Comparison of early neonatal valve ablation with vesicostomy in patient with posterior urethral valve.

BACKGROUND: To compare the results of final renal function by two methods of treatment in patients diagnosed as posterior urethral valve (PUV) (valve ablation vs. vesicostomy). MATERIALS AND METHODS: Fifty-four boys diagnosed with PUV participated in this study. They were divided into top two groups. Thirty-one of the total were treated with primary valve fulguration (Group 1) and 23 were treated with vesicostomy (Group 2). One-year-creatinine level and glomerular filtration rate (GFR) were measured. Also, they were taken ultrasonography detecting hydronephrosis. Data analysed in IBM SPSS21 with t-test and Chi-square test. Presented with 95% of confidence intervals. RESULTS: Fifty-four boys diagnosed with PUV participated in this study. The mean age of patients in Group 1 was 3.8 ± 1.48 days and Group 2 was 4.7 ± 1.85 days. One-year Cr level was 1.57 ± 1.45 in Group 1 and 1.57 ± 1.45 in Group 2 which was not statistically significant (P < 0.8). Also 1-year GFR level was 31.1 ± 4.4 in Group 1 and 33 ± 4.7% in Group 2 (P < 0.10/23) in Group 2 (43.47%) had severe hydronephrosis and 14/31 (45.16%) in Group 1 had severe hydronephrosis. Graded ultrasound results were not significantly different (P = 0.24). CONCLUSION: The results showed no significant difference. Vesicostomy might be a more favourable method due to less complication and follow-up in early neonatal life. Hence, the condition of the patients and decision of the surgeon are effective parameters in choosing an optimal method in patients diagnosed with PUV.

Socio-demographic Characteristics of Transsexuals Referred to the Forensic Medicine Center in Southwest of Iran.

BACKGROUND: Transsexualism or gender identity disorder affects person's gender identity. AIM: This study was to describe socio-demographic characteristics in a population of transsexuals. MATERIALS AND METHODS: We studied 44 persons of both sexes with diagnostic criteria of gender identity disorder who were referred to the Legal Medicine Organization of Fars, southwest of Iran during the time period 2005-2010. The general practitioners examined the following socio-demographic characteristics and then recorded them in a semi-structured questionnaire, which was developed by the Forensic Medicine Center in Shiraz: Sex, age, educational level, place of residence, marital status, duration of treatment, and employment status. RESULTS: A total of 44 persons (18 (40.9%) males versus 26 (59.1%) females) were referred for sex change during the study period. The sex ratio was 0.69:1. The mean age was 27.6 ± 2.9 years. The majority of patients were diploma and higher diploma education (77.3%), lived in urban areas (81.8%), were employed (56.9%), were single (93.1%), and were under six months of hormonal treatment (61.4%). CONCLUSIONS: It seems that social acceptance is lower for male to female transsexuals, since these patients have lower employment and literacy statuses. Further studies should be designed to evaluate and deeper analyze more socio-demographic, clinical, and psychiatric variables about transsexual patients.

Allele frequencies for 15 autosomal STR loci in Fars province population, southwest of Iran.

Allele frequency data at 15 short tandem repeat loci, D8S1179, D21S11, D7S820, CSF1PO, D3S1358, THO1, D13S317, D16S539, D2S1338, D19S433, VWA, TPOX, D18S51, D5S818 and FGA have been determined for unrelated individuals in a population sample of Iranian Fars individuals. With exception of the D13S317 (P-value=0.0458) and TPOX (P-value=0.0477), no deviation from HWE were found in the study population using the exact test. The most discriminating loci were FGA (PD=0.965) and D2S1338 (PD=0.964). These data can be used for estimating the frequency of short tandem repeat profiles in a population of Fars province individuals.

Role of bulking agents in bladder exstrophy-epispadias complexes.

BACKGROUND: Role of pelvic osteotomy in surgical management of bladder exstrophy is controversial But pelvic rim closure importantly. Bulking agents have been used for perineal and pelvic dysfunction in adults. In this study, bladder extrophy repair was performed without pubic closure And bulking agent injections were used as the strut of anterior pelvis for prevention of Organ prolapse and other functions in this series. PATIENTS AND METHODS: During the period 2008-2012, twenty-five exstrophy-epispadias complex patients with a mean age of 14 months underwent surgical reconstruction. Rectus abdominis muscle was detached from the superior pubis and sutured to each other in the midline and Re-anchored at the pubis and 8-9 month later urethra was constructed and placed between perineal muscles. Bladder neck repair and ntersyphyseal reconstruction was done with bulking agents one year after primary bladder closure when in our series bladder prolapse mainly occurred. One to 4 mL of bulking agents polyacrylate (vantris/promedon) was injected at the level of the intersymphyseal area and opening on either sides of the urethra. RESULTS: Mean urinary continence score, before, 3 and 6 months after injection Were (2.65 ± 074),(1.95 ± 082),(1.75 ± 0.78), respectively.(p < 0.001). The correlation factor Between before injection, 3 and 6 months were % 82, % 74 respectively. Mean capacity of bladder before, 3, 6 months after injection were (31 ± 14.01), (41 ± 12.81), (56 ± 11.98) mml, respectively. The correlation factor before and after injection were 59%. Comparing the CS and CB between male and female before and after injection were significant. (p < 0.001) but correlation factor in male 99% and Female 74%. Three out of five girls had improved bladder prolapse. There was no complication, infection or migration of bulking agents. Patients had increased in soft tissue according to MRI. CONCLUSION: Using bulking agents is a good alternative to sling pelvic floor not only cosmetically but also for ease of patients and operation.

First Report of Pharyngostomy Wound Myiasis Caused by Chrysomya bezziana (Diptera: Calliphoridae) in Iran.

Wound or traumatic Myiasis is the infestation of animal and human orifices or wounds by dipterous larvae. It is more common in tropical and sub-tropical countries. Chrysomya bezziana is a major agent of wound myiasis throughout the tropical regions of the Old World. In Iran many cases of human myiasis due to C. bezziana were reported from south and south-east of country. This study reports a case of wound myiasis in a 3-year-old pharyngostomized girl who referred to the Pediatric Hospital in Bandar Abbas for pharyngological follow-up. During the examination, several live and mobile larvae were removed from the lesion. The patient received antibiotics and then transferred to pediatric ward for respiratory care. The specimens were identified as C. bezziana according to the morphological characters of fully grown larvae. This is the first report of the pharyngostomy wound myiasis caused by C. bezziana in Iran. This finding also confirms the results of previous studies indicating the occurrence of the Old World screwworm fly, C. bezziana as a causative agent of human myiasis in the south of Iran.

Cyanoacrylate glue dressing for hypospadias surgery.

BACKGROUND: Hypospadias repair is a common pediatric operation. Several kinds of dressings are currently available, with their benefits and side effects. AIM: The aim of our study was to introduce a new method of dressing, by pouring several layers of cyanoacrylate (CA) glue as the dressing, in hypospadias surgery. MATERIALS AND METHODS: Twenty out of the 61 patients with hypospadias, with a mean age of 13.5 months, were enrolled in this study. Forty-one had conventional dressing (pressure wrap dressing), while CA glue was used in 20 patients. CA glue was applied around the penis and its base four times and each time it took one minute to dry. All patients were followed postoperatively for two weeks and six to twelve months, for early and late complications, respectively. RESULTS: One out of 20 developed wound hematoma, one had skin necrosis with infection, and edema was present in all. All these were easily diagnosed and managed rapidly. In the group treated with conventional methods, there were five infections, seven hematomas, all the patients in the group had edema and painful removal of the dressing, and 10 needed repeat dressing. CONCLUSIONS: CA glue is impermeable to urine and stool, and prevents edema and hematoma. Used in several layers, it is a good alternative dressing in hypospadias surgery.

The application of a new cyanoacrylate glue in pediatric surgery for fistula closure.

Surgical glues have been used in pediatric surgery because of the fragility of tissue, and to prevent major surgeries. The present report describes our experience with using a new cyanoacrylate Glubran 2 (Viareggio, Italy) in the treatment of five cases of tracheoesophageal atresia with fistula (one fistula protection, three recurrent fistula, and one unstable patients), two cases of hypospadias, one case of vesicutanouse fistula after bladder extrophy, and one case of cloacal extrophy from January-December 2008. Three cases of recurrent tracheoesophageal atresia with fistula were treated by bronchoscpic glue injection. The other two cases benefited from glue through its ability to plug the fistula and to act as a protecting layer on anastomosis. In two cases with hypospadias excessive use of the glue caused skin necrosis, which was repaired. The wounds of cloacal extrophy were protected from nearby colostomy contamination and infection, and the vesicocutanouse fistula was closed by deepithelialization and sealing with glue. Based on the outcomes of the cases, it may be possible to suggest that Glubran 2 may be used safely in Pediatric Surgery as a sealant for the prevention and treatment of fistulas.

Using inverted autogenous veins to substitute arteries in a canine model.

AIMS: Rapid harvesting of autogenous graft over a wire is an optional way in trauma surgery and it places the inverted conduit so that its adventitial layer is within the lumen of the graft. Our aim of this study was to compare the patency of inverted autogenous graft vs noninverted graft in dogs. SETTINGS AND DESIGN: Experimental animal models. MATERIALS AND METHODS: In this experimental study, 12 dogs were anesthetized and 10 cm of the external jugular vein was excised. The vein was equally divided into two 5-cm sections. One section was inverted and the other was left intact. Afterward, 5 cm of both the femoral arteries were removed and the right (inverted) and the left (not inverted) arteries were grafted, respectively. The patency of the arteries was evaluated by Color Doppler ultrasonography immediately postoperation and up to 6 months thereafter. STATISTICAL ANALYSIS: Data were analyzed with Fisher's exact test using SPSS version 15. P value below 0.05 was significant. RESULTS: None of the 12 inverted vein grafts were patent at 3(rd) to 14(th) days follow-up with Doppler ultrasonography. All of them were completely obstructed by thrombosis. However, 11 (92%) of the noninverted vein grafts were patent both at 3 and 6 months follow-up. One of the noninverted grafts was almost completely obstructed with thrombosis (90%) and the other 2 were incompletely obstructed with intimal thickening. CONCLUSIONS: Despite many favorable results in the previous studies with regard to excellent patency of inverted vein graft, our results were disappointing and we recommend using the graft in the right direction and taking care to preserve the intima intact.

Intrapulmonary solitary fibrous tumor with bronchial involvement: a rare case report in a child.

Intrapulmonary solitary fibrous tumor is a very rare neoplasm. Our review of the English literature suggests that it has not previously been reported in children younger than 10 years. Herein, the occurrence of such a rare lesion invading the tracheobronchial tree is reported in a 7-year-old boy.

Reduction of the severity of ischemia reperfusion-induced pancreatitis by ischemic pre-conditioning of the liver.

Pre-conditioning by brief exposure to ischemia does not only protect the concerned organ against subsequent severe ischemic damage, but also has protective effect on other organs, which is called remote pre-conditioning. Our aim in this study was to evaluate the protective effect of brief liver ischemia on the pancreas against severe ischemia-reperfusion-induced pancreatitis. This study was performed on 30 male Wistar rats. Ischemic pre-conditioning of liver was performed by first clamping of the hepatic pedicle for 10 minutes. Following this, ischemia-reperfusion of the pancreas was performed by first clamping the inferior splenic artery for 30 minutes, followed by reperfusion for one hour. The rats were divided into three groups (10 rats in each group). Group one was the sham operated group, without clamping of any artery. Group two developed ischemia-reperfusion-induced pancreatitis, without ischemic pre-conditioning of the liver, while Group three underwent ischemic pre-conditioning of the liver followed by ischemia-reperfusion of the pancreas. Ischemic pre-conditioning, applied prior to induction of pancreatitis, caused a reduction in plasma lipase, plasma interleukin-1beta and histological signs of pancreatic damage, but plasma interleukin-10 levels were not significantly different between the three groups. Ischemic pre-conditioning of the liver did not cause any alteration of the liver enzymes. Our study suggests that ischemic pre-conditioning of the liver reduces the severity of ischemia-reperfusion-induced pancreatitis. These effects are partly related to the reduction of pro-inflammatory interleukin -1beta.

Role of rectal biopsy in predicting response to intrasphincteric botulinum toxin injection for obstructive symptoms after a pullthrough operation.

OBJECTIVE: Our aim was to correlate the pathological results and clinical response in patients who underwent botulinum toxin (BT) injection for obstructive symptoms (OS) after a pullthrough operation for Hirschsprung's disease (HD). METHODS: Between August 2002 and February 2006, 16 of 107 HD patients (15%) were referred with persistent OS after pull-through (PT) operation in this center. They underwent rectal biopsy and BT injection in the internal sphincter. Their responses to BT injection were evaluated by the constipation score before, and at 1, 3 and 8 months after the injection, and anorectal manometry (ARM) before and at 2 weeks, and 1 and 8 months after the injection. The association between response to BT and acetylcholinesterase (AChE) staining of rectal biopsy was also assessed. RESULTS: Fourteen of 16 patients (87%) had improvement in bowel function after 2 weeks, and two patients did not respond at all. Six of the 14 patients with early response had recurrence of symptoms after 2-3 months. Eight patients with normal ganglia and negative AChE had good response with no recurrence on follow-up. However, 4 of 6 recurrences were neurogenic dysfunctions and 2 were intestinal neuronal dysplasia (2-4+AChE). Two patients with no response had an aganglionic segment (4+AChE). Four of 6 patients with recurrence showed improvement with BT re-injection and only 2 did not improve. CONCLUSION: A higher degree of AChE staining is associated with lack of response to BT injection. This is also a test for predicting the severity of neurogenic dysfunction in the intestinal wall.

Comparison of botulinium toxin injection and posterior anorectal myectomy in treatment of internal anal sphincter achalasia.

OBJECTIVE: We compared the efficacy of intra-sphincteric botulinum toxin (BT) injection and posterior anorectal myectomy (PARM) for the treatment of internal anal sphincter achalasia (IASA). METHODS: Twenty eight of 120 patients (23%) with chronic constipation, who were referred to our clinic from September 2005 to December 2006, were evaluated. Patients had an absence of rectoanal inhibitory reflex on anorectal manometry (ARM) and showed no transitional region on barium enema. Fourteen patients each underwent rectal biopsy, and were treated with either intrasphincteric BT injection (Group I) or PARM (Group II). Nine patients were excluded because of absent ganglion cells on histology or positive acetylcholinesterase staining (AChE). The remaining 19 patients were followed up. All patients underwent ARM and constipation severity score (CSS) assessment 2 weeks before, and 1 and 6 months after the treatment. Patients were followed up telephonically at 12 months after treatment. RESULTS: Clinically good response was seen after 12 months in 3 patients each in Groups I and II. The median values of resting rectal pressure in Group I before and 6 months after BT injection were 60 mmHg and 40 mmHg (p< 0.0001), respectively, while in Group II the corresponding values were 60 mmHg and 45 mmHg (p< 0.0001), respectively. Compared to pre-treatment, median CSS improved in both Group I (14 to 13) and Group II (16 to 14) at 6 months after treatment (p< 0.0001 for both). However, there was no difference in resting rectal pressure and CSS between the groups. Three patients in Group II developed local abscess, postoperatively. CONCLUSIONS: BT injection has a similar efficacy as compared with PARM for the treatment of IASA, is less invasive and, is also associated with fewer complications.

Esophageal Atresia: Migration of the gastrostomy tube into the bronchus.

A 2-day-old baby boy, 38 weeks gestation, weight 2000 g was brought due to hypersalivation and imperforate anus with gasless abdomen on plain X-ray. He underwent a gastrostomy tube insertion and colostomy. In contrast study of the stomach, on the 5th postoperative day, the dye spilled into the tracheo bronchial tree and the catheter was seen, entering the right main bronchus. The patient underwent right thoracotomy and the presence of fistula and catheter were confirmed. The fistula and distal esophagus were closed and fixed to the prevertebral fascia because of a long gap. He is under follow-up and recieving home care for a later delayed primary anastomosis.