ObjectiveSnodgrass urethroplasty remains the preferred technique in primary distal hypospadias but development of meatal stenosis often limits distal extension of the midline incision of the urethral plate (MIUP), which remains a limiting factor in reconstructing an apical neomeatus (NM). We here-in assess the cosmetic and functional outcome with distal extension of the MIUP in grafted tubularised incised-plate urethroplasty (G-TIP) repair.Patients and methodsThis prospective study included the surgical experience of 263 cases of primary hypospadias operated upon between 2012 and 2015. The G-TIP technique included standard steps of Snodgrass urethroplasty, including degloving and harvesting of glans wings, followed by MIUP that was extended distally beyond the margins of the urethral plate (UP) into the glans. The incised bed was grafted with a free preputial skin graft and fixed to the bed with polydioxanone 7-0 suture. The UP was tubularised and the suture line reinforced with a Dartos flap. The urethral catheter was removed at 7–10 days after the repair and the outcome was assessed at follow-up using the Hypospadias Objective Scoring Evaluation (HOSE) system.ResultsAn apical NM was achieved in 96% of the patients with a 3.7% incidence of urethrocutaneous fistula. The presence of suture tracks and graft at the margins of the NM were seen in the initial 4% and 5% of cases, respectively. Acceptable cosmetic results, with objective HOSE scores of >14, were achieved in 96% of cases.ConclusionThe G-TIP repair is a straightforward and feasible technique facilitating reconstruction of an apical NM, with an optimum outcome based on HOSE scoring. However, multicentre data are needed for undertaking comparative analysis and to assess the universal applicability of this technique in primary hypospadias.
Background: Thyroidectomy is the most common endocrine surgical procedure, and many challenges are encountered during the preoperative, intraoperative, and postoperative periods. After thyroidectomy, bilateral superficial cervical block is the most successful option reducing postoperative pain, analgesic needs and postoperative complications such as vomiting. Objective: Our study aimed to evaluate the analgesic effect, onset time of sensory block, duration time, postoperative visual analogue score (VAS) and complications of adding dexmedetomidine versus dexamethasone to levobupivacaine for cervical plexus block. Patients and Methods: A prospective-randomized clinical trial study that was conducted at Sohag University between April 2018 and March 2020. The study included fifty patients with (ASA) Class I or II, aged 30 to 60 years were scheduled for euthyroid surgeries (including thyroid adenoma, Hashimoto's goiter, and nodosity thyroiditis) Results: The addition of dexmedetomidine to levobupivacaine (group D) shortened the sensory block onset time compared to dexamethasone added to the levobupivacaine group (group S) (p < 0.05). The duration of analgesia of cervical plexus block in group (D) was significantly longer than that in group (S) (232.34 versus 303.55 min; p < 0.05). HR level in group (D) was significantly lower than that in group (S) (p < 0.05).
Conclusion:The addition of 1 μg kg−1 dexmedetomidine to levobupivacaine for cervical plexus block (BSCPB) shortened the sensory block onset time and extended the duration of analgesia and increased the quality of analgesia more superior than the addition of dexamethasone.
that nasal congestion with respiratory difficulty is 1 of the worst symptoms, which were most difficult to tolerate after bimaxillary orthognathic surgery including Le Fort I osteotomy. 7 Second, naso-tracheal intubation is usually required for the orthognathic surgery, which causes mucosal swelling inside nasal airway due to damage or irritation to the nasal mucosa. Furthermore, patients with intermaxillary fixation immediate after the surgery have difficulty in oral breathing.Regarding to treatment, conservative managements such as rest, oxygen therapy, and pain control with analgesia are preferred. Supplying oxygen will increase the diffusion pressure of nitrogen in the subcutaneous tissue and mediastinum. If resolving the pneumomediastinum is fail, mediastinotomy should be performed making incision in the supraclavicular fossa posterior to the sternocleidomastoid muscle and in the suprasternal notch. In our cases, case 1, 2, and 4 patients with treated with high oxygenation but case 3 patient were treated with both oxygenation and suprasternal notch incision.In conclusion, we reported 4 cases of subcutaneous emphysema with or without pneumomediastinum after orthognathic surgery. It can be occurred by cervical fascia injury or alveolar ruptures. To preventing the pneumomediastinum after the orthognathic surgery, traumatic naso-tracheal intubation, excessive positive pressure ventilation, intermaxillary fixation immediate after the surgery and increase of intra-alveolar pressure of the patients should be avoided. Plain chest radiography is useful tool for initial diagnosis of pneumomediastinum, however chest CT describes exact extent of lesion. Conservative management with pain control and oxygenation can be done first and mediastinotomy also performed if resolving the air is failed.
Background:The thyroid gland is one of the highly vascular tissues in the body. Hemostasis is one of the important and essential components of the procedure. Nowadays with the widespread use of energy instruments like ultrasonic coagulation (Harmonic Scalpel, Ethicon) and bipolar control (LigaSure, Valleylab) or cutting and hemostasis which integrates new approaches to vessel ligation and division without increase the postoperative complications. In a prospective comparative analysis of open complete thyroidectomy, this work aimed to examine the effect of modern suture ligation procedures using the Harmonic ® process in comparison with conventional suture ligation.
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