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Keywords: a case history, gynecology, a cyst, an ovary, commissures, a sterility, a dermoid cyst of the left ovary, a sterility
the CASE HISTORY
the Clinical diagnosis: a dermoid cyst of the left ovary, adhesive process in small to a basin, a sterility, an obesity of the second degree. A chronic cholecystitis, a chronic bronchitis.
NAMEPLATE DATA
- the Surname, a name, a patronymic of the patient - ****************************.
- Age - 27 flying (date of a birth: on January, 2 1976 years).
- the Address, phone - ************************************************.
- the Trade - the individual businessman.
- the Clinical diagnosis - a dermoid cyst of the left ovary, adhesive process in small to a basin, a sterility.
- Date of entering: on September, 25 2003 years.
- Date of a curatio: on September, 29 2003 years.
COMPLAINTS OF THE PATIENT
Complaints at entering in clinic - on an irregular menses, an increase in weight of 25 kg for last year, impossibility to become pregnant at regular sexual life.
Complaints at date of a curatio - on a pain in range of a postoperative wound, on an irregular menses, an increase in weight of +25 kg during last year, impossibility to become pregnant at regular sexual life and absence of contraception.
MENSTRUAL FUNCTION
A menses about 13 flying, were established in 2 years. Now irregular (fluctuations yo 2 weeks are possible), for 5-7 days in 35-40 days. Not abundant, spreading. Sometimes in 2 weeks after a menses there are not abundant spreading abjections within 2-3 days.
Last menses - 12.09.03.
THE ANAMNESIS OF DISEASE
Sexual life about 15 flying. To contraception did not resort. Has transferred a gonorrhea. Is married about 18 flying. At the first husband - a sterility. In 25 flying - second marriage. Now sexual life regular, brings satisfaction. Any methods of contraception do not use.
Counts itself the patient about 18 flying when after the transferred gonorrhea the inflammation of appendages has developed. At an appendectomia the right-hand salpingectomy is effected. About 20 flying has paid attention that cannot become pregnant at regular sexual life at absence of contraception.
The patient marks appreciable fluctuations of mass of a body. For last year has recovered on 25 kg. Binds it to the nutritional factor.
The patient has acted in a hospital for specification of the diagnosis and erasion of the oothecoma revealed on ultrasonic research.
THE ANAMNESIS OF LIFE
Was born from 1-st pregnancy (mothers was 20 flying). Pregnancy proceeded without a pathology. Labors proceeded without complications.
Further educed in conformity with the years. Prophylactic inoculations - in time, were tolerated without complications. The allergological anamnesis is not burdened. Intolerances of medicinal preparations are not present.
In the childhood frequently was sick, has transferred an angina, ORVI, a grippe, a pneumonia, a scarlatina, an epidemic parotitis.
From operations - an appendectomia, a right-hand salpingectomy.
Chronic diseases - a chronic bronchitis, a chronic cholecystitis, a pathology of a thyroid gland (particularly does not know).
Hemotransfusions, plasma, introductions of an immunoglobulin were not.
Domestic and sanitary-and-hygienic conditions - satisfactory. Presence in a stem of a tuberculosis, venereal, mental, endocrine and manifestative hereditary diseases is denied. Abortions, mertvorozhdennosti, frailty of children, congenital teratisms was not.
OBJECTIVE RESEARCH
the General conditionsatisfactory.
Nervous system.the Consciousness clear, on environmental reacts adequately. Belly reflexes alive, patellar and ahillov reflexes are invoked easily, moderately expressed. Meningialnyh (the stiff neck, a Kernig's sign, top and inferior signs Brudzinskogo) is not present signs. Signs of a tension of nerve cords (signs Lassega, Matskevich, Vassermana) are not present.
Physical development.Mass of a body - 90 kg, length of a body - 165 sm, an index of mass of a body=33.
the Skinusual colour, moderately wet, is coated with a pappus hair, is elastic. Cicatrixes, an eruption, hemorrhages, plots of a pigmentation and a depigmentation it is not observed. A hair, dactyls, nails. A hair shining. Trailer phalanxes of dactyls and nails of the usual form. A subcutaneously - fatty tissue. The patient of a supernutrition, the subcutaneously - fatty layer is well advanced, distributed in regular intervals. Depth of a subcutaneously - fatty tissue in an angle of a scapula 5 see. Edemas and are not present a pastosion.
Lymph nodes.individual cervical, occipital axillary, inguinal lymph nodes in size with a small pea not coherent among themselves and with subject tissues, moderately dense Are palpated. In submandibular range at the left it is palpated single enlarged (1 sm) a lymph node, moderately dense, not coherent with subject and integumentary tissues.
Musclesare well advanced, a tonus normal, at a palpation and at awake and passive locomotions are painless. Force of muscles is sufficient.
Osteal system.the Form of a head usual. Deformations of bones, morbidity at pressing, a beating it is not taped. The backbone is not curled. A chest of the usual form; deformations, asymmetries, are not present tortuosities.
System of a respiratory organs.the Chest is symmetric, is not deformed. Frequency of respiratory locomotions - 18-20 in one minute. Respiration deep, rhythmical. At a relative percussion in symmetric plots the clear pulmonary note above all fields is marked, focal changes of a percussion note it is not marked. Borders mild correspond to norm. At an auscultation - respiration vesicular above all pulmonary fields.
System of a circulation.Pulse symmetric, average filling, 92 impacts in one minute. The pulsation of peripheric arterias is palpated. Arterial pressure - 120/80 mm Hg on both arms. A Crocq's disease it is not marked. The chest in range of heart - is not changed, the apical beat is determined in the fifth intercostal space, on 2 sm inside from a mammilar line. Borders of relative and absolute dullness of heart correspond to age norm. At an auscultation - cardiac sounds clear, rhythmical. Hums, scission of tints it is not revealed.
System of digestion and organs of an abdominal cavity.Labiums of pink colour, moderately wet, a mucosa of an oral cavity and a gingiva of pink colour, wet; hemorrhages, aphthas, ulcers, it is not marked. Tongue of pink colour, wet, is marked a moderate hypertrophy of papillas.
the Bellysymmetric, enlarged, participates in the act of respiration; diverticulums, retractions it is not observed. A seen peristalsis of an intestine it is not observed. Vienna a forward wall of a belly are not amplate. At a palpation moderate morbidity in hypogastriums is marked, the prelum abdominale is advanced moderately, the divarication of recti is absent, the umbilical ring is not enlarged, the sign of a fluctuation is absent. Signs SHCHetkina-Bljumberga and Mendel negative.
The inferior edgea liverpainless, mild, elastic, smooth, acts on 1 sm from under a rib arch. Signs Georgievskogo-Mjussi, Ortnera-Grekova, Murphy - negative.
Genitourinary organs.Diverticulums above a pubis and in range of kidneys it is not determined. A sign of a beating on lumbar range negative. An emiction painlessly.
GYNECOLOGIC RESEARCH
Outside sexual organs are advanced correctly. Fauces nerozhavshej. The vagina is free. The cervical canal is closed. A uteral cervix cylindrical. A uterus of the normal dimensions, dense, circumscribed mobile.
The left and dextral appendages: precisely are not palpated because of depth of a forward abdominal wall.
ADDITIONAL METHODS OF RESEARCH
the Biochemical analysis of a blood (17.09):
the Glucose 4,9 mmole/l
AlAT 225 nmole/l
AsAT 39 nmole/l
the Bilirubin the general 11 mkmole/l
the Urea 5,5 mmole/l
the Creatinine 0,079
Protein 69 g/l
Trombinovyj an index 97
Fibrinogenum 3,5 g/l
the Electrocardiography:a sinus arrhythmia, a horizontal position of an electrical axis of heart, local infringement of intraventricular conduction.
THE COURSE OF OPERATION
the Premedication (intramuscularly):
Sol. Promedoli 2 % - 1,0 ml
Sol. Atropini 0,1 % - 1,0 ml
Sol. Dimedroli 1 % - 1,0 ml
Operation:
The laparotomy, an adhesiotomy, erasion of a dermoid cyst of the left ovary, a left-hand salpingostomy is effected. A drainage of an abdominal cavity.
The body of the womb of the normal dimensions and forms, a dextral uterine tube is absent, an ovary on the right with a flattened capsule, the left appendages is submitted by a dermoid cyst 5´6 sm, coherent with a hydrosalpinx 3-´ 8 see. The cyst is removed, a box ushito. The salpingostomy, a toilet, a drainage is effected.
THE CLINICAL DIAGNOSIS AND HIS SUBSTANTIATION
A dermoid cyst of the left ovary, adhesive process in small to a basin, a sterility, an obesity of 2 degrees. A chronic cholecystitis, a chronic bronchitis.
The diagnosis a dermoid oothecoma is put on the establishment of morphological and histological research of the material taken during carrying out of operation. Adhesive process is found during operation. Probably, it is connected to the transferred gonorrhea. It partly proves to be true complaints of the patient before operation on an irregularity of a menstrual cycle.
The diagnosis a sterility is put on the establishment of complaints of the patient on impossibility to become pregnant during several a flying at regular sexual life without contraception, on the establishment of revealing of adhesive process in small to a basin, on the establishment of absence of a dextral uterine tube as a result of a right-hand salpingectomy.
The diagnosis an obesity of 2 degrees is put on the establishment of disharmony of body height (165 sm) and weight (90 sm) to the patient, on the establishment of the big seen uniform adipopexis in range of a belly, extremities. An index of mass of a body=33, that is typical of 2 degrees of an obesity.
A chronic cholecystitis, a chronic bronchitis - on the establishment of the indicating on these diseases in an anamnesis.
THE DIFFERENTIAL DIAGNOSIS
The dermoid oothecoma is differentiated with a cancer of an ovary on the establishment of that the cancer of an ovary is observed more often at women of advanced age (more than 50 flying), is accompanied intoksikatsionnym by a set of symptoms, distresses of a stool and an emiction. The dermoid cyst and a cancer are differentiated as a result of cytologic research.
The dermoid oothecoma is differentiated with serous cystomas on the establishment of cytologic research.
The sterility of a tubal genesis is differentiated with an endocrine sterility owing to presence of adhesive process in small to a basin, absence of a dextral uterine tube and a dermoid cyst of the left ovary.
THE ETIOLOGY AND THE PATHOGENY
At the given patient with the major etiological factors resulted in a sterility are adhesive process of a specific genesis (as consequence of the transferred gonorrhea), that has resulted in a right-hand salpingectomy, presence of a dermoid cyst of the left ovary, spajannoj with a hydrosalpinx. Thus, the sterility at the given patient is caused by impossibility of ripening of an ootid in the left ovary and absence of a dextral uterine tube.
The obesity at the given patient can be connected to the nutritional factor, with an inactive mode of life, with a pathology of a thyroid gland (research is necessary: ultrasonic, Ò3, Ò4, TTG).
TREATMENT
At dermoid cysts surgical treatment is recommended.
The operative measure is effected: a laparotomy, an adhesiotomy, erasion of a dermoid cyst of the left ovary, a left-hand salpingostomy, a drainage of an abdominal cavity. In the postoperative season antibacterial therapy is appointed.
DIARIES
Date:30.09.2003 Condition of the patient satisfactory. Complains of pains in range of a postoperative wound. A belly mild, moderately morbid at a palpation in hypogastriums. Gaza departed. A diuresis in norm. Abjections sanious. Slept well.
T=36,4°C
×Ä=18 in 1 mines
×ÑÑ=92 in 1 mines
Date:1.10.2003 A condition of the patient satisfactory. Slept well. A belly mild, painless. A diuresis in norm.
T=36,8°C
×Ä=16 in 1 mines
×ÑÑ=74 in 1 mines
THE FORECAST
For life - congenial. For a working capacity - congenial. For detorozhdenija - doubtful.
THE EPICRISIS
****************************, 27 flying has acted in a gynecology department with complaints to an irregular menses, an increase in weight of 25 kg for last year, impossibility to become pregnant at regular sexual life. On the establishment of the complaints, given an anamnesis, objective research the diagnosis is put: the Dermoid cyst of the left ovary, adhesive process in small to a basin, a sterility, an obesity of 2 degrees. A chronic cholecystitis, a chronic bronchitis. Operation is effected: a laparotomy, an adhesiotomy, erasion of a dermoid cyst of the left ovary, a left-hand salpingostomy, a drainage of an abdominal cavity. In the postoperative season antibacterial therapy is appointed.
THE LITERATURE
- Gynecology/under L.N.Vasilevskoj.-'s edition of M.: Medicine, 1985.-432 with., an ooze.
- the Register of medical products of Russia. The RLS-ENCYCLOPEDIA of medicines. - 9 edition advanced and added/Ãë. red. J.F.Krylov.-of M.: ÐËÑ-2002.-1504 with.
- the Nosography. Diagnosis and therapy. Ò.1.: Translation with English/under red. R.Berkou, E.Fletchera.-of M.: the World, 1997. xxxiv + 1045 with.
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Keywords: a case history, gynecology, a cyst, an ovary, commissures, a sterility, a dermoid cyst of the left ovary, a sterility
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