Rabu, 30 Maret 2011

How to raising a baby owl?

There are many factors that apply when raising a baby owl, A owls primary source of food is meat. Such as mice,gophers,squirrels,chipmun ks,rabbits and also insects such as grasshoppers,beetles and even earthworms. Therefore what you feed them is most important, as their diet must consist of high protein.
Feeding them requires a source of food that contains blood. This can be done by giving your baby owl such foods as beef heart, stew meat,cut up steak, and purchasing mice from your local pet shop, You do not want to feed any types of grains or vegetation such as bird seed and lettuce,or any house hold foods.
The baby owl will eat better of a stick than out of your hand or by just placing a dish with its food on it. Wave the stick slowly in front of the owls face, similar to its parents way of feeding. They learn very fast that this is their way of getting food. It is also much safer than getting snipped by its sharp beak or clawed by its talons.
Owls are also very messy so the proper location is essential, in the house is not a good idea. The garage or its own little coop would be easiest to clean and maintain. Defecating, feathers, and the white shells from new feathers growing can be a chore to keep clean. A baby owl as it grows up can become very tame, They bob their heads and also hoot at you especially during feeding times.
Owls generally in the wild feed at night, so it is best to have covers on any windows or openings in its pen ,for they can get very restless at this time. But feeding them at night is not required . Raising an owl can be very educational and fun ,but when old enough if possible are better off to be returned back to the wild where they can find a mate and live out their natural lives.

Minggu, 20 Maret 2011

How to take care of baby owl?

 We have all seen the robin busily feeding his active youngster on our lawns and in our gardens, but not many people have witnessed the young owl being fed openly, on the ground. Raptors have learned to make themselves scarce when man appears, and with good reason. Only a few misguided humans would shoot a robin, but there are still many idiots around who would shoot an owl or hawk. Whether for this or more ancient reasons, the parent owls seldom contest man’s approach to the youngster on the ground although their reputation for vigilance at the nest is most intimidating. Thus we see the parent owls hiding and waiting for the human intruder to pass, while the fledgling sits uncomprehending....

To the unthinking, or inexperienced person, chancing upon such a situation, the parent owls are assumed to have abandoned their young. With the noblest of intentions, the person interferes with the whole future life of an owlet by capturing it, under the mistaken notion that he is "saving it". In the last five years alone, we at the Owl Rehabilitation Research Foundation have been the dismayed recipients of over one hundred of these fledglings, all around four weeks of age, all uninjured, all in good flesh (i.e. well fed), and all taken from the wild because the parent owls were not actually with them when they were encountered. Furthermore, several days have usually elapsed before the owlet is admitted here. This delay plus the circuitous route to our premises have then effectively precluded our returning [the bird] to parental care.
How should the chance encounter really have been handled? Let's go back to the nesting area and look at the options.

If the owlet has developed to the point of being aware of his surroundings, with focused vision, and is able to remain upright and to move around - especially if he is able to lift both wings above his body in defence - do not approach the owl but instead leave the immediate area as quickly as possible. If you can afford half an hour of your time in the interests of the owlet's whole life, post yourself as far away as you can while still keeping the owl's vicinity in your general view - ideally with binoculars. Stand still, making no noise, and both watch and listen for activity near the baby. Usually the owlet will be making food cries or unhappy chittering sounds when he perceives that he is alone; many will seize the opportunity to hide behind something or climb up off the ground in this interval. If you cannot stay in the area for purposes of observation, try to make sure that someone returns in less than an hour's time to check on developments.

After this time lapse, if the owlet is still grounded, still very obvious and more or less in the same place, and there is no evidence of parents in attendance, you should examine the owlet itself. Gently but firmly, holding both feet above the toes, turn him on his back. Feel the long bones of his wings and legs for possible fracture and feel the connecting joints for gross swelling, such as would be caused by dislocation. Doubtless the owlet will be loudly protesting these indignities, but you will likely discern a special cry of pain if there is some problem. Gently pull open the wings and legs to full extension, and then watch how quickly and naturally they are drawn back and folded against the body.

The other test easily performed is to check for emaciation. This is best gauged by the amount of muscle mass on either side of the sternum. (Think of the keel bone down the middle of the breast of a chicken, from either side of which the white breast meat is cut.) If the sides of this keel of the sternum can be felt between the thumb and forefinger, as one would feel the sides of a blade, then the bird is indeed emaciated and has been without parental support for several days. Since parent owls do NOT abandon able-bodied fledgling young, the owl's plight suggests a terminal separation from his parents caused by external factors such as their deaths or recent heavy storms. Obviously, if he is to survive, he must be brought out to foster care.

If the only apparent problem is a certain degree of thinness, without evident weakness, give the owlet one more chance to make it in the wild. Set him up off the ground in the fork of a tree or tall shrub and vacate the area to watch or to return. Once off the ground, he may be left for several hours or even overnight, if necessary, but do ensure that someone goes back to check. Finding a thin owlet on the ground a second time, and making no effort to elevate himself above danger, is pretty indicative of the loss of the parents. However reluctantly, there is now a case for human intervention.
Any fracture or dislocation, or other obvious abnormality, is also just cause for bringing the owl out to professional attention. He will not survive without it, and the parent owls, sensing his disability, will no longer feed him. Bring the owl to your home, put him in a warm, dark, confined place (a big carton at room temperature) and contact a rehabilitation facility without delay. Nourishment for the owl, during the brief period before transfer to the centre, is a commonsense affair. Although small rodents, cut into appropriate sizes, are the ideal food, adequate sustenance can be provided by mincing raw, lean stewing beef and rolling the pieces in powdered eggshell.
Whether the owlet now briefly in your possession has already developed a safe sense of his own identity is a matter of age and some individual variation. At six weeks of age he may safely be considered to have imprinted on his own species and no longer be at risk in this critical matter of relationship formation.
We have been reviewing alternative actions for the person finding an early fledgling owl displaced from the nest or its adjacent elevation. Suppose now that the owl you have found is unquestionably a real infant, unable to stand alone or to focus his eyes, if indeed they are even open. The choices here are much simpler, if you feel it should not be left to die, as it surely will, you can - ideally - try to replace it in the nest it fell from, or you can - less ideally - take it with you to a foster situation.
Replacing the owl in the nest can entail some athletics if the nest is high, and some risk if the parent owls are of a large species and misinterpret the generous nature of the climb to the nest. But when possible, successful replacement is the most effective course of action from every standpoint. Assuming the parent owls are still in a period of response to food cries (usually maintained by other siblings in the nest), have no fear about acceptance of the replaced infant. Anything in the nest, making the right noise, will be fed! Of course, if the nest itself is destroyed or impossible of access - or if the nestling is visibly damaged - the options are to leave it to die or take it home.
It is important to understand, in the manipulation of nestling owls, that the phenomenon of imprinting is not in itself an aberration, but rather a natural phase of the young owl's social development; he attains the perception of his own species. Therefore, an owlet deprived of any visual animate "model" during the relationship formation stage is as poorly equipped to perform in a socially acceptable way with his own kind as if he were actually imprinted on an alien species. Raising the owl in a relationship vacuum (such as in a big box, with no view of other animate life) will not postpone imprinting until the right model is available since the phenomenon is specific to a certain time-phase in his development and will not occur once it has passed....
Unfortunately for baby owls, they are invariably appealing to the average human who encounters them in the woods or fields.
Some spring day, somewhere in the fields or woods, confronted by the irresistible ball of fluff, sitting so innocently in a rapacious world, each of us must weigh the alternatives for himself. On behalf of all owls everywhere, may I make this final plea? If you are not prepared to follow through and deal effectively with that tender life, leave it alone and let nature take its course.

Sabtu, 19 Maret 2011

Anna Larsen

Anna Larsen is a native of Newton and is in the fifth grade. She has been studying piano since she was three years old, first with Sachiko Isihara at the Suzuki School of Newton and now with Tema Blackstone and Professor Hung Kuan Chen in the Preparatory School at the New England Conservatory of Music. In 2008, she received a scholarship from the Lang Lang Foundation. With her fellow scholars, she played collaborative pieces on the Oprah Winfrey Show, at Carnegie Hall with the YouTube Symphony Orchestra, and the virtuosic Mack Wilberg Carmen Fantasy (for two pianos, eight hands) at Carnegie Hall and Segerstrom Hall.

Anna maintains a wide repertoire and especially loves Bach.  She has mastered all 24 preludes and fugues from Bach's “Well Tempered Clavier,” book 1.  This was a huge project that took one and a half years to complete.  She recorded them all last summer and has released a CD, now available online. She is now just beginning to learn book 2. In addition, Anna composes her own music.  She has won first prize in the Music Teachers’ National Association Composition Competition for the last three years, and has been recognized in several other competitions at the national level.  Currently, she is orchestrating her first symphony and has completed the first movement.
Outside music, Anna loves swimming, skating, reading and drawing cartoons.

Kamis, 17 Maret 2011

Making owls as your pet

Many people think it would be fun to have an owl for a pet, but few people have any true comprehension of what is involved in caring for one. 

It is illegal to keep owls without special permits in most countries.  Some countries issue permits to individuals to keep owls after necessary training and proper facilities have been built.  The United States does not allow private individuals to keep native owls as pets--they may only be possessed by trained, licensed individuals while being rehabilitated, as foster parents in a rehabilitation facility, as part of a breeding program, for educational purposes, or certain species may be used for falconry in some states (although they rarely make good falconry birds.)  Even in these instances, the person licensed to keep the owl does not "own" the bird--the U.S. Fish and Wildlife Service retains "stewardship" of the birds so that they may recall them at any time if permit conditions are not being met.

Alice the Great Horned Owl is in a bit of an interesting situation.  She works at the Houston Nature Center, which is staffed by a single individual.  The facility isn't staffed seven days a week, nor is there a secure location for her to stay overnight, so Alice lives at the home of her handler, Karla (Kinstler) Bloem.  Alice was injured so young that she grew up thinking she's a person and considers Karla to be her mate.  As a result, she gets lonely and gives begging calls if housed in a pen outdoors. 

Through a series of baby steps, Alice eventually moved into Karla's home.  This involved all kinds of modifications to make the situation safe and healthy for Alice.  It also allowed Alice to freely interact with Karla, and presented the unique opportunity for Karla to conduct the first-ever vocal study on Great Horned Owls.  It has also given Karla a very unique perspective on why owls don't make good pets.  The following is a summary of Karla's experiences living with an owl.
Top 10 Reasons You Don't Want an Owl for a Pet

10. Taking a vacation or going on a business trip is difficult.  You can't just take the owl with you (especially since in the United States permits are usually needed every time you cross state lines.)  It takes a trained person to take care of an owl, and if you have a human-imprinted owl like Alice, they may be aggressive with anyone else who comes to take care of them.  Owls also like routine, so disruption to the normal scheme of things is very stressful for them.  Alice once lost half a pound when Karla was away for nine days...and she only weighed four pounds to begin with!

9. Owls can be very destructive.  They have a natural killing instinct that can be applied to blankets, pillows, clothing, stuffed animals, and just about anything else that can be shredded.  Alice also has a habit of clearing everything off her perches, which means she deliberately pushes and drops everything onto the floor from dressers or anyplace else she wants to be.  Talons are also really bad for woodwork.  They bring out the natural grain of the wood really well as they strip off the finish.

8. Mating season involves a lot of all-night racket.  Remember, owls are active at night, so that's when they'll be hooting and calling during mating season.  Since she thinks she's a human, Alice directs her hooting at Karla, and Karla is expected to hoot with her.  Alice can get quite crabby if Karla doesn't spend time hooting with her several times a day (early morning and late evening) during this time of year.  If you have neighbors nearby, they won't be very happy about the noise.

7. Owls don't like to be petted and cuddled.  Captive owls still retain their natural instincts, and traditional "petting" doesn't fit into the owl scheme of things.  Even though Karla has lived with Alice for over 10 years, Alice still bites if Karla tries to pet her on the back.

6. Owls are high maintenance.  They require daily feeding, cleaning, and attention, especial human-imprinted owls like Alice.  Owls that are capable of flying need to be flown regularly, or housed in very large cages where they can get adequate exercise.

5. Owls are long-lived.  A Great Horned Owl could live 30 or more years in captivity if things go well.  Small species could live 10 years.  Taking on the care of an owl is a long-term commitment.

4. Beaks and talons are sharp.  If an owl doesn't like what you're doing, it's going to let you know.  And you might wind up bleeding because of it.  It's also easy for an owl to scratch you even if they aren't trying if they step up onto your gloved fist but stand off the side of the glove on your bare arm.

3. Owls need specialized care.  Most veterinarians don't have the necessary training to properly care for owls, so you'd need to find a vet who's comfortable working with an owl.  And you as a caregiver need to know quite a bit about owl health also, including what "normal" poop looks like, which very subtle behaviors might indicate health problems, provide proper perching surfaces, a healthy diet, appropriate housing, and regular talon and beak maintenance.  There is a LOT to know, which is why proper training is normally required before permits are issued.

2. Feathers, pellets, and poop!  Owls molt thousands of feathers every year, and they wind up everywhere (including the furnace filter in Karla's house.)  Owls throw up pellets of fur and bones wherever they happen to be at the time.  And poop happens.  A lot.  In addition to "regular" poop (like most birds), owls also empty out the ceca at the end of their intestines about once a day.  This discharge is the consistency of chocolate pudding, but smells as bad as the nastiest thing you can imagine.  And it stains something awful.  Keeping owls involves non-stop cleaning.

1. FOOD.  You can't just go down to the local grocery store and buy Owl Chow.  Owls are strict carnivores and require diets of whole animals for proper health.  For Alice, that translates into her own chest freezer stocked with pocket gophers, rats, rabbits, and mice.  Each day Karla thaws an animal for her, removes the organs Alice won't eat, and serves it up for Alice.  Leftovers from the previous day must be located and removed, as owls like to cache (or hide) leftover food for later.  If you're not prepared to thaw and cut up dead animals every night of your life for 10 years or more, you aren't up for having an owl.

Female Genital Mutilation or Female Circumcission

Female Genital Mutilation (FGM) is a cultural practice that started in Africa approximately 2000 years ago. It is primarily a cultural practice, not a religious practice. But some religions do include FGM as part of their practices. This practice is so well ingrained into these cultures, it defines members of these cultures. In order to eliminate the practice one must eliminate the cultural belief that a girl will not become a women without this procedure.
What is Female Genital Mutilation?
Female Genital Mutilation is the term used for removal of all or just part of the external parts of the female genitalia. There are three varieties to this procedure.
  1. Sunna Circumcision - consists of the removal of the prepuce(retractable fold of skin, or hood) and /or the tip of the clitoris. Sunna in Arabic means "tradition".
  2. Clitoridectomy - consists of the removal of the entire clitoris (prepuce and glands) and the removal of the adjacent labia.
  3. Infibulation(pharonic circumcision)-- consists of performing a clitoridectomy (removal of all or part of the labia minora, the labia majora). This is then stitched up allowing a small hole to remain open to allow for urine and menstrual blood to flow through.
In Africa 85% of FGM cases consist of Clitoridectomy and 15% of cases consist of Infibulation. In some cases only the hood is removed.

What is the age, the procedure used and the side effects?
The age the procedure is carried out varies from just after birth to some time during the first pregnancy, but most cases occur between the ages of four and eight. Most times this procedure is done with out the care of medically trained people, due to poverty and lack of medical facilities. The use of anesthesia is rare. The girl is held down by older women to prevent the girl from moving around. The instruments used by the mid-wife will vary and could include any of the following items; broken glass, a tin lid, razor blades, knives, scissors or any other sharp object. These items usually are not sterilized before or after usage. Once the genital area for removal is gone, the child is stitched up and her legs are bound for up to 40 days.
This procedure can cause various side effects on the girls which can include death. Some of the results of this procedure are serious infections, HIV, abscesses and small benign tumors, hemorrhages, shock, clitoral cysts. The long term effects may also include kidney stones, sterility, sexual dysfunction, depression, various urinary tract infections, various gynecological and obstetric problems.
In order to have sexual intercourse the women have to be opened up in some fashion and in some cases cutting is necessary. After child birth some women are re-infibulated to make them (tight) for their husbands.
Is this practice a cultural or religious practice?
In an FGM society, a girl can not be considered to be an adult until she has undergone this procedure. As well as in most cultures a women can not marry with out FGM. The type of procedure used will vary with certain conditions and these conditions could include the females ethic group, the country they live in, rural or urban areas, as well as their socioeconomic provenance.
FGM is a culture identity practice. The fact that the procedure helps to define who is the group, is obvious in cultures that carry out this procedure as an initiation into womanhood. Most FGM societies feel that unless a girl has this procedure done she is not a woman as well as removal of these practices would lead to the demise of their culture.
FGM societies have many claims of why this procedure should be done and these are as follows:
  1. In most FGM societies one important belief is that this procedure will reduce a women's desire for sex and in doing so will reduce the chance of sex outside the marriage. This is vital to this society as her honor for the family is depended on her not to be opened up prior to marriage.
  2. Some view the clitoris and the labia as male parts on a female body, thus removal of these parts enhances the femininity of the girl.
  3. It is also believed that unless a female has undergone this procedure she is unclean and will not be allowed to handle food or water.
  4. Some groups believe that if the clitoris touches a man's penis the man will die. As well as the belief that if a baby's head touches the clitoris that the baby will die or the breast milk will be poisonous.
  5. The belief that an unmutilated female can not conceive, therefore the female should be militated in order to become fertile.
  6. Bad genital odors can only be eliminated by removing the clitoris and labia minora.
  7. Prevents vaginal cancer.
  8. An unmodified clitoris can lead to masturbation or lesbianism.
  9. Prevents nervousness from developing in girls and women.
  10. Prevents the face from turning yellow.
  11. Makes a women's face more beautiful.
  12. Older men may not be able to match their wives sex drive.
  13. Intact clitoris will generate sexual arousal and in women if repressed can cause nervousness.
FGM does predate Islam, but most Muslims do not practice this. FGM was also practice by Falasha (Ethiopian Jews). The remaining FGM society's follow traditional Animist religions. To see a list of groups click here. 

In countries where Muslim's practices FGM, they can justify it, in the words of the Prophet Mohammed, in these two controversial sayings that are found in the Sunnah (words and actions of Mohammed)

  • A discussion was recorded between Mohammed and Um Habibah (or Um'Alyyah), a women performed infibulation on slaves. She said that she would continue the procedure "unless it is forbidden and you order me to stop doing it". He replied (according to one translation) "Yes it is allowed. Come closer so I can teach you: if you cut, do not over do it, because it brings more radiance to the face and it is more pleasant for the husband."

  • Mohammed is recorded as speaking of the Sunna circumcision to Ansar's wives saying: "Cutting slightly with out exaggeration, because it is more pleasant for your husbands."

  • These passages are regarded to have little credibility or authenticity with in the Muslim religion and is contradiction in the Qur'an:

  • God apparently created the clitoris for the sole purpose of generating pleasure. It has no other purpose. There is no instructions in the Qur'an or in the writings of the Prophet Mohammed which require that the clitoris be surgically modified. Thus God must approve of its presence. And also, it should not be removed or reduced in size or function.

  • the Qur'an promotes the concept of a wife being given pleasure by her husband during sexual intercourse. Mutilated genitalia reduces or eliminates a women's pleasure during the act.

  • There is an estimated 135 million girls and women that have gone through this procedure with an additional 2 million a year at risk. This procedure is practiced in Africa (28 countries), Middle East, parts of Asia as well as in North America, Latin America, and as well as in Europe. It is now believed that the practice originated in Africa and is a cultural practice. Follow this link to see some indicators supporting this conclusion.

    Amnesty International now has taken up the fight to do away with this practice that mutilates millions of girls each year. Today FGM is seen as a human rights issue and is recognized at an international level. FGM was in the universal framework for protection of human rights that was tabled in the 1958 united Nation agenda. It was during the UN Decade for Women (1975-1985) that a UN Working Group on Traditional Practices Affecting the Health of Women and Children was created. This group helped to develop and aided to the development of the 1994 Plan of Action for the Elimination of Harmful Traditional Practices Affecting the Health of women and Children. the World Health Organization, the United Nations Children's' Fund and the Untied Nations Population Fund, unveiled a plan in April 1997 that would bring about a major decline in FGM within 10 years and the complete eradication of the practice within three generations.
    Nahld Toubia, MD, a physician from Sudan and assistant clinical professor in CSPH's center for Population and Family Health states: "Female circumcision is the physical marking of the marriage ability of women, because it symbolizes social control of their sexual pleasure-- clitoridectomy--and their reproduction--infibulation," Toubia also believes that female circumcision raises numerous human right issues, including reproductive rights, the protection from violence, women's rights and especially children’s rights since most circumcisions take place on girls who are four to ten years of age. Even though there is no theological basis for the practice of FGM, it will be hard to eradicate, until we have a better understanding of the cultural beliefs.
    Professor Stephen Isaacs, J.D, who specializes in human rights issues states "Human rights transcend cultural relativism by definition," and goes on to also state "But the cultural-religious argument has to be taken into consideration for implementation of policy." 
    But with this Toubia maintains that the goal in ending FGM must never be compromised. "No ethical defense can be made for preserving a cultural practice that damages women's health and interferes with their sexuality," "It is only a matter of time before all forms of female circumcision in children will be made illegal in Western countries and, eventually, in Africa." Toubia states.

    Rabu, 16 Maret 2011

    Female Circumcision: Indications and a New Technique

    Circumcision of the female is not a new subject. Early writings testify that this problem was known and discussed by physicians of the Roman Empire. Bryk in 1935 compiled a comprehensive book on the history and practice of male and female circumcision. The 265 references abstracted in his text cover the circumcision of the female from the ancient Egyptian era (approximately 1500 B.C.) to the present day.The value of this procedure in improving function has been accepted by various cultures for the past 3,500 years. Although this subject is not new, there are indications for its use that are being overlooked by some modern physicians.

    Indications for Circumcision
    In general terms, the main indications for circumcision are: (1) functional need - lack of ability to have a climax or ability to have one only with considerable difficulty, (2) an anatomic or mechanical factor that needs correction.
    When does this problem present itself and become our concern and responsibility as physicians? It is advisable to investigate sexual compatibility if unexplained symptoms of a psychosomatic type are elicited or if the problem of divorce is present. If there is no shyness or embarrassment on the doctor's part and his attitude is correct, the patient is seldom embarrassed. Often a patient appreciates being questioned on this subject because she had thought this might be her problem. If a patient is not sure that she has ever experienced a climax, it is probable that she has not.
    Patients with psychosomatic illness and marital problems make up a good portion of all types of medical practice. If these problems are based on abnormal anatomy, and it is corrected, these patients are often permanently cured. This cure is explained by the common origin of the primitive urges and of the subconscious, from which psychosomatic illnesses develop.
    Failure to elicit proper history and to examine patients carefully is illustrated by the following case. Mrs. B. G., age 34, had five divorces before coming to my office as a patient. She was found to have a rather severe redundancy and phimosis, and had never experienced a climax. After being circumcised, she remarried the last man she had divorced and has had no further sexual problem. She stated that she "wasted four perfectly good husbands." While having the five marriages and divorces, she had a great number of psychosomatic symptoms and illnesses. During this time she had been examined and treated by a number of physicians. None of them had told her of the severe phimosis and redundancy or suggested its correction. She has had no recurrence of psychosomatic illness since the circumcision five years ago. No tranquilizers, injections or other treatments were used.

    A difficult phase of the problem is presented when the wife of a recurrent ulcer patient states, "What difference does it make that I do not enjoy sex life if I do not refuse my husband"?
    In the earlier years of married life this form of prostitution is possibly not too harmful. A number of problems will probably develop in time however, because this practice is contrary to our instincts. If a man is legally married to a woman but not "mated" with her, one of four complications will probably develop: (1) a divorce, (2) another woman, (3) excessive use of alcohol or (4) suppression of normal urges with psychosomatic illness.

    Two Common Abnormalities
    The two common problems that make the highly sensitive area of the clitoris unable to be stimulated are phimosis and redundancy. Sebaceous glands about the clitoris attempt to prevent adhesions of the prepuce to it. This sometimes fails and the clitoris is tightly adherent to the prepuce. This defect is recorded as 1 plus or 25 per cent of the normal surface adherent, to 4 plus or complete coverage. A prepuce for the protection of the clitoris is normal and useful, but if it is excessive and extends past the eminence of clitoris it can prevent contact and is harmful. This excess is also classified from 1 to 4 plus. The greatest amount of redundant prepuce I have observed extended approximately one inch past the clitoris so that it is classified 4 plus. Thus, a 1 plus would represent approximately one-fourth inch of redundant tissue. Figure 5 represents a 3 plus redundancy.

    In general, the greater the degree of phimosis or redundancy, the greater the probability of satisfactory result by its correction. A 3 or 4 plus phimosis or 3 or 4 plus redundancy could be the anatomic indication. A combination of a 2 plus redundancy and 2 plus phimosis, could be an indication as well. Two rather unusual conditions which could be indications are the hard fibrotic prepuce and the type in which the prepuce is stretched tightly across the glans. Routine circumcision because of a functional problem alone, without the proper anatomic indications, will probably be of no benefit and might be harmful.

    Additional Indications
    The following situations would indicate the need for circumcision although less phimosis or redundancy is present.
    1. If the patient is quite adipose, a circumcision could be indicated although she has less anatomic defect. Obstruction by the adjacent tissues adds to her problem. This operation may help cure her adiposity by relieving psychosomatic factors.
    2. If the husband is unusually awkward or difficult to educate, one should at times make the clitoris easier to find.
    3. If the clitoris is quite small and is difficult to contact, a circumcision might help by making it more accessible.

    Relative Contraindications
    On the other hand, there are relative contraindications that make one more cautious and more selective in deciding to operate, for example:
    1. Frigidity from psychologic causes, such as fear of pregnancy, early adverse training and experiences.
    2. Incorrect attitude of patient or husband concerning desire to be helped, factors of abnormal jealousy, excessive psychoneurosis.

    Percentage of Favorable Results
    What percentage of favorable results can be expected when the previous indications are followed? To determine this percentage, a questionnaire (Figure 1) was sent to women whom I had circumcised within the past 15 years. One hundred twelve questionnaires were completed and returned. (Figure 2) gives the results obtained. A greater proportion of poor results occurred in early cases, giving evidence that my indications have improved. If cases are carefully selected, one should expect 85 to 90 per cent to show satisfactory improvement. This percentage could not be expected without adequate instructions to both the patient and her husband. When the anatomic problem is borderline, this instruction should be given before performing a circumcision in order to avoid unnecessary surgery.

    FIGURE 1.   Questionnaire Sent To PatientsPatient's Number ___________
    This questionnaire will be used as the statistical basis for a medical report. Your name will not be used. Kindly check in blanks and mail in enclosed envelope.
    Surgery: Circumcision done on _____________________________
    1. Could you have an orgasm prior to surgery: Yes _____   No _____
    If your answer is yes:
    a. Were you improved? Yes _____   No _____
    If your answer is no:
    b. Are you able to have an orgasm now? Yes _____   No _____
    The woman should be taught to develop voluntary control of the vaginal constrictor muscles. The judicious use of testosterone or stenedial to increase the sensitivity and size of the clitoris might be indicated.
    Advice concerning the male and female "libido curve" (Kinsey report) often helps to relieve a common worry of young wives. The interest and cooperation of the patient might be stimulated by a few words expressing the fact that it is a privilege (not a duty) to enjoy one of the greatest physical pleasures.

    FIGURE 2.  Questionnaires Received: 112
     73 had never experienced an orgasm:
    9 Not Successful (12.4%)
    64 Successful (87.6%)
     39 had experienced an orgasm with difficulty:
    5 Not Improved (12.5%)
    34 improved (87.5%)
    The husband must be instructed in female anatomy, proper body position, trituration. to develop desire, and such psychologic considerations as patience, atmosphere, kindness, affection, foreplay and other pointers suggested by his personality.

    Instrument for Female Circumcision

    figure 3: Jaws open

    figure 4: Jaws closed

    Technique of Circumcision

    It seems that such a relatively minor procedure should not require much detailed description. However, the fear of scar tissue formation, bleeding and the lack of a descriptive technique in the usual surgery texts, might prevent some physicians from attempting it. A few lines will be devoted to my previous technique, then a more simplified technique will be described.

    Allow two weeks before the next menstrual period. Give 3/4 gr. seconal one-half hour prior to surgery. Trilene inhalation makes the injection of 2 per cent Xylocaine or Nesacaine less painful. Most of the injection for adequate anesthesia can be made from one point, starting at the mid-line, about one inch anterior to the edge of the prepuce. The first injection is made three-eighths inch deep, to each side of the clitoris (Figure 5). Without removing the needle from the skin, the anesthetic is then injected subcutaneously to the base of the lateral attachment of the prepuce. The needle is then removed and injections are directed cephalad, as close as possible to the sides of the clitoris (Figure 6). This latter injection reduces the discomfort of separating the phimosis. The clitoris itself is not injected.

    The prepuce is then freed with a blunt probe. More Trilene is occasionally needed at this time, but the rest of the surgery should be painless. The operative area is resterilized.
    In the past, two long mosquito forceps were used to help perform the circumcision. They maintained the proper relationship of the internal and external skin layers and controlled the bleeding prior to suturing. Because the procedure was technically difficult and time consuming, I developed a clamp to be used for the procedure


    Clamp for Procedure
    This instrument is seen with jaws open Figure 4 and closed in Figure 3. It is simply a "vice-grip" pliers with strong, specially designed jaws for this procedure. After opening, the lower triangular plate or jaw (which is not perforated), is placed under the prepuce and the jaws are partially closed. A tooth thumb forceps is then used to reach through the hole in the upper jaw and pull the desired amount of prepuce into the clamp (Figure 7). The adjusting screw on the handle of the pliers can be turned to adjust for the various thicknesses of prepuce before the pliers are clamped. The cam action not only exerts adequate pressure to compress the tissues at the narrow lower edge of the upper jaw, but also sets itself so that no more force is needed by the operator.
    After a lapse of five minutes, the surgeon uses a scalpel to excise the prepuce within the upper jaw, being careful to stay close to the inner wall of the clamp (Figure 8). After the triangular piece of excised prepuce is removed, only the lower blade can be seen (Figure 9). The jaws are then opened and the clamp removed. On a thin prepuce, sutures are not necessary (Figure 10). When there is a doubt whether they are needed, however, the edge is reinforced with a few 5-0 plain catgut sutures on an atraumatic needle. This technique is extremely simple, accurate and bloodless. It has given excellent results because of the reduced healing time and absence of sear tissue.
    Postoperative Treatment
    To prevent recurrence of the phimosis until the raw surfaces are healed, a special preparation is applied to these surfaces after surgery. This is a wax containing Benzocaine 5 per cent and Terramycin 3 per cent. This preparation is heated to the melting point in its containing tube before being used.
    The patient is seen every two or three days for the purpose of keeping the adhesions free. Empirin and codeine, or Percodan, is given for postoperative discomfort. If the surgery is done on Friday morning, the patient can return to work on Monday. Complete recovery requires approximately ten to 14 days.

    Selasa, 15 Maret 2011

    Piano prodigy Ethan Bortnick

    Ethan Bortnick (born December 24, 2000 in Pembroke Pines Florida, USA) is a child prodigy, composer, songwriter, actor, musician and one of the youngest philantropis in the world.

    Ethan began playing a keyboard at the age of three and was composing music by the age of five. He is able to play any song by ear.He has been featured on National and International television programs. He has helped raise record amounts of money for charities around the world, by performing, inspiring and educating

    He's been seen on the Jay Lno show in 2007 making his national television debut. He has opened for or/and performed with Elton John, Beyonce, Josh Groban, Nelly, Santana, Smokey Robinson and Anatlie Cole just to name a few. With a talent well beyond his years and the ability to play almost any song by ear, he has developed a repertoire spanning from classical masterpieces to timeless jazz standards to current chart-toppers. His talent includes the outstanding ability to compose his own music, which he began doing at the age of five.
    If you haven't heard young Ethan perform then you are surely missing out on a delightful experience. On February 1, 2010, Ethan joined music’s biggest names as the youngest member of the all-star “We Are The World 25 For Haiti” line up. Produced by Quincy Jones and Lionel Richie, the track featured superstars including Barbra Streisand, Celine Dion, Kanye West and Miley Cyrus and made its debut during the opening ceremony of the 2010 Vancouver Winter Olympics.
    Ethan also recently earned the distinction of being the youngest musician to be endorsed by premier instrument manufacturer Gibson Guitar/Baldwin Piano.