Non-Tensile Tunica Albuginea Plication for the Correction of Penile Curvature

Objective: To evaluate the efficacy of non-tensile tunica albuginea plication (NTTAP) using nonabsorbable sutures for the correction of congenital and acquired penile curvature and to determine the key points for a successful outcome of this procedure. Patients and Methods: From June 2004 to July 2007, 43 patients with penile curvature (35 congenital and 8 secondary to Peyronie’s disease) underwent surgical correction by NTTAP. The indications were difficult or impossible vaginal penetration, and a cosmetically unacceptable penis. For tunica albuginea plication (TAP) we applied the 16 dot procedure using non-absorbable sutures (Tycron® 2/0 polyester fiber).Results: After a mean follow-up period of 18 months, successful results with respect to penile straightening, normal erection, penetration and sensation, confirmed both subjectively and objectively, were achieved in all patients. Post-operative penile shortening of less than 1.5 cmwas present in 50% of the cases, but did not affect intercourse. Post-operative complications were mild and reversible; they consisted of penile skin necrosis after circumcising incisions and post-operative pain upon nocturnal erection that subsided after a few weeks with the frequent use of ice compresses. The overall satisfaction rate was nearly 100% (35/43 very satisfied and 8/43 satisfied).Conclusion:NTTAP is a simple and effective method for the correction of congenital and acquired penile curvature. The key points for successful outcomes are: clear identification of the line of maximum curvature, adequate pre-operative evaluation, counseling of the patient to setappropriate expectations, and careful discussion of the location of the suture sites. There is no need for mobilization of the urethra or neurovascular bundle, which adds a great advantage to this easy and simple technique. Cutting through the tunica albuginea, which may prevent postoperative erectile dysfunction, is not necessary. A disadvantage of this procedure is that it cannot correct hour-glass deformity

Local is not always better: the impact of climate information on values, behavior and policy support

In the current research, we experimentally examined the effect of providing local or global information about the impacts of climate change on individuals’ perceived importance of climate change and on their willingness to take action to address it, including policy support. We examined these relationships in the context of individuals’ general value orientations. Our findings, from 99 US residents, suggest that different kinds of climate information (local, global, or none) interact with values vis-à-vis our dependent variables. Specifically, while self-transcendent values predict perceived importance and pro-environmental behavior across all three information conditions, the effect on policy support is less clear. Furthermore, we detected a “reactance effect” where individuals with self-enhancing values who read local information thought that climate change was less important and were less willing to engage in pro-environmental behavior and support policy than self-enhancing individuals in the other information conditions. These results suggest that policy makers and public communicators may want to be cognizant of their audience’s general value orientation. Local information may not only be ineffective but may also prove counterproductive with individuals whose value orientations are more self-enhancing than self-transcendent

Pooled analysis of WHO Surgical Safety Checklist use and mortality after emergency laparotomy

Background The World Health Organization (WHO) Surgical Safety Checklist has fostered safe practice for 10 years, yet its place in emergency surgery has not been assessed on a global scale. The aim of this study was to evaluate reported checklist use in emergency settings and examine the relationship with perioperative mortality in patients who had emergency laparotomy. Methods In two multinational cohort studies, adults undergoing emergency laparotomy were compared with those having elective gastrointestinal surgery. Relationships between reported checklist use and mortality were determined using multivariable logistic regression and bootstrapped simulation. Results Of 12 296 patients included from 76 countries, 4843 underwent emergency laparotomy. After adjusting for patient and disease factors, checklist use before emergency laparotomy was more common in countries with a high Human Development Index (HDI) (2455 of 2741, 89.6 per cent) compared with that in countries with a middle (753 of 1242, 60.6 per cent; odds ratio (OR) 0.17, 95 per cent c.i. 0.14 to 0.21, P <0001) or low (363 of 860, 422 per cent; OR 008, 007 to 010, P <0.001) HDI. Checklist use was less common in elective surgery than for emergency laparotomy in high-HDI countries (risk difference -94 (95 per cent c.i. -11.9 to -6.9) per cent; P <0001), but the relationship was reversed in low-HDI countries (+121 (+7.0 to +173) per cent; P <0001). In multivariable models, checklist use was associated with a lower 30-day perioperative mortality (OR 0.60, 0.50 to 073; P <0.001). The greatest absolute benefit was seen for emergency surgery in low- and middle-HDI countries. Conclusion Checklist use in emergency laparotomy was associated with a significantly lower perioperative mortality rate. Checklist use in low-HDI countries was half that in high-HDI countries.Peer reviewe