Acute fatty liver with pancreatitis in pregnancy after in vitro fertilization - literature review and case report.

BACKGROUND: Acute fatty liver disease in pregnancy (AFLP) is a low-incidence condition that usually affects women in the third trimester of pregnancy or the early postpartum period. This article reviews recent advances in the diagnosis and treatment of AFLP with pancreatitis in pregnancy induced by in vitro fertilization (IVF). CASE REPORT: A rare case of AFLP and pancreatitis occurred in a pregnant woman with an IVF-induced twin pregnancy delivered by cesarean section. Diagnosis of this condition is difficult, and delay in accurate diagnosis and timely and appropriate treatment can lead to serious complications such as acute pancreatitis or extensive damage to multiple organs and systems, which can have significant consequences. The main therapeutic approach was the rapid administration of drugs accompanied by therapeutic measures to support liver function and pancreatic complications. CONCLUSIONS: We would like to reemphasize the importance of multidisciplinary management and rapid intervention in AFLP with acute pancreatitis after IVF.

Ovarian reserve after treatment of ovarian endometriomas by ethanolic sclerotherapy compared to surgical treatment.

OBJECTIVE: To preserve ovarian reserve, we treated ovarian endometriomas by ultrasound-guided aspiration followed by sclerotherapy of the cyst mucosa. We compared the results with laparoscopic cystectomy. PATIENTS AND METHODS: We conducted a retrospective study of 96 women with ovarian endometriomas. In 54 of the women, ultrasound-guided aspiration of the contents was performed, followed by chemical sclerotherapy of the cyst plaque with ethanol. Laparoscopic cystectomy was performed in the remaining 42 women. RESULTS: Statistical analysis of anti-Mullerian hormone (AMH) levels before and after the procedures showed a significant decrease in the case of cystectomy compared with ethanolic ovarian sclerotherapy (EOS). CONCLUSIONS: Conservative treatment by echo-assisted puncture and sclerotherapy with ethanol proved to be a viable treatment for the removal of ovarian endometriomas. It is a simple procedure that does not affect ovarian reserve or fertility.

Gastroduodenal Surgery in Cirrhotic Patients - Case Series and Literature Review.

Specific risk factors for gastroduodenal surgery in cirrhotic patients have been identified, which dictates for a more personalized management. The retrospective study was conducted between 2012-2019 on twelve patients (7 cases of duodenal ulcer, 2 cases of gastric ulcer and 3 patients with gastric cancer). We took into account a number of possible factors involved in the unfavorable evolution of patients, based on data published in the literature so far. In order to follow the involvement of each factor we compared two groups of patients, one with unfavorable evolutions, exitus and another with favorable evolutions. Emergency surgery, the presence of ascites at the time of intervention, a higher than 30 MELD score, alcoholic cirrhosis, liver encephalopathy and liver failure are common factors that are found in a high percentage (between 75% and 100%) in patients who have had an unfavorable evolution, exitus. The same risk factors are found in much lower percentages in patients who have evolved favorably postoperatively, most between 12.5% and 25%. We analyzed preoperative aspects, surgical approach, complications and risk factors for these patients, compared them with the results of our study and identified future therapeutic possibilities. For CHILD B or C patients, the indication for surgery should be discussed in advance with a multidisciplinary team. Endoscopic submucosal dissection or discontinuation of D2 dissection should be considered in these patients.

Therapeutic Options in Diffuse Large B-Cell Lymphoma - A Retrospective Study and Review of the Literature.

The aim of this retrospective study was to assess the differences between standard R-CHOP and other Rituximab-associated chemotherapy (R-miniCHOP and R-CHOEP) regimens in terms of survival and potential adverse effects. The six-month survival outcomes of 94 diffuse large B-cell lymphomas (DLBCL) patients indicated no statistical difference between overall survival and disease-free survival in the two subgroups. The biological response to therapy (blood count, LDH levels) was similar in both subgroups. Despite having different clinical indications, R-miniCHOP and R-CHOEP provide viable therapeutic alternatives to the standard R-CHOP regimen.

Statistical Correlations of the Spontaneous Abortion with Trombophilia and Other Associated Pathologies.

15-20% of all known pregnancies progress with a miscarriage or an ectopic pregnancy. The recurrent miscarriage is a delicate clinical situation because with all the advances in genetic and immunologic research the incriminating factors haven't been discovered yet. The treatment is also subject to controversies, being perceived as either ineffective or aggressive. A number of 376 pregnant women with a gestational age smaller than 12 weeks have been selected, 226 of them with spontaneous abortion. In the study group of patients with previous spontaneous abortions we have found a series of associated pathology. From the cases with secondary non idiopathic recurrent miscarriage we have identified 4 cases of thrombophilia with antiphospholipid syndrome, 2 cases of thrombocytosis, one case of autoimmune thyroiditis, one case of uterine tumor, one case of MTHFR C homozygous thrombophilia and one case of FVL heterozygous thrombophilia. Knowing the correlations between the recurrent miscarriage and the hereditary thrombophilia as well as the options of treatment for increasing the chances of having a pregnancy with a normal evolution direct the doctors in testing the patients with recurrent miscarriage for hereditary thrombophilia.

Comparative study of placenta acute fetal distress and diabetes associated with pregnancy.

The authors analyze the main histopathological changes of placentas from pregnancies ended with fetal distress at birth and the tasks associated with diabetes. The parallel between the two types of placentas not trying to prove the existence of pathognomonic lesions. Are set out both the similarities between the two titles of placentas lesions (such as changes in microcirculation and so on) as well as particular aspects. The authors analyze a group of 19 pregnant women hospitalized in Obstetrics and Gynecology Clinics of Emergency County Hospital of Craiova, Romania, in September 2010-September 2011, who were born and who were diagnosed with diabetes. In the same period, were studied 21 pregnant women whose pregnancy ended with the birth of a child with fetal distress. Such were identified as placental lesions suggestive of fetal distress as diverse etiology of placental vascular changes and the placenta in pregnancy associated diabetes as immaturity and vascular edema and fibrinoid changes and glycogen stores. The authors have proposed to highlight some lesions suggestive of two groups of diseases but independent groups were analyzed and conclusions were drawn after discussing results. This study is justified by insufficient knowledge of the causes that lead to fetal distress regardless of its etiology. In conclusion, the authors mention both placenta's common changes as specifically changes of the placenta for each type of disorder.

Embryological, clinical and anatomopathological considerations on a very rare case of a bicephalous fetus (dicephalus dipus dibrachius).

In this paper, we present the very rare case of a 21 weeks pregnant woman, examined clinically and by ultrasound. We could observe the present of two heads and a common trunk and therefore we proceeded to the small caesarian of necessity. We examined the fetus from the clinical and pathological point of view and we could observe a rare case of pregnancy with a bicephalous malformed fetus. During the autopsy, we could reveal the common elements and the devised ones, which are described as it follows. The case is a very rare one and that probably explains the fact that until the 21 weeks examination, even if she was clinically and ultrasound examined there was the appreciation that it was a twin pregnancy with a normal evolution. In this case, it is necessary to underline that the difficulties concerning the diagnosis and the medical behavior are also because the patient was a primipara 34-year-old woman without any pathological or specific family history. This case analysis shows the necessity of a preconception genetic advice together with the extension of the analysis of the genetic risk in all mothers under 35-year-old, mandatory and supported by the medical system. At the same time, an ultrasound examination of great performance proves to be necessary in order not to prolong the development of a pathological pregnancy.