Thermal cautery-assisted circumcision and principles of its use to decrease complication rates.

INTRODUCTION: Circumcision is one of the most frequently applied surgical procedures all over the world and a number of techniques and devices have been described concerning its method. Especially in developing countries where circumcision has been performed intensively under local anaesthesia, the thermocautery device developed to perform circumcisions in a short time and safely has found a widespread application. OBJECTIVE: We aim to share our experiences concerning application principles of the thermocautery device so as to be able to achieve better cosmetic results with lower complication rates. MATERIALS AND METHODS: Between the years 2009 and 2016, a total of 12,355 children between the ages of 40 days and 16 years (mean: 5.1 ± 2.0 years) were circumcised at our hospital. All circumcisions were performed by urologists under local anaesthesia using a thermocautery device (Thermo-Med TM 802B device; Thermo Medikal, Adana, Turkey). RESULTS: Bleeding that required surgical intervention did not occur in any patient. Compressive dressing was applied to 62 patients who had moderate degrees of bleeding, for haemostasis purposes. Twelve syncopes and four epileptic seizures developed secondary to local anaesthesia were managed in consultation with the Department of Children Health and Diseases. The most serious complication, trapped penis, was seen in 48 patients. All these complications were resolved using surgical interventions. Infection developed in 15 patients, and it was relieved with the administration of oral antibiotherapy. Penile adhesions were relieved in 25 cases, and anti-inflammatory treatment was organised. Meatal stenosis occurred in three cases, and two cases of inclusion cysts were treated with surgical intervention. DISCUSSION: In countries where circumcision is routinely applied, developing swift and safer methods are of the utmost importance. To this end, we prefer thermocautery, which can satisfy patient demands swiftly and safely. CONCLUSION: To reduce the complications after circumcision using thermocautery, we think that it is appropriate to pay attention to the following issues during circumcision: The cautery should be turned in a serial manner and both sides of the blade should be used for cutting, and temperature of the thermocauter should be adjusted according to the skin thickness. The cutting process should be achieved in two steps, and another method should be preferred for buried penis. If these rules are followed, we think that the thermocautery-supported method can be a very safe and fast circumcision method.

Protective Effects of Carvacrol Against Methotrexate-induced Liver Toxicity in Rats.

BACKGROUND: To investigate whether carvacrol (CAR) pretreatment reduces the severity of methotrexate (MTX)-induced hepatotoxicity in rats. METHODS: A total of 24 rats were equally divided into three groups : group I, control ; group II, MTX-treated ; and group III, CAR+MTX-treated. On Day 1 group III received a one-time intraperitoneal dose of CAR (73 mg/kg), and on Day 2 both groups II and III received a single dose of intraperitoneal MTX (20 mg/kg). The rats were then sacrificed so to harvest blood and liver tissue samples to determine malondialdehyde (MDA), total antioxidant capacity (TAS), total oxidant status (TOS), alanine aminotransferase (ALT), aspartate aminotransferase (AST) and alkaline phosphatase (ALP) levels. Histological specimens were examined via light microscopy. RESULTS: Levels of MDA, ALT, AST and ALP in rat liver tissue samples were significantly higher in the MTX-treated group relative to the control group. However, TAS was significantly reduced in the MTX-treated group when compared to controls. Pretreating rats with CAR counteracted the effect of MTX exposure as MDA was significantly decreased and TAS was elevated in liver tissues when contrasted with the MTX-treated group. Furthermore, histological examination demonstrated significant liver injury in the MTX-treated group versus the CAR+MTX group. CONCLUSIONS: Pretreatment with CAR markedly diminished liver damage induced by MTX. Therefore, CAR administration preceding MTX treatment might be a promising therapeutic modality to prevent and/or lessen the extent of MTX-induced hepatotoxicity.