Biological effects of distension media in bipolar versus monopolar resectoscopic myomectomy: a randomized trial.

AIM: To estimate the effect of 0.9% saline during bipolar resectoscopy and 1.5% glycine during monopolar resectoscopy on hemodynamic, biochemical and hematological parameters. MATERIAL & METHODS: A prospective randomized study in a tertiary care university hospital and comprising of 155 patients scheduled for hysteroscopic myomectomy. They were subjected to bipolar resectoscopic myomectomy utilizing 0.9% saline in group A, and monopolar resectoscopic myomectomy utilizing 1.5% glycine in group B. Perioperative measurements of hemodynamic, hematological, and biochemical changes in all cases were reported. Likewise, intrauterine pressure throughout the different procedures was recorded. MAIN OUTCOME MEASURES: intraoperative difference with regards to fluid volume and subsequent systemic changes specially osmolarity. RESULTS: A significant increase of central venous pressure, end diastolic volume, end diastolic index, stroke volume, stroke index, cardiac output, cardiac index, postoperative prothrombin time and postoperative partial thromboplastin time in both groups with positive correlations between the absorbed fluid volume and these measurements in both groups. Moreover, there was a significant decrease in systemic vascular resistance, postoperative hemoglobin concentration, postoperative hematocrit value ratio, postoperative platelet count and postoperative prothrombin concentration in both groups and there were negative correlations between the absorptive fluid volume and these measurements in both groups. There were significant decrease in serum sodium concentration and postoperative serum osmolarity in glycine group (B) with negative correlations between the absorptive fluid volume and both serum sodium concentration and serum osmolarity in glycine group (B). CONCLUSIONS: The use of bipolar resectoscope utilizing 0.9% saline as a distention media is not associated with hyponatremia or hyposmolarity unlike monopolar resectoscope utilizing 1.5% glycine distending media in cases with submucous myoma of considerable size.

Lathyrism in rural northwestern Ethiopia: a highly prevalent neurotoxic disorder.

Lathyrism is a disorder of the central motor system, induced by heavy consumption of the grass-pea, Lathyrus sativus an environmentally tolerant legume containing the neurotoxic excitatory amino acid beta-N-oxalylamino-L-alanine (BOAA). A complete door-to-door resurvey of the Dembia and Fogera regions of northwestern Ethiopia, areas endemic for lathyrism, revealed an estimated mean disease prevalence of 0.6%-2.9%. Most patients developed the disease in the epidemic of 1976/77, although new cases appear to have occurred with an estimated mean annual incidence of 1.7:10,000. Production and consumption of grass-pea is increasing in Ethiopia, making attempts to develop low-BOAA strains to prevent lathyrism increasingly important.

Spontaneous reduction in Schistosoma mansoni infection in endemic communities of the lake Tana basin, north-western Ethiopia.

The prevalence and intensity of Schistosoma mansoni infections were studied in 3 endemic communities in north-western Ethiopia using the Kato-Katz stool examination technique to determine changes in the epidemiology of schistosomiasis in the absence of control programmes. The prevalence declined in Chwahit community by 21.6%, and in the villages of Jenda and Guramba by 43.2 and 100% respectively in the course of 15 years. This spontaneous reduction in schistosomiasis is perhaps the result of recurrent drought in the area. This finding has implications for public health programmes in the area and intervention measures against schistosomiasis.

An appraisal of the epidemiologic situation of onchocerciasis in Ethiopia.

The existence of onchocerciasis in Ethiopia has been known since 1939 as a result of investigation by Italians in south-western Ethiopia. In the last fifty years onchocerciasis has been spreading to previously non-endemic regions of Ethiopia. Although comprehensive epidemiological surveys are lacking, it is estimated that 7.3 million people or 17.4% of the population of Ethiopia is at risk from this disease. The principal vectors are S. damnosum complex and S. woodi ethiopiense. The clinical picture is mainly dermal and ocular manifestations are rare. In view of agricultural development projects and resettlement of millions of people from the highlands into endemic areas in southern and north-western parts of Ethiopia, further spread of onchocerciasis is expected. Experience gained in the control of the disease in west Africa by WHO and the introduction of effective mass chemotherapeutic agents as well as primary health care programmes and activities currently underway in Ethiopia indicate the feasibility of starting control programmes. A plea is therefore made to consider the control of onchocerciasis in Ethiopia urgently.

Haematocrit levels and anaemia in Ethiopian children.

The paucity of data on the haematological profile of Ethiopian children prompted this survey. In October and November, 1987, a survey of haematocrit levels utilizing capillary blood and morphological studies on blood films by means of the Wright stain was conducted in the peri-urban community of Koladiba in Northwestern Ethiopia. All but 21 children (0.5-6 years) in the community participated. The mean and median haematocrit levels in children 0.5-6 years was 38% each with a range of 26-52%. Lowest haematocrit was found between 1-2 years of age. The 3rd and 97th percentile values were 31-45% and identical with the mean +/- 2 S.D. values. On a third of the children (251), blood film studies were done and 20% had microcytic hypochromic red blood cells. When an altitude corrected cut-off point of 38% was employed to define anaemia, the prevalence rate was 47.2%, the highest rate (60%) in children 1-2 years. However, use of a cut-off point based on the third percentile or +/- 2 SD (31%), resulted in an underestimation of anaemia rates by 40%. The findings of this study are consistent with previous reports on anaemia rates and haematocrit levels in Ethiopian children residing in a similar environment. Although the iron content of the Ethiopian diet is one of the highest in the world, nutritional anaemia is a public health problem. Intervention measures using iron supplementation and nutrition education through existing primary health care network are recommended.

Abortion at Gondar College Hospital, Ethiopia.

OBJECTIVE: To review the pattern and magnitude of abortion in order to establish baseline facts and data for future studies. DESIGN: A descriptive cross-sectional study. SETTING: Gondar College of Medical Sciences Hospital, Gondar, Ethiopia. RESULTS: Most of the subjects originated from the Gondar city and were married housewives, parous and relatively young. The abortion rate and ratio per 100 pregnancies and deliveries were 11.5 and 16.4, respectively. Only 13.4% of the patients admitted history of interference with the pregnancy. Previous history of abortion was obtained in 10.6% of the patients. The mean gestational ages for septic and non-septic cases were 14.6 and 15.2 weeks, respectively even though pregnancies less than 12 weeks from the last normal menstrual period accounted for 50.5%. The commonly diagnosed clinical type was incomplete, followed by inevitable and threatened abortion. The vast majority of the clinical conditions were non-septic (85.1 %) and spontaneous(85.6 %). The most common complications registered were anaemia, genital tract infection, shock of various causes and soft tissue injury. Four mothers died of abortion-related complications. The mean hospital stays for non-septic and septic abortion were three and five days, respectively. CONCLUSION: The study has attempted to address the issue of abortion in its general clinical pattern in relation to the various parameters. Being comprehensive, it also provides awareness and sensitivity on the magnitude of abortion and is assumed quite helpful for policy and decision makers.

The morphology of O. volvulus microfilaria in the northwestern onchocerciasis endemic foci, Ethiopia.

Microfilariae obtained by corneoscleral biopsy machines from persons in the Humera area along the Sudan boarder in Northwestern Ethiopia were stained using hematoxylin. Morphological measurements were made using a microscope fitted with micrometer and camera, as well as map curvimeter. The mean size of microfilariae was 189 microns by 5.8 microns. The percentage of nucleifree cephalic space as percent of total body length was 3.4 and is close to reports in the literature. The measurement of the distance of the anterior end nerve ring as a percent of the total body length (22.1%) is also close to measurements obtained elsewhere. Although the microfilaria encountered in this study are of the short variety, morphological measurements and the absence of sheath suggests that the microfilaria observed belong to O. volvulus.

Gene frequency and type of colour blindness in Ethiopians.

All 954 boys and 1064 girls attending two schools in north-western Ethiopia were tested in February 1988 for colour blindness using the Ishihara plates. A total of 40 colour blinds (4.2%) were found among males and 2 (0.2%) among females. There were 31 (3.2%) deutans and 9 (0.9%) protans among males. Both female colour blinds were deutans. This study confirms a previous observation on the gene frequency of colour blindness in this population. For the first time it also provides information on the frequency of this polymorphism in female Ethiopians, as well as types of red-green defects.

[Challenges in building a surgical obesity center]. / Herausforderungen beim Aufbau eines operativen Adipositaszentrums.

BACKGROUND: It is estimated that approximately 1 million adults in Germany suffer from grade III obesity. The aim of this article is to describe the challenges faced when constructing an operative obesity center. METHODS: The inflow of patients as well as personnel and infrastructure of the interdisciplinary Diabetes and Obesity Center in Heidelberg were analyzed. The distribution of continuous data was described by mean values and standard deviation and analyzed using variance analysis. RESULTS: The interdisciplinary Diabetes and Obesity Center in Heidelberg was founded in 2006 and offers conservative therapeutic treatment and all currently available operative procedures. For every operative intervention carried out an average of 1.7 expert reports and 0.3 counter expertises were necessary. The time period from the initial presentation of patients in the department of surgery to an operation was on average 12.8 months (standard deviation SD ± 4.5 months). The 47 patients for whom remuneration for treatment was initially refused had an average body mass index (BMI) of 49.2 kg/m(2) and of these 39 had at least the necessity for treatment of a comorbidity. Of the 45 patients for whom the reason for the refusal of treatment costs was given as a lack of conservative treatment, 30 had undertaken a medically supervised attempt at losing weight over at least 6 months. Additionally, 19 of these patients could document participation in a course at a rehabilitation center, a Xenical® or Reduktil® therapy or had undertaken the Optifast® program. For the 20 patients who supposedly lacked a psychosomatic evaluation, an adequate psychosomatic evaluation was carried out in all cases. CONCLUSIONS: The establishment of an operative obesity center can last for several years. A essential prerequisite for success seems to be the constructive and targeted cooperation with the health insurance companies.