Objective: to evaluate the benefit of coverage of
the urethral repair by dorsal dartos flap as a second
layer for preventing fistula and V like incision on
the tip of the glans for preventing meatal stenosis.
Patients and Methods:
Forty five children included in this study age
ranged ( 11 months – 7 years), they underwent
hypospadias repair between December 2008 to
March 2012, all cases with distal hypospadias,
same technique used for all patients, a combination
of techniques used for reconstruction starting
withtubularized incised plate urethroplasty with deepithelialized
or stripping of the skin from both
sides of U shaped incision surrounding the urethral
plate, adding a V like incision on the top (tip of
glans) of the midline urethral plate incision that
give wide meatus subsequently prevent meatal
stenosis and no need for dilatation after stent
removal, followed by harvesting well vascularized
dartos flap from de-epithelialized preputial skin
and transposing itventrally by buttonholing
maneuver and suturing the flap as a second layer
along the neourthral suture line, finally
approximation of glans , so achieving three layer
closure.
Results :All patients are followed for (6 months-
24 months) mean was 15 months, only two patients
(4.4%) complicated with small fistula at the
subcoronal region at the beginning of the study
operated after 6 months and the fistula closed
successfully. Twenty five cases (55.5%) with
Chordee were completely released with no
recurrence. No dilatation was needed after removal
of stent for neomeatus developed a good stream of
urine with no problems regarding stenosis.
Conclusions: In this study hypospadias repair
should achieve three layer closures by using a
dartosfalp as a second layer to cover neourethral
suture line combined with stripping the skin on the
edge of the U shaped incision to gain secure
closure of the neourethra, which will prevent
fistula formation. We recommend adding a
Vincision on the tip of the glans connected with
midline urethral plate incision to prevent meatal
stenosis.
When optimizing the performance of neural network-based chatbots, determining the optimizer is one of the most important aspects. Optimizers primarily control the adjustment of model parameters such as weight and bias to minimize a loss function during training. Adaptive optimizers such as ADAM have become a standard choice and are widely used for their invariant parameter updates' magnitudes concerning gradient scale variations, but often pose generalization problems. Alternatively, Stochastic Gradient Descent (SGD) with Momentum and the extension of ADAM, the ADAMW, offers several advantages. This study aims to compare and examine the effects of these optimizers on the chatbot CST dataset. The effectiveness of each optimizer is evaluat
... Show MoreWith the recent growth of global populations, main roads in cities have witnessed an evident increase in the number of vehicles. This has led to unprecedented challenges for authorities in managing the traffic of ambulance vehicles to provide medical services in emergency cases. Despite the high technologies associated with medical tracks and advanced traffic management systems, there is still a current delay in ambulances’ attendance in times of emergency to provide patients with vital aid. Therefore, it is indispensable to introduce a new emergency service system that enables the ambulance to reach the patient in the least congested and shortest paths. However, designing an effici
Background: Radial neck fractures in children account for 5 to 10% of all elbow fractures in children. They are extra-articular fractures of the radius proximal to the bicipital tuberosity. The physis is typically involved as a Salter-Harris I or II pattern. Alternatively, the fracture sometimes is extraphyseal, through the metaphysis. In children there is considerable potential for remodeling after these fractures. Up to 30° of radial head tilt and up to 3 mm of transverse displacement are acceptable. Many modalities of treatment are available regarding Surgical &Non-Surgical treatments. Objectives: To evaluate the functional outcome after surgical percutaneous joystick reduction therapy of severely angulated radial neck fracture i
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Islamic banks are a financial institution that is interested in attracting financial savings from financial entities and directing them towards those with financial deficits, both for consumption purposes or for investment purposes. It provides banking services provided by commercial banks and other services But based on the principles and principles of Islamic law, and because of its recent emergence in Iraq, its ability to attract savings is not like non-Islamic commercial banks, which puts them in the option of using their capital to achieve its objective of banking. The research started from the premise that "Islamic banks in Iraq during the period (2008-2012) rely on their capital to perform their activities more than they rely on d
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When applying the Taylor rule to exchange rate with the inflation and the output gap, the results do not match the nominal price announced by the central thing, which proves the lack of commitment by the Central Bank by using the Taylor rule, whether short-run interest rate or exchange rate (Nominal Anchor), so it did not stay to the Iraqi Central Bank only using the principle of Taylor with the expected inflation rate below the level of output (Macro activity) for the separation of monetary behavior from the real one o
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