A first reported case of clear cell carcinoma associated with delayed extrusion of midurethral tape.

We present the first reported case of clear cell carcinoma associated with a midurethral tape (MUT), the possible hypotheses and the management pitfalls we encountered. We report a 58-year-old woman who presented with symptoms of urinary tract infection and acute retention of urine associated with vaginal tape exposure 10 years after placement of an inside-out transobturator tape. She subsequently had a partial transobturator tape excision and a diagnostic cystoscopy, which revealed inflammatory changes within the urethra. Postoperatively, her symptoms persisted and the vaginal epithelium healed poorly. A biopsy of the friable tissue reported clear cell carcinoma. Imaging showed a locally invasive periurethral mass and bony and lymphatic metastases. This was treated with palliative radiation therapy. She was still receiving palliative care 5 months after the initial surgery.

Venous Thromboembolism and Adenomyosis: A Retrospective Review.

OBJECTIVES: The objective of the study was to evaluate the incidence of venous thromboembolism (VTE) in patients who have been admitted for adenomyosis at our institute and describe their clinical characteristics and management. MATERIALS AND METHODS: A retrospective review of the medical records of all patients who were admitted to the gynecology ward between January 2015 and August 2016 was conducted, and all patients who had adenomyosis were included in this study. Clinical details that were evaluated included age, parity, body mass index, significant comorbidities, size of the uterus on physical examination, the size of the adenomyoma (if present) on pelvic ultrasonography, initial hemoglobin, and hematocrit on admission, whether blood transfusion was required, acute and long-term treatment and whether or not there were any associated VTE and treatment given. RESULTS: Forty-one patients were included in this study. Five (12.2%) out of the 41 patients had associated VTE; all five had pulmonary embolism (PE), while two also had a concurrent left lower limb deep-vein thrombosis. Three out of the five patients had worsening menorrhagia following anticoagulation, which gonadotropin-releasing hormone analogs were effective in controlling. Four of the five patients eventually underwent a hysterectomy for long-term management of adenomyosis. CONCLUSION: This case series describes a few clinical cases where VTE (particularly PE) has been observed with adenomyosis, the challenges in managing these patients, and effective treatment approaches.

A review of Zika virus infections in pregnancy and implications for antenatal care in Singapore.

Given the consensus that there is a causal relationship between Zika virus (ZIKV) infection in pregnancy and congenital Zika syndrome (CZS), clinicians must be prepared to manage affected patients despite the numerous gaps in current knowledge. The clinical course in pregnancy appears similar to that in non-pregnant women, although viraemia may be prolonged. ZIKV infection can be diagnosed by serum and urine reverse transcription-polymerase chain reaction, but commercially available serological tests are currently unreliable in dengue-endemic regions. Although vertical transmission can occur at any time during gestation, first- and second-trimester infections have the highest risk of developing central nervous system anomalies. Aberrant fetal growth and pregnancy loss may also occur. Serial ultrasonography should be conducted for infected cases. Without a vaccine, pregnant women should be advised to minimise mosquito bites and reduce sexual transmission risk. Overall, the absolute risk of CZS arising amid a ZIKV outbreak appears relatively low.