Intravenous leiomyoma with extension to the heart: a case report and review of the literature.

Introduction. Intravenous leiomyomatosis with cardiac extension is an extremely rare uterine tumor. We report here a case of intravenous leiomyoma extending to the right atrium, diagnosed in a patient having leiomyoma. Case Presentation. A 39-year-old woman with no symptoms and a past medical history of two myomectomy operations (7 and 3 years previously) was admitted to our clinic for routine control. We detected a uterine fibroid of 8 centimeters and 4 small solid masses of 1-2 centimeters near the uterus and ovaries at vaginal ultrasonography. Computed tomography (CT) was performed to investigate the abdominal cavity. It revealed a mass originating from the left common iliac vein, which invaded the inferior vena cava (IVC) and extended to the right atrium in addition to the uterine fibroids and pelvic masses. The operation was performed with a combined team of gynecologists and cardiac surgeons and a one-stage operation was accomplished. The postoperative course was uneventful. Conclusion. Abdominal CT is a useful imaging technique for the diagnosis of unusual pathology in a patient with uterine fibroid having suspicious pelvic masses. Also, when a right atrial mass is identified in a female with a prior history of hysterectomy because of leiomyoma or in whom there is a uterine myoma, then intravenous leiomyomatosis should be considered.

Is non-operative management feasible for splenic injury due to colonoscopy?

Colonoscopy is a widely used diagnostic and therapeutic procedure. While it is a relatively safe procedure, there is a risk of some complications. Splenic injury after colonoscopy is a very rare but a life-threatening complication; around 105 cases have been reported in the literature so far. Owing to the rarity of this complication, no management standards were defined. In the literature, most of the patients were managed with operative intervention and less frequently with observation. We report a case of splenic injury and massive hemoperitoneum due to colonoscopy treated non-operatively.

Iliopsoas haematoma: a rare complication of warfarin therapy.

Iliopsoas haematoma is a rare complication that occurs in patients receiving anticoagulant therapy. The clinical manifestation of iliopsoas haematoma is non-specific. It can mimic orthopaedic or neurological disorders, including paraesthesia or paresis of the thigh and leg due to compression of the nerve plexus. Among the many available diagnostic modalities, computed tomography is the most useful radiological method for diagnosis. Treatment approaches for iliopsoas haematoma include conservative therapy, surgical intervention, or transcatheter arterial embolisation. Conservative therapy consists of bed rest, restoration of circulating volume, and drug discontinuation for correcting underlying coagulopathy. Although a conservative approach is the first choice, transcatheter arterial embolisation and surgical intervention may be required in patients with hemodynamically unstable and active bleeding. The report described a case of iliopsoas haematoma due to anticoagulant therapy with paraesthesia in the left leg who was successfully treated by conservative approach.

Management of delayed presentation of a right-side traumatic diaphragmatic rupture.

BACKGROUND: Right-side diaphragmatic rupture is an unusual condition after blunt trauma. The diagnosis may be missed during the early period of trauma and may lead to progressive herniation of intraabdominal contents into the thorax. In this study, we aimed to evaluate the diagnosis and treatment options for the late diagnosis of cases of right-side traumatic diaphragmatic rupture. METHODS: We evaluated the patients with diaphragmatic hernia who were admitted to the hospital during an 8-year period. Only patients with a right-side diaphragmatic hernia and a history of high-energy trauma were included in the study. Patients with left-side diaphragmatic hernia or those who were subjected to emergency operation due to diaphragmatic rupture were excluded from the study. Patient characteristics, clinical presentations, diagnostic tools, and treatment options were evaluated. RESULTS: Eight patients (five men, three women) were enrolled in the study. The most common trauma type was a traffic accident, and the average interval between the trauma and diagnosis was 10 years. Thoracoabdominal computed tomography had high sensitivity and specificity for visualizing the diaphragmatic hernia. No predisposing factor was found to add laparotomy to thoracotomy. There was no postoperative mortality, and no late complications were observed at the assessments during the 45-month follow-up. CONCLUSIONS: Clinical presentation of late diagnosed diaphragmatic hernia, which is encountered only rarely on the right side, requires diagnostic and therapeutic approaches different from those associated with acute diaphragmatic rupture. It should not be forgotten during the differential diagnosis in patients with a history of trauma.

Lingual arch bar application for treatment of rostral mandibular body fractures in cats.

OBJECTIVE: To describe a lingual arch bar technique for fixation of rostral mandibular body fractures and report outcome in 16 cats. STUDY DESIGN: Original study. ANIMALS: Cats (n=16) with rostral mandibular body fracture (10 bilateral, 6 unilateral) just caudal to the canine teeth. METHODS: Orthodontic wire (Dentaurum® ; 0.9 mm) was used as a lingual arch bar by contouring it to the shape of the lingual side of the alveolar margin, and secured by circum-mandibular wires passed interproximal to teeth. Stability of fixation, occlusion, tolerance to the lingual arch bar, degree of secondary gingivitis/periodontitis, and ability to eat were evaluated clinically, and fracture union was assessed radiographically. RESULTS: The lingual arch bar was well tolerated. Eleven cats without a feeding tube were able to eat within 24 hours. Time to fracture union and appliance removal ranged from 28 to 64 days (mean, 42.5 days). Malocclusion of the rostral part of the fracture occurred in 5 cats; however only 1 required correction. CONCLUSIONS: Intraoral stabilization of rostral mandibular fractures using a lingual arch bar is a simple and effective method for the treatment of rostral mandibular fractures just caudal to the canine teeth.

[The effect of periosteum on the union of the autoclaved bone graft-host bone: experimental study in rabbits]. / Periost dokusunun otoklavize kemik grefti-alici kemik bütünlesmesine etkisi: Tavsanlarda deneysel çalisma.

OBJECTIVES: In this study, we investigated the effect of periosteum on the union of autoclaved segmental bone grafts harvested from rabbit radii and replanted to their beds with intramedullary fixation to host bone. MATERIALS AND METHODS: Segmental bone defects, 15 milimeters long, in the middle of the left radius were created in 16 adult rabbits. The resected bones were autoclaved 15 minutes at 120 °C and reimplanted and fixed with intramedullary Kirschner wires. The rats were divided into two groups; in the first group, eight rabbits' graft-host bone junctions were covered with periosteal flaps and in the second group, graft-host bone junctions were deperiostized. Plain X-rays were taken at 2, 4, 6 and 8 weeks after the operation. At the end of the 8(th) week radiological results were evaluated with modified Yang's radiological scoring system. RESULTS: Radiological results revealed more callus tissue and early, better healing in the first group (mean 10.94), than in the second group (mean 6.06) at 8(th) week. The difference was statistically significant (p=0.04, <0.05). CONCLUSION: Periosteal flaps are biologic tissues that can be easily performed and enhance the healing of graft-host junctions. The periosteal flap technique is effective on the healing of graft-host bone junctions and this technique is worth applying to structural allografts.

The impact of cervical dilatation on pregnancy outcomes after cerclage placement in women with a short cervical length.

OBJECTIVE: The aim of the study was to compare the outcome of pregnancies with cerclage placement in which cervical length was <15 mm and 15-25 mm. We further investigated the impact of cervical dilatation on delivery at <34 weeks. MATERIAL AND METHODS: Women with singleton gestations with cerclage placement due to cervical insufficiency were enrolled into the study. The data were collected prospectively between September 2004 and February 2009. We divided patients into two categories: (group I) cervical length below 15 mm, (group II) cervical length between 15-25 mm. We compared the pregnancy outcomes of the two groups and also analyzed the independent impact of cervical dilatation on delivery <34 weeks. RESULTS: The cervical cerclage group <15 mm had a similar incidence of preterm delivery <34 weeks gestation to the cerclage group 15-25 mm (p=0.4). No significant difference in rate of neonatal survival (p=0.6) was found between the two groups. Increased cervical dilatation in centimeters was found to be a significant predictor of delivery before 34 weeks gestation (OR: 3.4, 95% CI: 1.3-8.5, p=0.009). CONCLUSIONS: The extent of cervical shortening did not have a significant independent effect on the perinatal outcome of patients with cerclage placement. However, the presence of cervical dilatation prior to cerclage placement in cases of cervical insufficiency may worsen perinatal outcomes by increasing the rate of delivery before 34 weeks.

Impact of aromatase inhibitors on adhesion formation in a rat model.

OBJECTIVE: To investigate the antiadhesion potential of tamoxifen and anastrozole in a rat uterine horn model. DESIGN: Experimental animal study. SETTING: University animal laboratory. ANIMAL(S): Forty-five female Wistar albino rats. INTERVENTION(S): We examined the effects of tamoxifen and anastrozole to reduce the extent and severity of postoperative adhesions in a rat uterine horn model: the control group received no therapy while the second and third groups received 500 mug/day tamoxifen and 0.2 mg/kg/day anastrazole, respectively, through an enteric tube, starting 5 days before surgery. These protocols were continued for 14 days after the surgery until the rats were killed. MAIN OUTCOME MEASURE(S): Adhesions were scored according to their extent and severity, and specimens were also evaluated and scored histologically according to the following features: inflammation, fibroblastic activities, foreign body reaction, collagen formation, and vascular proliferation. RESULT(S): Anastrozole had the lowest mean adhesion scores, and these scores were significantly different from those of the controls. However, there were no statistically significant differences between control and tamoxifen groups and between tamoxifen and anastrozole groups. Histologic scores were lowest in the anastrozole group, which were statistically different from those of the tamoxifen and anastrozole groups, whereas scores of the control group were not statistically different from those of the tamoxifen group. CONCLUSION(S): Anastrazole decreased postsurgical adhesion scores by both visual scores and histologic analyses in a rat model. Further experimental and clinical trials are required to confirm these results.

Prenatal diagnosis of multiple pterygium syndrome associated with Klinefelter syndrome.

A nonlethal form of multiple pterygium syndrome (MPS) was diagnosed prenatally at 16 weeks of gestation with associated Klinefelter syndrome in the same fetus. The ultrasound findings were cystic hygroma, hypertelorism, micrognathia, low-set ears, flexion contractures of upper and lower extremities and rocker-bottom foot. Genetic amniocentesis revealed a 47,XXY karyotype. After genetic counseling, the parents decided to have a therapeutic abortion. We presented this case for the purpose of further describing the early ultrasound findings and clinical features of multiple pterygium syndromes. Also, what makes our patient unique is the coincidental presence of Klinefelter syndrome with MPS. To our knowledge, this is the first case in the literature in which a 47,XXY karyotype has been found in a fetus with multiple pterygium syndrome. The importance of delineating the exact subtype of MPS and making a precise differential diagnosis becomes critical during the process of evaluation of patients with MPS.