Comparison of the clinical efficacy of "one-cut" circumcision and traditional circumcision / 现代泌尿外科杂志

【Objective】 To introduce the key techniques of "one-cut" circumcision, and to compare its clinical efficacy with traditional circumcision. 【Methods】 A retrospective analysis was conducted on 120 cases of circumcision in our center during Jul.2020 and Jul.2022, including 60 cases in the "one-cut" group and 60 cases in the traditional circumcision group. The operation time, postoperative edema time, satisfaction with cosmetics and improvement of sexual life were compared between the two groups. 【Results】 Compared with the tradition group, the "one-cut" group had shorter operation time [(19.2±7.4) min vs. (23.1±1.7) min, P<0.001] , shorter postoperative edema time [(5.5±3.2) d vs. (9.6±5.5) d, P<0.001] , and higher satisfaction with cosmetics [(3.6±0.5) vs. (3.1±0.8), P<0.001)] , but there was no difference in improvement of sexual life between the two groups (P=0.08). 【Conclusion】 "One-cut" circumcision is easy to operate, with short operation time, fast postoperative recovery, neat incision and satisfactory appearance, which is worth popularizing.

Urosepsis and postrenal acute renal failure in a neonate following circumcision with Plastibell device / 소아과

Plastibell is one of the three most common devices used for neonatal circumcision in the United States, with a complication rate as low as 1.8%. The Plastibell circumcision device is commonly used under local anesthesia for religious circumcision in male neonates, because of cosmetic reasons and ease of use. Occasionally, instead of falling off, the device may get buried under the skin along the shaft of the penis, thereby obstructing the normal flow of urine. Furthermore, the foreskin of neonates is highly vascularized, and hence, hemorrhage and infection are possible when the skin is cut. Necrosis of penile skin, followed by urethral obstruction and renal failure, is a serious surgical mishap requiring immediate corrective surgery and medical attention. We report a case of fulminant urosepsis, acute renal failure, and pyelonephritis in a 4-day-old male neonate secondary to impaction of a Plastibell circumcision device. Immediate medical management was initiated with fluid resuscitation and mechanical ventilation; thereby correcting life threatening complications. Pediatricians and Emergency Department physicians should be cognizant of the complications from Plastibell circumcision device in order to institute appropriate and timely management in neonates.

Very-long-chain fatty acids activate lysosomal hydrolases in neonatal human skin tissue

The aim of this study was to examine the in vitro effect of peroxisomal dysfunction on lysosomal enzymes, the autophagic machinery in the cell, in order to understand the mechanisms of pathogenesis of peroxisomal disorders. Foreskin samples were obtained immediately after circumcision of 1- to 2-day-old infants at the Maternity Hospital, Kuwait. Skin tissues were cleaned, cut into slices of 1-2 mm[2] in size and treated with lignoceric acid [1-20 micro g/ml], a very-long-chain fatty acid [VLCFA], in the presence or absence of 1-5 mM aminotriazole [ATZ]. A battery of lysosomal enzymes were assayed following treatment of dermal tissue with VLCFA or ATZ. Treatment of skin slices with lignoceric acid significantly increased [p < 0.001] the enzymic activities of acid lipase, acid phosphatase, alpha -glucosidase, alpha -galactosidase, N-acetyl- alpha -D-glucosaminidase [NAGA] and N-acetyl- alpha -D-galactosaminidase [NAGTA]. ATZ [1-5 mM], an inhibitor of key peroxi somal enzyme catalase, also markedly increased the enzymic activities of acid phosphatase, alpha -glucosidase [23%] and alpha -galactosidase [18%] without any significant effect on NAGA or NAGTA. Western blot analysis further revealed that both VLCFA and ATZ significantly increased the protein expression of lysosomal enzymes, beta -galactosidase and beta -glucuronidase. Experimen tal dysfunction of peroxisomes mimicked by elevated VLCFA or ATZ-mediated catalase inhibition significantly increased the activities of lysosomal hydrolases in human dermal tissue, suggesting that activation of the lysosomal system could be one of the factors responsible for cellular damage during pathogenesis of peroxisomal diseases

Neonatal tetanus: the experince of King Fahad hospital in Al-Baha province, Saudi Arabia

Ten cases [eight males and 2 females] of neonatal tetanus were seen at King Fahad Hospital in Al-Baha over seven years ending June 1989. All patients were born outside the hospital, eight at home and two at a local dispensary. House tools, such as scissors and knives, were used to cut the umbilical cord and to perform circumcision in all home-delivered cases. Application of traditional therapy on the umbilical stump or circumcision site was identified in only four cases. While all children received standard doses of penicillin, sedatives, tetanus immunoglobulin, nine needed positive pressure assisted ventilation and muscle relaxants. One child died due to uncontrollable arrhythmia. Among the survivors one developed spastic quadriplegia. Neonatal tetanus may be under-reported in Saudi Arabia due to the lack of an adequate home death registry