Chronic Bleeding Research Articles

Predictors and outcomes of same day discharge after minimally invasive hysterectomy in gynecologic oncology within the National Surgical Quality Improvement Program database

ObjectiveTo assess trends over time of same day discharge after minimally invasive hysterectomy in oncology, identify perioperative factors influencing same day discharge, and evaluate 30 day postoperative morbidity.MethodsA retrospective cohort...

Non-surgical Recovery of a Chronic Subdural Hemorrhage Patient via the Exclusive Administration of <italic>Oryeong-san</italic>: A Case Report

Introduction: Chronic subdural hemorrhage (CSDH) primarily affects the elderly, and its incidence is rising due to aging trends. Although burr-hole craniostomy is a common treatment for CSDH, it often has a high recurrence rate and can sometimes result in poor outcomes. Oryeong-san, a traditional Korean medicine, is emerging as a potential remedy, with documented cases in both Korea and Japan.Case Presentation: In March 2021, a patient was diagnosed with an intracerebral hemorrhage in the left basal ganglia. A subsequent brain computed tomography in June 2022 revealed CSDH. Given the potential need for surgery if no CSDH absorption occurred, the patient was treated with <i>Oryeong-san</i>. Later computed tomography scans indicated that surgery was no longer necessary.Conclusions: This study evaluated the efficacy of <i>Oryeong-san</i> in treating CSDH. The results demonstrated complete CSDH absorption with no observed side effects, highlighting <i>Oryeong-san</i> as a promising and safe therapeutic option.

A Rare Case of Hypertrophic Pachymeningitis after Surgery for Chronic Subdural Hemorrhage: A Case Report

Hypertrophic pachymeningitis (HP) is a rare type of inflammatory fibrosis characterized by diffuse thickening of the dura mater, which may cause a compressive effect or vascular compromise. Progressively worsening headache is the usual symptom, along with ataxia and various cranial nerve palsies. This article describes a rare case of HP after burr hole trephination for a chronic subdural hemorrhage (CSDH). A 64-year-old man was admitted to the emergency room with a headache that had started approximately 2 weeks prior. After the diagnosis of CSDH on imaging, burr hole trephination was performed. Six months later, the patient visited the hospital again with a headache. He was diagnosed with a recurrence of CSDH, and a craniotomy was performed. A solid subdural granuloma was suspected and a pathological examination revealed acute and chronic inflammation. Tissue biopsy and laboratory blood tests did not reveal any abnormalities. Three months later, he visited the hospital again with a severe headache. Magnetic resonance imaging showed no significant difference in the area of the previous operation; however, focal venous congestion and localized venous ischemic or inflammatory changes were observed in the tentorium. A craniotomy was performed for biopsy, and the dura mater was very thick. The pathology was diagnosed as HP. After taking steroids and immunosuppressive agents, the patient's symptoms improved. HP is a rare chronic inflammatory condition of the dura mater that causes neurological deficits. If the diagnosis is not definitively established based on an imaging examination, it should be made through a surgical biopsy. Steroid and immunosuppressive agents can improve the prognosis after diagnosis.

Impact of left atrial appendage closure in patients on anticoagulation for atrial fibrillation and recurrent or chronic gastrointestinal bleeding

Impact of left atrial appendage closure in patients on anticoagulation for atrial fibrillation and recurrent or chronic gastrointestinal bleeding

Study of the cervical and vaginal microbiota in women with intrauterine pathology and infertility

The widespread introduction of hysteroscopy into clinical practice has significantly expanded the possibilities of diagnosis the causes of infertility. Almost 25% of patients with infertility are diagnosed with intrauterine pathology during hysteroscopy, which is not always identified during ultrasonography and/or hysterosalpingography. The World Health Organization recommends the use of office hysteroscopy in all cases of suspected intrauterine pathology. Among all complications of hysteroscopy, the frequency of which ranges from 0.4 to 6.0%, infectious and inflammatory complications occur most often (0.6-2.5%). Intrauterine interventions disturb the “cervical” protective barrier, which, in the presence of dysbiotic or inflammatory processes of the genital tract, increases the risk of complications. In view of the increase in the frequency of intrauterine pathology, and, accordingly, the frequency of diagnostic and operative intrauterine interventions in women of reproductive age, the development of algorithms for the prevention of infectious and inflammatory complications is relevant.The objective: to investigate the state of the cervical and vaginal microbiota of women of reproductive age with intrauterine pathology and infertility who are preparing for hysteroscopy.Materials and methods. 45 women aged 26 to 45 years (main group) and 30 women of the same age without gynecological pathology (comparison group) were examined before hysteroscopy. A comprehensive study of the state of the cervical and vaginal microbiota, diagnosis of infection with sexually transmitted pathogens, included pH-metry of vaginal contents, bacterioscopic examination of vaginal smears, and polymerase chain reaction (PCR).Results. Indications for hysteroscopy were chronic abnormal uterine bleeding (13.3%), endometrial hyperplasia (8.9%); suspicion of endometrial polyps (8.9%), submucosal myoma (8.9%) or uterine malformations (17.8%); infertility of unclear origin (42.2%). In patients of the main group, inflammatory and dysbiotic processes of the lower part of the genital organs in the anamnesis occurred 5.6 times more often. In 22.2% of the patients of the main group, the normal vaginal pH level was determined (3.8–4.5) versus 60.0% of the women of the comparison group (p<0.05). According to bacterioscopy, normocenosis was found in 28.9% of women in the main group and 43.3% – in the comparison group, while according to PCR normocenosis was determined in 35.6% and 63.3% of cases, respectively. A significant frequency of the intermediate state of the microbiota was estimated (37.8% in the main group and 23.3% – in the comparison group), which correlated with changes in the pH of the vagina (r=0.567). Of the 18 patients in the main group, bacterial vaginosis was diagnosed in 22.2% of cases, vulvovaginal candidiasis – in 4.4%, and chlamydia – in 8.9%.Conclusions. A significant frequency of diseases of the lower part of the genital tract in the anamnesis is typical for patients with infertility and intrauterine pathology. In 77.8% of patients with infertility and intrauterine pathology, a shift in vaginal pH to the alkaline side (> 4.5) is found, which creates conditions for the reproduction of opportunistic and pathogenic microflora. This is confirmed by the low frequency (35.6%) of normocenosis of the cervical and vaginal microbiota at 63.3% in patients without gynecological pathology and correlates with the frequency of intermediate microbiota state. Taking into account the risk of ascending infection during intrauterine interventions, the use of diagnostic methods with high sensitivity and specificity (PCR) is revealed for adequate diagnosis of the state of the cervical and vaginal microbiota, which at the same time will avoid unfounded medical measures.

Sinonasal Organizing Hematoma: Demographics, Diagnosis, and Treatment Outcomes of 112 patients.

Sinonasal organizing hematoma (OH) is a rare, nonneoplastic lesion that often presents with epistaxis, a reddish mass, and destruction of the involved sinonasal structures. Due to its rarity, the demographics, diagnostic modalities, treatment strategies, and outcomes have not yet been studied in a large, long-term study. Retrospect cohort of 112 sinonasal OH patients treated between 1997 and 2020 in a tertiary, university hospital were evaluated. Demographics, systemic comorbidities, sinonasal surgery history, serum laboratory tests, radiological findings, and treatment results were collected. The present study aimed to assess the accuracy of preoperative computed tomography (CT), Gadolinum-enhanced magnetic resonance (MR), and punch biopsies in detecting sinonasal OH as the most likely diagnosis. In addition, incidental differences by age and year of diagnosis were calculated using the Poisson log-linear regression model. The median age was 44, and 58% were male. Fewer than 20% of these cases had a chronic systemic comorbidity, bleeding tendency, or sinonasal surgery history. MR had the highest accuracy of (87%) to detect sinonasal OH as the most likely diagnosis, compared with contrast-enhanced-CT (53%), punch biopsy (49%), and non-enhanced-CT (16%) (all <0.05). Sinonasal OH incidence did not vary by age, but the yearly rate significantly increased by 1.05 times over 23 years (p < 0.05). Notably, 84% of 112 patients received surgical removal through the assistance of an endoscope, and none had substantial bleeding without preoperative embolization. Sinonasal OH was observed regardless of age, sex, systemic comorbidities, bleeding tendency, prior sinonasal surgery, or trauma. Preoperative MR gives the highest accuracy for detecting this disease. Sinonasal OH may be safely managed with endoscopic-assisted surgery removal without embolization. 4 Laryngoscope, 134:1581-1590, 2024.

Chronic gastrointestinal bleeding and anemia in a pancreas transplant recipient: A creative solution to a previously uncharacterized complication

Chronic gastrointestinal bleeding and anemia in a pancreas transplant recipient: A creative solution to a previously uncharacterized complication

Superficial siderosis presenting as hemiparesis in a paediatric patient with congenital Factor V deficiency – A case report.

Superficial siderosis is a rare abnormality caused by deposition of hemosiderin in the subpial or subarachnoid spaces of the brain, cranial nerves, and spinal cord. It results from chronic repetitive bleeding in the subpial/subarachnoid space. Magnetic resonance imaging of the brain is the diagnostic modality of choice. We describe a rare case of an 18-month-old male, a known case of congenital Factor V deficiency, who presented with recurrent vomiting, irritability and right-sided hemiparesis. On Magnetic resonance imaging, there was hypointense coating of the surface of the brainstem and cerebellum with ventricular dilatation. This case emphasizes the fact that superficial siderosis should be specifically looked for when evaluating a patient with a history of previous intracranial bleed followed by a thorough search for the source of the hemorrhage.

Erythropoiesis-stimulating agents—benefits and harms in the treatment of anemia in cancer patients

SummaryAnemia is a common finding in patients with solid or hematological malignancies. The underlying causes of cancer-related anemia can be multifactorial, including toxicity of cancer therapy, raised inflammatory conditions by the cancer, chronic bleeding and malnutrition. Therapeutic approaches for the treatment of chemotherapy induced anemia encompass red blood cell (RBC) transfusions and erythropoietin-stimulating agents (ESAs). The latter are approved for the treatment of patients with symptomatic anemia caused by palliative chemotherapy to reduce the number of RBC transfusions and gradually improve anemia-related symptoms. Before the treatment with ESA, a baseline Hb level &lt; 10 g/dl is mandatory and iron deficiency must be ruled out. ESAs are linked to an increase in thromboembolic events and potentially raised mortality. Therefore, the risk-benefit ratio should be carefully assessed.

Efficacy of the Non-Surgical Treatment of Chronic Subdural Hematoma: A Systematic Review

Background Chronic subdural hematoma (CSDH) is one of the most common neurological diseases. Surgical treatment is the gold standard treatment. However, the hematoma recurs in up to 25% of cases. In addition, many complications may occur after surgery. Despite the fact that conservative treatment for CSDH has grown in popularity, no medicine currently has level 1 evidence to back it up. Objective To figure out the efficacy of the non-surgical treatment of CSDH and to highlight its role in mildly symptomatic or asymptomatic patients. Patients and Methods The following electronic databases were searched for studies from 2000 to 2020: PubMed, Google Scholar, EMBASE, and Science Direct, using appropriate combinations of the following Keywords: chronic subdural hematoma, hemorrhage, CSDH, bleeding, non-surgical treatment, conservative management or treatment, alternative management or treatment, dexamethasone, steroids, corticosteroid, pharmacological treatment. Results Fifteen studies met our selection criteria. A total of 616 patients received medical treatment for CSDH. Their mean age was 70.49 years, including 468 males (76%) and 148 females (24%). Improvement of the presenting symptoms occurred in 477 patients (77.44%), and 139 patients (22.56%) required surgical intervention. Conclusion The results of the previous studies suggested that medical treatment in selected patients was a valid option as a primary treatment and as an adjuvant therapy with surgical evacuation for CSDH. Further randomized controlled studies with larger patient cohorts are needed to determine the true value of each drug in the conservative treatment of CSDH.

Comparison between Intraoperative and Ultrasound Determined Cesarean Scar Thickness after Elective Cesarean Sections and Unplanned Cesarean Sections in Subsequent Term Pregnancies

Background Cesarean section (CS) rates are increasing worldwide. As a result, women presenting with pregnancy with previous CS are also rising. Previous CS is becoming the most common indication for CS, confirming the age old dictum proposed by Edward Craigin in 1914 “Once a cesarean always a cesarean. Aim of the Work Assessment of cesarean scar; as non-healthy or poor-healed scar are associated with some complications such as chronic pelvic pain, dyspareunia, and abnormal bleeding. Moreover, these poor-healed scars may predispose to preterm labour and uterine dehiscence or rupture in subsequent pregnancy. It was reported also that poor-healed scar may predispose to abnormal placental invasion. Patients and Methods This comparative cross-sectional study was conducted on 100 randomly selected pregnant women attending the outpatient clinic of Ain Shams University Maternity Hospital (ASUMH) in the third trimester at term aged &amp;gt;18 years old with single intrauterine pregnancy, previous one cesarean delivery and not in labor. Pregnant women with abnormal placentation, uterine abnormalities and/or previous uterine surgeries other than one CS delivery were excluded from current study. Results there was no significant difference betweenn two studied groups according to demographic data as age (27.0±3.9 vs. 27.6±3.6, p = 0.382) and BMI (28.2 ± 3.3 vs. 28.7 ± 2.2, p = 0.283). Both groups were comparable with statistically significant difference regarding scar thickness in (ml) and LUS staging. The scar was thicker in elective cases compared with emergency ones (8.4±1.1 vs. 7.7±1.3, p = 0.002), stage I (34 (68.0%) vs. 16 (32.0%)), stage II (15 (30.0%) vs. 25 (50.0%)), stage III (1 (2.0%) vs. 7 (14.0%)) and stage IV (0 (0.0%) vs. 2 (4.0%)). Conclusions From the results of current study we can conclude that, Maternal age and BMI had no effect on cesarean scar quality, integrity and complications incidence. The scar was thicker in elective cases compared with emergency ones.

Re-examining poikilocytosis in goats: prevalence, type and association with age and disease.

Domestic goats (Capra aegagrus hircus) are a food, fiber and companion animal. Abnormal erythrocyte shapes (poikilocytes) are considered normal in young goats, but their association with disease is not well described. Likewise, there is little information on the significance of poikilocytosis in adult goats. The objective of this study was to investigate the prevalence, severity and type of poikilocytosis in young and adult goats and its association with age, sex, breed, laboratory results, and underlying disease. We retrospectively examined clinical and laboratory data from 1254 goats presented at the University of California-Davis Veterinary Medical Teaching Hospital from 1997 to 2019. We analyzed 313 blood smears from goats with moderate or marked (MOD-MKD) poikilocytosis on initial blood smear evaluation. Number and type of poikilocytes per 1000 red blood cells (RBCs) were enumerated. Laboratory values and primary disease categories were compared with the severity and type of poikilocytosis. Kids (<6 mos) and juveniles (>6 mos to <1 year) had a higher prevalence of MOD-MKD poikilocytosis (95/210, 45.2% kids; 27/59, 45.8% juveniles) than adult goats (≥1 year; 190/982, 19.3%) (p < 0.001). Kids had a higher percentage of elliptocytes, dacryocytes, and schistocytes and a lower percentage of polygonal and spiculated RBCs than juvenile and adult goats (p < 0.001). Of goats with MOD-MKD (vs NONE-SLIGHT) poikilocytosis, kids had lower HGB and MCH, and higher RDW (p ≤ 0.02); juveniles and adult goats had lower HCT, MCV, MCH, and albumin concentration (p ≤ 0.01), and all age groups had lower total CO2 concentration and higher PLT counts (p < 0.03). Adult goats with MOD-MKD poikilocytosis also had higher BUN:Cr ratios (p = 0.005). Gastrointestinal parasitism, Johne's disease, diarrhea/enteritis, lice, hepatic disease and renal disease (but not urolithiasis) were significantly associated with MOD-MKD poikilocytosis (p < 0.001). Goats with hepatic and renal disease had a higher prevalence and percentage of spiculated cells (p = 0.001). Goats with Johne's disease had a higher prevalence of polygonal cells (93.3%) and dacryocytes (66.7%) than other diseases, and elliptocytes predominated in a higher proportion (36.0%) of adult goats with GI parasitism vs other diseases (p < 0.05). These findings suggest that iron deficiency is an important pathophysiologic mechanism of poikilocytosis in juvenile and adult goats, and possibly in kids, whether due to iron-restricted erythropoiesis, chronic hemorrhage, functional iron deficiency, or a combination of these mechanisms. Further investigation into the detection and monitoring of iron deficiency and the value of poikilocytosis as a diagnostic marker of iron status in goats is warranted.

The impact of sex, body mass index and chronic kidney disease on outcomes following percutaneous coronary intervention

ObjectiveThis study sought to evaluate 1) the relationship between body mass index (BMI), chronic kidney disease (CKD) and bleeding complications in patients undergoing percutaneous coronary intervention (PCI); and 2) whether CKD modified the effect of BMI on major bleeding and major adverse cardiac and cerebrovascular events (MACCE). BackgroundThe interaction of CKD, sex and BMI in patients undergoing PCI is unclear. MethodsBetween 2010 and 2018, a total of 31,116 patients underwent PCI at six New York metropolitan area hospitals. Bleeding complications were classified by the Bleeding Academic Research Consortium (BARC). Major bleeding was defined as BARC≥3. MACCE was the composite of in-hospital death; myocardial infarction; cerebrovascular events and major bleeding complications. Interaction on multiplicative scales was assessed adjusting for other factors. A three-way multiplicative interaction between BMI, CKD and sex were considered and evaluated for both endpoints of primary interest (BARC≥3 and MACCE). ResultsPatients with BARC≥3 bleeding were older (p < 0.0001) and more likely female (p < 0.0001). A 3-way interaction existed between sex, BMI, and CKD on BARC≥3 (p = 0.02). Specifically, the effect of CKD status on odds of BARC≥3 depended on BMI group among males, whereas BMI did modify the relationship between CKD and BARC≥3 among females; after stratification by sex, a significant interaction between BMI and CKD was present in females (p = 0.03) but not in males (p = 0.43). Among females without CKD, normal BMI patients had the greatest odds of BARC≥3 compared to obese or overweight females. Contrasted to females without CKD, among females with CKD there was no significant increased odds of BARC≥3 in normal BMI patients compared to obese or overweight females. However, overweight females with CKD had a significantly increased odds of BARC≥3 compared to obese females with CKD. Furthermore, obese females with CKD had significantly greater BARC≥3 odds compared to obese females without CKD. Similarly, overweight females with CKD had an increased odds of BARC≥3 compared to overweight females without CKD. No significant interactions were found for the odds of MACCE. ConclusionIn patients undergoing PCI, there was evidence of a significant and complex 3-way interaction between BMI, CKD and sex for major bleeding events. The predicted probability of major bleeding was greater for females than for male patients, and for both sexes, greater among those with CKD, but BMI group influences these probabilities. Obese females with kidney disease had the lowest incidence of bleeding complications when compared with overweight or normal weight female patients undergoing PCI. This interaction was not seen in the male group or for MACCE. Furthermore, age, cardiogenic shock, STEMI and use of IABP/Impella were each independently associated with odds of major bleeding (among both males and females) and MACCE.

Diabetes mellitus as a risk factor for postoperative complications following arthroscopic rotator cuff repair

Patients with diabetes mellitus who undergo arthroscopic rotator cuff repair (aRCR) have an increased risk of postoperative complications when compared to nondiabetics. To further investigate these complications, we used a large national database to determine the 30-day postoperative complications associated with insulin-dependent and non-insulin-dependent diabetics following aRCR. The American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database was queried for all patients who underwent aRCR between 2015 and 2020. The study population was categorized into cohorts based on diabetes mellitus status: non-insulin-dependent diabetes mellitus (NIDDM), insulin-dependent diabetes mellitus (IDDM), and no diabetes. Multivariate analysis, adjusted for confounding demographics and comorbidities, was used to determine independently associated complications. There were 39,877 cases of aRCR in NQSIP included in this study. Diabetics comprised 6575 (16.7%) of these cases, with 4758 being NIDDM (11.9%) and 1817 being IDDM (4.6%). Bivariate logistic regression found both NIDDM and IDDM cohorts to be significantly associated with higher body mass index, ASA class ≥3, hypertension, chronic obstructive pulmonary disease, bleeding disorders, and preoperative wounds or infection (P<.001). NIDDM was an independently associated risk factor for sepsis (odds ratio [OR], 2.77; 95% confidence interval [CI]: 1.01-7.58; P=.047). IDDM was an independently associated risk factor for pneumonia (OR, 2.49; 95% CI: 1.13-5.48; P=.023), readmission (OR, 1.617; 95% CI: 1.19-2.33; P=.003), myocardial infarction (OR, 0.50; 95% CI: 0.12-1.00; P=.048), and on a ventilator >48 hours (OR, 5.63; 95% CI: 1.40-22.62; P=.015). NIDDM is an independent risk factor for sepsis, while IDDM is an independent risk factor for pneumonia, readmission, myocardial infarction, and remaining on a ventilator for greater than 48 hours following aRCR.

Pericardial malignant mesothelioma diagnosed in a dog by immunocytochemistry of the pericardial fluid: a case report

BackgroundPericardial effusions are one of the most common cardiac diseases in dogs. Common causes of haemorrhagic pericardial effusions include neoplasia, such as hemangiosarcoma, mesothelioma, chemodectoma, and ectopic thyroid tumours, and benign idiopathic pericardial effusion. Distinguishing among reactive mesothelial cells, malignant mesothelioma, and adenocarcinoma in body effusions is a diagnostic challenge. Therefore, the author aimed to discover whether the observed cells were reactive mesothelial, mesothelioma, or adenocarcinoma cells through immunocytochemistry using five markers (cytokeratin, vimentin, desmin, E-cadherin, and calretinin) in a canine patient.Case presentationA 2.1 kg, spayed female, 10-year-old Yorkshire Terrier dog presented to a local hospital with dyspnoea and was evaluated for pericardial effusion. The presence of pericardial fluid was confirmed, and she was referred to our hospital for further evaluation. In cytological evaluation, cells shed individually or in clusters were observed, along with numerous non-degenerative neutrophils and macrophages. The cells showed binucleation, anisocytosis, anisokaryosis, abnormal nucleoli, abundant basophilic cytoplasm, high nuclear–cytoplasmic ratio, and coarse chromatin. Large atypical multinucleate cells were also observed. Erythrophagia was observed, indicating chronic haemorrhage. Immunocytochemistry using pericardial fluid was positive for cytokeratin, vimentin, desmin, E-cadherin, and calretinin. Therefore, malignant mesothelioma was diagnosed.ConclusionsImmunocytochemistry is a very useful diagnostic technique because it can determine whether several fluorescent markers are simultaneously expressed in the same cell. Further, E-cadherin and calretinin can be used for the differential diagnosis of reactive mesothelial cells, malignant mesothelioma, and adenocarcinoma in dogs.

Menstrual dysfunction in women of reproductive age belonging to major ethnic groups in Eastern Siberia: a cross-sectional study

Aim. To determine the prevalence and features of menstrual dysfunction in premenopausal women of various ethnicities inhabitating Eastern Siberia.Materials and Methods. We conducted a cross-sectional study which included women of reproductive age (18-44 years) living in the Irkutsk region and the Republic of Buryatia. Out of 1134 women, 715 (63.1%) were Caucasians, 312 (27.5%) were Asians (Mongoloid), and 107 (9.4%) were of mixed ethnicity. The data have been collected during the annual physical examination carried out between March 2016 to May 2021,Results. The average age of menarche onset was 13.3 ± 1.4 years and did not differ significantly in Caucasians, Asians, and group of mixed ethnicities. The most frequent ages for menarche were 11 and 15 years among women of mixed ethnicity and Asians, respectively. Chronic abnormal uterine bleeding and dysmenorrhea was detected in 573/1134 (50.5%) and in 280/1134 (24.7%) of the examined women, respectively, without significant differences between the ethnicities. However, dysmenorrhea symptoms were more severe in Caucasians as compared to Asian women.Conclusion. The most frequent variant of menstrual dysfunction is chronic abnormal uterine bleeding. There were no significant differences in the prevalence of irregular menstrual cycles, oligo/anovulation, chronic abnormal uterine bleeding, and dysmenorrhea in women of reproductive age belonging to different ethnicities, although clinical manifestations of dysmenorrhea were most pronounced in Caucasians.

Diagnosis and Treatment of Adenomyosis with Office Hysteroscopy-A Narrative Review of Literature.

Adenomyosis is a common chronic disease in women of reproductive age, characterised by the presence of ectopic endometrial tissue within myometrium. Even though adenomyosis presents with chronic pelvic pain, menorrhagia or abnormal uterine bleeding, dysmenorrhoea, and dyspareunia and is often recognised after hysterectomies. However, the development of ultrasonography and magnetic resonance imaging has improved the pre-operative diagnosis of the disease. Hysteroscopy provides information in real time from the uterine cavity and the offers the possibility of obtaining direct biopsies. The literature was searched via Pubmed and Embase with the following headings: diagnosis of adenomyosis or adenomyoma and office hysteroscopy, hysteroscopy findings of adenomyosis or adenomyoma, treatment of adenomyosis or adenomyoma with office hysteroscopy. The literature showed that hysteroscopy can identify superficial adenomyosis. There are a variety of hysteroscopic images that can be connected with the disease. New equipment like the spirotome has been used to access deeper layers of myometrium and obtain biopsies under direct vision from the adenomyotic areas. Different methods of treatment have been also described, like enucleation of focal superficial adenomyoma, coagulation, evacuation of cystic adenomyosis when the lesion is smaller than 1.5 cm, and resection of adenomyotic nodules in case of bigger lesions (>1.5 cm). Diffuse superficial adenomyosis is also managed by resection. Hysteroscopy has revolutionised the approach to adenomyosis. It is a useful tool in assessing mainly superficial adenomyosis. The role of hysteroscopy in surgical management of adenomyosis need to be confirmed with further studies.

An Exceptional Presentation of “Watermelon Stomach” in a 30- Year-Old Cirrhotic Male

Gastric antral vascular ectasia (GAVE) is an unusual cause of chronic upper gastrointestinal bleeding commonly described in elderly females, with associated autoimmune diseases, and in cirrhotic males. The entity is characterized by angioectasia in the pyloric antrum, giving its classic streaky “watermelon stripe” appearance. This report highlights the rare presentation of a 30-year-old male with liver cirrhosis, who presented with anemia and fatigability. Diagnosis of GAVE was made using endoscopy, and trials of argon plasma coagulation were administered. Following this, an antrectomy was performed since there was a further drop in hemoglobin. The patient made a full recovery with no subsequent dependence on blood transfusions. GAVE can be mistakenly underdiagnosed as a treatable cause of occult gastrointestinal bleeding. This report mandates caution on endoscopy for younger patients with an upper gastrointestinal bleed while taking other more common causes of gastrointestinal bleeding (peptic ulcers, esophageal varices, and non-steroidal anti-inflammatory drugs [NSAID]-induced gastritis) into account.

Superficial siderosis suspected to be related to vertebral fracture and vertebroplasty

Superficial siderosis (SS) of the central nervous system is a rare disorder caused by chronic or recurrent hemorrhages into the subarachnoid space, and subsequent deposition of hemosiderin in the subpial layers of the brain and spinal cord lead to the development of neuronal damage. The diagnosis of SS is typically made by brain imaging and management may include identifying and treating the underlying cause of the bleeding, as well as symptomatic treatment. We present the case of a 79-year-old female with chronic progressive gait ataxia and dysarthria. She was eventually diagnosed with SS probably due to lumbar compression fracture treated with vertebroplasty 6 years ago.

Juvenile Colorectal Polyposis in Children: About a Clinical Case

Juvenile polyposis syndrome is a rare autosomal dominant hereditary disease characterized by the presence of several juvenile polyps in the gastrointestinal tract. This disease predisposes to colorectal cancer, hence the importance of an early detection and a rigorous endoscopic screening [1]. We report the case of a juvenile colorectal polyposis in a 16 years old child revealed by a chronic rectal bleeding.