Prophylactic neonatal surgery and infectious diseases
Prophylactic neonatal surgery and infectious diseases
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DOI：
10.1097/00006454-199708000-00002
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发表时间：
1997-08-01
影响因子：
3.6
通讯作者：
Weiss, GN
中科院分区：
文献类型：
--
作者：
Weiss, GN
1993年，全世界1650万死亡人数中有三分之一是由传染病造成的，略高于癌症和心脏病的总和。1全球约有18亿人患有疟疾，4亿人患有疟疾，2亿人患有血吸虫病，400多万人死于急性呼吸道感染。到1994年，有2 500多万人感染了人体免疫机能丧失病毒。在美国，1980年至1992年期间，传染性流行病的死灰复燃上升了58%。在美国，25岁至44岁的人（1995年超过3万人）最常见的死亡原因是艾滋病毒感染。2随着新的传染病的出现，全球范围内常见的旧传染病继续死灰复燃。在当今社会，传染病的治疗是危机驱动的。预防是对付感染的最有效武器，它仍然是一种公认的、不容置疑的武器。几千年来，男性的包皮腔一直是传染性疾病传播的温床，尽管可以进行预防性手术，如新生儿包皮环切术，这是儿童时期最常见的手术。[3]地球仪上有一半以上的人生活在对瘟疫的恐惧中，常常不知道预防瘟疫的方法。本文试图讲述外科手术在包皮切除后如何发挥其古老的作用，也许现在是新的作用，可以预防世界上许多传染病。此外，切除包皮不会损害男性生殖功能。它的有效性，不像已被证明的疫苗接种，可能不是绝对的，但有足够的有效性，认真促进它作为一种选择。作为当代美国预防艾滋病的一项措施，国家过敏和传染病研究所的一位流行病学家于1986年提倡包皮环切术。到1996年，诊所在坦桑尼亚报纸上刊登广告，提供成年男性包皮环切术，以防止艾滋病。5.病毒感染和恶性肿瘤的相互作用在当代研究中得到了更清楚的阐述。人类乳头瘤病毒研究6-9指出了它们在人类生殖器癌病因学中的作用。医学研究人员开始认识到兽医所说的传染性恶性肿瘤。传染性性病肿瘤在狗的外生殖器上很常见。10.动物乳头状瘤病的病毒病因类似于传染性普通疣。通过新生儿包皮环切术绝对预防阴茎癌的既定科学证据已被认可超过世纪。11，12研究表明包皮垢是一种致癌物质。13.马和人的包皮垢在小鼠中产生了宫颈癌。一些研究发现，包茎在阴茎癌的病例中更有贡献。14这些疾病的手术治疗已被广泛接受，但手术预防疾病的概念在今天仍然很陌生，就像四千年前埃及的包皮环切术一样。预防恶性肿瘤的一个典型例子是阴茎癌。在美国，没有一例出生时接受包皮环切术的患者发生阴茎癌的报道。它是唯一一种完全可以通过新生儿切除包皮来预防的癌症，而且不会损害器官的任何功能。可以预防的其他疾病是尿路感染、由人类寄生蠕虫、原生动物、真菌、细菌和病毒（如疱疹和HIV）引起的阴茎感染问题、可传播的恶性肿瘤以及甚至简单的机械或化学刺激。为什么最安全、最常见、最古老的外科手术未能被接受用于预防疾病？这个...
One-third of the 16.5 million deaths worldwide in 1993, slightly more than cancer and heart disease combined, were caused by infectious diseases. 1 Globally some 1.8 billion suffer diarrheal diseases, 400 million are affected by debilitating malaria, 200 million have schistosomiasis and over 4 million died with acute respiratory infections. By 1994 more than 25 million were infected by the human immunodeficiency virus. In the United States between 1980 and 1992 resurgence of infectious epidemic diseases rose 58%. The most common cause of death in the US from age 25 to 44, over 30 000 during 1995, was from HIV infection. 2 The global resurgence of old familiar infectious diseases continues as newer ones take hold. In today's society treatment of the infectious diseases is crisis-driven. Prevention, the most effective weapon against infections, remains an established unquestionable weapon. For millennia the male's preputial cavity has acted as a cesspool for infectious agents transmitting diseases, although amenable to prophylactic surgery-ie neonatal circumcision, the most frequently performed surgery in childhood. 3 More than half the people on this globe live in fear of plagues, often unaware of means of prevention.This paper is an attempt to relate how surgery acting in its old, and perhaps now new, role can prevent many of the world's infectious diseases when the prepuce is removed neonatally. Furthermore removal of the foreskin does not compromise male genital function. Its effectiveness, unlike proven vaccination, may not be as absolute but is of sufficient validity to seriously promote it as an option. As a measure of AIDS prevention in contemporary America an epidemiologist with the National Institute of Allergy and Infectious Diseases advocated circumcision 4 in 1986. By 1996 clinics advertised in Tanzanian newspapers offering adult male circumcision as a protection against AIDS. 5 The interaction of viral infection and malignancy has been more clearly elaborated with contemporary research. Human Papillomavirus studies 6-9 point to their role in the etiology of human genital cancer. Medical researchers are beginning to recognize what veterinarians call transmissible malignancy. Transmissible venereal tumors are common on the external genitalia of dogs. 10 The viral etiology of papillomatosis in animals is akin to the infectious common wart. Established scientific proof of the absolute prevention of penile cancer by neonatal circumcision has been recognized for much more than a century. 11, 12 Research has shown that foreskin smegma is a carcinogen. 13 Cervical cancer in mice has been produced by horse and human smegma. Some studies found that phimosis is even more contributory in cases of penile cancer. 14 The surgical treatment of these diseases is well-accepted, yet the concept of surgical prophylaxis of disease is as foreign today as it might have been four millennia ago in the Egyptian practice of circumcision. A classic example of malignancy prevention is penile cancer. No patient circumcised at birth in the United States has been reported to have developed carcinoma of the penis. 15 It is the only cancer totally preventable by neonatal removal of the foreskin and this without compromising any of the functions of the organ. Other diseases that may be prevented are urinary tract infections, penile infectious problems caused by human parasitic helminth, protozoa, fungi, bacteria and viruses such as herpes and HIV, the transmissible malignant tumors and even simple mechanical or chemical irritation. Why has the safest, commonest and oldest of all surgical procedures failed to be accepted for prevention of disease? This …