Abdominal Sarcoidosis May Mimic Peritoneal Carcinomatosis

Sarcoidosis is a multisystem inflammatory disorder of unknown etiology. It shows a great variety of clinical presentation, organ involvement, and disease progression. Lungs and lymphoid system are the most common sites involved with a frequency of 90% and 30%, respectively. Extrapulmonary involvement of sarcoidosis is reported in 30% of patients and abdomen is the most frequent site. Furthermore, peritoneal involvement is extremely rare in sarcoidosis. The case presented here described peritoneal manifestations of sarcoidosis without involvement of lungs. A 78-year-old woman possessing signs of malignancy on blood test and abdominal magnetic resonance imaging underwent laparatomy with a suspicion of ovarian malignancy. The macroscopic interpretation during surgery was peritoneal carcinomatosis. Total abdominal hysterectomy, bilateral salpingo-oophorectomy, peritoneal biopsies, total omentectomy, and appendectomy were performed. Final histopathological result revealed the diagnosis of sarcoidosis. Clinicians must keep in mind that peritoneal sarcoidosis can mimic intra-abdominal malignancies

Case Report Abdominal Sarcoidosis May Mimic Peritoneal Carcinomatosis

Sarcoidosis is a multisystem inflammatory disorder of unknown etiology. It shows a great variety of clinical presentation, organ involvement, and disease progression. Lungs and lymphoid system are the most common sites involved with a frequency of 90% and 30%, respectively. Extrapulmonary involvement of sarcoidosis is reported in 30% of patients and abdomen is the most frequent site. Furthermore, peritoneal involvement is extremely rare in sarcoidosis. The case presented here described peritoneal manifestations of sarcoidosis without involvement of lungs. A 78-year-old woman possessing signs of malignancy on blood test and abdominal magnetic resonance imaging underwent laparatomy with a suspicion of ovarian malignancy. The macroscopic interpretation during surgery was peritoneal carcinomatosis. Total abdominal hysterectomy, bilateral salpingo-oophorectomy, peritoneal biopsies, total omentectomy, and appendectomy were performed. Final histopathological result revealed the diagnosis of sarcoidosis. Clinicians must keep in mind that peritoneal sarcoidosis can mimic intra-abdominal malignancies

Obesity Does not Compromise Ovarian Reserve Markers in Infertile Women

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Intraoperative cardiac arrest during radical vulvectomy under combined spinal-epidural anesthesia: First among 2500 malignant cases in a single center

Abstract Complications which were related either to radical vulvectomy or to lymphadenectomy have mostly developed in post operative period. Here, we report an intra-operative cardiac arrest case during radical vulvectomy which is under combined spinal and epidural anesthesia. A 78 year-old female patient underwent radical vulvectomy under spinal anesthesia with a diagnosis of vulvar cancer. Intraoperative cardiac arrest developed and after immediate cardio-pulmonary ressusitation, sinus rhythm was restored. Cardiac arrest due to spinal anesthesia is a rare complication with the incidence of 0.063%. Despite, vulvar surgery is known as a relatively safe procedure for complications like cardiac arrest, maximum care should be given both before and during the operation. It can be descriced as "once in a life" experience for a surgeon and instant decisions for the management of this condition will be life saving or mortal

The role of trimetazidine in ischemia/reperfusion damage treatment in an ovary torsion model experimentally induced in rats

The aim of this experimental animal study was to investigate the histopathological and biochemical efficacy of trimetazidine (TMZ) in decreasing ovary damage in an ovary ischaemia/reperfusion (I/R) model in the rat. A total of 35 Wistar albino female rats were randomly separated into five groups, n = 7 per group: Group 1: Sham (S) was only given a laparotomy procedure. Group 2: Ischaemia (I) group with 2-hour ischaemia using a vascular sutur. Group 3: Ischaemia/Reperfusion (I/R) group with 2 hour ischaemia and 2-hour reperfusion. Group 4: Sham + 10 mg/kg orally TMZ (S + TMZ). Group 5: I/R + 10 mg/kg oral TMZ (I/R + TMZ) group with 2 hours ischaemia and 2 hours reperfusion after the administration orally 10 mg/kg oral TMZ. Two daily doses of TMZ were orally administered to Group 4 (S + TMZ) and Group 5 (I/R + TMZ) for three days. TMZ significantly decreased vascular congestion, haemorrhage, and polymorphonuclear leukocyte infiltration in group 5 compared to group 3 (p  .05). TMZ which is an antioxidant agent can efficiently prevent in I/R damage in rat ovaries but further studies are necessary in order to implement it in the clinical settings.IMPACT STATEMENT What is already known on this subject? Adnexial torsion is the most common gynecological emergency and there are no specific clinical, laboratories, or radiological findings for adnexal torsion. Unfortunatelly, the currently accepted treatment is adnexal detorsion. Cytoprotective effects of Trimetazidine (TMZ), an antianginal drug, are well-defined and it has been demonstrated to improve oxidative stress markers and limits membrane damage induced by reactive oxygen species and protects tissues from free radicals with its antioxidant effects. The aim of this study is to investigate the effects of TMZ in experimentally induced adnexal torsion in rats and to investigate possible effects in maintaining ovarian reserve to prevent I/R damage or reperfusion damage. What do the results of this study add? Our study showed that TMZ significantly decreased vascular congestion, haemorrhage, and PMNL infiltration. TMZ decreased the malondialdehyde, total oxidant status, and the oxidative stress index values, but these decreases were not statistically significant. What are the implications of these findings for clinical practice and/or further research? Although various antioxidant drugs and chemicals have been used to protect the ovaries against I/R damage, they have not been demostrated to prevent it completely. TMZ, an antioxidant efficacy agent, has been shown to prevent ovarian I/R damage by suppressing inflammation in terms of histopathological parameters. Further studies involving a greater number of experimental animals are required before using TMZ for the treatment of humans with I/R damage in the clinical setting

Factor XII (Hageman) Levels in Women with Recurrent Pregnancy Loss

Objective. To evaluate factor XII levels in women with recurrent pregnancy loss (RPL) in a tertiary referral hospital. Methods. Women who were referred to our hospital for two consecutive abortions or three abortions in between 2007 and 2013 were included in this retrospective observational study. Women were further grouped according to factor XII levels, as <60% and ≥60%. Results. Mean factor XII level was 109.1 ± 35.7% (range: 9-200). Ninety-three (7.4%) women had factor XII levels < 60%. Mean factor XII level was 44.8 ± 13.1, and levels ranged between 9 and 60 in this group. Only one woman had factor XII level < 10 %. Remaining 1164 (92.6%) women had factor XII levels ≥ 60%. Mean factor XII level was 114.3 ± 31.7, and levels ranged between 60.3 and 200 in this group, while 1015 (72.4%) women had factor XII levels within the normal range (60%-150% [100% = 30 g/mL]). Conclusion. Decreased activity of F-XII was diagnosed in 7.4% of women with RPL. We concluded factor XII deficiency that might be a rare but significant factor for RPL, and should be evaluated in women who are investigated for recurrent pregnancy loss

Influence of Maternal Toxoplasmosis on the Second-Trimester Aneuploidy Screening Test

Objective: With apoptosis being critical for the development and homeostasis of placental tissues, it is possible to hypothesize that accelerated trophoblastic apoptosis during pregnancy may result in a partial loss of trophoblastic activity or trophoblastic cell mass, and ultimately may alter the second-trimester screening test parameters. Thus, this study was conducted to investigate the influence of maternal toxoplasmosis on second-trimester aneuploidy screening tests. Study Design: This retrospective study was conducted with 552 pregnant women admitted to our University Hospital. The demographic data such as maternal age and weight; and the main parameters of second-trimester aneuploidy screening test including maternal serum alpha-fetoprotein, unconjugated estriol (uE3) and human chorionic gonadotropin were analyzed with the comparison of their Toxoplasma immunoglobulin serology results. Results: The mean age of the pregnant women was 27.6 (17.0 - 43.0) years, and the mean maternal weight was estimated at 65.0 (40.0 - 120.0) kg. The pregnant women with positive Toxoplasma IgG antibody had a higher mean maternal age than those with negative Toxoplasma IgG antibody (p< 0.0001). No significant difference for the concentrations and MoM values of second-trimester screening test parameters in women with Toxoplasma IgM and IgG antibodies was observed (p> 0.05, for all). Conclusion: Although IgG-seropositivity of toxoplasmosis may lead to an accelerated trophoblastic apoptosis during pregnancy, there is no significant influence on the second-trimester screening test results. There was no data regarding the unaffected population whom used for calculation of MoM, if the

A single centre’s experience of caesarean scar pregnancy and proposal of a management algorithm

The management of a caesarean scar pregnancy ranges from conservative medical therapy to surgical treatment. The aim of this study is to present our experience of caesarean scar ectopic pregnancies treated with different modalities and to develop a management algorithm. This retrospective clinical analysis included 21 caesarean scar pregnancies. The clinical data, ultrasonographic characteristics, b-human chorionic gonadotropin concentrations, the treatment options and complications were noted. One patient was managed expectantly, six patients were treated with D and C, seven patients were treated with systemic methotrexate, eight patients underwent a caesarean scar pregnancy removal with a laparoscopy, three patients were treated with a hysteroscopy. Three patients who recieved a methotrexate required additional treatment methods including a laparoscopy, hysteroscopy and D and C. Surgery was successful in all cases. An intra-abdominal haemorrhage from the vessels in the scar area occured in the patient managed expectantly, and a laparatomy and removal was performed. A systemic methotrexate, dilatation and curettage, hysteroscopic resection and laparoscopic resection are feasible methods for scar pregnancy treatment depending on the gestational age, β-hCG level, the type of scar pregnancy and the clinical status of the patient.IMPACT STATEMENT What is already known on this subject? CSP has increased gradually parallel to the increased rates of CS worldwide. There is no treatment consensus on that rare entity. What do the results of this study add? We aimed to present our cases and to discuss a proposal algorithm with further studies. What are the implications of these findings for clinical practice and/or further research? Our cases and proposal algorithm could help to determine the treatment options for CSP