Struma Ovarii with a focus of follicular variant of papillary thyroid cancer: a case report.

BACKGROUND: Struma Ovarii is a mature ovarian teratoma that consists mainly of thyroid tissue. Mature cystic teratomas may contain small amounts of thyroid tissue. Carcinomatous change in Struma Ovarii is extremely rare. No guidelines exist regarding the staging and treatment of malignant Struma Ovarii. OBJECTIVES: To report a case of Struma Ovarii with a focus follicular variant papillary thyroid cancer. CASE: A 36 year old nulligravid patient presented with a pelvic mass palpated on her routine annual exam. Struma Ovarii with a focus of follicular variant of papillary thyroid cancer was diagnosed during the subsequent laparoscopy and ovarian cystectomy. INTERVENTION: She then underwent a staging laparotomy, total hysterectomy, bilateral salpingoophorectomy, and infracolic omentecomy. FOLLOW-UP: Tumor markers, thyroid studies, thyroid scan, and whole body scans were normal. CONCLUSION: Optimal treatment and surveillance of malignant struma ovarii has yet to be determined.

Transperitoneal migration of multiple ova in a didelphic uterus: a case report.

Transperitioneal migration of the ova takes place frequently. This condition is often diagnosed during ectopic pregnancies. There are no case reports of such an occurrence in a multiple pregnancy with a didelphic uterus.

Paratubal cyst: a case report.

Paratubal cyst can undergo torsion that can make it difficult to diagnose since tubal cysts mimic ovarian cysts. Most reported cases of paratubal cysts have occurred in pediatric patients, and this type of cyst rarely causes symptoms of lower abdominal pain mimicking appendicitis. We present the case of a 28-year-old female who was taking Carbergoline for hyperprolactinoma associated with a pituitary adenoma who came to the ER at Henry Ford Hospital in Detroit experiencing severe abdominal pain. Her pain was not accompanied by nausea, vomiting or other gastrointestinal symptoms. A transvaginal ultrasound revealed a normal uterus with the right ovary containing a cyst measuring 3 cm. x 2 cm. She was released on analgesics and seen at the clinic at Henry Ford Hospital three days later. She was still experiencing pain and was given antibiotics and Darvocet. When the pain had not subsided 48 hours later, a decision was made to perform diagnostic laparoscopy. Surgery was performed 10 days later and a paratubal cyst was removed that was twisted twice on its pedicle. This case illustrates the fact that torsion of paratubal cyst should be included in the differential diagnosis of adnexal pain.

Effect of gonadotropin-releasing-hormone-induced hypogonadism on insulin action as assessed by euglycemic clamp studies in men.

OBJECTIVE: In view of the relationship between hyperandrogenism and impaired insulin action in women with polycystic ovarian syndrome, we sought to investigate the effects of decreasing androgen levels on insulin action in men. DESIGN: Prospective clinical study. SETTING: University hospital. PATIENT(S): Ten normal healthy men. INTERVENTION(S): GnRH agonist, 3.75 mg monthly for 3 months. MAIN OUTCOME MEASURE(S): Rate of glucose uptake, serum insulin, and glucose levels. RESULT(S): GnRH treatment caused a significant fall in circulating testosterone levels, from 572 +/- 58 ng/dL to 178 +/- 66 ng/dL (P<.05). However, as assessed by euglycemic hyperinsulinemic clamp studies, there was no significant change in glucose uptake. CONCLUSION(S): In normal men, administration of a GnRH analogue was associated with a decrease in testosterone levels but not in insulin action.

Team approach with gynecologists taking the lead role in selecting patients for uterine artery embolization.

Uterine Artery Embolization (UAE) has become an increasingly popular treatment alternative to hysterectomy in the management of symptomatic uterine fibroids. Despite its growing promise, UAE has yet to be consistently offered by gynecologists to their qualified patient candidates. At the West Virginia University School of Medicine, Charleston Division, and Charleston Area Medical Center's Vascular Center of Excellence, we have implemented a team approach with gynecologists taking a pivotal role in the selection, co-management, and follow up of patients receiving UAE for the treatment of their uterine fibroids. We have developed a list of indications for UAE treatment in patients using our experience plus a literature search using Medline with keywords "Uterine Artery Embolization" and "Uterine Fibroids/Myomas."

Effect of gonadotropin-releasing hormone hypogonadism on insulin action as assessed by hyperglycemic clamp studies in men.

OBJECTIVE: To investigate the effects of decreasing androgen levels on insulin action, in view of the relationship between hyperandrogenism and impaired insulin action in women with polycystic ovary syndrome. DESIGN: Prospective, clinical study. SETTING: University hospital. PATIENT(S): Ten normal healthy men. INTERVENTION(S): Gonadotropin-releasing hormone (GnRH) agonist, 3.75 mg, administered monthly for 3 months. MAIN OUTCOME MEASURE(S): Insulin action (M/I ratio). RESULT(S): The M/I ratio decreased from 0.24 +/- 0.04 to 0.17 +/- 0.04 after GnRH agonist therapy. CONCLUSION(S): In normal men, administration of a GnRH analogue was associated with a decrease in both testosterone levels and insulin action.

A case of molar ectopic pregnancy.

OBJECTIVE: To evaluate the occurrence of molar pregnancy in tubal ectopic pregnancy. DESIGN: Case report. SETTING: Outpatient clinic. PATIENT(S): A 27-year-old woman. INTERVENTION(S): Salpingectomy. MAIN OUTCOME MEASURE(S): Molar ectopic pregnancy. RESULT(S): Ectopic partial molar pregnancy. CONCLUSION(S): Molar pregnancy can occur in ectopic pregnancy. Molar pregnancy clinically mimics normal tubal ectopic pregnancy.

Values of fasting glucose levels, glucose tolerance tests, and glucose-insulin ratios as predictors of glucose tolerance.

OBJECTIVE: To examine the ability to use parameters obtainable from an oral glucose tolerance test to predict insulin action as determined under hyperinsulinemic, hyperglycemic conditions. DESIGN: Prospective clinical investigation. SETTING: University medical center clinical research unit. PATIENT(S): Healthy male volunteers. INTERVENTION(S): Oral glucose tolerance test and hyperglycemic (+125 mg/dL) clamp studies. MAIN OUTCOME MEASURE(S): Glucose and insulin (I) levels, rate of glucose uptake (M) under hyperglycemic conditions, and M/I ratios. RESULT(S): Among individuals with normal glucose tolerance, as assessed by an oral glucose tolerance test, the fasting insulin level is the glucose tolerance test parameter that correlates best with insulin action during a hyperglycemic clamp. CONCLUSION(S): Measurement of fasting serum insulin levels in conjunction with an oral glucose tolerance test improves the ability to assess insulin action. Such combinations may improve the ability to diagnose insulin-resistant states.

Seprafilm (modified hyaluronic acid and carboxymethylcellulose) acts as a physical barrier.

OBJECTIVE: To characterize the molecular changes that occur in normal fibroblasts, adhesion fibroblasts, and mesothelial cells as a result of exposure to modified hyaluronic acid and carboxymethylcellulose (Seprafilm). SETTING: University research laboratory. DESIGN: Human mesothelial and fibroblast cell culture. MAIN OUTCOME MEASURE(S): Multiplex reverse transcriptase polymerase chain reaction was used to examine control and Seprafilm-treated normal peritoneal fibroblasts, adhesion fibroblasts, and mesothelial cells in culture for levels of messenger RNA from molecules known to be associated with adhesion development (transforming growth factor-beta 1, type I collagen, matrix metalloproteinase-1, matrix metalloproteinase-2, tissue inhibitor of metalloproteinase-1, and tissue plasminogen activator). RESULT(S): Seprafilm treatment of normal peritoneal fibroblasts, adhesion fibroblasts and mesothelial cells did not alter the expression of markers examined. CONCLUSION(S): In the absence of a biological effect of Seprafilm on markers known to be involved in postoperative adhesion development, the ability of Seprafilm to reduce postoperative adhesions is most likely caused by its effect as a physical barrier.