Multistate outbreak of Escherichia coli O157:H7 infections associated with in-store sampling of an aged raw-milk Gouda cheese, 2010.

In 2010, 41 patients ill with Escherichia coli O157:H7 isolates determined to be indistinguishable by pulsed-field gel electrophoresis were identified among residents of five Southwestern U.S. states. A majority of patients reported consuming complimentary samples of aged raw-milk Gouda cheese at national warehouse chain store locations; sampling Gouda cheese was significantly associated with illness (odds ratio, 9.0; 95 % confidence interval, 1.7 to 47). Several Gouda samples yielded the O157:H7 outbreak strain, confirming the food vehicle and source of infections. Implicated retail food-sampling operations were inconsistently regulated among affected states, and sanitation deficiencies were common among sampling venues. Inspection of the cheese manufacturer indicated deficient sanitation practices and insufficient cheese curing times. Policymakers should continue to reexamine the adequacy and enforcement of existing rules intended to ensure the safety of raw-milk cheeses and retail food sampling. Additional research is necessary to clarify the food safety hazards posed to patrons who consume free food samples while shopping.

Cryptosporidiosis from a community swimming pool: outbreak investigation and follow-up study.

Tri-County Health Department investigated an outbreak of cryptosporidiosis linked to a community swimming pool. A cohort study was conducted in 37 persons who were invited to the pool party; 12 (57%) of 21 attendees had primary cryptosporidiosis infection. Risk factors for illness included swimming, getting water in mouth, and swallowing water. The pool met chlorination guidelines and used UV light irradiation, a supplemental disinfection technology that inactivates Cryptosporidium. A follow-up survey of the cohort was completed 7-8 weeks after the pool party; four (25%) of 16 non-attendees had secondary cryptosporidiosis infection. The median duration of illness, including patients with recurring symptoms, was 26 days. Clinical response rate to nitazoxanide, a therapeutic agent, was 67%. This study is unique because it describes a cryptosporidiosis outbreak from a well-maintained community swimming pool using supplemental disinfection. It also reports information on disease burden and treatment response.

Extraperitoneal hypogastric artery ligation in control of intractable haemorrhage from advanced carcinoma of cervix and choriocarcinoma.

Seven cases of extraperitoneal ligation of the hypogastric arteries to control bleeding from advanced cervical cancer and choriocarcinoma is presented. This method was able to arrest haemorrhage and there was no further transfusion. The surgical technique and advantages are described.

Management of difficult intra operative bleeding by abdominal packing: report of four cases.

Difficult perioperative bleeding in four obstetric and gynaecology patients was managed with temporising abdominal packs left in place with abdominal closure for 48-72 hours in order to avoid deaths on the operating table when blood loss could not be adequately replaced and hemostasis could not be secured. Abdominal re-opening to remove the packs was undertaken. Three of the patients were eventually discharged home after satisfactory recovery. The fourth died of sepsis three weeks after the fourth re-operation and bilateral internal iliac artery ligation. Abdominal packing thus has a place in the management and salvage of patients with difficult obstetric and gynaecologic perioperative bleeding.

Oral nifedipine therapy in the management of severe preeclampsia.

OBJECTIVE: The purpose of this study was to compare the efficacy of nifedipine (Cordipin) and hydralazine in lowering blood pressure in severe preeclampsia. METHOD: A randomized, prospective study of 104 patients with severe preeclampsia in the Department of Obstetrics and Gynecology, Korle-Bu Teaching Hospital, Accra, Ghana, was conducted between January 1992 and June 1994. RESULTS: Of the 104 patients recruited into the study, six did not deliver at our hospital and were thus excluded from the study. Nifedipine and hydralazine as first-line drugs controlled the blood pressure in 44 and 35 patients, respectively, but failed in 5 and 14, respectively. This was statistically significant (P < 0.05). The mean birth weight was higher in the nifedipine group (2500+/-800 g vs. 2400+/-800 g). There were 11 admissions to the neonatal intensive care unit in the nifedipine group and 13 in the hydralazine group but the difference was not statistically significant. CONCLUSION: Nifedipine and hydralazine could both be used effectively to control blood pressure in severe preeclampsia in our subregion. While hydralazine is administered intravenously and needs strict monitoring, nifedipine is more effective, is easy to administer orally, less demanding on hospital staff, convenient and more predictable.

Diabetes mellitus induced by thecoma-fibroma tumour of the ovary: case report.

A case of Thecoma-fibroma secreting oestrogen to cause insulin intolerance in a post-menopausal woman is presented. Blood levels of sugar became normal 24 hours after removal of the tumor. The possible mechanism is presented.

Perinatal and maternal mortality associated with retained second twins.

OBJECTIVES: The aim of this study of retained second twins admitted to Korle-Bu Hospital between 1988 and 1993 was to identify the factors contributing to the mode of delivery, perinatal and maternal mortalities, and draw up recommendations to improve outcome. METHODS: The study consisted of a review of record cards, outpatient admission and discharge books, delivery books, and inpatient case notes of women admitted with retained second twins of 28 weeks' or more gestation during the study period. RESULTS: Of the 65 cases fully reviewed, 33 (approximately 50%) were delivered by cesarean section due mainly to abnormal lie with or without shoulder impaction. The rest were assisted deliveries, mainly vertex deliveries or breech extractions. The perinatal mortality of the retained second twins was 38.5% compared with 12.3% for the first twins. Although in general the longer the interdelivery interval, the greater the second twin perinatal mortality risk, no clear direct correlation could be established. There was one perioperative maternal mortality due to anaphylactic reaction to intramuscular morphine injection. CONCLUSION: Irrespective of the antenatal course and early labor findings, twin delivery should be undertaken in a unit equipped for cesarean section and assisted delivery. The unacceptably high perinatal mortality of retained second twins could thus be significantly reduced.

Construction of an artificial vagina with sigmoid colon in vaginal agenesis.

OBJECTIVES: The study of 15 cases of colonic reconstruction for absent vagina. The outcome in cases of reconstruction of an artificial vagina using the colon is evaluated. METHODS: Fifteen female patients with congenital absence of vagina who were evaluated and treated with sigmoid colonic reconstruction at the Korle-Bu Teaching Hospital in Accra, Ghana were studied. RESULTS: This reconstructive method is successful in patients having a functioning vagina without progressive shrinkage or other symptoms. Disfigurement of the thighs and labia are avoided as is the need for active manipulation. CONCLUSION: Sigmoid colonic reconstruction for vaginal agenesis is an acceptable method especially in the developing world.

A new method of achieving total continence in vesico-urethro-vaginal fistula (circumferential fistula) with total urethral destruction--surgical technique.

Twelve (12) cases of urethral reconstruction from the anterior bladder wall combined with primary urethropexy to achieve total continence in 67% circumferential fistulae in women is presented. These operations were performed transvaginally and the technique is described.

Spontaneous rupture of the liver in severe preeclampsia. Case report.

Uncontrolled haemorrhage is the most common cause of death after spontaneous rupture of the liver in pregnancy. This severe complication of pregnancy-induced hypertension is associated with a high rate of both maternal and fetal mortality, and aggressive therapy should be instituted including treatment of haemorrhagic shock, control of hepatic bleeding, and delivery.

Maternal height as a predictor of vaginal delivery.

OBJECTIVE: The purpose of the study was to establish a relationship between maternal height and vaginal delivery. METHOD: A prospective study of 900 primigravidas in labor in the Department of Obstetrics and Gynecology, Korle-Bu Teaching Hospital was conducted. A questionnaire was developed and administered by research assistants. The results were analyzed using the X2-test. RESULTS: Of the 900 patients who delivered, 538 were studied. The remaining patients were excluded from the study because of factors described under exclusion criteria. A critical height of 154 cm was chosen as the screening height for 'at risk' of cephalopelvic disproportion (CPD). This height would identify 71.1% of women who would develop CPD. CONCLUSION: Short women with heights up to 150 cm are at risk of failing spontaneous vaginal delivery and should be referred to hospitals where labor could be closely monitored and cesarean section performed if necessary.

Anuric acute renal failure due to bilateral accidental ureteric ligation during abdominal hysterectomy.

OBJECTIVE: To determine the incidence of accidental ureteric ligation causing acute anuric renal failure (AARF) at the KorleBu Teaching Hospital, Accra, Between August 1984 and December 1991. METHOD: The records and operative data of all cases managed with acute anuric renal failure at the hospital during the period were reviewed. RESULT: The 7 patients with AARF presented with mean pre-referral anuria of 3.2 days. Total abdominal hysterectomy (4 for fibroids, 2 for carcinoma of uterus and 1 for post partum hemorrhage) was the cause of ureteric ligation. The 7 patients mean age 38.5 years were anemic (mean HB 4.1 g/dl) and uremic (mean blood urea 40.51 mmol/l) on admission. Abdominal ultrasonography was useful for diagnosis of obstructive uropathy. Hemodialysis was required in all cases prior to laparotomy and ureteroneocystostomy. The ureters were usually ligated at the distal 3 cm. Five survived ureteroneocystostomy and 2 died before laparatomy from septicemia and/or pulmonary edema. CONCLUSION: Abdominal hysterectomy is a major cause of anuric acute renal failure and early recognition and treatment prevents death.

Menopausal age of Ghanaian women.

OBJECTIVE: The purpose of the study was to determine the age of menopause among Ghanaian women. METHOD: A prospective survey involving 152 women in Akosombo District in Ghana was conducted. A questionnaire was developed including: age at menopause, symptoms of hot flushes or flashes, palpitations, anxiety, sleeplessness, headaches, frequency of urine, depression, irritability, tiredness, weight gain, poor memory and attitudes to coitus. RESULT: Of 152 women interviewed, 29 were excluded because they were not sure of their birth dates and 123 women were analyzed. The mean and median ages at menopause were 48.05 years +/- 3.62 S.D. and 48 years respectively. The major symptoms at menopause were tiredness 79.9%, sleeplessness 71.0%, palpitations 63.7%, weight gain 61.8%, hot flushes 56.5%, and irritability 56.5%. However, 85.6% of the women who experienced hot flushes reported this to be the most unpleasant. CONCLUSION: 1. The age at menopause in Ghanaian population was 48.05 +/- 3.62. 2. Tiredness, sleeplessness, palpitations, weight gain, hot flushes, irritability, anxiety and headache were the major symptoms at menopause. 3. Hot flushes or flashes was the most disturbing symptom at menopause.

Transvaginal mobilization and utilization of the anterior bladder wall to repair vesicovaginal fistulas involving the urethra.

Repair of vesicovaginal fistulas resulting from obstetric trauma remains a major challenge to surgeons worldwide. Large defects that result in partial or total urethral loss are especially difficult to repair. Even when closure of such fistulas is accomplished, return of normal urogenital function is often impaired, underscoring the need to improve existing surgical procedures. Transvaginal urethral and bladder neck reconstruction using mobilized anterior bladder wall was helpful in closing 18 of 20 vesicovaginal fistulas with urethral involvement caused by obstetric trauma. This method involves advancement of an anterior bladder wall flap into the vagina, where it is rolled into a neo-urethra or connected to whatever remnant of urethral tissue exists. Complications included stress incontinence requiring further surgery (four), small bladder capacity with detrusor instability (two), urethral stenosis requiring dilatation (two), postoperative hemorrhage (one), and vaginal stenosis (one). Continued modification of this procedure holds promise for many patients considered inoperable in the past.

Ligation of hypogastric artery in severe primary postpartum haemorrhage due to atonic uterus

Twenty-one (21) cases of hypogastric (internal iliac) artery ligation performed for severe postpartum haemorrhage due to hypotonic uterus are presented. The advantages of hypogastric artery ligation in severe primary postpartum haemorrhage are discussed and the technique is described