Hydrosalpinx reportedly reduces the pregnancy rate of in vitro fertilization, and salpingectomy is one of the proposed surgical treatments. However, there is no consensus regarding the effect of salpingectomy on the ovarian function. We performed laparoscopic salpingectomy for hydrosalpinx in women who wished to become pregnant and examined the ovarian function and pregnancy rate. We performed laparoscopic salpingectomy (which involves preserving the blood vessels in the intervascular membrane and extracting only the fallopian tubes) in 29 patients with hydrosalpinx between August 2012 and December 2016. Among the 29 cases, six had endometriosis lesions and were therefore excluded from this study, leaving 23 patients who underwent only salpingectomy to be examined. We compared the serum AMH and pregnancy rate between cases of salpingectomy (studied; n=23) and myomectomy (control; n=35). No significant differences in the serum AMH or FSH levels before and after laparoscopic salpingectomy were noted. Postoperative pregnancy was achieved in 10 of the 23 patients who underwent salpingectomy. Laparoscopic salpingectomy for hydrosalpinx does not reduce the postoperative ovarian function. [Adv Obstet Gynecol, 71(2) : 67-73, 2019 (R1.5)]

Guidelines recommend that cancer patients with the potential to become pregnant in the future should consult specialists. We investigated whether and how the explanations provided by medial practitioners influenced the choice of fertility preservation treatment by cancer patients. The subjects were 38 patients with breast cancer who attended our clinic between June 2015 and June 2018. We retrospectively investigated the performance of fertility preservation treatment, as well as the type of treatment. Patients received explanations regarding each method (e.g., costs and pregnancy rate).We found that 30/38 patients selected fertility preservation treatment, including ‘oocyte cryopreservation only’ in six patients, ‘embryo cryopreservation’ in 17 patients, and ‘ovarian tissue cryopreservation’ in seven patients. Many unmarried patients chose either oocyte cryopreservation or ovarian tissue cryopreservation, whereas married patients mainly chose embryo cryopreservation.The mean age of the patients undergoing ovarian tissue cryopreservation was 30.7 years, and they were significantly younger than the patients who received other treatments. All patients completed fertility preservation treatment within the period specified by their breast oncologists. These results suggest that adoption of fertility preservation treatment among cancer patients is influenced by the explanations provided by reproductive medicine practitioners. [Adv Obstet Gynecol, 71(2) : 74-80, 2019 (R1.5)]

Objective : Laparoscopic surgery for obese patients is technically difficult and the incidence of perioperative complications is high. Thus, preoperative weight control is important to treat these patients safely. The aim of this study was to evaluate the efficacy of preoperative hospitalization for weight control of obese patients with endometrial cancer. Methods : We reviewed 112 patients who underwent laparoscopic surgery for endometrial cancer between April 2014 and March 2018. Preoperative characteristics and surgical outcomes of the obese patients were evaluated. Results : Seven of 14 obese patients with a body mass index (BMI) ≥30 kg/m² were preoperatively hospitalized for weight control. The median body weight and BMI at the first visit were 105.7 kg and 37.0 kg/m², respectively. A median weight loss of 12.7 kg was achieved during a median of 23 days of hospitalization, which was significantly greater than that in the non-hospitalization group (median 4.3 kg). Although the median duration from diagnosis of endometrial cancer to surgery was slightly longer in the hospitalization group (67 vs 48 days), no progression of cancer was observed. The surgery was completed without severe complications or unintended transition to laparotomy.Conclusion : Preoperative hospitalization for weight control can lead to greater weight loss than that in outpatient settings and helps perform surgery safely. [Adv Obstet Gynecol, 71(2) : 81-86, 2019 (R1.5)]

Umbilical cord blood sampling is receiving increased attention in the setting of labor along with the progress of regenerative medicine using umbilical cord blood stem cells (UCBC). We have described the latest findings on utilizing UCBC in the case of hypoxic ischemic encephalopathy (HIE) and the management under the new law regarding regenerative medicine. As the need for regenerative medicine utilizing UCBC increases, obstetric physicians will be expected to sample umbilical cord blood. [Adv Obstet Gynecol, 71(2) : 87-94, 2019 (R1.5)]

Intravenous leiomyomatosis (IVL) is a rare disease characterized by extensions from a uterine myoma into venous channels. We present a case involving the successful removal of a leiomyoma, which extended into the right atrium (RA) through the right ovarian vein and the inferior vena cava (IVC) via one-stage surgery. The patient was a 50-year-old woman with symptoms of bloating and frequent urination who was diagnosed with uterine myoma. Abnormalities had been revealed via electrocardiography and echocardiography, performed during a preoperative examination at another hospital. Subsequently, she was referred to our hospital. Echocardiography and contrast enhanced three-dimensional computed tomography revealed a tumor originating from the uterine myoma and extending into the right ovarian vein, the IVC, and the RA. Therefore, the preoperative diagnosis of IVL was established. To avoid sudden death, we performed a one-stage operation involving thoracotomy and laparotomy in cooperation with cardiac surgeons. The tumor was 2-3 cm in width and 30 cm in length and was a cylindrical mass consisting of trabecular filaments. The pathological findings indicated that these tumors originated from a leiomyoma. No additional therapy was performed after surgery and the patient has shown no evidence of tumor recurrence for five years. [Adv Obstet Gynecol, 71(2) : 95-102, 2019 (R1.5)]

We report three cases of chronic renal failure (CRF) that underwent maintenance hemodialysis (mHD) during pregnancy. Case 1 : A 43-year-old woman underwent mHD from 25 gestational weeks (GW) for treating renal hypertension. The dry weight (DW) setpoint was decreased because of hypertension. She delivered a 1088-g infant with an Apgar scores (Aps) of 4/9 via cesarean section (CS) at 30 GW due to fetal growth restriction. Case2 : A 40-year-old woman underwent mHD to treat CRF caused by IgA nephropathy. She was transferred to our hospital at 22 GW. The DW setpoint was increased by 0.5 kg/week. At 32 GW, She underwent CS because of coagulation and fibrinolytic system disorder. Preanesthetic medication caused her to go into anaphylactic shock. She delivered a 2374-g infant with an Aps of 0/0. Her child had mild developmental disabilities. Case 3 : A 37-year-old woman underwent mHD for CRF caused by vesicoureteral reflux. She was admitted to our hospital at 15 GW. The DW setpoint was decreased because of hypertension. She delivered a 1038-g infant with an Aps of 4/6 via CS at 27 GW due to tocolytic failure.All three infants were born prematurely, and two of them were extremely low birth weight infants. Current guidelines recommend that the DW setpoint should be increased 0.3-0.5 kg/week during the second and third trimesters, but these increases in the DW setpoint may cause polyhydramnios. [Adv Obstet Gynecol, 71(2) : 103-108, 2019 (R1.5)]

Introduction : Adnexal torsion often accompanies ovarian tumors. However, (particularly in young women), normal ovaries may undergo torsion. Massive ovarian edema (MOE) is a rare tumor-like condition secondary to intermittent or partial ovarian torsion-induced accumulation of fluid. The twisted ovary resembles an enlarged solid mass, which is easily misdiagnosed as a neoplasm. Case : A 21-year-old woman presenting with sudden abdominal pain was transferred to our hospital. Torsion of a left ovarian solid tumor was suspected based on her initial work-up including ultrasonography. Magnetic resonance imaging showed findings characteristic of MOE, including peripheral distribution of follicles and a central stroma demonstrating low-signal intensity on T1- and high-signal intensity on T2-weighted imaging. The patient underwent laparoscopic detorsion of the ovary for a preoperative diagnosis of MOE. Conclusion : MOE should be considered in young women presenting with torsion of a solid adnexal mass. Awareness of MOE among clinicians is important to preserve ovarian function and fertility in young women by performing conservative surgery. [Adv Obstet Gynecol, 71(2) : 109-115, 2019 (R1.5)]

Although the popularity of adenomyomectomy as an infertility treatment is increasing, uterine rupture following conception has been reported as a postoperative complication of this procedure. We describe a case of spontaneous uterine rupture discovered during a cesarean section after a laparoscopic adenomyomectomy. A 39-year-old woman (gravida 1, para 0) underwent laparoscopic adenomyomectomy to preserve fertility, and 5 months later, she conceived through IVF-ET. However, she had placenta previa in the second trimester of the pregnancy and was referred to our department at 30 weeks of gestation. Magnetic resonance imaging performed at 33 weeks of gestation demonstrated placenta previa posteriorly and myometrial thinning in the uterine fundus. Because of threatened uterine rupture, we prepared for surgery. An elective cesarean section was performed at 35 weeks of gestation. Because a uterine rupture (five cm in diameter) was found in the uterine fundus where there was a scar from the previous adenomyomectomy, we decided to do a total hysterectomy. After the surgery, the puerperal and neonatal courses were uneventful. Because women who become pregnant after an adenomyomectomy have a high risk of uterine rupture, they should be cautious throughout pregnancy. [Adv Obstet Gynecol, 71(2) : 116-122, 2019 (R1.5)]

Acute pancreatitis during pregnancy is often difficult to distinguish from other diseases, such as premature labor, placental abruption, or appendicitis. Acute pancreatitis is associated with maternal and perinatal mortality and should always be considered in the differential diagnosis. A risk of acute pancreatitis includes cholelithiasis and alcohol, glucose metabolism abnormality , and hyperlipidemia is one of the risk , too. However, standard treatment methods for hyperlipidemia during pregnancy have not yet been established. We herein present a case of severe hypertriglyceridemia and hypothyroidism during pregnancy that was managed without acute pancreatitis. A 31-year-old female (gravida 2, para 1) was diagnosed with severe hypertriglyceridemia and hypothyroidism at 28 weeks of pregnancy. We controlled triglyceride levels using diet modifications and drug therapy designed by a team of experts. The remaining course of the patient’s pregnancy was uneventful, and she delivered vaginally 37 weeks without acute pancreatitis. As her hypertriglyceridemia improved promptly after delivery, we conclude that pregnancy may have been the primary cause of hyperlipidemia. [Adv Obstet Gynecol, 71(2) : 123-127, 2019 (R1.5)]

Uterine leiomyoma torsion, a rare disease found in 0.1-0.3% cases of uterine leiomyoma surgery, presents with acute abdominal pain and requires urgent treatment. We report a case of laparoscopically assisted myomectomy (LAM) for uterine fibroid torsion. A 28-year-old nulligravid woman visited a local clinic because of sudden lower abdominal pain. An abdominal mass the size of a child’s head was identified by transabdominal sonography, and she was referred to our hospital. During physical examination, a mass in the midline of the lower abdomen was palpated and tenderness and rebound pain was observed. Blood tests indicated inflammation. Magnetic resonance images showed a 12-cm subserosal uterine leiomyoma and a myoma pedicle spanning the uterus to myoma. No contrast effect was observed inside the tumor. Our diagnosis was uterine leiomyoma torsion, and we performed LAM with a 3-cm transverse skin incision in the lower abdomen. The uterine leiomyoma developed from the uterine anterior wall, and the pedicle was twisted 360° counterclockwise. The resected leiomyoma was removed through a small abdominal incision. The pathological diagnosis was degenerative leiomyoma. We conclude that laparoscopic surgery with small incisions is particularly useful for pedunculated subserosal leiomyoma, even large ones. [Adv Obstet Gynecol, 71(2) : 128-134, 2019 (R1.5)]

Infective endocarditis during pregnancy is a rare disease. It causes embolism after vegetation has occurred and exacerbates perinatal prognosis. In this case, the woman was a 28-year-old primipara. She had a high fever and vomiting at 36 weeks of gestation. She was diagnosed as having infection and administered antibiotics. Her condition changed for the worse, and she had a pansystolic murmur, whitch is audible at the cardiac apex. In echocardiography, vegetation was confirmed in her mitral valve. We diagnosed infective endocarditis, and an emergency cesarean section was performed. A 2676 g male infant was delivered with Apgar scores of 8 / 9 at 1-/5-min at 37 weeks of gestation. After half a year, a mitral valve plasty was performed. Although it is a very rare disease in pregnancy, we should consider infective endocarditis when pregnant women have a persistent fever. [Adv Obstet Gynecol, 71(2) : 135-141, 2019 (R1.5)]

Hepatoid adenocarcinoma (HA) is defined as a tumor that develops outside the liver; it is histologically similar to hepatocellular carcinoma and often produces α-fetoprotein (AFP). We report a case of advanced uterine corpus HA that was successfully treated with paclitaxel and carboplatin (TC) chemotherapy after surgery. A 76-year-old female presented with lower abdominal distention. MRI and PET-CT revealed an enhanced 94 × 67-mm mass in the uterine cavity, and metastases to the pelvic and para-aortic lymph nodes, and lung. Her serum AFP level was elevated: 1476 ng/ml (normal, <10 ng/ml). We performed cytoreduction surgery. The final diagnosis was HA of the uterine corpus, FIGO IVB stage (UICC pT3bN1M1). She received 16 courses of monthly TC therapy (paclitaxel, 175 mg/m²; carboplatin, AUC 5). Her serum AFP level decreased to the normal range, and she remains in complete remission. Advanced HA prognosis may be improved by the treatment involving TC therapy. [Adv Obstet Gynecol, 71(2) : 142-148, 2019 (R1.5)]

We report a case of goblet cell carcinoid (GCC) of the appendix, histopathologically diagnosed following a patient surgery for suspected giant ovarian tumors. The patient was a 44-year-old woman, G2P1. Her chief complaint was abdominal distension. Under the pre-operative diagnosis of ovarian cancer, we performed total abdominal hysterectomy, bilateral salpingo-oophorectomy, pelvic and para-aortic lymphadenectomy, omentectomy and appendectomy. Though the intraoperative pathology of both ovary was adenocarcinoma, the final diagnosis was made that the patient presented GCC of the appendix based on pathological findings showing diffuse invasion and proliferation of carcinoma including goblet cells in the appendix and immunohistochemistry. Similar observations were made upon examination of the ovarian tumors and lymph nodes, which was compatible with metastasis of the GCC. Though GCC is rare and it is difficult to be diagnosed pre-operatively, an appendectomy should be considered upon surgery for mucin-producing or malignant ovarian tumors. On the contrary, ovarian metastasis of GCC is not rare, hence, ovarian tissues should be carefully examined and oophorectomy be taken into consideration in post-menopausal women upon diagnosis of GCC. [Adv Obstet Gynecol, 71(2) : 149-154, 2019 (R1.5)]