RESUMEN
Caesarean scar pregnancy (CSP) occurs when the gestational sac implants in the region of a scar from a previous caesarean delivery. CSP can lead to life-threatening complications, including severe haemorrhage, uterine rupture, placenta accreta spectrum (PAS) and hysterectomy. A 40-year-old woman with one previous caesarean was referred to the specialist centre at 17+1 weeks of gestation with concerns about CSP. At 19 weeks, she was admitted with abdominal pain. Due to raised body habitus, accurate ultrasound assessment was challenging, necessitating reliance on magnetic resonance imaging (MRI). The patient desired to continue the pregnancy, but due to pain and concerns about uterine rupture she consented to a laparotomy to potentially terminate the pregnancy. Findings during the laparotomy were reassuring, leading to the decision not to terminate the pregnancy. The patient remained hospitalised until delivery by caesarean-hysterectomy at 33+6 weeks. Histopathology confirmed the PAS diagnosis. This case highlights the importance of achieving early diagnosis and obtaining clear sonographic findings. It emphasises the pitfalls of relying on MRI due to its tendency to over-diagnose severity. It emphasises the urgency for improved training in this domain. Early sonographic diagnosis allows safer performance of termination of pregnancy. It also provides women who continue with the pregnancy useful prognostic signs to facilitate decisions on the optimal gestation for delivery. Determining optimal conservative management for CSP remains an ongoing challenge. This case emphasises the importance of multidisciplinary discussion, comprehensive patient counselling and involving patients in their care planning, to create an individualised and adaptable treatment plan.
RESUMEN
We report the case of a 44-year-old presenting with breathlessness in her second trimester of pregnancy diagnosed with pulmonary diffuse large B cell lymphoma (DLBCL) which was further complicated by a placenta accreta spectrum (PAS) disorder. In pregnancy, she was treated with rituximab, cyclophosphamide, hydroxydaunorubicin, oncovin and prednisolone, which was associated with neutropenic sepsis requiring admissions to the intensive care unit with respiratory compromise. She safely delivered an infant at 31 weeks but required a hysterectomy at the time for PAS and seven days ventilation on the intensive care unit post-operatively. It is the first case report of DLBCL and PAS in pregnancy.
RESUMEN
OBJECTIVES: To assess the impact of the introduction of robot-assisted radical cystectomy (RARC) on an established enhanced recovery programme (ERP) and to examine the effect on mortality and morbidity rates, transfusion rates, and length of stay (LOS). PATIENTS AND METHODS: Data on 102 consecutive patients undergoing RARC with full intracorporeal reconstruction were obtained from our prospectively updated institutional database. These data were compared to previously published retrospective results from three separate groups of patients undergoing open radical cystectomy (ORC) at our centre. Our primary focus was perioperative outcomes including transfusion rate, complication rates, 30- and 90-day mortality rates, and LOS. RESULTS: The demographics of the comparative groups showed no significant difference in age, gender distribution, and American Society of Anesthesiologists grade. A significant reduction in transfusion rate was seen in RARC vs ORC (P < 0.001). The median LOS for the RARC group was 8 vs 13 days for the ORC group (P < 0.001). There was trend to a lower total complication rate (48% vs 31%). The 30- and 90-day mortality rates were equivalent between the groups (2%). CONCLUSIONS: Introduction of RARC and intracorporeal reconstruction represents the single biggest impact on our ERP, with significant reduction in transfusion rates and LOS, and a trend towards a lower complication rate.
Asunto(s)
Cistectomía , Procedimientos Quirúrgicos Robotizados , Neoplasias de la Vejiga Urinaria/cirugía , Derivación Urinaria , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Cistectomía/efectos adversos , Cistectomía/métodos , Cistectomía/estadística & datos numéricos , Femenino , Humanos , Masculino , Persona de Mediana Edad , Complicaciones Posoperatorias , Estudios Retrospectivos , Procedimientos Quirúrgicos Robotizados/efectos adversos , Procedimientos Quirúrgicos Robotizados/métodos , Procedimientos Quirúrgicos Robotizados/estadística & datos numéricos , Vejiga Urinaria/cirugía , Neoplasias de la Vejiga Urinaria/epidemiología , Derivación Urinaria/efectos adversos , Derivación Urinaria/métodos , Derivación Urinaria/estadística & datos numéricos , Adulto JovenRESUMEN
AIM: To evaluate the new pediatric Glidescope (Cobalt GVL Stat) by assessing the time taken to tracheal intubation under normal and difficult intubation conditions. We hypothesized that the Glidescope would perform as well as conventional laryngoscopy. BACKGROUND: A new pediatric Glidescope became available in October 2008. It combines a disposable, sterile laryngoscope blade and a reusable video baton. It is narrower and longer than the previous version and is available in a greater range of sizes more appropriate to pediatric use. METHODS: We performed a randomized study of 32 pediatric anesthetists and intensivists to compare the Cobalt GVL Stat with the Miller laryngoscope under simulated normal and difficult airway conditions in a pediatric manikin. RESULTS: We found no difference in time taken to tracheal intubation using the Glidescope or Miller laryngoscope under normal (29.3 vs 26.2 s, P = 0.36) or difficult (45.8 and 44.4 s, P = 0.84) conditions. Subjective evaluation of devices for field of view (excellent: 59% vs 53%) and ease of use (excellent: 69% vs 63%) was similar for the Miller laryngoscope and Glidescope, respectively. However, only 34% of participants said that they would definitely use the Glidescope in an emergency compared with 66% who would be willing to use the Miller laryngoscope. CONCLUSIONS: The new Glidescope performs as well as the Miller laryngoscope under simulated normal and difficult airway conditions.