[Diagnostic and therapeutic analyses for peritoneal malignant mesothelioma: a report of 26 women].

OBJECTIVE: To investigate the etiology, clinicopathologic features and prognosis of peritoneal malignant mesothelioma (PMM). METHODS: The diagnostic and therapeutic data for PMM from March 2000 to December 2010 were retrospectively analyzed for 26 women. They had an age range of 41 - 78 years old. Among them, 21 patients (81%) had a history of exposure to asbestos. Their major symptoms were abdominal distension, abdominal pain, ascites and abdominopelvic mass. Some had cachexia. Intestinal obstruction occurred in all cases during a late stage. RESULTS: Among them, the tumor marker of CA125 increased markedly in serum and ascitic samples. The positive rate of ascitic cytology was 31%. Type B ultrasound and CT (computed tomography) examinations showed ascites, peritoneal thickening and abdominopelvic mass and pie-shaped omentum. Their general pathological classifications were as follows: diffuse type (n = 23), localized type (n = 3), epithelial (n = 14), sarcoma (n = 3) and mixed type (n = 9). Cytoreductive surgery was performed in 16 cases. Ten patients underwent only laparoscopy while 23 patients received chemotherapy. The comparison of life span was not statistically significant between cytoreductive surgery and laparoscopy (P > 0.05); the difference of life span between ≤ 6 courses of chemotherapy and < 6 courses was not statistically significant (P > 0.05). CONCLUSION: The history of exposure to asbestos is a risk factor for PMM. PMM with no specific clinical features should be combined with laboratory and imaging studies to make a timely clinical diagnosis. Final diagnosis should be based upon histopathological and immunohistochemical examinations. Surgery and chemotherapy do not prolong the life span of patients. And the patients have a very poor prognosis.

[Diagnosis and treatment of cesarean scar pregnancy].

OBJECTIVE: To investigate the suitable measures of diagnosis and treatment of cesarean scar pregnancy (CSP). METHODS: From May 2003 to February 2010, 52 cases were diagnosed as CSP on the basis of the history of cesarean section and the manifestations of pregnancy by transvaginal ultrasound and magnetic resonance imaging (MRI) examination. According to the blood level of ß-HCG, 32 patients underwent uterine artery methotrexate perfusion and uterine artery embolization (UAE), 20 cases received a protocol of methotrexate and leucovorin (CF) while UAE or Foley catheter balloon hemostasis was performed for massive vaginal bleeding cases. When ß-HCG decreased 80% - 90% and mass blood flow reduced or disappeared, focal resection was administered. RESULTS: Forty-six cases were diagnosed by transvaginal ultrasound and 6 cases by MRI. On admission, 11 patients with severe vaginal bleeding underwent UAE or Foley catheter hemostasis. Forty patients undergoing curettage had no uterine perforation or rupture with hysteroscopic guidance and laparoscopic monitoring if necessary. Among them, 39 (97.5%) cases were successful. Six cases were directly treated by laparotomy or laparoscopic focal resection and uterine repair. And 6 cases underwent conservative treatment without focal resection. 52 patients were cured successfully without any case of hysterectomy. CONCLUSION: Transvaginal ultrasound is the preferred diagnostic method of CSP while MRI is an auxiliary method for diagnosis. The treatment of CSP should be based on blood ß-HCG levels and lesion location, size, muscle thickness of surface, the condition of blood supply and vaginal bleeding. Different measures may be selected to kill embryos, stop hemorrhage and resect lesions.

[Effect of pelvic inflammatory disease grades on in vitro fertilization-embryo transfer outcome].

OBJECTIVE: To evaluate the effect of different grades of pelvic inflammatory disease (PID) and of salpingectomy on outcomes of in vitro fertilization-embryo transfer (IVF-ET). METHODS: Two hundred and twenty three cycles of IVF-ET were divided into three groups, including mild group, moderate group and severe group, according to different grades of sequelae of PID finding in exploratory operations before IVF. Patients in each group were divided into two subgroups according to receiving salpingectomy or not. The data of total dose of gonadotrophin (Gn), oocyte number, low response rate, fertilization rate, good embryo number and pregnancy rate were analysed between three groups and the two subgroups of each group, respectively. RESULTS: All parameters were related to PID grades except fertilization rate. The total dose of Gn, oocyte number, good embryo number, low response rate and pregnancy rate were (2057 +/- 503) IU/L, (16 +/- 6), (6.0 +/- 4.3), 4.2%, 63.9% in mild group; (2204 +/- 603) IU/L, (12 +/- 6), (4.5 +/- 3.5), 13.9%, 46.8% in moderate group; and (2372 +/- 1018) IU/L, (9 +/- 6), (3.1 +/- 2.9), 33.8%, 41.2% in severe group. The total dose of Gn and low response rate increased with the aggravation of the grades of PID (P < 0.05). The oocyte number, good embryo number and pregnancy rate also had significant differences between three groups (P < 0.01, P < 0.01, P < 0.05, respectively). In mild and severe groups, the salpingectomy had no contribution to the outcome of IVF-ET treatment. In moderate group, patients receiving salpingectomy had more oocytes and good embryos and higher pregnancy rate than the others who retained oviducts (P < 0.05). CONCLUSIONS: Grades of PID have an adverse effect on IVF-ET outcomes. Receiving salpingectomy or not should be based on different grades of PID, but operations of ovary-free should be performed in all patients.