A rare case of fundal intramural ectopic pregnancy associated with previous B-Lynch sutures.

BACKGROUND: Intramural ectopic pregnancy is a rare form of ectopic pregnancy that occurs within the myometrium. It is challenging to diagnose it early because of its nonspecific clinical presentation, and there is no consensus or guideline on the optimal management among gynecologists. CASE PRESENTATION: We report a case of a 34-year-old woman who developed fundal intramural ectopic pregnancy after a previous caesarean section with B-Lynch suture. The B-Lynch suture was performed at 38 weeks of gestation for postpartum hemorrhage caused by refractory uterine atony about 8 years ago. Since then, the patient had oligomenorrhea. The diagnosis of intramural ectopic pregnancy was not confirmed by magnetic resonance imaging or ultrasound. An exploratory laparoscopy and hysteroscopy was performed to remove the gestational sac without significant bleeding. The surgery was successful and the patient recovered well. The patient was advised to monitor her ß-HCG levels regularly until they returned to normal, and a follow-up pelvic ultrasound showed no complications. However, she has not been able to conceive or have an ectopic pregnancy so far. CONCLUSIONS: This case illustrates the difficulty of diagnosing intramural ectopic pregnancy, especially when it is associated with previous uterine surgery and B-Lynch suture. It also demonstrates the feasibility and safety of laparoscopic surgery for treating complete IUP, especially when the gestational sac is located close to the uterine serosa. However, the risk of uterine rupture and hemorrhage should be considered, and the patient should be informed of the possible complications and alternatives. Gynecologists should be familiar with various management strategies and customize the treatment plan according to the patient's clinical situation and preferences.

Hidden blood loss and its risk factors in patients undergoing laparoscopy and laparotomy for cervical cancer management.

PURPOSE: Laparoscopy and laparotomy are the two most common surgical options used to treat women with early-stage cervical cancer. This study aimed to examine the volume of hidden blood loss (HBL) between laparoscopy and laparotomy for cervical cancer and to identify its risk factors. METHODS: Sixty-one patients treated with laparotomy and 50 patients treated with laparoscopy were enrolled in this study. Their medical data were collected to calculate the HBL according to the Nadler and Gross formula, and its risk factors were identified by multiple linear regression analysis. RESULTS: The visible blood loss was 574.9 ± 271.6 mL in the laparotomy surgery; however, the HBL was 345.2 ± 258.6 mL, accounting for 38.3 ± 21.4% of true TBL. The visible blood loss in the laparoscopy group was 168.9 ± 121.9 mL, and the HBL was 185.1 ± 130.5 mL (52.3 ± 28.1% of true TBL). The HBL blood loss in laparotomy was more than laparoscopy (p < 0.01). Multiple linear regression analysis suggested that patient age (p = 0.012), surgical time (p = 0.037) and pathological tumour type (p = 0.014) were independent risk factors contributing to HBL in laparotomy. Meanwhile, the following risk factors were positively correlated with HBL in laparoscopy: pre-operative value of Hb (p = 0.002), pre-operative value of Hct (p = 0.003), surgical time (p = 0.035), pathological tumour type (p = 0.036) and diabetes mellitus (p = 0.022). Ten and eight patients had pre-operative anaemia in the laparotomy group and the laparoscopy group, respectively, and 54 and 29 post-operatively. CONCLUSIONS: HBL is seriously underestimated, and accounts for a large percentage of total blood loss both in laparotomy and laparoscopy for cervical cancer. Additionally, age, pathological tumour type, pre-operative value of Hb and Hct, surgical time and diabetes mellitus have the potential to increase HBL. A correct understanding of HBL can ensure patient safety and improve post-operative rehabilitation.

The association of polymorphisms in nucleotide excision repair genes with ovarian cancer susceptibility.

Nucleotide excision repair (NER), the core mechanism of DNA repair pathway, was commonly used to maintain genomic stability and prevent tumorigenesis. Previous investigations have demonstrated that single nucleotide polymorphisms (SNPs) of NER pathway genes were associated with various types of cancer. However, there was no research elucidating the genetic association of entire NER pathway with ovarian cancer susceptibility. Therefore, we conducted genotyping for 17 SNPs of six NER core genes (XPA, XPC, XPG, ERCC1, ERCC2, and ERCC4) in 89 ovarian cancer cases and 356 cancer-free controls. Odds ratios (ORs) and 95% confidence intervals (CIs) were used to describe the strength of association. The result showed that both ERCC1 rs11615 and XPC rs2228000 were significantly associated with reduced risk of ovarian cancer under dominant genetic model (adjusted OR = 0.35, 95% CI = 0.20-0.61, P=0.0002 and adjusted OR = 0.49, 95% CI = 0.30-0.81, P=0.005 respectively). In addition, XPC rs2228001 and ERCC2 rs238406 had statistically significant association with the increased risk of ovarian cancer under dominant genetic model (adjusted OR = 1.72, 95% CI = 1.02-2.92, P=0.043 and adjusted OR = 2.07, 95% CI = 1.07-4.01, P=0.032 respectively). ERCC1 rs3212986 were related with the increased risk of ovarian cancer under recessive model (adjusted OR = 2.40, 95% CI = 1.30-4.44, P=0.005). In conclusion, our results indicated that ERCC1, XPC and ERCC2 might influence ovarian cancer susceptibility. Further research with large sample size is warranted to validate the reliability and accuracy of our results.

No association between TP53 Arg72Pro polymorphism and ovarian cancer risk: evidence from 10113 subjects.

The TP53 gene product is an important regulator of cell growth and a tumor suppressor. The association between TP53 Arg72Pro polymorphism and ovarian cancer risk has been widely investigated, but the results are contradictory. We therefore searched the PubMed, EMBASE and Chinese Biomedical databases for studies on the relation between TP53 Arg72Pro polymorphism and ovarian cancer risk. Our final meta-analysis included 24 published studies with 3271 cases and 6842 controls. Pooled results indicated that there was no significant association between TP53 Arg72Pro polymorphism and ovarian cancer risk [Pro/Pro vs. Arg/Arg: odds ratio (OR) =1.04, 95% confidence interval (CI) = 0.81-1.34; Arg/Pro vs. Arg/Arg: OR = 1.14, 95% CI = 0.96-1.36; recessive: OR = 1.05, 95% CI = 0.90-1.22; dominant: OR = 1.12, 95% CI = 0.94-1.33; and Pro vs. Arg: OR = 1.06, 95% CI=0.93-1.20]. Likewise, stratified analyses failed to reveal a genetic association. Despite some limitations, the present meta-analysis provides statistical evidence indicating a lack of association between TP53 Arg72Pro polymorphism and ovarian cancer risk.