Cervical pregnancy can become dangerous if not diagnosed accurately. Cesarean scar pregnancy is a similar type of pregnancy with the same clinical course. Case: 1) A 29-year-old woman noticed a bloody genital discharge. An 8.6 × 2.7 mm GS was detected in the cervix, FHB was not detected. She improved after 1 course of MTX 20 mg for 5 days. Thereafter, she delivered a 2564 g girl at 38 weeks. 2) A 36-year-old woman, who had 1 CS, consulted our hospital with a complaint of genital bleeding. Vaginal ultrasound examination (US) demonstrated GS and yolk sac. D&C was attempted, but uncontrolled massive bleeding prevented this procedure. Therefore, we performed total abdominal hysterectomy with blood transfusion. 3) A 32-year-old woman, who had 1 CS, consulted our department with a complaint of positive pregnancy test. At the first consultation, vaginal US detected a 6.4 mm GS-like echo in the cervix and 8.5 mm in the body. Cervical pregnancy was suspected but not finally diagnosed. Thereafter, Yolk sac and FHB could not be detected. Under spinal anesthesia, D&C was performed with abdominal US. 4) A 27-year-old woman consulted a local clinic with a complaint of atypical genital bleeding. A 17 mm GS was detected in the cervix and no FHB. She was referred to our hospital. D&C was performed uneventfully. 5) A 34-year-old woman became pregnant under assisted reproductive technology. She was referred to our hospital for suspicion of cervical pregnancy. The GS was 8.0 × 3.9 mm. D&C was performed. 6) A 33-year-old woman was referred to our hospital for suspicion of cervical pregnancy. Our US detected a 13.7 mm GS, a 5.0 mm CRL and positive FHB. She had MTX 15 mg for 5 days and D&C. We reviewed 28 cases recently. The mean patient age was 27 years. 3 cases had histories of CS and 11 cases had undergone induced abortions. 5 cases included descriptions of US findings and 23 cases included photographs. The main finding was GS in the cervix in 26 cases.
Objective: The authors examined the effect of 6.0 MIU interferon beta-1a (IFNβ-1a) administered IM each week on the evolution of monthly magnetization transfer ratio (MTR) within new gadolinium-enhancing (Gd+) lesions in patients with very early relapsing-remitting (RR) MS. Background: IFNβ is an effective disease-modifying treatment for patients with RRMS. Among other effects, it has been shown to decrease the number of new Gd+ and T2-weighted lesions. MTR is a putative marker for irreversible tissue damage and evolution of MTR within a lesion may reflect recovery of tissue damage. It is not known whether IFNβ-1a affects the recovery phase of lesions. Methods: Eight untreated patients with RRMS who completed up to 14 monthly brain MRI sessions elected to initiate treatment with IFNβ-1a. Four out of eight patients developed new Gd+ lesions during treatment. MTR of lesions at the time of appearance and subsequent rate of change of monthly MTR were compared before and after treatment (stratified Mann-Whitney test). Results: The difference between MTR at appearance of 47 new Gd+ lesions before treatment versus 23 new Gd+ lesions during treatment was not significant. Twenty-two of 47 new Gd+ lesions before treatment and 11 of 23 new Gd+ lesions after treatment were monitored for up to 6 months. After appearance of new Gd+ lesions, the rate of increase in MTR was faster during therapy (p = 0.037). Conclusion: MTR abnormalities within new Gd+ lesions evolve at a faster rate during treatment with IFNβ-1a than before initiating therapy. This is consistent with the hypothesis that IFNβ-1a promotes resolution of new Gd+ lesions.
e12057 Background: Vulvar Paget's disease is difficult to diagnose early because this is a rare disease with an incidence of 10 patients per one million females per year and often ocurrs in elderly women aged 60-70 years old. A randomized controlled trial, meta-analysis and evidence-based medicine are not suitable methods of improving the prognosis of this disease. Vulvar Paget's disease is an adenocarcinoma in situ and a malignant disease. Since early diagnosis and treatment is necessary to improve prognosis, we extracted the causes of late diagnosis and proposals to improve prognosis from the literature. Methods: Literature review was performed through Japana Centra Revuo Medicina and PubMed. Ten articles including our study on 283 Asian women and seven articles on 363 Caucasian women were collected and examined according to patient age, interval between the initial symptom and the start of therapy, reason for delay in treatment and measures to prevent delay. Results: The mean age was 69.2 years (min∼max: 41∼88) in Asian women and 67.8 years (35∼88) in Caucasian women. The interval between the initial symptom and treatment was 3.38 years (0.0∼17.0) in Asian women and 1.93 years (0.1∼16.0) in Caucasian women. Many authors indicated the delay between the initial symptoms to treatment was related with patient age, slight initial symptoms of the disease, slow progression and resemblance to eczema, mycosis and dermatitis. They also indicated that awareness of the disease among patients and doctors should be increased in order to promote early diagnosis. Conclusions: The mean patient age did not significantly differ among Asian and Caucasian women. The interval before treatment was longer for Asian women than for Caucasian women, because red exanthema was more easily distinguished on white skin than on pigmented skin. As a gynecologist, we must consider this disease a malignancy and provide rapid diagnosis in order to begin treatment without delay. Moreover, since there are some patients who rely on self-medication or folk medicine rather than consulting a doctor, education about the existence of vulvar Paget's disease must also be provided to the general public. No significant financial relationships to disclose.
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