Vaginal Misoprostol for Cervical Priming before Operative Hysteroscopy in Misurata Hospital, Libya

Background: Operative hysteroscopy has gained popularity as a minimally invasive approach in the management of intrauterine abnormalities. Cervical dilatation represents a real challenge during the procedure. Misoprostol, a synthetic prostaglandin E1 analogue has a cervical ripening effect in both pregnant and non-pregnant patients.Objectives: To investigate vaginal misoprostol in facilitating cervical dilatation prior to operative hysteroscopy.Material and Methods: This was an open controlled clinical trial conducted at Misurata, Libya. Patients were randomized into two groups of (60 each): misoprostol group received 400 μg misoprostol (cytotec), self-administered vaginally 3-4 hrs prior to the operation (hysteroscopy) and control group received no treatment.Results: The two groups were well matched in their age, parity, presentations and indications of the procedure. Compared with the controls, significantly more cervical dilatation was achieved in significantly shorter time in misoprostol group. Likewise the duration of the operative hysteroscopy was also significantly shorter in the misoprostol group. Significantly fewer patients in misoprostol group had cervical lacerations, creation of false passage during cervical dilatation and uterine perforations.Conclusion: In summary, the study showed that vaginal misoprostol administered 3-4 hour before operative hysteroscopy reduce the need for cervical dilatation and facilitate hysteroscopic surgery.Keywords: Misoprostol, cervical priming, hysteroscopy, Libya

Rare recurrence of a rare ovarian stromal tumor with luteinized cells: a case report

<p>Abstract</p> <p>Introduction</p> <p>Sex cord-stromal tumors of the ovary are uncommon. They behave unpredictably and often have a late recurrence, making counseling, management, and prediction of prognosis challenging.</p> <p>Case presentation</p> <p>A 52-year-old Moroccan woman with an sex cord-stromal tumors underwent a bilateral oophorectomy. The histology was unusual but was likely to be a luteinized thecoma with suspicious features for invasion. Seven years later, after a gastrointestinal bleed, a metastasis within the small bowel mucosa was detected. This represents probable isolated hematogenous or lymphatic spread, which is highly unusual, especially in the absence of concurrent peritoneal disease.</p> <p>Conclusions</p> <p>To the best of our knowledge, this is the second reported case of an sex cord-stromal tumors recurring in small bowel mucosa and mimicking a primary colorectal tumor. This highlights the diverse nature and behavior of these tumors.</p

Metastatic collecting duct carcinoma of the kidney treated with sunitinib

Collecting duct carcinoma (CDC) of the kidney is a rare and aggressive malignant tumor arising from the distal collecting tubules which has been shown to have a poor response to several kinds of systemic therapy. We present a case of metastatic CDC that responded favorably to a multiple tyrosine kinase inhibitor, sunitinib, achieving a partial response in both lung and skeletal metastases. To our knowledge, this is the first report showing therapeutic activity of sunitinib against CDC. Considering these findings, it would be worthwhile prospectively investigating the role of multiple tyrosine kinase inhibitors, particularly sunitinib, in the management of metastatic CDC

A systematic review of non-antibiotic measures for the prevention of urinary tract infections in pregnancy

Background: Urinary tract infections (UTIs) are common in pregnancy and account for the highest proportion of primary care antibiotic prescriptions issued to pregnant women in the UK. It is well known that antibiotic use is associated with increased antimicrobial resistance and therefore measures to minimise antibiotic use for UTI prevention have been studied. The efficacy and safety of these measures in pregnancy have not been addressed and therefore the aim of this study was to systematically review the literature to identify and evaluate potential measures to prevent UTIs in pregnant women. Methods: Ten databases (EMBASE, AMED, BNI, CINAHL, Medline, PubMed, PsycINFO, Cochrane Trials, Scopus and Science Direct) were systematically searched in July 2017 for studies reporting non-antibiotic measures to prevent UTIs in pregnancy. The terms (“urinary tract infection”or UTI or bacteriuria or cystitis) AND (prevention) AND (pregnan*) were used. The quality of the publications was appraised using the Critical Appraisal Skills Programme (CASP) checklists for cohort study, case-control study and randomised controlled trial. The results were synthesised using a textual narrative approach. Results: Search results yielded 3276 publications and after reviewing titles and removing duplicates, 57 full text articles were assessed for eligibility and eight were included in the review. Five different approaches (hygiene measures, cranberry juice, immunisation, ascorbic acid and Canephron® N) have been identified, all of which are reported to be safe in pregnancy. Conclusion: The quality of the evidence varied considerably and only hygiene measures were supported by evidence to be recommended in practice. Future work needs to concentrate on strengthening the evidence base through improved design and reporting of studies with a focus on immunisation, ascorbic acid and Canephron® N

Value of hysteroscopy in management of unexplained infertility

Objective: To assess the value of hysteroscopy in unexplained infertility. Methods: 200 infertile women in whom standard infertility investigations revealed no abnormalities were included in the study between January 2009 and December 2013. All women underwent hysteroscopy for diagnosis and treatment of any uterine lesion which was previously undetected by hysterosalpingography (HSG). Treated women were followed up for one year during which pregnancy rate was determined. As all other causes that contribute to infertility (other than the subtle uterine lesions) were excluded. No other infertility treatment was performed during this period. Results: Of the 200 women studied, hysteroscopy revealed abnormalities in 65 (33%) women. Most uterine abnormalities were mild adhesions, small submucous myomas and polyps and their incidence was greater in women aged ≥ 30 years and women with secondary infertility. The overall pregnancy rate in the treated women within one year of follow up was 46%. Conclusion: As a cause of unexplained infertility, subtle uterine abnormalities are diagnosed only during hysteroscopy and they are relatively common in infertility women. Although the presence of these abnormalities is not detected by the basic investigations for infertility, their correction seems to be necessary when infertility is desired and other infertility causes are excluded

Case Report - Abcès thyroïdien à Escherichia coli: à propos d’un cas et revue de la littérature

L&#8217;abc&#232;s de la thyro&#239;de est une entit&#233; pathologique extr&#234;mement rare, repr&#233;sentant seulement 0.1% des pathologies chirurgicales de la thyro&#239;de. C&#8217;est une situation inhabituelle en raison des caract&#233;ristiques anatomiques et physiologiques de la glande qui lui donne une capacit&#233; de r&#233;sistance vis-&#224;-vis des infections. Nous rapportons un cas rare d'abc&#232;s thyro&#239;dien &#224; Escherichia .coli survenu chez une patiente de 55 ans, immunod&#233;prim&#233;e: diab&#233;tique insulinod&#233;pendante non &#233;quilibr&#233;e, hypertendue mal suivie avec insuffisance cardiaque gauche, et en insuffisance r&#233;nale chronique terminale. La patiente s&#8217;est pr&#233;sent&#233;e aux urgences avec une tum&#233;faction basi-cervicale ant&#233;rieure &#233;voluant sur 10 jours, pr&#233;dominante &#224; droite, mesurant 6 cm, sensible, inflammatoire, mobile &#224; la d&#233;glutition, avec une dyspn&#233;e mixte, sueurs et fi&#232;vre. Un scanner cervico-thoracique mettait en &#233;vidence un &#233;norme processus du lobe thyro&#239;dien droit &#224; contenu liquidien de 9cm, refoulement des voies a&#233;riennes sup&#233;rieures. Une cytoponction &#224; l'aiguille ramenait 10 ml de liquide purulent. Le drainage chirurgical a &#233;t&#233; r&#233;alis&#233; sous anesth&#233;sie locale vue le risque d&#8217;intubation difficile devant le blindage cervical en pr&#233;sence d&#8217;une trach&#233;e difficilement accessible. Une E. coli &#233;tait isol&#233;e apr&#232;s la culture du liquide de drainage. La patiente &#233;tait porteuse d&#8217;un bricker depuis l&#8217;enfance pour malformation de la vessie. Ceci sugg&#232;re une bact&#233;ri&#233;mie &#224; point de d&#233;part urinaire, avec embole septique au niveau de la glande thyro&#239;de. L&#8217;&#233;volution &#233;tait bonne sous tri-antibioth&#233;rapie, et des pansements biquotidiens, avec &#233;quilibration de son diab&#232;te et insuffisance r&#233;nale chronique. Nous rappellerons &#224; travers cette observation les moyens de d&#233;fense de la thyro&#239;de contre les infections, les diff&#233;rents facteurs pr&#233;disposant &#224; l&#8217;abc&#232;s de la thyro&#239;de, et les germes incrimin&#233;s dans chaque &#233;tiologie. Nous discuterons les diagnostics diff&#233;rentiels et nous insisterons sur les modalit&#233;s diagnostiques et de prise en charge th&#233;rapeutique de ce type de malades