Adult onset Still’s disease in a patient with scleroderma: case report

Background Scleroderma and adult onset Still’s disease (AOSD) are both uncommon autoimmune disorders. These two disorders have rarely been documented to occur simultaneously. In fact, after a thorough literature review, we discovered only one prior case report in a pregnant individual. Here, we describe the first documented case of scleroderma and AOSD in a postmenopausal patient. Case presentation The patient is a 61-year-old Caucasian female with a past medical history significant for peptic ulcer disease, mitral valve prolapse, chronic idiopathic pancreatitis, and limited cutaneous scleroderma with sclerodactyly, Raynaud’s, and calcinosis. She was sent to the emergency room by her primary care physician due to one-week history of intermittent spiking fevers (Tmax 101°F), sore throat, myalgias, arthralgias, and non-pruritic bilateral lower extremity rash. Diagnostic evaluation in the hospital included complete blood count, comprehensive metabolic panel, respiratory viral panel, antinuclear antibody panel, bone marrow biopsy, and imaging with computerized tomography. Our patient fulfilled Yamaguchi Criteria for AOSD and all other possible etiologies were ruled out. She was treated with a steroid taper and methotrexate was initiated on post-discharge day number fourteen. Clinical and biochemical resolution was obtained at three months. Conclusions In this report, we describe the first ever documented case of scleroderma and AOSD in a postmenopausal patient. The clinical presentation, diagnostic work up, and management discussed herein may serve as a framework for which rheumatologists and other physicians may draw upon in similar future encounters.

Аpplication of nifuratel in treatment of cystitis in women

Cystitis is the most common pathology of the urinary tract in women both in our country and abroad. The high incidence of this disease in women in the population is influenced by anatomical, physiological features of the female body, violations of personal and sexual hygiene, burdened with an obstetric and gynecological (OAG) history, etc. In the current domestic and foreign recommendations for the diagnosis and treatment of cystitis in women, it is noted that in the vast majority of cases (up to 80% cases), the causative agent of cystitis is Escherichia coli, sensitive to nitrоfuran drugs.The purpose of the work. To demonstrate the effectiveness of the use of nifuratel (Nifuratel-SZ, Northern Star Co., Russia) in women with cystitis of various age groups using clinical examples. In the first clinical example, the high effectiveness of the use of nitrоfuran was shown in a woman of active reproductive age with OAG, in the second, in a teenager with an acute inflammatory process, in the 3rd-in a postmenopausal patient with concomitant multiple organ pathology.Conclusion. Nifuratel (Nifuratel-SZ, Northern Star Co., Russia) has proven to be a highly effective and safe drug with a wide range of antibacterial effects in patients with cystitis of different age groups.

Approach to Managing a Postmenopausal Patient

Case and Principles of Management The case of a symptomatic, postmenopausal woman is presented and a full discussion of the approach to her management is discussed. Pertinent guidelines and scientific evidence are emphasized as support for the recommendations.

Effective factors on inadequate results in endometrial biopsy with Pipelle

Objective: In this study, it was aimed to investigate the factors that may affect the pathological diagnosis in pipelle endometrial biopsies. Material and Methods: Four hundred and twenty endometrial biopsies performed by the same specialist using pipelle were analyzed retrospectively in our outpatient clinic for eleven months. Endometrial samples which were made for diagnosis of ectopic pregnancy and patients who have history of cancer or needed anesthesia for the procedure were excluded from the study. Group 1 was created from 65 patients whose endometrial biopsy were resulted as insufficient endometrial biopsy and Group 2 was created with 173 patients who had sufficient material as a result of biopsy. The effect of demographic information, ultrasound data (presence and localization of leiomyoma, endometrial thickness) and biopsy indications were investigated. Results: The average age of patients in Group 1 was found to be statistically significantly higher than Group 2, of 238 patients who were investigated retrospectively (p<0,001). Endometrial thickness in Group 1 was statistically lower than Group 2 (p<0,001). Endometrial biopsy indications were frequently observed as postmenopausal bleeding for Group 1 and abnormal uterine bleeding for Group 2. Conclusion: According to our opinion that it will be more appropriate to perform dilatation / curettage biopsy, instead of biopsy with pipelle if a need for endometrial sampling is required in older ages especially for the postmenopausal patient group.

Ruptured Ovarian Artery Pseudoaneurysm in a Postmenopausal Patient Treated with Transcatheter Embolization

Ovarian artery pseudoaneurysms are relatively rare entities, usually associated with pregnancy or the early postpregnancy period. Occurrence in older females is even less common. We present a case of ruptured ovarian artery pseudoaneurysm in an older postmenopausal patient, successfully treated with transcatheter embolization.

Vaginal stenosis with cervical intraepithelial neoplasia in a postmenopausal patient with pyometra: a diagnostic dilemma

Postmenopausal patient presenting with pain and lump in abdomen should be considered as a complication caused by gynaecological malignancy unless proved otherwise pyometra is most common in postmenopausal women but it can affect women of child bearing age as well. Usually it is caused by impairment of natural drainage of the cervix due to malignant diseases of genital tract and consequences of their treatment with radiotherapy. Authors report one such case with cervical intraepithelial neoplasia with uterus markedly enlarged to 26-28 weeks size with Vaginal stenosis in an eighty-year-old postmenopausal patient.

An Alternative Treatment for Vaginal Cuff Wart: a Case Report

Human papillomavirus (HPV) has been directly related to acuminate warts and cervical cancer, the second most common neoplasia among women. Given the lack of treatment against the virus itself, many medications have been utilised, mainly aiming in modifying the host’s immunological response. We present the case of a 54 years old postmenopausal patient with a history of vaginal cuff wart and HPV persistence that we managed in our clinic for 6 months with a mix of curcumin, aloe vera, amla and other natural ingredients. As the patient was found to be intolerant to imiquimod (one of the most common conservative methods of treatment) we attempted the use of curcumin, which was applied to the area of the wart three times per week for 6 months. Both clinical and colposcopical improvement was noted in regular clinic visits with regression of the lesion. The outcome of this case encourages our view that curcumin should be considered as a significant treatment modality against HPV infection and acuminate warts.