A Case of Cushing’s Syndrome in Pregnancy

Cushing’s syndrome (CS) occurs rarely during pregnancy. CS can be caused by prolonged abnormal exposure to excess glucocorticoids leading to special and significant signs and symptoms. It is often difficult to diagnose pathological hypercortisolism in pregnant women since some symptoms of the disease might be due to a complicated pregnancy, including preeclampsia or gestational diabetes. In this study, we report the case of a 29-year-old female who referred to our institution with hypertension, weakness, steria, and truncal obesity. Physical examination revealed cushingoid characteristic. She was also found to be 27 weeks pregnant. CS was diagnosed on the basis of abnormal serum cortisol and adrenocorticotropin hormone (ACTH) levels, as well as radiologic findings. She eventually gave birth to a preterm infant via vaginal delivery. A right adrenal adenoma was diagnosed and was subsequently treated with surgical resection. The patient’s condition remained stable after the surgery

Molar twin pregnancy with a live coexisting triple X fetus: case report

Background: Complete molar twin pregnancy with coexisting fetus is a rare and important diagnosis in obstetrics. Preeclampsia, preterm labor and life-threatening vaginal bleeding are the serious complications of this type of pregnancy. Gestational trophoblastic neoplasia should be ruled out after termination of pregnancy. In this study we reviewed a molar twin pregnancy with a live coexisting triple x fetus which has not been reported till now. Case Presentation: Our case was a 22-year-old primigravida woman and 17-18th week of pregnancy, who referred to an University Hospital in Mashhad, Iran with complaint of vaginal bleeding On October 2016. Her first trimester ultrasonography in 13th week of gestational age, reported a live single fetus with an anterior great placenta and cystic formation regarding molar pregnancy. According to above-report, Amniocentesis was done in 15th weeks of pregnancy and its result was triple X. After severe and life-threatening vaginal bleeding, she underwent an emergent hysterotomy. A fetus with no obvious anomaly and a great hydropic and vesicular placenta delivered. Episodic crisis of her blood pressure was best controlled with anti-hypertensive drugs. In our case, chemotherapy with methotrexate was started after poor decline of βHCG titration and definite diagnosis of gestational trophoblastic neoplasia. Remission was completely achieved after four courses of chemotherapy. Conclusion: Differentiation between complete molar pregnancy with live fetus and partial mole is always challenging in obstetrics. Serious complications as preeclampsia and severe vaginal bleeding may become life-threatening. Coexisting molar pregnancy should be ruled out in a pregnancy associated with frequent and unexpectant vaginal bleeding. Amniocentesis and an expert radiologist can help to differentiate them. Following these patients is very important to reveal any trophoblastic neoplasia

The association of diameter and depth of internal jugular and subclavian veins with hand dominancy

Background: The central veins’ catheterization, required in critically ill patients, is more successful in larger veins. Some researchers hypothesized that hand preference might be associated with larger ipsi/contra central veins. Objective: To determine the diameter and depth of internal jugular and subclavian veins on both sides and its association with left- or right-handedness. Methods: This cross-sectional study, was conducted on patients referring for elective breast or thyroid check-up to Shahid Faghihi Hospital ultrasound unit, Shiraz, Iran, from September 2014 to May 2015. Inclusion criteria consisted of adult normotensive patients with American Society of Anesthesiology (ASA) class I without underlying diseases. The patients’ demographics were recorded and the diameter and depth of the internal jugular and subclavian veins were measured by ultrasound. The results of measurements were compared between patients’ hand preference by SPSS version 19, using paired-samples t-test and independent-samples t-test. Results: Of 65 patients, 86% were women and 19 were left-handed (29%) with the only significant difference between the right and left subclavian diameter in right-handed individuals (p=0.007) and no significant difference between the left and right internal jugular vein diameter and depth and subclavian vein depth between the left- and right-handed patients. The subclavian diameter of the right and left side was also not different in left-handed patients. Conclusion: The right or left central veins are not superior to each other with respect to diameter and depth in right- or left-handed patient