Thirteen weeks ovarian pregnancy following in vitro fertilization for primary infertility treatment: a case report

Ovarian pregnancy constitutes 0.15-3% of all ectopic pregnancies. The incidence of ectopic pregnancy is on the rise owing to evolution in assisted reproductive techniques [ART]. The incidence reported following In vitro fertilization [IVF] or embryo transfer [ET] is 0.27% per clinical pregnancy. We present a case of a 13-weeks ovarian pregnancy following IVF-ET and through a review of the literature, the specific symptomatology, diagnostic criteria, and treatment of this particular pathology will be described. Ovarian pregnancy is a rare condition and its diagnosis is difficult and relies on criteria based on intraoperative and histopathological findings. The management is, in spite of medical improvement, based on surgery. But the trend has shifted towards conservative surgeries in majority of cases

Comparing the efficacy of preoperative magnetic resonance cholangiopancreatography with intra-operative cholangiography in patients suspicious to biliary stones

This study was performed to compare the efficacy of preoperative magnetic resonance cholangiopancreatography [MRCP] and intra-operative cholangiography [IOC] methods in patients suspicious to gall stones. According to previous studies, it is recommended that common bile duct investigation should be done in order to rule out choledocholithiasis in all patients with symptomatic cholelithiasis. IOC is an invasive procedure with probable complications, it would seem that MRCP could replace the direct cholangiography. In a diagnostic clinical trial, Fifty-nine patients with symptomatic biliary stones or cholecystitis were recruited in this study. The included patients had normal size biliary ducts in sonography but high serum alkaline phosphatase level. Preoperative MRCP and IOC were performed for the patients and the obtained results were analyzed and compared. The positive predictive value for IOC was 88% and for MRCP was 43%. The diagnostic accuracy of IOC and MRCP were 98% and 85% respectively, suggesting that IOC is much more diagnostically accurate. There were no significant difference in specificity and sensitivity of these two methods. According to the results, we can conclude that MRCP may not obviate the need for IOC. The suggestion for routine use of MRCP instead of IOC and as a substitution of that procedure needs further investigations on more patients

Heart trauma

To report five cases of heart trauma, managed in a civil trauma surgery ward in one year and to carry out a review of literature .Three young male patients have been transferred to our center after direct stab wound to their upper chest at the left side. Another one was a sixty years old man who was trapped between two parts of an elevator door and the fifth case was an iatrogenic trauma during bone marrow biopsy in a fifty five years old patient. All of them underwent emergency left sided anterior thoracotomy because of the positive signs of cardiac tamponade and circulatory instability. The exploration revealed cardiac tamponade in all cases due to three perforations in right ventricle, one perforation in left ventricle at the apex and one perforation at the root of aorta. Echocardiography was performed in one case and revealed cardiac tamponade. In all cases repair of perforation in the beating heart was performed. Four patients survived. Heart trauma is an emergent and life threatening situation which needs immediate surgical intervention without any unnecessary workup. The outcome of surgery depends on several factors including trauma surgery team expertise