Cases reported "Recurrence"

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1/12. hemoperitoneum in patients receiving hemodialysis.

    Acute abdominal pain in chronic hemodialysis patients has well-known causes, including acute pancreatitis, mesenteric arterial insufficiency, or complicated duodenal ulcer. Others, such as hemoperitoneum, are far less common. Although hemoperitoneum occurs in patients receiving peritoneal dialysis, dialysis is seldom if ever the direct cause of the bleeding. hemoperitoneum is often related to menses or ovulation, particularly to ovarian cyst rupture; therefore, it is more common in young women. In most cases, no specific treatment is required. hemoperitoneum is rarely considered as the cause of acute abdominal pain in chronic hemodialysis patients. In this report of hemoperitoneum confirmed by emergency laparotomy in 3 women, bleeding was not related to gynecologic origin. All of the women were younger than age 50 and undergoing long-term hemodialysis. All patients had a history of acute abdominal pain associated with shock. The cause of bleeding was always an organ lesion: hepatic amyloidosis with suspected portal hypertension or sclerosing peritonitis and acute hemorrhagic pancreatitis. Coagulation abnormalities and the use of anticoagulants during hemodialysis sessions may have been aggravating factors in all three patients. hemoperitoneum is difficult to diagnose, particularly in the minor forms, and consequently its incidence may be underestimated. Therefore, it should be considered whenever a chronic hemodialysis patient presents with persistent acute abdominal pain.
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keywords = ovulation
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2/12. Recurrent haemoperitoneum in a mild von Willebrand's disease combined with a storage pool deficit.

    Haemoperitoneum secondary to haemorrhagic corpus luteum has been described in severe bleeding disorders such as afibrinogenaemia, type 3 von Willebrand's disease and patients under oral anticoagulation. We have studied one patient who presented three episodes of severe bleeding at ovulation, requiring surgery twice, with the diagnosis of mild von Willebrand's disease and mild storage pool deficiency. Mild von Willebrand's disease (associated with other thrombopathies or coagulopathies) should be considered in this pathology, although physicians would prefer to find a severe haemorrhagic disorder as the underlying condition in these cases.
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keywords = ovulation
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3/12. Failure of tubal closure following laser salpingostomy for ampullary tubal ectopic pregnancy.

    A patient with recurrent ectopic pregnancy is described. The first ectopic gestation was treated by laparoscopic linear laser salpingostomy of the right fallopian tube. Her hCG became negative and a hysterosalpingogram demonstrated right tubal patency. She conceived again after Pergonal ovulation induction, but had a recurrent right ectopic pregnancy. At laparotomy, the pregnancy was extruding through the unhealed incision of her prior linear salpingostomy. This complication of conservative management of ectopic pregnancy has important potential clinical significance.
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ranking = 1
keywords = ovulation
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4/12. Induction of ovulation causing recurrent bloody ascites in a woman with endometriosis.

    Massive ascites associated with endometriosis is uncommon. Recurrent episodes of bloody ascites as a result of endometriosis occurred in a woman with familial mediterranean fever, who underwent therapy for induction of ovulation. Ovulatory agents may provoke accumulation of ascites in patients with endometriosis.
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ranking = 5
keywords = ovulation
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5/12. Recurrent hemoperitoneum in women receiving continuous ambulatory peritoneal dialysis.

    Of 27 women in the reproductive age group receiving continuous ambulatory peritoneal dialysis for more than 3 months, 4 of 7 who menstruated developed recurrent hemoperitoneum. Tubal ligation had been done in 3 of these 4 women. There were 37 episodes of hemoperitoneum; 22 occurred at midcycle and 15 with menstruation. One patient required repeated blood transfusion, but after oral anovulant therapy no further bleeding occurred and no transfusion was required. Two patients needed laparotomy: one for heavy intraperitoneal bleeding originating from a luteal cyst, and the other for severe lower abdominal pain from follicular and luteal cysts. Ultrasound examinations suggested the presence of small ovarian cysts in the two remaining patients. Recurrent midcycle hemoperitoneum in women on continuous ambulatory peritoneal dialysis may be triggered by ovulation and associated ovarian cyst formation. Suppression of ovulation should be considered.
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ranking = 2
keywords = ovulation
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6/12. Recurrent gestational trophoblastic disease following in-vitro fertilization.

    recurrence of gestational trophoblastic disease (GTD) following two attempts at in-vitro fertilization (IVF)/embryo transfer is reported in a childless couple after 17 years of unsuccessful trials of ovulation induction. The diagnosis of bilateral tubal obstruction was finally established, indicating IVF treatment. After the first IVF/embryo transfer treatment, the woman developed GTD and was treated with methotrexate. After a second IVF attempt, GTD was again diagnosed. This time there was no response to methotrexate, thus necessitating second-line chemotherapy. etoposide, methotrexate, actinomycin D, cyclophosphamide, oncovine was used, and after only four treatment cycles the beta-human chorionic gonadotrophin (HCG) dropped to < 5 mIU/ml. After 26 months of follow-up, the beta-HCG continues to be undetectable. Preimplantation evaluation and ovum donation are described as measures to minimize the risk for GTD recurrence in a future IVF/embryo transfer.
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ranking = 1
keywords = ovulation
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7/12. Balancing the risk of recurrent thromboembolism and pre-existing osteoporosis in pregnancy.

    In summary, our 31-year-old patient with hypogonadotrophic hypogonadism has severe osteoporosis caused by chronic oestrogen deficiency. Her GnRH deficiency can be overcome using ovulation induction therapy. However, if she becomes pregnant there is a small risk of recurrent thromboembolism because of her previous cerebral thrombosis. This risk is hard to quantify but would undoubtedly increase if her mobility were impaired. The metabolic and mechanical alterations of pregnancy may compromise her weakened skeleton and increase the risk of a second major fracture. Her skeletal status precludes the use of standard heparin. Fractionated low molecular weight heparins would be the prophylactic agent of choice, possibly switching to low-dose warfarin for the second trimester. Alternative prophylaxis using low-dose aspirin may be suitable, although this is not proven. The difficulty in this case is that pregnancy and the prophylactic measures designed to protect the patient may prove to be detrimental. The case also highlights the vital role of prepregnancy counselling and interdisciplinary consultation between obstetrician, haematologist and endocrinologist in order to steer the safest course through this therapeutic minefield.
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ranking = 1
keywords = ovulation
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8/12. Recurrent spontaneous ovarian hyperstimulation syndrome associated with polycystic ovary syndrome.

    ovarian hyperstimulation syndrome (OHSS) is the most serious potentially life-threatening iatrogenic complication of ovulation induction. Presented here is the first reported case of recurrent severe OHSS which developed spontaneously in a women with polycystic ovary syndrome, diagnosed early in her second pregnancy, and necessitated intensive fluid and colloid therapy.
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ranking = 1
keywords = ovulation
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9/12. Recurrent molar pregnancy after ovulation induction and repeat ovulation induction. A case report.

    BACKGROUND: Although hydatidiform mole is not commonly encountered following ovulation induction, patients who have already had molar pregnancies are at increased risk of developing further molar diseases with worsening histologic characteristics. That fact underlies the ethical dilemma of repeat ovulation induction. CASE: A 38-year-old woman, gravida 3, para 0, had three consecutive episodes of hydatidiform subsequent to clomiphene citrate and gonadotropin ovulation induction. She seems to be the first in the literature to develop three consecutive molar pregnancies without a normal intrauterine pregnancy. CONCLUSION: Although ovulation induction commenced again in this patient after she gave informed consent, the risks underlying the ethical dilemma persist.
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ranking = 12
keywords = ovulation
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10/12. Increased concentrations of renin, aldosterone and Ca125 in a case of spontaneous, recurrent, familial, severe ovarian hyperstimulation syndrome.

    We report for the first time increased concentrations of aldosterone and renin in a case of spontaneous, recurrent, familial, severe ovarian hyperstimulation syndrome (OHSS). High concentrations of Ca125 were also found. Our patient was a 26 year old woman, gravida 2, para 1, affected by severe OHSS, who denied having ever consumed any ovulation drug. Both the patient and her only sister had suffered from a similar condition in their previous pregnancies. The patient was treated with i.v. fluid therapy. paracentesis was performed on one occasion. The patient was dismissed after 25 days in good condition. Blood count and blood chemistry confirmed the severity of the clinical picture. We conclude that spontaneous OHSS, although very rare, may have been underestimated so far. It can be recurrent and may also be familial. The intra-ovarian prorenin-renin-angiotensin system may play a role in its aetiopathogenesis.
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ranking = 1
keywords = ovulation
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