Exploring the condom gap: is supply or demand the limiting factor - condom access and use in an urban and a rural setting in Kilifi district, Kenya.

Objective: to explore the extent of the condom gap, investigating the relative roles of supply-side and demand-side factors in determining condom use.

Design: GPS mapping of condom outlets, and population-based survey.

Methods: an urban and a rural site were selected within the Epidemiological and Demographic Surveillance Site in Kilifi district, Kenya.

Immunoguided lymph node dissection in colorectal cancer: a new challenge?

Knowledge of lymphatic involvement in patients with colorectal cancer is important in surgery and in the postoperative decision-making process. Fifty-eight patients with recurrent colorectal cancer underwent operation with the RIGS/(Radioimmunoguided Surgery) technology. Preoperatively, patients were injected with 1 mg monoclonal antibody (MoAb) CC49 (anti-TAG-72-tumor-associated glycoprotein) labeled with 2 mCi of iodine 125.

Identification of lymph node metastases in recurrent colorectal cancer.

Lymph node metastases are an important prognostic prediction factor in patients with recurrent colorectal cancer, particularly those with liver metastasis. Fifty-six patients with recurrent colorectal cancer were operated by us using the RIGS (radioimmunoguided surgery) technology. Patients were injected with 1 mg monoclonal antibody (MoAb) CC49 labeled with 2 mCi 125I.

Radioimmunoguided surgery benefits for recurrent colorectal cancer.

Background: Despite new adjuvant therapy, 50% of patients with colon cancer will have recurrent disease. This study investigated the use of a radiolabeled monoclonal antibody in locating occult tumor during surgery for recurrent colorectal cancer.

Methods: Twenty-two patients with recurrent colorectal cancer underwent surgery using the radioimmunoguided surgery (RIGS) system.

[Primary and metastatic hepatic cancer: the surgical option].

Major hepatic resection is the treatment of choice in patients with primary and secondary liver cancer. During a 22-month period 31 men and 27 women (mean age 63 years, range 14-84) with space-occupying hepatic lesions were admitted. All 15 patients with benign lesions were operated, except for 3 in whom a liver abscess was drained percutaneously.

Skin ulcer as the presenting symptom of primary antiphospholipid syndrome--resolution with anticoagulant therapy.

A 51-year-old woman with unilateral foot ulcers as the presenting symptom of primary antiphospholipid syndrome is described. Therapy with anticoagulants resulted in complete disappearance of the ulcers.

[Sclerotherapy of postoperative lymphocele].

Postoperative lymphocele is a well-documented complication of gynecological operations involving pelvic and retroperitoneal lymph node dissection. It is not uncommon following renal transplantation. We report a 77-year-old woman with a lymphocele which developed 4 months after panhysterectomy.

Combined transvaginal tubal catheterization and adhesiolysis of filmy uterine synechiae performed with a newly developed device under the guidance of digital road mapping fluoroscopy.

Transcervical fallopian tube catheterization is rapidly gaining favor as a minimally invasive diagnostic and therapeutic technique. On occasion, the presence of filmy adhesions not identified on HSG obstruct the passage of the cannula to the cornual angle. We describe the design and operative characteristics of a new transcervical adhesiolysis device that if used under the guidance of DRM mapping, can restore the shape of the uterine cavity and allow completion of the procedure during the same session.

Digital road mapping image--a novel fluoroscopic real-time guide for selective transcervical catheterization in the treatment of proximal tubal obstruction.

Ten infertile women 20 to 40 years of age, with a standard HSG diagnosis of unilateral proximal tubal obstruction, underwent a transvaginal catheterization and recanalization of the fallopian tubes. To set a fluoroscopic real-time guidance technique for improving the results of transvaginal catheterization and recanalization of the fallopian tubes and to increase its marginal safety, catheterization was performed under digital road mapping guidance. Transcervical catheterization resulted in an immediate patency of the obstructed tube in all 10 women.

Efficacy of varicocele embolization versus ligation of the left internal spermatic vein for improvement of sperm quality.

Efficacy of surgical varicocelectomy versus embolization of the spermatic vein was studied in 137 men diagnosed as suffering from left varicocele. The men were divided randomly into three groups according to the methods of treatment: A--embolization of the internal spermatic vein (51 men); B--Ivanissevich technique of high ligation of the spermatic veins (43 men); and C--Bernardi technique of high ligation (43 men). The groups were similar in terms of age, duration of infertility and possessed semen characterized as oligoteratoasthenozoospermia.

Association of von Willebrand's disease with plasma cell dyscrasia and gastrointestinal angiodysplasia.

A patient with acquired von Willebrand's disease (type I) had both plasma cell dyscrasia and angiodysplasia of the intestine. Based on examination of the components of F VIII/von Willebrand's factor (VWF) and the results obtained following the administration of cryoprecipitate and DDAVP (1-desamino-8-D-arginine-vasopressin), it was suggested that the production and release of VIII/VWF was normal and the rapid disappearance from the circulation was related to adsorption by abnormal cells in the bone marrow. The relation of acquired von Willebrand's disease, plasma cell dyscrasia and angiodysplasia is discussed and the literature reviewed.

Von Hippel-Lindau syndrome with unusual presentations in two brothers.

Two cases are reported of von Hippel-Lindau syndrome in two brothers. One had an asymptomatic adrenal pheochromocytoma (probably bilateral) and a synchronous metastatic hypernephroma which presented as a rather "innocent" renal colic. The second asymptomatic brother underwent urologic investigation which revealed multifocal tumors of the kidney.

Acute airway obstruction and achalasia of the esophagus.

Patients with achalasia tolerate considerable distension of the esophagus. Respiratory symptoms usually are due to regurgitation and pulmonary aspiration of retained food rather than to a space-occupying mechanism. We describe a case of previously undiagnosed achalasia presenting in an elderly woman with symptoms consistent with tracheal obstruction of acute onset.

Diagnosis of a small ovarian tumor (androgen secreting) by magnetic resonance: a new noninvasive procedure.

Virilizing ovarian tumors are rare and establishing their exact location before operation is difficult. We report a case in which a small left ovarian tumor was seen with magnetic resonance imaging.

Sclerosing peritonitis. Possible early diagnosis by computerized tomography of the abdomen.

Sclerosing peritonitis (SP) has come to be recognized as a serious complication of peritoneal dialysis (PD). However, diagnosis is often established at a late stage of the disease and at laparotomy. The use of computerized tomography (CT) of the abdomen in 2 patients, clinically suspected of suffering from SP, revealed loculated ascites, adherent bowel loops, bowel lumenal narrowing, and thickening of the peritoneal membrane.

Computed tomographic investigation of serosal and intramural gastrointestinal pathology.

Various cases are presented demonstrating the role of computed tomography (CT) in the assessment of serosal and bowel wall pathology. Reference is made to the morphology of the lesions. Illustrative examples of tumors, secondary malignant dissemination, irradiation injury to the gut, and intramural gas associated with ulcerative colitis, are all illustrated.

Computed tomographic demonstration of intramural colonic air (pneumatosis coli) as a feature of severe ulcerative colitis.

Fast rotational computed tomographic scanning techniques allow an accurate appreciation of the diameter of the colon, the presence of severe necrotizing mucosal change, and the detection of unsuspected intramural colonic air (pneumatosis coli) in cases of severe necrotizing ulcerative colitis.

High ligation or embolization of varicocele.

The presence of a varicocele was confirmed in 121 of 123 patients complaining of scrotal pain or infertility, in whom radionuclide scanning was performed. In the first 29 patients (retrospective study), a high ligation of the internal spermatic vein was performed. In 94 patients, a percutaneous venography was done via the jugular vein followed by embolization by Gianturco coils (occluding spring embolus, Cook Group Company, USA) in 84 of them.

Computed tomographic air enema technique to demonstrate colonic neoplasms.

The use of intravenous glucagon and the judicious introduction of air into a clean colon offer additional help in the confirmation of the larger intracolonic tumors on computed tomographic examination. The procedure is simple and may aid in the differentiation of an intrinsic colonic tumor from other pathologic conditions, particularly those that are extracolonic in origin.

Spontaneous breakage of a double pigtail stent and bladder stone formation.

Five years after prostate resection and hormonal treatment for carcinoma of prostate a 76 year old patient presented with bone and lung metastases and dilatation of left upper collecting system. After castration a double J stent was inserted in the ureter. Two years later he was admitted for alteration in general condition related to cholecystitis.

Transcatheter renal artery embolization in the treatment of infected cutaneous ureterostomy.

Palliative renal ablation by means of transcatheter embolization is described. A patient with left cutaneous ureterostomy suffered from urosepsis. The left kidney was embolized using isobutyl-2-cyanoacrylate and Lipiodol in order to stop infected urine excretion.