ObjectiveTo develop a convenient screening method that can predict perioperative venous thromboembolism (VTE) and identify patients at risk of fatal perioperative pulmonary embolism (PE).MethodsPatients hospitalized for gynecological abdominal surgery (n = 183) underwent hematology tests and multidetector computed tomography (MDCT) to detect VTE. All statistical analyses were carried out using the SPSS software program (PASWV19.0J)ResultsThe following risk factors for VTE were identified by univariate analysis: plasmin-alpha2-plasmin inhibitor complex (PIC), thrombin-antithrombin III complex (TAT), and prolonged immobility (all p<0.001); age, neoadjuvant chemotherapy (NAC), malignancy, hypertension, past history of VTE, and hormone therapy (all p<0.01); and hemoglobin, transverse tumor diameter, ovarian disease, and menopause (all p<0.05). Multivariate analysis using these factors revealed that PIC, age, and transverse tumor diameter were significant independent determinants of the risk of VTE. We then calculated the incidence rate of perioperative VTE using PIC and transverse tumor diameter in patient groups stratified by age. In patients aged≦40 years, PIC ≧1.3 µg/mL and a transverse tumor diameter ≧10 cm identified the high-risk group for VTE with an accuracy of 93.6%. For patients in their 50 s, PIC ≧1.3 µg/mL identified a high risk of VTE with an accuracy of 78.2%. In patients aged ≧60 years, a transverse tumor diameter ≧15 cm (irrespective of PIC) or PIC ≧1.3 µg/mL identified the high-risk group with an accuracy of 82.4%.ConclusionsWe propose new screening criteria for VTE risk that are based on PIC, transverse tumor diameter, and age. Our findings suggest the usefulness of these criteria for predicting the risk of perioperative VTE and for identifying patients with a high risk of fatal perioperative PE.

Introduction: Delayed diagnosis of tubal pregnancy may cause intra-abdominal hemorrhage secondary to tubal rupture or tubal abortion and progress to a shock state. Recent advances in transvaginal ultrasound devices and simplified measurement of blood hCG levels have made it possible to perform early pregnancy diagnosis before the onset of symptoms and to provide early treatment. We describe a patient with an ampullary tubal pregnancy in whom the fetus grew until week 11 of gestation without resulting in either rupture or miscarriage. This patient could be treated with laparoscopic surgery. Case presentation: The patient was a 37-year-old woman, gravida 0, para 0. Pregnancy had been achieved using artificial insemination at a nearby clinic. She received a diagnosis of pregnancy with uterine malformation and was referred to our hospital at 10 weeks and 5 days of gestation. The blood hCG level was 154,243.8 IU/L. A pregnancy in the left rudimentary uterine horn of the right unicorn uterus was suspected based on ultrasound and MRI examination. At 11 weeks and 1 day of gestation, she underwent laparoscopic surgery under general anesthesia. She had a small amount of hemorrhagic ascites and the uterus was normal in size without findings of uterine malformation; accordingly, pregnancy in the rudimentary uterine horn and abdominal pregnancy were both ruled out as possibilities. The fimbria

No abstract

No abstract

No abstract