Biomedical Engineering – From Theory to Applications

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336 Biomedical Engineering – From Theory to Applications could dispense with the scalpel cut, leaving the whole foreskin to necrotise. The procedure is illustrated in a two-part video available on the manufacturer's website. The Ali's Klamp differs from the SmartKlamp (below) only in one significant respect: The clamping ring is angled to match the typical slant of the coronal rim of the glans. In theory this achieves better capture of inner foreskin ventrally. The Ali's clamp apparently shares with the SmartKlamp one notable design weakness. An unwilling or meddlesome patient could, in theory, open the clamp by placing a flat object such as a table knife between the tube and the locking arms and then twisting. Additionally, such action would render the device liable to unscrupulous re-use several times over, until such time as the nominally single-use latching mechanism wore out. A review of 7,500 boys who underwent circumcision with this device under local anaesthesia concluded that cosmetic appearance was better than conventional circumcision of 5,700 boys (Senel et al., 2010). Duration was 4.5 ± 1.5 minutes versus 23 ± 4 minutes, respectively. Complications were seen in 2% of Ali’s clamp versus 10.4% for conventional circumcision, the most common for the Ali’s clamp being buried penis (1.04%), followed by infection (0.6%), bleeding (0.4%). A mass circumcision of 2,013 male infants, children, adolescents and adults (mean age 7.8 ± 2.5 years) over a 7-day period, noted a duration of 3.6 ± 1.2 minutes and complication rate of 2.93% in those < 2 years of age, mostly from buried penis (0.98%) and excessive foreskin (0.98%) (Senel et al., 2011). In older children, adolescents and adults complication rate was 2.39%, 2.51% and 2.40%, respectively. Overall, excessive foreskin (0.7%) was ther most common complication, followed by bleeding (0.60%), infection (0.55%), wound dehiscence (0.25%), buried penis (0.25%), and urine retention (0.10%). There was no effect on erectile function and libido, and a 96% satisfaction rate was recorded. Originally available only for children, adult sizes reportedly now exist for use on a trial basis. Correspondence received mid-February 2011 from Dr. Ali Canoğlu claims a successful field trial in Africa. At the time of writing official independent reports have not yet been published. 10.3 Ismail Klamp Inventor: Salleh, I. Primary patent: MY2008/000195 Patent priority date: 16 Jan 2008 Patient age range: Full-term neonate to puberty Website: http://www.ismailclamp.com/ Category: Ischaemic necrosis device Fig. 11. The Ismail Klamp.
Male Circumcision: An Appraisal of Current Instrumentation Procedure: The Ismail Klamp is another single-use ischaemic necrosis device, functioning in the same way as the Ali's Klamp, SmartKlamp and Tara KLamp. The distinguishing feature of Dr. Ismail Salleh's device is that the clamping ring can be loosened as well as tightened during the process of application. This the manufacturer describes as "Reversible Clamping". Such a feature is undoubtedly an advantage if a tight style of circumcision is required; it gives greater scope for clamp adjustment. Against that advantage must be offset two risks: A meddlesome patient might loosen the clamp during the healing period and the clamp might be re-used unscrupulously. 10.4 PrePex Inventors: Fuerst, O., Kilemnick, I. and Shohat, S. Primary patent: (Application:) IL2010/000568 Patent priority date: 16 Jul 2009 Patient age range: Adult only at present Website: http://www.prepex.com/ Category: Ischaemic necrosis device Fig. 12. The PrePex device. (Photo supplied by Circ MedTech ©2011) Developed in 2009/10 by Dr. Oren and Tzameret Fuerst, Ido Kilemnick & Shaul Shohat (Fuerst et al., 2009) and marketed by a company called Circ MedTech Limited (incorporated in the British Virgin Islands), this device is designed for use in non-sterile environments by minimally trained healthcare professionals. Possibly unique for modern clamps, publicized abstracts of safety and efficacy trials held in Rwanda found it to be suitable for use without anaesthesia. Four hundred milligrams of oral Brufen is routinely offered 30 minutes after placement of the clamp, but no other drug use is involved. Whilst the surplus foreskin can be severed, in these trials the foreskin was left to necrotize intact thus facilitating a quick and bloodless procedure that can be handled by minimally trained healthcare professionals in non-sterile settings. The company affirms that there have been no complications to the urine stream as a result of the necrotized foreskin being left in situ. In common with other ischaemic necrosis clamps, the PrePex device requires no sutures. 337
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BIOMEDICAL ENGINEERING - FROM THEOR
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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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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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