Management of Intrauterine Device Migrated into the Bladder: A Case Report and Literature Review.

Intrauterine device represents the most reversible method of contraceptive worldwide. Its insertion is a medical procedure not free from complication. We report a rare case of intravesical migration of a copper intrauterine device inserted 18 months earlier in a 28-year-old multiparous woman. The patient presented with irritative lower urinary tract symptoms, and she was managed endoscopically. This case underscores the role of cystoscopy in irritative lower urinary tract symptoms post IUD insertion.

Management of recurrent vault prolapse.

In the ageing female population, recurrent vaginal vault prolapse is a significant healthcare burden. There is limited evidence regarding the optimal management strategy for recurrent vault prolapse. This paper aims to discuss treatment modalities available for recurrent vault prolapse. A literature search and analysis was performed using Medline, PubMed, Cochrane database, current texts and references from relevant articles. We found inconclusive evidence supporting conservative, mechanical and some surgical options for treating recurrent vault prolapse; including iliococcygeal fixation, McCall culdoplasty, and infracoccygeal sacropexy. Sacrospinous ligament fixation (SSLF), sacrocolpopexy, mesh implants and colpocleisis are shown to have good outcomes in Level II studies. Nevertheless, the first two are associated with haemorrhage, dyspareunia and scarring whilst colpocleisis is limited to selected patients. More well-designed studies are required for recurrent vault prolapse. Current evidence suggests SSLF, and sacrocolpopexy are alternative surgical options to colpocleisis in treating recurrent vault prolapse. Randomised trials are required to determine the efficacy and safety of trocar-guided mesh kits.

Risk factors for placenta praevia in southern Nigeria.

OBJECTIVE: To determine the risk factors for placenta praevia in Ile-Ife, southern Nigeria. DESIGN: A prospective case control study. SETTING: A tertiary center--Obafemi Awolowo University Teaching Hospital, Ile-Ife, southern Nigeria. SUBJECTS: One hundred and thirty six patients with confirmed placenta praevia constituted the cases. Controls consisted of one hundred and thirty six patients who delivered at term immediately after each indexed case and did not have placenta praevia. RESULTS: Cases and controls were similar in terms of twin deliveries (P = 0.72) and past history of uterine surgery (P = 0.47). After adjusting for confounders, factors associated with risk of placenta praevia were history of retained placenta [OR = 6.7(95% CI 1.2-36.6)], previous caesarean section [OR = 4.7, (95% CI 1.9-11.4)], previous abortion [OR = 2.9 (95% CI 1.1-5.1)], grand multiparity [OR = 2.1 (95% CI 1.6-7.1)] and age over 35 years [OR = 1.4 (95% CI 1.2-6.6)]. CONCLUSIONS: From our study, the risk factors for placenta praevia are a history of retained placenta, previous caesarean section, previous abortion, grand multiparity and maternal age over 35 years.

Early jejunal nutrition and changes in the immunological parameters of patients with acute pancreatitis.

BACKGROUND/AIMS: We have compared the effects of glutamine-rich Stresson Multi Fibre and of Nutrison Fibre nutrients on the changes of some immunological parameters of 16 patients with acute pancreatitis. Laboratory parameters included: total protein, albumin, prealbumin, retinol binding protein, IgG, IgA, IgM, IgE, complement components: C3, C4, acute phase proteins: C-reactive protein, transferrin, CD-markers of peripheral lymphocytes and activity of peripheral phagocytes. METHODOLOGY: Nine patients were supplied with Stresson Multi Fibre and 7 patients with Nutrison Fibre, using a nasojejunal tube. The levels of serum proteins were measured with laser nephelometry, the CD markers of lymphocytes with flow cytometry and the phagocytic activity with chemiluminescence. RESULTS: The treatment with glutamine-rich Stresson resulted in significant elevations in the serum levels of IgG, retinol binding protein, compared to the effects of Nutrison Fibre. In addition, the recovery of treated patients was significantly shorter in the Stresson Multi Fibre group than in the Nutrison Fibre group. CONCLUSIONS: The Stresson Multi Fibre nutrient treatment of patients treated for acute pancreatitis seems to have clinical benefit based upon the fast recovery of IgG, IgM proteins which take part in the immunological defense mechanisms.

[Stomato-oncological screening examinations: possibilities for early diagnosis] / Stomato-onkológiai szûrôvizsgálatok: a korai diagnosis lehetôségei.

The dramatic increase in the mortality of lip- and oral cancers in Hungary in the last decades points to the importance of primary and secondary prevention. Stomato-oncological screening examinations belong to the latter category, and might represent useful tools in the early diagnosis and treatment of oral carcinomas and precancerous lesions. The aim of the paper is to review the methods, results and effectivity of stomato-oncological screening examinations in Hungary. Between 1962 and 2000 nine screening examinations were performed: one on a population sample, one in an industrial setting, four connected to X-ray lung-screening examinations (one with the help of a mobile unit), one on voluntary persons, one on high risk people (homeless), one in general medical practice. Among these, in the last five years, in the course of the stomato-oncological examination of 17325 individuals, oral carcinoma has been found in 0.12%, and oral precanceroses in 2.63%. Although the general dentist is obliged by law to perform a stomato-oncological examination on the patients appearing in the practice, unfortunately, about 50-to-90% of the population does not visit a dentist regularly. The regular examination of these - high risk - groups by the help of the above methods, including the help of general medical practitioners is highly recommended.

Undiagnosed breech in Zaria, Nigeria.

There is no certainty about the best way of dealing with a breech presentation first diagnosed in labour. In our unit, the decision to allow a trial of vaginal delivery rested on the clinical assessment of the size of the baby and the maternal pelvis, and the progress of labour. We compared the outcome of 32 cases where a breech presentation was first diagnosed in labour with 65 women where the malpresentation was diagnosed antenatally where a full assessment including ultrasound and radiological pelvimetry could be made. There was no significant difference in the mode of delivery and fetal outcome. We continue to favour careful case selection for vaginal delivery even where the breech is first diagnosed in labour.

Cervical cancer--a neglected health tragedy.

This is a review of the problems of cervical cancer in Nigeria, typified by data from a tertiary hospital over a 9-year period. Of 146 cases of cervical cancer studied, 79% presented in advanced stages, peak age incidence was between 40 and 70 years, mean 54.5 +/- 12.4 (SD) years. Squamous cell carcinoma was predominant (97% of cases). Presentation was typical: mainly abnormal vaginal bleeding, vaginal discharge and postmenopausal bleeding. Low socioeconomic status (90%) and high parity (83%) were prominent features. Treatment and outcome were poor because of late presentation, lack of radiotherapy facilities and inadequate surgical procedures. Comparison with previous Nigerian studies reveal a continued lack of improvement over the years as regards preventative strategies and adequate treatment facilities. Suggestions on cervical cancer control measures for developing countries like Nigeria are given.

Puerperal sepsis: a preventable post-partum complication.

Patients with puerperal sepsis following delivery at Ife State Hospital (ISH) of Obafemi Awolowo University Teaching Hospitals Complex (OAUTHC) Ile-Ife over a 10-year period spanning January 1986 to December 1995 were reviewed. One hundred and forty-six patients were diagnosed as having puerperal sepsis and there were 8428 deliveries giving an incidence of 1.7%. The incidence was higher among the unbooked patients 71.2%. Predisposing factors were: anaemia in pregnancy, 69.2%; prolonged labour (labour lasting up to 12 h or more), 65.7%; frequent vaginal examinations in labour (more than five), 50.7%; premature rupture of membranes, 31.5%; and non-adherence to asepsis during delivery. The case mortality rate was 4.1%. Antenatal care and supervised hospital delivery should be encouraged in order to prevent or reduce this serious post-partum morbidity.

PIP: This study of 146 consecutive cases of postpartum genital tract sepsis was undertaken to determine the characteristics and outcome of patients with puerperal sepsis. Included in the study were patients with puerperal sepsis admitted into Ife State Hospital of Obafemi Awolowo University Teaching Hospital Complex in Nigeria during the period of January 1986 to December 1995. Findings revealed that 1.7% out of 8428 deliveries were diagnosed as having puerperal sepsis. The incidence was higher among unbooked patients (71.2%). Predisposing factors of puerperal sepsis include anemia in pregnancy; prolonged labor (labor lasting up to 12 hours or more); frequent vaginal examination during labor (more than 5 times); premature rupture of membranes; and nonadherence to asepsis during delivery. In addition, the mortality rate was 4.1%. Thus, antenatal care and supervised hospital delivery should be encouraged in order to prevent or reduce the seriousness of postpartum morbidity.

Knowledge and use of emergency contraception amongst Nigerian undergraduates.

Randomly selected Nigerian female undergraduates were surveyed to determine their knowledge and use of emergency contraception. The majority of the students were nullipara (96%) and single (92%). Although awareness of the existence of emergency contraception was high (84%), only 31% of the respondents were correctly aware of the time limit for using emergency contraception. There is need to educate all women including the general population about emergency contraception and the correct timing of its use.