ABSTRACT
@#Turner syndrome and Mayer-Rokitansky-Kuster-Hauser syndrome are the most common causes of primary amenorrhea. However, mullerian agenesis in patients with Turner syndrome is rare, with only 15 reported cases worldwide. Described in this report is an 18-year-old female who presented with primary amenorrhea, absent secondary sexual characteristics, short stature, webbed neck, and shield chest. Work up revealed hypergonadotropic hypogonadism, absence of normal ovaries and uterus, and hypothyroidism. She had a 45,X karyotype and was diagnosed with a very rare case of Turner syndrome with associated Mayer-Rokitansky-Kuster-Hauser syndrome. Early detection of the etiology of amenorrhea is critical for prompt management and initiation of hormonal replacement. She was counseled on the possible systemic problems associated with her condition. The importance of regular follow-up and continuous care were also emphasized. With the coexistence of these two conditions, adoption is the only option for having children in the Philippines, where oocyte donation and uterine transplantation are currently unavailable.
Subject(s)
Turner SyndromeABSTRACT
BACKGROUND: A retrospective observational time motion study of elective gynecologic surgeries performed from January 2015 to December 2016 was conducted at the Operating Room Complex of a tertiary training hospital. There was a change from three operating suites with standard last stitch time in 2015 to only two with no cutoff times in 2016. This was due to the renovation of the Operating Room Complex.OBJECTIVE: To determine the factors and problems affecting operating room processesMATERIALS AND METHODS: Different time motion parameters such as induction time, length of induction, cutting time, last stitch time, total operation time, turnover time, and number of cases performed were collected from the nurses' documentation records. Average values from two different time periods were compared and analyzed.RESULTS: Results showed no improvement with the revised policies implemented in 2016. With only two rooms, surgeons were able to cope with the number of patients by extending operating hours later through the day. Recurring problems on manpower and lack of resources were noted.CONCLUSION: There is a need to identify hindrance to efficient operating room utilization with the goal to decrease patient queue, improve patient as well as staff satisfaction, and increase hospital revenue. Multi-disciplinary changes in practices, processes, and attitudes are timely for improvements in operating room utilization and consequently better patient centric outcomes.
Subject(s)
Operating Rooms , Personal Satisfaction , Operative Time , Surgeons , Tertiary Care Centers , Time and Motion Studies , AttitudeABSTRACT
Ovarian new growths are among the most common tumors in women. Their presentation at time of diagnosis vary and are often incidental findings on ultrasound examination. Complications of ovarian masses include torsion, rupture, infection, hemorrhage, and malignant degeneration. These masses have also been known to create fistulous tracts to other organs of the body. Entero-adnexal communications have been reported in literature. However, fistula formation to the skin has not yet been reported. Here, we present an adult woman diagnosed to have ovarian new growth and a one-year history of serous discharge from a skin lesion. Imaging studies show a fistulous connection to the abdominopelvic mass. She underwent excision of the mass with fistulectomy. This is the first reported case of an ovarian new growth which created a cutaneous fistula.