Hugh H Wynter

Laparoscopic Retrieval of Perforated Intrauterine Devices at University Hospital, Jamaica

Four intraabdominal, copper, T-shaped intrauterine devices (IUDs) were retrieved laparoscopically after the rare complication of complete perforation of the uterine wall. After the IUDs were located by ultrasound and radiographs, laparoscopy was performed under general anesthesia. The devices were easily located and all procedures were uncomplicated. In two cases anterior wall perforations with adhesion formation around the device were seen in the region of the uterovesical fold. Two IUDs were found adjacent to bowel, one in pararectal fat. Three surgeries were performed as day cases; the fourth patient, a diabetic, was kept for observation for 1 day.

Women in search of stability

This paper is based on a study of 97 recruits--50 sterilized and 47 non-sterilized--to a family planning programme in Kingston, Jamaica and tries to account for the reluctance of Jamaican women to accept contraceptive sterilization. The study demonstrates the association between mating patterns in the island and the acceptance of sterilization. This irreversible method was more likely to be chosen by women in more stable sexual unions.

Midazolam versus diazepam as premedication for gynaecologic laparoscopy done under local anaesthesia

SummaryA prospective randomised double blind trial was performed in 106 patients to compare the use of intravenous midazolam (mean dose 6·5 mg. range 4–9 mg) versus 10 mg diazepam. during gynaecologic laparoscopy under local anaesthesia. The parameters examined were: the ease of laparoscopy, patient tolerance, the amnesic effect and intra-operative blood pressure changes. Depth of sedation and recovery time were also measured, using the Trieger test. The preoperative demographic variables and the operators ability to perform the procedures were similar in the two groups. The patients were more deeply sedated with the midazolam but the recovery time was similar. The patients tolerated the procedure better with midazolam with fewer of them describing the procedure as unpleasant (22 per cent versus 53 per cent) (P<0·01), fewer of them had whole hod? movement during the procedure (24·5 versus 54·5 per cent) (P = 0·009) and more of them had amnesia for the procedure (85 per cent versus 36 per cent) (P < 0·4001...

Race, integration and family planning in Trinidad and Tobago.

The study considered the effect of the integration of the health services on family planning in Trinidad and Tobago. A drop-out study was based on a sample of six clinics, three representing integrated and three clinics that were non-integrated or vertical. Efforts were also made to solicit the views of a sample of drop outs, current acceptors and health-care providers.The study found that there were characteristics of the population from which acceptors were drawn that were more important in explaining utilization than the question of integration or non-integration of the clinics. Many of the problems were organizational and could, with adequate financing, be met by an even higher level of integration.