Laparoscopic diagnosis of idiopathic left ovarian vein thrombosis in a 27-year-old woman.

Idiopathic left ovarian vein thrombosis was diagnosed in a 27-year-old woman at the time of a diagnostic laparoscopy performed because of a suspected ovarian torsion. The diagnosis was confirmed by abdominal computed tomography scanning. Subsequent magnetic resonance imaging showed no signs of an abdominal or pelvic mass nor enlarged lymph nodes. The patient was treated with systemic anticoagulation therapy for 3 months and made a good recovery. During follow-up it became clear that the patient was already diagnosed with familial hypercholesterolemia before the occurrence of the ovarian vein thrombosis. It remains unclear if familial hypercholesterolemia played a role in the occurrence of ovarian vein thrombosis in our patient.

Morgagni and Boerhaave in 1719 : The European academic network in the 18th century demonstrated by a letter from Giovanni Battista Morgagni.

The European academic network in 18th century Europe and the interaction between two eminent 18th century scientists is illustrated by a recently recovered letter from 25.IX.1719 by Giovanni Battista Morgagni (1682-1771). It appears from this letter that Morgagni was interested in the latest edition of Boerhaave's Institutiones Medicae exactly in the same year that Boerhaave tried in vain to persuade him to transfer from the University of Padua to the University of Leiden.

An 18th century description of endometriosis : The autopsy of the Countess von Reitzenstein.

Descriptions of endometriosis in 18th century monographs and manuscripts are rare and the recorded macroscopic features of endometriosis seldom support this attribution to the described cases. Recently, we became aware of an anonymous German autopsy report from the 18th century. After transcription, the manuscript was assessed by pathologists with historical expertise. This revealed that the patient died because of a malignant tumor, most probably of a gynecological origin. Furthermore, the described ovarian pathologic findings strongly support the diagnosis endometriotic ovarian cyst. Like Giovanni Battista Morgagni (1668-1772) in his landmark publication De Sedibus et Causis Morborum per Anatomen Indagatis (1761), the author correlated the pathological findings at autopsy with the symptoms of the patient. The identity of the patient could, with high probability, be established as being the Countess of Reitzenstein, the wife of a Prussian general major in the army of Friedrich the Great: Karl Erdmann von Reitzenstein (1722-1789).

Gonadotropin-releasing hormone agonist against severe aggression in autism.

Aggression in patients with autism spectrum disorder (ASD) presents an important therapeutic challenge. Conventional treatment appears to be inadequate in a number of cases. The occurrence of severe aggressive symptoms since the inception of adolescence in a male patient with ASD suggested a hormonal influence by androgens. Conventional treatment with antipsychotic and antiepileptic drugs and benzodiazepines was ineffective. A subcutaneous long-acting gonadotropin-releasing hormone agonist (GnRH agonist) injection was given on a monthly basis resulting in a substantial improvement in his aggressive behaviour and renewed socialisation.

The conjoined twin sisters Helen and Judith (1701-1723) and their pictorial impact in later 18th-century science.

Given the uniqueness of the Hungarian conjoined twin sisters Helen and Judith (1701­1723) and their lasting influence as an anatomical showcase if not model for mental or social deviant states, we present here a closer scrutiny of their introduction into the scientific literature of the later 18th century by analyzing depictions of the twins from 1707 onwards.

[Thrombosis in ovarian hyperstimulation syndrome]. / Trombose bij ovarieel hyperstimulatiesyndroom.

BACKGROUND: Ovarian hyperstimulation syndrome is a rare complication of IVF treatment. In severe ovarian hyperstimulation syndrome there is an increased risk of thrombo-embolic events. Venous thrombotic complications tend to occur several weeks after the resolution of ovarian hyperstimulation syndrome. Predominant sites of venous thrombosis in OHSS are the upper extremities. CASE DESCRIPTION: A 34-year old woman presented to the emergency department with complaints about a painful swelling in the neck and a bluish discoloration of the right arm. She had been admitted to the hospital six weeks before, because of shortness of breath from pleural effusion due to ovarian hyperstimulation syndrome. The diagnosis of jugular vein and subclavian vein thrombosis was made. She was treated with therapeutic doses of low-molecular-weight heparin. CONCLUSION: Venous thrombosis is a rare but serious complication of ovarian hyperstimulation syndrome. For patients who require admission because of severe ovarian hyperstimulation syndrome, thromboprophylaxis should be continued several weeks after discharge.

Uterine artery pseudoaneurysm requiring embolization during pregnancy.

BACKGROUND: Uterine artery pseudoaneurysm has a pathognomonic ultrasound appearance. Its occurrence in pregnancy is life-threatening for both mother and fetus. We present an illustrative case and discuss management with selective uterine artery embolization during pregnancy. CASE: A 37-year-old pregnant woman presented with profuse painless vaginal blood loss at a gestational age of 27 weeks. Ultrasonography and magnetic resonance imaging indicated a left-sided uterine artery pseudoaneurysm. Selective embolization of the pseudoaneurysm was performed. Blood loss ceased allowing the pregnancy to continue until term. CONCLUSION: Endovascular embolization is a feasible therapeutic option for a uterine artery pseudoaneurysm during pregnancy without compromising fetoplacental perfusion.

Dynamic magnetic resonance imaging before and 6 months after laparoscopic sacrocolpopexy.

INTRODUCTION AND HYPOTHESIS: The objective of this study was to correlate dynamic magnetic resonance imaging (MRI) with Pelvic Organ Prolapse Quantification (POP-Q) measurements and pelvic floor symptoms in order to determine the value of dynamic MRI for evaluating vaginal vault prolapse both before and 6 months after laparoscopic sacrocolpopexy. METHODS: This was a prospective, single-center cohort study in 43 patients who underwent a modified laparoscopic sacrocolpopexy/hysteropexy operation using bone-anchor fixation and synthetic mesh. The study included dynamic MRI, POP-Q staging, and validated questionnaires before and 6 months after laparoscopic sacrocolpopexy. To assess MRI data, the pubococcygeal reference line and specifically defined anatomical landmarks for the separate compartments were used. Differences between pre- and postoperative measurements were evaluated with the Wilcoxon signed-rank test, and correlations at the 0.05 level were considered to be significant (Pearson correlation, two tailed). RESULTS: At 6 months, a statistically significant improvement was seen in POP-Q staging for all compartments. Dynamic MRI measurements only revealed a significant improvement after surgery for the apical compartment. The correlation between (changes in) MRI measurements, POP-Q measurements, and validated questionnaires was poor. CONCLUSIONS: The value of dynamic MRI for evaluating and documenting changes in vaginal vault support and position after laparoscopic sacrocolpopexy is limited due to the poor correlation with both POP-Q staging and pelvic floor symptoms.

Sequential urodynamic assessment before and after laparoscopic sacrocolpopexy.

OBJECTIVE: Controversial data are available as to whether to perform a simultaneous abdominal or vaginal colposuspension operation in laparoscopic sacrocolpopexy procedures. We wanted to evaluate the effect of a modified laparoscopic operation technique on urodynamic parameters and lower urinary tract symptoms. DESIGN: Prospective single center cohort study. SETTING: Teaching hospital. POPULATION: Forty-nine consecutive patients who underwent a modified laparoscopic sacrocolpopexy/hysteropexy operation using bone anchor fixation and synthetic mesh, performed by the same laparoscopic surgeons. METHODS: Pre- and postoperative multichannel urodynamic evaluation and validated questionnaires. The same urologist, blinded to the results of the questionnaire survey, interpreted all urodynamic evaluations. MAIN OUTCOME MEASURES: The effects of surgery on pelvic anatomy and patient satisfaction, urodynamic observations and diagnoses and symptom scores in validated questionnaires. RESULTS: Forty-two patients consented to pre- and postoperative urodynamic evaluation. Laparoscopic sacrocolpopexy successfully corrected vaginal vault prolapse in all 42 patients with urodynamic evaluation six months after surgery. The bladder volume at first desire to void was significantly increased and the maximal detrusor pressure at voiding phase was significantly decreased. In the questionnaires, irritative and storage voiding symptoms were significantly decreased. CONCLUSIONS: The results of the study demonstrate that there are no adverse urodynamic findings following this modified technique for laparoscopic sacrocolpopexy. The statistically significant urodynamic improvements are in accordance with the scores on the Urogenital Distress Inventory questionnaires. These results do not support a simultaneous routine prophylactic colposuspension procedure.

Transmural migration of retained surgical sponges: a systematic review.

Retained surgical sponges have been reported to occur after a diversity of surgical procedures, but transmural migration is a very unusual sequela. This article reports a case in which a retained surgical sponge eroded from the intra-abdominal space into the intestinal lumen, migrated distally, and spontaneously passed with defecation 12 weeks after the cesarean section. We performed a systematic review of the literature in Pubmed and found 64 cases of transmural migration of retained surgical sponges. Sixty-four cases have been reported of transmural migration, mainly after intra-abdominal surgery. The most frequent site of impaction is the intestine (75%), but we also found 2 cases that describe migration into the stomach and 7 into the bladder. Five more cases have been published describing transdiaphragmic migration. Only 4 cases describe a sponge spontaneously expelled through the rectum, whereas more than 93% needed re-intervention. We strongly advise only the use sponges with radiopaque markers during surgery and additional methodical wound/body cavity examination.

Human embryo-conditioned medium stimulates in vitro endometrial angiogenesis.

OBJECTIVE: Successful implantation and placentation depend on the interaction between the endometrium and the embryo. Angiogenesis is crucial at this time. In this article we investigate the direct influence of the human embryo on in vitro endometrial angiogenesis. DESIGN: In vitro study. SETTING: Human endometrial microvascular endothelial cells (hEMVEC) grown on an in vitro angiogenesis model. INTERVENTION(S): Conditioned media (CM) of human embryos were used to stimulate in vitro angiogenesis. MAIN OUTCOME MEASURE(S): In vitro angiogenesis of hEMVEC. RESULT(S): Conditioned media of human embryos, containing significant amounts of vascular endothelial growth factor (VEGF)-A, as determined by enzyme-linked immunosorbent assay (ELISA), caused an increase in hEMVEC tube formation. This effect was prevented by soluble VEGF receptor 1, which quenches VEGF-A activity. Recombinant EGF alone and leukemia inhibitory factor in combination with VEGF-A stimulated hEMVEC tube formation. None of the other tested recombinant mediators, which have been described as produced by the early embryo/trophoblast (interleukin (IL) 10, transforming growth factor (TGF) beta, placental growth factor, hCG, colony-stimulating factor 1, interferon-gamma, insulin-like growth factor I and II, IL-6, platelet-derived growth factor, and TGFalpha), had an effect on tube formation by hEMVEC. CONCLUSION(S): For the first time, it is shown that the human embryo is able to stimulate in vitro endometrial angiogenesis at the time of implantation, a process that is mediated by VEGF-A.

Membrane-type matrix metalloproteinases and vascularization in human endometrium during the menstrual cycle.

Endometrial angiogenesis is essential for a vascularized receptive endometrium. Previously, we described that membrane type-3 metalloproteinase (MT3-MMP) is associated with endometrial angiogenesis in vitro. The association of MT-MMPs with endometrial angiogenesis in vivo is unknown. Therefore, this study analysed the presence of MT-MMPs in human endometrium and their correlation with neovascularization. RNA/protein expressions of the six MT-MMPs were determined in cultured endometrial cells. Vascularization parameters and MT-MMP expressions in vivo were evaluated by immunohistochemistry in serial endometrium sections. MT1-, MT2-, MT3- and MT4-MMP antigens were expressed in cultured endometrial endothelial cells. MT2-, MT3- and MT4-MMP were expressed by endothelium during the proliferative and secretory phase. Strikingly, these phases showed elevated vascularization, elevated total vascular surface in proliferative phases, elevated number of vessels in proliferative/late secretory phases and increased luminal surface in the proliferative phases. All MT-MMP antigens were expressed in various endometrial cell types in vivo, with decreased levels during the early secretory phase. In conclusion, all MT-MMPs are expressed in endometrium in a cycle-dependent pattern. The vascular expression of MT2-, MT3- and MT4-MMP correlated with angiogenic episodes of the cycle. Since MT2- and MT3-MMP are known to regulate tube formation, these findings support earlier in vitro data on the role of MT3-MMP in endometrial angiogenesis. Additionally, MT2-MMP appears to be associated with endometrial neovascularization also.

Recurrent cornual pregnancy after heterotopic cornual pregnancy successfully treated with systemic methotrexate.

This report concerns a recurrent spontaneous cornual pregnancy 2 years after selective feticide of a heterotopic cornual pregnancy which occurred after IVF for tubal pathology. The recurrent cornual pregnancy was treated successfully with systemic methotrexate. Assisted reproductive techniques, especially in patients with tubal pathology, and non-invasive management of cornual pregnancies may lead to a higher incidence of recurrence.

Ectopic mesothelial cell proliferation in cervical lymph nodes after severe ovarian hyperstimulation syndrome.

OBJECTIVE: To report a case of ectopic mesothelial proliferation in cervical lymph nodes after severe ovarian hyperstimulation syndrome. DESIGN: Case report. SETTING: University-affiliated teaching hospital. PATIENT(S): A 42-year-old woman underwent a successful IVF attempt and developed severe ovarian hyperstimulation syndrome and pathologically enlarged cervical lymph nodes. INTERVENTION(S): Paracentesis, cervical lymph node biopsy followed by cytology, histology, and immunohistochemistry. MAIN OUTCOME MEASURE(S): Resolution of symptoms, pregnancy outcome, correct pathological diagnosis. RESULT(S): Paracentesis resulted in resolution of symptoms of ovarian hyperstimulation. The diagnosis of ectopic mesothelial proliferation in cervical lymph nodes was made after immunohistochemical examination of cervical lymph nodes. The pregnancy progressed normally, and at 40 weeks the patient spontaneously delivered a healthy son weighing 3,060 g. CONCLUSION(S): This case describes ectopic mesothelial cell proliferation localized in and around cervical lymph nodes occurring at 9 weeks' gestation in a patient who earlier developed severe ovarian hyperstimulation syndrome 10 days after ET. Ectopic mesothelial cell proliferation in lymph nodes is an extremely rare event, and this is the first case described after ovarian hyperstimulation. Familiarity with this event is important for the clinician as well as for the pathologist in preventing the misdiagnosis of malignancy.