Self-reported and observed female genital cutting in rural Tanzania: associated demographic factors, HIV and sexually transmitted infections

OBJECTIVES: To determine (i) the prevalence and type of female genital cutting (FGC) in a rural multi-ethnic village in Tanzania, (ii) its associated demographic factors, (iii) its possible associations with HIV, sexually transmitted infections (STIs) and infertility and (iv) to assess the consistency between self-reported and clinically observed FGC. METHOD: The study was part of a larger community-based, cross-sectional survey with an eligible female population of 1993. All were human immunodeficiency virus (HIV)-tested and asked whether they were circumcised (n = 1678; 84.2%). Participants aged 15-44 years were interviewed (n = 636; 79.7%), and 399 (50.0%) were gynaecologically examined to screen for STIs and determine the FGC status. RESULTS: At a mean age of 9.6 years, 45.2% reported being circumcised. In the age-group 15-44 years, 65.5% reported being cut, while FGC was observed in 72.5% and categorized as clitoridectomy or excision. The strongest predictors of FGC were ethnicity and religion, i.e. being a Protestant or a Muslim. FGC was not associated with HIV infection, other STIs or infertility. A positive, non-significant association between FGC and bacterial vaginosis was found with a crude odds ratio of 4.6. There was a significant decline of FGC over the last generation. An inconsistency between self-reported and clinically determined FGC status was observed in more than one-fifth of the women. CONCLUSION: The data indicate that both women and clinicians might incorrectly report women's circumcision status. This reveals methodological problems in determining women's circumcision status in populations practising the most common type of FGC. The positive association between FGC and bacterial vaginosis warrants further investigation.     

Effect of circumcision on urinary tract infection after successful antireflux surgery

OBJECTIVE: To evaluate whether circumcision during antireflux surgery can reduce the incidence of urinary tract infection (UTI) after successful ureteric reimplantation in patients with primary vesico-ureteric reflux (VUR). PATIENTS AND METHODS: Children who had undergone antireflux surgery for primary VUR were divided into group 1 (27, circumcised at the time of antireflux surgery at the parents' request) and group 2 (50, those not circumcised). All antireflux operations were by the Cohen method. Regular urine samples were cultured to detect UTI, which was defined as a single species with >10(5) colony-forming units/mL in a midstream voided specimen. Numbers of UTI episodes before and after surgery were compared between the groups, with (99m)Tc-dimercaptosuccinic acid (DMSA) renal scans also taken in all patients. Each scan was blindly reviewed in terms of the size, number and zonal location of cortical defects, based on morphology. Interval changes were categorised as improved, no change, progressed, and new scar formation, and compared between the groups. Prophylactic antibiotics were maintained until the follow-up studies at 4-6 months after surgery. RESULTS: There was no significant difference between the groups in age at the time of operation (mean 42.4 vs 47.4 months), the age at the first documented UTI (mean 26.5 vs 29.3 months), reflux grade, or number of UTI episodes and renal parenchymal scarring on DMSA before surgery. There was no significant difference between the groups in the number of UTI episodes at a mean (range) follow-up of 151.3 (114-207) months after antireflux surgery. Also there was no significant morphological change on follow-up renal scans and no difference between the groups. CONCLUSION: These findings suggest that circumcision during antireflux surgery has no effect on the incidence of postoperative UTI.     

A very late onset urethral fistula coexisting with skin bridge after neonatal circumcision: a case report

Complications of neonatal circumcision are generally minor and occur early; a few reports exist on the late or serious kind. The authors describe a case of urethrocutaneous fistula occurring 13 years postcircumcision. The patient also had a skin bridge, another late complication of circumcision. The authors suggest erections in puberty as the triggering factor for onset of fistula. To our knowledge, neither such a late occurrence of fistula nor coexistence of these complications have been reported.     

Attitudes and practices regarding circumcision in Turkey

BACKGROUND: In Turkey, circumcision is a necessity for boys to gain a masculine identity. In contrast to Western societies, where circumcision is performed in the neonatal period, it is performed at older ages in our population, and the timing may affect the psychosocial well-being of males. The person who performs the operation, a physician or a traditional circumciser, may affect their health as well. OBJECTIVE: To provide some information about the practice of circumcision in Turkey, such as timing, by whom and why it is performed in our country, and relation of their fathers' past emotions about their own circumcision to this current practice. METHODS: Questionnaires were filled out in face-to-face interviews with parents of 1235 male children under 16 years of age who attended well-child clinics of Gazi University Hospital and 10 different primary health care centres throughout Ankara, Turkey. RESULTS: Median age of circumcision was found to be 6 years. Only 14.8% of children were circumcised before 1 year of age. The main reasons for circumcision were religious and traditional. The medical benefits of the procedure outweighed the traditional reasons for only 15.2% of the families. The operation was carried out by a traditional circumciser in 13.3% of the children. Most of the fathers who could remember their own emotions about circumcision confessed that they had been frightened. They remembered the procedure as painful. Indeed, the mean age of their sons' circumcision was close to their own circumcision age. CONCLUSIONS: Traditions still play an important role in the timing of circumcision and by whom and why it is performed in Turkey. Changing times and educational levels do not seem to affect the traditional approach to circumcision.     

Billroth I Gastrectomy Using a Circular Stapler to Treat Gastric Cancer

We describe herein our technique of performing gastrectomy followed by side-to-end gastroduodenostomy. Because the clamp is removed at the resection line of the greater curvature, there is no need to perform an additional gastrotomy for insertion of the instrument. This feature differentiates our technique from previous methods of anastomosis using the circular stapler. We believe that our technique is superior in simplicity and security to the traditional hand-sewn anastomosis. Moreover, it allows for a shorter operative time. This technique is recommended for practical surgery over conventional techniques. Received: February 23, 2000 / Accepted: July 25, 2000     

Zirkularstapler-Mukosektomie vs. geschlossene submuköse Hämorrhoidektomie — eine prospektiv randomisierte Multicenter-Studie an 100 Patienten mit prolabierenden Hämorrhoidalknoten Grad III und IV

Zusammenfassung   Grundlagen:Longo’s Technik der Stapler-Mukosektomie in der Behandlung 3- bis 4-gradiger prolabierender H?morrhoidalknoten findet auch in ?sterreich breite Anwendung. Nach anf?nglicher Euphorie bezüglich des neuen nahezu schmerzlosen Verfahrens werden nach und nach Berichte über schwerwiegende Komplikationen bekannt. Die Ursache für postoperativ über Wochen bis Monate bestehende funktionelle Probleme wie Dranginkontinenz, verbunden mit brennenden Schmerzen im Bereich des Rektums trotz korrekt ausgeführter Longo-Technik, ist bis heute noch unbekannt. Methodik: Prospektiv randomisierte Multicenter-Studie an 100 Patienten mit prolabierenden H?morrhoidalknoten Grad III und IV. Ergebnisse: Vergleichende Studien mit der konventionellen H?morrhoidektomie nachMilligan-Morgan sind bisher in Frankreich (3) und Schweden (10) durchgeführt worden. Erste Ergebnisse wurden vonM. Rowsell und B. J. Mehigan (7, 13) publiziert. Schlu?folgerungen: Untersuchungen über funktionelle Langzeitergebnisse stehen noch aus. Wir glauben, da? es auch in ?sterreich wichtig und sinnvoll ist, Vorteile und Risiken der neuen Technik in randomisierten Studien zu untersuchen. Wir m?chten alle interessierten Koloroktologen zur Teilnahme an der Studie einladen.      

应用一次性宫腔管子宫输卵管动态碘水造影806例中的体会

目的提高一次性宫腔管在子宫输卵管动态碘水造影中临床价值的认识及优越性。方法本组806例,依次应用一次性宫腔管进行子宫输卵管动态碘水造影。结果806例均一次性造影成功。结论该方法简便、快捷、安全,有效成功率高。图像质量佳、信息多,克服了传统碘油造影方法造影剂容易逆流造成造影失败的缺点,增加了输卵管粘连后通过此方法进行造影再通的可能性。     

Z-plasty reconstruction for preputial stenosis — a surgical alternative to circumcision

ABSTRACT. A technique for the surgical treatment of phimosis of the prepuce to produce a cosmetic and functional result as an alternative to circumcision is described.     

Female circumcision: obstetrical and psychological sequelae continues unabated in the 21st century

Objectives.?To assess the incidence of female circumcision/female genital cutting (FGC) among pregnant women and describe the obstetrical and psychological sequelae of female circumcision.

Method.?Four thousand eight hundred pregnant women over a 4-year period were assessed for female circumcision. Odd ration (OR) and 95% confidence interval (CI) were calculated to measure association between female circumcision, maternal morbidity, and birth outcome. Variables included prolonged maternal hospitalization, low birth weight, prolonged labor, obstructed labor, cesarean section, and fetal outcome. Assessment measures to determine cognitive and emotional effects included the Mini international Neuro-psychiatric interview and Rey memory test.

Results.?The prevalence of female circumcision was 38%; women who were circumcised were more likely have extended hospital stay. There was a positive association between such women and prolonged labor, cesarean section, post-partum hemorrhage, early neonatal death, and hepatitis C infection. Psychiatric sequelae included: 80% continued to have flashbacks to the FGC event; 58% had a psychiatric disorder (affective disorder); 38% had other anxiety disorders, and 30% had post-traumatic stress disorder.

Conclusion.?Female circumcision is associated with adverse materno–fetal outcome and psychiatric sequelae. Many will need psychiatric as well as gynecological care.     

The use of circular stapler for cervical esophagogastric anastomosis after esophagectomy: surgical technique and early postoperative outcome

Stapled esophagogastric anastomosis after esophagectomy is considered to be superior to traditional handsewn techniques. Linear staplers are usually used. The aim of this study is to evaluate early postoperative results of circular stapler in cervical esophagogastric anastomosis. Records of all patients who underwent esophagectomy during the years 2003–2008 were reviewed. Patients that underwent transthoracic esophagectomy, colon transposition, or linear stapler anastomosis were excluded. Esophagogastric anastomosis was done either handsewn or using circular stapler. Patients underwent either pyloromyotomy, pyloroplasty, or no pyloric intervention. Postoperative leakage was diagnosed either clinically or radiologically. The end-point of this study was the incidence of anastomotic leak in the immediate postoperative period. Eighty-two patients (average age 66 years, male/female, 52/30) met the inclusion criteria. In 30 patients, the anastomosis was handsewn, and in 52 patients, it was done using a circular stapler. Overall operative mortality rate was 4.8% (four patients because of pulmonary or cardiac complications). Anastomotic leak occurred in five ( n  = 5, 16.6%) patients in the handsewn group and eight ( n  = 7, 13.4%) patients in the circular stapler group. Pyloric manipulation had no significant effect over the leakage rate. Routine upper-gastrointestinal (GI) series done on the fifth or sixth postoperative day did not reveal any of the leaks. Cervical esophagogastric anastomosis using an end-to-side circular stapler is feasible and safe, and has comparable outcomes to handsewn anastomosis in regard of leakage rates or other major surgical or general complications. Postoperative GI series seems to be a poor diagnostic tool for anastomotic leakage and could be omitted as a routine study for occult anastomotic leak.