Penile fracture: preoperative evaluation and surgical technique for optimal patient outcome

OBJECTIVE

To review the preoperative diagnostic evaluation and surgical treatment of penile fracture, as the condition is a urological emergency that requires immediate surgical exploration and repair.

PATIENTS AND METHODS

Between January 2003 and October 2007 eight patients presented to the emergency department with penile fracture after sexual intercourse. The clinical presentation, preoperative evaluation and imaging, surgical technique, and postoperative care were assessed to determine the optimal patient outcome.

RESULTS

Seven of the eight patients were treated surgically and one refused surgical intervention. Four cases involved unilateral corporal injury, two involved unilateral corporal injury with an associated urethral injury, and one involved bilateral corporal injury with an associated urethral injury. Although retrograde urethrogram were taken of all three urethral injuries, none of them revealed the injury. Diagnostic cavernosography or magnetic resonance imaging were not used in any of the patients. No complications occurred in the patients treated surgically.

CONCLUSIONS

Preoperative imaging should not delay surgical repair. If an associated urethral injury is suspected, flexible cystoscopy is recommended in the operating room, as opposed to a retrograde urethrogram. A subcoronal circumcising incision is recommended to deglove the entire penile shaft and have complete access to all three corporal bodies, as well as the neurovascular bundle. Saline mixed with indigo carmine can be injected both into the corpora cavernosum or corpus spongiosum via the glans penis, after a tourniquet is placed at the base of the penis, to evaluate the surgical repair and to determine if there are any missed injuries.     

User involvement in the making: Positions and types of knowledge enacted in the interaction between service users and researchers in user panel meetings

BackgroundNumerous studies of user involvement in research have been conducted. However, there is a lack of studies applying observational methods and addressing the concrete practice of involvement.ObjectiveTo determine what knowledge types and competences users apply when involved in the research process through user panel meetings.DesignUser panel meetings in a qualitative project in rehabilitation were sound‐recorded and transcribed verbatim. Data analysis applied an abductive approach framed by positioning theory.Setting and participantsSix rehabilitation service users and a similar number of researchers met 20 times during a six‐year project period. They discussed various issues in the research process such as interview guides, analysis and dissemination of results.FindingsThe service users combined their respective knowledge and competence into six positions enacted in the panel interactions. They engaged as co‐researchers, based their contributions on their respective personal histories, represented an NGO and peers, applied their respective professional and educational backgrounds and, finally, engaged as concerned citizens.Discussion and conclusionThe findings add to the discussion of professionalization of user involvement by introducing a wider array of positions enacted than do the findings of previous studies. Researchers recruiting user panel members, as well as NGOs appointing candidates for user panels, are advised to consider a wide competence profile for possible candidates. A panel is also considered as a resource in confirming and elaborating on a study''s findings.Patient and public contributionA service user panel contributed to the study.     

Pulp-dentin biology in restorative dentistry. Part 1: normal structure and physiology.

Considerable knowledge has accumulated over the years on the structure and function of the dental pulp and dentin. Some of this knowledge has important clinical implications. This review, which is the first of seven articles, will be limited to those parts of the normal structure and physiology of the pulp and dentin that have been shown to result in, or are likely lead to, tissue reactions associated with the clinical treatment of these tissues. Although certain normal structures will be highlighted in some detail, a basic knowledge of pulpal and dentinal development and structure is a prerequisite for an understanding of this text.     

Comparative mitogenicity and polyclonal B cell activation capacity of eight oral or nonoral bacterial lipopolysaccharides in cultures of spleen cells from athymic (nu/nu-BALB/c) and thymic (BALB/c) mice

Optimal stimulatory doses of purified phenol-water extracted lipopolysaccharides (LPS) from 5 selected strains of 3 putative periodontopathogens (Fusobacterium nucleatum, Prevotella intermedia, and Veillonella), 3 strains of 2 nonoral bacterial species (Bacteroides fragilis and Salmonella enteritidis), and pokeweed mitogen (PWM) induced significantly higher maximum mitogenic responses and polyclonal Ig production in cultures of unfractionated spleen cells from nu/nu-BALB/c (nude) than from BALB/c (normal) mice. Compared with PWM, the LPS were stronger mitogens showing relative mitogenic capacities: B. fragilis LPS greater than F. nucleatum LPS greater than S. enteritidis LPS, Veillonella LPS, and P. intermedia LPS. B. fragilis LPS was the most and S. enteritidis LPS the least effective polyclonal B cell activator of total Ig, IgG2a, IgG2b, IgG3, IgA, and IgM secretion. IgG1 was not detected. P. intermedia LPS was the strongest IgA inducer. Kinetic observations indicated mitogenic responses and polyclonal B cell activation in a close sequential order in nude and normal cells. The LPS were potent Ag- and T cell-independent polyclonal B cell activators and LPS of subgingival plaque bacteria may therefore play a nonspecific role in the pathogenesis of periodontal diseases.     

Erysipelothrix rhusiopathiae serotype 5‐associated metritis in a Norwegian Red heifer

This report summarized the findings of a case of Erysipelothrix rhusiopathiae infection in a farmed Norwegian Red heifer located in the south‐east of Norway. The 2.5‐year‐old pregnant heifer was found dead after a short episode of inappetence. On gross exam, the heifer was severely dehydrated with uterine torsion. Microscopically, necrosis of the endometrium was present throughout the uterus along with presence of intralesional Gram‐positive bacteria, interstitial nephritis, and pyelonephritis. E. rhusiopathiae was isolated from the uterus and placenta and was also demonstrated by immunohistochemistry (IHC) in the uterus, placenta, and kidney. The E. rhusiopathiae isolate was further characterized as serotype 5. To the authors’ knowledge, this is the first report of bacterial metritis associated with E. rhusiopathiae serotype 5 infection. The etiology of the infection is unknown but the E. rhusiopathiae could have been a primary or opportunistic pathogen. Serotype 5 of E. rhusiopathiae has been identified in several mammalian species in recent years and could be emerging.     

Malignant melanoma of the anorectum

Melanoma is a virulent tumor that can be widely disseminated and is genrally incurable even when the primary growth is small. Review of the cases of 34 patients with primary melanoma of the anorectum, with follow-up ranging from two to five years, suggests that improvement in survival depends on acute surgical awareness and aggressive surgical intervention. Read at the meeting of the American Society of Colon and Rectal Surgeons, Atlanta, Georgia, June 10 to 14, 1979.