Wednesday 28 November 2012

Problematic "Penile Enlargement Injection" in PNG

Problematic "Penile Enlargement Injection" in PNG

*Click on highlighted and/or underlined areas for in-depth information

Please be warned that, there is an unauthorized (by the PNG, National Department of Health as well as the broader medical scientific community) of a "Penile Enlargement Injection". The exact chemical content of this 'injection' is not known yet. However, it could be or we are suspecting a 'NON-MEDICAL GRADE, LIQUID SILICON' or PARAFFIN OIL (causing parafinoma or foreign body reaction and excessive and progressive scar tissue formation). Paraffin oil is commonly known in PNG as 'Baby Oil'. Furthermore, 'Medical Grade Liquid Silicon' is highly refined, has a long history of use and is injected in small amounts by experienced surgeons.

The main problem associated with this 'injection' is;  progressive enlargement of the penile skin with multiple lump formation, that actually compresses the penis & interferes or suppresses erection. In extreme cases, lumps growing around the foreskin, may close in & push the penis into the abdomen & prevent normal urination and erection. Sometimes the glands penis within this foreskin may become infected & cause more problems.

THIS 'INJECTION' DOES NOT ENLARGE THE PENIS BUT HAVE THE OPPOSITE EFFECT OF SHRINKING IT. 

We have done corrective surgeries on several young man who has been misled, to having this 'injection'.   Also be warned that this 'injection', if administered deeper below the skin planes, may be disastrous to the penis. It may result in necrosis, scaring, distortion & shrinkage of the penis.

Below is a photo of one case with the foreskin enlarging with multiple lumps. This lumps will not stop growing. This patient eventually underwent corrective surgery to de-bulk this enlarging foreskin. To completely remove this enlarging skin, will be a major surgery, requiring 'flap' transfers.




*Progressive enlargement of foreskin that may eventually shrink the penis.


Please consult our clinic for in-depth information.

Saturday 24 November 2012

BALDNESS (ALOPECIA)

BALDNESS (ALOPECIA)

*Click on highlighted and/or underlined areas, for links and further, indepth explanations.

There are various causes of hair loss or baldness. It could arise as a result of a systemic and/or localized illness or disorder. While researches are going on to find a medical cure, other localized forms of alopecia (devoid of or absence of hair) may be treated surgically, as in this case of post burn scaring and alopecia (shown below). Small areas of alopecia can be excised & closed off directly, using the nearby, normal hair-bearing skin. However, for larger areas, the following 2 techniques may be used:

1. Serial Excisions - partial excision, just enough to close of without tension, followed by 1 or 2 more excisions at a later time; eventually removing the lesion totally and replacing the area with normal, surrounding skin.

2. Tissue Expansion - inserting a special, inflatable material under the normal adjacent skin, and gradually filling it with fluid to increase the size, thus expanding the normal skin to a size that can completely replace/cover the defect area, before excising the lesion. There are 2 stages to this procedure; the first part is to insert the tissue expander & the second part is to excise the lesion, remove the tissue expander & reposition the normal expanded skin to cover the defect.

*BELOW IS A CASE OF POST BURN ALOPECIA, THAT WAS EXCISED, FOLLOWED BY DIRECT CLOSURE (APPROXIMATING THE NORMAL HAIR-BEARING SKIN)


BEFORE (ANTERIOR ASPECT)

BEFORE (POSTERIOR ASPECT)

ESTIMATION OF DIRECT CLOSURE

DESIGN & ADJACENT HAIR TRIMMING

EXCISION

COMPLETE EXCISION & RESULTING DEFECT

UNDERMINING OF NORMAL, HAIR-BEARING SKIN

APPROXIMATION OF ADJACENT SKIN

CLOSURE

AFTER 1 WEEK

TAKE NOTE: *TRIMMED, ADJACENT-SKIN-HAIR, ARE YET TO GROW
                          *TINY, INVISIBLE LINE, IN PLACE OF SCAR ALOPECIA

Our techniques for scarless (scar is obscured or less prominent) surgery and scarless skin closure will be published in the New PIH e-Med Journal in November 2017, including these photographs (techniques displayed/explained here).

Thursday 22 November 2012

Joint Problems (Osteoarthritis, Osteoarthrosis, Tendinitis & Tendinosis)

Joint Problems (Osteoarthritis, Osteoarthrosis, Tendinitis & Tendinosis)


The common joint problem seen in our hospital is painful/tender, swollen and/or stiff joint usually following an episode of trauma or injury to any component tissue, of that joint. This is a form of  secondary osteoarthritis (having a causative factor for the ongoing inflammation). Primary osteoarthritis is related to the process of aging without any causative factor. This is also known as osteoarthrosis:
 '-osis' means degeneration relating to aging without inflammation and '-itis' means inflammation with a causative factor, without any relation to the process of aging.

In people who are active in sports, tendon injuries are common (tendons link muscles to bones, while ligaments link bones to bones). With damage to the tendon, there will be painful joint movements in the short term, arising from the process of inflammation. Tendinosis is ongoing, continuous weakening or disruption of the tendon relating to aging and/or ongoing injuries/trauma. Thus, weakening the tendon and increasing the chances of tendon rupture. 

The principles of treatment for joint problems in our setting are:

  • 1. RICE (Rest, Ice, Compression & Elevation) treatment in the first few seconds to minutes of injury
  • 2. Rest & Minimal Use of joint for the first 2-3 weeks
  • 3. Early treatment with oral Diclofenac or Ibuprofen  
  • 4. Warm baths & application of topical Diclofenac or Salicylic acid 1-2 days following the injury for up to 2-3 weeks (while on oral Diclofenac or Ibuprofen)
  • 5. For patients who present to us more than 1 week after the injury, Ibuprofen may be more effective than Diclofenac
  • 6. Paracetamol (Panadol) is reserved for patients with fever and headaches 
  • 7. Oral Predisolone is not given to patients with OsteoarthritisOsteoarthrosisTendinitis & Tendinosis
  • 8. Oral Prednisolone is reserved for patients with multiple joint inflammation, as a result of autoimmune disorder (Rheumatic Arthritis)
  • 9. Intralesional/Intraarticular Methylprednisolone is given to patients with persistent, significant joint inflammation and/or, stiffness for more than 1 month after the injury
  • 10. Indometacin is not as effective as Ibuprofen & and is often associated with gastritis
  • 11. Oral Aspirin (Salicylic acid) is not given to patients with OsteoarthritisOsteoarthrosisTendinitis & Tendinosis
  • 12. Early, gradual mobilization with load increment is advised, once the signs/symptoms of inflammation subsides, while on the medications described above
  • 13. Surgery is not usually indicated for OsteoarthritisOsteoarthrosisTendinitis & Tendinosis, accept in severe joint stiffness (those presenting late and not following the above principles) and complete tearing of tendon and/or tethering of tendon and those with associated fractures
  • 14. Surgery is advised,  after the signs/symptoms of inflammation subsides
  • 15. Paracetamol is given, instead of Diclofenac and Ibuprofen, for patients with associated fractures as they may cause delayed or non union of fractured ends

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