Jesse Chuang

A Rapidly Growing Paraurethral Myoma with Profuse Bleeding from a Mucosal Vessel: Report of a Case

Paraurethral leiomyoma is rare. This is the first reported case of a woman with a 6 × 7 × 5 cm urethral leiomyoma with profuse vaginal bleeding. The site of bleeding was identified as the anterior vaginal mucosal vein, which we subsequently electrocauterized. Enucleation of the mass was performed smoothly with a Foley catheter to avoid damage to the urethra. Profuse bleeding from a paraurethral myoma is possibly due to increased vascularity and the prolapsed nature of the tumor in this area.

Conservative treatment of ectopic pregnancy in a caesarean section scar

A 40 year old woman was admitted with severe vaginal bleeding at seven weeks amenorrhea. In her past she had previously undergone one caesarean delivery and one miscarriage. A pregnancy test was positive and pelvic examination revealed profuse haemorrhage from the cervical canal. An ultrasound scan showed a sac embedded in the myometrium of the isthmus of the uterus (Fig. 1). The woman’s blood pressure was 94/48 mmHg, pulse was 120 bpm and haemoglobin concentration was 6.1 g/dL. A blood transfusion was given. In the operating theatre, using vaginal ultrasound guidance and an oocyte retrieval needle, vasopressin 20 units diluted in 60 mL normal saline was administered into the sac. The myometrium of the isthmus bulged with the solution of vasopressin and the bleeding became sero-sanguinous. This procedure was followed by balloon tamponade using a size 18 F Foley catheter with a three-way tap. About 30 mL of saline was injected into the balloon. The bleeding diminished after the vasopressin injection, ceasing altogether following the balloon placement. She was then given four doses of methotraxate 1 mg/kg on alternate days. The balloon was removed after 72 hours, and only spotting of blood occurred. She was discharged five days later. Her h-hCG level decreased from 7052 mIU/mL on the day of admission to 4.9 mIU/mL one month later, at which time no blood flow was detected at the isthmus of the uterus on Doppler examination. Menstruation resumed one month after her discharge from hospital.

Fetal compression syndrome caused by myoma in pregnancy: A case report

Myoma is a common pathologic finding in reproductive women. In 1989, Rice et al. showed that 1.4% of pregnancies were complicated by myoma, and the major complications were pre-term labor and abruptio placenta (1). Other complications included IUGR, abortion, fetal malpresentation, obstructed labor and post partum hemorrhage. We present the first reported case of pregnancy with fetal compression syndrome due to myoma manifested by molding the head that resulted in an asymmetric lateral ventricle, a shortened humerus and restricted growth.

Small cell carcinoma of the endometrium with concomitant pelvic inflammatory disease

Abstract Background: Small cell carcinoma of the endometrium is a rare disease entity characterized by bulkiness and predisposition to necrosis. Clinical presentations include postmenopausal bleeding, lower abdominal mass, chronic abdominal pain and menorrhagia. We present a case of small cell carcinoma of the endometrium with concomitant pelvic inflammatory disease. The literature is also reviewed. Case: A 64 year old female presented was admitted with the principal complaints of fever, lower abdominal pain and malodorous vaginal discharge. Bimanual examination revealed cervical motion tenderness with a WBC of 9400 cells/µL and increased levels of neutrophils, band cells and C-reactive protein. Sonography revealed an adnexal echocomplex compatible with tubo-ovarian abscess. Culture of the vaginal discharge revealed the presence of E. coli. Symptoms persisted despite three days of antibiotics administration so a laparotomy was performed with a friable hemorrhagic uterus revealed and an area of necrosis evident in the left adnexa. Malignancy was confirmed from frozen section. Total abdominal hysterectomy, with bilateral salpingo-oophorectomy and optimal debulking, was performed. The final pathology report confirmed small cell carcinoma of the endometrium. Conclusion: Malignancy and pelvic inflammatory disease have overlapping clinical characteristics. Once pelvic inflammatory disease is suspected in a postmenopausal patient, malignancy should also be suspected, and a thorough examination and a tumor-marker analysis performed.

The correlation between renal function and systolic or diastolic blood pressure in severe preeclamptic women.

Objective. To evaluate the correlation between renal function and systolic or diastolic blood pressure in preeclamptic mothers. Methods. In this prospective study from August 1998 to September 2002, 28 women ≥ 28 weeks gestation with severe preeclampsia were selected. Meanwhile, 56 normotensive pregnant women without proteinuria or edema served as the control group. Urine was collected for 24 hours for all subjects. The concentration of uric acid, blood urea nitrogen, creatinine, sodium, calcium, and albumin in the 24-hour urine and blood of both groups were examined. Neonatal outcome also was evaluated. Results. The serum and 24-hour urine concentration of blood urea nitrogen, creatinine, and albumin were significantly higher in severe preeclamptic women. Serum uric acid and urinary albumin/creatinine ratio was significantly higher in severe preeclamptic women compared with that in normotensive mothers and showed positive correlation with systolic or diastolic blood pressure. On the other hand, serum calcium/creatinine ratio was significantly lower in the severe preeclamptic group and negatively correlated to blood pressure. In multiple regressions, systolic or diastolic blood pressure was dependent on serum uric acid, albumin/creatinine, and calcium/creatinine ratios. Fetal birth weight was significantly lower in women with severe preeclampsia and with a lower Apgar score < 7 at 1 minute and 5 minutes and more preterm delivery compared with that in normotensive women. Conclusion. Renal function in women with severe preeclampsia was significantly impaired and highly correlated with systolic or diastolic blood pressure.