Akihiro Moriyama

Endometrial Development Was Improved by Transdermal Estradiol in Patients Treated with Clomiphene Citrate

The objective of this study was to examine the effect of transdermal estrogen therapy on the endometrial thickness and serum hormone levels in anovulatory patients treated with clomiphene citrate (CC). There was a significant difference in endometrial thickness between the CC + transdermal estrogen group and the CC only group from day –2 to day +2. Serum estradiol (E2) levels in the CC + transdermal estrogen group were significantly higher than those in the CC only group on day –2 and day 0. Our results support that addition of transdermal E2 to the treatment protocol of the women treated with CC elicited a favorable response of the endometrium.

Damage to adjacent organs during transvaginal surgery: A case complicated with sigmoid colon injury during uterine cervix conization

Here, we present a case of a sigmoid colon injury, which is a rare complication during uterine cervix surgery. The patient was a 54-year-oldwoman, gravida 3 and para 3, who had uneventful vaginal deliveries. There was no relevant personal or family history. Because a high-grade cervical intraepithelial neoplasia (CIN 3) was indicated on Papanicolaou smear analysis, confirmed by colposcopic biopsy, we considered uterine cervix conization. The procedure was performed using a suture needle and electric scalpel. The cone measured 1.5 cm in diameter and 3.5 cm in height. Active bleeding from the incision surface was controlled with repeated sutures and cautery. The total blood loss was 460 mL, and the surgery duration was 87 minutes. No obvious abnormalities were detected in the uterus or pelvis on sonography after the surgery. Two days after the surgery, the patient presented with fever (37.8 C). However, no abnormalities were found on medical examination, so it was considered a symptom of common cold. Therefore, she was discharged on schedule. On the 23rd postoperative day, stool from the vaginal cavity was observed and the intestinal mucosa could be visualized from the vaginal cavity on Cusco examination (Figure 1A). Then, contrasting computed tomography was performed. There was an abscess in the Douglas cavum, and a fistula between the uterine cervix and sigmoid colon was suspected (Figure 1B). When the contrast agent was injected into the intestine, leakage from the sigmoid colon to the vagina cavity was observed (Figure 1C). Therefore, sigmoid coloneuterine fistula