RESUMEN
Penile chordee, with and without hypospadias, is amenable to surgical correction. The Nesbit technique of dorsal plication of the ventral tunica albuginea is effective in correcting most cases of corporal disproportion. A hazard with this approach is the potential inclusion of the dorsal neurovascular bundle, with resultant erectile and sensory dysfunction. We developed a simple technique using the Freer elevator to isolate the neurovascular bundle prior to plication. This ensures that no injury occurs to the neurovascular bundle during plication. Since 1994, 37 boys with chordee have been repaired using this approach. Their ages at the time of operation ranged from 5 months to 28 years (mean 9 months). Following standard degloving of the penis, an incision through Buck's fascia is made lateral and parallel to the neurovascular bundle at the maximum level of the chordee. A similar incision is carried out on the contralateral side. A 4-mm-wide Freer elevator is positioned under Buck's fascia while hugging the tunica albuginea. The Freer elevator slides across the midline to the contralateral side, separating Buck's fascia and underlying layers from the tunica albuginea. Following isolation of the bundle, each corporal body is plicated by creating a longitudinal incision through the tunica albuginea, which then is closed transversely with a 5-0 polydioxanone suture. Buck's fascia subsequently is closed with an absorbable suture following confirmation of chordee correction. No complications have been encountered during a mean follow-up of 21 months (range 5-51 months). No patients have required reoperation for persistent chordee. We developed a technique that elevates the neurovascular bundle prior to plication, thereby ensuring no injury to this structure. We have successfully used this modified Nesbit technique since 1994 and have had no complications. Utilization of the Freer elevator adds an estimated 5 minutes to chordee correction compared to a standard plication lateral to the neurovascular bundles. Although long-term follow-up needs to be performed to confirm any erectile or sensory advantage, this approach should be considered whenever plication is to be performed.
Asunto(s)
Hipospadias/cirugía , Pene/cirugía , Procedimientos Quirúrgicos Urológicos Masculinos/métodos , Adolescente , Adulto , Niño , Preescolar , Humanos , Lactante , Masculino , Pene/irrigación sanguínea , Pene/inervación , Resultado del TratamientoRESUMEN
A 21-year-old man with Behçet's syndrome presented with both a left ventricular aneurysm and a left renal artery pseudoaneurysm. After successful embolization of the ruptured pseudoaneurysm, the patient underwent successful repair of the left ventricular aneurysm. Although multiple aneurysms have been reported previously, we believe this to be the first reported case of both a ventricular aneurysm and a renal artery pseudoaneurysm afflicting a patient with Behçet's syndrome.
Asunto(s)
Aneurisma Falso/etiología , Aneurisma Roto/etiología , Síndrome de Behçet/complicaciones , Aneurisma Cardíaco/etiología , Arteria Renal , Adulto , Aneurisma Falso/terapia , Aneurisma Roto/terapia , Síndrome de Behçet/terapia , Embolización Terapéutica , Aneurisma Cardíaco/cirugía , Humanos , MasculinoRESUMEN
PURPOSE: The development of contralateral reflux after unilateral antireflux surgery has spawned interest and controversy regarding etiology and management issues. We evaluate our experience to understand better the issues surrounding contralateral reflux. MATERIALS AND METHODS: We retrospectively reviewed the records of all children seen in a 7-year period who underwent unilateral extravesical ureteral advancement performed by one of us (M. R. Z.) at our institution. RESULTS: A total of 43 children a mean of 50.5 months old underwent unilateral reimplantation. The male-to-female ratio was 12:31. In 12 children contralateral reflux had resolved preoperatively. Overall contralateral reflux developed in 5 patients (11.6%) after unilateral extravesical ureteral advancement. In 1 child in whom new onset contralateral reflux developed on 1 side reflux resolved by 10 months with observation. In 8 of the 12 children (66%) with a history of resolved contralateral reflux there was no recurrence. In 4 of the 12 children recurrent contralateral reflux completely resolved by 14 months postoperatively with only observation. In these 4 patients initial reflux had been grades II and IV in 2 each. To date all fully evaluable reflux in children with previous contralateral reflux recurred has resolved. CONCLUSIONS: The recurrence of contralateral reflux after unilateral reimplantation that is expected in a small number of children resolves in the majority, if not in all, with conservative management. We believe that children should not be offered bilateral reimplantation for unilateral reflux and a history of resolved contralateral reflux. If contralateral reflux recurs, it will most likely resolve with time.
Asunto(s)
Complicaciones Posoperatorias/etiología , Uréter/cirugía , Reflujo Vesicoureteral/etiología , Reflujo Vesicoureteral/cirugía , Preescolar , Femenino , Humanos , Masculino , Estudios RetrospectivosRESUMEN
Cellular adhesion and specific cytotoxicity are two essential components for the successful cellular therapy of cancer. Intercellular adhesion molecule-1 (ICAM-1) is an essential participant in lymphocyte-endothelial cell adhesion and may also play a role in lymphocyte-mediated cytotoxicity. To study the effect of ICAM-1 on adhesion and cytotoxicity in vitro, MCA-105 tumor cells were cotransfected with ICAM-1 and the gene for neomycin resistance (NeoR). Two clones (Clones 81 and 149) with confirmed enhancement of ICAM-1 expression were selected. Studies were performed examining adhesion of lymphocytes to HUVECs, MCA-105, Clone 81 or Clone 149 alone, or combinations of the three tumor cell lines with HUVECs. Peripheral blood lymphocytes labeled with 51Cr were used and adhesion was determined by counting in a gamma-counter after rinsing away nonadherent cells. Cytotoxicity was performed using 51Cr-labeled MCA-105, NeoR, Clone 81, and Clone 149 target cells. LAK cells cultured from splenocytes of normal mice were used as the effector cells and a chromium release assay was performed. Adhesion data showed significant increases in adhesion (P < 0.05) for Clones 81 and 149 compared to MCA-105. However, the combination of HUVECs and tumor cells to mimic the in vivo condition had a variable effect on adhesion compared to tumor cells alone. Cytotoxicity experiments demonstrated that Clone 149 was significantly (P < 0.05) more susceptible to lysis by normal LAK cells compared to MCA-105, NeoR, and Clone 81. These results suggest that increased ICAM-1 expression enhances the susceptibility of tumor cells to lysis by LAK cells.
Asunto(s)
Citotoxicidad Inmunológica , Fibrosarcoma/terapia , Molécula 1 de Adhesión Intercelular/fisiología , Células Asesinas Activadas por Linfocinas/inmunología , Animales , Adhesión Celular , Endotelio Vascular/citología , Fibrosarcoma/inmunología , Fibrosarcoma/patología , Humanos , Molécula 1 de Adhesión Intercelular/genética , Linfocitos/fisiología , Ratones , Ratones Endogámicos C57BL , TransfecciónRESUMEN
BACKGROUND: Increasing the ability of antitumor effector cells to leave the vasculature and gain access to tumor cells may improve therapeutic efficacy. We undertook this study to determine whether increased expression of intercellular adhesion of molecular-1 (ICAM-1) by gene transfection would result in an improved response to adoptive immunotherapy in vivo. METHODS: C57BL/6 mice received 1 x 10(6) tumor cells on day 0. Tumor cells examined were MCA-105 (parental), NeoR (MCA-105 transfected with the neomycin resistance gene), or Clones 81 or 149 (MCA-105 cotransfected with NeoR and the gene for ICAM-1 and highly express ICAM-1). Animals were treated by use of no treatment, interleukin-2 alone (days 10 through 14), hyperthermia alone (days 10 and 13), or interleukin-2 + hyperthermia, and tumor growth was reported as a ratio to size on day 10. In vitro cytotoxicity was assayed by using murine lymphokine-activated killer cells. RESULTS: Tumors transfected with ICAM-1 and treated with hyperthermia + immunotherapy grew significantly (p < 0.05) slower (mean, 0.78 +/- 0.16 on day 19) than parental tumor (size, 1.35 +/- 0.22) or tumor cells transfected with NeoR alone (1.21 +/- 0.19). Tumors containing both MCA-105 and Clone 81 treated with hyperthermia + immunotherapy grew significantly slower (1.58 +/- 0.49 on day 19, p < 0.05) than untreated Clone 81 (2.38 +/- 0.46) or treated MCA-105 (2.49 +- 0.29) but more rapidly than treated Clone 81 (1.18 +/- 0.08), suggesting a paracrine efect for ICAM-1. CONCLUSIONS: These findings show that increased expression of ICAM-1 by tumor cells results in a significant increase in antitumor efficacy of combined interleukin-2 and hyperthermia in a murine model. Although the mechanism has yet to be elucidated, modulation of cellular adhesion may play a role in the therapeutic efficacy of cellular immunotherapy.