​(Fig.1).1). Although noted many years ago (12), the presence of autophagy has largely been ignored. It’s actually surprising that autophagy was not directly linked to

the pathogenesis of the disease. After all, the lysosome is the endpoint for both the endocytic selleck products pathway – the route of the recombinant enzyme to the lysosome, and the autophagic pathway. Figure 1 Electron microscopy Inhibitors,research,lifescience,medical of type I and type II fibers from a 9 month-old knockout mouse showing the presence of autophagic buildup in type II fiber. Autophagy is an evolutionarily conserved pathway of lysosomal degradation and recycling of long-lived proteins and damaged organelles (13), which maintains intracellular balance between biosynthetic and catabolic processes and is a critical survival mechanism under conditions of nutrient deprivation. Autophagy involves the formation of a double-membrane vesicle, which engulfs part of the cytoplasm and damaged organelles and then fuses with a lysosome where the content of the vesicle is degraded.

These double-membrane vesicles, known as Inhibitors,research,lifescience,medical autophagosomes, can be detected by staining with a highly specific marker, LC3 Inhibitors,research,lifescience,medical (14). Under normal conditions of productive autophagy, autophagosomes are quickly degraded by the lysosomes, and LC3-positive structures are barely detectable. To study the geographic distribution of the autophagic structures seen by electron microscopy in knockout fibers, we isolated single

muscle fibers, and stained them with LC3 as well as with lysosomal membrane protein LAMP1, which stains both late endosomes and lysosomes. Strikingly, the autophagic areas were huge, extending almost the full length of the fiber, and were often located in the center Inhibitors,research,lifescience,medical of the fiber. Once recognized, the autophagic areas could be clearly seen in fixed or live fibers without any staining by low resolution transmitted light microscopy (Fig. ​(Fig.2).2). In some fibers, the volume occupied Inhibitors,research,lifescience,medical by the autophagic buildup reached 40% of the total volume of the fiber (15). Figure 2 Autophagic area could be observed in type II fibers by low resolution transmitted light microscopy. Live cultured myofibers from predominantly type II gastrocnemius (pale) muscle of 2.5 month-old WT and KO mice. Confocal microscopy of immunostained KO single muscle fibers has revealed the presence of multiple Vasopressin Receptor LC3-positive autophagosomes, LAMP1-positive late endosomes and lysosomes, as well as LC3/LAMP1 double-positive structures. The abundance of LC3-positive and LC3/LAMP1 double-positive structures indicates the failure of the lysosomes to fuse with and degrade the content of autophagosomes. Excessive clustering of the vesicles of the autophagic and endocytic pathway, as well as the accumulation of intralysosomal and extralysosomal undigested material, have profound effects on muscle architecture (11, 15).

A randomized, wait-list controlled pilot trial has shown efficacy of HIRREM for relieving symptoms of insomnia (Tegeler et al. 2012), and a placebo-controlled trial testing efficacy for migraine has been completed. Changes in

temporal lobe EEG asymmetry associated with use of HIRREM as an intervention for insomnia We present changes in temporal lobe asymmetry for 19 subjects enrolled in a randomized, wait-list, Inhibitors,research,lifescience,medical controlled pilot trial of HIRREM as an intervention for insomnia. Methods and main clinical outcomes for this study have been reported elsewhere (Tegeler et al. 2012). Mean age of subjects was 45 (70% women), and at baseline, mean score on the Insomnia Severity Index (Bastien et al. 2001) was 18.8, indicating, on average, clinical insomnia of moderate severity. Subjects also reported Inhibitors,research,lifescience,medical Kinase Inhibitor Library clinical trial substantial depressive symptomatology (average CES-D score 14.9). All subjects underwent an average of nine (range 8–13) HIRREM sessions, beginning either immediately after enrollment into the study or after Inhibitors,research,lifescience,medical a waiting period (usual care) of 6 weeks. At the primary endpoint, subjects undergoing HIRREM reported a reduction of 10.3 points in the ISI, while those undergoing usual care reported no change. Though HIRREM exercises were conducted at the temporal,

occipital, parietal, central, and frontal lobes, and anterior and posterior midline, temporal lobes were chosen for the present analysis

on an a priori basis, because of the proximity of the insula and limbic structures related to autonomic functioning (see High-resolution spectral analysis of electroencephalic Inhibitors,research,lifescience,medical data and dynamic, iterative engagement of dominant frequencies). Data for calculation of asymmetry scores were derived from the HIRREM exercise conducted at the bilateral temporal lobes, for each subject and for each session. For those sessions in which two exercises were conducted at the temporal lobes, the first Inhibitors,research,lifescience,medical exercise was used for calculation aminophylline of the asymmetry score. Asymmetry scores were calculated based on the log of the average spectral power (23–36 Hz) at T4 over the course of the 8-min HIRREM exercise, minus log of the average spectral power (23–36 Hz) at T3. The high frequency (23-36 Hz) range of the EEG was chosen for the present analysis because of evidence of high-frequency arousal as being contributory to insomnia (Perlis et al. 2001; Wolynczyk-Gmaj and Szelenberger 2011). Figure 4 shows the average asymmetry score for T3 in comparison with T4, for all 19 subjects over the course of their HIRREM sessions. Rightward asymmetry (T4 > T3) diminished over the course of six HIRREM sessions, followed by a shift to average leftward asymmetry (T3 > T4) for session 7, and a return to rightward asymmetry for session 8.

2007; Valente et al. 2007). Additionally, Drosophila do not have extended antennae or vibrissae that maintain contact with the wall during movement. However, Drosophila will walk on the vertical arena boundaries in addition to the floor and ceiling of the arena. Centrophobicity was previously questioned as a driving force for wall-following buy VX-689 behavior since blind flies, incapable of seeing the arena center, also Inhibitors,research,lifescience,medical significantly prefer edge zones over central locations (Besson and Martin 2005; Liu et al. 2007). The behavior of flies in the parallelogram arenas and the alcove arena is also inconsistent with a strong centrophobic drive in the strict sense of this

term. Wild-type flies demonstrate equal preference for 30° corners and 150° corners, even

though the former is much further from the center and more confined space than the latter. Additionally, the flies did not significantly prefer the alcove, the farthest point from the center, during the initial exploration phase in the alcove arena. Inhibitors,research,lifescience,medical The strong alcove preference emerged after the specific exploration phase. During exploration of the arena containing an alcove, the flies still display strong wall-following behavior, indicating wall-following and centrophobicity are separable. Shelter-seeking behavior There was considerable preference for opaque internal corners over clear walls and for the dark alcove over clear Inhibitors,research,lifescience,medical circular boundaries. The absence of preference for a darkened wall section lacking a corner and the waning preferences for clear corners indicate that the predilection is for an emergent quality of the orthogonal darkened Inhibitors,research,lifescience,medical walls. Rats avoid bright light in an open-field arena and the plus maze, Inhibitors,research,lifescience,medical presumably because bright light increases the chances of being spotted by predators (Ennaceur et al. 2006). We suggest the most parsimonious explanation is that these

darkened corners represent shelter. However, this preference for dark corners was evident only when the specific exploration of the boundary waned. In rodents, anxiety induced by novelty is suggested as one of the main driving component of exploratory behavior (Simon et al. 1994; Treit and Fundytus 1988). The need to abrogate novelty with specific before exploration can supersede other needs such as hunger, thirst, or even predator avoidance (Hinde 1954; Chance and Mead 1955; Zimbardo and Montgomery 1957). The delayed expression of shelter-seeking behavior in Drosophila indicates that the shelter provided by the darkened corners does not satisfy the need to explore. Low turn angles are not responsible for arena edge preference Creed and Miller differentiated between active wall-following behavior, a positive drive toward the wall, and passive wall-following behavior resulting from dominant movement patterns independent of motivation (Creed and Miller 1990).

The sample size of some subgroups was small, mainly patients with ≥ T1b tumors and lymph node involvement. One explanation of the low prevalence of these two conditions in our cohort is that we only enrolled patients with superficial neoplasia; the patients who are more likely to have advanced disease with obvious masses were excluded. Conclusions Most patients

referred for consideration of endoscopic or surgical treatment of early BE neoplasia have unremarkable findings on EUS exam. The assessment of the invasion depth of early Barrett’s neoplasia based only in the EUS findings, leads to an overstaging Inhibitors,research,lifescience,medical in most of patients with a false Saracatinib research buy positive rate for diagnosis of submucosal invasion up to 84%. Given the high false positives rate for submucosal invasion and Inhibitors,research,lifescience,medical most of patients with suspicion of invasive disease according to the EUS findings had lesions limited to the mucosa, EUS has limited value in the pre-therapeutic

algorithm of patients with early Barrett’s neoplasia and has negligible impact in making decisions for therapy. EUS in the pre-therapeutic evaluation of early Barrett’s neoplasia does continue to have a role to rule out the presence of lymph node metastasis Inhibitors,research,lifescience,medical in cases with known cancer or suspected advanced pathology in settings of visible lesions. Acknowledgements This work was partially supported by a grant from the Consejería de Salud y Servicios Inhibitors,research,lifescience,medical Sanitarios of the Principality of Asturias (Asturias, Spain). Disclosure: The authors declare no conflict of interest.
Pancreatic cancer remains a highly lethal malignancy despite advances in treatment. In 2009 there were 42,470 new cases of pancreatic cancer and 35,240 deaths from the disease (1). At initial diagnosis, 50% of patients present with metastatic disease, 30% present with a locally advanced tumor, and only 20% Inhibitors,research,lifescience,medical are resectable. Surgical resection remains the only potentially curative therapy. The large number of recurrences and/or distant failures following resection suggest that microscopic metastases continue to be an obstacle to better outcomes.

Patterns of spread include direct extension, lymphatic spread to regional lymph nodes, and hematogenous Idoxuridine spread to distant sites. For all stages, the 1- and 5-year survival rates are 25% and 6%, respectively. Even for patients diagnosed with localized disease, the 5-year survival rate is only 22% (2). Treatment of locally advanced unresectable pancreatic cancer (LAPC) has evolved to consist of chemotherapy alone or in combination with radiation, in hopes of achieving better survival. Although the reported benefits of chemoradiation (CRT) are controversial, it remains a management option for patients with LAPC. The survival advantage to a chemoradiation approach has not been consistently demonstrated (3) and there are few randomized phase III studies evaluating the role of combined modality therapy in recent years (4-10).

Statistical Manual of Mental Disorders, 3rd edition (DSM-IIT) in order to capture the psychopathology associated with traumatization in adults. Over the years, numerous studies have GDC-0994 concentration demonstrated that the diagnostic construct of PTSD is clinically relevant to individuals who have suffered single incident traumas such as rape, physical assaults, torture, and motor vehicle accidents. However, it has also become clear that in clinical settings most treatment-seeking patients have been exposed to a range of different traumatic events over their life span, and suffer from a variety of psychological problems, only some of

which are covered in the definition of PTSD. These include affect dysregulation, Inhibitors,research,lifescience,medical aggression against self and others, amnesia and dissociation, somatization, depression, distrust, shame, and self-hatred. These other problems can either be conceptualized as comorbid conditions, or as part of a spectrum of trauma-related problems, that occur depending on the age at which the trauma Inhibitors,research,lifescience,medical occurred, the

relationship to the agent responsible for the trauma, social support received, and the duration of the traumatic experience(s). The diagnosis of PTSD is characterized by three major elements: The repeated reliving of memories of the traumatic experience. These tend to involve intense sensory and visual Inhibitors,research,lifescience,medical memories of the event, which are often accompanied by extreme physiological and psychological distress, and sometimes by a feeling of emotional numbing, during which there usually is no physiological arousal. These intrusive memories may Inhibitors,research,lifescience,medical occur spontaneously or can be triggered by a range of real and symbolic stimuli. Avoidance of reminders of the trauma, as well as of emotional numbing, detachment, and emotional blunting, often coexist with intrusive recollections.

This is associated with an inability to experience joy and pleasure, and with a general withdrawal from engagement with life. Over time, these features may become the dominant Inhibitors,research,lifescience,medical symptoms of PTSD. A pattern of increased arousal is the third element of PTSD. This is expressed by hypervigilance, irritability, memory and concentration problems, PDK4 sleep disturbances, and an exaggerated startle response. In the more chronic forms of the disorder, this pattern of hyperarousal and the avoidance may be the dominant clinical features. Hyperarousal causes traumatized people to become easily distressed by unexpected stimuli. Their tendency to be triggered into reliving traumatic memories illustrates how their perceptions become excessively focused on the involuntary seeking out of the similarities between the present and their traumatic past. As a consequence, many neutral experiences become reinterpreted as being associated with the traumatic past.

Earnest learning on the one side, ethical behavior on the other side, may lead to full accomplishment;

however, very few are those who are able to reach this goal. It may be remarked that Rambam does not completely set aside full accomplishment in this context. Many human beings have virtually the possibility of becoming intellectually and ethically perfect, although very few achieve such ideal status. TOWARD PERFECTION IN MEDICINE I would like to try and establish a tentative program of accomplished medical practice, according to Maimonides’ Inhibitors,research,lifescience,medical views featured in his medical works. Studying and Memorizing the Most Accurate Medical Works In the Book on Asthma,9 chapter 13, Maimonides quotes an aphorism of Rhazes, in which he stresses how difficult it is to become a skilled physician. To which he adds: The more accomplished one is in that science, the more precise his investigations are, the

more doubts and difficult questions arise in him. He will go into additional Inhibitors,research,lifescience,medical investigations and will hesitate in Inhibitors,research,lifescience,medical some of his answers. Maimonides also remarks that even if understanding theoretical medicine from the literature may seem easy for someone who is in full possession of his faculties, the application of these notions to a practical case is often problematic, even for a trained and BI 6727 solubility dmso conscientious practitioner.10 As stated above, Maimonides described how hard and tiring his days of work were. Once his practicing was over, he

reviewed and checked the difficult cases he had seen during the day, searching the literature that was at his disposal. He thus controlled Inhibitors,research,lifescience,medical his memory and checked himself constantly. This left him only the Sabbath for his theological studies, which were formerly his main field of interest. Discussing Difficult Cases with Colleagues When Maimonides and his family lived in Fes, Morocco, he saw a patient who was “very strong;” however, after having undergone bleeding, the patient weakened and died the next night. Maimonides notes the following11: Inhibitors,research,lifescience,medical “A learned physician under whom I studied asked me: ‘Do you know the nature of the mistake this physician made in bleeding that patient?’” His teacher then explained that the patient was a glutton whose stomach (the cardia) had therefore been weakened. He should have known that Galen had forbidden bleeding in such cases, for it may cause fainting.12 From this story we learn two things: one, that very Maimonides studied medicine in Fes; second, that he discussed practical cases with his teacher—he even quotes in toto the relevant passage from Galen. Both medical experience and remembrance of the adequate literature are thus documented. Further in the same chapter, Maimonides describes another case, treated by four physicians, “all of them trained in this art.” The Sultan was prescribed theriac, but he died soon after ingestion.

51 Glutamate transporter polymorphisms Three independent groups have found that the 3′ region of SCL1A1 may contain a susceptibility allele for OCD, predominantly in male offspring.52-54 The protein product is

the high-affinity neuronal and epithelial transporter (EAAT3, EAAC1) for L-glutamate, L- and D-aspartate, and cysteine.55,56 EAAT3/EAAC1 is found in cortex, basal ganglia, and hippocampus, and has been detected in all parts of the neuron.57 In the adults, glutamate transport helps to keep extracellular glutamate below neurotoxic concentrations.58 EAAT3/EAAC1 exhibits rather low expression and makes a minor contribution to the removal of synaptic glutamate as compared with EAAT1 Inhibitors,research,lifescience,medical and EAAT2.59 During early brain development, it is expressed before astrocytes are functional. This is suggestive that EAAT3/EAAC1 is involved in the developmental role of glutamate.59 A critical role

of EAAT3/EAAC1 in neurodevelopment is consistent with the linkage and Inhibitors,research,lifescience,medical Danusertib supplier association findings supporting SLC1A1 as a primary candidate gene Inhibitors,research,lifescience,medical in not only pediatric OCD,52-54 but also in autistic spectrum disorders.60 Testosterone and prolactin regulate the expression of EAAT3/EAAC1 .56 The increase in expression of EAAT3/EAAC1 by testosterone is consistent with the association of OCD with SLC1A1 being strongest in males.52,53 As for the possible function of the polymorphism, mice deficient in EAAC1 develop impaired self-grooming.55 This suggests that EAAT3/EAAC1 knockouts in pediatric OCD may be associated with increased rather than with decreased EAAT3 expression.

Glutamate receptor polymorphisms In addition to the glutamate transporter, Inhibitors,research,lifescience,medical the 5072T/G variant of NMDA subunit 2B gene (GRIN2B) has been associated with OCD in pediatric patients.61 Specifically, the 5072G-5988T haplotype was associated with OCD. GRIN2B, on chromosome 12p, encodes for the NR2B subunit of the ionotropic glutamate receptor. It is expressed mainly in the striatum and the prefrontal cortex.62 Inhibitors,research,lifescience,medical This consistent with regions demonstrating glutamatergic abnormalities in pediatric OCD patients.42,45 Furthermore, GRIN2B has been linked to schizophrenia,63 attention deficit hyperactivity disorder64 and bipolar disorder.65 During cortical development, GRIN2B is thought Adenosine to play a role in plasticity.66 In addition, neurotoxic levels of glutamate during the neonatal period increase the expression of NMDA NR2B in the striatum and cortex.67 Functionally, the increased expression of GRIN2B in reaction to excess glutamate68 suggests that pediatric OCD is associated with greater GRIN2B expression in the striatum. Most recently, a significant association was identified between the rs1019385 polymorphism of GRIN2B and decreased anterior cingulate cortex Glx but not with occipital Glx in pediatric OCD patients.

Instead, I will argue that principles and ways of thinking learned during the last 150 years since the emergence of the theory of evolution should be utilized in modern medicine. Moreover I will show (below) that not only the principles but, even, the same genetic changes could play a role both in disease and evolutionary

processes. THE DISCIPLINES OF MODERN MEDICINE AND THE CONFUSION WHILE DESIGNING THE TREATMENT FOR COMPLEX DISEASES Modern medicine and biomedical research have emerged during the eighteenth–nineteenth centuries when the #Selleckchem Saracatinib keyword# first vaccines were developed. Specifically the major starting marks are the development of smallpox vaccine by the English eighteenth-century physician Edward A. Jenner and the discovery of antibiotics by the nineteenth-century French scientist Louis Pasteur. During

Inhibitors,research,lifescience,medical that time the current division of medical disciplines was coined, mainly based on human anatomy first described in detail by the sixteenth-century physician and scholar Vessalius. As a result most of the medical departments in hospitals around the globe are currently named after specific Inhibitors,research,lifescience,medical organ systems (such as the department of cardiology) and tissues (such as the dermatology department). Diseases were also classified according to the major affected organ or tissue. However, the increase in human lifespan during the nineteenth and twentieth centuries was accompanied by an elevated frequency of age-related complex disorders, some of which were not readily classified in terms of treatment. For example, diabetic patients are normally treated by internal medicine specialists in endocrinology; but as these patients develop the common diabetic complications, i.e. cardiovascular diseases, Inhibitors,research,lifescience,medical nephropathy, and retinopathy, other specialists have to be involved. In the lack of directed specialty Inhibitors,research,lifescience,medical in the management of complex disorders much of the burden of the follow-up of these patients

usually falls upon the family physician. The only field in which the complexity of the disease is embedded within the medical infrastructure is cancer, the tremendous variability of which is addressed within oncology departments. The major complex disorders, such as Metalloexopeptidase diabetes, hypertension, the various types of cancer, and the cardiovascular family of disorders, are challenging to manage not only because of the slow adaptation of the medical infrastructure to changes. These diseases are caused by multiple changes, some of which are inherited and are termed ‘susceptibility factors’, some are somatic alterations of the genetic material, and some are environmental conditions (i.e. smoking, exposure to sunlight, exposure to various chemicals, etc.). Deciphering the interplay of all these factors constitutes the heart of the challenge when investigating the causes of and designing treatment strategies for complex disorders.

Studies that also included hospitalized TBI patients reported similar frequencies of IB as the one we reported. For example in the CRASH Trial which was the largest trial conducted among TBI patients, 56% of the patients have some type of IB and 27% presented a subarachnoid haemorrhage which

is similar to the 22% incidence reported in this study. [4] In the IMPACT study, which included 9 randomised clinical trials in TBI patients, the range of frequency #selleck kinase inhibitor keyword# for EPH and SDH was 7-20% and 20-36% respectively, which is similar to the frequency reported in our study. [16] Our results are consistent, but more precise, than those of previous studies showing that IB is associated with increased mortality. There has not been any systematic review describing the association between Inhibitors,research,lifescience,medical size of IB and prognosis in TBI but a comprehensive review has been reported in the Guideline for the Surgical Management of Traumatic Brain Injury”. [17] In this guideline bleeding size is taken

into account to recommend surgical evacuation. However, the evidence presented in the guideline is very limited. For EDH the guideline reported only seven studies that evaluated the effect of size on outcome. The median of patients included was 74 (range: 22-200). In relation to SDH only seven studies reported on the effect of size with a median number of patients of 91 (range 23-206). Inhibitors,research,lifescience,medical For IPH seven studies were reported, with a median of 85 patients included (range Inhibitors,research,lifescience,medical 23-321). Furthermore in only a few studies mortality or disability were considered as outcomes and, many of the studies included selected samples (e.g. only surgical patients) and were retrospective analysis of one centre database. Our findings are also in

keeping with the results of previous publications showing that SDH is associated with a much larger increased in the probability Inhibitors,research,lifescience,medical of death than EDH. [17] We found that only large IB, wherever the location (EDH, SDH or IPH) are associated with worse outcome and that large IB are associated with an increased risk of death in comparison with small IB. Further studies should also evaluate the effect of size on disability using outcomes such as the Glasgow Outcome Scale. The strength old of our analysis is that it included more than 13,000 patients with traumatic brain injury and so the precision of our estimates of the risk associated with IB is high. We also adjusted for most of the relevant potential confounding variables. An important limitation of this study is that in a large proportion of patients it was not reported whether the IB was small or large. These patients, with size coded as NFS, presented intermediate risk between patients with small and large lesions. Another limitation is that we did not have information on pupil reactivity which has been shown to be an important prognostic factor.

The left fallopian tube and ovary was healthy. The right ovary, along with the mass and fallopian tube, was removed. Infracolic omentectomy and left tubectomy was done (as per patient and her husband’s consent). The intact cyst was multiloculated, weighed 11,000 gm, and was filled with fluid. Figure 2 demonstrates the cystic mass after it was removed via laparotomy. There Inhibitors,research,lifescience,medical was mild omental adhesion,

but no ascites was observed. Specimens and peritoneal washing were sent for histopathology examination. The intraoperative and postoperative periods were uneventful, and she was discharged on the 8th postoperative day. In subsequent follow-up, no abnormality was detected. Figure 1 The patient’s abdominal swelling after vaginal delivery is demonstrated here Figure 2 This cystic mass (approximately 40 cm×30 cm×25 cm in size, pinkish in color, and with a smooth surface) arising from the right ovary was Inhibitors,research,lifescience,medical removed via laparotomy The ovarian cyst was sectioned in the Pathology Department of our institution. The inner surface of the cyst exhibited Inhibitors,research,lifescience,medical multiple trabeculae, without any solid component or hemorrhagic area. The cyst was filled with mucinous fluid. Unfortunately, the pathologist failed to provide us with the photograph of the macroscopic cut section. The mucinous ovarian cyst had features

of infarction, so the histopathology slides could not be stained with specific Periodic Acid Schiff (PAS) Inhibitors,research,lifescience,medical stain to confirm diagnosis with an alternative method. The histopathology examination report revealed features of a mucinous cystadenoma. Figure 3 shows the histopathology of the mass, demonstrating features of a mucinous PFT�� research buy cystadenoma with no malignant cells in peritoneal washing. Figure 3 Histopathology of the mass shows features of a mucinous cyst adenoma Discussion The most common benign adnexal masses during pregnancy are cystic teratomas (36%), followed by cystadenomas (15%).2 Several cases of ovarian

mucinous cystadenomas in pregnancy have been reported in the literature.2,4-8 Yenicesu GI et al.4 and Qublan HS et al.6 both described removal of right ovarian mucinous Inhibitors,research,lifescience,medical cystadenomas weighing around 6 kg after Caesarean section. The cysts old in both cases were very similar to that in our patient. In our case, however, the baby was delivered vaginally without any intrapartum and postpartum complications despite the presence of such a huge ovarian mass. This is indeed a rare case because there have hitherto been no reports in the existing literature on vaginal delivery complicated by such a huge ovarian mucinous cystadenoma. Noreen H et al.5 reported term vaginal delivery of a grand multipara (aged 30 years) after the removal of a huge left ovarian mass (42 cm×40 cm×20 cm) at 30 weeks of gestation. Balat O et al.7 also reported an unthreatened late pregnancy with a huge mucinous cystadenoma of the left ovary, diagnosed sonographically at 26 weeks of pregnancy.