Recurrent congenital hydrocephalus: two case reports and counseling highlights.

Familial hydrocephalus presents a very considerable morphological and etiological heterogenecity. It can be a manifestation of several autosomal dominant or recessive syndromes. The non-syndromal forms include autosomal X-linked or recessive types and these tend to be recurrent. We report for the first time in the literature on two families with recurrent congenital hydrocephalus each for the fourth time. The first showed evidence of X-linked recessive form, while the second was an autosomal recessive form. The objective of these reports is to highlight the need for proper counseling of such families.

The unconsummated marriage: causes and management.

OBJECTIVE: To describe the characteristics of a group of couples with unconsummated marriages and highlight the usual causes and factors for successful management. MATERIAL AND METHOD: Couples seen at King Khaled University Hospital, Riyadh, Saudi Arabia, between the years 1996 and 2001 with inability to consummate their marital relationship. RESULTS: A total of 36 couples were seen during the 5-year period. Vaginismus was the primary cause in 63.9% of the cases, erectile dysfunction in 11.2%, severe premature ejaculation in 8.3%, low male sexual desire in 2.7%, and low female sexual desire in 13.9%. A significant correlation was found between the age of the females and low sexual desire and a significant correlation between consanguinity and low sexual desire in the males. CONCLUSION: Dysfunction underlying non consummation of marriage is largely treatable. Adaptation to the situation usually occurs, and associated factors add to the primary cause. Treatment of the underlying dysfunction can challenge the relationship.

Obstetric handling of a deaf patient.

We report our experience of obstetric handling of a deaf pregnant patient antenatally, in labor and postpartum. The patient was deaf from childhood. The attending obstetrician had no training in the necessary skills for communication with the deaf. Fortunately, the patient could read and write English very well and communication was carried out through pen and paper. This proved to be difficult, time-consuming and required a lot of patience. The clinical, psychological and human aspects of the management were gratifying. The patient brought up interesting aspects that need to be considered when dealing with similar patients. Experience of deaf mothers and their ingenious approaches in dealing with babies, in the postpartum period, are quoted in this communication.

New trends in prenatal screening for chromosomal abnormalities.

In the recent years, the scope of prenatal genetic diagnosis has expanded greatly with the development of a number of new methods, such as maternal serum screening and ultrasound screening for detection of fetal abnormalities. These methods have the advantage of providing earlier diagnosis in addition to being non-invasive and of less psychological traumas. Pre-implantation genetic diagnosis is another new growing field offering the genetic diagnosis prior to implantation. The most promising of all is the first trimester biochemical screening in conjunction with ultrasound nuchal translucency screening.

Undiagnosed term breech: management and outcome.

OBJECTIVE: To assess the antenatal and intra-partum risk factors associated with undiagnosed breech at term and to compare their outcome with those diagnosed before the onset of labor, as well as identifying the determinants for cesarean section in breech presentation. METHODS: Case control study of 183 undiagnosed breech deliveries at term with those diagnosed before labor. RESULTS: There was no significant difference between diagnosed term breech and undiagnosed breech deliveries with regards to maternal, neonatal outcome and incidence of cesarean section. Footling breech presentation, hypertension and failure to attend antenatal visits were independent risk factor for cesarean section in all case of breech. CONCLUSION: Undiagnosed breech at term are not at increased risk for cesarean section and there is no additional maternal or fetal morbidity.

Vestibular anus presenting as a case of primary infertility: An unusual adult presentation.

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Spontaneous rupture of the urinary bladder: a late complication of radiotherapy--case report and review of the literature.

The spontaneous intraperitoneal rupture of the urinary bladder is an extremely rare life-threatening event. There are often difficulties in establishing the diagnosis. A patient with spontaneous perforation of the urinary bladder, 15 years after pelvic radiotherapy for carcinoma of the cervix is reported. Aspects of etiology, clinical presentation, diagnosis, and management are described. Special emphasis is placed on surgical management as it relates to long-term outcome.

Multiple pregnancy management: The King Khalid University Hospital experience.

This review analyzes the multiple pregnancies in King Khalid University Hospital (KKUH) from January 1985 to December 1989. Over this period, the incidence of multiple pregnancy was found to be 10.25/1000. The study confirms a higher incidence of complications among multiple pregnancy cases. For example, the cesarean section rate was 32.2% as compared with 3.6% for the single pregnancies, and the neonatal deaths occurred in a higher number (3.3%) as compared to 1.0% in the controls. However, even though the overall prematurity rate (

Fetal haemoglobin level--effect of gender, age and haemoglobin disorders.

Fetal haemoglobin (Hb F) levels shows significant variations in health and disease states. In this study we investigated Hb F level in 75 cord bloods, 1266 healthy individuals, 1582 Hb S heterozygotes, 464 sickle cell anaemia, 93 Hb S/beta(0) -thalassaemia and 65 beta-thalassemia major patients. The age range of the study groups varied from newborn to over 60 years of age. Hb F level was measured by an alkali denaturation procedure and by radial immunodiffusion. The ratio of the level of G gamma-globin chains to the level of A gamma-globin chains (G gamma/A gamma) was determined in the patients group by high performance liquid chromatography. The Hb F level was significantly higher in the sickle cell anaemia and beta-thalassemia major patients compared to the Hb S heterozygotes and the normal individuals. Within each group Hb F level was higher in the female population compared to the age-matched male groups. This difference was statistically significant (P < 0.05) in the sickle cell disease patients and beta-thalassemia major patients but not in the normal individuals. After the age of 30 years, the difference in the value of Hb F in the male and female population become more apparent (P < 0.05) in the sickle cell disease and beta-thalassaemia major patients. No statistically significant sex differences were found in the G gamma/A gamma ratio in the patient groups, and the range of G gamma/A gamma ratio in the patients groups were similar to those in the control group. The results showed that age, sex and genetic disorders of haemoglobin are factors that affect Hb F level and indicate the possible involvement of an X-linked factor in control of Hb F production.