Uterine artery chemoembolization followed by hysteroscopic resection for management of retained placenta accreta with marked vascularity after evacuation of first-trimester miscarriage in angular pregnancy: A case report.

BACKGROUND: Angular pregnancy is a rare form of eccentric intrauterine gestation. To determine the management strategy, angular pregnancy should be differentiated from interstitial pregnancy and cornual pregnancy. CASE: A 37-year-old woman (gravida 5, para 4) with no previous disease history was referred because of a retained placenta with hemorrhage 20 days following the manual vacuum aspiration of an intrauterine pregnancy performed after the diagnosis of miscarriage at 8 weeks of gestation. At the initial examination, a prominent vascular mass was identified in the left lateral portion of the uterus. The patient's serum ß-human chorionic gonadotropin level was 1949 IU/L. Magnetic resonance imaging revealed an enlarged angular space occupied by a suspected retained placenta with expansion of the surrounding myometrium. Three-dimensional computerized tomography showed a prominent vascular mass with a feeding left uterine artery and draining thick left ovarian vein. The diagnosis consisted of retained placenta accreta with marked vascularity after evacuation of a miscarriage in a woman with angular pregnancy. Uterine artery chemoembolization was performed followed by the administration of a single dose of systemic methotrexate. Because the gestational mass persisted and spontaneous expulsion appeared to be unlikely, despite the gradual decline of serum ß-human chorionic gonadotropin levels, hysteroscopic resection of the retained placenta was performed and the patient's subsequent recovery was uneventful.

Screening of COVID-19 polymerase chain reaction tests using saliva for pregnant women and their partners in Himeji city.

A screening of coronavirus disease 2019 (COVID-19) polymerase chain reaction (PCR) tests using saliva for pregnant women and their partners was performed at all 12 maternity facilities located in Himeji city between May 29 and September 5, 2020. Pregnant women at 37 or more weeks of gestation or who experienced threatened labor and their partners who cared for an infant underwent a saliva PCR test with informed consent. As a result, all of 1475 pregnant women and 1343 partners tested negative for COVID-19 PCR. There were no cases of false positive or false negative PCR tests. This cohort study revealed for the first time that a screening of COVID-19 PCR tests using saliva may be useful to sustain perinatal medical care during the pandemic period in Japan.

Pure Choriocarcinoma of the Ovary in Silver-Russell Syndrome.

Pure ovarian choriocarcinoma is an extremely rare malignancy that can be gestational or non-gestational in origin. Silver-Russell syndrome (SRS) is a rare congenital developmental disorder characterized by pre- and postnatal growth failure, relative macrocephaly, a triangular face, hemihypotrophy, and fifth-finger clinodactyly. We report a rare case of pure ovarian choriocarcinoma occurring in a 19-year-old woman with SRS. Following surgery, multiple chemotherapy courses were effective and she was free of disease at the 10-month follow-up.

Effects of olprinone on neuromuscular blockade caused by vecuronium.

We studied the effect of olprinone on neuromuscular blockade caused by vecuronium. Thirty women undergoing nitrous oxide-oxygen-isoflurane anesthesia were randomly divided into olprinone (n=15) or control group (n=15). In the olprinone group, the patients received an intravenous initial loading dose of olprinone at a rate of 2 microg/kg/minute for 5 minutes, followed by a continuous infusion of olprinone at 0.3 microg/kg/minute. In the control group, the patients received normal saline. Thirty minutes after the beginning of the infusion of olprinone or normal saline, vecuronium (0.1 mg/kg) was administered. The degree of neuromuscular blockade was monitored electromyographically at the adductor pollicis muscle. The time to the onset of neuromuscular blockade, and to the return of the first, second, third, or fourth response in train-of-four (TOF; T1, T2, T3, or T4, respectively), and the time course of recovery of T1/control did not differ significantly between the groups. After 50-70 minutes of vecuronium, the TOF ratio (T4/T1) in the olprinone group was significantly higher than in the control group. During this period, the mean TOF ratios in the control and olprinone groups were 0.15-0.39 and 0.40-0.57, respectively. In conclusion, olprinone accelerates the recovery of the TOF ratio, and the quickening effect of olprinone on the recovery of the TOF ratio may be apparent 50-70 minutes after vecuronium in anesthetized patients receiving vecuronium.

Neuromuscular blockade can be assessed accelerographically over the vastus medialis muscle in patients positioned prone.

PURPOSE: To study accelerographic monitoring of neuromuscular blockade over the vastus medialis muscle in anesthetized patients in the prone position. METHODS: Sixty adult patients were divided into four groups of 15: prone (P)-post-tetanic count (PTC), P-train-of-four (TOF), supine (S)-PTC or S-TOF group. In the P-PTC and P-TOF groups, the muscular branch of the femoral nerve was stimulated and the movement of the vastus medialis muscle was measured accelerographically. In the S-PTC and S-TOF groups, the depth of neuromuscular blockade was assessed mechanically at the thumb. After administration of vecuronium 0.1 mg.kg(-1), TOF stimuli were delivered every 20 sec in all groups. Onset of neuromuscular blockade (time from vecuronium to the minimum level of T1 (first response of TOF) was compared between the P-PTC or P-TOF group and S-PTC or S-TOF group. Recoveries of PTC and those of TOF were compared between the P-PTC and S-PTC groups and P-TOF and S-TOF groups, respectively. RESULTS: Onset of neuromuscular blockade in the P-PTC or P-TOF group was shorter than in the S-PTC or S-TOF group (132 +/- 43 vs 233 +/- 40 sec, mean +/- SD, P < 0.001). Recoveries of PTC in the P-PTC and S-PTC groups followed a similar time course. Recoveries of T1/control in the P-TOF and S-TOF groups were also comparable. In contrast, train-of-four ratio (T4/T1, TOFR) in the P-TOF group was higher than in the S-TOF group 60-120 min after vecuronium (P < 0.05). CONCLUSIONS: The degree of neuromuscular blockade can be assessed accelerographically over the vastus medialis muscle even when patients are in the prone position. When evaluated accelerographically over the vastus medialis muscle, onset of neuromuscular blockade is quicker and TOFR is higher than that assessed at the thumb.