Arie Dekel

Severe Unilateral Hydrothorax as the Only Manifestation of the Ovarian Hyperstimulation Syndrome

Background: Unilateral hydrothorax is rarely the sole manifestation of the ovarian hyperstimulation syndrome (OHSS) and is suggestive of the severity of the disease. Case: A 35-year-old woman presented with mild dyspnea 2 weeks after ovarian stimulation with hMG and hCG and IVF-ET. Chest X-ray revealed a large pleural effusion on the right side. Three consecutive thoracocenteses were needed to drain a total of 6,800 cm3 of fluid. Following drainage, the respiratory symptoms disappeared. An uneventful pregnancy is in progress. Conclusions: Thoracocentesis is safe and efficient for the treatment of hydrothorax and may be repeated as often as necessary. Clinicians should be aware of the possibility of unilateral hydrothorax as the sole symptom of OHSS.

Hyperemesis gravidarum during Ramadan

During Ramadan, adult Muslims fast from dawn to dusk. We frequently encounter young pregnant Muslim women with hyperemesis gravidarum who fast during this holy month. We have investigated whether there is an association between the prolonged fasting during Ramadan and excessive vomiting during pregnancy. Possible psychologic and physiologic explanations are presented and discussed.

Munchausen syndrome in obstetrics and gynecology

Munchausen syndrome (MS) is a well-defined clinical psychiatric entity. Furthermore, it is a complicated and intriguing problem in medicine in general and in obstetrics and gynecology in particular. The proportion of MS cases in obstetrics and gynecology is rising. This review covers relevant reports from the last four decades. Emphasis is put on the clinical expression of MS cases in obstetrics and gynecology. A discussion about their validity as such is included. Awareness of attending physicians to this type of illness in the era of patient rights, on the one hand, and the existence of defensive medicine on the other, is crucial.

Laparoscopic management of suspicious ovarian cysts in elderly, postmenopausal women

OBJECTIVES To present our experience with laparoscopic treatment of ovarian cysts in elderly, postmenopausal women. STUDY DESIGN During the period January 1996 to August 1997, 21 elderly, postmenopausal women were admitted to the Rabin Medical Center for laparoscopy. The indications for the operation were an ovarian cyst that did not meet the criteria of a simple cyst, was larger than 4 cm, had pathological Doppler flow or elevated CA-125 level. RESULTS The median age of the patients was 67.19 (range 60-74). Despite the fact that 15 (71.4%) of the patients suffered from chronic disease, all laparoscopies were successfully accomplished. No case of malignancy was found. CONCLUSIONS Laparoscopic management of carefully selected ovarian cysts is an appropriate alternative for exploratory laparotomy even in elderly patients with or without underlying diseases.

Vertebral osteomyelitis after abdominal colposacropexy

Although the prevalence of vaginal vault prolapse after hysterectomy is only 0.2–0.5% (1), and as hysterectomy is such a common procedure, most gynecologists encounter vaginal vault prolapse. Abdominal colposacropexy has been found to be the best method of colposuspension and is currently advocated as the permanent solution for post-hysterectomy vaginal vault prolapse (2). Abdominal colposacropexy involves suspension of the prolapsed vaginal vault to the promontorium of the sacrum by graft material such as polytetrafluoroethylene or Gore-Tex (W.L. Gore & Associates Inc., Flagstaff, AZ, USA) (3). This graft connects the prolapsed vaginal vault to the sacral promontorium, attached to both the vagina and the sacrum by sutures made from the same material. During the past 2years, while performing abdominal colposacropexy, we modified the operative process, by attaching the Gore-Tex graft to the sacral promontorium using nickel titanium clips with the Auto-Suture Stat Tack (Dexide, Fort Worth, TX, USA). Recently, we encountered a case of post-abdominal colposacropexy sacral osteomyelitis, attributed to the use of these clips. This case is herein discussed.

F08Real-time intraoperative ultrasound guidance; the transrectal approach: 4-7 October 2000, Zagreb, CroatiaFree Communications

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