Malignant Struma ovarii in a 30-year old nulliparous patient.

BACKGROUND: Struma ovarii is a rare monodermal germ cell tumor where the ovary is comprised of at least half thyroid tissue. This phenomenon may indicate an embryological origin. CASE PRESENTATION: A 30-year old nulliparous woman presented with acute right lower quadrant pain and underwent laparoscopic right salpingo-oophorectomy. The excised ovarian mass showed evidence of struma-derived papillary thyroid carcinoma. Ultrasound of the thyroid showed mild enlargement with two solid nodules. A fine needle aspirate of a thyroid nodule was positive for malignancy and a total thyroidectomy was performed. Microscopic features of the thyroid were consistent with papillary thyroid carcinoma. The two tumours were considered as synchronous independent primaries based on their histological presentation. CONCLUSIONS: We believe that aggressive surgical management followed by radioiodine therapy is best to reduce recurrence risk and optimize survival. The broad scope of interventions needed to treat malignant struma ovarii require a strong interdisciplinary team.

Uterine exteriorization compared with in situ repair for Cesarean delivery: a systematic review and meta-analysis.

PURPOSE: To compare perioperative outcomes following uterine exteriorization vs in situ repair after Cesarean delivery. SOURCE: We searched CENTRAL, MEDLINE®, EMBASE™, CINAHL, and ClinicalTrials.gov for randomized clinical trials that included any of our primary outcomes (blood loss, intraoperative nausea, vomiting, and pain), or secondary outcomes. PRINCIPAL FINDINGS: Sixteen studies were included. In total, 9,736 subjects underwent exteriorization, 9,703 had in situ uterine repair. Estimated blood loss was not statistically different between the two methods of uterine repair (mean difference [MD], -61.03 mL; 95% confidence interval [CI], -127.34 to 5.28); however, exteriorization reduced the decrease in hemoglobin (MD, -0.14 g·dL(-1); 95% CI, -0.22 to -0.07). Estimated blood loss was reduced with exteriorization in a sensitivity analysis that excluded an outlier study. There was no statistically significant difference in intraoperative nausea (odds ratio [OR], 0.99; 95% CI, 0.74 to 1.34), vomiting (OR, 0.94; 95% CI, 0.66 to 1.35), or pain (OR, 1.52; 95% CI, 0.86 to 2.71) between the two repair techniques. In situ repair was associated with faster return of bowel function (MD, 3.09 hr; 95% CI, 2.21 to 3.97). An association between exteriorization and endometritis did not reach statistical significance (OR, 1.25; 95% CI, 0.96 to 1.62). CONCLUSION: Uterine repair by exteriorization may reduce blood loss and the associated decrease in hemoglobin, but the difference may not be clinically relevant. There was no statistically significant difference between the two repair techniques for intraoperative nausea, vomiting, or pain. In situ repair may be associated with a faster return of bowel function.

Reducing the intensity and volume of interval training diminishes cardiovascular adaptation but not mitochondrial biogenesis in overweight/obese men.

OBJECTIVE: The purpose of this research was to determine if the adaptations to high intensity interval training (HIT) are mitigated when both intensity and training volume (i.e. exercise energy expenditure) are reduced. METHODS: 19 overweight/obese, sedentary males (Age: 22.7±3.9 yrs, Body Mass Index: 31.4±2.6 kg/m(2), Waist Circumference: 106.5±6.6 cm) performed 9 sessions of interval training using a 1-min on, 1-min off protocol on a cycle ergometer over three weeks at either 70% (LO) or 100% (HI) peak work rate. RESULTS: Cytochrome oxidase I protein content, cytochrome oxidase IV protein content, and citrate synthase maximal activity all demonstrated similar increases between groups with a significant effect of training for each. ß-hydroxyacyl-CoA dehydrogenase maximal activity tended to increase with training but did not reach statistical significance (p = 0.07). Peroxisome proliferator-activated receptor gamma coactivator-1α and silent mating type information regulator 2 homolog 1 protein contents also increased significantly (p = 0.047), while AMP-activated protein kinase protein content decreased following the intervention (p = 0.019). VO2peak increased by 11.0±7.4% and 27.7±4.4% in the LO and HI groups respectively with significant effects of both training (p<0.001) and interaction (p = 0.027). Exercise performance improved by 8.6±7.6% in the LO group and 14.1±4.3% in the HI group with a significant effect of training and a significant difference in the improvement between groups. There were no differences in perceived enjoyment or self-efficacy between groups despite significantly lower affect scores during training in the HI group. CONCLUSIONS: While improvements in aerobic capacity and exercise performance were different between groups, changes in oxidative capacity were similar despite reductions in both training intensity and volume.