Case report: Successful IVF programme after conservatively treated endometrial cancer.

Some cases of successful pregnancy after conservative endometrial cancer management have been reported. This paper presents such a case, an infertile patient with conservatively treated endometrial cancer (stage 1a grade 1) who conceived and carried a successful pregnancy after IVF treatment. The conservative treatment consisted of hysteroscopic biopsies and oral megestrol acetate 600 mg daily for 3 months. At the end of the treatment the endometrial cancer remitted to simple endometrial hyperplasia. IVF was performed immediately and 32 days after embryo transfer an intrauterine single gestational sac with fetal pole and heartbeat was detected by transvaginal ultrasound. The woman received routine obstetric care and a caesarean section was performed at 38 weeks of gestation. The histological evaluation after delivery showed no evidence of recurrent disease. Twenty-six months after the delivery, the woman is healthy and free of the disease. It is concluded that conservative treatment of stage 1a and grade 1 endometrial adenocarcinoma is an available option in young women who wish to preserve their fertility.

Activities of a medical emergency team twenty years after its introduction.

INTRODUCTION: We describe and quantify the wide range of activities that a mature Medical Emergency Team can progressively perform. METHODS: The activities performed by a Medical Emergency Team 20 years after its introduction were prospectively collected during 105 consecutive days. RESULTS: The main activity was focused on the follow-up visits to previously treated critically ill patients (mean 7.5 visits/die in working days, 5.1 in the others). A large amount of other scheduled or unscheduled activities (like sedation or analgesia for diagnostic procedures, central venous line placement, phone consultation regarding critical care aspects of treatments) were performed: on average, 7.3 side-activities/die in working days and 5.2 in the others. First consultations in patients not previously seen were on average 3.1/die on working days, 2.4 in the others. Cardiac arrest accounted for 27 (9%) of first time visits. CONCLUSIONS: A Medical Emergency Team can progressively perform many kinds of activities. An evaluation limited to the reduction of in-hospital cardiac arrests or a too early assessment may underestimate its beneficial effects on the Hospital complexity.

Dilatative percutaneous tracheostomy during double antiplatelet therapy: two consecutive cases.

This article reports two cases of dilatative percutaneous tracheostomy performed on patients treated with double antiplatelet therapy. Both patients had cardiac arrest following myocardial infarction. After primary angioplasty with stent placement, a double antiplatelet therapy was started. Due to poor neurological outcome, dilatative percutaneous tracheostomy was performed on both patients. Antiplatelet therapy was not discontinued because of the unacceptable risk of stent thrombosis. No immediate or late hemorrhagic complications occurred. In our experience, dilatative percutaneous tracheostomy during double antiplatelet therapy can be safely performed in selected patients without other risk factors.