Optimal timing of surgical intervention for penile fracture: a narrative review of the modern literature.

INTRODUCTION: Penile fracture is traditionally considered a surgical emergency warranting immediate repair with the goal to maximize long-term erectile function and minimize penile curvature. Nonetheless, consensus on the optimal timing for penile fracture repair remains to be elucidated and is the subject of continued research efforts. OBJECTIVES: This review aims to summarize the contemporary literature pertaining to optimal timing of penile fracture repair and associated outcomes. METHODS: We queried PubMed/MEDLINE and Google Scholar for relevant articles published between 2012 and 2022 to evaluate the most recent literature on the queried topic of early vs delayed intervention for penile fracture. All examined review articles were published within the last decade but may have included analyses of studies published prior to 2012. Reference lists of articles and reviews were manually reviewed to identify additional relevant articles. RESULTS: We identified 16 articles that met inclusion criteria: 12 primary articles and 4 systematic reviews or meta-analyses. Importantly, definitions of early and delayed intervention varied greatly among studies, making quantitative comparison challenging. In summary, 6 primary studies and 2 systematic review articles favored early intervention. There were also 6 primary studies and 2 systematic review articles suggesting equivocal outcomes between early and delayed repair. No articles demonstrated improved outcomes with delayed repair relative to early intervention. CONCLUSION: Surgical intervention for penile fracture remains the gold standard, with superior long-term sexual and functional outcomes when compared with conservative management. Optimal timing of penile fracture repair remains to be elucidated with data limited by low incidence, resulting in small case series and a lack of randomized controlled trials. Nonetheless, recent data suggest that a brief delay in surgical intervention for patients presenting with penile fractures does not affect long-term sexual and functional outcomes.

Arthur Conan Doyle, Sherlock Holmes, and gout.

Arthur Conan Doyle, the creator of Sherlock Holmes, was an experienced physician who treated gouty patients. A gouty character appears in The Adventure of the Missing Three-Quarter, a Sherlock Holmes novel. This offers the possibility of discussing gout from the peculiar perspective of a medical writer in light of the historical-medical context of the time. This study was conducted using Conan Doyle's autobiographical, scientific, and literary primary sources, as well as past and current medical literature. The Adventure of the Missing Three-Quarter was autobiographical. Conan Doyle himself was a rugby player and his wife died of tuberculosis. Furthermore, in 1884, in The Lancet, he described the hereditary case of a female gouty patient, presenting with ocular manifestations. In agreement with the concept of rich man's gout, the gouty patient of Sherlock Holmes' story, Lord Mount James, was a rich irascible noble but he was not addicted to the pleasures of food and sex. Following the usual funny representation of gouty patients, Conan Doyle made fun of Lord Mount James, but he misquoted a true case of gout cited in the literature. In his scientific and literary production on gout, Conan Doyle stuck to the most updated medical concepts of the time, demonstrating an uncommon knowledge of scientific literature.

"Listening Between the Lines": Soundscapes in Yusef Komunyakaa's Poetry.

Yusef Komunyakaa's poetry is widely acclaimed for its sui generis soundscapes, which shows the poet's highly sensitive auditory perception in his literary creations. Soundscapes, in his poetry, play a pivotal role in revealing social malaise-racial inequalities and gender-biased black relations-in the multiracial US. This article thus explores race- and gender-related societal problems mirrored in Komunyakaa's poetry through the prism of soundscapes. It first aims to examine how soundscapes are presented between poetic lines as a culture carrier, and then investigates the disciplinary power and oppositional function of soundscapes. Combining textual close reading with interdisciplinary research methodology, this article brings to light the complexity and specificity of soundscapes in Komunyakaa's poetry. For one thing, the soundscape constructed by the privileged serves as an oppressive force to discipline the disempowered groups; for another, the soundscape the underprivileged produce is utilized as an instrument of resistance and healing, offering them a sonic weapon to deconstruct the oppressive sound imperialism as well as construct the affective community of African Americans. This study not only adds to the research on Komunyakaa's poetry by offering a renewed viewpoint of excavating this poet and his political proposition of equality and equity, but also attracts academic attention to the role of literary soundscape in Afro-American literature in revealing the long-standing societal problems in the US.

Melville's "Bartleby, the Scrivener: A Story of Wall-Street": The Vicissitudes of Treating a Difficult Patient.

Taking the liberty of imagining the lawyer in Melville's "Bartleby, the Scrivener" as narrator/therapist and Bartleby as patient, this article, written with the therapist/reader in mind, traces the vicissitudes of countertransference and speculates on what constitutes a "good enough" therapeutic effort.

Dostoevsky's Doctor: Active Love in Modern Medicine and The Brothers Karamazov.

In this essay, the author draws from The Brothers Karamazov, a novel by Fyodor Dostoevsky, to consider the idea of love and its relevance to burnout in modern medicine. They argue that active love, as espoused by one of Dostoevsky's characters, might help clinicians care for their patients even in moments of exhaustion or disillusion. Coherent with Dostoevsky's Christian background, the author examines active love alongside the Christian concept of grace and Simone Weil's concept of attention. These explorations may yield fresh insights for clinicians struggling with burnout in health care, as well as those striving to master the timeless art of caregiving.

Authority and medical expertise: Arthur Conan Doyle in The Idler.

Arthur Conan Doyle's medical and writing careers intertwined and his work has a history of being read in the light of his medical expertise. He wrote at a time when the professionalisation and specialisation of medicine had resulted in an increasing distance between the profession and the public, yet general practitioners relied financially on maintaining good relationships with their patients and popular medical journalism proliferated. A variety of contrasting voices often disseminated narratives of medical science. These conflicting developments raised questions of authority and expertise in relation to the construction of medicine in the popular imagination: how is knowledge constructed? Who should disseminate it? How and by whom is authority conferred? How can the general population judge experts in medical science? These are questions explored more widely in Conan Doyle's writing as he examines the relationship between expertise and authority. In the early 1890s, Conan Doyle wrote for the popular, mass-market periodical The Idler: An Illustrated Magazine His contributions to it address these questions of authority and expertise for a lay audience. First establishing the medical context of doctor/patient relationships in which these questions arose, this article undertakes a close reading of these mostly rarely studied single-issue stories and articles as a means of ascertaining how Conan Doyle and his illustrators identified the relationship between competing narratives, expertise and authority. It argues that rather than maintaining a distance between public and professional, Conan Doyle's illustrated work demonstrates to his readers that there are ways to successfully navigate the appearance of authority and recognise expertise as they confront entangled representations of advances in medical science.

[Application characteristics of Qugu (CV 2) in ancient and modern literature].

To summarize and analyze the clinical application characteristics of Qugu (CV 2) in ancient and modern literature based on data mining technology. The Chinese Medical Code (the 5th edition) was taken as the retrieval source of ancient literature, while the CNKI, Wanfang, and VIP databases were taken as the retrieval source of modern literature. The indications of Qugu (CV 2) used alone or with compatible acupoints, compatible acupoints, acupuncture-moxibustion manipulation, etc., were systematically sorted out. As a result, a total of 140 articles of ancient literature were included. The common indications of Qugu (CV 2) used alone were urinary retention, profuse vaginal discharge and hernia. The common indications of Qugu (CV 2) used with compatible acupoints were profuse vaginal discharge, stranguria and hernia. Sixty-four acupoints were concurrently used with Qugu (CV 2), Qugu (CV 2) was mainly compatible with acupoints of conception vessel, bladder meridian and liver meridian, and the high-frequency acupoints included Zhongji (CV 3), Guanyuan (CV 4) and Sanyinjiao (SP 6); five-shu points were the most used special acupoints, and moxibustion therapy was often used. A total of 73 modern articles were included. The common indications of Qugu (CV 2) used alone were urinary retention, erectile dysfunction and chronic prostatitis; the common indications of Qugu (CV 2) used with compatible scupoints were urinary retention, erectile dysfunction and prostatic hyperplasia. Thirty-six acupoints were concurrently used with Qugu (CV 2), Qugu (CV 2) was mainly compatible with acupoints of conception vessel, kidney meridian and spleen meridian, and the high-frequency acupoints included Zhongji (CV 3), Guanyuan (CV 4) and Zusanli (ST 36); front-mu points were the most used special acupoints, and acupuncture therapy was often used. Qugu (CV 2) treats a wide range of diseases in ancient times, the distant treatment effectiveness of acupoints is emphasized; and it mainly treats local diseases in modern times, the nearby treatment effectiveness of acupoints is emphasized.

[Pity as pain: Narrative Medicine and Melville's "Bartleby"]. / Mitleid als Schmerz: Narrative Medizin und Melvilles "Bartleby".

BACKGROUND: Narrative Medicine is an interdisciplinary concept that joins literary texts and theory on the one hand with medical education on the other. It suggests that specific skills can be practiced by reflecting about literature and the arts, which represent existential human experiences. These skills are narrative competence, tolerance for ambiguity, changing one's perspective, empathy, and self-care. OBJECTIVES AND MATERIALS: This article describes a Narrative Medicine course and focuses on one unit in which Herman Melville's short story "Bartleby, the Scrivener: A Story of Wall Street" was discussed. METHODS: In combining participant observation and a close reading of the short story, the article describes how students responded to the text and how "Bartleby" speaks to central topics in medical practice, such as pain management and the significance (and limits) of pity and empathy. RESULTS: Melville's text represents pain and empathy in complex and ambiguous ways. In presenting a compassionate narrator who ultimately fails to empathize with the pain he perceives in his employee, the story challenges readers to reflect on the complexities of dealing with the suffering of others and invites a discussion about professionalism, personal values, and expectations. CONCLUSIONS: Literary texts in a medical classroom can be a productive resource to practice and critically discuss competences identified in the National Competency-Based Learning Objective Catalogue for Medicine 2.0.

Authoring Pain: Fragmentation and Autofiction in Maggie Nelson's Bluets.

This article analyzes Maggie Nelson's Bluets (2009) as a prominent example of the fragmentary narration that can result from the experience of pain and loss. I demonstrate how Nelson's disparate ruminations on her obsession for the color blue, her heartbreak, and her quadriplegic friend's chronic pain defy the superimposition of a teleological plot over these experiences, in favor of episodic reading and sporadic not-knowing. Still, the autofictional nature of the text-with its alternatively overbearing and elusive authorial presence-challenges any naïve emotional investment in it. Focusing on Nelson's narration of her quadriplegic friend's experience of chronic pain, I conclude by highlighting how Bluets calls for a reconsideration of the reader's stance vis-à-vis the description of suffering, as well as of simplistic critical approaches to illness narratives as life-writing.

Paraphrasing Finitude: Seeking Refuge from Death in Thomas Bernhard's Wittgenstein's Nephew.

Thomas Bernhard's novella Wittgenstein's Nephew is typically read as a quasi-memoir about Bernhard's relationship with Paul Wittgenstein, the nephew of the philosopher Ludwig Wittgenstein. But Bernhard is up to something else. The novella dramatizes the different ways that language and storytelling defend against anxieties associated with illness and mortality. Bernhard is able to show this defense mechanism at work while simultaneously crafting a broken narrative that tells a story of its own, a story of an illness that cannot be contained in usual narrative threads and that asks for new forms of storytelling. He thus reveals at once both the concealing and disclosive potential of language in the face of illness as he finds innovative ways to embody the experience of illness in the very fabric of the text.

Diagnosing Desire: Imaginative Experiments with Sexuality and the Nerves.

American fiction often tells us that there is something sick about romantic desire. But the writers who I discuss in this article told their readers this even as they critiqued the medical profession's pathologization of women's desires and non-normative sexual subjectivities. In particular, this article looks at two literary responses to the medical notion that marriage was a cure for hysteria and other nervous disorders: Oliver Wendell Holmes's A Mortal Antipathy (1885) and Elizabeth Stuart Phelps's Doctor Zay (1886). While the medical rhetoric of nervous pathology could be repressive and stigmatizing, these fictions sought to reclaim and reimagine the medical treatment of nervous desire in subversive ways.

The Case of the Peculiar Story: Medical Investigation and the Detective in Edgar Allan Poe and Marguerite Duras.

In "The Murders in the Rue Morgue" (1841), Poe invents the detective story in English, introducing his gentleman sleuth Auguste Dupin as he solves the locked-room mystery of two women found brutally murdered in a Paris apartment. In L'Amante Anglaise (1967), Duras revisits the detective form, fictionalizing the true 1949 crime of a woman murdering and dismembering her cousin in Viorne, France. These literary detective stories highlight the powerful but unspoken role of affective experience in driving what appears, on the surface, to be a forensic medical or psychological investigation. In both tales, peculiarity is an affective and cognitive force that, contrary to what the majority of affect literature argues, inherently moves toward resolution and closure. Using peculiarity as an analytical concept, we argue that the concealment / discovery binary must acknowledge its affective origins, breaking a barrier between narrative scholarship and medical practice.

Picturing sanity, in black and white.

This speculative work grapples with a riddle: if white supremacy is noxious, and if it is inescapable, is apparent black health, black sanity, in fact healthy? In order to help the reader appropriately appreciate the feat that is black sanity, I begin with a treatment of Fyodor Dostoevsky's literary character, Mr Golyadkin. I go on to extend my claim that Golyadkin's ill health or lack of sanity can be understood in terms of the violation of the norms of sociality, onto Antonin Artaud. Dostoevsky and Artaud therefore provide case studies with which it is possible to begin to develop an outline of the bounds and mechanics of white sanity. I juxtapose this outline to readings from a selection of works by African writers-Bessie Head, Véronique Tadjo and Dambudzo Marechera. This culminates in an interrogation of Franz Fanon's metaphorisation of disability. I grapple especially with the ethical and existential implications of his understanding of black amputation. The conclusion that I eventually reach is another riddle, which may or may not amount to a restatement of the riddle with which I begin.

[A review of clinical specifications of Scutellariae Radix pieces in ancient and modern literature].

Scutellariae Radix is a commonly used Chinese medicinal first recorded in the Shennong's Classic of Materia Medica. In the ancient books of traditional Chinese medicine(TCM), Scutellariae Radix is used in two specifications, solid one(Ziqin) and hollow one(Kuqin). In the current rules and regulations of Chinese medicine, Scutellariae Radix is used without the specific requirements for the specifications applied. To clarify the evolution of Scutellariae Radix specifications and analyze the current specifications of Scutellariae Radix pieces, the present study reviews the Scutellariae Radix from ancient literature, modern rules and regulations, and differences between Ziqin and Kuqin in composition, efficacy, and transformation mechanism. According to the research on ancient books, Kuqin is effective in clearing the fire of the upper energizer, and Ziqin in purging the heat of the lower energizer. Modern studies have revealed that Kuqin and Ziqin are significantly different in chemical components, and Ziqin and Kuqin target the colon and lung, respectively, which are consistent with the relevant records in ancient books. The review study suggests that the two specifications of Scutellariae Radix are reasonable since they can facilitate the precise treatment of Scutellariae Radix.