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Formation of a mucosal collar from the inner surface of the prepuce offers the surgeon who performs hypospadias repairs the opportunity to create a cosmetically normal-appearing phallus. This technique results in transposition of mucosal membrane type of tissue to the subglandular area to complete the normal repair.
Conventional circumcision techniques may result in bleeding, limited control of the mucosal collar, and the need for dressings. We describe a modified bipolar technique enabling near-bloodless dissection with precise mucosal trimming. Following bipolar division of the preputial skin, the inner mucosa is separated using two forceps and retracted proximally, creating a protective plane for safe skin adjustment. The mucosal collar is trimmed with scissors. The wound is closed with sutures and 2-octyl cyanoacrylate, avoiding dressings. This technique has been performed in 55 consecutive cases (median age: 2 years and 2 months; range: 0 days-17 years and 5 months) with no reported complications over a median follow-up of 2 years and 7 months (range: 3 months-4 years and 1 month).
In 39 patients a 2-stage modified Belt-Fuqua repair was performed for severe hypospadias and chordee. Patient age at initial surgery averaged 2 years and stage 2 was done 7 months later. Testosterone was given before stage 1 to 22 patients (56%) and before both stages to 13 (33%). Of 5 patients with intersex 2 had mixed gonadal dysgenesis, 1 was a true hermaphrodite and 2 were 46 XX male subjects. The preoperative meatal location was subglanular in 9 cases, mid shaft in 8, proximal shaft in 2, penoscrotal in 15 and perineal in 5. Those with subglanular meatus had hypoplastic distal urethras and severe chordee. A dorsal Nesbit procedure for chordee correction was done in 24 cases (62%). Neourethral length ranged from 3 to 7 cm. (average 4 cm.) and average followup was 16 months. Neourethral diverticula developed in 8 cases (21%) and they were repaired uneventfully an average of 7 months (range 2 to 24) after stage 2. Minor urethral strictures (3 distal and 4 proximal) were treated with a single visual internal urethrotomy and there was 1 (2.5%) urethrocutaneous fistula. All children had excellent cosmetic and functional outcomes. A staged approach allows for cosmetic reconstruction of the glans and mucosal collar during stage 1 and offers 2 opportunities to augment penile size with testosterone. Bladder or buccal mucosal grafts are avoided since the prepuce is always adequate. There are no hypospadias deformities, penile shaft torsion or asymmetry. Fistula formation is minimal and strictures are minor. The 2-stage repair remains a safe, reliable alternative for boys with severe hypospadias.
A modified technique using a submarginal free mucosal graft has been developed to aid in root coverage. The gingival collar of keratinized tissue is relaxed via a horizontal or semilunar incision and coronally placed. The periosteum is retained on the osseous structures of the recipient site. A free mucosal graft from the palate is sutured submarginally, while the dentist places tension on the gingival collar in an incisal direction. This method has been found, in 8 years of study, to be a predictable way for the periodontist to cover receded gingival tissue where esthetics or root sensitivity is a factor.
Lymphoepithelium and cells specialized for uptake and transport of foreign matter are characteristic of antigen sampling organs, including lymphoglandular complexes (LGCs). Distribution, histologic structure, and epithelial ultrastructure of colonic lymphoglandular complexes were determined in 5- to 13-week-old pigs. LGCs averaged 1,231 in number per colon, displayed a characteristic distribution pattern, and were most evenly distributed in colons of older pigs. LGCs consisted of well-defined submucosal masses composed of lymphatic nodules and internodular lymphoid tissue penetrated by radially branching extensions of mucosal glands. Epithelial diverticula of each LGC entered the submucosa as a group through a circular collar derived from the muscularis mucosae. LGC epithelium contained goblet cells, cuboidal and columnar enterocytes, enteroendocrine cells, individual and clustered intraepithelial leukocytes, and cells morphologically compatible with follicle-associated epithelial cells/M cells. We regard the colonic LGC as a distinct mucosal lymphoid organ and suggest a significant role for it in local and systemic immune responses. The porcine colonic LGC may serve as a model for the human LGC.
The radiologic, endoscopic, and histologic findings in two patients with flaskshaped or collar-button collections of barium in the duodenum are presented. These abnormal mucosal depressions, which may be related to inflammation, were seen endoscopically and identified radiographically and have not been reported previously.
Esophago-tracheal fistulae develop to an increasing extent due to the long-term intubation in intensive-care patients. Their treatment is usually problematic, since the general condition of the patient, weakened by his basic disease, very often does not permit any major intervention; in addition, the topographical location of the fistula makes the access to it even more difficult. In one patient two attempts failed to close the fistula from an extended tracheostomy. The narrow access passage between the anaesthetic tube and the tracheal wall did not permit an exact suture; the heavy formation of scars in the fistular environment did not permit either a preparation in layers or the shift of mucosal flaps for coverage. However, a fistula was successfully closed from a collar mediastinotomy. With normal tracheal width, unrestricted esophagus function was restored without damage to the recurrent laryngeal nerve. The advantages of this surgical method are discussed in greater detail.
Four major types of surface conformation were observed in the ceca of uninoculated control chickens. Spatulate villi were found in the cecal neck region, low ridges in the region where the neck expands, protruding collarlike structures in the mid cecal pouch, and flattened collars in the distal portion. In ceca infected with Eimeria tenella, there was some erosion and sloughing of the mucosal cells. These lesions were slight in the neck region, more severe in the dilated portion, most severe in the midregion, and moderate in the distal area. Oocysts were observed in the mucosal tissue of the cecal pouch.
The collar button-shaped ulcer is a distinctive radiographic manifestation of inflammatory disease of the GI tract. Its hallmark is mucosal ulceration with undermining submucosal extension limited by the relatively resistant underlying muscle wall. Such a process is commonly associated with ulcerative colitis where it may be seen diffusely in advanced stages of the acute disease. Occasionally, however, it may be seen in any ulcerating inflammatory disease. In the more aggressive transmural diseases, it is likely to be a localized and transient phenomenon. The same pathophysiological mechanism gives rise to the common appearance of benign ulceration anywhere in the GI tract and, particularly, in the undermined gastric ulcer.
The jejunal mucosa of 4 cases of equine granulomatous enteritis and 2 control horses was investigated by light microscopy and by scanning and transmission electron microscopy. Attention was focused upon changes in mucosal topography and enterocyte morphology in the inflamed mucosa. Structural changes ranged in severity from only a slight thickening and shortening of villi to the appearance of a virtually flat mucosa, upon which crypts opened directly or through shallow cavities encircled by collars of epithelial cells. Between these extremes, the mucosa showed a variety of patterns, all characterized by distinctly abnormal villus projections. These were often united by epithelial bridges and were commonly markedly short, broad and irregular. Enterocytes of mildly changed mucosae showed a normal histology and fine structure, whereas more severely changed specimens displayed a flattened surface epithelium with ultrastructural abnormalities, the most consistent being a pronounced shortening of microvilli. In particular, greatly flattened cells showed evidence of cellular injury, such as prominence of cytolysosomes and degenerative changes of the rough endoplasmic reticulum, while other cells were chiefly characterized by an abundance of non-membrane-bound ribosomes and other features signifying an immature state. Cell-membrane-tight junctions of the surface epithelium appeared to be intact. No intracellular micro-organisms were detected. It is suggested that several factors are involved in the creation of the abnormal mucosal topography in this disease, including excessive enterocyte loss, crypt cell destruction, inflammatory distension of villi and villus fusions.
The potential of ramosetron ((R)-5-[(1-methyl-3-indolyl)carbonyl]-4,5,6,7-tetrahydro-1 H-benzimidazole hydrochloride, CAS 132907-72-3, YM060) orally disintegrating tablets to cause irritation to the oral mucosa was assessed in a group of six male and six female Syrian hamsters. Each animal was given one tablet containing 0.1 mg YM060 into the right cheek pouch once daily for 14 consecutive days. A neck collar was fitted for 1 h after each administration to ensure that the tablet was not expelled. A similarly constituted group of hamsters received placebo tablets and acted as a contemporaneous control. Left and right cheek pouches were examined before dosing each day, and on the day following the last treatment. At the end of the treatment period the animals were killed, the cheek pouches excised and examined macroscopically. The cheek pouches of all animals were assessed for histopathological change. There were no signs to indicate systemic or local reactions to treatment in any animal. Macroscopic and microscopic examination of the cheek pouches did not reveal any treatment-related effect. It is concluded that YM060 orally disintegrating tablets are non-irritant to the hamster oral mucosa.
Twenty-two consecutive patients presenting with symptomatic human immunodeficiency virus 1 (HIV-1) seroconversion were studied. Most of the patients had a glandular fever-like illness. All patients had fever and pharyngitis, and eight of them also suffered from ulcers of the oral, genital or anal mucosa. Uniform skin eruptions were observed in 17 of the 22 patients. The exanthem consisted of varying numbers of macular or maculopapular lesions that were oval or rounded in shape, ranging from a few millimetres to 1 cm in diameter. The lesions were distributed on the upper thorax in all cases, and were particularly profuse in the collar region. The face, forehead and scalp were involved in most cases, but the eruption was sparse or absent at the periphery of the extremities. In the majority of patients, the exanthem appeared after 2 or 3 days of fever. The exanthem developed during the first day, persisted for 5-8 days, and then cleared concurrently with the general recovery of the patients. Histopathological studies of skin punch biopsy specimens from four patients showed a sparse lymphocytic cell infiltrate distributed around vessels of the dermal superficial plexus. The infiltrates predominantly consisted of equally represented T-helper/inducer and T-suppressor/cytotoxic cells. A vacuolar aberration of basal layer cells was found in two of the four cases studied histologically. The microscopic findings correspond to the histopathological patterns seen in toxicodermia and in the interface dermatitis of morbilliform viral exanthems. The exanthem is a frequent and characteristic sign of primary HIV infection, which is further indicated if mucosal ulcers are present.