Surgical lysis of nerve entrapment caused by retroperitoneal fibrosis/adhesions; two case reports and a literature review

2021 ◽  
pp. 228402652110584
Author(s):  
Taner Usta ◽  
Salih Yilmaz ◽  
Nura Fitnat Topbas Selcuki ◽  
Isil Ayhan ◽  
Ahmet Kale ◽  
...  
Keyword(s):  
Female Patient ◽  
Severe Pain ◽  
Retroperitoneal Fibrosis ◽  
Case Reports ◽  
Transvaginal Ultrasound ◽  
Left Groin ◽  
Gynecological Examination ◽  
Pouch Of Douglas ◽  
Case Presentations ◽  
Pain Symptoms

Introduction: Retroperitoneal fibrosis (adhesions) in the pelvic area is rare and not well known in gynecology. However, their presence can cause compression neuropathy leading to severe pain symptoms involving the lower extremities. A neuropelveological approach can be applied in dealing with such cases in diagnosis and management. Objective: To demonstrate neurolysis of sacral nerves in patients with retroperitoneal fibrosis (adhesions). Case presentations: Case 1: A 43-year-old gravidity 1 parity 1 female patient with known endometriosis presented with dysmenorrhea, dyspareunia, and left-sided sciatica. Gynecological examination revealed a rectovaginal nodule and full obliteration of pouch of Douglas. Robot-assisted laparoscopic sacral neurolysis and dissection of pouch of Douglas with rectal nodule shaving was performed. The patient was symptom free 6 months postoperatively. Case 2: A 49 years old gravidity 2 parity 2 female patient presented with severe pain on the left groin and leg, dysuria, and constipation, which required frequent manual evacuation of the feces. The begin of her symptoms coincided with a previous laparoscopic total hysterectomy, where she experienced postsurgical hemorrhage. Laparoscopic sacral neurolysis with adhesiolysis was performed. The patient was symptom free 6 months postoperatively. Conclusion: Pelvic retroperitoneal fibrosis (adhesions) are rarely encountered in gynecology. However, they should be included in differential diagnosis in patients presenting with pelvic pain accompanied by lower extremity pain, urinary, and/or bowel symptoms. Since presurgical diagnosis of fibrosis (adhesions) is hard with visualization techniques such as transvaginal ultrasound or magnetic resonance imaging, a thorough neuropelveological examination can be helpful in such cases.

scholarly journals Adenomyosis: diagnostics and treatment

2020 ◽  
Vol 53 (10) ◽  
pp. 683-688
Author(s):  
Harald Krentel ◽  
Rudy Leon De Wilde
Keyword(s):  
Family Planning ◽  
Negative Impact ◽  
Case Reports ◽  
Transvaginal Ultrasound ◽  
Clinical History ◽  
Deep Endometriosis ◽  
Gynecological Examination ◽  
Treatment Concepts ◽  
Planning Status ◽  
Evidenced Based

Abstract Background Adenomyosis is a frequent additional condition in patients with endometriosis and should be included in diagnostic and treatment concepts. Objective Description of diagnostic and therapeutic approaches in patients with adenomyosis in relation to patient age, family planning status, peritoneal and/or deep endometriosis and symptoms. Methods The current literature on adenomyosis including case reports was analyzed. Due to the lack of evidenced-based approaches the most probable trends in diagnostics and treatment are discussed. Results Adenomyosis plays an important role in fertile patients with dysmenorrhea, dyspareunia and pelvic pain, with or without additional peritoneal or deep endometriosis. It has a negative impact on fertility and can cause a variety of symptoms. The disease can be diagnosed by a skilled examiner and treatment concepts exist. Conclusion Adenomyosis can be diagnosed by a combination of clinical history, gynecological examination, transvaginal ultrasound and magnetic resonance imaging. Various medical and surgical treatment approaches are available to reduce symptoms and to increase fertility. The course of action depends on the family planning status of the patient.

scholarly journals Newly detected rapid eye movement associated sleep apnea after coronavirus disease 2019 as a possible cause for chronic fatigue: two case reports

2021 ◽  
Vol 15 (1) ◽  
Author(s):  
Andreas Rembert Koczulla ◽  
Antje Stegemann ◽  
Rainer Gloeckl ◽  
Sandra Winterkamp ◽  
Bernd Sczepanski ◽  
...  
Keyword(s):  
Sleep Apnea ◽  
Eye Movement ◽  
Case Reports ◽  
White Male ◽  
Chronic Fatigue ◽  
White Female ◽  
Rapid Eye Movement ◽  
Pressure Therapy ◽  
Fatigue Syndrome ◽  
Case Presentations

Abstract Background Coronavirus disease 2019 has become a health problem spreading worldwide with pandemic characteristics since March 2020. Post coronavirus disease 2019 symptoms are more frequent than initially expected, with fatigue as an often-mentioned issue. Case presentations We describe a 32-year-old white male and a 55-year-old white female who suffered from post coronavirus disease 2019 fatigue syndrome. On polysomnography, rapid eye movement associated sleep apnea with an increased hypopnea index during rapid eye movement phases of 36.8 and 19.5 events per hour was found. Based on the patients’ burdensome fatigue symptoms, we initiated automatic positive airway pressure therapy, which diminished sleep apnea (rapid eye movement index: 0.0 in both patients) and, consequently, also the fatigue symptoms. Conclusions Since sleep apnea and coronavirus disease 2019 are both associated with fatigue, a screening for sleep apnea might be considered in coronavirus disease 2019 patients with fatigue syndrome.

scholarly journals Paraurethral Leiomyoma in a Postmenopausal Woman: First European Case

2015 ◽  
Vol 2015 ◽  
pp. 1-3 ◽  
Author(s):  
Susy Shim ◽  
Camilla Skovvang Borg ◽  
Huda Galib Majeed ◽  
Peter Humaidan
Keyword(s):  
Smooth Muscle ◽  
Postmenopausal Woman ◽  
Smooth Muscle Cells ◽  
Postoperative Period ◽  
Transvaginal Ultrasound ◽  
Reproductive Age ◽  
Benign Tumors ◽  
Gynecological Examination ◽  
Urethral Pain ◽  
Paraurethral Leiomyoma

Leiomyomas are benign tumors extending from smooth muscle cells and only few cases of paraurethral leiomyomas have been described in the literature. They are often seen in the reproductive age and around 50% of the cases are asymptomatic. We describe a 59-year-old woman with a solid mobile tumor below the symphysis revealed at a gynecological examination. Transvaginal ultrasound and MRI confirmed the tumor and excision of the paraurethral tumor was carried out. The histological examination showed a benign paraurethral leiomyoma. The postoperative period was characterized by urethral pain as well as vaginal leakage of urine.

scholarly journals Therapeutic Management of a Substantial Pelvic Aneurysmatic Bone Cyst Including the Off-Label Use of Denosumab in a 35-Year-Old Female Patient

2017 ◽  
Vol 2017 ◽  
pp. 1-5
Author(s):  
D. Ntalos ◽  
M. Priemel ◽  
C. Schlickewei ◽  
D. M. Thiesen ◽  
J. M. Rueger ◽  
...  
Keyword(s):  
Monoclonal Antibody ◽  
Female Patient ◽  
Therapeutic Agent ◽  
Surgical Intervention ◽  
Case Reports ◽  
Bone Cyst ◽  
Off Label Use ◽  
Aneurysmal Bone Cysts ◽  
Promising Therapeutic Agent

Aneurysmal bone cysts (ABC) are benign bone tumors, which are highly vascularized. The main course of treatment is curettage followed by bone grafting or cement insertion. Still recurrence remains a main problem for patients. Denosumab is a monoclonal antibody, which acts as an inhibitor of the RANK/RANKL pathway, diminishing bone turnover. Recent case reports have shown that Denosumab can be a promising therapeutic agent for people suffering from therapy-resistant ABC. We report the case of a 35-year-old female patient presenting with a pronounced ABC of the pelvis. Since the tumor was inoperable, Denosumab was administered, leading to a significant shrinkage of the lesion, which allowed surgical intervention. Upon recurrence, Denosumab was restarted putting the patient once more into remission. Follow-up was four years overall with a clinical and radiological stable disease for fifteen months after final discontinuation of the monoclonal antibody. Therefore, our case further underlines the potential of Denosumab in the treatment of ABC.

scholarly journals Juvenile Type Granulosa Cell Tumor

2018 ◽  
Vol 19 (4) ◽  
pp. 389-392
Author(s):  
Branko Andric ◽  
Petar Arsenijevic ◽  
Nikola Jovic ◽  
Neda Arsenijevic ◽  
Zoran Protrka
Keyword(s):  
Female Patient ◽  
Granulosa Cell ◽  
Granulosa Cell Tumor ◽  
Cell Tumor ◽  
Plasma Testosterone ◽  
Histopathological Analysis ◽  
Gynecology And Obstetrics ◽  
Gynecological Examination ◽  
Clinical Center ◽  
Juvenile Type

Abstract Granulosa cell tumor is a type of neoplasm, which represents 2-5% of all ovarian cancers. About 5% of these tumors are juvenile- type and usually occur to girls before puberty and to women younger than thirty years of age. There are signs premature puberty or premature emergence of secondary sexual characteristics with irregular vaginal bleeding that occur to these kind of patients. To the rare cases, like this, the occurrence of granulosa cell tumors can cause the appearance of hyperandrogenism with high levels of plasma testosterone, leading to virilization which happened to this female patient. We will present the female patient who was 35 years old and which was originally hospitalized to the Clinic for Haematology Clinical Center Kragujevac, because of extreme fatigue accompanied by dizziness. During diagnostics the patient underwent to the complete gynecological examination. After gynecological examinations and necessary diagnostic procedures, it was decided continuing the treatment at the Clinic of Gynecology and Obstetrics Clinical Center Kragujevac, where she underwent a total abdominal hysterectomy with bilateral salpingo- oophorectomy for suspected uterine neoplasm. Histopathological analysis of the obtained material confirmed the presence of follicular cysts of both ovaries and juvenile type granulosa cell tumor on the right ovary; the uterus was enlarged with multiple fibroid tumors. Granulosa cell tumor should be suspected in the cases of girls and young females if there is present an ovarian cyst paired with signs of preterm puberty or hyperestrogenism. In this case, the presence of granulosa cell tumor was masked by signs of hyperandrogenism, which is not so typical, as well as the presence of uterine fibroids who have actually been the main cause for surgical treatment.

scholarly journals Malignant Peripheral Nerve Sheath Tumors in Africa: A Clinicopathological Study

ISRN Surgery ◽  
2011 ◽  
Vol 2011 ◽  
pp. 1-6 ◽  
Author(s):  
Peter M. Nthumba ◽  
Paul Irungu Juma
Keyword(s):  
Peripheral Nerve ◽  
Case Reports ◽  
Soft Tissue Sarcomas ◽  
Late Presentation ◽  
Sub Saharan Africa ◽  
Nerve Sheath Tumors ◽  
Peripheral Nerve Sheath Tumors ◽  
Nerve Sheath ◽  
Sub Saharan ◽  
Case Presentations

Introduction. Malignant peripheral nerve sheath tumors (MPNSTs) are rare, aggressive soft tissue sarcomas associated with poor prognosis, that most commonly affect patients aged 20 to 50 years, but have also been reported in children. There is little reported in literature on these tumors in Africa. Materials and Methods. A search of the hospital pathology database between 1992 and 2008 revealed 333 nerve sheath tumors, of which 31 were MPNSTs. Four representative case reports are presented. Discussion. MNPSTs have rarely been reported from sub-Saharan Africa; in this study, they constituted 9.3% of all nerve sheath tumors. The trunk (42%) and limbs (45%) were the most frequently affected anatomical sites. Late presentation of malignant lesions in this environment is exemplified by the four case presentations patients. Conclusions. This report confirms observations from studies on MPNSTs from other environments. Anatomically centrally located MPNSTs may have a higher incidence in sub-Saharan Africa than in the West. Because NF1-associated MPNSTs are difficult to diagnose clinically, and because surgery is the only mode of therapy that offers a complete cure, a lifetime follow-up is important, as this would enable diagnosis of early lesions amenable to surgical extirpation.

Direct Laminate Veneers with Resin Composites: Two Case Reports with Five-Year Follow-ups

2010 ◽  
Vol 11 (4) ◽  
pp. 56-62 ◽  
Author(s):  
Yusuf Ziya Bayindir ◽  
Yahya Orcun Zorba ◽  
Cagatay Barutcugil
Keyword(s):  
Case Report ◽  
Female Patient ◽  
Composite Laminate ◽  
Case Reports ◽  
Treatment Plan ◽  
Resin Composites ◽  
Enamel Hypoplasia ◽  
Anterior Teeth ◽  
Laminate Veneers

Abstract Aim The aim of this report is to present five-year follow-ups of two different applications for the use of direct laminate resin-based composite veneers to improve esthetics. Background Defects in the maxillary anterior teeth, such as enamel hypoplasia and peg lateral, can present esthetic challenges. Furthermore, a treatment plan that can be completed in a single appointment is highly desirable. This case report presents two different clinical cases involving the use of direct laminate resin-based composite veneers with five-year follow-ups. Case Report Case 1: A 17-year-old female patient was referred for treatment of her anterior teeth, which were unesthetically altered due to enamel hypoplasia and dental caries. A treatment plan was developed that included restoring the affected teeth with direct resin-based composite laminate veneers to improve the patient's appearance. The six maxillary anterior teeth were prepared for and restored with direct resinbased composite laminate veneers. At the fiveyear follow-up, the patient was satisfied with the restorations both esthetically and functionally. Case 2: A 15-year-old female patient also was referred for treatment to improve the appearance of her maxillary anterior teeth. A treatment plan was developed with two objectives: (1) to restore the undersized supernumerary crown in the area of the maxillary right lateral incisor and (2) to close the anterior diastemas. The facial surfaces were conservatively prepared and resin-based composite was applied with the aid of transparent crown forms. After completion of the treatment, the patient was recalled at six-month intervals. At the five-year follow-up appointment, the restorations were intact, no adverse effects were noted, and the resultant appearance was highly satisfactory for the patient. Summary The use of direct resin-based composite laminate veneers and adhesive bonding systems has been shown to provide an esthetic alternative to metal-ceramic or all-ceramic crowns for the rehabilitation of anterior teeth. This treatment option offers another advantage, namely a lower cost compared to an indirect technique. Other more complex and costly treatment options in the future are not ruled out. Clinical Significance In the present two cases, the initial and five-year follow-up results support the use of direct resin-based composite laminate veneers with minimal altering of healthy tooth structure. Such results should encourage clinicians to seek a cost-effective technique such as direct resin restorations to improve a patient's esthetic appearance in a single appointment. Citation Zorba YO, Bayindir YZ, Barutcugil C. Direct Laminate Veneers with Resin Composites: Two Case Reports with Five-Year Follow-ups. J Contemp Dent Pract [Internet]. 2010 July; 11(4):056-062. Available from: http://www. thejcdp.com/journal/view/volume11-issue4-zorba

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