Ovarian vein thrombosis presenting as acute abdomen in puerperium

Postpartum Ovarian Vein Thrombosis (POVT) is a rare, but serious condition that causes slow quadrant pain in the postpartum period. POVT must be considered in the differential diagnosis of postpartum acute abdomen. We hereby report a case on a 36-year-old Italian woman who developed an acute abdomen a week after spontaneous vaginal delivery. She had persistent fever and constipation. Diagnosis of POVT was made with an abdominal Computed Tomography (CT) and treatment with heparin and broad-spectrum antibiotics were started. After 72 hours, the patient was switched from low molecular weight heparin to oral anticoagulant treatment. After 5 months a complete recanalization was demonstrated by abdomen CT and the treatment was stopped 6 months after diagnosis. POVT is a diagnosis of exclusion in the puerperium. This case illustrated that POVT may also occur in low risk patient

Cerebral Venous Thrombosis: A Clinical Overview

Cerebral venous thrombosis (CVT) is a less common cause of stroke that is an often under recognized entity in clinical practice. The goal of this chapter will be to provide clinicians with the knowledge to succinctly recognize the various presentations of CVT, emphasizing rapid diagnosis and the potential treatments necessary to produce optimal clinical outcomes. Detailed descriptions of the relevant anatomy and associated clinical syndromes will be discussed. Detailed sections regarding CVT epidemiology, pathophysiology, etiology, diagnosis and treatment will be provided. Prognosis and long-term follow-up will also be discussed. Relevant literature will be cited and clinical trials across the spectrum of CVT will be highlighted

Can GPT-4V(ision) Serve Medical Applications? Case Studies on GPT-4V for Multimodal Medical Diagnosis

Driven by the large foundation models, the development of artificial intelligence has witnessed tremendous progress lately, leading to a surge of general interest from the public. In this study, we aim to assess the performance of OpenAI's newest model, GPT-4V(ision), specifically in the realm of multimodal medical diagnosis. Our evaluation encompasses 17 human body systems, including Central Nervous System, Head and Neck, Cardiac, Chest, Hematology, Hepatobiliary, Gastrointestinal, Urogenital, Gynecology, Obstetrics, Breast, Musculoskeletal, Spine, Vascular, Oncology, Trauma, Pediatrics, with images taken from 8 modalities used in daily clinic routine, e.g., X-ray, Computed Tomography (CT), Magnetic Resonance Imaging (MRI), Positron Emission Tomography (PET), Digital Subtraction Angiography (DSA), Mammography, Ultrasound, and Pathology. We probe the GPT-4V's ability on multiple clinical tasks with or without patent history provided, including imaging modality and anatomy recognition, disease diagnosis, report generation, disease localisation. Our observation shows that, while GPT-4V demonstrates proficiency in distinguishing between medical image modalities and anatomy, it faces significant challenges in disease diagnosis and generating comprehensive reports. These findings underscore that while large multimodal models have made significant advancements in computer vision and natural language processing, it remains far from being used to effectively support real-world medical applications and clinical decision-making. All images used in this report can be found in https://github.com/chaoyi-wu/GPT-4V_Medical_Evaluation

Case series of breast fillers and how things may go wrong: radiology point of view

INTRODUCTION: Breast augmentation is a procedure opted by women to overcome sagging breast due to breastfeeding or aging as well as small breast size. Recent years have shown the emergence of a variety of injectable materials on market as breast fillers. These injectable breast fillers have swiftly gained popularity among women, considering the minimal invasiveness of the procedure, nullifying the need for terrifying surgery. Little do they know that the procedure may pose detrimental complications, while visualization of breast parenchyma infiltrated by these fillers is also deemed substandard; posing diagnostic challenges. We present a case series of three patients with prior history of hyaluronic acid and collagen breast injections. REPORT: The first patient is a 37-year-old lady who presented to casualty with worsening shortness of breath, non-productive cough, central chest pain; associated with fever and chills for 2-weeks duration. The second patient is a 34-year-old lady who complained of cough, fever and haemoptysis; associated with shortness of breath for 1-week duration. CT in these cases revealed non thrombotic wedge-shaped peripheral air-space densities. The third patient is a 37‐year‐old female with right breast pain, swelling and redness for 2- weeks duration. Previous collagen breast injection performed 1 year ago had impeded sonographic visualization of the breast parenchyma. MRI breasts showed multiple non- enhancing round and oval shaped lesions exhibiting fat intensity. CONCLUSION: Radiologists should be familiar with the potential risks and hazards as well as limitations of imaging posed by breast fillers such that MRI is required as problem-solving tool

Characterization of alar ligament on 3.0T MRI: a cross-sectional study in IIUM Medical Centre, Kuantan

INTRODUCTION: The main purpose of the study is to compare the normal anatomy of alar ligament on MRI between male and female. The specific objectives are to assess the prevalence of alar ligament visualized on MRI, to describe its characteristics in term of its course, shape and signal homogeneity and to find differences in alar ligament signal intensity between male and female. This study also aims to determine the association between the heights of respondents with alar ligament signal intensity and dimensions. MATERIALS & METHODS: 50 healthy volunteers were studied on 3.0T MR scanner Siemens Magnetom Spectra using 2-mm proton density, T2 and fat-suppression sequences. Alar ligament is depicted in 3 planes and the visualization and variability of the ligament courses, shapes and signal intensity characteristics were determined. The alar ligament dimensions were also measured. RESULTS: Alar ligament was best depicted in coronal plane, followed by sagittal and axial planes. The orientations were laterally ascending in most of the subjects (60%), predominantly oval in shaped (54%) and 67% showed inhomogenous signal. No significant difference of alar ligament signal intensity between male and female respondents. No significant association was found between the heights of the respondents with alar ligament signal intensity and dimensions. CONCLUSION: Employing a 3.0T MR scanner, the alar ligament is best portrayed on coronal plane, followed by sagittal and axial planes. However, tremendous variability of alar ligament as depicted in our data shows that caution needs to be exercised when evaluating alar ligament, especially during circumstances of injury

Preeclampsia

Preeclampsia is a disorder of pregnancy characterized by high blood pressure, edema, and proteinuria that affects 2%–8% of pregnancies worldwide. Hypertensive disorders of pregnancy, including preeclampsia, are among the most common causes of death in pregnant persons. Over six chapters, this book examines the pathophysiology of preeclampsia, vitamin D deficiency as a risk factor for preeclampsia, the cellular changes that occur with preeclampsia, associated organ dysfunction, gestational endotheliopathy, and ophthalmic complications of preeclampsia

Women with inherited bleeding disorders and their offspring - the unresolved issues

The past few decades have seen major advances in management of gynaecological conditions and multidisciplinary obstetric care in women with inherited bleeding disorders (IBDs) and their offspring. However, there remain many unresolved issues within the field. A series of observational studies were conducted to address these issues with an overarching aim of improving patient care. A case-control study determined if there was an association between IBDs and endometriosis. Women with a surgically confirmed diagnosis of endometriosis (n = 84) and controls (n = 30) underwent investigations of haemostasis. Women with endometriosis had significantly more platelet aggregation defects to one and multiple agonists compared to controls (31% vs 4%, p = 0.005 and 15% vs 4%, p < 0.05, respectively). Reduced von willebrand factor (VWF) activity correlated with increased laparoscopic stage of endometriosis (r = -0.35, p = 0.01). A 10-year review and questionnaire study was carried out in carriers of haemophilia to determine their attitudes towards prenatal diagnosis. Sixty-one carriers of haemophilia had obstetric care in 73 pregnancies. Forty-one out of 61 women responded to the questionnaire. The uptake for invasive prenatal diagnosis of haemophilia was reduced compared to previous studies published at the Royal Free Hospital (15% versus 20% in 2008 [1], and 35% in 1997 [2]). Invasive testing to confirm the haemophilia status of the fetus was used to guide management decisions of labour and delivery. The rate of termination of pregnancy (TOP) for haemophilia was lower than in previous case series [1]. Non-invasive determination of fetal gender using free fetal DNA (ffDNA) was carried out in 58 pregnancies (79%). Fifty-nine deliveries were managed at the Royal Free Hospital over 10-years. The majority of women (66%) in this series underwent elective caesarean section (CS). The primary indication for CS was for haemophilia in 59% of deliveries. A literature review and meta-analysis assessed the incidence of cranial bleeding at birth in newborns with haemophilia. The incidence of symptomatic intracranial haemorrhage (ICH) was determined by mode of delivery (MOD). Newborns with haemophilia were 44 times (95%CI 34.7-57.1, p < 0.01) more likely to experience symptomatic ICH, and 8 times (95%CI 5.38-12.6, p < 0.01) more likely to experience extracranial haemorrhage (ECH) at birth, compared to the general population. The OR of experiencing ICH following an assisted vaginal delivery was 4.4 (95%CI 1.46-13.7, p = 0.008) compared to vaginal delivery in newborns with haemophilia. The OR of experiencing ICH following CS was 0.34 (95%CI 0.14-0.83, p = 0.018) compared to vaginal delivery. CS was associated with the lowest risk of ICH in newborns with haemophilia. A prospective MRI screening study in term newborns with severe IBDs was undertaken to determine feasibility and incidence of asymptomatic ICH. Cranial MRI within 72 hours of delivery excluded asymptomatic ICH in affected infants. No cases of ICH were reported among eight participants. One newborn experienced cephalohaematoma following an emergency CS. Two of the eight newborns experienced spontaneous ICH in early infancy. A case-control study analysed the differences in rotational thromboelastometry (ROTEM®) parameters between parturient women with FXI deficiency, and parturient and non-parturient controls. Women with FXI deficiency achieved a hypercoagulable status during the third trimester of pregnancy; however, the changes were not as pronounced as in pregnant controls. Women with prolonged clotting time and clot formation time were considered to have an increased risk of bleeding. A prospective cohort study evaluated the role of ROTEM® analysis in assessment of bleeding risk in women with FXI deficiency. Pregnancy outcomes and haemostatic cover was reviewed in 57 deliveries in women with FXI deficiency. ROTEM® enabled treatment decision and reduced the need for treatment with factor concentrate in women with severe FXI deficiency. A cohort study assessed the correlation between bleeding score, haemostatic and prothrombotic variables in women with VWD and carriers of haemophilia. The presence of a thrombotic marker (anticoagulant deficiency or prothrombotic gene mutation) altered the bleeding score for a given VWF:RCo level in women with VWD (p = 0.015). Co-inheritance of thrombophilia reduces bleeding severity in women with IBDs, and thrombotic risk must be considered in these women

Cervical weakness and preterm birth: The structure and function of the internal cervical os

The cervix is integral to the maintenance of pregnancy and timely delivery of the baby. Mechanical failure of the cervix resulting in spontaneous preterm birth presents with collapse of the internal os, yet little is known about why the cervix behaves in this way. This may in part be due to research being technically limited and/or limited to punch biopsies of the distal cervix that did not include tissue from the internal os. The aim of this thesis was to re-evaluate cervical anatomy using novel laboratory and imaging methods to gain further insight into the structure of the cervix and how this may influence function during pregnancy. To achieve this, whole cervical samples were obtained from women undergoing hysterectomy for benign pathology. Uterine tissue was subsequently fixed and analysed using 2D and 3D histological methods. Cervical anatomy was characterised using markers for smooth muscle and collagen and analysed using computer-assisted quantification methods. Sequential tissue slices were then reconstructed to produce 3D models of the proximal, middle and distal cervix. High-resolution diffusion-tensor imaging was used to determine whether complex cervical anatomy could be visualised using radiological methods. Tissue was assessed using quantitative and qualitative diffusion methods, and directly compared to immunohistochemically stained tissue. The results obtained demonstrated that diffusion-tensor imaging accurately assessed cervical anatomy and provided further detail in terms of fibre volume, density and organisation. Ex vivo endoscopic ultrasound was used to assess whether current, established medical imaging technology could discern cervical smooth muscle and collagen fibres. Although this method could be used to identify gross anatomical structures, it was not an appropriate method to identify cervical microanatomy. The results described in this thesis provide further insight into how the cervix resists intrauterine forces throughout pregnancy, and then dilates and effaces to allow for delivery of a fetus. Diffusion-tensor imaging accurately assessed cervical anatomy, which may have implications for in vivo characterisation of cervical remodelling during pregnancy and identifying those at risk of delivering early. Finally, observations in this thesis encourage continued re-examination of the cervix using high-resolution imaging to provide insight into function and to develop strategies to discern cervical insufficiency from other known causes of preterm birth