Chronic ectopic pregnancy presenting as a suspected tubo-ovarian abscess: a diagnostic dilemma.

Though there is no definite agreement on diagnostic criteria or definition of chronic ectopic pregnancy (CEP), it could be deemed to be a variant of pregnancy of unknown location with non-specific clinical signs and symptoms. This was a case of a para 2+2 who presented with lower abdominal pain and bleeding per vaginum, and initial ultrasound was suggestive of a tubo-ovarian abscess/mass. With a further MRI scan and a diagnostic laparoscopy, she was found to have a CEP and had a laparoscopic salpingectomy for management. The diagnosis of CEP could be quite challenging as a result of the protracted symptoms, often negative/low serum B-HCG and ultrasound features mimicking a pelvic mass. A high index of suspicion is needed, and an MRI scan and diagnostic laparoscopy often aid in diagnosis and management.

Fimbrial dermoid cyst with elevated CA19-9 levels: A case report.

We report the case of a 39-year-old woman who presented in an acute setting with pelvic pain, an adnexal mass on imaging and a high CA19-9 level. She was taken for surgery, where a large dermoid cyst was found at the fimbrial end of a fallopian tube at the time of laparoscopy, with no apparent connection to either ovary and absence of ovarian necrosis. This was corroborated on final histology. Dermoid cysts in aberrant locations are usually reported at Caesarean section or during laparoscopic sterilisation and thus, understandably, a pre-operative CA19-9 level is rarely available. That and the rarity of these 'ectopic dermoids' make it hard to give further support for a causative association with the high tumour marker levels. Some authors suggest that auto-amputation of a dermoid cyst or part thereof and subsequent reimplantation may give rise to this phenomenon, and thus the term 'wandering dermoid' has been applied to similar situations. This is what we postulated as the cause in our case. It is likely that a full understanding of the aetiology of wandering dermoid cysts will remain elusive, given the paucity of cases.

A neglected shelf pessary resulting in a urethrovaginal fistula.

Vaginal pessaries are safe, simple and effective treatment for pelvic organ prolapse. However, they must be fitted and followed-up correctly as serious complications can arise when pessaries are neglected. In this case report, we present the first reported case of a urethrovaginal fistula due to a neglected shelf pessary.

Interstitial cystitis/bladder pain syndrome: an update.

Interstitial cystitis, or painful bladder syndrome, is a condition characterized by bladder pain, urinary frequency, urgency, and nocturia. The cause of the condition remains obscure and it remains a diagnosis of exclusion. Current theories of pathogenesis include a chronic or subclinical infection, autoimmunity, neurogenic inflammation or bladder urothelial defects. The definitions and terminology have undergone several proposed changes in the last five years. The International Incontinence Society (ICS) provided a revised definition of painful bladder syndrome (PBS) in 2002. The European Society for the Study of Interstitial Cystitis (ESSIC) proposed a new nomenclature, "bladder pain syndrome", and classification system in 2008 for the same condition. Treatment strategies can be categorized broadly into four different approaches: (i) intravesical drug instillation, (ii) systemic (oral) medical therapy, (iii) administration of local treatments, and (iv) surgical procedures for refractory disease. Intravesical drug instillation or oral therapies are the mainstay of treatment.

Modification of rat detrusor muscle contraction by ascorbic acid and citric acid involving enhanced neurotransmitter release and Ca2+ influx.

AIMS: Consumption of carbonated soft drinks is independently associated with the development of overactive bladder (OR 1.41, 95% Cl 1.02-1.95). We have shown previously that artificial sweeteners, present in carbonated soft drinks, enhanced detrusor muscle contraction. Other constituents of soft drinks are preservatives and antioxidants, we evaluated the effects of two of these, ascorbic acid and citric acid, on the contractile response of isolated rat bladder muscle strips. METHODS: Detrusor muscle strips were suspended in a perfusion organ bath. We determined the effect of ascorbic acid and citric acid on the contractile responses to electrical field stimulation (EFS) in the absence and presence of atropine, carbachol, alpha, beta methylene ATP, potassium and calcium. RESULTS: Ascorbic acid and citric acid (10(-7) M to 10(-3) M) enhanced the contractile response to 10 Hz EFS compared to control (P < 0.01). The frequency and amplitude of spontaneous bladder contractions were enhanced in the presence of ascorbic acid and citric acid by 14%, 21%, 21%, and 11% respectively. Ascorbic acid 10(-4) M significantly increased the atropine resistant response to EFS 5 Hz by 37% (P < 0.01) and inhibited contraction in response to carbachol 10(-4) M by 24%, (P < 0.05). Both ascorbic acid 10(-4) M and citric acid 10(-5) M significantly enhanced maximum contractile responses to alpha, beta methylene ATP, KCI and calcium compared to control. CONCLUSIONS: Ascorbic acid and citric acid augmented bladder muscle contraction possibly by enhanced Ca(2+) influx. Presynaptic neurotransmitter release was enhanced by ascorbic acid. Carbonated beverages containing preservatives may aggravate symptoms of OAB.

Enhancement of rat bladder contraction by artificial sweeteners via increased extracellular Ca2+ influx.

INTRODUCTION: Consumption of carbonated soft drinks has been shown to be independently associated with the development of overactive bladder symptoms (OR 1.62, 95% CI 1.18, 2.22) [Dallosso, H.M., McGrother, C.W., Matthews, R.J., Donaldson, M.M.K., 2003. The association of diet and other lifestyle factors with overactive bladder and stress incontinence: a longitudinal study in women. BJU Int. 92, 69-77]. We evaluated the effects of three artificial sweeteners, acesulfame K, aspartame and sodium saccharin, on the contractile response of isolated rat detrusor muscle strips. METHODS: Strips of detrusor muscle were placed in an organ bath and stimulated with electrical field stimulation (EFS) in the absence and presence of atropine, and with alpha,beta methylene ATP, potassium, calcium and carbachol. RESULTS: Sweeteners 10(-7) M to 10(-2) M enhanced the contractile response to 10 Hz EFS compared to control (p<0.01). The atropine-resistant response to EFS was marginally increased by acesulfame K 10(-6) M, aspartame 10(-7) M and sodium saccharin 10(-7) M. Acesulfame K 10(-6) M increased the maximum contractile response to alpha,beta methylene ATP by 35% (+/-9.6%) (p<0.05) and to KCl by 12% (+/-3.1%) (p<0.01). Sodium saccharin also increased the response to KCl by 37% (+/-15.2%) (p<0.05). These sweeteners shifted the calcium concentration-response curves to the left. Acesulfame K 10(-6) M increased the log EC(50) from -2.79 (+/-0.037) to -3.03 (+/-0.048, p<0.01) and sodium saccharin 10(-7) M from -2.74 (+/-0.03) to 2.86 (+/-0.031, p<0.05). The sweeteners had no significant effect on the contractile response to carbachol but they did increase the amplitude of spontaneous bladder contractions. DISCUSSION: These results suggest that low concentrations of artificial sweeteners enhanced detrusor muscle contraction via modulation of L-type Ca(+2) channels.