RESUMEN
Brenner tumors are relatively uncommon surface epithelial tumors of the ovary, accounting for less than 2% of all ovarian tumors. They may be of benign, borderline, or malignant nature as classified by the World Health Organization. Definitive diagnosis is made by histopathological examination after surgical excision, as it does not have pathognomonic imaging features. Due to the rarity of these tumors, reporting these cases may be beneficial to develop diagnostic and treatment criteria. We herein report two cases of Brenner tumor and discuss the available literature. Two cases of Brenner tumor were reported in addition to the literature review. Electronic search in different databases was used, accessing published full free-text articles in the English language, between January 2010 and December 2017, with the following MeSH terms: ovarian Brenner, Brenner, and ovary Brenner. Nineteen articles were located, of which seven articles were selected because they were consistent with the aims of the review. Twelve articles were excluded as they did not meet the aim of the review. Data from the reviewed articles were used to finalize the conclusive recommendations. Brenner tumors are rare ovarian tumors that are diagnosed by histopathological examination. Radiological investigation has a negligible role in the diagnosis, as Brenner tumors exhibit nonspecific features in imaging studies. To date, surgical excision remains the primary modality in diagnosing and treating Brenner tumors. The clinical characteristics of Brenner tumors require more research to be fully understood.
RESUMEN
PURPOSE: Guidelines for managing neonatal hemolytic disease of the newborn (HDN) recommend a selective approach in the use of direct antiglobulin test (DAT). In Saudi Arabia, many hospitals still perform routine DAT for all newborns. This study assessed the need for phototherapy in relation to DAT results in full-term healthy newborns. PATIENTS AND METHODS: A retrospective analysis of all healthy newborns admitted during 2018 was performed. The primary outcome was the association of positive DAT results with phototherapy. RESULTS: There were 1463 newborns born during the study period. The DAT was positive at 4.4%. The 24-hour bilirubin levels were higher in DAT-positive cases (P=0.06); however, peak bilirubin levels were not correlated with the DAT results (P=0.717). Thirty-six neonates (2.46%) required phototherapy, and the need was similar among DAT-positive and DAT-negative cases (P=0.271). The most common indication for phototherapy was clinical jaundice in 22 neonates (61.1%), followed by DAT positivity in 12 (33.3%) and hospital protocol in 2 patients (5.6%) (P <0.01 by chi-square overall comparison). CONCLUSION: Our results indicate that factors other than DAT positivity are important in assessing the need for phototherapy in newborns. Clinical signs of jaundice were indicators of high serum bilirubin levels and subsequent phototherapy, further indicating that the DAT test was overused in predicting the need for phototherapy.
RESUMEN
Retained placenta is clinically diagnosed when the placenta has failed to deliver within 18 to 60 minutes after birth. The retained placenta is a risk factor for postpartum fever. In this paper, we report a patient with a delivery complicated by a retained placenta and postpartum fever. This patient, a 34-year-old pregnant female, was admitted at 32 weeks of gestation for a case of preterm labor with preterm premature rupture of membranes and bacterial vaginosis. A 2.5 kg infant was delivered by normal vaginal delivery, which was followed by active management of the third stage of labor. The retained placenta was removed manually under general anesthesia. Two days later, the patient developed a fever and elevated inflammatory markers. Ultrasound-guided evacuation and curettage were done, and two endometrial cavities were noted. Both cavities were evacuated of products of conception. Two days later, the patient started to have spikes of fever. Imaging revealed an intra-cavity soft tissue mass measuring 6.5 cm. Hysteroscopy with dilation and curettage was performed and showed fibrous bands covering a soft mass of products of conception, which was then evacuated.