1/9. Ovarian hyperstimulation caused by gonadotroph adenoma secreting follicle-stimulating hormone in 28-year-old woman.Ovarian hyperstimulation caused by a gonadotroph adenoma in premenopausal women has been described only twice before this report. A 28-yr-old woman presented with menstrual disturbances and pelvic pains that began after stopping the use of contraceptive pills. Transvaginal ultrasound revealed enlarged ovaries with multiple cysts. The patient had elevated serum estradiol (up to 2900 pmol/L; normal, 80-300 pmol/L in the follicular phase) and inhibin (6.4 kU/L; normal, 0.5-2.5 kU/L) levels. serum LH was appropriately suppressed (0.6 IU/L), but serum FSH varied from 4.9-8.1 IU/L. Both gonadotropins as well as the free alpha-subunit showed a paradoxical response to the stimulus by TRH. A nuclear magnetic resonance study unraveled a pituitary tumor, 12-14 mm in diameter, extending up to the suprasellar cistern. After pituitary surgery, all hormone values normalized, and the patient resumed regular ovulatory cycles. In immunostaining, 20-30% of the cells of the tumor stained positively for FSHbeta. We conclude that a gonadotropin-producing adenoma must be considered in the differential diagnosis of a patient presenting with large multicystic ovaries and high estradiol levels in the absence of exogenous gonadotropins.- - - - - - - - - - ranking = 1keywords = pain (Clic here for more details about this article) |
2/9. Use of gonadotropin-releasing hormone analog with tibolone to prevent cyclic attacks of acute intermittent porphyria.A 25-year-old woman with a 10-year history of recurrent attacks of acute abdominal pain just before menstrual periods had acute intermittent porphyria (AIP) diagnosed when she was 23.5 years old. Many acute attacks required hospitalization. Suppression of the menstrual cycle with a gonadotropin-releasing hormone analog (GnRHa; triptorelin) and tibolone administration as add-back therapy resulted in absence of acute porphyric attacks. The patient had no acute attacks over a 1-year follow-up period. This case suggests that long-term GnRHa therapy with tibolone add-back may be a therapeutic option for patients with AIP.- - - - - - - - - - ranking = 25.894736958986keywords = abdominal pain, pain (Clic here for more details about this article) |
3/9. Intramural pregnancy: a report of 2 cases.BACKGROUND: Intramural pregnancy is a rare type of ectopic pregnancy and may be easily misdiagnosed as cornual pregnancy or trophoblastic tumor. hysterectomy is performed due to extensive bleeding and uterine rupture in most cases. The incidence is <1% of ectopic pregnancy. Eighteen cases were reported in the People's Republic of china and 33 in the rest of the world since 1957. For a young woman who wishes to maintain her fertility, it is important to make an early diagnosis and to undertake conservative treatment. CASES: A 29-year-old woman, gravida 3, para 1, was admitted because of missed periods for >70 days, 1 week of mild vaginal bleeding and lower abdominal pain. Her serum beta-human chorionic gonadotropin (beta-hCG) level was 765 U/L. Transvaginal sonography (TVS) revealed an ill-defined mass measuring 3.0 x 3.5 x 2.0 cm within the fundal myometrium adjacent to the covering. At laparotomy, a mass 3 cm in diameter bulged from the left fundal covering and was resected to the surface of myometrium. The patient preserved her fertility through successful repair of the uterus. A 39-year-old woman, gravida 4, para 1, was admitted because of irregular vaginal bleeding for 2 months after intrauterine device insertion. Her serum beta-hCG level was 228 U/L. TVS revealed amorphous echoes in the uterine cavity. We made an initial, presumptive diagnosis of incomplete abortion. curettage was performed, but no fetal elements were found. The serum beta-hCG level was 360 U/L after 1 week. Computed tomography revealed a trophoblastic tumor with deep invasion of the myometrium. A subradical abdominal hysterectomy was performed and gave the impression of chorionic carcinoma. Pathologic examination revealed diffuse hemorrhage and early invasion of chorionic villi in the fundal myometrium with focal decidual reaction of the endometrium. The diagnosis of intramural pregnancy was made after the operation. CONCLUSION: Both cases of intramural pregnancy were treated successfully.- - - - - - - - - - ranking = 25.894736958986keywords = abdominal pain, pain (Clic here for more details about this article) |
4/9. Regular abdominal pain and fever in each menstruation onset: an unusual menses-associated familial Mediterrenean fever attacks and a favor result on colchicine treatment.We present a 38-year-old woman suffering from regular abdominal pain and fever only in each menstruation onset for 7 years. The clinical symptoms, along with inflammatory findings during painful attacks, the beneficial effect of colchicine and genetic mutation (M694 V and M680I) supported the diagnosis of familial mediterranean fever (FMF). A literature review indicated that FMF attacks occurring only during menstruation are rarely seen. This clinical picture may be confused with gynecological disorders especially in the people of Mediterranean origin.- - - - - - - - - - ranking = 130.47368479493keywords = abdominal pain, pain (Clic here for more details about this article) |
5/9. Macroprolactinemia in childhood and adolescence: a cause of hyperprolactinemia.Human prolactin consists of multiple forms of different sizes including three major prolactin (PRL) species, termed as little, big, and big-big PRL. If serum contains big-big PRL, it is termed macroprolactinemia; no symptoms of hyperprolactinemia develop due to low biological activity of big-big PRL. There are still few data regarding macroprolactinemia in children and adolescents. In this paper we describe six patients with macroprolactinemia, one of whom was asymptomatic and the other five either had headache, menstrual disturbance, short stature, increased hair growth or early puberty, compatible with high PRL levels. Two of the cases had microadenoma. Initial mean /- SD PRL levels of the patients were 75.2 /- 22.8 ng/ml (range: 42.3-105.2 ng/ml). Macroprolactin analysis revealed big-big PRL levels of the patients ranging between 21.6-98.6 ng/ml. It was noteworthy that bromocriptine (BRC) therapy started in three patients caused an abrupt decrease in PRL levels. It may be concluded that macroprolactinemia should be taken into account in the differential diagnosis of hyperprolactinemia in childhood and adolescence, whether or not they have relevant clinical symptoms.- - - - - - - - - - ranking = 5.784810643115keywords = headache (Clic here for more details about this article) |
6/9. Recurrent hemoperitoneum in women receiving continuous ambulatory peritoneal dialysis.Of 27 women in the reproductive age group receiving continuous ambulatory peritoneal dialysis for more than 3 months, 4 of 7 who menstruated developed recurrent hemoperitoneum. Tubal ligation had been done in 3 of these 4 women. There were 37 episodes of hemoperitoneum; 22 occurred at midcycle and 15 with menstruation. One patient required repeated blood transfusion, but after oral anovulant therapy no further bleeding occurred and no transfusion was required. Two patients needed laparotomy: one for heavy intraperitoneal bleeding originating from a luteal cyst, and the other for severe lower abdominal pain from follicular and luteal cysts. Ultrasound examinations suggested the presence of small ovarian cysts in the two remaining patients. Recurrent midcycle hemoperitoneum in women on continuous ambulatory peritoneal dialysis may be triggered by ovulation and associated ovarian cyst formation. Suppression of ovulation should be considered.- - - - - - - - - - ranking = 25.894736958986keywords = abdominal pain, pain (Clic here for more details about this article) |
7/9. Massive ovarian edema. A clinicopathologic study of five cases including ultrastructural observations and review of the literature.Massive ovarian edema is a tumor-like condition occurring in young women considered to be the result of torsion of the ovary to the extent that it interferes with venous and lymphatic drainage, but is insufficient to cause necrosis. Marked enlargement of the ovary occurs, and the patient usually presents with an adnexal mass. If the torsion occurs acutely abdominal pain is prominent. If it occurs gradually, the patient may be virilized and stromal luteinization is often observed microscopically within the involved ovary. edema fluid accumulates in the stroma but the tunica albuginea and superficial cortical zone are characteristically uninvolved. In one patient, precocious puberty was the presenting finding and this regressed following excision of the mass. This unique finding suggests that the lesion can result in the production of significant quantities of estrogen, and that this is less likely to be recognized after menarche. In the case studied by electron microscopy, the principal finding was the presence of both fibroblasts and myofibroblasts in the edematous stroma. The increased number of myofibroblasts may be a response to the edema.- - - - - - - - - - ranking = 25.894736958986keywords = abdominal pain, pain (Clic here for more details about this article) |
8/9. Fibromatosis and massive edema of the ovary, possibly related entities: a report of 14 cases of fibromatosis and 11 cases of massive edema.Twenty-five cases of ovarian enlargement secondary to massive edema, to a hitherto undescribed lesion that we have designated fibromatosis, or to both processes were reviewed to explore the possibility of a relation between them. The patients ranged in age from 13 to 39 years. The 14 patients with pure or predominant fibromatosis usually presented because of menstrual abnormalities; two had evidence of androgen excess and three had abdominal pain. At laparotomy two involved ovaries were observed to have twisted on their pedicles. There was definite bilateral ovarian involvement in two cases and probable bilateral involvement in two others. The excised specimens measured up to 12 cm in diameter and typically had firm, white sectioned surfaces. Microscopic examination showed a proliferation of spindle cells usually separated by dense collagen, which surrounded normal follicular structures. Lutein cells were present in the fibromatous areas in one patient, who was masculinized, and in the adjacent ovarian stroma in another patient, who was hirsute; a proliferation of cells of sex cord type was observed in the fibromatous areas in three cases. Six of the specimens contained focal areas of edema similar in appearance to that seen in cases of massive edema. The features of the 11 cases of massive edema were, in general, similar to those of the 40 examples of this entity reported in the literature. Six of the 11 patients had menstrual abnormalities and/or evidence of androgen excess, but most of them presented because of abdominal pain. At operation an involved ovary was observed to have undergone torsion in five of the cases; bilateral ovarian enlargement due to massive edema was present in two cases. The excised specimens, which measured up to 15 cm in diameter, typically had a watery appearance on sectioning. Microscopic examination showed edematous stroma surrounding residual normal ovarian structures. Lutein cells were identified in the edematous stroma in four cases and in the adjacent ovarian stroma in three of these cases. One of these patients was masculinized and another was hirsute. Small foci of fibromatosis similar to that seen in cases of pure fibromatosis were present in eight cases. The similar age range and clinical manifestations of these two processes and the overlap in their histologic features suggest that they are closely related and may reflect differing morphologic expressions of the same underlying disorder. Some of the cases of massive edema, however, may result from the development of stromal edema in ovaries involved by hyperthecosis.- - - - - - - - - - ranking = 51.789473917973keywords = abdominal pain, pain (Clic here for more details about this article) |
9/9. Satoyoshi's syndrome in an adult: a review of the literature of adult onset cases.Satoyoshi syndrome consists of painful intermittent muscle spasms, alopecia and diarrhea. The age of onset is commonly less than 20 years of age. adult onset of this syndrome is rare. We report a 65-year-old Japanese woman with Satoyoshi's syndrome of adult onset. Satoyoshi's syndrome of adult onset shows no skeletal abnormalities, in comparison with the classical pediatric cases. The clinical features in our patient revealed the benign and long-term course of muscle spasm and alopecia. This progression differed markedly from the other patients of adult onset. Thus, the severity of Satoyoshi's syndrome is variable in adult onset cases, and this diagnosis should be considered in adults with various and unexplained muscle spasms.- - - - - - - - - - ranking = 1keywords = pain (Clic here for more details about this article) |