Given the potential for high plasma concentrations from a bilateral TAP infusion technique, attention should be paid to individualized dosing strategies.

Amenorrhea is a common symptom that generally presents to the gynecologist for evaluation and therapy during adolescence. Its presence, in combination with an anomaly of the vagina and a pelvic mass, suggests many possible etiologies whose diagnosis and management is critical in the young patient. Here we present such a patient who was treated with a transabdominal hysterectomy and left salpingectomy. A 22-year-old nulliparous female presented with amenorrhea, pelvic pain, and dyspaurenia. Pelvic examination, ultrasonography and magnetic resonance imaging (MRI) showed a left adnexal mass suspicious for an endometrioma or hematosalpinx but further definition was difficult. Surgery confirmed a 10 3 6 cm "chocolate" fluid-filled fallopian tube and a uterine remnant, without a cervix. The vagina was hypoplastic and ended in a blunt pouch. Both ovaries appeared normal. Pathological evaluation of the fallopian tube demonstrated "chocolate" fluid and no tubal endometriosis. The myometrium and endometrium were unremarkable and there was no evidence of endometriosis in the pelvis. Primary amenorrhea secondary to vaginal hypoplasia can, in rare instances, be accompanied by congenital uterine and fallopian tube dysgenesis. The pelvic mass that was seen was of concern because even with advanced radiological studies, and ultrasound, it could not be determined if the patient had a patent cervix or if the uterine tissue could be joined to the vagina to allow normal attempt at fertility. Thus, it was critical to have reviewed the potential surgical options with the patient and her family prior to any intervention. This case is unique in its late presentation, its impact on the patient's reproductive potential, and the possible surgical management of the pelvis. (J GYNECOL SURG 19:43)

Purpose of the study: To identify strengths and weaknesses in current studies with a view to carrying out a major multi-center study in Australia. Methods: The literature was reviewed using standard Medline and Ovid methods. Bibliography of well known key recent papers were used to identify further papers. Results: Studies evaluating persistent pain after breast cancer surgery have been small and few were prospective controlled studies with adequate power. Like Jung et al [1] we found that the literature was inconsistent in defining chronic pain and differentiating the breast cancer surgery pain syndromes. Marked variations in prior studies are due to differences in: study size (n = 22 to 282 patients), methodology, diagnostic criteria, pain assessment instruments, and distribution of demographic and clinical characteristics in the samples studied.Unfortunately the largest study to date, the ALMANAC Trial (n = 1031) which compared sentinel node biopsy vs "standard axillary dissection" evaluated arm and shoulder function and quality of life, but not pain [2] . From the current literature, it appears that neuropathic breast and arm pain are most common.Widely varying prevalence estimates of different neuropathic pain syndromes have been reported: phantom breast pain (3-44%); intercostobrachial neuralgia (ICBN) (16-39%); ICBN in breast conserving surgery (14-61%); and "neuroma pain" (23-49%).The most established risk factors for surgically related neuropathic pain syndromes are intraoperative nerve trauma, severe acute postoperative pain, and high use of postoperative analgesics [1] . Psychosocial distress is reported to be a risk factor and a consequence of chronic pain [1] . Conclusions: Well-designed large multi-center studies are required to identify prevalences of various pain types, associated risk factors and treatment success for pain after breast cancer surgery. Such a study is in progress through the collaboration of our group with the Sentinel Node vs Axillary Clearance (SNAC) Study of 1000 women following breast surgery, conducted by the Royal Australian College of Surgeons (RACS). Purpose of the study:Flupirtine is an established clinical analgesic for mild to moderate musculoskeletal pain states. It has recently been shown to be a KCNQ 2-3 potassium channel opener. These experiments were performed to see if this property could be useful in treating more severe pain states characterised by central sensitisation with the drug either given alone or in combination with morphine. Methods: Experiments were performed in rats in an observer blinded fashion with vehicle controls. Non sedating doses of flupirtine, morphine and combinations containing both drugs were defined using the rotarod technique. Dose response relationships were determined for non sedating doses of both drugs given alone and together in combination in causing antinociception in three nociception paradigms: electrical pain; carrageenan paw inflammation; streptozotocin-induced diabetic neuropathy. Results: Flupirtine and morphine when g...