Hemorrhagic bullous lesions in Henoch-Schönlein purpura: a case report and review of the literature.

BACKGROUND: Henoch-Schönlein purpura (HSP) is a common vasculitis in childhood characterized by purpura, arthritis, abdominal pain and renal involvement. However, bullous HSP is a rare cutaneous manifestation, and a few cases have been reported. CASE PRESENTATION: Herein, we report a 15-year-old male with bullous HSP who presented with severe abdominal pain and hemorrhagic bullous lesions over his lower extremities. He was treated with corticosteroid, after which the symptoms improved dramatically. No recurrence was noted after follow-up, though scarring was present. We also reviewed the literature related to bullous HSP and identified 39 cases, most of whom were treated with corticosteroids. CONCLUSION: Clinicians should be aware of the atypical types of HSP, including bullous HSP. Most patients with bullous HSP have a good prognosis.

Seroprevalence, Seroconversion, and Risk Factors for Toxoplasmosis among Pregnant Women in Taipei, Taiwan.

Herein, we determined the seroprevalence, seroconversion, and risk factors associated with Toxoplasma gondii (T. gondii) infection among pregnant women in Taipei, Taiwan. Pregnant women attending antenatal consultation in a Taipei medical center were invited, and 104 women completed a self-administered structured questionnaire. Venous blood samples were collected during the first and third trimester after consent was obtained. Serum IgG and IgM antibodies (Abs) as well as IgG avidity were analyzed using an enzyme-linked fluorescent assay. Of the samples collected in the first trimester, seven were seropositive for IgG Abs and one was seropositive for IgG + IgM Abs with a borderline avidity index, resulting in an overall seroprevalence of 7.7%. No statistically significant association was found between toxoplasmosis and age, pregnancy history, or any risk factors. Seroconversion was not detected from paired sera between the first and third trimesters. Pregnant women with senior high school education level or those who claimed to knowing Toxoplasma exhibited a significantly higher seroprevalence than those with bachelor degree (P = 0.05) or those who claimed not to have this knowledge (P = 0.05). Therefore, failure to understand the importance of T. gondii infection and the prevention measures resulted in the development of toxoplasmosis among these women.

Ultrasonographic quantification of the endometrium during the menstrual cycle using computer-assisted analysis.

OBJECTIVE: Sonographic gray-scale histogram is used to assess the endometrial changes in the different phases of the menstrual cycle. The objective was to examine the usefulness of a gray-scale histogram and computer-assisted image analysis software in assessing normal physiologic states of the endometrium with sonography. MATERIALS AND METHODS: Thirty-eight patients, who visited the Taipei Medical University-Wan Fang Hospital and matched the eligibility criteria, were categorized into one of three groups: (1) menstrual phase; (2) follicular phase; and (3) luteal phase of the menstrual cycle. Ultrasonography of the uterus was performed on each patient and the endometrium was analyzed with ImageJ image analysis software. RESULTS: A statistically significant difference in signal intensity scores of the gray-level histogram, represented as m(j), was found among the three groups. CONCLUSION: Sonographic images analyzed by using computer-assisted image analysis software and gray-level histogram are proven to be useful in assessing the physiological state of the endometrium.

Polycystic ovary syndrome or hyperprolactinaemia: a study of mild hyperprolactinaemia.

Polycystic ovary syndrome (PCOS) and hyperprolactinaemia are both common causes of secondary amenorrhoea in reproductive women. The relationship between PCOS and hyperprolactinaemia has been reported with controversial results. To evaluate the clinical and laboratory features of women with mild hyperprolactinaemia and PCOS, we studied 474 Taiwan Chinese women: 101 had mild hyperprolactinaemia, 266 had PCOS and 107 were the control group. In this study, we found that 64% of the women with mild hyperprolactinaemia fulfilled the PCOS diagnostic criteria, regardless of their prolactin levels. Obese women with PCOS had significantly lower luteinising hormone (LH) and LH-to-FSH ratios than non-obese women with PCOS. Obese hyperprolactinaemic women had significantly lower follicle-stimulating hormone (FSH), but higher LH-to-FSH ratios than the non-obese hyperprolactinaemic women. For women with PCOS, the BMIs were significantly negative with LH (γ = -0.253, p < 0.001), but not with FSH (γ = -0.061, p = 0.319). For the hyperprolactinaemic women, the BMIs were significantly negative with FSH (γ = -0.353, p < 0.001), but not with LH (γ = -0.021, p = 0.837). Although PCOS-related syndrome was very prevalent in women with hyperprolactinaemia, the patterns of disturbance in gonadotropin secretion were different between the PCOS and the hyperprolactinaemia patients.

Evaluation of placental maturity by the sonographic textures.

PURPOSE: Routine ultrasound screening to predict gestational age is important for risk assessment of pregnancy complications among pregnant women. We explored a quantitative method for sonographic analysis of placental texture, with the objective of reproducible measurement. METHODS: We studied 151 pregnant women; the gestational ages of their fetuses ranged from 10 to 38 weeks. Three experienced sonographers delineated the placental contour to define the region of interest (ROI). From these sonograms, 72 texture features were derived from the spatial gray-level dependence matrices and gray-level difference matrices. We used these as input variables in a multiple linear regression analysis. RESULTS: A significant positive correlation (P < 0.01) was found between the multiple linear regression results and the corresponding gestation ages by the three assessors (r (A) = 0.755, r (B) = 0.851, and r (C) = 0.832). We also found good agreement between multiple linear regression results for the three observers. Their κ statistic values were 0.685 between assessors A and B, 0.679 between A and C, and 0.804 between B and C. CONCLUSION: Quantitative sonography using texture analysis of the placenta was useful in practice to determine gestational age.

Inappropriate gonadotropin secretion in polycystic ovary syndrome.

OBJECTIVE: To evaluate inappropriate gonadotropin secretion in women with polycystic ovary syndrome (PCOS). DESIGN: Retrospective study. SETTING: Academic tertiary center. PATIENT(S): A total of 373 women were classified into three groups: [1] healthy control women (n = 48); [2] women who were positive for PCOS risk factor; and [3] women with PCOS (n = 251). INTERVENTION(S): None. MAIN OUTCOME MEASURE(S): Gonadotropin levels, LH-FSH ratio, body mass index, and clinical and/or biochemical presentations of PCOS. RESULT(S): The area under the receiver operating characteristic curve, used to predict PCOS for the LH-FSH ratio, showed similar diagnostic performance to total T and average ovarian volume. The LH-FSH ratio exhibits greater observed accuracy than total T and average ovarian volume for evaluation of women with oligomenorrhea or anovulation. An LH-FSH ratio of >1 presented the best combination of sensitivity and specificity. Body mass index was positively correlated with total T in non-PCOS and PCOS groups; however, body mass index was negatively correlated with LH in PCOS but showed no correlation in non-PCOS subjects. CONCLUSION(S): The LH-FSH ratio is a valuable diagnostic tool in evaluating women with PCOS and oligomenorrhea or anovulation, and an LH-FSH ratio of >1 may be used as a decision threshold. The link between body mass index and LH may provide clues for further understanding the pathological milieu of PCOS.

Lung collapse induced by pulmonary hemorrhage: a rare complication of hysteroscopy.

Pulmonary hemorrhage is a rare but sometimes fatal complication of hysteroscopy. We present the first case report in which a healthy patient developed lung collapse induced by pulmonary hemorrhage after operative hysteroscopy. The possible etiologies of this rare complication are also discussed.

Risk-adjusted cesarean section rates for the assessment of physician performance in Taiwan: a population-based study.

BACKGROUND: Over the past decade, about one-third of all births nationwide in Taiwan were delivered by cesarean section (CS). Previous studies in the US and Europe have documented the need for risk adjustment for fairer comparisons among providers. In this study, we set out to determine the impact that adjustment for patient-specific risk factors has on CS among different physicians in Taiwan. METHODS: There were 172,511 live births which occurred in either hospitals or obstetrics/gynecology clinics between 1 January and 31 December 2003, and for whom birth certificate data could be linked with National Health Insurance (NHI) claims data, available as the sample for this study. Physicians were divided into four equivalent groups based upon the quartile distribution of their crude (actual) CS rates. Stepwise logistic regressions were conducted to develop a predictive model and to determine the expected (risk-adjusted) CS rate and 95% confidence interval (CI) for each physician. The actual rates were then compared with the expected CS rates to see the proportion of physicians whose actual rates were below, within, or above the predicted CI in each quartile. RESULTS: The proportion of physicians whose CS rates were above the predicted CI increased as the quartile moved to the higher level. However, more than half of the physicians whose actual rates were higher than the predicted CI were not in the highest quartile. Conversely, there were some physicians (40 of 258 physicians) in the highest quartile who were actually providing obstetric care that was appropriate to the risk. When a stricter standard was applied to the assessment of physician performance by excluding physicians in quartile 4 for predicting CS rates, as many as 60% of physicians were found to have higher CS rates than the predicted CI, and indeed, the CS rates of no physicians in either quartile 3 or quartile 4 were below the predicted CI. CONCLUSION: Overall, our study found that the comparison of unadjusted CS rates might not provide a valid reflection of the quality of obstetric care delivered by physicians, and may ultimately lead to biased judgments by purchasers. Our study has also shown that when we changed the standard of quality assessment, the evaluation results also changed.

Malignant fibrous histiocytoma during pregnancy: a case report.

OBJECTIVE: We present a case of a 38-year-old postpartum woman who had antepartal undiagnosed sarcoma with multiple metastasis. Although the patient underwent aggressive treatment with surgery and chemotherapy, she died 3 months after the vaginal delivery of a healthy female infant weighing 2,090 g at 35 weeks of gestation. CASE REPORT: The patient had right shoulder pain and mild chest discomfort during the last trimester of the pregnancy. Six days after delivery, she came to our emergency room because her pain had become more severe. A humeral neck tumor with bone destruction was found in the right shoulder on X-ray. After detailed evaluation, right humeral surgery, cardiac surgery, and liver biopsy were performed. All the removed specimens were sent for pathologic examination, and the results showed a sarcoma favoring malignant fibrous histiocytoma with its primary origin in the left atrium. CONCLUSION: Obstetricians should be aware that any non-specific complaint may be due to severe disease. It is better to evaluate all symptoms and signs that persist. In this case, early intervention such as radiologic imaging of the bone or echocardiography could have been performed during pregnancy to prevent tumor spread, maternal morbidity, and even death.