Primary uterine Ewing sarcoma – A case report

ObjectiveEwing sarcoma is a type of neuroectodermal tumors (Ewing family of tumors-EFT) that mostly affect the bone or soft tissue. Primary uterine Ewing sarcoma is extremely rare.Case reportWe report a case of a primary uterine Ewing sarcoma in a 46-year-old patient, treated with total abdominal hysterectomy, and bilateral salpingo-oophorectomy and following adjuvant chemotherapy with 6 cycles of vincristine, doxorubicin, and cyclophosphamide, achieving complete remission for one year.ConclusionComplete resection for EFT is the first choice of treatment, regardless of their origins. Adjuvant chemotherapy or radiotherapy is mandatory if needed. Due to rarity of the disease, this report re-emphasizes the accurate diagnosis and appropriate treatment for these unusual tumor types occurred in female genital organs.     

Three cases of transient hyperthyroidism after triptorelin treatment – case report and literature review

The impacts of gonadtropin-releasing hormone (GnRH) agonists on thyroid function have long been observed and the conclusions were controversial. We here reported three cases of transient hyperthyroidisms after triptorelin therapy. The three patients showed decreased thyroid-stimulating hormone (TSH), with or without elevated free triiodothyronine (FT3) and free thyroxine (FT4) 2 weeks after injection of triptorelin. Thyroid-specific autoantibody assays showed antithyroid microsome autoantibody (TMAb) and (or) antithyroglobulin autoantibody (TgAb) were positive in two patients while and antithyrotropin receptor autoantibody (TRAb) were negative in all three cases. One patient with all thyroid-specific autoantibodies negative showed enlarged thyroid in thyroid ultrasound scanning. Only mild symptoms of hyperthyroidism presented in one patient. Four weeks after triptorelin injection, thyroid function returned to normal in all three patients. These observations indicated transient hyperthyroidism due to thyroid destruction in patients receive triptorelin therapy. The hyperthyroidism was most possibly due to onset of the autoimmune thyroiditis, emphasizing monitoring thyroid function during triptorelin treatment in females.     

Conservative management of morbidly adherant placenta – A case report and review of literature

Placenta accreta is a condition when the placenta is abnormally adherent to the uterus. This can result in complications like severe haemorrhage, injuries to pelvic organs, possible need for Caesarian hysterectomy. There is always high risk of maternal morbidity and mortality. Over the last decade there has been gradual shift towards conservative management of placenta accreta involving uterine and placental conservation, with the main aim to reduce pelvic injury and to achieve haemostasis with the aid of intervention radiology by means of Uterine Artery embolisation and use of medical chemotherapeutic agents like Methotrexate. This strategy has previously been shown to reduce morbidity and mortality in carefully selected cases of Placenta accreta. We have successfully managed a case of Placenta percreta conservatively using Uterine Artery embolisation followed by Injection methotrexate.     

Streptococcal toxic shock syndrome following insertion of an intrauterine device – A case report

Background?Though the incidence of infection associated with the use of intrauterine devices (IUDs) is quite low, toxic shock syndrome (TSS) should be considered if fever and shock should develop rapidly following insertion of the device.

Case?A 31-year-old woman, para 4, developed fever, abdominal pain, nausea and vomiting two days after insertion of a CuT380A copper IUD. Six days after insertion the patient fulfilled the criteria for TSS. She presented evidence of an acute pelvic infection for which an emergency total abdominal hysterectomy with bilateral salpingectomy was performed. The sepsis appeared to be due to group A streptococcus (GAS). The patient made an uneventful recovery.

Conclusion?This is the first reported case of GAS causing a TSS associated with insertion of an IUD. Streptococcal TSS can be fatal. Early aggressive management is mandatory.     

Spontaneous subcapsular hematoma of liver in pregnancy of unknown etiology – Conservative management: A case report

Mrs. AB, a 40-year-old woman, in her second pregnancy had a spontaneous hematoma of liver of unknown etiology that was managed successfully conservatively under the umbrella of the multidisciplinary care. The subcapsular hematoma was diagnosed at 31 weeks gestational age while she was being investigated because of sudden and gross drop of hemoglobin from 12.8 to 8?g/dl in 2 weeks duration.

The dilemma remains as how to manage her future pregnancies and what are the risks of recurrence.     

Bilateral ampulary pregnancy after clomifen citrate and intrauterine insemination – a unique case report

Abstract

We report a case with bilateral tubal ampullary pregnancy after Clomifen Citrate medication. The first conception in the right tube was after intrauterine insemination or intercourse performed before insemination, while the second one was achieved 10?d after insemination, during the intercourse, in the left tube. This life-threatening and routinely unexpected finding must always have in mind all doctors dealing with patients in emergency care, especially those receiving fertility enhancing drugs. According to the literature data available, this is the first and unique such case in the literature.     

Fertility after “only B-Lynch” suture: A case report and literature review

ObjectiveA new fertility assessment after a B-Lynch suture without a concomitant uterine devascularization is proposed.Case ReportThe case of a 37-year-old woman who experienced postpartum hemorrhage due to uterine atony during cesarean delivery of the previous pregnancy is reported. A B-Lynch brace suturing technique, not associated to any other hemostatic surgical procedure, was carried out. One year later and after an uncomplicated pregnancy of 39 weeks, the patient delivered a healthy infant by an elective cesarean section. Only omental adhesions were found on the anterior surface of the uterus as a consequence of the previous B-Lynch suture.ConclusionThe B-Lynch hemostatic surgical procedure, alone, does not seem to have a negative impact on fertility. Additional clinical evidences in a greater case-series of patients are needed to assess the value of the method for fertility preservation.     

A familial case of Muenke syndrome. Diverse expressivity of the FGFR3 Pro252Arg mutation – case report and review of the literature

Abstract

Muenke is a fibroblast growth factor receptor 3 (FGFR-3)-associated syndrome, which was first described in late 1990s. Muenke syndrome is an autosomal dominant disorder characterized mainly by coronal suture craniosynostosis, hearing impairment and intellectual disability. The syndrome is defined molecularly by a unique point mutation c.749C?>?G in exon 7 of the FGFR3 gene which results to an amino acid substitution p.Pro250Arg of the protein product. Despite the fact that the mutation rate at this nucleotide is one of the most frequently described in human genome, few Muenke familial case reports are published in current literature. We describe individuals among three generations of a Greek family who are carriers of the same mutation. Medical record and physical examination of family members present a wide spectrum of clinical manifestations. In particular, a 38-year-old woman and her father appear milder clinical findings regarding craniofacial characteristics compared to her uncle and newborn female child. This familial case illustrates the variable expressivity of Muenke syndrome in association with an identical gene mutation.     

Twin pregnancy after kidney transplantation: what’s on? A case report and review of literature

Abstract

Objective: To describe the maternal and neonatal outcome of a twin pregnancy in a renal transplant recipient patient and reviewe the current literature on this theme.

Methods: A case of 27 years old woman with a twin pregnancy arisen spontaneously in a renal transplant recipient from living donor characterized by an episode of slight anemia, mild hypertension, and a subsequent optimal maternal/neonatal outcome. During admission, the patient was treated with iron therapy, nifedipine, and methyldopa due to anemia and hypertension episodes. Strict monitoring of patient’s blood and urinary parameters, ultrasound fetues evaluation, and fetal lung maturity induction was performed.

Results: Both anemia and hypertension were controlled through pharmacological intervention. During the second admission, the serum creatinine was 185?μmol/L and urine examination showed a proteinuria of 0.3?g/L. Ultrasound evaluation showed fetal wellness for both twin. Patient underwent caesarean section and gave birth to two healthy babies.

Conclusions: It is necessary to define more strict criteria for the management of women with twin pregnancy and a history of renal transplantation to ensure the better maternal and neonatal outcome.     

Leiomyosarcoma of the broad ligament mimicking as ovarian carcinoma – a case report

A 55-year-old postmenopausal lady presented with signs and symptoms of ovarian malignancy. Laparotomy revealed a 8×8-cm degenerated, cystic and haemorrhagic mass arising from left broad ligament which on histopathology proved to be leiomyosarcoma.     

Ectopic pregnancy with postcoital contraception – a case report

The incidence of ectopic pregnancies is increasing. Common risk factors are tubal pathology, previous tubal surgery, previous ectopic pregnancy, intrauterine device use and embryo transfer. Levonelle-2^®, a progesterone-only postcoital contraceptive works by a combination of mechanisms including ovulation inhibition, prevention of fertilization, and inhibition of implantation. It is 85% effective and there have been 12 reported cases of ectopic pregnancy in the UK with its use. It is believed that progesterone slows the intratubal migration of the fertilized ovum. In the case reported here, a woman presented with an ectopic pregnancy after use of Levonelle-2 as postcoital contraception; there were no clinical predisposing risk factors. In the absence of any histological evidence of tubal damage, we suspect that the levonorgestrel from Levonelle-2 could have been responsible for delayed embryo transfer which resulted in the ectopic pregnancy.     

A rare cause of fetal ascites: A case report of Günther's disease.

Despite an arsenal of ever-improving diagnostic tools, determining the precise etiology of fetal ascites is not always possible. We report a case history where moderately-severe fetal ascites was retrospectively determined to be due to Günther's disease (congenital erythropoietic porphyria). The infant was found to carry the mutation associated with the most severe disease phenotype in which fetal hydrops has been described.     

Is the Time of administration of misoprostol of value? The uterotonic effect of misoprostol given pre- and post-operative after elective cesarean section

ObjectiveThe aim of the current study was to compare blood loss in pre- and post-operatively rectally administered 600 μg of misoprostol in elective cesarean delivery, in order to determine the optimal time for drug administration (CS).Study designA 30-month prospective, single-blind, randomized, clinical trial was done in the Qena University Hospital, Egypt, from January 2010 to October, 2012.MethodsIntervention consisted of pre and post-operative rectally administered misoprostol. At baseline, there were no significant differences in the demographic and obstetric variable between groups. Primary outcome measures were differences in intra-operative and postoperative blood loss between groups. Secondary outcomes measures were hemoglobin levels pre and operative (24 h after CS) and the need for additional uterotonic drugs.ResultsA total of 300 subjects were enrolled (pre-operative administrated rectally misoprostol n = 150, post-operative administrated rectally misoprostol n = 150). Subjects receiving pre-operative misoprostol achieved significantly lower blood loss compared to those receiving post-operative misoprostol (620 ± 291 ml vs. 898 ± 321 ml, p < 0.05), respectively. The need for additional uterotonic was significantly higher in subjects receiving post-operative misoprostol compared to those receiving pre-operative misoprostol (53.3% vs. 30%, p, 0.05), respectively.ConclusionPre-operative rectally administrated misoprostol appears to be more effective than post-operative rectally administrated misoprostol in reducing blood loss, and in decreasing the need for other uterotonic drugs in cesarean section delivery.     

Can we reduce the recurrence of cornual pregnancy? A case report

In this paper, we discuss a successful attempt to reduce the incidence of recurrent cornual pregnancy by ipsilateral tubal occlusion in a lady with two previous cornual pregnancies and a healthy looking contralateral tube. Note: Patient consent was sought and given for the publication of her case.     

New mutation causing androgen insensitivity syndrome – a case report and review of literature

Androgen insensitivity syndrome (AIS) is a congenital disorder in which a defect in the androgen receptor (AR) gene leads to cellular resistance to androgens. Defects in the AR gene, located on the X chromosome, result in the development of a feminine phenotype in chromosomally male (46, XY) individuals. In this case report, we present a 44?years old patient with complete androgen insensitivity syndrome (CAIS) initially presenting with primary amenorrhea. The patient underwent a full clinical evaluation, revealing hypoplastic vagina and a lack of uterus and ovaries. Hormonal evaluation revealed markedly elevated testosterone, FSH, and LH serum concentrations. Diagnostic imaging, including pelvic MRI, confirmed the presence of two solid masses in the inguinal canals (right 26?×?13?mm, left 25?×?15?mm). The patient underwent genetic testing, revealing a 46 XY karyotype and an as of yet unprecedented androgen receptor mutation. The type of the mutation was a single-base exchange – the substitution from cytosine to thymine in chromosome X:66942710 position (referred to human reference genome GRCh37), which has resulted in an amino acid changes from leucine (CTT) to phenyloalanine (TTT) in ligand-binding domain.     

Laparoscopic management of cornual heterotopic pregnancy with the use of Harmonic ACE®—a case report

Heterotopic pregnancy is the simultaneous coexistence of both intrauterine and extrauterine pregnancies.Cornual heterotopic pregnancies can cause catastrophic haemorrhage because of their location. Available evidence suggests that they have usually been managed surgically by laparotomy and cornual resection, few were managed medically and two expectantly. Of the surgical group, only three underwent laparoscopic management. We report the first case of successful management of cornual heterotpic pregnancy by Harmonic ACE® and a favourable outcome of the intrauterine pregnancy.     

Pyosalpinx caused by the tubal migration of an intrauterine device – a case report

Migration of an intrauterine device (IUD) is a complication occurring at or following insertion. After having perforated the uterine wall, the IUD usually will settle into the peritoneal cavity. Tubal migration of an IUD is extremely rare and little is known about its mechanism. We describe a case of pyosalpinx caused by the tubal migration of a copper IUD. The tail of the device was embedded in the mesocolon.