Woman Presenting Research Articles

Prolactinoma Presenting with Secondary Amenorrhoea in a Young Girl

Prolactinoma is the most common secreting pituitary adenoma. It has different clinical presentation in men and women which varies with age. Young women present with menstrual problems, infertility and galactorrhoea, whilst older women and men may present with loss of libido, visual disturbances and in late cases, ith osteoporosis. In approaching a young woman with secondary amenorrhoea, other cuses such as pregnancy, functional hypothalamic amenorrhea, pituitary adenoma, Polycystic Ovarian Syndrome (PCOS) or primary ovarian insufficiency should be ruled out. Prolactinoma can be confirmed in the presence of high serum prolactin level and adenoma on pituitary gland magnetic resonance imaging (MRI). Dopaminergic agonist, cabergoline is efficacious in restoring gonadal and sexual functions by normalising prolactin levels. We presented a case report onan 18-year-old girl who presented with secondary amenorrhoea for six months. On further evaluation she was noted to have galactorrhoea with substantially high prolactin level of 466.9 ng/mL (normal range: 4.0- 23) and the MRI showed a pituitary tumour measuring 1.2 x 1.1 x 1.4 cm. A diagnosis of macroprolactinoma was made and she was managed with cabergoline with gradual dose increment. At 6 months of treatment, her menstrual cycle and serum prolactin had normalised. A repeat MRI pituitary one year later showed reduction in tumour size.

You’re a pain in my side! Abscess and microperforation as a complication of therapy from early-stage endometrial cancer: A case report

This paper reports on a 55-year-old woman presenting with left lower quadrant and groin pain that posed a significant diagnostic challenge. She had a history of obesity and stage 1B endometrial carcinoma treated with surgery and radiation 1-year prior. Despite several unsuccessful biopsy attempts and unclear imaging findings, she was ultimately diagnosed with a pelvic sidewall abscess secondary to a bowel microperforation, a rare late complication of radiation related to adhesions, weakened bowel, and peristalsis. Her condition was successfully treated with drainage and antibiotics. It is widely known that patients with endometrial cancer and comorbid obesity often experience diagnostic delay, weight stigma, and other barriers and thus deserve careful attention and continued advocacy.

Presenteeism and associated factors among women with menstrual symptoms.

Menstrual characteristics can affect a woman's productivity at work and college, but studies in a general population of adult women are scarce. In addition, it is important to know which menstrual symptoms are most associated with presenteeism in women to promote specific health actions. The present study aimed to assess menstrual symptoms associated with presenteeism in adult women. Online cross-sectional study in which menstrual characteristics, including menstrual flow, age of menarche, menstrual pain and cycle duration were assessed by a self-report questionnaire. The menstrual pain intensity was assessed by Numerical Rating Scale, and the presenteeism, by the Stanford Presenteeism Scale-6 (SPS-6). Women were divided in two groups, with and without presenteeism, based on the SPS-6 cutoff point. Data were analyzed by binary logistic regression and presented as odds ratios (OR). Among the 430 women who participated in the study, 44.2% were classified as with presenteeism. Women with severe menstrual flow were more likely to have presenteeism (OR = 2.12) compared with women with mild and moderate menstrual flow. The higher menstrual pain intensity the higher the chances of a woman presenting with presenteeism (OR = 1.29). These menstrual characteristics (intensity of menstrual flow and menstrual pain) seem to affect women's productivity at work and/or college, and should be assessed in research and clinical practice. Thus, public policies on women's health can be carried out based on these results.

Microsurgical Resection of a Medulla Oblongata Cavernoma: 3-Dimensional Operative Video.

Cavernous malformations occur in approximately 0.5% of the population. When it comes to the medulla oblongata, the incidence rate is around 5%.1,2 Patients with these conditions face potential risks such as hemorrhaging, substantial mortality, and morbidity. The symptoms experienced by the patient vary depending on the extent of hemorrhaging and the location of the lesion. Surgery stands as the primary and essential form of treatment in these cases.1-4 The aim of this operative video was to present the removal of a medulla oblongata cavernoma. The patient consented to the procedure and to the publication of her images and surgical video. We describe the case of a 53-year-old woman presenting with headaches and with swallowing difficulties, being tracheostomized on hospital admission. Magnetic resonance imaging showed a lesion located at the medulla oblongata. Owing to the patient's symptoms and cavernoma bleeding, surgical resection was determined. There were no adverse outcomes after surgery, and the patient evolved favorably. Postoperative imaging displayed complete removal of the cavernoma. Microsurgical resection of cavernomas in this location with neurophysiological monitoring and selection of the safe entry zone is an effective option.1-4.

Clinical Reasoning: A 38-Year-Old Woman Presenting With Acute Hyperkinetic Movements of Her Right Arm.

We present a case report of a 38-year-old woman who presented to the hospital with acute onset high amplitude, non-rhythmic, hyperkinetic movements of the right upper extremity, abnormal sensation of the right upper extremity from the elbow to the hand, and the inability to recognize her hand without visual input. This case discusses the differential diagnoses of acute hyperkinetic movement disorders and concurrent alien-limb in a patient presenting within the time window for vascular intervention. Readers are led through the reasoning behind acute interventional decision-making in a patient with a rare presentation. Workup reveals the eventual diagnosis.

Where does it come from? A large pelvi-abdominal mass with points to ponder

Ureteral leiomyosarcoma is a very rare aggressive retroperitoneal malignancy with limited possibility of an accurate pre-operative diagnosis. Incidence of ureter leiomyosarcoma is extremely rare. Hence, there is paucity of reported cases in the literature. We present a case of a 60-year-old postmenopausal woman presenting with abdominal distension and discomfort. This was initially reported as a malignancy arising from left ovary, as the lesion had apparent convergence toward left adnexal region and the left ovary was not seen separately. In addition, there was moderate hydronephrosis of the left kidney and left ureter was not separately made out from the lesion. Leiomyosarcoma should be considered as a differential diagnosis in cases of ureter stricture and retroperitoneal tumors causing ureteric obstruction.

Distal Fibular Metastasis of Colorectal Carcinoma: A Case Report.

A 62-year-old woman presenting with ankle pain was initially treated for a non-displaced fracture. Persistent pain despite months of conservative management for her presumed injury prompted repeat radiographs which demonstrated the progression of a lytic lesion and led to an orthopedic oncology referral. Following a complete work-up, including biopsy and staging, she was diagnosed with colorectal carcinoma metastatic to the distal fibula. Secondary tumors of the fibula are uncommon but an important diagnosis to consider for intractable lower extremity pain especially in patients with history of malignancy or lack of age-appropriate cancer screening.

Disseminated nocardiosis and anti-GM-CSF antibodies.

Infections that are unusually severe or caused by opportunistic pathogens are a hallmark of primary immunodeficiency (PID). Anti-cytokine autoantibodies (ACA) are an emerging cause of acquired immunodeficiency mimicking PID. Nocardia spp. are Gram-positive bacteria generally inducing disseminated infections in immunocompromised patients, but seldom also occurring in apparently immunocompetent hosts. Anti-GM-CSF autoantibodies are associated with autoimmune pulmonary alveolar proteinosis (PAP). In those patients, an increased incidence of disseminated nocardiosis and cryptococcosis has been observed. It is unclear whether the PAP or the autoantibodies predispose to the infection. We report an apparently immunocompetent woman presenting with disseminated nocardiosis without any evidence of PAP. Clinical data and radiological images were retrospectively collected. Lymphocyte populations were analyzed by flow cytometry. Anti-GM-CSF autoantibodies were measured by ELISA. A 55-year-old otherwise healthy woman presented with cerebral and pulmonary abscesses. Personal and familial history of infections or autoimmunity were negative. After extensive examinations, a final diagnosis of disseminated nocardiosis was made. Immunologic investigations including neutrophilic function and IFN-γ/IL-12 circuitry failed to identify a PID. Whole-exome sequencing did not find pathogenic variants associated with immunodeficiency. Serum anti-GM-CSF autoantibodies were positive. There were no clinical or instrumental signs of PAP. Trimethoprim-sulfamethoxazole and imipenem were administered, with progressive improvement and recovery of the infectious complication. We identified anti-GM-CSF autoantibodies as the cause of disseminated nocardiosis in a previously healthy and apparently immunocompetent adult. This case emphasizes the importance of including ACA in the differential diagnosis of PID, especially in previously healthy adults. Importantly, anti-GM-CSF autoantibodies can present with disseminated nocardiosis without PAP.

Tuberculum meningioma with recovery of glaucoma-like visual field defects after chiasmal decompression: a case report

BackgroundTo report a case of tuberculum meningioma with recovery of glaucoma-like visual field defects after chiasmal decompression.Case presentationA 39-year-old woman presenting with headache was found to have bilateral arcuate retinal nerve fiber layer (RNFL) thinning on optical coherence tomography (OCT) with a corresponding arcuate scotomas consistent with glaucomatous change. However a suprasellar tumor compressing the anterior chiasm from below was found on magnetic resonance imaging of the brain. After resection of the mass, which was diagnosed as meningothelial meningioma by the pathological examination, the glaucoma-like visual field defects resolved despite the RNFL thinning on the OCT showing no improvement.ConclusionsChiasmal compression may mimic glaucoma and produce arcuate scotoma rather than temporal visual field loss. There is a possibility that the development of chiasmal compression somehow converted preperimetric glaucoma into a more advanced form accompanied by visual field defects and that the glaucoma reverted to the preperimetric state after chiasmal decompression.

A166 STEROID-REFRACTORY ILEITIS FOLLOWING RITUXIMAB THERAPY: A CASE REPORT AND LITERATURE REVIEW

Abstract Background Rituximab, an anti-CD20 monoclonal antibody commonly used in treatment of hematologic and rheumatologic disease is generally well-tolerated from a gastrointestinal perspective however rare reported side effects include diarrhea and enterocolitis. Aims We describe a case of steroid-refractory ileitis presenting in a woman with follicular lymphoma post Rituximab therapy. Methods A case report and literature review were performed. Results A 73-year-old woman presented with a 4-week history of fevers, bloody diarrhea and abdominal pain. She had a known history of stage IV follicular lymphoma treated with six cycles of Bendamustine and Rituximab followed by four doses of maintenance Rituximab, with the last dose ending 4 weeks prior to her presentation. On examination, she had multiple peri-anal round ulcers. An abdominal CT revealed circumferential mural thickening involving the distal terminal ileum. On colonoscopy, there were multiple discrete ulcers and nodularity in the terminal ileum. Pathology showed evidence of chronic active ileitis with no signs of malignancy, lymphoproliferative disorders, or granulomas. AFB smear and cultures were negative. She was given IV steroids for 1 week and then placed on a Prednisone taper scheduled to finish in 9 weeks. 4 weeks later she presented again with fevers and abdominal pain. Inflammatory markers were elevated, and a repeat CT abdomen showed ongoing multifocal ileitis. She was put back on IV steroids and monitored. She continued to have persistent abdominal pain and fevers, and then underwent a repeat colonoscopy after 9 days of IV steroids which showed an interval increase in the size of her ileal ulcers. Pathology showed granulation tissue and reactive changes with no evidence of malignancy, lymphoma, granulomas, inclusion bodies or other viral cytopathic effects. Repeat AFB smear was negative. CMV PCR in blood was negative. She was assessed for Behcet’s disease (BD) given her peri-anal ulcers however she lacked other findings needed to fulfill the diagnostic criteria for BD. Steroids were continued with plans to initiate biological therapy. A review of literature revealed rare reports of rituximab-associated ileocolitis and development of de novo inflammatory bowel disease post rituximab therapy. Among patients who received Rituximab and underwent Colonoscopy, 4% had evidence of colitis. Rituximab-associated colitis appears to be usually mild presenting with diarrhea and requiring supportive care only, but in rare cases can lead to fulminant colitis and bowel perforation. Conclusions Rituximab-associated enterocolitis remains an under-reported entity and can lead to significant morbidity and treatment-associated challenges requiring prolonged courses of steroids and considerations for biological therapies. Important differentials to consider include malignancy, lymphoma, Tuberculosis, Bechet’s disease, and CMV enterocolitis. Ulcer in terminal ileum and ileocecal valve - Pre steroids (Left), Post steroids (Right) Funding Agencies None

Bizarre Bilateral Adrenal Metastasis: A Sinister of Internal Malignancy

Abstract The ability to produce secondary metastatic deposits at a distant site is the single most essential biological process that symbolizes a malignant tumor. Metastasis to adrenal glands is known to spread from the primaries of the lungs, breast, melanoma, Gatro Intestinal Tract (GIT), pancreas, and kidneys. Here, we report a case of an elderly woman presenting with features of metastasis to subcutaneous tissue, lungs, liver, lymph nodes, and bilateral adrenal gland with symptomatic adrenal insufficiency and primary being in left kidney-renal cell carcinoma-clear cell type. The presence of bilateral synchronous adrenal metastasis with symptomatic adrenal insufficiency with evidence of metastasis to subcutaneous tissue is catastrophic since it marks disseminated cancer.

Effect of early vitamin D supplementation on the incidence of preeclampsia in primigravid women: a randomised clinical trial in Eastern Democratic Republic of the Congo

BackgroundPrevious studies have reported the association between maternal vitamin D deficiency and preeclampsia. However, the efficacy of vitamin D supplementation in reducing the occurrence of preeclampsia remains unclear. The objective of this study was to evaluate the effect of cholecalciferol supplementation on the incidence of preeclampsia in primigravid women and its related maternal and foetal outcomes.MethodsA single-blinded clinical trial was conducted in fourteen antenatal care health facilities in the North (Goma, Mwesso, Nyiragongo) and South Kivu (Bukavu-Panzi) provinces of the Democratic Republic of Congo from March 1, 2020, to June 30, 2021. A total of 1300 primigravid women not exceeding 16 weeks of gestation were randomised with a 1:1 ratio to either the supplemented (A) or control (B) group. Each pregnant woman (A) presenting for antenatal care received a single monthly dose of cholecalciferol (60,000 IU) orally for 6 months. The control group received no vitamin D supplementation or placebo. Serum 25(OH)D was measured at recruitment and at 34 weeks of gestation. Outcomes were assessed monthly until delivery.ResultsThe median maternal age was 21 years (14–40), while the median gestational age was 15 weeks (5.4–29.0). A significant reduction in the risk of preeclampsia [RR = 0.36 (0.19–0.69); p = 0.001] and preterm delivery [RR = 0.5 (0.32–0.78); p = 0.002] was observed in the intervention group. An RR of 0.43 [(0.27–0.67); p < 0.001] was found for low birth weight. The RR for caesarean section was 0.63 [(0.52–0.75); p < 0.001]. The APGAR score at the 5th minute (p = 0.021) and the size of the newborn were significantly higher in the supplemented group (p = 0.005).ConclusionA single monthly dose (60,000 IU) of vitamin D supplementation, started in earlypregnancy, significantly reduced the incidence of preeclampsia and its maternal and foetal complications.Trial registrationISRCTN Register with ISRCTN46539495 on 17 November 2020.

Trend Diabetes Nursing Conference June 2023: key updates

The focus for the Trend Diabetes Nursing Conference in June 2023, which was held in London, Birmingham and Newcastle, was on ‘Diabetes: Making it personal’ and on continuing professional development in diabetes. Topics included presentations in women's health from cradle to grave and how they are impacted by diabetes, as well as specific challenges for men with diabetes.

Complex regional pain syndrome as acause of acute painful limb swelling &amp;ndash; acase report

Complex regional pain syndrome (CRPS) is a complex condition characterised by severe pain and various sensory and motor abnormalities. This case report is of an 18-year-old woman presenting with painful upper limb swelling for a few days, with skin mottling and dysesthesia, with significant disability. With negative investigations, a diagnosis of CRPS was made. The case emphasises the importance of early recognition and appropriate management of CRPS, as delayed diagnosis leads to poor quality of life and functional impairment. Healthcare professionals should maintain a high index of suspicion for CRPS in patients with unexplained limb pain and associated sensory and motor abnormalities, ensuring a comprehensive multidisciplinary approach to optimise patients' quality of life.

Isolated massive pleural effusion as a manifestation of chronic graft versus host disease successfully treated with corticosteroid

Isolated pleural effusion is a rare manifestation of chronic graft versus host disease (cGVHD) after hematopoietic stem cell transplantation (HSCT). We herein report a 58-year-old woman presenting with massive pleural effusion approximately 1 year after allogeneic HSCT, who was successfully treated with corticosteroid. She had discontinued tacrolimus approximately 1 month before she presented with pleural effusion, which was attributed to cGVHD after a thorough exclusion process. This case illustrates a unique manifestation of atypical cGVHD and highlights the need for prompt therapy initiation.

An ampullary adenoma presenting with jaundice caused by duodenal intussusception: a case report.

Ampullary adenomas are premalignant lesions. However, biliary obstruction causing jaundice is rare. Duodenal intussusception secondary to an ampullary adenoma rarely occurs because of the fixed position of the duodenum in the retroperitoneum. Herein, we have described a rare case of ampullary adenoma with jaundice caused by duodenal intussusception. A 40-year-old woman presenting with vomiting and yellowish discoloration of the skin was admitted to another hospital. The patient had experienced recurrent epigastric pain and vomiting for the past 18months. Blood test results showed elevated levels of bilirubin (3.9mg/dL), and abdominal computed tomography (CT) showed a 60-mm hypovascular mass in the third part of the duodenum and a left lateral shift of the dilated common bile duct. The patient was referred to our hospital for further evaluation. She recovered from hyperbilirubinemia spontaneously (levels of bilirubin, 1.0mg/dL), and the CT showed a tumor shift from the third part of the duodenum to the second part and improvement of the dilated common bile duct. Hypotonic duodenography revealed a tumor that moved easily from the second to the third portion of the patient's position. Upper gastrointestinal endoscopy revealed a large papillary tumor occupying the second part of the duodenum, which was diagnosed as an adenoma through biopsy. The possibility of malignancy could not be negated owing to the presence of jaundice and an elevated carbohydrate antigen 19-9 level (76.0U/mL). Pancreaticoduodenectomy was performed. The resected specimen showed a 60 × 40 × 40-mm pedunculated ampullary mass with submucosal elongation. The pathological examination indicated that the ampullary tumor was a high-grade intestinal adenoma. The postoperative course was uneventful, and the patient was discharged 26 days postoperatively. This report describes a rare case of a patient with an ampullary adenoma presenting with jaundice resulting from duodenal intussusception. Owing to the possibility of a postoperative cancer diagnosis which may have caused the biliary obstruction and the difficulty in making an accurate preoperative diagnosis, it is imperative to choose the appropriate surgical procedure such as a pancreaticoduodenectomy.

Size thresholds for repair of abdominal aortic aneurysms warrant reconsideration

BackgroundThe historical size threshold for abdominal aortic aneurysm (AAA) repair is widely accepted to be 5.5 cm for men and 5.0 cm for women. However, contemporary AAA rupture risks may be lower than historical benchmarks, which has implications for when AAAs should be repaired. Our objective was to use contemporary AAA rupture rates to inform optimal size thresholds for AAA repair. MethodsWe used a Markov chain analysis to estimate life expectancy for patients with AAA. The primary outcome was AAA-related mortality. We estimated survival using Social Security Administration life tables and published contemporary AAA rupture estimates. For those undergoing repair, we modified survival estimates using data from the Vascular Quality Initiative and Medicare on complications, late rupture, and open conversion. We used this model to estimate the AAA repair size threshold that minimizes AAA-related mortality for 60-year-old average-health men and women. We performed a sensitivity analysis of poor-health patients and 70- and 80-year-old base cases. ResultsThe annual risk of all-cause mortality under surveillance for a 60-year-old woman presenting with a 5.0 cm AAA using repair thresholds of 5.5 cm, 6.0 cm, 6.5 cm, and 7.0 cm was 1.7%, 2.3%, 2.7%, and 2.8%, respectively. The corresponding risk for a man was 2.3%, 2.9%, 3.3%, and 3.4% for the same repair thresholds, respectively. For a 60-year-old average-health woman, an AAA repair size of 6.1 cm was the optimal threshold to minimize AAA-related mortality. Life expectancy varied by <2 months for repair at sizes from 5.7 cm to 7.1 cm. For a 60-year-old average-health man, an AAA repair size of 6.9 cm was the optimal threshold to minimize AAA-related mortality. Life expectancy varied by <2 months for repair at sizes from 6.0 cm to 7.4 cm. Women in poor health, at various age strata, had optimal AAA repair size thresholds that were >6.5 cm, whereas men in poor health, at all ages, had optimal repair size thresholds that were >8.0 cm. ConclusionsThe optimal threshold for AAA repair is more nuanced than a discrete size. Specifically, there appears to be a range of AAA sizes for which repair is reasonable to minmized AAA-related mortality. Notably, they all are greater than current guideline recommendations. These findings would suggest that contemporary AAA size thresholds for repair should be reconsidered.

Symptomatic Preperitoneal Lipoma Resected via Preperitoneal Approach: A Case Report and Review of the Literature

Introduction: Lipomas are benign adipose tissue tumors that can vary in size and location. Magnetic resonance images should be obtained for all soft-tissue masses that are deep to fascia or those &gt;5 cm in subcutaneous tissue. In this case report, we present a minimal invasive technique to resect a large preperitoneal lipoma. Case Presentation: A 36-year-old woman presenting with left fossa pain caused by a large mass. MRI-imaging shows a large preperitoneal lipomatous lesion (61 × 58 × 40 mm) which compresses the bladder, tuba and surrounding vessels. We did a minimally invasive preperitoneal laparoscopic surgical resection. Postoperative follow-up was uneventful. The pathology report confirmed benign lipoma without signs of malignancy. Discussion: Preperitoneal lipomas should be considered in the diagnosis of lower abdominal pain and can be minimally invasive resected via preperitoneal laparoscopic approach in day clinic.

Police-reported family violence victimisation or perpetration and mental health-related emergency department presentations: an Australian data-linkage study

BackgroundFamily violence is a leading social determinant of mental ill-health but its link to mental health-related emergency department presentations is poorly understood. Existing research has largely used retrospective designs with a focus on victimisation, typically among women. We examined whether police-reported family violence victimisation and perpetration were prospectively associated with mental health emergency department presentations in women and men. We also identified family violence risk and vulnerability characteristics associated with such presentations.MethodsDemographics, prior police involvement, and individual and relationship vulnerabilities were provided by Victoria Police for 1520 affected family members (i.e., primary victims) and 1470 respondents (i.e., persons alleged to have perpetrated family violence) from family violence reports in 2016–17. Emergency mental health presentations 22–30 months post-family-violence report were determined through linkage with the Victorian Emergency Minimum Dataset and compared to statewide presentations.ResultsEmergency mental health presentations during follow-up were identified in 14.3% of the family violence sample, with 1.9% presenting for self-harm. Mental health presentation rates per 1,000 people were markedly higher among affected family members and respondents of both sexes and all ages than in the general population, except for male affected family members aged 45 + . Adjusting for age and sex, the mental health presentation rate was 6 and 11 times higher among affected family members and respondents, respectively, than in the general population. Individual vulnerabilities were more closely related to risk of emergency mental health presentations than relationship characteristics.ConclusionsPolice-recorded family violence is associated with increased mental health-related emergency department presentations over the short-to-medium term. Strengthened cross-sector collaboration is needed to identify, address, and refer individuals with overlapping family violence and mental health needs and to improve victims’ and perpetrators’ access to community mental health and related services. This should help prevent individuals from reaching a crisis point in their mental health.

Determinants Of The Neonatal Prognosis In Briech Delivery In Primipparous About 627 Cases At The Nabil Choucair Health Center In Dakar, Senegal From 2005 To 2023

OBJECTIVES: The objectives were to describe the frequency and sociodemographic profile of primiparous women with fetuses in breech presentation, and to assess the maternofetal prognosis of breech presentation in primiparous women. MATERIALS AND METHODS: This was a retrospective, descriptive and analytical study carried out at the Nabil Choucair Health Center over a period from January 1, 2005 to December 31, 2023. The study included all primiparous women carrying a singleton pregnancy. whose term was greater than 22 weeks of amenorrhea who came to give birth at the Nabil Choucair health center. Patients whose files were unusable due to a significant number of missing data, as well as terminated pregnancies were excluded. Data entry and analysis were carried out using Excel software. It included two parts: descriptive analysis and analytical analysis. In the descriptive analysis, the quantitative variables were described in number, percentage and average. The analytical study consisted of researching the link between the route of delivery and the parameters which can influence it theoretically and thus as well as the maternofetal prognosis. The Chi2 test was used for comparison of proportion. The difference was statistically significant when the p value was strictly less than 0.05. The Odds surrounded by the 95% confidence interval made it possible to determine the strength of the link. CONCLUSION: Vaginal delivery of breech presentation in primiparous women is still possible in a level II maternity ward with an operating theater. Indications for cesarean section should be reserved for breech presentations in primiparous women associated with other risk factors.