Primary tubal choriocarcinoma

Choriocarcinoma is one of the most serious forms of gestational trophoblastic tumor. It is a malignant tumor from the epithelium of the chorionic villi. The most frequent location site is the uterus. Associated with ectopic pregnancy, it is extremely rare and in general, very aggressive. In 75% of the cases, it items from distant metastasis; therefore, a histological examination of the tubes must be performed in all ectopic pregnancies. Our patient was a 33-year-old woman who was admitted to emergency room (ER) with an intense pain in the right, iliac cavity, and limited genital bleeding. During the exploration, there was abdominal pain, with doubtful signs of peritoneal irritation. The vaginal ultrasound offered an image that was compatible with an extra uterine pregnancy in the left appendages. At emergency, right salpingectomy was performed via laparotomy. The patient was treated with polychemotherapy and contraceptives for a year, with no recurrence of the disease. Control follow-up was performed using beta-human chorionic gonadotropin (HCG) testing on a weekly basis during the first month and then bi-monthly during the first year of follow-up.

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Incarcerated Lumbar Hernia Complicated by Retroperitoneal Pseudoaneurysm 50 Years after Resection and Radiation Therapy of a Sarcoma

Case Reports in Surgery ◽

10.1155/2019/1072821 ◽

2019 ◽

Vol 2019 ◽

pp. 1-6

Author(s):

Oluwatobi Onafowokan ◽

Dabanjan Bandyopadhyay ◽

Dale Johnson ◽

Hugo J. R. Bonatti

Keyword(s):

Abdominal Pain ◽

Small Bowel ◽

Ct Scan ◽

Late Complication ◽

Abdominal Hernia ◽

Emergency Laparotomy ◽

Incisional Hernias ◽

History Of ◽

The Right

Background. Lumbar hernias are rare abdominal hernias. Surgery is the only treatment option but remains challenging. Posterior incisional hernias are even rarer especially with incarceration of intra-abdominal contents.Case Presentation. A 68-year old female presented with a 3-day history of worsening acute abdominal pain and distension, with multiple episodes of emesis. A CT scan indicated a large incarcerated posterolateral abdominal hernia. The patient had a history of resection of a sarcoma on her back as a child and also received chemotherapy and radiation. During emergency laparoscopy, a hemorrhagic small bowel segment incarcerated in the hernia was reduced and resected, and the distended small bowel was decompressed. An elective hernia repair was scheduled. After temporary clinical improvement, the patient again developed abdominal pain, distention, and emesis. During emergency laparotomy, a large hematoma in the right flank was found and partially evacuated. The right colon was mobilized out of the hernia and the duodenum was kocherized. A20×20cm BIO-A mesh was placed on top of the Gerota fascia and cranially tucked under liver segment VI. Anteriorly, the mesh was fixated with absorbable tacks. The duodenum and colon were placed into the mesh pocket. A postoperative CT scan identified a 2 cm pseudoaneurysm of a side branch of a lumbar artery, and the bleeding source was embolized. The postoperative course was complicated byClostridium difficile-associated colitis, but ultimately, the patient recovered fully. At 6-month follow-up, there was no evidence for a recurrent hernia.Discussion. There is a paucity of literature concerning lumbar incisional hernias. Repair with bioabsorbable mesh seems feasible, but longer follow-up is necessary as the mesh was placed in an unusual fashion due to the retroperitoneal hematoma. The exact cause of the hemorrhage is unclear and may have been caused during the initial incarceration, during surgery, or may be a late complication of her previous radiation.

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Caution with bilateral salpingectomy and consideration of tubal stump ectopic in IVF

BMJ Case Reports ◽

10.1136/bcr-2020-235893 ◽

2020 ◽

Vol 13 (11) ◽

pp. e235893

Author(s):

Swee Lin Yip ◽

Shahul Hameed Mohamed Siraj ◽

Jerry Kok Yen Chan

Keyword(s):

Ectopic Pregnancy ◽

Cystic Mass ◽

In Vitro Fertilisation ◽

Beta Human Chorionic Gonadotropin ◽

Life Threatening ◽

History Of ◽

Bilateral Salpingectomy ◽

Ectopic Pregnancies ◽

The Right

We report a 35-year-old female patient with a history of bilateral salpingectomy from ectopic pregnancies presenting with a positive serum beta-human chorionic gonadotropin (bhCG) result following in vitro fertilisation (IVF) treatment. Apart from per vaginal spotting, she remained asymptomatic. Initial ultrasound showed an empty uterus with a cystic mass on the right side of the uterus. Serum beta-hCG was trended. A follow-up pelvic ultrasound 1 week later showed a live pregnancy in the right adnexa. A diagnostic laparoscopy was performed, which revealed an unruptured right stump ectopic pregnancy that was successfully removed. As a stump ectopic pregnancy can be a potentially life-threatening occurrence, we emphasise caution with salpingectomy and the consideration of tubal stump ectopic pregnancies following IVF treatment.

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A Rare Cause of Abdominal Pain in Adults: Meckel’s Diverticulitis

Case Reports in Gastroenterology ◽

10.1159/000494752 ◽

2018 ◽

Vol 12 (3) ◽

pp. 709-714 ◽

Cited By ~ 3

Author(s):

Usman Pirzada ◽

Hassan Tariq ◽

Sara Azam ◽

Kishore Kumar ◽

Anil Dev

Keyword(s):

Abdominal Pain ◽

Small Bowel ◽

Meckel’S Diverticulum ◽

Meckel's Diverticulum ◽

Emergency Laparotomy ◽

Contrast Enhanced ◽

Meckel’S Diverticulitis ◽

The Right ◽

Enhanced Computed Tomography

A 42-year-old man presented to the emergency room with complaints of periumbilical abdominal pain. A contrast-enhanced computed tomography revealed mucosal thickening in the small bowel of the right abdomen. There was a fairly large small bowel diverticulum associated with this segment. Findings were suggestive of small bowel diverticulitis or possibly focal enteritis. A Meckel’s diverticulum scan was diagnostic of Meckel’s diverticulum. The patient was then immediately taken to the operating room for emergency laparotomy and was intra-operatively found to have a thickened Meckel’s diverticulitis with adjacent small bowel obstruction. Meckel’s diverticulectomy was performed in continuity with the adjacent inflamed small bowel. The patient had a stable postoperative course without any complications and was discharged within 10 days. At the 3-month follow-up, the patient was well and remained asymptomatic.

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Right Ventricular Function during Trastuzumab Therapy for Breast Cancer

10.21203/rs.3.rs-721985/v1 ◽

2021 ◽

Author(s):

Geris Mazzutti ◽

Fernando Pivatto Júnior ◽

Guilherme Oliveira Magalhães Costa ◽

Andreia Biolo ◽

Angela Barreto Santiago Santos

Keyword(s):

Breast Cancer ◽

Global Longitudinal Strain ◽

First Year ◽

Relative Reduction ◽

Trastuzumab Therapy ◽

Main Adverse Effect ◽

The Right ◽

Rv Function

Abstract PurposeCardiotoxicity (CDT) is the main adverse effect related to trastuzumab (TTZ) use, and the role of the right ventricle (RV) in this context is not clear. We aimed to evaluate the longitudinal changes in RV function during TTZ therapy and to determine the differences in RV function associated with subclinical CDT.MethodsPatients with breast cancer underwent echocardiograms at the beginning of TTZ treatment (Ex 1) and every 3 months during the first year (Ex 2, 3, 4). Subclinical CDT was defined as ≥ 12% relative reduction of left ventricle global longitudinal strain (LV GLS).ResultsTwenty-five women (52.1 ± 13.1 y-o) were included. We found a decrease in LV ejection fraction between the first and fourth exams and the LV GLS gradually decreased during follow-up (Ex1: -20.6 ± 2.0; Ex2: -19.4 ± 2.1; Ex3: -19.2 ± 1.8; Ex4: -19.0 ± 2.1, all p < 0.05). RV GLS changed from baseline to 3 month and to 6 month (Ex1: -23.9% ± 1.6; Ex2: -22.5% ± 2.1; Ex3: -22.5% ± 2.3, all p < 0.05), and the RV Fractional Area Change was lower in the third exam (Ex1: 44.3% ± 6.6 vs Ex3: 39.9% ± 6.0, p = 0.004). We found subclinical CDT in 13 patients (52%); changes in RV parameters had the same pattern of changing in the group with and without subclinical CDT.ConclusionIn this sample, the RV function decreased during TTZ therapy and the decrease was not associated to the observed LV cardiotoxicity.

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Clinical study to evaluate the efficacy of Yavakshara with Varunaadi Kwatha Churna in Mutrashmari w.s.r to Urolithiasis - A Case Study

Journal of Ayurveda and Integrated Medical Sciences (JAIMS) ◽

10.21760/jaims.v3i4.13352 ◽

2018 ◽

Vol 3 (4) ◽

Author(s):

Dr. Mamatha TS ◽

Dr. Shankar S. Swamy ◽

Dr. S. V. Shailaja

Keyword(s):

Abdominal Pain ◽

Stone Formation ◽

Left Kidney ◽

Modern Science ◽

Signs And Symptoms ◽

Cost Effective ◽

End Of Treatment ◽

The Right

Mutrashmari is one of the commonest disease of Mutravaha Srotas, Acharya Sushruta described it as one of the Ashta-Mahagadas and considered as Yama because it gives intolerable pain. Charaka mentioned Ashmari as one of Basti Marmashritha Vyadhi. In modern science it is correlated with Urolithiasis. The incidence rate of Calculi varies as per geographical distribution, sex and age. Generally, men are more affected than women in the ratio of 3:1. The highest incidence of Urolithiasis occurs between the ages of 30-50 years. In Ayurveda various conservative medicine are mentioned for the management of Mutrashmari with less side effect, easily available, cost effective and minimum recurrences of stone formation. In this case report 40 years male patient visited OPD of Shalya Tantra with complaint of abdominal pain (radiating pain from loin to groin), nausea and burning micturation. The USG report showed two calculi measuring 6mm and 4 mm seen in the left kidney, no evidence of hydronephrosis, 3 calculi measuring 6mm, 5mm and 4mm are seen in the right kidney, and right kidney shows mild HUN due to calculus measuring 5mm in the VUJ. The patient was treated with Yavakshara 3 Gunja Pramana twice a day with 50ml of Varunaadi Kashaya for a period of 1 month. At the end of treatment and also in follow up period after 15 days patient got relief in signs and symptoms and USG report showed no evidence of calculi in both the kidneys.

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Long-term results of percutaneous transluminal coronary rotational atherectomy for localized stenosis caused by Kawasaki disease

Cardiology in the Young ◽

10.1017/s1047951121002031 ◽

2021 ◽

pp. 1-19

Author(s):

Etsuko Tsuda ◽

Yasuhide Asaumi ◽

Teruo Noguchi ◽

Satoshi Yasuda

Keyword(s):

Kawasaki Disease ◽

Rotational Atherectomy ◽

Long Term Results ◽

First Year ◽

Cardiac Events ◽

Main Trunk ◽

The Right ◽

Percutaneous Transluminal

Abstract Thirteen boys and one girl, 5–30 years (median 13 years), underwent percutaneous transluminal coronary rotational atherectomy. The interval from the onset of Kawasaki disease to PTCRA ranged from 5 to 29 years (median 12 years). The follow-up period was 1–22 years (median 13 years). The target vessels were the right coronary artery (7), left anterior descending artery (3), left circumflex (2), and left main trunk (2). The maximum burr size used was 1.75 mm in four, 2.00 mm in four, and 2.15 mm in six. The immediate results of rotational atherectomy were successful in all patients, and the mean stenosis degree improved from 86 ± 15% (mean ± standard deviation) to 37 ± 14% (p < 0.001). Cardiac events in the late period were found in four patients (29%). Acute myocardial infarction occurred in two, and syncope and ventricular fibrillation in one each. The cardiac event-free rate at 10 and 20 years was 79% (95% confidence interval 50–92) and 39% (6–87), respectively, (n = 14). The overall 20-year patency rate was 54% (95% CI 28–78). That in patients more than 10 years old was 77% (95% CI 42–94, n = 10). PTCRA alone is suitable for severe localised stenosis with calcification caused by KD in young adults except for small children. Re-stenosis within the first year after PTCRA often develops because of reactive intimal thickening after the procedure. If a target vessel is a patent 1 year after the procedure, long-term patency may be expected in patients more than 10 years old.

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Rare late metastasis of testis seminoma to the bladder

Canadian Urological Association Journal ◽

10.5489/cuaj.3250 ◽

2015 ◽

Vol 9 (11-12) ◽

pp. 823

Author(s):

Ali Rıza Türkoğlu ◽

Soner Coban ◽

Muhammet Guzelsoy ◽

Murat Demirbas ◽

Nazmi Mutlu ◽

...

Keyword(s):

Transurethral Resection ◽

Bladder Wall ◽

First Year ◽

Curative Surgery ◽

Evaluation Result ◽

Testis Tumour ◽

The Right ◽

Late Metastasis ◽

Disease Free

A 45-year-old male presented to our clinic with complaining of hematuria for a month. The investigations showed a 59 × 24-mm myxoid mass on the right lateral bladder wall and this was removed with transurethral resection. The histopathology evaluation result was seminoma (classic type). The medical history revealed that the patient had undergone inguinal orchiectomy for a testis tumour 10 years before and the diagnosis was classic type seminoma. He received chemotherapy following the orchiectomy, but had not gone for follow-up after the first year. There was no other metastasis and he was put on the iphosphamide, etoposide, cisplatin (IPE) protocol. The patient has been disease-free for the last 5 months and the tumour markers and cystoscopy were normal. Testis tumours can rarely cause other organ metastases in the late stage even if curative surgery and chemo-radiotherapy were initially administered. Proper follow-up is crucial. It is also necessary to query the tumour history when a tumour in any organ is considered.

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Role of methotrexate in ectopic pregnancy

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20205433 ◽

2020 ◽

Vol 10 (1) ◽

pp. 84

Author(s):

Munjal J. Pandya ◽

Neha V. Ninama ◽

Chirag V. Thummar ◽

Meet K. Patel

Keyword(s):

Ectopic Pregnancy ◽

Success Rate ◽

Surgical Intervention ◽

Cost Effective ◽

First Trimester ◽

Medical College ◽

Beta Human Chorionic Gonadotropin ◽

Ectopic Pregnancies

Background: Ectopic pregnancy is an acute emergency in obstetric if not timely diagnosed and timely treated. Ectopic pregnancy is leading cause of death in first trimester. Ectopic pregnancy can be managed surgically or medically. Medical management with Methotrexate administration avoids anesthesia in surgery, is cost effective and also offers success rate comparable to surgical management. Aim and objectives were to study the role of methotrexate in ectopic pregnancyMethods: This will be a retrospective observational study conducted in Obstetrics and Gynecology department of AMC MET medical college. Study group constitutes of 30 females with ectopic pregnancy. Preliminary blood investigations, ultrasonography and beta-human chorionic gonadotropin (b-hcg) level will be tested. Patients will be treated with single dose of methotrexate 50 mg/M2. Follow up b-hcg level will be done after 48 hours. Response and tolerance to methotrexate will be monitored.Results: The success rate of methotrexate therapy in our study was 83.33% (n=25) and 16.66% (n=5) required surgical intervention with tubal ruptured and abdominal pain.Conclusions: Methotrexate treatment of ectopic pregnancies is safe and effective with no major side effects. It has the advantage of tubal conservation and saves patients from surgical intervention.

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Laparoscopic Excision of Coexisting Left Tubal and Right Pseudotubal Pregnancy after Conservative Management of Previous Ectopic Pregnancy with Methotrexate: An Unusual Clinical Entity

Case Reports in Surgery ◽

10.1155/2015/645826 ◽

2015 ◽

Vol 2015 ◽

pp. 1-3

Author(s):

Panayotis Xiromeritis ◽

Chrysoula Margioula-Siarkou ◽

Dimosthenis Miliaras ◽

Ioannis Kalogiannidis

Keyword(s):

Ectopic Pregnancy ◽

Fallopian Tube ◽

Tubal Pregnancy ◽

Chorionic Villi ◽

Tubal Patency ◽

Laparoscopic Excision ◽

Future Pregnancy ◽

Ectopic Pregnancies ◽

Left Fallopian Tube ◽

The Right

Tubal pregnancy concerns 97% of all ectopic pregnancies. Treatment can be either surgical (salpingostomy or salpingectomy) or medical (methotrexate administration). We present a case of a pseudotubal pregnancy after methotrexate treatment of a previous ectopic pregnancy. A37-year-old woman was diagnosed with ectopic pregnancy in the left Fallopian tube. A year ago, she had an ectopic pregnancy in the right tube, which was successfully treated with intramuscular methotrexate. During laparoscopy, two tubal masses were revealed, one in each Fallopian tube, and bilateral salpingectomy was performed. Histological analysis confirmed tubal pregnancy in the left Fallopian tube and presence of endosalpingitis in the right tube with no signs of chorionic villi. The optimal management of such cases has not yet been clarified. However, evaluation of tubal patency after a medically treated ectopic pregnancy would permit proper counsel of the patient on her fertility options, in order to choose the appropriate method of conception to achieve and accomplish a future pregnancy.

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Ruptured salpingitis isthmica nodosa: a rare cause for spontaneous haemoperitoneum

BMJ Case Reports ◽

10.1136/bcr-2020-237860 ◽

2021 ◽

Vol 14 (1) ◽

pp. e237860

Author(s):

Dora Huang ◽

Sandon Lowe ◽

Pravena Kumaran ◽

Kay Tai Choy

Keyword(s):

Ectopic Pregnancy ◽

Fallopian Tube ◽

Diagnostic Laparoscopy ◽

Lower Abdominal Pain ◽

Atypical Presentation ◽

Pelvic Ultrasound ◽

Beta Human Chorionic Gonadotropin ◽

History Of ◽

Ectopic Pregnancies ◽

The Right

Salpingitis isthmica nodosa (SIN) is the nodular swelling or diverticulum of the isthmus of the fallopian tube. It is most commonly identified when investigating female infertility or in association with ruptured ectopic pregnancies. We experienced a rare and atypical presentation of SIN. A 33-year-old woman presented with a 1-hour history of acute lower abdominal pain associated with nausea and vomiting. CT and pelvic ultrasound revealed haemoperitoneum with no radiological evidence for its aetiology. Initial beta-human chorionic gonadotropin excluded ectopic pregnancy. A diagnostic laparoscopy was performed following clinical deterioration of the patient. Active bleeding of the right fallopian tube was identified and managed with a right partial salpingectomy, with subsequent histopathology revealing ruptured SIN. There have been no reported cases of SIN being a primary cause for an acute abdomen or haemoperitoneum in the absence of an ectopic pregnancy, making this case a surgical novelty.

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