Skin incision recurrence of adenocarcinoma of the cervix five years after radical surgery for stage 1A disease.

A 31-year-old para 1 had a radical hysterectomy for stage 1A adenocarcinoma of the cervix. She developed skin incision metastasis five years later in spite of normal regular vault smears.

Clinical and pathological evaluation of large loop diathermy excision of the transformation zone.

In order to make accurate diagnosis and to carry out treatment of cervical preneoplastic disease, large loop diathermy excision of the transformation zone was performed in 98 patients. The colposcopic assessment was indicated by abnormal smear or history of treatment for preneoplastic changes. The entire transformation zone could be excised in one piece in 90% of cases. Histological examination of the specimens confirmed dysplasia in 89% of patients and in 4 cases invasive cervical disease was revealed. The ectocervical and endocervical excision margins were free of dysplastic epithelium in 68% of cases. Compared to traditional cone biopsy, the new method is cheaper and more simple. Loop diathermy excision of the transformation zone can be performed in local anaesthesia as an out-patient procedure and there is no need for postoperative hospitalization. By reducing the number of general anesthesia, the workload in gynaecological theatres and by eliminating the need for postoperative hospital stay the method substantially contributes to the improvement of the hospital budget.

Priapism in sickle cell anaemia: a case report.

Priapism is an unusual and distressing complication of sickle cell anaemia and its management has been varied and generally unsatisfactory. We report priapism in a Libyan boy with sickle cell anaemia, managed successfully by blood transfusion.

The Melkersson-Rosenthal syndrome--a report of two cases.

Melkersson-Rosenthal syndrome (MRS) is a rare condition with variable presentation. In some cases there is sequential development of clinical features. This report describes the syndrome in two Arab children who showed partial response to therapy with oral steroids. Since the natural course of the disease is unpredictable and there may be natural remission of symptoms, the efficacy of steroids is difficult to establish.

The pathology in perinatal mortality in Nairobi, Kenya.

The clinico-pathological causes of death in 497 stillbirths and 1st 24 hour neonatal deaths in Nairobi are described. The major factors in stillbirth (303 cases) were cord compression and prolapse, birth trauma, and prolonged labour. Hyaline membrane disease and intraventricular haemorrhage caused death in 52% of the neonatal cases. The importance of intra-uterine infection is discussed.

PIP: For appropriate planning of obstetric health care, a knowledge of perinatal mortality is vital. To obtain the precise cause of death, both obstetric and pathological data must be correlated. To this end, an attempt was made to examine all the perinatal deaths in Nairobi over a 6-month period in 1981. All dead fetuses and neonates dying within 24 hours of birth and weighing 500 gm or more were autopsied and relevant obstetric data collected. An obstetric survey of all births within Nairobi over a 7-week period (5293 deliveries) was made to obtain baseline information. The restriction of neonatal deaths to those occurring in the 1st day of life was necessitated by logistical reasons. Preliminary data indicated that the stillbirth rate was 23/1000 total births and the 24-hour neonatal death rate was 12.6/1000 live births. Pathological findings are given; the data for singletons and multiple pregnancies have been combined. 497 of 702 perinatal deaths were autopsied. This sample is considered to be representative of the total. 494 of the 497 were blacks. Antepartum deaths comprised 23%, intrapartum (fresh stillbirth) deaths 38%, and 24-hour neonatal deaths 39% of the total. Overall, severe malformations were the cause of only 6.6% of the deaths, compared with 24% of the perinatal deaths in the UK in 1970. This low proportion is primarily due to the high frequency in Nairobi of avoidable obstetric causes of death such as cord prolapse (18% of all intrapartum deaths), birth trauma, and prolonged labor. The high mortality from the complications of low birth weight (52% of the neonatal deaths occurred from hyaline membrane disease and/or intraventricular hemorrhage) are to be expected where modern neonatal care facilities are minimal. Histologically, the lungs of the stillbirths in the "uncertain" category showed evidence of intrauterine anoxia, i.e., aspirated meconium and amniotic squames. Neonatal "uncertain" deaths were mostly in the very low birth weight category and their lungs were immature. 4 aspects of these perinatal deaths are discussed: congenital malformations, hyaline membrane disease, birth trauma, and infections. 21 of the 33 malformations were neural tube defects of which 15 had anencephaly with or without spina bifida. 50% of the neonatal deaths had hyaline mmembranes in their lungs. Cerebral birth trauma, present in 38 cases, resulted from excessive deforming pressure on the skull during delivery. Fetal infection may occur either transplacentally or from infected amniotic fluid. Of the former, syphilis was the most frequent, occurring in 3.2% of all the perinatal deaths. In Nairobi 62 stillbirths and 51 neonatal deaths showed evidence of amniotic fluid infection, 22.5% of the total deaths.

The Nairobi birth survey. II. Antenatal care in Nairobi.

PIP: Antenatal care is now universally accepted as an essential part of obstetric care and most health authorities in developing countries are trying to offer this service to their populations. This study, part of the Nairobi Birth Survey, looks into the pattern and distribution of antenatal care in the City of Nairobi, particularly to assess the quality and appropriateness of the service. 96.4% of women attended antenatal clinic at least once, the majority (74.7%) being looked after at health center level. There was an overrepresentation of young, single, primigravidae who had received little formal education in the group that received no antenatal care. The quality of care varied from clinic to clinic but on the whole there was a tendency either not to do certain important investigations or failure to obtain the results in the cases where the tests were requested. Nearly 60% of the antenatal women had height between 155 cm and 164 cm, 2.7% had positive tests for syphilis, 10.5% were anemic and 10.3% were hypertensive. The perinatal mortality rate in the group that did not have antenatal care was found to be 4.8 times greater than that in the group that received antenatal care. 1 way of facilitating detection of risk factors is by designing an appropriate record card. An example of such a card has been successfully tested in rural areas of Kenya. The quality of antenatal care can be assessed by maternal height, blood pressure, blood group, hemoglobin, serological test for syphilis and urine examination for protein and sugar. Private doctor antenatal care tended to be inferior to hospital care. Just under 20% of the women were under 20 years old while 44% were 35 and over. A comparatively larger proportion of adolescents did not receive antenatal care. Primigravida and highly parous mothers are also classified as high risk cases. Nearly 15% of the mothers were single and showed a marked tendency for lack of antenatal care and health care center utilization. Anemia existed in 10.5% of a sample of 789 women. Proteinuria was detected in only 3.6%. In about 80% of the antenatal mothers no complications were found. Perinatal mortality and morbidity rates will be reduced as a result of antenatal care.^ieng

The Nairobi Birth Survey 1. the study design, the population and outline results.

PIP: The Nairobi Birth Survey was planned with the following objectives: 1) establish the social, obstetric and epidemiological characteristics of the obstetric population of Nairobi, Kenya; 2) examine the pattern and distribution of antenatal and delivery care; and 3) assess the true incidence of stillbirths and 1st 24-hour neonatal deaths, congenital abnormalities and major obstetric complications. The Survey consisted of 1) a study of all stillbirths and 24-hour neonatal deaths over a period of 7 months (March-September 1981), and 2) recording of all births taking place in Nairobi over a 7 week period (June 15-August 4, 1981). During the 7 week period there were 5,293 single births, including 187 perinatal deaths, with a stillbirth rate of 23/1,000 births and a 24-hour neonatal death rate of 12/1,000. The obstetric population was found to be predominantly young, with 57.8% of all mothers being under 25 years of age. Nearly 20% were teenagers. 23% of the mothers were having their 5th or more children at the time of the Survey. In 79.3% of the mothers the antenatal period was uncomplicated. Hypertensive disease in pregnancy was found to be the leading cause of complications, existing in 10.4% of the pregnancies. The majority of the mothers delivered in public institutions. Together with the student midwives, midwives conducted 79.7% of the births. The 3 maternal deaths in this survey give a maternal mortality rate of .56/1,000 deliveries. 701 perinatal deaths occured in the 7 month study, which corresponds to 71.2%. These deaths were mostly associated with complications of labor, including prolonged and difficult labor. In 40.9% of the cases the deaths could have been avoided with appropriate action. In 436 babies that were autopsied, 33 had congenital abnormalities.^ieng

Epidemiology of induced abortion in Nairobi, Kenya.

PIP: This is a prospective analysis of 610 patients admitted for abortion at the Kenyatta National Hospital, Nairobi, Kenya, between May and October 1981. 60% of the acute gynecological beds are occupied by abortion seekers, and 62.3% of the total abortion admissions are induced or likely to be induced. Abortion is more common among single adolescent girls who had no knowledge of contraception--43% are adolescent girls; 79% are unmarried; and 60% school girls or unemployed women. 64% of the patients were aware of family planning, but only 20% had used any form of contraception within the previous 12 months. Others were either unaware of, or did not have access to contraceptive devices. In most cases abortion is an alternative to contraception. 25% of the cases are performed by nonmedical personnel using dangerous methods. Such abortions lead to complications, both immediate and long-term. Maternal mortality rate in this study is 3 abortion deaths/1,000 admissions. Mean hospital stay in the induced group is 98 hours, as compared with the 32 hours in the case of the non-induced group. This paper urges that unwanted pregnancies must be prevented through health, family planning and sex education, and effective contraception.^ieng