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Successful live birth following hysteroscopic adhesiolysis under laparoscopic observation for Asherman’s syndrome: A case report

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World Journal of Clinical Cases 2022年第32期10卷 11949-11954页

作者： Toshiyuki Kakinuma kaoru Kakinuma Yoshio Matsuda Michitaka Ohwada kaoru yanagida Department of Obstetrics and Gynecology International University of Health and Welfare HospitalNasushiobara-City 329-2763TochigiJapan

BACKGROUND Asherman’s syndrome is characterized by reduced menstrual volume and adhesions within the uterine cavity and cervix,resulting in inability to carry a pregnancy to term,placental malformation,or *** present the case of a 40-year-old woman diagnosed with Asherman’s syndrome who successfully gave birth to a live full-term neonate after hysteroscopic adhesiolysis under laparoscopic observation,intrauterine device insertion,and Kaufmann *** SUMMARY A 40-year-old woman(Gravida 3,Para 0)arrived at our hospital for specialist care to carry her pregnancy to *** had previously undergone six sessions of dilation and curettage owing to a hydatidiform mole and persistent trophoblastic disease,followed by *** subsequently became pregnant twice,but both pregnancies resulted in spontaneous miscarriages during the first *** menstrual periods were very light and of short *** adhesiolysis with concurrent laparoscopy was performed,and Asherman’s syndrome was *** uterine adhesions covered the area from the internal cervical os to the uterine *** Kaufmann therapy was administered,and endometrial regeneration was confirmed using *** became pregnant 9 mo postoperatively and delivered through elective cesarean section at 37 wk of *** postpartum course was uneventful,and she was discharged on postoperative day *** Hysteroscopic adhesiolysis with concurrent laparoscopy enables identification and resection of the affected area and safe and accurate surgery,without complications.

关键词： Hysteroscopic surgery Laparoscopy Intrauterine devices Live birth Pregnancy Case report

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Efficacy of transvaginal ultrasound-guided local injections of absolute ethanol for ectopic pregnancies with intrauterine implantation sites

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World Journal of Clinical Cases 2023年第4期11卷 788-796页

作者： Toshiyuki Kakinuma kaoru Kakinuma Yoshio Matsuda kaoru yanagida Michitaka Ohwada HirotsuneKaijima Department of Obstetrics and Gynecology International University of Health and Welfare HospitalNasushiobara 329-2763Japan Minatomirai Yume Clinic Yokohama 2200012Japan

BACKGROUND Cervical pregnancies,interstitial tubal pregnancies,and cesarean scar pregnancies,which are ectopic pregnancies with intrauterine implantation sites exhibit increasing trends with the recent widespread use of assisted reproductive technologies and increased rate of cesarean *** development of highsensitivity human chorionic gonadotropin testing reagents and the increased precision of transvaginal ultrasonic tomography have made early diagnosis possible and have enabled *** of ectopic pregnancies using methotrexate therapy and/or uterine artery embolization has been ***,delayed resumption of infertility treatments after methotrexate therapy is indicated,and negative effects on the next pregnancy after uterine artery embolization have been *** To examine the efficacy and safety of ultrasound-guided topical absolute ethanol injection in ectopic pregnancies with an intrauterine implantation *** In this study,we retrospectively examined the medical records of 21 patients who were diagnosed with an ectopic pregnancy with an intrauterine implantation site at our hospital,between April 2010 and December 2018,and underwent transvaginal ultrasound-guided local injections of absolute ethanol to determine the treatment *** evaluated the treatment methods,treatment outcomes,presence of bleeding requiring hemostasis measures and blood transfusion,complications,and treatment *** treatment was defined as the completion of treatment using transvaginal ultrasound-guided local injections of absolute ethanol *** There were 21 total cases comprising 10 cervical pregnancies,10 interstitial tubal pregnancies,and 1 cesarean scar *** patients completed treatment with this *** massive hemorrhaging or serious adverse reactions were observed during *** mean gestation ages at the time of diagnosis were 5.9 wk(SD,±0.9 wk)for cervical and 6.9 wk(SD,±2.1 wk)for interstitial

关键词： Embryo transfer Fertility Fertilization in vitro Pregnancy complications Prenatal care Ectopic pregnancy

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Ultrasound-guided local ethanol injection for fertility-preserving cervical pregnancy accompanied by fetal heartbeat: Two case reports

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World Journal of Clinical Cases 2022年第11期10卷 3587-3592页

作者： Toshiyuki Kakinuma kaoru Kakinuma Yoshio Matsuda Michitaka Ohwada kaoru yanagida Hirotsune Kaijima Department of Obstetrics and Gynecology International University of Health and Welfare HospitalNasushiobara 329-2763Japan Minatomirai Yume Clinic Yokohama 220-0012Japan

BACKGROUND The incidence of cervical pregnancy is increasing due to the recent widespread application of assisted reproductive *** hysterectomy has been a treatment option,high-sensitivity human chorionic gonadotropin testing and improved accuracy of transvaginal ultrasound imaging have increased possibility of uterine *** and curettage with methotrexate therapy and uterine artery embolization have been reported as treatments with fertility preservation;however,certain disadvantages limit their *** SUMMARY In our two reported cases,we avoided massive bleeding and immediately resumed infertility treatment using ultrasound-guided local ethanol injection for cervical pregnancies with fetal *** This treatment may be a new fertility-preserving option for cervical pregnancy.

关键词： Ultrasonography Ethanol Infertility Fertility preservation Methotrexate Case report

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Abnormal uterine bleeding successfully treated via ultrasoundguided microwave ablation of uterine myoma lesions: Three case reports

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World Journal of Clinical Cases 2024年第5期12卷 980-987页

作者： Toshiyuki Kakinuma kaoru Kakinuma Rora Okamoto kaoru yanagida Michitaka Ohwada NobuhiroTakeshima Takeshima Department of Obstetrics and GynecologyInternational University of Health and Welfare HospitalTochigi 329-2763Japan

BACKGROUND Microwave endometrial ablation(MEA)is a minimally invasive treatment method for heavy menstrual ***,additional treatment is often required after recurrence of uterine myomas treated with ***,because this treatment ablates the endometrium,it is not indicated for patients planning to become *** overcome these issues,we devised a method for ultrasound-guided microwave ablation of uterine myoma feeder *** report three patients successfully treated for heavy menstrual bleeding,secondary to uterine myoma,using our novel *** SUMMARY All patients had a favorable postoperative course,were discharged within 4 h,and experienced no ***,no postoperative recurrence of heavy menstrual bleeding was *** method also reduced the myoma’s maximum *** This method does not ablate the endometrium,suggesting its potential appli-cation in patients planning to become pregnant.

关键词： Uterine myoma Microwave Heavy menstrual bleeding Dysmenorrhea Fertility preservation Case report

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Effectiveness of treating menorrhagia using microwave endometrial ablation at a frequency of 2.45 GHz

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World Journal of Clinical Cases 2023年第24期11卷 5653-5659页

作者： Toshiyuki Kakinuma Ayaka Kaneko kaoru Kakinuma Yoshio Matsuda kaoru yanagida NobuhiroTakeshima Michitaka Ohwada Department of Obstetrics and Gynecology International University of Health and Welfare HospitalNasushiobara 329-2763Japan

BACKGROUND Microwave endometrial ablation(MEA)is a minimally invasive treatment for *** has been covered by the national insurance in Japan since April 2012,and its demand has been increasing as the importance of women’s health has advanced in *** To examine the efficacy of MEA as a treatment option for *** In this study,we retrospectively analyzed 76 patients who underwent MEA between January 2016 and March 2020 in our *** was performed in the lithotomy position,under general anesthesia,and with transabdominal ultrasound guidance,including the entire endometrial circumference while confirming endometrial *** Microtaze AFM-712 and the Sounding Applicator CSA-40CBL-1006200C were used for MEA,and the endometrium was ablated using a Microtaze output of 70 W and coagulation energization time of 50 s per *** visual analog scale(VAS)was used to evaluate menorrhagia,menstrual pain,and treatment ***,the hemoglobin(Hb)levels before and after MEA and associated complications were *** The average age of the patients was 44.8±4.0 *** 14 patients had functional menorrhagia,62 had organic menorrhagia,of whom 14 had endometrial polyps,40 had uterine fibroids,and 8 had *** VAS score before MEA and 3 and 6 mo after the procedure were 10,1.3±1.3,and 1.3±1.3,respectively,for menorrhagia and 10,1.3±1.8,and 1.3±1.8,respectively,for menstrual pain,both showing improvements(P<0.001).The MEA Hb level significantly improved from 9.2±4.2 g/dL before MEA to 13.4±1.2 g/dL after MEA(P=0.003).Treatment satisfaction was high,with a VAS score of 9.6±*** was observed in one patient after surgery and was treated with *** MEA is a safe and effective treatment for menorrhagia.

关键词： Menorrhagia Visual analog scale Dysmenorrhea Endometrial ablation techniques Microwaves Leiomyoma Adenomyosis

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LiNA OperaScope^(TM) for microwave endometrial ablation for endometrial polyps with heavy menstrual bleeding: A case report

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World Journal of Clinical Cases 2023年第36期11卷 8557-8562页

作者： kaoru Kakinuma Toshiyuki Kakinuma Kyouhei Ueyama Takumi Shinohara Rora Okamoto kaoru yanagida Nobuhiro Takeshima Michitaka Ohwada Department of Obstetrics and Gynecology International University of Health and Welfare HospitalTochigi 329-2763NasushiobaraJapan

BACKGROUND The procedure for microwave endometrial ablation(MEA)follows established MEA practice guidelines but requires hysteroscopic observation of the uterine lumen before and after *** a luminal uterine lesion is recognized,its removal requires preoperative dilation of the cervix because the outer diameter of a conventional rigid hysteroscope is 8.7 ***,a fully disposable rigid hysteroscope(LiNA OperaScope^(TM))with a narrow diameter(4.4 mm)and forceps capable of extracting endometrial lesions has become *** SUMMARY Here,we report a case of heavy menstrual bleeding(HMB)complicated by endometrial polyps where MEA was performed after removing endometrial polyps using the LiNA OperaScope^(TM) device.A 48-year-old woman with three prior pregnancies and three deliveries was referred to our hospital for further examination and treatment after being diagnosed with HMB 2 years *** patient underwent MEA following endometrial polypectomy using LiNA OperaScope^(TM).After MEA,endometrial cauterization was again examined using the LiNA OperaScope^(TM),and the procedure was *** preoperative cervical dilation was *** patient’s clinical course was favorable,and she was discharged 3 h after *** month after surgery,menstruation resumed,and both HMB and dysmenorrhea improved markedly from 10 preoperatively to 1 postoperatively,as assessed subjectively using the visual analog *** patient’s postoperative course was uneventful with no *** LiNA OperaScope^(TM) can be a minimally invasive treatment for MEA of HMB with uterine lumen lesions.

关键词： Heavy menstrual bleeding Microwave endometrial ablation Endometrial polyp Hysteroscopy Minimally invasive surgery Dysmenorrhea Case report

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Effectiveness of microwave endometrial ablation combined with hysteroscopic transcervical resection in treating submucous uterine myomas

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World Journal of Clinical Cases 2022年第36期10卷 13200-13207页

作者： Toshiyuki Kakinuma kaoru Kakinuma Ayano Shimizu Ayaka Kaneko Masataka Kagimoto Takafumi Okusa Eri Suizu Koyomi Saito Yoshio Matsuda kaoru yanagida Nobuhiro Takeshima Michitaka Ohwada Department of Obstetrics and Gynecology International University of Health and Welfare HospitalNasushiobara 329-2763Japan

BACKGROUND Hypermenorrhea is characterized by excessive menstrual bleeding that causes severe anemia and interferes with everyday *** condition can restrict women’s social activities and decrease their quality of *** endometrial ablation(MEA)using a 2.45-GHz energy source is a minimally invasive alternative to conventional hysterectomy for treating hypermenorrhea that is resistant to conservative treatment,triggered by systemic disease or medications,or caused by uterine myomas and *** popularity of MEA has increased *** MEA can safely and effectively treat submucous myomas,some patients may still experience recurrent hypermenorrhea postoperatively and may require additional *** To investigate the efficacy of MEA combined with transcervical resection(TCR).METHODS Participants underwent cervical and endometrial *** resonance imaging and hysteroscopy were performed to evaluate the size and location of the *** was performed before MEA using a *** was performed using transabdominal *** variables included operation time,number of ablation cycles,length of hospital stay,and visual analog scale cores for hypermenorrhea,dysmenorrhea,and treatment satisfaction at 3 and 6 mo *** postoperative incidence of amenorrhea,changes in hemoglobin concentrations,and MEA-related complications were *** A total of 34 women underwent a combination of MEA and TCR during the study *** patients were excluded from the study as their histopathological tests identified uterine malignancies(uterine sarcoma and endometrial cancer).The 32 eligible women(6 nulliparous,26 multiparous)had a mean age of 45.2±4.3 years(range:36–52 years).Patients reported very severe hypermenorrhea(10/10 points on the visual analog scale)before the ***,after the procedure,the hypermenorrhea scores decreased to 1.2±1.3 and 0.9±1.3 at 3 and 6 mo,respectively(P<0.001)

关键词： Dysmenorrhea Endometrial ablation techniques Menorrhagia Microwaves Myoma Uterus

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Diagnosed corrected transposition of great arteries after cesarean section:A case report

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World Journal of Clinical Cases 2022年第27期10卷 9821-9827页

作者： Naoki Ichii Toshiyuki Kakinuma Atsushi Fujikawa Morihiko Takeda Tomoyuki Ohta Masataka Kagimoto Ayaka Kaneko Ryo Izumi kaoru Kakinuma Koyomi Saito Asako Maeyama kaoru yanagida Nobuhiro Takeshima Michitaka Ohwada Department of Obstetrics and Gynecology International University of Health and Welfare HospitalTochigi 329-2763Japan Department of Cardiovascular Medicine International University of Health and Welfare HospitalTochigi 329-2763Japan Department of Radiology International University of Health and Welfare HospitalTochigi 329-2763Japan

BACKGROUND Corrected transposition of the great arteries(cTGA) is a cardiac malformation in which the ventricular and arterial-ventricular positions in the heart are doubly *** general,this defect puts a load on the systemic circulation and causes heart failure,resulting in a poor *** article reports a case of cTGA detected in a patient with post-caesarean pregnancy who had undergone elective caesarean section and was experiencing an episode of acute heart *** SUMMARY This was the case of a 36-year-old gravida 3 para 1 *** problems were noted in the puerperal course following the previous *** current pregnancy was also *** elective caesarean section was performed and the patient was discharged from the hospital 7 d after the *** postoperative day 18,the patient became aware of breathing difficulty and presented at a nearby clinic,where she was referred to our institution after bilateral pleural effusions were *** was then diagnosed with acute heart failure after noting the presence of a prominent pedal oedema and SpO_(2) 91%(supine position and room air);the patient was promptly hospitalised for close examination and *** chest computed tomography revealed the presence of cTGA,no other cardiac malformations were *** to improvements in both the pedal oedema and pleural effusions,the patient was discharged on day *** Close examination should be performed on the premise of congenital cardiac malformation when heart failure symptoms are noted during perinatal control.

关键词： Corrected transposition of the great arteries Pregnancy Puerperal period Tricuspid insufficiency Case report

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Uterine artery pseudoaneurysm caused by hysteroscopic surgery: A case report

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World Journal of Clinical Cases 2024年第26期12卷 5968-5973页

作者： kaoru Kakinuma Toshiyuki Kakinuma Kyouhei Ueyama Rora Okamoto kaoru yanagida Nobuhiro Takeshima Michitaka Ohwada Department of Obstetrics and Gynecology International University of Health and Welfare Hospital537-3 IguchiNasushiobaraTochigi 329-2763Japan

BACKGROUND We report a case of uterine artery pseudoaneurysm(UAP)occurrence during hysteroscopic endometrial polypectomy and its treatment via uterine artery embolization(UAE).CASE SUMMARY A 48-year-old primigravid,primiparous patient was incidentally found to have an endometrial polyp during a health checkup,and underwent a hysteroscopic polypectomy at another *** cervix was dilated with a Laminken-R®*** the Laminken-R®was withdrawn,a large amount of genital bleeding was *** bleeding persisted after the hysteroscopic polypectomy,and,as hemostasis became impossible,the patient was transferred to our hospital by *** arrival,transvaginal ultrasonography revealed a 3-cm hypoechoic mass with a swirling internal pulse on the right side of the uterus,and color Doppler ultrasonography showed feeder vessels penetrating the *** contrast-enhanced computed tomography(CT)confirmed the presence of a mass at this site,and vascular proliferation was observed within the uterine ***,UAP was diagnosed,and UAE was *** patient’s postoperative course was uneventful,and 6 mo post-UAE,no recurrence of blood flow to the UAP was *** When abnormal genital bleeding occurs during hysteroscopic surgery,ultrasonography and contrast-enhanced CT can assist in the detection of early UAPs.

关键词： Cervical dilation Hysteroscopic surgery Uterine artery pseudoaneurysm Uterine artery embolization Case report

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Managing Vogt–Koyanagi–Harada disease during pregnancy with steroid pulse therapy:A case report

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World Journal of Clinical Cases 2024年第31期12卷 6493-6499页

作者： Kyouhei Ueyama Toshiyuki Kakinuma Keisuke Mori Ayumi Hayashi kaoru Kakinuma Rora Okamoto Ayaka Kaneko kaoru yanagida Nobuhiro Takeshima Michitaka Ohwada Department of Obstetrics and Gynecology International University of Health and Welfare HospitalTochigi 329-2763NasushiobaraJapan Department of Ophthalmology International University of Health and Welfare HospitalTochigi 327-2763Japan

BACKGROUND High-dose steroid administration is a common initial therapeutic approach for Vogt–Koyanagi–Harada disease(VKH).Nonetheless,administering substantial doses of steroids to pregnant women necessitates meticulous consideration due to the potential impacts on the mother and *** present a case wherein steroid pulse therapy was administered to a patient who developed VKH during the late stages of *** SUMMARY The patient was a 26-year-old nulliparous *** 33 weeks and 1 day of her pregnancy,she experienced a decline in visual acuity and noticed metamorphopsia in her left *** revealed bilateral serous retinal detachment,leading to VKH diagnosis.A collaborative effort involving the departments of ophthalmology,internal medicine,and neonatology was *** pulse therapy was administered at 34 weeks and 1 day of pregnancy under hospital ***,such as threatened preterm labor and gestational diabetes,emerged,necessitating the initiation of oral ritodrine hydrochloride and insulin ***,serous retinal detachment was resolved,and visual acuity was *** pains initiated 32 days post-initiation of steroid pulse therapy(at 38 weeks and 4 days of gestation),culminating in a normal *** and newborn experienced an uneventful puerperal course and were discharged from the hospital on the 5th day following *** VKH management in pregnancy requires multidisciplinary coordination,emphasizing collaboration with ophthalmologists and specialists in internal medicine and neonatology.

关键词： Vogt-Koyanagi-Harada disease Gestational diabetes mellitus pregnancy Steroid pulse therapy Threatened preterm labor Case report

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