Although Crohn disease (CD) is considered an inflammatory bowel disease, extraintestinal gynecologic manifestations are varied, frequent, and oftentimes difficult to manage. Its predilection for young and reproductive-age women makes it an important disease process for the gynecologist to understand, as its complications can have long-term repercussions on the developmental, sexual, reproductive, and psychological health of affected women. Patients may present with a variety of vulvovaginal, perineal, perianal, and urologic complaints. Perianal involvement from an intestinal fistula is the most common skin manifestation seen in CD. Other gynecologic manifestations include metastatic CD and rectovaginal and urovaginal fistulas. Recognition and accurate diagnosis of extraintestinal gynecologic manifestations, as well as a good understanding of the gynecologic effects of chronic disease, are necessary for optimal management. The article provides an overview of CD and highlights the gynecologic considerations in caring for women affected by this disease.

SummaryA hypertensive response to the induction of anaesthesia with etomidate and ntracurium in a pntient who recent!); received tranylcypromine is described. The possible cause is discussed.

SummaryThe present study was designed to assess the incidence of pain when methohexitone was administered to 35 depressedpatients who had electroconvulsive therapy, and to determine whether the use of lignocaine could modijy this, without affecting seizure duration. The same patients were studied during three separate treatment sessions; they received either methohexitone alone or mixed with, or preceded by, lignocaine 10 mg. Six (17%) patients spontaneously complained of pain during injection of methohexitone alone: the use of lignocaine prior to methohexitone reduced this to zero ( p < 0.05). A total of 49% patients reported pain during injection of methohexitone; the use of lignocaine either mixed with, or given prior to, methohexitone significantly reduced this to 23% and 20% respectively ( p < 0.05). Seizure duration was not significantly different during the three treatments. Key wordsAnaesthetics, intravenous; methohexitone. Electroconvulsive therapy.Methohexitone has been described as the drug of choice for anaesthesia for electroconvulsive therapy (ECT).'.* However, 40-60% patients experience pain during its injection into a vein on the dorsum of the hand prior to surgery,'-5 but the incidence in patients who have anaesthesia for ECT is not known. Repeated anaesthesia is required for ECT treatment, and anticipation of pain on injection may be very distressing for patients, a pain which could be reduced if lignocaine is given with, or prior to, methohexitone.'~6The present study was designed to determine the incidence of pain during injection of methohexitone prior to ECT treatment, and to assess whether it could be reduced by the use of lignocaine. A bilateral generalised convulsion must be produced during ECT if treatment is to be beneficial.' The use of lignocaine prior to ECT is usually avoided,x because it reduces seizure duration and renders treatment less effe~tive.~ The effect of lignocaine on seizure duration was therefore also recorded during the present study. MethodsThirty-five patients who had a course of bilateral ECT for treatment of depression were included in the study, which was approved by the Hospital Ethics Committee. Eight male and 27 female unpremedicated patients, aged 18-80 years and who weighed 43-90 kg, were studied. Patients gave informed verbal consent to participate, and none receiving treatment under the provisions of the Mental Health Act were involved.Patients were studied during three consecutive ECT treatments over a period of 10-14 days, but not during the first treatment, because seizure duration is often prolonged at this time.I0 Concurrent medication was not altered during the study. Anaesthesia was induced with one of three regimens, the order of which was randomly selected for each patient. All subjects experienced all three methods of induction of anaesthesia on separate occasions.Methohexitone only. Venepuncture was performed using a 23-gauge butterfly needle inserted into a small vein on the dorsum of the hand. One millilitre 0.9% saline was injected, and venou...

Pulsed saline lavage is used to prepare bony surfaces during joint replacement surgery. A patient is described in whom a venous air embolism occurred as a result of a combination of the increased vascularity of bone seen in Paget's disease and possible air entrainment in the lavage equipment.

No abstract