{"title":"你的诊断是什么?","authors":"Kavita Khoiwal, Poonam Gill, Latika Chawla, Shruti Agrawal, Jaya Chaturvedi","doi":"10.4274/jtgga.galenos.2022.2022-2-3","DOIUrl":null,"url":null,"abstract":"A 39 year-old woman, P2L2, presented to the emergency department with vaginal bleeding. She was diagnosed as having a molar pregnancy one and half months previously, for which surgical evacuation was performed at a private clinic. Beta-human chorionic gonadotropin ( β -hCG) level before evacuation was 40,738 mIU/mL and follow-up values followed a declining trend from 3,820 mIU/mL 48 hours after evacuation, to 1,342 mIU/mL after one week. Histopathological examination (HPE) ruled out any possibility of malignancy. During follow-up, she had an episode of severe vaginal bleeding on the fifteenth day after evacuation. Magnetic resonance imaging of the pelvis suggested uterine arteriovenous (A-V) malformation with the possibility of residual gestational trophoblastic disease (GTD), in view of medical history and raised β -hCG (1,083 mIU/mL) (Figure1a-c). She received a blood transfusion and single-agent chemotherapy (methotrexate) at her primary centre, however, her β -hCG values continued to fall. After one month, she had another episode of severe vaginal bleeding and was referred to our centre. Here, her vitals were stable and systemic examination showed no abnormality. Gynecological examination revealed normal vulva, vagina, cervix, and soft and enlarged uterus of 14 weeks size. β -hCG was 23.55 mIU/mL. Transvaginal sonography showed thin endometrium and a cystic lesion in the uterine fundus invading the anterior myometrium, which was hyper-vascular on colour Doppler, suggestive of A-V malformation (Figure 2a,b). Therefore, bilateral uterine artery embolization (UAE) was performed. The patient was then discharged in a stable condition. After one week of UAE, she again presented with severe vaginal bleeding. She had pallor, pulse rate of 110/","PeriodicalId":1,"journal":{"name":"Accounts of Chemical Research","volume":null,"pages":null},"PeriodicalIF":16.4000,"publicationDate":"2023-03-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/a5/dd/JTGGA-24-76.PMC10019005.pdf","citationCount":"0","resultStr":"{\"title\":\"What is your diagnosis?\",\"authors\":\"Kavita Khoiwal, Poonam Gill, Latika Chawla, Shruti Agrawal, Jaya Chaturvedi\",\"doi\":\"10.4274/jtgga.galenos.2022.2022-2-3\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"A 39 year-old woman, P2L2, presented to the emergency department with vaginal bleeding. She was diagnosed as having a molar pregnancy one and half months previously, for which surgical evacuation was performed at a private clinic. Beta-human chorionic gonadotropin ( β -hCG) level before evacuation was 40,738 mIU/mL and follow-up values followed a declining trend from 3,820 mIU/mL 48 hours after evacuation, to 1,342 mIU/mL after one week. Histopathological examination (HPE) ruled out any possibility of malignancy. During follow-up, she had an episode of severe vaginal bleeding on the fifteenth day after evacuation. Magnetic resonance imaging of the pelvis suggested uterine arteriovenous (A-V) malformation with the possibility of residual gestational trophoblastic disease (GTD), in view of medical history and raised β -hCG (1,083 mIU/mL) (Figure1a-c). She received a blood transfusion and single-agent chemotherapy (methotrexate) at her primary centre, however, her β -hCG values continued to fall. After one month, she had another episode of severe vaginal bleeding and was referred to our centre. Here, her vitals were stable and systemic examination showed no abnormality. Gynecological examination revealed normal vulva, vagina, cervix, and soft and enlarged uterus of 14 weeks size. β -hCG was 23.55 mIU/mL. Transvaginal sonography showed thin endometrium and a cystic lesion in the uterine fundus invading the anterior myometrium, which was hyper-vascular on colour Doppler, suggestive of A-V malformation (Figure 2a,b). Therefore, bilateral uterine artery embolization (UAE) was performed. The patient was then discharged in a stable condition. After one week of UAE, she again presented with severe vaginal bleeding. She had pallor, pulse rate of 110/\",\"PeriodicalId\":1,\"journal\":{\"name\":\"Accounts of Chemical Research\",\"volume\":null,\"pages\":null},\"PeriodicalIF\":16.4000,\"publicationDate\":\"2023-03-15\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/a5/dd/JTGGA-24-76.PMC10019005.pdf\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Accounts of Chemical Research\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://doi.org/10.4274/jtgga.galenos.2022.2022-2-3\",\"RegionNum\":1,\"RegionCategory\":\"化学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q1\",\"JCRName\":\"CHEMISTRY, MULTIDISCIPLINARY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Accounts of Chemical Research","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.4274/jtgga.galenos.2022.2022-2-3","RegionNum":1,"RegionCategory":"化学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"CHEMISTRY, MULTIDISCIPLINARY","Score":null,"Total":0}
A 39 year-old woman, P2L2, presented to the emergency department with vaginal bleeding. She was diagnosed as having a molar pregnancy one and half months previously, for which surgical evacuation was performed at a private clinic. Beta-human chorionic gonadotropin ( β -hCG) level before evacuation was 40,738 mIU/mL and follow-up values followed a declining trend from 3,820 mIU/mL 48 hours after evacuation, to 1,342 mIU/mL after one week. Histopathological examination (HPE) ruled out any possibility of malignancy. During follow-up, she had an episode of severe vaginal bleeding on the fifteenth day after evacuation. Magnetic resonance imaging of the pelvis suggested uterine arteriovenous (A-V) malformation with the possibility of residual gestational trophoblastic disease (GTD), in view of medical history and raised β -hCG (1,083 mIU/mL) (Figure1a-c). She received a blood transfusion and single-agent chemotherapy (methotrexate) at her primary centre, however, her β -hCG values continued to fall. After one month, she had another episode of severe vaginal bleeding and was referred to our centre. Here, her vitals were stable and systemic examination showed no abnormality. Gynecological examination revealed normal vulva, vagina, cervix, and soft and enlarged uterus of 14 weeks size. β -hCG was 23.55 mIU/mL. Transvaginal sonography showed thin endometrium and a cystic lesion in the uterine fundus invading the anterior myometrium, which was hyper-vascular on colour Doppler, suggestive of A-V malformation (Figure 2a,b). Therefore, bilateral uterine artery embolization (UAE) was performed. The patient was then discharged in a stable condition. After one week of UAE, she again presented with severe vaginal bleeding. She had pallor, pulse rate of 110/
期刊介绍:
Accounts of Chemical Research presents short, concise and critical articles offering easy-to-read overviews of basic research and applications in all areas of chemistry and biochemistry. These short reviews focus on research from the author’s own laboratory and are designed to teach the reader about a research project. In addition, Accounts of Chemical Research publishes commentaries that give an informed opinion on a current research problem. Special Issues online are devoted to a single topic of unusual activity and significance.
Accounts of Chemical Research replaces the traditional article abstract with an article "Conspectus." These entries synopsize the research affording the reader a closer look at the content and significance of an article. Through this provision of a more detailed description of the article contents, the Conspectus enhances the article's discoverability by search engines and the exposure for the research.