This study aims to determine the level of origin, branching pattern and exits of the iliohypogastric and ilioinguinal nerves in relation to the psoas major muscle. Additionally, this study confirms the presence and retroperitoneal courses of the double nerves. We dissected a total of 24 iliohypogastric and ilioinguinal nerves (6 male and 6 female cadavers). The origin, branching, and exits in relation to the psoas major muscle, the absence of these nerves or the presence of double nerves, and their retroperitoneal course were carefully examined. All the images were recorded by photographing. In this study, we mainly observed variations in exits, branching patterns, and their retroperitoneal course. The iliohypogastric nerve was absent in 2 cases (8.3%). In the type I pattern, in 1 case (4.2%), the common trunk descends anteriorly to the iliac vessels from the iliolumbar vessels. In 4 cases (16.7%), the double ilioinguinal nerve with different branch patterns and retroperitoneal courses was observed. In 1 single nerve case (4.2%), the ilioinguinal nerve descends anterior to the iliac vessels from the iliolumbar vessels. To our knowledge, the branching pattern of the double ilioinguinal nerves and their retroperitoneal course have not been reported in any available data. Sound knowledge of the variations in the origin, branches, and retroperitoneal course of the iliohypogastric and ilioinguinal nerves is very helpful for the improvement of peripheral nerve blocks and other various surgical procedures to avoid complications and nerve injuries.

This study aims to determine the level of origin, branching pattern and exits of the iliohypogastric and ilioinguinal nerves in relation to the psoas major muscle. Additionally, this study confirms the presence and retroperitoneal courses of the double nerves. We dissected a total of 24 iliohypogastric and ilioinguinal nerves (6 male and 6 female cadavers). The origin, branching, and exits in relation to the psoas major muscle, the absence of these nerves or the presence of double nerves, and their retroperitoneal course were carefully examined. All the images were recorded by photographing. In this study, we mainly observed variations in exits, branching patterns, and their retroperitoneal course. The iliohypogastric nerve was absent in 2 cases (8.3%). In the type I pattern, in 1 case (4.2%), the common trunk descends anteriorly to the iliac vessels from the iliolumbar vessels. In 4 cases (16.7%), the double ilioinguinal nerve with different branch patterns and retroperitoneal courses was observed. In 1 single nerve case (4.2%), the ilioinguinal nerve descends anterior to the iliac vessels from the iliolumbar vessels. To our knowledge, the branching pattern of the double ilioinguinal nerves and their retroperitoneal course have not been reported in any available data. Sound knowledge of the variations in the origin, branches, and retroperitoneal course of the iliohypogastric and ilioinguinal nerves is very helpful for the improvement of peripheral nerve blocks and other various surgical procedures to avoid complications and nerve injuries.

Objectives: . This experimental study compared the precision and surgical outcomes of manual versus robotic electrode insertions in cochlear implantation. Methods: . The study was conducted on formalin-fixed cadaveric heads, with nine senior neurotologists performing both manual and robotic insertions. Results: . The results showed no statistically significant differences between the two methods in terms of insertion angle, cochlear coverage, or electrode coverage. However, the robotic method demonstrated a significantly slower and more controlled insertion speed (0.1 mm/sec) compared to manual insertion (0.66±0.31 mm/sec), which is crucial for minimizing intra-cochlear force and pressures. Although robotic insertions resulted in fewer complications such as tip fold-over or scala deviation, there were instances of incomplete insertion. Conclusion . The robotic system provided a consistent and controlled insertion process, potentially standardizing cochlear implant operations and reducing outcome variability. The study concludes that robotic-assisted insertion offers significant advantages in controlling insertion speed and consistency, supporting the continued development and clinical evaluation of robotic systems for cochlear implant surgery.

Peyronie's disease (PD) is a connective tissue disorder characterized by abnormal collagen deposition in the tunica albuginea, leading to penile curvature, pain, and erectile dysfunction. This study aimed to evaluate the outcomes of a combined treatment protocol incorporating collagenase clostridium histolyticum (CCH), vacuum erection device, and tadalafil. A retrospective analysis was conducted on 99 male patients with PD treated at the Department of Urology, Hamad Medical Corporation (Doha, Qatar) between January 2018 and January 2020. Patients received 4-8 CCH injections alongside vacuum therapy and daily tadalafil (5 mg). The baseline mean penile curvature of 49.0° improved by an average of 21.4% post-treatment. Erectile function scores also increased significantly, with a mean improvement of 2.3 points on the International Index of Erectile Function. Minor complications were observed in 15 patients, while 13 were dissatisfied with treatment, with six opting for surgery. The modified protocol demonstrated significant improvements in penile curvature and erectile function with minimal complications, offering a safe, cost-effective alternative to traditional intensive treatments.
Humans ; Male ; Penile Induration/therapy* ; Tadalafil/therapeutic use* ; Retrospective Studies ; Microbial Collagenase/administration & dosage* ; Middle Aged ; Vacuum ; Treatment Outcome ; Adult ; Penile Erection ; Combined Modality Therapy ; Phosphodiesterase 5 Inhibitors/therapeutic use* ; Aged ; Erectile Dysfunction/etiology*

OBJECTIVES: To investigate the growth parameters of children with phenylketonuria and assess the impact of a phenylalanine-restricted diet on their physical development. METHODS: The study involved 39 children diagnosed with phenylketonuria through newborn screening at the Central Child Teaching Hospital, Baghdad, Iraq. Data were collected during scheduled monthly check-ups, including phenylalanine levels, diet compliance, and anthropometric measurements. The children were divided into two groups based on their phenylalanine levels during the 3-year follow-up period: well-controlled group (average phenylalanine level of less than 360 μmol/L, with no single reading exceeding 600 μmol/L; n=14) and poorly-controlled group (one or more phenylalanine readings above 600 μmol/L during the follow-up period; n=25). RESULTS: The mean height readings for all time points (at birth and 3, 6, 9, 12, 15, 18, 21, 24 and 36 months of age) were higher in the well-controlled group than the poorly-controlled group, however, only at 3 months of age the difference was statistically significant. Height Z-scores revealed a clearer pattern: although the poorly-controlled group had higher height Z-scores at birth (P=0.001), the well-controlled group showed significantly higher height Z-scores at 3, 6, 12, 15, 18, 24, and 36 months (P<0.05). The well-controlled group exhibited significantly higher mean weight measurements compared to the poorly-controlled group at 3, 6, 9, 15, 18 months and 21 months (P<0.05). From 6 to 36 months, the well-controlled group consistently had significantly higher weight Z-scores than the poorly-controlled group (P<0.05). The well-controlled group showed more favorable height and weight Z-score distributions at 36 months of age compared to the poorly-controlled group, but the differences were not statistically significant (P>0.05). Both groups had height and weight Z-scores within the normal range at 36 months of age. CONCLUSIONS The children with phenylketonuria who receive good dietary control show better improvements in growth parameters compared to those with poor dietary control, however, both groups maintain height and weight Z-scores within the normal range, indicating generally adequate physical development across the cohort.
Humans ; Phenylketonurias/diet therapy* ; Male ; Female ; Child, Preschool ; Infant ; Body Height ; Infant, Newborn ; Child Development ; Phenylalanine/blood*

Objective: This study aimed to compare the clinical and comprehensive radiological outcomes of 3 types of endoscopic decompression surgery: unilateral biportal endoscopic lumbar decompression (UBELD), microendoscopic laminotomy (MEL), and percutaneous endoscopic lumbar decompression (PELD). Methods: Patients with single-level lumbar spinal stenosis without instability were included in this multicenter retrospective study. Visual analogue scale (VAS) scores for each extremity, VAS back pain, and Japanese Orthopaedic Association (JOA) scores at preoperative and postoperative 1st, 6th, and 12th months were used as clinical outcome measures. In order to compare the radiological results of the patients, bilateral superior articular distance (SAD), bilateral lateral recess height (LR height), bilateral lateral recess angle (LR angle), and cross-sectional spinal canal area values were measured. Results: Eighty patients in the UBELD group, 73 patients in the MEL group, and 62 patients in the PELD group were included in the study. There was a statistically significant improvement in VAS scores and JOA scores in all groups compared to the preoperative period. At the 12th month postoperatively, the highest lateral decompression values on the approach side were determined as MEL (SAD: 4.1 mm, LR angle: 38.8°, LR height: 4.0 mm), followed by UBELD (SAD: 3.6 mm, LR angle: 36.2°, LR height: 3.3 mm) and PELD (SAD: 3.0 mm, LR angle: 21.7°, LR height: 2.3 mm), respectively. For the contralateral side, the highest lateral recess decompression values were listed as UBELD > MEL > PELD. Conclusion Effective decompression can be performed using all endoscopic techniques in lumbar spinal stenosis. However lateral recess decompression values were found to be better in UBELD and MEL techniques, compared to PELD.

Clinical guidelines typically endorse conventional therapies such as 5-aminosalicylic acid (5-ASA) as the mainstay of ulcerative colitis management. However, the degree of adoption and application of guideline recommendations by physicians within Asia remains unclear. This study aims to understand the prescribing patterns of 5-ASA and implementation of current guideline recommendations across Asian clinical practice. A physician survey was conducted among inflammatory bowel disease specialists in 8 Asian territories to understand practices and preferences in ulcerative colitis management, focusing on the use of 5-ASA and concordance with guideline recommendations. Survey findings were validated by country experts in diverse healthcare settings. Subgroup analyses stratified data by income levels and treatment reimbursement status. Ninety-eight valid responses were received from inflammatory bowel disease specialists or gastroenterologists among 8 economic entities. Significant differences were found in clinical practices and treatment preferences for ulcerative colitis management among different income-level and government-subsidy groups. Survey results are summarized in 8 findings that illustrate trends in 5-ASA use and guideline implementation across Asian territories. This study emphasizes socioeconomic factors that impact the adoption of guideline recommendations in real-world practice. Our findings indicate an eclectic approach to guideline implementation across Asia, based on resource availability and feasibility of treatment goals.

Purpose: The optimal reconstruction method following distal gastrectomy has not been elucidated. Since Billroth-II (B-II) reconstruction is commonly associated with increased bile reflux, Braun jejunojejunostomy has been proposed to reduce this complication. Materials and Methods: We retrospectively analyzed 325 patients with gastric cancer who underwent distal gastrectomy with B-II reconstruction between January 2015 and December 2017, comprising 159 patients without Braun anastomosis and 166 with Braun anastomosis.Outcomes were assessed over three years using annual gastroscopy based on the residual food, gastritis, and bile reflux criteria and the Los Angeles classification for reflux esophagitis. Results: In the first postoperative year, the group with Braun anastomosis showed a significant reduction in bile reflux compared to the group without Braun anastomosis (75.9% vs. 86.2%; P=0.019). Moreover, multivariate analysis identified Braun anastomosis as the sole factor associated with this outcome. Additionally, the group with Braun anastomosis had a lower incidence of heartburn (12.0% vs. 20.1%; P=0.047) and reduced use of prokinetics (P<0.001) and acid reducers (P=0.002) compared to the group without Braun anastomosis.However, these benefits diminished in subsequent years, with no significant differences in residual food, gastritis, or reflux esophagitis between the groups. Both groups showed similar body mass index scores and nutritional outcomes over the 3-year follow-up period. Conclusions Although Braun anastomosis offers short-term benefits in reducing bile reflux after B-II reconstruction, these effects are not sustainable. The routine use of Braun anastomosis should be reconsidered, though either approach remains a viable option depending on the patient’s circumstances.