Complete genome sequencing of Naegleria gruberi has revealed that the organism encodes polypeptides similar to photoactivated adenylyl cyclases (PACs). Screening in the N. australiensis genome showed that the organism also encodes polypeptides similar to PACs. Each of the Naegleria proteins consists of a "sensors of blue-light using FAD" domain (BLUF domain) and an adenylyl cyclase domain (AC domain). PAC activity of the Naegleria proteins was assayed by comparing sensitivities of Escherichia coli cells heterologously expressing the proteins to antibiotics in a dark condition and a blue light-irradiated condition. Antibiotics used in the assays were fosfomycin and fosmidomycin. E. coli cells expressing the Naegleria proteins showed increased fosfomycin sensitivity and fosmidomycin sensitivity when incubated under blue light, indicating that the proteins functioned as PACs in the bacterial cells. Analysis of the N. fowleri genome revealed that the organism encodes a protein bearing an amino acid sequence similar to that of BLUF. A plasmid expressing a chimeric protein consisting of the BLUF-like sequence found in N. fowleri and the adenylyl cyclase domain of N. gruberi PAC was constructed to determine whether the BLUF-like sequence functioned as a sensor of blue light. E. coli cells expressing a chimeric protein showed increased fosfomycin sensitivity and fosmidomycin sensitivity when incubated under blue light. These experimental results indicated that the sequence similar to the BLUF domain found in N. fowleri functioned as a sensor of blue light.
Levonorgestrel-intrauterine system (LNG-IUS) is mainly used for contraception. Recently, several studies reported cases in which an LNG-IUS partially perforated the uterine myometrium and migrated into the abdominal cavity. However, there have been no reports describing LNG-IUS migration from the myometrium into the abdominal cavity within a short period. Herein, we reported a laparoscopic removal of an LNG-IUS that migrated into the abdominal cavity within a short period.Case: A 30-year-old woman (gravida, 3; para, 3) visited a clinic for LNG-IUS insertion for the purpose of contraception and improvement of dysmenorrhea at seven months postpartum. After five years, the doctor was unable to remove the LNG-IUS, and the patient was referred to our hospital. We attempted LNG-IUS removal under venous anesthesia, but it was unsuccessful. Ultrasound images showed LNG-IUS with partial myometrial perforation. We performed magnetic resonance imaging (MRI) after a 1-h procedure, and partial perforation was diagnosed. Two weeks later, we re-evaluated the MRI images because an abdominal computed tomography showed complete perforation. Upon the re-evaluation, we found that the previous MRI images actually showed complete perforation into the abdominal cavity. We thought that pulling the tail of the LNG-IUS in a state of partial perforation could lead to complete perforation due to uterine contraction. Under general anesthesia, the position of the LNG-IUS was determined on an abdominal X-ray. However, we successfully removed the LNG-IUS via laparoscopy.
Conclusion:Pulling the tail of an LNG-IUS in a state of partial perforation could lead to complete migration into the abdominal cavity. Abdominal X-ray tomography after induction of anesthesia was useful for determining the LNG-IUS location and facilitating its removal, laparoscopically.
Ovarian torsion is frequently found in benign cases of non-adhered ovarian tumors. When only a simple cyst without surface nodules is detected by preoperative ovarian imaging, we tend to classify the tumor as benign. We herein report a case of a simple ovarian cyst that presented as ovarian torsion and was found to be a high-grade serous carcinoma by laparoscopic adnexectomy in a postmenopausal woman.Case: A 74-year-old woman (postmenopausal age: 55 years, gravida 1 para 1) was referred to our hospital because of a right ovarian tumor detected by abdominal computed tomography. Magnetic resonance imaging showed a 12-cm simple cyst, and no findings suggestive of malignancy, such as a nodule on the tumor surface, were detected. The levels of tumor markers were as follows: CA 125, 19 U/ml and CA19-9, 9.9 U/ml. A right ovarian laparoscopic adnexectomy was performed because the tumor was considered benign. Laparoscopic findings showed that the tumor was twisted twice around the ovary ligament and no adhesion or peritoneal dissemination to the surrounding organs were evidenced.Pathological examination revealed a high-grade serous carcinoma of the ovary. At a later date, we performed staging laparotomy and no carcinoma cells were found in the organs. Therefore, we classified the ovarian cancer as stage IA according to the International Federation of Gynecology and Obstetrics.
Conclusion:We reported a case of a simple ovarian tumor presenting as ovarian torsion detected as a carcinoma by laparoscopic adnexectomy in a postmenopausal woman. Ovarian torsion occurrence should be considered a risk factor for postoperative ovarian carcinoma.
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