Hemostasis for Massive Hemorrhage during Cesarean Section

Arterial ligation for massive hemorrhage during cesarean section may often fail to achieve hemostasis because of abundant collateral circulation. In recent years, various methods of hemostasis have been used, of which the most common are compression sutures, uterine balloon tamponade. In cases of massive hemorrhage, patients must be kept in good systemic condition, and local hemostasis must be achieved while paying attention to the possible occurrence of coagulopathy under monitoring of fibrinogen levels. When concomitant coagulopathy is present, local hemostasis is difficult to achieve because of hemorrhagic tendency. In such a case, obstetrical damage control procedures should be performed. First, the hemorrhagic area should be compressed with a towel or balloon, and at the same time, the artery should be blocked or compressed to reduce the blood flow into the uterus. The following resuscitation must also be implemented for warming intervention; blood transfusion to maintain the circulating blood volume; and the treatment of coagulopathy by “triple C supplement,” such as combined administration of fresh-frozen plasma and concentrated coagulation factors promptly to obtain a blood fibrinogen level of at least 150–200 mg/dL. If coagulopathy is eliminated, the conventional hemostatic procedures become effective. Hysterectomy is the last measure for hemostasis

A Minimally Invasive Hemostatic Strategy for Cesarean Scar Pregnancy and Cervical Pregnancy

Cesarean scar pregnancy (CSP) and cervical pregnancy are categorized as non-tubal ectopic pregnancy, because these are associated with a high burden of maternal and fetal morbidity including early uterine rupture, prevalence of placenta previa accrete spectrum, massive hemorrhage, and hysterectomy. Although management methods vary according to the week of gestation, recent reviews and reports support an interventional or a combination of surgical and medical approaches for treatment of unruptured CSP and cervical pregnancy rather than medical approach alone. In cases of massive hemorrhage, pressure hemostasis using balloon tamponade should first be performed. If such hemostasis proves to be ineffective, surgical excision or transcatheter arterial embolization (TAE) should be selected next. TAE reportedly achieves a high hemostasis rate. However, complications such as subsequent endometrial hypoplasia, menstruation disorder, infertility, placenta accreta, and uterine rupture have been reported, even in cases that have undergone successful hemostasis with TAE using an absorbable embolus. Recently, a minimally invasive hemostatic strategy in obstetrics, which aims to preserve uterine function and enhance the safety of subsequent pregnancies, has been developed. Therefore, we should reconsider uterus-preserving hemostatic strategies for critical hemorrhage and management of non-tubal ectopic pregnancy under these circumstances by using safe and minimally invasive treatment modalities

Centronuclear Myopathy Caused by Defective Membrane Remodelling of Dynamin 2 and BIN1 Variants

Centronuclear myopathy (CNM) is a congenital myopathy characterised by centralised nuclei in skeletal myofibers. T-tubules, sarcolemmal invaginations required for excitation-contraction coupling, are disorganised in the skeletal muscles of CNM patients. Previous studies showed that various endocytic proteins are involved in T-tubule biogenesis and their dysfunction is tightly associated with CNM pathogenesis. DNM2 and BIN1 are two causative genes for CNM that encode essential membrane remodelling proteins in endocytosis, dynamin 2 and BIN1, respectively. In this review, we overview the functions of dynamin 2 and BIN1 in T-tubule biogenesis and discuss how their dysfunction in membrane remodelling leads to CNM pathogenesis

Laparoscopic removal of uterine vertical compression sutures

AbstractUterine compression suturing is a relatively easy and effective way of hemostasis during cesarean section and is becoming widely accepted. However, complications such as necrosis or synechiae have been reported. We firstly report a case of laparoscopic removal of vertical compression sutures and discuss its benefits and improvements to be made. This case report is of a 32-year-old woman with placenta previa who received uterine vertical compression sutures for controlling massive bleeding during cesarean section. Because she complained of unbearable pelvic pain, laparoscopic compression suture removal was performed. Her pain was relieved after the threads were removed, suggesting that the compression sutures were the cause of her pelvic pain due to uterine ischemia. Although the risks of reoperation during the early postpartum period still exist, compression suture thread removal should be considered in cases of suspected uterine ischemia

Mass, nitrogen content, and decomposition of woody debris in forest stands affected by excreta deposited in nesting colonies of Great Cormorant

First online: 14 March 2015Great Cormorant (Phalacrocorax carbo), a piscivorous bird, has established breeding colonies in a coniferous forest near Lake Biwa in central Japan. This study investigated the possible effects of the colony’s excreta on the mass, nitrogen (N) content, and decomposition of woody debris. Study plots were established in forest stands representing four stages from breeding colony establishment to post-abandonment. The mass of fallen branches (diameter 1–5 cm) and coarse woody debris (logs, snags, and stumps; diameter ≥10 cm) was greater in forest stands colonized by Cormorants than a control stand never colonized by Cormorants. This was primarily attributed to Cormorant activity that caused increased mortality of standing trees and by Cormorants breaking branches for nesting materials. Nitrogen content of branches and logs that had fallen to the forest floor was negatively correlated with the relative density of wood. Nitrogen content of branches was consistently higher (at a given value of relative density) in the colonized stands than in the control stand. The increase of branch N content was possibly caused by the incorporation of N into decomposing branches with excreta-derived N supplied as throughfall and/or soil solution. The mean value of 2-year mass loss of recently dead branches and logs was significantly greater for woody debris in the smallest diameter class but was not significantly different among the forest stands. This suggests that the excessive supply of excreta-derived N and concomitant enrichment of N in soil had negligible effects on the initial stages of decomposition of woody debris

Gender-specific regulation of response to thyroid hormone in aging

<p>Abstract</p> <p>Background</p> <p>Similar to other systems, the endocrine system is affected by aging. Thyroid hormone, the action of which is affected by many factors, has been shown to be associated with longevity. The most useful marker for the assessment of thyroid hormone action is TSH level. Although age and gender are believed to modify the pituitary set point or response to free thyroid hormone concentration, the precise age- and gender-dependent responses to thyroid hormone have yet to be reported.</p> <p>Methods</p> <p>We analyzed the results of 3564 thyroid function tests obtained from patients who received medication at both out- and inpatient clinics of Shinshu University Hospital. Subjects were from among those with thyroid function test results in the normal or mildly abnormal range. Based on a log-linear relationship between the concentrations of FHs and TSH, we established the putative resistance index to assess the relation between serum FH and TSH levels.</p> <p>Results</p> <p>Free thyroid hormone and TSH concentration showed an inverse log-linear relation. In males, there was a negative relationship between the free T3 resistance index and age. In females, although there were no relationships between age and FHs, the indices were positively related to age.</p> <p>Conclusions</p> <p>These findings indicated that there is a gender-specific response to thyroid hormone with aging. Although the TSH level is a useful marker for the assessment of peripheral thyroid hormone action, the values should be interpreted carefully, especially with regard to age- and gender-related differences.</p

Deficiency in clonogenic endometrial mesenchymal stem cells in obese women with reproductive failure – a pilot study

The mechanisms of obesity associated reproductive complications remain poorly understood. Endometrial mesenchymal stem-cells are critical for cyclic renewal and uterine function. Recently, W5C5+ cells, with high clonogenicity, capable of producing endometrial stroma in vivo, have been described. We sought to investigate the abundance and cloning efficiency of W5C5+ and W5C5− endometrial cells in relation to Body Mass Index, age and reproductive outcome. Design W5C5+ and W5C5− cells were purified from mid-luteal endometrial biopsies (n = 54) by magnetic bead separation and subjected to in vitro colony-forming assays. Results First trimester pregnancy losses were significantly higher in obese subjects (n = 12) compared to overweight (n = 20) and subjects with normal Body Mass Index (n = 22) (P0.05). Conclusions Our observations suggest that the regenerative capacity and plasticity of the endometrium of obese women is suboptimal, which in turn may account for the increased risk of reproductive complications associated with obesity