This manual details how to write a case report that uses the biopsychosocial approach in understanding and analyzing a patient’s disease in the context of the family in crisis. It begins by describing the illness characteristics of the index patient - the onset, course, prognosis, and family illness trajectory. The family structure and dynamics are then identified using various family assessment tools such as genogram, APGAR, SCREEM-RES, lifeline, family map, etc. Lastly, the physician formulates a family diagnosis: the presence of alliances and coalitions, the family’s strengths and coping mechanisms, how they adapt to the changes brought by the illness, etc. These data help the physician effectively engage the family as a source of support for the management of illness.

Family Structure

BACKGROUND

Hysteroscopic myomectomy is regarded as the gold standard in the management of intracavitary myomas. With its increased use, it is essential to explore its effectiveness for better therapeutic planning and patient selection.

OBJECTIVES

This study aimed to determine the effectiveness of hysteroscopic myomectomy performed in a tertiary hospital in the Philippines.

METHODS

A retrospective cross-sectional study of women who underwent hysteroscopic myomectomy in 5 years was performed.

RESULTS

A total of 167 women were included. Completeness of resection was achieved in 88.46% of the cases. In the final multivariate model, older age, pretreatment with gonadotropin-releasing hormone (GnRH) agonist, and lesser total fluid input were associated with increased odds of complete resection. Submucous myoma at least 3 cm in size had greater total fluid input, greater blood loss, the presence of complications, and a greater need for transfusion. Pretreatment with GnRH agonists had more International Federation of Gynecology and Obstetrics Grade 1 and 2 myoma, higher frequency of ≥3 myomas, lower frequency of complete resection, and increased operative time compared to those without pretreatment with GnRH agonists. Pretreatment with other hormonal therapy had a lesser need for transfusion compared to those without pretreatment with hormonal therapy.

CONCLUSIONS

Hysteroscopic myomectomy is a generally safe and effective procedure for the treatment of submucous myomas. The odds of complete resection are greater with older age and decreased with pretreatment with GnRH agonist and more distention fluid used. Larger submucous myoma was associated with greater total fluid input and blood loss, more complications, and greater need for transfusion. Pretreatment with GnRH agonist had no significant benefit and was associated with longer surgical time and lesser complete resection.

Human ; Female ; Fibroids ; Leiomyoma ; Hysteroscopy ; Myomectomy ; Uterine Myomectomy

Mature cystic teratoma of the ovary may occur in 10%–20% of women during their lifetime. Its biological behavior is benign, while 0.17%–2% of them may undergo malignant transformation. Various histological types of malignant transformation include Squamous cell carcinoma (SCC), adenocarcinoma, small cell carcinoma, sarcoma, malignant melanoma, and mixed histology. SCCA of the cervix occurs more commonly at ages 45–55. This is mainly caused by human papillomavirus 16 and 18. This tumor spreads to local then regional lymph nodes and can have hematogenous spread to bone and lungs, rarely to the ovaries. This report is of a 75‑year‑old Gravida 9 Para 9 (9009) with an enlarging pelviabdominal mass, managed as a case of ovarian new growth with later findings of cervical cancer. The case merits presentation because of the dilemma in diagnosis.
Carcinoma, Squamous Cell

Serratia marcescens is a recognized nosocomial opportunistic pathogen but rarely caused central nervous system infection especially in the neonates. Outbreaks have been documented in the neonatal intensive care units (NICU) and a higher incidence among those with surgical procedures. This review aims to describe a neonate with nonleaking lumbosacral myelomeningocele presenting with multiple pyogenic brain abscesses caused by S. marcescens admitted in a NICU. This review also presents a concise literature review discussing the potential risk factor involved, diagnostic measures and therapeutic possibilities. We present a neonate with Chiari II malformation admitted in the NICU developing S. marcescens ventriculitis after a lumbosacral myelomeningocele repair. With an empiric treatment of meropenem for one week, repeat ventricular cerebrospinal fluid analysis worsened and developed cerebral abscess as detected using cranial ultrasound. Ciprofloxacin was added and completed for six weeks with improved neurologic status. On a 6-month follow-up, sensorineural hearing loss, focal epilepsy and developmental delay were documented. A systematic review showed that prematurity and NICU outbreaks were among the most common risk factors for the central nervous system involvement of S. marcescens. Meropenem remains to be the antibiotic of choice adjunct with timely neurosurgical intervention. Brain abscess showed the worst prognosis among the neurologic sequelae.

Serratia marcescens ;