Drainage by Ovarian Incision for the Treatment of Massive Ovarian Edema Torsion During Pregnancy.

Massive ovarian edema (MOE) is a rare benign condition presenting as unilateral ovarian enlargement with stromal edema, and only a limited number of MOE cases during pregnancy have been reported. MOE is often complicated by ovarian torsion, which requires detorsion. Although the diagnosis of MOE can be made using ultrasound and magnetic resonance imaging, its rarity makes diagnosis difficult, usually leading to overtreatment. Preserving the ovary in the treatment of MOE torsion is essential, and consideration of oophoropexy after detorsion is often reported. However, fixing an enlarged ovary to the pelvic wall in the limited space of the pelvis is challenging. Herein, we present a case of MOE of the right ovary diagnosed at the fifth week of gestation after ovulation induced by clomiphene citrate. Torsion of the ovary occurred in the seventh week. We achieved preservation of the ovary through laparoscopic surgery with detorsion and drainage by making a small incision to the enlarged ovary, resulting in an immediate size reduction. There was no recurrence of torsion or MOE throughout the pregnancy, and the patient gave birth in the 39th week of gestation. This is the third reported case of MOE after ovulation using clomiphene citrate, and it highlights the effectiveness of treatment with detorsion and a small incision of the ovary via laparoscopic surgery in patients with MOE torsion during pregnancy.

Measurement of blood-oxygen saturation using a photoacoustic technique in the rabbit hypoxemia model.

The golden standard method to obtain accurate blood oxygen saturation is blood gas analysis that needs invasive procedure of blood sampling. Photoacoustic technique enables us to measure real-time blood oxygen saturation without invasive procedure. The aim of this study is to use the photoacoustic technique, an optical method, for accurately determining oxygen saturation in vivo. We measured induced photoacoustic signals of arterial blood in the rabbit model of stable hypoxemia after irradiation at 750 and 800 nm. Oxygen saturation was calculated from the photoacoustic signals using two calibration curves. Calibration curve 1 is a conventional curve derived from the absorbance coefficient of hemoglobin, whereas calibration curve 2 is derived from the photoacoustic signals obtained from the original blood vessel model. Simultaneously, blood-gas analysis was performed to obtain the reference standard of oxygen saturation. Regression analysis and Bland-Altman analysis were performed to assess the accuracy of oxygen saturation obtained using the two methods. The oxygen saturation calculated using calibration curves 1 and 2 showed strong correlations with the reference standard in regression analysis (R = 0.965, 0.964, respectively). The Bland-Altman analysis revealed better agreement and precision with calibration curve 2, whereas there was significant underestimation of values obtained using calibration curve 1. Photoacoustic measurement of oxygen saturation using calibration curve 2 provided an accurate estimate of oxygen saturation, which was similar to that obtained using a portable blood-gas analyzer.

Size of uterine leiomyoma is a predictor for massive haemorrhage during caesarean delivery.

BACKGROUND: Uterine leiomyoma is a common benign tumour, and a risk factor for various complications during pregnancy and peripartum period. Peripartum haemorrhage is the most critical complication that can cause maternal death. Although the relationship of leiomyoma and peripartum haemorrhage has been indicated, little is known about the characteristics of leiomyoma as predictors for massive haemorrhage in caesarean delivery. OBJECTIVE: We examined whether characteristics of leiomyoma and pregnant patients could predict massive haemorrhage in women undergoing caesarean delivery. STUDY DESIGN: This is a single-institution, retrospective cohort study. We reviewed singleton caesarean deliveries between January 2005 and December 2011. We excluded women with the following risk factors for massive haemorrhage: abnormality of placental position, abruptio placentae, haemorrhagic diseases, hydramnios, and labour arrest after induction. Myomectomy was not performed during delivery. Multivariate logistic regression analysis was performed to identify predictors of massive intraoperative haemorrhage (≥1000 ml). The following predictors were evaluated: maternal age, body mass index, parity, gestational week, birth weight, number of leiomyomas, and volume of the largest leiomyoma. Detailed characteristics of leiomyomas were evaluated using sonography or magnetic resonance imaging. RESULTS: Seven hundred and fifty-nine women were included; 55 women (7.25%) had leiomyoma. Thirty-eight women with leiomyoma underwent magnetic resonance imaging scan. The median intraoperative haemorrhage was 939 ml (395-5296 ml) in women with leiomyoma and 689 ml (129-3060 ml) in women without. Multivariate analysis revealed that a largest leiomyoma ≥175 cm3 (odds ratio 6.4 [95% confidence interval: 1.5-27], P = 0.007), birth weight of ≥2500 g (2.3 [1.53.6], P < 0.001), and primipara (1.5 [1.1-2.1], P = 0.025) were significant predictors of massive intraoperative haemorrhage. CONCLUSIONS: The presence of a leiomyoma of ≥175 cm3, birth weight of ≥2500 g, and primipara were found to be predictors for massive intraoperative haemorrhage during caesarean delivery. A leiomyoma ≥175 cm3 which is equivalent volume to a 7 cm diameter sphere can be diagnosed in the first trimester using sonography. In cases of cesarean delivery with these predictors, preparation for massive haemorrhage, including storage of autologous blood, may be considered.

Appropriate timing of blood sampling for blood gas analysis in the ventilated rabbit.

BACKGROUND: Arterial and venous blood gas analyses (BGAs) are essential to evaluate devices that measure biological oxygenation. The appropriate timing of blood sampling for BGA after respiratory rate (RR) change in animal experiments has not been reported. This study investigated the appropriate timing of blood sampling for BGA in ventilated rabbits and whether venous samples are an alternative to arterial samples. MATERIALS AND METHODS: Under general anesthesia, 14 rabbits (body weight, 3.02 ± 0.09 kg) were ventilated and their RR was changed (40/min, 30/min, and 20/min). Blood was sampled through cervical arterial and venous catheters. Experiment 1: in seven rabbits, arterial BGA was measured at 0, 0.5, 1, 2, 3, 5, 10, 15, and 20 min after the RR change. Experiment 2: in seven different rabbits, simultaneous arterial and venous BGA were measured at 0, 2, 5, 10, 15, and 20 min after the RR change. RESULTS: Oxygen partial pressure (PO2) and saturation (SO2) of the arterial blood stabilized 0.5 min after the RR changed. In venous BGA, no index stabilized during observation. The arterial and venous values of the carbon dioxide partial pressure (PCO2) and pH had significant correlations (arterial PCO2 = 0.9316 × venous PCO2-4.4425 [r = 0.9178]; arterial pH = 1.0835 × venous pH-0.5795 [r = 0.9453]). CONCLUSIONS: In ventilated rabbits, arterial PO2 and SO2 stabilized in 0.5 min. No venous value stabilized after the RR change. Only the PCO2 and pH of venous samples may be an alternative to arterial samples under the defined formula.

Moyamoya disease and pregnancy: case reports and criteria for successful vaginal delivery.

Based on our experience with seven deliveries (five cesarean and two vaginal deliveries) in five women with Moyamoya disease, we discussed the appropriate method of delivery and anesthesia for patients with Moyamoya disease. In certain conditions, women with Moyamoya disease can successfully undergo vaginal delivery.

Analysis about the influence on the fetus infected with parvovirus B19 using amniotic erythropoietin and troponin-T.

OBJECTIVE: We tried to identify the influence on the fetus infected with parvovirus B19 (PB19) and retrospectively analyze the severity of fetal infection. METHODS: Twenty pregnant women who developed maternal PB19 infection were included in this study. A total of 20 amniotic fluid samples were collected for measurement of PB19-DNA, erythropoietin (Epo) and troponin-T (TnT). RESULTS: Of the 5 fetuses with hydrops, 2 were rescued by fetal therapy. Significant differences between groups were found for Epo and TnT: Epo 107.1 ± 45.3 mU/ml and TnT 0.040 ± 0.028 ng/ml (mean ± standard deviation) for the symptomatic fetus group; and Epo 18.9 ± 13.7 mU/ml and TnT 0.008 ± 0.014 ng/ml for the asymptomatic fetus group (p = 0.043 for both variables). Setting Epo ≥50 mU/ml as the predictor of disease onset resulted in an Odds ratio of 56.0, with a 95 % confidence interval of 7.68-1,108.76. CONCLUSION: The study has determined an amniotic Epo level of ≥50 mU/ml as a factor of the influence on the fetus infected with PB19. The measurement of amniotic Epo level combined with amniotic TnT level is effective for determining the severity of fetal hypoxia.

Can measurement of maternal anti-cytomegalovirus immunoglobulin-M antibody levels be used to screen for cytomegalovirus infection in embryos and fetuses?

AIMS: Our study aims to estimate whether measurement of maternal anti-cytomegalovirus immunoglobulin-M antibody (CMV-IgM) levels are useful as a screening method for achieving early detection of congenital CMV infection. MATERIAL AND METHODS: Levels of maternal CMV-IgM were measured by enzyme immunoassay in all (n =2865) pregnant women who visited our hospital in the first trimester during the period from January 2005 to December 2009. RESULTS: Among them, 21 individuals (0.73%) had a CMV-IgM titer of ≥0.08 and were judged to be CMV-IgM-positive. Informed consent was obtained from all 21 individuals to perform the confirmation test that quantifies the levels of cytomegalovirus DNA (CMV-DNA) in amniotic fluid by real-time polymerase chain reaction. However, only one (0.03%) of the 21 individuals was CMV-DNA-positive (CMV-DNA concentration, 1.0 × 10(4) copies/ml). CONCLUSION: In order to detect congenital CMV infection in early pregnancy, it is considered appropriate to use ultrasound for close examination of embryo or fetal symptoms indicative of CMV instead of performing serological screening based on CMV-IgM.

Multiple atypical polypoid adenomyoma of the uterus.

Atypical polypoid adenomyoma (APA) of the uterus is a rare neoplasm that predominantly occurs in premenopausal woman. It typically appears as a polypoid mass with a mixture of hyperintensity and hypointensity on T2-weighted MRI. We report a case of a 45-year-old woman with multiple APAs (33 and 22 mm). She underwent hysteroscopic resection. The diagnosis of APAs was histologically made by irregularly proliferating atypical endometrial glands that were admixed with a stroma. This is the first case of multiple APAs with radiological findings. It is important to recognize the possible multiplicity of APA for proper diagnosis.