A true one-stage nonmicrosurgical technique for total phallic reconstruction

A new nonmicrosurgical technique for one-stage total phallic reconstruction is presented. In this procedure, an innervated anterolateral thigh (ALT) flap including the medial half of the fascia latae is combined with a sartorius perforator flap. Both flaps are elevated together as an island chimeric flap based on the lateral circumflex femoral vessels and tunneled to the recipient area. The neourethra is created with thin and hairless skin of the sartorius perforator flap, while the ALT flap is used to construct the shaft and glans of the neophallus. The rigidity was provided with a penile prosthesis covered with a neotunica albuginea created with vascularized fascia latae for the first time in the literature. The lateral femoral cutaneous nerve of the ALT flap is coapted to the pudendal nerve to provide erogenous sensibility. Here, a 15-year-old male in whom this new procedure was used for one-stage total phallic reconstruction is presented. Two years of follow-up revealed that an esthetically acceptable and functional neopenis with a nonhairy competent urethra, erogenous sensitivity, and a proper rigidity was achieved with no complication. This new technique, namely, the "Istanbul on the thigh" flap, is a one-stage, safe, and timesaving technique which fulfills all essential goals of phallic reconstruction but does not require microsurgical equipment and expertise. Moreover, the donor scar is located at an unexposed area, easy to conceal. Although more clinical experience is needed, this new procedure seems to be a useful alternative in phallic reconstruction.     

The dilemma of endometriosis: is consensus possible with an enigma?

Many will agree that the use of laparoscopy to diagnose and potientially treat endometriosis in patients who suffer from infertility has been superseded by IVF and sometimes oocyte donation, especially in older patients. The findings of our study add another dimension to management of endometriosis in the setting of infertility and emphasize the importance of keeping laparoscopy in the infertility management equation.     

Prevalence and recurrence rate of colonic lesions in acromegalic patients

Acromegaly is associated with an increased prevalence of colonic polyps. The aim of this study was to evaluate the prevalence and recurrence rate of colonic polyps in acromegalic patients. Ninety-six acromegalic patients and 100 irritable bowel syndrome patients (IBS) were enrolled in the study. Twenty patients who were cured exclusively by surgery, and 20 patients that could not be hormonally controlled were re-examined colonoscopically after 36 months. Twenty-nine of 96 acromegalic patients (30.2%) had colonic polyps. In the IBS group, 10 (10.0%) had colonic polyps. The prevalence of colonic polyps was significantly higher in acromegaly. The group of acromegalic patients with and without polyps did not differ significantly with regard to plasma GH, IGF-I, fasting insulin levels and glycemic status. The presence of colonic polyps was correlated with increased patient age and male gender. We did not observe a difference in terms of polyp recurrence frequencies in the patients cured by surgery compared to uncontrolled patients. Acromegalic patients have a higher prevalence of colonic polyps than that of control subjects. We could not identify any factors that could predict polyps within the acromegalic patients - but age and male sex.     

Prevalence of incidental thyroid cancer and its ultrasonographic features in subcentimeter thyroid nodules of patients with hyperthyroidism

In patients, who undergo surgery for hyperthyroidism, many cases of incidental thyroid cancer (ITC) have been detected. In the literature, there is no study about ITC in subcentimeter nodules in these patients. We performed this study to determine the frequency of ITC in subcentimeter nodules and ultrasonographic features that can predict malignancy in the patients with hyperthyroidism. We retrospectively reviewed our database about 3114 patients, who underwent thyroidectomy in our hospital. Among 869 patients (27.9%), who were operated because of hyperthyroidism, we enrolled 337 patients, who underwent total thyroidectomy and had subcentimeter nodule [59 Graves’ disease (GD) 98 subcentimeter nodule; 278 toxic multinodular goitre (TMNG), 359 subcentimeter nodule], in this study. Twenty-five nodules with ITC and 432 benign nodules have been detected and compared for ultrasonographic (US) features. Incidental thyroid cancer detection ratio was 5.4% [10.2% (10/98) in subcentimeter thyroid nodules in individuals with GD, and 4.1% (15/359) in individuals with TMNG, P = 0.018)]. Significant differences have been observed between the groups in terms of microcalcification in US examination of malign and benign subcentimeter thyroid nodules and the ratio of anterioposterior diameter to transverse diameter (A/T) ≥1 [(OR = 5.172; 95% CI: 1.495–17.886, P = 0.015), and (OR = 5.930; 95% CI: 1.531–22.971, P = 0.007), respectively]. We detected a higher incidence of ITC in subcentimeter thyroid nodules in GD compared to TMNG. US examination of subcentimeter nodules in hyperthyroid individuals has indicated that microcalcification and ratio of A/T ≥1 are the parameters that predict malignancy.     

Concomitant manifestation of pili annulati and alopecia areata: coincidental rather than true association

The autosomal dominantly inherited hair disorder pili annulati is characterized by alternating light and dark bands of the hair shaft. Concomitant manifestation of pili annulati with alopecia areata has been reported previously on several occasions. However, no systematic evaluation of patients manifesting both diseases has been performed. We studied the simultaneous or sequential occurrence of pili annulati and alopecia areata in individuals diagnosed in different European academic dermatology units. We included 162 Caucasian individuals from 14 extended families, comprising 76 affected and 86 unaffected family members. Statistical analysis showed that the frequency of alopecia areata among patients with pili annulati was higher than within the general population. Five of our patients with pili annulati have gone through severe episodes of alopecia areata. We cannot rule out that the currently unknown genetic defect underlying pili annulati might also confer an increased risk for the development of a more pronounced manifestation of alopecia areata. Based on the current data, and considering the low number within individual families of patients affected by both diseases, however, a direct association between pili annulati and alopecia areata seems unlikely.