Urgent gynecology: a new look

2021 ◽  
Vol 50 (3) ◽  
pp. 15-18
Author(s):  
V. I. Kulakov ◽  
A. S. Gasparov ◽  
A. G. Kosachenko

To improve the diagnostics and treatment of urgent gynecological diseases 1000 patients with the pathology were examined. 700 women were subjected to laparoscopy. The following structure of acute gynecological diseases was defined: 47% ectopic pregnancy, 24% acute inflammatory diseases of adnexa uteri, 17% ovarian apoplexy, 7% torsion of ovarian cyst pedicle, 4% uterine myoma associated with the disturbances of alimentation of the ganglion, 1% perforation of the uterus. On the basis of the analysis of complains, anamnesis, clinical symptoms and results of supplementary examinations the algorithm of management of patients with suspected acute gynecological diseases including diagnostic laparoscopy was elaborated

2021 ◽  
Vol 24 (6) ◽  
pp. 377-382
Author(s):  
I. S. Schneider ◽  
N. A. Tsap

Objective. The differential diagnostics of gynecological diseases with a picture of acute abdomen and acute appendicitis may be challenging and can cause a variety of complications, impaired reproductive function and infertility.Purpose. To assess outcomes after diagnosing and treating girls with the syndrome of “acute abdomen” in whom an acute gynecological pathology was revealed.Material and methods. Case histories of 85 girls with gynecological diseases who were hospitalized to the emergency surgical department of Children City Clinical Hospital No 9 in Yekaterinburg are analyzed. All children were admitted to the emergency department with a picture of “acute abdomen”.Results. All children were operated on laparoscopically, and the cause of their acute abdominal syndrome was clarified. Acute inflammatory diseases of the uterine adnexa prevailed in the structure of causes (59%). In 21% of cases, there was uterine adnexa torsion . The rest of children had apoplexy (11%) and ovarian cysts (9%).Conclusion. The differential diagnostics of acute appendicitis and acute gynecological pathologies is difficult due to various and similar clinical symptoms. Laparoscopy can not only identify the cause of pain syndrome, but also can help to chose a future curative tactics .


2018 ◽  
Vol 46 ◽  
pp. 5
Author(s):  
Jia-San Zheng ◽  
Zheng Wang ◽  
Jia-Ren Zhang ◽  
Shuang Qiu ◽  
Ren-Yue Wei ◽  
...  

Background: Ectopic pregnancy mainly refers to tubal pregnancy and abdominal pregnancy. Tubal pregnancy presents as an implanted embryo that develops in the fallopian tubes, and is relatively common in humans. In animals, tubal pregnancy occurs primarily in primates, for example monkeys. The probability of a tubal pregnancy in non-primate animals is extremely low. Abdominal pregnancy is a type of ectopic pregnancy that occurs outside of the uterus, fallopian tube, ovary, and ligament(broad ligament, ovarian ligament, suspensory ligament).This paper describes two cases of ectopic pregnancy in cats.Cases: Cat 1. The presenting sign was a significant increase in abdominal circumference. The age and immune and sterilization status of the cat were unknown. On palpation, a 4 cm, rough, oval-shaped, hard mass was found in the posterior abdomen. Radiographic examination showed three high-density images in the posterior abdomen. The fetus was significantlycalcified and some feces was evident in the colon. The condition was preliminarily diagnosed as ectopic pregnancy. Cat 2. The owner of a 2-year-old British shorthair cat visited us because of a hard lump in the cat’s abdomen. The cat had a normal diet and was drinking normally. Routine immunization and insect repulsion had been implemented. The cat had naturally delivered five healthy kittens two months previous. Radiographs showed an oval-shaped mass with a clear edge in the middle abdominal cavity. Other examinations were normal. The case was preliminarily diagnosed as ectopic pregnancy, and the pregnancy was surgically terminated. The ectopic pregnancies were surgically terminated. During surgery, the structures of the uterus and ovary of cat 1 were found to be intact and the organs were in a normal physiological position.Cat 1 was diagnosed with primary abdominal pregnancy. In cat 2, the uterus left side was small and the fallopian tube on the same side was both enlarged and longer than normal. Immature fetuses were found in the gestational sac. Thus, cat 2 was diagnosed with tubal ectopic pregnancy based on the presenting pathology.Discussion: Cats with ectopic pregnancies generally show no obvious clinical symptoms. The ectopic fetus can remain within the body for several months or even years. Occasionally, necrotic ectopic tissues or mechanical stimulation of the ectopic fetus can lead to a systemic inflammatory response, loss of appetite, and apathy. The two cats in our reportshowed no significant clinical symptoms. To our knowledge, there have been no previous reports of the development of an ectopic fetus to maturity, within the abdominal cavity of felines, because the placenta of cats cannot support the growth and development of the fetus outside of the uterus. Secondary abdominal ectopic pregnancy, lacking any signs of uterine rupture is likely associated with the strong regenerative ability of uterine muscles. A damaged uterus or fallopian tube can quickly recover and rarely leaves scar tissue. In the present report, cat 1 showed no apparent scar tissue, nor signs of a ruptured ovary or fallopian tubes. It was diagnosed with primary ectopic abdominal pregnancy, which could arise from the descent of the fertilized egg from the fallopian tube into the abdominal cavity. There was an abnormal protrusion in left of the fallopian tubes in cat 2, to which the gestational sac was directly connected. Based on pathological examination of the uterus, fallopian tubes, and gestational sac, the cat was diagnosed with a tubal pregnancy. Placental tissues and signs of fetal calcification were observed in both the fallopian tube and gestational sac.Keywords: tubal pregnancy, abdominal pregnancy, feline, ectopic fetus, fallopian tube, gestational sac.


2004 ◽  
Vol 1 (4) ◽  
pp. 267-269
Author(s):  
Ioannis Mylonas ◽  
Eva-Maria Lochm�ller ◽  
Tanja Greulich ◽  
Bernd Gerber ◽  
Klaus Friese

2018 ◽  
Vol 55 (8) ◽  
pp. 530-537 ◽  
Author(s):  
Marielle E Van Gijn ◽  
Isabella Ceccherini ◽  
Yael Shinar ◽  
Ellen C Carbo ◽  
Mariska Slofstra ◽  
...  

BackgroundHereditary recurrent fevers (HRFs) are rare inflammatory diseases sharing similar clinical symptoms and effectively treated with anti-inflammatory biological drugs. Accurate diagnosis of HRF relies heavily on genetic testing.ObjectivesThis study aimed to obtain an experts’ consensus on the clinical significance of gene variants in four well-known HRF genes: MEFV, TNFRSF1A, NLRP3 and MVK.MethodsWe configured a MOLGENIS web platform to share and analyse pathogenicity classifications of the variants and to manage a consensus-based classification process. Four experts in HRF genetics submitted independent classifications of 858 variants. Classifications were driven to consensus by recruiting four more expert opinions and by targeting discordant classifications in five iterative rounds.ResultsConsensus classification was reached for 804/858 variants (94%). None of the unsolved variants (6%) remained with opposite classifications (eg, pathogenic vs benign). New mutational hotspots were found in all genes. We noted a lower pathogenic variant load and a higher fraction of variants with unknown or unsolved clinical significance in the MEFV gene.ConclusionApplying a consensus-driven process on the pathogenicity assessment of experts yielded rapid classification of almost all variants of four HRF genes. The high-throughput database will profoundly assist clinicians and geneticists in the diagnosis of HRFs. The configured MOLGENIS platform and consensus evolution protocol are usable for assembly of other variant pathogenicity databases. The MOLGENIS software is available for reuse at http://github.com/molgenis/molgenis; the specific HRF configuration is available at http://molgenis.org/said/. The HRF pathogenicity classifications will be published on the INFEVERS database at https://fmf.igh.cnrs.fr/ISSAID/infevers/.


2015 ◽  
Vol 38 (3) ◽  
pp. 126
Author(s):  
Min Kyoung Kim ◽  
Hyun Soo Park ◽  
Myung Hwa Lee ◽  
Sung Hee Kim ◽  
Jung Hwan Shin

2020 ◽  
Vol 2020 ◽  
pp. 1-7
Author(s):  
Amr Elmoheen ◽  
Waleed Salem ◽  
Mahmoud Eltawagny ◽  
Rehab Elmoheen ◽  
Khalid Bashir

Subsequent development and implantation of embryo outside the uterine lining are defined as an ectopic pregnancy. Ectopic pregnancies have a wide range of presentations, for example, acute hemoperitoneum to chronic ectopic pregnancy. The case presented is an unusual case of ectopic pregnancy with large hematosalpinx with classic symptoms. To the best of the authors’ knowledge, this case is the largest intact tubal ectopic pregnancy reported ever in the 14th week of gestation. A 40-year-old patient presented to the emergency department with lower abdominal pain, mild dysuria, and loose motion. The patient’s previous menstrual cycles were regular till four months ago, then started to be irregular, and she had no history of chronic diseases except repeated pelvic inflammatory diseases (PID). Clinically, the patient was hemodynamically stable. On palpation, the abdomen was tender, and cervical movements were not tender. BHCG in the blood came very high. The bedside point-of-care ultrasound (POCUS) showed free fluid in the abdomen and a sac in the left adnexa with a living fetus (visible heartbeats). The conventional ultrasound showed 14 weeks of an extrauterine gestational sac with visible early pregnancy. Differential diagnosis was either an abdominal pregnancy versus a complicated tubal pregnancy. The surgical pathology report confirmed the diagnosis of ectopic tubal pregnancy as the tube was dilated in the middle portion containing chorionic villi, decidual reaction, and the whole gestational sac consistent with the ectopic tubal pregnancy. The patient had a successful laparotomy with salpingectomy and hemostasis and did well after the operation. So, an intact ectopic tubal pregnancy may last until the 14th week of gestation.


Author(s):  
Bhanupriya .

Primary ovarian ectopic is a rare variant of ectopic pregnancies. It is commonly confused with tubal pregnancy aborted over ovary, hemorrhagic ovarian cyst, ruptured corpus luteal cyst. The women with ovarian ectopic generally presents early because of early onset hemorrhage in ovary. This is a rare case where woman with ectopic pregnancy presents at 13 weeks. The clinical picture is also highly unusual with just spotting and fainting attacks at the end of first trimester to make a diagnosis of ectopic pregnancy. The laparotomy done showed an unruptured ovarian ectopic pregnancy and with 350 cc hemoperitoneum. Salpingoopherectomy was done and the ectopic mass was removed as hardly any ovarian tissue was left to conserve the ovary. Hence, clinicians should be cautious enough to keep a differential diagnosis of ectopic even at advanced gestation.


1962 ◽  
Vol 41 (2) ◽  
pp. 185-194 ◽  
Author(s):  
Bengt Skanse ◽  
Wilfried von Studnitz

ABSTRACT The metabolic effects of prolonged administration of thyrotrophic hormone were studied in 5 euthyroid subjects and in 1 patient who had been subjected to total thyroidectomy. Thyrotrophic hormone (TSH) had no effect in the thyroidectomized patient, thus showing that the metabolic effects were mediated by stimulation of the thyroid. In the euthyroid subjects the TSH caused an increase in thyroid activity as judged by the rise in basal metabolic rate (BMR) and serum protein-bound iodine (PBI) and the clinical symptoms. The administration of TSH resulted in: elevation of the erythrocyte sedimentation rate (ESR), and in an increase of the fibrinogen, haptoglobin, coeruloplasmin and total hexose content of the serum; an increase of α1-, α2-, and β2-globulins and smaller and less consistent changes in the albumin and β1- and γ-globulins, i. e. changes of the type seen in acute infections or acute inflammatory diseases; a fall in the total serum lipids, cholesterol and phospholipids, and less consistent changes in the α- and β-lipoproteins. During continued administration of TSH all the above mentioned metabolic effects tended to level off and/or disappear, probably owing to formation of antibodies. Withdrawal of TSH was followed by a rebound phenomenon, presumably because of diminished production of thyroid hormone. From the clinical point of view the possibility of increased thyroid function being a cause of elevated ESR and of the serum proteins changes resembling those seen in acute inflammatory processes should perhaps be considered.


Endoscopy ◽  
1992 ◽  
Vol 24 (08) ◽  
pp. 671-673 ◽  
Author(s):  
H. W. Boyce ◽  
H. Henning

2021 ◽  
Vol 10 (16) ◽  
pp. 3547
Author(s):  
Michael Koch ◽  
Matti Sievert ◽  
Heinrich Iro ◽  
Konstantinos Mantsopoulos ◽  
Mirco Schapher

Background: Ultrasound is established as a diagnostic tool in salivary glands for obstructive diseases such as sialolithiasis and tumors. Concerning inflammatory diseases and in non-sialolithiasis-caused obstruction, much fewer data are available. In recent years, technical development has allowed a better assessment of the gland parenchyma, and knowledge about intraductal pathologies has increased considerably, which has provided new insights and a new interpretation of ultrasound findings. Objectives: To provide a comprehensive review of the literature that includes our own experiences and to point out the state of the art in ultrasound in the diagnostics of inflammatory and obstructive salivary gland diseases, taking adequate techniques and recent technical developments into consideration. Data sources and study eligibility criteria: A systematic literature search was performed in Pubmed using various specific key words. Results: According to the literature results, including our own experiences, ultrasound is of value in up to >90% of cases presenting with inflammatory and/or obstructive diseases. Technical developments (e.g., elastography) and the application of modified ultrasound techniques (e.g., transoral ultrasound) have contributed to these results. Today, ultrasound is considered a first-line diagnostic tool in these diseases. However, in some inflammatory diseases, the final diagnosis can be made only after inclusion of the anamnesis, clinical symptoms, serologic blood tests, or histopathologic investigation. Conclusions: Ultrasound can be considered as a first-line diagnostic tool in obstructive and inflammatory salivary gland diseases. In obstructive diseases, it may be sufficient for diagnostics in >90% of cases. In inflammatory diseases, ultrasound is at least an excellent screening method and can be used to establish the diagnosis in cases of an early suspicion. In all diseases ultrasound can contribute to better management and can be used for monitoring during follow-up.


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