“The Habit Doesn’t Make the Monk” Dissecting Leiomyoma: Report of Two Cases and Literature Review

We report one case of dissecting leiomyoma and one case of cotyledonoid dissecting leiomyoma. Patients were hospitalized for the management of gynecologic bleeding and abdominal pain. The preoperative assessment revealed heterogeneous, fast-growing, possibly malignant, uterine masses. Non-conservative treatment by hysterectomy was performed in both cases. Histopathology of the surgical specimens revealed intramyometrial lesions with dense cellular proliferation, without serous invasion, compatible with dissecting leiomyomas. We review here the literature and discuss the clinical, radiological and histological aspects of these entities, which can mimic malignant lesions

Rectovaginal Fistula on Migration of an Intrauterine Device: A Case Report and Literature Review

editorial reviewedIntrauterine devices (IUDs) are effective methods of contraception widely used worldwide because of their efficacy, low cost, and reversibility. Although overall well-tolerated, they may, however, cause uterine perforation, a rare but serious complication that can endanger adjacent abdominal organs. We report the case of a 50-year-old woman who consulted a gastroenterologist three years ago for the detection of blood in her feces on a screening test (Hémoccult°). Colonoscopy and abdominopelvic imaging discovered a displaced IUD embedded in the recto-sigmoidal wall. A wait-and-see approach was proposed at that time because of the absence of symptoms. Three years later, she developed abdominal and pelvic pain. On a second laparoscopic surgery procedure, we removed the IUD. Intraoperatively, a rectovaginal fistula was also discovered and sutured in different anatomical planes. Based on a comprehensive review of the literature, the management of this case is confronted with guidelines available for this rare condition

Velamentous cord insertion associated with vasa praevia.

editorial reviewedVelamentous cord insertion is a rare placental abnormality, that may be associated with vasa praevia, i.e. the presence of an umbilical vessel near the internal cervical orifice. In case of spontaneous rupture of the membranes, there is a major risk of fetal haemorrhage, which is often lethal for the unborn baby. The challenge of care is based on the prenatal diagnosis during the 2nd trimester ultrasound. In case a vasa praevia is confirmed during the 3rd trimester, elective caesarean section should be carried out prior to the onset of labour, between 34 and 36 weeks of pregnancy. Corticosteroid treatment for fetal lung maturation is recommended at 32 weeks of gestation because of the increased risk of preterm delivery. Velamentous cord insertion may be associated with other adverse pregnancy outcomes such as intrauterine growth restriction, death in utero, placental abnormalities.L’insertion vélamenteuse du cordon ombilical est une anomalie placentaire rare, pouvant être associée à un vasa praevia, c’est-à-dire la présence d’un vaisseau ombilical en regard de l’orifice interne du col utérin. En cas de rupture spontanée des membranes, le risque d’hémorragie fœtale est majeur et, le plus souvent, létal pour l’enfant à naître. Le défi de la prise en charge est le diagnostic anténatal à l’échographie du 2ème trimestre. En cas de vasa praevia confirmé lors du 3ème trimestre, une césarienne doit être programmée avant la mise en travail spontanée, aux alentours de 34-36 semaines d’aménorrhée. Une cure de maturation pulmonaire par corticostéroïdes est recommandée à 32 semaines d’aménorrhée en raison du risque accru de prématurité. L’insertion vélamenteuse du cordon peut être associée à d’autres complications périnatales telles qu’un retard de croissance intra-utérin, une mort fœtale in utero, des anomalies placentaires

Amyand’s Hernia Complicated by Acute Appendicitis, A Rare Condition: Case Report and Review of the Literature

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Grades of Below-the-Ankle Arterial Occlusive Disease following the Angiosome Perfusion: A New Morphological Assessment and Correlations with the Inframalleolar GVG Stratification in CLTI Patients.

peer reviewed[en] PURPOSE: To assess a specific classification of the foot atherosclerotic disease concerning the angiosomal source arteries, the connected foot arches and attached collaterals for Rutherford 5, CLTI patients. To compare eventual analogies of this novel grading system with previously reported GLASS/GVG inframalleolar patterns of occlusive disease (P0-P2). MATERIALS AND METHODS: A series of 336 ischemic feet (221 diabetics) were selected and retrospectively analyzed. For each angiographic pattern of inframalleolar atherosclerotic disease, 4 severity classes of targeted angiosomal artery path (TAAP), associating 4 other classes concerning linked foot arches (LFA) and collaterals occlusive disease were described. By associating the 4 TAAP with the 4 others parallel LFA and collaterals classes, 4 novel anatomical "Grades" (A-D) of occlusive disease were described. Limb salvage was studied between groups of diabetic and non-diabetic patients. RESULTS: Using a primary endovascular approach, limb preservation comparison of grade A/B proved without significance for diabetics (P = 0.032) and non-diabetics (P = 0.226). Comparison in diabetics and/or non-diabetics between A/C (P = 0.045 and 0.046), A/D (P = 0.027 and 0.030,B/C (P = 0.009 and 0.038), and B/D (P = 0.006 and P = 0.042), as well as C/D groups (P = 0.048 and P = 0.034) proved ponderous. Parallel analysis of similar grades (A/A, B/B, etc.) with, or without diabetes appeared without significance (P > 0.05). Further comparison between grades A+B (assigned as P0/GVG), versus C (P1), and D (P2), proved significant (P < 0.0001). CONCLUSION: The present grading system proposes a useful correlation between the severity of foot angiosomal arteries, arches, and collaterals disease and limb salvage, confirming the clinical significance of P0-P2 GVG severity score. This analysis also points the limits of EVT to be probably avoided in grade D patients

The Role of Hybrid Femoropopliteal Revascularization in High-risk (ASA 3-4) Patients: A Decade of Dual Center Clinical Experience

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Chemotherapy is not needed when complete evacuation of gestational choriocarcinoma leads to hCG normalisation.

peer reviewe