A novel honeycomb-like 3D-printed device for rotating-disk sorptive extraction of organochlorine and organophosphorus pesticides from environmental water samples.

In this study, 3D-printing based on fused-deposition modeling (FDM) was employed as simple and cost-effective strategy to fabricate a novel format of rotating-disk sorptive devices. As proof-of-concept, twenty organochlorine and organophosphorus pesticides were determined in water samples through rotating-disk sorptive extraction (RDSE) using honeycomb-like 3D-printed disks followed by gas chromatography coupled to mass spectrometry (GC-MS). The devices that exhibited the best performance were comprised of polyamide + 15 % carbon fiber (PA + 15 % C) with the morphology being evaluated through X-ray microtomography. The optimized extraction conditions consisted of 120 min of extraction using 20 mL of sample at stirring speed of 1100 rpm. Additionally, liquid desorption using 800 µL of acetonitrile for 25 min at stirring speed of 1100 rpm provided the best response. Importantly, the methodology also exhibited high throughput since an extraction/desorption platform that permitted up to fifteen simultaneous extractions was employed. The method was validated, providing coefficients of determination higher than 0.9706 for all analytes; limits of detection (LODs) and limits of quantification (LOQs) ranged from 0.15 to 3.03 µg L-1 and from 0.5 to 10.0 µg L-1, respectively. Intraday precision ranged from 4.01 to 18.73 %, and interday precision varied from 4.83 to 20.00 %. Accuracy was examined through relative recoveries and ranged from 73.29 to 121.51 %. This method was successfully applied to analyze nine groundwater samples from monitoring wells of gas stations in São Paulo. Moreover, the greenness was assessed through AGREEprep metrics, and an overall score of 0.69 was obtained indicating that the method proposed can be considered sustainable.

The Influence of Cleaning Solutions on the Retention of Overdenture Attachment Systems.

Dental-implant-supported reconstructions provide comfort and improvements in prosthetic function, adaptation, and stability over conventional treatment options. The objective of this study was to evaluate the effect of different denture cleansing solutions and their influence on the deterioration and loss of retention of overdenture attachments in a 12-month clinical-use simulation. In this way, ten specimens each of different brands of retentive caps made of Teflon (OT Equator® (Rhein83, Bologna, Italy), Locator® (Zest Anchors, Escondido, CA, USA), Kerator® (KJ Meditech, Gwangiu, Republic of Korea), and Locator R-Tx® (Zest Anchors, Escondido, CA, USA)) were immersed in five different cleaning solutions (Kukident® (P&G Tech, Oxford Parkway, UK), Benfix® (Laboratorios URGO S.L., Guipúzcoa, Spain), Corega® (Stafford Miller, Waterford, Ireland), and Protefix® (Neuhofer Weiche, Parchim, Germany)), and tap water was used as the control group, in a simulation that lasted 12 months. Data were analyzed using two-way ANOVA and a Tukey HSD. Furthermore, a Levene Test and Shapiro-Wilk tests were performed to assess the validation of the ANOVA assumptions. The statistical analysis was performed using R version 4.2.2 software with the significance level set to p < 0.05. There were significant statistical differences between the different manufacturers regarding the retention forces of the attachment's retentive caps (F = 322.066, p < 0.001). For the cleaning solution groups, different statistical results between Kukident® (P&G Tech, Oxford Parkway, UK) (p < 0.05) and Benfix® (Laboratorios URGO S.L., Guipúzcoa, Spain) (p < 0.05) were observed. There were no significant statistical differences between Corega® (Stafford Miller, Ireland), Protefix® (Neuhofer Weiche, Parchim, Germany), and tap water, even though the retention forces decreased in all of them.

A Case of Cerebral Air Embolism After Dental Procedure.

Air embolism is a rare and life-threatening event that occurs when air enters the cardiovascular system, usually secondary to iatrogenic vascular procedures. We present a 58-year-old woman who underwent a dental procedure (devitalization of a tooth) under local anesthesia, with a sudden onset of coma during manipulation and documentation of air in the vessels of the right frontal convexity sulci. After cerebral air embolism was confirmed, she received hyperbaric oxygen therapy, with resorption of the gas, but clinically she developed a super-refractory status epilepticus with a persistent coma. The slow clinical course required the exclusion of other etiologies of coma. The pathophysiology is not well known; however, it appears to be related to the injection of air by the high-speed dental drill through the soft tissue adjacent to the roots of the teeth, nearby the bloodstream. We highlight this event because of this unlikely association, which may delay diagnosis and the good results of hyperbaric medicine on prognosis.

Extreme Makeover in a health center: LEAN methodology applied to clinical practice.

INTRODUCTION: The LEAN methodology is an integration of methods and tools developed in the 90s in the industrial sector. It aims to reduce waste (things that don't add value to the final product), add worth and work towards continuous quality improvement. METHODS: LEAN tools to improve the clinical practice of a health center include:5S methodology: helps organize, clean, develop and maintain a productive work environment;'Spaghetti' diagram: displays the movement and distance that a given element has to travel throughout the entire process; andTime and motion studies: measure the various times associated with the process and the associated motion. RESULTS: The LEAN methodology made it possible to manage space and time efficiently and optimally. There was a substantial reduction in both the time and number of trips for not only the health professionals but also for the patients. DISCUSSION: Clinical practice should focus on the permission of continuous quality improvement. The LEAN methodology, through its different tools, generates an increase in productivity and profitability. It promotes teamwork through multidisciplinary teams and the empowerment and training of employees. The implementation of the LEAN methodology improved the practices and strengthened the team spirit based on everyone's participation, because the whole is greater than the sum of the parts.

EcoHealth Center: reduce, reuse, recycle!

INTRODUCTION: Climate change is a topic of growing interest and should guide our actions in society. Clinical practice must improve sustainability and ecological behavior as an opportunity. We intend to show how measures were implemented to reduce resource consumption in a health center in Gonçalo, a small village in the center of Portugal, with the support of local government spreading these practices across the community. METHODS: The first step was to account for daily resource use in Gonçalo's Health Center. Opportunities for improvement were listed in a multidisciplinary team meeting and subsequently implemented. Local government was very cooperative in the implementation of such measures, helping us spread the intervention to the community. RESULTS: A considerable reduction in resource consumption was verified, mainly the reduction of consumption of paper. Before this intervention, there was neither separation nor recycling of waste, which was initiated by this program. This change was implemented in the building of the Parish Council, at the Health Center and School Center of Gonçalo, where health education activities were promoted. DISCUSSION: In a rural area, the health center is an integral part of the life of the community in which it operates. Thus, their behaviors have the power to influence that same community. By showing our interventions and through practical examples, we intend to influence other health units to be an agent for change within their communities. By reducing, reusing and recycling, we intend to be a role model.

'Consultas em dia': consultations at the day care center for the elderly.

INTRODUCTION: Gonçalo, a village with 1316 inhabitants of which 573 are 65 years old or older, presents itself as the 'Cradle of Fine Basketry'. Its population, rich in culture and stories to tell, has the support of a day care center for the elderly, where around 20 elderly people spend their days and find social connection. These patients make individual trips to access medical and nursing consultations. METHODS: Creation of a monthly consultation at the day care center for the elderly patients there. RESULTS: Reduction in the number of individual trips by the elderly patients, through the displacement of the family team;Optimizing the management of each individual health plan with the support of the day center's technical director, including therapeutic management and carrying out complementary diagnostic tests;Observation of the elderly patients in a safer way, avoiding traveling and maintaining a familiar space;Closer ties between the elderly patients and healthcare team; and Training of day care center professionals. DISCUSSION: At the heart of the practice of a healthcare team is the health and well-being of each patient. Therefore, meeting their needs, reallocating resources and involving the community will lead to health gains. The 'Consultas em Dia' project reflects this same onjective: the need of each elderly person to have access to GP/family nurse consultations joined with the healthcare team's willingness to provide an adapted response. Together we improved access and care delivery … we improved the health of our community!

Adding protein to a carbohydrate pre-exercise beverage does not influence running performance and metabolism.

BACKGROUND: To analyze whether pre-exercise CHO+PRO vs. CHO intake distinctly influences running performance and metabolic biomarkers along a various of exercise intensities. METHODS: In a randomized, double blind, counterbalanced, crossover and placebo control design, 10 middle distance runners were tested in 3 occasions. After 10 h of fasting, participants ingested isovolumic beverages (0.75+0.25g·BW-1 of CHO+PRO, 1.0g·BW-1 of CHO and placebo control) 30 min before a treadmill running incremental protocol of 4 min steps until exhaustion. Venous blood was collected at fasting, 30 min after beverage ingestion and after the 3rd and 7th running steps. Oxygen uptake-related variables, including respiratory exchange ratio, heart rate, plasma glucose, insulin, glucagon, free fatty acids, blood lactate concentrations, gastrointestinal discomfort and rate of perceived exertion were measured. RESULTS: The addition of PRO to CHO had no influence on the measured variables, which did not differ between conditions along all incremental protocol intensities. The intake of CHO+PRO (compared to CHO) tended to decrease glycemia (106.5±21.3 vs. 113.6±26.5) and to increase insulinemia (14.4±15.1 vs. 12.7±10.8) at intensities close to maximum oxygen uptake. CONCLUSIONS: The addition of PRO to a pre-exercise CHO beverage had no impact on running performance and related metabolic variables at a wide spectrum of exercise intensities.

Cushing Syndrome as a Manifestation of Neuroendocrine Prostate Cancer: A Rare Presentation Within a Rare Tumor.

Neuroendocrine prostate cancer (NEPC) is a rare entity representing 1% of all prostate malignancies, associated with poor prognosis and often concomitant with paraneoplastic syndromes such as Cushing's syndrome (CS) with ectopic adrenocorticotropic hormone (ACTH) production. We present a case of a 56-year-old man with recent lower urinary tract symptoms hospitalized for pelvic pain, rectal tenesmus, and fatigue. A CT scan documented a large prostatic mass, adenomegalies, and hepatic lesions. Bone scintigraphy showed dispersed osteoblastic metastization. The patient had uncontrolled hypertension and hypokalemia that lead to the diagnosis of paraneoplastic ACTH-dependent CS. Prostate biopsy confirmed small cell NEPC. Potassium supplementation, anti-hypertensive medication, and metyrapone were initiated. The patient was proposed for palliative chemotherapy but died within a few days from a urinary tract infection. The authors aim to draw attention to a case of paraneoplastic CS, a rare manifestation, within the rarity that is NEPC.

The Cost-Effectiveness of Empagliflozin Versus Liraglutide Treatment in People with Type 2 Diabetes and Established Cardiovascular Disease.

INTRODUCTION: The increasing financial burden associated with diabetes treatment presents a challenge to healthcare systems worldwide. Recently, clinical guidelines have focussed on patients with type 2 diabetes (T2D) and established cardiovascular disease (CVD) and recommend a sodium-glucose co-transporter 2 (SGLT2) inhibitor or a glucagon-like peptide 1 (GLP-1) receptor agonist as second-line treatment after metformin or independently of baseline glycated haemogloblin A1c (HbA1c). In Danish clinical guidelines, empagliflozin and liraglutide are highlighted owing to their positive impact on mortality. Thus, this study aimed to assess the cost-effectiveness of empagliflozin plus standard of care (SoC) versus liraglutide plus SoC in Danish patients with T2D and established CVD using a lifetime and 5-year horizon. METHODS: The IQVIA Core Diabetes Model (CDM) was calibrated to reproduce the clinical event rates observed in the cardiovascular outcome trial EMPA-REG OUTCOME. Network meta-analysis provided the relative risks for cardiovascular outcomes with empagliflozin versus liraglutide. Microvascular outcomes were predicted by standard CDM risk equations. The relative treatment effect was assumed for 9 years after which treatment was switched to basal-bolus therapy. The CDM was populated with Danish costs of events and drug costs at price-level 2019. Discounting of 4% was applied. RESULTS: Over a lifetime horizon, CDM projected 9.858 and 9.667 life years, 6.162 and 5.976 quality-adjusted life years (QALY) and DKK 478,026 (€64,079) and DKK 500,025 (€67,027) in total costs for empagliflozin plus SoC and liraglutide plus SoC, respectively. For a 5-year horizon, the results were 4.189 and 4.140 life years, 2.746 and 2.655 QALY, as well as DKK 123,413 (€16,543) and DKK 161,783 (€21,687), respectively. Empagliflozin was the dominant treatment alternative. Sensitivity analyses showed the robustness of these results. CONCLUSION: The cost-effectiveness analysis suggests that empagliflozin plus SoC is dominant compared to liraglutide plus SoC in Denmark over both lifetime and 5-year horizons.

Differential inflammasome activation predisposes to acute-on-chronic liver failure in human and experimental cirrhosis with and without previous decompensation.

OBJECTIVE: Systemic inflammation predisposes acutely decompensated (AD) cirrhosis to the development of acute-on-chronic liver failure (ACLF). Supportive treatment can improve AD patients, becoming recompensated. Little is known about the outcome of patients recompensated after AD. We hypothesise that different inflammasome activation is involved in ACLF development in compensated and recompensated patients. DESIGN: 249 patients with cirrhosis, divided into compensated and recompensated (previous AD), were followed prospectively for fatal ACLF development. Two external cohorts (n=327) (recompensation, AD and ACLF) were included. Inflammasome-driving interleukins (ILs), IL-1α (caspase-4/11-dependent) and IL-1ß (caspase-1-dependent), were measured. In rats, bile duct ligation-induced cirrhosis and lipopolysaccharide exposition were used to induce AD and subsequent recompensation. IL-1α and IL-1ß levels and upstream/downstream gene expression were measured. RESULTS: Patients developing ACLF showed higher baseline levels of ILs. Recompensated patients and patients with detectable ILs had higher rates of ACLF development than compensated patients. Baseline CLIF-C (European Foundation for the study of chronic liver failure consortium) AD, albumin and IL-1α were independent predictors of ACLF development in compensated and CLIF-C AD and IL-1ß in recompensated patients. Compensated rats showed higher IL-1α gene expression and recompensated rats higher IL-1ß levels with higher hepatic gene expression. Higher IL-1ß detection rates in recompensated patients developing ACLF and higher IL-1α and IL-1ß detection rates in patients with ACLF were confirmed in the two external cohorts. CONCLUSION: Previous AD is an important risk factor for fatal ACLF development and possibly linked with inflammasome activation. Animal models confirmed the results showing a link between ACLF development and IL-1α in compensated cirrhosis and IL-1ß in recompensated cirrhosis.

Erdheim-Chester Disease: A Rare Clinical Entity.

Pericardial effusion represents a diagnostic challenge. Erdheim-Chester disease (ECD), though a rare cause, should be considered in the differential diagnosis. An 88-year-old woman was admitted to the hospital due to retrosternal pain, dyspnoea and constitutional symptoms. Hypoxaemic respiratory failure and increased inflammatory markers were documented. A chest x-ray revealed an increased cardiothoracic ratio. An echocardiogram showed a moderate-volume pericardial effusion, without signs of cardiac tamponade. A thoraco-abdomino-pelvic CT scan found a bilateral perirenal soft tissue halo. Perirenal mass biopsy showed diffuse infiltration by foamy histiocytes (CD68+), without IgG4, compatible with ECD. The correlation of anamnesis, radiology and histology is crucial for the diagnosis of ECD. LEARNING POINTS: Erdheim-Chester disease is a non-Langerhans cell histiocytosis that affects multiple organs and systems.Thorough study of a pericardial effusion is important as it is still considered idiopathic in 10-20% of cases.It is a rare disease so high diagnostic suspicion is important. The diagnosis is established through clinical manifestations, radiologic findings and histological confirmation.

Cardiodynamic state is associated with systemic inflammation and fatal acute-on-chronic liver failure.

BACKGROUND & AIMS: Acute-on-chronic liver failure (ACLF) is characterized by high short-term mortality and systemic inflammation (SI). Recently, different cardiodynamic states were shown to independently predict outcomes in cirrhosis. The relationship between cardiodynamic states, SI, and portal hypertension and their impact on ACLF development remains unclear. The aim of this study was therefore to evaluate the interplay of cardiodynamic state and SI on fatal ACLF development in cirrhosis. RESULTS: At inclusion, hemodynamic measures including cardiac index (CI) and hepatic venous pressure gradient of 208 patients were measured. Patients were followed prospectively for fatal ACLF development (primary endpoint). SI was assessed by proinflammatory markers such as interleukins (ILs) 6 and 8 and soluble IL-33 receptor (sIL-33R). Patients were divided according to CI (<3.2; 3.2-4.2; >4.2 L/min/m2 ) in hypo- (n = 84), normo- (n = 69) and hyperdynamic group (n = 55). After a median follow-up of 3 years, the highest risk of fatal ACLF was seen in hyperdynamic (35%) and hypodynamic patients (25%) compared with normodynamic (14%) (P = .011). Hyperdynamic patients showed the highest rate of SI. The detectable level of IL-6 was an independent predictor of fatal ACLF development. CONCLUSIONS: Cirrhotic patients with hyperdynamic and hypodynamic circulation have a higher risk of fatal ACLF. Therefore, the cardiodynamic state is strongly associated with SI, which is an independent predictor of development of fatal ACLF.

Left Ventricular Longitudinal Contractility Predicts Acute-on-Chronic Liver Failure Development and Mortality After Transjugular Intrahepatic Portosystemic Shunt.

Acute deterioration of liver cirrhosis (e.g., infections, acute-on-chronic liver failure [ACLF]) requires an increase in cardiac contractility. The insufficiency to respond to these situations could be deleterious. Left ventricular global longitudinal strain (LV-GLS) has been shown to reflect left cardiac contractility in cirrhosis better than other parameters and might bear prognostic value. Therefore, this retrospective study investigated the role of LV-GLS in the outcome after transjugular intrahepatic portosystemic shunt (TIPS) and the development of ACLF. We included 114 patients (48 female patients) from the Noninvasive Evaluation Program for TIPS and Their Follow-Up Network (NEPTUN) cohort. This number provided sufficient quality and structured follow-up with the possibility of calculating major scores (Child, Model for End-Stage Liver Disease [MELD], Chronic Liver Failure Consortium acute decompensation [CLIF-C AD] scores) and recording of the events (development of decompensation episode and ACLF). We analyzed the association of LV-GLS with overall mortality and development of ACLF in patients with TIPS. LV-GLS was independently associated with overall mortality (hazard ratio [HR], 1.123; 95% confidence interval [CI],1.010-1.250) together with aspartate aminotransferase (HR, 1.009; 95% CI, 1.004-1.014) and CLIF-C AD score (HR, 1.080; 95% CI, 1.018-1.137). Area under the receiver operating characteristic curve (AUROC) analysis for LV-GLS for overall survival showed higher area under the curve (AUC) than MELD and CLIF-C AD scores (AUC, 0.688 versus 0.646 and 0.573, respectively). The best AUROC-determined LV-GLS cutoff was -16.6% to identify patients with a significantly worse outcome after TIPS at 3 months, 6 months, and overall. LV-GLS was independently associated with development of ACLF (HR, 1.613; 95% CI, 1.025-2.540) together with a MELD score above 15 (HR, 2.222; 95% CI, 1.400-3.528). Conclusion: LV-GLS is useful for identifying patients at risk of developing ACLF and a worse outcome after TIPS. Although validation is required, this tool might help to stratify risk in patients receiving TIPS.

Interobserver agreement in CTG interpretation using the 2015 FIGO guidelines for intrapartum fetal monitoring.

BACKGROUND: Visual analysis of cardiotocographic (CTG) tracings has been shown to be prone to poor intra- and interobserver agreement when several interpretation guidelines are used, and this may have an important impact on the technology's performance. OBJECTIVES: The aim of this study was to evaluate agreement in CTG interpretation using the new 2015 FIGO guidelines on intrapartum fetal monitoring. STUDY DESIGN: A pre-existing database of intrapartum CTG tracings was used to sequentially select 151 cases acquired with a fetal electrode, with duration exceeding 60minutes, and signal loss less than 15%. These tracings were presented to six clinicians, three with more than 5 years' experience in the labor ward, and three with 5 or less years' experience. Observers were asked to evaluate tracings independently, to assess basic CTG features: baseline, variability, accelerations, decelerations, sinusoidal pattern, tachysystole, and to classify each tracing as normal, suspicious or pathologic, according to the 2015 FIGO guidelines on intrapartum fetal monitoring. Agreement between observers was evaluated using the proportions of agreement (Pa), with 95% confidence intervals (95%CI). RESULTS: A good interobserver agreement was found in the evaluation of most CTG features, but not bradycardia, reduced variability, saltatory pattern, absence of accelerations and absence of decelerations. For baseline classification Pa was 0.85 [0.82-0.90], for variability 0.82 [0.78-0.85], for accelerations 0.72 [0.68-0.75], for tachysystole 0.77 [0.74-0.81], for decelerations 0.92 [0.90-0.95], for variable decelerations 0.62 [0.58-0.65], for late decelerations 0.63 [0.59-0.66], for repetitive decelerations 0.73 [0.69-0.78], and for prolonged decelerations 0.81 [0.77-0.85]. For overall CTG classification, Pa were 0.60 [0.56-0.64], for classification as normal 0.67 [0.61-0.72], for suspicious 0.54 [0.48-0.60] and for pathologic 0.59 [0.51-0.66]. No differences in agreement according to the level of expertise were observed, except in the identification of accelerations, where it was better in the more experienced group. CONCLUSIONS: A good interobserver agreement was found in evaluation of most CTG features and in overall tracing classification. Results were better than those reported in previous studies evaluating agreement in overall tracing classification. Observer experience did not appear to play a role in agreement.

Novel (188)Re multi-functional bone-seeking compounds: Synthesis, biological and radiotoxic effects in metastatic breast cancer cells.

INTRODUCTION: Radiolabeled bisphosphonates (BPs) have been used for bone imaging and delivery of ß(-) emitting radionuclides for bone pain palliation. As a ß(-) emitter, (188)Re has been considered particularly promising for bone metastases therapy. Aimed at finding innovative bone-seeking agents for systemic radiotherapy of bone metastases, we describe herein novel organometallic compounds of the type fac-[(188)Re(CO)3(k(3)-L)], (L=BP-containing chelator), their in vitro and in vivo stability, and their cellular damage in MDAMB231 cells, a metastatic breast cancer cell line. METHODS: After synthesis and characterization of the novel organometallic compounds of the type fac-[(188)Re(CO)3(k(3)-L)] their radiochemical purity and in vitro stability was assessed by HPLC. In vivo stability and pharmacokinetic profile were evaluated in mice and the radiocytotoxic activity and DNA damage were assessed by MTT assay and by the cytokinesis-block micronucleus (CBMN) assay, respectively. RESULTS: Among all complexes, (188)Re3 was obtained with high radiochemical purity (>95%) and high specific activity and presented high in vitro and in vivo stability. Biodistribution studies of (188)Re3 in Balb/c mice showed fast blood clearance, high bone uptake (16.1 ± 3.3% IA/g organ, 1h p.i.) and high bone-to-blood and bone-to-muscle radioactivity ratios, indicating that it is able to deliver radiation to bone in a very selective way. The radiocytotoxic effect elicited by (188)Re3 in the MDAMB231 cells was dependent on its concentration, and was higher than that induced by identical concentrations of [(188)ReO4](-). Additionally, (188)Re3 elicited morphological changes in the cells and induced DNA damage by the increased number of MN observed. CONCLUSION: Altogether, our results demonstrate that (188)Re3 could be considered an attractive candidate for further preclinical evaluation for systemic radionuclide therapy of bone metastases considering its ability to deliver radiation to bone in a very selective way and to induce radiation damage.

Inter- and intra-observer variability in cervical measurement by ultrasound in the first and second trimesters of pregnancy: does it matter?

OBJECTIVES: The aim of this study was to evaluate the inter- and intra-observer variabilities in the cervical length (CL) measurement by transvaginal ultrasound (TVU) in the first and second trimesters of pregnancy. MATERIALS AND METHODS: A total of 55 singleton pregnant women were evaluated in the first or second ultrasound. Each patient was blindly evaluated by three of the four observers who performed three measurements each. RESULTS: In the first and second trimesters, patients were evaluated at 12.3 weeks (mean) and 21.3 weeks (mean), respectively. The intra-class correlation coefficients (ICC) between observers in the first and second trimesters were 0.76 and 0.72, respectively, and the ICCs within observers were 0.889 and 0.899, respectively. In both trimesters, the main source of variance was the patient and the second source of variance was the interaction, Patient×Observer (12.0% and 13.5%, respectively). The observer and measurement explained a small proportion of variance in both trimesters (1.4% and 0.4%, respectively in the 1st trimester, and 3.3% and 0%, respectively in the 2nd trimester). The residual variances were 10.6% and 11.2%, and the standard errors of measurement were 1.78 mm and 1.82 mm for the first and second trimesters, respectively. CONCLUSIONS: TVU is a reliable and reproducible method by which to predict preterm birth in both the first and second trimesters.

Mitotically active cellular ovarian fibroma with Meigs' syndrome and elevated CA-125: towards fertility preservation.

BACKGROUND: Meigs syndrome is rare in women under 30 years of age and even more if associated with an elevated CA-125. In this case, malignancy was suspected and raised concerns about fertility preservation. CASE: A 13-year-old girl presented with a 4-month amenorrhea, abdominal enlargement and dyspnea. Ultrasonography showed a 14-cm solid mass with ascites, bilateral pleural effusion and, analytically, elevated serum CA-125. Unilateral salpingo-oophorectomy was performed, with a 19 × 15 × 12 cm mass being disclosed from the right ovary. Final pathology diagnosed a mitotically active cellular ovarian fibroma (MACF), with no significant nuclear atypia. CONCLUSION: MACF is a recent histopathologic entity. Despite the high count of mitotic figures, it is not associated with atypia, which contributes to favorable outcome. Although initial suspicions of malignancy, a conservative surgical intervention allowed fertility preservation. This was clinically appropriate and with no implications on survival and prognosis of these patients.