Gynaefix frameless IUD: Cause of bowel resection.

A case of a lost GyneFix intrauterine contraceptive device (IUD) is described, in which laparoscopy failed to identify the device and laparotomy had to be carried out to remove the IUD, which was embedded in the small bowel necessitating bowel resection. Awareness of this complication is necessary, and advanced training is required in order to minimize risks. A description of the GyneFix device, the possible adverse effects and incidence of complications, the importance of post-insertion follow-up, and the need for awareness of the possibility of migration through the bowel are discussed.

A systematic review of acute and late toxicity of concomitant chemoradiation for cervical cancer.

BACKGROUND AND PURPOSE: Concomitant chemoradiation (CRT) for locally advanced cervical cancer has become an established treatment based on randomised trials. Major concerns, however, remain over the acute and late toxicity and hence the generalisability of the conclusions of these studies. MATERIALS AND METHODS: A review of all known randomised trials using the Cochrane Collaboration methodology identified 19 trials (17 published, two unpublished) between 1981 and 2000 including 4580 randomised patients. Data on toxicity were available for 1766 patients. The trials differed in size, design, and accrual period. As a conceptual ranking, six grades of severity were used in all scales; groups 1-4 were combined to allow comparison of CRT and radiotherapy and expressed as an odds ratio. This systematic review examines the toxicity of the meta-analysis, with the cisplatin containing trials discussed separately. RESULTS: Grade 1 and 2 haematological toxicities were higher in the CRT group. Significant differences were seen in grade 3 and 4 haematological and gastrointestinal toxicities where a twofold increase in white cell count [OR 2.15 CI 95% (1.57-2.95) P<0.001], a threefold increase in platelet toxicity [OR 3.04 CI 95% (1.08-8.51) P=0.005] and a twofold increase in gastrointestinal toxicity [OR 1.92 CI 95% (1.26-2.92) P<0.001] were seen. Long-term toxicity was only described in eight trials, seven of which reported no statistical difference. CONCLUSIONS: In view of the consistency and extent of the survival benefit for CRT the additional acute toxicity appears to be acceptable. The lack of data on long-term toxicity needs to be addressed.

Effect of delays in primary care referral on survival of women with epithelial ovarian cancer: retrospective audit.

OBJECTIVE: To examine referral pathways from primary care for patients with epithelial ovarian cancer and to identify factors related to survival at 18 months. DESIGN: Retrospective review of patient notes. SETTING: General practices and receiving hospitals within Mersey region. SUBJECTS: 135 patients with epithelial ovarian cancer identified from an audit in the Mersey area between 1992 and 1994. MAIN OUTCOME MEASURES: Delays between onset of symptoms and treatment attributable to patient, general practitioner, and hospital. RESULTS: 105 (78%) women first presented to their general practitioner within four weeks of the onset of symptoms. 99 (73%) women were referred to hospital by their general practitioners within four weeks of presentation, and 95 (70%) were seen in hospital within two weeks of referral. Multivariate analysis with survival as the dependent variable identified age (odds ratio 0.96, 95% confidence interval 0.93 to 0.99) cancer stage III or more (0.15, 0.05 to 0.43), and non-specific symptoms (0.36, 0.14 to 0.89) as significant variables. CONCLUSION: Most patients attended their general practitioner within four weeks and were referred within two weeks. No evidence was found that delays in referral or diagnosis adversely affected survival at 18 months. Stage of disease at surgery was the most important adverse factor. An effective screening programme is the most likely method to improve survival.