A case of unilateral Horner's syndrome after combined spinal epidural anesthesia with ropivacaine 10mg/mL for cesarean section.

We report a case of transient unilateral Horner's syndrome during the setting of combined spinal epidural anesthesia for elective cesarean section using ropivacaine 10mg/mL. The pathophysiology of Horner's syndrome and the possible mechanisms in relation to combined spinal epidural anesthesia are also presented.

Fine needle aspiration cytology of the ovary: is it reliable?

PURPOSE OF INVESTIGATION: The purpose of this study was to evaluate the cytologic findings from the fluid of ovarian cysts in comparison with the histologic diagnosis. METHODS: Over a four-year period all women with single ovarian cysts and no evidence of malignancy from ultrasound examination and tumour marker levels were included in the study. Prior to removal of the cyst, fluid was aspirated from the cyst and prepared for cytologic examination. Subsequently the ovarian cyst wall and biopsy from the ovary were sent for histologic examination. The cytologic findings were compared to the histologic diagnosis. RESULTS: The material of the study was 120 ovarian specimens from 107 women. Twenty-four (20%) of the specimens submitted for cytology were non diagnostic and a comparison between cytologic and histologic findings was possible in 96 cases. The sensitivity and the specificity of fine needle aspiration (FNA) cytology of the ovary was 25% and 97%, respectively. CONCLUSIONS: FNA cytology of the ovary is an accurate method for predicting benign ovarian histologic findings in carefully selected populations.

Asynchronous delivery of twins and triplets with an interval period ranging from 48 hours to 19 weeks.

OBJECTIVE: To improve perinatal survival rates by prolonging the rest of the pregnancy after an abortion or extremely premature birth of one fetus in multiple pregnancies, especially in women with low fertility potential. METHODS: Following the expulsion of one fetus a cervical cerclage was applied to all patients. The placenta of the expelled fetus including a small portion of its cord after it was ligated close to the external os, was left in situ. The patients were invariably kept on bed rest until the pregnancy was completed under close observation, tocolysis and preventive antibiosis. After the 24th week of gestation corticosteroids were administered. RESULTS: The delivery interval achieved ranged between two and 135 days, the longest reported. Although the survival rate was relatively low (40%) all but one of the women (83%) managed eventually to have a live child, one with twins. CONCLUSIONS: In selected multiple pregnancies the attempt to prolong the rest or the pregnancy, following the abortion or the extremely premature birth of one fetus, seems efficacious and justified especially in women with a history of long-term infertility.

Current and potential application of GnRH agonists in gynecologic practice.

The development of GnRH-a (analogues or agonists) is a major leap forward in the treatment of various hormone-dependent diseases in medicine. Their introduction in reproductive endocrinology, in in vitro fertilization/embryo transfer (IVF/ET) and other assisted reproduction techniques had a revolutionary impact. They have been effective in other gynecologic conditions including fibroids, endometriosis, anovulatory disorders, precocious puberty, dysfunctional uterine bleeding, and operative hysteroscopy. Medical castration induced by GnRH-a has become first-line therapy in metastatic breast cancer. Their long-term use, though, has been associated with a variety of adverse effects such as bone loss and decreased cardioprotection. "Steroid add-back" therapy in these cases apparently is an effective alternative. It may allow their safe long-term application beyond 6 months, averting unpleasant side-effects and maintaining bone mass and cardioprotection.

Single high dose of local methotrexate for the management of relatively advanced ectopic pregnancies.

OBJECTIVE: To evaluate the limits of the conservative management of relatively advanced ectopic pregnancies (EPs) with local methotrexate given at a higher than standard dose. DESIGN: Nonrandomized prospective study. SETTING: A tertiary teaching hospital and an affiliated infertility center. PATIENT(S): We treated 118 EPs of up to 56 days' gestation (8 weeks) regardless of the presence of fetal heart activity, the size of the gestational mass, and the initial beta-hCG levels. INTERVENTION(S): Transvaginal intraamniotic or laparoscopic intratubal injection of 100 mg of methotrexate as a single dose. MAIN OUTCOME MEASURE(S): beta-hCG levels, red and white blood cell count, and liver function tests before and after methotrexate injection, followed by repeat transvaginal color Doppler assessments. RESULT(S): Treatment was successful in 105 (88.98%) of the 118 patients included in the study. In 7 of them with persistent fetal cardiac activity after the methotrexate injection, treatment was concluded with a complementary intracardiac injection of 10% KCl. No grade 3 or important clinical, hematologic, or biochemical toxicities occurred. CONCLUSION(S): Local administration of a single high dose of methotrexate (100 mg) proved safe and effective in the medical management of relatively advanced and unselected EPs, including cases with fetal heart activity, with high initial beta-hCG levels, and with a gestational mass beyond the standard maximum of 3.5 cm. Complementary hypertonic KCl proved to be effective in cases with persistent cardiac activity.

The purpose of prelaparoscopy transvaginal retrieval and evaluation of oocytes in a modified GIFT procedure.

To minimize the risk of submitting the patient to an 'unnecessary' laparoscopy in cases of unsuccessful oocyte retrieval and to reduce gamete exposure to the probable adverse effects of the CO2 pneumoperitoneum and anaesthetic agents, we have performed transvaginal oocyte recovery prior to performing the laparoscopy for gamete intra-Fallopian transfer (GIFT). When the recovered oocytes had a low potential for fertilization, the GIFT laparoscopy was cancelled and fertilization in vitro and zygote intra-Fallopian transfer (ZIFT) were attempted instead. By introducing this modified, two-stage GIFT procedure, the laparoscopy time was reduced to a quarter of that required for the more time-consuming, conventional GIFT method (18 +/- 4 min and 76 +/- 13 min respectively in the same unit). Of the 35 cases selected for this modified GIFT treatment, only 26 were considered suitable to proceed to laparoscopy, resulting in eight clinical pregnancies (30.7%). The remaining nine (25.7%) GIFT cases were cancelled, due either to the absence of oocytes in four or to their poor quality in five (oopenia). The latter were diverted to IVF and out of five cases, only two oocytes were fertilized and proceeded to ZIFT. No clinical pregnancy resulted. In conclusion, we propose that securing the retrieval of oocytes of appropriate quality seems to be a logical and necessary preliminary step before embarking upon laparoscopy for GIFT or ZIFT, depending upon the biological status of the gametes. By employing this procedure, unnecessary and costly laparoscopy can be avoided in certain cases.

L/S ratio, biochemical and clinical changes after ritodrine intravenous infusion.

The effects of ritodrine hydrochloride on the L/S ratio, the clinical and biochemical status of the mother, and the amniotic fluid were studied in a total of 46 women between the 28th and 35th wk of their pregnancy. An increase in the L/S ratio and creatinine levels in the amniotic fluid, significant changes in the maternal serum levels of potassium, sodium, alpha 1-antitrypsin and glucose were found, whereas the urea levels remained unchanged. Maternal hyperglycemia and hypokalemia in both maternal serum and amniotic fluid, were more pronounced when the ritodrine was infused in 5% dextrose. The findings from monitoring the cardiovascular systems of both mother and fetus, agreed with previous reports. It was concluded that ritodrine hydrochloride has a positive effect on the fetal lung maturation, probably by accelerating the release of surfactant. Its administration, however, should be under laboratory control.