BACKGROUND The traditional definition of late postpartum hemorrhage is a massive uterine hemorrhage from 24 h after delivery to the puerperal period.Here,we report a case of late postpartum hemorrhage that occurred 3 ...BACKGROUND The traditional definition of late postpartum hemorrhage is a massive uterine hemorrhage from 24 h after delivery to the puerperal period.Here,we report a case of late postpartum hemorrhage that occurred 3 mo after cesarean section and endangered the patient's life.The cause of the case we are reporting was poor incision healing.By reporting this case,we hope to make doctors aware that late postpartum hemorrhage due to poor incision healing may happen as late as 3 mo after cesarean section.CASE SUMMARY A 31-year-old woman complained of acute,severe vaginal bleeding for 1 h;the patient had a history of cesarean section 3 mo prior.After receiving antiinflammatory treatment,fluid supplementation,blood transfusion,oxytocin administration,and hemostatic treatment,the vaginal bleeding ceased,and the patient’s clinical status improved.Unfortunately,she experienced recurrent massive vaginal bleeding,and uterine contractile agents did not decrease the persistent bleeding.To save the patient’s life,she was admitted for emergency laparotomy.At exploratory laparotomy,dehiscence and necrosis of the previous cesarean section scar were noted;the dehiscence penetrated through the entire thickness of the uterine muscle wall and extended to the left uterine artery.Ultimately,we performed a total hysterectomy.CONCLUSION Late postpartum hemorrhage due to poor incision healing after cesarean section may occur in the 3 mo after cesarean section or even later.Therefore,obstetricians-gynecologists should monitor for this potential complication in all patients post–cesarean section.Such hemorrhages can be severe enough to endanger the patient's life.展开更多
BACKGROUND For the past few years,preventive interventional therapy has been widely used domestically and overseas,bringing great benefits to pregnant women at high-risk for complications,such as pernicious placenta p...BACKGROUND For the past few years,preventive interventional therapy has been widely used domestically and overseas,bringing great benefits to pregnant women at high-risk for complications,such as pernicious placenta previa(PPP)and placenta accreta.Nevertheless,there are still few reports on surgical complications related to interventional therapy,and its safety should be a concern.CASE SUMMARY We report a 36-year-old pregnant woman with PPP who underwent balloon implantation in the lower segment of the abdominal aorta before caesarean section.However,the balloon shifted during the operation,which damaged the arterial vessels after filling,resulting in severe postpartum haemorrhage in the patient.Fortunately,after emergency interventional stent implantation,the pa-tient was successfully relieved of the massive haemorrhage crisis.CONCLUSION It seems that massive postoperative bleeding has been largely avoided in preventive interventional therapy in high-risk pregnant women with placenta-related diseases,but surgical complications related to intervention therapy can also cause adverse consequences.It is equally important for clinical doctors to learn how to promptly identify and effectively treat these rare complications.展开更多
BACKGROUND In recent years,people have paid more attention to oral health with the development of stomatology.Due to the various physiological changes during pregnancy,such as changing hormone levels and immune functi...BACKGROUND In recent years,people have paid more attention to oral health with the development of stomatology.Due to the various physiological changes during pregnancy,such as changing hormone levels and immune functions,oral diseases have a high incidence during pregnancy,and the prevention and treatment of oral diseases have also received the attention of both dentists and obstetricians.However,the anesthetic management of pregnant patients with oral disease,especially severe maxillofacial infections,and patients who need surgical treatment or have obstetric emergencies and need to terminate their pregnancy is not clear.CASE SUMMARY This article describes a parturient patient with a severe masseteric space infection who had an emergency cesarean section.CONCLUSION This case report aims to discuss the important anesthetic considerations for these patients.展开更多
BACKGROUND Thrombotic pulmonary embolism(TPE)is one of the most critical diseases in obstetrics but is rarely reported in caesarean section(CS)because TPE patients in CS have a high risk of death and are difficult to ...BACKGROUND Thrombotic pulmonary embolism(TPE)is one of the most critical diseases in obstetrics but is rarely reported in caesarean section(CS)because TPE patients in CS have a high risk of death and are difficult to diagnose.This case report of TPE during CS was recorded by transthoracic echocardiography(TTE)and can provide a reference for the differential diagnosis of critical illnesses in CS.CASE SUMMARY A 37-year-old pregnant woman with rheumatic heart disease(RHD),gravida 5 and para 1(G5P1),presented for emergency CS at 33 wk and 3 d of gestation under general anesthesia because of acute heart failure,pulmonary hypertension and arrhythmia.After placental removal during CS,TTE revealed a nascent thrombus in the inferior vena cava(IVC)that elongated,detached and fragmented leading to acute thromboembolic events and acute TPE.This report presents the whole process and details of TPE during CS and successful rescue without any sequelae in the patient.This case gives us new ideas for the diagnosis of death or cardiovascular accidents during CS in pregnant women with heart disease and the detailed presentation of the rapid development of TPE may also elucidate new ideas for treatment.This case also highlighted the importance of prophylactic anticoagulation in the management of heart disease during pregnancy.CONCLUSION Pregnancy with heart failure could trigger inferior vena cava(IVC)-origin TPE during CS.Detection and timely treatment can avoid serious consequences.展开更多
Dear editor, In July 2015, a 39-year-old gravida 2, para 0 lady at 35 weeks＇ gestation was found collapsed at home and sent to the emergency department （ED） by ambulance. She had a background of chronic hypertensio...Dear editor, In July 2015, a 39-year-old gravida 2, para 0 lady at 35 weeks＇ gestation was found collapsed at home and sent to the emergency department （ED） by ambulance. She had a background of chronic hypertension on anti- hypertensives and aspirin, but repeatedly refused in- patient treatment for her uncontrolled hypertension. She had received pre-hospital cardiopulmonary resuscitation （CPR） for 17 minutes en route to the ED.展开更多
In this paper, the step reduction method is discussed, which was advanced by Prof. Yeh Kai-yuan for calculating a non-uniform beam with various sections. The following result is proved. The approximate solution by thi...In this paper, the step reduction method is discussed, which was advanced by Prof. Yeh Kai-yuan for calculating a non-uniform beam with various sections. The following result is proved. The approximate solution by this method approaches the true solution if the number of the steps approaches the infinity. However, the measure of the error between the limit solution and the ture solution is not in the pure mathematics sense but in the mechanics sense.展开更多
BACKGROUND Parathyroid carcinoma(PC)is a difficult-to-diagnose rare disease with low incidence.Relatively accurate preoperative diagnosis is very important in choosing surgical methods and patient prognosis.CASE SUMMA...BACKGROUND Parathyroid carcinoma(PC)is a difficult-to-diagnose rare disease with low incidence.Relatively accurate preoperative diagnosis is very important in choosing surgical methods and patient prognosis.CASE SUMMARY This study reported the clinical diagnosis and treatment of a rare patient with PC located in the thyroid gland and provided a case reference for the diagnosis and treatment of PC.A case of a 64-year-old male patient who presented to our hospital with systemic muscle and joint pain and palpitations is outlined.Subsequently,the patient was admitted to the Department of Nephrology for the treatment of“multiple myeloma nephropathy pending investigation”.The patient was diagnosed with“primary hyperparathyroidism and hypercalcemic crisis”using thyroid color ultrasound.CONCLUSION The intraoperative frozen section report considered the parathyroid tumor.Surgical tumor resection was promptly performed,and the diagnosis of PC was confirmed.展开更多
BACKGROUND With the increasing trend of vaginal birth after caesarean delivery(VBAC),evaluation of the feasibility and safety of a second VBAC with grand multiparity is worth considering.Intrapartum uterine rupture is...BACKGROUND With the increasing trend of vaginal birth after caesarean delivery(VBAC),evaluation of the feasibility and safety of a second VBAC with grand multiparity is worth considering.Intrapartum uterine rupture is diagnosed in approximately one-fifth of all VBAC cases following successful vaginal delivery.To our knowledge,no report is available on the application of laparoscopy to repair postpartum uterine rupture after a successful second VBAC in China.CASE SUMMARY A 31-year-old woman(gravida 5,para 2)at 39 wk and 5 d of gestation was admitted to the hospital in labour.After a successful VBAC and observation for approximately 13 h,the patient complained of progressive abdominal pain.Given the symptoms,signs,and auxiliary examination results,intraperitoneal bleeding was considered.Because the patient was stable and ultrasound imaging was the only method available to assess the possibility of rupture,we recommended laparoscopy to clarify the diagnosis and for prompt laparoscopic uterine repair or exploratory laparotomy if necessary.Operative findings included transverse uterine scar rupture at the lower uterine segment of approximately 5.0 cm in length and 800 mL of intraoperative pelvic haemoperitoneum.Finally,she successfully underwent laparoscopic repair of uterine rupture and recovered very well according to three-dimensional magnetic resonance imaging at 42 d postpartum.CONCLUSION Routine postpartum intrauterine exploration is not beneficial to the mother and may even increase the risk of rupture.This case highlights a laparoscopic approach for repairing uterine rupture in the immediate postpartum period.展开更多
BACKGROUND Laparoscopic living donor hepatectomy(LLDH)has been successfully carried out in several transplant centers.Biliary reconstruction is key in living donor liver transplantation(LDLT).Reliable biliary reconstr...BACKGROUND Laparoscopic living donor hepatectomy(LLDH)has been successfully carried out in several transplant centers.Biliary reconstruction is key in living donor liver transplantation(LDLT).Reliable biliary reconstruction can effectively prevent postoperative biliary stricture and leakage.Although preoperative magnetic resonance cholangiopancreatography and intraoperative indocyanine green cholangiography have been shown to be helpful in determining optimal division points,biliary variability and limitations associated with LLDH,multiple biliary tracts are often encountered during surgery,which inhibits biliary reconstruction.A reliable cholangiojejunostomy for multiple biliary ducts has been utilized in LDLT.This procedure provides a reference for multiple biliary reconstructions after LLDH.CASE SUMMARY A 2-year-old girl diagnosed with ornithine transcarbamylase deficiency required liver transplantation.Due to the scarcity of deceased donors,she was put on the waiting list for LDLT.Her father was a suitable donor;however,after a rigorous evaluation,preoperative magnetic resonance cholangiopancreatography examination of the donor indicated the possibility of multivessel variation in the biliary tract.Therefore,a laparoscopic left lateral section was performed on the donor,which met the estimated graft-to-recipient weight ratio.Under intraoperative indocyanine green cholangiography,4 biliary tracts were confirmed in the graft.It was difficult to reform the intrahepatic bile ducts due to their openings of more than 5 mm.A reliable cholangiojejunostomy was,therefore,utilized:Suture of the jejunum to the adjacent liver was performed around the bile duct openings with 6/0 absorbable sutures.At the last follow-up(1 year after surgery),the patient was complication-free.CONCLUSION Intrahepatic cholangiojejunostomy is reliable for multiple biliary ducts after LLDH in LDLT.展开更多
BACKGROUND We describe the treatment strategy for a patient who was found to have a partial hydatidiform mole and coexisting fetus(PHMCF)during the second trimester.The patient was a 38-year-old Chinese woman who had ...BACKGROUND We describe the treatment strategy for a patient who was found to have a partial hydatidiform mole and coexisting fetus(PHMCF)during the second trimester.The patient was a 38-year-old Chinese woman who had become pregnant following in vitro fertilization and embryo transplantation.We wanted to determine the safest therapeutic strategy to terminate the PHMCF during the second trimester.CASE SUMMARY In this case,we present a patient who was found to have a PHMCF complicated with serious continuous vaginal bleeding and pre-eclampsia during the second trimester.After careful evaluation,the pregnancy was considered to be unsustainable and was terminated via caesarean section(CS).An infant with weak vital signs and a partially cystic placenta measuring 110 mm×95 mm×35 mm were delivered by CS.The patient was discharged after 4 d.The serum levels ofβ-human chorionic gonadotropin decreased to within a normal range 5 wk after the operation,and no evidence of persistent trophoblastic disease or lung metastases was noticed at the 6-mo follow-up.CONCLUSION CS termination of PHMCF during the second trimester may be a relatively safe therapeutic strategy.展开更多
BACKGROUND Fetal hydrops is a serious condition difficult to manage,often with a poor prognosis,and it is characterized by the collection of fluid in the extravascular compartments.Before 1968,the most frequent cause ...BACKGROUND Fetal hydrops is a serious condition difficult to manage,often with a poor prognosis,and it is characterized by the collection of fluid in the extravascular compartments.Before 1968,the most frequent cause was the maternal-fetal Rh incompatibility.Today,90%of the cases are non-immune hydrops fetalis.Multiple fetal anatomic and functional disorders can cause non-immune hydrops fetalis and the pathogenesis is incompletely understood.Etiology varies from viral infections to heart disease,chromosomal abnormalities,hematological and autoimmune causes.CASE SUMMARY A 38-year-old pregnant woman has neck lymphoadenomegaly,fever,cough,tonsillar plaques at 14 wk of amenorrhea and a rash with widespread itching.At 27.5 wk a fetal ultrasound shows signs of severe anemia and hydrops.Cordocentesis is performed with confirmation of severe fetal anemia and subsequent fetal transfusion.The karyotype is 46,XX,array-comparative genome hybridization(CGH)negative,and infectious tests are not conclusive.In the following days there is a progressive improvement of the indirect signs of fetal anemia.At 33.6 wk,for relapse of severe fetal anemia,further fetal transfusions are necessary and an urgent cesarean section is performed.On the day 12 of life,for the detection of anemia,the newborn is subjected to transfusion of concentrated red blood cells and begins treatment with erythropoietin.Later there is a normalization of blood chemistry values and the baby does not need new transfusions.A 29-year-old pregnant woman,with Sjogren's syndrome and positive Anti-Ro/SSA antibodies,is subjected to serial fetal ecocardio for branch block.At 26.5 wk there is a finding of fetal ascites.Infectious disease tests on amniotic fluid are negative as well as quantitative fluorescent polymerase chain reaction,Array CGH.At cordocentesis Hb is 1.3 mmol/L,consequently fetal transfusion is performed.Also in this case,due to continuous episodes of relapse of fetal anemia with consequent transfusions,at 29.4 wk a cesarean section is performed.On day 9 of life,a treatment with erythropoietin is started in the newborn,but the baby needs three blood transfusions.The search for autoantibodies in the baby found SS-A Ro60 positive,SSA-Ro52 positive and SS-B negative.The hemoglobin values normalized after the disappearance of maternal autoantibodies.CONCLUSION An attempt to determine the etiology of hydrops should be made at the time of diagnosis because the goal is to treat underlying cause,whenever possible.Even if the infectious examinations are not conclusive,but the pregnancy history is strongly suggestive of infection as in the first case,the infectious etiology must not be excluded.In the second case,instead,transplacental passage of maternal autoantibodies caused hydrops fetalis and severe anemia.Finally,obstetric management must be aimed at fetal support up to an optimal timing for delivery by evaluating risks and benefits to increase the chances of survival without sequelae.展开更多
BACKGROUND Comamonas kerstersii(C.kerstersii)infections have considered as non-pathogenic to humans,however due to new techniques such as matrix-assisted laser desorption ionization-time of flight mass spectrometry(MA...BACKGROUND Comamonas kerstersii(C.kerstersii)infections have considered as non-pathogenic to humans,however due to new techniques such as matrix-assisted laser desorption ionization-time of flight mass spectrometry(MALDI-TOF-MS),more cases have been identified.CASE SUMMARY This is the first report of a maternal patient with a C.kerstersii bacteremia following caesarean section.Due to the severity of the patient’s condition;high fever and rapidly progressing organ damage,the patient was transferred to the intensive care unit.C.kerstersii was detected by metagenomic next-generation sequencing testing.Based on the drug sensitivity test,appropriate antibiotic treatment was given and the patient recovered fully.CONCLUSION This case report confirms that the detection via MALDI-TOF-MS and metagenomic next-generation sequencing testing provides a reliable basis for the diagnosis of this rare bacterial infection.展开更多
基金Supported by National Natural Science Foundation of China,No.81202048.
文摘BACKGROUND The traditional definition of late postpartum hemorrhage is a massive uterine hemorrhage from 24 h after delivery to the puerperal period.Here,we report a case of late postpartum hemorrhage that occurred 3 mo after cesarean section and endangered the patient's life.The cause of the case we are reporting was poor incision healing.By reporting this case,we hope to make doctors aware that late postpartum hemorrhage due to poor incision healing may happen as late as 3 mo after cesarean section.CASE SUMMARY A 31-year-old woman complained of acute,severe vaginal bleeding for 1 h;the patient had a history of cesarean section 3 mo prior.After receiving antiinflammatory treatment,fluid supplementation,blood transfusion,oxytocin administration,and hemostatic treatment,the vaginal bleeding ceased,and the patient’s clinical status improved.Unfortunately,she experienced recurrent massive vaginal bleeding,and uterine contractile agents did not decrease the persistent bleeding.To save the patient’s life,she was admitted for emergency laparotomy.At exploratory laparotomy,dehiscence and necrosis of the previous cesarean section scar were noted;the dehiscence penetrated through the entire thickness of the uterine muscle wall and extended to the left uterine artery.Ultimately,we performed a total hysterectomy.CONCLUSION Late postpartum hemorrhage due to poor incision healing after cesarean section may occur in the 3 mo after cesarean section or even later.Therefore,obstetricians-gynecologists should monitor for this potential complication in all patients post–cesarean section.Such hemorrhages can be severe enough to endanger the patient's life.
基金Curriculum Case Base Construction Project of the First Affiliated Hospital of Xinjiang Shihezi University,No.2021Y-AL15.
文摘BACKGROUND For the past few years,preventive interventional therapy has been widely used domestically and overseas,bringing great benefits to pregnant women at high-risk for complications,such as pernicious placenta previa(PPP)and placenta accreta.Nevertheless,there are still few reports on surgical complications related to interventional therapy,and its safety should be a concern.CASE SUMMARY We report a 36-year-old pregnant woman with PPP who underwent balloon implantation in the lower segment of the abdominal aorta before caesarean section.However,the balloon shifted during the operation,which damaged the arterial vessels after filling,resulting in severe postpartum haemorrhage in the patient.Fortunately,after emergency interventional stent implantation,the pa-tient was successfully relieved of the massive haemorrhage crisis.CONCLUSION It seems that massive postoperative bleeding has been largely avoided in preventive interventional therapy in high-risk pregnant women with placenta-related diseases,but surgical complications related to intervention therapy can also cause adverse consequences.It is equally important for clinical doctors to learn how to promptly identify and effectively treat these rare complications.
文摘BACKGROUND In recent years,people have paid more attention to oral health with the development of stomatology.Due to the various physiological changes during pregnancy,such as changing hormone levels and immune functions,oral diseases have a high incidence during pregnancy,and the prevention and treatment of oral diseases have also received the attention of both dentists and obstetricians.However,the anesthetic management of pregnant patients with oral disease,especially severe maxillofacial infections,and patients who need surgical treatment or have obstetric emergencies and need to terminate their pregnancy is not clear.CASE SUMMARY This article describes a parturient patient with a severe masseteric space infection who had an emergency cesarean section.CONCLUSION This case report aims to discuss the important anesthetic considerations for these patients.
基金Supported by the National Natural Science Foundation of China,No.81870320the Health Science and Technology Project of Guangzhou,No.20191A011086.
文摘BACKGROUND Thrombotic pulmonary embolism(TPE)is one of the most critical diseases in obstetrics but is rarely reported in caesarean section(CS)because TPE patients in CS have a high risk of death and are difficult to diagnose.This case report of TPE during CS was recorded by transthoracic echocardiography(TTE)and can provide a reference for the differential diagnosis of critical illnesses in CS.CASE SUMMARY A 37-year-old pregnant woman with rheumatic heart disease(RHD),gravida 5 and para 1(G5P1),presented for emergency CS at 33 wk and 3 d of gestation under general anesthesia because of acute heart failure,pulmonary hypertension and arrhythmia.After placental removal during CS,TTE revealed a nascent thrombus in the inferior vena cava(IVC)that elongated,detached and fragmented leading to acute thromboembolic events and acute TPE.This report presents the whole process and details of TPE during CS and successful rescue without any sequelae in the patient.This case gives us new ideas for the diagnosis of death or cardiovascular accidents during CS in pregnant women with heart disease and the detailed presentation of the rapid development of TPE may also elucidate new ideas for treatment.This case also highlighted the importance of prophylactic anticoagulation in the management of heart disease during pregnancy.CONCLUSION Pregnancy with heart failure could trigger inferior vena cava(IVC)-origin TPE during CS.Detection and timely treatment can avoid serious consequences.
文摘Dear editor, In July 2015, a 39-year-old gravida 2, para 0 lady at 35 weeks＇ gestation was found collapsed at home and sent to the emergency department （ED） by ambulance. She had a background of chronic hypertension on anti- hypertensives and aspirin, but repeatedly refused in- patient treatment for her uncontrolled hypertension. She had received pre-hospital cardiopulmonary resuscitation （CPR） for 17 minutes en route to the ED.
文摘In this paper, the step reduction method is discussed, which was advanced by Prof. Yeh Kai-yuan for calculating a non-uniform beam with various sections. The following result is proved. The approximate solution by this method approaches the true solution if the number of the steps approaches the infinity. However, the measure of the error between the limit solution and the ture solution is not in the pure mathematics sense but in the mechanics sense.
文摘BACKGROUND Parathyroid carcinoma(PC)is a difficult-to-diagnose rare disease with low incidence.Relatively accurate preoperative diagnosis is very important in choosing surgical methods and patient prognosis.CASE SUMMARY This study reported the clinical diagnosis and treatment of a rare patient with PC located in the thyroid gland and provided a case reference for the diagnosis and treatment of PC.A case of a 64-year-old male patient who presented to our hospital with systemic muscle and joint pain and palpitations is outlined.Subsequently,the patient was admitted to the Department of Nephrology for the treatment of“multiple myeloma nephropathy pending investigation”.The patient was diagnosed with“primary hyperparathyroidism and hypercalcemic crisis”using thyroid color ultrasound.CONCLUSION The intraoperative frozen section report considered the parathyroid tumor.Surgical tumor resection was promptly performed,and the diagnosis of PC was confirmed.
基金Supported by International Peace Maternal and Child Health Institute Clinical Research Program,No.YN201910Translational Medicine Cross Fund from Shanghai Jiao Tong University,No.YG2017QN38.
文摘BACKGROUND With the increasing trend of vaginal birth after caesarean delivery(VBAC),evaluation of the feasibility and safety of a second VBAC with grand multiparity is worth considering.Intrapartum uterine rupture is diagnosed in approximately one-fifth of all VBAC cases following successful vaginal delivery.To our knowledge,no report is available on the application of laparoscopy to repair postpartum uterine rupture after a successful second VBAC in China.CASE SUMMARY A 31-year-old woman(gravida 5,para 2)at 39 wk and 5 d of gestation was admitted to the hospital in labour.After a successful VBAC and observation for approximately 13 h,the patient complained of progressive abdominal pain.Given the symptoms,signs,and auxiliary examination results,intraperitoneal bleeding was considered.Because the patient was stable and ultrasound imaging was the only method available to assess the possibility of rupture,we recommended laparoscopy to clarify the diagnosis and for prompt laparoscopic uterine repair or exploratory laparotomy if necessary.Operative findings included transverse uterine scar rupture at the lower uterine segment of approximately 5.0 cm in length and 800 mL of intraoperative pelvic haemoperitoneum.Finally,she successfully underwent laparoscopic repair of uterine rupture and recovered very well according to three-dimensional magnetic resonance imaging at 42 d postpartum.CONCLUSION Routine postpartum intrauterine exploration is not beneficial to the mother and may even increase the risk of rupture.This case highlights a laparoscopic approach for repairing uterine rupture in the immediate postpartum period.
基金Capital's Funds for Health Improvement and Research,No.2020-1-2024.
文摘BACKGROUND Laparoscopic living donor hepatectomy(LLDH)has been successfully carried out in several transplant centers.Biliary reconstruction is key in living donor liver transplantation(LDLT).Reliable biliary reconstruction can effectively prevent postoperative biliary stricture and leakage.Although preoperative magnetic resonance cholangiopancreatography and intraoperative indocyanine green cholangiography have been shown to be helpful in determining optimal division points,biliary variability and limitations associated with LLDH,multiple biliary tracts are often encountered during surgery,which inhibits biliary reconstruction.A reliable cholangiojejunostomy for multiple biliary ducts has been utilized in LDLT.This procedure provides a reference for multiple biliary reconstructions after LLDH.CASE SUMMARY A 2-year-old girl diagnosed with ornithine transcarbamylase deficiency required liver transplantation.Due to the scarcity of deceased donors,she was put on the waiting list for LDLT.Her father was a suitable donor;however,after a rigorous evaluation,preoperative magnetic resonance cholangiopancreatography examination of the donor indicated the possibility of multivessel variation in the biliary tract.Therefore,a laparoscopic left lateral section was performed on the donor,which met the estimated graft-to-recipient weight ratio.Under intraoperative indocyanine green cholangiography,4 biliary tracts were confirmed in the graft.It was difficult to reform the intrahepatic bile ducts due to their openings of more than 5 mm.A reliable cholangiojejunostomy was,therefore,utilized:Suture of the jejunum to the adjacent liver was performed around the bile duct openings with 6/0 absorbable sutures.At the last follow-up(1 year after surgery),the patient was complication-free.CONCLUSION Intrahepatic cholangiojejunostomy is reliable for multiple biliary ducts after LLDH in LDLT.
文摘BACKGROUND We describe the treatment strategy for a patient who was found to have a partial hydatidiform mole and coexisting fetus(PHMCF)during the second trimester.The patient was a 38-year-old Chinese woman who had become pregnant following in vitro fertilization and embryo transplantation.We wanted to determine the safest therapeutic strategy to terminate the PHMCF during the second trimester.CASE SUMMARY In this case,we present a patient who was found to have a PHMCF complicated with serious continuous vaginal bleeding and pre-eclampsia during the second trimester.After careful evaluation,the pregnancy was considered to be unsustainable and was terminated via caesarean section(CS).An infant with weak vital signs and a partially cystic placenta measuring 110 mm×95 mm×35 mm were delivered by CS.The patient was discharged after 4 d.The serum levels ofβ-human chorionic gonadotropin decreased to within a normal range 5 wk after the operation,and no evidence of persistent trophoblastic disease or lung metastases was noticed at the 6-mo follow-up.CONCLUSION CS termination of PHMCF during the second trimester may be a relatively safe therapeutic strategy.
文摘BACKGROUND Fetal hydrops is a serious condition difficult to manage,often with a poor prognosis,and it is characterized by the collection of fluid in the extravascular compartments.Before 1968,the most frequent cause was the maternal-fetal Rh incompatibility.Today,90%of the cases are non-immune hydrops fetalis.Multiple fetal anatomic and functional disorders can cause non-immune hydrops fetalis and the pathogenesis is incompletely understood.Etiology varies from viral infections to heart disease,chromosomal abnormalities,hematological and autoimmune causes.CASE SUMMARY A 38-year-old pregnant woman has neck lymphoadenomegaly,fever,cough,tonsillar plaques at 14 wk of amenorrhea and a rash with widespread itching.At 27.5 wk a fetal ultrasound shows signs of severe anemia and hydrops.Cordocentesis is performed with confirmation of severe fetal anemia and subsequent fetal transfusion.The karyotype is 46,XX,array-comparative genome hybridization(CGH)negative,and infectious tests are not conclusive.In the following days there is a progressive improvement of the indirect signs of fetal anemia.At 33.6 wk,for relapse of severe fetal anemia,further fetal transfusions are necessary and an urgent cesarean section is performed.On the day 12 of life,for the detection of anemia,the newborn is subjected to transfusion of concentrated red blood cells and begins treatment with erythropoietin.Later there is a normalization of blood chemistry values and the baby does not need new transfusions.A 29-year-old pregnant woman,with Sjogren's syndrome and positive Anti-Ro/SSA antibodies,is subjected to serial fetal ecocardio for branch block.At 26.5 wk there is a finding of fetal ascites.Infectious disease tests on amniotic fluid are negative as well as quantitative fluorescent polymerase chain reaction,Array CGH.At cordocentesis Hb is 1.3 mmol/L,consequently fetal transfusion is performed.Also in this case,due to continuous episodes of relapse of fetal anemia with consequent transfusions,at 29.4 wk a cesarean section is performed.On day 9 of life,a treatment with erythropoietin is started in the newborn,but the baby needs three blood transfusions.The search for autoantibodies in the baby found SS-A Ro60 positive,SSA-Ro52 positive and SS-B negative.The hemoglobin values normalized after the disappearance of maternal autoantibodies.CONCLUSION An attempt to determine the etiology of hydrops should be made at the time of diagnosis because the goal is to treat underlying cause,whenever possible.Even if the infectious examinations are not conclusive,but the pregnancy history is strongly suggestive of infection as in the first case,the infectious etiology must not be excluded.In the second case,instead,transplacental passage of maternal autoantibodies caused hydrops fetalis and severe anemia.Finally,obstetric management must be aimed at fetal support up to an optimal timing for delivery by evaluating risks and benefits to increase the chances of survival without sequelae.
文摘BACKGROUND Comamonas kerstersii(C.kerstersii)infections have considered as non-pathogenic to humans,however due to new techniques such as matrix-assisted laser desorption ionization-time of flight mass spectrometry(MALDI-TOF-MS),more cases have been identified.CASE SUMMARY This is the first report of a maternal patient with a C.kerstersii bacteremia following caesarean section.Due to the severity of the patient’s condition;high fever and rapidly progressing organ damage,the patient was transferred to the intensive care unit.C.kerstersii was detected by metagenomic next-generation sequencing testing.Based on the drug sensitivity test,appropriate antibiotic treatment was given and the patient recovered fully.CONCLUSION This case report confirms that the detection via MALDI-TOF-MS and metagenomic next-generation sequencing testing provides a reliable basis for the diagnosis of this rare bacterial infection.
