Massive ascites due to abdominal pregnancy

We describe a case of an abdominal pregnancy which presented in the first trimester with rapid accumulation of blood stained ascites. The ascites resolved completely following surgical removal of a gestational sac from the peritoneal cavity. The pathophysiology of ascites in this case may be similar to that in cases of ascites in other non-malignant gynaecological conditions.     

Massive hydronephrosis associated with traumatic rupture

Twelve cases of traumatic rupture of a massive hydronephrosis are reported. The key points in the diagnosis are: injury around the loin, peritonitis, a fall of pH in the abdominal paracentesis fluid, a rise of blood urea nitrogen (BUN) and structural abnormality of the affected renal pelvis seen on ultrasonography. The treatment differed according to the disease causing the hydronephrosis before the injury. All patients were treated surgically with a satisfactory overall cure rate. Follow-up of 12 years has not revealed any significant sequelae.     

Massive hemoperitoneum from endometriosis of the fallopian tube. A case report

BACKGROUND: Endometriosis is a common gynecologic disease that usually presents with pelvic pain and infertility in the reproductive years. It can be complicated by bleeding, such as hematuria or hemoptysis; however, acute massive hemoperitoneum caused by tubal endometriosis without any concomitant disorder has not been reported previously. CASE: An unusual case of massive hemoperitoneum led to preshock as a result of bleeding from a tubal endometriosis implant in a previously healthy 29-year-old woman without previous history suggesting endometriosis. CONCLUSION: Although the most common gynecologic cause of hemoperitoneum in a reproductive-age woman is ruptured ectopic pregnancy, endometriosis should also be considered, especially after exclusion of pregnancy.     

Conservative management of post-operative peritoneal cysts associated with endometriosis

BACKGROUND: Early amniocentesis has been claimed to confer a higher risk of fetal loss than standard amniocentesis after the 15th gestational week. Our experience of early amniocentesis in single and twin gestations from 1990 - 1995 is presented with 99.3% follow-up. METHODS: Amniocentesis was performed between 11 gestational weeks + 5 days and 14 gestational weeks + 6 days. RESULTS: In 1646 pregnancies 1678 amniocenteses were performed. Thirty-two reamniocenteses were done, 17 due to amniocyte culture failure and 15 due to failure to obtain sufficient amount of amniotic fluid on the first occasion. After puncture 1.49% (25/1678) suffered a spontaneous abortion. Twenty twin pregnancies were included. One spontaneous abortion was noted in this group, as well as three cases where one fetus was normal and the other had a severe defect. Selective abortions were performed without complications. CONCLUSIONS: The difference of postprocedure fetal loss in our population between early and standard amniocentesis is 0.8%. A comparison of postprocedure losses is not appropriate when amniocenteses are performed at a different gestational age, as spontaneous loss decreases with increased gestational age. Our results compare well with the only randomized study between early and standard amniocentesis where the fetal loss after early amniocentesis is similar to that in standard amniocentesis.     

Subfertility associated with minimal to mild endometriosis. Main mechanisms

Our knowledge of the relationship between minimal to mild endometriosis and subfertility is limited. The main reason for this lack of progress is most probably that the mechanism of subfertility remains to be determined. It has been claimed that mild endometriosis causes subfertility in a variety of ways--ovulation disturbances, inhibition of ovum uptake, dysfunction of the oviducts, recurrent abortions, decrease in implantation, modified response to the immune system and endoperitoneal inflammation. Currently, minimal to mild endometriosis is associated with subfertility of unknown etiology.     

Massive lymphocytic infiltration of uterine leiomyomas associated with GnRH agonist treatment

OBJECTIVE: This study was designed to clarify how thrombopoietin (TPO) functions in and, to some extent, causes thrombocytopenia complicating liver cirrhosis and portal hypertension. METHODS: Our study population consisted of 19 cirrhotic and six noncirrhotic patients who underwent percutaneous transhepatic portography (PTP) and hepatic venography. RESULTS: The platelet counts of the cirrhotic patients were significantly lower than those of the noncirrhotic patients (8.7 +/- 4.1 vs 17.4 +/- 7 x 10(4)/microl; p < 0.01). The flow direction in the splenic vein was confirmed by PTP. Ten hepatofugal and nine hepatopetal flow directions in the splenic vein were noted among the cirrhotics. The hepatofugal group showed lower portal venous pressure (20 +/- 10 vs 32 +/- 4 cm H2O; p < 0.01) than the hepatopetal group and had a higher incidence of hepatic encephalopathy (six of 10 vs zero of nine; p < 0.01). The hepatic vein-portal difference in TPO did not differ substantially between the cirrhotics and noncirrhotics (0.12 +/- 0.04 vs 0.24 +/- 0.07 fmol/ml). Comparisons of this value among the three groups showed the TPO difference to be lowest in the hepatofugal group (hepatofugal: 0.04 +/- 0.03, hepatopetal: 0.21 +/- 0.07, noncirrhotic: 0.24 +/- 0.07; p < 0.05). CONCLUSIONS: Our findings suggest that TPO production in the cirrhotic liver is regulated by the portal blood supply to the liver. Thus, portal hemodynamics may play a critical role in the development of thrombocytopenia.     

Massive hemorrhage from a gastric neuroma associated with a kidney neoplasm

A case of a gastric neuroma and kidney cancer were reported. The first symptoms of the disease was gastric haemorrhage. Urgent endoscopy showed submucous tumor of the gastric wall. The physical examination showed a presence of a tumor of the rib, proved to be secondary deposit from kidney carcinoma which had been found on abdominal ultrasound examination. Submucous excision of the followed by left nephrectomy was performed. At present an intensive x-ray therapy of rib tumor is continued because of patient's disagreement for rib resection.     

Bronchioalveolar adenocarcinoma associated with a chylous ascites. An unusual case

A case of bronchioloalveolar carcinoma with long evolution associated to chylous is reported. The natural clinical history of the adenocarcinoma follows with an unusual dissemination as an atypical manifestation of lymphatic metastasis.     

Massive hemoptysis from a pulmonary artery aneurysm associated with an emphysematous bulla

A new method for specific reamplification of DDRT-PCR products is presented. After transient ligation of the primary DDRT-PCR fragments into a T-vector, the cDNAs of interest were reamplified by hemi-nested PCR and thermally asymmetric cycles. In contrast to the originally described protocol, this method of reamplification is specific, sensitive, reproducibly gives a high yield of DNA and allows direct sequencing of the reamplified product without purification or cloning.     

Menetrier's disease: report of a transient case associated with chylous ascites

We present a case of transient Menetrier's disease (MD) that was associated with chylous ascites. Using immunohistochemistry, we studied the expression of transforming growth factor alpha in this patient's gastric mucosa biopsy over time; a growth factor that has previously been shown to play an active role in the pathogenesis of MD. Excessive expression and altered localization of transforming growth factor alpha was observed while the patient had active disease with return to the normal pattern after resolution of the disease. This case is the first one reported of transient MD associated with chylous ascites; it lends further credible evidence to the concept that altered transforming growth factor alpha expression may play an important role in the pathogenesis of MD.     

A novel approach to the treatment of ascites associated with ovarian hyperstimulation syndrome

Ascites is a clinical manifestation of severe ovarian hyperstimulation syndrome (OHSS) which may complicate the induction of ovulation using exogenous gonadotrophins. In severe OHSS severe ascites may occur and can lead to dyspnoea, abdominal discomfort and oliguria. To relieve ascites paracentesis is performed two to three times weekly as needed. We report three cases where an indwelling peritoneal catheter was used to decrease the need for repeated paracentesis. Under ultrasound guidance a closed system Dawson-Mueller catheter with 'simp-loc' locking design was inserted to allow continuous drainage of the ascitic fluid. A total of 23 l of the ascitic fluid were drained from the first, 20 l from the second and 28 l from the third patient with significant decrease in abdominal discomfort and improvement in the urine output. No complications or adverse reactions were noted. Continuous drainage of the ascitic fluid is efficient. It quickly decreases the abdominal discomfort, improves the urine output and prevents the need for multiple abdominal paracenteses which some patients may require.     

Artificial insemination by husband in unexplained infertility compared with infertility associated with peritoneal endometriosis

There have been numerous inconclusive studies examining the differences between unexplained and peritoneal endometriosis-associated infertility. Hence, the choice of artificial reproductive technique may be difficult. This prospective study compares outcome in couples with unexplained infertility and with minimal or mild endometriosis-associated infertility, undergoing treatment with ovarian stimulation combined with artificial insemination by husband. No differences were found between the unexplained infertile and the endometriosis group as to patient characteristics, response to ovarian stimulation and semen qualities. There was a significantly higher total pregnancy rate, with more multiple gestations, in the unexplained infertile compared with the endometriosis group. The difference in outcome could reflect differences in pathogenesis and aetiology for the two groups.     

Invagination of the vermiform appendix. A report of two cases associated with endometriosis

Two cases of invagination of the Vermiform appendix associated with endometriosis are presented. Classification, incidence, etiology, symptomatology, diagnosis and treatment are discussed. The literature is reviewed in brief, and it is concluded that the possibility of invagination of the Vermiform appendix should be considered in obsure abdominal cases with recurrent right lower quadrant pain.     

Chylous ascites associated with acute pancreatitis in a patient undergoing continuous ambulatory peritoneal dialysis

We report on a case of chylous ascites associated with acute pancreatitis secondary to gallbladder stone disease, in a patient undergoing continuous ambulatory peritoneal dialysis. The initial clinical presentation was one of bacterial peritonitis, with later appearance of chylous peritoneal drainage. Diagnosis was suggested by abdominal computed tomography and confirmed by surgical exploration. We discuss the main diagnostic keys of peritoneal dialysis-associated pancreatitis and the possible etiologic role of this entity in chylous ascites of these patients.     

Massive osteolysis

Massive osteolysis is rare, peculiar, and enigmatic. The clinical, radiographic, and histologic features were reviewed in 11 cases. The patients were generally young (mean age, 20.7 years), and males outnumbered females. More than half the patients had involvement of either the femur or the ribs alone or including the vertebrae. On the basis of radiographic studies, the disease process is capable of originating either in bone or adjacent soft tissues. Histologically, the authors were unable to identify pathognomonic features. Other than excision of all involved tissue, surgical treatment was generally ineffective. Radiation therapy may be successful in eradicating the disease in selected cases.     

Intestinal endometriosis

Pelvic endometriosis affects 5 to 10% of all menstruating women, and of these 3% to 34% have intestinal involvement. Commonly, intestinal endometrial lesion affects only the serosa. Although the invading endometrial tissue may extend into the intestinal wall, it does not usually reach the mucosa. The majority of the patients are asymptomatic. The most common symptom is lower recurrent abdominal pain. It has been estimated that 0,9% of women with intestinal endometriosis have obstructive symptoms. Occasionally deeper and more extensive intestinal wall involvement results in cyclic menstrual rectal bleeding. The authors describe a case with obstructive symptoms associated to rectal bleeding. This is an uncommon finding. Histological confirmation of deep muscular and mucosal involvement was obtained. This case led us to some considerations about the diagnostic difficulties and therapeutic possibilities in the present.     

Malignant endometriosis

Presentation of two case reports of severe and multiple urinary tract involvement by endometriosis due to the low frequency of this disorder. Although this is a benign condition, the term "malignant" endometriosis has been used because of the significant consequences it may have for the urinary tract, since it may compromise both excretory systems with a likely vital risk.