Ovarian vein thrombosis mimicking acute abdomen: a case report and literature review

<p>Abstract</p> <p>Background</p> <p>Ovarian vein thrombosis (OVT) is a rare, but serious condition that affects mostly postpartum women. A high index of suspicion is required in order to diagnose this unusual cause of abdominal pain.</p> <p>Case presentation</p> <p>A 19-year-old woman at three days postpartum was admitted to our hospital because of severe right lower quandrant abdominal pain and fever 38.5'C. Physical examination revealed an acutely ill patient and right lower quadrant tenderness with positive rebound and Giordano signs. The patient underwent appendectomy which proved to be negative for acute appendicitis. Postoperatively fever and pain persisted and abdominal CT-scan with intravenous contrast agent demonstrated a thrombosed right ovarian vein. The patient was initiated on low-molecular weight heparin (LMWH) and antibiotic treatment and a month later a new abdominal CT-scan showed a patent right ovarian vein.</p> <p>Discussion</p> <p>Pathophysiologically, OVT is explained by Virchow's triad, because pregnancy is associated with a hypercoagulable state, venous stasis due to compression of the inferior vena cava by the uterus and endothelial trauma during delivery or from local inflammation. Common symptoms and signs of OVT include lower abdomen or flank pain, fever and leukocytosis usually within the first ten days after delivery. The reported incidence of OVT ranges 0,05-0,18% of pregnancies and in most cases the right ovarian vein is the one affected. Anticoagulation and antibiotics is the mainstay of treatment of OVT. Complications of OVT include sepsis, extension of the thrombus to the inferior vena cava and renal veins, and pulmonary embolism. The incidence of pulmonary embolism is reported to be 13.2% and represents the main source of mortality due to OVT.</p> <p>Conclusions</p> <p>OVT is a rare condition, usually in the postpartum period. A high index of suspicion is required for the prompt diagnosis and management especially in cases that mimic acute abdomen.</p

Successful Treatment of a Severe Case of Fournier's Gangrene Complicating a Perianal Abscess

A 67-year-old male patient with diabetes mellitus and nephritic syndrome under cortisone treatment was admitted to our hospital with fever and severe perianal pain. Upon physical examination, a perianal abscess was identified. Furthermore, the scrotum was gangrenous with extensive cellulitis of the perineum and left lower abdominal wall. Crepitations between the skin and fascia were palpable. A diagnosis of Fournier's gangrene was made. He was treated with immediate extensive surgical debridement under general anesthesia. The patient received broad-spectrum antibiotics, and repeated extensive debridements were performed until healthy granulation was present in the wound. Due to the fact that his left testicle was severely exposed, it was transpositioned into a subcutaneous pocket in the inner side of the left thigh. He was finally discharged on the 57th postoperative day. Fournier's gangrene is characterized by high mortality rates, ranging from 15% to 50% and is an acute surgical emergency. The mainstay of treatment should be open drainage and early aggressive surgical debridement of all necrotic tissue, followed by broad-spectrum antibiotics therapy

Intranodal palisaded myofibroblastoma: a case report

Intranodal palisaded myofibroblastoma is a rare benign soft tissue tumor, almost always arising from inguinal lymph nodes. It usually presents as a painless, slow-growing inguinal mass. We report herein a case of an intranodal palisaded myofibroblastoma occurring in a 36-year-old man. The salient clinicopathologic features of this unusual tumor are presented and the literature is briefly reviewed

Unilateral simultaneous renal oncocytoma and angiomyolipoma: case report

A rare case of synchronous angiomyolipoma and oncocytoma in the same kidney of a 70 year old man is presented. A left renal mass was found incidentally by ultrasound. Computerized tomography and magnetic resonance imaging revealed a 1,3 cm mass in the mid-portion of the left kidney, whereas on the lower pole of the same kidney, a 3,3 cm mass was also revealed, consistent with angiomyolipoma. A working diagnosis of renal cell carcinoma was made. A radical nephrectomy was performed. Microscopically, the tumor of the lower pole was found to be an angiomyolipoma, whereas the mid-portion tumor was an oncocytoma. Until now, only 16 cases of unilateral simultaneous presence of renal angiomyolipoma and oncocytoma have been reported. Of these cases, all except one were female and three were associated with the tuberous sclerosis complex. It is well worth remarking, that renal oncocytoma overlap with other renal neoplasms, therefore nephrectomy remains the treatment of choice

Mixed acinar-endocrine carcinoma of the pancreas: a case report and review of the literature

and review of the literatur

A rare coexistence of adrenal cavernous hemangioma with extramedullar hemopoietic tissue: a case report and brief review of the literature

<p>Abstract</p> <p>Background</p> <p>Cavernous hemangiomas of the adrenal gland are rare, benign, non-functioning neoplastic tumors. To our knowledge, 55 cases have been reported in the literature to date.</p> <p>Case presentation</p> <p>We report the first case of a large, non-functioning adrenal cavernous hemangioma that was incidentally found during the preoperative staging workup of a 75 year old woman with left breast adenocarcinoma. Imaging with US, CT scan and MRI showed a heterogeneous 8 cm mass with non-specific radiological features that was located on the left adrenal gland. The mass was surgically excised and pathology revealed an adrenal hemangioma with areas of extramedullar hemopoiesis.</p> <p>Conclusion</p> <p>Although adrenal hemangiomas are rare and their preoperative diagnosis is difficult, they should always be included in the differential diagnosis of adrenal neoplasms.</p

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Association of circulating tumour cells, markers of apoptosis’ homeostasis, and genetic heterogeneity of factors that influence apoptosis in breast cancer: clinical relevance

Purpose: The aim of this study was to prospectively examine the association of FokI polymorphism in the Vitamin D Receptor (VDR) gene, as well as PvuII polymorphism in the Estrogen Receptor (ESR) gene with histopathological features and prognosis among women with histologically proven breast cancer, and, the detection of circulating tumor cells (CTCs) with metastatic potential. Methods: Patient characteristics, tumor histopathology, detection of CTCs, and genotyping of VDR polymorphism variant (FokI) and ER polymorphism variant (PvuII) were recorded. Patients were also routinely followed up.Results: There was a significant difference regarding nodal stage (p<0.001) between the different genotypes of FokI polymorphisms (FF, Ff, ff), even though a trend was also detected in the frequency between ductal and lobular type, as well as tumor size (p=0.07). When further analysis was performed regarding patients whose polymorphism included the f allele, we found statistically significant differences in tumor size (p<0.001), nodal stage (p=0.03), tumor grade (p=0.04) and lymphovascular invasion (p<0.001), while no differences in nodal status, distant metastases and tumor stage were noticed. No significant associations were found between any of the PvuII polymorphism variants and tumor histopathology and stage. No statistical significance was proven between FokI polymorphism’s variants or f allele and overall or progression-free survival. Statistically significant associations between overall and progression-free survival and PvuII polymorphism’s variants was demonstrated (p<0.001). No statistical significance was depicted between CTCs’ detection and any of the polymorphisms’ variants.Conclusion: The f allele was associated with the presence of lymphovascular invasion and poorly differentiated tumors, whereas the PP genotype was associated with increased overall and progression-free survival, suggesting that this variant is related to a more favorable prognosis.Σκοπός: Σκοπός της παρούσας μελέτης ήταν η προοπτική ανάλυση της σχέσης μεταξύ του πολυμορφισμού FokI του γονιδίου του υποδοχέα της βιταμίνης D, καθώς και του πολυμορφισμού PvuII του γονιδίου του υποδοχέα των οιστρογόνων με τα ιστοπαθολογικά χαρακτηριστικά, την πρόγνωση, καθώς και την ανίχνευση κυκλοφορούντων καρκινικών κυττάρων (ΚΚΚΜ) με μεταστατικό δυναμικό στην συστηματική κυκλοφορία γυναικών με ιστολογικά επιβεβαιωμένο καρκίνο μαστού.Μέθοδοι: Καταγράφησαν τα δημογραφικά στοιχεία, τα ιστοπαθολογικά χαρακτηριστικά, η ανίχευση των ΚΚΚΜ, όπως και οι γονότυποι των πολυμορφισμών FokI και PvuII για κάθε ασθενή. Ακολούθησε τακτική παρακολούθηση των ασθενών.Αποτελέσματα: Παρατηρήθηκε στατιστικά σημαντική διαφορά όσον αφορά στο στάδιο των εξαιρεθέντων μασχαλιαίων λεμφαδένων (p<0.001) μεταξύ των διαφορετικών γονοτύπων του πολυμορφισμού FokI (FF, Ff, ff), παρόλο που παρουσιάστηκε και τάση θετικής συσχέτισης στην συχνότητα εμφάνισης πορογενούς- λοβιακού καρκινώματος, όπως και στο μέγεθος του όγκου (p=0.07). Σε περαιτέρω ανάλυση του δείγματος των ασθενών των οποίων ο πολυμορφισμός περιείχε το αλλήλιο f, παρατηρήθηκε στατιστικά σημαντική διαφορά στο μέγεθος του όγκου (p<0.001), στο στάδιο των μασχαλιαίων λεμφαδένων (p=0.03), τον βαθμό διαφοροποίησης του όγκου (p=0.04), καθώς και την ύπαρξη λεμφαγγειακής διήθησης (p<0.001), ενώ δεν παρατηρήθηκαν διαφορές στην ύπαρξη απομακρυσμένων μεταστάσεων και στο στάδιο νόσου. Δεν παρατηρήθηκαν στατιστικά σημαντικές διαφορές μεταξύ των γονοτύπων του πολυμορφισμού PvuII και των ιστοπαθολογικών χαρακτηριστικών του όγκου και το στάδιο νόσου. Όσον αφορά στην πρόγνωση νόσου, δεν παρατηρήθηκαν διαφορές μεταξύ των γονοτύπων του πολυμορφισμού FokI και της συνολικής επιβίωσης και του ελεύθερου νόσου διαστήματος. Αντίθετα, καταγράφησαν στατιστικά σημαντικές διαφορές στην συνολική επιβίωση και στο ελεύθερο νόσου διάστημα (p<0.001) σχετικά με τον πολυμορφισμό PvuII. Τέλος, δεν παρατηρήθηκε συσχέτιση μεταξύ της ανίχνευσης των ΚΚΚΜ και των διαφορετικών γονοτύπων των δύο πολυμορφισμών.Συμπέρασμα: Η παρουσία του αλληλίου f σχετίζεται με την παρουσία λεμφαγγειακής διήθησης και όγκων χαμηλής διαφοροποίησης, ενώ η παρουσία του γονοτύπου PP σχετίσθηκε με μεγαλύτερη συνολική επιβίωση και ελεύθερο νόσου διάστημα, δηλαδή ευνοϊκότερη πρόγνωση

Ovarian vein thrombosis mimicking acute abdomen: a case report and literature review

Background: Ovarian vein thrombosis (OVT) is a rare, but serious condition that affects mostly postpartum women. A high index of suspicion is required in order to diagnose this unusual cause of abdominal pain. Case presentation: A 19-year-old woman at three days postpartum was admitted to our hospital because of severe right lower quandrant abdominal pain and fever 38.5’C. Physical examination revealed an acutely ill patient and right lower quadrant tenderness with positive rebound and Giordano signs. The patient underwent appendectomy which proved to be negative for acute appendicitis. Postoperatively fever and pain persisted and abdominal CT-scan with intravenous contrast agent demonstrated a thrombosed right ovarian vein. The patient was initiated on low-molecular weight heparin (LMWH) and antibiotic treatment and a month later a new abdominal CT-scan showed a patent right ovarian vein. Discussion: Pathophysiologically, OVT is explained by Virchow’s triad, because pregnancy is associated with a hypercoagulable state, venous stasis due to compression of the inferior vena cava by the uterus and endothelial trauma during delivery or from local inflammation. Common symptoms and signs of OVT include lower abdomen or flank pain, fever and leukocytosis usually within the first ten days after delivery. The reported incidence of OVT ranges 0,05-0,18% of pregnancies and in most cases the right ovarian vein is the one affected. Anticoagulation and antibiotics is the mainstay of treatment of OVT. Complications of OVT include sepsis, extension of the thrombus to the inferior vena cava and renal veins, and pulmonary embolism. The incidence of pulmonary embolism is reported to be 13.2% and represents the main source of mortality due to OVT. Conclusions: OVT is a rare condition, usually in the postpartum period. A high index of suspicion is required for the prompt diagnosis and management especially in cases that mimic acute abdomen