Ovarian tumours in Ugandan Africans.
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Biomedical subjects
Publications and source records attributed to E S Grech.
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A detailed study of the obstetric services in Lusaka is presented. The maternal and perinatal mortality rates for 1976 were estimated at 1.7 and 55.1 per 1000 live births respectively. The persistent increase in mortality suggests a fall of accepted standards of maternity care. The causes of deaths are discussed. Avoidable factors were identified in 79.6% of the maternal deaths and 49.1% of the stillbirths. Recommendations are made for a more integrated type of maternity service, provisions of maternity centres, education programmes for the public and a more thorough perinatal care. Only a concerted effort of this nature will eventually result in a satisfactory progress in the obstetric services and a reduction of obstetric deaths and morbidity.
The problem of cervical cancer in Zambia is discussed. The pathogenesis of carcinoma of the cervix is described and the benefits of cervical cytology are highlighted. The role of cervical cytology in the context of a developing country is also discussed and a plea is made for a selective mass screening programme, the objective of which will be to limit and prevent cancer of the cervix. The establishment of a Central Cytology Laboratory at the University Teaching Hospital is described in some detail. This service could be extended in stages until it is possible to screen all women over the age of 20 years, at least every 3 years.
A diagnostic cytology service was started in the Obstetric and Gynaecology Department of University Teaching Hospital, Lusaka in September, 1974. Its primary aim was to diagnose precancerous lesions or early invasive cancer of the cervix. However, the service was offered to other disciplines in the hospital who could benefit from cytology. During the two and a half period, September 1974, to 31st December 1976, 2,877 cervical smears were examined. Of these, 138 smears (4.8%) showed evidence of cellular abnormality consistent with dysplasia, carcinoma in situe, or invasive cancer. Trichomonas vaginalis was diagnosed in 464 cases (16%), Candidiasis in 89 (3.1%), and Schistosomiasis in 19 (0.7%).
Fifty patients with acute pelvic inflammatory disease were treated with Alphacillin (Pivampicillin Hcl). The total daily dose consisted of 1050mg, given in three divided doses. Treatment was continued for six days. Full bacteriological investigations were performed. Therapy was continued so long as the condition of the patient improved. In case of failure change to other antibiotics or surgery were considered. The clinical response to Alphacillin was considered successful in 92% of patients. A significant observation in the trial was the low rate of residual pelvic pathology especially in patients with Acute/Chronic pelvic infection. The drug was found to be free from complications or any serious side effects. Mild epigastric discomfort was noticed in only 3 patients.