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1/21. The management of non-traumatic cardiac arrest in the operating room with cardiopulmonary bypass.

    We present a case of a 29-year-old woman whom, while undergoing an elective gynecological procedure, acutely arrested. Closed chest cardiopulmonary compressions were not effective. Fortuitously, the cardiac surgical team was in an adjacent operating room, about to start an elective bypass case. After sternotomy, the patient was placed on cardiopulmonary bypass within 20 min of the arrest. The patient achieved return of spontaneous circulation and was ultimately discharged with only mild extremity weakness. The etiology of the arrest was never fully explained. Open chest massage and cardiopulmonary bypass should be considered early in the management of unexpected cardiac arrest, especially in the operating room where surgical expertise should be immediately available. Surgeons and anesthesiologists need to be aware of, and consider, the possibility of employing these techniques.
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ranking = 1
keywords = gynecologic
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2/21. Urinomas as a complication of iatrogenic ureteric injuries in gynecological surgery.

    We examined the incidence of ureteric injuries in relation to gynecologic operations. In 5240 gynecological operations, eighteen (0.34%) cases of ureteric injuries and four cases of urinomas were found. We present the four cases of ureteric injuries that were found with postoperative development of urinomas.
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ranking = 6
keywords = gynecologic
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3/21. urinary tract injuries during advanced gynecologic laparoscopy.

    urinary tract injuries are important complications of laparoscopic surgery. The intraoperative diagnosis may be delayed, resulting in severe clinical complications, such as fistulas, in the immediate and late postoperative periods. A review of 776 endoscopic procedures revealed 6 urinary tract injuries and postoperative complications during laparoscopy. We believe that surgical experience, intraoperative diagnosis, immediate repair of the lesion, and close follow-up are the main factors contributing to decreased morbidity associated with these injuries.
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ranking = 4
keywords = gynecologic
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4/21. An unusual source of massive intra-abdominal hemorrhage during cardio-pulmonary bypass.

    Intra-abdominal hemorrhage occurring while on cardio-pulmonary bypass (CPB) is a rare and potentially lethal event during coronary artery bypass procedures. We herein report an unusual case in which massive intra-abdominal bleeding during CPB originated from a previously undiagnosed ovarian tumor, leading to acute anemization and hemodynamic instability and requiring emergency gynecologic surgery.
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ranking = 1
keywords = gynecologic
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5/21. Radical abdominal trachelectomy and pelvic lymphadenectomy with uterine conservation and subsequent pregnancy in the treatment of early invasive cervical cancer.

    BACKGROUND: Recently, pregnancies in patients after radical vaginal trachelectomy and laparoscopic pelvic lymphadenectomy have been reported. Radical abdominal trachelectomy and pelvic lymphadenectomy with uterine conservation has been previously described; however, subsequent outcome and pregnancy has not. methods: Three patients with cervical carcinoma, 1 with stage IA1 with lymph-vascular space invasion and 2 with stage IA2, were treated with radical abdominal trachelectomy and pelvic lymphadenectomy with uterine conservation. RESULTS: All patients underwent the planned procedure with no significant intraoperative or postoperative complications. All patients had return to normal menstrual function. One patient had a successful pregnancy delivered at 39 weeks by cesarean section and is now subsequently pregnant with a second pregnancy. CONCLUSION: Radical abdominal trachelectomy is a technically feasible operation that uses operative techniques familiar to the American-trained gynecologic oncologist and results in wider parametrial resection than radical vaginal trachelectomy. In young patients desiring to retain fertility, successful pregnancies after radical abdominal trachelectomy are possible. Intraoperative and postoperative complications are likely to be lower with an abdominal versus a vaginal approach. Long-term survival of patients treated with radical trachelectomy for early invasive cervical cancer are yet to be determined.
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ranking = 1
keywords = gynecologic
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6/21. Ureteral injury presenting with hyponatremia.

    BACKGROUND: Ureteral injuries in gynecologic surgery, although rare, classically present with a well-described constitution of symptoms. hyponatremia in association with ureteral injury has not been described. CASE: A 44-year-old multiparous woman presented with chronic pelvic pain and a persistent adnexal mass underwent exploratory laparotomy, lysis of adhesions, and left salpingo-oophorectomy. On postoperative day 5, she demonstrated classic signs and symptoms of ureteral obstruction. In addition, she developed hyponatremia with a serum sodium concentration of 124 mEq/L that immediately resolved after percutaneous drainage of the urinoma. CONCLUSION: hyponatremia may develop with untreated and unrecognized ureteral injuries. serum electrolytes may be helpful in the evaluation of suspected ureteral injury.
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ranking = 1
keywords = gynecologic
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7/21. Unplanned return to operating room in a community hospital-based obstetrics and gynecology residency.

    The American College of Obstetricians and Gynecologists clinical indicator for unplanned return to the operating room during the same admission in an obstetrics and gynecology residency is reviewed in this article. A retrospective chart review of all gynecologic surgeries during a 3-year period was evaluated for this indicator. An incidence of 0.03% was noted, with 3 of 1,492 procedures meeting the definition of this indicator. The incidence of this clinical indicator is uncommon in a community hospital-based obstetrics and gynecology residency.
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ranking = 1
keywords = gynecologic
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8/21. Accidental subdural catheterization due to complication of epidural anesthesia--a case report.

    Although accidental subdural injection is a well-recognized complication of epidural block, only a mere handful cases have been substantially proven by radiological evidence. Here we report a case of subdural catheterization during the attempt of epidural anesthesia for a gynecological procedure. Its clinical course and radiological findings are compared with those of the cases previously reported in literature. Whenever there is the occurrence of widespread of sensory block together with respiratory distress and hemodynamic unstability following epidural injection of local anesthetic, a subdural injection should be considered in spite of a negative confirmation. Repeated subdural injection of a local anesthetic at the same site may predispose patients to serious morbidity. Therefore, we recommend that when a subdural injection is evident or suspected, reinsertion of the catheter in the epidural space via another entry or contemplation of a switch to another anesthetic technique is mandatory.
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ranking = 1
keywords = gynecologic
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9/21. Laparoscopic repair of ureter resected during operative laparoscopy.

    Ureteral injury is a recognized complication of gynecologic surgery. During operative laparoscopy performed to treat extensive endometriosis of the pelvic sidewall, a 1.5-cm portion of the right ureter was resected and was repaired successfully. Repair of a resected ureter may be effectively accomplished endoscopically by experienced operative laparoscopists.
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ranking = 1
keywords = gynecologic
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10/21. Anaestethic problems in Sanfilippo syndrome. A rare case of adult patient.

    The authors report the case of a female patient (41 years old) affected by mucopolysaccharidosis type III or Sanfilippo syndrome submitted to a gynecologic surgical procedure and describe the main anesthesiologic problems. A sub-arachnoid anesthesia with hyperbaric Bupivacain 0.5% was used. This technique proved to be safe and convenient without peri- and postoperative complications.
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ranking = 1
keywords = gynecologic
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