General surgery of childhood
Stephen Brennan in FRCS General Surgery Viva Topics and Revision Notes, 2017
Umbilical hernias are common presentations to surgical outpatients. A true umbilical hernia in a child is usually closed spontaneously by the age of 2 years. Any umbilical hernia presenting up to this age should be reassured and managed conservatively. If the hernia persists after this then surgical repair is warranted. Epigastric hernia on the otherhand should be fixed. These have a higher rate of obstruction and should be placed on the elective waiting list. Effortless, non-bilious vomiting in an infant 3-5 weeks of age is the typical presentation of infantile hypertrophic pyloric stenosis. The first priority in treating an infant with pyloric stenosis is to correct the fluid and electrolyte inbalance. This is achieved with 0.45" saline with potassium over 1-2 days. A hydrocoele is a collection of fluid around the testicle, in the tunica vaginalis. Hydrocoeles only occur in males. Possible causes of hydrocoeles in adults include: trauma, infection, testicular tumour and torsion of the testes.
Asbestos exposure and mesothelioma
Dorsett D. Smith in The Health Effects of Asbestos, 2015
Mesothelioma is a rare tumor that primarily affects the lining of the chest cavity or pleura, or the lining of the abdominal cavity, the peritoneum. It rarely can primarily involve the tunica vaginalis of the testicle, the pericardium, and other areas. The rate for malignant mesothelioma in women has been remarkably stable for several decades in the United States. The most common cause of mesothelioma is heavy amphibole asbestos exposure. The British government held an advisory panel on problems arising from the use of asbestos in 1967. The general medical community had believed that if asbestosis could be avoided by reducing exposure to friable asbestos, then asbestos-related malignancy would also be avoided. Mesotheliomas have been associated with a variety of different causative agents besides amphibole asbestos, including other fibrous mineral fibers, radiation, viruses, metals, chemicals, and genetics.
Hernia and hydrocele
Brice Antao, S Irish Michael, Anthony Lander, S Rothenberg MD Steven in Succeeding in Paediatric Surgery Examinations, 2017
The superficial inguinal ring is a defect in the aponeurosis of external oblique, located above and medial to the pubic tubercle. An indirect hernia passes through the deep inguinal ring and along the inguinal canal into the scrotum, while a direct hernia bulges through the posterior wall of the canal medial to the inferior epigastric artery through Hesselbach's triangle. A femoral hernia occurs through the femoral canal, which is the medial compartment of the femoral sheath, and is entered via the femoral ring. After hernia repair, scrotal swelling may develop as a result of fluid accumulating in the distal sac, forming a hydrocele. A hydrocele is a collection of fluid in the space surrounding the testicle between the layers of the tunica vaginalis. Hydroceles may be communicating or non-communicating. A hydrocele that was not present at birth, or that dramatically changes in size or fluctuates in size, is suggestive of a patent processus vaginalis.
Neo-glans reconstruction for penile cancer: Description of the primary technique using autologous testicular tunica vaginalis graft
Published in Arab Journal of Urology, 2018
Peter Weibl, Christina Plank, Rudolf Hoelzel, Stefan Hacker, Mesut Remzi, Wilhelm Huebner
Partial penectomy (glansectomy with/or without distal corporectomy) is an acceptable alternative for smaller distal pT3 penile carcinoma lesions in highly motivated and compliant patients. The authors describe a novel technique of neo-glans reconstruction using a tunica vaginalis (TV) testis allograft. However, due to an unclear resection margin on final histology, the patient underwent re-do surgery with a neo-glans revision using the well-established mesh split-thickness skin graft (STSG) technique. The penile length was preserved and the penile and bulbar part of the urethra was additionally mobilised in order to obtain a natural and aesthetic result for the meatus.Neo-glans reconstruction with TV coverage may be another promising alternative, which certainly requires further evaluation. We believe that the donor-site associated morbidity is minimal when compared to other harvesting sites. However, this is just an assumption, because direct comparison data on grafting techniques and neo-glans reconstruction are not available. Nevertheless, we think that for re-do procedures a standardised approach using a STSG technique should be the treatment method of choice.
Induction of tunica vaginalis mesotheliomas in rats by xenobiotics
Published in Critical Reviews in Toxicology, 2009
R. R. Maronpot, E. Zeiger, E. E. McConnell, H. Kolenda-Roberts, H. Wall, M. A. Friedman
To better understand the relevance of tunica vaginalis mesotheliomas (TVM) to human cancer risk, we examined the nature of TVM responses in 21 published rat cancer bioassays against the backdrop of the biology and molecular biology of mesothelium, and of spontaneous and treatment-induced TVM. Although relatively rare in all species including humans, TVM are seen most frequently in F344 male rats, as opposed to other rat strains, and are causally associated with the high background incidence of Leydig-cell tumors of the testes of these rats. Hormone imbalance brought about by perturbations of the endocrine system is proposed as a key factor leading to both spontaneous and treatment-associated TVM. Of 21 F344 rat studies with a treatment-associated TVM response, 7 were judged to have a nonsignificant to marginal response, 11 had a robust TVM response, and 3 were noninformative due to early mortality from other induced tumors. Of the 11 chemicals with robust responses, 8 were directly mutagenic in Salmonella and 3 are known to be mutagenic after metabolism. Only 2 of the 7 with nonsignificant to marginal responses were Ames test positive. TVM induction is a male F344 rat-specific event, and chemicals/agents that induce only TVM in the male F344 rat from a typical two-sex rat and mouse chronic bioassay are likely irrelevant in human risk assessment.
Lingual mucosal graft two-stage Bracka technique for redo hypospadias repair
Published in Arab Journal of Urology, 2017
Ahmed Sakr, Ehab Elkady, Mohamed Abdalla, Amr Fawzi, Mostafa Kamel, Esam Desoky, Mohamed Seleem, Mohamed Omran, Ehab Elsayed, Salem Khalil
Objectives:To report our initial experience in redo hypospadias repair with a lingual mucosal graft (LMG) using a two-stage Bracka technique. Patients and methods:This study was prospectively conducted and included 26 patients with hypospadias with failed previous repairs. All the patients had a LMG using a two-stage Bracka technique. In the first stage, the harvested LMG, from the ventro-lateral surface of the tongue, was implanted in a well-prepared vascularised bed in the ventral aspect of the penis. After 6 months, tubularisation of the well-taken graft was completed. Tunica vaginalis or a dartos flap was used as second-layer coverage of the neourethra. Success was defined as acceptable aesthetic and functional outcomes without any additional surgical interventions. Results:The mean (SD) patient age was 5.15 (1.6) years. The mean (SD) LMG length was 3.82 (0.9) cm and the width was 1.5 (0.5) cm. The mean (SD) number of previous repairs was 2.76 (1.1). The mean (SD) follow-up was 12 (2) months. Donor-site complications included: pain in all patients, with a pain score of >3 on the visual analogue pain scale (0–10) in 10 (38%); and speech problems in 19 (73%). First-stage complications were graft loss (n = 2) and contracture (n = 1). The second stage was completed in 23 patients resulting in the following significant complications: meatal stenosis plus fistula (n = 2), breakdown (n = 1). Successful hypospadias repair was achieved in 77% (20/26) of the patients. Conclusion:Lingual mucosa is a reliable and versatile graft material in the armamentarium of two-stage Bracka hypospadias repair with the merits of easy harvesting and minor donor-site complications.
Related Knowledge Centers
- Fetus
- Peritoneum
- Processus Vaginalis
- Abdomen
- Scrotum
- Serous
- Testes