Laparoscopic treatment of ovarian cysts in adolescents and young adults

Study Objective

To investigate the laparoscopic management of ovarian cysts in adolescents and young adults.

Design

A retrospective chart review study.

Setting

Zekai Tahir Burak Women’s Health Research and Education Hospital.

Participants

A total of 282 females aged 25 years or younger underwent laparoscopic surgery for a presumed benign ovarian cyst. Patients were grouped as adolescents (ages 12–19, n = 79) or young adults (ages 20–25, n = 203).

Main Outcome Measures

Surgical approach, operative findings and the correlation of intraoperative diagnosis with the definitive pathological reports.

Results

The mean age of the patients was 21.2 years. At laparoscopic surgery, 89 patients (31.6%) had endometriomas, 47 (16.7%) had dermoid cysts, and 37 (13.1%) had paraovarian cysts. Ninety-seven patients (34.4%) had simple ovarian cysts. Pathological reports revealed that young adults were more likely to have endometriomas (34.0% vs 7.6%, P < 0.01), but dermoid cysts and simple ovarian cysts were more frequent (20.3% vs 15.3%, P < 0.01 and 60.7% vs 40.9%, P < 0.01, respectively).in adolescents. Eleven of the cases (3.9%) were found to have mucinous cystadenomas and fourteen (5.0%) to have serous cystadenomas. Four cysts were malignant (1.4%). Cystectomy was performed in 205 cases (72.7%), fenestration of cyst wall was performed in 53 cases (18.8%), and aspiration was applied in 22 cases (7.8%). The types of operation were not significantly different among adolescents and young adults (P > 0.05). The operative diagnosis was highly correlated with the final pathological reports (kappa value= 0.901, P < 0.001). There were no operative and postoperative complications in our series.

Conclusion

With a careful preoperative screening, the laparoscopic surgery of ovarian cyst is an efficient and safe treatment for adolescents and young adults.     

Penile keratoacanthoma associated with urothelial carcinoma of the bladder in Muir-Torre syndrome

A combination of some specific skin tumors with visceral cancers characterize Muir-Torre syndrome. A 60-year-old male patient who presented with penile keratoacanthoma accompanied by bladder and colorectal cancer is presented.     

Bouveret＇s syndrome complicated by a distal gallstone ileus

AIM: Gastric outlet obstruction caused by duodenal impaction of a large gallstone migrated through a cholecystoduodenal fistula has been referred as Bouveret‘s syndrome. Endoscopic lithotomy is the first-step treatment, however, surgery is indicated in case of failure or complication during this procedure .METHODS: We report herein an 84-year-old woman presenting with features of gastric outlet obstruction due to impacted gallstone. She underwent an endoscopic retrieval which was unsuccessful and was further complicated by distal gallstone ileus. Physical examination was irrelevant. RESULTS: Endoscopy revealed multiple erosions around the cardia, a large stone in the second part of the duodenum causing complete obstruction, and wide ulceration in the duodenal wall where the stone was impacted. Several attempts of endoscopic extraction by using foreign body forceps failed and surgical intervention was mandatory. Preoperative ultrasound evidenced pneumobilia whilst computerized tomography showed a large stone, 5cm&#215;4cm&#215;3cm, logging at the proximal jejunum and another one, 2.5cm&#215;2cm&#215;2cm, in the duodenal bulb causing a closed-loop syndrome. She underwent laparotomy and the jejunal stone was removed by enterotomy. Another stone reported as located in the duodenum preoperatively was found to be present in the gallbladder by intraoperative ultrasound. Therefore, cholecystoduodenal fistula was broken down, the stone was retrieved and cholecystectomy with duodenal repair was carried out. She was discharged after an uneventful postoperative course. CONCLUSION: As the simplest and the least morbid procedure, endoscopic stone retrieval should be attempted in the treatment of patients with Bouveret‘s syndrome. When it fails, surgical lithotomy consisting of simple enterotomy may solve me problem. Albhough cholecystectomy and cholecystoduodenal fistula breakdown is unnecessary in every case, conditions may urge the surgeon to perform such operations even though they carry high morbidity andmortality.     

Combined resection and radiofrequency ablation of rhabdomyoma in a child with sustained ventricular tachycardia

Abstract Cardiac rhabdomyoma is a benign tumor of the heart in childhood and can be associated with life-threatening arrhythmia. In this report, we present the case of a 2-year-old male with right ventricular rhabdomyoma, who was admitted with syncope that was associated with episodes of sustained ventricular tachycardia. The patient underwent combined surgical resection and radiofrequency ablation of the tumor. There was no recurrence of ventricular tachycardia after surgery. (J Card Surg 2012;27:649-652).     

Congenital Seminal Vesicle Cyst Accompanying Ipsilateral Renal Agenesis and Rudimentary Ureter

Congenital seminal vesicle cysts are usually diagnosed as incidental sonographic findings in patients with voiding complaints. Rarely they could also be detected in asymptomatic cases. In our study, a seminal vesicle cyst associated with ipsilateral renal agenesis and ureteral bud remnant in an asymptomatic patient is presented.     

Does hysteroscopic polypectomy without cycle cancellation affect IVF?

Endometrial polyp (measuring <2 cm) was diagnosed by transvaginal ultrasonography performed on days 7 and 9 of the cycle in six patients who underwent IVF. These six patients were treated by hysteroscopic polypectomy preceding oocyte retrieval under general anaesthesia after informed consent was obtained. The cause of infertility was male factor in three patients, tubal factor in one, and two cases were unexplained. All patients had undergone ovulation induction and luteal support according to the long luteal protocol. As a result, in three cases pregnancy was achieved (one multiple and two singleton) and three cases were unsuccessful. One of the pregnant women gave birth at term, while the other two pregnancies are still ongoing. There is still no consensus regarding the management of patients diagnosed with endometrial polyp in IVF cycles. Cryopreservation, cycle cancellation and embryo transfer preceding polypectomy is the current management choice. The treatment modalities will be clarified only if embryo transfer preceding polypectomy in the same cycle is proven to be safe. This approach has been used in only six patients so far, and further studies with more patients are needed to confirm these findings.     

Meningitis due to methicillin-resistant Staphylococcus aureus (MRSA): review of 10 cases

We evaluated retrospectively, 10 MRSA meningitis cases in our hospital that occurred between January 1999 and June 2004. All were post-neurosurgical and were considered to have hospital-acquired meningitis. Fever, leukocytosis, variable conscious levels were the most common findings. Six patients were treated with regimens including teicoplanin, and four with vancomycin. Mean duration of treatment was 23.5+/-18.8 days (range, 3-60 days). One patient died. In cases of MRSA meningitis, intravenous vancomycin is the mainstay of therapy. However, six of these 10 patients were successfully treated with regimens including teicoplanin, suggesting that this agent may be an alternative to vancomycin in the therapy of these cases.     

Impact of high levels of progesterone on alpha(1)-integrin distribution in the endometrium of patients with unexplained infertility

Irregular or low expression of integrins, which are cell adhesion molecules, may be associated with infertility. We conducted a prospective controlled study evaluating the effects of supraphysiological levels of estrogen and progesterone created by human menopausal gonadotropins (HMG) and progesterone support on alpha(1)-integrin immunolocalisation in the endometrium. Three groups were enrolled in the study. The first group of patients (group 1) had unexplained infertility and had been treated with HMG and progesterone (n=27). The second group of patients (group 2) was an untreated fertile group (n=24). The third group (group 3) consisted of patients who had unexplained infertility and had received no treatment (n=11). Endometrial biopsy specimens were taken from individuals from each group during the ovulation induction period. alpha(1)-integrin immunohistochemistry was performed. Serum estradiol and progesterone levels were also measured in parallel with histological dating of endometrial biopsies. Group 1 showed no statistical difference from group 2 in alpha(1)-integrin or histological dating. Group 3 showed less alpha(1)-integrin in the glandular epithelium in the secretory phase. We observed that alpha(1)-integrin was specific to the secretory phase. Its localization was denser in group 2 when compared with group 3, which supports the conclusion that alpha(1)-integrin may be a useful marker for luteal phase quality. Moreover, the supraphysiological estrogen and progesterone levels created by HMG and progesterone support may affect the alpha(1)-integrin in the endometrium in the secretory phase in the case of unexplained infertile patients.