An asymptomatic male individual carrying a 5.72 Mb de novo deletion in 8p23.2­p23.3: A case report.

Numerous rearrangements in the 8p23 chromosomal region have been reported; included in these rearrangements are isolated deletions in this area. Such deletions are associated with a wide range of phenotypic characteristics, including motor impairment, epilepsy, intellectual disability, cardiac defects and seizures. The present study describes the case of a 30-year-old asymptomatic man that carries a de novo deletion in 8p23.2-p23.3. Molecular karyotyping indicated that the detected deletion involves genes that are in the critical region which is hypothesized to be responsible for the phenotypic characteristics associated with such deletions. The normal phenotype of the patient supports the hypothesis that there is incomplete penetrance of 8p23.2-p23.3 deletions.

Paraovarian tumor of borderline malignancy: A case report.

Paraovarian tumors of borderline malignancy (PTBM) are exceedingly rare, with only slightly over 60 cases reported worldwide. This report presents the case of a 22-year-old nulliparous patient who incidentally discovered a left paraovarian mass during a routine abdominal ultrasound. Subsequent MRI revealed a 2.5×2.1 cm cystic lesion located in close proximity to, but outside of, the left ovary, with no other pathological findings. A laparoscopic cystectomy was performed with meticulous care to prevent tumor spillage, and the patient experienced an uneventful recovery. Histopathological examination unveiled irregularly shaped tissue measuring 2.2×1.2×1 cm, characterized by fibrous tissue/wall with spindle cell stroma and an epithelium displaying features consistent with a serous borderline tumor. Our multidisciplinary team recommended diligent follow-up. This case contributes to the existing literature on PTBM and highlights the imperative for additional cases to enhance our comprehension of the optimal management of these exceedingly rare tumors.

Perforation of the Cervix by the Strings of an Intrauterine Device (IUD): a Novel Case and Systematic Review of the Literature.

Introduction:Geriatric population is most vulnerable to various emerging communicable and noncommunicable diseases due to various socio-economic, physiological, psychological and nutritional risk factors. Adequate nutritional status is utmost important in older age as it helps in maintaining the immune response and preventing the morbidities and mortalities in this age. Thus, the opportunistic screening of malnutrition among geriatric population gives an extra edge for achievement of healthy ageing in the elderly. The objective of the present study was to assess the nutritional status among the elderly population and provide cut-off values of various anthropometric measurements for detecting the risk of malnutrition among old age people. Materials and methods:A 43-year-old female patient attended the gynecology clinic in order to remove her copper IUD. Speculum examination revealed that both strings of the IUD had perforated the anterior lip of the cervix. Management options were offered and the patient opted for a hysteroscopic removal. We searched several electronic databases, including MEDLINE, Cochrane Library, Google Scholar, and EBSCO, in order to find similar cases. Results:The electronic search yielded 1 821 articles, of which eight were selected for inclusion. The mean age of women was 35.37±7.781 (range 26-47) years. One woman (12.5%) was nulligravida, and three women were multigravida (37.5%). Seven women (87.5%) were asymptomatic. Of all IUDs, three (37.5%) were LNG-IUS and five (62.5%) contained copper. Conclusion:Cervical perforation by the strings of the IUD is an extremely rare clinical entity. It is generally asymptomatic and, in most cases, the strings of the IUD may be returned back to the endocervical canal after surgical maneuvers.

Peripartum Ηysterectomy: A Four-Year Obstetric and Anesthetic Experience in a Tertiary Referral Hospital in Greece.

Background Although peripartum hysterectomy (PH) is a life-saving procedure in cases of abnormal placentation and postpartum hemorrhage, it can be associated with major obstetric and anesthetic complications. This retrospective study aimed to evaluate the incidence, etiology, perioperative anesthetic and obstetric management, complications, and fetal outcomes in women undergoing PH in a single tertiary referral hospital in Greece. Methodology This was a retrospective analysis of medical records of women who underwent emergency or elective PH in our hospital between January 2015 and December 2018. Results During the study period, 69 women who underwent a PH were identified. The incidence rate of elective and emergency PH was 4 and 1.2 per 1,000 deliveries, respectively. The main indication for PH was abnormal placentation (81.2%), followed by uterine atony (13%). Conversion to general anesthesia (GA) was performed in 21 (30.4%) cases. Conclusions This study showed a high prevalence of PH in our hospital compared to high-income countries. A neuraxial-only technique may be a safe alternative in individual cases of abnormal placentation. Conversion to GA can be reserved for complex surgical cases when massive hemorrhage is anticipated and, if possible, after the neonate has been delivered.

Improving tissue characterization, differentiation and diagnosis in gynecology with the narrow-band imaging technique: A systematic review.

Narrow-band imaging (NBI), an on-demand, real-time endoscopic imaging technique, was developed to enhance visualization of the mucosal vascular network and surface texture. The present article provides a systematic review of studies that assessed the use of NBI in gynecological endoscopy. The following electronic databases were searched: PubMed (1950-2020), Google Scholar (2004-2020) and Cochrane Library (2010-2020). In the initial search, 3,836 entries were identified, of which 31 were finally included in the systematic review. Of the selected studies, 10 (32%) were case reports, 19 (61.2%) were prospective studies and 2 (6.4%) were randomized controlled trials with control groups. The selected studies reported on the use of NBI in hysteroscopy, laparoscopy and colposcopy. It was revealed that NBI utilization in hysteroscopy increased the accuracy, sensitivity and specificity in detecting malignant and premalignant lesions. NBI improved the specificity and sensitivity in the detection of endometriotic lesions and cervical lesions. Conventional white light endoscopy in gynecology may be significantly improved by the use of NBI. Further studies with larger cohorts and improved design are required to achieve more reliable results. It is of special interest that utilization of this method requires apparatus which is expensive; concerns are the long training and experience of staff required and the long learning curve.

Evaluation of the efficacy of cervical pessary combined with vaginal progesterone in women with a short cervix and additional risk factors for preterm delivery.

OBJECTIVE: The aim of this study was to examine the efficacy of a combined management with cervical pessary and vaginal progesterone of women with a singleton pregnancy and a short cervix in both low and high risk-cases based on their previous obstetrical history and maternal factors. STUDY DESIGN: This was a prospective cohort study of women with a singleton pregnancy and a sonographically detected mid-trimester cervical length ≤ 25 mm. The high-risk group consisted of women with a history of a previous spontaneous preterm birth (PB), or a second-trimester miscarriage, or a loop electrosurgical excision procedure of the cervix (LEEP) while the low-risk group of women without such a history. All women were managed with cervical pessary and daily vaginal administration of 200 mg of progesterone. The primary outcome measure was spontaneous delivery before 34 weeks (238 days) of gestation. RESULTS: One hundred ninety-six cases with a CL ≤ 25 mm were detected during the study period. Fifty-two women declined to participate in the study. The remaining 144 women were divided into two groups based on the presence (n = 44) or absence (n = 100) of specific risk factors for PB. The rate of PTB < 34 weeks was similar in both low and high-risk pregnancies while a significantly higher rate of sPTB < 37 weeks was found in women with high-risk pregnancies (p = .005). CONCLUSION: The combined treatment of cervical pessary and vaginal progesterone has a similar influence on preterm delivery rate < 34 weeks, in both low and high-risk women, with a mid-trimester short cervix.

3D vocal power Doppler sonography for the estimation of tumor volume and vascularization in stage IB1 cervical cancer.

PURPOSE: To evaluate the tumor's volume and intratumoral vascularization with 3D vocal power Doppler ultrasound in patients with stage 1B1 cervical cancer. METHODS: This was a prospective study on patients with cervical cancer and stage 1B1 disease, which took place between 2012 and 2015. All women had an initial 2D ultrasound examination for the estimation of the tumor volume. Following this, 3D volumes of the cervix were acquired and were further analyzed using the Virtual Organ Computer Aided Analysis (VOCAL) program. In the selected volume, the vascular pattern (linear or complex vascularization) was also examined. The ultrasonographic findings were compared to the histological ones following surgery. RESULTS: Twenty-seven patients were included. The average cervical tumor volume measured by the 2D ultrasound and 3D VOCAL-PD were 3.14 and 3.08 cm3, respectively. Both 2D and 3D VOCAL-PD overestimated the tumor staging. Further analysis showed a statistically significant superiority of 2D ultrasound over 3D VOCAL-PD for tumors equal or smaller than 2.5 cm3 with linear vascularity (p < 0.001), while for tumors of larger volume with complex vascularization, a statistically significant superiority of 3D VOCAL-PD was confirmed (p < 0.001). CONCLUSIONS: 3-D VOCAL-PD is extremely accurate and superior to 2D ultrasound for the estimation of tumor volume and vascularization when it is more than 2.5 cm3 and has a complex vascularization in patients with stage 1B1 cervical cancer.

Correction to: The role of three-dimensional power Doppler hysterosonography (3-DPDS) in distinguishing atypical polypoid adenomyomas (APAs) from other intrauterine tumors: correlation with pathologic findings.

In the original publication of the article, the first name and last name of the authors were interchanged. The correct names should read as given below.

The role of three-dimensional power Doppler hysterosonography (3-DPDS) in distinguishing atypical polypoid adenomyomas (APAs) from other intrauterine tumors: correlation with pathologic findings.

OBJECTIVE: This study was undertaken to describe the sonographic characteristics of atypical polypoid adenomyomas (APAs) of the uterus and to determine the value of three-dimensional power Doppler hysterosonography (3-DPDS) in distinguishing APA from other polypoid uterine tumors. METHODS: Ninety-five women with a mean age of 37 years (range 28-45) with a suspicious polypoid uterine tumor were referred for preoperative evaluation with 3-DPDS. Sonographic criteria used for the diagnosis of APA were based on a system that consisted of morphological characteristics, histological evaluation and power Doppler imaging. Biopsy samples of the intrauterine tumors were obtained via operative hysteroscopy. RESULTS: Fifteen lesions were histopathologically diagnosed as APAs, 25 as endometrial polyps and 55 as submucous myomas. In the present study, the sensitivity and specificity of 3-DPDSs in discriminating APA from other polypoid tumors was 82.5 and 86.7%, respectively. CONCLUSIONS: APAs can be accurately distinguished from other polypoid tumors of the uterus with the use of 3-DPDS demonstrating the following characteristics: lobular tumor with inhomogeneous echotexture, echogenicity similar to myometrium, broad base, acoustic shadow and linear vessel arrangement.

Characterization of ovarian tumors and staging ovarian cancer with 3-dimensional power Doppler angiography: correlation with pathologic findings.

OBJECTIVE: The aims of this study were to evaluate ovarian tumors with 3-dimensional power Doppler angiography (3-DPDA), to determine its correlation with histology findings, and to explore its role in staging patients with ovarian cancer. METHODS: Three hundred eighteen women with an unknown unilateral pelvic mass were referred for preoperative evaluation by 3-DPDA angiography. Patients' ages ranged from 18 to 72 years (47.4 ± 13.8 years). Sonographic criteria used for the characterization of ovarian tumors were based on a system that included morphological characteristics, histological evaluation, and Power Doppler imaging. RESULTS: Two hundred twenty-five tumors were histopathologically diagnosed as benign and 93 as malignant. Sensitivity and specificity of the 3-DPDA of ovarian masses reached 93.5% and 92.9%, respectively, whereas positive predictive value was 84.5% and negative predictive value was 97.2%. CONCLUSIONS: Three-dimensional power Doppler sonography is an effective imaging technique for discriminating ovarian neoplasms and classifying them according to histopathology.

Three Dimensional Power Doppler evaluation of human endometrium after administration of oxytocine receptor antagonist (OTRa) in an IVF program.

PURPOSE: To compare endometrial and subendometrial morphological changes and vascularity as measured by 3D Power Doppler sonography, based on a specific scoring system between women subjected or not to oxytocine receptor antagonist (OTRa) during IVF cycles. METHODS: Twenty-six women were divided into groups according to OTRa (Atosiban tractocide) administration. The first group (control n = 13 women) was examined with 3D Power Doppler 3 days after embryo transfer. The second group (n = 13 women) was administered 7.5 mg intravenous tractocide 2 days after embryo transfer and a 3D Power Doppler was performed after a day. RESULTS: The control group presented the following ultrasonographic characteristics: (a) echogenic endometrium in all cases, (b) endometrial thickness >7 mm in all cases (84.6%), (c) endometrial volume >2.31 cm(3) in 5 cases (38.5%), (d) abnormal sub-endometrial halo in 3 cases (23.1%), (e) endometrial blood flow in 6 cases (46.2%) and (f) complex vessel's architecture in 2 cases (15.4%). In women who underwent OTRa administration were observed: (a) echogenic endometrium in 1 case (7.7%), triple line endometrium in 12 cases (92.3%), (b) endometrial thickness >7 mm in all cases, (c) endometrial volume >2.31 cm(3) in 11 cases (84.6%), (d) abnormal sub-endometrial halo in 3 cases (23.1%), (e) endometrial blood flow in 11 cases (84.6%) and (f) complex vessel's architecture in 6 cases (46.2%). CONCLUSIONS: Women who have taken OTRa presented an endometrium with characteristics more predictive of implantation.

The role of 3-dimensional power Doppler imaging in the assessment of ovarian teratoma in pregnancy: a case report.

Background. Conventional sonography is the primary imaging tool for these pregnant women who present with an ovarian teratoma. In some cases, however, sonography diagnosis is difficult. We report a case of ovarian teratoma during pregnancy diagnosed by three-dimensional Power Doppler. The cyst was removed via laparotomy without fetal or maternal complications. Three-dimensional ultrasound with multiplanar view can better discriminate a benign ovarian teratoma from complex ovarian lesions or malignant tumors. Its role is significant especially during pregnancy as it may assist in determining which patients are requiring surgery and which are not. The results of three-dimensional sonography and magnetic resonance (MR) were equal but the role of MR imaging is limited in early pregnancy. Conclusions. Three-dimensional technique is a reliable diagnostic modality for preoperative assessment of an ovarian teratoma as it can be performed during the first trimester of pregnancy.

Fournier's gangrene in a patient after third-degree burns: a case report.

INTRODUCTION: Fournier's gangrene is characterized by tissue ischemia leading to rapidly progressing necrotizing fasciitis. CASE PRESENTATION: We present the case of a patient with Fournier's gangrene after third-degree burns. Clinical manifestations, laboratory results and treatment options are discussed. CONCLUSION: Fournier's gangrene is a surgical emergency. Although it can be lethal, it is still a challenging situation in the field of surgical infections.