U-shaped prostatobulbar anastomosis for urethral injury after pelvic trauma

Background: We describe a technique of U‐shaped bulboprostatic anastomosis for urethral injury after pelvic trauma. Methods: Sixty‐eight male patients were included in our study. Suprapubic cystostomy was carried out initially, followed by U‐shaped prostatobulbar anastomosis after 6–12 weeks. Follow ups were carried out at 6, 12 and 18 months by assessing patient satisfaction rates along with preoperative and postoperative urethrogram, uroflowmetry and labelled as good, fair and poor. The surgical technique used was as follows: after an inverted Y‐shaped skin incision, subcutaneous tissue and Colle’s fascia was opened. Bulbospongiosum was mobilized to gain access to the stricture membranous urethra, which was excised and the bulbar urethra freed. A sound was passed through the suprapubic cystostomy and complete resection of the scar over the tip of the sound was carried out. A silicon catheter was then passed into the bladder and the anastomosis was completed in a ‘U’ shape; that is, there were no stitches from the 10 to the 2 o’clock position. Results: Good and fair results were considered as successful. Overall success rate was 97.05% immediately and after 6 months, but decreased to 95.6% at 12 months and 93.6% at 18 months. Conclusion: U‐shaped end‐to‐end prostatobulbar anastomosis markedly decreases the chance of restenosis and impotence.     

A large population-based study on the prevalence of electrocardiographic abnormalities: A result of Mashhad stroke and heart atherosclerotic disorder cohort study

Background

Twelve-lead electrocardiogram (ECG) is a common and inexpensive tool for the diagnostic workup of patients with suspected cardiovascular disease, both in clinical and epidemiological settings. The present study was designed to evaluate ECG abnormalities in Mashhad population.

Methods

ECGs were taken as part of MASHAD cohort study (phase1) and were coded according to the Minnesota coding criteria. Data were analyzed using SPSS.

Results

Total 9035 ECGs were available for final analysis including 3615 (40.0%) male and 5420 (60.0%) female. Among ECG abnormalities precordial Q wave, major T-wave abnormalities, inferior Q wave, sinus bradycardia, and left axis deviation were the most prevalent abnormalities. The frequency of precordial and inferior Q wave, inferior QS pattern, major and minor ST abnormalities, major and minor T abnormalities, Wolff-Parkinson-White and Brugada pattern, sinus bradycardia, sinus tachycardia, left axis deviation, ST elevation, and tall T wave were significantly different between two genders. Moreover, the frequency of Q wave in precordial and aVL leads, QS pattern in precordial and inferior leads, major and minor T-wave abnormalities, Wolff-Parkinson-White, atrial fibrillation, sinus bradycardia, left axis deviation, and ST elevation were significantly different in different age groups. A comparison of the heart rate, P-wave duration, and QRS duration between men and women indicated that there was a significant difference.

Conclusions

Our finding indicated that the prevalence ECG abnormalities are different between men and women and also it varied in different age groups.     

Cigarette smoking and psychiatric comorbidity in children and adolescents

OBJECTIVE: To review the current state of knowledge of psychiatric comorbidity in adolescent cigarette smokers. METHOD: assisted literature search was conducted and seminal articles were cross-referenced for comprehensiveness of the search. For each disorder, a synopsis of knowledge in adults is provided and compared with the knowledge in adolescents. RESULTS: Psychiatric comorbidity is common in adolescent cigarette smokers, especially disruptive behavior disorders (such as oppositional defiant disorder, conduct disorder, and attention-deficit/hyperactivity disorder), major depressive disorders, and drug and alcohol use disorders. Anxiety disorders are modestly associated with cigarette smoking. Both early onset (<13 years) cigarette smoking and conduct problems seem to be robust markers of increased psychopathology, including substance abuse, later in life. In spite of the high comorbidity, very few adolescents have nicotine dependence diagnosed or receive smoking cessation treatment in child and adolescent psychiatric treatment settings. CONCLUSIONS: There is increasing evidence for high rates of psychiatric comorbidity in adolescent cigarette smokers. Cigarette smoking in adolescence appears to be a strong marker of future psychopathology. Child and adolescent psychiatry treatment programs may be a good setting for prevention efforts and treatment, which should focus on both nicotine dependence and psychiatric disorders.     

Ipsilateral re-expansion pulmonary edema in a neurosurgical patient--a case report

We report a case of a 42-year-old female with right parietal glioma, scheduled for elective craniotomy and tumor excision. The patient developed pneumothorax in the postoperative period. An incidence of unilateral pulmonary edema occurring as a result of rapid re-expansion of collapsed lungs is described. This type of pulmonary edema may delay postoperative recovery and have a catastrophic course especially in neurosurgical patients.     

Further delineation of dosage-sensitive K/L mediated Xq28 duplication syndrome includes incomplete penetrance

The low copy tandem repeat area at Xq28 is prone to recurrent copy number gains, including the K/L mediated duplications of 300 kb size (herein described as the K/L mediated Xq28 duplication syndrome). We describe five families, including nine males with K/L mediated Xq28 duplications, some with regions of greater copy number variation (CNV). We summarise findings in 25 affected males reported to date. Within the five families, males were variably affected by seizures, intellectual disability, and neurological features; however, one male with a familial K/L mediated Xq28 duplication has normal intelligence, suggesting that this CNV is not 100% penetrant. Including our five families, 13 carrier females have been identified, with nine presenting phenotypically normal. Three carrier females reported mild learning difficulties, and all of them had duplications containing regions with at least four copies. Delineation of the spectrum of K/L mediated Xq28 duplication syndrome highlights GDI1 as the most likely candidate gene contributing to the phenotype. For patients identified with CNVs in this region, high-resolution microarray is required to define copy number gains and provide families with accurate information.