THE PROS AND CONS OF ROUTINE CIRCUMCISION

The origin of the practice of circumcision is an ancient one having a ritual significance in most cases, but the operation is done primarily for hygienic purposes amongst English-speaking people.Critical evaluation of the indication for circumcision suggests that the hygienic principles are probably overrated. If it were understood that the anatomy of the prepuce and glans has a morphological development which in most cases removes the possibility of phimosis after the third year, less emphasis would be placed on the necessity for the operation.On the other hand, the feeling exists that boys who will require circumcision because of phimosis, balanitis, etc., should not be subjected to the operation at the age when psychological trauma can result. Convention and conformity demand the continuation of the procedure in many areas. The decision to circumcise remains a matter of individual preference as prescribed in the doctor-patient relationship.     

Risk factors for development of sexually abusive behaviour in sexually victimised adolescent boys: cross sectional study

Objective: To identify factors that may increase the risk of a sexually victimised adolescent boy developing sexually abusive behaviour. Design: Sexually victimised boys who had sexually abused other children were compared with sexually victimised boys who had not done so. Setting: Social services departments in south east England were invited to refer sexually abused and sexually abusing boys to a London postgraduate teaching hospital. Subjects: 25 adolescent boys aged between 11 years and 15 years and 11 months. Main outcome measures: Adjusted odds ratios estimated from unconditional logistic regression. Results: Unadjusted odds rations for witnessing (8.1) as well as experiencing (18.0) intrafamilial violence and discontinuity of care (7.2) discriminated boys who had sexually abused from others who were solely victims of sexual abuse. Only the adjusted odds ratios for witnessing intrafamilial violence (39.7) discriminated the two groups. Conclusions: The risk of adolescent boys who have been victims of sexual abuse engaging in sexually abusive behaviour towards other children is increased by life circumstances which may be unrelated directly to the original abusive experience, in particular exposure to a climate of intrafamilial violence. Our findings have implications for the management of boys found to have been sexually abused and raise important questions about the possibility of secondary prevention of subsequent abusive behaviour in those at greatest risk.

Key messages

• The risk of sexually abused boys in early adolescence abusing other children may be associated with experiences in early life that are independent of sexual victimisation
• Exposure to persistent violence within the family may be a particularly important risk factor
• Management of sexually abused boys should take into account the impact of early life experiences that may be associated with increased risk with a view to the secondary prevention of sexually abusive behaviour

     

Zinc,copper, selenium,and glutathione peroxidase in blood of 11-yr-old dunedin,New Zealand children

Blood was obtained from 564 11-yr-old children who had participated since birth in a multidisciplinary health and development study. Serum zinc concentration did not differ between the boys and the girls (mean±SD: 91=17 μg/100 mL,n=453). Five-6% of serum zinc values were low; although there was a weak correlation with height, none of the boys with low values were below the 10th percentile for height for this group. Serum copper concentration (112±24 μg/100 mL,n=454) was unrelated to sex, height, weight, body mass index, socioeconomic status (SES), or iron status. Blood selenium concentration (49±10 ng/mL,n=564) was lower than previously reported for Dunedin children; it was higher in children in the lower SES categories. The data represent normal values for healthy, 11-yr-old NZ children.     

Breast cancer stromal elastosis is associated with mammography screening detection,low Ki67 expression and favourable prognosis in a population-based study

Squamous cell carcinomas (SCCs) are uncommon, high-grade tumors, predominantly composed of round cells in the prepuce. The aim of this study is to better define the clinicopathologic features of this neoplasm. We conducted cyto-histopathologic analysis on the manifestations of the prepuce SCC by H &; E staining in a terrier mix dog. Grossly, tumor was large, multiple erythematous patch, and ulcerated masses frequently affecting the prepuce and deeply invading to distal prepuce out from the ventro-lateral of penis and the tumor covered by a necrotic discharge. Cytological evaluation of fine-needle aspirates from the cutaneous mass from the prepuce comprised of round nuclei, coarse chromatin pattern, distinct nucleoli and nuclear pleomorphism. Furthermore, the neoplastic cells were pleomorphic, round to caudate in shape, exhibiting prominent anisokaryosis and anisocytosis with rare mitotic features. Microscopically, the lesions were predominantly composed of atypical round cells disposed in interlacing fascicles. Frequent findings include keratin formation, horn pearls, mitoses and cellular atypia. The cells showed distinct borders, ranged from polygonal to round or elongate and had moderate amounts of eosinophilic cytoplasm. The histopathologic features coupled with the cytopathology findings led to a diagnosis of squamous cell carcinoma. To the authors’ knowledge, this is the first time that multiple erythematous plaques have undergone malignant transformation in a terrier mix dog. The virtual slide(s) for this article can be found here: http://www.diagnosticpathology.diagnomx.eu/vs/5748771971272873     

Aerobic work capacity of mentally retarded boys and girls in junior high schools.

The maximal oxygen uptake (Vo2 max) and ergometer load at a heart rate of 170 beats/min (PWC170) were determined in mentally retarded children (74 boys and 53 girls) of ages 12-15, whose IQ ranged from 36 to 91, and the results were compared with those for normal children. Mentally retarded boys and girls showed significantly inferior body height and weight, but no significant difference was found in skinfold thickness. The mean value of PWC170 for boys and girls was 14.34 kpm/kg/min and 11.31 kpm/kg/min, respectively, significantly less than that of the normal group. The mentally retarded boys had mean VO2 max per unit body weight of 42.4 ml/kg/min, which was significantly less than the 51.2 ml/kg/min of normal boys. The mentally retarded girls had a mean of 33.1 ml/kg/min which was also less than the 41.3 ml/kg/min of normal girls. The correlation coefficient between body weight and PWC170 (kpm/min) was 0.711 and 0.720 for boys and girls, respectively, while that between body weight and VO2 max (liter/min) was 0.641 for boys and 0.656 for girls. No significant correlation was found between IQ and PWC170 (kpm/kg/min) nor between IQ and VO2 max (ml/kg/min) both for boys and for girls. Similarly, no significant correlation was found between mental age and the VO2 max value (ml/kg/min).     

Characterization of infertility and bovine leukemia virus infection in beef bulls on southwestern Louisiana coastal range

One hundred and twenty-six beef bulls on southwestern Louisiana coastal range were evaluated for breeding soundness. Samples were taken to determine the incidence of bovine leukemia virus (BLV) infection, and the prepuce was cultured for potential pathogens. A high incidence (47.6%) of questionable and unsatisfactory potential breeders resulted mainly from 37.0% of the bulls exhibiting high numbers of abnormal sperm cells in the semen. Only bulls in the 4-to 5-yr age group exhibited the expected incidence of normal spermiograms. Genital campylobacteriosis was not diagnosed but there was genital trichomoniasis in three of the seven herds. Hemophilus somnus , mycoplasma and ureaplasma were isolated from the prepuce of 13.3, 48.8 and 36.7% of the bulls, respectively. Isolation of these organisms from the prepuce did not appear to be associated with abnormal spermiograms. Of the bulls studied, 34.4% had positive AGID reactions for BLV. Bulls seropositive to BLV had an increased incidence of leukocyte counts that were above the normal range. There was no apparent relationship between BLV infection and abnormal spermiograms.     

Squamous cell carcinoma with metastasis in a rhesus monkey (Macaca mulatta)

A squamous cell carcinoma of the prepuce and penis with metastases to the inguinal lymph nodes and lung occurred in a rhesus monkey (Macaca mulatta). The primary tumor consisted of eroded nodular masses at the mucocutaneous junction of the prepuce and in the epithelium of the prepuce and penis.     

游泳训练对儿童最大有氧活动能力的影响

本文利用步行机对９１名８－１１岁男女儿童进行最大有氧活动能力的测试,其中训练组４２人选自北京市海滨区业余游泳队的儿童,对照组４９人（男２４人,女２５人）选自与训练组儿童条件相近的普通学校学生。观察９个月的游泳训练对儿童有氧活动能力的影响。研究结果表明,训练组儿童的身高,体重,瘦体重和肺活量在观察前及观察后的两次测试中均高于对照组。观察期间形态指标的增长值和两组值在两组间大都无明显差别,表明两组儿童     

Effect of in-utero exposure to diethylstilbestrol on age at onset of puberty and on postpubertal hormone levels in boys.

A group of boys exposed to diethylstilbestrol (DES) in utero who had earlier been found to have urogenital abnormalities were studied for evidence of later effects of DES on their health, physical development and hormonal status. They showed no difference in age at onset of puberty, development of sexual characteristics or hormone levels from boys of the same age who had not been exposed to DES. However, the exposed group tended to have smaller testes.     

Study of urinary tract infection in children in one health district.

OBJECTIVES--To determine the number of children who had urine specimens sent for culture, who had infections or sterile pyuria, and who were investigated further. To relate the laboratory findings to the results of imaging. DESIGN--One year survey of urine specimens submitted to a laboratory; review of previous and subsequent laboratory reports; review of the findings of imaging of the urinary tract. SETTING--Portsmouth and South East Hampshire health district. SUBJECTS--An estimated population of 89,086 children aged 12 years or under. MAIN OUTCOME MEASURES--Urine bacterial count and results of imaging. RESULTS--12,551 urine specimens were submitted from 7450 children, 3138 boys and 4312 girls. 2238 children had infection or sterile pyuria at least once during the study (13.9/1000 boys, 37/1000 girls). 996 (45%) of the children with infection or sterile pyuria underwent some form of imaging. 128 children who had infection or sterile pyuria were already known to have urinary tract abnormalities and 114 children had newly identified abnormalities (1.0/1000 boys, 1.5/1000 girls). 50 (44%) of the children with newly detected abnormalities had no pyuria and 48 (42%) had bacterial counts below 10(8)/l. Eight children who had sterile pyuria on presentation were found to have abnormalities on imaging. CONCLUSIONS--Urinary tract infection is much commoner in children than is widely believed. Low bacterial counts, the absence of pyuria, or a finding of sterile pyuria should not be disregarded.     

Natural history of the maldescended testis

In a series of 545 boys with undescended testis, 91 had bilateral spontaneous descent after the age of 10. Forty-five accepted to take part in an investigation of their fertility based on history, clinical examination, sperm analysis and estimation of serum FSH levels. In the majority, the volume of the testis was below normal and the sperm concentration was below the lower limit of the normal range. It is concluded that late spontaneous bilateral descent of the testis carries a serious risk of later impaired spermatogenesis.     

Relation between age of mothers with breast cancer and sex of their children.

In a consecutive series of 150 women with breast cancer 122 had borne one or more children. Sixty-two patients were aged below 55 years at diagnosis (group A) and 60 were 55 years or older (group B). In group A 91 out of 153 children (59%) were boys compared with 48 out of 141 (34%) in group B (p=0.000007). In group A 54 of the 62 patients (87%) had given birth to one or more boys compared with 35 of the 60 (58%) in group B (p=0.0003). The mean age at diagnosis in mothers of two or more boys was 49.0 years, in those of one boy 55.2 years, and in those of only girls 61.0 years. The differences between each of the mean ages was significant. The mean age at diagnosis in 28 nulliparous patients was 57.7 years. There was no significant correlation between the number of female pregnancies and age at diagnosis. These results suggest that in women liable to develop breast cancer male pregnancies are associated with an early onset of the disease.     

Pseudo-iatrogenic hypospadias: the megameatus intact-prepuce hypospadias variant

This article presents the authors' experience with 21 patients with the megameatus variant of hypospadias who were treated during an 8-year period. In nine of the cases, the parents were convinced that the defect was a complication of circumcision, and the patients were examined in consultations in preparation for litigation. Seven of those nine patients had been previously examined by either a plastic surgeon or a urologist, who failed to recognize this variant. The typical appearance of the defect and how to differentiate this congenital deformity from true iatrogenic hypospadias are described. The features of the megameatus intact-prepuce variant of hypospadias include a wide spatulated glans, a deep groove, a large wide patulous meatus at the subglanular groove, an intact prepuce before circumcision, no evidence of glanular scarring, and no history of bleeding at the time of circumcision.     

Seasonal changes in the prepuce of adult Fallow deer (Dama dama) and its probable function as a scent organ

The penis sheath of adult Fallow deer, which is an integral part of the abdominal skin, extends from the scrotum to the preputial orifice. Marked seasonal changes occur in the prepuce. In the non-rutting animal, the outer region of the prepuce, which is similar in structure to normal skin, passes through a transition zone characterized by a corrugated epidermis and multi-lobed sebaceous glands, before becoming the inner-sheath lining. Just before the rut, hypertrophy of the epidermis of the transition zone occurs with the formation of keratinous villi-like processes. The sebaceous glands enlarge and lipid production is increased. At the beginning of the rut, the transition zone everts and becomes located on the outer periphery of the prepuce, which now has the appearance of a dark brown, coarse, short-haired brush. At this stage, the animal and its voided urine develop a characteristic pungent odour whereas urine aspirated from the bladder is relatively odourless. After the rut, the prepuce returns to normal, the keratinous papillae being shed. It is suggested that the strong smelling rutting odour of male Fallow deer helps to synchronize oestrus in the females. The gross hyperkeratosis and associated epidermal hypertrophy of the prepuce produces a sponge-like mass which may help in scent production and dispersal.     

Histomorphology of the glans penis in Vespertilionidae and Phyllostomidae species (Chiroptera,Mammalia)

The penises of bats are taxonomically distinctive in size and shape. In addition, they are variable in microscopic anatomy, indicating that histomorphological studies of copulatory organs of bats may help understanding their successful reproductive strategies. We studied adult males of 13 species of vespertilionid and phyllostomid bats. Both families exhibited the basic structure of the vascular penis of mammals: the hydrostatic elements of the corpora cavernosa and the corpus spongiosum surrounding the urethra, as well as accessory cavernous tissue. Variation in the position and amount of the tissues were observed in these families. Vespertilionid bats have a small glans penis with abundant accessory cavernous tissue on the prepuce and a highly variable baculum. The baculum varied in size and morphology, even among congeneric species, such as the three Lasiurus species and the two Myotis species. Phyllostomid species possess no bacula, but vascular structures are present to produce penile stiffening, particularly on the glans. Variation in the microscopic anatomy of the phyllostomid prepuce was observed, for example, Artibeus species had accessory cavernous tissue surrounded by a tunica albuginea, but Carollia perspicillata had two bundles of striated musculature and some adipose tissue; abundant pigments were present in the prepuce of most species.     

Physical exercise, body mass index, subcutaneous adiposity and body composition among Bengalee boys aged 10-17 years of Kolkata, India

A comparative study of 215 sedentary (no regular physical exercise undertaken) and 313 physically active (regular physical exercise undertaken) Bengalee boys aged 10-17 years was undertaken to investigate the differences in overall adiposity (body mass index), subcutaneous adiposity (skinfolds) and body composition (percent body fat, fat mass and fat mass index). Both groups had a similar age. The results revealed that boys who did not undertake regular physical exercise (NPE) had a significantly greater mean body mass index (BMI) compared with those who undertook regular physical exercise (PE); p < 0.001. The means for all the skinfolds as well as percent body fat (PBF), fat mass (FM) and fat mass index (FMI) were significantly higher among the NPE group. The percentile distributions of all these variables and indices were consistently higher among the NPE group. The results of ANOVA of physical exercise (PE = yes, NPE = no) and PBF, FM and FMI, with age as covariate, revealed that PE had a significant negative effect on all these measures of body composition even after controlling for the impact of age. The means in each case were greater among the NPE group. In conclusion, this study provided evidence that Bengalee boys, who undertook regular physical exercise, had significantly less adiposity compared with those who did not undertake regular physical exercise.     

The natural history of childhood asthma to adult life.

A randomly selected group of 331 children who had started to wheeze in childhood and a control group of 77 children were prospectively studied clinically and physiologically from 7 to 21 years of age. Most subjects improved during adolescence and about 55% of those whose wheezing had started before 7 years and stopped before adolescence remained wheeze free. Forty-five per cent of subjects who had apparently ceased to wheeze at 14 years had minor recurrences of wheezing between 14 and 21 years of age. Fewer than 20% of those with persistent symptoms in childhood had become totally wheeze free during adolescence, although there was amelioration in symptoms. Girls did less well during adolescence than boys, so that there was no longer an increased preponderance of boys with increasing severity of asthma. Normal growth was achieved in all grades despite the persistence of symptoms in many cases. At 21 years of age features of airways obstruction were often found during an interval phase, especially in those who had more persistent symptoms.     

Factors Associated with Knowledge of and Willingness for Adult Male Circumcision in Changsha,China

Background

Male circumcision (MC) has been shown to reduce the risk of male genital diseases. MC is not commonly practiced among Chinese males and little is known about the factors associated with their knowledge of and willingness for MC. This study was to explore the knowledge regarding the foreskin among Chinese males and to identify factors associated with their willingness to undergo circumcision.

Methods

A total of 237 patients with redundant prepuce/phimosis were interviewed through face-to-face interviews. The items on the questionnaire included: demographics, an objective scale assessing knowledge about the foreskin, willingness to have MC, the attitudes of sexual partners and doctors toward redundant prepuce/phimosis, and the approaches that patients used to acquire knowledge regarding the prepuce. Univariate analysis and multiple logistic regression analysis were performed to identify factors that are associated with willingness to be circumcised (WTC).

Results

A total of 212 patients completed the interview. Multivariable logistic regression showed that three factors were significantly associated with WTC: being married (OR = 0.43), perceiving redundant prepuce/phimosis as a disease (OR = 1.93), and if a patient’s partner supported MC (OR = 1.39). 58% (n = 122) had received information about the foreskin from another party: 18% (n = 37) from school, 8% (n = 17) from family, 17% (n = 36) from friends, 27% (n = 57) from health care providers. About 4% (n = 8) believed that their partners disliked their redundant prepuce/phimosis. 20% (n = 42) had received doctors’ advice to undergo circumcision.

Conclusion

Knowledge about the foreskin was low among Chinese males. Our study elucidates the factors associated with WTC and suggests that more education of the population about the foreskin can help improve the recognition of a correctible abnormality and help patients assess the potential role of MC in their health.     

Ethnic Differences in Subcutaneous Adiposity and Waist Girth in Children and Adolescents

The purpose of this study was to examine ethnic differences in adiposity as measured by sum of skinfolds (SKF) and waist circumference (WC) in children and adolescents, after statistical adjustment for the BMI and age. A cross sectional sample of 3,218 (55% white, 49% male) children and adolescents aged 5–18 years who participated in the Bogalusa Heart Study (1992–1994) were included in these analyses. Sex‐specific ANOVAs, adjusted for BMI and age, for each 2‐year age group compared measures of adiposity (SKF and WC) between ethnic groups. No significant differences in the proportions of children and adolescents who were overweight and obese by ethnicity or sex were found. Mean SKF in normal weight (P < 0.0001) and overweight (P < 0.0001) categories was higher for white than black children of both sexes. Across most age categories, white boys and girls had significantly higher SKF than black boys and girls, respectively (P ≤ 0.05). Across most age categories, white boys had significantly higher WC than black boys (P ≤ 0.05) with no difference in the girls, when adjusted for BMI and age. Measures of adiposity in childhood and adolescence were significantly higher in white children compared to black children, when adjusted for BMI and age. Throughout childhood and adolescence, white boys and girls had higher SKF and white boys had higher WC. Differences in adiposity between ethnic groups should be considered in disease risk assessment and stratification as they are observed even for a given BMI level.     

Health concerns and health-related behaviours of adolescents.

Health promotion and treatment programs for adolescents must be tailored to the unique concerns and needs of this population. A questionnaire was mailed to 1000 adolescents aged 12 to 20 years in the Ottawa-Carleton region; 729 responded, giving information on their health concerns and habits. The teenagers reported worrying mostly about chronic conditions such as acne, menstrual disorders, emotional problems, dental problems and being overweight. Some of these conditions can be treated if care is sought. The psychosocial problems most important to the adolescents were school and family problems. Girls tended to report health concerns more often than boys, but there was little variation by age or social group. Although the proportions of adolescents who were smoking cigarettes, drinking alcoholic beverages or using "recreational" drugs or who had ever had sexual intercourse were relatively high, the number of respondents who perceived such habits as health problems was low. There was a low level of concern about birth control among the respondents, including those who indicated that they had had sexual intercourse. The fact that significantly more girls than boys reported that they smoked and had engaged in sexual intercourse suggests specific targets for health promotion activities.