ABSTRACT
Benign ovarian cysts are common among both pre- and postmenstrual women. Surgical intervention for excision of an ovarian cyst is mandated when symptomatic, or chance for malignancy is high. The damaging effect of surgical ovarian cystectomy on ovarian reserve is debated in recent studies. In the present study we investigated serum level of anti-mullerian hormone [AMH] as an indicator of ovarian reserve before and after surgical cystectomy. 60 patients with dermoid cyst, serous cystadenoma, and mucinous cystadenoma were recruited. Measurement of serum AMH was performed prior to surgery, and at one and 3 months after laparoscopic cystectomy. Serum AMH levels were compared before and after the surgery and between various types of ovarian cyst. Serum AMH level declined significantly after the surgery which recovered to 65% of its baseline value three months later. Decreased serum AMH can be contributed to decreased ovarian reserve after laparoscopic ovarian cystectomy. This can result from thermo-coagulation used for hemostasis during the operation
Subject(s)
Humans , Female , Ovarian Cysts , Ovarian Neoplasms , Teratoma , Cystadenoma, Serous , Cystadenoma, Mucinous , Laparoscopy , EndometriumABSTRACT
Objectives: To identify the predictive factors of successful non-operative management of patients with intraperitoneal bleeding following blunt abdominal trauma
Methods: This was cross-sectional study being performed in our Level I trauma center in southern Iran between 2010 and 2011. We included adult [>14 years] patients with blunt abdominal trauma and intraperitoneal hemorrhage detected by CT-Scan who were hemodynamically stable and did not require any surgical intervention. Patients were managed conservatively in ICU. Those who required laparotomy during the study period were named as non-operative management failure [NOM-F] while the other were nonoperative management success [NOM-S]. The baseline, clinical and laboratory characteristics were compared between two study groups in order to detect the predictors of successful NOM of intra-peritoneal bleeding
Results: Overall we included 80 eligible patients among whom there were 55 [68.7%] men and 25 [31.3%] women with mean age of 30.63.6 +/- years. Finally, 43 [53.8%] were successfully managed conservatively [NOM-S] while 37 [46.2%] required laparotomy [NOM-F]. We found that those who underwent emergency laparotomy had significantly higher [delta]Hb [p=0.016] and lower base deficit [p=0.005] when compared to those who were successfully managed conservatively. Those who required surgical intervention had significantly lower baseline systolic blood pressure [p<0.001] and higher shock index [p=0.002]. The other parameters such as pulse rate and respiratory rate were comparable between two study groups
Conclusion: In patients with intra-peritoneal bleeding following blunt abdominal trauma, the most reliable predictive clinical and para-clinical factor of successful non-operative management are shock index and systolic blood pressure on arrival, base deficit and hemoglobin drop within first 12 hours of admission
ABSTRACT
Proximity of the vagus nerve to a patent ductus arteriosus [PDA] can cause traction or entrapment of vagus nerve during surgical closure of the in rare occasions. This can lead to a life threatening postoperative bradycardia. Herein, we report a case of bradycardia caused by unexpected irritation of the vagal trunk by the end of operation. The patient was managed byre-opening the chest, lung retraction and removal of mediastinal pleura sutures
The vagal trunk entrapped in the suture line was released immediately. Heart rate accelerated and hemodynamic restored after a short period of observation. The operation terminated as routine, patient extubated in OR and discharged within 24 hours with no further complication. This irritation of vagus results in vagal bradycardia during or by the end of operation. Awareness of a surgeon of this issue can minimize the risks and complications of the open closure of PDA