Higher Perforation Rate Research Articles

Deep-Vein Thrombosis Mimicking Acute Appendicitis

IN THE very young and the elderly, acute appendicitis commonly has an atypical presentation and a high perforation rate.¹It represents a difficult clinical challenge. The surgical and nonsurgical conditions that mimic acute appendicitis are well known.²The overall rate of a normal appendix at appendectomy is 20%, and the rate is much higher in women.¹In highrisk patients, particularly those with a history of recent myocardial infarction or other serious illnesses, a correct preoperative diagnosis is of the utmost importance because unnecessary surgery carries with it a substantial morbidity and mortality for these patients. Recent literature has incriminated the Swan-Ganz catheter and other invasive intravascular devices in the development of venous or arterial thrombosis. Ileofemoral venous thrombosis can mimic the symptoms of acute appendicitis, and it should be included in the differential diagnosis of right lower quadrant abdominal pain. A complete history and careful physical examination

The Hong Kong experience in the use of the Dalkon Shield

Two-thousand-seven Dalkon Shield users from three family planning clinics in Hong Kong with 23,598 months of contraceptive exposure were studied, and the majority of the patients in this study, 64.7 per cent, had been previously using another type of IUD, mainly the Lippes loop, without problems. The follow-up rate per 100 users of this series at the end of one year was 90.72. At the end of the first year of use, the cumulative rate per 100 users calculated according to the Tietze/Potter life table approach was 1.68 for pregnancy, 1.90 for expulsion, 18.60 for removal while 79.07 per cent of the couples continued to use the Dalkon Shield. The perforation or translocation rate for this series of users was 1:500. The menstrual and other side effects are reported. The event rates as compared with that reported by other centres and the possible reason for the high perforation or translocation rate are discussed.

Uterine perforation with intrauterine contraceptive devices: Review of the literature and cases reported to the National Committee on Maternal Health

The National Committee on Maternal Health reported on 28 cases of perforation of the uterus in a total of 16,338 first insertions of IUCD's after confinement, an incidence of 1.7 perforations per 1,000 insertions. Twenty of the perforations followed the insertion of a “Bow”. Sixteen of these occurred in patients less than 12 weeks post partum. With the “Bow” there is a highly significant correlation between the perforation rate and the number of weeks post partum, especially if no menses have occurred. The perforation rate after 12 weeks post partum for the “Bow” is 2.0 per 1,000 insertions. This is less than the perforation rate of 3.23 per 1,000 found in a collected series of 77,903 curettages. The high perforation rate for the early postpartum insertions indicates that softness and friability of the uterus is a greater factor in the etiology of the perforations than the type of introducer employed. Perforations with other devices are difficult to determine due to the lack of accompanying symptoms and the presence of a tail protruding through the cervix. Care in examining the patient, judicious timing of insertion, the use of a tenaculum, traction to straighten flexion deformities of the uterus, sounding the uterus, and gentleness during the introduction and ejection of the device into the uterus should greatly reduce the incidence of uterine perforation.