IntroductionPerforming a myomectomy during pregnancy is extremely rare due to the risk of pregnancy loss, hemorrhage and hysterectomy. Favorable outcomes have been demonstrated with select second trimester gravid myomectomies. Literature documenting first trimester surgical management of myomas during pregnancy is scant. Patients with symptomatic myomas failing conservative management in the first trimester may be counseled to abort the pregnancy and then undergo myomectomy. Reports focusing on myomectomy in the first trimester are needed to permit more thorough options counseling for patients failing conservative management in the first trimester.Case presentationA 30-year-old Caucasian primagravid (G1P0) was referred for termination of her pregnancy at 10 weeks due to a 14 cm myoma causing severe pain, constipation and urine retention. Her referring physician planned an interval myomectomy following the abortion. Instead, our patient underwent myomectomy at 11 weeks. Two leiomyomas were successfully removed; she delivered a healthy infant at term.ConclusionPatients in the first trimester should not be counseled that termination followed by myomectomy is the best option for symptomatic myomas, failing conservative treatment. Management should be individualized after taking into account the patient's symptoms, gestational age and the location of the myomas in relation to the placenta. Any field providing women's health services will be impacted by the ability to offer more thorough options counseling for women with refractory myomas in the first trimester.
Anorexia nervosa (AN) is a mental illness which is associated with many different medical complications. A comprehensive medical literature review of the medical complications of AN was undertaken using relevant search terms on PubMed to prepare this manuscript. We demonstrate that every body system is adversely affected by the ravages of AN. As the body mass index becomes progressively lower, the number and acuity of these medical complications increase. No body system is ultimately immune to medical complications, which most commonly impact the cardiac, gastrointestinal, and endocrine systems. AN has the highest mortality of any psychiatric illness. About half of the excess mortality risk associated with AN is due to the medical complications which are inextricably tied to AN. Nutritional rehabilitation and weight restoration attenuate and reverse the long-term medical complications.
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