Ovarian endometrioid adenocarcinoma in a young woman with hemorrhagic shock due to tumor disintegration: A case report

Acute abdomen secondary to ovarian carcinoma is rare, especially in a young woman. A 28-year-old obese woman underwent bilateral salpingo-oophorectomy and omentectomy as emergency surgery. The specimen from the right ovarian adenocarcinoma was fragmented because the tumor had disintegrated. The largest fragment measured 14 × 8 × 2.5 cm. The left ovary had a solid adenocarcinomatous tumor measuring 6 × 5 × 3 cm. In addition, there were disseminated lesions in the greater omentum, peritoneum, pouch of Douglas and the serosal surface of the uterus. Microscopically, the specimen was a Grade 3 poorly differentiated ovarian endometrioid adenocarcinoma with focal cyst-like structures. Several moderately dilated follicular cysts were seen in addition to the adenocarcinomas but no definite endometriosis was identified in the noncancerous areas of the bilateral ovaries. The endometrium was atrophic and there was endometriosis in the serosa of the uterus, which was resected 3 months later during a second-look operation. These observations suggest that the acute abdomen in this case was caused by disintegration and bleeding right ovarian cancer. The risk factors for ovarian endometrioid adenocarcinoma in this case might have been obesity and possibly endometriosis

Effects of CPAP therapy on the sympathovagal balance and arterial stiffness in obstructive sleep apnea

SummaryObjectiveIncreased arterial stiffness and sympathovagal imbalance are noted in patients with obstructive sleep apnea (OSA). It has been thought that continuous positive airway pressure (CPAP) therapy can have beneficial effects on the vascular function in such cases. However, it is not yet clear whether the improvement of sympathovagal balance by CPAP might be related to reduction of the arterial stiffness, independent of changes in the blood pressure.MethodsIn 50 consecutive eligible patients with OSA (apnea–hypopnea index≥20/hour) receiving CPAP therapy, the brachial-ankle pulse wave velocity (baPWV), heart rate variability (LF, HF and LF/HF ratio), baroreceptor sensitivity (BRS), plasma levels of C-reactive protein (CRP), and endothelial function as assessed by changes in the forearm blood flow before and after reactive hyperemia (END) were measured before and after 3-months' CPAP therapy.ResultsSignificant decrease of the LF/HF ratio, plasma levels of CRP, baPWV and heart rate were observed after 3 months' CPAP therapy. The change in the baPWV following 3-months' CPAP therapy was significantly correlated with the change in the LF/HF ratio and mean blood pressure (MBP), but not with that of the BRS, CRP or END after the therapy. Multivariate linear regression analysis demonstrated a significant correlation between the change in the LF/HF ratio and that in the baPWV (beta=0.305, p=0.041), independent of the changes in the MBP, plasma CRP levels and heart rate.ConclusionsImprovement of the sympathovagal balance by CPAP therapy may be significantly related to decreased stiffness of the central to middle-sized arteries, independent of the changes in the blood pressure and vascular endothelial status