Intravascular papillary endothelial hyperplasia (IPEH) or Masson’s tumour is a benign vascular proliferation that mimics other malignant vascular tumour. To date, this is the fourth case of Masson’s tumour at urethra being reported in the literature. A 65-year-old female Para 2, presented with post-menopausal bleeding. Examination revealed a 4x3x3 cm growth surrounding the urethral meatus. She underwent examination under anaesthesia and excision of the periurethral mass. Histopathological examination confirmed Masson’s tumour. Diagnosis and management of this uncommon tumour at a rare location was discuss. angiosarcoma; endothelial hyperplasia; Masson’s tumour; urethral neoplasm; vascular neoplasm

Adenomyotic cyst is a rare variant of adenomyosis. It is believed to arise from repeated focal haemorrhages resulting in cystic spaces filled with altered blood products. We present a rare case of a huge adenomyotic cyst in a 27-yearold primigravida, who was in her first trimester, complaining of sudden lower abdominal pain. Diagnostic laparoscopy performed to rule out other cause of acute abdomen. Her pregnancy went on smoothly. She delivered a baby girl of 2.82 kg via vaginal delivery at 39 weeks. Diagnosis and management of this rare clinical entity were reviewed and discussed.
Cysts ; Pregnancy

Primary malignant melanoma of the vagina is rare but aggressive. Various treatment options include surgery and adjuvant therapy has been advocated but the outcome remained unpredictable. Standard treatment protocol is yet to be established. We report a case of 54-year-old, Para 4+1, with malignant melanoma of the vagina. She underwent wide local excision but the surgical margin was not clear of malignant cells, hence adjuvant radiotherapy was given. Combination chemotherapy was initiated subsequently as her disease disseminated. She succumbed later due to septicaemic shock. The treatment options for vaginal melanoma were reviewed.

We report a case of dislodged Levornogestrel-intrauterine system (LNG-IUS, Mirena®) without evidence of uterine perforation. A 37-year-old Para 4+1presented with 3 months history of lower abdominal pain. Examination and imaging showed that the device was not present in the uterine cavity. She underwent laparoscopic retrieval of Mirena®. There was no evidence of uterine perforation intra-operatively. This case illustrated the rare possibility of dislodged Mirena®intra-abdominally without evidence of uterine perforation. The management for missing IUS was reviewed.
Levonorgestrel

Congenital peritoneal band is an extremely rare condition, but may induce small bowel obstruction (SBO) at any age, predominantly in childhood and rarely in adults. We report a case of extensive bowel ischaemia following caesarean section, due to trapping of an intestinal loop between a congenital peritoneal band and the mesentery. A 42-year-old, Gravida 2 Para 1, who has no history of prior abdominal surgery or trauma, presented in spontaneous labour and underwent an uncomplicated emergency lower segment caesarean section, for fetal distress. Postoperatively, she had worsening abdominal distension and pain, followed by vomiting. Computed Tomography Scan of the abdomen showed gross fluid retention with marked small bowel dilatation and fluid filled bowel loops. An emergency exploratory laparotomy was performed which revealed a congenital band, extending between the right fimbrial end and the small bowel mesentery, looping over the small bowel, causing extensive small bowel ischemia. Postoperative course was uneventful. In conclusion, congenital peritoneal band causing small bowel obstruction, although rare, should be considered in the differential, especially for patients with virgin abdomen.

Adult ; Age Factors ; Burnout, Professional ; epidemiology ; Female ; Health Status ; Humans ; Male ; Marital Status ; Mental Health ; Occupational Health ; Orthopedic Surgeons ; statistics & numerical data ; Pain ; epidemiology ; Personnel Staffing and Scheduling ; Sex Factors ; Singapore ; epidemiology ; Social Behavior ; Stress, Psychological ; epidemiology ; Surveys and Questionnaires ; Work Schedule Tolerance

Miscarriage is one of the most common complications in pregnancy. There is emerging evidence that psychological impact following miscarriage is not unusual. Understanding the magnitude of psychological morbidity is important in the management of miscarriage. The main objective of this study was to compare the mean Hospital Anxiety and Depression Scale (HADS) score between women with miscarriage and women with successful pregnancy and to determine the socio-demographic factor and clinical characteristic that are associated with anxiety and depression. A descriptive case control study was conducted in a teaching hospital, over a period of 12-months (from October 2014 till September 2015). A total of 65 women were recruited with 32 women as the study group (miscarriage) and another 33 women as the control group (women with successful pregnancy). Mean HADS-anxiety score was higher in the study group compared to control group although it was not statistically significant (6.53 ± 3.427 vs 5.73 ± 2.875, p=0.309). Mean HADS-depression score was higher in the control group (4.34 ±2.695 vs 4.45 ± 3.073, p=0.878). Women with maternal age more than 35 years and history of previous miscarriage had a higher tendency of anxiety and depression with higher mean HADS score. There was no association between other socio-demographic data and clinical characteristic with risk of anxiety and depression. As conclusion, there was no significant difference in women with miscarriage as compared to those with successful pregnancies, although older women with history of miscarriage had a preponderance to both disord

Administration of additional 'rescue' hCG immediately after IUI appeared to intensify considerably the pregnancy rate in IUI cycles. With a strong confirmatory result, it might eventually lead to avoidance of expensive artificial reproductive techniques i.e. IVF or ICSI in selected couples undergoing infertility treatment. 'Rescue' hCG post-IUI in couple with repeated failed conventional IUI may be recommended as it appeared to be safe with minimal detrimental effect.