Symptomatic hyponatremia and hyperglycemia complicating hysteroscopic resection of intrauterine adhesion: a case report / 中华医学杂志(英文版)

Hysteroscopic surgery is a minimally invasive procedure for the treatment of intrauterine pathologies. However, it can result in fatal complications. We herein report a case of symptomatic hyponatremia and hyperglycemia during hysteroscopic resection of severe intrauterine adhesion with 5% dextrose in water as the distension medium. Because of the difficulty of the incision, the infusion pressure was 100 to 150 mmHg, and surgery was continued for 70 minutes. A total of 19 L of 5% dextrose in water was used as an irrigating fluid. Large-scale absorption of irrigating fluid (3 L) induced dilutional hyponatremia (120 mmol/L) and hyperglycemia (30 mmol/L). Initial signs were abnormal flatulence and postoperative coma. Hypertonic saline, diuretics, insulin, and liquid restriction were the prevailing treatment strategies for hyponatremia and hyperglycemia. Ionized calcium and potassium levels decreased during treatment. We emphasize the importance of prevention, recognition, and a meticulous perioperative treatment standard. Surgical teams must be vigilant in fluid deficit monitoring and serum electrolyte analysis.

Predisposing factors, diagnosis, treatment and prognosis of cerebral venous thrombosis during pregnancy and postpartum: a case-control study / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Previous investigations have demonstrated a relatively low incidence of stroke among young women, though both pregnancy and delivery can substantially increase the risk. Cerebral venous thrombosis may manifest different characteristics during pregnancy and postpartum as a result of their specific physiological statuses. This study aimed to identify the clinical manifestations, diagnosis, treatment, and prognosis of cerebral venous thrombosis during pregnancy and postpartum.</p><p><b>METHODS</b>We conducted a retrospective analysis of 22 patients with cerebral venous thrombosis who were assigned to either group A (during pregnancy) or group B (during postpartum). The relevant risk factors, initiation and development of the disease, clinical presentations, diagnosis, treatment, and prognosis were compared between the two stages.</p><p><b>RESULTS</b>Cerebral venous thrombosis occurred during both pregnancy and postpartum, but was more common postpartum. Patients in group A had a longer hospitalization period than those in group B. Confirmed predisposing factors in 85.7% of patients of group A were dehydration, infection, and underlying cerebrovascular disorders. No obvious predisposing factors were identified in group B. The most frequent symptom was headache, with epileptic seizures, hemiparalysis and aphasia being less frequent symptoms. Focal neurological symptoms (P = 0.022) and cerebral infarction (P = 0.014) occurred more frequently in group A than in group B. Anticoagulation therapy proved to be safe for cerebral venous thrombosis patients during puerperium, regardless of parenchymal hemorrhage. However, more attention should be paid to spontaneous in-site placental hemorrhage in pregnant patients. Both groups had similar prognoses (P = 1.000), with 36.3% patients suffering from consequential dysfunction or recurrent intracranial hypertension. Delayed diagnosis was associated with a poorer prognosis.</p><p><b>CONCLUSIONS</b>Cerebral venous thrombosis manifests different clinical characteristics during pregnancy and postpartum, though both have a good prognosis. Early diagnosis and prompt anticoagulation therapy are essential.</p>

Combination of methotrexate injection through hysteroscopic tubal catheterization and mifepristone per os in the conservative treatment of tubal pregnancy / 中国医学科学院学报

<p><b>OBJECTIVE</b>To evaluate the value of the combination of methotrexate(MTX) injection through hysteroscopic tubal catheterization and mifepristone per os in the conservative treatment of tubal pregnancy.</p><p><b>METHODS</b>Forty patients who met the criteria of conservative treatment were enrolled in this study and received the combined therapy of MTX 50 mg/d injection through hysteroscopic tubal catheterization and oral mifepristone 100mg/d for 5 days.</p><p><b>RESULTS</b>Of these 40 patients, 38 (95.0%) were cured. The human chorionic gonadotropin decreased to normal level within 3-48 days. The masses disappeared within 16-65 days. The menstruation returned normal within 28-42 days. No obvious side effect was observed. Of 30 patients who underwent hydrotubation through hysteroscopy three months later, 12 patients were unobstructed, 2 patients were completely obstructed, and 16 patients were partially obstructed. Five patients had full-term deliveries up to this report.</p><p><b>CONCLUSION</b>The combination of MTX injection through hysteroscopic tubal catheterization and mifepristone per os is safe and effective for early tubal pregnancy.</p>