El autor agradece a la Universidad Johns Hopkins de operación personal de la sala, y Relaciones con los Medios en el departamento de pediatría del Hospital Infantil Johns Hopkins.

Introducción: Tratamiento de trastornos genitales se encuentran comúnmente en las oficinas de los médicos de atención primaria. Estenosis del meato, un estrechamiento anormal del orificio de la uretra (meato) es una complicación frecuente después de la circuncisión que ocurren en el 9% -10% de los hombres. Este trastorno se caracteriza por una tendencia al alza desviado, de difícil objetivo del chorro de orina, disuria, urgencia, frecuencia, y la micción prolongada. Si no se trata, esto puede conducir a infecciones del tracto urinario y problemas renales. Quirúrgica meatotomía / meatoplastia es curativa. Tratamiento / diagnóstico de procedimiento: Un análisis de orina de rutina que descartar una infección del tracto urinario o la diabetes como causa potencial de la frecuencia urinaria. Historia clínica detallada y un examen físico, incluyen la observación de la micción, confirmar el diagnóstico. La cirugía ambulatoria / meatoplastia es curativa. El procedimiento se realiza bajo anestesia 5-10 minutos. Preparación intraoperatoria incluye la ampliación lupa quirúrgica, pinza hemostática mosquito, tijeras de punta fina de microcirugía plástica, titular de Castroviejo aguja y sutura de Vicryl 7-0; <ol><li> Niño es colocado en posición supina. </li><li> Preparación mínima de la piel y la caída de los genitales. No necesita antibióticos profilácticos. <ul><li> POVIDONA Betadine solución de yodo es usado para limpiar la zona genital, y se deja durante unos 3 minutos antes de la incisión inicial. </li><li> El pene debe ser cubierto con toallas estériles. </li></ul></li><li> Un cirujano con la mano derecha se mantendrá en el lado izquierdo de la mandíbula del paciente y una de una pinza hemostática mosquito bien lubricada se introduce en la punta / ventral del meato uretral hasta una profundidad de aproximadamente 3.2 mm. El tejido ventral es entonces aplastado por el cierre de la pinza. Tiempo de sujeción total será de 60 segundos. </li><li> El tejido ventral aplastado se incide fuertemente con las tijeras de microcirugía (figura 1) y la mucosa interna de la uretra y el tejido glandular se reaproximados con 7-0 puntos de sutura vicryl (agujas Castroviejo figura titular 2) en forma interrumpida. </li></ol> El tiempo de recuperación es mínimo, y un niño es enviado a casa con Tylenol, según sea necesario para aliviar las molestias. La vaselina es aplicado a la 3-4x/day herida.

<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>

Resultado: Estenosis del meato sintomático es frustrante para el niño y su familia. Si no se trata, hay un potencial para el vaciado incompleto de la vejiga crónica, con el desarrollo ocasional de infección urinaria y daño renal posterior. Reconstructiva meatoplastia es curativa, y se puede hacer en un breve anestésico. Conclusión: Estenosis del meato es una complicación común de la circuncisión. Una...

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surgical management of meatal stenosis with meatoplasty

Estenosis del meato es una complicación común urológica después de la circuncisión. Los niños presentan a sus médicos de atención primaria con quejas de flujo desviado urinario, de difícil objetivo, dolor al orinar, y frecuencia urinaria. Examen clínico revela un meato identificar y si el niño se le pregunta a orinar, por lo general tienen una tendencia al alza, chorro fino, orina de vez en cuando con fuerza el vaciado incompleto de la vejiga. El pilar del tratamiento es meatoplastia (reconstrucción de la uretra distal / meato). Este video educativo a demostrar cómo se realiza esto.

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

Surgical Management of Meatal Stenosis with Meatoplasty

Meatoplastia, el tratamiento quirúrgico de la estenosis del meato.

Tratamiento quirúrgico de la estenosis del meato con meatoplastia

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

surgical-management-of-meatal-stenosis-with-meatoplasty

Research

JoVE Journal

Medicine

52.3K vistas.  Johns Hopkins School of Medicine. Meatoplastia, el tratamiento quirúrgico de la estenosis del meato.

Video: 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.

Eficacia terapéutica de un suplemento dietético para la Gestión de la halitosis en los perros

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

Investigación

Medicina

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.

Modelos quirúrgicos de reflujo gastroesofágico con ratones

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.

Usando Saccadometry con estimulación cerebral profunda para estudiar la función cerebral normal y patológica

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.

La microscopia intravital de la utilización de la vasculatura asociada a Tumor avanzado Dorsal cámaras de ventana pliegues cutáneos en ratones transgénicos fluorescentes

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.

Modelo murino de estenosis venosa central usando fístula aortocaval con una estenosis de salida

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.

Gastrectomía de manga en ratones usando clips quirúrgicos

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

Banda aórtica ascendente para el estudio de la insuficiencia cardíaca inducida por sobrecarga de presión

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 destacado: Desarrollo de un modelo mínimamente invasivo de animales grandes para una investigación cardiovascular fiable y reproducible 

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

Un modelo mínimamente invasivo de estenosis aórtica en cerdos

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