Re-torsion of the ovaries.

The increasing use of de-torsion of the ovaries may result in re-torsion. This review addresses risk of re-torsion and describes preventive strategies to avoid re-torsion in pre-menarcheal girls, and fertile and pregnant women. We clinically reviewed PubMed, Embase, Trip and Cochrane databases. The main outcome measures were re-torsion and viability of ovary with fixation measures. A total of 38 publications including 71 girls, 363 fertile women, and 69 pregnant women were found to be relevant. All studies were case reports or case series, sometimes with non-randomized controls. The studies show considerable heterogeneity in design, population, management and outcome. Only four studies included more than 50 cases. In pregnancy the risk of re-torsion was as high as 19.5-37.5%; among fertile women it was 28.6%. Most articles concluded that fixation of the ovaries to the pelvic sidewall or plication of the ovarian ligament after torsion may prevent re-torsion. In one case a girl experienced re-torsion after ovariopexy. Based on observational studies it seems that de-torsion and fixation of the ovary is a safe procedure that usually ensures maintenance of ovarian function and reduces the risk of recurrence, especially when there are no ovarian cysts or adnexal masses.

[Tubercular spondylodiscitis in a young woman with thoracic backpain]. / Tuberkuløs spondylodiskitis hos en ung kvinde med torakale rygsmerter.

We present a case of a young woman experiencing high thoracic backpain and neurological symptoms of medullar compression due to spondylodiscitis from Mycobacterium tuberculosis. An important differential diagnosis of spondylodiscitis is metastatic lesions of the spine. Metastatic lesions most often appear in the thoracic region of the spine and high thoracic pain should be considered a "red flag". Both conditions often show up late on conventional imaging and we discuss the need for the primary sector to be able to refer directly to magnetic resonance imaging for quick and reliable diagnosis.

[Craniopharyngeoma preceded by many years of psychological peculiarity in a young man].

We present a case of a young man with severe hypothermia on the basis of a large craniopharyngeoma. He had been psychologically peculiar since the age of six and had deteriorated dramatically since his late teens. Craniopharyngeomas are slowly developing benign tumours but they can cause severe damage to the neuroendocrinological systems or hypothalamus causing a wide range of symptoms including psychiatric disorders and hypothermia. Intracraniel neoplasms should be considered as a differential diagnosis in cognitive dysfunction in the young or in acute hypothermia.