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Epistaxis
Published in John C Watkinson, Raymond W Clarke, Louise Jayne Clark, Adam J Donne, R James A England, Hisham M Mehanna, Gerald William McGarry, Sean Carrie, Basic Sciences Endocrine Surgery Rhinology, 2018
Hereditary haemorrhagic telangiectasia (HHT) or Osler-Weber-Rendu disease is an autosomal dominant condition affecting blood vessels in skin, mucous membranes and viscera. Penetrance is variable but reaches 97% by age 50 years and occasional atavistic cases are observed. The genetic abnormality has been located to chromosome 9q (HHT1) and chromosome 12q (HHT2). The classical features are telangiectasia, a-v malformations and aneurysms. Recurrent epistaxis occurs in 93% of cases.67 Management involves packing, cautery, antifibrinolytics, systemic or topical oestrogens, coagulative lasers, septal dermoplasty, ligation and embolization and as a last resort permanent surgical closure of the nostrils (Young’s operation). Laser photocoagulation has become a popular therapy and the NdYAG, Argon and KTP532 lasers have all been used with some success. Large multicentre comparisons of these treatments have not been conducted and due to the relative rarity of the condition this situation is likely to persist. Figure 106.10 is an algorithm for management of this condition.68 A recent study showed that the disability produced by Young’s operation was more than offset by an improved quality of life due to reduced bleeding. Trials of systemic, topical or locally injectable Bevacizumab have produced conflicting results and at present the efficacy of this drug in HHT is unproven.69
The nose and nasopharynx
Published in Rogan J Corbridge, Essential ENT, 2011
One condition in particular deserves special mention: HHT. Here, multiple abnormal capillaries occur and may be found throughout the respiratory, gastrointestinal and urogenital tracts and the skin. The most effective treatments consist of argon laser cautery of the telangiectasias and closure of the nostril (Young’s operation). Although poorly tolerated by many patients, this does dramatically reduce the number and severity of nosebleeds.
Clitoroplasty: A variant of the technique by Acimi
Published in Arab Journal of Urology, 2018
Smail Acimi, Mohammed Ali Acimi, Lamia Debbous, Mimouna Bessahraoui, Ibtisseme Bouanani
In the 1930s, Young [1] performed an operation for clitoral reduction in a child with congenital adrenal hyperplasia, but the glans later sloughed leaving granulation tissue. In 1954, Jones and Jones [9] reported a modification to Young’s operation, but the remaining erectile tissue was painful. However, the true first clitoroplasty was described by Lattimer in 1961 [3]. The principle of this technique was to dissect the corpora cavernosa, which are thereafter buried in a tunnel created under the skin. However, this technique does not correct the malformation, but hides it. In addition, this surgical technique was responsible for pain during erection at puberty [10]. However, the preferred technique for many medical centres was the technique described by Kumar et al. [4] in 1974. This technique is characterised by a partial resection of the corpus cavernosum after the release of the dorsal neurovascular pedicle, followed by suturing of the edges using nonabsorbable fine wire. But, this technique is responsible for an unacceptable cosmetic appearance with a large glans disproportionate to its surroundings. Both mentioned techniques, do not involve any reduction in the diameter of the corpus cavernosum responsible for a voluminous clitoris during erection. In 1983, Kogan et al. [4] proposed the subtunical resection of the cavernous tissue of the enlarged clitoris, a safe method that allows a reduction in shaft and glans size with maintenance of an intact blood supply to the glans.