**17. References**


An early operation minimizes the potential psychological damage caused by genital surgery (Manley, 1982). Also, avoids sensitive phases of psychosocial development (maternal bonding, separation anxiety, development of genital body image, gender identity, and phallic awareness), the disruption of which is thought to predispose to psychological problems in later life. The age at which surgery took place was not associated with abnormal

The advantages of male circumcision are much more than the disadvantages and this explains the increased number of parents asking for circumcision for their male infants.

[3] Bistschai J. and Brodney, ML: A History of urology in Egypt Cambridge, Mass-Riveside

[4] Arnaout H.; Elfiky G.F. and Sherif M.: Circumcision. Kasr-ElAini J Surg. 3:169; 1962. [5] Badr M.M.: The History of urology in Ancient Egypt. L Intern. Coll. surgeons 39:404;

[7] Gray's Anatomy D.: D.Davis 4th ed. (254-585-1561- Langrnans green and co. 1950).

[9] Bailey and Love's, short practice of surgery. Urethra and penis, vol II, 21Ist ed; 1992. [10] Dewan PA; Tieu HC and ChTeng BS.: Phimosis is a circumicsion necessary. J. Ped.

[13] Donovan B; Bassett I and Bodsvorth NJ.: Male circumcision and common sexua, transmissible diseases in a developed nationsetting: Genitourim Med. Oct.; 70(5):317;

[14] Moses S; Plummer FA; Bradley JE; Ndinya-Acloal-Jo; Nagelkerke NJ and Roland- AR.: The association between lack of male circum. and risk for HIV. infection: A review of

[15] Tyndall MVV; Ronald AR; Agoki E; iMalisa \V; Bvvayo JJ; Nadinya Achola Jo; Moses S and Plummer FA.: Increased risk of infeciion with human immunodeficency virus type 1 among uncircumcised men presenting with genital ulcer dis. in Kenya: clin.

[16] Caldwell JC and Caldwell P.: African AIDS, epidemic. Sci. Am. Mats; .274(3) 62; 1996. [17] Taylor P.K.; Rodin P.: Herpes genitalis and circumcision. British Journal of veneral

the epidemiological data: sex- Transm. Dis. Jul- Aug: 21(4): 201; 1994.

[8] Eiger MS.: The case for circumcision. Today's Health. (50)4: p. 14; 1972.

[1] Leitch I.O.W. Circumcision, A continuing engima Aust. ped. J.G. 59-1970. [2] Kaplan G.W.: Circumcision. An overview current problemsi in ped. 7: 1; 1977.

[6] Blandy J.P.: Circumcision Hospital Mediane. 3:551; 1968.

[11] Manson-Bakr; PH.: Manson's 16th. ed; page 677 London 1966.

Child. - Health. Aug.; 32(4):285; 1996.

[12] Ross J.C.: Brit. J. Surg., 42,29,194; 1941.

Infect. Dis. Sep; 23(3) 449; 1996.

diseases, 51:274; 1975.

**15. Psychological effect of circumcision** 

psychological adjustment later in life (Freud 1955).

**16. Conclusions** 

**17. References** 

press; 1956.

1963.

1994.


**4** 

 *Israel* 

**Nifedipine Gel with Lidocaine in the** 

*2Pediatric Intensive Care Unit, Assaf Harofeh Medical Center,* 

*Zerifin, Affiliated to the Sackler School of Medicine,* 

Baruch Klin1, Ibrahim Abu-Kishk2, Yigal Efrati1 and Gad Lotan1 *1Department of Pediatric Surgery &* 

*Tel-Aviv University, Tel-Aviv,* 

**Treatment of Anal Fissure in Children:** 

**A Pilot Study and Review of the Literature** 

Anal fissures are common in infancy and represent the most common cause of bright rectal bleeding at any age. Delayed diagnosis and treatment can lead to a disturbing cycle of constipation, repeat rectal bleeding, and crying, due to increasing pain during and after defecation. In spite of its high frequency, the problem remains underrated by most clinicians, with only a paucity of data on the management of anal fissures in children being found in the literature. The objective of this work is to bring this common and distressing problem into a more positive light, based on our good results achieved by the nifedipine gel

The first description of anal sphincterotomy in the world literature is found in Alexis Boyer's 11-volume Traite des Maladies Chirurgicales published between 1818 and 1826 (DeMoulin, 1977). His descriptions of the condition are dramatic, detailing the severe suffering patients endured. Louis Lemmonier, in 1869, gave the world the first anatomic description of an anal fissure. Boyer established the relationship between anal sphincter spasm and no healing of anal fissures, as well as the association between constipation and anal fissure. He was the first to divide the sphincter to cure the problem. This procedure, routine and quite safe today, caused deaths and pelvic abscesses in four patients, as reported by Velpeau in 1832. During the 1950s, fissure excision, anal sphincter stretching, injection therapy (local anesthetic and sclerotherapy) and sphincterotomy were performed for chronic anal fissures. Later, in the late 1960s and early 1970s, cutaneous island advancement flaps were added to this group (Ruiz-Moreno, 1968; Samson & Stewart, 1970). The modern reintroduction of sphincterotomy for anal fissure can be attributed to Eisenhammer (1951). In 1953, Inburg published his technique of partial internal sphincterotomy, cutting the sphincter through the bed of the fissure. It was not until the mid to late 1970s that lateral internal sphincterotomy became accepted as the standard of care to treat anal fissures surgically (J. Nelson, 2006).

**1. Introduction** 

with lidocaine treatment.

**2. History** 

