Ovarian dysgerminoma in an adolescent: a case report.

INTRODUCTION: Ovarian cancer is the second most frequent gynaecological cancer in Nigeria ranking next after carcinoma of the cervix. It has the highest case-fatality rate worldwide because of insidious onset, lack of effective screening methods and late presentation. This case of a sixteen-year old girl with a three-week history of abdominal pain which was later accompanied by abdominal swelling is a classic example of how dysgerminomas present. METHOD: The presumptive diagnosis of an ovarian tumour was made after physical examination and this was later confirmed by ultrasound scan. Urgent laparotomy was carried out based on a suspicion of torsion of the pedicle of the cyst. RESULT: At laparotomy, torsion of the pedicle with an intact capsule and imminent gangrene were found. The histology report revealed a malignant germ cell neoplasm (Dysgerminoma) with focal areas of necrosis without infiltration of the attached omentum. CONCLUSION: She had conservative surgery (left oophorectomy) done. She, however, defaulted from further follow-up.

Discontinuation pattern among IUCD users at the family planning clinic, University College Hospital, Ibadan.

Despite the high popularity of the intrauterine contraceptive device (IUCD) among family planning clients at University College Hospital, Ibadan, some users discontinued its use for a variety of reasons. This study was to determine the discontinuation rate among IUCD users at UCH, Ibadan. It was a 5-year retrospective analytical study. The records of patients using an IUCD seen at the Family Planning Clinic between 1 January, 1998 and 31 December, 2003 were analysed. A total of 867 clients were seen during the study period; 258(29.8%) clients discontinued within 5 years with the highest rate at 1 year 10.1% and least after 5 years 2.8%. The most common reason for discontinuation was the desire for pregnancy (57.0%). Other reasons included: side-effects (28.3%), husband's views (7.0%) and the menopause (8.0%). The reason for discontinuation varied significantly with the age of the clients (92.5% of clients that discontinued were less than 35 years), educational status, husband coercion, number of living children and religion. The discontinuation rate for the IUCD is high inspite of the high initial acceptability of the method in Nigeria. In a country experiencing a very rapid population growth where the prevalence of contraceptive use hardly attains double figures, it is imperative that policy makers double their efforts at ensuring an appreciable continuation rate of contraceptive use in general and IUCD in particular, among Nigerian women.

Ruptured uterus in a primigravida: a case report.

Maternal mortality and morbidity have remained very high in the developing countries and one of its commonest causes is ruptured uterus, which in a primigravida is rather unusual. The patient reported was a primigravida with no previous uterine scar who had prenatal care and delivery of a live male infant at a private clinic in Ibadan. The identifiable aetiological factors in this case are pitocin augmentation and manual removal of the placenta. Fortunately, a timely exploratory laparatomy averted another mortality. This is not usually the case in the majority of high-risk patients labouring outside a proper hospital setting consequent upon a declining economy and the rising influence of religion. Methods to reduce this obstetric catastrophy are discussed.

Surgical management of tuberculum sellae meningioma in a patient with a twin pregnancy: case report.

BACKGROUND: Meningioma in twin pregnancy is rare. The tumor has an accelerated growth during the pregnancy and may enlarge or become symptomatic during this period. This relationship makes management of patients with this tumor quite challenging. CASE DESCRIPTION: We describe a case of a rapidly deteriorating 35-year-old woman harboring an extensive tuberculum sellae meningioma who underwent craniotomy during the 24th week of pregnancy because of rapid deterioration. The surgical procedure and postoperative period were relatively uneventful. CONCLUSION: To the best of our knowledge, this is the first reported case of surgical management of a meningioma in a patient carrying a twin pregnancy (one missed abortus). When indicated, craniotomy is a safe and effective treatment option for huge frontobasal tumors during the second trimester of pregnancy.

Sexuality, contraceptive choice and AIDS awareness among Nigerian undergraduates.

A survey of 2388 Nigerian undergraduates revealed that 87% were sexually active and 66% had more than one sexual partner, while 17.5% have had clandestine abortions. All respondents were quite knowledgeable about HIV/AIDS but few sexually active ones took precautions to prevent HIV transmission. Majority (87.5%) were knowledgeable about contraception and approved of its use, but only 34.2% were current users of contraceptives. About 58% of these cited pharmacy shops as their source of contraceptives. The attitudes of the students were below expectation. Specially designated centres for the provision of appropriate contraceptive services to students by trained personnel are needed in the institutions in order to tackle their reproductive health problems.

Adolescent contraception: survey of attitudes and practice of health professionals.

In Nigeria, there is a persistent reluctance to provide adolescents with contraceptives and this is based largely on the premise that the culture does not support pre-marital sexual activity. However, several studies have revealed that a large number of adolescents are experiencing early sexual debut, some as early as 13 years. Furthermore, mortality resulting from termination of unwanted pregnancies is on the increase among Nigerian adolescents. The aim of this study is to assess the attitudes and practice of health workers in Ibadan regarding adolescent contraception. A structured questionnaire was administered to 735 health workers in selected hospitals and health facilities in Ibadan, Nigeria. Information relating to their practice and attitudes towards adolescent contraception was sought. The results revealed that while 58.9% of the respondents had counselled adolescents, only 30.7% had ever prescribed contraceptives for them. Among health workers that approved of family planning, 52.6% were favourably disposed to adolescent contraception while 23.9% were not. We observed that 40.2% of health workers that did not approve of family planning are not favourably disposed to adolescent contraception. Health workers who counsel adolescents on the use of contraceptives are more likely than those who do not to approve of its use. In addition, those who approve of family planning are 12 times more than those who do not, to have a favourable disposition to adolescent contraception. Perhaps, if providers are more receptive to adolescent contraception, the services will be more accessible to those who are sexually active. This will, no doubt, stem the incidence of unwanted pregnancies in our community.