Spontaneous reseal of ruptured membranes after genetic amniocentesis.

BACKGROUND: Rupture of membranes is an uncommon complication of genetic amniocentesis. The risk of ruptured membranes is reported as 1-1.2%. CASE: Genetic amniocentesis complicated by ruptured membranes was diagnosed in a 31-year-old woman. The membranes resealed after 48 hours with conservative management and the pregnancy ended with a favorable outcome. CONCLUSION: Spontaneous reseal of ruptured membranes after genetic amniocentesis can occur with conservative management and end with a favorable pregnancy outcome.

Primary ovarian pregnancy.

BACKGROUND: Primary ovarian pregnancy is a relatively rare form of ectopic pregnancy with an incidence of 1/6000 - 1/40000 pregnancies. CASE REPORT: A 25-year-old woman, gravida 1, parity 0, presented with vaginal bleeding after 8 weeks of amenorrhea. Pelvic examination revealed a left adnexal mass and transvaginal ultrasound confirmed a left adnexal echocomplex mass with free fluid in the cul-de-sac. Serum beta hCG was 3441 mIU/mL. Emergency exploratory laparotomy was performed with a preoperative diagnosis of left ectopic pregnancy, suspected of ovarian pregnancy. Ruptured left ovarian pregnancy was intraoperatively diagnosed. Left salpingo-oophorectomy was performed. The histopathology confirmed ovarian pregnancy. She was well at discharge and throughout a 4-week period of follow-up. CONCLUSION: Although primary ovarian pregnancy is rare and difficult to diagnose clinically and even intraoperatively, it can be detected early with the use of combined transvaginal ultrasonography and serum beta hCG The standard of care is conservative treatment in order to preserve the patient's fertility.

High level of CA 125 due to large endometrioma.

BACKGROUND: CA 125 is a tumor-associated antigen. Its high levels are usually associated with ovarian malignancies, whereas smaller increases in the levels were associated with benign gynecologic conditions. The authors report a high level of CA 125 in a case of large ovarian endometrioma. CASE REPORT: A 45-year-old nulliparous Thai woman, presented with an increase of her abdominal girth for 7 months. Transabdominal ultrasonogram demonstrated a large ovarian cyst and multiple small leiomyoma uteri, and serum CA 125 level was 1,006 U/ml. The preoperative diagnosis was ovarian cancer with leiomyoma uteri. Exploratory laparotomy was performed. There were a large right ovarian endometrioma, small left ovarian endometrioma and multiple small leiomyoma. Total abdominal hysterectomy and bilateral salpingo-oophorectomy was performed and histopathology confirmed the diagnosis of endometrioma and leiomyoma. The serum CA 125 level declined to non-detectable at the 4th week. She was well at discharge and throughout her 4th week follow-up period CONCLUSION: Although a very high level of CA 125 is associated with a malignant process, it can also be found in benign conditions such as a large endometrioma. The case emphasizes the association of high levels of CA 125 with benign gynecologic conditions.

Parasitic leiomyoma: a case report of an unusual tumor and literature review.

Uterine leiomyomas are one of the most common tumors in women. Parasitic leiomyoma is an uncommon type of uterine leiomyoma. It may present with a wide spectrum of symptoms. The authors report a case of a 44-year-old woman who presented with a palpable pelvic mass and increased frequency of urination for 2 years. A parasitic leiomyoma that had blood supplies from the common iliac vessels was diagnosed during the operation. Total abdominal hysterectomy and mass removal were performed without complication. Even though a parasitic leiomyoma is uncommon, it should be included in the differential diagnosis of pelvic mass. The management depends on the operative finding and the desired fertility function of the patients. Literature on parasitic leiomyoma is also reviewed.

Risk factors for predicting mortality in a surgical intensive care unit in the year 2000.

OBJECTIVE: To determine the mortality and risk factors of mortality in a surgical intensive care unit (SICU), King Chulalongkorn Memorial Hospital. DESIGN: Review of retrospective data. SETTING: a SICU of a tertiary-care academic medical center. PATIENTS: Out of a total of 546 patients admitted to SICU during a one year period (January 1, 2000 - December 31, 2000), 458 (83.9%) had complete medical data which were analyzed. MEASUREMENTS AND MAIN RESULTS: One hundred and ninety-three variables of 6 categories of patients' characteristics, chronic disease, acute illness, physiologic variables, therapy and miscellaneous were studied. Univariate and multivariate analyses were used. The SICU and hospital mortality was 8.1 and 14.6 per cent, respectively. Multivariate logistic regression analysis identified seven variables as independent risk factors for mortality (p < 0.05): chronic renal failure (adjusted odds ratio [AOR], 7.5; 95% CI, 3.0 to 19.0; p = 0.000), coma (AOR, 11.7; 95% CI, 2.4 to 57.4; p = 0.002), Staphylococcus aureus infection (AOR, 15.4; 95% CI, 1.6 to 147.6; p = 0.018), diagnosis of systemic inflammatory response (AOR, 2.9; 95% CI, 1.2 to 7.1; p = 0.017), mechanical ventilation (AOR, 11.2; 95% CI, 2.0 to 61.4; p = 0.005), having received adrenaline (AOR, 7.1; 95% CI, 2.3 to 22.2; p = 0.001) and diuretic (AOR, 3.3; 95% CI, 1.4 to 8.1; p = 0.008). Besides weight (AOR, 0.9; 95% CI, 0.9 to 1.0; p = 0.002) and having received H2-blocker (AOR, 0.2; 95% CI, 0.1 to 0.5; p = 0.001) were two independent protective factors for mortality. CONCLUSION: Knowing the risk factors of SICU mortality will help physicians to improve patient care, educate patients and their families, optimize ICU resource planning and may decrease health care costs.

Prevention of phantom sensations after spinal anesthesia.

BACKGROUND AND OBJECTIVES: Phantom limb sensation (PLS) after the spinal anesthesia is an unpleasant experience. The occurrence rate was 80 to 83 per cent from previous studies. The purpose of this study is to evaluate the incidence of PLS, comparing between placing the lower limbs in the neutral position when analgesic level reach L1 dermatome (L1 group) and T6 dermatome (T6 group). METHODS: Ninety ASA physical status I-II patients, 19-50 year of age, scheduled for lower abdominal surgery under spinal anesthesia were enrolled. Immediately after the spinal injection, the patients were placed supine with one of lower limbs flexed (both hip and knee) and the other kept straight in the neutral position. The analgesic levels were checked every minute; the flexed limbs were turned to the neutral position when the analgesic level reached L1 and T6, the L1 group and the T6 group respectively. The images of the lower limbs and patients' satisfactions were evaluated 15 minutes after the blockage. RESULTS: Twenty per cent of the patients in the L1 group experienced PLS of the flexed limbs while 82.2 per cent of the patients in the T6 group did (P<0.05). None of the patients in the L1 group felt unsatisfied with PLS, on the other hand, 11.1 per cent of the patients in the T6 group expressed their dissatisfaction and would like to have their limbs extended. CONCLUSIONS: This study revealed that by placing the lower limbs in the neutral position immediately after the spinal injection, before the unwanted positions are memorized, could effectively minimize phantom limb sensation after spinal anesthesia.