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[My paper] Yieh-Loong Tsai, Kok-Min Seow, Chung-Hsin Yieh, Kian-Mei Chong, Jiann-Loung Hwang, Yu-Hung Lin, Lee-Wen Huang
Background. To analyze the role of different measures in the treatment of acute moderate or severe symptomatic hydronephrosis in pregnancy. Methods. Of the 18,130 women delivering at our institution between January 2000 and December 2004, 93 patients were admitted due to symptomatic hydronephrosis. Among these, 50 patients were diagnosed with moderate or severe hydronephrosis, and were randomly treated with conservative measures (25 patients) or double pigtail stent insertion (25 patients). Renal sonography, urinalysis, serum creatinine levels, white blood cell counts, and urine culture were done in all patients at first visit. The clinical and perinatal outcomes of the two groups were compared. Results. The incidence of symptomatic hydronephrosis in pregnancy was 0.5% in our institution (93/18,130). The majority of the moderate or severe hydronephrosis (88%) cases were diagnosed after the first trimester. There were no statistically significant differences in the fetal body weight, Apgar score, preterm labor, and hospitalization day between the two groups. Among those receiving conservative treatment, five patients (5/25, 20%) failed to respond and were subsequently treated by double pigtail stent insertion successfully, compared with the surgical group, in which all patients were successfully relieved by double pigtail stent (p=0.018). Four patients receiving double pigtail stent insertion complained of stent discomfort and flank pain after the procedure (16%). Conclusion. Double pigtail stent insertion is effective for the treatment of moderate or severe symptomatic hydronephrosis in pregnancy, and showed a lower failure rate than the conservative treatment. However, due to the complications and discomfort with surgical treatment, conservative treatment should still be the first choice.
[My paper] Kian-Mei Chong, Jesse Chuang, Yieh-Loong Tsai, Jiann-Loung Hwang, Chun-Cheng Chu
Department of Obstetrics and Gynecology, Shin-Kong Wu Ho Su Memorial Hospital, No. 95, Wen Chang Road, Shih Lin District, Taipei, Taiwan.
BACKGROUND: The specimen from a vaginal cuff fistula between the vagina and abdominal cavity revealed endometriosis. Culture of the fluid revealed Streptococcus viridans. CASE: A 44-year-old woman presented with lower abdominal pain for 1 week. She also had cyclic vaginal spotting that had started 1 month after she underwent laparoscopically assisted vaginal hysterectomy for a myoma 2 years earlier. One year prior to this admission, she was noted to have a right endometrioma on a sonographic examination; monthly follow-up revealed that the cyst was enlarging. The patient was admitted for surgery. On laparotomy, severe adhesions were noted. After adhesiolysis, a right adnexal cyst with chocolatelike contents mixed with malodorous, yellowish, mucoid fluid was noted. A vaginal cuff fistula between the vagina and abdominal cavity was also noted. The specimen from this area revealed endometriosis. Culture of the fluid showed Streptococcus viridans. CONCLUSION: Various laparoscopic complications are cited in the literature. Although rare, the risk of infection after laparoscopy can occur. In our case the infection may have been caused by the presence of vaginal cuff fistula in the presence of endometriosis.
[My paper] Kian Mei Chong, Yieh-Loong Tsai, Jesse Chuang, Jiann-Loung Hwang, Kuan-Tien Chen
Department of Obstetrics and Gynecology, Shin Kong Wu Ho-Su Memorial Hospital, No. 95, Wen Chang Road, Shih Lin District, Taipei 111, Taiwan. m002246@ms.skh.org.tw
BACKGROUND: Thyroid cancer in pregnancy presents a unique challenge to the thyroid specialist and the obstetrician. We report 3 cases of thyroid cancer diagnosed during pregnancy. CASES: Three cases of papillary thyroid carcinoma were diagnosed during pregnancy, at the 14th, 19th and 40th weeks of gestation. The first 2 cases underwent thyroidectomy immediately after the diagnosis, while in the third the operation was deferred until the postpartum period. All 3 women delivered healthy infants, who were 2 months to 8 years of age at the last follow-up visit. CONCLUSION: If well-differentiated thyroid cancer is diagnosed prior to the midtrimester, it is possible to carry out the surgical intervention in the midtrimester. During late pregnancy, resection after delivery is the option of choice. There is no indication for termination of pregnancy.
[My paper] Shin-Yee Ling, Kian-Mei Chong, Jiann-Loung Hwang
Department of Obstetrics and Gynecology, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan.
Objective: Ovarian hyperstimulation syndrome (OHSS) is more severe when pregnancy occurs, as the developing pregnancy produces human chorionic gonadotropin, which stimulates the ovary's persistent growth. If no pregnancy occurs, the syndrome will typically resolve within 1 week. In a maintained pregnancy, slow resolution of symptoms usually occurs over 1-2 months. Case Report: A 31-year-old woman, gravida 2, para 1, aborta 1, with polycystic ovary syndrome underwent in vitro fertilization (IVF) with clomiphene citrate and follicle-stimulating hormone/gonadotropin releasing hormone-antagonist stimulation. During transvaginal oocyte retrieval, enlarged bilateral ovaries were noted. She had an episode of OHSS after IVF/embryo transfer, for which paracentesis was performed three times. Pregnancy was achieved. Throughout antenatal examinations, bilateral ovaries were enlarged. She delivered a healthy baby by cesarean section at term. However, 1 month after delivery, the bilateral ovary had not shrunk, and levels of tumor markers CA125 and CA199 were 50.84 and 41.34 U/mL, respectively. At laparotomy for suspected malignancy, both adnexae formed "kissing ovaries", which were multinodulated with yellow serous fluid. Specimens from wedge resection submitted for frozen section showed a benign ovarian cyst. The final pathology report showed bilateral follicle cysts. Conclusion: With the increasing use of gonadotropins in the management of infertility, ovarian enlargement secondary to hyperstimulation is common. Generally, symptoms appear between the 6th and 13th weeks of pregnancy and disappear thereafter. The hyperstimulated ovary often subsides after the first trimester. This case is unusual as the megalocystic ovary persisted after delivery. To the best of our knowledge, we report the first case of enlarged bilateral ovaries persisting 2 months after delivery.
[My paper] Kian Mei Chong, Jesse Chuang, Yieh-Loong Tsai, Jiann-Loung Hwang
Paraurethral leiomyoma is rare. This is the first reported case of a woman with a 6 x 7 x 5 cm urethral leiomyoma with profuse vaginal bleeding. The site of bleeding was identified as the anterior vaginal mucosal vein, which we subsequently electrocauterized. Enucleation of the mass was performed smoothly with a Foley catheter to avoid damage to the urethra. Profuse bleeding from a paraurethral myoma is possibly due to increased vascularity and the prolapsed nature of the tumor in this area. Copyright (c) 2006 S. Karger AG, Basel.
Vulvar Lobular Capillary Hemangioma(Pyogenic Granuloma).
Kian-Mei Chong, Tzu-Chen Yeh, Jiann-Loung Hwang.
Taiwanese J Obstet Gynecol 44(1):94-95, 2005.
Objective: Pyogenic granuloma is a relatively common skin growth. The skin of the head, neck, upper trunk, and hands and feet and the oral mucosa and gingiva are the most common sites, but t seldom appears on the female genitalia. Case Report: A 52-year-old woman presented with a lobulated lesion on the right labia majora. The surface of the lesion was reddish and bled occasionally. The lesion was excised and histopathology revealed features suggestive of lobular capillary hemangioma (pyogenic granuloma). Conclusion: Pyogenic granuloma s considered a reactive hyperproliferative vascular response to trauma or other stimuli. The name "pyogenic granuloma" s a misnomer since the condition is not associated with pus and does not represent a granuloma histologically. There are a few cases of lobular capillary hemangioma of the glans penis but it is rare on the female genitalia. We present this case to help physicians become aware that lobular capillary hemangiomas may occur at this site.
Primitive Neuroectodermal Tumor of the Uterus:A Case Report.
Tzu-Chen Yeh, Kian-Mei Chong, Yu-Hung Lin, Hun-Shan Pan, Kok-Min Seow,Jiann-Loung Hwang, Lee-Wen Huang.
Taiwanese J Obstet Gynecol 44(1):96-100, 2005.
Objective: Primitive neuroectodermal tumors (PNETs) are a group of unusual malignancies arising in the bone and soft tissue. Pure uterine neuroectodermal tumors are rare. We report the first case of PNET arising from the uterus in our hospital. Case Report: A 52-year-old perimenopausal woman had multiple myoma and was regularly followed-up in our hospital. She suddenly developed lower abdominal pain without vaginal bleeding. Sonography revealed a pelvic mass measuring 10.7×6.8cm with multiple myoma. The patient underwent tumor resection. There were multiple necrotic tumors on the uterus, bladder, broad ligaments, cardinal ligaments, and cul-de-sac. Final pathology revealed PNET because tumor cells were CD99 positive. Conclusion: PNETs belong to the Ewing's sarcoma family. They are closely related to malignant, small round-cell tumors of soft tissue and bones. They strongly express the glycoprotein p30/32 (CD99) on the cell membrane, which is encoded by the MIC2 gene. A translocation at t (11;22)(q24;q12) has been identified. PNETs are mostly recognized by the histologic characteristics of neural differentiation and immunohistochemical expression of at least two different neural markers. Uterine PNETs have a poor prognosis and, to date, there is no standard treatment. Total abdominal hysterectomy and bilateral salpingo-oophorectomy plus adjuvant chemotherapy or radiotherapy are recommended.
Impending Sepsis due to a Ruptured Pyomyoma with Purulent Peritonitis: A Case Report and Literature Review.
Sew-Khee Yeat, Kian-Mei Chong, Hun-Shan Pan, Wei-Chi Cheng, Jiann-Loung Hwang, Chin-Cheng Lee.
Taiwanese J Obstet Gynecol 44(1):75-79, 2005.
Objective: Pyomyoma is an uncommon complication of benign leiomyoma. Here, we report a rare case of a perforated pyomyoma with purulent peritonitis. Case Report: A 53-year-old postmenopausal woman presented with impending septic shock on arrival at our emergency department. Physical examination and imaging studies revealed a pelvic mass with peritonitis. Emergency exploratory laparotomy due to suspicion of a ruptured pyomyoma or malignancy revealed a spontaneously perforated large pyomyoma leaking copious purulent material directly into the peritoneal cavity. Total hysterectomy and bilateral salpingo-oophorectomy were performed. Histopathology revealed no malignancy. The patient recovered smoothly after combined antibiotic therapy. Conclusion: Cynecologists should be aware of this rare emergency condition, especially when handling a patient with a history of leiomyoma uteri and if signs of infection or even sepsis are present.
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