Tubo-ovarian abscess (TOA) is a severe manifestation of pelvic inflammatory disease. Irrespective of medical treatment with antibiotics, surgical procedures are required in most TOA cases. Some reports recently described the effectiveness of laparoscopic drainage for TOA in women with stage III-IV endometriosis. When a case of TOA is complicated with deep endometriosis, it can be difficult to know how to best manage such a condition. In this report, we present a case of TOA complex with deep endometriosis. We firstly chose to perform laparoscopic drainage for TOA, and secondly laparoscopic radical surgery to remove the deep endometriosis in five months.
Objective: To present a case of cesarean scar pregnancy（CSP）undergoing a hysteroscopic resection of the villi following temporal laparoscopic uterine artery ligationCase: A 31-year-old woman, with a past history of two cesarean sections, presented a chief complaint of irregular vaginal bleeding. The diagnosis of CSP was made by ultrasonography when a gestational sac was detected in the area of the cesarean scar. In addition, an examination of contrasted computed tomography showed that the gestational sac was depicted in the same area. The level of serum hCG was 2694mIU/ml. We laparoscopically ligated uterine arteries on both sides with vessel tapes. The villi were confirmed to be located in the cesarean section scar portion. We completely resected the villi through a hysteroscope. No bleeding from the scar section appeared after the ligations of the uterine arteries were released. The serum hCG level rapidly decreased in the postoperative period. It was demonstrated that the procedures shown here could be safely performed as a treatment for CSP.
Introduction: Transumbilical single-port access laparoscopic surgery has a lower rate of incisional morbidity and a favorable cosmetic outcome. However, the procedure is sometimes difficult to perform because of collision between the forceps and the scope. Therefore, we have used pre-bent forceps and a 5 mm-diameter long scope since April 2012. This study aims to evaluate the feasibility and efficacy of the revised single-port access laparoscopic surgery. Methods: We evaluated 29 cases of transumbilical single-port access total laparoscopic hysterectomy (SPA-TLH) using straight forceps or pre-bent forceps. Results: The pre-bent forceps group had shorter operative times for the procedures of ligating uterine arteries, dividing the cardinal ligament, incising the vaginal wall, and suturing the vaginal stump, compared with the straight forceps group. Conclusion: SPA-TLH using a pre-bent forceps and a 5 mm-diameter long scope could be more feasible, compared with SPA-TLH without such instruments.
Diagnosis of endometriosis needs invasive maneuvers. New serum marker that possesses both high sensitivity and high specificity has long been desired. To establish novel serum marker for endometriosis, serum autoantibodies (autoAbs) were investigated using proteomic approach. AutoAbs in sera of endometriotic patients and healthy controls were analyzed using a mesothelial cell line, 2-DE and Western blotting. Proteins in reacted spots were identified using MALDI TOF-MS with MASCOT analysis. ELISAs were established using recombinant proteins and autoAb-titers were estimated in sera of endometriotic patients, disease and healthy controls. Several autoAbs were identified. Anti-α-enolase (Eno1)-autoAb levels in endometriotic patients were significantly elevated compared with both healthy and disease controls. Sensitivity and specificity of serum anti-Eno1-autoAb was nearly comparable to serum CA125. When anti-Eno1-autoAb and CA125 assays were combined, diagnostic sensitivity and accuracy improved. Serum anti-Eno1-autoAb can be a new serum endometriotic marker and it is useful as a supplement assay for CA125. This study validates further clinical evaluation of this novel marker.
Tocilizumab (TCZ) is a humanized anti-human IL-6 receptor monoclonal antibody that suppresses the signaling of IL-6, which is important for inflammation and immune activation. In Japan, the use of TCZ for treatment of rheumatoid arthritis (RA), Castleman's disease, juvenile idiopathic arteritis, and Takayasu's arteritis / giant cell arteritis, etc. has been approved. IL-6 inhibition of TCZ suppresses leukocyte infiltration into the inflamed area. In addition, when TCZ achieves an effective blood concentration, C-reactive protein (CRP) becomes negative regardless of clinical presentation. Inflammatory outcomes such as CRP and erythrocyte sedimentation rate may be significantly different from clinical symptoms. We report a case of pelvic abscess following a laparoscopic simple total hysterectomy and bilateral salpingectomy during TCZ administration, along with a review of literature.
