A new technique for skin closure in hypospadias: ipsilateral penoscrotal approximation for closure

Sixteen patients, between 2 and 45 years old, with hypospadias underwent repair with our new skin closure procedure called ipsilateral penoscrotal approximation for closure (IPSAC). Complete functional success was obtained in all 6 patients with distal hypospadias and in 7 of 10 patients with proximal hypospadias. Meatal regression and urethrocutaneous fistula were complications in one-stage repair. Another urethrocutaneous fistula resulted from fifth-stage repair in the case of an adult hypospadias cripple. Cosmetically, there were two cases with unsightly thickening of the base of the penis in this early series. It was found that this IPSAC procedure had two major advantages: it provided (1) a tension-relieving skin closure, and (2) correction of scrotal deformity, especially in one-stage repair with the parameatal flap and in multi-staged repair with absolute penile skin deficiency.

Low-density lipoprotein receptor activity in the guinea pig adrenal cortex. II. Zonal response to aminoglutethimide and 17 alpha-ethinylestradiol

Low-density lipoprotein (LDL) receptor activity and the concentration of cholesterol were measured in the outer (glomerulosa/fasciculata) and inner (reticularis) zones of the adrenal cortex of the guinea pig to examine the relation between cholesterol content and LDL receptor activity. While the concentration of cholesterol was 2-3-times higher in the outer cortical zone, the maximum high-affinity binding capacity for LDL was essentially the same for the two zones, or slightly higher for the inner zone. Adrenocorticotrophic hormone (ACTH) caused a significant increase in LDL receptor activity only in the outer zone, but led to a reduction in the cholesterol content in both adrenocortical zones. The treatment of animals with 17 alpha-ethinyl-estradiol also resulted in a reduction of cholesterol in both adrenocortical zones, but an increase in LDL receptor number only in the outer zone. The latter effect was partially reversed by the administration of dexamethasone. Aminoglutethimide, which was used in a dose that did not block steroidogenesis but did block the hydrolysis of cholesteryl esters in response to ACTH, did not prevent the ACTH-induced increase in LDL receptor number in the outer zone. Thus, the number of LDL receptors was increased in the zona fasciculata by ACTH in the absence of a reduction in cellular cholesterol content, while the number of LDL receptors in the zona reticularis was not increased by ACTH even in the face of a reduction in cellular cholesterol. Exclusive of the experiments employing aminoglutethimide, when the cellular cholesterol content was plotted against LDL binding activity, an excellent inverse correlation was revealed for the zona fasciculata, but essentially no correlation was noted for the zona reticularis. It is concluded that the outer and inner cortical zones of the guinea pig adrenal are quite distinct in the nature of their LDL receptor activity and regulation: the LDL receptor of the outer zone appears to function in a way similar to what has been reported for the whole adrenal cortex of other species in that receptor number correlates with tissue cholesterol content and is primarily regulated by ACTH; the LDL receptor number of the inner zone, however, does not correlate with tissue cholesterol content and is apparently not regulated by ACTH.

Low density lipoprotein receptor activity in the guinea pig adrenal cortex. I. Zonal characterization and response to adrenocorticotropin

The binding of [125I]iodo-low density lipoprotein ([125I]iodo-LDL) to isolated membranes was determined for the outer (glomerulosa/fasciculata) and inner (reticularis) zones of the guinea pig adrenal cortex. Binding of [125I]iodo-LDL to membranes from both zones was found to be highly specific and dependent on the presence of divalent cations, such as calcium. Saturation analysis revealed that the maximum high affinity binding capacity was similar for both zones under control conditions (approximately 400 ng/mg protein). When ACTH was administered, however, the maximum high affinity binding capacity increased in the outer zone by at least 3-fold, while there was no significant change for the inner zone. It was also noted that dexamethasone administration decreased [125I]iodo-LDL high affinity binding activity to less than half the control level in the outer zone without altering the binding activity in the inner zone. The cholesterol content in the outer zone was 2-3 times greater than that in the inner zone. When ACTH was administered, the concentration of cholesterol decreased significantly in both zones. Thus, ACTH appeared to influence cholesterol metabolism in the outer and inner adrenocortical zones, but was able to modulate LDL receptor activity only in the outer zone.

Pituitary and gonadal function in prepubertal boys with hypospadias

Luteinizing hormone releasing hormone and human chorionic gonadotropin tests were performed to examine the pituitary gonadal axis in 31 prepubertal boys with hypospadias. Luteinizing hormone and follicle stimulating hormone responses to luteinizing hormone releasing hormone in these boys with hypospadias were significantly higher than those in prepubertal control subjects (luteinizing hormone, p less than 0.01). follicle stimulating hormone, p less than 0.05). Prepubertal boys with hypospadias had remarkably reduced testosterone responses to human chorionic gonadotropin stimulation compared to controls (p less than 0.01). Hormonal milieus were further analyzed in the subtypes of hypospadias depending on their severity (distal vs. proximal). Nine of the 31 boys with hypospadias were classified as the proximal type. Basal luteinizing hormone levels in the proximal type were significantly higher than in the distal type (p less than 0.05). Luteinizing hormone and follicle stimulating hormone responses to luteinizing hormone releasing hormone and responses of testosterone to human chorionic gonadotropin were not significantly different in the 2 types. Seven of the 31 boys with hypospadias had a history of maternal progestin ingestion. Basal luteinizing hormone levels and responses of luteinizing hormone and follicle stimulating hormone to luteinizing hormone releasing hormone were also significantly higher in these subjects than in controls (p less than 0.005), though basal levels and responses of testosterone to human chorionic gonadotropin were not different from those of controls. Tests conducted to determine luteinizing hormone and follicle stimulating hormone and testosterone levels using luteinizing hormone releasing hormone and human chorionic gonadotropin stimulation revealed no statistical differences between the boys with hypospadias who had a history of maternal progestin ingestion and those without such a history. The majority of prepubertal boys with hypospadias had varying degrees of deficient testicular activity. The testicular function of these patients should be evaluated longitudinally at puberty and thereafter in order to insure the completion of secondary sexual development.

One-stage repair of perineal hypospadias and scrotal transposition

Our experience with one-stage repair of severe perineal hypospadias and scrotal transposition is described. In essence the urethra is formed by our (extended parameatal) wing flap-flipping method, while the scrotum is normally repositioned with skin closure. Comparison is made with other repairs, while the safety of the extended parameatal pedicle flap is stressed.

Complete repair of severe penoscrotal hypospadias in 1 stage: experience with urethral mobilization, wing flap-flipping urethroplasty and "glanulomeatoplasty"

We describe our experience with complete repair of severe penoscrotal hypospadias in 1 stage. The operative technique includes several innovative points, such as release of chordee by urethral mobilization (without detaching it from the glans) after penile degloving of dartos chordee, wing flap-flipping urethroplasty to the tip of the glans and incrimination of "glanulomeatoplasty" for better cosmetic and functional results. Our technique is compared to other 1-stage methods.

Plasma LRH levels in chronic renal failure before and during haemodialysis

Endogenous immunoreactive luteinizing hormone - releasing hormone (LRH) in plasma was determined in 6 male and 7 female patients with chronic renal failure before and during haemodialysis. Basal plasma LRH levels ranged from 5.8 to 23.0 pg/ml and, in 11 out of 13 patients, were above the levels seen in healthy subjects (less than 7 pg/ml for men and less than 8 pg/ml for women). This immunoreactivity was eluted iun identical fractions with synthetic LRH and plasma extracts from climacteric women on Sephadex G-25 chromatography, and the dilution gave a displacement curve parallel to the standard. Within 5 h of haemodialysis, these high LRH levels declined into the normal range. The concentrations of LH in plasma in these patients were also elevated, but those of testosterone in male patients were decreased. These results suggest 1) that elevated plasma LRH reflects decreased feedback inhibition by primary gonadal failure and might in turn be responsible at least in part for high concentrations of plasma LH in chronic renal failure, and 2) that plasma LRH is mainly not bound to plasma proteins.

[Composition of the 32-detector rCBF system (Meditronic) and experience in its use (author's transl)]

Regional cerebral blood flow (rCBF) was measured in patients with no neurological deficit and no abnormal findings of cerebral angiograms except aneurysm itself with Xenon-133 injection technique by using the computerized 32-detector rCBF system (rCBF-322, Meditronic, Denmark). This system consists of a 32-detector head with a concave surface and a 32 pulse height analyser and analog-digital ratemeter as the accumulator connected to display units with an oscilloscope for 32 clearance curves and also a microcomputer programmed for calculating the rCBF initial with the initial slope analysis, for calculating the rCBF 10 with the height-over-area method and the rCBF gray, rCBF white, weight gray and weight white with the SHAM method. The results obtained were as follows: 1) The mean value and SD of rCBF initial was 58.4 +/- 6.2 ml/100 g brain/min; rCBF 10, 50.6 +/- 5.0 ml/100 g brain/min; rCBF gray, 78.0 +/- 14.0 ml/100 g brain/min; rCBF white, 22.1 +/- 6.6 ml/100 g brain/min; weight gray, 49.0 +/- 3.7%; weight white, 51.0 +/- 3.7%. These data should be considered normal values as reported also by others. 2) Reproducibilities were estimated by measuring twice the rCBF initial and the rCBF 10 at rest with closed eyes. The reproducibilities of the rCBF initial eyes 13.55% (P less than 0.05) and one of the rCBF 10 was 8.85% (P less than 0.05). It was concluded that this system should be widely used for measuring the rCBF in patients with various cerebral diseases.