ABSTRACT
OBJECTIVE: To analysis the 10 cases of relaparotomy for intractable hemorrhage after emergency postpartum hysterectomy with massive transfusion. METHODS: Between January 1995 and December 2008, relaparotomies for intractable hemorrhage and unstable vital sign after emergency postpartum hysterectomy with massive transfusion were performed on 10 patients. Medical records were reviewed and detailed to collect clinical data including patients' clinical status, causes of bleeding, duration from hysterectomy to relaparotomy, bleeding sites, procedures for bleeding control, amount of transfusions, complications and prognosis. RESULTS: In relaparotomies, the points of bleeding were identified in all cases and multiple bleeding foci than one bleeding focus were found, and procedures for bleeding control were performed. In 8 cases, the bleeding were controlled successfully and these patients recovered without long term sequales. But in the other 2 cases, although the bleeding controls were successful during relaparotomy and bleeding amount decreased after relaparotomy, but bleeding amount increased the next day and angiographic embolizations were performed. These patients died due to multi-organ failure and continued bleeding. In one of these cases, the endotracheal intubation had been done on arrival at our hospital with postpartum hemorrhage after vaginal delivery at private clinic. In another case, the cardiopulmonary resuscitation was performed on arriving at our hospital with intractable bleeding after postpartum subtotal hysterectomy in other hospital. CONCLUSION: In most cases, bleeding controls for intractable bleeding after postpartum hysterectomy were successful during and after relaparotomy in spite of development of dilutional coagulopthy due to massive transfusion, and resulted in rapid recovery and good prognosis. Even though dilutional coagulopthy was developed because of massive transfusion, relaparotomy was safe and effective procedure for management of intractable hemorrhage after emergency postpartum hysterectomy with clotting factor replacement. If personnel and adequate clotting factor replacement are available, relaparotomy should not be delayed for management of intractable hemorrhage and unstable vital sign after emergency postpartum hysterectomy.
Subject(s)
Humans , Cardiopulmonary Resuscitation , Emergencies , Hemorrhage , Hysterectomy , Intubation, Intratracheal , Medical Records , Postpartum Hemorrhage , Postpartum Period , Prognosis , Vital SignsABSTRACT
A 41-year-old female underwent an uneventful cesarean section, which was followed by a pulmonary saddle embolism complicated by cardiac arrest. This case shows that successful embolectomy is possible, despite a potentially lethal pulmonary saddle embolism, 34 cm in length, and intra-operative cardiopulmonary resuscitation. We report our case and discuss the anesthetic considerations based on the literature.
Subject(s)
Adult , Female , Humans , Pregnancy , Cardiopulmonary Resuscitation , Cesarean Section , Embolectomy , Embolism , Heart Arrest , Pulmonary EmbolismABSTRACT
OBJECTIVE: To evaluate the expression of vascular endothelial growth factor (VEGF) and matrix metalloproteinases (MMPs) in the progression of cervical cancer. METHODS: A total 87 specimens of uterine cervix, representing 6 normal epithelium, 11 intraepithelial neoplasm, 25 cervical carcioma in situ (CIS), 19 cervical microinvasive carcinoma and 26 cervical invasive carcinoma, were evaluated. All specimens were prepared with tissue array method which can allow evaluation many specimens in one slide. The protein expressions of VEGF and MMPs (MMP-2, MMP-9) were evaluated by immunohistochemical staining. RESULTS: The protein expressions of VEGF and MMP-2 were increased significantly with the progression of cervical cancer (p0.05). The VEGF and MMP-2 expressions revealed positive correlations with the progression of cervical cancer. CONCLUSIONS: The VEGF, MMP-2 in each or together may play a role in the progression of cervical cancer.
Subject(s)
Female , Carcinoma in Situ , Cervix Uteri , Epithelium , Matrix Metalloproteinases , Uterine Cervical Neoplasms , Vascular Endothelial Growth Factor AABSTRACT
We experienced a case of acute postpartum cardiomyopathy after cesarean section. A twin-pregnant woman at 36 weeks gestation showed pregnancy-induced hypertension. After an emergency cesarean section, shortness of breath, paroxysmal dyspnea, hypertension, and tachycardia developed in the recovery room. She was diagnosed with acute peripartum cardiomyopathy.
Subject(s)
Female , Humans , Pregnancy , Cardiomyopathies , Cesarean Section , Dyspnea , Dyspnea, Paroxysmal , Emergencies , Hypertension , Hypertension, Pregnancy-Induced , Peripartum Period , Postpartum Period , Recovery Room , TachycardiaABSTRACT
We experienced a case of acute postpartum cardiomyopathy after cesarean section. A twin-pregnant woman at 36 weeks gestation showed pregnancy-induced hypertension. After an emergency cesarean section, shortness of breath, paroxysmal dyspnea, hypertension, and tachycardia developed in the recovery room. She was diagnosed with acute peripartum cardiomyopathy.
Subject(s)
Female , Humans , Pregnancy , Cardiomyopathies , Cesarean Section , Dyspnea , Dyspnea, Paroxysmal , Emergencies , Hypertension , Hypertension, Pregnancy-Induced , Peripartum Period , Postpartum Period , Recovery Room , TachycardiaABSTRACT
Retroperitoneal hemorrhage caused by intra-abdominal vascular injury during pregnancy or puerperium is rare, but a very fatal complication. Massive retroperitoneal hemorrhage causes the high mortality rate of mother and fetus. But the difficulty of diagnosis and rarity may delay prompt treatment. We experienced a case of massive retroperitoneal hemorrhage, which was caused by a suspected left lumbar artery aneurysm rupture on the fifth day of vaginal delivery. The patient was successfully treated by surgery and arterial embolization. We reported this case with a brief review of literature.
Subject(s)
Humans , Pregnancy , Aneurysm , Arteries , Diagnosis , Fetus , Hemorrhage , Mortality , Mothers , Postpartum Hemorrhage , Postpartum Period , Rupture , Rupture, Spontaneous , Vascular System InjuriesABSTRACT
Unclassified type occupies about 5 to 10 percent of all ovarian sex cord stromal tumors. Diagnosis is very difficult and subjective because tumors show insufficient differentiation to ovarian or testicular line or display insufficient findings to diagnose as a gynandroblastoma in spite of divergent differentiation. To our knowledge sixty-two cases have been reported in the pathology literatures as yet. The behavior of this group of tumors has not been adequately studied but is similar to granulose cell tumors or Sertoli-Leydig cell tumors. We present a case of unclassified sex cord-stromal tumor which has been experienced in our hospital with brief review of the literature.
Subject(s)
Female , Diagnosis , Ovary , Pathology , Sertoli-Leydig Cell Tumor , Sex Cord-Gonadal Stromal TumorsABSTRACT
The cervical pregnancy is a rare condition representing less than 1% of ectopic gestations. But, it is potentially life-threatening condition because of profuse hemorrhage and requires hysterectomy in some cases. With ultrasound, diagnosis can be made earlier and conservative management is attempted in order to preserve the reproductive potential. Most cervical pregnancies are implanted within the cervical canal below the internal os of the cervix. However, we experienced one case of a unique viable cervical pregnancy in anterior lip of the cervix and treated successfully by local injection of potassium chloride into gestational sac and systemic methotrexate treatment.
Subject(s)
Female , Pregnancy , Cervix Uteri , Diagnosis , Gestational Sac , Hemorrhage , Hysterectomy , Lip , Methotrexate , Potassium Chloride , Potassium , UltrasonographyABSTRACT
We experienced a case of fetal supraventricular tachycardia (SVT) with fetal ascites diagnosed at 29 weeks of gestation in 29 year-old primigravida woman. Transplacental fetal therapy with maternal oral antiarrhythmic agent (verapamil, diltiazem) resulted in restoration of normal fetal sinus rhythm and disappearance of fetal ascites. At birth, the infant did not show any cardiac arrhythmia and hydropic appearance.
Subject(s)
Adult , Female , Humans , Infant , Pregnancy , Arrhythmias, Cardiac , Ascites , Diltiazem , Fetal Therapies , Hydrops Fetalis , Parturition , Tachycardia, Supraventricular , VerapamilABSTRACT
Pregnancy complicated by aplastic anemia is uncommon condition with the significant morbidity and mortality rates. the main complication to mother is hemorrhage due to thrombocytopenia and sepsis due to leukopenia and mortality rate in pregnancy complicated by aplastic anemia is more than 20%. But it remain controversy whether pregnancy play a pathogenic role in the development of the disease. We experienced a patient with severe aplastic anemia in pregnancy who was treated with supportive transfusion of red blood cells and platelets and so we present it here with brief review of literature.
Subject(s)
Humans , Pregnancy , Anemia, Aplastic , Erythrocytes , Hemorrhage , Leukopenia , Mortality , Mothers , Sepsis , ThrombocytopeniaABSTRACT
OBJECTIVE: To compare the advantages and disadvantages between total vaginal hysterectomy (VTH) and laparoscopically assisted vaginal hysterectomy (LAVH) including the indications and safety. METHODS: We reviewed the medical records of patients who underwent VTH from July 1998 to December 1999 and those who underwent LAVH from January 2000 to April 2002. We evaluated age, parity, previous abdominal operations, indications for hysterectomy, combined operations, operation time, bleeding amount, hemoglobin change, weight of uterus, and postoperative complications. RESULTS: 1. Age was not a notable factor but parity was significantly lower in LAVH group. 2. In VTH group, 48% of patients had previous operations compared with 46% in LAVH group. 3. The most common indication for hysterectomy of both group was uterine myoma. 4. The weight of hysterectomized specimen was 256 g in VTH group and 237 g in LAVH group. 5. In VTH group, 38% received concurrent surgical procedures of which colporrhaphy was the most common (14 cases). In LAVH group, 72.5% received concurrent surgical procedures of which salpingoo- phorectomy was most common. 6. The operation time showed a notable difference; 78.6 min. in VTH group and 105.4 min. in LAVH. 7. There was no significant difference in bleeding amount and hemoglobin change. 8. Postoperative complication was higher in VTH group (14%) than LAVH group (7.5%). However all the patients recovered with conservative treatment and close observation. CONCLUSION: Both VTH and LAVH had the following advantages compared with abdominal hysterectomy: less pain, shorter hospital stay, cosmetic advantages, lower prevalence. In this study we found out that in VTH, the procedure could be done safely even if the uterus was big or with previous abdominal operations. Limited operation field and the fact that we couldn't check the abdominal cavity were some disadvantages. In comparison, LAVH offered a view of the abdominal cavity which make easy adnexal operation but because of expensive operative tools, cost was a problem. In order to satisfy the patient and lower the cost, appropriate study on the indications and training on procedures will be necessary.
Subject(s)
Female , Humans , Abdominal Cavity , Bleeding Time , Hemorrhage , Hysterectomy , Hysterectomy, Vaginal , Leiomyoma , Length of Stay , Medical Records , Parity , Postoperative Complications , Prevalence , Uterine Prolapse , UterusABSTRACT
Immature teratoma is composed of varying quantities of immature differentiating among anyone or all three germ layer. The pure immature teratoma accounts for fewer than 1% of all ovarian cancer, but it is the second most common germ cell malignancy. About 50% of pure immature teratomas of the ovary occur in women between the ages of 10 and 20 years, and they rarely occur in postmenopausal women. The most frequent site of dissemination is the peritoneum, and much less commonly, the retroperitoneal lymph node. Among the tumors with embryonal elements, those containing neural tissues demonstrate most clearly the importance of the ability to mature. Gliomatosis peritonei is the most dramatic demonstration of the significance of maturation, because most patients with these tumors have survived, even with this disseminated disease. The purpose of this paper is to report on a immature ovarian teratoma with predominantly mature glial tissues in peritoneum which we have experienced in this hospital recently with brief review of the literature.
Subject(s)
Female , Humans , Germ Cells , Germ Layers , Lymph Nodes , Ovarian Neoplasms , Ovary , Peritoneum , TeratomaABSTRACT
Trisomy 13 (Patau syndrome) is rare and usually fatal if contracted within the first six months of life. We report a case of a male fetus with the typical features of Patau syndrome. He was terminated in a 27-year-old mother at the gestational age of 32+4 weeks. In chromsomal analysis by GTG banding technique, the karyotype of the fetus was 46,XY,rec(13) dup(13q)inv(13)(p13q21.3)(=partial trisomy 13q); and his mother's karyotype was 46,XX, inv(13)(p13q21.3)(=pericentric inversion). His father had normal karyotype, 46,XY. Ultrasonography showed fluid-nature content, which was occupying the entire intracranium, but preserving the brain stem and cerebellum. Postmortem examination disclosed holoprosencephaly, hydrocephalus, a single nostril, bilateral anophthalmia, ventricular septal defect, and a single umbilical artery.
Subject(s)
Adult , Humans , Male , Anophthalmos , Autopsy , Brain Stem , Cerebellum , Fathers , Fetus , Gestational Age , Heart Septal Defects, Ventricular , Holoprosencephaly , Hydrocephalus , Karyotype , Karyotyping , Mothers , Single Umbilical Artery , Trisomy , UltrasonographyABSTRACT
Sclerosing stromal tumor, which was first described by Chalvardjian and Scully in 1973, is a very rare benign tumor of the ovary. This tumor differs from the fibroma, thecoma and lipoid cell tumor clinically and pathologically by showing prominent pseudolobular pattern and hypervascularity. We experienced a case of sclerosing stromal tumor of the ovary in 38 year-old woman. We report this case with a brief review of the literature.
Subject(s)
Adult , Female , Humans , Fibroma , Ovary , ThecomaABSTRACT
Trisomy 18, called Edward syndrome, occurs in about 3500-8000 births. It is much more common at conception, with about 95% of cases resulting in spontaneous abortion or stillbirth. Postnatal survival is poor, with the majority of patients dying in early infancy. Characteristic findings include cardiac malformations, mental retardation, growth retardation, a prominent occiput, micrognathia, clenched hands, and rocker-bottom feet, omphalocele. The prenatal sonographic findings of our case include delayed growth, omphalocele, wrist joint fixation, choroid plexus cyst, hydramnios and postnatal gross findings include growth retardation, omphalocele, wirst joint fixation, absence of radius, syndactyly, focal absence of phalanges and flexion deformities of fingers and toes. We report a case of prenatally diagnosed Edward syndrome, which is confirmed by chromosome analysis, with brief review of related literatures.
Subject(s)
Female , Humans , Pregnancy , Abortion, Spontaneous , Choroid Plexus , Congenital Abnormalities , Fertilization , Fingers , Foot , Hand , Hernia, Umbilical , Intellectual Disability , Joints , Parturition , Polyhydramnios , Radius , Stillbirth , Syndactyly , Toes , Trisomy , Ultrasonography , Ultrasonography, Prenatal , Wrist JointABSTRACT
OBJECTIVE: To compare cervical dilatation efficacy and safety of intravaginal misoprostol with that of cervical laminaria tent insertion in endometrial curettage due to abnormal uterine bleeding METHOD: Patients requesting endometrial curettage due to abnormal uterine bleeding were randomized into two group. In group I (n=53), 100 g tablet of misoprostol was placed in the posterior vaginal fornix at midnight. In Group II (n=54), laminaria tent number 5 was inserted in cervical canal at midnight. Endometrial curettage was performed on the next morning. The degrees of cervical dilatation were measured by Hegar dilator just before endometrial curettage. Both groups were compared about cervical dilatation efficacy and side effect. RESULT: The degrees of cervical dilatation were 8.8+/-1.1 mm in group I and 9.3+/-1.9 mm in group II. There was no significant statistical difference. (P=0.134) The mean intervals from the use of misoprostol or laminaria to endometrial curettage were 704+/-140 minutes in group I and 829+/-156 in group II. In group I, mild fever (less than 38 degrees) was observed in four women and one complained mild abdominal pain. In group II, five women revealed mild fever and fifty women complained abdominal discomfort. All didn't need any medication or special therapy. CONCLUSION: Intravaginal misoprostol was appeared as efficacious as laminaria tent in cervical dilatatory effect before endometrial curettage in abnormal uterine bleeding patients. It was considered more convenient, safer and more cost effective method compared than cervical laminaria tent in cervical preparation before endometrial curettage.
Subject(s)
Female , Humans , Pregnancy , Abdominal Pain , Curettage , Fever , Labor Stage, First , Laminaria , Misoprostol , Uterine HemorrhageABSTRACT
Obstetrical hemorrhage is one of the deadly triad, along with hypertensive disorder in pregnancy and infection. Postpartum hemorrhage is the major cause of obstetrical hemorrhage. Uterine atony is the most common cause of postpartum hemorrhage, and resulted from poor uterine contraction after delivery of the fetus and placenta. Initial management to control postpartum uterine atonic bleeding is based on the use of uterotonics such as well known oxytocin and ergot preparations together with uterine massage. Prostaglandin E2 analogue, sulprostone can be used next when these agents are failed to produce uterine contraction. The woman unresponsive to non-surgical managements requires surgical interventions including emergency hysterectomy. Recently prostaglandin E1 analogue, misoprostol, has been known to elicit potent uterine contraction and cervical ripening after oral, vaginal or rectal administration. We have experienced two cases of postpartum uterine atonic bleedings which were unresponsive to oxytocin, ergot, or prostaglandin E2, but were successfully controlled by rectal administration of misoprostols.
Subject(s)
Female , Humans , Pregnancy , Administration, Rectal , Alprostadil , Cervical Ripening , Dinoprostone , Emergencies , Fetus , Hemorrhage , Hysterectomy , Massage , Misoprostol , Oxytocin , Placenta , Postpartum Hemorrhage , Postpartum Period , Uterine Contraction , Uterine InertiaABSTRACT
No abstract available.