Struma ovarii complicating pregnancy. Case report and literature review

A 19-year-old woman at 12th week of pregnancy was referred to our hospital with severe acute abdominal pain, nausea and vomiting. Patient's abdomen was untreatable. Routine examinations, except neutrophilic leukocytosis, were normal. Ultrasound imaging showed the presence of intrauterine pregnancy corresponding to amenorrhea and a right complex ovarian mass, with well defined margins without papillary projection, 14x12 cm in diameter. No free fluid was evident. Due to untreatable abdomen and suspecting torsion of the ovarian tumor the patient underwent laparotomy under general anesthesia. The pregnant uterus was normal. The right ovary had increased volume for a cystic-solid mass of the size of 14 cm with smooth surface and twisted on the vascular peduncle. A right adnexectomy was performed. Intraoperative frozen section was negative for malignancy and postoperative histological examination revealed a struma ovarii without atypia of the follicular cells. Postoperative course was normal. The patient was discharged after three days and she delivered at term a normal baby. Mostly struma ovarii represents an incidental finding during cesarean section, but in rare case it may be cause of complications such as torsion, rupture, hypertiroidism and rarely may be a malignant tumor. The AA describe literature data on struma ovarii diagnosed in pregnancy.

Anatomical variations of the median nerve and of the vascular-nervous structures at the wrist

Three cases of anatomical variation of the median nerve at the wrist found during our surgical activity led us to take the opportunity to expose anatomical variations by reviewing already published reviews. Consequently, on the basis of anatomical studies, clinical reports and imaging, as a result of careful examination of the published literature, it has been observed that the interventions in such anatomical area must take into account these variations. In particular, the most performed procedure is the lysis of the transverse carpal ligament (TCL), which is not free from complications. In our opinion it is therefore necessary, in order to avoid the complications of the nervous, vascular and tendinous sections, to use some specific technical procedures.

Peripheral quantitative Computed Tomography (PQCT) in the evaluation of bone geometry, biomechanics and mineral density in postmenopausal women

AIM

Non-invasive assessment of bone geometry, biomechanics, and mineral content in postmenopausal women by peripheral quantitative Computed Tomography (pQCT).

MATERIAL AND METHODS

Total, trabecular and cortical mineral density (totBMD, cortBMD, trabBMD), and the geometrical (total area, trabecular area, cortical area) and biomechanical properties of bone (strength-strain index, cortical thickness) were assessed in 93 consecutive post-menopausal women (mean age: 63+/-7 yrs; age at menopause: 49+/-6 yrs; years since menopause: 14+/-9 yrs) by pQCT at the ultradistal radius of non-dominant forearm.

RESULTS

Compared with 50 healthy women at peak of bone mass, volumetric total, trabecular and cortical bone densities were significantly reduced in postmenopausal subjects (TotBMD: 318+/-106 mg/cm3 vs ctr 442+/-100, -28%, p<0.001; TrabBMD: 117+/-59 mg/cm3 vs ctr: 203+/-47, -42%, p<0.001; CorBMD: 764+/-159 mg/cm3 vs 921+/-111, -17%, p<0.001). The bone loss was greater in trabecular bone. Cortical area (0.7+/-0,1 cm2 vs ctr: 0.8+/-0.1, -12.5%, p<0.001), cortical thickness (0.151+/-0.02 cm vs ctr: 0.169+/-0.03, -11%, p<0.001), and strength-strain index (686+/-207 mm3 vs ctr: 883+/-165, -22%, p<0.001) were significantly lower in post-menopausal women in comparison with the controls. Years since menopause and age showed a significant negative correlation with bone mineral densities and biomechanical parameters.

CONCLUSIONS

In post-menopausal women pQCT showed: 1) osteopoenia in all bone compartments, greater at the trabecular level, related to age and years since menopause; 2) reduced cortical density and cortical thickness, consistent with a reduced ability of bone to absorb loading forces; 3) reduced strength-strain index, indicative of inability to adapt to mechanical use and augmented risk for fracture. We conclude that pQCT is a valuable tool for measuring the true volumetric mineral density and the geometrical and biomechanical indexes of bone, which could be proposed in current clinical practice for the assessment of osteoporosis.

[Osteoporosis and phytoestrogens: an assessment of bone mineral density via quantitative peripheral computed tomography in milk-egg-vegetarian women in the premenopause]

PURPOSE

Noninvasive assessment of bone mineral density, geometrical and biomechanical properties in premenopausal women with dietary intake of phytoestrogens and comparison of these parameters with those of age-matched female subjects with "Mediterranean" dietary intake lacking in these substances.

MATERIAL AND METHODS

Volumetric cortical, trabecular and total mineral density and bone geometrical properties were evaluated in 15 female subjects with phytoestrogens dietary intake. Peripheral quantitative Computed Tomography (pQCT) was used to make measurements at the distal radius of the nondominant forearm. Fifteen age-matched subjects with "Mediterranean" dietary intake were chosen as a control group. Cross-sectional area (Total A), trabecular area (TA), cortical area (CA), cortical thickness (CThk) and strength strain index (SSI) were assessed as biomechanical parameters.

RESULTS

Daily consumption of phytoestrogens was significatively different in the two groups (phy: 17.45 mg/die vs ctr: 0.35; p < 0.0005), while calcium intake was similar (phy: 652 mg/die vs ctr: 650). Total (0.460 g/cm3 vs ctr: 0.433) and trabecular (phy: 0.209 g/cm3 vs ctr: 0.189) bone mineral densities, such as SSI (phy: 925 mm3 vs ctr: 894) values, were higher in women with dietary intake of phytoestrogens, in comparison with the relative controls, but not significantly (p = ns). Among geometrical parameters, total area and cortical area were tendential in women with a vegetarian diet while cortical thickness was the same in both groups.

CONCLUSIONS

pQCT showed higher bone mineral density (total and trabecular) and SSI values in premenopausal women with dietary intake of phytoestrogens. Despite the lack of statistical significance, these preliminary results, should further support the few literature findings about the potential role of phytoestrogens consumption in preventing trabecular bone loss. However, further studies are warranted to evaluate definitively the efficacy of phytoestrogens in preventing postmenopausal osteoporosis.