Endometrial resection in the treatment of persistent metrorrhagia

STUDY OBJECTIVE: To evaluate the efficacy of hysteroscopic endometrial resection such us a surgical alternative to hysterectomy in treating abnormal uterine bleeding unresponsive to treatment with progestogens. METHODES: A retrospective analysis was carried out on 54 patients who underwent endometrial ablation for abnormal uterine bleeding unresponsive to conservative medical management between January 1, 1991, and December 31, 1998. The average patient was 43 years (Range: 36-57 years) and was followed for a mean of 37 months (range 12-80 months). RESULTS: 83.3% of women were satisfied during the study period. The overall amenorrhea rate was 29.62%. Only 16.66% of subjects reported no improvement. Histologic analysis of the endomyometrial specimens revelated hyperplasia in 48.1% of cases, atrophy in 3.7% of cases and adenomyosis in 44.6% of cases. 8 women (14.8%) needed secondary hysterectomy for continued symptoms during a mean follow up of 10 months. Adenomyosis was present in 4 specimens (50%), myomas in 3 specimens (37.5%), and the association in 1 specimen (12.5%). CONCLUSION: Endometrial ablation is a safe and effective hysteroscopic procedure for dysfunctional uterine bleeding, its prognosis depends of several factors, that shows the importance of patients selection.     

Endometrial carcinomas in Gabon. A study of 34 cases in 11 years: 1988-1998

The aim of this retrospective study was to determine the importance of endometrium cancer in Gabon over an eleven-year period (1988-1998). We studied 34 cases from the register of cancers at the Faculty of Medicine in Libreville. The incidence of endometrium cancers was 5.3%. The patients came from areas with medical care facilities. They were all mature women with a mean age of 58.8 years (range: 34 to 80 years). Most of these women were menopausal (88. 24%). Uterine bleeding was the main symptom (100% of cases). Histologically, endometrium adenocarcinomas (79.41%) were the most frequently observed. The setting up of medical facilities in rural areas and efforts to provide the population with information concerning these cancers may affect the incidence and prognosis of endometrium cancer in Gabon.     

Respiratory disease associated with community air pollution and a steel mill, Utah Valley.

This study assessed the association between hospital admissions and fine particulate pollution (PM10) in Utah Valley during the period April 1985-February 1988. This time period included the closure and reopening of the local steel mill, the primary source of PM10. An association between elevated PM10 levels and hospital admissions for pneumonia, pleurisy, bronchitis, and asthma was observed. During months when 24-hour PM10 levels exceeded 150 micrograms/m3, average admissions for children nearly tripled; in adults, the increase in admissions was 44 per cent. During months with mean PM10 levels greater than or equal to 50 micrograms/m3 average admissions for children and adults increased by 89 and 47 per cent, respectively. During the winter months when the steel mill was open, PM10 levels were nearly double the levels experienced during the winter months when the mill was closed. This occurred even though relatively stagnant air was experienced during the winter the mill was closed. Children's admissions were two to three times higher during the winters when the mill was open compared to when it was closed. Regression analysis also revealed that PM10 levels were strongly correlated with hospital admissions. They were more strongly correlated with children's admissions than with adult admissions and were more strongly correlated with admissions for bronchitis and asthma than with admissions for pneumonia and pleurisy.     

Increasing United States hospital admissions for acute pancreatitis, 1988-2003

PURPOSE: To examine the epidemiology of hospital admissions for acute pancreatitis in the United States. METHODS: We compiled data from the 1988-2003 National Hospital Discharge Survey and analyzed it with respect to patient demographics, hospital type and region, procedures performed, length of hospital stay, and inpatient mortality. RESULTS: Hospital admissions for acute pancreatitis increased from a 1988 low of 101,000 (95% confidence interval [CI]: 87,000-116,000) to a 2002 peak of 210,000 (95% CI: 186,000-234,000). The corresponding admission rate increased from 0.4 to 0.7 hospitalizations per 1000 U.S. population (p = 0.001). The patients' average age was 53 years, 51% were male, and 23% were black. The hospitalization rate was higher among blacks (0.9; 95% CI, 0.6-1.1) than among whites (0.4; 95% CI, 0.3-0.5). The mean length of stay was 6.9 days and decreased over the study period. Overall mortality was 2%, with increasing age and male gender comprising independent risk factors for death. CONCLUSIONS: The hospitalization rate for acute pancreatitis in the United States is rising and is higher in blacks than in whites. Further research is necessary to identify the cause(s) of increasing pancreatitis admissions, the observed racial disparity, and the cost of these admissions.     

Epidemiology of juvenile insulin-dependent diabetes in Algeria (Wilaya of Oran)

In order to precise the prevalence and incidence of IDDM in a well characterized population, we have ascertained between 1979 and 1988 all juvenile diabetic patients living in the department of Oran (Wilaya of Oran), Algeria, aged less than 20 years at the date of Dec. 31th 1988 who had onset of the disease before 15 years old. Cross comparisons of the data obtained both by a IDDM registry and a questionnaire sent to the practitioners show an excellent correlation. A total of 173 families was studied, including 155 Simplex Families (SF), and 18 Multiplex Families (MF). The prevalence was 0.27 p. 1000 among children aged less than 15 years. The annual incidence (mean = 4.4 p. 100,000) increased regularly from 1.6 p. 100,000 in 1981 to 8.1 p. 100,000 in 1988. The prevalence of IDDM among siblings was 3.8%. The birth order of index cases (first affected siblings) was lower in MF (3.0 +/- 0.4) than both in index cases of SF (4.0 +/- 0.3; p less than 0.01) and in secondary affected siblings of MF (4.8 +/- 0.05; p less than 0.001). The frequency of 2nd degree consanguineous marriages (between first cousins) was greater among the IDDM families compared with control families: 25% vs 11% (RR = 2.9; p less than 0.001).     

Trends of the characteristics and appropriateness of admissions to acute geriatric and medical wards in Italy from 1988 through 1993

Recent modifications in the health care system in Italy reduced the number of inpatient care beds and limited the access to outpatient services while the proportion of older persons increased. To assess the burden of these changes on hospital care the characteristics of admissions to 35 acute geriatric wards and 31 internal medicine wards in Italy were studied between 1988 and 1993. All patients admitted during 4 months in 1988, 1 month in 1991 and 4 months in 1993 were enrolled in the study. The appropriateness of admission was assessed by means of the Appropriateness Evaluation Protocol criteria. The Charlson comorbidity index score was used to quantify comorbidity. Between 1988 and 1993, 18,790 patients were studied. The mean age increased from 67.9 ± 0.2 to 71.7 ± 0.2 years (p < 0.0001), the mean number of drugs taken during hospital stay increased from 5.2 ± 0.0 to 5.5 ± 0.0 drugs (p < 0.0001), the mean Charlson comorbidity index score increased from 1.33 ± 0.02 to 1.50 ± 0.03 (p < 0.0001) and the mean length of stay decreased from 17.6 ± 0.2 to 16.1 ± 0.2 days (p < 0.0001). The rate of appropriate admissions increased from 68.6% to 85.5% (p < 0.0001). Consistent results were found when the data were stratified according to gender and type of ward. It was concluded that in Italy, concurrently to an increased load of hospital care, inappropriate admissions diminished over time. These data show that the need for geriatric care is increasing.Abbreviations ATC anatomical therapeutic and chemical codes - GIFA Gruppo Italiano di Farmacovigilanza nell'Anziano — Italian Group of Pharmacoepidemiology in the Elderly The GIFA investigators are listed in the Appendix.     

Evaluation by Doppler echocardiography of hemodynamic profil of mitral bileaflet prothesis. Report on 90 cases

From 1981 to 1999 Mitral bileaflet prosthesis was implanted to 90 patients. Doppler echocardiography was performed for these patients between January and March 2002 with a mean deadline of 111 months after the intervention. 36 were women (40%) and 54 were men (60%) the mean age was 41 years (20 - 70 years) The mitral bileaflet prosthesis was a Saint Jude in 65 cases, Jyros 8 cases, Carbomédics 7 cases, Sorin Bicarbon 7 cases, Edwards Duromédics 2 cases et an ON-X in one case. The maximal transprosthetic gradient was 15.7 mm Hg +/- 5.06 (6.25 mm Hg). The mean transprosthetic gradient was 5.6 mm Hg +/- 1.07 (39.5 mmHg). The mean prosthesis functional area 2.37 cm2 +/- 0.44 (1.75 cm2 et 3.60 cm2). Maximal gradient, mean gradient and prosthesis functional area are independent from kind mitral bileaflet prosthesis and from the prosthesis size.     

Poliomyelitis outbreak--Republic of the Congo, September 2010-February 2011

On November 4, 2010, a case of wild poliovirus type 1 (WPV1) was confirmed in a resident of the port city, Pointe Noire, the first WPV case in Republic of the Congo (ROC) in 10 years. The WPV1 isolate from this resident was genetically most closely related to WPV1 isolated in Angola in 2010. Subsequent investigation, including active case finding, revealed increased acute flaccid paralysis (AFP) hospital admissions beginning in September. Weekly admissions rose from approximately 10 AFP patients in early October to approximately 80 by the end of October and November. With response immunization activities, weekly AFP admissions fell to fewer than five by the end of December. A provisional total of 554 AFP cases were identified nationally, with paralysis onset from September 20, 2010, to February 27, 2011; 374 (68%) of the AFP cases were among males. Overall, 465 (84%) AFP cases were among residents of the neighboring departments of Kouilou and Pointe Noire, where the outbreak apparently began and where approximately 21% of ROC's 4.2 million persons reside. The case-fatality rate (CFR) in Kouilou and Pointe Noire was 40% (187 deaths of 465 cases), compared with 11% (10 of 89) elsewhere in ROC. Additionally, the median age of patients with AFP in Kouilou and Pointe Noire was 20 years (range: 0-63 years), compared with 7.5 years (range: 1-68 years) elsewhere in ROC.     

Trends in Canadian infant pertussis hospitalizations in the pre- and post-acellular vaccine era, 1981–2016

ObjectiveThe acellular pertussis vaccine was introduced into the routine childhood immunization schedule across Canada in 1997–98 and adolescent booster doses were added between 1999 and 2005. We sought to assess the impact of these changes on infant pertussis hospitalizations and admissions to intensive care units (ICU) in Canada.MethodsHospitalizations with a primary diagnosis of pertussis were extracted from the Canadian Discharge Abstract Database (DAD) for cases with hospital discharge dates between 1981 and 2016 using relevant ICD-9 and ICD-10 codes. Only cases with age less than one year at time of admission were included. Disease severity was assessed by admission to ICU. Cases were categorized into two periods: pre-program implementation period (1981–1995) and the post-program implementation period (2006–2016). Incidence rates, risk ratios, and rate differences were calculated for each period and comparisons for the two periods were done using chi-squared and t-tests. Quasi Poisson analysis was used to investigate trends.ResultsWhen comparing the pre- and post-implementation periods, the average annual hospitalization rates for infants less than 1 year declined from 165.1 (95% CI 161.3, 168.9) to 33.6 (95% CI 31.6, 35.6) pertussis-related admissions per 100,000 population, with a corresponding reduction in the risk ratio of 4.9 (95% CI 4.6, 5.2). The risk of admission into an ICU was 1.58 times higher in the pre- versus post-implementation period while the highest reduction in average annual hospitalizations was 263.3 admissions per 100,000 population in infants 2 months of age. In the post-implementation period, infants less than 1 month of age had the highest average annual hospitalization rate at 126.6 (95% CI 113.1, 140.1) hospitalizations per 100,000 infants.ConclusionInfant pertussis hospitalizations have reduced greatly over time. Infants under 2 months of age remain the most at-risk age group for hospitalization and admission to ICU.     

Parasuicide in central London 1984-1988.

Experience of a central London unit dedicated to the care of patients following parasuicide between 1984 and 1988 is reviewed. There were 1160 admissions, which accounted for 11% of all acute adult medical admissions. The female to male ratio was 1.3, with a peak rate for females below 25 years and for males between 20 and 35. Unemployment was found to be a risk factor for parasuicide in men. Benzodiazepines were the most frequently used drug in parasuicide (35%), followed by paracetamol (13%) and aspirin (9%).     

Contribution of RSV to bronchiolitis and pneumonia-associated hospitalizations in English children,April 1995-March 1998

Estimates of the number of hospitalizations attributable to specific pathogens are required to predict the potential impact of vaccination. All hospital admissions for lower respiratory tract infection (LRI) in children < 5 years in England in 1995-8 were reviewed. Most admissions (76.8%) were not associated with specific organisms. Seasonality in pathogens that cause bronchiolitis and pneumonia was used to predict the proportion of cases with unspecified aetiology attributable to different organisms using multiple linear regression. Of 12,298 admissions for LRI, 17.5% were due to RSV infection. An estimated 74.8% (95% CI, 72.0-77.7%) of 'unspecified bronchiolitis' admissions and 16.3% (95% CI, 13.7-18.8%) of unspecified pneumonia' admissions were RSV related. The total mean annual incidence of hospital admissions attributable to RSV is 28.3/1000 children < 1 year of age, and 1.3/1000 children 1-4 years old. The greater burden of RSV infection than indicated through discharge data is revealed through applying simple statistical methods.     

Immune thrombocytopenia following immunisation with Vaxzevria ChadOx1-S (AstraZeneca) vaccine,Victoria, Australia

Emerging evidence suggest a possible association between immune thrombocytopenia (ITP) and some formulations of COVID-19 vaccine. We conducted a retrospective case series of ITP following vaccination with Vaxzevria ChadOx1-S (AstraZeneca) and mRNA Comirnaty BNT162b2 COVID-19 (Pfizer-BioNTech) vaccines and compare the incidence to expected background rates for Victoria during the first six months of the Australian COVID-19 vaccination roll-out in 2021. Cases were identified by reports to the Victorian state vaccine safety service, SAEFVIC, of individuals aged 18 years or older presenting with thrombocytopenia following COVID-19 vaccination without evidence of thrombosis. Twenty-one confirmed or probable cases of ITP were identified following receipt of AstraZeneca (n = 17) or Pfizer-BioNTech (n = 4) vaccines. This translates to an observed incidence of 8 per million doses for AstraZeneca vaccine, twice the expected background rate of 4.1 per million. The observed rate for Pfizer-BioNTech was consistent with the expected background rate. The median time to onset for the cases post AstraZeneca vaccination was 10 days (range 1–78) and median platelet nadir 5 × 10⁹/L (range 0–67 × 10⁹/L). Hospital presentations or admissions for management of symptoms such as bleeding occurred in 18 (86%) of the cases. The majority of cases (n = 11) required intervention with at least 2 therapy modalities. In conclusion, we observed a substantially higher than expected rate of ITP following AstraZeneca vaccination. ITP is the second haematological adverse event, distinct from that of thrombosis with thrombocytopenia syndrome (TTS), observed following AstraZeneca vaccination.     

Changing epidemiology of human brucellosis, Germany, 1962-2005

Trends in the epidemiology of human brucellosis in Germany were investigated by analyzing national surveillance data (1962-2005) complemented by a questionnaire-based survey (1995-2000). After a steady decrease in brucellosis incidence from 1962 to the 1980s, a persistent number of cases has been reported in recent years, with the highest incidence in Turkish immigrants (0.3/100,000 Turks vs. 0.01/100,000 in the German population; incidence rate ratio 29). Among cases with reported exposure risks, 59% were related to the consumption of unpasteurized cheese from brucellosis-endemic countries. The mean diagnostic delay was 2.5 months. Case fatality rates increased from 0.4% (1978-1981) to a maximum of 6.5% (1998-2001). The epidemiology of brucellosis in Germany has evolved from an endemic occupational disease among the German population into a travel-associated foodborne zoonosis, primarily affecting Turkish immigrants. Prolonged diagnostic delays and high case fatality call for targeted public health measures.     

Epidemiology of peptic ulcer in north Bengal, India.

A retrospective analysis of hospital records of inpatients of Medicine department of North Bengal Medical College and Hospital during the period between 1988-90 revealed that 6.2% of all medical admissions were on account of peptic ulcer and or acute gastritis. Duodenal ulcer was prevalent accounting for more than 50% of the cases of peptic ulcer and acute gastritis. Duodenal ulcer was more common in the working age groups (> 21 years) among males and more than 31 yrs among females. Gastric ulcer was more common among older age groups. In respect to ethnicity, Bengali speaking hindus showed high probability for gastric ulcers in both sexes. The probability for duodenal ulcer was within confidence limits among all social groups.     

Thromboembolic accident after mitral valve replacement

Between January 1981 and December 2000, we report 112 cases of mitral valvular replacement with bileaflet prothesis. Saint Jude prosthesis was implanted in 71% of cases. With a mean follow-up of 110 months we report a thromboembolic accident in 7 cases (6.2%). The linear rate of thromboembolic accident is 0.69% A/P. This complication was concerned 5 women and 5 men. The mean age is 54 years (43-65 years). An embolic accident without prosthesis thrombosis is noted in 6 cases. We report only one case of prosthesis occlusive thrombosis with urgent chirurgical intervention. Par rapport au RVM, l'ATE est survenue dans uns délai moyen de 129 months (86-168 months). Left atrium size, embolic antecedent, and bad anticoagulation are the predicted factors of thromboembolic accidents in our study. Patient age and sex, atrial fibrillation, type of bileaflet prosthesis don't influence the occurrence of thromboembolic accident.     

Incidence of colon cancer in Tianjin, China, 1981-2000

The objective of this study is to describe and analyze the incidence trend of colon cancer in Tianjin, China from 1981 to 2000. Tumour cases were coded by ICD-9 in this study. Incidence rates were calculated by five-year age-groups as well as sex and year of diagnosis. From 1981 to 2000, the total number of colon cancer cases ascertained in urban Tianjin was 4954, including 2547 males and 2407 females. 67.88% colon cancer cases occurred in the age group 55-79 and age specific incidence rate reached its peak in the age group 75-79. The mean incidence rate of colon cancer during the 20 years was 7.01/100000 and this rate had been increasing constantly from 1981 to 2000. The average age at diagnosis was 62.41 years. An ascending trend was observed in the mean age at diagnosis of colon cancer from 1981 through 2000. As for the sex ratio, there was no clear trend exhibited. The incidence trend of colon cancer during 1981 to 2000 in Tianjin warranted a further research on its risk factors and prevention warranted.     

Revisiting saw-scaled viper (Echis carinatus) bites in the Jaffna Peninsula of Sri Lanka: distribution, epidemiology and clinical manifestations

In Sri Lanka, the saw-scaled viper (Echis carinatus) is distributed in the arid, dry and sandy coastal plains and in a prospective study we describe its bites in the Jaffna peninsula. Of the 304 snake bite admissions to the Jaffna Hospital in 2009, 217 (71.4%) were bitten by either venomous species or envenomed by unidentified snakes. There were 99 (45.6%) reported saw-scaled viper bites, of which 26 were confirmed cases. The length of the offending snakes ranged from 228–310 mm and bites mainly occurred in the nearby islands. The median age of the confirmed cases was 34 years (range 1.5–72 years); occupations included housewives (8, 31%), school children (4, 15%) and farmers (2, 8%). In 18 patients (69%), bites occurred in daylight and in 8 (31%) within or near the compounds. The fingers were bitten in 8 (31%) and toes/foot in 11 (42%) cases. There were 2 (8%) dry bites and 19 patients (73%) developed local swelling; one patient developed haemorrhagic blisters. In 24 patients (92%), blood incoagulability manifested between 40 and 1095 min after the bite, and three patients (12%) developed spontaneous bleeding. One patient (4%) developed mild acute renal dysfunction. The median time for correction of coagulopathy was 802 min (range 180–1669 min) with Indian polyvalent antivenom. All recovered. The saw scaled viper is responsible for most venomous bites in the Jaffna peninsula.     

Diagnosis deferred--the clinical spectrum of diagnostic uncertainty

This study attempts to define the term "Diagnosis Deferred" (DD) and determine its natural history and outcome. It is suggested that such a "non-diagnosis" should be used when the clinical and laboratory picture cannot be explained by any known disease entity after a minimum of 5 days hospitalization. During a 9 year period (1972-1980) 250 patients (1.8%) were identified as warranting the term DD from a total of 14,098 admissions to a department of Internal Medicine. Their average stay in hospital was 11.5 days. There was no sex difference between the patients, whose average age was 42.8 +/- 17.6 years (mean +/- SD; range 14-93). Three complaints predominated: joint pains (21.6%), abdominal pain (20.4%) and chest pain (16.8%). In 103 of the patients, there was follow-up information until the diagnosis was made or for at least 24 months (average 53.0 +/- 40.0 months, range 2-186). These patients were representative of the original cohort in both age, sex and classification of symptoms. Forty-three patients (42%) were subsequently diagnosed. 58% of these patients were diagnosed as a result of a change in or appearance of a clinical symptom during the follow-up period. "The survival of diagnostic uncertainty" in 50% of the patients was 84.5 months (7 years) with a range of 2-13 years. This time was significantly shorter for chest pain than for abdominal pain (33 months vs 87 months) (p = 0.003). In patients with "Diagnosis Deferred", a diagnosis was reached in 42%; in 22% the symptoms disappeared leaving 36% undiagnosed, and a continuing clinical challenge.     

Viruses in acute gastroenteritis in children in Pune, India

A 2-year study from January 1981 to December 1982 was undertaken to determine the role of viruses in the causation of diarrhoea in hospitalized children in Pune, Maharashtra State, India. The stool samples of 426 children (213 diarrhoeal and 213 non-diarrhoeal controls) were investigated by electron microscopy and ELISA for the presence of viruses. Six morphologically distinct viruses were visualized: rotavirus, coronavirus-like particles (CVLP), adenovirus, astrovirus, calicivirus and small round virus-like particles (SRV). Rotavirus was detected in 28.6% of the diarrhoeal patients and in 1.4% of the controls. The frequency of infection with rotavirus was highest in the children aged less than 5 years. The mean age of rotavirus-positive patients was 11 months. Although rotavirus was detected in almost every month, there has a seasonal trend for colder months when CVLP cases were fewest. However, the prevalence of CVLP was greater in the control group (23.0%) rather than in those with diarrhoea (8.9%). In the control group, CVLP were detected more frequently during the summer months. An inverse relationship between CVLP and rotavirus was observed in children. Adenovirus, astrovirus, calicivirus and SRV were detected in a small proportion of children with and without clinical symptoms of gastroenteritis.