Median arcuate ligament syndrome often poses a diagnostic challenge: A literature review with a scope of our own experience.

The median arcuate ligament syndrome (MALS) is recognized as a rare clinical entity, characterized by chronic post-prandial abdominal pain, nausea, vomiting, and unintentional weight loss. Due to its vague symptomatology, it is mainly regarded as a diagnosis of exclusion. Patients can often be misdiagnosed for several years before a correct diagnosis is established, also due to a medical team's clinical suspicion. We present a case series of two patients who suffered from MALS and were treated successfully. The first patient is a 32-year-old woman, presenting with post-prandial abdominal pain and weight loss that have lasted for the past ten years. The second patient, a 50-year-old woman, presented with similar symptomatology, with the symptoms lasting for the last five years. Both cases were treated by laparoscopic division of the median arcuate ligament fibers, which alleviated extrinsic pressure from the celiac artery. Previous cases of MALS were retrieved from PubMed, to assemble a better diagnostic algorithm and propose a treatment method of choice. The literature review suggests an angiography with a respiratory variation protocol as the diagnostic modality of choice, along with the laparoscopic division of the median arcuate ligament fibers as the proposed treatment of choice.

Second trimester amniotic fluid uric acid, potassium, and cysteine to methionine ratio levels as possible signs of early preeclampsia: A case report.

OBJECTIVE: The precise etiopathogenesis of preeclampsia (PE) still remains enigmatic. In recent published work, there is a scientific trend aiming to unveil early biomarkers of PE based on amniotic fluid compositional changes before the development of clinical symptoms. CASE REPORT: We describe a case of an apparently clinically healthy woman, whose amniotic fluid, retrieved after amniocentesis at 222/7 gestational week, had elevated uric acid and potassium concentration, as well as cysteine to methionine ratio. At the time of amniocentesis, conventional clinical signs of PE were absent. The woman developed severe PE and intrauterine growth restriction, at the 280/7 week of gestation. CONCLUSION: Although the limitation of such studies lies in the fact that amniocentesis is an invasive procedure, and thus employed only under specific indications, our scientific observations might be useful for future research towards unraveling the causes of PE.

The involvement of uric acid in the pathogenesis of preeclampsia.

Preeclampsia is a common disorder of human pregnancy and a major cause of worldwide pregnancy-related maternal and neonatal morbidity and mortality. Oxidative stress, angiogenic imbalance, placental ischemia and an inflammatory response have been proposed to play role in the pathogenesis of the disease. Hyperuricemia is a key biochemical feature in preeclampsia with elevated levels of uric acid being diagnosed as early as the 10(th) week of gestation. Traditionally, elevated uric acid levels were considered a result of renal dysfunction known to exist in preeclampsia. The contribution of uric acid in the pathogenesis of preeclampsia is being recently further investigated. We, hereby, review the possible mechanisms by which uric acid contributes to the development of the disease and its complications both on mother and fetus.

Biomarkers of endothelial dysfunction in preeclampsia and neonatal morbidity: a case-control study.

OBJECTIVE: To investigate the association of preeclampsia with angiogenic imbalance, and the correlation of levels of angiogenic and anti-angiogenic factors to complications in mother and fetus. STUDY DESIGN: Serum samples were obtained from 40 women with established preeclampsia (study group) and from 40 normotensive women (control group). Epidemiological characteristics of the two groups were analyzed. The levels of the angiogenic (VEGF and PlGF) and anti-angiogenic (sFlt-1) factors of the two study groups were determined in serum using ELISA. Neonatal adverse outcomes (late preterm, early term, low birth weight (LBW), very LBW (VLBW), intrauterine growth restriction (IUGR), and neonatal intensive care unit (NICU) admission) between the groups of the study were analyzed, as well as the association between the biomarkers of the study and neonatal adverse outcomes of the preeclamptic group of patients. RESULTS: sFlt-1 levels were significantly higher in the preeclamptic women compared to normotensive women (median (range): 21297 (690-32637)pg/ml vs. 846.45 (363-2867)pg/ml, respectively), whereas there was a significant decrease in the levels of VEGF (90 (90-211)pg/ml vs. 90.55 (90-521)pg/ml, respectively), as well as in the levels of PlGF (13.62 (8-532)pg/ml vs. 239.86 (61-685)pg/ml, respectively). The increased serum values of the anti-angiogenic sFlt-1 were associated with increased rates of late preterm and early term births and VLBW. CONCLUSION: An imbalance between angiogenic and anti-angiogenic factors exists in preeclampsia and is associated with adverse maternal and neonatal outcomes.

Primary primitive neuroectodermal tumor of the cervix confirmed with molecular analysis in a 23-year-old woman: A case report.

Primitive Neuroectodermal Tumor (PNET) of the genital tract is very rare, especially in the cervix. A case report of a young woman with a diagnosis of PNET originating from the uterine cervix is presented here. A 23-year-old woman presented with abnormal uterine bleeding and sharp lower abdominal pain of two months duration. CT and MRI of the abdomen and thorax revealed the presence of a large mass in the uterine cervix, enlarged pelvic lymph nodes and broncho-pulmonary infiltrations with regional nodes. Pathological examination of the tumor revealed a malignant neoplasm composed predominantly of small cells, immunohistochemically positive for CD99, vimentin and c-Kit. Molecular testing demonstrated the expression of EWS/FLI1 fusion transcripts corresponding to the t(11;22)(q24;q12) translocation, which confirmed the diagnosis of PNET of the uterine cervix. Despite surgical excision and administration of the first cycle of adjuvant chemotherapy, the patient died from multiple-organ failure and cardiac arrest. PNET arising from the genital tract, especially in the uterine cervix, is very rare and presents a diagnostic challenge. A timely confirmation with molecular analysis is essential for the diagnosis of such a tumor at an unusual site as in the present case.