Contraceptive efficacy of intrauterine devices.

To compare the contraceptive efficacy of various types of intrauterine devices (IUD; copper devices, Nova-T, intrauterine contraceptive systems, levonorgestrel-releasing devices), we reviewed all relevant publications on this subject that have been published over the last 2 decades. The first point to be highlighted by this review is the excellent effectiveness of IUDs, with a global cumulative pregnancy rate <2% at 5 years, whatever the type of device used. We observed a large variation in efficacy rate according to the type of IUD and also according to study design. Nevertheless, of all the types of IUDs, the levonorgestrel-releasing IUD and to a lesser extent the TCu380A IUD seem to be the most effective, with a cumulative pregnancy rate at 5 years of <0.5% for the levonorgestrel-releasing IUD and between 0.3% and 0.6% for the TCu380A IUD.

Polyorchidism: presentation of 2 cases, review of the literature and a new management strategy.

OBJECTIVES: To present 2 cases with polyorchidism, to review the literature about polyorchidism, and to propose a rational therapeutic algorithm. METHODS: In our institution, we encountered 2 patients with polyorchidism: The 1st patient had bilateral double testis with testicular torsion, and the 2nd patient presented with an indolent scrotal mass. We also performed a literature search (PubMed) for other reports of polyorchidism. RESULTS: Polyorchidism is a rare congenital anomaly that is not well known by most urologists. So far, as illustrated by our 2 cases, the management of polyorchidism is rarely conservative, and usually the supernumerary testis is removed without any evidence supporting this attitude. Rare cases are complicated by torsion (case 1), cryptorchidism, or testicular neoplasm. In case of torsion, the conservative approach depends on the viability of the twisted testis. In case of cryptorchidism, notably in children or young adults, conservative management should be proposed, if technically feasible. In case of signs of malignancy, orchiectomy must be performed. CONCLUSIONS: Conservative treatment is advised in all uncomplicated cases. Complicated cases need a careful management, but several situations can be managed conservatively. Based on the literature, we propose a simple, rational therapeutic algorithm.

Ectopic pregnancy in Africa: a population-based study.

OBJECTIVE: To estimate the incidence of ectopic pregnancy in Yaounde, the capital of Cameroon (Central Africa). METHODS: In 2000, all women admitted for an ectopic pregnancy to health facilities in the city of Yaounde were systematically enrolled. Sociodemographic information on the women and their reproductive history was collected by questionnaire during a face-to-face interview. Medical and obstetrical data (clinical findings at hospital entry, medical history, type of surgery, and final vital status) were collected from gynecologic and surgical files and admission registers. RESULTS: We recorded 320 cases of ectopic pregnancy in health facilities in the city of Yaounde and we estimated that 40100 live births occurred during the same study period (January to December 2000). The population-based incidence rate of ectopic pregnancy in the city of Yaounde was 0.79% (95% confidence interval 0.72%, 0.88%) in 2000. Three maternal deaths were recorded giving a mortality rate of 0.94% (95% confidence interval 0.32%, 2.72%). CONCLUSION: The 0.79% ectopic pregnancy incidence rate observed in this African country must be considered a minimum due to probable underestimation. Nevertheless, this rate is lower than that currently observed in industrialized countries. Late diagnosis, low percentage of conservative treatment, and subsequent maternal deaths are important findings that should encourage African gynecologists to promote ectopic pregnancy prevention programs and to improve the care given to women with ectopic pregnancy. LEVEL OF EVIDENCE: III

Distribution of causes of maternal mortality during delivery and post-partum: results of an African multicentre hospital-based study.

OBJECTIVE: To assess the maternal mortality ratio in maternity units of reference hospitals in large west African cities, and to describe the distribution of complications and causes of maternal deaths. STUDY DESIGN: Prospective descriptive study in twelve reference maternities located in three African countries (Benin, Ivory Coast, Senegal). Data (clinical findings at hospital entry, medical history, complications, type of surgery, vital status of the women at discharge) were collected from obstetrical and surgical files and from admission hospital registers. All cases of maternal deaths were systematically reviewed by African and European staff. RESULTS: Of a total of 10,515 women, 1495 presented a major obstetric complication with dystocia or inappropriate management of the labour phase as the leading cause. Eighty-five maternal deaths were reported, giving a global hospital-based maternal mortality ratio of 800/100,000. Hypertensive disorders were involved in 25/85 cases (29%) and post-partum haemorrhage in 13/85 cases (15%). Relatively few cases (14) of major sepsis were reported, leading to three maternal deaths. CONCLUSION: The results of this multicentre study confirm the high rates of maternal mortality in maternity units of reference hospitals in large African cities, and in addition to dystocia the contribution of hypertensive disorders and post-partum haemorrhage to maternal deaths.

Testicular cancer variations in time and space in Europe.

OBJECTIVES: Testicular cancer (TC) is the most common malignancy in young men. A review of all published articles on TC incidence revealed an increased incidence in Northern and Central Europe. We extended the analysis to the whole of Europe by using all data available, notably from registries. METHODS: We performed a PubMed search and selected articles dealing with TC incidence. We obtained additional information from data of European registries through the eight volumes of the Cancer Incidence in Five Continents, IARC Scientific Publications. RESULTS: Since the Second World War, TC incidence has been increasing in nearly all European countries. It has doubled in several countries, including France, since 1970. We observed that the increase followed a gradient: the highest rate is centred in Denmark and Germany, and decreases progressively in a centrifugal manner. CONCLUSIONS: TC incidence is increasing throughout Europe, but wide discrepancies exist between the different countries. The reasons for such a phenomenon are still unclear although environmental factors are strongly suspected, which could have an impact on male fertility. From a public health perspective, further research using cases collected through national and regional population-based registers and case-control studies must be strongly encouraged.