Torsion of a Large Adnexal Mass after Intercourse

​BY GREGORY TAYLOR, DO, &FRANK SCHELL, DOA 30-year-old woman presented to the ED complaining of pelvic pain. She said she felt an acute onset of sharp lower right pelvic pain during intercourse two days earlier. The pain continued to worsen, becoming diffuse. She was also experiencing nausea, vomiting, malaise, anorexia, and vaginal spotting. She had no history or concern for sexually transmitted disease, and had no fever or vaginal discharge. She had had a previous Cesarean section and bilateral tubal ligation.Her vital signs were a heart rate of 110 bpm, a respiratory rate of 25 bpm, a blood pressure of 113/88 mm Hg, and a pulse ox of 100% on room air. She was in distress, lying flat, and diaphoretic, and she did not want to move. Her abdominal exam revealed a mildly distended abdomen, diffuse tenderness to palpation, with a palpable mass in the right lower quadrant with guarding and rebound. Her genital/urinary exam revealed clotted blood within the posterior vaginal vault, right adnexal tenderness, and no evidence of cervical motion tenderness.A bedside FAST exam showed no evidence of free fluid within her abdomen or pelvis, but showed a large cystic mass within the right lower quadrant. Urine hCG and total beta hCG were negative. Transvaginal ultrasound revealed a multiloculated right adnexal cystic mass measuring 9 cm x 8 cm x 6 cm with little evidence of adequate blood flow to the ovary. (Image A.)Image A. Transvaginal ultrasound revealed a multiloculated right a...
Source: The Case Files - Category: Emergency Medicine Tags: Blog Posts Source Type: research

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Authors: Ali S, Sirota E, Ali H, Bezrukov E, Okhunov Z, Bukatov M, Letunovskiy A, Grygoriev N, Taratkin M, Vovdenko S, Afyouni A, Alyaev Y Abstract Objective: We sought to improve the educational and pre-operative training on various stages of percutaneous nephrolithotomy (PCNL) under fluoroscopic and ultrasound guidance. We developed a three-dimensional (3D) printed simulator (3D-printed PCNL model) for urological trainees.Methods: 40 s year urology residents were randomly assigned into two groups, completing PCNL surgical steps on a URO Mentor™ surgical simulator (Group A) or on our new 3D-printed PC...
Source: Scandinavian Journal of Urology - Category: Urology & Nephrology Tags: Scand J Urol Source Type: research
CONCLUSION: Data suggest different roles of opioidergic system and their antagonist in pain control and mood in PTSD. However, further investigations need to be done in order to reveal the role of endogenous opioidergic system and opioidergic antagonist system as a mediator in PTSD patients suffering from acute or chronic pain. PMID: 32492768 [PubMed - as supplied by publisher]
Source: Psychiatry Investigation - Category: Psychiatry Tags: Psychiatry Investig Source Type: research
CONCLUSIONS: MSG administered parenterally to the higher dose to adult rats affects the immunoreactivity of S100β protein in PAG. Phenotypic changes of the studied cells may indicate reactivity of glial cells and increased expression of the studied protein whereas a decrease in their number may result from the increased protein secretion into the extracellular space or cytotoxic death of glial cells. PMID: 32495938 [PubMed - as supplied by publisher]
Source: Folia Histochemica et Cytobiologica - Category: Cytology Tags: Folia Histochem Cytobiol Source Type: research
LUNG CANCER symptoms include difficulty breathing, headaches, and persistent chest pain. But you could also be at risk of an advanced tumour if you develop a subtle sign on your eyes. Could you be at risk of lung cancer?
Source: Daily Express - Health - Category: Consumer Health News Source Type: news
Conclusion: Early diagnosis and direct surgery for excision of hemangioblastoma is a good option during pregnancy while avoiding CSF diversion procedures. The symptomatic hemangioblastoma during pregnancy can be safely operated during early pregnancy. PMID: 32494398 [PubMed]
Source: Surgical Neurology International - Category: Neurosurgery Tags: Surg Neurol Int Source Type: research
Publication date: Available online 4 June 2020Source: Anaesthesia Critical Care &Pain MedicineAuthor(s): Losser Marie-Reine, Lapoix Coline, Delannoy Matthieu, Champigneulle Benoit, Payen Didier
Source: Anaesthesia, Critical Care and Pain Medicine - Category: Anesthesiology Source Type: research
Publication date: Available online 4 June 2020Source: Anaesthesia Critical Care &Pain MedicineAuthor(s): Michael Cardinale, Pierre Esnault, Jean Cotte, Pierre J Cungi, Philippe Goutorbe
Source: Anaesthesia, Critical Care and Pain Medicine - Category: Anesthesiology Source Type: research
Authors: Karakoc G, Turgal M, Eroglu H, Cakir C, Yavuz A, Yucel A Abstract We aimed to assess whether the second-trimester maternal serum markers could be used for the prediction of labour induction success. This prospective study enrolled women planned labour induction at term. Women were assigned to one of two groups: vaginal prostaglandin or balloon dilatation. All patients were evaluated for Bishop score, maternal serum oestriol, human chorionic gonadotropin and progesterone at the time of second-aneuploidy screening. The total successful rate for induction of labour was 63.9% in both groups. Maternal serum oes...
Source: Journal of Obstetrics and Gynaecology - Category: OBGYN Tags: J Obstet Gynaecol Source Type: research
We present a surgical cystectomy technique that correctly identifies the cleavage plane with a low risk of ovarian cyst rupture, even in patients with multicystic ovarian cysts. Cystectomy was performed using Maryland forceps with gentle open and close dissecting motions only. Both the surgeon and assistant handled the ovarian cortex and cyst wall, and soft traction between the cortex and cyst wall as far as the nearby dissection plane without grasping the cyst wall was essential. In patients with multicystic ovarian cysts, making a plane at the notch between cysts decreases the risk of cyst rupture. This technique allows ...
Source: Journal of Obstetrics and Gynaecology - Category: OBGYN Tags: J Obstet Gynaecol Source Type: research
In conclusion, Dexamethasone administration affected only the middle cerebral artery pulsatility index before 34 weeks of gestation.IMPACT STATEMENTWhat is already known on this subject? Preterm births account for 75% of neonatal morbidity and pulmonary dysfunction plays an important role on such morbidities. Also, neonates born after an elective CS have significantly higher rates of respiratory morbidity and neonatal intensive care unit admission. Corticosteroids are wildly used to improve neonatal outcome in women who have expected preterm labour and before an elective CS.What do the results of this study add? Dex...
Source: Journal of Obstetrics and Gynaecology - Category: OBGYN Tags: J Obstet Gynaecol Source Type: research
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