Chun Sen Hsu

ISOLATED TORSION OF THE FALLOPIAN TUBE: A RARE DIAGNOSIS IN AN ADOLESCENT WITHOUT SEXUAL EXPERIENCE

is usually established after surgical intervention. A 19-year-old adolescent, who denied any sexual experience, was twice presented with sudden onset of lower abdominal pain, predominantly in the left lower quadrant, in the last year. The first episode occurred 1 year previously and the patient was brought to our emergency room. The abdominal pain was sharp, persistent, non-radiating and mainly in the left lower quadrant of abdomen, but with no obvious peritoneal signs. Plain abdominal film showed much fecal material retained in the large bowel. Enema and nonsteroidal antiinflammatory drug were prescribed. The tenderness was relieved. She was discharged with the presumptive diagnosis of stool impaction. Unfortunately, she experienced a second episode of

Spontaneous umbilical cord hematoma diagnosed antenatally with ultrasonography

Umbilical cord abnormalities include aneurysms, true knots, false knots, hematoma, etc. Spontaneous umbilical cord hematoma is a rare anomaly, which has an estimated incidence of approximately 1 in 5000 deliveries (1,2). The complications of this anomaly are uneventful pregnancy, fetal distress, or even intrauterine fetal death (1). We present the case of spontaneous umbilical cord hematoma diagnosed antenatally with ultrasonography, with the baby being successfully delivered vaginally.

Polycystic ovary syndrome or hyperprolactinaemia: a study of mild hyperprolactinaemia

Polycystic ovary syndrome (PCOS) and hyperprolactinaemia are both common causes of secondary amenorrhoea in reproductive women. The relationship between PCOS and hyperprolactinaemia has been reported with controversial results. To evaluate the clinical and laboratory features of women with mild hyperprolactinaemia and PCOS, we studied 474 Taiwan Chinese women: 101 had mild hyperprolactinaemia, 266 had PCOS and 107 were the control group. In this study, we found that 64% of the women with mild hyperprolactinaemia fulfilled the PCOS diagnostic criteria, regardless of their prolactin levels. Obese women with PCOS had significantly lower luteinising hormone (LH) and LH-to-FSH ratios than non-obese women with PCOS. Obese hyperprolactinaemic women had significantly lower follicle-stimulating hormone (FSH), but higher LH-to-FSH ratios than the non-obese hyperprolactinaemic women. For women with PCOS, the BMIs were significantly negative with LH (γu2009=u2009−0.253, pu2009<u20090.001), but not with FSH (γu2009=u2009−0.061, pu2009=u20090.319). For the hyperprolactinaemic women, the BMIs were significantly negative with FSH (γu2009=u2009−0.353, pu2009<u20090.001), but not with LH (γu2009=u2009−0.021, pu2009=u20090.837). Although PCOS-related syndrome was very prevalent in women with hyperprolactinaemia, the patterns of disturbance in gonadotropin secretion were different between the PCOS and the hyperprolactinaemia patients.

Evaluation of placental maturity by the sonographic textures

PurposeRoutine ultrasound screening to predict gestational age is important for risk assessment of pregnancy complications among pregnant women. We explored a quantitative method for sonographic analysis of placental texture, with the objective of reproducible measurement.MethodsWe studied 151 pregnant women; the gestational ages of their fetuses ranged from 10 to 38xa0weeks. Three experienced sonographers delineated the placental contour to define the region of interest (ROI). From these sonograms, 72 texture features were derived from the spatial gray-level dependence matrices and gray-level difference matrices. We used these as input variables in a multiple linear regression analysis.ResultsA significant positive correlation (Pxa0<xa00.01) was found between the multiple linear regression results and the corresponding gestation ages by the three assessors (rAxa0=xa00.755, rBxa0=xa00.851, and rCxa0=xa00.832). We also found good agreement between multiple linear regression results for the three observers. Their κ statistic values were 0.685 between assessors A and B, 0.679 between A and C, and 0.804 between B and C.ConclusionQuantitative sonography using texture analysis of the placenta was useful in practice to determine gestational age.

Delayed recurrence of cervical cancer after radical hysterectomy for carcinoma in situ

Cervical cancer is the leading gynecologic cancer in Taiwan. For the early stage of this cancer, aggressive treatment, i.e. radical hysterectomy, is performed with a very good prognosis. After years of promoting the necessity of Pap smear examinations, the early detection of high-grade squamous intraepithelial lesions (HSIL) has been made much easier, and the incidence of these cases has increased yearly. In this stage of disease, conservative treatment with a loop electrosurgical excision procedure (LEEP) or cold knife conization can eradicate the lesion successfully, with good control of the disease. However, 20–30 years ago, carcinoma in situ (CIS) was treated as an early stage of cancer, and simple abdominal hysterectomy, or even radical hysterectomy with pelvic lymph node dissection, was sometimes performed. Logically, it should result in a complete cure. However, we have a patient who had a recurrence of cervical cancer 27 years after an extended operation. This case is described below. A 71-year-old woman, gravida 6, para 4, abortus 2, was admitted to our hospital in November 2006 because of the finding of a vaginal cuff mass. This patient’s medical history revealed that she underwent a radical hysterectomy, bilateral salpingo-oophorectomy and bilateral pelvic lymph node dissection for cervical CIS at Taipei Medical University Hospital 27 years previously. After that, she received regular gynecologic follow-up. Her latest Pap smear was done at Mackay Memorial Hospital in December 2005, with normal cytopathologic findings. However, she had a small amount of whitish vaginal discharge for 1 month, but no unpleasant scent, bloody discharge or bowel/urinary problems were noted. By colposcopic examination, a vaginal cuff mass measuring about 2 cm in diameter was found. A vaginal cuff biopsy was done, revealing the presence of squamous cell carcinoma. Hence, with a diagnosis of vaginal cuff carcinoma and possible recurrence of her cervical cancer, she was admitted for further cancer work-up. Pelvic magnetic resonance image, cystoscopy and rectoscopy were performed. No bladder or rectal invasion was noted, but two ovoid, enhanced, welldefined solid tumors of 3.5 cm and 4.5 cm were located between the urinary bladder and rectum, in the left pelvic cavity. Laparotomy with partial vaginectomy for excision of the mass in the vaginal cuff was performed on November 16, 2006. The peritoneal cavity was explored thoroughly, and no metastatic tumor was found. The vaginal apex was exposed, and the mass was located at the vaginal apex, just between the bladder and the rectum. No serosal involvement was found (Figures 1 and 2). The whole mass with the surrounding tissue was grasped with Allis clamps and excised completely (Figure 3). The vaginal edges and the peritoneum were sutured with 2-0 Vicryl. After thorough hemostasis,

Lung Collapse Induced by Pulmonary Hemorrhage: A Rare Complication of Hysteroscopy

Pulmonary hemorrhage is a rare but sometimes fatal complication of hysteroscopy. We present the first case report in which a healthy patient developed lung collapse induced by pulmonary hemorrhage after operative hysteroscopy. The possible etiologies of this rare complication are also discussed.

Efficacy of Mifepristone/Misoprostol Combination for Medical Abortion Determined by Detection of Retained Products in a Community Hospital in Taipei, Taiwan

Summary Objective The oral mifepristone/misoprostol combination (MMC) is safe for medical abortion in early pregnancy. The rate of complete abortion in MMC-treated pregnancies at a community hospital in Taipei, Taiwan, was determined by ultrasonography and histopathology. Materials and Methods A total of 149 women who asked for legal termination of pregnancy before 49 days since the last menstruation were given 600 mg of oral mifepristone followed by 600 μg misoprostol 48 hours later. After 14 days, all women who had vaginal spotting or bleeding and in whom transvaginal ultrasonography demonstrated an endometrial thickness of more than 10 mm underwent vacuum aspiration or therapeutic dilatation and curettage (D&C). Specimens were identified by histopathology. Results A total of 108 women had complete abortions without the need for surgical intervention. Of 41 women who underwent vacuum aspiration or therapeutic D&C, histopathology showed that nine had decidual tissue, 29 had gestational tissue, and three had ongoing pregnancies. Conclusion In this study, the complete abortion rate was 78.5% after oral MMC.

Partial Hydatidiform Mole in a Medical Abortion with the Mifepristone/Misoprostol Combination

Summary Objective Gestational trophoblastic disease after an early elective medical abortion with the mifepristone/ misoprostol combination (MMC) is rare. Case Report We report a case of a young woman who was at 6–7 weeks of gestation who requested a medical abortion. The pretreatment ultrasonogram indicated a normal pregnancy. Passage of tissue ensued after the MMC, with good recovery. Postabortal ultrasonogram on day 14 showed the presence of intracavitary content. The patient declined our suggestion of serial ultrasonographic surveillance, and she was later lost to follow- up. Fifty days after the initial treatment, she again presented to our hospital with intermittent bleeding and an increase in the blood flow signal with a low resistance index in the uterus on color Doppler ultrasonography. After curettage, she was diagnosed as having a partial hydatidiform mole; she had complete regression of beta- human chorionic gonadotropin, monitored for 1 week after the evacuation. Conclusion Obstetricians should be aware of the possibility of a partial hydatidiform mole after a medical abortion.