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Objectives: Research on endometrial cancer (EC) has demonstrated an association between increasing tumor size and poor outcomes, including increase in nodal disease and advanced stage at diagnosis. However, the implications of overall uterine weight (UW) at the time of hysterectomy for EC are unknown. The aim of this study is to investigate if increasing UW is associated with poor prognosis, specifically regarding lymph node metastasis (LNM), lymphovascular space invasion (LVSI), and stage. Materials and Methods: This is a retrospective cohort study of patients undergoing robotic-assisted surgical management of EC at two institutions. Patients with a preoperative diagnosis of complex atypical hyperplasia (CAH) or EC were included. All patients underwent surgical staging including hysterectomy, bilateral salpingo-oophorectomy, pelvic lymphadenectomy, and when feasible, para-aortic lymphadenectomy. Patients were categorized based on UW on final pathology report, into one of six groups: < 50 grams, 51-100 grams, 101-150 grams, 151-200 grams, 201-250 grams, and > 250 grams. The rate of lymph node involvement, LVSI, and stage were then analyzed for each group. Chi-Square and t-test were used for statistical analysis. Results: From 2013-2017, 161 patients were identified. Twenty-seven patients were excluded due to final pathology diagnosis other than EC. Of the remaining 134 patients, 103 had LVSI, 96 had LNM and 116 had stage reported. There were 120 (89.6%) endometrioid, four (2.9%) papillary serous, three (2.2%) clear cell, three (2.2%) carcinosarcoma, three (2.2%) undifferentiated, and one (0.7%) endometrial stromal sarcoma histologies. Among the entire cohort, the incidence of LNM was 19.8% and LVSI was 12.6%. Increasing UW was associated with increase in LVSI (p = 0.003), LN metastasis (p = 0.000), and stage (p = 0.010). On further analysis, the cohort was examined as two separate groups, UW < 200 vs. > 200 grams. UW > 200 grams is associated with significant increase in LVSI (p = 0.045) and LNM (p = 0.0005). There were no LNM in patients with UW < 100 grams. Conclusions: Increasing UW at the time of hysterectomy for EC is associated with increase in LVSI, LN metastasis, and stage. [ABSTRACT FROM AUTHOR]

Background: Rectus sheath hematoma (RSH) represents a rare, but serious cause of abdominal pain., Case: Here we discuss the case of a healthy multigravida female who presented at 28 weeks gestation with spontaneous RSH. Conservative management with multiple blood transfusions led to the development of transfusion related acute lung injury (TRALI) and intensive care unit admission. She was managed with noninvasive ventilatory support, gradually improved, and was weaned of ventilation. After hospital discharge, she progressed to full term and delivered a viable male infant vaginally at 37 weeks gestation., Conclusion: Review of the literature demonstrates 13 cases of RSH in pregnancy, including our own. No other cases were complicated by transfusion related morbidity. RSH and TRALI are rare, but life threatening entities that can complicate pregnancy.

Background: Blood pressure derangements are common in orthotopic liver transplantation (OLT), and are potentially associated with adverse outcomes if they are sustained. While this concept is often believed to be true, few have rigorously demonstrated the validity of this claim, especially in likely vulnerable OLT patients., Methods: We retrospectively investigated 827 patients who underwent OLT to determine the magnitude of these hemodynamic associations with adverse outcomes. The median value of the mean arterial pressure (MAP) and the fractional change in the median MAP between subsequent epochs (FCM) were calculated for every 5-minute epoch intraoperatively. Epochs were classified according to prespecified ranges of MAP and fractional changes in MAP (lability) between epochs. Multivariate stepwise logistic regression was used to model associations of risk factors and epochs of intraoperative blood pressure (BP) instability with primary (30-day mortality and/or graft failure) and secondary adverse outcomes., Results: Primary adverse outcomes occurred in 10.9% and 12.2% of patients for 30-day mortality and 30-day graft failure, respectively. Independent hemodynamic predictors for 30-day mortality and graft failure included sustained periods of MAP <50 mmHg and BP lability where the MAP changed >25%. All of these values were statistically significant., Conclusion: Although severe intraoperative hypotension and BP lability during OLT are often observed in current practice as consequences of major surgical manipulations and patient vulnerability, these are likely not benign conditions based on this retrospective analysis. Prospective trials are warranted to investigate the possibility that interventions tailored to avoidance of hypotension and BP lability may improve outcomes.