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Biomedical subjects

R S Van Howe

Publications and source records attributed to R S Van Howe.

At least 37 records · Page 2Linked to original sources
PubMed1998

Cost-effective treatment of phimosis.

OBJECTIVE: To determine the most cost-effective treatment for phimosis. DESIGN: The costs of three treatment strategies for treating phimosis were evaluated using a decision-tree analysis. Three therapeutic approaches were considered: circumcision, preputial plasty (the use of plastic surgical techniques to enlarge the preputial opening without removing tissue), and topical therapy with steroids and nonsteroidal antiinflammatories. Published failure and complication rates were used to calculate the cost per case. Outcome Measures. Cost in dollars to treat each case of phimosis. RESULTS: Topical steroid therapy was the most cost-effective strategy, costing between $758 and $800 per case. Preputial plasty cost between $2515 and $2580 per case. Circumcision cost between $3009 and $3241 per case. CONCLUSIONS: The most cost-effective management for treating phimosis is to initiate topical therapy. Daily external application from the tip of the foreskin to the glandis corona with betamethasone 0.05% cream for 4 to 6 weeks has been demonstrated to be very effective, resulting in a 75% savings compared with circumcision. Surgical intervention should not be considered until topical therapy has been given an adequate trial. When contemplating surgery, the lower morbidity, lower costs, and tissue preservation of preputial plasty may make it preferable.

Administration, Topical↗
PubMed1997

Variability in penile appearance and penile findings: a prospective study.

OBJECTIVE: To document prospectively variation in penile morphology and clinical findings in children. PATIENTS AND METHODS: The study comprised a consecutive sample of 468 boys whose consultation with a physician included a genital examination in a primary-care paediatric practice in rural northern Wisconsin. RESULTS: Circumcised boys under 3 years of age were significantly more likely to have a partially or completely covered glans, a reddened meatus, balanitis, or trapped epithelial debris, and less likely to have a fully exposed glans than were circumcised boys of 3 years or older. Among the 238 boys under 3 years, those circumcised were significantly more likely to have non-cosmetic problems, including coronal adhesions, trapped epithelial debris, a reddened meatus, preputial stenosis (phimosis) and balanitis, than were boys with a foreskin. Findings in the circumcised group under 3 years included: fully exposed glans (n = 78, 35.6%), partially covered glans (n = 67, 30.6%), adhesions (25.6%), completely covered glans (20.1%), entrapped desquamated epithelial debris (24.7%), reddened meatus (19.1%), balanitis (15.5%), and preputial stenosis (0.9%). Only two genital examinations in boys with foreskins revealed pertinent findings. Coronal adhesions develop in circumcised boys at 2-6 months of age and usually resolve by 24 months. The degree of skin covering the glans after neonatal circumcision peaks at 6 months of age. CONCLUSIONS: There are significant variations of appearance in circumcised boys; clinical findings are much more common in these boys than previously reported in retrospective studies. The circumcised penis requires more care than the intact penis during the first 3 years of life. Parents should be instructed to retract and clean any skin covering the glans in circumcised boys, to prevent adhesions forming and debris from accumulating. Penile inflammation (balanitis) may be more common in circumcised boys; preputial stenosis (phimosis) affects circumcised and intact boys with equal frequency. The revision of circumcision for purely cosmetic reasons should be discouraged on both medical and ethical grounds.

Adolescent↗
PubMed1997

Carcinoma in situ of the penis in a 76-year-old circumcised man.

The commonly believed notion that circumcised men cannot develop penile cancer can result in delays in diagnosis. Recent medical literature has failed to confirm the protective effect of circumcision on penile neoplasms. Physicians need to be aware that men circumcised after 1 month of age may be at higher risk for penile cancer than those never circumcised.

Aged↗
PubMed1989

Chronic, recurrent multifocal osteomyelitis. Case report and review of the literature.

Chronic recurrent multifocal osteomyelitis (CRMO) is an unusual inflammatory process involving multiple osseous sites, often recurrently. The authors recently diagnosed CRMO in an 8-year-old girl who had complained of toe pain for several weeks. A number of other involved, asymptomatic areas were discovered by bone scan. Biopsy of the lesions did not reveal any pathogens. Antibiotics and inflammatory agents were not used, and the patient recovered. A review of previously reported cases of CRMO showed 1) that this entity affects children almost exclusively, 2) that from two to 18 sites, usually in the extremities, can be affected at one time, and 3) that about 20 percent of the patients develop a pustular rash on their palms and soles. Other than an elevated erythrocyte sedimentation rate, there are no consistent laboratory abnormalities, and cultures of affected bone are negative. Histopathology typically shows a chronic inflammatory response, sometimes with granulomas. Antiinflammatory agents and antibiotics offer little consistent beneficial effect. The disease is self-limited, and patients usually recover fully, although exacerbations may occur. In the proper clinical setting, CRMO should be considered, since recognition of this entity avoids costly and potentially harmful diagnostic and therapeutic interventions.

Child↗