A small mature cystic ovarian teratoma associated with anti-NMDA receptor encephalitis and acute respiratory failure: A case report.

OBJECTIVE: To report a rare case of anti-N-Methyl-d-aspartate receptor encephalitis (anti-NMDARE) presented by mental and behavioral changes and seizures accompanied with respiratory failure. CASE REPORT: A 37-year-old multiparous woman was initially presented with abnormal mental behavior and the diagnosis of schizophrenia was made, but the disease progressed rapidly to general convulsion and acute respiratory failure. Although active treatment, including steroids, intravenous immunoglobulins (IVIGs) and plasma exchange was applied, no significant improvement was obtained. Transvaginal ultrasound and pelvic magnetic resonance image (MRI) were arranged and the results showed a suspicious cystic lesion (3 × 2.3 cm) at the right ovary. Laparoscopic unilateral salpingo-oophorectomy was performed and final pathology reported a matured cystic teratoma, suggesting that this patient had anti-NMDARE secondary to ovarian mature teratoma. After surgery, the clinical condition was dramatically improved and she recovered completely without sequelae. CONCLUSION: Although it is well-known about the relation between anti-NMDARE and ovarian mature teratoma, this small tumor may result in the missing diagnosis. Remind us to consider the possibility of any small ovarian cystic lesion-related anti-NMDARE in women with autoimmune encephalitis.

Factors influencing the abortion interval of second trimester pregnancy termination using misoprostol.

OBJECTIVES: To determine the factors influencing the abortion interval (AI) for medical termination of second-trimester pregnancy using misoprostol. MATERIALS AND METHODS: All patients who were admitted for second-trimester pregnancy termination between January 2008 and August 2013 were reviewed. Those who received either 200 µg or 400 µg of priming vaginal misoprostol, followed by 200 µg of misoprostol orally at 6-hour intervals were enrolled. RESULTS: In a total of 101 patients, delivery occurred within 24 hours of commencement in 62 patients (61%) and within 48 hours in 84 patients (83%), and the median AI was 16.5 hours. One patient (1%) failed to deliver. The remaining 100 fetuses were delivered successfully, and the median AI was 16.3 hours. Higher parity [hazard ratio (HR) = 1.28, p = 0.04], the presence of intrauterine fetal demise (HR = 2.66, p = 0.003), and the presence of premature preterm rupture of membranes (HR = 4.51, p = 0.003) were associated with shorter AI. Additionally, all women with premature preterm rupture of membranes delivered successfully within 12 hours; higher parity (odds ratio = 2.12, p = 0.01) and lower fetal birth body weight (odds ratio = 0.992, p = 0.01) were associated with successful delivery within 12 hours. There was no significant difference in AI in the groups that received different doses of priming vaginal misoprostol (200 µg vs. 400 µg). CONCLUSION: Higher parity, intrauterine fetal demise, and preterm premature rupture of membranes were associated with shorter AI. The regimen of 200 µg oral misoprostol at 6-hour intervals following a 200 µg or 400 µg priming vaginal dose is feasible and efficacious for second trimester pregnancy termination.

Extended estrogen administration for women with thin endometrium in frozen-thawed in-vitro fertilization programs.

PURPOSE: To evaluate the effect of extended estrogen administration for women with thin endometrium in frozen-thawed in-vitro fertilization (IVF) programs. METHODS: Thirty-six women undergoing IVF program had thin endometrium (<8 mm). Among them, 23 received fresh embryo transfer (control group), but 13 canceled embryo transfer and underwent frozen-thawed embryo transfer in the subsequent cycle after extended administration of exogenous estrogen (study group). RESULTS: In the study group, the mean endometrial thickness increased significantly from 6.7 mm in controlled ovarian hyperstimulation cycles to 8.6 mm after an extended estrogen therapy for 14 to 82 days (P=0.031). Their pregnancy rate was significantly higher than that in the control group (38.5% vs. 4.3%, P=0.016). Among 5 women achieving pregnancies in the study group, one was complicated with placenta accreta, and the other 4 had uneventful pregnancies. CONCLUSIONS: Extended estrogen administration followed by frozen-thawed IVF programs is beneficial for women with thin endometrium. However, the risk of abnormal placentation and peripartal complication should be kept in mind.