Recurrent laryngeal nerve schwannoma: same setting of resection and injection laryngoplasty

A 33-year-old woman was diagnosed with right recurrent laryngeal nerve (RLN) schwannoma. She presented with a long history of hoarseness, and only recently developed dysphagia. On physical examination, a mass was observed over the right cervical level IV. Endoscopic examination of the larynx showed that she had right unilateral vocal cord palsy. She successfully underwent transcervical resection of the tumour followed by injection laryngoplasty. This study discusses the presentation of the tumour, radiological findings, our working diagnosis and treatment options of RLN schwannoma.

Application of Bioactive Hydrogels for Functional Treatment of Intrauterine Adhesion

Intrauterine adhesion (IUA) is a common endometrial disease and one of the main causes of infertility in women of childbearing age. Current treatment strategies, such as hysteroscopic adhesion resection, hysteroscopic transcervical resection of adhesion (TCRA), the use of local hormone drugs, and anti-adhesion scaffold implantation, do not provide a satisfactory pregnancy outcome for moderate-severe IUA, which presents a great challenge in reproductive medicine. With the development of material engineering, various bioactive and functional hydrogels have been developed using natural and synthetic biomaterials. These hydrogels are not only used as barely physical barriers but are also designed as vectors of hormone drugs, growth factors, and stem cells. These characteristics give bioactive hydrogels potentially important roles in the prevention and treatment of IUA. However, there is still no systematic review or consensus on the current advances and future research direction in this field. Herein, we review recent advances in bioactive hydrogels as physical anti-adhesion barriers, in situ drug delivery systems, and 3D cell delivery and culture systems for seeded cells in IUA treatment. In addition, current limitations and future perspectives are presented for further research guidance, which may provide a comprehensive understanding of the application of bioactive hydrogels in intrauterine adhesion treatment.

The effectiveness of microwave endometrial ablation combined with hysteroscopic transcervical resection in treating submucous uterine myomas: A retrospective study

Background Submucous uterine myomas can be effectively and safely treated using microwave endometrial ablation (MEA). However, recurrence is common and requires additional treatment. This study investigated the efficacy of MEA combined with transcervical resection (TCR). Methods This retrospective study included 32 women who underwent MEA in addition to TCR for submucous uterine myomas at the International University of Medicine and Welfare Hospital between January 2016 and June 2020. All patients were followed up for ≥ 6 months after the procedure. Results The 32 women had a mean age of 45.2 ± 4.3 years. The myomas had a mean major diameter of 26.3 ± 12.3 mm and a protrusion degree of 51.3 ± 11.3%. The patients reported very severe hypermenorrhea/dysmenorrhea (10/10 points on the visual analogue scale) before the procedure. After the procedure, the hypermenorrhea scores decreased to 1.2 ± 1.3 and 0.9 ± 1.3 after 3 and 6 months, respectively (both p < 0.001). The dysmenorrhea scores also decreased to 1.3 ± 1.8 and 1.3 ± 1.8 after 3 and 6 months, respectively (both p < 0.001). Circulating hemoglobin concentrations improved significantly from 8.7 ± 1.9 g/dL to 13.5 ± 1.1 g/dL (p < 0.001). The mean follow-up duration was 33.8 ± 16.8 months and 10 women (31.3%) developed amenorrhea during this period, although none experienced recurrence of hypermenorrhea. No surgical complications were observed. The patients reported being highly satisfied with the ability of the combined treatment to relieve hypermenorrhea (mean visual analogue scale score: 9.5 ± 0.8). Conclusion Reducing the size of uterine fibroids via a combination of MEA and TCR can safely and effectively treat hypermenorrhea in patients with submucous myomas. Furthermore, the procedure’s effectiveness is complemented by the patients’ high satisfaction level.

Predictive value of live birth rate based on different intrauterine adhesion evaluation systems following TCRA

Objective The aim of this study was to assess the predictive value of five different intrauterine adhesion (IUA) evaluation systems for live birth rate following transcervical resection of adhesion (TCRA). Method This retrospective study included 128 women with IUA who desired for spontaneous conception after TCRA. All the patients were retrospectively scored by the American Fertility Society (AFS) classification, European Society of Gynecological Endoscopy (ESGE) classification, March’s classification (March), Nasr classification (Nasr) and Chinese IUA diagnosis classification criteria (Chinese). The predictive value of these evaluation systems was determined by receiver operating characteristic (ROC) curves and area under a ROC curve (AUC). Results The correlation coefficients of AFS, ESGE, March, Nasr and Chinese classification and the live birth rate were 0.313, 0.313, 0.288, 0.380, and 0.336, respectively. Among women with hypomenorrhea and amenorrhea, as well as women with no infertility, the severities determined by all five evaluation systems were correlated with live birth rate (P < 0.001). All five scoring systems were efficient to predict live birth rate. Among them, Nasr classification showed the highest AUC (0.748) with the best predictive value. Multivariate logistic regression analyses showed that Nasr classification had the highest OR (OR, 6.523; 95% CI, 2.612, 18.263). And, Nasr’s classification system also showed highest sensitivity (81.8%) and negative predictive value (96.7%) when divide the system into mild IUA vs. moderate and severe IUA. Conclusion AFS, ESGE, March, Nasr and Chinese classification were demonstrated to be capable of predicting live birth following TCRA although the predictive capacities might be limited, and Nasr classification showed the highest predictive value of live birth.

Excessive distension absorption in patient went through hysteroscopic surgery distended with 5%mannitol solution : a retrospective study.

Objective: To estimate the incidence of excessive distension absorption in the patient went through hysteroscopic surgery distended with 5% mannitol solution, to evaluate the use of 5% mannitol solution for hysteroscopic surgical procedure specifically and to testify the safe threshold for distension absorption. Design: Retrospective. Setting: Academic medical center. Patients: 10693 patients went through inpatient hysteroscopic surgery distended with 5% mannitol solution using monopolar electrosurgical instrument from Jan. 2015 to Sep. 2020. Intervention(s): None. This study has been approved by the Ethics Committee of Sun Yat-sen Memorial Hospital. Measurements and Main Results: Fluid deficit more than 1000mL is defined as excessive distension absorption. Incidence of excessive distension absorption in all the inpatient hysteroscopic surgeries is 0.46% (49/10693). It is 2.57% (16/623) in transcervical resection of fibroid (TCRF), 2.36% (9/381) in retained products of conception (RPOC) removal, 1.20% (6/501) in hysteroscopic uterine septum resection (HSR), 0.53% (14/2621) in transcervical resections of adhesion (TCRA) while in the severe cases it was 2.34% (14/598), 0.48% (4/828) in transcervical resection of the endometrium (TCRE). Excessive distension absorption developed within ten minutes in two cases. Twelve of thirty nine patients with fluid deficit under 2500mL presented with clinical consequences related to circulation overload. Conclusion: Incidence of excessive distension absorption could be low generally however it would be five times higher in TCRP, RPOC removal and TCRA. Resection by needle electrode may contribute to the excessive distension absorption developed within short time. 30.77% of the patients could not tolerate the less than 2500mL distension absorption.

Predictive value of live birth rate based on different intrauterine adhesion evaluation systems following TCRA

Objective: The aim of this study was to assess the predictive value of five different intrauterine adhesion (IUA) evaluation systems for live birth rate following transcervical resection of adhesion (TCRA).Method: This retrospective study included 128 women with IUA who desired for spontaneous conception after TCRA. All the patients were retrospectively scored by the American Fertility Society (AFS) classification, European Society of Gynecological Endoscopy (ESGE) classification, March’s classification (March), Nasr’s classification (Nasr) and Chinese IUA diagnosis classification criteria (Chinese). The predictive value of these evaluation systems was determined by receiver operating characteristic (ROC) curves and area under a ROC curve (AUC).Results: The correlation coefficients of AFS, ESGE, March, Nasr and Chinese classification and the live birth rate were 0.313, 0.313, 0.288, 0.380, and 0.336, respectively. Among women with hypomenorrhea and amenorrhea, as well as women with no infertility, the severities determined by all five evaluation systems were correlated with live birth rate (P < 0.001). All five scoring systems were efficient to predict live birth rate. Among them, Nasr’s classification showed the highest AUC (0.748) with the best predictive value. Multivariate logistic regression analyses showed that Nasr’s classification had the highest OR (OR, 6.523; 95% CI, 2.612, 18.263). And, Nasr’s classification system also showed highest sensitivity (81.8%) and negative predictive value (96.7%) when divide the system into mild IUA vs. moderate and severe IUA Conclusion: AFS, ESGE, March, Nasr and Chinese classification were demonstrated to be capable of predicting live birth following TCRA although the predictive capacities might be limited, and Nasr’s classification showed the highest predictive value of live birth.