scholarly journals Urethral pull-up operation for distal and mid-penile hypospadias: a new safe method

2018 ◽  
Vol 49 (1) ◽  
pp. 65-67
Author(s):  
Sagar A. Jawale ◽  
Gnanaraj Jesudian ◽  
Rajendra Nehete
Keyword(s):  
Postoperative Period ◽  
Corpus Cavernosum ◽  
Case Series ◽  
Wound Dehiscence ◽  
Corpus Spongiosum ◽  
Safe Method ◽  
Meatal Stenosis ◽  
Age Range

This case series of 51 patients (age range = 11–17 years; 30-month follow-up) describes a new modified approach to treatment of distal and mid-penile hypospadias that has fewer complications. The meatal locations were sub-coronal (51%), coronal (45%) and mid-penile (4%). Forty patients had chordee. Urethra with the corpus spongiosum was dissected off the corpus cavernosum up to the peno-scrotal junction. The distal 5 mm stenotic and avascular part of the urethral tube was excised. The elastic urethra was then stretched and sutured to form a neo-meatus. The urethra was anchored to the Buck’s fascia at the glandular, sub-coronal and mid-penile levels. Meatal regression in one patient (2%), subcutaneous hematomas in two patients (4%) and wound dehiscence in two patients (4%) were the complications in the immediate postoperative period. None developed fistula, meatal stenosis or residual chordee in the 30-month follow-up.

Primary Calvarial Ewing Sarcoma: A Case Series

2021 ◽  
Author(s):  
Sandeep Mohindra ◽  
Manjul Tripathi ◽  
Aman Batish ◽  
Ankur Kapoor ◽  
Ninad Ramesh Patil ◽  
...  
Keyword(s):  
Ewing Sarcoma ◽  
Tumor Resection ◽  
Case Series ◽  
Radical Excision ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Intradural Tumor ◽  
Age Range

Abstract Background Calvarial Ewing tumor is a relatively rare differential among bony neoplasms. We present our experience of managing primary calvarial Ewing sarcoma (EWS), highlighting their clinical and radiological findings. Method In a retrospective analysis, we evaluated our 12-year database for pathologically proven EWS. A literature search was conducted for the comparative presentation and update on the management and outcome. Result From January 2008 to December 2020, we managed eight patients (male:female = 5:3; age range 6 months to 19 years, mean 11.5 years) harboring primary calvarial EWS. All cases underwent wide local excision; two patients required intradural tumor resection, while one required rotation flap for scalp reconstruction. Mean hospital stay was 8 days. All patients received adjuvant chemo- and radiotherapy. Three patients remained asymptomatic at 5 years of follow-up, while two patients died. Conclusion Primary calvarial EWS is a rare entity. It usually affects patients in the first two decades of life. These tumors can be purely intracranial, causing raised intracranial pressure symptoms, which may exhibit rapidly enlarging subgaleal tumors with only cosmetic deformities or symptoms of both. Radical excision followed by adjuvant therapy may offer a favorable long-term outcome.

WP1-21 Maximum safe resection of large medial temporal intrinsic tumours: does the outcome justify the risk?

2019 ◽  
Vol 90 (3) ◽  
pp. e7.1-e7
Author(s):  
A Kumaria ◽  
A Paterson ◽  
M Sitaraman ◽  
S Basu
Keyword(s):  
Case Series ◽  
Csf Leak ◽  
Visual Field Defects ◽  
Long Term Outcomes ◽  
Karnofsky Score ◽  
Female Age ◽  
Grade 3 ◽  
Age Range

ObjectivesTo analyse on the long-term outcomes in patients undergoing maximum safe resection (MSR) for large intrinsic temporal tumours.DesignCase seriesSubjectsAll patients undergoing MSR of large medial temporal intrinsic tumours between May 2006 and February 2012 at a tertiary neurosurgical centre with a minimum follow up of 6 years.MethodsRetrospective review of hospital records.ResultsFifty-one patients underwent MSR (28 male, 23 female); age range 20–80 years (mean age 55.3). There was no difference in laterality, although dysphasia was a feature in 32% of left-sided lesions. Presenting features in general included seizures (46%), headaches (27%), hemiparesis (12%) and visual field defects (6%). Surgery was generally well tolerated (median post-operative Karnofsky score 92.5). No patients developed new dysphasia or weakness, but there was transient worsening of existing hemiparesis (n=4) and dysphasia (n=2). Other complications included CSF leak/pseudomeningocoele (n=2), oculomotor palsy (n=1) and wound infection (n=1). Histopathological casemix was GBM (50%), WHO 3 gliomas (14%), WHO 2 gliomas (10%) and metastases (4%). In total, 57% of patients received radiotherapy and 35% received chemotherapy. Survival correlated with pathology; in glioblastoma patients it ranged from 2–19 months (mean 10.4 months). Survival in grade 3 tumours ranged from 10–38 months (mean 24.4 months). 60% of patients with Grade 2 tumours are surviving symptom free with no histological upscale at 8–10 years follow-up. No patient required a second debulking procedure.ConclusionsMSR did not result in survival benefit in glioblastoma. MSR is justified in lesions with pre-operative radiological features of Grade 2 glioma.

scholarly journals PEDIATRIC IDIOPATHIC INTERVERTEBRAL DISC CALCIFICATION: A SINGLE INSTITUTION CASE SERIES OF A RARE DISORDER

2018 ◽  
Vol 23 (suppl_1) ◽  
pp. e41-e41
Author(s):  
Molly Dushnicky ◽  
Ronald Laxer ◽  
Abhaya Kulkarni ◽  
Manohar Shroff ◽  
Hidehiro Okura
Keyword(s):  
Intervertebral Disc ◽  
English Language ◽  
Medical Condition ◽  
Case Series ◽  
Retrospective Chart Review ◽  
Spinal Pain ◽  
Single Institution ◽  
Intervertebral Disc Calcification ◽  
Age Range

Abstract BACKGROUND Paediatric idiopathic intervertebral disc calcification (PIIVDC) is a rare, poorly understood condition with just over 300 reported cases in the literature since the first report in 1924. The condition is characterized by calcification of an intervertebral disc which can progress to inflammation or extrusion and lead to neck or spinal pain in some patients. OBJECTIVES We report a series of patients seen at a single institution with PIIVDC and outline the disease course, management and outcome and review the literature. DESIGN/METHODS A retrospective chart review was performed at a single institution spanning the period between January 2001 and February 2016 for diagnoses of PIIVDC. Patient age, gender, symptoms, and medical history and physical and neurologic findings were reviewed. Laboratory and imaging findings, management, follow-up, and outcome were also studied. A literature review was carried out by MEDLINE and Embase, using the search terms “pediatric disc calcification” and “disc calcification in children” between the years 1997 and 2017, in the English language. Articles were reviewed and data was extracted. RESULTS Nine cases of PIIVDC were identified (6 males, 3 females) with an age range of 1 to 14 years. Two patients were asymptomatic and PIIVDC was discovered incidentally. Of the remaining patients, five presented with neck/back pain, one painless torticollis, and one painful torticollis. One patient was noted to have pain radiating along one dermatome. Disc spaces affected were five cervical, five thoracic, and two lumbar, with two patients having more than one space affected. All patients were managed conservatively. In one case, symptoms and lesions persisted after 5-years, but the remainder had complete symptom resolution, generally within 6 months. CONCLUSION Although the etiology of PIIVDC remains unknown it appears to occur spontaneously, without preceding trauma or underlying medical condition. A conservative approach to patients without severe neurologic deficit with out-patient close follow-up is supported.

Distally Based Adipofascial Sural Flap for Foot and Ankle Reconstruction

2011 ◽  
Vol 101 (1) ◽  
pp. 41-48 ◽  
Author(s):  
Ali Mojallal ◽  
Christo D. Shipkov ◽  
Fabienne Braye ◽  
Pierre Breton
Keyword(s):  
Donor Site ◽  
Case Series ◽  
Dorsal Side ◽  
Medial Malleolus ◽  
Foot And Ankle ◽  
Sural Flap ◽  
Post Traumatic ◽  
Distally Based ◽  
Age Range

Background: This retrospective study of a case series analyzed the results from the application of a distally based adipofascial sural flap for nonweightbearing defects of the foot and ankle. Methods: Twenty-eight patients with post-traumatic ankle and foot defects (ten women and 18 men; age range, 17–63 years) underwent surgery between November 1, 2003, and November 30, 2008. Distally based adipofascial sural flaps were used in ten open fractures, 14 soft-tissue post-traumatic defects, and four deep burns. Defects were on the dorsal side of the foot (eight cases), the lateral malleolus (four cases), the medial malleolus and inframalleolar region (four cases), the Achilles tendon region (eight cases), and the anterior surface of the ankle (four cases). Surgical procedures were performed by a single surgeon (A.M.). Results: All of the flaps healed uneventfully. There was no partial or total flap loss. All 28 patients walked normally at the time of follow-up. Three delayed healings occurred at the donor site. Conclusions: This is a homogeneous series of lower-limb reconstructions with the distally based adipofascial sural flap, which permits better analysis of the results. This flap has a constant and reliable blood supply. It can be used for the reconstruction of nonweightbearing foot and ankle regions to avoid the bulky volume of the fasciocutaneous flap in this area and to minimize the donor site scar. (J Am Podiatr Med Assoc 101(1): 41–48, 2011)

Periocular intravascular papillary endothelial hyperplasia: A retrospective study

2021 ◽  
pp. 112067212110481
Author(s):  
Azza MY Maktabi ◽  
Abdullah I Almater ◽  
Hind M Alkatan
Keyword(s):  
Thrombus Formation ◽  
Case Series ◽  
Excisional Biopsy ◽  
Vascular Lesions ◽  
Intravascular Papillary Endothelial Hyperplasia ◽  
Retrospective Case ◽  
Management Options ◽  
Papillary Endothelial Hyperplasia ◽  
Age Range

Introduction: Intravascular papillary endothelial hyperplasia (IPEH) is a rare proliferation of endothelial cells with uncertain etiology related to thrombus formation. Diagnosis is usually confirmed histopathologically. This condition has been previously described in the periocular region but not in the conjunctiva. Methods: It is a retrospective case series in which we evaluated seven patients with histopathologically confirmed IPEH cases. Data regarding the demographics, clinical presentation, radiological description, histopathological features including any IHC staining, suspected underlying vascular etiology, management options, and follow up outcome were collected. Results: A total of seven cases of histologically confirmed IPEH were included. Five out of seven patients were male (71.4%). The age range was between 6 and 69 years with a median age of 36 years. Three cases involved the eyelid (42.8%) and another three were found in the conjunctiva (42.8%). Pre-existing underlying vascular lesions were observed in all patients, five malformations (mostly lymphatic-venous) and two conjunctival hemorrhagic lymphangiectasis. All cases were treated with excisional biopsy with no signs of recurrence within an average of 7 months follow up. Conclusions: Periocular IPEH is a rare tumor that is likely to coexist with underlying vascular lesions and thrombus formation. We are reporting its existence in the conjunctiva for the first time. Therefore, pathologists should be aware of the histopathological spectrum of this lesion.

scholarly journals Soft tissue reinforcement interposition flaps in hypospadias repair

2007 ◽  
Vol 40 (02) ◽  
pp. 170-177
Author(s):  
R B Singh ◽  
S Dalal ◽  
N M Pavithram ◽  
B D Sharma
Keyword(s):  
Soft Tissue ◽  
Mechanism Of Action ◽  
Donor Site ◽  
Suture Line ◽  
Fistula Formation ◽  
Corpus Spongiosum ◽  
Meatal Stenosis ◽  
Surgical Closure ◽  
Urethral Strictures

ABSTRACT Purpose: To discuss the role and mechanism of action of soft tissue reinforcement interposition flaps (strifs) in hypospadias repairs (reinforced hypospadiac urethroplasties). Materials and methods: between 2000-2005, 120 consecutive hypospadiacs (distal 85, mid 20, proximal 15), who underwent primary reinforced urethroplasties employing different types of strifs, were retrospectively analyzed. the strifs were highly vascular soft tissue pedicled flaps (devoid of epithelium) interposed between neo-urethras and the covering skin to reinforce the neo-urethras against fistula formation. the strifs were harvested, without much donor site deformity, from: preputial skin, penile skin and scrotal skin by de-epithelialization. those from buck′s fascia, corpus spongiosum and tunica vaginalis are strifs without epithelium anyway, therefore do not need de-epithelialization. redo urethroplasties and micropenises were not included. seven patients were excluded because they had incomplete follow-up. the remaining 113 (distal 84, mid 17, proximal 12) were followed up for nine to 40 months for number, size, location, spontaneous closure and persistence of urethro-cutaneous fistula (ucf), and other complications with regard to the severity of hypospadias, method of neourethral re-construction, types of strifs employed and skin cover used. a total of 158 strifs and 124 skin covers were used in 113 hypospadiac urethroplasties. Results: the first surgery was curative in 74 (65%) of 113 patients. in the remaining 39 (35%), various complications included 12 urethro-cutaneous fistulas (ucfs), 10 urethral strictures, six cases each of penile torsion and meatal stenosis and five cases each of superficial necrosis and poor cosmesis. of these 39 patients, 25 (64%) recovered with conservative treatment and 14 (36%) required re-operation, i.e. ucfs and strictures in four cases each and penile torsion, meatal stenosis and dog-ears in two cases each. all the 12 ucfs were single, pinpointed and were located at the corona in five and at the shaft in seven. eight (67%) of the 12 ucfs healed spontaneously during the follow-up period of 12 weeks.Conclusions: harvesting strifs is technically easy, however, great care is required in their handling, accurate placement and suturing over and around the re-constructed neo-urethras for their secured reinforcement against fistula formation. use of strifs in hypospadias repairs decreases fistula-associated morbidity but does not absolutely prevent fistula formation. the strifs reduce the size and prevent multiplicity of ucfs and locate the ucfs eccentrically well away from the neo-urethra to facilitate their spontaneous (conservative) as well as subsequent (surgical) closure. the mechanism of action of strifs is multi-factorial, like acting as a mechanical barrier; preventing suture line superimposition; inducing neo-angio-genesis; working as biological drain; providing mechanical support; and, filling the dead spaces.

scholarly journals Management of boys with abnormal appearance of meatus at circumcision for balanitis xerotica obliterans

2011 ◽  
Vol 93 (6) ◽  
pp. 482-484 ◽  
Author(s):  
C Holbrook ◽  
T Tsang
Keyword(s):  
Clinical Evidence ◽  
Topical Steroid ◽  
Management Plan ◽  
Meatal Stenosis ◽  
Balanitis Xerotica Obliterans ◽  
Presenting Symptoms ◽  
Additional Procedure ◽  
Age Range

INTRODUCTION The aim of this study was to develop a standardised management plan for boys with abnormal appearance of meatus at circumcision for balanitis xerotica obliterans (BXO). METHODS Between 1995 and 2008, 107 boys underwent circumcision for BXO (confirmed on histology). Of these, 23 had abnormal appearance of the meatus at operation; their case notes were reviewed for age, presenting symptoms, management, outcome and follow up. RESULTS The age range at operation was 3–15 years (mean: 9 years). Patients commonly presented with phimosis and balanitis. Seven patients had an additional procedure at circumcision: six had meatotomy, one had meatal dilatation. Thirteen were treated with topical steroid cream post-operatively. Eight of these (62%) subsequently required meatotomy. Three patients were observed and did not require further intervention. Meatotomy was required in 9 patients, 6–29 months after circumcision (mean: 11 months). Two patients required dilatation, including one with a previous intraoperative meatotomy, who required multiple dilatations. CONCLUSIONS We propose the following standardised management plan: 1. With clinical evidence of BXO at circumcision, prepuce should be sent for histology. 2. If BXO is confirmed but the meatus appears normal, patients should be seen once post-operatively to give information about meatal stenosis. 3. When the meatus appears scarred with a narrowed lumen at operation, a meatotomy should be performed, with follow up for at least two years. 4. If the lumen is scarred but adequate, patients should be followed up in clinic for the same period for possible development of stenosis. 5. Topical steroid cream can be considered for voiding discomfort without decreased urine stream.

scholarly journals 218 The Impact on Minimally Invasive Urological Cancer Surgery During the Covid-19 Pandemic

2021 ◽  
Vol 108 (Supplement_6) ◽  
Author(s):  
C Boyle ◽  
K Gallagher ◽  
S Leung ◽  
D Good ◽  
S A McNeill ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Postoperative Period ◽  
Case Series ◽  
Patient Characteristics ◽  
Urological Cancer ◽  
Increased Risk ◽  
Theatre Staff ◽  
Restricted Use ◽  
The Impact

Abstract Aim Learned bodies recommended restricted use of, or extensive precautions when using, laparoscopic/robotic surgery during the Covid-19 pandemic. We aimed to determine whether minimally invasive surgery (MIS) in uro-oncology patients was safe for patients and staff. Method From 16 March to 16 June 2020, patients having MIS in a tertiary referral urology centre were identified from a prospectively collected database. Patient characteristics, operative details and 30-day follow-up for adverse events were recorded including Covid-19 tests and results. Any theatre staff Covid-19 event was traced back 14 days to determine any involvement in these cases. Results 87 patients were eligible for inclusion (33 robotic prostatectomies, 38 laparoscopic prostatectomies, 11 laparoscopic nephrectomies, 5 robotic nephrectomies). All patients were assessed for symptoms of Covid-19 on the day of theatre. 18(21%) patients had pre-operative screening (all swabs, no CT chest). 46(53%) underwent 14 days pre-operative self-isolation. 38(44%) cases were performed with FFP3 protection. No modification to operating procedure was made for any cases. No patients tested positive for Covid-19 in the 30-day postoperative period. No staff member involved tested positive in the postoperative period. 1 patient tested positive pre-operatively, delaying the operation by 7 weeks. No patients tested positive after the introduction of mandatory screening. Conclusions Based on our case-series MIS urological surgery appears to be safe for patients and staff, with no increased risk of Covid-19 complications in patients who are asymptomatic pre-operatively. The introduction of mandatory pre-operative swabs for elective patients, and the use of FFP3 protection, did not significantly alter results.

scholarly journals AB0872 EFFICACY AND SAFETY OF THE COMBINATION OF APOCYNIN AND PAEONOL (APPA) IN PATIENTS WITH OSTEOARTHRITIS: AN UNCONTROLLED PATIENT CASE SERIES

2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 1742.1-1742
Author(s):  
N. Larkins
Keyword(s):  
Adverse Events ◽  
Meniscal Tear ◽  
Case Series ◽  
Duration Of Treatment ◽  
R And D ◽  
Lower Back ◽  
Asian Medicine ◽  
End Stage ◽  
Age Range

Background:Apocynin and paeonol are secondary metabolites of plants used in traditional Asian medicine for centuries. The combination of synthetic versions of these two molecules (APPA) was developed initially for the treatment of osteoarthritis (OA) in animals where it has been found at least as effective as meloxicam. Human clinical trials are currently ongoing.Objectives:To report the outcomes from a case series of patients treated with APPA.Methods:Subjects with a diagnosis of OA, who had tried unsuccessfully a number of standard therapies, requested treatment with APPA from the author (NL), often following successful treatment of their animals with the combination or via networking. The usual daily dose was 1240 mg paeonol and 352 mg of apocynin taken as two 400mg capsules twice daily.Results:Twenty-three subjects with a diagnosis of OA of whom 7 were scheduled for surgery have been treated with APPA. There were 10 female and 13 males with an age range from 40 to 81 years. Nine patients had OA of the knees, 5 of whom had bilateral involvement, 7 had hip OA, 5 bilaterally and 2 with end stage bone on bone disease. Four patients had hand OA, one of whom also had disease of the hip, lower back and feet. In 3 patients the joints involved was not recorded. In 19 patients treatment was reported as effective. In 4 patients the treatment was ineffective, all of who were scheduled or had been recommended for surgery. In 2 of these cases cases this was bone on bone The duration of treatment for OA at the last recorded follow-up was reported for 16 patients in whom treatment was deemed effective and ranged from 9 to 120 months (median 24 months). In a further 3 patients the treatment the duration was not reported. In the 4 patients where no benefit was reported APPA was discontinued within a few weeks. In no case was there a report of APPA being discontinued due to adverse events. In 13 patients it was specifically stated that there had been no adverse events whereas for the remaining 10 patients it was not documented whether adverse events had occurred or not.Conclusion:Treatment with APPA was reported as effective by 82.6% of patients. In all patients in which the combination was ineffective the disease was severe with joint replacement recommended or scheduled; in two patients this was bone on bone. This would suggest that APPA is not a simple analgesic, a conclusion supported by effects seen in the rat meniscal tear model where possible disease modifying effects have been reported (1).References:[1]Glasson, S., Bendele, A. and Larkins, N. (2012). APPA provides disease modification in preclinical osteoarthritis. Osteoarthritis and Cartilage20: S72 -S73 Abstract 132.Disclosure of Interests:Nicholas Larkins Shareholder of: AKL R and D Ltd, Employee of: AKL R and D Ltd

Effectiveness of the Dorsal Thermoplastic Locking Orthosis to Prevent Floating Toes in Postoperative Follow-up of Weil Osteotomies

2014 ◽  
Vol 7 (5) ◽  
pp. 356-362 ◽  
Author(s):  
Alexandre Leme Godoy-Santos ◽  
Tulio Diniz Fernandes ◽  
Candida Luzo ◽  
Rafael Trevisan Ortiz ◽  
Marcos Sakaki ◽  
...  
Keyword(s):  
Postoperative Period ◽  
Healing Process ◽  
Case Series ◽  
Metatarsal Osteotomy ◽  
Level Of Evidence ◽  
Surgical Incision ◽  
Superficial Wound ◽  
Distal Metatarsal Osteotomy ◽  
American Orthopaedic

Background: The Weil oblique distal metatarsal osteotomy is regularly used in the treatment of primary metatarsalgia. The most frequent complication is the floating toe, which occurs in up to 36% of postoperative follow-up. The theory of reducing the plantar flexor mechanism tension associated with the retraction of the dorsal structures during the healing process of the surgical procedure may explain this negative evolution. Objective: This study aimed at assessing the effectiveness of the Tucade dorsal thermoplastic locking orthosis in the prevention of floating toe after Weil osteotomy. Methods: In all, 30 patients with metatarsalgia diagnosis submitted to Weil osteotomy were treated in the postoperative period with the Tucade dorsal thermoplastic locking orthosis. Results: The floating toe was not observed in this case series. There was 1 case of superficial wound irritation at the dorsal surgical incision and 1 case that evolved with transfer metatarsalgia. Statistical analyses were performed—American Orthopaedic Foot and Ankle Society Scale for lateral toes and extension of the lateral toes—using the t test, and P < .0001 was obtained for comparison of the preoperative and postoperative periods in the population studied. Conclusion: The Tucade dorsal thermoplastic locking orthosis during the postoperative period of Weil osteotomy proved to be effective in the prevention of floating toes. Level of Evidence: Therapeutic Level IV: Case Series

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