Normal Bell Research Articles

Stand growth, Biomass and Carbon sequestration potentials of Parkia biglobosa (jacq.) Bench plantation in South-Western Nigeria

This study assessed tree growth variables, above (AGB), below ground biomass (BGB) and total carbon content (TC) sequestered by Parkia biglobosa (Jacq.) Bench. Plantation in Wasangare, Oyo State using non-destructive ground base survey. Tree growth data (Diameter at breast height, Dbh and Tree height, Th) were collected using lacer ace hypsometer and diameter girth tape from 20 temporary sampling plots of size 25 m X 25 m established through systematic transect lines. Diameter size classes (DSC) for the plantation was examined, carbon stock for each DSC was also determine while basal area (m2 ha-1), volume (m3 ha-1), Biomass (Mg ha-1) and Carbon (Mg ha-1) were also estimated. Results showed mean Dbh of 18.7 + 0.25 cm with 8.14 + 0.10 m, 0.033 + 0.00 m2 ha-1 and 0.320 + 0.01 m3 ha-1 for tree height, basal area and volume respectively. AGB and BGB were 10.877 + 0.39 Mgha-1 and 2.175 + 0.08 Mgha-1 respectively while TC was 6.527 + 0.24 Mgha-1. The percentage carbon stock proportion for each DSC revealed class size 25-29-9 cm (19.02%) as the highest while the least proportion was observed in less than 5 cm class with 0.04% of carbon. The DSC showed majority of the tree Dbh in lower Dbh classes with fewer trees in higher classes forming almost a normal bell shape. The study provides information that can help the management in planning silvicultural activities and selective removal from the stand (harvesting schedule). Tree Dbh, height, basal area, volume and biomass are the determinant characteristics for forest carbon assessment. In conclusion, the plantation actively sequesters carbon showing potentials for indigenous trees in climate change mitigation.

RN to BSN Jump Start to Success

As part of the call to increase the number of registered nurses prepared with a Bachelor of Science in Nursing degree coupled with barriers faced in nursing education due to COVID-19, one for-profit university launched an registered nurses to Bachelor of Science in Nursing Jump Start to Success initiative. The purpose of this descriptive review of an educational innovation was to determine if outcomes between Jump Start students and matriculated students would be equal in the program. The Jump Start initiative enrolled non-matriculating students who were awaiting graduation and successful National Council of State Boards of Nursing completion by offering two courses tuition-free. During the analysis period, data revealed the first course mean final numeric grade for matriculated students was 94.5 compared to 95.0 for Jump Start students (x2 = 0.2064, p = 0.649588; t-test = -5.11, p = 1.84). Final numeric grades for both groups had a normal bell curve distribution. Additionally, 55% of Jump Start students matriculated into the registered nurses to Bachelor of Science in Nursing Online Degree Completion Option. The Jump Start initiative has provided a foundation on which future initiatives can be built that promote seamless academic progression. Educational institutions should continue to collaborate to develop creative and innovative enrollment strategies.

Ocular myocysticercosis: Atypical presentation with unilateral blepharoptosis

Cysticercosis is a parasitic infection caused by Cysticercus cellulosae, the larval form of cestode, Taenia solium. It is a preventable cause of blindness endemic in many developing countries especially where there is poor hygiene and sanitation. Humans become infected by ingestion of contaminated food and water. The most preferred locations are central nervous system (CNS), eyes, heart, bladder, muscles and subcutaneous tissues. Ocular cysticercosis can be extraocular or intraocular and may show different clinical presentations. We report a case of ocular cysticercosis which presented with unilateral ptosis and mild pain. A young male patient presented with mild swelling and drooping of right upper eyelid for 2 weeks associated with mild pain and redness on first 3 days. Ocular examination revealed ptosis and mild swelling on temporal side of right upper eyelid. The swelling was soft in consistency with no tenderness. Levator function was good with normal Bell’s phenomenon and ocular motility was in full in all cardinal gazes. The computed tomography imaging of the orbit showed bulky right superior rectus muscle with ring enhancing hypodense lesion suggestive of right eye myocysticercosis involving superior rectus muscle. The patient was treated with oral albendazole and oral prednisolone for 4 weeks and a significant improvement of ptosis was seen at 1 month follow up visit. Extraocular muscle cysticercosis should be highly suspicious in young patients with unilateral acquired blepharoptosis. Radiological investigations play a vital role in diagnosis and a complete resolution can be achieved with standard medical therapy alone.

Urological Aspects in Patients with Alkaptonuria: A Case-Control Study.

This study aimed to evaluate the urinary tract for dynamic function and stones and calcifications in patients with alkaptonuria. Thirty-eight patients were prospectively divided into two groups. Study group (A) involved 17 patients; the average age was 42 years. The control group (B) involved 21 patients; the average age was 37 years. All patients from the two groups underwent uroflowmetry assessment and ultrasonography for the kidneys and urinary bladder, and prostate in two phases (full bladder and empty bladder). Group A—Bladder volume ranged between 400 and 520 cc. The peak flow rate was between 7 and 23 mL/s, with an average of 18.6 mL/s. Flow rate curves shape were acceptable to the normal bell-shape curve in 11 patients. Seven patients (41%) had prostate calcification accounting for 5%–35% of prostate size. Group B—Bladder volume ranged between 290 and 510 cc. The peak flow rate was 8–27 ml/s, with an average of 20 mL/sec. Normal bell shape voiding curves were observed in 17 patients (80%). Four patients (19%) had prostate calcification accounting for 2%–12% of prostate size. Renal measurements on ultrasonography were the same in both groups. Patients with alkaptonuria developed prostate calcification at younger age; they have a slight but not statistically significant reduced peak urinary flow rate and post void residual urine.

Connector Tensor Networks: A Renormalization-Type Approach to Quantum Certification

As quantum technologies develop, we acquire control of an ever-growing number of quantum systems. Unfortunately, current tools to detect relevant quantum properties of quantum states, such as entanglement and Bell nonlocality, suffer from severe scalability issues and can only be computed for systems of a very modest size, of around $6$ sites. In order to address large many-body systems, we propose a renormalisation-type approach based on a class of local linear transformations, called connectors, which can be used to coarse-grain the system in a way that preserves the property under investigation. Repeated coarse-graining produces a system of manageable size, whose properties can then be explored by means of usual techniques for small systems. In case of a successful detection of the desired property, the method outputs a linear witness which admits an exact tensor network representation, composed of connectors. We demonstrate the power of our method by certifying using a normal desktop computer entanglement, Bell nonlocality and supra-quantum Bell nonlocality in systems with hundreds of sites.

Evaluation of antipyretic activity of Belladonna and Pyrogenium ultrahigh dilutions in induced fever model.

Background Belladonna and Pyrogenium are commonly used to treat fever in homeopathy. But in vivo antipyretic activity of these medicines is not reported yet. The study was conducted to evaluate the effectiveness of ultrahigh dilutions of Belladonna (Bell) and Pyrogenium (Pyro) in fever model of rabbits induced by Baker's yeast. Methods Healthy, local strain rabbits (♂ and ♀) were divided into seven groups (n=42): Normal control, negative control, standard control, pyro 1000c, pyro 200c, Bell 1000c and Bell 200c. Fever was induced by intra peritoneal injection of 135 mg/kg Baker's yeast suspension. Rectal temperature was measured hourly. All the medicines were administered once a day. The results were expressed as mean ± SEM. ANOVA and least significant difference post hoc test were applied for checking the level of significance, p-value of ≤0.05 was considered significant statistically. Results Pyro in both potencies significantly reduced fever in rabbits compared to negative control group, while both potencies of Bell were ineffective. Paracetamol and Pyro 1000c reduced by 1.2 °C (39.7 ± 0.1 to 38.5 ± 0.1), while Pyro 200c reduced by 1 °C temperature (39.7 ± 0.5 to 38.7 ± 0.2). Conclusions Pyro possesses marked antipyretic activity in rabbit's Baker's yeast fever model. It would embolden its clinical use in fever with more guarantee of its efficacy. However, caveat of small sample size necessitates replication of experiment in large sample size.

Study of Similarity between Stone Bell sound in Maneo temple and normal bell sound

Study of Similarity between Stone Bell sound in Maneo temple and normal bell sound

Study of Similarity between Stone Bell sound in Maneo temple and normal bell sound

Study of Similarity between Stone Bell sound in Maneo temple and normal bell sound

Spontaneous Blinking Kinematics in Patients Who Have Undergone Autogeneous Fascia Frontalis Suspension

ABSTRACTPurpose: To measure spontaneous blink metrics and brow motion in patients with congenital ptosis operated with frontalis slings with autogenous fascia lata.Methods: An infrared three-dimensional video motion analyzer was employed to simultaneously measure brow motion and spontaneous blinks of 17 patients with congenital ptosis who underwent frontalis sling with autogenous fascia lata and a control group of equal number of healthy subjects. A customized software identified and quantified the amplitude and maximum velocity spontaneous blinks eyelid and brown motion during a 5-minute observation of a commercial movie. The corneal status of the patients with and without lagophthamos was evaluated with slit-lamp biomicroscopy with fluorescein staining.Results: Lagophthalmos was detected on 13 (76.5%) patients. Out of these 3 (23%) showed signs of inferior superficial keratopathy despite the presence of normal (upwards) Bell’s phenomenon in all of them. Blink rate was significantly diminished in the patients. The distribution of interblink time was similar in both groups. The mean amplitude of the down-phase of the patients’ blinks was only 38% of the controls. The main sequence slope of the patients’ blinks was abnormally low. In controls brow motion was a minute and random event no related to blinks. In the patients, the mean brow amplitude was five times higher than in controls reaching 45% of the blink amplitude.Conclusions: Spontaneous blink amplitude and velocity are severely impaired in patients with fascia lata autogenous slings. After surgery blinking amplitude is linearly related to the amplitude of brow motion.

Not Normal: the uncertainties of scientific measurements.

Judging the significance and reproducibility of quantitative research requires a good understanding of relevant uncertainties, but it is often unclear how well these have been evaluated and what they imply. Reported scientific uncertainties were studied by analysing 41 000 measurements of 3200 quantities from medicine, nuclear and particle physics, and interlaboratory comparisons ranging from chemistry to toxicology. Outliers are common, with 5σ disagreements up to five orders of magnitude more frequent than naively expected. Uncertainty-normalized differences between multiple measurements of the same quantity are consistent with heavy-tailed Student’s t-distributions that are often almost Cauchy, far from a Gaussian Normal bell curve. Medical research uncertainties are generally as well evaluated as those in physics, but physics uncertainty improves more rapidly, making feasible simple significance criteria such as the 5σ discovery convention in particle physics. Contributions to measurement uncertainty from mistakes and unknown problems are not completely unpredictable. Such errors appear to have power-law distributions consistent with how designed complex systems fail, and how unknown systematic errors are constrained by researchers. This better understanding may help improve analysis and meta-analysis of data, and help scientists and the public have more realistic expectations of what scientific results imply.

Residential property market performance and extreme risk measures

Residential property is a popular investment option and has historically attracted small Australian individual investors with debt financing lowering the initial equity component, favourable tax structure and past evidence of good returns. A major concern with this approach is uncertainty, where stable assumptions cease to hold and there is concentrated negative price movement. This extreme downside volatility may not be fully reflected in traditional risk calculations. This research studies 40 years of quarterly Melbourne established residential property market performance data for normal distribution features and signs of extreme downside risk. The results show that the normal bell curve distribution underestimated actual extreme values both by frequency and extent for ungeared residential property data. This is magnified as the gearing is increased to an extent where the outermost data point on 80% debt leverage shows an unrealistic probability of a 1 in 192 year event. Alternatively adopting the Cubic Power Law of returns, the probabilities of the most extreme event occurring drops to a realistic 1 in 38 year event. In highlighting the challenges to measuring the impact of leverage on residential property market performance, the analysis of extreme downside risk should be separated from traditional standard deviation risk calculations.

Experimental generation of a high-fidelity four-photon linear cluster state

Cluster state plays a crucial role in the one-way quantum computation. Here, we propose and experimentally demonstrate a new scheme to prepare an ultrahigh-fidelity four-photon linear cluster state via spontaneous parametric down-conversion process. The state fidelity is measured to be $0.9517\pm0.0027$. Our scheme can be directly extended to more photons to generate N-qubit linear cluster state. Furthermore, our scheme is optimal for generating photonic linear cluster states in the sense of achieving the maximal success probability and having the simplest strategy. The key idea is that the photon pairs are prepared in some special non-maximally entangled states instead of the normal Bell states. To generate a 2N-qubit linear cluster state from N pairs of entangled photons, only (N-1) Hong-Ou-Mandel interferences are needed and a success probability of $(\frac{1}{4})^{N-1}$ is achieved.

Medicolegal Sidebar: Blowback: The Unintended Consequences of Medical Liability Reform

The Medicolegal Sidebar column addresses issues that orthopaedic surgeons may face at the intersection of law and medicine. One of the goals of the column is to assist orthopaedic surgeons in making legally sound clinical and business decisions. In doing so, the column focuses on legal issues, avoiding the public debate on whether our current malpractice system favors providers or patients. Accordingly, our column will periodically publish articles by distinguished guest commentators to express their personal opinions on the current status of our malpractice system. The goal of these commentaries is to stimulate discussion among our readers and others who have an interest in malpractice litigation. Our first distinguished commentator is attorney Christopher Stombaugh. Mr. Stombaugh is an accomplished trial attorney, a faculty member of The Gerry Spence Trial Lawyers College and Past President of The Wisconsin Association of Justice. —B. Sonny Bal MD, JD, MBA, Lawrence H. Brenner JD While physicians and trial lawyers in the medical liability system may speak the same language, they really misunderstand each other. Physicians and lawyers, like the United States and Great Britain, are ‘‘[t]wo nations divided by a common language’’ [5]. A clear example of this disconnect is when we discuss medical negligence claims and medical liability reform. The common impression among many physicians is that a claim for medical negligence is, in essence, a claim that a physician is a ‘‘bad doctor.’’ Worse yet, verdicts against physicians can result in those physicians being reported to the national databank, and even unsuccessful claims have to be reported to future hospitals when one seeks employment. Litigation, therefore, can adversely affect a physician’s reputation and livelihood. Trial lawyers in the medical liability system, however, would submit that the issue should not be the fear of litigation, rather the fear of carelessly injuring patients. The latest statistics (August 2015) from the New York Law School’s Center for Justice and Democracy reveals that medical negligence cases made up Note from the Editor-in-Chief: We are pleased to publish the next installment of ‘‘Medicolegal Sidebar’’ in Clinical Orthopaedics and Related Research. The goal of this quarterly column is to encourage thoughtful debate about how the law and medicine interact, and how this interaction affects the practice of orthopaedic surgery. We welcome reader feedback on all of our columns and articles; please send your comments to eic@clinorthop.org. The author certifies that he, or any member of his immediate family, has no funding or commercial associations (eg, consultancies, stock ownership, equity interest, patent/ licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article. All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research editors and board members are on file with the publication and can be viewed on request. The opinions expressed are those of the writers and do not reflect the opinion or policy of CORR or The Association of Bone and Joint Surgeons. C. D. Stombaugh JD (&) Stombaugh, Smith & Co., 600 Washington Ave., Towson, MD 21204, USA e-mail: chris@stombaughsmith.com Medicolegal Sidebar Published online: 28 October 2015 The Association of Bone and Joint Surgeons1 2015

Defining the three Rs of commercial property market performance

Purpose – Modern property investment allocation techniques are typically based on recognised measures of return and risk. Whilst these models work well in theory under stable conditions, they can fail when stable assumptions cease to hold and extreme volatility occurs. This is evident in commercial property markets which can experience extended stable periods followed by large concentrated negative price fluctuations as a result of major unpredictable events. This extreme volatility may not be fully reflected in traditional risk calculations and can lead to ruin. The paper aims to discuss these issues. Design/methodology/approach – This research studies 28 years of quarterly Australian direct commercial property market performance data for normal distribution features and signs of extreme downside risk. For the extreme values, Power Law distribution models were examined as to provide a better probability measure of large negative price fluctuations. Findings – The results show that the normal bell curve distribution underestimated actual extreme values both by frequency and extent, being by at least 30 per cent for the outermost data point. For the statistical outliers beyond 2 SD, a Power Law distribution can overcome many of the shortcomings of the standard deviation approach and therefore better measure the probability of ruin, being extreme downside risk. Practical implications – In highlighting the challenges to measuring property market performance, analysis of extreme downside risk should be separated from traditional standard deviation risk calculations. In recognising these two different types of risk, extreme downside risk has a magnified domino effect with the tendency of bad news to come in crowds. Big price changes can lead to market crashes and financial ruin which is well beyond the standard deviation risk measure. This needs to be recognised and developed as there is evidence that extreme downside risk determinants are increasing by magnitude, frequency and impact. Originality/value – Analysis of extreme downside risk should form a key part of the property decision process and be included in the property investment manager’s toolkit. Modelling techniques for estimating measures of tail risk provide challenges and have shown to be beyond traditional risk management practices, being too narrow and constraining a definition. Measuring extreme risk and the likelihood of ruin is the first step in analysing and dealing with risk in both an asset class and portfolio context.

ERβ splice variant expression in four large cohorts of human breast cancer patient tumors.

Though the role of Estrogen Receptor (ER)α in breast cancer has been studied extensively, there is little consensus about the role of alternative ER isoform ERβ in breast cancer biology. ERβ has significant sequence homology to ERα but is located on a different chromosome and maintains both overlapping and unique functional attributes. Five variants exist, resulting from alternative splicing of the C-terminal region of ERβ. The relevance of ERβ variants in breast cancer outcomes and response to therapy is difficult to assess because of conflicting reports in the literature, likely due to variable methods used to assess ERβ in patient tumors. Here, we quantitatively assess expression of ERβ splice variants on over 2,000 breast cancer patient samples. Antibodies against ERβ variants were validated for staining specificity in cell lines by siRNA knockdown of ESR2 and staining reproducibility on formalin-fixed paraffin-embedded tissue by quantitative immunofluorescence (QIF) using AQUA technology. We found antibodies against splice variants ERβ1 and ERβ5, but not ERβ2/cx, which were sensitive, specific, and reproducible. QIF staining of validated antibodies showed both ERβ1 and ERβ5 QIF scores, which have a normal (bell shaped) distribution on most cohorts assessed, and their expression is significantly associated with each other. Extensive survival analyses show that ERβ1 is not a prognostic or predictive biomarker for breast cancer. ERβ5 appears to be a context-dependent marker of worse outcome in HER2-positive and triple-negative patients, suggesting an unknown biological function in the absence of ERα.

Relationship of Bell Phenomenon With Salzmann Nodular Degeneration

To determine the relationship of Bell phenomenon with the presence and the location of Salzmann nodular degeneration. This is a noninterventional observational case series study. We reviewed the medical records of 10 patients with Salzmann nodules between 2001 and 2012. The mean age of participants was 60 years with 8 women and 2 men. A complete history and eye examination was performed with regular follow-up visits to document the progression of the disease. The data collected were as follows: age, gender, Snellen visual acuity, manifest refraction, Salzmann nodule location, presence of Bell or inverse Bell phenomenon, treatment, and associated conditions. Slit-lamp pictures to document the location of the Salzmann nodules and the direction of the Bell phenomenon were obtained. Five patients had inferior Salzmann nodules with a normal Bell phenomenon and 5 patients had superior nodules with inverse Bell phenomenon. Nine of 10 patients had moderate to severe meibomian gland disease and dry eye syndrome as associated conditions. Two of the patients underwent removal of the nodules with lamellar keratectomy and 1 with phototherapeutic keratectomy, all with mitomycin-C application and without recurrence of the nodules at 1 year of follow-up. In all 10 patients the direction of the globe rotation during a normal or inverse Bell phenomenon was directly correlated to the location of the Salzmann nodules. Specifically, patients with inverse Bell phenomenon presented with superior nodule formation, whereas patients with a normal Bell phenomenon presented with inferior nodules.

The black swan effect and the impact on Australian property forecasting

PurposeThe term “Black Swan” has gained recent popularity to describe an extraordinary event that causes extensive damage. The combination of low predictability and major impact makes an upswing in the magnitude of Black Swan events an important factor when making property market forecasts. The difficulty is that the preferred property forecast models traditionally depend on input data constructed on a normal (bell curve) conditions. As outliers, Black Swan events appear not to form part of the property forecast process. The aim of this research is to examine Black Swan events.Design/methodology/approachThis research examines Black Swan events and tests their impact on the accuracy of short term, six month bi‐annual survey forecasts from leading economists and property analysts for key Australian property market determinants: economic activity (GDP), ten year bonds and CBD office vacancy rates for the 2005‐2011 period.FindingsA range of statistical tests showed inconsistencies with the expert forecasts to actual performance and importantly all the experts appeared to miss the start of the Global Financial Crisis in the December 2008 period. The variations in the margin of forecast error suggest that the experts examine the selected property determinants independently. Also, for economic activity and CBD office vacancy rates, there is an interesting trend that in several consecutive time periods, a simple naïve “no change” forecast was better than those of the experts.Originality/valueIn an environment of increasing occurrence of Black Swan events, this inability to forecast short term property market determinants with confidence highlights serious issues with the current approach to forecasting property market performance. The first step for research in this area is to understand and frame the property risks associated with Black Swan events.

821 RESPONSIVENESS OF THE DYSFUNCTIONAL VOIDING SYMPTOM SCORE IN CHILDREN UNDERGOING BIOFEEDBACK: ANALYSIS OF DATA FROM A RANDOMIZED CONTROLLED TRIAL

You have accessJournal of UrologyPediatrics: Bladder Dysfunction - Myelodysplasia, Voiding Dysfunction, Enuresis1 Apr 2011821 RESPONSIVENESS OF THE DYSFUNCTIONAL VOIDING SYMPTOM SCORE IN CHILDREN UNDERGOING BIOFEEDBACK: ANALYSIS OF DATA FROM A RANDOMIZED CONTROLLED TRIAL Bryce Weber, Joao Luiz Pippi Salle, Angela Buffett, Sharon Guger, Bruno Leslie, Luis Braga, Darius Bagli, Walid Farhat, and Armando Lorenzo Bryce WeberBryce Weber Toronto, Canada More articles by this author , Joao Luiz Pippi SalleJoao Luiz Pippi Salle Toronto, Canada More articles by this author , Angela BuffettAngela Buffett Toronto, Canada More articles by this author , Sharon GugerSharon Guger Toronto, Canada More articles by this author , Bruno LeslieBruno Leslie Toronto, Canada More articles by this author , Luis BragaLuis Braga Toronto, Canada More articles by this author , Darius BagliDarius Bagli Toronto, Canada More articles by this author , Walid FarhatWalid Farhat Toronto, Canada More articles by this author , and Armando LorenzoArmando Lorenzo Toronto, Canada More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2011.02.640AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES The Dysfunctional Voiding Symptom Scale (DVSS) has been increasingly utilized as an objective measurement tool for patients with dysfunctional voiding. Herein we evaluate the responsiveness of this scale compared to objective measures of uroflowmetry pattern and post-void residual urine volume (PVR) in children enrolled in a prospective randomized study. METHODS Data before and after biofeedback for 61 children diagnosed with dysfunctional voiding (strictly including patients with EMG activity during voiding phase of flow curve) was extracted. Enrolment, evaluation and intervention were conducted based on protocol and standardized to include DVSS score, uroflowmetry, and PVR before and after biofeedback. RESULTS Within the study there were 18 boys and 43 girls with a mean age of 10.5 years. Twenty five (40%) of patients had a history of urinary tract infections, and 33 patients (54%) complained of incontinence prior to therapy. In comparison with those patients that did not show improvement, patients following biofeedback that displayed a normal bell shaped uroflowmetry curve had a significant decrease in their DVSS (−3.45, P=0.001). Similarly, children with normal PVR (<20 ml, ICCS criteria) after biofeedback also displayed a significantly lower DVSS (−3.26, P=0.05). CONCLUSIONS Our results suggest that within a randomized trial the DVSS score is responsive to improvement as documented by objective measures of uroflowmetry and PVR parameters. These significant findings help validate the expanded use of this scale in this patient population, and provide further support of its value as a research tool for studies addressing children with dysfunctional voiding. © 2011 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 185Issue 4SApril 2011Page: e331 Advertisement Copyright & Permissions© 2011 by American Urological Association Education and Research, Inc.MetricsAuthor Information Bryce Weber Toronto, Canada More articles by this author Joao Luiz Pippi Salle Toronto, Canada More articles by this author Angela Buffett Toronto, Canada More articles by this author Sharon Guger Toronto, Canada More articles by this author Bruno Leslie Toronto, Canada More articles by this author Luis Braga Toronto, Canada More articles by this author Darius Bagli Toronto, Canada More articles by this author Walid Farhat Toronto, Canada More articles by this author Armando Lorenzo Toronto, Canada More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Onlay urethroplaty with one-lateral parameatal foreskin flap repair for distal hypospadias

Objective To compare two operative approaches for treatment of distal hypospadias. Methods One hundred and seven patients were recruited into the study. Group1(n=51) underwent OUPF and group2(n= 56) underwent TIPU repair. The results were analyzed with Chi-square and two Sided test. Results Operative times for OUPF and TIPU repair were (103±29) min and (92±21)min respectively (P>0.05). Fistula occurred rates were 7.8% (4/51)and 14.2% (8/56) (P>0.05). Satisfied rates for the appearance of the penis post-operation were 84.8% (39/46)and 87.8%(36/41) respectively (P>0.05). 87 patients were followed up. With mean follow-ups of 15 months (range 6 to 47) , the overall complication rates were 15.7% (8/51) and 32.1 % (18/56)(P<0. 05) for OUPF and TIPU repair. Only 4 of 51 patients (7.8%) undergoing OUPF underwent re-operations, compared to 15 of 56 patients (26.8%) undergoing TIPU repair (P<0.001). A plateau uroflow curve (vs normal bell curve)was observed in 33.3% (13/39)and 67.6(25/37) ,respectively(P<0. 001). The average flow rate was 9. 4 ml per second (range 3. 2 to 17. 1) in patients undergoing OUPF repair, compared to 6. 8 ml per second (3. 3 to 15, P<0. 05) for those undergoing TIPU repair. Mean peak flow rates were12.2 ml per second (range 3.9 to 22.9) and 8. 3 mi per second (range 3.7 to 18. 1, P<0.01) for OUPF and TIPU procedures. Conclusion OUPF is superior to TIPU in the surgical treatment of distal hypospadias. Key words: Hypospadias; Surgical procedures, elective

Comparative Analysis of Tubularized Incised Plate Versus Onlay Island Flap Urethroplasty for Penoscrotal Hypospadias

Despite being the dominant technique for repair of distal hypospadias, application of the tubularized incised plate approach for penoscrotal hypospadias remains controversial. We report our experience with severe hypospadias, comparing tubularized incised plate to transverse island flap onlay urethroplasty. We retrospectively reviewed consecutive patients with penoscrotal hypospadias presenting between 1998 and 2006. Based on surgeon preference 35 children underwent tubularized incised plate and 40 underwent onlay urethroplasty. Penoscrotal transposition and degree of ventral curvature, type of ventral curvature repair, complication rate, postoperative uroflowmetry pattern in toilet trained patients and number of reoperations were compared between the 2 groups. Mean patient age at surgery was 17 months (range 9 to 91) for tubularized incised plate urethroplasty and 17.8 months (10 to 58) for the onlay procedure. Urethroplasty was performed over an 8Fr catheter in all patients. With mean followups of 30 months (range 6 to 74) and 38.8 months (16 to 80) the overall complication rates were 60% and 45% for the tubularized incised plate and onlay procedures, respectively. Fistula occurred in 15 patients and repair breakdown in 3 patients (total 51.4%) treated with tubularized incised plate repair, compared to 8 and 2 patients, respectively (25%), treated with onlay repair (p = 0.01). Fistula location also differed significantly between the 2 groups, with proximal fistulas occurring in 11 of 15 tubularized incised plate repairs (73.3%) vs 2 of 8 onlay repairs (25%, p = 0.02). Recurrent ventral curvature was more frequent after onlay urethroplasty (5.7% vs 12.5%, not significant). At a mean age of 5.1 years a plateau uroflow curve (vs normal bell curve) was observed in 16 of 24 children (66.7%) who underwent tubularized incised plate repair and in 7 of 21 (33.3%) who underwent onlay repair (p <0.01). In this series the overall complication rate was similar for tubularized incised plate and onlay urethroplasty. Despite similar urethroplasty calibers, the uroflow curves and fistula positions in patients undergoing tubularized incised plate repair suggest that the neourethra distal to the fistula may be relatively narrow, creating flow resistance and leading to proximal fistula. Longer followup and close monitoring are needed before embracing one approach over the other.