Incarceration of early gravid uterus with adenomyosis and myoma: report of two patients managed with uterine reduction

Although gravid uterine incarceration is typically diagnosed during the early second trimester, we encountered two unusual cases in early pregnancy. A 34-year-old multiparous woman with adenomyosis presented at 7 + 2 weeks of gestation with increased urinary frequency and a sensation of incomplete bladder emptying. The uterine incarceration was successfully reduced by manual reduction and pessary insertion, and she delivered a normal infant at term. In the second case, a 31-year-old nulliparous woman with a large myoma complained of dysuria, acute urinary retention, and intense back pain at 6 weeks of gestation. Manual reduction was successful in the knee-chest position. Subsequent pessary insertion failed; however, a slight reduction in pain was achieved. After a week, the fetus spontaneously aborted. In summary, gravid uterine incarceration is a rare but potentially fatal condition for the fetus, and a suspicion of this condition in patients with urinary symptoms, especially urinary retention and pelvic pain, is important in the early gestation period.

The Morphologic Changes of Femoral Artery-graft Anastomosis with the Squatting Position

PURPOSE: There is a traditional belief that the oriental squatting position could be harmful to a femoral artery-graft anastomosis. Should patients be advised not to squat after a femoral artery bypass-graft? We studied the morphological changes during squatting to determine if there were any negative effects on the anastomosis configuration. METHOD: For a fluoroscopic marker, after the anastomosis at least five 2 mm Hemo-clips(R) (Telefix, Inc., US) with an interval of 1 mm, were left along the PTFE graft and native artery in eight patients. Five patients (10 limbs) were evaluated by fluoroscopy at 2 weeks post surgery. X-rays were taken serially for lateral views of the hip joint supine, in hip flexion (90 degrees) and in the knee to chest position, which simulated squatting. The angle of the graft-artery at each position was measured in the PACS computer screen. RESULT: The angle for each position in the 10 limbs was studied. The mean angle changed from supine to the knee-chest position and was 22.2 degrees. The larger angle between the abdominal wall and the graft was reduced in all cases, which means that the shape of the graft-artery became T-shaped. CONCLUSION: The configuration of the graft-artery after squatting became T-shaped, which was contrary to our belief that the angle would decrease between the abdominal wall and the graft. There is no evidence that this configuration would have a negative influence on the graft patency.

Intraocular pressure during lumbar disc surgery - a comparative study between prone position and knee-elbow position

Post-operative visual loss occurs more commonly in spinal surgery. Increased intra-ocular pressure is often Implicated In the etiology of postoperative visual impairment. We Investigated intraocular pressure in 20 patients undergoing lumber disc surgery. We classified the patients into two groups: Group I: patients were in the knee-elbow position with the head resting on a cushion and turned to one side and group II: patients were in prone position and the head neutral. We classified patients in knee-elbow position into two sub-groups: subgroup A where we measured IOP in nondependant eye and subgroup B where we measured IOP in dependant eye. In both groups we measured lOP during 2 times, the first time in both group when the patients were awake and In supine position and the second time was In group I at the end of surgery when the patients were still anesthetized and in knee elbow position and in group II at the end of surgery when the patients were still anesthetized and in prone position. In group I after mean duration of surgery 120 +/- 18 min. [mean +/- SD], the mean intra-ocular pressure in the non-dependnnt eye was unchanged when compared to awake state 16.3 +/- 2.1 vs. 17.2 +/- 3.2 mmHg [p >/= 0.05]. whereas the intraocular pressure in the dependant eye had significantly increased 17.1 +/- 2.2 vs. 19.2 +/- 1.1 mmHg [p<0.05]. In group II after mean duration of surgery 119 +19 mmHg, mean Intra-ocular pressure had highly significant increase compared to awake state 16.7 +/- 2.2 vs. 21.3 +/- 2.1 mmHg [p<0.01]. We conclude that IOP increased when anesthetized - patients are placed in prone position more than when placed in knee-elbow position

Basal narcosis: a thchnique for culdoscopy in an awkward position

Culdoscopy was performed for 249 cases underbasal narcosis. This technique was used to achieve analgesia and sedation in a patient who has to be conscious and aware to be put in an awkward knee-chest position. This method was compared with other techniques used which included general, local or regional blocks. The results and side effects were discussed