Hemorrhagic Bartholin’s cyst in a woman using anti-platelet medication:A case report and review of the literature

BACKGROUND We report the case of a postmenopausal female with a hemorrhagic Bartholin’s cyst who has been using an antiplatelet medication.CASE SUMMARY A postmenopausal woman,84 years of age,had a medical history of hypertension,diabetes mellitus,coronary artery disease(three-vessel disease),chronic kidney disease(stage 3),and dementia.The patient has been taking clopidogrel,an antiplatelet medication,for several years.She presented at our outpatient clinic complaining of painful swelling over her left vulva for several days.A Bartholin’s cyst over the left vulva was suspected,and the patient underwent marsupialization under local anesthesia,which was well-tolerated.During the incision procedure,bright-red blood with some blood clots was discharged,and a hemorrhagic Bartholin’s cyst was observed.There was no recurrence of the hemorrhagic Bartholin’s cyst during the 6-mo subsequent follow-up period.CONCLUSION Hemorrhagic Bartholin’s cysts rarely occur.We report the case of a postmenopausal female with a hemorrhagic Bartholin’s cyst who had been on antiplatelets and was successfully treated with marsupialization.No recurrence was noted during the 6-mo follow-up period.Older females taking antiplatelets should be cautious of bleeding when presenting with a Bartholin’s cyst.

Huge Bartholin’s cyst managed by primary marsupialization:A case report

BACKGROUND We report on the case of a 21-year-old female who could not walk due to a huge Bartholin's cyst occupying the right vulvar region.The patient was treated by marsupialization of the Bartholin’s cyst and postoperative antibiotic therapy.CASE SUMMARY A 21-year-old female without a medical history of sexually transmitted diseases presented to our outpatient clinic with complaints of a painful vulvar lump and a green-yellowish discharge for 4 d.A large Bartholin’s cyst,10 cm in diameter,was suspected over the right side of the vulva.She was advised to be admitted to the ward for intravenous antibiotic treatment and to perform marsupialization several days later.However,the patient requested immediate surgery because of time limitations.The patient underwent marsupialization under local anesthesia.The procedure was well-tolerated.After making the incision,a significant amount of malodorous pus(approximately 30 mL)was removed from the abscess.The patient was followed up for 1 wk postoperatively.The Bartholin’s cyst regressed,and the surgical wound healed well.CONCLUSION Our case shows that an initial marsupialization followed by oral antibiotic therapy can be an appropriate treatment option for a large Bartholin’s cyst.However,depending on the patient’s condition,a suitable treatment,either cystectomy or marsupialization,can be considered.

Incidence, Presentation and Management of Bartholin’s Gland Cysts/Abscesses: A Four-Year Review in Federal Teaching Hospital, Abakaliki, South-East Nigeria

Background: The Bartholin’s gland cysts and abscesses are one of the most common vulva cyst or abscesses in gynaecological practice. Symptomatic cases give significant discomfort to sufferers and have a negative impact on their quality of life. Objective: To investigate the incidence, pattern of presentation and management of Barthholin’s gland cysts and abscesses in the Federal Teaching Hospital Abakaliki (FETHA) Ebonyi State, Nigeria. Methodology: This was a four-year retrospective study of cases of Bartholin’s gland cysts and abscesses in FETHA. We studied all cases of Bartholin’s gland cysts and abscesses that were managed at the Federal Teaching Hospital Abakaliki from 1st January 2012 to 31st December 2015. Results: During the study period, there were 1015 gynaecological surgical cases of which 18 were for Bartholin’s gland cysts or abscess giving an incidence of 1.78%. The mean age of the patients was 28.8 ± 5.6 years with 61% of the patients within the age range of 21 to 30 years. The commonest risk factor that was found for the occurrence of Bartholin’s gland cyst or abscess was previous history of the disease in 14 (77.8%) followed by previous history of sexually transmitted diseases 8 (44.4%). Pain was the commonest presenting symptom in 14 (77.8%) of cases. The left vulva was the commonest site of disease as noted in 15 (83.3%) of patients. Escherichia coli and Staphylococcus aureus were the commonest isolates on swabs with 16 (88.9%) and 14 (77.8%) prevalence respectively. The disease presented commonly in form of abscess as observed in 10 (55.6%) of patients. All the patients had Marsupialization as the modality of treatment. Conclusion: Symptomatic Bartholin’s gland cyst and abscess cause significant morbidity for the sufferers and decreased quality of life. Accurate diagnosis and treatment is advocated to prevent chronicity and complications. Although options of treatment abound, Marsupialization remains the mainstay of treatment in low resource setting like ours.

Adenoid cystic carcinoma of the Bartholin's gland:a case report and review of the literature

Adenoid cystic carcinoma(ACC) of the Bartholin's gland is a rare malignant tumor of vulvar which is characterized by slow growth,local invasion and perineural infiltration.The survival rates for 10 years range from 50% to 100%.The disease free interval for 10 years range from 33% to 38%.Currently,there is no consensus on the treatment of ACC of the Bartholin's gland.Primary surgery includes wide local excision or radical vulvectomy with or without lymph node dissection.Adjuvant radiotherapy and chemotherapy are advocated for the treatment of this cancer.Work is still needed to identify an effective systemic therapy.

“Management of Bartholin Cysts and Abscess” in a Tertiary Care Centre, Jeddah, Saudi Arabia

Objective: To analyse all cases of Bartholin glands pathology (cysts and abscess), and identify the different variable affecting the method of management with Marsupialization or excision. Methods: This study is a cross-sectional retrospective analysis of all cases of Bartholin cysts and abscess admitted and managed at KAUH, from January 2017 to December 2017. Results: 48 patients were analysed: age (32.60 ± 9.9), parity, BMI (26.9 ± 4.98). Out of 48 patients, 25 (52.1%) were diagnosed as Bartholin cysts and 23 (47.9%) as Bartholin abscess. 72.9% (35) patients were managed with Marsupialization, and only 27.1% ended with excision. Comparing age in years, parity and BMI in the cases managed by Marsupialization with those with excision, the only statically significant difference was found in the parity. When comparing the important factors collected, younger subjects less than 35 years old, never being pregnant and BMI less than 30 had more Marsupialization than excision. But age . Abscess and non-recurrent had more Marsupialization but were statistically not significant. Other factors, past medical and surgical history and type of anaesthesia were the same in both groups. Logistic regression performed using the dependent variable for Marsupialization rather than excision with different covariant categorised variable, age less than 35, single, abscess, non-recurrent, and BMI less than 30 (Table 2). Age less than 35 and BMI less than 30

Identification of Endophytic Bacillus BHL3501 from Wild Soybean and Its Inhibitory Effect against Soybean Cyst Nematode (Heterodera glycines Ichinohe)

[ Objective] The paper was to identify endophytic bacillus BHL3501 from wild soybean and its inhibitory effect against soybean cyst nematode. [ Meth- od] Through morphological characteristic, physiological and biochemical characteristics and 16S rDNA analysis, a strain of endophytic bacterium BHL3501 with ne- maticidal activity isolated and screened from the root of wild soybean was identified, the effects of BHL3501 metabolite solutions with different dilution multiples on egg hatching and activity of 2rd instar juvenile of soybean cyst nematode were also studied. [ Result ] BHL3501 strain was preliminarily identified to be Bacillus sp.. The relative inhibitory rate of its original fermentation broth on egg hatching of soybean cyst nematode after 24 h was 98.3% ; the relative inhibitory rate under 10- time diluted solution treatment was 79.5%, which had significant difference with sterile water control. The corrected mortality rate of 24 instar juvenile was 93.1% after treated by original fermentation broth for 24 h, the treatments of all diluted solutions had significant difference with sterile water control. [ Conclusion ] BHL3501 metabolites had strong inhibitory effect against egg hatching of soybean cyst nematode, which also had strong toxic effect on its 2nd instar juvenile.

Diagnosis and treatment of congenital choledochal cyst: 20 years' experience in China

AIM: To summarize the experience of diagnosis and treatment of congenital choledochal cyst in the past 20 years (1980-2000). METHODS: The clinical data of 108 patients admitted from 1980 to 2000 were analyzed retrospectively. RESULTS: Abdominal pain,jaundice and abdominal mass were presented in most child cases. Clinical symptoms in adult cases were non-specific, resulting in delayed diagnosis frequently. Fifty-seven patients (52.7%) had coexistent pancreatiobiliary disease. Carcinoma of the biliary duct occurred in 18 patients (16.6%).Ultrasonic examination was undertaken in 94 cases, ERCP performed in 46 cases and CT in 71 cases. All of the cases were correctly diagnosed before operation. Abnormal pancreatobiliary duct junction was found in 39 patients. Before 1985 the diagnosis and classification of congenital choledochal cyst were established by ultrasonography preoperatively and confirmed during operation, the main procedures were internal drainage by cyst enterostomy. After 1985, the diagnosis was established by ERCP and CT, and cystectomy with Roux-en-Y hepaticojejunostomy was the conventional procedures.In 1994, we reported a new and simplified operative procedure in order to reduce the risk of choledochal cyst malignancy. Postoperative complication was mainly retrograde infection of biliary tract, which could be controlled by the administration of antibiotics, there was no perioperative mortality. CONCLUSION: The concept in diagnosis and treatment of congenital choledochal cyst has obviously been changed greatly.CT and ERCP were of great help in the classification of the disease.Currently, cystectomy with Roux-en-Y hepaticojejunostomy is strongly recommended as the choice for patients with type I and type IV cysts. Piggyback orthotopic liver transplantation is indicated in type V cysts (Caroli's disease) with frequently recurrent cholangitis.

Current management of noninfectious hepatic cystic lesions:A review of the literature

Nonparasitic hepatic cysts consist of a heterogeneous group of disorders, which differ in etiology, prevalence,and manifestations. With improving diagnostic techniques, hepatic cysts are becoming more common.Recent advancements in minimally invasive technology created a new Era in the management of hepatic cystic disease. Herein, the most current recommendations for management of noninfectious hepatic cysts are described, thereby discussing differential diagnosis, new therapeutic modalities and outcomes.

Paraurethral Cysts in a Female Newborn

Paraurethral cysts are a rare congenital abnormality seen in female neonates. We present the case of a female newborn with a paraurethral cyst resulting in urinary obstruction. Surgical intervention was chosen as a result of the obstruction.

Bartholin’s Gland Carcinomas: A 20 plus-year experience from Queensland

Objective: To review the records of cases of Bartholin’s Gland Carcinoma referred to the Queensland Centre for Gynaecological Cancer (QCGC) between mid 1993 and mid 2012. Methods: Bartholin’s Gland Carcinoma case data from QCGC were reviewed and analysed using the computer software Statistical Package for the Social Sciences 11.0. Results: Of the 12 cases four died of their disease, seven are still alive and disease free and one is alive with recurrent disease. The mean age at diagnosis was 52.8 years. Time from onset of symptoms to diagnosis averaged 5.8 months. All diagnoses were confirmed histologically. Presenting symptoms included a lump and pain. The most common presenting complaint was a lump. Treatment included surgical excision, occasional biopsy followed by radiotherapy with or without chemotherapy. In some cases radiation and chemotherapy was followed by vulvectomy of various extent. Conclusions: Bartholin’s Gland Carcinoma is a rare condition with outcome dependent on duration of symptoms, including delay in diagnosis, cell-type, cellular differentiation and the International Federation of Gynecology and Obstetrics (FIGO) classification. A Bartholin’s gland mass in a woman aged 40 years or more should be considered malignant until a biopsy proves otherwise.The incidence of Bartholin’s Gland Carcinoma in Queensland is less than that reported elsewhere but a higher proportion of squamous cell carcinomas was found in this small series.

Calcifying Odontogenic Cyst of the Oral Cavity: A Clinical Case and Current Updates on the Ethiopathogenesis

Background: The calcifying odontogenic cyst (COC) is a rare pathological entity. It falls into a group of lesions with calcifications that present benign and sometime malignant tumor variants. Case Presentation: In the present study, we report on a case of intraosseous/intrasinusal COC with impacted maxillary canine and dentinoid structures odontoma-like. The clinical, radiographical, histopathological, and molecular characteristics of this pathological entity are discussed in relation also to the problems of differential diagnosis, treatment, and prognosis. Conclusion: The true COC is a rare entity in the oral cavity and represents about less than 1% of all odontogenic lesions. Careful clinical, instrumental and histological analysis must be performed for odontogenic cysts in order to accomplish the correct surgical act and to avoid recurrence.

Klestadt’s Cyst: Case Report

Klestadt’s cyst, more commonly known as the nasolabial cyst, is an uncommon, non-odontogenic, and soft tissue cyst. It is classified as a fissural cyst, found outside the bone, and on the region corresponding to the nasolabial furrow and alar nose. Following its description first by Zukuerkandl in 1882, only 267 cases have been found in English literature. In spite of the low occurrence of nasolabial cysts, it is important to recognize the clinical characteristics of this lesion. The purpose of this report is to review the literature and discuss the histomorphology and etiology of this condition, and also its management by surgical excision. As per our experience, sublabial approach is the best for complete and scarless excision of this cyst.

Loose Body in the Knee Joint: A Case Report

Background: Loose bodies (LBs) within the knee joint are commonly encountered during clinical practice and are frequently observed during knee arthroscopy. The primary treatment involves the removal of loose bodies;however, their complete eradication is often challenging and may not address underlying diseases, leading to persistent symptoms and the risk of new loose body formation. Aim: This case report aims to present the findings and surgical management of a 52-year-old male with an unusually large osseous loose body in the knee joint and associated pathologies. Case Presentation: The patient, a 52-year-old male, experienced recurrent episodes of severe, sudden, and painful locking of the knee joint, leading to difficulties moving. A plain MRI study was conducted to evaluate the condition of the knee joint, which revealed various degenerative changes and the presence of a loose body. Subsequently, an arthroscopic examination was performed under general anesthesia, uncovering the presence of an abnormally large loose body, as well as other pathologies including chondropathy, meniscal degeneration, and Baker’s cyst. Conclusion: Loose bodies (LBs) in the knee joint pose significant challenges and may lead to debilitating symptoms. Timely diagnosis and appropriate surgical intervention are crucial for symptom relief and the prevention of further joint damage as arthroscopic excision. Comprehensive imaging has a vital role in guiding treatment decisions and optimizing patient outcomes. In this case, the removal of the loose body improved patient outcomes and helped prevent potential joint complications.

血清SAM/SAH在Hcy引起动脉粥样硬化基因组DNA甲基化中的作用

目的探讨血清S-腺苷甲硫氨酸(SAM)/S-腺苷同型半胱氨酸(SAH)比值在同型半胱氨酸(Hcy)致载脂蛋白E基因敲除(Apo E―/―)小鼠血管动脉粥样硬化(As)B1重复序列DNA甲基化改变中的作用。方法 36只饲养4周龄Apo E―/―小鼠,随机分为三组:模型对照组、高蛋氨酸组、叶酸+Vit B12干预组,每组12只,分别给予不同饮食;另取健康4周龄雄鼠(SPF级C57BL/6J)12只作为正常对照组,饲以普通饮食。饲养15周后,HE染色观察血管内动脉斑块的形成,高效液相色谱检测血清中Hcy、SAM、SAH的水平改变,n MS-PCR检测各组小鼠动脉粥样硬化斑块中Bl重复序列DNA甲基化改变。结果高蛋氨酸组血清Hcy与正常对照组相比升高约2.39倍(P<0.01),HE染色可见高蛋氨酸组中有动脉斑块形成;与正常对照组相比,模型对照组、高蛋氨酸组SAM/SAH增加了1.68倍和2.75倍(P<0.01);高蛋氨酸组B1重复序列DNA甲基化水平降低11.8%(P<0.05),且与SAM/SAH比值呈明显负相关(r=-0.3638,P=0.0210)。结论 ApoE―/―小鼠中B1重复序列发生DNA低甲基化改变,且与SAM/SAH呈负相关,提示血清SAM/SAH可作为一个判断血管As的生物学指标。

Rathke’s裂囊肿手术前后血泌乳素水平的变化分析

目的探讨垂体Rathkes裂囊肿(Rathkes cleft cyst,RCC)患者手术前后血泌乳素(prolactin,PRL)水平的变化特征。方法回顾性分析上海交通大学医学院附属仁济医院南院2015年6月—2019年6月,行神经内镜下经鼻蝶手术治疗的14例RCC患者的临床资料。采用Wilcoxon秩和检验对比RCC患者术前与术后血PRL水平的差异。结果本组患者中,男6例,女8例;术前血PRL水平升高者7例,术后血PRL水平较术前下降者10例。手术后患者的症状均缓解,血PRL水平比术前明显下降(P=0.0052)。结论RCC可以轻度刺激垂体PRL分泌增加;神经内镜手术治疗RCC可有效降低PRL的分泌水平,对于改善患者的临床症状和血PRL水平有显著效果。

鞍区Rathke′s囊肿的影像学与组织学相关性研究

目的 研究鞍区Rathke′s囊肿影像学与组织学的相关性 ,提高对其影像学诊断的准确性。资料与方法 搜集 2 9例经病理证实的Rathke′s囊肿 ,分析Rathke′s囊肿的囊液性质和囊壁组织成分与影像学的关系。结果 多数Rathke′s囊肿在X线平片显示无蝶鞍扩大 ,这在影像诊断中有助于同囊性垂体腺瘤相区别。 9例囊肿在MRT1WI显示高信号 ,组织学证实在囊壁上存在含铁血黄素和胆固醇。结论 典型的Rathke′s囊肿MRT1WI显示为低信号 ,非典型Rathke′s囊肿MRT1WI呈高信号。出现高信号的原因可能为Rathke′s囊肿内的反复出血和胆固醇结晶沉积。

鞍区Rathke’s囊肿临床分析

目的:探讨鞍区Rathke囊肿的诊断和手术治疗。方法:对6例Rathke囊肿病例采用单鼻孔蝶窦入路、翼点入路和眉弓锁孔入路显微神经外科手术治疗,切除部分囊壁,敞开囊腔,清除囊肿内容物。结果:术后随诊6mo～3a,本组症状均有缓解,3a均未复发。结论:鞍区Rathke囊肿CT、MRI检查无特异性,术前较难明确诊断。经单鼻孔蝶窦入路显微外科手术是其有效治疗方法,可以明确诊断,缓解症状,病人预后良好,是治疗垂体Rathke囊肿的有效办法。

下肢骨折患者实施基于ERAS理念的深静脉血栓形成预防方案的应用效果

探究 ERAS 理念实施于下肢骨折患者中对深静脉血栓(DVT)的预防效果.方法:遴选2020年1月-2020年12月80例下肢骨折患者,参考"系统抽样法"分2组,观察组、对照组(均n=40).对照组实施常规护理;观察组基于ERAS理念实施预防性措施.观察比较2组干预结果,患肢肿胀程度、下床活动时间、住院时间、DVT发生率.结果:观察组DVT发生率为0%,明显低于对照组的4%;同时观察组患肢肿胀程度较对照组更轻,下床活动时间、住院时间较对照组更短,差异有统计学意义(P<0.05);干预前2组的凝血功能指标、肢体运动功能评分(Barthel 指数)、日常生活能力评分(FMA)、生活质量评分(QOL)比较(P>0.05),干预后,较对照组研究结果,观察组TT、APTT、APTT更长,D-D更低,Barthel指数、FMA评分、生活质量各维度评分均更高(P<0.05).结论:下肢骨折患者基于ERAS理念实施预防性干预措施,可有效预防及控制DVT的发生,改善患肢肿胀,实现促进生活质量改善、提高预后的目的.

Clinical application of serial operations with preserving spleen

AIM: To evaluate the clinical application of serial operations with preservation of spleen. METHODS: Serial operations with preserving spleen were performed on 211 cases in our hospital from 1980 to 2000. The patient's age ranged from 13 to 56 years, averaging 38 years. Diseases included splenic injury in 171 cases, portal hypertension in 9 cases, splenic cyst in 10 cases, and the lesion of pancreatic body and tail in 21 cases. RESULTS: All the cases were cured, and 129 patients were followed up from 3 months to 3 years with the leukocyte phagocytosis test, detection of immunoglubin, CT,(99m)Tc scanning and ultrasonography. The results were satisfactory. CONCLUSION: The operations with preserving spleen were safe, feasible, and worth of clinical application.

Unusual Contents of Inguinal Hernia Sac. An Approach to Management

Background-Unusual contents of hernia sac are uncommon, but are likely to be encountered by a surgeon in his career due to the frequency of hernia repair. The aim of this study, is to present our experience of unusual contents in inguinal hernia sac, discuss its management and review the relevant literature with regards to others experience. Patients and methods-Retrospective study of 662 patients who underwent inguinal hernia repair over an 8 year period from 2000 to 2008 was carried out. Results-Seven patients presented with unusual contents in inguinal hernia sac;an incidence of 1.05%. Three of them had vermiform appendix, with acute appendicitis (Amyand’s Hernia) noted in one of them. All patients underwent appendicectomy with repair of hernia, with mesh being employed only in patients with normal appendix. In 2 cases urinary bladder had herniated and there was one case each of ovarian cyst and fallopian tube with ovary as its content. In all these patients hernia repair was carried out after carefully reducing the contents. Conclusion-Unusual contents of hernia may pose a surgical dilemma during hernia repair even to an experienced surgeon. Although rare, a hernia may contain vermiform appendix and exceptionally it may be acutely inflamed. Tubal and ovarian herniation in an inguinal hernia may be found in adult and perimenopausal women, though the incidence is reported to be more common in children. Urinary bladder herniation occurs with similar incidence as tubo ovarian hernia;however it requires special attention because of the risk of iatrogenic bladder injury during inguinal dissection. Though appendix as a content is dealt with by appendicectomy followed by hernioplasty, every effort should be made to preserve other organs found in the hernia sac to achieve an uneventful postoperative period.