Unusual presentation of 22-kilogram retroperitoneal müllerian serous cystadenoma

BACKGROUND

Müllerian cyst of the retroperitoneum is an extremely rare disease that is thought to be a subtype of urogenital cyst. It is a benign condition that can only be diagnosed and cured by surgical resection.

CASE

An 80-year-old female with a huge cystic swelling, thought to be ovarian in origin, underwent laparotomy. Surgical exploration and subsequent histopathological analysis of the cyst revealed a müllerian serous cystadenoma of the retroperitoneum, 22 kg in weight. Preoperative ultrasound scan and computed tomography failed to elucidate a correct preoperative etiology.

CONCLUSION

Huge retroperitoneal cysts may coexist with other pelvic pathology creating diagnostic and therapeutic dilemmas. The use of computed tomography for diagnosis may be not helpful with huge cysts. Good preoperative preparation and surgical technique are essential for managing these cases.

Systemic spread of meconium peritonitis

Meconium peritonitis is a chemical peritonitis which occurs following bowel perforation during fetal life. It is generally looked upon as benign, resulting in no long-term sequelae. We present a case of a newborn infant with meconium peritonitis who developed infarcts in several organs. At autopsy the infarcts proved to be caused by emboli as a result of intravascular dissemination of meconium. To our knowledge, this is the first reported case of systemic spread of meconium peritonitis in the literature and suggests that meconium peritonitis may have more serious implications than generally thought.

Comparison of physical health benefits utilization. Mental and physical health claimants, 1989 and 1990

Research has indicated an association between mental health problems and physical illness, including higher physical health benefits utilization among persons with a mental health diagnosis. We hypothesized that mental health claimants will have higher covered health benefits and be more likely to make physical health claims than physical health claimants. The data for the study included all health benefits claims for 1989 and 1990. The results indicated that mental health claimants have higher total covered benefits and higher covered benefits in a number of diagnostic categories. In addition, the findings revealed a greater likelihood to make any health claim as well as a claim for several diagnostic categories among persons with a mental health diagnosis. The study indicates the need for coordination between mental health and physical health benefits cost management.

Color flow ultrasound for delineating microsurgical vessels: a clinical and experimental study

There is a need in plastic and reconstructive surgery for a method of monitoring flaps and replants pre- and postoperatively. This study evaluates color flow Doppler done as a monitoring technique for microvascular vessels. The capability of color flow ultrasound to monitor venous and arterial insufficiency and occlusion was studied by means of an experimental system in the Yucatan miniature swine model. A circulatory circuit in line with a magnetic flow probe is created. Measurements are made on the isolated hind limb of the animal. Color flow ultrasound is demonstrated to be a technique that is sensitive to venous and arterial insufficiency at flow rates as low as 3.0 ml/min. Characteristic waveform patterns are shown to predict arterial and venous insufficiency before they actually progress to occlusion. A clinical series of 25 postoperative patients is presented, consisting of volunteer studies as well as pre- and postoperative examinations of free flaps and replantations. Color flow ultrasound is shown to visualize a spectrum of pre- and postoperative microvascular conduits encountered in plastic and reconstructive surgery.

Selective termination of multiple gestations

Twenty-two selective terminations in multiple gestations were performed by a number of different methods. In 17 dichorionic pregnancies there was a successful delivery in surviving singletons or twins. In five monochorionic pregnancies undergoing selective termination there was a successful delivery in only one and a pregnancy loss in the other four. Six of the 18 delivered pregnancies were complicated by premature labor and delivery. Among the several methods used for selective termination, intracardiac potassium chloride injection appears to be the procedure of choice in dichorionic pregnancies.

Pressure, biochemical, and culture characteristics of CSF associated with the in utero drainage of various fetal CNS defects

An attempt has been made to begin delineation of the in utero dynamics of fetal intracranial fluid in the presence of brain malformations. In a series of patients with fetal CNS defects, cephalocentesis was performed at the time of therapeutic abortion or to facilitate vaginal delivery. Intracranial CSF pressures and volumes were quite variable. There did not appear to be any discernible correlation between the type of lesion and the intracranial pressure. Fetal CSF glucose levels were moderately depressed and protein concentrations were very high. Neither virus nor bacteria were cultured from fetal CSF or amniotic fluid of any patients in this series.

Gastroschisis: prenatal diagnosis and management

Ten fetuses with gastroschisis on whom a prenatal sonographic diagnosis and evaluation were available and who delivered at the University of California, San Francisco, were evaluated retrospectively. Six fetuses were delivered vaginally without mortality and minimal or absent morbidity. Four were delivered abdominally, 2 for unrelated obstetrical indications. A 3rd fetus had a suspected prenatal bowel perforation and was the sole mortality. Only 1 mother underwent primary cesarean section, specifically due to the fetal gastroschisis. Umbilical cord pH values were normal in those delivered vaginally. With careful ultrasound examination and immediate neonatal surgical capability in a level III perinatal center, vaginal delivery of fetuses with gastroschisis can be associated with excellent outcome. A multinational randomized study of the delivery mode of fetuses with gastroschisis is necessary and appropriate at this time.

Sonographic monitoring of hepatic cryosurgery in an experimental animal model

Several cryosurgical techniques for freezing hepatic parenchyma have been developed. To assess the efficacy of sonographic monitoring of hepatic cryosurgery, an experimental animal model was devised. Real-time sonography was used to monitor the in vivo evolution of hypothermically induced hepatic cryolesions in four mongrel dogs. The results suggest that sonography is an effective and accurate means of monitoring the entire freezing and thawing cycle in hepatic cryosurgery.

Mode of delivery and the lecithin/sphingomyelin ratio

Babies born by elective Caesarean section are more likely to develop the respiratory distress syndrome that babies born vaginally. We studied the amniotic fluid and pharyngeal lecithin/sphingomyelin (L/S) ratios in three groups of babies born at term: 20 were delivered vaginally after elective induction of labour; 20 were delivered by elective Caesarean section; and 14 by Caesarean section after spontaneous onset of labour. Babies born after induction of labour had higher pharyngeal L/S ratios than babies born by elective Caesarean section. Those born by Caesarean section after spontaneous onset of labour had significantly higher pharyngeal L/S ratios than those in both of the elective delivery groups. There were no significant differences in the amniotic fluid L/S ratios of the two groups who underwent elective delivery. Regression analysis showed a significant relationship between length of labour and increase in the L/S ratio. These results indicate that, during labour, there is a release of fetal lung surfactant into the airways.