A system for reporting gynecologic procedures. A linguistic-logical approach.

A system was developed for reporting gynecologic procedures at Chicago Lying-In Hospital. The system is designed to report procedures and treatments performed during both inpatient stays and outpatient visits. Key features of the system are (1) the automatic encoding of all gynecologic procedures in both the ICD (International Classification of Diseases) and CPT (Current Procedural Terminology) coding systems, (2) the use of an independent program to maintain and update a multiply referenced network of operative procedures and (3) the use of a cross-indexing system that allows each procedure to be accessed in several ways and according to several patterns of keys (billing code number, CPT category, common abbreviation and/or linguistic feature).

Malacoplakia of the endometrium, a probable cause of postmenopausal bleeding.

A 60-year-old woman, 20 years post-menopausal, who had deforming rheumatoid arthritis of 7 years' duration and Sjögren's syndrome of 1 year's duration, had had postmenopausal bleeding for a month prior to admission to the hospital. A diagnosis dilatation and curettage was interpreted as showing acute suppurative endometritis. The patient was discharged, only to have recurrent vaginal bleeding. She was readmitted five weeks later, at which time results of another dilatation and curettage were interpreted as showing xanthromatous endometritis. Total hysterectomy with bilateral salpingo-oophorectomy was done. Examination of Epon-embedded endometrium 1 micrometer thick by light microscopy and subsequently by electron microscopy disclosed intracellular bacilliform organisms within phagolysosomes of atypical histiocytes, lamellar bodies, and various developing stages of calcospherites, Michaelis-Gutmann bodies. The curettings were then received and classic Michaelis-Gutmann bodies were identified in periodic acid--Schiff-stained sections.

Acute leukemia in advanced ovarian carcinoma after treatment with alkylating agents.

Two cases of advanced ovarian carcinoma treated with chlorambucil and terminating in acute leukemia are presented and the literature reviewed. The first patient was diagnosed by laparotomy as having Stage III ovarian carcinoma, and total abdominal hysterectomy and bilateral salpingo-ophorectomy were performed. After 7 years and 2 months of chemotherapy, acute myeloblastic leukemia was diagnosed, and the patient expired 4 months later. At autopsy no residual ovarian tumor was found. The second patient had a right oophorectomy after the diagnosis of Stage III ovarian carcinoma had been made. After 5 years and 9 months of chemotherapy she developed acute myelomonocytic leukemia and expired 2 months later, with residual ovarian tumor present on autopsy. The benefits of surgical reexploration in occasional cases of good clinical remission after chemotherapy are discussed in view of potential carcinogenicity of cytostatic agents.

Ketamine anesthesia for laparoscopy.

PIP: A total of 57 patients were selected for ketamine anesthesia during laparoscopy. Of these 45 underwent bilateral partial salpingectomy for sterilization, 7 had diagnostic laparoscopy, and 5 a combination of dilation and curettage and sterilization. All were given meperidine HCl, 50 mg, and atropine sulfate, .4 mg, shortly before surgery. Most were also given hydroxyzine hydrochloride, 50 mg, or occasionally 75 mg. A few received valium, 10 mg, instead. Total average dose of ketamine was 431 mg, with a range of 225-1093 mg. Only 1 patient received over 1 gm. Statistical analysis of data showed that time of anesthesia rather than weight of the patient was the more important factor in determining dosage. Initial dose of ketamine was about 1 mg per pound of body weight, given iv. For maintenance, at 5-10 minute intervals amounts half the original dose were used. Average operating time was 45 minutes. Effective anesthesia was produced for the duration of the procedure. 2 patients had laryngospasm, 2 had postoperative hallucinations, 1 had postoperative confusion and irrational behavior, and 1 patient developed tachycardia. Transient elevations of blood pressure were the rule. Advantages of ketamine anesthesia are claimed to be: special selective effect on pain perception, stimulation of cardi ovascular system, antiarrhythmic properties, increase of reflexes, patent airway, and more natural appearance of the patient.^ieng