The American Academy of Pediatrics recently released its new Technical Report and Policy Statement on male circumcision, concluding that current evidence indicates that the health benefits of newborn male circumcision outweigh the risks. The technical report is based on the scrutiny of a large number of complex scientific articles. Therefore, while striving for objectivity, the conclusions drawn by the 8 task force members reflect what these individual physicians perceived as trustworthy evidence. Seen from the outside, cultural bias reflecting the normality of nontherapeutic male circumcision in the United States seems obvious, and the report’s conclusions are different from those reached by physicians in other parts of the Western world, including Europe, Canada, and Australia. In this commentary, a different view is presented by non–US-based physicians and representatives of general medical associations and societies for pediatrics, pediatric surgery, and pediatric urology in Northern Europe. To these authors, only 1 of the arguments put forward by the American Academy of Pediatrics has some theoretical relevance in relation to infant male circumcision; namely, the possible protection against urinary tract infections in infant boys, which can easily be treated with antibiotics without tissue loss. The other claimed health benefits, including protection against HIV/AIDS, genital herpes, genital warts, and penile cancer, are questionable, weak, and likely to have little public health relevance in a Western context, and they do not represent compelling reasons for surgery before boys are old enough to decide for themselves.
The purpose of this study was to investigate the biocompatibility of viscose cellulose sponge (VCS) with bone. Twenty-five Sprague-Dawley rats were used for the study. After curettage of the bone marrow from both femoral cavities, VCS (15 × 1 × 1 mm) was implanted into one femur, leaving the contralateral side empty as a control. The rats were killed 1–6 weeks after curettage, and bone formation inside the sponge was assessed by light-microscopic examination and histomorphometric assessment. Whereas normal bone formation in rat femoral cavity took place in 2 weeks after curettage, 4 weeks were needed for bone formation in the cellulose sponge. VCS is a compatible matrix for osseous tissue ingrowth and it may be useful as a scaffold for bone tissue engineering in experiments and possibly also in clinical practice.
Porous poly(epsilon-caprolactone-co-L-lactide) (P(CL-co-LA, wt % ca. 5/95) sponges were prepared, coated biomimetically with CaP/apatite, and implanted with noncoated control sponges into rat femur cortical defects and dorsal subcutaneous space. The implants were inspected histologically at 2, 4, and 33 weeks after the operation. All implants were filled with fibrovascular tissue within 4 weeks. The femur implants were partially ossified with compact bone, which in the CaP-coated sponges was less mature and more fragmented. Approximately equal amounts of bone were observed in both types of implants. The polymer induced a mild inflammatory reaction with foreign body giant cells but no accumulation of fluid. Degradation of the polymer was slow; most of it was found intact at 33 weeks in histological samples. Nondegraded polymer seems to prevent complete ossification. Cultured osteoblasts proliferated well on apatite-coated material, whereas only a few cells were seen on noncoated material. Thus CaP/apatite coating helped the attachment of osteoblasts in cell cultures but did not offer any advantage in bone formation over noncoated material in vivo. We conclude that a shorter degradation time of P(CL-co-LA) is needed to create an optimal implant. Furthermore, in vivo experiments seem to be necessary for the estimation of osteopromotive properties of a biomaterial.
Granulation tissue formation was studied in viscose cellulose sponges with different cellulose contents and sizes after subcutaneous implantation in rats. Samples were removed and studied histologically and histomorphometrically 1–16 weeks after implantation. The implants with lower cellulose content and smaller size were invaded by more cells and filled with connective tissue more rapidly than those with the higher content and larger size. In larger sponge implants the beneficial effect of the lower cellulose content was more conspicuous.
This study examined potential regional differences in the deposition of granulation tissue in cellulose sponges placed in the dorsum of rats. Four cellulose sponge implants, 10 x 10 x 5 mm in size, two in cranial and two in caudal positions, were used to induce granulation tissue formation in the back of the rat. A cranio-caudal difference in connective tissue formation was assessed from 1 to 24 weeks after implantation. Granulation tissue ingrowth, measured histomorphometrically, was enhanced at 2 weeks and the surrounding capsule was thinner from 1 to 3 weeks in implants located in the cranial part of the back. In the cranial position, the number of fibroblasts, assessed semiquantitatively, was higher and the ratio of inflammatory cells to fibroblasts lower at 2-3 weeks. Also, the ratio of hydroxyproline content to total nitrogen content was higher after the first week in cranial specimens. Thus, a distinct cranio-caudal difference in the proliferative phase was observed. These results show the obvious practical considerations underlying the need for randomization or comparison between implants from exactly corresponding cranio-caudal locations.
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