Asymptomatic Ovarian Mucinous Cystadenoma with a Solid Mural Leiomyoma : Case report and brief review

Mucinous neoplasms of the ovary may have associated benign or malignant mural nodules. A leiomyomatous mural nodule is a rare, benign lesion associated with mucinous tumors of the ovary. We report a case of a mural leiomyomatous nodule arising in a benign mucinous cystadenoma in a 29-year-old woman who presented with a large heterogenous abdominal mass. After pre-operative evaluation, exploratory laparotomy was performed upon suspicion of ovarian malignancy. A pathological examination confirmed the benign nature of the mural nodule. 

Use of Intracervical Foley Catheter for Induction of Labour in Cases of Previous Caesarean Section : Experience of a single tertiary centre in Oman

Objectives: This study aimed to evaluate rates of success and perinatal complications of labour induction using an intracervical Foley catheter among women with a previous Caesarean delivery at a tertiary centre in Oman. Methods: This retrospective cohort study included 68 pregnant women with a history of a previous Caesarean section who were admitted for induction via Foley catheter between January 2011 and December 2013 to the Sultan Qaboos University Hospital, Muscat, Oman. Patient data were collected from electronic and delivery ward records. Results: Most women were 25–35 years old (76.5%) and 20 women had had one previous vaginal delivery (29.4%). The most common indication for induction of labour was intrauterine growth restriction with oligohydramnios (27.9%). Most women delivered after 40 gestational weeks (48.5%) and there were no neonatal admissions or complications. The majority experienced no complications during the induction period (85.3%), although a few had vaginal bleeding (5.9%), intrapartum fever (4.4%), rupture of the membranes (2.9%) and cord prolapse shortly after insertion of the Foley catheter (1.5%). However, no cases of uterine rupture or scar dehiscence were noted. Overall, the success rate of vaginal birth after a previous Caesarean delivery was 69.1%, with the remaining patients undergoing an emergency Caesarean section (30.9%). Conclusion: The use of a Foley catheter in the induction of labour in women with a previous Caesarean delivery appears a safe option with a good success rate and few maternal and fetal complications

False-positive widal in melioidosis

Enteric fever is endemic in this part of the world, and Widal test is one of the time-honored laboratory tests that are being used for years to diagnose the disease. On the other hand, melioidosis is a newly emerging disease from this region, which is most often misdiagnosed or underdiagnosed by clinicians. It is well accepted that false-positive Widal reactions following certain non-typhoid Salmonella infections may occur commonly. Three cases of high titers of Widal test are described, where melioidosis was the actual diagnosis in every occasion and was never suspected until diagnosed microbiologically. All the patients had shown a partial response to ceftriaxone. Blood and pus cultures grew Burkholderia pseudomallei, whereas Salmonella typhi was not isolated from blood in any patient. With appropriate antibiotics, the patients showed clinical and microbiological improvement with lowering of Widal titers. These 3 cases show that high Widal titer in any patient may mislead the diagnosis of melioidosis, and further laboratory workup should always be done to rule out melioidosis, especially in cases with nonresponsiveness to treatment

Transarterial 90Yttrium Radioembolisation

none2noThe term transarteria radioembolisation includes those procedures in which intra-arterially injected radioactive microspheres are used for internal radiation purposes. This procedure aims to selectively target radiation to liver tumours and to limit the dose involving the normal liver parenchyma. The yttrium-90 microspheres delivered throught the hepatic artery are implanted into liver tumours in a ratio ranging from 3:1 to 20:1 as compared to a normal liver. A work-up, involving computed tomography scanning, contrast-enhanced magnetic resonance imaging and hepatic angiography, is essencial for assessing the appropriateness of yttrium-90 treatment for each patient. A simulation of the procedure, carried out with technetium-99 m-labelled macroaggregated albumin particles, which approximate the size of microsphere, is used to identify the shunting of microparticles to the lungs or the gastrointestinal tract, thus helping in patient selection. Excellent periprocedural care, discharge planning and follow-up are essential for assessing treatment response and ensuring thatthe short-term side effects of radioembolisation are adequately managed. The purpose of this chapter is to summarise the relevant recent results regarding technical aspect, dosimetric advanced, adverse events, safety and efficacy of radioembolisation in the treatment of hepatocellular carcinoma, intrahepatic cholangiocarcinoma and liver metastasis.noneCristina Mosconi; Rita GolfieriCristina Mosconi; Rita Golfier