Biomedical Engineering – From Theory to Applications

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320 Biomedical Engineering – From Theory to Applications Fig. 1. Depiction of flaccid penis before and after circumcision showing what gets removed for extremes of style; in each case the tissue to be removed is shown in orange. (A) before and (B) after for the “low and loose” style: Almost all the inner foreskin has been removed along with an equal amount of outer foreskin. No tension has been placed in the shaft skin, with the result that the flaccid penis droops and the sulcus is not held fully open. Thus, despite circumcision, it remains possible for smegma to accumulate. (C) before and (D) after for the “low and tight” style: The maximum possible amount of inner foreskin has been removed along with the whole of the outer foreskin plus a considerable portion of shaft skin. This has placed the residual shaft skin under tension, with the result that the flaccid penis appears to be short and semi-erect. The sulcus is held fully open; therefore it is not possible for smegma to accumulate. (E) before and (F) after for the “high and loose” style: Much of the of inner foreskin has been retained, folded back on itself to face outwards and assume the role of shaft skin. The outer foreskin has been removed along with some shaft skin, but not enough to place the residue under tension. Thus the flaccid penis still droops as it did before circumcision. The sulcus is not held fully open; therefore it is still possible for smegma to accumulate. (G) before and (H) after for the “high and tight” style: Much of the inner foreskin has been retained, folded back on itself to face outwards and assume the role of shaft skin. The outer foreskin has been removed, as has a considerable amount of shaft skin. This has placed the residual shaft skin under tension, with the result that the flaccid penis appears to be short and semi-erect. The sulcus is held fully open; therefore it is not possible for smegma to accumulate. Diagrams from: http://www.circlist.com/styles/page1.html#terminology
Male Circumcision: An Appraisal of Current Instrumentation view is that, unless or until proof positive emerges to the effect that a “high” style confers as great a degree of prophylaxis as a “low” style, the Precautionary Principle should be applied and circumcisions should be done in the “low” style. Traditional circumcisions done using "tug-&-chop" methods (Fig. 2) already provide us with ample examples of residual inner foreskin. There appears to be scope for a population study here, comparing HIV infection rates amongst groups with “high” and “low” styles of circumcision. Fig. 2. The “tug-and-chop” method of circumcision. Another somewhat contentious style issue is the matter of tightness. Often, tightness is considered to be nothing more than a cosmetic matter. However, theoretical models of STI transmission tend to suggest that benefit is gained from the sulcus being dry. This implies that circumcisions should be sufficiently tight to hold the sulcus open, such that no moisture will accumulate there. The third style issue to be resolved relates to removal or retention of the frenulum. As well as having high concentrations of antigen receptor cells targeted by HIV, the highly vascular frenulum is particularly susceptible to tearing or other damage during intercourse, as well as being a frequent site of lesions produced by other STIs (Szabo & Short, 2000). Persistent debate relates to resulting changes in sexual sensitivity; anecdotal evidence from those who have had their frenulum surgically removed suggest that no loss of sensitivity occurs. It is also worthy of note that the frenulum can be lost as a result of tearing; such loss does not appear to give rise to complaint about effects long-term. In the light of all of the above, there appears to be a good cause not just to circumcise but to circumcise in a particular way. It seems appropriate for the surgery to specifically target certain classes of cells for removal, at the same time achieving a result that holds the sulcus open so that it remains dry and clean, unable to harbour a viral payload either in smegma or in residues of erogenously triggered body fluids. 5. Methods of circumcision We will now present information on current approaches to circumcision, mostly stemming from experience in developed nation settings, the USA in particular. We will start with infants and then move on to adults and older boys. We will end with speculation about what is needed for low-resource settings in terms of devising novel devices. There is no standard circumcision procedure and the issue of standards has been a rallying call for years. At the Western Section American Urological meeting in 2007 Dr Sam Kunin, 321
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BIOMEDICAL ENGINEERING - FROM THEOR
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free online editions of InTech Book
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VI Contents Chapter 9 Targeted Magn
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X Preface stand-alone and readers c
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6 Biomedical search engine Scientif
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12 Bireme http://regional.bv salud.
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108 Method (Detection) CIEF-tITP-CZ
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110 Method (Detection) Analyte Matr
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120 6. Conclusion Biomedical Engine
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150 5. Conclusions Biomedical Engin
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162 1 st phase : half year 4 2 nd p
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166 7. Innovative active training B
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172 12. Maturing projects’ story
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180 16. Acknowledgments Biomedical
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190 R* M M M M MR*M O O O O M O R*
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196 Fig. 9. Chemical structure of 5
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198 Relative Intensity (AU) Biomedi
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204 2. Preparation of IO nanopartic
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256 3. Deposition techniques Biomed
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454 In this case, the eigenvalues a
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456 where Biomedical Engineering -
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472 Nb b b l l1 Biomedical Engineer
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Biomedical Engineering – From Theory to Applications

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