Control of Postpartum Haemorrhage with Uterine Balloon Tamponade Using Foley Catheter in a Rural Mission Hospital in Ebonyi State, Southeast Nigeria

Background: Postpartum haemorrhage is the leading cause of maternal deaths worldwide, the majority of which occur in low resource settings. Uterine atony is the commonest cause of postpartum haemorrhage. Uterine balloon tamponade (UBT) is an effective method of treating refractory postpartum haemorrhage. Aim: Commercial UBT devices are often not affordable and not readily available in rural settings. The aim of this paper is to report on three cases of postpartum haemorrhage successfully managed with uterine balloon tamponade using Foley catheters. Case Reports: We report on three patients with major obstetric haemorrhage from uterine atony who were successfully managed with uterine balloon tamponade using Foley’s urethral catheter. The first two patients had primary postpartum haemorrhage while the third patient had significant bleeding during the surgical evacuation of the uterus for a molar pregnancy. In each case, uterine bleeding was refractory to pharmacologic uterotonics. They all had uterine tamponade with a Foley catheter with the dramatic resolution of their bleeding. Conclusion: In well-selected patients, uterine balloon tamponade with Foley catheter is cheap, arrests bleeding and prevents clinical deterioration among women with refractory postpartum haemorrhage, especially in low resource settings where commercial balloon tamponade may not be available or affordable.

Hepatobiliary manifestations following two-stages elective laparoscopic restorative proctocolectomy for patients with ulcerative colitis:A prospective observational study

BACKGROUND Hepatobiliary manifestations occur in ulcerative colitis(UC)patients.The effect of laparoscopic restorative proctocolectomy(LRP)with ileal pouch anal anastomosis(IPAA)on hepatobiliary manifestations is debated.AIM To evaluate hepatobiliary changes after two-stages elective laparoscopic restorative proctocolectomy for patients with UC.METHODS Between June 2013 and June 2018,167 patients with hepatobiliary symptoms underwent two-stage elective LRP for UC in a prospective observational study.Patients with UC and having at least one hepatobiliary manifestation who underwent LRP with IPAA were included in the study.The patients were followed up for four years to assess the outcomes of hepatobiliary manifestations.RESULTS The patients'mean age was 36±8 years,and males predominated(67.1%).The most common hepatobiliary diagnostic method was liver biopsy(85.6%),followed by Magnetic resonance cholangiopancreatography(63.5%),Antineutrophil cytoplasmic antibodies(62.5%),abdominal ultrasonography(35.9%),and Endoscopic retrograde cholangiopancreatography(6%).The most common hepatobiliary symptom was Primary sclerosing cholangitis(PSC)(62.3%),followed by fatty liver(16.8%)and gallbladder stone(10.2%).66.4%of patients showed a stable course after surgery.Progressive or regressive courses occurred in 16.8%of each.Mortality was 6%,and recurrence or progression of symptoms required surgery for 15%.Most PSC patients(87.5%)had a stable course,and only 12.5%became worse.Two-thirds(64.3%)of fatty liver patients showed a regressive course,while one-third(35.7%)showed a stable course.Survival rates were 98.8%,97%,95.8%,and 94%at 12 mo,24 mo,36 mo,and at the end of the follow-up.CONCLUSION In patients with UC who had LRP,there is a positive impact on hepatobiliary disease.It caused an improvement in PSC and fatty liver disease.The most prevalent unchanged course was PSC,while the most common improvement was fatty liver disease.

Pattern of Presentation and Associated Morbidities of Women Presenting with Postmenopausal Bleeding

Background: Postmenopausal bleeding (PMB) is caused mainly by benign disorders;however it is sometimes caused by endometrial cancer. Aim: We here attempted to determine what conditions account for PMB in an outpatient clinic of a University hospital in London. Methodology: Study subjects consisted of 179 patients with PMB who were referred to us from July to December 2019. Sociodemographic data including patient’s age, risk factors, diagnosis and management were reviewed. Underlying conditions where determined. Results: Of 179 subjects, the following findings were made: 1) Age 59.63 ± 8.3 (mean and standard deviation). 2) Parity;multiparity, 57.0% (mean ± 1.67). 3) First episode of PMB, 77.1%. 4) The most frequently observed risk factor;obesity 34.6%. 5) The following accounted for PMB (diagnosis in order of incidence rate);genital atrophy 37.4%, submucosal fibroid 28.5%, endometrial polyp 20.7%, endometrial hyperplasia 6.7%, and endometrial cancer 5.6%. All patients were treated appropriately. We did not determine the prognosis of patients with endometrial cancer. Conclusion: Although the incidence of rate among women with PMB has already been reported, its reconfirmation in a single facility is important for making policies in the treatment of PMB.

产后子痫发生可逆性脑白质病变

This case report describes an atypical presentation of eclampsia. A 26- year- old lady presented 5 days’ postpartum with a series of grand mal seizures after an uneventful pregnancy and delivery. An MRI scan of the brain showed areas of low signal involving cerebral white matter and right cerebellum. Within 2 weeks, all symptoms and radiologic abnormalities had resolved.

CathCam引导导丝行结肠镜检查:首次针对既往未完成结肠镜检查患者的先导性研究

Background and Study Aims:Conventional colonoscopy as the gold standard for large-bowel diagnostics and therapy may fail in 5%-20%of cases,depending on the experience of the examiner.Colonoscopy is regarded as difficult and painful by many patients.In an attempt to overcome the limitations of conventional colonoscopes,a guide wire-directed,thin,flexible diagnostic colonoscope,the CathCam was developed.In this prospective pilot study,we report its use in patients in whom conventional colonoscopy had failed.Patients and Methods:49 patients with a previous or current failure of complete colonoscopy were invited to participate in a trial using the new CathCam system,and 14(nine men;mean age 59 years)accepted.The CathCam is an 11-mm diameter disposable,multilumen catheter,with visualization by a 3-mm camera with six light-emitting diodes.In the first five patients,the CathCam was inserted over a newly developed 0.024-inch,hinged,lumen-seeking guide wire.Subsequently,a modified combined approach was used:a conventional colonoscope was introduced into the sigmoid or left colon,then the guide wire was advanced as far as possible,followed by CathCam insertion over it.Caecal intubation rate,insertion times and patient discomfort were recorded;patients received low-dose midazolam sedation(2-5 mg).Results:One patient was excluded during colonoscopy.The caecum could be eventually reached in 12 of 13 patients;in the remaining patient a significant sigmoid stricture could be passed,but further advancement appeared too risky.The mean caecal intubation time was 24 minutes(range 3-105 min).Only two patients experienced pain and discomfort during the procedure(one immediate assessment and one case reported at later telephone interview).No complications occurred,and previously undiagnosed important findings were obtained in 9 cases.Conclusions:A combined approach,consisting of guide wire insertion via a partially introduced colonoscope followed by CathCam or colonoscope insertion into the caecum was successful in over 90%of patients with previous failure of complete colonoscopy.Further improvements may make this system suitable for use as a standard diagnostic colonoscope,either as a single unit(CathCam plus guide wire)or using the guide wire alone with a standard colonoscope in difficult cases.

早产儿和足月儿尿柠檬酸盐浓度分析

Objectives: (1) To determine a normal range for urinary citrate for term babies.(2) To compare urinary citrate measured in ex preterm babies at term with this normal range.(3) To evaluate whether urinary citrate was related to presence of nephrocalcinosis (NC) and chronicLung Disease (CLD) in these ex preterm babies.Study design: Urinary citrate was measured in 38 healthy term babies (mean birth weight 3.52 kg, mean gestation 41weeks) at amean postnatal age of 3 days (1-5 days) and in 53 ex preterm babies ( < 32 weeks gestation at birth) at term.These preterm babies were part of a larger study on NC in which two renal ultrasound scans were performed at 1 month and term.Results: The normal range for urinary citrate in term babies was 0.025-2.97 (mean 1.03) mmol/l and citrate/creatinine ratio 0.0011-0.852 (mean 0.27).In the ex-preterm urinary citrate was not significantly different (mean 1.1 vs.1.03, p=0.7232)-but urine citrate /creatinine ratio was significantly higher (mean 1.27 vs.0.27, p=0.0005).There was no significant difference in urinary citrate or ratios of citrate/creatinine and calcium/citrate in the 11 (20.7%) with NC or in the 17 (32%) babies with CLD.There was no significant relationship found between duration of TPN and urinary citrate measured at term.Conclusion: We have determined a normal range for urinary citrate in healthy term babies in the first week of life.The range was very wide.Ex preterm babies had similar values at term and there was no association between urinary citrate and NC or CLD.

早产儿和足月儿尿液中的柠檬酸盐

Objectives: (1) To determine a normal range for urinary citrate for term babi es. (2) To compare urinary citrate measured in ex preterm babies at term with th is normal range. (3) To evaluate whether urinary citrate was related to presence of nephrocalcinosis (NC) and chronic Lung Disease (CLD) in these ex preterm bab ies. Study design: Urinary citrate was measured in 38 healthy term babies (mean birth weight 3.52 kg, mean gestation 41weeks) at amean postnatal age of 3 days ( 1- 5 days) and in 53 ex preterm babies ( < 32 weeks gestation at birth) at term . These preterm babies were part of a larger study on NC in which two renal ultr asound scans were performed at 1 month and term. Results: The normal range for u rinary citrate in term babies was 0.025- 2.97 (mean 1.03) mmol/l and citrate/cr eatinine ratio 0.0011- 0.852 (mean 0.27). In the ex- preterm urinary citrate w as not significantly different (mean 1.1 vs. 1.03, p=0.7232)- but urine citrate /creatinine ratio was significantly higher (mean 1.27 vs. 0.27, p=0.0005). There was no significant difference in urinary citrate or ratios of citrate/creatinin e and calcium/citrate in the 11 (20.7% ) with NC or in the 17 (32% ) babies wi th CLD. There was no significant relationship found between duration of TPN and urinary citrate measured at term. Conclusion: We have determined a normal range for urinary citrate in healthy term babies in the first week of life. The range was very wide. Ex preterm babies had similar values at term and there was no ass ociation between urinary citrate and NC or CLD.

Sigmoid Volvulus, Intestinal Obstruction and Bowel Perforation;an Unusual Presentation of Pedunculated Fibroid Torsion. Case Report

Pedunculated fibroid torsion presenting as a case of acute abdomen from sigmoid volvulus and large bowel perforation is rare. Without prompt diagnosis and intervention, this could lead to serious morbidity and mortality. Ms FM was a 52-year-old perimenopusal woman who was admitted to the Intensive Therapy Unit (ITU) with worsening symptoms of confirmed Covid-19 infection. On the 10th day of her admission, she developed abdominal distension and tenderness. A pelvic ultrasound scan showed a large pedunculated fibroid measuring 23 × 15 × 22 cm. The plan was for conservative management to use pain killers. Following deterioration of her clinical state, an abdominal CT scan was done which confirmed a large uterine fibroid, large bowel distention. CT findings also showed sigmoid volvulus and large bowel perforation. Following a multidisciplinary team assessment, she had an emergency exploratory laparotomy with findings of a large, torted, pedunculated fibroid with adherent sigmoid colon which had become twisted and obstructed. The large bowel segment above the Sigmoid volvulus was grossly distended and there was a gangrenous hepatic flexure with perforation. She had a right hemicolectomy, a de-functioning colostomy and subtotal hysterectomy. Postoperatively, she made very good clinical improvement. Fibroid histology report showed tissue infarction and necrosis which confirmed the torsion. She was discharged home after making good recovery.

抗抑郁药和抑郁症的5-羟色胺假说--即使没有“化学失衡”解释,抗抑郁药仍然是治疗抑郁症的有效方法

近来,一篇关于抑郁症5-羟色胺学说证据的伞形综述^(1)在英国被媒体广泛报道,综述作者认为抑郁症不是由5-羟色胺水平低或“化学失衡”造成的,因此公众对应用5-羟色胺再摄取抑制剂(SSRI)类抗抑郁药治疗抑郁症提出了质疑^(2-5)。

结直肠癌

结直肠癌是常见的、无特异临床表现、且生存时间与确诊时疾病分期密切相关的恶性肿瘤。本综述将讨论该疾病的临床表现、病人需要接受专科紧急处理的标准，以及旨在降低结直肠癌死亡率的国家筛查计划的进展。许多全科医生也会建议可疑结直肠癌患者直接进行检查，此综述同时还对具有结直肠癌症状的患者所采用的不同检查手段进行了阐述。