Impact of intrauterine insemination as first line treatment of subfertility.

OBJECTIVE: To determine the success rate of intrauterine insemination (IUI) in couples presenting with subfertility following controlled ovarian hyperstimulation (COH) by the use of cost effective intrauterine catheter (insertion tube). METHODS: An experimental study was conducted at the Obstetric and Gynaecology Departments of Combined Military Hospital Kharian and PNS SHIFA Karachi in collaboration with the Department of Pathology from June 2002 to March 2005. A total of 89 couples were studied, out of which 28 couples presented with abnormal finding in the seminal fluid of husband whereas in 61 couples no identifiable cause could be detected. The mean age of women was 29 years and the duration of infertility was variable. All women had tubal patency confirmed before undergoing COH. IUI was performed at follicular maturity of 18-22 mm. Main outcome measures analyzed were pregnancy rate per cycle of IUI, miscarriage rate and ongoing pregnancy rate. Prognostic factors associated with successful outcome in IUI, such as maternal age and motile sperm count was also observed. For cost effective measures, we used the sterilized disposable insertion tube of the 'Copper-T 380 A' device for insemination of reated sperms into the uterine cavity. Chi-square test was applied to assess the effectiveness of IUI in relation with these variables. RESULTS: A total of 205 insemination cycles were performed resulting in achievement of pregnancy in 31 patients. Miscarriage occurred in 3 patients. Out of these 31 women who conceived, 21 (67.7%, p=0.003) were aged < 35 years with higher pregnancy rate per cycle (21 / 90 = 23.3%). CONCLUSION: Intrauterine insemination may be regarded as valuable procedure for couples presenting at younger age with lesser duration of infertility and unexplained subfertility.

Use of amnion in vaginoplasty for vaginal atresia.

A 25 years old lady with vaginal atresia, secondary to a mismanaged spontaneous vaginal delivery, underwent vaginoplasty using human amnion. The amnion was kept in its place using a 60cc syringe as a mould. For the next three months, dilatation by soft mould was followed by regular intercourse. Alongwith the restoration of normal coital function, she also conceived and was delivered by planned caesarean section at 38 weeks.

Primary non-Hodgkin's lymphoma of vagina associated with pregnancy.

We report a case of non-Hodgkin's lymphoma (NHL) in 23 years old, 36 weeks pregnant female, who presented with a swelling in the vagina. Biopsy of the lesion led to profuse haemorrhage and emergency caesarean-section along with bilateral ligation of internal iliac arteries were required. Recovery was smooth and she was discharged from the hospital on the 5th postoperative day. Histopathology revealed non-Hodgkin's lymphoma, diffuse large B cell type (DLBCL). Further treatment by medical oncologist led to complete resolution of the tumour at three months.

Two displaced intrauterine contraceptive devices (copper-T).

An unusual case of two displaced intrauterine contraceptive devices (copper-T) is described in a 34 years old lady. One copper-T was found in the urinary bladder with stone formation around it and the other embedded in the posterior wall of the urinary bladder. This was managed operatively and the patient made a smooth recovery.

Diagnosing Hirschsprung's disease: increasing the odds of a positive rectal biopsy result.

BACKGROUND/PURPOSE: Rectal biopsies are performed as a definitive means of diagnosing Hirschsprung's Disease (HD) in children presenting with constipation. The authors hypothesized that key features in the history, physical examination, and radiographic evaluation would allow us to avoid unnecessary rectal biopsies. METHODS: A retrospective analysis was conducted on patients undergoing rectal biopsy between 1995 and 2001. Patients with HD were identified (n = 50), and a concurrent cohort of patients with idiopathic constipation (IC; n = 50) was selected. Pertinent features in patients with HD versus those with IC were cross tabulated using Pearson Chi2 testing (significance was P <.05). RESULTS: Sixty percent of patients with HD and 15% of patients with IC experienced onset of symptoms in the first week of life. HD patients more frequently experienced delayed passage of meconium (P <.05), abdominal distension (P <.05), vomiting (P <.05), and transition zone on contrast enema (P <.05). All patients with HD had one or more of these significant features. In contrast, only 64% of patients with IC had one or more of these features. The classic triad of symptoms (ie, delayed passage of meconium, vomiting, and abdominal distension) was present in 18%, and one or more of these symptoms was present in 98% of HD patients. In contrast, only 60% of patients with IC had a history of delayed passage of meconium, vomiting, or abdominal distension. CONCLUSIONS: A history of delayed passage of meconium, abdominal distension, vomiting or the results of a contrast enema identified all patients with HD and excluded HD in approximately 36% of patients with idiopathic constipation. The authors have shown that key features in a patient's history, physical examination, and radiologic evaluation can differentiate between HD and IC. In a child presenting with constipation and none of the above features, it is not necessary to perform a rectal biopsy to exclude HD.