A large intrauterine vascular lesion developing after the successful treatment of a cesarean scar pregnancy with methotrexate injection.

A cesarean scar pregnancy is a rare type of ectopic pregnancy. Induced abortion by local methotrexate (MTX) injection is an effective management approach. We describe a case in which a large intrauterine vascular lesion appeared after the sonographic-guided local injection of MTX, which successfully induced the abortion of the cesarean scar pregnancy. Although a cesarean scar pregnancy may be safely treated with a local MTX injection, close follow-up, including serum ß-human chorionic gonadotropin level measurement and Doppler sonography, is needed because an intrauterine vascular lesion could develop even after a successfully induced abortion. © 2017 Wiley Periodicals, Inc. J Clin Ultrasound 46:222-226, 2018.

Acquired uterine vascular abnormalities associated with persistent human chorionic gonadotropin: Experience at a Korean teaching hospital.

OBJECTIVE: The aim of this study was to describe our experience with the diagnosis and management of acquired uterine vascular abnormalities associated with persistent human chorionic gonadotropin (hCG). Through this case series, we sought to establish our protocol for the treatment and follow-up of uterine vascular lesions associated with persistent hCG. MATERIALS AND METHODS: We examined the clinical presentations of 28 Korean women with acquired vascular uterine abnormalities associated with persistent hCG who were seen in the Department of Obstetrics and Gynecology of the Gangneung Asan Teaching Hospital, Gangneung-si, Korea between October 2006 and July 2012 and retrospectively reviewed their medical records. RESULTS: The mean patient age was 32.5 ± 6.4 years, and the mean parity was 1.4 ± 1.2. The mean size of the vascular lesions in color Doppler sonography and multidetector computed tomography with angiography was 3.1 ± 1.6 cm and 3.9 ± 1.6 cm, respectively. Multidetector computed tomography revealed arteriovenous malformation-like vascular lesions (n = 15) and pseudoaneurysms (n = 3). Treatments included clinical observation (n = 11), uterine artery embolization (n = 11), hysterectomy (n = 4), and chemotherapy, including single methotrexate (MTX) treatment and combination chemotherapy (n = 9). CONCLUSION: When the uterine vascular lesion is not decreased, or if weekly clinical follow-up reveals that the serum ß-hCG level is persistently elevated or sustained in conjunction with vaginal hemorrhage, a proper management strategy is required.

Correlation between postpartum depression and premenstrual dysphoric disorder: Single center study.

OBJECTIVE: To describe the prevalence and correlates of the postpartum depression and premenstrual dysphoric disorder. METHODS: One hundred sixty six women were assessed around 10th to 14th days after delivery in Gangneung Asan Hospital, Korea, from September 2011 to March 2012. We checked their risk factors for postpartum depressive disorders using the Beck Depression Inventory and the Edinburgh Postnatal Depression Scale. Premenstrual dysphoric disorder was evaluated retrospectively and was defined as having more than 5 of the following 10 symptoms: breast tenderness, bloating, headache, peripheral edema (hand and foot), depressive symptoms, anger, irritability, anxiety, oversensitivity, and exaggerated mood swings. RESULTS: The prevalence rate of postpartum depression using the Edinburgh Postnatal Depression Scale ≥10 and Beck Depression Inventory ≥10 was 13.9% (23/166). We found statistical differences (P<0.01) between the postpartum depression group and the postpartum non-depression group in smoking history, past history of psychiatric problems, and level of marital satisfaction. The prevalence rate of premenstrual syndrome (PMS) was 9% (15/166) and among 23 women in the postpartum depression group, eight were determined to have premenstrual dysphoric disorder, yielding a prevalence rate of 34.8% (8/23). Among 143 women in the postpartum non-depression group, seven were determined to have PMS, yielding a prevalence rate of 4.9% (7/143). A correlation between postpartum depression and PMS was thus found (P<0.01). CONCLUSION: PMS appears to be associated with postpartum depression. This means that a hormone-related etiology appears to be one risk factor for postpartum depression.

Transumbilical retrieval of surgical specimens through a multichannel port.

BACKGROUND: Laparoscopic surgery is often used to excise adnexal masses; however, the retrieval of specimens such as large cystic masses through conventional 5- or 10-mm ports is difficult and time-consuming. We compared outcomes between conventional laparoscopic surgery for adnexal masses and transumbilical specimen retrieval through a multichannel port during single- or 2-port laparoscopy. METHODS: A total of 341 patients who underwent laparoscopic surgery for adnexal masses from November 2006 to December 2010 were included. The patients were divided into 2 groups: group I consisted of 249 patients who underwent conventional laparoscopy, and group II consisted of 92 patients who underwent single- or 2-port laparoscopy using a multichannel port. The clinical characteristics and operative outcomes of the 2 groups were compared. RESULTS: The mean operation time was 51.8 ± 21.5 minutes in group I and 57.2 ± 23.9 minutes in group II. The mean specimen retrieval time was longer in group I (2.9 ± 4.0 minutes) than in group II (2.2 ± 1.8 minutes). Endoscopic bag rupture during specimen retrieval occurred in 11 patients in group I and in no patients in group II. CONCLUSIONS: The transumbilical retrieval of surgical specimens through a multichannel port with a wound retractor was safe and did not result in leakage of the cystic contents. This technique reduced the specimen retrieval time, especially for large masses. However, the mean operation time was not shortened with this procedure, because of the learning period and the time required to prepare the umbilical multichannel port.

Successful management of maternal factor VII deficiency in a cesarean section.

Factor VII (FVII) deficiency is an infrequent hereditary bleeding disorder that can make excessive bleeding in surgical interventions, such as a postpartum hemorrhage in a cesarean section. Although a recombinant form of activated FVII has been applied for bleeding control in FVII-deficient patients, its applications in the field of obstetrics are still limited, especially in Korea. Replacement of blood products is still preferred as first-line therapy, with antifibrinolytic agents used as adjunctive therapy. We report herein the case of a successful cesarean section in an 18-year-old woman with FVII deficiency.

Endometrioid adenocarcinoma arising from endometriosis of the uterine cervix: a case report.

Endometrioid adenocarcinoma arising from endometriosis of the uterine cervix is rare in premenopausal woman. We describe here a patient with this condition and review the clinical and pathological features of these tumors. A 48-yr-old woman complaining of severe dysmenorrhea was referred for investigation of a pelvic mass. Total abdominal hysterectomy and bilateral salpingo-oophorectomy were performed. Histological examination revealed an endometrioid adenocarcinoma directly adjacent to the endometriosis at the uterine cervix, with a transition observed between endometriosis and endometrioid adenocarcinoma. The patient was diagnosed as having endometrioid adenocarcinoma arising from endometriosis of the uterine cervix and underwent postoperative chemotherapy. Gynecologists and pathologists should be aware of the difficulties associated with a delay in diagnosis of endometrioid adenocarcinoma arising from endometriosis when the tumor presents as a benign looking endometrioma.

Two-port total laparoscopic hysterectomy with a multichannel port.

Total laparoscopic hysterectomy (TLH) is often performed in many countries. TLH has been shown to involve shorter hospital stays, as well as less bleeding and postoperative pain, than conventional abdominal hysterectomy. The skin incision for the laparoscopy is smaller than that of the laparotomy, but multiple incisions may decrease the cosmetic satisfaction of patients. The multiple puncture sites also increase the cost of trocars and trocar-associated complications, such as bleeding, hernias, and wound infection. Therefore, in this paper we introduce a two-port TLH technique with a multichannel port employing the transumbilical one-port technique performed by Ryu et al. To perform a two-port TLH, the ancillary 5-mm trocar was inserted at the left iliac fossa under laparoscopic view. The inserted umbilical trocar was removed and the skin incision was extended about 1.5 cm. An Alexis wound retractor XS (Applied Medical) was inserted through the extended umbilical wound. The wrist portion of a 6 (1/2) rubber glove covered the wound retractor, and two trocars were inserted into the fingers of the glove and ligated with rubber bands. A 5- or 10-mm laparoscope and atraumatic forceps were inserted through the umbilical port. TLH was performed in the usual manner. This two-port method would be cost-effective considering the conventional laparoscopic instruments. The development of multichannel trocars and minimized laparoscopic devices may confer less invasive operative techniques that also cause less scarring.