Ligation of internal iliac artery for severe obstetric and pelvic haemorrhage: 10 year experience with 11 cases in a university hospital.

Bilateral iliac artery ligation is an effective second-line procedure to control massive obstetric and gynaecological haemorrhage, it is life-saving in certain cases and has the advantage that it preserves fertility, which is particularly important in young women of low parity. Bilateral ligation of internal iliac arteries is a life-saving procedure in cases of massive obstetric haemorrhage. It has the advantage of preserving fertility compared with the commonly performed emergency obstetric hysterectomy. It has also proved effective in cases of secondary pelvic haemorrhage in gynaecological operations. We report here a case series of 11 women who had bilateral internal iliac artery ligation for severe pelvic haemorrhage in a period of 10 years in our department. Ten of them were obstetric cases and one was a case of haemorrhage following vaginal hysterectomy. The outcome was favourable in 10 out of the 11 cases and there was only one case of massive postpartum haemorrhage where the procedure failed and required an emergency hysterectomy.

Effect of depleted uranium weapons used in the Balkan war on the incidence of cervical intraepithelial neoplasia (CIN) and invasive cancer of the cervix in Greece.

OBJECTIVE: To compare the incidence rates of CIN and invasive cancer of the cervix in two district areas near the borders with the former Yugoslavia and an urban area away from these borders three years before and three years after the bombings in this country. MATERIAL: Two peripheral hospitals (in Kilkis and Serres) which are near the border with the former Yugoslavia and one University hospital (Hippocratio hospital of Thessaloniki) in a rural area away from the borders, where routine Papanicolaou smear tests for screening of CIN and invasive cancer of the cervix are performed in the general female population. METHODS: Hospital records were searched for abnormal smear test results. Incidence rates of CIN and invasive cancer of the cervix three years before (1997-1999) and three years after (2000-2002) the bombings were calculated and compared in the three different settings. The relation between the mean age of the first occurrence of an abnormal smear test was also examined. The results were examined using the chi-square test. RESULTS: The incidence of CIN in the three-year period 1997-1999 was 0.68% and 0.9% for the two district hospitals of Kilkis and Serres, respectively. These figures rose to 1.11% and 1.13% in the three-year period 2000-2002 for the two district hospitals. The incidence of CIN in the three-year period 1997-1999 was 1.06% for the Hippokrateion University Hospital of Thessaloniki and 0.88% for the three-year period 2000-2002. There has been a small but not statistically significant increase in the incidence rates of CIN in the two district areas near the borders with the former Yugoslavia over the last few years (p = 0.355 for Kilkis and p = 0.472 for Serres), compared with the small but statistically significant decrease in the incidence of CIN in the urban area of Thessaloniki (p = 0.0275). The rates of invasive cancer of the cervix diagnosed from the routine smear tests were too small to make any conclusions. CONCLUSION: The increase in the incidence of precancerous lesions of the cervix in areas near the borders with the former Yugoslavia during the last three years may be influenced by environmental factors such as exposure to depleted uranium due to the bombings of 1999. To comfirm this bigger epidemiological studies are needed.