Placenta percreta with bladder invasion is an extremely rare complication causing life-threatening hemorrhage, up to 17 liters.1 Most reported cases have been diagnosed after 30 weeks of pregnancy and few have presented before 20 weeks.2 Only 20 cases of placenta percreta with invasion of the bladder have been reported during last decade. In this condition, chorionic villi attach directly to the myometrium without intervening decidua. The exact etiology of impaired decidualization is unknown; however, a previous endometrial insult, such as previous cesarian section or endometrial curettage may be a contributing factor. To avoid massive bleeding, uterine body incision, hypogastric artery ligation before hysterectomy and uterine cervical removal have been attempted.1 Chorionic villi may attach to the myometrium (accreta), invade the myometrium(increta), or in its severe form (percreta) the trophoblastic tissue penetrates the whole myometrium and invades adjacent structures. We experienced a case of placenta previa percreta with bladder invasion and review the literatures.
Animals ; Arteries ; Chorionic Villi ; Curettage ; Decidua ; Female ; Hemorrhage ; Hysterectomy ; Ligation ; Mice ; Myometrium ; Placenta Accreta ; Placenta Previa* ; Placenta* ; Pregnancy ; Trophoblasts ; Urinary Bladder* ; Uterine Hemorrhage

Background: Reactive oxygen species (ROS) generated by neutrophils are closely correlated with the pathogenesis of a variety of inflammatory skin diseases. The aim of this study was to investigate whether the amount of reactive oxygen species (hydrogen peroxide) generated by neutrophils from patients with acne inflammation decrease after oral administration of standard doses of isotretinoin. Method: In order to measure neutrophil hydrogen peroxide production, phorbol myristate acetate (PMA, neutrophil stimulant), was added to whole blood. Intracellular dichlorofluorescein (DCF) fluorescence of neutrophils was determined by flow cytometry. In order to assess treatment efficacy, we used a Global Acne Grading Score (GAGS) and assessed the efficacy based on examinations at baseline and week 8. Results: Patients with acne inflammation showed a significantly increased level of hydrogen peroxide produced by neutrophils compared to healthy controls. Patients with acne inflammation treated with isotretinoin showed a significant decrease in the ability of neutrophils to produce hydrogen peroxide in accordance with a clinical improvement of acne lesions. Conclusion: Our result shows that the generation of ROS which induce a chemical insult to the integrity of the follicular epithelium in acne, can be suppressed in isotretinoin-treated acne patients.
Acne Vulgaris* ; Administration, Oral ; Epithelium ; Flow Cytometry ; Fluorescence ; Humans ; Hydrogen Peroxide* ; Hydrogen* ; Inflammation ; Isotretinoin* ; Neutrophils* ; Reactive Oxygen Species ; Skin Diseases ; Tetradecanoylphorbol Acetate ; Treatment Outcome