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"Hypertrophic obstructive cardiomyopathy (HOCM) is a genetic disorder associated with significant morbidity and mortality. Patients with this illness are prone to sudden death, angina, syncope, and heart failure. Symptomatic patients with HOCM are usually medically treated; in the few patients with persistent symptoms, surgical myomectomy offers satisfactory control.1'1 The role of DDD pacing in effort to reduce left ventricular outflow tract (LVOT) gradient is still controversial.3-4 Recently, non-surgical septal reduction therapy (NSRT) has gained popularity as an alternative to surgery, because the procedure is much simpler, safe and effective for relief of symptoms of LVOT obstruction.5 7This paper will report a case of HOCM successfully treated with NSRT."

"Seorang ibu primigravida berumur 20 tahun hamil 38 minggu dengan komplikasi tumor uterus intraligamenter kiri yang besar dan padat. Operasi dimulai dengan seksio sesarea untuk melahirkan bayi. Diberikan uterotonika intramural dan kontraksi uterus baik; diberikan infus oksitosin intra dan postoperatif selama 24 jam. Teknik jahitan ?double circle? dilakukan pada bagian lateral mioma sebelum miomektomi. Tidak diberikan transfusi darah. Histopatologinya adalah leiomioma. Pasien tersebut pulang dalam keadaan sehat 4 hari setelah operasi. (Med J Indones 2004; 13: 66-8)

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A 20-year-old primigravida with 38th weeks of gestation complicated with a left large solid intraligamentous uterine tumor. The operation started with lower segment cesarean section to delivere the fetus. Intramural uterotonica was given and the uterus contracted well; intra- and up to 24 hours post-operatively oxytocin infusion was administered. Double circle stitching technique was performed on lateral side of the mioma before starting myomectomy. No blood transfusion was given. The histopatological report was leiomyoma. She was discharged in healthy condition 4 days post-operatively. (Med J Indones 2004; 13: 66-8)"

"Tulisan ini membahas dan melaporkan ruptura uteri saat kehamilan dan persalinan pada kasus pasca miomektomi perlaparoskopi. Laporan kasus kejadian ruptur uterus pada pasien yang sebelumnya mengalami laparoskopi operatif miomektomi miom intramural Æ 3.5 cm, yang 6 bulan kemudian mengalami kehamilan. Tidak ada gejala ke arah ruptura uteri saat kehamilan namun pada saat usia gestasi 34 minggu, pasien mengalami gejala ruptura uteri. Pada saat laparotomi; ditemukan fetus 2100 gram mati, dan robekan jaringan 5 cm pada sikatriks bekas miomektomi. Pada pasien yang mengalami miomektomi per laparoskopi khususnya miom intramural mempunyai risiko ruptura uteri pada saat persalinan. (Med J Indones 2004; 14: 113-6)

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Following laparoscopic myomectomy, uterine rupture during pregnancy or delivery in the area of the scar is a very rare but dangerous complication. Individual cases of uterine rupture during pregnancy are described in the literature. Case report of uterine rupture during delivery in a patient who had previously undergone laparoscopic myomectomy. In the case presented here, the patient conceived 6 months after an 3.5 cm intramural myoma, had been laparoscopically removed. No symptoms suggesting uterine rupture were observed during the pregnancy, but in the first stage of delivery the condition of the patient deteriorated and symptoms of oligaemic shock developed. A laparotomy was performed, which showed the presence of 2100 gr fresh dead fetus in the abdominal cavity and ruptured uterine muscle in the scarred area about 5 cm. In patients who have previously undergone a laparoscopic myomectomy, there is some risk of uterine rupture at delivery. This is also the case where unappropriate suturing of the uterine muscle had been required. (Med J Indones 2004; 14: 113-6)"

"Mioma Uteri merupakan neoplasma jinak yang berasal dari otot uterus dan jaringan ikat yang menumpangnya. Tujuan dari penulisan ini adalah untuk mengetahui gambaran kegiatan pelaksanaan praktek residensi dengan menerapkan teori unpleasant symptoms pada klien dengan Mioma Uteri. Kedua kasus mengalami ketidaknyamanan yang berkaitan dengan Mioma Uteri. Kedua kasus mengalami masalah baik fisik, psikologis maupun situasional. Kasus pertama dilakukan laparoskopi miomektomi dan kasus kedua dilakukan laparotomi miomektomi. Masalah keperawatan yang muncul sebelum pembedahan adalah nyeri dan cemas, sedangkan masalah keperawatan setelah pembedahan adalah resiko gangguan perfusi jaringan, nyeri, cemas, resiko infeksi, intoleransi aktifitas dan mengembangkan rencana tujuan jangka panjang dalam perencanaan kehamilan. Implementasi yang dilakukan adalah mengatasi gejala ketidaknyamanan yang dirasakan klien. Pendekatan teori unpleasant symptoms pada asuhan keperawatan pada klien Mioma Uteri dapat menangani ketidaknyamanan yang dirasakan oleh klien serta meningkatkan pemberian asuhan keperawatan yang komprehensif.

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Uterine Myomas are benign neoplasma, monoclonal tumors of the smoth muscle cells of the myometrium. The purpose of this report is to have a report of clinical practice in residency in implementing nursing role in maternity setting, focusing on implementation of unpleasant symptoms. Both cases are experiencing unpleasants associated with uterine myomas. Both cases have problems, either physical, psychological and situational. The first case performed laparoscopic myomectomy and second cases laparotomy myomectomy.

Nursing problems that arise before surgery are pain and anxiety, while nursing problems after surgery is the risk of tissue perfusion disorders, pain, anxiety, risk of infection, intolerance activities and develop aplan for long term goals of pragnancyng planning. The implementation is to overcome the perceived unpleasant symptoms cliens. Application of the theory unpleasant symptoms with uterine myomas can handle the unpleasant symptoms as well as improve the delivery of comprehensive nursing care."