Rotational profile of the lower extremity and foot progression angle: computerized tomographic examination of 50 male adults

Acetabular, femoral and tibial torsion of 50 normal adult male subjects were measured by computerized tomography and the relationship between these angles and foot-progression angle was examined. The mean acetabular anteversion was 15.6° on the right and 15.8° on the left, (range 3°–30°). The mean femoral torsion was 6.5° on the right and 5.8°on the left (range 14°–28°). The mean tibiofibular torsion was 30.9° on the right and 29.1° on the left (range 16°–50°). Although the normal range of torsional measurements of the lower extremity was very broad, subjects usually had out-toeing with a mean foot-progression angle of 13.7° on the right and 13.0° on the left (range 6°–21°). No correlation was detected on the rotation between different levels of the lower limb. No difference was detected in the lower extremity rotational profile between right and left sides. Received: 29 June 1999     

Anatomical studies of the urethral plate: why preservation of the urethral plate is important in hypospadias repair

OBJECTIVE: To describe the detailed anatomy of the urethral plate in relation to its controversial role in hypospadias surgery. MATERIALS AND METHODS: A newborn penis with proximal penile hypospadias and two fetal penises with distal shaft hypospadias were included in the study; 30 normal fetal penises served as the control. Specimens were embedded in paraffin and serially sectioned (6 microm) after formalin fixation. Every 10th section was stained with haematoxylin and eosin. Immunohistochemical staining for nerves (S100), smooth muscles (alpha-actin), blood vessels (factor VIII) and epithelium (cytokeratins 7, 14 and 18) were used on selected sections, with particular attention to the urethral plate. Masson's trichrome and Sirius Red stains were used to localize collagen. RESULTS: There were extensive blood vessels, glands and smooth muscle under the urethral plate in the hypospadias specimens. These relatively well organized tissues corresponded to an abnormally formed corpus spongiosum. The glands underneath the urethral plate and adjacent to the normal urethra showed positive staining for cytokeratins 7 and 18, respectively (markers of endodermal origin) but were negative for cytokeratin 14 (a marker of ectodermal origin). Penile skin and urethral plate epithelium stained positively for cytokeratin 14 but not for cytokeratin 7 and 18. The urethral plate has a rich nerve supply, as determined by S100 staining. Collagen intensity under the urethral plate was no different from that in normal areas. Tunica albuginea stained intensely for type I and III collagen. CONCLUSION: These results show that the urethral plate is well vascularized, has a rich nerve supply and an extensive muscular and connective tissue backing. These features may explain the lower complication rate with onlay flaps than with tube flaps. Therefore, from these anatomical findings, we continue to advocate preservation of the urethral plate and the onlay island flap for hypospadias reconstruction.     

Isolated preauricular pits and tags: is it necessary to investigate renal abnormalities and hearing impairment?

We investigated the incidence and co-existence of hearing impairment and renal abnormalities in healthy children with preauricular tags and pits. Study population consists of 13,740 primary school children from routine health check. Thirty-five children with preauricular tags and pits were noted. Control group consisted of 91 patients without pits and tags, who underwent renal ultrasound and were scheduled to pediatric outpatient clinic. Urinalysis, renal ultrasound, otoacoustic emission were performed in both the groups. The prevalence of renal abnormality (1/36; 2.7%) and hearing impairment (1/36; 2.7%) in patients with preauricular tags and pits was similar to that of control group (3/91; 3.2% and 4/91; 4.3%) (P = 0.87, P = 0.64, respectively). According to our results, it is not necessary to investigate hearing or urinary abnormality in patients with preauricular tag or pit, unless there is an association of a syndrome or family history of hearing or renal impairment.     

An unusual auricular malformation accompanied by accessory tragus: macrotragus

Definition of malformations of the tragus is important for terminology and treatment. Most common entities are the skin tag, accessory tragus, preauricular sinus, and cyst, whereas macrotragus is an uncommon and unaddressed deformity that should be distinguished from these. In this report, three cases with diagnosis of the macrotragus are presented. The tragus was uniformly large and displaced anteriorly, and external auditory meatus was not obliterated in all cases. For correction, excision of the excess tragal cartilage and skin was performed. In all cases, bilaterally symmetric tragus was achieved. There were no complications in the early postoperative period and there was no enlargement after 6 months of observation. Macrotragus and accessory tragus are different entities that should be distinguished for accurate diagnosis. They have similar histopathological but distinct anatomical characteristics. Although both are treated by a simple excision, in the case of macrotragus, special effort should be taken to leave enough cartilage to restore normal tragal contours. Presented at the 5th Congress of the Balkan Association for Plastic, Reconstructive Aesthetic Surgery, Kuşadası, Turkey, May 22–26, 2007.     

A case against elective nephron sparing surgery for renal cell carcinoma

A 62-year old man who incidentally was discovered to have a mass lesion in the lower pole of the left kidney underwent left radical nephrectomy. The mass was 32 millimetres in its largest diameter. Although the left adrenal gland was radiologically and macroscopically normal, histopathological examination revealed microscopic foci of metastasis. The present case urges us to be more cautious in offering partial nephrectomy for left sided tumours even though it is incidentally detected and small.     

Pericardial involvement in familial Mediterranean fever

Two patients with familial Mediterranean fever showed the classic features of pericardial involvement and one of them (Case 2) had pericardial effusion detected by echocardiography. These and previously published cases show that familial Mediterranean fever should be considered as a cause of pericarditis and/or pericardial effusion.     

Determination of apoptosis through Bax expression in cryptorchid testis: an experimental study

The aim was to determine the expression of Bax in germ cells of rats with unilateral experimental cryptorchidism, and to evaluate the role of apoptosis in germ cell loss. Twenty-one prepubertal rats were randomly subdivided into three groups after the execution of the left cryptorchidism model. Group 1 (n=8), group 2 (n=6) and group 3 (n=7) rats were killed at the end of the first, second and third month, respectively. Bax expression was assessed in Sertoli cells, spermatogonia and spermatocytes by immunohistochemistry. Percentages of Bax expression in spermatocytes and spermatogonia were decreased in the left testicles in the 2^nd and 3^rd months compared to results obtained in the 1^st month (p<0.05). Percentage of Bax expression in the left testicles of group 1, at the level of both spermatogonia and spermatocytes was higher than that in the right one (p<0.05). However, in groups 2 and 3, the higher Bax expression on the left side was only seen in the spermatocytes (p<0.05). In all groups, the mean weight of the left testicle was lower than that of the scrotal counterpart where the difference was significant only in groups 1 and 3 (p<0.05). The weight of the left and right testicles was increasing with time. In this model of cryptorchidism, the affected testis had a decreased weight compared to the normal one. Based on the increased Bax expression, we think that apoptosis may play a role in the germ cell loss.     

Use of continuous horizontal mattress suture techniques in microsurgery: an experimental study in rats

PURPOSE: The purpose of this study was to determine whether the continuous horizontal mattress suture technique can replace the continuous simple suture technique and to compare the results with other microvascular suture procedures. METHODS: Sixty-four femoral arteries of 32 Sprague-Dawley rats were used in this study. The animals were divided equally into 4 groups with 16 anastomoses in each group. The arteries (0.8-1.0 mm diameter) were anastomosed by using the continuous horizontal mattress suture technique in group I, interrupted horizontal mattress suture technique in group II, simple interrupted suture technique in group III, and simple continuous suture technique in group IV. At the end of the anastomosis time, leakage, and patency were assessed and graded in all groups. On the 14th day after surgery the rats were killed and 5 patent specimens from each group were examined under light microscopy for histology. One specimen from each group was prepared for scanning of the endothelial surface under electron scanning microscopy. RESULTS: Group I anastomoses were performed the most quickly. Groups I and III anastomoses had 100% patency rates. Under light microscopy the edge eversion was apparent consistently and under electron microscopy all endothelial surfaces were intact and no suture material was seen in groups I and II. In group III some suture material was covered by endothelial cells and lumen surfaces were torn; endothelization also was rough compared with groups I and II. In group IV suture material was seen in the lumen because of a loose suture knot. The endothelium also was not regular. CONCLUSIONS: The horizontal mattress suturing technique is the only technique in which the suture material never contacts the lumen. Continuous horizontal mattress suture technique is superior to the other microvascular procedures and is the safest and fastest procedure for microvascular anastomosis in rats.     

Staged Abdominal Repair for Treatment of Moderate to Severe Secondary Peritonitis

The aim of this study was to evaluate the effects of planned relaparotomy and to assess factors that may contribute to mortality in patients with moderate to severe secondary peritonitis. A total of 36 consecutive patients with an Acute Physiologic and Clinical Health Evaluation (APACHE) II score of >10 were enrolled the study for a 2-year period. The mean age of the patients was 56 years (17-92 years), and 23% of them were male. One-third of them had postoperative peritonitis; 152 scheduled operations were done, and the overall mortality rate was 36%. For patients whose septic source was in the upper gastrointestinal system, control of the source was more difficult (p = 0.004). Overall, 28 complications developed in 61% of the patients. Initial and second-day APACHE II scores were 14.5 (11-27) and 12.0 (9-25), respectively. The initial APACHE II score of survivors was lower than that of nonsurvivors [p = 0.0001, 95% confidence interval (CI) -9.5, -3.6]. Second-day APACHE II scores were not different (p = 0.19; 95% CI -3.79, 0.80). Striking end or lateral duodenal leaks were clearly associated with high mortality. It is found that the initial APACHE II score, the success of controlling the source, the occurrence of complications, and the type of illness are independent factors that may affect mortality. We concluded that staged abdominal repair should be used with caution in the treatment of lateral or end duodenal leaks. It is a good alternative to conventional laparotomy for moderate to severe forms of secondary peritonitis from other sources.The preliminary data of this study were presented at the Turkish Surgical Congress in Antalya, Turkey in 2002.     

Risk of developing fibroadenoma with the use of cyclosporine A in renal transplant recipients

To investigate the effect of cyclosporine A (Cyc A) on the development of fibroadenomas, 30 renal transplant patients and 20 chronic renal failure patients on dialysis were breast examined with ultrasonography and/or mammography. Of the renal transplant patients, 17 were receiving Cyc A-based combination therapy for immunosuppression. All patients were female with the age range of 29.7+/-9.2 years in the transplant group and 33.95+/-9.91 in the dialysis group. Eight of the 17 patients receiving Cyc A had fibroadenomas, 5 of them having bilateral lesions. None of the other patients, those on dialysis and on non-Cyc A combination therapy had fibroadenomas. A significant difference for fibroadenoma incidence in patients receiving Cyc A combination immunosuppression was found.