Der Autor dankt der Johns Hopkins OP-Personal und Media Relations in der Abteilung für Pädiatrie an der Johns Hopkins-Kinderklinik.

Einleitung: Genital-Erkrankungen sind häufig in den Büros von Hausärzten begegnet. Gehörgangsstenose, ist eine abnorme Verengung der Harnröhrenöffnung (Meatus) eine häufige Komplikation nach der Beschneidung vorkommende in 9% -10% der Männer. Diese Störung ist gekennzeichnet durch eine nach oben abgelenkt werden, schwer zu zielen Harnstrahl, Dysurie, Harndrang, häufiges und verlängerte Wasserlassen. Unbehandelt kann dies zu Infektionen der Harnwege und Nierenproblemen führen. Chirurgische meatotomy / meatoplasty ist heilend. Behandlung / Diagnose Vorgehensweise: Eine Routine Urinuntersuchung wird ausgeschlossen Harnwegsinfektion oder Diabetes als mögliche Ursachen für häufiges Wasserlassen. Detaillierte Anamnese und körperliche Untersuchung, zählen Beobachtung der Miktion, die Diagnose bestätigen. Ambulante Operationen / meatoplasty ist heilend. Das Verfahren ist unter einer 5-10 Minuten Betäubung durchgeführt. Intraoperative Vorbereitung umfasst chirurgische Lupenvergrößerung, Moskito hemostat, feine Spitze aus Kunststoff mikrochirurgische Schere, Castroviejo Nadelhalter, und 7-0 Vicryl Naht; <ol><li> Child ist in Rückenlage gebracht. </li><li> Minimal Haut desinfizieren und steril abdecken der Genitalien. Keine Antibiotika-Prophylaxe erforderlich. <ul><li> Betadine Povidoniod Lösung wird verwendet, um den Genitalbereich schrubben, und man ließ sie für etwa 3 Minuten vor dem ersten Schnitt bleiben. </li><li> Der Penis sollte off mit sterilen Tüchern drapiert werden. </li></ul></li><li> Ein Rechtshänder Chirurg wird auf die linke Seite des Patienten und eine Backe einer gut geschmierten Mücke hemostat Stand wird dann in die Spitze / ventralen Aspekt der Harnröhre bis in eine Tiefe von ca. 2-3 mm eingeführt. Die ventralen Gewebe wird dann durch das Schließen der hemostat zerkleinert. Insgesamt Span-Zeit beträgt 60 Sekunden. </li><li> Das zerkleinerte ventralen Gewebe ist stark mit mikrochirurgischen Schere eingeschnitten (Abb. 1) und die innere Schleimhaut der Harnröhre und glanduläre Gewebe readaptiert mit 7-0 Vicryl Nahtmaterial (Castroviejo Nadelhalter Abbildung 2) in einer unterbrochenen Mode. </li></ol> Die Erholungszeit ist minimal, und ein Kind mit nach Hause Tylenol geschickt wie für Beschwerden benötigt. Vaseline wird auf die Wunde 3-4x/day angewendet.

<ol>
	<li>Van Howe, R. S. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Incidence+of+meatal+stenosis+following+neonatal+circumcision+in+a+primary+care+setting.">Incidence of meatal stenosis following neonatal circumcision in a primary care setting.</a> Clin Pediatr (Phila). 45 (1), 49-54 (2006).</li><li>Litvak, A. S., Morris, J. A., McRoberts, J. W. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Normal+size+of+the+urethral+meatus+in+boys.">Normal size of the urethral meatus in boys.</a> J Uro. 115 (6), 736-737 (1976).</li><li>Brown, M. R., Cartwright, P. C., Snow, B. W. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Common+office+problems+in+pediatric+urology+and+gynecology.">Common office problems in pediatric urology and gynecology.</a> Pediatr Clin North Am. 44 (5), 1091-1115 (1997).</li><li>Smith, C., Smith, D. P. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Office+pediatric+urologic+procedures+from+a+parental+perspective.">Office pediatric urologic procedures from a parental perspective.</a> Urology. 55 (2), 272-276 (2000).</li><li>Frank, J. D., Pocock, R. D., Stower, M. J. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Urethral+strictures+in+childhood.">Urethral strictures in childhood.</a> Br J Urol. 62 (6), 590-592 (1988).</li><li>Persad, R., Sharma, S., McTavish, J. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Clinical+presentation+and+pathophysiology+of+meatal+stenosis+following+circumcision.">Clinical presentation and pathophysiology of meatal stenosis following circumcision.</a> Br J Urol. 75 (1), 91-93 (1995).</li><li>Stenram, A., Malmfors, G., Okmian, L. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Circumcision+for+phimosis:+a+follow-up+study.">Circumcision for phimosis: a follow-up study.</a> Scand J Urol Nephrol. 20 (2), 89-92 (1986).</li><li>Hinman, F., Baskin, L. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Chapter+155.">Chapter 155.</a> Hinman s Atlas of Pediatric Urologic Surgery. , 773-775 (2008).</li><li>Belman, A. B., King, L. R., Kramer, S. A. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=.">.</a> Clinical Pediatric Urology. , 214-215 (2002).</li><li>Wein, A. J., Kavoussi, L. R., Novick, A. C., Partin, A. W., Peters, C. A. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=.">.</a> Campbell-Walsh Urology. , 1044-1045 (2007).</li></ol>

Ergebnis: Symptomatisch Gehörgangsstenose ist frustrierend für das Kind und Familie. Wenn sie unbehandelt bleiben, gibt es ein Potential für chronische unvollständige Blasenentleerung mit gelegentlichen Entwicklung von Harnwegsinfektionen und anschließende Nierenschäden. Rekonstruktive meatoplasty ist heilend, und kann unter einer kurzen Narkose durchgeführt werden. Fazit: Gehörgangsstenose ist eine h?...

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surgical management of meatal stenosis with meatoplasty

Gehörgangsstenose ist eine häufige Komplikation nach urologischen Beschneidung. Kinder anwesend, um ihre Hausärzte mit Beschwerden über abgewichen Harnstrahl, schwer zu zielen, Schmerzen beim Wasserlassen und häufiger Harndrang. Klinische Untersuchung zeigt zielgenau Gehörgang und wenn das Kind wird gebeten, zu urinieren, wird er meist nach oben, dünn, manchmal kraftvoll Harnstrahl mit unvollständigen Blasenentleerung. Die Hauptstütze des Managements ist meatoplasty (Rekonstruktion des distalen Harnröhre / Gehörgang). Das Bildungs-Video wird gezeigt, wie diese durchgeführt wird.

Watch this Scientific Journal Video about Surgical Management of Meatal Stenosis with Meatoplasty at JoVE.com

Surgical Management of Meatal Stenosis with Meatoplasty

Meatoplasty, chirurgische Behandlung von Gehörgangsstenose.

Surgical Management Gehörgangsstenose mit Meatoplasty

Meatal stenosis is a common urologic complication after circumcision.  Children present to their primary care physicians with complaints of deviated ...

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52.3K Aufrufe.  Johns Hopkins School of Medicine. Meatoplasty, chirurgische Behandlung von Gehörgangsstenose.

Serie: Surgical Management of Meatal Stenosis with Meatoplasty

Therapeutic Effectiveness of a Dietary Supplement for Management of Halitosis in Dogs

Halitosis is a common complaint involving social and communicational problems in humans and also affects the pet-owner relationship. In this randomized placebo-controlled crossover clinical evaluation, we assessed&#160;the effectiveness of a dedicated dietary supplement to improve chronic halitosis in 32 dogs of different breeds and ages. This protocol describes how to evalute the presence of oral volatile suphur compunds, e.g. methyl mercaptan, hydrogen sulfide and dimethyl sulfide, by means of a portable gas chromatograph device coupled with a syringe, which was used to collect the breath, and a dedicated software, which allows the operator to monitor each compound concentration during each measurement, in a relatively short time (8 min).
A significant modification of halitosis parameters was observed after 30 days since the beginning of treatment (p &#60;0.05), while a long-lasting effect was still observed even 20 days after the suspension of the treatment. Portable gas chromatograph, which is also widely used in clinical practice, can be therefore used to confirm&#160;and control halitosis in humans and animals. Even though human and animal species present some differences,&#160;this innovative and alternative therapy for halitosis management might be extended to human clinical practice as an adjuvant dietary approach.

We describe a simple approach for diagnosis of halitosis in dogs as well as a dietary approach for its management. This protocol may be extended to the management of halitosis in humans in the near future.

Therapeutische Wirksamkeit von Nahrungsergänzungsmittel für Verwaltung von Halitosis in Dogs

Halitosis is a common complaint involving social and communicational problems in humans and also affects the pet-owner relationship. In this randomized ...

Forschung

Medizin

Surgical Models of Gastroesophageal Reflux with Mice

Multiple surgical procedures have been reported to induce gastroesophageal reflux in animals. Herein, we report three surgical models with mice aiming to induce reflux of gastric contents, duodenal contents or mixed contents. Surgical procedures and general principles have been described in detail. A researcher with surgical experience should be able to grasp the technique after a short period of practice. After surgery, most mice can survive and develop reflux esophagitis similar to that in humans. However, it should be noted that histological differences between mouse and human esophagus are the inherent limitations of these surgical models. If used for research on Barrett&#8217;s esophagus and adenocarcinoma, these procedures may need to be combined with genetic modifications.

This article demonstrates surgical procedures of gastroesophageal reflux with mice. These models are useful tools for research on mechanisms and treatment of gastroesophageal reflux disease and potentially Barrett&#8217;s esophagus and esophageal adenocarcinoma.

Chirurgische Modelle aus gastroösophagealen Reflux mit Mäusen

Multiple surgical procedures have been reported to induce gastroesophageal reflux in animals. Herein, we report three surgical models with mice aiming to ...

Using Saccadometry with Deep Brain Stimulation to Study Normal and Pathological Brain Function

The oculomotor system involves a large number of brain areas including parts of the basal ganglia, and various neurodegenerative diseases including Parkinson's and Huntington's can disrupt it. People with Parkinson's disease, for example, tend to have increased saccadic latencies. Consequently, the quantitative measurement of saccadic eye movements has received considerable attention as a potential biomarker for neurodegenerative conditions. A lot more can be learned about the brain in both health and disease by observing what happens to eye movements when the function of specific brain areas is perturbed. Deep brain stimulation is a surgical intervention used for the management of a range of neurological conditions including Parkinson's disease, in which stimulating electrodes are placed in specific brain areas including several sites in the basal ganglia. Eye movement measurements can then be made with the stimulator systems both off and on and the results compared. With suitable experimental design, this approach can be used to study the pathophysiology of the disease being treated, the mechanism by which DBS exerts it beneficial effects, and even aspects of normal neurophysiology.

This paper describes the use of quantitative measurement of eye movements in conjunction with stimulation of focal areas of the deep brain in order to study physiology, pathophysiology, and the mechanisms of deep brain stimulation.

Mit Saccadometry mit Deep Brain Stimulation Normale und Pathologische Funktion des Gehirns zu studieren

The oculomotor system involves a large number of brain areas including parts of the basal ganglia, and various neurodegenerative diseases including ...

Intravital Microscopy of Tumor-associated Vasculature Using Advanced Dorsal Skinfold Window Chambers on Transgenic Fluorescent Mice

Tumor and tumor vessel development, as well as tumor response to therapeutics, are highly dynamic biological processes. Histology provides static information and is often not sufficient for a correct interpretation. Intravital evaluation, in which a process is followed in time, provides extra and often unexpected information. With the creation of transgenic animals expressing cell-specific markers and live cell tracers, improvements to imaging equipment, and the development of several imaging chambers, intravital microscopy has become an important tool to better understand biological processes. This paper describes an experimental design for the investigation of tumor vessel development and of therapeutic effects in a spatial and temporal manner. Using this setup, the stage of vessel development, tip cell and lumen formation, blood flow, extravasation, an established vascular bed, and vascular destruction can be visualized and followed. Furthermore, therapeutic effects, intratumoral fate, and the localization of chemotherapeutic compounds can also be followed.

This protocol describes the intravital imaging of transgenic mice expressing cell-specific fluorescent markers. Intravital imaging provides a non-invasive method for high-resolution observations in living animals using implantable windows through which the microscopic visualization of processes is possible. This method is especially useful to study longitudinal processes.

Intravitalen Mikroskopie von Tumor-assoziierten Gefäßsystem mit erweiterten dorsalen Hautfalte Fenster Kammern an transgenen Mäusen fluoreszierende

Tumor and tumor vessel development, as well as tumor response to therapeutics, are highly dynamic biological processes. Histology provides static ...

Murine Model of Central Venous Stenosis using Aortocaval Fistula with an Outflow Stenosis

Central venous stenosis is an important entity contributing to arteriovenous fistula (AVF) failure. A murine AVF model was modified to create a partial ligation of the inferior vena cava (IVC) in the outflow of the fistula, mimicking central venous stenosis. Technical aspects of this model are introduced. The aorta and IVC are exposed, following an abdominal incision. The infra-renal aorta and IVC are dissected for proximal clamping, and the distal aorta is exposed for puncture. The IVC at the midpoint between the left renal vein and the aortic bifurcation is carefully dissected to place an 8-0 suture beneath the IVC. After clamping the aorta and IVC, an AVF is created by puncturing the infra-renal aorta through both walls into the IVC with a 25 G needle, followed by ligating a 22 G intra-venous (IV) catheter and IVC together. The catheter is then removed, creating a reproducible venous stenosis without occlusion. The aorta and IVC are unclamped after confirming primary hemostasis. This novel model of central vein stenosis is easy to perform, reproducible, and will facilitate studies on AVF failure.

An aortocaval fistula was created by puncturing the murine infra-renal aorta through both walls into the inferior vena cava and was followed by creation of a stenosis in its outflow via partial ligation of the inferior vena cava. This reproducible model can be used to study central venous stenosis.

Murine Modell der zentralen venösen Stenose mit Aortocaval Fistel mit einem Abfluss Stenose

Central venous stenosis is an important entity contributing to arteriovenous fistula (AVF) failure. A murine AVF model was modified to create a partial ...

Sleeve Gastrectomy in Mice using Surgical Clips

The number of people who are overweight and obese is continually increasing both in the adult and adolescent populations. This coincides with the increased universal phenomenon of type 2 diabetes (T2D) and other metabolic problems. Bariatric surgery, such as SG, is currently one of the most effective and commonly used long-term treatment for obesity and T2D, but the association between them is not completely explored yet. The mechanisms underlying the outcomes seen after bariatric surgery in humans can be investigated based on preclinical animal studies. The SG reduces body weight, glucose levels and many metabolic parameters, and is easy to perform with a low incidence of complications. The goal of this work is to provide a simple method and an uncomplicated preclinical model of bariatric surgery in animals for researchers.

The prevalence of diabetes and obesity is continuously increasing worldwide. The mechanisms between diabetes, obesity and their associated mortality and co-morbidities need to be further investigated. Here, we present a protocol for sleeve gastrectomy (SG) in animals as an uncomplicated preclinical model of bariatric surgery.

Ärmel-Gastrektomie bei Mäusen mit chirurgischen Clips

The number of people who are overweight and obese is continually increasing both in the adult and adolescent populations. This coincides with the ...

Aufsteigendes Aortenband zur Untersuchung der durch Drucküberlastung induzierten Herzinsuffizienz

A Minimally Invasive Model of Aortic Stenosis in Swine

Large animal models of heart failure play an essential role in the development of new therapeutic interventions due to their size and physiological similarities to humans. Efforts have been dedicated to creating a model of pressure-overload induced heart failure, and ascending aortic banding while still supra-coronary and not a perfect mimic of aortic stenosis in humans, closely resembling the human condition.
The purpose of this study is to demonstrate a minimally invasive approach to induce left ventricular pressure overload by placing an aortic band, precisely calibrated with percutaneously introduced high-fidelity pressure sensors. This method represents a refinement of the surgical procedure (3Rs), resulting in homogenous trans-stenotic gradients and reduced intragroup variability. Additionally, it enables swift and uneventful animal recovery, leading to minimal mortality rates. Throughout the study, animals were followed for up to 2 months after surgery, employing transthoracic echocardiography and pressure-volume loop analysis. However, longer follow-up periods can be achieved if desired. This large animal model proves valuable for testing new drugs, particularly those targeting hypertrophy and the structural and functional alterations associated with left ventricular pressure overload.

Autor im Rampenlicht: Entwicklung eines minimal-invasiven Großtiermodells für zuverlässige und reproduzierbare kardiovaskuläre Forschung 

This protocol describes a minimally invasive surgical procedure for ascending aortic banding in swine.

Ein minimal-invasives Modell der Aortenstenose beim Schwein

Large animal models of heart failure play an essential role in the development of new therapeutic interventions due to their size and physiological ...