Gestational trophoblastic tumor became one of the curable disease due to the development of chemotherapy, appropriate follow up of beta- human chorionic gonadotropin and others. But metastatic trophoblastic tumor still shows high mortality rate because of resistance to the chemotherapy and large tumor burden.One of the important prognostic factors determining the prognosis of gestational trophoblastic tumor is antecedent pregnancy, which affects the response to therapy. Choriocarcinoma following term pregnancy is rare one with the incidence of one per 160,000 pregnancies in United States and the prognosis is poor because of late diagnosis and combined high risk prognostic factors.We present a choriocarcinoma following term pregnancy that required emergency total abdominal hysterectomy due to profuse bleeding with brief review of literatures.
Choriocarcinoma* ; Chorionic Gonadotropin ; Delayed Diagnosis ; Drug Therapy ; Emergencies ; Female ; Follow-Up Studies ; Hemorrhage ; Hysterectomy ; Incidence ; Mortality ; Pregnancy ; Pregnancy* ; Prognosis ; Trophoblastic Neoplasms ; United States

PURPOSE: The aims of this study were to investigate the efficacy of combining the systematized behavioral modification program (SBMP) with desmopressin therapy and to compare this with desmopressin monotherapy in the treatment of nocturnal polyuria (NPU). METHODS: Patients were randomized at 8 centers to receive desmopressin monotherapy (group A) or combination therapy, comprising desmopressin and the SBMP (group B). Nocturia was defined as an average of 2 or more nightly voids. The primary endpoint was a change in the mean number of nocturnal voids from baseline during the 3-month treatment period. The secondary endpoints were changes in the bladder diary parameters and questionnaires scores, and improvements in self-perception for nocturia. RESULTS: A total of 200 patients were screened and 76 were excluded from the study, because they failed the screening process. A total of 124 patients were randomized to receive treatment, with group A comprising 68 patients and group B comprising 56 patients. The patients' characteristics were similar between the groups. Nocturnal voids showed a greater decline in group B (-1.5) compared with group A (-1.2), a difference that was not statistically significant. Significant differences were observed between groups A and B with respect to the NPU index (0.37 vs. 0.29, P=0.028), the change in the maximal bladder capacity (-41.3 mL vs. 13.3 mL, P<0.001), and the rate of patients lost to follow up (10.3% [7/68] vs. 0% [0/56], P=0.016). Self-perception for nocturia significantly improved in both groups. CONCLUSIONS: Combination treatment did not have any additional benefits in relation to reducing nocturnal voids in patients with NPU; however, combination therapy is helpful because it increases the maximal bladder capacity and decreases the NPI. Furthermore, combination therapy increased the persistence of desmopressin in patients with NPU.
Behavior Therapy ; Deamino Arginine Vasopressin* ; Education* ; Humans ; Lost to Follow-Up ; Mass Screening ; Nocturia* ; Polyuria ; Prospective Studies* ; Self Concept ; Urinary Bladder

BACKGROUND: Hypertensive myocardial fibrosis promotes abnormalities of cardiac function that may adversely affect the clinical outcome of hypertensive patients. Imatinib mesylate blocks receptor tyrosine kinase and is clinically used to treat leukemia. Platelet-derived growth factor (PDGF) is a downstream target of receptor tyrosine kinases. Cardiac fibroblasts can be activated by PDGF. Thus we evaluated whether imatinib attenuate myocardial fibrosis and prevents diastolic dysfunction in spontaneously hypertensive rats (SHR). METHODS: 8 weeks old male SHRs were subjected to treatment with 8 weeks of low dose imatinib (SHR-10; 10 mg/kg), high dose imatinib (SHR-30; 30 mg/kg) or saline (SHR-C; n = 6 in each group). At the age of 16 weeks, all rats underwent hemodynamic studies and Doppler echocardiography, and were sacrificed. Their hearts were extracted for histopathological, immunoblotting and quantitative reverse transcriptase-polymerase chain reaction analyses. RESULTS: While imatinib did not affect blood pressure (BP), it markedly reduced perivascular and interstitial fibrosis in the hearts of SHR. Echocardigram showed that high-dose imatinib significantly reduced left ventricular (LV) wall thickness (septal/posterior wall; SHR-C vs. SHR-30: 18 +/- 2/19 +/- 2 mm vs. 15 +/- 1/14 +/- 1 mm; p < 0.05) and improved the parameters of LV diastolic function such as E/A ratio (SHR-C vs. SHR-30: 1.60 +/- 0.10 vs. 1.86 +/- 0.20; p < 0.05). Imatinib also significantly reduced mRNA expression of collagen III and PDGF beta-receptor tyrosine phosphorylation in the hearts of SHR. CONCLUSIONS: These results suggest that imatinib, especially high dose, could attenuate myocardial fibrosis and prevent LV diastolic dysfunction in hypertensive rat model by decreased activity of PDGF. Imatinib may provide a potential therapeutic approach for hypertensive heart disease.
Animals ; Benzamides ; Blood Pressure ; Collagen ; Diastole ; Echocardiography ; Echocardiography, Doppler ; Fibroblasts ; Fibrosis ; Heart ; Heart Diseases ; Hemodynamics ; Humans ; Immunoblotting ; Leukemia ; Male ; Mesylates ; Phosphorylation ; Phosphotransferases ; Piperazines ; Platelet-Derived Growth Factor ; Protein-Tyrosine Kinases ; Pyrimidines ; Rats ; Rats, Inbred SHR ; RNA, Messenger ; Tyrosine ; Imatinib Mesylate