Belt-Fuqua operation for penile hypospadias repair

Between 1983 and 1993, 41 patients underwent a first-stage Belt-Fuqua operation for penile hypospadias repair and 39 completed the second stage. Minor complications were observed after the first stage. The primary success rate following the second stage was 82%. Major complications noted after the second stage consisted mainly of fistula formation. The surgical technique is described and alternative methods are discussed.     

Intrapulmonary gas mixing and dead space in artificially ventilated dogs

In this study we have investigated the effects of breath holding and of the physical properties of gases on four different respiratory dead spaces (V _D): the Fowler, the physiological, the washout and the inert gas dead space. The experiments were performed with dogs which were ventilated artifically with breathing patterns with different post-inspiratory breath holding times (t _a) of 0, 0.5, 1.0 and 2.0 s. Tracer amounts of acetone, ether and enflurane were infused continuously into a peripheral vein and a bolus of a mixture of krypton, Freon12 and SF₆ was introduced into the peritoneal cavity. After reaching steady state, samples of arterial blood, mixed venous blood and mixed expired air were taken simultaneously. From the partial pressures (P _a, P _¯V and P respectively) we determined the excretion (=P/P_¯V), retention (R=P_a/P_¯V) and the physiological dead space fraction (V _D,phys/V _T=(1 P/P_a) for each gas, where V _T is tidal volume. Further, we recorded the expirograms of the six tracer gases and of CO₂ from which the Fowler dead space fractions (V _D,Fowler/V _T) of the different gases were determined. Also the washout dead space fractions (V _D,washout/V _T) for He and SF₆ were determined as well as the inert gas dead space fraction (V _D,MIGET/V _T) with the use of the multiple inert gas elimination technique (MIGET).With the exception of V _D,phys/V _T for SF₆, all dead space fractions decreased with increasing t _a. V _D,phys/V _T for the poorly soluble gas SF₆ was considerably larger than V _D,phys/V _T for the remaining gases. For the highly soluble acetone V _Fowler/V _T was considerably smaller than V _D,Fowler/V _T for the other gases. V _{D,washout,SF6}/V _T was always larger than V _D,washout,He/V _T and V _D,Fowler,SF6/V _T. Further, V _D,phys/V _T was larger than V _D,Fowler/V _T for SF₆ and acetone. However, for gases with intermediate solubility in blood V _D,phys/V _T tended to be smaller than V _D,Fowler/V _T. We conclude that the respiratory dead spaces are affected by the breathing pattern and by the physical properties of gases, i.e. their diffusivity in alveolar gas and their solubility in blood or lung tissue.     

Laparoscopic bipolar strip-tease appendicectomy

Since its conception, several techniques have been described for laparoscopic appendicectomy. We describe a technique which utilizes a 5-mm bipolar forceps designed to coagulate and cut tissues at the same time; 50 pediatric patients underwent laparoscopic appendicectomy for acute appendicitis using this stripping and teasing technique. No bleeding complications occurred. There were only two postoperative abscesses in the series. We believe that the bipolar laparoscopic striptease appendicectomy technique as developed by the senior author is safe, quick, and effective, even for severe appendicitis.     

Mega-Liposuction: Analysis of 1520 Patients

Fifteen hundred and twenty cases of liposuction/liposculpture were performed at Dr. M. Erfan & Bagedo Hospitals and King Abdulaziz University Hospital in Jeddah from January 1983 to December 1994. These cases were mostly females. The age group was from 16–65 years. Multiple procedures were performed in 11.68% of these cases. The change in hemoglobin and the hematocrit ratio pre- and post-operatively, and the incidence of complications, were studied. The percentage of surface area operated upon rather than the amount of fat removed was the most important relevant factor.     

Comparison of ultrasound transmission velocity with computed metacarpal radiogrammetry and dual-photon absorptiometry

The aim of our study was to evaluate the validity of a quantitative US technique for measuring the bone density of the proximal phalanges of the nondominant hand compared with computed metacarpal radiogrammetry and dual-photon absorptiometry (DPA) of the lumbar spine. Mean US bone velocity (UBV) correlated with mean metacarpal cortical index (MCI), with mean metacarpal bone density (MBD) and with bone mineral density (BMD) of the lumbar spine, whereas it was correlated negatively with age and menopause duration. The average UBV was significantly higher in premenopausal women than in postmenopausal women, and higher in normal lumbar DPA patients than in reduced lumbar DPA patients. We conclude that the US evaluation of the nondominant hand proximal phalanges may be a new alternative way for measuring bone mass in screening of osteoporosis. Correspondence to: A. Sili Scavalli     

Therapeutic Megalipoextraction or Megaliposculpture

Background: For a long time, surgeons hesitated to extract more than 2.5 liters of adipose tissue from a patient. Through the years, liposuction has advanced, now allowing megaliposculptures to be performed so that more than 10 liters can be extracted without posing any greater risk to the patient than a conventional esthetic liposculpture. Methods: This article traces the progressive evolution of the technique, discussing complications and the concept of megaliposculpturing. Results: The syringe-assisted extraction of large quantities of adipose tissue without transfusion, hypovolemic shock, or any major complication opens new horizons in the symptomatic treatment of certain types of osteoarthritis of the lower extremities and the potential complications of obesity. Conclusions: Large quantities of adipose tissue may safely, quickly and efficiently be extracted. Numerous investigations in various pathological domains can now begin after this first step (megalipotherapy). Therapeutic megalipoextraction can be done either as a preliminary indication or as a treatment of the residual adiposities that occur after bariatric operations.     

Spatio-temporal progression of the AEP P300 component using the cortical imaging technique

Summary The cortical imaging technique (CIT), a mathematical method for simulating the potential fields on the surface of the brain, was used to analyze the spatio-temporal progression of the AEP P300 component (as well as the preceding and subsequent N2a and N3 components) from thirty normal adult subjects recorded in a standard oddball paradigm. Comparisons were made between the progressions of the endogenous event-related cognitive potentials and the exogenous stimulus-dependent potentials (Nl component). Cortical imaging results suggest that different and multiple generator sites are involved in the production of exogenous and endogenous evoked responses. We particularly note the asymmetric development of the P300 component and the apparent anterior generator sites for the N2a component. This last result is interesting because the N2a precedes the P300 component and supports an earlier frontal contribution.     

Intra-anal intussusception: diagnosis by posteroanterior stress proctography

Intra-anal intussusception was diagnosed in eight of 39 patients on evacuation proctography. Posteroanterior views revealed prolapse of the infolded rectum into the anal canal on straining in seven of eight patients, associated with splaying open of the anal canal and sudden distal movement of the fold during prolapse. Similar changes were seen in four of 31 patients in whom intussusception had not been diagnosed on lateral evacuation proctography. The pattern of the collapsed rectum was assessed for fold length, thickness, and angulation in relation to the midline of the rectum. Infoldings that prolapsed were closer to the anorectal junction on stress (mean 14.6 42.4 mm, p < 0.0001) showed greater change in height between rest and strain (28.8 14.6 mm, p < 0.05) and became more acutely angled during straining (41.9 5.3°, p < 0.01). Intra-anal intussusception may be missed in 33% (four of 12 patients) on routine evacuation proctography. Posteroanterior stress proctography is a simple supplementary examination to validate intussusception.