Cervical Hydatidiform Moles Pregnancy: Diagnosis and Treatment

Cervical partial hydatidiform mole is a rare condition and difficult to diagnose. A 39-year-old Balinese woman from Sanglah General Hospital, Bali, Indonesia complained vaginal bleeding with abdominal pain. The patient was diagnosed with a partial hydatidiform mole based on physical examination, ultrasound, beta HCG levels and pathology examinations. Mass evacuation surgery followed by arterial ligation to stop the bleeding and periodically examination of beta HCG levels was carried out until the 14th week after the procedure. Beta HCG decreased gradually to normal level and indicate no risk of trophoblastic malignancy. Establishing the early diagnosis significantly affects the outcome of patient. Keywords: partial cervical hydatidiform mole, blighted ovum, pregnancy, diagnosis, therapy.

Identification of The Intersegmental Plane By Arterial-Ligation Method During Thoracoscopic Segmentectomy

Purpose The purpose of this study is to explore the feasibility of identifying the intersegmental plane by arterial ligation alone during thoracoscopic anatomical segmentectomy. Methods We selected 35 patients with peripheral small lung nodules who underwent thoracoscopic anatomical segmentectomy between May and December 2020. First, the targeted segmental arteries were distinguished and ligated during the operation. Then, bilateral pulmonary ventilation was performed with pure oxygen to fully inflate the entirety pulmonary lobes. After waiting for a while, the intersegmental plane appeared. Finally, the intersegmental plane was observed using thoracoscopy after indocyanine green was injected into the peripheral vein. The intersegmental planes determined by these two methods were compared. Results Thirty-four patients underwent segmental resection and one patient finally underwent lobectomy. The intersegmental planes were successfully observed in all patients using the arterial ligation method. The time from contralateral pulmonary ventilation to the appearance of the intersegmental plane was 13.7±3.2 min (6-19 min). The intersegmental planes determined by the arterial ligation method and the fluorescence method were comparable. After the operation, CT examinations showed that the remaining lung segments of all patients were well inflated. The mean duration of closed thoracic drainage was 3.1±0.9 days. Conclusion The arterial ligation method can be used to determine the intersegmental plane in anatomical segmentectomy. The method is feasible, reliable, and safe.

Assessment, treatment and new approaches to facial veins

Patients with prominent or cosmetically embarrassing facial veins may often seek an aesthetic opinion for removal. The authors present a methodology to approach classifying facial veins by describing the veins in terms of position, colour, size and flat or bulging appearance. Tiny telangiectasia (also known as thread or spider veins) or smaller discrete blue/green or green veins are regularly treated by heat, using electrocautery, radiofrequency, intense pulsed light or extra-corporeal laser. However, the authors present the use of microphlebectomy, endovenous laser and arterial ligation for larger facial veins and arteries that are often thought to be too big or complex to treat.

Epistaxis

Epistaxis, also known as nosebleeds, is a commonly treated condition in medicine and especially otolaryngology. 1 in 200 emergency room visits are due to acute epistaxis, with a higher frequency during the winter and among young children and the elderly. A strong understanding of the etiology, anatomy, and available therapeutic options is necessary for optimal management of epistaxis.1,2 This review contains 11 figures, 5 tables, 1 video, and 66 references. Keywords: epistaxis, nose bleed, nasal packing, hemostasis, nasal cauterization, arterial ligation, arterial embolization, hereditary hemorrhagic telangiectasias

Uterine necrosis, infection, and subinvolution: complications observed after combined application of modified B-Lynch suture and vascular ligation

Compression sutures are primarily used to treat atonic postpartum hemorrhage. We herein describe three cases of selective arterial ligation combined with B-Lynch or modified B-Lynch suture for the treatment of intractable postpartum hemorrhage unresponsive to available conservative interventions. Three pregnant women underwent a cesarean section for a macrosomic fetus, fetal distress, and oligohydramnios, respectively. All three women developed intractable postpartum hemorrhage due to uterine atony with no chance of embolization therapy. B-Lynch or modified B-Lynch suture and additional selective arterial ligation were performed using braided absorbable suture. The first woman developed postoperative hematometra and infection without response to drainage and antibiotic therapy. Although laparoscopic exploration was performed to loosen the suture line and drain the hematometra and pyometra, the necrosis and infection could not be controlled. Subtotal hysterectomy was therefore conducted, and the necrotic uterine adnexa was removed. The other two women developed subinvolution of the uterus resulting in prolonged menstruation and amenorrhea, although the uterus was preserved and the bleeding was controlled. Modified B-Lynch suture combined with vascular ligation is an invaluable technique for women with severe intractable postpartum hemorrhage. However, it can lead to serious complications such as uterine necrosis, infection, and subinvolution.