Cecal obstruction caused by paratubal cysts in a 24-year-old woman.

A 24-year-old woman with no significant past medical or surgical history presented with diffuse abdominal pain and distention with decreased frequency of bowel movements for 1 month. A computerized tomography scan showed a massively dilated cecum suggesting obstruction. Exploratory laparotomy revealed bowel obstruction secondary to a band of fibroadipose tissue associated with paratubal cysts originating from the left fallopian tube. Removal of the band was performed with thorough examination of the bowel confirming absence of perforation or necrosis.

Neonatal ovarian torsion complicated by intestinal obstruction and perforation, and review of the literature.

We present a case of neonatal ovarian torsion complicated by bowel obstruction and perforation and review the literature regarding the incidence of bowel obstruction in neonatal ovarian cysts, the presentation, and treatment. A term neonate was prenatally diagnosed with a cystic abdominal mass palpable on physical examination. A postnatal abdominal x-ray showed paucity of gas in the left hemiabdomen with rightward displacement of bowel loops. Exploratory laparotomy on day 2 of life revealed a large cystic mass in the left lower quadrant consistent with a torsed left ovary, an omental band causing strangulation of the bowel mesentery, and a perforation of the distal ileum. Our literature search revealed 19 reported cases of neonatal ovarian cysts resulting in bowel obstruction. Infants may present with a palpable abdominal mass, respiratory distress, as well as signs and symptoms of intestinal obstruction. Two mechanisms exist for bowel obstruction: adhesions caused by a torsed necrotic ovary and mass effect of a large ovarian cyst, often measuring 9 to 10 cm in diameter. Options to treat ovarian cysts include antenatal or postnatal aspiration, laparoscopy, and laparotomy. Cysts less than 4 to 5 cm can be observed, whereas operative intervention is indicated in symptomatic cases and in persistent or enlarging ovarian cysts.

Dose reponse behavior in a physiologically accurate defibrillation model.

Termination of an episode of ventricular fibrillation by electric countershock is a probabilistic phenomenon. In a clinical or experimental setting, defibrillation exhibits dose-response behavior. We demonstrate for the first time that a physiologically and anatomically accurate model of defibrillation is able to simulate this dose-response behavior. We also demonstrate the ability of this computational model to reproduce the full range of observed shock responses. Finally, we show that the brief cessation of electrical activity on the epicardial surface after a shock near the defibrillation threshold, the isoelectric window, can be explained by the slowed propagation velocity of transmural activation wavefronts around a filament of singularity in the myocardium.