[Oral mucosa for hypospadias repair: a report of 19 cases].

OBJECTIVE: To investigate the indications and clinical effect of using oral mucosa as the graft in hypospadias repair. METHODS: We performed hypospadias repair using oral mucosa for 19 patients, 10 with the urethral opening at the root of the penis, 7 at the scrotum and 2 at the perineum. Of these patients, 8 had received urethroplasty once, and 6 twice, unsuccessfully, and 7 of them were complicated by penile chordee. The lower lip mucosa was used as the graft for 14 cases, and the buccal mucosa for the other 5. Fifteen cases received autologous oral mucosa onlay for repair, with the new urethra covered by the dartos coat of the dorsal skin. For the other 4 cases, whose urethral plates had been damaged in the previous operations, oral mucosa strips were used to substitute the urethral plates to get the penis straightened, followed by urethroplasty 6 months later. RESULTS: Of the 19 patients, 17 (89.5%) achieved satisfactory results, with a desirable shape of the penis and a vertical slit-like meatus at the tip of the glans. Chordee was corrected in all the patients. No urethral stricture was found during the 3 - 18 months follow-up. Urethral fistula occurred in 2 cases because of infection, but cured by surgical repair 6 months later. CONCLUSION: Using oral mucosa as the graft is an effective surgical option for hypospadias repair.

How well can an idiotope peptide mimic replace its parent idiotype in a synthetic peptide vaccine?

PURPOSE: To determine whether a vaccine consisting of an idiotope peptide mimic of the third complementarity-determining region of the immunoglobulin heavy chain (CDR-H3) is an effective substitute for its parent idiotype. Such peptide vaccines could ultimately be used for targeting pathological B lymphocytes. METHODS: Hen egg lysozyme (HEL) conjugates of the Fab' fragment of monoclonal anti-fluorescein antibody 9-40 (Fab'-HEL) or a peptide mimic of the 9-40 CDR-H3 (referred to as the "B epitope" or "Bep," the conjugate is referred to as "Bep-HEL") were injected into separate cohorts of B10.A mice. Two additional control cohorts were injected with either the Bep peptide alone or a noncovalent mixture of Bep and HEL. Sera were assayed for both anti-idiotope and anti-idiotype activity by enzyme-linked immunosorbant assay (ELISA). Primary, secondary, and tertiary immune responses were examined. RESULTS: Both the Bep-HEL idiotope and the Fab-HEL idiotype immunogens elicited homologous, allogenic immune responses. No cross-reactivity was observed between anti-idiotope and anti-idiotype responses after primary immunization. With secondary immunization, 50% of mice immunized with the Bep-HEL conjugate exhibited a cross-reactive anti-idiotype response. Conversely, 100% of mice immunized with the Fab'-HEL conjugate exhibited a marginal, but statistically significant cross-reactive anti-idiotope response. Upon tertiary immunization, 100% of mice immunized with Bep-HEL exhibited a cross-reactive anti-idiotype response, and 55.6% of mice immunized with the Fab'-HEL conjugate exhibited a cross-reactive anti-idiotope response. CONCLUSIONS: Covalent coupling of a xenogenic carrier protein to an idiotype immunogen or its peptide mimic significantly enhances the intensity of homologous, allogenic anti-idiotype or anti-idiotope immune responses. Multiple immunizations are necessary to induce cross-reactivity between the peptide mimic and its parent idiotype.