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N Feins

Publications and source records attributed to N Feins.

9 recordsLinked to original sources
PubMed2001

Penoplasty for buried penis in children: report of 50 cases.

PURPOSE: The authors report their experience with a large number of children with buried penis and describe their surgical technique. METHODS: Fifty consecutive cases of buried penis that occurred between 1993 and 1999 were analyzed by chart review. Age at the time of surgery was 11 months to 13 years. Each patient underwent elective surgical repair utilizing a surgical technique not described previously. The authors' technique avoids a circumferential incision at the base of the penis, decreasing postoperative edema. The authors also utilize a unique through and through vertical mattress suture at the base of the penis that firmly attaches the shaft skin to the underlying corpora. RESULTS: All patients had a good to excellent outcome with a low postoperative complication rate. One patient fell during the postoperative period and developed a wound dehiscence. Early in the series 3 patients underwent additional procedures for recurrent retraction (6%). All patients experienced some postoperative discomfort as expected. Edema, when present, was mild and resolved within an acceptable period of time. All patients had a good cosmetic result with increased visualization of the penile shaft. CONCLUSIONS: A surgical approach to the buried penis is warranted in most circumstances. There are psychological benefits to both the patients and the parents. Although the authors perform the procedure as early as 11 months, it can be performed safely at 3 months. The procedure reported here provides immediate excellent cosmetic results with a low complication rate. The authors do not recommend suprapubic lipectomy either alone or in combination with the buried penis procedure. Circumcision should be avoided in an infant with a definite diagnosis of buried penis.

Adolescent↗
PubMed2001

Female circumcision.

Female circumcision, more accurately known as female genital mutilation, is still a common practice in parts of Africa. This ritual genital operation can involve partial or complete excision of the clitoris and labia minora as well as infibulation (labial fusion). The case reported here involves a 16-year-old African girl with a complication of this mutilating procedure.

Adolescent↗
PubMed2000

Rotary atlanto-axial subluxation with torticollis following central-venous catheter insertion.

Atlanto-axial subluxation with torticollis is an uncommon condition that occurs in children usually as a result of pharyngeal infection, minor trauma, or neck surgery. Passive motion of the head and neck during general anesthesia is probably another etiologic factor. Torticollis is the most common presenting physical finding. Pain may or may not be present, but is commonly present with passive neck motion. Neurologic sequelae are uncommon. Our case illustrates this condition as a complication of central venous catheter (CVC) insertion in a child under general anesthesia. The surgeon should suspect this pathology when a child presents with torticollis following CVC placement. Precautions should be taken in the operating room to avoid aggressive rotation and extension of the child's neck while under general anesthesia whether or not cervical inflammation is present. Special attention to head and neck positioning should be taken in patients with Down's syndrome since they are at increased risk for atlanto-axial subluxation. The prognosis is excellent when diagnosed early. A delay in diagnosis can result in the need for surgical intervention.

Anesthesia, General↗
PubMed2000

Horse-related injuries in pediatric patients.

PURPOSE: The aim of this study was to describe the characteristics, nature, severity and outcome of injuries from horse-related trauma in pediatric patients, aged of 19 years or younger. METHODS: Retrospective analysis was conducted of 315 patients recorded in the National Pediatric Trauma Registry from February 1995 to August 1999. RESULTS: A total of 62% of the 315 patients were girls. The median age of injury was 10 years. Sixty-five percent of the patients were injured while mounted on a horse, and the most common mechanism of injury was falling off the horse. The most frequent reason for hospital admission was skeletal fractures followed by head injuries. The head, neck, and face area was the most commonly injured anatomic site, followed by the upper extremity, the abdomen, and then the lower extremity. The median length of stay in the hospital was 2 days. Forty percent of the patients needed treatment in the intensive care unit with a median length of stay of 2 days. Thirty-nine percent of patients underwent surgical procedures. The Injury Severity Score ranged from moderate to critical in 31.5% of the children. There were 8 deaths, 2.5% of the injured children. The most common cause of mortality was head injuries. Of the 307 survivors, 3% were discharged to a rehabilitation center, and 2% of the children had 1 or more functional impairments lasting longer than 7 months after discharge. CONCLUSIONS: Horse-related trauma is frequent in children and can cause severe injuries resulting in death and long-term disability. Awareness of the nature of injuries is important to avoid underestimation of their severity.

Abdominal Injuries↗
PubMed1999

Cremasteric muscle hypertrophy accompanies inguinal hernias in children.

PURPOSE: The physical finding of a thickened spermatic cord as indicator of an inguinal hernia in children is well documented. This thickening has been attributed to the presence of a hernia sac. Based on our clinical observations, cremasteric fibers appeared thickened in the presence of an inguinal hernia. The authors postulated that hypertrophy of cremasteric fibers contributed to the physical finding of cord thickening. METHODS: The authors evaluated 18 patients ages 5 months to 9 years, 17 boys and one girl. Each patient was found to have a unilateral inguinal hernia with palpable thickened cord on the affected side. The contralateral side contained no detectable hernia or palpable cord thickening. Each patient underwent repair of the clinical hernia and exploration of the contralateral groin. Cremasteric fiber biopsy sections were taken from both sides for cross-sectional measurement and comparison. The biopsy specimens were evaluated by a pathologist unaware of the hypothesis. RESULTS: In 15 of 18 patients microscopic measurement of the cremasteric fibers showed hypertrophy on the side of the clinical hernia when compared with the contralateral side. The contralateral side was found to have either no hernia or a small patent or obliterated processus vaginalis. CONCLUSION: The authors conclude that the palpable thickening of the spermatic cord, the "silk glove sign," in most cases is caused not only by an empty hernia sac but also by hypertrophied cremasteric muscle fibers.

Child↗
PubMed1990

Rectal duplications.

Recent experience with two cases of rectal duplication, which had been misdiagnosed as hemorrhoids, or fistula-in-ano with resultant delay in diagnosis, prompted us to review our prior experience with 11 of these unusual cases. Age at presentation ranged from newborn to 18 years (mean, 17 months). The most common presenting sign was a perianal or anal fistula, observed in five children. Two children presenting with fistulae had concomitant infection in the duplication. Other presenting signs included obstruction or prolapse caused by the rectal mass in three patients, rectal bleeding in three, and urinary retention in one. Some children presented with more than one finding. No associated spinal or vertebral anomalies were observed. Total excision was performed using a transanal approach in eight patients, postanal (transcoccygeal) in two, and posterior sagittal in one. Postoperative continence was normal in all patients. These cases illustrate that rectal duplications can be confused with other types of anorectal pathology including hemorrhoids, fistula-in-ano, and perirectal abscess. Total excision performed using a posterior sagittal, transanal, or transcoccygeal approach is curative.

Child↗
PubMed1987

Bilateral neonatal torsion.

Extravaginal neonatal torsion of the spermatic cord, although rare, is being recognized with increasing frequency. Bilateral neonatal torsion is even more uncommon. Only 1 previous case of asynchronous neonatal torsion has been reported. Controversy exists concerning the urgency of exploration as well as the need for contralateral orchiopexy, since some reports suggest that the contralateral testicle is not at risk for torsion. We present 4 consecutive cases of bilateral neonatal torsion seen between 1966 and 1986. Two cases were asynchronous, 1 of which with a previously normal-appearing contralateral gonad was rendered anorchid. In the other patient a testicle was salvaged by prompt intervention. We have adopted a policy of prompt exploration with contralateral orchiopexy in all cases of unilateral neonatal torsion. Treatment of the ipsilateral testicle is determined by operative findings.

Humans↗