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Urology Jul 2023To describe our technique for performing gender affirming graft only vaginoplasty.
OBJECTIVE
To describe our technique for performing gender affirming graft only vaginoplasty.
METHODS
In graft only vaginoplasty, penile skin is used only for the external genitals, and the entire vaginal canal is created from a full thickness skin graft. The inner scrotum is excised and used as a skin graft to line the vaginal canal. The outer scrotum is left in place then moved medially to form the labia majora. The penile skin and Dartos fascia are incised dorsally and ventrally then advanced to the posterior perineum to become the labia minora. The glans clitoris is constructed from a W-shaped dorsally-based portion of the glans penis, and the clitoral hood is constructed from the distal 2-3 cm of penile shaft skin. The posterior wall of the introitus is formed from a posterior perineal flap.
RESULTS
The patient presented here is a 26-year-old transgender woman with marked and sustained gender incongruence. She is circumcised, has typical penile length, scrotal contents are normal, and all hair has been removed on the scrotum and perineum. She underwent graft only vaginoplasty, as shown in the accompanying video.
CONCLUSION
Gender affirming graft only vaginoplasty allows for construction of the vaginal canal from a full thickness skin graft, and construction of external genitals from penile and scrotal skin. Advantages of this approach include availability of more tissue for construction of the external genitals and an external skin to graft anastomosis. The procedure is modified slightly when the patient has a small scrotum, short penis, or is uncircumcised.
Topics: Male; Female; Humans; Adult; Sex Reassignment Surgery; Transsexualism; Surgical Flaps; Vulva; Clitoris; Penis; Vagina
PubMed: 37187273
DOI: 10.1016/j.urology.2023.05.006 -
Current Biology : CB Nov 2023The elephant trunk operates as a muscular hydrostat and is actuated by the most complex musculature known in animals. Because the number of trunk muscles is unclear, we...
The elephant trunk operates as a muscular hydrostat and is actuated by the most complex musculature known in animals. Because the number of trunk muscles is unclear, we performed dense reconstructions of trunk muscle fascicles, elementary muscle units, from microCT scans of an Asian baby elephant trunk. Muscle architecture changes markedly across the trunk. Trunk tip and finger consist of about 8,000 extraordinarily filigree fascicles. The dexterous finger consists exclusively of microscopic radial fascicles pointing to a role of muscle miniaturization in elephant dexterity. Radial fascicles also predominate (at 82% volume) the remainder of the trunk tip, and we wonder if radial muscle fascicles are of particular significance for fine motor control of the dexterous trunk tip. By volume, trunk-shaft muscles comprise one-third of the numerous, small radial muscle fascicles; two-thirds of the three subtypes of large longitudinal fascicles (dorsal longitudinals, ventral outer obliques, and ventral inner obliques); and a small fraction of transversal fascicles. Shaft musculature is laterally, but not radially, symmetric. A predominance of dorsal over ventral radial muscles and of ventral over dorsal longitudinal muscles may result in a larger ability of the shaft to extend dorsally than ventrally and to bend inward rather than outward. There are around 90,000 trunk muscle fascicles. While primate hand control is based on fine control of contraction by the convergence of many motor neurons on a small set of relatively large muscles, evolution of elephant grasping has led to thousands of microscopic fascicles, which probably outnumber facial motor neurons.
Topics: Animals; Elephants; Muscle, Skeletal; Motor Neurons
PubMed: 37757829
DOI: 10.1016/j.cub.2023.09.007 -
Veterinary Surgery : VS Feb 2023To investigate the feasibility and describe the clinical experience of performing laryngeal tie-forward (LTF) in standing horses unaffected (experimental) and affected...
OBJECTIVES
To investigate the feasibility and describe the clinical experience of performing laryngeal tie-forward (LTF) in standing horses unaffected (experimental) and affected (clinical) by intermittent dorsal displacement of the soft palate (iDDSP).
STUDY DESIGN
Experimental study and case series.
ANIMALS
Five normal experimental controls and five client owned horses affected by iDDSP.
METHODS
Standing LTF was performed and evaluated in five experimental horses and five clinical cases diagnosed with iDDSP. Standing LTF was performed under endoscopic guidance with horses sedated and the surgical site desensitized with local anesthetic solution. Short term outcome was assessed using radiography, resting and (in clinical cases) dynamic upper respiratory tract (URT) endoscopy.
RESULTS
Standing LTF was well tolerated and completed in all horses. Radiographic assessment demonstrated that compared to preoperatively, the basihyoid bone and thyrohyoid-thyroid articulation were positioned dorsally (9.6 mm, p = .006 and 20.4 mm, p = .007, respectively) at 2 days postoperatively. During repeat dynamic URT endoscopy at 48 hours postoperatively, 3/5 horses showed resolution of iDDSP and 2/5 marked improvement. One horse experienced brief iDDSP associated with neck flexion which corrected after swallowing. The second achieved a greater speed and total distance prior to iDDSP.
CONCLUSIONS
Standing LTF did not incur any major peri- or postoperative complications. The laryngohyoid apparatus was repositioned dorsally and in a small case series had a similar surgical effect on laryngeal position.
CLINICAL SIGNIFICANCE
Standing LTF is feasible, mitigates the risk of general anesthesia related complications and reduces cost.
Topics: Horses; Animals; Larynx; Palate, Soft; Endoscopy; Nose; Radiography; Horse Diseases
PubMed: 36448601
DOI: 10.1111/vsu.13920 -
BJU International Oct 2023To present a surgical modification for the repair of bulbar urethral strictures containing short, highly obliterative segments and report on long-term objective and...
OBJECTIVES
To present a surgical modification for the repair of bulbar urethral strictures containing short, highly obliterative segments and report on long-term objective and patient-reported outcomes.
PATIENTS AND METHODS
We considered patients undergoing bulbar buccal mucosal graft urethroplasty (BMGU) between July 2016 and December 2019. Eligibility criteria for mucomucosal anastomotic non-transecting augmentation (MANTA) urethroplasty were strictures of ≥2 cm with an obliterative segment of ≤1.5 cm. The stricture is approached ventrally to avoid extensive dissection and mobilisation. Dorsally, the scar is superficially excised and the spongiosum is left intact. Dorsal mucomucosal anastomosis is complemented by ventral onlay graft. Perioperative characteristics were prospectively collected including uroflowmetry data and validated patient-reported outcome measures on voiding, erectile, and continence function. We evaluated functional follow-up, incorporating patient-reported (lower urinary tract symptoms [LUTS] score) and functional success. Recurrence was defined as need of re-treatment.
RESULTS
Of 641 men treated with anterior BMGU, 54 (8.4%) underwent MANTA urethroplasty. Overall, 26 (48%) and 45 (83%) had a history of dilatation and urethrotomy, respectively, and 14 (26%) were redo cases. Location was bulbar in 38 (70%) and penobulbar in 16 patients (30%), and the mean (SD) graft length was 4.5 (1.4) cm. At a median (interquartile range) follow-up of 41 (27-53) months, the functional success rate was 93%. Whereas the median LUTS score significantly improved from baseline to postoperatively (13 vs 3.5; P < 0.001), there was no change in erectile function (median International Index of Erectile Function - erectile function domain score 27 vs 24) or urinary continence (median International Consultation on Incontinence Questionnaire - Urinary Incontinence Short Form sum score 0 vs 0; all P ≥ 0.4). All patients were 'satisfied' (27%) or 'very satisfied' (73%) with the outcome of their operation.
CONCLUSION
With excellent long-term objective and patient-reported outcomes, MANTA urethroplasty adds to the armamentarium for long bulbar strictures with a short obliterative segment.
Topics: Male; Humans; Constriction, Pathologic; Erectile Dysfunction; Treatment Outcome; Urologic Surgical Procedures, Male; Mouth Mucosa; Urethra; Urethral Stricture; Retrospective Studies
PubMed: 37409824
DOI: 10.1111/bju.16112 -
Operative Neurosurgery (Hagerstown, Md.) Dec 2023The retrosigmoid intradural suprameatal approach is mostly indicated for tumors in the cerebellopontine angle extending toward the Meckel cave and supratentorial...
INDICATIONS CORRIDOR AND LIMITS OF EXPOSURE
The retrosigmoid intradural suprameatal approach is mostly indicated for tumors in the cerebellopontine angle extending toward the Meckel cave and supratentorial regions, most frequently meningiomas and schwannomas. This approach was first established by the senior author in 1982.
ANATOMIC ESSENTIALS NEED FOR PREOPERATIVE PLANNING AND ASSESSMENT
Nervous structures: cranial nerves III to XII, cerebellum, and brainstem. Vascular structures: anterior inferior cerebellar artery, posterior inferior cerebellar artery, superior cerebellar artery, basilar artery, vertebral artery, transverse, sigmoid, and petrous sinus, petrosal vein/veins, basilar plexus, and the mastoid emissary vein. Bony structures: petrous bone with internal auditory canal, jugular foramen and suprameatal tubercle, petrous apex, dorsum sellae, and posterior clinoid process. Structures within the petrous bone: vestibule, semicircular canals, and jugular bulb.
ESSENTIALS STEPS OF THE PROCEDURE
After a suboccipital retrosigmoid craniectomy in the semisitting position and debulking of the tumor mass in the cerebellopontine angle, extension is achieved by drilling suprameatal tubercle above cranial nerve VII and VIII toward the petrous apex. The extent of bone drilling is tailored for each patient.
PITFALLS/AVOIDANCE OF COMPLICATIONS
Avoid damage to cranial nerves, arteries, and veins during drilling, dissection, and tumor removal or by retraction.
VARIANTS AND INDICATIONS FOR THEIR USE
In case of extreme supratentorial extensions laterally and dorsally, the opening of the tentorium may be helpful. For inferior extensions toward the upper spinal canal, opening of the foramen magnum and hemilaminectomy of C1 may be necessary.The patient consented to the procedure and to the publication of his/her image. Institutional logo in title slide, © 2023, INI Hannover. Used with permission.
PubMed: 38084947
DOI: 10.1227/ons.0000000000001030 -
Ugeskrift For Laeger Aug 2019
PubMed: 31495362
DOI: No ID Found -
Ugeskrift For Laeger Sep 2019
PubMed: 31566177
DOI: No ID Found -
Biology Open Sep 2021The tracheal basal cells (BCs) function as stem cells to maintain the epithelium in steady state and repair it after injury. The airway is surrounded by cartilage...
The tracheal basal cells (BCs) function as stem cells to maintain the epithelium in steady state and repair it after injury. The airway is surrounded by cartilage ventrolaterally and smooth muscle dorsally. Lineage tracing using Krt5-CreER shows dorsal BCs produce more, larger, clones than ventral BCs. Large clones were found between cartilage and smooth muscle where subpopulation of dorsal BCs exists. Three-dimensional organoid culture of BCs demonstrated that dorsal BCs show higher colony forming efficacy to ventral BCs. Gene ontology analysis revealed that genes expressed in dorsal BCs are enriched in wound healing while ventral BCs are enriched in response to external stimulus and immune response. Significantly, ventral BCs express Myostatin, which inhibits the growth of smooth muscle cells, and HGF, which facilitates cartilage repair. The results support the hypothesis that BCs from the dorso-ventral airways have intrinsic molecular and behavioural differences relevant to their in vivo function.
Topics: Cell Differentiation; Epithelial Cells; Gene Ontology; Genetic Heterogeneity; Humans; Stem Cells; Trachea
PubMed: 34396394
DOI: 10.1242/bio.058676 -
Cells Nov 2021The heart, also referred to as the dorsal vessel, pumps the insect blood, the hemolymph. The bilateral heart primordia develop from the most dorsally located mesodermal... (Review)
Review
The heart, also referred to as the dorsal vessel, pumps the insect blood, the hemolymph. The bilateral heart primordia develop from the most dorsally located mesodermal cells, migrate coordinately, and fuse to form the cardiac tube. Though much simpler, the fruit fly heart displays several developmental and functional similarities to the vertebrate heart and, as we discuss here, represents an attractive model system for dissecting mechanisms of cardiac aging and heart failure and identifying genes causing congenital heart diseases. Fast imaging technologies allow for the characterization of heartbeat parameters in the adult fly and there is growing evidence that cardiac dysfunction in human diseases could be reproduced and analyzed in , as discussed here for heart defects associated with the myotonic dystrophy type 1. Overall, the power of genetics and unsuspected conservation of genes and pathways puts at the heart of fundamental and applied cardiac research.
Topics: Aging; Animals; Disease Models, Animal; Drosophila; Gene Expression Regulation, Developmental; Heart; Heart Diseases; Humans
PubMed: 34831301
DOI: 10.3390/cells10113078 -
Acta Histochemica Aug 2022Intraventricular and extraventricular choroid plexuses are neuroepithelial folds which arise from the roof of the diencephalon. We describe the circumventricular...
Intraventricular and extraventricular choroid plexuses are neuroepithelial folds which arise from the roof of the diencephalon. We describe the circumventricular structure of the diencephalon roof (paraphysis cerebri) during the various development stages of Ambystoma mexicanum. The parasagittal sections of the larvae epithalamus exhibit the presence, in addition to the epiphysis, of two dorsal primordia in nearby areas, which appear to be extraventricular saccular evaginations of different origin that give rise to two structures we define as the anterior extraventricular choroid plexus (AEP) and posterior extraventricular choroid plexus (PEP). During larvae development, the primordia arise perpendicular to each other, grow and show luminal folds and invaginations. Later, the two extraventricular evaginations, which are separate units, become interrelated. As the PEP grows, it covers the AEP dorsally, but it is difficult to define the borders of these organs. AEP is formed by alveolar-acinar epithelial aggregates with evidence of secretion-like content. PEP structure is like a choroid plexus, but its position is extraventricular and dorsal to the AEP. The PEP is always between the AEP and the meninges and can be small or large in size. This means that in A. mexicanum, the paraphysis cerebri is made up of two adjacent organs, which arise almost simultaneously from two different primordia (the AEP and the PEP) and as the posterior one grows, it overlaps the anterior one and masks itself. In conclusion, we suggest that AEP and PEP are homologous to paraphysis cerebri and the dorsal sac, respectively.
Topics: Ambystoma mexicanum; Animals; Choroid Plexus; Fetus
PubMed: 35738026
DOI: 10.1016/j.acthis.2022.151915