Medicaltalks
Medicaltalks
in Case Study
Surgical excision of a massive uterine fibroid!
Surgical excision of a massive uterine fibroid!
Uterine fibroids (also known as leiomyomas) are a benign proliferation of smooth muscle cells of the uterus (myometrium), with the majority occurring during the childbearing years. The interesting fact is that a single cell divides repeatedly, eventually creating a firm, rubbery tissue. They can grow slowly of rapidly, be single or multiple, and can vary in size from microscopic to the size of a full-term pregnancy!! They are classified by their location as follows - submucosal (beneath the endometrium), intramural (in the muscular wall of the uterus), and subserosal (beneath the uterine serosa - the outermost layer). Most women with fibroids have no clinical symptoms at all, but those who do, experience abnormal uterine bleeding which presents with menorrhagia (menstrual periods with heavy or prolonged bleeding), and pelvic pain. Blood loss from fibroids can be heavy enough to cause chronic iron-deficiency anemia. Depending on the size and the location, the fibroid can compress the adjacent organs and cause additional complications such as constipation, frequent urination and venous stasis. There are theories that are believed to play a role in the cause of fibroids, these are hormonal changes (estrogen and progesterone) and genetics. Very rarely, a cancerous fibroid can occur, known as a leiomyosarcoma.Now the treatment is indicated only when there's a severe pain, heavy and irregular bleeding, infertility or pressure symptoms. Basically there are medical therapies (GnRH agonists are decreasing the estrogen levels, and shrinks the fibroid), and a surgical treatment, myomectomy or hysterectomy. Photo by @aneeshkarwande
Marry
Marry
in Case Study
Calcified Spleen and Gallstones
Calcified Spleen and Gallstones
A 35-year-old man presented to the gastroenterology clinic for treatment of chronic hepatitis C virus (HCV) infection. He had a type of sickle cell disease, hemoglobin Sβ thalassemia, with recurrent, episodic abdominal pain that had been present since childhood. A complete blood count showed microcytic anemia. The total bilirubin level was 8.5 mg per deciliter (145 μmol per liter; reference range, 0.3 to 1.2 mg per deciliter [5.1 to 20.5 μmol per liter]) and the indirect bilirubin level was 6.2 mg per deciliter (106 μmol per liter; reference range, 0.1 to 1.0 mg per deciliter [1.7 to 17.1 μmol per liter]). A peripheral-blood smear showed microcytic and hypochromic red cells, target cells, nucleated red cells, and sickle cells. An abdominal radiograph, which was obtained during a previous presentation for abdominal pain, showed a radiopaque gallstone (Panel A, arrowhead) and a calcified spleen (Panel A, arrow). A computed tomographic scan of the abdomen, obtained without the administration of contrast material, showed multiple gallstones and a calcified splenic pulp and capsule (Panel B). Pigment gallstones may occur as a result of hemolysis. Bilirubin stones, which are normally radiolucent, can be radiopaque when bilirubin binds with calcium. This patient completed treatment for chronic HCV infection, and he was vaccinated against encapsulated organisms. He has continued to do well on follow-up visits. Ankur Gupta, D.M. Priyanka Jain, M.D. Max Super Specialty Hospital, Dehradun, India source: nejm.org
Dr Vijay Sharma
Dr Vijay Sharma
in Discussion | 2 days ago
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