scholarly journals Transverse Preputial Island Flap for Hypospedias Repair: A Study in A Tertiary Level Hospital

2020 ◽  
Vol 23 (1) ◽  
pp. 43-47
Author(s):  
Hafiz Al Asad ◽  
Md Selim Morshed ◽  
Tasnim Alam Manzer ◽  
Abu Naser Md Lutful Hasan ◽  
Zulfia Zinat Chowdhury ◽  
...  
Keyword(s):  
Cosmetic Outcome ◽  
Island Flap ◽  
Tertiary Level ◽  
Challenging Problem ◽  
Penile Skin ◽  
Urethrocutaneous Fistula ◽  
Urethral Plate ◽  
Age Range ◽  
Level Hospital

Introduction: Hypospadias continues to be a challenging problem for reconstructive surgeon. As urethral plate preservation got an important role, transverse preputial island flap (TPIF) urethroplasty is one of the preferred technique for sub-coronal and distal penile hypospadius. Methods: This study was conducted at urology department, DMCH, from February, 2014 to June, 2017 where 15 patients underwent TPIF urethroplasty. Inner preputial flap with its pedicle was developed and separated from the dorsal penile skin which was sutured to the urethral plate in an onlay manner over a stent by running suture. Glanuloplasty and meatoplasty was done and skin closed.SPC was done in every cases. Dressing was checked on 5th POD, stent was removed after 03 weeks. SPC was removed 2 to 3 days after satisfactory voiding. All patients were followed up at 6th and 12th week. Results: Among the 15 patients age range was 2-14 years and mean age. Sub-coronal in 4 and distal penile was in 11 patients. Following TPIF urethroplasty wound disruption was noted in one patient for that glans closure was done successfully. There was no meatal stenosis and urethrocutaneous fistula in follow up. Regarding cosmetic outcome 12 were good, 2 were acceptable and 1 was poor. Conclusion: Success rate of TPIF urethroplasty in case of sub-coronal and distal penile hypospadias is excellent. Cosmetic outcome should be considered most challenging and with experience of surgeons this aspect will be improved. Bangladesh Journal of Urology, Vol. 23, No. 1, January 2020 p.43-47

Ustekinumab treatment for moderate to severe psoriasis. Eight-year real-world follow-up of 61 cases in a tertiary level hospital

2019 ◽  
Vol 31 (7) ◽  
pp. 698-701 ◽  
Author(s):  
L. Elberdín ◽  
Rm Fernández-Torres ◽  
S. Paradela ◽  
E. Blanco ◽  
M. Outeda ◽  
...  
Keyword(s):  
Real World ◽  
Severe Psoriasis ◽  
Tertiary Level ◽  
Level Hospital

scholarly journals Clinico-Epidemiological Study of Self-Poisoning by Different Pharmaceutical Agents

2017 ◽  
Vol 8 (1) ◽  
pp. 17-22
Author(s):  
Habib Ahmed ◽  
Ferdousi Rahman ◽  
Mahbubur Rahman ◽  
Mohammad Enamul Karim ◽  
Sayeda Rahim ◽  
...  
Keyword(s):  
Urban Area ◽  
Urban Areas ◽  
Previous History ◽  
Socioeconomic Background ◽  
Tertiary Level ◽  
Organophosphorous Compound ◽  
History Of ◽  
Pharmaceutical Agents ◽  
Age Range ◽  
Level Hospital

Background: In Bangladesh self-poisoning cases are mostly of organophosphorous compound (OPC). It is documented that 14% of all deaths amongst 10 to 50 year old women in Bangladesh were due to poisoning, the majority following suicidal ingestion of pesticides. In tertiary level hospital, a large number of self-poisoning cases are of different pharmaceutical agents, mostly from urban areas and mostly of teenager group. So the trend of self-poisoning is different in urban area than that of rural area. These pharmaceutical agent self-poisoning cases admitted into the hospitals have different modalities of clinical features with variable outcomes and socioeconomic background. But there is no actual data of these self-poisoning by the different pharmaceutical agents. Therefore, this study was aimed to describe the pattern of self-poisoning by different pharmaceutical agents.Methods: A descriptive longitudinal study was conducted in five adult medicine units of a tertiary level hospital from January 2008 to June 2008. All self-poisoned patients with different pharmaceutical agents were included with their prior informed written consent. A pre-tested questionnaire was used for data collection.Results: A total of 281 patients were interviewed. Most of the patients were female (70.8%) with highest age range from 13 to 30 years (91.81%). Most of the patients were students (53%) and 40.9% were secondary school certificate pass. 60.1% patients were unmarried. Most of the patients were from urban area (84%). The commonest background for self-poisoning was family disharmony (74.46%). Most common offending pharmaceutical agents were benzodiazepines (44.10%), collected mostly from local dispensary without prescription (89.33%). Most of the patients consulted within 1 to 2 hours of poisoning (44.5%). Commonest consultation before admission was in a Government hospital (48.40%). Only 3 patients (1.10%) were known to have psychiatric illness. Five patients (1.80%) had previous history of self-poisoning. Most of the patients (89.3%) stayed in the hospital for 1 day with no mortality.Conclusion: Self poisoning by pharmaceutical agents is common especially in urban areas. Common offending pharmaceutical agents were benzodiazepines. The commonest background for self-poisoning was family disharmony.J Shaheed Suhrawardy Med Coll, June 2016, Vol.8(1); 17-22

scholarly journals Outcome of myringoplasty

1970 ◽  
Vol 15 (2) ◽  
pp. 40-44 ◽  
Author(s):  
Mani Lal Aich ◽  
ABM Khorshed Alam ◽  
Debesha Chandra Talukder ◽  
Abdullah Al Harun ◽  
M Abdullah
Keyword(s):  
Observational Study ◽  
Surgical Outcome ◽  
Tertiary Level ◽  
Temporalis Fascia ◽  
Cross Sectional ◽  
The Mean ◽  
Age Range ◽  
Level Hospital ◽  
Outcome Of Surgery ◽  
Air Conduction

A cross sectional, observational study was carried out on myringoplasty at a tertiary level hospital, with the aims to see the outcome of surgery. The study included 100 myringoplasty in central dry perforations of tubotympanic variety of CSOM. Age range of patients was from 15 years to 45 years; male was 56%.There was insignificant influences of age or sex on success rate. The surgeries were done under either local or general anaesthesia by underlay technique with temporalis fascia as a graft in all cases with different approaches without any significant influences on outcome. Site and size of the perforations had significant effect on surgical outcome. The overall graft take rate was 84%. The mean preoperative and postoperative air conduction threshold in the successful cases were 35.2dB & 24.1dB respectively with a mean audiological improvement of 11.1dB & air bone gap improvement was 12.4dB. Key words: Myringoplasty, outcome. DOI: 10.3329/bjo.v15i2.5054 Bangladesh J Otorhinolaryngol 2009; 15(2): 40-44

Sural Island Flap – A Good Option for Coverage of the Exposed Heel (Tendo-Achillis)

1970 ◽  
Vol 19 (1) ◽  
pp. 19-24 ◽  
Author(s):  
MK Alam ◽  
MS Shaheen ◽  
S Hossain ◽  
S Anam ◽  
S Rahman
Keyword(s):  
Prospective Observational Study ◽  
Normal Activity ◽  
Tendon Injury ◽  
Island Flap ◽  
Direct Trauma ◽  
Flap Repair ◽  
Distally Based ◽  
Tendo Achillis ◽  
Age Range

A prospective observational study was carried out in DMCH and some other private clinics in Dhaka from January 2008 to March 2010. A total of 15 patients with exposed Tendo-Achillis with or without tendon injury were taken in this study . M:F= 13:2. Age range was 18- 45 years. In 13 cases Tendo-achillis (TA) were cut and repaired in emergency department of DMCH and other Hospitals followed by loss of skin over the TA. In 2 cases skin over the TA were lost due to direct trauma. Mode of injury was cut injury in toilet pan 9(59.99%), RTA 4(26.66 %) and direct cut injury without tendon injury 2 (13.33%).All the patients were treated with surgical toileting after admission and wound were covered by distally based sural island flap .Average follow up period was 36 weeks. Flap coverage were done within 5 days to 25 days from the day of injury. Outcome was evaluated by flap vascularity and skin colour .Majority of the patients were returned to normal activity after 20 weeks of operation. The purpose of the study was to find out the way of coverage of the exposed TA(Tendo-Achillis) by orthopaedic surgeons without any special training. Key words: Sural Island Flap; Repair of Tendo-Achillis. DOI: 10.3329/jdmc.v19i1.6246 J Dhaka Med. Coll. 2010; 19(1) : 19-24.

scholarly journals Dorsal vertical island flap urethroplasty in children with hypospadias: a single center’s experience 75 patients

2019 ◽  
Vol 2 (1) ◽  
pp. e000021
Author(s):  
Gontumukkala Chalapathi ◽  
Kadiri Sitha Ramaiah ◽  
Javvadi Veeraswamy
Keyword(s):  
Good Alternative ◽  
Urethral Diverticulum ◽  
Vertical Tube ◽  
Island Flap ◽  
Urethrocutaneous Fistula ◽  
Urethral Plate ◽  
Meatal Stenosis ◽  
Cosmetic Appearance ◽  
Good Cosmetic ◽  
The Mean

ObjectiveTo assess the results and complications of dorsal vertical island flap (DVIF) urethroplasty.MethodsA total of 175 children were operated on for hypospadias. Out of these, 41 with proximal hypospadias with severe chordee required two-stage urethroplasty. In 18 babies with glanular hypospadias, a meatal advancement and glanuloplasty procedure was done. In 25 babies with mid-penile and distal penile hypospadias, tubularized incised urethral plate (TIP) urethroplasty was the option. 16 babies with unhealthy urethral plate and chordee were chosen for dorsal vertical tube urethroplasty after excision of the urethral plate. The rest of the 75 babies with proximal, mid-penile or distal penile hypospadias with no or minimal chordee after degloving and poor urethral plate were chosen for DVIF urethroplasty. These 75 babies with DVIF were followed up from 3 months to 5 years to assess complications such as urethrocutaneous fistula, meatal stenosis, glans dehiscence, megalourethra or urethral diverticulum, stricture, and penile torsion/rotation.ResultsA total of 75 patients with proximal, mid-penile, or distal penile hypospadias in whom DVIF was used during the study period were included. The mean age was 3.7 years, ranging from 8 months to 14 years. Fourteen patients developed complications (18.6%). The most common complication was urethrocutaneous fistula, which was seen in seven (9.3%) patients. Glans dehiscence was seen in five patients (6.6%), and one had meatal stenosis with diverticulum formation. Skin necrosis was observed in one patient. In 61 patients, stream was good, with no torsion, and good cosmetic appearance was observed.ConclusionsDVIF is a good alternative to TIP in mid-penile and distal penile hypospadias. Our early experience with DVIF urethroplasty showed an acceptable rate of complications and good cosmetic results.

Recurrent Ventral Curvature with Long-Term Follow-up after Transverse Preputial Island Urethroplasty

2019 ◽  
Vol 30 (05) ◽  
pp. 429-433
Author(s):  
Chaoxu Wang ◽  
Hongcheng Song ◽  
Weiping Zhang
Keyword(s):  
Island Flap ◽  
Surgical Reconstruction ◽  
Long Term Outcomes ◽  
Urethral Plate ◽  
Urethral Strictures ◽  
Primary Surgery ◽  
Age At Surgery ◽  
Long Term Follow Up

Abstract Objective This study was aimed to assess the long-term outcomes of recurrent ventral curvature (VC) repaired in early childhood after transverse preputial island flap urethroplasty. Materials and Methods A total of 378 patients underwent transverse preputial island flap urethroplasty between January 2000 and January 2005 at our hospital. Of these patients, 43 were invited for assessment of VC after puberty. The age at surgery, types of hypospadias, degrees of recurrent VC, and surgical procedures were analyzed. Results The study included 43 patients with a mean age of 15.9 years (range, 12.3–17.9). The average age at the time of primary surgery was 1.9 years (range, 1.2–3.6). Of 43 patients, recurrent VC was identified in 14 (32.5%). In total, 8 out of 16 patients (50.0%) were successfully treated by urethral plate transection with skin release during the primary surgery, and 6 out of 27 patients (28.6%) underwent additional dorsal plication (DP; p = 0.093). Severe recurrent VC was observed in four, moderate curvature was observed in four, and mild curvature was observed in six cases. Recurrent VC was present more often in patients with complications (34.6 vs. 24.1%, p = 0.331), especially in severe urethral strictures that required open surgical reconstruction (p = 0.039). Conclusion Although the patients in our study represent only a small portion of the overall hypospadias population, it is notable that 32.5% of these patients showed recurrent VC, including 28.6% of patients with transection plus DP. We suggest long-term follow-up of hypospadias at least during adolescence or even into adulthood.

scholarly journals Improving the Penile Skin Adequacy and Appearance by Patching of the Preputial Skin Island Flap (PSIF) in Distal and Midshaft Hypospadias Associated with Severe Ventral Skin Deficiency: Experience in 224 Cases

2020 ◽  
Vol 30 (3) ◽  
Author(s):  
Mansour Molaeian ◽  
Farid Eskandari ◽  
Hojattollah Raji ◽  
Maryam Ghavami-Adel ◽  
Arash Mollaeian
Keyword(s):  
Island Flap ◽  
Penile Skin ◽  
Bare Area ◽  
Skin Island ◽  
Long Term Follow Up ◽  
Distal Hypospadias ◽  
Ventral Skin ◽  
Skin Island Flap

Objectives: Reconstruction of ventral penile skin, in midshaft and distal hypospadias is problematic in many cases of severe ventral dysplasia. So we plan to use the tailored preputial skin island flap (PSIF) to cover the ventral defect. Methods: In this prospective cohort study 224 boys with midshaft and distal hypospadias associated with sever ventral dysplasia were operated from March 2009 until January 2016. The large U-shaped bare area which exposed on the ventrum after release of curvature was quilted by the PSIF as a patch. In each case, the variable size of the flap was required. The prepuces without the predominant artery were excluded from the study due to poor vasculature. The patients followed for 8 months to 7years. Results: Flap ischemia developed in 7 initial cases (3.125%), all of which subsequently faded. Some degree of ischemic discoloration was encountered at margins of the flap (12 cases, 5.3%), which resolved spontaneously. In 5 out of 224 patients (2.23 %), the flap persisted as a hypertrophied area of skin in the long-term follow-up. All of them needed to be corrected surgically. Near normal appearing penile skin was accomplished in the majority of patients during the follow-up. However, lack of the median raphe in the ventrum was evident in all. Conclusions: Tailored preputial skin island flap, as a native tissue to cover the exposed large bare area on the ventrum in cases of the distal and mid hypospadias with severe ventral dysplasia may improve the appearance and adequacy of the penile skin. It provides room for full erection and improves the patient’ s perception of body image and self-esteem.

scholarly journals Combination of the pedicled penile skin flap with the penile advancement flap as a coverage technique for repair of urethrocutaneous fistulas secondary to urethroplasty

2021 ◽  
Author(s):  
chongrui Jin ◽  
Yinglong Sa ◽  
Yuemin Xu ◽  
Qiang Fu
Keyword(s):  
Success Rate ◽  
Skin Flap ◽  
Treatment Success ◽  
Advancement Flap ◽  
Treatment Success Rate ◽  
Penile Skin ◽  
Fistula Repair ◽  
Urethrocutaneous Fistula ◽  
Local Skin

Abstract Background: The urethrocutaneous fistula is a common complication secondary to urethroplasty. The management is complex and not standard yet. We report our experience and techique with combined pedicled skin flap and local skin advancement flap for urethrocutaneous fistulas secondary to urethroplasty. Methods: We retrospectively analysed data of 36 cases of urethrocutaneous fistulas secondary to different urethroplasties treated from January 2014 to January 2019. All patients underwent treatment with the combination of a pedicled penile skin flap and local skin advancement flap as a coverage technique. The fistula size, fistula location, number of fistulas, and surgical outcomes of fistula repair were recorded. Postoperative evaluation included voiding cystourethrography, uroflowmetry. All patients underwent postoperative follow-up for 6 to 12 months. Results: Fistula repair was successfully performed in all 36 patients. The overall success rate of urethrocutaneous fistula repair was 30/36 (83.3%). Three patients were cured after a second surgery, one was cured after wound dressing, and two were lost to follow-up after failure of the second surgery. Among all patients, the treatment success rate for urethrocutaneous fistulas in the coronal sulcus, penis, penoscrotal junction, and perineum was 2/2 (100%), 21/26 (80.8%), 5/6 (83.3%), and 2/2 (100%), respectively. The treatment success rate for small- and large-diameter urethrocutaneous fistulas was 23/27 (85.2%) and 7/9 (77.8%), respectively. The treatment success rate for single and double urethrocutaneous fistulas was 28/33 (84.8%) and 2/3 (66.7%), respectively. During the 6- to 12-month follow-up, one patient developed a urethral stricture at the urethral fistula repair site and was cured by urethral dilation Conclusions: The repair of urethrocutaneous fistula secondary urethroplasty induces minimal trauma but is quite challenging for surgeons and has a high failure rate. The combined pedicled skin flap and local skin advancement flap for coverage the urethrocutaneous fistulas secondary to urethroplasty can improve the success rate.

Analysis of adolescent oncology cases from 2008 through 2018 in a tertiary-level hospital: an opportunity for improvement

2021 ◽  
Author(s):  
Domingo A Sánchez Martínez ◽  
Marta Cañadilla-Ferreira ◽  
Pilar Sánchez Henarejos ◽  
José Luis Alonso Romero
Keyword(s):  
Central Nervous System ◽  
Nervous System ◽  
Retrospective Study ◽  
Cancer Diagnosis ◽  
Tertiary Level ◽  
Cross Sectional ◽  
Adolescent Patients ◽  
Adolescent Oncology ◽  
Level Hospital

Purpose: The purpose of this study was to disclose the variability of pathways currently taken in the treatment of adolescent patients from diagnosis to final follow-up with a view to developing a more homogenous system. Patients & methods: A cross-sectional, observational and retrospective study of the cancer diagnosis and assignment to medical care teams in adolescent patients (12–20 years) from January 2008 to December 2018 was conducted. A total of 345 adolescent patients aged between 12 and 20 years, diagnosed with cancer and treated at Hospital Clinico Universitario Virgen de la Arrixaca were included. Results: Central nervous system (CNS) tumors, followed by leukemia were the most frequent tumors. At the time of diagnosis, the highest incidences of patients were assisted in the pediatrics service adult oncology service (21.7%) and hematology (11%). Conclusion: Our aim is to highlight the need for a better transition for patients from pediatric to adult oncology and hematology services.

Current Practices and Challenges of Medical Services on Health Care System of Mandalay General Hospital

2019 ◽  
Vol 31 (2) ◽  
pp. 131
Keyword(s):  
Health Care ◽  
General Hospital ◽  
Health Care Providers ◽  
Quality Care ◽  
Healthcare Providers ◽  
Medical Services ◽  
Tertiary Level ◽  
Care Providers ◽  
Level Hospital ◽  
Care System

In Myanmar, the main challenge to provide quality healthcare by Universal Health Care approach is documented as low health services coverage with substantial wealth-based inequality. To achieve the effective health care system, strong medical care system is essential. Understanding on challenges and needs in provision of medical services among patients and health care providers is critical to provide quality care with desirable outcomes. The aim of the study was to explore the patients’ and health care providers’ perceptions on the challenges in provision of medical services at the Mandalay General Hospital. This was a qualitative study conducted at the tertiary level hospital (Mandalay General Hospital). The data was collected by using focus group discussions and in-depth interviews with hospitalized patients or attendants, healthcare providers such as medical doctors, nurses, laboratory scientists and hospital administrators in March 2017. The qualitative data was analyzed using themes by themes matrix analysis. Most patients were satisfied with the care provided by the doctors because they believed that they received quality care. However, some patients complained about long waiting time for elective operation, congested conditions in the ward, burden for investigations outside the hospital for urgent needs and impolite manners of general workers. Healthcare providers reported that they had heavy workload due to limited human and financial resources in the hospital, poor compliances with hospital rules and regulation among patients and attendants, and inefficient referral practices from other health facilities. Other challenges experienced by healthcare providers were lack of ongoing training to improve knowledge and skills, limited health infrastructure and inadequate medicinal supplies. The findings highlighted the areas needed to be improved to provide quality health care at the tertiary level hospital. The challenges and problems encountered in this hospital can be improved by allocating adequate financial and human resources. The systematic referral system and hospital management guidelines are needed to reduce workload of health staff.

Sign in / Sign up

Export Citation Format

Share Document