A Spontaneous Tubal Heterotopic Triplet Pregnancy Resulting in Viable Twin Deliveries.

There are limited U.S. reports of spontaneous triplet heterotopic pregnancies discussing both maternal and fetal outcomes. A 34-year-old patient at 7 weeks of gestation presented to the emergency department with abdominal pain. She was diagnosed with a spontaneous heterotopic triplet pregnancy, consisting of a twin monochorionic-diamniotic intrauterine gestation and a ruptured left ectopic pregnancy. She underwent a laparoscopic unilateral salpingectomy. Her antepartum course was complicated by gestational diabetes mellitus and fetal growth restriction. Delivery of liveborn twins was via a cesarean delivery at 32 weeks. Timely intervention and management of a ruptured spontaneous triplet heterotopic pregnancy can result in a viable twin delivery with overall favorable maternal and newborn outcomes, although long-term implications due to prematurity and other twin sequelae exist.

Surgical Pain Control With Ropivacaine by Atomized Delivery (Spray): A Randomized Controlled Trial.

STUDY OBJECTIVE: To investigate the role of intraoperative atomized intraperitoneal ropivacaine (AIR) as an adjuvant to anesthetic agents at the time of minimally invasive pelvic surgery. DESIGN: Double-blind, randomized controlled trial. CLASSIFICATION: Randomized controlled trial (Canadian Task Force classification I). SETTING: Tertiary care teaching hospital. PARTICIPANTS: Fifty-five patients who underwent laparoscopic and robotic gynecologic procedures. INTERVENTION: Patients received AIR or atomized intraperitoneal saline (AIS) (dose, 2 mg/kg) immediately after the initiation of pneumoperitoneum. MEASUREMENTS AND MAIN RESULTS: Visual analog scale (VAS) pain scores and narcotic use (in morphine equivalents) were collected and recorded at 2, 4, 8, and 12 hours postoperatively. RESULTS: Fifty-five patients completed the study protocol and data collection, with 30 patients allocated to the AIS group and 25 patients allocated to the AIR group. Demographic and surgical variables did not vary between the groups, with the exception of median operative duration. Postoperative VAS scores at 2, 4, 8, and 12 postoperative hours were higher in the AIS group, but the difference failed to reach statistical significance. Narcotic use was also similar in the 2 groups. CONCLUSION: The use of intraperitoneal ropivacaine was not associated with a statistically significant difference in patients' postoperative VAS scores. Thus, in contrast to findings of similar studies performed in general surgery, AIR might not confer a benefit in women undergoing minimally invasive gynecologic procedures.

Quality of CT colonography-related web sites for consumers.

PURPOSE: Patients often request to undergo computed tomographic colonography (CTC) from radiologists or referring physicians on the basis of their personal examination of information on the Web. Therefore, the authors examined the information on CTC and virtual colonoscopy available for consumers on the Web to assess its quality. MATERIALS AND METHODS: The term virtual colonoscopy was entered into 3 popular search engines: Google, Yahoo, and MSN. In each case, evaluation was limited to the first 50 Web sites, or hits, which were recorded and analyzed for content, comprehensiveness, and accuracy. RESULTS: Sixty-seven Web sites were deemed appropriate for further analysis. More than half of the sites reported currency dates more than 2 years old. Only a third of the sites included information about the risk factors for colorectal cancer. About a third of the sites did not explain the indications for the use of CTC, and the remaining sites lacked consistent descriptions of the indications. Few Web sites offered or described the option of performing same-day optical colonoscopy for patients with abnormal results on CTC. CONCLUSION: The data suggest that patients are often armed with very incomplete information from Web sites on CTC. Web sites were often found to be outdated, to contain conflicting information, and were lacking descriptions of patient risk factors for colorectal cancer. Several suggestions are made to improve the dissemination of comprehensive, current, and accurate information.