Intrauterine Device Migration: A Diagnostic and Management Dilemma.

Intrauterine devices (IUDs) are an effective method of contraception, with failure rates comparable to sterilization. In rare cases, IUDs can migrate to other sites, including the bladder, cecum, and fallopian tubes. This case reports a 44-year-old woman who was misdiagnosed with a urachal cyst due to the migration of her IUD into the anterior abdominal wall. A laparoscopic retrieval was successfully performed. To prevent any further serious complications, it is imperative to promptly diagnose and manage migrated IUDs.

Ultrasonographic endometrial thickness for diagnosing endometrial pathology in postmenopausal bleeding.

We conducted this retrospective analysis of our clinical data to identify the incidence of benign endometrial abnormalities, endometrial carcinoma and to find out the endometrial thickness (ET) cut-off point using trans-vaginal ultrasonography for patients with postmenopausal bleeding (PMB) referred to the Rapid Access Clinic in Northampton General Hospital. All women referred between April 2004 and April 2005 with PMB were included in this analysis. Final diagnostic outcome was classified into benign endometrial polyp, endometrial hyperplasia, endometrial carcinoma or normal (by excluding these pathologies). A total of 142 patients were included in this survey. The incidence of abnormal endometrial pathology was found to be 23.9% and 5% for endometrial carcinoma. Our results suggested that benign endometrial pathology is the most common cause of postmenopausal bleeding. Lowering the endometrial thickness cut-off point from 5 mm to 3 mm will not improve the diagnostic accuracy of endometrial carcinoma.

Blastocyst culture and transfer: a step toward improved in vitro fertilization outcome.

OBJECTIVE: To evaluate the efficacy of blastocyst culture and transfer in human in vitro fertilization (IVF) as compared to day 3 embryo transfer. DESIGN: Prospective randomized trial. SETTING: Private assisted reproduction unit. PATIENT(S): A total of 162 IVF patients were included in the day 3 embryo transfer (n = 82) and blastocyst transfer (n = 80) groups. INTERVENTION(S): Embryo transfer on day 3 after culture in the standard culture media and blastocyst transfer on day 5 or 6 after culture in the sequential culture media. MAIN OUTCOME MEASURE(S): Implantation and pregnancy rates, multiple gestation rate. RESULT(S): The implantation rate for embryos transferred at the blastocyst stage was significantly higher than that for embryos transferred on day 3 (26% vs. 13%). The viable pregnancy rate was similar in both groups (29% vs. 26%). Significantly fewer embryos were required for transfer at the blastocyst stage compared with day 3 embryo transfer (2.0 +/- 0.1 vs. 3.5 +/- 0.63). The high-order multiple gestation rate was significantly less with the blastocyst transfer than with the day 3 embryo transfer (4% vs. 19%). CONCLUSION(S): With the use of blastocyst culture, a few embryos can be transferred without decreasing the overall pregnancy rate. This may reduce multiple gestations and improve human IVF outcome.

Tuberculous spondylitis: analysis of 69 cases from Saudi Arabia.

DESIGN: Retrospective chart and radiographic review of all cases admitted to the authors' hospital and diagnosed to have tuberculous spondylitis. OBJECTIVE: To identify the frequency, presenting features, utility of diagnostic tests, and treatment outcome of spinal tuberculosis in a tertiary care center. METHODS: All cases of spinal tuberculosis treated in the authors' hospital over 14 years were reviewed. Only those with histologic or microbiologic confirmation or those who responded to antituberculous spondylitis therapy were included. Outcome was assessed according to predefined criteria. RESULTS: Between 1985 and 1998, 69 cases of tuberculous spondylitis were found, i.e., 5% of all tuberculous spondylitis cases diagnosed. The mean age was 52.8 years (range, 15-80 years), and 37 (53.6%) were male. Only five patients had a history of tuberculosis. The most frequent symptoms were backache (84%) and fever (32%), and the most frequent sign was spinal tenderness (45%). Nineteen (28%) patients had paraparesis and 12 (17%) had kyphosis. Except for elevated sedimentation rate (94.5%), the laboratory workup was not helpful. Both computed tomography and magnetic resonance imaging were found to be helpful in diagnosis, often with complementary information. Thirty-eight patients (55%) had thoracic spine involvement and 55 patients (80%) had paraspinal abscesses. Tissue aspirates had a yield of 70%, 35%, and 57% for granulomas, acid-fast bacilli smear, and culture, respectively. Medical therapy alone was given in 37 cases (54%), whereas 32 patients (46%) required additional surgical intervention, mainly those with spinal cord compression, spinal deformity, or risk of spinal instability. There was definite improvement in 63 cases (91%). The best outcome was in those patients presenting early before the occurrence of spinal deformity or neurologic symptoms. CONCLUSION: Tuberculous spondylitis is prevalent in the authors' hospital. Both computed tomography and magnetic resonance imaging are extremely helpful for diagnosis, and tissue aspirate is a good confirmatory method. A good outcome is expected if the diagnosis is made in early stages before the appearance of spinal deformity and neurologic symptoms. Surgical intervention can be avoided in these cases regardless of the presence or absence of paraspinal abscesses.

Tuberculosis in the belly: a review of forty-six cases involving the gastrointestinal tract and peritoneum.

BACKGROUND: Abdominal tuberculosis has varied presentation and can be confused with other conditions. METHODS: We report our experience with 46 patients. Charts of patients managed during 1984-97 were reviewed. RESULTS: Fifty-two percent were women and mean age was 46 years. Presenting symptoms were as follows: fever 70%; abdominal pain 70%; weight loss 68%; abdominal swelling 67%; change in bowel habit 39%; anorexia 30%; and sweating 30%. Common physical signs were as follows: fever 73%; ascites 61%; abdominal mass 13%; and doughy abdomen 9%. Thirty percent of patients either gave past history of TB or presented with active TB of other sites. TB skin test was positive in only 27% of patients. CT scans of abdomen were abnormal in 80%, showing ascites, peritoneal lesions or enlarged nodes. Ascitic fluid was diagnostic for TB on smear/culture in 33%. Peritoneal biopsy was performed by laparoscopy or laparotomy in 61%. It was positive for ganulomas in 97% and for smear/culture in 68%. Forty-two patients recovered after receiving anti-TB therapy for 9-12 months. Four patients died. One died within 1 month of initiation of therapy due to extensive TB, and death in the other 3 was due to unrelated causes. CONCLUSION: Abdominal TB should be suspected in patients with fever, abdominal pain and ascites. This condition carries good prognosis if promptly diagnosed and treated.

Cross-protection studies with vaccine strain H-120 of infectious bronchitis virus using ciliary activity.

Forty 3-day-old chickens were immunized intratracheally and another 40 intranasally-intraocularly with vaccine strain H-120 of infectious bronchitis virus (IBV). The chickens were divided into groups of five and each group was challenged intratracheally or intranasally-intraocularly with one of 8 different heterologous strains of IBV 4 weeks after vaccination. The vaccinated chickens were protected against challenge with three heterologous strains (Massachusetts M41, B and AEG), showing 89, 86 and 89% ciliary activity, respectively, but were not protected against challenge with strains D-3896 and D-3128. Clinical signs and/or a reduction in ciliary activity was observed neither for the vaccinated nor for the unvaccinated groups challenged with strains Sz, D-207 and D-212. This suggests that these isolates have no primary pathogenic role in broiler flocks. The remaining 5 strains (M41, B, AEG, D-3896 and D-3128) caused mild respiratory signs and ciliostasis in birds of the unvaccinated groups.