High Intensity Focused Ultrasound Treatment for Uterine Fibroid in a Nigerian Hospital: A Case Report and Review of Literature.

High intensity focused ultrasound (HIFU) is a non-invasive method of treating uterine fibroid that is based on the principle of using extracorporeal ultrasound to cause coagulative necrosis of uterine fibroid. While the technology has been used in other parts of the world, it is new in West Africa. The reported case was the first HIFU treatment of uterine fibroid in Nigeria. A 38-year-old woman was prepared for HIFU treatment of uterine fibroid. Abdomino-pelvic ultrasound scan, Magnetic Resonance Imaging (MRI) and pre-procedural bowel preparation were done. High intensity focused ultrasound (JC200) treatment was done under conscious sedation using average power of 400 Watts with total energy consumption of 278.0 Kilo Joules with total sonication time of 700 seconds. The patient was able to resume her daily activities one week post-HIFU procedure.

Ultrasons focalisés de haute intensité (HIFU)est une méthode non invasive de traitement des fibromes utérins à base sur le principe de l'utilisation d'ultrasons extracorporels pour provoquer nécrose coagulative du fibrome utérin. Alors que la technologie a été utilisé dans d'autres parties du monde, il est nouveau en Occident Afrique. Le cas signalé était le premier traitement HIFU de l'utérus fibrome au Nigeria. Une femme de 38 ans était préparée pour HIFU traitement du fibrome utérin. Échographie abdomino-pelvienne, Imagerie par résonance magnétique (IRM) et intestin pré-procéduralla préparation a été faite. Ultrasons focalisés de haute intensité (JC200) le traitement a été effectué sous sédation consciente en utilisant puissance moyenne de 400 Watts avec une consommation totale d'énergie de278,0 kilojoules avec un temps de sonication total de 700 secondes. Le patiente a pu reprendre ses activités quotidiennes une semaine après la procédure de HIFU.

Menstrual Characteristics of sub-Sahara Black African Women with and without Endometriosis.

BACKGROUND: One gynecological disorder which is often a mystery to premenopausal women who are affected is endometriosis, a benign condition characterized by ectopic endometrium growing outside the uterus but behaving as if it is still within the uterus. MATERIALS AND METHODS: Hospital records of 226 women who consulted for fertility management at Nordica Fertility Center were surveyed retrospectively. These women were stratified by age into <35 years and >35 years and by BMI into <18.5 (underweight), 18.5-24.9 (normal), 25.0-29.9 (overweight) and >30 (obese). There were 113 who had laparoscopic diagnosis of endometriosis and 113 without endometriosis but just infertility. STATA 13 statistical software was used for analysis of data. RESULTS: The mean (±sd) age of the women in the study was 34.3 (4.9) with no significant difference among those with (33.9 (4.3)) and without (34.6 (5.4)) endometriosis. There was a significant difference (t=-3.36, P-value=0.0005) in the mean BMI (Kg/m2) of women with endometriosis (25.8±4.9) compared to that of women without endometriosis (27.9±4.5). The probability of endometriosis among normal weight women was higher at age <35 years (OR=2.76, 95% Confidence Interval 1.33,5.73) than at age >35 years (OR=1.59, 95% Confidence Interval 0.62, 4.10). The mean (±SD) parity among those with endometriosis (0.13±0.34) was significantly lower (t-test=2.31; P-value=0.01) than that among women without endometriosis (0.28 ± 0.60). Primary infertility was more prevalent (62.0%) than secondary infertility (38.0%) among those with endometriosis while secondary infertility was more prevalent (55.8%) than primary infertility (44.3%) among those without endometriosis. The mean age (years) at menarche of women without endometriosis (13.3±1.6) was significantly higher (t-test=1.88, P-value=0.03) than that among those with endometriosis (12.9±1). Those with endometriosis were most likely to have dysmenorrhea alone, menorrhagia alone and both dysmenorrhea and menorrhagia concurrently than those without the disease. CONCLUSION: Anthropometric and abnormal menstrual profile of patients presenting with pelvic pain, co-morbidity of dysmenorrhea and menorrhagia, infertility and low parity can guide clinicians and gynecologist to make early and proper diagnosis of endometriosis for better treatment outcomes.

CONTEXTE: Un mal gynécologique qui est souvent un mystère pour les femmes préménopausées qui sont touchées est l'endométriose, une affection bénigne caractérisée par un endomètre ectopique poussant à l'extérieur de l'utérus mais se comportant comme s'il était toujours dans l'utérus. MATÉRIEL ET MÉTHODES: Les dossiers hospitaliers de 226 femmes ayant consulté pour la gestion de la fertilité au Nordica Fertility Center ont été étudiés rétrospectivement. Ces femmes ont été stratifiées par âge en <35 ans et> 35 ans et par IMC en <18,5 (poids insuffisant), 18,5 à 24,9 (normal), 25,0 à 29,9 (surpoids) et> 30 (obèse). Il y avait 113 qui avaient un diagnostic laparoscopique d'endométriose et 113 sans endométriose, mais juste l'infertilité. Le logiciel statistique STATA 13 a été utilisé pour l'analyse des données. RÉSULTATS: L'âge moyen (± sd) des femmes de l'étude était de 34,3 (4,9) sans différence significative entre celles avec (33,9 (4,3)) et sans (34,6 (5,4)) endométriose. Il y avait une différence significative (t = -3,36, valeur p = 0,0005) dans l'IMC moyen (Kg / m2) des femmes atteintes d'endométriose (25,8 ± 4,9) par rapport à celle des femmes sans endométriose (27,9 ± 4,5). La probabilité d'endométriose chez les femmes de poids normal était plus élevée à l'âge <35 ans (OR = 2,76, intervalle de confiance à 95% 1,33,5,73) qu'à l'âge> 35 ans (OR = 1,59, intervalle de confiance à 95% 0,62, 4,10). La parité moyenne (± ET) parmi les personnes atteintes d'endométriose (0,13 ± 0,34) était significativement plus faible (test t = 2,31; valeur p = 0,01) que chez les femmes sans endométriose (0,28 ± 0,60). L'infertilité primaire était plus fréquente (62,0%) que l'infertilité secondaire (38,0%) chez les personnes atteintes d'endométriose, tandis que l'infertilité secondaire était plus fréquente (55,8%) que infertilité primaire (44,3%) chez les personnes sans endométriose. L'âge moyen (années) à la ménarche des femmes sans endométriose (13,3 ± 1,6) était significativement plus élevé (test t = 1,88, valeur p = 0,03) que celui des femmes atteintes d'endométriose (12,9 ± 1). Les personnes atteintes d'endométriose étaient plus susceptibles de souffrir de dysménorrhée seule, de ménorragie seule et à la fois de dysménorrhée et de ménorragie en même temps que celles sans maladie. CONCLUSION: Le profil anthropométrique et menstruel anormal des patientes présentant des douleurs pelviennes, une comorbidité de dysménorrhée et de ménorragie, l'infertilité et une faible parité peuvent guider les cliniciens et le gynécologue pour faire un diagnostic précoce et approprié de l'endométriose pour de meilleurs résultats de traitement. Mots clés: femmes noires africaines, dysménorrhée, endométriose, infertilité, ménorragie, parité, profil menstruel, sub-saharienne.

Viral infections among couples for assisted reproduction in a fertility clinic in Nigeria.

CONTEXT: The risk of laboratory cross-contamination may limit the availability of assisted conception for couples infected with chronic viruses. However, assisted conception is the standard of care for people living with human immunodeficiency virus (HIV) to minimize risk of transmission or reinfection. AIMS: To assess the burden of viral infection among couples that present for assisted reproductive technology (ART) with a view to evaluating implications for their care. SETTINGS AND DESIGN: A cross-sectional descriptive study carried out among 138 couples at a private fertility clinic in Nigeria. MATERIALS AND METHODS: Screening for HIV, hepatitis B virus (HBV) and hepatitis C virus were carried out among these clients. The males' seminal parameters were analyzed according to World Health Organization (WHO) criteria. STATISTICAL ANALYSIS USED: Statistical Package for Social Sciences was employed. Analysis was by Chi-square test; statistical significance was set at 0.05. RESULTS: Viral infections were found in 10/138 women (7.2%) and 15/138 (10.9%) men. The most prevalent infection was HBV. Twenty-one couples were sero-discordant. Two couples had concordant HIV and HBV infections, respectively. There was no significant association between sperm quality and chronic hepatitis infection. CONCLUSION: Nearly a fifth of the couples had at least one partner infected with a chronic virus - a proportion significant enough to demand attention. Apart from separate laboratory and storage facilities, basic principles to minimize transmission are recommended: HBV vaccination in sero-discordant partners of HBV carriers (and immunoprophylaxis for the baby) and antiretroviral therapy for HIV-positive partners to reduce the viral load before fertility treatment is commenced.

Reliability of urine multistix and gram stain in the detection of asymptomatic bacteriuria in pregnancy.

BACKGROUND: urinary tract infection is a common problem during pregnancy. Asymptomatic bacteriuria can cause the development of serious complications affecting both the mother and foetus. Urine culture, the traditional screening test is relatively expensive, time consuming and requires a microbiology laboratory and trained staff. However simpler, less expensive tests which include urine multistix and urine gramstain better suited for developing countries are available. OBJECTIVE: to determine the sensitivity, specificity and predictive values of multistix nitrite, leucocyte esterase (LE) and urine gram staining for asymptomatic bacteriuria in pregnancy. METHODS: A cross-sectional study was carried out from 1st July to 31st October 2007, at the University of Ilorin Teaching Hospital (UITH) on 125 consenting asymptomatic pregnant women. A structured proforma was used to collect information from the women and a midstream urine specimen collected in two sterile bottles. One was tested with Multistix® for the presence of nitrite and leucocyte esterase and the other for bacteriological culture and urine gram stain. RESULTS: using the gold standard of urine culture, the sensitivities of Multistix® nitrite and leucocyte esterase were each 14% and the specificity 100% and 96% respectively. Urine gram stain had a sensitivity of 98% and a specificity of 74.7%. CONCLUSION: multistix® nitrite and leucocyte esterase are not sufficiently sensitive to be used as a screening tool for asymptomatic bacteriuria. Urine gram stain can be used in areas where facilities are inadequate for culture but cannot replace it. More studies are required to determine the accuracy of urine gram-stain.

Obstetric pubic symphysis arthropathy: a study of nine cases.

Nine Nigerian women who were either pregnant or recently delivered presented with a symptom complex comprising severe pain or tenderness over the symphysis pubis with ambulatory difficulty. Radiography and ultrasonography were used as complements to confirm diagnosis, and management was non-operative. Seven of the nine women recovered completely, but two died from presumed pulmonary embolism. There is no evidence that pelvic radiography influences diagnosis or management. We suggest routine thromboprophylaxis in the management of the entity and use of obstetric pubic symphysis arthropathy as a specific, descriptive and all encompassing nomenclature.

Maternal height and prior vaginal delivery as predictive factors in trial of labour after one caesarean section.

A retrospective study of 304 booked parturients with one previous lower segment caesarean section for non-recurrent indications was carried out with regards to factors predicting successful trial of vaginal delivery. The height of the parturients, as well as a history of a previous vaginal delivery appeared to be predictive factors of success. Seventy per cent of the parturients succeeded in delivering vaginally. The mean fetal birthweight was 3362 g for women with vaginal delivery, while the mean maternal height was 1.58 m. Of those who needed a repeat caesarean section, surgical intervention in 46.15% of the patients was indicated by poor cervicometric progress, which might have been appropriately addressed by oxytocin augmentation and careful monitoring in labour. Regarding prior vaginal delivery, only 31.1% of parturients with a negative history, but 63.15% with a positive history, had a successful trial. Three cases of ruptured uterus were all the result of unacceptable delay in carrying out an abdominal delivery when it was clearly indicated. A large prospective study into this aspect of obstetric care will probably define additive effects of these two definite factors.

Ovarian cancer associated with ovulation induction: a case report.

A case report of a 38 year old lady who developed ovarian malignancy following 3 cycles of ovulation induction therapy is presented. She was observed to have clinically normal ovaries at laparotomy for tubal infertility 12 months previously. Although direct causal link between ovarian stimulation and cancer has not been established yet, a case is made for increased monitoring of patients receiving ovulation induction medication by physicians.

Coitally--related morbidities in the non-pregnant female.

The consequences of coital experience in the non-pregnant female are varied and are occasional diagnostic puzzles. They range from those typified by manifest or concealed haemorrhage, to those revealed by immunologic, neurologic or pharmacologic phenomena and to those, whose patho-physiology is as yet, unclear. Observations are made of the likelihood of recurrence, and that, most patients would typically not readily admit to the preceding act of coitus.