Hun-Shan Pan

Transvaginal three-dimensional ultrasonography combined with serum CA 125 level for the diagnosis of pelvic adhesions before laparoscopic surgery.

STUDY OBJECTIVE To investigate the role of transvaginal three-dimensional ultrasonography combined with serum CA 125 level in diagnosing pelvic adhesions before scheduled laparoscopic surgery. DESIGN Prospective study (Canadian Task Force classification II-1). SETTING Tertiary care academic hospital. PATIENTS Fifty-nine women with an adnexal mass diagnosed by two-dimensional transvaginal ultrasonography. INTERVENTION Preoperative transvaginal three-dimensional ultrasonography and serum CA 125 level, followed by laparoscopy or laparotomy. MEASUREMENTS AND MAIN RESULTS Pelvic adhesions were correctly identified by transvaginal three-dimensional ultrasonography in 26 of 32 women in whom the lesions were confirmed at laparoscopy or laparotomy. Mean serum CA125 level in women with adhesions was 70 +/- 73.7 U/ml, which was significantly higher than that in women without adhesions (24 +/- 16.16 U/ml, p = 0.004). The sensitivity of combined transvaginal three-dimensional ultrasonography and serum CA 125 level was 90%, specificity was 100%, positive predictive value was 100%, and negative predictive value was 89%. The two methods showed strong agreement with surgical results (kappa = 0.889). Eight scheduled laparoscopies (13.6%) were converted to laparotomy due to severe adhesions. One patient (1.7%) experienced colon injury during laparoscopic adhesiolysis. CONCLUSION Transvaginal three-dimensional ultrasonography combined with serum CA 125 level is sensitive in detecting pelvic adhesions before laparoscopic surgery. Patients with suspected severe pelvic adhesions should have preoperative bowel preparation to reduce the risk of intraoperative injury.

Prenatal three-dimensional ultrasound diagnosis of a camptomelic dysplasia.

Abstract. We describe a case of camptomelic dysplasia identified prenatally with the assistance of three-dimensional ultrasonography. The typical skeletal dysplasia of camptomelic dysplasia – including anterior bowing of the tibia, with skin dimpling over a convex surface at the point of maximal deformity, and talipes equinovarus – was successfully identified using the techniques of surface-rendering, multiplanar displays and rotated volume data. Three-dimensional ultrasonography allows the diagnosis of camptomelic dysplasia , which has a poor prognosis as it is accompanied by respiratory insufficiency and spinal deformities, to be made without delay and provides information supplementary to that provided by two-dimensional ultrasound for early diagnosis of skeletal dysplasia.

Ovarian pregnancy torsion.

IntroductionOvarian-cyst torsion is often seen in early pregnancy due to progesterone stimulation. It is the fifth-most-common gynecological emergency, with a reported incidence of 3%. An ectopic pregnancy implanted in the ovary is rare, occurring in only 0.5–1% of such pregnancies.Case reportWe presented a case of ovarian pregnancy with concomitant ipsilateral side tubal torsion managed by laparoscopy.Discussion and conclusionsVarying density distribution in the ovary can predispose to ovarian torsion. Emergency surgery may offer the possibility of avoiding the ablation of functional ovarian tissue. Early detection and prompt management can preserve fertility and ovarian function. The etiology, presenting syndrome and management are discussed.

Comparison of the outcomes of primary twin pregnancies and twin pregnancies following fetal reduction

High-order multifetal pregnancy is an inevitable consequence of assisted reproduction; and is associated with an increase in perinatal morbidity and mortality. Fetal reduction appears to be a safe and efficacious method for improving obstetric outcome. We made a retrospective study of study population 54 high multiple pregnancy following assisted reproduction that were reduced to twins at Shin Kong Memorial Hospital, Taipei,Taiwan from September 1992 to March 2000. Our study compares the outcome of multifetal pregnancy reduced to twins with the outcome of primary twin pregnancy. Maternal age, birth weight, gestational age at delivery and the incidence of preterm contractions were the only statistically significant differences between the two groups.

Impending Sepsis Due to a Ruptured Pyomyoma with Purulent Peritonitis: A Case Report and Literature Review

Summary Objective Pyomyoma is an uncommon complication of benign leiomyoma. Here, we report a rare case of a perforated pyomyoma with purulent peritonitis. Case Report A 53-year-old postmenopausal woman presented with impending septic shock on arrival at our emergency department. Physical examination and imaging studies revealed a pelvic mass with peritonitis. Emergency exploratory laparotomy due to suspicion of a ruptured pyomyoma or malignancy revealed a spontaneously perforated large pyomyoma leaking copious purulent material directly into the peritoneal cavity. Total hysterectomy and bilateral salpingo-oophorectomy were performed. Histopathology revealed no malignancy. The patient recovered smoothly after combined antibiotic therapy. Conclusion Gynecologists should be aware of this rare emergency condition, especially when handling a patient with a history of leiomyoma uteri and if signs of infection or even sepsis are present.

An Adhesion Barrier May Induce Peritonitis and Abscess after Laparoscopy-Assisted Myomectomy with Vaginal Extraction: Report of a Case

Following a myomectomy, postoperative adhesions occur in many patients. Although laparoscopy has been shown to decrease the development of adhesions compared to laparotomy, adhesions still occur. There are several commercially available adhesion barriers but these are not designed to be easily applied during laparoscopic surgery. In this study, we report a case involving a 34-year-old patient who developed pelvic peritonitis and abscess without an obvious etiology; this might have been related to the off-label use of a bioabsorbable membrane converted into a slurry during recent surgery. Surgeons should be aware of such complications, which might be attributed to this product.

MASSIVE ASCITES COMPLICATING PRE-ECLAMPSIA

Summary Objective We report a case of a woman 27 weeks into her pregnancy with severe pre-eclampsia complicated by severe ascites diagnosed using ultrasonography and managed with paracentesis. Case Report A 41-year-old woman, gravida 5, para 2, abortus 2, was referred from a prenatal clinic due to pre-eclampsia and complaints of headaches, blurred vision, and abdominal discomfort. In spite of treatment with hydralazine and magnesium sulfate and an albumin infusion, she developed orthopnea and abdominal distension. During ultrasound, severe maternal ascites of about 2,000 mL was discovered. Paracentesis was performed at 27 +3 weeks. After the procedure, there was significant improvement in the patients symptoms. However, complaints of abdominal distension and difficulty breathing recurred in week 31. Repeat paracentesis was performed followed by administration of corticosteroid for fetal lung maturation. At 31 +3 weeks, the baby was delivered by cesarean section due to progressive toxemia and intrauterine growth retardation. During the operation, 1,500 mL of ascitic fluid was aspirated from the pelvic cavity. A female neonate was delivered with a birth weight of 1,020 g and Apgar scores of 6 and 8 at 1 and 5 minutes, respectively. At the 6-week follow-up, the patient was well and normotensive, and the baby was discharged from the neonatal intensive care unit. Conclusion Clinicians should be aware of the possible presence of ascites in patients with severe pre-eclampsia. If the hypertension is controlled and the fetus is healthy, abdominal paracentesis without pregnancy termination is an efficacious procedure for the management of massive ascites complicating severe pre-eclampsia.

Fetal meconium peritonitis in single and twin pregnancy: two cases report.

Abstract We present two cases of fetal meconium peritonitis in a single and twin pregnancy, respectively. The first case diagnosis was made at 30 weeks and was confirmed after delivery of the twins by cesarean section at 37 weeks. The second case diagnosis was made at 31 week and was confirmed at 37 weeks. Meconium peritonitis is a rare prenatal complication that results from intrauterine perforation of small bowel with spillage of sterile meconium into peritoneal cavity. We now report two cases of meconium peritonitis diagnosed at 30 and 31 weeks gestation.

Human papillomavirus DNA in triple neoplasms of the cervix, perianus and ureter in one woman.

Background: Multiple malignancies of the urogenital tract have been reported. We investigated the etiological role of human papillomavirus (HPV) in the pathogenesis of urogenital cancers. Case: We present a case of cervical squamous carcinoma in a 64-year-old woman who subsequently developed Bowen’s disease in the perianal skin and transitional cell carcinoma of the ureter. HPV DNA was detected in these tumor specimens using polymerase chain reaction. Conclusion: The results strongly suggest that HPV may play a major role in the carcinogenesis of urogenital and perianal tumors.

Large Gastrointestinal Stromal Tumor Mimicking A Gynecologic Tumor

Summary Objective Gastrointestinal stromal tumors (GISTs) are a group of uncommon bowel tumors. We report two cases of GISTs arising from the ileum and jejunum, both of which appeared to mimic a gynecologic tumor. Case Report In the first case, an 83-year-old, postmenopausal, woman presented with poor appetite, abdominal fullness and constipation for the preceding 3-4 days. Physical examination and imaging studies revealed a huge pelvic mass, suggestive of a huge cystic degenerated myoma. An exploratory laparotomy revealed a large tumor originating from the ileum, and immunohistochemical stains confirmed the presence of CD-117. In the second case, a 48-year-old woman presented with intermittent right lower abdominal pain and urinary frequency over the preceding 4 months. Physical examination and imaging studies revealed a pelvic mass of 21-week-gestational size. An exploratory laparotomy showed a huge fragile pelvic tumor, measuring 20 × 20 cm, arising from the jejunum. Immunohistochemical staining confirmed the presence of CD-117. Conclusion GISTs express c-kit proteins (CD-117) on immunohistochemistry. They may mimic gynecologic tumors since they share the same pelvic cavity. One should always consider GISTs as part of the differential diagnosis in pelvic tumors.