Accurate preoperative diagnosis of ovarian pregnancy with transvaginal scan.

Ovarian pregnancy is a rare variant of ectopic pregnancy, and an accurate preoperative diagnosis is very challenging. Dr. Saint Monnissey described the first reported case of ovarian pregnancy in 17th century. Transvaginal ultrasonography is a valuable tool in identifying an ovarian pregnancy from other types of ectopic pregnancies. Management with laparoscopy or laparotomy is required in all cases, and in almost all cases, ovary can be preserved since implantation is usually superficial (Koo et al.; 2011). A single case of an ovarian pregnancy, consistent with Spiegelberg's criteria is presented here. This case history demonstrates the use of ultrasonography (USG) and surgery in the diagnosis and treatment, respectively, of the ovarian pregnancy. As we step into an era where in vitro fertilization rate is on its hike, one should be aware that incidence of ovarian pregnancy is also increasing, necessitating a high index of suspicion.

Serum water analysis in normal pregnancy and preeclampsia.

Hemodilution and hemoconcentration affect hematology measurements and serum analyte concentrations but whether a given blood sample is hemodiluted or hemoconcentrated is frequently not known. Preeclampsia (PE) is a serious pregnancy complication and samples obtained from PE patients may be relatively hemoconcentrated when compared to those of normal pregnancy, where hemodilution is the norm. Laboratory test results may appear similar when values would differ if adjusted for hemodilution and hemoconcentration. We sought to determine if serum water (SW) content analysis can facilitate differentiation of the hemodilution of normal pregnancy from the hemoconcentration of PE, within the broader search of a clinical laboratory method to potentially correct for pregnancy-related, sample concentration variations. Serum samples from 59 non-pregnant, 64 normal pregnant, 23 mild PE, and 8 severe PE patients were tested for SW content. The mean results in g/100g were as follows: 91.15, 91.86, 92.00, and 92.46 respectively. SW data were also compared with corresponding total protein (TP), serum albumin (SA), and hematocrit (HCT) results. The t-test was significant (p= <0.001) for TP, SA, HCT, and SW in group-by-group comparisons. SA and SW were significantly, inversely correlated in the normal pregnant and severe PE groups, while TP and SW were significantly, inversely correlated in all groups. Correlation coefficients were stronger in the pregnancy groups than the non-pregnant group. This study demonstrates differences in the SW content between: non-pregnant, normal pregnant, mild PE, and severe PE patient sera.

Con: Licensure unnecessary in the clinical laboratory.

Those who argue in favor of licensure for clinical laboratory scientists have their priorities in order, but fail to recognize the realities that would ensue were national licensure to be instituted. Higher health-care costs, elimination of rural facilities, and licensure board fraud are all unintended, yet dangerous, consequences that could occur. In his argument against national licensure, laboratory director Jack Garon summarizes some of the most salient research done regarding licensure and presents his case why it is unnecessary in the clinical laboratory.

Patient safety and the preanalytic phase of testing.

The preanalytic phase of testing includes a variety of procedural steps and variables that affect the patient and the test results. During the preanalytic phase, the patient may be directly harmed or injured. Failures of technique during the preanalytic phase lead to incorrect laboratory results, which threaten the patient's health. This article highlights key problems in the preanalytic phase and offers plans to reduce the problems based on a review of the literature. The key problem areas include: order entry, patient identification, phlebotomy-induced suffering and injury, medical vampirism, and dangerously inaccurate test results caused by failures in preanalytic technique.

Metastatic pure small-cell carcinoma of prostate.

Extrapulmonary small-cell carcinoma arising in the prostate gland has been described in several case series and case reports. However, pure small-cell carcinoma of the prostate is rare, and there are only a few reports in literature describing the clinical features and management of this neoplasm. These tumors are highly aggressive and commonly manifest with visceral metastasis at the time of diagnosis. We report a case of metastatic pure prostatic small-cell carcinoma and an associated paraneoplastic polyneuropathy.

Sickle cell patient with an acute chest syndrome and a negative chest X-ray: potential role of the ventilation and perfusion (V/Q) lung scan.

Acute chest syndrome (ACS) in sickle cell disease is caused by thromboemboli in the pulmonary vasculature. The diagnostic criteria include the presence of pulmonary infiltrate(s) on chest x-ray. This case report suggests that a V/Q scan may play a diagnostic role in sickle cell patients with symptoms of ACS and a negative chest x-ray.

Monitoring low molecular weight heparins.

Low molecular weight heparin (LMWH) is used in the treatment of various thrombotic disorders. The clinical indications, pharmacology, and complications of therapy are reviewed. The indications for the need for monitoring include renal failure, obesity, pregnancy, and pediatric use. Monitoring focuses on the anti-Xa properties of LMWH. The two major assay types, chronometric (clotting) and chromogenic (amidolytic), are reviewed and compared.

Facilitating meetings.

Facilitating is an alternative style of running meetings. It is collaborative and goal-oriented and is especially useful when creative problem solving or group buy-in is important. Facilitators must master five skills: goal orientation, using ground rules, listening, problem solving, and decisionmaking. This article explains how to successfully master those skills.

Recent advances in parathyroid disease and parathyroid hormone assays.

Parathyroid hormone (PTH) regulates extracellular calcium. The physiology and pathology of PTH and the many circulating fragments of PTH are reviewed. Various PTH assays have been used, leading to the now standard intact PTH (iPTH). The recently discovered 7-84 fragment may have profound implications in PTH measurement and management, particularly in renal-failure patients. Newer assays measuring true PTH, exclusive of this fragment, are appearing on the market and may have use in monitoring calcitriol analogue therapy and other settings. Rapid PTH assays have application as intraoperative measures of success during excision of parathyroid adenomas.