Sarcoidosis Presenting as an Intraperitoneal Mass

Background: Sarcoidosis is an idiopathic, inflammatory condition primarily encountered within the lungs but very rarely identified in the peritoneum. Case Study: A 34-year-old woman presented with pleural effusion, ascites and an adnexal mass, indicative of ovarian cancer. Results: A biopsy revealed granulomas and lymphocytic infiltrate, consistent with sarcoidosis. The patient’s symptoms were resolved with corticosteroids. However, 2 years later, she developed another pelvic mass and underwent a diagnostic laparoscopy. Final pathology revealed granulomas and endometriosis, consistent with sarcoidosis. Conclusion: Since intraperitoneal sarcoidosis is extremely rare, the differential diagnosis is unlikely to include this condition in the context of presumptive ovarian cancer. However, in patients with a history of sarcoidosis, physicians should maintain a high index of suspicion to effectuate early detection and provide appropriate treatment

A Rare Case of Idiopathic Pyometra in a Premenopausal Patient.

Pyometra is a very uncommon disease principally occurring in postmenopausal women. It is characterized by the accumulation of purulent material within the uterine cavity. This paper presents the clinical history of a 35-year-old premenopausal woman with otherwise normal menstruation who developed heavy menstruation and was diagnosed with a benign pyometra of indeterminate etiology in March 2017. The patient underwent repeated ultrasound-guided drainage, dilation and curettage, and antibiotic therapy. Biopsies of the pelvic sidewall revealed endometriosis in June 2017. The heavy menstruation and suppurative fluid in the uterus of the patient persisted in which intramuscular leuprolide acetate was prescribed to address the endometriosis and heavy menstrual bleeding. Ultimately, the leuprolide acetate effectively resolved the patient\u27s bleeding and pyometra. The medication was concluded after 12 months of supervision and the patient is currently symptom free. Pyometra is an unusual condition rarely identified in premenopausal women. Drainage and antibiotic therapy are routinely employed; however, one may consider gonadotropin-releasing hormone agonist medication to potentially confer a beneficial patient outcome in rare cases where endometriosis and bleeding are intractable

Extraordinarily Prolonged Disease Recurrence in a Granulosa Cell Tumor Patient

Background: Granulosa cell tumors are rare sex cord stromal lesions that comprise approximately 3% of all ovarian neoplasms. The vast majority of granulosa cell tumors are considered indolent but in spite of aggressive management, delayed recurrence is of significant concern. Case Report: We describe a case involving a 67-year-old woman who presented with abdominal pain, bloody stools, and mild nausea. Following a CT scan of the abdomen and pelvis, a 19-cm pelvic mass was identified. Her prior medical history included a hysterectomy for uterine fibroids 40 years ago and a bilateral salpingo-oophorectomy for a presumed granulosa cell tumor 20 years ago. Final pathology revealed granulosa cell tumor with small bowel mesentery involvement. The patient underwent surgical resection and adjuvant chemotherapy; she is currently doing well. Conclusion: Granulosa cell tumors are considered to be of low malignant potential but they have the capacity to recur, even several years following initial patient management. This case exemplifies the disease’s capacity for prolonged recurrence and further accentuates the significance of long-term follow-up in these patients

Endometrial Adenocarcinoma with Concomitant Left Atrial Myxoma

Background: Atrial myxomas are the most common primary heart tumors and predominantly considered to be benign lesions. Case Study: We report a case involving a 77-year-old woman who presented with a pelvic mass. She was found to have a primary endometrial cancer and primary lung cancer with concomitant metastatic adrenal gland and mesenteric lesions. Her prior medical history also included an untreated 4.0 × 2.0-cm left atrial myxoma which was identified on CT scan during the workup of her pelvic mass. Results: A clinical decision was made to proceed with surgery for the pelvic mass with a subsequent recommendation for left atrial mass resection. Currently, the patient is scheduled to begin chemotherapy for primary lung cancer. Conclusion: The reported incidence of uterine cancer and a concurrent atrial myxoma is very rare. Consequently, the manner and timing in which treatment should be provided is imprecise. In the present case, the risk for cardiac complications was high, but given the presence of a partial bowel obstruction and the need to diagnose the primary site of her metastatic malignancy, the decision was made to proceed with exploratory abdominal surgery

Cranial and intra-axial metastasis originating from a primary ovarian Dysgerminoma.

Dysgerminomas are aggressive germ cell tumors that typically have a favorable prognosis, especially in patients diagnosed with early stage disease. We recount the history of a 23-year-old woman who was treated for a stage IA ovarian dysgerminoma in November 2017. Postoperatively, the patient was noncompliant insofar as obtaining routine lab evaluations; ten months later, she was diagnosed with a cranial metastasis that extended into the meninges. The patient subsequently underwent a posterior fossa craniotomy and adjuvant etoposide, bleomycin and cisplatin chemotherapy to which she initially responded; however, during cycle 4, she developed pancytopenia whereupon the chemotherapy was summarily discontinued. Thereafter, the patient was surveilled and currently, she remains in clinical remission. Early stage ovarian dysgerminoma, albeit rarely, has the capacity to metastasize to the cranium or brain, further underscoring the significance of employing active follow-up with these patients

Using the Autism-Spectrum Quotient to Discriminate Autism Spectrum Disorder from ADHD in Adult Patients With and Without Comorbid Substance Use Disorder

It is unknown whether the Autism-spectrum quotient (AQ) can discriminate between Autism Spectrum Disorder (ASD) and Attention Deficit and Hyperactivity Disorder (ADHD) with or without comorbid Substance Use Disorder (SUD). ANOVA’s were used to analyse the mean AQ (sub)scores of 129 adults with ASD or ADHD. We applied receiver operating characteristic (ROC) computations to assess discriminant power. All but one of the mean AQ (sub)scores were significantly higher for adults with ASD compared to those with ADHD. The SUD status in general was not significantly associated with AQ (sub)scores. On the Social Skills subscale patients with ASD and comorbid SUD showed less impairment than those without SUD. The cut-off score 26 yielded 73% correct classifications. The clinical use of the AQ in differentiating between ASD and ADHD is limited

Process management in hospitals: an empirically grounded maturity model

In order to improve transparency and stabilise health care costs, several countries have decided to reform their healthcare system on the basis of diagnosis-related groups (DRG). DRGs are not only used for classifying medical treatments, but also for case-based reimbursement, hence induce active competition among hospitals, forcing them to become more efficient and effective. In consequence, hospitals are investing considerably in process orientation and management. However, to date there is neither a consensus on what capabilities hospitals need to acquire for becoming process-oriented, nor a general agreement on the sequence of development stages they have to traverse. To this end, this study proposes an empirically grounded conceptualisation of process management capabilities and presents a staged capability maturity model algorithmically derived on the basis of empirical data from 129 acute somatic hospitals in Switzerland. The five capability maturity levels start with 'encouragement of process orientation' (level 1), 'case-by-case handling' (level 2), and 'defined processes' (level 3). Ultimately, hospitals can reach the levels 'occasional corrective action' (level 4) and 'closed loop improvement' (level 5). The empirically derived model reveals why existing, generic capability maturity models for process management are not applicable in the hospitals context: their comparatively high complexity on the one hand and their strong focus on topics like an adequate IT integration and process automation on the other make them inadequate for solving the problems felt in the hospital sector, which are primarily of cultural and structural nature. We deem the proposed capability maturity model capable to overcome these shortcomings

The Management of a patient with a fragmented intrauterine device embedded within the cervical canal.

A 28-year-old woman presented with a malpositioned intrauterine device (IUD) that was fragmented and significantly entrenched within the cervical canal and myometrium. IUD malposition with concomitant device fragmentation and embedded segments, albeit rare, should be a consideration given the device\u27s prevalence

Successful management of persistent lower extremity lymphedema with suction-assisted lipectomy

Introduction: Lower-extremity lymphedema is a significant complication attributed to gynecologic cancer surgery, potentially effectuating severe edema and discernible pain. Case report: We report on a patient who developed persistent, lower-extremity lymphedema following her treatment for cervix cancer. Despite repeated efforts to manage the lymphedema with conventional measures, the patient's condition had not markedly improved. Thereafter, she underwent a suction-assisted lipectomy that effectively resolved her symptoms. Conclusion: Since lymphedema often remains disabling and incurable following traditional therapy, suction-assisted lipectomy should be considered as an alternative when endeavoring to optimally manage this complication