Sen-Wen Teng

Comprehensive treatment for infertile women with severe Asherman syndrome

OBJECTIVE Many preoperative, intraoperative, and postoperative methods have been described that improve the outcomes of women with severe Asherman syndrome, and it is likely that an integrated application of all of these methods may provide better reproductive outcomes; however, there is as yet no report on this type of integrated approach. MATERIALS AND METHODS The cases of four infertile women with severe Asherman syndrome were analyzed retrospectively. The comprehensive therapeutic plan for the four women included (1) preoperative office hysteroscopy to confirm the diagnosis and evaluate the severity of disease; (2) the use of ultrasound-guided intraoperative abdominal procedures during the surgical procedure, including hysteroscopic adhesiolysis to ensure the entire the hysteroscopic dissection, and placement of a Hyalobarrier(®) gel and an intrauterine balloon catheter at the end of the surgery; (3) postoperative oral estrogen supplementation to enhance endometrial proliferation, removal of the balloon catheter, and a second-look office hysteroscopy; and (4) in vitro fertilization and embryo transfer (IVF & ET) for three of the four patients. RESULT After treatment, the endometrium was significantly thicker than at baseline (median endometrial thickness, 7.5 mm versus 3.0 mm, p < 0.05). All the women (100%, 4/4) conceived successfully (three undergoing IVF & ET, and one had a spontaneous pregnancy), but only two patients had a term pregnancy with cesarean section (one placenta previa and the other placental abruption), contributing to 50% of successful term pregnancies. One patient had the complication of abortion after amniocentesis. The last one woman underwent an abortion because of thyroid problems. CONCLUSION Comprehensive management offers promising reproductive outcomes for infertile women with severe Asherman syndrome.

Primary omental pregnancy treated by laparoscopic surgery

Abdominal pregnancy occurs in 1.4% of all ectopic pregnancy cases, and omental pregnancy is the least common form of abdominal pregnancies. The mortality rate for abdominal pregnancy is seven times higher than for non-abdominal ectopic pregnancy w1x. A review of the literature showed that only a few cases of omental pregnancies have been reported to date, and most were secondary omental pregnancies treated by laparotomic surgery. To support a diagnosis of primary abdominal pregnancy, histologic evidence of neovascularization or growth of trophoblast into the supporting tissue must be found w2x. This is the report of a case of a primary omental pregnancy treated by laparoscopic partial omentectomy. The patient, a 28-year-old woman in her 5th week of gestation, gravida 4, para 1, presented to the emergency room with lower abdominal pain accompanied by cold sweat and episodes of syncope. Physical examination was remarkable for the presence of diffuse abdominal tenderness. Her urine pregnancy test was positive and ultrasonographic exploration revealed internal bleeding and a complex mass in the right uterine adnexa. The

Women with endometriosis have higher comorbidities: Analysis of domestic data in Taiwan.

Abstract Endometriosis, defined by the presence of viable extrauterine endometrial glands and stroma, can grow or bleed cyclically, and possesses characteristics including a destructive, invasive, and metastatic nature. Since endometriosis may result in pelvic inflammation, adhesion, chronic pain, and infertility, and can progress to biologically malignant tumors, it is a long‐term major health issue in women of reproductive age. In this review, we analyze the Taiwan domestic research addressing associations between endometriosis and other diseases. Concerning malignant tumors, we identified four studies on the links between endometriosis and ovarian cancer, one on breast cancer, two on endometrial cancer, one on colorectal cancer, and one on other malignancies, as well as one on associations between endometriosis and irritable bowel syndrome, one on links with migraine headache, three on links with pelvic inflammatory diseases, four on links with infertility, four on links with obesity, four on links with chronic liver disease, four on links with rheumatoid arthritis, four on links with chronic renal disease, five on links with diabetes mellitus, and five on links with cardiovascular diseases (hypertension, hyperlipidemia, etc.). The data available to date support that women with endometriosis might be at risk of some chronic illnesses and certain malignancies, although we consider the evidence for some comorbidities to be of low quality, for example, the association between colon cancer and adenomyosis/endometriosis. We still believe that the risk of comorbidity might be higher in women with endometriosis than that we supposed before. More research is needed to determine whether women with endometriosis are really at risk of these comorbidities.

Disease activity of pregnant women with systemic lupus erythematosus.

Systemic lupus erythematosus (SLE) is an autoimmune and multisystemic disease with a significant female predominance, particularly during the reproductive years (ratio 15:1), affecting up to one in 1000 women of child-bearing age. Pregnancy is considered a very high-risk period for women with SLE, and therefore has been strongly discouraged in those suffering from SLE for the most part until recent years. A study of 13,555 deliveries of women with SLE showed that they had a 20-fold higher risk of maternal mortality and a higher rate than pregnant women without SLE of hypertension, pregestational diabetes mellitus, renal impairment, pulmonary hypertension, major infection, and hematological complications, as well as events such as bleeding, anemia, thrombocytopenia, stroke, deep vein thrombosis, and pulmonary embolism. Therefore, the management of SLE during pregnancy remains challenging for physicians, and outcomes for both mother and baby can be less than optimal if the disease is not managed with caution. In this issue Dr. Yang has an article addressing this important topicdpregnancy outcomes of woman with SLE in a single institute in northern Taiwan. The authors studied 60 pregnancies of 55 women with SLE and found that the pregnancy outcome was strongly positively related to the remitted disease activity of the women with SLE prior to conception and during pregnancy; these women with SLE that was quiescent prior to conception and during pregnancy had a longer gestation period and a lower complication rate with pregnancy, and delivered newborns with higher body weight than those women with active SLE. Therefore, the authors emphasized the importance of requiring women with SLE to consult with obstetricians prior to conception, and to maintain remitted disease activity with the help of rheumatologists before and during pregnancy. In fact, teamwork in modern medical care has become one of the most important issues in providing better care for diseased patients and for improving the global health of the general population. We congratulate the authors on their success and also appreciate their contribution to this field. There is much evidence supporting the importance of SLE quiescence prior to conception, although multivariate analysis from Dr. Yangs report failed to identify its value. The risk of flare appears to be dependent on disease activity 6e12 months before becoming pregnant. Women without active SLE during this period have a lower risk of flare

Prognostic factors of primary fallopian tube cancer in a single institute in Taiwan

To improve the understanding of primary fallopian tube carcinoma (PFTC) through an analysis of possible clinical and pathologic determinants of prognosis.

Squamous cell carcinoma occurring in the pelvis after total hysterectomy and bilateral salpingo-oophorectomy for an ovarian mature teratoma with malignant transformation.

Department of Obstetrics and Gynecology, Cardinal Tien Hospital-Hsintien, New Taipei City, Taiwan Department of Obstetrics and Gynecology, Fu Jen Catholic University, New Taipei City, Taiwan Department of Obstetrics and Gynecology, National Yang-Ming University School of Medicine, Taipei, Taiwan Department of Obstetrics and Gynecology, Taipei Veterans General Hospital, Taipei, Taiwan e Institute of Clinical Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan Department of Obstetrics and Gynecology, Cathay General Hospital, Taipei, Taiwan Department of Nursing, Taipei Veterans General Hospital, Taipei, Taiwan h Institute of Hospital and Health Care Administration, National Yang-Ming University School of Medicine, Taipei, Taiwan Department of Nursing, Oriental Institute of Technology, New Taipei City, Taiwan j Immunology Center, Taipei Veterans General Hospital, Taipei, Taiwan k Infection and Immunity Research Center, National Yang-Ming University, Taipei, Taiwan

Laparoscopy versus laparotomy for cystic ovarian teratomas

This retrospective study compared the advantages and disadvantages of laparoscopic surgery and conventional laparotomy for women with cystic ovarian teratomas. The records of 120 women with ovarian teratomas were retrieved via a computer search for a histologically proven diagnosis of benign cystic teratoma and/or dermoid cyst; 49 cases were excluded after review. There was no significant difference in age parity body mass index and history of laparotomy between the laparoscopic and laparotomy groups but there were significant differences in teratoma diameter operating time blood loss and hospital stay between the two groups. When criteria for surgical treatment were compared no differences were noted in the patients’ age parity body mass index or history of pelvic surgery between the group of 30 women who underwent laparoscopic surgery and the group of 41 women who underwent laparotomy. (excerpt)

Degenerative leiomyoma of the cervix: Atypical clinical presentation and an unusual finding

a Department of Obstetrics and Gynecology, Cardinal Tien Hospital-Hsintien, New Taipei City, Taiwan b Department of Obstetrics and Gynecology, Fu Jen Catholic University, New Taipei City, Taiwan c Department of Obstetrics and Gynecology, National Yang-Ming University School of Medicine, Taipei, Taiwan d Department of Obstetrics and Gynecology, Taipei Veterans General Hospital, Taipei, Taiwan e Department of Medical Research, China Medical University Hospital, Taichung, Taiwan

Uterine sarcoma part III—Targeted therapy: The Taiwan Association of Gynecology (TAG) systematic review

Uterine sarcoma is a very aggressive and highly lethal disease. Even after a comprehensive staging surgery or en block cytoreduction surgery followed by multimodality therapy (often chemotherapy and/or radiation therapy), many patients relapse or present with distant metastases, and finally die of diseases. The worst outcome of uterine sarcomas is partly because of their rarity, unknown etiology, and highly divergent genetic aberration. Uterine sarcomas are often classified into four distinct subtypes, including uterine leiomyosarcoma, low-grade uterine endometrial stromal sarcoma, high-grade uterine endometrial stromal sarcoma, and undifferentiated uterine sarcoma. Currently, evidence from tumor biology found that these tumors showed alternation and/or mutation of genomes and the intracellular signal pathway. In addition, some preclinical studies showed promising results for targeting receptor tyrosine kinase signaling, phosphatidylinositol 3-kinase/AKT/mammalian target of rapamycin pathway, various kinds of growth factor pathways, Wnt/beta-catenin signaling pathway, transforming growth factor β/bone morphogenetic protein signal pathway, aurora kinase A, MDM2 proto-oncogene, histone deacetylases, sex hormone receptors, certain types of oncoproteins, and/or loss of tumor suppressor genes. The current review is attempted to summarize the recurrent advance of targeted therapy for uterine sarcomas.

EphA2 is a biomarker of hMSCs derived from human placenta and umbilical cord

OBJECTIVE The heterogeneous nature of mesenchymal stem cells (MSCs) and the absence of known MSC-specific biomarkers make it challenging to define MSC phenotypes and characteristics. In this study, we compared the phenotypic and functional features of human placenta-derived MSCs with those of human dermal fibroblasts in vitro in order to identify a biomarker that can be used to increase the purity of MSCs in a primary culture of placenta-derived cells. MATERIALS AND METHODS Liquid chromatography-tandem mass spectrometry analysis was used to analyze and compare the proteome of human placenta-derived MSCs with that of fibroblasts. Quantitative real-time polymerase chain reaction, immunofluorescence, and flow cytometry were used to determine expression levels of EphA2 in placenta-derived MSCs. EphA2-positive cells were enriched by magnetic-activated cell sorting or with a cell sorter. An shRNA-mediated EphA2 knockdown was used to assess the role of EphA2 in MSC response to Tumor necrosis factor (TNF)-α stimulation. RESULTS Analysis of proteomics data from MSCs and fibroblasts resulted in the identification of the EphA2 surface protein biomarker, which could reliably distinguish MSCs from fibroblasts. EphA2 was significantly upregulated in placenta-derived MSCs when compared to fibroblasts. EphA2 played an important role in MSC migration in response to inflammatory stimuli, such as TNF-α. EphA2-enriched MSCs were also more responsive to inflammatory stimuli in vitro when compared to unsorted MSCs, indicating a role for EphA2 in the immunomodulatory functionality of MSCs. CONCLUSION EphA2 can be used to distinguish and isolate MSCs from a primary culture of placenta-derived cells. EphA2-sorted MSCs exhibited superior responsiveness to TNF-α signaling in an inflammatory environment compared with unsorted MSCs or MSC-like cells.