Leiomyosarcoma of the broad ligament: a case report with CT and MRI images.

Primary leiomyosarcoma of the broad ligament is a very rare and highly malignant gynecological tumor. The authors report a 61-year-old postmenopausal woman with signs and symptoms of malignant ovarian tumor. Preoperative magnetic resonance imaging (MRI) was interpreted as being suspicious for malignant tumors, such as an ovarian cancer or a leiomyosarcoma of the broad ligament, so laparotomy was performed. Macroscopically, the tumor was revealed with a 18 x 13.7 x 9.5 cm degenerated, multiple cystic part and solid whitish part arising from broad ligament which on histopathology proved to be leiomyosarcoma. To the best of the authors' knowledge, primary leiomyosarcoma of the broad ligament has been documented in 21 reports or so, and no imaging findings are available. Here the authors present the MRI findings of primary leiomyosarcoma of the broad ligament.

The development of placenta increta following pelvic transcatheter artery embolization for postpartum hemorrhage.

OBJECTIVE: Pelvic transcatheter artery embolization (TAE) has been widely used for the management of postpartum hemorrhage (PPH). However, the adverse effects of TAE on the subsequent pregnancy remain poorly understood. CASE: A 30-year-old woman, gravida 2, para 1, developed PPH due to atonic bleeding and underwent TAE. Thereafter, her menstrual cycle became irregular with less blood volume. Three years later, she became pregnant despite a thin endometrial thickness of 6 mm during the ovulatory period. She delivered a healthy baby at 39 weeks of gestation. No signs of placental separation were obtained, and an attempt at manual extraction of the placenta failed, followed by massive PPH. She underwent emergent TAE. The placenta was not spontaneously delivered even on day 8 postpartum. A supracervical hysterectomy was performed due to a worsening intrauterine infection. Pathological examination revealed findings compatible with placenta increta. CONCLUSION: A TAE-associated thin endometrium may be attributable to the development of placenta increta. Pregnant women undergoing TAE should be managed carefully because the information about pregnancy outcomes after TAE remains scanty.

Ruptured cornual pregnancy: case report.

Cornual pregnancy is uncommon among ectopic pregnancies. A diagnosis of cornual pregnancy remains challenging, and rupture of a cornual pregnancy causes catastrophic consequence due to massive bleeding. We report a case of a ruptured cornual pregnancy occurring at 12 weeks of gestation. A 34-year-old woman was suspected of having a left cornual pregnancy at 11 weeks of gestation. Transabdominal ultrasound and magnetic resonance imaging revealed an eccentric localization of a gestational sac containing a viable fetus outside the uterine cavity adjacent to the left uterine cornua. The gestational sac was surrounded with a thin myometrial layer. The patient developed a rupture of the left cornual pregnancy with unstable hemodynamics. She underwent emergency laparotomy, which revealed the ruptured left cornual pregnancy with a hemoperitoneum. Cornual resection was performed. The pathological examination confirmed a ruptured cornual pregnancy.

A pregnant woman with anti-Gregory antigen: case report.

Negative Gregory antigen (Gy(a-)) remains an extremely uncommon blood phenotype. We describe a 32-year-old pregnant woman with (Gy(a-)) and anti-Gregory antigen (anti-Gy(a)). There was no evidence of consanguineous mating in her family. Blood typing study revealed that only her father was Gy(a-) among the family. Anti-Gy(a) had a titer of 16 before pregnancy, but increased to 1024 at 33 weeks of gestation with a titer of 512 at 34 weeks. Her own blood stores were collected starting at 14 weeks, amounting to 1800 g totally. She underwent an emergency cesarean section at 35 weeks due to a non-reassuring fetal status. Blood loss was approximately 1090 g. Cord blood type was found to be Gy(a-). The indirect Coombs test of cord blood was positive, while the direct Coombs test was negative. No neonatal hemorrhagic disease developed. The storage of a sufficient amount of crossmatch-compatible Gy(a-) blood during pregnancy is important in case of possible need of blood transfusion at delivery for women with anti-Gy(a).

Effect of hyperbaric oxygenation on bone in HEBP-induced rachitic rats.

The effect of hyperbaric oxygenation (HBO) treatment on rachitic change was studied using 4-wk-old, 1-hydroxyethylidene-1, 1-bisphosphonic acid disodium (HEBP-EHDP)-induced rachitic rats. After treatment, the dry weight, ash weight, Ca and P content, and bone mineral density of the hind leg bones were measured in each rat. These parameters were significantly increased in the rats that were treated with HBO after HEBP administration compared with those parameters in the rats that received HEBP alone. However, there was no significant differences between the rats treated simultaneously with HEBP and HBO and those that were treated with HEBP alone. These results were consistent with radiologic and histologic findings. Marked calcification in the center of the growth plate was revealed in the rats treated with HBO after HEBP administration. We suggest that intermittent high-pressure pure oxygen has a beneficial effect on osteogenesis in rachitic bone but does not prevent rachitic change.

Bone composition and metabolism after hyperbaric oxygenation in rats with 1-hydroxyethylidene-1,1-bisphosphonate-induced rickets.

We examined bone composition and metabolism after hyperbaric oxygenation (HBO) in Wistar rats with 1-hydroxyethylidene-1, 1-bisphosphonate (HEBP)-induced rickets. Twenty rats at 4 wk of age were divided into four groups of five rats each. The HEBP + HBO group received high dose (50 mg.kg-1.day-1) HEBP injections subcutaneously for 7 days and were then exposed to HBO for 7 days. The HEBP group received only high dose HEBP injection for the first 7 days. Control group A received neither HEBP nor HBO. Control group B received no HEBP injection and was exposed to HBO only for the second 7 days. Both bone mineral and hydroxyproline contents significantly increased in rats in the HEBP + HBO group as compared with the HEBP group. Alkaline phosphatase activity of bone, which is a marker of osteoblastic activity and bone formation, was high in the HEBP + HBO and HEBP groups compared with control groups A and B, although there was no difference between the former two groups. On the other hand, tartrate-resistant acid phosphatase activity, which is a marker of bone resorption, was lower in the HEBP + HBO group than in the HEBP group. These findings suggest that HBO suppresses bone resorption in high osteoblastic activity after the cessation of HEBP administration, and this phenomenon increases total bone mass.

PP094. A comparison of gestational changes in urinary excretion of magnesium with those of calcium.

INTRODUCTION: Magnesium is one of the essential minerals required in various cellular functions. Some investigators have postulated that some aspects of pathophysiology in preeclampsia could be associated with alteration in regulatory mechanisms of the mineral. However, gestational changes in absorption, excretion and blood concentration of magnesium have remained less elucidated compared with those of calcium, which is another important mineral forming a divalent cation. OBJECTIVES: The purpose of this study was to clarify if urinary excretion of magnesium during pregnancy might be altered compared with those of calcium. METHODS: Sixty specimens of 24h urine and 586 samples of spot urine were collected from healthy pregnant women who gave consent. Determination of the minerals were according to Orthocresol-phthalein complexone method for calcium, and xylidyl blue method for magnesium. Urinary creatinine was determined by Jaffe Method. RESULTS: Daily excretions of magnesium determined with 24h samples were 60, 70, 81, 65, and 102mg in 1st, 2nd, and early 3rd trimesters, term, and postpartum 4weeks, respectively. There were no statistical differences among the values. Those of calcium were 174, 186, 139, 52, and 40mg, respectively. The values in term and in postpartum were significantly lower than those in 1st through early 3rd trimesters. The Mg/Cr ratios (mg/mg Cr) determined with spot urine samples were 0.064, 0.071, 0.066, 0.067, and 0.086, in 1st, 2nd, and early 3rd trimesters, term, and postpartum 4weeks, respectively. The value of Mg/Cr in postpartum was significantly higher than the values in pregnant period. The Ca/Cr ratios (mg/mg Cr) were 0.164, 0.163, 0.135, 0.118, and 0.090, respectively. There was a trend of decreasing pattern in changes of Ca/Cr from 2nd trimester to postpartum. CONCLUSION: It is suggested that there is a mechanism of preservation of calcium in the late phase of pregnancy or puerperal period by reducing urinary excretion of the mineral. However, human pregnancy does not seem to show such a function controlling magnesium metabolism.