Cringu Ionescu

Invasive Molar Pregnancy in a Woman Aged 54 Years A Case Report

We reported a 54-year-old patient with a complete hydatidiform mole invasive in myometrium. This diagnostic was suggested by irregular vaginal haemorrhage, amenorrhea and reduced nausea. Our paraclinical investigation was: pelvic ultrasound and level of serum beta-human chorionic gonadotropin (β-hCG). Endovaginal ultrasound reveal enlarged uterus volume, with dimensions 12/15/8 cm, with the presence of multiple nodular formations located intramural and subserosal and a mass with Doppler rich blood supply through myometrium and endometrium. The level of β-hCG was 28099.00 mIU/L. Therapeutic method applied was abdominal hysterectomy and bilateral salpingo-oophorectomy. Anatomopathological report revealed a complete invasive mole and endometrial polyp. After the surgical intervention the patient was treated with Methotrexate as prophylactic chemotherapy recommended by oncologists because of the invasive character of mole and age of patient. The complete invasive mole is a benign tumor that is characterized by abnormal proliferation of trophoblast and is locally invasive and possible metastatic. Developing pregnancy rate in perimenopause period is very rare and most of the pregnancies that occur at this age are abnormal, spontaneous abortion occurring most often. We choose to report this case to emphasize that this condition can occur in a relatively advanced age, especially during perimenopause period.

Primary myelofibrosis and pregnancy outcomes after low molecular-weight heparin administration: A case report and literature review

Rationale: Primary myelofibrosis is encountered with the myeloproliferative diseases and is the least prevalent among women of childbearing age. The prognosis is guided by pancytopenia, leukemic transformation and thrombosis which are the dominant complications. Patient concerns: Data regarding protocol management during pregnancy in the context of myelofibrosis are insufficient. Fewer than ten cases have been described until now and half of this cases have resulted in fetal death due to placental infarction during the second and third trimesters. Diagnoses: We present the case of a 34-year-old pregnant woman diagnosed with Jak 2- negative primary myelofibrosis. Personal history did not include miscarriage or stillbirth. Interventions: The patient was previously treated with anagrelide hydrochloride, which was interrupted at 6 weeks of gestation when the pregnancy was confirmed. It was replaced with Interferon-a 3 MU/day. Because of severe thrombocytosis, administration of aspirin 150 mg/day was recommended. Outcomes: The pregnancy was uneventful. The patient was hospitalized at 33 weeks of gestation because of moderate vaginal bleeding and high risk of preterm birth. After a specialized hematological investigation, the treatment with aspirin was replaced with low-molecular-weight heparin 0.6 ml per day. This combined treatment assisted in the natural tendency to lower platelet counts during pregnancy and resulted in stabilization of the hematological status. At 38 weeks of gestation the patient delivered a healthy baby boy via cesarean. He weight 2850 grams and his Apgar score was 9. Anticoagulant and interferon treatments were continued post-partum under hematologist surveillance. Lessons: This case was rare and complex. Because it was related to pregnancy it required continuos collaboration and supervision between obstetrician and hematologist.

Controversies in the role of vitamin D in infertility

The study that implicates vitamin D in playing a role in fertility is compelling, and it is backed up by sound hypothesis. Nevertheless, further research needs to be assess for the health benefits and reaching appropriate levels. This could represent a starting point of a new domain which could find simple approaches to improve health. Notwithstanding fertility benefits, patients should have vitamin D supplementation for health benefits, including pregnancy health, bone health and chronic disease risk reduction. This review is based on the results of clinical trials and studies published in medical journals and database from the moment it was first acknowledged until nowadays. We aim to present the evolution of the perspective on the subject and the new findings surrounding it. Vitamin D has its well-known function in calcium and phosphorus hemostasis, and its deficiency is predominant in high-risk populations, but the prevalence among healthy or asymptomatic adults is not well defined. Several theories and hypothesis have been launched over the last years regarding the etiology of vitamin D deficiency, none of them being flawless or able to explain the entire panel of symptoms. Taken into consideration the insufficiency of vitamin D which could have implications also in infertility, especially in young fertile women, the newest research could lead to new supplementation of vitamin D in the treatment of both women and male infertility management.

Progesterone and neuroprotection at menopause

The neuroprotective effect of progesterone has been demonstrated in numerous experimental cell and animal studies, in traumatic brain/spinal injury, neurodegenerative diseases, storke, demyelinating diseases. Thus progesterone has emerged as a promising candidate for preventing and treating neuronal related disorders leading to a few promising clinical studies.The effects of progesterone in the nervous system involve a variety of signaling actions, therefore we review the evidence that supports the neuroprotective effects of progesterone and recall the mechanisms that mediate these effects. We also discuss the biology of progesterone and the effects of this hormone on myelination and remyelination of the central and peripheral nervous system. Progesterone in the brain is derived from the steroidogenic endocrine glands or from local synthesis by neural cells. Stimulating the formation of endogenous progesterone is currently explored as an alternative strategy for neuroprotection, axonal regeneration, and myelin repair.

Laparoscopic Myomectomy in Infertility Treatment

Abstract Leiomyomas (fibroids or myomas) are benign uterine tumors of unknown etiology. Fibroids are most common in women aged between 30 and 40 years, but they can occur at any age. At present, laparoscopic myomectomy is the most appropriate surgical technique for patients with fertility disturbances. We conducted a prospective study, in which a number of 72 patients diagnosed with uterine fibromatosis and infertility were investigated for the impact of laparoscopic myomectomy (i.e. intramural and subserosal fibroids), the fertility rate and the average time for the appearance of pregnancy. The patients were randomly divided into 2 groups: Group 1, consisted of 36 patients with infertility and uterine fibroids associated in which laparoscopic myomectomy it was practiced, and Group 2, consisted of 36 patients, having the same diagnosis who refused surgical ablation. From the 36 patients which were operated, 11 had intramural fibroids and 25 had presented one or more subserosal fibroids (Group 1). The fertility rate was 25% for patients with no surgery (Group 2) comparing with 86.5% for patients with laparoscopic myomectomy (Group 1, 54.5% for patients with intramural fibroids and 32% for patients with subserosal fibroids). The average time of the appearance of the pregnancy was 23 months for the patients which were not operated (Group 2), and 35.2 months for patients with laparoscopic myomectomy (Group 1, 19.2 months for the patients with intramural fibroids and 16 months for the patients with subserosal fibroids). Our study shows that laparoscopic myomectomy improves the fertility rate compared to non-surgical treatment in the case of patients with uterine fibroids and infertility.

Aberrant right subclavian artery - a marker for chromosomal abnormalities?

Abstract The aberrant right subclavian artery or the aberrant right subclavian artery syndrome is a rare anatomical variant of the right subclavian artery origin but it is the most common form of congenital anomaly of the aortic arch. The normal or abnormal appearance of the aortic arch can be explained by the regression or the persistence of one or other of the two embryonic aortic arches. The regression of the right aortic arch after the origin of the right subclavian artery will result in a normal aspect of left aortic arch with normal vascular anatomy. While the right ductus arteriosus is regressing, the left one persists. This anomaly is apparently found in the general population in approximately 0.5-1.4% of the cases and in approximately 3% of cases with congenital heart malformations. The present review is focus on the prevalence of aberrant right subclavian artery in Down syndrome. Until present it is known that ultrasound evaluation in the screening programs for Down syndrome is of uncertain value and studies on larger number of cases are reconsidered. In addition we suggest that the echocardiographic examination in the first and second trimesters should be included as a first step of the diagnosis in such congenital anomalies.