Massive ovarian edema: a case of over 30 cm ovarian mass in young woman.

Massive ovarian edema is a rare entity that can be confused with ovarian neoplasm. A 20-year-old nulligravid woman presented with a large solid pelvic mass and abdominal mass. On examination a solid mass was found which extended from the pelvis until over the umbilical transversal line. Abdominal ultrasound revealed a solid non-homogenous mass originating from the right ovary with largest diameter of over 30 cm, fine internal echoes, regular margins, and poor vascularization. The abdominal computed tomography (CT) image was non-contributory. Blood work including hematology and biochemistry was normal. There was no sign of systemic infection and the tumour markers are negative. Unilateral adnexectomy was performed during exploratory laparotomy. Histological examination demonstrated massive ovarian edema. The adnexa weighted 1,585 g. Massive edema of the ovary remains difficult to diagnose before surgery because it may clinically and radiologically mimic an ovarian neoplasm. The majority of cases present with recurrent abdominal pain or a palpable adnexal mass. Nausea with or without vomiting can be present. Menstrual irregularities are common. Some patients have signs of masculinization including hirsutism, clitoromegaly, voice deepening, precocious puberty. However, this entity should be considered in young women presenting with an ovarian mass and abdominal pain. Treatment of massive ovarian edema is controversial.

Asthma in women with endometriosis.

INTRODUCTION: This study aimed to investigate asthma prevalence and severity in women with and without endometriosis. METHODS: Before laparoscopy, asthma prevalence was evaluated in 879 women of reproductive age, undergoing surgery because of benign gynaecological conditions. Diagnosis of bronchial asthma was based on the American Thoracic Society criteria; asthma severity was classified in four categories according to the 2002 Global Initiative for Asthma guidelines. Asthmatic patients completed the Living with Asthma Questionnaire (LWAQ). Endometriosis was confirmed histologically and classified according to the revised American Fertility Society criteria. RESULTS: There were no significant differences in age, smoking status, and other demographic and health characteristics between patients with endometriosis (n = 467) and controls (n = 412). Asthma prevalence was similar in women with (23/467, 4.9%; 95% CI, 3.1-7.3) and without (22/412, 5.3%; 95% CI, 3.4-8.0; P = 0.781) endometriosis. Asthma severity was similar in women with and without endometriosis, with 12 (52.2%) women with endometriosis and 13 (59.1%) controls being in the intermittent (mildest) degree of severity. No significant difference was observed between women with and without endometriosis in the LWAQ total score. CONCLUSIONS: Women with endometriosis do not have an increased risk of having asthma.

Revision total hip arthroplasty with a retroperitoneal approach to the iliac vessels.

Although vascular complications during revision total hip arthroplasty are rare, the results can be devastating. Reports in the literature describe staged operations, with the first procedure being abdominal to remove cement and/or the acetabular component followed by a second joint reconstruction procedure. A protocol was developed that combines a retroperitoneal approach with revision total hip arthroplasty in one operative procedure in patients at risk for vascular injury. The patient first undergoes a retroperitoneal incision and the iliac artery and vein are dissected free of surrounding tissue. A silicone loop is placed around the iliac artery and vein and brought out through the wound. The wound is temporarily closed using staples. Revision total hip arthroplasty then proceeds in the usual fashion. If hemorrhage is encountered, bleeding can be rapidly controlled by tensioning the abdominal vessel loops and opening the incision for exposure to the vessels. No complications have been encountered in 23 patients when using this approach.

Revision Total Hip Arthroplasty: The Acetabular Component.

Intermediate and long-term results of revision total hip arthroplasty performed with the use of a cemented acetabular component have been disappointing, with high rates of radiographic and clinical failure. Other methods of acetabular revision involving the use of threaded cups and bipolar implants have also met with high failure rates. Although the long-term results of revision arthroplasty with uncemented acetabular components, especially in terms of polyethylene wear and pelvic osteolysis, are not yet available, the intermediate results have been excellent.