Factor XI (eleven) deficiency is a bleeding disorder which is common in Jewish people. The genetic Inheritance is autosomal dominant or recessive. It affects males and females equally. Bleeding can occur after surgical operations including circumcision Bris Milah but there are a number of treatments which can be given to prevent bleeding

Dr Harris worked as Circumcision Surgeon and Mohel with Dr. Niamh O’Connell when she investigated aspects of factor XI deficiency and developed a protocol for the management of circumcision on the male infants of factor XI deficient patients. She was then working as a research fellow at the Haemophilia Centre and Haemostasis Unit Royal Free Hospital in London with Professor Christine Lee and Dr Ri Liesner, Consultant Haematologist & Director of the Haemophilia Centre Great Ormond Street Hospital for Children London.

CASE HISTORY
Baby A was born with a family history of Factor XI deficiency haemophilia C. Dr Harris arranged the blood testing for Factor XI level. After consultation with colleagues to discuss the blood level, Dr Harris performed the Bris Milah according to the protocol.

For any medical problems related to Factor XI deficiency Haemophilia C and performing a Bris Milah (Brit Mila), contact Dr Harris 020 8209 2401.

www.londoncircumcision.com
Dr Martin Harris, Doctor and Mohel for Jewish Circumcision Clinic in London Bris Mila Brit Milah.

Hypospadias in boys is where the urethra (urine opening) development appears in a slightly different position. The frequency of occurrence is 0.5% (1 in 200). In general, if the hypospadias is mild, with the opening of the urethra just a little down from normal and with no bending of the penis, then no treatment may be needed. In general when treatment is indicated, repair operation is performed when aged one year. The degree of repair will indicate whether the repair is by one operation (known as one stage) or two operations (known as two stage).

Circumcision Bris Mila (Brit Milah) on hypospadias babies is performed by combining the hypospadias repair operation and the Bris Milah at the same operation.

CASE HISTORY:
Baby A I examined and assessed for Bris Milah I diagnosed hypospadias.

I discussed this with the family GP and consultant colleagues at Great Ormond Street Hospital for Children London.

After further assessment, Baby had an operation aged one year for hypospadias and I performed the Bris Milah at the same operation.

For any medical problems of hypospadias related to performing a Bris Milah (Brit Mila), contact Dr Harris 020 8209 2401.

Written by Dr Martin Harris, Doctor and Mohel for Jewish Circumcision Clinic in London Bris Mila Brit Milah.
www.londoncircumcision.com

A Ugandan study of 5534 men aged 15-49 by Dr Quinn and others has just been published in the New England Journal of Medicine (NEJM March 26 2009 volume 360 number 13 p1298-1309) on Male Circumcision for the Prevention of HSV-2 and HPV Infections.

In addition to decreasing the incidence of HIV infection, male circumcision significantly reduced the incidence of herpes simplex type2 (HSV-2) infection and the prevalence of and human papilloma virus infection (HPV infection), findings that underscore the potential public health benefits of the procedure.

COMMENT
The editorial says that these data add to the already compelling evidence that male circumcision can protect men from serious sexually transmitted infections.

www.londoncircumcision.com
Dr Martin Harris, Doctor and Mohel for Jewish Circumcision Clinic in London Bris Mila Brit Milah.

Question:
The baby was born and the midwife and/or the doctor have mentioned jaundice, but they are not concerned with the baby who is well since the degree of jaundice or blood level is “below the medical line” and the midwife and/or the doctor says needs no specific treatment like ultraviolet light?

Answer:
•Baby being jaundiced (yellow colour) appearing on the third day is very common, called physiological jaundice which generally clears spontaneously by 14 days in a full term baby.
•However if the jaundice level is high with a high bilirubin blood test, or the jaundice is prolonged in time, then medically this may require investigation of the cause and treatment.
•The Bris Milah Brit Mila is performed on the eighth day if the baby is well. The procedure is not performed while the baby is jaundiced, or there is any health problem. The Bris is delayed until the jaundice has cleared and the baby is well.
•Please obtain all the medical information including any blood test results.

CASE HISTORY
Baby A was born and developed jaundice within the first three days.

I reviewed the blood tests and the baby , then I discussed these with the hospital Paediatric doctors.

After investigation and treatment the jaundice cleared and I carried out the Bris Milah.

For any medical problems of jaundice related to performing a Bris Milah (Brit Mila), contact Dr Harris 020 8209 2401.

www.londoncircumcision.com
Dr Martin Harris, Doctor and Mohel for Jewish Circumcision Clinic in London Bris Mila Brit Milah.