Partial or complete rotation of the adnexa on its vascular pedicle.
It can involve
Ovary
fallopian tube, or
both.
Isolated fallopian tube torsion is uncommon in any age group
Various diseases related to organ in pediatric pelvis of females and males, their imaging features on various modalities such as radiograph, and ultrasound.
Undescended testis , Guidelines for managmentSameh Shehata
Updated guidelines on the management undescended testis
;
Incidence/ Etiology.
Genes and syndromes.
Retractile Testis.
Laboratory.
Role of imaging.
Hormonal treatment.
Surgery .
Complications.
Practical Aspects about Urogenital Fistula Repair GrothuesmannDr Dirk Grothuesmann
Each year between 50 000 to 100 000 women worldwide are affected by obstetric fistula. I share here practical aspects of my personal experiences dealing with this complex issue mainly affecting the weak and the poor.
During the last two decades huge international interest towards this problem has been raised up in the global medical arena. One might think anyone equipped with abilities to adjust to resource poor settings, armed with comprehensive surgical skills fulfill essentials to learn how to repair fistulas. This is definitely not enough to be a part of the solution!
Regardless surgeons must understand both their own limitations as well as the limitations given by the environment in place as precondition to deal with this problem. Sharing my experiences I hope to contribute to make this understood.
Partial or complete rotation of the adnexa on its vascular pedicle.
It can involve
Ovary
fallopian tube, or
both.
Isolated fallopian tube torsion is uncommon in any age group
Various diseases related to organ in pediatric pelvis of females and males, their imaging features on various modalities such as radiograph, and ultrasound.
Undescended testis , Guidelines for managmentSameh Shehata
Updated guidelines on the management undescended testis
;
Incidence/ Etiology.
Genes and syndromes.
Retractile Testis.
Laboratory.
Role of imaging.
Hormonal treatment.
Surgery .
Complications.
Practical Aspects about Urogenital Fistula Repair GrothuesmannDr Dirk Grothuesmann
Each year between 50 000 to 100 000 women worldwide are affected by obstetric fistula. I share here practical aspects of my personal experiences dealing with this complex issue mainly affecting the weak and the poor.
During the last two decades huge international interest towards this problem has been raised up in the global medical arena. One might think anyone equipped with abilities to adjust to resource poor settings, armed with comprehensive surgical skills fulfill essentials to learn how to repair fistulas. This is definitely not enough to be a part of the solution!
Regardless surgeons must understand both their own limitations as well as the limitations given by the environment in place as precondition to deal with this problem. Sharing my experiences I hope to contribute to make this understood.
this presentation covers anatomy of the testis, embryological development, causes, clinical features, complications, differences between various types, investigations, and management of undescended testis.
4 cases of pelvic mass are discussed .Adnexal mass invilves masses arisinf from ovary,fallopian tube,uterus,bowel and some miscellenious masses.USG is used to detect its size and the origin.Histopathological findings are diagnostic.
Spontaneous rupture of endometriotic cyst in 3rd trimester of pregnancyApollo Hospitals
Endometriosis is a well established cause of female infertility and may be associated with early pregnancy losses. Association of endometriosis with pregnancy is rare. Ruptured endometriotic cyst presenting as acute abdomen in pregnancy is even a rarer presentation.
We present hereby a rare and interesting case, presented in our hospital, of Spontaneous rupture of endometiotic Cyst in 3rd trimester of pregnancy and its subsequent management.
tubal factor is almost 30% of all female infertility causes.Hence evaluation of tubes is usulally the first of the testings.
this presentation evaluates all the methods for evaluation of fallopian tubes
1. Undescended Testis : Along the normal path, but not reached scrotum.
2. Retractile Testis : Hyperreflexic Cremaster
3. Ectopic Testis : Deviation from normal path of descent
Absence of testis in scrotum since birth
Hemiscrotum empty, hypoplastic
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
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ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
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- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
MANAGEMENT OF ATRIOVENTRICULAR CONDUCTION BLOCK.pdfJim Jacob Roy
Cardiac conduction defects can occur due to various causes.
Atrioventricular conduction blocks ( AV blocks ) are classified into 3 types.
This document describes the acute management of AV block.
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
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5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
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1. PRIMARY AMENORRHOEA
WITH
MENOURIA
By-
Akash Srivatsav.T ,Final year(II)
Moderator-
Dr. Chandra Sekhar Rao, MD.
Prof. and HOD, dept of OBG,
GGH. Guntur
2. Primary amenorrhea is when a girl has not yet
started her monthly periods,
She has gone through other normal changes
that occur during puberty and
Is older than 16yrs
3. Congenital urogenital fistulas are rare.
Coexistence of congenital urogenital fistula
with vaginal atresia presenting as primary
amenorrhoea with menouria is of extremely
uncommon occurence.
We are reporting a case of primary
amenorrhoea with menouria diagnosed and
being treated in our hospital.
4. Particulars of patient
Name Mrs.SFR
Age 20 years
Occupation Daily wage labourer
Address Bapatla
Marital status Married
Regd no 13023
DOA 18-03-2013
Referred from Bapatla govt hospital
5. She complained of-
Not attaining menarche
Passing blood stained urine for 3-4 days every
month for the past 7 years
Backache and abdominal pain for 3 days while
passing blood stained urine.
6. Gynaecology history-
Not attained menarche
Married for 14 months
Last episode of blood stained urine-19-03-
2013
7. Past history-
No histories of- diabetes
hypertension
jaundice
tuberculosis
epilepsy
blood transfusions
bronchial asthma
surgeries
8. Personal history-
She takes mixed diet
Sleep and appetite are normal
Bowel and bladder habits are
regular
Family history-
Her mother is an
epileptic
9. General physical examination-
Conscious and coherent
Moderately built and
nourished
No- pallor
icterus
cyanosis
clubbing
lymphadenopathy
oedma
Thyroid,breast,spine are
normal
10. Secondary sexual characters-
Axillary hair
Pubic hair
Breast development
Vitals-
Temperature-afebrile
Pulse-82 /min
Respiratory rate-15bpm
Blood pressure-100/70 mm of Hg
11. Abdominal examination did not reveal any abnormal
masses.
Genital examination ---A small blind ending pouch
was identified in place of vagina.
Rectal examination--- Retroverted uterus felt. Cervix
felt as cylindrical structure about 5 cm above the level
of introitus. No other abnormalities detected.
15. The possible differential diagnoses are-
imperforate hymen,
Rokitansky-Kustner-Hauser Syndrome,
Testicular-feminisation syndrome,
Youseff's syndrome.
16. Investigations -
Haemoglobin - 9gm%
TC ---7500/mm, DC—P 51%,L 37%,E 4%.
Blood group and Rh type –AB+
ESR ----25mm/hr
Random blood sugar--- 100mg/dl
HIV---- non reactive
Hep.B & Hep C--- Negative
BT –2min,.CT– 3 min.
Platelets –1,26,000/mm3.
Urine routine examination was normal
17. LFT – within normal limits
RFT– within normal limits.
Thyroid function tests----- normal.
FSH,LH,Prolactin levels-normal
Buccal and peripheral smears for sex chromatin---- positive.
Chest X ray --- Normal study.
ECHO --- Normal study.
18. Urine culture and sensitivity examination
showed growth of coagulase +Staphylococcus
sensitive to Ceftazidime, Levulofloxacine and
Piperacillin.
19. USG of abdomen - Liver normal.
Gallbladder, pancrease, left
and right kidneys were normal.
Uterus – measured 70x30x35
mms.
Thin endometrium. Both
ovaries visualised. No
free
fluid noted in the POD.
No abnormal masses
20. Cystoscopy was performed under local anaesthesia
Bladder volume was normal.
Bladder mucosa was normal.
Uterine impression was seen on
posterior wall of bladder.
Interureteric bar is V- shaped ending in a
dimple proximal to bladder neck.
21. Trans perineal USG
Uterus 6.3x3.4cm
Cervix measures– 1.2 cms
Endometrial thickness 0.8 cms
Myometrium normal.
Right and left ovaries normal.
Rudimentary distal vagina,
No evidence of free fluid
22. Retrograde contrast CT cystogram -
Contrast was noted in the distal portion of the
uterus and proximal portion of the vagina.
Entire uterine contour and site of fistulous
communication was not identified.
MRI scan with contrast was suggested
23.
24. MRI scan---
Bladder distended with urine.Wall thickness normal. No calculi. Focal loss of fat
planes between bladder wall and vaginal wall.Anteriorly pulled up vaginal wall
in the right lateral aspect.
Suspicious linear hyperintensities noted on the posterior wall of bladder on the
right side.
Uterus—normal size (5.8x3.4x4.2cm). Weight 41 gms.Endometrium 6mm in
thickness.
Ovaries normal in size and show immature follicles bilaterally.
Vaginal length is 3cm and minimally distended with fluid.
No free fluid, no lymphadenopathy,no masses.
Vertebrae normal.
Anterior abdominal wall normal.
Impression- Suggestive of Vesico-vaginal fistula.
30. Management -
Planned to undertake stepwise
1. Reconstruction of vagina
2.Restoration of continuity of genital
tract.
3. Repair of vesico-vaginal fistula
31. Abbe-Wharton-McIndoe Vaginoplasty was carried out on
15-07-2013 under epidural anaesthesia. Split skin graft was
raised from the lateral aspect of the right thigh and wrapped
around a mould and secured in the space created between
the bladder and rectum .
Postoperatively patient was managed with antibiotics and
analgesics.
Patient is under follow up for further management.
32.
33. A VVF repair will be done by O’Conor’s
method on a future date
34.
35. Case discussion
• Primary amenorrhea is when a girl has not
yet started her monthly periods,
• She has gone through other normal
changes that occur during puberty and
• Is older than 16yrs
36. The relative prevalence of primary amenorrhea includes
Percentage of prevalence-
Hypergona
dotrohic
48%
Hypogona
dotrohic
28%
Eugonadot
rophic
24%
37. Eugonadism may result from –
a. Absence of Mullerian
development
b. Normal Mullerian development
c. Cryptomenorrhoea
38. The work up of eugonadotrophic amenorrhoea
includes-
Clinical examination for the presence of secondary
sexual characters and external genitalia
Buccal smear for Barr body
Gonadotrophin assay
Imaging studies- USG
MRI
39. Urogenital fistula
Acquired causes are-
• obstructed labour
• pelvic surgery
• malignancy of genital tract
• Pelvic irradiation
Congenital genital fistulas are extremely rare
40. Diagnosis of genital fistulas involve
Detailed history
Clinical examination
Three swab test
Cystoscopy
IVU
MRI with contrast
In our patient due to vaginal atresia three swab test
was not possible
41. Summary
All women with menouria need complete investigation
with exhaustive exploration, analytic evaluation, ultrasound,
imaging tests (principally magnetic resonance) and, very
importantly cystoscopy on the days of menouria.
Surgical treatment must be careful and individualized.
Multidisciplinary input in the management is the cornerstone
for successful reproductive outcome.
42. Bibliography-
1.Shaw’s text book of Gynaecology 15th edition
2.William’s Gynaecology 2nd edition
3.Te Linde’s operative gynecology volume-1,10th edition
4.Female Urology Shlomo Raz and Larissa V.Rodriguez 3rd edition
43. Similar cases-
Primary menouria due to a congenital vesico-vaginal
fistula with distal vaginal agenesis: a
rarity.
Singh V, Sinha RJ, Mehrotra S.
Source
Department of Urology, Chhatrapati Shahuji Maharaj
Medical University (formerly King George's Medical
University), Lucknow, UP 226003, India