After placental abruption with intrauterine fetal death, VD is feasible and safe regardless of gestational age, parity, cervical maturity, and duration of labor when intensive medical resources are available.
ObjectiveCarcinosarcoma of the uterine corpus has a poor prognosis. Although pathological necrosis is a prognostic factor of endometrial cancer, the clinicopathological influences of an unenhanced region observed on magnetic resonance imaging (MRI) are inconclusive. The aim of our study was to determine the clinicobiological impact of the presence of an unenhanced region on MRI, which can represent necrosis, in uterine carcinosarcoma.MethodsThe clinicopathological factors of 29 patients diagnosed with uterine carcinosarcoma were assessed retrospectively. The percentage of the tumor that was unenhanced on MRI was determined. The clinicopathological factors related to the unenhanced regions were evaluated. The prognostic significance was assessed using the Kaplan-Meier method and Cox regression model.ResultsAlthough the presence of pathological necrosis was not a poor prognostic factor (p=0.704), unenhanced regions on MRI correlated with poor prognosis when the unenhanced regions in the tumor accounted for more than 10% of the total tumor (p=0.019). The percentage of unenhanced regions was positively correlated with stage (p=0.028; r=0.4691) and related to tumor size (p=0.086; r=0.3749). The Cox regression analysis indicated that the presence of lymph node (LN) metastasis and more than 10% of the tumor being unenhanced on MRI were prognostic factors of overall survival in the univariate analyses (p=0.018 and p=0.047, respectively).ConclusionThe unenhanced region on MRI, which represents pathological necrosis, reflects tumor progression, and semi-quantification of the region is useful to predict the prognosis in patients with uterine carcinosarcoma.
Objective: Ectopic pregnancies (EP) commonly occur in the fallopian tube. As a result of improvements in technology and surgical techniques, laparoscopic surgery is a widely-utilized therapy in cases of EP in the fallopian tube, and also seems to be useful in cases of unusual EP. We aimed to evaluate the efficacy of laparoscopic surgery for unusual EP. Method: We defined unusual EP as peritoneal pregnancy, ovarian pregnancy, and interstitial pregnancy. We experienced 165 cases of EP from April 2011 to March 2016. Among these cases, 105 cases underwent surgery. 85 cases occurred in a fallopian tube, and 20 cases occurred in an unusual site (peritoneal pregnancy n=5, ovarian pregnancy n=5, interstitial pregnancy n=10.). We retrospectively investigated the clinical features and analyzed treatment from the medical records of unusual EP at our hospital. Results: Laparoscopic surgery was performed in two cases of peritoneal pregnancies (40%), five cases of ovarian pregnancies (100%), and three cases of interstitial pregnancies (30%). Although in eight cases with unusual EP there was a presentation with massive bleeding, laparoscopic surgery was tried in three of eight cases and completed without conversion to laparotomy. By undertaking intraoperative red blood cell salvage, we were able to could avoid homologous blood transfusion, except in one case. Conclusion: EP requires emergency treatment, and the diagnosis of unusual EP is particularly difficult. Laparoscopy can facilitate correct diagnosis, results in less physical stress for the patient, and is effective in treatment.
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