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Biomedical subjects

A M Kajbafzadeh

Publications and source records attributed to A M Kajbafzadeh.

11 recordsLinked to original sources
PubMed2006

A novel technique for approximation of the symphysis pubis in bladder exstrophy without pelvic osteotomy.

PURPOSE: We evaluated the outcome of pubic bone approximation and internal fixation using a miniature metal plate and screws without osteotomy in children with bladder exstrophy. MATERIALS AND METHODS: A total of 17 children with bladder exstrophy underwent surgery. Mean patient age was 27 months. Of the patients 15 had a history of 1 or more failed bladder closures with or without osteotomy. All children underwent bladder closure and complete posterior and anterior urethroplasty with bladder neck wrap. Both ureteral orifices were brought together by the Gil-Vernet antireflux procedure. The pubes were brought together with 3 deeply placed 1 mm polyglactin sutures through the bone and fixed by placing a miniature metal plate with 6 to 7 screws. Patients remained in a frog leg bandage for 1 to 3 weeks. The plate was removed during additional surgery. Median followup was 61 months (range 14 to 71). RESULTS: All children had an uneventful postoperative period without any serious complications, except for skin erosion caused by a screw without bone infection in 1 patient, and miniature plate subluxation following cystoscopy for reinsertion of urethral catheter 3 days after initial surgery in 1. Operating time and hospital stay were significantly lower than in children undergoing osteotomy or Bryant's traction. Overall continence rate was 53.8%. CONCLUSIONS: Although the number of patients is low, these results are promising. Pubic bone adaptation with miniature plate fixation without any type of osteotomy or leg traction is safe and less invasive than bilateral osteotomy and postoperative leg traction or plaster.

Bladder Exstrophy↗
PubMed2006

Fetus in fetu.

Fetus in fetu (FIF) is a very rare condition, with a reported incidence of one in 500,000 live births. It most likely represents a monozygotic diamniotic twin that implants itself and grows within the body of its normal karyotypically identical sibling, which typically manifests as a fetiform abdominal mass in a newborn or infant. The mass is located in the retroperitoneum in most cases, including our example, and is commonly surrounded by encapsulated fluid. However, FIF has been reported to occur in other locations, such as within the cranium, the scrotum, and the oral cavity. Usually only one fetus is present but very rarely multiple fetuses may also be present. Five fetuses in the cranium of a 1-day-old female infant with hydrocephalus (although three of these fetuses were composed of extremities only) had been reported. The fetus itself is incomplete, containing a variable number of identifiable organs. The lung, the liver, the adrenal gland, the pancreas, and the genital organs may be seen in the more complex specimens. The presence of a head with eyes, hair, and teeth has been reported, but most of these fetuses are anencephalic. We are presenting a FIF mimicking a solid and cystic renal mass in a 6-month-old boy.

Fetus↗
PubMed2001

Simultaneous Malone antegrade continent enema and Mitrofanoff principle using the divided appendix: report of a new technique for prevention of stoma complications.

PURPOSE: We determine the results and complications of continent urinary diversion and simultaneous Malone antegrade continent enema (MACE) and the Mitrofanoff principle using the divided appendix, and report on the VQQ and VQ technique for prevention of complications at the stoma level. MATERIALS AND METHODS: Between June 1995 and June 1999, 40 patients 4 to 22 years old (mean age 9.5) underwent Mitrofanoff procedures in conjunction with the MACE and augmentation cystoplasty as primary (5) or salvage (35) therapy. Of the patients 35 had neuropathic bladder, and 5 had bladder and bowel dysfunction without detectable neurological abnormalities. All patients had an antireflux Mitrofanoff channel constructed using distal part of the appendix with its divided mesothelium. The proximal half of the appendix was preserved as a modified MACE. Average length of appendix was 10.3 cm. (range 9 to 15) and no correlation was found between the length of appendix and age of child. The stoma construction was performed as 2 different techniques. The 2 appendix stomas were initially anastomosed with 2 separate triangular posterior V shape skin flaps on the right lower abdominal wall. Both appendix mucosae were completely buried with a single or double quadrilateral skin flap (VQQ and VQ technique). RESULTS: All patients are continent day and night without diapers. Mean followup was 22 months (range 8 to 48) and the overall incidence of complications was 7.5%. Mitrofanoff stomal stenosis due to catheter false passage occurred postoperatively in 1 case, gas leakage from the MACE in 1 and partial mucosal prolapse in 1. CONCLUSIONS: The MACE and Mitrofanoff principle have proved invaluable for the treatment of children with urinary and fecal incontinence. The divided appendix with 2 separate mesotheliums is an ideal channel for simultaneous Mitrofanoff and MACE when the appendix length is 9 cm. or more with a suitable branching mesothelium. When the appendix is short we prefer to use it as the Mitrofanoff and create a pediculed tube flap from the cecum for the MACE. All patients with a short appendix or history of appendectomy operated on by different techniques, such as the Monti procedure, Casale technique, cecal flap or ureteral Mitrofanoff, were excluded from our study. Most of the minor complications are preventable by meticulous technique. The VQQ and VQ stomas have the lowest incidence of complications and produce the most satisfactory cosmetic appearance.

Adolescent↗
PubMed1997

Arteriovenous fistula following nephrectomy.

UNLABELLED: Arteriovenous fistula (AVF) of the renal pedicle is a rare complication of nephrectomy. Since the 1st case report in the literature, 62 cases have been reported in the world literature. A continuous abdominal or lumbar bruit is diagnosed. They may also present with symptoms of congestive heart failure and/or hypertension. METHODS: 37 years following nephrectomy, a case of AVF of the right renal pedicle associated with gross proteinuria is described. RESULTS: The clinical diagnosis was confirmed by aortogram, and the proteinuria subsided after successful surgical management. CONCLUSION: The causes of proteinuria may be due to the hyperfiltration state. To our knowledge, there has been no previous report of this combination in the literature.

Arteriovenous Fistula↗
PubMed1997

The role of ureter in the creation of Mitrofanoff channels in children.

PURPOSE: Since 1980 numerous variations of the Mitrofanoff principle have been described. We report on 22 children in whom a ureteral Mitrofanoff channel was created. MATERIALS AND METHODS: Between 1986 and 1995 a ureteral Mitrofanoff channel was constructed as a catheterizable conduit in 22 children 2 to 15 years old (average age 6.5) with various abnormalities of the lower urinary tract, mainly exstrophy and neurogenic bladder. Indications included unavailability or unsuitability of the appendix, preference for appendix as a catheterizable colonic stoma for antegrade washouts or concomitant removal of a nonfunctioning kidney, leaving the ureter available for use. Surgical technique was based on the principles of appendicovesicostomy and in 9 cases the ureteral Mitrofanoff channel was reimplanted. RESULTS: Followup ranged from 1 to 72 months (average 30.5). Complications included stenosis of the conduit that caused difficult catheterization in 3 patients, necessitating dilation or minor revision in 2 and complete replacement by appendix in 1. Urinary leakage from the Mitrofanoff channel in 5 patients was treated with polydimethylsiloxane injection or oxybutinin. In 1 patient the channel was reimplanted, since the catheter struck the bladder neck during catheterization and caused severe pain. CONCLUSIONS: Results of the ureteral Mitrofanoff channel seem somewhat less satisfactory than those of appendicovesicostomy but they remain acceptable and even comparable, strongly supporting its use in certain circumstances.

Adolescent↗
PubMed1995

The evolution of penile reconstruction in epispadias repair: a report of 180 cases.

From 1978 to 1993, 180 boys with epispadias (85) and the exstrophy/epispadias complex (95) underwent epispadias reconstruction at our institution. The 180 patients were divided into 4 groups: group 1--2-stage epispadias reconstruction with dissection of the corporo (30 patients), group 2--pedicled preputial tube urethroplasty either alone or with a lyophilized human dural patch to the corpora for correction of penile deformity (35), group 3--pedicled preputial tube urethroplasty and corporeal rotation (40), and group 4--a modified Cantwell epispadias repair incorporating complete tubularized urethroplasty, cavernocavernostomy and corporeal rotation. In 46 patients from groups 1 to 3 the primary outcome was not considered satisfactory and they underwent radical penile revision with the modified Cantwell technique. Followup ranges from 1 to 15 years (mean 6 years). We conclude that a good cosmetic result can be achieved in almost all cases using the modified Cantwell technique as a primary procedure in experienced hands. This technique has a low complication rate and can be used as a salvage procedure following previous unsuccessful epispadias reconstruction using other techniques.

Adolescent↗
PubMed1995

Radical single stage reconstruction in failed exstrophy.

Staged repair of exstrophy-epispadias complex cases with initial bladder closure followed by epispadias and bladder neck repair at a later date is well documented. However, the role of single stage repair as a primary and salvage procedure after failed closure is not well established. A total of 12 male patients with bladder exstrophy has undergone single stage repair at our facility (10 secondary and 2 primary procedures). Mean age of the 10 patients referred for secondary repair was 5.5 years (8 months to 13 years). In this group there had been 16 previously unsuccessful attempts at bladder closure and 15 operations for epispadias repair. The 2 primary repair patients were 15 months and 13 years old. Continence was achieved by bladder neck reconstruction combined with epispadias repair and all cases were augmented by enterocystoplasty in conjunction with a Mitrofanoff channel. Pelvic osteotomy was performed in 3 cases. After bladder neck revision in 2 children all are dry day and night on clean intermittent catheterization and have a satisfactory cosmetic appearance. Single stage reconstruction of the exstrophy complex is a satisfactory method with a low morbidity for treating children in whom previous repair has failed. Its more extended role in the primary case requires further evaluation.

Adolescent↗
PubMed1995

Augmentation cystoplasty in boys with posterior urethral valves.

The role of augmentation cystoplasty in the neuropathic and exstrophy bladder has been well documented. However, its place and the timing of such surgery in the "valve bladder" are not well established. We report our experience with augmentation cystoplasty in 20 boys with previously treated posterior urethral valves. Urodynamic studies confirmed poorly compliant, unstable bladders with low functional capacities, which had failed to respond to anticholinergic treatment in all patients. The bladder was augmented with ileum in 9 cases, stomach in 7, colon in 2 and ureter in 2. A Mitrofanoff channel was fashioned in 6 cases. Upper tract dilatation improved in 17 patients and remained stable in 3. Of the patients 17 are dry day and night. Eleven patients void spontaneously without significant residual urine, 7 are on clean intermittent catheterization for residual urine of greater than 50 ml. and 2 are completely dependent on catheterization. Augmentation cystoplasty is a safe and effective method to achieve continence with a low capacity, poorly compliant bladder in children with posterior urethral valves who do not respond to medical management. In contrast to the neuropathic and exstrophy bladder, the augmented valve bladder allows spontaneous voiding without significant residual urine in the majority of cases. Early intervention in these patients may prevent deterioration in renal function.

Adolescent↗