Behcet's disease associated with hyperthyroidism: case report and review of literature

Behcet's Disease is a multi-system, chronic inflammatory disorder characterized by chronic relapsing course. Its principal manifestations are oral and genital ulcers as well as inflammation of the eyes, skin and joints, while vascular and neurological complications may results in death. The etiology and pathogenesis of the disease are still obscure and specific treatment is not available. We report the case history of a patient with Behcet's Disease. He presented with fever, arthritis and weight loss of 3-week duration. He was also found to have hyperthyroidism, extra-pulmonary tuberculosis, and strongyloidiasis. Although, the association between thyroid diseases and auto-immune connective tissue disorders as well as tuberculosis is well recognized, there had been, to the best of our knowledge, no reports of Behcet's Disease associated with thyroid dysfunction. However, further studies are required to investigate any association between Behcet's Disease and thyroid dysfunction

Fetal macrosomia greater than or equal to 4000 grains. Comparing maternal and neonatal outcomes in diabetic and nondiabetic women

To compare maternal and neonatal outcomes of fetal macrosomia in diabetic and nondiabetic women. A retrospective case-control study was conducted at Riyadh Military Hospital, Riyadh, Kingdom of Saudi Arabia from January 2004 to December 2006. A total of 766 macrosomic newborns met the inclusion criteria. We compared maternal and neonatal characteristics and outcomes between diabetic [group 1, n=207] and nondiabetic [group 2, n=559] women. There were significantly more macrosomic newborns in nondiabetic women; 73% versus 27% in diabetic women, p=0.0001. Cesarean deliveries were significantly higher in diabetic women compared to nondiabetic women [30.4% versus 19.5%, p=0.002]. There were no significant differences between either group in total maternal morbidity [12.6% versus 14.1%, p=0.7]. There were significantly more severe cases of shoulder dystocia occurring in newborns of diabetic women compared to nondiabetic women [1.9% versus 0.2%, p=0.03]. Elective cesarean delivery for estimated fetal weight >/= 4500g for nondiabetic women and >/= 4250 g for diabetic women may avoid severe shoulder dystocia without increasing maternal morbidity rates

Laparoscopic management of non-communicating rudimentary horn in a dysmenorrheic and infertile patient

A case of laparoscopic excision of non-communicating rudimentary horn. The anatomical features of this case were unique. A 19-year-old nulligravida presented with severe dysmenorrhea and primary infertility. Hysterosalpingogram revealed a left uterine horn that had a solitary patent tube. Magnetic resonance imaging showed a left unicornuate uterus continuous with the cervix and the vagina, and a rudimentary right uterine horn. This confirmed the diagnosis of non-communicating cavitated right rudimentary horn. At laparoscopy the patient had stage III endometriosis, and non-communicating right rudimentary horn, which was attached to the unicornuate uterus by a long fibrous band. The rudimentary horn was freed from the pelvic side wall, excised and removed laparoscopically with no complication

Polycystic ovary syndrome and insulin resistance: a new approach to understanding its pathogenesis and management

Herein we review the role of insulin resistance in the pathogenesis of polycystic ovary syndrome [PCOS] in infertile women and the current view of laparoscopic ovarian drilling for women with clomiphene-resistant PCOS. We evaluated the medical and surgical treatment of PCOS with special emphasis on the laparoscopic approach. Pertinent studies and their references were identified through computer MEDLINE search. It was found that to date there is no standardization of the technique of laparoscopic ovarian drilling, through it can be offered to clomiphene-resistant PCOS women. The ovulation rates after ovarian drilling with electrocoagulation or laser are 83% and 77.5%, respectively and the cumulative pregnancy rates at 12 months after surgery are 65% and 54.5%, respectively. Metformin may be included in a stepwise approach for medical ovulation induction before a surgical approach. Laparoscopic ovarian drilling with electrocautery is superior to laser drilling and gonadotrophin therapy

management of Pyonephrosis

Sixty cases of pyonephrosis were treated in an 8-year period between 1977 and 1987. All patients were treated surgically. The operation consisted of primary nephrectomy. In contrast, nephrostomy as initial treatment was performed in some cases, There were many major complications [i.e. leading to death or substantial prolongation of hospitalization]. This experience suggests that nephrostomy is indicated when the patient is severely ill or the kidney is expected to recover function. Where dialysis is available, it may be applied to improve the patient's condition for a definitive radical operation instead of nephrostomy. It was prefered by us to apply percutaneous drainage where function appeared to be limited and there is still some function of the kidney by isotopic screening

Neoplasms and cysts of the mediastinum, clinical presentation, methods of diagnosis and management

This study included fifty five patients, thirty one males and twenty four females, who were admitted for mediastinal masses in Alexandria main University Hospital during the period from 1980 to 1988. Symptoms and signs were present in 60.5% of patients, such as cough in 18.2% Dyspnoea in 10%, Chest pain in 10%, superior vena canal obstruction in 7.3%, Dysphagia in 5%, and other. 42 of the presenting patients required thoracotomy for diagnosis and treatment, 9 patients were diagnosed by mediastinoscopy and mediastinotomy, the remaining cases were diagnosed by lasser procedures such as cervical lymph node biopsy in two patients, fiberoptic bronchoscopy was done in two and the remaining patient diagnosed by CT guided needle biopsy. The primary mediastinal masses included mediastinal lymphadenopathy [41.8%], mediastinal cysts [14.55%], thymic tumors [10.9%], retrosternal goitre [7.27%], carcinoma of the mediastinum [5.45%], germ cell tumors [5.45%], mesenchymal tumors [3.64%], and neurogenic tumors [7.27%]. The anterosuperior mediastinum was the most commonly involved site of mediastinal masses [65.5%], followed by the posterior mediastinum [21.8] and the middle mediastinum [10.9%]. 45.5% of the cases were treated by excision, 45.5% were treated by excision followed by radio therapy and chemotherapy and 9.1% were treated medically by antituberculous drugs and steroids