The safety of echo contrast-enhanced ultrasound in high-intensity focused ultrasound ablation for abdominal wall endometriosis: a retrospective study.

BACKGROUND: We aimed to investigate the efficacy and safety of echo contrast-enhanced ultrasound (CEUS) during high-intensity focused ultrasound (HIFU) ablation therapy for abdominal wall endometriosis (AWE). METHODS: A total of 67 patients with AWE were treated with HIFU ablation, and their demographic characteristics were retrospectively analysed. Blood perfusion of the focal lesion was assessed before the operation, during ablation and after the operation with the use of an ultrasound contrast agent, and the effect of the ultrasound contrast agent on treatment was assessed over a 1-year follow-up period. The degree of symptom relief and adverse effects were evaluated after HIFU ablation. RESULTS: Eighty-two lesions were ablated in 67 patients. CEUS showed that all lesions were successfully ablated with HIFU. The shrinkage ratio of the lesions significantly increased over the follow-up period. Intermittent pain disappeared at 1 month after the operation, and the patients' pain scores significantly decreased at the 1-year follow-up. The mean [± standard deviation (SD)] lesion volume was 7.64±8.95 cm3 on B-mode ultrasound. The post-HIFU non-perfused volume was 18.34±24.08 cm3, and the rate of massive changes on greyscale imaging was 96.16%±5.44% at 12 months. During the procedure, the main complications were a prickling sensation and tenderness in the treatment area and/or a transient "hot" sensation on the skin. After the procedure, there was no obvious discomfort except for pain. Two patients developed an approximately 1-cm area of skin that exhibited a waxy appearance. Seven patients had haematuria. No severe complications were observed. CONCLUSIONS: Ultrasound contrast agents are effective and safe for evaluating the effect of HIFU ablation on AWE, and this approach provides significant guidance and evaluation benefits for the use of HIFU treatment for AWE without obvious side effects.

Expression of oxytocin receptors in the uterine junctional zone in women with adenomyosis.

OBJECTIVE: To compare the expression of oxytocin receptor in the uterine junctional zone of the fundus and isthmus in the proliferative and secretory phases in women with and without adenomyosis. DESIGN: Experimental prospective clinical study. SETTING: Tertiary gynecologic medical center. POPULATION: Twenty-nine women with adenomyosis (15 in proliferative phase, 14 in secretory phase) and 27 women without adenomyosis (15 in proliferative phase, 12 in secretory phase). METHODS: Samples from the uterine fundus and isthmus were obtained at hysterectomy. The expression of oxytocin receptor was evaluated using immunohistochemistry. MAIN OUTCOME MEASURES: Immuno-reactive score was used evaluate semi-quantitatively the oxytocin receptor expression. RESULTS: In normal uteri, the expression of oxytocin receptor in the isthmus was significantly higher than in the fundus in the proliferative phase (p < 0.01) but the opposite distribution pattern was observed in the secretory phase. Conversely, in adenomyosis uteri, the expression of oxytocin receptor in the fundus was significantly higher than in the isthmus in the proliferative phase (p < 0.05); however, this difference was not significant in the secretory phase. Moreover, oxytocin receptor expression in the fundus of adenomyosis uteri was higher than that in the control uteri in both the proliferative and secretory phases. CONCLUSIONS: The expression pattern of oxytocin receptor in the normal junctional zone is disrupted in women with adenomyosis. This may be one possible explanation for the symptomatology of the condition.

Treatment options to terminate persistent cesarean scar pregnancy.

AIMS: Persistent Cesarean scar pregnancy (PCSP) is a rare and special type of Cesarean scar pregnancy (CSP) which is resistant to conservative treatment. The treatment option is challenging. We report a case series to provide indications for further treatment. METHODS: Ten women diagnosed as having a PCSP, seeking better treatment because of primary treatment failure, were admitted to a gynecologic minimally invasive center. Ultrasound combined with office hysteroscopy was used for preoperative evaluation, and then a further surgical strategy was selected. Clinical data were retrospectively studied. RESULTS: Among ten PCSP patients, 4 were type I and 6 were type II. In the 4 type I cases, 2 were treated by laparoscopy and the other 2 by hysteroscopy; to stop bleeding in 1 of them, the uterine artery was occluded laparoscopically. All type II cases were successfully treated by laparoscopic excision. The mean operating time was 61.5 min. The mean blood loss was 83.5 ml. No complications occurred except one intraoperative hemorrage. CONCLUSIONS: Experience from this case series indicates that an individualized surgical plan based on a full preoperative evaluation provides useful information for choosing a suitable treatment for PCSP. Endoscopically guided surgical excision with experienced hands may be considered the most useful treatment.

[Clinical analysis of conversion from gynecological laparoscopic surgery to laparotomy].

OBJECTIVE: To discuss the causes and clinical significance of conversion to laparotomy during laparoscopic surgery. METHOD: Three thousand two hundred and three cases who underwent laparoscopic surgery during the past five years were analyzed retrospectively. RESULTS: Three thousand one hundred and eighty cases underwent laparoscopic surgery, in which 23 cases were converted to laparotomy due to factors including severe pelvic adhesions (6 cases), complex disease with difficulties in laparoscopy (7 cases), massive haemorrhage (3 cases), bladder trauma (1 case), gastric trauma (1 case), intestinal trauma (1 case), as well as unexpected malignant genitalia neoplasm (4 cases). CONCLUSION: The major causes for the conversion to laparotomy during gynecology laparoscopic surgery are severe pelvic adhesion and complex disease with difficulties in laparoscopy. Careful evaluation before surgery and conversion to laparotomy at the right moment can decrease the complication.

[Analysis on the complications of hysteroscopic surgeries].

OBJECTIVE: To investigate the causations, management and prevention methods on the complications of hysteroscopic procedures. METHODS: Retrospective analysis of 36 cases with hysteroscopic complication, focusing on their characteristics and clinical management as well as prevention methods during the ten years from 1993 to 2004. RESULTS: Among 36 cases, 11 cases with uterine perforation and incomplete perforation, which happened during the complicated procedures, were treated by both laparoscopy and laparotomy. Five cases with heavy bleeding were encountered because of the deeply injury to the uterine wall and Foley catheter was inserted into uterine cavity and it stopped the bleeding successfully except in one case done by hysterectomy. Three cases with fluid overload syndrome were cured by using diuretic agent and saline infusion. There is no serious consequence in one case with air embolism due to prompt diagnosis and treatment. Four cases with postablation-sterilization syndrome were treated effectively by performing hysterectomy plus single or bilateral salpingectomy, dilating cervical canal as well as resecting adhesions. Twelve cases with adhesion inside uterine cavity followed hysteroscopy were also treated by dilating cervical canal, underwent adhesionlysis and hysterectomy. CONCLUSIONS: The potential factors causing complications of hysteroscopy include complicated procedures inside uterine cavity, higher pressure of irrigation, deep injury of endometrium as well as incomplete removal of endometrium during hysteroscopic operations. It is the necessary measures to reduce the complications by performing laparoscopy or B ultrasound monitoring simultaneously, standardizing the procedure and strengthening postoperation management.

[Analysis of the efficiency of transcervical resection of endometrium for treating dysfunctional uterine bleeding and factors reducing the efficiency of the operation].

OBJECTIVE: To investigate the efficiency and factors related to the recurrence of transcervical resection of endometrium (TCRE) in treating women with dysfunctional uterine bleeding (DUB). METHODS: Two hundred and twenty women with DUB were selected for TCRE. Specimens from removed endometrium were obtained during the procedures and their menstruation and menorrhagia after the operations were followed up. We also studied the uterine specimens obtained from the recurrent cases undergoing hysterectomies. The specimens were stained by hematoxylin-eosin and immuno-histochemistry respectively to evaluate the depth of removed myometrium and the histopathologic changes in relapsed cases. RESULTS: The follow up period after operation was 24 to 114 months. (1) Overall effective rate was 94.5%, in which amenorrhea rate was 25.9%, menstruation reduction rate was 68.6%. (2) The effective rate of corrective anemia was 97.3% and the satisfaction rate for the operation was 92.3%. (3) Thirty-eight cases required subsequent treatment as a result of recurrence, of which 10 cases underwent hysterectomy and 3 cases underwent repeat TCRE and 25 cases were given medicine treatment. (4) The average depth of myometrium in removed endometrium strip was 2.12 approximately 3.26 mm. (5) Endometrium regrowth was seen in the resected uterine specimens from relapsed cases and adenomyosis was also found in the intra-uterine wall in some cases. CONCLUSIONS: (1) TCRE is a safe and effective alternative treatment for DUB. (2) The main factor reducing the efficiency is either incomplete removal of endometrium or adenomyosis. (3) Standardizing the procedures and strengthening postoperative management are essential requirements for improving the efficiency of TCRE.