Huge adenomyotic cyst in pregnancy

Adenomyotic cyst is a rare variant of adenomyosis. It is believed to arise from repeated focal haemorrhages resulting in cystic spaces filled with altered blood products. We present a rare case of a huge adenomyotic cyst in a 27-year-old primigravida, who was in her first trimester, complaining of sudden lower abdominal pain. Diagnostic laparoscopy performed to rule out other cause of acute abdomen. Her pregnancy went on smoothly. She delivered a baby girl of 2.82 kg via vaginal delivery at 39 weeks. Diagnosis and management of this rare clinical entity were reviewed and discussed

Velamentous cord insertion: a rare cause of emergency caesarean section

Pregnancies complicated with velamentous cord insertion (VCI) are at risk of adverse perinatal outcome. Placental and umbilical cord assessment should be performed during routine obstetric ultrasound. We report a case of velamentous cord insertion that was not identified antenatally. A 28-year-old primigravida at 40 weeks gestation presented in active phase of labour. Intrapartum, cardiotocography (CTG) tracing was pathological. Thus, decision was made for emergency caesarean section and a velamentous cord insertion was found. Despite a favourable outcome, this case highlighted the importance of antenatal diagnosis of VCI and thus preventing catastrophic outcome

Urethral masson’s tumour: a rare and puzzling entity

Intravascular papillary endothelial hyperplasia (IPEH) or Masson’s tumour is a benign vascular proliferation that mimics other malignant vascular tumour. To date, this is the fourth case of Masson’s tumour at urethra being reported in the literature. A 65-year-old female Para 2, presented with post-menopausal bleeding. Examination revealed a 4x3x3 cm growth surrounding the urethral meatus. She underwent examination under anaesthesia and excision of the periurethral mass. Histopathological examination confirmed Masson’s tumour. Diagnosis and management of this uncommon tumour at a rare location was discussed

Dislodged Levornogestrel-intrauterine system intra-abdominally without uterine perforation: is it possible?

We report a case of dislodged Levornogestrel-intrauterine system (LNG-IUS, Mirena®) without evidence of uterine perforation. A 37-year-old Para 4+1presented with 3 months history of lower abdominal pain. Examination and imaging showed that the device was not present in the uterine cavity. She underwent laparoscopic retrieval of Mirena®. There was no evidence of uterine perforation intra-operatively. This case illustrated the rare possibility of dislodged Mirena®intra-abdominally without evidence of uterine perforation. The management for missing IUS was reviewed

Adaptive path finding algorithm in dynamic environment for warehouse robot

Warehouse robots have been widely used by manufacturers and online retailer to automate good delivery process. One of the fundamental components when designing a warehouse robot is path finding algorithm. In the past, many path finding algorithms had been proposed to identify the optimal path and improve the efficiency in different conditions. For example, A* path finding algorithm is developed to obtain the shortest path, while D* obtains a complete coverage path from source to destination. Although these algorithms improved the efficiency in path finding, dynamic obstacle that may exist in warehouse environment was not considered. This paper presents AD* algorithm, a path finding algorithm that works in dynamic environment for warehouse robot. AD* algorithm is able to detect not only static obstacle but also dynamic obstacles while operating in warehouse environment. In dynamic obstacle path prediction, image of the warehouse environment is processed to identify and track obstacles in the path. The image is pre-processed using perspective transformation, dilation and erosion. Once obstacle has been identified using background subtraction, the server will track and predict future path of the dynamic object to avoid the obstacle

Intracystic haemorrhage in a non-endometriotic Mullerian vaginal cyst: an unexpected phenomenon

We report a case of rare, Mullerian vaginal cyst with intracystic haemorrhage in the absence of endometrial components. To date, this is the second case reported in the literature. A 51-year-old post-menopausal woman with history of anterior vaginal wall cyst was misdiagnosed to have cystocele. The cyst was excised and the content was old blood mixed with mucous. Histopathological examination revealed a Mullerian vaginal cyst without endometrial component. Thus, diagnosis and management of vaginal cyst was revisited and discussed

First trimester placenta accreta: a rare clinical entity and diagnostic dilemma

First trimester placenta accreta is a rare occurrence but potential life threatening and catastrophic. Most of these cases ended up with emergency hysterectomy. We report a case of incidental finding of placental accreta during evacuation of retained product of conception (ERPOC) for missed miscarriage. A 33-year-old, Gravida 4 Para 2 + 1 at 15 weeks’ gestation admitted for missed miscarriage, failed medical evacuation requiring ERPOC. There was excessive bleeding during the procedure and required hysterectomy and bilateral internal iliac artery ligation. Histopathological examination confirmed products of conception with evidence of placenta accreta. This case highlighted the diagnostic dilemma and importance of early accurate diagnosis of placental accreta prior to any surgical intervention for miscarriage

Validation of the Malay version of the p-QOL questionnaire

Introduction This study aimed to translate and validate the P-QOL questionnaire in the Malay language. Methods The P-QOL questionnaire was translated into the Malay language and subsequently back-translated to English. Testretest reliability and internal consistency were tested. All patients who visited the gynecology outpatient clinic of UKMMC, UMMC and IIUM between January 2016 and May 2017 completed the P-QOL questionnaires and were assessed for POP-Q staging. Results One hundred twenty patients with symptomatic pelvic organ prolapse and 180 asymptomatic patients were included. The Cronbach’s alpha for each domain was > 0.70, which confirmed that there was a highly acceptable internal consistency. The value varied between 0.88 (role limitation) and 0.912 (sleep/energy). Test-retest reliability showed a significant correlation between the total scores for each domain (p < 0.001). There was a significant correlation between P-QOL domain scores and vaginal examination findings (POP-Q). With a higher POP-Q stage, a higher impact on the quality of life was detected in symptomatic patients. The total scores from all domains were significantly higher in symptomatic patients. Conclusion The Malay translated version of the P-QOL questionnaire is a reliable, consistent, and valid instrument for assessing the severity of the symptoms and impact on the quality of life among women with uterovaginal prolapse. It is easily understood, administered, and self-completed by patient

Case control study of anxiety and depression among patients with miscarriage compared to those with successful pregnancy

Miscarriage is one of the most common complications in pregnancy. There is emerging evidence that psychological impact following miscarriage is not unusual. Understanding the magnitude of psychological morbidity is important in the management of miscarriage. The main objective of this study was to compare the mean Hospital Anxiety and Depression Scale (HADS) score between women with miscarriage and women with successful pregnancy and to determine the socio-demographic factor and clinical characteristic that are associated with anxiety and depression. A descriptive case control study was conducted in a teaching hospital, over a period of 12-months (from October 2014 till September 2015). A total of 65 women were recruited with 32 women as the study group (miscarriage) and another 33 women as the control group (women with successful pregnancy). Mean HADS-anxiety score was higher in the study group compared to control group although it was not statistically significant (6.53 ± 3.427 vs 5.73 ± 2.875, p=0.309). Mean HADS-depression score was higher in the control group (4.34 ± 2.695 vs 4.45 ± 3.073, p=0.878). Women with maternal age more than 35 years and history of previous miscarriage had a higher tendency of anxiety and depression with higher mean HADS score. There was no association between other socio-demographic data and clinical characteristic with risk of anxiety and depression. As conclusion, there was no significant difference in women with miscarriage as compared to those with successful pregnancies, although older women with history of miscarriage had a preponderance to both disorders