Ovarian hyperstimulation syndrome. A case report

An iatrogenic disease resulting from the induction of ovulation is described. It would appear that it is uncommon in southern Africa.     

Human leucocyte antigen status in African women with eclampsia

Investigation of the HLA system in 53 African eclamptic or imminently eclamptic women showed that they were significantly more likely to be heterozygous at the B locus than were normal controls. This did not apply to the A or D related loci.     

Calcium deficiency in rural black children in South Africa--a comparison between rural and urban communities

The prevalence of biochemical abnormalities usually associated with rickets was investigated in three black school-going populations, one from a rural community, one from a small urban community, and one from a large urban area. A high prevalence of biochemical abnormalities was found in the rural community, where 13.2% of children were hypocalcemic and 41.5% had elevated alkaline phosphatase concentrations. No hypocalcemia was detected in the children from the large urban area. Urinary calcium excretion was lowest in the community with the highest prevalence of hypocalcimia and elevated alkaline phosphatase concentrations. Dietary calcium intake in those children with biochemical abnormalities was estimated at 125 mg/day, compared with 337 mg/day in those children with normal biochemistry. It is suggested that the pathogenesis of the biochemical abnormalities in the rural community is due to a low dietary intake of calcium.     

Peritoneal tuberculosis imitating ovarian carcinoma "special category"

A case report, of a patient with peritoneal tuberculosis in whom the provisional diagnosis of ovarian carcinoma--"special category" was made is presented. As most gynecologists see hardly any cases of peritoneal tuberculosis nowadays, this possible diagnosis--which should always be considered--is reviewed. It illustrates the importance of a definite histopathological diagnosis.     

Challenges to microbicide introduction in South Africa

Qualitative research was conducted in South Africa to determine perceptions about intra-vaginal microbicides in order to better understand the socioeconomic, cultural and structural contexts for the support of future introduction of this new HIV prevention method. Focus group discussions and in-depth interviews were conducted at community, health service, and policy levels of inquiry. The main study site was a black working class urban area close to Cape Town. "Desperation" in response to the HIV/AIDS epidemic, rape, sexual coercion and unplanned consensual sex emerged as major reasons to support microbicides, while concerns about the partial effectiveness of microbicide protection and its hypothetical nature elicited a more cautious approach. Other key findings included the likelihood that microbicides would be "mainstream", the possible impact on sexual practices and gender norms, issues of condom substitution/migration and potential avenues for education and distribution. We found that microbicides have the potential to meet diverse needs beyond that suggested by prior research. This included a desire for products that could protect against HIV infection following rape, sexual coercion and unplanned sex, and the finding that a wider range of people than previously suggested would potentially use microbicides. The challenge for microbicide introduction will be to develop products that can meet diverse needs not only in South Africa, but also in the broader global context.     

Horner syndrome after sympathectomy in the thoracoscopic era

OBJECTIVE: Horner syndrome after sympathectomy has significantly decreased in current surgical practice. This is predominantly due to refinements in operative techniques, and an improved understanding of the patterns of sympathetic outflow pathways. We present a review of our experience with this disconcerting complication of sympathectomy when undertaken for palmar hyperhidrosis. METHODS AND TECHNIQUE: Over a 12-year period (1992 to 2004), patients undergoing sympathectomy for palmar hyperhidrosis were prospectively evaluated. In all patients the thoracoscopic approach was attempted bilaterally. The technique entailed the accurate identification of the second thoracic ganglion, followed by its dissection and resection. Excessive manipulation and cautery on the sympathetic chain was avoided. RESULTS: A total of 1137 procedures were undertaken in 567 patients. In 1 patient (during the early part of the technical experience) a unilateral Horner syndrome was noted on the first postoperative day; this effect was noted to have resolved spontaneously within 6 months. Review at 3 months was possible in 382 patients, either directly or telephonically. In these patients no further case of Horner syndrome was documented. CONCLUSIONS: The key to avoiding the development of a Horner syndrome after sympathectomy entails a thorough appreciation of the appropriate surgical anatomy, avoidance of violent manipulation and traction of the sympathetic chain, and the avoidance of diathermy on the sympathetic chain. The adherence to these principles has consigned Horner syndrome after sympathectomy as an entity of historical interest.     

Update on pathophysiologic mechanisms of human papillomavirus

PURPOSE OF REVIEW: The role of the human papillomavirus in the pathogenesis has been the subject of many publications in the recent literature. The physical state of the human papillomavirus and the role of chromosomal aneuploidy has been reported. This review discusses the recent pathological mechanisms described in the genesis of human papillomavirus-related disease. RECENT FINDINGS: The mere presence of the human papillomavirus is not sufficient for the development of neoplasia. Genetic and other co-factors seem to be necessary for the expression of the invasive phenotype. The expression of human papillomavirus 16 E6-E7 oncogenes results in chromosomal aneuploidy, favouring the integration of high-risk human papillomavirus genomes into cellular chromosomes. The integration of human papillomavirus 16 may not always be required for the progression to the invasive phenotype unlike human papillomavirus 18 DNA. Such integration sites are randomly distributed over the whole genome. The genetic susceptibility of codon 98 of the fragile histadine triad has been elucidated. SUMMARY: Various molecular mechanisms of human papillomavirus-associated neoplasia are discussed. The interaction between HIV and human papillomavirus are complex and favour the persistence and progression of cervical disease. Future research should pave the way for therapeutic vaccine development.