INTRODUCTION AND OBJECTIVES: Tubularized incised plate urethroplasty (TIPU) has been the standard for distal hypospadias repair. Herein, we compare the use of dartos pedicle versus small intestinal submucosal (SIS) graft as a secondary layer with TIPU for distal hypospadias repair. METHODS: Forty-one patients with distal hypospadias were enrolled in a double blinded randomized controlled study comparing the use of dartos pedicle versus 4-layer SIS graft as a secondary layer during TIPU. The two groups were analyzed regarding patient age, urethral plate width, glans groove, stent size and duration, operative time and complications. Patients were followed up to 6 (mean 4.3 months). RESULTS: Group (A) included 20 patients with distal hypospadias (12 distal penile and 8 coronal) and managed with dartos pedicle during TIP repair. Patients’ age ranged from 6-96 (mean 51 months). Group (B) included 21 patients (12 distal penile and 9 coronal) and managed with SIS graft as a secondary layer during TIP repair. Patients’ age ranged from 7-144 (mean 64.4 months). Mean urethral plate width was 7 & 5.7 mm respectively. The glans groove was shallow in 76.1% and 71.4% respectively. Operative time ranged from 60-90 min (mean 70 & 69.3 min for both group respectively). An 8Fr Nelaton catheter was left indwelling for 7 & 7.6 days respectively. Complications rate was 10% (urethrocutaneous fistula in 2 patients) and 42.9% (urethrocutaneous fistula in 6 and disruption in 3 patients) respectively. CONCLUSIONS: The use of dartos pedicle with TIP repair remains the gold standard for distal hypospadias repair with the least complications rate. SIS graft may have place in case of circumcised hypospadiac patients or redo cases. A larger study group with longer follow up is required to assess long-term outcome for distal hypospadias repair utilizing SIS graft. Source of Funding: none

Objectives The purpose of this study was to describe a putative role for a novel soxS mutation in contributing to multiple-antibiotic resistance in canine fluoroquinolone-associated MDR (FQ-MDR) Escherichia coli. This soxS mutation was discovered in canine faecal E. coli isolates during a study investigating the effect of oral fluoroquinolone administration on faecal E. coli in healthy dogs. Methods We determined via quantitative real-time RT–PCR that both soxS and acrB were overexpressed in the clinical soxS Ala-12→Ser (soxSA12S) mutants and this may account for their FQ-MDR phenotype. We validated the FQ-MDR phenotype of the clinical isolates by reconstructing the WT and the soxSA12S mutation in the E. coli soxS null mutant JW4023 (soxS::kn) via allelic exchange. Results The JW4023 soxSA12S derivative showed an increase in MICs of ciprofloxacin, enrofloxacin and chloramphenicol compared with the JW4023 derivative in which the WT soxS had been restored. The soxS and acrB genes were overexpressed in the JW4023 soxSA12S mutant compared with JW4023 with WT soxS. A similar overexpression of efflux pump genes and an increase in antibiotic resistance were observed upon stimulation with paraquat to resemble the phenotype of the clinical soxSA12S isolates. Conclusions Our data suggest that the soxSA12S substitution mutation is selected in clinical isolates when dogs are exposed to a fluoroquinolone and that this mutation contributes to the FQ-MDR phenotype of E. coli isolates.

Background: Elevated high sensitivity C reactive protein (hs-CRP) has been identified as a strong predictor of prognosis acute coronary syndrome. The prognostic significance of hs-sensitivity CRP level in percutaneous coronary intervention (PCI) is unclear. Aim of the work: is study is to assess the hs-CRP value and its prognostic significance in short and long term follow up after PCI. Methods: We prospectively studied 41 patients with chronic stable angina (28 patients) and unstable angina (13 patients) who underwent elective coronary stenting. All patients had normal troponin level before the procedure. Blood samples for hs-CRP were obtained before the procedure, 24 hours after the procedure and followed up at 1 month and after 2years. Results: Mean hs-CRP before and post the procedure in all patients underwent PCI was 2.38±2.21µg/ml and 7.43± 10.6 µg/ml respectively. There was significant difference between pre procedural hs-CRP and 24 hours post procedural (P= 0.007). At follow up period (1 month), no major adverse cardiac events (MACE) have occurred. At follow up period (2 years), MACE has occurred in 13 patients. There was a weak correlation between the level of the pre-procedural hs-CRP and occurrence of MACE (r=0.22, P=0.2) and no correlation between post procedural hs-CRP and occurrence of MACE. Conclusion: Mechanical disruption of atherosclerotic plaque during elective coronary stent implantation causes a systemic inflammatory response. Measuring of hs-CRP either pre-procedural or post procedural in low risk patients is not useful for predicting of either early or late cardiovascular events.

Purpose The optimal management of complicated umbilical hernia in patients with liver cirrhosis is still undefined. The purpose of this study is to evaluate the use of polypropylene mesh to treat complicated umbilical hernia in cirrhotic patients. Methods In the period from January 2005 to May 2008, 80 patients with complicated umbilical hernia combined with liver cirrhosis underwent hernia repair. The patients were randomly divided into two groups; each group consisted of 40 patients. Hernia repair was carried out by conventional fascial repair in group I and by mesh hernioplasty in group II. Results The male/female ratio, Child-Pugh class, and mode of hernia complication were almost matched in both groups. Hernia recurrence was significantly less in the mesh hernioplasty group. No mesh exposure or fistulae were experienced. There was no need to remove any of the meshes. Conclusions Permanent mesh can be used in complicated hernias in cirrhotic patients with minimal wound-related morbidity and a significantly lower rate of recurrence.