Search

Background/Objective To draw a hint towards two simple modifications that could potentially decrease the complication rate. Patients and Methods It was a single center, single operator and retrospective study. All patients with severe hypospadias operated according to koyanagi with or without modifications were presented. The surgical technique was described. Complications like fistula, stenosis, dehiscence and urethral diverticulum were studied. Results and Limitations Nineteen patients were included and presented in a chronological manner. The first four patients were operated according to the original koyanagi technique. The next 15 patients were operated according to koyanagi and the urethroplasty was covered by a tunica vaginalis flap. In 10 of them, glanduloplasty was done primarily and in the last 5 patients, glanduloplasty was done as a secondary procedure. The complication rates were 100% in the original koyanagi group, and 0% in the subset were glanduoplasty was deferred. Conclusions Systematically covering the urethroplasty with a tunica vaginalis flap and deferring the glanuloplasty might ameliorate the results of the koyanagi technique.

MAVT has been proposed for the treatment of irreversible hepatic dysfunction secondary to the neonatal short bowel syndrome and total parenteral nutrition. Evolution of the intestinal graft after MAVT In two male, 18 and 10 month old infants was studied by means of nutriment absorption rates and periodical endoscopic and histologic examination. The graft comprised the liver, the stomach, the duodeno-pancreas and the jejunum in one case or the small intestine and a part of the colon in the other case. Immunosuppression Included antilymphocyte-globulins, corticosteroids, azathioprlne and cyclosporin. In both cases, 2 and 3 months after MAVT, intestinal biopsies revealed irregularly located inflammatory lesions of the mucosa, consisting of a multicellular infiltrate and villous atrophy, whereas previously described, typical aspects of small bowel rejection were not observed. Near-normal nutrient absorption (absorption rate for carbohydrates: 97%) was achieved despite the develoment of these lesions in one infant, who deceased of intractable sepsis on the seventh month. The second patient Is presently treated with high doses of corticosteroids after unsuccessful! OKT3 therapy. These observations may be consistent with a particular form of acute intestinal rejection, associated with MAVT.