The largest ovarian cyst in Songklanagarind Hospital: a case report.

Giant ovarian cysts (more than 12 kilogram) are now rarely seen because of the development in health care systems and education. We report a patient with an ovarian cyst weighing 64 kilogram, marked distended abdomen, tachypnea and dyspnea, pitting edema of both legs and inability to walk. The successful management required multidisciplinary team approach. Slow paracentesis of the cyst was done to relieve 20 litres of fluid before surgery to improve the respiratory function. Subtotal hysterectomy with bilateral salpingo-oophorectomy and partial omentectomy was done with about 4 litres of blood loss during operation. We replaced with 9 units of packed red cells and 25 units of fresh frozen plasma and plasma. Postoperative complications were pneumonia, urinary tract and surgical wound infection which were treated by appropriate antibiotics, dressing and physiotherapy until the patient was able to walk. She was discharged home on postoperative day 33. The pathological report of this cyst was mucinous cystadenoma. Only 4 courses of prophylactic chemotherapy were given because she was lost to follow-up.

A cost-effectiveness analysis of routine pretreatment investigation for staging in cervical cancer patients.

Two methods of analysing the cost-effectiveness of routine pretreatment investigation of 524 cervical cancer patients were studied. It seems to be cost-effective to perform the complete pretreatment investigation only in patients at clinical stage III, while in initial stage I and II patients, only chest X-ray and IVP should be performed. This will be more significant if most of the patients are in an early stage and the hospital costs are higher, as well as the very high professional fees for private consultations especially in the developed countries. Following this suggestion, the direct and indirect cost to the patients and their relatives will be reduced without compromising the treatment of cervical cancer.