A comparative study to evaluate the effect of double dartos flaps in primary hypospadias repair: no fistula anymore

Purpose  

The aim of this study was to compare the complication rates of the single flap and double flaps versus flapless procedure in the tubularized incised plate urethroplasty.     

Radiographic changes in the lumbar spine in former professional football players: a comparative and matched controlled study

Heavy physical work and activity lead to degenerative changes, especially in the lumbar spine. We aimed to find out the occurence of radiographic changes (vertebral osteophytes, heights of lumbar dicsc, concavity index) and abnormalities of the lumbar spine in former professional football (association football or soccer) players according to their specialization (goalkeeper, defender, midfielder, forward) in their past professional sport life. We included 70 male former professional football players and 59 men as the control group. The football players group consisted of 15 defenders (21%), 29 midfielders (41%), 18 forwards (26%) and 8 goalkeepers (12%). Their mean professional football life was 11.04 years and the mean time period after their retirement was 13.87 years. Radiographs of both groups were taken to measure the disc height, concavity index and to determine osteophytes and abnormalities of the lumbar spine. FFbH-R score was assessed for daily activities. The mean FFbH-R score of football players was lower than that of the control group (P = 0.005). The total number of osteophytes in the player group was higher than in the control group (P = 0.001). The mean disc height of L1–L2 in football players was higher than in the control group (P = 0.045). The mean disc height of T12–L1 in goalkeepers was higher than in forward players (P = 0.019). The mean concavity index of L1 in forward players was lower than in defenders (P = 0.018). The mean disc heights of T12–L1 and L2–L3 were both higher in players whose professional sport life was >10 years than in players with ≤10 years (P = 0.018, P = 0.016). The mean disc height of L5–S1 was higher in players who had continued sport activity after retirement (P = 0.025). No statistically significant result was obtained with the rest of the variables. Playing football is heavy work. The decreased height of lumbar discs and the lower value of concavity index of forward players are because the lumbar spine of forward players is loaded more than in the rest of the players. Presented in part orally at Eurospine 2006, İstanbul, Turkey, 25–28 October 2006. Presented in part as poster at XXXVI Scientific Congress of Polish Orthopaedic and Traumatology Society, Katowice, Polland, 28–30 September 2006.     

Giant arachnoid granulation in a patient with benign intracranial hypertension (2009: 1b)

We report magnetic resonance (MR), computed tomography (CT) and angiographic imaging of an unusual giant arachnoid granulation 7(GAG) in the superior sagittal sinus in a man with headache and vertigo. Intrasinus pressure measurements revealed a significant pressure gradient across the lesion. MR imaging is useful to identify GAG and dural sinus thrombosis, whereas dural sinus pressure measurement in certain cases of GAGs can be used to evaluate the lesion as the cause of the patient’s symptoms.     

Velopharyngeal anthropometric analysis with MRI in normal subjects.

Magnetic resonance imaging (MRI) is a new method of evaluating velopharyngeal dysfunction. The anatomy of the palate and velopharyngeal closure can be visualized with MRI. Also, fast scanning with turboflash sequences allows surgeons to evaluate the speech mechanism during phonation. The dimensions of the velopharynx are another important factor in velopharyngeal closure, together with the functional performance of the soft palate during phonation. During this study, velopharyngeal anthropometric analyses were performed in cerebral MR images of 136 male and 141 female normal speakers who underwent cerebral MRI for reasons other than speech problems. Age-dependent changes in velopharyngeal dimensions were evaluated. Although the growth of the soft palate was continuous throughout life, hard palate growth ceased by age 15. By using anthropometric data available from MR images taken on normal subjects for other reasons, a large database of age-, gender-, and race-specific data on palatal and pharyngeal morphology was acquired. Comparative data of noncleft subjects in multiple age groups were obtained with MRI.     

Morgagni’s Hernia: Analysis of 21 Patients with Our Clinical Experience in Diagnosis and Treatment

A Morgagni’s hernia is a congenital defect found in the anterior aspect of the diaphragm between the costal and the sternal portions of this muscle. This defect is also referred to as the space of Larrey. It has been reported that 70% of patients with Morgagni’s hernia are female, 90% of the hernias are right-sided, and 92% of the hernias have hernia sacs. This type of hernia is a rare clinical entity and accounts for 3% of all surgically treated diaphragmatic hernias. There are no large retrospective or prospective studies on this topic. This type of hernia is a rare type among adults without a well-described prevalence and without well-established definitive management strategies. There are also few clinical reports about this clinical entity and its surgical treatment. We treated 21 patients with Morgagni’s hernia in a 12-year period, and we report our experience while discussing the surgical treatment of this disease. We performed a retrospective review of the 21 patients who were operated between 2003 and 2015. These patients had undergone surgical repair of Morgagni’s hernia. For each subject, demographic data, symptoms of presentation, physical examination findings, preoperative imaging studies and diagnosis, and surgical procedures were documented. Location of the hernia sac and its contents, postoperative complications, and duration of hospital stay were recorded and evaluated. Twelve patients were females and nine were males. The mean age of patients was 63.85 years. Dyspnea was the most prominent symptom in our patients. Morgagni’s hernias were located on the right side in 19 patients and on the left side in 2 patients. Chest X-ray in 10 patients and abdominal computerized tomography in 17 patients were the major diagnostic tools. Four patients were operated as emergency while others underwent elective surgery (17 patients). Twelve patients were operated with laparoscopy and the remaining nine were operated with the conventional open abdominal technique. Hernia sacs were observed in all of the patients and removed except in four of them. The omentum and the transverse colon were the most commonly seen organs in hernia sacs. Hernia defects were repaired with primary sutures in four patients (all open cases) and primary closure supported with mesh in six patients (four laparoscopic, two open cases). In the remaining 11 patients, hernia defects were closed with synthetic meshes (eight laparoscopic, three open cases). Mean postoperative hospital stay was 9.8 days. No recurrence was observed in any patients. Only one of our patients died during follow-up. In Morgagni’s hernias, surgical intervention is necessary as the hernia may cause complications such as strangulation of the colon or intestines. A laparoscopic approach has increased its popularity in recent years because of the well-known advantages of laparoscopy.     

Asemptomatic single coronary artery in patient with severe peripheric artery disease

This report describes a 70-year-old patient with single coronary artery, in whom the right coronary artery originated from the distal left circumflex. This patient did not have any other cardiovascular anomaly. However, this patient suffered from severe and proggressive peripheric arterial disease.     

Duplex sonography of retro-orbital and carotid arteries in patients with normal-tension glaucoma

PURPOSE: To evaluate retrobulbar and carotid arterial hemodynamics in patients with normal-tension glaucoma using Doppler sonography. MATERIALS AND METHODS: Duplex sonography was performed in 41 patients with normal-tension glaucoma and 30 control subjects to evaluate resistance indices (RIs) in retro-orbital and carotid arteries. Mean values were compared using the independent t-test. The ratios of the RI in retro-orbital to RIs in the carotid arteries (CCA and ICA) and interocular and intercarotid differences in RI (DeltaRI) were also calculated. RESULTS: Is in the central retinal (CRA) and temporal and nasal posterior ciliary arteries (TPCA and NPCA) were statistically significantly greater in glaucomatous eyes (p < 0.001). Plaque formation in carotid arteries without significant stenosis was noted in 12% of patients and 10% of control subjects. Ratios of RI of CRA or TPCA or NPCA to that of CCA and the ratios of RI of CRA or NPCA to that of ophthalmic arteries (OA) were significantly greater in glaucomatous eyes. We also found that ratios of the RI of CRA or TPCA or NPCA to that of ICA and the ratio of the RI of OA to CCA were nearly equal to 1 in both patients and control subjects. We found no significant difference between interocular and intercarotid DeltaRIs in patients and control subjects. CONCLUSIONS: In patients with symmetric normal-tension glaucoma, duplex sonography showed an elevated RI in CRA and PCA. The Doppler evaluation of carotid arteries was useful.