[Twin pregnancy complicated by single intrauterine death. Report of six cases and literature review].

From 1982 to 1991, six twin pregnancies, in which one of the fetuses died in utero, have been encountered. The causes of antepartum death in twin gestation could be identified in four cases; one with abruptio placenta, one with twin-to-twin transfusion syndrome, one with twisting of cord and one with velamentous insertion of cord. All six surviving infants had no abnormality in the follow-up of two to seven years. Although a conclusion about the prognosis could not be drawn from such a small series, these good results may have resulted from 1) 2 cases having been dichorionic twins, and 2) the other 4 monochorionic twins of 31-36 gestation weeks were delivered 1 to 5 days after the diagnosis. Conservative treatment was usually suggested until the fetal lung was mature enough for induction of labor. One case was treated after the death of its counterpart with tocolytic agent for a further 15 days because of prematurity. Cesarean section was performed finally for fetal distress resulting from chronic abruption placenta. The other five cases were delivered through vaginal route. According to experience as well as literature review, to improve the prognosis, obstetricians should be familiar with the management of one fetal death in twin pregnancy, especially in those with monchorionic twins.

[Transcervical resection of endometrium and submucous myomas].

Transcervical resection of the endometrium and submucous myomas using an unmodified urologic resectoscope has recently been developed as a treatment for menorrhagia and/or infertility when conservative management proves unsatisfactory but the patient desires to preserve the fertility or wishes to avoid hysterectomy. Through June 1990, 7 patients were treated with this procedure including one for endometrial ablation and six for transcervical myomectomy alone. No significant complication was seen and the results were relatively satisfactory in an average 7 1/2 months follow up. This approach seems a safe, effective surgical procedure and represents an attractive alternative to hysterectomy or abdominal myomectomy.

[Uterine lipoleiomyoma with calcification: report of a case].

Uterine lipoleiomyoma is uncommon and has received little attention from gynecologists. We report a case of uterine lipoleiomyoma with subsequent pelvic abscess after rupture of the appendix. Its clinical picture mimicked uterine malignancy. The patient was a 60-year-old woman, who presented with a 2-week period of lower abdominal pain which was exacerbated 10 days later. After admission, gynecologic examination revealed a large pelvic mass of firm consistency. On a plain film of the abdomen, there was a large calcified mass in the pelvis. Pelvic ultrasound demonstrated a 15 yen 12 yen 12 cm mass with strong echogenicity in the margin, but the central component of the mass was attenuating and revealed a poorly defined echogenic mass. A computed tomography scan of the pelvis demonstrated a well-encapsulated mass that was predominantly the density of fat (-65 Hounsfield unit) in the central part, with calcification present in the peripheral layer of the mass. There was also a cystic lesion measuring 3 yen 2.5 yen 1.5 cm in the right adnexal area. A preoperative diagnosis of uterine lipoleiomyoma with necrosis, liposarcoma of the uterus or teratocarcinoma of the ovary was made by the CT scan. A diagnostic dilatation and curettage (D&C) revealed a uterine cavity length of 12 cm by sounding, and the specimen showed no malignant tissue. Therefore, the preoperative suspicion of ovarian teratocarcinoma could be excluded. The patient underwent an exploratory laparotomy, multiple pockets of pelvic abscess, enlargement of the uterus and induration of omentum surrounding the appendix were found.(ABSTRACT TRUNCATED AT 250 WORDS)

Scrub typhus and pregnancy: a case report and literature review.

Scrub typhus is still prevalent on Penghu Islands. We herein report a case in a pregnant woman who had been to Yi-Lan County in Taiwan. The patient responded well to Minocycline (Minocin) therapy without complication. Her newborn baby was found not complicated with the disease. The relative literature is reviewed.

[Improved control of cisplatin-induced emesis with high-dose metoclopramide, dexamethasone and lorazepam].

Despite treatment, emesis remains a major problem with cisplatin chemotherapy. Three potent antiemetics, metoclopramide, dexamethasone and lorazepam, were combined in prophylaxis of 18 patients receiving cisplatin based combination chemotherapy. In 75 courses of chemotherapy, 57% experienced complete protection from vomiting and 89% of treatment courses had two or fewer vomiting episodes. Complete protection and mild episodes from nausea was 47% and 53% respectively. Toxicities were mild and infrequent. It was concluded that combination of high-dose metoclopramide, dexamethasone and lorazepam was highly efficacious in preventing nausea and vomiting in moderate or high-dose cisplatin chemotherapy with little side effects.

[Chlamydia trachomatis infection in women with ectopic pregnancy].

Chlamydia trachomatis infection, presumably sexually transmitted, has been implicated in the spread of tubal infertility and ectopic pregnancy. In searching evidence of Chlamydia trachomatis infection as a possible cause of tubal ectopic pregnancy, we enrolled 40 consecutive pathologically proven tubal ectopic women and 37 normal early intrauterine pregnant women from our OPD and ward from Jan. 1989 to July 1989. All cases underwent a structured interview giving particular attention to past reproductive history, contraception history and past history of STD. The levels of serum antibody IgG to Chlamydia trachomatis in all cases were determined. Seven ectopic women with wearing IUD in situ (group A) and 33 ectopic women with no identical factor (group B) were compared with 37 normal early intrauterine pregnant women (control group). The result showed group B more often had IgG antibody to Chlamydia trachomatis than control group (P = 0.001). Group A had higher antibody to Chlamydia trachomatis than control group but the difference was not statistically significant (P greater than 0.05). We concluded that the above findings add to the evidence that Chlamydia trachomatis infection is a major cause of tubal ectopic pregnancy.