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Clinically and through auxiliary examinations, distinguishing uterine leiomyoma from early-stage uterine sarcoma presents significant challenges. A 48-year-old patient underwent a laparoscopic hysterectomy for uterine leiomyoma, during which a large uterus was excised through the vagina and extracted. Four months post-operation, the patient developed abdominal distension, indicative of extensive pelvic-abdominal dissemination of uterine sarcoma. We hypothesize that unprotected fibroid fragmentation increases the risk of uterine sarcoma spread, thereby worsening the prognosis. Our literature review aims to thoroughly understand the risks associated with unprotected transvaginal laparoscopic tumor division.

BackgroundPrevious studies have found that exposure to heavy metals increased the incidence of congenital heart defects (CHDs). However, there is a paucity of information about the connection between exposure to titanium and CHDs. This study sought to examine the relationship between prenatal titanium exposure and the risk of CHDs in offspring.MethodsWe looked back on a birth cohort study that was carried out in our hospital between 2010 and 2012. The associations between titanium exposure and the risk of CHDs were analyzed by using logistic regression analysis to investigate titanium concentrations in maternal whole blood and fetal umbilical cord blood.ResultsA total of 97 case groups and 194 control groups were included for a nested case-control study. The [P50 (P25, P75)] of titanium were 371.91 (188.85, 659.15) μg/L and 370.43 (264.86, 459.76) μg/L in serum titanium levels in pregnant women and in umbilical cord serum titanium content in the CHDs group, respectively. There was a moderate positive correlation between the concentration of titanium in pregnant women's blood and that in umbilical cord blood. A higher concentrations of maternal blood titanium level was associated with a greater risk of CHDs (OR 2.706, 95% CI 1.547–4.734), the multiple CHDs (OR 2.382, 95% CI 1.219–4.655), atrial septal defects (OR 2.367, 95% CI 1.215–4.609), and patent ductus arteriosus (OR 2.412, 95% CI 1.336–4.357). Dramatically higher concentrations of umbilical cord blood levels had an increased risk of CHDs and different heart defects.ConclusionTitanium can cross the placental barrier and the occurrence of CHDs may be related to titanium exposure.