Hysterosalpingographic diagnosis of Crohn's disease. A case report.

A woman presented with abdominal pain, weight loss and a pelvic mass. At the time of laparotomy she had a lower abdominal abscess from perforation of the ileum. Two years later she returned with a tender uterus and purulent cervical discharge. A hysterosalpingogram demonstrated an uteroileal fistula secondary to Crohn's disease, and the patient underwent a total abdominal hysterectomy and bilateral salpingo-oophorectomy.     

Laparoscopic removal of an intraperitoneal translocated intrauterine contraceptive device.

The use of an intrauterine contraceptive device (IUD) is often accompanied by various complications, the perforation of the uterus constituting the most dangerous. Here we report the case of a patient who complained of abdominal pains. She had had an IUD inserted 15 months previously. Three months later, as she could no longer see the IUD strings at the external os of the cervix, she underwent pelvic ultrasonography, which did not show the IUD in the uterine cavity. A diagnosis of expulsion of the IUD was made. A few months later, the patient accidentally became pregnant, and decided to have an abortion. From that time on, she started to complain of the above-mentioned symptoms. She had an abdominal X-ray which revealed the IUD in the abdominal cavity. She then underwent a laparoscopic removal of the translocated IUD.     

The natural history of an hematosalpinx.

A patient who had experienced an actopic pregnancy and subsequent salpingectomy was found to have an ectopic pregnancy, presenting as an hematosalpinx, in the remaining fallopian tube. The diagnosis was made at the time of laparoscopy, and the patient refused definitive surgery. Fourteen months later she achieved an intrauterine pregnancy, and repeat laparoscopic examination revealed an essentially normal pelvis and fallopian tube. This is evidently the first case report of a pregnancy occurring through a fallopian tube that had had a previous ectopic gestation and in which no surgical procedure was performed on the affected tube.     

Brainstem ischemia and preeclampsia.

Diffuse neurological manifestations of preeclampsia are due to endothelial involvement that lead to ischemia, hemorrhage, or edema. We analyzed clinical and radiological features and the course of brainstem ischemic strokes in a preeclampsia patient. We report a case of severe preeclampsia in a 30-year-old woman who was admitted 10 hr after a vaginal delivery at home. The pregnancy was at 39 wk, with no prenatal care. At her admission, she was conscious, and she had tetraparesia, swinging deep tendon reflex testing, drowsiness, and dysarthria; the BP was at 160/100 mmHg and 4 + proteinuria; magnetic resonance imaging revealed brainstem ischemic stroke. The evolution was favorable with symptomatic treatment. The patient was discharged on the 16th day; 2 months later she had a normal recovery. Brainstem strokes are rare. They are frequently due to hemorrhage; sometimes, they can also be ischemic. Their course is favorable.     

Ofuji's diseases and pregnancy. A report of a case

Eosinophilic pustular folliculitis, which was first described by Ofuji, is a type of dermatosis characterized by pruritic, follicular, papules and pustules that gradually extend peripherally and have central tendency. Ofuji's disease has been rarely reported, and has not been reported in pregnancy. It's possible that hypersensitivity reaction plays an important role. There is no consensus on treatment approaches. We present the case of a 27 year-old woman during the 12.5 weeks of her first pregnancy; she had developed Ofuji's disease for 17 years. Previously, she had been treated with corticosteroid and azatioprine for 15 years, which were suspended by the time she was diagnosed with pregnancy. Then, she was referred to our maternal fetal medicine department, and was treated with prednisone 25 mg a day. The patient had urinary infection and vulvovaginitis at the week 14.2, with peripheral blood eosinophilia. She had exacerbations at the weeks 35.2 and 38.1, which were treated only with prednisone and topical management; furthermore she had a total of 4 kg of weight gain during the whole pregnancy. Cesarean delivery was performed for nonreassuring fetal heart rate. Perinatal results were: woman with lower birth weight: 2,450 g, Apgar 5.8, placenta with calcifications on 60% of it and single nuchal cord. She had exacerbations in late puerperium. A healthy newborn was obtained and no clinical findings of dermatoses were found. Maternal autoimmune diseases may induce remission or exacerbation during pregnancy. Nevertheless, in this case the induced exacerbations during puerperium and the fact that a low birth weight was obtained are problems commonly associated with the prolonged use of corticosteroids during pregnancy.     

Recurrent bowel obstruction during pregnancy after ileo-jejunal by-pass. Case report.

A patient weighing 140 kg had a jejuno-ileal by-pass procedure. In two subsequent pregnancies she developed bowel obstruction on a total of three occasions.     

Acrorenal syndrome: further observations.

A 23-year-old female patient with the acrorenal syndrome is described. In addition to acral and renal malformations, she had anomalies of the gastrointestinal and genital tracts. An annular pancreas had caused duodenal obstruction and had been associated with malrotation of the bowel. Secondary sexual characteristics were absent; no ovaries were identified by pelvic ultrasound, and endocrine investigations were compatible with non-functioning ovaries.     

Laparoscopic removal of an intraperitoneal translocated intrauterine contraceptive device

The use of an intrauterine contraceptive device (IUD) is often accompanied by various complications, the perforation of the uterus constituting the most dangerous. Here we report the case of a patient who complained of abdominal pains. She had had an IUD inserted 15 months previously. Three months later, as she could no longer see the IUD strings at the external os of the cervix, she underwent pelvic ultrasonography, which did not show the IUD in the uterine cavity. A diagnosis of expulsion of the IUD was made. A few months later, the patient accidentally became pregnant, and decided to have an abortion. From that time on, she started to complain of the above-mentioned symptoms. She had an abdominal X-ray which revealed the IUD in the abdominal cavity. She then underwent a laparoscopic removal of the translocated IUD.     

Acute menopausal transition associated with clomiphene therapy: Two case reports.

Two patients presenting with anovulation and secondary infertility were treated with clomiphene citrate. Intermittent blood samples were obtained for the first three months of therapy in each case. One patient failed either to ovulate or menstruate in response to clomiphene and the other patient had only two episodes of cyclical bleeding before she too became amenorrhoeic. Hormonal analyses revealed that both women had undergone a rapid and precocious menopausal transition which has persisted throughout the subsequent three years.     

Abdominal pregnancy complicated by genital and renal tuberculosts and hemolytic anemia.

After a 10-year period of primary infertility, a patient presented with abdominal pregnancy. Known to have had previously treated genital tuberculosis, on admission she was found to have renal tuberculosis and autoimmune hemolytic anemia. After fetal death, laparotomy was performed and the fetus was removed. The patient's anemia responded well to steroid therapy and she was discharged on antituberculous triple therapy. The literature on hemolytic anemia in pregnancy and in association with tuberculosis, as well as on ectopic gestations, was reviewed.     

Extensive Postoperative Ecchymosis in a Patient Taking Dabigatran

Herein we present the case of a 71-year-old woman who had a severe postoperative ecchymotic reaction. Our patient had a history of atrial fibrillation, for which she was given dabigatran etexilate mesylate as an anticoagulant. She discontinued her anticoagulant therapy 2 days before undergoing total laparoscopic hysterectomy with pelvic and periaortic lymph node sampling for uterine endometrioid adenocarcinoma. Despite an uneventful surgical procedure, she had widespread ecchymosis, edema, and anemia.     

Primary gestational choriocarcinoma of the uterine cervix. Report of a case and review of the literature

Gestational choriocarcinoma usually arises in the uterine cavity and is associated with coincident or antecedent pregnancy. Extrauterine choriocarcinomas are very rare entities, and most of these are located in the uterine cervix. In our case, a 43-year-old woman was admitted in our hospital because she had amenorrhea for 2 months and elevated serum beta-human chorionic gonadotropin levels. The patient was considered to have an ectopic pregnancy. Initially, she was treated with methotrexate, but since there was a continuous rise in human chorionic gonadotropin levels, the patient underwent a laparoscopy, along with dilatation and curettage (D&C) of the uterine cavity. Histopathologic findings, including immunohistochemical study, led to the diagnosis of choriocarcinoma of the cervix. Finally, the patient underwent a transabdominal hysterectomy and received single agent chemotherapy with methotrexate. Our case represents a primary choriocarcinoma of the cervix, which was initially misdiagnosed as an ectopic pregnancy. The difficulties in differential diagnosis are discussed. Immunohistochemical evaluation remains the mainstay of the diagnosis in most cases. Choriocarcinoma has a very good prognosis even in advanced stages, since it is a very chemosensitive tumor.     

A maternal death caused by AIDS. Case report

Physicians at a district general hospital in London, England admitted a 26 year old pregnant political refugee from Uganda complaining of shortness of breath, fever, and a productive cough for 1 week. She was at 10 weeks gestation and had not yet sought prenatal care. 6 years earlier she had a child and her pregnancy and delivery were normal. They diagnosed an interstitial pneumonia based on an X ray, arterial gases, and quick breathing and administered intravenous (IV) ampicillin and erythromycin for 3 days. Her condition deteriorated nevertheless, so they had her blood tested for HIV. She tested positive and suspected pneumocystosis (later confirmed) and began treatment with IV Septrin and hydrocortisone. She worsened, and by the 10th day of this treatment she was receiving 60% oxygen. They changed her treatment to IV pentamidine and oral rifampicin and isoniazid. By this time, her white blood cell count was 28.7x109/1 and hemoglobin concentration 8.2g/dl. Her condition would not allow her to undergo general anesthesia so an abortion requested by the patient was not performed. Additional treatment included continuous infusion of eflornithine, but she died despite it. This case poses 2 questions. Could she have lived if there had not been a delay in HIV diagnosis? Research shows that CD4 lymphocytes cell counts fall considerably during pregnancy in HIV positive women. So some advocate prophylaxis earlier in these women than other immunocompromised patients. Was it indeed her pregnancy that contributed to the severity of her illness and its inability to respond to treatment? Some researchers find pregnancy accelerates the progress of HIV infection, but researchers do not yet know if it also accelerates the progress of opportunistic infections. If so, terminating pregnancy may be considered.     

Insulinoma causing hypoglycemia in a patient with type 2 diabetes.

Insulinoma in a patient with pre-existing diabetes is extremely rare. A 74-year-old woman with type 2 diabetes mellitus who had been treated with a sulfonylurea for 6 years began experiencing frequent episodes of hypoglycemia. Endogenous hyperinsulinism was found 9 months after the sulfonylurea was discontinued, and transabdominal ultrasonography and magnetic resonance imaging identified a pancreatic tumor. Pathology examination of the resected tumor demonstrated an insulinoma. Postoperatively, the patient had no further episodes of hypoglycemia. Thereafter, she required insulin to control her hyperglycemia. Although hypoglycemic agents are the commonest cause of hypoglycemia in type 2 diabetes, insulinomas may occur in these patients. This possibility should be considered if the hypoglycemia persists despite dose adjustment or cessation of the drugs.     

Latent pelvic tuberculosis reactivating in a postmenopausal woman: a case report

BACKGROUND: Tuberculosis most often affects the pulmonary system; however, 8-15% of cases infect the genitourinary system. The primary treatment of uterine tuberculosis is medical therapy, and only when that fails is surgical intervention warranted. CASE: A 75-year-old woman presented with chronic back pain and fatigue. She had been on prednisone for 9 years for autoimmune hepatitis and had earlier exposure to tuberculosis. Evaluation led to the diagnosis of uterine tuberculosis. The patient was unable to tolerate a full course of antituberculin therapy, so she underwent an abdominal hysterectomy and bilateral salpingo-oophorectomy. CONCLUSION: We believe the patient had latent uterine tuberculosis that was reactivated from her chronic steroid use. If she had a purified protein derivative test prior to the start of prednisone therapy, latent tuberculosis may have been diagnosed and treated before she developed a clinically active infection.     

Pregnancy in a patient with Raynaud's disease.

We report a patient who, at the time of her third pregnancy at the age of 35, had had Raynaud's disease for 18 years. Her first pregnancy (during which she took Marcumar, an anticoagulant) ended in a miscarriage at three months gestation. The second pregnancy ended in fetal death due to placental insufficiency. The third pregnancy was also complicated by placental insufficiency which became evident during the second trimester. The patient was observed carefully and allowed to continue to 37 weeks gestation when a Caesarean section was done for late fetal heart rate decelerations during early labour of spontaneous onset. The baby had a low birth weight but developed normally. The placenta showed certain abnormalities which are described.     

Emesis gravidarum bei Magenbandpatientin

Many patients who have bariatric surgery are in fertile age, and the number of pregnancies after these operations is increasing. Therefore, pregnancy after bariatric surgery is of great clinical relevance. Moreover, a large number of pregnant women experience nausea and vomiting and some suffer from hyperemesis gravidarum, with symptoms frighteningly similar to the potential complications after bariatric surgery. We report of a 24-year-old woman with grade-III obesity who underwent laparoscopic gastric banding. A few years later, she presented to hospital because of recurrent vomiting and it was discovered she was pregnant.. The patient’s vomiting continued, but she was discharged with the diagnosis of hyperemesis gravidarum. The patient’s condition deteriorated progressively, she had to be transferred to intensive care, and the pregnancy had to be terminated. After her condition stabilized, she was assigned to our obesity center. A contrast swallow examination showed complete band slippage with a parastomal passage stop. The patient was immediately operated on laparoscopically and the gastric band was removed.     

Pregnancy in a patient with aneurysms of the right coronary artery and an arterioventricular fistula. A case report

A woman with aneurysms of the right coronary artery and right coronary sinus of Valsalva and a right coronary arterioventricular fistula developed angina during pregnancy. Lumbar epidural anesthesia was utilized during induction of labor and cesarean delivery. The patient had no intrapartum evidence of ischemia or congestive heart failure, and she recovered without an immediate recurrence of angina.     

Anterior sacral meningocele presenting as a pelvic mass and diagnosed only at celiotomy after an extensive workup. A case report

A marfanoid patient underwent celiotomy for a pelvic mass and was found to have an anterior sacral meningocele. Nine years prior to that time she had undergone surgery because of a "sacrococcygeal cyst," which in retrospect seemed to be a posterior meningocele. The preoperative diagnosis of meningocele is important to successful treatment.     

Postpartum cerebral angiopathy: an important diagnostic consideration in the postpartum period

A 32-year-old woman, gravida 4, para 2, presented with a severe headache 5 days after she had a vaginal delivery with epidural anesthesia. Nine days later she had neurologic symptoms develop. Magnetic resonance imaging and cerebral angiogram were abnormal with evidence of a vasculitis consistent with postpartum cerebral angiopathy. The patient received both methylprednisolone and cyclophosphamide pulses with improvement of her symptoms. This is an important diagnosis for obstetricians to consider because it may result in serious neurologic damage if it is not diagnosed and treated early.