Amniotic membrane wrapping: an alternative method to the splenorrhaphy in the injured spleen.

Human amnion, which has been used experimentally and clinically as an ideal bioprosthesis, was used in the present study to wrap the experimentally injured spleens and the technique was compared to splenorrhaphy. Standard splenic injuries were made on 30 male albino rats. 15 of the spleens were repaired by splenorrhaphy and the other 15 were wrapped with sterile human amniotic membrane. Isotope uptakes of the spleens calculated at the 30th postoperative day were similar in both groups (p less than 0.05). But the histopathological examination revealed a better healing in the amnion group with better preservation of the splenic architecture. It was concluded that in heavily injured spleens, amnion wrapping may be an effective alternative to splenorrhaphy.     

Effect of bipolar cautery on tensile strength of 6-0 polyglactin 910 suture

PURPOSE: To determine the effect of bipolar cautery on 6-0 polyglactin 910 suture. METHODS: Three groups of sutures were tested for maximum tensile strength. The first group (direct cautery) had bipolar cautery applied directly to the suture. The second group (scleral cautery) had bipolar cautery applied directly on top of the sclera, through which the suture was passed one-half scleral thickness. The third group (control) had no application of cautery to the suture. RESULTS: The mean tensile strength for the direct cautery sutures (n=8) was 553 g; for the scleral cautery sutures (n=7), 577 g; and for the control sutures (n=5), 553 g. There was no statistically significant difference in tensile strength between the three groups, with the analysis of variance yielding P=.56. CONCLUSION: Bipolar cautery causes little to no risk of reducing the tensile strength of 6-0 polyglactin 910 suture in the setting of strabismus surgery.     

Miltefosine in children with visceral leishmaniasis

Sixty four children (38 boys and 26 girls), aged 1 yr to 14 yr, presenting with fever, splenomegaly and positive LD body in splenic smear examination, admitted to pediatric ward of Nalanda Medical college and Child care center between 1st July 03 to 30th June 04 were taken for study. Patients were categorized into two groups: 44 were in Group I (Patients who had not received prior antileishmanial drug) and 20 in Group II (Patients who had received 30 days course of SAG; 20 mg per kg per day). All patients were given Miltefosine in dose of 2.5 per kg per day od or bid per orally to a maximum of 100 mg and were followed at completion of therapy, 1 month and 6 months for clinical response, splenic size and parasite density. 63 patients had parasitological cure with relapse in one patient of Group I during follow up. One patient in Group II had no response with first course but became parasitologically negative with 2nd course of Miltefosine. In Group I, one patient had persistent splenomegaly and found to have associated portal hypertension. GI side effects i.e. diarrhea and vomiting were observed in 26 and 23 patients respectively. Majority of patients had pancytopenia. Elevated ALT (> 3 times of normal) were seen in 28 and 11 patients of Group I and Group II respectively which returned to normal in subsequent follow up. The final cure rates were 93.2 percent and 95 percent in Groups I and II respectively.     

Microsurgical intestinal anastomosis

The present investigation examined the morphological and functional effects of different microsurgical suture materials and techniques for intestinal anastomosis in 220 Sprague-Dawley rats. Extramucous end-on and inverted anastomoses were performed using non-absorbable monofilament 7-0, 8-0, and 10-0 (metric 0.2) nylon (Ethilon), absorbable braided 8-0 polyglactin 910 (Vicryl), and monofilament 10-0 Vicryl. Both suture materials were swaged onto taper-point needles. The efficacy of the anastomoses was evaluated by measurement of bursting strength, the healing by light microscopic and scanning electron microscopic (SEM) examination, and revascularization by perfusion of India ink into the aorta. Non-inverting, single-layer, extramucous end-on intestinal anastomoses performed with microsurgical technique and micromonofilament suture material gave excellent results without complications, a bursting pressure superior to the inverting technique, rapid revascularization, and per primam healing. Thicker sutures were less favorable. The highest bursting strength was obtained in anastomoses performed using 10-0 Vicryl and 10-0 Ethilon. Fine absorbable sutures are thus the optimal material for intestinal anastomoses. Offprint requests to: A. J. Lamesch     

Conservation of the ruptured spleen in children: an African series.

In the Zaria region of northern Nigeria, which is endemic for malaria and schistosomiasis, laparotomy was performed for traumatic rupture of the spleen in 27 children, 10 of whom had splenomegaly. Eleven of the children were pedestrians knocked down by motor vehicles while crossing the road and six were boys who fell off mango or guava trees. Using suture techniques, 17 ruptured spleens were repaired and one was partially resected: eight of them were enlarged. Total splenectomy was performed in nine cases. Five of the children in the splenic conservation group died within 4 days of surgery owing to severe associated injuries. It is concluded that splenorrhaphy is quite feasible in both normal-sized and enlarged spleens and should be encouraged in similar tropical countries where splenomegaly is a common response to endemic malaria and schistosoma.     

Exercise testing after surgical repair of coarctation of the aorta

Summary After repair of coarctation, exercise testing was performed in 20 patients with an isolated coarctation (group I) and in 26 with additional congenital cardiac malformations (group II). Ages at time of operation were significantly different in both groups (7.9±6.0 years in group I; 4.6±3.8 years in group II;p≤0.01). Simultaneous blood pressures were obtained from upper and lower limbs at rest and after exercise. There was no significant difference regarding the systolic blood pressures at rest (122.5±15.6 mmHg in group I versus 119±15.8 mmHg in group II). Seven (14%) of the patients were hypertensive; five of them had blood pressure gradients between arms and legs of 15–45 mmHg. But the gradients at rest were found to be significantly different in both groups (9.0±10.5 mmHg in group I; 18.5±16.1 mmHg in group II;p≤0.05). Six patients, all in group II, had gradients ≥30 mmHg at rest. After exercise there were no significant differences in systolic blood pressure and gradients in both groups. Values for blood pressures and gradients at rest and after exercise showed a positive correlation (blood pressurer=0.76,p≤0.001; gradientr=0.44,p≤0.01). Thus exercise testing can provide valuable information about blood pressure and gradient changes during physical activity, but angiography is required to reveal restenosis or residual stenosis.     

Advanced paediatric laparoscopic surgery: repetitive training in a rabbit model provides superior skills for live operations.

TOPIC: The rapid development of advanced laparoscopic techniques is a strong challenge for the skills and competence of the paediatric surgeon. It is therefore mandatory that training must offer adequate preparation. The present experimental study investigates how surgical residents perform laparoscopic bowel biopsy and defect repair after training with a pelvitrainer versus a rabbit model. METHODS: New Zealand white rabbits, 3 mm instruments, a 5 mm scope and a 6 - 0 prolene suture were used. Twelve surgical residents were randomised into two groups. Their basic task was to take a seromuscular bowel biopsy laparoscopically and to repair the defect using an intracorporeal suture. Group I trained 8 times (on 8 occasions) with a pelvitrainer (PT), group II trained similarly using a rabbit model (RM). Each participant took a final test to demonstrate the operation in the rabbit. Operating time, suture time and perforation of the bowel were analysed. RESULTS: In the PT group, mean operating times decreased from 11.18 (+/- 5.04) min to 4.91 (+/- 0.89) min (p < 0.01), however the final test procedure in the rabbit model lasted 9.62 (+/- 5.11) min. In the RM group mean operating times also decreased from 10.04 (+/- 3.39) min to 6.38 (+/- 1.40) min (p < 0.01) during the eight training operations. Within this group the final live operation lasted 5.45 (+/- 0.67) min and was significantly faster than in the PT group 9.62 (+/- 5.11) min (p < 0.1). The suture times showed a similar pattern. A significant difference with respect to the rate of perforation was not found. CONCLUSIONS: Repetitive training in the rabbit provides superior skills for live operations. In paediatric surgical centres with advanced laparoscopic procedures, an animal model should be considered as an important step in training which may contribute to a beneficial outcome in patients.     

Combined treatment strategy in over 200 children with Hodgkin's disease: graduated chemotherapy, involved field irradiation with low dosage and selective splenectomy. A report of the cooperative therapy study DAL-HD-82

It was the aim of the cooperative therapy study HD-82 for children with Hodgkin's disease to reduce chemo- and radiotherapy and to investigate of a strategy for selective splenectomy previously developed in the Hodgkin study HD-78. Between December 1981 and December 1984 207 patients (131 boys and 76 girls) below 16 years of age were enrolled in this study. In 174 out of 207 patients (84.1%) the criteria for selective splenectomy were applied i.e. the spleen was only removed when the splenic surface was nodular or when the lymphnodes at the splenic hilus and/or the pancreatic tail were enlarged. 69 out of 174 patients (39.7%) had a splenectomy. 50 of the removed 69 spleens (72%) showed histological evidence of Hodgkin's disease. These results were comparable to the 36% and 73% predicted from the retrospective analysis in the HD-78 study. According to the stage of Hodgkin's disease three different treatment groups with 2, 4 and 6 cycles of OPPA/COPP were formed (stage I/IIA, IIB/IIIA and IIIB/IV). Radiation therapy was given as involved field irradiation with a total dose of 35, 30 and 25 Gy depending on the extent of the chemotherapy. 203 patients were treated according to the protocol. Until the 30th of November 1985 3 patients died from intercurrent disease during a follow-up period of 11 to 47 months (median 29 months). 5 patients relapsed. The probability for disease-free survival after 3 1/2 years is 96% for the total group and 99%, 96% and 87% for the three treatment groups including 100, 53 and 50 patients in each group respectively. Conclusions: 1. The OPPA/COPP chemotherapy eliminates reliably occult microfoci. 2. The radiation doses in combination with the chemotherapy are sufficient to prevent local recurrences. 3. The decisional model for selective splenectomy has proved to be extremely valuable prospectively.     

Prepuce preserving versus conventional Mathieu urethroplasty for distal hypospadias - a prospective randomized study

ObjectivesTo evaluate the impact of prepuce preservation during Mathieu repair for distal hypospadias.MethodsThis prospective randomized comparative study, carried out in Assiut University Hospital, between 2006 and 2009, included 200 patients with distal penile or coronal hypospadias. They underwent either Mathieu repair with prepuce preservation (group I, n = 100) or traditional Mathieu repair with circumcision (group II, n = 100). Follow up was at 2 weeks, and 1 and 3 months postoperatively, which only 153 patients completed (I: n = 86 and II: n = 67).ResultsThe mean operative time was 64.5 min in group I and 121.7 min in group II (p < 0.001). All patients in group I developed postoperative preputial edema. Patients from group I who had a successful operation underwent circumcision at least 3 months later. Urethrocutaneous fistulae developed in 7 and 6 patients in group I and II respectively (p = 0.967). Fistula closure was done at least 3 months postoperatively, and there was no significant difference in success between the two groups. Two cases of glanular dehiscence were detected (one in each group); the patient from group I had a successful onlay island flap repair.ConclusionsPreputial preservation during Mathieu repair is a time-saving procedure with similar complication rate to traditional repair. Valuable local tissue is preserved to deal with complications that may occur.     

The effect of zinc therapy on damaged testis in pre-pubertal rats

This experimental study was instituted to evaluate whether or not there is an effect of zinc aspartate administration on injured testes. Sixty prepubertal male Sprague-Dawley rats (weighing 180–240 g) were divided into six equal groups each containing ten rats. Group I was the control group. Rats in group II and group III which were blunt testicular trauma groups were subjected to right blunt testicular trauma to rupture the tunica albuginea. Just after this, animals in group III were given 30 mg/kg zinc aspartate intraperitoneally, and this treatment was continued for 30 days at a dose of 10 mg/kg per day. Animals in group IV and group V which were thermal injury groups were subjected to right thermal testicular injury with injection of boiling normal saline. After that, animals in group V were also treated with zinc aspartate as described in group III. Group VI was used as a sham group. After 30 days, both testes were removed and examined. Damage in ipsilateral testes was evaluated with histological scoring methods. Contralateral testes were evaluated with measurement of tubular diameter and percentage of spermatogenesis histologically. Ipsilateral testes from non-treated groups had much greater histological injury than treated groups (p>0.05). Additionally, contralateral testes had no evidence of injury. As a consequence, after acute testicular injury that takes form in a variety of ways, immediate administration of zinc aspartate and its continuation for some period may prevent the progression of the injury and improves the healing process.     

小儿外伤性脾损伤的治疗(附50例分析)

目的探讨不同程度小儿脾损伤的治疗方法,以提高小儿脾损伤的治疗效果。方法回顾性总结1990年1月～2003年12月间收治的50例小儿脾损伤的临床资料,讨论不同类型脾损伤的临床诊断和处理方法。结果非手术治疗33例,手术治疗17例,其中单纯性脾缝合7例,脾切除5例,脾切除且大网膜移植5例,50例患儿全部治愈。结论早期正确诊断,并根据不同损伤类型选择合理的治疗方法,小儿脾损伤可以取得满意的疗效。     

Non-operative management of isolated solid organ injuries due to blunt abdominal trauma in children: a fifteen-year experience.

The purpose of this study was to evaluate essential prerequisites for a selective non-operative approach in children with solid organ injuries due to blunt abdominal trauma, and to determine the predictive value of two different trauma scoring systems: the Injury Severity Score (ISS) and the Paediatric Trauma Score (PTS). A retrospective review of children who were admitted with blunt abdominal solid organ injuries to a paediatric trauma centre between January 1986 and September 2001 was performed. Hepatic, splenic, and renal injuries were graded, based on the American Association for the Surgery of Trauma (AAST) Organ Injury Scale (ranged from grade I to IV). The patients were treated non-operatively or operatively and the two groups were compared for variables such as age, blood transfusion, ISS, PTS, length of hospitalisation, morbidity and mortality rate. Two hundred and five patients (147 boys and 58 girls) entered in this study. Median age was 7 years (1 - 15 yrs). The most common cause of trauma was falls (50%). Abdominal organ injuries were present in all patients with the spleen as the most commonly injured organ (111 patients). Fifty-one patients (32%) had additional extra-abdominal organ injuries. Thirty-five (17%) patients were treated operatively, while 170 (83%) were treated non-operatively. Post-traumatic complications developed in 10 patients treated operatively versus 4 patients treated non-operatively. Four patients died due to multiple organ failure (2 non-operative, 2 operative). When compared to the non-operative group, higher transfusion requirements (p < 0.05), a higher ISS (p < 0.01), lower PTS values (p = 0.0001), a longer hospitalisation period (p = 0.0001), and a higher complication rate (p < 0.05) were observed in the operative group. In addition, the non-operative treatment approach was more common in the last five years compared to the previous ten years (p = 0.002). In conclusion, the appropriate non-operative management of injured children reduces the risks of blood transfusion and decreases the length of hospital stay compared with a surgical approach. The use of physiological parameters and radiological findings may be sufficient criteria for observing haemodynamically stable patients with isolated abdominal organ injuries, and thus intensive care unit costs may be avoided. In addition, a careful and close follow-up is essential in injured patients with a low PTS or high ISS.     

卡托普利对高氧致新生大鼠慢性肺疾病的保护作用及机制探讨

目的：观察高氧致慢性肺疾病（CLD）新生大鼠肺组织ACE,AngⅡ和ColⅠ蛋白及mRNA含量的动态变化,以探讨卡托普利的保护作用及机制。方法：足月新生Wistar大鼠240只,随机分为高氧组、空气对照组、卡托普利治疗组和盐水对照组,每组各60只。将高氧组、盐水对照组和卡托普利治疗组的足月新生Wistar 大鼠（连同母鼠）生后即置于氧舱内持续吸入高浓度氧（FiO2=0.9）21 d造成高氧肺损伤模型,空气对照组吸入空气。卡托普利治疗组于生后7 d每天经胃管灌服卡托普利每日30 mg/kg, 盐水对照组每天经胃管灌服等量生理盐水。每组分别于实验开始后第1,3,7,14,21天随机选取6只麻醉后处死。肺组织采用ELISA法测定ColⅠ蛋白含量,用日产7170全自动生化分析仪测定ACE活性,用放免法测定AngⅡ的含量。用RT-PCR法检测肺组织ACE,AngⅡ,ColⅠmRNA表达的动态变化并同时观察肺组织形态学变化。结果：与空气对照组比较,高氧组、盐水对照组肺组织ACE,AngⅡ,ColⅠ蛋白含量及mRNA表达在实验后第14天明显升高,第21天达高峰(P<0.05或P<0.01),卡托普利治疗组上述指标与高氧组、盐水对照组比较明显降低(P<0.05或P<0.01),但仍高于空气对照组（P<0.05）。 肺组织形态学改变：高氧组、盐水对照组第14天肺组织间质细胞增多,出现纤维化改变。第21天正常肺泡结构消失,肺组织出现严重的纤维化。卡托普利治疗组肺组织纤维化病变明显减轻。结论：卡托普利干预抑制了高氧致CLD新生大鼠肺组织ACE,AngⅡ,ColⅠ蛋白含量及mRNA表达,减轻了肺纤维化病变,这可能是卡托普利对高氧肺损伤具有保护作用的机制之一。［中国当代儿科杂志,2007,9（2）：169-173］     

Splenic function in Omani children with sickle cell disease: correlation with severity index,hemoglobin phenotype,iron status,and alpha-thalassemia trait

The prevalence of functional asplenia in Omani children with sickle cell disease (SCD) has not been previously defined. In this study, the authors aim to compare the natural history of splenic dysfunction in their patients to other reports. The splenic function was studied in 72 Omani patients with sickle cell disease (50 homozygous for hemoglobin S (HbS-S), 11 double heterozygotes for HbS and beta(0)-thalassemia (HbS-beta(0)-thal), 5 HbS-beta(+)-thal, 5 patients with hemoglobin S-D disease, and 1 child with hemoglobin S oman trait) aged 4.8-16 years, using (99m)Tc-labeled tin colloid scintigraphy. The study revealed 4 groups according to their colloid uptake: group I included 20 patients (28%) with normal splenic function; group II, 6 patients (8%) with mild hyposplenism; group III, 20 (28%) with severe hyposplenism; and group IV, 26 (36%) patients with functional asplenia. Overall, more than 60% of them had preserved splenic function. Except for HbS-beta(+) patients, the developmental pattern of hyposplenism was not different among the different Hb phenotypes. Factors associated with preservation of spleen function in these patients were larger splenic size (p < .01), less clinical severity (p < .05), lower MCH (p < .01), higher HbF (p < .001), and presence of alpha-thalassemia trait (p < .05).     

SPLENIC FUNCTION IN OMANI CHILDREN WITH SICKLE CELL DISEASE: Correlation with Severity Index,Hemoglobin Phenotype,Iron Status,and α -Thalassemia Trait

The prevalence of functional asplenia in Omani children with sickle cell disease (SCD) has not been previously defined. In this study, the authors aim to compare the natural history of splenic dysfunction in their patients to other reports. The splenic function was studied in 72 Omani patients with sickle cell disease (50 homozygous for hemoglobin S (HbS-S), 11 double heterozygotes for HbS and &#103 0 -thalassemia (HbS- &#103 0 -thal), 5 HbS- &#103 + -thal, 5 patients with hemoglobin S-D disease, and 1 child with hemoglobin S oman trait) aged 4.8-16 years, using 99m Tc-labeled tin colloid scintigraphy. The study revealed 4 groups according to their colloid uptake: group I included 20 patients (28%) with normal splenic function; group II, 6 patients (8%) with mild hyposplenism; group III, 20 (28%) with severe hyposplenism; and group IV, 26 (36%) patients with functional asplenia. Overall, more than 60% of them had preserved splenic function. Except for HbS- &#103 + patients, the developmental pattern of hyposplenism was not different among the different Hb phenotypes. Factors associated with preservation of spleen function in these patients were larger splenic size ( p < .01), less clinical severity ( p < .05), lower MCH ( p < .01), higher HbF ( p < .001), and presence of &#102 -thalassemia trait ( p < .05).     

Induction of pleural empyema in rats by thoracentesis with intrapleural pressure monitoring

Our objective was to evaluate experimental induction of empyema in rats by intrapleural inoculation of Staphylococcus aureus by means of thoracentesis with pleural pressure monitoring. Forty female albino Wistar rats, anesthetized with droperidol and fentanyl, underwent intrapleural inoculation of a 0.2-ml solution. Group I (N=25) received 10¹⁰ colony-forming units/ml of Staphylococcus aureus cultivated in brain-heart infusion agar (BHI); group II (N=15), the control group, received sterile BHI agar. Rats were inoculated after right hemithorax thoracentesis with a needle connected to an oscilloscope for pressure monitoring to confirm that the needle was inside the pleural space. Animals were killed after 3 (groups Ia and IIa) to 5 (groups Ib and IIb) days with sodium pentobarbital. The macroscopic changes, amount of pleural fluid, and anatomopathological aspects of pleura and lungs were recorded, as well as death causes and bacteriological findings of pleural fluid for animals that died before the time established for euthanasia. In group I, three animals died of thoracentesis complications, and five others died in the first 24 h due to septicemia; blood and spleen cultures isolated the bacteria previously inoculated. In group II, there was one death of unknown cause. Of the 17 rats inoculated with bacteria, nine (group Ia) were killed on the 3rd day; all had bacteria in pleural fluid (volume 0.5–3.8 ml). The other eight rats (group Ib) were killed on the 5th day; three (39.5%) had pleural fluid with bacteria (0.5–1.5 ml), and five (60.5%) had no pleural fluid. Rats from group II killed on the 3rd (group IIa) and 5th (group IIb) days had no pleural fluid. Pathologic examination revealed inflammatory infiltrate (93.75%) and fibrin (18.75%) in pleura, and inflammatory interstitial infiltrate (12.5%) in the right lung in group I; no changes were observed in 93.3% of the lungs in group II. Macroscopic examination revealed only turbid and bloody pleural fluid (class I) without pleural adhesions. Pleural inflammatory infiltrate was found in rats that received the bacteria but had no fluid at necropsy (class 0). One control rat, although with no clinical signs of disease or pleural fluid, had signs of pleural and pulmonary infection at necropsy. We conclude that empyema may be induced in rats by the inoculation of Staphylococcus aureus by means of thoracentesis with pleural pressure monitoring. The highest amount of pleural fluid was observed 3 days after bacterial inoculation.     

The prognostic factors and the outcome of primary isolated fetal ascites

Purpose

The purpose of the present study was to evaluate the prognostic factors and review the outcome of primary isolated fetal ascites.

Methods

A retrospective cohort study was conducted for fetuses with primary isolated ascites with a prenatal diagnosis between 1994 and 2009. The patients were divided into the favorable group (Group I) whose ascites were resolved by medical treatment alone and an unfavorable group (Group II) who required surgical intervention after birth due to refractory ascites.

Results

There were seven patients in Group I and five patients in Group II. Six of seven patients who developed ascites after 30?weeks?? gestation were categorized in Group I, and four of five infants who developed ascites before 30?weeks?? gestation were categorized in Group II. There was a negative correlation between the gestational age at diagnosis and the severity of the fetal abdominal distention. In Group II, the ascites resolved in two cases and was reaccommodated in another two cases after surgery. An infant with trisomy 21 received continuous drainage and eventually died of infection.

Conclusions

The prognosis of primary isolated fetal ascites can be predicted based on the gestational age at diagnosis and the severity of the fetal abdominal distention.     

Can time to healing in pediatric blunt splenic injury be predicted?

Background

Current consensus guidelines do not recommend routine follow-up imaging for blunt splenic injury (BSI) in children. However, repeat imaging is recommended based on persistent symptoms. Wide variation of practice continues to exist among surgeons. By defining the natural evolution of BSI, we sought to identify patients at higher risk for delayed healing who could benefit from outpatient imaging.

Methods

A retrospective review of all children with BSI at a Level 1 Pediatric Trauma Center was completed. Grade of injury, hospital course, laboratory values and follow-up imaging results were obtained. Injured spleens were classified as ‘healed’, ‘healing’ (with echogenic scar), or ‘non-healing’ with persistence of parenchymal abnormalities.

Results

Between 2000 and 2014, 222 patients with BSI were identified. Seven patients (3%) underwent immediate splenectomy. Packed red blood cell transfusion was required in 13 (6%) of the 222 patients, and 3 (2%) of 145 with isolated splenic injuries. Seventy-one percent of patients underwent additional imaging 2–74 weeks post-injury. A receiver operating characteristics (ROC) curve was used to establish the relationship between sensitivity and specificity of capturing non-healing spleens over time. Optimal timing for post-injury imaging for grades I–II was 7–8 weeks; healing of higher-grade injuries could not accurately be predicted.

Conclusions

If return to full physical activity, in particular contact sports, is contingent upon documented healing of the splenic parenchyma after blunt trauma in the pediatric population, follow-up imaging for low-grade injuries is best obtained around 7–8 weeks. No such recommendations can be made for high-grade splenic injuries, as the exact time to healing cannot be predicted based on initial data.

Level of evidence

IV. Diagnostic test.

     

Glans meatus proportion in hypospadias versus normal: Does marking reference points impact outcome?

ObjectiveThe aims of this study were to assess anatomical landmarks with reference to urethral meatus and glans in hypospadias and compare the findings with those of healthy individuals, and to assess whether marking reference points helps in improving outcome.Methods1. Patients who underwent repair for hypospadias had reference points marked. Vertical meatal length, ventral glans closure and glans meatus proportion were derived, and the values compared with those obtained from healthy boys. 2. The outcomes of TIP repair after marking reference points (Group I) were compared with those of a similar group without skin markings (Group II).Results1. There was significant difference in the age distribution of hypospadiac patients and healthy individuals, reflected in the meatal length and ventral glans closure. However, there was no significant difference in glans meatus proportion. 2. The fistula rate was 2/35 (5.7%) in group I compared with 5/47 (10.5%) in group II. The meatal stenosis was 2/35 (5.7%) in group I and 4/47 (8.5%) in group II.Conclusion1. Anatomical landmarks in hypospadias are similar to those found in healthy individuals. 2. Marking reference points prior to incision helps to reduce the rate of meatal stenosis and fistula.     

Post-natal growth of 157 children born as extremely premature neonates

Aim: With increasing survival rate of extremely premature neonates, their long‐term outcomes including growth and risk factors for later disorders need to be considered. We prospectively evaluated anthropometric parameters in children born as extremely premature neonates. Methods: Anthropometric parameters were measured at the ages of 2 and 5 years in 72 extremely premature children born between the 22nd and 25 + 6th weeks of gestation (group I) and 85 children born between the 26th and 27 + 6th weeks of gestation (group II). Results: Although catch‐up in the postnatal growth was observed in both groups of children, resulting in growth improvement, the height of the extremely premature children at the ages of 2 and 5 years remains lower (P < 0.01) compared with the control population. A decline in head growth was observed in both groups between the ages of 2 and 5 years, resulting in decrease of standard deviation score (SDS) for head circumference (HC) in comparison with that of the control population, accompanied by an increased number of children with microcephaly, defined as HC < ?2 SD. At the age of five, microcephaly was found in 18% of children from group I and 11.7% of children from group II. At the age of 5 years, the waist and hip circumferences and ten skinfolds were not different between both groups of children. Conclusion: Long‐term follow‐up of extremely premature neonates is important not only to establish their growth patterns but also for risk factors assessment including adiposity for later development of adult‐onset diseases.