New Theory of Effusive and Explosive Volcanic Eruptions

In this study, we presented new theory of effusive and explosive of volcanic eruptions. New explanation of eruption mechanisms was done by using the Elemental Buoyancy Theory and new K-Th-U structure of Earth, developed early by author. During investigation of effusive eruptions, it was given clear answer on the question why the light chemical elements, mainly silicon and sulfur compound, currently dominate in the volcanic ashes, gases, and in the magma lavas. At investigation of explosive mechanism, we analyzed 38 strong eruptions with Volcanic Explosivity Index (VEI) more than 4+. It was shown that there is a link between the planet configurations and volcanic eruptions. It can be found that volcano eruptions occurred at the different types of planet alignments. The phenomenon does depend neither on planet mass nor on the relative positions of planets. Also the phenomenon does not depend on the distance between planets, but often eruptions were observed when the distances between planets are multiple units. Also in work, it was demonstrated that the planet alignment affects not only natural processes on the Earth, but also impact the Sun activity. Based on the comparison phenomenon on the Earth and Sun, we get new mechanism to rapidly rising up pressure under the lithospheric planes by gravity vortexes. This gravity vortex was called as terrestrial magmatic protuberances.

Chronic Effusive Pericarditis and Chronic Constrictive Pericarditis

Chronic Pericarditis is infl ammation that begins gradually,is long lasting and results in fl uid accumulation in the pericardial space or thickening of the pericardium.The etiology is unknown but may be cancer,TB or hypothyroidism.Arrhythmias are common and seen in almost half the patients.The commonest arrhythmia is atrial fi brillation.Symptoms and signs are related to increased right atrial pressure and physical fi ndings include elevated JVP and pericardial knock.Non surgical therapy consists mainly of no salt.Surgery cures about 85%of patients,however 5–15%of patients will die.Chronic effusive pericarditis occurs when there is persistent restriction of the visceral pericardium after pericardiocentesis.

经鼓室口咽鼓管球囊扩张术的疗效及咽鼓管功能的影响

目的探讨经鼓室口咽鼓管球囊扩张(balloon dilatation Eustachian tuboplasty,BET)联合腺样体消融术对慢性分泌性中耳炎(chronic secretory otitis media,CSOM)患儿的疗效及咽鼓管功能的影响。方法选取2020年6月~2022年12月间在中山市小榄人民医院就诊的CSOM患儿82例作为研究对象,采用随机数字表法分为对照组和观察组,每组41例。对照组接受腺样体消融术+鼓膜切开置管术治疗,观察组接受腺样体消融术+鼓膜切开置管术+BET术。比较两组手术相关指标及住院时间、临床症状、咽鼓管功能、临床疗效及随访6个月并发症及复发情况。结果两组术中出血量比较,差异无统计学意义(P>0.05),与对照组相比,观察组手术时间更长,住院时间更短(P<0.05)。与对照组相比,观察组中耳积液消失时间、耳鸣消失时间、鼓膜愈合时间、听力恢复时间均更短(P<0.05)。与治疗前相比,治疗后两组咽鼓管评分(Eustachian tube score,ETS)升高、咽鼓管功能障碍评分量表(Eustachian tube dysfunction questionnaire-7,ETDQ-7)评分降低(P<0.05),观察组ETS评分高于对照组,ETDQ-7评分则低于对照组(P<0.05)。观察组临床总有效率高于对照组,差异具有统计学意义(P<0.05)。两组并发症发生率比较,差异无统计学意义(14.63%vs.9.76%,P>0.05),与对照组相比,观察组复发率更低,差异具有统计学意义(21.95%vs.2.44%,P<0.05)。结论经鼓室口BET联合腺样体消融术有助于提高CSOM患儿的临床疗效,改善咽鼓管功能,促进术后恢复,减少复发率,且并发症发生率低。

Pulmonary Edema and Pleural Effusion Detection Using Efficient Net-V1-B4 Architecture and AdamW Optimizer from Chest X-Rays Images

This paper presents a novelmulticlass systemdesigned to detect pleural effusion and pulmonary edema on chest Xray images,addressing the critical need for early detection in healthcare.A new comprehensive dataset was formed by combining 28,309 samples from the ChestX-ray14,PadChest,and CheXpert databases,with 10,287,6022,and 12,000 samples representing Pleural Effusion,Pulmonary Edema,and Normal cases,respectively.Consequently,the preprocessing step involves applying the Contrast Limited Adaptive Histogram Equalization(CLAHE)method to boost the local contrast of the X-ray samples,then resizing the images to 380×380 dimensions,followed by using the data augmentation technique.The classification task employs a deep learning model based on the EfficientNet-V1-B4 architecture and is trained using the AdamW optimizer.The proposed multiclass system achieved an accuracy(ACC)of 98.3%,recall of 98.3%,precision of 98.7%,and F1-score of 98.7%.Moreover,the robustness of the model was revealed by the Receiver Operating Characteristic(ROC)analysis,which demonstrated an Area Under the Curve(AUC)of 1.00 for edema and normal cases and 0.99 for effusion.The experimental results demonstrate the superiority of the proposedmulti-class system,which has the potential to assist clinicians in timely and accurate diagnosis,leading to improved patient outcomes.Notably,ablation-CAM visualization at the last convolutional layer portrayed further enhanced diagnostic capabilities with heat maps on X-ray images,which will aid clinicians in interpreting and localizing abnormalities more effectively.

Pleural effusion,ascites,colon ulcers and hematochezia:What we can learn from the diagnostic process of a patient with plasma cell myeloma:A case report

BACKGROUND Plasma cell myeloma(PCM)is characterized by hypercalcemia,renal impairment,anemia,and bone destruction.While pleural effusion,ascites,abdominal pain,and bloody stool are common manifestations of lung disease or gastrointestinal disorders,they are rarely observed in patients with PCM.CASE SUMMARY A 66-year-old woman presented with complaints of recurrent chest tightness,wheezing,and abdominal bloating accompanied by bloody stools.Computed tomography revealed pleural effusion and ascites.Pleural effusion tests showed inflammation,but the T-cell spot test and carcinoembryonic antigen were negative.Endoscopy showed colonic mucosal edema with ulcer formation and local intestinal lumen stenosis.Echocardiography revealed enlarged atria and reduced left ventricular systolic function.The diagnosis remained unclear.Further testing revealed elevated blood light chain lambda and urine immunoglobulin levels.Blood immunofixation electrophoresis was positive for immunoglobulin G lambda type.Smear cytology of the bone marrow showed a high proportion of plasma cells,accounting for about 4.5%.Histopathological examination of the bone marrow suggested PCM.Flow cytometry showed abnormal plasma cells with strong expression of CD38,CD138,cLambda,CD28,CD200,and CD117.Fluorescence in situ hybridization gene testing of the bone marrow suggested 1q21 gene amplification,but cytogenetic testing showed no clonal abnormalities.Colonic mucosa and bone marrow biopsy tissues were negative for Highman Congo red staining.The patient was finally diagnosed with PCM.CONCLUSION A diagnosis of PCM should be considered in older patients with pleural effusion,ascites,and multi-organ injury.

Subdural effusion associated with COVID-19 encephalopathy: A case report

BACKGROUND The precise mechanism by which severe acute respiratory syndrome coronavirus 2(SARS-CoV-2)impacts the central nervous system remains unclear,with manifestations spanning from mild symptoms(e.g.,olfactory and gustatory deficits,hallucinations,and headache)to severe complications(e.g.,stroke,seizures,encephalitis,and neurally demyelinating lesions).The occurrence of single-pass subdural effusion,as described below,is extremely rare.CASE SUMMARY A 56-year-old male patient presented with left-sided limb weakness and slurred speech as predominant clinical symptoms.Through comprehensive imaging and diagnostic assessments,he was diagnosed with cerebral infarction complicated by hemorrhagic transformation affecting the right frontal,temporal,and parietal regions.In addition,an intracranial infection with SARS-CoV-2 was identified during the rehabilitation process;consequently,an idiopathic subdural effusion developed.Remarkably,the subdural effusion underwent absorption within 6 d,with no recurrence observed during the 3-month follow-up.CONCLUSION Subdural effusion is a potentially rare intracranial complication associated with SARS-CoV-2 infection.

Subxyphoid Pericardial Drainage for Tuberculous Pericardial Effusion in Antananarivo

Introduction: Tuberculosis is the leading cause of pericardial effusion in sub-Saharan African countries. The aim of this study was to describe the diagnosis and the surgical management of tuberculous pericardial effusion in low-income country. Methods: This was a retrospective and descriptive study performed at Vascular Surgery Unit for 10 years-period (from January 2012 to December 2021), including all cases of drainage of pericardial effusion due to tuberculosis. Results: Sixty-seven cases were recorded, including 38 males (56.71%) and 29 women (43.28%). The average age was 35.47 years old. Patients lived in urban areas in 67.16% of cases. Thirteen patients (13.43%) had a previous history of pulmonary tuberculosis. The most common risk factors for tuberculosis infection were malnourishment (80.59%), indoor air pollution (77.61%) and close contact with tuberculosis patient (40.29%). The commonest symptom were dyspnea, (95.52%), chest pain (89.55%), fever (67.16%), tachycardia (95.52%) and cough (80.59%). Twenty-seven patients (39.02%) presented clinical signs of cardiac tamponade. Electrocardiogram showed sinus tachycardia (97.53%) with microvoltage (39.02%). Chest-X-ray showed cardiomegaly (100%) and pleural effusion (56.71%). Echocardiography showed moderate (43.28%) and large (56.71%) pericardial effusion. All patients underwent subxiphoid pericardial drainage. Mycobacterium tuberculosis detection via GeneXpert test of pericardial effusion were positive in 38.80% of patients. Pericardial biopsies confirmed the diagnosis of tuberculosis in 41.79%. The mortality rate was 8.95%. Conclusion: Subxiphoid pericardial drainage reduced thr risk of cardiac tamponade in patients with massive pericardial effusion. Histopathology of pericardial biopsies made a definitive diagnosis for tuberculosis.

Bacteriological Profile of Effusion Fluids Infections at Charles De Gaulle University Pediatric Hospital from 2017 to 2020

Introduction: Microbiology of effusion fluids in children in Burkina Faso is characterized by the scarcity of data. This work aimed to study the bacteriological and antibiotics susceptibility profile of bacteria involved in effusion fluid infections in paediatrics in order to improve the choice of probabilistic antibiotics therapy. Methods: A cross-sectional, descriptive study was used in children aged 0 to 15 years from 2017 to 2020 at the Charles De Gaulle Pediatric University Hospital Center (CHUP-CDG) in Ouagadougou. Classical bacteriology methods such as macroscopy, Gram staining, identification galleries and antibiotics susceptibility testing were used. Results: Of 231 samples, 64 bacteria were isolated. The most common bacterial strains of pleural fluid were Staphylococcus aureus (25%) and 40% for Enterobacteriaceae. Of the peritoneal fluid, 77% were Enterobacteriaceae with 57% Escherichia coli;and from joint fluid, 33% were S. aureus and 22% for P. aeruginosa. The overall susceptibility profile showed 29% extended-spectrum beta-lactamase-producing Enterobacteriaceae (ESBL), 10% methicillin-resistant S. aureus (MRSA), and 8% carbapenemases. Conclusion: Bacteriological profile is characterized by ESBL-producing Enterobacteriaceae and MRSA. The most active antibiotics were macrolides, aminoglycosides, and cefoxitin (methicillin) for Gram-positive cocci, carbapenems, and aminoglycosides for Gram-negative bacilli. Then, the monitoring of antibiotics resistance must be permanent.

Comparison of efficacy of lung ultrasound and chest X-ray in diagnosing pulmonary edema and pleural effusion in ICU patients: A single centre, prospective, observational study

Background and Aims While chest X-ray (CXR) has been a conventional tool in intensive care units (ICUs) to identify lung pathologies, computed tomography (CT) scan remains the gold standard. Use of lung ultrasound (LUS) in resource-rich ICUs is still under investigation. The present study compares the utility of LUS to that of CXR in identifying pulmonary edema and pleural effusion in ICU patients. In addition, consolidation and pneumothorax were analyzed as secondary outcome measures. Material and Methods This is a prospective, single centric, observational study. Patients admitted in ICU were examined for lung pathologies, using LUS by a trained intensivist;and CXR done within 4 hours of each other. The final diagnosis was ascertained by an independent senior radiologist, based on the complete medical chart including clinical findings and the results of thoracic CT, if available. The results were compared and analyzed. Results Sensitivity, specificity and diagnostic accuracy of LUS was 95%, 94.4%, 94.67% for pleural effusion;and 98.33%, 97.78%, 98.00% for pulmonary edema respectively. Corresponding values with CXR were 48.33%, 76.67%, 65.33% for pleural effusion;and 36.67%, 82.22% and 64.00% for pulmonary edema respectively. Sensitivity, specificity and diagnostic accuracy of LUS was 91.30%, 96.85%, 96.00% for consolidation;and 100.00%, 79.02%, 80.00% for pneumothorax respectively. Corresponding values with CXR were 60.87%, 81.10%, 78.00% for consolidation;and 71.3%, 97.20%, 96.00% for pneumothorax respectively. Conclusion LUS has better diagnostic accuracy in diagnosis of pleural effusion and pulmonary edema when compared with CXR and is thus recommended as an effective alternative for diagnosis of these conditions in acute care settings. Our study recommends that a thoracic CT scan can be avoided in most of such cases.

耳内窥镜下鼓膜置管联合腺样体切除术与鼓膜穿刺治疗分泌性中耳炎患儿的临床疗效比较

目的探讨耳内窥镜下鼓膜置管联合腺样体切除术治疗分泌性中耳炎(OME)患儿的临床疗效。方法选取2021年1月~2022年3月SOM患儿120例,按术式分为穿刺组(n=60)和置管组(n=60),穿刺组给予耳内窥镜下鼓膜穿刺联合腺样体切除术,置管组给予耳内窥镜下鼓膜置管联合腺样体切除术,比较两组积液消退时间、听觉脑干诱发电位(ABR)阈值、ABRⅠ波潜伏期、干扰素γ(IFN-γ)、白细胞介素6(IL-6)、肿瘤坏死因子α(TNF-α)、治疗效果以及并发症。结果置管组积液消退时间显著低于穿刺组,差异有统计学意义(P<0.05);穿刺组和置管组术后ABR、ABRⅠ波潜伏期、IFN-γ、IL-6和TNF-α均显著低于术前(P均<0.05);置管组术后ABR、ABRⅠ波潜伏期、IFN-γ、IL-6和TNF-α均显著低于穿刺组,差异有统计学意义(P均<0.05);置管组治疗有效率显著高于穿刺组,差异有统计学意义(P<0.05);置管组并发症发生率显著低于穿刺组,差异有统计学意义(P<0.05)。结论耳内窥镜下鼓膜置管联合腺样体切除术可有效改善SOM患儿听力及炎症,有利于提高疗效,且可减少并发症,值得临床推广。

巴曲酶对预防鼻咽癌放疗后分泌性中耳炎的临床分析

目的 探讨巴曲酶对预防鼻咽癌放射冶疗后分泌性中耳炎的临床效果。方法 选取2020年1月~2021年6月确诊为鼻咽癌并接受放疗的63例无分泌性中耳炎患者为研究对象。根据方案不同分为对照组(n=32)和观察组(n=31)。放疗开始后,对照组定期给予鼻咽部、鼻道及鼻窦口清理并冲洗鼻腔;观察组在同对照组治疗的基础上,应用巴曲酶。两组患者放疗结束后1周,比较两组患者分泌性中耳炎相关指征的出现情况。结果 观察组出现耳鸣、耳闷、鼓室积液、鼓室内陷、鼓室“B”型图、气-骨导差>10 dB HL、声反射消失的例数均少于对照组,差异有统计学意义(P<0.05)。结论 巴曲酶对预防鼻咽癌放疗后中耳炎的发生效果显著,值得临床推广应用。

Pleural effusion in critically ill patients and intensive care setting

Pleural effusion usually causes a diagnostic dilemma with a long list of differential diagnoses.Many studies found a high prevalence of pleural effusions in critically ill and mechanically ventilated patients,with a wide range of variable prevalence rates of up to 50%-60%in some studies.This review emphasizes the importance of pleural effusion diagnosis and management in patients admitted to the intensive care unit(ICU).The original disease that caused pleural effusion can be the exact cause of ICU admission.There is an impairment in the pleural fluid turnover and cycling in critically ill and mechanically ventilated patients.There are also many difficulties in diagnosing pleural effusion in the ICU,including clinical,radiological,and even laboratory difficulties.These difficulties are due to unusual presentation,inability to undergo some diagnostic procedures,and heterogenous results of some of the performed tests.Pleural effusion can affect the patient’s outcome and prognosis due to the hemodynamics and lung mechanics changes in these patients,who usually have frequent comorbidities.Similarly,pleural effusion drainage can modify the ICUadmitted patient’s outcome.Finally,pleural effusion analysis can change the original diagnosis in some cases and redirect the management toward a different way.

Combined aqueous misdirection and persistent choroidal effusions following implantation of a Preserflo Micro Shunt

AIM:To describe a case of aqueous misdirection complicated by subsequent persistent choroidal effusions following implantation of a Preserflo Micro Shunt(PMS)device to treat advanced closed angle glaucoma.METHODS:A 67-year-old caucasian female with advanced primar y angle-closure glaucoma on four medications with an intraocular pressure(IOP)of 26 mm Hg was listed for a PMS insertion with mitomycin C(MMC).RESULTS:Past ocular history was significant for pseudophakia and previous yttrium aluminum garnet(YAG)peripheral iridotomy.Surgery was uneventful but on the first postoperative day,she developed aqueous misdirection complicated by subsequent development of persistent uveal effusions.Conventional treatment strategies including atropine drops,YAG hyaloidotomy and choroidal effusion drainage proved ineffective.A combination of oral steroids and pars plana vitrectomy(PPV)along with an irido-zonulohyloidectomy(IZH)proved efficacious.CONCLUSION:To the best of the author’s knowledge,this is the first published case of aqueous misdirection complicated with the presence of significant,unresolving choroidal effusions,highlighting the possibility and sequelae of comorbid pathology in nanophthalmic eyes.

Development of subdural empyema from subdural effusion after suppurative encephalitis:A case report

BACKGROUND Chronic subdural effusion is very common in the cranial imaging of middle-aged and older people.Herein,we report a patient misdiagnosed with subdural effusion,who was eventually diagnosed with chronic subdural empyema(SDE)caused by Streptococcus pneumoniae.CASE SUMMARY A 63-year-old man was brought to our emergency room with a headache,vomiting,and disturbed consciousness.Computed tomography(CT)revealed a bilateral subdural effusion at the top left side of the frontal lobe.Cerebrospinal fluid examination after lumbar puncture indicated suppurative meningitis,which improved after anti-infective therapy.However,the patient then presented with acute cognitive dysfunction and right limb paralysis.Repeat CT showed an increase in left frontoparietal subdural effusion,disappearance of the left lateral ventricle,and a shift of the midline to the right.Urgent burr hole drainage showed SDE that was culture-positive for Streptococcus pneumoniae.His condition improved after adequate drainage and antibiotic treatment.CONCLUSION Patients with unexplained subdural effusion,especially asymmetric subdural effusion with intracranial infection,should be assessed for chronic SDE.Early surgical treatment may be beneficial.

Metagenomic next-generation sequencing for pleural effusions induced by viral pleurisy:A case report

BACKGROUND Viral pleurisy is a viral infected disease with exudative pleural effusions.It is one of the causes for pleural effusions.Because of the difficult etiology diagnosis,clinically pleural effusions tend to be misdiagnosed as tuberculous pleurisy or idiopathic pleural effusion.Here,we report a case of pleural effusion secondary to viral pleurisy which is driven by infection with epstein-barr virus.Viral infection was identified by metagenomic next-generation sequencing(mNGS).CASE SUMMARY A 40-year-old male with a history of dermatomyositis,rheumatoid arthritis,and secondary interstitial pneumonia was administered with long-term oral prednisone.He presented with fever and chest pain after exposure to cold,accompanied by generalized sore and weakness,night sweat,occasional cough,and few sputums.The computed tomography scan showed bilateral pleural effusions and atelectasis of the partial right lower lobe was revealed.The pleural fluids were found to be yellow and slightly turbid after pleural catheterization.Thoracoscopy showed fibrous adhesion and auto-pleurodesis.Combining the results in pleural fluid analysis and mNGS,the patient was diagnosed as viral pleuritis.After receiving Aciclovir,the symptoms and signs of the patient were relieved.CONCLUSION Viral infection should be considered in cases of idiopathic pleural effusion unexplained by routine examination.mNGS is helpful for diagnosis.

Primary membranous nephrotic syndrome with chylothorax as first presentation:A case report and literature review

BACKGROUND Primary membranous nephrotic syndrome with chylothorax as the first manifestation is an unusual condition.To date,only a few cases have been reported in clinical practice.CASE SUMMARY The clinical data of a 48-year-old man with primary nephrotic syndrome combined with chylothorax admitted to the Department of Respiratory and Critical Care Medicine of Shaanxi Provincial People's Hospital were retrospec-tively analysed.The patient was admitted to the hospital for 12 d due to shortness of breath.Imaging showed pleural effusion,laboratory tests confirmed true chylothorax,and renal biopsy revealed membranous nephropathy.After primary disease treatment and early active symptom treatment,the prognosis of the patient was good.This case suggests that chylothorax is a rare complication of primary membranous nephrotic syndrome in adults,and early lymphan-giography and renal biopsy can assist in the diagnosis when there are no contrain-dications.CONCLUSION Primary membranous nephrotic syndrome combined with chylothorax is rare in clinical practice.We report a relevant case to provide case information for clinicians and to improve diagnosis and treatment.

Diagnosis of Middle Ear Diseases Based on Convolutional Neural Network

An otoscope is traditionally used to examine the eardrum and ear canal.A diagnosis of otitis media(OM)relies on the experience of clinicians.If an examiner lacks experience,the examination may be difficult and time-consuming.This paper presents an ear disease classification method using middle ear images based on a convolutional neural network(CNN).Especially the segmentation and classification networks are used to classify an otoscopic image into six classes:normal,acute otitis media(AOM),otitis media with effusion(OME),chronic otitis media(COM),congenital cholesteatoma(CC)and traumatic perforations(TMPs).The Mask R-CNN is utilized for the segmentation network to extract the region of interest(ROI)from otoscopic images.The extracted ROIs are used as guiding features for the classification.The classification is based on transfer learning with an ensemble of two CNN classifiers:EfficientNetB0 and Inception-V3.The proposed model was trained with a 5-fold cross-validation technique.The proposed method was evaluated and achieved a classification accuracy of 97.29%.

ADAMTS3 and FLT4 gene mutations result in congenital lymphangiectasia in newborns:A case report

BACKGROUND Congenital lymphangiectasia is a rare disease characterized by dilated interstitial lymphatic vessels and cystic expansion of the lymphatic vessels.Congenital lymphangiectasia can affect various organ systems;however,it frequently occurs in the lungs accompanied with unexplained pleural effusion.Further,it might not be diagnosed during prenatal examination owing to the absence of pronounced abnormalities.However,after birth the newborn rapidly develops respiratory distress that quickly deteriorates.Genetic variations in proteins controlling the development of lymphatic vessels contribute to the pathophysiology of this disease.We report a rare case of heterozygous mutation of ADAMTS3 and FLT4 genes,which have not been reported previously.CASE SUMMARY We analysed the case of a neonate who had presented with only pleural effusion at a late gestational age and eventually died due to its inability to establish spontaneous breathing after birth.An autopsy revealed lymphangiectasia of the organ systems.Further,whole exome sequencing revealed heterozygous mutations of the lymphangiogenesis-controlling genes,ADAMTS3 and FLT4,and Sanger verification revealed similar lesions in the mother with no symptoms.CONCLUSION Considering the presented case,obstetricians should observe unexplained foetal pleural effusion,and perform pathology analysis and whole exome sequencing for a conclusive diagnosis and prompt treatment.

Pleuro-Pericardial Inflammation and Effusion: A Rare Acute Initial Presentation of Rheumatoid Arthritis

Background: Rheumatoid arthritis is a systemic inflammatory arthritis characterized by joint pain and morning stiffness. The affected joints are typically symmetrically affected, and given the inflammatory nature of this condition, patients often present with warmth and erythema around affected joints as well as fatigue. Extra-articular manifestations, especially pleuro-pericardial inflammation, are rare initial presentations, although may be seen in advanced or undertreated disease. Case Presentation: We describe a case of a rheumatoid arthritis presenting atypically in a middle-aged male who came to the emergency department complaining of diffuse muscle pain and swelling in the distal extremities. Cardiac ultrasound revealed pleuro-pericardial inflammation and effusions. Myositis and infectious causes were ruled out and bilateral hand x-rays did not show erosions or any evidence of arthritic changes. All rheumatological auto-antibodies were negative except for rheumatoid factor and anti-cyclic citrullinated peptide (CCP) and a diagnosis of rheumatoid arthritis was made. The patient was started on prednisone with excellent response. Conclusions: This case highlights that rheumatoid arthritis can uncommonly present initially with extra-articular manifestations that are often manifested in advanced disease. Typically, extra-articular manifestations, especially those as severe as this patient’s, occur with untreated, advanced disease and could accompany extensive arthritic joint changes. Thus, it is important to have an understanding of rare, atypical presentations of rheumatoid arthritis so that a high index of suspicion can be maintained to make the diagnosis and initiate treatment in a timely manner.

Demons-Meigs Syndrome with a High CA 125 Level: A Case Report at Soavinandriana Center Hospital Antananarivo

Introduction: Demons-Meigs syndrome combines a benign tumor of the ovary with ascites and pleural effusion. It is a rare disease and the pathophysiological mechanism is not yet well understood. The aim of our study is to report a case of Demons-Meigs syndrome, to determine its different characteristics and to make clinicians aware of the malignant predictive value of CA 125 in front of an ovarian tumor. Observation: The patient was 42 years old and had no previous history. She presented with intense abdominal pain of sudden onset, prompting a medical consultation. On clinical examination, the abdomen was distended with signs of peritoneal effusion and right pleural effusion. Ultrasound revealed a well-circumscribed, ovarian mass with an internal fluid component and hypervascularization on Doppler. The CA 125 level was elevated (293.9 U/ml). Exploratory laparotomy revealed two bilateral, firm, solid ovarian tumors without vegetation or peritoneal lesions. Macroscopically, one of the tumors was well circumscribed, lobulated with a smooth outer surface. It measured 20 × 17 × 8 cm and weighed 1400 g. The other tumor measured 19 × 11 × 5 cm, weighed 1090 g and had the same characteristics as the other tumor. Histologically, both tumors were a proliferation of fibroblastic spindle cells organized in short intersecting or storiform bundles, without cyto-nuclear atypia or excess mitoses. The diagnosis retained was bilateral ovarian fibroma in the context of a Demons-Meigs syndrome. Conclusion: Demons-Meigs syndrome is a rare entity. The concomitant elevation of the CA 125 level is not always an indicator of ovarian cancer. The curative treatment is surgical based on tumor removal ensuring the disappearance of peritoneal and pleural effusions.