Yajun Wan

Etiology, treatment, and reproductive prognosis of women with moderate-to-severe intrauterine adhesions

To analyze data from the hysteroscopic adhesiolysis of moderate‐to‐severe intrauterine adhesions (IUAs), and to review the disease etiology, changes in menstruation, uterine recovery, and reproductive prognosis of women after comprehensive therapy.

High-intensity focused ultrasound combined with suction curettage for the treatment of cesarean scar pregnancy.

AbstractThe aim of this study was to retrospectively evaluate the safety and feasibility of high-intensity focused ultrasound (HIFU) treatment combined with suction curettage under hysteroscopic guidance for cesarean scar pregnancy (CSP).Fifty-three patients with definite CSP were treated with HIFU followed by suction curettage under hysteroscopic guidance. All the patients received 1 session of HIFU ablation under conscious sedation. Suction curettage under hysteroscopic guidance was performed at an average of 2.9 (range: 1–5) days after HIFU ablation. Blood flow of pregnancy tissue before and after HIFU, intraoperative blood loss in suction curettage and hysteroscopy procedure, time for &bgr;-human chorionic gonadotropin (&bgr;-hCG) to return to normal level, and time for normal menstruation recovery were recorded.Immediately after HIFU treatment, color Doppler ultrasound showed that the fetal cardiac activity disappeared and the blood flow in the pregnancy tissue significantly decreased. All the patients underwent suction curettage under hysteroscopic guidance after the treatment of HIFU, the median volume of blood loss in the procedure was 20 mL (range: 10–400 mL). The average time for menstruation recovery was 35.1 ± 8.1 (range: 19–60) days. The average time needed for serum &bgr;-hCG to return to normal levels was 27.5 ± 6.4 (range: 12–40) days. The average hospital stay was 7.8 ± 1.5 (range: 5–11) days.Based on our results, it appears that HIFU combined with suction curettage under hysteroscopic guidance is safe and effective in treating patients with CSP at gestational ages <8 weeks.

Analysis of the efficacy of three treatment options for cesarean scar pregnancy management

To assess three different methods in treating patients with cesarean scar pregnancy (CSP).

A comparison of high-intensity focused ultrasound and uterine artery embolisation for the management of caesarean scar pregnancy

Abstract Purpose: The aim of this study was to retrospectively analyse the clinical data of 122 patients with caesarean scar pregnancy (CSP) treated in our hospital, to compare the outcomes between high-intensity focused ultrasound (HIFU) and uterine artery embolisation (UAE). Materials and methods: Among the 122 patients, 76 patients were treated with HIFU followed by suction curettage under hysteroscopic guidance, 46 patients were treated with UAE followed by suction curettage under hysteroscopic guidance. Pain score, intraoperative blood loss in suction curettage under hysteroscopy guidance, time for vaginal bleeding, β-human chorionic gonadotropin (β-hCG) to return to normal level, normal menstruation recovery, hospital stay, and the adverse effects were all compared. Results: No statistically significant differences between the two groups in the intraoperative blood loss, hospital stay, time for β-human chorionic gonadotropin (β-hCG) to return to normal level, or time for normal menstruation recovery were observed. The pain score was lower and the adverse effects were fewer in the HIFU group than those in the UAE group. However, the time for vaginal bleeding was longer in the patients treated with HIFU than that of patients treated with UAE. Conclusions: Based on our results, it appears that either HIFU or UAE combined with suction curettage under hysteroscopic guidance is safe and effective in treating patients with CSP. Compared with UAE, HIFU treatment for CSP has the advantages of a lower pain score and fewer adverse effects.

Uterine diverticulum complicating pregnancy diagnosed by ultrasound and uteroscopy.

oral glucose tolerance test for gestational diabetes mellitus at 24 and 33 weeks of pregnancy, with negative results. A healthy female was delivered at 41 weeks, after spontaneous labor. The infant weighed 3830 g andwas 51 cm in length, with a 370-mm cephalic circumference (75th–80th percentile for gestational age). There were no phenotypic anomalies or neonatal problems. At 12 months, the child was healthy, and pediatric evaluations showed normal growth. Developmental status was assessed using French neurodevelopmental scales. Rimonabant contributes to weight loss by preventing endogenous cannabinoids from binding to neuronal CB1 receptors, which have a role in the control of food intake [1]. Prospective trials showed that obese patients taking rimonabant achieved significant reductions in body weight and waist circumference, in addition to improved lipid and glycemic profiles, compared with those taking placebo [1]. In 2007, however, theFoodandDrugAdministrationandtheEuropeanMedicines Agency disapproved rimonabant, concluding that it was effective for weight control but that its benefits no longer outweighed the potential risks (psychiatric alteration, severe depression, and suicidal ideation). In a search of PubMed (with no time limit for the studies), no cases were found concerning fetal exposure to rimonabant during pregnancy, although several animal studies have been published. In mice, the promotion of the attachment and outgrowth of blastocysts by low concentrations of the CB1 receptor agonist anandamide was blocked by rimonabant [2]. Other animal studies showed a particularly high risk of central nervous system malformation with rimonabant, but the mechanism by which abnormal development may be induced is unknown [1]. In 4-day-old male Wistar rats, a CB1 receptor agonist (e.g. marijuana) or a CB1 receptor antagonist (e.g. rimonabant) can disrupt neuronal plasticity, causing epilepsy or reducing network activity [3]. Thus, endocannabinoid signaling and the effects of rimonabant during the early stages of brain development could have major consequences for brain maturation. Recent in vitro and animal studies have demonstrated the presence of CB1 receptors in human uterine smoothmuscle, and shown a potent and direct effect—mediated via CB1 receptors—of endogenous cannabinoids on human pregnant myometrium [4,5]. The authors of these studies concluded that CB1 deficiency could influence parturition events and that the CB1 receptor may represent a new therapeutic target for the treatment of preterm labor. Because the present case involved fetal exposure to rimonabant during early pregnancy, we feel that it is an important addition to the existing literature, although the absence of a teratogenic effect following drug exposure in a single case is of little value. Further followup and large registries are required to demonstrate safety and exclude possible effects on behavioral or cognitive development.

Retained permanent uterine suture after cesarean.

Currently, the standard practice in obstetrics is to use absorbable suture to close the myometrium at the time of cesarean delivery. We treated 14 patients with a retained permanent suture in a previous cesarean scar. With globalization and increased transit of people across borders it is possible that this complicationwill be seen in other countries. The average age of the patients was 27 years (21–38 years), and the period of time between the cesarean delivery and diagnosis was an average of 3.5 years (range 62 days to 11 years). A continuous liquid irrigation rigid hysteroscope (Karl-Storz, Tuttlingen,Germany)with 5 Fr instrument channel was used in this study. Five of the 14 patients who were diagnosed during hysteroscopy-guided early pregnancy termination were asymptomatic. The other 9 were symptomatic. Of the 9 symptomatic patients, 6 presented with irregular menstrual bleeding, 2 complained of prolonged periods, and 1 presented with bloody discharge. Among the 6 patients who suffered irregular bleeding, 1 had a history of passage of a permanent suture from the vagina, and 2 had undergone dilation and curettage (D&C) and were diagnosed with simple endometrial hyperplasia but failed to respond to hormone therapy. All 9 of the symptomatic patients failed to respond to antibiotics before removal of the retained suture and preoperative ultrasound failed to confirm the cause of the abnormal bleeding. All 14 patients were diagnosed by hysteroscopic visualization of permanent suture in the cesarean scar (Fig. 1). The sutures were removed under direct hysteroscopic visualization. Postoperative pathology revealed that among the 6 patients who presented with irregular menstrual bleeding, 3 had simple endometrial hyperplasia, 1 had endometritis, and 2 had both endometritis and endometrial polyps. In the 2 patients who presented with prolonged periods, 1 had endometrial polypoid hyperplasia and 1 had endometritis. The patient who presented with bloody discharge had endometritis. All 9 symptomatic patients were followed-up for 3 months after the surgery, and all recovered from abnormal bleeding. In order to determine the source of this aberrant operative procedure, we succeeded in communicating with 7 of the surgeons who had conducted the cesarean deliveries and learned that they had used permanent suture to close the myometrial layer of the uterus because of the cheaper cost or lack of absorbable suture. Removal of the suture is the critical component necessary to eliminate symptoms. Concurrent treatment, such as removal of endometrial polyps, use of hormones for cycle control, and use of antibiotics to control infection can be ancillary aids. Some patients might experience symptom recurrence because of the later extrusion of retained suture from the myometrium which was not seen during the initial surgery and patients should be informed of this possibility.

MircroRNA-139 sensitizes ovarian cancer cell to cisplatin-based chemotherapy through regulation of ATP7A/B

PurposeOvarian cancer remains a most malignant female cancer nowadays. The acquisition of chemoresistance to common-used cisplatin-based chemotherapy results in a decreased overall patient survival. The present study is aimed to investigate the role and mechanism by which miR-139/ ATPases7A/B axis modulates the chemoresistance of ovarian cancer to cisplatin-based chemotherapy.MethodsThe expression of miR-139 in cisplatin-sensitive (n = 23) and cisplatin-resistant (n = 14) ovarian cancer tissues and cell lines (CAOV-3 and SNU119) was determined using real-time PCR assays; its effect on ovarian cancer cell chemoresistance to different concentrations of cisplatin was then assessed by measuring the cell viability using MTT assays. Next, miR-139 binding to the 3′UTR of ATP7A/B was confirmed using luciferase reporter gene assays. Finally, the combined effect of miR-139 and ATP7A/B on the chemoresistance of ovarian cancer cell was assessed.ResultsmiR-139 expression was down-regulated in cisplatin-resistant ovarian cancer tissues (**P < 0.01) and reduced by cisplatin treatment in ovarian cell lines (*P < 0.05, **P < 0.01); miR-139 could enhance cisplatin-induced suppression on ovarian cancer cell viability, shown as reduced lC50 values; ATP7A and ATP7B protein levesincreased approximately 2 ~ fold-changein cisplatin-resistant cell lines. MiR-139 directly bound to the 3′UTR of ATP7A/B, respectively; miR-139 inhibition increased lC50 values whereas ATP7A/B knockdown reduced lC50 values of CAOV-3 and SNU119 cell lines under cisplatin treatment; the effect of miR-139 inhibition could be partially attenuated by ATP7A/B knockdown.ConclusionsMiR-139/ATP7A/B axis can be a reliable biomarker for ovarian cancer diagnosis, and may affect the chemoresistance of ovarian cancer to cisplatin-based chemotherapy; rescuing miR-139 expression thus to inhibit ATP7A/B might contribute to dealing with the chemoresistance of ovarian cancer.

Hysteroscopy- and laparoscopy-based diagnosis and treatment of girls with unbroken hymen with an obstructing uterine septum: two case reports

IntroductionObstructing uterine septum is a rare uterine malformation. Patients with obstructing uterine septum are usually treated with laparouterotomy, causing obvious injury to both the uterus and body of the patients. Therefore, using the natural channel of the vagina is undoubtedly the best way to carry out the surgery. However, obstructing uterine septum usually occurs in puberty in girls without a history of sexual intercourse, thus iatrogenic damage to the hymen during the diagnosis and treatment cannot probably be avoided. However, Chinese people traditionally tend to use hymen intactness as a standard to judge whether an unmarried woman is chaste. Therefore, in China, to protect the hymen from damage during hysteroscopic diagnosis and treatment is of special significance for girls and women with unbroken hymens. None of the previously reported cases were treated with electrosurgical obstructing uterine septum excision based on B-ultrasound-guided hymen-protecting hysteroscopy and laparoscopy.Case presentationCase 1 patient was a virgo intacta 13-year-old Chinese girl. She was admitted due to an 8-day post-menstruation lower abdominal pain. With the guidance of B-ultrasound, we observed a 30mm×20mm mixed echogenicity mass in her uterine cavity. Case 2 patient was a virgo intacta 14-year-old Chinese girl. She was admitted to our hospital more than 6 months after secondary dysmenorrhea and 6 days after B-ultrasound-diagnosed uterine malformations. We observed a 30mm×25mm mixed echoic area in her uterine cavity with the guidance of B-ultrasound.Both patients were surgically treated without hymen damage with B-ultrasound-guided combined therapy of hysteroscopy and laparoscopy. A needle electrode with an 8mm diameter was placed into their uterine cavities under hysteroscopy. After obstructing uterine septum removal, their uterine cavities showed normal morphology. To protect their hymens, misoprostol was placed into their rectums to soften their cervices, so that the hysteroscope could be inserted into their cavities without damaging their hymens.ConclusionVirgo intacta women with obstructing uterine septum could be treated with electrosurgical obstructing uterine septum excision based on B-ultrasound-guided hymen-protecting hysteroscopy and laparoscopy.

Occurrence of Multiple Müllerian Adenocele Inside the Uterine Body

Abstract Background: Female mullerian cysts are commonly found in the fallopian tube, sometimes in ovary, but it is rare for them to be found in the uterus. Mullerian cysts are formed by mucus secretion from these residual mullerian tissues, and they are usually single form. Case: A 51-year-old woman had a history of 4+ years of menstrual disorders, but was otherwise healthy. A pelvic mass was found 1 week before hospitalization. Bimanual examination disclosed that the uterus was slightly enlarged with average texture and good range of motion. After admission, a total laparoscopic vaginal hysterectomy and bilateral adnexal resection were performed with the patient under general anesthesia. Findings during the operation included the following: the uterine fundus was slightly enlarged with smooth surface and irregular shape, and the lower corpus had two oval-shaped cystic masses, measuring 5 cm × 4 cm and 5 cm × 3 cm, respectively. The larger one was connected to the left fallopian tube. The posterior seros...

Use of Suction Curettage in Operative Hysteroscopy

We investigated the efficiency of suction curettage used during operative hysteroscopy to facilitate removal of relatively large multiple endometrial polyps (MPs), single endometrial polyps (SPs), and submucous uterine myomas (SMs). Four hundred patients with MPs, 200 with SPs, and 60 with SMs were randomly selected into treatment group 1 (study group), and the same numbers of patients in each category was included in treatment group 2 (control group). In total, 1320 patients were recruited. The operator in group 1 used suction curettage to aid removal of the lesions, whereas the operator in group 2 used the conventional procedure. Operation times in the 2 treatment groups were recorded and compared. Surgical skills were described, and possible surgical complications were monitored. Mean (SD) operation time in patients with MPs, SPs, and SMs in group 1 vs group 2 was 4.5 (1.5) vs 15.0 (7.5) minutes, 5.5 (2.5) vs 12.0 (6.5) minutes, and 17.0 (4.5) vs 26.5 (8.5) minutes, respectively. Difference in operation time between the 2 treatment groups was significant (p<.001). No surgical complications occurred in either group. Suction curettage used to aid removal of relatively large MPs, SPs, and SMs during operative hysteroscopy is efficient, effective, and easy.