Experimental tracheal ligation (TL) has been shown to reverse the pulmonary hypoplasia associated with congenital diaphragmatic hernia (CDH) and to normalize gas exchange. The purpose of this study was to determine whether the TL would correct the surfactant deficiency present in the fetal rabbit model of CDH by using lamellar body count. Lamellar bodies are synthesized and secreted by the type II pneumocytes of fetal lung. The phospholipids present in these bodies constitute the major component of pulmonary surfactant. Twenty-one pregnant New Zealand rabbits underwent hysterotomy and fetal surgery on gestational day 24. Two fetuses of each pregnant rabbit were operated. In the fetus of one end of bicornuate uterus, left DH was created by excision of fetal diaphragm through open thoracotomy (DH Group). In the fetus of the other end of bicornuate uterus, left DH and TL were created (TL Group). The fetuses were delivered by Cesarean section on gestational day 31. Fourteen in control group, 12 in the DH group and 13 in TL group were born alive. En bloc excision of lungs, bronchi and trachea was done in all newborn rabbits. A five Fr catheter was inserted through trachea and repeated irrigations with 10 cc normal saline were done. The irrigated fluid was centrifuged at 280 xg for 5 minutes and the lamellar bodies were counted with the upper level fluid in platelet channel of electronic cell counter. The average lamellar body counts were 37.1 +/- 14.2 x 10(3)/microL in control group, 11.5 +/- 4.4 x 10(3)/microL in DH group, and 6.5+/- 0.9 x 10(3)/microL in TL group. Lamellar body count in DH group was lower than in control group and did not increase after TL. This study shows TL has no therapeutic effect on decreased surfactant level of CDH and the pregnant rabbit is appropriate for the animal model of CDH.
Blood Platelets ; Bronchi ; Catheters ; Cell Count ; Cesarean Section ; Diaphragm ; Electronics ; Electrons ; Female ; Fetus ; Hernia, Diaphragmatic ; Humans ; Hysterotomy ; Infant, Newborn ; Ligation ; Lung ; Models, Animal ; Organothiophosphorus Compounds ; Phospholipids ; Pneumocytes ; Pregnancy ; Pulmonary Surfactants ; Rabbits ; Thoracotomy ; Trachea ; Uterus

Advances in prenatal diagnosis have led to the prenatal management of a variety of congenital diseases. Fetal surgery was born of clinical necessity. Observations by pediatric surgeons and neonatologists of neonates that were born with irreversible organ damage led to the conclusion that one possible approach to prevent this alteration of developmental physiology, was fetal surgical intervention. The demonstration in animal models that the correction of an anatomical defect could reverse the associated pathophysiology led to the first systematic application of fetal surgery at the University of California, San Francisco, in the early 1980s . There has been a dramatic improvement in our ability to diagnose, select and safely operate on an expanding number of fetal anomalies. Many fetal interventions remain investigational but for a number of conditions randomized trials have established the role of in utero surgery, making fetal surgery a clinical reality in a number of fetal therapy programs. Although prenatal stem cell and gene therapy await clinical application, they offer tremendous potential for the treatment of many genetic disorders. Here we review the prenatal evaluation, current status and future potential of various prenatal operative approaches, such as open hysterotomy, fetoscopy, and percutaneous, including tissue engineering, and prenatal cellular and genetic therapy.
California ; Fetal Therapies ; Fetoscopy ; Genetic Therapy ; Humans ; Hysterotomy ; Infant, Newborn ; Models, Animal ; Prenatal Diagnosis ; San Francisco ; Stem Cells ; Tissue Engineering

Implantation of a pregnancy within the scar of previous cesarean section is the rarest form of ectopic pregnancy. Delayed diagnosis and treatment can lead to uterine rupture, hemorrhage and maternal morbidity. But diagnosed early by transvaginal sonography, treatment options are capable of preserving the uterus and subsequent fertility. Suction curettage, exploratory laparotomy, laparoscopic surgery, systemic or local injection of methotrexate is the treatment method currently performed. In this report, we treated a case of this patient by transvaginal hysterotomy. This is the first case report in the recent literature. By this surgery, we could successfully remove gestational sac from the implantation site and repair the defect by primary suture and preserve uterus.
Cesarean Section ; Cicatrix ; Delayed Diagnosis ; Female ; Fertility ; Gestational Sac ; Hemorrhage ; Humans ; Hysterotomy ; Laparoscopy ; Laparotomy ; Methotrexate ; Pregnancy ; Pregnancy, Ectopic ; Sutures ; Uterine Rupture ; Uterus ; Vacuum Curettage

Endometriosis is defined as the presence of endometrial tissue outside the uterus and located usually within the pelvis. It may be detected as a rare complication associated with surgery. Endometriosis following obstetric and gynecologic procedure, which is localized mostly in the surgical scar including Cesarean section scar, hysterotomy scar, trocar scar, Bartholin cyst exision scar, or episiotomy scar, may caused by implantation of endometrial gland and stroma. Endometriosis developing after hysterectomy, especially, is a quite rare condition except a recurrent disease. We have experienced a case of a 47-year-old woman who had diagnosed ovarian endometriosis two years after laparoscopically assisted vaginal hysterectomy for a large leiomyomatous uterus with no evidence of endometriosis, so we report this case with a brief review of literature.
Cesarean Section ; Cicatrix ; Endometriosis* ; Episiotomy ; Female ; Humans ; Hysterectomy ; Hysterectomy, Vaginal* ; Hysterotomy ; Middle Aged ; Pelvis ; Pregnancy ; Surgical Instruments ; Uterus

We present two cases of acute interstitial pneumonia (AIP) during the second trimester of pregnancy managed by mechanical ventilation, high dose corticosteroids. We described clinical course, laboratory data and imaging studies. Case 1) A 29-year-old woman, G1P1, was referred for aggravated continuous coughing, sputum and dyspnea, pleuritic chest pain and mild fever for 3 weeks at 24(+3) weeks of gestation. There were coarse breathing sounds with crackles on the both lung field. Her chest X-ray showed diffuse haziness in both lungs with suspicious nodular opacities and suggested pneumonia. HRCT showed diffuse ground glass opacities with interstitial thickening and suspicious fine nodular infiltration in both lungs suggesting acute interstitial pneumonia combined with ARDS. Because her symptoms were more aggravated, she was performed mechanical ventilation treatment. After that, she was performed cesarean hysterotomy and delivered a dead male 850grams. After her symptoms were much more improved. All antibiotics were stopped and reduced the doses of steroids, she was discharged with t-tube capped state. Case 2) A 33-year-old woman, G1P1, was referred for continuous coughing, sputum and dyspnea for 3 months and low abdominal discomfort at 24(+4) weeks of gestation. There were coarse breathing sounds with rales on the both lung field. Her chest X-ray showed diffuse haziness in both lungs with suspicious nodular opacities and suggested interstitial pneumonia. HRCT showed diffuse ground glass opacities with some intralobular and interlobular interstitial thickening and suspicious fine nodular infiltration in both lungs suggesting acute interstitial pneumonia or miliary TBc combined with ARDS. She was treated with antibiotics, oxygen, high dose corticosteroids, and tocolytics. There was no evidence of TBc in the bronchoscopy. She showed decreased mentality and decreased O2 saturation below 90% in spite of mechanical ventilation, high dose steroids and IVGV therapy. She delivered a boy of 870 g (Apgar score 1/5). After delivery, she was expired due to combined aggravating DIC. Her baby was expired at the next day, too. The outcome of AIP is fatal, reporting 59~100% mortality rate. The clinical course, laboratory data and treatment are not well established due to rarity of this disease entity. Chest X-ray and HRCT may be helpful in diagnosis and high dose steroid and immunosuppressive agents usually used but the efficacy is not guaranteed.
Adrenal Cortex Hormones ; Adult ; Anti-Bacterial Agents ; Bronchoscopy ; Chest Pain ; Cough ; Dacarbazine ; Diagnosis ; Dyspnea ; Female ; Fever ; Glass ; Humans ; Hysterotomy ; Immunosuppressive Agents ; Lung ; Lung Diseases, Interstitial* ; Male ; Mortality ; Oxygen ; Pneumonia ; Pregnancy ; Pregnancy Trimester, Second* ; Pregnancy* ; Respiration, Artificial ; Respiratory Sounds ; Sputum ; Steroids ; Thorax ; Tocolytic Agents

Endometriosis is generally confined to the pelvic viscera and the peritoneum, but it can proliferate in other areas like pleura, skin, extremities, lung, gallbladder, stomach, kidney and surgical scar. Scar endometriosis usually occurs in the surgical scar of previous cesarean sections, hysterotomy and episiotomy. The occurrence of endometrioma in cesarean scar is an infrequent event, usually presenting as a tender abdominal wall mass. We report two cases of abdominal wall endometrioma after cesarean section, which is presented with a brief review of the literature.
Abdominal Wall ; Cesarean Section* ; Cicatrix* ; Endometriosis* ; Episiotomy ; Extremities ; Female ; Gallbladder ; Hysterotomy ; Kidney ; Lung ; Peritoneum ; Pleura ; Pregnancy ; Skin ; Stomach ; Subcutaneous Tissue* ; Viscera

To our knowledge, implantation into the uterine muscle wall is one of the rare form of ectopic pregnancy, with only 16 cases reported until 1995. The early diagnosis depends upon the sonographic finding of intramural gestational sac-like growth and persistent high beta human chorionic gonadotropin (beta-hCG) levels after dilatation and curettage. But, nobody can't exclude intramural pregnancy in case that associated with adenomyosis in uterus in spite of negative beta-hCG. Hsieh et al. and Dousias et al. mentioned 2 cases of such situation with negative beta-hCG result. And confirmative diagnosis depends upon the pathologic finding for specimen obtained from laparoscopic or explorative hysterotomy. The authors have experienced one case of intramural pregnancy in uterus and report our case with a brief review of literature.
Adenomyosis ; Animals ; Chorionic Gonadotropin ; Diagnosis ; Dilatation and Curettage ; Early Diagnosis ; Female ; Hysterotomy ; Mice ; Myometrium ; Pregnancy* ; Pregnancy, Ectopic ; Ultrasonography ; Uterus*

This is a very important differential diagnosis for postpartum hemorrhage following cesarean delivery because repeated life-threatening bleeding may induce multiple blood transfusion and require emergency surgery including hysterotomy. False or pseudoanuerysm can be acquired in association with trauma, previous surgery, trophoblastic disease, neoplasm, infection or diethylstilbestrol exposure. When a punctured or lacerated artery does not seal completely, blood may escape and dissects the adjacent tissues, and collects in perivascular areas. If this collection maintains in communication with the parent vessel, a pseudoaneurysm could result. Typically the lesion are discovered because the patients have symptoms related to delayed rupture of the pseudoaneurysms, causing hemorrhage. Radiographic techniques (angiography, ultrasound, and magnetic resonance imaging) have provided the opportunity to diagnose pseudoaneurysm, arteriovenous malformation. We report a case of postpartum hemorrhage following cesarean delivery attributed to a pseudoaneurysm of the uterine pedicle and treated with arterial embolization. Angiographic study confirmed the diagnosis and embolization of the false aneurysm was successful in controlling the hemorrhage.
Aneurysm, False* ; Arteries ; Arteriovenous Malformations ; Blood Transfusion ; Cesarean Section* ; Diagnosis ; Diagnosis, Differential ; Diethylstilbestrol ; Emergencies ; Female ; Hemorrhage ; Humans ; Hysterotomy ; Parents ; Postpartum Hemorrhage* ; Postpartum Period* ; Pregnancy ; Rupture ; Trophoblasts ; Ultrasonography ; United Nations

OBJECTIVE: To describe diagnosis and management of Cesarean section scar pregnancy increased at recently due to high Cesarean section rate. METHODS: Eleven cases of pregnancies implanted into the lower uterine segment Cesarean section scar were diagnosed and treated at Daegu Fatima hospital during January 1999 to May 2004. All cases are confirmed by transvaginal ultrasound scan. The management of Cesarean section scar pregnancies included transvaginal evacuation, hysterotomy and medical treatment with methotrexate systemic or local injection into gestational sac. RESULTS: Eleven Cesarean section scar pregnancies were diagnosed. Medical treatment was used in nine women and four women was successful. The success rate were 44% (4/9). Surgical treatment was used in two women included transvaginal evacuation and hysterotomy. Seven women (63%) required blood transfusion and one women (9%) had a hysterectomy. CONCLUSION: Cesarean section scar pregnancies are more common. When the diagnosis is made in early pregnancy the prognosis is good and prevent late pregnancy complication include placenta previa, placental accreta and uterine rupture. The risk of hystrectomy is relatively low.
Blood Transfusion ; Cesarean Section* ; Cicatrix* ; Daegu ; Diagnosis* ; Female ; Gestational Sac ; Humans ; Hysterectomy ; Hysterotomy ; Methotrexate ; Placenta Previa ; Pregnancy Complications ; Pregnancy* ; Pregnancy, Ectopic ; Prognosis ; Ultrasonography ; Uterine Rupture

Congenital intracranial teratoma is a very rare tumor. We recently experienced a case of massive congenital intracranial teratoma that discovered in a male infant of 28 weeks of gestation. A 33-year old multigravida was observed at 28 weeks gestation for prenatal ultrasound examination and ultrasonography revealed the fetus was severely macrocephalic with marked hydrocephalus. For therapeutic termination, Hysterotomy and fetal cephalocentesis was performed to deliver a stillborn infant. Autopsy revealed a 2,420 g male infant with severe macrocephaly. A multilobulated intracerebral tumor was found a diameter 18 cm involving both cerebral hemisphere. The tumor was considered to have originated in the vicinity of pineal gland and suprasellar region. Microscopic examination showed the characteristic picture of a teratoma. The predominent component is immature neuroepithelium in the form of primitive neural tubules variably mature somatic tissure from other germ cell layers accompany the neuroepithelium. We report a case of congenital intracranial immature teratoma.
Adult ; Autopsy ; Cerebrum ; Fetus ; Germ Cells ; Humans ; Hydrocephalus ; Hysterotomy ; Infant ; Macrocephaly ; Male ; Pineal Gland ; Pregnancy ; Teratoma* ; Ultrasonography