[Assessment of medical waste management in a Palestinian hospital].

We studied medical waste management in a Palestinian hospital in the West Bank and the role of municipality in this management. In general, "good management practices" were inadequate; there was insufficient separation between hazardous and non-hazardous wastes, an absence of necessary rules and regulations for the collection of wastes from the hospital wards and the on-site transport to a temporary storage location inside and outside the hospital and inadequate waste treatment and disposal of hospital wastes along with municipal garbage. Moreover, training of personnel was lacking and protective equipment and measures for staff were not available. No special landfills for hazardous wastes were found within the municipality.

Fever treatment and household wealth: the challenge posed for rolling out combination therapy for malaria.

OBJECTIVE: To investigate the variation in malaria parasitaemia, reported fever, care seeking, antimalarials obtained and household expenditure by socio-economic status (SES), and to assess the implications for ensuring equitable and appropriate use of antimalarial combination therapy. METHODS: A total of 2,500 households were surveyed in three rural districts in southern Tanzania in mid-2001. Blood samples and data on SES were collected from all households. Half the households completed a detailed questionnaire on care seeking and treatment costs. Households were categorised into SES thirds based on an index of household wealth derived using principal components analysis. RESULTS: Of individuals completing the detailed survey, 16% reported a fever episode in the previous 2 weeks. People from the better-off stratum were significantly less likely to be parasitaemic, and significantly more likely to obtain antimalarials than those in the middle or poor stratum. The better treatment obtained by the better off led them to spend two to three times more than the middle and poor third spent. This reflected greater use of non-governmental organisation (NGO) facilities, which were the most expensive source of care, and higher expenditure at NGO facilities and drug stores. CONCLUSION: The coverage of appropriate malaria treatment was low in all SES groups, but the two poorer groups were particularly disadvantaged. As countries switch to antimalarial combination therapy, distribution must be targeted to ensure that the poorest groups fully benefit from these new and highly effective medicines.

[Assessment of medical waste management in a Palestinian hospital]

We studied medical waste management in a Palestinian hospital in the West Bank and the role of municipality in this management. In general, "good management practices" were inadequate; there was insufficient separation between hazardous and non-hazardous wastes, an absence of necessary rules and regulations for the collection of wastes from the hospital wards and the on-site transport to a temporary storage location inside and outside the hospital and inadequate waste treatment and disposal of hospital wastes along with municipal garbage. Moreover, training of personnel was lacking and protective equipment and measures for staff were not available. No special landfills for hazardous wastes were found within the municipality

Artificial hormonal replacement cycles have no advantage over hyperstimulated cycles in a gamete intrafallopian transfer oocyte donation program.

OBJECTIVE: To evaluate if the previously reported increased implantation rates in hormonally replaced egg donation cycles relative to hyperstimulated IVF-ET cycles apply when GIFT is used. The increased implantation rates in the recipients have been attributed to the absence of the negative effects of hyperstimulation on endometrial receptivity. DESIGN: A prospective comparison of implantation rates in hyperstimulated and hormonally replaced cycles when GIFT was used in both the egg donors and their corresponding recipients. PATIENTS: Excess mature oocytes from 35 women undergoing GIFT after controlled ovarian hyperstimulation (COH) were transferred into the fallopian tubes of 35 hormonally replaced women. RESULTS: The male partners of all donors and recipients had normal semen parameters. The two groups did not differ significantly in the mean age, duration of infertility, and quality of eggs transferred. There was no statistically significant difference in the mean number of oocytes transferred per cycle between the donors and the recipients. The mean implantation rate per mature oocyte transferred was significantly higher in the donors (19.3%) than in the recipients (6.6%). CONCLUSION: Our results with GIFT show higher implantation rates in hyperstimulated cycles than in hormonally replaced cycles. These results differ from those reported in IVF-ET that suggest an adverse effect of COH on implantation rates.

Prolonged intake of chlorambucil for ovarian cancer.

The use of alkylating agents has been reported to be a cause of secondary leukemia particularly in patients surviving for 2 years or more after treatment of ovarian carcinoma. The risk of developing leukemia is possibly related to the duration of treatment and the total dose of alkylating agents administered. We report a patient with epithelial ovarian carcinoma who received chlorambucil for 130 consecutive months with no clinical or laboratory evidence of leukemia.

A pelvic retroperitoneal Schwannoma presenting as an adnexal mass.

Solitary nerve sheath tumors such as benign schwannomas arising in the pelvic retroperitoneum are infrequently reported. We report a case of a benign retroperitoneal pelvic schwannoma that presented with pelvic pain and an adnexal mass. Complete surgical excision was achieved only after transection of the S1 nerve root on the left side. The adjacent vascular and urinary channels sustained no injuries and the patient had minimal neurologic deficit.

Squamous cell carcinoma of the cervix implanting in the episiotomy site.

The implantation of cervical cancer in an episiotomy scar is very rare. We present such a case in a patient with stage IIIB squamous cell carcinoma of the cervix. The tumor implantation responded only partially to chemotherapy and radiotherapy. Review of the literature revealed six cases of cervical cancer implanting in the episiotomy site. All followed a normal vaginal delivery. Early initial stage, small-size implantation lesion, and early surgical intervention seemed to be good prognostic factors.

Non-Hodgkin's lymphoma presenting as a urethral caruncle.

Primary malignant lymphoma of the female urethra is a rare entity. Five cases of non-Hodgkin's lymphoma of the female urethra have been previously reported. We report another case presenting with a urethral caruncle. A review of the literature is included.

Effect of alpha-stat versus pH-stat strategy on oxyhemoglobin dissociation and whole-body oxygen consumption during hypothermic cardiopulmonary bypass.

To determine whether alpha-stat or pH-stat strategy should be used, 20 patients undergoing coronary artery bypass grafting during moderate hypothermic hemodilutional cardiopulmonary bypass were studied. The carbon dioxide management during bypass was randomly done according to alpha-stat strategy in 10 patients (i.e., temperature-uncorrected PaCO2 was kept near 40 mm Hg and uncorrected pHa was kept at about 7.4) and according to pH-stat strategy in the other 10 patients (i.e., temperature-corrected PaCO2 was kept near 40 mm Hg and uncorrected pHa was kept at about 7.4). In both groups, when the central venous temperature was stable at 26.5 +/- 2.5 degrees C, the perfusion flow was altered sequentially from 2.4 to 1.8 and 1.2 L.min-1.m-2. The mixed venous oxyhemoglobin saturation at the different perfusion flows was monitored by the Oxy-Stat meter and was correlated with the corresponding mixed venous oxygen tension to construct an oxyhemoglobin dissociation curve. Also, the whole-body oxygen consumption at the different perfusion flows was computed. The whole-body oxygen consumption and the oxyhemoglobin dissociation were not significantly different between the alpha-stat and the pH-stat groups. In both groups, the dissociation curve is shifted to the left, but the oxygen consumption per unit time does not significantly change despite decreasing the perfusion flow from 2.4 to 1.2 L.min-1.m-2. The results suggest that oxygen delivery is not impaired during moderate hypothermic cardiopulmonary bypass independent of whether alpha-stat or pH-stat strategy is used.