine or ten 90-min hyperbaric oxygen therapy sessions. Following the first stage, two patients developed hypertrophy of the mucosal grafts, and one skin graft contracted. These three patients underwent revision using a second buccal mucosal graft harvested from the cheek. One recurrent fistula was closed during the second stage. Following the second stage two patients developed a urethral fistula, and the distal sutures broke down in one patient, resulting in an over-sized meatus. None developed meatal stenosis or glans dehiscence. Graft initial take and subsequent behavior were unpredictable, but the two stage approach optimized the process of take and healing. Glans dehiscence was repaired safely and successfully by developing a deep groove, with creation of a new urethral plate followed by tubularization in two stages. Copyright © 2018. Published by Elsevier Ltd.

The contemporary role of 1 vs. 2-stage repair for proximal hypospadias

PubMed Central

Dason, Shawn; Wong, Nathan

2014-01-01

This review discusses the most commonly employed techniques in the repair of proximal hypospadias, highlighting the advantages and disadvantages of single versus staged surgical techniques. Hypospadias can have a spectrum of severity with a urethral meatus ranging from the perineum to the glans. Associated abnormalities are commonly found with proximal hypospadias and encompass a large spectrum, including ventral curvature (VC) up to 50 degrees or more, ventral skin deficiency, a flattened glans, penile torsion and penoscrotal transposition. Our contemporary understanding of hypospadiology is comprised of a foundation built by experts who have described a number of techniques and their outcomes, combined with survey data detailing practice patterns. The two largest components of hypospadias repair include repair of VC and urethroplasty. VC greater than 20 degrees is considered clinically relevant to warrant surgical correction. To repair VC, the penis is first degloved—a procedure that may reduce or remove curvature by itself in some cases. Residual curvature is then repaired with dorsal plication techniques, transection of the urethral plate, and/or ventral lengthening techniques. Urethroplasty takes the form of 1- or 2-stage repairs. One-stage options include the tubularized incised urethroplasty (TIP) or various graft or flap-based techniques. Two-stage options also include grafts or flaps, including oral mucosal and preputial skin grafting. One stage repairs are an attractive option in that they may reduce cost, hospital stay, anesthetic risks, and time to the final result. The downside is that these repairs require mastery of multiple techniques may be more complex, and—depending on technique—have higher complication rates. Two-stage repairs are preferred by the majority of surveyed hypospadiologists. The 2-stage repair is versatile and has satisfactory outcomes, but necessitates a second procedure. Given the lack of clear high-quality evidence supporting the superiority of one approach over the others, hypospadiologists should develop their own algorithm, which gives them the best outcomes. PMID:26813851

The contemporary role of 1 vs. 2-stage repair for proximal hypospadias.

PubMed

Dason, Shawn; Wong, Nathan; Braga, Luis H

2014-12-01

This review discusses the most commonly employed techniques in the repair of proximal hypospadias, highlighting the advantages and disadvantages of single versus staged surgical techniques. Hypospadias can have a spectrum of severity with a urethral meatus ranging from the perineum to the glans. Associated abnormalities are commonly found with proximal hypospadias and encompass a large spectrum, including ventral curvature (VC) up to 50 degrees or more, ventral skin deficiency, a flattened glans, penile torsion and penoscrotal transposition. Our contemporary understanding of hypospadiology is comprised of a foundation built by experts who have described a number of techniques and their outcomes, combined with survey data detailing practice patterns. The two largest components of hypospadias repair include repair of VC and urethroplasty. VC greater than 20 degrees is considered clinically relevant to warrant surgical correction. To repair VC, the penis is first degloved-a procedure that may reduce or remove curvature by itself in some cases. Residual curvature is then repaired with dorsal plication techniques, transection of the urethral plate, and/or ventral lengthening techniques. Urethroplasty takes the form of 1- or 2-stage repairs. One-stage options include the tubularized incised urethroplasty (TIP) or various graft or flap-based techniques. Two-stage options also include grafts or flaps, including oral mucosal and preputial skin grafting. One stage repairs are an attractive option in that they may reduce cost, hospital stay, anesthetic risks, and time to the final result. The downside is that these repairs require mastery of multiple techniques may be more complex, and-depending on technique-have higher complication rates. Two-stage repairs are preferred by the majority of surveyed hypospadiologists. The 2-stage repair is versatile and has satisfactory outcomes, but necessitates a second procedure. Given the lack of clear high-quality evidence supporting the superiority of one approach over the others, hypospadiologists should develop their own algorithm, which gives them the best outcomes.

Correction of distal hypospadias: ventral adaption of the prepuce and meatal advancement.

PubMed

Persson-Jünemann, C; Seemann, O; Köhrmann, K U; Potempa, D; Jünemann, K P; Alken, P

1993-01-01

In distal hypospadias without chordee, surgical correction has a purely cosmetic character. In contrast to standard techniques focusing on meatal position, parents often regard the redundant dorsal prepuce and its missing ventral fusion as the essential constituent of this malformation. The operative technique, presented in detail, emphasizes on foreskin reconstruction. The ventral adaption of the prepuce (VAP procedure) results in a penis with normal appearance. Complications presented reveal the importance of proper patient selection.

Correction of Residual Ventral Penile Curvature After Division of the Urethral Plate in the First Stage of a 2-Stage Proximal Hypospadias Repair.

PubMed

Schlomer, Bruce J

2017-02-01

The first stage of a 2-stage proximal hypospadias repair involves division of the urethral plate and correction of any residual ventral penile curvature (VPC). Options to correct residual VPC include dorsal corporal shortening or ventral corporal lengthening techniques. This review discusses these options and suggests an approach to management. Recent reports of 2-stage proximal hypospadias repairs indicate low rates of recurrent VPC with either dorsal corporal shortening or ventral corporal lengthening. Dorsal corporal shortening with dorsal plication may be preferentially used for mild to moderate residual VPC after division of urethral plate and ventral corporal lengthening reserved for severe residual VPC. Ventral corporal lengthening with grafts has been associated with urethroplasty complications after the second stage hypospadias surgery. Ventral corporal lengthening with relaxing incisions of corpora has been reported, but concerns about adverse effects require longer term studies. Little guidance exists to choose the best technique for VPC correction during first stage hypospadias repair after division of urethral plate. Reported literature suggests good results with dorsal plication techniques and ventral corporal lengthening. A practical approach is to use dorsal plication techniques for mild to moderate residual VPC after division of urethral plate (<45°) and reserve ventral corporal lengthening for severe residual VPC (>45°).

Current hypospadias management: Diagnosis, surgical management, and long-term patient-centred outcomes

PubMed Central

Keays, Melise A.; Dave, Sumit

2017-01-01

In this article, we present the current approach to hypospadias, a review of the classification, preoperative evaluation, and factors that enable decision-making during surgery. We will then discuss patient-reported outcomes, evaluating the patients’ and parents’ perspectives regarding hypospadias repair. PMID:28265319

Normalized Urinary Flow at Puberty after Tubularized Incised Plate Urethroplasty for Hypospadias in Childhood.

PubMed

Andersson, Marie; Doroszkiewicz, Monika; Arfwidsson, Charlotte; Abrahamsson, Kate; Sillén, Ulla; Holmdahl, Gundela

2015-11-01

An obstructive urinary flow pattern is frequently seen after tubularized incised plate urethroplasty for hypospadias. However, the significance of this finding has not been determined and long-term results are few. We describe postoperative long-term uroflowmetry results after puberty in males who underwent tubularized incised plate urethroplasty in childhood. A total of 126 boys underwent tubularized incised plate urethroplasty for distal penile to mid shaft hypospadias at Queen Silvia Children's Hospital in Gothenburg between 1999 and 2003. Of the patients 48 were toilet trained at surgery. We report on 40 patients who had data available at 2 and 12 months postoperatively, 7 years postoperatively and at puberty (median age 15.0 years, range 13.7 to 17.1). Of the patients 31 had distal and 9 had mid penile hypospadias. Clinical examination, urinary medical history, uroflowmetry and ultrasound measuring residual urine were performed. Maximum urinary flow was correlated to age and voided volume, using Miskolc nomograms for comparison of percentiles. At 1 year postoperatively 15 boys (37.5%) had normal urinary flow (above 25th percentile), compared to 16 (40%) at 7 years and 38 (95%) at puberty (p <0.0001). Improvement was significant in patients with distal (p <0.0001) and mid penile hypospadias (p = 0.008), as well as in patients who did (p = 0.0078) and did not undergo intervention (p <0.0001). During followup 5 patients underwent meatotomy due to obstructive symptoms and 4 underwent dilation. Three of these 9 patients had lichen sclerosus. There is great potential for normalization of urinary flow at puberty for boys with hypospadias treated with tubularized incised plate urethroplasty. Unless symptoms occur, a conservative approach seems preferable. Copyright © 2015 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.

Prenatal diagnosis of Wolf-Hirschhorn syndrome (4p-) in association with congenital hypospadias and foot deformity

PubMed Central

Aslan, Halil; Karaca, Nilay; Basaran, Seher; Ermis, Hayri; Ceylan, Yavuz

2003-01-01

Background Wolf-Hirschhorn syndrome is caused by distal deletion of the short arm of chromosome 4 (4p-). We report a case in which intrauterine growth restriction, hypospadias and foot deformity were detected by prenatal ultrasound examination at 29 weeks of gestation. Case Presentation A 31-year-old gravida 2 partus 1 woman was referred at 29 weeks' gestation with suspicion of intrauterine growth restriction. Sonographic examination revealed deformity of the right lower limb and undescended testes with an irregular distal penis. A cordocentesis was performed and chromosome analysis revealed a 46,XY,del(4)(p14) karyotype. Conclusion The prenatal detection of intrauterine growth restriction, hypospadias and foot deformity should lead doctors to suspect the presence of Wolf-Hirschhorn syndrome. PMID:12546710

Prenatal diagnosis of Wolf-Hirschhorn syndrome (4p-) in association with congenital hypospadias and foot deformity.

PubMed

Aslan, Halil; Karaca, Nilay; Basaran, Seher; Ermis, Hayri; Ceylan, Yavuz

2003-01-24

BACKGROUND: Wolf-Hirschhorn syndrome is caused by distal deletion of the short arm of chromosome 4 (4p-). We report a case in which intrauterine growth restriction, hypospadias and foot deformity were detected by prenatal ultrasound examination at 29 weeks of gestation. CASE PRESENTATION: A 31-year-old gravida 2 partus 1 woman was referred at 29 weeks' gestation with suspicion of intrauterine growth restriction. Sonographic examination revealed deformity of the right lower limb and undescended testes with an irregular distal penis. A cordocentesis was performed and chromosome analysis revealed a 46,XY,del(4)(p14) karyotype. CONCLUSION: The prenatal detection of intrauterine growth restriction, hypospadias and foot deformity should lead doctors to suspect the presence of Wolf-Hirschhorn syndrome.

Laser tissue soldering for hypospadias repair: results of a controlled prospective clinical trial.

PubMed

Kirsch, A J; Cooper, C S; Gatti, J; Scherz, H C; Canning, D A; Zderic, S A; Snyder, H M

2001-02-01

Laser tissue soldering has been shown to provide safe and effective tissue closure by creating an immediate leak-free anastomosis with minimal scar formation. We compared the results of laser tissue soldering and conventional suturing for hypospadias repair. A consecutive group of 138 boys 4 months to 8 years old (mean age 15 months) was divided into a standard suturing (84) and a sutureless laser (54) hypospadias repair group. Urethral repair was defined as simple (Thiersch-Duplay or Snodgrass) and complex (onlay island flap or tube) in 101 and 37 cases, respectively. Laser tissue soldering was performed with 50% human albumin solder doped with 2.5 mg./ml. indocyanine green dye using an 808 nm. diode laser at 0.5 W. In the laser group sutures were used for tissue alignment only. At surgery neourethral and penile length, operative time for neourethral construction and the number of sutures or throws were measured. Postoperatively patients were examined for complications of wound healing, stricture or fistula. Mean patient age, urethral defect severity, type of repair, neourethral length and stenting time plus or minus standard error of mean were not significantly different in the 2 groups. Mean operative time was a fifth as long for laser tissue soldering in simple and complex hypospadias repair compared to controls (1.5 +/- 0.1 and 5.1 +/- 0.3 versus 8.5 +/- 0.8 and 26.7 +/- 1.7 minutes, respectively, p <0.001). The mean number of sutures used for tissue alignment in the laser group for simple and complex repair was significantly less than in controls (3.0 +/- 0.2 and 8.2 +/- 0.6 versus 8.5 +/- 0.8 and 23.2 +/- 1.5, respectively, p <0.001). All patients were followed a mean of 12 months (minimum 6, maximum 22). The complication rate was 4.7% in the laser group and 10.7% in controls with fistula in 2 of 54 cases, and fistula and meatal stenosis in 7 and 2 of 84, respectively. These preliminary results indicate that laser tissue soldering for hypospadias repair may be performed in almost sutureless fashion and more rapidly than conventional suturing. The ease of the laser technique and the lower complication rate in the laser group indicate that laser tissue soldering is an acceptable means of tissue closure in hypospadias repair.

Impact of preoperative hormonal stimulation on postoperative complication rates after hypospadias repair: a meta-analysis.

PubMed

Chao, Min; Zhang, Yin; Liang, Chaozhao

2017-06-01

To improve the surgical outcome of hypospadias repair surgery, preoperative hormonal stimulation (PHS) has been proposed. We conducted a meta-analysis to evaluate the impact of preoperative hormonal stimulation (PHS) treatment on complication rates following hypospadias repair surgery. A comprehensive literature search up to June 1st, 2015 was carried out for relevant studies. After literature identification and data extraction, relative ratio (RR) was calculated to compare postoperative complication rates. Heterogeneity among individual studies was tested using the Cochran χ2 Q test and quantified by calculating the I2 index. Meta-regression was applied to find potential affective factors. Overall, 428 patients from 6 studies had undergone primary hypospadias repair, of which 171 (39.95%) received some form of PHS with human chorionic gonadotropin (HCG), dihydrotestosterone (DHT) or testosterone (T). They underwent three different types of surgical techniques, including onlay island flap (N.=277), tubularized incised plate (N.=99) and Koyanagi urethroplasty (N.=52). These 6 studies classified the complication rates based on PHS. The relative ratio (RR) for a complication occurring following PHS use was 1.18 (95% CI: 0.70-2.00, Z=0.91, P=0.539). Significant heterogeneity (I2=47.1%, P=0.092) among various research literature was found and meta-regression was undertaken for the heterogeneity, but surgical technique, mean age of patients at time of surgery, types of PHS and the quality of studies were not the cause of heterogeneity. Use of T, DHT and HCG prior to hypospadias repair does not appear to increase the incidence of postoperative complications, but further investigation is needed.

Use of buccal mucosa patch graft for recurrent large urethrocutaneous fistula after hypospadias repair.

PubMed

Kiss, András; Pirót, László; Karsza, Levente; Merksz, Miklós

2004-01-01

To assess the effectiveness of buccal mucosa patch graft in the treatment of recurrent large urethrocutaneous fistula after hypospadias repair. A free graft of buccal mucosa was used for closure in 7 boys (mean age 4.8 years) with large (>4 mm) urethocutaneous fistula. Four fistulas were in the midshaft, 2 of them penoscrotal and 1 coronal type. All patients had undergone at least two previous unsuccessful fistula repairs, and 3 of them had undergone three attempts for closure. Fistula repairs were similar in all cases. The repair was successful in 6 out of 7 cases, and in these cases the urinary stream was good after the removal of the catheter. The unsuccessful case was the coronal one. Based on our experience it seems that in cases with recurrent large fistula after hypospadias reconstruction, the use of buccal mucosa patch graft for closure is a good treatment choice. Copyright 2004 S. Karger AG, Basel

Tubularized incised plate urethroplasty for hypospadias reoperation: a review and meta-analysis.

PubMed

Mousavi, Seyed A; Aarabi, Mohsen

2014-01-01

Tubularized Incised Plate (TIP) urethroplasty is a technique for urethral reconstruction of hypospadias although there are some controversies for its use in recurrent cases. The aim of this study was to review the results of TIP technique in various studies and the usage of different flaps for covering the repair site. Extensive Search was performed for articles published between 1994 and 2013 in common electronic databases. The overall TIP complication rates were estimated by a fixed effects model meta-analysis. 17 articles of hypospadia repair using the TIP method were reviewed. All studies performed surgery and repair on the basis of the Snodgrass's method; however, some introduced modifications to the method. The prevalence of complications in repeated TIP surgery was 11.1 to 33.3% and the most prevalent complication in different studies was fistula. Based on the meta-analysis, the overall estimation of complications was 21.8% (95% CI: 18.3 to 25.5). Most studies performed the incision of the urethral plate to create a supportive coverage upon neourethra, and confirmed its success. We recommend further investigation on using different flaps in well-designed randomized controlled trials to choose the best surgical method for repairing recurrent hypospadias.

Three-week or one-week bladder catheterization for hypospadias repair? A retrospective-prospective observational study of 189 patients.

PubMed

Daher, Paul; Khoury, Antoine; Riachy, Edward; Atallah, Bachir

2015-06-01

While there is little scientific evidence over the optimal duration for transurethral bladder catheterization after hypospadias repair, most surgeons leave the catheter for 7-10 days. We herein describe our experience with bladder catheterization for three weeks after hypospadias repair, an approach not previously described in the literature. We reviewed the charts of 189 patients who underwent hypospadias repair by a single pediatric urologist. The study population was divided as follows: group 1 consisted of children operated between March 2007 and September 2010 and whose catheters were left for one week (n=95); group 2 consisted of those operated between September 2010 and July 2013 and whose catheters were left for three weeks (n=94). The primary objective of the study was to compare complication rates between the two groups. Secondary outcomes were evaluation of the effect of age, surgical technique, curvature, and hypospadias degree as potential factors for postoperative complications. Median age at hypospadias repair was 18 months (range, 3-100 months) in group 1, and 16 months (range, 2-96 months) in group 2, P=.209. The complication rate was 22.1% (n=21) for group 1 and 7.4% (n=7) for group 2, P=.005. Complications observed in group 1 and 2 were meatal stenosis (n=4 and 2, respectively) and urethro-cutaneous fistulas (n=17 and 5, respectively). Coronal fistulas manifested more frequently in patients in group 1 compared to those in group 2 (13.7% vs. 3.2%, P=.01). Complications were observed in 20 patients out of 139 (11.5%) after Duplay, and in 8 patients out of 15 (53.3%) after Duckett (P<.001). In Duplay cases, complications were significantly associated with one-week bladder catheterization (OR: 5.00; 95% CI: 1.53-16.32; P=.008) and higher age group at operation (OR: 1.88; 95% CI 1.07-3.28; P=.026). In Duckett cases, number of surgeries, age, severity, curvature and catheter duration were not found to be associated with complications. In cases of Duplay, a three-week instead of one-week catheterization and age below 6 months at hypospadias repair are associated with a better outcome and fewer complications. Copyright © 2015 Elsevier Inc. All rights reserved.

Hypospadias surgery in children: improved service model of enhanced recovery pathway and dedicated surgical team.

PubMed

Wong, Y S; Pang, K K; Tam, Y H

2018-05-21

Children in Hong Kong are generally hospitalised for 1 to 2 weeks after hypospadias repairs. In July 2013, we introduced a new service model that featured an enhanced recovery pathway and a dedicated surgical team responsible for all perioperative services. In this study, we investigated the outcomes of hypospadias repair after the introduction of the new service model. We conducted a retrospective study on consecutive children who underwent primary hypospadias repair from January 2006 to August 2016, comparing patients under the old service with those under the new service. Outcome measures included early morbidity, operative success, and completion of enhanced recovery pathway. The old service and new service cohorts comprised 176 and 126 cases, respectively. There was no difference between the two cohorts in types of hypospadias and surgical procedures performed. The median hospital stay was 2 days in the new service cohort compared with 10 days in the old service cohort (P<0.001). Patients experienced less early morbidity (5.6% vs 15.9%; P=0.006) and had a lower operative failure rate (20.2% vs 44.2%; P<0.001) under the new service than the old service. Multivariable analysis revealed that the new service significantly reduced the odds of early morbidity (odds ratio=0.35, 95% confidence interval=0.15-0.85; P=0.02) and operative failure (odds ratio=0.32, 95% confidence interval=0.17-0.59; P<0.001) in comparison with the old service. Of the new service cohort, 111(88.1%) patients successfully completed the enhanced recovery pathway. The enhanced recovery pathway can be implemented safely and effectively to primary hypospadias repair. A dedicated surgical team may play an important role in successful implementation of the enhanced recovery pathway and optimisation of surgical outcomes.

Impact of smartphone digital photography, email, and media communication on emergency room visits post-hypospadias repair.

PubMed

Chua, Michael E; Saunders, Megan A; Bowlin, Paul R; Ming, Jessica M; Lopes, Roberto Iglesias; Farhat, Walid A; Dos Santos, Joana

2017-01-01

Advances in communication technology are shaping our medical practice. To date, there is no clear evidence that this mode of communication will have any effect on unnecessary postoperative emergency room (ER) visits. We aim to evaluate the effect of email and media communication with application of smartphone digital photography on post-hypospadias repair ER visit rates. This prospective cohort study included all patients who underwent hypospadias repair performed by a single surgeon from October 2014 to November 2015. Patients were categorized into two groups: Group A consented for smartphone photography and email communication and Group B declined. Reason for ER visits within 30 days postoperatively was assessed by another physician, who was blinded of patient group assignment. The reasons were categorized as: unnecessary ER visit, indicated ER visit, or visit unrelated to hypospadias surgery. Chi-square test and T-test were used for statistical analysis. Relative risk (RR) and corresponding 95% confidence interval (CI) were also calculated. Statistical significance was set at p<0.05. Over a 14-month period, 96 patients underwent hypospadias repair (81 in Group A, 15 in Group B 5). No significant difference was noted between groups for overall ER return rate (RR 0.46, 95% CI 0.21, 1.0). However, the number of ER visits for wound check not requiring intervention was significantly lower in Group A than in Group B (RR 0.14, 95% CI 0.035, 0.56); likewise, a higher number of ER visits requiring intervention was noted in Group A compared with Group B, although statistically this was not significant (RR 1.67, 95% CI 0.23, 12.21). Email communication with the use of smartphone digital photography significantly reduced the number of unnecessary ER visits for post-hypospadias wound checks.

Ex-Premature Infant Boys with Hypospadias are Similar in Size to Age-Matched, Ex-Premature Infant Boys Without Hypospadias

PubMed Central

Hsieh, Michael H.; Alonzo, David G.; Gonzales, Edmond T.; Jones, Eric A.; Cisek, Lars J.; Roth, David R.

2010-01-01

OBJECTIVE Studies have postulated that hypospadias, prematurity, and low birth weight are linked by defects in androgen signaling. To determine whether premature, hypospadiac boys are small and remain so, we compared their size at birth and at hypospadias repair to premature boys who underwent post-neonatal circumcision. METHODS We identified premature boys admitted to Texas Children's Hospital who underwent either hypospadias repair or circumcision after 4 months of age. Age, weight, and height at birth and surgery were recorded. RESULTS Fifty-four boys had hypospadias and 34 did not. For hypospadiac boys, the mean birth weight and age, height, and weight at surgery were lower than for boys without hypospadias. More importantly, length-for-age and weight-for-age percentiles were also lower for hypospadiac boys. When subset analysis was performed on boys younger than 2 years at surgery, however, there were no significant differences in height or weight between hypospadiac and nonhypospadiac boys. CONCLUSION Our series suggests that premature, hypospadiac boys are born smaller than age-matched, non-hypospadiac controls. However, there were no age-corrected size differences between hypospadiac and non-hypospadiac boys at surgery. This implies that hypospadiac boys exhibit postneonatal ‘rebound’ growth. Global growth deficits, if any, do not persist in hypospadiac boys. PMID:20833109

Midline dorsal plication to repair recurrent chordee at reoperation for hypospadias surgery complication.

PubMed

Yucel, Selcuk; Sanli, Ahmet; Kukul, Erdal; Karaguzel, Gungor; Melikoglu, Mustafa; Guntekin, Erol

2006-02-01

Midline dorsal plication is an efficient and safe surgical technique to correct chordee. We investigated the efficacy of midline dorsal plication for recurrent chordee in complicated hypospadias reoperations. We retrospectively evaluated the charts of 25 boys who underwent reoperation between 1999 and 2004 due to complications of primary hypospadias repair other than meatal stenosis. A total of 15 cases were initially managed elsewhere for primary repair or complications. The etiology of recurrent chordee was defined at surgical correction. When recurrent chordee was noted a midline dorsal plication was performed. Of 25 patients 10 had previously undergone chordee repair. Nine of these patients were observed to have recurrent chordee and 1 had de novo chordee. A total of 10 patients had recurrent or delayed onset chordee. Mean patient age at primary repair was 6.28 years (range 1 to 33). Mean age at last operation for chordee was 15.9 years (range 4 to 66). Mean interval to recurrent chordee was 6 years (range 1 to 16), excluding a 66-year-old blind patient who did not know when recurrent chordee developed. Five patients had chordee recur before puberty at a mean interval of 2.6 years. Mean reoperation rate was 2.4 for recurrent chordee cases and 2.6 for chordee-free cases. Mean followup after midline dorsal plication for recurrent chordee repair was 22 months (range 8 to 56), while mean followup in pubertal and postpubertal cases was 20 months. No recurrence of chordee or surgery related morbidity was observed after recurrent chordee repair by midline dorsal plication. Chordee may recur during puberty following successful chordee repair. The midline dorsal plication technique is simple, efficient and safe even in patients who have undergone multiple surgeries for hypospadias and chordee repair.

Complications of hypospadias surgery: Experience in a tertiary hospital of a developing country

PubMed Central

Appeadu-Mensah, William; Hesse, Afua Adwo Jectey; Glover-Addy, Hope; Osei-Nketiah, Samuel; Etwire, Victor; Sarpong, Pokua Ama

2015-01-01

Background: Over 300 different operations have been described for the management of hypospadias. In recent times, the numbers of operations used in various centres have gradually reduced as the principles necessary to ensure adequate cosmetic and functional results with minimum complications are better understood. The aim of this article was to review the different types of operations used for managing hypospadias in a tertiary hospital in a developing country, to analyse the complications of surgery and discuss the factors that contribute to complications. Materials and Methods: Patient folders, theatre, and ward records were used to obtain the required information. The age at surgery, types of hypospadias at presentation, types of operations done and complications were analysed. Results and Conclusion: With three main types of operations, tubularised incised plate urethroplasty and meatal advancement and glanuloplasty incorporated for anterior hypospadias (glanular, coronal, subcoronal, distal, midpenile), and lateral based flap urethroplasty for posterior hypospadias (proximal penile, penoscrotal, scrotal, perineal), most hypospadias were corrected with acceptable complication rates. PMID:26712282

Psychosocial outcome in adult men born with hypospadias.

PubMed

Örtqvist, L; Andersson, M; Strandqvist, A; Nordenström, A; Frisén, L; Holmdahl, G; Nordenskjöld, A

2017-02-01

Hypospadias, which is a surgically treated congenital malformation of the male urethra, may have a negative impact on quality of life. This aspect has previously been subject to limited research. This study examined the long-term psychosocial outcome of a large cohort of adult males born with hypospadias. The purpose of this case-control study was to assess a possible negative influence on the psychosocial outcome in adult males with hypospadias. Males with hypospadias treated in Sweden and aged ≥18 years old participated in this follow-up study. Age-matched men and university students were recruited as controls. The participants answered a questionnaire designed to reflect the subjective quality of life, social factors, need of support and follow-up, and the perceived impact of the disease upon upbringing. It also looked at the validated Psychological General Well-Being (PGWB) questionnaire and Relationship Questionnaire (RQ). A total of 167 patients (median age 34 years, 63% distal, 24% mid, and 13% proximal hypospadias) and 169 controls (median age 33 years) participated in the study. Patients had their first operation at 4 years of age (median) and the median follow-up time was 29 years following the first surgery. Men with hypospadias had a comparable total quality of life level with a mean total PGWB score of 82 (normal range 78-83) compared with 85.6 in controls. Scores on wellbeing and vitality were lower, even if the differences were small. Hypospadias did not affect marital status, presence of children in the family, frequency of employment or experience of bullying. These men more often lived at home with their parents (P=0.001) and had a lower level of education (P=0.004), even if the educational level in both patients and controls was high compared with the general Swedish population. Patients with proximal hypospadias were shorter compared with controls (P=0.003), which was consistent with the prenatal growth restriction associated with hypospadias. The group with proximal hypospadias expressed a greater need for medical (45.5%) follow-up compared with mid (28.2%) and distal (18.1%) cases (P=0.001). Patients with proximal hypospadias tended to avoid close relationships because of fear of being hurt. The findings suggested that patients treated for hypospadias have a good HRQoL, can be expected to have a normal psychosocial life, and marry and have children. Repeated follow-up and psychological support during childhood/adolescence is however of great importance for patients with more proximal hypospadias. Copyright © 2016 Journal of Pediatric Urology Company. Published by Elsevier Ltd. All rights reserved.

Is glans penis width a risk factor for complications after hypospadias repair?

PubMed

Faasse, M A; Johnson, E K; Bowen, D K; Lindgren, B W; Maizels, M; Marcus, C R; Jovanovic, B D; Yerkes, E B

2016-08-01

Recent studies have suggested that a smaller glans penis size may be associated with a higher likelihood of complications after hypospadias repair. Accurate identification of risk factors other than the well-understood variable of meatal location would allow development of better prognostic models and individualized risk stratification. To test the hypothesis that a smaller width of the glans penis predicts adverse outcomes after hypospadias surgery. Prospectively recorded clinical data were reviewed from a single-institution registry of primary hypospadias repairs performed between 2011 and 2014. Follow-up records were examined for occurrence of complications. Urethroplasty complications were defined to include meatal stenosis, dehiscence, urethrocutaneous fistula, urethral stricture, and/or urethral diverticulum. The subset of meatal stenosis and dehiscence were regarded as glanular complications. Regression analyses were performed to determine association between glans width and occurrence of complications. Because pre-operative androgen stimulation is known to increase glans penis size, separate subgroup analyses were included of patients with and without pre-operative use of testosterone cream. A total of 159 patients met criteria for inclusion in the study cohort: 140 patients underwent a single-stage repair, while 19 patients had a two-stage repair. The median glans penis width was 15 mm (range 10-22). Eighty-four patients (53%) received testosterone cream pre-operatively and had a significantly wider glans penis than the 75 patients who did not (median 15.5 vs 14 mm; P < 0.001). Median clinical follow-up was 7 months (IQR 1-12), with a minimum time elapsed since surgery of 10 months at the time of chart review. Twenty-four patients (15%) had one or more urethroplasty complications, including 11 (7%) with glanular complications. Overall, there was no statistically significant association between glans width and urethroplasty complications (P = 0.26) or glanular complications (P = 0.90) (Summary Table). Subgroup analyses of patients with and without pre-operative testosterone also revealed no significant associations between glans width and complications. Glans penis width was not a risk factor for complications after hypospadias repair. This finding differs from the results of other recent studies and encourages further research into the value of measuring penile parameters in patients undergoing hypospadias repair. Copyright © 2016 Journal of Pediatric Urology Company. Published by Elsevier Ltd. All rights reserved.

High GMS score hypospadias: Outcomes after one- and two-stage operations.

PubMed

Huang, Jonathan; Rayfield, Lael; Broecker, Bruce; Cerwinka, Wolfgang; Kirsch, Andrew; Scherz, Hal; Smith, Edwin; Elmore, James

2017-06-01

Established criteria to assist surgeons in deciding between a one- or two-stage operation for severe hypospadias are lacking. While anatomical features may preclude some surgical options, the decision to approach severe hypospadias in a one- or two-stage fashion is generally based on individual surgeon preference. This decision has been described as a dilemma as outcomes range widely and there is lack of evidence supporting the superiority of one approach over the other. The aim of this study is to determine whether the GMS hypospadias score may provide some guidance in choosing the surgical approach used for correction of severe hypospadias. GMS scores were preoperatively assigned to patients having primary surgery for hypospadias. Those patients having surgery for the most severe hypospadias were selected and formed the study cohort. The records of these patients were reviewed and pertinent data collected. Complications requiring further surgery were assessed and correlated with the GMS score and the surgical technique used for repair (one-stage vs. two-stage). Eighty-seven boys were identified with a GMS score (range 3-12) of 10 or higher. At a mean follow-up of 22 months the overall complication rate for the cohort after final planned surgery was 39%. For intended one-stage procedures (n = 48) an acceptable result was achieved with one surgery for 28 patients (58%), with two surgeries for 14 (29%), and with three to five surgeries for six (13%). For intended two-stage procedures (n = 39) an acceptable result was achieved with two surgeries for 26 patients (67%), three surgeries for eight (21%), and four surgeries for three (8%). Two other patients having two-stage surgery required seven surgeries to achieve an acceptable result. Complication rates are summarized in the Table. The complication rates for GMS 10 patients were similar (27% and 33%, p = 0.28) for one- and two-stage repairs, respectively. GMS 11 patients having a one-stage repair had a significantly higher complication rate (69%) than those having a two-stage repair (29%) (p = 0.04). GMS 12 patients had the highest complication rate with a one-stage repair (80%) compared with a complication rate of 37% when a two-stage repair was used (p = 0.12). Guidelines to help standardize the surgical approach to severe hypospadias are needed. Staged surgery for GMS 11 and 12 patients may result in a lower complication rate but may not reduce the number of surgeries required for an acceptable result. Although further study is needed, the GMS score may be helpful for establishing such criteria. Copyright © 2017 Journal of Pediatric Urology Company. Published by Elsevier Ltd. All rights reserved.

The hypospadias classification affected the surgical outcomes of staged oral mucosa graft urethroplasty in hypospadias reoperation: An observational study.

PubMed

Zheng, Dachao; Fu, Shi; Li, Wenji; Xie, Minkai; Guo, Jianhua; Yao, Haijun; Wang, Zhong

2017-11-01

The staged graft urethroplasty is a recommended technique for repairing complex hypospadias. This retrospective study aimed to investigate the outcomes of this technique in hypospadias patients undergoing reoperation and to analyze the underlying contributing factors including age, meatus location, and graft and suture type.We retrospectively analyzed 40 hypospadias patients undergoing reoperation who received a staged oral graft urethroplasty, including 15 buccal mucosal grafts and 25 lingual mucosal grafts. Median age at presentation was 18.5 years, and median follow-up was 17.5 months (range 8-30 months). The patients were classified according to their original meatus location.Twenty-five complications developed in 12 of 40 (30%) cases, including 6 fistulas (15%), 7 infections (17.5%), 9 cases of glans dehiscence (22.5%), and 3 cases of stenosis (7.5%). There was no significant difference in the overall complication rates between prepuberty and postpuberty groups. In addition, no significant difference in complications was found between the 2 graft techniques. The complications were significantly higher in the original perineal type compared with the original penoscrotal type (7/10 vs 5/30, P = .0031). Seven patients who originally had perineal hypospadias developed multiple complications.Based on this study, the staged graft urethroplasty is an effective technique in reoperative hypospadias repairs with reasonable complication risk. The hypospadias classification affects the surgical outcomes. Copyright © 2017 The Authors. Published by Wolters Kluwer Health, Inc. All rights reserved.

Outcome of urethroplasty after parenteral testosterone in children with distal hypospadias.

PubMed

Menon, P; Rao, K L N; Handu, A; Balan, L; Kakkar, N

2017-06-01

Pre-operative testosterone use in hypospadias surgery is known to increase penile dimensions and vascularity, which should facilitate tension-less formation of the urethral tube and tissue healing. However, androgens can have a negative effect on wound healing. There are very few randomized studies on postoperative results after androgen use, and this study attempted to understand the utility of pre-operative testosterone in distal hypospadias. To study the effect of parenteral testosterone in children undergoing single stage urethroplasty for distal hypospadias, especially the occurrence of urethrocutaneous fistula and wound dehiscence. Patients were prospectively enrolled and randomized into two groups: Group 1 (control group) and Group 2 (receiving three injections of pre-operative intramuscular testosterone enanthate (2 mg/kg) at 1 monthly intervals; they were further subdivided into those operated 1 month (Group 2A) or 3 months (Group 2B) later. Patients with micropenis, previous testosterone use or any surgical intervention were excluded. Preputial skin was studied with hematoxylin and eosin (H&E) staining and CD31 immunohistochemistry. Patients were followed up for at least 18 months. Ninety four patients underwent urethroplasty over a 3.5-year period. Penile dimensions increased significantly after testosterone use (Summary table). On H&E staining, proliferating blood vessels and increased lymphocytic infiltrates were significantly increased in Group 2B. Group 2 patients tended to have more postoperative edema and inflammation. Although urethrocutaneous fistula rates were similar in Group 1 (n = 7) and Group 2 (n = 5) (P = 0.438), wound dehiscence occurred only in Group 2 (P = 0.01). The total number of patients in this study was small and this was a drawback. Although, several factors played a role in wound healing, the overall higher complication rate, especially wound dehiscence in Group 2, pointed to a higher incidence of inflammatory reaction and healing complication rates with testosterone use. Testosterone should be used judiciously in distal hypospadias. While tissue availability significantly increased, there was an increase in inflammatory reaction and edema, which increased the risk of wound dehiscence in cases of precocious surgery. Copyright © 2017 Journal of Pediatric Urology Company. Published by Elsevier Ltd. All rights reserved.

2-stage repair in infancy for severe hypospadias with chordee: long-term results after puberty.

PubMed

Lam, Po N; Greenfield, Saul P; Williot, Pierre

2005-10-01

Urinary and sexual functions were assessed in post-pubescent boys who had undergone 2-stage hypospadias repair in infancy for severe hypospadias with chordee. A total of 44 boys who had undergone 2-stage hypospadias repair from 1985 to 1993 and who were at least 13 years old were contacted. Of the 44 boys 27 (61%) with an average age of 15.4 years (range 13 to 21) responded. Meatal locations were midshaft in 14 cases, penoscrotal in 9 and perineal in 4. Four boys had bifid scrotum and 5 had intersex disorders. Intramuscular testosterone was administered preoperatively to 15 (56%) boys. A Nesbit procedure was performed in 18 boys (67%). Average patient age at stage 2 repair was 2.3 years. Mean followup was 12.7 years (range 10.7 to 17.2). Additional surgery was performed for diverticuli in 5 cases, fistula in 3 and minor strictures in 4. Of the 27 patients 25 presented for examination and 2 responded to questionnaire only. All patients had normal meatal position, normal glanular anatomy, a well-defined coronal sulcus, normal cylindrical shafts without extra skin and well-defined penoscrotal junctions. Ten boys (40%) had minor spraying of stream, all stood to void and 10 (40%) milked the urethra after voiding. None had chordee. Twenty patients were able to ejaculate and 9 (42.9%) had to milk the ejaculate. Two patients (7.7%) had minor pain with erection. All subjects were satisfied with urinary, erectile and ejaculatory functions, and 23 (92%) were pleased with appearance. The 2-stage approach for severe hypospadias results in excellent function, cosmesis and patient satisfaction after puberty, with no chordee. Minor voiding and ejaculatory problems are to be expected. Late complications are rare. The use of extragenital skin to either primarily repair or salvage a "cripple" has not been necessary.

Improved outcomes after technical modifications in tubularized incised plate urethroplasty for mid-shaft and proximal hypospadias.

PubMed

Tam, Yuk Him; Pang, Kristine Kit Yi; Wong, Yuen Shan; Tsui, Siu Yan; Wong, Hei Yi; Mou, Jennifer Wai Cheung; Chan, Kin Wai; Lee, Kim Hung

2016-11-01

To investigate and compare the outcomes after tubularized incised plate (TIP) urethroplasty in mid-shaft and proximal hypospadias using a standard and a modified technique. We conducted a retrospective study in 104 consecutive children who underwent mid-shaft or proximal TIP repairs from Jan 2007 to Sept 2015. Patients in Cohort One had dorsal dartos (DD) neourethral coverage while patients in Cohort Two had either de-epithelialized split preputial (DESP) or tunica vaginalis (TV) flap coverage. TV flap was used only when DESP flap was not sufficient to cover the neourethra. There were 52 patients each in Cohort One (DD, n = 52) and Cohort Two (DESP, n = 38; TV, n = 14) with no difference in ratio of mid-shaft/proximal between the two cohorts. At a median follow-up of 28 months, 36 patients (34.6 %) developed 47 complications including fistula (n = 19; 18.3 %) and neourethral dehiscence (n = 4; 3.8 %). Cohort One patients had significantly more fistula (28.8 vs 7.7 %; p = 0.005) and neourethral dehiscence (7.7 vs 0 %; p = 0.04) than Cohort Two. There was no difference between the two cohorts in the complication rates of meatal stenosis, recurrent ventral curvature and neourethral stricture. Both DESP and TV flap appear to be superior to DD in preventing fistula and neourethral dehiscence in non-distal TIP repairs.

Two-stage graft urethroplasty for proximal and complicated hypospadias in children: A retrospective study.

PubMed

Faure, Alice; Bouty, Aurore; Nyo, Yoke Lin; O'Brien, Mike; Heloury, Yves

2016-10-01

Although two-stage graft urethroplasty is widely used, the literature regarding the complication rates and functional characteristics of reconstructed neourethra is relatively modest. The aim was to analyze the complication rates and uroflow data of boys who have previously undergone a two-stage graft urethroplasty procedure for proximal and complicated hypospadias. We retrospectively reviewed the clinical outcomes of 52 boys with proximal (n = 44) and complicated (n = 8) hypospadias who underwent two-stage graft urethroplasty repair (median age of 15 months and 3 years respectively) between 2004 and 2015. Fifteen toilet-trained boys without fistulas underwent uroflowmetry. The uroflow data were plotted on age-volume-dependent normograms with normal controls. The median follow-up was 34 months (8 months-8 years). Complications were identified in three patients (6%) after the first stage (i.e. contracture of the graft) and in 20 patients (38.4%) after the second stage, including meatal stenosis (n = 8, 15.3%), urethral stricture (n = 4, 7.6%), urethrocutaneous fistula (n = 8, 15.3%), glandular dehiscence (n = 1, 1.9%), and diverticulum (n = 1, 1.9%). The patients with failed hypospadias experienced fewer complications than those who underwent the two-stage procedure for primary repair (25% and 45%, respectively). The reoperation rate was 36.8%. Eleven of the 15 toilet-trained boys were asymptomatic but exhibited flow rates below the normal range (median Q max  = 7 mL/s, range 3.5-16.7). Only one of the boys with a low flow rate was confirmed to have urethral stenosis under general anesthesia. In our study, primary hypospadias repair requiring urethral plate transection elicited worse outcomes than those observed in the prior failed hypospadias cases. However, because of our study's retrospective design, we were unable to accurately assess the initial position of the meatus in the redo hypospadias cases. Our data also demonstrated that the majority of cases without any voiding symptoms exhibited flow rates that were below the normal range despite no urethral stricture under general anesthesia. These findings indicate that urethras reconstructed via two-stage graft urethroplasty repair are not functionally equivalent to normal urethras, at least prior to puberty. Two-stage graft urethroplasty repair was successful in 62% of cases after the second-stage procedure, but one-third of the boys required a reoperation after the two-stage planned repair. We demonstrated that although we used a urethral tissue substitute, the urine flow patterns of the patients without strictures were abnormal. Copyright © 2016 Journal of Pediatric Urology Company. All rights reserved.

Cri-du-chat (5p-) syndrome presenting with cerebellar hypoplasia and hypospadias: prenatal diagnosis and aCGH characterization using uncultured amniocytes.

PubMed

Chen, Chih-Ping; Huang, Ming-Chao; Chen, Yi-Yung; Chern, Schu-Rern; Wu, Peih-Shan; Su, Jun-Wei; Town, Dai-Dyi; Wang, Wayseen

2013-07-25

We present prenatal diagnosis of a de novo distal deletion involving 5p(5p15.1→pter) using uncultured amniocytes in a pregnancy with cerebellar hypoplasia, hypospadias and facial dysmorphisms in the fetus. We discuss the genotype-phenotype correlation and the consequence of haploinsufficiency of CTNND2, SEMA5A, TERT, SRD5A1 and TPPP. We speculate that haploinsufficiency of SRD5A1 and TPPP may be responsible for hypospadias and cerebellar hypoplasia, respectively, in this case. Copyright © 2013 Elsevier B.V. All rights reserved.

Proximal hypospadias: A persistent challenge. Single institution outcome analysis of three surgical techniques over a 10-year period.

PubMed

Pippi Salle, J L; Sayed, S; Salle, A; Bagli, D; Farhat, W; Koyle, M; Lorenzo, A J

2016-02-01

The optimal treatment of proximal hypospadias remains controversial. Several techniques have been described, but the best approach remains unsettled. To evaluate and compare the complication rates of proximal hypospadias with and without ventral curvature (VC), according to three different surgical techniques: tubularized incised plate (TIP) uretroplasty, dorsal inlay graft TIP (DIG), and staged preputial repair (SR). It was hypothesized that SR performs better than TIP and DIG for proximal hypospadias. Single-center, retrospective chart review of all patients with primary proximal hypospadias reconstructed between 2003 and 2013. The DIG was selectively employed in cases with narrow urethral plate (UP) and deficient spongiosum. Extensive urethral plate (UP) mobilization (UPM), dorsal plication (DP) and/or deep transverse incisions of tunica albuginea (DTITA) were selectively performed when attempting to spare transecting the UP. Division of UP and SR was favored in cases with severe VC (>50°), which was often concurrently managed with DTITA if intrinsic curvature was present. For SR, tubularization of the graft was performed 6 months later. A total of 140 patients were included. Tubularized incised plate (TIP), DIG, and SR techniques were performed in 57, 23, and 60 patients, respectively. The TIP and DIG techniques achieved similar success rates, although DIG was performed in cases of narrow and spongiosum-deficient plates. Reoperation rates with TIP and DIG techniques was 52.6% and 52.1% (NS). Urethro-cutaneous fistulas were seen in 31.5% and 13% of TIP and DIG techniques, respectively. Staged repair accomplished better results than both TIP and DIG techniques, despite being performed in the most unfavorable cases (reoperation rate 28%). After technical modifications, the DIG technique achieved similar outcomes of SR. Proximal hypospadias remains challenging, regardless of the technique utilized for its repair. Urethro-cutaneous fistulas were more commonly seen after long TIP repairs. Approximately half of the patients undergoing long TIP and DIG procedures needed re-intervention, although the percentage decreased significantly with late modifications in the DIG group. Recurrence of VC after TIP and DIG techniques seemed to be a significant and under-reported complication. Staged repairs, despite being performed for the most severe cases, resulted in overall better outcomes. Copyright © 2015 Journal of Pediatric Urology Company. Published by Elsevier Ltd. All rights reserved.

Hypospadias anatomy: Elastosonographic evaluation of the normal and hypospadic penis.

PubMed

Camoglio, Francesco Saverio; Bruno, Costanza; Zambaldo, Silvia; Zampieri, Nicola

2016-08-01

Hypospadias is one of the most common congenital anomalies in childhood. The aim of this study is to apply elastosonography on normal and hypospadic penis to verify the structural differences in tissues composition and stiffness. We analyzed medical chart of patients treated at our Institution for hypospadias during the period December 2005 and December 2014 (group 1). Other two groups were enrolled for this study: group 2- patients with hypospadias waiting for surgery and group 3-patients without hypospadias. Inclusion and exclusion criteria were created; all patients underwent penile ultrasound and elastosonography. Elastographic index of elasticity was defined as soft, medium-hard or hard. We assigned the value 1 to soft tissue, 2 and 3 to medium-hard and hard respectively. During the study period 294 patients were treated for hypospadias. After reviewing medical chart 115 patients were considered for analysis (group 1). 22 patients were enrolled in group 2 and 38 patients were enrolled in group 3. Group 1: 7 proximal hypospadias, 29 penile hypospadias, 79 distal hypospadias. Patients with hypospadias had malformation also at corpus spongiosum and cavernosum respect to controls. Elastography showed a corpus spongiosum stiffness defined as medium-hard or hard in all cases of the pathologic group and soft in all the subjects of the control group (p < 0.05). Elastosonography showed how the hypospadia anatomy is deeply altered, even in an anatomical area far from meatal abnormality: corpus spongiosum in hypospadic penis seems to be globally stiffer and less elastic and cavernous corpora are less developed. Copyright © 2016 Journal of Pediatric Urology Company. Published by Elsevier Ltd. All rights reserved.

Craniofacial anomalies associated with hypospadias. Description of a hospital based population in South America.

PubMed

Fernandez, Nicolas; Escobar, Rebeca; Zarante, Ignacio

2016-01-01

Hypospadias is a congenital abnormality of the penis, in which there is incomplete development of the distal urethra. There are numerous reports showing na increase of prevalence of hypospadias. Association of craniofacial malformations in patients diagnosed with hypospadias is rare. The aim of this study is to describe the association between hypospadias and craniofacial congenital anomalies. A retrospective review of the Latin-American collaborative study of congenital malformations (ECLAMC) data was performed between January 1982 and December 2011. We included children diagnosed with associated hypospadias and among them we selected those that were associated with any craniofacial congenital anomaly. Global prevalence was 11.3 per 10.000 newborns. In this population a total of 809 patients with 1117 associated anomalies were identified. On average there were 1.7 anomalies per patient. Facial anomalies were present in 13.2%. The most commonly major facial anomaly associated to hypospadias was cleft lip/palate with 52 cases. We identified that 18% have an association with other anomalies, and found an association between craniofacial anomalies and hypospadias in 0.59 cases/10.000 newborns. Hypospadias is the most common congenital anomaly affecting the genitals. Its association with other anomalies is rare. It has been reported that other malformations occur in 29.3% of the cases with hypospadias. The more proximal the meatus, the higher the risk for having another associated anomaly. Associated hypospadias are rare, and it is important to identify the concurrent occurrence of craniofacial anomalies to better treat patients that might need a multidisciplinary approach. Copyright© by the International Brazilian Journal of Urology.

Craniofacial anomalies associated with hypospadias. Description of a hospital based population in South America

PubMed Central

Fernandez, Nicolas; Escobar, Rebeca; Zarante, Ignacio

2016-01-01

ABSTRACT Introduction: Hypospadias is a congenital abnormality of the penis, in which there is incomplete development of the distal urethra. There are numerous reports showing an increase of prevalence of hypospadias. Association of craniofacial malformations in patients diagnosed with hypospadias is rare. The aim of this study is to describe the association between hypospadias and craniofacial congenital anomalies. Materials and Methods: A retrospective review of the Latin-American collaborative study of congenital malformations (ECLAMC) data was performed between January 1982 and December 2011. We included children diagnosed with associated hypospadias and among them we selected those that were associated with any craniofacial congenital anomaly. Results: Global prevalence was 11.3 per 10.000 newborns. In this population a total of 809 patients with 1117 associated anomalies were identified. On average there were 1.7 anomalies per patient. Facial anomalies were present in 13.2%. The most commonly major facial anomaly associated to hypospadias was cleft lip/palate with 52 cases. We identified that 18% have an association with other anomalies, and found an association between craniofacial anomalies and hypospadias in 0.59 cases/10.000 newborns. Discussion: Hypospadias is the most common congenital anomaly affecting the genitals. Its association with other anomalies is rare. It has been reported that other malformations occur in 29.3% of the cases with hypospadias. The more proximal the meatus, the higher the risk for having another associated anomaly. Conclusion: Associated hypospadias are rare, and it is important to identify the concurrent occurrence of craniofacial anomalies to better treat patients that might need a multidisciplinary approach. PMID:27564292

Hypospadias repair using laser tissue soldering (LTS): preliminary results of a prospective randomized study

NASA Astrophysics Data System (ADS)

Kirsch, Andrew J.; Cooper, Christopher S.; Canning, Douglas A.; Snyder, Howard M., III; Zderic, Stephen A.

1998-07-01

Purpose: The purpose of this study was to evaluate laser tissue soldering using an 808 nm diode laser and wavelength- matched human albumin solder for urethral surgery in children. Methods: Currently, 30 boys, ages 3 months to 8 years were randomized to standard suturing (n equals 22) or 'sutureless' laser hypospadias repair (n equals 18). Laser soldering was performed with a human albumin solder doped with indocyanine green dye (2.5 mg/ml) using a laser power output of 0.5 W, pulse duration of 0.5 sec, and interval of 0.1 sec. Power density was approximately 16 W/cm2. In the laser group, sutures were used for tissue alignment only. At the time of surgery, neourethral and penile lengths, operative time for urethral repair, and number of sutures/throws were measured. Postoperatively, patients were examined for complications of wound healing, stricture, or fistula formation. Results: Mean age, severity of urethral defect, type of repair, and neourethra length were equivalent between the two groups. Operative time was significantly faster for laser soldering in both simple (1.6 plus or minus 0.21 min, p less than 0.001) and complex (5.4 plus or minus 0.28 min, p less than 0.0001) hypospadias repairs compared to controls (10.6 plus or minus 1.4 min and 27.8 plus or minus 2.9 min, respectively). The mean number of sutures used in the laser group for simple and complex repairs (3.3 plus or minus 0.3 and 8.1 plus or minus 0.64, respectively) were significantly (p less than 0.0001) less than for controls (8.2 plus or minus 0.84 and 20 plus or minus 2.3, respectively). Followup was between 3 months and 14 months. The overall complication rate in the laser group (11%) was lower than the controls (23%). However, statistical significance (p less than 0.05) was achieved only for the subgroup of patients undergoing simple repairs (LTS, 100% success versus suturing, 69% success). Conclusions: These preliminary results indicate that laser tissue soldering for hypospadias repair may be performed in a nearly sutureless fashion and in a more rapid manner than for conventional suturing. The trend towards a decreased rate of complications in the laser group at this time indicates that laser soldering may be an improved method of tissue closure for hypospadias repair. We continue to accrue patients to this study.

A novel technique for repair of mid-penile hypospadias using a preputial skin flap: results of 110 patients.

PubMed

Elmoghazy, Hazem; Hussein, Mohamed M; Mohamed, Elnisr; Badawy, Abdelbasset; Alsagheer, Gamal; Abd Elhamed, Ahmed Mamdouh

2016-12-01

Several techniques have been used to repair mid-penile hypospadias; however, high failure rates and major complications have been reported. In this study, we describe a novel technique using a well-vascularized flap of the inner and outer preputial skin. A total of 110 male children with hypospadias underwent repair by our technique between 2008 and 2015. The inclusion criteria were children with mid-penile or slightly more proximal hypospadias, with or without ventral chordae, and an intact prepuce of the cobra eyes variety. Recurrent cases, patients with other preputial types, and circumcised children were excluded from this study. The prepared flap was sutured in its natural longitudinal orientation to the created urethral plate strip to form a neo-urethra over a urethral catheter. Outcome measures included surgical success without the formation of a urethra-cutaneous fistula, no ischaemia of the flaps, glans dehiscence or infection and functional outcome and cosmetic appearance. The median follow-up duration was 3.3 years. There were 63 cases of mid-penile hypospadias (57.3 %), and in 47 cases (42.7 %), the meatus was slightly more proximal. The age of the patients ranged from 1.1 to 8.0 years, with a mean age of 4.6 ± 1.2 years. Surgery was successful in 106 (96.4 %) cases. Minor complications occurred in 11 patients (10 %) and included oedema of glans in ten patients and bluish discoloration on the ventral aspect of the glans close to the suture line in three patients. All patients improved within 2 weeks after surgery. Long-term follow-up revealed a properly functioning urethra with a forward, projectile, single, compact, and rifled urinary stream of adequate calibre and cosmetically acceptable repair. No cases of meatal retraction, meatal stenosis, urethral stricture, or acquired urethral diverticulum occurred. Our technique is different from the split prepuce in situ technique. We create a narrow strip of the urethral plate that facilitates glanular closure, and we use the inner and adjacent outer skin in a vertical manner to preserve excess skin for penile coverage. Prepuce is split at midline to preserve more preputial skin with favourable dartos tissue for penile skin coverage. The glans is closed using a stitch-by-stitch method that has not been described previously. This study presents a novel technique for mid-penile hypospadias repair using a preputial skin flap with excellent results in terms of short- and long-term outcomes.

Modified tubularized incised plate urethroplasty reduces the risk of fistula and meatal stenosis for proximal hypospadias: a report of 63 cases.

PubMed

Arshadi, Hamid; Sabetkish, Shabnam; Kajbafzadeh, Abdol-Mohammad

2017-12-01

To report the feasibility of modified tubularized incised plate (TIP) urethroplasty technique for proximal hypospadias in 63 cases. From January 2004 to March 2010, 63 patients underwent one-stage TIP urethroplasty (modified Snodgrass technique repair) using 2-3 of three covering layers (corpus spongiosum, dartos, and tunica vaginalis). The primary meatus was proximal penile, penoscrotal, scrotal, and perineal in 38, 13, 10, and 2 patients, respectively. All patients had chordee that was corrected with dorsal plication. Glanuloplasty was performed in all cases. Complications and cosmetic results were documented after 6-72 months of follow-up. A total of 63 boys with proximal hypospadias underwent Snodgrass hypospadias repair at a mean age of 8.5 months (range 6-54). Mean operative time was 210 ± 35 min. Patients were followed up with 6-month intervals for up to 6 years postoperatively. After 6 years of follow-up, nine urethrocutaneous fistulae, four bleeding, four meatal stenoses, and one urethral stricture were reported. Cosmetic result was satisfactory according to parent's opinion and another surgeon. No residual chordee was observed in any cases (without artificial correction). In conclusion, this preliminary report can be estimated as an alternative technique with acceptable complication and cosmetic results for proximal hypospadias correction.

How to improve outcome in surgery for Proximal Hypospadias?

PubMed

Qureshi, Abdul Hafeez; Zaidi, Syed Zafar

2016-02-01

To evaluate the role of subdartos fascial tissue as watertight layer in improving outcome for 2-stage proximal hypospadias surgery. The experimental study was conducted at the Department of Urology, Indus Hospital, Karachi, and comprised an audit of patients with proximal hypospadias who underwent surgery from July 1, 2007, to December 31, 2011. The initial two-stage repair of proximal hypospadias led to a high rate of urethrocutanous fistula formation (Group A), and, thus, a modification was introduced and subdartos facial double layer was applied over the urethral suture line (Group B). The results were compared regarding age, type of hypospadias, graft failure and urethrocutanous fistula in these patients. There were 27 patients in Group A and 16(59.3%) of them ended up having urethrocutanous fistula. Group B had 25 patients and only 2(8%) had fistula formation. The application of dartos facial flap waterproofing layer reduced fistula rate.

External Genital Development, Urethra Formation, and Hypospadias Induction in Guinea Pig: A Double Zipper Model for Human Urethral Development.

PubMed

Wang, Shanshan; Shi, Mingxin; Zhu, Dongqing; Mathews, Ranjiv; Zheng, Zhengui

2018-03-01

To determine whether the guinea pig phallus would be an appropriate model of human penile development, we characterized the embryology and sexual differentiation of guinea pig external genitalia and attended to induce hypospadias in males and tubular urethra formation in females pharmacologically. The external genitalia of guinea pig were collected from genital swelling initiation to newborn stages, and scanning electronic microscopy and histology were performed to visualize the morphology and structure. Immunohistochemistry was used to determine the androgen receptor localization. Bicalutamide and methyltestosterone were given to pregnant dams to reveal the role and timing of androgen in guinea pig penile masculinization. Canalization and dorsal-to-ventral movement of the urethral canal develops the urethral groove in both sexes, and then the males perform distal-opening-proximal-closing to form tubular urethra. More nuclear-localized androgen receptor is found in proximal genital tubercles of males than in females at (E) 29. Antiandrogen treatment at E26-E30 can cause hypospadias, and methyltestosterone administration at E27-E31 can induce tubular urethra formation in females. Fetal development of the guinea pig phallus is homologous to that of humans. Although guinea pig has structures similar to mouse, the urethral groove and the tubular urethra formation are more similar to humans. Antiandrogen treatment causes hypospadias in males and additional androgen induces tubular urethra formation in females. Thus, guinea pig is an appropriate model for further study of cellular and molecular mechanisms involved in distal-opening-proximal-closing in tubular urethra formation and the evaluation of the pathophysiological processes of hypospadias. Published by Elsevier Inc.

Management of Proximal Hypospadias with 2-Stage Repair: 20 Year Experience

PubMed Central

McNamara, Erin R.; Schaeffer, Anthony J.; Logvinenko, Tanya; Seager, Catherine; Rosoklija, Ilina; Nelson, Caleb P.; Retik, Alan B.; Diamond, David A.; Cendron, Marc

2015-01-01

Purpose To describe our experience with 2-stage proximal hypospadias repair and report outcomes. To look at patient and procedure characteristics associated with surgical complications. Materials and Methods This was a retrospective study of patients with proximal hypospadias who underwent staged repair from January 1993–December 2012. Demographics, preoperative management, and operative technique were reviewed. Complications included glans dehiscence, fistula, meatal stenosis, non-meatal stricture, urethrocele/diverticula, and residual chordee. Cox proportional hazards model was used to evaluate the associations between the time to surgery for complications and patient- and procedure level factors. Results There were 134 patients. The median age at time of first stage surgery was 8.8 months. The median age at time of second stage surgery was 17.1 months and median time between surgeries was 8 months. The median follow-up was 3.8 years. Complications were seen in 71/134 (53%), the most common being fistula in 39/134 (29.1%). Reoperation was performed in 66/134 (49%) patients. Median time from urethroplasty to surgery for complication was 14.9 months. Use of preoperative testosterone decreased risk of having surgery for complication by 27% (hazard ratio (HR)=0.73 95%CI:0.55–0.98, p=0.04). In addition, patients that identified as Hispanic had an increased risk of having surgery for complications (HR=2.40 95%CI:1.28–4.53, p=0.01). Conclusions This study reviews the largest cohort of patients undergoing 2-stage hypospadias repair at a single institution. Complications and reoperation are close to 50% in the setting of complex genital reconstruction. PMID:25963188

Fetal growth restriction but not preterm birth is a risk factor for severe hypospadias.

PubMed

Hashimoto, Yukiko; Kawai, Masahiko; Nagai, Sizuyo; Matsukura, Takashi; Niwa, Fusako; Hasegawa, Takeshi; Heike, Toshio

2016-07-01

Hypospadias has multifactorial causes and occurs at a high frequency among very low-birthweight infants. Placental insufficiency is hypothesized to be one cause of hypospadias; that is, decreased human chorionic gonadotropin (hCG) secretion caused by placental insufficiency is suspected to result in abnormal male external genitalia, but there is little direct evidence to support this. The aim of this study was therefore to identify the features of hypospadias and to clarify the male genital abnormalities caused by fetal growth restriction (FGR). We reviewed the clinical data of boys who underwent hypospadias repair between 2005 and 2011 at Kyoto University Hospital. Twenty boys were included in this study. Fifteen (75%) of the subjects were preterm or low-birthweight infants. Thirteen (65%) had FGR, 60% of whom had severe hypospadias regardless of gestational age. In addition, 92% of the FGR infants also had other genital anomalies, such as cryptorchidism, bifid scrotum, or micropenis. In contrast, only 14% and 43% of the non-FGR infants had severe hypospadias or genital anomalies other than hypospadias, respectively. Placental histopathology was available in eight FGR infants, in seven of whom it was suggestive of blood flow deficiency such as infarction and single umbilical artery. Infants with FGR have a high incidence of hypospadias. FGR caused by placental dysfunction, but not low birthweight, is a risk factor for severe hypospadias associated with multiple genital anomalies. © 2015 Japan Pediatric Society.

Transitioning patients with hypospadias and other penile abnormalities to adulthood: What to expect?

PubMed Central

Braga, Luis H.

2018-01-01

Hypospadias patients presenting to adult urologists do so with a wide range of symptoms and problems, including urethral stricture (45–72%), lower urinary tract symptoms (with or without stricture) (50–82%), urethrocutaneous fistula (16–30%), persisting hypospadias (14–43%), micturition spraying (24%), ventral curvature (14–24%), urinary tract infection (15–25%), or lichen sclerosus (13%; range 8–43). Many of these men have concurrent complications as the result of multiple operations and a variety of techniques. Patients with childhood repairs performed by a pediatric urologist are often lost to followup during adolescence and will reemerge in adulthood after what appeared to be a successful pediatric single-stage repair, stressing the need for long-term followup and transitional care. One of the major challenges in successful transitional care is that patients can feel traumatized with feelings of hopelessness surrounding their defects, leaving them hesitant to seek care. As well, these patients often have little knowledge regarding the type of repair or original location of the meatus. Urethral stricture is the most common presenting complication and could be related to various factors, with the clear etiology still under debate. These strictures can fall under four categories based on length, location, and previous surgeries. To lessen the difficulties in transitioning hypospadias patients from pediatric to adult practitioners, followup throughout childhood and adolescence for physical examination, as well as uroflowmetry, is mandatory. PMID:29681271

Long-term followup of men born with hypospadias: urological and cosmetic results.

PubMed

Örtqvist, Lisa; Fossum, Magdalena; Andersson, Marie; Nordenström, Anna; Frisén, Louise; Holmdahl, Gundela; Nordenskjöld, Agneta

2015-03-01

We present data on long-term functional and cosmetic results after hypospadias surgery. Males older than 18 years with hypospadias treated in Sweden were asked to participate in the study, as well as age matched controls and circumcised men. All participants answered questionnaires, and a subgroup was examined during an outpatient visit. Relationships with outcome were analyzed using analysis of variance and regression analysis. A total of 167 patients with a mean age of 34 years and 169 controls with a mean age of 33 years answered the questionnaire. Of the patients 63% had distal, 24% mid and 13% proximal hypospadias. A total of 46 patients and 49 controls presented for physical examination. Patients were significantly less satisfied with the penile cosmetic outcome regarding all parameters of the Penile Perception Score. There was a difference in penile length between patients and controls (mean 9.7 vs 11.6 cm, p <0.001). More patients than controls reported voiding dysfunction symptoms (p = 0.003). Patients had a lower maximum urinary flow rate than controls (p = 0.001). These differences were most prominent between patients with proximal hypospadias and controls. Men operated on for hypospadias were less satisfied with the cosmetic result than controls, and had a shorter penile length. Patients presented with more symptoms of voiding dysfunction and displayed a lower maximum urinary flow rate. Patients with proximal hypospadias were more affected than those with milder hypospadias. Our results indicate that patients with hypospadias can be subgrouped and that those with severe phenotypes should be followed more closely during childhood as well as later in adulthood. Copyright © 2015 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.

Resurfacing the Penis of Complex Hypospadias Repair ("Hypospadias Cripples").

PubMed

Fam, Mina M; Hanna, Moneer K

2017-03-01

After the creation of a neourethra in a "hypospadias cripple," resurfacing the penis with healthy skin is a significant challenge because local tissue is often scarred and unusable. We reviewed our experience with various strategies to resurface the penis of hypospadias cripples. We retrospectively reviewed the records of 215 patients referred after multiple unsuccessful hypospadias repairs from 1981 to 2014. In 130 of 215 patients we performed resurfacing using local penile flaps using various techniques, including Byars flaps, Z-plasty or double Z-plasty, or a dorsal relaxing incision. Of the 215 patients 85 did not have adequate healthy local penile skin to resurface the penis after urethroplasty. Scrotal skin was used to resurface the penis in 54 patients, 6 underwent tissue expansion of the dorsal penile skin during a 12 to 16-week period prior to penile resurfacing, 23 underwent full-thickness skin grafting and another 4 received a split-thickness skin graft. Of the 56 patients who underwent fasciomyocutaneous rotational flaps, tissue expansion or a combination of both approaches 54 (96.4%) finally had a successful outcome. All 6 patients who underwent tissue expansion had a successful outcome without complications and were reported on previously. All 23 full-thickness skin grafts took with excellent results. All 4 patients who underwent fenestrated split-thickness skin grafting had 100% graft take but secondary contraction and ulceration were associated with sexual activity. In our experience scrotal skin flaps, tissue expansion of the dorsal penile skin and full-thickness skin grafts serve as reliable approaches in resurfacing the penis in almost any hypospadias cripple lacking healthy local skin. Copyright © 2017 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.

Long-term functional outcomes after penoscrotal hypospadias repair: A retrospective comparative study of proximal TIP, Onlay, and Duckett.

PubMed

Hueber, Pierre-Alain; Salgado Diaz, Monica; Chaussy, Yann; Franc-Guimond, Julie; Barrieras, Diego; Houle, Anne-Marie

2016-08-01

A variety of techniques are available for proximal hypospadias repair. Onlay, proximal tubularized incised plate (TIP), and Duckett are among the popular choices because they can be performed as a one-step procedure. However, the decision to select a procedure often comes down to the surgeon's preference rather than that supported by evidence-based data. In particular, there is a paucity of literature on the long-term urinary outcomes after proximal hypospadias repair. The aim of this study was to evaluate the evolution of long-term uroflowmetry parameters after proximal hypospadias surgery over a long-term follow-up including the adolescent period. Files from patients who underwent primary proximal hypospadias repair at our institution between 1997 and 2001 were reviewed. Only patients with documented serial postoperative uroflowmetry profiles at follow-up visits were included. Comparison between surgeries (pTIP vs. Onlay vs. Duckett) was performed according to the following postoperative time interval endpoints: 0-1 years, 1-2, >2-4, >4-6, >6-10, >10-12, and >12 years. Maximal urinary flow rate (Qmax) in relation to voiding volume (VV) adjusted for age or body surface area (BSA) were also evaluated in comparison to normal children using established Miskolc nomograms and compared between surgery techniques. Fifty-two patients met the inclusion criteria with a median follow-up of 10 years: 25 (59.6%) TIP, 18 (34/6%) Onlay, and nine (17.3%) Duckett. Overall, Qmax increased progressively according to time and age in particular during the period covering adolescence. At follow-up 12 years postoperatively, median Qmax values were 18.5 mL/second, 13.8 mL/second and 16.6 mL/second for TIP, Onlay, and Duckett, respectively, with no significant differenced detected between groups (p = 0.5) see figure). Compared with normal children when adjusted for voiding volume and BSA, the proportion of obstructive uroflowmetry patterns defined as Qmax<25th percentile of nomograms was more prevalent in patients aged 3-7 years old at 83.8% but decreased to less than 21.2% in patients aged >13 years for all procedures (see figure). These results are consistent with previous work showing frequently reduced Qmax after hypospadias surgery with great potential for improvement at puberty. These results suggest that the obstructive urinary flow pattern observed in patients early on is a frequent finding after proximal hypospadias surgery. However, because of the remarkable improvement observed at puberty a watchful waiting approach is proposed in order to avoid unnecessary intervention. Copyright © 2016 Journal of Pediatric Urology Company. Published by Elsevier Ltd. All rights reserved.

History of hypospadias: Lost in translation.

PubMed

Hadidi, Ahmed T

2017-02-01

The evolution of hypospadias surgery can be classified under 3 periods that were closely related to advances in surgical instruments, introduction of anesthesia, and newer suture materials. Stretching dominated the early period, tunneling during the Middle Ages, and flaps during the modern period. Suture materials have included at various time silver wires, horsehair, and stainless steel. Examination and translation of the original manuscripts showed that Galen recommended stretching and suturing of glanular hypospadias and not amputation or partial penectomy as has been currently reported. The term chordee was first introduced in the 18th century in relation to gonorrhea and was defined as "painful imperfect erection of the penis during gonorrhea, with downward incurvation." This was a common complication of gonorrhea before the introduction of antibiotics. Mettauer, Duplay, Mayo, and others used the terms incurvation, ventral deformity, ventral curvature, and others. Clinton Smith in 1938 was the first surgeon to use the term congenital chordee in direct relation to hypospadias. The use of prepuce for urethroplasty, popular now, was first reported by Liston in 1838, Rochet in 1899, Russell in 1900, and Mayo in 1901. The two stage repair performed in the early 20th century differed from that in the early 21st century in that urethroplasty was performed in the first stage and only anastomosis to the original meatus was performed in the second stage. The two-stage repair, currently known as Bracka's two-stage repair, was first described in 1962 by Cloutier. The use of the urethral plate in epispadias was first described by Liston in 1838, Thiersch in 1869 and by Anger & Duplay in hypospadias in 1874. Partially epithelialized urethroplasty using the urethral plate was described by Duplay in 1880, Russell 1915, Denis Browne 1940, Reddy 1975, Orkiszewski 1987, Rich 1989, and Snodgrass in 1994. V. Copyright © 2017 Elsevier Inc. All rights reserved.

Sexuality and fertility in men with hypospadias; improved outcome.

PubMed

Örtqvist, L; Fossum, M; Andersson, M; Nordenström, A; Frisén, L; Holmdahl, G; Nordenskjöld, A

2017-03-01

The aim of this study was to investigate sexual function and fertility in adult men born with hypospadias. Patients born with hypospadias, age-matched controls, and a group of circumcised men completed a questionnaire constructed to reflect their psychosexual situation and fertility. Core gender identity, sexual orientation, and gender role behavior was also assessed. 167 patients [63% distal, 24% mid shaft and 13% proximal, mean age 34 (19-54) years], 169 controls from the general population [mean age 33 (19-48) years] and 47 controls circumcised because of phimosis (mean age 26 [19-44]) participated and completed the questionnaire. There were no differences in having a partner, reported fertility, age at sexarche (mean age 17.8), number of sex partners or sexual interest between the patients and controls. More patients than controls reported anejaculation. Reported glanular sensitivity was lower in hypospadias patients and circumcised controls compared with non-circumcised controls. The odds of being satisfied with their sexual life increased with a higher penile perception score in patients (OR = 1.54, p = 0.01). There was no association with penile length. Sexual orientation, core gender identity and gender role behavior were sex-typical in both patients and controls. Patients with proximal hypospadias had a lower reported fertility, experienced anejaculation more often, and were less satisfied with their sexual life. Men born with hypospadias have a good long-term outcome concerning sexual function and fertility. Men born with proximal hypospadias have a more impaired outcome concerning both sexual function and fertility. As satisfaction with genital appearance is important for sexual life satisfaction, clinical, and psychological follow-up into adulthood is especially important in boys born with proximal hypospadias. © 2016 American Society of Andrology and European Academy of Andrology.

Two-stage urethroplasty is a better choice for proximal hypospadias with severe chordee after urethral plate transection: a single-center experience.

PubMed

Zheng, Da-Chao; Yao, Hai-Jun; Cai, Zhi-Kang; Da, Jun; Chen, Qi; Chen, Yan-Bo; Zhang, Ke; Xu, Ming-Xi; Lu, Mu-Jun; Wang, Zhong

2015-01-01

It is still debatable whether single- or two-stage urethroplasty is a more suitable technique for treating hypospadias with severe chordee after urethral plate transection. This retrospective study evaluated these two techniques. A total of 66 patients of proximal hypospadias with severe chordee were divided into two groups according to the techniques they underwent: 32 and 34 patients underwent single-stage (Duckett) or two-stage urethroplasty, respectively. Median ages at presentation were 7.5 years and 11.0 years in single-stage and two-stage repair groups, respectively. Median follow-ups were 28.5 months (20-60 months) and 35 months (18-60 months) in the single-stage and two-stage groups, respectively. The meatus of the neourethra was located at the top of the glans in all patients. No recurrence of chordee was found during follow-up, and all patients or parents were satisfied with the penile length and appearance. Complications were encountered in eight patients in both groups, with no statistically significant differences between the two techniques. The late complication rate of stricture was higher after the single-stage procedure (18.75% vs 0%). The complication rate after single-stage repairs was significantly lower in the prepubescent subgroup (10.52%) than in the postpubescent cohort (46.15%). These results indicate that the urethral plate transection effectively corrects severe chordee associated with proximal hypospadias during the intermediate follow-up period. Considering the higher rate of stricture after single-stage urethroplasty, two-stage urethroplasty is recommended for proximal hypospadias with severe chordee after urethral plate transection.

Gender reversal in 46XX congenital virilizing adrenal hyperplasia.

PubMed

Sripathi, V; Ahmed, S; Sakati, N; al-Ashwal, A

1997-05-01

To review the results of gender reversal in six patients with 46XX congenital virilizing adrenal hyperplasia (CVAH). Fifty-one patients with 46XX CVAH were seen in an 8 year period; 45 were managed by conventional feminizing genitoplasty, but six underwent gender reversal and were managed as males. The clinical decision for gender reversal was made after appropriate counselling and was based primarily on parental choice, this being influenced significantly by a delayed diagnosis in four patients. Surgical management consisted of gonadectomy, excision of Müllerian structures and staged hypospadias repair/ chordee correction in four patients, and circumcision in two completely masculinized children. All six boys are well adjusted to their gender of rearing, with ages ranging from 3 years to 16.5 years (mean 8.5) at the time of review. Two children have normal penises and four have a satisfactory result after two-stage repair of hypospadias/chordee. Most patients with 46XX CVAH are preferably raised as females and require a feminizing genitoplasty. However, the clinical decision may be influenced by many factors, including delay in diagnosis, social bias and the premium on male rearing in certain communities. When male rearing is chosen, early gonadectomy and excision of Müllerian structures, together with staged hypospadias repair, gives satisfactory results.

[Results of urethral reconstruction in adults after multiple hypospadias repairs].

PubMed

Gamidov, S I; Shneiderman, M G; Pushkar, D Yu; Vasil'ev, A O; Govorov, A V; Ovchinnikov, R I; Popova, A Yu; Dusmukhamedov, R D

2017-06-01

To improve treatment results in patients after multiple hypospadias repairs by optimizing the postoperative management. Eighty-two patients (mean age 48.1+/-15.3 years) with urethral strictures secondary to failed hypospadias repairs underwent staged graft urethroplasty using oral mucosa (cheek, lip, tongue) as a grafting material. In 62 patients, at the end of surgery the bladder was drained with a standard Foley catheter. In twenty patients the bladder was drained with a modified silicone urethral catheter, which had an additional channel for delivering drugs and removing the urethral wound effluent, and a second additional channel for inflating a balloon fixed to the catheter tube at different parts of the catheter. The mean length of the stricture was 5.4+/-1.2 cm (from 1 to 16 cm). Twenty-eight patients had postoperative complications. Using the modified catheter resulted in statistically significantly (p<0.05) smaller percentage of complications (10% vs 41.9%) compared to standard Foley catheter. Urinalysis and sperm test on the follow up examination at 12 months showed that only 9 (10.9%) patients had signs of the inflammatory process. Seventy-five patients (91.5%) rated the appearance of the penis as "good"; only 5 (6.1%) and 2 (2.4%) patients considered the result as "satisfactory" and "unsatisfactory", respectively. Eighty patient (97.6%) regarded the treatment result as "good" for the quality of urination and only two (2.4%) considered it "satisfactory". When assessing the strength of urinary stream, 64 (78.1%), 13 (15.8%) and 5 (6.1%) patients rated it as "good", "satisfactory", and "unsatisfactory", respectively. The study findings shows that staged urethroplasty using the oral mucosa restores the urethral patency, reduces the severity of the inflammatory process, thus improving the quality of life of patients after failed hypospadias repair. The proposed modification of the catheter ensures the timely delivery of drugs to the surgical site, evacuation the wound effluent from the urethra and helps prevent strictures by periodically inflating the adjustable balloon-dilator.

Two-Stage Urethroplasty with Buccal Mucosa for Penoscrotal Hypospadias Reconstruction in a Male with a 46,XX Karyotype.

PubMed

D'hulst, Pieter; Darras, Jochen; Joniau, Steven; Mattelaer, Pieter; Winne, Linsey; Ponette, Diederik

2017-09-01

We present a case regarding a 32-year old African male with penoscrotal hypospadias, left cryptorchidism and a left inguinal hernia. There were moderate masculinization characteristics. He underwent a Lichtenstein hernia repair with perioperative biopsies of the left inguinal testis and epididymis. Microscopic examination showed a Sertoli-only left testis with Leydig-cell hyperplasia and the left epididymis consisted of ovarian tissue with corpora albicantia and maturing follicles. Endocrinological evaluation showed a sex-determining region Y (SRY) negative 46,XX karyotype. We successfully performed a two-stage urethroplasty with buccal mucosa graft to reconstruct his penoscrotal hypospadias.

Mouse hypospadias: A critical examination and definition

PubMed Central

Sinclair, Adriane Watkins; Cao, Mei; Shen, Joel; Cooke, Paul; Risbridger, Gail; Baskin, Laurence; Cunha, Gerald R.

2016-01-01

Hypospadias is a common malformation whose etiology is based upon perturbation of normal penile development. The mouse has been previously used as a model of hypospadias, despite an unacceptably wide range of definitions for this malformation. The current paper presents objective criteria and a definition of mouse hypospadias. Accordingly, diethylstilbestrol (DES) induced penile malformations were examined at 60 days postnatal (P60) in mice treated with DES over the age range of 12 days embryonic to 20 days postnatal (E12 to P20). DES-induced hypospadias involves malformation of the urethral meatus, which is most severe in DES E12-P10, DES P0-P10 and DES P5-P15 groups and less so or absent in the other treatment groups. A frenulum-like ventral tether between the penis and the prepuce was seen in the most severely affected DES-treated mice. Internal penile morphology was also altered in the DES E12-P10, DES P0-P10 and DES P5-P15 groups (with little effect in the other DES treatment groups). Thus, adverse effects of DES are a function of the period of DES treatment and most severe in the P0 to P10 period. In “estrogen mutant mice” (NERKI, βERKO, αERKO and AROM+) hypospadias was only seen in AROM+ male mice having genetically-engineered elevation is serum estrogen. Significantly, mouse hypospadias was only seen distally at and near the urethral meatus where epithelial fusion events are known to take place and never in the penile midshaft, where urethral formation occurs via an entirely different morphogenetic process. PMID:27068029

Surgical Repair of Mid-shaft Hypospadias Using a Transverse Preputial Island Flap and Pedicled Dartos Flap Around Urethral Orifice.

PubMed

Liang, Weiqiang; Ji, Chenyang; Chen, Yuhong; Zhang, Ganling; Zhang, Jiaqi; Yao, Yuanyuan; Zhang, Jinming

2016-08-01

To evaluate the effects, particularly the incidence of anastomotic fistula, of a pedicled dartos flap around the urethral orifice in the treatment of urethroplasty of mid-shaft hypospadias. A total of 46 cases of congenital mid-shaft hypospadias were included in this study. The patients ranged in age from 0.7 to 25.4 years and the average was 5.8 years. The patients received penis chordee correction. A transverse preputial island flap was developed for urethral reconstruction. The proximal dartos of the urethral orifice was used to develop a pedicled dartos flap, which was transposed to cover and strengthen neourethral anastomosis. The ventral penile skin defect was repaired by another flap. The 46 patients were examined during follow-up visits for 6 months to 3 years. An anastomotic fistula was observed in one case (2.2 %). Scar healing without fistula was observed in another patient due to poor blood supply to part of the ventral penile skin. No other incidences of fistula, urethral rupture, flap necrosis, wound infections, urinary tract (meatal) stenosis, or urethral diverticulum were observed in the patients. A pedicled dartos flap around the urethral orifice can take advantage of well-vascularized local tissue to add a protective layer to the proximal aspect of the neourethral anastomosis for reducing the incidence of anastomotic fistula in mid-shaft hypospadias repair using a transverse preputial island flap. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

ZEB1 is Estrogen Responsive In Vitro in Human Foreskin Cells and is Over Expressed in Penile Skin in Patients With Severe Hypospadias

PubMed Central

Qiao, Liang; Tasian, Gregory E.; Zhang, Haiyang; Cunha, Gerald R.; Baskin, Laurence

2012-01-01

Purpose We determined the effect of estrogen on ZEB1 in vitro and tested the hypothesis that ZEB1 is over expressed in the penile skin of subjects with hypospadias. Materials and Methods Hs68 cells, a fibroblast cell line derived from human foreskin, were exposed to 0, 1, 10 and 100 nM estrogen, and the expression level of ZEB1 was assessed using reverse transcription real-time polymerase chain reaction, Western blot and immunocytochemical analysis. Next, preputial skin was prospectively collected from case and control subjects at hypospadias repair (37 cases) and circumcision (11). Hypospadias was classified as severe (13 cases) or mild (24) based on the position of the urethral meatus. ZEB1 expression was quantified using reverse transcription real-time polymerase chain reaction, Western blot and immunohistochemical analysis. Results Estrogen increased ZEB1 expression at the mRNA and protein levels in Hs68 cells in a concentration dependent fashion (p <0.01). Subjects with severe hypospadias had significantly higher ZEB1 mRNA levels and protein expression compared to controls or subjects with mild hypospadias (both p <0.01). Subjects with severe hypospadias had increased expression of ZEB1 in the basal layers of the preputial epidermis. Conclusions Estrogen increases ZEB1 expression in a human foreskin fibroblast cell line in vitro. Furthermore, ZEB1 is significantly over expressed in the penile skin of subjects with severe hypospadias. We propose that ZEB1 overexpression may contribute to development of hypospadias and may mediate the effect of estrogen on developing external male genitalia. PMID:21421232

Mouse hypospadias: A critical examination and definition.

PubMed

Sinclair, Adriane Watkins; Cao, Mei; Shen, Joel; Cooke, Paul; Risbridger, Gail; Baskin, Laurence; Cunha, Gerald R

2016-12-01

Hypospadias is a common malformation whose etiology is based upon perturbation of normal penile development. The mouse has been previously used as a model of hypospadias, despite an unacceptably wide range of definitions for this malformation. The current paper presents objective criteria and a definition of mouse hypospadias. Accordingly, diethylstilbestrol (DES) induced penile malformations were examined at 60 days postnatal (P60) in mice treated with DES over the age range of 12 days embryonic to 20 days postnatal (E12-P20). DES-induced hypospadias involves malformation of the urethral meatus, which is most severe in DES E12-P10, DES P0-P10 and DES P5-P15 groups, and less so or absent in the other treatment groups. A frenulum-like ventral tether between the penis and the prepuce was seen in the most severely affected DES-treated mice. Internal penile morphology was also altered in the DES E12-P10, DES P0-P10 and DES P5-P15 groups (with little effect in the other DES treatment groups). Thus, adverse effects of DES are a function of the period of DES treatment and most severe in the P0-P10 period. In "estrogen mutant mice" (NERKI, βERKO, αERKO and AROM+) hypospadias was only seen in AROM+ male mice having genetically-engineered elevation is serum estrogen. Significantly, mouse hypospadias was only seen distally at and near the urethral meatus where epithelial fusion events are known to take place and never in the penile midshaft, where urethral formation occurs via an entirely different morphogenetic process. Copyright © 2016 International Society of Differentiation. Published by Elsevier B.V. All rights reserved.

ECLAMC Study: prevalence patterns of hypospadias in South America: multi-national analysis over a 24-year period

PubMed Central

Fernández, Nicolás; Pérez, Jaime; Monterrey, Pedro; Poletta, Fernando A.; Bägli, Darius J.; Lorenzo, Armando J.; Zarante, Ignacio

2017-01-01

ABSTRACT Objective To evaluate prevalence trends of hypospadias in South-America it is essential to perform multicenter and multinational studies with the same methodology. Herein we present systematic data as part of an international multicenter initiative evaluating congenital malformations in South America over a 24-year period. Materials and Methods A nested case-control study was conducted using the Latin American Collaborative Study of Congenital Malformations (ECLAMC), between January 1989 and December 2012. Cases were stratified as isolated (IH) and non-isolated hypospadias (NIH). Global prevalence was calculated and discriminated by country. Associations between birth weight and gestational age, and NIH distribution by associated abnormality and severity of hypospadias, were analyzed. Results A total of 159 hospitals from six countries participated, reporting surveillance on 4.020.384 newborns. A total of 4.537 hypospadias cases were detected, with a global prevalence of 11.3/10.000 newborns. Trend analyses showed in Chile, Brazil and Uruguay a statistically significant increase in prevalence. Analysis of severity and associated anomalies did not to find an association for distal cases, but did for proximal (RR=1.64 [95% CI=1.33-2.03]). Conclusion This is one of only a few Latin American multicenter studies reporting on the epidemiology of hypospadias in South America in the last two decades. Our data adds to evidence suggesting an increase in some countries in the region at different times. There were also variations in prevalence according to severity. This study adds to literature describing associated anomalies at a hospital-based level. PMID:27802003

ECLAMC Study: Prevalence patterns of hypospadias in South America: Multi-national analysis over a 24-year period.

PubMed

Fernández, Nicolás; Pérez, Jaime; Monterrey, Pedro; Poletta, Fernando A; Bägli, Darius J; Lorenzo, Armando J; Zarante, Ignacio

2017-01-01

To evaluate prevalence trends of hypospadias in South-America it is essential to perform multicenter and multinational studies with the same methodology. Herein we present systematic data as part of an international multicenter initiative evaluating congenital malformations in South America over a 24-year period. A nested case-control study was conducted using the Latin American Collaborative Study of Congenital Malformations (ECLAMC), between January 1989 and December 2012. Cases were stratified as isolated (IH) and non-isolated hypospadias (NIH). Global prevalence was calculated and discriminated by country. Associations between birth weight and gestational age, and NIH distribution by associated abnormality and severity of hypospadias, were analyzed. A total of 159 hospitals from six countries participated, reporting surveillance on 4.020.384 newborns. A total of 4.537 hypospadias cases were detected, with a global prevalence of 11.3/10.000 newborns. Trend analyses showed in Chile, Brazil and Uruguay a statistically significant increase in prevalence. Analysis of severity and associated anomalies did not to find an association for distal cases, but did for proximal (RR=1.64 [95% CI=1.33-2.03]). This is one of only a few Latin American multicenter studies reporting on the epidemiology of hypospadias in South America in the last two decades. Our data adds to evidence suggesting an increase in some countries in the region at different times. There were also variations in prevalence according to severity. This study adds to literature describing associated anomalies at a hospital-based level. Copyright® by the International Brazilian Journal of Urology.

Multivariate Analysis of the Factors Associated With Sexual Intercourse, Marriage, and Paternity of Hypospadias Patients.

PubMed

Kanematsu, Akihiro; Higuchi, Yoshihide; Tanaka, Shiro; Hashimoto, Takahiko; Nojima, Michio; Yamamoto, Shingo

2016-10-01

Patients with hypospadias are treated surgically during childhood, which has the intention of enabling a satisfactory sexual life in adulthood. However, it is unclear whether patients with corrected hypospadias can lead a satisfactory sexual life and sustain a marital relationship and produce offspring. To evaluate factors associated with achievement of sexual intercourse, marriage, and paternity in patients with hypospadias who have reached adulthood. Self-completion questionnaires were mailed in April 2012 to patients with hypospadias at least 18 years old who had been treated at our institution during childhood from 1973 through 1998 by a single surgeon and the same surgical policy. Assessments included the International Prostate Symptom Score, the International Index for Erectile Function-5, and non-validated questions related to current social and physical status and sexual, marital, and paternity experiences. Candidate factors were extracted from patients' neonatal data, surgical findings and results, and current physical and social status obtained by the questionnaires. Candidate factors associated with heterosexual intercourse, marriage, and paternity experiences were analyzed using univariate and multivariate proportional hazard models and log-rank test of Kaplan-Meier curves. Of the 518 patients contacted, 108 (age = 18-50 years, median = 28 years) met the inclusion criteria. Two- and one-stage repairs were performed as the initial treatment in 79 and 12, respectively, and 17 of the analyzed cases were reoperations for patients initially treated elsewhere. Fifty-seven patients had the milder type (31 glandular, 26 penile), 36 had the proximal type (13 penoscrotal, 23 scrotal-perineal), and 15 had an unknown type. Multivariate analyses by Cox proportional hazard model and log-rank tests confirmed that experience of sexual intercourse was associated with the milder type of hypospadias (P = .025 and .0076 respectively), marriage was associated with stable employment (P = .020 and .026, respectively), and paternity was associated with the absence of additional surgery after completion of the initial repair (P = .013 by multivariate analysis). There was scant overlap of factors associated with the three events. The present findings provide reference information for surgeons and parents regarding future sexual and marriage experiences of children treated for hypospadias. Copyright © 2016 International Society for Sexual Medicine. Published by Elsevier Inc. All rights reserved.

Unexpected outcome of a modification of Bracka repair for proximal hypospadias: High incidence of diverticula with flaps.

PubMed

Tiryaki, Sibel; Ələkbərova, Vüsalə; Dokumcu, Zafer; Ergun, Raziye; Tekin, Ali; Yagmur, Ismail; Ulman, Ibrahim; Avanoglu, Ali

2016-12-01

Various graft and flap techniques have been proposed for urethral reconstruction in proximal hypospadias repair. The Bracka repair involving the transfer of inner prepuce like a Wolfe graft mostly results in satisfactory results besides a high fistula rate. The aim was to decrease the high fistula rate with Bracka repair; we wanted to use the advantages of vascularized skin in the Bracka method. The aim of this study was to evaluate our results with this modification. Our modification involves using a flap instead of a graft. In the first stage, chordee was corrected by transection of the urethral plate and dorsal midline plication when necessary. Instead of a graft as suggested by Bracka, inner preputial skin with ample blood supply was transferred and stitched to the denuded ventral penile surface. In the second stage after 6 months, this flap was tubularized in the Thiersch-Duplay fashion. Hospital records of patients who had undergone two stage modified Bracka repair between June 2007 and July 2012 were reviewed, including complaints, complications, and need for interventions. Thirty-eight patients had undergone this operation. Four patients were lost to follow-up. The main complaint was obstructed urinary flow. Voiding symptoms were first attributed to urethral stenosis, but were, however, found to be due to diverticulum and vortex of the urine in the dilated urethra. Twenty-one patients (61%) had voiding problems and 10 patients (29%) had urinary tract infections. Fistula was observed in 23 and diverticula were observed in 24 patients. Of these, 16 patients had both fistula and diverticula. Only two patients (5%) were free of complications and totally satisfied with the operation, and 23 of the 34 patients had complications requiring intervention (Figure). Inner preputial flaps used in proximal hypospadias repairs are prone to diverticula formation. They become redundant in time requiring reoperation, thus decreasing the success rate. Careful fixation of the flap to the corpora and allowing time for additional attachment of the urethral plate substitution through fibrotic activity could not overcome this complication. Our modification of the Bracka technique using a flap for the plate resulted in a high rate of complications (in particular diverticulum formation) and was therefore abandoned. We recommend careful use of flaps in hypospadias surgery and long-term follow-up studies to evaluate actual functional and cosmetic results. Copyright © 2016 Journal of Pediatric Urology Company. Published by Elsevier Ltd. All rights reserved.

Hypospadias repair

MedlinePlus

... before the procedure. Always tell the provider: What medicines your child is taking Drugs, herbs, and vitamins your child ... you bought without a prescription Any allergies your child has to medicine, latex, tape, or skin cleaner Ask the child's ...

Advantages of Reduced Prophylaxis after Tubularized Incised Plate Repair of Hypospadias.

PubMed

Zeiai, Said; Nordenskjöld, Agneta; Fossum, Magdalena

2016-10-01

Concerns about antibiotic resistance, adverse drug reactions and questionable medical benefits have led to changes in prophylactic antibiotic management in hypospadias repair at our clinic. In March 2010 our guidelines were changed from continuous prophylaxis for 14 days to 1 dose preoperatively and another at removal of the stent. We analyze the effects of this new regimen. We performed a prospective journal cohort study of all our hypospadias operations from June 2008 to December 2011. We collected data from consecutive patients undergoing primary tubularized incised plate repair and postoperative stent. Patients operated on before March 2010 were compared to those operated on later. End points were postoperative infection requiring antibiotics and any complication that required redo surgery. The study included 113 primary tubularized incised plate repairs with postoperative stents. Patient distribution was the same in both groups. Of 58 patients in the group receiving continuous antibiotic prophylaxis 17 had a complication and/or infection, compared to 9 of 55 patients receiving 2-dose prophylaxis. The infection rate was 5% in the continuous prophylaxis group and 4% in the 2-dose group. In contrast to our expectations, a lower complication rate was observed in the group with lower antibiotic dose without an increased risk of infection. There is little documented evidence concerning benefits of antibiotic prophylaxis for postoperative complications, which gives rise to large variations in clinical practice. In our study lower antibiotic dose did not increase the number of infections, but rather decreased complication rates. We advocate antibiotic prophylaxis with only a 2-dose regimen. Copyright © 2016 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.

Worldwide prevalence of hypospadias.

PubMed

Springer, A; van den Heijkant, M; Baumann, S

2016-06-01

Hypospadias is a common congenital malformation. Surgical repair and management of the long-term consequences require a substantial amount of socioeconomic resources. It is generally accepted that genetic and environmental factors play a major role in the etiology of hypospadias. There have been contradictory reports on rising hypospadias rates, and regional and ethnical differences. The exact prevalence of hypospadias is of major interest for healthcare providers, clinical medicine, and research. To review the literature regarding the worldwide prevalence of hypospadias. Pubmed, EMBASE and Google were systematically screened for: hypospadias, congenital malformation, anomaly, incidence, prevalence, and epidemiology. Exclusion criteria were surgical and risk-factor studies. To give an additional comprehensive overview, prevalence data were harvested from the Annual Report of the International Clearinghouse Centre for Birth Defects Surveillance and Research. Prevalence was reported as per 10,000 live births. Data were available from 1910 to 2013. The median study period was 9 years (range: 1-36 years). Approximately 90,255,200 births have been screened in all studies. The mean prevalence were: Europe 19.9 (range: 1-464), North America 34.2 (6-129.8), South America 5.2 (2.8-110), Asia 0.6-69, Africa 5.9 (1.9-110), and Australia 17.1-34.8. There were major geographical, regional, and ethnical differences, with an extreme heterogeneity of published studies. Numerous studies showed an increasing prevalence; on the other hand, there were a lot of contradictory data on the prevalence of hypospadias. The summary table shows contradictory data from the five largest international studies available. There was huge literature available on the prevalence of hypospadias. Most data derived from Europe and North America. Many methodological factors influenced the calculation of an accurate prevalence, and even more of the true changes in prevalence over time (no generally accepted and standardized definition of hypospadias, different monitoring systems, unclear efficiency of notification and data ascertainment, etc.). There was wide variation of prevalence according to countries and ethnicity, and there were conflicting data on the recent trends of prevalence. Moreover, there weren't any epidemiologic data available from many parts of the world. True prevalence of hypospadias and trends were difficult to estimate. For the future, to be able to assess the true prevalence of hypospadias and changes in prevalence collaboration of national and international prospective registers is recommended. Copyright © 2015 Journal of Pediatric Urology Company. Published by Elsevier Ltd. All rights reserved.

20-year experience with iatrogenic penile injury.

PubMed

Amukele, Samuel A; Lee, Gene W; Stock, Jeffrey A; Hanna, Moneer K

2003-10-01

We review our experience with the management of iatrogenic penile injuries. Apart from circumcision, serious damage to the penis can occur following hypospadias repair, surgery for priapism or total loss of the penis following surgical repair of bladder exstrophy. A retrospective analysis of patients with iatrogenic penile amputation referred to us between 1980 and 2000 was undertaken. Causes of injury and choice of management were reviewed. Of the 13 cases treated during the 20-year period mechanism of primary injury was circumcision in 4, hypospadias repair in 6, priapism in 1, bladder exstrophy repair in 1 and penile carcinoma in 1. A variety of techniques were used for phallic reconstruction. Penile degloving, division of suspensory ligament and rotational skin flaps achieved penile augmentation and enhancement. Reasonable cosmesis and penile length were achieved in all cases. In indicated cases microsurgical phalloplasty was technically feasible. However long-term followup showed various complications including erosions from the use of a penile stiffener. The ultimate goal of reconstructive surgery is to have a penis with normal function and appearance. The management of penile injury requires a wide variety of surgical techniques that are tailored to the individual patient. Expedient penile reconstruction is successful and therapeutic delay is associated with complications.

Perineal hypospadias: the Bilateral Based (BILAB) skin flap technique.

PubMed

Hadidi, Ahmed T

2014-01-01

The purpose of this study was to present the "bilateral based skin flap (BILAB) technique" for patients with perineal hypospadias associated with severe deep chordee and report the follow up. The short urethral plate is incised, the hypoplastic corpus spongiosum excised, the glans split in the midline, and a healthy urethral plate is reconstructed from the lateral penile skin and foreskin to the tip of the glans. Between January 2005 and December 2011, the BILAB technique was performed in 68 patients with perineal hypospadias associated with severe chordee as a one or two stage repair. The records of 63 patients who maintained regular follow up were reviewed. The new urethra was reconstructed from the new urethral plate during the same setting in 26 patients. The remaining 37 patients had the urethroplasty performed 3-6 months later as a two stage repair. Patient age ranged from 8 months and 2 years (mean 10 months). Follow-up period ranged from 18 months to 8 years (mean 43 months). Satisfactory results were obtained in 54 patients (85%). Two children developed diverticula, two patients developed glans dehiscence, one child developed fistula, and one child had complete wound dehiscence, and urethroplasty was successfully reconstructed 6 months later. Three patients developed scar contraction 6-12 months after surgery. This was corrected by excision of the scarred intermediate layer. The BILAB technique is a reliable technique for patients with perineal hypospadias. It produces slit like meatus at the tip of the glans. The surgeon may decide intra-operatively whether to complete the urethroplasty in one or two stages. Long term follow up until puberty is being carried out. Copyright © 2014 Elsevier Inc. All rights reserved.

Does maternal exposure during pregnancy to higher ambient temperature increase the risk of hypospadias?

PubMed

Kilinc, Muhammet Fatih; Cakmak, Sedat; Demir, Demirhan Orsan; Doluoglu, Omer Gokhan; Yildiz, Yildiray; Horasanli, Kaya; Dalkilic, Ayhan

2016-12-01

The association between ambient temperature that the mother is exposed to during pregnancy and hypospadias has not been investigated by the studies, although the recent studies showed the correlation between some congenital malformations (congenital heart disease, neural tube defect, etc.) and ambient temperature. The aim was to investigate the relation between hypospadias and the ambient temperatures that the mother is exposed to during her pregnancy. The data of patients with hypospadias that had their gestational periods in Ankara and Istanbul regions, and had other urological treatments (circumcision, urinary tract infection, pyeloplasty, nephrolithotomy, etc.) between January 2000 and November 2015 were analyzed retrospectively. The ambient temperature at 8-14 weeks of gestation was investigated for each patient by reviewing the data of the General Directorate of Meteorology, since this period was risky for development of hypospadias. The data including ambient temperature that the pregnant mother was exposed to, maternal age, parity, economical status, gestational age at birth, and birth weight were compared between two groups. The retrospective nature of the study may be a potential source for selection bias. The data of 1,709 children that had hypospadias repair and 4,946 children that had other urological treatments between 2000 and 2015 were retrospectively analyzed. There were no differences between the groups for maternal age, parity, economical status, gestational age at birth, and birth weight (Table). Analysis of exposed maximum and average ambient temperatures at 8-14 weeks of gestation revealed that July and August, hot periods in summer time, were more prevalent in the hypospadias group (p = 0.01). The average and maximum monthly ambient temperatures during summer increased the risk for hypospadias (OR, 1.32; 95% CI, 1.08-1.52; and OR, 1.22; 95% CI, 0.99-1.54, respectively. In this paper, we evaluated the relation between hypospadias and the ambient temperatures that the mother is exposed during her pregnancy. The results of this study indicated that the high ambient temperatures the mother and fetus are exposed to at 8-14 weeks of gestation increased the risk of hypospadias in the offspring. Copyright © 2016 Journal of Pediatric Urology Company. Published by Elsevier Ltd. All rights reserved.

Safety of latex urinary catheters for the short time drainage

PubMed Central

Hosseinpour, Mehrdad; Noori, Saeed; Amir-Beigi, Mahdieh; Pourfakharan, Mohammad Hassan; Ehteram, Hassan; Hamsayeh, Mohadese

2014-01-01

Background: In this study, we attempt to identify the most appropriate catheter (silicone vs. latex) for short-term urinary catheterization. We compared the post-operative clinico-pathological complications between latex and silicone for short term catheterization in rabbits with hypospadias. Materials and Methods: Forty rabbits were used in our study to compare complications of catheterization. They were divided in two groups. Hypospadias like defect was created by a 1 cm long excision of the ventral urethra. For urethroplasty, we used tubularized incised plate technique. Latex and silicon catheters were used in groups 1 and 2, respectively. Post-operatively, routine laboratory urine test and complications (allergy, infection, bleeding) were compared in groups. Results: A total of 40 rabbits underwent hypospadias repair. Findings showed that there were no significant differences between groups based on urine test indices (P = NS). Urinary tract infection rate was 10% (2 rabbits) in latex and 0% in silicone groups (P = NS). There were no significant differences between groups regarding of cystitis grades between study groups (P = NS). Conclusion: It seems that urinary tract catheterization with latex catheters is a safe, feasible, and in-expensive procedure for short-term post-operative course in hypospadias surgery in patients without latex hypersensitivity. PMID:25125890

The V-Shaped Distal Triceps Tendon Repair: A Comparative Biomechanical Analysis.

PubMed

Scheiderer, Bastian; Imhoff, Florian B; Morikawa, Daichi; Lacheta, Lucca; Obopilwe, Elifho; Cote, Mark P; Imhoff, Andreas B; Mazzocca, Augustus D; Siebenlist, Sebastian

2018-05-01

Restoring footprint anatomy, minimizing gap formation, and maximizing the strength of distal triceps tendon repairs are essential factors for a successful healing process and return to sport. The novel V-shaped distal triceps tendon repair technique with unicortical button fixation closely restores footprint anatomy, provides minimal gap formation and high ultimate failure load, and minimizes iatrogenic fracture risk in acute/subacute distal triceps tendon tears. Controlled laboratory study. Twenty-four cadaveric elbows (mean ± SD age, 66 ± 5 years) were randomly assigned to 1 of 3 repair groups: the transosseous cruciate repair technique (gold standard), the knotless suture-bridge repair technique, and the V-shaped distal triceps tendon repair technique. Anatomic measurements of the central triceps tendon footprint were obtained in all specimens with a 3-dimensional digitizer before and after the repair. Cyclic loading was performed for a total of 1500 cycles at a rate of 0.25 Hz, pulling in the direction of the triceps. Displacements were measured on the medial and lateral tendon sites with 2 differential variable reluctance transducers. Load to failure and construct failure mode were recorded. The mean triceps bony insertion area was 399.05 ± 81.23 mm 2 . The transosseous cruciate repair technique restored 36.6% ± 16.8% of the native tendon insertion area, which was significantly different when compared with the knotless suture-bridge repair technique (85.2% ± 14.8%, P = .001) and the V-shaped distal triceps tendon repair technique (88.9% ± 14.8%, P = .002). Mean displacement showed no significant difference between the V-shaped distal triceps tendon repair technique (medial side, 0.75 ± 0.56 mm; lateral side, 0.99 ± 0.59 mm) and the knotless suture-bridge repair technique (1.61 ± 0.97 mm and 1.29 ± 0.8 mm) but significance between the V-shaped distal triceps tendon repair technique and the transosseous cruciate repair technique (4.91 ± 1.12 mm and 5.78 ± 0.9 mm, P < .001). Mean peak failure load of the V-shaped distal triceps tendon repair technique (732.1 ± 156.0 N) was significantly higher than that of the knotless suture-bridge repair technique (505.4 ± 173.9 N, P = .011) and the transosseous cruciate repair technique (281.1 ± 74.8 N, P < .001). Mechanism of failure differed among the 3 repairs, with the only olecranon fracture occurring in the knotless suture-bridge repair technique at the level of the lateral row suture anchors. At time zero, the V-shaped distal triceps tendon repair technique and the knotless suture-bridge repair technique both provided anatomic footprint coverage. Ultimate load to failure was highest for the V-shaped distal triceps tendon repair technique, while gap formation was different only in comparison with the transosseous cruciate repair technique. The V-shaped distal triceps tendon repair technique provides an alternative procedure to other established repairs for acute/subacute distal triceps tendon ruptures. The reduced repair site motion of the V-shaped distal triceps tendon repair technique and the knotless suture-bridge repair technique at the time of surgery may allow a more aggressive rehabilitation program in the early postoperative period.

Two-stage hypospadias repair: audit in a district general hospital.

PubMed

Price, R D; Lambe, G F; Jones, R P

2003-12-01

The number of techniques for hypospadias repair is testament to the challenges associated with this condition. In 1994, the senior author undertook an audit of his repairs using the van der Meulen [Plast. Reconstr. Surg. 59 (1977) 20615] technique and determined that the revision rate of 11% was unsatisfactory and the cosmetic result sub-optimal. He, therefore, retrained and began in 1995, using the two-stage technique popularised by Bracka [Br. J. Plast. Surg. 48 (1995) 345]. We undertook an audit of all corrections performed in the period from September 1995 to March 2002. The computer database in the main theatre suite was used to identify all patients on whom such a repair had been undertaken and those notes retrieved. Data was collected on a number of variables including age at operations, complications such as urinary tract infection and fistulae, and total number of corrective operations. One hundred and nineteen patients were identified, of which seven had no records available. Of the remaining 112, 81 were primary repairs, in whom the complication rate was 2.5% for stage I (graft loss) and 9.8% for stage II (fistula rate 7.4%, stenosis 1.2%, baggy urethra requiring reconstruction 1.2%). The remaining 31 patients were those with unsatisfactory single-stage repairs and in this group, graft loss was seen in three cases (10%). The fistula rate was 4/31 (12.9%) and the stenosis rate 2/31 (6.5%). These results compare favourably with a number of published series from surgeons who have super-specialised in this field. We conclude that the two-stage repair is a useful and reliable technique in the hands of a Plastic Surgeon who has a broader interest.

Enlargement and sculpturing of a small and deformed glans.

PubMed

Perovic, Savra; Radojicic, Zoran I; Djordjevic, Miroslav Lj; Vukadinovic, Vojkan V

2003-10-01

We present 2 techniques of enhancement and sculpturing of a small and/or deformed glans. The small glans in primary or re-do hypospadias repair was enhanced by longitudinal double-faced island flaps incorporated onto the ventral side of the glans between the glans wings. The deformed glans, of small or normal size (with normal urethra or well functioning neourethra), was enlarged and sculptured by injection of hydrogel. Between May 1997 and March 2002, 27 patients underwent glans enhancement and sculpturing. Small deformed glans occurred after failed hypospadias repair in 10 patients, penile trauma in 3, hemangioma sclerozation in 2, primary hypospadias in 8 and normally developed penile body in 4. A double-faced island flap was performed in 14 patients, glans was enhanced by hydrogel injection in 9 and both procedures were performed in 4. Mean followup was 34 months for the double-faced flap technique 17 months for hydrogel injection. Satisfactory enlargement and esthetic appearance were achieved in 13 of the 14 patients who underwent the double-faced flap technique and 1 required surgical correction. Of the 9 patients who underwent either single or multistage hydrogel injection 8 had good results and 1 required partial removal of hydrogel after hypercorrection. The combination of these 2 techniques provided satisfactory results in all 4 cases. Enlargement and sculpturing of a small deformed glans are challenging and difficult. A double-faced island flap and/or injection of hydrogel resolves this problem satisfactorily.

Effect of human urine on the tensile strength of sutures used for hypospadias surgery.

PubMed

Kerstein, Ryan L; Sedaghati, Tina; Seifalian, Alexander M; Kang, Norbert

2013-06-01

Hypospadias is the most common congenital condition affecting between 1 in 250 and 300 live births. Even in experienced hands, surgery to repair this congenital defect can have a high complication rate. Wound dehiscence is reported to occur in 5% and fistula formation in 6%-40% depending on technique. The choice of suture material has been shown to affect the complication rate although there is (currently) no consensus about the best suture material to use. Ideally, the sutures used for urethroplasty should be absorbable while maintaining sufficient mechanical strength to support the wounds until they are self-supporting and able to resist urinary flow. Previous studies have compared the effects of human urine on different suture materials especially catgut. However, catgut is now banned in Europe. Our study examined the tensile and breaking strength as well as rate of degradation for four types of absorbable suture now commonly used for hypospadias repairs in the UK. We examined the effect of prolonged storage (up to 27 days) in human urine on 6/0 gauge Vicryl, Vicryl Rapide, Monocryl and polydioxanone (PDS) sutures. These four suture materials are commonly used by the senior plastic consultant surgeon (NK) for hypospadias repairs. 50 mm sections of these suture materials were stored in either urine or saline as control. At specified time points, each suture was placed in a uniaxial load testing machine to assess the stress-strain profile and the mechanical load required to break the suture was measured. Exposure to urine reduced the tensile and breaking strength of all the suture materials tested. PDS demonstrated the greatest resilience. Vicryl Rapide was the weakest suture and degraded completely by day 6. Vicryl and Monocryl had similar degradation profiles, but Vicryl retained more of its tensile strength for longer. There is a balance to be struck between the duration that a suture material must remain in any surgical wound and the risk that it causes foreign body effects. The results of this study suggest that Vicryl has the best characteristics for urethroplasty of the four suture materials tested. Copyright © 2013 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.

Role of parenteral testosterone in hypospadias: A study from a teaching hospital in India

PubMed Central

Ahmad, Reyaz; Chana, Rajendra Singh; Ali, Syed Manazir; Khan, Shehtaj

2011-01-01

Objectives: To evaluate the effect of parenteral testosterone on penile length, preputial skin and side effects in patients with hypospadias. Materials and Methods: 23 patients with hypospadias were included in this study. An oily solution, each ml of which contained testosterone propionate 25 mg, and testosterone enanthate 110 mg, equivalent to 100 mg of testosterone was given deep intramuscularly 4, 3 and 2 weeks before reconstructive surgery at the dose of 2 mg/kg body weight. Increase in penile length, transverse preputial diameter, and diameter at the base of penis were noted. Basal testosterone levels were obtained before the institution of therapy and on the day of operation. In addition, side effect such as development of pubic hair and delay in bone age was noted. Results: Following parenteral testosterone administration, the mean increase in penile length, transverse preputial diameter and diameter at the base of penis was 1.35±0.40 cm (P<0.001), 1.40±0.47 cm (P<0.001), and 0.72±0.47 cm (P<0.001), respectively. Serum testosterone level after injection was well within normal range for that age. Minimal side effects were noted in form of development of fine pubic hair. Conclusion: We conclude that parenteral testosterone can be safely used to improve the surgical outcome of hypospadias repair. PMID:21976926

Late surgical correction of hypospadias increases the risk of complications: a series of 501 consecutive patients.

PubMed

Garnier, Sarah; Maillet, Olivier; Cereda, Barbara; Ollivier, Margot; Jeandel, Clement; Broussous, Sylvie; Lopez, Christophe; Paris, Francoise; Philibert, Pascal; Amouroux, Cyril; Jeandel, Claire; Coffy, Amandine; Gaspari, Laura; Daures, Jean Pierre; Sultan, Charles; Kalfa, Nicolas

2017-06-01

To evaluate the outcomes of hypospadias surgery according to age and to determine if some complications are age-related. This retrospective study was based on 722 boys with hypospadias undergoing primary repair. A total of 501 boys underwent urethroplasty and were included in the study. Complications requiring an additional procedure (stenosis, fistula, dehiscence, relapse of curvature, urethrocele) were included in the analysis, as well as healing problems, infections, haematomas and detrusor-sphincter dyssynergy. Logistic regression analysis was performed. Hypospadias was anterior in 63.1%, mid-penile in 20.5%, posterior in 8.4% and scrotal in 7.9% of the boys. The median (range) age was 4 (1-16) years. The overall rates of re-intervention and complications were 22.8% and 36.2%, respectively. Age >2 years was a significant predictor of complications (P = 0.002, odds ratio 1.98 [95% confidence interval 1.26-3.13]). Some periods of time appeared to be associated with a specific complication: dyssynergy was more common between the ages of 24 and 36 months (12.5 vs 3.6%; P = 0.01) and healing problems were more common in boys aged >13 years (1.5 vs 28.5%; P = 0.06). Delayed surgery may be detrimental for patients. Factors related to age may influence the rate of complications. After the age of 2 years, urethral surgery may interfere with the normal toilet-training process. During puberty, endogenous testosterone may alter healing. Even if no specific data exist for severe hypospadias, it may be prudent to continue to advocate early surgery in patients with disorders of sex development. © 2017 The Authors BJU International © 2017 BJU International Published by John Wiley & Sons Ltd.

Modified Penile Augmentation by Dermal-Fat Graft in Post-Hypospadias Adults.

PubMed

Xu, Lisi; Zhao, Muxin; Yang, Zhe; Chen, Wen; Li, Yangqun; Ma, Ning; Wang, Weixin; Feng, Jun; Liu, Qiyu; Ma, Tong

2016-02-01

Although a considerable part of patients desire further improvement in penile size after hypospadias repairs, penile augmentation is only considered in patients with congenital penile hypoplasia or acquired penile retraction. Modified penile augmentation by free dermal-fat graft is introduced to satisfy these patients and improve surgical safety. From April 2012 to December 2014, a total of 15 male adults after hypospadias repairs, aged 18-24 years, underwent modified penile augmentation which involved girth enhancement by a free dermal-fat graft and penile elongation (suprapubic skin advancement-ligamentolysis). A specially designed tunneling instrument was introduced to facilitate pericavernous thickening without degloving. Outcome evaluation was mainly based on objective penile measurements and results of the Male Genital Image Scale. With 6 months' follow-up, all patients had achieved excellent cosmetic results, with a significant average dimensional increase of 1.53 ± 0.23 cm in flaccid girth and 1.67 ± 0.24 cm in flaccid length. No erection deficiencies or urinary fistula occurred. Patients' perception of male genitalia improved postoperatively, with the average MGIS score rising from 31.73 ± 4.86 to 40.20 ± 4.54. This modified technique is safe and effective in enlarging penile size. The use of the specially designed tunneling instrument simplifies penile girth enhancement, avoiding unnecessary trauma to the neo-urethra and neurovascular bundle. It is confirmed that physical dimensional enhancement does contribute to improving their underestimation of penile size. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.

Long-term followup of visual internal urethrotomy for management of short (less than 1 cm) penile urethral strictures following hypospadias repair.

PubMed

Husmann, D A; Rathbun, S R

2006-10-01

We reviewed the results of direct vision urethrotomy for short (less than 1 cm) penile urethral strictures following hypospadias surgery. Patients with less than 1 cm anterior penile urethral strictures located proximal to the meatus underwent direct vision urethrotomy. Based on the type of initial urethroplasty patients were randomly divided into treatment with direct vision urethrotomy vs direct vision urethrotomy plus clean intermittent catheterization for 3 months. Success was defined as absent obstructive voiding symptoms and a normal urine flow 2 years following the last patient instrumentation. Of patients with urethral strictures following hypospadias repair 44% (32) had previously undergone tubularized graft urethroplasty and 56% (40) had previously undergone flap urethroplasty, including a tubularized island flap in 18, an onlay flap in 11 and urethral plate urethroplasty in 11. Direct vision urethrotomy alone was performed in 51% of patients (37), and direct vision urethrotomy and clean intermittent catheterization were performed in 49% (35). Success with the 2 methods was similar, that is 24% (9 of 37 patients) vs 22% (8 of 35). Following direct vision urethrotomy all patients with tubularized graft urethroplasty showed failure (0 of 32). Success was noted in 11% of patients (2 of 18) with tubularized island flap urethroplasty compared to 72% (8 of 11) with onlay urethroplasty and 63% (7 of 11) with urethral plate urethroplasty (each p <0.05). The addition of clean intermittent catheterization to direct vision urethrotomy does not improve the likelihood of success. Direct vision urethrotomy for short (less than 1 cm) urethral stricture usually fails following any type of tubularized graft or flap urethroplasty but it had moderate success following onlay flap and urethral plate urethroplasties.

Re-rupture rate of primarily repaired distal biceps tendon injuries.

PubMed

Hinchey, John W; Aronowitz, Jessica G; Sanchez-Sotelo, Joaquin; Morrey, Bernard F

2014-06-01

Distal biceps tendon rupture is a common injury, and primary repair results in excellent return of function and strength. Complications resulting from distal biceps tendon repairs are well reported, but the incidence of re-ruptures has never been investigated. A search of the Mayo Clinic's Medical/Surgical Index was performed, and all distal biceps tendon repairs from January 1981 through May 2009 were identified. All patients who completed 12 months or more of follow-up were included. All charts were reviewed and patients contacted as necessary to identify a re-rupture. We also investigated the situation causing the re-rupture. We identified a total of 190 distal biceps tendon ruptures that underwent repair and met our inclusion and exclusion criteria. Of the 190 repairs, 172 (90.5%) were performed by the Mayo modification of the Boyd-Anderson 2-incision technique. Bilateral ruptures occurred in 13 patients (7.3%). Six primary ruptures (3.2%) occurred in women, 4 of the 6 being partial ruptures. Partial ruptures were found to be statistically more common than complete ruptures in women (P = .05). We identified 3 re-ruptures (1.5%), all occurring within 3 weeks of the index surgery. The re-rupture rate after primary repair of the distal biceps tendon is low at 1.5% and occurs within 3 weeks of index repair. This appears to be due to patient compliance and excessive force placed on repairs. We also found the incidence of women who sustain a distal biceps tendon tear to be 3.2%, with partial tears being statistically more common than complete ruptures. Level IV, case series, treatment study Copyright © 2014 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Mosby, Inc. All rights reserved.

Combined open proximal and stent-graft distal repair for distal arch aneurysms: an alternative to total debranching.

PubMed

Zierer, Andreas; Sanchez, Luis A; Moon, Marc R

2009-07-01

We present herein a novel, combined, simultaneous open proximal and stent-graft distal repair for complex distal aortic arch aneurysms involving the descending aorta. In the first surgical step, the transverse arch is opened during selective antegrade cerebral perfusion, and a Dacron graft (DuPont, Wilmington, DE) is positioned down the descending aorta in an elephant trunk-like fashion with its proximal free margin sutured circumferentially to the aorta just distal to the left subclavian or left common carotid artery. With the graft serving as the new proximal landing zone, subsequent endovascular repair is performed antegrade during rewarming through the ascending aorta.

A comparison between tourniquet application and epinephrine injection for hemostasis during hypospadias surgery: The effect on bleeding and postoperative outcome.

PubMed

Alizadeh, F; Fakoor, A; Haghdani, S

2016-06-01

To compare tourniquet application and epinephrine injection for hemostasis during hypospadias surgery in terms of bleeding and complications. Between April 2013 and September 2014, patients who were admitted for hypospadias repair were divided by random allocation into either a diluted epinephrine injection (DE) group or tourniquet application (T) group for hemostasis during the procedure. In the T group, a rubber band was applied at the base of the penis after skin dissection, and in the DE group, epinephrine 1/100,000 was injected along the incision lines. The patients' ages, urethral defect lengths, pre-operative, intraoperative and postoperative variables were compared between the two groups. A total of 70 patients (35 in each group) were enrolled into the study. The mean ages and preoperative variables were not significantly different. Average blood loss was 23.51 ± 15.36 cc in the tourniquet group and 15.99 ± 10.00 cc in the epinephrine group, and was significantly higher in tourniquet group (P = 0.022); however, the mean operative time was not significantly different. Postoperative complications, described as Clavian classification, were reported in eight patients (23%) in the T group and 10 patients (30%) in the DE group, which was not significantly different. Epinephrine injections minimize operative bleeding without significant harmful effects on postoperative outcomes; therefore, it could be considered to be a safe and effective method for preparation of a bloodless field during hypospadias surgery. Copyright © 2016 Journal of Pediatric Urology Company. Published by Elsevier Ltd. All rights reserved.

Epidemiology of hypospadias in Europe: a registry-based study.

PubMed

Bergman, Jorieke E H; Loane, Maria; Vrijheid, Martine; Pierini, Anna; Nijman, Rien J M; Addor, Marie-Claude; Barisic, Ingeborg; Béres, Judit; Braz, Paula; Budd, Judith; Delaney, Virginia; Gatt, Miriam; Khoshnood, Babak; Klungsøyr, Kari; Martos, Carmen; Mullaney, Carmel; Nelen, Vera; Neville, Amanda J; O'Mahony, Mary; Queisser-Luft, Annette; Randrianaivo, Hanitra; Rissmann, Anke; Rounding, Catherine; Tucker, David; Wellesley, Diana; Zymak-Zakutnia, Natalya; Bakker, Marian K; de Walle, Hermien E K

2015-12-01

Hypospadias is a common congenital malformation. The prevalence of hypospadias has a large geographical variation, and recent studies have reported both increasing and decreasing temporal trends. It is unclear whether hypospadias prevalence is associated with maternal age. To analyze the prevalence and trends of total hypospadias, isolated hypospadias, hypospadias with multiple congenital anomalies, hypospadias with a known cause, and hypospadias severity subtypes in Europe over a 10-year period and to investigate whether maternal age is associated with hypospadias. We included all children with hypospadias born from 2001 to 2010 who were registered in 23 EUROCAT registries. Information on the total number of births and maternal age distribution for the registry population was also provided. We analyzed the total prevalence of hypospadias and relative risks by maternal age. From 2001 to 2010, 10,929 hypospadias cases were registered in 5,871,855 births, yielding a total prevalence of 18.61 per 10,000 births. Prevalence varied considerably between different registries, probably due to differences in ascertainment of hypospadias cases. No significant temporal trends were observed with the exceptions of an increasing trend for anterior and posterior hypospadias and a decreasing trend for unspecified hypospadias. After adjusting for registry effects, maternal age was not significantly associated with hypospadias. Total hypospadias prevalence was stable in 23 EUROCAT registries from 2001 to 2010 and was not significantly influenced by maternal age.

De morseir syndrome presenting as ambiguous genitalia.

PubMed

Thukral, Anubhav; Chitra, S; Chakraborty, Partho P; Roy, Ajitesh; Goswami, Soumik; Bhattacharjee, Rana; Dutta, Deep; Maisnam, Indira; Ghosh, Sujoy; Mukherjee, Satinath; Chowdhury, Subhankar

2012-12-01

A 10-year-old boy presented with genital ambiguity, poor linear growth, and delayed milestones. The aim and to highlight that although rare but congenital, hypogonadotropic hypogonadism may rarely present as ambiguity. The patient was found to have bilateral cryptorchidism with proximal penile hypospadias, microphallus with a proportionate dwarfism with mildly delayed bone age, and karyotype 46XY. Euthyroid with normal steroid axis, growth hormone insufficient as suggested by auxology, low IGF1, and poor response to clonidine stimulation. MRI brain shows hypoplastic corpus callosum, hypoplastic anterior pituitary, and ectopic posterior pituitary bright spot. The patient underwent laparoscopic removal of right intrabdominal testis and orchidoplexy was performed on the left one. Testicular biopsy revealed no malignancy and growth hormone replacement was initiated. The patient awaits definitive repair of hypospadias. As a provisional diagnosis of combined growth hormone and gonadotropin deficiency, most probable diagnosis is septo-optic dysplasia or de moseir syndrome leading to genital ambiguity.

Functional and aesthetic results in hypospadias repair with Hinderer's techniques.

PubMed

Hinderer, U T

2000-01-01

In his editorial to the first issue of Aesthetic Plastic Surgery in 1976, the Managing Editor, Dr. Blair Rogers lays special emphasis on the publication of papers and reports dealing with the increasing role of Aesthetic Plastic Surgery as the final step in the overall rehabilitation of Reconstructive Surgery patients. In genitourinary malformations-hypospadias and epispadias-without any doubt a satisfactory sexual and urinary functional result is essential. However, also a normal aesthetic appearance, resembling a circumcised penis, and with the meatus at the tip of the glans, is becoming increasingly important, notably since the second half of the last century. An abnormal aesthetic appearance affects the patient's body image and has a negative influence on his self-esteem and sexual behaviour. Psychological stress is brought on from genital comparison with school-mates, in adulthood in gym changing rooms and, specifically, in sexual relations. In these days of greater sexual freedom, the knowledge of male genital anatomy and aesthetic appearance has considerably improved. Penile hypoplasia creates a psychological impact perhaps only comparable with that of female mammary hypoplasia. It is therefore unsurprising that not only normal aesthetic appearance after hypospadias surgery is essential, but also the demand for penile lengthening and girth augmentation has progressively increased over these past recent years.

Do adult men with untreated hypospadias have adverse outcomes? A pilot study using a social media advertised survey

PubMed Central

Schlomer, Bruce; Breyer, Benjamin; Copp, Hillary; Baskin, Laurence; DiSandro, Michael

2014-01-01

Objective Hypospadias is usually treated in childhood. Therefore, the natural history of untreated mild hypospadias is unknown. We hypothesized that men with untreated hypospadias, especially mild, do not have adverse outcomes. Materials Facebook was used to advertise an electronic survey to men older than 18 years. Men with untreated hypospadias identified themselves and indicated the severity of hypospadias with a series of questions. Outcomes included: Sexual Health Inventory for Men (SHIM), penile curvature and difficulty with intercourse, International Prostate Symptom Score (IPSS), Penile Perception Score (PPS), psychosexual milestones, paternity, infertility, sitting to urinate, and the CDC HRQOL-4 module. Results 736 men completed self-anatomy questions and 52 (7.1%) self-identified with untreated hypospadias. Untreated hypospadias participants reported worse SHIM (p < 0.001) and IPSS scores (p = 0.05), more ventral penile curvature (p = 0.003) and resulting difficulty with intercourse (p < 0.001), worse satisfaction with meatus (p = 0.011) and penile curvature (p = 0.048), and more sitting to urinate (p = 0.07). When stratified by mild and severe hypospadias, severe hypospadias was associated with more adverse outcomes than mild hypospadias. Conclusion Men with untreated hypospadias reported worse outcomes compared with non-hypospadiac men. Mild untreated hypospadias had fewer adverse outcomes than severe hypospadias. Research is needed to determine if treatment of childhood hypospadias improves outcomes in adults, especially for mild hypospadias. PMID:24613143

[The history of pediatric plastic surgery].

PubMed

Glicenstein, J

2016-10-01

The history of pediatric plastic surgery is linked to that of paediatrics. Until the early 19th century, there was no children's hospital. Only some operations were performed before the discovery of anesthesia, aseptic and antisepsis: cleft lip repair, amputation for polydactyly. Many operations were described in the 19th century for cleft lip and palate repair, hypospadias, syndactylies. The first operation for protruding ears was performed in 1881. Pediatric plastic surgery is diversified in the 2nd half of the 20th century: cleft lip and palate, burns, craniofacial surgery, hand surgery become separate parts of the speciality. Copyright © 2016 Elsevier Masson SAS. All rights reserved.

Do adult men with untreated hypospadias have adverse outcomes? A pilot study using a social media advertised survey.

PubMed

Schlomer, Bruce; Breyer, Benjamin; Copp, Hillary; Baskin, Laurence; DiSandro, Michael

2014-08-01

Hypospadias is usually treated in childhood. Therefore, the natural history of untreated mild hypospadias is unknown. We hypothesized that men with untreated hypospadias, especially mild, do not have adverse outcomes. Facebook was used to advertise an electronic survey to men older than 18 years. Men with untreated hypospadias identified themselves and indicated the severity of hypospadias with a series of questions. Outcomes included: Sexual Health Inventory for Men (SHIM), penile curvature and difficulty with intercourse, International Prostate Symptom Score (IPSS), Penile Perception Score (PPS), psychosexual milestones, paternity, infertility, sitting to urinate, and the CDC HRQOL-4 module. 736 men completed self-anatomy questions and 52 (7.1%) self-identified with untreated hypospadias. Untreated hypospadias participants reported worse SHIM (p < 0.001) and IPSS scores (p = 0.05), more ventral penile curvature (p = 0.003) and resulting difficulty with intercourse (p < 0.001), worse satisfaction with meatus (p = 0.011) and penile curvature (p = 0.048), and more sitting to urinate (p = 0.07). When stratified by mild and severe hypospadias, severe hypospadias was associated with more adverse outcomes than mild hypospadias. Men with untreated hypospadias reported worse outcomes compared with non-hypospadiac men. Mild untreated hypospadias had fewer adverse outcomes than severe hypospadias. Research is needed to determine if treatment of childhood hypospadias improves outcomes in adults, especially for mild hypospadias. Copyright © 2014 Journal of Pediatric Urology Company. Published by Elsevier Ltd. All rights reserved.

Acute distal biceps tendon rupture--a new surgical technique using a de-tensioning suture to brachialis.

PubMed

Taylor, C J; Bansal, R; Pimpalnerkar, A

2006-09-01

Acute distal biceps rupture is a devastating injury in the young athlete and surgical repair offers the only chance of a full recovery. We report a new surgical technique used in 14 cases of acute distal tendon rupture in which the 'suture anchor technique' and a de-tensioning suture was employed. In this procedure the distal end of the biceps is re-attached to the radial tuberosity using a sliding whip stitch suture and the proximal part of the distal tendon repair attached to the underlying brachialis muscle with absorbable sutures. This restores correct anatomical alignment and isometric pull on the distal tendon and de-tensions the repair in the early post-operative period, allowing early rehabilitation and an early return to activity. In all cases patients regained a full pre-injury level of sporting activity at a mean period of 6.2 months (2-9 months).

[Oral mucosa graft urethroplasty for complicated urethral strictures].

PubMed

Horiguchi, Akio; Sumitomo, Makoto; Kanbara, Taiki; Tsujita, Yujiro; Yoshii, Takahiko; Yoshii, Hidehiko; Satoh, Akinori; Asakuma, Junichi; Ito, Keiichi; Hayakawa, Masamichi; Asano, Tomohiko

2010-03-01

We evaluated the efficacy and outcome of one-stage oral mucosa graft urethroplasty, which is currently the procedure of choice for treating lengthy and complicated urethral strictures not amenable to excision and primary end-to-end anastomosis. Seven patients 33 to 74 years old (mean age = 53.7) underwent one-stage oral mucosa graft urethroplasty for a stricture in either the bulbar urethra (four patients), penile urethra (two patients), or pan-anterior urethra (one patient). Three of the strictures were due to trauma, one was due to inflammation, and one was due to a failed hypospadia repair. The other two were iatrogenic. All patients had previously undergone either internal urethrotomy or repeated urethral dilation. Three patients received a tube graft, three received a ventral onlay, and one received a dorsal onlay. A free graft of oral mucosa was harvested from the inside of each patient's left cheek, and if necessary to obtain a sufficient length, the harvest was extended to include mucosa from the lower lip and the right cheek. The graft lengths ranged from 2.5 to 12 cm (mean = 4.6 cm). A urethral catheter was left in place for 3 weeks postoperatively. While no severe complications at the donor site were observed during follow-up periods ranging from 3 to 55 months (mean = 14 months), two patients who had received a tube graft developed distal anastomotic ring strictures that were managed by internal urethrotomy. The other five required no postoperative urological procedure even though one who had received a ventral onlay developed a penoscrotal fistula. Oral mucosa is an ideal urethral graft, and oral mucosa graft urethroplasty is an effective procedure for repairing complicated urethral strictures involving long portions of the urethra.

FUNCTIONAL OUTCOMES AFTER DISTAL BICEPS BRACHII REPAIR: A CASE SERIES

PubMed Central

Morris, Tim; Otto, Charissa; Zerella, Tanisha; Semmler, John G; Human, Taaibos; Phadnis, Joideep; Bain, Gregory I

2016-01-01

Objectives To investigate outcomes after surgical repair of distal biceps tendon rupture and the influence of arm dominance on isokinetic flexion and supination results. Background/Purpose While relatively uncommon, rupture of the distal biceps tendon can result in significant strength deficits, for which surgical repair is recommended. The purpose of this study was to assess patient reported functional outcomes and muscle performance following surgery. Methods A sample of 23 participants (22 males, 1 female), who had previously undergone surgical repair of the distal biceps tendon, were re-examined at a minimum of one year after surgery. Biodex isokinetic elbow flexion and supination testing was performed to assess strength (as measured by peak torque) and endurance (as measured by total work and work fatigue). The Quick Disabilities of the Arm, Shoulder and Hand (QuickDASH) and Mayo Elbow Performance Scale (MEPS) were used to assess participants' subjectively reported functional recovery. Results At a mean of 7.6 years after surgical repair, there were no differences between the repaired and uninvolved elbows in peak torque (p = 0.47) or total work (p = 0.60) for flexion or supination. There was also no difference in elbow flexion work fatigue (p = 0.22). However, there was significantly less work fatigue in supination, which was likely influenced by arm dominance, as most repairs were to the dominant arm, F(1,22)=5.67, p = 0.03. Conclusion The long-term strength of the repaired elbow was similar to the uninvolved elbow after surgery to the distal biceps tendon. Endurance of the repaired elbow was similar in flexion but greater in supination, probably influenced by arm dominance. Study design Retrospective case series Level of Evidence Level 4 PMID:27904798

FUNCTIONAL OUTCOMES AFTER DISTAL BICEPS BRACHII REPAIR: A CASE SERIES.

PubMed

Redmond, Christine L; Morris, Tim; Otto, Charissa; Zerella, Tanisha; Semmler, John G; Human, Taaibos; Phadnis, Joideep; Bain, Gregory I

2016-12-01

To investigate outcomes after surgical repair of distal biceps tendon rupture and the influence of arm dominance on isokinetic flexion and supination results. While relatively uncommon, rupture of the distal biceps tendon can result in significant strength deficits, for which surgical repair is recommended. The purpose of this study was to assess patient reported functional outcomes and muscle performance following surgery. A sample of 23 participants (22 males, 1 female), who had previously undergone surgical repair of the distal biceps tendon, were re-examined at a minimum of one year after surgery. Biodex isokinetic elbow flexion and supination testing was performed to assess strength (as measured by peak torque) and endurance (as measured by total work and work fatigue). The Quick Disabilities of the Arm, Shoulder and Hand (QuickDASH) and Mayo Elbow Performance Scale (MEPS) were used to assess participants' subjectively reported functional recovery. At a mean of 7.6 years after surgical repair, there were no differences between the repaired and uninvolved elbows in peak torque ( p  = 0.47) or total work ( p  = 0.60) for flexion or supination. There was also no difference in elbow flexion work fatigue ( p  = 0.22). However, there was significantly less work fatigue in supination, which was likely influenced by arm dominance, as most repairs were to the dominant arm, F (1,22)=5.67, p  = 0.03. The long-term strength of the repaired elbow was similar to the uninvolved elbow after surgery to the distal biceps tendon. Endurance of the repaired elbow was similar in flexion but greater in supination, probably influenced by arm dominance. Retrospective case series. Level 4.

Glans wings are separated ventrally by the septum glandis and frenulum penis: MRI documentation and surgical implications

PubMed Central

Özbey, Hüseyin; Kumbasar, Ali

2017-01-01

Objective In the normal human penis, the glans wings are in apposition in the midline ventrally, and are separated by the “septum glandis” and “frenulum” of the prepuce. However, most of the hypospadias repair techniques include dissection of the glans wings and their approximation enclosing the neourethra within the glans. Material and methods In order to obtain detailed information about the normal anatomy of glans penis, magnetic resonance imaging (MRI) findings of the penis were studied in three adults. Transverse, and sagittal sections of the penis were performed with a 1.5-T MRI scanner. Results The present MRI study has confirmed that the glans wings do not fuse at the ventral midline and they are seperated by a fibrous tissue (septum glandis). This fibrous tissue is connected to the frenulum, traversing the wings of the glans penis. The glanular urethra forming the fossa navicularis has a wider caliber than the proximal urethra, and its walls are radiologically seen as the extension of that fibrous tissue. Conclusion The male urethra is not a uniform tubular structure and has distinct attachments in glans penis. The glans wings are separated ventrally by the septum glandis and frenulum. In hypospadias, the septum glandis and frenulum are entirely missing structures. Therefore, in hypospadias surgery, the anatomical features of the glanular urethra must be taken into consideration. PMID:29201519

Hypospadias: Prevalence, birthweight and associated major congenital anomalies.

PubMed

Nissen, Karin Baekgaard; Udesen, Ann; Garne, Ester

2015-02-01

The aim of this study was to determine the prevalence of hypospadias over 24 years in a Danish population and to describe the relation to birthweight and associated major congenital anomalies. It is a population-based study of all cases (live births, fetal deaths and elective terminations of pregnancy) with hypospadias born in the period 1986-2009 in Funen County and reported to the EUROCAT registry of congenital anomalies. Cases were included only if surgery for hypospadias was performed. 223 cases of hypospadias were registered during the period 1986-2009 with an overall prevalence of 16.9 per 10 000 births. The prevalence was significantly higher in 2000-2009 compared to 1986-1999 (P < 0.001). We found a three times higher occurrence of VLBW (very low birthweight) infants among cases with hypospadias. Infants with isolated hypospadias were more likely to have mild hypospadias (68%) while cases with associated major congenital anomalies were less likely to have mild hypospadias (42%) (P < 0.05). Hypospadias was associated with VLBW and the severity of the defect was related to the presence of major congenital anomalies. The prevalence of hypospadias has increased during the study period. The relation to VLBW could indicate a causal relationship for hypospadias or a shared pathogenic factor. © 2014 Japanese Teratology Society.

Ovotesticular disorder of sexual development and a rare 46,XX/47,XXY karyotype.

PubMed

Ozsu, Elif; Mutlu, Gul Yesiltepe; Cizmecioglu, Filiz M; Ekingen, Gülsen; Muezzinoglu, Bahar; Hatun, Sukru

2013-01-01

Ovotesticular disorder of sexual development (DSD) is characterized by the presence of both ovarian and testicular tissues in the same individual. The most common karyotype is 46,XX. Here, we report the case of a boy with a 46,XX/47,XXY karyotype diagnosed as ovotesticular DSD by gonadal biopsy. A 5-month-old boy presented with hypospadias, unilateral cryptorchidism, and a micropenis. Pelvic magnetic resonance imaging revealed a suspicious gonad tissue that is solid in structure in the right scrotum and a suspicious gonad that is cystic in structure in the left inguinal canal. He underwent a diagnostic laparoscopy. Cytogenetic analysis of peripheral blood revealed a 46,XX/47,XXY karyotype. Histopathologic examination of the left gonad showed ovarian tissue containing primordial follicles with ipsilateral undifferentiated tuba uterina. The right gonad showed immature testis tissue. He underwent left gonadectomy and hypospadias repair, and was raised as a male. Through this rare case, we highlight the importance of histological and cytogenetic investigation in DSD.

Accuracy of the hypospadias diagnoses and surgical treatment registrations in the Danish National Patient Register

PubMed Central

Lindhard, Morten Søndergaard; Jønsson, Anne Aggerholm; Henriksen, Tine Brink; Olsen, Jørn; Thorup, Jorgen; Olsen, L Henning; Ramlau-Hansen, Cecilia Høst

2017-01-01

Purpose The Danish National Health registers provide a valuable data source that offers unique opportunities for observational research, including studies on the congenital anomaly hypospadias. The accuracy of the diagnosis and surgical treatment registration of hypospadias in the Danish National Patient Register (DNPR) remains unknown. Patients and methods We randomly sampled 500 patients diagnosed with hypospadias in the DNPR from January 1, 1995 to December 31, 2012. Among these, 384 patients were also registered with surgical treatment for hypospadias. Medical records were collected and reviewed independently by two investigators. Any classification disagreements were resolved by consensus. Using the medical records as the gold standard, we estimated positive predictive values (PPVs) with 95% confidence intervals (CIs) for the hypospadias diagnoses and surgical treatment registrations overall, as well as for the clinical subtypes. Results We were able to retrieve medical records for 463 (92.6%) patients with hypospadias diagnoses and for 329 (85.7%) patients registered with surgical treatment. Presence of hypospadias was confirmed in 450 of 463 patients, yielding an overall PPV (95% CI) of 97.6% (95.8%–98.7%). For subtypes of hypospadias, the PPVs ranged between 37.5% and 72.7%. For surgical treatment of hypospadias, the overall PPV was 99.7% (97.9%–99.9%). Conclusion The validity of the registration of hypospadias diagnoses as well as surgical treatment for hypospadias in the DNPR is overall very high. For the specific subtypes of hypospadias diagnoses codes and the specific surgical treatment codes, the PPVs are lower and cautious use is warranted. However, the DNPR remains a valuable tool for future observational research on hypospadias. PMID:29042817

Primary repair of retracted distal biceps tendon ruptures in extreme flexion.

PubMed

Morrey, Mark E; Abdel, Matthew P; Sanchez-Sotelo, Joaquin; Morrey, Bernard F

2014-05-01

Distal biceps tendon ruptures may have tendinous retraction, making primary repair difficult and calling into question the need for graft reconstruction. The decision for when to primarily fix or augment high-flexion repairs has not been addressed. We hypothesized high-flexion repairs would have good outcomes without graft augmentation. The purpose of this study was to examine allograft use and outcomes of distal biceps tendon ruptures requiring repair in greater than 60° of flexion. This was a retrospective case-control study 188 distal biceps tendon repairs; of these, 19 chronic and 4 acute cases were identified with repairs of >60° of flexion using a 2-incision technique. Graft need, complications, and Mayo Elbow Performance Score to assess function, were examined with a record review. Patients were surveyed regarding return to work and subjective satisfaction. A control group matched for surgeon, chronicity, and age, but without a high-flexion repair, was compared with cases by using the Student paired t test. Graft augmentation was used in 1 patient with poor tendon quality. The Mayo Elbow Performance Score was 100 for all 23 patients, with extension/flexion range of motion from 3° to 138°. All were subjectively "very satisfied/satisfied," with full work return, yet 3 reported mild fatigability. There were 4 complications: 3 transient lateral antebrachial cutaneous neurapraxias and 1 rerupture at the myotendinous junction after retrauma. Differences between cases and controls were not statistically significant. Contracted distal biceps tendons may be reliably reattached to their anatomic insertion with up to 90° of elbow flexion. This lessens the need for reconstruction in such circumstances. Copyright © 2014 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Mosby, Inc. All rights reserved.

Higher Incidence of Hypospadias in Monochorionic Twins.

PubMed

Visser, Remco; Burger, Nienke C M; van Zwet, Erik W; Hilhorst-Hofstee, Yvonne; Haak, Monique C; van den Hoek, Joop; Oepkes, Dick; Lopriore, Enrico

2015-10-01

Hypospadias is associated with twinning. The incidence of hypospadias in monochorionic and dichorionic male twins is, however, yet to be determined. All medical records of monochorionic and dichorionic twins admitted to our neonatal nursery between January 2004 and August 2013 were reviewed for the presence of hypospadias. A total of 350 monochorionic and 303 dichorionic male twins were included in the study. The incidence of hypospadias in monochorionic and dichorionic groups was 4% (14/350) and 1% (3/303) (p = .016) respectively. In 11 of the 15 twin couples, hypospadias occurred in the twin with the lowest birth weight. The rate of hypospadias in twin infants small-for-gestational-age group was 10% (6/60) compared with 2% (11/593) in the appropriate-for-gestational-age group (p = .002). In a multivariate analysis, both monochorionicity and small-for-gestational-age were independently associated with hypospadias, odds ratio 4.1 (95% confidence interval (CI): 1.1-14.7) and 6.1 (95% CI: 2.2-17.2) respectively. The incidence of hypospadias is four-fold higher in monochorionic twins compared with dichorionic twins. Hypospadias is also independently associated with small-for-gestational-age.

DNA mismatch repair and oligonucleotide end-protection promote base-pair substitution distal from a CRISPR/Cas9-induced DNA break

PubMed Central

Harmsen, Tim; Klaasen, Sjoerd; van de Vrugt, Henri; te Riele, Hein

2018-01-01

Abstract Single-stranded oligodeoxyribonucleotide (ssODN)-mediated repair of CRISPR/Cas9-induced DNA double-strand breaks (DSB) can effectively be used to introduce small genomic alterations in a defined locus. Here, we reveal DNA mismatch repair (MMR) activity is crucial for efficient nucleotide substitution distal from the Cas9-induced DNA break when the substitution is instructed by the 3′ half of the ssODN. Furthermore, protecting the ssODN 3′ end with phosphorothioate linkages enhances MMR-dependent gene editing events. Our findings can be exploited to optimize efficiencies of nucleotide substitutions distal from the DSB and imply that oligonucleotide-mediated gene editing is effectuated by templated break repair. PMID:29447381

[Aneurysm of the extracranial portion of the internal carotid artery combined with kinking of its distal segment].

PubMed

Zotov, S P; Shcherbakov, A V; Ufimtsev, M S; Kostromitin, N E; Semashko, T V; Korzina, E N; Tsar'kova, T A; Zharov, K A

Presented herein is a clinical case report regarding successful operation for an aneurysm of the left internal carotid artery (measuring 4.5*8.3 cm) combined with pathological tortuosity in its distal portion. The patient was subjected to aneurysmectomy of the left internal carotid artery with prosthetic repair. Kinking in the distal portion of the aneurysm made it possible with minimal technical difficulties to establish a distal anastomosis during prosthetic repair. The diagnosis of an atherosclerotic-aetiology aneurysm was morphologically confirmed.

DOE Office of Scientific and Technical Information (OSTI.GOV)

Tar, A.; Ion, A.; Gyoervari, B.

A de novo apparently balanced translocation involving chromosomes 8 and 20 was found in a 14-year-old boy with minor anomalies, mild skeletal abnormalities and ambiguous external genitalia including perineoscrotal hypospadias, rudimentary fused labioscrotal folds, bilateral cryptorchidism, and small penis. The karyotype was 46,XY, t(8;20)(q22.3-23;p13). No signs of other conditions known to be associated with structural anomalies of either chromosome 8 or 20 were present and incomplete masculinisation of the external genitalia appears to be the main component of the phenotype. Clinical and biological studies showed apparently normal testicular function in utero and after birth. Examinations excluded 5{alpha}-reductase deficiency or amore » block in any enzymatic steps of testosterone, glucocorticoid and mineralocorticoid biosynthesis. Coding sequences of the sex-determining gene (SRY) and androgen receptor gene (AR) were found to be identical to those of a normal male excluding their role in the cause of the present condition. Since several other reports describe the association of hypospadias and hypertelorism with deletions or translocations involving 8q, we suggest that a locus necessary for male sex differentiation is located at distal 8q. 24 refs., 3 figs.« less

Severe forms of concealed penis without hypospadias: Surgical strategies

PubMed Central

de Jesus, Lisieux Eyer; Dekermacher, Samuel; Anderson, Kleber M.

2015-01-01

Introduction: Concealed penis (CP) may vary in severity and includes megaprepuce (MP) as a variant. Many different surgical strategies have been described in order to maximize penile exposure and to deal with skin deficiency. We describe the strategies that we use to overcome technical problems in severe cases of CP. Materials and Methods: Six consecutive cases of severe CP (including 3 with MP) were treated in a 2-year period between January 2011 and April 2013. These patients were treated using extensive degloving, removal of dysplastic dartos, Alexander's preputial flap, scrotal flaps and skin grafts. Three patients had been previously circumcised. Cases associated with hypospadias, obesity, disorders of sexual differentiation and micropenises were excluded. Results: All six patients attained good results, with good exposure of the penis, ability to void standing with a well-directed flow and reasonable esthetic results. A technical algorithm for the treatment of primary or recurring cases of CP is proposed. Conclusion: Alexander’ s distally based ventral preputial flap is a useful technical resource to treat MP cases. Free skin grafts and/or laterally based scrotal flaps may be used to cover the penis after release in severe cases of CP. PMID:26604447

[Caudal migration of the verumontanum and enlargement of the utricle in hypospadias].

PubMed

Ikoma, F; Hohenfellner, R; Yamamoto, S

2014-09-01

Hypospadias is one of the morphological and functional alterations of the internal urogenital organs under the influence of androgen deficiency. In the time period 1974-1998 a total of 823 cases of hypospadias were surgically treated and the findings of the preoperative X-ray diagnostics with micturating cystourethrogram (MCU) and urethrocystogram (UCG) as well as urethrocystoscopy were analyzed. A caudal migration of the verumontanum could be detected in 55% of cases with hypospadias (453/823) and in 79% (322/403) of middle grade (penoscrotal) and high grade (scrotoperineal) cases of hypospadias. Enlargement of the utricle was present in 31.5% (259/823) cases of hypospadias and in 46.2% (186/423) of middle grade (penoscrotal) and high grade (scrotoperineal) cases of hypospadias.

Diacylglycerol kinase κ (DGKK) variants and hypospadias in Han Chinese: association and meta-analysis.

PubMed

Ma, Qichao; Tang, Yunman; Lin, Houwei; Xu, Maosheng; Xu, Guofeng; Fang, Xiaoliang; Chen, Jianhua; Song, Zhijian; Li, Zhiqiang; Shi, Yongyong; Geng, Hongquan

2015-10-01

To investigate whether diacylglycerol kinase κ (DGKK) is a susceptibility gene for hypospadias in the Han Chinese population as has been suggested by previous publications. A case-control study involving 466 patients with hypospadias and 402 healthy subjects was conducted to assess the relationship between DGKK single nucleotide polymorphisms (SNPs) and hypospadias risk in the Han Chinese population. The 466 hypospadias patients were further divided into mild, moderate and severe subgroups for analysis. Six SNPs (rs1934179, rs4143304, rs9969978, rs1934188, rs4826632 and rs4599945) were marginally associated with mild and moderate hypospadias [odds ratios (ORs) > 1, P = 0.05 to P < 0.1), whereas no significant relationship was seen with the severe cases (ORs >1, P > 0.1). After correcting for multiple testing, it was determined that neither individual SNPs nor individual haplotypes were associated with hypospadias. To evaluate this relationship in multiple populations, we performed a meta-analysis on six SNPs, using combined data from our present results and those of previous studies of different races (including 1966 patients and 2492 controls). Six SNPs (rs1934179, rs4143304, rs9969978, rs1934188, rs7063116 and rs1934190) were significantly associated with mild/moderate hypospadias (ORs >1, P < 0.05), and rs1934179 was significantly associated with severe hypospadias (OR > 1, P < 0.05). DGKK gene variants do not appear to play a major role in hypospadias susceptibility in the Chinese Han population. Our meta-analysis supports the hypothesis that DGKK is a common risk gene for hypospadias, particularly in cases of mild or moderate hypospadias in Caucasian populations. © 2014 The Authors BJU International © 2014 BJU International Published by John Wiley & Sons Ltd.

Interaction between MTHFR 677C>T and periconceptional folic acid supplementation in the risk of Hypospadias.

PubMed

Dokter, Elisabeth M J; van Rooij, Iris A L M; Wijers, Charlotte H W; Groothuismink, Johanne M; van der Biezen, Jan Jaap; Feitz, Wout F J; Roeleveld, Nel; van der Zanden, Loes F M

2016-04-01

Hypospadias is a congenital malformation with both environmental factors and genetic predisposition involved in the pathogenesis. The role of maternal periconceptional folic acid supplement use in the development of hypospadias is unclear. As folate levels may also be influenced by the C677T polymorphism in the methylenetetrahydrofolate reductase (MTHFR) gene, we hypothesize that a gene-environment interaction between this polymorphism and folic acid use is involved in the etiology of hypospadias. We conducted a case-control study among 855 hypospadias cases and 713 population-based controls from the AGORA data- and biobank. Folic acid supplement use was derived from maternal questionnaires and infant and maternal DNA was used to determine the MTHFR C677T polymorphism using Taqman assays. We performed separate analyses for different hypospadias phenotypes (anterior/middle/posterior). Hypospadias was neither associated with folic acid use or the MTHFR C677T polymorphism, nor with their interaction. However, we did find an association with middle hypospadias when no supplements were used (odds ratio = 1.6; 95% confidence interval, 1.1-2.4), especially in infants carrying the CT/TT genotype (odds ratio = 2.5; 95% confidence interval, 1.4-4.7). In addition, more infants with these genotypes seemed to have posterior hypospadias, regardless of folic acid use. Our study does not suggest a major role for folic acid supplements or the MTHFR C677T polymorphism in the etiology of hypospadias in general, but not using folic acid and/or carrying the MTHFR C677T polymorphism may be associated with middle and posterior hypospadias. Therefore, we stress the importance of studying gene-environment interactions preferably in stratified analyses for different hypospadias phenotypes. © 2016 Wiley Periodicals, Inc.

Placental pathology and hypospadias.

PubMed

Chen, Yan; Sun, Luming; Geng, Hongquan; Lei, Xiaoping; Zhang, Jun

2017-03-01

Studies have shown that hypospadias is associated with placenta-mediated pregnancy complication (PMPC). The role of placental lesions is still unclear. We aimed to examine the association between hyposadias and placental pathology, and the effect of PMPC. Using data from the US Collaborative Perinatal Project in 1959-1966, we identified 15,780 male subjects (167 hypospadias) for analysis. Detailed placental examinations were conducted following a standard protocol. Subjects were divided into two groups according to whether they had PMPC, including small-for-gestational-age, pre-eclampsia/eclampsia or placental abruption. Logistic regression models were used to explore the association. The prevalence of hypospadias was two times higher in subjects with PMPC than those without. Compared to pregnancies with PMPC but no hypospadias, those with both PMPC and hypospadias had significant higher prevalence of placental lesions, such as low placental weight, vascular lesions, villous lesions, and membranous insertion of cord (adjusted odds ratio (OR) ranging from 2.6 to 5.2) after adjusting for potential confounders. In subjects without PMPC, no significant difference of placental pathology was found between those with or without hypospadias. About one third of hypospadias cases were complicated with PMPC and had a higher risk of placental lesions, suggesting heterogeneity of hypospadias etiology and mechanisms.

Delayed repair of distal biceps tendon ruptures is successful: a case-control study.

PubMed

Haverstock, John; Grewal, Ruby; King, Graham J W; Athwal, George S

2017-06-01

The literature has shown an increased complication rate with a delay to surgical repair of acute distal biceps tendon ruptures; however, little has been documented regarding the outcome of delayed repairs. This case-control study compared a study cohort of delayed (>21 days) distal biceps tendon repairs with a control cohort repaired acutely (<21 days). Sixteen delayed repair cases were reviewed and matched with acute controls (1:3) based on repair technique, age, and workers' compensation status. The delayed cohort was reviewed and completed isometric strength testing and the Disabilities of the Arm, Shoulder and Hand questionnaire; Patient-Rated Elbow Evaluation; and American Shoulder and Elbow Surgeons elbow questionnaire. The time to surgery averaged 37 ± 12 days in the delayed cohort versus 10 ± 6 days in the acute cohort. Complications occurred in 63% of patients in the delayed cohort versus 29% in the acute cohort (P = .04); however, 90% of the delayed cohort's complications consisted of transient paresthesias. Follow-up scores on the Patient-Rated Elbow Evaluation, Disabilities of the Arm, Shoulder and Hand questionnaire, and American Shoulder and Elbow Surgeons elbow questionnaire were not statistically different between cohorts (P > .37, P > .22, and P > .46, respectively). Despite a high rate of initial complications, patients treated with distal biceps tendon repair after a delay (>21 days) can expect similar functional outcomes to those treated acutely. Copyright © 2017 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.

[How and when to evaluate hypospadias?].

PubMed

Bouvattier, C

2013-09-01

Hypospadias is a frequent congenital malformation, which severity is connected to the spongiosum divergence. Biological and anatomical explorations are necessary, before the recourse to the surgeon, in posterior hypospadias, familial hypospadias, but also in any type of hypospadias associated with cryptorchidism, bifid scrotum, micropenis less than 20mm (full-term newborn), or any other anomaly (skeletal, renal, cardiac…). The "mini-puberty", occurring in the first 4-6 months of life, is a period of intense gonadotropic activity in male newborns. It allows an easy investigation of the testicular function in boys with hypospadias. Hormonal evaluation (testosterone, AMH) should be done the first day of life. Let us remind that a newborn with "hypospadias" and bilateral cryptorchidism must be considered, until proved otherwise, as a girl with congenital adrenal hyperplasia. Copyright © 2013 Elsevier Masson SAS. All rights reserved.

Clinical and functional outcome of open primary repair of triangular fibrocartilage complex tears associated with distal radius fractures.

PubMed

Johandi, Faisal; Sechachalam, Sreedharan

2017-01-01

We evaluate the clinical and functional outcome of open primary repair of acute TFCC tears in distal radius fracture, when there is gross intraoperative distal radioulnar joint (DRUJ) instability after fixation of the distal radius, in the absence of an ulnar styloid fracture or when the ulnar fracture fragment is too small to be fixed. A retrospective review of our institution's distal radius fracture database over a 4-year period (January 2010 to December 2013). A total of 12 (1.38%) out of 3379 patients had an open TFCC repair in the same setting as fixation of distal radius. Assessment of outcome involved the analysis of objective and subjective clinical and functional outcomes. All patient regained Activities of Daily Living (ADL) independence; eleven out of 12 patients (91.7%) returned to pre-injury function and 8 out of 11 patients (72.7%) returned to their jobs. DRUJ stability was preserved in 10 patients (83.3%) with 10 patients (83.3%) having grip strength of at least 50%, compared to the uninjured hand, and 7 (58.3%) with grip strength of more than or equal to 75%. Complications of surgery identified can be classified into 4 broad categories: infection, neurological complications, persistent DRUJ instability and prolonged pain. The authors believe a primary open repair of the TFCC should be considered when patients present with instability during intra-operative DRUJ ballottement test after distal radius fixation, in the absence of an ulnar styloid fracture or when the ulnar fracture fragment is too small to be fixed.

Outcome of Repair of Distal Radial and Ulnar Fractures in Dogs Weighing 4 kg or Less Using a 1.5-mm Locking Adaption Plate or 2.0-mm Limited Contact Dynamic Compression Plate.

PubMed

Nelson, Thomas A; Strom, Adam

2017-11-01

Objectives  Retrospective evaluation of repairing distal radial and ulnar fractures in small breed dogs with the Synthes 1.5-mm locking Adaption plate system and compare results in a similar group of patients repaired with the Synthes 2.0-mm limited contact-dynamic compression plate (LC-DCP). Methods  Electronic medical records from one specialty referral centre were reviewed from March 21, 2010, to October 9, 2015, for patients weighing less than or equal to 4 kg that had a distal one-third radial and ulnar fracture repaired with a Synthes 1.5-mm locking adaption plate or Synthes 2.0-mm LC-DCP. Further inclusion criteria included application of the plate to the cranial surface of the radius via open reduction and internal fixation. Results  Six 1.5-mm Adaption plates and 7 2.0-mm LC-DCPs were used to repair 13 distal radial and ulnar fractures in 12 dogs. There were three major complications in the 1.5-mm adaption plate group (one plate fracture, one screw pull-out and one fracture through a distal screw hole) and one major complication in the 2.0-mm LC-DCP group due to a re-fracture. All patients without a complication had good or excellent functional outcome. Clinical Significance  The authors recommend that the 1.5-mm Adaption plate be used only when a 2.0-mm LC-DCP would not allow for a minimum of two screws in the distal segment and at the discretion of the surgeon. Schattauer GmbH Stuttgart.

Collateral development and spinal motor reorganization after nerve injury and repair

PubMed Central

Yu, Youlai; Zhang, Peixun; Han, Na; Kou, Yuhui; Yin, Xiaofeng; Jiang, Baoguo

2016-01-01

Functional recovery is often unsatisfactory after severe extended nerve defects or proximal nerve trunks injuries repaired by traditional repair methods, as the long regeneration distance for the regenerated axons to reinnervate their original target end-organs. The proximal nerve stump can regenerate with many collaterals that reinnervate the distal stump after peripheral nerve injury, it may be possible to use nearby fewer nerve fibers to repair more nerve fibers at the distal end to shorten the regenerating distance. In this study, the proximal peroneal nerve was used to repair both the distal peroneal and tibial nerve. The number and location of motor neurons in spinal cord as well as functional and morphological recovery were assessed at 2 months, 4 months and 8 months after nerve repair, respectively. Projections from the intact peroneal and tibial nerves were also studied in normal animals. The changes of motor neurons were assessed using the retrograde neurotracers FG and DiI to backlabel motor neurons that regenerate axons into two different pathways. To evaluate the functional recovery, the muscle forces and sciatic function index were examined. The muscles and myelinated axons were assessed using electrophysiology and histology. The results showed that all labeled motor neurons after nerve repair were always confined within the normal peroneal nerve pool and nearly all the distribution of motor neurons labeled via distal different nerves was disorganized as compared to normal group. However, there was a significant decline in the number of double labeled motor neurons and an obvious improvement with respect to the functional and morphological recovery between 2 and 8 months. In addition, the tibial/peroneal motor neuron number ratio at different times was 2.11±0.05, 2.13±0.08, 2.09±0.12, respectively, and was close to normal group (2.21±0.09). Quantitative analysis showed no significant morphological differences between myelinated nerve fibers regenerated along the two distal nerves except for the number of nerve fibers, which was higher in the tibial nerve. The ratio of distal regenerated axon numbers to proximal donor nerve axon numbers was about 3.95±0.10, 4.06±0.19 and 3.87±0.23, respectively. This study demonstrated that fewer nerve fibers can regenerate a large number of collaterals which successfully repopulate both distal nerves and lead to the partial recovery of lost functions. It may provide a new method to repair severe extended nerve defects or proximal nerve trunks injuries. PMID:27508011

Endocrine disruptors and hypospadias: role of genistein and the fungicide vinclozolin.

PubMed

Vilela, Marcelo L B; Willingham, Emily; Buckley, Jill; Liu, Ben Chun; Agras, Koray; Shiroyanagi, Yoshiyuki; Baskin, Laurence S

2007-09-01

The phytoestrogen (plant estrogen) genistein, present in soy products, is of interest because in utero exposure to genistein can cause hypospadias in our mouse model and maternal consumption of soy is prevalent in human populations. Another compound of interest is the fungicide vinclozolin, which also causes hypospadias in the mouse and rat and can occur concurrently with genistein in the diet as a residue on exposed foods. A study in the United Kingdom found no relationship between a maternal organic vegetarian diet and hypospadias frequency, but women who consumed nonorganic vegetarian diets had a greater percentage of sons with hypospadias. Because nonorganic diets can include residues of pesticides such as vinclozolin, we sought to assess the interaction of realistic daily exposures to genistein and vinclozolin and their effects on the incidence of hypospadias. Pregnant mice were fed a soy-free diet and orally gavaged from gestational days 13 to 17 with 0.17 mg/kg/day of genistein, 10 mg/kg/day of vinclozolin, or genistein and vinclozolin together at the same doses, all in 100 microL of corn oil. The controls received the corn oil vehicle. The male fetuses were examined at gestational day 19 for hypospadias, both macroscopically and histologically. We identified no hypospadias in the corn oil group. The incidence of hypospadias was 25% with genistein alone, 42% with vinclozolin alone, and 41% with genistein and vinclozolin together. These findings support the idea that exposure to these compounds during gestation could contribute to the development of hypospadias.

Long-term follow-up and late complications following treatment of pediatric urologic disorders.

PubMed

Akhavan, Ardavan; Stock, Jeffrey A

2011-01-01

Many pediatric urologic disorders have sequelae that may affect patients well into adulthood. Despite adequate treatment, many patients are at risk for progressive urologic deterioration years after surgical reconstruction. While many pediatric urologists follow their patients years after surgery, screening for late complications is a shared responsibility with primary care providers. This article discusses potential late complications and appropriate follow-up for patients who have a history of ureteral reimplantation, pyeloplasty, hypospadias repair, posterior urethral valve ablation, and intestinal interposition. Copyright © 2011 Elsevier Inc. All rights reserved.

Surgical repair of sciatic nerve traumatic rupture: technical considerations and approaches.

PubMed

Abou-Al-Shaar, Hussam; Yoon, Nam; Mahan, Mark A

2018-01-01

Traumatic proximal sciatic nerve rupture poses surgical repair dilemmas. Disruption often causes a large nerve gap after proximal neuroma and distal scar removal. Also, autologous graft material to bridge the segmental defect may be insufficient, given the sciatic nerve diameter. The authors utilized knee flexion to allow single neurorrhaphy repair of a large sciatic nerve defect, bringing healthy proximal stump to healthy distal segment. To avoid aberrant regeneration, the authors split the sciatic nerve into common peroneal and tibial divisions. After 3 months, the patient can fully extend the knee and has evidence of distal regeneration and nerve continuity without substantial injury. The video can be found here: https://youtu.be/lsezRT5I8MU .

Restrictive bare stent prevents distal stent graft-induced new entry in endovascular repair of type B aortic dissection.

PubMed

Zhao, Yang; Yin, Henghui; Chen, Yitian; Wang, Mian; Zheng, Liang; Li, Zilun; Chang, Guangqi

2018-01-01

Distal stent graft-induced new entry (SINE) can occur after thoracic endovascular aortic repair (TEVAR) of type B aortic dissection. This study investigated the mechanism of distal SINE and its prevention using a restrictive bare stent (RBS) technique. From January 2013 to December 2014, 68 consecutive type B aortic dissection patients received endovascular repair at our center. The RBS technique was used with distal oversizing (between the diameter of the thoracic stent graft and the descending aorta true lumen diameter at the level of the intended distal edge of the thoracic stent graft) >20%. Twenty-three patients received TEVAR with a single thoracic stent graft (TEVAR group, n = 23); the rest received TEVAR combined with the RBS technique (TEVAR + RBS group, n = 45). Four distal SINEs occurred in the TEVAR group. Distal oversizing (69.7% ± 35.5% vs 31.2% ± 24.5%; P = .005) and expansion mismatch ratio (132.2% ± 16.9% vs 106.5% ± 11.6%; P < .05) were significantly higher in the SINE patients. Compared with standard TEVAR, TEVAR + RBS was associated with significantly lower distal oversizing (TEVAR vs TEVAR + RBS group, 59.8% ± 24.7% vs 16.7% ± 7.6%; P < .05), lower expansion mismatch ratio (113.8% ± 14.6% vs 103.8% ± 11.7%; P = .012), and lower distal SINE rate (4/23 [17.4%] vs 0/45 [0%]; P = .011). Compared with the TEVAR group, the false lumen was reduced significantly at the level of the RBS distal edge (P = .029). Excessive distal oversizing and distal expansion mismatch ratio may contribute to the occurrence of distal SINE. The RBS technique reduced the incidence of distal SINE. Based on our midterm and long-term observations, implantation of an RBS may improve aortic remodeling. Copyright © 2017 Society for Vascular Surgery. Published by Elsevier Inc. All rights reserved.

Plication procedures—excisional and incisional corporoplasty and imbrication for Peyronie’s disease

PubMed Central

Chen, Roger; McCraw, Casey

2016-01-01

Plication procedures for the correction of Peyronie’s disease (PD) curvature are management options for PD patients. There are basically three types of procedures: excisional corporoplasty, incisional corporoplasty, and plication-only. This review is a compilation of English literature, peer-reviewed, published articles addressing these types of operations for Peyronie’s curvature correction, not congenital curvature. According to the urology literature, this surgical type was initially used for correction of curvature associated with hypospadias repair or congenital penile curvature. The procedures also, for the most part, historically became an alternative for plaque excision and graft repair, because of the difficulty with such repairs and the often-resultant erectile dysfunction (ED). A brief section traces some of the origins of these various repairs, followed by a brief section on the selection criteria for these types of surgery for the patient with PD penile curvature. We also review the significant articles in which the three types were presented with modifications. Finally, several articles that compare the various surgical repairs are summarized in the order that they appear in the literature. These types of surgery have become a mainstay for the surgical correction of penile curvature due to PD. PMID:27298779

A geographic analysis of individual and environmental risk factors for hypospadias births

PubMed Central

Winston, Jennifer J; Meyer, Robert E; Emch, Michael E

2014-01-01

Background Hypospadias is a relatively common birth defect affecting the male urinary tract. We explored the etiology of hypospadias by examining its spatial distribution in North Carolina and the spatial clustering of residuals from individual and environmental risk factors. Methods We used data collected by the North Carolina Birth Defects Monitoring Program from 2003-2005 to estimate local Moran's I statistics to identify geographic clustering of overall and severe hypospadias, using 995 overall cases and 16,013 controls. We conducted logistic regression and local Moran's I statistics on standardized residuals to consider the contribution of individual variables (maternal age, maternal race/ethnicity, maternal education, smoking, parity, and diabetes) and environmental variables (block group land cover) to this clustering. Results Local Moran's I statistics indicated significant clustering of overall and severe hypospadias in eastern central North Carolina. Spatial clustering of hypospadias persisted when controlling for individual factors, but diminished somewhat when controlling for environmental factors. In adjusted models, maternal residence in a block group with more than 5% crop cover was associated with overall hypospadias (OR = 1.22; 95% CI = 1.04 – 1.43); that is living in a block group with greater than 5% crop cover was associated with a 22% increase in the odds of having a baby with hypospadias. Land cover was not associated with severe hypospadias. Conclusions This study illustrates the potential contribution of mapping in generating hypotheses about disease etiology. Results suggest that environmental factors including proximity to agriculture may play some role in the spatial distribution of hypospadias. PMID:25196538

Factors affecting post-pubertal penile size in patients with hypospadias.

PubMed

Moriya, Kimihiko; Nakamura, Michiko; Nishimura, Yoko; Kitta, Takeya; Kanno, Yukiko; Chiba, Hiroki; Kon, Masafumi; Shinohara, Nobuo

2016-09-01

To evaluate actual post-pubertal penile size and factors affecting it in hypospadias patients, we retrospectively reviewed medical charts. Hypospadias patients whose external genitalia were categorized into Tanner stage 5, and whose stretched penile length was evaluated at 15 years old or older from April 2008 to April 2015, were enrolled in the present study. Stretched penile length was measured by a single examiner. Actual post-pubertal stretched penile length and factors affecting the post-pubertal stretched penile length were estimated. Statistical analysis was performed using Mann-Whitney U test and univariate and multivariate linear regression models for the determination of independent factors. Thirty patients met the inclusion criteria. Median age at evaluation was 17.2 years. Thirteen and 17 had mild and severe hypospadias, respectively. Endocrinological abnormality was identified in 5. Multivariate analysis showed that the severity of hypospadias and endocrinological abnormality were significant factors affecting stretched penile length. Stretched penile length in 25 patients without endocrinological abnormality was significantly longer than that in those with endocrinological abnormality (p = 0.036). Among patients without endocrinological abnormality, stretched penile length in 13 with severe hypospadias was significantly shorter than that in 12 with mild hypospadias (p = 0.004). While the severity of hypospadias and endocrinological abnormality at post-pubertal evaluation were factors affecting post-pubertal penile size, stretched penile length in patients with severe hypospadias was shorter even in cases without endocrinological abnormality. These results suggest that severe hypospadias is not only a disorder of urethral development, but also a disorder of penile development.

Environmental and Genetic Contributors to Hypospadias: A Review of the Epidemiologic Evidence

PubMed Central

Carmichael, Suzan L.; Shaw, Gary M.; Lammer, Edward J.

2012-01-01

This review evaluates current knowledge related to trends in the prevalence of hypospadias, the association of hypospadias with endocrine-disrupting exposures, and the potential contribution of genetic susceptibility to its etiology. The review focuses on epidemiologic evidence. Increasing prevalence of hypospadias has been observed, but such increases tend to be localized to specific regions or time periods. Thus, generalized statements that hypospadias is increasing are unsupported. Due to limitations of study designs and inconsistent results, firm conclusions cannot be made regarding the association of endocrine-disrupting exposures with hypospadias. Studies with more rigorous study designs (e.g., larger and more detailed phenotypes) and exposure assessment that encompasses more breadth as well as depth (e.g., specific endocrine-related chemicals) will be critical to make better inferences about these important environmental exposures. Many candidate genes for hypospadias have been identified, but few of them have been examined to an extent that enables solid conclusions. Further studies are needed that include larger sample sizes, comparison groups that are more representative of the populations from which the cases were derived, phenotype-specific analyses, and more extensive exploration of variants. In conclusion, examining the associations of environmental and genetic factors with hypospadias remain important areas of inquiry, although our actual understanding of their contribution to hypospadias risk in humans is currently limited. PMID:22678668

Further Evidence of the Association of the Diacylglycerol Kinase Kappa (DGKK) Gene With Hypospadias.

PubMed

Hozyasz, Kamil Konrad; Mostowska, Adrianna; Kowal, Andrzej; Mydlak, Dariusz; Tsibulski, Alexander; Jagodzinski, Pawel P

2018-02-18

Hypospadias is a common developmental anomaly of the male external genitalia. In previous studies conducted on West European, Californian, and Han Chinese populations the relationship between polymorphic variants of the diacylglycerol kinase kappa (DGKK) gene and hypospadias have been reported. The aim was to study the possible associations between polymorphic variants of the DGKK gene and hypospadias using an independent sample of the Polish population. Ten single nucleotide polymorphisms in DGKK, which were reported to have an impact on the risk of hypospadias in other populations, were genotyped using high-resolution melting curve analysis in a group of 166 boys with isolated anterior (66%) and middle (34%) forms of hypospadias and 285 properly matched controls without congenital anomalies. Two DGKK variants rs11091748 and rs12171755 were associated with increased risk of hypospadias in the Polish population. These results were statistically significant, even after applying the Bonferroni correction for multiple comparisons (P < .005). All the tested nucleotide variants were involved in haplotype combinations associated with hypospadias. The global p-values for haplotypes comprising of rs4143304-rs11091748, rs11091748-rs17328236, rs1934179-rs4554617, rs1934183-rs1934179-rs4554617 and rs12171755-rs1934183-rs1934179-rs4554617 were statistically significant, even after the permutation test correction. Our study provides strong evidence of an association between DGKK nucleotide variants, haplotypes and hypospadias susceptibility.

Toward the effective surveillance of hypospadias.

PubMed

Dolk, Helen; Vrijheid, Martine; Scott, John E S; Addor, Marie-Claude; Botting, Bev; de Vigan, Catherine; de Walle, Hermien; Garne, Ester; Loane, Maria; Pierini, Anna; Garcia-Minaur, Sixto; Physick, Nigel; Tenconi, Romano; Wiesel, Awi; Calzolari, Elisa; Stone, David

2004-03-01

Concern about apparent increases in the prevalence of hypospadias--a congenital male reproductive-tract abnormality--in the 1960s to 1980s and the possible connection to increasing exposures to endocrine-disrupting chemicals have underlined the importance of effective surveillance of hypospadias prevalence in the population. We report here the prevalence of hypospadias from 1980 to 1999 in 20 regions of Europe with EUROCAT (European Surveillance of Congenital Anomalies) population-based congenital anomaly registers, 14 of which implemented a guideline to exclude glanular hypospadias. We also report data from the England and Wales National Congenital Anomaly System (NCAS). Our results do not suggest a continuation of rising trends of hypospadias prevalence in Europe. However, a survey of the registers and a special validation study conducted for the years 1994-1996 in nine EUROCAT registers as well as NCAS identified a clear need for a change in the guidelines for registration of hypospadias. We recommend that all hypospadias be included in surveillance, but that information from surgeons be obtained to verify location of the meatus, and whether surgery was performed, in order to interpret trends. Investing resources in repeated special surveys may be more cost-effective than continuous population surveillance. We conclude that it is doubtful whether we have had the systems in place worldwide for the effective surveillance of hypospadias in relation to exposure to potential endocrine-disrupting chemicals.

Proximal Hypospadias

PubMed Central

Kraft, Kate H.; Shukla, Aseem R.; Canning, Douglas A.

2011-01-01

Hypospadias results from abnormal development of the penis that leaves the urethral meatus proximal to its normal glanular position. Meatal position may be located anywhere along the penile shaft, but more severe forms of hypospadias may have a urethral meatus located at the scrotum or perineum. The spectrum of abnormalities may also include ventral curvature of the penis, a dorsally redundant prepuce, and atrophic corpus spongiosum. Due to the severity of these abnormalities, proximal hypospadias often requires more extensive reconstruction in order to achieve an anatomically and functionally successful result. We review the spectrum of proximal hypospadias etiology, presentation, correction, and possible associated complications. PMID:21516286

Loratadine and Pregnancy

MedlinePlus

... with several limitations suggested a small risk for hypospadias (a condition where the opening of the penis ... risk of any type of birth defect, including hypospadias. Also, studies involving infants with hypospadias did not ...

Use of a Temporary Shunt as a Salvage Technique for Distal Extremity Amputations Requiring Repair by Vessel Grafting during Critical Ischemia

PubMed Central

Dadaci, Mehmet; Altuntas, Zeynep

2016-01-01

Background Although the use of temporary shunts in proximal extremity amputations has been reported, no study has described the use of temporary shunts in distal extremity amputations that require vein grafting. Moreover, the total volume of blood loss when temporary shunts are used has not been reported. The aim of this study was to investigate the applicability of a temporary shunt for distal extremity amputations requiring repair by vessel grafting with an ischemia time of >6 hours. This study also aimed to determine the total volume of blood loss when temporary shunts were used. Methods Patients who underwent distal major extremity replantation and/or revascularization with a vessel graft and who experienced ischemia for 6–8 hours between 2013 and 2014 were included in the study. A 6-Fr suction catheter was cut to 5 cm in length after the infusion of heparin, and secured with a 5-0 silk suture between the distal and the proximal ends of the artery. While bleeding continued, the bones were shortened and fixed. After the complete restoration of circulation, the arterial shunt created using the catheter was also repaired with a vein graft. Results Six patients were included in this study. The mean duration of ischemia was 7.25 hours. The mean duration of suction catheter use during limb revascularization was 7 minutes. The mean transfusion volume was 7.5 units. No losses of the extremity were observed. Conclusions This procedure should be considered in distal extremity amputations requiring repair by vessel grafting during critical ischemia. PMID:27896186

Application of the STROBE statement to the hypospadias literature: Report of the international pediatric urology task force on hypospadias.

PubMed

Braga, Luis H; Lorenzo, Armando J; Bagli, Darius J; Pippi Salle, Joao L; Caldamone, Anthony

2016-12-01

Observational studies, particularly case series, represent the majority of the current hypospadias research. As a result, this literature lacks standardization of surgical techniques, uniform definitions of hypospadias complications, and consistency of outcome reporting, which may make it difficult to compare results across studies. A modified version of the STROBE statement, containing 20 items, was presented at the International Pediatric Urology Task Force on Hypospadias meeting to assist with clear and transparent reporting of hypospadias studies. The adoption and implementation of this modified tool will allow investigators and health care providers to critically evaluate quality and identify bias within the literature. In addition this instrument will ensure consistency of reporting, improving objective comparisons between studies, unification of results, and development of evidence-based clinical guidelines. In this article, we have applied the modified STROBE statement to the hypospadias literature, aiming to create a guide on study reporting for pediatric urologists, and ultimately improve the quality of research in our field. We present itemized recommendations for adequate reporting of hypospadias studies and case series, ranging from drafting the abstract to addressing biases and potential sources of confounding. Included with each item is a brief explanation of its importance and potential effect on the study, as well as pertinent examples of hypospadias articles. A modified STROBE summary table containing 20 items is presented in (Supplementary Table 1). If properly conducted and reported, hypospadias studies have the potential to provide useful information to clinicians and surgeons. However, authors should recognize the inherent limitations of these observational studies, especially in the form of bias, which may introduce invalid data or limit generalizability. Thus, we expect that the use of this guiding tool will not only improve transparency of hypospadias reporting, but also improve its methodological quality, allowing proper comparison and interpretation of data across different institutions. Copyright © 2016 Journal of Pediatric Urology Company. Published by Elsevier Ltd. All rights reserved.

Di-n-butyl phthalate induced hypospadias relates to autophagy in genital tubercle via the PI3K/Akt/mTOR pathway.

PubMed

Li, Xiang; Li, Jinhao; Zhang, Ya; Zhou, Yun

2017-01-24

To explore the mechanisms of hypospadias induced by in utero exposure to din-butyl phthalate (DBP). Timed-pregnant Sprague-Dawley rats were administered 750 mg/kg of DBP by gavage from GD (gestation days) 13 to GD 18, whereas control group received corn oil. Genital tubercles (GTs) and blood samples were collected from male fetuses on GD 19. The serum testosterone concentration, apoptosis activity, autophagosomes and their related proteins (light chain 3 (LC3-I, LC3-II) ), and sequestosomes (SQSTM1/p62) in the GTs were then measured. Protein expression of protein kinase B (Akt), Beclin 1, phosphorylated Akt (p-Akt), p-S6, and phosphorylated mammalian target of rapamycin (p-mTOR) in the GTs were analyzed by Western blotting. The incidence of hypospadias induced by DBP was 43.64% in male fetuses. The GT volume and GT volume/body weight of fetuses were significantly reduced in the hypospadias and the non-hypospadias groups. Apoptotic cell number was significantly decreased in the GTs of the hypospadias group, but unchanged in the non-hyposadias group. The ratio of LC3-II/LC3-I was higher in the GTs from DBP exposed fetuses compared to the control group. The ratio of LC3-II/LC3-I in the GTs was higher in the hypospadias group than in the non-hypospadias group. The number of autophagosomes was increased in the GTs of the hypospadias group. Protein expression of p-S6, p-mTOR, and p-Akt were significantly decreased in the GTs of hypospadiac rats. DBP-induced hypospadias might be associated with apoptosis and autophagy mediated by the PI3K/Akt/mTOR signaling pathway in the GT.

No Association between Maternal Pre-pregnancy Obesity and Risk of Hypospadias or Cryptorchidism in Male Newborns

PubMed Central

Adams, Scott V.; Hastert, Theresa A.; Huang, Yi; Starr, Jacqueline R.

2011-01-01

BACKGROUND Hypospadias and cryptorchidism, two relatively common male genital anomalies, may be caused by altered maternal hormone levels, blood glucose levels, or nutritional deficiencies. Maternal obesity, which increases risk of diabetes and could influence hormone levels, may therefore be associated with risk of hypospadias and cryptorchidism. The purpose of this study was to assess the association between pre-pregnancy maternal obesity and hypospadias and cryptorchidism. METHODS We conducted a case-control study of hypospadias and cryptorchidism in male singleton newborns using Washington State birth records from 1992 to 2008 linked to birth-hospitalization discharge records. Maternal pre-pregnancy body mass index (BMI) was calculated from pre-pregnancy weight and height. Adjusted odds ratios (aORs) and 95% confidence intervals (95% CIs) for hypospadias or cryptorchidism were estimated by fitting multivariable logistic regression models adjusted for year of birth, and maternal age, education, parity, race, and cigarette smoking during pregnancy. RESULTS The complete-case analysis included 2,219 hypospadias cases, 2,563 cryptorchidism cases, and 32,734 controls. Maternal obesity (BMI ≥ 30 kg/m2) was not associated with risk of hypospadias or cryptorchidism in male offspring (aOR(95% CI), hypospadias: 1.07(0.95–1.21); cryptorchidism: 0.99(0.89–1.11)), and no trend in risk with increasing maternal BMI was found. There was little indication of risk associated with BMI among any sub-group of mothers examined, including women with pre-existing diabetes or hypertension, women who developed preeclampsia, non-Hispanic white women, first-time mothers, or mothers aged ≥30 years. CONCLUSIONS The results of this study do not support the hypothesis that pre-pregnancy maternal obesity is a cause of hypospadias or cryptorchidism in male infants. PMID:21462299

Di-n-butyl phthalate induced hypospadias relates to autophagy in genital tubercle via the PI3K/Akt/mTOR pathway

PubMed Central

Li, Xiang; Li, Jinhao; Zhang, Ya; Zhou, Yun

2016-01-01

Objective: To explore the mechanisms of hypospadias induced by in utero exposure to din-butyl phthalate (DBP). Methods: Timed-pregnant Sprague-Dawley rats were administered 750 mg/kg of DBP by gavage from GD (gestation days) 13 to GD 18, whereas control group received corn oil. Genital tubercles (GTs) and blood samples were collected from male fetuses on GD 19. The serum testosterone concentration, apoptosis activity, autophagosomes and their related proteins (light chain 3 (LC3-I, LC3-II) ), and sequestosomes (SQSTM1/p62) in the GTs were then measured. Protein expression of protein kinase B (Akt), Beclin 1, phosphorylated Akt (p-Akt), p-S6, and phosphorylated mammalian target of rapamycin (p-mTOR) in the GTs were analyzed by Western blotting. Results: The incidence of hypospadias induced by DBP was 43.64% in male fetuses. The GT volume and GT volume/body weight of fetuses were significantly reduced in the hypospadias and the non-hypospadias groups. Apoptotic cell number was significantly decreased in the GTs of the hypospadias group, but unchanged in the non-hyposadias group. The ratio of LC3-II/LC3-I was higher in the GTs from DBP exposed fetuses compared to the control group. The ratio of LC3-II/LC3-I in the GTs was higher in the hypospadias group than in the non-hypospadias group. The number of autophagosomes was increased in the GTs of the hypospadias group. Protein expression of p-S6, p-mTOR, and p-Akt were significantly decreased in the GTs of hypospadiac rats. Conclusions: DBP-induced hypospadias might be associated with apoptosis and autophagy mediated by the PI3K/Akt/mTOR signaling pathway in the GT. PMID:27885243

Maternal and Gestational Risk Factors for Hypospadias

PubMed Central

Akre, Olof; Boyd, Heather A.; Ahlgren, Martin; Wilbrand, Kerstin; Westergaard, Tine; Hjalgrim, Henrik; Nordenskjöld, Agneta; Ekbom, Anders; Melbye, Mads

2008-01-01

Background An increase in the prevalence of hypospadias has been reported, but the environmental causes remain virtually unknown. Objectives Our goal was to assess the association between risk of hypospadias and indicators of placental function and endogenous hormone levels, exposure to exogenous hormones, maternal diet during pregnancy, and other environmental factors. Methods We conducted a case–control study in Sweden and Denmark from 2000 through 2005 using self-administered questionnaires completed by mothers of hypospadias cases and matched controls. The response rate was 88% and 81% among mothers of cases and controls, respectively. The analyses included 292 cases and 427 controls. Results A diet during pregnancy lacking both fish and meat was associated with a more than 4-fold increased risk of hypospadias [odds ratio (OR) = 4.6; 95% confidence interval (CI), 1.6–13.3]. Boys born to obese [body mass index (BMI) ≥ 30] women had a more than 2-fold increased risk of hypospadias (OR = 2.6; 95% CI, 1.2–5.7) compared with boys born to mothers with a normal weight (BMI = 20–24). Maternal hypertension during pregnancy and absence of maternal nausea increased a boy’s risk of hypospadias 2.0-fold (95% CI, 1.1–3.7) and 1.8-fold (95% CI, 1.2–2.8), respectively. Nausea in late pregnancy also appeared to be positively associated with hypospadias risk (OR = 7.6; 95% CI, 1.1–53). Conclusions A pregnancy diet lacking meat and fish appears to increase the risk of hypospadias in the offspring. Other risk associations were compatible with a role for placental insufficiency in the etiology of hypospadias. PMID:18709149

The CAG repeat polymorphism in the Androgen receptor gene modifies the risk for hypospadias in Caucasians

PubMed Central

2012-01-01

Background Hypospadias is a birth defect of the urethra in males, and a milder form of 46,XY disorder of sexual development (DSD). The disease is characterized by a ventrally placed urinary opening due to a premature fetal arrest of the urethra development. Moreover, the Androgen receptor (AR) gene has an essential role in the hormone-dependent stage of sexual development. In addition, longer AR polyglutamine repeat lengths encoded by CAG repeats are associated with lower transcriptional activity in vitro. In the present study, we aimed at investigating the role of the CAG repeat length in the AR gene in hypospadias cases as compared to the controls. Our study included 211 hypospadias and 208 controls of Caucasian origin. Methods We amplified the CAG repeat region with PCR, and calculated the difference in the mean CAG repeat length between the hypospadias and control group using the T-test for independent groups. Results We detected a significant increase of the CAG repeat length in the hypospadias cases when compared to the controls (contrast estimate: 2.29, 95% Confidence Interval (1.73-2.84); p-value: 0.001). In addition, the odds ratios between the hypospadias and controls revealed that the hypospadias cases are two to 3 times as likely to have longer CAG repeats than a shorter length for each repeat length investigated. Conclusions We have investigated the largest number of hypospadias cases with regards to the CAG repeat length, and we provide evidence that a higher number of the CAG repeat sequence in the AR gene have a clear effect on the risk of hypospadias in Caucasians. PMID:23167717

Simultaneous Umbilical Hernia Repair with Transumbilical Ventriculoperitoneal Shunt Placement.

PubMed

Montalbano, Michael J; Loukas, Marios; Oakes, W Jerry; Tubbs, R Shane

2017-01-01

Recently, placement of a ventriculoperitoneal shunt via a transumbilical approach has been reported. Herein, we report the repair of an umbilical hernia via the same incision and introduction of the distal end of a ventricultoperitoneal shunt into the peritoneal cavity in 3 patients. A case illustration is included. Both hernia repair and placement of the distal end of the ventriculoperitoneal shunt were uncomplicated in our small case series. To our knowledge, simultaneous repair of an umbilical hernia followed by transumbilical shunt placement has not been reported. As umbilical hernias are so common in infants, this finding, based on our experience, should not exclude placement of peritoneal tubing in the same setting. © 2017 S. Karger AG, Basel.

Maternal hypertension and risk for hypospadias in offspring.

PubMed

Agopian, A J; Hoang, Thanh T; Mitchell, Laura E; Morrison, Alanna C; Tu, Duong; Nassar, Natasha; Canfield, Mark A

2016-12-01

Hypospadias is one of the most common birth defects in male infants. Maternal hypertension is a suspected risk factor; however, few previous studies have addressed the possibility of reporting bias, and several previous studies have not accounted for hypospadias severity. We analyzed data from the Texas Birth Defects Registry for 10,924 nonsyndromic cases and statewide vital records for deliveries during 1999-2009, using Poisson regression. After adjustment for potential confounders, hypospadias was associated with maternal hypertension (adjusted prevalence ratio: 1.5, 95% confidence interval: 1.4-1.7). Similar associations were observed with gestational and pregestational hypertension, including separate analyses restricted to the subset of cases with severe (second- or third-degree) hypospadias. All of these associations were also similar among the subset of cases with isolated hypospadias (without additional birth defects). To evaluate the potential for bias due to potential hypertension misclassification, we repeated our analyses using logistic regression, comparing the cases to controls with other birth defects. In these analyses, the associations with gestational hypertension were similar, but adjusted associations with pregestational hypertension were no longer observed. Our findings support an association between gestational hypertension and hypospadias in offspring, but also suggest that previously observed associations with pregestational hypertension may have been inflated due to differential misclassification of hypertension (e.g., reporting bias). As gestational hypertension is recognized after hypospadias development, more research is needed to determine if this association reflects an increase in gestational hypertension risk secondary to hypospadias or if both conditions have shared risk factors (e.g., precursors of gestational hypertension). © 2016 Wiley Periodicals, Inc. © 2016 Wiley Periodicals, Inc.

Acute distal biceps rupture in an adolescent weightlifter on chronic steroid suppression: a case report.

PubMed

Ding, David Y; LaMartina, Joey A; Zhang, Alan L; Pandya, Nirav K

2016-09-01

Distal biceps tendon ruptures are uncommon events in the adult population and exceedingly rare in the adolescent population. To the best of our knowledge, this is the first and only report of a distal biceps tendon rupture in an adolescent with a history of chronic corticosteroid suppression. We present a case of a 17-year-old male on chronic corticosteroid suppression who underwent a successful distal biceps tendon repair after an acute rupture following weightlifting. At the 1-year follow-up, the patient reports full range of motion and strength, and is able to return to his preinjury activity level with sports and weightlifting. Acute distal biceps ruptures are uncommon injuries in the pediatric population, but may occur in conjunction with chronic corticosteroid use. Anatomic repair, when possible, can restore function and strength. level IV, case report.

Androgen receptor is overexpressed in boys with severe hypospadias, and ZEB1 regulates androgen receptor expression in human foreskin cells

PubMed Central

Qiao, Liang; Tasian, Gregory E.; Zhang, Haiyang; Cao, Mei; Ferretti, Max; Cunha, Gerald R.; Baskin, Laurence S.

2012-01-01

INTRODUCTION ZEB1 is overexpressed in patients with severe hypospadias. We examined the interaction between ZeB1 and the androgen receptor (AR) in vitro and the expression of AR in boys with hypospadias. RESULTS ZEB1 and AR colocalize to the nucleus. Estrogen upregulated ZEB1 and AR expression. Chromatin immunoprecipitation (ChIP) demonstrated that ZEB1 binds to an E-box sequence in the AR gene promoter. AR expression is higher in subjects with severe hypospadias than those with mild hypospadias and control subjects (P < 0.05). ZEB1 physically interacts with AR in human foreskin cells. DISCUSSION AR is overexpressed in patients with severe hypospadias. Environmental estrogenic compounds may increase the risk of hypospadias by facilitating the interaction between ZEB1 and AR. METHODS Hs68 cells, a fibroblast cell line derived from neonatal human foreskin, were exposed to 0, 10, and 100 nmol/l of estrogen, after which the cellular localization of ZEB1 and AR was assessed using immunocytochemistry. To determine if ZEB1 interacted with the AR gene, ChIP was performed using ZEB1 antibody and polymerase chain reaction (PCR) for AR. Second, AR expression was quantified using real-time PcR and western blot in normal subjects (n = 32), and subjects with mild (n = 16) and severe hypospadia (n = 16). PMID:22391641

Complications after Hypospadias Correction: Prognostic Factors and Impact on Final Clinical Outcome.

PubMed

Dokter, Elisabeth Maria; Mouës, Chantal M; Rooij, Iris A L M van; Biezen, Jan Jaap van der

2018-04-01

 The purpose of this study was to analyze the influence of patient and treatment characteristics on the occurrence of complications after hypospadias correction and the impact of complications on final clinical outcome.  The study cohort consisted of 205 hypospadias patients who had surgery in the Medical Centre Leeuwarden (1996-2011). Patient and treatment characteristics were hypospadias severity (preoperative meatal location and chordee), number of planned surgeries, reconstruction technique, operation year, and patient's age at the time of surgery. The final clinical outcome was measured with the Hypospadias Objective Scoring Evaluation (HOSE) (maximum score = 16) and compared between patients with and without complications.  Sixty-four patients (31%) had complications, most of which were fistulas ( n  = 40). An increased complication risk was seen in patients with severe hypospadias (preoperative proximal meatus or chordee), multistage reconstruction, reconstruction techniques other than Mathieu, and surgeries performed before 2005. Uncomplicated treatment resulted only in a marginally higher HOSE (15.7) compared with complicated treatment (15.4). Fistulas and multiple complications reduced clinical outcome more (15.3 and 14.9, respectively), while urinary tract infections, wound dehiscence, or prepuce related complications did not (16.0, 16.0, and 15.8, respectively).  The complication risk after hypospadias correction is influenced by hypospadias severity and type and year of reconstruction. Certain, but not all complications diminish final clinical outcome. Georg Thieme Verlag KG Stuttgart · New York.

Anogenital Distance and Penile Length in Infants with Hypospadias or Cryptorchidism: Comparison with Normative Data

PubMed Central

Thankamony, Ajay; Lek, Ngee; Carroll, Dan; Williams, Martyn; Dunger, David B.; Acerini, Carlo L.; Ong, Ken K.

2013-01-01

Background: Anogenital distance (AGD) in animals is a sensitive biomarker of fetal endocrine disruption and the associated testicular dysgenesis syndrome (TDS). However, AGD in human infants with cryptorchidism and hypospadias, which are potential manifestations of TDS during childhood, is not clearly described. Objective: Our aim was to compare AGD in boys with cryptorchidism or hypospadias against normative data. Methods: Boys with isolated cryptorchidism (n = 71, age 13.4 ± 5.8 months) or hypospadias (n = 81, age 11.4 ± 6.2 months) were recruited from a tertiary center for measurement of AGD and penile length; they were compared with 487 healthy full-term boys from a birth cohort by deriving age-specific standard deviation scores (SDS). Results: Boys with cryptorchidism were older (p = 0.048) compared with boys with hypospadias. Boys with hypospadias had shorter mean AGD and penile length SDS than healthy boys (both p < 0.0001). Mean AGD and penile length SDS values in boys with cryptorchidism were longer than mean values in boys with hypospadias (both p < 0.01) and shorter than mean values in healthy boys (both p < 0.0001). Mean penile length SDS decreased as the severity of hypospadias increased (ptrend = 0.078). Conclusions: In the study population, AGD and penile length were reduced in boys with hypospadias or cryptorchidism relative to normative data derived from a longitudinal birth cohort. The findings support the use of AGD as a quantitative biomarker to examine the prenatal effects of exposure to endocrine disruptors on the development of the male reproductive tract. Citation: Thankamony A, Lek N, Carroll D, Williams M, Dunger DB, Acerini CL, Ong KK, Hughes IA. 2014. Anogenital distance and penile length in infants with hypospadias or cryptorchidism: comparison with normative data. Environ Health Perspect 122:207–211; http://dx.doi.org/10.1289/ehp.1307178 PMID:24316680

Genetic polymorphisms in ESR1 and ESR2 genes, and risk of hypospadias in a multiethnic study population.

PubMed

Choudhry, Shweta; Baskin, Laurence S; Lammer, Edward J; Witte, John S; Dasgupta, Sudeshna; Ma, Chen; Surampalli, Abhilasha; Shen, Joel; Shaw, Gary M; Carmichael, Suzan L

2015-05-01

Estrogenic endocrine disruptors acting via estrogen receptors α (ESR1) and β (ESR2) have been implicated in the etiology of hypospadias, a common congenital malformation of the male external genitalia. We determined the association of single nucleotide polymorphisms in ESR1 and ESR2 genes with hypospadias in a racially/ethnically diverse study population of California births. We investigated the relationship between hypospadias and 108 ESR1 and 36 ESR2 single nucleotide polymorphisms in 647 cases and 877 population based nonmalformed controls among infants born in selected California counties from 1990 to 2003. Subgroup analyses were performed by race/ethnicity (nonHispanic white and Hispanic subjects) and by hypospadias severity (mild to moderate and severe). Odds ratios for 33 of the 108 ESR1 single nucleotide polymorphisms had p values less than 0.05 (p = 0.05 to 0.007) for risk of hypospadias. However, none of the 36 ESR2 single nucleotide polymorphisms was significantly associated. In stratified analyses the association results were consistent by disease severity but different sets of single nucleotide polymorphisms were significantly associated with hypospadias in nonHispanic white and Hispanic subjects. Due to high linkage disequilibrium across the single nucleotide polymorphisms, haplotype analyses were conducted and identified 6 haplotype blocks in ESR1 gene that had haplotypes significantly associated with an increased risk of hypospadias (OR 1.3 to 1.8, p = 0.04 to 0.00001). Similar to single nucleotide polymorphism analysis, different ESR1 haplotypes were associated with risk of hypospadias in nonHispanic white and Hispanic subjects. No significant haplotype association was observed for ESR2. The data provide evidence that ESR1 single nucleotide polymorphisms and haplotypes influence the risk of hypospadias in white and Hispanic subjects, and warrant further examination in other study populations. Copyright © 2015 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.

Differences in risk factors for 2nd and 3rd degree hypospadias in the National Birth Defects Prevention Study

PubMed Central

in 't Woud, Sander Groen; van Rooij, Iris A.L.M.; van Gelder, Marleen M.H.J.; Olney, Richard S.; Carmichael, Suzan L.; Roeleveld, Nel; Reefhuis, Jennita

2015-01-01

Background Hypospadias is a frequent birth defect with three phenotypic subtypes. With data from the National Birth Defects Prevention Study, a large, multi-state, population-based, case-control study, we compared risk factors for second and third degree hypospadias. Methods A wide variety of data on maternal and pregnancy-related risk factors for isolated second and third degree hypospadias was collected via computer-assisted telephone interviews to identify potential etiological differences between the two phenotypes. Logistic regression was used to calculate odds ratios including a random effect by study center. Results In total, 1547 second degree cases, 389 third degree cases, and 5183 male controls were included in our study. Third degree cases were more likely to have a non-Hispanic black or Asian/Pacific Islander mother, be delivered preterm, have a low birth weight, be small for gestational age, and be conceived with fertility treatments than second degree cases and controls. Associations with both second and third degree hypospadias were observed for maternal age, family history, parity, plurality, and hypertension during pregnancy. Risk estimates were generally higher for third degree hypospadias except for family history. Conclusions Most risk factors were associated with both or neither phenotype. Therefore, it is likely that the underlying mechanism is at least partly similar for both phenotypes. However, some associations were different between 2nd and 3rd degree hypospadias, and went in opposite directions for second and third degree hypospadias for Asian/Pacific Islander mothers. Effect estimates for subtypes of hypospadias may be over- or underestimated in studies without stratification by phenotype. PMID:25181604

Risk factors for hypospadias in China

PubMed Central

Xu, Ling-Fan; Liang, Chao-Zhao; Lipianskaya, Julia; Chen, Xian-Guo; Fan, Song; Zhang, Li; Zhou, Jun; Tai, Sheng; Jiang, Chang-Qin

2014-01-01

This case-controlled study was designed to evaluate the association between various baseline parental factors and the risk of hypospadias in China. Patients were selected from tertiary referral hospitals in Anhui, a province in mid-eastern China. A questionnaire was given to the parents of each patient. The final database included 193 cases and 835 controls. The incidence of additional coexistent anomalies was 13.0%, primarily cryptorchidism (9.8%). Ten patients (5.1%) were from families with genital anomaly, including five families (2.6%) with hypospadias. The risks of hypospadias was higher for children of mothers > 35 (odds ratio [OR] =1.47) and < 18 (OR = 2.95) years of age, and in mothers who had consumed alcohol (OR = 2.67), used drugs (OR = 1.53) and had an infection (OR = 1.87) during pregnancy. The risk of hypospadias was also higher when mothers (OR = 1.68) and fathers (OR = 1.74) were engaged in agriculture. Other factors assessed were not associated with the risk of hypospadias. PMID:24875823

Selective reinnervation: a comparison of recovery following microsuture and conduit nerve repair.

PubMed

Evans, P J; Bain, J R; Mackinnon, S E; Makino, A P; Hunter, D A

1991-09-20

Selective reinnervation was studied by comparing the regeneration across a conventional neurorraphy versus a conduit nerve repair. Lewis rats underwent right sciatic nerve transection followed by one of four different nerve repairs (n = 8/group). In groups I and II a conventional neurorraphy was performed and in groups III and IV the proximal and distal stumps were coapted by use of a silicone conduit with an interstump gap of 5 mm. The proximal and distal stumps in groups I and III were aligned anatomically correct and the proximal stump was rotated 180 degrees in groups II and IV (i.e. proximal peroneal nerve opposite the distal tibial nerve and the proximal tibial nerve opposite the distal peroneal nerve). By 14 weeks, there was an equivalent, but incomplete return in sciatic function index (SFI) in groups I, III, and IV as measured by walking track analysis. However, the SFI became unmeasurable by 6 weeks in all group II animals. At 14 weeks, the percent innervation of the tibialis anterior and medial gastronemius muscles by the peroneal and tibial nerves respectively was estimated by selective compound muscle action potential amplitude recordings. When fascicular alignment was reversed, there was greater tibial (P = 0.02) and lesser peroneal (P = 0.005) innervation of the gastrocnemius muscle in the conduit (group IV) versus the neurorraphy (group II) group. This suggests that the gastrocnemius muscle may be selectively reinnervated by the tibial nerve. However, there was no evidence of selective reinnervation of the tibialis anterior muscle. Despite these differences, the functional recovery in both conduit repair groups (III and IV) was equivalent to a correctly aligned microsuture repair (group I) and superior to that in the incorrectly aligned microsuture repair (group II).

[Management of recurrent urethrocutaneous fistula after hypospadias surgery in pediatric patients: initial experience with dermal regeneration sheet Integra].

PubMed

Casal-Beloy, I; Somoza Argibay, I; García-González, M; García-Novoa, A M; Míguez Fortes, L; Blanco, C; Dargallo Carbonell, T

2017-10-25

To present our initial experience using a dermal regeneration sheet as an urethral cover in the repair of recurrent urethrocutaneous fistulae in pediatric patients. Since May 2016 to March a total of 8 fistulaes were repaired using this new technique. We performed the ddissection of the fistulous tract and posterior closure of the urethral defect. A dermal regeneration sheet was used to cover the urethral suture. Finally a rotational flap was performed to avoid overlap sutures. During the follow-up (average 6 months), one patient presented in the immediate postoperative period infection of the surgical wound. This patient presented recurrence of the fistula. 88% of the patients included presented a good evolution with no other complications. In our initial experience the new technique seems easy, safe and effective in the management of the recurrent urethrocutaneous fistulae in pediatric patients. More studies are needed to prove these results.

Hypospadias as a novel feature in spinal bulbar muscle atrophy.

PubMed

Nordenvall, Anna Skarin; Paucar, Martin; Almqvist, Catarina; Nordenström, Anna; Frisén, Louise; Nordenskjöld, Agneta

2016-04-01

Spinal and bulbar muscle atrophy (SBMA) is an X-linked neuromuscular disorder caused by CAG repeat expansions in the androgen receptor (AR) gene. The SBMA phenotype consists of slowly progressive neuromuscular symptoms and undermasculinization features as the result of malfunction of the AR. The latter mainly includes gynecomastia and infertility. Hypospadias is also a feature of undermasculinization with an underdeveloped urethra and penis; it has not been described as part of the SBMA phenotype but has been suggested to be associated with a prolonged CAG repeat in the AR gene. This study includes the first epidemiologic description of the co-occurrence of hypospadias and SBMA in subjects and their male relatives in Swedish population-based health registers, as well as an additional clinical case. One boy with severe hypospadias was screened for mutations in the AR gene and was found to have 42 CAG repeats in it, which is in the full range of mutations causing SBMA later in life. We also detected a maximum of four cases displaying the combination of SBMA and hypospadias in our national register databases. This is the third case report with hypospadias in association with CAG repeat expansions in the AR gene in the full range known to cause SBMA later in life. Our findings suggest that hypospadias may be an under diagnosed feature of the SBMA phenotype and we propose that neurologists working with SBMA further investigate and report the true prevalence of hypospadias among patients with SBMA.

Hypospadias Is Not Rare in Dogs: Five New Cases, a Retrospective Study, and a Review of the Literature.

PubMed

Switonski, Marek; Dzimira, Stanislaw; Aleksiewicz, Roman; Szczerbal, Izabela; Nowacka-Woszuk, Joanna; Krzeminska, Paulina; Deska, Tomasz; Nizanski, Wojciech

2018-06-13

Hypospadias, the abnormal position of the urethral orifice, is considered a rare congenital malformation of the reproductive organs in male dogs. We present 5 new cases of hypospadias - 2 of the penile type in German Shepherd Dogs and 3 perineal types in a Bavarian Mountain Hound, a French Bulldog, and an American Staffordshire Terrier. Other abnormalities (rudimentary or underdeveloped penis, incompletely formed preputial sheath, and bilateral cryptorchidism) were also observed. Molecular analysis of all cases revealed the presence of Y-linked genes (SRY and ZFY). Cytogenetic and histological analysis could be performed for only 2 cases: a normal male sex chromosome complement (78,XY) and spermatogenetically inactive testicles were observed. A retrospective search for hypospadias in 19,950 medical records of male dogs from a single veterinary clinic in Poland (2006-2017) was also performed. Altogether, 10 reports of penile hypospadias were found (0.05%). The majority of the reports concerned German Shepherd Dogs (8 cases among 1,511 male dogs of this breed), and thus, the estimated incidence of hypospadias in this breed was 0.5%. Moreover, we performed a review of 26 cases of canine hypospadias reported in the years 2004-2017. Our study and the review of the literature suggest that hypospadias is not rare in dogs and that some breeds (such as German Shepherd Dog and Boston Terrier) may be prone to this disorder. © 2018 S. Karger AG, Basel.

Risk factors, prevalence trend, and clustering of hypospadias cases in Puerto Rico.

PubMed

Avilés, Luis A; Alvelo-Maldonado, Laureane; Padró-Mojica, Irmari; Seguinot, José; Jorge, Juan Carlos

2014-12-01

The aim was to determine the distribution pattern of hypospadias cases across a well-defined geographic space. The dataset for this study was produced by the Birth Defects Prevention and Surveillance System of the Department of Health of Puerto Rico (BDSS-PR), which linked the information of male newborns of the Puerto Rico Birth Cohort dataset (PRBC; n=92,285) from 2007 to 2010. A population-based case-control study was conducted to determine prevalence trend and to estimate the potential effects of maternal age, paternal age, birth-related variables, and health insurance status on hypospadias. Two types of geographic information systems (GIS) methods (Anselin Local Moran's I and Getis-Ord G) were used to determine the spatial distribution of hypospadias prevalence. Birthweight (<2500 g), age of mother (40+years), and private health insurance were associated with hypospadias as confirmed with univariate and multivariate analyses at 95% CI. A cluster of hypospadias cases was detected in the north-central region of Puerto Rico with both GIS methods (p≤0.05). The clustering of hypospadias prevalence provides an opportunity to assess the underlying causes of the condition and their relationships with geographical space. Copyright © 2014 Journal of Pediatric Urology Company. Published by Elsevier Ltd. All rights reserved.

Do endocrine disruptors cause hypospadias?

PubMed Central

Botta, Sisir; Cunha, Gerald R.

2014-01-01

Introduction Endocrine disruptors or environmental agents, disrupt the endocrine system, leading to various adverse effects in humans and animals. Although the phenomenon has been noted historically in the cases of diethylstilbestrol (DES) and dichlorodiphenyltrichloroethane (DDT), the term “endocrine disruptor” is relatively new. Endocrine disruptors can have a variety of hormonal activities such as estrogenicity or anti-androgenicity. The focus of this review concerns on the induction of hypospadias by exogenous estrogenic endocrine disruptors. This has been a particular clinical concern secondary to reported increased incidence of hypospadias. Herein, the recent literature is reviewed as to whether endocrine disruptors cause hypospadias. Methods A literature search was performed for studies involving both humans and animals. Studies within the past 5 years were reviewed and categorized into basic science, clinical science, epidemiologic, or review studies. Results Forty-three scientific articles were identified. Relevant sentinel articles were also reviewed. Additional pertinent studies were extracted from the reference of the articles that obtained from initial search results. Each article was reviewed and results presented. Overall, there were no studies which definitely stated that endocrine disruptors caused hypospadias. However, there were multiple studies which implicated endocrine disruptors as one component of a multifactorial model for hypospadias. Conclusions Endocrine disruption may be one of the many critical steps in aberrant development that manifests as hypospadias. PMID:26816789

Shorter anogenital distance correlates with the severity of hypospadias in pre-pubertal boys.

PubMed

Singal, Arbinder K; Jain, Viral G; Gazali, Zarine; Shekhawat, Prem

2016-07-01

Do pre-pubertal boys with hypospadias have a shorter anogenital distance (AGD) than boys with normal genitalia? AGD is significantly shorter in boys with hypospadias and decreases with the severity of hypospadias. Animal studies have shown that androgen disruption and exposure to endocrine disrupting chemicals during a critical time period in early gestation, termed the male programming window (MPW), result in hypospadias and reduced AGD; and the severity of hypospadias correlates with the reduction in AGD. However, this correlation has not been established in humans. A prospective descriptive study involving measurement of AGD in pre-pubertal boys (n = 458) presenting to our pediatric urology clinic with hypospadias and normal genitalia was performed over a period of 3 years. AGD was measured in pre-pubertal boys from 5 months to 14 years of age presenting to our clinic with hypospadias (n = 180: four were excluded) and compared with randomly selected boys with normal genitalia (controls, n = 274). Three variants of AGD, from the midpoint of the anus to base of the scrotum (AGD-AS), to the anterior base of penis (AGD-1) and to the posterior base of penis (AGD-2), were measured and assessed for correlation with the severity of hypospadias. Severity of hypospadias was classified as anterior, middle and posterior according to the meatal location. No significant difference in weight (P = 0.123), age (P = 0.162) or height (P = 0.591) between the two groups was observed. Only AGD-AS was significantly shorter in boys with hypospadias compared with controls (mean ± SD: 40.6 ± 9.7 mm versus 45.6 ± 9.4 mm, P < 0.001). This relation persisted after adjusting AGD for weight, height and age (β = 0.016, 95% confidence interval: 0.10-0.21; P < 0.001). The Spearman test showed a significant negative correlation for the severity of hypospadias with all the three AGD measures. Analysis of variance between anterior, middle and posterior subgroups showed a significant reduction in mean AGD-AS (P = 0.003) and AGD-2 (P = 0.008). No data were collected pertaining to in utero exposure to endocrine disrupting chemicals (EDCs) or cigarette smoke, or current diet and environmental exposure to EDCs, which may have influenced the AGD. Family history of genital malformation and use of IVF were not known. There may have been a selection bias as only boys presenting to our clinic were included. The findings suggest that prenatal androgens during early gestation influence development of the male reproductive system and support the existence of a MPW in humans. Of the three AGDs, AGD-AS may be the most reliable biomarker of this in utero androgen action. However, no direct link to any specific exposure leading to shortened AGD in pre-pubertal boys with hypospadias could be determined. Further large scale multi-center studies are needed to understand this association better. Funding was from the Hypospadias Foundation. No conflicts of interest to disclose. © The Author 2016. Published by Oxford University Press on behalf of the European Society of Human Reproduction and Embryology. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

Anastomotic fibrous ring as cause of stricture recurrence after bulbar onlay graft urethroplasty.

PubMed

Barbagli, Guido; Guazzoni, Giorgio; Palminteri, Enzo; Lazzeri, Massimo

2006-08-01

We retrospectively reviewed patterns of failure after bulbar substitution urethroplasty. In particular we investigated the prevalence and location of anastomotic fibrous ring strictures occurring at the apical anastomoses between the graft and urethral plate after 3 types of onlay graft techniques. We reviewed the records of 107 patients who underwent bulbar urethroplasty between 1994 and 2004. Mean patient age was 44 years. Patients with lichen sclerosus, failed hypospadias repair or urethroplasty and panurethral strictures were excluded. A total of 45 patients underwent dorsal onlay skin graft urethroplasty, 50 underwent buccal mucosa onlay graft urethroplasty and 12 underwent augmented end-to-end urethroplasty. The clinical outcome was considered a success or failure at the time that any postoperative procedure was needed, including dilation. Mean followup was 74 months (range 12 to 130). Of 107 cases 85 (80%) were successful and 22 (20%) failed. Failure in 12 patients (11%) involved the whole grafted area and in 10 (9%) it involved the anastomotic site, which was distal and proximal in 5 each. Urethrography, urethral ultrasound and urethroscopy were fundamental for determining the difference between full-length and focal extension of re-stricture. Failures were treated with multistage urethroplasty in 12 cases, urethrotomy in 7 and 1-stage urethroplasty in 3. Of the patients 16 had a satisfactory final outcome and 6 underwent definitive perineal urinary diversion. The prevalence and location of anastomotic ring strictures after bulbar urethroplasty were uniformly distributed in after 3 surgical techniques using skin or buccal mucosa. Further studies are necessary to clarify the etiology of these fibrous ring strictures.

Maternal Exposure to Domestic Hair Cosmetics and Occupational Endocrine Disruptors Is Associated with a Higher Risk of Hypospadias in the Offspring

PubMed Central

Haraux, Elodie; Braun, Karine; Buisson, Philippe; Stéphan-Blanchard, Erwan; Devauchelle, Camille; Ricard, Jannick; Boudailliez, Bernard; Tourneux, Pierre; Gouron, Richard; Chardon, Karen

2016-01-01

Pregnant women are exposed to various chemical products at home and at work. Some of these products contain endocrine-disrupting chemicals (EDCs) such as cosmetics, pesticides, industrial chemicals, heavy metals, plastics or medications that could alter sexual differentiation and increase the risk of hypospadias. We evaluated maternal occupational and household exposures that could constitute risk factors for hypospadias. From 2011 to 2014, we enrolled 57 full-term newborns with hypospadias and three randomly selected controls per case (162 control newborns), matched for gestational age, from 11 maternity units in Picardy, France. Neonatal and parental data were collected at birth (personal characteristics, maternal lifestyle, and medical history). Maternal occupational exposure was assessed by a job-exposure matrix for EDCs from a job history questionnaire completed by mothers. Odds ratios (OR) and 95% confidence intervals (CI) were calculated with univariate and multivariable logistic regression, and adjusted for relevant covariates. Multivariate analysis showed a strong association between hypospadias and potential maternal occupational exposure to EDCs and maternal household use of hair cosmetics (OR 6.1, 95% CI: 1.1–34.9; OR: 9.6, 95% CI: 1.4–66.1, respectively). Our results suggest that maternal occupational exposure to EDCs is a risk factor for hypospadias and suggests a possible influence of household use of hair cosmetics during early pregnancy on the incidence of hypospadias in the offspring. A larger study with more accurate exposure assessment should evaluate the impact of EDCs in hair cosmetics on the incidence of hypospadias. PMID:28036072

Endocrine disruptors in the workplace, hair spray, folate supplementation, and risk of hypospadias: case-control study.

PubMed

Ormond, Gillian; Nieuwenhuijsen, Mark J; Nelson, Paul; Toledano, Mireille B; Iszatt, Nina; Geneletti, Sara; Elliott, Paul

2009-02-01

Hypospadias is one of the most common urogenital congenital anomalies affecting baby boys. Prevalence estimates in Europe range from 4 to 24 per 10,000 births, depending on definition, with higher rates reported from the United States. Relatively little is known about potential risk factors, but a role for endocrine-disrupting chemicals (EDCs) has been proposed. Our goal was to elucidate the risk of hypospadias associated with occupational exposure of the mother to endocrine-disruptor chemicals, use of folate supplementation during pregnancy, and vegetarianism. We designed a case-control study of 471 hypospadias cases referred to surgeons and 490 randomly selected birth controls, born 1 January 1997-30 September 1998 in southeast England. Telephone interviews of mothers elicited information on folate supplementation during pregnancy and vegetarianism. We used a job exposure matrix to classify occupational exposure. In multiple logistic regression analysis, there were increased risks for self-reported occupational exposure to hair spray [exposed vs. nonexposed, odds ratio (OR) = 2.39; 95% confidence interval (CI), 1.40-4.17] and phthalate exposure obtained by a job exposure matrix (OR = 3.12; 95% CI, 1.04-11.46). There was a significantly reduced risk of hypospadias associated with of folate use during the first 3 months of pregnancy (OR = 0.64; 95% CI, 0.44-0.93). Vegetarianism was not associated with hypospadias risk. Excess risks of hypospadias associated with occupational exposures to phthalates and hair spray suggest that antiandrogenic EDCs may play a role in hypospadias. Folate supplementation in early pregnancy may be protective.

Maternal Exposure to Domestic Hair Cosmetics and Occupational Endocrine Disruptors Is Associated with a Higher Risk of Hypospadias in the Offspring.

PubMed

Haraux, Elodie; Braun, Karine; Buisson, Philippe; Stéphan-Blanchard, Erwan; Devauchelle, Camille; Ricard, Jannick; Boudailliez, Bernard; Tourneux, Pierre; Gouron, Richard; Chardon, Karen

2016-12-29

Pregnant women are exposed to various chemical products at home and at work. Some of these products contain endocrine-disrupting chemicals (EDCs) such as cosmetics, pesticides, industrial chemicals, heavy metals, plastics or medications that could alter sexual differentiation and increase the risk of hypospadias. We evaluated maternal occupational and household exposures that could constitute risk factors for hypospadias. From 2011 to 2014, we enrolled 57 full-term newborns with hypospadias and three randomly selected controls per case (162 control newborns), matched for gestational age, from 11 maternity units in Picardy, France. Neonatal and parental data were collected at birth (personal characteristics, maternal lifestyle, and medical history). Maternal occupational exposure was assessed by a job-exposure matrix for EDCs from a job history questionnaire completed by mothers. Odds ratios (OR) and 95% confidence intervals (CI) were calculated with univariate and multivariable logistic regression, and adjusted for relevant covariates. Multivariate analysis showed a strong association between hypospadias and potential maternal occupational exposure to EDCs and maternal household use of hair cosmetics (OR 6.1, 95% CI: 1.1-34.9; OR: 9.6, 95% CI: 1.4-66.1, respectively). Our results suggest that maternal occupational exposure to EDCs is a risk factor for hypospadias and suggests a possible influence of household use of hair cosmetics during early pregnancy on the incidence of hypospadias in the offspring. A larger study with more accurate exposure assessment should evaluate the impact of EDCs in hair cosmetics on the incidence of hypospadias.

Patellar tendon re-rupture on the opposite end of the previous site of surgical repair

PubMed Central

KOH, Bryan Thean Howe; SAYAMPANATHAN, Andrew A; LEE, Keng Thiam

2017-01-01

We describe a rare case of a patellar tendon “re-rupture” at the opposite end of a previous proximal tendon repair. A 32-year-old male with a history of surgically repaired right proximal patellar tendon rupture presented with an acute non-traumatic right knee pain and instability during sports. Magnetic resonance imaging confirmed a complete rupture of his distal patellar tendon at the tibial tuberosity. The patellar tendon was repaired using two 5.5 mm BioCorkscrews (Arthrex) inserted into the tibial tuberosity; the tendon was stitched with the No. 2 fiberwires using Krackow technique. As the patellar tendon was degenerative, the repair was augmented with a semitendinosus tendon harvested using an open tendon stripper, leaving the distal attachment intact. At 2.6 years followup he had mild anterior knee pain, range of motion 0-130° and was able to squat. MRI scan done at followup revealed good healing of repaired patellar tendon. PMID:28566788

Genotype-phenotype correlation and identification of two novel SRD5A2 mutations in 33 Chinese patients with hypospadias.

PubMed

Yuan, Shimin; Meng, Lanlan; Zhang, Yanan; Tu, Chaofeng; Du, Juan; Li, Wen; Liang, Ping; Lu, Guangxiu; Tan, Yue-Qiu

2017-09-01

Hypospadias, a common congenital malformation of male external genitalia, is characterized mainly by an aberrant opening of the urethra on the ventral side of the penis. Depending on the severity of the disease, it can be classified into three types: anterior, middle, and posterior. In our study, 33 patients with hypospadias were recruited, including eight with anterior hypospadias and 25 with posterior hypospadias. We performed mutation analysis of the SRD5A2, AR and HSD17B3 genes in these patients. Eight different SRD5A2 mutations were detected in 15 patients with posterior hypospadias (60%, 15/25), including six previously described mutations (p.Q6X, Q71X, p.L20P, p.G203S, p.R227Q, and p.R246Q) and two novel mutations (p.G196R and p.L73Pfs ∗ 17). One AR gene mutation (p.A597T) was found in a patient and no HSD17B3 mutations were detected. Additionally, we carried out routine semen analyses in all adult patients. Combing mutation analysis with semen examination results, showed that whole five adult patients who carried SRD5A2 mutations had abnormal semen quality. In summary, all the detected mutations were responsible for the clinical features observed in these 16 patients. Our data suggest that mutations of the SRD5A2 gene are the main causes of posterior hypospadias and seem to affect the semen quality of adult patients, whereas mutations in AR and HSD17B3 gene were rare in these hypospadias patients. Our study expanded the SRD5A2 mutation spectrum in the Han Chinese population and provided useful information for genetic and reproductive counselling for patients with hypospadias. Copyright © 2017 Elsevier Inc. All rights reserved.

Hypospadias and maternal exposure to atrazine via drinking water in the National Birth Defects Prevention study.

PubMed

Winston, Jennifer J; Emch, Michael; Meyer, Robert E; Langlois, Peter; Weyer, Peter; Mosley, Bridget; Olshan, Andrew F; Band, Lawrence E; Luben, Thomas J

2016-07-15

Hypospadias is a relatively common birth defect affecting the male urinary tract. It has been suggested that exposure to endocrine disrupting chemicals might increase the risk of hypospadias by interrupting normal urethral development. Using data from the National Birth Defects Prevention Study, a population-based case-control study, we considered the role of maternal exposure to atrazine, a widely used herbicide and potential endocrine disruptor, via drinking water in the etiology of 2nd and 3rd degree hypospadias. We used data on 343 hypospadias cases and 1,422 male controls in North Carolina, Arkansas, Iowa, and Texas from 1998-2005. Using catchment level stream and groundwater contaminant models from the US Geological Survey, we estimated atrazine concentrations in public water supplies and in private wells. We assigned case and control mothers to public water supplies based on geocoded maternal address during the critical window of exposure for hypospadias (i.e., gestational weeks 6-16). Using maternal questionnaire data about water consumption and drinking water, we estimated a surrogate for total maternal consumption of atrazine via drinking water. We then included additional maternal covariates, including age, race/ethnicity, parity, and plurality, in logistic regression analyses to consider an association between atrazine and hypospadias. When controlling for maternal characteristics, any association between hypospadias and daily maternal atrazine exposure during the critical window of genitourinary development was found to be weak or null (odds ratio for atrazine in drinking water = 1. 00, 95 % CI = 0.97 to 1.03 per 0.04 μg/day increase; odds ratio for maternal consumption = 1.02, 95 % CI = 0.99 to 1.05; per 0.05 μg/day increase). While the association that we observed was weak, our results suggest that additional research into a possible association between atrazine and hypospadias occurrence, using a more sensitive exposure metric, would be useful.

A population-based study of prevalence trends and geospatial analysis of hypospadias and cryptorchidism compared with non-endocrine mediated congenital anomalies.

PubMed

Lane, Ciaran; Boxall, James; MacLellan, Dawn; Anderson, Peter A; Dodds, Linda; Romao, Rodrigo L P

2017-06-01

Several reports have suggested an increase in the prevalence of hypospadias and cryptorchidism over the last few decades. Endocrine disruption caused by exposure to environmental chemicals has been postulated as a possible cause. The objectives of our study were: 1) to determine whether the prevalence of hypospadias and cryptorchidism is increasing compared with other congenital anomalies not known to be mediated by endocrine factors; and 2) to perform a geospatial analysis of these congenital malformations looking for clustering that could offer insight into environmental risk factors. Data were obtained from the Nova Scotia ATLEE Perinatal Database containing the perinatal records of all live births in Nova Scotia, Canada since 1988. Records from 1988 to 2013 defined the study cohort. Overall prevalence rates and prevalence trends by year were calculated for hypospadias, cryptorchidism, gastroschisis, and clubfoot. County of residence was collected and spatial autocorrelation testing for clustering was performed for each of the congenital anomalies. There were 258,147 live births during the study period. Overall prevalence rates for the four malformations over the study period were: hypospadias 78 per 10,000 male births, cryptorchidism 75 per 10,000 male births, clubfoot 24 per 10,000 total births, and gastroschisis 4 per 10,000 total births. Incidence rate ratios per year for hypospadias, cryptorchidism, clubfoot, and gastroschisis were 1.00 (0.99-1.01), 0.99 (0.98-1.00), 0.98 (0.97-0.99), and 1.04 (1.04-1.07), respectively. During the study period, the prevalence rates in the region were unchanged for hypospadias, slightly reduced for cryptorchidism and clubfoot, and rising for gastroschisis (Figure). Spatial autocorrelation testing revealed statistically significant clustering for hypospadias (p = 0.03) and cryptorchidism (p = 0.03), while no spatial autocorrelation was observed for the other malformations. Contrary to previous studies we show that hypospadias and cryptorchidism prevalence rates are not increasing over time in our region. Nonetheless, rates for these conditions in our area are high compared with other regions of the world. Local clustering of these congenital anomalies without clustering of the control, non-endocrine mediated congenital malformations supports a possible unique spatial distribution associated with environmental exposure. The hotspots identified for hypospadias and cryptorchidism are associated with intense agricultural activity. Our study found no increase in hypospadias and cryptorchidism prevalence over a 26-year period compared with other congenital anomalies not known to be associated with endocrine factors. Geospatial analysis supports high clustering for hypospadias and cryptorchidism in areas of intense agricultural activity. Copyright © 2017 Journal of Pediatric Urology Company. Published by Elsevier Ltd. All rights reserved.

Distal Attachment of Flexor Tendon Allograft: A Biomechanical Study of Different Reconstruction Techniques in Human Cadaver Hands

PubMed Central

Wei, Zhuang; Thoreson, Andrew R.; Amadio, Peter C.; An, Kai-Nan; Zhao, Chunfeng

2014-01-01

We compared the mechanical force of tendon-to-bone repair techniques for flexor tendon reconstruction. Thirty-six flexor digitorum profundus (FDP) tendons were divided into three groups based upon the repair technique: (1) suture/button repair using FDP tendon (Pullout button group), (2) suture bony anchor using FDP tendon (Suture anchor group), and (3) suture/button repair using FDP tendon with its bony attachment preserved (Bony attachment group). The repair failure force and stiffness were measured. The mean load to failure and stiffness in the bony attachment group were significantly higher than that in the pullout button and suture anchor groups. No significant difference was found in failure force and stiffness between the pullout button and suture anchor groups. An intrasynovial flexor tendon graft with its bony attachment has significantly improved tensile properties at the distal repair site when compared with a typical tendon-to-bone attachment with a button or suture anchor. The improvement in the tensile properties at the repair site may facilitate postoperative rehabilitation and reduce the risk of graft rupture. PMID:23754507

Biomechanics of the Proximal Radius Following Drilling of the Bicipital Tuberosity to Mimic Cortical Button Distal Biceps Repair Technique.

PubMed

Oak, Nikhil R; Lien, John R; Brunfeldt, Alexander; Lawton, Jeffrey N

2018-05-01

A fracture through the proximal radius is a theoretical concern after cortical button distal biceps fixation in an active patient. The permanent, nonossified cortical defect and medullary tunnel is at risk during a fall eliciting rotational and compressive forces. We hypothesized that during simulated torsion and compression, in comparison with unaltered specimens, the cortical button distal biceps repair model would have decreased torsional and compressive strength and would fracture in the vicinity of the bicipital tuberosity bone tunnel. Sixteen fourth-generation composite radius Sawbones models were used in this controlled laboratory study. A bone tunnel was created through the bicipital tuberosity to mimic the exact bone tunnel, 8 mm near cortex and 3.2 mm far cortex, made for the BicepsButton distal biceps tendon repair. The radius was then prepared and mounted on either a torsional or compression testing device and compared with undrilled control specimens. Compression tests resulted in average failure loads of 9015.2 N in controls versus 8253.25 N in drilled specimens ( P = .074). Torsional testing resulted in an average failure torque of 27.3 Nm in controls and 19.3 Nm in drilled specimens ( P = .024). Average fracture angle was 35.1° in controls versus 21.1° in drilled. Gross fracture patterns were similar in compression testing; however, in torsional testing all fractures occurred through the bone tunnel in the drilled group. There are weaknesses in the vicinity of the bone tunnel in the proximal radius during biomechanical stress testing which may not be clinically relevant in nature. In cortical button fixation, distal biceps repairs creates a permanent, nonossified cortical defect with tendon interposed in the bone tunnel, which can alter the biomechanical properties of the proximal radius during compressive and torsional loading.

Association of SRD5A2 gene mutations with risk of hypospadias in the Iranian population.

PubMed

Rahimi, M; Ghanbari, M; Fazeli, Z; Rouzrokh, M; Omrani, S; Mirfakhraie, R; Omrani, M D

2017-04-01

Hypospadias is one of the most common forms of congenital malformation of the male external genitalia worldwide. The ratio in the Iranian population is one in 250 live male births. The conversion of testosterone to dihydrotestosterone (DHT) in the presence of steroid 5α-reductase 2, which is encoded by SRD5A2 gene, plays an important role in the normal development of the male reproductive system. We examined whether SRD5A2 gene mutations (V89L and A49T polymorphisms) are associated with the risk of hypospadias in the Iranian population. We performed exons sequencing for SRD5A2 gene in 109 hypospadias patients. We identified two new mutations in the subgroups of affected cases: including a substitution of the nucleotide T > A in the codon 73 [c.219T > A (p.Leu73_Ser74insHisPro)] and an insertion of an extra A nucleotide in the codon 77 [c.229insA* (p.Gly77*)]. Additionally, we performed PCR-RFLP for the two identified polymorphisms and revealed that V89L [OR = 5.8, 95% CI (3.8-8.8), p value < 0.001] and A49T [OR = 10.16, 95% CI (3.94-26.25), p value < 0.001] are significantly associated with hypospadias occurrence in patients. Our haplotype analysis further indicated that the Leu-Ala haplotype increases risk of hypospadias; conversely, the Val-Ala haplotype decreases the risk of hypospadias in the studied patients. This study demonstrates that polymorphisms in the SRD5A2 gene could be considered as a risk factor for hypospadias disease emergence.

Genome-wide DNA Methylation Profiling of CpG Islands in Hypospadias

PubMed Central

Choudhry, Shweta; Deshpande, Archana; Qiao, Liang; Beckman, Kenneth; Sen, Saunak; Baskin, Laurence S.

2013-01-01

Purpose Hypospadias is one of the most frequent genital malformations in the male newborn, and results from abnormal penile and urethral development. The etiology of hypospadias remains largely unknown despite intensive investigations. Fetal androgens have a crucial role in genital differentiation. Recent studies have suggested that molecular mechanisms that underlie the effects of androgens on the fetus may involve disruption of epigenetic programming of gene expression during development. We assessed whether epigenetic modification of DNA methylation is associated with hypospadias in a case-control study of 12 hypospadias and 8 control subjects. Materials and Methods Genome-wide DNA methylation profiling was performed on the study subjects using the Illumina Infinium® HumanMethylation450 Bead-Chip, which enables the direct investigation of methylation status of more than 485,000 individual CpG sites throughout the genome. The methylation level at each CpG site was compared between cases and controls using the t test and logistic regression. Results We identified 14 CpG sites that were associated with hypospadias with p <0.00001. These CpG sites were in or near the SCARB1, MYBPH, SORBS1, LAMA4, HOXD11, MYO1D, EGFL7, C10orf41, LMAN1L and SULF1 genes. Two CpG sites in SCARB1 and MYBPH genes remained statistically significant after correction for multiple testing (p = 2.61×10−09, pcorrected = 0.008; p = 3.06×10−08, pcorrected = 0.02, respectively). Conclusions To our knowledge this is the first study to investigate hypospadias using a unique and novel epigenetic approach. Our findings suggest DNA methylation patterns are useful in identifying new genes such as SCARB1 and MYBPH that may be involved in the etiology of hypospadias. PMID:22906644

Hypospadias and concomitant undescended testis: Comparison of no skin incision with inguinal and scrotal skin incision orchiopexy.

PubMed

Sabetkish, Shabnam; Kajbafzadeh, Abdol-Mohammad; Sabetkish, Nastaran

2015-10-01

To present the feasibility of no skin incision orchiopexy in children with concomitant hypospadias and undescended testis (UDT) by a single subcoronal incision technique. To introduce the creation of subdartos muscle scrotal pouch with no scrotal skin incision. From one thousand and twenty-one children with hypospadias, 61 patients presented with concomitant palpable UDT and hypospadias. In group I (N = 34) single subcoronal incision with no scrotal skin incision was applied. In group II (N = 27), multi-incision technique was applied for classical orchiopexy and hypospadias surgery. For hypospadias reconstruction, all patients had classical subcoronal and para urethral plate incision with penile skin degloving according to the location of urethral meatus. Early and late complications, surgical time, hospital stay, and cosmetic results were recorded. Children with unilateral UDT and hypospadias had one incision in group I and three skin incisions in group II. Patients with bilateral UDT had one incision in group I and five skin incisions in group II. The operation time was significantly shorter in group I (93 ± 11 min) compared with group II (138 ± 17 min) (P = 0.03). Both groups were operated as day care basis; however, the hospital stay was slightly longer in group II (group I = 12 ± 2 h, vs group II = 16 ± 3 h) (P = 0.07). All testes were satisfactorily positioned into the bottom of the scrotum without development of any testicular atrophy. Single subcoronal penile skin incision is a feasible, safe, and cosmetically satisfactory technique in patients with hypospadias and concomitant UDT. Reduced postoperative pain, better objective cosmetic results, shorter operative time and comfortable post-operative period are the most significant advantages of this approach. Copyright © 2015 IJS Publishing Group Limited. Published by Elsevier Ltd. All rights reserved.

Family history is under-estimated in children with isolated hypospadias: a French multicenter report of 88 families.

PubMed

Ollivier, Margot; Paris, Francoise; Philibert, Pascal; Garnier, Sarah; Coffy, Amandine; Fauconnet-Servant, Nadège; Haddad, Mirna; Guys, Jean Michel; Reynaud, Rachel; Faure, Alice; Merrot, Thierry; Wagner, Kathy; Bréaud, Jean; Valla, Jean Stéphane; Dobremez, Eric; Gaspari, Laura; Daures, Jean-Pierre; Sultan, Charles; Kalfa, Nicolas

2018-04-30

Whereas familial forms of complex disorders/differences of sex development have been widely reported, data regarding isolated hypospadias are sparse and a family history is thought to be less frequent. We aimed 1-to determine the frequency of hypospadias in families of hypospadiac boys 2-to determine if theses familial forms exhibit a particular phenotype 3-to evaluate the prevalence of genetic defects of the main candidate genes. A prospective inclusion of 395 hypospadiac boys screened for family history with a standardized questionnaire, extensive clinical description, family tree and sequencing of AR, SF1, SRD5A2 and MAMLD1 was performed. Family history of hypospadias was more frequent than expected (22.3%, n=88). In 19.3% of cases, the familial cases were multiple (n=17). Familial hypospadias were related to the paternal side in 59.1% of cases including the father himself (30.7%), paternal uncles and cousins. Prematurity, assisted-reproductive techniques, other congenital abnormalities and growth retardation were not more frequent in familial hypospadias than in sporadic cases. The severity of phenotype was similar in both groups. The results of the genetic analysis combined to previous data on AR sequencing showed that familial cases tend to reveal more frequently genetic defects than sporadic cases (5.68% vs 1,63%, p=0,048). Familial forms of hypospadias are far more frequent than previously reported. Even minor and isolated hypospadias justify a full clinical investigation of the family history. Detecting these hereditary forms may help to find out the underlying genetic defects and may improve the follow-up and counseling of these patients. Copyright © 2018 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.

Maternal hypertension, medication use, and hypospadias in the National Birth Defects Prevention Study.

PubMed

Van Zutphen, Alissa R; Werler, Martha M; Browne, Marilyn M; Romitti, Paul A; Bell, Erin M; McNutt, Louise-Anne; Druschel, Charlotte M; Mitchell, Allen A

2014-02-01

To investigate whether antihypertensive classes and specific medications in early pregnancy increase the risk of severe hypospadias and to assess prior associations detected for late-treated and untreated hypertension in the National Birth Defects Prevention Study. Using telephone interviews from mothers of 2,131 children with severe hypospadias and 5,129 nonmalformed male control children for 1997-2009 births in a population-based case-control study, we estimated adjusted odds ratios (ORs) and 95% confidence intervals (CIs) with multivariable logistic regression. We adjusted P values to account for multiple testing. Forty-eight (2.3%) case and 70 (1.4%) control mothers reported early pregnancy antihypertensive treatment, 45 (2.1%) case and 31 (0.6%) control mothers reported late treatment, and 315 (14.8%) case and 394 (7.7%) control mothers reported untreated hypertension. Selective β-blockers, centrally acting agents, renin-angiotensin system-acting agents, diuretics, and specific medications, methyldopa and atenolol, were not associated with hypospadias. Nonselective β-blockers (adjusted OR 3.22, 95% CI 1.47-7.05) were associated with hypospadias; however, P values adjusted for multiple testing were not statistically significant. We confirmed prior findings for associations between hypospadias and untreated hypertension (adjusted OR 2.09, 95% CI 1.76-2.48) and late initiation of treatment (adjusted OR 3.98, 95% CI 2.41-6.55). The increased risks would translate to severe hypospadias prevalences of 11.5, 17.7, and 21.9 per 10,000 births for women with untreated hypertension, nonselective β-blocker use, and late initiation of treatment, respectively. Our study suggests a relationship between hypospadias and the severity of hypertension. II.

Endocrine Disruptors in the Workplace, Hair Spray, Folate Supplementation, and Risk of Hypospadias: Case–Control Study

PubMed Central

Ormond, Gillian; Nieuwenhuijsen, Mark J.; Nelson, Paul; Toledano, Mireille B.; Iszatt, Nina; Geneletti, Sara; Elliott, Paul

2009-01-01

Background Hypospadias is one of the most common urogenital congenital anomalies affecting baby boys. Prevalence estimates in Europe range from 4 to 24 per 10,000 births, depending on definition, with higher rates reported from the United States. Relatively little is known about potential risk factors, but a role for endocrine-disrupting chemicals (EDCs) has been proposed. Objective Our goal was to elucidate the risk of hypospadias associated with occupational exposure of the mother to endocrine-disruptor chemicals, use of folate supplementation during pregnancy, and vegetarianism. Design We designed a case–control study of 471 hypospadias cases referred to surgeons and 490 randomly selected birth controls, born 1 January 1997–30 September 1998 in southeast England. Telephone interviews of mothers elicited information on folate supplementation during pregnancy and vegetarianism. We used a job exposure matrix to classify occupational exposure. Results In multiple logistic regression analysis, there were increased risks for self-reported occupational exposure to hair spray [exposed vs. nonexposed, odds ratio (OR) = 2.39; 95% confidence interval (CI), 1.40–4.17] and phthalate exposure obtained by a job exposure matrix (OR = 3.12; 95% CI, 1.04–11.46). There was a significantly reduced risk of hypospadias associated with of folate use during the first 3 months of pregnancy (OR = 0.64; 95% CI, 0.44–0.93). Vegetarianism was not associated with hypospadias risk. Conclusions Excess risks of hypospadias associated with occupational exposures to phthalates and hair spray suggest that antiandrogenic EDCs may play a role in hypospadias. Folate supplementation in early pregnancy may be protective. PMID:19270804

[Clinical effect of distally-based dorsal thumb neurocutaneous vascular flap on repair of soft tissue defect in thumb].

PubMed

Huang, Yixiong; Shen, Zunli; Wang, Yongchun; Zhang, Shimin

2009-10-01

To investigate the surgical methods and clinical results of repairing soft tissue defects in the thumb with distally-based dorsal thumb neurocutaneous vascular flap. From January 2006 to October 2007, 23 patients with soft tissue defect in the thumb were treated, including 20 males and 3 females aged 19-46 years old (average 27.5 years old). The defect was caused by crush injury in 1 case, electric planer accident in 6 cases, incised injury in 8 cases, and avulsion injury in 8 cases. The defect was located on the palmar aspect of the thumb distal phalanx in 3 cases, the dorsal-radial aspect of the thumb distal phalanx in 3 cases, and ulnar or dorsal aspect in 17 cases. The defect size ranged from 3.3 cm x 1.2 cm to 4.2 cm x 1.2 cm. Among them, 18 cases were complicated with distal 1/2 nail bed defect or injury. The time between injury and hospital admission was 1-72 hours (average 22 hours). During operation, the defect was repaired with distally-based dorsal-radial neurovenocutaneous vascular flap of the thumb in 3 cases and distally-based dorsal-ulnar neurovenocutaneous vascular flap of the thumb in 20 cases. The size of those flaps was 4.0 cm x 1.6 cm-5.0 cm x 3.0 cm. The donor site underwent direct suture or split thickness skin graft repair. At 10 days after operation, 3 cases suffered from the epidermal necrosis in the distal part of the flap, 2 of them experienced the exfoliation of dark scab 14 days later and the flap survived, and the flap of the rest one survived after dressing change. The other flaps and the skin graft at the donor site all survived uneventfully. The wounds healed by first intention. All the patients were followed up for 10-16 months (average 12.6 months). The flaps were soft in texture and full in appearance. The two-point discrimination value 6 months after operation was 8-10 mm. At 12 months after operation, the growth of the residual fingernail was evident in 18 cases, including 4 cases of curved or hook fingernail. Active flexion and extension of the thumb were normal. The abduction of the first web space reached or surpassed 80 percent of the normal side in 20 cases and was below 80 percent of the normal side in 3 cases. The clinical outcomes were satisfactory in 11 cases, approximately satisfactory in 8 cases, and unsatisfactory in 4 cases according to self-designed evaluation system. The operative method of repairing the soft tissue defects in the thumb with the distally-based dorsal thumb neurocutaneous vascular flap is simple, stable in anatomy, in line with the principle of proximity, and suitable for repairing thumb tip defect 3 cm in size. It can bring a good postoperative appearance of the thumb and little influence on the hand function.

Intrauterine growth restriction and hypospadias: is there a connection?

PubMed Central

2014-01-01

Hypospadias is one of the most common congenital malformations of the genitourinary tract in males. It is an incomplete fusion of urethral folds early in fetal development and may be associated with other malformations of the genital tract. The etiology is poorly understood and may be hormonal, genetic, or environmental, but most often is idiopathic or multifactorial. Among many possible risk factors identified, of particular importance is low birth weight, which is defined in various ways in the literature. No mechanism has been identified for the association of low birth weight and hypospadias, but some authors propose placental insufficiency as a common inciting factor. Currently, there is no standardized approach for evaluating children with hypospadias in the setting of intrauterine growth restriction. We reviewed the available published literature on the association of hypospadias and growth restriction to determine whether it should be considered a separate entity within the category of disorders of sexual differentiation. PMID:25337123

Fine mapping analysis confirms and strengthens linkage of four chromosomal regions in familial hypospadias

PubMed Central

Söderhäll, Cilla; Körberg, Izabella Baranowska; Thai, Hanh T T; Cao, Jia; Chen, Yougen; Zhang, Xufeng; Shulu, Zu; van der Zanden, Loes F M; van Rooij, Iris A L M; Frisén, Louise; Roeleveld, Nel; Markljung, Ellen; Kockum, Ingrid; Nordenskjöld, Agneta

2015-01-01

Hypospadias is a common male genital malformation and is regarded as a complex disease affected by multiple genetic as well as environmental factors. In a previous genome-wide scan for familial hypospadias, we reported suggestive linkage in nine chromosomal regions. We have extended this analysis by including new families and additional markers using non-parametric linkage. The fine mapping analysis displayed an increased LOD score on chromosome 8q24.1 and 10p15 in altogether 82 families. On chromosome 10p15, with the highest LOD score, we further studied AKR1C2, AKR1C3 and AKR1C4 involved in steroid metabolism, as well as KLF6 expressed in preputial tissue from hypospadias patients. Mutation analysis of the AKR1C3 gene showed a new mutation, c.643G>A (p.(Ala215Thr)), in a boy with penile hypospadias. This mutation is predicted to have an impact on protein function and structure and was not found in controls. Altogether, we homed in on four chromosomal regions likely to harbor genes for hypospadias. Future studies will aim for studying regulatory sequence variants in these regions. PMID:24986825

Nutritional factors and hypospadias risks

PubMed Central

Carmichael, Suzan L.; Ma, Chen; Feldkamp, Marcia L.; Munger, Ronald G.; Olney, Richard S.; Botto, Lorenzo D.; Shaw, Gary M.; Correa, Adolfo

2012-01-01

SUMMARY We examined whether hypospadias was associated with several aspects of the diet, including intake of animal products, intake of several nutrients and food groups related to a vegetarian diet and estrogen metabolism, and diet quality. The study included deliveries from 1997 to 2005 that were part of the National Birth Defects Prevention Study. Diet was assessed by food frequency questionnaire during maternal telephone interviews, and two diet quality indices were developed based on existing indices. Analyses included 1,250 cases with second or third degree hypospadias (urethra opened at the penile shaft, scrotum or perineum) and 3,118 male, liveborn, non-malformed controls. All odds ratios (ORs) and 95% confidence intervals (CI) were estimated from logistic regression models that included several potential confounders, including energy intake. Intake of animal products was not associated with hypospadias; e.g., the adjusted OR for any versus no intake of meat was 1.0 (95% CI 0.6, 1.6). Frequency of intake of meat or other animal products was also not associated with hypospadias, nor was intake of iron or several nutrients that are potentially related to estrogen metabolism. Diet quality was also not associated with hypospadias; the ORs for diet quality in the highest versus lowest quartile for the two diet quality indices were 1.0 (95% CI 0.6, 1.6) and 0.9 (95% CI 0.7, 1.1). In conclusion, this large study does not support an association of a vegetarian diet or worse diet quality with hypospadias. PMID:22686387

Suture anchor tenodesis in repair of distal Achilles tendon injuries.

PubMed

Kiliçoğlu, Onder; Türker, Mehmet; Yildız, Fatih; Akalan, Ekin; Temelli, Yener

2014-01-01

Distal Achilles tendon avulsions are in the form of either bony and nonbony avulsion of Achilles tendon from its calcaneal insertion. Four patients with distal Achilles tendon avulsions or ruptures which were treated with tendon to bone repair using suture anchors are presented here. Operated leg was immobilized in above-knee cast for 4 weeks while the patient walked non-weight-bearing. Then, cast was changed to below knee, and full weight-bearing was allowed. Patients underwent gait analysis minimum at first postoperative year. Mean American Orthopedics Foot Ankle Society ankle/hindfoot score of patients at last visit was 88.75 (range 85-100), and Achilles tendon total rupture score was 77.75 (range 58-87). Mean passive dorsiflexion of injured ankles (14° ± 5°) was lower than uninjured ankles (23° ± 9°). All the kinematic parameters of gait analysis were comparable to the uninjured side. Maximum plantar flexion power of injured ankle was 1.40 W/kg, and this was significantly lower than the contralateral side value 2.38 W/kg; (P = 0.0143). There were no visually altered gait or problems in daily life. Suture anchor tenodesis technique of distal Achilles tendon avulsions was successful in achieving durable osteotendinous repairs.

Laparoscopic repair of ureter damaged during laparoscopic hysterectomy: Presentation of two cases

PubMed Central

Api, Murat; Boza, Ayşen; Kayataş, Semra; Boza, Barış

2017-01-01

Ureter injuries are uncommon but dreaded complications in gynecologic surgery and a frequent cause of conversion to laparotomy. Recently, a few papers reported the repair of gynecologic ureteral injuries using laparoscopy with encouraging results. In these case reports, we aimed to present two laparoscopically repaired ureter injuries during total laparoscopic hysterectomies (TLH). In the first case, the ureter was transected during the dissection of the cardinal ligament, approximately 7 to 8 cm distal to the ureterovesical junction (UVJ), and in the second case, it was damaged approximately 10 cm distal to the UVJ. Both transections were identified during surgery. The injured ureter was repaired without converting to laparotomy or additional trocar insertion. Ureteroureterostomy was performed in both cases uneventfully. Although ureteric injury is a rare complication during TLH, it can be managed by the same surgeon laparoscopically during the same procedure. PMID:29085711

[Disorders of sex development and proximal hypospadias].

PubMed

Oswald, J

2016-01-01

Children with ambiguous genitalia due to different chromosome or gonadal sex are a particular challenge concerning the diagnostic and therapeutic implications. Proximal hypospadias patients with normal gonadal development should be distinguished from children with DSD (disorders of sex development) to guarantee normal gender identity and the best possible surgical therapy. This paper focuses on the terminology, embryology, and pathophysiology of the different manifestations of DSD. The state of knowledge about this disease pattern with particular emphasis on proximal hypospadias based on national and international scientific discussions is presented. The different clinical pictures as well as therapeutic options of DSD with a special focus on recent literature and giving particular attention to patients with proximal hypospadias are presented. Because of the complexity of patients suffering from disorders of sex development an interdisciplinary DSD healthcare team including a paediatric endocrinologist as well as paediatric urologist should be provided. These specialists enable an accurate diagnosis in severe hypospadias patients without reference to DSD diseases patterns.

Endoscopic-assisted Distal Biceps Footprint Repair.

PubMed

Phadnis, Joideep; Bain, Gregory

2015-06-01

Distal biceps tendon ruptures have been treated successfully with a variety of techniques; however, no current technique is able to restore the biceps to its native footprint on the ulnar surface of the radial tuberosity. We describe a technique, using an endobutton that better recreates the anatomic distal biceps footprint. This is likely to better restore absoloute and repetitive supination strength, which is not reliably achieved with current techniques.

'Batman excision' of ventral skin in hypospadias repair, clue to aesthetic repair (point of technique).

PubMed

Hoebeke, P B; De Kuyper, P; Van Laecke, E

2002-11-01

In the hypospadiac penis the ventral skin is poorly developed, while dorsal skin is redundant. The classical Byars' flaps are a way to use the excess dorsal skin to cover the penile shaft. The appearance after Byars' flaps however is not natural. We use a more natural looking skin allocation with superior aesthetic results. The clue in this reconstruction is an inverted triangle shaped excision of ventral skin expanding over the edges of the hooded prepuce (which makes it look like Batman). After excision of the ventral skin it is possible to close the penile skin in the midline, thus mimicking the natural raphe. In case of preputial reconstruction the excised ventral skin makes the prepuce look more natural. The trend of further refining aesthetic appearance of the hypospadiac penis often neglects the penile skin reconstruction. A technique is presented by which the total penile appearances after surgery ameliorates due to better skin reconstruction.

Unusual presentation of Klinefelter syndrome

PubMed Central

Das, Chanchal; Sahana, Pranab Kumar; Sengupta, Nilanjan; Roy, Mukut; Dasgupta, Ranen

2013-01-01

Introduction: Klinefelter syndrome usually presents in the puberty and adulthood with its characteristic features. We report a boy who had Klinefelter syndrome with hypospadias and hydrocele. Case Note: Six and half year old boy had complaints of genitourinary problem in the form of hypospadias, small phallus and hydrocele. Karyotyping showed 47,XXY. Conclusion: This case illustrates that Klinefelter syndrome was presented in the infancy with hypospadias and hydrocele which are very uncommon presentation of the disease PMID:24910838

The Genetic and Environmental Factors Underlying Hypospadias

PubMed Central

Pask, Andrew; Heloury, Yves; Sinclair, Andrew H.

2016-01-01

Hypospadias results from a failure of urethral closure in the male phallus and affects 1 in 200–300 boys. It is thought to be due to a combination of genetic and environmental factors. The development of the penis progresses in 2 stages: an initial hormone-independent phase and a secondary hormone-dependent phase. Here, we review the molecular pathways that contribute to each of these stages, drawing on studies from both human and mouse models. Hypospadias can occur when normal development of the phallus is disrupted, and we provide evidence that mutations in genes underlying this developmental process are causative. Finally, we discuss the environmental factors that may contribute to hypospadias and their potential immediate and transgen erational epigenetic impacts. PMID:26613581

Repair of distal biceps tendon rupture with the Biotenodesis screw.

PubMed

Khan, W; Agarwal, M; Funk, L

2004-04-01

Distal biceps tendon ruptures are uncommon injuries with only around 300 cases reported in the literature. Current management tends to favour anatomical reinsertion of the tendon into the radial tuberosity, especially in young and active individuals. These injuries are commonly repaired using either a single anterior incision with suture anchors or the Boyd-Anderson dual incision technique. We report the use of a bioabsorbable interference screw for the repair of distal biceps tendon rupture using a minimal incision technique. In this technique the avulsed tendon and a bioabsorbable screw are secured in a drill hole on the radial tuberosity using whip stitch and fibre wire sutures according to Biotenodesis system guidelines. The technique described requires minimal volar dissection that is associated with a reduced number of synostosis and posterior interosseous nerve injuries. The bioabsorbable interference screw has all the advantages of being biodegradable and has been shown to have greater pullout strength than suture anchors. It is also a reasonable alternative to titanium screws in terms of primary fixation strength. The strong fixation provided allows early active motion and return to previous activities as seen in our case.

Partial trisomy 14q and monosomy 20q due to an unbalanced familial translocation

DOE Office of Scientific and Technical Information (OSTI.GOV)

Menasse-Palmer, L; Leo, J.; Cannizaro, L.

Partial trisomy of distal 14q and monosomy of 20q are rare. There have been several reports of a partial distal trisomy 14q with characteristic clinical findings, including hypogonadism and a conotruncal cardiac anomaly. There is no deletion distal 20q syndrome. We have recently examined a newborn with this unique duplication/deletion syndrome. Case report: J.S. was the 2980 gm product of a term uneventful pregnancy delivered to a 24-year-old gravida 2, para 1001 mother. The newborn exam revealed a dysmorphic newborn male with a sloping forehead, bitemporal narrowing, glabellar furrowing and micrognathia. A systolic murmur was audible. The genital abnormalities weremore » micropenis, hypospadias with chordee and bifid scrotum with prominent raphe, and gonads were palpable. A CAT scan of the head revealed grade I IVH. An echocardiogram showed a VSD, ASD and an AP window. A sonogram of the liver showed absence of the gallbladder. Chromosome analysis revealed an abnormal male karyotype containing a derivative 20, subsequently shown to be inherited as a result of malsegregation of a paternal translocation: 46,XY,-20,+der(20)t(14;20)(q32.1;q13.3)pat. The infant fed poorly and required tube feedings and was treated for congestive heart failure with Digoxin, Lasix and oxygen. A decreased cortisol level and cholestasis were noted. The infant died after a cardiopulmonary arrest at one month of age. No post-mortem was obtained. Clinical cytogenetic correlation (conotruncal abnormality and hypogonadism) with partial duplication of distal 14q was positive. This case helps to further delineate duplication 14q and a syndrome due to partial deletion 20q.« less

Is Hypospadias Associated with Prenatal Exposure to Endocrine Disruptors? A French Collaborative Controlled Study of a Cohort of 300 Consecutive Children Without Genetic Defect.

PubMed

Kalfa, Nicolas; Paris, Françoise; Philibert, Pascal; Orsini, Mattea; Broussous, Sylvie; Fauconnet-Servant, Nadège; Audran, Françoise; Gaspari, Laura; Lehors, Hélène; Haddad, Myriam; Guys, Jean-Michel; Reynaud, Rachel; Alessandrini, Pierre; Merrot, Thierry; Wagner, Kathy; Kurzenne, Jean-Yves; Bastiani, Florence; Bréaud, Jean; Valla, Jean-Stéphane; Lacombe, Gérard Morisson; Dobremez, Eric; Zahhaf, Amel; Daures, Jean-Pierre; Sultan, Charles

2015-12-01

Numerous studies have focused on the association between endocrine-disrupting chemicals (EDCs) and hypospadias. Phenotype variability, the absence of representative comparison groups and concomitant genetic testing prevent any definitive conclusions. To identify the role of occupational and environmental exposures to EDCs in nongenetic isolated hypospadias. A total of 408 consecutive children with isolated hypospadias and 302 normal boys were prospectively included (2009-2014) in a multi-institutional study in the south of France, the area of the country with the highest prevalence of hypospadias surgery. In patients without AR, SRD5A2, and MAMLD1 mutations, parental occupational and professional exposures to EDCs were evaluated based on European questionnaire QLK4-1999-01422 and a validated job-exposure matrix for EDCs. Environmental exposure was estimated using the zip code, the type of surrounding hazards, and distance from these hazards. Multivariate analysis was performed. Fetal exposure to EDCs around the window of genital differentiation was more frequent in the case of hypospadias (40.00% vs 17.55%, odds ratio 3.13, 95% confidence interval 2.11-4.65). The substances were paints/solvents/adhesives (16.0%), detergents (11.0%), pesticides (9.0%), cosmetics (5.6%), and industrial chemicals (4.0%). Jobs with exposure were more frequent in mothers of hypospadiac boys (19.73% vs 10.26%, p=0.0019), especially cleaners, hairdressers, beauticians, and laboratory workers. Paternal job exposure was more frequent in the cases of hypospadias (40.13% vs 27.48%, p=0.02). Industrial areas, incinerators, and waste areas were more frequent within a 3-km radius for mothers of hypospadiac boys (13.29% vs. 6.64%, p<0.00005). Association of occupational and environmental exposures increases this risk. This multicenter prospective controlled study with a homogeneous cohort of hypospadiac boys without genetic defects strongly suggests that EDCs are a risk factor for hypospadias through occupational and environmental exposure during fetal life. The association of various types of exposures may increase this risk. Our multi-institutional study showed that parental professional, occupational, and environmental exposures to chemical products increase the risk of hypospadias in children. Copyright © 2015 European Association of Urology. Published by Elsevier B.V. All rights reserved.

Two novel translocation breakpoints upstream of SOX9 define borders of the proximal and distal breakpoint cluster region in campomelic dysplasia.

PubMed

Leipoldt, M; Erdel, M; Bien-Willner, G A; Smyk, M; Theurl, M; Yatsenko, S A; Lupski, J R; Lane, A H; Shanske, A L; Stankiewicz, P; Scherer, G

2007-01-01

The semilethal skeletal malformation syndrome campomelic dysplasia (CD) with or without XY sex reversal is caused by mutations within the SOX9 gene on 17q24.3 or by chromosomal aberrations (translocations, inversions or deletions) with breakpoints outside the SOX9 coding region. The previously published CD translocation breakpoints upstream of SOX9 fall into two clusters: a proximal cluster with breakpoints between 50-300 kb and a distal cluster with breakpoints between 899-932 kb. Here, we present clinical, cytogenetic and molecular data from two novel CD translocation cases. Case 1 with karyotype 46,XY,t(1;17)(q42.1;q24.3) has characteristic symptoms of CD, including mild tibial bowing, cryptorchidism and hypospadias. By standard fluorescence in situ hybridization (FISH) and by high-resolution fiber FISH, the 17q breakpoint was mapped 375 kb from SOX9, defining the centromeric border of the proximal breakpoint cluster region. Case 2 with karyotype 46,X,t(Y;17)(q11.2;q24.3) has the acampomelic form of CD and complete XY sex reversal. By FISH and somatic cell hybrid analysis, the 17q breakpoint was mapped 789 kb from SOX9, defining the telomeric border of the distal breakpoint cluster region. We discuss the structure of the 1 Mb cis-control region upstream of SOX9 and the correlation between the position of the 14 mapped translocation breakpoints with respect to disease severity and XY sex reversal.

Simultaneous bilateral distal biceps tendon ruptures repaired using an endobutton technique: a case report.

PubMed

Dacambra, Mark P; Walker, Richard Ea; Hildebrand, Kevin A

2013-08-23

The simultaneous rupture of both distal biceps tendons is a rare clinical entity that is difficult to treat and can have poor outcomes. A variety of treatment and rehabilitation options exist and have been reported for single sided and staged bilateral repairs, but none have described an approach for acute bilateral ruptures. Repairing distal biceps tendon ruptures using a single anterior incision and a cortical suspensory button technique has become increasingly popular in recent years. We present a report of our surgical approach using an endobutton technique and rehabilitation algorithm for this unusual injury pattern. A 43-year-old Caucasian man presented with acute onset bilateral elbow pain while lifting a large sheet of drywall off the ground. He initially felt a 'pop' on the right and almost immediately felt another on the left after having to quickly shift the weight. He was unable to continue working and sought medical attention. His pain was predominantly in his bilateral antecubital fossae and he had significant swelling and ecchymoses. His clinical examination demonstrated no palpable tendon, a retracted biceps muscle belly, and clear supination weakness. Magnetic resonance imaging was performed and showed bilateral distal biceps tendon ruptures with retraction on both sides. After discussion with our patient, we decided that both sides would be repaired using a single anterior incision with endobutton fixation, first his right followed by his left six weeks later. Overall, our patient did very well and had returned to full manual work by our last follow-up at 30 months. Although he was never able to return to competitive recreational hockey and was left with mild lateral antebrachial cutaneous nerve dysesthesias on his right, he felt he was at 85% of his premorbid level of function. We describe what we believe to be, to the best of our knowledge, the first case of simultaneous bilateral distal biceps tendon ruptures successfully treated with a single-incision endobutton technique, which represents a valid option in managing this difficult problem.

Open repair of chronic distal aortic dissection in the endovascular era: Implications for disease management.

PubMed

Pujara, Akshat C; Roselli, Eric E; Hernandez, Adrian V; Vargas Abello, Lina M; Burke, Jacob M; Svensson, Lars G; Greenberg, Roy K

2012-10-01

Controversy surrounds the treatment of chronic aortic dissection. Open surgical and endovascular experiences include mixed populations treated with evolving strategies and limited follow-up. We establish a standard against which endovascular repair can be compared by assessing outcomes after open repair of chronic distal aortic dissections anatomically suitable to stent-grafting. From 2000 to 2008, 169 patients underwent open repair of the descending thoracic artery only (n = 88) or thoracoabdominal (n = 81) chronic aortic dissection (elective in 98, urgent/emergency in 71). Chart review and 3-dimensional assessment of computed tomography were performed. Poor outcome included all-cause mortality or vascular reintervention. Thirty-day mortality was 8% (n = 14). Serious complications included neurologic (n = 12 [spinal cord n = 4, 2.4%]), respiratory (n = 32), and renal failure (n = 1 descending thoracic artery only vs 17 thoracoabdominal, P < .001). Chronic obstructive pulmonary disease predicted early mortality (hazard ratio 8.0, P = .005). Survival at 1, 2, and 5 years was 76%, 69%, and 55%, respectively; 23 patients (14%) required reintervention. Event-free survival at 5 years was 51% and 47% after descending thoracic artery only or thoracoabdominal repair, respectively. Greater maximum aortic diameter (hazard ratio 1.9, P = .03) and greater diameter at the diaphragm (hazard ratio 3.7, P = .01) or renal segment (hazard ratio 4.3, P = .03) predicted poor outcome. Early outcomes are good and late outcomes are less than desirable after open repair of chronic distal aortic dissection, regardless of the extent of repair. High-risk and late-stage patients with larger and more extensive aneurysmal degeneration warrant further investigation, including the use of newer, less-invasive techniques. Select patients at risk for aneurysmal degeneration should undergo a more aggressive initial approach with aortic dissection repair. Copyright © 2012 The American Association for Thoracic Surgery. Published by Mosby, Inc. All rights reserved.

Penile appearance after hypospadias correction from a parent's point of view: Comparison of the hypospadias objective penile evaluation score and parents penile perception score.

PubMed

Haid, Bernhard; Becker, Tanja; Koen, Mark; Berger, Christoph; Strasser, Christa; Roesch, Judith; Zniva, Christian; Oswald, Josef

2016-02-01

As there is only scarce information on the parents' view of the cosmetic outcome after hypospadias surgery we aimed to evaluate whether the results of the hypospadias objective penile evaluation (HOPE) score are transferable to parents satisfaction as measured by the pediatric penile perception score (PPPS). 42 patients after hypospadias correction were included (2 (6.9%) glandular, 20 (68.9%) coronal, 6 (20.6%) penile and 1 (3.4%) scrotal hypospadias, median age 15.0 months). Two surgeons independently assessed HOPE score; the PPPS score as well as 4 questions specifically designed by a psychologist were completed by fathers and mothers. 29 (69.9%) full datasets were available for evaluation. Parents' assessment of the cosmetic results was worse than surgeons' assessment (81.13% [PPPS] vs. 92.81% [HOPE] of the respectively possible highest score, P < 0.0001). All 58 parents (100%) were convinced that surgery led to a better cosmetic aspect of their sons' genitalia although both, mothers and fathers, perceived the operation as a major encumbrance (fathers 3.62 vs. mothers 3.97 on a scale from 0-6, P = 0.22). Parents can be encouraged preoperatively that a hypospadias operation, seen from their point of view will be a major amendment to the cosmetic appearance of their sons' genitalia even if the operation itself is perceived as a major psychological burden. In direct comparison of the highest possible score of either tool (HOPE or PPPS), the cosmetic results were judged significantly more optimistic by surgeons as compared to parents using validated tools. HOPE score results therefore may not be transferred uncritically to the parents view on the cosmetic results. Copyright © 2015 Journal of Pediatric Urology Company. Published by Elsevier Ltd. All rights reserved.

Ethnic patterns of hypospadias in New Zealand do not resemble those observed for cryptorchidism and testicular cancer: evidence of differential aetiology?

PubMed

Gurney, J K; Stanley, J; Shaw, C; Sarfati, D

2016-01-01

It has been proposed that hypospadias, cryptorchidism, poor semen quality and testicular cancer might share common prenatal causes. We have previously demonstrated similar ethnic patterns for the incidence of testicular cancer and cryptorchidism - a known risk factor for testicular cancer. If the underlying exposure(s) that cause hypospadias, cryptorchidism and testicular cancer are shared, then we would expect the incidence relationship between ethnic groups to follow the same pattern across all three conditions. We followed a birth cohort of 318 345 eligible male neonates born in New Zealand between 2000-2010, and linked routinely collected maternity records with inpatient hospitalization and mortality records through to 2011. We searched hospitalization records for diagnoses of hypospadias, and used mortality records for censoring. We used Poisson regression methods to compare the relative risk of hypospadias between ethnic groups, adjusting for perinatal risk factors and total person time. We observed that European/Other children had the highest risk of hypospadias, with Māori, Pacific and Asian boys having around 40% lower risk of disease compared with this group (adjusted relative risk [RR]: Māori 0.62, 95% CI 0.55-0.70; Pacific 0.62, 95% CI 0.53-0.72; Asian 0.57, 95% CI 0.47-0.69). This contrasts substantially with our previous observations for cryptorchidism and testicular cancer, where Māori males have the greatest risk. Our observations suggest that - at least in New Zealand - the exposures that drive the development of hypospadias may differ to those that that drive the development of cryptorchidism and/or testicular cancer. © 2015 American Society of Andrology and European Academy of Andrology.

JAG Tearing Technique with Radiofrequency Guide Wire for Aortic Fenestration in Thoracic Endovascular Aneurysm Repair

DOE Office of Scientific and Technical Information (OSTI.GOV)

Ricci, Carmelo; Ceccherini, Claudio, E-mail: claudiocec@hotmail.it; Leonini, Sara

An innovative approach, the JAG tearing technique, was performed during thoracic endovascular aneurysm repair in a patient with previous surgical replacement of the ascending aorta with a residual uncomplicated type B aortic dissection who developed an aneurysm of the descending thoracic aorta with its lumen divided in two parts by an intimal flap. The proximal landing zone was suitable to place a thoracic stent graft. The distal landing zone was created by cutting the intimal flap in the distal third of the descending thoracic aorta with a radiofrequency guide wire and intravascular ultrasound catheter.

Psychosocial outcomes in adult men born with hypospadias: A register-based study

PubMed Central

Skarin Nordenvall, Anna; Norrby, Christina; Butwicka, Agnieszka; Frisén, Louise; Nordenström, Anna; Almqvist, Catarina; Nordenskjöld, Agneta

2017-01-01

In this nationwide matched cohort study, we have investigated whether being born with hypospadias affect subsequent psychosocial outcomes in adulthood. We analyzed prospectively collected data from national Swedish registers. Data on the diagnoses were collected from the National Patient Register and the Medical Birth Register. Data on psychosocial outcomes such as educational and income level, marital status and disability pension were collected from Statistics Sweden. The effects of covariates, such as age, county of birth, presence of other malformations and psychiatric illness, were taken into account. The associations between hypospadias and psychosocial outcomes were calculated using conditional logistic regression and expressed as odds ratios (OR) and 95% confidence intervals (CI). We included 4378 men diagnosed with hypospadias, born between 1969 and 1993 in Sweden. Patients with hypospadias were matched with unaffected men by year of birth and birth county. We did not detect any differences in educational or income level. The probability of entering marriage (OR 1.02, 95% CI 0.90–1.14) did not differ, regardless of phenotype. We did, however, detect a 40% increased probability of receiving a disability pension, (OR 1.39, 95% CI 1.20–1.61). In conclusion, men born with hypospadias in Sweden do not differ from unaffected men with respect to the majority of psychosocial outcomes studied. They are, however, at increased risk of receiving a disability pension, which motivates further investigations. PMID:28384289

The mechanism underlying dibutyl phthalate induced shortened anogenital distance and hypospadias in rats.

PubMed

Li, Ning; Chen, Xuyong; Zhou, Xuefeng; Zhang, Wen; Yuan, Jiyan; Feng, Jiexiong

2015-12-01

The purpose of this study was to investigate the mechanism of dibutyl phthalate (DBP) induced hypospadias and shortened anogenital distance (AGD). AGD, hypospadias, and cryptorchidism incidence was observed in male offspring of DBP treated pregnant Wistar rats. Testicular development and testosterone levels of normal and DBP-treated rat embryos were compared. Male offspring of 300mg and 900mg DBP-treated pregnant Wistar rats exhibited shortened average AGD compared with the control group. A 22.7% hypospadias incidence was observed in the 300mg group, but no offspring with cryptorchidism were identified. In the 900mg group, hypospadias and cryptorchidism incidence reached 43.5% and 17.4%, respectively. Between E15.5 and E17.5, the 300mg group exhibited delayed testicular development and testosterone secretion. However, testicular development and testosterone secretion subsequently recovered. The 300mg treated and control groups had similar measures after E19.5. Contrastingly, testicular development and testosterone secretion were significantly diminished throughout development in the 900mg group. Exogenous testosterone partially counteracted DBP-induced changes in the reproductive organs of male offspring of DBP-treated rats. High-dose DBP exposure may induce testicular dysgenesis in rat embryos. Additionally, low-dose DBP may delay testicular development and testosterone secretion during urethral development. This disruption may result in hypospadias. Copyright © 2015 Elsevier Inc. All rights reserved.

A Mouse Model of Hypospadias Induced by Estradiol Benzoate.

PubMed

He, Hou-Guang; Han, Cong-Hui; Zhang, Wei

2015-12-01

We wished to establish a mouse model of hypospadias using injections of estradiol benzoate for investigating the molecular mechanisms of hypospadias. Fifty timed pregnant mice were randomly divided into five study groups: A, B, C, D, and E. These groups were injected subcutaneously with estradiol benzoate mixed with sesame oil at, respectively, the doses of 0, 0.1, 0.5, 2.5, or 12.5 mg kg(-1) days(-1) from gestation day (GD) 12 to GD 16. The pups' mortality was recorded on the day of delivery. Urethras and positions of testes were examined on postnatal day 28. The numbers of live pups were significantly lower in the study groups D and E compared to study group A (p < 0.01). Hypospadias was seen in groups C (3.3 %; 1/30), D (18.2 %; 4/22), and E (21.4 %; 3/14), while cryptorchidism was observed in groups C (10 %; 3/30), D (31.8 %; 7/22), and E (57.1 %; 8/14) on postnatal day 28. The experimental model of hypospadias induced by estradiol benzoate in the group D (2.5 mg kg(-1) days(-1)) was more reliable considering high mortality of the study group E. The dose of estradiol benzoate used in the group D is suitable for establishing mouse model of hypospadias.

Investigation of gender role behaviors in boys with hypospadias: comparative study with unaffected boys and girls.

PubMed

Sung, Ji Yean; Han, Sang Won; Chung, Kyong-Mee; Lee, Hyeyoung; Cho, Sang Hee

2014-10-01

The purpose of the study was (1) to investigate gender role behaviors of boys with hypospadias compared with groups of unaffected boys and girls using parental reports and direct observations; and (2) to directly observe effects of socialization (mothers' presence) on children's gender role behaviors. Ages of 19 children with hypospadias ranged from 3 to 7 years, and each of them were matched to controls of unaffected boys and girls by age. All the children participated with their mothers. Children's gender role behaviors and their mothers' behaviors were evaluated using an observation coding system. Mothers also completed questionnaires regarding their children's gender role behaviors. Results indicated no atypical gender role behavior for the boys with hypospadias and no direct effects of socialization on their gender role behaviors. However, differences were found in negative communicative behaviors between boys with hypospadias and unaffected boys, suggesting a possible role of socialization. © The Author 2014. Published by Oxford University Press on behalf of the Society of Pediatric Psychology. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

Simultaneous bilateral distal biceps tendon repair: case report.

PubMed

Storti, Thiago Medeiros; Paniago, Alexandre Firmino; Faria, Rafael Salomon Silva

2017-01-01

Simultaneous bilateral rupture of the distal biceps tendon is a rare clinical entity, seldom reported in the literature and with unclear therapeutic setting. The authors report the case of a 39-year-old white man who suffered a simultaneous bilateral rupture while working out. When weightlifting with elbows at 90° of flexion, he suddenly felt pain on the anterior aspect of the arms, coming for evaluation after two days. He presented bulging contour of the biceps muscle belly and ecchymosis in the antecubital fossa, extending distally to the medial aspect of the forearm, as well as a marked decrease of supination strength and pain in active elbow flexion. MRI confirmed the rupture with retraction of the distal biceps bilaterally. The authors opted for performing the tendon repairs simultaneously through the double incision technique and fixation to the bicipital tuberosity with anchors. The patient progressed quite well, with full return to labor and sports activities, being satisfied with the result after two years of surgery. In the literature search, few reports of simultaneous bilateral rupture of the distal biceps were retrieved, with only one treated in the acute phase of injury. Therefore, the authors consider this procedure to be a good option to solve this complex condition.

[Biodegradable catheters for fistula prevention in hypospadias. Experimental preliminary study].

PubMed

Ramos, J L; Aldazabal, P; Zuza, E; Sarasúa, J R; Arrieta, A; Villanueva, A; Eizaguirre, I

2013-04-01

Continuous technical innovations are not enough to resolve the high incidence of fistula after hypospadias repair. A urethral catheter-tutor made of reabsorbable polymeric biomaterial (RPB) which could be left in situ long enough could reduce the complications. To investigate in an animal model differents RPB to be used in urology. CRL Wistar rats, males, divided into 5 equal groups according to the used polymers: polylactide; lactic-coprolactone copolymer; lactic-glycolic copolymer; simulated; control silicones. Three individuals were sacrificed per group at 4th, 10th and 16th week. In all animals (exceptuating the simulated group), biomaterial was fixed to the bladder wall bylaparotomy. Animals remained in individual housing and kept under daily control of hematuria during the first 15 days and weekly weight and urine control for pH and lactate. After being slaughtered, remaining polymer was collected for chemical analysis and bladder tissue for hystologic study. There was no mortality, hematuria nor other clinical signs. The bladder wall showed a mild foreign body reaction. The values of lactate and pH in urine did not reach toxic levels. Lactic-glycolic was totally reabsorbed by the 10th week and had the lowest degree of calcification. Polylactide and lactic-coprolactone remained intact. The model of urinary bladder has proven useful for studying the degradation of bioresorbable polymers. The analyzed polymers have spent long time to be reabsorbed, so we will have to study new others.

Arthroscopic knotless anchor repair of triangular fibrocartilage in distal radius fracture.

PubMed

García-Ruano, Á A; Najarro-Cid, F; Jiménez-Martín, A; Gómez de los Infantes-Troncoso, J G; Sicre-González, M

2015-01-01

Lesions of triangular fibrocartilage (TFC) are associated with distal radioulnar joint instability. Arthroscopic treatment of these lesions improves functional outcome of affected patients. The aim of the present work is to evaluate functional and occupational outcome of TCF repair using an arthroscopic knotless anchor device in patients with associated distal radius fracture. An observational, descriptive study was carried out between November 2011 and January 2014 including 21 patients with distal radius fracture and Palmer 1B lesions of TCF (Atzei class 2 and 3) that were treated by arthroscopic knotless anchor (PopLok® 2,8mm, ConMed, USA). Mean follow-up was 18 months. Functional (Mayo Wrist Score) and occupational outcome results were analyzed. Mean age of the group was 43.0±8.8 years, with 19% of the patients being female. There was an associated scapholunate lesion in 5 cases. Functional results reached a mean of 83.4±16.1 points onMayo Wrist Score. Mean sick-leave time was 153.16±48.5 days. Complete occupational reintegration was reached in 89.5% of cases. There were no postoperative complications. Arthroscopic knotless anchor repair of 1B TFC tears is a minimally invasive method of treatment that improves tension of fixation, avoiding subsequent loosen, in our experience, with few complications and good functional and occupational results. Copyright © 2014 SECOT. Published by Elsevier Espana. All rights reserved.

The long-term outcomes of partial arch repair using the frozen elephant trunk technique for distal arch aortic aneurysm.

PubMed

Sueda, Taijiro; Takahashi, Shinya; Katayama, Keijiro; Morita, Shohei; Watanabe, Masazumi; Kurosaki, Tatsuya

2018-06-22

The purpose of this study was to evaluate the long-term results of partial arch repair using the frozen elephant trunk (FET) technique for distal arch aortic aneurysm and to examine the late complications. Thirty-eight patients with true distal arch aortic aneurysms were repaired with FET introduced through an incision in the proximal arch aorta. Follow-up computed tomography was performed every 6 or 12 months in 36 surviving patients. The maximum dimension of the excluded aneurysmal space was measured to determine whether the aneurysmal space had decreased or disappeared. Late complications were also evaluated during the long-term follow-up. There was 1 hospital death (2.6%) and 1 (2.6%) case of paraplegia. There were 2 late sudden deaths (5.2%) thought to be due to aneurysm rupture and arrhythmia. Postoperative serial-computed tomography showed shrinkage of the excluded aneurysmal space in 33 of 36 patients. Late aneurysmal formation occurred in the anastomotic site in three patients. One patient underwent thoracic endovascular stent grafting 10 years after surgery, 1 patient had total arch replacement 9 years after surgery, and 1 died due to rupture. Frozen elephant trunk was found to be a useful alternative for treating true distal arch aortic aneurysm. However, we must be alert for late aneurysmal formation at the incision site.

Long-term Results of Ventral Penile Curvature Repair in Childhood.

PubMed

Golomb, Dor; Sivan, Bezalel; Livne, Pinhas M; Nevo, Amihay; Ben-Meir, David

2018-02-01

To assess the postpubertal outcome of ventral penile curvature repaired in infancy in terms of recurrence and aesthetics. Postpubertal patients treated for hypospadias and ventral penile curvature in infancy at a tertiary medical center were invited to undergo assessment of the quality of the repair. Findings were compared between patients with a straight penis after skin release and patients who required dorsal plication. The cohort included 27 patients of mean age 16.5 years who were reported with straight penis after surgery. Postpubertal curvature was found in 6 of 14 patients (43%) successfully treated by skin release and 10 of 13 patients (77%) who underwent dorsal plication (P = .087). Significant curvature (≥30 degrees) was found in 1 of 14 patients in the skin-release group and 4 of 13 in the dorsal plication group (P = .16). Rates of redo urethroplasty were 2 of 14 (14%) and 5 of 10 (50%), respectively. Patient satisfaction with the appearance of the penis did not differ significantly. Ventral penile curvature repaired in infancy often recurs after puberty. The need for dorsal plication has a trend-level association with recurrence of penile curvature in puberty. It might also be related to the degree of postpubertal penile curvature and the need for redo urethroplasty. Procedure type does not affect patient satisfaction with the postpubertal appearance of the penis. Copyright © 2017 Elsevier Inc. All rights reserved.

Altitude as a risk factor for the development of hypospadias. Geographical cluster distribution analysis in South America.

PubMed

Fernández, Nicolas; Lorenzo, Armando; Bägli, Darius; Zarante, Ignacio

2016-10-01

Hypospadias is the most common congenital anomaly affecting the genitals. It has been established as a multifactorial disease with increasing prevalence. Many risk factors have been identified such as prematurity, birth weight, mother's age, and exposure to endocrine disruptors. In recent decades multiple authors using surveillance systems have described an increase in prevalence of hypospadias, but most of the published literature comes from developed countries in Europe and North America and few of the published studies have involved cluster analysis. Few large-scale studies have been performed addressing the effect of altitude and other geographical aspects on the development of hypospadias. Acknowledging this limitation, we present novel results of a multinational spatial scan statistical analysis over a 30-year period in South America and an altitude analysis of hypospadias distribution on a continent level. A retrospective review was performed of the Latin American collaborative study of congenital malformations (ECLAMC). A total of 4,020,384 newborns was surveyed between 1982 and December 2011 in all participating centers. We selected all patients with hypospadias. All degrees of clinical severity were included in the analysis. Each participating center was geographically identified with its coordinates and altitude above sea level. A spatial scan statistical analysis was performed using Kulldorf's methodology and a prevalence trend analysis over time in centers below and above 2000 m. During the study period we found 159 hospitals in six different countries (Colombia, Bolivia, Brazil, Argentina, Chile, and Uruguay) with 4,537 cases of hypospadias and a global prevalence rate of 11.3/10,000 newborns. Trend analysis showed that centers below 2000 m had an increasing trend with an average of 10/10,000 newborns as opposed to those centers above 2000 m that showed a reducing trend with an average prevalence of 7.8 (p = 0.1246). We identified clusters with significant increases of prevalence in five centers along the coast at an average altitude of 219.8 m above sea level (p > 0.0000). Reduction in prevalence was found in clusters located in two centers on the Andes mountains. Altitude of 2,000 m was associated with hypospadias (Figure), with an OR 0.59 (0.5-0.69). There are ethnic arguments to support our results supported by protective polymorphism distribution in high lands. Altitude above 2,000 m is suggested to have a protective effect for hypospadias. Specific clusters have been identified with increased risk for hypospadias. Environmental risk factors in these areas need to be further studied given the association seen between altitude and the distribution of more severe cases. Copyright © 2016 Journal of Pediatric Urology Company. Published by Elsevier Ltd. All rights reserved.

Elevated incidence of hypospadias in two sicilian towns where exposure to industrial and agricultural pollutants is high.

PubMed

Bianca, Sebastiano; Li Volti, Giovanni; Caruso-Nicoletti, Manuela; Ettore, Giuseppe; Barone, Patrizia; Lupo, Lorenzo; Li Volti, Salvatore

2003-01-01

We found significant elevated incidence of hypospadias in two towns in Southeastern Sicily selected on the basis of the presence of intense industrial (Augusta) and agricultural (Vittoria) activities. Cases and controls were chosen in records collected from a surveillance system on abnormal live births in the same area and in a large city (Catania) located in an area at low risk of exposure to environmental pollutants. From 1991 to 1998, 16 cases of isolated hypospadias were recorded among male live births in Augusta (12.1 per 1000 male live births) and 24 cases in Vittoria (7.4 per 1000 male live births) with an incidence significantly higher than that expected (3.2 per 1000 in Southeastern Sicily). Relative risks in Augusta and Vittoria were 3.8 (95% confidence interval: 2.16-6.14) and 2.3 (95% confidence interval: 1.48-3.43; P=0.00003 and 0.04, respectively). In Augusta, the incidence of hypospadias was higher than in Vittoria. Significant log odds ratios were found for occupational exposure in fathers both in Augusta and Vittoria (P=0.0478 and 0.026, respectively). However, daily contact with pollutants in Augusta may not be sufficient by itself to determine hypospadias and other factors might be involved. Similar factors may act also in Vittoria. Thus, contact with large amounts of pesticides is, by itself, a risk factor for hypospadias, though genetic and other environmental factors might be involved.

Does immediate elbow mobilization after distal biceps tendon repair carry the risk of wound breakdown, failure of repair, or patient dissatisfaction?

PubMed

Smith, James R A; Amirfeyz, Rouin

2016-05-01

Rehabilitation protocols after distal biceps repair are highly variable, with many surgeons favoring at least 2 weeks of immobilization. Is this conservative approach necessary to protect the repair? This was a consecutive series of 22 distal biceps tendon repairs in which a cortical button system was used. Patients were encouraged to mobilize their elbow actively from the day of surgery. Physiotherapy commenced at 3 weeks, with strengthening exercises when full range of movement (ROM) was achieved. The primary outcome measured was the clinical integrity of the repaired tendon. Secondary outcomes comprised wound or nerve complication, elbow ROM, and patient-reported outcome measures (the 11-item version of the Disabilities of Arm, Shoulder and Hand, Mayo Elbow Performance Index, and Oxford Elbow Score). All patients were male, and the dominant arm was repaired in 60%. Mean age was 40.6 years (range, 27-62 years), and mean time to surgery was 17 days (range, 5-99 days). Mean follow-up was 16.6 months (range, 3.8-29 months). All tendons were clinically intact at time of review. No wound breakdown occurred. Mean extension was -6° (range, -10° to 10°), and flexion was 144° (range, 135°-150°). All patients achieved full pronosupination. ROM was equivalent to the uninjured arm (P = .7). The mean 11-item version of the Disabilities of Arm, Shoulder and Hand score was 2.7 (range, 0-15.9), the Mayo Elbow Performance Index was 97.8 (range, 70-100), and the Oxford Elbow Score was 46.9 (range, 43-48) at the latest follow-up. One-third of patients experienced a transient sensory neurapraxia. Immediate mobilization after biceps tendon repair with a cortical button is possible, and in this series was not associated with failure of the repair, wound breakdown, or patient dissatisfaction. However, this series emphasizes the high incidence of nerve complication that can be associated with the single transverse incision technique. Copyright © 2016 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.

Changes in the structural properties of peripheral nerves after transection.

PubMed

Toby, E B; Meyer, B M; Schwappach, J; Alvine, G

1996-11-01

Changes in peripheral nerve structural properties after transection were measured weekly for 5 weeks in the distal stump of the sciatic nerve in 50 Sprague-Dawley rats. Each week after transection, the distal stump of the transected nerve showed increased stiffness when compared to intact nerves. Linear elastic stiffness reached a maximum at weeks 1 and 2 after transection, when the transected nerves were 15% stiffer than the contralateral control sides. Toughness was also increased and reached a maximum at week 4 with a 50% difference between values for experimental and control sides. Overall failure load was between 21% and 27% greater, peaking at week 3. An increase in stiffness of the distal stump would result in increased tension at the suture line, as the nerve gap is overcome when performing a delayed neurorraphy. These data suggest, with respect to structural properties, that an end-to-end repair should be carried out at the time of injury; after only 1 week, significant stiffness in the distal segment of the nerve developed, which should result in an increase in tension at the repair site.

Flutamide-induced hypospadias in rats: A critical assessment.

PubMed

Sinclair, Adriane Watkins; Cao, Mei; Pask, Andrew; Baskin, Laurence; Cunha, Gerald R

This paper provides the first detailed description of flutamide-induced hypospadias in the rat based upon wholemount, histologic, three-dimensional reconstruction, scanning electron microscopic, and immunocytochemical analysis. The penile malformations elicited by this potent anti-androgen include a substantial proximal shift in the urethral meatus that clearly conforms to the definition of hypospadias based upon specific morphological criteria for this malformation. Through examination of the normal penile development and flutamide-induced abnormal penile development observed in prenatally oil- and flutamide-treated rats, our analysis provides insights into the morphogenetic mechanism of development of hypospadias. In this regard, a common theme in normal penile development is midline fusion of epithelia followed by removal of the epithelial seam and establishment of midline mesenchymal confluence during development of the penile urethra and prepuce, processes which are impaired as a result of prenatal flutamide treatment. The developmental processes occurring in normal penile development, through comparison with development of female external genitalia and those impaired due to prenatal flutamide treatment, are consistent with critical role of androgen receptors in normal penile development in the rat, and the specific penile abnormalities embodied in flutamide-induced rat hypospadias. Copyright © 2016 International Society of Differentiation. Published by Elsevier B.V. All rights reserved.

Use of double pigtail stent in hypospadias surgery.

PubMed

Chang, Paul C Y; Yeh, Ming-Lun; Chao, Chun-Chih; Chang, Chi-Jen

2011-01-01

Various types and materials of stents have been used for urinary diversion in hypospadias surgery. We evaluated whether double pigtail stents are superior to straight silicone stents. We conducted a retrospective chart review of all patients who underwent hypospadias surgery with straight silicone or double pigtail stents between November 1997 and October 2005. Comparisons were made between the two groups specifically with regard to the complication rates. A total of 86 patients were included. The complication rates in patients who received double pigtail stents were significantly reduced as compared with those who received straight silicon stents. There was less wound disruption associated with early stent dislodgement in the double pigtail group compared with the straight silicone group (3.2%vs. 17.4%, p< 0.05). The rate of urethrocutaneous fistula was also lower in the double pigtail stent group (12.7%vs. 30.4%). Subjectively, there was also improved patient comfort and parent anxiety in the double pigtail stent group. Double pigtail stent is a suitable material for urinary diversion in hypospadias surgery. It not only reduces patient discomfort, but also decreases complication rates in hypospadias surgery. Copyright © 2011 Asian Surgical Association. Published by Elsevier B.V. All rights reserved.

Organic Food Consumption during Pregnancy and Hypospadias and Cryptorchidism at Birth: The Norwegian Mother and Child Cohort Study (MoBa).

PubMed

Brantsæter, Anne Lise; Torjusen, Hanne; Meltzer, Helle Margrete; Papadopoulou, Eleni; Hoppin, Jane A; Alexander, Jan; Lieblein, Geir; Roos, Gun; Holten, Jon Magne; Swartz, Jackie; Haugen, Margaretha

2016-03-01

The etiologies of the male urogenital anomalies hypospadias and cryptorchidism remain unclear. It has been suggested that maternal diet and environmental contaminants may affect the risk of these anomalies via placental or hormonal disturbances. We examined associations between organic food consumption during pregnancy and prevalence of hypospadias and cryptorchidism at birth. Our study includes 35,107 women participating in the Norwegian Mother and Child Cohort Study (MoBa) who delivered a singleton male infant. Information about use of six groups of organically produced food (vegetables, fruit, bread/cereal, milk/dairy products, eggs, and meat) during pregnancy was collected by a food frequency questionnaire. Women who indicated that they sometimes, often, or mostly consumed organic foods in at least one of the six food groups were classified as organic food consumers in analyses. Hypospadias and cryptorchidism diagnoses were retrieved from the Medical Birth Registry of Norway. We estimated odds ratios (ORs) and 95% confidence intervals (CIs) using multiple logistic regression. Seventy-four male newborns were diagnosed with hypospadias (0.2%), and 151 with cryptorchidism (0.4%). Women who consumed any organic food during pregnancy were less likely to give birth to a boy with hypospadias (OR = 0.42; 95% CI: 0.25, 0.70, based on 21 exposed cases) than women who reported they never or seldom consumed organic food. Associations with specific organic foods were strongest for vegetable (OR = 0.36; 95% CI: 0.15, 0.85; 10 exposed cases) and milk/dairy (OR = 0.43; 95% CI: 0.17, 1.07; 7 exposed cases) consumption. No substantial association was observed for consumption of organic food and cryptorchidism. Consumption of organically produced foods during pregnancy was associated with a lower prevalence of hypospadias in our study population. These findings were based on small numbers of cases and require replication in other study populations.

Lacertus Fibrosus Versus Achilles Allograft Reconstruction for Distal Biceps Tears: A Biomechanical Study.

PubMed

Murthi, Anand M; Ramirez, Miguel A; Parks, Brent G; Carpenter, Shannon R

2017-12-01

The bicipital aponeurosis, or lacertus fibrosus, can potentially be used as a reconstruction graft in chronic distal biceps tendon tears. To evaluate construct stiffness, load to failure, and failure mechanism with lacertus fibrosus versus Achilles allograft for distal biceps tendon reconstruction. Controlled laboratory study. Ten fresh-frozen matched cadaveric pairs of elbows were used. Three centimeters of the distal biceps tendon was resected. Specimens were randomized to the lacertus fibrosus or Achilles tendon group. In one group, the lacertus fibrosus was released from its distal attachment and then tubularized and repaired intraosseously to the radius. In the other group, an Achilles tendon graft was sutured to the biceps muscle and repaired to the ulna. The prepared radii were rigidly mounted at a 45° angle on a load frame. The proximal biceps muscle was secured in a custom-fabricated cryogenic grip. Displacement was measured using a differential variable reluctance transducer mounted at the radius-soft tissue junction and in the muscle- or muscle allograft-tissue junction proximal to the repair. Specimens were loaded at 20 mm/min until failure, defined as a 3-mm displacement at the radius-soft tissue junction. No significant difference was found in mean load to failure between the lacertus fibrosus and Achilles tendon group (mean ± SD, 20.2 ± 5.5 N vs 16.89 ± 4.54 N; P = .18). Stiffness also did not differ significantly between the lacertus fibrosus and Achilles tendon group (12.3 ± 7.1 kPa vs 10.5 ± 5.7 kPa; P = .34). The primary mode of failure in the lacertus fibrosus group was suture pullout from the tissue at the musculotendinous junction (7 of 10). In the Achilles group, failures were observed at the muscle-allograft interface (3) and the allograft-bone (radial tuberosity) interface (3), and 3 suture failures were observed. The button fixation did not fail in any specimens. The mean stiffness and load-to-failure values were not significantly different between a lacertus fibrosus construct and Achilles tendon allograft. Use of the lacertus fibrosus may be a potential alternative to Achilles tendon allograft reconstruction of chronic distal biceps tears when primary repair is not possible.

[Urethroplasty with transection of urethral orifice and preservation and lengthening of urethral plate: highly applicable to the treatment of hypospadias].

PubMed

Wang, Wen-Min; Qiu, Wei-Feng; Qian, Chong

2010-07-01

To explore the feasibility of urethroplasty with transection of the urethral orifice and preservation and lengthening of the urethral plate in the treatment of hypospadias. Forty-eight patients with hypospadias (18 of the coronal type, 21 the penile type, 8 the penoscrotal type and 1 the perineal type) underwent urethroplasty with transection of the urethral orifice and preservation and lengthening of the urethral plate. The surgical effects were observed by following up the patients for 3-27 months. One-stage surgical success was achieved in 44 of the cases, with satisfactory functional and cosmetic results but no complications. Two cases developed urinary fistula and another 2 urethral stricture, but all cured by the second surgery. Urethroplasty with transection of the urethral orifice and preservation and lengthening of the urethral plate is a simple, safe and effective surgical procedure for the treatment of hypospadias.

Proximity to AGCT sequences dictates MMR-independent versus MMR-dependent mechanisms for AID-induced mutation via UNG2

PubMed Central

Thientosapol, Eddy Sanchai; Sharbeen, George; Lau, K.K. Edwin; Bosnjak, Daniel; Durack, Timothy; Stevanovski, Igor; Weninger, Wolfgang

2017-01-01

Abstract AID deaminates C to U in either strand of Ig genes, exclusively producing C:G/G:C to T:A/A:T transition mutations if U is left unrepaired. Error-prone processing by UNG2 or mismatch repair diversifies mutation, predominantly at C:G or A:T base pairs, respectively. Here, we show that transversions at C:G base pairs occur by two distinct processing pathways that are dictated by sequence context. Within and near AGCT mutation hotspots, transversion mutation at C:G was driven by UNG2 without requirement for mismatch repair. Deaminations in AGCT were refractive both to processing by UNG2 and to high-fidelity base excision repair (BER) downstream of UNG2, regardless of mismatch repair activity. We propose that AGCT sequences resist faithful BER because they bind BER-inhibitory protein(s) and/or because hemi-deaminated AGCT motifs innately form a BER-resistant DNA structure. Distal to AGCT sequences, transversions at G were largely co-dependent on UNG2 and mismatch repair. We propose that AGCT-distal transversions are produced when apyrimidinic sites are exposed in mismatch excision patches, because completion of mismatch repair would require bypass of these sites. PMID:28039326

Laparoscopic repair of indirect inguinal hernia in children: does partial resection of the sac make any impact on outcome?

PubMed

Borkar, Nitinkumar B; Pant, Nitin; Ratan, Simmi; Aggarwal, Satish K

2012-04-01

To test the hypothesis that during laparoscopic hernia repair, partial resection of the distal sac along with suture ligation of the neck is better than simple transection and ligation. The following two techniques of laparoscopic hernia repair were compared: Group I, circumferential incision of peritoneum at the deep ring and partial resection of the distal sac and suture ligation at the neck; versus Group II, circumferential incision of the peritoneum at the deep ring and suture ligation at the neck. Twenty-five cases of inguinal hernia were randomly selected in each group between the age group of 6 months to 12 years. The outcome measures were recurrence, intra- or postoperative complications, and time taken for surgery. There were no recurrences in either group. Other parameters for comparison were also not statistically different between the two groups. There was no conversion. Although partial resection of the sac has been an essential step in open hernia repair over five decades, its value has been questioned by our study, because omitting this step during laparoscopic repair has not adversely affected the outcomes. Partial resection of the sac is not a necessary component of hernia repair. It is a technical necessity of the open approach. Therefore, omitting this step in laparoscopic repair does not adversely affect the outcome.

Efficacy of Low Level Laser Therapy After Hand Flexor Tendon Repair

DOE Office of Scientific and Technical Information (OSTI.GOV)

Ayad, K. E.; Abd El Mejeed, S. F.; El Gohary, H. M.

Flexor tendon injury is a common problem requiring suturing repair followed by early postoperative mobilization. Muscle atrophy, joint stiffness, osteoarthritis, infection, skin necrosis, ulceration of joint cartilage and tendocutaneous adhesion are familiar complications produced by prolonged immobilization of surgically repaired tendon ruptures. The purpose of this study was to clarify the importance of low level laser therapy after hand flexor tendon repair in zone II. Thirty patients aging between 20 and 40 years were divided into two groups. Patients in group A (n = 15) received a conventional therapeutic exercise program while patients in group B (n = 15) receivedmore » low level laser therapy combined with the same therapeutic exercise program. The results showed a statistically significant increase in total active motion of the proximal and distal interphalangeal joints as well as maximum hand grip strength at three weeks and three months postoperative, but improvement was more significant in group B. It was concluded that the combination of low level laser therapy and early therapeutic exercises was more effective than therapeutic exercises alone in improving total active motion of proximal and distal interphalangeal joints and hand grip strength after hand flexor tendon repair.« less

Distal re-entry closure with neobranching technique after thoracic endovascular aortic repair of Type B aortic dissection.

PubMed

Yamamoto, Masaki; Fukutomi, Takashi; Noguchi, Tatsuya; Orihashi, Kazumasa

2018-04-01

Retrograde false-lumen flow after thoracic endovascular aortic repair of Type B aortic dissection occurs occasionally and may have a negative impact on aortic remodelling and even prevent the decompression of the false lumen. A 67-year-old man with a Type B aortic dissection underwent thoracic endovascular aortic repair for severe compression of the true lumen and visceral malperfusion 7 weeks after the onset. Intraoperative angiography revealed proximal entry tear closure, but the false-lumen flow increased because of retrograde flow through the re-entry tear. Additional intervention including re-entry tear closure was performed with a neobranching technique with covered stent placement in the visceral artery from the aortic true lumen through the distal re-entry tear. We report a case of Type B aortic dissection and discuss the surgical techniques used.

Large Extremity Peripheral Nerve Repair

DTIC Science & Technology

2016-12-01

Corp., Rock- ville, Md.); and then baked overnight in a 60°C oven. Using a diamond blade, 1-μm sections were cut 5 mm proximal and 5 mm distal to the...Epoxy resin (Tousimis Research Corpora- tion, Rockville, MD), and then baked overnight in a 60°C oven. From each proximal and distal end, 1 µm

Organic Food Consumption during Pregnancy and Hypospadias and Cryptorchidism at Birth: The Norwegian Mother and Child Cohort Study (MoBa)

PubMed Central

Brantsæter, Anne Lise; Torjusen, Hanne; Meltzer, Helle Margrete; Papadopoulou, Eleni; Hoppin, Jane A.; Alexander, Jan; Lieblein, Geir; Roos, Gun; Holten, Jon Magne; Swartz, Jackie; Haugen, Margaretha

2015-01-01

Background The etiologies of the male urogenital anomalies hypospadias and cryptorchidism remain unclear. It has been suggested that maternal diet and environmental contaminants may affect the risk of these anomalies via placental or hormonal disturbances. Objectives We examined associations between organic food consumption during pregnancy and prevalence of hypospadias and cryptorchidism at birth. Methods Our study includes 35,107 women participating in the Norwegian Mother and Child Cohort Study (MoBa) who delivered a singleton male infant. Information about use of six groups of organically produced food (vegetables, fruit, bread/cereal, milk/dairy products, eggs, and meat) during pregnancy was collected by a food frequency questionnaire. Women who indicated that they sometimes, often, or mostly consumed organic foods in at least one of the six food groups were classified as organic food consumers in analyses. Hypospadias and cryptorchidism diagnoses were retrieved from the Medical Birth Registry of Norway. We estimated odds ratios (ORs) and 95% confidence intervals (CIs) using multiple logistic regression. Results Seventy-four male newborns were diagnosed with hypospadias (0.2%), and 151 with cryptorchidism (0.4%). Women who consumed any organic food during pregnancy were less likely to give birth to a boy with hypospadias (OR = 0.42; 95% CI: 0.25, 0.70, based on 21 exposed cases) than women who reported they never or seldom consumed organic food. Associations with specific organic foods were strongest for vegetable (OR = 0.36; 95% CI: 0.15, 0.85; 10 exposed cases) and milk/dairy (OR = 0.43; 95% CI: 0.17, 1.07; 7 exposed cases) consumption. No substantial association was observed for consumption of organic food and cryptorchidism. Conclusions Consumption of organically produced foods during pregnancy was associated with a lower prevalence of hypospadias in our study population. These findings were based on small numbers of cases and require replication in other study populations. Citation Brantsæter AL, Torjusen H, Meltzer HM, Papadopoulou E, Hoppin JA, Alexander J, Lieblein G, Roos G, Holten JM, Swartz J, Haugen M. 2016. Organic food consumption during pregnancy and hypospadias and cryptorchidism at birth: the Norwegian Mother and Child Cohort Study (MoBa). Environ Health Perspect 124:357–364; http://dx.doi.org/10.1289/ehp.1409518 PMID:26307850

Variation spatiotemporelle de la cryptorchidie et de l’hypospadias au Québec : Une étude exploratoire

PubMed Central

Guertin, Sophie; Lemieux, Karine-Sylvie; Makhoulian, Natalie; Michaud, Sébastien; Patry, Rose-Marie; Côté, Anne-Andrée; Gagnon, Fabien; Ayotte, Pierre; Bolduc, Stéphane

2011-01-01

Résumé Objectifs : La majorité des études effectuées au cours des dernières décennies ont mis en évidence une augmentation du nombre de cas de cryptorchidie et d’hypospadias entre 1970 et 1990. De plus, l’importante variabilité géographique de ces anomalies est bien décrite. Cette étude vise à mesurer la prévalence à la naissance de la cryptorchidie et de l’hypospadias au Québec, à vérifier si ces anomalies sont en augmentation et à en évaluer la répartition interrégionale. Méthode : Une étude épidémiologique descriptive a été réalisée à partir du nombre de garçons de cinq ans et moins hospitalisés pour une cryptorchidie ou un hypospadias au Québec de 1989 à 2004 selon les données du fichier administratif d’hospitalisation MED-ÉCHO. Les données sur les naissances provenaient de l’Institut de la statistique du Québec. Résultats : La prévalence annuelle moyenne pour 1000 naissances vivantes de sexe masculin est de 19,1 (IC à 95 % : 18,8–19,4) pour la cryptorchidie et 11,4 (IC à 95 % 11,1–11,6) pour l’hypospadias au Québec. Au cours de la période étudiée, la prévalence de cryptorchidie a légèrement diminué, alors que celle de l’hypospadias est demeurée stable. Comparativement à la province du Québec, des régions présentent une prévalence significativement différente de cryptorchidie et/ou d’hypospadias. . Conclusion : Au Québec, la prévalence de cryptorchidie est en légère diminution alors que celle de l’hypospadias est stable. Des variations régionales significatives sont observables. D’autres études sont nécessaires afin d’évaluer l’hypothèse d’un lien avec les contaminants environnementaux en émergence. L’implantation d’un système de surveillance des anomalies congénitales permettrait une représentation plus valide de la situation. PMID:21672476

Variation spatiotemporelle de la cryptorchidie et de l'hypospadias au Québec : Une étude exploratoire.

PubMed

Guertin, Sophie; Lemieux, Karine-Sylvie; Makhoulian, Natalie; Michaud, Sébastien; Patry, Rose-Marie; Côté, Anne-Andrée; Gagnon, Fabien; Ayotte, Pierre; Bolduc, Stéphane

2011-06-01

RéSUMé: : La majorité des études effectuées au cours des dernières décennies ont mis en évidence une augmentation du nombre de cas de cryptorchidie et d'hypospadias entre 1970 et 1990. De plus, l'importante variabilité géographique de ces anomalies est bien décrite. Cette étude vise à mesurer la prévalence à la naissance de la cryptorchidie et de l'hypospadias au Québec, à vérifier si ces anomalies sont en augmentation et à en évaluer la répartition interrégionale. MéTHODE :: Une étude épidémiologique descriptive a été réalisée à partir du nombre de garçons de cinq ans et moins hospitalisés pour une cryptorchidie ou un hypospadias au Québec de 1989 à 2004 selon les données du fichier administratif d'hospitalisation MED-ÉCHO. Les données sur les naissances provenaient de l'Institut de la statistique du Québec. RéSULTATS :: La prévalence annuelle moyenne pour 1000 naissances vivantes de sexe masculin est de 19,1 (IC à 95 % : 18,8-19,4) pour la cryptorchidie et 11,4 (IC à 95 % 11,1-11,6) pour l'hypospadias au Québec. Au cours de la période étudiée, la prévalence de cryptorchidie a légèrement diminué, alors que celle de l'hypospadias est demeurée stable. Comparativement à la province du Québec, des régions présentent une prévalence significativement différente de cryptorchidie et/ou d'hypospadias. . : Au Québec, la prévalence de cryptorchidie est en légère diminution alors que celle de l'hypospadias est stable. Des variations régionales significatives sont observables. D'autres études sont nécessaires afin d'évaluer l'hypothèse d'un lien avec les contaminants environnementaux en émergence. L'implantation d'un système de surveillance des anomalies congénitales permettrait une représentation plus valide de la situation.

Is approximated de-epithelized glanuloplasty beneficial for hypospadiologist?

PubMed

ZakiEldahshoury, M; Gamal, W; Salem, E; Rashed, E; Mamdouh, A

2016-05-01

Further evaluation of the cosmetic and functional results of approximated de-epithelized glanuloplasty in different degree of hypospadias. 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. 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. 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. Copyright © 2015 AEU. Publicado por Elsevier España, S.L.U. All rights reserved.

Simultaneous bilateral distal biceps tendon ruptures repaired using an endobutton technique: a case report

PubMed Central

2013-01-01

Introduction The simultaneous rupture of both distal biceps tendons is a rare clinical entity that is difficult to treat and can have poor outcomes. A variety of treatment and rehabilitation options exist and have been reported for single sided and staged bilateral repairs, but none have described an approach for acute bilateral ruptures. Repairing distal biceps tendon ruptures using a single anterior incision and a cortical suspensory button technique has become increasingly popular in recent years. We present a report of our surgical approach using an endobutton technique and rehabilitation algorithm for this unusual injury pattern. Case presentation A 43-year-old Caucasian man presented with acute onset bilateral elbow pain while lifting a large sheet of drywall off the ground. He initially felt a ‘pop’ on the right and almost immediately felt another on the left after having to quickly shift the weight. He was unable to continue working and sought medical attention. His pain was predominantly in his bilateral antecubital fossae and he had significant swelling and ecchymoses. His clinical examination demonstrated no palpable tendon, a retracted biceps muscle belly, and clear supination weakness. Magnetic resonance imaging was performed and showed bilateral distal biceps tendon ruptures with retraction on both sides. After discussion with our patient, we decided that both sides would be repaired using a single anterior incision with endobutton fixation, first his right followed by his left six weeks later. Conclusion Overall, our patient did very well and had returned to full manual work by our last follow-up at 30 months. Although he was never able to return to competitive recreational hockey and was left with mild lateral antebrachial cutaneous nerve dysesthesias on his right, he felt he was at 85% of his premorbid level of function. We describe what we believe to be, to the best of our knowledge, the first case of simultaneous bilateral distal biceps tendon ruptures successfully treated with a single-incision endobutton technique, which represents a valid option in managing this difficult problem. PMID:23972255

Penile hair tourniquet resulting in hypospadias failure

PubMed Central

Jesus, Lisieux E.; Bragança, Jailma J.; Rocha, Julia M.; Dekermacher, Samuel; Anderson, Kleber M.

2014-01-01

Penile hair tourniquet (PHT) is a painless form of penile ischemia, typically seen in toddlers with long-haired mothers, caused by entanglement of hair on the balano-prepucial sulcus, normally associated with circumcision. Its association with hypospadias has been reported only once. A school-aged boy admitted for surgery to treat hypospadias failure was incidentally detected to have PHT and severe hourglass deformity of the penis. Urethral anastomosis and glanuloplasty were done after removal of the constricting ring, without complications. Normal erections were reported during follow up. Treatment may involve urethral reconstruction and penile reimplantation in extreme cases. PMID:25097325

Molecular basis of non-syndromic hypospadias: systematic mutation screening and genome-wide copy-number analysis of 62 patients.

PubMed

Kon, M; Suzuki, E; Dung, V C; Hasegawa, Y; Mitsui, T; Muroya, K; Ueoka, K; Igarashi, N; Nagasaki, K; Oto, Y; Hamajima, T; Yoshino, K; Igarashi, M; Kato-Fukui, Y; Nakabayashi, K; Hayashi, K; Hata, K; Matsubara, Y; Moriya, K; Ogata, T; Nonomura, K; Fukami, M

2015-03-01

What percentage of cases with non-syndromic hypospadias can be ascribed to mutations in known causative/candidate/susceptibility genes or submicroscopic copy-number variations (CNVs) in the genome? Monogenic and digenic mutations in known causative genes and cryptic CNVs account for >10% of cases with non-syndromic hypospadias. While known susceptibility polymorphisms appear to play a minor role in the development of this condition, further studies are required to validate this observation. Fifteen causative, three candidate, and 14 susceptible genes, and a few submicroscopic CNVs have been implicated in non-syndromic hypospadias. Systematic mutation screening and genome-wide copy-number analysis of 62 patients. The study group consisted of 57 Japanese and five Vietnamese patients with non-syndromic hypospadias. Systematic mutation screening was performed for 25 known causative/candidate/susceptibility genes using a next-generation sequencer. Functional consequences of nucleotide alterations were assessed by in silico assays. The frequencies of polymorphisms in the patient group were compared with those in the male general population. CNVs were analyzed by array-based comparative genomic hybridization and characterized by fluorescence in situ hybridization. Seven of 62 patients with anterior or posterior hypospadias carried putative pathogenic mutations, such as hemizygous mutations in AR, a heterozygous mutation in BNC2, and homozygous mutations in SRD5A2 and HSD3B2. Two of the seven patients had mutations in multiple genes. We did not find any rare polymorphisms that were abundant specifically in the patient group. One patient carried mosaic dicentric Y chromosome. The patient group consisted solely of Japanese and Vietnamese individuals and clinical and hormonal information of the patients remained rather fragmentary. In addition, mutation analysis focused on protein-altering substitutions. Our data provide evidence that pathogenic mutations can underlie both mild and severe hypospadias and that HSD3B2 mutations cause non-syndromic hypospadias as a sole clinical manifestation. Most importantly, this is the first report documenting possible oligogenicity of non-syndromic hypospadias. This study was funded by the Grant-in-Aid from the Ministry of Education, Culture, Sports, Science and Technology; by the Grant-in-Aid from the Japan Society for the Promotion of Science; by the Grants from the Ministry of Health, Labour and Welfare, from the National Center for Child Health and Development and from the Takeda Foundation. The authors have no competing interests to disclose. Not applicable. © The Author 2015. Published by Oxford University Press on behalf of the European Society of Human Reproduction and Embryology. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

Short frontal plane fractures involving the dorsoproximal articular surface of the proximal phalanx: Description of the injury and a technique for repair.

PubMed

Wright, I M; Minshall, G J

2018-01-01

Chip fractures of the dorsoproximal articular margin of the proximal phalanx are common injuries in racehorses. Large fractures can extend distal to the joint capsule insertion and have been described as dorsal frontal fractures. To report the location and morphology of short frontal plane fractures involving the dorsoproximal articular surface of the proximal phalanx and describe a technique for repair under arthroscopic and radiographic guidance. Single centre retrospective case study. Case records of horses with frontal plane fractures restricted to the dorsoproximal epiphysis and metaphysis of the proximal phalanx referred to Newmarket Equine Hospital were retrieved, images reviewed and lesion morphology described. A technique for repair and the results obtained are reported. A total of 22 fractures in 21 horses commencing at the proximal articular surface exited the dorsal cortex of the proximal phalanx distal to the metacarpophalangeal/metatarsophalangeal joint capsule in 17 hind- and five forelimbs. All were in Thoroughbred racehorses. In 16 cases these were acute racing or training injuries; 20 fractures were medial, one lateral and one was midline. All were repaired with a single lag screw using arthroscopic and radiographically determined landmarks. A total of 16 horses raced after surgery with performance data similar to their preinjury levels. The study demonstrates substantial morphological similarities between individual lesions supporting a common pathophysiology, but does not identify precise causation. There are no cases managed differently that might permit assessment of the comparative efficacy of the treatment described. Short frontal plane fractures involving the dorsoproximal margin of the proximal phalanx that exit the bone distal to the metacarpophalangeal/metatarsophalangeal joint capsule have substantial morphological similarities, are amenable to minimally invasive repair and carry a good prognosis for return to training and racing. © 2017 EVJ Ltd.

Surgical Exposure to Control the Distal Internal Carotid Artery at the Base of the Skull during Carotid Aneurysm Repair.

PubMed

Davis, Laura; Zeitouni, Anthony; Makhoul, Nicholas; Steinmetz, Oren K

2016-07-01

Extracranial carotid artery aneurysms are rare. Treatment options for these lesions include endovascular interventions, such as coiling and stenting, or surgical reconstruction, such as resection and primary reanastomosis, or interposition bypass grafting. In this report, we describe the surgical technique used to perform surgical repair of an internal carotid artery aneurysm extending up to the base of the skull. Anterior exposure of the infratemporal fossa and distal control of the carotid artery at the level of the carotid canal was achieved through a transcervical approach, performing double mandibular osteotomies with superior reflection of the middle mandibular section. Copyright © 2016 Elsevier Inc. All rights reserved.

The Provisional Extension To Induce Complete Attachment (PETTICOAT) technique to promote distal aortic remodelling in repair of acute DeBakey type I aortic dissection: preliminary results.

PubMed

Hsu, Hung-Lung; Chen, Yin-Yin; Huang, Chun-Yang; Huang, Jih-Hsin; Chen, Jer-Shen

2016-07-01

To report our preliminary results of an aggressive technique, the Provisional Extension To Induce Complete Attachment (PETTICOAT), in repair of acute DeBakey type I aortic dissection. From April 2014 to November 2014, 18 patients with acute DeBakey type I aortic dissection were reviewed retrospectively. Nine patients underwent open repair combined with proximal stent grafting and distal bare stenting (PETTICOAT group). For comparison, another 9 patients underwent open repair combined with proximal stent grafting (NON-PETTICOAT group) were included. Open repair entailed ascending aorta plus total arch replacement under circulatory arrest, with variable aortic root work. Mortality and morbidity were recorded, and computed tomography was performed to evaluate the aortic remodelling at 6 months postoperatively. Preoperative parameters were similar. In the PETTICOAT group, one early mortality was noted. One complication of cardiac tamponade and sternal wound infection led to reopen surgeries. In the NON-PETTICOAT group, one case of transient ischaemic attack took place. Compared with the NON-PETTICOAT group, a significant increase in diameter of true lumen (median, 0.6 vs 0.1 mm, P < 0.01) and a decrease in diameter of false lumen (FL; median, -0.9 vs 0.0 mm, P < 0.01) at the level of lowest renal artery were noted in the PETTICOAT group. Moreover, significant FL volume regression (median, -102.0 vs -42.2 mm(3), P = 0.03) was observed in the PETTICOAT group. More cases of total thrombosis or regression of FL down to the level of renal artery were also noted in the PETTICOAT group (5/8 vs 0/9, P < 0.01). Two patients of the NON-PETTICOAT group received endovascular distal aortic reintervention at 6 months. The PETTICOAT technique in the management of acute DeBakey type I dissection is a feasible and promising method to promote distal aortic remodelling. However, outcomes are preliminary and further follow-up is required. © The Author 2016. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.

Augmentation of Distal Biceps Repair With an Acellular Dermal Graft Restores Native Biomechanical Properties in a Tendon-Deficient Model.

PubMed

Conroy, Christine; Sethi, Paul; Macken, Craig; Wei, David; Kowalsky, Marc; Mirzayan, Raffy; Pauzenberger, Leo; Dyrna, Felix; Obopilwe, Elifho; Mazzocca, Augustus D

2017-07-01

The majority of distal biceps tendon injuries can be repaired in a single procedure. In contrast, complete chronic tears with severe tendon substance deficiency and retraction often require tendon graft augmentation. In cases with extensive partial tears of the distal biceps, a human dermal allograft may be used as an alternative to restore tendon thickness and biomechanical integrity. Dermal graft augmentation will improve load to failure compared with nonaugmented repair in a tendon-deficient model. Controlled laboratory study. Thirty-six matched specimens were organized into 1 of 4 groups: native tendon, native tendon with dermal graft augmentation, tendon with an attritional defect, and tendon with an attritional defect repaired with a graft. To mimic a chronic attritional biceps lesion, a defect was created by a complete tear, leaving 30% of the tendon's width intact. The repair technique in all groups consisted of cortical button and interference screw fixation. All specimens underwent cyclical loading for 3000 cycles and were then tested to failure; gap formation and peak load at failure were documented. The mean (±SD) load to failure (320.9 ± 49.1 N vs 348.8 ± 77.6 N, respectively; P = .38) and gap formation (displacement) (1.8 ± 1.4 mm vs 1.6 ± 1.1 mm, respectively; P = .38) did not differ between the native tendon groups with and without graft augmentation. In the tendon-deficient model, the mean load to failure was significantly improved with graft augmentation compared with no graft augmentation (282.1 ± 83.8 N vs 199.7 ± 45.5 N, respectively; P = .04), while the mean gap formation was significantly reduced (1.2 ± 1.0 mm vs 2.7 ± 1.4 mm, respectively; P = .04). The mean load to failure of the deficient tendon with graft augmentation (282.1 N) compared with the native tendon (348.8 N) was not significantly different ( P = .12). This indicates that the native tendon did not perform differently from the grafted deficient tendon. In a tendon-deficient, complete distal biceps rupture model, acellular dermal allograft augmentation restored the native tendon's biomechanical properties at time zero. The grafted tissue-deficient model demonstrated no significant differences in the load to failure and gap formation compared with the native tendon. As expected, dermal augmentation of attritional tendon repair increased the load to failure and stiffness as well as decreased displacement compared with the ungrafted tissue-deficient model. Tendons with their native width showed no statistical difference or negative biomechanical consequences of dermal augmentation. Dermal augmentation of the distal biceps is a biomechanically feasible option for patients with an attritionally thinned-out tendon.

DNA Damage Response Factors from Diverse Pathways, Including DNA Crosslink Repair, Mediate Alternative End Joining

PubMed Central

Howard, Sean M.; Yanez, Diana A.; Stark, Jeremy M.

2015-01-01

Alternative end joining (Alt-EJ) chromosomal break repair involves bypassing classical non-homologous end joining (c-NHEJ), and such repair causes mutations often with microhomology at the repair junction. Since the mediators of Alt-EJ are not well understood, we have sought to identify DNA damage response (DDR) factors important for this repair event. Using chromosomal break reporter assays, we surveyed an RNAi library targeting known DDR factors for siRNAs that cause a specific decrease in Alt-EJ, relative to an EJ event that is a composite of Alt-EJ and c-NHEJ (Distal-EJ between two tandem breaks). From this analysis, we identified several DDR factors that are specifically important for Alt-EJ relative to Distal-EJ. While these factors are from diverse pathways, we also found that most of them also promote homologous recombination (HR), including factors important for DNA crosslink repair, such as the Fanconi Anemia factor, FANCA. Since bypass of c-NHEJ is likely important for both Alt-EJ and HR, we disrupted the c-NHEJ factor Ku70 in Fanca-deficient mouse cells and found that Ku70 loss significantly diminishes the influence of Fanca on Alt-EJ. In contrast, an inhibitor of poly ADP-ribose polymerase (PARP) causes a decrease in Alt-EJ that is enhanced by Ku70 loss. Additionally, the helicase/nuclease DNA2 appears to have distinct effects from FANCA and PARP on both Alt-EJ, as well as end resection. Finally, we found that the proteasome inhibitor Bortezomib, a cancer therapeutic that has been shown to disrupt FANC signaling, causes a significant reduction in both Alt-EJ and HR, relative to Distal-EJ, as well as a substantial loss of end resection. We suggest that several distinct DDR functions are important for Alt-EJ, which include promoting bypass of c-NHEJ and end resection. PMID:25629353

Maternal Medication and Herbal Use and Risk for Hypospadias: Data from the National Birth Defects Prevention Study, 1997--2007

PubMed Central

Lind, Jennifer N.; Tinker, Sarah C.; Broussard, Cheryl S.; Reefhuis, Jennita; Carmichael, Suzan L.; Honein, Margaret A.; Olney, Richard S.; Parker, Samantha E.; Werler, Martha M.

2014-01-01

Purpose Investigate associations between maternal use of common medications and herbals during early pregnancy and risk for hypospadias in male infants. Methods We used data from the National Birth Defects Prevention Study, a multi-site, population-based, case-control study. We analyzed data from 1,537 infants with second-or third-degree isolated hypospadias and 4,314 liveborn male control infants without major birth defects, with estimated dates of delivery from 1997–2007. Exposure was reported use of prescription or over-the-counter medications or herbal products, from 1 month before to 4 months after conception. Adjusted odds ratios (aORs) and 95% confidence intervals (CI) were estimated using multivariable logistic regression, adjusting for maternal age, race/ethnicity, education, pre-pregnancy BMI, previous live births, maternal sub-fertility, study site, and year. Results We assessed 64 medication and 24 herbal components. Maternal uses of most components were not associated with an increased risk of hypospadias. Two new associations were observed for venlafaxine (aOR 2.4; 95% CI 1.0, 6.0) and progestin only oral contraceptives (aOR 1.9, 95% CI 1.1, 3.2). The previously reported association for clomiphene citrate was confirmed (aOR 1.9, 95% CI 1.2, 3.0). Numbers were relatively small for exposure to other specific patterns of fertility agents, but elevated aORs were observed for the most common of them. Conclusions Overall, findings were reassuring that hypospadias is not associated with most medication components examined in this analysis. New associations will need to be confirmed in other studies. Increased risks for hypospadias associated with various fertility agents raises the possibility of confounding by underlying subfertility. PMID:23620412

Prenatal Anogenital Distance Is Shorter in Fetuses With Hypospadias.

PubMed

Gilboa, Yinon; Perlman, Sharon; Kivilevitch, Zvi; Messing, Baruch; Achiron, Reuven

2017-01-01

Recent research provides evidence that anogenital distance may serve as a novel metric to assess reproductive potential in men. In children, a shorter anogenital distance was linked with cryptorchidism, hypospadias, and micropenis. Scarce data exist in the literature regarding anogenital distance measurement in the fetus. The aim of our study was to assess whether intrauterine measurement of fetal anogenital distance could assist in the differential diagnosis of male genital anomalies. Anogenital distance was prospectively measured in all cases referred for suspected isolated abnormal male genitalia. Final diagnoses, confirmed by a pediatric urologist, were compared with anogenital distance prenatal measurements. Fifty-two cases were referred for evaluation because of suspected male external genital malformation during a 12-month period. Cases with normal-appearing genitalia, associated major malformations, and early severe fetal growth restriction were excluded from the study. Postnatal examination revealed 14 cases of hypospadias in varying severity and 8 cases of a buried penis. All fetuses with hypospadias had an anogenital distance measurement below the fifth percentile. Statistical analysis revealed a significant difference between the normal mean anogenital distance for gestational age versus those with hypospadias (mean ± SD, 16.90 ± 4.08 and 11.68 ± 3.31 mm, respectively; P = .001). No significant difference was found between the normal mean anogenital distance for gestational age versus those with a buried penis (18.85 ± 2.76 and 19.46 ± 3.41 mm; P = .700). Fetuses with hypospadias have a statistically significant shorter anogenital distance compared with the general population. Therefore, anogenital distance may serve as a complementary objective sonographic parameter in the prenatal assessment and counseling of male external genital anomalies. © 2016 by the American Institute of Ultrasound in Medicine.

A Nested Case-Control Study of Intrauterine Exposure to Persistent Organochlorine Pollutants and the Risk of Hypospadias

PubMed Central

Rignell-Hydbom, Anna; Lindh, Christian H.; Dillner, Joakim; Jönsson, Bo A. G.; Rylander, Lars

2012-01-01

Background Environmental exposures to endocrine disrupting chemicals have been suggested as a risk factor for male genital abnormalities such as hypospadias. The aim of this case-control study was to investigate the association between fetal exposure to persistent organochlorine pollutants (POP) and the risk for hypospadias. Methodology/Principal Findings The Southern Sweden Maternity Cohort (SSMC) contains serum samples collected in early pregnancy among women in Southern Sweden. Linkages with the Medical Birth Register, the Malformation Register and the In-patient Register resulted in 390 SSMC mothers who had given birth to a boy with hypospadias in year 1986–2002 (mean 1995). For 237 of these (cases) sufficient amounts of serum for the chemical analyses were available. For each case, a control boy from the SSMC was randomly selected, matched for maternal age, birth year, parity and maternal smoking. PCB-153, p,p’-DDE and hexachlorbenzene (HCB) were used as biomarkers for POP exposure. The exposures were categorized into quartiles based on the distributions among the controls. There were no statistically significant trends between the a priori categorisation of the exposure variables and the risk for hypospadias. However, when the upper HCB quartile (>26 ng/ml) was compared to the other quartiles an odds ratio of 1.65 (95% CI 1.02 to 2.69) was obtained. p,p′-DDE levels above median (>1.0 ng/ml) compared to levels below 0.1 ng/ml gave an OR of 1.69 (95% CI 0.97 to 2.93). Conclusions The present study suggests that fetal exposure to HCB and p,p’-DDE may be a risk factor for hypospadias. PMID:23028613

Parents' experience of hospitalization: different strategies for feeling secure.

PubMed

Kristensson-Hallström, I; Elander, G

1997-01-01

Twenty parents of boys (ages 2-14 years) hospitalized for hypospadias repair in a pediatric surgery department in Sweden, were interviewed concerning their experience when their child was hospitalized. A qualitative analysis of the interviews indicated that the most important issue to the parents was finding security at the hospital. Parents manifested one of three different strategies that enabled them to feel secure at the hospital; (a) relinquishing the care of their children to the nursing staff; (b) obtaining a measure of control over their children's care; and (c) relying on knowing their child best. The parental strategy adopted to feel secure was found to correspond with the way parents experienced the hospitalization. Differences were found in their children's experiences of pain and the alleviation of the pain during the hospitalization.

Computational Embryology and Predictive Toxicology of Hypospadias (SOT)

EPA Science Inventory

Hypospadias, one of the most common birth defects in human male infants, is a condition in which the urethral opening is misplaced along ventral aspect of the penis. We developed an Adverse Outcome Pathway (AOP) framework and computer simulation that describes the pathogenesis of...

REHABILITATION OF A SURGICALLY REPAIRED RUPTURE OF THE DISTAL BICEPS TENDON IN AN ACTIVE MIDDLE AGED MALE: A CASE REPORT

PubMed Central

Sayers, Stephen P.; LaFontaine, Tom; Scheussler, Scott

2012-01-01

Background: Complete rupture of the distal tendon of the biceps brachii is relatively rare and there is little information to guide therapists in rehabilitation after this injury. The purposes of this case report are to review the rehabilitation concepts used for treating such an injury, and discuss how to modify exercises during rehabilitation based on patient progression while adhering to physician recommended guidelines and standard treatment protocols. Case Presentation: The patient was an active 38‐year old male experienced in weight‐training. He presented with a surgically repaired right distal biceps tendon following an accident on a trampoline adapted with a bungee suspension harness. The intervention focused on restoring range of motion and strengthening of the supporting muscles of the upper extremity without placing undue stress on the biceps brachii. Outcomes: The patient was able to progress from a moderate restriction in ROM to full AROM two weeks ahead of the physician's post‐operative orders and initiate a re‐strengthening protocol by the eighth week of rehabilitation. At the eighth post‐operative week the patient reported no deficits in functional abilities throughout his normal daily activities with his affected upper extremity. Discussion: The results of this case report strengthen current knowledge regarding physical therapy treatment for a distal biceps tendon repair while at the same time providing new insights for future protocol considerations in active individuals. Most current protocols do not advocate aggressive stretching, AROM, or strengthening of a surgically repaired biceps tendon early in the rehabilitation process due to the fear of a re‐rupture. In the opinion of the authors, if full AROM can be achieved before the 6th week of rehabilitation, initiating a slow transition into light strengthening of the biceps brachii may be possible. Level of evidence: 4‐Single Case report PMID:23316429

Microhomology-mediated end joining induces hypermutagenesis at breakpoint junctions

PubMed Central

Li, Fuyang; Villarreal, Diana; Shim, Jae Hoon; Myung, Kyungjae; Shim, Eun Yong; Lee, Sang Eun

2017-01-01

Microhomology (MH) flanking a DNA double-strand break (DSB) drives chromosomal rearrangements but its role in mutagenesis has not yet been analyzed. Here we determined the mutation frequency of a URA3 reporter gene placed at multiple locations distal to a DSB, which is flanked by different sizes (15-, 18-, or 203-bp) of direct repeat sequences for efficient repair in budding yeast. Induction of a DSB accumulates mutations in the reporter gene situated up to 14-kb distal to the 15-bp MH, but more modestly to those carrying 18- and 203-bp or no homology. Increased mutagenesis in MH-mediated end joining (MMEJ) appears coupled to its slower repair kinetics and the extensive resection occurring at flanking DNA. Chromosomal translocations via MMEJ also elevate mutagenesis of the flanking DNA sequences 7.1 kb distal to the breakpoint junction as compared to those without MH. The results suggest that MMEJ could destabilize genomes by triggering structural alterations and increasing mutation burden. PMID:28419093

Neodymium:yttrium-aluminum-garnet laser fusion of endarterectomy flaps.

PubMed

Humphrey, P W; Slocum, M M; Loy, T S; Silver, D

1995-07-01

This study evaluated the efficacy of neodymium:yttrium-aluminum-garnet laser welding of flaps in canine arteries and in securing the distal flap during human carotid endarterectomy. Endarterectomy flaps were created in both common carotid and both common femoral arteries in 12 dogs. The flaps were repaired with either the neodymium:yttrium-aluminum-garnet laser or with 6-0 polypropylene sutures. The arteries were removed after duplex scanning at either 7 or 28 days. Eighteen high carotid endarterectomy flaps in 16 patients have been subsequently secured with the laser welding technique. Laser repairs (125 +/- 19 joule) of the canine arteries were completed more quickly than suture repairs (mean 25 seconds vs 135 seconds, respectively; p < 0.04). Duplex ultrasonography revealed no discernable differences between the two groups of arteries. Arteries studied at 7 days revealed three microscopic flaps (two suture, one laser), more subintimal fibroblastic proliferation in suture than laser-repaired carotid arteries (3: 1, p = 0.0530), and similar amounts of inflammation in suture- and laser-repaired arteries. Arteries studied at 28 days revealed one microscopic intimal flap (suture-repaired); equal fibroblastic and inflammatory responses in suture- and laser-repaired vessels; and no evidence of laser thermal injury. Eighteen carotid endarterectomy flaps have been successfully fused with no immediate or long-term complications in 16 patients (follow-up of 0 to 24 months). Laser fusion appears to be a safe and effective method for securing distal carotid endarterectomy flaps.

Health effects among refrigeration repair workers exposed to fluorocarbons.

PubMed Central

Campbell, D D; Lockey, J E; Petajan, J; Gunter, B J; Rom, W N

1986-01-01

Refrigeration repair workers may be intermittently exposed to fluorocarbons and their thermal decomposition products. A case of peripheral neuropathy (distal axonopathy) in a commercial refrigeration repairman prompted an epidemiological investigation of the health of refrigeration repair workers. No additional cases of peripheral neuropathy were identified among the 27 refrigeration repair workers studied. A reference group of 14 non-refrigeration repair workers was also studied. No differences were noted between groups for the ulnar (motor and sensory), median (motor and sensory), peroneal, sural, or tibial nerve conduction velocities. Refrigeration repair workers reported palpitations and lightheadedness significantly more often than workers in the reference group. No clinical neurological or electroneurophysiological abnormalities were detected in eight refrigeration repair workers followed up for three years during continuous employment. PMID:3004555

Single-row versus double-row repair of the distal Achilles tendon: a biomechanical comparison.

PubMed

Pilson, Holly; Brown, Philip; Stitzel, Joel; Scott, Aaron

2012-01-01

Surgery for recalcitrant insertional Achilles tendinopathy often consists of partial or total release of the insertion site, debridement of the diseased portion of the tendon, calcaneal ostectomy, and reattachment of the Achilles to the calcaneus. Although single-row and double-row techniques exist for repair of the detached Achilles tendon, biomechanical data are lacking to support one technique over the other. Based on data extrapolated from the study of rotator cuff repairs, we hypothesized that a double-row construct would provide superior fixation strength over a single-row repair. Eighteen human cadaveric Achilles tendons (9 matched pairs) with attached calcanei were repaired with single-row or double-row techniques. Specimens were mounted in a servohydraulic materials testing machine, subjected to a preconditioning cycle, and loaded to failure. Failure was defined as suture breakage or pullout, midsubstance tendon rupture, or anchor pullout. Among the failures were 12 suture failures, 5 proximal-row anchor failures, and 1 distal-row anchor failure. No midsubstance tendon ruptures or testing apparatus failures were observed. There were no statistically significant differences in the peak load to failure between the single-row and double-row repairs (p = .46). Similarly, no significant differences were observed with regards to mean energy expenditure to failure (p = .069). The present study demonstrated no biomechanical advantages of the double-row repair over a single-row repair. Despite the lack of a clear biomechanical advantage, there may exist clinical advantages of a double-row repair, such as reduction in knot prominence and restoration of the Achilles footprint. Copyright © 2012 American College of Foot and Ankle Surgeons. Published by Elsevier Inc. All rights reserved.

Femoral fracture repair using a locking plate technique in an adult captive polar bear (Ursus maritimus).

PubMed

Zimmerman, Dawn M; Dew, Terry; Douglass, Michael; Perez, Edward

2010-02-01

To report successful femoral fracture repair in a polar bear. Case report. Female polar bear (Ursus maritimus) 5 years and approximately 250 kg. A closed, complete, comminuted fracture of the distal midshaft femur was successfully reduced and stabilized using a compression plating technique with 2 specialized human femur plates offering axial, rotational, and bending support, and allowing the bone to share loads with the implant. Postoperative radiographs were obtained at 11.5 weeks, 11 months, and 24 months. Bone healing characterized by marked periosteal reaction was evident at 11 months with extensive remodeling evident at 24 months. No complications were noted. Distal mid shaft femoral fracture was reduced, stabilized, and healed in an adult polar bear with a locking plate technique using 2 plates. Previously, femoral fractures in polar bears were considered irreparable. Use of 2 plates applied with a locking plate technique can result in successful fracture repair despite large body weight and inability to restrict postoperative activity.

Proposal for a Study of the Incidence and Occupational Distribution of Testicular Neoplasms in United States Air Force Personnel

DTIC Science & Technology

1988-04-01

anomalies (including duplication of the ureters, hypospadias and ectopic kidney) in 6%.(34) I. Pottern reports on 73 testicular cancer patients seen...urogenital anomalies such as hypospadias and ureteral duplication.( 5 2 ) Among 100 consecutive urograms performed on cryptorchid boys -. anomalies were

[Crypto-hypospadias: a new therapeutic approach].

PubMed

Ottolenghi, A; Belligoli, A

1984-01-01

The AA present 26 cases of crypto-hypospadias traited by different methods. Particularly they describe a new technique, suitable to avoid urethroplasty; it consists in a wide mobilization of the urethra as Koff (modified) and a plasty of the tunica albuginea on the dorsal aspect of the shaft as Nesbit (modified). The first results are much satisfactories.

BioCartilage Improves Cartilage Repair Compared With Microfracture Alone in an Equine Model of Full-Thickness Cartilage Loss.

PubMed

Fortier, Lisa A; Chapman, Hannah S; Pownder, Sarah L; Roller, Brandon L; Cross, Jessica A; Cook, James L; Cole, Brian J

2016-09-01

Microfracture (MFx) remains a dominant treatment strategy for symptomatic articular cartilage defects. Biologic scaffold adjuncts, such as particulated allograft articular cartilage (BioCartilage) combined with platelet-rich plasma (PRP), offer promise in improving clinical outcomes as an adjunct to MFx. To evaluate the safety, biocompatibility, and efficacy of BioCartilage and PRP for cartilage repair in a preclinical equine model of full-thickness articular cartilage loss. Controlled laboratory study. Two 10-mm-diameter full-thickness cartilage defects were created in 5 horses in the trochlear ridge of both knees: one proximal (high load) and another distal (low load). Complete blood counts were performed on each peripheral blood and resultant PRP sample. In each horse, one knee received MFx with BioCartilage + PRP, and the other knee received MFx alone. Horses were euthanized at 13 months. Outcomes were assessed with serial arthroscopy, magnetic resonance imaging (MRI), micro-computed tomography (micro-CT), and histology. Statistics were performed using a mixed-effects model with response variable contrasts. No complications occurred. PRP generated in all subjects yielded an increase in platelet fold of 3.8 ± 4.7. Leukocyte concentration decreased in PRP samples by an average fold change of 5 ± 0.1. The overall International Cartilage Repair Society repair score in both the proximal and distal defects was significantly higher (better) in the BioCartilage group compared with MFx (proximal BioCartilage: 7.4 ± 0.51, MFx 4.8 ± 0.1, P = .041; distal BioCartilage: 5.6 ± 0.98, MFx 2.6 ± 1.5, P = .022). BioCartilage-treated proximal defects demonstrated improved histologic scores for repair-host integration (BioCartilage, 96 ± 9; MFx, 68 ± 18; P = .02), base integration (BioCartilage, 100 ± 0; MFx, 70 ± 37; P = .04), and formation of collagen type II (BioCartilage, 82 ± 8; MFx, 58 ± 11; P = .05) compared with the positive control. On MRI, T2 relaxation time was significantly shorter (better) in the superficial region of BioCartilage-treated distal defects compared with MFx (P = .05). There were no significant differences between BioCartilage and MFx on micro-CT analysis. BioCartilage with PRP safely improved cartilage repair compared with MFx alone in an equine model of articular cartilage defects up to 13 months after implantation. The 1-year results of BioCartilage + PRP suggest that homologous allograft tissue provides a safe and effective augmentation of traditional MFx. © 2016 The Author(s).

Anatomic findings and complications after surgical treatment of chronic, partial distal biceps tendon tears: a case cohort comparison study.

PubMed

Ruch, David S; Watters, Tyler Steven; Wartinbee, Daniel A; Richard, Marc J; Leversedge, Fraser J; Mithani, Suhail K

2014-08-01

To describe pertinent anatomic findings during repair of chronic, partial distal biceps tendon tears and to compare the complications of surgery with a similar cohort of acute, complete tears. Group 1 included 14 patients (15 elbows) with partial tears managed operatively an average of 10 months from onset of injury or symptoms. Group 2 included a matched cohort of 16 patients (17 elbows) treated for complete, acute tears an average of 19 days from injury. A retrospective review of all 30 patients focused on demographic data, intraoperative findings, and postoperative complications. A single, anterior incision was used in all cases with multiple suture anchors or a bicortical toggling button for fixation of the repair. We evaluated 27 men and 3 women with an average age of 55 years (group 1) and 48 years (group 2). Intratendinous ganglion formation at the site of rupture of the degenerative tendon was observed in 5 cases of partial tears and none of the complete tears. Partial tears involved the lateral aspect or short head of the biceps tendon insertion in all cases. Postoperative complications included lateral antebrachial cutaneous nerve neuritis in 8 group 1 patients and 6 group 2 patients and transient posterior interosseus nerve palsy in 3 group 1 patients. Partial distal biceps tendon ruptures showed a consistent pattern of pathology involving disruption of the lateral side of the tendon insertion involving the small head of the biceps. Degenerative intratendinous ganglion formation was present in one third of cases. Repair of chronic, partial distal biceps tendon injuries may have a higher incidence of posterior interosseous and lateral antebrachial cutaneous nerve palsies. Therapeutic III. Copyright © 2014 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.

Open fenestration of the distal landing zone via a subxyphoid incision for subsequent endovascular repair of a dissecting thoracic aneurysm.

PubMed

Konings, Renske; de Bruin, Jorg L; Wisselink, Willem

2013-02-01

To describe a novel hybrid technique to address two challenges in endovascular repair of chronic dissecting thoracic aortic aneurysm (dTAA): obtaining an adequate seal of the stent-graft in a half-moon-shaped fibrotic aortic lumen and preserving flow into the distal true and false lumens. The technique is demonstrated in a 52-year-old man who presented with progressive asymptomatic dilatation of the thoracic aorta 9 years after undergoing a Bentall procedure for a Stanford type A dissection followed by arch replacement and elephant trunk construction. Imaging at this admission showed a 6.8-cm dissecting aneurysm extending distally to ∼4 cm above the celiac trunk; the dissection included both common iliac arteries. The patient refused a thoracotomy, so a hybrid procedure was devised to resect the intimal flap via a median subxyphoid incision and transperitoneal approach through the lesser sac. Two overlapping Zenith TX-2 stent-grafts were deployed into the elephant trunk, terminating just above the surgically created "flow divider" at the level of the celiac trunk. Imaging showed adequate sealing at both ends of the stent-graft and a type II endoleak that persisted into follow-up, but the aneurysm diameter decreased to 6.4 cm, and there was unobstructed flow into the visceral, renal, and iliac arteries. In this case of chronic dTAA, open surgical removal of a segment of the dissection flap via a subxyphoid incision provided a distal landing zone for subsequent endoluminal repair, with exclusion of the aneurysm and preservation of antegrade flow in both true and false lumens.

Celiac trunk embolization, as a means of elongating short distal descending thoracic aortic aneurysm necks, prior to endovascular aortic repair.

PubMed

Belenky, Alexander; Haddad, Menashe; Idov, Igor; Knizhnik, Michael; Litvin, Sergey; Bachar, Gil N; Atar, Eli

2009-09-01

The purpose of this study was to report our experience in elongating short distal necks of descending thoracic aortic aneurysms (DTAAs) by coil embolization of the celiac trunk prior to endovascular aneurysm repair (EVAR). During 6 years seven patients (five men and two women; mean age, 74) who had DTAAs with short distal necks unsuitable for conventional EVAR, and well patent superior and inferior mesenteric arteries based on CT, were treated in one session with EVAR after the celiac trunk was coil embolized to elongate the neck. All patients were followed by CT every 3 months in the first year and every 6 months thereafter. Technical success was achieved in all patients, and no early or late ischemic complications were noted. No procedural complications occurred and good aneurysm sealing was obtained in all patients. Three endoleaks were identified after 3 months (one patient) and 6 months (two patients); all were treated successfully with insertion of an additional stent-graft. In patients with DTAAs who are candidates for EVAR but have short aneurysm distal necks, celiac trunk embolization -- only if the superior and inferior mesenteric arteries are patent -- is a good and safe way to elongate the neck and enable EVAR.

Celiac Trunk Embolization, as a Means of Elongating Short Distal Descending Thoracic Aortic Aneurysm Necks, Prior to Endovascular Aortic Repair

DOE Office of Scientific and Technical Information (OSTI.GOV)

Belenky, Alexander; Haddad, Menashe; Idov, Igor

2009-09-15

The purpose of this study was to report our experience in elongating short distal necks of descending thoracic aortic aneurysms (DTAAs) by coil embolization of the celiac trunk prior to endovascular aneurysm repair (EVAR). During 6 years seven patients (five men and two women; mean age, 74) who had DTAAs with short distal necks unsuitable for conventional EVAR, and well patent superior and inferior mesenteric arteries based on CT, were treated in one session with EVAR after the celiac trunk was coil embolized to elongate the neck. All patients were followed by CT every 3 months in the first yearmore » and every 6 months thereafter. Technical success was achieved in all patients, and no early or late ischemic complications were noted. No procedural complications occurred and good aneurysm sealing was obtained in all patients. Three endoleaks were identified after 3 months (one patient) and 6 months (two patients); all were treated successfully with insertion of an additional stent-graft. In patients with DTAAs who are candidates for EVAR but have short aneurysm distal necks, celiac trunk embolization-only if the superior and inferior mesenteric arteries are patent-is a good and safe way to elongate the neck and enable EVAR.« less

Mechanism of continence after repair of posterior urethral disruption: evidence of rhabdosphincter activity.

PubMed

Whitson, Jared M; McAninch, Jack W; Tanagho, Emil A; Metro, Michael J; Rahman, Nadeem U

2008-03-01

Controversy exists regarding continence mechanisms in patients who undergo posterior urethral reconstruction after pelvic fracture. Some evidence suggests that continence after posterior urethroplasty is maintained by the bladder neck or proximal urethral mechanism without a functioning distal mechanism. We studied distal urethral sphincter activity in patients who have undergone posterior urethroplasty for pelvic fracture. A total of 12 patients who had undergone surgical repair of urethral disruption involving the prostatomembranous region underwent videourodynamics with urethral pressure profiles at rest, and during stress and hold maneuvers. Bladder pressure and urethral pressure, including proximal and distal urethral sphincter activity and pressure, were assessed in each patient. All 12 patients had daytime continence of urine postoperatively with a followup after anastomotic urethroplasty of 12 to 242 months (mean 76). Average maximum urethral pressure was 71 cm H2O. Average maximum urethral closure pressure was 61 cm H2O. The average urethral pressure seen during a brief hold maneuver was 111 cm H2O. Average functional sphincteric length was 2.5 cm. Six of the 12 patients had clear evidence of distal urethral sphincter function, as demonstrated by the profile. Continence after anastomotic urethroplasty for posttraumatic urethral strictures is maintained primarily by the proximal bladder neck. However, there is a significant contribution of the rhabdosphincter in many patients.

Penile length is a very important factor for cosmesis, function and psychosexual development in patients affected by hypospadias: Results from a long-term longitudinal cohort study.

PubMed

Ciancio, Francesco; Lo Russo, G; Innocenti, A; Portincasa, A; Parisi, D; Mondaini, N

2015-09-01

Few studies of long-term outcome of hypospadias treatment in terms of voiding, surgical complications, sexual functioning, intimate relationships and cosmetic results have been investigated and contrasting results have been obtained so far. The aim of our study is to investigate the long-term outcome of urinary and sexual function, cosmesis and the quality of intimate relationships in a series of hypospadias. In this study, 42 patients who underwent surgery for hypospadias were prospectively followed for 15 years. Medical records provided the hypospadias data, the number of reconstructive operations and the reconstruction technique that was used. Patients underwent physical examination, including penile length measurement and completed International Prostatic Symptoms Score (I-PSS), International Index Of Erectile Function (IIEF 15) and the Penile Perception Score questionnaire (PPPS). Twenty patients agreed to participate in the study. At the enrolment, the median value of HOSE was 13, as regards PPPS, 18/20 (90%) were satisfied, while in 1998 only 80% were satisfied. No significant statistical difference has been reported from the results obtained at enrolment and those obtained at follow-up, in terms of PPPS (P = 0.81), IPSS and IIEF-15. Penile length was 6.5 cm flaccid and 10.5 cm stretched. Our data show how cosmesis, function and psychosexual development for these patients are highly connected to surgical outcome, which is understood to be a decrease in penile size. © The Author(s) 2015.

Simultaneous acute rotator cuff tear and distal biceps rupture in a strongman competitor.

PubMed

George, Michael S

2010-04-01

Acute rotator cuff tear is commonly associated with tearing of the proximal biceps tendon, but has never been reported to occur simultaneously with a distal biceps tendon rupture. A 38-year-old right-hand-dominant strongman competitor attempted a 300-pound overhead axle press and experienced immediate pain in the right shoulder and elbow. He had no known systemic risk factors for tendon ruptures including hyperparathyroidism, hemodialysis, alcoholism, rheumatoid arthritis, statin medications, fluoroquinolones, and steroid use.Right shoulder magnetic resonance imaging (MRI) showed a full-thickness supraspinatus tear with 3 cm of retraction. There was minimal fatty infiltration of the supraspinatus on the sagittal cuts consistent with acute rupture. The subscapularis was intact. The long head of the biceps tendon had mild medial subluxation but was completely within the bicipital groove. Right elbow MRI showed a complete distal biceps tendon rupture. Thirteen days after his injury, the patient underwent arthroscopic supraspinatus repair and proximal biceps tenodesis. Distal biceps tendon repair was performed using the modified 2-incision muscle-splitting technique. At 24-month follow-up, the patient was pain free and had returned to full activity including weightlifting but had not returned to strongman competition.This is the first report of simultaneous acute full thickness ruptures of the rotator cuff and distal biceps tendon. This case report underscores the importance of a complete physical examination and a high index of suspicion for additional concomitant injuries, particularly in athletes with unusually high stresses to the body. Copyright 2010, SLACK Incorporated.

Models of tibial fracture healing in normal and Nf1-deficient mice.

PubMed

Schindeler, Aaron; Morse, Alyson; Harry, Lorraine; Godfrey, Craig; Mikulec, Kathy; McDonald, Michelle; Gasser, Jürg A; Little, David G

2008-08-01

Delayed union and nonunion are common complications associated with tibial fractures, particularly in the distal tibia. Existing mouse tibial fracture models are typically closed and middiaphyseal, and thus poorly recapitulate the prevailing conditions following surgery on a human open distal tibial fracture. This report describes our development of two open tibial fracture models in the mouse, where the bone is broken either in the tibial midshaft (mid-diaphysis) or in the distal tibia. Fractures in the distal tibial model showed delayed repair compared to fractures in the tibial midshaft. These tibial fracture models were applied to both wild-type and Nf1-deficient (Nf1+/-) mice. Bone repair has been reported to be exceptionally problematic in human NF1 patients, and these patients can also spontaneously develop tibial nonunions (known as congenital pseudarthrosis of the tibia), which are recalcitrant to even vigorous intervention. pQCT analysis confirmed no fundamental differences in cortical or cancellous bone in Nf1-deficient mouse tibiae compared to wild-type mice. Although no difference in bone healing was seen in the tibial midshaft fracture model, the healing of distal tibial fractures was found to be impaired in Nf1+/- mice. The histological features associated with nonunited Nf1+/- fractures were variable, but included delayed cartilage removal, disproportionate fibrous invasion, insufficient new bone anabolism, and excessive catabolism. These findings imply that the pathology of tibial pseudarthrosis in human NF1 is complex and likely to be multifactorial.

Sexual quality of life after total phalloplasty in men with penile deficiency: an exploratory study.

PubMed

Callens, Nina; De Cuypere, Griet; T'Sjoen, Guy; Monstrey, Stan; Lumen, Nicolaas; Van Laecke, Erik; Hoebeke, Piet; Cools, Martine

2015-01-01

Total phalloplasty is rarely performed today in males with severe penile deficiency, despite its successful use in the transgender population. Can phalloplasty replicate the complexity of penile anatomy and function on the long term? Sexual quality of life (QoL) was assessed in 10 men (aged 20-43 years) at least 1 year after phalloplasty in a single institution (80 % radial forearm flap and 20 % anterolateral thigh flap). In all but one, an erectile prosthesis was implanted on average 1 year after phallic reconstruction. Sexual QoL outcomes were compared to those of men with hypospadias repair (n = 73) and control men (n = 50). After phalloplasty (mean 36.9 months, 14-92 months), all men were sexually active (80 % intercourse and 100 % masturbation with orgasm and ejaculation). However, 75 % indicated to be inhibited in seeking sexual contacts, compared to 40 % of hypospadias patients (p < 0.05) and 11 % of controls (p < 0.01). Although 90 % were satisfied with the final surgical result, dissatisfaction with some aspects of genital appearance was present in 50 %. Erogenous neophallus sensitivity was said to be less than previously hoped for. Six men developed urinary complications (urethral stricture and/or fistula), and one man underwent revision of the erectile implant because of dysfunction. Nevertheless, all indicated they would choose again for phalloplasty if necessary. Total phalloplasty opens new horizons for the treatment of men with penile deficiency, but limitations of the technique should be emphasized prior to surgery. An exploration of patient expectations and continued follow-up including psychological support is important for optimizing psychosexual comfort.

Nonoperative treatment of distal biceps brachii musculotendinous partial rupture: a report of two cases.

PubMed

López-Zabala, I; Fernández-Valencia, J A

2013-01-01

Musculotendinous ruptures of the distal biceps brachii are extremely rare injuries whose clinical presentation is similar to distal biceps avulsion. We describe two cases of patients who suffered a distal biceps brachii musculotendinous partial rupture. The first patient was playing soccer as goalkeeper and experienced sudden pain while throwing the ball overhead with his left arm. The second patient experienced sudden pain while weightlifting with his right arm. The mechanism of injury was the same in the two cases, as both involved glenohumeral elevation with elbow extension and forearm supination. Neither of these two patients underwent surgical repair or rehabilitation, and both had perfect scores of 100 on the Mayo Clinic Performance Index for the Elbow at one-year followup.

Sonographic differentiation of digital tendon rupture from adhesive scarring after primary surgical repair.

PubMed

Budovec, Joseph J; Sudakoff, Gary S; Dzwierzynski, William W; Matloub, Hani S; Sanger, James R

2006-04-01

After the surgical repair of finger tendons finger range of motion may be limited by tendon rupture or adhesive scarring. Differentiating tendon rupture from adhesive scarring may be difficult clinically. Digital tendon sonography allows the evaluation of tendon integrity in a dynamic setting. Our objective was to determine if sonography could differentiate tendon rupture from adhesive scarring in patients who have had primary tendon repair. A retrospective review was performed of the radiographic, clinical, and surgical records of patients referred for finger sonography over a 2-year period. Twenty-eight digits in 21 patients were evaluated for finger tendon disruption after primary surgical repair. The diagnosis of complete tendon rupture was made when 1 or more of the following was identified: a gap separating the proximal and distal tendon margins, visualization of only the proximal tendon margin, or visualization of only the distal tendon margin. Adhesive scarring was diagnosed if the tendon appeared intact with abnormal peritendinous soft tissue abutting or partially encasing the tendon, with synovial sheath thickening, or with restricted tendon motion during dynamic evaluation. Sonography correctly identified tendon rupture or adhesive scarring in 27 of 28 digits with 1 false-positive case (sensitivity, 100%; specificity, 93%; positive-predictive value, 93%; negative-predictive value, 100%; accuracy, 96%). Sonography is an accurate modality for differentiating tendon rupture from adhesive scarring in patients with prior surgical tendon repair. Diagnostic, Level I.

Management of High-Grade Penile Curvature Associated With Hypospadias in Children

PubMed Central

Moscardi, Paulo R. M.; Gosalbez, Rafael; Castellan, Miguel Alfedo

2017-01-01

Penile curvature is a frequent feature associated with hypospadias with also a great variability of severity among each patient. While the low-grade curvature (<30°) can be relatively easily corrected by simple techniques like penile degloving and dorsal plication, severe cases often demand more complex maneuvers to manage it. A great number of surgical techniques have been developed to adequately correct curvatures greater than 30°; however, each one of them should be individualized to different patients and local conditions encountered. In this article, we will review the evaluation of the pediatric patient with penile curvature associated with hypospadias with a special attention to high-grade cases, their management, indications for surgical treatment, and several surgical options for their definitive treatment. PMID:28929092

DOE Office of Scientific and Technical Information (OSTI.GOV)

Schuffenhauer, S.; Daumer-Haas, C.; Murken, J.

Karyotypes with an interstitial deletion and a marker chromosome formed from the deleted segment are rare. We identified such a rearrangement in a newborn infant, who presented with macrocephaly, asymmetric square skull, minor facial anomalies, omphalocele, inguinal hernias, hypospadias, and club feet. The karyotype 46,XY,del(5)(pter{r_arrow}p13::cen{r_arrow}qter)/47,XY,+dicr(5)(:p13{r_arrow}cen::p13{r_arrow}cen),del(5)(pter{r_arrow}p13::cen{r_arrow}qter) was identified by banding studies and FISH analysis in the peripheral lymphocytes. One breakpoint on the del(5) maps distal to GDNF, and FISH analysis using an {alpha}-satellite probe suggests that the proximal breakpoint maps within the centromere. The dicentric r(5) consists of two copies of the segment deleted in the del(5), resulting in trisomy ofmore » proximal 5p (5p13-cen). The phenotype of the propositus is compared with other trisomy 5p cases and possible mechanisms for the generation of this unique chromosomal rearrangement are discussed. 27 refs., 3 figs.« less

Vocal cord paralysis after aortic arch surgery: predictors and clinical outcome.

PubMed

Ohta, Noriyuki; Kuratani, Toru; Hagihira, Satoshi; Kazumi, Ken-Ichiro; Kaneko, Mitsunori; Mori, Takahiko

2006-04-01

This study is retrospective cohort study of data on vocal cord paralysis after aortic arch surgery collected during 14 years at a general hospital. We investigated factors in the development of vocal cord paralysis after aortic arch surgery and the effect of vocal cord paralysis on clinical course and outcome. We reviewed data for 182 patients who underwent aortic arch surgery for aortic arch aneurysm and aortic dissection between 1989 and 2003, of whom 58 patients had proximal aortic repair, 62 had distal arch repair, and 62 had total arch repair. We assessed factors associated with the development of vocal cord paralysis and examined in detail the clinical outcome of patients with vocal cord paralysis. Postoperative vocal cord paralysis occurred in 40 patients. Multiple logistic regression analysis revealed the following risk factors with odds ratios (OR) for vocal cord paralysis: extension of procedures into distal arch (OR, 17.0), chronic dilatation of the aorta at the left subclavian artery (OR, 9.14), and total arch repair (OR, 4.24). Adoption of open-style stent-grafts reduced the incidence of vocal cord paralysis (OR, 0.031). The postoperative occurrence of vocal cord paralysis itself emerges as an independent predictor of pulmonary complications (OR, 4.12) and leads to a longer duration of hospital stay. The risk of vocal cord paralysis after aortic arch surgery depends on surgical factors, such as aneurysmal involvement of the distal arch, or the application of newer, less invasive surgical procedures. Vocal cord paralysis after aortic arch surgery itself, under aggressive postoperative respiratory management, did not increase aspiration pneumonia but was associated with postoperative complications leading to higher hospital mortality and prolonged hospitalization.

Best surgical option for arch extension of type B aortic dissection: the open approach

PubMed Central

Kim, Joon Bum

2014-01-01

Arch extension of aortic dissection (AD) is reported to occur in 4-25% of patients presenting with acute type B AD. The DeBakey and Stanford classifications do not specifically account for this subset, however, recent studies have demonstrated that the prognosis of patients with arch extension in acute type B AD is virtually identical to that of others with type B AD. In this sense, it seems reasonable to extend the general management principles that are applied to classic acute type B AD even to patients with arch extension. This may be because even in patients with arch extension, most complications occur at locations distal to the arch, and therefore treatment of these patients is similar to that of complicated type B AD, namely thoracic endovascular aortic repair (TEVAR). Conversely, 10% of patients with acute type B AD and arch extension develop complications that are directly related to the arch pathology. This clinical scenario generally necessitates surgical arch repair through a sternotomy approach. The frozen elephant trunk technique combined with arch repair is a very reasonable option to treat this unique clinical entity that involves relatively distal locations of the aortic diseases. Combined arch and descending aorta replacement through thoracotomy is an alternative option particularly when the anatomical features of the target lesions are not suitable for a sternotomy approach or TEVAR. Nonetheless, the reported mortality associated with this approach has been exceedingly high. Hybrid arch repair is another consideration in treating these patients to reduce the treatment-related mortality and morbidity, especially when the arch pathology is limited to the distal part. Nevertheless, the safety and efficacy of this procedure in cases with more extensive arch involvement needs to be assessed in further studies in comparison with other treatment modalities. PMID:25133105

DNA Resection at Chromosome Breaks Promotes Genome Stability by Constraining Non-Allelic Homologous Recombination

PubMed Central

Koshland, Douglas

2012-01-01

DNA double-strand breaks impact genome stability by triggering many of the large-scale genome rearrangements associated with evolution and cancer. One of the first steps in repairing this damage is 5′→3′ resection beginning at the break site. Recently, tools have become available to study the consequences of not extensively resecting double-strand breaks. Here we examine the role of Sgs1- and Exo1-dependent resection on genome stability using a non-selective assay that we previously developed using diploid yeast. We find that Saccharomyces cerevisiae lacking Sgs1 and Exo1 retains a very efficient repair process that is highly mutagenic to genome structure. Specifically, 51% of cells lacking Sgs1 and Exo1 repair a double-strand break using repetitive sequences 12–48 kb distal from the initial break site, thereby generating a genome rearrangement. These Sgs1- and Exo1-independent rearrangements depend partially upon a Rad51-mediated homologous recombination pathway. Furthermore, without resection a robust cell cycle arrest is not activated, allowing a cell with a single double-strand break to divide before repair, potentially yielding multiple progeny each with a different rearrangement. This profusion of rearranged genomes suggests that cells tolerate any dangers associated with extensive resection to inhibit mutagenic pathways such as break-distal recombination. The activation of break-distal recipient repeats and amplification of broken chromosomes when resection is limited raise the possibility that genome regions that are difficult to resect may be hotspots for rearrangements. These results may also explain why mutations in resection machinery are associated with cancer. PMID:22479212

Ebselen attenuates oxidative DNA damage and enhances its repair activity in the thalamus after focal cortical infarction in hypertensive rats.

PubMed

He, Meixia; Xing, Shihui; Yang, Bo; Zhao, Liqun; Hua, Haiying; Liang, Zhijian; Zhou, Wenliang; Zeng, Jinsheng; Pei, Zhong

2007-11-21

Oxidative DNA damage has been proposed to be a major contributor to focal cerebral ischemic injury. However, little is known about the role of oxidative DNA damage in remote damage secondary to the primary infarction. In the present study, we investigated oxidative damage within the ventroposterior nucleus (VPN) after distal middle cerebral artery occlusion (MCAO) in hypertensive rats. We also examined the possible protective effect of ebselen, one glutathione peroxidase mimic, on delayed degeneration in the VPN after distal MCAO. Neuronal damage in the ipsilateral VPN was examined by Nissl staining. Oxidative DNA damage and base repair enzyme activity were assessed by analyzing immunoreactivity of 8-hydroxy-2'-deoxyguanosine (8-ohdG) and 8-oxoguanine DNA glycosylase (OGG1), respectively. The number of intact neurons in the ipsilateral VPN decreased by 52% compared to the contralateral side in ischemia group 2 weeks after distal cerebral cortical infarction. The immunoreactivity of 8-ohdG significantly increased while OGG1 immunoreactivity significantly decreased in the ipsilateral VPN 2 weeks after distal cortical infarction (all p<0.01). Compared with vehicle treatment, ebselen significantly attenuated the neuron loss, ameliorated ischemia-induced increase in 8-ohdG level as well as decrease in OGG1 level within the ipsilateral VPN (all p<0.01). OGG1 was further demonstrated to mainly express in neurons. These findings strongly suggest that oxidative DNA damage may be involved in the delayed neuronal death in the VPN region following distal MCAO. Furthermore, ebselen protects against the delayed damage in the VPN when given at 24 h following distal MCAO.

Semitendinosus Tendon Transfer Associated With Distal Alignment for Patella Alta in a Patient With Recurrent Dislocations.

PubMed

Calderazzi, Filippo; Pellegrini, Andrea; Coviello, Gianluca; Groppi, Giulia; Ceccarelli, Francesco

2015-10-01

Patellofemoral instability is characterized by pain during normal daily activities and frequent dislocation events. In the reported case, an adolescent girl, aged 15 years, affected by left patellofemoral instability, underwent surgery with a double technique comprising tibial tubercle distalization and medial patellofemoral ligament reconstruction. In case of patella alta associated with patellofemoral instability, surgical treatment should focus on medial patellofemoral ligament repair and on recurrent instability prevention.

Reconstruction of the anus, rectovaginal septum, and distal part of the vagina after postirradiation necrosis. Report of a unique case

DOE Office of Scientific and Technical Information (OSTI.GOV)

Nowacki, M.P.; Towpik, E.

1988-08-01

Successful repair of postirradiation total loss of the anal sphincters, rectovaginal septum, and distal part of the vagina is reported. Gracilis muscle flap was used as a substitute sphincter. Part of the muscle was wrapped-up in a split skin graft. To the authors' knowledge, this is the first report on new application of gracilis muscle and split skin graft in perineal reconstruction.

Hypertensive Disorders of Pregnancy and Genital Anomalies in Boys: A Danish Nationwide Cohort Study.

PubMed

Arendt, Linn Håkonsen; Henriksen, Tine Brink; Lindhard, Morten Søndergaard; Parner, Erik T; Olsen, Jørn; Ramlau-Hansen, Cecilia Høst

2018-06-14

Although congenital abnormalities in the male reproductive tract are common, their causes remain poorly understood. We studied associations between hypertensive disorders of pregnancy (pre-gestational hypertension, gestational hypertension, and preeclampsia) and the genital anomalies, cryptorchidism (undescended testes), and hypospadias (ventrally displaced urethral meatus). We established a population of 1,073,026 Danish boys born alive between 1 January 1978 and 31 December 2012. By means of Cox regression analyses, we estimated hazard ratios with 95% confidence intervals for cryptorchidism and hypospadias according to type and severity of hypertensive disorder. Further, we used restricted cubic spline analyses to investigate the association between gestational age at onset of severe and moderate preeclampsia and the two genital anomalies. We found associations between pre-gestational hypertension and cryptorchidism [HR: 1.3 (95% CI: 1.1, 1.6)] and hypospadias [HR: 1.7 (95% CI: 1.3, 2.3)], whereas gestational hypertension was only associated with cryptorchidism [HR: 1.2 (95% CI: 1.1, 1.4)]. Boys of mothers with preeclampsia had the highest occurrence of cryptorchidism and hypospadias, increasing with preeclampsia severity. Women with HELLP syndrome faced the highest risk of having a child with both cryptorchidism [HR: 2.1 (95% CI: 1.4, 3.2)] and hypospadias [HR: 3.9 (95% CI: 2.5, 6.1)]. Further, the occurrence increased with early onset of preeclampsia diagnosis. These findings support the hypotheses that preeclampsia and genital anomalies share common etiologic factors and that placental dysfunction and androgen deficiency in early pregnancy are important in the etiology of male genital anomalies.

Effect of Pre-Designed Instructions for Mothers of Children with Hypospadias on Reducing Postoperative Complications

ERIC Educational Resources Information Center

Mohamed, Sanaa A.

2015-01-01

Hypospadias is a common congenital anomaly with a prevalence estimated to be as high as 1 in 125 live male births. Complications after surgical procedures are possible. The incidence of complications can be reduced by meticulous preoperative planning, and judicious postoperative care. So the aim of the study was to investigate the effect of…

Molecular Mechanisms of External Genitalia Development

PubMed Central

Blaschko, Sarah D.; Cunha, Gerald R.; Baskin, Laurence S.

2012-01-01

External genitalia development occurs through a combination of hormone independent, hormone dependent, and endocrine pathways. Perturbation of these pathways can lead to abnormal external genitalia development. We review human and animal mechanisms of normal and abnormal external genitalia development, and we evaluate abnormal mechanisms that lead to hypospadias. We also discuss recent laboratory findings that further our understanding of animal models of hypospadias. PMID:22790208

An Innovative Approach to the Repair of Distal Tibia Nonunion Using a Retrograde Buried Tibio-Talar-Calcaneal Nail: A Case Report.

PubMed

Van Steyn, Peter; Romash, Michael

We report a case using retrograde tibial nailing as treatment of nonunion of a distal tibial osteotomy, which was performed as part of a complex reconstruction of distal tibial malunion with ankle arthritis. Although retrograde nailing has classically been used for tibial-talar-calcaneal arthrodesis, this method spares the subtalar joint. Preservation of some hindfoot motion by subtalar mobility allows for a decrease in the loss of function typically seen with tibial-talar-calcaneal arthrodesis. Copyright © 2016 American College of Foot and Ankle Surgeons. Published by Elsevier Inc. All rights reserved.

Extensor Tendon Injuries and Repairs in the Hand

PubMed Central

Kontor, J. A.

1982-01-01

Due to their superficial course, the extensor tendons are frequently lacerated over the dorsum of the hand and fingers. Excellent functional results are obtained in repairs of simple tendon lacerations. ‘Open’ mallet lacerations over the distal IP joint or involving the central extensor slip over the proximal IP joint require more precise suturing methods. More proximal extensor tendon divisions near the wrist involve dissection of the retracted finger extensors or long thumb extensor in the distal forearm and more formal tendon repairs, including a possible tendon transfer to the thumb. ‘Closed injuries’, with varying degrees of extensor tendon disruption, occur at three main sites. The mallet injury at the DIP joint and the boutonnière deformity over the PIP joint are sometimes recognized late, but respond to conservative splinting for a minimum of four weeks with guarded motion avoiding secondary stiffening of the remaining small joints of the hand. Surgery of closed injuries most frequently involves the intra-articular traction fracture type of mallet deformities in which the DIP joint has taken the brunt of the injury. PMID:21286174

Endovascular Therapy in Trauma

DTIC Science & Technology

2014-11-23

patients. The use of endovascu- lar techniques in trauma can be considered in three broad categories: (1) large-vessel repair (e.g. covered stent repair...covered stent grafts, and coils and other thrombotic adjuncts. Devices from these categories are introduced over a wire at the access site through...technique or some form of distal aortic perfusion [6]. The use of stent grafts to manage tho- racic aortic trauma stemmed from favorable observations

[Transhiatal esophagectomy for cardia and esophagus cancer].

PubMed

Moiseev, A Yu; Shulutko, A M; Gryaznov, S E

To present the result of transhiatal esophagectomies with simultaneous repair. The study included 67 procedures. In 35 cases surgery was carried out for adenocarcinoma of distal esophagus or cardia with high transition to esophagus, in 32 cases - for epidermal carcinoma of the esophagus. Gastric graft and left half of the colon were used in 60 and 7 cases respectively for simultaneous repair. 29 patients underwent transhiatal instrumental esophagectomy using author's original technique.

Sensitivity of indentation testing to step-off edges and interface integrity in cartilage repair.

PubMed

Bae, Won C; Law, Amanda W; Amiel, David; Sah, Robert L

2004-03-01

Step-off edges and tissue interfaces are prevalent in cartilage injury such as after intra-articular fracture and reduction, and in focal defects and surgical repair procedures such as osteochondral graft implantation. It would be useful to assess the function of injured or donor tissues near such step-off edges and the extent of integration at material interfaces. The objective of this study was to determine if indentation testing is sensitive to the presence of step-off edges and the integrity of material interfaces, in both in vitro simulated repair samples of bovine cartilage defect filled with fibrin matrix, and in vivo biological repair samples from a goat animal model. Indentation stiffness decreased at locations approaching a step-off edge, a lacerated interface, or an integrated interface in which the distal tissue was relatively soft. The indentation stiffness increased or remained constant when the site of indentation approached an integrated interface in which the distal tissue was relatively stiff or similar in stiffness to the tissue being tested. These results indicate that indentation testing is sensitive to step-off edges and interface integrity, and may be useful for assessing cartilage injury and for following the progression of tissue integration after surgical treatments.

Biomechanical Assessment of Patellar Advancement Procedures for Patella Alta.

PubMed

Seidl, Adam; Baldini, Todd; Krughoff, Kevin; Shapiro, Joshua A; Lindeque, Bennie; Rhodes, Jason; Carollo, James

2016-05-01

Crouch gait deformity is common in children with cerebral palsy and often is associated with patella alta. Patellar tendon advancement typically is used to correct patella alta and restore normal knee mechanics. The purpose of this study was to determine the mechanical strength of surgical constructs used for fixation during patellar advancement procedures. This study used a cadaveric model to determine which of 3 surgical techniques is biomechanically optimal for patellar tendon advancement in treating patella alta. Twenty-four human cadaveric knees (8 per group) were prepared using 1 of 3 different common surgical techniques: tibial tubercle osteotomy, patellar tendon partial resection and repair at the distal patella, and patellar tendon imbrication. The patella was loaded from 25 to 250 N at 1 Hz for 1000 cycles. A significant difference in patella displacement under cyclical loading was found between surgical techniques. Tibial tubercle osteotomy exhibited significantly less displacement under cyclical loading than distal patella excision and repair (P<.0001) or imbrication (P=.0088). Imbrication exhibited significantly less displacement than distal patella excision and repair (P=.0006). Tibial tubercle osteotomy survived longest. Based on failure criteria of 5 mm of displacement, tibial tubercle osteotomy lasted between 250 and 500 cycles. The other 2 techniques failed by 25 cycles. This study offers quantitative evidence regarding the relative mechanical strength of each construct and may influence choice of surgical technique. [Orthopedics. 2016; 39(3):e492-e497.]. Copyright 2016, SLACK Incorporated.

Molecular Mechanism of MicroRNA-200c Regulating Transforming Growth Factor-β (TGF-β)/SMAD Family Member 3 (SMAD3) Pathway by Targeting Zinc Finger E-Box Binding Homeobox 1 (ZEB1) in Hypospadias in Rats.

PubMed

Qian, Chong; Dang, Xiangyang; Wang, Xianglin; Xu, Wei; Pang, Guijian; Chen, Yifeng; Liu, Chengbei

2016-10-29

BACKGROUND The aim of this study was to explore effects of microRNA-200c regulating TGF-β/Smad3 pathway by targeting Zeb1 on the occurrence and development of hypospadias and to evaluate the relationship between microRNA-200c and occurrence of hypospadias. MATERIAL AND METHODS Pregnant rats with a gestational age of 12 days were allocated into 2 groups; one received gavage of DEHP-contained soybean oil (1 ml/day, 8 days; Group A) and the other had gavage of normal soybean oil (1 ml/day, 8 days; Group B). Baby rats with hypospadias from Group A were assigned to the model group (n=20) and healthy baby rats from Group B were assigned to the control group (n=20). Real-time quantitative polymerase chain reaction (qRT-PCR), immunohistochemistry and Western blot analysis were performed to detect microRNA-200c, Zeb1, TGF-β, and Smad3 mRNA and protein expressions in the model group (n=20) and the control group (n=20). The relationship between microRNA-200c and Zeb1 was detected using a dual-luciferase reporter gene experiment. After the in vitro intervention experiment in fetal rat penises, Western blot was used to detect the expression of Zeb1, TGF-β, and Smad3. RESULTS In the model group, microRNA-200c was expressed at a low level, and microRNA-200c expression in control group was 2.1 times higher than in the model group (P<0.05). When compared with the control group, mRNA expressions, protein expressions, and positive rates of Zeb1, TGF-β, and Smad3 were higher in the model group (all P<0.01). Luciferase gene report determined that Zeb1 is a target gene of microRNA-200c. The in vitro intervention experiment in fetal rat penises found that a high concentration of microRNA-200c inhibited hypospadias occurrence by suppressing the expression of Zeb1, TGF-β, and Smad3. CONCLUSIONS MicroRNA-200c was expressed in hypospadias penis tissues at low levels and was negatively correlated with Zeb1 expression. MicroRNA-200c up-regulated Zeb1 expression to regulate the TGF-β/Smad3 pathway, which led to the occurrence of hypospadias.

Molecular Mechanism of MicroRNA-200c Regulating Transforming Growth Factor-β (TGF-β)/SMAD Family Member 3 (SMAD3) Pathway by Targeting Zinc Finger E-Box Binding Homeobox 1 (ZEB1) in Hypospadias in Rats

PubMed Central

Qian, Chong; Dang, Xiangyang; Wang, Xianglin; Xu, Wei; Pang, Guijian; Chen, Yifeng; Liu, Chengbei

2016-01-01

Background The aim of this study was to explore effects of microRNA-200c regulating TGF-β/Smad3 pathway by targeting Zeb1 on the occurrence and development of hypospadias and to evaluate the relationship between microRNA-200c and occurrence of hypospadias. Material/Methods Pregnant rats with a gestational age of 12 days were allocated into 2 groups; one received gavage of DEHP-contained soybean oil (1 ml/day, 8 days; Group A) and the other had gavage of normal soybean oil (1 ml/day, 8 days; Group B). Baby rats with hypospadias from Group A were assigned to the model group (n=20) and healthy baby rats from Group B were assigned to the control group (n=20). Real-time quantitative polymerase chain reaction (qRT-PCR), immunohistochemistry and Western blot analysis were performed to detect microRNA-200c, Zeb1, TGF-β, and Smad3 mRNA and protein expressions in the model group (n=20) and the control group (n=20). The relationship between microRNA-200c and Zeb1 was detected using a dual-luciferase reporter gene experiment. After the in vitro intervention experiment in fetal rat penises, Western blot was used to detect the expression of Zeb1, TGF-β, and Smad3. Results In the model group, microRNA-200c was expressed at a low level, and microRNA-200c expression in control group was 2.1 times higher than in the model group (P<0.05). When compared with the control group, mRNA expressions, protein expressions, and positive rates of Zeb1, TGF-β, and Smad3 were higher in the model group (all P<0.01). Luciferase gene report determined that Zeb1 is a target gene of microRNA-200c. The in vitro intervention experiment in fetal rat penises found that a high concentration of microRNA-200c inhibited hypospadias occurrence by suppressing the expression of Zeb1, TGF-β, and Smad3. Conclusions MicroRNA-200c was expressed in hypospadias penis tissues at low levels and was negatively correlated with Zeb1 expression. MicroRNA-200c up-regulated Zeb1 expression to regulate the TGF-β/Smad3 pathway, which led to the occurrence of hypospadias. PMID:27794206

Chronologic and Geographic Trends of Triangular Fibrocartilage Complex Repair.

PubMed

Saito, Taichi; Sterbenz, Jennifer M; Chung, Kevin C

2017-11-01

This article shows trends in triangular fibrocartilage complex (TFCC) repair since 1990 by geographic area and year. The repair methods presented in the literature were inside-out, outside-in, all-inside, and open repair. The outside-in technique was reported most often for ulnar-side tears, whereas the inside-out technique was reported most frequently for radial-side tears. Recently, a foveal reattachment technique for ulnar-side tears has garnered attention and has been reported with increasing frequency, especially in Asia, because the deepest portion of TFCC, attached to fovea, plays a key role in stabilizing the distal radioulnar joint. Understanding these trends can help clinicians best treat TFCC tears. Copyright © 2017 Elsevier Inc. All rights reserved.

Robot-Assisted Laparoscopic Repair of Spontaneous Appendicovesical Fistula

PubMed Central

Kibar, Yusuf; Yalcin, Serdar; Kopru, Burak; Topuz, Bahadir; Ebiloglu, Turgay

2016-01-01

Abstract Background: To report the first case of the spontaneous appendicovesical fistulas' (AVF) repair with robot assisted laparoscopy. Case Presentation: A 29-year-old male patient with urgent persistant bacteriuria and dysuria was referred to our clinic. Physical examination and blood tests were normal. He had used various antibiotics due to recurrent UTI for about 20 years. Computed tomography revealed the fistula tract between the distal end of the appendix and right lateral wall of the bladder dome. He was successfully treated with robot-assisted laparoscopic repair. Following this surgery, the patient's complaints were resolved completely. Conclusion: AVF is the rare condition. Robot-assisted laparoscopy repair of AVF is safe and effective treatment option. PMID:27579435

Direct visual internal urethrotomy: Is it a durable treatment option?

PubMed Central

Pal, Dilip Kumar; Kumar, Sanjay; Ghosh, Bastab

2017-01-01

Objective: To evaluate the long-term success rate of direct vision internal urethrotomy as a treatment for anterior urethral strictures. Materials and Methods: We retrospectively analyzed the results for patients who underwent internal urethrotomy from January 2009 to January 2014 for anterior urethral strictures. Patients were followed till January 2016. Patients with complicated urethral strictures with a history of previous urethroplasty, hypospadias repair, or previous radiation were excluded from the study, as anticipated low success rate of direct visual internal urethrotomy (DVIU) in these patients. The Kaplan–Meier method was used to analyze stricture-free probability after the first, second, and third urethrotomy. Results: A total of 186 patients were included in this study. Stricture-free rates after first, second, and third urethrotomy were 29.66%, 22.64%, and 13.33%, respectively. Conclusions: Although DVIU may be a management option for anterior urethral stricture disease, it seems that long-term results are disappointing. PMID:28216923

Direct visual internal urethrotomy: Is it a durable treatment option?

PubMed

Pal, Dilip Kumar; Kumar, Sanjay; Ghosh, Bastab

2017-01-01

To evaluate the long-term success rate of direct vision internal urethrotomy as a treatment for anterior urethral strictures. We retrospectively analyzed the results for patients who underwent internal urethrotomy from January 2009 to January 2014 for anterior urethral strictures. Patients were followed till January 2016. Patients with complicated urethral strictures with a history of previous urethroplasty, hypospadias repair, or previous radiation were excluded from the study, as anticipated low success rate of direct visual internal urethrotomy (DVIU) in these patients. The Kaplan-Meier method was used to analyze stricture-free probability after the first, second, and third urethrotomy. A total of 186 patients were included in this study. Stricture-free rates after first, second, and third urethrotomy were 29.66%, 22.64%, and 13.33%, respectively. Although DVIU may be a management option for anterior urethral stricture disease, it seems that long-term results are disappointing.

Subchondral chitosan/blood implant-guided bone plate resorption and woven bone repair is coupled to hyaline cartilage regeneration from microdrill holes in aged rabbit knees.

PubMed

Guzmán-Morales, J; Lafantaisie-Favreau, C-H; Chen, G; Hoemann, C D

2014-02-01

Little is known of how to routinely elicit hyaline cartilage repair tissue in middle-aged patients. We tested the hypothesis that in skeletally aged rabbit knees, microdrill holes can be stimulated to remodel the bone plate and induce a more integrated, voluminous and hyaline cartilage repair tissue when treated by subchondral chitosan/blood implants. New Zealand White rabbits (13 or 32 months old, N = 7) received two 1.5 mm diameter, 2 mm depth drill holes in each knee, either left to bleed as surgical controls or press-fit with a 10 kDa (distal hole: 10K) or 40 kDa (proximal hole: 40K) chitosan/blood implant with fluorescent chitosan tracer. Post-operative knee effusion was documented. Repair tissues at day 0 (N = 1) and day 70 post-surgery (N = 6) were analyzed by micro-computed tomography, and by histological scoring and histomorphometry (SafO, Col-2, and Col-1) at day 70. All chitosan implants were completely cleared after 70 days, without increasing transient post-operative knee effusion compared to controls. Proximal control holes had worse osteochondral repair than distal holes. Both implant formulations induced bone remodeling and improved lateral integration of the bone plate at the hole edge. The 40K implant inhibited further bone repair inside 50% of the proximal holes, while the 10K implant specifically induced a "wound bloom" reaction, characterized by decreased bone plate density in a limited zone beyond the initial hole edge, and increased woven bone (WB) plate repair inside the initial hole (P = 0.016), which was accompanied by a more voluminous and hyaline cartilage repair (P < 0.05 vs control defects). In a challenging aged rabbit model, bone marrow-derived hyaline cartilage repair can be promoted by treating acute drill holes with a biodegradable subchondral implant that elicits bone plate resorption followed by anabolic WB repair within a 70-day repair period. Copyright © 2013 Osteoarthritis Research Society International. Published by Elsevier Ltd. All rights reserved.

Patient with bilateral breast enlargement and hypospadias.

PubMed

Ali, A A; Ahmed, T; Rashid, M M

2009-01-01

A 20 year old man was admitted in the surgical unit of Dhaka Medical College Hospital on August 2007 presented with Hypospadias & underdeveloped penis from childhood, gradual enlargement of both breasts for the last 10 years, absence of axillary and pubic hair from puberty & painful swelling of both testes for the last 3 years. The patient was regarded as a female upto the age of 10 years. He has got no voice change since puberty. On examination he had average body built, there was bilateral gynaecomastia, hypospadias, rudimentary penis & absence of pubic and axillary hair. His testosterone level, serum prolactin level, serum progesterone level, serum estradiol level was done. Cytology on buccal smear done and ultrasonography revealed no ovary and uterus. Ultimately patient was diagnosed as a case of androgen insensitivity syndrome (AIS). The case is reported for clinical awareness & to share our experience.

[A Case of Laparoscopic Repair of Internal Hernia after Laparoscope-Assisted Distal Gastrectomy with Antecolic Roux-en-Y Reconstruction].

PubMed

Maezawa, Yukio; Cho, Haruhiko; Kano, Kazuki; Nakajima, Tetsushi; Ikeda, Kousuke; Yamada, Takanobu; Sato, Tsutomu; Ohshima, Takashi; Rino, Yasushi; Masuda, Munetaka; Ogata, Takashi; Yoshikawa, Takaki

2017-10-01

A 72-year-old woman had undergone laparoscope-assisted distal gastrectomy with D1 plus lymph node dissection and antecolic Roux-en-Y reconstruction for early gastric cancer. She visited our department outpatient clinic with left upper abdominal pain 1 year and 9 months after the surgery. CT revealed a spiral sign of the superior mesenteric arteriovenous branch. An internal hernia was suspected on hospitalization. Although abdominal symptoms were relieved by conservative treatment, the hernia persisted. Laparoscopic surgery was performed and revealed that almost entire small intestine had been affected due to Petersen's defect. Since no ischemic changes were observed, the defect was repaired laparoscopically with suture closure. There has been no recurrence of internal hernia after the laparoscopic surgery. Internal hernia after distal gastrectomy is relatively rare. However, the risk of internal hernia is high due to the gap between the elevated jejunum and transverse colon mesentery in Roux-en-Y reconstruction and can lead to intestinal necrosis. Since an internal hernia can occur in patients who have undergone gastric resection with Roux-en-Y reconstruction, suture closure of Petersen's defect should be performed to prevent this occurrence.

Risk factors in past histories and familial episodes related to development of testicular germ cell tumor.

PubMed

Kanto, Satoru; Hiramatsu, Masayoshi; Suzuki, Kenichi; Ishidoya, Shigeto; Saito, Hideo; Yamada, Shigeyuki; Satoh, Makoto; Saito, Seiichi; Fukuzaki, Atsushi; Arai, Yoichi

2004-08-01

A retrospective study was conducted to examine the host factors of 240 testicular germ cell tumor patients. This study was performed to address a new theory proposed by Skakkebaek called testicular dysgenesis syndrome which claims that cryptorchism, hypospadias, poor semen quality and testicular germ cell tumors are symptoms of an underlying testicular dysgenesis in uterus. The past health histories and familial episodes of 240 testicular germ cell tumor patients were examined. The past health histories included cryptorchism, hypospadias, infertility, atrophic testis and inguinal hernia. Of the 240 patients, 13 (5.4%) had a history of cryptorchism or orchidopexy. Two (0.8%) showed existence of hypospadias or had experienced urethroplasty. Among 129 married couples, 104 (80.6%) couples were fertile. Three (1.3%) patients developed testicular tumors after they were diagnosed as infertile or came to the hospital with the complaints of infertility. Four (1.7%) had contralateral atrophic testis. 19 (7.9%) had experienced inguinal herniorrhaphy before age 15. Three (1.3%) had testicular germ cell tumor patients among their family or relatives. The testicular germ cell tumor patients showed a considerable incidence of complications such as cryptorchism, hypospadias and incomplete closure of processus vaginalis. Cryptorchism, perinatal factors and familial factors could be risks for developing testicular germ cell tumors.

Surgical treatment of partial biceps tendon ruptures at the elbow.

PubMed

Dellaero, David T; Mallon, William J

2006-01-01

We present the treatment and results of a consecutive series of 7 patients (mean age, 42.7 years) with partial ruptures of the distal biceps tendon. All injuries occurred as the result of either heavy labor or weightlifting. Diagnosis in all cases was made with magnetic resonance imaging. After failure of conservative therapy, the patients were treated with repair of the distal biceps tendon. Mean follow-up was 30.6 months (range, 25-39 months). Results were uniformly good, with all patients satisfied with the outcome. All patients maintained their preoperative range of motion, with none reporting significant postoperative pain. The only complication was transient neurapraxias of the lateral antebrachial cutaneous nerve in 2 cases. We conclude that patients presenting with chronic pain in the cubital fossa should be evaluated for possible partial biceps tendon tear. If the diagnosis of partial tendon tear is made, surgical repair is a safe and effective method of treatment.

Murine P-glycoprotein deficiency alters intestinal injury repair and blunts lipopolysaccharide-induced radioprotection.

PubMed

Staley, Elizabeth M; Yarbrough, Vanisha R; Schoeb, Trenton R; Daft, Joseph G; Tanner, Scott M; Steverson, Dennis; Lorenz, Robin G

2012-09-01

P-glycoprotein (P-gp) has been reported to increase stem cell proliferation and regulate apoptosis. Absence of P-gp results in decreased repair of intestinal epithelial cells after chemical injury. To further explore the mechanisms involved in the effects of P-gp on intestinal injury and repair, we used the well-characterized radiation injury model. In this model, injury repair is mediated by production of prostaglandins (PGE(2)) and lipopolysaccharide (LPS) has been shown to confer radioprotection. B6.mdr1a(-/-) mice and wild-type controls were subjected to 12 Gy total body X-ray irradiation and surviving crypts in the proximal jejunum and distal colon were evaluated 3.5 days after irradiation. B6.mdr1a(-/-) mice exhibited normal baseline stem cell proliferation and COX dependent crypt regeneration after irradiation. However, radiation induced apoptosis was increased and LPS-induced radioprotection was blunted in the C57BL6.mdr1a(-/-) distal colon, compared to B6 wild-type controls. The LPS treatment induced gene expression of the radioprotective cytokine IL-1α, in B6 wild-type controls but not in B6.mdr1a(-/-) animals. Lipopolysaccharid-induced radioprotection was absent in IL-1R1(-/-) animals, indicating a role for IL-1α in radioprotection, and demonstrating that P-gp deficiency interferes with IL-1α gene expression in response to systemic exposure to LPS.

Exponential Increase in Relative Biological Effectiveness Along Distal Edge of a Proton Bragg Peak as Measured by Deoxyribonucleic Acid Double-Strand Breaks

PubMed Central

Cuaron, John J.; Chang, Chang; Lovelock, Michael; Higginson, Daniel S.; Mah, Dennis; Cahlon, Oren; Powell, Simon

2016-01-01

Purpose To quantify the relative biological effectiveness (RBE) of the distal edge of the proton Bragg peak, using an in vitro assay of DNA double-strand breaks (DSBs). Methods and Materials U2OS cells were irradiated within the plateau of a spread-out Bragg peak and at each millimeter position along the distal edge using a custom slide holder, allowing for simultaneous measurement of physical dose. A reference radiation signal was generated using photons. The DNA DSBs at 3 hours (to assess for early damage) and at 24 hours (to assess for residual damage and repair) after irradiation were measured using the γH2AX assay and quantified via flow cytometry. Results were confirmed with clonogenic survival assays. A detailed map of the RBE as a function of depth along the Bragg peak was generated using γH2AX measurements as a biological endpoint. Results At 3 hours after irradiation, DNA DSBs were higher with protons at every point along the distal edge compared with samples irradiated with photons to similar doses. This effect was even more pronounced after 24 hours, indicating that the impact of DNA repair is less after proton irradiation relative to photons. The RBE demonstrated an exponential increase as a function of depth and was measured to be as high as 4.0 after 3 hours and as high as 6.0 after 24 hours. When the RBE-corrected dose was plotted as a function of depth, the peak effective dose was extended 2-3 mm beyond what would be expected with physical measurement. Conclusions We generated a highly comprehensive map of the RBE of the distal edge of the Bragg peak, using a direct assay of DNA DSBs in vitro. Our data show that the RBE of the distal edge increases with depth and is significantly higher than previously reported estimates. PMID:27084629

Exponential Increase in Relative Biological Effectiveness Along Distal Edge of a Proton Bragg Peak as Measured by Deoxyribonucleic Acid Double-Strand Breaks.

PubMed

Cuaron, John J; Chang, Chang; Lovelock, Michael; Higginson, Daniel S; Mah, Dennis; Cahlon, Oren; Powell, Simon

2016-05-01

To quantify the relative biological effectiveness (RBE) of the distal edge of the proton Bragg peak, using an in vitro assay of DNA double-strand breaks (DSBs). U2OS cells were irradiated within the plateau of a spread-out Bragg peak and at each millimeter position along the distal edge using a custom slide holder, allowing for simultaneous measurement of physical dose. A reference radiation signal was generated using photons. The DNA DSBs at 3 hours (to assess for early damage) and at 24 hours (to assess for residual damage and repair) after irradiation were measured using the γH2AX assay and quantified via flow cytometry. Results were confirmed with clonogenic survival assays. A detailed map of the RBE as a function of depth along the Bragg peak was generated using γH2AX measurements as a biological endpoint. At 3 hours after irradiation, DNA DSBs were higher with protons at every point along the distal edge compared with samples irradiated with photons to similar doses. This effect was even more pronounced after 24 hours, indicating that the impact of DNA repair is less after proton irradiation relative to photons. The RBE demonstrated an exponential increase as a function of depth and was measured to be as high as 4.0 after 3 hours and as high as 6.0 after 24 hours. When the RBE-corrected dose was plotted as a function of depth, the peak effective dose was extended 2-3 mm beyond what would be expected with physical measurement. We generated a highly comprehensive map of the RBE of the distal edge of the Bragg peak, using a direct assay of DNA DSBs in vitro. Our data show that the RBE of the distal edge increases with depth and is significantly higher than previously reported estimates. Copyright © 2016 Elsevier Inc. All rights reserved.

Incidence and clinical outcomes of tendon rupture following distal radius fracture.

PubMed

White, Brian D; Nydick, Jason A; Karsky, Dawnne; Williams, Bailee D; Hess, Alfred V; Stone, Jeffrey D

2012-10-01

To evaluate the incidence of tendon rupture after nonoperative and operative management of distal radius fractures, report clinical outcomes after tendon repair or transfer, and examine volar plate and dorsal screw prominence as a predictor of tendon rupture. We performed a retrospective chart review on patients treated for tendon rupture after distal radius fracture. We evaluated active range of motion, Disabilities of Arm, Shoulder, and Hand score, grip strength, and pain score, and performed radiographic evaluation of volar plate and dorsal screw prominence in both the study group and a matched control group. There were 6 tendon ruptures in 1,359 patients (0.4%) treated nonoperatively and 8 tendon ruptures in 999 patients (0.8%) treated with volar plate fixation. At the time of final follow-up, regardless of treatment, we noted that patients had minimal pain and excellent motion and grip strength. Mean Disabilities of the Shoulder, Arm, and Hand scores were 6 for patients treated nonoperatively and 4 for those treated with volar plating. We were unable to verify volar plate or dorsal screw prominence as independent risk factors for tendon rupture after distal radius fractures. However, we recommend continued follow-up and plate removal for symptomatic patients who have volar plate prominence or dorsal screw prominence. In the event of tendon rupture, we report excellent clinical outcomes after tendon repair or tendon transfer. Therapeutic IV. Copyright © 2012 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.

Primary nerve grafting: A study of revascularization.

PubMed

Chalfoun, Charbel; Scholz, Thomas; Cole, Matthew D; Steward, Earl; Vanderkam, Victoria; Evans, Gregory R D

2003-01-01

It was the purpose of this study to evaluate the revascularization of primary nerve repair and grafts using orthogonal polarization spectral (OPS) (Cytometrix, Inc.) imaging, a novel method for real-time evaluation of microcirculatory blood flow. Twenty male Sprague Dawley rats (250 g) were anesthetized with vaporized halothane and surgically prepared for common peroneal nerve resection. Group I animals (n = 10) underwent primary neurorraphy following transection, utilizing a microsurgical technique with 10-0 nylon suture. Group II (n = 10) animals had a 7-mm segment of nerve excised, reversed, and subsequently replaced as a nerve graft under similar techniques. All animals were evaluated using the OPS imaging system on three portions (proximal, transection site/graft, and distal) of the nerve following repair or grafting. Reevaluation of 5 animals randomly selected from each group using the OPS imaging system was again performed on days 14 and 28 following microsurgical repair/grafting. Values were determined by percent change in vascularity of the common peroneal nerve at 0 hr following surgery. Real-time evaluation of blood flow was utilized as an additional objective criterion. Percent vascularity in group I and II animals increased from baseline in all segments at day 14. By day 28, vascularity in nerves of group I rats decreased in all segments to values below baseline, with the exception of the transection site, which remained at a higher value than obtained directly after surgical repair. In group II animals, vascularity remained above baseline in all segments except the distal segment, which returned to vascularity levels similar to those at 0 hr. Further, occlusion of the vessels demonstrated in the graft and distal segments following initial transection appeared to be corrected. This study suggests that revascularization may occur via bidirectional inosculation with favored proximal vascular growth advancement. The use of real-time imaging offers a unique evaluation of tissues through emerging technologies. Copyright 2003 Wiley-Liss, Inc.

Reconstruction of the nasal infratip, columella, and soft triangle.

PubMed

Goldman, Glenn D

2014-09-01

Tumors of the soft triangle and distal nose are common, and the wounds created when removing them are among the more challenging defects to repair. Reconstruction of the soft triangle, infratip, and columella requires attention to form and function beyond what is usually needed in cutaneous surgery. The complexities of the anatomy demand meticulous planning and surgical execution. In this review, the goal is to provide the cutaneous surgeon with a logical approach to repair this challenging region. Skin grafts, composite grafts, local flaps, and pedicle flaps are presented with pearls and pointers. Cartilage grafting for stability is reviewed and detailed. A step-by-step approach allows the surgeon to plan appropriately and execute repairs with excellence. Ten cases are reviewed in sequential photo format to demonstrate successful reconstruction of operative wounds from this challenging region of the nose. The most distal nasal contours pose many challenges for reconstruction. Success depends on a good knowledge of anatomy, rigorous planning, and superior surgical skills. Skin grafts, composite grafts, local and interpolated flaps are all options that need to be considered when recreating the delicate folds and contours of this region. Cartilage support may be needed to maintain structural integrity. With care, excellent outcomes are predictably achieved.

Mediator MED23 Links Pigmentation and DNA Repair through the Transcription Factor MITF.

PubMed

Xia, Min; Chen, Kun; Yao, Xiao; Xu, Yichi; Yao, Jiaying; Yan, Jun; Shao, Zhen; Wang, Gang

2017-08-22

DNA repair is related to many physiological and pathological processes, including pigmentation. Little is known about the role of the transcriptional cofactor Mediator complex in DNA repair and pigmentation. Here, we demonstrate that Mediator MED23 plays an important role in coupling UV-induced DNA repair to pigmentation. The loss of Med23 specifically impairs the pigmentation process in melanocyte-lineage cells and in zebrafish. Med23 deficiency leads to enhanced nucleotide excision repair (NER) and less DNA damage following UV radiation because of the enhanced expression and recruitment of NER factors to chromatin for genomic stability. Integrative analyses of melanoma cells reveal that MED23 controls the expression of a melanocyte master regulator, Mitf, by modulating its distal enhancer activity, leading to opposing effects on pigmentation and DNA repair. Collectively, the Mediator MED23/MITF axis connects DNA repair to pigmentation, thus providing molecular insights into the DNA damage response and skin-related diseases. Copyright © 2017 The Author(s). Published by Elsevier Inc. All rights reserved.

Imaging of the rabbit supraspinatus enthesis at 7 Tesla: a 4-week time course after repair surgery and effect of channeling.

PubMed

Trudel, Guy; Melkus, Gerd; Cron, Greg O; Louati, Hakim; Sheikh, Adnan; Larson, Peder E Z; Schweitzer, Mark; Lapner, Peter; Uhthoff, Hans K; Laneuville, Odette

2017-08-01

To image the supraspinatus enthesis reformation of rabbit shoulders by magnetic resonance at 7 Tesla (T) using T2 mapping after surgical repair and to assess the effects of channeling aimed at enhancing enthesis reformation. In 112 rabbits, the distal supraspinatus (SSP) tendon was unilaterally detached and reattached after 1 week. At the first surgery, channeling was performed at the footprint in 64 rabbits. At the second surgery, the SSP tendon of all rabbits was re-attached to the greater tuberosity. The shoulders were harvested at 0, 1, 2, or 4 weeks after the repair surgery and were imaged at 7T. Quantitative T2 mapping was performed using multi slice two-dimensional multi-echo spin-echo sequence with fat saturation. Enthesis regions of interests were drawn on three slices at the footprint to measure T2 relaxation times. Tendon repair (F (2, 218)  = 44; P < 2.2e-16) and postoperative duration (F (3, 218)  = 4.8; P = 0.006) both affected significantly the T2 values while channeling had no significant effect. For the time effect, the only pair with a statistical difference was the 0-week and 4-week for the channeling groups (P = 0.023). Enthesis reformation early after surgical repair of the SSP distal tendon was characterized by increasing T2 values. 2 Technical Efficacy: Stage 1 J. MAGN. RESON. IMAGING 2017;46:461-467. © 2017 International Society for Magnetic Resonance in Medicine.

Predictors of paraplegia with current thoracoabdominal aortic aneurysm repair.

PubMed

Wongkornrat, Wanchai; Yamamoto, Shin; Sekine, Yuji; Ono, Makoto; Fujikawa, Takuya; Oshima, Susumu; Sasaguri, Shiro

2015-05-01

Although the results of surgical repair of thoracoabdominal aortic aneurysm continue to improve, the incidence of paraplegia remains within a wide range depending on each institution. The purpose of this study was to find predictors of paraplegia following thoracoabdominal aortic aneurysm repair in our institute, using the current spinal cord protection strategies. From January 2007 to December 2011, 200 consecutive patients underwent thoracoabdominal aortic aneurysm repair. Of these, 24 (12%) had Crawford extent I repair, 82 (41%) had extent II, 51 (25.5%) had extent III, 10 (5%) had extent IV, and 33 (16.5%) had extent V (modified by Safi). Aortic dissection was present in 101 (50.5%) patients. Adjuncts used during the procedures included left heart bypass in all patients, cerebrospinal fluid drainage in 164 (82%), and intercostal artery reimplantation in 76 (38%). There were 20 (10%) hospital deaths including 6 (3%) within 30 days; hospital mortality was 8.8% in elective operations. Postoperative complications included paraplegia in 17 (8.5%) patients, stroke in 5 (2.5%), and acute renal failure requiring dialysis in 5 (2.5%). Logistic regression analysis revealed that significant factors for the development of paraplegia were preoperative hypotension (p = 0.005, odds ratio 18.5), intraoperative hypotension (p = 0.001, odds ratio 77.6), and an open distal anastomosis technique (p = 0.012, odds ratio 4.6). The predictors of postoperative paraplegia in our institution were perioperative hypotension and an open distal anastomosis technique. Avoidance of these risk factors might diminish the incidence of postoperative paraplegia. © The Author(s) 2014 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav.

Endovascular aortic aneurysm repair with chimney and snorkel grafts: indications, techniques and results.

PubMed

Patel, Rakesh P; Katsargyris, Athanasios; Verhoeven, Eric L G; Adam, Donald J; Hardman, John A

2013-12-01

The chimney technique in endovascular aortic aneurysm repair (Ch-EVAR) involves placement of a stent or stent-graft parallel to the main aortic stent-graft to extend the proximal or distal sealing zone while maintaining side branch patency. Ch-EVAR can facilitate endovascular repair of juxtarenal and aortic arch pathology using available standard aortic stent-grafts, therefore, eliminating the manufacturing delays required for customised fenestrated and branched stent-grafts. Several case series have demonstrated the feasibility of Ch-EVAR both in acute and elective cases with good early results. This review discusses indications, technique, and the current available clinical data on Ch-EVAR.

Complex epithelial remodeling underlie the fusion event in early fetal development of the human penile urethra.

PubMed

Shen, Joel; Overland, Maya; Sinclair, Adriane; Cao, Mei; Yue, Xuan; Cunha, Gerald; Baskin, Laurence

We recently described a two-step process of urethral plate canalization and urethral fold fusion to form the human penile urethra. Canalization ("opening zipper") opens the solid urethral plate into a groove, and fusion ("closing zipper") closes the urethral groove to form the penile urethra. We hypothesize that failure of canalization and/or fusion during human urethral formation can lead to hypospadias. Herein, we use scanning electron microscopy (SEM) and analysis of transverse serial sections to better characterize development of the human fetal penile urethra as contrasted to the development of the human fetal clitoris. Eighteen 7-13 week human fetal external genitalia specimens were analyzed by SEM, and fifteen additional human fetal specimens were sectioned for histologic analysis. SEM images demonstrate canalization of the urethral/vestibular plate in the developing male and female external genitalia, respectively, followed by proximal to distal fusion of the urethral folds in males only. The fusion process during penile development occurs sequentially in multiple layers and through the interlacing of epidermal "cords". Complex epithelial organization is also noted at the site of active canalization. The demarcation between the epidermis of the shaft and the glans becomes distinct during development, and the epithelial tag at the distal tip of the penile and clitoral glans regresses as development progresses. In summary, SEM analysis of human fetal specimens supports the two-zipper hypothesis of formation of the penile urethra. The opening zipper progresses from proximal to distal along the shaft of the penis and clitoris into the glans in identical fashion in both sexes. The closing zipper mechanism is active only in males and is not a single process but rather a series of layered fusion events, uniquely different from the simple fusion of two epithelial surfaces as occurs in formation of the palate and neural tube. Copyright © 2016 International Society of Differentiation. Published by Elsevier B.V. All rights reserved.

Simultaneous bilateral distal biceps tendon rupture during a preacher curl exercise: a case report.

PubMed

Rokito, Andrew S; lofin, Ilya

2008-01-01

Complete rupture of the distal biceps tendon is a rare injury, the overwhelming majority occurring in the dominant arm of males during the fourth to sixth decades of life. Simultaneous bilateral rupture of the distal biceps tendon is an extremely rare occurrence, with only three cases reported in the literature. This unusual injury occurred in a recreational weightlifter during a preacher curl exercise. In this particular case, a 6-week delay in presentation necessitated a staged procedure in which a primary repair was feasible in one elbow, while reconstruction using allograft tissue was required in the contralateral elbow. Satisfactory results for both elbows were achieved, with return to weightlifting by one year following surgery.

Nerves and Tissue Repair.

DTIC Science & Technology

1994-07-01

axolotl limbs are transected the concentration of transferrin in the distal limb tissue declines rapidly and limb regeneration stops. These results...transferrin binding and expression of the transferrin gene in cells of axolotl peripheral nerve indicate that both uptake and synthesis of this factor occur

Contrast enema findings in patients presenting with poor functional outcome after primary repair for Hirschsprung disease.

PubMed

Garrett, Kevin M; Levitt, Marc A; Peña, Alberto; Kraus, Steven J

2012-09-01

The radiologic evaluation of Hirschsprung disease is well described in the literature. However, there is a paucity of literature describing the appearance of the neo-rectum and colon after repair, specifically describing findings in patients with poor functional outcome, which would suggest the need for reoperation. We describe findings on contrast enema and correlate them with surgical findings at reoperation in children with poor functional outcome after primary repair for Hirschsprung disease who suffer from bowel dysfunction that can manifest with either soiling or obstructive symptoms such as enterocolitis. Children were identified from our colorectal surgery database. At the time of abstract submission, 35 children had contrast enemas prior to reoperation. Additional children continue to present for evaluation. The majority of children included in the study had their primary repair performed elsewhere. The initial procedures included: Duhamel (n = 11), Soave (n = 20) or Swenson (n = 3). One child had undergone a primary Soave repair and subsequently had a Swenson-type reoperation but continued to have a poor outcome. One child's initial surgical repair could not be determined. Images were reviewed by a staff pediatric radiologist and a pediatric radiology fellow. Findings encountered on contrast enema in these children include a distal narrowed segment due to stricture or aganglionic/transitional zone segment (8), dilated/hypomotile distal segment (7), thickened presacral space due to compressing Soave cuff (11), dilated Duhamel pouch (8), active enterocolitis (3) and partially obstructing twist of the pull-through segment (1). Multiple anatomical and pathological complications exist that can lead to bowel dysfunction in children after repair of Hirschsprung disease. Little recent literature exists regarding the radiographic findings in children. We had the opportunity to review a substantial series of these children, describe the contrast enema findings in these difficult cases and correlate them with operative findings. Radiologic evaluation is key to assessing such patients; it defines the potential anatomical problem with the pull-through and facilitates surgical planning.

Challenging surgical dogma in the management of proximal esophageal atresia with distal tracheoesophageal fistula: Outcomes from the Midwest Pediatric Surgery Consortium.

PubMed

Lal, Dave R; Gadepalli, Samir K; Downard, Cynthia D; Ostlie, Daniel J; Minneci, Peter C; Swedler, Ruth M; Chelius, Thomas H; Cassidy, Laura; Rapp, Cooper T; Billmire, Deborah; Bruch, Steven; Burns, R Carland; Deans, Katherine J; Fallat, Mary E; Fraser, Jason D; Grabowski, Julia; Hebel, Ferdynand; Helmrath, Michael A; Hirschl, Ronald B; Kabre, Rashmi; Kohler, Jonathan; Landman, Matthew P; Leys, Charles M; Mak, Grace Z; Raque, Jessica; Rymeski, Beth; Saito, Jacqueline M; St Peter, Shawn D; von Allmen, Daniel; Warner, Brad W; Sato, Thomas T

2017-06-01

Perioperative management of infants with esophageal atresia and tracheoesophageal fistula (EA/TEF) is frequently based on surgeon experience and dogma rather than evidence-based guidelines. This study examines whether commonly perceived important aspects of practice affect outcome in a contemporary multi-institutional cohort of patients undergoing primary repair for the most common type of esophageal atresia anomaly, proximal EA with distal TEF. The Midwest Pediatric Surgery Consortium conducted a multicenter, retrospective study examining selected outcomes on infants diagnosed with proximal EA with distal TEF who underwent primary repair over a 5-year period (2009-2014), with a minimum 1-year follow up, across 11 centers. 292 patients with proximal EA and distal TEF who underwent primary repair were reviewed. The overall mortality was 6% and was significantly associated with the presence of congenital heart disease (OR 4.82, p=0.005). Postoperative complications occurred in 181 (62%) infants, including: anastomotic stricture requiring intervention (n=127; 43%); anastomotic leak (n=54; 18%); recurrent fistula (n=15; 5%); vocal cord paralysis/paresis (n=14; 5%); and esophageal dehiscence (n=5; 2%). Placement of a transanastomotic tube was associated with an increase in esophageal stricture formation (OR 2.2, p=0.01). Acid suppression was not associated with altered rates of stricture, leak or pneumonia (all p>0.1). Placement of interposing prosthetic material between the esophageal and tracheal suture lines was associated with an increased leak rate (OR 4.7, p<0.001), but no difference in the incidence of recurrent fistula (p=0.3). Empiric postoperative antibiotics for >24h were used in 193 patients (66%) with no difference in rates of infection, shock or death when compared to antibiotic use ≤24h (all p>0.3). Hospital volume was not associated with postoperative complication rates (p>0.08). Routine postoperative esophagram obtained on day 5 resulted in no delayed/missed anastomotic leaks or a difference in anastomotic leak rate as compared to esophagrams obtained on day 7. Morbidity after primary repair of proximal EA and distal TEF patients is substantial, and many common practices do not appear to reduce complications. Specifically, this large retrospective series does not support the use of prophylactic antibiotics beyond 24h and empiric acid suppression may not prevent complications. Use of a transanastomotic tube was associated with higher rates of stricture, and interposition of prosthetic material was associated with higher leak rates. Routine postoperative esophagram can be safely obtained on day 5 resulting in earlier initiation of oral feeds. Treatment study. III. Copyright © 2017 Elsevier Inc. All rights reserved.

Distal small bowel motility and lipid absorption in patients following abdominal aortic aneurysm repair surgery

PubMed Central

Fraser, Robert J; Ritz, Marc; Matteo, Addolorata C Di; Vozzo, Rosalie; Kwiatek, Monika; Foreman, Robert; Stanley, Brendan; Walsh, Jack; Burnett, Jim; Jury, Paul; Dent, John

2006-01-01

AIM: To investigate distal small bowel motility and lipid absorption in patients following elective abdominal aortic aneurysm (AAA) repair surgery. METHODS: Nine patients (aged 35-78 years; body mass index (BMI) range: 23-36 kg/m2) post-surgery for AAA repair, and seven healthy control subjects (20-50 years; BMI range: 21-29 kg/m2) were studied. Continuous distal small bowel manometry was performed for up to 72 h, during periods of fasting and enteral feeding (Nutrison®). Recordings were analyzed for the frequency, origin, length of migration, and direction of small intestinal burst activity. Lipid absorption was assessed on the first day and the third day post surgery in a subset of patients using the 13C-triolein-breath test, and compared with healthy controls. Subjects received a 20-min intraduodenal infusion of 50 mL liquid feed mixed with 200 μL 13C-triolein. End-expiratory breath samples were collected for 6 h and analyzed for 13CO2 concentration. RESULTS: The frequency of burst activity in the proximal and distal small intestine was higher in patients than in healthy subjects, under both fasting and fed conditions (P < 0.005). In patients there was a higher proportion of abnormally propagated bursts (71% abnormal), which began to normalize by d 3 (25% abnormal) post-surgery. Lipid absorption data was available for seven patients on d 1 and four patients on d 3 post surgery. In patients, absorption on d 1 post-surgery was half that of healthy control subjects (AUC 13CO2 1 323 ± 244 vs 2 646 ±365; P < 0.05, respectively), and was reduced to the one-fifth that of healthy controls by d 3 (AUC 13CO2 470 ± 832 vs 2 646 ± 365; P < 0.05, respectively). CONCLUSION: Both proximal and distal small intestinal motor activity are transiently disrupted in critically ill patients immediately after major surgery, with abnormal motility patterns extending as far as the ileum. These motor disturbances may contribute to impaired absorption of enteral nutrition, especially when intraluminal processing is necessary for efficient digestion. PMID:16489672

Correlation Analysis of Cocoa Consumption Data with Worldwide Incidence Rates of Testicular Cancer and Hypospadias

PubMed Central

Giannandrea, Fabrizio

2009-01-01

The underlying reasons for the increasing occurrence of male reproductive diseases (MRD) such as hypospadias, cryptorchidism, and testicular cancer (TC) over the last decades are still unknown. It has been hypothesized that the risk of MRD is determined in utero and that pregnancy dietary intake could also affect MRD risk in the offspring. Various studies in animals reported that cocoa and theobromine, the main stimulant of cocoa, exert toxic effects on the testis, inducing testicular atrophy and impaired sperm quality. A correlation analysis was conducted to examine the possible role of cocoa consumption on the occurrence of selected MRD during the prenatal and early life period of cases. The incidence rates between 1998–2002 of TC in 18 countries obtained from Cancer Incidence in Five Continents were correlated with the average per-capita consumption of cocoa (kg/capita/year) (FAOSTAT-Database) in these countries from 1965 to 1980, i.e. the period corresponding to the early life of TC cases. In order to test the above correlation in the case of hypospadias, the mean prevalence at birth in 20 countries (1999–2003) with average per-capita consumption of cocoa in these countries in the same period corresponding to pregnancy were used. The consumption of cocoa in the period 1965–80, was most closely correlated with the incidence of TC in young adults (r=0.859; p<0.001). An analogous significant correlation was also observed between early cocoa consumption and the prevalence rates of hypospadias in the period 1999–2003 (r=0.760; p<0.001). Although the ecological approach used in this study cannot provide an answer on the causal relationship between consumption of cocoa in early life and TC and hypospadias, the results are suggestive and indicate the need of further analytic studies to investigate the role of individual exposure to cocoa, particularly during the prenatal and in early life of the patients. PMID:19440400

Correlation analysis of cocoa consumption data with worldwide incidence rates of testicular cancer and hypospadias.

PubMed

Giannandrea, Fabrizio

2009-02-01

The underlying reasons for the increasing occurrence of male reproductive diseases (MRD) such as hypospadias, cryptorchidism, and testicular cancer (TC) over the last decades are still unknown. It has been hypothesized that the risk of MRD is determined in utero and that pregnancy dietary intake could also affect MRD risk in the offspring. Various studies in animals reported that cocoa and theobromine, the main stimulant of cocoa, exert toxic effects on the testis, inducing testicular atrophy and impaired sperm quality. A correlation analysis was conducted to examine the possible role of cocoa consumption on the occurrence of selected MRD during the prenatal and early life period of cases. The incidence rates between 1998-2002 of TC in 18 countries obtained from Cancer Incidence in Five Continents were correlated with the average per-capita consumption of cocoa (kg/capita/year) (FAOSTAT-Database) in these countries from 1965 to 1980, i.e. the period corresponding to the early life of TC cases. In order to test the above correlation in the case of hypospadias, the mean prevalence at birth in 20 countries (1999-2003) with average per-capita consumption of cocoa in these countries in the same period corresponding to pregnancy were used. The consumption of cocoa in the period 1965-80, was most closely correlated with the incidence of TC in young adults (r=0.859; p<0.001). An analogous significant correlation was also observed between early cocoa consumption and the prevalence rates of hypospadias in the period 1999-2003 (r=0.760; p<0.001). Although the ecological approach used in this study cannot provide an answer on the causal relationship between consumption of cocoa in early life and TC and hypospadias, the results are suggestive and indicate the need of further analytic studies to investigate the role of individual exposure to cocoa, particularly during the prenatal and in early life of the patients.

Comparison between open and arthroscopic-assisted foveal triangular fibrocartilage complex repair for post-traumatic distal radio-ulnar joint instability.

PubMed

Luchetti, R; Atzei, A; Cozzolino, R; Fairplay, T; Badur, N

2014-10-01

The aim of this study was to assess the objective and subjective functional outcomes after foveal reattachment of proximal or complete ulnar-sided triangular fibrocartilage complex lesions by two surgical procedures: an open technique or an arthroscopically assisted repair. The study was done prospectively on 49 wrists affected by post-traumatic distal radio-ulnar joint instability. Twenty-four patients were treated with the open technique (Group 1) and 25 by the arthroscopically assisted technique (Group 2). Magnetic resonance imaging demonstrated a clear foveal detachment of the triangular fibrocartilage complex in 67% of the cases. Arthroscopy showed a positive ulnar-sided detachment of the triangular fibrocartilage complex (positive hook test) in all cases. Distal radio-ulnar joint stability was obtained in all but five patients at a mean follow-up of 6 months. Both groups had improvement of all parameters with significant differences in wrist pain scores, Mayo wrist score, Disability of the Arm, Shoulder and Hand questionnaire and Patient-Rated Wrist/Hand Evaluation questionnaire scores. There were no significant post-operative differences between the two groups in the outcome parameters except for the Disability of the Arm Shoulder and Hand questionnaire score, which was significantly better in Group 2 (p < 0.001). © The Author(s) 2013.

Murine P-glycoprotein Deficiency Alters Intestinal Injury Repair and Blunts Lipopolysaccharide-Induced Radioprotection

PubMed Central

Staley, Elizabeth M.; Yarbrough, Vanisha R.; Schoeb, Trenton R.; Daft, Joseph G.; Tanner, Scott M.; Steverson, Dennis; Lorenz, Robin G.

2012-01-01

P-glycoprotein (P-gp) has been reported to increase stem cell proliferation and regulate apoptosis. Absence of P-gp results in decreased repair of intestinal epithelial cells after chemical injury. To further explore the mechanisms involved in the effects of P-gp on intestinal injury and repair, we used the well-characterized radiation injury model. In this model, injury repair is mediated by production of prostaglandins (PGE2) and lipopolysaccharide (LPS) has been shown to confer radioprotection. B6.mdr1a−/− mice and wild-type controls were subjected to 12 Gy total body X-ray irradiation and surviving crypts in the proximal jejunum and distal colon were evaluated 3.5 days after irradiation. B6.mdr1a−/−mice exhibited normal baseline stem cell proliferation and COX dependent crypt regeneration after irradiation. However, radiation induced apoptosis was increased and LPS-induced radioprotection was blunted in the C57BL6.mdr1a−/−distal colon, compared to B6 wild-type controls. The LPS treatment induced gene expression of the radioprotective cytokine IL-1α, in B6 wild-type controls but not in B6.mdr1a−/− animals. Lipopolysaccharid-induced radioprotection was absent in IL-1R1−/− animals, indicating a role for IL-1α in radioprotection, and demonstrating that P-gp deficiency interferes with IL-1α gene expression in response to systemic exposure to LPS. PMID:22780103

Repair of the posterior root of the medial meniscus.

PubMed

Jones, Christopher; Reddy, Sudheer; Ma, C Benjamin

2010-01-01

Tears of the posterior root of the medial meniscus are becoming increasingly recognized. Early identification and treatment of these tears help halt the progression of cartilage degeneration and osteoarthritis of the knee. Repair of these tears is essential for recreating the hoop stress of the medial meniscus. In this note, we describe a successful arthroscopic technique to repair this lesion. A posteromedial portal is established by which two 2-0 PDS sutures are placed through the meniscus root and pulled down through a trans-tibial tunnel and fixed using an EndoButton distally along the anterolateral cortex of the tibia. This has been performed successfully in five patients with no complications.

Large Extremity Peripheral Nerve Repair

DTIC Science & Technology

2016-12-01

norbornene-2,3-dicarboxylic anhydride)/DMP-30 [2,4,6-tri (dimethylamino- methyl)phenol] (Tousimis Research Corp., Rock- ville, Md.); and then baked ...embedded in Epoxy resin (Tousimis Research Corpora- tion, Rockville, MD), and then baked overnight in a 60°C oven. From each proximal and distal

Reconstruction of a ruptured patellar tendon using ipsilateral semitendinosus and gracilis tendons with preserved distal insertions: two case reports

PubMed Central

2013-01-01

Background Acute patellar tendon ruptures with poor tissue quality. Ruptures that have been neglected are difficult to repair. Several surgical techniques for the repair of the patellar tendon have been reported, however, these techniques remain difficult because of contractures, adhesions, and atrophy of the quadriceps muscle after surgery. Case presentation We report the cases of 2 Japanese patients (Case 1: a 16-year-old male and Case 2: a 43-year-old male) with patellar tendon ruptures who were treated by reconstruction using semitendinosus-gracilis (STG) tendons with preserved distal insertions. Retaining the original insertion of the STG appears to preserve its viability and provide the revascularization necessary to accelerate healing. Both tendons were placed in front of the patella, in a figure-of-eight fashion, providing stability to the patella. Conclusion Both patients recovered near normal strength and stability of the patellar tendon as well as restoration of function after the operation. PMID:24010848

Case report and review of the literature total endovascular repair of acute ascending aortic rupture: a case report and review of the literature.

PubMed

McCallum, John C; Limmer, Karl K; Perricone, Anthony; Bandyk, Dennis; Kansal, Nikhil

2013-07-01

Thoracic aortic endografting has been successfully implemented to treat aneurysmal disease of the distal aortic arch and descending thoracic aorta. Although there are reports of ascending aortic endovascular interventions, the total endovascular repair of a ruptured ascending aorta secondary to a Type A dissection has not been described. We report the case of a 77-year-old patient who presented with a ruptured ascending aortic aneurysm secondary to degeneration of a Stanford type A aortic dissection. His surgical history was significant for orthotropic heart transplant 19 years prior. The dissection, aneurysm, and rupture occurred in the native aorta distal to the ascending aortic suture line. At presentation, he was hemodynamically unstable with a right hemothorax. We placed 3 Medtronic Talent Thoracic Stent Graft devices (Medtronic Inc, Minneapolis, MN) across the suture line in the ascending aorta, excluding the rupture. The patient survived and has been followed to 25 months.

Analogous cellular contribution and healing mechanisms following digit amputation and phalangeal fracture in mice

PubMed Central

Dawson, Lindsay A.; Simkin, Jennifer; Sauque, Michelle; Pela, Maegan; Palkowski, Teresa

2016-01-01

Abstract Regeneration of amputated structures is severely limited in humans and mice, with complete regeneration restricted to the distal portion of the terminal phalanx (P3). Here, we investigate the dynamic tissue repair response of the second phalangeal element (P2) post amputation in the adult mouse, and show that the repair response of the amputated bone is similar to the proximal P2 bone fragment in fracture healing. The regeneration‐incompetent P2 amputation response is characterized by periosteal endochondral ossification resulting in the deposition of new trabecular bone, corresponding to a significant increase in bone volume; however, this response is not associated with bone lengthening. We show that cells of the periosteum respond to amputation and fracture by contributing both chondrocytes and osteoblasts to the endochondral ossification response. Based on our studies, we suggest that the amputation response represents an attempt at regeneration that ultimately fails due to the lack of a distal organizing influence that is present in fracture healing. PMID:27499878

Iatrogenic injuries of the common femoral artery (CFA) and external iliac artery (EIA) during endograft placement: an underdiagnosed entity.

PubMed

Hingorani, Anil P; Ascher, Enrico; Marks, Natalie; Shiferson, Alexander; Patel, Nirav; Gopal, Kapil; Jacob, Theresa

2009-09-01

Early limb occlusions following endovascular treatment of aorto-iliac aneurysmal disease is not uncommon (4%-13%). To assess whether the femoral artery entry site could potentially cause this complication, we prospectively evaluated the ipsilateral common femoral artery (CFA) and distal external iliac artery (EIA) with intraoperative duplex scans (IDS). There were 134 patients with infrarenal nonruptured abdominal aorto-iliac aneurysms treated with endografts since 2002 at our institution. Age ranged from 65 to 89 years (mean: 77 +/- 7 years). Aneuryx (n = 41), Zenith (n = 50), and Excluder (n = 43) endografts were used for repair. All procedures were performed via open exposure of the CFA. Introducer diameter varied from 12 mm to 22 mm. All patients underwent IDS of the CFA and distal EIA after repair of the arteriotomies. In 34 patients (25%), we documented intimal dissections causing severe (>70%) stenoses. Of the 271 arteries that were examined, 38 (14%) had abnormal findings that demanded intervention. These were repaired with flap excision, tacking sutures revision, or patch angioplasty (n = 36). Repeat IDS confirmed the adequacy of the repair. No statistical difference was noted if the site of larger introducer sheath and the incidence of flap formation. In addition, 10 small flaps or plaques were visualized but did not create significant stenosis. No differences were noted in the incidence of positive duplex exams between each type graft (P = .4). No early or late iliac limb occlusions were noted. Follow-up of 94% was obtained. Completion arterial duplex scans are helpful in detecting a substantial number of clinically unsuspected technical defects caused by introducer sheaths. Timely diagnosis and repair of these defects may decrease the incidence of early limb occlusion following endograft placement.

Comparative Evaluation of Chitosan Nerve Guides with Regular or Increased Bendability for Acute and Delayed Peripheral Nerve Repair: A Comprehensive Comparison with Autologous Nerve Grafts and Muscle-in-Vein Grafts.

PubMed

Stößel, Maria; Wildhagen, Vivien M; Helmecke, Olaf; Metzen, Jennifer; Pfund, Charlotte B; Freier, Thomas; Haastert-Talini, Kirsten

2018-05-08

Reconstruction of joint-crossing digital nerves requires the application of nerve guides with a much higher flexibility than used for peripheral nerve repair along larger bones. Nevertheless, collapse-resistance should be preserved to avoid secondary damage to the regrowing nerve tissue. In recent years, we presented chitosan nerve guides (CNGs) to be highly supportive for the regeneration of critical gap length peripheral nerve defects in the rat. Now, we evidently increased the bendability of regular CNGs (regCNGs) by developing a wavy wall structure, that is, corrugated CNGs (corrCNGs). In a comprehensive in vivo study, we compared both types of CNGs with clinical gold standard autologous nerve grafts (ANGs) and muscle-in-vein grafts (MVGs) that have recently been highlighted in the literature as a suitable alternative to ANGs. We reconstructed rat sciatic nerves over a critical gap length of 15 mm either immediately upon transection or after a delay period of 45 days. Electrodiagnostic measurements were applied to monitor functional motor recovery at 60, 90, 120, and 150 (only delayed repair) days postreconstruction. Upon explanation, tube properties were analyzed. Furthermore, distal nerve ends were evaluated using histomorphometry, while connective tissue specimens were subjected to immunohistological stainings. After 120 days (acute repair) or 150 days (delayed repair), respectively, compression-stability of regCNGs was slightly increased while it remained stable in corrCNGs. In both substudies, regCNGs and corrCNGs supported functional recovery of distal plantar muscles in a similar way and to a greater extent when compared with MVGs, while ANGs demonstrated the best support of regeneration. Anat Rec, 2018. © 2018 Wiley Periodicals, Inc. © 2018 Wiley Periodicals, Inc.

A novel conduit-based coaptation device for primary nerve repair.

PubMed

Bamba, Ravinder; Riley, D Colton; Kelm, Nathaniel D; Cardwell, Nancy; Pollins, Alonda C; Afshari, Ashkan; Nguyen, Lyly; Dortch, Richard D; Thayer, Wesley P

2018-06-01

Conduit-based nerve repairs are commonly used for small nerve gaps, whereas primary repair may be performed if there is no tension on nerve endings. We hypothesize that a conduit-based nerve coaptation device will improve nerve repair outcomes by avoiding sutures at the nerve repair site and utilizing the advantages of a conduit-based repair. The left sciatic nerves of female Sprague-Dawley rats were transected and repaired using a novel conduit-based device. The conduit-based device group was compared to a control group of rats that underwent a standard end-to-end microsurgical repair of the sciatic nerve. Animals underwent behavioral assessments at weekly intervals post-operatively using the sciatic functional index (SFI) test. Animals were sacrificed at four weeks to obtain motor axon counts from immunohistochemistry. A sub-group of animals were sacrificed immediately post repair to obtain MRI images. SFI scores were superior in rats which received conduit-based repairs compared to the control group. Motor axon counts distal to the injury in the device group at four weeks were statistically superior to the control group. MRI tractography was used to demonstrate repair of two nerves using the novel conduit device. A conduit-based nerve coaptation device avoids sutures at the nerve repair site and leads to improved outcomes in a rat model. Conduit-based nerve repair devices have the potential to standardize nerve repairs while improving outcomes.

[Repairing of soft tissue defect in leg by free vascularized thoracoumbilical flap with reversed flow].

PubMed

Xu, Y Q; Li, Z Y; Li, J

2000-11-01

To investigate the clinical effect of free vascularized thoracoumbilical flap with reversal flow in repairing the soft tissue defect in leg with tibia exposure. Forty-four casting mould specimens of leg arteries were studied firstly. Then 25 cases with soft tissue defect and tibia exposure in the proximal-middle segment of leg were adopted in this study. Among them, 18 cases had long distance thrombosis of the anterior tibial vessels or posterior tibial vessels due to traumatic lesion. The maximal size of defect was 28 cm x 11 cm and the minimal size of defect was 11 cm x 9 cm. In operation, the thoracoumbilical flap which was based on the inferior epigastric vessels was anastomosed to the distal end of the anterior tibial vessels or posterior tibial vessels. Anterior tibial artery, posterior tibial artery and fibular artery had rich communication branches in foot and ankle. All the flaps survived, the color and cosmetic result of them were good. The free vascularized thoracoumbilical flap with reversed flow is practical in repairing the soft tissue defect of leg with tibia exposure. Either the anterior tibial vessels or the posterior tibial vessels is normal, and the distal end of injured blood vessels is available, this technique can be adopted.

[RESEARCH PROGRESS OF BIOMECHANICS OF PROXIMAL ROW CARPAL INSTABILITY].

PubMed

Guo, Jinhai; Huang, Fuguo

2015-01-01

To review the research progress of the biomechanics of proximal row carpal instability (IPRC). The related literature concerning IPRC was extensively reviewed. The biomechanical mechanism of the surrounding soft tissue in maintaining the stability of the proximal row carpal (PRC) was analyzed, and the methods to repair or reconstruct the stability and function of the PRC were summarized from two aspects including basic biomechanics and clinical biomechanics. The muscles and ligaments of the PRC are critical to its stability. Most scholars have reached a consensus about biomechanical mechanism of the PRC, but there are still controversial conclusions on the biomechanics mechanism of the surrounding soft tissue to stability of distal radioulnar joint when the triangular fibrocartilage complex are damaged and the biomechanics mechanism of the scapholunate ligament. At present, there is no unified standard about the methods to repair or reconstruct the stability and function of the PRC. So, it is difficult for clinical practice. Some strides have been made in the basic biomechanical study on muscle and ligament and clinical biomechanical study on the methods to repair or reconstruct the stability and function of PRC, but it will be needed to further study the morphology of carpal articular surface and the adjacent articular surface, the pressure of distal carpals to proximal carpal and so on.

Flightless I Expression Enhances Murine Claw Regeneration Following Digit Amputation.

PubMed

Strudwick, Xanthe L; Waters, James M; Cowin, Allison J

2017-01-01

The mammalian digit tip is capable of both reparative and regenerative wound healing dependent on the level of amputation injury. Removal of the distal third of the terminal phalange results in successful regeneration, whereas a more severe, proximal, amputation heals by tissue repair. Flightless I (Flii) is involved in both tissue repair and regeneration. It negatively regulates wound repair but elicits a positive effect in hair follicle regeneration, with Flii overexpression resulting in significantly longer hair fibers. Using a model of digit amputation in Flii overexpressing (FIT) mice, we investigated Flii in digit regeneration. Both wild-type and FIT digits regenerated after distal amputation with newly regenerated FIT claws being significantly longer than intact controls. No regeneration was observed in wild-type mice after severe proximal amputation; however, FIT mice showed significant regeneration of the missing digit. Using a three-dimensional model of nail formation, connective tissue fibroblasts isolated from the mesenchymal tissue surrounding the wild-type and FIT digit tips and cocultured with skin keratinocytes demonstrated aggregate structures resembling rudimentary nail buds only when Flii was overexpressed. Moreover, β-catenin and cyclin D1 expression was maintained in the FIT regenerating germinal matrix suggesting a potential interaction of Flii with Wnt signaling during regeneration. Copyright © 2016 The Authors. Published by Elsevier Inc. All rights reserved.

A new tactile gnosis instrument in sensibility testing.

PubMed

Rosén, B; Lundborg, G

1998-01-01

A new quantitative test instrument for the assessment of tactile gnosis--the ability to identify shapes and textures without vision--is introduced. Introductory investigations of validity and reliability are presented. Fifty-four patients (60 hands) with carpal tunnel syndrome, vibration-induced neuropathy, or nerve repair at distal forearm level, and a matched asymptomatic control group were initially examined. After establishing the cut-off limit for normal tactile gnosis, sensitivity and specificity were calculated to determine the discriminative power of the new instrument. A high sensitivity (1.0) of the new shape/texture identification test was found in the group of patients with nerve repair. Given a cut-off limit, the sensitivity was lower in the groups with vibration-induced neuropathy and carpal tunnel syndrome (0.65 and 0.40, respectively), and the specificity of the test was 0.90 to 0.95. In a second step, a group of 52 patients who had had nerve repair at the distal forearm level were examined. Test-retest reliability was good, with a weighted kappa value of 0.79 to 0.81. Good reliability was also shown in the internal consistency of test items, with a Cronbach alpha value of 0.78. These introductory results indicate that the new shape/texture identification test can be useful in the assessment of tactile gnosis.

Pyoderma Gangranosum of the Penis

PubMed Central

Kim, Tae Heung; Oh, Seung Young

2009-01-01

We report a patient who developed pyoderma gangrenosum in the penis with invasion of the distal urethra. The patient was treated with prednisolone and thalidomide, followed by a reconstructive surgical repair using a scrotal island flap. We report this case with a brief review of the literature. PMID:19949683

DOE Office of Scientific and Technical Information (OSTI.GOV)

Patel, Rakesh P., E-mail: rpatel9@nhs.net; Katsargyris, Athanasios, E-mail: kthanassos@yahoo.com; Verhoeven, Eric L. G., E-mail: Eric.Verhoeven@klinikum-nuernberg.de

The chimney technique in endovascular aortic aneurysm repair (Ch-EVAR) involves placement of a stent or stent-graft parallel to the main aortic stent-graft to extend the proximal or distal sealing zone while maintaining side branch patency. Ch-EVAR can facilitate endovascular repair of juxtarenal and aortic arch pathology using available standard aortic stent-grafts, therefore, eliminating the manufacturing delays required for customised fenestrated and branched stent-grafts. Several case series have demonstrated the feasibility of Ch-EVAR both in acute and elective cases with good early results. This review discusses indications, technique, and the current available clinical data on Ch-EVAR.

Arthroscopic Management of Triangular Fibrocartilage Complex Foveal Injury.

PubMed

Fujio, Keiji

2017-11-01

The deep component of triangular fibrocartilage complex (TFCC) inserts onto the fovea of the ulnar head. This component is critical to provide distal radioulnar joint stability. The surgical techniques and results of transosseous inside-out TFCC foveal repair are discussed. The rewarding results encouraged the repair of TFCC to the fovea arthroscopically. Although the results are good, the factors of age (traumatic or degenerative) and quality of stump and TFCC proper, which relate to the results should be considered in the future. Copyright © 2017 Elsevier Inc. All rights reserved.

[Chronic ankle joint instability: in unrecognized distal rupture of the syndosmosis and malunion of the distal fibula].

PubMed

Michelitsch, C; Acklin, Y P; Stoffel, K; Bereiter, H

2014-04-01

It is often difficult in the acute phase to diagnose a lesion of the distal tibiofibular syndesmosis. If this lesion is overlooked, the patient will develop an incongruity of the upper ankle joint with a pathological external rotation of the talus. The risk of a possible premature arthritis is clearly increased. In this case study a distal rupture of the syndesmosis in a young patient was overlooked in the initial diagnostic work-up. A search of the relevant literature and a case report. In the case described the shortened fibula and chronic instability of the tibiofibular syndesmosis were repaired with a lengthening and derotational osteotomy and reconstruction using the gracilis muscle tendon. Through this method an exact reconstruction of the normal anatomy could be achieved. Posttraumatic misalignment in the ankle joint is associated with a high risk of secondary degenerative lesions. In cases with suspicion of a syndesmosis lesion, confirmation of the diagnosis is imperative so as to perform an anatomic repositioning and reconstruction of stability.

Comparison of complete distal release of the medial collateral ligament and medial epicondylar osteotomy during ligament balancing in varus knee total knee arthroplasty.

PubMed

Sim, Jae Ang; Lee, Yong Seuk; Kwak, Ji Hoon; Yang, Sang Hoon; Kim, Kwang Hui; Lee, Beom Koo

2013-12-01

During ligament balancing for severe medial contracture in varus knee total knee arthroplasty (TKA), complete distal release of the medial collateral ligament (MCL) or a medial epicondylar osteotomy can be necessary if a large amount of correction is needed. This study retrospectively reviewed 9 cases of complete distal release of the MCL and 11 cases of medial epicondylar osteotomy which were used to correct severe medial contracture. The mean follow-up periods were 46.5 months (range, 36 to 78 months) and 39.8 months (range, 32 to 65 months), respectively. There were no significant differences in the clinical results between the two groups. However, the valgus stress radiograph revealed significant differences in medial instability. In complete distal release of the MCL, some stability was obtained by repair and bracing but the medial instability could not be removed completely. Medial epicondylar osteotomy for a varus deformity in TKA could provide constant medial stability and be a useful ligament balancing technique.

Management of Endovascular Aortic Aneurysm Complications via Retrograde Catheterization Through the Distal Stent-Graft Landing Zone.

PubMed

Zhang, Xicheng; Sun, Yuan; Chen, Zhaolei; Jing, Yuanhu; Xu, Miao

2017-08-01

A retrograde technique through the gap between the distal stent landing zone and the iliac artery wall has been applied to treat type II endoleak after endovascular aortic aneurysm repair (EVAR). In this study, we tried to investigate its efficacy in the management of type III endoleak and intraoperative accidental events. We reported 2 complications of EVAR that were difficult to treat with conventional methods. One patient had a sustained type III endoleak after EVAR, and the right renal artery was accidentally sealed by a graft stent in the other patient during the operation. Both complications were managed by the retrograde technique from the distal stent landing zone. In the first case, the endoleak was easily embolized by the retrograde catheterization technique, and in the second case, a stent was implanted in the right renal artery using the retrograde technique to restore blood flow. In some EVAR cases, the technique of retrograde catheterization through the distal stent-graft landing zone is feasible, safe, and easy to perform.

Exponential Increase in Relative Biological Effectiveness Along Distal Edge of a Proton Bragg Peak as Measured by Deoxyribonucleic Acid Double-Strand Breaks

DOE Office of Scientific and Technical Information (OSTI.GOV)

Cuaron, John J., E-mail: cuaronj@mskcc.org; Chang, Chang; Lovelock, Michael

2016-05-01

Purpose: To quantify the relative biological effectiveness (RBE) of the distal edge of the proton Bragg peak, using an in vitro assay of DNA double-strand breaks (DSBs). Methods and Materials: U2OS cells were irradiated within the plateau of a spread-out Bragg peak and at each millimeter position along the distal edge using a custom slide holder, allowing for simultaneous measurement of physical dose. A reference radiation signal was generated using photons. The DNA DSBs at 3 hours (to assess for early damage) and at 24 hours (to assess for residual damage and repair) after irradiation were measured using the γH2AX assay and quantifiedmore » via flow cytometry. Results were confirmed with clonogenic survival assays. A detailed map of the RBE as a function of depth along the Bragg peak was generated using γH2AX measurements as a biological endpoint. Results: At 3 hours after irradiation, DNA DSBs were higher with protons at every point along the distal edge compared with samples irradiated with photons to similar doses. This effect was even more pronounced after 24 hours, indicating that the impact of DNA repair is less after proton irradiation relative to photons. The RBE demonstrated an exponential increase as a function of depth and was measured to be as high as 4.0 after 3 hours and as high as 6.0 after 24 hours. When the RBE-corrected dose was plotted as a function of depth, the peak effective dose was extended 2-3 mm beyond what would be expected with physical measurement. Conclusions: We generated a highly comprehensive map of the RBE of the distal edge of the Bragg peak, using a direct assay of DNA DSBs in vitro. Our data show that the RBE of the distal edge increases with depth and is significantly higher than previously reported estimates.« less

The Effects of Bio-Lubricating Molecules on Flexor Tendon Reconstruction in A Canine Allograft Model In Vivo

PubMed Central

Zhao, Chunfeng; Wei, Zhuang; Kirk, Ramona L.; Thoreson, Andrew R.; Jay, Gregory D.; Moran, Steven L.; An, Kai-Nan; Amadio, Peter C.

2014-01-01

Background Using allograft is an attractive alternative for flexor tendon reconstruction because of the lack of donor morbidity, and better matching to the intrasynovial environment. The purpose of this study was to use biolubricant molecules to modify the graft surface to decrease adhesions and improve digit function. Methods 28 flexor digitorum profundus (FDP) tendons from the 2nd and 5th digits of 14 dogs were first lacerated and repaired to create a model with repair failure and scar digit for tendon reconstruction. Six weeks after the initial surgery, the tendons were reconstructed with FDP allograft tendons obtained from canine cadavers. One graft tendon in each dog was treated with saline as a control and the other was treated with gelatin, carbodiimide derivatized, hyaluronic acid and lubricin (cd-HA-Lubricin). Six weeks postoperatively, digit function, graft mechanics, and biology were analyzed. Results Allograft tendons treated with cd-HA-Lubricin had decreased adhesions at the proximal tendon/graft repair and within flexor sheath, improved digit function, and increased graft gliding ability. The treatment also reduced the strength at the distal tendon to bone repair, but the distal attachment rupture rate was similar for both graft types. Histology showed that viable cells migrated to the allograft, but these were limited to the tendon surface. Conclusion cd-HA-Lubricin treatment of tendon allograft improves digit functional outcomes after flexor tendon reconstruction. However, delayed bone-tendon healing should be a caution. Furthermore, the cell infiltration into the allograft tendons substance should be a target for future studies, to shorten the allograft self-regeneration period. PMID:24445876

Arthroscopic-assisted repair of triangular fibrocartilage complex foveal avulsion in distal radioulnar joint injury

PubMed Central

Woo, Sung Jong; Jegal, Midum; Park, Min Jong

2016-01-01

Background: Disruption of the triangular fibrocartilage complex (TFCC) foveal insertion can lead to distal radioulnar joint (DRUJ) instability accompanied by ulnar-sided pain, weakness, snapping, and limited forearm rotation. We investigated the clinical outcomes of patients with TFCC foveal tears treated with arthroscopic-assisted repair. Materials and Methods: Twelve patients underwent foveal repair of avulsed TFCC with the assistance of arthroscopy between 2011 and 2013. These patients were followed up for an average of 19 months (range 14–25 months). The avulsed TFCC were reattached to the fovea using a transosseous pull-out suture or a knotless suture anchor. At the final followup, the range of motion, grip strength and DRUJ stability were measured as objective outcomes. Subjective outcomes were assessed using the Visual Analog Scale (VAS) for pain, patient rated wrist evaluation (PRWE), Disabilities of the Arm, Shoulder and Hand questionnaire (DASH score) and return to work. Results: Based on the DRUJ stress test, 5 patients had normal stability and 7 patients showed mild laxity as compared with the contralateral side. Postoperatively, the mean range of pronation supination increased from 141° to 166°, and the mean VAS score for pain decreased from 5.3 to 1.7 significantly. The PRWE and DASH questionnaires also showed significant functional improvement. All patients were able to return to their jobs. However, two patients complained of persistent pain. Conclusions: Arthroscopically assisted repair of TFCC foveal injury can provide significant pain relief, functional improvement and restoration of DRUJ stability. PMID:27293286

Hydraulic safety margins and embolism reversal in stems and leaves: why are conifers and angiosperms so different?

PubMed

Johnson, Daniel M; McCulloh, Katherine A; Woodruff, David R; Meinzer, Frederick C

2012-10-01

Angiosperm and coniferous tree species utilize a continuum of hydraulic strategies. Hydraulic safety margins (defined as differences between naturally occurring xylem pressures and pressures that would cause hydraulic dysfunction, or differences between pressures resulting in loss of hydraulic function in adjacent organs (e.g., stems vs. leaves) tend to be much greater in conifers than angiosperms and serve to prevent stem embolism. However, conifers tend to experience embolism more frequently in leaves and roots than angiosperms. Embolism repair is thought to occur by active transport of sugars into empty conduits followed by passive water movement. The most likely source of sugar for refilling is from nonstructural carbohydrate depolymerization in nearby parenchyma cells. Compared to angiosperms, conifers tend to have little parenchyma or nonstructural carbohydrates in their wood. The ability to rapidly repair embolisms may rely on having nearby parenchyma cells, which could explain the need for greater safety margins in conifer wood as compared to angiosperms. The frequent embolisms that occur in the distal portions of conifers are readily repaired, perhaps due to the abundant parenchyma in leaves and roots, and these distal tissues may act as hydraulic circuit breakers that prevent tension-induced embolisms in the attached stems. Frequent embolisms in conifer leaves may also be due to weaker stomatal response to changes in ambient humidity. Although there is a continuum of hydraulic strategies among woody plants, there appear to be two distinct 'behaviors' at the extremes: (1) embolism prevention and (2) embolism occurrence and subsequent repair. Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.

Hypospadias and residential proximity to pesticide applications.

PubMed

Carmichael, Suzan L; Yang, Wei; Roberts, Eric M; Kegley, Susan E; Wolff, Craig; Guo, Liang; Lammer, Edward J; English, Paul; Shaw, Gary M

2013-11-01

Experimental evidence suggests pesticides may be associated with hypospadias. Examine the association of hypospadias with residential proximity to commercial agricultural pesticide applications. The study population included male infants born from 1991 to 2004 to mothers residing in 8 California counties. Cases (n = 690) were ascertained by the California Birth Defects Monitoring Program; controls were selected randomly from the birth population (n = 2195). We determined early pregnancy exposure to pesticide applications within a 500-m radius of mother's residential address, using detailed data on applications and land use. Associations with exposures to physicochemical groups of pesticides and specific chemicals were assessed using logistic regression adjusted for maternal race or ethnicity and age and infant birth year. Forty-one percent of cases and controls were classified as exposed to 57 chemical groups and 292 chemicals. Despite >500 statistical comparisons, there were few elevated odds ratios with confidence intervals that excluded 1 for chemical groups or specific chemicals. Those that did were for monochlorophenoxy acid or ester herbicides; the insecticides aldicarb, dimethoate, phorate, and petroleum oils; and adjuvant polyoxyethylene sorbitol among all cases; 2,6-dinitroaniline herbicides, the herbicide oxyfluorfen, and the fungicide copper sulfate among mild cases; and chloroacetanilide herbicides, polyalkyloxy compounds used as adjuvants, the insecticides aldicarb and acephate, and the adjuvant nonyl-phenoxy-poly(ethylene oxy)ethanol among moderate and severe cases. Odds ratios ranged from 1.9 to 2.9. Most pesticides were not associated with elevated hypospadias risk. For the few that were associated, results should be interpreted with caution until replicated in other study populations.

Hypospadias and Residential Proximity to Pesticide Applications

PubMed Central

Yang, Wei; Roberts, Eric M.; Kegley, Susan E.; Wolff, Craig; Guo, Liang; Lammer, Edward J.; English, Paul; Shaw, Gary M.

2013-01-01

BACKGROUND: Experimental evidence suggests pesticides may be associated with hypospadias. OBJECTIVE: Examine the association of hypospadias with residential proximity to commercial agricultural pesticide applications. METHODS: The study population included male infants born from 1991 to 2004 to mothers residing in 8 California counties. Cases (n = 690) were ascertained by the California Birth Defects Monitoring Program; controls were selected randomly from the birth population (n = 2195). We determined early pregnancy exposure to pesticide applications within a 500-m radius of mother’s residential address, using detailed data on applications and land use. Associations with exposures to physicochemical groups of pesticides and specific chemicals were assessed using logistic regression adjusted for maternal race or ethnicity and age and infant birth year. RESULTS: Forty-one percent of cases and controls were classified as exposed to 57 chemical groups and 292 chemicals. Despite >500 statistical comparisons, there were few elevated odds ratios with confidence intervals that excluded 1 for chemical groups or specific chemicals. Those that did were for monochlorophenoxy acid or ester herbicides; the insecticides aldicarb, dimethoate, phorate, and petroleum oils; and adjuvant polyoxyethylene sorbitol among all cases; 2,6-dinitroaniline herbicides, the herbicide oxyfluorfen, and the fungicide copper sulfate among mild cases; and chloroacetanilide herbicides, polyalkyloxy compounds used as adjuvants, the insecticides aldicarb and acephate, and the adjuvant nonyl-phenoxy-poly(ethylene oxy)ethanol among moderate and severe cases. Odds ratios ranged from 1.9 to 2.9. CONCLUSIONS: Most pesticides were not associated with elevated hypospadias risk. For the few that were associated, results should be interpreted with caution until replicated in other study populations. PMID:24167181

Endovascular repair of a traumatic arteriovenous fistula 34 years after the injury: report of a case.

PubMed

Baril, Donald T; Denoya, Paula I; Ellozy, Sharif H; Carroccio, Alfio; Marin, Michael L

2007-01-01

Penetrating extremity injuries can result in the development of arteriovenous fistulas (AVFs), whereby normal blood flow through the capillary bed is bypassed. Late complications of untreated AVFs include proximal arterial dilatation, venous congestion, congestive heart failure, and distal ischemia. We report the case of a 57-year-old man who was referred to us for treatment of a traumatic AVF with multiple sequelae, 34 years after he sustained a shrapnel injury to his right lower leg. We performed successful endovascular repair of this AVF with the patient under spinal anesthesia. Computed tomographic angiography (CTA) done 1 month and 6 months later confirmed AVF exclusion. Patients may present with sequelae of traumatic AVFs many years after their initial injury. Endovascular repair of AVFs offers several advantages over conventional repair and can be performed successfully even in the presence of complex anatomic abnormalities.

Somatically Acquired Isodicentric Y and Mosaic Loss of Chromosome Y in a Boy with Hypospadias.

PubMed

Miyado, Mami; Muroya, Koji; Katsumi, Momori; Saito, Kazuki; Kon, Masafumi; Fukami, Maki

2018-04-07

Isodicentric Y chromosome [idic(Y)] represents a relatively common subtype of Y chromosomal rearrangements in the germline; however, limited evidence supports the postzygotic occurrence of idic(Y). Here, we report a boy with hypospadias and somatically acquired idic(Y). The 3.5-year-old boy has been identified in our previous study for patients with hypospadias. In the present study, cytogenetic analysis including FISH revealed a 45,X[5]/46,X,idic(Y)[7]/46,XY[8] karyotype. MLPA showed a mosaic deletion involving PPP1R12BP1 and RBMY2DP. The idic(Y) was likely to have been formed through aberrant recombination between P1 palindromes and subsequently underwent mosaic loss. The patient's phenotype was attributable to deletion of some Y chromosomal genes and/or mosaic loss of chromosome Y (mLOY). The results suggest that idic(Y) can originate in postzygotic cells via palindrome-mediated crossovers. Moreover, our data indicate that somatically acquired idic(Y) can trigger mLOY, which usually appears as an aging-related phenomenon in elderly men. © 2018 S. Karger AG, Basel.

Variants in congenital hypogonadotrophic hypogonadism genes identified in an Indonesian cohort of 46,XY under-virilised boys.

PubMed

Ayers, Katie L; Bouty, Aurore; Robevska, Gorjana; van den Bergen, Jocelyn A; Juniarto, Achmad Zulfa; Listyasari, Nurin Aisyiyah; Sinclair, Andrew H; Faradz, Sultana M H

2017-02-16

Congenital hypogonadotrophic hypogonadism (CHH) and Kallmann syndrome (KS) are caused by disruption to the hypothalamic-pituitary-gonadal (H-P-G) axis. In particular, reduced production, secretion or action of gonadotrophin-releasing hormone (GnRH) is often responsible. Various genes, many of which play a role in the development and function of the GnRH neurons, have been implicated in these disorders. Clinically, CHH and KS are heterogeneous; however, in 46,XY patients, they can be characterised by under-virilisation phenotypes such as cryptorchidism and micropenis or delayed puberty. In rare cases, hypospadias may also be present. Here, we describe genetic mutational analysis of CHH genes in Indonesian 46,XY disorder of sex development patients with under-virilisation. We present 11 male patients with varying degrees of under-virilisation who have rare variants in known CHH genes. Interestingly, many of these patients had hypospadias. We postulate that variants in CHH genes, in particular PROKR2, PROK2, WDR11 and FGFR1 with CHD7, may contribute to under-virilisation phenotypes including hypospadias in Indonesia.

After Nerve Injury, Lineage Tracing Shows That Myelin and Remak Schwann Cells Elongate Extensively and Branch to Form Repair Schwann Cells, Which Shorten Radically on Remyelination

PubMed Central

van der Lans, Milou; Benito, Cristina; Wagstaff, Laura J.

2017-01-01

There is consensus that, distal to peripheral nerve injury, myelin and Remak cells reorganize to form cellular columns, Bungner's bands, which are indispensable for regeneration. However, knowledge of the structure of these regeneration tracks has not advanced for decades and the structure of the cells that form them, denervated or repair Schwann cells, remains obscure. Furthermore, the origin of these cells from myelin and Remak cells and their ability to give rise to myelin cells after regeneration has not been demonstrated directly, although these conversions are believed to be central to nerve repair. Using genetic lineage-tracing and scanning-block face electron microscopy, we show that injury of sciatic nerves from mice of either sex triggers extensive and unexpected Schwann cell elongation and branching to form long, parallel processes. Repair cells are 2- to 3-fold longer than myelin and Remak cells and 7- to 10-fold longer than immature Schwann cells. Remarkably, when repair cells transit back to myelinating cells, they shorten ∼7-fold to generate the typically short internodes of regenerated nerves. The present experiments define novel morphological transitions in injured nerves and show that repair Schwann cells have a cell-type-specific structure that differentiates them from other cells in the Schwann cell lineage. They also provide the first direct evidence using genetic lineage tracing for two basic assumptions in Schwann cell biology: that myelin and Remak cells generate the elongated cells that build Bungner bands in injured nerves and that such cells can transform to myelin cells after regeneration. SIGNIFICANCE STATEMENT After injury to peripheral nerves, the myelin and Remak Schwann cells distal to the injury site reorganize and modify their properties to form cells that support the survival of injured neurons, promote axon growth, remove myelin-associated growth inhibitors, and guide regenerating axons to their targets. We show that the generation of these repair-supportive Schwann cells involves an extensive cellular elongation and branching, often to form long, parallel processes. This generates a distinctive repair cell morphology that is favorable for the formation of the regeneration tracks that are essential for nerve repair. Remyelination, conversely, involves a striking cell shortening to form the typical short myelin cells of regenerated nerves. We also provide evidence for direct lineage relationships between: (1) repair cells and myelin and Remak cells of uninjured nerves and (2) remyelinating cells in regenerated nerves. PMID:28904214

After Nerve Injury, Lineage Tracing Shows That Myelin and Remak Schwann Cells Elongate Extensively and Branch to Form Repair Schwann Cells, Which Shorten Radically on Remyelination.

PubMed

Gomez-Sanchez, Jose A; Pilch, Kjara S; van der Lans, Milou; Fazal, Shaline V; Benito, Cristina; Wagstaff, Laura J; Mirsky, Rhona; Jessen, Kristjan R

2017-09-13

There is consensus that, distal to peripheral nerve injury, myelin and Remak cells reorganize to form cellular columns, Bungner's bands, which are indispensable for regeneration. However, knowledge of the structure of these regeneration tracks has not advanced for decades and the structure of the cells that form them, denervated or repair Schwann cells, remains obscure. Furthermore, the origin of these cells from myelin and Remak cells and their ability to give rise to myelin cells after regeneration has not been demonstrated directly, although these conversions are believed to be central to nerve repair. Using genetic lineage-tracing and scanning-block face electron microscopy, we show that injury of sciatic nerves from mice of either sex triggers extensive and unexpected Schwann cell elongation and branching to form long, parallel processes. Repair cells are 2- to 3-fold longer than myelin and Remak cells and 7- to 10-fold longer than immature Schwann cells. Remarkably, when repair cells transit back to myelinating cells, they shorten ∼7-fold to generate the typically short internodes of regenerated nerves. The present experiments define novel morphological transitions in injured nerves and show that repair Schwann cells have a cell-type-specific structure that differentiates them from other cells in the Schwann cell lineage. They also provide the first direct evidence using genetic lineage tracing for two basic assumptions in Schwann cell biology: that myelin and Remak cells generate the elongated cells that build Bungner bands in injured nerves and that such cells can transform to myelin cells after regeneration. SIGNIFICANCE STATEMENT After injury to peripheral nerves, the myelin and Remak Schwann cells distal to the injury site reorganize and modify their properties to form cells that support the survival of injured neurons, promote axon growth, remove myelin-associated growth inhibitors, and guide regenerating axons to their targets. We show that the generation of these repair-supportive Schwann cells involves an extensive cellular elongation and branching, often to form long, parallel processes. This generates a distinctive repair cell morphology that is favorable for the formation of the regeneration tracks that are essential for nerve repair. Remyelination, conversely, involves a striking cell shortening to form the typical short myelin cells of regenerated nerves. We also provide evidence for direct lineage relationships between: (1) repair cells and myelin and Remak cells of uninjured nerves and (2) remyelinating cells in regenerated nerves. Copyright © 2017 Gomez-Sanchez et al.

Large Extremity Peripheral Nerve Repair

DTIC Science & Technology

2016-12-01

baked overnight in a 60°C oven. Using a diamond blade, 1-μm sections were cut 5 mm proximal and 5 mm distal to the graft. Histologic slides were...Scien- ces), embedded in Epoxy resin (Tousimis Research Corpora- tion, Rockville, MD), and then baked overnight in a 60°C oven. From each proximal and

Persistent effects of chlorine inhalation on respiratory health

PubMed Central

Hoyle, Gary W.; Svendsen, Erik R.

2016-01-01

Chlorine gas is a toxic respiratory irritant that is considered a chemical threat agent because of the potential for release in industrial accidents or terrorist attacks. Chlorine inhalation damages the respiratory tract, including the airways and distal lung, and can result in acute lung injury. Some individuals exposed to chlorine experience a full recovery from acute injury, whereas others develop persistent adverse effects, such as respiratory symptoms, inflammation, and lung-function decrements. In animal models, chlorine can produce persistent inflammation, remodeling, and obstruction in large or small airways, depending on species. Airways with pseudostratified epithelium are repaired efficiently, with surviving basal epithelial cells serving as progenitor cells that repopulate the complement of differentiated cell types. Distal airways lacking basal cells are repaired less efficiently, leading to chronic inflammation and fibrosis at these sites. Persistent chlorine-induced airway disease in humans is treated with asthma medication to relieve symptoms. However, such treatment does not ameliorate the underlying disease pathogenesis, so treatments that are more effective at preventing initial development of airway disease after irritant gas exposure and at reversing established disease are needed. PMID:27385061

Repair of esophageal atresia with proximal fistula using endoscopic magnetic compression anastomosis (magnamosis) after staged lengthening.

PubMed

Dorman, Robert M; Vali, Kaveh; Harmon, Carroll M; Zaritzky, Mario; Bass, Kathryn D

2016-05-01

We describe the treatment of a patient with long-gap esophageal atresia with an upper pouch fistula, mircogastria and minimal distal esophageal remnant. After 4.5 months of feeding via gastrostomy, a proximal fistula was identified by bronchoscopy and a thoracoscopic modified Foker procedure was performed reducing the gap from approximately 7-5 cm over 2 weeks of traction. A second stage to ligate the fistula and suture approximate the proximal and distal esophagus resulted in a gap of 1.5 cm. IRB and FDA approval was then obtained for endoscopic placement of 10-French catheter mounted magnets in the proximal and distal pouches promoting a magnetic compression anastomosis (magnamosis). Magnetic coupling occurred at 4 days and after magnet removal at 13 days an esophagram demonstrated a 10 French channel without leak. Serial endoscopic balloon dilation has allowed drainage of swallowed secretions as the baby learns bottling behavior at home.

[The repair of bulky tissue defect of forearm with skin flaps].

PubMed

Huang, Xiaoyuan; Long, Jianhong; Xie, Tinghong; Zhang, Minghua; Zhang, Pihong; Yang, Xinghua; Zhong, Keqin

2002-12-01

To evaluate the repairing methods of bulky tissue defect of forearm with flaps. Twenty-one burned patients with wounds in the forearm were enrolled in this study. The injury causes were high-voltage electricity, hot press or crush injury. After local debridement, the forearm defects were repaired with pedicled complex flaps, latissimus dorsi musculocutaneous island flaps or large thoraco-abdominal flaps immediately. All the flaps survived very well with satisfactory results except for 1 patient in whom local ischemic necrosis and sub-flap infection at the distal end of the flap occurred. Early debridement followed by skin flaps with pedicles or musculocutaneous flaps transfer could be simple, safe and reliable treatment strategies in the management of bulky tissue defects of the forearm due to burn, electric injury, or other devastating injuries.

G-CSF prevents caspase 3 activation in Schwann cells after sciatic nerve transection, but does not improve nerve regeneration.

PubMed

Frost, Hanna K; Kodama, Akira; Ekström, Per; Dahlin, Lars B

2016-10-15

Exogenous granulocyte-colony stimulating factor (G-CSF) has emerged as a drug candidate for improving the outcome after peripheral nerve injuries. We raised the question if exogenous G-CSF can improve nerve regeneration following a clinically relevant model - nerve transection and repair - in healthy and diabetic rats. In short-term experiments, distance of axonal regeneration and extent of injury-induced Schwann cell death was quantified by staining for neurofilaments and cleaved caspase 3, respectively, seven days after repair. There was no difference in axonal outgrowth between G-CSF-treated and non-treated rats, regardless if healthy Wistar or diabetic Goto-Kakizaki (GK) rats were examined. However, G-CSF treatment caused a significant 13% decrease of cleaved caspase 3-positive Schwann cells at the lesion site in healthy rats, but only a trend in diabetic rats. In the distal nerve segments of healthy rats a similar trend was observed. In long-term experiments of healthy rats, regeneration outcome was evaluated at 90days after repair by presence of neurofilaments, wet weight of gastrocnemius muscle, and perception of touch (von Frey monofilament testing weekly). The presence of neurofilaments distal to the suture line was similar in G-CSF-treated and non-treated rats. The weight ratio of ipsi-over contralateral gastrocnemius muscles, and perception of touch at any time point, were likewise not affected by G-CSF treatment. In addition, the inflammatory response in short- and long-term experiments was studied by analyzing ED1 stainable macrophages in healthy rats, but in neither case was any attenuation seen at the injury site or distal to it. G-CSF can prevent caspase 3 activation in Schwann cells in the short-term, but does not detectably affect the inflammatory response, nor improve early or late axonal outgrowth or functional recovery. Copyright © 2016 IBRO. Published by Elsevier Ltd. All rights reserved.

Anatomic changes of target vessels after fenestrated and branched aortic aneurysm repair.

PubMed

Kalder, J; Keschenau, P; Tamm, M; Jalaie, H; Jacobs, M J; Greiner, A

2014-04-01

Objective of this study was to evaluate the anatomic changes of the stented target vessels after endovascular repair of complex aortic aneurysms. Between July 2011 and December 2013, 53 aortic aneurysms were treated in our department with fenestrated and branched stent-graft devices. Forty-two of these patients were pre- and postoperatively scanned with a high resolution computer tomography (CT) (Cook Zenith® fenestrated or branched, Australia Pty. Ltd., Brisbane, Australia: N.=19; AnacondaTM fenestrated, Vascutek, Glasgow, Scotland, UK: N.=23). The other 11 out of the 53 patients did not receive a CT scan, because of a pre-existing renal failure. In the CT scans we retrospectively evaluated the anatomic vessel deviation at the origin of the target vessel and the vessel shift distal to the stent. For the first measurement the CT scans were loaded into OsiriX MD®, and the pre- and postoperative angles of the target vessels were measured and subtracted. For matching, the CT-scans were normalized at vertebral body lumbar 2. The second measured angle was the maximal measured angle distal to the target vessel stent-graft. Altogether, 113 target vessels were stented (celiac trunk [CT] 15, superior mesenteric arteries [SMA] 26, renal arteries [RA] 72), with 97 balloon-expandable PTFE stents: 90 Atrium V12 (Maquet Getinge group, Hudson, NH, USA), 7 BeGrafts (Bentley InnoMed, Hechingen, Germany) and 16 self-expandable fluency PTFE stents (Bard, Karlsruhe, Germany). The mean anatomic deviation at the target vessel origin was 28±17.3 and the mean vessel shift distal to the stent was 36.3±18.8. There were no significant differences between the main device and the target vessel stent types. Fenestrated and branched stent-graft solutions for aortic aneurysm repair induce changes of the target vessel anatomy. We did not observe significant differences between the several devices.

Combined KIT and FGFR2b Signaling Regulates Epithelial Progenitor Expansion during Organogenesis

PubMed Central

Lombaert, Isabelle M.A.; Abrams, Shaun R.; Li, Li; Eswarakumar, Veraragavan P.; Sethi, Aditya J.; Witt, Robert L.; Hoffman, Matthew P.

2013-01-01

Summary Organ formation and regeneration require epithelial progenitor expansion to engineer, maintain, and repair the branched tissue architecture. Identifying the mechanisms that control progenitor expansion will inform therapeutic organ (re)generation. Here, we discover that combined KIT and fibroblast growth factor receptor 2b (FGFR2b) signaling specifically increases distal progenitor expansion during salivary gland organogenesis. FGFR2b signaling upregulates the epithelial KIT pathway so that combined KIT/FGFR2b signaling, via separate AKT and mitogen-activated protein kinase (MAPK) pathways, amplifies FGFR2b-dependent transcription. Combined KIT/FGFR2b signaling selectively expands the number of KIT+K14+SOX10+ distal progenitors, and a genetic loss of KIT signaling depletes the distal progenitors but also unexpectedly depletes the K5+ proximal progenitors. This occurs because the distal progenitors produce neurotrophic factors that support gland innervation, which maintains the proximal progenitors. Furthermore, a rare population of KIT+FGFR2b+ cells is present in adult glands, in which KIT signaling also regulates epithelial-neuronal communication during homeostasis. Our findings provide a framework to direct regeneration of branched epithelial organs. PMID:24371813

Prenatal exposure to glycol ethers and cryptorchidism and hypospadias: a nested case-control study.

PubMed

Warembourg, Charline; Botton, Jérémie; Lelong, Nathalie; Rouget, Florence; Khoshnood, Babak; Le Gléau, Florent; Monfort, Christine; Labat, Laurence; Pierre, Fabrice; Heude, Barbara; Slama, Rémy; Multigner, Luc; Charles, Marie-Aline; Cordier, Sylvaine; Garlantézec, Ronan

2018-01-01

Glycol ethers (GE) are oxygenated solvents frequently found in occupational and consumer products. Some of them are well-known testicular and developmental animal toxicants. This study aims to evaluate the risk of male genital anomalies in association with prenatal exposure to GE using urinary biomarkers of exposure. We conducted a case-control study nested in two joint mother-child cohorts (5303 pregnant women). Cases of cryptorchidism and hypospadias were identified at birth and confirmed during a 2-year follow-up period (n=14 cryptorchidism and n=15 hypospadias). Each case was matched to three randomly selected controls within the cohorts for region of inclusion and gestational age at urine sampling. Concentrations of five GE acidic metabolites were measured in spot maternal urine samples collected during pregnancy. ORs were estimated with multivariate conditional logistic regressions including a Firth's penalisation. Detection rates of urinary GE metabolites ranged from 8% to 93% and only two were sufficiently detected (>33%) in each cohort to be studied: methoxyacetic acid (MAA) and phenoxyacetic acid (PhAA). A significantly higher risk of hypospadias was associated with the highest tertile of exposure to MAA: OR (95% CI) 4.5(1.4 to 23.4). No association were observed with urinary concentration of PhAA, nor with the risk of cryptorchidism. In view of the toxicological plausibility of our results, this study, despite its small sample size, raises concern about the potential developmental toxicity of MAA on the male genital system and calls for thorough identification of current sources of exposure to MAA. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

The Location of Anterior Cruciate Ligament Tears: A Prevalence Study Using Magnetic Resonance Imaging

PubMed Central

van der List, Jelle P.; Mintz, Douglas N.; DiFelice, Gregory S.

2017-01-01

Background: Over the past decade, there has been a resurgence of interest in anterior cruciate ligament (ACL) preservation. Proximal and distal avulsion tears have been treated with arthroscopic primary repair, while augmented repair, remnant tensioning, primary repair with biological scaffold, and remnant preservation have been proposed for different types of midsubstance tears. Currently, the incidence of these different tear types is unknown. Purpose: To propose a magnetic resonance imaging (MRI) classification system for different tear types based on clinical relevance and to assess the distribution of these different ACL tear types. Study Design: Case series; Level of evidence, 4. Methods: A retrospective search in an institutional radiographic database was performed for patients who underwent knee MRI at our institution between June 2014 and June 2016. Patients younger than 18 years and those with reports of chronic tears, partial tears, multiligamentous injuries, were excluded. Tear types were graded as proximal avulsion (distal remnant length >90% of total ligament length, type I), proximal (75%-90%, type II), midsubstance (25%-75%, type III), distal (10%-25%, type IV), and distal avulsion (<10%, type V). An orthopaedic surgeon, a radiologist, and a research fellow graded the tear type on 30 MRIs to determine reliability, and the research fellow graded all MRIs. Inter- and intraobserver reliability were measured using kappa statistics. Results: A total of 353 patients (57% male; mean age, 37.1 years; range, 18.1-81.2 years) were included. Interobserver reliability was 0.670 (95% confidence interval, 0.505-0.836), and intraobserver reliability ranged from 0.741 to 0.934. Incidence of type I tears was 16%, type II tears 27%, type III tears 52%, type IV tears 1%, and type V tears 3% (2.5% with bony avulsion). Type I tears were more common in patients older than 35 years compared with those younger than 35 years (23% vs 8%; P < .001). Conclusion: This classification system was reliable in assessing tear location in acute ACL injuries. Type I tears were seen in 16%, type II in 27%, and type III in 52% of patients in our cohort. These data suggest that there may be greater potential application for ACL preservation techniques. PMID:28680889

[Endovascular repair of primary retrograde Stanford type A aortic dissection].

PubMed

Wu, H W; Sun, L; Li, D M; Jing, H; Xu, B; Wang, C T; Zhang, L

2016-10-01

Objective: To summarize the short- and mid-term results on endovascular repair of primary retrograde Stanford type A aortic dissection with an entry tear in distal aortic arch or descending aorta. Methods: Between December 2009 and December 2014, 21 male patients of primary retrograde Stanford type A aortic dissection with a mean age of (52±9) years received endovascular repair in Department of Cardiothoracic Surgery, Jinling Hospital. Among the 21 cases, 17 patients were presented as ascending aortic intramural hematoma, 4 patients as active blood flow in false lumen and partial thrombosis, 8 patients as ulcer on descending aorta combined intramural hematoma in descending aorta, and 13 patients as typical dissection changes. All patients received endovascular stent-graft repair successfully, with 15 cases in acute phase and 6 cases in chronic phase. Results: Cone stent was implanted in 13 cases, while straight stent in 8 cases, including 1 case of left common carotid-left subclavian artery bypass surgery and 1 case of restrictive bare-metal stent implantation. No perioperative stroke, paraplegia, stent fracture or displacement, limbs or abdominal organ ischemia or other severe complications occured, except for tracheotomy in 2 patients. Active blood flow in ascending aorta or aortic arch disappeared, and intramural hematoma started being absorbed on CT angiography images before discharge. All patients were alive during follow-up (6 to 72 months), and intramural hematoma in ascending aorta and aortic arch was absorbed thoroughly. Type Ⅰ endoleak and ulcer expansion were found in 1 patient, and type Ⅳ endoleak in distal stent was found in another one patient. Secondary ascending aortic dissection was found in 1 case two years later, which was cured by hybrid procedure with cardiopulmonary bypass. Conclusion: Endovascular repair of primary retrograde Stanford type A aortic dissection was safe and effective, which correlated with favorable short- and mid-term results.

Spinal cord ischemia after simultaneous and sequential treatment of multilevel aortic disease.

PubMed

Piffaretti, Gabriele; Bonardelli, Stefano; Bellosta, Raffaello; Mariscalco, Giovanni; Lomazzi, Chiara; Tolenaar, Jip L; Zanotti, Camilla; Guadrini, Cristina; Sarcina, Antonio; Castelli, Patrizio; Trimarchi, Santi

2014-10-01

The aim of the present study is to report a risk analysis for spinal cord injury in a recent cohort of patients with simultaneous and sequential treatment of multilevel aortic disease. We performed a multicenter study with a retrospective data analysis. Simultaneous treatment refers to descending thoracic and infrarenal aortic lesions treated during the same operation, and sequential treatment refers to separate operations. All descending replacements were managed with endovascular repair. Of 4320 patients, multilevel aortic disease was detected in 77 (1.8%). Simultaneous repair was performed in 32 patients (41.5%), and a sequential repair was performed in 45 patients (58.4%). Postoperative spinal cord injury developed in 6 patients (7.8%). At multivariable analysis, the distance of the distal aortic neck from the celiac trunk was the only independent predictor of postoperative spinal cord injury (odds ratio, 0.75; 95% confidence interval, 0.56-0.99; P=.046); open surgical repair of the abdominal aortic disease was associated with a higher risk of spinal cord injury but did not reach statistical significance (odds ratio, 0.16; 95% confidence interval, 0.02-1.06; P=.057). Actuarial survival estimates at 1, 2, and 5 years after the procedure were 80%±5%, 68%±6%, and 63%±7%, respectively. Spinal cord injury did not impair survival (P=.885). In our experience, the risk of spinal cord injury is still substantial at 8% in patients with multilevel aortic disease. The distance of the distal landing zone from the celiac trunk is a significant predictor of spinal cord ischemia. Copyright © 2014 The American Association for Thoracic Surgery. Published by Elsevier Inc. All rights reserved.

Endoscopic repair of tears of the superficial layer of the distal triceps tendon.

PubMed

Heikenfeld, Roderich; Listringhaus, Rico; Godolias, Georgios

2014-07-01

The purpose of this study was to evaluate the results after endoscopic repair of partial superficial layer triceps tendon tears. Fourteen patients treated surgically between July 2005 and December 2012 were studied prospectively for 12 months. Indication for surgery was a partial detachment of the triceps tendon from the olecranon that was proved by magnetic resonance imaging (MRI) in all cases. Ten of these patients had chronic olecranon bursitis. All patients were treated with endoscopic surgery including bursectomy and repair of the distal triceps tendon with double-loaded suture anchors. Clinical examination of the patients as well as functional and subjective scores (Mayo Elbow Performance Index [MEPI], Disabilities of the Arm, Shoulder and Hand Score [Quick DASH]) were obtained preoperatively and postoperatively at 6 and 12 months. An isokinetic strength measurement and MRI were performed preoperatively and 12 months after surgery. All 14 patients were completely evaluated. The MEPI and Quick DASH Score improved significantly after the repair at all postoperative examinations. The MEPI gained 29 points, up to 96 points at last follow-up (P < .05), and the Quick DASH Score went down 15.6 points after 12 months to 4.5 points (P < .05). Maximum extension power improved 55.8%, up to 94.7% at last follow-up compared with the contralateral side. Using MRI, we found one reruptured partial tear of the triceps tendon that did not require revision surgery. Although triceps tendon ruptures are generally uncommon, partial superficial tears might be more common than previously described. Once the diagnosis is made, endoscopic repair is a method leading to good clinical results with improved function of the affected elbow. Endoscopic repair of superficial tears of the triceps tendon is able to restore function and strength and leads to excellent clinical results after 1 year. Strength recovers to nearly that of the contralateral side, and serious complications appear to be infrequent. Level IV, therapeutic case series. Copyright © 2014 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.

A Comprehensive Atlas of the Adult Mouse Penis

PubMed Central

Phillips, Tiffany R.; Wright, David K.; Gradie, Paul E.; Johnston, Leigh A.; Pask, Andrew J.

2016-01-01

Mice are routinely used to study the development of the external genitalia and, in particular, the process of male urethral closure. This is because misplacement of the male penile urethra, or hypospadias, is amongst the most common birth defects reported in humans. While mice present a tractable model to study penile development, several structures differ between mice and humans, and there is a lack of consensus in the literature on their annotation and developmental origins. Defining the ontology of the mouse prepuce is especially important for the relevance and interpretation of mouse models of hypospadias to human conditions. We have developed a detailed annotation of the adult mouse penis that addresses these differences and enables an accurate comparison of murine and human hypospadias phenotypes. Through MRI data, gross morphology and section histology, we define the origin of the mouse external and internal prepuces, their relationship to the single human foreskin as well as provide a comprehensive view of the various structures of the mouse penis and their associated muscle attachments within the body. These data are combined to annotate structures in a novel 3D adult penis atlas that can be downloaded, viewed at any angle, and manipulated to examine the relationship of various structures. PMID:26112156

Treatment of a Persistent False Lumen with Aneurysm Formation Following Surgical Repair of Type A Dissection

DOE Office of Scientific and Technical Information (OSTI.GOV)

Jeganathan, Reubendra, E-mail: reubenj@hotmail.com; Kennedy, Peter; MacGowan, Simon

2007-06-15

We describe the case of a 68-year-old man who developed aneurysmal dilatation of the proximal descending thoracic aorta 8 years after repair of a type A dissection. The aneurysm was due to an anastomotic leak at the distal end of the previous repair in the ascending aorta with antegrade perfusion of the false lumen. Surgical repair of the anastomotic leak partially obliterated the false lumen and computed tomography scan demonstrated thrombosis in a large proportion of the false lumen aneurysm. Follow-up with surveillance scans showed persistent filling of this aneurysm due to retrograde flow of blood within the false lumen.more » Coil embolization of the false lumen within the thoracic aorta was performed which successfully thrombosed the aneurysm with a reduction in diameter. Late aneurysm formation may complicate type A dissection repairs during follow-up due to a persistent false lumen, especially if there is an anastomotic leak. This case report describes a strategy to deal with this difficult clinical problem.« less

Distal Ulnar Artery Aneurysm Repair by End-to-End Technique: A Case Report.

PubMed

Cotroneo, Attilio; Barillà, David; Armienti, Felice; Martinelli, Gian Luca; Diena, Marco

2018-01-01

We report the case of a 33-year-old man presented with a posttraumatic 20-mm left ulnar artery aneurysm without intraluminal thrombus in the left hypothenar eminence. The patient reported left hand paresthesia. Because of symptoms and the embolic risk, we decide to plan an aneurysm resection and an interposition graft with inverted basilic vein for adequacy diameter (∼2 mm), but an end-to-end anastomosis was performed instead. We think that the posttraumatic distal artery aneurysm could be treated without a bypass but, after a meticulous anatomic dissection, with a microvascular anastomosis between the artery stumps. Copyright © 2017 Elsevier Inc. All rights reserved.

Endovascular Treatment of Distal Aortic Arch Aneurysm Associated with Coarctation of Aorta in a Jehovah's Witness

PubMed Central

Mannacio, Vito A.; Di Tommaso, Ettorino; Pinna, Giovanni B.; Fontana, Immacolata; Iannelli, Gabriele

2017-01-01

Late aneurysm formation in the proximal aorta or distal aortic arch is a recognized sequela of untreated stenosis of the aortic isthmus and is associated with substantial risk of aortic rupture. We describe the case of a 44-year-old man with untreated coarctation of the aorta who presented with a prestenotic dissecting thoracic aortic aneurysm. He declined surgery because he was a Jehovah's Witness. Instead, we performed emergency endovascular aortic repair in which 2 stent-grafts were placed in the descending aorta. Our experience suggests that this procedure is a useful and safe alternative to open surgery in patients who have aneurysms associated with coarctation of the aorta. PMID:29276439

Repair of tracheal epithelium by basal cells after chlorine-induced injury

PubMed Central

2012-01-01

Background Chlorine is a widely used toxic compound that is considered a chemical threat agent. Chlorine inhalation injures airway epithelial cells, leading to pulmonary abnormalities. Efficient repair of injured epithelium is necessary to restore normal lung structure and function. The objective of the current study was to characterize repair of the tracheal epithelium after acute chlorine injury. Methods C57BL/6 mice were exposed to chlorine and injected with 5-ethynyl-2′-deoxyuridine (EdU) to label proliferating cells prior to sacrifice and collection of tracheas on days 2, 4, 7, and 10 after exposure. Airway repair and restoration of a differentiated epithelium were examined by co-localization of EdU labeling with markers for the three major tracheal epithelial cell types [keratin 5 (K5) and keratin 14 (K14) for basal cells, Clara cell secretory protein (CCSP) for Clara cells, and acetylated tubulin (AcTub) for ciliated cells]. Morphometric analysis was used to measure proliferation and restoration of a pseudostratified epithelium. Results Epithelial repair was fastest and most extensive in proximal trachea compared with middle and distal trachea. In unexposed mice, cell proliferation was minimal, all basal cells expressed K5, and K14-expressing basal cells were absent from most sections. Chlorine exposure resulted in the sloughing of Clara and ciliated cells from the tracheal epithelium. Two to four days after chlorine exposure, cell proliferation occurred in K5- and K14-expressing basal cells, and the number of K14 cells was dramatically increased. In the period of peak cell proliferation, few if any ciliated or Clara cells were detected in repairing trachea. Expression of ciliated and Clara cell markers was detected at later times (days 7–10), but cell proliferation was not detected in areas in which these differentiated markers were re-expressed. Fibrotic lesions were observed at days 7–10 primarily in distal trachea. Conclusion The data are consistent with a model where surviving basal cells function as progenitor cells to repopulate the tracheal epithelium after chlorine injury. In areas with few remaining basal cells, repair is inefficient, leading to airway fibrosis. These studies establish a model for understanding regenerative processes in the respiratory epithelium useful for testing therapies for airway injury. PMID:23170909

Postoperative Aortic Neck Dilation: Myth or Fact?

PubMed

Ribner, A S; Tassiopoulos, A K

2018-06-01

The abdominal aorta is the most common site of an aortic aneurysm. The visceral and most proximal infrarenal segment (aneurysm neck) are usually spared and considered more resistant to aneurysmal degeneration. However, if an abdominal aortic aneurysm (AAA) is left untreated, the natural history of the aortic neck is progressive dilatation and shortening. This may have significant implications for patients undergoing endovascular repair of AAAs (EVAR) as endograft stability and integrity of the repair are dependent on an intact proximal seal zone. Compromised seal zones, caused by progressive diameter enlargement and foreshortening of the aortic neck, may lead to distal endograft migration, type Ia endoleak, aortic sac repressurization, and, ultimately, aortic rupture.

Pathologic fracture of the distal radius in a 25-year-old patient with a large unicameral bone cyst.

PubMed

Massen, Felix; Baumbach, Sebastian; Volkmer, Elias; Mutschler, Wolf; Grote, Stefan

2014-06-13

Distal radius fractures (DRF) are often referred to as osteoporosis indicator fractures as their incidence increases from age 45. In the group of young adults, distal radius fractures normally result from high-energy trauma. Wrist fractures in young patients without adequate trauma thus raise suspicion of a pathologic fracture. In this report we present the case of a fractured unicameral bone cyst (UBC) at the distal radius in a young adult.To the author's best knowledge, this is the first detailed report in an UBC at the distal radius causing a pathologic DRF in an adult patient. A 25-year-old otherwise healthy male presented to our Emergency Department after a simple fall on his right outstretched hand. Extended diagnostics revealed a pathologic, dorsally displaced, intra-articular distal radius fracture secondary to a unicameral bone cyst occupying almost the whole metaphysis of the distal radius. To stabilize the fracture, a combined dorsal and volar approach was used for open reduction and internal fixation. A tissue specimen for histopathological examination was gathered and the lesion was filled with an autologous bone graft harvested from the ipsilateral femur using a reamer-irrigator-aspirator (RIA) system. Following one revision surgery due to an intra-articular step-off, the patient recovered without further complications. Pathologic fractures in young patients caused by unicameral bone cysts require extended diagnostics and adequate treatment. A single step surgical treatment is reasonable if fracture and bone cyst are treated appropriately. Arthroscopically assisted fracture repair may be considered in intra-articular fractures or whenever co-pathologies of the carpus are suspected.

Examination of the pronator quadratus muscle during hardware removal procedures after volar plating for distal radius fractures.

PubMed

Nho, Jae-Hwi; Gong, Hyun Sik; Song, Cheol Ho; Wi, Seung Myung; Lee, Young Ho; Baek, Goo Hyun

2014-09-01

It is not clear whether the pronator quadratus (PQ) muscle actually heals and provides a meaningful pronation force after volar plating for distal radius fractures (DRFs). We aimed to determine whether the length of the PQ muscle, which is dissected and then repaired during volar plating for a DRF, affects the forearm rotation strength and clinical outcomes. We examined 41 patients who requested hardware removal after volar plating. We measured the isokinetic forearm rotation strength and clinical outcomes including grip strength, wrist range of motion, and disabilities of the arm, shoulder and hand (DASH) scores at 6 months after fracture fixation. During the hardware removal surgery, which was performed at an average of 9 months (range, 8.3 to 11.5 months) after fracture fixation, we measured the PQ muscle length. The average PQ muscle length was 68% of the normal muscle length, and no significant relationship was found between the PQ muscle length and the outcomes including isokinetic forearm rotation strength, grip strength, wrist range of motion, and DASH scores. This study demonstrates that the length of the healed PQ muscle does not affect isokinetic forearm rotation strength and clinical outcomes after volar plating for DRFs. The results of this study support our current practice of loose repair of the PQ that is performed by most of the surgeons to prevent tendon irritation over the plate, and suggest that tight repair of the PQ is not necessary for achieving improved forearm function.

Surgical repair of giant inguinoscrotal hernias in an austere environment: leaving the distal sac limits early complications.

PubMed

Savoie, P-H; Abdalla, S; Bordes, J; Laroche, J; Fournier, R; Pons, F; Bonnet, S

2014-02-01

Giant inguinoscrotal hernias represent a real public health problem in the Ivory Coast that can dramatically impair patients' quality of life. Limited resources require a simplified surgical strategy including, in our experience, not using a mesh and leaving the distal hernia sac. The aim of this study was to evaluate the benefits of this technique in terms of complications (seroma, haematoma, trophic troubles) and the ability to recover from surgery and return to work at 1 month postsurgery. Between January and May 2012, all patients who presented with a giant primary inguinoscrotal hernia that was spontaneously reducible in the decubitus position and who did not have any trophic changes in the scrotal skin were prospectively studied. The surgical procedure was a herniorrhaphy as described by Bassini. All patients received follow-up examinations on postoperative days 5, 12 and 30. Twenty-five males with a median age of 42 years (range 18-60) underwent surgery. Three patients (12 %) presented with a superficial skin infection and four (16 %) with early scrotal swelling without seroma, spontaneously resolved by postoperative day 30. Three patients (12 %) presented with scrotal swelling and seroma; two required aspiration. No early recurrence was observed at the end of follow-up, and all patients were able to return to work. Leaving the distal hernial sac in the scrotum does not interfere with the type of hernia repair and can limit the occurrence of complications. This technique is reliable, reproducible and does not incur additional morbidity when used in selected patients.

Variations in the Processing of DNA Double-Strand Breaks Along 60-MeV Therapeutic Proton Beams

DOE Office of Scientific and Technical Information (OSTI.GOV)

Chaudhary, Pankaj; Marshall, Thomas I.; Currell, Frederick J.

Purpose: To investigate the variations in induction and repair of DNA damage along the proton path, after a previous report on the increasing biological effectiveness along clinically modulated 60-MeV proton beams. Methods and Materials: Human skin fibroblast (AG01522) cells were irradiated along a monoenergetic and a modulated spread-out Bragg peak (SOBP) proton beam used for treating ocular melanoma at the Douglas Cyclotron, Clatterbridge Centre for Oncology, Wirral, Liverpool, United Kingdom. The DNA damage response was studied using the 53BP1 foci formation assay. The linear energy transfer (LET) dependence was studied by irradiating the cells at depths corresponding to entrance, proximal, middle, andmore » distal positions of SOBP and the entrance and peak position for the pristine beam. Results: A significant amount of persistent foci was observed at the distal end of the SOBP, suggesting complex residual DNA double-strand break damage induction corresponding to the highest LET values achievable by modulated proton beams. Unlike the directly irradiated, medium-sharing bystander cells did not show any significant increase in residual foci. Conclusions: The DNA damage response along the proton beam path was similar to the response of X rays, confirming the low-LET quality of the proton exposure. However, at the distal end of SOBP our data indicate an increased complexity of DNA lesions and slower repair kinetics. A lack of significant induction of 53BP1 foci in the bystander cells suggests a minor role of cell signaling for DNA damage under these conditions.« less

Vaginal Migration of Ventriculoperitoneal Shunt Catheter and Cerebrospinal Fluid Leak as a Complication of Hysterectomy.

PubMed

Houten, John K; Smith, Shiela; Schwartz, Amit Y

2017-08-01

Ventriculoperitoneal (VP) shunting is a common neurosurgical procedure to treat hydrocephalus that diverts cerebrospinal fluid from the cerebral ventricles to the peritoneal cavity for reabsorption. The distal catheter may potentially migrate through any potential or iatrogenic opening in the peritoneal cavity. Increasingly successfully management of childhood hydrocephalus and adult-onset conditions leading to hydrocephalus, such as subarachnoid hemorrhage, is leading many adult female patients harboring VP shunts needing to undergo hysterectomy. Hysterectomy creates a potential defect though which a VP shunt catheter may migrate. It is not known whether the hysterectomy cuff closure technique may affect the likelihood of distal catheter migration though the repair site. We report the case of a 38-year-old woman with a VP shunt who underwent laparoscopic hysterectomy via an open vaginal cuff technique who subsequently presented with vaginal cerebrospinal fluid leakage secondary to migration of the distal shunt catheter through the hysterectomy cuff. Vaginal migration of the distal VP shunt catheter is a possible complication of hysterectomy. The authors postulate that an open cuff hysterectomy closure technique may increase the risk of catheter migration, an issue that may be better understood with further investigation. Copyright © 2017 Elsevier Inc. All rights reserved.

Outcomes of Iatrogenic Genitourinary Injuries During Colorectal Surgery.

PubMed

Eswara, Jairam R; Raup, Valary T; Potretzke, Aaron M; Hunt, Steven R; Brandes, Steven B

2015-12-01

To describe, categorize, and determine the outcomes of repairs of genitourinary (GU) injuries that occur during colorectal surgery. Presently, little is known regarding these injuries or the long-term outcomes of their repair. We performed a retrospective review of patients undergoing colorectal surgery between 2003 and 2013 who experienced iatrogenic GU injuries requiring surgical repair. GU repair failures were defined as development of urine leak, urinary fistula, or anastomotic stricture requiring secondary GU intervention. Possible risk factors associated with repair failures were examined and included age, American Society of Anesthesiology score, comorbidities, type of colorectal surgery, radiation, and chemotherapy. Of 42,570 colorectal surgeries performed, 75 GU injuries were identified (0.18%). Mean age was 57.5 years (range, 22-91), and median follow-up was 19.5 months (range, 1-128). Fifty-nine (59/75, 79%) patients required a single GU repair whereas 16 of 75 (21%) patients experienced repair failure requiring additional GU intervention. The most common GU injuries were cystotomy (26/75, 35%), incomplete ureteral transection (22/75, 29%), complete proximal and distal ureteral injuries (13/75, 17%; 11/75, 15%), urethral injury (2/75, 3%), and injury to a pre-existing ileal conduit (1/75, 1). Twenty-seven patients (36%) had prior radiation and 35 patients (47%) had prior chemotherapy. Preoperative radiation and chemotherapy were both associated with failure of the GU repair (P = .003; P = .013). Delayed repair of the GU injury was also associated with repair failure (P = .001). Iatrogenic GU injuries during colorectal surgery are rare, affecting only 0.18% of colorectal procedures. Preoperative external beam radiation therapy/chemotherapy and delayed GU repair are associated with worse outcomes of repairs of these injuries. Copyright © 2015 Elsevier Inc. All rights reserved.

Distal clavicular osteolysis: a review of the literature.

PubMed

Schwarzkopf, Ran; Ishak, Charbel; Elman, Michael; Gelber, Jonathan; Strauss, David N; Jazrawi, Laith M

2008-01-01

Acute distal clavicular osteolysis was first described in 1936. Since then, distal clavicular osteolysis (DCO) has been separated into traumatic and atraumatic pathogeneses. In 1982 the first series of male weight trainers who developed ADCO was reported. The association of weightlifting and ADCO is especially important considering how routine a component weights are to the male athlete's training. The pathogenesis of DCO has often been debated. The most widely accepted etiology involves a connection between microfractures of the subchondral bone and subsequent attempts at repair, which is consistent with repetitive microtrauma. Symptoms usually begin with an insidious aching pain in the AC region that is exacerbated by weight training. On examination, patients have point tenderness over the affected AC joint and pain with a cross-body adduction maneuver. Although DCO may seem like an easy and quick diagnosis, one must rule out other possibilities. Avoidance of provocative maneuvers, modification of weight training techniques, ice massage, and nonsteroidal anti-inflammatory drugs (NSAID) constitute the basis of initial treatment. Much of the literature supports the same general indications for surgery. These include point tenderness of the AC joint, evident abnormal signs with AC joint scintigraphy and AC radiographs, lack of response to conservative treatment, and an unwillingness to give up or modify weight training or manual labor. Distal clavicle resection has provided good results. Distal clavicle osteolysis is a unique disease most likely due to an overuse phenomenon.

Development of the External Genitalia: Perspectives from the Spotted Hyena (Crocuta crocuta)

PubMed Central

Cunha, Gerald R.; Risbridger, Gail; Wang, Hong; Place, Ned J.; Grumbach, Mel; Cunha, Tristan J.; Weldele, Mary; Conley, Al J.; Barcellos, Dale; Agarwal, Sanjana; Bhargava, Argun; Drea, Christine; Hammond, Geoffrey L.; Siiteri, Penti; Coscia, Elizabeth M.; McPhaul, Michael J; Baskin, Laurence S.; Glickman, Stephen E.

2014-01-01

This review/research paper summarizes data on development of the external genitalia of the spotted hyena, a fascinating mammal noted for extreme masculinization of the female external genitalia. The female spotted hyena is the only extant mammal that mates and gives birth through a pendulous penis-like clitoris. Our studies indicate that early formation of the phallus in both males and females is independent of androgens; indeed the phallus forms before the fetal testes or ovaries are capable of synthesizing androgens. Likewise, pre- and postnatal growth in length of the penis and clitoris is minimally affected by “androgen status”. Nonetheless, several internal morphologies, as well as external surface features of the phallus, are androgen-dependent and thus account for dimorphism between the penis and clitoris. Finally, estrogens play a critical role in penile and clitoral development, specifying the position of the urethral orifice, determining elasticity of the urethral meatus, and facilitating epithelial-epithelial fusion events required for proper formation of the distal urethra/urogenital sinus and prepuce. Accordingly, prenatal inhibition of estrogen synthesis via administration of letrozole (an aromatase inhibitor) leads to malformations of the glans as well as the prepuce (hypospadias). The effects of prenatal androgens, anti-androgens and impaired estrogen synthesis correlated with the tissue expression of androgen and estrogen receptors. PMID:24582573

Medications Used to Treat Nausea and Vomiting of Pregnancy and the Risk of Selected Birth Defects

PubMed Central

Anderka, Marlene; Mitchell, Allen A.; Louik, Carol; Werler, Martha M.; Hernández-Diaz, Sonia; Rasmussen, Sonja A.

2012-01-01

Background Nausea and vomiting of pregnancy (NVP) occurs in up to 80% of pregnant women, yet its association with birth outcomes is not clear. Several medications are used for the treatment of NVP; however, data are limited on their possible associations with birth defects. Methods Using data from the National Birth Defects Prevention Study (NBDPS), a multi-site population-based case-control study, we examined whether NVP or its treatment was associated with the most common non-cardiac defects in the NBDPS (non-syndromic cleft lip with or without cleft palate (CL/P), cleft palate alone (CP), neural tube defects (NTDs), and hypospadias) compared to randomly-selected non-malformed live births. Results Among the 4524 cases and 5859 controls included in this study, 67.1% reported first trimester NVP, and 15.4% of them reported using at least one agent for NVP. Nausea and vomiting of pregnancy was not associated with CP or NTDs, but modest risk reductions were observed for CL/P (aOR=0.87, 0.77–0.98), and hypospadias (OR=0.84, 0.72–0.98). In regards to treatments for NVP in the first trimester, the following adjusted associations were observed with an increased risk: proton pump inhibitors and hypospadias (aOR=4.36, 1.21–15.81), steroids and hypospadias (aOR=2.87, 1.03–7.97), and ondansetron and CP (aOR=2.37, 1.18–4.76), while antacids were associated with a reduced risk for CL/P (aOR=0.58, 0.38–0.89). Conclusions Nausea and vomiting of pregnancy was not observed to be associated with an increased risk of birth defects, but possible risks related to three treatments (i.e. proton pump inhibitors, steroids and ondansetron), which could be chance findings, warrant further investigation. PMID:22102545

Pathologic fracture of the distal radius in a 25-year-old patient with a large unicameral bone cyst

PubMed Central

2014-01-01

Background Distal radius fractures (DRF) are often referred to as osteoporosis indicator fractures as their incidence increases from age 45. In the group of young adults, distal radius fractures normally result from high-energy trauma. Wrist fractures in young patients without adequate trauma thus raise suspicion of a pathologic fracture. In this report we present the case of a fractured unicameral bone cyst (UBC) at the distal radius in a young adult. To the author’s best knowledge, this is the first detailed report in an UBC at the distal radius causing a pathologic DRF in an adult patient. Case presentation A 25-year-old otherwise healthy male presented to our Emergency Department after a simple fall on his right outstretched hand. Extended diagnostics revealed a pathologic, dorsally displaced, intra-articular distal radius fracture secondary to a unicameral bone cyst occupying almost the whole metaphysis of the distal radius. To stabilize the fracture, a combined dorsal and volar approach was used for open reduction and internal fixation. A tissue specimen for histopathological examination was gathered and the lesion was filled with an autologous bone graft harvested from the ipsilateral femur using a reamer-irrigator-aspirator (RIA) system. Following one revision surgery due to an intra-articular step-off, the patient recovered without further complications. Conclusions Pathologic fractures in young patients caused by unicameral bone cysts require extended diagnostics and adequate treatment. A single step surgical treatment is reasonable if fracture and bone cyst are treated appropriately. Arthroscopically assisted fracture repair may be considered in intra-articular fractures or whenever co-pathologies of the carpus are suspected. PMID:24925068

The use of small (2.7 mm) screws for arthroscopically guided repair of carpal chip fractures.

PubMed

Wright, I M; Smith, M R W

2011-05-01

Removal of large chip fractures of the carpal bones and the osteochondral deficits that result, have been associated with a worse prognosis than removal of small fragments in similar locations. Reducing the articular defects by repair of large osteochondral fragments may have advantages over removal. Horses with osteochondral chip fractures that were of sufficient size and infrastructure to be repaired with small (2.7 mm diameter) AO/ASIF cortex screws were identified and repair effected by arthroscopically guided internal fixation. Thirty-three horses underwent surgery to repair 35 fractures of the dorsodistal radial carpal bone (n = 25), the dorsal margin of the radial facet of the third carpal bone (n = 9) and the intermediate facet of the distal radius (n = 1). There were no surgical complications and fractures healed satisfactorily in 26 of 28 horses and 23 horses returned to racing performance. Arthroscopically guided repair of carpal chip fractures with small diameter cortex screws is technically feasible and experiences with 33 cases suggest that this may have advantages over fragment removal in managing such cases. Surgeons treating horses with large chip fractures of the carpal bones should consider arthroscopically guided internal fixation as an alternative to removal. © 2010 EVJ Ltd.

Debates to personal conclusion in peripheral nerve injury and reconstruction: A 30-year experience at Chang Gung Memorial Hospital

PubMed Central

Chuang, David Chwei-Chin

2016-01-01

Significant progress has been achieved in the science and management of peripheral nerve injuries over the past 40 years. Yet there are many questions and few answers. The author, with 30 years of experience in treating them at the Chang Gung Memorial Hospital, addresses debates on various issues with personal conclusions. These include: (1) Degree of peripheral nerve injury, (2) Timing of nerve repair, (3)Technique of nerve repair, (4) Level of brachial plexus injury,(5) Level of radial nerve injury,(6) Traction avulsion amputation of major limb, (7) Proximal Vs distal nerve transfers in brachial plexus injuries and (8) Post paralysis facial synkinesis. PMID:27833273

Spinal cord protection in descending thoracic and thoracoabdominal aortic aneurysm repair.

PubMed

Safi, H J; Campbell, M P; Ferreira, M L; Azizzadeh, A; Miller, C C

1998-01-01

During aneurysm repair of the descending thoracic or thoracoabdominal aorta, the likelihood of neurological complications increases greatly after only 30 minutes of spinal cord ischemia. However, the manifestation of paraplegia or paraparesis relates not only to aortic cross-clamping time, but to multiple factors that may include aortic dissection, previous aortic surgery, advanced age, preoperative renal insufficiency, rupture, and most significantly, aneurysm extent. At greatest risk is the patient with type II thoracoabdominal aortic aneurysm. For this patient the simple cross-clamp technique, which uses no protective surgical adjuncts, heightens the threat of neurological deficit. With the surgical adjuncts of cerebrospinal fluid drainage and distal aortic perfusion, the probability of neurological deficit is appreciably lowered.

Total Endovascular Aortic Repair in a Patient with Marfan Syndrome.

PubMed

Amako, Mau; Spear, Rafaëlle; Clough, Rachel E; Hertault, Adrien; Azzaoui, Richard; Martin-Gonzalez, Teresa; Sobocinski, Jonathan; Haulon, Stéphan

2017-02-01

The aim of this study is to describe a total endovascular aortic repair with branched and fenestrated endografts in a young patient with Marfan syndrome and a chronic aortic dissection. Open surgery is the gold standard to treat aortic dissections in patients with aortic disease and Marfan syndrome. In 2000, a 38-year-old man with Marfan syndrome underwent open ascending aorta repair for an acute type A aortic dissection. One year later, a redo sternotomy was performed for aortic valve replacement. In 2013, the patient presented with endocarditis and pulmonary infection, which necessitated tracheostomy and temporary dialysis. In 2014, the first stage of the endovascular repair was performed using an inner branched endograft to exclude a 77-mm distal arch and descending thoracic aortic aneurysm. In 2015, a 63-mm thoracoabdominal aortic aneurysm was excluded by implantation of a 4-fenestrated endograft. Follow-up after both endovascular repairs was uneventful. Total aortic endovascular repair was successfully performed to treat a patient with arch and thoraco-abdominal aortic aneurysm associated with chronic aortic dissection and Marfan syndrome. The postoperative images confirmed patency of the endograft and its branches, and complete exclusion of the aortic false lumen. Endovascular repair is a treatment option in patients with connective tissue disease who are not candidates for open surgery. Long-term follow-up is required to confirm these favorable early outcomes. Copyright © 2016 Elsevier Inc. All rights reserved.

Articular Cartilage Increases Transition Zone Regeneration in Bone-tendon Junction Healing

PubMed Central

Qin, Ling; Lee, Kwong Man; Leung, Kwok Sui

2008-01-01

The fibrocartilage transition zone in the direct bone-tendon junction reduces stress concentration and protects the junction from failure. Unfortunately, bone-tendon junctions often heal without fibrocartilage transition zone regeneration. We hypothesized articular cartilage grafts could increase fibrocartilage transition zone regeneration. Using a goat partial patellectomy repair model, autologous articular cartilage was harvested from the excised distal third patella and interposed between the residual proximal two-thirds bone fragment and tendon during repair in 36 knees. We evaluated fibrocartilage transition zone regeneration, bone formation, and mechanical strength after repair at 6, 12, and 24 weeks and compared them with direct repair. Autologous articular cartilage interposition resulted in more fibrocartilage transition zone regeneration (69.10% ± 14.11% [mean ± standard deviation] versus 8.67% ± 7.01% at 24 weeks) than direct repair at all times. There was no difference in the amount of bone formation and mechanical strength achieved. Autologous articular cartilage interposition increases fibrocartilage transition zone regeneration in bone-tendon junction healing, but additional research is required to ascertain the mechanism of stimulation and to establish the clinical applicability. PMID:18987921

Primary intraosseous fibrosarcoma in a cat.

PubMed

Fox, S M; Cooke, M M; Beban, H J

1995-10-01

A case of primary intraosseous fibrosarcoma of the left femur in a cat was diagnosed at necropsy following 9 months of managing a fracture of the same bone. Case features were those of probable pathological fracture, fracture repair and ultimate lysis of all but a fragment of the distal femoral epiphysis. Histology revealed closely packed whorls of fibroblasts typical of fibrosarcoma. This neoplasm is rare in the cat.

Substitution urethroplasty using oral mucosa graft for male anterior urethral stricture disease: Current topics and reviews.

PubMed

Horiguchi, Akio

2017-07-01

Male anterior urethral stricture is scarring of the subepithelial tissue of the corpus spongiosum that constricts the urethral lumen, decreasing the urinary stream. Its surgical management is a challenging problem, and has changed dramatically in the past several decades. Open surgical repair using grafts or flaps, called substitution urethroplasty, has become the gold standard procedure for anterior urethral strictures that are not amenable to excision and primary anastomosis. Oral mucosa harvested from the inner cheek (buccal mucosa) is an ideal material, and is most commonly used for substitution urethroplasty, and lingual mucosa harvested from the underside of the tongue has recently emerged as an alternative material with equivalent outcome. Onlay augmentation of oral mucosa graft on the ventral side (ventral onlay) or dorsal side (dorsal onlay, Barbagli procedure) has been widely used for bulbar urethral stricture with comparable success rates. In bulbar urethral strictures containing obliterative or nearly obliterative segments, either a two-sided dorsal plus ventral onlay (Palminteri technique) or a combination of excision and primary anastomosis and onlay augmentation (augmented anastomotic urethroplasty) are the procedures of choice. Most penile urethral strictures can be repaired in a one-stage procedure either by dorsal inlay with ventral sagittal urethrotomy (Asopa technique) or dorsolateral onlay with one-sided urethral dissection (Kulkarni technique); however, staged urethroplasty remains the procedure of choice for complex strictures, including strictures associated with genital lichen sclerosus or failed hypospadias. This article presents an overview of substitution urethroplasty using oral mucosa graft, and reviews current topics. © 2017 The Japanese Urological Association.

Rotator cuff repair augmentation in a rat model that combines a multilayer xenograft tendon scaffold with bone marrow stromal cells

PubMed Central

Omi, Rei; Gingery, Anne; Steinmann, Scott P.; Amadio, Peter C.; An, Kai-Nan; Zhao, Chunfeng

2016-01-01

Hypothesis A composite of multilayer tendon slices (COMTS) seeded with bone marrow stromal cells (BMSCs) may impart mechanical and biologic augmentation effects on supraspinatus tendon repair under tension, thereby improving the healing process after surgery in rats. Methods Adult female Lewis rats (n = 39) underwent transection of the supraspinatus tendon and a 2-mm tendon resection at the distal end, followed by immediate repair to its bony insertion site under tension. Animals received 1 of 3 treatments at the repair site: (1) no augmentation, (2) COMTS augmentation alone, or (3) BMSC-seeded COMTS augmentation. BMSCs were labeled with a fluorescent cell marker. Animals were euthanized 6 weeks after surgery, and the extent of healing of the repaired supraspinatus tendon was evaluated with biomechanical testing and histologic analysis. Results Histologic analysis showed gap formation between the repaired tendon and bone in all specimens, regardless of treatment. Robust fibrous tissue was observed in rats with BMSC-seeded COMTS augmentation; however, fibrous tissue was scarce within the gap in rats with no augmentation or COMTS-only augmentation. Labeled transplanted BMSCs were observed throughout the repair site. Biomechanical analysis showed that the repairs augmented with BMSC-seeded COMTS had significantly greater ultimate load to failure and stiffness compared with other treatments. However, baseline (time 0) data showed that COMTS-only augmentation did not increase mechanical strength of the repair site. Conclusion Although the COMTS scaffold did not increase the initial repair strength, the BMSC-seeded scaffold increased healing strength and stiffness 6 weeks after rotator cuff repair in a rat model. Level of evidence Basic Science Study, Animal Model. PMID:26387915

Distal biceps brachii tendon repair: a systematic review of patient outcome determination using modified Coleman methodology score criteria.

PubMed

Nyland, John; Causey, Brandon; Wera, Jeff; Krupp, Ryan; Tate, David; Gupta, Amit

2017-07-01

This systematic literature review evaluated the methodological research design quality of studies that evaluated patient outcomes following distal biceps brachii tendon repair and developed evidence-based recommendations for future patient clinical outcomes research. Following the preferred reporting items for systematic reviews and meta-analyses criteria, and using "biceps brachii", "tendon", "repair" and "outcome assessment" search terms, the CINAHL, Academic Search Premier and MEDLINE databases were searched from January 1960-October 2015. The modified Coleman methodology score (MCMS) served as the primary outcome measure. Descriptive statistical analysis was performed for composite and component MCMS and for patient outcome assessment methodology use frequency. A total of 93 studies were evaluated. Overall MCMS was low (57.1 ± 14). Only 12 (12.9 %) had prospective cohort or randomized controlled trial designs. There was a moderate relationship between publication year and MCMS (r = 0.53, P < 0.0001). Although 61 studies (65.6 %) had adequate surgical descriptions, only 3 (3.2 %) had well-described rehabilitation. Of 2253 subjects, only 39 (1.7 %) were women. Studies published after 2008 had higher MCMS scores than studies published earlier (61.3 ± 10 versus 52.9 ± 16, P = 0.003). Although overall research study methodological scores improved on average since 2008, generally low MCMS scores, retrospective designs, lack of eccentric elbow flexor or supinator strength testing, and poorly described surgical and rehabilitation descriptions remain commonplace. These findings decrease clinical study validity and generalizability. III.

Good isometric and isokinetic power restoration after distal biceps tendon repair with anchors.

PubMed

Suda, Arnold J; Prajitno, Julia; Grützner, Paul A; Tinelli, Marco

2017-07-01

Distal biceps brachii tendon rupture can lead to 30-40% power loss of elbow flexion and up to 50% of forearm supination. Re-fixation of the distal biceps brachii tendon is recommended to warrant an adequate quality of the patient's life. This study reports the isometric and isokinetic results after anchor re-fixation 2.5 years after surgery. Between 2007 and 2010, 69 patients with distal biceps brachii tendon tear underwent a suture anchor reattachment. During the follow-up examination, a questionnaire and DASH score were filled in, the circumferences of the arm were measured, range of motion was collected, and different trials were conducted at the BTE Primus RS™ (Baltimore Therapeutic Equipment) on both arms. 49 patients (71%) were reinvestigated with a follow-up of 32 months (11-58 months). A significant difference was found in the ability of elbow flexion between the affected arm and the opposite side as well as in pronation and supination. In elbow flexion and extension as well as in pronation and supination of the forearm, the strength was significantly diminished. 32 months after surgical re-fixation of the distal biceps brachii tendon rupture, strength in all exercises is marginally reduced in comparison to the opposite arm. Re-fixation of the distal biceps brachii tendon is an adequate method to return the range of motion and the strength in the elbow joint to an almost normal level and that gives rise to a high level of patient satisfaction. Level III, case-control study.

[Urethroplasty in hypoplastic-dysplastic corpus spongiosum and short urethra].

PubMed

Vitarelli, Antonio; Divenuto, Lucia; Altomare, Mauro; Masiello, Giuseppe; Pagliarulo, Arcangelo

2013-01-01

Congenital penile curvature and chordee are a rare malformative condition most frequently associated with hypospadias, but varying degrees of penile curvature are observed with an orthotopic meatus. Disease becomes evident after puberty, when curvature becomes more apparent with erection. We present a case of a young man (16 years old), with ventral congenital penile curvature without hypospadias and with hypoplastic-dysplastic corpus spongiosum and short urethra, who could not have normal sexual intercourses. The patient underwent first-stage urethroplasty with urethral opening and graft of buccal mucosa and creation of a temporary hypospadic meatus. No post-operative complications were observed. There were no residual penile curvatures. Results are promising and satisfactory after the first surgical stage and provide a solid ground for the final reconstruction.

Bone-to-bone Fixation Enhances Functional Healing of the Porcine Anterior Cruciate Ligament Using a Collagen-Platelet Composite

PubMed Central

Murray, Martha M.; Magarian, Elise; Zurakowski, David; Fleming, Braden C.

2010-01-01

Purpose The purpose of this study was to determine if providing bony stabilization between the tibia and femur would improve the structural properties of an “enhanced” ACL repair using a collagen-platelet composite when compared to the traditional (Marshall) suture technique. Methods Twelve pigs underwent unilateral ACL transection and were treated with sutures connecting the bony femoral ACL attachment site to the distal ACL stump (LIGAMENT group), or to the tibia via a bone tunnel (TIBIA group). A collagen-platelet composite was placed around the sutures to enhance the biologic repair in both groups. Anteroposterior (AP) knee laxity and the graft structural properties were measured after 15 weeks of healing in both the ACL-repaired and contralateral ACL-intact joints. Results Enhanced ACL repair with bone-to-bone fixation significantly improved yield load and linear stiffness of the ACL repairs (p<0.05) after 15 weeks of healing. However, laxity values of the knees were similar in both groups of repaired knees (p>0.10). Conclusions Using an enhanced ACL suture repair technique that includes bone-to-bone fixation to protect the repair in the initial healing stages resulted in an ACL with improved structural properties after 15 weeks in the porcine model. Clinical Relevance The healing response of an ACL suture repair using a collagen-platelet composite can be enhanced by providing bony stabilization between the tibia and femur to protect the graft during the initial healing process in a translational model. PMID:20810092

[Preliminary investigation of treatment of ulnar nerve defect by end-to-side neurorrhaphy].

PubMed

Luo, Y; Wang, T; Fang, H

1997-11-01

In the repair of the defect of peripheral nerve, it was necessary to find an operative method with excellent therapeutic effect but simple technique. Based on the experimental study, one case of old injury of the ulnar nerve was treated by end-to-side neurorraphy with the intact median nerve. In this case the nerve defect was over 3 cm and unable to be sutured directly. The patient was followed up for fourteen months after the operation. The recovery of the sensation and the myodynamia was evaluated. The results showed that: the sensation and the motor function innervated by ulnar nerve were recovered. The function of the hand was almost recovered to be normal. It was proved that the end-to-side neurorraphy between the distal stump with the intact median nerve to repair the defect of the ulnar nerve was a new operative procedure for nerve repair. Clinically it had good effect with little operative difficulty. This would give a bright prospect to repair of peripheral nerve defect in the future.

[APPLICATION OF V-Y ADVANCED SENSE-REMAINED POSTERIOR TIBIAL ARTERY PERFORATOR FLAP IN REPAIRING WOUND AROUND ANKLE].

PubMed

Tang, Xiujun; Wang, Bo; Wei, Zairong; Wang, Dali; Han, Wenjie; Zhang, Wenduo; Li, Shujun

2015-12-01

OBJECTIVE To explore the feasibility and effectiveness of V-Y advanced sense-remained posterior tibial artery perforator flap in repairing wound around the ankle. METHODS Between March 2012 and January 2015, 11 patients with wounds around the ankle were treated by V-Y advanced sense-remained posterior tibial artery perforator flap. There were 6 males and 5 females with a median age of 37 years (range, 21-56 years). The causes were traffic accident injury in 3 cases, thermal injury in 2 cases, burn in 2 cases, iatrogenic wounds in 2 cases, and local contusion in 2 cases. The disease duration ranged from 1 to 3 weeks (mean, 2 weeks). Injury was located at the medial malleolus in 4 cases, at the lateral malleolus in 3 cases, and at the heel in 4 cases. All had exposure of bone, tendon, or plate. The defect area ranged from 4 cmx2 cm to 5 cmx3 cm; the area of the flap ranged from 11 cmx4 cm to 15 cmx6 cm. Necrosis of distal flap occurred in 1 case after operation; re-operation to amputate the posterior tibial artery was given and the wound was repaired by proximal skin graft. Light necrosis of distal end was observed in 2 cases, and wound healed at 3 weeks after dressing. And other flaps successfully survived, and primary healing of wounds were obtained. The patients were followed up 6-24 months (mean, 11 months). The flaps were good in color, texture, and appearance. The ankle joint had normal activity. At last follow-up, 10 cases restored fine sense, and 1 case restored protective feeling with posterior tibial artery advanced flap after amputation. V-Y advanced sense-remained posterior tibial artery perforator flap has the advantages of reliable blood supply, simple operation, good appearance, and sensory recovery. Therefore, it is an ideal method to repair wound around the ankle.

Nonanatomic free cartilage batten grafting with second intention healing for defects on the distal nose.

PubMed

Ibrahimi, Omar A; Campbell, Tracy; Youker, Summer; Eisen, Daniel B

2012-01-01

Defects of the distal nose, particularly the nasal ala, pose a reconstructive challenge due to the lack of loose adjacent tissue and proximity to a free margin. We report our experience using nonanatomic free cartilage batten grafts in combination with second intention healing for nasal ala defects. A retrospective study of distal nose defects repaired using nonanatomic free cartilage batten grafting with second intention healing was performed. Detailed data on the quality of the scar, post-operative complications, free margin distortion, functional impairments, and patient satisfaction were recorded. Digital images were also shown to an experienced fellowship-trained Mohs surgeon to assess the overall aesthetic outcome using a 5-point score ranging from poor to excellent. Sixteen subjects were included in the study. Complications were common, but minor. Five (~31%) subjects had subtle contour depressions, three (~18%) subjects had excessive granulation tissue, two (~12%) subjects had post-operative ear pain at the donor site lasting up to 10 days, and one (~6%) subject had a hypertrophic scar at the recipient site. There were two occurrences (~12%) of mild alar notching but no occurrences of significant alar margin distortion or nasal valve dysfunction. In terms of aesthetic outcome, seven (~43%) were assessed by an independent fellowship-trained Mohs surgeon as having excellent aesthetic outcomes, six (~38%) were very good, and three (~19%) were good. All sixteen subjects reported satisfaction on follow-up evaluation. Nonanatomic free cartilage grafting with second intention healing allows for facile, single-step repair of nasal ala defects with high patient satisfaction and aesthetically pleasing results. This provides an attractive alternative to other flap techniques, skin grafting, and healing via secondary intention.

Congenital esophageal stenosis associated with esophageal atresia/tracheoesophageal fistula: clinical and radiologic features.

PubMed

Yoo, Hye Jin; Kim, Woo Sun; Cheon, Jung-Eun; Yoo, So-Young; Park, Kwi-Won; Jung, Sung-Eun; Shin, Su-Mi; Kim, In-One; Yeon, Kyung Mo

2010-08-01

Congenital esophageal stenosis (CES) can be associated with esophageal atresia/tracheoesophageal fistula (EA/TEF). Because there are a variety of degrees of obstruction and symptoms of CES, it is frequently difficult to make a pre- and post-operative diagnosis of the distal CES associated with EA/TEF. To evaluate the clinical and radiologic features of congenital esophageal stenosis associated with esophageal atresia/tracheoesophageal fistula. We retrospectively reviewed postoperative esophagograms and medical records of 187 children (107 boys, 80 girls) who had primary repair of EA/TEF from 1992 to 2009 at our institution. We evaluated the incidence of CES, clinical findings, radiologic features and management of CES in these children. CES was diagnosed in 22 of 187 EA/TEF children (12%); one child had double CES lesions, for a total of 23 lesions. Ten of those 22 children (45%) had presented with significant symptoms of esophageal obstruction. The diagnosis of CES was delayed in 10 children (45%) until 1-10 years of age. On esophagogram, CES (n = 23) was located in the distal esophagus (n = 20, 87%) or mid-esophagus (n = 3, 13%). The degree of stenosis was severe (n = 6, 26%), moderate (n = 10, 43%), or mild (n = 7, 30%). Eight children, including two with unsuccessful esophageal balloon dilatation of CES, were treated surgically. Histologic examination revealed tracheobronchial remnant (n = 7) or fibromuscular hyperplasia (n = 1). One child with surgically treated CES developed achalasia at the age of 3 years 9 months. Esophagography after EA/TEF repair should be performed with a high index of suspicion for the presence of distal CES, because the diagnosis and adequate management of CES can often be delayed.

[Bone repair in pseudarthrosis after arthrodesis of the upper ankle joint].

PubMed

Eingartner, C; Volkmann, R; Winter, E; Weller, S

1994-06-01

Delayed union or non-union of ankle arthrodesis is a common problem and revision arthrodesis is necessary in those difficult cases. Three cases are presented, in which a non-union after tibiotalar or tibiacalcanear fusion could be treated effectively with a bone graft taken from the anterior cortex of the distal tibia or from the anterior iliacal spine. The bone graft was fixed proximally with a screw. Distally the graft was inserted in an slot gouged into the talus or the calcaneus respectively with or without screw fixation. Postoperative care included short-time external fixation and immobilisation with a shortleg weight bearing cast. We conclude that the technique of a sliding tibiotalar graft can be used for effective treatment of non-union following ankle arthrodesis.

Comparison of computer assisted surgery with conventional technique for treatment of abaxial distal phalanx fractures in horses: an in vitro study.

PubMed

Rossol, Melanie; Gygax, Diego; Andritzky-Waas, Juliane; Zheng, Guoyan; Lischer, Christoph J; Zhang, Xuan; Auer, Joerg A

2008-01-01

To (1) evaluate and compare computer-assisted surgery (CAS) with conventional screw insertion (conventional osteosynthesis [COS]) for treatment of equine abaxial distal phalanx fractures; (2) compare planned screw position with actual postoperative position; and (3) determine preferred screw insertion direction. Experimental study. Cadaveric equine limbs (n=32). In 8 specimens each, a 4.5 mm cortex bone screw was inserted in lag fashion in dorsopalmar (plantar) direction using CAS or COS. In 2 other groups of 8, the screws were inserted in opposite direction. Precision of CAS was determined by comparison of planned and actual screw position. Preferred screw direction was also assessed for CAS and COS. In 4 of 6 direct comparisons, screw positioning was significantly better with CAS. Results of precision analysis for screw position were similar to studies published in human medicine. None of evaluated criteria identified a preferred direction for screw insertion. For abaxial fractures of the distal phalanx, superior precision in screw position is achieved with CAS technique compared with COS technique. Abaxial fractures of the distal phalanx lend themselves to computer-assisted implantation of 1 screw in a dorsopalmar (plantar) direction. Because of the complex anatomic relationships, and our results, we discourage use of COS technique for repair of this fracture type.

Distal biceps tendon rupture reconstruction using muscle-splitting double-incision approach

PubMed Central

Tarallo, Luigi; Mugnai, Raffaele; Zambianchi, Francesco; Adani, Roberto; Catani, Fabio

2014-01-01

AIM: To evaluate the clinical and functional results after repair of distal biceps tendon tears, following the Morrey’s modified double-incision approach. METHODS: We retrospectively reviewed 47 patients with distal rupture of biceps brachii treated between 2003 and 2012 in our Orthopedic Department with muscle-splitting double-incision technique. Outcome measures included the Mayo elbow performance, the DASH questionnaire, patient’s satisfaction, elbow and forearm motion, grip strength and complications occurrence. RESULTS: At an average 18 mo follow-up (range, 7 mo-10 years) the average Mayo elbow performance and DASH score were respectively 97.2 and 4.8. The elbow flexion range was 94%, extension was -2°, supination was 93% and pronation 96% compared with the uninjured limb. The mean grip strength, expressed as percentage of respective contralateral limb, was 83%. The average patient satisfaction rating on a Likert scale (from 0 to 10) was 9.4. The following complications were observed: 3 cases of heterotopic ossification (6.4%), one (2.1%) re-rupture of the tendon at the site of reattachment and 2 cases (4.3%) of posterior interosseous nerve palsy. No complication required further surgical treatment. CONCLUSION: This technique allows an anatomic reattachment of distal biceps tendon at the radial tuberosity providing full functional recovery with low complication rate. PMID:25133147

[Island flap in the surgical treatment of hypospadias].

PubMed

Austoni, E; Mantovani, F; Colombo, F; Fenice, O; Mastromarino, G; Vecchio, D; Canclini, L

1994-06-01

Surgery of hypospadias represents an interesting field of innovatory ideas. Many methods may be suitable and many modifications can be performed. There is no one method for all kinds of hypospadias. It is necessary to find the right method for each patient. The result often depends upon the experience of the surgeon with a particular method. The choice between straightening and urethroplasty in one or two stages depends on cost-benefit ratio and evolution at distance of the straightening must be taken into account as well tissue consumption imposed by the urethroplasty, with one stage straightening that makes reintervention very difficult. In the latter case, a multi-stage operation will be necessary with flaps for urethroplasty after the straightening, or, in a more developed penis, a shortening operation according to Nesbit. With two-stage method, in case of relapsed curvature, this can easily be treated, if tissue is available. For a good result of urethroplasty the ability of surgeon, a constant calibration of the canal, plenty of elastic tissue for the neo-urethra, care not to suture on these planes, are highly important. In our opinion Duplay's method observes these requisites. Two-stages surgery allows easy correction of any eventual relapsing incurvature, with no problems for the following urethroplasty. One-stage surgery allows the problems to be resolved in a single surgical Step, but involves the risk of tissue consumption and proximal stricture.

Mesenchymal Stem Cell Therapy for Nerve Regeneration and Immunomodulation after Composite Tissue Allotransplantation

DTIC Science & Technology

2012-08-01

early rejection of the grafts, there was no significant functional recovery noted on electromyography or Catwalk gait analysis. However, in vitro...Figure 10: Light Microscopic Image (100X, stained with Toluidine Blue): Nerve Cross Section 5-8 mm distal to anastomosis site. Representative... images from (A) Systemic MSC therapy, (B) Local MSC therapy and (c) No treatment Control Figure 11: Sciatic Nerve Transection and Repair (6

The periosteal requirement and temporal dynamics of BMP2‐induced middle phalanx regeneration in the adult mouse

PubMed Central

Dawson, Lindsay A.; Yu, Ling; Yan, Mingquan; Marrero, Luis; Schanes, Paula P.; Dolan, Connor; Pela, Maegan; Petersen, Britta; Han, Manjong

2017-01-01

Abstract Regeneration of mammalian limbs is restricted to amputation of the distal digit tip, the terminal phalanx (P3). The adjacent skeletal element, the middle phalanx (P2), has emerged as a model system to investigate regenerative failure and as a site to test approaches aimed at enhancing regeneration. We report that exogenous application of bone morphogenetic protein 2 (BMP2) stimulates the formation of a transient cartilaginous callus distal to the amputation plane that mediates the regeneration of the amputated P2 bone. BMP2 initiates a significant regeneration response during the periosteal‐derived cartilaginous healing phase of P2 bone repair, yet fails to induce regeneration in the absence of periosteal tissue, or after boney callus formation. We provide evidence that a temporal component exists in the induced regeneration of P2 that we define as the “regeneration window.” In this window, cells are transiently responsive to BMP2 after the amputation injury. Simple re‐injury of the healed P2 stump acts to reinitiate endogenous bone repair, complete with periosteal chondrogenesis, thus reopening the “regeneration window” and thereby recreating a regeneration‐permissive environment that is responsive to exogenous BMP2 treatment. PMID:28975034

Validation of the Simbionix PROcedure Rehearsal Studio sizing module: A comparison of software for endovascular aneurysm repair sizing and planning.

PubMed

Velu, Juliëtte F; Groot Jebbink, Erik; de Vries, Jean-Paul P M; Slump, Cornelis H; Geelkerken, Robert H

2017-02-01

An important determinant of successful endovascular aortic aneurysm repair is proper sizing of the dimensions of the aortic-iliac vessels. The goal of the present study was to determine the concurrent validity, a method for comparison of test scores, for EVAR sizing and planning of the recently introduced Simbionix PROcedure Rehearsal Studio (PRORS). Seven vascular specialists analyzed anonymized computed tomography angiography scans of 70 patients with an infrarenal aneurysm of the abdominal aorta, using three different sizing software packages Simbionix PRORS (Simbionix USA Corp., Cleveland, OH, USA), 3mensio (Pie Medical Imaging BV, Maastricht, The Netherlands), and TeraRecon (Aquarius, Foster City, CA, USA). The following measurements were included in the protocol: diameter 1 mm below the most distal main renal artery, diameter 15 mm below the lowest renal artery, maximum aneurysm diameter, and length from the most distal renal artery to the left iliac artery bifurcation. Averaged over the locations, the intraclass correlation coefficient is 0.83 for Simbionix versus 3mensio, 0.81 for Simbionix versus TeraRecon, and 0.86 for 3mensio versus TeraRecon. It can be concluded that the Simbionix sizing software is as precise as two other validated and commercially available software packages.

A Comparative Biomechanical Analysis of 2 Double-Row, Distal Triceps Tendon Repairs

PubMed Central

Dorweiler, Matthew A.; Van Dyke, Rufus O.; Siska, Robert C.; Boin, Michael A.; DiPaola, Mathew J.

2017-01-01

Background: Triceps tendon ruptures are rare orthopaedic injuries that almost always require surgical repair. This study tests the biomechanical properties of an original anchorless double-row triceps repair against a previously reported knotless double-row repair. Hypothesis: The anchorless double-row triceps repair technique will yield similar biomechanical properties when compared with the knotless double-row repair technique. Study Design: Controlled laboratory study. Methods: Eighteen cadaver arms were randomized into 2 groups. One group received the anchorless repair and the other received the knotless anchor repair. A materials testing system (MTS) machine was used to cycle the repaired arms from 0° to 90° with a 2.5-pound weight for 1500 cycles at 0.25 Hz. Real-time displacement of the tendon was measured during cycling using a probe. Load to failure was performed after completion of cyclic loading. Results: The mean displacement with the anchorless technique was 0.77 mm (SD, 0.25 mm) at 0° (full elbow extension) and 0.76 mm (SD, 0.38 mm) at 90° (elbow flexion). The mean displacement with the anchored technique was 0.83 mm (SD, 0.57 mm) at 0° and 1.01 mm (SD, 0.62 mm) at 90°. There was no statistically significant difference for tendon displacement at 0º (P = .75) or 90º (P = .31). The mean load to failure with the anchorless technique was 618.9 N (SD, 185.6 N), while it was 560.5 N (SD, 154.1 N) with the anchored technique, again with no statistically significant difference (P = .28). Conclusion: Our anchorless double-row triceps repair technique yields comparable biomechanical properties to previously described double-row triceps tendon repair techniques, with the added benefit of avoiding the cost of suture anchors. Clinical Relevance: This anchorless double-row triceps tendon repair can be considered as an acceptable alternative to a knotless anchor repair for triceps tendon ruptures. PMID:28607942

A Comparative Biomechanical Analysis of 2 Double-Row, Distal Triceps Tendon Repairs.

PubMed

Dorweiler, Matthew A; Van Dyke, Rufus O; Siska, Robert C; Boin, Michael A; DiPaola, Mathew J

2017-05-01

Triceps tendon ruptures are rare orthopaedic injuries that almost always require surgical repair. This study tests the biomechanical properties of an original anchorless double-row triceps repair against a previously reported knotless double-row repair. The anchorless double-row triceps repair technique will yield similar biomechanical properties when compared with the knotless double-row repair technique. Controlled laboratory study. Eighteen cadaver arms were randomized into 2 groups. One group received the anchorless repair and the other received the knotless anchor repair. A materials testing system (MTS) machine was used to cycle the repaired arms from 0° to 90° with a 2.5-pound weight for 1500 cycles at 0.25 Hz. Real-time displacement of the tendon was measured during cycling using a probe. Load to failure was performed after completion of cyclic loading. The mean displacement with the anchorless technique was 0.77 mm (SD, 0.25 mm) at 0° (full elbow extension) and 0.76 mm (SD, 0.38 mm) at 90° (elbow flexion). The mean displacement with the anchored technique was 0.83 mm (SD, 0.57 mm) at 0° and 1.01 mm (SD, 0.62 mm) at 90°. There was no statistically significant difference for tendon displacement at 0º ( P = .75) or 90º ( P = .31). The mean load to failure with the anchorless technique was 618.9 N (SD, 185.6 N), while it was 560.5 N (SD, 154.1 N) with the anchored technique, again with no statistically significant difference ( P = .28). Our anchorless double-row triceps repair technique yields comparable biomechanical properties to previously described double-row triceps tendon repair techniques, with the added benefit of avoiding the cost of suture anchors. This anchorless double-row triceps tendon repair can be considered as an acceptable alternative to a knotless anchor repair for triceps tendon ruptures.

Anatomic distribution of nerves and microvascular density in the human anterior vaginal wall: prospective study.

PubMed

Li, Ting; Liao, Qinping; Zhang, Hong; Gao, Xuelian; Li, Xueying; Zhang, Miao

2014-01-01

The presence of the G-spot (an assumed erotic sensitive area in the anterior wall of the vagina) remains controversial. We explored the histomorphological basis of the G-spot. Biopsies were drawn from a 12 o'clock direction in the distal- and proximal-third areas of the anterior vagina of 32 Chinese subjects. The total number of protein gene product 9.5-immunoreactive nerves and smooth muscle actin-immunoreactive blood vessels in each specimen was quantified using the avidin-biotin-peroxidase assay. Vaginal innervation was observed in the lamina propria and muscle layer of the anterior vaginal wall. The distal-third of the anterior vaginal wall had significantly richer small-nerve-fiber innervation in the lamina propria than the proximal-third (p = 0.000) and in the vaginal muscle layer (p = 0.006). There were abundant microvessels in the lamina propria and muscle layer, but no small vessels in the lamina propria and few in the muscle layer. Significant differences were noted in the number of microvessels when comparing the distal- with proximal-third parts in the lamina propria (p = 0.046) and muscle layer (p = 0.002). Significantly increased density of nerves and microvessels in the distal-third of the anterior vaginal wall could be the histomorphological basis of the G-spot. Distal anterior vaginal repair could disrupt the normal anatomy, neurovascular supply and function of the G-spot, and cause sexual dysfunction.

Acute repair of traumatic pan-brachial plexus injury: technical considerations and approaches.

PubMed

Abou-Al-Shaar, Hussam; Karsy, Michael; Ravindra, Vijay; Joyce, Evan; Mahan, Mark A

2018-01-01

Particularly challenging after complete brachial plexus avulsion is reestablishing effective hand function, due to limited neurological donors to reanimate the arm. Acute repair of avulsion injuries may enable reinnervation strategies for achieving hand function. This patient presented with pan-brachial plexus injury. Given its irreparable nature, the authors recommended multistage reconstruction, including contralateral C-7 transfer for hand function, multiple intercostal nerves for shoulder/triceps function, shoulder fusion, and spinal accessory nerve-to-musculocutaneous nerve transfer for elbow flexion. The video demonstrates distal contraction from electrical stimulation of the avulsed roots. Single neurorrhaphy of the contralateral C-7 transfer was performed along with a retrosternocleidomastoid approach. The video can be found here: https://youtu.be/GMPfno8sK0U .

[A case of strangulated congenital diaphragmatic hernia with necrosis and rupture of the colon and herniation into a left hemithorax in an adult (author's transl)].

PubMed

Sarris, M; Georgoulis, J; Gatos, M; Dariotis, A

This is a case report of a successful repair of congenital diaphragmatic hernia in a 48 years old male that contained the transverse colon which was strangulated and ruptured in the left thoracic cavity. It was approached in two stages. First through a laparotomy the proximal part of the transverse colon was divided. The side going to the hernial sac was sutured and the proximal stump was anastomosed to the descending colon. In a second stage, two days later, through a felt thoracotomy the strangulated and ruptured colon was resected and the distal stump of the transverse colon was sutured and the hernia repaired.

Slab fractures of the third tarsal bone: Minimally invasive repair using a single 3.5 mm cortex screw placed in lag fashion in 17 Thoroughbred racehorses.

PubMed

Barker, W H J; Wright, I M

2017-03-01

A technique for minimally invasive repair of slab fractures of the third tarsal bone has not previously been reported. Results of third tarsal bone slab fracture repair in Thoroughbred racehorses are lacking. To report the outcomes of repair of uniplanar frontal slab factures of the third tarsal bone using a single 3.5 mm cortex screw in lag fashion. Retrospective case series. Case records of horses that had undergone this procedure were reviewed. Seventeen horses underwent surgery. Eighteen percent of cases had wedge shaped third tarsal bones. A point midway between the long and lateral digital extensor tendons and centrodistal and tarsometatarsal joints created a suitable entry site for implants. The fracture location, configuration and curvature of the third tarsal bone and associated joints requires a dorsolateral proximal-plantaromedial distal trajectory for the screw, which was determined by preplaced needles. There were no complications and fractures healed in all cases at 4-6 months post surgery. Seventy-nine percent of horses returned to racing and, at the time of reporting, 3 are in post operative rehabilitation programmes. The technique reported provides a safe, appropriate and repeatable means of repairing slab fractures of the third tarsal bone. Surgical repair is a viable alternative to conservative management. © 2016 EVJ Ltd.

Distal triceps injuries (including snapping triceps): A systematic review of the literature.

PubMed

Shuttlewood, Kimberley; Beazley, James; Smith, Christopher D

2017-06-18

To review current literature on types of distal triceps injury and determine diagnosis and appropriate management. We performed a systematic review in PubMed, Cochrane and EMBASE using the terms distal triceps tears and snapping triceps on the 10 th January 2017. We excluded all animal, review, foreign language and repeat papers. We reviewed all papers for relevance and of the papers left we were able to establish the types of distal triceps injury, how these injuries are diagnosed and investigated and the types of management of these injuries including surgical. The results are then presented in a review paper format. Three hundred and seventy-nine papers were identified of which 65 were relevant to distal triceps injuries. After exclusion we had 47 appropriate papers. The papers highlighted 2 main distal triceps injuries: Distal triceps tears and snapping triceps. Triceps tear are more common in males than females occurring in the 4 th -5 th decade of life and often due to a direct trauma but are also strongly associated with weightlifting and American football. The tears are diagnosed by history and clinically with a palpable gap. Diagnosis can be confirmed with the use of ultrasound (US) and magnetic resonance imaging. Treatment depends on type of tear. Partial tears can be treated conservatively with bracing and physio whereas acute tears need repair either open or arthroscopic using suture anchor or bone tunnel techniques with similar success. Chronic tears often need augmenting with tendon allograft or autograft. Snapping triceps are also seen more in men than women but at a mean age of 32 years. They are characterized by a snapping sensation mostly medially and can be associated with ulna nerve subluxation and ulna nerve symptoms. US is the diagnostic modality of choice due to its dynamic nature and to differentiate between snapping triceps tendon or ulna nerve. Treatment is conservative initially with activity avoidance and if that fails surgical management includes resection of triceps edge or transposition of the tendon plus or minus ulna nerve transposition. Distal triceps injuries are uncommon. This systematic review examines the evidence base behind diagnosis, imaging and treatment options of distal triceps injuries including tears and snapping triceps.

BDNF gene delivery within and beyond templated agarose multi-channel guidance scaffolds enhances peripheral nerve regeneration

NASA Astrophysics Data System (ADS)

Gao, Mingyong; Lu, Paul; Lynam, Dan; Bednark, Bridget; Campana, W. Marie; Sakamoto, Jeff; Tuszynski, Mark

2016-12-01

Objective. We combined implantation of multi-channel templated agarose scaffolds with growth factor gene delivery to examine whether this combinatorial treatment can enhance peripheral axonal regeneration through long sciatic nerve gaps. Approach. 15 mm long scaffolds were templated into highly organized, strictly linear channels, mimicking the linear organization of natural nerves into fascicles of related function. Scaffolds were filled with syngeneic bone marrow stromal cells (MSCs) secreting the growth factor brain derived neurotrophic factor (BDNF), and lentiviral vectors expressing BDNF were injected into the sciatic nerve segment distal to the scaffold implantation site. Main results. Twelve weeks after injury, scaffolds supported highly linear regeneration of host axons across the 15 mm lesion gap. The incorporation of BDNF-secreting cells into scaffolds significantly increased axonal regeneration, and additional injection of viral vectors expressing BDNF into the distal segment of the transected nerve significantly enhanced axonal regeneration beyond the lesion. Significance. Combinatorial treatment with multichannel bioengineered scaffolds and distal growth factor delivery significantly improves peripheral nerve repair, rivaling the gold standard of autografts.

Distal biceps reconstruction using an Achilles tendon allograft, transosseous EndoButton, and Pulvertaft weave with tendon wrap technique for retracted, irreparable distal biceps ruptures.

PubMed

Phadnis, Joideep; Flannery, Olivia; Watts, Adam C

2016-06-01

Distal biceps ruptures can result in ongoing pain and weakness when treated nonoperatively. If retraction of the tendon renders primary repair impossible, reconstruction using a graft is recommended. The current literature includes a variety of techniques with studies reporting small patient numbers. The aim of this study was to report the results of a larger cohort of patients using a technique modified from those previously described in the literature. Twenty-one consecutive male patients underwent distal biceps reconstruction through 2 small anterior incisions using an Achilles tendon allograft that was fixed distally using a transosseous EndoButton and secured proximally using a Pulvertaft weave and tendon wrap. The mean age was 44 years, and the mean time to surgery was 25 months (range, 2-96 months). Functional outcomes were collected prospectively. The mean preoperative Quick Disabilities of the Arm, Shoulder and Hand (QuickDASH) score (11 patients) was 1.9 (range, 0-4.5). The mean postoperative Oxford Elbow Score, QuickDASH score, and Mayo Elbow Performance Score were 44.7 (range, 35-48), 4 (range, 0-20.5), and 92.9 (range, 70-100), respectively, at a mean follow up of 15 months (range, 6-35 months). The mean postoperative QuickDASH score was significantly improved compared with preoperatively (P < .001). All patients were satisfied and all returned to their previous level of activity. There were 2 transient lateral antebrachial cutaneous nerve paresthesias, and 2 patients had a 5° extension lag. There were no other complications. Achilles allograft reconstruction of retracted irreparable distal biceps ruptures provides consistently good results with few complications using this technique. Crown Copyright © 2016. Published by Elsevier Inc. All rights reserved.

In utero repair of myelomeningocele: experimental pathophysiology, initial clinical experience, and outcomes.

PubMed

Farmer, Diana L; von Koch, Cornelia S; Peacock, Warwick J; Danielpour, Moise; Gupta, Nalin; Lee, Hanmin; Harrison, Michael R

2003-08-01

Experimental work raises the possibility that in utero repair of myelomeningocele (MMC) may improve lower extremity, bladder, and bowel function, ameliorate the Arnold-Chiari malformation, and decrease the need for postnatal shunting. We previously developed fetal lamb models to create and reverse lower extremity damage and the Arnold-Chiari malformation in utero. We then applied our extensive experience with fetal surgery, including fetal endoscopic (fetoscopic) surgical manipulation, to develop techniques for MMC repair. A tertiary referral center. All patients treated between 1998 and 2002 for a prenatally diagnosed MMC. Either fetoscopic MMC repair, fetoscopic patch repair, or limited maternal hysterotomy and microsurgical 3-layered fetal MMC repair was performed. Gestational age at delivery, survival, neurologic outcome, and need for ventricular shunting at 1 year. Complete fetoscopic repair was accomplished in 1 fetus. Two other fetuses underwent partial fetoscopic procedures. The remaining 10 patients underwent limited maternal hysterotomy and microsurgical 3-layered fetal MMC repair. Four of 13 patients died, and the mean gestational age at delivery of 11 fetuses born alive was 31 weeks. Five of 9 required ventricular shunting by age 1 year. In 2 patients, lower extremity function improved by more than 2 vertebral levels compared with prenatal ultrasonography. Five of 10 patients who lived longer than 3 weeks required postnatal wound revision within 7 days after birth. Fetoscopic repair, although feasible, does not yet yield optimal surgical results. Open surgical repair before 22 weeks' gestation is physiologically sound and technically feasible. One third of patients appear to be spared the need for a shunt at age 1 year, but improvement in distal neurologic function is less clear. Additionally, fetal mortality is associated with this procedure. Our results complement the data published by groups at Children's Hospital of Philadelphia, in Pennsylvania, and Vanderbilt University, Nashville, Tenn. A National Institutes of Health-sponsored prospective randomized trial is now underway at these 3 centers to compare fetal repair with postnatal repair.

Flow-Through Free Fibula Osteocutaneous Flap in Reconstruction of Tibial Bone, Soft Tissue, and Main Artery Segmental Defects.

PubMed

Li, Zonghuan; Yu, Aixi; Qi, Baiwen; Pan, Zhenyu; Ding, Junhui

2017-08-01

The aim of this report was to present the use of flow-through free fibula osteocutaneous flap for the repair of complex tibial bone, soft tissue, and main artery segmental defects. Five patients with bone, soft tissue, and segmental anterior tibial artery defects were included. The lengths of injured tibial bones ranged from 4 to 7 cm. The sizes of impaired soft tissues were between 9 × 4 and 15 × 6 cm. The lengths of defect of anterior tibial artery segments ranged from 6 to 10 cm. Two patients had distal limb perfusion problems. Flow-through free fibula osteocutaneous flap was performed for all 5 patients. Patients were followed for 12 to 18 months. All wounds healed after 1-stage operation, and all flow-through flaps survived. The distal perfusion after vascular repair was normal in all patients. Superficial necrosis of flap edge was noted in 1 case. After the local debridement and partial thickness skin graft, the flap healed uneventfully, and the surgical operation did not increase injury to the donor site. Satisfactory bone union was achieved in all patients in 2 to 4 months postoperation. Enlargement of fibula graft was observed during follow-up from 12 to 18 months. The functions of adjacent joints were recovered, and all patients were able to walk normally. Flow-through free fibula osteocutaneous flap was shown to be an effective and efficient technique for repairing composite tibial bone, soft tissue, and main artery segmental defects. This 1-stage operation should be useful in clinical practice for the treatment of complex bone, soft tissue, and vessel defects.

[Midterm results of thoracic aortic dissection endovascular repair in conjunctions with the location of Adamkiewicz artery].

PubMed

Jia, Ying-bin; Li, Jian; Su, Yong-hui; Ma, Jie-fei; Guan, Xiao-dong; Zhang, Bai-meng

2012-10-23

To evaluate the effects of using longer xenografts in conjunctions with the location of Adamkiewicz artery (AKA) on midterm outcomes of endovascular treatment for thoracic aortic dissection. From March 2005 to September 2011, 217 patients with type B dissection were recruited. There were 143 males and 74 females with a mean age of 65 ± 11 years. Among them, 43 patients were from Fifth Affiliated Hospital of Sun Yat-Sen University while another 174 patients from Affiliated Zhongshan Hospital of Fudan University. They were divided into 2 groups according to whether AKA was identified or not pre-operatively. Endovascular repairs were performed for all patients. Distal landing levels of xenografts were recorded. The thrombosis of false lumen and the complications of spinal cord injury and endoleak were analyzed. AKA was detected in 121 (55.8%) patients (group A) but not in 96 (44.2%) patients (group B). According to the levels of AKA, the patients of group A obtained the stabilization of affected thoracic aorta over a longer distance. And the ratio of patients with distal landing levels at T8-T10 was significantly higher than in group B (59.5% vs 12.5%, χ² = 49.85, P < 0.01). Also, during the follow-up period of 7.3 months, the ratio of patients with total thrombosis of false lumen in group A was significantly higher than that in group B (32.1% vs 19.1%, χ² = 4.34, P < 0.05). During the endovascular repair of thoracic aortic dissection, selecting a longer device may provide a better structural stability of affected aorta and promote false lumen thrombosis.

Polyethylene glycol treated allografts not tissue matched nor immunosuppressed rapidly repair sciatic nerve gaps, maintain neuromuscular functions, and restore voluntary behaviors in female rats.

PubMed

Mikesh, Michelle; Ghergherehchi, Cameron L; Rahesh, Sina; Jagannath, Karthik; Ali, Amir; Sengelaub, Dale R; Trevino, Richard C; Jackson, David M; Tucker, Haley O; Bittner, George D

2018-07-01

Many publications report that ablations of segments of peripheral nerves produce the following unfortunate results: (1) Immediate loss of sensory signaling and motor control; (2) rapid Wallerian degeneration of severed distal axons within days; (3) muscle atrophy within weeks; (4) poor behavioral (functional) recovery after many months, if ever, by slowly-regenerating (∼1mm/d) axon outgrowths from surviving proximal nerve stumps; and (5) Nerve allografts to repair gap injuries are rejected, often even if tissue matched and immunosuppressed. In contrast, using a female rat sciatic nerve model system, we report that neurorrhaphy of allografts plus a well-specified-sequence of solutions (one containing polyethylene glycol: PEG) successfully addresses each of these problems by: (a) Reestablishing axonal continuity/signaling within minutes by nonspecific ally PEG-fusing (connecting) severed motor and sensory axons across each anastomosis; (b) preventing Wallerian degeneration by maintaining many distal segments of inappropriately-reconnected, PEG-fused axons that continuously activate nerve-muscle junctions; (c) maintaining innervation of muscle fibers that undergo much less atrophy than otherwise-denervated muscle fibers; (d) inducing remarkable behavioral recovery to near-unoperated levels within days to weeks, almost certainly by CNS and PNS plasticities well-beyond what most neuroscientists currently imagine; and (e) preventing rejection of PEG-fused donor nerve allografts with no tissue matching or immunosuppression. Similar behavioral results are produced by PEG-fused autografts. All results for Negative Control allografts agree with current neuroscience data 1-5 given above. Hence, PEG-fusion of allografts for repair of ablated peripheral nerve segments expand on previous observations in single-cut injuries, provoke reconsideration of some current neuroscience dogma, and further extend the potential of PEG-fusion in clinical practice. © 2018 Wiley Periodicals, Inc.

Risk factors of surgical failure following sacrospinous colpopexy for the treatment of uterovaginal prolapse.

PubMed

Qatawneh, Ayman; Thekrallah, Fida; Bata, Majed; Al-Kazaleh, Fawaz; Almustafa, Mahmoud; Abu-Kader, Ilham

2013-06-01

Trans-vaginal sacrospinous colpopexy is one of the surgical procedures used to repair varying degrees of vaginal vault and uterovaginal prolapse. The purpose of this study is to analyse the potential risk factors of surgical failure following sacrospinous colpopexy. A retrospective study of 114 women who underwent unilateral sacrospinous colpopexy at Jordan University Hospital from January 2005 to January 2008 were included. Patient demographics, clinical characteristics and concomitant pelvic organ prolapse surgery were assessed. The patients were evaluated at 6 weeks, and every 6 months thereafter. Twelve (11 %) had recurrent apical (vaginal cuff) prolapse, 26 (23 %) had recurrent prolapse at any compartment were compared with those who had successful surgery. Univariate and logistic regression analyses were used to assess the independent prognostic values of the variables associated with surgical failure. After a mean follow-up of 40 months, the statistically significant predictors of surgical failure included the presence of advanced pre-operative stages of prolapse (stages III and IV), the more distally located points Ba, Bp and C and a lack of mesh augmentation of the anterior vaginal wall during surgery (P = 0.01, 0.027, 0.024, 0.034 and 0.006, respectively). However, a history of prior vaginal repair, the more distally located point Ba and a lack of anterior vaginal wall mesh augmentation were defined as independent predictive variables based on logistic regression analyses (P = 0.04, 0.005 and 0.046, respectively). The presence of advanced anterior vaginal wall prolapse, prior vaginal repair and a lack of mesh augmentation of the anterior compartment are significant risk factors for the surgical failure of sacrospinous suspension surgery.

Facts about Hypospadias

MedlinePlus

... 1997-2011) and the Birth Defects Study to Evaluate Pregnancy exposureS (BD-STEPS; began with births in ... to 2012: Presentation of state-specific data and descriptive brief on variability of prevalence. Birth Def Res ( ...

Twelve-year prevalence of common neonatal congenital malformations in Zhejiang Province, China.

PubMed

Sun, Ge; Xu, Zhe-Ming; Liang, Jian-Feng; Li, Lin; Tang, Da-Xing

2011-11-01

One of the challenges that pediatricians face when examining birth defects is to understand the trends in its occurrence and provide clues to etiology. This study was undertaken to retrospectively assess the prevalence of 10 common neonatal congenital malformations by reviewing a database of all deliveries from 28 weeks up until 7 days of birth from January 1998 to December 2009 in Zhejiang Province, China. Ten common neonatal congenital malformations were selected for analysis. The incidence and the Cochran-Armitage Trend were assessed via SAS9.2. A P value ≤0.05 was considered statistically significant. Of 83 888 perinatals, 374 (4.46‰) suffered from congenital heart diseases (CHD), 77 (0.92‰) from congenital hydrocephalus, 32 (0.38‰) from intestinal atresia/stenosis, 36 (0.43‰) from anorectal malformations, 149 (1.78‰) from kidney malformations, 139 (3.31‰) from hypospadias (male), 178 (2.12‰) from orofacial clefts (OFC), 188 (2.24‰) from polydactyly, 62 (0.74‰) from syndactyly, and 269 (3.21‰) from accessory auricle anomaly. Their trend of prevalence varied as follows: CHD, P=0.0026; hydrocephalus, P=0.0042; intestinal atresia/stenosis, P=0.0103; anorectal malformations, P=0.4332; kidney malformations, P<0.0001; hypospadias, P=0.0021; OFC, P=0.005; polydactyly, P=0.0867; syndactyly, P=0.1941; and accessory auricle anomaly, P=0.0011. The upward trend was as follows: CHD (P=0.0026), intestinal atresia/stenosis (P=0.0103), kidney malformations (P<0.0001), hypospadias (P=0.0021), OFC (P=0.005), and accessory auricle anomaly (P=0.0011). The incidence of hydrocephalus (P=0.0042) showed a downward trend. No statistical significant trend was found in anorectal malformations (P=0.4332), polydactyly (P=0.0867) and syndactyly (P=0.1941). The incidences of CHD, intestinal atresia/stenosis, kidney malformations, hypospadias, OFC, and accessory auricle anomaly have increased in the last 12 years, but the incidences of anorectal malformations, polydactyly and syndactyly remain stable. The incidence of hydrocephalus shows a downward trend.

High Ulnar Nerve Injuries: Nerve Transfers to Restore Function.

PubMed

Patterson, Jennifer Megan M

2016-05-01

Peripheral nerve injuries are challenging problems. Nerve transfers are one of many options available to surgeons caring for these patients, although they do not replace tendon transfers, nerve graft, or primary repair in all patients. Distal nerve transfers for the treatment of high ulnar nerve injuries allow for a shorter reinnervation period and improved ulnar intrinsic recovery, which are critical to function of the hand. Copyright © 2016 Elsevier Inc. All rights reserved.

Double-Row Suture Anchor Repair of Posterolateral Corner Avulsion Fractures.

PubMed

Gilmer, Brian B

2017-08-01

Posterolateral corner avulsion fractures are a rare variant of ligamentous knee injury primarily described in the skeletally immature population. Injury is often related to a direct varus moment placed on the knee during sporting activities. Various treatment strategies have been discussed ranging from nonoperative management, to excision of the bony fragment, to primary repair with screws or suture. The described technique is a means for achieving fixation of the bony avulsion using principles familiar to double-row transosseous equivalent rotator cuff repair. Proximal anchors are placed in the epiphysis, and sutures are passed in horizontal mattress fashion. Once tied, the limbs of these same sutures are then passed to more distal anchors. Remaining eyelet sutures can be used to manage peripheral tissue. The final repair provides anatomic reduction and compression of the fragment to its bony bed with minimal extracortical hardware prominence and no violation of the physis. Risks include potential for physeal injury or chondral damage to the lateral femoral condyle through aberrant anchor placement. Postoperative care includes toe-touch weight-bearing restrictions and range of motion restrictions of 0°-90° in a hinged brace for 6 weeks followed by gradual return to activity.

A female patient with congenital pouch colon (CPC): a case report.

PubMed

Yilmaz, O; Genc, A; Ayhan, S; Ozcan, T; Aygoren, R; Taneli, C

2011-01-01

Congenital short colon, more commonly known as pouch colon, is a rare anomaly that can be encountered with anorectal malformations (ARM). The colon is shorter than normal and the distal end is dilated like a pouch. We report the case of a newborn with a Type 2 pouch colon. A female newborn was brought to our clinic with a diagnosis of cloaca anomaly. Her physical examination revealed a single canal introitus and flat perineum. In the abdominal x-ray taken in the upright position, a prominent air sac was noticed at the left side. A laparotomy was performed and exploration demonstrated that the colon was like a pouch. The pouch terminated in the upper part of the vagina with a wide canal. A genitogram displayed the presence of double uteri and double vaginas. One month after the operation we performed a cystoscopy, which showed the urethral meatus to be more proximal than normal (female type hypospadias). When the patient was 8 months old she was re-operated and anterior-abdomino-posterior sagittal anorectoplasty plus tube coloplasty were performed. She is now 4 years old and has a stool discharge of 2-3 times a day. Her physical and psychosocial development is in concordance with her age. Congenital pouch colon is a very rare anomaly, which has to be considered especially during the clinical evaluation of children with cloacal malformations and high type anorectal anomalies.

Correction of penile ventral curvature in patients with minor or no hypospadias: a single surgeon's experience of 43 cases.

PubMed

Seo, Shogo; Ochi, Takanori; Yazaki, Yuta; Murakami, Hiroshi; Okawada, Manabu; Doi, Takashi; Miyano, Go; Koga, Hiroyuki; Lane, Geoffrey J; Yamataka, Atsuyuki

2016-10-01

To report our experience of correcting penile ventral curvature associated with minor or no hypospadias. We reviewed 43 penile ventral curvature patients treated by a single surgeon from 1997 to 2015. Of these, 23 had minor hypospadias. Curvature was corrected using degloving, chordectomy, dorsal plication (DP), tunica albuginea incision (TAI), or a combination of these. Outcome was confirmed by induced artificial erection and post-operative appearance. Mean age at curvature correction was 3.2 ± 2.6 years. 17/43 had degloving and chordectomy (DC), 16/43 had DP after DC, and 10/43 had TAI after DC, because of ventral shortening and severe curvature caused by a short hypoplastic urethra. Other procedures required were primary meatoplasty (n = 4) and urethroplasty (UP; n = 1) at the time of curvature correction, and UP after correction of curvature (n = 11). Complications included recurrence of curvature after DP (n = 3/16; 18.8 %) and urethral stenosis after UP with tubed peritoneum (n = 1/10; 10 %). There were no recurrences of curvature in TAI cases. Parents reported penile cosmesis as good (n = 38; 88.4 %), acceptable (n = 4; 9.3 %), or poor (n = 1; 2.3 %). We recommend TAI followed by UP for correcting penile ventral curvature with short hypoplastic urethra. Tubed peritoneum is not recommended for UP.

[Long-term outcomes after hypospadias surgery: Sexual reported outcomes and quality of life in adulthood].

PubMed

Even, L; Bouali, O; Moscovici, J; Huyghe, E; Pienkowski, C; Rischmann, P; Galinier, P; Game, X

2015-09-01

To evaluate outcomes and long-term sexual quality of life after hypospadias surgery. Seventeen-years-old patients operated for a posterior hypospadias in childhood were included in a transversal study. Fifteen patients, among the forty children treated since 1997, accepted to participate. These young men (mean age at the first surgery was 27.9±20months) were clinically reviewed and responded to questionnaires (EUROQOL 5, IIEF15 and non-validated questionnaire). This study arises about 8.4±5years after the last visit in paediatric department. Mean study age was 21.2±4.7years. One third of patients thought that global quality of life was distorted. Although 33% of the patients had erectile dysfunction, 80% were satisfied with their sexual quality of life. The most important complains were relative to the penile appearance. Number of procedures was not predictive of patient's satisfaction about penile function and appearance. Thirty-three percents of the patients would have been satisfied to have psychological and medical support. They would be interested in having contact with patients who suffered from the same congenital abnormality. These patients had functional and esthetical disturbances. This visit leads to a specific visit in 20% cases. In this study, medical follow-up does not seem to be counselling and had to be adapted. Adequate follow-up transition between paediatric and adult departments especially during adolescence seems to be necessary. Copyright © 2015 Elsevier Masson SAS. All rights reserved.

Rupture of the distal biceps brachii tendon: conservative treatment versus anatomic reinsertion--clinical and radiological evaluation after 2 years.

PubMed

Chillemi, Claudio; Marinelli, Mario; De Cupis, Vincenzo

2007-10-01

Distal biceps tendon rupture is a relatively rare injury. It commonly occurs in the dominant extremity of middle-aged men during an excessive eccentric tension as the arm is forced from a flexed position, while it is rarely observed during sport activities. Many techniques, including non-operative and surgical option, have been described for the treatment of a ruptured distal biceps tendon, but there is still considerable controversy about the management of choice. Nine patients affected with traumatic distal tendon ruptures of the biceps brachii were followed-up for a minimum of 24 months. Five patients underwent surgery (two-incision technique) and four patients were treated conservatively. Tendon readaptation to its origin was done by a suture metal anchor. Outcome was evaluated based on the physical examination, radiographic analysis and the SECEC elbow score. The SECEC elbow score results show that every single item result is in favour of surgical treatment. On measurements of motion, we found a slight flexion-extension deficit in two patients, but reduced supination in six patients and reduced pronation in four. Two patients had postoperative dysfunction of the deep branch of the radial nerve. Radiographic examination showed heterotopic bone formation on the radial tuberosity around the presumed insertion of the reattached tendon in 2 of 5 patients and ectopic ossification more proximally in the area of the biceps muscle Our findings confirm the view that anatomic repair of distal biceps tendon rupture provides consistently good results and early anatomic reconstruction can restore strength and endurance for the elbow.

Supinator to ulnar nerve transfer via in situ anterior interosseous nerve bridge to restore intrinsic muscle function in combined proximal median and ulnar nerve injury: a novel cadaveric study.

PubMed

Namazi, Hamid; HajiVandi, Shahin

2017-05-01

In cases of high ulnar nerve palsy, result of nerve repair in term of intrinsic muscle recovery is unsatisfactory. Distal nerve transfer can diminish the regeneration time and improve the results. But, there was no perfect distal nerve transfer for restoring intrinsic hand function in combined proximal median and ulnar nerve injuries. This cadaveric study aims to evaluate the possibility and feasibility of supinator nerve transfer to motor branch of ulnar nerve (MUN). Ten cadaveric upper limbs dissected to identify the location of the supinator branch, anterior interosseous nerve (AIN), and MUN. The AIN was cut from its origin and transferred to the supinator branches. Also, the AIN was distally cut and transferred to the MUN. After nerve coaptation, surface area, fascicle count, and axon number were determined by histologic methods. In all limbs, the proximal and distal stumps of AIN reached the supinator branch and the MUN without tension, respectively. The mean of axon number in the supinator, proximal stump of AIN, distal stump of AIN and MUN branches were 32,426, 45,542, 25,288, and 35,426, respectively. This study showed that transfer of the supinator branches to the MUN is possible via the in situ AIN bridge. The axon count data showed a favorable match between the supinator branches, AIN, and MUN. Therefore, it is suggested that this technique can be useful for patients with combined high median and ulnar nerve injuries. Copyright © 2016 Elsevier Inc. All rights reserved.

Surgical internal iliac artery preservation associated with endovascular repair of infrarenal aortoiliac aneurysms to avoid buttock claudication and distal type I endoleaks.

PubMed

Gaudric, Julien; Tresson, Philippe; Derycke, Lucie; Tezenas Du Montcel, Sophie; Couture, Thibault; Davaine, Jean-Michel; Kashi, Mahine; Lawton, James; Chiche, Laurent; Koskas, Fabien

2018-06-21

The objective of this study was to assess outcomes of a hybrid technique for treatment of abdominal aortic aneurysm (AAA) associated with iliac aneurysm without distal neck by combining an AAA endovascular repair approach with open surgery for preservation of the internal iliac artery (IIA). The files of 51 patients operated on between 1998 and 2017 in a single vascular surgery department were retrospectively analyzed. Inclusion criteria were patients with AAA associated with uni-iliac or bi-iliac aneurysm without suitable distal sealing zone. Surgery consisted of deployment of an aortouni-iliac stent graft combined with an extra-anatomic crossover prosthetic bypass. With use of a limited retroperitoneal approach, the contralateral proximal common iliac aneurysm was surgically excluded and the IIA revascularized by direct ilioiliac anastomosis or terminal common iliac suture, preserving the iliac bifurcation. The patients' mean age was 74 years (58-88 years), and 92% were men. The mean follow-up was 5.8 years (0.1-18 years). Twenty-nine patients (57%) had one or more high-risk criteria for open surgery. Nineteen patients (37.3%) had aortouni-iliac aneurysms, 19 (37.3%) aortobi-iliac aneurysms, 5 (10%) isolated iliac aneurysms, and 8 (15.7%) bi-iliac aneurysms without aortic location. Four patients (7.8%) also had IIA aneurysms. Surgery was successful in all cases. Two patients (4%) died during the 30 days after surgery. One surgically preserved IIA occluded within the first month, resulting in buttock claudication. The 5-year IIA primary patency rate was 96%. Type I proximal endoleaks occurred in two patients, requiring additional surgery 3 years and 13 years after the initial surgery, respectively. This hybrid technique, consisting of AAA endovascular exclusion combined with open IIA revascularization, is safe and effective for preservation of pelvic vascularization. It is associated with long-term patency and low morbidity rates. We have been using this technique since before the advent of branched dedicated devices, allowing preservation of the IIA with good results. This technique should continue to be proposed, especially in patients not eligible for endovascular iliac branch repair because of anatomic contraindications, to avoid pelvic ischemia if the IIA has to be sacrificed. Copyright © 2018 Society for Vascular Surgery. Published by Elsevier Inc. All rights reserved.

Refining the intraoperative measurement of the distal intrapancreatic part of a choledochal cyst during laparoscopic repair allows near total excision.

PubMed

Koga, Hiroyuki; Okawada, Manabu; Doi, Takashi; Miyano, Go; Lane, Geoffrey J; Yamataka, Atsuyuki

2015-10-01

During surgery for choledochal cyst (CC), any intrapancreatic CC (IPCC) must also be excised to prevent postoperative pancreatitis and stone formation. We report our technique for laparoscopic total IPCC excision (n = 16; mean age 6.0 years). We insert a fine ureteroscope with a light source into the opened CC through an extra 3.9-mm trocar placed in the epigastrium through a minute incision to identify the pancreatic duct orifice. By pulling the end of the ureteroscope emerging from the trocar gently to withdraw the tip from the pancreatic duct to where distal dissection was ceased under laparoscopic view, the IPCC can be measured. If longer than 5 mm, the distal CC is dissected further caudally until it is less than 5 mm. For accuracy, the distal CC is elevated with a suture that is exteriorized and clamped to provide constant traction. The IPCC was able to be measured in 11/16 (68 %). Initial lengths measured were 3-10 mm (5.2 ± 2.7 mm). Final IPCC were all 5 mm or less. Surgery was uncomplicated without any pancreatic duct injury and postoperative recovery was unremarkable. Follow-up MRI at 32 months showed no IPCC in any case. Measuring the IPCC enables total CC excision, thus reducing the potential for postoperative complications.

New Developments Are Improving Flexor Tendon Repair.

PubMed

Tang, Jin Bo

2018-06-01

New developments in primary tendon repair in recent decades include stronger core tendon repair techniques, judicious and adequate venting of critical pulleys, followed by a combination of passive and active digital flexion and extension. During repair, core sutures over the tendon should have sufficient suture purchase (no shorter than 0.7 to 1 cm) in each tendon end and must be sufficiently tensioned to resist loosening and gap formation between tendon ends. Slight or even modest bulkiness in the tendon substance at the repair site is not harmful, although marked bulkiness should always be avoided. To expose the tendon ends and reduce restriction to tendon gliding, the longest annular pulley in the fingers (i.e., the A2 pulley) can be vented partially with an incision over its distal or proximal sheath no longer than 1.5 to 2 cm; the annular pulley over the middle phalanx (i.e., the A4 pulley) can be vented entirely. Surgeons have not observed adverse effects on hand function after judicious and limited venting. The digital extension-flexion test to check the quality of the repair during surgery has become increasingly routine. A wide-awake surgical setting allows patient to actively move the digits. After surgery, surgeons and therapists protect patients with a short splint and flexible wrist positioning, and are now moving toward out-of-splint freer early active motion. Improved outcomes have been reported over the past decade with minimal or no rupture during postoperative active motion, along with lower rates of tenolysis.

A comparison of the application of fibrin glue and adhesive film for repair of anastomotic leaks in the rat.

PubMed

Ayhan, Baris; Erikoglu, Mehmet; Tavli, Süleyman S; Toy, Hatice

2012-08-04

Anastomotic leaks constitute one of the most serious intraoperative complications and although many studies have been devoted to finding a solution for this problem, none of them has yet been able offer a decisive, successful method. In this study, the ability of fibrin glue and adhesive film to repair anastomotic leaks in an experimental model was compared. The sample comprised four groups of seven rats: Group 1 (Control): the distal colon was transected and anastomosis was performed. Group 2 (Primary repair): incomplete anastomosis produced a leak that was closed by primary repair on day 3. Group 3 (Fibrin glue): incomplete anastomosis produced a leak that was closed by primary repair and fibrin glue applied on day 3. Group 4 (Adhesive film): incomplete anastomosis produced a leak that was closed by primary repair and adhesive film was applied on day 3. The rats were sacrificed on day 6 following anastomosis. Anastomotic blast compressions were measured and fibroblast activation, inflammation, neovascularization and levels of collagen were evaluated. The results from Group 4 showed that blast compression values were high and statistically significantly increased over control values (p < 0.05). Inflammation in Group 2 was significantly higher than the other groups (p < 0.05). No significant differences were detected in the comparison of the groups regarding the other scoring criteria (p > 0.05). Adhesive film is more effective in reducing anastomotic leakage than fibrin glue.

Website malfunction: a case report highlighting the danger of using electrical insulating tape for buddy strapping

PubMed Central

Devitt, Brian Meldan; Baker, Joseph F; Fitzgerald, Eilis; McCarthy, Conor

2010-01-01

A case of injury to the third web space of the right hand of a rugby player, as a result of buddy strapping with electrical insulating tape of the little and ring finger, is presented. A deep laceration of the web space and distal palmar fascia resulted, necessitating wound exploration and repair. This case highlights the danger of using electrical insulating tape as a means to buddy strap fingers. PMID:22736733

Peroneal perforator pedicle propeller flap for lower leg soft tissue defect reconstruction: Clinical applications and treatment of venous congestion

PubMed Central

Liu, Yiyang; Zhang, Chun; Guo, Qiaofeng; Huang, Wenhua; Wong, Kelvin Kian Loong; Chang, Shimin

2017-01-01

Objective To describe the characteristics of the perforator vessel in the peroneal artery of the lower leg and to explore the use of perforator pedicle propeller flaps to repair soft tissue defects in the lower leg, heel and foot. Methods This retrospective study enrolled patients with soft tissue defects of the distal lower leg, heel and foot who underwent surgery using peroneal perforator-based propeller flaps. The peroneal artery perforators were identified preoperatively by colour duplex Doppler ultrasound. The flap was designed based on the preoperatively-identified perforator location, with the posterior border of the fibula employed as an axis, and the perforator vessel as the pivot point of rotation. Patients were followed-up to determine the outcomes. Results The study analysed 36 patients (mean age, 39.7 years). The majority of the soft tissue defects were on the heel (20; 55.6%). The donor-site of the flap was closed in 11 patients by direct suturing and skin grafting was undertaken in 25 patients. Postoperative complications included venous congestion (nine patients), which was managed with delayed wound coverage and bleeding therapy. All wounds were eventually cured and the flaps were cosmetically acceptable. Conclusions The peroneal perforator pedicle propeller flap is an appropriate choice to repair soft tissue defects of the distal limbs. PMID:28345420

Peroneal perforator pedicle propeller flap for lower leg soft tissue defect reconstruction: Clinical applications and treatment of venous congestion.

PubMed

Shen, Lifeng; Liu, Yiyang; Zhang, Chun; Guo, Qiaofeng; Huang, Wenhua; Wong, Kelvin Kian Loong; Chang, Shimin

2017-06-01

Objective To describe the characteristics of the perforator vessel in the peroneal artery of the lower leg and to explore the use of perforator pedicle propeller flaps to repair soft tissue defects in the lower leg, heel and foot. Methods This retrospective study enrolled patients with soft tissue defects of the distal lower leg, heel and foot who underwent surgery using peroneal perforator-based propeller flaps. The peroneal artery perforators were identified preoperatively by colour duplex Doppler ultrasound. The flap was designed based on the preoperatively-identified perforator location, with the posterior border of the fibula employed as an axis, and the perforator vessel as the pivot point of rotation. Patients were followed-up to determine the outcomes. Results The study analysed 36 patients (mean age, 39.7 years). The majority of the soft tissue defects were on the heel (20; 55.6%). The donor-site of the flap was closed in 11 patients by direct suturing and skin grafting was undertaken in 25 patients. Postoperative complications included venous congestion (nine patients), which was managed with delayed wound coverage and bleeding therapy. All wounds were eventually cured and the flaps were cosmetically acceptable. Conclusions The peroneal perforator pedicle propeller flap is an appropriate choice to repair soft tissue defects of the distal limbs.

The relationship between age, rotator cuff integrity, and osseous microarchitecture of greater tuberosity: Where should we put anchor?

PubMed

Kholinne, Erica; Lee, Hyun Joo; Kim, Sung Jung; Park, So Hyun; Jeon, In-Ho

2018-01-01

The aim of this study was to compare the microarchitecture of the greater tuberosity with or without rotator cuff tear and to obtain optimum location for anchor screw insertion for rotator cuff repair. Twenty-five humeral heads were harvested from 13 male cadavers of mean age 58.4 years, including 6 humeri with rotator cuff tear and 19 intact humeri. Six regions of interest (proximal, intermediate, and distal zones of the superficial and deep regions) were divided into the anterior (G1), middle (G2), and posterior (G3) areas of the greater tuberosity. Trabecular bone volume and cortical thickness were evaluated. Total trabecular bone volume was greater in subjects <50 years old than in subjects >50 years old but did not differ significantly in subjects with and without rotator cuff tear. Cortical thickness in both intact and torn rotator cuff groups was significantly greater in the proximal and intermediate zones than in the distal zone. Cortical thickness was related to anatomic location rather than age or cuff tear. The optimal location for anchor screw insertion during rotator cuff repair is either the proximal or intermediate region of the greater tuberosity. Age has more influence in terms of trabecular bone volume loss than rotator cuff integrity. Copyright © 2017. Production and hosting by Elsevier B.V.

STAT3 Controls the Long-Term Survival and Phenotype of Repair Schwann Cells during Nerve Regeneration.

PubMed

Benito, Cristina; Davis, Catherine M; Gomez-Sanchez, Jose A; Turmaine, Mark; Meijer, Dies; Poli, Valeria; Mirsky, Rhona; Jessen, Kristjan R

2017-04-19

After nerve injury, Schwann cells convert to a phenotype specialized to promote repair. But during the slow process of axonal regrowth, these repair Schwann cells gradually lose their regeneration-supportive features and eventually die. Although this is a key reason for the frequent regeneration failures in humans, the transcriptional mechanisms that control long-term survival and phenotype of repair cells have not been studied, and the molecular signaling underlying their decline is obscure. We show, in mice, that Schwann cell STAT3 has a dual role. It supports the long-term survival of repair Schwann cells and is required for the maintenance of repair Schwann cell properties. In contrast, STAT3 is less important for the initial generation of repair Schwann cells after injury. In repair Schwann cells, we find that Schwann cell STAT3 activation by Tyr705 phosphorylation is sustained during long-term denervation. STAT3 is required for maintaining autocrine Schwann cell survival signaling, and inactivation of Schwann cell STAT3 results in a striking loss of repair cells from chronically denervated distal stumps. STAT3 inactivation also results in abnormal morphology of repair cells and regeneration tracks, and failure to sustain expression of repair cell markers, including Shh, GDNF, and BDNF. Because Schwann cell development proceeds normally without STAT3, the function of this factor appears restricted to Schwann cells after injury. This identification of transcriptional mechanisms that support long-term survival and differentiation of repair cells will help identify, and eventually correct, the failures that lead to the deterioration of this important cell population. SIGNIFICANCE STATEMENT Although injured peripheral nerves contain repair Schwann cells that provide signals and spatial clues for promoting regeneration, the clinical outcome after nerve damage is frequently poor. A key reason for this is that, during the slow growth of axons through the proximal parts of injured nerves repair, Schwann cells gradually lose regeneration-supporting features and eventually die. Identification of signals that sustain repair cells is therefore an important goal. We have found that in mice the transcription factor STAT3 protects these cells from death and contributes to maintaining the molecular and morphological repair phenotype that promotes axonal regeneration. Defining the molecular mechanisms that maintain repair Schwann cells is an essential step toward developing therapeutic strategies that improve nerve regeneration and functional recovery. Copyright © 2017 Benito, Davis et al.

Echocardiographic evaluation of left ventricular mass index in children with hypospadias after hormonal stimulation with topical testosterone: A randomized controlled trial.

PubMed

de Andrade, Elisabeth Campos; de Castro Paiva, Kelly Christina; da Silva Guedes, Sarah; Souza, Mariana Lima C; Pereira, Marina Novellino; Miana, Laura Pimenta; de Figueiredo, André Avarese; de Bessa, José; Netto, José Murillo B

2017-08-01

Testosterone is often used in the preoperative period of hypospadias surgery. Previous studies have demonstrated the presence of androgen receptors in cardiac myocytes that can modulate the phenotype. The use of supraphysiological doses of androgens can lead to toxicity on the heart muscle and, in some cases, to left ventricular hypertrophy. This randomized double blind controlled clinical trial aims to evaluate the effect of topical testosterone on left ventricular mass index in boys with hypospadias. Boys with hypospadias aged 6 months to 9 years were included. Children were divided into two groups: G1 - boys who received testosterone propionate 1% ointment twice a day for 30 days, and G2 - boys receiving placebo ointment in the same regimen. All children were submitted to bi-dimensional echocardiographic evaluation to compare the left ventricular mass index, blood pressure, and body mass index before and after treatment (30 and 90 days). Levels of serum testosterone, LH, and FSH were measured. Thirty-five children were analyzed: 17 in G1 and 18 in G2. No differences were found in left ventricular mass index (left ventricular mass indexed by body surface area) prior to treatment. Left ventricular mass index was 59.21 ± 11.91 g/m 2 in G1 and 55.12 ± 8.29 g/m 2 in G2 (p = 0.244) after 30 days of treatment, and 61.13 ± 11.69 g/m 2 in G1 and 62.84 ± 35.99 g/m 2 in G2 (p = 0.852) after 90 days. Serum testosterone levels were 12 (7-80) ng/dL in G1 and 5 (5-7) ng/dL in G2 (p = 0.018) after 30 days of treatment, and 10 (5-11) ng/dL in G1 and 5 (4-5) ng/dL in G2 (p = 0.155), after 90 days (Figure). There was a small increase in systolic blood pressure (SBP) after 30 days (83.82 ± 7.18 mmHg) in the group who receive testosterone (G1) compared with controls (77.5 ± 6.69 mmHg) (p = 0.010). After 90 days, SBP levels returned to basal levels in G1 (82.35 ± 5.62 mmHg) and in G2 (81.38 ± 4.79 mmHg) (p = 0.588). Topical testosterone can be considered safe in the preoperative period of children with hypospadias with no risk of left ventricular hypertrophy. An increase in systolic blood pressure occurs while using testosterone but it is transitory, returning to normal levels after 90 days. Copyright © 2017 Journal of Pediatric Urology Company. Published by Elsevier Ltd. All rights reserved.

Distal triceps injuries (including snapping triceps): A systematic review of the literature

PubMed Central

Shuttlewood, Kimberley; Beazley, James; Smith, Christopher D

2017-01-01

AIM To review current literature on types of distal triceps injury and determine diagnosis and appropriate management. METHODS We performed a systematic review in PubMed, Cochrane and EMBASE using the terms distal triceps tears and snapping triceps on the 10th January 2017. We excluded all animal, review, foreign language and repeat papers. We reviewed all papers for relevance and of the papers left we were able to establish the types of distal triceps injury, how these injuries are diagnosed and investigated and the types of management of these injuries including surgical. The results are then presented in a review paper format. RESULTS Three hundred and seventy-nine papers were identified of which 65 were relevant to distal triceps injuries. After exclusion we had 47 appropriate papers. The papers highlighted 2 main distal triceps injuries: Distal triceps tears and snapping triceps. Triceps tear are more common in males than females occurring in the 4th-5th decade of life and often due to a direct trauma but are also strongly associated with weightlifting and American football. The tears are diagnosed by history and clinically with a palpable gap. Diagnosis can be confirmed with the use of ultrasound (US) and magnetic resonance imaging. Treatment depends on type of tear. Partial tears can be treated conservatively with bracing and physio whereas acute tears need repair either open or arthroscopic using suture anchor or bone tunnel techniques with similar success. Chronic tears often need augmenting with tendon allograft or autograft. Snapping triceps are also seen more in men than women but at a mean age of 32 years. They are characterized by a snapping sensation mostly medially and can be associated with ulna nerve subluxation and ulna nerve symptoms. US is the diagnostic modality of choice due to its dynamic nature and to differentiate between snapping triceps tendon or ulna nerve. Treatment is conservative initially with activity avoidance and if that fails surgical management includes resection of triceps edge or transposition of the tendon plus or minus ulna nerve transposition. CONCLUSION Distal triceps injuries are uncommon. This systematic review examines the evidence base behind diagnosis, imaging and treatment options of distal triceps injuries including tears and snapping triceps. PMID:28660143

Distally based saphenous neurocutaneous perforator flap combined with vac therapy for soft tissue reconstruction and hardware salvage in the lower extremities.

PubMed

Wen, Gen; Wang, Chun-Yang; Chai, Yi-Min; Cheng, Liang; Chen, Ming; Yi-Min, L V

2013-11-01

The complex wound with the exposed hardware and infection is one of the common complications after the internal fixation of the tibia fracture. The salvage of hardware and reconstruction of soft tissue defect remain challenging. In this report, we presented our experience on the use of the distally based saphenous neurocutaneous perforator flap combined with vacuum-assisted closure (VAC) therapy for the coverage of the soft tissue defect and the exposed hardware in the lower extremity with fracture. Between January 2008 and July 2010, seven patients underwent the VAC therapy followed by transferring a reversed saphenous neurocutaneous perforator flap for reconstruction of the wound with exposed hardware around the distal tibia. The sizes of the flaps ranged from 6 × 3 cm to 15 × 6 cm. Six flaps survived completely. Partial necrosis occurred in one patient. There were no other complications of repair and donor sites. Bone healing was achieved in all patients. In conclusion, the reversed saphenous neurocutaneous perfortor flaps combined with the VAC therapy might be one of the options to cover the complex wound with exposed hardware in the lower extremities. © 2013 Wiley Periodicals, Inc.

Validated Computational Model to Compute Re-apposition Pressures for Treating Type-B Aortic Dissections.

PubMed

Ahuja, Aashish; Guo, Xiaomei; Noblet, Jillian N; Krieger, Joshua F; Roeder, Blayne; Haulon, Stephan; Chambers, Sean; Kassab, Ghassan S

2018-01-01

The use of endovascular treatment in the thoracic aorta has revolutionized the clinical approach for treating Stanford type B aortic dissection. The endograft procedure is a minimally invasive alternative to traditional surgery for the management of complicated type-B patients. The endograft is first deployed to exclude the proximal entry tear to redirect blood flow toward the true lumen and then a stent graft is used to push the intimal flap against the false lumen (FL) wall such that the aorta is reconstituted by sealing the FL. Although endovascular treatment has reduced the mortality rate in patients compared to those undergoing surgical repair, more than 30% of patients who were initially successfully treated require a new endovascular or surgical intervention in the aortic segments distal to the endograft. One reason for failure of the repair is persistent FL perfusion from distal entry tears. This creates a patent FL channel which can be associated with FL growth. Thus, it is necessary to develop stents that can promote full re-apposition of the flap leading to complete closure of the FL. In the current study, we determine the radial pressures required to re-appose the mid and distal ends of a dissected porcine thoracic aorta using a balloon catheter under static inflation pressure. The same analysis is simulated using finite element analysis (FEA) models by incorporating the hyperelastic properties of porcine aortic tissues. It is shown that the FEA models capture the change in the radial pressures required to re-appose the intimal flap as a function of pressure. The predictions from the simulation models match closely the results from the bench experiments. The use of validated computational models can support development of better stents by calculating the proper radial pressures required for complete re-apposition of the intimal flap.

Case report. Pediatric carpal fracture dislocation.

PubMed

DeCoster, T A; Faherty, S; Morris, A L

1994-01-01

Transcarpal fractures in children are rare in the orthopaedic literature. This is a case report of a 10-year-old boy who sustained fractures across the distal radius, scaphoid, lunate, and triquetrum with gross displacement. Treatment consisted of open reduction with internal fixation of the fractures and ligamentous repair through a combined dorsal and palmar approach. The injury healed with good wrist function but abnormal carpal development. This unusual pattern of injury is described so that it may be more readily appreciated in the future.

Coil embolization of an aneurysmal type B dissection persistent false lumen after visceral hybrid repair.

PubMed

Riga, Celia; Bicknell, Colin; Jenkins, Michael; Hamady, Mohamad

2009-01-01

Complex aortic dissections with subsequent dilatation may be managed by using a visceral hybrid approach. In some cases, however, there is substantial retrograde blood flow into the false lumen, leaving a pressurized aneurysmal segment. The authors describe a novel treatment method whereby successful seal of a distal type 1 endoleak was achieved with coil embolization and a liquid injectable embolic agent. The patient was followed up for 2 years without further aortic dilatation or complications.

DOE Office of Scientific and Technical Information (OSTI.GOV)

Virtanen, H.E.; Rajpert-De Meyts, E.; Main, K.M.

Patients with 45,X0/46XY karyotype often present with intersex phenotype and testicular dysgenesis. These patients may also have undescended testes (cryptorchidism), hypospadias and their spermatogenesis is severely disrupted. They have a high risk for testicular cancer. These patients have the most severe form of testicular dysgenesis syndrome (TDS). We have hypothesized that testicular cancer, cryptorchidism, hypospadias and poor spermatogenesis are all signs of a developmental disturbance that was named as testicular dysgenesis syndrome. The hypothesis is based on clinical and epidemiological findings and on biological and experimental evidence. Signs of TDS share several risk factors, such as small birth weight (particularlymore » being small for gestational age), and they are risk factors for each other. All of them have background in fetal development. They show strong epidemiological links so that countries with high incidence of testicular cancer, such as Denmark, tend to also have high prevalence rates of cryptorchidism and hypospadias and poor semen quality. Vice versa, in countries with good male reproductive health, e.g., in Finland, all these aspects are better than in Denmark. Although genetic abnormalities can cause these disorders, in the majority of cases, the reasons remain unclear. Adverse trends in the incidence of male reproductive disorders suggest that environmental and life style factors contribute to the problem. Endocrine disrupters are considered as prime candidates for environmental influence. Fetal exposure to high doses of dibutyl phthalate was shown to cause a TDS-like phenotype in the rats. Studies are underway to assess whether there is any exposure-outcome relation with selected chemicals (persistent organic pollutants, pesticides, phthalates) and cryptorchidism00.« less

Maternal serum level of 1,1-dichloro-2,2-bis(p-chlorophenyl)ethylene and risk of cryptorchidism, hypospadias, and polythelia among male offspring.

PubMed

Longnecker, Matthew P; Klebanoff, Mark A; Brock, John W; Zhou, Haibo; Gray, Kimberly A; Needham, Larry L; Wilcox, Allen J

2002-02-15

1,1-Dichloro-2,2-bis(p-chlorophenyl)ethylene (p,p'-DDE) is a metabolite of the insecticide 2,2-bis(p-chlorophenyl)-1,1,1-trichloroethane (DDT) and is a ubiquitous environmental contaminant. Nearly everyone in the United States has a detectable serum level of DDE. DDE was recently found to inhibit binding of androgen to its receptor and to block androgen action in rodents. Normal development of male genitalia in mammals depends on androgen action. The authors used stored serum samples to examine the relation between maternal DDE levels during pregnancy and adjusted odds of cryptorchidism (n = 219), hypospadias (n = 199), and polythelia (extra nipples) (n = 167) among male offspring, using a nested case-control design with one control group (n = 552). Subjects were selected from the Collaborative Perinatal Project, a US birth cohort study begun in 1959-1966, when DDE levels were much higher than they are at present. Compared with boys whose mother's recovery-adjusted serum DDE level was less than 21.4 microg/liter, boys with maternal levels greater than or equal to 85.6 microg/liter had adjusted odds ratios of 1.3 (95% confidence interval (CI): 0.7, 2.4) for crypt-orchidism, 1.2 (95% CI: 0.6, 2.4) for hypospadias, and 1.9 (95% CI: 0.9, 4.0) for polythelia. For cryptorchidism and polythelia, the results were consistent with a modest-to-moderate association, but in no instance was the estimate very precise. The results were inconclusive.

Resveratrol Promotes Nerve Regeneration via Activation of p300 Acetyltransferase-Mediated VEGF Signaling in a Rat Model of Sciatic Nerve Crush Injury.

PubMed

Ding, Zhuofeng; Cao, Jiawei; Shen, Yu; Zou, Yu; Yang, Xin; Zhou, Wen; Guo, Qulian; Huang, Changsheng

2018-01-01

Peripheral nerve injuries are generally associated with incomplete restoration of motor function. The slow rate of nerve regeneration after injury may account for this. Although many benefits of resveratrol have been shown in the nervous system, it is not clear whether resveratrol could promote fast nerve regeneration and motor repair after peripheral nerve injury. This study showed that the motor deficits caused by sciatic nerve crush injury were alleviated by daily systematic resveratrol treatment within 10 days. Resveratrol increased the number of axons in the distal part of the injured nerve, indicating enhanced nerve regeneration. In the affected ventral spinal cord, resveratrol enhanced the expression of several vascular endothelial growth factor family proteins (VEGFs) and increased the phosphorylation of p300 through Akt signaling, indicating activation of p300 acetyltransferase. Inactivation of p300 acetyltransferase reversed the resveratrol-induced expression of VEGFs and motor repair in rats that had undergone sciatic nerve crush injury. The above results indicated that daily systematic resveratrol treatment promoted nerve regeneration and led to rapid motor repair. Resveratrol activated p300 acetyltransferase-mediated VEGF signaling in the affected ventral spinal cord, which may have thus contributed to the acceleration of nerve regeneration and motor repair.

Results of Heineke-Mikulicz type choledochoplasty in benign biliary strictures.

PubMed

Csendes, A; Burdiles, P; Diaz, J C; Maluenda, F

1993-10-01

During a 20-year period from 1970 to 1991, a total of 30,800 patients underwent biliary tract surgery at the Department of Surgery, University of Chile Clinical Hospital. Of these, seven female adults with a mean age of 39.7 years (range 29 to 54) were considered for analysis in this study. The results of the Heineke-Mikulicz type choledochoplasty repair in patients with short localized strictures of the biliary tract were analyzed in these patients. In six cases, the repair was performed at a mean time of 20 months after cholecystectomy and accidental injury of the common bile duct; in one case it was carried out during cholecystectomy and repair of a Mirizzi type II cholecysto-hepatic fistula. This patient remained asymptomatic during a follow-up of 120 months. Of the six cases on whom choledochoplasty was performed as treatment of short strictures, five patients (83%) developed a new stricture at a mean time of 14 months after surgery; a hepatico-jejunostomy was performed in all. After this procedure, only one patient was re-operated again, and all remained asymptomatic long after surgery. We believe that this Heineke-Mikulicz type choledochoplasty, which has been recommended in short distal strictures, is not advisable as a definitive surgical repair for this kind of stricture.

Chlamydomonas chloroplasts can use short dispersed repeats and multiple pathways to repair a double-strand break in the genome.

PubMed

Odom, Obed W; Baek, Kwang-Hyun; Dani, Radhika N; Herrin, David L

2008-03-01

Certain group I introns insert into intronless DNA via an endonuclease that creates a double-strand break (DSB). There are two models for intron homing in phage: synthesis-dependent strand annealing (SDSA) and double-strand break repair (DSBR). The Cr.psbA4 intron homes efficiently from a plasmid into the chloroplast psbA gene in Chlamydomonas, but little is known about the mechanism. Analysis of co-transformants selected using a spectinomycin-resistant 16S gene (16S(spec)) provided evidence for both pathways. We also examined the consequences of the donor DNA having only one-sided or no homology with the psbA gene. When there was no homology with the donor DNA, deletions of up to 5 kb involving direct repeats that flank the psbA gene were obtained. Remarkably, repeats as short as 15 bp were used for this repair, which is consistent with the single-strand annealing (SSA) pathway. When the donor had one-sided homology, the DSB in most co-transformants was repaired using two DNAs, the donor and the 16S(spec) plasmid, which, coincidentally, contained a region that is repeated upstream of psbA. DSB repair using two separate DNAs provides further evidence for the SDSA pathway. These data show that the chloroplast can repair a DSB using short dispersed repeats located proximally, distally, or even on separate molecules relative to the DSB. They also provide a rationale for the extensive repertoire of repeated sequences in this genome.

Predictors of Reintervention After Endovascular Repair of Isolated Iliac Artery Aneurysm

DOE Office of Scientific and Technical Information (OSTI.GOV)

Zayed, Hany A., E-mail: hany.zayed@gstt.nhs.uk; Attia, Rizwan; Modarai, Bijan

2011-02-15

The objective of this study was to identify factors predicting the need for reintervention after endovascular repair of isolated iliac artery aneurysm (IIAA). We reviewed prospectively collected database records of all patients who underwent endovascular repair of IIAA between 1999 and 2008. Detailed assessment of the aneurysms was performed using computed tomography angiography (CTA). Follow-up protocol included CTA at 3 months. If this showed no complication, then annual duplex scan was arranged. Multivariate analysis and analysis of patient survival and freedom from reintervention were performed using Kaplan-Meier life tables. Forty IIAAs (median diameter 44 mm) in 38 patients were treatedmore » (all men; median age 75 years), and median follow-up was 27 months. Endovascular repair of IIAA was required in 14 of 40 aneurysms (35%). The rate of type I endoleak was significantly higher with proximal landing zone (PLZ) diameter >30 mm in the aorta or >24 mm in the common iliac artery or distal landing zone (DLZ) diameter >24 mm (P = 0.03, 0.03, and 0.0014, respectively). Reintervention rate (RR) increased significantly with increased diameter or decreased length of PLZ; increased DLZ diameter; and endovascular IIAA repair (P = 0.005, 0.005, 0.02, and 0.02 respectively); however, RR was not significantly affected by length of PLZ or DLZ. Freedom-from-reintervention was 97, 93, and 86% at 12, 24, and 108 months. There was no in-hospital or aneurysm-related mortality. Endovascular IIAA repair is a safe treatment option. Proper patient selection is essential to decrease the RR.« less

Muscle fibers are injured at the time of acute and chronic rotator cuff repair.

PubMed

Davis, Max E; Stafford, Patrick L; Jergenson, Matthew J; Bedi, Asheesh; Mendias, Christopher L

2015-01-01

Rotator cuff tears are a common source of shoulder pain and disability. Even after surgical repair, some patients continue to have reduced function and progression of fatty degeneration. Because patients with chronic cuff tears often experience muscle shortening, it is possible that repairing the tendon to its anatomic footprint induces a stretch-induced muscle injury that could contribute to failures of the repair and perhaps ongoing pain. We hypothesized that, compared with acutely torn and repaired muscles, the stretch that is required to repair a chronically torn cuff would result in more muscle fiber damage. Specifically, we asked: (1) Is there muscle fiber damage that occurs from repair of an acutely torn rotator cuff and does it vary by location in the muscle; and (2) is the damage greater in the case of repair of a chronic injury? We used an open surgical approach to create a full-thickness rotator cuff tear in rats, and measured changes in muscle mass, length, and the number of fibers containing the membrane impermeable Evans Blue Dye after acute (1 day) or chronic (28 days) cuff tear or repair in rats. Differences between groups were tested using a one-way ANOVA followed by Tukey's post hoc sorting. Chronic tears resulted in 24% to 35% decreases in mass and a 20% decrease in length. The repair of acutely and chronically torn muscles resulted in damage to 90% of fibers in the distal portion of the muscle. In the proximal portion, no differences between the acutely torn and repaired groups and controls were observed, whereas repairing the chronically torn group resulted in injury to almost 70% of fibers. In a rat model, marked injury to muscle fibers is induced when the tendons of torn rotator cuffs are repaired to their anatomic footprint. In this animal model, we found that repair of chronically torn cuff muscles results in extensive injury throughout the muscle. Based on these findings, we posit that inducing a widespread injury at the time of surgical repair of chronically torn rotator cuff muscles may contribute to the problems of failed repairs or continued progression of fatty degeneration that is observed in some patients that undergo rotator cuff repair. Therapeutic interventions to protect muscle fiber membranes potentially could enhance outcomes for patients undergoing rotator cuff repair. To evaluate this, future studies that evaluate the use of membrane sealing compounds or drugs that upregulate endogenous membrane-sealing proteins are warranted.

Subsequent Shoulder Surgery After Isolated Arthroscopic SLAP Repair.

PubMed

Mollon, Brent; Mahure, Siddharth A; Ensor, Kelsey L; Zuckerman, Joseph D; Kwon, Young W; Rokito, Andrew S

2016-10-01

To quantify the incidence of and identify the risk factors for subsequent shoulder procedures after isolated SLAP repair. New York's Statewide Planning and Research Cooperative System database was searched between 2003 and 2014 to identify individuals with the sole diagnosis of a SLAP lesion who underwent isolated arthroscopic SLAP repair. Patients were longitudinally followed up for a minimum of 3 years to analyze for subsequent ipsilateral shoulder procedures. Between 2003 and 2014, 2,524 patients met our inclusion criteria. After 3 to 11 years of follow-up, 10.1% of patients (254 of 2,524) underwent repeat surgical intervention on the same shoulder as the initial SLAP repair. The mean time to repeat shoulder surgery was 2.3 ± 2.1 years. Subsequent procedures included subacromial decompression (35%), debridement (26.7%). repeat SLAP repair (19.7%), and biceps tenodesis or tenotomy (13.0%). After isolated SLAP repair, patients aged 20 years or younger were more likely to undergo arthroscopic Bankart repair (odds ratio [OR], 2.91; 95% confidence interval [CI], 1.36-6.21; P = .005), whereas age older than 30 years was an independent risk factor for subsequent acromioplasty (OR, 2.3; 95% CI, 1.4-3.7; P < .001) and distal clavicle resection (OR, 2.5; 95% CI, 1.1-5.5; P = .030). The need for a subsequent procedure was significantly associated with Workers' Compensation cases (OR, 2.4; 95% CI, 1.7-3.2; P < .001). We identified a 10.1% incidence of subsequent surgery after isolated SLAP repair, often related to an additional diagnosis, suggesting that clinicians should consider other potential causes of shoulder pain when considering surgery for patients with SLAP lesions. In addition, the number of isolated SLAP repairs performed has decreased over time, and management of failed SLAP repair has shifted toward biceps tenodesis or tenotomy over revision SLAP repair in more recent years. Level III, case-control study. Copyright © 2016 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.

Computational Modeling and Simulation of Genital Tubercle Development

EPA Science Inventory

Hypospadias is a developmental defect of urethral tube closure that has a complex etiology. Here, we describe a multicellular agent-based model of genital tubercle development that simulates urethrogenesis from the urethral plate stage to urethral tube closure in differentiating ...

Cadaveric aorta implantation for aortic graft infection.

PubMed

Ali, Asad; Bahia, Sandeep S S; Ali, Tahir

2016-01-01

This case report describes a 73-year-old gentleman who underwent explantation of an infected prosthetic aorto-iliac graft and replacement with a cryopreserved thoracic and aorto-iliac allograft. The patient has been followed up a for more than a year after surgery and remains well. After elective tube graft repair of his abdominal aortic aneurysm (AAA) in 2003, he presented to our unit in 2012 in cardiac arrest as a result of a rupture of the distal graft suture line due to infection. After resuscitation he underwent aorto-bifemoral grafting using a cuff of the original aortic graft proximally. Distally the new graft was anastomosed to his common femoral arteries, with gentamicin beads left in situ. Post discharge the patient was kept under close surveillance with serial investigations including nuclear scanning, however it became apparent that his new graft was infected and that he would require aortic graft replacement, an operation with a mortality of at least 50%. The patient underwent the operation and findings confirmed a synthetic graft infection. This tube graft was explanted and a cryopreserved aorta was used to the refashion the abdominal aorta and its bifurcation. The operation required a return to theatre day one post operatively for a bleeding side branch, which was repaired. The patient went on to make a full recovery stepping down from the intensive therapy unit day 6 post operatively and went on to be discharged 32 days after his cryopreserved aorta implantation. Copyright © 2016 The Author(s). Published by Elsevier Ltd.. All rights reserved.

An ex vivo mechanical evaluation of single versus double semitubular plate fixation of a transverse distal-third scapular osteotomy in the dog.

PubMed

Mair, Jacqueline J; Belkoff, Stephen M; Boudrieau, Randy J

2003-01-01

To compare single versus double semitubular plate fixation for scapular body fractures. Ex vivo mechanical study. Eighteen paired cadaveric canine scapulae. Transverse scapular body osteotomies were created in the distal third of 18 pairs of scapulae. One scapula of each pair was repaired with a single plate, whereas the contralateral scapula was repaired with 2 plates. Initial strength and stiffness of the constructs were measured in 10 pairs of scapulae. Eight pairs of scapulae underwent cyclic loading and then were subjected to failure testing. Double-plate fixation was significantly stronger (3,899 +/- 632 N) but not stiffer (614 +/- 130 N/mm) than the single-plate fixation (3,238 +/- 935 N and 537 +/- 202 N/mm, respectively). Cyclic loading variables were not significantly different between the 2 methods of fixation. After cyclic loading, double-plate fixation was significantly stronger (2,916 +/- 618 N) than single-plate fixation (2,347 +/- 495 N). There was no significant difference (P =.11) in stiffness between double- versus single-plate fixations: 734 +/- 247 N/mm and 595 +/- 139 N/mm, respectively. Double-plate fixation was generally stronger and stiffer than single-plate fixation. Because all constructs failed at loads that greatly exceeded those estimated to occur clinically, any difference between the 2 methods of fixation probably is not clinically relevant. Single-plate fixation may be of sufficient strength for fixation of scapular body fractures. Copyright 2003 by The American College of Veterinary Surgeons

Feasibility Study of a Novel Thoraco-abdominal Aortic Hybrid Device (SPIDER-graft) in a Translational Pig Model.

PubMed

Debus, Eike S; Kölbel, Tilo; Duprée, Anna; Daum, Günter; Sandhu, Harleen K; Manzoni, Daniel; Wipper, Sabine H

2018-02-01

The hybrid SPIDER-graft consists of a proximal descending aortic stent graft and a conventional six branched Dacron graft for open abdominal aortic repair. Technical feasibility with regard to avoiding thoracotomy and extracorporeal circulation (ECC) during thoraco-abdominal aortic hybrid repair and peri-procedural safety of this novel device are unknown. This was a feasibility and safety study in domestic pigs (75-85 kg). The abdominal aorta including iliac bifurcation, left renal artery, and visceral arteries were exposed via retroperitoneal access. The right iliac branch was first temporarily anastomosed end to side to the distal aorta via partial clamping. During inflow reduction and infra-coeliac cross-clamping, the coeliac trunk (CT) was divided and the proximal stent graft portion of the SPIDER-graft was deployed into the descending aorta via the CT ostium. Retrograde visceral and antegrade aorto-iliac blood flow was maintained via the iliac side branch. The visceral, renal, and iliac arteries were sequentially anastomosed, finally replacing the first iliac end to side anastomosis. Technical success, blood flow, periods of ischaemia, and peri-procedural complications were evaluated after intra-operative completion angiography and post-operative computed tomography angiography. Six animals underwent successful thoracic stent graft deployment and distal open reconstruction without peri-operative death. The median thoracic graft implantation time was 4.5 min, and the median ischaemia times before reperfusion were 10 min for the CT, 8 min for the superior mesenteric artery, 13 min for the right renal artery, and 22 min for the left renal artery. Angiography demonstrated appropriate graft implantation and blood flow measurements confirmed sufficient blood flow through all side branches. In this translational pig model, thoraco-abdominal hybrid repair using the novel SPIDER-graft was successful in avoiding thoracotomy and ECC. Technical feasibility and safety appear promising, but need to be reassessed in humans. Copyright © 2017. Published by Elsevier Ltd.

Morphology-related limitations of EVAR applicability in the treatment of AAA in West-Central Poland.

PubMed

Dzieciuchowicz, Łukasz; Tomczak, Jolanta; Strauss, Ewa; Oszkinis, Grzegorz

2018-05-14

To analyze the current applicability of endovascular aneurysm repair (EVAR) in patients with an infrarenal abdominal aortic aneurysm (AAAs) with indication for elective treatment in West-Central Poland. Computed tomography angiograms of 100 consecutive patients with infrarenal AAA deemed to require treatment were analyzed with an OsiriX DICOM viewer in 3D-MPR mode. Proximal neck diameter, length, angulation, shape, the presence of thrombus and calcification, distal neck diameter, and morphology of the iliac arteries were determined. Three sets of morphological criteria were established. The optimal criteria consisted of a non-conical proximal neck without moderate or severe calcification or thrombus, with a diameter of 18-28 mm, length of ≥15 mm, and β angulation of <60%; a distal neck with a diameter of ≥20 mm; a landing zone in the common iliac arteries with a length of ≥ 10 mm and diameter of ≤ 20 mm; and external iliac arteries with diameters of ≥7 mm. The suboptimal criteria included proximal neck diameters of 18-32 mm, neck lengths ≥10 mm, infrarenal neck angulations of up to 75˚, and common iliac artery diameters of up to 25 mm. Finally, the extended suboptimal criteria included proximal neck diameters of 16-34 mm and infrarenal neck angulations ≤90˚, without limits in the maximal diameter of the common iliac arteries. The median maximum aneurysm diameter was 61 mm. The optimal, suboptimal, and extended suboptimal criteria were met by 23%, 32%, and 53% of patients, respectively. The most common deviations were wide, conical, and angulated proximal necks and aneurysmal iliac arteries. The majority of patients with AAA deemed to be candidates for elective repair do not meet the most favorable criteria for EVAR. Availability of better endovascular solutions for conical, angulated, and wide necks and aneurysmal iliac arteries would likely expand EVAR applicability. Open repair remains a valid option. Copyright © 2018 Elsevier Inc. All rights reserved.

Quadriceps tendon injuries in national football league players.

PubMed

Boublik, Martin; Schlegel, Theodore F; Koonce, Ryan C; Genuario, James W; Kinkartz, Jason D

2013-08-01

Distal quadriceps tendon tears are uncommon injuries that typically occur in patients older than 40 years of age, and they have a guarded prognosis. Predisposing factors, prodromal findings, mechanisms of injury, treatment guidelines, and recovery expectations are not well described in high-level athletes. Professional American football players with an isolated tear of the quadriceps tendon treated with timely surgical repair will return to their sport. Case series; Level of evidence, 4. Fourteen unilateral distal quadriceps tendon tears were identified in National Football League (NFL) players from 1994 to 2004. Team physicians retrospectively reviewed training room and clinic records, operative notes, and imaging studies for each of these players. Data on each player were analyzed to identify variables predicting return to play. A successful outcome was defined as returning to play in regular-season NFL games. Eccentric contraction of the quadriceps was the most common mechanism of injury, occurring in 10 players. Only 1 player had antecedent ipsilateral extensor mechanism symptoms. Eleven players had a complete rupture of the quadriceps tendon, and 3 had partial tears. There were no associated knee injuries. All ruptures were treated with surgical repair, 1 of which was delayed after failure of nonoperative treatment. Fifty percent of players returned to play in regular-season NFL games. There was a trend toward earlier draft status for those who returned to play compared with those who did not (draft round, 3.1 ± 2.5 vs. 6.0 ± 2.9, respectively; P = .073). For those who returned to play, the average number of games after injury was 40.9 (range, 12-92). Quadriceps tendon tears are rare in professional American football players, and they usually occur from eccentric load on the extensor mechanism. Prodromal symptoms and predisposing factors are usually absent. Even with timely surgical repair, there is a low rate of return to play in regular-season games. There is a trend toward early draft rounds for those who successfully return to play.

DOE Office of Scientific and Technical Information (OSTI.GOV)

Schimmenti, L.A.; Berry, S.A.; Tuchman, M.

The authors report on a male infant with developmental delay, growth failure, hypotonia, dolichocephaly, hypoplastic midface, epicanthal folds, down-slanting palpebral fissures, foveal hypoplasia, tracheomalacia, pectus excavatum, supraventricular tachycardia, gut malrotation, hypospadias, talipes equinovarus, short third metatarsals, capillary hemangiomata, and a de novo terminal deletion at 9q34.3.

Tendon injuries of the hand

PubMed Central

Schöffl, Volker; Heid, Andreas; Küpper, Thomas

2012-01-01

Tendon injuries are the second most common injuries of the hand and therefore an important topic in trauma and orthopedic patients. Most injuries are open injuries to the flexor or extensor tendons, but less frequent injuries, e.g., damage to the functional system tendon sheath and pulley or dull avulsions, also need to be considered. After clinical examination, ultrasound and magnetic resonance imaging have proved to be important diagnostic tools. Tendon injuries mostly require surgical repair, dull avulsions of the distal phalanges extensor tendon can receive conservative therapy. Injuries of the flexor tendon sheath or single pulley injuries are treated conservatively and multiple pulley injuries receive surgical repair. In the postoperative course of flexor tendon injuries, the principle of early passive movement is important to trigger an “intrinsic” tendon healing to guarantee a good outcome. Many substances were evaluated to see if they improved tendon healing; however, little evidence was found. Nevertheless, hyaluronic acid may improve intrinsic tendon healing. PMID:22720265

EUROmediCAT signal detection: an evaluation of selected congenital anomaly‐medication associations

PubMed Central

Given, Joanne E.; Loane, Maria; Luteijn, Johannes M.; Morris, Joan K.; de Jong van den Berg, Lolkje T.W.; Garne, Ester; Addor, Marie‐Claude; Barisic, Ingeborg; de Walle, Hermien; Gatt, Miriam; Klungsoyr, Kari; Khoshnood, Babak; Latos‐Bielenska, Anna; Nelen, Vera; Neville, Amanda J.; O'Mahony, Mary; Pierini, Anna; Tucker, David; Wiesel, Awi

2016-01-01

Aims To evaluate congenital anomaly (CA)‐medication exposure associations produced by the new EUROmediCAT signal detection system and determine which require further investigation. Methods Data from 15 EUROCAT registries (1995–2011) with medication exposures at the chemical substance (5th level of Anatomic Therapeutic Chemical classification) and chemical subgroup (4th level) were analysed using a 50% false detection rate. After excluding antiepileptics, antidiabetics, antiasthmatics and SSRIs/psycholeptics already under investigation, 27 associations were evaluated. If evidence for a signal persisted after data validation, a literature review was conducted for prior evidence of human teratogenicity. Results Thirteen out of 27 CA‐medication exposure signals, based on 389 exposed cases, passed data validation. There was some prior evidence in the literature to support six signals (gastroschisis and levonorgestrel/ethinylestradiol (OR 4.10, 95% CI 1.70–8.53; congenital heart disease/pulmonary valve stenosis and nucleoside/tide reverse transcriptase inhibitors (OR 5.01, 95% CI 1.99–14.20/OR 28.20, 95% CI 4.63–122.24); complete absence of a limb and pregnen (4) derivatives (OR 6.60, 95% CI 1.70–22.93); hypospadias and pregnadien derivatives (OR 1.40, 95% CI 1.10–1.76); hypospadias and synthetic ovulation stimulants (OR 1.89, 95% CI 1.28–2.70). Antipropulsives produced a signal for syndactyly while the literature revealed a signal for hypospadias. There was no prior evidence to support the remaining six signals involving the ordinary salt combinations, propulsives, bulk‐forming laxatives, hydrazinophthalazine derivatives, gonadotropin releasing hormone analogues and selective serotonin agonists. Conclusion Signals which strengthened prior evidence should be prioritized for further investigation, and independent evidence sought to confirm the remaining signals. Some chance associations are expected and confounding by indication is possible. PMID:27028286

Pediatric Penile and Glans Anthropometry Nomograms: An Aid in Hypospadias Management.

PubMed

Puri, Archana; Sikdar, Satyajit; Prakash, Raghu

2017-01-01

To establish pediatric penile and glans anthropometry nomograms. This may be used as a reference model for penile assessment while managing hypospadias. Between October 2012 and September 2013, 263 boys of varying ages (0-16 years) were included in the study. Those with genetic, endocrine disorders, having genital anomaly, undescended testis, neonates, and infants with a nonretractile prepuce, with multiple congenital anomalies and refusal to take part in the study were excluded. Evaluated outcome variables were stretched penile length, glans circumference (GC) at coronal sulcus, glans diameter at coronal sulcus (Gdcl), mid glans diameter, and ventral glans length. Glans ratios were generated by dividing Gdcl by GC. Data were expressed as mean, median, and standard deviation. Correlation between age and variables was evaluated using nonparametric Spearman's rank correlation coefficient. The patients were divided in six age groups, namely 0-1 ( n = 61), 1-3 ( n = 37), 3-5 ( n = 36), 5-7 ( n = 36), 7-12 ( n = 45), and >12 years ( n = 48). Gdcl was the maximum transverse glans diameter and based on it small glans size varied widely from 8.9 to 35.04 mm for various age groups. Although glans anthropometry showed age-related changes, glans ratio remained relatively constant between 0.49 and 0.53 (mean: 0.5 ± 0.051, r = 0.29). All the variables except glans ratio showed a significant positive correlation with age ( r = 0.954-0.98, P < 0.01). Penile anthropometry nomograms provide a reference model for hypospadias. This may aid in (a) objective preoperative assessment of glans size (b) patient selection for preoperative hormonal stimulation (c) provides a yardstick for postoperative cosmesis.

Results of a Two-stage Technique for Treatment of Proximal Hypospadias with Severe Curvature: Creation of a Urethral Plate Using a Vascularized Preputial Island Flap.

PubMed

Ozcan, Rahsan; Emre, Senol; Kendigelen, Pinar; Elicevik, Mehmet; Emir, Haluk; Soylet, Yunus; Buyukunal, S N Cenk

2016-04-16

To present the results of a two-stage technique used for the treatment of proximal hypospadias with severe curvature. The medical records of children with proximal hypospadias and severe curvature were retrospectively analyzed. A 2-stage procedure was performed in 30 children. In the first stage, the release of chordee was performed, and a well-vascularized preputial island flap was created. The vascularized island flap was brought anteriorly and sutured over the ventral surface of the glans and degloved penile shaft. The second stage was performed 6-8 months later. A neourethra was reconstructed by the tubularization of the preputial-urethral plate utilizing the principles of Duplay technique. All surgical procedures were performed between 2005 and 2011. The mean age of the patients was 4.4 years (1-17 years). The mean duration of urethral catheterization was 6 days after the first stage and 10 days following the second stage. The flaps were viable in all of the children. There was no residual chordee. Following the second stage (n = 30), complications developed in 11 children (36%), namely, a fistula in 7, a pinpoint fistula in 3, and a diverticulum formation in 1. The cosmetic outcome was satisfactory. Uroflowmetry measurements were evaluated, and only one patient had a diverticulum formation at the late follow-up. Vascularized preputial island flap is an alternative to free grafts for the reconstruction of the urethra. The main advantage of this flap technique is the creation of a thick, healthy and well-vascularized urethral plate. The advantages of this technique include better aesthetic appearance, an acceptable complication rate, and a very low rate of diverticula formation.

MOLECULAR EPIDEMIOLOGY OF HYPOSPADIAS: REVIEW OF GENETIC AND ENVIRONMENTAL RISK FACTORS. (R828599)

EPA Science Inventory

The perspectives, information and conclusions conveyed in research project abstracts, progress reports, final reports, journal abstracts and journal publications convey the viewpoints of the principal investigator and may not represent the views and policies of ORD and EPA. Concl...

MOLECULAR EPIDEMIOLOGY OF HYPOSPADIAS; REVIEW OF GENETIC AND ENVIRONMENTAL RISK FACTORS. (R828599)

EPA Science Inventory

The perspectives, information and conclusions conveyed in research project abstracts, progress reports, final reports, journal abstracts and journal publications convey the viewpoints of the principal investigator and may not represent the views and policies of ORD and EPA. Concl...

Genital and Urinary Tract Defects

MedlinePlus

... wrong place. The clitoris is a female external sex organ. For boys and girls, bladder control problems Some babies need ... to sit down to urinate. And in some boys, the testicles don’t fully drop down ... problems with sex or urinating later in life. Hypospadias usually is ...

Computational Modeling of Male Reproductive Tract Development for Use in Predictive Toxicology (ASCCT meeting)

EPA Science Inventory

Adverse trends in male reproductive health have been reported for increased rates of testicular germ cell tumor, low semen quality, cryptorchidism, and hypospadias. An association with prenatal environmental exposure has been inferred from human and animal studies underlying male...

NOVEL MOLECULAR TARGETS IMPLICATED IN TESTICULAR DYSGENESIS INDUCED BY GESTATIONAL EXPOSURE TO DIETHYLHEXYL PHTHALATE (DEHP)

EPA Science Inventory

Phthalate-induced Testicular Dysgenesis Syndrome describes reproductive alterations in human males such as: hypospadias, cryptorchism, low sperm counts, and testicular cancer. This work is the first comprehensive evaluation of the rat fetal testis proteome following phthalate exp...

Endodontic Treatment of a Double-Rooted Maxillary Second Molar with Four Canals: A Case Report

PubMed Central

Ashraf, Hengameh; Dianat, Omid; Hajrezai, Reihaneh; Paymanpour, Payam; Azadnia, Sina

2014-01-01

A healthy female was referred to Endodontic Department. The referral letter from her dentist expressed that an emergency pulpotomy of tooth #27 had been carried out with probable perforation of the chamber floor which was due to the unusual anatomy of the chamber. Cone-beam computed tomography (CBCT) revealed that the tooth had two mesial and two distal canals. Perforation site was repaired and endodontic treatment was completed. At 24-month follow-up, patient was asymptomatic and clinical and radiographic examinations showed successful outcomes. PMID:25386215

The repair of a type Ia endoleak following thoracic endovascular aortic repair using a stented elephant trunk procedure.

PubMed

Qi, Rui-Dong; Zhu, Jun-Ming; Liu, Yong-Min; Chen, Lei; Li, Cheng-Nan; Xing, Xiao-Yan; Sun, Li-Zhong

2018-04-01

Type Ia endoleaks are not uncommon complications that occur after thoracic endovascular aortic repair (TEVAR). Because aortic arch vessels prevent extension of the landing zone, it is very difficult to manipulate a type Ia endoleak using an extension cuff or stent-graft, especially when the aortic arch is involved. Here, we retrospectively review our experience of surgical treatment of type Ia endoleak after TEVAR using a stented elephant trunk procedure. From July 2010 to August 2016, we treated 17 patients diagnosed with a type Ia endoleak following TEVAR using stented elephant trunk procedure. The mean age of our patients was 52 ± 8 years. The mean interval between TEVAR and the open surgical repair was 38 ± 43 months. All cases of type Ia endoleak (100%) were repaired successfully. There were no in-hospital deaths. One case required reintubation and continuous renal replacement therapy due to renal failure; this patient recovered smoothly before discharge. One other patient suffered a stroke and renal failure and did not fully recover following discharge, or follow-up. During follow-up, there were 3 deaths. Acceptable results were obtained using a stented elephant trunk procedure in patients with a type Ia endoleak after TEVAR. This technique allowed us to repair the proximal aortic arch lesions, surgically correct the type Ia endoleak, and promote false lumen thrombosis in the distal aorta. Implantation of a stented elephant trunk, with or without a concomitant aortic arch procedure, is an alternative approach for this type of lesion. Copyright © 2017 The American Association for Thoracic Surgery. Published by Elsevier Inc. All rights reserved.

Significance of a Pronator Quadratus–Sparing Approach for Volar Locking Plate Fixation of Comminuted Intra-articular Fractures of the Distal Radius

PubMed Central

Itoh, Soichiro; Yumoto, Myu; Kanai, Misa; Yoshida, Wataru; Yoshioka, Taro

2016-01-01

Background: The preservation of the integrity of the pronator quadratus (PQ) muscle is expected to have many benefits, particularly in cases of highly comminuted intra-articular fractures of the distal radius. Therefore, we examined the significance of a PQ muscle–sparing approach for volar locking plate (VLP) fixation of these types of fractures. Methods: Sixty-five patients who sustained AO Foundation and Orthopaedic Trauma Association (AO/OTA) type C2 and C3 distal radius fractures were treated with VLP fixation using either a PQ muscle release and repair (PQ-releasing group, n = 30) or a PQ muscle–sparing approach (PQ-sparing group, n = 35). Radiographic parameters, active range of motion (ROM), percentage of the grip power of the injured hand compared with that of the opposite hand, wrist pain visual analog scale (VAS) score, and Quick Disability of the Arm, Shoulder, and Hand (DASH) score (disability/symptom) were evaluated monthly up to 12 months after surgery. Results: The mean VAS score was significantly lower in the PQ-sparing group at 2, 3, and 4 months postoperatively than in the PQ-releasing group. Furthermore, the mean Quick DASH score in the PQ-sparing group was significantly lower than that in the PQ-releasing group at 1 and 2 months postoperatively. There were no significant differences, however, in the other functional parameters in the groups through the observation period. Conclusions: The PQ muscle–sparing approach appears to achieve satisfactory results in patients undergoing VLP fixation of comminuted intra-articular fractures of the distal radius. PMID:27418895

Comparison of computer-assisted surgery with conventional technique for the treatment of axial distal phalanx fractures in horses: an in vitro study.

PubMed

Andritzky, Juliane; Rossol, Melanie; Lischer, Christoph; Auer, Joerg A

2005-01-01

To compare the precision obtained with computer-assisted screw insertion for treatment of mid-sagittal articular fractures of the distal phalanx (P3) with results achieved with a conventional technique. In vitro experimental study. Thirty-two cadaveric equine limbs. Four groups of 8 limbs were studied. Either 1 or 2 screws were inserted perpendicular to an imaginary axial fracture of P3 using computer-assisted surgery (CAS) or conventional technique. Screw insertion time, predetermined screw length, inserted screw length, fit of the screw, and errors in placement were recorded. CAS technique took 15-20 minutes longer but resulted in greater precision of screw length and placement compared with the conventional technique. Improved precision in screw insertion with CAS makes insertion of 2 screws possible for repair of mid-sagittal P3 fractures. CAS although expensive improves precision in screw insertion into P3 and consequently should yield improved clinical outcome.

Dedifferentiated Schwann Cell Precursors Secreting Paracrine Factors Are Required for Regeneration of the Mammalian Digit Tip.

PubMed

Johnston, Adam P W; Yuzwa, Scott A; Carr, Matthew J; Mahmud, Neemat; Storer, Mekayla A; Krause, Matthew P; Jones, Karen; Paul, Smitha; Kaplan, David R; Miller, Freda D

2016-10-06

Adult mammals have lost multi-tissue regenerative capacity, except for the distal digit, which is able to regenerate via mechanisms that remain largely unknown. Here, we show that, after adult mouse distal digit removal, nerve-associated Schwann cell precursors (SCPs) dedifferentiate and secrete growth factors that promote expansion of the blastema and digit regeneration. When SCPs were dysregulated or ablated, mesenchymal precursor proliferation in the blastema was decreased and nail and bone regeneration were impaired. Transplantation of exogenous SCPs rescued these regeneration defects. We found that SCPs secrete factors that promote self-renewal of mesenchymal precursors, and we used transcriptomic and proteomic analysis to define candidate factors. Two of these, oncostatin M (OSM) and platelet-derived growth factor AA (PDGF-AA), are made by SCPs in the regenerating digit and rescued the deficits in regeneration caused by loss of SCPs. As all peripheral tissues contain nerves, these results could have broad implications for mammalian tissue repair and regeneration. Copyright © 2016 Elsevier Inc. All rights reserved.

IL-22 Is Essential for Lung Epithelial Repair following Influenza Infection

PubMed Central

Pociask, Derek A.; Scheller, Erich V.; Mandalapu, Sivanarayana; McHugh, Kevin J.; Enelow, Richard I.; Fattman, Cheryl L.; Kolls, Jay K.; Alcorn, John F.

2014-01-01

Influenza infection is widespread in the United States and the world. Despite low mortality rates due to infection, morbidity is common and little is known about the molecular events involved in recovery. Influenza infection results in persistent distal lung remodeling, and the mechanism(s) involved are poorly understood. Recently IL-22 has been found to mediate epithelial repair. We propose that IL-22 is critical for recovery of normal lung function and architecture after influenza infection. Wild-type and IL-22−/− mice were infected with influenza A PR8/34 H1N1 and were followed up for up to 21 days post infection. IL-22 receptor was localized to the airway epithelium in naive mice but was expressed at the sites of parenchymal lung remodeling induced by influenza infection. IL-22−/− mice displayed exacerbated lung injury compared with wild-type mice, which correlated with decreased lung function 21 days post infection. Epithelial metaplasia was observed in wild-type mice but was not evident in IL-22−/− animals that were characterized with an increased fibrotic phenotype. Gene expression analysis revealed aberrant expression of epithelial genes involved in repair processes, among changes in several other biological processes. These data indicate that IL-22 is required for normal lung repair after influenza infection. IL-22 represents a novel pathway involved in interstitial lung disease. PMID:23490254

A case of right-sided Bochdalek hernia incidentally diagnosed in a gastric cancer patient.

PubMed

Kikuchi, Satoru; Nishizaki, Masahiko; Kuroda, Shinji; Kagawa, Shunsuke; Fujiwara, Toshiyoshi

2016-06-01

Bochdalek hernia (BH) is generally congenital, presenting with respiratory distress. However, this pathology is rarely detected in adults. Some adult cases of BH present with symptoms attributed to the hernia, but incidental detection of BH is increasing among asymptomatic adults due to advances in imaging modalities. This report presents the management of incidental BH patients detected in the preoperative period of gastric cancer. An asymptomatic 76-year-old woman was diagnosed with advanced gastric cancer during follow-up after radiotherapy for uterine cervical cancer. Computed tomography (CT) was performed to exclude metastatic gastric cancer, incidentally detecting right-sided BH. We planned distal gastrectomy with lymph node dissection for gastric cancer and simultaneous repair of BH using a laparoscopic approach. We performed laparoscopic gastrectomy for gastric cancer and investigated the right-sided BH to assess whether repair during surgery was warranted. Herniation of the liver into the right hemithorax was observed, but was followed-up without surgical repair because the right hepatic lobe was adherent to the remnant right anterior hemidiaphragm and covered the huge defect in the right hemidiaphragm. No intra- or postoperative pneumothorax was observed during pneumoperitoneum. Regardless of symptoms, repair of adult BH is generally recommended to prevent visceral incarceration. However, BH in asymptomatic adults appears to be more common than previously reported in the literature. Surgeons need to consider the management of incidental BH encountered during thoracic or abdominal surgery.

Systems Toxicology of Male Reproductive Development: Profiling 774 Chemicals for Molecular Targets and Adverse Outcomes

EPA Science Inventory

Adverse trends in male reproductive health have been reported for increased rates of testicular germ cell tumor, low semen quality, cryptorchidism, and hypospadias. An association with prenatal environmental exposure has been inferred from human and animal studies underlying male...

TOXICOLOGY OF MALE REPRODUCTIVE DEVELOPMENT: PROFILING 774 CHEMICALS FOR MOLECULAR TARGETS AND ADVERSE OUTCOMES (SOT)

EPA Science Inventory

Adverse trends in male reproductive health have been reported for increased rates of testicular germ cell tumor, low semen quality, cryptorchidism, and hypospadias. An association with prenatal environmental exposure has been inferred from human and animal studies underlying male...

Collagen insulated from tensile damage by domains that unfold reversibly: in situ X-ray investigation of mechanical yield and damage repair in the mussel byssus

PubMed Central

Harrington, Matthew J.; Gupta, Himadri S.; Fratzl, Peter; Waite, J. Herbert

2009-01-01

The byssal threads of the California mussel, Mytilus californianus, are highly hysteretic, elastomeric fibers that collectively perform a holdfast function in wave-swept rocky seashore habitats. Following cyclic loading past the mechanical yield point, threads exhibit a damage-dependent reduction in mechanical performance. However, the distal portion of the byssal thread is capable of recovering initial material properties through a time-dependent healing process in the absence of active cellular metabolism. Byssal threads are composed almost exclusively of multi-domain hybrid collagens known as preCols, which largely determine the mechanical properties of the thread. Here, the structure-property relationships that govern thread mechanical performance are further probed. The molecular rearrangements that occur during yield and damage repair were investigated using time-resolved in situ wide angle X-ray diffraction (WAXD) coupled with cyclic tensile loading of threads and through thermally enhanced damage-repair studies. Results indicate that the collagen domains in byssal preCols are mechanically protected by the unfolding of sacrificial non-collagenous domains that refold on a slower time-scale. Time-dependent healing is primarily attributed to stochastic recoupling of broken histidine-metal coordination complexes. PMID:19275941

End-to-side neurorraphy: a long-term study of neural regeneration in a rat model.

PubMed

Tarasidis, G; Watanabe, O; Mackinnon, S E; Strasberg, S R; Haughey, B H; Hunter, D A

1998-10-01

This study evaluated long-term reinnervation of an end-to-side neurorraphy and the resultant functional recovery in a rat model. The divided distal posterior tibial nerve was repaired to the side of an intact peroneal nerve. Control groups included a cut-and-repair of the posterior tibial nerve and an end-to-end repair of the peroneal nerve to the posterior tibial nerve. Evaluations included walking-track analysis, nerve conduction studies, muscle mass measurements, retrograde nerve tracing, and histologic evaluation. Walking tracks indicated poor recovery of posterior tibial nerve function in the experimental group. No significant difference in nerve conduction velocities was seen between the experimental and control groups. Gastrocnemius muscle mass measurements revealed no functional recovery in the experimental group. Similarly, retrograde nerve tracing revealed minimal motor neuron staining in the experimental group. However, some sensory staining was seen within the dorsal root ganglia of the end-to-side group. Histologic study revealed minimal myelinated axonal regeneration in the experimental group as compared with findings in the other groups. These results suggest that predominantly sensory regeneration occurs in an end-to-side neurorraphy at an end point of 6 months.

Surgical repair of femoral fractures in New World camelids: five cases (1996-2003).

PubMed

Shoemaker, R W; Wilson, D G

2007-04-01

Five New World camelids were admitted to the Western College of Veterinary Medicine between 1996 and 2003 for evaluation of femoral fractures. There were three alpacas and two llamas. Four of the animals were female and three were less than 3 months of age. Fracture configurations consisted of distal physeal fractures (three), a comminuted diaphyseal/metaphyseal fracture, and a transverse diaphyseal fracture. Fractures were diagnosed with a combination of physical examination and radiographs in all cases. All five fractures were repaired with internal fixation and three animals were discharged from the hospital with fractures that healed. One cria underwent successful internal fixation but died from pulmonary oedema during recovery from anaesthesia. Postoperative complications were rare and limited to inadequate fracture stability in one alpaca and prolonged recovery to weight bearing in another. One llama with a comminuted metaphyseal fracture, repaired with a 4.5 mm dynamic compression plate, subsequently had catastrophic failure of the bone 17 days after surgery. Overall the clients were pleased with the outcome of discharged animals. Although femoral fractures are considered rare, they pose a unique opportunity for the large animal veterinarian to successfully achieve fracture union with the aid of internal fixation.