Perineal endometriosis with anal sphincter involvement

Perineal endometriosis with anal sphincter involvement is a rare occurence with only 11 reported cases so far. This is a case of a 32 year old woman presenting with cyclic perineal pain, abnormal uterine bleeding, and a history of episiotomy. On physical examination, a perineal mass was palpated. There was also finding of an endocervical polyp. Endoanal sonography revealed external anal involvement of the perineal mass. Surgical excision of the endometric mass together with part of the external anal sphincter was carried out. The procedure was followed by anal sphincter reconstruction in an "overlapping" fashion. A fractional curettage with cervical polypectomy was also done. Histopathologic tests confirmed endometriosis and endocervical polyp. She was then given mefenamic acid for the pain. Since then, the patient has been asymptomatic. There were no complications and no anal incontinence. Awareness of the occurence of this rare type of extrapelvic endometriosis is important in the management of patients presenting with perineal pain occurring during menses.

Thyrotoxic periodic paralysis in mexican mestizo patients: a clinical, biochemical and HLA-Serological study

Background. Thyrotoxic periodic paralysis (TPP) is characterized by episodes of neuromuscular weakness occurring in the context of hypokalemia and hyperthyroidism and has been predominantly described in Oriental populations. Whereas it is uncommon in Caucasians and Blacks, TPP does occur in individuals of Native American descent. The objective was to analyze the clinical, biochemical, and HLA characteristics of group of Mexican mestizo patients with TPP. Methods. The sample was comprised of 14 men with TPP diagnosed since january 1990, based on one or more episodes of flaccid paralysis, accompanied by hypokalemia and occurring in the context of clinical and biochemical hyperthyroidism. Eight were available HLA testing. Results. Hyperthyroidsm was diagnosed before the development of periodic paralysis in five of the patients, whereas in six it occurred afterward. The severity of paralysis did not correlate with the degree of either hypokalemia or hyperthyroidism. An increased frequency of HLA-DR3 was found in Graves' patients without paralysis but not in those with paralysis, as compared to the general population. Conclusions. TPP is more common than previously thoought in Mexicans, in whom it behaves as in other Native American groups. The lack of HLA-DR3 association in Graves' patients with TPP is interesting, but at the moment has no pathophysiological implications