Primary pulmonary synovial sarcoma in pregnancy.

Background. Primary pulmonary synovial sarcoma is a rare malignancy with a poor prognosis. Surgical resection and postoperative management of these tumors has not been previously described in pregnancy. Case. A 38-year-old pregnant woman was admitted for evaluation of a right thoracic mass found on chest radiography at 26 weeks of gestation. A computed tomography-guided biopsy was subsequently completed and demonstrated a high-grade neoplasm. A right pneumonectomy was performed at 28 weeks of gestation due to pulmonary decompensation, and pathological examination revealed a pulmonary synovial sarcoma. The patient developed a postpartum pulmonary embolism and expired 6 weeks after delivery. Conclusion. Aggressive intervention for pulmonary malignancies during pregnancy may be necessary. Complete tumor resection is the most important prognostic factor in primary pulmonary synovial sarcoma.

Sustaining simulation training programmes--experience from maternity care.

There is little scientific evidence to support the majority of simulation-based maternity training programmes, but some characteristics appear to be associated with sustainability. Among these are a clear institutional-level commitment to the course, strong leadership in course organisation, a curriculum relevant to clinical practice, a nonthreatening learning environment, the establishment of multiprofessional training and the use of simulators appropriate to the learning objectives. There is still some debate on whether simulation-based sessions should be carried out in dedicated training time outside normal working hours or in ad-hoc drills that are run during clinical sessions, whether they should be located in clinical areas, simulation centres, or both, and whether or not they should include standardised generic teamwork training sessions. In this review, we discuss the main characteristics that appear to make a simulation-based training programme a sustainable initiative.

Eating disorders: recognition, evaluation, and implications for obstetrician/gynecologists(1).

Eating disorders are a common finding in adolescent females. The lifetime prevalence of anorexia nervosa and bulimia nervosa is as high as 3.7% and 4.2%, respectively. The disease is much more common in females than males and is often associated with depression and other mood disorders. Complications from eating disorders can include amenorrhea, osteoporosis with pathologic fractures, electrolyte disturbances, dehydration, cardiac arrhythmias, and even death. Eating disorders appear not only to increase the risk of miscarriage, but also are associated with preterm delivery and lower infant birth weights. Treatment for eating disorders can be lifesaving and is more effective when instituted before the patient becomes severely underweight. Evaluation of patients with suspected eating disorders includes a thorough history and physical examination as well as baseline screening laboratory tests. A high index of suspicion is needed to detect patients with eating disorders because many are in denial about their illness. Inpatient hospitalization is recommended for significant metabolic abnormalities and for patients who weigh <85% of their estimated healthy body weight. Treatment for eating disorders includes nutritional rehabilitation, behavioral therapy, and often antidepressant therapy. The obstetrician/gynecologist is one of the few health care providers that young, otherwise healthy women who are at risk for eating disorders will see on a regular basis, and they must be diligent to recognize the signs and symptoms of these diseases so that appropriate and timely interventions can be made.

Recurrent leiomyomatosis peritonealis disseminata exacerbated by in vitro fertilization.

Leiomyomatosis peritonealis disseminata is a rare disease that is most often discovered during pregnancy or in patients with a history of oral contraceptive use. We report the first case of a patient with the disease who conceived by in vitro fertilization and the complications that occurred.