Recurrent Bouts of Fever and Transient Hydrosalpinx Manifested in a Female Carrying MEFV G304R Gene Variant: A Case Report.

Familial Mediterranean fever (FMF) is an inherited autoinflammatory disease characterized by recurrent bouts of fever and serositis. Mediterranean Fever (MEFV) gene mutations may cause not just FMF but various serositis including arthritis, enterocolitis, aseptic meningitis, pulmonary disease, and pericarditis. In this report, we present a 44-year-old female carrying MEFV gene variant. She was admitted to our hospital with a high fever, right back pain during inspiration, and lower-left abdominal pain. Laboratory findings showed high inflammatory response. Computed tomography (CT) indicated pleurisy of the right lobe and inflammation of the left uterine appendage. Transvaginal sonography and magnetic resonance imaging (MRI) indicated hydrosalpinx of the left oviduct. The symptoms of recurrent fever and transient serositis suggested FMF, and abdominal pain was resolved after taking colchicine. Later, it turned out that she had MEFV gene mutation (exon2 G304R heterozygous). Although she did not meet the criteria of FMF, this is the first reported MEFV variant carrier with transient hydrosalpinx. Attacks in female patients with FMF are triggered by menstruation. Moreover, FMF and associated amyloidosis may cause both male and female infertility. Although male patients with FMF may present with acute scrotum, diagnostic criteria of FMF do not include inflammation of uterine appendages. Internal medicine physicians need to cooperate with gynecologists to diagnose female patients carrying MEFV gene variants.

Effectiveness of a lower-abdominal incision in an extremely underweight patient with thin skin who underwent laparotomy during an upper abdominal surgery: A case report.

INTRODUCTION: Although laparoscopic surgery is often difficult in patients with obesity, very few studies have investigated its difficulty in extremely underweight patients. PRESENTATION OF CASE: We present the case of a 44-year-old nulliparous woman with an extremely low body weight who underwent laparoscopic adnexal surgery. She had undergone laparotomy for partial hepatectomy and was referred to our hospital 6 months later for an ovarian tumor. She weighed 25.5 kg and had a body mass index of 10.6 kg/m2. Abdominal magnetic resonance imaging revealed a relatively large rectus abdominis and a dilated bowel. An umbilical approach was considered dangerous because of the existing surgical scar. Thus, a small incision was made in the lower abdomen, and the first trocar was inserted under direct view. Laparoscopic resection of the right adnexa was performed; however, the operative time was longer than expected (96 min) because the dilated intestinal tract obstructed our view and the lower abdominal mini-incision approach with the EZ access device was used. DISCUSSION: Underweight patients are reportedly at an increased risk of subcutaneous emphysema and initial trocar puncture injuries. We avoided these by approaching through a small, lower abdominal incision. We considered the unexpectedly rapid and deep trocar entry to be dangerous and expected a hand-assisted approach to be safer. CONCLUSION: Our findings indicate that considerably difficulties are encountered during a laparoscopic surgery in extremely underweight patients with a history of laparotomy; thus, special care should be taken during such surgeries.

An electrical scalpel conization versus Shimodaira-Taniguchi conization procedure for cervical intraepithelial neoplasia.

The incidence of cervical intraepithelial neoplasia(CIN) among reproductive-aged women has increased in Japan. Cervical conization is commonly applied for local cervical treatment to preserve fertility. The Shimodaira-Taniguchi (S-T) conization procedure is widely used in Japan. S-T conization uses a high-frequency current and a triangular probe with a linear excision electrode to remove cervical tissue as a single informative specimen. However, alternative of an electrosurgical scalpel (ES) has the advantage of adjusting the surgical margin to the transformation zone in order to preserve the maximum amount of healthy cervical tissue with good hemostasis. The aim of this study is to retrospectively analyze data regarding surgical margin status, perioperative adverse events, cervical stenosis, and preterm birth between S-T and ES.Between January 2009 and December 2014, the medical records of 1166 patients who were diagnosed as CIN II, III, or stage 1a1 cervical cancer and who were treated with conization in 7 hospitals in Gunma Prefecture, Japan were enrolled for this retrospective study. The clinicopathological data was analyzed to statistically compare outcome between S-T and ES conization.There was no difference for age or post-operative follow-up period between ES and S-T treatments. However, positive surgical margins were significantly less frequent in patients who were treated with S-T than in those treated with ES, resulting in a reduced incidence of re-treatment for S-T in comparison with ES patients. In perioperative adverse events, S-T had more patients who were administered antibiotics. The incidence of preterm delivery and cervical stenosis did not differ significantly between the groups.We demonstrate here that S-T is an alternative procedure for cervical conization with a low risk of recurrence and acceptably low rate of adverse events such as cervical stenosis and preterm delivery. The results of this study can provide useful information for future management of patient with cervical intraepithelial neoplasia.