Ryzophagia secondary to PCOS -related menorrhagia.

We report the peculiar case of a patient who consumed raw rice daily and had iron-deficiency anaemia secondary to menorrhagia with underlying polycystic ovarian syndrome. A 32-year-old lady of Asian descent presented with symptoms of fatigue, lethargy and prolonged, irregular periods for the last two months. There was noticeable increase in body weight, male pattern alopecia and facial acne. In addition, she experienced sudden, unexplained predilection towards consumption of raw rice (up to 300- 400g/day). The patient was treated with oral iron and cyclical progestin. After three weeks, her haemoglobin improved and her ryzophagia subsided. Gynaecologists should be vigilant of pica, which can occur outside of the context of pregnancy and also poses potential health risks including tooth attrition, electrolyte imbalance, intestinal obstruction and poisoning.

Systemic lupus erythematosus pregnancies: the Sarawak experience and review of lupus pregnancies in Asia.

We performed a cross-sessional study of all systemic lupus erythematosus (SLE) pregnancies during a 4-year period (2006-2009) to describe the clinical features, maternal and foetal outcomes in our centre. There were 48 pregnancies in 44 women with SLE. Our patients have a mean age of 30.0 years (SD 6.36) and a mean disease duration of 40.67 months (SD 48.23). Our patients have complicated pregnancies: 32.7% have SLE flares, 17.3% have preeclampsia and 48.9% needed caesarean sections. There were 20.0% foetal losses and 17.8% preterm deliveries in our patients. SLE flares contributed to 60.0% of foetal losses in our patients. Lupus pregnancies in our centre generally have a good maternal and foetal outcome comparable to developed countries in Asia. The low incidence of APS, the high usage of hydroxychloroquine and the high SLE remission rate in our patients prior to conceptions contributed to the good outcome.

Criss-cross heart: report of three cases with double-inlet ventricles diagnosed in utero.

Criss-cross heart is a rare congenital cardiac anomaly characterized by crossing of the inflow streams of the two ventricles, due to an apparent twisting of the heart about its long axis and when the axes of the openings of the atrioventricular (AV) valves are not parallel. If unrecognized, this leads to incorrect sequential segmental analysis. We report three cases of double-inlet ventricle with a criss-cross spatial relationship of the AV valves detected on prenatal ultrasound examination at 19-23 weeks' gestation. The sequential diagnosis was confirmed at postmortem examination in two cases and by neonatal echocardiography in the other. Antenatal diagnosis of criss-cross effect of the AV valves is feasible, allowing correct fetal diagnosis and appropriate counseling for this rare form of congenital cardiac disease.

Ultrasound assessment of cervical length in prolonged pregnancy: prediction of spontaneous onset of labor and successful vaginal delivery.

OBJECTIVES: To evaluate the usefulness of sonographic assessment of cervical length in the prediction of spontaneous onset of labor and of vaginal delivery. METHODS: Two hundred and six women who attended a dedicated postdates clinic at 41 + 3 weeks of pregnancy and agreed to the assessment of cervical length using transvaginal ultrasound imaging were included in the study. Those who had not delivered at 42 weeks were offered induction of labor. The labor details were recorded prospectively, and the onset of spontaneous labor and mode of delivery were correlated with cervical length data. RESULTS: Women who underwent spontaneous onset of labor (n = 112) had a significantly shorter cervical length (mean (SD) 25.0 (8.3) mm) than had women whose labor was induced (n = 67; mean (SD) 29.7 (8.5) mm). Logistic regression analysis showed that cervical length was an independent predictor of the likelihood of spontaneous labor in nulliparous women, and of vaginal delivery in both nulliparous and parous women. Parity had no independent effect on the onset of spontaneous labor, but was an independent predictor of the likelihood of vaginal delivery. CONCLUSIONS: Sonographic assessment of cervical length is a significant independent predictor of the likelihood of the onset of spontaneous labor in nulliparous women, and of successful vaginal delivery in both nulliparous and parous women with prolonged pregnancy.

Clinical outcomes of neoadjuvant chemotherapy and primary debulking surgery in advanced ovarian carcinoma.

BACKGROUND: Primary debulking surgery (PDS) and paclitaxel-platinum chemotherapy remains the mainstay of treatment for advanced ovarian cancer. However, there is considerable morbidity and even mortality associated with this approach. The concept of primary chemotherapy followed by interval debulking surgery (IDS) has emerged for advanced stage disease with the aim of improving sensitivity to chemotherapy and improving survival. The purpose of our study was to examine the impact of IDS on clinical outcomes of patients considered unsuitable for PDS and compare them with outcomes of women that had conventional PDS followed by chemotherapy. PATIENTS AND METHODS: A non-randomised prospective cohort study of 35 patients who underwent IDS and 29 patients treated with PDS were included. All patients had Stage IIIC or IV disease. The IDS patients were considered unresectable based on an initial laparoscopy or preoperative computed tomography findings. All patients were treated by the same lead surgeons and received the same regimen of chemotherapy. RESULTS: The median intraoperative blood loss, the incidence of pelvic lymphadenectomies, the median hospital stay and the possibility of admission to the Intensive Care Unit were significantly less in the IDS group. Optimal cytoreduction was higher in the IDS compared to the PDS group, but did not reach statistical significance. CONCLUSIONS: IDS for advanced ovarian cancer may be associated with less morbidity compared to PDS and appears to require less use of hospital resources. If the ongoing randomised studies confirm that IDS does not adversely affect the long-term survival of these patients, morbidity related to ovarian cancer surgery may evolve as a crucial factor for choosing treatment options.

Systemic lupus erythematosus pregnancies: a case series from a tertiary, East Malaysian hospital.

We performed a retrospective study of all systemic lupus erythematosus (SLE) pregnancies during a two-year period (2006-2007) to describe the clinical features, maternal and foetal outcomes in our centre. There were 17 pregnancies in 16 women with SLE. Our patients have a mean age of 28.31 years (SD 5.24) and a mean disease duration of 38.62 months (SD 38.03). Our patients have complicated pregnancies: 35.3% have SLE flares, 21.1% have preeclampsia and 47.4% needed caesarean sections. There were 15.8% foetal losses and 12.5% preterm deliveries in our patients. All the foetal losses occurred in patients with severe SLE flares during pregnancies. Lupus pregnancies in our centre generally have a good maternal and foetal outcome comparable with developed countries. The low incidence of antiphospholipid syndrome, the high usage of hydroxychloroquine and the high SLE remission rate in our patients before conceptions are the possible factors contributing to the good outcome.

Propranolol reduces the anxiety associated with day case surgery.

OBJECTIVE: To find out if propranolol, a non-cardioselective beta-blocker, can reduce the anxiety associated with day case surgery. DESIGN: Prospective randomized double blind trial. SETTING: University hospital, Ireland. SUBJECTS: An unselected group of 53 patients undergoing day case surgery. INTERVENTION: Subjects randomised to receive either propranolol (10 mg) or placebo on the morning of operation. MAIN OUTCOME MEASURES: Blood pressure; pulse, anxiety, pain score and patient satisfaction. RESULTS: Mean (SD) Hospital Anxiety and Depression score was significantly lower in the propranolol group than in the control group (2.5 (0.7) compared with 4.6 (0.7), p < 0.0001) before discharge. CONCLUSION: A low dose of propranolol given on the morning of day case surgery significantly reduced patients' anxiety.