Rupture of the Left Renal Fornix after Vaginal Repair of Postpartum Vesicovaginal Fistula.

Surgical repair of vesicovaginal fistulas carries a risk of postoperative obstruction of the upper urinary tract. In the case described here, a postoperative intramural edema led to urinary retention and subsequent rupture of the renal pelvis. This is a rare but typical urological emergency. If patients complain postoperatively of flank pain, ultrasound should be carried out promptly. If the findings are unclear (no urinary retention despite clinical symptoms), additional computed tomography should be performed to determine whether rupture of the fornix has occurred.

Low inhibin B levels alone are not a reliable marker of dysfunctional spermatogenesis in childhood cancer survivors.

Hormone and semen analyses were carried out to examine the diagnostic value of hormones and hormone combinations as markers of spermatogenesis in male patients who had received oncological treatment in childhood. Hormone analyses from 73 participants and spermiograms from 42 participants were evaluated. Spearman's correlation coefficients and measures of diagnostic accuracy were calculated for the hormone and semen analysis values. Inhibin B levels of <80 ml/ml, follicle-stimulating hormone (FSH) levels of >10 IU l(-1) and a combination of the two parameters showed positive predictive values for azoospermia of 0.423, 0.6154 and 0.6667 respectively. While 32% of the 73 participants showed a combination of abnormal inhibin B and FSH values, which strongly indicates impaired spermatogenesis, 31% of the 42 spermiogram results revealed azoospermia. The hormone and semen analyses showed that approximately one-third of the participants had fertility impairment. Inhibin B alone thus does not reflect spermatogenesis as well as inhibin B in combination with FSH in patients who have undergone cancer treatment in childhood. Both parameters should therefore be evaluated in paediatric cancer follow-up programmes to allow better identification of treatment regimens that cause persistent azoospermia in male childhood cancer survivors.

Fertility after allogeneic haematopoietic stem cell transplantation in childhood and adolescence.

Infertility is a major late effect in patients receiving haematopoietic stem cell transplantation (HSCT). The aim of this study was to determine the proportion of patients having fertility impairment after allogeneic HSCT in childhood/adolescence and to identify the potential risk factors. Treatment and fertility data of paediatric patients with malignant and non-malignant diseases treated with allogeneic HSCT between 2000 and 2005 were collected from seven European centres. Data were obtained for 138 female and 206 male patients after a median follow-up of 6 years (range 3-12). The patients' median age was 13 years (range 4-28) at the time of HSCT and 19 (range 12-35) years at the time of the enquiry. Seven children were born to the overall group, all at term and healthy. Fertility impairment was suspected in 69% males and 83% females. Start of treatment at age 13 years was a risk factor in females (odds ratio (OR) 4.7; 95% confidence interval (CI), 1.5 to 14.9), whereas pre-pubertal therapy was a risk factor in males (OR 0.4; 95% CI, 0.2 to 0.8). The major treatment-related risk factors were BU in females (OR 47.4; 95% CI, 5.4 to 418.1) and TBI in males (OR 7.7; 95% CI, 2.3 to 25.4). In light of the significant proportion of HSCT patients reviewed with impaired fertility, fertility conservation procedures should be considered for all patients undergoing HSCT, particularly those receiving TBI or BU-based preparative regimens.

Normal Pressure Hydrocephalus as Cause of Urinary Incontinence - A Shunt for Incontinence.

Normal pressure hydrocephalus is a frequently missed clinical entity with the typical symptom triad of gait disturbance, urinary incontinence and dementia (Hakim's triad) and occurs mostly from the 6th decade of life onwards. Early therapy can lead to a complete reversal of the symptoms. The present case report is intended to draw attention to the clinical entity normal pressure hydrocephalus (NPH) since the afflicted patients often primarily consult a gynaecologist on account of the urinary bladder disorders.

Hormone and Sperm Analyses after Chemo- and Radiotherapy in Childhood and Adolescence.

BACKGROUND: Since prevalence of and reasons for infertility were unclear in survivors of childhood cancer we conducted a two centre survey in 2006 and nationwide in 2008. In 2008/2009 we undertook a study entitled "Hormone and Sperm Analyses after Chemo- and Radiotherapy in Childhood and Adolescence". PATIENTS AND METHODS: Letters were sent to 748 former paediatric oncological patients who were at least 18 years of age at the time of the survey. Serum and sperm samples were analysed. RESULTS: We obtained 159 blood samples (86 women, 73 men). 42 men took part in the sperm analyses. The average participants' age at the time of the survey was 25 years. The anti-Mullerian hormone levels (AMH) in 14/86 female participants (16 %) were < 0.1 ng/ml. The follicular reserve of these women seemed manifestly impaired, which is consistent with suspected infertility. The AMH levels in 21/86 women (24 %) were 0.1 - 1.0 ng/ml indicating limited follicular reserve and therefore suspected early ovarian failure. Inhibin B levels of < 80 pg/ml and FSH levels of > 10 IU/L were found in 23/73 male participants (32 %), which may indicate impaired spermiogenesis with increased risk of infertility. 13/42 sperm analyses (31 %) revealed azoospermia. DISCUSSION: Paediatric oncological therapy seems to have led to fertility impairment in about 1/3 of the participants. Considering this serious impairment, patients and their families should be given comprehensive counselling ahead of therapy to enable fertility-preserving measures. For persons who wish to have children after undergoing therapy we recommend a hormone and sperm analysis. An early analysis may enable a more successful family planning.

Selective screening of hospitalized patients for the presence of asymptomatic hepatitis B virus carriage: predictability based on census tract data.

Review of all hepatitis B surface antigen-positive patients reported to the county health department over the past 3 years showed that 60% of patients had been diagnosed at our hospital, which serves an inner city, predominantly black, indigent population. Sera from 524 adult patients admitted to the hospital were prospectively collected and tested for hepatitis B surface antigen, eight (1.5%) of which were antigen-positive. Census tract data allowed us to perform selective screening of sera from 95 other patients who were subsequently hospitalized and deemed "high risk" for hepatitis B infection. Nine of 95 (9.5%) selectively screened samples were positive for hepatitis B surface antigen, which represented a significantly higher rate of antigen carriage (P less than 0.0001) in hospitalized patients from "high risk" areas than that found in the general population screen. The methodology presented herein may be useful in providing a means of identifying hepatitis B surface antigen-positive patients from adult, urban, indigent care populations.

A multistate outbreak of infections caused by Yersinia enterocolitica transmitted by pasteurized milk.

In June and July 1982, a large interstate outbreak of Yersinia enterocolitica infections caused by an unusual serotype occurred in Tennessee, Arkansas, and Mississippi. Eighty-six percent of cases had enteritis characterized by fever, abdominal pain, and diarrhea. In three separate case-control studies, drinking milk pasteurized by plant A was statistically associated with illness. In a survey of randomly chosen households, 8.3% of persons who recalled having drunk milk from plant A during the suspect period experienced a yersiniosislike illness. Inspection of the plant and cultures of the available raw and pasteurized milk did not reveal the source or mechanism of contamination or a breach in normal pasteurizing technique. Although outbreaks of enteric disease caused by pasteurized milk are rare in the United States, the ability of Y enterocolitica to grow in milk at refrigeration temperatures makes pasteurized milk a possible vehicle for virulent Y enterocolitica. The extent to which milk is responsible for sporadic cases of yersiniosis is unknown.

An outbreak of Legionnaires' disease associated with a contaminated air-conditioning cooling tower.

In August and September 1978, an outbreak of Legionnaires' disease occurred in Memphis, Tennessee. Of the 44 ill, 39 had been either patients, employees, visitors, or passers-by at one Memphis hospital (Hospital A) during the 10 days before. Assuming an incubation period of between two and 10 days, the onset of cases correlated precisely with the use of Hospital A's auxiliary air-conditioning cooling tower. L. pneumophila was recovered from two samples of water from the tower. Infection appeared to have occurred both outside and within the hospital. A significant association was demonstrated between acquisition of Legionnaires' disease and prior hospitalization in those areas of Hospital A that received ventilating air from air intakes near the auxiliary cooling tower. Tracer-smoke studies indicated that contaminated aerosols from the tower could easily reach these air intakes, as well as the street below, where four passers-by had been before they contracted Legionnaires' disease. This represents a common-source outbreak in which the source of L. pneumophila infection and airborne transmission were identified.

The impact of urban community hospital surveillance for gonorrhoea on the infection rate and complications in the female. A progress report.

This study substantiates a previous report concerning the importance of the urban community hospital, particularly its emergency room, in the detection of gonorrhoea in women. Pelvic inflammatory disease (PID), a major complication of gonorrhoea in women, significantly declined during a nine-year surveillance and control programme in the Memphis-Shelby County area. This suggests that the programme may have prevented PID developing in women through the early detection and treatment of asymptomatic infections.

PIP: The experience of a community surveillance program aimed at detecting gonorrhea in women in Memphis-Shelby County, Tennessee, is reported. This report, presenting data from 1975-76, updates an earlier report from the 1973-74 period. Data from both periods are compared in an attempt to determine the program's impact on the rate of women with gonorrhea and on the number of hospital admissions for pelvic inflammatory disease (PID), the most serious complication of gonorrhea. The total number of tests performed in the community increased from 113,063 in 1973-74 to 140,201 in 1975-76. The percentage of women with positive cultures was 5.1 in the earlier period and 5.0 in the latter period. The total number of positive cultures at the City of Memphis Hospital declined by 7.4% from 3097 in 1973-74 and 2868 in 1975-76. This decline is largely due to a reduction in the number of positive cultures identified in the emergency room. Despite this decline, the emergency room continued to provide the highest number of positive cultures (16.5% in 1975-76) and the highest ratio of positive cultures to number of tests. City of Memphis Hospital as a whole provided 40.6% of the positive cultures in only 31.5% of total tests. The number of cultures obtained from other community health services increased by 54.5% from 2709 to 4185 in the 2 study periods. This increase is largely attributed to the establishment of new family planning clinics in poor areas and increased participation in the surveillance program among private physicians in these areas. The 3 year moving average incidence of PID recorded in the City of Memphis Hospital discharge at diagnosis showed a dramatic decline between 1968 (the year the surveillance program was initiated) and 1976, suggesting that the program has effectively prevented much infection from progressing to PID. Moreover, the unchanged incidence of gonorrhea observed in the 2 study periods indicates that the infection rate has stabilized. This is in contrast to the continuous upward trend observed on a national level.

The role of the urban community hospital in gonorrhoea surveillance.

In a progressive surveillance programme designed to detect gonococcal infection in females, 113,063 women were screened for gonorrhoea in Memphis-Shelby County, Tennessee, during a 2-year period. The importance of including the urban community hospital in the surveillance programme is emphasized by the contribution of the City of Memphis Hospital where 53-3 per cent. of all positive cases of gonorrhoea were detected in only 34-2 per cent. of all tests done. The City of Memphis Hospital emergency room was an especially productive surveillance area, giving 29-0 per cent. of all positives with only 6-1 per cent. of all tests performed. The importance of taking routine cultures for gonococci from women presenting for prenatal care, delivery, or for genitourinary complaints in an urban hospital is stressed.

Female gonorrhea: its relation to abnormal uterine bleeding, urinary tract symptoms, and cervicitis.

Data are presented from an investigation of the assocation of presenting complaints with gonococcal infection in females seeking primary care in an urban emergency room. Over 27% of patients in the study had cultures positive for Neisseria gonorrhoeae (GC). The GC positivity rates which were significantly higher than expected were found in patients with abnormal uterine bleeding, urinary tract symptoms, and cervicitis, as well as acute PID. Clinical findings suggest an etiologic role for the gonococcus in the pathogenesis of these disorders. Where the incidence of gonorrhea is high, new approaches in the managment of patients with these presenting complaints are necessary in order to prevent the more serious complications of gonorrhea and further spread of the disease.