Total laparoscopic hysterectomy versus vaginal hysterectomy at the University Hospital of the West Indies: a 5-year retrospective study

OBJECTIVE: To compare the outcomes of total laparoscopic hysterectomy (TLH), a relatively new procedure, with vaginal hysterectomy (VH), a wellestablished procedure, in a university teaching hospital. SUBJECTS AND METHODS: A retrospective chart review of all patients who underwent TLH at the University Hospital of the West Indies between January 2007 and December 2011 was conducted. Chart review was also conducted of a group of patients who underwent VH during this time period. The groups were compared with respect to demographic data and intraoperative and postoperative outcomes. Statistical analysis was undertaken using the SPSS software, version 12.0 (SPSS, Chicago, IL). The Student unpaired ttest was used to analyse continuous variables, and the Chi-square test and Fisher exact test for categorical variables, when appropriate. A p-value of < 0.05 was considered statistically significant. RESULTS: Ten patients underwent TLH, and were compared with 22 women who underwent VH. There was no statistically significant difference between groups in uterine weight, estimated blood loss, postoperative analgesic requirement, or length of hospitalization. Total laparoscopic hysterectomy took significantly longer to perform (209.9 vs 145.6 minutes, p = 0.004). One patient in the TLH group had to be brought back to the operating theatre after three months because of bowel prolapse secondary to vault dehiscence. With the exception of one case of bladder injury in the VH group, there were no significant differences between the groups in terms of intraoperative and postoperative complications. CONCLUSION: Total laparoscopic hysterectomy, notwithstanding its learning curve, is as safe as VH. However, TLH was associated with a significantly longer operative time.

Anticardiolipin antibodies and lupus anticoagulants among women undergoing in vitro fertilization in Jamaica / Anticuerpos anticardiolipinas y anticoagulantes lúpicos entre mujeres a las que se les realiza FIV en Jamaica

OBJECTIVE: The aims of this study were to evaluate the effect of anticardiolipin antibody (aCL) and lupus anticoagulant (LA) on the outcome of the in vitro ferlitization (IVF) cycles and to determine the prevalence of these antibodies in infertile women seeking IVF in Jamaica. METHODS: A retrospective cohort study was performed to determine if screening patients for aCL and LA had any significant impact on the outcome of the IVF process. Each patient's hospital record, between March 2000 and March 2010, was collected and the relevant data extracted. RESULTS: The prevalence of aCL in this cohort of Jamaican women was moderate/high positive 3.88%, low positive 0.68% and those with negative aCL results 95.4%. The prevalence of women who were LA positive was 4.1% and 0.9% of the women were positive for both LA and aCL. Of the patients who were LA and/or aCL positive, eight out of 30 patients (26.7%) had a positive pregnancy test in comparison to 61 out of 181 patients (33.7%) who were LA and/or aCL negative (p = 0.5787). CONCLUSION: The prevalence of positive aCL and/or lA in infertile women seeking IVF in Jamaica is 7.76%. The presence of these antibodies did not affect the pregnancy rate of these women nor did it demonstrate an increased risk for IVF cycle cancellation or ovarian hyperstimulation syndrome. Screening women undergoing IVF for these antibodies is not justified.

OBJETIVO: Los objetivos de este estudio fueron evaluar el efecto del anticuerpo anticardiolipina (aCL) y el anticoagulante lúpico (LA) sobre el resultado de los ciclos de la fertilización en vitro (FIV), así como determinar la prevalencia de estos anticuerpos en mujeres estériles que buscan tratamiento de FIV en Jamaica. MÉTODOS: Se realizó un estudio de cohorte para determinar si el tamizaje de pacientes para detectar el anticuerpo anticardiolipina y el anticoagulante lúpico tenía un impacto significativo en el resultado del proceso de FIV. Se obtuvieron las historias clínicas hospitalarias de cada una de las pacientes, entre marzo de 2000 y marzo de 2010, y se extrajeron los datos pertinentes. RESULTADOS: La prevalencia de aCL en esta cohorte de mujeres jamaicanas fue 3.88% moderada/alta positiva, 0.68% positiva baja, y aquellas con resultados negativos de aCL, 95.4%. La prevalencia de mujeres con resultados de anticoagulante lúpico positivos fue 4.1%, y 0.9% de las mujeres resultaron positivas con respecto tanto al LA como al aCL. De las pacientes que fueron positivas al LA y/o al aCL, ocho de cada 30 pacientes (26.7%) tuvieron una prueba de embarazo positiva, en comparación con 61 de cada 181 pacientes (33.7%) negativas al LA y/o al aCL (p = 0.5787). CONCLUSIÓN: La prevalencia de resultados positivos en relación con anticuerpos anticardiolipinas y/o anticoagulantes lúpicos en mujeres estériles que buscan FIV en Jamaica es 7.76%. La presencia de estos anticuerpos no afectó la tasa de embarazo de estas mujeres, ni mostró un aumento de riesgo de la cancelación del ciclo FIV, o riesgo de síndrome de hiperestimulación ovárica. El tamizaje en busca de estos anticuerpos en mujeres que buscan tratamiento de FIV, no está justificado.

Total laparoscopic hysterectomy versus vaginal hysterectomy at the University Hospital of the West Indies: a 5-year retrospective study.

OBJECTIVE: To compare the outcomes of total laparoscopic hysterectomy (TLH), a relatively new procedure, with vaginal hysterectomy (VH), a well-established procedure, in a university teaching hospital. SUBJECTS AND METHODS: A retrospective chart review of all patients who underwent TLH at the University Hospital of the West Indies between January 2007 and December 2011 was conducted. Chart review was also conducted of a group of patients who underwent VH during this time period. The groups were compared with respect to demographic data and intraoperative and postoperative outcomes. Statistical analysis was undertaken using the SPSS software, version 12.0 (SPSS, Chicago, IL). The Student unpaired t-test was used to analyse continuous variables, and the Chi-square test and Fisher exact test for categorical variables, when appropriate. A p-value of < 0.05 was considered statistically significant. RESULTS: Ten patients underwent TLH, and were compared with 22 women who underwent VH. There was no statistically significant difference between groups in uterine weight, estimated blood loss, postoperative analgesic requirement, or length of hospitalization. Total laparoscopic hysterectomy took significantly longer to perform (209.9 vs 145.6 minutes, p = 0.004). One patient in the TLH group had to be brought back to the operating theatre after three months because of bowel prolapse secondary to vault dehiscence. With the exception of one case of bladder injury in the VH group, there were no significant differences between the groups in terms of intraoperative and postoperative complications. CONCLUSION: Total laparoscopic hysterectomy, notwithstanding its learning curve, is as safe as VH However, TLH was associated with a significantly longer operative time.

Anticardiolipin antibodies and lupus anticoagulants among women undergoing in vitro fertilization in Jamaica.

OBJECTIVE: The aims of this study were to evaluate the effect of anticardiolipin antibody (aCL) and lupus anticoagulant (LA) on the outcome of the in vitro ferlitization (IVF) cycles and to determine the prevalence of these antibodies in infertile women seeking IVF in Jamaica. METHODS: A retrospective cohort study was performed to determine if screening patients for aCL and LA had any significant impact on the outcome of the IVF process. Each patients hospital record, between March 2000 and March 2010, was collected and the relevant data extracted. RESULTS: The prevalence of aCL in this cohort of Jamaican women was moderate/high positive 3.88%, low positive 0.68% and those with negative aCL results 95.4%. The prevalence of women who were LA positive was 4.1% and 0.9% of the women were positive for both LA and aCL. Of the patients who were LA and/or aCL positive, eight out of 30 patients (26.7%) had a positive pregnancy test in comparison to 61 out of 181 patients (33.7%) who were LA and/or aCL negative (p = 0.5787). CONCLUSION: The prevalence of positive aCL and/or LA in infertile women seeking IVF in Jamaica is 7.76%. The presence of these antibodies did not affect the pregnancy rate of these women nor did it demonstrate an increased risk for IVF cycle cancellation or ovarian hyperstimulation syndrome. Screening women undergoing IVF for these antibodies is not justified.

Operative hysteroscopy in a jamaican cohort / Histeroscopia operatoria en una cohorte jamaicana

OBJECTIVE: The objective of this study is to determine the indications, success, and complications of operative hysteroscopy performed at The University of the West Indies (UWI). METHODS: A five-year retrospective cohort study was done of women undergoing operative hysteroscopy at the Hugh Wynter Fertility Management Unit (HWFMU) of the University of the West Indies from January 1, 2001 to December 31, 2005. The demographics of the patients, indications, complications of the procedure and postoperative follow-up were assessed. Patient's post-procedural quality of life was assessed by a questionnaire. RESULTS: During this period, 92 operative hysteroscopies were performed on 87 patients, with repeat procedures being performed in three patients. The mean age of patients undergoing operative hysteros-copy was 36.65 years with a range of 23 to 50 years. The main indications for operative hysteroscopy at the HWFMU were submucosal fibroids (50%), intrauterine synechiae (26%) and removal of an intrauterine contraceptive device (11%). There were four procedure-related complications, all of which occurred during myomectomy and required hospitalization. CONCLUSION: Operative hysteroscopy is a safe and highly effective therapy for carefully selected women. As a consequence of technological advancements, an increasing number of gynaecological conditions, traditionally treated by laparotomy, can now be treated safely and effectively using outpatient operative hysteroscopy.

OBJETIVO: El objetivo de este estudio es determinar las indicaciones, éxito, y complicaciones de las histeroscopías operatorias realizadas en la Universidad de West Indies (UWI). MÉTODOS: Se realizó un estudio de cohorte retrospectivo de cinco años con mujeres sometidas a Histeroscopia operatoria en la Unidad de Fertilidad "Hugo Wynter", en la Universidad de West Indies (HWFMU), del 1ero de enero de 2001 al 31 de diciembre de 2005. Se evaluaron los datos demográficos de los pacientes, así como las indicaciones, las complicaciones del procedimiento y el seguimiento post-operatorio. Se aplicó un cuestionario para evaluar la calidad de vida del paciente luego del procedimiento. RESULTADOS: Durante este período se realizaron 92 histeroscopías operatorias a 87 pacientes, repitiéndose los procedimientos en tres pacientes. La edad promedio de los pacientes sometidos a Histeroscopia operatoria fue 36.65 años, con una rango de 23 a 50 años. Las indicaciones principales para la histeroscopía operatoria en la Unidad HWFMU fueron los miomas submucosos (50%), las sinéquias intrauterinas (26%) y la extracción del dispositivo anticonceptivo intrauterino (11%). Hubo cuatro complicaciones relacionadas con los procedimientos, todas las cuales tuvieron lugar durante la miomectomía y requirieron hospitalización. CONCLUSIÓN: La histeroscopía operatoria es una terapia segura y altamente efectiva para mujeres cuidadosamente seleccionadas. Como consecuencia de los avances tecnológicos, un número creciente de condiciones ginecológicas, tradicionalmente tratadas mediante laparotomía, pueden ahora ser tratadas con seguridad y efectividad mediante histeroscopía operatoria ambulatoria.

Laparoscopic cervicoisthmic cerclage for the treatment of cervical incompetence: case reports / Cerclaje cérvico-ístmico laparoscópico en el tratamiento de la incompetencia cervical: reporte de casos

Cervical insufficiency/incompetence occurs in 0.5-1% of all pregnancies, often resulting in significant pregnancy lost. Three women with a history of second trimester miscarriages after failed transvaginal cervical cerclages were reviewed. A laparoscopic cervicoisthmic cerclage (LCC) was placed before pregnancy without any intra-operative or postoperative complications. Two patients have since delivered live babies at term by Caesarean section. This small case series supports the conclusion that LCC is a safe and cost-effective procedure in properly selected patients. Laparoscopic cervicoisthmic cerclage costs less, is less invasive, has fewer complications and should replace the traditional laparotomy technique.

La insuficiencia/incompetencia cervical ocurre en 0.5-1% de todos los embarazos, trayendo a menudo como consecuencia una pérdida significativa de embarazos. Se revisaron los casos de tres mujeres con una historia de abortos en el segundo trimestre después de cerclajes cervicales transvaginales fallidos. Un cerclaje cérvico-ístmico laparoscópico (CCL) se realizó antes del embarazo sin ninguna complicación intraoperatoria o postoperatoria. Desde entonces, dos pacientes han parido bebés vivos a término por cesárea. Esta pequeña serie de casos sustenta la conclusión de que el CCL es un procedimiento seguro y costo-efectivo en pacientes propiamente seleccionados. El cerclaje cérvico-ístmico laparoscópico cuesta menos, es menos invasivo, tiene menos complicaciones, y debe reemplazar la técnica de laparotomía tradicional.

Factors related to obstetric third and fourth degree perineal lacerations in a Jamaican cohort.

OBJECTIVES: The aim of this study was to identify significant and modifiable risk factors associated with obstetric third and fourth degree perineal lacerations and to produce recommendations that may reduce their morbidity and prevalence. METHODS: This is a retrospective case control study performed between March 2004 and March 2008. All patients diagnosed with third and fourth degree perineal lacerations were identified (cases) along with randomly assigned controls who delivered during the same time period. Nineteen cases and 38 controls were identified giving a total of 57 patients. Each patient's hospital record was collected and the data extracted. RESULTS: When analysed for weight greater than or equal to 3.5 kg versus birthweight of less than 3.5 kg, the difference between cases and controls was found to be statistically significant, with a p-value of 0.012. Of the cases, 21% had an operative delivery (forceps or vacuum) whereas only 2.6% of the controls had an operative delivery. This was found to be statistically significant (p = 0.011). CONCLUSION: This study has shown that the two main factors related to the obstetric third and fourth degree perineal lacerations were babies weighing more than 3.5 kg and the use of forceps or vacuum to assist with deliveries. These high risk patients should be attended to by the most senior staff that is available.

Successful treatment of severe male factor infertility in Jamaica with intracytoplasmic sperm injection.

OBJECTIVE: To examine the impact of intracytoplasmic sperm injection (ICSI) on the treatment of subfertile couples in Jamaica. METHOD: A review of the outcome of treatment cycles for infertile couples that underwent in-vitro fertilisation (IVF) and ICSI from 2003-05 at the Hugh Wynter Fertility Management Unit (HWFMU) of the University of the West Indies. Fertilisation and pregnancy rates for the cycles as well as the factors determining the success of the procedure were reviewed. SPSS 11.1 was used to do statistical calculations. RESULTS: Ninety-six ICSI cycles were done from January 1, 2003 to December 31, 2005. For couples with previous poor or no fertilisation in a standard IVF group (n = 12), the fertilisation rate was 72%; for those with substandard semen (n = 73), the fertilisation rate was 77.5%, for those with semen retrieved by surgical sperm method (n = 11), the fertilisation rate was 59%. The resulting live births were 0%, 12.5% and 27.3% respectively. There was a statistically significant impact of age on pregnancy rates as the mean age of the females in the previously poor or no fertilisation in a standard IVF group (39.08 +/- 5.14) was greater than those of the substandard semen group (35.93 +/- 4.22) [p = 0.023] as well as the group with surgical sperm retrieval (32.82 +/- 6.65) [p = 0.019]. CONCLUSION: With ICSI, the fertilisation and pregnancy rates in Jamaica are comparable to international rates regardless of the cause of infertility. However, the age of the female partner does have a significant impact on the pregnancy rate following ICSI.

Comfort care in burns: the Burn Modified Liverpool Care Pathway (BM-LCP).

INTRODUCTION: Despite advances in burn care some injuries remain non survivable. Good end of life care for these patients is arguably as important as life prolonging care. The Liverpool Care Pathway is a useful tool for providing good quality end of life care. It has previously been modified for the acute setting. We modified it further specifically for use in burn care in 2007 and would like to share our experience of using it. METHODS: A retrospective case series of deaths occurring between 01/01/08 and 31/12/09 is presented and adherence to the Burn Modified Liverpool Care Pathway (BM-LCP) is assessed. RESULTS: There were 22 deaths over the study period with a mean TBSA of 55%. Mean Acute Burn Severity Index score (ABSI) 12.5. A decision of futility was made in 14 cases, 11 of these were started on the BM-LCP. 7 were started on the pathway at the time of admission. Mean time from decision to start the pathway to death 11 h (range 3-48). There were no variances from the pathway. CONCLUSION: The BM-LCP appears to be an appropriate tool for assisting in end of life care in burns and when used appears to improve end of life care. We recommend its use and would encourage others to implement its use.

Factors related to obstetric third and fourth degree perineal lacerations in a jamaican cohort / Factores relacionados con las laceraciones perineales obstétricas de tercer y cuarto grado en una cohorte de Jamaica

OBJECTIVES: The aim of this study was to identify significant and modifiable risk factors associated with obstetric third and fourth degree perineal lacerations and to produce recommendations that may reduce their morbidity and prevalence. METHODS: This is a retrospective case control study performed between March 2004 and March 2008. All patients diagnosed with third and fourth degree perineal lacerations were identified (cases) along with randomly assigned controls who delivered during the same time period. Nineteen cases and 38 controls were identified giving a total of 57 patients. Each patient's hospital record was collected and the data extracted. RESULTS: When analysed for weight greater than or equal to 3.5 kg versus birthweight of less than 3.5 kg, the difference between cases and controls was found to be statistically significant, with a p value of 0.012. Of the cases, 21% had an operative delivery (forceps or vacuum) whereas only 2.6% of the controls had an operative delivery. This was found to be statistically significant (p = 0.011). CONCLUSIONS: This study has shown that the two main factors related to the obstetric third and fourth degree perineal lacerations were babies weighing more than 3.5 kg and the use of forceps or vacuum to assist with deliveries. These high risk patients should be attended to by the most senior staff that is available.

OBJETIVOS: El objetivo de este estudio fue identificar factores de riesgo modificables y significativos asociados con las laceraciones perineales obstétricas de 3er y 4to grado, y producir recomendaciones que puedan reducir su morbilidad y prevalencia. MÉTODOS: Se trata de un estudio de caso control retrospectivo realizado entre marzo de 2004 y marzo de 2008. Todas las pacientes diagnosticadas con laceraciones perineales de 3er y 4to grado fueron identificadas (casos) con controles asignados de manera aleatoria, que tuvieron el parto en el mismo período de tiempo. Diecinueve casos y 38 controles fueron identificados, para un total de 57 pacientes. Se recogieron y se extrajeron los datos de las historias clínicas de cada paciente. RESULTADOS: Al analizárseles en términos de peso superior o igual a 3.5 kg frente a un peso al nacer por debajo de 3.5 kg, la diferencia entre los controles y los casos resultó ser estadísticamente significativa, con un valor p de 0.012. De los casos, el 21% tuvo un parto operativo (fórceps o vacío), mientras que sólo el 2.6% de los controles tuvo un parto operativo. Esto resultó ser estadísticamente significativo (p = 0.011). CONCLUSIONES: Este estudio ha demostrado que los dos factores principales relacionados con las laceraciones perineales obstétricos de 3er y 4to grado, eran bebés con un peso de más de 3.5 kg y el uso de fórceps o vacío en la asistencia a los partos. Estos pacientes de alto riesgo deben ser atendidos por el personal disponible de mayor experiencia.

Successful treatment of severe male factor infertility in Jamaica with intracytoplasmic sperm injection / Tratamiento exitoso de la infertilidad severa por factor masculino en Jamaica mediante inyección de esperma intracitoplasmático

OBJECTIVES: To examine the impact of intracytoplasmic sperm injection (ICSI) on the treatment of subfertile couples in Jamaica. METHOD: A review of the outcome of treatment cycles for infertile couples that underwent in-vitro fertilisation (IVF) and ICSI from 2003-05 at the Hugh Wynter Fertility Management Unit (HWFMU) of the University of the West Indies. Fertilisation and pregnancy rates for the cycles as well as the factors determining the success of the procedure were reviewed. SPSS 11.1 was used to do statistical calculations. RESULTS: Ninety-six ICSI cycles were done from January 1, 2003 to December 31, 2005. For couples with previous poor or no fertilisation in a standard IVF group (n = 12), the fertilisation rate was 72%; for those with substandard semen (n = 73), the fertilisation rate was 77.5%, for those with semen retrieved by surgical sperm method (n = 11), the fertilisation rate was 59%. The resulting live births were 0%, 12.5% and 27.3% respectively. There was a statistically significant impact ofage on pregnancy rates as the mean age ofthe females in the previously poor or no fertilisation in a standard IVF group (39.08 ± 5.14) was greater than those of the substandard semen group (35.93 ± 4.22) ]p = 0.023[ as well as the group with surgical sperm retrieval (32.82 ± 6.65) ]p = 0.019[. CONCLUSION: With ICSI, the fertilisation and pregnancy rates in Jamaica are comparable to international rates regardless of the cause of infertility. However, the age of the female partner does have a significant impact on the pregnancy rate following ICSI.

OBJETIVO: Examinar el impacto de la inyección de esperma intracitoplasmático (IEIC) en el tratamiento de las parejas subfértiles en Jamaica. MÉTODO: Se realizó un examen del resultado de los ciclos de tratamiento para las parejas infértiles que recurrieron a la fertilización in vitro (FIV) y a la IEIC de 2003 a 2005 en la Unidad de Tratamiento de la Fertilidad Hugh Wynter del Hospital Universitario de West Indies (HWFMU). Se examinaron las tasas de fertilización y embarazos en todos los ciclos así como los factores que determinan el éxito del procedimiento. Se usó el programa SPSS para realizar los cálculos estadísticos. RESULTADOS: Se realizaron noventa y seis ciclos de IEIC del 1ero de enero de 2003, al 31 de diciembre de 2005. Para parejas con ninguna o pobre fertilización en un grupo estándar de FIV (n - 12), la tasa de fertilización fue 72%; para aquellos con semen subestándar (n = 73), la tasa de fertilización fue 77.5%; para aquellos con semen recuperado mediante recuperación quirúrgica de esperma (n = 11), la tasa de fertilización fue 59%. Los nacimientos vivos resultantes fueron 0%, 12.5%, y 27.3% respectivamente. Hubo un impacto estadísticamente significativo de la edad sobre las tasas de comembarazo, ya que la edad promedio de las hembras en la fertilización previamente pobre o sin fertilización en un grupo FIV estándar (39.08 ± 5.14) fue mayor para las del grupo de semen subestándar (35.93 ± 4.22) ]p = 0.023[ así como las del grupo con recuperación quirúrgica del esperma (32.82 ± 6.65) ]p = 0.019[. CONCLUSIÓN: Con el uso de IEIC, las tasas de fertilización y embarazo en Jamaica, son comparables a las tasas internacionales, independientemente de cual sea la causa de la infertilidad. Sin embargo, la edad de la pareja hembra no tiene un impacto significativo sobre la tasa de embarazo una vez aplicada la IEIC.

Operative hysteroscopy in a Jamaican cohort.

OBJECTIVE: The objective of this study is to determine the indications, success, and complications of operative hysteroscopy performed at The University of the West Indies (UWI). METHODS: A five-year retrospective cohort study was done of women undergoing operative hysteroscopy at the Hugh Wynter Fertility Management Unit (HWFMU) of the University of the West Indies from January 1, 2001 to December 31, 2005. The demographics of the patients, indications, complications of the procedure and postoperative follow-up were assessed. Patient's post-procedural quality of life was assessed by a questionnaire. RESULTS: During this period, 92 operative hysteroscopies were performed on 87 patients, with repeat procedures being performed in three patients. The mean age of patients undergoing operative hysteroscopy was 36.65 years with a range of 23 to 50 years. The main indications for operative hysteroscopy at the HWFMU were submucosal fibroids (50%), intrauterine synechiae (26%) and removal of an intrauterine contraceptive device (11%). There were four procedure-related complications, all of which occurred during myomectomy and required hospitalization. CONCLUSION: Operative hysteroscopy is a safe and highly effective therapy for carefully selected women. As a consequence of technological advancements, an increasing number of gynaecological conditions, traditionally treated by laparotomy, can now be treated safely and effectively using outpatient operative hysteroscopy.

Laparoscopic cervicoisthmic cerclage for the treatment of cervical incompetence: case reports.

Cervical insufficiency/incompetence occurs in 0.5-1% of all pregnancies, often resulting in significant pregnancy lost. Three women with a history of second trimester miscarriages after failed transvaginal cervical cerclages were reviewed. A laparoscopic cervicoisthmic cerclage (LCC) was placed before pregnancy without any intra-operative or postoperative complications. Two patients have since delivered live babies at term by Caesarean section. This small case series supports the conclusion that LCC is a safe and cost-effective procedure in properly selected patients. Laparoscopic cervicoisthmic cerclage costs less, is less invasive, has fewer complications and should replace the traditional laparotomy technique.

Uterus bicornis bicollis, imperforate hemivagina and ipsilateral renal agenesis case report and literature review / Útero bicorne bicollis, hemivagina imperforada, y agenesia renal ipsilateral reporte de caso y revisión de la literatura

We present a case of a patient with Uterus bicornis bicollis, imperforate hemivagina and ipsilateral renal agenesis. This group of congenital malformations is often asymptomatic until puberty, when it presents as cyclic dysmenorrhoea, leucorrhoea or a pelvic mass. Magnetic resonance imaging is becoming the preferred modality for delineation of uterine malformations. When congenital abnormalities ofthe reproductive tract are encountered, a search should also be made for renal anomalies. Patients with Uterus bicornis bicollis and unilateral imperforate vagina are often seen with pain severe enough to mimic an acute abdomen. It is important to keep this unusual congenital malformation in mind in the differential diagnosis of vaginal discharge, pelvic mass and/or abdominopelvic pain in young women so as to avoid inappropriate surgical procedures.

Presentamos el caso de una paciente con útero bicorne bicollis, hemivagina imperforada, y agenesia renal ipsilateral. Este grupo de malformaciones congénitas es a menudo asintomático hasta la pubertad, cuando se presenta en forma de dismenorrea cíclica, leucorrea, o una masa pélvica. La imagen por resonancia magnética se está convirtiendo en la modalidad preferida para delinear las malformaciones uterinas. Cuando se encuentran anormalidades del aparato reproductor, debe realizarse también una investigación en busca de anomalías renales. A los pacientes con útero bicorne bicollis y vagina imperforada se les ve a menudo con dolores suficientemente severos como para parecer un abdomen agudo. Es importante tener en mente esta inusual malformación congénita en el diagnóstico diferencial del flujo vaginal, la masa pélvica y/o el dolor pélvico-abdominal en las mujeres jóvenes, a fin de evitar procedimientos quirúrgicos inadecuados.

A randomized comparison of rectal misoprostol with syntometrine on blood loss in the third stage of labour / Comparación randomizada del misoprostol rectal con la sintometrina en la pérdida de sangre en la tercera etapa del parto

OBJECTIVES: a) To compare the clinical effect of rectal misoprostol with intramuscular syntometrine in reducing blood loss in the third stage of labour, b) to determine the severity and incidence of side effects of both drugs and c) to measure blood loss, patient tolerance and acceptance of rectal misoprostol. METHODS: One hundred and forty parturients were randomly allocated to receive intramuscular syntometrine (syntocinon 10 IU + ergometrine 0.5 mg) or rectal misoprostol 400 ?g within five minutes of the delivery of the anterior shoulder. Blood loss was measured by the use of a plastic collection drape. Additional oxytocic therapy was instituted for uterine atony or if blood loss was in excess of one litre. RESULTS: There was no significant difference in patient demographics of each treatment group (Table 1). There was no difference in mean duration of the third stage of labour (8.4 ± 14 min vs 7.8 ± 6.6 min). The mean blood loss from those parturients receiving misoprostol (180.1 ± 120 mls) was not significantly different (p = 0.5) from those receiving syntometrine (197 ± 176.97 mls) for the active management of the third stage of labour. Treatment with syntometrine was associated with a significant elevation of post-partum systolic blood pressure compared with misoprostol treatment (mean increase 0.57 ± 18.79 mmHg vs -1.43 ± 14.17 mmHg, (mean ± SD), p < 0.04). Rectal misoprostol was well tolerated in 88.5% of participants, 11.4% reported that insertion was uncomfortable, of which 2.8% reported that they would have preferred parenteral drug administration. CONCLUSION: The clinical effect of rectal misoprostol and intramuscular syntometrine were not different at the doses used in the active management of the third stage of labour in this study. Rectal misoprostol was well tolerated by the patients and had a low side effect profile. Blood loss assessment using the blood collection drape is of invaluable benefit in resource-poor settings.

OBJETIVOS: a) Comparar el efecto clínico del misoprostol rectal con la sintometrina intramuscular en la reducción de la pérdida de sangre en la tercera etapa del parto, b) determinar la severidad y la incidencia de los efectos colaterales de ambos medicamentos, y c) medir la pérdida de sangre, la tolerancia de las pacientes y la aceptación del misoprostol rectal. MÉTODOS: Ciento cuarenta parturientas fueron elegidas de forma aleatoria para que recibieran la sintometrina intramuscular (syntocinon 10 IU + ergometrina 0.5 mg) o el misoprostol rectal 400 µg dentro de los cinco minutos de la salida del hombro anterior. Se midió la pérdida de sangre usando una bolsa plástica de recolección de sangre. Se instituyó una terapia oxitócica adicional para la atonía uterina o para el caso de que la pérdida de sangre excediera un litro. RESULTADOS: No hubo diferencia significativa en la demografía de los pacientes de cada grupo de tratamiento (tabla 1). No hubo diferencia en la duración promedio de la tercera etapa del parto (8.4 ± 14 min vs 7.8 ± 6.6 min). La pérdida promedio de sangre de las parturientas que recibieron el misoprostol (180.1 ± 120 mls) no fue significativamente diferente (p = 0.5) de las que recibieron sintometrina (197 ± 176.97 mls) para el tratamiento activo de la tercera etapa del parto. El tratamiento con sintometrina estuvo asociado con una elevación significativa de la presión sistólica postparto comparada con el tratamiento con misoprostol (aumento promedio 0.57 ± 18.79 mmHg vs -1.43 ± 14.17 mmHg, (media ± sd), p < 0.04). El misoprostol rectal fue bien tolerado por el 88.5% de las participantes, 11.4% reportaron que la inserción fue incómoda, y de ellas 2.8% reportó que hubieran preferido una administración parenteral del medicamento. CONCLUSIÓN: El efecto clínico del misoprostol rectal y el de la sintometrina intramuscular, no fueron diferentes en las dosis usadas en el tratamiento activo de la tercera etapa del parto en este estudio. El misoprostol rectal fue bien tolerado por las pacientes y tuvo un perfil de efecto colateral bajo. La evaluación de la pérdida de sangre utilizando una bolsa de recolección de sangre posee un valor inapreciable en escenarios de recursos pobres.

Uterus bicornis bicollis, imperforate hemivagina and ipsilateral renal agenesis: case report and literature review.

We present a case of a patient with Uterus bicornis bicollis, imperforate hemivagina and ipsilateral renal agenesis. This group of congenital malformations is often asymptomatic until puberty, when it presents as cyclic dysmenorrhoea, leucorrhoea or a pelvic mass. Magnetic resonance imaging is becoming the preferred modality for delineation of uterine malformations. When congenital abnormalities of the reproductive tract are encountered, a search should also be made for renal anomalies. Patients with Uterus bicornis bicollis and unilateral imperforate vagina are often seen with pain severe enough to mimic an acute abdomen. It is important to keep this unusual congenital malformation in mind in the differential diagnosis of vaginal discharge, pelvic mass and/or abdominopelvic pain in young women so as to avoid inappropriate surgical procedures.

A randomized comparison of rectal misoprostol with syntometrine on blood loss in the third stage of labour.

OBJECTIVES: a) To compare the clinical effect of rectal misoprostol with intramuscular syntometrine in reducing blood loss in the third stage of labour b) to determine the severity and incidence of side effects of both drugs and c) to measure blood loss, patient tolerance and acceptance of rectal misoprostol. METHODS: One hundred and forty parturients were randomly allocated to receive intramuscular syntometrine (syntocinon 10 IU + ergometrine 0.5 mg) or rectal misoprostol 400 microg within five minutes of the delivery of the anterior shoulder Blood loss was measured by the use of a plastic collection drape. Additional oxytocic therapy was instituted for uterine atony or if blood loss was in excess of one litre. RESULTS: There was no significant difference in patient demographics of each treatment group (Table 1). There was no difference in mean duration of the third stage of labour (8.4 +/- 14 min vs 7.8 +/- 6.6 min). The mean blood loss from those parturients receiving misoprostol (180.1 +/- 120 mls) was not significantly different (p = 0.5) from those receiving syntometrine (197 +/- 176.97 mls) for the active management of the third stage of labour Treatment with syntometrine was associated with a significant elevation of post-partum systolic blood pressure compared with misoprostol treatment (mean increase 0.57 +/- 18.79 mmHg vs -1.43 +/- 14.17 mmHg, (mean +/- SD), p < 0.04). Rectal misoprostol was well tolerated in 88.5% of participants, 11.4% reported that insertion was uncomfortable, of which 2.8% reported that they would have preferred parenteral drug administration. CONCLUSION: The clinical effect of rectal misoprostol and intramuscular syntometrine were not different at the doses used in the active management of the third stage of labour in this study. Rectal misoprostol was well tolerated by the patients and had a low side effect profile. Blood loss assessment using the blood collection drape is of invaluable benefit in resource-poor settings.

In-vitro fertilization: donor egg sharing for premature ovarian failure.

Premature ovarian failure may be a consequence of gonadotoxic cytotoxic chemotherapy or radiation therapy for malignant or systemic disease often resulting in major quality of life concerns. This is the first reported case in the English-speaking Caribbean using in-vitro fertilization (IVF) donor egg sharing in a patient who experienced premature ovarian failure following chemotherapy and radiation for Hodgkin's disease. The donor's indication was tubal factor infertility. Both patients delivered healthy infants.

Normal ultrasound in abdominal trauma - clinical outcomes

Imaging plays an increasingly important role in trauma and the access to CT scans in more advanced centres has decreased the number of exploratory laparotomies. Ultrasound has not been given the status of CT scanning in trauma centres because it does not give a panoramic view of the abdomen, is operator dependent and surgeons are not as "comfortable" with the images generated. It is however cheaper and more readily available than CTs, especially in developing countries. The aim of this study is to determine the negative value of abdominal ultrasound in trauma. A retrospective study was done using data from the Ultrasound register of the Radiology Department and the Trauma Registry of the Department of Surgery for the period 1st August 1998 to 28th February 1999. Sixty-four (64) patients had normal abdominal ultrasounds: twenty-four (24) for penetrating and forty (40) for blunt trauma. Fifteen (15) patients were female and forty-nine (49) male. Fifty-five (55) patients were discharged from A&E. Nine (9) patients were admitted to the ward of which eight (8) were subsequently discharged without surgical intervention. One (1) patient had an exploratory laparotomy which was negative for injury. No patient developed problems on follow-up. In this preliminary study, normal ultrasound in blunt or penetrating trauma had a 100 percent negative predictive value. We conclude that in competent hands, ultra-sound is useful in decreasing both the number of admissions to hospitals and the need for exploratory laparotomies.(AU)

Transient disappearance of a symptomatic macular hyperfluorescent lesion following vitrectomy: a case report.

We have presented a case of symptomatic macular fluorescence of a presumed vascular etiology that transiently disappeared post vitrectomy. Laser photocoagulation to the involved area resulted in a good visual outcome. We propose that the transient improvement in the fluorescein leakage represented a temporary alteration of cellular metabolism, or vascular perfusion, attributable to the perfusion solution. We suggest that additional studies are indicated to further explore this phenomenon and its potential clinical applicability.