IUD String Perforation Through Anterior Cervix: A Case Report.

BACKGROUND: Intrauterine devices are increasingly the preferred method of contraception chosen by Canadian women. IUD strings are commonly not visible at follow-up, but rarely are visible yet not located within the endocervical canal. We report a case of IUD strings perforating the ectocervix. CASE: An asymptomatic, 26-year-old woman presented for removal of her levonorgestrel-releasing intrauterine system, over a year following insertion of the device. Upon examination the IUD strings were found to be emerging from within the cervical tissue, 10 mm above the external os. CONCLUSION: We discuss removal techniques, review the literature, and examine possible reasons for this presentation. These techniques may interest a range of practitioners managing contraceptive care for women.

Contexte : Les dispositifs intra-utérins constituent de plus en plus le mode de contraception privilégié par les Canadiennes. Les fils de DIU ne sont fréquemment pas visibles au moment du suivi; toutefois, lorsqu'ils sont visibles, il est rare que l'on ne soit pas en mesure de les localiser dans le canal endocervical. Nous signalons un cas de fils de DIU ayant perforé l'exocol. Cas : Une femme asymptomatique de 26 ans a sollicité nos services pour le retrait de son système intra-utérin à libération de lévonorgestrel, plus d'un an à la suite de l'insertion de ce dernier. Au moment de l'examen, nous avons constaté que les fils du DIU émergeaient du tissu cervical (10 mm au-dessus de l'orifice externe). Conclusion : Nous discutons des techniques de retrait, nous passons en revue la littérature et nous examinons les raisons possibles d'une telle présentation. Ces techniques pourraient intéresser un certain nombre de praticiens offrant des soins contraceptifs aux femmes.

Substantial variation of both opinions and practice regarding perioperative fluid resuscitation.

BACKGROUND: There are no current standards of care guiding perioperative fluid administration, and clinicians continue to debate restrictive versus liberal fluid administration. We sought to simultaneously evaluate the opinions and practice of surgeons, intensivists and anesthesiologists in a single centre regarding perioperative fluid resuscitation. METHODS: A postal survey sent to surgeons, intensivists and anesthesiologists in a single academic health care centre presented case-based scenarios followed by questions on fluid requirements and 5-point Likert scales involving statements about resuscitation. We performed a retrospective chart review to evaluate amount and type of intra-and postoperative (72-h) fluid administration, urine output and postoperative ventilation time in patients undergoing uncomplicated esophagectomy or pneumonectomy. RESULTS: Seventy-four of 77 respondents (96%) agreed that precise fluid resuscitation diminishes the risk of adverse events. Surgeons overall gave less fluids than anesthesiologists or intensivists and used fewer resuscitation end points to estimate fluid requirements perioperatively. For right hemicolectomies, only 3% of surgeons chose a fluid rate greater than 150 mL/h, compared with 55% of intensivists. We reviewed 49 patients' charts (25 who had pneumonectomies, 24 who had esophagectomies) retrospectively. The coefficient of variation (COV = standard deviation divided by its mean) of fluid administration intraoperatively was 0.56 for pneumonectomy and 0.35 for esophagectomy; postoperatively, the COV was greater than 0.50 for the first 24 hours, but less than 0.50 after 24 hours postoperatively. CONCLUSION: The presence of substantial variability of both opinion and practice of perioperative fluid resuscitation in a single centre supports the need for further research to identify objective methods to define perioperative fluid requirements and standards of perioperative resuscitation.