Endometriosis is the presence of functioning endometrium (gland and stroma) in sites other than uterine mucosa, usually in the pelvis, causing dysmenorrhea, dyspareunia, menstrual irregularities, and infertility. case report: A 27-year-old, had caesarean section 11 months ago presented to Obstetrics and Gynaecology clinic with cyclical bleeding from her surgical scar from ten months. she noted bleeding from the small nodule over the healed pfannenstial scar on day of her menses. Examination revealed a small reddish nodule 0.5 cmx0.5 cm, non-tender, with two blackish dots on it. transabdominal ultrasound examination revealed that the nodule confined at the subcutaneous tissue, above the rectus. Ahmad Akram Omar1, Mohd Shukri Othman2, Pek Sung Hoo3, Erinna Mohamad Zon4, Ahmad Amir Ismail1, Rahimah Abdul Rahim1, Nik Rafiza Afendi1, Adibah Ibrahim5 Affiliations: 1Senior lecturer, Obstetrics and Gynaecology Department, School of Medical Science, University Sains Malaysia, Kota Bharu, Kelantan, Malaysia; 2Professor, Obstetrics and Gynaecology Department, School of Medical Science, University Sains Malaysia, Kota Bharu, Kelantan, Malaysia; 3Clinical lecturer, Obstetrics and Gynaecology Department, School of Medical Science, University Sains Malaysia, Kota Bharu, Kelantan, Malaysia; 4Specialist trainee, Obstetrics and Gynaecology Department, School of Medical Science, University Sains Malaysia, Kota Bharu, Kelantan, Malaysia; 5Associate Professor, Obstetrics and Gynaecology Department, School of Medical Science, University Sains Malaysia, Kota Bharu, Kelantan. Corresponding Author: Pek Sung Hoo, Clinical lecturer, Obstetrics and Gynaecology Department, School of Medical Science, University Sains Malaysia, Kota Bharu, Kelantan, Malaysia. Received: 20 August 2017 Accepted: 26 December 2017 Published: 11 April 2018 Diagnosis of scar endometriosis was made. she had wide local excision and recovered well. the histological examination was consistent with scar endometriosis. conclusion: scar endometriosis is a very rare condition. Women in the reproductive age with swelling, pain and discharge at the scar following surgery should be suspected for scar endometriosis.
Hyperemesis gravidarum is associated with childhood trauma, depression, trait anxiety, and somatization: a case-control study Objective: Hyperemesis gravidarum (HG) is a disease characterized by severe nausea and vomiting; it is the most common cause of hospitalization in the first months of pregnancy. The effects of childhood trauma, anxiety types, and exaggeration of somatic sensations on HG have not been defined. In this study, it was aimed to investigate the relationship between HG and factors including depression, anxiety, childhood abuse, and exaggeration of physical sensations. Method: Forty-five pregnant women diagnosed with HG and 45 healthy pregnant women were included in the study. Socio-demographic data form, Beck Depression Inventory (BDI), State-Trait Anxiety Inventory (STAI), Somatosensory Amplification Scale (SSAS), Childhood Trauma Questionnaire (CTQ), and PregnancyUnique Quantification of Emesis (PUQE) scales were administered to the participants in the study. Results: No significant differences were observed between the groups in relation to socio-demographic data except income levels. The income level of the patient group was lower than that of the control group. Compared to the control group, scores for PUQE (p<0.01), BDI (p<0.01), Trait Anxiety Scale (TAI) (p<0.05), SSAS (p<0.05), and CTQ (p<0.001) were found to be significantly higher in the patient group. According to correlation analysis, while a relation was detected between PUQE scale results and CTQ, BDI, SSAS, and TAI results, no relation was found with the State Anxiety Inventory (SAI). Conclusion: In this study, a history of childhood trauma, depression, exaggeration of somatic sensations, and trait anxiety were found to be more common in individuals with HG. In addition, these factors were also found to be associated with the severity of nausea and vomiting.
Does a history of surgically repaired intracranial aneurysm interfere with electroconvulsive therapy? Electroconvulsive therapy (ECT) is a comparably safe treatment option frequently administered for treatment-refractory mental disorders. It has no absolute contraindication; however, careful attention should be given when ECT is applied to patients with comorbid conditions. Intracranial aneurysms are among the comorbidities that increase certain risks associated with ECT. Increase in cerebral blood flow during ECT may be associated with increased risk of rupture of an aneurysm and bleeding from vascular malformation. In the literature, there is a limited number of case reports on ECT administration in patients with surgically repaired cerebral aneurysm. In this case report, application of ECT in a 53-year-old female patient diagnosed with treatment-refractory major depressive disorder and with a history of surgical repair for intracranial aneurysm is presented. In addition, special considerations and precautions about ECT application for patients with repaired intracranial aneurysms are reviewed.
Sexual abuse and exploitation of an adolescent girl with gender dysphoria and congenital adrenal hyperplasia Gender dysphoria is a psychosexual disorder characterized by powerful cross-gender identification and a continuous dissatisfaction with one’s biological gender role. Congenital Adrenal Hyperplasia (CAH) is a sexual developmental disorder resulting from congenital deficiency and functional impairment of enzymes enabling cortisol synthesis. Gender dysphoria may be developed in 5.2% of CAH patients. In our case, sexual abuse and exploitation of an adolescent girl with gender dysphoria and CAH will be discussed. The 17-year-old girl was admitted to our clinic with complaints of increasing sexual desire for girls, dissatisfaction with being a girl, desire to be male, self-harming, and overstepping personal borders. She sexually touched girls against their will, tried to kiss them, desired to have sex with them, and when they rejected sexual intercourse, she threatened them with a knife when her demands were not met; she attacked the officials at the institution and cut her own arm. In her medical history, a diagnosis of 46XX simple virilizing CAH had been made on the basis of labioscrotal fusion and the presence of a single urogenital opening at 1 month. At the age of 1.5 years, the patient was operated to be raised as a girl and surgical reconstruction was completed. As a result of inadequate parental care, she had been taken into institutional care at the age of 4. We learned that the patient who was in the institution until the age of 17 was frequently running away from the institution and once had been exposed to sexual abuse. We also learned that she had threatened a girl in her last institution and sexually abused her for 3 months. Gender dysphoria and personality disorder traits were detected in the patient. Genetic and environmental causes may lead to gender dysphoria. As in our case, interest in same-sex partners and forced sexual contact are problems that may occur in gender dysphoria. It should be emphasized that in individuals with genetic or environmental risk factors of gender dysphoria, the risk of developing gender dysphoria and the risk of sexual abuse need to be considered.