Rare Vascular Malformations of Ovary: A Clinical Masquerader

Presenting two cases of vascular malformations of ovary, both presenting with different and deceptive clinical features.Clinical presentation were:Case 1. 55/F with hyper-estrogenemia and dysfunctional uterine bleeding.Case 2. 45/F with ovarian mass suspicious of malignancy.A laprotomy was done in both cases and we received Uterus with cervix with bilateral adenexa. Relevant sections were taken. Histopathological examination revealed numerous dilated vascular channels lined by endothelial cells. Features were suggestive of:Case 1. Ovarian hemangioma with endometrial hyperplasia.Case 2. Cavernous hemangioma, ovary.Vascular malformations of ovary are very rare arising from failure in vascular formation, particularly in the canalizing process. The number of well documented cases seems to be nearly 60. It has been hypothesized that these induce stromal luteinization by mass effect in rare cases, leading to endometrial hyperplasia, thus making our cases even rarer

Impact of opioid-free analgesia on pain severity and patient satisfaction after discharge from surgery: multispecialty, prospective cohort study in 25 countries

Background: Balancing opioid stewardship and the need for adequate analgesia following discharge after surgery is challenging. This study aimed to compare the outcomes for patients discharged with opioid versus opioid-free analgesia after common surgical procedures.Methods: This international, multicentre, prospective cohort study collected data from patients undergoing common acute and elective general surgical, urological, gynaecological, and orthopaedic procedures. The primary outcomes were patient-reported time in severe pain measured on a numerical analogue scale from 0 to 100% and patient-reported satisfaction with pain relief during the first week following discharge. Data were collected by in-hospital chart review and patient telephone interview 1 week after discharge.Results: The study recruited 4273 patients from 144 centres in 25 countries; 1311 patients (30.7%) were prescribed opioid analgesia at discharge. Patients reported being in severe pain for 10 (i.q.r. 1-30)% of the first week after discharge and rated satisfaction with analgesia as 90 (i.q.r. 80-100) of 100. After adjustment for confounders, opioid analgesia on discharge was independently associated with increased pain severity (risk ratio 1.52, 95% c.i. 1.31 to 1.76; P < 0.001) and re-presentation to healthcare providers owing to side-effects of medication (OR 2.38, 95% c.i. 1.36 to 4.17; P = 0.004), but not with satisfaction with analgesia (beta coefficient 0.92, 95% c.i. -1.52 to 3.36; P = 0.468) compared with opioid-free analgesia. Although opioid prescribing varied greatly between high-income and low- and middle-income countries, patient-reported outcomes did not.Conclusion: Opioid analgesia prescription on surgical discharge is associated with a higher risk of re-presentation owing to side-effects of medication and increased patient-reported pain, but not with changes in patient-reported satisfaction. Opioid-free discharge analgesia should be adopted routinely