Glans reconfiguration for management of glanular mutilation

IntroductionThe glans penis is prone to mutilation in a handful of conditions, some accidental and others iatrogenic. Deformed functioning remnants of the glans challenge the surgeon's decision. Neither is the glans totally amputated, justifying a neoglansplasty, nor are the remnants cosmetically acceptable, though retaining sensibility and engorgement.AimIn this work, we described the “reconfiguration of the glans penis” whereby deformed glanular tissue remnants can be made into a functional and cosmetically acceptable glans.MethodsFive patients with separate mutilated lumps of functioning glanular tissue were operated upon. The lumps were mobilized and flattened into sheets and configured to redrape the summit of the penis, minding their vascular and nerve supply.Main Outcome MeasuresCosmetic and functional outcome.ResultsThe outcome was cosmetically acceptable for all patients in comparison to the preoperative state.ConclusionGlans reconfiguration may possibly confer an acceptable cosmetic outlook to a mutilated glans without compromising valuable functional characteristics. Shaeer O, El-Sebaie A, Sherif A, El-Sadat A, and Shaeer A. Glans reconfiguration for management of glanular mutilation.     

Bilateral uterine artery ligation via minilaparotomy for heavy menstrual bleeding

Objective

To assess the safety and short-term efficacy of bilateral uterine artery ligation (UAL) via minilaparotomy for the management of heavy menstrual bleeding (HMB).

Methods

A prospective study of 30 women with HMB who underwent UAL. The primary outcome was cumulative treatment failure 12 months after the procedure. Treatment failure was defined as the need for hysterectomy during the follow-up period.

Results

At 12 months, 6 women had undergone hysterectomy for bleeding, for a cumulative failure rate of 20% (95% CI, 9%-38%). The number of bleeding days was significantly reduced by 11.9 ± 1.5 days (P < 0.001) and hemoglobin level significantly increased by 1.3 ± 0.15 g/dL (P < 0.001). Of the 30 women, 24 (80%) were satisfied with the results. No major complications were reported during the procedure or median follow-up period of 13.2 months.

Conclusion

Bilateral UAL is a safe and effective minimally invasive procedure that can provide an alternative treatment for HMB.     

Higher hydroxyurea adherence among young adults with sickle cell disease compared to children and adolescents

BackgroundSickle cell disease (SCD) results in severe complications, such as anaemia and pain episodes. Hydroxyurea (HU) is efficacious in SCD, yet adherence remains low.ObjectiveTo assess the relationship of HU adherence to health care utilization and patients’ characteristics.MethodsThis is a 5-year retrospective chart review. Patients’ demographics and medical history were collected from the electronic medical record (EMR). HU adherence was evaluated using foetal haemoglobin “HbF%”, mean corpuscular volume “MCV”, and absolute neutrophil count “ANC”. Age groups included children (<12 years), adolescents (12–17 years), and young adults (≥18 years).ResultsA total of 113 SCD patients on HU were included (median age 14 years, IQR 10–20; 50% female; 88% HbSS). Young adults had significantly higher HU adherence compared to adolescents and children, including higher median HbF% (24.2 vs. 12.4 vs. 8.6, p = .003), MCV (fl) (106.4 vs. 96.2 vs. 95.4, p = .01) and lower ANC (10³/ml) (3.25 vs. 4.9 vs. 4.2, p = .01), respectively. Patients with chronic pain had lower HU adherence (HbF% 15.3 vs. 10.7, p = .04; ANC 3.6 vs. 6.3, p = .002; MCV 102.3 vs. 93.1, p = .1). Patients with higher HbF or MCV and lower ANC had significantly less frequent emergency room visits (r_s=–0.26, p = .01; r_s=–0.23, p = .01; r_s=0.24, p = .01) and hospitalizations (r_s=–0.27, p = .01; r_s=–0.31, p = .01; r_s=0.21, p = .02) as well as shorter length of stays (r_s=–0.27, p = .0045; r_s=–.34, p = 0.004; r_s=0.23, p = .02), respectively. Similar trends in HU adherence and health care utilization were seen in subgroup analysis of only HbSS patients. There was no significant association of HU adherence to patients’ sex, socio-economic status, distance from hospital, and HU duration.ConclusionsYoung adults with SCD had significantly higher HU adherence compared to children and adolescents. Patients with lower HU adherence and/or chronic pain had increased health care utilization. Future studies examining barriers to adherence and evaluating interventions to optimize HU adherence in SCD are warranted.

KEY MESSAGES

1. Young adults with SCD had significantly higher HU adherence, as reflected in their laboratory markers, compared to children and adolescents.
2. Patients with higher HU adherence and/or those without chronic pain had lower or less frequent health care utilization.
3. No significant association of HU adherence to patients’ sex, socio-economic status and distance from hospital.

     

Overdrive pacing for endovascular repair of an aortic arch aneurysm

The endovascular treatment of aortic arch aneurysms is a relatively new technique and is associated with significant surgical and anesthetic challenges. We report a case of a 77-year-old patient with an aortic arch aneurysm at the level of the isthmus, measuring 4.9 × 6.5 cm. The aneurysm involved the origin of the left subclavian and vertebral arteries. The arch was of the bovine type and the left vertebral artery came directly off the aorta. The patient underwent an uneventful open left carotid-to-subclavian bypass several days before the aortic repair. During the endovascular surgery, a stent-graft was deployed just distal to the innominate trunk. Endoleak was noted at the inferior aspect of the stent-graft, which failed to seal with placement of an extension stent-graft. The surgeon then chose to employ a Palmaz stent, to seal the endoleak. Balloon expansion in the ascending aorta was required in order to properly seat the Palmaz stent. Overdrive pacing at a rate of 220 beats·min^?1, which lowered the systolic blood pressure (SBP) to 40s mmHg was used during this process after connecting the patient to a Zoll defibrillator with external pads. The Palmaz stent was successfully deployed at the proximal end of the previously deployed stent-graft, using a Tyshak balloon. The patient reverted to normal sinus rhythm with no evidence of ischemia at the conclusion of the overdrive pacing. No endoleak was appreciated after the Palmaz stent was placed.     

Utility of the Guy’s Stone Score in predicting different aspects of percutaneous nephrolithotomy

Objective

To evaluate Guy’s scoring system (GSS) as a grading system for complexity of kidney stone before percutaneous nephrolithotomy (PCNL) as a predictor for different items of outcome.

Vascular injuries: experience during the Afghanistan War.

This is a prospective study done over an 18-month period in three base evacuation hospitals serving the Afghan refugees in Pakistan. Out of 224 patients, 78 had major and 146 had minor arterial injuries. Late presentation was a common finding. Mine explosions ranked first as a causative agent. This explains the high incidence of lower limb affections and minor vascular injuries. In the major arterial injury group, the superficial femoral artery was the commonest injured (33.4%), followed by the brachial (28.2%). Associated major venous injury occurred in 41% of cases while 25.6% had a compound fracture of the nearby bone. All subclavian and axillary artery injury patients had concomitant brachial plexus injury. Arterial repair was done in 73 patients (93.6%) and ligation in 5. The importance of venous repair was emphasised; venous ligation was done in 6 patients only (19.4%). Repeated extensive debridement was done in 4 patients and useful limbs were left. This is believed to be a good alternative for selected cases with extensive muscle laceration. 3 patients died in the early post-operative period and 3 needed amputation (4%). Other complications were graft sloughing (1.3%) thrombosis (6%) and stenosis (9%). Only 56.9% of patients were followed up for 3-6 months.     

Implication of tumor necrosis factor alpha receptor 1 and hexosaminidase: relationship to pathogenesis of liver diseases

Liver disease is the main cause of morbidity and mortality worldwide. The spectrum of the disease ranged from fatty liver to hepatic inflammation, necrosis, progressive fibrosis, and hepatocellular carcinoma. We evaluated the serum levels of soluble tumor necrosis factor alpha receptor 1, total B-hexosaminidase and its isoenzymes Hex A and B activities, and nitric oxide in patients with liver diseases and their association with aminotransferase level. Seventy patients and 12 healthy subjects were recruited. Patients were divided into three groups: chronic hepatitis group (20 patients), liver cirrhosis group (30 patients), and malignant liver group (20 patients). Serum levels of soluble tumor necrosis factor alpha receptor 1, total B-hexosaminidase and its isoenzymes Hex A and B activities, and nitric oxide were measured. Serum levels of soluble tumor necrosis factor alpha receptor 1, total B-hexosaminidase activity, and nitric oxide were significantly higher in the liver disease patients. Serum levels of isoenzymes Hex A and B were significantly higher in malignant liver patients. Total B-hexosaminidase and its isoenzyme Hex A activity levels were significantly higher in positive HBsAg and positive anti-HCV patients. Serum levels of soluble tumor necrosis factor alpha receptor 1 were positively correlated with aminotransferase level. Taken together, these findings suggested that these biochemical indices might reflect ongoing disease activity and played an important role in the pathophysiology of liver diseases.