Amputation du gland après circoncision

Introduction

Circumcision is still the most commonly performed surgery in our society. It??s often performed by an unlicensed paramedic or even by a traditional practitioner outside the hospital under the non sterile conditions. Although, not technically difficult, circumcision may have serious complications that can endanger the sexuality or even the life of male children. The aim of this study is to emphasize the important problem of glandular amputation after circumcision.

Patients and methods

We report 8 cases of glandular amputation after circumcision performed outside the hospital within traditional methods.

Results

The mean age of these patients was 6 years (3 to 8 years). Glandular amputation occurred during circumcision in 4 cases including that 2 cases with total glandular amputation. On the other cases it was about glandular necrosis caused by inadequate use of electric lancet. An urgent reparation of glans was performed on only 3 cases. On the forth the amputed glans was unrepairable. We noticed only one case on wich glans revascularization succeeded. In case of glandular necrosis, patients consulted after 3 days. The treatment consisted of meatoplasty.

Conclusion

Glandular amputation is a rare but very severe complication of circumcision because it endangers the future sexuality of the child. So, the operation should be performed by educated and experienced personnel.     

Emergency cross-arm transfer

This report describes a case of cross-arm transfer. Satisfactory function was restored, including good protective sensation, excellent grip strength, and surprisingly good return to preoperative activities. Cross-arm transfer should be considered in situations where bilateral arm amputation is present and neither can be replanted because of tissue loss.     

Trisomy 8 mosaicism syndrome

Authors present the case of a 15-year-old boy assessed for Marfan syndrome for many years. The child was treated because of skeletal defects, mild mental deficiency and dysmorphic features of face. Chromosomal analysis showed a trisomy 8 mosaicism.     

Development and regeneration of the neonatal digit tip in mice

The digit tips of children and rodents are known to regenerate following amputation. The skeletal structure that regenerates is the distal region of the terminal phalangeal bone that is associated with the nail organ. The terminal phalanx forms late in gestation by endochondral ossification and continues to elongate until sexual maturity (8 weeks of age). Postnatal elongation at its distal end occurs by appositional ossification, i.e. direct ossification on the surface of the terminal phalanx, whereas proximal elongation results from an endochondral growth plate. Amputation through the middle of the terminal phalanx regenerates whereas regenerative failure is observed following amputation to remove the distal 2/3 of the bone. Regeneration is characterized by the formation of a blastema of proliferating cells that appear undifferentiated and express Bmp4. Using chondrogenic and osteogenic markers we show that redifferentiation does not occur by endochondral ossification but by the direct ossification of blastema cells that form the rudiment of the digit tip. Once formed the rudiment elongates by appositional ossification in parallel with unamputated control digits. Regenerated digits are consistently shorter than unamputated control digits. Finally, we present a case study of a child who suffered an amputation injury at a proximal level of the terminal phalanx, but failed to regenerate despite conservative treatment and the presence of the nail organ. These clinical and experimental findings expand on previously published observations and initiate a molecular assessment of a mammalian regeneration model.     

西周时期一例疑似刖刑的病例

本文对周原齐家东M24墓主骨骼进行了生物考古学研究,发现其右侧胫、腓骨下端1/5处为截肢后畸形愈合;胫骨生理长缩短约5 cm,足部离断后缺失。结合创伤情况、考古学背景及文献实物资料,该个体生前极有可能遭受了“惩罚性截肢”,即刖刑。商周时期刖刑的致死率极高,施刑工具可能有青铜刀锯、钻头、石块等,除拉切外还伴有砍砸行为。被刖之人康复后需拄杖行走并承担守门之责,社会地位低下、饮食状况不佳且饱受他人歧视,境遇十分悲惨。周原齐家东M24墓主是我国经过系统研究且年代最早的截肢病例,也是目前所见最为疑似刖刑的首例个体,为深入了解西周时期的刑罚体系、医疗水平及社会观念等提供了生动资料。     

Congenital amputation of the toes with replantation at the site of a constriction band in the mid-calf. Case report

We present a case of congenital amputation of the toes with replantation at the site of a constriction band in the mid-calf. The theories of the etiology of constriction bands are discussed, and the importance of this case in supporting the amniotic constriction band theory is emphasized.     

A case of Cushing's syndrome in pregnancy

Cushing's syndrome (also known as hypercortisolemia) is rare in pregnant women due to the menstrual disturbances and infertility in women with hypercortisolism. A diagnosis of pathological hypercortisolism in pregnant women is often difficult as some symptoms of the disease may be associated with a complicated pregnancy. Hypercortisolemia leads to serious complications for mother and foetus, and is associated with premature labour and high foetal mortality. Hormonal and radiological diagnostics in pregnancy are limited. The results of hormonal measurements and dynamic tests are difficult to interpret due to the physiological changes in the hypothalamo-pituitaryadrenal axis connected with pregnancy. The optimal time and method of treatment should be chosen cautiously case by case because of the possibility of maternal and foetal complications. In this paper, we present a case of Cushing's syndrome secondary to adrenal adenoma in which the diagnosis was made in the 22(nd) week of pregnancy. Due to the advanced gestational status and mild symptoms of hypercortisolism, only symptomatic treatment was introduced. The patient was under continuous obstetric and endocrinological care. At 35 weeks of gestation, the pregnancy was terminated by emergency caesarean section because of premature detachment of the placenta. A male infant weighing 2,450 g was delivered; neither adrenal insufficiency in the child nor hypercortisolemia complications in the mother were observed.     

Geriatric Nutritional Risk Index (GNRI) Independently Predicts Amputation Inchronic Criticallimb Ischemia (CLI)

Objective

General malnutrition usually occurs in critical limb ischemia (CLI) patients because of shortness of appetite and sleeplessness leaded by chronic pain. And amputation frequently is end-point of CLI patients. So the aim of this study was to assess the predictive ability of Geriatric nutritional risk index (GNRI) for predicting amputation in patients with CLI.

Methods

A retrospective study was designed. Demographics, history, comorbidity, and risk factors for peripheral vascular disease of admitted patients, and laboratory study were documented. Patients’ height, weight and BMI were recorded. Amputation was identified as end-point during follow-up. Patients’ amputation-free survival (AFS) was recorded.

Result

172 patients were identified, with mean age 71.98±3.12. Geriatric nutritional risk index (GNRI) = 90 was taken as cutoff value of high risk of amputation for CLI patients via using receiver operating characteristic (ROC) curve. Span of follow-up was 12–48 months. During follow-up, 60 patients (36.04%) received amputation surgery. And analyzed by Cox proportional hazards model, it is found that GNRI was the independent predictive factor for amputation in long term.

Conclusion

This study revealed that GNRI was a reliable and effective predictive marker for AFS. GNRI could identify patients with high risk for amputation in early time.     

CONSERVATIVE AMPUTATION IN ARTERIOSCLEROSIS OBLITERANS

Sixty-three toe and leg amputations in patients with arteriosclerosis obliterans were reviewed in an attempt to determine how often and under what conditions a toe or leg amputation gave satisfactory results, and when transmetatarsal amputation might better have been considered. In many cases in which toes were amputated, it was necessary later to amputate the leg or the thigh because of improper healing or spread of infection. Transmetatarsal amputations apparently heal frequently in carefully selected cases and permit better function in the foot than do toe amputations. Successful use of a prosthesis is not obtained in many cases after leg amputation. When this difficulty is anticipated transmetatarsal rather than leg amputation should be attempted, if other conditions warrant, since prosthesis is not necessary after transmetatarsal amputation.     

Long QT syndrome with AV Wenckebaching & bundle branch block in a neonate

We present a case of 21-day-old neonate brought with history of 3 episodes of syncope. Evaluation revealed congenital long QT syndrome associated with long cycle atypical AV Wenkebaching with a long short cycle sequence related left bundle branch aberrancy. Syncope was attributed to multiple episodes of Torsades de Pointes, necessitating emergency epicardial pacemaker implantation. In addition, child was started on oral propranolol therapy. On 2 months follow up, child was stable with no ventricular high rate episodes during pacemaker interrogation.     

Salmonella typhimurium-endocarditis secondary to an acquired environmental infection: a case report

A diabetic, cardiopathic and anemic 44-year-old farmer presented with a seven-day history of remittent fever with evening peaks. Two months before he had undergone amputation of the V-finger of the left hand secondary to a phlegmon caused by an agricultural injury. Prior to amputation, anaerobic culture analysis of phlegmon-pus and selective procedures used to isolate Gram-positive cocci and/or Pseudomonas spp. resulted negative. The diagnosis of endocarditis was supported by isolation of S. typhimurium from blood and by echocardiography showing endocarditic lesions. The source of infection was identified by PCR ribotyping as the same Salmonella typhimurium strain that was present, but not sought, both in the anatomic explanted tissues and from blood samples of the patient. The infection was successfully treated with a combination of gentamicin and ampicillin with consequent improvement in the general clinical picture of the patient. We believe this is the first reported case of S. typhimurium-endocarditis secondary to a phlegmon resulting from an environmental source of infection.     

Amputation du gland au cours de la circoncision et réimplantation : à propos d’un cas et revue de la littérature

Penile amputation due to circumcision is a tragic complication in which the operator is responsible. The current treatment is based on microsurgical replantation methods by anastomosing penile dorsal vessels and nerves. We report a new case of penile glans amputation due to circumcision in a 6-year-old boy. Replantation was done without microvascular and nerves anastomosis. After 7 months of treatment, the final result was found to be good in terms of the urinary stream, erectile function, sensitivity and morphological aspect of the glans.     

Parent predictors of child weight change in family based behavioral obesity treatment

Family based behavioral treatment for overweight and obese children includes parenting skills targeting the modification of child eating and activity change. The purpose of this study was to examine parenting skills and parent weight change as predictors of child weight change in a sample of 80 parent/child dyads who were enrolled in a family based behavioral weight loss program for childhood obesity. Eighty overweight and obese children and their parents who enrolled in treatment in two sites were included in the study. Variables included those related to parent modeling (parent BMI), home food environment, parenting (parent and child report), and demographics. Results suggested that parent BMI change was a significant predictor of child weight, in that a reduction of 1 BMI unit in the parent was associated with a 0.255 reduction in child BMI. None of the other variables were significant in the final model. This study is consistent with other research showing that parent weight change is a key contributor to child weight change in behavioral treatment for childhood obesity. Researchers and clinicians should focus on encouraging parents to lose weight to assist their overweight and obese child in weight management.     

Screening for microcytemia in Italy: analysis of data collected in the past 30 years.

Extensive population surveys begun in Italy in 1943 revealed a high incidence of mycrocytemia. Health authorities established a national organization to combat microcytemia which financed and directed activities throughout Italy from 1955 to 1971. The work performed by the microcytemia centers in screening and prophylaxis is described. The results of a screening program underway since 1967 involving 46,559 students of the University of Rome are presented in detail. A preliminary survey of 256 families revealed that the incidence of subsequent births after the births of a child affected by Cooley's anemia was generally low. Results obtained to date are encouraging and justify more extensive programs for the prevention and treatment of microcytemia.     

Malignant clear-cell hidradenoma

In this paper the authors present a case of malignant clear-cell hidradenoma developed on the dorsum of the hand. This is only the eleventh complete report in the literature, including follow-up, and only the third to include necropsy. It is the first to find both lung and myocardial metastases. The tumor was very invasive and was treated first by wide surgical excision and radical node dissection, and when the tumor recurred, amputation of the arm was done. The world literature was carefully reviewed and compared with this case. Owing to the already known failure of radiotherapy, and since chemotherapy was not successful in our patient, the authors advise early aggressive surgery, including block dissection of the regional nodes, and thereafter a careful follow-up.     

Wound infection by multiresistant Staphylococcus sciuri identified by molecular methods

We describe a case of wound infection by multidrug-resistant Staphylococcus sciuri in a patient admitted to hospital for injuries in Agreste Alagoas, Brazil, identified through broad-spectrum PCR and sequencing of 16S rDNA gene. Due to its high resistance profile, the infection was characterized as methicillin-resistant Staphylococcus presenting sensitive only to vancomycin and chloramphenicol. The injury resulting from trauma associated with infection resulted in amputation of the infected limb.     

An unusual log-splitter injury leading to radial artery thrombosis, ulnar artery laceration, and scapholunate dissociation

A log splitter is a gasoline- or diesel-powered machine that uses a hydraulic-powered cutting wedge to do the work of an axe. Log-splitter injuries that do not result in amputation of digits or limbs are uncommon and not well described in the literature. We present a unique case of a patient who sustained a log-splitter injury that resulted in thrombosis of the radial artery and avulsion laceration of the ulnar artery leading to acute hand ischemia, in addition to scapholunate ligament disruption leading to a DISI deformity. In this case, thrombolytic therapy was contraindicated and surgical revascularization was the best possible treatment option. Our case illustrates the pitfalls of using this modality in a crush injury, since the use of thrombolytics in this instance would have resulted in severe hemorrhage. An important clinical caveat is the potentially misleading arteriographic diagnosis of thrombosis and/or spasm.     

Thumb reconstruction by free microvascular transfer of an injured index finger

Thumb reconstruction for amputation at the metacarpal phalangeal level was accomplished by microneurovascular transfer of the contralateral damaged index finger ray, including metacarpal phalangeal joint. This transfer accomplished a successful thumb restoration and removed a cumbersome index finger amputation stump, improving function in both hands. This case emphasizes the merits of spare part transfer in hand reconstructive surgery made possible by microneurovascular techniques.     

Storage of a free forearm flap for 55 hours

A case is presented in which a filleted flap from the unreplantable forearm was used successfully to cover the upper arm amputation stump after 55 hours of cold ischemia.     

Metastasis of bronchogenic carcinoma to the thumb

Bone metastasis in the hand is rare. The etiology is quite different from that of metastasis to other bones; bronchogenic carcinoma is by far the most frequent case. Distal phalanges are mainly involved with irregular osteolysis and cortical destruction. Differential diagnosis of phalangeal metastasis includes osteomyelitis, rheumatoid arthritis and gout. The prognosis is always that of metastatic bronchial cancer with an average survival of three months. Treatment may involve distal digital amputation or antalgic radiotherapy. A case of bronchogenic carcinoma with metastasis to the thumb is presented. The metastasis was located in the distal phalanx of the left thumb. The primary tumor was located in the lung. Treatment consisted of amputation. The overall survival was five months.