OBJECTIVE: To evaluate whether intraoperative rupture affects oncological outcomes in patients with early-stage epithelial ovarian cancer (EOC).
METHODS: A multicenter retrospective study was conducted on patients with early-stage EOC based on surgical and final pathological reports between 2007 and 2021. Oncologic outcomes were compared between the unruptured group (International Federation of Gynaecology and Obstetrics [FIGO] stage IA/IB) and ruptured group (FIGO stage IC1). The primary endpoint was progression-free survival (PFS). Propensity score matching (PSM) was performed to adjust for the imbalance in prognostic factors between the groups.
RESULTS: Overall, 197 (58.3 %) patients comprised the unruptured group (FIGO stage IA/IB), and 141 (41.7 %) were in the intraoperatively ruptured group (FIGO stage IC1). No significant difference in the 5-year PFS was observed between the two groups before PSM (92.65 % vs. 92.80 %, P = 0.93). After PSM, the 5-year PFS showed a noticeable decrease in the ruptured group compared to the unruptured group, although this difference showed borderline statistical significance (96.90 % vs. 89.82 %, P = 0.061). This trend was particularly discernible in cases with aggressive tumor characteristics; intraoperative rupture remained an independent prognostic factor for shorter PFS in patients with high-grade histology (adjusted hazard ratio = 14.4, 95 % confidence interval = 2.8-74.1).
CONCLUSIONS: Although not statistically significant, intraoperative rupture may negatively affect PFS in these patients after PSM. Therefore, rupture during surgery should be avoided as it can cause upstaging and unnecessary chemotherapy.

OBJECTIVE: Women with a history of spontaneous preterm birth (sPTB) face an increased risk of recurrence. Yet, the factors contributing to the increased risk are unknown, hampering the development of targeted interventions. Noninvasive quantitative ultrasound (QUS) has been validated in the characterization of cervical tissue and has the potential to provide information about postpartum cervical remodeling. The objective of this study was to determine the postpartum cervical remodeling trajectories of women over 12 mo post-delivery and to determine whether there were differences between women who delivered full-term and spontaneous preterm that were sensitive to QUS biomarkers.
METHODS: Data were collected prospectively from 55 women: 41 who delivered full-term and 14 who delivered spontaneously preterm at 6 wk, 3, 6, 9 and 12 mo (±2 wk) postpartum. Data from QUS biomarkers: Attenuation Coefficient; Backscatter Coefficient; Shear Wave Speed; and Lizzi-Feleppa Slope, Intercept and Midband were analyzed from the acquired radiofrequency data using a Siemens S2000 ultrasound system with a transvaginal MC 9-4 MHz probe. The biomarkers were analyzed using descriptive statistics and linear mixed-effects models.
RESULTS: QUS biomarkers, Backscatter Coefficient and Lizzi-Feleppa Intercept showed significant differences during the year after delivery between women who had a full-term birth and sPTB (p < 0.05), suggesting that there are differences in the cervical remodeling trajectories between the two groups. All QUS biomarkers demonstrated significant variations between the full-term birth and sPTB groups over time (p < 0.05), indicating ongoing cervical remodeling for both groups during the 12-mo postpartum period.
CONCLUSIONS: QUS biomarkers identified cervical microstructure differences and trajectories in the year after delivery between women who delivered full-term and spontaneous preterm.

Spontaneous celiac artery dissection is uncommon. Abdominal pain is a common clinical presentation. Conservative medical treatments, endovascular interventions, and open surgery are used to treat spontaneous celiac artery dissection. A 49-year-old male patient visited our hospital, with back and subxiphoid pain that had persisted for 11 hours. He has been smoking 40 cigarettes a day for 20 years. The blood pressure was 180/100mmHg. Aortic computed tomography angiography (CTA) images revealed dissection of the celiac artery, common hepatic artery, left hepatic artery, right hepatic artery, and splenic artery. Urapidil hydrochloride and isosorbide dinitrate were administered to lower the blood pressure to approximately 110/70 mmHg. However, the back and subxiphoid pain persisted without relief. Angiography was performed and a vascular stent (BARD, LIFE STENT, VASCULAR, 8 × 60) was implanted into the celiac artery without involving the branches. Pain was immediately relieved after interventional therapy. The patient was discharged after 4 days. A subsequent aortic CTA after 10 months confirmed that the celiac artery dissection had still not reoccurred.

Spontaneous internal fistulae (cystocolonic, cystogastric and cystoenteric) have been described as potential complications of severe acute pancreatitis with pseudocyst or walled off necrosis (WON). Ours is possibly the first ever report of double internal fistulae (pancreatico-gastric and pancreatico-colonic) occurring as a spontaneous complication of acute pancreatitis.

BACKGROUND: Spontaneous Coronary Artery Dissection (SCAD) is an acute coronary event of uncertain origin. SCAD occurs when the coronary artery wall dissects non-traumatically and non-atherosclerotically, leading to the formation of an intramural hematoma or intimal tear, ultimately compressing and restricting the true lumen, or even occluding it. The management of SCAD remains controversial despite modern imaging techniques. In addition to supportive drug therapy, percutaneous coronary intervention (PCI) is another option that can be used as an effective treatment modality.
METHODS: We describe A 50-year-old male with SCAD presented to the hospital emergency department complaining of chest pain. Coronary angiography incidentally showed spiral dissection from the proximal to distal right coronary artery (RCA). Three overlapping coroflex stents were deployed from the distal to the proximal RCA.
CONCLUSIONS: To stabilize the coronary artery in Acute Coronary Syndrome (ACS) patients due to SCAD, prompt interventions such as stenting and angioplasty are needed. However, it is necessary to pay attention to the clinical condition of patients and quick diagnosis for the recovery of patients and reduction of complications.

BACKGROUND: Spontaneous splenic rupture (SSR) is a rare but potentially fatal condition. It is commonly linked to underlying conditions such as infections, neoplasms, or hematologic diseases. SSR can also occur in a healthy spleen without any associated pathology, termed idiopathic splenic rupture. Symptoms range from non-specific abdominal pain to hemodynamic instability, often requiring emergency splenectomy. Early recognition using CT is crucial for improving outcomes.
METHODS: A 32-year-old male presented with severe abdominal pain for 24 h. Examination showed stable hemodynamics but tenderness in the left upper quadrant. CT revealed a subcapsular hematoma and moderate hemoperitoneum, leading to a diagnosis of SSR. Initially managed conservatively, the patient developed hemorrhagic shock 24 h later, with hemoglobin decreasing to 6.2 g/dL. An exploratory laparotomy confirmed a superior pole splenic fracture with significant hemoperitoneum, necessitating a total splenectomy. Postoperative recovery was uneventful, and the patient was discharged on postoperative day 6 with prophylactic vaccinations and lifelong penicillin.
CONCLUSIONS: SSR in a normal spleen is extremely rare and poses significant diagnostic and therapeutic challenges. The exact mechanisms are unclear, with theories including vascular anomalies, microtrauma, increased splenic pressure, and idiopathic factors. SSR symptoms are often non-specific, leading to misdiagnosis. Timely diagnosis using imaging, particularly contrast-enhanced CT, is essential. Management varies from conservative approaches to splenectomy, based on hemodynamic stability and splenic damage.
CONCLUSIONS: Spontaneous rupture of a normal spleen is a critical condition requiring high clinical suspicion for timely diagnosis and management. Further research is needed to understand its pathophysiology and risk factors.

A 53-year-old man with acute myeloid leukemia received an allogeneic hematopoietic cell transplant (HCT) from a matched unrelated donor. One month after his transplantation, he developed ARDS requiring initiation of VV-ECMO. He suffered from pancytopenia, managed with frequent transfusions, granulocyte-colony stimulating factor (G-CSF) and weekly thrombopoietin receptor agonist. On ECMO day 17, the patient developed severe hypotension after insertion of a chest tube for a large right-sided pneumothorax. CT angiography of the abdomen showed hemoperitoneum. Exploratory laparotomy revealed approximately 4 L of blood and a ruptured splenic hilum. A splenectomy was performed. Unfortunately, the patient continued to require multiple daily blood products and his condition continued to decline despite two reoperations. His family chose to discontinue ECMO and he passed away peacefully. Spontaneous splenic rupture after GM-CSF has never been reported in patients on VV-ECMO. This manuscript reviews the literature regarding the pathophysiology and clinical manifestation of this rare occurrence.

The incidence of bacterial infections is high in patients with liver cirrhosis (LC) due to compromised immune systems. They are associated with acute hepatic decompensation, multiorgan dysfunction, high morbidity, and mortality and account for 25-46% of all hospitalizations. The mortality rate is about 30% after one month and increases to 63% at one-year follow-up. While spontaneous bacterial peritonitis (SBP), urinary tract infections, soft tissue infections, and respiratory tract infections (pneumonia) are some of the common infections, SBP accounts for 25-31% of the cases and is the most frequent bacterial infection. Impaired activity of the phagocytes of the reticuloendothelial system, decreased production of the complement, and bacteria gaining access into the systemic circulation through the porto-systemic shunts are some of the causes of high-risk bacterial infection in patients with LC. The diagnosis of bacterial infection may be challenging as the typical symptoms like fever may not always be evident. We present a very challenging, middle-aged patient of cirrhosis with diabetes mellitus (DM) who presented with infections at multiple sites like SBP due to Serratia ficaria, multiple pyemic liver abscesses, left peri-nephric abscess with septicaemia, further complicated by portal vein thrombosis - all during single hospital admission. SBP was unique in the sense that no case of SBP due to Serratia ficaria has been published in the literature to date. The stormy clinical course, management, and outcome of the patient are described here.

Spontaneous pneumothorax usually presents as a medical emergency and requires prompt attention and treatment. In patients with underlying lung diseases, it is often associated with prolonged hospitalization, persistent air leak and also a high rate of recurrence. It brings considerable clinical burden to patients and therefore advancement of spontaneous pneumothorax management is eagerly anticipated. In recent years, conservative approach with avoidance of invasive treatment has risen to be a main consideration for primary spontaneous pneumothorax (PSP) patients who are clinically stable with minimal symptoms. The body of evidence in secondary spontaneous pneumothorax (SSP) group is less robust compared with that in PSP group. Non-surgical treatment in SSP is becoming more common due to concerns about morbidity and mortality after surgical pleurodesis as patients are usually older with more underlying medical diseases. Until last year, there have been no updates on the international recommendation of pneumothorax management since the British Thoracic Society (BTS) guideline published in 2010. The latest 2023 BTS guideline on pleural diseases provides us a good opportunity to review the latest development and literature of the care for patients with spontaneous pneumothorax. This article will explore the goals of pneumothorax treatment including air evacuation, cessation of persistent air leak and prevention of recurrence.

The quadriceps tendon, crucial for body movement, is among the body\'s strongest tendons. Factors like diabetes or hormone use can weaken it, making even minor trauma potentially causing rupture. Bilateral spontaneous quadriceps tendon rupture, where both tendons tear simultaneously, is rare. Prompt diagnosis and treatment are crucial. We present a case of a 44-year-old woman who experienced bilateral rupture after falling while doing chores. She had immediate pain and limited knee movement. Diagnosis via physical examination and CT/MRI scans confirmed the rupture. Surgical repair followed by rehabilitation led to significant pain reduction and improved function within two months. Overall, her postoperative outcome was satisfactory. This study underscores the importance of clear diagnosis, timely surgery, and thorough rehabilitation for optimal patient recovery from bilateral quadriceps tendon rupture.