Ovarian strumal carcinoid: a case report.

BACKGROUND: Carcinoid tumors of the ovary are rare tumors, histopathologically classified as monodermal teratomas and somatic-type tumors arising from dermoid cysts. Their malignancy varies from borderline to malignant. Carcinoid tumors can occur in young and elderly women, and are sometimes seen in mature teratoma, struma ovarii, or mucinous cystadenoma as a nodule or tumor. Strumal carcinoid and mucinous carcinoid present as special types of carcinoid tumors of the ovary. CASE REPORT: This report describes a 56-year-old woman who presented with a large pelvic mass on abdominal ultrasonography during a medical examination. The diameter of the pelvic tumor was approximately 11 cm and was suspected to be ovarian cancer. The values of CA125 and CEA were above their reference intervals on preoperative examination. Abdominal total hysterectomy and bilateral salpingo-oophorectomy were performed. Intraoperative frozen-section histopathology suggested a diagnosis of mucinous adenocarcinoma; therefore, partial omentectomy and pelvic lymphadenectomy were also performed. Permanent-section histopathology led to a final diagnosis of strumal carcinoid of the ovary, stage IA (FIGO 2014). Six years post-operation, the patient had no sign of recurrence.

Delayed Birth-Related Femur Fracture after Cesarean Section: A Case Report.

Background Birth-related femur fractures are rare. They have been reported following difficult delivery and are commonly diagnosed immediately after birth or on the following day. However, some birth-related femur fractures are diagnosed several days after birth. Mechanisms underlying the development of delayed femur fracture are incompletely understood. Case We report the case of a girl diagnosed with a left spiral femur fracture with associated edema and hypoesthesia on postpartum day 9. A nondisplacement femur fracture was identified on plain radiography at birth after cesarean section; however, it was undiagnosed due to the lack of symptoms. She was treated with plaster cast fixation; the physical examination at age 1 was normal. Herein, the diagnosis of birth-related femur fracture according to plain radiography findings suggests that the symptoms related to birth trauma develop several days after birth. Conclusion Birth-related fracture should be considered in all neonatal femur fracture cases and in patients with no symptoms at birth. Neonates delivered in the breech presentation by cesarean section should be carefully monitored after birth. The findings of the present case further our understanding of the pathogenic mechanisms underlying delayed diagnosis of birth-related femur fracture.

Effects of exogenous big endothelin-1 on regional blood flow in fetal lambs.

OBJECTIVE: Endothelin-1, a 21 amino acid polypeptide produced by vascular endothelial cells, has potent vasoactive properties. The purpose of this study was to estimate the effects of exogenous big endothelin-1 on fetal lamb circulation. METHODS: Regional blood flow was measured by the colored microsphere technique during continuous infusion (60 minutes) of big endothelin-1, or saline (control), in 12 chronically instrumented sheep fetuses. RESULTS: After 60 minutes of big endothelin-1 administration, the fetal plasma endothelin-1 concentration increased significantly from 24.0 +/- 6.7 to 49.7 +/- 31.4 pg/mL (P = .018) without significant changes in fetal arterial blood gases. Continuous infusion of big endothelin-1 decreased blood flow in most organs except the brain and the heart. After the big endothelin-1 infusion, the blood flow to the brain significantly increased from 158 +/- 51 to 174 +/- 71 mL/min/100 g (P = .002); the blood flow to the heart also increased significantly from 171 +/- 95 to 200 +/- 112 mL/min/100 g (P = .001), respectively. CONCLUSION: Continuous infusion of endothelin-1 decreases blood flow in most of organs except the brain and the heart. It is likely that endothelin-1 plays an important role in fetal redistribution of blood flow.

Effects of nitric oxide and prostacyclin on hemodynamic response by big endothelin-1 in near term fetal sheep.

AIMS: To measure plasma concentrations of endothelin (ET)-1, NO metabolites (nitrate/nitrite; NOx) and 6-keto PGF1 alpha (PGF1 alpha) in maternal and fetal sheep blood, and to evaluate the effects of big ET-1 on hemodynamic response, blood gases and NO and 6-keto PGF1 alpha production in near term fetal sheep. METHODS: Hemodynamic parameters were measured during infusion of big ET-1 into the carotid vein in chronically catheterized fetal sheep on day 125 of gestation. Fetal arterial blood samples were obtained for ET-1, PGF1 alpha) and nitrate/nitrite (NOx) measurements. RESULTS: ET-1, NOx and PGF1 alpha plasma concentrations were all significantly higher in fetal compared with the maternal plasma. Big ET-1 significantly decreased fetal systolic and diastolic blood pressure and significantly increased fetal heart rate. Big ET-1 stimulated plasma PGF1 alpha), but not NOx , concentration. CONCLUSIONS: Circulatory regulating factors in the fetus were up-regulated. The effects of ET-1 on fetal hemodynamic response may be mediated via prostacyclin, but not via the NO pathway.

Identification of a dysfibrinogenemia of gammaR275C (Fibrinogen Fukushima).

BACKGROUND: Various dysfibrinogenemias have been identified worldwide. This paper describes a case of dysfibrinogenemia recently identified in our laboratory. PATIENT: A 34-year-old pregnant woman without any clinical complaints was admitted to our hospital for delivery. She had an extremely low fibrinogen concentration as determined by the thrombin time method though immunoassay showed a titer within the reference range. Dysfibrinogenemia was suspected and further analyses were performed including on her family. Thrombin time was measured using human and bovine thrombin with and without calcium ion. Reptilase time was also measured. To identify the genetic mutation responsible for this dysfibrinogen, genomic DNA extracted from the blood was analyzed for mutation-rich regions in the fibrinogen gene. RESULTS: The subject, her mother and her two infants showed the same pattern of results while her father showed a regular pattern. Thrombin time calculated using both human and bovine thrombin and reptilase time was elongated in the propositus. The extent of the elongation was decreased in the presence of calcium ion. DNA sequencing showed heterogeneous fibrinogen gammaR275C mutations in the propositus, mother and two children. The father showed no mutation. CONCLUSIONS: A case of dysfibrinogenemia gammaR275C without any clinical symptoms was found by routine coagulation testing and was genetically identified.