Chin-Hsiung Hsieh

Major complications associated with laparoscopic-assisted vaginal hysterectomy: ten-year experience.

STUDY OBJECTIVE To describe our experience with major complications associated with laparoscopic-assisted vaginal hysterectomy (LAVH) and compare our results with those of the American Association of Gynecologic Laparoscopists (AAGL) membership survey and another similar study. DESIGN Retrospective study (Canadian Task Force classification II-3). SETTING University-affiliated hospital. PATIENTS Two thousand seven hundred two women. Intervention. LAVH. MEASUREMENTS AND MAIN RESULTS Demographic data and medical histories (age, parity, surgical indications, pathologic findings, major complications) were analyzed. Major complications were 11 bladder injuries, 4 ureter injuries, 11 bowel injuries, 2 vascular injuries, 2 cases of massive bleeding from the vaginal cuff or colpotomy wound with associated impending shock, 2 cases of postoperative ileus, and 2 pelvic abscesses. Our overall major complication rate was 1.3% compared with 2.7% in the AAGL 1995 membership survey (p <0.001). Similar rates of febrile morbidity (2.2% and 2.0%), bleeding requiring transfusion (0.05% and 0.06%), and bowel, ureteral, or bladder injury (1.0% and 1.0%) were noted between our study and the other 1995 study (all p >0.05). Of 34 major complications in our study, 24 occurred during hysterectomy performed by inexperienced general gynecologists and 10 by an experienced endoscopist (p = 0.005). CONCLUSION The rate of major complications associated with LAVH can be reduced when the procedure is performed by a well-trained laparoscopic surgeon compared with a less-experienced general gynecologist.

Clinical outcomes and development of children born after intracytoplasmic sperm injection (ICSI) using extracted testicular sperm or ejaculated extreme severe oligo-astheno-teratozoospermia sperm: a comparative study

OBJECTIVE To evaluate the clinical outcomes and development of children born after intracytoplasmic sperm injection (ICSI) with extracted testicular sperm or ejaculated extreme severe oligo-astheno-teratozoospermia (OAT) sperm. DESIGN Retrospective study. SETTING Infertility clinic at Chang Gung Memorial Hospital. PATIENT(S) A total of 126 ICSI cycles were performed using extracted testicular sperm from men with azoospermia and 65 ICSI cycles using fresh ejaculated sperm from men with extreme severe OAT. INTERVENTION(S) Retrospective analysis of clinical outcomes and development of children born after ICSI with extracted testicular sperm or ejaculated extreme severe OAT sperm. MAIN OUTCOME MEASURE(S) Fertilization rates, number of grade 1 zygotes and number of embryos produced, implantation rate, clinical pregnancy rate, abortion and live birth rate per transfer, perinatal outcomes, and birth defects. RESULT(S) The demographic and clinical factors, including age, E(2) level on hCG day, number of oocytes retrieved, normal fertilization rate, zygote grade 1 score distribution, number of top-quality embryos transferred, clinical pregnancy rate per transfer, chemical pregnancy rate per transfer, implantation rate, live birth rate per transfer, and abortion rate per transfer, were similar between the groups. Sixty live births resulted from 48 extracted testicular sperm cycles and 21 live births from 19 extreme severe OAT. The obstetric and perinatal outcomes were similar between the groups, and children conceived by using ICSI were healthy and without major psychomotor or intellectual development retardation. One case of tetralogy of Fallot occurred in each group. CONCLUSION(S) There is no evidence of differences in the clinical outcomes and development of children result after ICSI with extracted testicular sperm or ejaculated extreme severe OAT sperm.

Multiple uterine angioleiomyomas in a woman presenting with severe menorrhagia

BACKGROUND Angioleiomyoma is a rare benign neoplasm that originates from smooth muscle cells and contains thick-walled vessels. There were only five cases of uterine angioleiomyoma reported in the available English literatures. We present here the unique computed tomography finding in a patient with multiple uterine angioleiomyomas causing severe menorrhagia. CASE A 50-year-old, nulligravid woman consulted us with the complaint of menorrhagia for 3 years and progressively palpable lower abdominal mass for a half year. Laboratory findings were all within normal limits except lower hemoglobin concentration (6.2 g/dl). An abdomino-pelvic computed tomography (CT) showed that a huge 30-cm heterogeneously multilobulate mass with solid and laminated configuration, with cystic and multiseptal contents was found in left lower abdomen and pelvic cavity. At laparotomy, the area beneath the left broad ligament was filled with a well-encapsulated, elastic, ovoid, and lobulate mass that connected to the uterus and measured up to 20 cm in greatest diameter. The uterus was composed of a huge intramural tumor and measured 28 x 21 x 12 cm. The uterus and huge subserosal tumor were resected completely and a frozen section was obtained. The final histopathologic diagnosis was angioleiomyoma, a definitely benign soft tissue tumor. Eighteen months after surgery there was no recurrence. CONCLUSION Uterine angioleiomyoma should be considered when prominent tortuous vascular-like enhancing structures are noted on CT examination of a well-demarcated soft tissue mass arising from the uterus in pelvis. Either angiomyomectomy with tumor-free margins or hysterectomy proved to be an effective treatment in these cases, and resulted in a good recovery and a satisfactory outcome.

Leiomyosarcoma of the uterus: a clinicopathologic study of 21 cases.

Acta Obstet Gynecol Scand 2003; 82: 74–81.

Pelvic Castleman's disease presenting as an adnexal tumor

Castleman’s disease, first described in 1954 (1), is a rare benign disorder of unknown etiology characterized by a proliferation of lymphoid tissues. It is also known as angiofollicular lymph node hyperplasia, angiomatous lymphoid hamartoma, lymphoid hamartoma, and giant lymph node hyperplasia. Flendrig et al. (2) distinguished two basic histopathologic types and one mixed variant, which Keller et al. (3) designated the hyaline-vascular, plasma-cell, and hyaline-vascular plasma-cell types. Two clinical entities also have been described: a unicentric presentation with disease confined to a single anatomic lymph node-bearing region and a multicentric presentation characterized by generalized lymphadenopathy, systemic symptoms, hepatosplenomegaly, and a more aggressive clinical course with the potential for malignant transformation (4–6). In 70% of cases, this tumor occurs in the mediastinum (3), and the neck (7), pancreas (8), pelvis (9–13), and axillary and inguinal lymph nodes (14) are uncommon sites of involvement. In gynecologic practice, the condition appears to be extremely rare. We report a patient with unicentric Castleman’s disease of the hyaline-vascular type in the pelvic retroperitoneum, which initially presented as an adnexal tumor.