Fracture of the penis: A report of two cases

We present two cases of fracture of the penis in two young men at the extremes of the social strata the first an unemployed tailor while the other a practicing engineer. The first one was a bachelor while the other wasmarried with children. In the first case, the fracture occurred during masturbation while in the second case it occurred during consensual intercoursewith hiswife on top. In the first case the fracture occurred at the base of the peniswith associated rupture of the deep dorsal veinwhile in the second case it affected themid-shaftwith urethral rupture and blood at the tip of the penis at presentation. Both of them presented within two hours of their injuries with deformed, swollen and tender penis. Laubscher's subcoronal sleeve operation with evacuation of clots and repair of the tear with absorbable sutures to ensure a leak-proof repair was promptly performedwith no complications.Both patients experienced spontaneous erectionwhilst in hospital evenwith indwelling catheter in place. The wife of the second case became pregnant six months after the repair. Counselingwas successfulwith the engineer butwas unsuccessfulwith the tailor-bachelorwho continuedwith masturbation despite professional help.Thoughwe published the first case of fracture of the penis in this centre almost a decade ago, we still found it necessary to report these newcasesmanaged after we created awareness of this uncommon condition in our environment in order to highlight the presentations and the factors that influenced outcome

Surgery in refractory metabolic derangements: Report of a case

No Abstract

Genotoxicity of metal oxide nanomaterials: review of recent data and discussion of possible mechanisms

Nanotechnology has rapidly entered into human society, revolutionized many areas, including technology, medicine and cosmetics. This progress is due to the many valuable and unique properties that nanomaterials possess. In turn, these properties might become an issue of concern when considering potentially uncontrolled release to the environment. The rapid development of new nanomaterials thus raises questions about their impact on the environment and human health. This review focuses on the potential of nanomaterials to cause genotoxicity and summarizes recent genotoxicity studies on metal oxide/silica nanomaterials. Though the number of genotoxicity studies on metal oxide/silica nanomaterials is still limited, this endpoint has recently received more attention for nanomaterials, and the number of related publications has increased. An analysis of these peer reviewed publications over nearly two decades shows that the test most employed to evaluate the genotoxicity of these nanomaterials is the comet assay, followed by micronucleus, Ames and chromosome aberration tests. Based on the data studied, we concluded that in the majority of the publications analysed in this review, the metal oxide (or silica) nanoparticles of the same core chemical composition did not show different genotoxicity study calls (i.e. positive or negative) in the same test, although some results are inconsistent and need to be confirmed by additional experiments. Where the results are conflicting, it may be due to the following reasons: (1) variation in size of the nanoparticles; (2) variations in size distribution; (3) various purities of nanomaterials; (4) variation in surface areas for nanomaterials with the same average size; (5) differences in coatings; (6) differences in crystal structures of the same types of nanomaterials; (7) differences in size of aggregates in solution/media; (8) differences in assays; (9) different concentrations of nanomaterials in assay tests. Indeed, due to the observed inconsistencies in the recent literature and the lack of adherence to appropriate, standardized test methods, reliable genotoxicity assessment of nanomaterials is still challenging

Impact of opioid-free analgesia on pain severity and patient satisfaction after discharge from surgery: multispecialty, prospective cohort study in 25 countries

Background: Balancing opioid stewardship and the need for adequate analgesia following discharge after surgery is challenging. This study aimed to compare the outcomes for patients discharged with opioid versus opioid-free analgesia after common surgical procedures.Methods: This international, multicentre, prospective cohort study collected data from patients undergoing common acute and elective general surgical, urological, gynaecological, and orthopaedic procedures. The primary outcomes were patient-reported time in severe pain measured on a numerical analogue scale from 0 to 100% and patient-reported satisfaction with pain relief during the first week following discharge. Data were collected by in-hospital chart review and patient telephone interview 1 week after discharge.Results: The study recruited 4273 patients from 144 centres in 25 countries; 1311 patients (30.7%) were prescribed opioid analgesia at discharge. Patients reported being in severe pain for 10 (i.q.r. 1-30)% of the first week after discharge and rated satisfaction with analgesia as 90 (i.q.r. 80-100) of 100. After adjustment for confounders, opioid analgesia on discharge was independently associated with increased pain severity (risk ratio 1.52, 95% c.i. 1.31 to 1.76; P < 0.001) and re-presentation to healthcare providers owing to side-effects of medication (OR 2.38, 95% c.i. 1.36 to 4.17; P = 0.004), but not with satisfaction with analgesia (beta coefficient 0.92, 95% c.i. -1.52 to 3.36; P = 0.468) compared with opioid-free analgesia. Although opioid prescribing varied greatly between high-income and low- and middle-income countries, patient-reported outcomes did not.Conclusion: Opioid analgesia prescription on surgical discharge is associated with a higher risk of re-presentation owing to side-effects of medication and increased patient-reported pain, but not with changes in patient-reported satisfaction. Opioid-free discharge analgesia should be adopted routinely

The Management of Prostatic Haematuria

Background: Prostatic haematuria s a common clinical problem. In this report, we have reviewed the incidence, precipitating/co morbid factors, treatment and outcome of haematuria in patients with benign prostatic hyperplasia and prostate cancer Methods: A two year prospective review of 37 patients who presented with haematuria associated with benign prostatic hyperplasia and prostate cancer. Each patient had full clinical assessment, including any associated precipitating or co morbid factors. All patients had urethral catheterization; and cystoscopy to exclude bladder tumours or bladder stones. Subsequent management depended on severity of bleeding; and consisted of one of the following: observation only, irrigation only, irrigation and blood transfusion and emergency prostatectomy. Upon stabilization, the definitive treatment in each patient was based on primary pathology. Results: A total of 134 patients who had either benign prostatic hyperplasia or prostate cancer were treated. Thirty seven (27.6%) patients presented with haematuria. The incidences of haematuria in benign prostatic hyperplasia and prostate cancer were 26.7% and 29.2% respectively. Haematuria was precipitated in 17 (45.9%) patients; while nine (24.3%) patients had 12 associated co morbidities. Seventeen (45.9%) patients had blood transfusion. A total of 34 (91.8%) patients were managed conservatively. There were four (10.8%) deaths. Conclusion: Prostatic haematuria is a common urologic challenge. In most cases conservative management is the key. In the absence of modern facilities, emergency open prostatectomy may be needed to control bleeding, in those in whom conservative approach has failed; or when specifically indicated based on the individual patient or as dictated by other local factors. Keywords: haematuria, prostatic, common, conservative treatment.Nigerian Journal of Medicine Vol. 17 (4) 2008: pp. 439-44

Varicocele: Management and the continuing controversies

Varicoceles have long been associated with infertility. Despite this long history, there remains much controversy regarding their aetiology and management. The aim of this review is to present the mostcurrent information on the management of varicoceles and to highlight some of the management controversies: Association of varicocele with male infertility; Management of varicocele in adolescent; safety and effectiveness of varicocele embolization and management of subclinical varicoceles. It is hoped that this review study will stimulate further research into this condition in order to find a more common ground regarding its management

Design and implementation of urban logistics distribution center location optimization system

In order to improve the efficiency of urban logistics distribution center location selection, and to overcome the shortcomings of the traditional method based on human aided calculation, the online map is used to obtain the path distance information. Considering the practical construction and operation situation of the logistics distribution center, the cost related impact factors are determined and the location optimization frame is described. Then the mathematical formulation is proposed for minimizing the total cost, and the genetic algorithm based on integer code is designed to solve the problem under consideration. The corresponding system is implemented by C# language. The system is tested based on the practical data, and the computational results demonstrate that the proposed system can automatically obtain the distance information between various nodes and perform the location optimization. Finally the optimal feasible location scheme is delivered by the proposed system