Sonohysterography: Time to step up its use in gynaecologic imaging in west Africa

Sonohysterography is a simple, safe and convenient technique that is easily and rapidly performed in the ultrasound room; yet the technique seems to be underutilized in West Africa. We present two cases that weresuccessfully done in our centre followed by detailed description, uses and challenges of the technique, with the hope of encouraging clinicians and sonographers in the sub-region to step up its use. Two women were referred for evaluation of their endometrial cavities on account of increasingly heavy menstrual bleeding. Sonohysterography revealed intracavity uterine masses with hyperechoic focal thickening highly suggestive of endometrial polyps; histology confirmed the diagnosis of endometrial polyps. Sonohysterography is an affordable and feasible diagnostic modality for evaluating the endometrial cavity. Where equipment and skill permit, the technique should be used more often in the West African sub-region.Keywords: Sonohysterography, transvaginal sonography, gynaecologic imaging, West Afric

Spontaneous Heterotopic Pregnancy With Live Infant: Report Of Two Cases

Heterotopic pregnancy is a potentially fatal condition that rarely occurs in natural conception cycles. We report two cases diagnosed within one month in a 20 year old gravida 3, para 0+2 without any known risk factor and a 38 year old gravida 12, para 6+5 with risk factors. The ectopic pregnancies were diagnosed after rupturing at 10 and 17 weeks respectively and resected via laparotomies. The courses of the intrauterine pregnancies were uneventful and both clients delivered vaginally at term. Heterotopic pregnancy is an important differential diagnosis to consider in clients with intrauterine pregnancies presenting with acute abdominal pain and haemoperitoneum

Case ReportsVulvar Lipoma: Is it so Rare?

Vulvar lipoma is said to be so rare that only a few cases have been reported. We present two cases of vulvar lipoma that were diagnosed within six months in our centre in a 28 year-old para 2 and 35 year-old para 1 woman both of whom presented with slow-growing masses in the vulva. A detailed discussion of the clinical features and current management options are outlined, with emphasis on the need to subject all excised lesions to histopathological evaluation; to ensure accurate diagnosis and differentiate this benign swelling from cystic swellings and malignant neoplasms in the vulva.Keywords: Vulva, lipoma, benign neoplasm, surgical excisionGhana Medical Journal, September 2011, Volume 45, Number

Pooled analysis of WHO Surgical Safety Checklist use and mortality after emergency laparotomy

Background The World Health Organization (WHO) Surgical Safety Checklist has fostered safe practice for 10 years, yet its place in emergency surgery has not been assessed on a global scale. The aim of this study was to evaluate reported checklist use in emergency settings and examine the relationship with perioperative mortality in patients who had emergency laparotomy. Methods In two multinational cohort studies, adults undergoing emergency laparotomy were compared with those having elective gastrointestinal surgery. Relationships between reported checklist use and mortality were determined using multivariable logistic regression and bootstrapped simulation. Results Of 12 296 patients included from 76 countries, 4843 underwent emergency laparotomy. After adjusting for patient and disease factors, checklist use before emergency laparotomy was more common in countries with a high Human Development Index (HDI) (2455 of 2741, 89.6 per cent) compared with that in countries with a middle (753 of 1242, 60.6 per cent; odds ratio (OR) 0.17, 95 per cent c.i. 0.14 to 0.21, P <0001) or low (363 of 860, 422 per cent; OR 008, 007 to 010, P <0.001) HDI. Checklist use was less common in elective surgery than for emergency laparotomy in high-HDI countries (risk difference -94 (95 per cent c.i. -11.9 to -6.9) per cent; P <0001), but the relationship was reversed in low-HDI countries (+121 (+7.0 to +173) per cent; P <0001). In multivariable models, checklist use was associated with a lower 30-day perioperative mortality (OR 0.60, 0.50 to 073; P <0.001). The greatest absolute benefit was seen for emergency surgery in low- and middle-HDI countries. Conclusion Checklist use in emergency laparotomy was associated with a significantly lower perioperative mortality rate. Checklist use in low-HDI countries was half that in high-HDI countries.Peer reviewe

Global variation in anastomosis and end colostomy formation following left-sided colorectal resection

Background End colostomy rates following colorectal resection vary across institutions in high-income settings, being influenced by patient, disease, surgeon and system factors. This study aimed to assess global variation in end colostomy rates after left-sided colorectal resection. Methods This study comprised an analysis of GlobalSurg-1 and -2 international, prospective, observational cohort studies (2014, 2016), including consecutive adult patients undergoing elective or emergency left-sided colorectal resection within discrete 2-week windows. Countries were grouped into high-, middle- and low-income tertiles according to the United Nations Human Development Index (HDI). Factors associated with colostomy formation versus primary anastomosis were explored using a multilevel, multivariable logistic regression model. Results In total, 1635 patients from 242 hospitals in 57 countries undergoing left-sided colorectal resection were included: 113 (6·9 per cent) from low-HDI, 254 (15·5 per cent) from middle-HDI and 1268 (77·6 per cent) from high-HDI countries. There was a higher proportion of patients with perforated disease (57·5, 40·9 and 35·4 per cent; P < 0·001) and subsequent use of end colostomy (52·2, 24·8 and 18·9 per cent; P < 0·001) in low- compared with middle- and high-HDI settings. The association with colostomy use in low-HDI settings persisted (odds ratio (OR) 3·20, 95 per cent c.i. 1·35 to 7·57; P = 0·008) after risk adjustment for malignant disease (OR 2·34, 1·65 to 3·32; P < 0·001), emergency surgery (OR 4·08, 2·73 to 6·10; P < 0·001), time to operation at least 48 h (OR 1·99, 1·28 to 3·09; P = 0·002) and disease perforation (OR 4·00, 2·81 to 5·69; P < 0·001). Conclusion Global differences existed in the proportion of patients receiving end stomas after left-sided colorectal resection based on income, which went beyond case mix alone

Sonohysterography: Time to Step up its Use in Gynaecologic Imaging in West Africa

Sonohysterography is a simple, safe and convenient technique that is easily and rapidly performed in the ultrasound room; yet the technique seems to be underutilized in West Africa. We present two cases that were successfully carried out in our centre followed by detailed description, uses and challenges of the technique, with the hope of encouraging clinicians and sonographers in the sub-region to step up its use. Two women were referred for evaluation of their endometrial cavities on account of increasingly heavy menstrual bleeding. Sonohysterography revealed intracavity uterine masses with hyper-echoic focal thickening highly suggestive of endometrial polyps; histology confirmed the diagnosis of endometrial polyps. Sonohysterography is an affordable and feasible diagnostic modality for evaluating the endometrial cavity. Where equipment and skill permit, the technique should be used more often in the West African sub-region.La sonohyst&eacute;rographie est une technique simple, non dangereuse et commode, qui est accomplie dans la salle d'ultrason ; pourtant, il semble que la technique est sous utilis&eacute;e en Afrique de l'Ouest. Nous pr&eacute;sentons deux cas qui ont &eacute;t&eacute; accomplis dans notre centre, suivi d'une description d&eacute;taill&eacute;e, l'emploi et les d&eacute;fis de la technique, avec l'espoir d'aider des cliniciens et des sonographes de la sous&ndash;r&eacute;gion &agrave; augmenter son emploi. Deux femmes nous ont &eacute;t&eacute; envoy&eacute;es pour l'&eacute;valuation de leurs cavit&eacute;s endom&eacute;triales &agrave; cause dune h&eacute;morragie menstruelle excessive. La sonohyst&eacute;rographie a r&eacute;v&eacute;l&eacute; des masses ut&eacute;rines d'intra cavit&eacute;, ayant un &eacute;paissement focaux hyper-r&eacute;sonnant qui indique la pr&eacute;sence des polypes endom&eacute;triales; l'histologie a confirm&eacute; le diagnostic de polypes endom&eacute;triales. La sonohyst&eacute;rographie est une modalit&eacute; diagnostique faisable et abordable pour &eacute;valuer la cavit&eacute; endom&eacute;triale. L&agrave; ou l'on se dispose des &eacute;quipements et le savoir- faire, il faut se servir de la technique plus souvent dans la sous-r&eacute;gion ouest africaine.Key words: Sonohysterography, transvaginal sonography, gynaecologic imaging, West Afric

Advanced Alveolar Rhabdomyosarcoma of the Uterus: A Case Report

Alveolar rhabdomyosarcoma is an uncommon malignant soft tissue tumour rarely found in the female genital tract and carries a very poor prognosis especially in adults. A 44 year old premenopausal womanwas evaluated for a lower abdominal mass, intermittent unprovoked vaginal bleeding and weight loss. Examination showed a huge abdomino-pelvic mass, and an irregular cauliflower mass protruding from the cervix, from which a biopsy was taken. Exploratory laparotomy revealed a widespread disseminated uterine tumour with an “omental cake” and involving virtually all the abdominal viscera. Debulkingsurgery was found to be non-beneficial and uterine and omental biopsies were taken. The cervical, uterine and omental biopsies were all diagnosed alveolar rhabdomyosarcoma. Neither chemotherapy norradiotherapy could be started before the client died of fulminant neoplastic dissemination 17days postoperatively.While the optimal management of this rare tumour is unknown, early recognition and diagnosis, and a prompt multimodality treatment approach of surgery, chemotherapy and radiotherapy offers the best chance of cure (Afr J Reprod Health 2009; 13[1]:167-173)

Determinants of stillbirths in Ghana: does quality of antenatal care matter?

BACKGROUND: Each year, over two million babies die before they are born. Like maternal deaths, the great majority of these stillbirths occur in developing countries, with about a third of all cases worldwide in sub-Saharan Africa (SSA). Few studies have, however, examined the determinants of stillbirths in SSA. In addition, the emphases on promoting deliveries by skilled birth attendants and/or in health facilities to prevent maternal deaths, though important, may have undermined efforts to provide good quality antenatal care (ANC), which may have an additional role in preventing stillbirths. This study examines the factors associated with stillbirths in Ghana, focusing on the role of ANC quality. METHODS: Data are from the Ghana Maternal Health Survey (N = 4,868)—a national survey of women of reproductive age. The main analysis includes women who had a pregnancy ending in a live birth or stillbirth in the five years preceding the survey and who received ANC at least once. ANC quality is measured by an index based on receipt (or otherwise) of nine antenatal services during the last pregnancy, including education about pregnancy complications; with receipt of at least of eight services classified as higher quality ANC. Stillbirths refer to babies born dead at seven or more months of pregnancy. Analytic techniques include multilevel logistic regression, with moderation and mediation analysis to examine conditional and intervening effects respectively. RESULTS: Higher quality ANC decreases the odds of a stillbirth by almost half after accounting for other factors, including the type of delivery provider and facility. Educating pregnant women about pregnancy complications contributes significantly to this difference by ANC quality. The type of delivery facility and provider account for a small proportion (14 %) of the ANC quality effect on stillbirths and a larger proportion of the rural/urban difference (27 %) in stillbirths. Completing the recommended four antenatal visits decreases the odds of a stillbirth. Having a pregnancy complication, a multiple gestation, a past stillbirth, or a sister who died from pregnancy complications increases the odds of a stillbirth. CONCLUSIONS: Good quality ANC can improve birth outcomes in two ways: directly through preventative measures, and indirectly through promoting deliveries in health facilities where complications can be better managed. Targeted programs and policies to increase ANC quality, including adequately educating women on pregnancy complications, will help improve birth outcomes in Ghana, and in SSA as a whole. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1186/s12884-016-0925-9) contains supplementary material, which is available to authorized users