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Mabuchi S, Kamiura S, Saito T, Furukawa H, Abe A, Sasagawa T. FD-2, an Anticervical Stenosis Device for Patients Undergoing Radical Trachelectomy or Cervical Conization. Bioengineering (Basel) 2023; 10:1032. [PMID: 37760134 PMCID: PMC10525620 DOI: 10.3390/bioengineering10091032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Revised: 08/16/2023] [Accepted: 08/20/2023] [Indexed: 09/29/2023] Open
Abstract
This study aimed to introduce FD-2, a newly developed anticervical stenosis device for patients with cervical cancer undergoing radical trachelectomy. Using ethylene-vinyl acetate copolymers, we developed FD-2 to prevent uterine cervical stenosis after radical trachelectomy. The tensile test and extractables and leachables testing were performed to evaluate FD-2's safety as a medical device. FD-2 was indwelled in three patients with cervical cancer during radical trachelectomy and its utility was preliminarily evaluated. FD-2 consists of a head (fish-born-like structure), neck (connecting bridges), and body (tubular structure); the head is identical to FD-1, an intrauterine contraceptive device. FD-2 passed the tensile test and extractables and leachables testing. The average time required for the application or removal of FD-2 in cervical cancer patients was less than 10 s. The median duration of FD-2 indwelling was 8 weeks. No complications, including abdominal pain, pelvic infections, or hemorrhages, associated with FD-2 indwelling were reported. At the 3-12-month follow-up after the radical trachelectomy, no patients developed cervical stenosis or experienced dysmenorrhea. In conclusion, we developed FD-2, a novel device that can be used for preventing cervical stenosis after radical trachelectomy for uterine cervical cancer.
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Affiliation(s)
- Seiji Mabuchi
- Department of Gynecology, Osaka International Cancer Institute, 3-1-69, Otemae, Chuo-ku, Osaka-shi 541-8567, Japan;
| | - Shoji Kamiura
- Department of Gynecology, Osaka International Cancer Institute, 3-1-69, Otemae, Chuo-ku, Osaka-shi 541-8567, Japan;
| | - Takuya Saito
- Medical Technical Sec., Fuji Latex Co., Ltd., 1705 Chizuka-machi, Tochigi 328-0135, Japan; (T.S.); (H.F.)
| | - Hayato Furukawa
- Medical Technical Sec., Fuji Latex Co., Ltd., 1705 Chizuka-machi, Tochigi 328-0135, Japan; (T.S.); (H.F.)
| | - Azusa Abe
- Quality Control Sec., Fuji Latex Co., Ltd., 1705 Chizuka-machi, Tochigi 328-0135, Japan;
| | - Takashi Sasagawa
- Fuji Latex Co., Ltd., 3-19-1 Kanda Nishiki-cho, Chiyoda-ku, Tokyo 101-0054, Japan;
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Wu Y, Zhang J, Wang T, Lou K. Clinical efficacy of turtle shell decocted pills for endometriosis and their influence on cellular immunity. Am J Transl Res 2022; 14:1901-1908. [PMID: 35422950 PMCID: PMC8991112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Accepted: 02/20/2022] [Indexed: 06/14/2023]
Abstract
OBJECTIVE To explore the therapeutic efficacy of the levonorgestrel-releasing intrauterine system combined with turtle shell decocted pills for endometriosis and their effect on cellular immune function. METHODS Clinical data of 118 patients with endometriosis admitted to Taizhou First People's Hospital from January 2019 to January 2020 were retrospectively analyzed. The patients were assigned into a single-drug group (n=68) and a combined traditional Chinese medicine group (n=50) according to treatment methods. The single-drug group was treated with the levonorgestrel-releasing intrauterine system, and the combined traditional Chinese medicine group was treated with additional turtle shell decocted pills for three cycles for a total of 12 weeks. Enzyme-linked immunosorbent assay was adopted to measure the concentration of Th1 cytokines (tumor necrosis factor (TNF)-α and interferon (IFN)-γ) and Th2 cytokines (interleukin (IL)-6 and IL-10), and the protein level of programmed cell death 1 (PD-1) and programmed cell death ligand 1 (PD-L1). The levels of serum luteinizing hormone (LH), follicle stimulating hormone (FSH), and estradiol (E2) were compared between the two groups. The response rate of treatment, the control rate of blood pressure and the incidence of adverse reactions were recorded in both groups. RESULTS The response rate of treatment in the combined traditional Chinese medicine group was higher than that in the single-drug group (P<0.05). Compared to before treatment, the TNF-α and IFN-γ increased in both groups after treatment, and the expressions were higher in the combined traditional Chinese medicine group than in the single-drug group (all P<0.05). After treatment, the levels of IL-6, IL-10, PD-1, and PD-L1 decreased, and the decreases in the combined traditional Chinese medicine group were greater than those in the single-drug group (all P<0.05). Serum LH, FSH and E2 levels before and after the treatment in the two groups were not statistically different (all P>0.05). The incidence of treatment-related adverse reactions between the two groups of patients was also not statistically different (P>0.05). CONCLUSION Turtle shell decocted pills can increase the clinical efficacy of levonorgestrel-releasing intrauterine system in the treatment of endometriosis, reduce levels of PD-1, and PD-L1 and improve cellular immune function. The pills do not affect the secretion of ovarian hormones or increase adverse reactions.
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Affiliation(s)
- Yunfang Wu
- Department of Gynecology, Shandong Provincial Hospital, Shandong UniversityJinan 250021, Shandong Province, China
- Department of Gynecology, Zibo Hospital of Traditional Chinese MedicineZibo 255200, Shandong Province, China
| | - Jichen Zhang
- Department of Cardiothoracic Surgery, Taizhou First People’s HospitalTaizhou 318020, Zhejiang Province, China
| | - Ting Wang
- Department of Clinical Laboratory, Zibo Hospital of Traditional Chinese MedicineZibo 255200, Shandong Province, China
| | - Kai Lou
- Department of Emergency, Taizhou First People’s HospitalTaizhou 318020, Zhejiang Province, China
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Ross S, Ragupathy K. Role of an IUCD in managing patients with post-LLETZ cervical stenosis. BMJ Case Rep 2022; 15:e246118. [PMID: 35232733 PMCID: PMC8889152 DOI: 10.1136/bcr-2021-246118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/27/2022] [Indexed: 11/03/2022] Open
Abstract
Large loop excision of the transformation zone (LLETZ) is one of the fertility sparing treatments for people with high-grade cervical intraepithelial neoplasia, however, this procedure is known to increase the risk of postoperative cervical stenosis by 1.3%-5.2%. We present a case demonstrating the successful use of a copper intrauterine contraceptive device to manage a patient with cervical stenosis secondary to three LLETZ procedures for severe dyskaryosis.
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Affiliation(s)
| | - Kalpana Ragupathy
- Gynaecology, University of Dundee College of Medicine Dentistry and Nursing and Ninewells Hospital, Dundee, UK
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Pires R, Neves AR, Geraldes F, Águas F. Innovating the conservative management of isolated cervical aplasia. BMJ Case Rep 2021; 14:e242475. [PMID: 34706907 PMCID: PMC8552162 DOI: 10.1136/bcr-2021-242475] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/02/2021] [Indexed: 11/03/2022] Open
Abstract
Isolated cervical aplasia (ESHRE/ESGE U0C4V0) is a rare condition with an incidence of approximately 1:100,000 births.This congenital malformation of the female genital tract represents an impairment of the outflow tract and is an inevitable cause of infertility. Patients usually present with pelvic pain or haematometra and surgical treatment is needed. Conservative management is the first line of approach, allowing for future fertility. However, complications are not negligible. Choosing the best surgical technique remains controversial as few follow-up studies have been published.We describe a case report of isolated cervical aplasia diagnosed in a 16-year-old patient, managed by a canalisation procedure using a Foley catheter. Following failure of this approach, a levonorgestrel intrauterine system was inserted, which remained efficient after 4 years.This case adds to the few reports of success in the management of this challenging clinical entity and might guide clinicians to avoid non-conservative approaches in young patients.
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Affiliation(s)
- Rafaela Pires
- Department of Gynaecology, Coimbra Hospital and University Centre, Coimbra, Portugal
| | - Ana Raquel Neves
- Department of Reproductive Medicine, Dexeus University Hospital, Barcelona, Catalunya, Spain
- Faculty of Medicine, Autonomous University of Barcelona, Barcelona, Spain
| | - Fernanda Geraldes
- Department of Gynaecology, Coimbra Hospital and University Centre, Coimbra, Portugal
| | - Fernanda Águas
- Department of Gynaecology, Coimbra Hospital and University Centre, Coimbra, Portugal
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Hashiguchi M, Takezawa T, Nagase K, Tayama-Abe M, Matsuhisa F, Kitajima S, Morito S, Yamaji K, Futamata M, Sakata Y, Akutagawa T, Yokoyama M, Toda S, Aoki S. Collagen Vitrigel Membrane-Coated Nylon Line Prevents Stenosis After Conization of the Cervix Uteri. Tissue Eng Part A 2021; 27:1480-1489. [PMID: 33813837 DOI: 10.1089/ten.tea.2020.0374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Cervical stenosis is a postoperative complication of conization for uterine cervical malignancy, but a standard method of preventing this complication has yet to be established. Collagen vitrigel is a collagen-based biomaterial that has antifibrotic and epithelization promoting actions. We evaluated the antistenotic effect of an indwelling collagen vitrigel membrane-coated nylon line (CVNL) after cervical conization in rabbits. In one group of rabbits, a CVNL was placed in the cervical canal after conization. In another group, a nylon line without a collagen coating was placed in the cervical canal after conization. The control group underwent cervical conization without placement of a device. The control (conization alone) and nylon (conization plus indwelling nylon line) groups exhibited cervical swelling. Rabbits in the CVNL group (cervical conization plus indwelling CVNL in the xerogel state) had a normal cervical surface. The cervical canal in the control group was enlarged and showed cystic changes attributed to cervical stenosis. The nylon group exhibited a trend toward cervical canal dilatation. In the CVNL group, the cervical canal was normal and did not show cystic dilatation. Fibrosis occurred to a lesser degree in the nylon group than in the control group, and the CVNL group exhibited minimal interstitial fibrosis. The control and nylon groups showed increased numbers of myofibroblasts in the regenerated cervix, but few myofibroblasts were observed in the CVNL group. Abundant collagen type III was observed in regenerated cervical tissue in the control and nylon groups but not in the CVNL group. The number of proliferative mesenchymal cells in the regenerated cervix was lowest in the CVNL group. The expressions of connective tissue growth factor (CTGF, a regulator of fibroblast growth and extracellular matrix secretion), extracellular signal-regulated protein kinases 1 and 2, and c-Jun N-terminal kinase (which are involved in the induction of CTGF by transforming growth factor-β) were lower in the CVNL group than in the control or nylon groups. This study describes an indwelling CVNL that prevents cervical stenosis and cystic changes after conization. These effects were likely mediated by inhibition of fibrosis, myofibroblast emergence, CTGF expression, and collagen type III deposition in regenerating cervix. Impact statement Collagen vitrigel is a high-density collagen material that promotes epithelization, inhibits fibrosis, and suppresses inflammation in regenerating tissue. We evaluated whether a collagen vitrigel membrane-coated nylon line would prevent cervical stenosis after conization in the rabbit. We found that an indwelling collagen vitrigel membrane-coated nylon line prevented cervical canal stenosis and cystic changes after cervical conization by inhibiting fibrosis, myofibroblast emergence, connective tissue growth factor expression, and collagen type III deposition in the regenerating cervix. Our device has potential as a new method of preventing cervical canal fibrosis and stenosis after conization for cervical cancer.
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Affiliation(s)
- Mariko Hashiguchi
- Department of Obstetrics and Gynecology, Faculty of Medicine, Saga University, Saga, Japan
| | - Toshiaki Takezawa
- Vitrigel Project Research Team, Institute of Agrobiological Sciences, National Agriculture and Food Research Organization, Tsukuba, Japan
| | - Kei Nagase
- Department of Pathology and Microbiology, Faculty of Medicine, Saga University, Saga, Japan
| | - Mizuki Tayama-Abe
- Vitrigel Project Research Team, Institute of Agrobiological Sciences, National Agriculture and Food Research Organization, Tsukuba, Japan
| | - Fumikazu Matsuhisa
- Biological Resources and Development, Analytical Research Center for Experimental Sciences, Saga University, Saga, Japan
| | - Shuji Kitajima
- Biological Resources and Development, Analytical Research Center for Experimental Sciences, Saga University, Saga, Japan
| | - Sayuri Morito
- Department of Pathology and Microbiology, Faculty of Medicine, Saga University, Saga, Japan
| | - Kotaro Yamaji
- Department of Pathology and Microbiology, Faculty of Medicine, Saga University, Saga, Japan
| | - Maki Futamata
- Department of Pathology and Microbiology, Faculty of Medicine, Saga University, Saga, Japan
| | - Yasuhisa Sakata
- Department of Internal Medicine and Gastrointestinal Endoscopy, Faculty of Medicine, Saga University, Saga, Japan
| | - Takashi Akutagawa
- Department of Pathology and Microbiology, Faculty of Medicine, Saga University, Saga, Japan.,Department of Internal Medicine and Gastrointestinal Endoscopy, Faculty of Medicine, Saga University, Saga, Japan
| | - Masatoshi Yokoyama
- Department of Obstetrics and Gynecology, Faculty of Medicine, Saga University, Saga, Japan
| | - Shuji Toda
- Department of Pathology and Microbiology, Faculty of Medicine, Saga University, Saga, Japan.,Department of Pathology, Takagi Hospital, Okawa, Japan
| | - Shigehisa Aoki
- Department of Pathology and Microbiology, Faculty of Medicine, Saga University, Saga, Japan
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Park JY, Lee YH, Chong GO, Hong DG. A uterine cervix supporting device (Con-CapTM) for reducing canal stenosis after Loop Electrosurgical Excisional Procedure. Technol Health Care 2021; 29:955-962. [PMID: 33843706 DOI: 10.3233/thc-202639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACGROUND Cervical stenoses are one of the main long-term consequences after conization of the uterine cervix. OBJECTIVE The purpose of this study was to evaluate the safety and efficacy of a uterine cervix supporting device (Con-CapTM) in reducing uterine cervical stenosis after Loop Electrosurgical Excisional Procedure (LEEP). METHODS We enrolled 112 patients who underwent LEEP between March 2017 to May 2019. Con-CapTM was inserted into the uterine endocervical canal for 4 weeks after LEEP. Laboratory values and clinical symptoms were evaluated. The presence of uterine cervical narrowing was determined at 2 weeks after removal of the Con-CapTM. Data were analyzed using the two-sample t test and χ2 test. RESULTS A total of 78 women completed the 6-week study period. Thirty-four patients did not complete the study period. The diameter of the uterine cervical canal was significantly greater at postoperative 6 weeks than preoperatively (Hegar dilator No, 2.10 ± 0.56 vs. 3.21 ± 0.71, P< 0.01). The complications were acceptable. CONCLUSIONS Con-CapTM can be used to reduce uterine cervical stenosis safely and effectively after conization of uterine cervix.
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Affiliation(s)
- Ji Young Park
- Department of Pathology, Kyungpook National University Chilgok Hospital, Daegu, Korea
| | - Yoon Hee Lee
- Department of Obstetrics and Gynecology, Kyungpook National University Chilgok Hospital, Daegu, Korea
| | - Gun Oh Chong
- Department of Obstetrics and Gynecology, Kyungpook National University Chilgok Hospital, Daegu, Korea
| | - Dae Gy Hong
- Department of Obstetrics and Gynecology, Kyungpook National University Chilgok Hospital, Daegu, Korea
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Vieira MDA, de Araújo RLC, da Cunha Andrade CEM, Schmidt RL, Filho AL, dos Reis R. A randomized clinical trial of a new anti-cervical stenosis device after conization by loop electrosurgical excision. PLoS One 2021; 16:e0242067. [PMID: 33471788 PMCID: PMC7816995 DOI: 10.1371/journal.pone.0242067] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Accepted: 10/26/2020] [Indexed: 11/25/2022] Open
Abstract
Background The complications inherent to conization include vaginal bleeding, cervical stenosis, amenorrhea, dysmenorrhea, and deep dyspareunia. Cervical stenosis is the most important complication due to the clinical repercussions. Studies show rates of cervical stenosis ranging from 1.3 to 19% after the Loop Electrosurgical Excision Procedure (LEEP). Objective Our primary outcome was to compare the role of a new endocervical device to prevent cervical stenosis after LEEP in patients with high-grade squamous intraepithelial lesions (HSILs). Methods A randomized clinical trial was performed including phases II and III for evaluation of a new device for cervical stenosis prevention. In Phase II, we included 25 patients who underwent LEEP and placement of the device to assess its toxicity and efficacy. In phase III, we compared two groups (with and without the use of an anti-stenosis device) to evaluate its efficacy and safety. Results From August 2015 to June 2018, 265 participants were randomized (Phase II: 25, Phase III: 120 with DUDA and 120 without DUDA). The toxicity during phase II was observed in only one patient (4%) with pain grade > 7. There were 7 cases of toxicity during Phase III, 2 in the DUDA group (1.8%), and 5 in the No DUDA group (4.5%). The complications rate was numerically higher in the No DUDA group (2.5x higher) than the DUDA group, but this difference did not reach statistical significance (p = 0.52). The rate of cervical stenosis in DUDA group was (4–7,3%), and in No DUDA group was (4.3–5.8%) (p = 0.5). We did not find a significant difference when comparing the evolution at 3, 6, and 12 months in terms of cervical patency and visualization of the squamocolumnar junction (SCJ) during colposcopy. The DUDA group exhibited 15% to 19% nonvisualization of the SCJ, whereas that rate ranged from 10 to 12% in the No DUDA group. Conclusions The rate of cervical stenosis was not different comparing the use of a new device, specifically produced to prevent cervical stenosis, compared to no use after LEEP procedure. This clinical trial opens up space for a discussion of the utility of using cervical stenosis devices after LEEP. Perhaps in another type of conization it can be evaluated to avoid cervical stenosis.
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Affiliation(s)
| | | | | | - Ronaldo Luis Schmidt
- Department of Gynecologic Oncology, Barretos Cancer Hospital, Barretos, São Paulo, Brazil
| | - Agnaldo Lopes Filho
- Department of Obstetrics and Gynecology, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, Minas Gerais, Brazil
| | - Ricardo dos Reis
- Department of Gynecologic Oncology, Barretos Cancer Hospital, Barretos, São Paulo, Brazil
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Chen M, Cai H, Chen S, Wu X, Ma X, Liu M, Chen L. Comparative analysis of transcervical resection and loop electrosurgical excision in the treatment of high-grade cervical intraepithelial neoplasia. Int J Gynaecol Obstet 2018; 143:306-312. [PMID: 30129038 DOI: 10.1002/ijgo.12655] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2017] [Revised: 06/16/2018] [Accepted: 08/17/2018] [Indexed: 11/05/2022]
Abstract
OBJECTIVE To compare the efficacy of transcervical resection of the cervix (TCRC) and loop electrosurgical excision procedure (LEEP) in the treatment of high-grade cervical squamous intraepithelial lesions (HSIL). METHODS A retrospective case record review was conducted of patients with HSIL treated with TCRC or LEEP at Guangdong General Hospital, Guangdong Academy of Medical Sciences and Zhujiang Hospital, Guangzhou, China, from 2009 to 2015. The clinical characteristics, cone margin statuses, clinical outcomes, and adverse events were compared between the two groups. RESULTS Among 647 included patients, 292 (45.1%) were treated with TCRC and 355 (54.9%) with LEEP. The incidences of positive margins, persistent and recurrent lesions, and intraoperative bleeding were lower in the TCRC group than in the LEEP group (P<0.001 for all comparisons). The rates of cervical adhesions were comparable between the two groups. During TCRC, 78 (26.7%) intrauterine lesions were diagnosed; most of these had been missed by transvaginal sonography. CONCLUSION TCRC may be an alternative method to LEEP in the treatment of HSIL. Compared with LEEP, TCRC has comparable clinical efficacy without additional adverse events. Moreover, TCRC is useful for detecting and/or removing intrauterine lesions during surgery.
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Affiliation(s)
- Meizhuang Chen
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, China.,Department of Obstetrics and Gynecology, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Huihua Cai
- Department of Obstetrics and Gynecology, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Songqiang Chen
- Department of Obstetrics and Gynecology, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Xinyi Wu
- Department of Obstetrics and Gynecology, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Xiao Ma
- Department of Obstetrics and Gynecology, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Mubiao Liu
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, China.,Department of Obstetrics and Gynecology, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Le Chen
- Department of Obstetrics and Gynecology, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
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Rezai S. Hematometra and Hematocolpos, Secondary to Cervical Canal Occlusion, a Case Report and Review of Literature. ACTA ACUST UNITED AC 2017. [DOI: 10.15406/ogij.2017.06.00208] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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