1/7. Lessons to be learned: a case study approach: pseudohyperkalaemia due to thrombocytosis in a case of tubo-ovarian abscess.The case described here is that of a 48-year-old lady who presented with abdominal pain and fever; at a later stage she was found to have hyperkalaemia of uncertain origin. blood examination revealed there to be marked elevation of the platelets (thrombocytosis) on some occasions. It was then realised that there was correlation between the platelet levels and serum potassium values. During the clotting process the release of potassium from the increased number of platelets caused the serum potassium to be elevated on account of an in vitro effect. The important point is that the raised serum potassium levels were not due to an in vivo phenomenon and, therefore, the patient did not need treatment for this; however, the presence of thrombocytosis was itself a clue to the diagnosis--which was eventually recognised as being due to an infection. At operation a tubo-ovarian abscess was discovered to be the cause of the problem.- - - - - - - - - - ranking = 1keywords = serum (Clic here for more details about this article) |
2/7. Elevated serum cancer antigen 125 levels in advanced abdominal tuberculosis.A 48-yr-old female presented with a 1-yr history of pain in the hypochondrium and epigastrium. All routine investigations and computed tomography (CT) of the abdomen were done. CT findings revealed a well-defined cystic mass in the right ovary, and ascitis with features suggestive of secondaries over the omentum and peritoneal surface. The serum CA125 was 1255 U/mL (normal range 0-35 U/mL), which was indicative of ovarian malignancy. An exploratory laparotomy was performed. Histopathological examination of organs revealed the presence of granuloma. The patient was advised to undergo antitubercular treatment (ATT) and follow-up every month. After 1 mo of ATT, the CA125 level came down to 42 U/mL, which was near normal. As tuberculosis requires only a conservative management, we suggest that in cases of abdominopelvic mass with or without ascitis, high serum CA125 should always raise a suspicion of tuberculosis and a laparoscopy combined with peritoneal biopsy should be performed to confirm the diagnosis. This will prevent unnecessary laparotomies. Moreover, serum CA125 can be used to monitor the response of disease to antitubercular treatment.- - - - - - - - - - ranking = 2.3333333333333keywords = serum (Clic here for more details about this article) |
3/7. Four ovarian cancers diagnosed during laparoscopic management of 1011 women with adnexal masses.OBJECTIVES: This study was conducted to assess the value of laparoscopic management of adnexal masses. Two concerns we wish to address are the failure to diagnose early ovarian cancer at laparoscopy and worsening the prognosis of stage I cancer by spilling fluid during surgery. STUDY DESIGN: The setting is a predominantly referral-based, private subspecialty practice. All operations were preformed in the outpatient surgical suite of a large suburban hospital. After extensive patient screenings, which included history and physical examination, preoperative serum CA 125 levels (since 1988), and pelvic ultrasonography, 1209 adnexal masses were managed laparoscopically. RESULTS: Of 1011 patients with surgical management, ovarian cancer was discovered intraoperatively in four. CONCLUSIONS: Our findings indicate that with consistent use of frozen sections of all cyst walls and suspicious tissue, laparoscopic management did not alter the prognosis. Neither CA 125 level, pelvic ultrasonography, nor peritoneal cytologic testing had sufficient diagnostic specificity to predict malignancy. Experienced surgeons using intraoperative histologic sampling may safely evaluate adnexal mass laparoscopically.- - - - - - - - - - ranking = 0.33333333333333keywords = serum (Clic here for more details about this article) |
4/7. Appendiceal mucocele: a rare differential diagnosis of a cystic right adnexal mass.CASE REPORT: We present the case of a 42-year-old woman with an incidental finding of a large right adnexal mass during pelvic ultrasound scan for a spontaneous miscarriage. Ultrasound suggested the mass was ovarian in origin and serum Ca125 was normal. laparotomy, however, revealed normal ovaries with no ovarian pathology. The right adnexal mass was appendiceal in origin and was delivered intact with no spillage. histology confirmed a diagnosis of mucinous cystoadenoma of the appendix. DISCUSSION: Pre-operative diagnosis of this condition is difficult. Various radiological tools including CT scans, MRI, and ultrasound scans have been used with poor results. Pre-operative diagnosis would be useful, as extra measures could be taken to avoid intra-peritoneal rupture during surgery with the consequent development of pseudomyxoma peritonei. For a similar reason, needle aspiration should be avoided. In malignant cases co-existing ovarian neoplasm must be excluded as this will be present in 2-24% of cases. Simple appendicectomy is curative in uncomplicated, unruptured cases. CONCLUSION: Although relatively rare, appendiceal tumours should be considered in women who present to gynaecologists with a right adnexal mass.- - - - - - - - - - ranking = 0.33333333333333keywords = serum (Clic here for more details about this article) |
5/7. mucocele of the vermiform appendix with sonographic appearance of an adnexal mass.mucocele of the vermiform appendix is caused by mucus retention in its lumen, due to obstruction or hyperproduction. Appendiceal malignancy can be the underlying cause, making accurate preoperative diagnosis imperative. In women, it can sometimes present as an adnexal mass. A rare case of an appendiceal mucocele is presented, mimicking a cystic tumor of the right adnexum, both clinically and ultrasonographically. In addition, serum levels of CA-125 were increased. This is the first case of a mucocele of the appendix simulating an adnexal mass on ultrasound with increased levels of CA-125 to be reported. This clinical entity should be considered in patients presenting on ultrasound with a right-sided adnexal mass as a rare potential diagnosis.- - - - - - - - - - ranking = 0.33333333333333keywords = serum (Clic here for more details about this article) |
6/7. Pelvic-peritoneal tuberculosis with elevated serum and peritoneal fluid Ca-125 levels. A report of two cases.We report 2 patients with pelvic-peritoneal tuberculosis and elevated serum and peritoneal fluid levels of Ca-125. The first was a young and infertile women who had cul-de-sac nodularity and dysmenorrhea. The other was postmenopausal and presented with weight loss and ascites. While a preoperative diagnosis of endometriosis was made in the former, intraperitoneal malignancy was considered in the latter. The diagnosis of pelvic-peritoneal tuberculosis was reached by laparoscopic-directed biopsy in both patients. serum levels of Ca-125 returned to normal limits following antituberculous drug treatment.- - - - - - - - - - ranking = 1.6666666666667keywords = serum (Clic here for more details about this article) |
7/7. Drastic elevation of serum CA125, CA72-4 and CA19-9 levels during menses in a patient with probable endometriosis.Levels of CA125, CA72-4 and CA19-9, serum markers for ovarian cancer, were measured throughout menstrual cycles in a patient with probable pelvic endometriosis. The patient had CA125 levels >1000 U ml(-1), CA72-4>10 U ml(-1) and CA19-9>150 U ml(-1) during but not after menses (P<0.01). In luteal phase and premenstrual phase, the levels of these markers seemed to return normal ranges, although CA125 remained over the upper normal limit. knowledge that a physiological elevation of these markers may occur during menses might avoid misinterpretation.- - - - - - - - - - ranking = 1.6666666666667keywords = serum (Clic here for more details about this article) |