Pain In Abdomen Research Articles

Role of traditional Chinese medicine-based acupuncture in the resolution of ovarian torsion

Abstract Ovarian torsion (OT) is a gynecological emergency that affects females of childbearing age and usually requires surgical management. Here, we present a 30-year-old female who presented with an ultrasonographically confirmed OT along with an ovarian cyst and severe pain in the lower abdomen. She was treated at a private acupuncture clinic as an outpatient. She underwent one acupuncture session per week for 11 weeks. St 40, Sp6, Sp9, Lv3, Li4, CV4, St 29, K6, Lu7, Sp4, and Pc6 were selected and punctured based on traditional Chinese medicine diagnosis. The patient reported mild relief from pain immediately after the first session. A complete relief of pain was reported by the patient by the end of the third session. A follow-up ultrasound revealed no significant ovarian abnormality. This report indicates the possibility of using acupuncture in emergency conditions like OT.

Comparative Study of Epidural Anaesthesia Versus Combined Spinal Epidural Block for Surgical Procedures Involving the Lower Abdomen or Lower Limb.

Background: Effective anesthesia techniques are essential for managing pain and facilitating recovery in surgical procedures involving the lower abdomen and lower limbs. Epidural anesthesia and combined spinal-epidural (CSE) block are commonly used methods, each with distinct advantages and limitations. This study compared the efficacy, safety, and patient satisfaction of epidural anesthesia versus CSE block in lower abdomen and lower limb surgeries. Methods: A trial was conducted with 100 participants undergoing elective lower abdomen or lower limb surgeries. Participants were assigned randomly to receive either epidural anesthesia or CSE block. Data on demographic characteristics, intraoperative and postoperative pain scores, analgesic consumption, complications, and duration of hospital stay were collected and analyzed using SPSS version 23.0. Results: The CSE block group had significantly decreased postoperative pain levels at 1, 6, 12, and 24 hours contrasted to the epidural group (p<0.001). Total post-operative analgesic consumption was decreased in the CSE group (p<0.001). The groups had similar hypotension, nausea, and urine retention rates. Although not statistically significant (p=0.09), the CSE group had a shorter mean hospital stay. Conclusion: The CSE block provides superior postoperative pain relief and reduces the need for additional analgesics compared to epidural anesthesia, without increasing the risk of complications. These findings suggest that CSE block may be a more effective option for managing postoperative pain in lower abdomen and lower limb surgeries. Recommendations: Larger trials with long-term follow-up are needed to confirm these findings and examine CSE block's benefits in diverse surgical settings. Keywords: Epidural anesthesia, Combined spinal-epidural block, Lower abdomen surgery, Lower limb surgery, Postoperative pain management.

A RARE RETROPERITONEAL SOFT TISSUE NEOPLASM IN A 27-YEAR-OLD FEMALE: A CLINICAL CASE

Relevance: Myopericytoma is a soft tissue tumor characterized by the proliferation of myopericytes. The tumor originates from myoid cells localized in the skin and soft tissues. Usually, this tumor is benign, but in rare cases, it can be malignant. Myopericytoma is a rare neoplasm, so specific data on its prevalence around the world are limited. The article presents a clinical case of retroperitoneal myopericytoma and a review of the cases described in the literature to analyze the epidemiology and clinical characteristics. Accurate data on the global prevalence of myopericytoma are not available due to the rarity of the disease and the difficulties of diagnosis. Thus, the study of myopericytoma has significant relevance, as it contributes to a better understanding and management of this rare soft tissue tumor and improves patients’ quality of life. The study aimed to describe a clinical case of retroperitoneal soft tissue myopericytoma in a 27-year-old patient. Methods: The authors present a clinical case of retroperitoneal soft tissue myopericytoma. The descriptions of the other 50 clinical cases of myopericytoma were found in the PubMed, Cochrane Library, eLibrary, CyberLeninka, and Google Scholar electronic databases, including the results of clinical examination, computed tomography (CT) and magnetic resonance imaging (MRI), and histopathological examination of biopsy material. Results: A 27-year-old girl went to the clinic complaining of pressure pains in the lower abdomen. A formation in the retroperitoneal space was revealed after a comprehensive examination, including CT and MRI. Further, soft tissue biopsies of the retroperitoneal space were performed, and the diagnosis of myopericytoma was confirmed. The patient was successfully surgically removed from the tumor. Conclusion: Myopericytomas, although classified as benign tumors, pose a serious problem due to their tendency to relapse. Despite their slow growth, they can reach significant sizes and grow into surrounding structures and organs. Consequently, the experience and skill of surgeons play an important role in the vastness of surgical intervention for radical tumor removal, which is important for the patient’s prognosis and quality of life. Radical surgical treatment for myopericytoma is especially important because it allows the complete removal of the neoplasm and minimizes the risk of recurrence, thereby improving long-term results and reducing the need for additional therapeutic interventions.

Diagnosis of Empyema as a Complication of Liver Abscess in Peripheral Area

Right pleural empyema is one of the rare complications in liver abscess. This condition is life-threatening as it causes breathing difficulties and requires immediate life-saving. This case report aims to diagnose and manage empyema in a male patient with a liver abscess in a limited diagnostic setting. Methods: According to medical records, a 44-year-old man came to the emergency room (ER) of Umbu Rara Meha General Hospital with complaints of shortness of breath that had been getting worse for two months, accompanied by a cough with phlegm for one week, fever, and weight loss. The patient also complained of pain in the right upper abdomen for the last four months. History of pulmonary tuberculosis, diabetes mellitus, or hypertension was denied. The patient is not a smoker. On physical examination, there was an increase in the frequency of breathing and a decrease in the vesicular sounds on the right side. Right thorax X-ray examination revealed massive right pleural effusion without pulmonary infiltrates. Abdominal ultrasound showed a liver abscess. Emergency pleural puncture was performed in the ER, and 1600 cc of purulent pleural fluid was removed, followed by Water Sealed Draignase (WSD) installation. The patient was given intravenous broad-spectrum antibiotics and treated for 12 days. Conclusion: Empyema can be a rare but life-threatening complication of liver abscess. Medical action must be taken immediately in the ER to save the patient. Delaying pus drainage can increase morbidity and mortality rates.

Nephrectomy for emphysematous pyelonephritis in a nonfunctional renal allograft due to rejection after kidney transplantation

BackgroundEmphysematous pyelonephritis represents an acute and necrotizing infection characterized by the accumulation of gas within the kidney. This condition poses a swift progression toward sepsis, leading to a poor prognosis. We experienced a rare case of emphysematous pyelonephritis in a nonfunctioning renal allograft attributed to antibody‐mediated rejection after kidney transplantation.Case presentationA 71-year-old man with diabetes had undergone living-donor renal transplantation from his wife. Unfortunately, the transplanted kidney’s function declined due to antibody-mediated rejection, necessitating the introduction of hemodialysis 12 months post-transplantation. Subsequently, 4 months after initiating hemodialysis, the patient presented with pain and swelling in the right lower abdomen. A computed tomography scan revealed the enlargement of the transplanted kidney and gas formation. This constellation of symptoms led to the diagnosis of emphysematous pyelonephritis, resulting in his hospitalization. Further contrast-enhanced computed tomography scans demonstrated an absence of arterial flow and ischemia within the renal allograft. Despite antibiotic treatment and percutaneous drainage, both the gas and fluid in the renal parenchyma and surrounding tissue displayed minimal reduction. Given these compelling findings, an allograft nephrectomy was performed 20 days into his hospital stay. Pathological examination confirmed complete allograft necrosis, revealing nonviable renal parenchyma. The patient’s postoperative recovery progressed favorably.ConclusionsInstances of emphysematous pyelonephritis within transplanted kidneys are infrequently documented. Among these cases, emphysematous pyelonephritis in a nonfunctioning renal allograft is very rare and may be associated with graft ischemia and the presence of injured tissue. The determination of an immediate diagnosis and surgery is important.

Neuralgia Pasca Herpes

Herpes zoster, also known as snake pox and shingles , is a skin disease caused by reactivation of latent varicella zoster virus (VVZ) infection also known as human herpesvirus-3 (HHV-3) in the dorsal root sensory ganglion after primary infection. Mrs. A, 64 years old female was consulted with complaints of burning pain in the lower right abdomen to the right waist, that happened approximately 2 month after diagnosed with herpes zoster. Based on anamneses and physical examination the patient was diagnosed by Postherpetic neuralgia. Postherpetic neuralgia is persistent chronic pain and the most common complication in herpes zoster. In the majority of patients, pain from shingles is usually felt within 2 to 4 weeks. However, patients who experience NPH will experience continuous pain at the site of infection for 3 to 9 weeks after infection. The patients was given supportive treatment accompanied by education that can be provided to relieve the symptoms caused by this disease.

CLINICO-RADIOLOGICAL DIAGNOSIS OFAPPENDICITIS

Background : The symptom of right lower quadrant pain had puzzled clinicians for many centuries. Appendicitis needs to be considered in the differential diagnosis of nearly every patient presenting with acute abdomen, misdiagnosis of appendicitis is significantly higher in females. Early diagnosis remains the most important goal in patients, despite use of ultrasonography, CT scanning and diagnostic laparoscopy the rate of misdiagnosis of appendicitis and rate of negative appendicectomy is significantly high. Surgical treatment is a highly successful medical intervention In this study we have attempted to find a co-relation between the efficiency of clinical diagnosis with radiological diagnosis of appendicitis. Aim and Objectives: To determine the sensitivity, specificity and diagnostic accuracy of clinical scores, ultrasonography and CT of abdomen in a case of acute appendicitis. Materials and Method: 50 patients with acute onset lower abdominal pain and diagnosed as appendicitis were evaluated by the emergency surgical team.A detailed clinical evaluation was carried out as per criteria of the three clinical scores (Alvarado, Fenyo, Ohman).The inference from each of the scores was noted.The patients underwent ultrasonography(USG) and contrast CT of the abdomen and pelvis.The findings of both these investigations and intra operative findings were noted. The specimen was sent for histopathological examination which was considered as gold standard for the diagnosis of acute appendicitis. Result: In this study we found that Alvarado score had the highest sensitivity among females 92.31% and also the highest NPV 66.67%.Ohmann score had the overall highest sensitivity 100% and NPV Hence, it can be used as a simple, quick and effective screening score for detection of appendicitis in a large number of patients. The score is simple to use and can also be calculated by paramedical staff. USG of the abdomen is a useful screening tool however CT had a high specificity 88.89% and PPV 97.30% and diagnostic accuracy of 88%. Conclusion: Despite the advent of various investigation modalities, a surgeons clinical acumen should never be compromised. The clinical scores and investigations should always be used as an adjunct history taking and clinical examination. Appendicitis should always be considered as a differential diagnosis in every case of acute pain abdomen.

Clinical and haematological parameters in malaria caused by different plasmodium species in children

Background: Malaria is a disease of global importance and affects more than ninety countries in both the tropical and subtropical regions. Clinical and haematological parameters vary with type of malaria, although data relating to different species of malaria in children is limited. This study aims to understand the clinical and haematological profile of malaria and to correlate these with different malarial species among children. Methods: This is a descriptive cross-sectional study involving 130 proven malaria cases done over 18 months from October 2014 to April 2016. A detailed history and clinical examination along with haematological parameters were analysed and correlated with different types of malaria. Results: Among 130 children, 97 children were vivax positive, 4 were falciparum and 27 were mixed malaria. Fever was present in all, whilst other symptoms were chills and rigors (86.15%), vomiting (39.52%), headache (19%), pain abdomen (6.84%), myalgia (4.56%) and convulsions (1.52%). Clinical signs were pallor (29.64%), icterus (0.76%), splenomegaly (65.36%), hepatomegaly (23.56%) and hepatosplenomegaly (21.28%).75% of children with falciparum malaria had splenomegaly and pallor whereas hepatomegaly was observed in 34% of mixed malaria cases. Haematological parameters observed were anaemia (47.6%), severe anaemia (2%), leucocytosis (11.5%), leukopenia (39.2%), thrombocytopenia (87%) and severe thrombocytopenia (30%). Severe thrombocytopenia was seen with vivax malaria (70%). No mortality was noted in the studied population. Conclusions: Fever and splenomegaly are important clinical features, whereas anaemia and thrombocytopenia are the most noted haematological parameters in malaria. The parameters vary with different species of malaria knowledge of clinical and haematological parameters aid us in early diagnosis and prompt initiation of treatment and prevention of associated complications.

Profile of gastroduodenal perforation patients admitted in a rural tertiary care hospital: An observational cross-sectional study.

Gastro-duodenal perforation is a common surgical emergency that remains a formidable health burden worldwide with significant morbidity and mortality. Ulcer disease remains the most common cause of gastro-duodenal perforation. Diagnosing the presence of H. pylori can help eradicate the infection from the community at large and thereby reduce the chances of gastro-duodenal perforation. To assess the clinical presentation of gastro-duodenal perforation patients and to evaluate the detection of Helicobacter pylori infection by available investigations. A descriptive observational study was conducted among 80 patients presenting with clinical features suggestive of gastro-duodenal perforation and confirmed by clinical, radiological basis and operative findings admitted at a rural tertiary care hospital during 2019-2020. Detailed history was taken from the patient/party, clinically examined, and blood/tissue samples were investigated. The patients were managed with standard treatment modality in the studied institute. Data were collected, compiled, and entered MS Excel and analyzed using appropriate software. Descriptive analysis was done in the form of proportion for categorical variables, mean or median for continuous variables. Cases of gastro-duodenal perforations were more among middle to later age of life, mostly affecting married male patients hailed from rural area and unskilled workers. History of intake of spicy food, prolonged starvation, history of NSAID use were common among them. Majority of the patients had history of pain abdomen in the past suggesting of PUD and history of taking variety group of acid reducing agents. Most of them presented with epigastric pain, vomiting, abdominal distension along with other signs of peritonitis. Obliteration of liver dullness and free gas under right dome of diaphragm was also noted in large proportion among them. Majority of cases were found positive for H. pylori on Histology (85%), followed by rapid urease test (RUT) (80%) and a positivity of 72.5% and 68.8% on serum IgG and IgA antibody respectively. Rapid Urease Test was more sensitive as well as specific in diagnosing of H. pylori than antibody detection test. Early detection of H. pylori infection and treatment with potent anti H. pylori therapy postoperatively has been found to be adequate.

#2781 Renal cortical necrosis—a rare cause of acute kidney injury

Abstract Background and Aims Renal cortical necrosis (RCN) is a rare and catastrophic cause of acute kidney injury (AKI). It is characterized by ischemic destruction of all the elements of renal cortex due to marked reduction in renal arterial perfusion of renal cortex due to vascular spasm and microvascular injury. It can be patchy or diffuse depending upon the cause and extent of hypoperfusion. Snake bite is rare cause of RCN. Incidence of RCN following snake bite has been reported to be as high as in 25% of the bitten patients to <1%. Lack or delay in receiving anti snake venom (ASV) has been observed to be a contributing factor in development of RCN following snake bite. Method A 45-year-old female had an unknown bite on foot while returning to home at twilight. She had intense pain at site of bite with slight ooze of blood. Overnight she had vomiting and pain abdomen. Subsequently she developed progressive fall in urine output and dyspnoea. After about 36 hours of bite at the time of admission in hospital she had anuria, prolonged whole blood clotting time, tachypnoea, hypoxemia and required oxygen (O2) to maintain normal O2 saturation. She was given two doses of polyvalent ASV 6 hours apart which corrected her coagulation defect. Investigations showed: haemoglobin—9 gm/dl, total leucocyte count—18700/mcl, platelet—1.15 lakh/mcl, blood urea—88 mg/dl and serum creatinine—10.5 mg/dl. She was managed with haemodialysis and supportive care. Even after 3 weeks of onset of AKI, she had anuria so a kidney biopsy was done. Results kidney biopsy on light microscopy examination showed 9 glomeruli; 8 revealing global tuft necrosis along with necrosis of adjacent tubules and vasculature and necrotic process affected around 60% of sampled cortical area consistent with cortical necrosis (Fig. 1). She was continued with haemodialysis support and urine output and pre-dialysis serum creatinine were monitored. Her urine output after 3 months of onset of AKI is around one litre per day but her pre-dialysis serum creatinine stays in the range of 9-10 mg/dl and so she continues to receive biweekly haemodialysis. Conclusion In our index case, there was delay in getting ASV which may have contributed to development of RCN. So, early treatment of snake bite is important to prevent this catastrophic complication.

Chemical Peritonitis Due to Ruptured Ovarian Teratoma: A Case Report and Literature Review

Introduction: Mature cystic teratomas (MCT) are the most common ovarian tumors in pediatric patients, often asymptomatic due to slow growth, when symptomatic, they can lead to abdominal pain. Spontaneous rupture can result in acute chemical peritonitis (CP), a rare but life-threatening complication. This study presents a clinical case of a patient with spontaneous rupture of an ovarian teratoma and associated acute CP. Clinical Case: 13-year-old female presented with acute abdominal pain, fever, distended and painful abdomen with peritoneal reaction in the right iliac fossa and hypogastrium. Abdominal ultrasound showed a hypoechoic rounded image with an anechoic center in the right adnexal region. Laparoscopic exploration revealed a cystic teratoma of the right ovary with torsion, but no compromise of vitality. Purulent fluid indicated CP due to ruptured and twisted ovarian teratoma. Right ovarian cystectomy was performed, drainage was offered in the Douglas pouch. The patient's condition improved, and she was discharged after recovery. Discussion: Rupture and CP are rare but require emergency surgery. Preoperative diagnosis can be challenging due to their non-specific clinical presentation and the need to rule out malignant complications. Conclusion: Early and appropriate management of MCT is essential to prevent serious complications. Sebum spillage can cause CP, the treatment of choice is teratoma removal, combined with extensive lavage to avoid chronic peritonitis. Laparoscopic surgery stands out as a safe and effective option. A high index of suspicion and comprehensive approach are emphasized in managing this uncommon condition in the pediatric population.

Diagnostic and management dilemmas of pregnancies at the utero-tubal junction: A case series and management algorithm.

A pregnancy at the utero-tubal junction is a rare type of ectopic pregnancy and is associated with high maternal morbidity if it remains undetected. In the present study we discuss four cases of ectopic pregnancies at the utero-tubal junction which caused diagnostic and management dilemmas. Four cases of early pregnancies with the gestational sac (G-sac) implanted near the utero-tubal junction are described. In case 1 this was suspected after a failed attempt at dilatation and curettage at our hospital, cases 2 and 3 presented with amenorrhea and pain abdomen and case 4 was diagnosed on first pregnancy documentation scan after frozen embryo transfer. As initial two-dimensional (2D) transvaginal scan (TVS) failed to diagnose the exact location of the G-sac, three-dimensional (3D) TVS helped to localize the exact location of pregnancy and subsequent individualized management. Case 1 had a partial intramural ectopic pregnancy managed by laparotomy and removal of the ectopic sac. The second and third cases were eccentric uterine pregnancies. The fourth was an interstitial ectopic pregnancy managed by a laparoscopic loop and stitch technique. This case series describes the role of 3D TVS for the evaluation of pregnancies implanted at the utero-tubal junction and individual management of eccentric intrauterine, interstitial ectopic and intramural ectopic pregnancies. A diagnostic algorithm for such types of cases and management options is discussed.

Адаптация русскоязычной версии детского опросника соматических симптомов на выборке детей-сирот и детей, оставшихся без попечения родителей

<p>This study was aimed to adapt the Russian version of the Children’s Somatic Symptoms Inventory-8 (CSSI-8). The participants were 160 orphans and children and adolescents left without parental care, including 80 girls and 80 boys aged 9 to 17 years (M=14,51; Me=15 years; SD=1,79). All participants completed CSSI-8 and the Revised Child Anxiety and Depression Scale-30 (RCADS-30). The Russian version of the inventory was reliable and valid: firstly, it has a high Cronbach’s α, showing its internal reliability; secondly, it has a one-factor structure, indicating its factor validity; thirdly, the relationship of somatic symptoms with anxiety and depressive symptoms proves convergent validity. Thus, 76,2% of children and adolescents had at least one specific somatic symptom, 44,4% complained of pain in stomach or abdomen, 58,7% of headaches, 30,6% of pain in lower back, 19,4% of faintness or dizziness, 29,4% of pain in arms or legs, 28,7% of heart palpitations, nausea or upset stomach, 47,5% of weakness in some parts of the body. In conclusion, it is important to make future psychometric examinations of the adapted questionnaire, which allow us to recommend it for school diagnosis and psychological counseling of children and adolescents, as well as screening and monitoring of somatoform disorders.</p>

Woman with lower abdomen and flank pain

Woman with lower abdomen and flank pain

Pneumoperitoneum Due to Spontaneous Uterine Perforation Caused by Pyometra – A Rare Finding and a Diagnostic Challenge

Background: Spontaneous perforation of uterus resulting in generalized peritonitis in postmenopausal women is a very rare entity usually caused by pyometra and is associated with high morbidity and mortality. The clinical picture of uterine perforation secondary to pyometra are similar to hollow viscus perforation which makes preoperative diagnosis difficult. A correct and definitive diagnosis can be made with laparotomy or laparoscopy. Case: We report a case of 64-years-old female patient who presented with pain abdomen and distension and inability to pass flatus/motion with signs suggestive of acute generalised peritonitis and genital prolapse with pneumoperitoneum underwent Total Abdominal Hysterectomy with bilateral salpingo-oophorectomy. Results: Despite the surgical intervention, Total Abdominal Hysterectomy with bilateral salpingo-oophorectomy and use of several antibiotics, this patient did not improve and died post-operatively. Conclusions: This case report aim for awareness of the many etiologies for peritonitis is of great importance and to alert the surgeons to the possibility that uterine perforation secondary to pyometra also shows air under diaphragm apart from hollow viscus perforation. Correct diagnosis and proper treatment are essential for survival of patients.

Role of Ayurveda medicine in the management of Amashaya Arbhuda w.s.r. to Carcinoma of Stomach

Due to faulty lifestyle, altered food habits and chronic psychological stress and mental depression, the incidence of Malignancy has been raised. Carcinoma of stomach is one such disorder which is commonly seen in Indian population. Symptoms like pain abdomen, burning sensation of the stomach, malena, weight loss, loss of appetite and anaemia are the common clinical features of this disease. Ayurveda medicine is beneficial in the cases with early diagnosis. After radical excision of the active lesion, palliative treatment can be given by using Ayurveda medicine. In Ayurveda, Vyadhi Pratyanika Aushadhi Prayoga, Yogasana and Pranayama, Assurance, changes in food and life style and Pathapathya Prayoga are advised. Medicines having actions like Anticancer, cytotoxic, Shoolahara, Antacid, antispasmodics, antidepressant, anxiolytic, antistress, adaptogenic, CNS depressant, Balya, Brimhala, Ojaskara, immunomodulator and cytoprotective actions are used as palliative measures. In this paper, the role of Ayurveda medicines in the management of Amashaya Arbhuda w.s.r. to carcinoma of stomach is discussed elaborately.

A clinical case of ectopic pregnancy with localization in the liver

The article describes a clinical case of ectopic pregnancy with localization in the liver. The patient Sh. was admitted to the gynecological department with pain in the lower abdomen and epigastrium. Clinical, laboratory and instrumental examinations were conducted in accordance with clinical recommendations. The examinations showed that human chorionic gonadotropin level was 17,440.85 mIU/ml. Pelvic ultrasound did not determine the fetal egg in the uterine cavity. However, free fluid in the pelvis (about 50 ml) was found. Repeated pelvic ultrasound revealed a paraovarial formation on the right, and free fluid in the pelvis. Laparoscopic surgery was performed, during which a fetal egg was found in the V segment of the liver. Liver resection and cholecystectomy were performed on an emergency basis. This case describes the importance of timely and correct diagnostics and determination of patient management tactics to prevent the development of life-threatening complications.

Liver Histopathology in Pediatric Patients with Choledochal Cyst.

The aim is to study the various histopathological changes in the liver in pediatric patients with choledochal cyst (CC) and correlate with the presentation and type of cyst. In a prospective observational study including all pediatric patients who underwent CC excision, histopathological changes of the liver in the form of cholestasis (CHS), portal inflammation (PI), bile duct proliferation (BDP), and fibrosis were studied and graded using a scoring system. They were analyzed in relation to age, sex, symptoms, and type of the cyst. All 30 patients of CC showed various degrees of histopathological changes in the liver in the form of CHS, PI, BDP, and liver fibrosis. Patients <1 years had 9/13 (69.2%) cystic variety and those >1 years had 17/17 (100%) fusiform variety of CC (P < 0.001). Patients <1 years frequently presented with jaundice and hepatomegaly and those >1 years presented with pain abdomen (P < 0.002). Higher grades of liver fibrosis and BDP were seen in the cystic variety compared to the fusiform variety (P < 0.001). However, no significant association was found with CHS and PI (P > 1.23). Histopathological changes in the liver of varying grades are seen in all patients of CC. Patients of CC <1 year presented frequently with jaundice, had the cystic type, and had a higher degree of liver damage on histopathology.

Comparison of Conventional Pap Smear With Liquid-based Cytology for Screening of Cancer Cervix

Abstract Objective: The objective of the study was to compare conventional Pap smear (CPS) and liquid-based cytology (LBC) by the split technique method in terms of satisfactory/unsatisfactory smear, the prevalence of inflammatory smear, and cellular atypia. Materials and Methods: This cross-sectional study was carried out between 2017 and 2019 after obtaining ethics committee approval. A total of 200 women were recruited for the study attending the gynecology outpatient clinic with various symptoms, such as discharge per vaginum, dysmenorrhea, infertility, and pain abdomen, and after obtaining written informed consent. Pregnant women, women with pelvic inflammatory disease, and cases with obvious cervical lesions or growth were excluded. Pap smear was taken with a Rovers Cervex-Brush. The split sample technique was followed wherein using one side of the brush conventional slide was prepared and fixed with cytospray. The brush head was detached and suspended in the preservative fluid for LBC. Both CPS and LBC were sent for examination. The same experienced pathologist examined the samples. The qualitative variables were compared using the Mcnamer test to compare the prevalence of unsatisfactory smear, inflammatory smear, and cellular abnormalities between CP and LBC. The categorical variables were presented in number and percentage (%) and continuous variables were presented as mean ± standard deviation and median. P &lt; 0.05 was considered statistically significant. Results: The maximum number of patients (62.5%) belonged to the fourth decade of life. The mean age was 39 years. A total of 93% of women were from the urban areas while 7% belonged to the rural areas. The majority of the women (78.5%) were multiparous and around 43% were second para. Pap smear reports were satisfactory in 93.5% of women in CPS, while 99% of reports were satisfactory in LBC. The difference between CPS and LBC in terms of the prevalence of satisfactory/unsatisfactory smear was statistically significant with a P = 0.0064. Dense inflammation reported by all LBC smears was reported as the same in CPS. The strength of agreement between CPS and LBC was not strong in terms of different grades of inflammation with a kappa value of 0.24. There was no difference in the reporting of cellular atypia between both methods. Conclusions: CPS and LBC are equal in terms of detection of inflammation and epithelial cell abnormality. Infections were also detected by both the screening methods CPS and LBC. The only thing which makes LBC better is the rate of satisfactory smears and the benefit of adding human papillomavirus DNA testing possible only in LBC.

Post-Transplant Nephroptosis as a Cause of Recurrent Urinary Tract Infections: A Case Report

ObjectiveThe aim of this study is to present a rare cause of recurrent urinary tract infections (UTI) in a patient after kidney transplantation. MethodsPatient's consent was obtained and full medical documentation was reviewed. After analyzing the literature, only 3 case reports of post-transplant nephroptosis were found. ResultsA 32-year-old woman with a history of type 1 diabetes, after kidney and pancreas transplantation a year earlier, was admitted to hospital due to another incident of fever, dysuria and pain of lower abdomen. Recurrent UTIs had been occurring for several months despite prophylaxis, initially with co-trimoxazole and then with fosfomycin. There were no anatomic abnormalities and tacrolimus concentrations always remained at the lower range of normal. Kinking of the ureter was suspected because of a change in the position of the transplanted kidney. Ultrasonography performed in the standing and lying position confirmed the diagnosis. A DJ catheter was inserted into the ureter. In the following months, no recurrence of UTI or urinary retention was observed. Nephroptosis of a transplanted kidney is extremely rare. The standard place for graft implantation - the iliac fossa - significantly limits the potential for migration. Kidneys implanted intraperitoneally also do not show clinically significant mobility due to postoperative adhesions. Floating kidney potentially leads to serious complications. In addition to pain, a migrating graft may cause urine retention, predisposing to UTI and acute kidney injury. ConclusionsNephroptosis of transplanted kidney is extremely rare, therefore the diagnosis is not always obvious, which may result in treatment delay.