Anatomical alignment for the correction of buried penis

PURPOSE: We report a straightforward surgical technique for the correction and anatomical alignment of the skin in patients with various degrees of buried penis. MATERIALS AND METHODS: A combined series of 74 patients 7 months to 10 years old who were treated for buried penis at 2 institutions during a 7-year period. Patients presented with various symptoms, including balanitis, urinary tract infection, painful voiding, ballooning of the foreskin and urinary retention. In 29 patients (38%) trapped penis was due to previous circumcision. In our estimation the major anatomical defect in buried penis is an insufficient attachment of the dartos fascia and penile skin to Buck's fascia. Our technique involves making a circumferential incision of the inner preputial skin layer proximal to the corona, unfurling it from the shaft skin and leaving a coronal collar of approximately 1 cm. The annular band that usually constricts the corpora on retraction of the penile skin is incised, and the remaining proximal penile skin and dartos fascia are dissected off Buck's fascia proximally to the base of the penis. The penile dermis is sutured to the lateral aspect of the tunica albuginea at the penopubic junction and mid shaft of the penis. This technique restores normal anatomical relationships with excellent cosmetic results and negligible complications. RESULTS: At a median 5-year followup cosmesis was excellent in all cases. Two patients with micropenis who required revision responded to endocrine therapy. CONCLUSIONS: Excellent cosmetic results were obtained in all cases using this surgical technique.     

Surgical correction of the kinked carotid artery

The hemodynamic significance of the kinked internal carotid artery and cerebrovascular insufficiency are demonstrated. Several procedures have been devised to correct a carotid kink, but these involve resection or excision of the internal, external or common carotid artery. We currently prefer a reimplantation technique whereby preservation of the external carotid is maintained, resection of the internal carotid artery is avoided and, when necessary, endarterectomy may be safely employed.     

Surgical and nonsurgical correction of uterine torsion in New World camelids: 20 cases (1990-1996)

OBJECTIVE: To report clinical findings for New World comelids with uterine torsion and to compare results of 3 methods of correction. DESIGN: Retrospective case series. ANIMALS: 11 llamas and 3 alpacas with 20 uterine torsions. PROCEDURE: Information concerning history, clinical signs, management, and postpartum complications was retrieved from medical records. Information concerning subsequent reproductive performance was obtained by telephone interview of owners. RESULTS: Uterine torsion was corrected by celiotomy (n = 7); transvaginal manipulation (5), or rolling the dam (8). Direction of 19 of 20 torsions was clockwise when viewed from the rear. Retention of fetal membranes was reported for 5 camelids that underwent celiotomy, but was not reported in camelids after nonsurgical correction. The uterus prolapsed in 1 llama that underwent celiotomy and in another that underwent the rolling technique. Although 2 camelids that underwent celiotomy subsequently failed to conceive, all camelids treated by nonsurgical techniques conceived. CLINICAL IMPLICATIONS: Uterine torsion in camelids may be diagnosed by methods similar to those used in cattle. Surgical and nonsurgical methods can be used to correct torsion, and postpartum complications are rare when torsion is corrected by a nonsurgical method.     

Surgical repair of fracture of the os penis in a dog

An eight-year-old male Australian cattle dog cross was presented with complete urethral obstruction secondary to fracture of the os penis which had occurred two years earlier. Obstruction was associated with callus and fibrous tissue proliferation compressing the urethra at the fracture site. The problem was satisfactorily resolved by removing excess bone and fibrous tissue and stabilising the fracture with a stainless steel finger plate.     

One-stage correction of chordee and 180-degree penile torsion

Transplantation is now an acceptable mode of therapy for end stage renal disease. Increased survival rates and acceptance of older recipients have resulted in an increased frequency of outlet obstruction in the male recipient. Reviews of urological complications in renal allotraansplantation have failed to emphasize this clinical entity. We present 3 patients, each emphasizing a different facet in the natural history of outlet obstruction in the male recipient of a renal allotransplant. The rationale for aggressive investigation of outlet obstruction is emphasized.     

Surgical correction of spastic thumb-in-palm deformity

A series of 31 operations on 27 patients for correction of the spastic thumb-in-palm deformity is reported. 19 patients were followed four years or longer post-operatively; the remainder have been followed for at least one year. In approximately 70 per cent of the operations, supplementary procedures were performed on the hand or forearm, as the deformity is usually only one facet of a complex spastic disability of the upper extremity. The surgical technique and illustrative cases are presented. Augmentation of a markedly weak extensor-abductor motor function is necessary, otherwise the spastic thumb-in-palm deformity will recur, as in two cases in the present series which required a second operation. The remainder of the patients were classified as improved, indicating that the thumb was no longer clenched in the palm, could be used in gross grasping activities, and the hand had become more useful. In no instance did the spastic hand become the primary functioning hand post-operatively.     

Surgical correction of dural herniation into the mastoid cavity

A temporoparietal craniotomy as the approach of choice employed by the authors is presented for the surgical correction of dural herniation into the mastoid cavity in our series of four cases of middle fossa defects caused by previous operative procedures (mastoidectomy for removal of cholesteatoma) performed elsewhere. At the Triological Meeting a color movie accompanied the presentation of this paper.     

Surgical correction of postkeratoplasty astigmatism with the Hanna arcitome

PURPOSE: To report the results of arcuate keratotomy performed with the Hanna arcitome in patients with postkeratoplasty astigmatism. SETTING: Department of Ophthalmology, Saint-Antoine Hospital, Paris VI University, Paris, France. METHODS: This retrospective study comprised 22 eyes (22 patients) with postkeratoplasty astigmatism. Paired symmetrical arcuate keratotomy was performed with the Hanna arcitome. Outcome measures included refraction, videokeratography, and keratometry. RESULTS: At 6.6 months +/- 8.9 (SD) after surgery, the mean increase in best spectacle-corrected visual acuity (BSCVA) was 2.1 +/- 2.4 lines. Thirteen eyes gained 2 lines or more of BSCVA, and 15 gained 3 lines or more of uncorrected visual acuity. Two patients had a decrease in BSCVA: 1 had lens opacification unrelated to arcuate keratotomy and 1, increased corneal irregularity. Mean refractive astigmatism was 6.94 +/- 2.11 diopters (D) preoperatively and 3.85 +/- 1.95 D postoperatively (P < .01). Mean change in keratometric astigmatism was -51 +/- 36%. Astigmatism decreased in 21 eyes as measured by manifest refraction, keratometry, and videokeratography; it increased in 1 cornea with a microperforation. CONCLUSIONS: The results of arcuate keratotomy performed with the Hanna arcitome were comparable to those with freehand relaxing incisions. The instrument made safer and more uniform arcuate incisions than a freehand technique.     

Surgical correction of acute congenital cardiopathies in the newborn infant

The experience of the Cardiac Surgery Service at the Hospital del Ni?o IMAN with the deep hypothermia method and hemodynamic arrest is shown in 30 infants with severe congenital cardiac malformations. The procedures followed before and during the operation are carefully described in their three aspects; anesthesia, extracorporeal circulation and surgery, including postoperative care. Ventilatory assistance is stressed. Results are analyzed considering postoperative evolution; stress is made on the causes of morbidity and mortality. Considering the results of this and other similar reports, we believe that the deep hypothermia method and heart arrest in treating severe cardiac malformations in infants are of outstanding importance since they have significantly improved results in these problems.     

Surgical correction of recurrent stenosed submandibular duct orifice

Ten patients complaining of recurrent stone formation in submandibular stenosed duct orifice were diagnosed and evaluated. Surgical technique for removal of the stones and widening of the orifice to heal by secondary intention was discussed. Irrigation of the duct and wound with 5% diluted hydrogen peroxide was done to remove all desquamated epithelial cells and microliths to prevent narrowing the lumen of the duct. One year post operative follow up revealed no recurrence of stone formation in the submandibular duct and normal salivary flow for all patients.     

Surgical planning and correction of medial craniofacial cleft

A 3.3 year old girl with Prader-Willi syndrome (PWS) and mosaicism for two aneuploidies, 47,XXX and 47,XX,+15, is presented. The triplo-X cell line was found in white blood cells and fibroblasts, the trisomy 15 cell line in 50% of the fibroblasts. Using methylation studies of the PWS critical region and by polymorphic microsatellite analysis, the existence of uniparental maternal heterodisomy for chromosome 15 was shown in white blood cells. This provided a molecular explanation for the PWS in this child. In fibrolasts, an additional paternal allele was detected for markers on chromosome 15, which is in agreement with the presence of mosaicism for trisomy 15 in these cells. This example provides direct evidence for trisomic rescue by reduction to disomy as a possible basis for PWS. Whereas the trisomy 15 was caused by a maternal meiosis I error, the triplo-X resulted from a postzygotic gain of a maternal X chromosome, as shown by the finding of two identical maternal X chromosomes in the 47,XXX cell line. Because the triplo-X and the trisomy 15 were present in different cell lines, gain of an X chromosome occurred either in the same cell division as the trisomy 15 rescue or shortly before or after.     

Surgical correction of sagittal craniosynostosis: complications of the pi procedure

BACKGROUND: Although numerous anecdotal reports are being offered about the growing number of unfilled faculty positions in US family medicine departments, virtually no literature exists on faculty recruitment. The objective of this study was to define the scope and nature of current faculty recruitment needs in family medicine. METHODS: A national survey was sent to all family medicine department chairs and family practice residency program directors concerning faculty positions unfilled at their sites and positions for which recruitment would occur within the next 5 years. The survey asked for information on currently available positions; academic title of position; percentage of time to be devoted to clinical, educational, administrative, and research activities; primary focus of the position; date when the position became available; and the length of time the position has been unfilled. Similar information was collected on positions anticipated to be available within the next 5 years. RESULTS: A total of 364 surveys were returned, for an overall response rate of 70%. Information from the survey revealed a current, substantial demand for family medicine faculty throughout the country, with an even greater demand anticipated for the near future. Respondents reported 496 currently unfilled positions for family medicine faculty and another 677 positions anticipated to be available within the next 19.5 months on average. A total of 89.7% of those anticipated positions were reported as either "certain" or "somewhat certain," in terms of likelihood of availability. CONCLUSIONS: The demand for family medicine faculty is increasing, and much of the demand is financially motivated. Clinical expectations appear to be higher among departments than for residencies. Finally, it was revealed that most positions had minimal allotments for research time. Family medicine must recommit itself to the development of a scholarly agenda as it recruits new faculty.     

Surgical correction of lagophthalmos, complicated by paralytic ectropion

The effects of emasculation in the pars distalis of the pituitary gland were studied in male buffalo. Following castration, no size or percentage value changes could be noted in the acidophila and thyrotrophs of the pars distalis. The acidophils were found in greater numbers in the peripheral area of the pars distalis as compared to the central area. However, the frequency of thyrotroph distribution was observed to be more so in the central zone. As for the gonadotrophs, a significant increase in the cell size (P less than 0.05) and percentage value (P less than 0.01) was observed in animals castrated by the Burdizzo method. This points to a state of hyperplasia and hypertrophy of the gonadotrophs as a result of this method of emasculation.     

Surgical correction of failures associated with corrected transposition of the main vessels

The results of a study carried out on 90 subjects exposed to vibratory trauma of the hand-arm compared to a non-risk control group of 54 subjects are reported. All subjects underwent a medical and neurological examination and Doppler ultrasound of the upper limbs, plethysmography of the hands, electromyography of the bilateral median nerve area and T.T.T. (Thermal Threshold Tester) evaluation of the thermal threshold, were performed. Workers exposed to risks show a higher threshold for hot/cold sensitivity compared to those not exposed. This increase is earlier compared to the onset of vascular and neurophysiological changes detected by plethysmography, Doppler ultrasound and electromyography. Thermal threshold evaluation by T.T.T. would seem to be a useful test for monitoring workers exposed to vibrations.     

Fracture of the penis

Fracture of the penis is not an uncommon urological emergency. Six patients with this injury, treated at the Institute of Urology, General Hospital, Kuala Lumpur, since 1988, were reviewed. Their ages ranged from 21 to 30 years old (mean 25). Four cases were self-inflicted by abnormal bending and 2 cases occurred during sexual intercourse. A sudden "cracking sound", violent pain, rapid flaccidity and deformity of the penis were documented. Duration of injury at presentation ranged from 12 to 90 hours (mean 35 hours). Primary repair of the tunica albuginea with absorbable suture was performed in all cases. The results of surgery was excellent, with restoration of normal function in 4 patients (2 patients defaulted follow-up). We advocate immediate surgical repair for this injury.     

Paraffinoma of the penis

Paraffinomas of the male genitalia are now rare. We report on a Russian patient with subcutaneous nodules of the penis and the prepuce. Injections of exogenous lipids into the male genitalia are still performed in many Eastern European countries. Thus, a paraffinoma should be considered in the differential diagnosis of subcutaneous nodules of the male genitalia in patients from these areas.     

Histoplasmosis of the penis

Histoplasmosis is a common cause of systemic mycosis in endemic areas of the United States. Genitourinary and cutaneous involvement with this dimorphous fungus is rare. We report a case of disseminated histoplasmosis associated with nonpainful ulcerative lesions of the glans and shaft of the penis.