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Journal of Medical Case Reports Jul 2022Urothelial carcinoma of the bladder accounts for nearly 90% of all bladder cancers. Risk factors include cigarette smoke, chronic cystitis, and human papilloma virus... (Review)
Review
BACKGROUND
Urothelial carcinoma of the bladder accounts for nearly 90% of all bladder cancers. Risk factors include cigarette smoke, chronic cystitis, and human papilloma virus infection. It is commonly diagnosed by hematuria, obstructive voiding, and irritative symptoms. Despite the prevalence of urothelial carcinoma, elevation of β-human chorionic gonadotropin in the setting of these malignancies is not common. This case report informs gynecologic practitioners to consider urologic causes of β-human chorionic gonadotropin elevation even in the setting of recent spontaneous abortion and details comprehensive review of diagnostic testing in the setting of β-human chorionic gonadotropin elevation.
CASE PRESENTATION
A 49-year-old, non-Hispanic Caucasian woman, former smoker, with a history of polycystic ovary syndrome, high-risk human chorionic gonadotropin infection, and hypertension, underwent vacuum-assisted aspiration for significant vaginal bleeding in the setting of incomplete abortion. Fetal tissue was confirmed pathologically. Human chorionic gonadotropin levels decreased to 12.5 mU/mL and were no longer followed due to resumption of menses. Five months later during routine preoperative evaluation for orthopedic surgery, her human chorionic gonadotropin level was found to be elevated. She was also noted to have persistent asymptomatic hematuria. She completed an extensive gynecologic and urologic work-up, including hysteroscopy, dilation and curettage, methotrexate therapy, computerized tomographic imaging, and cystoscopy to finally arrive at the diagnosis of urothelial carcinoma.
CONCLUSIONS
Only a rare subset of urothelial carcinomas secretes β-human chorionic gonadotropin. Therefore, diagnosis of urothelial carcinoma is typically achieved by urine cytology with cystoscopic biopsy. Although rare, urothelial carcinoma should be considered in patients with risk factors presenting with persistently elevated beta-human chorionic gonadotropin.
Topics: Abortion, Spontaneous; Carcinoma, Transitional Cell; Chorionic Gonadotropin; Chorionic Gonadotropin, beta Subunit, Human; Female; Hematuria; Humans; Middle Aged; Pregnancy; Urinary Bladder Neoplasms
PubMed: 35842706
DOI: 10.1186/s13256-022-03511-7 -
Fertility and Sterility Jan 2015To study the expression of a gene associated with retinoid-interferon (IFN)-induced mortality 19 (GRIM-19) in the villi of patients with missed abortion and possible...
OBJECTIVE
To study the expression of a gene associated with retinoid-interferon (IFN)-induced mortality 19 (GRIM-19) in the villi of patients with missed abortion and possible pathogenesis.
DESIGN
Case-control study.
SETTING
University hospital.
PATIENT(S)
Villous samples were collected from a total of 50 women with missed abortion and 50 women with normal pregnancies.
INTERVENTION(S)
Villous samples from the missed-abortion group were collected by curettage or manual vacuum aspiration. The control villous samples were obtained by vacuum aspiration.
MAIN OUTCOME MEASURE(S)
Protein and messenger RNA levels of GRIM-19 in villous samples were measured by Western blot and real-time polymerase chain reaction, and the location of GRIM-19 in trophoblasts was detected by immunohistochemistry. Apoptotic cells and microvessel density in villous sample were assayed by TUNEL and immunostaining. Mitochondrial membrane potential and apoptotic changes of the HTR-8/SVneo cell line in response to down-regulation of GRIM-19 were evaluated by 5,5',6,6'-Tetrachloro-1,1',3,3'-tetraethyl-imidacarbocyanine iodide and annexin V/propidium iodide. Vascular endothelial growth factor production was measured by ELISA.
RESULT(S)
GRIM-19 protein and messenger RNA levels in the villi from women with missed abortion were found to be significantly lower than in women who had normal pregnancies. Many more apoptotic cells and lower microvessel density were detected in villi from patients with missed abortion. Knockdown of GRIM-19 in HTR-8/SVneo cells gave rise to a collapse of mitochondrial membrane potential and increase in apoptosis. Simultaneously, the vascular endothelial growth factor secretion in the HTR-8/SVneo cells culture medium decreased as GRIM-19 became down-regulated.
CONCLUSION(S)
The GRIM-19 deficiency in the villus may be associated with missed abortion via increasing apoptosis and affecting angiogenesis.
Topics: Abortion, Missed; Adult; Apoptosis Regulatory Proteins; Biomarkers; Case-Control Studies; China; Chorionic Villi; Female; Humans; Middle Aged; NADH, NADPH Oxidoreductases; Pregnancy; Prevalence; Reproducibility of Results; Risk Factors; Sensitivity and Specificity; Young Adult
PubMed: 25455534
DOI: 10.1016/j.fertnstert.2014.10.012 -
International Journal of Hyperthermia :... 2022To explore a new high-intensity focused ultrasound (HIFU) sonication strategy for cesarean scar pregnancy (CSP) and to compare the clinical effectiveness and safety of...
High intensity focused ultrasound combined with ultrasound-guided suction curettage treatment for cesarean scar pregnancy: a comparison of different HIFU sonication strategies.
OBJECTIVE
To explore a new high-intensity focused ultrasound (HIFU) sonication strategy for cesarean scar pregnancy (CSP) and to compare the clinical effectiveness and safety of this new HIFU sonication strategy with the conventional HIFU sonication strategy followed by ultrasound-guided dilation and curettage (USg-D&C) for CSP.
MATERIALS AND METHODS
91 patients with CSP treated by HIFU and USg-D&C in People's Hospital of Deyang City between January 2017 and December 2019 were retrospectively reviewed in this study. Based on the HIFU sonication strategy, patients were divided to two groups: 44 patients were exposed to 'C-shape' sonication layer by layer around the implantation location of the pregnancy sac (control group), while the other 47 patients were exposed to 'I-shape' sonication layer by layer only on the deep part which close to the bladder of the implantation location of the pregnancy sac (experimental group). The differences in clinical efficacy between the two groups were analyzed. Baseline characteristics, technical parameters of HIFU treatment and USg-D&C data were recorded. Adverse events were also recorded.
RESULTS
No statistically significant difference was observed between the two groups in baseline characteristics including age, body mass index (BMI), menopause time, largest diameter of gestational sac, pretreatment serum β-hCG, thickness of gestational sac, embedding myometrium, previous cesarean sections and interval from last cesarean section (CS). The average treatment intensity in the experimental group was significantly lower than that in the control group ( < .05). The median sonication time, total energy used for HIFU ablation, and energy efficiency factor (EEF) in the experimental group were significantly lower than the control group ( < .05). No statistically significant difference was observed between the two groups in treatment power and treatment time ( > .05). Sciatic/buttock pain and postoperative lower abdominal pain in the control group were significantly stronger than that in the experimental group ( < .05). There were no statistically significant differences in post-HIFU vaginal bleeding and discharging, urinary tract irritation, the operation time of USg-D&C, the amount of vaginal bleeding during USg-D&C, and the time for serum β-hCG back to a normal level between the two groups ( > .05).
CONCLUSIONS
The 'I-shape' strategy of HIFU treatment for CSP was effective and safe, with shorter sonication time, less energy input and lower incidence of sonication-related pain occurred in postoperative lower abdominal and sciatic nerve/buttock.
Topics: Cesarean Section; Cicatrix; Extracorporeal Shockwave Therapy; Female; Humans; Pregnancy; Pregnancy, Ectopic; Retrospective Studies; Sonication; Treatment Outcome; Ultrasonography, Interventional; Vacuum Curettage
PubMed: 35196957
DOI: 10.1080/02656736.2022.2044078 -
Frontiers in Surgery 2023This study aims to evaluate the importance of the gestational age at diagnosis and the types of cesarean scar pregnancy (CSP) for treatment outcomes and to identify the...
OBJECTIVE
This study aims to evaluate the importance of the gestational age at diagnosis and the types of cesarean scar pregnancy (CSP) for treatment outcomes and to identify the optimal treatment based on both the gestational age at diagnosis and the CSP type.
METHODS
A retrospective cohort study included 223 pregnant women diagnosed with CSP at Peking University First Hospital, Beijing, China, between 2014 and 2018. All CSP cases underwent ultrasound-guided vacuum aspiration followed by supplementary curettage. Adjuvant treatment modalities included intramuscular injection of systemic methotrexate, uterine artery embolization, and hysteroscopy before ultrasound-guided vacuum aspiration. Linear regression was used to determine the relationship between intraoperative blood loss and gestational age at diagnosis, CSP type, highest β-human chorionic gonadotropin level, and management procedures.
RESULTS
None of the patients required blood transfusions or hysterectomies. Patients presenting at <8, 8-10, and >10 weeks had median estimated blood loss of 5, 10, and 35 ml, respectively. Patients with type I CSP, type II CSP, and type III CSP had median blood loss of 5, 5 and 10 ml, respectively. Multivariate linear regression analysis demonstrated that the gestational age at diagnosis ( < 0.001) and type of CSP ( = 0.023) were independent predictors of intraoperative estimated blood loss. For type I CSP patients, ultrasound-guided vacuum aspiration followed by supplementary curettage alone was performed in 15 of 34 (44.1%) patients, including 12/27 (44.4%) diagnosed at <8 weeks, 2/6 (33.3%) at 8-10 weeks, and 1/1 for >10 weeks. In type II CSP patients, fewer cases were managed by ultrasound-guided vacuum aspiration followed by supplementary curettage alone as the gestational age at diagnosis increased [18/96 (18.8%) for <8 weeks, 7/41 (17.1%) for 8-10 weeks, none for >10 weeks]. Most type III CSP patients (41/45, 91.1%) needed treatments in addition to the ultrasound-guided vacuum aspiration regardless of the gestational age at diagnosis. All CSP patients were treated successfully and did not require readmission or further medical interventions.
CONCLUSION
Gestational age at diagnosis of CSP and its type show a strong correlation with estimated blood loss during ultrasound-guided vacuum aspiration. With careful management, CSPs may be treated at any gestational week, regardless of their type, with minimal intraoperative bleeding.
PubMed: 36874460
DOI: 10.3389/fsurg.2023.1055245 -
Medical Archives (Sarajevo, Bosnia and... Feb 2019Cesarean scar pregnancy is potentially life-threatening condition because of heavy complications and includes adherent placenta: accreta, increta or percreta as a result...
INTRODUCTION
Cesarean scar pregnancy is potentially life-threatening condition because of heavy complications and includes adherent placenta: accreta, increta or percreta as a result of deep placental invasion.
AIM
To present a rare case of ectopic cesarean scar pregnancy combined with placenta percreta in 38-year old woman who undergone previous cesarean section delivery.
CASE REPORT
A multiparous woman aged 38 years with prior cesarean section delivery, admitted first time to the Clinic in 7th week of gestation, due to her medical record (light bleeding). Diagnosis was: graviditas hbd 7, gemellar pregnancy, blighted ovum gemellus I, graviditas isthmico-cervicalis gemellus II. Due to diagnosis it was performed vacuum aspiration et curettage and woman leaved hospital same day. One month later same woman was admitted again to the Clinic due to bleeding and ultrasound finding suspicious to residual trophoblastic tissue. Beta human chorionic gonadotropin serum concentration at the day of admittance was 8,419 IU/ml. Ultrasound finding showed inhomogeneous supracervical formation with dimension 2,73x1,89 cm with increased vascularity and resistant index 0.36 and suspicious placenta increta. We made decision to surgery, and performed hysterectomy in view of heavy intraoperative haemorrhage. Woman was discharged at fifth day after surgery in good condition. Histological finding showed cervical pregnancy complicated with placenta percreta parietis isthmicocervicalis of the uterus.
CONCLUSION
We showed the importance of early and opportune diagnosis of cervical pregnancy specially complicated with one of kind of throphoblastic disease, to prevent life-threatening complication.
Topics: Adult; Cesarean Section; Cicatrix; Female; Humans; Hysterectomy; Placenta Accreta; Pregnancy; Pregnancy, Ectopic
PubMed: 31097863
DOI: 10.5455/medarh.2019.73.58-60 -
PloS One 2023Approximately one in four women will experience a miscarriage in their lifetime. Ultrasound-guided manual vacuum aspiration (USG-MVA) is an ideal outpatient surgical...
BACKGROUND AND AIM
Approximately one in four women will experience a miscarriage in their lifetime. Ultrasound-guided manual vacuum aspiration (USG-MVA) is an ideal outpatient surgical treatment alternative to traditional surgical evacuation. We aimed to examine the cost-effectiveness of US-MVA with cervical preparation for treatment of early pregnancy loss from the perspective of public healthcare provider of Hong Kong.
METHODS
A decision-analytic model was designed to simulate outcomes in a hypothetical cohort of patients with early pregnancy loss on four interventions: (1) US-MVA, (2) misoprostol, (3) surgical evacuation of uterus by dilation and curettage (surgical evacuation), and (4) expectant care. Model inputs were retrieved from published literature and public data. Model outcome measures were total direct medical cost and disutility-adjusted life-year (DALY). Base-case model results were examined by sensitivity analysis.
RESULTS
The expected DALYs (0.00141) and total direct medical cost (USD736) of US-MVA were the lowest of all interventions in base-case analysis, and US-MVA was the preferred cost-effective option. One-way sensitivity analysis showed that the misoprostol group became less costly than the US-MVA group if the evacuation rate of misoprostol (base-case value 0.832) exceeded 0.920. In probabilistic sensitivity analysis, At the willingness-to-pay (WTP) threshold of 49630 USD/DALY averted (1x gross domestic product per capita of Hong Kong), the US-MVA was cost-effective in 72.9% of the time.
CONCLUSIONS
US-MVA appeared to be cost-saving and effective for treatment of early pregnancy loss from the perspective of public healthcare provider of Hong Kong.
Topics: Pregnancy; Female; Humans; Abortion, Spontaneous; Misoprostol; Vacuum Curettage; Cost-Effectiveness Analysis; Pregnancy Trimester, First; Ultrasonography, Interventional; Cost-Benefit Analysis
PubMed: 37922290
DOI: 10.1371/journal.pone.0294058 -
Journal of Health Monitoring Jun 2022Unwanted pregnancies and abortions are experiences shared by many women. In light of the fact that some general framework conditions are currently changing in Germany,...
Unwanted pregnancies and abortions are experiences shared by many women. In light of the fact that some general framework conditions are currently changing in Germany, and that the Corona pandemic represents a particular challenge for the care of women with unwanted pregnancies, current data from the statistics on terminations of pregnancy of the Federal Statistical Office are outlined. Compared to Europe, Germany has a low proportion of induced abortions. In 2021, 94,596 abortions were reported. The number of abortions as well as the abortion rate and the abortion ratio have decreased since 2001. 95.8% of abortions took place according to the so-called counselling provision. In more than half of the abortions (52.1%) vacuum aspiration was used, in 11.4% curettage, 32.3% were medical abortions using mifepristone. There are large regional differences in the method used.
PubMed: 35891938
DOI: 10.25646/9956 -
Medicine Jul 2022Interstitial pregnancy (IP) is a rare but extremely life-threatening form of ectopic pregnancy. The traditional surgical treatment for this anomaly is the resection of...
RATIONALE
Interstitial pregnancy (IP) is a rare but extremely life-threatening form of ectopic pregnancy. The traditional surgical treatment for this anomaly is the resection of uterine cornua or fallopian tubes, which often damages their structural integrity, thereby compromising the reproductive potential for women who wish to preserve fertility.
PATIENT CONCERNS
A 33-year-old female was admitted to our hospital with suspected ectopic pregnancy, following a 4-weeks history of positive pregnancy tests after uterine evacuation. The patient was hemodynamically stable on arrival. Ultrasound revealed an empty uterus with an eccentric gestational sac located at the fundus and surrounded by a thin myometrium, indicative of a suspected interstitial pregnancy.
DIAGNOSIS AND INTERVENTION
After failed attempt at medical management with a single dose of intramuscular methotrexate, the patient was arranged for hysteroscopy-assisted laparoscopy. In surgery, the uterine cavity appeared empty, and a 2 × 2 cm bulge with increased vascularity at the right uterine courna was identified upon examination. The gestational sac was aspirated through the vagina from the right ostium of the uterine tube using a suction curette pointing at the right ostium. Sutures were not needed afterward, and the myometrial anatomy was left undisrupted. The diagnosis of IP was confirmed by the postoperative histological report.
OUTCOMES
Perioperative blood loss was approximately 10 ml and the operative time was 40 minutes. The patient had an uneventful postoperative recovery and was discharged after 3 days. Subsequent follow-ups showed a significant reduction in the patient serum beta hCG to 48IU/L within 5 days postoperation, and a negative result after 7 days.
LESSONS
This novel surgical technique is an alternative minimally-invasive approach for selected early diagnosed and hemodynamically stable IP patients. The technique represents a safe, quick, and simple approach combining the benefits of laparoscopy, such as allowing for immediate conversion of cornuectomy when uterus ruptures, and the benefits of suction curettage, such as shorter operative time and minimal blood loss. We believe patients with interstitial pregnancy who still have fertility wishes would benefit from this surgical technique to a larger extent in the future.
Topics: Adult; Female; Humans; Hysteroscopy; Laparoscopy; Pregnancy; Pregnancy, Interstitial; Uterus; Vacuum Curettage
PubMed: 35777020
DOI: 10.1097/MD.0000000000029730 -
International Journal of Gynaecology... Jul 2020To explore the strategies undertaken to decentralize menstrual regulation services and implement task-sharing, including barriers and facilitators, with nonphysician...
OBJECTIVE
To explore the strategies undertaken to decentralize menstrual regulation services and implement task-sharing, including barriers and facilitators, with nonphysician providers in Bangladesh.
METHODS
We conducted a desk review of relevant policies and health service information from grey and published literature on task-sharing in menstrual regulation services, plus stakeholder interviews with 19 representatives of relevant health organizations to investigate facilitators for and barriers to the implementation of task-sharing of these services.
RESULTS
Task-sharing in menstrual regulation began in 1979 as part of the national family planning program. The Ministry of Health and Family Welfare has guidelines for menstrual regulation services provided by a wide range of healthcare workers using manual vacuum aspiration and the medications misoprostol and mifepristone. Despite government approval, implementation of task-sharing is challenging owing to lack of skilled providers, lack of facility readiness, and unmet need for family planning.
CONCLUSION
The government needs to implement effective planning for skills building of nonphysician providers and ensuring facility readiness for provision of menstrual regulation services to reduce unsafe abortion in Bangladesh.
Topics: Abortion, Induced; Bangladesh; Family Planning Services; Female; Humans; Menstrual Cycle; Mifepristone; Misoprostol; Pregnancy; Vacuum Curettage
PubMed: 33219997
DOI: 10.1002/ijgo.13009 -
Fertility and Sterility Jan 2022To report a peculiar case of ultrasound diagnosis of spontaneous angular twin pregnancy. In literature, the terms "angular," "interstitial," and "cornual" pregnancies...
OBJECTIVE
To report a peculiar case of ultrasound diagnosis of spontaneous angular twin pregnancy. In literature, the terms "angular," "interstitial," and "cornual" pregnancies are often used inappropriately. Confusion in terminology may have contributed to difficulties in developing diagnostic ultrasound criteria to differentiate these ectopic pregnancies.
DESIGN
Case report.
SETTING
Obstetrics and Gynecology, Community Hospital "S. Maria delle Croci."
PATIENT
A 28-year-old patient with a previous cesarean delivery was admitted to our hospital for management of a presumed angular ectopic pregnancy. Transvaginal ultrasound confirmed an ectopic dichorionic diamniotic twin pregnancy eccentrically located in the right superior angle of the uterine cavity: the first gestational sac appeared to have right angular implantation, whereas the second gestational sac seemed to deepen inside the myometrium, with a thin myometrial margin of only 3 mm.
INTERVENTIONS
After discussing the risks, the patient requested to proceed with termination. A single intramuscular injection of 75 mg of methotrexate was administered, followed by ultrasound-guided hysterosuction after 19 days due to severe vaginal bleeding.
MAIN OUTCOME MEASURES
An early and accurate ultrasound diagnosis of a high-risk condition allowed for conservative medical treatment.
RESULTS
The serum beta-human chorionic gonadotropin levels progressively decreased. After 1 month, a clinical and ultrasound examination showed a regular endometrial line with a regular reappearance of menstrual bleeding.
CONCLUSIONS
Although there are remarkable advances in ultrasound techniques, angular pregnancy remains a condition of difficult diagnosis and management; it is potentially dangerous and may lead to severe complications. An early and accurate diagnosis of this condition is necessary to avoid complications and individualize the subsequent management.
Topics: Adult; Conservative Treatment; Female; Humans; Italy; Laparoscopy; Methotrexate; Pregnancy; Pregnancy, Angular; Pregnancy, Twin; Twins, Dizygotic; Ultrasonography; Vacuum Curettage
PubMed: 34961613
DOI: 10.1016/j.fertnstert.2021.09.003