Spontaneous Perforation of Pyometra Presenting as Acute Abdomen and Pneumoperitoneum Mimicking Those of Gastrointestinal Origin

Gastrointestinal (GI) perforation accounts for over 90% of acute abdomen and pneumoperitoneum. The presence of pneumoperitoneum secondary to spontaneously perforated pyometra is an interesting yet confusing finding given the absence of gastrointestinal (GI) perforation, because pyometra is more common in postmenopausal women. We report an instructive case of diffuse peritonitis caused by spontaneous perforation of pyometra. A 70-year-old postmenopausal female was admitted to surgical emergency with signs of diffuse peritonitis. After resuscitation, an emergency laparotomy was performed because of suspicion of GI perforation. At laparotomy, about 2,000 mL of purulent fluid was found to be present in peritoneal cavity, while GI tract was intact. A rent with a diameter of 5 mm was found on anterior fundus of uterus. A total abdominal hysterectomy with a bilateral salpingo-oophorectomy was performed. Despite intensive care and a course of antibiotics, the patient died of multiple organ failure resulting from sepsis on postoperative day 16. Our case illustrates the importance of clinical knowledge of acute gynecological diseases, which are not uncommonly encountered by the general surgeon. Moreover, good appreciation of pelvic anatomy and close collaboration with gynecology and GI surgery colleagues is essential as operative intervention is often required

Decreasing radioactive cesium in lodged buckwheat grain after harvest

This study assessed soil contamination with high radioactive cesium (R–Cs) concentration in buckwheat grains by lodging, and assessed the possibility of R–Cs reduction in grain through post-harvest preparation. Analysis of buckwheat grain produced in farmers’ fields and reports from farmers indicated that grain from fields that had lodging showed higher R–Cs than grain from fields with no lodging. A field experiment demonstrated that R–Cs in grain after threshing and winnowing (TW) was about six times higher in lodged plants than in nonlodged plants. In lodged plants, R–Cs in grain was decreased to about one-fourth by polishing, and was decreased to about one-seventh by ultrasonic cleaning, compared with R–Cs in grain after TW. These results demonstrate that R–Cs of buckwheat grain of lodged plants can be decreased by removing soil from the grain surface by polishing and winnowing

Transitional cell carcinoma of the ovary (Review)

Transitional cell carcinoma (TCC) of the ovary is a rare recently recognized subtype of ovarian epithelial cancer. Ovarian TCC has a modest response to chemotherapy, and metastatic TCC from the renal pelvis results in mortality. The clinical presentation is indistinguishable from other types of ovarian carcinoma. Histopathological examination remains the first tool used in the diagnosis of these heterogeneous tumors and in the separation of closely related tumors. Since it is generally accepted that surgical resection is the primary therapeutic approach, and patient outcomes following chemotherapy are better than for other types of ovarian cancers, it is a reasonable concept to detect tumors when they are still confined within the ovaries. Thus, the aim of this review was to describe typical cases of primary TCC, and to review the medical literature for information on TCC management in order to determine appropriate diagnostic methods and therapy