Fumikazu Kotsuji

A microperforate hymen is a rare congenital hymenal anomaly frequently mistaken for an imperforate hymen. While an imperforate hymen is suggested when hematocolpos is present and the hymen bulges and is discolored by retained menstrual blood, a microperforate hymen is an incomplete obstructive anomaly usually permitting normal menstrual flow. The microperforation is quite difficult to visualize. A 21-year-old primigravida at 38 weeks' gestation in active labor was referred to a university hospital because of absence of a vaginal opening. Inspection revealed normal external genitalia with an obstructing membrane at the level of the introitus. Because of arrest of labor coupled with lack of a definitive diagnosis, a cesarean section was performed. Subsequent digital exploration confirmed the diagnosis of microperforate hymen. A pinhead-sized opening of the hymen can permit spontaneous pregnancy. Lack of awareness of this unusual entity can cause diagnostic difficulty.

Control of bleeding is the goal of management for placenta accreta, which usually necessitates hysterectomy. A Committee Opinion of The American College of Obstetricians and Gynecologists (ACOG) has addressed the difficulties of conservative treatments. Placentas of 2 primiparous women with placenta accreta were removed operatively from their uteri. One woman underwent a low transverse cesarean delivery, and the other had delivered vaginally. In each case, the anterior uterine wall was incised vertically between the lower segment and fundus before manual removal. After eversion of the uterus, the placenta was successfully detached from the uterine wall after intramyometrial administration of oxytocin. A vertical incision in the anterior uterine wall and subsequent eversion of the uterus may aid in avoiding hysterectomy with placenta accreta.

Subamniotic hematoma is a placental pathological lesion resulting from the rupture of allntochorionic vessels. Some of them decrease in size during pregnancy. However, the relation between the reduction of the lesions during pregnancy and the structure of the placenta at delivery has not been previously reported. We report a case of subamniotic hematoma detected prenatally, which decreased in size during the third trimester, and presented with a cystic structure resembling a deflated balloon at delivery, and also review the literature of the placental surface cysts detected by prenatal ultrasound.

Detorsion and cystectomy of twisted adnexa have been performed in young women. However, identification was incomplete, and the function of the affected tube was not investigated. A 23-year-old, nulligravid woman with an acute abdomen was diagnosed with adnexal torsion. An emergency laparotomy revealed that both ovaries were 12x9x9 cm. the right adnexa were twisted and bluish black. Detorsion of the twisted lesion and ipsilateral fallopian tube was performed, with subsequent cystectomy of both lesions. Hysterosalpingography on the 14th postoperative day showed right tubal obstruction; 6 months postoperatively, repeat hysterosalpingography revealed patency of the right tube. At least several months may be required for functional recovery of an untwisted tube. For that reason, postoperative repeat hysterosalpingography is a useful method for follow-up of function in an untwisted tube.

The aim of this study was to assess the toxicity of a neoadjuvant chemotherapy (NAC) regimen consisting of cisplatin (CDDP) and 5-fluorouracil (5-FU) through 24-hour intravenous continuous infusion on days 1-4 in a Phase I study. Thirteen patients were recruited for this study. All patients were treated with a regimen consisting of CDDP and 5-FU through a 24-hour intravenous continuous infusion on days 1-4, followed by radical hysterectomy and/or radiation. Each initial dose of CDDP and 5-FU was 20 mg/m2/day and 750 mg/m2/day, respectively, for 4 days. In the third step, seven patients were treated at 25 mg/m2 day CDDP and 1000 mg/m2/day 5-FU, respectively, for 4 days. One of seven patients showed Grade 4 thrombopenia. However, in this dose step, all the patients showed an objective response. Although maximum tolerated doses (MTDs) were not reached, we decided to stop the escalation and to recommend this level for the Phase II study.