Objective:This study aimed to develop a nomogram that can predict occult high-grade squamous intraepithelial lesions or worse(HSIL+)and determine the need for endocervical curettage(ECC)in patients referred for colpos...Objective:This study aimed to develop a nomogram that can predict occult high-grade squamous intraepithelial lesions or worse(HSIL+)and determine the need for endocervical curettage(ECC)in patients referred for colposcopy.Methods:This retrospective multicenter study included 4,149 patients who were referred to any one of six tertiary hospitals in China for colposcopy between January 2020 and November 2021 because of abnormal screening results.ECC data were extracted from the medical records.Univariate and multivariate logistic regression analyses were performed to identify factors that could predict HSIL+on ECC.Patients were randomly assigned to a training set or to an internal validation set for performance and comparability testing.The model was externally validated and tested in patients from two additional hospitals.The nomogram was assessed in terms of discrimination and calibration and subjected to decision curve analysis.Results:HSIL+was found on ECC in 38.8%(n=388)of cases.Our predictive nomogram included age group,cytology,human papillomavirus(HPV)status,visibility of the cervix and colposcopic impression.The nomogram had good overall discrimination,which was internally validated[area under the receiver-operator characteristic(AUC),0.839;95%confidence interval(95%CI),0.773-0.904].In terms of external validation,the AUC was 0.843(95%CI,0.773-0.912)for the consecutive sample and 0.843(95%CI,0.783-0.902)for the comparative sample.Calibration analysis suggested good consistency between predicted and observed probabilities.Decision curve analysis suggested this nomogram would be clinically useful with almost the entire range of threshold probabilities.Conclusions:This internally and externally validated nomogram can be easily applied and incorporates multiple clinically relevant variables that can be used to identify patients with occult HSIL+who need ECC.展开更多
AIM: To test the efficacy of lay open(deroofing, not excision) with curettage under local anesthesia(LOCULA) for pilonidal sinus as an outpatient procedure. METHODS: LOCULA procedure was done for all types of pilonida...AIM: To test the efficacy of lay open(deroofing, not excision) with curettage under local anesthesia(LOCULA) for pilonidal sinus as an outpatient procedure. METHODS: LOCULA procedure was done for all types of pilonidal disease. The primary outcome measure was cure rate. The secondary outcome measures were hospital stay, operating time, return to work, healing time and complication rate.RESULTS: Thirty-three(M/F-30/3, mean age-23.4 ± 5.8 years) consecutive patients were operated and followed for 24 mo(6-46 mo). Eleven were pilonidal abscess and 22 were chronic pilonidal disease. Six had recurrent disease. Operating time and the hospital stay was 22.3 ± 5.6 min and 63.8 ± 22.3 min respectively. The patients could resume normal work in 4.3 ± 3.2 d and the healing time was 42.9 ± 8.1 d. Thirty(93.8%)patients had complete resolution of the disease and two(6.2%) had a recurrence. Both the recurrences happened in patients who had complete healing but ignored the prescribed recommendations. One out of these got cured after getting operated again with the same procedure. Thus the overall success rate of this procedure was 96.9%.CONCLUSION: Lay open(deroofing) with curettage procedure under local anesthesia is an effective procedure to treat both simple and complicated pilonidal sinus and abscess. It is a simple procedure, has a high cure rate(up to 97%), doesn't require admission and is associated with minimal morbidity and scarring. Considering the distinct advantages, this procedure has the potential to become the first line procedure for treating pilonidal disease.展开更多
BACKGROUND Uterine rupture is a serious obstetric emergency,a severe event,and a serious threat to maternal and fetal life.It is a rare and not well characterized by the fact that multiple operations of uterine caviti...BACKGROUND Uterine rupture is a serious obstetric emergency,a severe event,and a serious threat to maternal and fetal life.It is a rare and not well characterized by the fact that multiple operations of uterine cavities contribute to uterine rupture during pregnancy.Atypical uterine rupture is easily misdiagnosed as other obstetric or surgical diseases.In current guidelines,abdominocentesis is a contraindication for late pregnancy.Therefore,the cases presented in this report provide new ideas for clinical diagnosis and treatment of uterine rupture.CASE SUMMARY Case 1,a 34-year-old woman(gravida 5,para 2),32 wk and 4 d of gestation,presented with acute upper abdominal pain for 8 h with nausea and vomiting.Computed tomography(CT)revealed pelvic and abdominal effusion.We extracted 3 mL unclotted blood from her abdominal cavity.An emergency caesarean section was performed.A uterine rupture was found,and the fimbrial portion of the left fallopian tube was completely adhered to the rupture.The prognosis of both the mother and the infant was good.Case 2,a 39-year-old woman(gravida 10,para 1)at 34 wk and 3 d of gestation complained of persistent lower abdominal pain for half a day.Her vital signs were normal.CT revealed a high probability of pelvic and abdominal hemoperitoneum.We extracted 4 mL dark red blood without coagulation.An emergency laparotomy was performed.Uterine rupture was identified during the operation.Postoperative course in both the mother and infant was uneventful.CONCLUSION For pregnant women in the second or the third trimester with persistent abdominal pain,abdominal effusion,fetal distress and even fetal death,the possibility of uterine rupture should be highly suspected.CT can identify acute abdominal surgical or gynecological and obstetric diseases.Abdominocentesis is helpful for diagnosing and clarifying the nature of effusion,but its clinical value need to be confirmed by further clinical studies.展开更多
Although rare,small bowel perforation post pregnancy related dilation and curettage presents a serious complication.Herein,we reported a case of 34-year-old female patient presenting for uterine-ileal perforation post...Although rare,small bowel perforation post pregnancy related dilation and curettage presents a serious complication.Herein,we reported a case of 34-year-old female patient presenting for uterine-ileal perforation post pregnancy related dilatation and curettage managed successfully by laparoscopic small bowel resection and primary anastomosis.展开更多
Endocervical curettage(ECC)is an optional practice during colposcopy,and the indication for endocervical curettage(ECC)is controversial between Europe and the USA.Here,we explored the value of ECC in a specific situat...Endocervical curettage(ECC)is an optional practice during colposcopy,and the indication for endocervical curettage(ECC)is controversial between Europe and the USA.Here,we explored the value of ECC in a specific situation.An elderly post-loop electrosurgical excision procedure woman,who had undergone a colposcopy 4 months before,went for her follow-up and abnormal cytology was found,and both the ECC and punch biopsy showed negative results.Then,a second ECC was performed,which led to the diagnosis of a high-grade squamous intraepithelial lesion.This case report shows that ECC is useful for diagnosing elderly women with Type 3 squamocolumnar junction.展开更多
Cherubism is a rare disease characterized by significant loss of medullary bone which is replaced by excessive amounts of fibrous tissue growth within the mandible and maxilla. We present a case of a 4-year-old boy wi...Cherubism is a rare disease characterized by significant loss of medullary bone which is replaced by excessive amounts of fibrous tissue growth within the mandible and maxilla. We present a case of a 4-year-old boy with a rapidly enlarging mandible and maxilla, causing significant change in the facial contour, malocclusion and phonation difficulties. He was treated with aggressive tumor curettage, lateral mandibular cortex osteotomies with medial repositioning. This allowed obliteration of the enlarged medullary space and restoration of the normal mandibular anatomy. At 12 months postoperatively, the patient had significant improvement in facial contour, normal outward appearance, and stable dentition.展开更多
BACKGROUND Fibrous dysplasia associated with aneurysmal bone cyst(ABC)-like changes in the right proximal femur has a low incidence.It is considered more difficult to make early diagnosis than for single fibrous dyspl...BACKGROUND Fibrous dysplasia associated with aneurysmal bone cyst(ABC)-like changes in the right proximal femur has a low incidence.It is considered more difficult to make early diagnosis than for single fibrous dysplasia.CASE SUMMARY A 14-year-old woman was admitted because of persistent pain in the right hip and abnormal gait over the previous 2 mo.She had no history of present or past illness.Preoperative photography,enhanced computed tomography,and magnetic resonance imaging showed ground-glass appearance with cortical scalloping and expansion of the right proximal femur and femoral neck.Pathological examination by preoperative puncture biopsy revealed fibrous dysplasia of the right proximal femur.The patient was diagnosed with fibrous dysplasia based on medical history,physical examination,and results of laboratory,imaging and pathological examinations.According to final pathological examination,the patient was diagnosed with fibrous dysplasia of the right proximal femur associated with ABC.Curettage and allograft along with fixation of compression screws was performed for fibrous dysplasia associated with ABClike changes.No obvious allograft absorption,loosening of fixation,or secondary fracture were observed during 6-months’follow-up with re-examination by plain radiography and computed tomography.Fibrous dysplasia associated with ABClike changes in the right proximal femur has a low incidence and early diagnosis is considered more difficult than for single fibrous dysplasia.CONCLUSION We report a cases of fibrous dysplasia associated with ABC-like changes in the right proximal femur treated with curettage and allograft along with hip compression screws.展开更多
Background: Retention of fetal bones is a rare cause of abnormal uterine bleeding. Others may present as subfertility, chronic pelvic pain, abnormal vaginal discharge, menometrorrhagia, dysmenorrhea and spontaneous ex...Background: Retention of fetal bones is a rare cause of abnormal uterine bleeding. Others may present as subfertility, chronic pelvic pain, abnormal vaginal discharge, menometrorrhagia, dysmenorrhea and spontaneous expulsion of bony fragments. Incidence is 0.26% among patients undergoing hysteroscopy. Aim: To document a pattern of presentation of retained fetal bone and its management. Case Presentation: Our patient is an 18-year old who presented with vaginal bleeding of four weeks duration and managed for abnormal uterine bleeding due to retained fetal bone following second trimester abortion. Conclusion: The use of transvaginal ultrasound in making diagnosis of retained fetal bone is effective. Treatment by removal of bones through evacuation by dilatation and curettage or hysteroscopy brings about resolution of symptoms. Use of pelvic ultrasonography to confirm complete evacuation of the uterus after abortion especially second trimester abortion could aid in early diagnosis and management of incomplete abortion.展开更多
Objective To survey effective treatment strategies for cesarean scar pregnancy(CSP). Methods The clinical data of 78 patients diagnosed with CSP from January 2010 to December 2013 were reviewed. Results Among these pa...Objective To survey effective treatment strategies for cesarean scar pregnancy(CSP). Methods The clinical data of 78 patients diagnosed with CSP from January 2010 to December 2013 were reviewed. Results Among these patients, 17 patients were first treated at our hospital; of them, 2 were misdiagnosed. The other 61 patients were referred from other hospitals; of them, 21 were initially misdiagnosed. There were 9 patients who were treated with laparotomy, 50 patients with curettage after uterine artery embolization(UAE) with or without local methotrexate(MTX) infusion, 10 patients with dilatation and curettage, 6 patients with transvaginal sonographic guided local intragestational MTX injection, and 3 patients with systemic MTX injection. All patients finally recovered. Patients with excessive vaginal hemorrhage underwent either emergency UAE treatment or laparotomy. These two treatments had similar success rates(81.82% vs. 100%, χ2 =0.289, P>0.05). Conclusions The accurate diagnosis of CSP is important. Curettage after UAE with or without local MTX infusion is a safe and effective method.展开更多
BACKGROUND Heterotopic cesarean scar pregnancy(HCSP)is very rare and has a high risk of massive uterine bleeding.Preservation of concurrent intrauterine pregnancy(IUP)is one of the great challenges in the management o...BACKGROUND Heterotopic cesarean scar pregnancy(HCSP)is very rare and has a high risk of massive uterine bleeding.Preservation of concurrent intrauterine pregnancy(IUP)is one of the great challenges in the management of HCSP.No universal treatment protocol has been established when IUP is desired to be preserved.CASE SUMMARY We report a case of HCSP at 8+wk gestation in a 34-year-old woman with stable hemodynamics.A two-step intervention was applied.Selective embryo aspiration was performed first,and surgical removal of ectopic gestational tissue by suction and curettage was performed 2 d later.Both steps were performed under ultrasound guidance.The patient had an uneventful course,and a healthy baby was delivered at 34+6 wk gestation.CONCLUSION Selective embryo aspiration followed by suction and curettage was successful in the preservation of IUP in the management of HCSP.This approach is an alternative option for HCSP in the first trimester when the IUP is desired to be preserved.展开更多
Purpose: Minor gynecologic surgery is the cornerstone of gynecologic evaluation and intervention in countries with a well-established medical infrastructure. Surgical training and exposure to minor procedures are not ...Purpose: Minor gynecologic surgery is the cornerstone of gynecologic evaluation and intervention in countries with a well-established medical infrastructure. Surgical training and exposure to minor procedures are not available in low and middle-income countries due to the complex challenges of patient delay and lack of access to healthcare, physician shortages, and the lack of ancillary services such as pathology and radiology. This paper reviews current training statistics, the international literature on minor gynecologic surgery and training strategies. Methods: PubMed searches using MESH terms cone biopsy, dilation and curettage, and loop electrosurgical excision procedure were performed. Statistics of minor surgical procedures among US Obstetrics and Gynecology Residency programs were tabulated. We then searched for data of training programs and surgical statistics in low resource countries. Results:Dilation and curettage is the most common minor gynecologic procedure in the United States but is performed with significantly lower frequency in low and middle-income countries. The most common procedure for the treatment of preinvasive disease was cryotherapy followed by loop electrosurgical excision procedure. There was no information about minor surgical procedures performed in hospitals in low and middle-income countries. Statistics from four-year American training programs showed an average of 209 minor cervical procedures performed annually. Conclusion: Expertise in minor gynecologic procedures is vital and requires the development of both adequate training programs and local medical infrastructure. Strategies for training in minor surgery for providers in low and middle-income countries include online curriculums, mentored relationships with senior physicians, and simulation models.展开更多
The aim of this retrospective case series report is to evaluate systemic methotrexate therapy in conjunction with uterine artery embolization (UAE) in the conservative management of cervical pregnancy. We examined cli...The aim of this retrospective case series report is to evaluate systemic methotrexate therapy in conjunction with uterine artery embolization (UAE) in the conservative management of cervical pregnancy. We examined clinical presentations, treatments, and therapeutic outcomes in fifteen patients with a cervical pregnancy who wished for preservation of fertility, treated at Okayama University Hospital between 1998 and 2012. Twelve patients received systemic methotrexate including five treated with UAE. One was treated with UAE alone. Two patients received neither UAE nor methotrexate because of a low human chorionic gonadotropin (hCG) level and poor blood flow around the gestational sac (GS). An increased GS size and the elevated hCG level during methotrexate therapy might be risk factors for emergent UAE. Two of six patients treated with UAE had subsequent confirmed viable pregnancies. In patients with a cervical pregnancy, methotrexate therapy in combination with UAE can be considered as an option before performing a hysterectomy with suitable counseling about the risk of loss of fertility. Careful observation of the GS size and hCG level during methotrexate therapy might be important for management.展开更多
There have been not many reports on the result of intralesional excision for giant cell tumors (GCTs) of the great trochanter and femoral neck because of its rarity. The authors present the case of a 35-year-old femal...There have been not many reports on the result of intralesional excision for giant cell tumors (GCTs) of the great trochanter and femoral neck because of its rarity. The authors present the case of a 35-year-old female patient managed with intralesional curettage and filling the defect with autologous bone graft from iliac crest. An appoint of three doses of Denosumab was done postoperatively. The article discusses the clinical aspects and surgical treatment, and the benefits of Denosumab. This report aimed to demonstrate the possibility to perform curetage for giant cell tumor of the hip even the recommandation for this location is wide resection and endoprothesis fixation.展开更多
Hysteroscopy is widely used for the detection and treatment of intrauterine adhesion.Such technique,however,sometimes has limitations and even second damages.We report a rare case of severe intrauterine adhesion cause...Hysteroscopy is widely used for the detection and treatment of intrauterine adhesion.Such technique,however,sometimes has limitations and even second damages.We report a rare case of severe intrauterine adhesion caused by uterine perforation with a fallopian tube incarceration.A 24-year-old woman underwent severe intrauterine adhesion and secondary infertility caused by fallopian tube incaceration into the uterine cavity after postpartum curettage.First hysteroscopy created a false passage through the previous uterine perforation,entered into the cavity of incarcerated fallopian tube,and led to iatrogenic hydrosalpinx.Secondary hysteroscopy combined with laparoscopy revealed a connection between the right tubal lumen and the uterine cavity by the false passage,released the adhesion,and reconstructed the uterine cavity.Early recognition of uterine perforation or tissue incarcerarion is significant in preventing further damage.展开更多
BACKGROUND Microglandular hyperplasia(MGH)is a proliferation of endocervical glands,related to estrogen stimulation,mainly occurring in the reproductive age group.The differential diagnosis includes endometrial adenoc...BACKGROUND Microglandular hyperplasia(MGH)is a proliferation of endocervical glands,related to estrogen stimulation,mainly occurring in the reproductive age group.The differential diagnosis includes endometrial adenocarcinoma with MGH-like pattern(MGA),a distinction that may be particularly problematic in curettage specimen.CASE SUMMARY A 57-year-old,postmenopausal woman was admitted in our hospital for surgical treatment.She had been diagnosed with a uterine leiomyoma,after complaints of irregular vaginal bleeding.She underwent dilatation and curettage(D&C)and subsequent total abdominal hysterectomy with bilateral salpingo-oophorectomy.D&C were compatible with MGA.Histologically,a proliferation of small glands,without intervening stroma,with mucin production,accumulation of neutrophils in the gland lumen and stroma,mild nuclear atypia and rare mitoses,were seen.In the hysterectomy specimen,the endometrium was thickened,but without apparent tumor formation.On microscopic examination,a residual similar adenocarcinoma was seen in the isthmus and more conventional-of endometrioid and mucinous type,in the rest of the endometrium.CONCLUSION MGH-like proliferation with mild cytologic atypia,detected in the endometrial curettage specimen of a postmenopausal woman,should alert pathologists for MGA of the endometrium.VIM,p16,PAX-2,CD10 and CD34 may help in the differential diagnosis.展开更多
Objective:The purpose of this study is to identify existing literature on recurrent atypical mycobacterial cervicofacial lymphadenitis to augment our understanding of a unique patient who presented to our tertiary‐ca...Objective:The purpose of this study is to identify existing literature on recurrent atypical mycobacterial cervicofacial lymphadenitis to augment our understanding of a unique patient who presented to our tertiary‐care center 5‐years posttreatment with recurrence following curettage.Data Sources:OVID Medline,Scopus,and Web of Science.Methods:A literature search was conducted yielding 49 original articles which were screened twice by two independent reviewers resulting in 14 studies meeting inclusion criteria for data extraction using Covidence software.Two independent reviewers extracted data on recurrence of atypical mycobacterial cervicofacial lymphadenitis and consensus was reached on data points from all included studies.Results:This study illuminated the paucity of recurrence reporting in the literature regarding atypical mycobacterial lymphadenitis.Sixteen studies identified in our review included discussions on recurrence with few elaborating beyond the rate of recurrence to describe their management.Fourteen out of sixteen studies provided recurrence rates for their cohort,11 out of 14 specified the initial treatment modality,and only five out of eight studies that described initial treatment with surgery differentiated recurrence rates between complete and incomplete excision.The mean length of follow‐up in the included studies was 20 months.There was one previously reported case of late recurrence at 5‐years.Conclusions:We identified few reports that discussed the management of recurrence of atypical mycobacterial cervicofacial lymphadenitis.There was minimal data on recurrence rates between surgical treatment modalities.The case discussed in our study showcases that treatment with curettage has the potential to present with late recurrence.展开更多
Objective:To compare the efficacy and safety of four surgical strategies currently used for the management of deep implantation cesarean scar pregnancy(CSP-Ⅱ).Methods:This was a retrospective clinical cohort study,an...Objective:To compare the efficacy and safety of four surgical strategies currently used for the management of deep implantation cesarean scar pregnancy(CSP-Ⅱ).Methods:This was a retrospective clinical cohort study,and,in total,131 women diagnosed with CSP-Ⅱ and primarily treated in our hospital were recruited.Women treated using laparoscopy assisted by operative hysteroscopy(LAOH;Group A,n=25),uterine artery embolization(UAE)followed by LAOH(Group B,n=21),ultrasound-guided dilatation and curettage(D&C;Group C,n=24),and UAE followed by D&C(Group D,n=61)were evaluated.Univariate and multiple logistic analyses were performed to identify the risk factors.Results:No statistically significant difference was found in patient age,gestational age,size of lesion,and pretreatment serumβ-human chorionic gonadotropins(β-hCG)level.Operation time was longer(P<0.001)and the success rate was higher(P=0.01)in both Group A and Group B than in Group C and Group D.When the cohort was further analyzed regarding patients with myometrial thickness≤3 mm(n=75,defined as CSP-IIb),a lower rate of perioperative complications(P=0.036)and a higher success rate(P<0.001)remained in Group A(n=15)and Group B(n=15)but not in Group C(n=11)or Group D(n=34).In multiple logistic regression analysis,the risk factors related to lower treatment efficacy for patients with CSP-Ⅱ were thinner myometrial thickness of cesarean scar(CS)(≤3 mm)(odds ratio[OR]=5.470,P=0.062),number of cesarean sections(a2)(OR=8.877,P=0.013),mass protruding into the bladder or abdominal cavity(OR=25.507,P<0.001),and direct D&C modality(OR=38.247,P=0.010).Conclusions:Compared with D&C±UAE,LAOH±UAE showed a higher success rate for patients with CSP-Ⅱ,especially when the zygote was more deeply implanted with a myometrial thickness of CS≤3 mm.CSP-Ⅱ treatment should be individualized on the basis of many risk factors.展开更多
基金supported by CAMS Innovation Fund for Medical Sciences(No.CAMS 2021-I2M-1-004)。
文摘Objective:This study aimed to develop a nomogram that can predict occult high-grade squamous intraepithelial lesions or worse(HSIL+)and determine the need for endocervical curettage(ECC)in patients referred for colposcopy.Methods:This retrospective multicenter study included 4,149 patients who were referred to any one of six tertiary hospitals in China for colposcopy between January 2020 and November 2021 because of abnormal screening results.ECC data were extracted from the medical records.Univariate and multivariate logistic regression analyses were performed to identify factors that could predict HSIL+on ECC.Patients were randomly assigned to a training set or to an internal validation set for performance and comparability testing.The model was externally validated and tested in patients from two additional hospitals.The nomogram was assessed in terms of discrimination and calibration and subjected to decision curve analysis.Results:HSIL+was found on ECC in 38.8%(n=388)of cases.Our predictive nomogram included age group,cytology,human papillomavirus(HPV)status,visibility of the cervix and colposcopic impression.The nomogram had good overall discrimination,which was internally validated[area under the receiver-operator characteristic(AUC),0.839;95%confidence interval(95%CI),0.773-0.904].In terms of external validation,the AUC was 0.843(95%CI,0.773-0.912)for the consecutive sample and 0.843(95%CI,0.783-0.902)for the comparative sample.Calibration analysis suggested good consistency between predicted and observed probabilities.Decision curve analysis suggested this nomogram would be clinically useful with almost the entire range of threshold probabilities.Conclusions:This internally and externally validated nomogram can be easily applied and incorporates multiple clinically relevant variables that can be used to identify patients with occult HSIL+who need ECC.
文摘AIM: To test the efficacy of lay open(deroofing, not excision) with curettage under local anesthesia(LOCULA) for pilonidal sinus as an outpatient procedure. METHODS: LOCULA procedure was done for all types of pilonidal disease. The primary outcome measure was cure rate. The secondary outcome measures were hospital stay, operating time, return to work, healing time and complication rate.RESULTS: Thirty-three(M/F-30/3, mean age-23.4 ± 5.8 years) consecutive patients were operated and followed for 24 mo(6-46 mo). Eleven were pilonidal abscess and 22 were chronic pilonidal disease. Six had recurrent disease. Operating time and the hospital stay was 22.3 ± 5.6 min and 63.8 ± 22.3 min respectively. The patients could resume normal work in 4.3 ± 3.2 d and the healing time was 42.9 ± 8.1 d. Thirty(93.8%)patients had complete resolution of the disease and two(6.2%) had a recurrence. Both the recurrences happened in patients who had complete healing but ignored the prescribed recommendations. One out of these got cured after getting operated again with the same procedure. Thus the overall success rate of this procedure was 96.9%.CONCLUSION: Lay open(deroofing) with curettage procedure under local anesthesia is an effective procedure to treat both simple and complicated pilonidal sinus and abscess. It is a simple procedure, has a high cure rate(up to 97%), doesn't require admission and is associated with minimal morbidity and scarring. Considering the distinct advantages, this procedure has the potential to become the first line procedure for treating pilonidal disease.
基金We would like to thank these two patients for allowing us to share their cases and using their picture and we are also grateful to all of our team members who were involved in the management of the cases。
文摘BACKGROUND Uterine rupture is a serious obstetric emergency,a severe event,and a serious threat to maternal and fetal life.It is a rare and not well characterized by the fact that multiple operations of uterine cavities contribute to uterine rupture during pregnancy.Atypical uterine rupture is easily misdiagnosed as other obstetric or surgical diseases.In current guidelines,abdominocentesis is a contraindication for late pregnancy.Therefore,the cases presented in this report provide new ideas for clinical diagnosis and treatment of uterine rupture.CASE SUMMARY Case 1,a 34-year-old woman(gravida 5,para 2),32 wk and 4 d of gestation,presented with acute upper abdominal pain for 8 h with nausea and vomiting.Computed tomography(CT)revealed pelvic and abdominal effusion.We extracted 3 mL unclotted blood from her abdominal cavity.An emergency caesarean section was performed.A uterine rupture was found,and the fimbrial portion of the left fallopian tube was completely adhered to the rupture.The prognosis of both the mother and the infant was good.Case 2,a 39-year-old woman(gravida 10,para 1)at 34 wk and 3 d of gestation complained of persistent lower abdominal pain for half a day.Her vital signs were normal.CT revealed a high probability of pelvic and abdominal hemoperitoneum.We extracted 4 mL dark red blood without coagulation.An emergency laparotomy was performed.Uterine rupture was identified during the operation.Postoperative course in both the mother and infant was uneventful.CONCLUSION For pregnant women in the second or the third trimester with persistent abdominal pain,abdominal effusion,fetal distress and even fetal death,the possibility of uterine rupture should be highly suspected.CT can identify acute abdominal surgical or gynecological and obstetric diseases.Abdominocentesis is helpful for diagnosing and clarifying the nature of effusion,but its clinical value need to be confirmed by further clinical studies.
文摘Although rare,small bowel perforation post pregnancy related dilation and curettage presents a serious complication.Herein,we reported a case of 34-year-old female patient presenting for uterine-ileal perforation post pregnancy related dilatation and curettage managed successfully by laparoscopic small bowel resection and primary anastomosis.
基金Shanghai Medical Center of Key Programs for Female Reproductive Diseases(No.2017ZZ01016).
文摘Endocervical curettage(ECC)is an optional practice during colposcopy,and the indication for endocervical curettage(ECC)is controversial between Europe and the USA.Here,we explored the value of ECC in a specific situation.An elderly post-loop electrosurgical excision procedure woman,who had undergone a colposcopy 4 months before,went for her follow-up and abnormal cytology was found,and both the ECC and punch biopsy showed negative results.Then,a second ECC was performed,which led to the diagnosis of a high-grade squamous intraepithelial lesion.This case report shows that ECC is useful for diagnosing elderly women with Type 3 squamocolumnar junction.
文摘Cherubism is a rare disease characterized by significant loss of medullary bone which is replaced by excessive amounts of fibrous tissue growth within the mandible and maxilla. We present a case of a 4-year-old boy with a rapidly enlarging mandible and maxilla, causing significant change in the facial contour, malocclusion and phonation difficulties. He was treated with aggressive tumor curettage, lateral mandibular cortex osteotomies with medial repositioning. This allowed obliteration of the enlarged medullary space and restoration of the normal mandibular anatomy. At 12 months postoperatively, the patient had significant improvement in facial contour, normal outward appearance, and stable dentition.
基金The Scientific Program of the Health and Family Planning Commission of Hunan Province,China,No.C20190940The Science and Technology Planning Project of Huaihua,China,NO.2021R3117。
文摘BACKGROUND Fibrous dysplasia associated with aneurysmal bone cyst(ABC)-like changes in the right proximal femur has a low incidence.It is considered more difficult to make early diagnosis than for single fibrous dysplasia.CASE SUMMARY A 14-year-old woman was admitted because of persistent pain in the right hip and abnormal gait over the previous 2 mo.She had no history of present or past illness.Preoperative photography,enhanced computed tomography,and magnetic resonance imaging showed ground-glass appearance with cortical scalloping and expansion of the right proximal femur and femoral neck.Pathological examination by preoperative puncture biopsy revealed fibrous dysplasia of the right proximal femur.The patient was diagnosed with fibrous dysplasia based on medical history,physical examination,and results of laboratory,imaging and pathological examinations.According to final pathological examination,the patient was diagnosed with fibrous dysplasia of the right proximal femur associated with ABC.Curettage and allograft along with fixation of compression screws was performed for fibrous dysplasia associated with ABClike changes.No obvious allograft absorption,loosening of fixation,or secondary fracture were observed during 6-months’follow-up with re-examination by plain radiography and computed tomography.Fibrous dysplasia associated with ABClike changes in the right proximal femur has a low incidence and early diagnosis is considered more difficult than for single fibrous dysplasia.CONCLUSION We report a cases of fibrous dysplasia associated with ABC-like changes in the right proximal femur treated with curettage and allograft along with hip compression screws.
文摘Background: Retention of fetal bones is a rare cause of abnormal uterine bleeding. Others may present as subfertility, chronic pelvic pain, abnormal vaginal discharge, menometrorrhagia, dysmenorrhea and spontaneous expulsion of bony fragments. Incidence is 0.26% among patients undergoing hysteroscopy. Aim: To document a pattern of presentation of retained fetal bone and its management. Case Presentation: Our patient is an 18-year old who presented with vaginal bleeding of four weeks duration and managed for abnormal uterine bleeding due to retained fetal bone following second trimester abortion. Conclusion: The use of transvaginal ultrasound in making diagnosis of retained fetal bone is effective. Treatment by removal of bones through evacuation by dilatation and curettage or hysteroscopy brings about resolution of symptoms. Use of pelvic ultrasonography to confirm complete evacuation of the uterus after abortion especially second trimester abortion could aid in early diagnosis and management of incomplete abortion.
文摘Objective To survey effective treatment strategies for cesarean scar pregnancy(CSP). Methods The clinical data of 78 patients diagnosed with CSP from January 2010 to December 2013 were reviewed. Results Among these patients, 17 patients were first treated at our hospital; of them, 2 were misdiagnosed. The other 61 patients were referred from other hospitals; of them, 21 were initially misdiagnosed. There were 9 patients who were treated with laparotomy, 50 patients with curettage after uterine artery embolization(UAE) with or without local methotrexate(MTX) infusion, 10 patients with dilatation and curettage, 6 patients with transvaginal sonographic guided local intragestational MTX injection, and 3 patients with systemic MTX injection. All patients finally recovered. Patients with excessive vaginal hemorrhage underwent either emergency UAE treatment or laparotomy. These two treatments had similar success rates(81.82% vs. 100%, χ2 =0.289, P>0.05). Conclusions The accurate diagnosis of CSP is important. Curettage after UAE with or without local MTX infusion is a safe and effective method.
基金Supported by Zhejiang National Science Foundation,No.LGF20H04001Zhejiang Bureau of Traditional Chinese Medicine,No.2017ZA092.
文摘BACKGROUND Heterotopic cesarean scar pregnancy(HCSP)is very rare and has a high risk of massive uterine bleeding.Preservation of concurrent intrauterine pregnancy(IUP)is one of the great challenges in the management of HCSP.No universal treatment protocol has been established when IUP is desired to be preserved.CASE SUMMARY We report a case of HCSP at 8+wk gestation in a 34-year-old woman with stable hemodynamics.A two-step intervention was applied.Selective embryo aspiration was performed first,and surgical removal of ectopic gestational tissue by suction and curettage was performed 2 d later.Both steps were performed under ultrasound guidance.The patient had an uneventful course,and a healthy baby was delivered at 34+6 wk gestation.CONCLUSION Selective embryo aspiration followed by suction and curettage was successful in the preservation of IUP in the management of HCSP.This approach is an alternative option for HCSP in the first trimester when the IUP is desired to be preserved.
文摘Purpose: Minor gynecologic surgery is the cornerstone of gynecologic evaluation and intervention in countries with a well-established medical infrastructure. Surgical training and exposure to minor procedures are not available in low and middle-income countries due to the complex challenges of patient delay and lack of access to healthcare, physician shortages, and the lack of ancillary services such as pathology and radiology. This paper reviews current training statistics, the international literature on minor gynecologic surgery and training strategies. Methods: PubMed searches using MESH terms cone biopsy, dilation and curettage, and loop electrosurgical excision procedure were performed. Statistics of minor surgical procedures among US Obstetrics and Gynecology Residency programs were tabulated. We then searched for data of training programs and surgical statistics in low resource countries. Results:Dilation and curettage is the most common minor gynecologic procedure in the United States but is performed with significantly lower frequency in low and middle-income countries. The most common procedure for the treatment of preinvasive disease was cryotherapy followed by loop electrosurgical excision procedure. There was no information about minor surgical procedures performed in hospitals in low and middle-income countries. Statistics from four-year American training programs showed an average of 209 minor cervical procedures performed annually. Conclusion: Expertise in minor gynecologic procedures is vital and requires the development of both adequate training programs and local medical infrastructure. Strategies for training in minor surgery for providers in low and middle-income countries include online curriculums, mentored relationships with senior physicians, and simulation models.
文摘The aim of this retrospective case series report is to evaluate systemic methotrexate therapy in conjunction with uterine artery embolization (UAE) in the conservative management of cervical pregnancy. We examined clinical presentations, treatments, and therapeutic outcomes in fifteen patients with a cervical pregnancy who wished for preservation of fertility, treated at Okayama University Hospital between 1998 and 2012. Twelve patients received systemic methotrexate including five treated with UAE. One was treated with UAE alone. Two patients received neither UAE nor methotrexate because of a low human chorionic gonadotropin (hCG) level and poor blood flow around the gestational sac (GS). An increased GS size and the elevated hCG level during methotrexate therapy might be risk factors for emergent UAE. Two of six patients treated with UAE had subsequent confirmed viable pregnancies. In patients with a cervical pregnancy, methotrexate therapy in combination with UAE can be considered as an option before performing a hysterectomy with suitable counseling about the risk of loss of fertility. Careful observation of the GS size and hCG level during methotrexate therapy might be important for management.
文摘There have been not many reports on the result of intralesional excision for giant cell tumors (GCTs) of the great trochanter and femoral neck because of its rarity. The authors present the case of a 35-year-old female patient managed with intralesional curettage and filling the defect with autologous bone graft from iliac crest. An appoint of three doses of Denosumab was done postoperatively. The article discusses the clinical aspects and surgical treatment, and the benefits of Denosumab. This report aimed to demonstrate the possibility to perform curetage for giant cell tumor of the hip even the recommandation for this location is wide resection and endoprothesis fixation.
文摘Hysteroscopy is widely used for the detection and treatment of intrauterine adhesion.Such technique,however,sometimes has limitations and even second damages.We report a rare case of severe intrauterine adhesion caused by uterine perforation with a fallopian tube incarceration.A 24-year-old woman underwent severe intrauterine adhesion and secondary infertility caused by fallopian tube incaceration into the uterine cavity after postpartum curettage.First hysteroscopy created a false passage through the previous uterine perforation,entered into the cavity of incarcerated fallopian tube,and led to iatrogenic hydrosalpinx.Secondary hysteroscopy combined with laparoscopy revealed a connection between the right tubal lumen and the uterine cavity by the false passage,released the adhesion,and reconstructed the uterine cavity.Early recognition of uterine perforation or tissue incarcerarion is significant in preventing further damage.
文摘BACKGROUND Microglandular hyperplasia(MGH)is a proliferation of endocervical glands,related to estrogen stimulation,mainly occurring in the reproductive age group.The differential diagnosis includes endometrial adenocarcinoma with MGH-like pattern(MGA),a distinction that may be particularly problematic in curettage specimen.CASE SUMMARY A 57-year-old,postmenopausal woman was admitted in our hospital for surgical treatment.She had been diagnosed with a uterine leiomyoma,after complaints of irregular vaginal bleeding.She underwent dilatation and curettage(D&C)and subsequent total abdominal hysterectomy with bilateral salpingo-oophorectomy.D&C were compatible with MGA.Histologically,a proliferation of small glands,without intervening stroma,with mucin production,accumulation of neutrophils in the gland lumen and stroma,mild nuclear atypia and rare mitoses,were seen.In the hysterectomy specimen,the endometrium was thickened,but without apparent tumor formation.On microscopic examination,a residual similar adenocarcinoma was seen in the isthmus and more conventional-of endometrioid and mucinous type,in the rest of the endometrium.CONCLUSION MGH-like proliferation with mild cytologic atypia,detected in the endometrial curettage specimen of a postmenopausal woman,should alert pathologists for MGA of the endometrium.VIM,p16,PAX-2,CD10 and CD34 may help in the differential diagnosis.
文摘Objective:The purpose of this study is to identify existing literature on recurrent atypical mycobacterial cervicofacial lymphadenitis to augment our understanding of a unique patient who presented to our tertiary‐care center 5‐years posttreatment with recurrence following curettage.Data Sources:OVID Medline,Scopus,and Web of Science.Methods:A literature search was conducted yielding 49 original articles which were screened twice by two independent reviewers resulting in 14 studies meeting inclusion criteria for data extraction using Covidence software.Two independent reviewers extracted data on recurrence of atypical mycobacterial cervicofacial lymphadenitis and consensus was reached on data points from all included studies.Results:This study illuminated the paucity of recurrence reporting in the literature regarding atypical mycobacterial lymphadenitis.Sixteen studies identified in our review included discussions on recurrence with few elaborating beyond the rate of recurrence to describe their management.Fourteen out of sixteen studies provided recurrence rates for their cohort,11 out of 14 specified the initial treatment modality,and only five out of eight studies that described initial treatment with surgery differentiated recurrence rates between complete and incomplete excision.The mean length of follow‐up in the included studies was 20 months.There was one previously reported case of late recurrence at 5‐years.Conclusions:We identified few reports that discussed the management of recurrence of atypical mycobacterial cervicofacial lymphadenitis.There was minimal data on recurrence rates between surgical treatment modalities.The case discussed in our study showcases that treatment with curettage has the potential to present with late recurrence.
文摘Objective:To compare the efficacy and safety of four surgical strategies currently used for the management of deep implantation cesarean scar pregnancy(CSP-Ⅱ).Methods:This was a retrospective clinical cohort study,and,in total,131 women diagnosed with CSP-Ⅱ and primarily treated in our hospital were recruited.Women treated using laparoscopy assisted by operative hysteroscopy(LAOH;Group A,n=25),uterine artery embolization(UAE)followed by LAOH(Group B,n=21),ultrasound-guided dilatation and curettage(D&C;Group C,n=24),and UAE followed by D&C(Group D,n=61)were evaluated.Univariate and multiple logistic analyses were performed to identify the risk factors.Results:No statistically significant difference was found in patient age,gestational age,size of lesion,and pretreatment serumβ-human chorionic gonadotropins(β-hCG)level.Operation time was longer(P<0.001)and the success rate was higher(P=0.01)in both Group A and Group B than in Group C and Group D.When the cohort was further analyzed regarding patients with myometrial thickness≤3 mm(n=75,defined as CSP-IIb),a lower rate of perioperative complications(P=0.036)and a higher success rate(P<0.001)remained in Group A(n=15)and Group B(n=15)but not in Group C(n=11)or Group D(n=34).In multiple logistic regression analysis,the risk factors related to lower treatment efficacy for patients with CSP-Ⅱ were thinner myometrial thickness of cesarean scar(CS)(≤3 mm)(odds ratio[OR]=5.470,P=0.062),number of cesarean sections(a2)(OR=8.877,P=0.013),mass protruding into the bladder or abdominal cavity(OR=25.507,P<0.001),and direct D&C modality(OR=38.247,P=0.010).Conclusions:Compared with D&C±UAE,LAOH±UAE showed a higher success rate for patients with CSP-Ⅱ,especially when the zygote was more deeply implanted with a myometrial thickness of CS≤3 mm.CSP-Ⅱ treatment should be individualized on the basis of many risk factors.
