Ovarian tumors in pregnancy: diagnosis and management.

Ovarian tumors first diagnosed during pregnancy often present a challenge for both the obstetrician and gynecologists providing pregnancy care and for the consulting subspecialists. Although the vast majority of these tumors is benign, on rare occasions, patients present with tumors that turn out to be malignant requiring more comprehensive and extensive surgical procedures that are more likely to lead to pregnancy loss. Hence accurate knowledge of tumor characteristics, especially the ultrasound appearance and gestational age at diagnosis, are key prerequisite for establishing the most effective management plan not just for the index but also for future pregnancies. The primary objective of the current review is to provide practical guidelines for the evaluation and management of ovarian tumors first diagnosed during pregnancy.

Early effects of coronary artery bypass grafting on left ventricular regional wall motion abnormalities.

OBJECTIVE: To determine the early effects of Coronary Artery Bypass Grafting (CABG) on regional left ventricular wall motion abnormality in patients undergoing surgery for proven Coronary Artery Disease (CAD). DESIGN: Quasi-experimental study. PLACE AND DURATION OF STUDY: Department of Cardiac Surgery, National Institute of Cardiovascular Diseases, Karachi. from October 2005 to April 2006. PATIENTS AND METHODS: A total of a 100 adult patients who underwent elective CABG were selected. Pre-operative echocardiography was done to note if segmental left ventricular wall motion at basal, mid and apical levels were normal, hypokinetic, akinetic, dyskinetic, or aneurysmal. Postoperative echocardiography was done between 4th and 6th day and change in left ventricular segmental wall motion was noted. RESULTS: Seventy-five patients (n=75) were included in the analysis. These results showed that effect of CABG on anterior segmental wall motion abnormalities was insignificant (p=.609), the effect on the anterior IVS showed deterioration of segmental wall motion and this effect was significant (p=.001), effect is insignificant on anteriolateral segmental wall motion abnormalities (p=.078), normal pre-operative segments in posterior wall showed stability (p=.664) while disappearance of dyskinetic, reduction in akinetic segments postoperatively and inferior wall motion have same effects as of posterior wall. Comparison of pre-operative and postoperative echocardiographic data revealed early improvement in segmental wall motion of posterior and inferior wall, while alterations in segmental wall motion of anterior, anterior-lateral and septal wall. CONCLUSION: Myocardial revascularization by CABG improves early left ventricular regional wall motion abnormalities where SVG is used as conduit for revascularization whereas no significant improvement occurs in early segmental wall motion in areas revascularized by LIMA.

Placental transfer of ganciclovir in a woman with acquired immunodeficiency syndrome and cytomegalovirus disease.

A pregnant woman with AIDS developed cytomegalovirus (CMV) retinitis and pneumonitis, requiring intravenous ganciclovir. At 34 weeks gestation the woman delivered a 1.4-kg girl. Examination of the placenta revealed transplacental passage of CMV. Low concentrations of ganciclovir were detected in the neonate's plasma. The neonate had mild anemia but no other signs of congenital CMV infection.