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AEI currently utilizes a RIEGL VZ400 Terrestrial Laser Scanner on various job sites.  This proecss utilizes a high accuracy 3D terrestrial LiDAR unit.  The data collected will be brought into a feature extraction software, TopoDOT.  TopoDOT utilizes a variety of tools to identify adn quickly extrapolate features within pointcloud data.  All features can then be imported into an AutoCAD drawing file.  AEI can provide an accurate 3D pointcloud of terrain plus any existing building or structures.  The pointcloud can also be converted for Building Information Models.

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Follow-up is generally successful medicine hat mall discount alphagan 0.2% with amex, with about 90% of patients complying with follow-up treatment integrity checklist cheap alphagan 0.2% line. India has a well-established treatment program for thyroid cancer patients symptoms job disease skin infections buy alphagan 0.2% with mastercard, and by the sheer volume of the population medicine 3605 0.2% alphagan otc, by world standards a large number of patients are diagnosed, treated and registered for follow-up. Islamic Republic of Iran this Islamic middle-eastern country has a population of approximately 65 million. Although only 46% of the population are Persians, this group is culturally dominant. Other ethnic groups include Azeris (17%) and Kurds (9%), as well as smaller groups including Gilaki, Mazandarani, Lur, Bakhtiari, Arabs and Baloch. Iran has modern health care and education facilities in the larger cities, and an excellent health network in the rural regions. The Iranian 211 economy is principally based upon oil, other natural resources and the manufacturing industry. There are forests in the north and west but desert dominates the central regions and semi-arid country is found in the east and south. Iran is very mountainous, with all the larger cities found at altitudes greater than 1 000 metres above sea level. Prior to 1992, mild to moderately severe iodine deficiency was estimated to affect 20 million people in Iran. A national salt iodisation program has achieved a greater than 90% success based upon median urinary iodine concentrations in all provinces greater than 10 µg/dl. The estimated prevalence of thyroid cancer is 295/100 000 in Iran, although this may be an overestimate since no accurate National Registry Cancer data is available. Thyroid cancer is treated in seven nuclear medicine centres in Iran, including five in Tehran (three government and two private facilities), one in Isfahan and one in Shiraz. Patients employed in government jobs, generally have government-funded health insurance coverage which reduces personal costs by 80-100%. People otherwise employed can have private health insurance that provides free health care in private health care facilities. In addition, there are a few public-funded organizations that provide health care support for patients with certain chronic diseases, including cancer. In the larger cities endocrinologists and internists are the main referrers of patients, and they also manage the ongoing care of the patients after surgery and radioiodine therapy. Nuclear medicine physicians, having completed the 7-year undergraduate medical degree course provided by the Iran Ministry of health and medical education, enter a nuclear medicine residency program for an additional 3 years of post-graduate training. Upon the histological diagnosis of differentiated thyroid cancer, the surgeon performs a unilateral thyroid lobectomy and isthmus excision if the primary cancer is less than 1 cm in diameter and confined to one lobe. Where the primary cancer is larger, and/or there is evidence or strong suspicion of extra-thyroidal extension or metastatic spread, or a history of previous radiation exposure to the head and neck region, a near-total thyroidectomy is performed. This may include lymph node dissection and resection of metastatic disease where appropriate. In preparation for 131I therapy, patients stop thyroxine therapy for 4 weeks prior to treatment, or convert from thyroxine to T3 for 2-3 weeks before discontinuing all thyroid hormone replacement for another 2-3 weeks before treatment. The dose selected depends upon the clinico-pathologic staging, post surgery scan and serum thyroglobulin level. Serum thyroglobulin levels are usually measured every 6 months during the first few years after surgery, and then annually lifelong. The laboratories usually measure antithyroglobulin antibodies and do appropriate dilutions only if requested by the physician. Unfortunately, many patients are lost to follow-up in Iran, mostly due to economic reasons and a lack of education about the need for follow-up. Although 123I can be produced locally it is currently not used due to relatively high costs. Japan this group of islands of total area 370 000 square kilometres has a population of 127 million. There is a high dietary intake of sea-foods including seaweed and its related products. There are approximately 60 nuclear medicine facilities within Japan equipped with modern gamma cameras and isolation wards suitable for thyroid cancer therapy. The major referrers of patients with thyroid cancer for radioiodine therapy are surgeons, endocrinologists and oto-rhino-laryngologists. Generally, nuclear medicine physicians administer radioiodine therapy, although in a few institutions, radiation oncologists may do this. The role of the surgeon is to perform the thyroidectomy operation, and endocrinologists are involved in both the diagnostic work-up and may prescribe thyroid hormone replacement for some patients. Medical and radiation oncologists generally have little role in management of patients with thyroid cancer. Typically, a nuclear medicine specialist has 6 years of basic medical training and 3-5 years of specialty training. Patients generally are required to pay between 20-30% of their health care costs after hospital admission for treatment of thyroid cancer. A typical diagnostic work-up of a patient with a neck mass suspicious for thyroid cancer includes thyroid ultrasound guided fine-needle aspiration biopsy. Those patients with clinically detected distant metastases, multi-focal disease within the gland, local extrathyroidal tumour spread, tumour involving the isthmus or contralateral lobe or extensive nodal disease, have a total thyroidectomy procedure. For preparation for 131I therapy, thyroxine replacement therapy is replaced by T3 hormone replacement therapy for 2 weeks. All thyroid hormone replacement therapy is ceased for 2-3 weeks prior to 131I therapy.

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Note: Every resource available at the reporting facility must be reviewed in order to medications not to be crushed buy 0.2% alphagan with visa determine the date of diagnosis medications mitral valve prolapse discount 0.2% alphagan with mastercard. Example: Patient admitted to treatment plan for depression generic 0.2% alphagan with amex your facility on April 26 treatment h pylori generic 0.2% alphagan amex, 2018 with recurrent melanoma but the original date of diagnosis is unknown. Use January (01) for the month Use July (07) for the month Use December (12) for the month Use the year and month of admission and leave the day blank. The History and Physical states the patient has bone and brain metastasis from malignant melanoma diagnosed in the spring. Note: For users of Web Plus always press the calculator icon in order to calculate age at diagnosis. The behavior code is used by pathologists to describe whether tissue samples are benign (0), borderline (1), in situ (2), or malignant (3). Refer to Solid Tumor Rule 2018 rules to determine the number of primaries for solid tumors. Nine of the 32 new codes were listed in the prior crosswalk effective for January 1, 2015. Coding Instructions for Hematopoietic and Lymphoid Neoplasms (9590/3-9992/3): For hematopoietic and lymphoid diseases code histology after the Hematopoietic and Lymphoid Neoplasm Database has been searched for reportability at seer. Follow the steps in priority order for using the Hematopoietic and Lymphoid Neoplasm Database and Coding Manual. Note: If the patient has a hematopoietic or lymphoid neoplasm diagnosed prior to 2010 and a new one diagnosed January 1, 2010 or later, use the Hematopoietic and Lymphoid Neoplasm Database and Manual. Code the primary site as lung and the morphology as small cell carcinoma (8041/3). The exception is with in situ breast cancer; code as non-invasive (/2) in the presence of isolated tumor cells or if cells are artifactually displaced from a previous procedure. Clinical evidence alone cannot identify the behavior as in situ; the code must be based on pathologic examination and documentation. Code the behavior as malignant (/3) if any portion of the primary tumor is invasive no matter how limited, i. Example: Right colon biopsy reveals tubulovillous adenoma with microfocal carcinoma in situ; right hemicolectomy is negative for residual disease. Certain histologies will never have in situ behaviors (8000­8005, 8020, 8021, 8331, 8332, 8800­ 9055, 9062, 9082, 9083, 9110­9493, 9501­9989). The 2018 Solid Tumor Rules contain additional coding instructions for some primary sites, including Head and Neck, Lung and Urinary. Refer to the Hematopoietic and Lymphoid Neoplasm Database and Coding Manual at seer. Code to the more detailed description from the History and Physical, upper outer quadrant of the right breast (C504). Patient has a right branchial cleft cyst; the pathology report identifies an adenocarcinoma arising in an ectopic focus of thyroid tissue within the branchial cleft cyst. The patient had a total hysterectomy with a bilateral salpingo-oophorectomy ten years ago for non- cancer reasons. She now has widespread cystadenocarcinoma in 121 Texas Cancer Registry 2018/2019 Cancer Reporting Handbook Version 1. Code the last digit of the primary site code to "8" when a single tumor overlaps an adjacent subsite(s) of an organ and the point of origin cannot be determined. The patient has a 5 cm tumor overlapping the base of tongue and anterior 2/3 of tongue. Code overlapping lesion of the bladder when a single lesion involves the dome (C67. Assign the primary site code for the site where the bulk of the tumor is or where the epicenter is; do not nuse C448. Code the site of the invasive tumor when there is an invasive tumor and an in situ tumor in different subsites of the same anatomic site. Code the last digit of the primary site code to 9 for single primaries, when multiple tumors arise in different subsites of the same anatomic site and the point of origin cannot be determined. The patient has an excision of the right axillary nodes which reveals metastatic infiltrating duct carcinoma. If a tumor is metastatic and the primary site is unknown, code the primary site as unknown (C809). Note: If at any time a specific primary site is identified, change the site code from Unknown Primary (C809) to the specified primary site. Changing the Primary Site may be other associated fields that need to be changed appropriately. Code C422 (Spleen) as the primary site for angiosarcoma of spleen with mets to bone marrow. Although angiosarcoma actually originates in the lining of the blood vessels, an angiosarcoma originating in the breast has a poorer prognosis than many other breast tumors. For information about organ or tissue transplants, see the section Determining Multiple Primaries. For additional information about hematopoietic-related transplants, refer to the Hematopoietic and Lymphoid Neoplasm Coding Manual and Database. Code to the tissue in which such tumors arise rather than the ill-defined region (C76 ) of the body, which contains multiple tissues. Sarcomas may also arise in the walls of hollow organs and in the viscera covering an organ. Code primary site to prostate (C619) 126 Texas Cancer Registry 2018/2019 Cancer Reporting Handbook Version 1. Additional Guidelines for Coding Primary Site · · · A subareolar/retroareolar carcinoma is coded to the central portion of the breast (C50.

Although rare medicine natural cheap alphagan 0.2% fast delivery, occasional mortalities do occur especially in children who are less than 10 years old at the time of diagnosis mueller sports medicine generic alphagan 0.2% on-line. Prognostic factors the host and tumour factors are predictor of survival in almost all cancers medicine gabapentin cheap alphagan 0.2% with visa. None of the known variables like age treatment effect order alphagan 0.2% otc, sex, histology, type of surgery, radioiodine therapy and nodal status influences survival. This is because very few large series have been published with long term follow-up. In most of the published report the number of children is too small, and the upper age cut-off varies from 12-year to 25-years that does not permit robust statistical analysis. However, to determine death rate, the duration of follow-up should be longer than 5 years in the majority of patients. On the other hand, it is well known that the vast majority of recurrences occur in the first 5 years after the primary treatment. Therefore the importance of prognostic factors is calculated in relation to disease-free survival. There is disagreement in the literature on the relation between tumour histopathology and disease free survival. In this series, there was no correlation between tumour histopathology and disease-free survival, although the patients with follicular cancer were quite numerous. This is probably due to the moderate iodine deficiency which was observed in Northern India till mid eighties [9. Recently, more and more authors have claimed that local metastases adversely influence disease-free survival [9. In this group, diagnosis of lymph node metastases was associated with a doubled risk of recurrence. Routine use of radical thyroid surgery in their study did not improve the outcome and was associated with an increased risk of complications. In their opinion complete thyroid removal should be standard in patients with distant metastases, extensive lymph node involvement or invasive extracapsular tumours. Of those patients who underwent less than total thyroidectomy, only 15% remained relapse free after 10 years, with 59% of them having relapsed during the first 5 years of observation. By contrast, disease-free survival was very good in patients treated by total thyroidectomy. There is a risk of bias in the estimation of the recurrence rate following surgery performed at many centres over a long period of time, as disease free patients may more easily disappear from the long term control. Whereas some authors question the necessity of extensive thyroid surgery, others [9. In their opinion, combined treatment decreases the rate of local and distant metastases. In fact, radioiodine treatment results not only in thyroid ablation but also in the treatment of micrometastases undetectable by other imaging method [9. These patients were mostly asymptomatic and pulmonary metastases would have remained undetected for a longer time, increasing morbidity and mortality significantly, if remnant thyroid tissue ablation with radioiodine were not attempted in these patients. The biological behaviour differs from that in adults and is related to the factor of age. Younger the age (<10 years), more aggressive and widespread is the disease with male preponderance and high mortality. A total/near total thyroidectomy followed by 131I ablation of residual/remnant thyroid tissue and nodal or distal metastases if present reduces the rate of mortality and recurrence. Unfortunately, his work was largely forgotten, and for many hundreds of years there was no progress in thyroid surgery. In fact in 1850, the mortality rate for thyroid surgery was very high, about 50% of patients died following thyroidectomy, usually from uncontrolled bleeding. Theodor Kocher of Berne, Switzerland made outstanding contributions to the understanding of thyroid disease at the turn of the past century. In recognition of his accomplishment, he was awarded the Nobel Prize in Medicine in 1909. Since that time, there have been major advances in the understanding of thyroid disorders and in the management of patients with thyroid nodules. Thyroid scans using radioactive iodine became available and were frequently used in identifying functional abnormalities of the thyroid gland. However, it soon became evident that this procedure was of little help in separating malignant from the more numerous benign thyroid nodules. Pre-operative evaluation Pre-operative preparation of patients for thyroidectomy may include evaluation of thyroid function and vocal cord movement by direct or indirect laryngoscopy. The cytology report usually is classified as non-diagnostic, benign, suspicious or malignant. Non-diagnostic cytology indicates that there is insufficient number of thyroid cells in the aspirate. Aspiration should be repeated since a diagnosis will be obtained in approximately 50 per cent of the repeat aspirates. Malignant thyroid aspirations may include cytology findings consistent with thyroid cancer which may be papillary, medullary, anaplastic and thyroid lymphomas. These patients often end up requiring surgical removal of the thyroid lobe that harbours the nodule. Surgery is recommended for the treatment of thyroid nodules from which a suspicious aspiration has been obtained. Thyroid surgery An incision that provides a clear exposure of the thyroid gland, maintenance of a relatively bloodless field, and appropriate traction and counter traction of the thyroid gland, all aid in the performance of a safe operation. Thyroid surgery is performed with the patient in supine position with a hyperextended neck. A low transverse cervical incision is made two finger-breadths above the manubrium.

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Treatment with Bleomycin showed a partial response rate of 25% in primary tumours and 50% in lymph node metastases [14 treatment hiccups 0.2% alphagan sale. Aclarubicin was found to medications 222 discount 0.2% alphagan amex be ineffective with a brief partial response of only 14% [14 medicine dictionary pill identification buy alphagan 0.2% low cost. Methotrexate (5 mg/day medicine lyrics purchase alphagan 0.2% with mastercard, for 5 days) treatment with external radiotherapy (40 Gy in divided doses over 5-6 weeks) in five patients has been reported to result in complete regression of primary tumour. However, patients had severe side effects and they died due to local tumour recurrence and pulmonary metastases within 5-13 months [14. Sixteen patients were treated with pre- and postoperative doxorubicin and hyperfractionated radiotherapy. Of these, five patients had a complete remission, and two patients survived more than 2 years [14. They found the response rate to be significantly better in combined drug therapy as compared to monotherapy. Although, they found complete response in 18%, which lasted for more than 1 year, 73% of cases had a progressive disease indicating the ineffectiveness of the treatment. However, most of their patients developed distant metastases and died (median survival 1 year). A higher success rate (4 with complete response and 5 with partial response in a total of 10 evaluable cases) has been reported using multimodal treatment with doxorubicin (60 mg/m2) and cisplatin (90 mg/m2) along with a split course of external radiotherapy [14. This regimen was effective in longer survival and local control, but was ineffective in controlling distal metastases. They obtained complete local remission in 48% and four patients survived for more than 2 years with no evidence of disease. A total of 16 patients (Group 1) were treated with total thyroidectomy, radiotherapy and chemotherapy with adriamycin and bleomycin in various order. Nine patients with distant metastases at diagnosis (Group 2) received chemotherapy; one of them had a disappearance of lung metastases and was then treated by total thyroidectomy and further chemotherapy. Only a few patients responded to chemotherapy, confirming that anaplastic thyroid carcinoma is often resistant to anticancer drugs. They concluded that aggressive and appropriate combinations of radiotherapy, total thyroidectomy and chemotherapy may provide some benefit in patients with anaplastic thyroid carcinoma. Preoperative chemotherapy and radiotherapy may enhance surgical resectability of the primary tumour. A combination of carboplatin and epirubicin was administered at 4- to 6-week intervals for six courses in fourteen patients with poorly differentiated thyroid carcinoma and nonfunctioning diffuse lung metastases. Five patients had partial remission, and seven patients had disease stabilization. The overall rate of positive responses was 37% that rose to 81% when patients with stable disease were included. Serum thyroglobulin after chemotherapy declined more than 50% in six patients, with respect to basal levels. The appropriate treatment strategy of anaplastic thyroid cancer is yet to be evolved. Medullary thyroid cancer Medullary thyroid cancer is a neoplasm of calcitonin secreting parafollicular C-cells of the thyroid gland. Medullary thyroid carcinoma may have an indolent behaviour and patients with distant metastases do well. As this cancer does not accumulate radioiodine, these patients are left with only option of chemotherapy with or without radiotherapy in cases of disseminated disease. Reports on the use of chemotherapy in medullary thyroid cancer are limited to a small number of cases and at times is a single case report. The combination of doxorubicin and cisplatin showed response rate varying between 0-33% [14. Although, there was not a single complete response, there were three partial responses lasting for 9, 10 and 18 months. There was no complete response either in terms of tumour size reduction or decrease in the levels of tumour markers. Two patients had partial biochemical response and reduction in tumour size; one had partial biochemical response with stable tumour size, while three had progressive disease. The response was partial regression of tumours in three patients (at 11, 9 and 3 months) and stabilization of the disease in 11 patients. Yet another combination of doxorubicin (45-70 mg/m2), imidazole carboxamide (600-800 mg/m2), vincristine (2 mg) and cyclophosphamide (600-750 mg/m2) has been tried. There was progressive improvement in three patients and one patient had progressive disease [14. Hence although there is no hope of a complete response, it appears that single or combination drug regimes can in a small number of subjects induce a partial response or stabilize disease for some months. There is not enough data to indicate whether the partial response is transient or long lasting. Conclusion the response to chemotherapy in patients with advanced differentiated thyroid carcinoma is not encouraging. Doxorubicin, cisplatin, and etoposide alone or in combination are the drugs currently considered effective. However, side effects may be severe and chemotherapy cannot as yet be routinely recommended. Chemotherapy in combination with external radiotherapy should be tried in cases of anaplastic thyroid cancer and chemotherapy remains the only alternative, though not very effective, in cases of aggressive and widespread medullary thyroid cancer. Chemotherapy in metastatic non-anaplastic thyroid cancer: Experience at the Institut Gustave-Roussy, Tumouri 76 (1990) 480-483. The success of this management structure is highly dependent on the bulk of thyroid tissue left behind after thyroidectomy and the effectiveness of ablation.

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Prior to 10 medications doctors wont take generic 0.2% alphagan free shipping the middle of the 19th Century treatment pancreatitis cheap 0.2% alphagan with mastercard, an obstetric vesicovaginal fistula was generally regarded as an incurable and hopeless condition symptoms dizziness nausea discount alphagan 0.2% line. Marion Sims and his colleague and successor Thomas Addis Emmett (Sims 1852 treatment 4s syndrome buy discount alphagan 0.2% line, Emmett 1868, Harris 1950, Zacharin 1988) that surgical cure of this condition could be undertaken with confidence. As obstetrics developed as a scientific specialty in the first half of the 20th Century, maternal mortality underwent a precipitous decline throughout Europe, the United States, and other developed nations (Loudon 1992a, 1992b). This meant that the obstetric fistula vanished from the clinical and social experience of the West just as it was starting to become rigorously scientific. As a result of these historical circumstances, the Western medical literature on obstetric fistulas is old and generally uncritical by current scientific criteria. This literature consists almost entirely of anecdotes, case series (some quite large), and personal experiences reported by dedicated surgeons who have labored in remote corners of the world while facing enormous clinical challenges with scanty or absent resources at their disposal (Evidence Levels 4 and 5). The committee charged with producing this report was able to locate only a handful of articles, all quite recent, that rise to a higher level of evidence. For example, there appears to be only one prospective, randomized clinical trial in the literature on vesico-vaginal fistulas in the developing world (Tomlinson and Thornton 1998), and only one comparative study of surgical technique (Rangnekar et. This fact underlines how the entire problem of obstetric fistulas in developing countries has been neglected by the bioscientific medical community of the industrialized world. The most common measure of maternal mortality used for international comparative purposes is the maternal mortality ratio: the number of maternal deaths per 100,000 live births. The overall world maternal mortality ratio is estimated at 430 maternal deaths per 100,000 live births. In more developed regions of the world the ratio is 27 deaths per 100,000 live births, contrasted with 480 deaths per 100,000 live births in less developed regions. The numbers are substantially worse for Africa: 870 for the continent as a whole, 950 in middle Africa, 1,020 in West Africa, and 1,060 in East Africa. In northern Europe and North America there are 11 maternal deaths per 100,000 live births. There are many problems associated with the collection of maternal mortality statistics, especially in developing countries, and all such statistics are acknowledged to be underestimates to some (usually to a substantial) degree. For an individual woman, a more important statistic than the maternal mortality ratio is her lifetime risk of pregnancy-related death. This statistic is a function of the risk of dying in any particular pregnancy multiplied by the number of times she is likely to become pregnant. The risks are therefore highest in areas of high fertility where access to emergency obstetric care is poor. In more developed regions, the risk is only 1 in 1800; in less developed regions the risk is 1 in 48. In North America or Northern Europe, a woman has a lifetime risk of pregnancy-related death of approximately 1 in 4,000; in 896 Africa, the risk is 1 in 16, and in the poorest parts of Africa a womanХs lifetime risk of dying as the result of pregnancy or childbirth is as high as 1 in 7. The majority of maternal deaths are due to five principal causes: hemorrhage, sepsis, hypertensive disorders of pregnancy, unsafe abortion, and obstructed labor (AbouZahr and Royston 1991). Not surprisingly, obstetric fistulas are most prevalent in areas where maternal mortality is high and where obstructed labor is a major contributor to maternal deaths. These are areas where access to emergency obstetric care is poor; correspondingly, accurate epidemiological information is also poor in these regionsС-a continuing point of difficulty in the evaluation of maternal mortality in general and in the evaluation of obstetric fistulas in particular. The problem of obstetric fistula formation is linked directly to that of maternal mortality. Maternal mortali- ty is embedded in a complex network of social issues that have to do with the social status of women, the distribution and availability of healthcare resources, perceptions about the nature and importance of maternal health problems, and the social, economic and political infrastructures of developing countries. Indeed, it is commonly said that obstetric fistulas result from the combination of Зobstructed labor and obstructed transportation. И Thaddeus and Maine (1994) have articulated the concept of three Зstages of delayИ that result in maternal mortality: delay in deciding to seek care, delay in arriving at a health care facility, and delay in receiving adequate care once a woman arrives at such a facility. Women in labor are often neglected in the hopes that Зeverything will come out all rightИ on its own. Other women refuse to seek care for fear they will be perceived as ТweakУ or Тcowardly. У Frequently the seriousness of the situation is not appreciated or help is not sought for fear of incurring high financial costs. The three Тstages of delayУ keep women on what is sometimes termed the Тroad to maternal death. У In similar fashion it seems that there is also a Зroad to obstetric fistulaИ that begins when young girls grow up in nutritionally marginal circumstances, are married around the age of menarche, become pregnant while still adolescents, and labor at home either alone or under the care of untrained birth attendants for prolonged periods of time and with inadequate access to emergency obstetrical care. In addition, many become victims of harmful traditional medical practices that further complicate matters. In a short survey of available information on obstetric fistulas published by the World Health Organization in 1991 that encompassed a literature review and correspondence with over 250 individuals, institutions and organizations in developing countries, a map was created showing the distribution of countries where obstetric fistulas had been reported (Figure 2). The committee members, from personal experience and contact with other workers in the field, know that this map should include virtually all of Africa and south Asia, the less developed parts of Oceania, Latin America, and the Middle East; and, we suspect (though we cannot prove) the more remote regions of Central Asia and selected isolated areas of the former Soviet Union and Soviet-dominated eastern Europe. The true magnitude of the fistula problem worldwide is unknown, but it is clearly enormous. Arrowsmith (1994), writing from the plateau region of central Nigeria, noted that Зthe local popular press estimates that the region may harbor up to 150,000 victims of vesicovaginal fistula. И Harrison, also writing from northern Nigeria, reported a vesico-vaginal fistula rate of 350 cases per 100,000 deliveries at a university teaching hospital (1985). Karshima, who has carried out villagebased survey work on obstetric fistulas in the middle belt of Nigeria, suspects that there may be as many as 400,000 unrepaired fistulas in Nigeria (J. Karshima, personal communication, 2001), and the Nigerian Federal Minister for Women Affairs and Youth Development, Hajiya Aisha M. Ismail, has estimated the number of unrepaired vesico-vaginal fistulas in Nigeria at between 800,000 and 1,000,000 (personal communication, 2001). The data on maternal morbidity (non-fatal obstetric complications) in developing countries are poor, but it is obvious that the number of serious morbid episodes or Зnear missesИ greatly exceeds the number of maternal deaths in the developing nations (Prual et.

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