A case of pyelonephritis due to ureteral obstruction caused by complete uterine prolapse.

We present the case of a patient with pyelonephritis secondary to urinary tract obstruction caused by uterine prolapse. An 80-year-old woman with uterine prolapse (pelvic organ prolapse stage 4) was treated with a pessary at an outside hospital due to her high perioperative risk. However, the pessary prolapsed. The patient developed pyelonephritis with hydronephrosis. A pessary was inserted to resolve the blockage of the urinary tract, antibiotic treatment was initiated, and the patient's condition improved. A total vaginal hysterectomy was ultimately performed. Challenges remain in the treatment of pelvic organ prolapse stage 4 for which a pessary cannot be used.

A case of severe pulmonary embolism after total robotic hysterectomy despite venous thromboembolism prophylaxis as prescribed.

INTRODUCTION: We report the case of a patient who developed a severe pulmonary embolus postoperatively despite perioperative venous thromboembolism (VTE) prophylaxis as prescribed. PRESENTATION OF CASE: A 50-year-old female patient underwent a robotic total hysterectomy for uterine fibroids. Her perioperative VTE risk was assessed as moderate, and compression and intermittent air compression stockings were used postoperatively until the morning following the surgery. The surgery was uneventful, and the patient was discharged on postoperative day 4. On postoperative day 19, the patient experienced rapid dyspnea and was diagnosed with a severe pulmonary embolus. DISCUSSION: Heparin, a tissue-type plasminogen activator, and a catecholamine were administered, and the patient recovered well. CONCLUSION: VTE measures in minimally invasive gynecologic surgery are not well defined, and future thrombotic risk assessments specific to minimally invasive gynecologic surgery may be necessary.

A case of periodic abdominal pain and fever due to left ovarian abscess.

Tubo-ovarian abscess (TOA) is a late complication of pelvic inflammatory disease. Its diagnosis is difficult because it is occasionally accompanied by atypical symptoms such as abdominal pain and fever. A 45-year-old married woman presented with recurrent abdominal pain and fever. Her medical history included ovarian surgery 14 years prior to presentation. Computed tomography (CT) performed by her local doctor confirmed uterine fibroids and a left ovarian tumor. Following a detailed examination and magnetic resonance imaging at our hospital, a TOA was suspected, and surgery was planned. During surgery, the adhesion was firm and required laparotomy. Ultimately, the left ovarian tumor was confirmed to be a TOA. Although complete surgical resection was not feasible. A surgical drain was inserted, and the pus was drained. Cultures revealed Citrobacter freundii and other organisms, and oral quinolone antibiotics were administered. CT performed on the fourth postoperative day demonstrated a residual abscess; however, 5 weeks after surgery, CT showed complete resolution of the residual abscess. Subsequently, the antibiotic regimen was terminated, and progestins were administered for the treatment of endometriosis, which is still ongoing.

A Case of Ultrasound Suspected Microcephaly With a Normal Head Circumference at Birth.

A 25-year-old first-time mother from Nepal had a well-progressing spontaneous pregnancy. However, from the 37th week, her baby's biparietal diameter (BPD) stopped growing at around 83 mm. At 40 weeks, measurements suggested possible microcephaly and fetal growth failure but no other abnormalities. No travel, infections, or cytomegalovirus were identified prenatally. By 41 weeks, the BPD and head circumference (HC) decreased further, while the estimated fetal birth weight (EFBW) slightly increased. The baby girl was born at 41 weeks and 1 day with a low birth weight but a normal head circumference. Postnatal checks showed no abnormalities, and she was discharged with normal growth at 10 days old.

A case of hyponatremia attributed to carboplatin-induced syndrome of inappropriate anti-diuretic hormone.

•A patient who used carboplatin in the treatment of ovarian cancer developed SIADH.•She was able to continue treatment with regular salt intake.•This treatment may be an option for similar patients in the future.

A case of sudden multiple hematomas during cesarean section due to amniotic fluid embolism.

INTRODUCTION: We report a case of multiple hematomas, a rare manifestation of amniotic fluid embolism (AFE), during cesarean section. PRESENTATION OF CASE: The patient had a history of pregnancy and cesarean section birth due to placental abruption. At 38 weeks and 2 days, her membrane ruptured, and an emergency cesarean section was performed. During uterine suturing, hematomas suddenly formed in multiple locations, and bleeding began. Intraoperative blood tests revealed decreased hemoglobin and fibrinogen levels, leading to the administration of red blood cells and fresh frozen plasma. Despite initial transfusions, hemoglobin and fibrinogen levels did not increase, necessitating additional transfusions, which ultimately improved the hemoglobin and fibrinogen levels. A post-discharge blood draw showed decreased C3 levels, supporting a diagnosis of disseminated intravascular coagulation (DIC)-type AFE. DISCUSSION: The sudden onset of hematomas in multiple locations other than the uterine incision wound was an atypical presentation of AFE in this case. The multiple hematomas were caused by DIC-induced hemostasis, and the decreased C3 level in the blood test supported the diagnosis of DIC-type AFE. CONCLUSION: Multiple hematomas may occur as a symptom of DIC-type AFE and require attention.

Comparison of postoperative analgesia use between robotic and laparoscopic total hysterectomy: a retrospective cohort study.

Although robotic and laparoscopic total hysterectomies are widely used as minimally invasive procedures, consensus on which is superior regarding lesser postoperative pain is lacking. This study determines whether there is a difference in the proportion of postoperative use of non-steroidal anti-inflammatory drugs (NSAIDs) and acetaminophen between robotic and laparoscopic total hysterectomies. This retrospective cohort study enrolled patients who underwent robotic or laparoscopic total hysterectomy for uterine fibroids, adenomyosis, or cervical intraepithelial neoplasia grade 3 at a hospital between July 2016 and November 2021. The outcome was postoperative analgesics (i.e., NSAIDs or acetaminophen) use. Unadjusted and adjusted logistic regression analyses were performed to evaluate the association between the procedure and outcome. Adjusted variables were age, body mass index, surgeon's laparoscopic technique certification, intravenous patient-controlled analgesia, and wound local anesthesia. Of 127 patients, 3 were excluded, and 124 were included. Robotic and laparoscopic hysterectomy was performed in 38 and 86 patients, respectively. Postoperative analgesics were administered to 10 (26.3%) and 52 (60.5%) patients in the robotic and laparoscopic groups, respectively. Unadjusted logistic regression analysis showed significantly more frequent analgesics use in the laparoscopy group (odds ratio [OR] 4.28; 95% confidence interval [CI] 1.85-9.93; p < 0.01). Adjusted logistic regression analysis did not detect significant differences (OR 2.62; 95% CI 0.91-7.56; p = 0.07). No significant difference in the proportion of postoperative analgesia was observed between robotic total hysterectomy and laparoscopy. Future studies must include larger sample sizes and aligned intraoperative and postoperative analgesic management.

A case of endometriotic cyst enlargement during pregnancy owing to desmoplasia and rupture at 36 weeks of gestation.

Decidualized ovarian endometrioma is a rare phenomenon that occurs during pregnancy. A 43-year-old pregnant woman with an endometriotic cyst increased owing to desmoplasia presented to us urgently with abdominal pain and was performed a cesarean section at 36 weeks and 1 day of pregnancy. The left ovarian cyst was noted to be partially ruptured, and the pathological diagnosis was an endometriotic cyst with desmoplasia. Endometriotic cysts may enlarge during pregnancy owing to desmoplasia and rupture in the last trimester of pregnancy, causing acute abdomen.

A Case of Postpartum Pulmonary Edema With Preserved Ejection Fraction and Diastolic Capacity.

A 21-year-old female patient delivered vaginally at 40 weeks of gestation after an uneventful pregnancy. She bled profusely during delivery and underwent a blood transfusion and was discharged home on postpartum day 6. On postpartum day 8, she developed respiratory distress and visited our emergency room. She was admitted after a computed tomography scan showed evidence of pulmonary edema; pneumonia was suspected. After admission, her oxygenation worsened, and she was transferred to a higher institution. A PCR test performed at the higher institution was negative for coronavirus disease 2019, and echocardiography showed that the patient's ejection fraction was maintained. Oxygenation improved with oxygen administration alone, and the patient was transferred to our hospital on the same day. Echocardiography performed at our hospital showed no abnormalities in diastolic function, but the left ventricle was enlarged and mild mitral regurgitation was observed. Oxygenation gradually improved with diuretics and oxygen administration, and the patient was discharged home on the fifth day of hospitalization. An echocardiogram performed three months postpartum was normal.

Primary Peritoneal Carcinosarcoma With Metastasis to the Umbilicus and Pancreas.

A 51-year-old woman visited our hospital after being diagnosed with ascites effusion by her previous physician due to weight gain for 6 months. Ascites cytology showed adenocarcinoma, MRI showed an omental cake, and CT showed neoplastic lesions in the umbilicus and pancreas. Laparoscopy revealed that the omentum had been replaced by a tumor. Biopsies of the omentum and umbilicus revealed a carcinosarcoma. Treatment with paclitaxel and carboplatin was unsuccessful, and the patient's general condition deteriorated, leading to her demise. Pathological autopsy revealed carcinosarcoma of peritoneal origin metastasizing to the umbilicus and tail of the pancreas. No tumors were found in the uterus, ovaries, or fallopian tubes.

A Case of Ovarian Metastasis of Pancreatic Cancer Causing Ovarian Torsion.

A 55-year-old female who had been diagnosed with stage 4 pancreatic cancer visited the emergency department of our hospital owing to sudden lower abdominal pain and was found to have an ovarian tumor. An urgent laparoscopic resection of the right adnexa was performed with a diagnosis of ovarian tumor stalk torsion. Postoperative pathological diagnosis revealed ovarian metastasis of pancreatic cancer. Our case report demonstrates that an ovarian tumor on one side in a patient with advanced pancreatic cancer may represent ovarian metastasis of the primary tumor.

Zinc Deficiency-Associated Dysgeusia Preventing the Improvement of Severe Hyperemesis Gravidarum.

A 23-year-old primigravida visited the hospital frequently since the early phase of her pregnancy because of severe hyperemesis gravidarum. She was hospitalized for the same at 14 weeks and 1 day of pregnancy. After admission, peripheral intravenous nutrition was started; however, her symptoms did not improve. At 17 weeks and 1 day of gestation, a blood sample was collected to determine the presence of trace element deficiencies, and a zinc deficiency was revealed. We examined the patient's symptoms and found that she had developed dysgeusia. After receiving a zinc preparation, her taste disorder gradually improved, and her oral intake increased. Her hyperemesis gravidarum resolved, and she was discharged from the hospital at 18 weeks and 2 days of gestation. The findings from this case suggest that prolonged peripheral intravenous nutrition in patients with severe hyperemesis gravidarum can lead to zinc deficiency and impede the successful treatment of hyperemesis gravidarum.

A Case of Incidental Detection of Asymptomatic Bladder Cancer by Transvaginal Ultrasound.

We report a case of an incidental diagnosis of early asymptomatic bladder cancer using transvaginal ultrasonography. The patient was a 68-year-old female without urinary symptoms. Transvaginal ultrasonography revealed a 2-cm papillary mass in the bladder mucosa. Urine cytology revealed the presence of atypical cells indicative of malignancy. Cystoscopy revealed a stalked papillary tumor at the apex of the posterior wall of the bladder. Transurethral resection of the bladder tumor was performed, and a 2-cm papillary tumor was resected. A pathological diagnosis of non-muscle-invasive bladder cancer was made.

Diagnosis of desmoplastic small-round-cell tumor by cytogenetic analysis: a case report.

We herein present atypical histologic and immunohistochemical features of DSRCT. The various differential diagnoses of DSRCT may occasionally generate confusion. Cytogenetic analysis may solve diagnostic dilemmas such as that in our case. Further studies are required to establish a standard treatment for DSRCT.

A preoperative low cancer antigen 125 level (≤25.8 mg/dl) is a useful criterion to determine the optimal timing of interval debulking surgery following neoadjuvant chemotherapy in epithelial ovarian cancer.

OBJECTIVE: The purpose of this study is to investigate the clinical characteristics to determine the optimal timing of interval debulking surgery following neoadjuvant chemotherapy in patients with advanced epithelial ovarian cancer. METHODS: We reviewed the charts of women with advanced epithelial ovarian cancer, fallopian tube cancer or primary peritoneal cancer who underwent interval debulking surgery following neoadjuvant chemotherapy at our cancer center from April 2006 to April 2014. RESULTS: There were 139 patients, including 91 with ovarian cancer [International Federation of Gynecology and Obstetrics (FIGO) Stage IIIc in 56 and IV in 35], two with fallopian tube cancers (FIGO Stage IV, both) and 46 with primary peritoneal cancer (FIGO Stage IIIc in 27 and IV in 19). After 3-6 cycles (median, 4 cycles) of platinum-based chemotherapy, interval debulking surgery was performed. Sixty-seven patients (48.2%) achieved complete resection of all macroscopic disease, while 72 did not. More patients with cancer antigen 125 levels ≤25.8 mg/dl at pre-interval debulking surgery achieved complete resection than those with higher cancer antigen 125 levels (84.7 vs. 21.3%; P< 0.0001). Patients with no ascites at pre-interval debulking surgery also achieved a higher complete resection rate (63.5 vs. 34.1%; P< 0.0001). Moreover, most patients (86.7%) with cancer antigen 125 levels ≤25.8 mg/dl and no ascites at pre-interval debulking surgery achieved complete resection. CONCLUSIONS: A low cancer antigen 125 level of ≤25.8 mg/dl and the absence of ascites at pre-interval debulking surgery are major predictive factors for complete resection during interval debulking surgery and present useful criteria to determine the optimal timing of interval debulking surgery.

Clinical Features of Neuroendocrine Carcinoma of the Uterine Cervix: A Single-Institution Retrospective Review.

OBJECTIVE: Neuroendocrine carcinoma of the cervix is a rare and aggressive subtype of cervical cancer and includes small cell neuroendocrine carcinoma (SCNEC) and large cell neuroendocrine carcinoma (LCNEC). We conducted a single-institution retrospective review to explore the pattern of treatments and outcomes with the aim of defining an optimum treatment strategy for these carcinomas. METHODS: Twenty-three consecutive patients with SCNEC or LCNEC of the cervix diagnosed at the Hyogo Cancer Center between 1996 and 2013 were included in this study. Pertinent information, including clinical and pathological characteristics, and survival data were collected from clinical records and/or telephone surveys. The pathological review was conducted by a pathologist specializing in gynecologic cancer. RESULTS: Eleven patients had SCNEC and 12 had LCNEC. Eighteen patients with International Federation of Gynecology and Obstetrics (FIGO) stage I/II underwent type III radical hysterectomy with pelvic lymphadenectomy. After surgery, 9 received adjuvant chemotherapy (8, irinotecan plus cisplatin; 1, paclitaxel plus carboplatin), 7 received concurrent chemoradiation therapy (CCRT; 6, nedaplatin; 1, cisplatin), and 2 received radiation therapy (RT). Patients who received adjuvant chemotherapy had a better overall survival than did patients who received CCRT or RT (hazard ratio, 0.21; 95% confidence interval, 0.030-1.51; P = 0.12). Although the overall survival rates are not statistically significant, the 9 patients who underwent radical hysterectomy followed by adjuvant chemotherapy are all alive. Among the remaining 5 patients who did not undergo radical hysterectomy, 2 with FIGO stage III and 1 with stage IVa received CCRT, and 2 with stage IVb received palliative RT or chemotherapy. These 5 patients with FIGO stage III/IV died of disease within 36 months. CONCLUSIONS: Radical hysterectomy followed by platinum-based chemotherapy, especially the irinotecan plus cisplatin combination, is beneficial for long-term survival in patients with early-stage neuroendocrine carcinoma of the cervix.

Plasma adiponectin concentrations and placental adiponectin expression in pre-eclamptic women.

This study was conducted to compare maternal plasma adiponectin concentrations and adiponectin expression in term placentas between normotensive pregnant women and pre-eclamptic women. Plasma adiponectin concentrations were assessed by a sandwich enzyme-linked immunosorbent assay in 81 normotensive pregnant women, 27 pre-eclamptic women and 15 non-pregnant healthy women. The expression of adiponectin in the placentas was assessed by immunohistochemistry. Plasma adiponectin concentrations in normotensive pregnant women did not show a significant change during pregnancy and postpartum compared with non-pregnant women. However, plasma adiponectin concentrations in pre-eclamptic women were significantly (p < 0.05) lower than in non-pregnant and normotensive pregnant women. No immunoreactive adiponectin was detected in the term placentas of normotensive pregnant women, whereas a positive immunostaining for adiponectin was observed in endothelial cells of chorionic vessels in pre-eclamptic women. Our data suggest that decreased plasma adiponectin concentrations may contribute to the pathophysiology of pre-eclampsia and that adiponectin localized in chorionic vessels may play a role in the restoring of endothelial damage in the feto-maternal units of pre-eclampsia.