Tuba ovarian abscesses formation from decidualized ovarian endometrioma after appendiceal endometriosis presenting as acute appendicitis in pregnancy

Acute appendicitis with appendicial endometriosis is a very infrequently encountered condition during pregnancy. Decidualization is the hypertrophy of endometrial stromal cells by the effect of progesterone. Similarly, in pregnancy, ectopic stromal endometrial cells in endometriosis can also be transformed by the same mechanism and ectopic decidua [deciduosis] may occur. Here we report a 30 year old pregnant woman presenting twice with acute abdominal symptoms requiring surgery for appendicial and ovarian endometriosis and deciduosis. We emphasize that deciudualized endometriosis may first present during pregnancy with acute abdomen necessitating emergency laparotomy and complicating the course of gestation. To our knowledge only 9 cases in which decidualized endometriotic tissue causing acute abdomen necessitating surgery during pregnancy were reported in the literature. What makes our case special is that the patient needed two laparotomies during the pregnancy period which was a very stressful situation for both the patient and the physicians

Comparison of the effects of 2 different doses of remifentanil infusion for sedation during in-vitro fertilization procedure

To compare the sedation level, hemodynamic effects, patient and physician satisfactions following sedation achieved by 2 different doses of remifentanil [R] infusion with additional bolus infusions of propofol for in vitro fertilization [IVF] procedure. A double-blind prospective randomized study was implemented on 86 ASA I-II grade female patients, 18-40 years of age that underwent IVF procedure. This study was performed in the Department of Anesthesiology and Obstetrics and Gynecology, School of Medicine, Dokuz Eylul University, Izmir, Turkey between November 2006 to August 2008. Group R1 received 0.1mcg/kg/min while Group R2 received 0.15 mcg/kg/min infusion dose remifentanil. Side effects, total doses of remifentanil and propofol administered, heart rate [HR], systolic arterial pressure and diastolic arterial pressure values have been recorded. Fertilization, cleavage, and pregnancy rates together with prognosis of pregnancies were compared. Groups did not show statistically significant differences for hemodynamic parameters of HR and MAP [p=0.281]. Comparison of the satisfaction levels of 2 groups showed that anesthesiologist satisfaction was superior in R1 [p=0.009] whereas surgeon satisfaction was superior in R2 [p=0.01]. Both groups reported good patient satisfaction levels [p=0.31]. There were no differences between the groups in terms of fertilization, cleavage, pregnancy rates and prognosis of pregnancies [p>0.05]. Both doses of remifentanil provided stable hemodynamics along with fast and uncomplicated recovery