Serial urinary and cervical cytological studies in women undergoing renal transplantation.

Cervical dysplasia has been reported to occur more frequently in female renal transplant patients. The incidence of pre-existing dysplasia is unknown. A prospective study of several urinary and cervical cytological screenings of 50 transplant patients was undertaken. Two of 38 patients studied before transplantation had pre-existing dysplasia. No new cases of dysplasia were found during the study (mean surveillance 3 years). A high incidence of urinary viral infection was found, but a relation to cervical dysplasia was not noted. The frequency of cervical abnormalities previously reported might have been due to different immunosuppressive regimes or to failure to exclude pre-existing disease. Despite the low incidence of abnormalities the use of cytological screening provided valuable reassurance to our patients, and its use is recommended.

Uterine perforation by a Copper 7 intrauterine contraceptive device with subsequent penetration of the appendix. Case report.

PIP: This case is presented of a 24-year old woman who came to an antenatal booking clinic following a 17-week period of amenorrhea and 10 months after her last pregnancy. A Copper 7 IUD had been inserted 8 weeks after the birth of her last child. Follow up visits after IUD insertion had shown no problems but an unplanned pregnancy followed and there was no evidence of an IUD within the uterus. When the infant was born no IUD was found although the uterine cavity was not explored. At laparoscopy the IUD was found to be embedded in omentum and apparently lying adjacent to the appendix but at laparotomy was seen to have penetrated the appendix wall. The appendix, IUD, and adherent omentum were removed and no site of uterine perforation was identified. Reported incidence of uterine perforation with IUDs varies from 1/350 to 1/2500 insertions. Copper containing devices are more often embedded in omentum than plastic devices and thus require laparotomy for removal. Intraperitoneal IUDs do not necessarily produce symptoms but may intrude on neighboring viscera such as the bladder or intestinal tract. Copper containing IUDs are known to cause irritation and although translocation may have occured at the time of insertion, appendiceal penetration was almost certainly a later event.^ieng

The influence of suture material on vaginal vault granulations following abdominal hysterectomy.

A questionnaire was circulated to 1147 members (consultant status) and fellows of the Royal College of Obstetricians and Gynaecologists to survey the current management of the vaginal vault following abdominal hysterectomy. Of the 56% who responded, the majority (87%) routinely close the vault. An interrupted mattress suture is used by 60%, a continuous suture by 43% and the Lembert suture by 2%. Chromic catgut is favoured by 60%, a synthetic polymer by 33% and plain catgut by 6%. We then organized a prospective, randomized trial involving 114 women who underwent total abdominal hysterectomy for benign indications. No. 1 polygalactide (Vicryl) was used in 58 women, and No. 1 chromic catgut in 56. Overall, 37 (32%) had vault granulations 6 weeks post-operatively. Chromic catgut had been used in 25 (68%) and polygalactide in the remaining 12 (32%) (P = 0.01). Only 2 (5%) of these women denied any symptoms, while the rest complained of vaginal discharge, bleeding or both. Neither the patients' age, weight or parity, nor the status of the surgeon influenced the occurrence of granulations. We conclude that the widespread use of chromic catgut revealed by our survey is unacceptable: polygalactide, a synthetic polymer, is associated with fewer vaginal vault granulations than chromic catgut.