Paraphimosis revisited: is chronic paraphimosis a predominantly third world condition?

Paraphimosis is an acute condition characterized by all the signs of inflammation. Here we describe a 'chronic' variant of paraphimosis where patients often present many days after the initial injury. The aim of this study is to identify and possibly classify this new variation of paraphimosis - the chronic condition. We studied 68 patients with this condition between 1997 and 2005. In all, the prepuce was fibrous and bunched up behind the glans penis and, in some cases, with ulcerations. All patients were treated by excision of the fibrous flap and circumcision, under local anaesthesia. Patients were discharged on the same day on which the excision was done. Follow-up was on the third, seventh and ninetieth days. Long-term follow-up was possible in only 22 patients. This technique of modified circumcision was effective in treating this condition and we think a new classification of paraphimosis is warranted - acute and chronic.

Laparoscopic orchiectomy for the adult impalpable testis--experiences in a rural teaching hospital.

BACKGROUND: Undescended testis is a relatively common condition in boys. The standard treatment is orchiopexy. In adults, orchiopexy is done only if sufficient length can be mobilized. Otherwise, orchiectomy is ideal as undescended testis predisposes to carcinoma. The incidence of carcinoma increases with age. The aim of this study is to highlight the value of laparoscopy in treatment of impalpable testis and simultaneously repair associated hernias. This is our experience in a rural tertiary hospital. METHODS: In our rural hospital, it is not uncommon to see men aged 30 years or more presenting with unilateral absence of testis/empty hemiscrotum. A total of 35 patients were studied. Ultrasonography of the abdomen was done to localize the exact position of the testis; it was detected in 12 cases. A computed tomography (CT) scan was done in the other 23 cases and was positive in 16. The testis was found in the retroperitoneum (close to the internal inguinal ring) in 12 cases and in the inguinal canal in 23 cases. There were associated hernias in 9 patients. RESULTS: Laparoscopy accurately identified the exact location of the missing testis and resection was also accomplished and associated hernias were repaired laparoscopically. DISCUSSION: In countries like India, the majority of the population is poor and illiterate. By the time a boy or young man with an undescended testis arrives at the hospital, it is already too late to do orchiopexy. Even though most of our patients had no symptoms, orchiectomy had to be done because of the risk of torsion and malignant transformation. By using laparoscopy in these patients, the advantages of minimally invasive surgery can be utilized. CONCLUSIONS: Laparoscopic orchiectomy seems to be advantageous and well received by patients. We preferred the laparoscopic approach for the obvious benefits of less pain, better cosmesis, and early discharge.

Genetic analysis of human obesity in an Italian sample.

An analysis of the genetic factors in obesity has been carried out on a sample of nuclear families from Aosta (N. Italy). The families consisted of the parents and sibs of all elementary school children considered to be obese during a preliminary screening and a similar sample of non-obese children and their nuclear families. The numbers of such families were 67 and 112, respectively. Several tests were applied in order to examine the genetic contribution to obesity, and in particular to investigate the presence of a dominant major gene. Our conclusions are that genetic factors are certainly present. Several analyses suggest the presence of a dominant major gene with weak effect.

A morphotypological analysis of an Italian population: association with obesity.

The morphotypological method of Brian (1960) was applied to the data collected in Aosta (N. Italy) during an investigation on human obesity. The data consist of anthropometric measurements on members of families ascertained by the presence of obesity in the children and therefore the frequency of obesity is much higher than in the general population. One of the morphotypes was found only among the obese and two others were much more common among the obese than among the non-obese. More than 80% of the obese (vs. 10% of the non-obese) belonged to these three classes. There was a positive parent-offspring association for two of the components of the morphotype (morphy and somy).

A nonparametric and a parametric version of a test for the detection of the presence of a major gene applicable on data for the complete nuclear family.

Nonparametric and parametric tests are suggested for detecting the presence of a major gene for a quantitative trait. The model for the determination of the quantitative trait is an additive one with polygenic, family environment, and individual environment components. The power functions with respect to the major gene effect have been calculated by simulation, and the tests have therefore been compared with each other. The tests have been applied to nuclear family data on human obesity, and the results compared with those obtained using other methods on the same data.

Multivariate statistical analysis of quantitative serum protein data in populations of Rwanda.

Data on serum protein levels of four populations from Rwanda were analyzed by multivariate statistical methods to assess their utility as an anthropological tool. These populations consisted of two ethnic groups in two different environments. Seven proteins were considered in the analysis. The total concentration of proteins is intermediate between Italian levels and those of the Binga pygmies of the Republic of Central Africa (RCA). Discrimination between the populations was possible with a 25% misclassification. The major principal components can be interpreted from a medical viewpoint, and show significant differences between the populations.

Coevolution of species in competition: a theoretical study.

A model is presented for the coevolution of several species in competition, each species being genetically variable at one locus with respect to this competition. A function was fund that is maximized during coevolution. This maximization principle was used in order to study the result of competition for a single resource on the utilization functions of the species competing for that resource. In particular, the conditions under which ecological character displacement can evolve were examined.

Ontogeny of secretory immunity: levels of secretory IgA and natural antibodies in saliva.

In 187 healthy subjects from 2 months to 27 years of age, secretory IgA and free secretory component were assayed in samples of whole saliva obtained before and after stimulation with lemon juice. Antibody titers against Escherichia coli O antigens and against rabbit erythrocytes were also dosed in unstimulated saliva. Secretory IgA, undetectable in newborns, was present in all 2-month-olds tested in both unstimulated and stimulated saliva; thereafter secretory IgA levels increased progressively, reaching adult values by 6 to 8 years in unstimulated saliva and already by 2 to 4 years in stimulated saliva. The antibody titers assessed in unstimulated saliva followed a similar pattern also reaching adult values by 6 to 8 years. On the other hand, free secretory component levels showed no significant variation with age in unstimulated saliva whereas a slight increase was observed in the first year of life in stimulated saliva.

A new improved clinical staging system for multiple myeloma based on analysis of 123 treated patients.

The effect of the presenting clinical features on survival time was evaluated in 173 patients of a population of 201 individuals with multiple myeloma observed at Malmö General Hospital during the 11-yr period 1960 to January 1, 1971. Complete follow-up was continued until December 1978. One-hundred and five of the patients came from the city of Malmö and constitute a complete nonselected myeloma population. Bivariate correlation and multivariate regression analyses showed that the survival (i.e., the prognosis) could be accurately predicted in IgG and pure Bence Jones myeloma patients from (A) serum creatinine level, (B) serum calcium level, and (C) bone marrow plasma cell percentage; and in IgA myeloma patients from (A) hemoglobin level, (B) serum calcium level, and (C) serum M-component level. The results were synthesized to produce a simple and reliable clinical staging system with three stages (i.e., risks of death). To facilitate the clinical application, multivariate regression equations were developed to optimally predict the prognosis, and graphs were constructed in order to make the staging of the myeloma patients easier and quicker. The comparison of the duration of survival between the three groups of staged patients confirmed the high reliability of the present staging system.

High incidence and heterogeneity of functional defects of the alternative pathway of complement among atopic children.

Two separate functional defects of the alternate pathway of complement (defective yeast opsonisation and defective rabbit erythrocyte lysis) are very frequent (of the order of 55% for the former and 35% for the latter) among atopic children and their unaffected relatives. The defects are independent of each other and of sex, age, season of sampling, type of atopic syndrome and IgE level. The alternative pathway initiation mechanism is probably involved in both defects.

Parasite-reactive serum IgE antibodies in African populations. Relation to intestinal parasite load.

Serum IgE levels and IgE antibodies against four intestinal parasites, and the presence and abundance of parasites in stool samples were investigated in 161 Rwanda natives. Most of the IgE turn out to be helminth-reacting antibodies. The stimulation and production of these antibodies are much different from those of anti-amoeba antibodies in their relation to the specific intestinal parasite load; helminth infestations seem to play a major role in the development of anti-amoeba antibodies as well.