A Sizeable Adrenal Ganglioneuroma: A Case Report.

Adrenal ganglioneuromas are mostly asymptomatic, although they may manifest with compressive local effects. We present a 27-year-old man with no medical history who was referred to the surgical oncology clinic due to the incidental finding of a left adrenal mass. The initial computed tomography (CT) abdomen revealed a large mass causing displacement of adjacent organs. A CT-guided biopsy was inconclusive, and further evaluation with an NM endo-adrenal (MIBG) medullary scan pointed to a possible diagnosis of pheochromocytoma. Laboratory tests showed normal levels of urinary metanephrine and normetanephrine. The patient's history revealed chronic abdominal pain, with no symptoms of hypertension, headache, palpitations, or sweating. Subsequently, the patient underwent a left adrenalectomy without complications. This case underscores the importance of a comprehensive approach in managing adrenal masses, particularly when dealing with non-specific symptoms, emphasizing the importance of timely diagnosis and appropriate treatment.

Retroperitoneal Lipoblastoma With Cord Compression in an Adult Patient: A Case Report.

Lipoblastoma is an extremely rare disease and mostly affects the infant to pediatric age group. Primarily, it involves the extremities, head and neck region, and rarely, the retroperitoneal region. Retroperitoneal lipoblastoma mainly presents with either abdominal pain or distension. We report a case of a 24-year-old male who presented with acute cord compression and underwent decompression and fixation with biopsy. Histopathology established the presence of lipoblastoma. Further staging workup showed no metastasis. Immunostaining and cytogenetics were positive for CD34 and negative for desmin, DNA damage-inducible transcript 3 (DDIT3), mouse double minute 2 (MDM2)(12q15), and pleomorphic adenoma gene 1 (PLAG1). The patient underwent resection of the retroperitoneal mass with intraoperative radiation therapy to the tumor bed. The histopathology identified the mass as retroperitoneal lipoblastoma. The postoperative course was uneventful and CT images showed no recurrence or metastasis. This was a unique case of retroperitoneal lipoblastoma in an adult with a unique clinical presentation.

A case report of emphysematous pyelonephritis as a first presentation of diabetes mellitus.

Emphysematous Pyelonephritis (EPN) is an acute suppurative Infection of the kidney. It is an uncommon infection, occurs mostly in patients with diabetes and a predilection for females. It has a high fatality rate; therefore, aggressive medical, early intervention or surgical approach is recommended. We present here a woman with no previous medical history presented with uncontrolled hyperglycemia for the first time associated with EPN.

An RCT: use of oxytocin drip during hysteroscopic endometrial resection and its effect on operative blood loss and glycine deficit.

OBJECTIVE: To estimate the influence of oxytocin infusion on operative blood loss and glycine deficit during hysteroscopic transcervical endometrial resection (TCRE) for abnormal uterine bleeding (AUB). DESIGN: Prospective, randomized, placebo-controlled study (Canadian Task Force classification I). SETTING: Tertiary Care University Hospital. PATIENTS: Forty-eight women with abnormal uterine bleeding that was unresponsive to conservative medical management were randomly assigned to undergo hysteroscopic TCRE with either oxytocin infusion (group A) or saline (group B). Intravenous Ringer's lactate solution was used during surgery. INTERVENTIONS: TCRE was carried out with glycine 1.5% mixed with 2% ethanol as a distension medium. For group A: one ampoule of oxytocin (10 U/mL/amp) was added to 500 mL Ringer's lactate solution running at a rate of 400 mU/min during surgery. In group B, one ampoule of saline solution was added to the Ringer's solution and run at a similar rate. The amount of distension medium used, fluid deficit, blood levels of albumin and ethanol, hematocrit, hemoglobin, changes in serum sodium levels (Na+), and central venous pressure were compared between the groups. MEASUREMENTS AND MAIN RESULTS: The mean volume of distension fluid used and operating time were not significantly different in both groups (4.18 ± 0.2 vs 4.5 ± 0.5 L, and 28.3 ± 4.2 vs 27.5 ± 5.4 min, respectively). Although operating time, volume of distension fluid used, decrease in albumin level and hematocrit were less in the oxytocin than in the saline group, the differences were not statistically significant. The ethanol levels in blood, decrease in serum Na+, and glycine deficit were significantly lower in the oxytocin than in the saline group (17.4 ± 3.8 vs 25.3 ± 4.2 mg/ml, 6.7 ± 1.2 vs 9.1 ± 0.9 mEq/L, and 0.49 ± 0.08 vs 0.66 ± 0.05 L, respectively; p <.05). There was no significant difference in mean total uterine size, endometrial thickness, weight of resected tissue, and other demographic data between the study groups. CONCLUSIONS: Oxytocin infusion combined with skillful surgical techniques may prevent fluid overload and glycine deficit during hysteroscopic TCRE for abnormal uterine bleeding. Although there is a trend toward a decrease in operative blood loss, further randomized trials are required to confirm this finding.

Effect of childhood kidney transplantation on puberty.

OBJECTIVE: To evaluate sexual and linear growth in kidney transplant (KTX) children receiving cyclosporine A, low-dose prednisolone and azathioprine. STUDY DESIGN: Prospective case-control study. SETTING: University-affiliated urology and nephrology center, obstetric and gynecology departments. PATIENT(S): Eighteen girls and 21 boys with successful KTX before the age of 16 years. Controls were healthy and age matched (200 girls and 171 boys). INTERVENTION(S): Assessment of sexual maturation by Tanner staging and linear growth by height standard deviation score (HSDS) and height increment (HI). MAIN OUTCOME MEASURE(S): Pubertal age in KTX vs. control, ratios of KTX with normal and retarded sexual maturation and linear growth. RESULT(S): Puberty in KTX children was significantly delayed compared with controls. Delayed sexual maturation was found in 22.2% of girls and 19.1% of boys, and poor HSDS was found in 38.9% of girls and 33.3% of boys. Improvement in HSDS was significantly lower in girls compared with boys. Improvement in HSDS did not significantly differ in prepubertal vs. pubertal children. Prepubertal HI was significantly higher than pubertal HI in boys, but not in girls. Significant negative correlation was found between HI, duration of immunosuppression, and serum creatinine level. CONCLUSION(S): KTX children receiving cyclosporine A, low-dose prednisolone, and azathioprine showed acceptable sexual and physical maturation in a majority of cases. Impaired sexual and linear growth after receiving KTX is related to poor graft function, post-KTX interval, and gender.

Submucous myomas and their implications in the pregnancy rates of patients with otherwise unexplained primary infertility undergoing hysteroscopic myomectomy: a randomized matched control study.

OBJECTIVE: To determine whether hysteroscopic myomectomy for submucous fibroids in women with unexplained primary infertility achieved better pregnancy rates than no intervention. DESIGN: Prospective randomized matched control trial. SETTING: Tertiary university fertility care unit. PATIENT(S): From January 1999 to February 2006, a total of 215 women with unexplained primary infertility and with ultrasonographically diagnosed submucous myomas as the sole cause for fertility failure were recruited. INTERVENTION(S): Women were randomly allocated to one of two pretreatment groups matched by age. Hysteroscopic myomectomy was performed in the study group (n = 101). Diagnostic hysteroscopy and myoma biopsy was performed in the control group (n = 103). No fertility therapy was given for either group. MAIN OUTCOME MEASURE(S): Clinical pregnancy rates according to patient and myoma characteristics. RESULT(S): The baseline characteristics of both patients and submucous myomas were comparable. Among patients with complete follow-up, a total of 93 (45.6%) pregnancies occured-64 (63.4%) in the study group and 29 (28.2%) in the control group. Women in the study group had a better possibility of becoming pregnant after hysteroscopic myomectomy with a relative risk of 2.1 (95% confidence interval, 1.5-2.9). No difference in pregnancy rates was observed according to size, number, and location of myomas in both groups. However, fertility rates appeared to increase after hysteroscopic myomectomy of type 0 and type I myomas (P < 0.05). In contrast, for the subgroup of patients with type II myomas, no difference in fertility rates were noted. CONCLUSION(S): Hysteroscopic myomectomy for submucous fibroids in women with unexplained primary infertility is effective in achieving a better pregnancy rate. We think that a multicenter study should be conducted before evaluating the impact of submucous myoma characteristics on fertility outcome.

The effect of luteal phase support protocol on cycle outcome and luteal phase hormone profile in long agonist protocol intracytoplasmic sperm injection cycles: a randomized clinical trial.

OBJECTIVE: To study the effect of luteal phase support protocol on cycle outcome and luteal phase hormone profile, in long agonist protocol intracytoplasmic sperm injection (ICSI) cycles. DESIGN: Prospective randomized trial. SETTING: Private infertility center. PATIENT(S): Two hundred seventy-four women undergoing first ICSI cycles were randomized after ovum pickup into three groups of luteal support. INTERVENTION(S): Group I received IM P (P(4)) only, group II received P(4) + oral E(2) valerate, group III received P(4) + hCG. MAIN OUTCOME MEASURE(S): Pregnancy rate (PR), implantation rate, rates of multiple pregnancy and miscarriage, and midluteal serum E(2) and P(4), and midluteal E(2):P(4) ratio. RESULT(S): The PR and implantation rates were significantly higher in group II compared to group I and the miscarriage rate was significantly lower in group II compared with group I. Midluteal E(2) was significantly higher in group II compared with group I. The decline in E(2) after ovum pickup was lowest in group II, highest in group I. The midluteal E(2):P(4) ratio was significantly higher in group II compared with groups I and III. CONCLUSION(S): The E(2) luteal phase supplementation in long GnRH-agonist (GnRH-a) protocol ICSI cycles resulted in better cycle outcome and better luteal phase hormone profile.