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BackgroundIntrauterine contraceptive device is the most common method of reversible contraception in women. The intrauterine contraceptive device can perforate the uterus and can also migrate into pelvic or abdominal organs. Perforation of the urinary bladder by an intrauterine contraceptive device is not common. In West Africa, intravesical migration of an intrauterine contraceptive device has been rarely reported. In this report, we present a case of an intrauterine contraceptive device migration into the urinary bladder of a 33 year old African woman at the Komfo Anokye Teaching Hospital, Kumasi, Ghana.Case reportA 33 year old African woman presented with persistent urinary tract infection of 7 months duration despite appropriate antibiotic treatments. An abdominal ultrasonography revealed a urinary bladder calculus which was found to be an intrauterine contraceptive device on removal at cystoscopy. She got pregnant whilst having the intrauterine contraceptive device in place and delivered at term.ConclusionThe presence of recurrent or persistent urinary tract infection in any woman with an intrauterine contraceptive device should raise the suspicion of intravesical migration of the intrauterine contraceptive device.

BackgroundCircumcision is a common minor surgical procedure and it is performed to a varying extent across countries and religions. Despite being a minor surgical procedure, major complications may result from it. In Ghana, although commonly practiced, circumcision-related injuries have not been well documented. This study is to describe the scope of circumcision-related injuries seen at the Komfo Anokye Teaching Hospital in Kumasi, Ghana.MethodsThe study was conducted at the Urology Unit of the Komfo Anokye Teaching Hospital in Kumasi. Consecutive cases of circumcision-related injuries seen at the unit over an 18 month period were identified and included in the study. Data was collected using a structured questionnaire. Data was entered and analysed using SPSS version 16. Charts and tables were generated using Microsoft Excel.ResultsA total of 72 cases of circumcision-related injuries were recorded during the 18 month period. Urethrocutaneous fistula was the commonest injury recorded, accounting for 77.8 % of cases. Other injuries recorded were glans amputations (6.9 %); iatrogenic hypospadias (5.6 %), and epidermal inclusion cysts (2.8 %). The majority of children were circumcised in health facilities (75 %) and nurses were the leading providers (77.8 %). The majority of circumcisions were conducted in the neonatal period (94.7 %).ConclusionCircumcision-related injuries commonly occurred in the neonatal period. Most of the injuries happened in health facilities. The most common injury recorded was urethrocutaneous fistula but the most tragic was penile amputation. There is the need for education and training of providers to minimise circumcision-related injuries in Ghana.

We studied 102 children undergoing day-case surgery, allocated randomly to receive either thiopentone 5 mg kg-1 or propofol 3 mg kg-1 i.v. at induction of anaesthesia. They then inhaled nitrous oxide and halothane in oxygen until a laryngeal mask airway could be inserted. Thereafter, halothane was substituted by isoflurane and analgesia provided by regional nerve block. Recovery from anaesthesia was assessed by the time taken to reach clinically-defined criteria and by calculation of sedation, pain and vomiting scores. In children aged less than 5 yr, only the time to spontaneous eye opening was shorter after propofol induction (P < 0.05). In children aged 5-11 yr, times of spontaneous eye opening, giving name and discharge were shorter after propofol induction (P < 0.05). These results indicate that propofol hastened early recovery in children undergoing day-case surgery, but earlier discharge occurred only in older children.

At a time when the agent of choice for paediatric anaesthesia was chloroform, the introduction of spinal anaesthesia (Bainbridge, 1900; Gray, 1909a,b, 1910) produced a considerable reduction in morbidity and mortality (Farr, 1920). Other advantages of note were limitation of anaesthesia to the part to be operated on, muscular relaxation and avoidance of the over-distended gut but, more significantly, during the postoperative period there was an almost total absence of vomiting, with an associated rapid return to normal feeding. Gray was also impressed by the long duration of postoperative analgesia and the commensurate reduction in the use of opioids. Local anaesthesia continued to remain popular for use in children into the 1940s and Leigh and Belton(1948) reported that 10% of all anaesthetics at their hospital were spinal blocks, even for lobectomy and pneumonectomy. The introduction of neuromuscular blocking agents to paediatric anaesthetic practice (Rees, 1950), followed by halothane, coincided with a growing controversy over the use of techniques such as spinal anaesthesia in children. Some authors continued to extol the technique: " Spinal anaesthesia is an excellent method for children" (Berkowitz and Greene, 1951), while others contended that" Spinal anaesthesia in children has been and still is frowned upon by the majority of anaesthetists and surgeons" (Slater and Stephen, 1950). Following the Woolley and Roe case, it was proposed that all forms of local anaesthesia for major surgery should give place to general anaesthesia (Armstrong Davison, 1965).