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Sample records for abdominal ectopic pregnancy

  1. Ectopic Pregnancy

    MedlinePLUS

    ... is used to remove the ectopic pregnancy. Careful Observation In some cases, a very early ectopic pregnancy ... I have complications? Even with appropriate treatment and observation, an ectopic pregnancy might cause life-threatening internal ...

  2. Ectopic Pregnancy

    MedlinePLUS

    ... spotting dizziness or fainting (caused by blood loss) low blood pressure (also caused by blood loss) lower back pain continue What Causes an Ectopic Pregnancy? An ectopic pregnancy usually happens because a fertilized ...

  3. Ectopic Pregnancy

    MedlinePLUS

    ... woman is pregnant. If you have an ectopic pregnancy, the fertilized egg grows in the wrong place, ... tubes. The result is usually a miscarriage. Ectopic pregnancy can be a medical emergency if it ruptures. ...

  4. Ectopic pregnancy

    MedlinePLUS

    Tubal pregnancy; Cervical pregnancy; Tubal ligation-ectopic pregnancy ... In most pregnancies, the fertilized egg travels through the fallopian tube to the womb (uterus). If the movement of the egg ...

  5. Ectopic Pregnancy

    MedlinePLUS

    ... removed using methotrexate or more surgery. What About Future Pregnancies? Many women who have had an ectopic ... go on to have normal pregnancies in the future, but some will have difficulty becoming pregnant again. ...

  6. Abdominal Compartment Syndrome complicating massive hemorrhage from an unusual presentation of ruptured ectopic pregnancy.

    PubMed

    Sanda, Robert B; Aziz, Rafeeqa; Bhutto, Abdulrazaque; Seliem, Salah I

    2011-01-01

    Abdominal Compartment Syndrome (ACS) is characterized by intra-abdominal hypertension (IAH), elevation and splinting of the diaphragm, high pleural pressure, and poor venous return to the heart, producing low cardiac output and shock which, in turn, results in poor venous return across the capillaries to set in a vicious cycle. Unless the Intra-abdominal pressure is reduced quickly by urgent surgical or medical interventions, death is inevitable. We report a case of ACS resulting from an unrecognized slow but massive intra-abdominal bleeding caused by a ruptured ectopic pregnancy (REP) in an Arab woman. Due to the unusual nature of the presentation of the REP, the diagnosis proved elusive for over a week until the patient succumbed to hypovolemic shock after losing about 4.2 l inside the peritoneal space. The fruitless effort at aggressive fluid resuscitation was at operation found not due to hypovolemia per se but due to IAH causing ACS. The lessons learned from this case emphasize the need for awareness about atypical presentations of REP and the need for quick intervention to terminate the vicious cycle of ACS. PMID:21912014

  7. [Abdominal pregnancy, institutional experience].

    PubMed

    Bonfante Ramírez, E; Bolaños Ancona, R; Simón Pereyra, L; Juárez García, L; García-Benitez, C Q

    1998-07-01

    Abdominal pregnancy is a rare entity, which has been classified as primary or secondary by Studiford criteria. A retrospective study, between January 1989 and December 1994, realized at Instituto Nacional de Perinatología, found 35,080 pregnancies, from which 149 happened to be ectopic, and 6 of them were abdominal. All patients belonged to a low income society class, age between 24 and 35 years, and average of gestations in 2.6. Gestational age varied from 15 weeks to 32.2 weeks having only one delivery at term with satisfactory postnatal evolution. One patient had a recurrent abdominal pregnancy, with genital Tb as a conditional factor. Time of hospitalization varied from 4 to 5 days, and no further patient complications were reported. Fetal loss was estimated in 83.4%. Abdominal pregnancy is often the sequence of a tubarian ectopic pregnancy an when present, it has a very high maternal mortality reported in world literature, not found in this study. The stated frequency of abdominal pregnancy is from 1 of each 3372, up to 1 in every 10,200 deliveries, reporting in the study 1 abdominal pregnancy in 5846 deliveries. The study had two characteristic entities one, the recurrence and two, the delivery at term of one newborn. Abdominal pregnancy accounts for 4% of all ectopic pregnancies. Clinical findings in abdominal pregnancies are pain, transvaginal bleeding and amenorrea, being the cardinal signs of ectopic pregnancy. PMID:9737070

  8. Ectopic Pregnancy

    MedlinePLUS

    ... Perform a pelvic exam. Check your blood pressure (low blood pressure may mean internal bleeding) and pulse. Perform an ultrasound exam (a test in which sound waves are used to create an image) to see if there are early signs of a pregnancy. Test your blood to detect the hormone human ...

  9. Cervical ectopic pregnancy

    PubMed Central

    Samal, Sunil Kumar; Rathod, Setu

    2015-01-01

    Cervical pregnancy is a rare type of ectopic pregnancy and it represents <1% of all ectopic pregnancies. Early diagnosis and medical management with systemic or local administration of methotrexate is the treatment of choice. If the pregnancy is disturbed, it may lead to massive hemorrhage, which may require hysterectomy to save the patient. We report three cases of cervical pregnancy managed successfully with different approaches of management. Our first case, 28 years old G3P2L2 with previous two lower segment cesarean sections, presented with bleeding per vaginum following 6 weeks of amenorrhea. Clinical examination followed by transvaginal ultrasound confirmed the diagnosis of cervical pregnancy. Total abdominal hysterectomy was done in view of intractable bleeding to save the patient. The second case, a 26-year-old second gravida with previous normal vaginal delivery presented with pain abdomen and single episode of spotting per vaginum following 7 weeks of amenorrhea. Transvaginal ultrasound revealed empty endometrial cavity, closed internal os with gestational sac containing live fetus of 7 weeks gestational age in cervical canal and she was treated with intra-amniotic potassium chloride followed by systemic methotrexate. Follow up with serum beta human chorionic gonadotropin level revealed successful outcome. Our third case, a 27-year-old primigravida with history of infertility treatment admitted with complaints of bleeding per vaginum for 1 day following 8 weeks amenorrhea. She was diagnosed as cervical pregnancy by clinical examination, confirmed by transvaginal ultrasonography and subsequently managed by dilation and curettage with intracervical Foleys ballon tamponade. PMID:25810679

  10. Abdominal pregnancy - Case presentation

    PubMed Central

    Bohiltea, R; Radoi, V; Tufan, C; Horhoianu, IA; Bohiltea, C

    2015-01-01

    Introduction. Abdominal pregnancy, a rare diagnosis, belongs to the ectopic pregnancy group, the leading cause of pregnancy related exitus. The positive diagnosis is very difficult to establish most often in an acute setting, leading to a staggering percent of feto-maternal morbidity and mortality. Case report. We present the case of 26-weeks-old abdominal pregnancy with partial feto-placental detachment in a patient, after hysteroscopy and in vitro fertilization, which until the acute symptoms that led to emergency laparotomy went unrecognized. The patient recovered completely and satisfactorily after surgery and, due to the high risk of uterine rupture with regard to a second pregnancy, opted for a surrogate mother. Conclusion. Abdominal pregnancy can be regarded as a difficult to establish diagnosis, with a greater chance in case of increased awareness. It is compulsory to be well informed in order not to be surprised by the diagnosis and to apply the correct treatment immediately as the morbidity and mortality rate is elevated. PMID:25914739

  11. [Update on Current Care Guidelines: Ectopic pregnancy].

    PubMed

    Mkinen, Juha; Tyli, Mira; Niemimaa, Marko; Kulju, Pekka; Sokka, Tarja; Vuorela, Piia

    2015-01-01

    Ectopic pregnancy should be suspected it a woman of fertile age has lower abdominal pain and irregular vaginal bleeding. Symptoms range from almost none to shock. The diagnosis is based on a quantitative serum pregnancy test (hCG) and transvaginal ultrasound. An acute situation requires emergency surgery, whereas patients with mild symptoms should be treated policlinically by follow-up or a single intramuscular dose (1 mg/kg) of methotrexate. No folic acid supplementation is needed. In later pregnancies their location should be verified by transvaginal ultrasound done by the seventh gestational week at the latest. PMID:26245062

  12. Ectopic pregnancy in previous Caesarean section scar.

    PubMed

    Hong, S C; Lau, M S K; Yam, P K L

    2011-06-01

    We report two cases of Caesarean scar pregnancies that were managed surgically. The first case was a 33-year-old woman who presented at 21 weeks of gestation with lower abdominal pain. An exploratory laparotomy was performed as she was hypotensive and had a drastic drop in haemoglobin level. Intraoperatively, a ruptured scar ectopic pregnancy with placenta percreta was found. A hysterectomy was performed in view of uncontrolled haemorrhage. The second case was a 30-year-old woman who presented with irregular per vaginal spotting without abdominal pain. Ultrasonography revealed a gestational sac at a previous Caesarean scar, with interval increase in size and development of a yolk sac. On laparoscopy, the diagnosis of scar pregnancy was confirmed, and the gestational sac and surrounding myometrium were excised. Our case report shows that early diagnosis of scar pregnancy is important, as timely intervention can prevent life-threatening complications and preserve fertility. PMID:21731980

  13. A fifteen year experience with ectopic pregnancy.

    PubMed

    Tancer, M L; Delke, I; Veridiano, N P

    1981-02-01

    The increasing importance of an ectopic pregnancy as a cause of maternal death presents a challenge that will be met when primary care physicians combine a high index of suspicion with the ability to recognize the patient most at risk. The major symptoms, abdominal pain, secondary amenorrhea and abnormal vaginal bleeding are well known, as are the major signs, abdominal tenderness, adnexal mass and tenderness on motion of the cervix. Less well known are factors in the clinical history which indicate the patient to be at high risk. These include primary or secondary infertility, previous abortion or ectopic pregnancy and previous tubal operation, either reconstructive or sterilizing. In addition, the use of an intrauterine contraceptive device or its recent removal because of abdominal pain or bleeding, or both, is highly significant. Of major importance is a history of recent uterine evacuation. Should the diagnosis of ectopic pregnancy be under consideration, procrastination by observation is no longer acceptable. An active effort must be made to confirm or deny the diagnosis, Culdocentesis should be performed in the emergency department or clinic. If positive, prompt laparotomy is indicated. Should the result of culdocentesis be unsatisfactory or negative, laparotomy should be undertaken with further delay. PMID:6451944

  14. Laparoscopic Treatment of Cesarean Scar Ectopic Pregnancy

    PubMed Central

    Felsingerov, Zuzana; Felsinger, Michal; Jandakova, Eva

    2014-01-01

    Abstract Background: An ectopic pregnancy within a Cesarean scar represents a rare type of extrauterine pregnancy in which the fertilized egg nidates in the myometrium of the uterine wall within a scar left from a previous Cesarean delivery. An unrecognized growing Cesarian scar pregnancy may result in uterine rupture, uncontrollable metrorrhagia, and bleeding into the abdominal cavity; therefore, early diagnosis and therapy are necessary to prevent the development of severe complications. Case: A 34-year-old woman after a previous Cesarean delivery presented with amenorrhoa of 7 weeks' duration. Transvaginal ultrasonography revealed an ectopic pregnancy in the Cesarean scar, and a laparoscopic removal of the gestational sac was performed with no complications. Results: Three months later, another laparoscopy with chromopertubation showed no signs of penetration in the suture, both the Fallopian tubes being bilaterally passable. The patient was advised that she could try to achieve pregnancy through spontaneous conception, after which monitoring of the gestational development and a careful assessment of the nidation site would be needed. Conclusions: Laparoscopic surgical management of a viable ectopic pregnancy is technically simple, and is followed by a good recovery. (J GYNECOL SURG 30:309) PMID:25336858

  15. Heterochronic bilateral ectopic pregnancy after ovulation induction*

    PubMed Central

    Zhu, Bo; Xu, Gu-feng; Liu, Yi-feng; Qu, Fan; Yao, Wei-miao; Zhu, Yi-min; Gao, Hui-juan; Zhang, Dan

    2014-01-01

    Ectopic pregnancy is identified with the widely-applied assisted reproductive technology (ART). Bilateral ectopic pregnancy is a rare form of ectopic pregnancy which is difficult to be diagnosed at the pre-operation stage. In this paper, we presented an unusual case of heterochronic bilateral ectopic pregnancy after stimulated intrauterine insemination (IUI), where there has been a delay of 22 d between the diagnoses of the two ectopic pregnancies. Literature was reviewed on the occurrence of bilateral ectopic pregnancy during the past four years in the MEDLINE database. We found 16 cases of bilateral ectopic pregnancy reported since 2008, and analyzed the characteristics of those cases of bilateral ectopic pregnancy. We emphasize that ovulation induction and other ARTs may increase the risk of bilateral ectopic pregnancy. Because of the difficulty in identification of bilateral ectopic pregnancy by ultrasonography, the clinician should be aware that the treatment of one ectopic pregnancy does not preclude the occurrence of a second ectopic pregnancy in the same patient and should pay attention to the intra-operation inspection of both side fallopian tubes in any ectopic pregnancy case. PMID:25091994

  16. Ectopic/Tubal Pregnancy

    MedlinePLUS

    ... miscarriage? The medical term for miscarriage is “spontaneous abortion”, but it’s not the same thing as a therapeutic or planned abortion. A spontaneous abortion is when a pregnancy ends “ ...

  17. Demonstration of the route of embryo migration in retroperitoneal ectopic pregnancy using contrast-enhanced computed tomography.

    PubMed

    Liang, Changhu; Li, Xueli; Zhao, Bin; Du, Yinglin; Xu, Shifeng

    2014-03-01

    Retroperitoneal abdominal pregnancy is exceptionally rare. An unusual retroperitoneal pregnancy has a high risk of severe bleeding. Abdominal ultrasonography and whole abdominal computerized tomography scanning should be performed for the early diagnosis of ectopic pregnancy. A case of retroperitoneal ectopic pregnancy located very close to large retroperitoneal blood vessels and treated with resection is presented. Many unusual features of retroperitoneal ectopic pregnancy were highlighted as providing further evidence in support of the main proposed embryo migration mechanism via lymphatic vessels. PMID:24738128

  18. Primary ovarian pregnancy mimicking abdominal pregnancy.

    PubMed

    Ogunbode, O O; Aremu, O O; Okolo, C A

    2015-01-01

    The objectives of this study were to emphasise that ectopic pregnancy (EP) can occasionally occur in rare sites such as the ovary, and to show that it may be difficult making the diagnosis clinically and radiologically. It also highlighted the benefit of early surgical intervention in reducing mortality and morbidity from this condition. The case was a 31-year-old nulliparous woman who presented with amenorrhoea of 20 weeks and a 2-month history of lower abdominal pain. Radiological studies suggested abdominal pregnancy coexisting with uterine fibroids for which she had an exploratory laparotomy, which revealed a primary right ovarian pregnancy necessitating the performance of right ovariectomy. Locating the sites of EP may still pose a diagnostic challenge. Despite the benefits and reliability of ultrasound scanning, there will still be situations where the definitive diagnosis can only be confirmed at surgery. PMID:26739207

  19. [Ectopic pregnancy: Its current interest in Primary Health Care].

    PubMed

    López-Luque, P R; Bergal-Mateo, G J; López-Olivares, M C

    2014-01-01

    An ectopic pregnancy is the implantation and development of the ovum fertilized outside the endometrial cavity. Its incidence has increased in the last 30 years, and although its morbimortality has decreased, it is still the first cause of mortality in the first trimester of the pregnancy. Early suspicion is important, particularly in women of fertile age and with risk factors indicative of an extrauterine gestation. The symptomatology is usually amenorrhea, abdominal pain, metrorrhagia, general pregnancy symptoms, and even syncope and shock. The diagnosis of ectopic pregnancy is based on the clinical information, analytical results on mother blood and urine, ultrasound examination, transvaginal culdocentesis, laparoscopic or laparotomic inspection, and a histological study. The treatment can be surgical (salpingostomy or salpingectomy), medical (methotrexate) or expectant, depending on the factors of the ectopic pregnancy: early diagnosis, presence of acute complications, clinical condition of the patient, etc. PMID:24529529

  20. Ruptured ipsilateral ectopic pregnancies: a rare emergency case series.

    PubMed

    Kaplano?lu, M; Kaplano?lu, D; Yce, T; Kiran, H

    2015-01-01

    Ectopic pregnancy is one of the most important causes of maternal mortality in first trimester pregnancy. Several etiologic factors are suspected for ectopic pregnancy. Fertility-saving surgery in ectopic pregnancy is associated with recurrent ectopic pregnancy. Most common site of ectopic pregnancy is in the fallopian tube, especially in the ampullar region. Ipsilateral tube is rare site for ectopic pregnancy. Previous tubal surgery, especially partial salpingectomy, is an important factor in this disease. PMID:25864285

  1. Tubal ectopic pregnancy two years after laparoscopic supracervical hysterectomy

    PubMed Central

    2014-01-01

    Background Ectopic pregnancy after hysterectomy is a very rare condition, but it must be kept in mind in women with history of hysterectomy who present with abdominal pain and ecographic adnexal heterogeneous images. Since first described by Wendeler in 1895, at least 67 ectopic pregnancies (tubal, ovarian and abdominal) have been described in patients subjected to prior hysterectomy. Case presentation We describe the case of a 41-year-old white caucasian woman admitted to the emergency room due to abdominal pain for two days. The ultrasounds scan and the quantification of beta-HCG led to the diagnosis of tubal ectopic pregnancy, although she had been hysterectomized two years before. An emergency laparoscopy was performed for salpingectomy. The pathology report indicated trophoblastic tubal implantation and hematosalpinx. Conclusions Ectopic pregnancy is one of the conditions to be considered in the differential diagnosis of abdominal pain in women of child bearing potential, and the absence of the uterus does not rule out its diagnosis. PMID:24886255

  2. Diagnosis and management of cervical ectopic pregnancy

    PubMed Central

    Singh, Sweta

    2013-01-01

    Cervical ectopic pregnancy (CP) is a rare condition with an incidence of less than 0.1% of all ectopic pregnancies. It is associated with a high morbidity and mortality potential. Timely intervention is required to preserve fertility and avoid the need for a hysterectomy. A case of CP is reported and the challenges in the diagnosis and management are discussed. PMID:24672169

  3. Trends in ectopic pregnancy in Canada.

    PubMed Central

    Hockin, J C; Jessamine, A G

    1984-01-01

    The incidence in Canada of one complication of sexually transmitted disease, ectopic pregnancy, was examined by age group for the years 1971 through 1980 by means of hospital statistics provided by Statistics Canada. The denominator was "reported pregnancies"--the total of live births, stillbirths, legal abortions and ectopic pregnancies in a given year. In 1980, 4123 ectopic pregnancies (9.3/1000 reported pregnancies) were reported, a 63% increase from 1970. The incidence had increased in each age stratum. This trend may be related to increasing rates of gonococcal infection and of hospitalization for pelvic inflammatory disease and lends confirmation to data from other countries that relate the increase in the rate of ectopic pregnancy to rising rates of sexually transmitted disease. PMID:6478362

  4. Moral absolutism and ectopic pregnancy.

    PubMed

    Kaczor, C

    2001-02-01

    If one accepts a version of absolutism that excludes the intentional killing of any innocent human person from conception to natural death, ectopic pregnancy poses vexing difficulties. Given that the embryonic life almost certainly will die anyway, how can one retain one's moral principle and yet adequately respond to a situation that gravely threatens the life of the mother and her future fertility? The four options of treatment most often discussed in the literature are non-intervention, salpingectomy (removal of tube with embryo), salpingostomy (removal of embryo alone), and use of methotrexate (MXT). In this essay, I review these four options and introduce a fifth (the milking technique). In order to assess these options in terms of the absolutism mentioned, it will also be necessary to discuss various accounts of the intention/foresight distinction. I conclude that salpingectomy, salpingostomy, and the milking technique are compatible with absolutist presuppositions, but not the use of methotrexate. PMID:11262641

  5. Abdominal emergencies during pregnancy.

    PubMed

    Bouyou, J; Gaujoux, S; Marcellin, L; Leconte, M; Goffinet, F; Chapron, C; Dousset, B

    2015-12-01

    Abdominal emergencies during pregnancy (excluding obstetrical emergencies) occur in one out of 500-700 pregnancies and may involve gastrointestinal, gynecologic, urologic, vascular and traumatic etiologies; surgery is necessary in 0.2-2% of cases. Since these emergencies are relatively rare, patients should be referred to specialized centers where surgical, obstetrical and neonatal cares are available, particularly because surgical intervention increases the risk of premature labor. Clinical presentations may be atypical and misleading because of pregnancy-associated anatomical and physiologic alterations, which often result in diagnostic uncertainty and therapeutic delay with increased risks of maternal and infant morbidity. The most common abdominal emergencies are acute appendicitis (best treated by laparoscopic appendectomy), acute calculous cholecystitis (best treated by laparoscopic cholecystectomy from the first trimester through the early part of the third trimester) and intestinal obstruction (where medical treatment is the first-line approach, just as in the non-pregnant patient). Acute pancreatitis is rare, usually resulting from trans-ampullary passage of gallstones; it usually resolves with medical treatment but an elevated risk of recurrent episodes justifies laparoscopic cholecystectomy in the 2nd trimester and endoscopic sphincterotomy in the 3rd trimester. The aim of the present work is to review pregnancy-induced anatomical and physiological modifications, to describe the main abdominal emergencies during pregnancy, their specific features and their diagnostic and therapeutic management. PMID:26527261

  6. Transvaginal sonographic findings of chronic ectopic pregnancy.

    PubMed

    Turan, C; Ugur, M; Dogan, M; Ekici, E; Vicdan, K; Gökmen, O

    1996-08-01

    Chronic ectopic pregnancy is not precisely defined in gynecologic and sonographic texts. The diagnosis of this enigmatic clinical condition is frequently not made until laparotomy. In the present retrospective study, we evaluated the transvaginal sonographic findings of cases who were diagnosed as chronic ectopic pregnancy intraoperatively and/or postoperatively. The incidence of chronic ectopic pregnancy was found to be 20.3% (62/305) of all ectopic pregnancies. Of these 62 cases, 55 had transvaginal sonographic examination. On transvaginal sonographic examination, all 55 cases of chronic ectopic pregnancy had a complex adnexal mass with an empty uterus and only 18 (32.7%) had simple fluid in the pelvis/cul-de-sac. In the majority of cases (82.7%, n = 48), there was a non-homogeneous echo pattern within the adnexal mass. Of 55 cases, 30 had color Doppler flow examination, of whom none had color Doppler flow imaging on the wall of the mass or within the mass. There was a negative quantitative beta human chorionic gonadotropin (beta-hCG) assay (i.e. 0 mIU/ml) in only 4 cases. Based on this study, we concluded that chronic ectopic pregnancy is not a rare clinical entity and should be considered in differential diagnosis among patients presenting with an adnexal mass and an overt clinical picture. Transvaginal sonography is sensitive in diagnosing chronic ectopic pregnancy, but not specific. The combined use of transvaginal ultrasonography and beta-hCG assay increases diagnostic accuracy. However, it should be kept in mind that a negative beta-hCG value does not rule out chronic ectopic pregnancy. PMID:8841798

  7. Ovarian ectopic pregnancy in adolescence

    PubMed Central

    Andrade, Ana Gonçalves; Rocha, Sara; Marques, Catarina O; Simões, Mafalda; Martins, Isabel; Biscaia, Isabel; F Barros, Carlos

    2015-01-01

    Key Clinical Message Ovarian pregnancy is one of the rarest types of extrauterine pregnancy. Its preoperative diagnosis remains a challenge since it presents quite similarly to tubal pregnancy and complicated ovarian cysts. Although in most cases, histology is necessary to confirm the diagnosis, we present an ovarian pregnancy in a teenager, correctly diagnosed during ultrasound examination. PMID:26576271

  8. Successful Laparoscopic Management of Ruptured Tubal Pregnancy with an Ipsilateral Ectopic Pelvic Kidney

    PubMed Central

    Belotte, Jimmy; Belotte, Jim; Alexis, Mitchell; Awonuga, Awoniyi O.; Aguin, Tina Jessica

    2014-01-01

    Objective. To report a case of successful laparoscopic management of a left ruptured tubal pregnancy in the setting of an ipsilateral ectopic pelvic kidney. Method. Case report was prepared at Wayne State University/Detroit Medical Center. The patient is a young woman gravida 2 para 0 in her twenties who presented with severe abdominal pain and vaginal bleeding. She had a plateaued beta HCG and ultrasonographic findings suggestive of ectopic left tubal pregnancy along with an ectopic ipsilateral pelvic kidney. The IRB approval is not needed, as this is a case report. The informed consent could not be obtained, as the patient was not reachable. Result. Multiple intraperitoneal adhesions, left ruptured ampullary ectopic pregnancy and left retroperitoneal pelvic mass consistent with ipsilateral ectopic pelvic kidney. Conclusion. Laparoscopic management of tubal pregnancy can be safely performed in the setting of an ipsilateral ectopic pelvic kidney. PMID:25136465

  9. A Rare Case of Bilateral Ectopic Pregnancy and Differential Diagnosis of Gestational Trophoblastic Disease

    PubMed Central

    Arab, Maliheh; Neda Kazemi, Seyyedeh; Vahedpoorfard, Zahra; Ashoori, Adeleh

    2015-01-01

    Background Bilateral ectopic pregnancy is a rare condition and is divided in two subgroups, primary and secondary, based on history of assisted reproductive technology. Case Presentation A 30 year old primigravid woman with history of infertility and ovulation induction presented to a hospital in Kashan in year 2013. She had vaginal bleeding, abdominal pain and ultrasound findings suggested early pregnancy. Due to high titer of ?-HCG, gestational trophoblastic disease was proposed and D8C was done in referral and admission to gyneco-oncology ward in Tehran. Repeat sonography suggested ectopic pregnancy in left side and repeat ?-HCG level showed an increase of 19435 mIU/ml. Laparotomy findings revealed bilateral ampullary ectopic pregnancy. Bilateral salpingostomy followed by one course of methotrexate was prescribed. Conclusion Bilateral ectopic gestation should be considered as a rare differential diagnosis for ectopic pregnancy. In this study, bigger size and rupture in left side was observed. PMID:25717436

  10. Primary Tubal Choriocarcinoma Presented as Ruptured Ectopic Pregnancy.

    PubMed

    Karaman, Erbil; etin, Orkun; Kolusari, Ali; Bayram, Irfan

    2015-09-01

    The primary tubal choriocarcinoma associated with ectopic pregnancy is very rare. A 31-year-old woman was admitted to the emergency room due to amenorrhea, left lower abdominal pain and fatigue. Her ?-Hcg level was 29251.4 mIU/ml and transvaginal ultrasund revealed a 24x21 mm of left tubal ectopic pregancy mass with large amount of free fluid in pelvic cavity. The patient was diagnosed with ruptured tubal ectopic pregnancy and thus, she underwent laparotomy with left total salpingectomy. The pathological assessment was reported as primary tubal choriocarcinoma with the involvement of whole tubal layer. The patient was defined to have stage I choriocarcinoma with good prognostic factors and methotrexate monotherapy was administered. Serum ?- Hcg levels of the patient gradually declined and eventually became negative at the first month of the treatment. With this case report we aimed to implicate that when diagnosing the ectopic pregnancy, even very rare, the tubal choriocarcinoma should be kept in mind. PMID:26500968

  11. Ectopic Pregnancy in Uncommon Implantation Sites: Intramural Pregnancy and Rudimentary Horn Pregnancy

    PubMed Central

    Wang, Yi; Yu, Fan; Zeng, Li-Qin

    2015-01-01

    Ectopic pregnancy is commonly located in the fallopian tube. Nevertheless, two unusual types of ectopic pregnancy, intramural pregnancy and rudimentary horn pregnancy, seriously threaten maternal life. The diagnosis and treatment of these unusual implantation sites present a clinical challenge. In this study, we illustrated the two unusual types of ectopic pregnancy and summarized the current data regarding diagnosis and optimal treatment from our experience. PMID:26819788

  12. Intramural ectopic pregnancy: a case and review of the literature.

    PubMed

    Kirk, Emma; McDonald, Katie; Rees, Julia; Govind, Abha

    2013-06-01

    An intramural ectopic is a rare type of ectopic pregnancy in which the gestational sac is implanted within the myometrium, separate from the endometrial cavity and Fallopian tubes. There are only 53 cases in the published literature. We report a case of intramural ectopic pregnancy treated surgically and review the published data on this rare type of ectopic pregnancy, with respect to aetiology, diagnosis and management. PMID:23375906

  13. [Non surgical management of ectopic pregnancy].

    PubMed

    Kdous, Moez

    2006-06-01

    During the past 25 years, the incidence of ectopic pregnancy has progressively increased while the morbidity and mortality have substantialy decreased, and the treatment has progressed from salpingectomy by laparotomy to conservative surgery by laparoscopy and more recently to medical therapy with Methotrexate or expectant management. This therapeutic transition from surgical emergency to non surgical managment has been attributed to early diagnosis through the use of sensitive assays for hCG and the high definition of vaginal ultrasound. By using these sensitive diagnostic tools, we are now able to select those patients who are most likely to respond to expectant or medical managment versus those who are at high risk of rupture and require surgery. We have reviewed the scientific literature on ectopic pregnancy published over the past 20 years, with the aim to assess the value of non surgical managment of etopic pregnancy. Predictor factors of expectant managment are discussed. Medical therapy with methotrexate: results, indications, Unpleasant side effects and complications are detailed. Several protocols are defined and therapeutic supervision is etablished. The authors offred several recommandations for OB/GY wich will optimize the effectivness of non invasive methods for treatment of ectopic pregnancy. PMID:17042204

  14. A painless pelvic wall ectopic pregnancy.

    PubMed

    Borton, Zakk; Landon, Alice G; Singh, Savita

    2015-01-01

    A 38-year-old woman presented with light vaginal bleeding at approximately 8 weeks gestation. Although she initially presented to accident and emergency with vaginal bleeding and menstrual-like pain, this rapidly settled and both symptoms resolved over the following days. An initial ultrasound scan revealed an empty uterus, with no adnexal masses or free fluid. Miscarriage was presumed. However, following suboptimal β-human chorionic gonadotropin decline, further ultrasonography noted a mass next to the right ovary. The patient underwent laparoscopy, revealing an ectopic pregnancy closely adherent to the peritoneum of the right pelvic wall. The patient was treated with systemic methotrexate and responded well. This rare form of ectopic pregnancy has a high maternal morbidity and mortality, and its optimal management is not definitively decided, due to the scarcity of the condition and subsequent lack of high-powered data. We present a case of successful medical management. PMID:26424823

  15. Cervical Ectopic Pregnancy following Assisted Reproductive Technology: A Case Report

    PubMed Central

    Ahmadi, Firoozeh; Irani, Shohreh

    2012-01-01

    Cervical ectopic pregnancy (EP) is an infrequent, life-threatening form of ectopic gestation pregnancy that implants within the endocervical canal. With the increase in use of assisted reproductive technology (ART) worldwide and more liberal use of transvaginal sonography (TVS) during early pregnancy, more cases of cervical ectopic pregnancy are being diagnosed. Early diagnosis of this condition by using ultrasound imaging allows for prevention of maternal morbidity due to hemorrhage and leads to conservative management of this condition.We present the case of a 38-year old woman (gravida 1, para 0) who was found to have acervical ectopic pregnancy at six weeks of gestation. PMID:24520440

  16. Unusual ectopic pregnancies: sonographic findings and implications for management.

    PubMed

    Ghaneie, Ashkan; Grajo, Joseph R; Derr, Charlotte; Kumm, Todd R

    2015-06-01

    Ectopic pregnancy is a considerable source of morbidity and mortality for women of childbearing age. Improved detection and increased risk factors have led to a dramatic rise in the incidence of ectopic pregnancy in recent years. Early diagnosis is critical for the health of the patient as well as the success rate of future pregnancies. Besides laparoscopy, sonography is the mainstay for evaluating ectopic pregnancy. It is important to understand the sonographic features of ectopic pregnancies, including unusual cases that occur outside the fallopian tube. PMID:26014313

  17. The diagnosis of ectopic pregnancy by real-time ultrasonography.

    PubMed

    Iloabachie, G O; Mgbor, S

    1991-01-01

    The value of ultrasonography in the diagnosis of ectopic gestation was jointly investigated at UNTH and Hansa Clinics. One hundred and two doubtful ectopic pregnancies had ultrasonic evaluation after initial clinical work up. 52 (76.5%) patients out of 68 who had ectopic pregnancy were diagnosed at the first scan. There were 16 (23.5%) false negatives. Twenty-eight (82.4%) patients out of 34 patients who never had ectopic pregnancy were cleared at the first scan. There were 6 (17.6%) false positives who had laparotomy performed. Fetal pulsations were seen as early as 6 weeks in 11.8% of the ectopic pregnancies. This sign was considered diagnostic. Ultrasound was found promising in the confirmatory diagnosis of ectopic pregnancy especially when a strong suspicion was established by history clinical examination and pregnancy test. PMID:2069882

  18. Molar tubal ectopic pregnancy: Report of two cases.

    PubMed

    Mbarki, Chaouki; Jerbi, Emna; Hsayaoui, Najeh; Zouari, Fatma; Ben Brahim, Ehsen; Oueslati, Hedhili

    2015-06-01

    Ectopic molar pregnancy is a rare occurrence and consequently not often considered as a diagnostic possibility. We report two cases of molar hydatidiform tubal pregnancy. Diagnosis of ectopic pregnancy was confirmed on clinical biological and sonographic investigations. Diagnosis of molar pregnancy was done on histopathology. The clinical course was favorable for both patients. Although rare, molar changes can occur at any site of an ectopic pregnancy. Clinical diagnosis of a molar pregnancy is difficult but histopathology is the gold standard for diagnosis. PMID:25510265

  19. A Rare Localization of Ectopic Pregnancy: Intramyometrial Pregnancy in Twin Pregnancy following IVF.

    PubMed

    Boukhanni, Lahcen; Ait Benkaddour, Yassir; Bassir, Ahlam; Aboulfalah, Abdrahim; Asmouki, Hamid; Soummani, Abderraouf

    2014-01-01

    Intramyometrial pregnancy is a rare form of ectopic pregnancy. It makes a diagnostic and therapeutic challenge. If misdiagnosed the intramyometrial pregnancy can cause a uterine rupture and become life-threatening condition. We report a case of intramyometrial pregnancy in twin pregnancy following IVF with spontaneous abortion of the first twin At 9 weeks of gestation. The 10 weeks scan showed a normal fetus which was described to be highly localized in the uterus but the diagnosis of intramyometrial pregnancy was not suspected. The patient was admitted at 14 weeks of gestation with pelvic pain, hemorrhage, and shock. She was operated and the diagnosis of ruptured intramyometrial pregnancy was done and managed conservatively. This case illustrates the diagnostic difficulties of intramyometrial pregnancy. We discuss pathophysiology, diagnosis, and treatment of this exceptional form of ectopic pregnancy. PMID:24744925

  20. Persistent trophoblastic tissue following salpingostomy for unruptured ectopic pregnancy

    SciTech Connect

    Rivlin, M.E.; Meeks, G.R.; Cowan, B.D.; Bates, G.W.

    1985-02-01

    Radioimmunoassay of beta-hCG was used to diagnose an ectopic pregnancy in a 30 year old patient and the site of pregnancy was determined by ultrasonography. A salpingostomy was performed; the ectopic pregnancy and the residual trophoblastic tissue were removed. Six weeks later a right salpingectomy was performed to remove persistent trophoblastic tissue. Histologic examination of the surgical specimen demonstrated viable chorionic villi. Serial measurements of beta-hCG are recommended following conservative surgery for ectopic gestation to assure the patient and the surgeon that the tube contains no residual products of conception.

  1. Lymphoma presenting as an abdominal mass involving an ectopic spleen

    SciTech Connect

    Barloon, T.J.; Lu, C.

    1984-09-01

    We recently evaluated a patient with a huge asymptomatic abdominal mass which eventually proved to be an ectopic spleen. Pathology revealed a well-differentiated lymphoma involving the entire spleen and hilar nodes. Before her operation, a series of radiographic procedures was carried out which demonstrated the nature of the mass. The radiographic findings and diagnostic modalities used to establish the diagnosis form the basis of this report.

  2. Induced abortion and the risk of subsequent ectopic pregnancy.

    PubMed Central

    Holt, V L; Daling, J R; Voigt, L F; McKnight, B; Stergachis, A; Chu, J; Weiss, N S

    1989-01-01

    This study assessed the effect of legal induced abortion on ectopic pregnancy risk by using a comparison group of reproductive-age women who were at risk of becoming pregnant during the same time period the women with ectopic pregnancy conceived. Cases were members of Group Health Cooperative of Puget Sound who were hospitalized for ectopic pregnancy from October 1981 through September 1986 (N = 211). Controls were randomly selected members matched to cases on age and county of residence (N = 457). All subjects in this analysis had had one or more prior pregnancies. Eighty-eight cases (41.7 per cent) and 177 controls (38.7 per cent) had a history of one or more induced abortions. The relative risk of ectopic pregnancy associated with one abortion was 0.9 (95 per cent confidence interval 0.6, 1.3), adjusted for age, county, reference date, religion, gravidity, age at first pregnancy, lifetime number of sexual partners, and miscarriage history. Among women with two or more prior pregnancies, the risk associated with two or more abortions was 1.2 (0.6, 2.4). Controlling for pelvic inflammatory disease and use of intrauterine devices did not alter these risks. We conclude that legal abortion as performed in the US since 1970 has little or no influence on a woman's risk of ectopic pregnancy in subsequent pregnancies. PMID:2764199

  3. Management of miscarriage and ectopic pregnancy.

    PubMed

    Marquardt, Udo

    2011-11-01

    The National Institute for Health and Clinical Excellence (2010) estimates that 137,000 women in England experience per vaginal (PV) bleeding and abdominal pain in early pregnancy every year, while the Royal College of Obstetricians and Gynaecologists (2006) estimates that PV bleeding occurs in between 10 and 25 per cent of women who are less than 12 weeks pregnant and that up to half of these women miscarry. Some authors suggest that care for such women could be improved and that their psychological needs could be met more effectively (Washbourne and Cox 2002). This article aims to help emergency department nurses give safe and compassionate care to women who experience PV bleeding by offering an overview of its pathophysiology, diagnosis and treatment. PMID:22167925

  4. Multiple ectopic hepatocellular carcinomas arising in the abdominal cavity.

    PubMed

    Miyake, Toru; Hoshino, Seiichiro; Yoshida, Yoichiro; Aisu, Naoya; Tanimura, Syu; Hisano, Satoshi; Kuno, Nobuaki; Sohda, Tetsuro; Sakisaka, Shotaro; Yamashita, Yuichi

    2012-09-01

    Ectopic hepatocellular carcinoma (HCC) is a very rare clinical entity that is defined as HCC arising from extrahepatic liver tissue. This report presents a case of ectopic multiple HCC arising in the abdominal cavity. A 42-year-old otherwise healthy male presented with liver dysfunction at a general health checkup. Both HCV antibody and hepatitis B surface antigen were negative. Laboratory examination showed elevations in serum alpha-fetoprotein and PIVKA-II. Ultrasonography and computed tomography revealed multiple nodular lesions in the abdominal cavity with ascites without a possible primary tumor. Exploratory laparoscopy was performed, which revealed bloody ascites and multiple brown nodular tumors measuring approximately 10 mm in size that were disseminated on the perineum and mesentery. A postoperative PET-CT scan was performed but it did not reveal any evidence of a tumor in the liver. The tumors resected from the peritoneum were diagnosed as HCC. The present case of HCC was thought to have possibly developed from ectopic liver on the peritoneum or mesentery. PMID:23139654

  5. Ectopic pregnancy in an undescended fallopian tube: a diagnostic challenge.

    PubMed

    Pardal, Catarina; Braga, Lus; Vides, Belisa

    2016-01-01

    Uterine malformations are the most frequent anomalies of the Mllerian ducts, but undescended ovaries and fallopian tubes are very rare congenital defects. Pregnancy in these misplaced organs may occur, frequently posing a diagnostic challenge. A case of a ruptured ectopic pregnancy in an undescended fallopian tube associated with other genital malformations is presented. This case provides evidence for the recognised phenomenon of peritoneal gametes or embryo transmigration. PMID:26869540

  6. Ectopic Pregnancy in caesarean section scar: A case report.

    PubMed

    Aich, Rajarshi; Solanki, Narayan; Kakadiya, Ketan; Bansal, Ashank; Joshi, Manisha; Nawale, Ajita

    2015-12-01

    We report a rare case of ectopic pregnancy occurring in the scar of a previous caesarean section, diagnosed by ultrasonography and confirmed by 3.0-T magnetic resonance imaging of pelvis. We present the clinical details and imaging findings, followed by discussion of the etiology, pathogenesis, and imaging of this condition. PMID:26649124

  7. Ectopic Pregnancy in caesarean section scar: A case report

    PubMed Central

    Aich, Rajarshi; Solanki, Narayan; Kakadiya, Ketan; Bansal, Ashank; Joshi, Manisha; Nawale, Ajita

    2015-01-01

    We report a rare case of ectopic pregnancy occurring in the scar of a previous caesarean section, diagnosed by ultrasonography and confirmed by 3.0-T magnetic resonance imaging of pelvis. We present the clinical details and imaging findings, followed by discussion of the etiology, pathogenesis, and imaging of this condition. PMID:26649124

  8. Reduced expression of aquaporin 9 in tubal ectopic pregnancy.

    PubMed

    Ji, Yin Fen; Chen, Li You; Xu, Kai Hong; Yao, Ji Fen; Shi, Yi Fu; Shanguan, Xue Jun

    2013-04-01

    Previous studies demonstrate significant roles for passive water channels (aquaporins, AQPs) in maintaining water homeostasis in cell membranes of endometrial cells during decidualisation and embryo implantation. However, there is little information regarding the role of AQPs in the human fallopian tube, specifically their role in human tubal ectopic pregnancy. In this study we took tissue samples from the site of implantation of tubal ectopic pregnancy (group 1, N = 30, mean age 32 years, range 23-42) and the corresponding non-implantation site in women undergoing salpingectomy for tubal pregnancy (group 2). Ampullary fallopian tubes during mid-secretory phase were collected as control group (group 3, N = 17, mean age 37 years, range 30-50). Thin sections were prepared and stained with anti-AQP9, and, for estrogen and progesterone receptors in each group. Immunohistochemical studies showed that AQP9 proteins localize in the cytoplasm of epithelial cells of Fallopian tube. Expression of AQP9 was significantly reduced during tubal pregnancy compared to controls (group 1 vs. group 3, P = 0.036; group 2 vs. group 3, P = 0.029), and, this reduced expression was not related to estrogen receptor or progesterone receptor status (group 2, ER vs. AQP9, Pearson r = 0.173, P = 0.361; PR vs. AQP9, Pearson r = 0.124, P = 0.514, respectively). Similarly, there is no correlation between AQP9 and estrogen receptor or progesterone receptor status in the normal group (group 3, ER vs. AQP9, Pearson r = -0.026, P = 0.923; PR vs. AQP9, Pearson r = -0.292, P = 0.255, respectively). Reduced expression of AQP9 in human fallopian tube may contribute to aspects of pathophysiology of tubal ectopic pregnancy. PMID:23238960

  9. Successful Management of Live Cervical Ectopic Pregnancy: A Case Report

    PubMed Central

    Ghose, Seetesh; Pallavee, P; Porkkodi, P

    2015-01-01

    Cervical pregnancy is a rare form of ectopic pregnancy with potential grave consequences occurring in approximately 1:9,000 deliveries. It is life-threatening as the pregnancy is implanted in the endocervical canal and the trophoblast can penetrate through the cervical wall and into the uterine blood supply resulting in catastrophic haemorrhage. Historically, the treatment had been hysterectomy because of the considerable risk of life-threatening haemorrhage, but in the recent past various conservative management modalities have been applied to preserve fertility. Here, we report a case of successful (both medical and surgical) management of cervical ectopic pregnancy in a young woman. A 29-year-old, gravid 2, para1 and living 1 with previous caesarean section had presented with mild bleeding per vagina for 5 days following 7 weeks of amenorrhoea. Past menstrual, medical, surgical and family history were unremarkable except the previous caesarean section. On examination vital signs were normal but pelvic examination revealed a distended cervix with bulky uterus, without anyadnexal mass or tenderness and no cervical motion tenderness. Further transvaginal sonography showed a live cervical gestation of 7 weeks and 4 days and serum beta-HCG value of 1,03,113mIU/ml. Patient received conservative approach with combination of intraamniotic potassium chloride and methotrexate and suction curettage. Due to conservative approach emergency hysterectomy and blood transfusion was avoided. PMID:26816951

  10. 42 CFR 441.207 - Drugs and devices and termination of ectopic pregnancies.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... pregnancies. 441.207 Section 441.207 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF... APPLICABLE TO SPECIFIC SERVICES Abortions § 441.207 Drugs and devices and termination of ectopic pregnancies... and for medical procedures necessary for the termination of an ectopic pregnancy....

  11. 42 CFR 441.207 - Drugs and devices and termination of ectopic pregnancies.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... pregnancies. 441.207 Section 441.207 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF... APPLICABLE TO SPECIFIC SERVICES Abortions § 441.207 Drugs and devices and termination of ectopic pregnancies... and for medical procedures necessary for the termination of an ectopic pregnancy....

  12. 42 CFR 441.207 - Drugs and devices and termination of ectopic pregnancies.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... pregnancies. 441.207 Section 441.207 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF... APPLICABLE TO SPECIFIC SERVICES Abortions 441.207 Drugs and devices and termination of ectopic pregnancies... and for medical procedures necessary for the termination of an ectopic pregnancy....

  13. 42 CFR 441.207 - Drugs and devices and termination of ectopic pregnancies.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... pregnancies. 441.207 Section 441.207 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF... APPLICABLE TO SPECIFIC SERVICES Abortions 441.207 Drugs and devices and termination of ectopic pregnancies... and for medical procedures necessary for the termination of an ectopic pregnancy....

  14. 42 CFR 441.207 - Drugs and devices and termination of ectopic pregnancies.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... pregnancies. 441.207 Section 441.207 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF... APPLICABLE TO SPECIFIC SERVICES Abortions 441.207 Drugs and devices and termination of ectopic pregnancies... and for medical procedures necessary for the termination of an ectopic pregnancy....

  15. Multiple induced abortions as risk factor for ectopic pregnancy. A prospective study.

    PubMed

    Skjeldestad, F E; Gargiullo, P M; Kendrick, J S

    1997-08-01

    To assess the association between induced abortion and subsequent ectopic pregnancy, 3754 Norwegian women 39 years or younger who had at least one induced abortion at the University Hospital of Trondheim during 1987-92 were followed for histologically confirmed ectopic pregnancies through the end of 1993. In a total of 164,167 woman-months of follow-up, 24 ectopic pregnancies were recorded. No woman had more than one ectopic pregnancy. The overall cumulative incidence of ectopic pregnancy among women with an induced abortion history rose from 3.5 per 1000 women at 1 year to 11.1 per 1000 women at 6 years of follow-up. The adjusted incidence density ratio (aIDR) for women with 2 or more induced abortions was 1.2 (95% confidence interval, 0.5-3.1). No dose-response to ectopic pregnancy was found between 2 consecutive (aIDR, 0.9) and 3 or more consecutive (aIDR, 1.1) abortions compared with the reference group. Ectopic pregnancy after the most recent abortion was more likely to occur among women whose first pregnancy ended as an ectopic one than among those whose first pregnancy resulted in a birth. Although the results of longer-term follow-up of this cohort of Norwegian women have not yet been analyzed, the present findings suggest that induced abortion does not increase the risk of ectopic pregnancy. PMID:9292646

  16. [Ectopic decidua: variability of presentation in pregnancy and differential diagnoses].

    PubMed

    Canlorbe, G; Goubin-Versini, I; Azria, E; Abdul-Razak, R; Muray, J-M

    2012-04-01

    The ectopic decidua is a common occurrence during pregnancy, corresponding to the presence of decidual tissue outside the endometrium. The pathophysiology of these lesions is not yet fully elucidated. The phenomenon is most often benign, with a favourable outcome in the post-partum and without follow-up. Because of the wide range of clinical presentations, from localized peritoneal granulation to large pelvic mass, the clinical diagnosis of ectopic decidua is difficult. Furthermore, imaging is not specific. The discovery of such lesions should lead to the realization of systematic biopsies for histological examination and rule out other causes such as lesions of tuberculosis or carcinomatosis. Immunohistochemical studies are helpful in differentiating deciduosis from malignant deciduoid mesothelioma, its main differential diagnosis with a catastrophic prognosis. PMID:22464747

  17. Jehovahs Witness patients presenting with ruptured ectopic pregnancies: two case reports

    PubMed Central

    2014-01-01

    Introduction The management of emergencies in Jehovahs Witnesses presents several challenges to obstetricians and gynaecologists. We present two cases of ectopic pregnancies in Jehovahs Witnesses recently managed in our institution. This is the first case review series of its kind that we could identify. We feel it is of clinical importance for all physicians caring for Jehovahs Witnesses. Case presentation The first patient was a 28-year-old Caucasian Irish woman who presented in a state of collapse and a ruptured ectopic pregnancy was suspected. She refused treatment and took her own discharge against the advice of senior hospital staff. She re-presented to our Emergency Room 6 hours later in hypovolaemic shock. She ultimately consented to blood products including plasma and platelets and underwent laparoscopic left-sided salpingectomy. This consent was queried postoperatively by her next-of-kin but the validity of her consent was clarified by the hospital legal team. The second patient was a 35-year-old Nigerian woman who presented to our Emergency Room with a 2-week history of intermittent vaginal bleeding and abdominal pain with a haemoglobin of 5.4g/dL. An ectopic pregnancy was diagnosed following assessment. She refused all blood products and underwent right-sided salpingectomy. Intravenous tranexamic acid was administered and cell salvage employed intraoperatively. Conclusions We feel that this case review series emphasises the importance of appropriate management of Jehovahs Witnesses in our units. In both of the above cases, these women were in potentially life-threatening situations. Advances in haematology and pharmaceutical therapy contributed to their survival. We welcome these advances in the treatment of this patient population. PMID:25238752

  18. Evaluation of serum creatine phosphokinase in diagnosis of tubal ectopic pregnancy compared with intrauterine pregnancy and threatened abortion

    PubMed Central

    Asgharnia, Maryam; Faraji, Roya; Mirblouk, Fariba; Atrkar Roshan, Zahra; Parvizi, Ayda

    2012-01-01

    Background: Vaginal sonograghy and serial -hCG are the most common diagnostic methods for ectopic pregnancy but about 50% of cases are initially misdiagnosed. In tubal pregnancy the zygote lies next to the muscular layer, and this invasion causes an increase in creatine phosphokinase (CPK) in blood. Objective: assessment of CPK and its isoenzyme CPK-MB as a diagnostic marker for tubal pregnancy. Materials and Methods: In this case-control study, 111 women between 16-40 years in first-trimester pregnancy admitted to emergency ward of Rasht Alzahra hospital with abdominal pain or vaginal bleeding were included and according to sonography and βhCG divided into 3 groups (N=37): tubal pregnancy (1), threatened abortion (2) and normal pregnancy (3). Blood samples were taken for totalCPK and CPK-MB before any invasive procedure. Results: Mean total CPK level were 96.27±63.9 u/lit (group 1), 55.37±14.1 u/lit (group 2) and 48.94±19.2 u/lit (group 3) and was significantly higher in tubal pregnancy compared to other groups. Mean CPK-MB levels in 3 groups were 15.62±5.2 u/lit, 17.32±6.9 u/lit, and 15.1±4.7 u/lit, respectively which was not significant. Conclusion: It seems that determination of total CPK can enhance the diagnostic value of tubal pregnancy. PMID:25246890

  19. Background factors of ectopic pregnancy. II. Risk estimation by means of a logistic model.

    PubMed

    Thorburn, J; Philipson, M; Lindblom, B

    1986-12-01

    Based on the frequency distribution in a previous case-control study of ectopic pregnancy in Sweden, the prognostic value of a number of risk factors was analysed. A logistic procedure was applied in a stepwise manner, resulting in a risk-scoring model in which the probability of ectopic pregnancy can be determined on the basis of four background factors. PMID:3803685

  20. Ectopic Pregnancy Rates and Racial Disparities in the Medicaid Population, 200408

    PubMed Central

    STULBERG, Debra B.; CAIN, Loretta R.; DAHLQUIST, Irma; LAUDERDALE, Diane S.

    2014-01-01

    Objective To assess 200408 ectopic pregnancy rates among Medicaid recipients in 14 states and 200008 time trends in 3 states, and to identify differences in rate by race/ethnicity. Design Secondary analysis of Medicaid administrative claims data. Setting United States. Subjects Women ages 1544 enrolled in Medicaid in Arizona, California, Colorado, Florida, Illinois, Indiana, Iowa, Louisiana, Massachusetts, Michigan, Minnesota, Mississippi, New York, or Texas in 200408 (n=19,135,106), and in California, Illinois and New York in 200003. Interventions None. Main Outcome Measure Number of ectopic pregnancies divided by the number of total pregnancies (spontaneous abortions, induced abortions, ectopic pregnancies, and all births). Results The 200408 Medicaid ectopic pregnancy rate for all 14 states combined was 1.40% of all reported pregnancies. Adjusted for age, the rate was 1.47%. Ectopic pregnancy incidence was 2.3 per 1,000 woman-years. In states for which longer-term data were available (California, Illinois and New York), the rate declined significantly 200008. In all 14 states, Black women were more likely to experience an ectopic pregnancy compared to whites (Relative Risk 1.46, 95% Confidence Interval 1.451.47). Conclusions Ectopic pregnancy remains an important health risk for women enrolled in Medicaid. Black women are at consistently higher risk than whites. PMID:25439806

  1. Chlamydia trachomatis and ectopic pregnancy: retrospective analysis of salpingectomy specimens, endometrial biopsies, and cervical smears.

    PubMed Central

    Lan, J; van den Brule, A J; Hemrika, D J; Risse, E K; Walboomers, J M; Schipper, M E; Meijer, C J

    1995-01-01

    AIMS--To examine the role of Chlamydia trachomatis in ectopic pregnancy by detection of DNA in archival salpingectomy specimens, and in their preceding cervical specimens and endometrial biopsies, by using the polymerase chain reaction (PCR). METHODS--Archival paraffin embedded salpingectomy tissues (n = 48) from 37 women with ectopic pregnancy were examined for the presence of C trachomatis plasmid and omp1 DNA by PCR. In addition, preceding cervical specimens (n = 58) stored either as cervical cell suspensions or as archival cervical smears, and preceding endometrial biopsies (n = 18), taken 0-5.8 years before the ectopic pregnancy, were examined by PCR for the presence of C trachomatis. RESULTS--C trachomatis DNA was detected in only one of the 48 salpingectomy specimens from 37 women. However, in six of the 37 women, C trachomatis DNA was detected in the genital specimens (cervix and/or endometrial) taken before salpingectomy. C trachomatis infections were mostly found in endometrial or cervical specimens taken more than three years before ectopic pregnancy. No chlamydial DNA was found in endometrial or cervical specimens taken at the same time of the ectopic pregnancy. CONCLUSIONS--Although no C trachomatis DNA was found in salpingectomy specimens, several women with ectopic pregnancy had C trachomatis infections in endometrial and cervical specimens in the past. This suggests that at least in these cases the ectopic pregnancy is a late post-inflammatory complication of an ascending C trachomatis infection resulting in a scarred fallopian tube. PMID:7490313

  2. Secondary Advanced Abdominal Pregnancy after Suspected Ruptured Cornual Pregnancy with Good Maternal Outcome: A Case with Unusual Gangrenous Fetal Toes and Ultrasound Diagnoses Managed by Hysterectomy

    PubMed Central

    El-Agwany, Ahmed Samy; El-badawy, El-sayed; El-habashy, Ahmed; El-gammal, Hesham; Abdelnaby, Mahmoud

    2016-01-01

    Incidence of abdominal pregnancy is accounting for 1.4% of all ectopic pregnancies. This is a rare case report of a 35-year-old multigravida who was presented to our hospital at 24 weeks of gestation with advanced live intraabdominal pregnancy diagnosed by ultrasound. The patient was followed up till 28 weeks in hospital for medicolegal viability in Egypt. Midline laparotomy was done, a live baby was delivered, and hysterectomy was done for attached placenta. Mother was discharged in good health, and baby was admitted in neonatal intensive care unit with no congenital anomalies and died after three weeks of sepsis. The management of advanced abdominal pregnancy remains controversial. Diagnosis and management of advanced abdominal pregnancy is still a challenge to today’s medical world. But high index of suspicion aided with imaging studies can help in timely diagnosis, thereby preventing the associated life-threatening complications. PMID:26862301

  3. Combination gefitinib and methotrexate treatment for non-tubal ectopic pregnancies: a case series.

    PubMed

    Horne, A W; Skubisz, M M; Tong, S; Duncan, W C; Neil, P; Wallace, E M; Johns, T G

    2014-07-01

    Non-tubal ectopic pregnancies are a rare subgroup of ectopic pregnancies implanted at sites other than the Fallopian tube. Mortality from non-tubal ectopic pregnancies is higher compared with that for tubal ectopic pregnancies, and they are becoming more common, partly due to the rising incidence of Caesarean sections and use of assisted reproductive technologies. Non-tubal ectopic pregnancies can be especially difficult to treat. Surgical treatment is complex, and follow-up after medical treatment is usually protracted. There is therefore a need for more effective medical therapies to resolve non-tubal ectopic pregnancies and reduce operative intervention. We have recently reported successful use of combination gefitinib (an orally available epidermal growth factor receptor inhibitor) and methotrexate for treatment of tubal pregnancies. To our knowledge, this combination has not been used to treat non-tubal pregnancies. Here we report the use of combination gefitinib and methotrexate to treat eight women with stable, non-tubal ectopic pregnancies at two tertiary academic teaching hospitals (Edinburgh, UK and Melbourne, Australia); five interstitial and three Caesarean section scar ectopic pregnancies. Pretreatment serum hCG levels ranged from 2458 to 48 550 IU/l, and six women had pretreatment hCG levels >5000 IU/l. The women were co-administered 1-2 doses of i.m. methotrexate (50 mg/m on Day 1, Day 4 or Day 7) with seven once daily doses of oral gefitinib (250 mg). The women were monitored until complete resolution of the ectopic pregnancy, defined as a serum hCG <15 IU/l. Time to resolution (days from first methotrexate dose until serum hCG <15 IU/l), safety and tolerability, complication rates and subsequent fertility outcomes were also recorded. All eight women were successfully treated with combination gefitinib and methotrexate. The most common side effects were transient acne/rash and diarrhoea, known side effects of gefitinib. All women promptly resumed menstruation and importantly, three women subsequently conceived spontaneously. Two have delivered a healthy infant at term and the third is currently in her second trimester of pregnancy. Hence, our case series supports a future clinical trial to determine the efficacy of combination gefitinib and methotrexate to treat non-tubal ectopic pregnancies. PMID:24812320

  4. Prioritization of Susceptibility Genes for Ectopic Pregnancy by Gene Network Analysis.

    PubMed

    Liu, Ji-Long; Zhao, Miao

    2016-01-01

    Ectopic pregnancy is a very dangerous complication of pregnancy, affecting 1%-2% of all reported pregnancies. Due to ethical constraints on human biopsies and the lack of suitable animal models, there has been little success in identifying functionally important genes in the pathogenesis of ectopic pregnancy. In the present study, we developed a random walk-based computational method named TM-rank to prioritize ectopic pregnancy-related genes based on text mining data and gene network information. Using a defined threshold value, we identified five top-ranked genes: VEGFA (vascular endothelial growth factor A), IL8 (interleukin 8), IL6 (interleukin 6), ESR1 (estrogen receptor 1) and EGFR (epidermal growth factor receptor). These genes are promising candidate genes that can serve as useful diagnostic biomarkers and therapeutic targets. Our approach represents a novel strategy for prioritizing disease susceptibility genes. PMID:26840308

  5. Advanced abdominal pregnancy: an increasingly challenging clinical concern for obstetricians

    PubMed Central

    Huang, Ke; Song, Lei; Wang, Longxia; Gao, Zhiying; Meng, Yuanguang; Lu, Yanping

    2014-01-01

    Advanced abdominal pregnancy is rare. The low incidence, high misdiagnosis rate, and lack of specific clinical signs and symptoms explain the fact that there are no standard diagnostic and treatment options available for advanced abdominal pregnancy. We managed a case of abdominal pregnancy in a woman who was pregnant for the first time. This case was further complicated by a concurrent singleton intrauterine pregnancy; the twin pregnancy was not detected until 20 weeks of pregnancy. The case was confirmed at 26 weeks gestational age using MRI to be an abdominal combined with intrauterine pregnancy. The pregnancy was terminated by cesarean section at 33 + 5 weeks gestation. We collected the relevant data of the case while reviewing the advanced abdominal pregnancy-related English literature in the Pubmed, Proquest, and OVID databases. We compared and analyzed the pregnancy history, gestational age when the diagnosis was confirmed, the placental colonization position, the course of treatment and surgical processes, related concurrency rate, post-operative drug treatment programs, and follow-up results with the expectation to provide guidance for other physicians who might encounter similar cases. PMID:25337188

  6. Advanced abdominal pregnancy: an increasingly challenging clinical concern for obstetricians.

    PubMed

    Huang, Ke; Song, Lei; Wang, Longxia; Gao, Zhiying; Meng, Yuanguang; Lu, Yanping

    2014-01-01

    Advanced abdominal pregnancy is rare. The low incidence, high misdiagnosis rate, and lack of specific clinical signs and symptoms explain the fact that there are no standard diagnostic and treatment options available for advanced abdominal pregnancy. We managed a case of abdominal pregnancy in a woman who was pregnant for the first time. This case was further complicated by a concurrent singleton intrauterine pregnancy; the twin pregnancy was not detected until 20 weeks of pregnancy. The case was confirmed at 26 weeks gestational age using MRI to be an abdominal combined with intrauterine pregnancy. The pregnancy was terminated by cesarean section at 33 + 5 weeks gestation. We collected the relevant data of the case while reviewing the advanced abdominal pregnancy-related English literature in the Pubmed, Proquest, and OVID databases. We compared and analyzed the pregnancy history, gestational age when the diagnosis was confirmed, the placental colonization position, the course of treatment and surgical processes, related concurrency rate, post-operative drug treatment programs, and follow-up results with the expectation to provide guidance for other physicians who might encounter similar cases. PMID:25337188

  7. Genital Schistosomiasis Leading to Ectopic Pregnancy and Subfertility: A Case for Parasitic Evaluation of Gynaecologic Patients in Schistosomiasis Endemic Areas

    PubMed Central

    Owusu-Bempah, Atta; Odoi, Alexander Tawiah; Dassah, Edward Tieru

    2013-01-01

    Female genital schistosomiasis is a significant risk factor for ectopic pregnancy and infertility in schistosomiasis-endemic areas. A case of one previous ectopic pregnancy and subsequent obstruction of the contralateral tube in a secondary subfertility patient with chronic genital schistosomiasis is presented, emphasizing the need for a detailed history and parasitic evaluation of patients presenting with ectopic pregnancy or subfertility in areas where the disease is endemic. PMID:23984134

  8. Prioritization of Susceptibility Genes for Ectopic Pregnancy by Gene Network Analysis

    PubMed Central

    Liu, Ji-Long; Zhao, Miao

    2016-01-01

    Ectopic pregnancy is a very dangerous complication of pregnancy, affecting 1%–2% of all reported pregnancies. Due to ethical constraints on human biopsies and the lack of suitable animal models, there has been little success in identifying functionally important genes in the pathogenesis of ectopic pregnancy. In the present study, we developed a random walk–based computational method named TM-rank to prioritize ectopic pregnancy–related genes based on text mining data and gene network information. Using a defined threshold value, we identified five top-ranked genes: VEGFA (vascular endothelial growth factor A), IL8 (interleukin 8), IL6 (interleukin 6), ESR1 (estrogen receptor 1) and EGFR (epidermal growth factor receptor). These genes are promising candidate genes that can serve as useful diagnostic biomarkers and therapeutic targets. Our approach represents a novel strategy for prioritizing disease susceptibility genes. PMID:26840308

  9. The Lin28/Let-7 system in early human embryonic tissue and ectopic pregnancy.

    PubMed

    Lozoya, Teresa; Domnguez, Francisco; Romero-Ruiz, Antonio; Steffani, Liliana; Martnez, Sebastin; Monterde, Mercedes; Ferri, Blanca; Nez, Maria Jose; AinhoaRomero-Espins; Zamora, Omar; Gurrea, Marta; Sangiao-Alvarellos, Susana; Vega, Olivia; Simn, Carlos; Pellicer, Antonio; Tena-Sempere, Manuel

    2014-01-01

    Our objective was to determine the expression of the elements of the Lin28/Let-7 system, and related microRNAs (miRNAs), in early stages of human placentation and ectopic pregnancy, as a means to assess the potential role of this molecular hub in the pathogenesis of ectopic gestation. Seventeen patients suffering from tubal ectopic pregnancy (cases) and forty-three women with normal on-going gestation that desired voluntary termination of pregnancy (VTOP; controls) were recruited for the study. Embryonic tissues were subjected to RNA extraction and quantitative PCR analyses for LIN28B, Let-7a, miR-132, miR-145 and mir-323-3p were performed. Our results demonstrate that the expression of LIN28B mRNA was barely detectable in embryonic tissue from early stages of gestation and sharply increased thereafter to plateau between gestational weeks 7-9. In contrast, expression levels of Let-7, mir-132 and mir-145 were high in embryonic tissue from early gestations (? 6-weeks) and abruptly declined thereafter, especially for Let-7. Opposite trends were detected for mir-323-3p. Embryonic expression of LIN28B mRNA was higher in early stages (? 6-weeks) of ectopic pregnancy than in normal gestation. In contrast, Let-7a expression was significantly lower in early ectopic pregnancies, while miR-132 and miR-145 levels were not altered. Expression of mir-323-3p was also suppressed in ectopic embryonic tissue. We are the first to document reciprocal changes in the expression profiles of the gene encoding the RNA-binding protein, LIN28B, and the related miRNAs, Let-7a, mir-132 and mir-145, in early stages of human placentation. This finding suggests the potential involvement of LIN28B/Let-7 (de)regulated pathways in the pathophysiology of ectopic pregnancy in humans. PMID:24498170

  10. Effectiveness of gefitinib in combination with methotrexate in the treatment of ectopic pregnancy

    PubMed Central

    Capmas, Perrine; Fernandez, Herv

    2015-01-01

    Medical management for ectopic pregnancy is subject to substantial variations with different protocols and various routes of administration. Regardless the protocol used, methotrexate is currently the medical treatment of choice for ectopic pregnancy. The risk of a rescue surgery is a main concern. Recently, some studies suggested combining gefitinib and methotrexate to improve medical treatment and to decrease the need for reinjection and for additional surgery. Gefitinib is an orally administered EGF receptor-tyrosine kinase inhibitor. For tubal ectopic pregnancy, median recovery time was shorter after combination treatment with gefitinib and methotrexate. Toxicity reported with combination treatment was acneiform rash in 67% of cases and diarrhea in 42%. They were always transient and are known side effects of gefitinib previously described in lung cancer. These preliminary results are very promising but need to be explored further before wide distribution. For ectopic pregnancy, combining treatment seems to be interesting but results of the first randomized trial have to be evaluated first. For other indications, such as non-tubal ectopic pregnancy or choriocarcinoma, randomized studies are needed before wide use of the combination in current practice. PMID:26170723

  11. Aberrant alteration of vascular endothelial growth factor-family signaling in human tubal ectopic pregnancy: what is known and unknown?

    PubMed

    Shao, Ruijin; Hu, Junting; Feng, Yi; Billig, Hkan

    2013-01-01

    More than 98% of ectopic pregnancies occur in the Fallopian tube. Because many facets of tubal ectopic pregnancy remain unclear, prediction, prevention and treatment of tubal ectopic pregnancy are still a major clinical challenge. Compelling evidence suggests that angiogenic growth factors are involved in normal and abnormal implantation. While acknowledging the importance of an intrauterine pregnancy requires the development of a local blood supply and angiogenesis, we hypothesize that the hypoxic- and estrogen-dependent regulation of vascular endothelial growth factor/placental growth factor expression, secretion, and signaling pathways that are possibly involved in the pathophysiology of tubal ectopic pregnancy. Our hypothesis may also lead to a new therapeutic strategy for women with tubal ectopic pregnancy. PMID:23573332

  12. Failure Rate of Single Dose Methotrexate in Managment of Ectopic Pregnancy

    PubMed Central

    Sendy, Feras; AlShehri, Eman; AlAjmi, Amani; Bamanie, Elham; Appani, Surekha; Shams, Taghreed

    2015-01-01

    Background. One of the treatment modalities for ectopic pregnancy is methotrexate. The purpose of this study is to identify the failure rate of methotrexate in treating patients with ectopic pregnancy as well as the risk factors leading to treatment failure. Methods. A retrospective chart review of 225 patients who received methotrexate as a primary management option for ectopic pregnancy. Failure of single dose of methotrexate was defined as drop of BHCG level less than or equal to 14% in the seventh day after administration of methotrexate. Results. 225 patients had methotrexate. Most of the patients (151 (67%)) received methotrexate based on the following formula: f 50?mg X body surface area. Single dose of methotrexate was successful in 72% (162/225) of the patients. 28% (63/225) were labeled as failure of single dose of methotrexate because of suboptimal drop in BhCG. 63% (40/63) of failure received a second dose of methotrexate, and 37% (23/63) underwent surgical treatment. Among patient who received initial dose of methotrexate, 71% had moderate or severe pain, and 58% had ectopic mass size of more than 4 cm on ultrasound. Conclusion. Liberal use of medical treatment of ectopic pregnancy results in 71% success rate. PMID:25861275

  13. Failure rate of single dose methotrexate in managment of ectopic pregnancy.

    PubMed

    Sendy, Feras; AlShehri, Eman; AlAjmi, Amani; Bamanie, Elham; Appani, Surekha; Shams, Taghreed

    2015-01-01

    Background. One of the treatment modalities for ectopic pregnancy is methotrexate. The purpose of this study is to identify the failure rate of methotrexate in treating patients with ectopic pregnancy as well as the risk factors leading to treatment failure. Methods. A retrospective chart review of 225 patients who received methotrexate as a primary management option for ectopic pregnancy. Failure of single dose of methotrexate was defined as drop of BHCG level less than or equal to 14% in the seventh day after administration of methotrexate. Results. 225 patients had methotrexate. Most of the patients (151 (67%)) received methotrexate based on the following formula: f 50?mg X body surface area. Single dose of methotrexate was successful in 72% (162/225) of the patients. 28% (63/225) were labeled as failure of single dose of methotrexate because of suboptimal drop in BhCG. 63% (40/63) of failure received a second dose of methotrexate, and 37% (23/63) underwent surgical treatment. Among patient who received initial dose of methotrexate, 71% had moderate or severe pain, and 58% had ectopic mass size of more than 4 cm on ultrasound. Conclusion. Liberal use of medical treatment of ectopic pregnancy results in 71% success rate. PMID:25861275

  14. Viable abdominal pregnancy: a case report in Yaound (Cameroon).

    PubMed

    Fouelifack, Florent Ymele; Fouogue, Jovanny Tsuala; Fouedjio, Jeanne Hortence; Sando, Zacharie

    2014-01-01

    We herein report a case of abdominal pregnancy managed in Yaounde (Cameroon). The 33 year old G5P2022 woman was referred to our setting for management of an abdominal pregnancy of 34 weeks diagnosed during the first routine obstetrical ultrasonography done two days earlier. This ultrasonography revealed a live foetus within intestinal loops with a severe oligoamnios. After two days of lung maturation, laparotomy was carried out and the live male baby weighed 2 600 grammes. The placenta was left on its implantation sites: omentun, uterine fundus and intestinal loops. The mother did well post-operatively and the resorption of the placenta took 11 months. The newborn presented compression deformities and died three days later of respiratory distress. This case illustrates that intra-abdominal fetuses can reach viability. Though rare, abdominal pregnancy remains a threat to mothers. Practitioners should therefore know the traps in its management. PMID:25419308

  15. 42 CFR 50.308 - Drugs and devices and termination of ectopic pregnancies.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... 42 Public Health 1 2013-10-01 2013-10-01 false Drugs and devices and termination of ectopic pregnancies. 50.308 Section 50.308 Public Health PUBLIC HEALTH SERVICE, DEPARTMENT OF HEALTH AND HUMAN SERVICES GRANTS POLICIES OF GENERAL APPLICABILITY Abortions and Related Medical Services in...

  16. 42 CFR 136a.55 - Drugs and devices and termination of ectopic pregnancies.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 42 Public Health 1 2011-10-01 2011-10-01 false Drugs and devices and termination of ectopic pregnancies. 136a.55 Section 136a.55 Public Health PUBLIC HEALTH SERVICE, DEPARTMENT OF HEALTH AND HUMAN SERVICES INDIAN HEALTH SERVICE, DEPARTMENT OF HEALTH AND HUMAN SERVICES INDIAN HEALTH Abortions and...

  17. 42 CFR 136a.55 - Drugs and devices and termination of ectopic pregnancies.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... 42 Public Health 1 2012-10-01 2012-10-01 false Drugs and devices and termination of ectopic pregnancies. 136a.55 Section 136a.55 Public Health PUBLIC HEALTH SERVICE, DEPARTMENT OF HEALTH AND HUMAN SERVICES INDIAN HEALTH SERVICE, DEPARTMENT OF HEALTH AND HUMAN SERVICES INDIAN HEALTH Abortions and...

  18. 42 CFR 136a.55 - Drugs and devices and termination of ectopic pregnancies.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... 42 Public Health 1 2013-10-01 2013-10-01 false Drugs and devices and termination of ectopic pregnancies. 136a.55 Section 136a.55 Public Health PUBLIC HEALTH SERVICE, DEPARTMENT OF HEALTH AND HUMAN SERVICES INDIAN HEALTH SERVICE, DEPARTMENT OF HEALTH AND HUMAN SERVICES INDIAN HEALTH Abortions and...

  19. 42 CFR 50.308 - Drugs and devices and termination of ectopic pregnancies.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 42 Public Health 1 2014-10-01 2014-10-01 false Drugs and devices and termination of ectopic pregnancies. 50.308 Section 50.308 Public Health PUBLIC HEALTH SERVICE, DEPARTMENT OF HEALTH AND HUMAN SERVICES GRANTS POLICIES OF GENERAL APPLICABILITY Abortions and Related Medical Services in...

  20. 42 CFR 136.55 - Drugs and devices and termination of ectopic pregnancies.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 42 Public Health 1 2010-10-01 2010-10-01 false Drugs and devices and termination of ectopic pregnancies. 136.55 Section 136.55 Public Health PUBLIC HEALTH SERVICE, DEPARTMENT OF HEALTH AND HUMAN SERVICES INDIAN HEALTH SERVICE, DEPARTMENT OF HEALTH AND HUMAN SERVICES INDIAN HEALTH Abortions and...

  1. 42 CFR 136.55 - Drugs and devices and termination of ectopic pregnancies.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 42 Public Health 1 2014-10-01 2014-10-01 false Drugs and devices and termination of ectopic pregnancies. 136.55 Section 136.55 Public Health PUBLIC HEALTH SERVICE, DEPARTMENT OF HEALTH AND HUMAN SERVICES INDIAN HEALTH SERVICE, DEPARTMENT OF HEALTH AND HUMAN SERVICES INDIAN HEALTH Abortions and...

  2. 42 CFR 136a.55 - Drugs and devices and termination of ectopic pregnancies.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 42 Public Health 1 2014-10-01 2014-10-01 false Drugs and devices and termination of ectopic pregnancies. 136a.55 Section 136a.55 Public Health PUBLIC HEALTH SERVICE, DEPARTMENT OF HEALTH AND HUMAN SERVICES INDIAN HEALTH SERVICE, DEPARTMENT OF HEALTH AND HUMAN SERVICES INDIAN HEALTH Abortions and...

  3. 42 CFR 50.308 - Drugs and devices and termination of ectopic pregnancies.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 42 Public Health 1 2010-10-01 2010-10-01 false Drugs and devices and termination of ectopic pregnancies. 50.308 Section 50.308 Public Health PUBLIC HEALTH SERVICE, DEPARTMENT OF HEALTH AND HUMAN SERVICES GRANTS POLICIES OF GENERAL APPLICABILITY Abortions and Related Medical Services in...

  4. 42 CFR 136.55 - Drugs and devices and termination of ectopic pregnancies.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... 42 Public Health 1 2013-10-01 2013-10-01 false Drugs and devices and termination of ectopic pregnancies. 136.55 Section 136.55 Public Health PUBLIC HEALTH SERVICE, DEPARTMENT OF HEALTH AND HUMAN SERVICES INDIAN HEALTH SERVICE, DEPARTMENT OF HEALTH AND HUMAN SERVICES INDIAN HEALTH Abortions and...

  5. 42 CFR 136.55 - Drugs and devices and termination of ectopic pregnancies.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 42 Public Health 1 2011-10-01 2011-10-01 false Drugs and devices and termination of ectopic pregnancies. 136.55 Section 136.55 Public Health PUBLIC HEALTH SERVICE, DEPARTMENT OF HEALTH AND HUMAN SERVICES INDIAN HEALTH SERVICE, DEPARTMENT OF HEALTH AND HUMAN SERVICES INDIAN HEALTH Abortions and...

  6. 42 CFR 50.308 - Drugs and devices and termination of ectopic pregnancies.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 42 Public Health 1 2011-10-01 2011-10-01 false Drugs and devices and termination of ectopic pregnancies. 50.308 Section 50.308 Public Health PUBLIC HEALTH SERVICE, DEPARTMENT OF HEALTH AND HUMAN SERVICES GRANTS POLICIES OF GENERAL APPLICABILITY Abortions and Related Medical Services in...

  7. 42 CFR 136.55 - Drugs and devices and termination of ectopic pregnancies.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... 42 Public Health 1 2012-10-01 2012-10-01 false Drugs and devices and termination of ectopic pregnancies. 136.55 Section 136.55 Public Health PUBLIC HEALTH SERVICE, DEPARTMENT OF HEALTH AND HUMAN SERVICES INDIAN HEALTH SERVICE, DEPARTMENT OF HEALTH AND HUMAN SERVICES INDIAN HEALTH Abortions and...

  8. 42 CFR 136a.55 - Drugs and devices and termination of ectopic pregnancies.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 42 Public Health 1 2010-10-01 2010-10-01 false Drugs and devices and termination of ectopic pregnancies. 136a.55 Section 136a.55 Public Health PUBLIC HEALTH SERVICE, DEPARTMENT OF HEALTH AND HUMAN SERVICES INDIAN HEALTH SERVICE, DEPARTMENT OF HEALTH AND HUMAN SERVICES INDIAN HEALTH Abortions and...

  9. 42 CFR 50.308 - Drugs and devices and termination of ectopic pregnancies.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... 42 Public Health 1 2012-10-01 2012-10-01 false Drugs and devices and termination of ectopic pregnancies. 50.308 Section 50.308 Public Health PUBLIC HEALTH SERVICE, DEPARTMENT OF HEALTH AND HUMAN SERVICES GRANTS POLICIES OF GENERAL APPLICABILITY Abortions and Related Medical Services in...

  10. Nonobstetric abdominal pain and surgical emergencies in pregnancy.

    PubMed

    Diegelmann, Laura

    2012-11-01

    The focus of this article is the evaluation and management of pregnant patients with nonobstetric abdominal pain and surgical emergencies. The anatomic and physiologic changes that occur during pregnancy can cause difficulties in interpreting patients' signs and symptoms in emergency departments. This article reviews some of the common causes of nonobstetric abdominal pain and surgical emergencies that present to emergency departments and discusses some of the literature surrounding the use of imaging modalities during pregnancy. After a review of these changes and their causes, imaging modalities that can be used for the assessment are discussed. PMID:23137401

  11. Aberrant sphingolipid metabolism in the human fallopian tube with ectopic pregnancy.

    PubMed

    Gao, Xiaolin; Ning, Nannan; Kong, Beihua; Xu, Yongping; Xu, Hui; Zhou, Chengjun; Li, Su; Shao, Yi; Qiu, Jianqing; Li, Jingxin

    2013-10-01

    Sphingosine 1-phosphate (S1P), a product of sphingomyelin metabolism, is generated via phosphorylation of sphingosine by sphingosine kinases (SphK). It acts via a family of G protein-coupled receptors or as an intracellular second messenger for agonists acting through the S1P receptors (S1P1-5). In our study, the expression of SphK1 and S1P1 was identified by immunohistochemistry and immunoblot. The concentration of S1P was measured using ELISA. The spontaneous contraction of isolated fallopian tube strips was determined by tension recording. Our results showed that SphK1 and S1P1 were localized in the fallopian tube epithelial cells. In addition, smooth muscle cells also contained S1P1. Compared with the intrauterine pregnancy group, SPHK1 and S1P1 were overexpressed in ectopic pregnancy. However, the S1P concentration within the human oviduct from ectopic pregnancy subjects was largely reduced than that from normal pregnancy subject. The results from tension recording indicated that exogenous and intracellularly generated S1P can regulate the spontaneous contraction of oviduct isolated from rats and human. In conclusion, the sphingolipid metabolism signal pathway functionally existed in the human fallopian tube. Aberrant sphingolipid metabolism in the human fallopian tube may be involved in ectopic pregnancy. PMID:23881382

  12. Unilateral twin tubal ectopic pregnancy in a patient following tubal surgery

    PubMed Central

    Ghanbarzadeh, Nahid; Nadjafi-Semnani, Mohammad; Nadjafi-Semnani, Ali; Nadjfai-Semnani, Fatemeh; Shahabinejad, Sima

    2015-01-01

    We report a spontaneous unilateral live tubal twin pregnancy in a patient with a history of previous ectopic pregnancy (EP) and tubal surgery. Transvaginal ultrasound showed one pregnancy sac containing two fetal poles with cardiac activity, which appeared to be sited within the right adnexum. The right tubal EP was removed by salpingectomy. Ultrasound findings of suspected adnexal mass and free liquid in the Douglas pouch along with an increased a beta-human chorionic gonadotrophin levels, especially in association of risk factors, can help the early diagnosis of EP and reduce the related mortality and morbidity. PMID:25983775

  13. A Case of Live Birth after Uterine Reconstruction for Recurrent Cornual Ectopic Pregnancy following IVF Treatment

    PubMed Central

    Maruthini, Deivanayagam; Sharma, Vinay

    2013-01-01

    We present a case of recurrent ruptured right cornual ectopic pregnancies conceived after IVF. Following the second episode, a sonohysterography was undertaken to identify possible areas of scar weakness that may rupture with uterine distension in a future pregnancy. The scan revealed asymmetrical muscle thickness in the cornual regions, the right (6?mm) being thinner than the left (1.6?cm). Subsequently, an elective laparotomy was undertaken, and the cornua were reconstructed and thickened in several layers by bringing the laterally retracted myometrial fibres onto the reconstruction site. A sono-hysterography after surgery showed satisfactory (3-4?cm) myometrial thickness all around. A further cycle of IVF resulted in a singleton pregnancy. Pelvic scans confirmed normal intrauterine pregnancy without any myometrial thinning. She was delivered by an uneventful elective caesarean section at term. We propose that, in those who intend to have further pregnancies after a cornual ectopic pregnancy, a sono-hysterography is possibly the best investigative tool to assess myometrial integrity. This case demonstrates that in women with areas of muscle weakness it is possible to successfully perform an interval elective reconstructive surgery on the uterus that can result in an uneventful pregnancy and birth. PMID:23476844

  14. The role of estrogen in the pathophysiology of tubal ectopic pregnancy.

    PubMed

    Shao, Ruijin; Feng, Yi; Zou, Shien; Weijdegrd, Birgitta; Wu, Gencheng; Brnnstrm, Mats; Billig, Hkan

    2012-01-01

    17?-estradiol, acting through estrogen receptors ? and ?, plays a fundamental role in the regulation of Fallopian tube cell homeostasis and in the modulation of normal tubal physiological processes. Fluctuations in E2 levels also play crucial roles in the initiation or progression of numerous human diseases. Fallopian tube malfunction often results in tubal ectopic pregnancy, which is one cause of maternal morbidity and mortality in women. Several factors have been proposed to be associated with increased risk of tubal ectopic pregnancy, but whether these factors are the cause of, or are merely symptoms of, such pregnancies remains unresolved due to the lack of knowledge in regards to the mechanisms by which embryos inadvertently implant in the Fallopian tube. This review summarizes recent findings, including data from our own laboratory, on E2 metabolism and estrogen receptor (ER) subtype expression within the Fallopian tube in humans and rodents. This review also outlines several important, unresolved questions in the field that, once addressed, could offer important clues into how E2/ER signaling contributes to the pathology of tubal function. A better understanding of the specific functions of estrogen receptor subtypes in vivo, as well as of the mechanism and consequences of receptor subtype interactions is critical to understanding their respective roles in Fallopian tube physiology and in the pathophysiology and etiology of tubal ectopic pregnancy. PMID:22937205

  15. Predictive value of maternal serum ?-hCG concentration in the ruptured tubal ectopic pregnancy

    PubMed Central

    Faraji Darkhaneh, Roya; Asgharnia, Maryam; Farahmand Porkar, Nastaran; Alipoor, Ali Akbar

    2015-01-01

    Background: Measurement of serum ?-hCG concentration commonly used to diagnose tubal ectopic pregnancy (EP) and follow up patients treated conservatively. Objective: The aim of this study was to determine the predictive value of maternal serum ?-hCG concentration in ruptured tubal ectopic pregnancy to help physicians identify those women who are at greatest risk. Materials and Methods: This is a cross-sectional study conducted on all women with a diagnosis of tubal ectopic pregnancy who were treated in Alzahra Hospital, in Rasht, from March 2002 to February 2011. The data was collected for each woman from medical records and included age, parity, gravidia, gestational age, primary level of serum ?-hCG, rupture status, past history of pelvic inflammation disease, EP, abortion, and intrauterine contraceptive device use. Women with tubal rupture were compared to those without rupture. Statistical analysis was conducted by SPSS 19 for Windows. Results: A total of 247 cases of tubal ectopic pregnancy were recorded during the study period. One hundred and ninety seven (79.8%) were cases with unruptured EP and 50 patients (20.2 %) were cases with ruptured EP. The mean level of ?-hCG was significantly higher in patients with ruptured EP compared to patients with unruptured EP (p=0.03). Logistic regression analysis revealed that >1750 IU/ml of ?-hCG levels (OR: 1.41; 95% CI: 1.18-1.68) was the significant risk factors for tubal rupture. Conclusion: Higher ?-hCG levels seem to be significant risk factors for rupture of a tubal EP. PMID:25999999

  16. Enterobius vermicularis salpingitis seen in the setting of ectopic pregnancy in a Malaysian patient.

    PubMed

    Ngui, Romano; Ravindran, Sarala; Ong, Diana Bee Lan; Chow, Tak Kuan; Low, Kah Pin; Nureena, Zaidi Syeda; Rajoo, Yamuna; Chin, Yuee Teng; Amir, Amirah; Ahmad, Arine Fadzlun; Lim, Yvonne Ai Lian; Mahmud, Rohela

    2014-09-01

    We report a rare and unusual case of invasive Enterobius vermicularis infection in a fallopian tube. The patient was a 23-year-old Malaysian woman who presented with suprapubic pain and vaginal bleeding. A clinical diagnosis of ruptured right ovarian ectopic pregnancy was made. She underwent a laparotomy with a right salpingo-oophorectomy. Histopathological examination of the right fallopian tube showed eggs and adult remnants of E. vermicularis, and the results were confirmed using PCR and DNA sequencing. PMID:24989613

  17. Enterobius vermicularis Salpingitis Seen in the Setting of Ectopic Pregnancy in a Malaysian Patient

    PubMed Central

    Ravindran, Sarala; Ong, Diana Bee Lan; Chow, Tak Kuan; Low, Kah Pin; Nureena, Zaidi Syeda; Rajoo, Yamuna; Chin, Yuee Teng; Amir, Amirah; Ahmad, Arine Fadzlun; Lim, Yvonne Ai Lian

    2014-01-01

    We report a rare and unusual case of invasive Enterobius vermicularis infection in a fallopian tube. The patient was a 23-year-old Malaysian woman who presented with suprapubic pain and vaginal bleeding. A clinical diagnosis of ruptured right ovarian ectopic pregnancy was made. She underwent a laparotomy with a right salpingo-oophorectomy. Histopathological examination of the right fallopian tube showed eggs and adult remnants of E. vermicularis, and the results were confirmed using PCR and DNA sequencing. PMID:24989613

  18. Screening for chlamydial infections and the risk of ectopic pregnancy in a county in Sweden: ecological analysis

    PubMed Central

    Egger, Matthias; Low, Nicola; Smith, George Davey; Lindblom, Bo; Herrmann, Bjrn

    1998-01-01

    Objectives: To analyse trends in rates of genital chlamydial infection and ectopic pregnancy between 1985 and 1995 in a county in Sweden. Setting: Uppsala county where screening for chlamydial infection, treatment, and contact tracing has been widespread and where ectopic pregnancies are recorded. Methods: Rates of chlamydial infections and ectopic pregnancy between 1985 and 1995 were calculated for women aged 20-39 years. Poisson and linear regression were used to examine the association between the risk of ectopic pregnancy and the current rates of chlamydial infection and rates of chlamydial infection from up to 5 years earlier. Main outcome measures: Rates of chlamydial infection per 100 examinations, rates of ectopic pregnancy per 1000 pregnancies, rate ratios and 95% confidence intervals for an increase in chlamydial infections of 5 new cases per 100 examinations. Results: 103?870 cervical samples from women aged 15-39 years were analysed; 5648 (5.4%) were positive for chlamydia. 51?630 pregnancies were analysed; 930 (1.8%) were ectopic. Both rates declined over time. For women aged 20-24 years there was a strong correlation between the rate of ectopic pregnancy and the rate of chlamydial infection in the same year (r=0.93, P<0.001); among older women correlations were stronger with rates of chlamydial infection occurring 1 or 2 years earlier. In Poisson regression ectopic pregnancy was most strongly associated with the current rate of chlamydial infection among women aged 20-24 (rate ratio 1.85, 95% confidence interval 1.44 to 2.38), with the rate of infection 1 year earlier among 25-29 year olds (rate ratio 1.72, 1.33 to 2.22) and 30-34 year olds (rate ratio 2.27, 1.53 to 3.37); and with the rate 2 years earlier among 35 to 39 year olds (rate ratio 2.58, 1.45 to 4.60). Conclusions: Declining rates of genital chlamydial infections have probably led to a fall in the rate of ectopic pregnancies. The timing of the decline in the rate of ectopic pregnancies varies with age. Among young women falling rates of chlamydial infection have been accompanied by an immediate reduction in the rate of ectopic pregnancy. Key messages The effect of measures to diagnose and treat genital chlamydial infections on the risk of ectopic pregnancy was examined in a county in Sweden Rates of chlamydial infection and ectopic pregnancy both declined between 1985 and 1995 Chlamydial infections seem to be the main cause of ectopic pregnancy in young women; the risk of ectopic pregnancy decreased concurrently with the decline in chlamydial infections In older women the associations were less pronounced PMID:9624063

  19. Ectopic Pregnancy Among American Indian and Alaska Native Women, 20022009

    PubMed Central

    Folkema, Arianne; Tulloch, Scott; Taylor, Melanie; Reilley, Brigg; Hoover, Karen; Holman, Robert; Creanga, Andreea

    2015-01-01

    To examine rates of ectopic pregnancy (EP) among American Indian and Alaska Native (AI/AN) women aged 1544 years seeking care at Indian Health Service (IHS), Tribal, and urban Indian health facilities during 20022009. We used 20022009 inpatient and outpatient data from the IHS National Patient Information Reporting System to identify EP-associated visits and obtain the number of pregnancies among AI/AN women. Repeat visits for the same EP were determined by calculating the interval between visits; if more than 90 days between visits, the visit was considered related to a new EP. We identified 229,986 pregnancies among AI/AN women 1544 years receiving care at IHS-affiliated facilities during 20022009. Of these, 2,406 (1.05 %) were coded as EPs, corresponding to an average annual rate of 10.5 per 1,000 pregnancies. The EP rate among AI/AN women was lowest in the 1519 years age group (5.5 EPs per 1,000 pregnancies) and highest among 3539 year olds (18.7 EPs per 1,000 pregnancies). EP rates varied by geographic region, ranging between 6.9 and 24.4 per 1,000 pregnancies in the Northern Plains East and the East region, respectively. The percentage of ectopic pregnancies found among AI/AN women is within the national 12 % range. We found relatively stable annual rates of EP among AI/AN women receiving care at IHS-affiliated facilities during 20022009, but considerable variation by age group and geographic region. Coupling timely diagnosis and management with public health interventions focused on tobacco use and sexually transmitted diseases may provide opportunities for reducing EP and EP-associated complications among AI/AN women. PMID:25023759

  20. Role of activins in embryo implantation and diagnosis of ectopic pregnancy: a review.

    PubMed

    Refaat, Bassem

    2014-01-01

    Embryo implantation is a major prerequisite for the successful establishment of pregnancy. Ectopic implantation outside the intrauterine cavity and the development of ectopic pregnancy (EP) is a major cause of maternal morbidity and occasionally mortality during the first trimester. EP may be induced by failure of tubal transport and/or increased tubal receptivity. Activins, their type II receptors and follistatin have been localised in the human endometrial and tubal epithelium and they are major regulators of endometrial and tubal physiology during the menstrual cycle. Pathological expression of activins and their binding protein, follistatin, was observed in tissue and serum samples collected from EP. Several studies with different designs investigated the diagnostic value of a single measurement of serum activin-A in the differentiation between normal intrauterine and failing early pregnancy and the results are controversial. Nevertheless, the diagnostic value of activins in EP, including the other activin isoforms (activin-B and -AB) and follistatin, merits further research. This review appraises the data to date researching the role of activins in the establishment of normal pregnancy and, pathogenesis and diagnosis of tubal EP. PMID:25421645

  1. Comparison of Two Different Protocols of Methotrexate Therapy in Medical Management of Ectopic Pregnancy

    PubMed Central

    Saadati, Najmieh; Najafian, Mahin; Masihi, Sara; Safiary, Sara; Abedi, Parvin

    2015-01-01

    Background: Ectopic pregnancy (EP) is one of the most dangerous complications of pregnancy and without prompt diagnosis and treatment, it could become a major cause of maternal morbidity and mortality. Objectives: In this randomized controlled study, we compared single and double dose of methotrexate (MTX) therapy in the treatment of ectopic pregnancy. Patients and Methods: This study was performed on 76 patients who were admitted to Obstetrics Ward with primary diagnosis of ectopic pregnancy based on their medical history, physical examination, beta subunit (?-HCG) level, and transvaginal ultrasonography. Using random block allocation, the patients were classified in two groups of single dose and double dose administration of MTX. In single dose group, 50 mg/m2 of MTX was given at day 0 and in double dose group, the patients received two doses of MTX at day 0 and 4. The level of ?-HCG was measured at day 0, 4, 7 in both groups. The successful treatment was defined as 15% reduction in ?-HCG level between day 4 and 7. The two groups were compared with each other with regard to their need for operation, or extra dose of MTX; duration of hospitalization; and MTX complications. Results: Results showed that the rate of success in double dose method was more than single dose one (79% versus 69%) but the difference was not significant (P = 0.29). Although the need for operation and extra dose of MTX were lower in the double dose group (15.8% vs. 18.8% and 5.26% vs. 13.2%, respectively), these differences were not significant too. Duration of hospitalization was significantly lower in double dose compared to the single dose (11.55 d vs. 14.76 d, P < 0.001). Conclusions: Single dose therapy of MTX has sufficient power and efficacy in the treatment of ectopic pregnancy, however in patients with higher serum level of ?-HCG, the successful treatment increases by using double dose method. Using double dose also could decrease the necessity of operation, re-administration of MTX, and duration of hospitalization. PMID:26756008

  2. Reproductive Outcomes Following Ectopic Pregnancy: Register-Based Retrospective Cohort Study

    PubMed Central

    Bhattacharya, Sohinee; McLernon, David J; Lee, Amanda J; Bhattacharya, Siladitya

    2012-01-01

    Background We aimed to compare reproductive outcomes following ectopic pregnancy (EP) versus livebirth, miscarriage, or termination in a first pregnancy. Methods And Findings A retrospective cohort study design was used. Scottish national data on all women whose first pregnancy occurred between 1981 and 2000 were linked to records of a subsequent pregnancy. The exposed cohort comprised women with an EP in their first pregnancy. There were three unexposed cohorts: women with livebirth, miscarriage, and termination of their first pregnancies. Any differences in rates of second pregnancy, livebirth, EP, miscarriage, or terminations and complications of a second ongoing pregnancy and delivery were assessed among the different exposure groups. A total of 2,969 women had an initial EP; 667,299 had a livebirth, 39,705 women miscarried, and 78,697 terminated their first pregnancies. Women with an initial EP had an increased chance of another pregnancy within 2 years (adjusted hazard ratio (AHR) 2.76 [95% CI 2.582.95]) or after 6 years (AHR 1.57 [95% CI 1.291.91]) compared to women with a livebirth. In comparison with women with an initial miscarriage, women who had an EP had a lower chance of a second pregnancy (AHR 0.53 [95% CI 0.500.56]). Compared to women with an initial termination, women with an EP had an increased chance of a second pregnancy (AHR 2.38 [95% CI 2.232.55]) within 2 years. Women with an initial EP suffered an increased risk of another EP compared to women with a livebirth (AHR 13.0 [95% CI 11.6316.86]), miscarriage (AHR 6.07 [95% CI 4.837.62]), or termination (AHR 12.84 [95% CI 10.0716.37]). Perinatal complications in a pregnancy following EP were not significantly higher than those in primigravidae or in women with a previous miscarriage or termination. Conclusion Women with an initial EP have a lower chance of conception than those who miscarry but an increased risk of a repeat EP in comparison with all three comparison groups. A major limitation of this study was the inability to separate women using contraception from those who were intending to conceive. Please see later in the article for the Editors' Summary PMID:22723747

  3. Life-threatening complications following multidose methotrexate for medical management of ectopic pregnancy

    PubMed Central

    Dasari, Papa; Sagili, Haritha

    2012-01-01

    A 25-year-old primigravida was diagnosed to be suffering from unruptured ectopic pregnancy. The serum ?-human chorionic gonadotropin levels were 2851?mIU/l and the ectopic gestational sac was 2.72.7?cm without any fetal pole. It was decided to manage her by expectant therapy. But she received medical therapy with multidose methotrexate because of misinterpretation of expectant therapy as medical therapy. She suffered from methotrexate toxicity, which manifested as high-grade fever, vomiting, melena, oral ulcerations, pneumonitis, subconjunctival haemorrhages and skin pigmentation. She developed severe third space fluid collection and shock, which was mistaken for rupture ectopic gestation. Her haematological picture showed severe neutropaenia and thrombocytopaenia which confirmed the clinical picture to be due to methotrexate toxicity. She also developed septicaemia and candidal infection secondary to immunosuppression. She was managed in intensive care unit with ventilatory support, high-dose leucovorin and injection filgastrim. She responded well to the therapy with dramatic recovery in 4?days. PMID:22922914

  4. Minimally invasive surgery to manage a complicated case of a caesarean scar ectopic pregnancy

    PubMed Central

    Ong, Xiaohui; Mathur, Manisha

    2014-01-01

    A 30-year-old woman, gravida 3 para 1, presented at 5?weeks of amenorrhoea with vaginal spotting and mild abdominal pain. A transvaginal scan confirmed a caesarean scar pregnancy (CSP). Serum hCG level at presentation was 4357. She declined treatment initially, but eventually underwent laparoscopic-guided suction curettage and excision of CSP. hCG was undetectable at 5?weeks postoperatively. She had an uneventful recovery and was advised to take oral contraceptives. PMID:24503665

  5. The Importance of Gestational Sac Size of Ectopic Pregnancy in Response to Single-Dose Methotrexate

    PubMed Central

    Kimiaei, Parichehr; Khani, Zahra; Marefian, Azadeh; Gholampour Ghavamabadi, Maryam; Salimnejad, Maryam

    2013-01-01

    This retrospective cohort study was designed in a selective group of 185 patients diagnosed with and treated for ectopic pregnancy. Intramuscular administration of a single dose of methotrexate (50?mg/m2) was performed to measure predictors of failure or resistance to treatment necessitating surgical intervention. During the time of treatment with a single dose of MTX, 20 patients (10.8%) failed to response, in which 6 of 20 (30%) indicated side effects to MTX and rupture of the ectopic pregnancy. Remaining cases (n = 14) showed resistance to the drug; the level of ?-hCG did not fall at least 15% during 7 days after treatment and necessitated laparotomy. In backward-step analysis by multiple logistic regressions of various types of predictor factors, size of gestational sac (coefficient = 1.91, OR = 6.78, 95% confidence interval = 3.188.22) and baseline level ?-hCG (coefficient = 1.60, OR = 5.0, 95% confidence interval = 4.266.72) had significant correlation with leading EP patients failing to response to MTX. This study suggests that further investigation for finding relative contraindications of MTX treatment in EP women should be considered on the gestational sac size because other variables are in the causal pathway of this variable. PMID:23762575

  6. Magnetic Resonance Imaging as an Adjunct to Ultrasound in Evaluating Cesarean Scar Ectopic Pregnancy

    PubMed Central

    Wu, Rebecca; Klein, Michelle A.; Mahboob, Sabrina; Gupta, Mala; Katz, Douglas S.

    2013-01-01

    Cesarean scar pregnancies (CSPs) are a relatively rare form of ectopic pregnancy in which the embryo is implanted within the fibrous scar of a previous cesarean section. A greater number of cases of CSPs are currently being reported as the rates of cesarean section are increasing globally and as detection of scar pregnancy has improved with use of transvaginal ultrasound (TVUS) with color Doppler imaging. Delayed diagnosis and management of this potentially life-threatening condition may result in complications, predominantly uterine rupture and hemorrhage with significant potential maternal morbidity. Diagnosis of a cesarean scar pregnancy (CSP) requires a high index of clinical suspicion, as up to 40% of patients may be asymptomatic. TVUS has a reported sensitivity of 84.6% and has become the imaging examination of choice for diagnosis of a CSP. Magnetic resonance imaging (MRI) has been used in a small number of patients as an adjunct to TVUS. In the present report, MRI is highlighted as a problem-solving tool capable of more precisely identifying the relationship of a CSP to adjacent structures, thereby providing additional information critical to directing appropriate patient management and therapy. PMID:23814688

  7. A Case of Recurrent Rudimentary Horn Ectopic Pregnancies Managed by Methotrexate Therapy and Laparoscopic Excision of the Rudimentary Horn

    PubMed Central

    Moawad, Gaby N.; Abi Khalil, Elias D.

    2016-01-01

    This report presents a case of a 31-year-old woman successfully treated medically for a noncommunicating rudimentary horn ectopic pregnancy who presented with a second, successive rudimentary horn pregnancy. Patient underwent laparoscopic excision of right rudimentary horn and right salpingectomy after failed methotrexate therapy. Given the potential for rupture and recurrence, serious efforts should be made to excise a uterine rudimentary horn. PMID:26966602

  8. Diagnostic value of the plasmatic ADM level for early ectopic pregnancy

    PubMed Central

    Yan, Qi; Lu, Qi; Tao, Yu; Wang, Yu-Dong; Zhao, Wen-Xia

    2015-01-01

    Objective: To analyze the plasmatic ADM level in early pregnancy and to investigate the diagnostic value of ADM in early ectopic pregnancy (EP). Methods: 70 patients with EP who had menopause for 5~8 weeks were included as study group, while 155 women with normal intrauterine pregnancy were also included as control group. The correlation between ADM level and menopause weeks was statistically analyzed and ROC curve was used to identify the diagnostic value of ADM. Results: (1) In 155 cases of normal intrauterine pregnancy, the plasmatic ADM level was increased with menopause weeks in linear relationship, and the correlation coefficient (R) was 0.991 (P<0.05). In 70 patients with EP, no significant increase was found with menopause weeks and no linear relationship can be found between ADM level and menopause weeks in EP group. The correlation coefficient (R) was 0.744 (P>0.05). (2) The multiple of median of plasmatic ADM level in EP group of menopause for 8 weeks was obviously lower than the intrauterine control group (P<0.01). (3) ROC curve was used to analyze the cut-off value of ADM level in the diagnosis of EP, and the area under the ROC curve was 0.523 (P>0.05) regardless of menopause weeks, however, the area under the ROC curve was 0.702 (P<0.05) at 8 weeks after menopause with sensitivity of 53.50% and specificity of 85.00%. Conclusions: Different from normal intrauterine pregnancy, plasmatic ADM level in early EP was relatively lower and no significant increase was found with menopause weeks; further studies are still needed for plasmatic ADM level as an indicator in the early diagnosis of EP. PMID:26823809

  9. The efficacy of the systemic methotrexate treatment in caesarean scar ectopic pregnancy: A quantitative review of English literature.

    PubMed

    Bodur, S; zdamar, ; K?l?, S; Gn, I

    2015-04-01

    To determine the efficacy and safety of primary medical treatment with systemic methotrexate (MTX) in caesarean scar ectopic pregnancy, we conducted a Medline/PubMed search on the relevant English literature from January 1978 to January 2012. The search yielded 27 publications of 40 cases of caesarean scar ectopic pregnancy. The literature search showed a very liberal use of systemic MTX treatment with unfavourable outcomes, although the major determinant of the clinical efficacy was found in here to be ?-hCG level together with embryonic cardiac activity (ECA) status. A caesarean scar ectopic pregnancy presented with a serum ?-hCG concentration of ? 12,000 mIU/ml (odds ratio, OR 5.68, 95% confidence interval, CI, 1.37-23.48) and absence of ECA (OR 4.80, 95% CI, 1.14-20.08) was found to be associated with higher efficacy rate of primary systemic MTX treatment. Administration of primary systemic MTX treatment was found to be ideal for a caesarean scar ectopic pregnancy presented before 8 weeks' gestation, with a ?-hCG concentration of ? 12,000 mIU/ml together with an absent ECA (OR 14.52, 95% CI, 2.36-89.09). PMID:25259651

  10. The regulation of nitric oxide synthase isoform expression in mouse and human fallopian tubes: potential insights for ectopic pregnancy.

    PubMed

    Hu, Junting; Ma, Shulan; Zou, Sien; Li, Xin; Cui, Peng; Weijdegrd, Birgitta; Wu, Gencheng; Shao, Ruijin; Billig, Hkan; Feng, Yi

    2015-01-01

    Nitric oxide (NO) is highly unstable and has a half-life of seconds in buffer solutions. It is synthesized by NO-synthase (NOS), which has been found to exist in the following three isoforms: neuro nitric oxide synthase (nNOS), inducible nitric oxide synthase (iNOS), and endothelial nitric oxide synthase (eNOS). NOS activity is localized in the reproductive tracts of many species, although direct evidence for NOS isoforms in the Fallopian tubes of mice is still lacking. In the present study, we investigated the expression and regulation of NOS isoforms in the mouse and human Fallopian tubes during the estrous and menstrual cycles, respectively. We also measured isoform expression in humans with ectopic pregnancy and in mice treated with lipopolysaccharide (LPS). Our results confirmed the presence of different NOS isoforms in the mouse and human Fallopian tubes during different stages of the estrous and menstrual cycles and showed that iNOS expression increased in the Fallopian tubes of women with ectopic pregnancy and in LPS-treated mice. Elevated iNOS activity might influence ovulation, cilia beats, contractility, and embryo transportation in such a manner as to increase the risk of ectopic pregnancy. This study has provided morphological and molecular evidence that NOS isoforms are present and active in the human and mouse Fallopian tubes and suggests that iNOS might play an important role in both the reproductive cycle and infection-induced ectopic pregnancies. PMID:25546387

  11. Pre-eclampsia renamed and reframed: Intra-abdominal hypertension in pregnancy.

    PubMed

    Sawchuck, Diane J; Wittmann, Bernd K

    2014-11-01

    This hypothesis proposes pre-eclampsia is caused by intra-abdominal hypertension in pregnancy. Sustained or increasing intra-abdominal pressure ?12mmHg causes impaired venous return to the heart, systemic vascular resistance, ischemia reperfusion injury, intestinal permeability, translocation of lipopolysaccharide endotoxin to the liver, cytotoxic immune response, systemic inflammatory response, pressure transmission to thoracic and intra-cranial compartments, and multi-organ dysfunction. This hypothesis is predicated on Pascal's law, evidence founded in the intra-abdominal hypertension literature, and the adapted equation ?IAP-P=?IAVF/Cab, where ?IAP-P=change in intra-abdominal pressure in pregnancy, ?IAVF=change in intra-abdominal vector force (volume and force direction) and Cab=abdominal compliance. Factors causing increased intra-abdominal pressure in pregnancy include: progressive uterine expansion, obstetrical factors that increase intra-uterine volume excessively or acutely, maternal anthropometric measurements that affect intra-abdominal pressure thresholds, maternal postures that increase abdominal force direction, abdominal compliance that is decreased, diminished with advancing gestation, or has reached maximum expansion, habitation at high altitude, and rapid drops in barometric pressure. We postulate that the threshold for lipopolysaccharide translocation depends on the magnitude of intra-abdominal pressure, the intestinal microbiome complex, and the degree of intestinal permeability. We advance that delivery cures pre-eclampsia through the mechanism of abdominal decompression. PMID:25189485

  12. Intact removal of spontaneous twin ectopic Caesarean scar pregnancy by office hysteroscopy: case report and literature review.

    PubMed

    Mollo, Antonio; Alviggi, Carlo; Conforti, Alessandro; Insabato, Luigi; De Placido, Giuseppe

    2014-11-01

    Caesarean scar pregnancy is a dangerous condition that occurs when an embryo is implanted in a previous Caesarean scar. This condition has become more frequent as a direct consequence of the increased number of Caesarean sections reported worldwide. Timely diagnosis of this condition is fundamental, and allows a conservative approach to preserving fertility. A wide range of medical and surgical strategies has been described, with no consensus on preferred management. Recently, hysteroscopic surgery has been proposed as a conservative strategy, with interesting results in reproductive outcome, postoperative course and success rate. Most cases of Caesarean scar pregnancy reported worldwide involve a singleton pregnancy. A peculiar case of fully documented office hysteroscopic removal of twin Caesarean scar pregnancy is presented in this paper. This procedure took place in a tertiary care university hospital without cervix dilatation, under conscious sedation, after failure of systemic methotrexate administration. Complete removal of the ectopic pregnancy was obtained without intra- and postoperative complications. PMID:25246120

  13. Ectopic Pregnancy-Derived Human Trophoblastic Stem Cells Regenerate Dopaminergic Nigrostriatal Pathway to Treat Parkinsonian Rats

    PubMed Central

    Hsieh, Tsung-Hsun; Chen, Jia-Jin Jason; Wang, Yu-Chih; Kao, Mi-Chun; Wu, Ruey-Meei; Singh, Sher; Tsai, Eing-Mei; Lee, Jau-Nan

    2012-01-01

    Background Stem cell therapy is a potential strategy to treat patients with Parkinsons disease (PD); however, several practical limitations remain. As such, finding the appropriate stem cell remains the primary issue in regenerative medicine today. We isolated a pre-placental pluripotent stem cell from the chorionic villi of women with early tubal ectopic pregnancies. Our objectives in this study were (i) to identify the characteristics of hTS cells as a potential cell source for therapy; and (ii) to test if hTS cells can be used as a potential therapeutic strategy for PD. Methods and Findings hTS cells expressed gene markers of both the trophectoderm (TE) and the inner cell mass (ICM). hTS cells exhibited genetic and biological characteristics similar to that of hES cells, yet genetically distinct from placenta-derived mesenchymal stem cells. All-trans retinoic acid (RA) efficiently induced hTS cells into trophoblast neural stem cells (tNSCs) in 1-day. Overexpression of transcription factor Nanog was possibly achieved through a RA-induced non-genomic c-Src/Stat3/Nanog signaling pathway mediated by the subcellular c-Src mRNA localization for the maintenance of pluripotency in tNSCs. tNSC transplantation into the lesioned striatum of acute and chronic PD rats not only improved behavioral deficits but also regenerated dopaminergic neurons in the nigrostriatal pathway, evidenced by immunofluorescent and immunohistological analyses at 18-weeks. Furthermore, tNSCs showed immunological advantages for the application in regenerative medicine. Conclusions We successfully isolated and characterized the unique ectopic pregnancy-derived hTS cells. hTS cells are pluripotent stem cells that can be efficiently induced to tNSCs with positive results in PD rat models. Our data suggest that the hTS cell is a dynamic stem cell platform that is potentially suitable for use in disease models, drug discovery, and cell therapy such as PD. PMID:23285066

  14. Intra-abdominal hypertension and abdominal compartment syndrome in burns, obesity, pregnancy, and general medicine.

    PubMed

    Malbrain, Manu L N G; De Keulenaer, Bart L; Oda, Jun; De Laet, Inneke; De Waele, Jan J; Roberts, Derek J; Kirkpatrick, Andrew W; Kimball, Edward; Ivatury, Rao

    2015-01-01

    Intra-abdominal hypertension (IAH) is an important contributor to early organ dysfunction in trauma and sepsis. However, relatively little is known about the impact of intra-abdominal pressure (IAP) in general internal medicine, pregnant patients, and those with obesity or burns. The aim of this paper is to review the pathophysiologic implications and treatment options for IAH in these specific situations. A MEDLINE and PubMed search was performed and the resulting body-of-evidence included in the current review on the basis of relevance and scientific merit. There is increasing awareness of the role of IAH in different clinical situations. Specifically, IAH will develop in most (if not all) severely burned patients, and may contribute to early mortality. One should avoid over-resuscitation of these patients with large volumes of fluids, especially crystalloids. Acute elevations in IAP have similar effects in obese patients compared to non-obese patients, but the threshold IAP associated with organ dysfunction may be higher. Chronic elevations in IAP may, in part, be responsible for the pathogenesis of obesity-related co-morbid conditions such as hypertension, pseudotumor cerebri, pulmonary dysfunction, gastroesophageal reflux disease, and abdominal wall hernias. At the bedside, measuring IAP and considering IAH in all critical maternal conditions is essential, especially in preeclampsia/eclampsia where some have hypothesized that IAH may have an additional role. IAH in pregnancy must take into account the precautions for aorto-caval compression and has been associated with ovarian hyperstimulation syndrome. Recently, IAP has been associated with the cardiorenal dilemma and hepatorenal syndrome, and this has led to the recognition of the polycompartment syndrome. In conclusion, IAH and ACS have been associated with several patient populations beyond the classical ICU, surgical, and trauma patients. In all at risk conditions the focus should be on the early recognition of IAH and prevention of ACS. Patients at risk for IAH should be identified early through measurements of IAP. Appropriate actions should be taken when IAP increases above 15 mm Hg, especially if pressures reach above 20 mm Hg with new onset organ failure. Although non-operative measures come first, surgical decompression must not be delayed if these fail. Percutaneous drainage of ascites is a simple and potentially effective tool to reduce IAP if organ dysfunction develops, especially in burn patients. Escharotomy may also dramatically reduce IAP in the case of abdominal burns. PMID:25973659

  15. A 26-year-old retained demised abdominal pregnancy presenting with umbilical fistula.

    PubMed

    Daniel, Nnadi; Bashir, Bello; Ibrahim, Ango; Swati, Singh

    2014-01-01

    This is a report on a 72-year-old postmenopausal woman who presented with passage of fetal bones through an umbilical fistula. She was diagnosed as a case of demised abdominal pregnancy, which had been retained for 26 years. She subsequently had exploratory laparotomy, evacuation of the abdominal pregnancy, hysterectomy, and bowel resection. The patient's condition remained unstable throughout the postoperative period and she died from septicemia on the eleventh day. PMID:24639908

  16. A comparison of methotrexate versus laparoscopic surgery for the treatment of ectopic pregnancy: a cost analysis.

    PubMed

    Yao, M; Tulandi, T; Kaplow, M; Smith, A P

    1996-12-01

    This study was a cost analysis of direct medical costs of the methotrexate management versus laparoscopic surgery in the treatment of ectopic pregnancy. A total of 40 patients treated from January 1991 to October 1994 with methotrexate were compared with another 40 patients treated at the same hospital by laparoscopy from April 1986 to June 1994. Medical records for all these patients were received and hospital databases were used to retrieve information on cost. Treatment cost included the primary treatment, hospitalization and outpatient follow-up necessitated by treatment, complications and secondary treatment in cases of treatment failure. The cost related to diagnosis was excluded. The direct medical costs for methotrexate and laparoscopy groups were based on success rates of 72.5 and 95% respectively. The total cost of methotrexate treatment was Canadian $35,180 compared with Canadian $73,440 for the laparoscopic treatment. The mean +/- SD cost per patient was Canadian $880 +/- 160 in the methotrexate group compared with Canadian $1,840 +/- 150 in the laparoscopic group (P < 0.001). The mean +/- SE cost per patient with methotrexate success was Canadian $330 +/- 67 compared with Canadian $2,330 +/- 220 per patient with methotrexate failure (P = 0.001). A complete assessment of methotrexate treatment, including cost-benefit and cost-effectiveness, is warranted. PMID:9021386

  17. Cesarean Section and Rate of Subsequent Stillbirth, Miscarriage, and Ectopic Pregnancy: A Danish Register-Based Cohort Study

    PubMed Central

    O'Neill, Sinad M.; Agerbo, Esben; Kenny, Louise C.; Henriksen, Tine B.; Kearney, Patricia M.; Greene, Richard A.; Mortensen, Preben Bo; Khashan, Ali S.

    2014-01-01

    Background With cesarean section rates increasing worldwide, clarity regarding negative effects is essential. This study aimed to investigate the rate of subsequent stillbirth, miscarriage, and ectopic pregnancy following primary cesarean section, controlling for confounding by indication. Methods and Findings We performed a population-based cohort study using Danish national registry data linking various registers. The cohort included primiparous women with a live birth between January 1, 1982, and December 31, 2010 (n?=?832,996), with follow-up until the next event (stillbirth, miscarriage, or ectopic pregnancy) or censoring by live birth, death, emigration, or study end. Cox regression models for all types of cesarean sections, sub-group analyses by type of cesarean, and competing risks analyses for the causes of stillbirth were performed. An increased rate of stillbirth (hazard ratio [HR] 1.14, 95% CI 1.01, 1.28) was found in women with primary cesarean section compared to spontaneous vaginal delivery, giving a theoretical absolute risk increase (ARI) of 0.03% for stillbirth, and a number needed to harm (NNH) of 3,333 women. Analyses by type of cesarean section showed similarly increased rates for emergency (HR 1.15, 95% CI 1.01, 1.31) and elective cesarean (HR 1.11, 95% CI 0.91, 1.35), although not statistically significant in the latter case. An increased rate of ectopic pregnancy was found among women with primary cesarean overall (HR 1.09, 95% CI 1.04, 1.15) and by type (emergency cesarean, HR 1.09, 95% CI 1.03, 1.15, and elective cesarean, HR 1.12, 95% CI 1.03, 1.21), yielding an ARI of 0.1% and a NNH of 1,000 women for ectopic pregnancy. No increased rate of miscarriage was found among women with primary cesarean, with maternally requested cesarean section associated with a decreased rate of miscarriage (HR 0.72, 95% CI 0.60, 0.85). Limitations include incomplete data on maternal body mass index, maternal smoking, fertility treatment, causes of stillbirth, and maternally requested cesarean section, as well as lack of data on antepartum/intrapartum stillbirth and gestational age for stillbirth and miscarriage. Conclusions This study found that cesarean section is associated with a small increased rate of subsequent stillbirth and ectopic pregnancy. Underlying medical conditions, however, and confounding by indication for the primary cesarean delivery account for at least part of this increased rate. These findings will assist women and health-care providers to reach more informed decisions regarding mode of delivery. Please see later in the article for the Editors' Summary PMID:24983970

  18. The value of ratio of hCG, progesterone in local blood of pregnancy location versus venous blood in the diagnosis of ectopic pregnancy

    PubMed Central

    Lu, Qi; Li, Yuhong; Shi, Hong; Lang, Xiao; Wang, Yudong

    2015-01-01

    Objective: The aim of this study is to combine the ratios of venous serum/colporrhagia and hemoperitoneum/venous serum of human chorionic gonadotropin (hCG) and Progesterone (P) to generate and evaluate a new method to improve the prognosis of Ectopic pregnancy (EP). Methods: For patients with curettage procedure, curettage material and venous blood were obtained at the same time. For patients receiving culdocentesis and laparoscopic exploration, abdominal fluid and venous blood samples were obtained synchronously during surgery. Results: The sensitivity and specificity of Rp/v-hCG>1.0 and Rp/v-P>1.0 for diagnosis of EP was 88.2% and 80.71%, 93.8% and 87.53%, respectively. The sensitivity of parallel test (Rp/v-hCG>1.0 or Rp/v-P>1.0) was 92.23%. The specificity of serial test (Rp/v-hCG>1.0 and Rp/v-P>1.0) was 100%. For the area under the ROC curve of Rp/v-hCG and Rp/v-P, the parallel test and serial test were 0.91 and 0.82,0.90 and 0.87, respectively. At the determining threshold point of 1.0, the sensitivity of Rv/c-hCG and Rv/c-P for the diagnosis of EP was 56.73% and 60.01%. The specificity was 100% and 100%, respectively. The sensitivity of parallel test (Rv/c-hCG>1.0 or Rv/c-P>1.0) was 73.33%. For the area under the ROC curve of Rv/c-hCG, Rv/c-P and the parallel test was 0.78,0.80 and 0.87, respectively. Conclusions: It is proposed that EP can more rapidly and accurately be diagnosed by multiple biomarkers test of Rp/v-hCG>1.0 and/or Rp/v-P>1.0, as well as Rv/c-hCG>1.0 and/or Rv/c-P>1.0 via culdocentesis or curettage. PMID:26309611

  19. Shotgun Proteomics Identifies Serum Fibronectin as a Candidate Diagnostic Biomarker for Inclusion in Future Multiplex Tests for Ectopic Pregnancy

    PubMed Central

    Brown, Jeremy K.; Lauer, Katarina B.; Ironmonger, Emily L.; Inglis, Neil F.; Bourne, Tom H.; Critchley, Hilary O. D.; Horne, Andrew W.

    2013-01-01

    Ectopic pregnancy (EP) is difficult to diagnose early and accurately. Women often present at emergency departments in early pregnancy with a pregnancy of unknown location (PUL), and diagnosis and exclusion of EP is challenging due to a lack of reliable biomarkers. The objective of this study was to identify novel diagnostic biomarkers for EP. Shotgun proteomics, incorporating combinatorial-ligand library pre-fractionation, was used to interrogate pooled sera (n?=?40) from women undergoing surgery for EP, termination of viable intrauterine pregnancy and management of non-viable intrauterine pregnancy. Western blot was used to validate results in individual sera. ELISAs were developed to interrogate sera from women with PUL (n?=?120). Sera were collected at time of first symptomatic presentation and categorized according to pregnancy outcome. The main outcome measures were differences between groups and area under the receiver operating curve (ROC). Proteomics identified six biomarker candidates. Western blot detected significant differences in levels of two of these candidates. ELISA of sera from second cohort revealed that these differences were only significant for one of these candidates, fibronectin. ROC analysis of ability of fibronectin to discriminate EP from other pregnancy outcomes suggested that fibronectin has diagnostic potential (ROC 0.6439; 95% CI 0.5090 to 0.7788; P>0.05), becoming significant when ambiguous medically managed PUL excluded from analysis (ROC 0.6538; 95% CI 0.5158 to 0.7918; P<0.05). Fibronectin may make a useful adjunct to future multiplex EP diagnostic tests. PMID:23826180

  20. Conservative Management of Cesarean Scar Ectopic Pregnancy with Fetal Heart Activity and a Very High ?-hCG

    PubMed Central

    McLaren, Rodney; McCalla, Sandra

    2015-01-01

    Cesarean scar ectopic pregnancy (CSP) is a rare type of ectopic pregnancy that is growing in incidence. The diagnosis of most CSP occurs when patients present in unstable conditions requiring surgical management and leading sometimes to hysterectomy. It has been shown that medical management is a safe option for early diagnosed hemodynamically stable CSP. However, no cases of CSP with ?-hCG higher than 62,000?IU/L, conservatively treated, have been reported. We report the case of a 29-year-old patient who presented for her first prenatal visit at 13-week gestation and was diagnosed with CSP with present fetal heart tones and a quantitative ?-hCG of 144,337?IU/L. She was treated with bilateral uterine artery embolization and systemic methotrexate. Her ?-hCG significantly decreased and became undetectable within 10 weeks. We propose that patients with CSP with very high ?-hCG and fetal heart activity can be offered conservative or fertility preserving management. PMID:26770852

  1. Quantitative analysis of hormones and inflammatory cytokines in Chlamydia trachomatis-infected women with tubal ectopic pregnancy and early intrauterine pregnancy.

    PubMed

    Shao, Ruijin; Feng, Yi; Zou, Shien; Li, Xin; Cui, Peng; Billig, Håkan

    2016-03-01

    In this data, non-pregnant women during the menstrual cycle, women with normal intrauterine pregnancy (IUP), and women with tubal ectopic pregnancy (EP) after informed consent were included. The serum levels of 17β-estradiol, progesterone, testosterone, beta-human chorionic gonadotropin, interleukin (IL)-1β, IL-4, IL-6, IL-7, IL-8, IL-10, tumor necrosis factor α (TNFα), and interferon-γ (IFN-γ), epidermal growth factor, the Chlamydia (C.) trachomatis IgG and HSP60 were analyzed. Receiver operating characteristic analysis was used to assess the diagnostic discrimination of tubal EP and gestational age-matched IUP. Our data show that C. trachomatis infection is associated with IL-8 levels, which had excellent discriminative validity in positively identifying tubal EP (concomitant with C. trachomatis infection) from IUP and non-pregnant conditions regardless of C. trachomatis infection. PMID:26858978

  2. Quantitative analysis of hormones and inflammatory cytokines in Chlamydia trachomatis-infected women with tubal ectopic pregnancy and early intrauterine pregnancy

    PubMed Central

    Shao, Ruijin; Feng, Yi; Zou, Shien; Li, Xin; Cui, Peng; Billig, Hkan

    2015-01-01

    In this data, non-pregnant women during the menstrual cycle, women with normal intrauterine pregnancy (IUP), and women with tubal ectopic pregnancy (EP) after informed consent were included. The serum levels of 17?-estradiol, progesterone, testosterone, beta-human chorionic gonadotropin, interleukin (IL)-1?, IL-4, IL-6, IL-7, IL-8, IL-10, tumor necrosis factor ? (TNF?), and interferon-? (IFN-?), epidermal growth factor, the Chlamydia (C.) trachomatis IgG and HSP60 were analyzed. Receiver operating characteristic analysis was used to assess the diagnostic discrimination of tubal EP and gestational age-matched IUP. Our data show that C. trachomatis infection is associated with IL-8 levels, which had excellent discriminative validity in positively identifying tubal EP (concomitant with C. trachomatis infection) from IUP and non-pregnant conditions regardless of C. trachomatis infection. PMID:26858978

  3. Serum Human Chorionic Gonadotropin (β- hCG) Clearance Curves in Women with Successfully Expectantly Managed Tubal Ectopic Pregnancies: A Retrospective Cohort Study

    PubMed Central

    Helmy, Samir; Mavrelos, Dimitrios; Sawyer, Elinor; Ben-Nagi, Jara; Koch, Marianne; Day, Andrea; Jurkovic, Davor

    2015-01-01

    Objective To establish clearance curves for serum β -hCG in women with successfully expectantly managed tubal ectopic pregnancies. Design Retrospective cohort study. Non- viable tubal ectopic pregnancy was diagnosed on transvaginal ultrasound. If initial serum β hCG was less than 5000 IU/L and patients were asymptomatic, expectant management was offered. Patients underwent serial β hCG measurements until serum β hCG was less than 20 IU/l, or the urine pregnancy test was negative. Setting Early Pregnancy and Gynaecology Assessment Unit, Kings College Hospital, London (December 1998 to July 2006). Patients We included 161 women with diagnosed non-viable tubal ectopic pregnancy who underwent successful expectant management. Main outcome measure Serum β hCG level. Results Mean initial serum β- hCG was 488 IU/L (41 - 4883) and median serum β hCG clearance time was 19 days (5 - 82). The average half-life of β hCG clearance was 82.5 hours (±SD 50.2) in patients with steadily declining serum β- hCG levels compared to 106.7 hours (±SD 72.0) in patients with primarily plateauing β-hCG levels in the declining phase. However, these differences were not significant (p>0.05). Conclusion We identified a median follow-up of 19 days until serum β hCG clearance in women with tubal ectopic pregnancy and successful expectant management. Although non- significant, women with initially plateauing serum β hCG showed a longer follow-up time until clearance compared to women with steadily declining β hCG levels. This information may serve as a guideline enabling clinicians to predict the length of follow-up for women with tubal ectopic pregnancy and expectant management. PMID:26135923

  4. Placental localization in abdominal pregnancy using technetium-99m-labeled red blood cells

    SciTech Connect

    Martin, B.; Payan, J.M.; Jones, J.S.; Buse, M.G. )

    1990-06-01

    In a patient with third trimester abdominal pregnancy with fetal demise, technetium-99m-labeled erythrocytes ({sup 99m}Tc-RBCs) localized the placenta preoperatively, after nonvisualization by ultrasonography and arteriography. Extrauterine placental localization by blood-pool imaging may be useful when ultrasound fails.

  5. Endometrial cysteine-rich secretory protein 3 is inhibited by human chorionic gonadotrophin, and is increased in the decidua of tubal ectopic pregnancy.

    PubMed

    Horne, A W; Duncan, W C; King, A E; Burgess, S; Lourenco, P C; Cornes, P; Ghazal, P; Williams, A R; Udby, L; Critchley, H O D

    2009-05-01

    Ectopic pregnancy (EP) remains a considerable cause of morbidity and occasional mortality. Currently, there is no reliable test to differentiate ectopic from intrauterine gestation. We have previously used array technology to demonstrate that differences in gene expression in decidualized endometrium from women with ectopic and intrauterine gestations could be used to identify candidate diagnostic biomarkers for EP. The aim of this study was to further investigate the decidual gene with the highest fold increase in EP, cysteine-rich secretory protein-3 (CRISP-3). Decidualized endometrium from gestation-matched women undergoing surgical termination of pregnancy (n = 8), evacuation of uterus for miscarriage (n = 6) and surgery for EP (n = 11) was subjected to quantitative RT-PCR, morphological assessment, immunohistochemistry and western blot analysis. Sera were analysed for progesterone and human chorionic gonadotrophin (hCG) levels. Immortalized endometrial epithelial cells were cultured with physiological concentrations of hCG. CRISP-3 mRNA and protein expression were greater in endometrium from ectopic when compared with intrauterine pregnancies (P < 0.05). CRISP-3 protein was localized to epithelium and granulocytes of endometrium. CRISP-3 serum concentrations were not different in women with ectopic compared with intrauterine pregnancies. CRISP-3 expression in endometrium was not related to the degree of decidualization or to serum progesterone levels. Endometrial CRISP-3 expression was inversely proportional to serum hCG concentrations (P < 0.001). Stimulation of endometrial epithelial cells with hCG in vitro caused a reduction in CRISP-3 expression (P < 0.01). The measurement of CRISP-3 in endometrium could provide an additional tool in the diagnosis of failing early pregnancy of unknown location. The absence of a local reduction in expression of CRISP-3 in decidualized endometrium of women with EP may be due to reduced exposure to hCG due to the ectopic location of the trophoblast. PMID:19282327

  6. The Expression and Cellular Localization of Galectin-1 and Galectin-3 in the Fallopian Tube Are Altered in Women with Tubal Ectopic Pregnancy.

    PubMed

    Nio-Kobayashi, Junko; Abidin, Hazirah B Z; Brown, Jeremy K; Iwanaga, Toshihiko; Horne, Andrew W; Duncan, W Colin

    2015-12-01

    Galectin-1 and galectin-3 are abundantly expressed at implantation sites in the uterus, suggesting their involvement in the establishment of pregnancy. In this study, we examined the expression and localization of galectin-1 and galectin-3 in fallopian tubes from nonpregnant women, and in those presenting with tubal ectopic pregnancy. There was no significant difference in the expression of either galectin-1 (LGALS1) or galectin-3 (LGALS3) transcripts in the fallopian tube across the menstrual cycle. Their expressions in the fallopian tube were inversely correlated to each other (r = -0.5134, p < 0.0001) and differentially localized. Galectin-1 protein was abundant in the stroma of nonpregnant fallopian tubes, whereas galectin-3 was mainly localized to the epithelium, notably to the cilia of ciliated cells and the apical cytoplasm of secretory cells. In ectopic pregnancies, LGALS3 expression was significantly reduced (p < 0.0001), but LGALS1 expression did not change when compared to nonpregnant fallopian tubes collected during the mid-secretory phase. The percentage of fallopian tube epithelial cells expressing galectin-3 in cilia tended to be reduced (p = 0.0685), with an accompanying loss of a normal ciliary structure, while nuclear galectin-3 increased (p < 0.05) in ectopic pregnancies. Epithelial immunostaining for galectin-1 tended to be elevated in fallopian tubes from women with ectopic pregnancy. Coculture of human trophoblast origin SW71 cells significantly increased LGALS1 expression in human fallopian tube epithelial OE-E6/E7 cells, suggesting that trophoblast-derived products regulate LGALS1 expression in the oviductal epithelium. These findings imply a differential contribution of galectin-1 and galectin-3 in the homeostasis of human fallopian tubes and in the pathophysiology of ectopic pregnancy. PMID:26359845

  7. Ineffectual Medical Treatment of Cesarean Scar Ectopic Pregnancy With Systemic Methotrexate: A Report of Two Cases.

    PubMed

    Keleki, Sefa; Aydo?mu?, Serpil; Aydo?mu?, Hseyin; Eri?, Serenat; Demirel, Emine; ?en Selim, Halime

    2014-01-01

    The implantation of a pregnancy within the scar of a previous cesarean section is known as a "cesarean scar pregnancy." Its incidence was reported to be 6.1%. However, with the increasing rates of cesarean sections, the incidence is expected to rise. A variety of conservative and surgical treatment modalities have been proposed for the management of cesarean scar pregnancy; however, there are no optimal universal treatment guidelines because of its rarity. Treatment should be tailored to the individual patient. It is obvious that more scar pregnancies will be seen in the future and therefore a set of criteria for the choice of various modes of management should be developed. Here, we present 2 cases of cesarean scar pregnancies treated with a local injection of potassium chloride after the failure of methotrexate administration. PMID:26425599

  8. Misdiagnosis of Abdominal Pain in Pregnancy: Acute Pancreatitis

    PubMed Central

    Samal, Sunita; Gupta, Shweta; Begum, Jasmina; Ghose, Seetesh

    2015-01-01

    We report a case of acute pancreatitis in a pregnant woman who presented to our emergency department with complaints of severe abdominal pain, was misdiagnosed as scar dehiscence and underwent emergency repeat caesarean section at 33 wks for fetal distress. The preterm baby developed severe respiratory distress and succumbed on the second postnatal day. Persistent severe pain in the postoperative period in the mother prompted further evaluation which led to a diagnosis of acute pancreatitis. Conservative and supportive management was instituted leading to an eventual favourable maternal outcome. PMID:25738042

  9. mRNA Expression of VEGF and Its Receptors in Fallopian Tubes of Women with Ectopic Pregnancies

    PubMed Central

    Zarezade, Nafise; Saboori Darabi, Samane; Ramezanali, Fariba; Amirchaghmaghi, Elham; Khalili, Gholamreza; Moini, Ashraf; Aflatoonian, Reza

    2015-01-01

    Background Establishment of viable pregnancy requires embryo implantation and placentation. Ectopic pregnancy (EP) is a pregnancy complication which occurs when an embryo implants outside of the uterine cavity, most often in a fallopian tube. On the other hand, an important aspect of successful implantation is angiogenesis. Vascular endothelial growth factor (VEGF) is a potent angiogenic factor responsible for vascular development that acts through its receptors, VEGF receptor 1 (VEGFR1) and VEGFR2. This study aims to investigate mRNA expression of VEGF and its receptors in fallopian tubes of women who have EP compared with fallopian tubes of pseudo-pregnant women. We hypothesize that expression of VEGF and its receptors in human fallopian tubes may change during EP. Materials and Methods This was a case-control study. The case group consisted of women who underwent salpingectomy because of EP. The control group consisted of women with normal fallopian tubes that underwent hysterectomy. Prior to tubal sampling, each control subject received an injection of human chorionic gonadotropin (hCG) to produce a state of pseudo-pregnancy. Fallopian tubes from both groups were procured. We investigated VEGF, VEGFR1 and VEGFR2 mRNA expressions in different sections of these tubes (infundibulum, ampulla and isthmus) by reverse transcription polymerase chain reaction (RT-PCR) and quantitative PCR (Q-PCR). Results RT-PCR showed expressions of these genes in all sections of the fallopian tubes in both groups. Q-PCR analysis revealed that expressions of VEGF, VEGFR1 and VEGFR2 were lower in all sections of the fallopian tubes from the case group compared to the controls. Only VEGFR2 had higher expression in the ampulla of the case group. Conclusion Decreased expressions of VEGF, VEGFR1 and VEGFR2 in the EP group may have a role in the pathogenesis of embryo implantation in fallopian tubes. PMID:25918593

  10. Ectopic pregnancy as a model to identify endometrial genes and signaling pathways important in decidualization and regulated by local trophoblast.

    PubMed

    Duncan, W Colin; Shaw, Julie L V; Burgess, Stewart; McDonald, Sarah E; Critchley, Hilary O D; Horne, Andrew W

    2011-01-01

    The endometrium in early pregnancy undergoes decidualization and functional changes induced by local trophoblast, which are not fully understood. We hypothesized that endometrium from tubal ectopic pregnancy (EP) could be interrogated to identify novel genes and pathways involved in these processes. Gestation-matched endometrium was collected from women with EP (n = 11) and intrauterine pregnancies (IUP) (n = 13). RNA was extracted from the tissue. In addition, tissues were prepared for histological analysis for degree of decidualization. We compared a) the samples from EP that were decidualized (n = 6) with non-decidualized samples (n = 5), and b) the decidualized EP (n = 6) with decidualization-matched IUP (n = 6) samples using an Affymetrix gene array platform, with Ingenuity Pathway Analysis, combined with quantitative RT-PCR. Expression of PRL and IGFBP1 was used to confirm the degree of decidualization in each group. There were no differences in PRL or IGFBP1 expression in the decidualization-matched samples but a marked reduction (P<0.001) in the non-decidualized samples. Decidualization was associated with increased expression of 428 genes including SCARA5 (181-fold), DKK1 (71-fold) and PROK1 (32-fold), and decreased expression of 230 genes including MMP-7 (35-fold) and SFRP4 (21-fold). The top canonical pathways associated with these differentially expressed genes were Natural Killer Cell and Wnt/b-Catenin signaling. Local trophoblast was associated with much less alteration of endometrial gene expression with an increase in 56 genes, including CSH1 (8-fold), and a reduction in 29 genes including CRISP3 (8-fold). The top associated canonical pathway was Antigen Presentation. The study of endometrium from tubal EP may promote novel insights into genes involved in decidualization and those influenced by factors from neighboring trophoblast. This has afforded unique information not highlighted by previous studies and adds to our understanding of the endometrium in early pregnancy. PMID:21858178

  11. Ectopic Pregnancy as a Model to Identify Endometrial Genes and Signaling Pathways Important in Decidualization and Regulated by Local Trophoblast

    PubMed Central

    Burgess, Stewart; McDonald, Sarah E.; Critchley, Hilary O. D.; Horne, Andrew W.

    2011-01-01

    The endometrium in early pregnancy undergoes decidualization and functional changes induced by local trophoblast, which are not fully understood. We hypothesized that endometrium from tubal ectopic pregnancy (EP) could be interrogated to identify novel genes and pathways involved in these processes. Gestation-matched endometrium was collected from women with EP (n = 11) and intrauterine pregnancies (IUP) (n = 13). RNA was extracted from the tissue. In addition, tissues were prepared for histological analysis for degree of decidualization. We compared a) the samples from EP that were decidualized (n = 6) with non-decidualized samples (n = 5), and b) the decidualized EP (n = 6) with decidualization-matched IUP (n = 6) samples using an Affymetrix gene array platform, with Ingenuity Pathway Analysis, combined with quantitative RT-PCR. Expression of PRL and IGFBP1 was used to confirm the degree of decidualization in each group. There were no differences in PRL or IGFBP1 expression in the decidualization-matched samples but a marked reduction (P<0.001) in the non-decidualized samples. Decidualization was associated with increased expression of 428 genes including SCARA5 (181-fold), DKK1 (71-fold) and PROK1 (32-fold), and decreased expression of 230 genes including MMP-7 (35-fold) and SFRP4 (21-fold). The top canonical pathways associated with these differentially expressed genes were Natural Killer Cell and Wnt/b-Catenin signaling. Local trophoblast was associated with much less alteration of endometrial gene expression with an increase in 56 genes, including CSH1 (8-fold), and a reduction in 29 genes including CRISP3 (8-fold). The top associated canonical pathway was Antigen Presentation. The study of endometrium from tubal EP may promote novel insights into genes involved in decidualization and those influenced by factors from neighboring trophoblast. This has afforded unique information not highlighted by previous studies and adds to our understanding of the endometrium in early pregnancy. PMID:21858178

  12. Prevalence of cytomegalovirus, and its effect on the expression of inducible and endothelial nitric oxide synthases in Fallopian tubes collected from women with and without ectopic pregnancy.

    PubMed

    Batwa, S A; Ashshi, A M; Kamfar, F F; Ahmad, J; Idris, S; Khojah, A; Al-Qadi, N M; Refaat, B

    2016-01-01

    To measure the prevalence of cytomegalovirus (CMV) infection in ectopic pregnancy (EP) and its effect on the expression of inducible and endothelial nitric oxide synthases (iNOS, eNOS) by Fallopian tubes (FT) bearing an EP. This was a prospective case-control study. Blood and tubal samples were collected from 84 Eps and 51 controls (20 total abdominal hysterectomy (TAH) during the luteal phase and another 31 tubal ligations). CMV IgM and IgG antibodies were measured by ELISA, and an IVD CE PCR kit was used to detect CMV in the FTs. iNOS and eNOS were measured by immunohistochemistry and quantitative RT-PCR in FTs obtained from CMV-positive EP (n?=?12), and the results were compared with those obtained from CMV-negative EP (n?=?11) and TAH (n?=?8). The frequencies of CMV IgM (51.2% vs 17.6%), IgG (77.4% vs 52.9%) or both antibodies (41.6% vs 11.7%) were significantly higher in EP compared with control. CMV was more common by PCR in FTs from EP (21.4%) than controls (5.9%). Twelve women from the PCR positive EP cases (66.6%) were also simultaneously positive for both CMV IgM & IgG antibodies and had higher expression of eNOS and iNOS at the protein and gene levels compared with negative EP and TAH. Tubal infection with CMV may lead to EP by increasing the production of endothelial and inducible NOS by the FT epithelial cells. Further studies are required to illustrate the role of CMV in the pathogenesis of EP. PMID:26563896

  13. The medical antigravity suit for management of surgically uncontrollable bleeding associated with abdominal pregnancy.

    PubMed

    Sandberg, E C; Pelligra, R

    1983-07-01

    Three patients with abdominal pregnancy have been treated at Stanford University Hospital in recent years. Common to each was surgically uncontrolled hemorrhage for which circumferential pneumatic compression (supplied by a medical antigravity suit) was used to stop the bleeding. In each patient, the hemostatic effect of treatment was dramatic. In published accounts of the use of the garment in other severely hemorrhaging patients, the effects have been similarly dramatic and equally successful. These observations lead to a compelling consideration in regard to optimum management of patients with abdominal pregnancy. If our experience is confirmed by others, optimum management in abdominal pregnancy hereafter should regularly and routinely include removal of the placenta at the primary operation. This approach would anticipate use of the medical antigravity suit to provide hemostasis if surgically uncontrollable bleeding is encountered. Theoretically, the complications and long-term morbidity associated with retention of the placenta would be eliminated by this means while the previous disadvantage of placental removal, the potential for exsanguinating hemorrhage, would be circumvented. PMID:6859176

  14. Association between levonorgestrel emergency contraception and the risk of ectopic pregnancy: a multicenter case-control study.

    PubMed

    Zhang, Jian; Li, Cheng; Zhao, Wei-Hong; Xi, Xiaowei; Cao, Shu-Jun; Ping, Hua; Qin, Guo-Juan; Cheng, Linan; Huang, He-Feng

    2015-01-01

    Cases of ectopic pregnancy (EP) following levonorgestrel emergency contraception (LNG-EC) failure have been reported continuously, but whether there is an association between EP risk and LNG-EC is unclear. We concluded a case-control study to explore this association by recruiting 2,411 EP patients as case group, and 2,416 women with intrauterine pregnancy and 2,419 non-pregnant women as control groups. Odds ratios (ORs) and their 95% confidential intervals (CIs) were calculated and adjusted for potential confounding factors. Previous use of LNG-EC was not correlated with the EP. Compared to women who did not use contraceptives, current use of LNG-EC reduced the risk for intrauterine pregnancy (Adjusted OR [AOR] = 0.20, 95%CI: 0.14-0.27), but did not increase the risk for EP (AOR2 = 1.04, 95%CI: 0.76-1.42). Furthermore, compared to women who did not have further act of intercourse, women with unprotected further act of intercourse were at a higher risk of EP (AOR1 = 2.35, 95%CI: 1.17-4.71), and women with repeated use of LNG-EC for further intercourse during the same cycle was also associated with a higher risk for EP (AOR1 = 3.08, 95%CI: 1.09-8.71; AOR2 = 2.49, 95%CI: 1.00-6.19). A better understanding of the risk of EP following LNG-EC failure can optimize LNG-EC use and thus reduce the risk of EP. PMID:25674909

  15. Association between levonorgestrel emergency contraception and the risk of ectopic pregnancy: a multicenter case-control study

    PubMed Central

    Zhang, Jian; Li, Cheng; Zhao, Wei-Hong; Xi, Xiaowei; Cao, Shu-Jun; Ping, Hua; Qin, Guo-Juan; Cheng, Linan; Huang, He-Feng

    2015-01-01

    Cases of ectopic pregnancy (EP) following levonorgestrel emergency contraception (LNG-EC) failure have been reported continuously, but whether there is an association between EP risk and LNG-EC is unclear. We concluded a case-control study to explore this association by recruiting 2,411 EP patients as case group, and 2,416 women with intrauterine pregnancy and 2,419 non-pregnant women as control groups. Odds ratios (ORs) and their 95% confidential intervals (CIs) were calculated and adjusted for potential confounding factors. Previous use of LNG-EC was not correlated with the EP. Compared to women who did not use contraceptives, current use of LNG-EC reduced the risk for intrauterine pregnancy (Adjusted OR [AOR] = 0.20, 95%CI: 0.140.27), but did not increase the risk for EP (AOR2 = 1.04, 95%CI: 0.761.42). Furthermore, compared to women who did not have further act of intercourse, women with unprotected further act of intercourse were at a higher risk of EP (AOR1 = 2.35, 95%CI: 1.174.71), and women with repeated use of LNG-EC for further intercourse during the same cycle was also associated with a higher risk for EP (AOR1 = 3.08, 95%CI: 1.098.71; AOR2 = 2.49, 95%CI: 1.006.19). A better understanding of the risk of EP following LNG-EC failure can optimize LNG-EC use and thus reduce the risk of EP. PMID:25674909

  16. Linear salpingotomy with suturing by single incision laparoscopic surgery for tubal ectopic pregnancy.

    PubMed

    Kumakiri, Jun; Kikuchi, Iwaho; Kitade, Mari; Matsuoka, Shozo; Tokita, Sachiko; Takeda, Satoru

    2010-12-01

    We investigated the feasibility of linear salpingotomy with suturing for ampullary tubal pregnancy via single incision laparoscopic surgery (SILS). Three patients underwent SILS between April and May 2010 at our hospital due to ampullary tubal pregnancy. A multichannel port was inserted into the umbilicus via a 2.5-cm incision to accommodate a 5-mm flexible laparoscope and a disposable articulating forceps. The linearly incised Fallopian tube was intracorporeally sutured using an articulating suturing device dedicated to SILS. The mean surgical duration was 54 minutes. Tubal preservation by linear salpingotomy was accomplished for all patients without up-conversion to conventional laparoscopy. Serum ?-hCG values of all patients immediately decreased and further medical treatment was unnecessary. PMID:21050154

  17. The ESEP study: Salpingostomy versus salpingectomy for tubal ectopic pregnancy; The impact on future fertility: A randomised controlled trial

    PubMed Central

    Mol, Femke; Strandell, Annika; Jurkovic, Davor; Yalcinkaya, Tamer; Verhoeve, Harold R; Koks, Carolien AM; van der Linden, Paul JQ; Graziosi, Giuseppe CM; Thurkow, Andreas L; Hoek, Annemieke; Hogström, Lars; Klinte, Ingemar; Nilsson, Kerstin; van Mello, Norah M; Ankum, Willem M; van der Veen, Fulco; Mol, Ben WM; Hajenius, Petra J

    2008-01-01

    Background For most tubal ectopic pregnancies (EP) surgery is the treatment of first choice. Whether surgical treatment should be performed conservatively (salpingostomy) or radically (salpingectomy) in women wishing to preserve their reproductive capacity, is subject to debate. Salpingostomy preserves the tube, but bears the risks of both persistent trophoblast and repeat ipsilateral tubal EP. Salpingectomy, avoids these risks, but leaves only one tube for reproductive capacity. This study aims to reveal the trade-off between both surgical options: whether the potential advantage of salpingostomy, i.e. a better fertility prognosis as compared to salpingectomy, outweighs the potential disadvantages, i.e. persistent trophoblast and an increased risk for a repeat EP. Methods/Design International multi centre randomised controlled trial comparing salpingostomy versus salpingectomy in women with a tubal EP without contra lateral tubal pathology. Hemodynamically stable women with a presumptive diagnosis of tubal EP, scheduled for surgery, are eligible for inclusion. Patients pregnant after in vitro fertilisation (IVF) and/or known documented tubal pathology are excluded. At surgery, a tubal EP must be confirmed. Only women with a tubal EP amenable to both interventions and a healthy contra lateral tube are included. Salpingostomy and salpingectomy are performed according to standard procedures of participating hospitals. Up to 36 months after surgery, women will be contacted to assess their fertility status at six months intervals starting form the day of the operation. The primary outcome measure is the occurrence of spontaneous viable intra uterine pregnancy. Secondary outcome measures are persistent trophoblast, repeat EP, all pregnancies including those resulting from IVF and financial costs. The analysis will be performed according to the intention to treat principle. A cost-effectiveness analysis will be performed within a decision analysis framework, based on costs per live birth, including IVF treatment whenever a spontaneous pregnancy does not occur. Patients' preferences will be assessed using a discrete choice experiment. Discussion This trial will provide evidence on the trade off between salpingostomy and salpingectomy for tubal EP in view of the pros and cons of both interventions and will offer guidance to clinicians in making the right treatment choice. Trial registration Current Controlled Trials ISRCTN37002267 PMID:18582372

  18. Association between increased expression of endothelial isoform of nitric oxide synthase in the human fallopian tube and tubal ectopic pregnancy

    PubMed Central

    Fath Bayati, Leyla; Ghaffari Novin, Marefat; Fadaei Fathabadi, Fatemeh; Piryaei, Abbas; Heidari, Mohammad Hasan; Bandehpour, Mozhgan; Norouzian, Mohsen; Alizadeh Parhizgar, Mahdi; Shakooriyan Fard, Mahmood

    2014-01-01

    Background: Tubal ectopic pregnancy (tEP) is the most common type of extra-uterine pregnancy and the most common cause of maternal mortality. Nitric oxide (NO) is a molecule that incorporates in many physiological processes of female reproductive system. Recent studies have demonstrated the possible role of endothelial isoform of nitric oxide synthase (eNOS) enzyme in the regulation of many reproductive events that occur in the fallopian tube (FT). Objective: The aim of this study was to evaluate the expression of eNOS in the FTs of women with tEP. Materials and Methods: In this case-control study, a total number of 30FTs samples were obtained from three groups including: 10 FTs of women that bearing an EP, 10 FTs from the non-pregnant women at luteal phase of the menstrual cycle, and 10 FTs of healthy pregnant women (n=10). Samples were fixed in 10% buffered formalin and then were evaluated by immunohistochemistry. Results: Localization of eNOS was seen in secretory and ciliated luminal epithelium and vascular endothelium of all groups. However, we did not observed the expression of eNOS in smooth muscle cells of all groups. Expression of eNOS in luminal epithelium of women with EP compared to non-pregnant women at luteal phase of menstrual cycle and healthy pregnant group showed statistically significant increase (p=0.00). Significant difference in expression of eNOS was not observed in luminal epithelium of FTs of women at luteal phase compared to healthy pregnant groups (p=0.78). Conclusion: This study indicates that changes in expression of eNOS in luminal epithelium of FT may lead to development of EP. This article extracted from M.Sc. thesis. (Leyla Fath Bayati) PMID:24799858

  19. Awareness about a Life-Threatening Condition: Ectopic Pregnancy in a Network for Surveillance of Severe Maternal Morbidity in Brazil

    PubMed Central

    Filho, Edilberto Alves Rocha; Santana, Danielly Scaranello; Costa, Maria Laura; Haddad, Samira Maerrawe; Parpinelli, Mary Angela; Sousa, Maria Helena; Camargo, Rodrigo Soares; Pacagnella, Rodolfo Carvalho; Surita, Fernanda Garanhani; Pinto e Silva, Joao Luiz

    2014-01-01

    Objective. To assess occurrence of severe maternal complications associated with ectopic pregnancy (EP). Method. A multicenter cross-sectional study was conducted, with prospective surveillance of potentially life-threatening conditions (PLTC), maternal near miss (MNM), and maternal death (MD). EP complications, patient sociodemographic/obstetric characteristics, and conditions of severity management were assessed, estimating prevalence ratios with respective 95% CI. Factors independently associated with greater severity were identified using multiple regression analysis. Results. Of the 9.555 severe maternal morbidity patients, 312 women (3.3%) had complications after EP: 286 (91.7%) PLTC, 25 (8.0%) MNM, and 1 (0.3%) MD. Severe maternal outcome ratio (SMOR) was 0.3/1000 LB among EP cases and 10.8/1000 LB among other causes. Complicated EP patients faced a higher risk of blood transfusion, laparotomy, and lower risk of ICU admission and prolonged hospitalization than women developing complications resulting from other causes. Substandard care was the most common in more severe maternal morbidity and EP cases (22.7% MNM and MD versus 15% PLTC), although not significant. Conclusion. Increased maternal morbidity due to EP raised awareness about the condition and its impact on female reproductive life. No important risk factors for greater severity were identified. Care providers should develop specific guidelines and interventions to prevent severe maternal morbidity. PMID:24772441

  20. Abdominal wall desmoid tumor during pregnancy: case report and literature review.

    PubMed

    Zhou, H; Lu, H; Wang, L; Xie, L; Wu, M; Li, J; Abdallahi, N; Lin, Z

    2015-01-01

    Desmoid tumors are fibromatous lesions that are the result of abnormal proliferation of myofibroblasts. Despite its benign microscopic appearance and non-metastasizing behavior, tumor infiltrates surrounding tissues and has a high risk of recurrence. Pregnancy-associated desmoid tumors are very rare and optimal management of this tumor is not well established. The authors report a case of a 31-year-old pregnant woman with a large desmoid tumor, which increased rapidly in size and caused worsening symptom of dyspnea. The tumor was successfully removed during a caesarian section, which resulted in an anterior abdominal wall defect. Reconstruction of the abdominal wall defect was performed with a polypropylene mesh. The postoperative recovery of the patient was uneventful. After a follow-up of 44 months, the patient was found to be well and there was no evidence of local recurrence. The authors also reviewed the literature on the world's experience with this tumor and its management during pregnancy.Twelve desmoid tumors arising during pregnancy were reported in the existing literature; the managements were varied and has yet to be defined. PMID:26054134

  1. Wnt activation downregulates olfactomedin-1 in Fallopian tubal epithelial cells: a microenvironment predisposed to tubal ectopic pregnancy.

    PubMed

    Kodithuwakku, Suranga P; Pang, Ronald T K; Ng, Ernest H Y; Cheung, Annie N Y; Horne, Andrew W; Ho, Pak-Chung; Yeung, William S B; Lee, Kai-Fai

    2012-02-01

    Ectopic pregnancy (EP) occurs when the embryo fails to transit to the uterus and attach to the luminal epithelium of the Fallopian tube (FT). Tubal EP is a common gynecological emergency and more than 95% of EP occurs in the ampullary region of the FT. In humans, Wnt activation and downregulation of olfactomedin-1 (Olfm-1) occur in the receptive endometrium and coincided with embryo implantation in vivo. Whether similar molecular changes happen in the FT leading to EP remains unclear. We hypothesized that activation of Wnt signaling downregulates Olfm-1 expression predisposes to EP. We investigated the spatiotemporal expression of Olfm-1 in FT from non-pregnant women and women with EP, and used a novel trophoblastic spheroid (embryo surrogate)-FT epithelial cell co-culture model (JAr and OE-E6/E7 cells) to study the role of Olfm-1 on spheroid attachment. Olfm-1 mRNA expression in the ampullary region of non-pregnant FT was higher (P<0.05) in the follicular phase than in the luteal phase. Ampullary tubal Olfm-1 expression was lower in FT from women with EP compared to normal controls at the luteal phase (histological scoring (H-SCORE)=1.30.2 vs 2.40.5; P<0.05). Treatment of OE-E6/E7 with recombinant Olfm-1 (0.2-5??g/ml) suppressed spheroid attachment to OE-E6/E7 cells, while activation of Wnt-signaling pathway by Wnt3a or LiCl reduced endogenous Olfm-1 expression and increased spheroid attachment. Conversely, suppression of Olfm-1 expression by RNAi increased spheroid attachment to OE-E6/E7 cells. Taken together, Wnt activation suppresses Olfm-1 expression, and this may predispose a favorable microenvironment of the retained embryo in the FT, leading to EP in humans. PMID:21968811

  2. Predicting factors of medical treatment success with single dose methotrexate in tubal ectopic pregnancy: a retrospective study

    PubMed Central

    Mirbolouk, Fariba; Yousefnezhad, Azadeh; Ghanbari, Atefeh

    2015-01-01

    Background: Nowadays, The first step in treatment of ectopic pregnancy (EP) is medical treatment. Medical treatment with methotrexate (MTX) for EP is safe and effective method without the risks associated with the surgical procedure. But there are controversies between studies for which patients will respond better to medical treatment. Objective: The aim of the present study was to investigate the predictive factors of success or failure of treatment of EP with single dose MTX. Materials and Methods: In this retrospective study, records of 370 patients who were treated for tubal EP with single dose of MTX were reviewed during four years. Patients were divided into two groups; the first group or success group are the patients who were successfully treated with MTX. The second group or failure group consist the patients who did not respond to the MTX therapy. The week of gestation, size and location of EP and ?-hCG level were compared between groups. Results: Of 370 patients, 285 (77.1%) were successfully treated with MTX. 85 patients (22.9%) required surgery after a mean of 5.4 (range 2-15) days. Day-1 beta- human chorionic gonadotropin (?-hCG) and fall in ?-hCG between day 1 and day 4 were the best predictors for single dose MTX treatment success. The cutoff value of initial ?-hCG with the success treatment results was found to be 1375 IU/mL there was no statistical difference between groups about week of gestation, size and location of EP. Conclusion: The results showed that patients who have ?-hCG levels below 1375 and the number of cases with decreasing ?-hCG level on day 4 are the good candidates for medical treatment. PMID:26330849

  3. An Ovarian Pregnancy in a Patient with a History of Bilateral Salpingectomies: A Rare Case

    PubMed Central

    Chitkara, Pranav; Cochran, Eric; Cutler, Jed

    2015-01-01

    Background. 1 in 200 ectopic pregnancies are true ovarian pregnancies that fulfill the Spiegelberg criteria. Despite being rare, multiple case reports and series have been reported. Few cases have been published in which the event was preceded by salpingectomy. Case. The patient is a 32-year-old female who presented to the emergency room with abdominal pain. She was found to be pregnant, despite a history of two previous ectopic pregnancies treated with salpingectomies. Sonography confirmed a left adnexal mass and free fluid. Surgery revealed a ruptured ovarian pregnancy which was also confirmed by pathology. Conclusion. This is a case of an ovarian pregnancy in a patient with two previous salpingectomies. It underscores the importance of searching for an ectopic pregnancy in patients with abdominal pain after fertility impairing surgery. PMID:25852956

  4. Earlier menarche is associated with non-alcoholic fatty liver disease and abdominal ectopic fat in midlife, independent of young-adult BMI: The CARDIA Study

    PubMed Central

    Mueller, Noel T.; Pereira, Mark A.; Demerath, Ellen W.; Dreyfus, Jill G.; MacLehose, Richard F.; Carr, J. Jeffrey; Terry, James G.; Jacobs, David R.

    2014-01-01

    Objective We test the hypothesis that earlier menarche is associated with higher non-alcoholic fatty liver disease (NAFLD) and ectopic adiposity, independent of young-adult BMI. Design and Methods We use data from 1,214 black and white women in the Coronary Artery Risk Development in Young Adults (CARDIA) study who reliably reported menarche age at exam years 0 and 2, had multiple-slice abdominal computed tomography (CT) at exam year 25, and had no known liver disease or secondary causes of steatosis. Women were aged 1830 at year 0 and 4355 at year 25. Liver attenuation, visceral adipose tissue (VAT), subcutaneous adipose tissue (SAT), and inter-muscular adipose tissue (IMAT) were derived from CT. NAFLD was defined as liver attenuation <51 Hounsfield units. Results One-year earlier menarche was associated with higher NAFLD (RR=1.15; 95% CI: 1.071.24), and VAT (6.7; 95% CI: 4.39.0cc), IMAT (1.0; 95% CI: 0.61.4cc), and SAT (19.3; 95% CI: 13.226.0cc) after confounder adjustment. Associations remained significant (p<0.05) after further adjustment for year-0 BMI. Only VAT remained significant (p=0.047) after adjustment for weight gain between year 0 and 25. Conclusion Earlier menarche is positively associated with NAFLD and ectopic fat independent of confounders and young-adult BMI. Weight gain between young adulthood and midlife explains some of this association. PMID:25521620

  5. Sonography of Methotrexate for Ectopics

    NASA Astrophysics Data System (ADS)

    Urzic?, Denise; Dorohoi, Dana-Ortansa

    2007-04-01

    Treatment unruptured ectopic pregnancy with methotrexate (MTX) and citrovorum factor is now an established alternative to surgical therapy. Serial measurements of serum beta-HCG and early ultrasound examination have allowed detection of early and unruptured tubal ectopic pregnancies, permitting treatment without removal of the tube. It is believed that preserving the tube increases the chance of subsequent live births. Our findings suggest that outpatient transvaginal intratubal methorexate administration can provide a safe and effective alternative to surgical treatment for patients with early and unruptured tubal ectopic pregnancy.

  6. Primary omental pregnancy with secondary implantation into posterior cul-de-sac: laparoscopic treatment using hemostatic matrix.

    PubMed

    Watrowski, Rafa?; Lange, Annabel; Mckel, Jochen

    2015-01-01

    Primary omental pregnancy is a rare form of ectopic pregnancy. Only a few reported cases have been treated using laparoscopy. Hemostasis after trophoblast removal can be challenging. A 25-year-old primigravida in week 8 of pregnancy was admitted to our hospital with a diagnosis of missed abortion. An ultrasound scan showed an empty uterine cavity and a gestational sac with a 15-mm embryo dorsal to the uterus, indicative of an ectopic pregnancy. The preoperative serum concentration of human chorionic gonadotropin was 33 600 U/mL. Laparoscopy was performed, which revealed an omental pregnancy invading the peritoneum of the Douglas pouch. After laparoscopic removal of the ectopic pregnancy with partial omentectomy, diffuse bleeding from the crater between both sacrouterine ligaments was treated using the gelatin-thrombin matrix (FloSeal). The final histologic analysis confirmed the omentum as the primary site of the ectopic pregnancy (multiple chorionic villi and decidua within the omental fat). The postoperative period was uneventful. This case expands the classic Studdiford criteria. Secondary peritoneal ectopic pregnancy implantation can occur not only after tubal rupture or expulsion of tubal ectopic pregnancy but also after primary implantation at any other ectopic site. The laparoscopic approach to abdominal pregnancy is safe and feasible if there is sufficient intraoperative hemostasis. The hemostatic matrix facilitates quick and effective control of bleeding. PMID:24973638

  7. Fertility and Pregnancy Outcome After Abdominal Irradiation That Included or Excluded the Pelvis in Childhood Tumor Survivors

    SciTech Connect

    Sudour, Helene; Chastagner, Pascal; Claude, Line; Desandes, Emmanuel; Klein, Marc; Carrie, Christian; Bernier, Valerie

    2010-03-01

    Purpose: To evaluate fertility after abdominal and/or pelvic irradiation in long-term female survivors. Methods and Materials: Puberty and pregnancy outcome were analyzed in female survivors of childhood cancer (aged <18 years) treated with abdominal and/or pelvic radiotherapy (RT) at one of two French centers (Nancy and Lyon) between 1975 and 2004. Data were obtained from medical records and questionnaires sent to the women. Results: A total of 84 patients who had received abdominal and/or pelvic RT during childhood and were alive and aged more than 18 years at the time of the study made up the study population. Of the 57 female survivors treated with abdominal RT that excluded the pelvis, 52 (91%) progressed normally through puberty and 23 (40%) had at least one recorded pregnancy. Of the 27 patients treated with pelvic RT, only 10 (37%) progressed normally through puberty and 5 (19%) had at least one recorded pregnancy. Twenty-two women (seventeen of whom were treated with pelvic RT) had certain subfertility. A total of 50 births occurred in 28 women, with one baby dying at birth; one miscarriage also occurred. There was a high prevalence of prematurity and low birth weight but not of congenital malformations. Conclusions: Fertility can be preserved in patients who undergo abdominal RT that excludes the pelvis, taking into account the other treatments (e.g., chemotherapy with alkylating agents) are taken into account. When RT includes the pelvis, fertility is frequently impaired and women can have difficulty conceiving. Nevertheless, pregnancies can occur in some of these women. The most important factor that endangers a successful pregnancy after RT is the total dose received by the ovaries and uterus. This radiation dose has to be systematically recorded to improve our ability to follow up patients.

  8. Relation between abdominal subcutaneous fat tissue thickness and inflammatory markers during pregnancy

    PubMed Central

    Köşüş, Aydın; Turhan, Nilgün

    2014-01-01

    Introduction Subcutaneous abdominal fat thickness (SCFT) is important for predisposition to metabolic and cardiovascular diseases. Our aim was to evaluate maternal SCFT and metabolic changes (such as insulin resistance and high inflammatory markers) during pregnancy. Material and methods A total of 92 pregnant women between 24–28 weeks of gestation were enrolled in the study. The SCFT was measured by ultrasonography and patients were divided into 2 groups according to thickness of maternal SCFT and body mass index (BMI). Groups were compared with each other for oral glucose loading test (OGL) results, and for haematological, biochemical and fetal biometric parameters. Results After analysis of frequency for SCFT, the most appropriate cut-off value for grouping patients was found to be 15 mm for SCFT. In 48 cases SCFT was over 15 mm. High C reactive protein (CRP) was found in 47.9% (23) of cases with SCFT over 15 mm. Serum haemoglobin A1c (HbA1c) level was significantly correlated with SCFT thickness. The most important factors for determination of OGL level were found to be serum HbA1c level, BMI and SCFT. In obese subjects (BMI ≥ 25 kg/m2), levels of inflammatory markers and SCFT thickness were higher. The CRP and γ-glutamyltransferase (GGT) levels were significantly correlated with BMI and SCFT. Conclusions High SCFT during pregnancy is associated with elevated inflammatory marker levels and HbA1c. Pregnant women with thicker SCFT may be susceptible to the development of metabolic complications of pregnancy, such as gestational diabetes mellitus (GDM) and hypertension, as well as risk of future metabolic and cardiovascular disease. PMID:25276159

  9. Spontaneous Unruptured Bilateral Tubal Pregnancy: A Case Report.

    PubMed

    Ghomian, Nayereh; Lotfalizadeh, Marziyeh

    2015-11-01

    Bilateral spontaneous tubal ectopic pregnancy is the rarest form of extra uterine pregnancy. The diagnosis is usually made intraoperatively and levels of serum BHCG and ultrasound has not been useful in the diagnosis of bilateral tubal ectopic pregnancy. A 33-year-old woman with 8 weeks amenorrhea and sever lower abdominal pain was admitted. A transvaginal pelvic ultrasound revealed left adnexal mass and massive fluid collection in the pelvis and abdomen. The serum BHCG was 5,700 mIU/ml and in laparotomy bilateral unruptured tubal pregnancy was noted. Left salpingectomy and right salpingostomy were performed. The diagnosis of bilateral spontaneous tubal ectopic pregnancy is usually made intraoperatively. Both tubes at the time of surgery should be closely examined in order to prevent maternal morbidity and mortality. PMID:26538784

  10. Implementation Study of Patient-Ready Syringes Containing 25 mg/mL Methotrexate Solution for Use in Treating Ectopic Pregnancy

    PubMed Central

    Respaud, R.; Gaudy, A. S.; Arlicot, C.; Tournamille, J. F.; Viaud-Massuard, M. C.; Elfakir, C.; Antier, D.

    2014-01-01

    Background. Ectopic pregnancy (EP) is a significant cause of morbidity and mortality during the first trimester of pregnancy. Small unruptured tubal pregnancies can be treated medically with a single dose of methotrexate (MTX). Objective. The aim of this study was to evaluate the stability of a 25 mg/mL solution of MTX to devise a secure delivery circuit for the preparation and use of this medication in the management of EP. Method. MTX solutions were packaged in polypropylene syringes, stored over an 84-day period, and protected from light either at +2 to +8°C or at 23°C. We assessed the physical and chemical stability of the solutions at various time points over the storage period. A pharmaceutical delivery circuit was implemented that involved the batch preparation of MTX syringes. Results. We show that 25 mg/mL MTX solutions remain stable over an 84-day period under the storage conditions tested. Standard doses were prepared, ranging from 50 mg to 100 mg. The results of this study suggest that MTX syringes can be prepared in advance by the pharmacy, ready to be dispensed at any time that a diagnosis of EP is made. Conclusion. The high stability of a 25 mg/mL MTX solution in polypropylene syringes makes it possible to implement a flexible and cost-effective delivery circuit for ready-to-use preparations of this drug, providing 24-hour access and preventing treatment delays. PMID:24900977

  11. Ectopic osteogenesis in the rectus sheath.

    PubMed

    Me?in?, C; Me?in?-Botoran, Mihaela Iustina; Dr?goi, G S; Pa?alega, M; Vlcea, D; Vasile, I

    2006-01-01

    Although was published many cases of ectopic osteogenesis of traumatic, neurogenic cause or hereditable form, the etiology of ectopic osteogenesis remaining unknown. We present ectopic osteogenesis in the rectus abdominal sheath. The study material was represented from fragments of ectopic bones discovered in rectus sheath of four patients suffering iterative surgical abdominal interventions. The pieces of ectopic bone were decalcified and then were made to the standard techniques (paraffin inclusion, general techniques dyeing). The process of ectopic osteogenesis was analyzed through microscopically study to seriated sections of discovered piece, finding the presence of the hematopoesis foci. We conclude that is important identifying and characterizing the osteoinductor agents because these allowed the study of osteogenesis to the cellular level and make an estimation of the abnormally bone developing mechanisms. A possible osteoinductor factor has been considerate the non-absorbable wound closure material. PMID:16838064

  12. Topical tretinoin 0.1% for pregnancy-related abdominal striae: an open-label, multicenter, prospective study.

    PubMed

    Rangel, O; Arias, I; Garca, E; Lopez-Padilla, S

    2001-01-01

    In an open-label, multicenter, prospective study, 20 women applied tretinoin (retinoic acid) cream 0.1% daily for 3 months to pregnancy-related stretch marks in the abdominal area. Efficacy was evaluated by analysis of one preselected target lesion, which was rated on a six-point scale (-1 = worse to 4 = cleared). At week 12, significant global improvement was noted from baseline in all stretch marks, and the target lesion decreased in length by 20% (P = .01). Erythema and scaling, the most common adverse events, occurred in 11 patients, decreased in severity after the first month of treatment, and were controlled with continued application of tretinoin and petroleum jelly ointment. In this small study, topical application of tretinoin significantly improved the clinical appearance of pregnancy-related stretch marks. PMID:11697021

  13. Ectopic Ureter

    MedlinePLUS

    ... the need for stitches. Frequently asked questions: Are boys or girls more likely to have an ectopic ureter? This condition is more common in girls than boys, but can occur in either sex. What is ...

  14. [Girls' abdominal pains and gynaecological emergencies].

    PubMed

    Le Hors-Albouze, Hlne; Boutin, Aurlie; Louis-Borrione, Claude; Jouve, Jean-Luc

    2011-05-01

    Among many causes of abdominal pain in children, gynaecological ones have to be systematically considered in even no pubescent girls. Diagnosis leans on physical and US examinations and has to screen first urgent causes before frequent ones. Rare but urgent are ovarian torsions either on a normal ovary or an underlying ovarian tumor, an earlier surgery may avoid oophorectomy. Hematocolpos linked to imperforate hymen is the most common obstructive congenital abnormality of the female genital tract and the diagnosis is easy with inspection of external genitalia. Ovarian tumors are infrequent and most often begnin but torsion, rupture or bleeding complications causes acute abdominal pains. Dysmenorrhea is the most common cause of abdominal pain in pubescent girls. In adolescents, genital tract infections and rare ectopic pregnancy have also to be mentioned. PMID:21698890

  15. Comparing the diagnostic performance of MRI versus CT in the evaluation of acute nontraumatic abdominal pain during pregnancy.

    PubMed

    Baron, Keren Tuvia; Arleo, Elizabeth Kagan; Robinson, Christopher; Sanelli, Pina C

    2012-12-01

    The objectives of this study were to document the utilization of MRI compared with CT in pregnant patients presenting with acute nontraumatic abdominal pain at our institution and to compare the diagnostic performance of the two modalities. A retrospective review identified all pregnant patients at our institution who had MRI or CT exams of the abdomen and/or pelvis for acute nontraumatic abdominal pain over a 3-year period from January 2008 through December 2010. The imaging diagnoses were compared with pathologic data or operative findings as the primary reference standard or with clinical follow-up and laboratory data as the secondary reference standard. Patients without surgically proven diagnoses were followed clinically until delivery, when possible. Ninety-four pregnant patients were included in this study: 61 MRI exams were performed in 57 patients, 44 CT exams were performed in 43 patients (including six patients who had both), and 72 patients (77 %) had ultrasound prior to cross-sectional imaging, with the appendix specifically assessed in 25 patients but visualized in only two of them. Of 61 MRI exams, 24 were considered positive for imaging diagnoses, 33 were negative, and 4 were equivocal. Of 44 CT exams, 24 were positive and 20 were negative. The test characteristics for MRI and CT in the diagnosis of acute abdominal pain were as follows: sensitivity 91 and 88 %, specificity 85 and 90 %, positive predictive value 81 and 91 %, negative predictive value 94 and 8 5 %, and diagnostic accuracy 88 and 88 %, respectively. Differences were not statistically significant (p value?=?1). The majority of MRIs (34/61?=?56 %) were read by emergency radiologists. MRI and CT performed equally well in the evaluation of acute nontraumatic abdominal pain during pregnancy. Given its lack of ionizing radiation, MRI may be preferable. Given that the majority of MRIs were read by radiologists specializing in emergency imaging, this is a technique that emergency radiologists should be comfortable interpreting. PMID:22886287

  16. Ectopic Kidney

    MedlinePLUS

    ... Human Development March of Dimes National Office MedlinePlus Kidney and Urologic Disease Organizations Many organizations provide support ... Organizations​​ . (PDF, 345 KB)​​​​​ Alternate Language URL Ectopic Kidney Page Content On this page: What is an ...

  17. Role of Activins and Inducible Nitric Oxide in the Pathogenesis of Ectopic Pregnancy in Patients with or without Chlamydia trachomatis Infection▿

    PubMed Central

    Refaat, Bassem; Al-Azemi, Majedah; Geary, Ian; Eley, Adrian; Ledger, William

    2009-01-01

    Chlamydia trachomatis infection can lead to pelvic inflammatory disease, ectopic pregnancy (EP), infertility, and chronic pelvic pain in women. Activins and inducible nitric oxide synthase (iNOS) are produced by the human fallopian tube, and we speculate that tubal activins and iNOS may be involved in the immune response to C. trachomatis in humans and their pathological alteration may result in tubal pathology and the development of EP. Blood and fallopian tubes were collected from 14 women with EP. Sera were analyzed by enzyme-linked immunosorbent assay to detect antibodies against chlamydial heat shock protein 60 (chsp60) and the major outer membrane protein of C. trachomatis. Confirmation of C. trachomatis serology was made using the microimmunofluorescence test. The patients were classified into three groups according to their serological results, and immunohistochemistry and quantitative reverse transcription-PCR were performed to investigate the expression of candidate molecules by tubal epithelial cells among the three groups. This is the first study to show an increase in the expression of activin βA subunit, type II receptors, follistatin, and iNOS within the human fallopian tube of EP patients who were serologically positive for C. trachomatis. A similar expression profile was observed in the fallopian tubes with detectable antibodies only against chsp60. These results were shown at the mRNA and protein levels. We suggest that tubal activin A, its type II receptors, follistatin, and NO could be involved in the microbial-mediated immune response within the fallopian tube, and their pathological expression may lead to tubal damage and the development of EP. PMID:19692623

  18. Ovarian Pregnancy Following in Vitro Fertilization in a Woman After Bilateral Salpingectomy: A Case Report and Review of the Literature.

    PubMed

    Feit, Hagit; Leibovitz, Zvi; Kerner, Ram; Keidar, Ran; Sagiv, Ron

    2015-01-01

    We present a rare case of ovarian pregnancy that occurred in a woman who underwent in vitro fertilization (IVF) after bilateral salpingectomy. The patient presented with abdominal pain and a positive pregnancy test. Ovarian pregnancy was diagnosed owing to a suspicious mass detected on ultrasound. She underwent laparoscopy to confirm the diagnosis, which was subsequently verified by histopathological examination. The question that comes in mind is: How did the pregnancy get there? After a review of the literature, we have found a few possible explanations for the mechanism of this rare event. This case emphasizes the need for vigilance in suspecting ectopic pregnancy even in women who have undergone salpingectomy. PMID:25623367

  19. Measurement of Fetal Abdominal and Subscapular Subcutaneous Tissue Thickness during Pregnancy to Predict Macrosomia: A Pilot Study

    PubMed Central

    Chen, Xiao-Hui; Cao, Li; Wu, Yun; Zhu, Li-Jun; Lv, Kang-Tai; Ji, Chen-Bo; Guo, Xi-Rong

    2014-01-01

    This study assessed the growth trends and reference ranges of the ultrasound parameters, fetal abdominal subcutaneous tissue thickness (ASTT) and subscapular subcutaneous tissue thickness (SSTT), in the last two trimesters of normal pregnancy in a Chinese population. We recruited 744 healthy women with singleton pregnancies. The ASTT and SSTT were evaluated at different times between 21 and 36 weeks of gestation. The correlations between these parameters and fetal gestational weeks were assessed using linear regression analysis. Both ASTT and SSTT increased with gestation, and both parameters showed a strong correlation with gestation (ASTT vs. GA, R2?=?0.792; P<0.0001; SSTT vs. GA, R2?=?0.302; P<0.0001). Time-specific reference ranges, including 5th, 50th and 95th percentiles and means SD, were constructed for ASTT and SSTT. These results provide a preliminary reference range to evaluate whether fetal development and maternal metabolic health is normal or not in a Chinese population. PMID:24675769

  20. Intrahepatic pregnancy: A unique opportunity for evaluation with sonography, computed tomography, and magnetic resonance imaging

    SciTech Connect

    Harris, G.J.; Al-Jurf, A.S.; Yuh, W.T.C.; Abu-Yousef, M.M. )

    1989-02-10

    The incidence of ectopic pregnancy ranges from one in 84 to one in 357 live births. The most common site of implantation is within the fallopian tubes; abdominal pregnancies are unusual, and primary hepatic pregnancies are extremely rare. A computer search revealed only six case of placental attachment to the liver in the English-language literature since Cornell and Lash reported eight cases in 1933. Newer imaging techniques have a greater ability to define tissue planes, thus allowing more accurate diagnosis and preoperative planning by the surgical team. The authors take this opportunity to present radiological and other images, obtained by ultrasonography, CT, and MR to demonstrate a primary hepatic pregnancy.

  1. In Subfertile Couple, Abdominal Fat Loss in Men Is Associated with Improvement of Sperm Quality and Pregnancy: A Case-Series

    PubMed Central

    Faure, Cline; Dupont, Charlotte; Baraibar, Martin A.; Ladouce, Romain; Cedrin-Durnerin, Isabelle; Wolf, Jean Philippe; Lvy, Rachel

    2014-01-01

    Background The impact of overweight among men of reproductive-age may affect fertility. Abdominal fat, more than body mass index, is an indicator of higher metabolic risk, which seems to be involved in decreasing sperm quality. This study aims to assess the relationship between abdominal fat and sperm DNA fragmentation and the effect of abdominal fat loss, among 6 men in subfertile couples. Methods Sperm DNA fragmentation, abdominal fat and metabolic and hormonal profiles were measured in the 6 men before and after dietary advices. Seminal oxidative stress and antioxidant markers were determined. Results After several months of a lifestyle program, all 6 men lost abdominal fat (patient 1: loss of 3 points of abdominal fat, patient 2: loss of 3 points, patient 3: loss of 2 points, patient 4: loss of 1 point, patient 5: loss of 4 points and patient 6: loss of 13 points). At the same time, their rate of sperm DNA fragmentation decreased: 9.5% vs 31%, 24% vs 43%, 18% vs 47%, 26.3% vs 66%, 25.4% vs 35% and 1.7% vs 25%. Also, an improvement in both metabolic (significant decrease in triglycerides and total cholesterol; p?=?0.0139) and hormonal (significant increase in testosterone/oestradiol ratio; p?=?0.0139) blood profiles was observed after following the lifestyle program. In seminal plasma, the amount of SOD2 has significantly increased (p?=?0.0139) while in parallel carbonylated proteins have decreased. Furthermore, all spouses got pregnant. All pregnancies were brought to term. Conclusion This study shows specifically that sperm DNA fragmentation among men in subfertile couples could be affected by abdominal fat, but improvement of lifestyle factor may correct this alteration. The effect of specific abdominal fat loss on sperm quality needs further investigation. The reduction of oxidative stress may be a contributing factor. PMID:24520319

  2. A case of spontaneous tubal pregnancy with caesarean scar pregnancy

    PubMed Central

    Zhu, Jie; Shen, Yue-Ying; Zhao, Yu-Qing; Lin, Ru; Fang, Fang

    2014-01-01

    Tubal pregnancy with caesarean scar pregnancy is rare. Early, accurate diagnosis and treatment for this kind of ectopic pregnancy can lead to a decrease of maternal morbidity and mortality. Here, we report a rare case of spontaneous tubal pregnancy co-existing with caesarean scar pregnancy. After timely emergency laparoscopy and curettage, the patient was cured. PMID:25356166

  3. Ectopic pancreas presenting with pancreatitis and a mesenteric mass.

    PubMed

    Ginsburg, Michael; Ahmed, Osman; Rana, Kuntal A; Boumendjel, Redouane; Dachman, Abraham H; Zaritzky, Mario

    2013-01-01

    Ectopic pancreas is defined by the presence of abnormally situated pancreatic tissue that lacks contact with normal pancreas and possesses its own duct system and vascular supply. Ectopic pancreas in the gastrointestinal tract is not uncommon. Moreover, there are several reported cases of adult ectopic pancreatitis in the literature, but to date, only two cases of pediatric ectopic pancreatitis have been reported. We describe a 15-year-old female with acute right upper quadrant pain and elevated serum lipase and amylase, in whom the radiological diagnosis was mesenteric soft tissue mass with adjacent inflammatory changes. The surgical pathology diagnosis, however, was mesenteric ectopic pancreas complicated by pancreatitis. We advocate for ectopic pancreatitis to be considered in a pediatric patient with acute abdominal pain, laboratory findings consistent with pancreatitis, and imaging findings of a mesenteric mass and normal orthotopic pancreas. PMID:23331836

  4. Ectopic Male Breast Cancer: A Case Report.

    PubMed

    Samanta, Dipti Rani; Bose, Chaitali; Upadhyay, Ashish; Sheet, Saikat; Senapati, Surendra Nath

    2015-08-01

    Carcinoma of male breast constitutes 1% of total breast malignancy. Carcinoma arising from ectopic breast tissue in male is an extremely rare entity and can be misdiagnosed. Ectopic breast tissue may be supernumerary or aberrant one. Despite morphologic difference, ectopic breast tissue presents characteristics analogous to orthoptic breast in terms of functional and pathologic degeneration. Most of the ectopic breast tissue occurs in thoracic or abdominal portion of milk line. If found in a location outside the milk line, it proves a diagnostic dilemma. We are reporting a case of 60-year-old male who presented with a fixed mass of size 10cm8cm, in right chest wall infraclavicular area of 6 months duration. Histopathology of the mass revealed invasive duct carcinoma. He had no evidence of malignant or occult primary lesion in the bilateral mammary glands. Due to the paucity of the literature, incidence of ectopic male breast cancer and its management is not well understood. There is high probability of misdiagnosis of this disease. To the best of our knowledge this is the first described case of ectopic male breast cancer in the chest wall, not along the milk line, which is being reported here for documentation. PMID:26436033

  5. Pregnancy

    MedlinePLUS

    ... each trimester are described below. 1 First Trimester (Week 1 to Week 12) The events that lead to pregnancy begin ... and oxygen to the fetus. 2 Second Trimester (Week 13 to Week 28) At 16 weeks, and ...

  6. Advanced extrauterine pregnancy at 33 weeks with a healthy newborn.

    PubMed

    Dabiri, Tajudeen; Marroquin, Guillermo A; Bendek, Boleslaw; Agamasu, Enyonam; Mikhail, Magdy

    2014-01-01

    Abdominal pregnancy is a very rare form of ectopic pregnancy, associated with high morbidity and mortality for both fetus and mother. It is, and often, seen in poor resource nations, where early diagnosis is often a major challenge due to poor prenatal care and lack of medical resources. An advanced abdominal pregnancy with a good fetal and maternal outcome is therefore a more extraordinary occurrence in the modern developed world. We present a case of an abdominal pregnancy at 33.4?weeks in an individual with no documented prenatal care, who arrived in a hospital in the Bronx, in June 25th 2014, with symptoms of generalized, severe lower abdominal pain. Upon examination it was found that due to category III fetal tracing an emergent cesarean section was performed. At the time of laparotomy the fetus was located in the pelvis covered by the uterine serosa, with distortion of the entire right adnexa and invasion to the right parametrium. The placenta invaded the pouch of Douglas and the lower part of the sigmoid colon. A massive hemorrhage followed, followed by a supracervical hysterectomy. A viable infant was delivered and mother discharged on postoperative day 4. PMID:25544940

  7. Ruptured tubal molar pregnancy.

    PubMed

    Yakasai, I A; Adamu, N; Galadanchi, H S

    2012-01-01

    Molar pregnancies in most instances develop within the uterine cavity, but may occur at any site. Ectopic molar pregnancy is a rare event. The objective of this study was to present a case of ruptured tubal molar gestation, discuss its clinical features and ways to improve diagnostic accuracy. A 35-year-old woman presented with features suggestive of ruptured tubal ectopic pregnancy. There was neither any evidence at the time of presentation to suspect a molar gestation, nor ? human chorionic gonadotrophin (?hCG) hormone estimation was done, but only a clearview pregnancy test was carried out. She had total left salpingectomy and histological evaluation of the specimen revealed complete hydatidiform mole. The hCG level normalized within 3 weeks of follow-up. Clinical features of ectopic molar pregnancy may be indistinguishable from non-molar ectopic pregnancy. We recommend ?hCG estimation as well as histological examination of the surgical specimen for all patients coming with features suggestive of ectopic pregnancy. PMID:23238205

  8. An unusual cause of intra-abdominal calcification: A lithopedion

    PubMed Central

    Ramos-Andrade, Daniel; Ruivo, Catarina; Portilha, M. Antnia; Brito, Jorge B.; Caseiro-Alves, Filipe; Curvo-Semedo, Lus

    2014-01-01

    We report a case of a 77-year-old female who was admitted to the emergency department complaining of diffuse abdominal pain for five days, associated with nausea, vomiting and constipation. Physical examination disclosed a large incarcerated umbilical hernia, which was readily apparent on supine abdominal plain films. These also showed a calcified heterogeneous mass in the mid-abdominal region, which was further characterized by CT as a lithopedion (calcified ectopic pregnancy). This is one of the few cases studied on a MDCT equipment, and it clearly enhances the post-processing abilities of this imaging method which allows diagnostic high-quality MIP images. Lithopedion is a rare entity, with less than 300 cases previously described in the medical literature. However, many reported cases corresponded to cases of skeletonization or collections of fetal bone fragments discovered encysted in the pelvic region at surgery or autopsy. It is thus estimated that true lithopedion is a much rarer entity. The diagnosis may be reached by a suggestive clinical history and a palpable mass on physical examination, while the value of modern cross-sectional techniques is still virtually unknown. Ultrasonography may depict an empty uterine cavity and a calcified abdominal mass of non-specific characteristics, and computed tomography or magnetic resonance imaging are able to reach a conclusive diagnosis and may additionally define the involvement of adjacent structures. The differential diagnosis includes other calcified pathologic situations, including ovarian tumors, uterine fibroids, urinary tract neoplasms, inflammatory masses or epiploic calcifications.

  9. Ectopic ADH secretion

    MedlinePLUS

    Ectopic ADH secretion is the release of antidiuretic hormone (ADH, also called vasopressin, or AVP) from a place in the body where it is not normally produced. ADH is a substance produced naturally by the hypothalamus ...

  10. Characterizing the Propagation of Uterine Electrophysiological Signals Recorded with a Multi-Sensor Abdominal Array in Term Pregnancies

    PubMed Central

    Escalona-Vargas, Diana; Govindan, Rathinaswamy B.; Furdea, Adrian; Murphy, Pam; Lowery, Curtis L.; Eswaran, Hari

    2015-01-01

    The objective of this study was to quantify the number of segments that have contractile activity and determine the propagation speed from uterine electrophysiological signals recorded over the abdomen. The uterine magnetomyographic (MMG) signals were recorded with a 151 channel SARA (SQUID Array for Reproductive Assessment) system from 36 pregnant women between 37 and 40 weeks of gestational age. The MMG signals were scored and segments were classified based on presence of uterine contractile burst activity. The sensor space was then split into four quadrants and in each quadrant signal strength at each sample was calculated using center-of-gravity (COG). To this end, the cross-correlation analysis of the COG was performed to calculate the delay between pairwise combinations of quadrants. The relationship in propagation across the quadrants was quantified and propagation speeds were calculated from the delays. MMG recordings were successfully processed from 25 subjects and the average values of propagation speeds ranged from 1.39.5 cm/s, which was within the physiological range. The propagation was observed between both vertical and horizontal quadrants confirming multidirectional propagation. After the multiple pairwise test (99% CI), significant differences in speeds can be observed between certain vertical or horizontal combinations and the crossed pair combinations. The number of segments containing contractile activity in any given quadrant pair with a detectable delay was significantly higher in the lower abdominal pairwise combination as compared to all others. The quadrant-based approach using MMG signals provided us with high spatial-temporal information of the uterine contractile activity and will help us in the future to optimize abdominal electromyographic (EMG) recordings that are practical in a clinical setting. PMID:26505624

  11. Ectopic Hidradenoma Papilliferum

    PubMed Central

    Rosmaninho, Aristóteles David Neiva; de Almeida, Maria Teresa Duarte Pinto; Costa, Vírgilio; Sanches, Maria Madalena Vasconcelos; Lopes, Carlos; Selores Gomes Meirinhos, Maria Manuela

    2010-01-01

    Hidradenoma papilliferum is a rare tumor that occurs almost exclusively in females on the anogenital area. Rare cases of ectopic (nongenital) hidradenoma papilliferum have been described. The lesions usually present as an asymptomatic slow-growing, red, firm, mobile, well-delimitated nodule that grows for a long time before resection. We describe a case of an 26-year-old man that presented with an enlarging nodule on his right eyelid. The histological findings revealed a hidradenoma papilliferum. So far, among the very few reports of ectopic hidradenoma papilliferum, only a very small number were localized to the eyelid. PMID:21197082

  12. A Rare Case of Heterotopic Pregnancy with Ruptured Left Rudimentary Horn Pregnancy

    PubMed Central

    Rathod, Setu

    2015-01-01

    Heterotopic pregnancy(HP) occurs when intrauterine and ectopic pregnancies coexist. We report a case of HP at 14 wk of gestation presenting as ruptured left rudimentary horn ectopic pregnancy with live intrauterine gestation and was managed with emergency laparotomy followed by resection of left rudimentary non communicating horn of uterus. The intrauterine pregnancy continued uneventfully. A female baby was delivered vaginally at 41 wk following induction of labour. PMID:25954670

  13. [Cesarean scar pregnancy].

    PubMed

    Matyszkiewicz, Anna; Jach, Robert; Nocu?, Agnieszka; Posadzka, Ewa; Huras, Hubert; Pity?ski, Kazimierz; Wolski, Hubert; Basta, Pawe?

    2015-10-01

    Pregnancy in the uterine scare after previous caesarean section is the rarest type of ectopic pregnancy Due to the possibility of life-threatening complications, cesarean scar pregnancy (CSP) needs rapid and proper diagnosis and management. Hereby we present 3 cases of women with CSP, diagnosed and treated at the Department of Gynecology and Obstetrics of Jagiellonian University Medical College, in Krakow, in 2013, as well as literature review. PMID:26677591

  14. Ectopic cutaneous Schistosomiasis*

    PubMed Central

    Vargas, Thiago Jeunon de Sousa; Lopes, Raquel; Moraes, Maria de Lourdes Palermo F. N.; de Azevedo, Karen Grace Pena; Sousa, Maria Auxiliadora Jeunon

    2013-01-01

    The authors report a case of ectopic cutaneous schistosomiasis in a 35 year-old female who presented clustered reddish macules and papules on the left buttock. The diagnosis was not suspected during clinical evaluation and required visualization of Schistosoma mansoni eggs on sections of tissue. PMID:24173194

  15. Primary ectopic frontotemporal craniopharyngioma

    PubMed Central

    Ortega-Porcayo, Luis Alberto; Ponce-Gmez, Juan Antonio; Martnez-Moreno, Mauricio; Portocarrero-Ortz, Lesly; Tena-Suck, Martha Lilia; Gmez-Amador, Juan Luis

    2015-01-01

    Introduction Primary ectopic craniopharyngiomas have only rarely been reported. Craniopharyngiomas involve usually the sellar and suprasellar region, but can be originated from cell remnants of the obliterated craniopharyngeal duct or metaplastic change of andenohypophyseal cells. We present the first case of a primary ectopic frontotemporal craniopharyngioma. Presentation of case A 35-year old woman presented with a one-year history of headache and diplopia. MRI showed a large frontotemporal cystic lesion. Tumor resection was performed with a keyhole endoscopic frontal lateral approach. The pathological features showed an adamantinomatous craniopharyngioma with a cholesterol granuloma reaction. Discussion There have been reported different localizations for primary ectopic craniopharyngioma. Our case presented a lobulated frontotemporal cystic mass formed by a dense eosinophilic proteinaceous material dystrophic calcifications and cholesterol crystals, with epithelial remnants. No tumor regrowth was observed in the magnetic resonance image 27 months postoperatively. Conclusion Primary ectopic craniopharyngioma is a rare entity with a pathogenesis that remains uncertain. This is an unusual anatomic location associated with unique clinical findings. PMID:25725331

  16. Rare case of primary peritoneal pregnancy infiltrated into the Gerota's fascia of the right kidney.

    PubMed

    Chishima, Fumihisa; Kato-Suzuki, Erina; Ichikawa, Go; Hayashi, Chuyu; Ohni, Sumie; Yamamoto, Tatsuo

    2013-05-01

    A 33-year-old, gravida 3, para 2, woman was transferred to our hospital, with acute abdominal pain. Abdominal computed tomography (CT) revealed a cystic lesion accompanied by ring-enhancement between the liver and right kidney with fluid collection in the pelvic cavity. Serum hCG value was 3100?mIU/mL. Transvaginal sonography revealed a pseudo-gestational sac in a thickened endometrium. With a preoperative diagnosis of ectopic pregnancy at 7 weeks of gestation, laparotomy was performed. Following careful removal of clots between the liver and right kidney that contained a gestational sac, continuous bleeding from a defect in the Gerota's fascia of the right kidney was noted. The postoperative course was uneventful and the serum hCG concentration decreased markedly. This case demonstrates that the Gerota's fascia is a possible site of ectopic pregnancy, and that CT can identify a pregnancy in the Gerota's fascia as well as in the liver and spleen. PMID:23278946

  17. Pregnancy after failed tubal sterilization.

    PubMed

    Napolitano, P G; Vu, K; Rosa, C

    1996-08-01

    Various research studies have documented post-sterilization ectopic pregnancy rates ranging from 5% to 90%. To investigate this complication further, the pregnancy outcomes of the 12 women with failed tubal sterilizations who received care during 1989-91 at the Beaumont Army Medical Center in El Paso, Texas, and of 137 such patients at other Texas military hospitals during 1984-88 were reviewed. Ectopic pregnancies occurred in 8 (67%) women in the former group and 49 (36%) in the latter. The incidence of ectopic pregnancy was similar for minilaparotomy, cesarean section-associated sterilization, and laparoscopy, indicating that there is no significant advantage associated with any one procedure. A post-sterilization pregnancy may be due to tubal recanalization or to a proximal fistula. Recommended is the practice of electrocoagulating both cornual regions to cause scarring of the myometrium and closing of any fistula. PMID:8866391

  18. Rh Factor: How It Can Affect Your Pregnancy

    MedlinePLUS

    ... a miscarriage , an ectopic pregnancy , or an induced abortion . If an Rh-negative woman becomes pregnant after ... caused by destruction of red blood cells. Induced Abortion: The planned termination of a pregnancy before the ...

  19. An Ectopic Pelvic Kidney

    PubMed Central

    Bhoil, Rohit; Sood, Dinesh; Singh, Yash Paul; Nimkar, Kshama; Shukla, Anurag

    2015-01-01

    Summary Background If a kidney does not ascend as it should in normal fetal development, it remains in the pelvic area and is called a pelvic kidney. Often a person with a pelvic kidney will go through his/her whole life unaware of this condition, unless it is discovered during neonatal kidney ultrasound screening or if complications arise later in life due to this or a completely different reason and the condition is noted during investigations. Generally, this is not a harmful condition but it can lead to complications like in our case. With appropriate testing and treatment, if needed, an ectopic kidney should cause no serious long-term health complications and all that may be required for the patient is reassurance with advice to follow up at regular intervals. Case Report A 28-year-old male presented with recurrent pain in his lower left abdomen for one month and an episode of hematuria 3 days earlier accompanied by an attack of acute pain lasting for 34 hours. He gave a history of passing 2 small (about 5 mm each) calculi in his urine after the occurrence of hematuria, following which pain decreased in intensity. No history of fever was present. Conclusions Although a simple ectopic kidney seldom causes symptoms, the association of malrotation of the renal pelvis with calculus increases the risk of hematuria and/or hydronephrosis, presenting with colicky pain as in the present case. The clinician should be aware of these in such a case. If asymptomatic, no treatment is required. However, the patient should be advised to have follow-up ultrasounds at regular intervals to detect complications like calculus, hydronephrosis, etc. With appropriate testing and treatment, if required, an ectopic kidney should not cause serious long-term health complications. PMID:26413178

  20. Intralaryngeal ectopic thyroid.

    PubMed

    Zato?ski, Tomasz; Bolanowski, Marek; J?drzejuk, Diana; Zato?ska, Katarzyna; Kr?cicki, Tomasz

    2014-01-01

    Lingual thyroid is the most common presentation of ectopic thyroid tissue. In contrast, to that laryngeal location is extremely rare. We report a case of 59 years old woman with a history of progressive dyspnea and nodular thyroid goiter. Endoscopic examination revealed subglottic smooth tumor of the right side of the larynx. CT scans revealed mass localized in infraglottic part of the larynx, causing infraglottic stenosis. The biopsy of the tumor revealed: Struma nodosa. Reviewing the literature we found only seven cases described. We present development of the thyroid gland and origins causing ectopy. PMID:24484950

  1. Gastric and ectopic varices.

    PubMed

    Henry, Zachary; Uppal, Dushant; Saad, Wael; Caldwell, Stephen

    2014-05-01

    Although often considered together, gastric and ectopic varices represent complications of a heterogeneous group of underlying diseases. Commonly, these are known to arise in patients with cirrhosis secondary to portal hypertension; however, they also arise in patients with noncirrhotic portal hypertension, most often secondary to venous thrombosis of the portal venous system. One of the key initial assessments is to define the underlying condition leading to the formation of these portal-collateral pathways to guide management. In the authors' experience, these patients can be grouped into distinct although sometimes overlapping conditions, which can provide a helpful conceptual basis of management. PMID:24679501

  2. Abdominal mass

    MedlinePLUS

    Several conditions can cause an abdominal mass: Abdominal aortic aneurysm can cause a pulsating mass around the navel. ... This could be a sign of a ruptured aortic aneurysm, which is an emergency condition. Contact your health ...

  3. Spectrum of ectopic ureters in children.

    PubMed

    Roy Choudhury, Subhasis; Chadha, Rajiv; Bagga, Deepak; Puri, Archana; Debnath, Pinaki Ranjan

    2008-07-01

    We reviewed the clinicopathological features, diagnosis, and surgical treatment of ectopic ureters (EU) in children in order to evaluate the anatomy, renal function, outcome, and the existence of any racial or regional difference in this abnormality. The records of 27 consecutive patients with 33 EU managed over a period of 7 years were analyzed. There were 25 female and two male patients. Their age ranged from 1 to 13 years, with an average of 4.5 years. The presenting features included history of continuous dribbling of urine with otherwise normal voiding in toilet-trained female patients, incontinence of urine, urinary tract infection, abdominal pain, and renal failure. The diagnostic work-up included ultrasonography (US) in all 27 patients, intravenous pyelography (IVP) in 23, micturating cystourethrogram (MCU) in 19, nuclear imaging (NI) in 16, and computed tomogram (CT) in five patients. All patients underwent examination under anesthesia (EUA) and cystourethrovaginoscopy immediately before the operation. Single-system ectopic ureter (SSEU) was present in 19 patients with 25 ureters (six bilateral), and duplex with ectopic ureter was present in eight cases. The left side was involved in 14 cases, the right side in seven, and the anomaly was bilateral in six cases. Abnormalities noted in the imaging studies were USG 23/27, IVP 23/23, MCU 11/19, NI 13/16, and CT 5/5 cases. EUA and cystourethrovaginocsopy helped in localization of the ectopic site and evaluation of the bladder. The surgical treatment included nephroureterectomy (NUT) for non-functioning kidney in 7 patients, heminephroureterectomy (HNUT) for non functioning upper pole of duplex kidney with EU in 6 patients, ureteric reimplantation (UTR) in 13 patients (19 ureters, 6 bilateral), and ureteropyelostomy (UTP) in one patient. In the follow-up period ranging from 1 to 5 years, 20 patients achieved continence; however, six cases with bilateral SSEU and one case of unilateral SSEU, who also had a patulous bladder neck, continued to dribble urine. SSEU was more common than duplex with ectopic ureter. A large number of functioning renal units associated with SSEU deserved preservation. The success of surgical treatment in terms of achievement of continence was high and depended on the integrity of the bladder neck. PMID:18463883

  4. Visceral surgery and pregnancy.

    PubMed

    Germain, A; Brunaud, L

    2010-06-01

    With an incidence of 950,000 pregnancies per year in France, the likelihood of seeing one or more surgical abdominal diseases during pregnancy is high. The goal of this update was to describe the management of four different settings in the pregnant woman: colorectal cancer, laparoscopic surgery, gastrointestinal emergency surgery, and bariatric surgery. PMID:20813621

  5. Abdominal Assessment.

    PubMed

    Fritz, Deborah; Weilitz, Pamela Becker

    2016-03-01

    Abdominal pain is one of the most common complaints by patients, and assessment of abdominal pain and associated symptoms can be challenging for home healthcare providers. Reasons for abdominal pain are related to inflammation, organ distention, and ischemia. The history and physical examination are important to narrow the source of acute or chronic problems, identify immediate interventions, and when necessary, facilitate emergency department care. PMID:26925941

  6. Appendicitis during pregnancy.

    PubMed Central

    Guttman, Rachelle; Goldman, Ran D.; Koren, Gideon

    2004-01-01

    QUESTION: A 26-year-old patient in our clinic, who was 18 weeks pregnant at the time, experienced acute abdominal pain and was diagnosed with appendicitis. The inflamed appendix was successfully removed. Is her pregnancy at risk? ANSWER: Appendicitis is not rare during pregnancy and is associated with increased reproductive risk. Women who have undergone appendectomy during pregnancy are at higher risk of fetal loss, especially in early pregnancy and with appendiceal perforation, and of premature contractions and labour. Despite the difficulty of diagnosing appendicitis during pregnancy, appendectomy should not be delayed. PMID:15318670

  7. Abdominal splenosis

    PubMed Central

    Pirozynski, W. J.; Allan, C. M.

    1974-01-01

    Abdominal splenosis was an incidental finding at laparotomy for acute appendicitis in a 39-year-old man who had had splenectomy for traumatic rupture of the spleen nine years previously. Similar cases of abdominal and intrathoracic splenosis are reviewed. ImagesFIG. 1 PMID:4841838

  8. Abdominal pain

    MedlinePLUS

    Stomach pain; Pain - abdomen; Belly ache; Abdominal cramps; Bellyache; Stomachache ... Almost everyone has pain in the abdomen at some point. Most of the time, it is not serious. How bad your pain is ...

  9. Abdominal Pain

    MedlinePLUS

    ... can I find more information and related topics? Functional Abdominal Pain (English, French or Spanish)—from The North American Society for Pediatric Gastroenterology, Hepatology and Nutrition (NASPGHAN). Gastro Kids , a site for kids with ...

  10. [Cancer in ectopic breast tissue].

    PubMed

    Røikjer, Johan; Lindmark, Ida; Knudsen, Thor

    2015-06-15

    Two different forms of ectopic breast tissue exist in human beings: supernumerary and aberrant. Both forms are usually seen alongside the milk lines, which extend from the upper limbs to the inguinal region where they give rise to mammary glands, areolas and nipples. Although ectopic- and orthotopic breast tissue are placed in different areas of the body, they still share the same ability to undergo pathological degeneration. The focus of this case report is to shed light on this unusual form of breast cancer, and raise the level of awareness in cases with lumps located in the milk lines. PMID:26101129

  11. [Cervical pregnancy--an unusual form of extrauterine pregnancy].

    PubMed

    Abu Hmeidan, F; Pretzsch, G; Alexander, H; Schollmeyer, M

    1991-01-01

    We present a case report about a 27 years old patient with cervical pregnancy. The extrauterine implantation was recognized in the 14th week of gestation. Abdominal hysterectomy was performed because of a life threatening bleeding. PMID:1927121

  12. [Choriocarcinoma in extrauterine tubal pregnancy].

    PubMed

    Horn, L C; Bilek, K; Pretzsch, G; Baier, D

    1994-06-01

    Hydatidiform moles and chorionic carcinomas associated with ectopic pregnancy are extremely rare. We report on three cases of non-metastatic GTD after tubar pregnancy of low and medium risk in the WHO prognostic score and FIGO-stage II in each case. Two of them required several courses of (poly-) chemotherapy to reach complete remission (CR). The follow-up was on average 36.6 months, without any metastases and recurrences. One woman was delivered of a healthy infant. All cases were surgically treated with extirpation of the affected adnexa. Additionally, in one case hysterectomy was necessary to reach CR. As reported in the literature, chorionic carcinomas associated with ectopic pregnancy are often very aggressive and show a metastasis rate of 75% at time of diagnosis. For this reason it is essential, to examine tubar pregnancy by histopathology carefully to define small and in situ changes. The cases presented stress the need for appropriate HCG and clinical monitoring. PMID:8088495

  13. Heterotopic Triplet Pregnancy after In Vitro Fertilization with Favorable Outcome of the Intrauterine Twin Pregnancy Subsequent to Surgical Treatment of the Tubal Pregnancy

    PubMed Central

    Akrivis, Christodoulos; Tsirkas, Panagiotis; Korkontzelos, Ioannis

    2014-01-01

    Heterotopic triplet pregnancy is an exceptionally rare medical condition. The broad use of assisted reproductive technologies has contributed to the increase of ectopic and subsequently heterotopic pregnancy rate, masking a life-threatening condition for the gravid and the intrauterine pregnancy. We describe a case of a woman with heterotopic triplets at 9+4 gestational week following transfer of three embryos obtained by in vitro fertilization techniques. The ectopic tubal pregnancy was ruptured and salpingectomy was performed by laparotomy. The intrauterine pregnancy progressed to the delivery by cesarean section of two healthy twins at 36+2 gestational age. Heterotopic triplets with tubal ectopic are a special diagnostic and therapeutic challenge for the obstetrician. High index of suspicion and timely treatment by laparotomy or laparoscopy can preserve the intrauterine gestation with a successful outcome of the pregnancy. PMID:24527252

  14. Treatment of ectopic varices with portal hypertension

    PubMed Central

    Sato, Takahiro

    2015-01-01

    Ectopic varices are unusual with portal hypertension and can involve any site along the digestive tract outside the gastroesophageal region. Hemorrhage from ectopic varices generally are massive and life threatening. Diagnosis of ectopic varices is difficult and subsequent treatment is also difficult; the optimal treatment has not been established. Recently, interventional radiology and endoscopic treatments have been carried out successfully for hemorrhage from ectopic varices. PMID:26140080

  15. Abdominal cocoon

    PubMed Central

    Katz, Christian B S; Diggory, Robert T; Samee, Abdus

    2014-01-01

    Intestinal obstruction secondary to cocoon formation is not common. We report a case of a patient who had presented with abdominal pain and distension accompanied by vomiting. Investigations, laparotomy and histology together revealed primary peritoneal carcinoma as the cause of the patient's symptoms. PMID:24682136

  16. Abdominal Adhesions

    MedlinePLUS

    ... found that eating, diet, and nutrition play a role in causing or preventing abdominal adhesions. A person with a partial intestinal obstruction may relieve symptoms with a liquid or low-fiber diet, which is more easily broken down into smaller ...

  17. Abdominal thrusts

    MedlinePLUS

    ... call 911 . If the person loses consciousness, start CPR . If you are not comfortable performing abdominal thrusts, ... American Red Cross. First Aid/CPR/AED Participant's Manual. 2nd ... Red Cross; 2014. Berg RA, Hemphill R, Abella BS, et al. Part 5: ...

  18. Rh Disease

    MedlinePLUS

    ... ACOG, 1999; Moise, 2008): Miscarriage Ectopic pregnancy Induced abortion Amniocentesis Chorionic villus sampling (CVS) Abdominal trauma External ... ACOG, 1999; Moise, 2008): Miscarriage Ectopic pregnancy Induced abortion Amniocentesis Chorionic villus sampling (CVS) Abdominal trauma External ...

  19. Ectopic ACTH syndrome: clinicopathological correlations.

    PubMed Central

    Singer, W; Kovacs, K; Ryan, N; Horvath, E

    1978-01-01

    Ten out of 164 cases of bronchogenic carcinoma showed pathological evidence at necropsy of the ectopic ACTH syndrome. All occurred in association with oat-cell carcinoma, constituting 19% of that group. The pathological features consisted of adrenocortical hyperplasia confined to the zona fasciculata and Crooke's hyaline change in the pituitary. Immunoperoxidase stainable ACTH was detected in the pituitary but not in the carcinoma tissue, a surprising finding, which may be due to the different nature of ACTH present in tumour tissue. The ectopic ACTH syndrome was diagnosed ante mortem in only four out of 10 patients on the basis of hypokalaemia and metabolic alkalosis. The lack of clinical pointers in all but terminal cases is discussed as well as possible measures for earlier diagnosis. Images Fig. 1 Fig. 2 Fig. 3 Fig. 4 PMID:209063

  20. Cutaneous ectopic schistosomiasis: diagnostic challenge*

    PubMed Central

    Barros, Cláudia Renata Castro do Rêgo; Maia, Daniela Cristina Caetano; dos Santos, Josemir Belo; Medeiros, Camila Carolina Queiroz; de Araújo, Jessica Guido

    2016-01-01

    Cutaneous schistosomiasis is a rare clinical manifestation of schistosomiasis, an infectious and parasitic disease, caused in Brazil by the trematode Schistosoma mansoni. The lesions are due to the deposition of eggs or, rarely, adult worms, usually involving the genital and groin areas. Extra-genital lesions occur mainly on the torso as papules of zosteriform appearance. The case of a patient with ectopic cutaneous schistosomiasis is reported in this article, due to the rarity of its occurrence and its difficult clinical diagnosis.

  1. Mechanisms of ectopic gene conversion.

    PubMed

    Hastings, P J

    2010-11-29

    Gene conversion (conversion), the unidirectional transfer of DNA sequence information, occurs as a byproduct of recombinational repair of broken or damaged DNA molecules. Whereas excision repair processes replace damaged DNA by copying the complementary sequence from the undamaged strand of duplex DNA, recombinational mechanisms copy similar sequence, usually in another molecule, to replace the damaged sequence. In mitotic cells, the other molecule is usually a sister chromatid, and the repair does not lead to genetic change. Less often a homologous chromosome or homologous sequence in an ectopic position is used. Conversion results from repair in two ways. First, if there was a double-strand gap at the site of a break, homologous sequence will be used as the template for synthesis to fill the gap, thus transferring sequence information in both strands. Second, recombinational repair uses complementary base pairing, and the heteroduplex molecule formed is a source of conversion, both as heteroduplex and when donor (undamaged template) information is retained after correction of mismatched bases in heteroduplex. There are mechanisms that favor the use of sister molecules that must fail before ectopic homology can be used. Meiotic recombination events lead to the formation of crossovers required in meiosis for orderly segregation of pairs of homologous chromosomes. These events result from recombinational repair of programmed double-strand breaks, but in contrast with mitotic recombination, meiotic recombinational events occur predominantly between homologous chromosomes, so that transfer of sequence differences by conversion is very frequent. Transient recombination events that do not form crossovers form both between homologous chromosomes and between regions of ectopic homology, and leave their mark in the occurrence of frequent non-crossover conversion, including ectopic conversion. PMID:24000309

  2. [Pregnancy in a rudimentary horn of the uterus].

    PubMed

    Sroczy?ski, Tomasz

    2014-01-01

    Pregnancy in a rudimentary horn of the uterus, a rare form of ectopic pregnancy, develops in women affected by developmental abnormalities of the growth and fusion of the Mllerian paramesonephric ducts. In the Polish population, this problem affects 4-8 women per year. The paper analyzes the problems that are associated with pregnancy developing in the rudimentary horn. Due to the continuous progress in medical sciences, maternal mortality has been almost completely eliminated in this form of ectopic pregnancy, while neonatal survival has risen to about 20%. Further devel- opments in medicine allow us to be moderately optimis- tic about further improvement of the treatment's statistics. PMID:25518088

  3. Severe Acute Pancreatitis in Pregnancy

    PubMed Central

    Abdullah, Bahiyah; Kathiresan Pillai, Thanikasalam; Cheen, Lim Huay; Ryan, Ray Joshua

    2015-01-01

    This is a case of a pregnant lady at 8 weeks of gestation, who presented with acute abdomen. She was initially diagnosed with ruptured ectopic pregnancy and ruptured corpus luteal cyst as the differential diagnosis. However she then, was finally diagnosed as acute hemorrhagic pancreatitis with spontaneous complete miscarriage. This is followed by review of literature on this topic. Acute pancreatitis in pregnancy is not uncommon. The emphasis on high index of suspicion of acute pancreatitis in women who presented with acute abdomen in pregnancy is highlighted. Early diagnosis and good supportive care by multidisciplinary team are crucial to ensure good maternal and fetal outcomes. PMID:25628906

  4. Abdominal intrauterine vacuum aspiration.

    PubMed

    Tjalma, W A A

    2014-01-01

    Evaluating and "cleaning" of the uterine cavity is probably the most performed operation in women. It is done for several reasons: abortion, evaluation of irregular bleeding in premenopausal period, and postmenopausal bleeding. Abortion is undoubtedly the number one procedure with more than 44 million pregnancies terminated every year. This procedure should not be underestimated and a careful preoperative evaluation is needed. Ideally a sensitive pregnancy test should be done together with an ultrasound in order to confirm a uterine pregnancy, excluding extra-uterine pregnancy, and to detect genital and/or uterine malformations. Three out of four abortions are performed by surgical methods. Surgical methods include a sharp, blunt, and suction curettage. Suction curettage or vacuum aspiration is the preferred method. Despite the fact that it is a relative safe procedure with major complications in less than one percent of cases, it is still responsible for 13% of all maternal deaths. All the figures have not declined in the last decade. Trauma, perforation, and bleeding are a danger triage. When there is a perforation, a laparoscopy should be performed immediately, in order to detect intra-abdominal lacerations and bleeding. The bleeding should be stopped as soon as possible in order to not destabilize the patient. When there is a perforation in the uterus, this "entrance" can be used to perform the curettage. This is particularly useful if there is trauma of the isthmus and uterine wall, and it is difficult to identify the uterine canal. A curettage is a frequent performed procedure, which should not be underestimated. If there is a perforation in the uterus, then this opening can safely be used for vacuum aspiration. PMID:25134300

  5. [Does echography resolve the problem of diagnosis of extrauterine pregnancy at its onset?].

    PubMed

    Crequat, J; Loufrani, B; Madelenat, P

    1983-05-01

    Incipient ectopic pregnancy is always difficult to diagnose. Hormonal assays confirm pregnancy, but in "high tubal risk" women the site of ovular implantation must be determined as early as possible and this, in theory, can be done by ultrasound examination. However pseudogestational images resembling incipient ectopic pregnancy may be misleading, and in the tubal context ultrasound scans must be interpreted with caution before embryonic echoes can be identified in the amniotic cavity. PMID:6222297

  6. Ectopic Paratubal Adrenal Cell Rest Associated with Mucinous Cystadenoma of Ovary.

    PubMed

    Khandakar, Binny; Dey, Soumit; Ray, Prasenjit Sen; Sarkar, Ranu; Bhattacharyya, Palas

    2015-10-01

    Ectopic adrenal cortex is a rare entity. Usually found in male children; commonly located around kidney, retroperitoneum, spermatic cord and para-testicular region. Rarely, adults with heterotopic adrenal glands are described. Incidence in females is very less; though sometimes detected accidentally in hysterectomy specimens. We describe a case of ectopic adrenal cortical cell in paratubal region in a patient with mucinous cyst adenoma of ovary. A 26-year-old female presented with complains of menstrual irregularities and abdominal discomfort for 6 months. Investigations suggested a right ovarian cyst. Right ovarian cystectomy with partial salpingectomy was performed; histopathology revealed mucinous cyst adenoma. Sections from tube showed presence of ectopic adrenal cortical rest in the paratubal region, incidentally discovered on microscopy. We present this case because of its rarity in females, interesting presentation with another unrelated gynaecological pathology, its potentiality for malignant transformation and possible complications. PMID:26557532

  7. Ectopic lymphoid tissues and local immunity.

    PubMed

    Carragher, Damian M; Rangel-Moreno, Javier; Randall, Troy D

    2008-02-01

    Ectopic or tertiary lymphoid tissues develop at sites of inflammation or infection in peripheral, non-lymphoid organs. These tissues are architecturally similar to conventional secondary lymphoid organs, with separated B and T cell areas, specialized populations of dendritic cells, well-differentiated stromal cells and high endothelial venules. Ectopic lymphoid tissues are often associated with the local pathology that results from chronic infection or chronic inflammation. However, there are also examples in which ectopic lymphoid tissues appear to contribute to local protective immune responses. Here we review how ectopic lymphoid structures develop and function in the context of local immunity and pathology. PMID:18243731

  8. Ectopic lymphoid tissues and local immunity

    PubMed Central

    Carragher, Damian M.; Rangel-Moreno, Javier; Randall, Troy D.

    2008-01-01

    Ectopic or tertiary lymphoid tissues develop at sites of inflammation or infection in peripheral, non-lymphoid organs. These tissues are architecturally similar to conventional secondary lymphoid organs, with separated B and T cell areas, specialized populations of dendritic cells, well-differentiated stromal cells and high endothelial venules. Ectopic lymphoid tissues are often associated with the local pathology that results from chronic infection or chronic inflammation. However, there are also examples in which ectopic lymphoid tissues appear to contribute to local protective immune responses. Here we review how ectopic lymphoid structures develop and function in the context of local immunity and pathology. PMID:18243731

  9. Diagnosis of emergencies/urgencies in gynecology and during the first trimester of pregnancy.

    PubMed

    Zucchini, Stefano; Marra, Elena

    2014-03-01

    Several surgical and/or medical emergencies/urgencies may occur in gynecologic patients and in pregnant women during the first trimester. Particularly, ectopic pregnancies, ruptured or hemorrhagic ovarian cysts, ovarian or adnexal torsions, threatened or inevitable miscarriages, phlogistic gynecological disorders, complications involving the uterine fibroids, endometriosis, and spontaneous uterine rupture are possible acute complications. The diagnosis is suspected on the basis of symptoms (acute pelvic and/or abdominal pain, with or without vaginal bleeding or discharge, until acute abdomen with peritonitis), by means physical evaluation (abdominal, pelvic, and bimanual gynecological examinations), by means of transabdominal (TAS) and/or transvaginal (TVS) sonography, and laboratory tests. However, the diagnosis is often not that simple, especially when the symptoms and clinical signs are minimal, and ultrasound (US) examination is not diriment. The differential diagnosis of abdominal/pelvic pain is broad and includes primarily gastrointestinal and urogenital disorders. Generally, TAS should usually be used in conjunction with TVS for evaluation of the female pelvis. If the US examination is not conclusive, CT or MRI, especially in pregnant patients, should be considered. PMID:24616750

  10. Ectopic liver and gallbladder in a cloned dog: Possible nonheritable anomaly.

    PubMed

    Kim, Min Jung; Kang, Sang Chul; Kim, Jae Hwan; Oh, Hyun Ju; Kim, Geon A; Jo, Young Kwang; Choi, Jin; Kim, Hyunil; Lee, Yeon Hea; Yoo, Ji Min; Eom, Ki Dong; Lee, Byeong Chun

    2015-10-01

    Ectopic liver and gallbladder are rare anomalies usually not accompanied by any symptoms and are found during surgical exploration or autopsy. We aimed to find a cause of this anomaly using somatic cell nuclear transfer (SCNT) technology, which can produce genetically identical organisms. A cloned beagle having ectopic organs was produced and died on the day of birth. Major and ectopic organs were fixed and underwent histologic analysis. SCNT was performed using cells derived from the dead puppy to produce reclones. Normality of internal organs in the original donor dog and recloned dogs was evaluated by computed tomography. While a liver without the gallbladder was located in the abdominal cavity of the cloned dog, a well-defined, reddish brown mass with a small sac was also positioned outside of the thoracic cavity. Histologically, they presented as normal liver and gallbladder. Five reclones were produced, and computed tomography results revealed that the original donor dog and reclones had normal liver and gallbladder structure and location. This is the first report of both ectopic liver and gallbladder in an organism and investigation on the etiology of these abnormalities. Normal organ structure and position in the original donor dog and reclones suggests that the ectopic liver and gallbladder is a possible nonheritable anomaly. PMID:26159091

  11. Ectopic scrotum: A unique case report

    PubMed Central

    Moorthy, H. Krishna; Pillai, Biju S.; Rathore, Renjeeth Singh; Mehta, Nisarg

    2015-01-01

    Ectopic scrotum is a rare congenital anomaly. Most common location is supra-inguinal. We present a case of left ectopic scrotum in a three year old boy with no associated congenital anomalies, who underwent successful scrotoplasty and orchiopexy. PMID:26425237

  12. Hysteroscopy and suction evacuation of cesarean scar pregnancies: a case report and review.

    PubMed

    Fylstra, Donald L

    2014-03-01

    Implantation of a pregnancy into the scar of a prior cesarean is an uncommon type of ectopic pregnancy. The incidence of cesarean scar pregnancy is thought to be one in 1800-2216 pregnancies. The increase in the incidence of cesarean scar pregnancy is thought to be a consequence of the increasing rates of cesarean delivery. The natural history of cesarean scar pregnancy is unknown. However, if such a pregnancy is allowed to continue, uterine scar rupture with hemorrhage and possible hysterectomy seem likely. Two early diagnosed cesarean scar pregnancies were treated with hysteroscopy and suction curettage removal. One required intramuscular methotrexate to resolve a persistent cesarean scar ectopic pregnancy. It would seem reasonable that simple suction evacuation would frequently leave chorionic villi imbedded within the cesarean scar, as the pregnancy is not within the endometrial cavity. PMID:24320609

  13. Abdominal wall surgery

    MedlinePLUS

    Abdominal wall surgery is a procedure that improves the appearance of flabby, stretched-out abdominal (belly) muscles and skin. ... mini-tummy tuck to more extensive surgery. Abdominal wall surgery is not the same as liposuction, which ...

  14. Ectopic mediastinal parathyroid carcinoma presenting as acute pancreatitis.

    PubMed

    Tseng, Chih-Wei; Lin, Shan-Zu; Sun, Chih-Hao; Chen, Chun-Chia; Yang, An-Hang; Chang, Full-Young; Lin, Han-Chieh; Lee, Shou-Dong

    2013-02-01

    Parathyroid carcinoma is a rare cause of hyperparathyroidism, accounting for fewer than 1% of cases. The incidence of acute pancreatitis in patients with hyperparathyroidism was reported to be only 1.5%. We report a very rare case of ectopic mediastinal parathyroid carcinoma presenting as acute pancreatitis. A 72-year-old man presented with acute pancreatitis and hypercalcemia. During the work-up for hypercalcemia, a mediastinal parathyroid tumor was identified by (99m)Tc-sestamibi scintigraphy and magnetic resonance imaging. The tumor was completely removed via a lower cervical collar incision. The histopathology revealed parathyroid carcinoma. There was no tumor recurrence or abdominal symptoms at 3-year follow-up. PMID:23351422

  15. An ectopic approach for engineering a vascularized tracheal substitute.

    PubMed

    Tsao, Chung-Kan; Ko, Chao-Yin; Yang, Shu-Rui; Yang, Chin-Yu; Brey, Eric M; Huang, Simon; Chu, I-Ming; Cheng, Ming-Huei

    2014-01-01

    Tissue engineering can provide alternatives to current methods for tracheal reconstruction. Here we describe an approach for ectopic engineering of vascularized trachea based on the implantation of co-cultured scaffolds surrounded by a muscle flap. Poly(L-lactic-co-glycolic acid) (PLGA) or poly(ε-caprolactone) (PCL) scaffolds were seeded with chondrocytes, bone marrow stem cells and co-cultured both cells respectively (8 groups), wrapped in a pedicled muscle flap, placed as an ectopic culture on the abdominal wall of rabbits (n = 24), and harvested after two and four weeks. Analysis of the biochemical and mechanical properties demonstrated that the PCL scaffold with co-culture cells seeding displayed the optimal chondrogenesis with adequate rigidity to maintain the cylindrical shape and luminal patency. Histological analysis confirmed that cartilage formed in the co-culture groups contained a more homogeneous and higher extracellular matrix content. The luminal surfaces appeared to support adequate epithelialization due to the formation of vascularized capsular tissue. A prefabricated neo-trachea was transferred to the defect as a tracheal replacement and yielded satisfactory results. These encouraging results indicate that our co-culture approach may enable the development of a clinically applicable neo-trachea. PMID:24239301

  16. Endometriosis-Related Hemoperitoneum in Pregnancy: A Diagnosis to Keep in Mind

    PubMed Central

    Cozzolino, Mauro; Corioni, Serena; Maggio, Luana; Sorbi, Flavia; Guaschino, Secondo; Fambrini, Massimiliano

    2015-01-01

    Background Endometriosis is an important gynecologic clinical entity, pathologically defined by the ectopic presence of endometrium and frequently associated with pelvic pain, that affects approximately 10% of females of reproductive age. A rare but severe complication of endometriosis during pregnancy is spontaneous hemoperitoneum in pregnancy (SHiP), severe intraabdominal bleeding that can be life threatening. Case Report We present the case of a patient with SHiP at 29 weeks of pregnancy. A supraumbilical midline laparotomy was performed, and pelvic exploration revealed a lacerated and bleeding right ovary. Right annessiectomy was performed, and a cesarean section was performed because hemostasis was not achievable. A healthy baby was born, and hemostasis was finally achieved. Conclusion We believe that in gravid females with a history of endometriosis, severe abdominal pain, and a reduction of hemoglobin, physicians should always suspect SHiP. Because SHiP is a life-threatening condition for both the mother and the baby, a prompt diagnosis must lead to prompt treatment. PMID:26413000

  17. [Pregnancy tests: urine versus blood pregnancy tests].

    PubMed

    Franken, Willeke; van Rheenen-Flach, Leonie; Buijs, Madelon M

    2014-01-01

    In this article, we discuss possible explanations for the discrepancy in results between urine and blood pregnancy tests. The first patient, a 26-year-old woman, had breast tenderness, was tired and suffered from abdominal pain. A urine pregnancy test was negative, but blood human chorion gonadotropin (hCG) concentration was 455 U/l (reference value < 6 U/l). It was concluded that the patient was pregnant and she was followed in the outpatient clinic. Three days later she suffered blood loss and her hCG levels returned to normal. The diagnosis was a spontaneous abortion. The second patient, a 45-year-old woman, complained of abdominal pain, nausea and more blood loss than with a normal period. The urine pregnancy test was negative, but the hCG level in her blood was 470.000 U/l. Echography showed a thickened, irregular endometrium. A molar pregnancy was suspected and curettage was performed. The hCG level dropped initially but had increased at follow-up. Persistent trophoblastic disease was suspected and the patient underwent additional treatment. PMID:24594124

  18. Robotic-assisted laparoscopic removal of cesarean scar ectopic and hysterotomy revision.

    PubMed

    Siedhoff, Matthew T; Schiff, Lauren D; Moulder, Janelle K; Toubia, Tarek; Ivester, Thomas

    2015-05-01

    A 38-year-old gravida 6 para 2042 woman presented in consultation regarding management of a uterine defect, or "niche," following resolution of a cesarean scar ectopic pregnancy. She had 3 prior losses, followed by invitro fertilization that resulted in 2 healthy births, both delivered by cesarean. A third invitro embryo transfer resulted in the cesarean scar ectopic. After consideration of treatment options, she underwent multiple-dose parenteral methotrexate with eventual termination of the ectopic. Magnetic resonance imaging demonstrated a uterine defect, suspected to contain residual pregnancy tissue. Questions considered in her consultation included whether the defect should be repaired and, if so, from a hysteroscopic or laparoscopic approach, as well as her risk of intrauterine scarring, when, or if, it would be safe to pursue another pregnancy, and her subsequent risk of uterine rupture. Literature review regarding cesarean niche was helpful, but did not seem to completely inform this particular clinical scenario. She elected to proceed with robotic-assisted laparoscopic repair. The vesicovaginal space was opened to expose the defect. Dilute vasopressin was injected circumferentially around the defect to help minimize the use of electrosurgery in opening the hysterotomy. Scar overlying the defect was resected and pregnancy tissue removed. The hysterotomy was closed with delayed-absorbable barbed suture, extrapolating technique from laparoscopic myomectomy. The first layer was imbricated with a second, similar to a 2-layer closure in cesarean delivery. Follow-up magnetic resonance imaging revealed resolution of the defect. After several failed attempts at repeat invitro fertilization, spontaneous pregnancy was achieved 18 months postoperatively. The pregnancy was uncomplicated and she underwent scheduled cesarean delivery of a healthy neonate at 37 weeks' gestation. The lower uterine segment was thick and developed, with no evidence of a dehiscence. PMID:25499261

  19. Radiation risks in pregnancy

    SciTech Connect

    Mossman, K.L.; Hill, L.T.

    1982-08-01

    A major contraindication of radiodiagnostic procedures is pregnancy. Approximately 1% of all pregnant women are given abdominal x-rays during the first trimester of pregnancy. Evaluation of radiation exposure should involve consideration of the types of examinations performed and when performed, as well as radiation dose and risk estimation. This information is then weighed against other possible risks of the pregnancy as well as personal factors. In the authors' experiences, radiation exposures usually result in doses to the embryo of less than 5 cGy (rad); the resulting radiation risks are usually small compared with other risks of pregnancy. Procedures to minimize diagnostic x-ray exposure of the fetus are also discussed.

  20. A case of severe ectopic ACTH syndrome from an occult primary – diagnostic and management dilemmas

    PubMed Central

    Griffin, Katherine; Amer, Saima

    2015-01-01

    Summary Resection of primary tumour is the management of choice in patients with ectopic ACTH syndrome. However, tumours may remain unidentified or occult in spite of extensive efforts at trying to locate them. This can, therefore, pose a major management issue as uncontrolled hypercortisolaemia can lead to life-threatening infections. We present the case of a 66-year-old gentleman with ectopic ACTH syndrome from an occult primary tumour with multiple significant complications from hypercortisolaemia. Ectopic nature of his ACTH-dependent Cushing's syndrome was confirmed by non-suppression with high-dose dexamethasone suppression test and bilateral inferior petrosal sinus sampling. The primary ectopic source remained unidentified in spite of extensive anatomical and functional imaging studies, including CT scans and Dotatate-PET scan. Medical adrenolytic treatment at maximum tolerated doses failed to control his hypercortisolaemia, which led to recurrent intra-abdominal and pelvic abscesses, requiring multiple surgical interventions. Laparoscopic bilateral adrenalectomy was considered but decided against given concerns of technical difficulties due to recurrent intra-abdominal infections and his moribund state. Eventually, alcohol ablation of adrenal glands by retrograde adrenal vein approach was attempted, which resulted in biochemical remission of Cushing's syndrome. Our case emphasizes the importance of aggressive management of hypercortisolaemia in order to reduce the associated morbidity and mortality and also demonstrates that techniques like percutaneous adrenal ablation using a retrograde venous approach may be extremely helpful in patients who are otherwise unable to undergo bilateral adrenalectomy. Learning points Evaluation and management of patients with ectopic ACTH syndrome from an unidentified primary tumour can be very challenging.Persisting hypercortisolaemia in this setting can lead to debilitating and even life-threatening complications and hence needs to be managed aggressively.Bilateral adrenalectomy should be considered when medical treatment is ineffective or poorly tolerated.Percutaneous adrenal ablation may be considered in patients who are otherwise unable to undergo bilateral adrenalectomy. PMID:26649179

  1. Ectopic Schistosoma mansoni Eggs Inside a Lipoma.

    PubMed

    Sabino, Kelly Renata; Nunes, Maurcio Buzelin; Petroianu, Andy

    2016-01-01

    Ectopic schistosomiasis is uncommon and tends to occur when the parasite's eggs or adult forms are located far from their normal site. This report presents the first described case of ectopic Schistosoma mansoni eggs inside a subcutaneous lipoma far from the tissues of this worm's life cycle and with no connection to either portal veins or any other vascular system. These eggs were found inside giant cells surrounded by inflammatory cells. In conclusion, in humans, ectopic S. mansoni eggs can be found far from the tissues of the described life cycle of this worm, with no connection to portal veins or other blood vessels used for their migration. PMID:26598562

  2. Formation of ectopic osteogenesis in weightlessness

    NASA Technical Reports Server (NTRS)

    1977-01-01

    An ectopic osteogenesis experiment aboard the Cosmos-936 biosatellite is described. Decalcified, lyophilized femur and tibia were implanted under the fascia or in the anterior wall of the abdomen in rats. Bone formation before and after the tests is described and illustrated. The extent of formation of ectopic bone in weightlessness did not differ significantly from that in the ground controls, but the bone marrow of the ectopic bone of the flight rats consisted exclusively of fat cells. The deficit of support-muscle loading was considered to cause the disturbance in skeletal bone tissue development.

  3. hCG Test (Pregnancy Test)

    MedlinePLUS

    ... may include: Dizziness, weakness Feeling faint or fainting Low blood pressure Pain in the shoulder area Sudden, sharp pain in the pelvic area Fever, flu-like symptoms Vomiting The area around an ectopic pregnancy may rupture and start to bleed, and, if ...

  4. Explaining Pregnancy Loss: Parents' and Physicians' Attributions.

    ERIC Educational Resources Information Center

    Dunn, Dana S.; And Others

    1991-01-01

    Asked 138 females and 56 of their male partners to explain why they believed their spontaneous abortion, fetal or neonatal death, or ectopic pregnancy occurred. Explanations for loss included blaming mother, physical problems with mother or fetus, fate, or no explanation. Physicians' explanations related to gestational age of fetus, although

  5. Ectopic Varices in the Gastrointestinal Tract: Short- and Long-Term Outcomes of Percutaneous Therapy

    SciTech Connect

    Macedo, Thanila A. Andrews, James C.; Kamath, Patrick S.

    2005-04-15

    To evaluate the results of percutaneous management of ectopic varices, a retrospective review was carried out of 14 patients (9 men, 5 women; mean age 58 years) who between 1992 and 2001 underwent interventional radiological techniques for management of bleeding ectopic varices. A history of prior abdominal surgery was present in 12 of 14 patients. The interval between the surgery and percutaneous intervention ranged from 2 to 38 years. Transhepatic portal venography confirmed ectopic varices to be the source of portal hypertension-related gastrointestinal bleeding. Embolization of the ectopic varices was performed by a transhepatic approach with coil embolization of the veins draining into the ectopic varices. Transjugular intrahepatic portosystemic shunt (TIPS) was performed in the standard fashion. Eighteen procedures (12 primary coil embolizations, 1 primary TIPS, 2 re-embolizations, 3 secondary TIPS) were performed in 13 patients. One patient was not a candidate for percutaneous treatment. All interventions but one (re-embolization) were technically successful. In 2 of 18 interventions, re-bleeding occurred within 72 hr (both embolization patients). Recurrent bleeding (23 days to 27 months after initial intervention) was identified in 9 procedures (8 coil embolizations, 1 TIPS due to biliary fistula). One patient had TIPS revision because of ultrasound surveillance findings. New encephalopathy developed in 2 of 4 TIPS patients. Percutaneous coil embolization is a simple and safe treatment for bleeding ectopic varices; however, recurrent bleeding is frequent and reintervention often required. TIPS can offer good control of bleeding at the expense of a more complex procedure and associated risk of encephalopathy.

  6. Predictors of Ectopic Fat in Humans.

    PubMed

    Zamboni, Mauro; Rossi, Andrea P; Fantin, Francesco; Budui, Simona L; Zoico, Elena; Zamboni, Giulia A; Mazzali, Gloria

    2014-12-01

    In the last decade there has been increasing focus on body fat distribution, rather than on the degree of obesity. More recently, great interest has also been dedicated to ectopic fat deposition in overnourished individuals that reflects a failure of the system of intracellular lipid homeostasis, which, in normal conditions, prevents lipotoxicity in the organs, by confining lipid overload to cells specifically designed to store large quantities of surplus calories, the white adipocytes. Consequently, excess body weight leads to fat infiltration of multiple organs including liver, pancreas, skeletal muscle, and heart thus forming "ectopic fat". Although overfeeding is considered the main predictor of ectopic fat deposition, other factors may be also involved. The purpose of this review is to evaluate the current available data on the predictors of ectopic fat deposition in humans. PMID:26626917

  7. Pregnancy after hydrosalpinx treatment with Essure.

    PubMed

    Inocncio, Gonalo; Coutinho, Lcia; Maciel, Raquel; Barreiro, Mrcia

    2013-01-01

    We present a case of a 29-year-old woman, with a history of ectopic pregnancy, which required left salpingectomy, and with a tortuous and impermeable right fallopian tube, compatible with hydrosalpinx. As hydrosalpinx itself can compromise a future pregnancy, treatment with Essure was proposed before passing to medically assisted procreation techniques. Five months after placement of Essure in the right fallopian tube, an in vitro fertilisation cycle was successfully completed and the woman had a singleton pregnancy and vaginal delivery without intercurrences. PMID:23536627

  8. Pregnancy after hydrosalpinx treatment with Essure

    PubMed Central

    Inocncio, Gonalo; Coutinho, Lcia; Maciel, Raquel; Barreiro, Mrcia

    2013-01-01

    We present a case of a 29-year-old woman, with a history of ectopic pregnancy, which required left salpingectomy, and with a tortuous and impermeable right fallopian tube, compatible with hydrosalpinx. As hydrosalpinx itself can compromise a future pregnancy, treatment with Essure was proposed before passing to medically assisted procreation techniques. Five months after placement of Essure in the right fallopian tube, an in vitro fertilisation cycle was successfully completed and the woman had a singleton pregnancy and vaginal delivery without intercurrences. PMID:23536627

  9. Ectopic Human Fasciola hepatica Infection by an Adult Worm in the Mesocolon

    PubMed Central

    Kim, Ah Jin; Choi, Chang Hwan; Choi, Sun Keun; Shin, Yong Woon; Park, Yun-Kyu; Kim, Lucia; Choi, Suk Jin; Han, Jee Young; Kim, Joon Mee; Chu, Young Chae; Park, In Suh

    2015-01-01

    We report here an ectopic case of Fasciola hepatica infection confirmed by recovery of an adult worm in the mesocolon. A 56-year-old female was admitted to our hospital with discomfort and pain in the left lower quadrant of the abdomen. Abdominal CT showed 3 abscesses in the left upper quadrant, mesentery, and pelvic cavity. On surgical exploration, abscess pockets were found in the mesocolon of the sigmoid colon and transverse colon. A leaf-like worm found in the abscess pocket of the mesocolon of the left colon was diagnosed as an adult fluke of F. hepatica. Histologically, numerous eggs of F. hepatica were noted with acute and chronic granulomatous inflammations in the subserosa and pericolic adipose tissues. Conclusively, a rare case of ectopic fascioliasis has been confirmed in this study by the adult worm recovery of F. hepatica in the mesocolon. PMID:26797440

  10. Ectopic Human Fasciola hepatica Infection by an Adult Worm in the Mesocolon.

    PubMed

    Kim, Ah Jin; Choi, Chang Hwan; Choi, Sun Keun; Shin, Yong Woon; Park, Yun-Kyu; Kim, Lucia; Choi, Suk Jin; Han, Jee Young; Kim, Joon Mee; Chu, Young Chae; Park, In Suh

    2015-12-01

    We report here an ectopic case of Fasciola hepatica infection confirmed by recovery of an adult worm in the mesocolon. A 56-year-old female was admitted to our hospital with discomfort and pain in the left lower quadrant of the abdomen. Abdominal CT showed 3 abscesses in the left upper quadrant, mesentery, and pelvic cavity. On surgical exploration, abscess pockets were found in the mesocolon of the sigmoid colon and transverse colon. A leaf-like worm found in the abscess pocket of the mesocolon of the left colon was diagnosed as an adult fluke of F. hepatica. Histologically, numerous eggs of F. hepatica were noted with acute and chronic granulomatous inflammations in the subserosa and pericolic adipose tissues. Conclusively, a rare case of ectopic fascioliasis has been confirmed in this study by the adult worm recovery of F. hepatica in the mesocolon. PMID:26797440

  11. Effects of aerobic versus resistance exercise without caloric restriction on abdominal fat, intrahepatic lipid, and insulin sensitivity in obese adolescent boys: a randomized, controlled trial

    Technology Transfer Automated Retrieval System (TEKTRAN)

    The optimal exercise modality for reductions of abdominal obesity and risk factors for type 2 diabetes in youth is unknown. We examined the effects of aerobic exercise (AE) versus resistance exercise (RE) without caloric restriction on abdominal adiposity, ectopic fat, and insulin sensitivity and se...

  12. Abdominal aortic aneurysm

    MedlinePLUS

    ... blood to the abdomen, pelvis, and legs. An abdominal aortic aneurysm occurs when an area of the aorta becomes ... High blood pressure Male gender Genetic factors An abdominal aortic aneurysm is most often seen in males over age ...

  13. Abdominal Aortic Aneurysm

    MedlinePLUS

    MENU Abdominal Aortic Aneurysm Overview What is an abdominal aortic aneurysm (AAA)? The main blood vessel in your body is the aorta ( ... burst. Symptoms What are the symptoms of an AAA? As the aneurysm develops, there are usually no ...

  14. Pregnancy and birth after assisted reproduction.

    PubMed

    Gutirrez Njar, Alfonso; Stern Colin Y Nunes, Jaroslav; Gonzalez Panzzi, Maria Elena; Orbea Travez, Marco

    2002-01-01

    Pregnancy and birth after IVF has attracted much critical attention. Overall, pregnancy rates are about 30-40% with three transferred embryos. Abortion rates are high before 19 weeks of gestation, at 8% of established pregnancies, and ectopic pregnancies are regular occurrences. Pregnancy rates are highest (35%) in women aged 20-24 years, declining to 10% at and above age 40. The use of intracytoplasmic sperm injection (ICSI) and blastocyst transfer has transformed the establishment of pregnancies for couples with differing indications. High rates of implantation are achieved with blastocyst transfers, although many embryos die in vitro before this stage. Twins and triplets can result in up to 50% of pregnancies. Heterotopic pregnancies are rare. Abortion afflicts fetuses before 12 weeks (vanishing fetuses). Rates of spontaneous abortion can be as high as 50% with quadruplets and quintuplets, and may be even higher in cases of fetal aneuploidy. At birth, prematurity is high, especially with twins or higher multiple pregnancies. Fetal reduction is used to reduce multiple pregnancies for singletons. Ovarian hyperstimulation is a risk associated with multiple pregnancy. PMID:12470551

  15. Pregnancy test

    MedlinePLUS

    HCG level rises rapidly during the first trimester of pregnancy and then slightly declines. ... hours in the beginning of a pregnancy. HCG level that does not rise appropriately may indicate a problem with your pregnancy. ...

  16. Post trauma abdominal cocoon

    PubMed Central

    Kaur, Supreet; Doley, Rudra Prasad; Chabbhra, Mohinish; Kapoor, Rajeev; Wig, Jaidev

    2014-01-01

    Abdominal cocoon or sclerosing peritonitis refers to a rare cause of intestinal obstruction due to formation of a membrane encasing the bowel. We report a case of abdominal cocoon post blunt trauma abdomen. The patient presented with a history of subacute intestinal obstruction and a mobile abdomen lump. Abdominal cocoon was diagnosed on computed tomography. He underwent adhesiolysis with excision of membrane. PMID:25590647

  17. Ectopic fat deposition and global cardiometabolic risk: new paradigm in cardiovascular medicine.

    PubMed

    Shimabukuro, Michio; Kozuka, Chisayo; Taira, Shin-ichiro; Yabiku, Koichi; Dagvasumberel, Munkhbaatar; Ishida, Masayoshi; Matsumoto, Sachiko; Yagi, Shusuke; Fukuda, Daiju; Yamakawa, Ken; Higa, Moritake; Soeki, Takeshi; Yoshida, Hisashi; Masuzaki, Hiroaki; Sata, Masataka

    2013-01-01

    The obesity epidemic is a global public health concern that increases the likelihood of morbidity and mortality of metabolic and cardiovascular disease (CVD) and threatens to reduce life expectancy around the world. The concept of the metabolic syndrome (MetS) takes into account that visceral fat plays an essential role in the development of metabolic and cardiovascular diseases. However, MetS cannot be used to assess global CVD risk but is at best one more modifiable CVD risk factor. Thus, global cardiometabolic risk (the global risk of cardiovascular disease resulting from traditional risk factors combined with the additional contribution of the metabolic syndrome and/or insulin resistance) should be considered individually. There is solid evidence supporting the notion that excess abdominal fat is predictive of insulin resistance and the presence of related metabolic abnormalities currently referred to as MetS. Despite the fact that abdominal obesity is a highly prevalent feature of MetS, the mechanisms by which abdominal obesity is causally related to MetS are not fully elucidated. Besides visceral fat accumulation, ectopic lipid deposition, especially in liver and skeletal muscle, has been implicated in the pathophysiology of diabetes, insulin resistance and obesity-related disorders. Also, ectopic fat deposition could be deteriorated in the heart components such as (1) circulatory and locally recruited fat, (2) intra- and extra-myocellular fat, (3) perivascular fat, and (4) pericardial fat. In this review, the contribution of ectopic lipid deposition to global cardiometabolic risk is reviewed and also discussed are potential underlying mechanisms including adipocytokine, insulin resistance and lipotoxicity. PMID:23614905

  18. Tubal pregnancy associated with additional conception in a contralateral tube.

    PubMed

    Ishikawa, Hiroshi; Kiyokawa, Takako; Okayama, Jun; Usui, Hirokazu; Shozu, Makio

    2015-09-01

    Pregnancy of unknown location is defined as empty endometrial cavity despite positive pregnancy test, and often develops as overt intrauterine or ectopic pregnancy. The pathophysiology of persistent pregnancy of unknown location, however, which involves continuous low serum human chorionic gonadotropin without any visible implantation site, is unknown. We report a case of left tubal pregnancy associated with additional conception in the contralateral tube. Left tubal pregnancy was suspected in a 40-year-old nulligravid woman after two embryo transfers following in vitro fertilization. Laparoscopic bilateral salpingectomy was performed for bilateral hydrosalpinx. Products from an additional conception were identified in the right tube. Short tandem repeat analysis using genomic DNA from resected specimens indicated two conceptions of different origin. The extra conception identified on microscopy may indicate one pathogenesis of persistent pregnancy of unknown location. Salpingectomy of the contralateral tube with hydrosalpinx is an option to prevent persistent occult pregnancy. PMID:26098862

  19. Thoracoscopic Removal of Ectopic Mediastinal Parathyroid Adenoma

    PubMed Central

    Kim, Young Su; Kim, Jhingook; Shin, Sumin

    2014-01-01

    Ectopic mediastinal parathyroid adenomas or hyperplasias account for up to 25% of primary hyperparathyroidism cases. Most abnormal parathyroid glands are found in the superior mediastinum within the thymus and can be removed through a cervical incision; however, a few of these glands are not accessible using standard cervical surgical approaches. Surgical resection has traditionally been performed via median sternotomy or thoracotomy. However, recent advancement in video-assisted thoracic surgery techniques has decreased the need for sternotomy or thoracotomy to remove these ectopic parathyroid glands. Here, we report a successful case of video-assisted thoracoscopic removal of a mediastinal parathyroid adenoma. PMID:25207237

  20. Abdominal Compartment Hypertension and Abdominal Compartment Syndrome.

    PubMed

    Maluso, Patrick; Olson, Jody; Sarani, Babak

    2016-04-01

    Intra-abdominal hypertension (IAH) and abdominal compartment syndrome (ACS) are rare but potentially morbid diagnoses. Clinical index of suspicion for these disorders should be raised following massive resuscitation, abdominal wall reconstruction/injury, and in those with space-occupying disorders in the abdomen. Gold standard for diagnosis involves measurement of bladder pressure, with a pressure greater than 12 mm Hg being consistent with IAH and greater than 25 mm Hg being consistent with ACS. Decompressive laparotomy is definitive therapy but paracentesis can be equally therapeutic in properly selected patients. Left untreated, ACS can lead to multisystem organ failure and death. PMID:27016163

  1. Abdominal Circulatory Interactions.

    PubMed

    Dagar, Gaurav; Taneja, Amit; Nanchal, Rahul S

    2016-04-01

    The abdominal compartment is separated from the thoracic compartment by the diaphragm. Under normal circumstances, a large portion of the venous return crosses the splanchnic and nonsplanchnic abdominal regions before entering the thorax and the right side of the heart. Mechanical ventilation may affect abdominal venous return independent of its interactions at the thoracic level. Changes in pressure in the intra-abdominal compartment may have important implications for organ function within the thorax, particularly if there is a sustained rise in intra-abdominal pressure. It is important to understand the consequences of abdominal pressure changes on respiratory and circulatory physiology. This article elucidates important abdominal-respiratory-circulatory interactions and their clinical effects. PMID:27016167

  2. Two cases of primary hyperparathyroidism in pregnancy

    PubMed Central

    Hession, Paul; Walsh, Jennifer; Gaffney, Geraldine

    2014-01-01

    Two women suffering from primary hyperparathyroidism in pregnancy are presented. Patient 1 with a history of four miscarriages, an ectopic pregnancy and a sixth pregnancy complicated by severe early onset preeclampsia. She was found to have high serum Ca2+ levels after delivery and parathyroid adenoma was diagnosed by ultrasound. A right inferior parathyroidectomy was performed. Patient 2 with a history of high serum Ca2+ and generalised symptoms of hypercalcaemia. Ultrasound did not reveal adenoma but an elective neck exploration was performed in light of the abnormal blood results. The right inferior parathyroid gland was excised and histology confirmed the presence of adenoma. These cases help highlight the different ways in which primary hyperparathyroidism can present and the barriers to diagnosis in pregnancy. Various potential complications (including miscarriage and preeclampsia) are explored and the appropriateness of surgical treatment during pregnancy is emphasised. PMID:24469844

  3. An Ectopic ACTH Secreting Metastatic Parotid Tumour

    PubMed Central

    Dacruz, Thomas; Kalhan, Atul; Rashid, Majid; Obuobie, Kofi

    2016-01-01

    A 60-year old woman presented with features of Cushing's syndrome (CS) secondary to an ectopic adrenocorticotropic hormone (ACTH) secreting metastatic parotid tumour 3 years after excision of the original tumour. She subsequently developed fatal intestinal perforation and unfortunately died despite best possible medical measures. Ectopic ACTH secretion accounts for 5–10% of all patients presenting with ACTH dependent hypercortisolism; small cell carcinoma of lung (SCLC) and neuroendocrine tumours (NET) account for the majority of such cases. Although there are 4 previous case reports of ectopic ACTH secreting salivary tumours in literature, to our knowledge this is the first published case report in which the CS developed after 3 years of what was deemed as a successful surgical excision of primary salivary tumour. Our patient initially had nonspecific symptoms which may have contributed to a delay in diagnosis. Perforation of sigmoid colon is a recognised though underdiagnosed complication associated with steroid therapy and hypercortisolism. This case demonstrates the challenges faced in diagnosis as well as management of patients with CS apart from the practical difficulties faced while trying to identify source of ectopic ACTH. PMID:26904316

  4. Addiction in pregnancy.

    PubMed

    Keegan, Joan; Parva, Mehdi; Finnegan, Mark; Gerson, Andrew; Belden, Michael

    2010-04-01

    Substance abuse in pregnancy has increased over the past three decades in the United States, resulting in approximately 225,000 infants yearly with prenatal exposure to illicit substances. Routine screening and the education of women of child bearing age remain the most important ways to reduce addiction in pregnancy. Legal and illegal substances and their effect on pregnancy discussed in this review include opiates, cocaine, alcohol, tobacco, marijuana, and amphetamines. Most literature regarding opiate abuse is derived from clinical experience with heroin and methadone. Poor obstetric outcomes can be up to six times higher in patients abusing opiates. Neonatal care must be specialized to treat symptoms of withdrawal. Cocaine use in pregnancy can lead to spontaneous abortion, preterm births, placental abruption, and congenital anomalies. Neonatal issues include poor feeding, lethargy, and seizures. Mothers using cocaine require specialized prenatal care and the neonate may require extra supportive care. More than 50% of women in their reproductive years use alcohol. Alcohol is a teratogen and its effects can include spontaneous abortion, growth restriction, birth defects, and mental retardation. Fetal alcohol spectrum disorder can have long-term sequelae for the infant. Tobacco use is high among pregnant women, but this can be a time of great motivation to begin cessation efforts. Long-term effects of prenatal tobacco exposure include spontaneous abortion, ectopic pregnancy, placental insufficiency, low birth weight, fetal growth restriction, preterm delivery, childhood respiratory disease, and behavioral issues. Marijuana use can lead to fetal growth restriction, as well as withdrawal symptoms in the neonate. Lastly, amphetamines can lead to congenital anomalies and other poor obstetric outcomes. Once recognized, a multidisciplinary approach can lead to improved maternal and neonatal outcomes. PMID:20407975

  5. Desmoid tumor of the abdominal wall: a case report

    PubMed Central

    2011-01-01

    Introduction Desmoid tumors are rare lesions without any metastatic potential but a strong tendency to invade locally and to recur. These tumors are associated with women of fertile age, especially during and after pregnancy. Case presentation The case of a desmoid tumor of the anterior abdominal wall in a 40-year-old Caucasian man with no relevant family history is presented, describing its appearance on computed tomography and ultrasonography. The patient, who presented with a painless mass in the left anterolateral abdomen, had a history of previous urgent abdominal surgery after a shotgun injury two years earlier. Radical resection of the affected abdominal wall musculature was performed, and the defect was reconstructed with polypropylene mesh. Conclusion The diagnosis of desmoid tumor should be strongly considered even in male patients with an abdominal mass and a history of previous abdominal surgery. The goal of its treatment is complete tumor excision and avoidance of the development of complications such as hernia. PMID:21787413

  6. Management of cesarean heterotopic pregnancy with transvaginal ultrasound-guided potassium chloride injection and gestational sac aspiration, and review of the literature.

    PubMed

    Ugurlucan, Funda Gungor; Bastu, Ercan; Dogan, Murat; Kalelioglu, Ibrahim; Alanya, Sebnem; Has, Recep

    2012-01-01

    Cesarean scar pregnancy is one of the rarest forms of ectopic pregnancy, located in the scar from a previous cesarean section. There are few reports of such pregnancies, and there is no consensus about the best management. Herein is reported a case of cesarean heterotopic pregnancy, diagnosed at 6 weeks' gestation and successfully treated via transvaginal ultrasound-guided potassium chloride injection and gestational sac aspiration, with preservation of the intrauterine pregnancy. PMID:22935313

  7. Laparoscopic surgery in the treatment of nonruptured tubal pregnancy

    NASA Astrophysics Data System (ADS)

    Mutrynowski, Andrzej; Zabielska, Renata

    1996-03-01

    Introduction of the endoscopic techniques into gynecology enabled a change in the procedures in the case of ectopic pregnancy. This paper aims at presenting 76 cases of non-ruptured tubal pregnancies treated conservatively by the laparoscopic surgery with the application of the electrocoagulation or the Nd:YAG laser. The investigated group consisted of 76 patients. Forty-one (54%) of them were operated on using electrocoagulation and 35 (46%) using the Nd:YAG laser. Sixty-three pregnancies (83%) were localized in the ampulla. The ectopic pregnancy was confirmed histopathologically in 74 cases (97%). There were no complications noticed in the postoperative course. There were no differences in the efficacy and the postoperative general condition in cases treated conservatively by the laparoscopic surgery with the application of the electrocoagulation or the laser.

  8. Abdominal Aortic Aneurysms: Treatments

    MedlinePLUS

    ... renal disease Infertility Liver disease Needle biopsy Osteoporosis Pediatrics Pelvic pain ... Aortic Aneurysms Interventional Radiologists Treat Abdominal Aneurysms Nonsurgically Interventional radiologists ...

  9. Electrohysterography during pregnancy: preliminary report.

    PubMed

    Gondry, J; Marque, C; Duchene, J; Cabrol, D

    1993-01-01

    The purpose of this study was to test the ability of uterine electrical activity recorded by electrohysterography (EHG) from abdominal electrodes during pregnancy to provide reliable information about uterine contractions. In this preliminary study, abdominal EHG was used to monitor the uterine contractions of eight women, three of whom were having spontaneous contractions related to preterm labor and five of whom were having medical abortions after intrauterine fetal death. The EHG signal consisting of one electrical burst (EB) correlated with a single episode of mechanical activity (MA) in more than 66% of the recorded contractions. When mechanical or electrical activity identified as artifactual was excluded, the temporal correlation of EBs with MA was found in 89% of the recorded contractions. Furthermore, the electrical bursts detected had temporal and spectral characteristics similar to those described previously. Reliable detection of mechanical activity during early pregnancy remains problematic. Nevertheless, abdominal EHG appears suitable for noninvasive monitoring of pregnancies at risk. Further studies are needed to elucidate the significance of the EHG signal in both normal and abnormal pregnancies. It may eventually be possible to use EHG as an ambulatory monitoring tool for the early diagnosis of preterm labor. PMID:8369867

  10. Ectopic ureter draining into the uterus

    PubMed Central

    Ghosh, Bastab; Shridhar, Kartik; Pal, Dilip Kumar; Banerjee, Manju

    2016-01-01

    We report a rare case of a 13-year-old female child with a right-sided duplex system with the upper moiety draining into the uterus. Only one such case has been reported in scientific literature in English, of ectopic ureter draining into the uterus has been reported in literature. The patient was managed with laparoscopic end-to-side ureteroureterostomy into the normal ureter of the lower moiety. PMID:26834415

  11. Bochdalek hernia in pregnancy.

    PubMed

    Ngai, Ivan; Sheen, Jean-Ju; Govindappagari, Shravya; Garry, David J

    2012-01-01

    Asymptomatic diaphragmatic hernias in reproductive-aged women are rare but pose significant morbidity for pregnancy. This is a case of a woman at 29 weeks' gestation with abdominal pain and shortness of breath. Five years prior she had been incidentally diagnosed with a small congenital diaphragmatic hernia of Bochdalek. Following preconception care, she opted against repair of the hernia prior to pregnancy due to lack of symptoms and no clear recommendation for repair from the surgeon. Imaging studies on emergency room presentation demonstrated a large herniation of viscera into her chest occupying her entire left chest with slight cardiac displacement. Through a multidisciplinary approach, she was stabilised and eventually delivered at 31 weeks due to worsening pulmonary function. The hernia was repaired postpartum. We recommend repair of any diaphragmatic hernia prior to conception to prevent significant maternal and fetal morbidity or mortality. A multidisciplinary approach allows for planning. PMID:22967686

  12. Bochdalek hernia in pregnancy

    PubMed Central

    Ngai, Ivan; Sheen, Jean-Ju; Govindappagari, Shravya; Garry, David J

    2012-01-01

    Asymptomatic diaphragmatic hernias in reproductive-aged women are rare but pose significant morbidity for pregnancy. This is a case of a woman at 29?weeks gestation with abdominal pain and shortness of breath. Five years prior she had been incidentally diagnosed with a small congenital diaphragmatic hernia of Bochdalek. Following preconception care, she opted against repair of the hernia prior to pregnancy due to lack of symptoms and no clear recommendation for repair from the surgeon. Imaging studies on emergency room presentation demonstrated a large herniation of viscera into her chest occupying her entire left chest with slight cardiac displacement. Through a multidisciplinary approach, she was stabilised and eventually delivered at 31?weeks due to worsening pulmonary function. The hernia was repaired postpartum. We recommend repair of any diaphragmatic hernia prior to conception to prevent significant maternal and fetal morbidity or mortality. A multidisciplinary approach allows for planning. PMID:22967686

  13. Recurrent Abdominal Pain

    ERIC Educational Resources Information Center

    Banez, Gerard A.; Gallagher, Heather M.

    2006-01-01

    The purpose of this article is to provide an empirically informed but clinically oriented overview of behavioral treatment of recurrent abdominal pain. The epidemiology and scope of recurrent abdominal pain are presented. Referral process and procedures are discussed, and standardized approaches to assessment are summarized. Treatment protocols

  14. Recurrent Abdominal Pain

    ERIC Educational Resources Information Center

    Banez, Gerard A.; Gallagher, Heather M.

    2006-01-01

    The purpose of this article is to provide an empirically informed but clinically oriented overview of behavioral treatment of recurrent abdominal pain. The epidemiology and scope of recurrent abdominal pain are presented. Referral process and procedures are discussed, and standardized approaches to assessment are summarized. Treatment protocols…

  15. Simulation of Ectopic Pacemakers in the Heart: Multiple Ectopic Beats Generated by Reentry inside Fibrotic Regions

    PubMed Central

    Gouvêa de Barros, Bruno; Weber dos Santos, Rodrigo; Lobosco, Marcelo; Alonso, Sergio

    2015-01-01

    The inclusion of nonconducting media, mimicking cardiac fibrosis, in two models of cardiac tissue produces the formation of ectopic beats. The fraction of nonconducting media in comparison with the fraction of healthy myocytes and the topological distribution of cells determines the probability of ectopic beat generation. First, a detailed subcellular microscopic model that accounts for the microstructure of the cardiac tissue is constructed and employed for the numerical simulation of action potential propagation. Next, an equivalent discrete model is implemented, which permits a faster integration of the equations. This discrete model is a simplified version of the microscopic model that maintains the distribution of connections between cells. Both models produce similar results when describing action potential propagation in homogeneous tissue; however, they slightly differ in the generation of ectopic beats in heterogeneous tissue. Nevertheless, both models present the generation of reentry inside fibrotic tissues. This kind of reentry restricted to microfibrosis regions can result in the formation of ectopic pacemakers, that is, regions that will generate a series of ectopic stimulus at a fast pacing rate. In turn, such activity has been related to trigger fibrillation in the atria and in the ventricles in clinical and animal studies. PMID:26583127

  16. Abdominal hernias: Radiological features

    PubMed Central

    Lassandro, Francesco; Iasiello, Francesca; Pizza, Nunzia Luisa; Valente, Tullio; Stefano, Maria Luisa Mangoni di Santo; Grassi, Roberto; Muto, Roberto

    2011-01-01

    Abdominal wall hernias are common diseases of the abdomen with a global incidence approximately 4%-5%. They are distinguished in external, diaphragmatic and internal hernias on the basis of their localisation. Groin hernias are the most common with a prevalence of 75%, followed by femoral (15%) and umbilical (8%). There is a higher prevalence in males (M:F, 8:1). Diagnosis is usually made on physical examination. However, clinical diagnosis may be difficult, especially in patients with obesity, pain or abdominal wall scarring. In these cases, abdominal imaging may be the first clue to the correct diagnosis and to confirm suspected complications. Different imaging modalities are used: conventional radiographs or barium studies, ultrasonography and Computed Tomography. Imaging modalities can aid in the differential diagnosis of palpable abdominal wall masses and can help to define hernial contents such as fatty tissue, bowel, other organs or fluid. This work focuses on the main radiological findings of abdominal herniations. PMID:21860678

  17. Obstetric outcome of 904 pregnancies after intracytoplasmic sperm injection.

    PubMed

    Wisanto, A; Bonduelle, M; Camus, M; Tournaye, H; Magnus, M; Liebaers, I; Van Steirteghem, A; Devroey, P

    1996-12-01

    The obstetric data of 904 consecutive pregnancies obtained after intracytoplasmic sperm injection (ICSI) using ejaculated spermatozoa (group I), epididymal spermatozoa (group II), testicular spermatozoa (group III) and after the replacement of frozen-thawed embryos (group IV) are described. In all, there were 785 pregnancies in group I, 37 pregnancies in group II, 30 pregnancies in group III and 52 pregnancies in group IV. A total of 24 pregnancies (2.5%) have so far been lost to follow-up. The incidence of pregnancy loss, i.e. subclinical pregnancies, clinical abortions and ectopic pregnancies were highest in group IV (61.4%). Early pregnancy loss in groups I, II and III were 21.9, 37.8 and 33.3% respectively. Prenatal diagnosis was performed in 64.4% of the clinical pregnancies: amniocentesis in 48.2% and chorionic villus sampling in 16.2%. The karyotypes were normal in 97.6% of the prenatal diagnoses and there were 1.2% de novo and 1.2% inherited chromosome aberrations. Pregnancy complications such as prematurity and low birthweight were related to pregnancy multiplicity. Perinatal mortality occurred in 15 babies (17.1 per thousand), including nine intrauterine fetal deaths after 25 weeks of gestation and six cases of mortality during the first 7 days after birth. There is no evidence that the technique of ICSI using sperm cells of different origins yielded a higher obstetric risk. PMID:9147115

  18. Pregnancy care

    MedlinePLUS

    ... Avoid all alcohol and drug use and limit caffeine. Quit smoking, if you smoke. Go for prenatal ... and pains during pregnancy Problems sleeping Skin and hair changes Vaginal bleeding in early pregnancy No two ...

  19. Teenage pregnancy

    MedlinePLUS

    Most pregnant teenage girls did not plan to get pregnant. If you are a pregnant teen, it is very important to ... Yes. Teenage pregnancies are riskier than pregnancies in women who are older. This is partly because a teenager's body ...

  20. Teenage Pregnancy

    MedlinePLUS

    ... plan to get pregnant, but many do. Teen pregnancies carry extra health risks to both the mother ... later on. They have a higher risk for pregnancy-related high blood pressure and its complications. Risks ...

  1. Pregnant and severe acute abdominal pain: A surgical diagnostic dilemma.

    PubMed

    Kosai, N R; Amin-Tai, H; Gendeh, H S; Salleh, S; Reynu, R; Taher, M M; Sutton, P A; Das, S

    2015-01-01

    Acute abdominal pain in pregnancy remains a surgical conundrum. A 25-year-old primigravid at 29 weeks gestation presented with a two-week history of epigastric pain, nausea and vomiting. She had a distended abdomen consistent with a full term gravid uterus; tender at the epigastric and right hypochondrium suggestive of small bowel obstruction or acute appendicitis. Abdominal ultrasound was inconclusive but abdominal Computed Tomography (CT) suggested small bowel volvulus. An exploratory laparotomy revealed a segmental jejunal volvulus and small bowel diverticulum contributing to the volvulus. A short segmental bowel resection was performed. Histopathology confirmed a Meckel's Diverticulum. The patient recovered well but underwent premature labour 10 days later. Small bowel obstruction secondary to Meckel's diverticulum is rare in pregnancy. In an acute gestational abdomen, clinical examination is key. Radiological imaging may be helpful, whilst surgical intervention is confirmatory and therapeutic in the event of an obstructive volvulus. PMID:26152617

  2. Multiple Pregnancy

    MedlinePLUS

    ... 8 completed weeks of pregnancy. Fetus: The developing organism in the uterus from the ninth week of pregnancy until the end of pregnancy. Fraternal Twins: Twins that have developed from two fertilized eggs that are not genetically identical. Genetic Disorders: A term for disorders caused ...

  3. Spontaneous splenic rupture in pregnancy

    PubMed Central

    Elghanmi, Adil; Mohamed, Jou; Khabouz, Samira

    2015-01-01

    Splenic rupture during pregnancy is a rare and can frequently be a misdiagnosed pathology. This rupture is associated with a high maternal and fetal mortality rate. A 26 years old Moroccan woman para II gravida II presented at the third stage of pregnancy with acute onset of severe abdominal pain. She developed immediately a hypovolemic shock. After both a physical and sonographical exam, it was revealed that it was due to a massive hemoperitoneum. Therefore, an emergent laparotomy and cesarean delivery with abdominal exploration were performed; also, an active bleeding was identified at the splenic hilum consistent with splenic rupture. Through this case report, we want to raise awareness of this surgical emergency that requires immediate recognition because any delay can lead to catastrophic consequences PMID:26587160

  4. Abdominal ultrasound (image)

    MedlinePLUS

    Abdominal ultrasound is a scanning technique used to image the interior of the abdomen. Like the X- ... use high frequency sound waves to produce an image and do not expose the individual to radiation. ...

  5. Abdominal Pain Syndrome

    MedlinePLUS

    ... problems: Mesenteric vascular insufficiency (blocked arteries or veins) Abdominal aortic aneurysm (swelling of the main artery in the belly) Inflammatory conditions in the mid- and lower abdomen: Enteritis (infections of the small bowel, Crohn's disease) ...

  6. Abdominal exploration - series (image)

    MedlinePLUS

    The abdomen contains many vital organs: the stomach, the small intestine (jejunum and ileum), the large intestine (colon), the ... The surgical exploration of the abdomen, also called an ... abdominal disease from an unknown cause (to diagnose), or trauma ...

  7. Abdominal aortic aneurysm.

    PubMed

    Setacci, Francesco; Galzerano, Giuseppe; DE Donato, Gianmarco; Benevento, Domenico; Guerrieri, Massimiliano W; Ruzzi, Umberto; Borrelli, Maria P; Setacci, Carlo

    2016-02-01

    Endovascular repair of abdominal aortic aneurysms has become a milestone in the treatment of patients with abdominal aortic aneurysm. Technological improvement allows treatment in more and more complex cases. This review summarizes all grafts available on the market. A complete review of most important trial on this topic is provided to the best of our knowledge, and technical tips and tricks for standard cases are also included. PMID:26771730

  8. Management of Heterotopic Pregnancy: Experience From 1 Tertiary Medical Center.

    PubMed

    Li, Jin-Bo; Kong, Ling-Zhi; Yang, Jian-Bo; Niu, Gang; Fan, Li; Huang, Jing-Zhi; Chen, Shu-Qin

    2016-02-01

    The objective of this study is to summarize the experiences of our department in the management of heterotopic pregnancy (HP) and to analyze the influence of different treatment modality on the viable intrauterine pregnancy.There were 64 patients diagnosed as HP in the Department of Gynecology and Obstetrics in our hospital between January 2003 and June 2014, 52 HP patients with viable intrauterine pregnancy were included and analyzed in our study. Interventions included expectant management, surgical management and transabdominal sonographic guided transvaginal aspiration of ectopic gestational embryo (embryo aspiration) management.Main outcome measures are maternal outcome and pregnancy outcome.In expectant management group, 4 patients suffered rupture of ectopic pregnancy, 6 patients transferred to surgical management, 1 patient suffered a fever of 40.4C, the abortion rate was 5% (1/20). In surgical management group, emergency surgery was performed in 9 patients with unstable hemodynamics and 3 patients with stable hemodynamics, 1 patient suffered uterine rupture 5 weeks later and dead fetus was demonstrated, 1 patient suffered urinary retention postoperative, the abortion rate was 14.8% (4/27). In embryo aspiration management group, 1 patient needed another embryo aspiration, all patients were eventful and no abortion was observed.In our retrospective study, transabdominal sonographic guided aspiration of ectopic gestational embryo has the best maternal outcome and the lowest abortion rate, surgical management group shows the highest abortion rate, and expectant management presents the worst maternal outcome. PMID:26844463

  9. Serum markers in the diagnosis of tubal pregnancy.

    PubMed

    Cabar, Fabio Roberto; Fettback, Paula Beatriz; Pereira, Pedro Paulo; Zugaib, Marcelo

    2008-10-01

    The introduction of highly sensitive methods, such as transvaginal sonography and measurement of serum b-human chorionic gonadotropin, has dramatically improved ectopic pregnancy diagnosis in recent years. Early diagnosis is the key to successful and conservative management of women with ectopic pregnancy; however, approximately 50 percent of such women are initially misdiagnosed, resulting in significant morbidity and mortality. In order to improve diagnosis, several serum markers are being investigated including progesterone, CA 125, pregnancy-associated plasma protein-A, vascular endothelial growth factor, and maternal creatine kinase. Measurement of serum vascular endothelial growth factor, alone or together with other markers, could be a promising method for earlier and more accurate differential diagnosis. However, the clinical applicability of these findings remains to be evaluated in larger prospective studies. PMID:18925333

  10. Developmental Outcome of Children Born From Extrauterine Pregnancies

    PubMed Central

    Clark, John F. J.; Dahl-Regis, Merceline; Epps, Roselyn P.

    1987-01-01

    From 1947 to 1984, 45 advanced ectopic pregnancies were delivered at Freedmen's Hospital and its successor, Howard University Hospital. Four patients of extrauterine pregnancies were contacted to determine their developmental outcome. At the time of the study, their ages ranged from infancy to adulthood. Results are presented of two children who received in-depth interdisciplinary evaluations at the Howard University Child Development Center. The authors reviewed the literature and questioned other authors, who, based on single examinations, reported normal function in children born after extrauterine pregnancies. ImagesFigure 1Figure 2Figure 3 PMID:3320379

  11. Pregnancy in acromegaly patients treated with pegvisomant.

    PubMed

    van der Lely, A J; Gomez, Roy; Heissler, Joseph F; Åkerblad, Ann-Charlotte; Jönsson, Peter; Camacho-Hübner, Cecilia; Kołtowska-Häggström, Maria

    2015-08-01

    To summarize all available data on pregnancy outcome of acromegaly patients exposed to the growth hormone receptor antagonist pegvisomant (PEGV) during pregnancy as present in the Pfizer's Global Safety Database. Pfizer's Global Safety Database contains adverse event data obtained from the following sources: spontaneous reports, health authorities, Pfizer-sponsored post-marketing surveillance program (ACROSTUDY), customer engagement programs, and clinical studies, reported regardless of outcome. The safety database was searched up to 10th March 2014. From the 35 pregnancy cases, 27 involved maternal [mean age (range) 33.3 years (23-41) and 8 paternal (33.7 years (32-38)] PEGV exposure. Two female patients were reported with two pregnancy cases each. Fetal outcome was normal in 14 (4 paternal) of the 18 reported as live birth, while 4 cases (1 paternal) did not specify the birth outcome. At conception, PEGV mean dose (range) was 15.3 mg/d (4.3-30). In 3 cases of maternal exposure of the 18 cases reporting live birth, PEGV was continued throughout the pregnancy in a dose of 12.1 mg/d (10-15). In 5 cases (all maternal) an elective termination of the pregnancy was performed with no reported fetal abnormalities, 2 cases (maternal) reported a non-PEGV-related spontaneous abortion and in 1 maternal case an ectopic pregnancy occurred. In 9 cases (3 paternal), the fetal outcome was not reported. Three women reported gestational diabetes; one woman continued PEGV treatment during pregnancy. Although the number of reported pregnancies with exposure to PEGV is very small, the presented data reflect the largest series of data available to date and do not suggest adverse consequences of PEGV on pregnancy outcome. Nevertheless, it should be stressed that PEGV should not be used during pregnancy unless absolutely necessary. PMID:25542184

  12. Ovarian pregnancy associated with pelvic adhesions

    PubMed Central

    CIORTEA, R?ZVAN; COSTIN, NICOLAE; CHIROIU, BOGDAN; M?LUTAN, ANDREI; MOCAN, RADU; HUDACSKO, AURORA; GAIA, ADRIANA; BUCURI, CARMEN; MIHU, DAN

    2013-01-01

    Ovarian pregnancy is a rare entity. Making a definitive preoperative or even intraoperative diagnosis of ovarian pregnancy is difficult and the diagnosis is usually established by the pathologist. Rupture in the first trimester is the usual rule in ovarian ectopy. Thus, it continues to challenge practicing clinicians. The literature shows an association between intrauterine device usage and ovarian gestation. We present a case of ovarian pregnancy in a secundipara complaining of abdominal pain that also has pelvic adhesions. This case meets the four criteria of Spiegelberg and is interesting because of its rarity and association with adhesions, which makes diagnosis more difficult. PMID:26527922

  13. Ovarian pregnancy associated with pelvic adhesions.

    PubMed

    Ciortea, R?zvan; Costin, Nicolae; Chiroiu, Bogdan; M?lutan, Andrei; Mocan, Radu; Hudacsko, Aurora; Gaia, Adriana; Bucuri, Carmen; Mihu, Dan

    2013-01-01

    Ovarian pregnancy is a rare entity. Making a definitive preoperative or even intraoperative diagnosis of ovarian pregnancy is difficult and the diagnosis is usually established by the pathologist. Rupture in the first trimester is the usual rule in ovarian ectopy. Thus, it continues to challenge practicing clinicians. The literature shows an association between intrauterine device usage and ovarian gestation. We present a case of ovarian pregnancy in a secundipara complaining of abdominal pain that also has pelvic adhesions. This case meets the four criteria of Spiegelberg and is interesting because of its rarity and association with adhesions, which makes diagnosis more difficult. PMID:26527922

  14. A case of neck ectopic meningioma.

    PubMed

    Sanei, Mohammad Hossein; Berjis, Nezamaldin; Mahzouni, Parvin; Naimi, Azar

    2008-04-01

    Primary extra cranial and extra spinal meningioma is rare and is usually limited to the head and neck region or to the paravertebral soft tissues. Histologic diagnosis (in particular for fresh specimens) is often difficult. A 16-year-old girl with a cervical mass is presented. It was a relatively large mass with an approximate diameter of 5 cm. It was diagnosed in fine needle aspiration as a pleomorphic adenoma. Intra-operative diagnosis was paraganglioma and frozen section suggested an infiltrative tumor. Histologically, the lesion showed uniform spindle cell proliferation separated by hyalinized collagen bundles. The cells were often arranged in sweeping fascicles and concentrically wrapped in tight whorls. Immunohistochemically, tumor cells were positive for epithelial membrane antigen and vimentin, while showing no reaction for cytokeratin, chromogranin, neuron-specific enolase and thyroglobulin. A diagnosis of ectopic meningioma was established based on microscopic appearance and immunohistochemical profile of the tumor. Despite its rarity, ectopic meningioma should be considered in differential diagnosis of any mass lesion in head and neck regions, containing spindle cells. PMID:18179413

  15. Suspected ovarian molar pregnancy after assisted reproductive technology conception: a diagnostic challenge.

    PubMed

    Obeidi, Nedaa; Tchrakian, Nairi; Abu Saadeh, Feras; Mocanu, Edgar

    2015-01-01

    A 32-year-old patient with primary infertility received in vitro fertilisation (IVF) therapy. Four weeks later she developed intermittent left iliac fossa pain. Transvaginal ultrasound showed an empty uterus and an adnexal mass adjacent to the right ovary. Serum ?-human chronic gonadotropin was 33,492 IU/L. At laparoscopy a mass attached to right ovary, suggestive of a right ovarian ectopic pregnancy, was excised. Histological examination confirmed an ovarian ectopic gestation, but noted enlarged chorionic villi and trophoblastic atypia, which raised the suspicion of molar pregnancy. Subsequent p57 immunohistochemistry and DNA ploidy studies excluded a mole, however. Cases of suspected molar disease in ectopic pregnancy present a diagnostic challenge for both clinicians and histopathologists, and establishing a definitive diagnosis may be difficult. PMID:25837656

  16. An unruptured tubal pregnancy at term.

    PubMed

    Chokroverty, M; Caballes, R L; Gear, P E

    1986-03-01

    We report a case of advanced, unruptured tubal pregnancy proceeding beyond term. A 25-year-old woman was admitted at 42 weeks' gestation because of lower abdominal pain and inability to feel fetal movements. An ultrasound examination suggested fetal death. At laparotomy three weeks after admission, a right-sided, unruptured tubal mass containing a macerated fetus was found. PMID:3753863

  17. What is the best treatment of heterotopic cervical pregnancies for a successful pregnancy outcome?

    PubMed Central

    Kim, Ji Won; Park, Han Moie; Lee, Woo Sik

    2012-01-01

    Heterotopic pregnancy is rare event and the risk is increased with assisted reproductive technology procedures. Heterotopic cervical pregnancy is even more unusual. We report a rare case of heterotopic cervical pregnancy that was managed successfully. A 36-year-old women who conceived by IVF-ICSI was diagnosed with heterotopic cervical pregnancy. She visited the emergency room with vaginal bleeding at 5 weeks of gestation and underwent careful intracervical gestational sac reduction with forceps under abdominal guidance the next day. The postoperative course was uneventful and with regular check-ups, the intrauterine pregnancy (IUP) progressed unremarkably through 41 weeks with delivery of a healthy newborn. We reviewed a total of 37 cases of heterotopic pregnancy that have been reported in the English language literature. There have been many attempts to eliminate the cervical embryo while preserving the IUP, and complete cervical evacuation is important in order to avoid infection, bleeding, and premature birth. PMID:23346531

  18. Bleeding Ectopic Varices as the First Manifestation of Portal Hypertension

    PubMed Central

    Sharma, Brij; Raina, Sujeet; Sharma, Rajesh

    2014-01-01

    Ectopic varices are defined as dilated portosystemic collateral veins in locations other than the gastroesophageal region. We present a case of recurrent upper gastrointestinal bleeding as the first manifestation of portal hypertension. We diagnosed ectopic duodenal varices without gastroesophageal varices on upper GI endoscopy and extrahepatic portal venous obstruction (EHPVO) on CT angiography and managed this case. PMID:25374725

  19. Persistent Urinary Incontinence: A Case Series of Missed Ectopic Ureters

    PubMed Central

    Wang, Ming-Hsien

    2015-01-01

    Ectopic ureter is a rare cause of urinary incontinence in children. Symptomatic cases are unlikely to resolve spontaneously, and incontinence are often associated with significant psychological impact on these children. This case series of 2 older children with missed ectopic ureters by the urologic community outline workup for persistent urinary incontinence, with emphasis on history, physical, embryology review, and radiographic evaluations. PMID:26793560

  20. Intrathoracic Kidney after Blunt Abdominal Trauma: A Case Report and Review of the Literature

    PubMed Central

    Halis, Fikret; Amasyali, Akin Soner; Yucak, Aysel; Yildiz, Turan; Gokce, Ahmet

    2015-01-01

    Abdominal trauma is responsible for most genitourinary injuries. The incidence of renal artery injury and intrathoracic kidney is quite low in patients who present with blunt trauma experiencing damage. There are four defined etiologies for intrathoracic kidney, which include real intrathoracic ectopic kidney, eventration of the diaphragm, congenital diaphragmatic herniation, and traumatic diaphragmatic rupture. The traumatic intrathoracic kidney is an extremely rare case. We presented intrathoracic kidney case after traumatic posterior diaphragmatic rupture. PMID:26881170

  1. Total abdominal colectomy

    MedlinePLUS

    ... about the following things: Intimacy and sexuality Pregnancy Sports Work During the 2 weeks before your surgery: ... were doing before their surgery. This includes most sports, travel, gardening, hiking, and other outdoor activities, and ...

  2. Hypoganglionosis in pregnancy: a case report

    PubMed Central

    2012-01-01

    Introduction We report a very rare case of isolated hypoganglionosis first diagnosed during early pregnancy, which should be discussed from an obstetric and a gastroenterological point of view. Case presentation A pregnant 18-year-old Caucasian woman presented at twelve weeks of gestation with lower abdominal pain, mild constipation and a large abdominal mass. Abdominal and pelvic magnetic resonance imaging demonstrated a megarectum and megasigmoid, and our patient was managed with medical therapy during her pregnancy, which occurred without major incidents. At the onset of labor, a fecaloma obstructing the pelvic outlet was detected, which required manual disimpaction. However, during the procedure a sudden continuous fetal bradycardia was detected. An emergency Cesarean section was performed but the fetus suffered hypoxic ischemic encephalopathy. One year after the delivery, our patient underwent a sigmoid resection. A histopathological analysis revealed a reduction of nerve cells in the myenteric and submucous plexus, suggesting hypoganglionosis. Conclusion Although there are some reports of pregnancies complicated by megacolon, they are too few and too old to delineate guidelines for clinical orientation. In our article, we discuss several issues regarding the management of these rare intestinal innervation disorders during pregnancy that we believe will enhance their obstetric and gastroenterological management during pregnancy. PMID:22974065

  3. Dual Ectopic Thyroid with Normally Located Thyroid: A Case Report

    PubMed Central

    Kumar Choudhury, Bipul; Kaimal Saikia, Uma; Sarma, Dipti; Saikia, Mihir; Dutta Choudhury, Sarojini; Barua, Santanu; Dewri, Swapna

    2011-01-01

    Dual ectopic thyroid is a rare presentation of thyroid ectopia. Only a few cases have been reported in the world literature. Dual ectopic thyroid in the presence of a normally located thyroid is even rarer. We report a case of dual ectopic thyroid in the lingual and submandibular areas in a seventeen-year-old female with hypoplastic thyroid gland in its normal location. The patient presented with a midline swelling at the base of tongue with dysphagia. Thyroid function test revealed primary hypothyroidism. Ultrasonography of the neck showed hypoplastic thyroid in its normal location. A thyroid scan with Technetium-99?m pertechnate showed two intensely hyperfunctioning foci of ectopic thyroid tissue at a higher level in the midline consistent with dual ectopic thyroid, one at the base of tongue and the other in submental region. No uptake was seen in the normal bed. PMID:21765986

  4. Teenage Pregnancy.

    ERIC Educational Resources Information Center

    McClellan, Mary C.

    1987-01-01

    Reviews the problems of teenage pregnancy, including the costs to society, the challenge to educators, and the types of preventive programs developing across the country. Programs dealing strictly with reproduction and contraception are the least effective deterrents to teenage pregnancy. (MD)

  5. Pregnancy Tests

    MedlinePLUS

    ... This is because the amount of the pregnancy hormone, called human chorionic gonadotropin, or hCG, in your urine increases ... This is because the amount of the pregnancy hormone, called human chorionic gonadotropin, or hCG, in your urine increases ...

  6. Usefulness of Transjugular Intrahepatic Portosystemic Shunt in the Management of Bleeding Ectopic Varices in Cirrhotic Patients

    SciTech Connect

    Vidal, V.; Joly, L.; Perreault, P.; Bouchard, L.; Lafortune, M.; Pomier-Layrargues, G.

    2006-04-15

    Purpose. To evaluate the safety and efficacy of transjugular intrahepatic portosystemic shunt (TIPS) in the control of bleeding from ectopic varices. Methods. From 1995 to 2004, 24 cirrhotic patients, bleeding from ectopic varices, mean age 54.5 years (range 15-76 years), were treated by TIPS. The etiology of cirrhosis was alcoholic in 13 patients and nonalcoholic in 11 patients. The location of the varices was duodenal (n = 5), stomal (n = 8), ileocolic (n = 6), anorectal (n = 3), umbilical (n = 1), and peritoneal (n 1). Results. TIPS controlled the bleeding in all patients and induced a decrease in the portacaval gradient from 19.7 {+-} 5.4 to 6.4 {+-} 3.1 mmHg. Postoperative complications included self-limited intra-abdominal bleeding (n = 2), self-limited hemobilia (n = 1), acute thrombosis of the shunt (n = 1), and bile leak treated by a covered stent (n = 1). Median follow-up was 592 days (range 28-2482 days). Rebleeding occurred in 6 patients. In 2 cases rebleeding was observed despite a post-TIPS portacaval gradient lower than 12 mmHg and was controlled by variceal embolization; 1 patient underwent surgical portacaval shunt and never rebled; in 3 patients rebleeding was related to TIPS stenosis and treated with shunt dilatation with addition of a new stent. The cumulative rate of rebleeding was 23% and 31% at 1 and 2 years, respectively. One- and 2-year survival rates were 80% and 76%, respectively. Conclusion. The present series demonstrates that bleeding from ectopic varices, a challenging clinical problem, can be managed safely by TIPS placement with low rebleeding and good survival rates.

  7. The orthodontic management of ectopic canine

    PubMed Central

    Thirunavukkarasu, R.; Sriram, G.; Satish, R.

    2015-01-01

    The canines being the cornerstone of the arch and smile is one of the teeth, which has the longest eruption passage that gets influenced by local and general etiological factors easily. The initial calcification of the crowns starts at 4–5 months of age and proceeds toward eruption about 11–13 years of age with mesiobuccal crown angulation that gets corrected toward occlusion. It gets displaced buccally or palatally or may sometimes get impacted. Early intervention is the best suited to manage canine eruption patterns. Once erupted ectopically, they possess a great challenge in repositioning them back into their correct position. This case report discusses an orthodontic treatment planning and execution to correct a buccally placed canine with an anterior crossbite in an adult. PMID:26538959

  8. Conservative Management for Lingual Thyroid Ectopic

    PubMed Central

    Sigua-Rodriguez, Eder Alberto; Rangel Goulart, Douglas; Asprino, Luciana; de Moraes Manzano, Afonso Celso

    2015-01-01

    Lingual thyroid gland is a rare clinical entity. The presence of an ectopic thyroid gland located at the base of the tongue may be presented with symptoms like dysphagia, dysphonia, and upper airway obstruction. We are introducing a case of an 8-year-old girl who had lingual thyroid that presented dysphagia and foreign body sensation in the throat. The diagnostic was reached with clinical examination, thyroid scintigraphy with Tc99m and ultrasound. A laryngoscopy was performed which confirmed a spherical mass at base of tongue. Investigation should include thyroid function tests. In this case we observed subclinical hypothyroidism. There are different types of surgical approaches for the treatment of this condition; however, the treatment with Levothyroxine Sodium allowed the stabilization of TSH levels and clinical improvement of symptoms in a follow-up of 2 years. PMID:25785216

  9. Functional ectopic adrenal carcinoma in a dog

    PubMed Central

    Taylor, Jim A.; Lee, Maris S.; Nicholson, Matthew E.; Justin, Robert B.

    2014-01-01

    An 11-year-old spayed female pit bull terrier was presented with a 2-month history of polyuria, polydipsia, polyphagia, and panting. Serum chemistry, blood and urine analysis, and tests for hyperadrenocorticism suggested an adrenal tumor. Abdominal ultrasound identified a mass caudal to the right kidney. The mass was completely excised and histopathology was consistent with endocrine carcinoma. Three years later there was no evidence of recurrence or metastasis. PMID:25183891

  10. Black widow spider (Latrodectus mactans) envenomation in a term pregnancy.

    PubMed

    Sherman; Groll; Gonzalez; Aerts

    2000-07-01

    Description of a black widow spider (Latrodectus mactans) envenomation in a term pregnancy.Case report conducted at an Air Force tertiary care hospital of a 27-year-old primigravida at 38 1/7 weeks pregnancy.Latrodectus mactans antivenin can be given to treat symptoms of black widow envenomation.Black widow envenomations can cause symptoms associated with acute intra-abdominal processes. In pregnancy, envenomations can result in symptoms and signs similar to those seen in preeclampsia (abdominal pain, headache, hypertension, and proteinuria). Latrodectism should be considered in patients complaining of these symptoms in association with a spider bite. If latrodectism is considered to be the underlying origin for these symptoms, appropriate treatment should be administered. In cases of pregnancy, treatment should include L. mactans antivenin if believed to be clinically indicated. There is no current evidence that this antivenin is contraindicated in pregnancy. (Curr Surg 57:346-348) PMID:11024247

  11. An Investigation into the Use of Stimulant Therapy during Pregnancy

    PubMed Central

    Shields, Natalie; Muza, Rexford; Kosky, Christopher; Williams, Adrian J.

    2012-01-01

    Introduction. A lack of documentation of stimulant use during pregnancy means that doctors have difficulty advising narcoleptic and hypersomnolent patients. Objectives. To investigate the use of stimulant therapy in narcoleptic and hypersomnolent patients during pregnancy. Method. A search of clinic letters at a tertiary sleep clinic identified women who became pregnant whilst receiving stimulant therapy between 01/09/1999 and 18/11/2010. Fifteen patients were included in a telephone survey. Results. There were 20 pregnancies. The reported advice received with regards to stimulant use was variable. In 7 pregnancies, medication was stopped preconceptually: 1 had a cleft palate and an extra digit 6 had good foetal outcomes. In 8 pregnancies, medication was stopped postconceptually: 1 had autism and attention-deficit hyperactivity disorder; 7 had good foetal outcomes. In 5 pregnancies, medication was continued throughout pregnancy: 2 ended in miscarriage; 1 was ectopic; 2 had good foetal outcomes. The most common symptom experienced was debilitating hypersomnolence. Conclusion. There are no standardised guidelines for use of stimulants during pregnancy. Women have significant symptoms during pregnancy for which there is an unmet clinical need. More research is needed into whether medication can be safely continued during pregnancy, and if not, when it should be discontinued. Better standardized advice should be made available. PMID:23470841

  12. Intra-abdominal sepsis.

    PubMed

    Holliday, R L

    1976-01-01

    Intra-abdominal sepsis remains one of the major challenges to the surgeon. With a proper appreciation of the bacteriology and pathophysiology involved and an awareness of new diagnostic and therapeutic modalities, hopefully, mortality and morbidity rates can be reduced. PMID:1048948

  13. Heterotopic cesarean scar pregnancy: diagnosis, treatment, and prognosis.

    PubMed

    OuYang, Zhenbo; Yin, Qian; Xu, Yujing; Ma, Yunyan; Zhang, Qiushi; Yu, Yanhong

    2014-09-01

    Heterotopic cesarean scar pregnancy is a rare, life-threatening form of ectopic pregnancy. To provide information regarding the clinical manifestations, diagnosis, management, and prognosis of this condition, we reviewed all cases reported in the English literature. All literature on heterotopic cesarean scar pregnancy was retrieved by searching the PubMed database and tracking references of the relevant literature. Full texts were reviewed, and clinical manifestations, diagnostic methods, and the relationship between the treatment and prognosis were summarized. A total of 14 patients with heterotopic cesarean scar pregnancies were identified, including 6 spontaneous pregnancies and 8 following in vitro fertilization-embryo transfer. Gestational ages at diagnosis ranged from 5 weeks to 8 weeks 4 days. Only 5 cases presented with vaginal bleeding, and the others were asymptomatic. All 14 cases were diagnosed by transvaginal sonography. One patient with no future fertility requirements underwent pregnancy termination by methotrexate. Of the remaining 13 patients who desired to preserve their intrauterine gestations, 10 were treated by sonographically guided selective embryo reduction in situ (by embryo aspiration, drug injection, or both); 2 underwent laparoscopic and hysteroscopic excision of the ectopic pregnancy masses; and 1 was treated by expectant management. All operations were successful and maintained a living intrauterine gestation. Twelve cases resulted in live births by cesarean delivery (3 at term and 9 preterm). One patient underwent pregnancy termination at 12 weeks because of a fetal malformation confirmed by sonography. The possibility of heterotopic cesarean scar pregnancy after cesarean delivery should be considered, especially when pregnancy follows assisted reproductive technology. Transvaginal sonography is an important tool for diagnosis and management. Despite the many options, the best treatment for this condition remains unclear. Selective embryo reduction in situ with sonographic guidance is the main treatment modality and can result in a successful intrauterine gestation, albeit at high risk. PMID:25154932

  14. Abdominal Aortic Aneurysm (AAA) Screening

    MedlinePLUS

    ... covered? Search Medicare.gov for covered items Abdominal aortic aneurysm screening How often is it covered? Medicare Part B (Medical Insurance) covers a one-time abdominal aortic aneurysm ultrasound. You must get a referral for it ...

  15. Screening for Abdominal Aortic Aneurysm

    MedlinePLUS

    Understanding Task Force Recommendations Screening for Abdominal Aortic Aneurysm The U.S. Preventive Services Task Force (Task Force) has issued a final recommendation statement on Screening for Abdominal Aortic Aneurysm. This final recommendation ...

  16. [Sickle cell disease and pregnancy].

    PubMed

    Leborgne-Samuel, Yannick; Kadhel, Philippe; Ryan, Catherine; Vendittelli, Françoise

    2004-09-30

    Pregnancy in SCD women, with a major sickle cell syndrome, is a high-risk situation and is associated with raised incidence of maternal and fetal morbidity and mortality, mainly in late pregnancy, during delivery and in the postpartal periods. Pregnancy increases the incidence of sickle cell specific complications such as anaemia, vaso-occlusive crisis, abdominal, pulmonary (acute chest syndrome) or placental thrombosis, infections (urinary tract infection, pyelonephritis, pneumonia), and toxemia. Maternal death can occur. Sickle cell disease is responsible for high risk of spontaneous abortion, intra-uterine growth retardation, intra-uterine fetal death, preterm delivery, and perinatal mortality related to hypoxemia and placental thrombosis. More and more sickle cell affected women reach adulthood and reproductive age (fertility of sickle cell women is normal). The knowledge of these risks has contributed to the implementation of specific management program and to a better outcome of pregnancy. Such a program includes a close multidisciplinary approach for the duration of the pregnancy, the delivery and the postpartal period, in tertiary maternal health services level. Blood transfusion depends on teams and is related to strictly restricted maternal, obstetrical and hematologic indications. PMID:15558971

  17. Interstitial pregnancy treated with a single-dose of systemic methotrexate: A successful management

    PubMed Central

    Corioni, Serena; Perelli, Federica; Bianchi, Claudia; Cozzolino, Mauro; Maggio, Luana; Masini, Giulia; Coccia, Maria Elisabetta

    2015-01-01

    Interstitial pregnancy is an ectopic pregnancy at high hemorrhagic risk. It often poses a diagnostic and therapeutic challenge to the clinician, with a significant risk of morbidity and mortality. It presents a difficult management problem with no absolute standard of care; the most appropriate treatment technique for these pregnancies remains controversial. We describe a case of unruptured interstitial pregnancy successfully treated with a single-dose of systemic methotrexate with subsequent ultrasound and serum beta human chorionic gonadotropin monitoring. Medical management can be a safe and successful option in selected cases that satisfy specific criteria and in women who are able to be monitored after treatment. PMID:26109980

  18. Interstitial pregnancy treated with a single-dose of systemic methotrexate: A successful management.

    PubMed

    Corioni, Serena; Perelli, Federica; Bianchi, Claudia; Cozzolino, Mauro; Maggio, Luana; Masini, Giulia; Coccia, Maria Elisabetta

    2015-03-01

    Interstitial pregnancy is an ectopic pregnancy at high hemorrhagic risk. It often poses a diagnostic and therapeutic challenge to the clinician, with a significant risk of morbidity and mortality. It presents a difficult management problem with no absolute standard of care; the most appropriate treatment technique for these pregnancies remains controversial. We describe a case of unruptured interstitial pregnancy successfully treated with a single-dose of systemic methotrexate with subsequent ultrasound and serum beta human chorionic gonadotropin monitoring. Medical management can be a safe and successful option in selected cases that satisfy specific criteria and in women who are able to be monitored after treatment. PMID:26109980

  19. Papillary Carcinoma in Median Aberrant Thyroid (Ectopic) - Case Report

    PubMed Central

    K, Shashidhar; Deshmane, Vijaya Laxmi; Kumar, Veerendra; Arjunan, Ravi

    2014-01-01

    Median ectopic thyroid may be encountered anywhere from the foramen caecum to the diaphragm. Non lingual median aberrant thyroid (incomplete descent) usually found in the infrahyoid region and malignant transformation in this ectopic thyroid tissue is very rare. We report an extremely rare case of papillary carcinoma in non lingual median aberrant thyroid in a 25-year-old female. The differentiation between a carcinoma arising in the median ectopic thyroid tissue and a metastatic papillary carcinoma from an occult primary in the main thyroid gland is also discussed. PMID:25121039

  20. Ectopic liver masquerading as a floating intracaval mass.

    PubMed

    Morris, Michael Wyatt; Helling, Thomas S; Creswell, Lawrence L; Jordan, Brenda; Mitchell, Marc E

    2012-06-01

    Ectopic liver is defined as liver parenchyma situated outside the liver proper with no connection to native hepatic tissue. This rare developmental anomaly is most commonly described as an attachment to the gallbladder with an incidence <0.3%, but it has been reported in other locations within the abdomen and thorax.(2-4) Most cases are found incidentally in asymptomatic patients, but ectopic liver has been known to cause visceral or vascular obstruction.(4,5) Herein we present a unique case of ectopic liver attached by a thin stalk seemingly floating in the suprahepatic inferior vena cava. PMID:22360917

  1. Management of Ectopically Erupting Maxillary Incisors: A Case Series.

    PubMed

    Suresh, Kotumachagi Sangappa; Uma, H L; Nagarathna, J; Kumar, Pravin

    2015-01-01

    Eruption disturbances related to the position include ectopic eruption and transpositions. The occurrence of ectopic eruption is most commonly associated with maxillary incisors. The normal eruption, position and morphology of these teeth are crucial to craniofacial development, facial esthetics as well as phonetics. It is essential that the clinicians have thorough knowledge of the eruption disturbances in order to make an appropriate, as well as timely intervention, as dictated by the complexity of the problem. How to cite this article: Suresh KS, Uma HL, Nagarathna J, Kumar P. Management of Ectopically Erupting Maxillary Incisors: A Case Series. Int J Clin Pediatr Dent 2015;8(3):227-233. PMID:26604543

  2. Management of Ectopically Erupting Maxillary Incisors: A Case Series

    PubMed Central

    Suresh, Kotumachagi Sangappa; Uma, HL; Nagarathna, J

    2015-01-01

    ABSTRACT Eruption disturbances related to the position include ectopic eruption and transpositions. The occurrence of ectopic eruption is most commonly associated with maxillary incisors. The normal eruption, position and morphology of these teeth are crucial to craniofacial development, facial esthetics as well as phonetics. It is essential that the clinicians have thorough knowledge of the eruption disturbances in order to make an appropriate, as well as timely intervention, as dictated by the complexity of the problem. How to cite this article: Suresh KS, Uma HL, Nagarathna J, Kumar P. Management of Ectopically Erupting Maxillary Incisors: A Case Series. Int J Clin Pediatr Dent 2015;8(3):227-233. PMID:26604543

  3. Combination of flecainide and propranolol for congenital junctional ectopic tachycardia.

    PubMed

    Imamura, Tomohiko; Tanaka, Yuji; Ninomiya, Yumiko; Yoshinaga, Masao

    2015-08-01

    Congenital junctional ectopic tachycardia is a rare tachyarrhythmia with high mortality. A pharmacological approach in early infancy is regarded as the first-line therapeutic option. Pharmacologically, amiodarone alone or in combination with other drugs is the most commonly reported effective agent for congenital junctional ectopic tachycardia, but it has many adverse effects. Here we report the case of a 40-day-old infant. The clinical course suggests that combined oral flecainide and propranolol is an effective alternative therapy for early infants. Esophageal lead electrocardiography may give a clear diagnosis of junctional ectopic tachycardia. PMID:25809220

  4. Intramuscular ectopic lacrimal gland cyst masquerading as myocysticercosis.

    PubMed

    Pujari, Aditi; Ali, Mohammad Javed; Vemuganti, Geeta K; Naik, Milind N

    2015-01-01

    Ectopic lacrimal gland within the orbit is an extremely rare choristoma occurring due to sequestration of a portion of normal lacrimal gland at an abnormal site during embryogenesis. Most cases of orbital ectopic lacrimal gland present with progressive unilateral proptosis and often become symptomatic in the first 3 decades of life. Although diagnosis is aided by a high clinical suspicion and radiologic features, histopathologic examination is confirmatory. To the best of the knowledge, the authors report the first case of an intramuscular ectopic lacrimal gland in the inferior rectus muscle simulating myocysticercosis. PMID:24492733

  5. A case report of abdominal splenosis - a practical mini-review for a gastroenterologist.

    PubMed

    Ksi?dzyna, Dorota

    2011-09-01

    Splenosis is a benign condition caused by ectopic autotransplantation of splenic tissues after splenic trauma or surgery. It is usually diagnosed accidentally. However, occasionally splenosis poses a significant diagnostic dilemma, especially when this condition presents as a metastatic malignant disease on abdominal imaging. This is the case report of a 54-year-old woman, who underwent post-traumatic splenectomy at the age of 12 years. The physical examination of this patient complaining of epigastric and low back pain, except for postoperative abdominal scar, as well as laboratory tests were normal. Esophagogastroduodenoscopy showed chronic gastritis. Abdominal ultrasound revealed no spleen, enlarged lymph nodes in the right retroperitoneum and a focal lesion in the uterus. In addition, the CT scan disclosed enlarged left hepatic lobe, numerous oval tumors between intestinal loops, in the caecal region, under the diaphragm and abdominal wall, periaortic enlarged lymph nodes and an osteolytic lesion in the first lumbar vertebra, suggesting disseminated malignant disease. The exploratory laparotomy showed multiple abdominal nodules, a tumor of the ileum, the greater omentum and the uterus. Except for the last one (leiomyoma), all excised tumors proved to have histological structure typical for the spleen and, finally, abdominal splenosis was diagnosed. Splenosis should be considered when a differential diagnosis of tumor-like lesions disclosed on abdominal imaging occurs in a patient with a splenic injury in the past. PMID:21961104

  6. Pregnancy Loss

    MedlinePLUS

    ... that most women who have gone through pregnancy loss go on to have healthy babies. Return to top Content last updated: September 27, 2010. Print Return to top Accessibility | Privacy policy | Disclaimers | FOIA | Link to us | USA.gov | ...

  7. Ectopic folliculosebaceous units at the coronal sulcus.

    PubMed

    Fernandez-Flores, Angel

    2014-12-01

    Tyson glands were described in the 17th century as modified sebaceous glands of the coronal sulcus of the penis. However, this description and other early texts supporting the existence of Tyson glands were not accompanied by illustrations. The existence of such glands has been passing through the literature without adequate graphical demonstration, which has contributed to controversial debates. Herein we present a case of a partial penectomy performed on a 65-year-old man with a squamous cell carcinoma of the penis. In this case we identified sebaceous glands as well as folliculosebaceous units in the coronal sulcus. We also comparatively examined 12 cases of partial penectomy to search for sebaceous glands or folliculosebaceous units in the coronal sulcus or the preputium. We found neither sebaceous glands nor folliculosebaceous units at the coronal sulcus or the mucosal aspect of the prepuce. We conclude that: (1) folliculosebaceous units are possible in the coronal sulcus, as the current case illustrates for the first time in literature and (2) the current case is an oddity, probably induced by the accompanying squamous cell carcinoma, and therefore it may represent an ectopic folliculosebaceous unit rather than an anatomic variation. PMID:25382761

  8. A case of ACTH-producing pheochromocytoma associated with pregnancy.

    PubMed

    Oh, Hyoung Chul; Koh, Jung-Min; Kim, Min Seon; Park, Joong Yoel; Shong, Young Kee; Lee, Ki-Up; Kim, Ghi Su; Hong, Suck Joon; Koo, Hyun Lyoung; Kim, Won Bae

    2003-12-01

    Ectopic ACTH syndrome is rarely caused by pheochromocytoma. We report a case of a 28-year-old woman with Cushing's syndrome due to ACTH-producing adrenal pheochromocytoma. She had delivered preterm baby at 32nd week of gestation with 'severe preeclampsia'. After delivery, persistent hypertension accompanied by severe headache led her to being misdiagnosed as Cushing's syndrome due to right adrenal adenoma (normal plasma ACTH level) and cerebral vasculitis of unknown etiology. She was referred to our hospital for surgical treatment. Repeated biochemical studies suggested coexistence of ectopic ACTH syndrome and pheochromocytoma. To reverse her clinical deterioration, right total and left subtotal adrenalectomy was performed with presumptive diagnosis of 1) right adrenal pheochromocytoma causing ectopic ACTH syndrome or 2) coexistence of ACTH-dependent Cushing's syndrome and right adrenal pheochromocytoma. Pathologic examination of right adrenal mass revealed pheochromocytoma which showed strong immunostaining for ACTH. Plasma ACTH and urinary cortisol excretion normalized after surgery, but she succumbed to multiple cerebral infarcts and disseminated intravascular coagulation. Pregnancy and inappropriately low plasma ACTH at initial evaluation might have hampered early diagnosis. To our knowledge, this is the first description of a case with ectopic ACTH syndrome due to pheochromocytoma associated with pregnancy. PMID:14709846

  9. Pregnancy scares and subsequent unintended pregnancy1

    PubMed Central

    Gatny, Heather H.; Kusunoki, Yasamin; Barber, Jennifer S.

    2014-01-01

    Background A substantial number of young women experience pregnancy scares – thinking they might be pregnant, and later discovering that they are not. Although pregnancy scares are distressing events, little is known about who experiences them and whether they are important to our understanding of unintended pregnancy. Objective We describe the young women who experience pregnancy scares, and examine the link between pregnancy scares and subsequent unintended pregnancy. Methods We used data from the Relationship Dynamics and Social Life Study. T-tests and regression analyses were conducted using baseline and weekly data to estimate relationships between respondent characteristics and subsequent pregnancy scares. Event history methods were used to assess pregnancy scares as a predictor of unintended pregnancy. Results Nine percent of the young women experienced a pregnancy scare during the study. African-American race, lack of two-parent family structure, lower GPA, cohabitation, and sex without birth control prior to the study are associated with experiencing a pregnancy scare and with experiencing a greater number of pregnancy scares. Further, experiencing a pregnancy scare is strongly associated with subsequent unintended pregnancy, independent of background factors. Forty percent of the women who experienced a pregnancy scare subsequently had an unintended pregnancy during the study period, relative to only 11% of those who did not experience a pregnancy scare. Conclusions Young women from less advantaged backgrounds are more likely to experience a pregnancy scare, and pregnancy scares are often followed by an unintended pregnancy. PMID:25642141

  10. [Heterotopic pregnancy with intrauterine dizygotic twins following embryo transfer in the blastocyst phase].

    PubMed

    Barrón Vallejo, J; Ortega Díaz, R; Kably Ambe, A

    1999-04-01

    Ectopic pregnancy is a common complication of in vitro fertilization and embryo transfer (IVF-ET). On other hand, heterotopic pregnancy complicates 1-2% of all IVF-ET pregnancies. Tubal damage as reason for treatment and multiple embryo transfer might predispose patients to this complication. We present a successful treated case of an infertile patient that developed simultaneous twin intra- and single extra- uterine pregnancy after blastocyst-stage embryo transfer. In IVF-ET patients presence of an intrauterine gestation not exclude the possibility of a concomitant extrauterine pregnancy. Awareness of the possibility of heterotopic pregnancy after IVF-ET plays an important role in the successful treatment of this reproductive complication. Transfer of good quality embryos can be a risk factor to develop heterotopic pregnancy. PMID:10363416

  11. The abdominal circulatory pump.

    PubMed

    Aliverti, Andrea; Bovio, Dario; Fullin, Irene; Dellac, Raffaele L; Lo Mauro, Antonella; Pedotti, Antonio; Macklem, Peter T

    2009-01-01

    Blood in the splanchnic vasculature can be transferred to the extremities. We quantified such blood shifts in normal subjects by measuring trunk volume by optoelectronic plethysmography, simultaneously with changes in body volume by whole body plethysmography during contractions of the diaphragm and abdominal muscles. Trunk volume changes with blood shifts, but body volume does not so that the blood volume shifted between trunk and extremities (Vbs) is the difference between changes in trunk and body volume. This is so because both trunk and body volume change identically with breathing and gas expansion or compression. During tidal breathing Vbs was 50-75 ml with an ejection fraction of 4-6% and an output of 750-1500 ml/min. Step increases in abdominal pressure resulted in rapid emptying presumably from the liver with a time constant of 0.61+/-0.1SE sec. followed by slower flow from non-hepatic viscera. The filling time constant was 0.57+/-0.09SE sec. Splanchnic emptying shifted up to 650 ml blood. With emptying, the increased hepatic vein flow increases the blood pressure at its entry into the inferior vena cava (IVC) and abolishes the pressure gradient producing flow between the femoral vein and the IVC inducing blood pooling in the legs. The findings are important for exercise because the larger the Vbs the greater the perfusion of locomotor muscles. During asystolic cardiac arrest we calculate that appropriate timing of abdominal compression could produce an output of 6 L/min. so that the abdominal circulatory pump might act as an auxiliary heart. PMID:19440240

  12. The Abdominal Circulatory Pump

    PubMed Central

    Aliverti, Andrea; Bovio, Dario; Fullin, Irene; Dellac, Raffaele L.; Lo Mauro, Antonella; Pedotti, Antonio; Macklem, Peter T.

    2009-01-01

    Blood in the splanchnic vasculature can be transferred to the extremities. We quantified such blood shifts in normal subjects by measuring trunk volume by optoelectronic plethysmography, simultaneously with changes in body volume by whole body plethysmography during contractions of the diaphragm and abdominal muscles. Trunk volume changes with blood shifts, but body volume does not so that the blood volume shifted between trunk and extremities (Vbs) is the difference between changes in trunk and body volume. This is so because both trunk and body volume change identically with breathing and gas expansion or compression. During tidal breathing Vbs was 5075 ml with an ejection fraction of 46% and an output of 7501500 ml/min. Step increases in abdominal pressure resulted in rapid emptying presumably from the liver with a time constant of 0.610.1SE sec. followed by slower flow from non-hepatic viscera. The filling time constant was 0.570.09SE sec. Splanchnic emptying shifted up to 650 ml blood. With emptying, the increased hepatic vein flow increases the blood pressure at its entry into the inferior vena cava (IVC) and abolishes the pressure gradient producing flow between the femoral vein and the IVC inducing blood pooling in the legs. The findings are important for exercise because the larger the Vbs the greater the perfusion of locomotor muscles. During asystolic cardiac arrest we calculate that appropriate timing of abdominal compression could produce an output of 6 L/min. so that the abdominal circulatory pump might act as an auxiliary heart. PMID:19440240

  13. Ruptured abdominal aortic aneurysm.

    PubMed

    Sachs, T; Schermerhorn, M

    2010-06-01

    Ruptured abdominal aortic aneurysm (AAA) continues to be one of the most lethal vascular pathologies we encounter. Its management demands prompt and efficient evaluation and repair. Open repair has traditionally been the mainstay of treatment. However, the introduction of endovascular techniques has altered the treatment algorithm for ruptured AAA in most major medical centers. We present recent literature and techniques for ruptured AAA and its surgical management. PMID:20668419

  14. Temporary ectopic testicular replantation, refabrication and orthotopic transfer.

    PubMed

    Ramdas, Sharad; Thomas, Abraham; Arun Kumar, S

    2007-01-01

    Bilateral traumatic castration if left untreated can result in permanent sexual, social and psychological maladjustments. We hereby report a novel procedure of temporary ectopic replantation of a traumatically avulsed testis on the forearm with refabrication and subsequent successful orthotopic microsurgical transfer to the perineum. The significance of this replantation is related to the refabrication of a long pedicle for subsequent reattachment to the perineum. This would not have been possible but for the ectopic replantation. PMID:17526441

  15. Unusual anatomic variation of bilateral ectopic ureters in a dog.

    PubMed

    Hosgood, G; Salisbury, K; Blevins, W E; Widmer, W R

    1989-12-01

    An unusual anatomic variation of bilateral ectopic ureters was diagnosed in a 6-week-old female Siberian Husky with urinary incontinence. Assessment during surgery revealed bilateral ectopic ureters with a common opening in the proximal portion of the urethra. Ureteroneocystostomy was performed bilaterally. After surgery, intermittent urinary incontinence continued, but was less severe. After resection of a persistent hymen in the 6-month-old dog, incontinence appeared to resolve, but then recurred, and has been controlled by phenylpropanolamine administration. PMID:2599944

  16. Ectopic (subcutaneous) Paragonimus miyazakii infection in a dog.

    PubMed

    Madarame, H; Suzuki, H; Saitoh, Y; Tachibana, M; Habe, S; Uchida, A; Sugiyama, H

    2009-09-01

    Ectopic infection with Paragonimus miyazakii was determined to be the cause of a subcutaneous inguinal mass in a 15-month-old, male, boar-hunting dog. On histologic examination, the mass comprised granulomatous panniculitis, intralesional adult trematodes and eggs, and lymphadenitis. Extrapulmonary paragonimosis in animals is rare. This appears to be the first report in a dog of ectopic P. miyazakii infection with mature trematodes and eggs that involved the inguinofemoral lymphocenter and surrounding subcutis. PMID:19429999

  17. Abdominal trauma by ostrich

    PubMed Central

    Usurelu, Sergiu; Bettencourt, Vanessa; Melo, Gina

    2015-01-01

    Introduction Ostriches typically avoid humans in the wild, since they correctly assess humans as potential predators, and, if approached, often run away. However, ostriches may turn aggressive rather than run when threatened, especially when cornered, and may also attack when they feel the need to defend their offspring or territories. Presentation of case A 71-year-old male patient presented with intra abdominal injury sustained from being kicked in the abdominal wall by an ostrich. During laparotomy, were found free peritoneal effusion and perforation of the small intestine. Discussion The clinical history and physical examination are extremely important for diagnostic and therapeutic decision making. CT-scan is the most accurate exam for making diagnosis. Surgery is the treatment of choice, and is always indicated when there is injury to the hollow viscera. In general it is possible to suture the defect. Conclusion In cases of blunt abdominal trauma by animals is necessary to have a low threshold of suspicion for acute abdomen. PMID:25685344

  18. [Hypertriglyceridemic pancreatitis and pregnancy].

    PubMed

    Sanduende Otero, Y; Figueira Moure, A; Rama-Maceiras, P; Bautista Guilln, A; Diguez Fernndez, M

    2003-11-01

    A 33-year-old secundipara with a history of gestational diabetes and familial hypertriglyceridemia exacerbated during her previous pregnancy was admitted in the 36th week of gestation with diffuse abdominal pain, vomiting, low-grade fever, and general malaise. A blood sample had a lipemic, milky-pink appearance and plasma concentrations were as follows: triglycerides 2173 mg/dL, cholesterol 320 mg/dL, amylase 801 U/L, lactate dehydrogenase 650 U/L, creatinine 1.5 mg/dL, glucose 380 mg/dL, and left-shifted white cells. Acute pancreatitis was diagnosed and owing to signs of fetal distress, a cesarean was performed under light general anesthesia with propofol, succinylcholine, and sevoflurane. After the umbilical cord was cut, rocoronium and fentanyl were administered. The neonate was healthy and the patient's condition evolved favorably with conservative treatment. The incidence of pancreatitis during pregnancy is low but related morbidity and mortality are high. The usual cause is biliary tract disease, although rare metabolic alterations such as hyperlipidemia may occasionally act as the trigger. Early diagnosis and treatment are the keys to successful surgery and postoperative recovery. PMID:14753142

  19. [Acute pancreatitis and pregnancy].

    PubMed

    Scollo, P; Licitra, G

    1993-12-01

    Aetiologic factors (gallstones, hyperlipidemia I-IV, hypertriglyceridaemia) make their occurrence, mainly, in the third trimester of gestation. Two cases of acute pancreatitis in pregnancy are described; in both cases patients referred healthy diet, no habit to smoke and no previous episode of pancreatitis. An obstructive pathology of biliary tract was the aetiologic factor. Vomiting, upper abdominal pain are aspecific symptoms that impose a differential diagnosis with acute appendicitis, cholecystitis and obstructive intestinal pathology. Laboratory data (elevated serum amylase and lipase levels) and ultrasonography carry out an accurate diagnosis. The management of acute pancreatitis is based on the use of symptomatic drugs, a low fat diet alternated to the parenteral nutrition when triglycerides levels are more than 28 mmol/L. Surgical therapy, used only in case of obstructive pathology of biliary tract, is optimally collected in the third trimester or immediately after postpartum. Our patients, treated only medically, delivered respectively at 38th and 40th week of gestation. Tempestivity of diagnosis and appropriate therapy permit to improve prognosis of a pathology that, although really associated with pregnancy, presents high maternal mortality (37%) cause of complications (shock, coagulopathy, acute respiratory insufficiency) and fetal (37.9%) by occurrence of preterm delivery. PMID:8139793

  20. Unplanned pregnancy.

    PubMed

    Nuthall, J

    1986-07-01

    Teenage pregnancy rates continue to increase in New Zealand. In 1981 there were 7040 teenage pregnancies, of which 5105 resulted in live births; 1985 were terminated by abortion. This discussion focuses on the crisis of unplanned pregnancy for 1 young woman and the possible outcomes she considered. No contraceptives were used by Natasha and her friend Bruce. It was the 1st time of intercourse for both of them. A nurse, a doctor, and a counselor at the family planning clinic devoted many hours to discussing the pregnancy with Natasha and Bruce -- their feelings about it, possible plans of action, and the ramification of each of these. Natasha considered marrying and keeping the baby, not marrying and keeping the child, carrying the pregnancy to term and giving the child up for adoption,and abortion. A friendly, relaxed, and supportive atmosphere was provided to help Natasha and Bruce evaluate their situation and explore all possible plans of action. Natasha's evental decision was to have an abortion. The abortion was performed by a gynecologist under general anesthesia in a public hospital when Natasha was 9 weeks pregnant. There has been much debate about the need for sex education and courses focusing on human relationships in the schools. The need for school programs has been substaintiated. In addition a need exists for in-depth analysis of the causes of unplanned pregnancy. Many studies have shown that ignorance about contraceptive methods does not emerge as a major factor, although incomplete understanding of a particular method does have significant effects. More information is needed to prevent pregnancy. A cognitive behavioral approach, involving the following 4 steps, has been suggested: access to relevant reproductive and contraceptive information; accurate perception, comprehension, and storage of this information; personalization and the use of the information in decision making; and decision implementation through overt behavior. PMID:3462577

  1. Laparoscopic resection of recurrent ectopic hepatocellular carcinoma: A case report with review of the literature and guidelines for follow-up

    PubMed Central

    Aars, Arne Marino; Reitan-Gjerse, Truls Andr; Waage, Anne; Mala, Tom; Edwin, Bjrn; Lberg, Else Marit; Abildgaard, Andreas; Rsok, Brd Ingvald

    2015-01-01

    Introduction Hepatocellular carcinoma (HCC) in ectopic liver tissue is extremely rare. Presentation of case A 64-year-old woman presented initially with abdominal complaints. Computed tomography (CT) revealed a tumor in the diaphragm and laparoscopic resection of the tumor was performed. Histology showed HCC. During the next 4 years four more tumors, all of which showed HCC on histology and were located extrahepatically, was treated with laparoscopic resection. During this course the patient was followed with regular thoracoabdominal CT and measurement of serum alpha-fetoprotein (AFP). A negative magnetic resonance imaging (MRI) examination of the liver excluded a primary intrahepatic tumor. Discussion The literature available on ectopic HCC and the guidelines for management of HCC do not address the postoperative surveillance of patients undergoing curative treatment. A follow-up regime has been proposed by Hatzaras et al. (2014) to include cross-sectional imaging of the liver and measurement of serum AFP levels [1]. CT would be the preferred study of choice in a total radiologic investigation of the abdomen. While MRI is prone to artifacts due to movements, CT scans allows so rapid recordings that this no longer is an issue. An early investigation of the liver for intrahepatic HCC should nevertheless be performed early to exclude primary intrahepatic HCC. Conclusion We recommend that patients with ectopic HCC should be followed every 6 months with measurement of AFP and abdominal CT imaging. MRI of the liver should be performed early to exclude primary intrahepatic HCC. PMID:26590353

  2. Pregnancy and Rheumatic Disease

    MedlinePLUS

    ... Conditions Living Well with Rheumatic Disease Pregnancy & Rheumatic Disease Pregnancy and Rheumatic Disease Fast Facts Diseases with the ... your rheumatologist. What are the effects of rheumatic disease on pregnancy? During pregnancy, the effects of inflammation when a ...

  3. Early Pregnancy Loss

    MedlinePLUS

    ... is called early pregnancy loss , miscarriage , or spontaneous abortion . How common is early pregnancy loss? Early pregnancy ... testes that can fertilize a female egg. Spontaneous Abortion: The medical term for early pregnancy loss. Trimester: ...

  4. Sex during Pregnancy

    MedlinePLUS

    ... Caring for Your Child All About Food Allergies Sex During Pregnancy KidsHealth > For Parents > Sex During Pregnancy ... satisfying and safe sexual relationship during pregnancy. Is Sex During Pregnancy Safe? Sex is considered safe during ...

  5. Sex during Pregnancy

    MedlinePLUS

    ... Allergy Emergency Cerebral Palsy: Caring for Your Child Sex During Pregnancy KidsHealth > For Parents > Sex During Pregnancy ... satisfying and safe sexual relationship during pregnancy. Is Sex During Pregnancy Safe? Sex is considered safe during ...

  6. Pregnancy and Medicines

    MedlinePLUS

    ... Pregnancy and medicines fact sheet ePublications Pregnancy and medicines fact sheet Print this fact sheet Pregnancy and ... pregnancy and medicines Is it safe to use medicine while I am pregnant? There is no clear- ...

  7. Back Pain During Pregnancy

    MedlinePLUS

    ... Management Education & Events Advocacy For Patients About ACOG Back Pain During Pregnancy Home For Patients Search FAQs Back ... Pain During Pregnancy FAQ115, January 2016 PDF Format Back Pain During Pregnancy Pregnancy What causes back pain during ...

  8. Pregnancy Complications: Genital Herpes

    MedlinePLUS

    ... Loss > Pregnancy complications > Genital herpes and pregnancy Genital herpes and pregnancy Now playing: E-mail to a ... the United States has genital herpes. Can genital herpes cause complications during pregnancy? Yes. Genital herpes can ...

  9. HIV and Pregnancy

    MedlinePLUS

    ... Management Education & Events Advocacy For Patients About ACOG HIV and Pregnancy Home For Patients Search FAQs HIV ... HIV and Pregnancy FAQ113, December 2012 PDF Format HIV and Pregnancy Pregnancy What is human immunodeficiency virus ( ...

  10. Pregnancy diagnosis.

    PubMed

    Millar, D R; Jarvis, G J

    1980-04-19

    Urine pregnancy diagnostic tests are now widely available to doctors and patients and give accurate results in minutes. These tests have received such wide publicity that even physicians appear to accept them as the norm without doing vaginal examinations. To assess the apparent trend, 100 consecutive patient bookings at Jessop Hospital for Women antenatal clinics were queried about whether they had a urine pregnancy test, and whether their physicians had given them vaginal examinations. Results, in tabular form, show that 37% of the women had an independent diagnostic test, the Predictor costing 4 1/2 pounds, with other tests costing between 2 - 3 1/2 pounds. Only 14% of the women arriving at the hospital clinic had not had a urine test and 75% had not had a vaginal. Certainly there are reasons why biochemical testing is preferable to clinical diagnosis, but one might question why 86% of pregnant women have an expensive urine pregnancy test. Hospitals rarely use these tests in normal pregnancies; usually their use is reserved for cases of missed abortion or pseudocyesis. Even here, however, ultrasound is usually more helpful. However, where gestational age is in doubt, urine testing does imply that the mother was at least 6 weeks pregnant at the time of testing. The sentiment, however, is that such testing for early pregnancy is an extravagance that the N.H.S. cannot afford. PMID:6103226

  11. Postterm pregnancy

    PubMed Central

    Galal, M.; Symonds, I.; Murray, H.; Petraglia, F.; Smith, R.

    2012-01-01

    Postterm pregnancy is a pregnancy that extends to 42 weeks of gestation or beyond. Fetal, neonatal and maternal complications associated with this condition have always been underestimated. It is not well understood why some women become postterm although in obesity, hormonal and genetic factors have been implicated. The management of postterm pregnancy constitutes a challenge to clinicians; knowing who to induce, who will respond to induction and who will require a caesarean section (CS). The current definition and management of postterm pregnancy have been challenged in several studies as the emerging evidence demonstrates that the incidence of complications associated with postterm pregnancy also increase prior to 42 weeks of gestation. For example the incidence of stillbirth increases from 39 weeks onwards with a sharp rise after 40 weeks of gestation. Induction of labour before 42 weeks of gestation has the potential to prevent these complications; however, both patients and clinicians alike are concerned about risks associated with induction of labour such as failure of induction and increases in CS rates. There is a strong body of evidence however that demonstrates that induction of labour at term and prior to 42 weeks of gestation (particularly between 40 & 42 weeks) is associated with a reduction in perinatal complications without an associated increase in CS rates. It seems therefore that a policy of induction of labour at 41 weeks in postterm women could be beneficial with potential improvement in perinatal outcome and a reduction in maternal complications. PMID:24753906

  12. Pregnancy in a unilaterally ovariohysterectomised queen.

    PubMed

    Jurka, Piotr; Kacprzak, Kamil J; Degórska, Beata

    2015-04-01

    A 4-year-old female Russian Blue cat presented with signs of right-sided abdominal distension, anorexia and a mucoid vaginal discharge. On the basis of clinical and ultrasonographical findings a tentative diagnosis of uterine torsion was made. Exploratory coeliotomy revealed a 900º right uterine torsion along the longitudinal axis. Unilateral ovariohysterectomy was performed. Subsequently, the cat had two successful and uneventful pregnancies. To our knowledge this is the first case report of pregnancy in a unilaterally ovariohysterectomised queen. PMID:25414240

  13. Abdominal imaging: An introduction

    SciTech Connect

    Frick, M.P.; Feinberg, S.B.

    1986-01-01

    This nine-chapter book gives an overview of the integrated approach to abdominal imaging. Chapter 1 provides an introduction to the physics used in medical imaging; chapter 2 is on the selection of imaging modalities. These are followed by four chapters that deal, respectively, with plain radiography, computed tomographic scanning, sonography, and nuclear imaging, as applied to the abdomen. Two chapters then cover contrast material-enhanced studies of the gastrointestinal (GI) tract: one focusing on technical considerations; the other, on radiologic study of disease processes. The final chapter is a brief account of different interventional procedures.

  14. [Abdominal penetrating trauma].

    PubMed

    Kring, Sren; Helligse, Per; Kg, Lise

    2009-06-22

    A 19-year-old female was brought to the Emergency Room as a trauma patient. During a tilting contest she fell off the horse and was penetrated by a spear used for tilting the ring. She was respiratorically as well as haemodynamically stable. The spear was supported but not removed by the paramedics. The spear penetrated the patient near the left iliac crest pointing at the heart. Further investigation at the Emergency Room is described briefly and guidelines for penetrating, impaled foreign bodies in the (thoraco)abdominal region are outlined. PMID:19671404

  15. [Differential diagnosis of abdominal pain].

    PubMed

    Frei, Pascal

    2015-09-01

    Despite the frequency of functional abdominal pain, potentially dangerous causes of abdominal pain need to be excluded. Medical history and clinical examination must focus on red flags and signs for imflammatory or malignant diseases. See the patient twice in the case of severe and acute abdominal pain if lab parameters or radiological examinations are normal. Avoid repeated and useless X-ray exposure whenever possible. In the case of subacute or chronic abdominal pain, lab tests such as fecal calprotectin, helicobacter stool antigen and serological tests for celiac disease are very useful. Elderly patients may show atypical or missing clinical signs. Take care of red herrings and be skeptical whether your initial diagnosis is really correct. Abdominal pain can frequently be an abdominal wall pain. PMID:26331201

  16. A case of thoracic splenosis in a post-splenectomy patient following abdominal trauma: Hello Howell-Jolly.

    PubMed

    Viviers, Petrus J

    2014-08-01

    Seeding of splenic tissue to extra-abdominal sites is a relatively infrequent consequence of open abdominal trauma. Immunological function of these small foci of ectopic splenic tissue is unknown and their use in determining the splenic function may be limited. In this case report, a patient is described who had previously undergone an emergency splenectomy. The absence of Howell-Jolly bodies on the blood smear in a patient who had previously undergone surgical splenectomy raised the suspicion of splenosis. The immunological features as well as non-invasive evaluation of these ill-defined splenic tissue sites are discussed. PMID:25988041

  17. Antichlamydial Antibodies, Human Fertility, and Pregnancy Wastage

    PubMed Central

    Stephens, Amanda J.; Aubuchon, Mira; Schust, Danny J.

    2011-01-01

    Genital infections with Chlamydia trachomatis (C. trachomatis) continue to be a worldwide epidemic. Immune response to chlamydia is important to both clearance of the disease and disease pathogenesis. Interindividual responses and current chlamydial control programs will have enormous effects on this disease and its control strategies. Humoral immune response to C. trachomatis occurs in humans and persistent antibody levels appear to be most directly correlated with more severe and longstanding disease and with reinfection. There is a close correlation between the presence of antichlamydial antibodies in females and tubal factor infertility; the closest associations have been found for antibodies against chlamydial heat shock proteins. The latter antibodies have also been shown to be useful among infertile patients with prior ectopic pregnancy, and their presence has been correlated with poor IVF outcomes, including early pregnancy loss. We review the existing literature on chlamydial antibody testing in infertile patients and present an algorithm for such testing in the infertile couple. PMID:21949601

  18. Postural balance and the risk of falling during pregnancy.

    PubMed

    Cakmak, Bulent; Ribeiro, Ana Paula; Inanir, Ahmet

    2016-05-01

    Pregnancy is a physiological process and many changes occur in a woman's body during pregnancy. These changes occur in all systems to varying degrees, including the cardiovascular, respiratory, genitourinary, and musculoskeletal systems. The hormonal, anatomical, and physiological changes occurring during pregnancy result in weight gain, decreased abdominal muscle strength and neuromuscular control, increased ligamentous laxity, and spinal lordosis. These alterations shift the centre of gravity of the body, altering the postural balance and increasing the risk of falls. Falls during pregnancy can cause maternal and foetal complications, such as maternal bone fractures, head injuries, internal haemorrhage, abruption placenta, rupture of the uterus and membranes, and occasionally maternal death or intrauterine foetal demise. Preventative strategies, such as physical exercise and the use of maternity support belts, can increase postural stability and reduce the risk of falls during pregnancy. This article reviews studies that have investigated changes in postural balance and risk of falling during pregnancy. PMID:26212584

  19. Robotic-assisted laparoscopic resection of ectopic pancreas in the posterior wall of gastric high body: Case report and review of the literature

    PubMed Central

    Hsu, Sheng-Der; Wu, Hurng-Sheng; Kuo, Chien-Long; Lee, Yueh-Tsung

    2005-01-01

    Minimally invasive surgery has revolutionized the treatment of gastrointestinal tumors. Submucosal tumors of the stomach can be resected using laparoscopic techniques. We report here a case of ectopic pancreas tissue in the gastric wall that was removed using robotic-assisted laparoscopic resection. The patient was a 15-year-old female who presented with abdominal discomfort and tarry stools. Laboratory analysis showed iron deficiency anemia. Preoperative endoscopy revealed a submucosal lesion in the posterior wall of the gastric high body. Intraoperative upper endoscopy clearly located the lesion. A robotic-assisted laparoscopic wedge resection of the putative gastric submucosal tumor was performed. The pathology results showed an ectopic pancreas. The patient had an uneventful recovery and we believe that this is a valid treatment option for this benign condition. PMID:16437703

  20. Abdominal MR Elastography

    PubMed Central

    Yin, Meng; Chen, Jun; Glaser, Kevin J.; Talwalkar, Jayant A.; Ehman, Richard L.

    2011-01-01

    MR Elastography (MRE) is an MRI-based technique for quantitatively assessing the mechanical properties of tissues, based on the propagation of shear waves. Multiple studies have described many potential applications of MRE, from characterizing tumors to detecting diffuse disease processes. Studies have shown that MRE can be successfully implemented to assess abdominal organs. The first clinical application MRE to be well documented is the detection and characterization of hepatic fibrosis, which systematically increases the stiffness of liver tissue. In this diagnostic role, offers a safer, and less expensive, and potentially more accurate alternative to invasive liver biopsy. Emerging results suggest that measurements of liver and spleen stiffness may provide an indirect way to assess portal hypertension. Preliminary studies have demonstrated that is possible to use MRE to evaluate the mechanical properties of other abdominal structures, such as the pancreas and kidneys. Steady technical progress in developing practical protocols for applying MRE in the abdomen and pelvis provides opportunities to explore many other potential applications of this emerging technology. PMID:20010062

  1. [Pathophysiology of abdominal pain].

    PubMed

    Curatolo, Michele

    2011-08-01

    Abdominal pain can be induced by stimulation of visceral nociceptors. Activation of nociceptors usually requires previous sensitization by pathological events, such as inflammation, ischemia or acidosis. Although abdominal pain can obviously be caused by pathology of a visceral structure, clinicians frequently observe that such a pathology explains only part of the pain complaints. Occasionally, there is lack of objective signs of visceral lesions. There is clear evidence that pain states are associated with profound changes of the central processing of the sensory input. The main consequences of such alterations for patients are twofold: 1) a central sensitization, i.e. an increased excitability of the central nervous system; 2) an alteration of the endogenous pain modulation, which under normal conditions inhibits the processing of nociceptive signals in the central nervous system. Both phenomena lead to a spread of pain to other body regions and an amplification of the pain perception. The interactions between visceral pathology and alterations of the central pain processes represent an at least partial explanation for the discrepancy between objective signs of peripheral lesions and severity of the symptoms. Today, both central hypersensitivity and alteration in endogenous pain modulation can be measured in clinical practice. This information can be used to provide the patients with an explanatory model for their pain. Furthermore, first data suggest that alterations in central pain processing may represent negative prognostic factors. A better understanding of the individual pathophysiology may allow in the future the development of individual therapeutic strategies. PMID:21796591

  2. Pregnancy and Vaginal Delivery after Sacrohysteropexy

    PubMed Central

    Balsak, Deniz; Eser, Ahmet; Erol, Onur; Deniz Alt?nta?, Derya; Aksin, ?erif

    2015-01-01

    Pregnancy and birth after a Pelvic Organ Prolapse (POP) surgery is a rare condition and less is known about the method for delivery. A 31-year-old women with gravida 3 para 3 underwent abdominal sacrohysteropexy and transobturatuar tape (TOT) procedures for stage III prolapse who delivered via vaginal birth and showed no relapse. Sacrohysteropexy is a good option for women with POP who desire fertility with a long term follow-up period. PMID:26199773

  3. A true cornual pregnancy with placenta percreta resulting in a viable fetus

    PubMed Central

    Rathod, Setu; Samal, Sunil Kumar

    2015-01-01

    Cornual pregnancy is uncommon among ectopic pregnancies. A diagnosis of cornual pregnancy remains challenging, and rupture of a cornual pregnancy causes catastrophic consequence due to massive bleeding. In very rare circumstances, cornual pregnancies can result in a viable fetus. We report a case of a 24-year-old primigravida who presented to us with complaints of decrease fetal movements at 37+5 weeks. Ultrasound revealed a single live intrauterine fetus with anterior low lying placenta with severe oligohydramnios (amniotic fluid index = 1.8). Emergency cesarean section was done and intraoperatively it was diagnosed as a case of placenta percreta with pregnancy in right noncommunicating horn of uterus. Right cornual resection with right salpingectomy done. Uterus, left fallopian tube and bilateral ovary were healthy. Postoperative period was uneventful. PMID:26539372

  4. Clinics in diagnostic imaging (158). Duodenal ectopic pancreas

    PubMed Central

    Subramanian, Manickam; Wee, Eric; Desai, Vijayadwaja; Peh, Wilfred CG

    2014-01-01

    A 46-year-old man presented with right loin tenderness following a road traffic accident. Computed tomography and magnetic resonance imaging showed a well-defined, smooth, enhancing oval lesion in the wall of the first part of the duodenum. The lesion was seen separately from the normal pancreas. It showed attenuation, intensity and enhancement similar to that of normal pancreas. Based on the imaging appearance, a diagnosis of ectopic pancreas was made. The patient underwent oesophagogastroduodenoscopy, endoscopic ultrasonography and fine-needle aspiration cytology of the lesion, which confirmed ectopic pancreatic tissue. Since the patient was asymptomatic, surgical resection was deferred. The embryologic origin, various locations, imaging appearance and clinical significance of ectopic pancreas are discussed. PMID:25630315

  5. PET imaging in ectopic Cushing syndrome: a systematic review.

    PubMed

    Santhanam, Prasanna; Taieb, David; Giovanella, Luca; Treglia, Giorgio

    2015-11-01

    Cushing syndrome due to endogenous hypercortisolism may cause significant morbidity and mortality. The source of excess cortisol may be adrenal, pituitary, or ectopic. Ectopic Cushing syndrome is sometimes difficult to localize on conventional imaging like CT and MRI. After performing a multilevel thoracoabdominal imaging with CT, the evidence regarding the use of radiotracers for PET imaging is unclear due to significant molecular and etiological heterogeneity of potential causes of ectopic Cushing's syndrome. In our systematic review of literature, it appears that GalLium-based (Ga68) somatostatin receptor analogs have better sensitivity in diagnosis of bronchial carcinoids causing Cushing syndrome and FDG PET appears superior for small-cell lung cancers and other aggressive tumors. Further large-scale studies are needed to identify the best PET tracer for this condition. PMID:26206753

  6. How I Manage Abdominal Injuries.

    ERIC Educational Resources Information Center

    Haycock, Christine E.

    1986-01-01

    In sports, abdominal injuries occur most frequently in cycling, horseback riding, and skiing. Most involve children, not adults. Any athlete sustaining a severe blow to the abdomen should be examined. Guidelines are provided for recognizing and treating injuries to the abdominal muscles, kidneys, spleen, and liver. (Author/MT)

  7. Abdominal aortic aneurysm repair - open

    MedlinePLUS

    Open abdominal aortic aneurysm repair is surgery to fix a widened part in your aorta. This is called an aneurysm. The ... Open surgery to repair an abdominal aortic aneurysm is sometimes ... is bleeding inside your body from the aneurysm. You may have an ...

  8. CT of abdominal tuberculosis

    SciTech Connect

    Epstein, B.M.; Mann, J.H.

    1982-11-01

    Intraabdominal tuberculosis (TB) presents with a wide variety of clinical and radiologic features. Besides the reported computed tomographic (CT) finding of high-density ascites in tuberculous peritonitis, this report describes additional CT features highly suggestive of abdominal tuberculosis in eight cases: (1) irregular soft-tissue densities in the omental area; (2) low-density masses surrounded by thick solid rims; (3) a disorganized appearance of soft-tissue densities, fluid, and bowel loops forming a poorly defined mass; (4) low-density lymph nodes with a multilocular appearance after intravenous contrast administration; and (5) possibly high-density ascites. The differential diagnosis of these features include lymphoma, various forms of peritonitis, peritoneal carcinomatosis, and peritoneal mesothelioma. It is important that the CT features of intraabdominal tuberculosis be recognized in order that laparotomy be avoided and less invasive procedures (e.g., laparoscopy, biopsy, or a trial of antituberculous therapy) be instituted.

  9. Hemostatic Techniques for Laparoscopic Management of Cornual Pregnancy: Double-Impact Devascularization Technique.

    PubMed

    Afifi, Yousri; Mahmud, Ayesha; Fatma, Alfia

    2016-02-01

    Cornual pregnancy is a rare form of ectopic pregnancy, accounting for up to 2% to 4% of all ectopic pregnancies, with a mortality range of 2.0% to 2.5%. Hemorrhage is a key concern in the management of such pregnancies. Traditional treatment options include a conservative approach, failing which patients are offered surgical options such as cornual resection at laparotomy, which carries a high risk of hysterectomy. In recent years newer laparoscopic cornual resection or cornuotomy techniques have been used successfully to achieve better outcomes with fewer complications. We present the double-impact devascularization (DID) technique for laparoscopic management of cornual ectopic pregnancies. This technique permits hemostatic control by compression effect, which in turn allows reduction in procedure-related patient morbidity and mortality. We also provide an overview of other reported methods of hemostatic control used in similar laparoscopic procedures. DID appears to be a useful, safe, minimally invasive technique that can be used in both laparoscopic and open surgical procedures. PMID:26383879

  10. [Teenage pregnancy].

    PubMed

    Mora-Cancino, María; Hernández-Valencia, Varcelino

    2015-05-01

    In Mexico, 20% of the annual births are presented in women younger than 20 years old. Pregnancy in adolescents puts at risk mother and child health. This risk is major while the woman is younger, especially when the social and economic conditions are not favorable, which is decisive in later psychosocial development. It has been pointed out that the youths with low education, with minor academic and laboral expectations, with low self-esteem and assertiveness, tend to begin early their active sexual life, to use less frequently contraceptives, and in the case of younger women, to be pregnant, with the risk of abortion because they cannot to make the best decision. It is important to take into account the social context and the special characteristics of the family to understand situation of adolescent at risk of pregnancy. PMID:26233975

  11. Conception, complicated pregnancy, and labour of gods and heroes in Greek mythology.

    PubMed

    Iavazzo, Christos; Trompoukis, Constantinos; Sardi, Thalia; Falagas, Matthew E

    2008-01-01

    Pregnancy and labour are holy moments in a woman's life. Even in Greek mythology we can find descriptions of them. We searched in the Greek myths to find descriptions of labours of ancient heroes and gods. We identified descriptions of extracorporeal fertilization, superfecundation, ectopic pregnancy, preterm labour, prolonged pregnancy and Caesarean section. The use of imagination could help the reader to find similarities in present or future developments in the field of obstetrics. It could be concluded that various aspects of modern obstetrical practice are described in Greek mythology. PMID:18644217

  12. The hemorheological basis of transfusion therapy in the case of extrauterine pregnancy

    NASA Astrophysics Data System (ADS)

    Smirnova, T. A.; Gerasimovich, G. I.; Kostin, G. M.

    1996-05-01

    The authors have studied 122 medical histories of extrauterine pregnancies from archives and directly followed up 122 patients who underwent emergency surgery for extrauterine pregnancy. Particular disturbances of rheological properties of blood in patients with ectopic pregnancy are revealed. The authors prove the necessity of rheologically active infusion-transfusion therapy, which normalizes rheological properties of blood, its acidic and basic conditions, and protein composition both during the operation and in the postoperational period. The following solutions were used: acesol, Haemodesum, rheopolyglucine, rheoglumane, gelatinol, 10% albumin solution, and fresh frozen plasma.

  13. Genetics, Pregnancy, and Aortic Degeneration.

    PubMed

    Crawford, Jeffrey D; Hsieh, Cindy M; Schenning, Ryan C; Slater, Matthew S; Landry, Gregory J; Moneta, Gregory L; Mitchell, Erica L

    2016-01-01

    We present a case of familial thoracic aortic aneurysm and dissection (FTAAD) in a pregnant female. FTAAD is an inherited, nonsyndromic aortopathy resulting from several genetic mutations critical to aortic wall integrity have been identified. One such mutation is the myosin heavy chain gene (MYH11) which is responsible for 1-2% of all FTAAD cases. This mutation results in aortic medial degeneration, loss of elastin, and reticulin fiber fragmentation predisposing to TAAD. Aortic disease is more aggressive during pregnancy as a result of increased wall stress from hyperdynamic cardiovascular changes and estrogen-induced aortic media degeneration. Our patient was a 29-year-old G2P1 woman at 26weeks gestation presenting with abdominal and back pain. Work-up revealed a 6.4-cm ascending aortic aneurysm with a type A dissection extending into all arch vessels, aortic coarctation at the isthmus, and a separate focal type B aortic dissection with visceral involvement. Surgical management included concomitant cesarean section with delivery of a live premature infant, tubal ligation, ascending aortic replacement with reconstruction of the arch vessels, and aortic valve resuspension. The type B dissection was managed medically without complication. This is the first reported case of aortic dissection in a patient with FTAAD/MYH11 mutation and pregnancy. This case highlights that FTAAD and pregnancy cause aortic degeneration via distinct mechanisms and that hyperdynamics of pregnancy increase aortic wall stress. Management of pregnancy associated with aortopathy requires early transfer to a tertiary center, careful investigation to identify familial aortopathy, fetal monitoring, and a multidisciplinary team approach. PMID:26381327

  14. Abdominal wall extraction using constrained deformable model and abdominal context.

    PubMed

    Huang, Weimin; Quan, Lijie; Lin, Zhiping; Duan, Yuping; Zhou, Jiayin; Yang, Yongzhong; Xiong, Wei

    2014-01-01

    Information about abdominal wall can be used for many applications from organ segmentation, registration, and surgical simulation. The challenges exist in abdominal wall extraction due to its varieties in shapes, connection to the internal organs and anterior layer edge formed between the muscle and fascia/fatty layer, which may distract the shape model. In this paper we present an approach to the posterior abdominal wall extraction using the shape model and other abdominal context, particularly with the rib-spine bone information and the wall image features. The shape model is constructed based on the training abdominal walls that are delineated manually. After bone information being extracted, the wall shape deforms from the prior shape model using the snake, which is constrained by the bone context and guided by the processed image energy map with the aim of removing distracted image features of anterior abdominal wall and the outer region from the original map. Meanwhile, an overall convex shape is maintained by limiting the angles of the contour points. The proposed approach is tested on abdominal CT data which provides encouraging results. PMID:25571041

  15. Large benign retroperitoneal tumour in pregnancy

    PubMed Central

    Berczi, Csaba; Osvath, Peter; Flasko, Tibor

    2015-01-01

    A 31-year-old female was in the 13th week of pregnancy when an abdominal ultrasound examination revealed a large retroperitoneal tumour. Magnetic resonance imaging was carried out and the imaging described a 10-cm mass in diameter extending from the right kidney. Given that the patient was in her first trimester and that there was a suspicion of malignancy, further surgical exploration of the tumour was warranted. During the operation, the tumour was removed, but nephrectomy was not necessary. Histologic analysis of the resected tumour showed a mucinous cystic adenoma, and no signs of malignancy were present. Following the surgery, the pregnancy was otherwise uneventful and further complications did not occur. This case illustrates that surgery is recommended in patients with a retroperitoneal tumour early during a pregnancy, when a malignancy cannot be excluded. PMID:26609332

  16. Ectopic integration of chromosomal genes in Streptococcus pneumoniae

    SciTech Connect

    Mannarelli, B.M.; Lacks, S.A.

    1984-12-01

    When a DNA fragment containing a marker gene was ligated to random chromosomal fragments of Streptococcus pneumoniae and used to transform a recipient strain lacking that gene, the gene was integrated at various locations in the chromosome. Such ectopic integration was demonstrated for the malM gene, and its molecular basis was analyzed with defined donor molecules consisting of ligated fragments containing the malM and sul genes of S. pneumoniae. In a recipient strain deleted in the mal region of its chromosome, these constructs gave Mal/sup +/ transformants in which the malM and sul genes were now linked, with malM located between duplicate sul segments. Ectopic integration was unstable under nonselective conditions; mal(sul) ectopic insertions were lost at a rate of 0.05% per generation. Several possible mechanisms of ectopic integration were examined. The donor molecule is most likely to be a circular form of ligated homologous and nonhomologous fragments that, after entry into the cell, undergoes circular synapsis with the recipient chromosome at the site of homology, followed by repair and additive integration.

  17. Laparoscope resection of retroperitoneal ectopic insulinoma: A rare case

    PubMed Central

    Liu, Jie; Zhang, Cheng-Wu; Hong, De-Fei; Wu, Jia; Yang, Hong-Guo; Chen, Yuan; Zhao, Da-Jian; Zhang, Yu-Hua

    2015-01-01

    Ectopic insulinoma is a very rare and dormant tumor. Here we report the case of a 79-year-old female who presented with repeated episodes of hypoglycemia and was diagnosed with insulinoma based on laboratory and imaging examinations. Computed tomography and positron emission tomography revealed a tumor in the retroperitoneum under and left of the hepatoduodenal ligament, which was resected successfully using a laparoscopic approach. Pathologic results revealed an ectopic insulinoma, which was confirmed immunohistochemically. Ectopic insulinomas are accompanied by hypoglycemia that can be misdiagnosed as drug- or disease-induced. These tumors are difficult to diagnose and locate, particularly in atypical cases or for very small tumors. Synthetic or targeted examinations, including low blood glucose, elevated insulin, proinsulin, and C-peptide levels, 48-h fasting tests, and relevant imaging methods should be considered for suspected cases of insulinoma. Surgery is the treatment of choice for patients with insulinoma, and laparoscopic resection is a feasible and effective method for select ectopic insulinoma cases. PMID:25892896

  18. /sup 123/I-metaiodobenzylguanidine scintigraphy of ectopic intracranial retinoblastoma

    SciTech Connect

    Bomanji, J.; Kingston, J.E.; Hungerford, J.L.; Britton, K.E.

    1989-01-01

    Radioiodinated metaiodobenzylguanidine (MIBG) has been used for diagnostic purposes to image neural crest tumors. We report the uptake of /sup 123/I MIBG in a child with ectopic intracranial retinoblastoma. It is felt that /sup 123/I MIBG scintigraphy may have a role in detecting occult metastatic disease in these patients.

  19. Ciprofloxacin and Pregnancy

    MedlinePLUS

    ... Ciprofloxacin for multiresistant enteric fever in pregnancy. The Lancet 346:307-308. Leung D, et al. 1995. Treatment of typhoid in pregnancy. The Lancet 346:648. Loebstein R, et al. 1998. Pregnancy ...

  20. Anemia and Pregnancy

    MedlinePLUS

    ... For Patients Blood Disorders Anemia Anemia and Pregnancy Anemia & Pregnancy Your body goes through significant changes when ... becoming anemic. back to top Is Pregnancy-Related Anemia Preventable? Good nutrition is the best way to ...

  1. Perineal Massage in Pregnancy

    MedlinePLUS

    PERINEAL MASSAGE IN PREGNANCY S HARE W ITH W OMEN PERINEAL MASSAGE IN PREGNANCY What Is My Perineum? Your perineum ... research studies. Several studies have found that perineal massage during the last weeks of pregnancy can reduce ...

  2. Pregnancy and Thyroid Disease

    MedlinePLUS

    ... Disease Organizations (PDF, 269 KB). Alternate Language URL Pregnancy and Thyroid Disease Page Content On this page: ... responds by decreasing TSH production. [ Top ] How does pregnancy normally affect thyroid function? Two pregnancy-related hormones ...

  3. Cystic Fibrosis and Pregnancy

    MedlinePLUS

    ... Preterm labor and premature birth Lead and pregnancy Zika virus and pregnancy Microcephaly Medicine safety and pregnancy Prescription ... Disparities March of Dimes Plan Aims to Make United States a Leader in Preterm Birth Prevention March of ...

  4. Pregnancy and Healthy Weight

    MedlinePLUS

    ... and during pregnancy can reduce the likelihood of negative effects for mothers and babies We’ve heard ... that prepregnancy weight and pregnancy weight gain can impact not only pregnancy outcomes for mother and baby, ...

  5. Folic Acid and Pregnancy

    MedlinePLUS

    ... Kids Deal With Bullies Pregnant? What to Expect Folic Acid and Pregnancy KidsHealth > Parents > Pregnancy & Newborn Center > Your ... especially before conception and during early pregnancy . About Folic Acid Folic acid, sometimes called folate, is a B ...

  6. Updates in abdominal wall management.

    PubMed

    Hope, W W; Williams, Z

    2015-10-01

    The field of abdominal wall hernia surgery continues to evolve at a rapid pace. Surgeons dealing with abdominal wall hernias must constantly stay abreast as new biomaterials and surgical techniques evolve. Increasing knowledge related to hernia formation and factors affecting outcomes will help surgeons prevent hernias and individualize hernia repair techniques and biomaterials based on specific clinical situations and patient characteristics. This review outlines some new advances in abdominal wall hernia management focusing on hernia prevention, preoperative strategies to improve outcomes, available biomaterials and mesh products used in hernia repair, new surgical techniques, and improving ways to evaluate outcomes and perform continuous quality improvement in hernia repair. PMID:26149522

  7. Acute incarcerated external abdominal hernia

    PubMed Central

    Yang, Xue-Fei

    2014-01-01

    External abdominal hernia occurs when abdominal organs or tissues leave their normal anatomic site and protrude outside the skin through the congenital or acquired weakness, defects or holes on the abdominal wall, including inguinal hernia, umbilical hernia, femoral hernia and so on. Acute incarcerated hernia is a common surgical emergency. With advances in minimally invasive devices and techniques, the diagnosis and treatment have witnessed major changes, such as the use of laparoscopic surgery in some cases to achieve minimally invasive treatment. However, strict adherence to the indications and contraindications is still required. PMID:25489584

  8. Abdominal aortic feminism.

    PubMed

    Mortimer, Alice Emily

    2014-01-01

    A 79-year-old woman presented to a private medical practice 2 years previously for an elective ultrasound screening scan. This imaging provided the evidence for a diagnosis of an abdominal aortic aneurysm (AAA) to be made. Despite having a number of recognised risk factors for an AAA, her general practitioner at the time did not follow the guidance set out by the private medical professional, that is, to refer the patient to a vascular specialist to be entered into a surveillance programme and surgically evaluated. The patient became symptomatic with her AAA, was admitted to hospital and found to have a tender, symptomatic, 6 cm leaking AAA. She consented for an emergency open AAA repair within a few hours of being admitted to hospital, despite the 50% perioperative mortality risk. The patient spent 4 days in intensive care where she recovered well. She was discharged after a 12 day hospital stay but unfortunately passed away shortly after her discharge from a previously undiagnosed gastric cancer. PMID:25398912

  9. CT of abdominal tuberculosis.

    PubMed

    Epstein, B M; Mann, J H

    1982-11-01

    Intraabdominal tuberculosis (TB) presents with a wide variety of clinical and radiologic features. Besides the reported computed tomographic (CT) finding of high-density ascites in tuberculous peritonitis, this report describes additional CT features highly suggestive of abdominal tuberculosis in eight cases: (1)irregular soft-tissue densities in the omental area; (2) low-density masses surrounded by thick solid rims; (3) a disorganized appearance of soft-tissue densities, fluid, and bowel loops forming a disorganized appearance of soft-tissue densities, fluid, and bowel loops forming a poorly defined mass; (4) low-density lymph nodes with a multilocular appearance after intravenous contrast administration; and (5) possibly high-density ascites. The differential diagnosis of these features include lymphoma, various forms of peritonitis, peritoneal carcinomatosis, and peritoneal mesothelioma. It is important that the CT features of intraabdominal tuberculosis be recognized in order that laparotomy be avoided and less invasive procedures (e.g., laparoscopy, biopsy, or a trail of antituberculous therapy) be instituted. PMID:6981966

  10. Metastatic Colorectal Cancer Resembling Severe Preeclampsia in Pregnancy.

    PubMed

    Khangura, Raminder Kaur; Khangura, Charanpreet Kaur; Desai, Anagha; Goyert, Gregory; Sangha, Roopina

    2015-01-01

    Although colorectal cancer (CRC) is the third most common cancer in women, it is a rare malignancy in pregnancy. Symptoms of CRC such as fatigue, malaise, nausea, vomiting, rectal bleeding, anemia, altered bowel habits, and abdominal mass are often considered typical symptoms of pregnancy. Many cases of CRC are diagnosed in advanced stages due to missed warning signs of CRC, which may be misinterpreted as normal symptoms related to pregnancy. This report reviews 2 cases of CRC diagnosed within a 4-month interval at our institution. Both cases were initially thought to be atypical presentations of preeclampsia. Prenatal history, hospital course, and postpartum course were reviewed for both patients. CRC is often diagnosed at advanced stages in pregnancy. Common physiological symptoms of pregnancy should be scrutinized carefully and worked up appropriately, especially if symptoms remain persistent or increase in intensity or severity. PMID:26770850

  11. Metastatic Colorectal Cancer Resembling Severe Preeclampsia in Pregnancy

    PubMed Central

    Khangura, Raminder Kaur; Khangura, Charanpreet Kaur; Desai, Anagha; Goyert, Gregory; Sangha, Roopina

    2015-01-01

    Although colorectal cancer (CRC) is the third most common cancer in women, it is a rare malignancy in pregnancy. Symptoms of CRC such as fatigue, malaise, nausea, vomiting, rectal bleeding, anemia, altered bowel habits, and abdominal mass are often considered typical symptoms of pregnancy. Many cases of CRC are diagnosed in advanced stages due to missed warning signs of CRC, which may be misinterpreted as normal symptoms related to pregnancy. This report reviews 2 cases of CRC diagnosed within a 4-month interval at our institution. Both cases were initially thought to be atypical presentations of preeclampsia. Prenatal history, hospital course, and postpartum course were reviewed for both patients. CRC is often diagnosed at advanced stages in pregnancy. Common physiological symptoms of pregnancy should be scrutinized carefully and worked up appropriately, especially if symptoms remain persistent or increase in intensity or severity. PMID:26770850

  12. Functional Abdominal Pain in Children

    MedlinePLUS

    ... psychological state. The pain may interfere with school attendance, participation in sports and other extra-curricular activities. ... cause for abdominal pain is discovered during the evaluation, the physician will discuss specific management of conditions ...

  13. Simulated spaceflight effects on mating and pregnancy of rats

    NASA Technical Reports Server (NTRS)

    Sabelman, E. E.; Chetirkin, P. V.; Howard, R. M.

    1981-01-01

    The mating of rats was studied to determine the effects of: simulated reentry stresses at known stages of pregnancy, and full flight simulation, consisting of sequential launch stresses, group housing, mating opportunity, diet, simulated reentry, and postreentry isolation of male and female rats. Uterine contents, adrenal mass and abdominal fat as a proportion of body mass, duration of pregnancy, and number and sex of offspring were studied. It is found that: (1) parturition following full flight simulation was delayed relative to that of controls; (2) litter size was reduced and resorptions increased compared with previous matings in the same group of animals; and (3) abdominal fat was highly elevated in animals that were fed the Soviet paste diet. It is suggested that the combined effects of diet, stress, spacecraft environment, and weightlessness decreased the probability of mating or of viable pregnancies in the Cosmos 1129 flight and control animals.

  14. [Surgery of ectopic ureterocele in children: strategy based on prenatal function].

    PubMed

    Encinas Goenechea, A; Gómez Fraile, A; Aransay Bramtot, A; López Vázquez, F; Matute de Cárdenas, J A

    1995-07-01

    From 1981 to 1993, we have treated 31 pediatric patients with ectopic ureterocele (associated to duplex system, intra and extravesicals). Diagnostic work-up included abdominal ultrasound, intravenous urography (IVU), sequence mictional cystouretrography (SM-CU) and diuresis renography (DTPA-DMSA o MAG-3). Patients were divided in two groups: 1. Good renal function in the affected system (5 cases) with 2 endoscopic incision of the ureterocele and 3 without surgical treatment (all intravesical). 2. Almost non-existent ipsilateral renal function (26 cases), treated by heminephrectomy and ureterocelic aspiration, and in the remaining a nephrectomy was done for ipsilateral non-existent renal function. 2 cases treated by endoscopic incision presented vesicoureteral reflux, and 4 cases treated by nephrectomy had a low grade reflux. There is no a definite treatment established. The choice should by made based on renal function. Endoscopic incision is a good choice in obstructed cases with good renal function. In those with no function at all, heminephrectomy with aspiration of the ureterocele will be the best treatment if we consider that almost 50 percent of the patients will need a second surgical procedure. PMID:8527314

  15. Transient diabetes insipidus in pregnancy

    PubMed Central

    Gunawardana, Kavinga; Grossman, Ashley

    2015-01-01

    Summary Gestational diabetes insipidus (DI) is a rare complication of pregnancy, usually developing in the third trimester and remitting spontaneously 46 weeks post-partum. It is mainly caused by excessive vasopressinase activity, an enzyme expressed by placental trophoblasts which metabolises arginine vasopressin (AVP). Its diagnosis is challenging, and the treatment requires desmopressin. A 38-year-old Chinese woman was referred in the 37th week of her first single-gestation due to polyuria, nocturia and polydipsia. She was known to have gestational diabetes mellitus diagnosed in the second trimester, well-controlled with diet. Her medical history was unremarkable. Physical examination demonstrated decreased skin turgor; her blood pressure was 102/63?mmHg, heart rate 78?beats/min and weight 53?kg (BMI 22.6?kg/m2). Laboratory data revealed low urine osmolality 89?mOsmol/kg (3501000), serum osmolality 293?mOsmol/kg (278295), serum sodium 144?mmol/l (135145), potassium 4.1?mmol/l (3.55.0), urea 2.2?mmol/l (2.56.7), glucose 3.5?mmol/l and HbA1c 5.3%. Bilirubin, alanine transaminase, alkaline phosphatase and full blood count were normal. The patient was started on desmopressin with improvement in her symptoms, and normalisation of serum and urine osmolality (280 and 310?mOsmol/kg respectively). A fetus was delivered at the 39th week without major problems. After delivery, desmopressin was stopped and she had no further evidence of polyuria, polydipsia or nocturia. Her sodium, serum/urine osmolality at 12-weeks post-partum were normal. A pituitary magnetic resonance imaging (MRI) revealed the neurohypophyseal T1-bright spot situated ectopically, with a normal adenohypophysis and infundibulum. She remains clinically well, currently breastfeeding, and off all medication. This case illustrates some challenges in the diagnosis and management of transient gestational DI. Learning points Gestational DI is a rare complication of pregnancy occurring in two to four out of 100?000 pregnancies. It usually develops at the end of the second or third trimester of pregnancy and remits spontaneously 46 weeks after delivery. Gestational DI occurrence is related to excessive vasopressinase activity, an enzyme expressed by placental trophoblasts during pregnancy, which metabolises AVP. Its activity is proportional to the placental weight, explaining the higher vasopressinase activity in third trimester or in multiple pregnancies. Vasopressinase is metabolised by the liver, which most likely explains its higher concentrations in pregnant women with hepatic dysfunction, such acute fatty liver of pregnancy, HELLP syndrome, hepatitis and cirrhosis. Therefore, it is important to assess liver function in patients with gestational DI, and to be aware of the risk of DI in pregnant women with liver disease. Serum and urine osmolality are essential for the diagnosis, but other tests such as serum sodium, glucose, urea, creatinine, liver function may be informative. The water deprivation test is normally not recommended during pregnancy because it may lead to significant dehydration, but a pituitary MRI should be performed at some point to exclude lesions in the hypothalamo-pituitary region. These patients should be monitored for vital signs, fluid balance, body weight, fetal status, renal and liver function, and treated with desmopressin. The recommended doses are similar or slightly higher than those recommended for central DI in non-pregnant women, and should be titrated individually. PMID:26524979

  16. Teenage pregnancy.

    PubMed

    Block, R W; Saltzman, S; Block, S A

    1981-01-01

    The pediatrician's role in teenage pregnancy is multifaceted. The problem is a sociologic phenomenon with medical consequences. The pregnant teenager actually represents three patients: the mother, the baby, and the adolescent herself. Prepregnancy nutrition can be improved through pediatric education and advice. Sex education can be improved through the advocacy of pediatricians, who can discuss postponing parenthood until the end of adolescence with many of their patients. Services to prevent pregnancy can be offered by pediatricians. Unfortunately, in Oklahoma it is illegal to dispense contraceptives to minors without parental consent. Pediatricians should work to gain acceptance of laws modeled after the American Academy of Pediatrics' health care for minors policy. Lastly, support services to promote proper parenthood and establishment of families can be developed with pediatric input. The entire problem must be viewed in the context of current social patterns, an understanding of adolescent development, the significance of peer pressures, and the biological changes that make it possible for children to bear children. PMID:7041565

  17. The effect of trombophilia on pregnancy outcome and IVF success.

    PubMed

    Goldstajn, Marina Sprem; Kovacevi?, Daria

    2014-12-01

    Thrombophilia is a group of inherited and acquired coagulation disorders often associated with an increased risk of thrombosis. Over the last decade, inherited thrombophilia is often referred as a possible cause of recurrent miscarriages and in vitro fertilisation (IVF) failure. However, many studies in this area still give conflicting results, so the goal of our study was to determine the effect of thrombophilia on pregnancy outcome and success of IVF. The study included 38 patients with proven gene mutation for thrombophilia and 53patients without mutations. The studied parameters were age, duration of infertility, dose of gonadotropins, duration of stimulation, number of embryo transfer (ET), number of oocytes retrieved, the number of days to ET and the outcome in terms of delivery (full term or premature), ectopic pregnancy or abortion. There was no significant difference between two groups in the number of procedures performed, the number of twin pregnancies, abortions, twin miscarriages, ectopic pregnancies, births and the etiology of infertility. A statistically significant difference was found in the number of pregnancies (p=0.018) and in duration of infertility which was signifi- cantly longer in the group with thrombophilia (p<0.001). The number of abortions in homozygous PAI-1 was significantly more common (p=0.012). Procedures in natural cycle were significantly more frequent in group with thrombophila (p=0.011), so we recommend in patients with proven mutation first to start with procedures in the natural cycle, and only in case of failure to use the possibility of stimulating cycles. In conclusion, in patients on anticoagulant therapy a higher percentage of IVF failure has not been proven. Therefore, we strongly recommend the prophylactic use of low molecular weight heparin during pregnancy and screening for the most common mutations in our population, particularly in patients with a history of IVF failure and those with a long duration of infertility. PMID:25842749

  18. Abdominal emergencies in the geriatric patient

    PubMed Central

    2014-01-01

    Abdominal pain is one of the most frequent reasons that elderly people visit the emergency department (ED). In this article, we review the deadliest causes of abdominal pain in this population, including mesenteric ischemia, abdominal aortic aneurysm, and appendicitis and potentially lethal non-abdominal causes. We also highlight the pitfalls in diagnosing, or rather misdiagnosing, these clinical entities. PMID:25635203

  19. A stubborn anemia caused by ectopic pancreas bleeding in the jejunum revealed by capsule endoscopy

    PubMed Central

    Wang, Qun-Ying; Yang, Xiao-Yun

    2015-01-01

    Ectopic pancreas is extremely rare in clinical setting. Meanwhile, a stubborn anemia without obvious dark bloody stool due to ectopic pancreas diagnosed by capsule endoscopy has not been reported. We reported a case of an ectopic pancreas inducing obscure gastrointestinal bleeding in a 70-year-old woman presenting as stubborn anemia, which was diagnosed by capsule endoscopy. The patient recovered well after resection the lesion. Diagnosis of ectopic pancreas is extremely difficult with conventional techniques. Endoscopists should pay more attention to the ectopic pancreas as a rare differential consideration for occult intestinal bleeding. PMID:26682148

  20. Ectopic Liver Tissue on the Gallbladder: An Incidental Mass in Laparoscopy.

    PubMed

    Karaca, Gkhan; zden, Hseyin; Pehlivanl?, Faruk; Pekcici, M Recep; Y?ld?r?m, Ye?im

    2016-01-01

    Ectopic liver is a rare developmental abnormality. It is often asymptomatic and could be determined during the surgery. AIthough it could be detected in different areas of the body either below or above of the diaphragm, ectopic liver is usually found on the wall of the gallbladder. The importance of the ectopic liver came from the elevated risk of development of hepatocellulary carcinoma from ectopic tissue. Ectopic liver tissue could also mimic malign masses in radiographic studies. Ultrasound-guided percutaneous biopsies could be helpful for preoperative diagnosis. Recently, widespread usage of laparoscopic techniques caused an increase on the description of ectopic liver tissues located on the gallbladder. Due to the potential risk of developing malignancy the resection of the mass should be the preferred approach for an incidentally or intraoperatively diagnosed ectopic liver tissue. PMID:26702754

  1. Teenage Pregnancy

    PubMed Central

    Wolfish, Martin G.

    1984-01-01

    More liberal teenage behavior has made pregnancy in this age group an important issue. Live births to adolescent mothers have decreased, while therapeutic abortions for this age group have increased by 27.9% in Canada. The obstetrical and psychosocial risks of the pregnant teenager are related more to inadequate care than to her age. There is a higher perinatal mortality rate among infants born of teenaged mothers. Risk of abuse, neglect, or developmental delay is mitigated by family and societal support. Management of the pregnant adolescent is multi-faceted. She needs nutritional counselling, optimal antenatal and obstetrical care, and access to continuing education or job training. After the child is born, follow up should be directed towards health care, nutrition, education, employment, financial counselling or support, and family and community support. PMID:21279043

  2. Pregnancy and Fifth Disease

    MedlinePLUS

    ... B19 and Other Illnesses References Pregnancy and Fifth Disease Recommend on Facebook Tweet Share Compartir On this Page Testing for Parvovirus B19 during Pregnancy Monitoring Parvovirus B19 Infection during Pregnancy Fifth Disease Outbreaks in the Workplace & Pregnancy Fifth disease is ...

  3. The intricate role of mast cell proteases and the annexin A1-FPR1 system in abdominal wall endometriosis.

    PubMed

    Paula, Rubens; Oliani, Antonio H; Vaz-Oliani, Denise C M; D'Ávila, Solange C G P; Oliani, Sonia M; Gil, Cristiane D

    2015-02-01

    Endometriosis is a continuous and progressive disease with a poorly understood aetiology, pathophysiology and natural history. This study evaluated the histological differences between eutopic and ectopic endometria (abdominal wall endometriosis) and the expression of mast cell proteases (tryptase and chymase), annexin A1 (ANXA1) and formyl peptide receptor 1 (FPR1). Ectopic endometrium from 18 women with abdominal wall endometriosis and eutopic endometrium from 10 women without endometriosis were obtained. The endometrial samples were analysed by histopathology, immunohistochemistry and ultrastructural immunogold labeling to determine mast cell heterogeneity (tryptase and chymase positive cells) and the expression levels of ANXA1 and FPR1. Histopathological analysis of the endometriotic lesions showed a glandular pattern of mixed differentiation and an undifferentiated morphology with a significant influx of inflammatory cells and a change in mast cell heterogeneity, as evidenced by a significant increase in the number of chymase-positive cells and endogenous chymase expression. The undifferentiated glandular pattern of endometriotic lesions was positively associated with a marked increase and co-localization of ANXA1 and FPR1 in the epithelial cells. In conclusion, the co-upregulated expression of mast cell chymase and ANXA1-FPR1 system in ectopic endometrium suggests their involvement in the development of endometriotic lesions. PMID:25201101

  4. Ectopic eruption of permanent incisors after predecessor pulpectomy: five cases.

    PubMed

    Tannure, Patricia Nivoloni; Fidalgo, Tatiana Kelly da Silva; Barcelos, Roberta; Gleiser, Rogerio; Primo, Laura Guimaraes

    2011-01-01

    Pulpectomy in primary teeth is a common technique that preserves teeth in the oral environment and maintains or recovers periapical tissues to a healthy condition. This article describes the ectopic eruption of permanent incisors whose primary predecessors underwent pulpectomy using ZOE filler paste. In a group of 135 teeth that received pulpectomy therapy due to caries, 10 primary maxillary incisors had overretention and were followed for at least 3.5 years (mean time of 4.2 years), both clinically and radiographically, until the permanent teeth erupted. The proposed treatment included extraction of the overretained primary incisors based on permanent successor eruption chronology and contralateral eruption. Seven permanent teeth erupted ectopically. Autocorrection of the permanent tooth positions was observed in five cases. It can be concluded that periodic clinical and radiographic assessments are essential to verify radicular and filling paste resorptions and to avoid overretention and any subsequent malocclusion. PMID:21903556

  5. Ectopic internal carotid artery presenting as an oropharyngeal mass

    PubMed Central

    Prokopakis, Emmanuel P; Bourolias, Constantinos A; Bizaki, Argyro J; Karampekios, Spyros K; Velegrakis, George A; Bizakis, John G

    2008-01-01

    Ectopic internal carotid artery (ICA) is a very rare variation. The major congenital abnormalities of the ICA can be classified as agenesis, aplasia and hypoplasia, and they can be unilateral or bilateral. Anomalies of the neck artery may be vascular neoplasms or ectopic position. Carotid angiograms provide absolute confirmation of an aberrant carotid artery, while EcoColorDoppler (ECD) gives also important information about the evaluation of carotid vassels. Nevertheless Computed Tomography (CT) and Magnetic Resonance Imaging (MRI) of the neck provide spatial information about the adjacent pharyngeal anatomy and are less invasive than angiogram. Injuries to the ICA during simple pharyngeal surgical procedures can be catastrophic due to the risk of massive bleeding. We report a case of a 56 year-old male patient suffering from dysphagia associated with aberrant ICA manifesting itself as a pulsative protruding of the left lateral wall of the oropharynx. PMID:18727830

  6. Mifepristone Improves Octreotide Efficacy in Resistant Ectopic Cushing's Syndrome

    PubMed Central

    Moraitis, Andreas G.; Auchus, Richard J.

    2016-01-01

    A 30-year-old Caucasian man presented with severe Cushing's syndrome (CS) resulting from ectopic adrenocorticotropin syndrome (EAS) from a metastatic pancreatic neuroendocrine tumor. The patient remained hypercortisolemic despite treatment with steroidogenesis inhibitors, chemotherapy, and octreotide long-acting release (LAR) and was enrolled in a 24-week, phase 3 clinical trial of mifepristone for inoperable hypercortisolemia. After mifepristone was added to ongoing octreotide LAR treatment, EAS symptoms essentially resolved. Cortisol decreased dramatically, despite mifepristone's competitive glucocorticoid receptor antagonist effects. The clinical and biochemical effects reversed upon mifepristone discontinuation despite the continued use of octreotide LAR therapy. Substantial improvement in octreotide LAR efficacy with mifepristone use was noted in this patient with ectopic CS, consistent with upregulation of somatostatin receptors previously downregulated by hypercortisolemia. PMID:26989527

  7. Management of Class II malocclusion with ectopic maxillary canines

    PubMed Central

    Mascarenhas, Rohan; Parveen, Shahista; Ansari, Tariq Aziz

    2015-01-01

    Correction of Class II relationship, deep bite and ectopically erupting canines is an orthodontic challenge for the clinician. A 13-year-old male patient presented with Class II malocclusion, ectopically erupting canines, and cross bite with maxillary left lateral incisor. He was treated with a combination of Headgear, Forsus fatigue resistant device [FFRD] with fixed mechanotherapy for the management of space deficiency and correction of Class II malocclusions. Headgear was used to distalize upper first molars and also to prevent further downward and forward growth of the maxilla. Then Forsus FFRD was used for the advancement of the mandible. The molar and canine relationship were corrected from a Class II to a Class I. The objectives were to establish good occlusion and enable eruption of unerupted canines. All these objectives were achieved and remained stable. PMID:26097371

  8. Ectopic 3rd molar tooth in the maxillary antrum.

    PubMed

    Bello, Seidu A; Oketade, Ifeoluwa O; Osunde, Otasowie D

    2014-01-01

    Location of ectopic tooth in a nondentate area like the maxillary antrum is rare. A 17-year-old boy, with one year history of recurrent right facial swelling and radiographic finding of a maxillary third molar tooth located at the posterior wall of the maxillary antrum, is presented. Under endotracheal intubation, the tooth was extracted through a Caldwell-Luc antrostomy approach and patient had an uneventful recovery and has been symptom free for eight months. Ectopic tooth in the maxillary antrum is rare and is commonest with maxillary third molar. It may be symptomless but is more commonly associated with inflammatory symptoms. The treatment of choice is surgical excision which is mostly carried out with Caldwell-Luc approach, even though endoscopic approach is being reported. PMID:25132999

  9. Rates and outcome of pregnancies achieved in the first 4 years of an in-vitro fertilization program.

    PubMed Central

    Yuzpe, A A; Brown, S E; Casper, R F; Nisker, J A; Graves, G

    1989-01-01

    Between Feb. 1, 1984, and Dec. 31, 1987, 578 couples were treated in the in-vitro fertilization (IVF) program at University Hospital, London, Ont. The 160 confirmed pregnancies resulted in 86 deliveries and the birth of 108 babies. There were 20 spontaneous abortions, 12 ectopic pregnancies, 11 presumptive pregnancies, 4 neonatal deaths and 1 stillbirth. At the time of writing, 41 pregnancies of 20 weeks' gestation or more were in progress. Except for a high cesarean section rate the obstetric outcome of pregnancies achieved with IVF does not appear to be different from that expected for a group of infertile couples treated with conventional therapies. The pregnancy rates varied according to the denominator used. PMID:2910399

  10. [Pregnancy-specific dermatoses].

    PubMed

    Soutou, B; Aractingi, S

    2015-03-01

    Pregnancy-specific dermatoses include polymorphic eruption of pregnancy, atopic eczema of pregnancy, and pemphigoid gestationis. Intrahepatic cholestasis of pregnancy and impetigo herpetiformis are not real pregnancy-specific dermatoses but they are important to know considering the fetal and maternal risks. Polymorphic eruption of pregnancy is a pruritic disease that usually occurs in primiparous women during the last trimester of pregnancy. Atopic eczema of pregnancy is still controversial as an entity covering conditions with eczematous lesions, prurigo, or folliculitis, and inconstantly associated with a personal history of atopy. Skin biopsy with direct immunofluorescence or search for serum anti-BPAg1 (180kD) NC16a antibodies is mandatory in pruritic dermatoses of pregnancy in order to rule out pemphigoid gestationis. Serum bile salts levels should be tested whenever a generalized pruritus develops during pregnancy in order to rule out intrahepatic cholestasis. PMID:25194221

  11. Ectopic thyroid tissue on thallium/technetium parathyroid scan

    SciTech Connect

    Asp, A.; Hasbargen, J.; Blue, P.; Kidd, G.S.

    1987-03-01

    The thallium 201/technetium 99m pertechnetate radionuclide study is becoming widely accepted as a means of localizing abnormal or aberrantly located parathyroid tissue. We describe a case in which ectopic retrosternal thyroid tissue appeared as a parathyroid adenoma on thallium-201/technetium-99m pertechnetate scan. Physicians who use this radionuclide study should be aware of the possibility of false-positive images within the mediastinum.

  12. Ectopic banking of amputated parts: a clinical review.

    PubMed

    Higgins, James P

    2011-11-01

    Since its first clinical description by Marco Godina in 1986, the technique of temporary ectopic banking of amputated parts has been employed in a growing body of reported cases. This installment provides a review of the reported cases in the international literature to date, focusing on our evolving understanding of clinical indications, operative timing, and surgical technical consideration. Two illustrative cases are provided to highlight these concepts. PMID:22036286

  13. A Challenging Case of an Ectopic Cushing Syndrome

    PubMed Central

    Menezes Nunes, Joana; Camões, Isabel; Maciel, João; Cabral Bastos, Pedro; Souto de Moura, Conceição; Bettencourt, Paulo

    2014-01-01

    Bronchopulmonary carcinoids are rare pulmonary neoplasms although they account for most cases of ectopic ACTH syndromes. When feasible, the mainstay treatment is surgical resection of the tumor. We report the case of a 52-year-old woman with signs and symptoms suggestive of hypercortisolism for 12 months, admitted to our department because of community acquired pneumonia. Blood hormone analysis showed increased levels of ACTH and urinary free cortisol and nonsuppressibility to high- and low-dose dexamethasone tests. Pituitary MRI showed no lesion and no central-to-peripheral ACTH gradient was present in bilateral inferior petrosal sinus sampling. CRH stimulation test suggested an ectopic ACTH source. Thoracic CT scan revealed a nodular region measuring 12 mm located in the inferior lingular lobule of the left superior lung with negative uptake by 18-FDG-PET scan and negative SRS. The patient was successfully treated with an atypical lung resection and histology revealed an atypical bronchial carcinoid tumor with positive ACTH immunoreactivity. This was an interesting case because the patient was admitted due to pneumonia that may have been associated with her untreated and chronic hypercortisolism and a challenging case of ectopic ACTH syndrome due to conflicting results on the diagnostic exams. PMID:25431598

  14. A case of gallbladder cancer combined with ectopic individual opening of pancreatic and bile ducts to the duodenal bulb

    PubMed Central

    Lee, Woohyung; Park, Ji-Ho; Kim, Ju-Yeon; Kwag, Seung-Jin; Park, Taejin; Jeong, Sang-Ho; Ju, Young-Tae; Jung, Eun-Jung; Lee, Young-Joon; Choi, Sang-Kyung; Hong, Soon-Chan

    2015-01-01

    Ectopic opening of the pancreatic and bile ducts (EOPBD) into the duodenal bulb is an extremely rare congenital anomaly with unknown clinical implications. We presented a case of gallbladder cancer with EOPBD into the duodenal bulb. A 57-year-old male was referred to our hospital with intermittent right upper abdominal pain. Endoscopic retrograde cholangiopancreatography and magnetic resonance cholangiopancreatography showed individual EOPBD into the duodenal bulb with no papillary structure, and a focal nodular lesion in the gallbladder. A follow-up abdominal computed tomography scan 9 months later revealed a slight increase in the size of the fundal nodule, which was suspected as gallbladder cancer. An intraoperative frozen biopsy identified the nodular lesion as adenocarcinoma involving the cystic duct, and the patient underwent radical cholecystectomy including bile duct resection with hepaticojejunostomy. EOPBD is an extremely rare condition that can be associated with gallbladder malignancy as well as benign disease. Clinicians should follow up carefully and consider surgical treatment for suspected malignant lesions. PMID:26379734

  15. Abdominal Hysterectomy (Beyond the Basics)

    MedlinePLUS

    ... occur in up to one-third of all women. Fibroids may become larger during pregnancy, and typically shrink after menopause. They may cause ... Basics) Patient information: Endometriosis (The Basics) Patient ... (The Basics) Patient information: Uterine adenomyosis (The Basics) ...

  16. Abdominal aortic aneurysm repair.

    PubMed

    Cruz, C P; Drouilhet, J C; Southern, F N; Eidt, J F; Barnes, R W; Moursi, M M

    2001-01-01

    Newer, minimally invasive catheter-based endovascular technology utilizing stent grafts are currently being evaluated for abdominal aortic aneurysm (AAA) repair. A retrospective review of all (3 years) consecutive, non-ruptured elective AAA repairs was undertaken to document the results of AAA surgical repair in a modern cohort of patients to allow a contemporary comparison with the evolving endoluminal data. One hundred twenty-one AAAs were identified in a male veteran population. Mean age was 68.5 +/-7.7 years. Medical history review showed hypertension in 55%, heart disease in 73.5%, peripheral vascular disease in 21%, stroke and transient ischemic attacks in 22%, diabetes mellitus in 7%, renal insufficiency in 10%, and smoking history in 80%. The AAA size was documented with ultrasound (5.2 +/-1.3 cm, n=40) and computed tomography (5.6 +/-1.3 cm, n=100). Fifty-nine percent had angiography. Intraoperative end points included an operative time of 165 +/-6.3 minutes from incision to dressing placement. A Dacron tube graft was used in 78%, the remaining were Dacron bifurcated grafts. A suprarenal clamp was used in 8% for proximal aortic control with juxtarenal aneurysms. A pulmonary-artery catheter was placed in 69%. A transverse incision was used in 69% of patients and a midline incision was used in the rest. Estimated blood loss was 1505 +/-103 mL; cell saver blood returned 754 +/-53 mL; crystalloid/Hespan 4771 +/-176 mL; banked packed red blood cells 0.75 +/-0.11 U. Time to extubation was, in the operating room (78.5%), on the day of the operation (5.0%), postoperative day (POD) 1 (12.4%), POD2 (1.7%), POD3 (0.8%), and one case was performed with epidural anesthesia only. Postoperative end points included a 30-day mortality rate of 1.6% (two patients). Postoperative morbidity included wound dehiscence 0.8%; sepsis, urinary tract infection, wound infection, leg ischemia, ischemic colitis, and stroke each had an incidence of 1.6%; myocardial infarction, congestive heart failure, pneumonia, re-operation for suspected bleeding, and ileus or bowel obstruction occurred with an incidence of 3.3%. No significant increase in serum creatinine levels was noted. Time to enteral fluids/nutrition was 3.5 +/-0.08 days. Patients were out of bed to a chair or walking by 1.3 +/-0.06 days postoperatively. The length of stay in the intensive care unit (ICU) was 2.0 +/-0.12 days and postoperative hospital stay was 6.6 +/- 0.33 days. Transfusion requirement for the hospital stay was 1.6 +/-0.2 U per patient. This review highlights a cohort of male veteran patients with significant cardiac co-morbidity who have undergone repair with a conventional open technique and low mortality and morbidity rates. This group had rapid extubation, time to oral intake, and ambulation. In addition, ICU and hospital stays were relatively short. PMID:11565037

  17. Abdominal actinomycosis mimicking acute appendicitis.

    PubMed

    Conrad, Robert Joseph; Riela, Steven; Patel, Ravi; Misra, Subhasis

    2015-01-01

    A 52-year-old Hispanic woman presented to the emergency department, reporting worsening sharp lower right quadrant abdominal pain for 3?days. CT of the abdomen and pelvis showed evidence of inflammation in the peritoneal soft tissues adjacent to an enlarged and thick-walled appendix, an appendicolith, no abscess formation and a slightly thickened caecum consistent with acute appendicitis. During laparoscopic appendectomy, the caecum was noted to be firm, raising suspicion of malignancy. Surgical oncology team was consulted and open laparotomy with right hemicolectomy was performed. Pathology reported that the ileocaecal mass was not a malignancy but was, rather, actinomycosis. The patient was discharged after 10?days of intravenous antibiotics in the hospital, with the diagnosis of abdominal actinomycosis. Although the original clinical and radiological findings in this case were highly suggestive of acute appendicitis, abdominal actinomycosis should be in the differential for right lower quadrant pain as it may be treated non-operatively. PMID:26611488

  18. Abdominal radiation causes bacterial translocation

    SciTech Connect

    Guzman-Stein, G.; Bonsack, M.; Liberty, J.; Delaney, J.P.

    1989-02-01

    The purpose of this study was to determine if a single dose of radiation to the rat abdomen leads to bacterial translocation into the mesenteric lymph nodes (MLN). A second issue addressed was whether translocation correlates with anatomic damage to the mucosa. The radiated group (1100 cGy) which received anesthesia also was compared with a control group and a third group which received anesthesia alone but no abdominal radiation. Abdominal radiation lead to 100% positive cultures of MLN between 12 hr and 4 days postradiation. Bacterial translocation was almost nonexistent in the control and anesthesia group. Signs of inflammation and ulceration of the intestinal mucosa were not seen until Day 3 postradiation. Mucosal damage was maximal by Day 4. Bacterial translocation onto the MLN after a single dose of abdominal radiation was not apparently dependent on anatomical, histologic damage of the mucosa.

  19. Ectopic Thyroid Tissue in the Adrenal Gland: A Report of Two Cases with Pathogenetic Implications

    PubMed Central

    Romero-Rojas, Alfredo; Bella-Cueto, Mara Rosa; Meza-Cabrera, Ivonne A.; Cabezuelo-Hernndez, Angeles; Garca-Rojo, Daro; Vargas-Uricoechea, Hernando

    2013-01-01

    Background: Ectopic thyroid tissue is usually found anywhere along the embryonic descent pathway of the medial thyroid anlage from the tongue to the trachea (Wlfler area). However, ectopic thyroid tissue in the adrenal gland (ETTAG) is not easy to understand on the basis of thyroid embryology; because it is so rare, the possibility of metastasis should first be considered. Here, we describe two cases of ETTAG with pathogenetic implications and review the associated literature. Patient findings: Two cases of ETTAG presented as incidental cystic adrenal masses in adult females, one having a congenital hernia of Morgagni. The ETTAG was histologically indistinguishable from normal orthotopic thyroid tissue, and its follicular nature was confirmed by immunohistochemical positivity for thyroglobulin, thyroperoxidase, thyroid transcription factor-1 (TTF-1/Titf-1/Nkx2.1), cytokeratin AE1/AE3, cytokeratin 7, pendrin, human sodium iodide symporter, paired box gene 8, and forkhead box E1 (TTF-2), as well as positivity for the messenger RNA of the thyroglobulin gene by in situ hybridization analysis. No C cells (negativity for calcitonin, chromogranin, and synaptophysin) were present. Neither BRAF nor KRAS mutations were detected with real-time polymerase chain reaction analysis. Further work-up did not show evidence of thyroid malignancy. Summary: ETTAG is a rare finding, with only seven cases reported; women are much more frequently affected than men (8:1), and it usually presents in the fifth decade (mean age 54, range 3867) as a cystic adrenal mass incidentally discovered on abdominal ultrasonography and/or in computed tomography images. ETTAG is composed of normal follicular cells without C cells. The expression of some transcription factors (TTF-1, paired box gene 8, and FOXE1) involved in development and/or migration of the medial thyroid anlage is preserved. Coexistence of a congenital hernia of Morgagni in one patient suggests an overdescent of medial thyroid anlagederived cells in its pathogenesis. Conclusion: Although ETTAG pathogenesis remains unknown, the lack of C cells together with the coexistence of a congenital defect of the anterior diaphragm (hernia of Morgagni) in one of our patients could suggest an overdescent of medial thyroid anlagederived cells in the origin of this heterotopia. PMID:23510370

  20. Abdominal Bloating: Pathophysiology and Treatment

    PubMed Central

    Seo, A Young; Oh, Dong Hyun

    2013-01-01

    Abdominal bloating is a very common and troublesome symptom of all ages, but it has not been fully understood to date. Bloating is usually associated with functional gastrointestinal disorders or organic diseases, but it may also appear alone. The pathophysiology of bloating remains ambiguous, although some evidences support the potential mechanisms, including gut hypersensitivity, impaired gas handling, altered gut microbiota, and abnormal abdominal-phrenic reflexes. Owing to the insufficient understanding of these mechanisms, the available therapeutic options are limited. However, medical treatment with some prokinetics, rifaximin, lubiprostone and linaclotide could be considered in the treatment of bloating. In addition, dietary intervention is important in relieving symptom in patients with bloating. PMID:24199004

  1. Abdominal aortic aneurysms: case report

    PubMed Central

    Hadida, Camille; Rajwani, Moez

    1998-01-01

    A 71-year-old male presented to a chiropractic clinic with subacute low back pain. While the pain appeared to be mechanical in nature, radiographic evaluation revealed an abdominal aortic aneurysm, which required the patient to have vascular surgery. This case report illustrates the importance of the history and physical examination in addition to a thorough knowledge of the features of abdominal aortic aneurysms. The application of spinal manipulative therapy in patients with (AAA) is also discussed. ImagesFigure 1Figure 2Figure 3

  2. Functional abdominal bloating with distention.

    PubMed

    Sullivan, Stephen Norman

    2012-01-01

    Ten to 25% of healthy persons experience bloating. It is particularly common in persons with the irritable bowel syndrome and constipation. While the cause of bloating remains unknown old explanations such as a excessive intestinal gas, exaggerated lumbar lordosis and psychiatric problems have been disproved. New suggestions include recent weight gain, weak or inappropriately relaxed abdominal muscles, an inappropriately contracted diaphragm and retained fluid in loops of distal small bowel. No treatment is of unequivocal benefit but a low FODMAPs diet, probiotics and the non-absorbable antibiotic rifaximin offer some hope. Treatment by weight loss, abdominal exercise, prokinetics and girdles need more study. PMID:22778978

  3. Early Parental and Child Predictors of Recurrent Abdominal Pain at School Age: Results of a Large Population-Based Study

    ERIC Educational Resources Information Center

    Ramchandani, Paul G.; Stein, Alan; Hotopf, Matthew; Wiles, Nicola J.

    2006-01-01

    Objective: To assess whether parental psychological and physical factors and child factors measured in the first year of life were associated with recurrent abdominal pain (RAP) in children at age 6 3/4 years. Method: A longitudinal cohort study (the Avon Longitudinal Study of Parents and Children), followed 8,272 children from pregnancy to age 6

  4. [Asthma and pregnancy].

    PubMed

    Bentaleb, F; Tachinante, R; Tazi, A

    2003-02-01

    Asthma is the most frequent respiratory disorder complicating pregnancy. Diagnosis and evaluation of severity of asthma are unchanged by the presence of pregnancy, but the course of asthma varies: asthma may improve, remain stable, or worsen. Conversely, chronically poor control is associated with pregnancy-induced hypertension, preeclampsia, as well as greater rates of cesarian section, preterm delivery, intrauterine growth retardation, low birth weight, and congenital malformation. Highly-motivated women with well-controlled asthma during pregnancy, can achieve pregnancy outcome as good as their non-asthmatic conterparts. Inhalation therapies remain the cornerstone of treatment; most appear to be safe in pregnancy. PMID:12717323

  5. Genetics Home Reference: Abdominal wall defect

    MedlinePLUS

    ... main types of abdominal wall defects: omphalocele and gastroschisis. Omphalocele is an opening in the center of ... same protective membrane that covers the umbilical cord. Gastroschisis is a defect in the abdominal wall, usually ...

  6. Abdominal pain - children under age 12

    MedlinePLUS

    Stomach pain in children; Pain - abdomen - children; Abdominal cramps in children; Belly ache in children ... When your child complains of abdominal pain, see if they can ... kinds of pain: Generalized pain or pain over more than half ...

  7. The tip of the iceberg: Post caesarean wound dehiscence presenting as abdominal wound sepsis

    PubMed Central

    Bharatam, Kaundinya Kiran; Sivaraja, P.K.; Abineshwar, N.J.; Thiagarajan, Vasundhara; Thiagarajan, D.A.; Bodduluri, Sudeep; Sriraman, K.B.; Vasantha Ragavan, A.; Priya, Shanmuga

    2015-01-01

    Introduction Uterine scar dehiscence can complicate caesarean section with complications like post partum hemorrhage, endomyometritis, localized/generalized peritonitis, and sepsis. Presentation of case Our patient had abdominal wound infection after LSCS surgery and features of sepsis. The wound infection was actually the presentation of a uterine scar dehiscence and localized peritonitis. Discussion Incidence of uterine scar dehiscence is around 0.6%. Presentation can be post partum hemorrhage, endomyometritis, and generalized/localized peritonitis. Peritonitis caused by uterine incisional necrosis must be dealt surgically. A high index of suspicion with appropriate investigations can highlight such problems for early treatment and cure with least morbidity especially related to further pregnancies. Conclusion Uterine scar dehiscence with infection requires high index of suspicion as rare cause for post partum localized/generalized peritonitis with sepsis. Severe abdominal wound infection after caesarean section may be associated with uterine wound dehiscence, which poses a grave risk to the mother in a future pregnancy. PMID:25728672

  8. Treatment of Ectopic Permanent Maxillary First Molar Using a K-loop.

    PubMed

    Nam, Ok Hyung; Ahn, Hyo Jung; Kim, Mi Sun; Park, Jae-Hong

    2015-01-01

    Ectopic eruption of permanent maxillary first molar can cause root resorption of adjacent primary second molar, thus leading to early loss of primary maxillary second molar. Therefore, it is necessary to correct ectopic maxillary first molar. This case report demonstrates that K-loop can be used as a simple, comfortable, and easier method to correct ectopic eruption of permanent maxillary first molar in existing severe root resorption on adjacent primary second molar. PMID:26161613

  9. Successful Non-fluoroscopic Radiofrequency Ablation of Incessant Atrial Tachycardia in a High Risk Twin Pregnancy

    PubMed Central

    Zuberi, Zia; Silberbauer, John; Murgatroyd, Francis

    2014-01-01

    We describe a patient presenting with incessant ectopic atrial tachycardia during a high risk twin pregnancy. Tachycardia was resistant to escalating doses of beta-blockade with digoxin. Because of increasing left ventricular dysfunction early in the third trimester, catheter ablation was performed successfully at 30 weeks gestation. Electro-anatomic mapping permitted the entire procedure to be conducted without the use of ionizing radiation. The pregnancy proceeded to successful delivery near term and after three years the patient remains recurrence free with normal left ventricular function, off all medication. PMID:24493913

  10. Keratocystic Odontogenic Tumor with an Ectopic Tooth in Maxilla

    PubMed Central

    Bhagawati, Basavaraj T.; Gupta, Manish; Narang, Gaurav; Bhagawati, Sharanamma

    2013-01-01

    The term odontogenic keratocyst was first used by Philipsen in the year 1956. The lesion was renamed by him as keratocystic odontogenic tumor (KCOT) and reclassified as odontogenic neoplasm in the World Health Organization's 2005 edition that occurs commonly in the jaws having a predilection for the angle and ascending ramus of mandible. In contrast, KCOTs arising in the maxillary premolar region are relatively rare. Here, we discuss a rare case of keratocystic odontogenic tumor occurring in the maxilla with an ectopic tooth position. PMID:24396609

  11. Case report: nocardia infection associated with ectopic cushings

    PubMed Central

    2014-01-01

    Background Cushings syndrome results from exposure to excess glucocorticoids. Ectopic Cushings is endogenous ACTH dependant form of Cushings associated with markedly raised ACTH and cortisol levels. This leads to an impaired immune response, setting the stage for occurrence of opportunistic infections. Nocardiosis is a gram positive bacterial infection caused by aerobic actinomycetes in genus Nocardia. We report a series of patients diagnosed with ectopic Cushings, having pneumonia with Nocardia spp. In one of these cases, the manifestations of Cushings disappeared with treatment for Nocardia. Case presentation Two middle aged men of Asian descent presented to the Endocrine clinic: the first with history of exertional shortness of breath, and weight loss for 1 year, the other with facial swelling, disturbed sleep and lethargy for a month. The third case was a young Asian male who presented with progressive weakness & weight loss for 2 months. All three patients had uncontrolled hypertension, high blood sugars & were hypokalemic (K: 2.52, 2.9, 1.5mmol/l); 24hour urine cortisol was elevated at 2000, 27216 and 9088 (32-243 ug/24 hours); ACTH 68.5, 159, 255 [048pg/ml), respectively. Their MRI pituitary was normal, inferior petrosal sinus sampling revealed no central peripheral gradient. CT chest of these subjects demonstrated cavitatory lung lesions; microscopic analysis of respiratory samples was suggestive of infection with Nocardia spp. Histopathology of bronchoscopic-guided biopsy revealed no malignancy. Antihypertensives, insulin, potassium replacement, ketoconazole & trimethoprim-sulphamethoxazole (TS) were initiated. The patients symptomatology improved & cavitatory lesions resolved with treatment. The primary source for the ectopic cushings remained unknown. The first case required bilateral adrenalectomy. The second case followed a progressively downhill course leading to death. In the third case, we were able to completely taper off ketoconazole, potassium, insulin & antihypertensives, after starting TS. Conclusion Opportunistic infections are known to be associated with Cushings syndrome, and higher levels of glucocorticoid secretion are found in patients with ectopically produced ACTH. Pulmonary nocardiosis is important differential to consider. This series includes the first case reported in which signs and symptoms of cushings subsided after treatment of Nocardia. PMID:24950706

  12. Pesticides and Pregnancy

    MedlinePLUS

    Pesticides and Pregnancy In every pregnancy, a woman starts out with a 3-5% chance of having ... risk. This sheet talks about whether exposure to pesticides may increase the risk for birth defects over ...

  13. Hair Treatments and Pregnancy

    MedlinePLUS

    Hair Treatments and Pregnancy In every pregnancy, a woman starts out with a 3-5% chance of ... risk. This sheet talks about whether exposure to hair treatments may increase the risk for birth defects ...

  14. Vaginal bleeding in pregnancy

    MedlinePLUS

    Pregnancy - vaginal bleeding; Maternal blood loss ... Up to 1 in 4 women have vaginal bleeding at some time during their pregnancy. Bleeding is more commonin the first 3 months (first trimester), especially with twins.

  15. Eating Right during Pregnancy

    MedlinePLUS

    ... as regular soda, sweets and fried snacks. Key Nutrients for Healthy Pregnancy Folic Acid: Folic acid reduces ... you get enough iron, folic acid and other nutrients. Reviewed November 2015 Tags Health Pregnancy What to ...

  16. Smoking During Pregnancy

    MedlinePLUS

    ... Program Division of Reproductive Health More CDC Sites Smoking During Pregnancy Recommend on Facebook Tweet Share Compartir ... they are born. 1,3 Health Effects of Smoking and Secondhand Smoke on Pregnancies Women who smoke ...

  17. Tetracycline and Pregnancy

    MedlinePLUS

    Tetracycline and Pregnancy In every pregnancy, a woman starts out with a 3-5% chance of having ... risk. This sheet talks about whether exposure to tetracycline may increase the risk for birth defects over ...

  18. Pregnancy Complications: Preexisting Diabetes

    MedlinePLUS

    ... Home > Complications & Loss > Pregnancy complications > Preexisting diabetes Preexisting diabetes Now playing: E-mail to a friend Please ... to help prevent problems like these. Can preexisting diabetes cause problems during pregnancy? Yes. If it’s not ...

  19. Pregnancy Loss and Miscarriage

    MedlinePLUS

    ... pregnancy Trying to conceive soon after a pregnancy loss may increase chances of live birth All related news Home Accessibility Contact Disclaimer Privacy Policy FOIA Facebook Twitter Pinterest YouTube Mobile RSS ...

  20. Immunization and Pregnancy

    MedlinePLUS

    Immunization & Pregnancy Vaccines help keep apregnant woman and her growing family healthy. Vaccine Before pregnancy Hepatitis A ... 232-4636) • English or Spanish National Center for Immunization and Respiratory Diseases Immunization Services Division CS238938B 03/ ...

  1. Chickenpox and Pregnancy

    MedlinePLUS

    ... Baby Arrives Trouble Getting Pregnant Avoiding Pregnancy Articles Chickenpox and Pregnancy Language: English Espaol (Spanish) Recommend on Facebook Tweet Share Compartir Chickenpox, also known as varicella, is an infectious disease. ...

  2. Marijuana and Pregnancy

    MedlinePLUS

    Marijuana and Pregnancy In every pregnancy, a woman starts out with a 3-5% chance of having ... risk. This sheet talks about whether exposure to marijuana may increase the risk for birth defects over ...

  3. Pregnancy and IBD

    MedlinePLUS

    ... should be avoided in the first trimester. THE IMPACT OF SURGERY BEFORE AND DURING PREGNANCY Previous bowel resections do not appear to have any negative effects on pregnancy in women with Crohn’s disease. ...

  4. Pregnancy and Nutrition

    MedlinePLUS

    ... calcium, and folic acid than you did before pregnancy. You also need more calories. But "eating for ... baby. You should gain weight gradually during your pregnancy, with most of the weight gained in the ...

  5. Tumors and Pregnancy

    MedlinePLUS

    Tumors during pregnancy are rare, but they can happen. Tumors can be either benign or malignant. Benign tumors aren't cancer. Malignant ones are. The most common cancers in pregnancy are breast cancer, cervical cancer, lymphoma, and melanoma. ...

  6. Health Problems in Pregnancy

    MedlinePLUS

    Every pregnancy has some risk of problems. The causes can be conditions you already have or conditions you develop. ... pregnant with more than one baby, previous problem pregnancies, or being over age 35. They can affect ...

  7. Folic Acid and Pregnancy

    MedlinePLUS

    ... for Your Child All About Food Allergies Folic Acid and Pregnancy KidsHealth > For Parents > Folic Acid and ... before conception and during early pregnancy . About Folic Acid Folic acid, sometimes called folate, is a B ...

  8. Cytomegalovirus (CMV) and Pregnancy

    MedlinePLUS

    Cytomegalovirus (CMV) and Pregnancy In every pregnancy, a woman starts out with a 3-5% chance of having a ... from your health care provider. What is cytomegalovirus (CMV)? CMV is a common virus that can infect ...

  9. Abdominal cocoon secondary to disseminated tuberculosis.

    PubMed

    Puppala, Radha; Sripathi, Smiti; Kadavigere, Rajagopal; Koteshwar, Prakashini; Singh, Jyoti

    2014-01-01

    Abdominal cocoon, also known as sclerosing encapsulating peritonitis, represents a rare entity where a variable length of the small bowel is enveloped by a fibrocollagenous membrane giving the appearance of a cocoon. It may be asymptomatic and is often diagnosed incidentally at laparotomy. We present a rare case of abdominal cocoon due to abdominal tuberculosis. PMID:25239980

  10. Asthma May Raise Risk for Abdominal Aneurysm

    MedlinePLUS

    ... to be at an increased risk of abdominal aortic aneurysm, a new study suggests. An abdominal aortic aneurysm is a weak spot in the body's main ... those without recent asthma activity. "People with abdominal aortic aneurysm who were diagnosed with asthma within the past ...

  11. [Diagnosis of postpartum abdominal pain: about a rare case of portal vein thrombosis].

    PubMed

    Adrados, C; Trastour, C; Havet, J; Chassang, M; Bongain, A

    2015-01-01

    We report the management of patient with acute abdominal pain in the immediate post-partum caesarean section performed in the context of preeclampsia. Acute portal vein thrombosis is diagnosed, in a patient with no personal or family history of venous thrombosis. Blood tests showed a protein C and S deficiencies. Portal vein thrombosis is an extremely rare occurrence in pregnancy and postpartum. PMID:25242438

  12. Pregnancy and Skin

    PubMed Central

    Vora, Rita V.; Gupta, Rajat; Mehta, Malay J.; Chaudhari, Arvind H.; Pilani, Abhishek P.; Patel, Nidhi

    2014-01-01

    Pregnancy is associated with complex of endocrinological, immunological, metabolic, and vascular changes that may influence the skin and other organs in various ways. Pregnancy is a period in which more than 90% women have significant and complex skin changes that may have great impact on the woman's life. The dermatoses of pregnancy represent a heterogeneous group of skin diseases related to pregnancy and/or the postpartum period. The dermatoses of pregnancy can be classified into the following three groups: Physiologic skin changes in pregnancy, pre-existing dermatoses affected by pregnancy, and specific dermatoses of pregnancy. Though most of these skin dermatoses are benign and resolve in postpartum period, a few can risk fetal life and require antenatal surveillance. Most of the dermatoses of pregnancy can be treated conservatively but a few require intervention in the form of termination of pregnancy. Correct diagnosis is essential for the treatment of these disorders. This article discusses the current knowledge of various skin changes during pregnancy and the evaluation of the patient with pregnancy dermatoses with special emphasis on clinical features, diagnostic tests, maternal and fetal prognosis, therapy, and management. PMID:25657937

  13. Pregnancy and skin.

    PubMed

    Vora, Rita V; Gupta, Rajat; Mehta, Malay J; Chaudhari, Arvind H; Pilani, Abhishek P; Patel, Nidhi

    2014-01-01

    Pregnancy is associated with complex of endocrinological, immunological, metabolic, and vascular changes that may influence the skin and other organs in various ways. Pregnancy is a period in which more than 90% women have significant and complex skin changes that may have great impact on the woman's life. The dermatoses of pregnancy represent a heterogeneous group of skin diseases related to pregnancy and/or the postpartum period. The dermatoses of pregnancy can be classified into the following three groups: Physiologic skin changes in pregnancy, pre-existing dermatoses affected by pregnancy, and specific dermatoses of pregnancy. Though most of these skin dermatoses are benign and resolve in postpartum period, a few can risk fetal life and require antenatal surveillance. Most of the dermatoses of pregnancy can be treated conservatively but a few require intervention in the form of termination of pregnancy. Correct diagnosis is essential for the treatment of these disorders. This article discusses the current knowledge of various skin changes during pregnancy and the evaluation of the patient with pregnancy dermatoses with special emphasis on clinical features, diagnostic tests, maternal and fetal prognosis, therapy, and management. PMID:25657937

  14. Restoration of Vision with Ectopic Expression of Human Rod Opsin

    PubMed Central

    Cehajic-Kapetanovic, Jasmina; Eleftheriou, Cyril; Allen, Annette E.; Milosavljevic, Nina; Pienaar, Abigail; Bedford, Robert; Davis, Katherine E.; Bishop, Paul N.; Lucas, Robert J.

    2015-01-01

    Summary Many retinal dystrophies result in photoreceptor loss, but the inner retinal neurons can survive, making them potentially amenable to emerging optogenetic therapies. Here, we show that ectopically expressed human rod opsin, driven by either a non-selective or ON-bipolar cell-specific promoter, can function outside native photoreceptors and restore visual function in a mouse model of advanced retinal degeneration. Electrophysiological recordings from retinal explants and the visual thalamus revealed changes in firing (increases and decreases) induced by simple light pulses, luminance increases, and naturalistic movies in treated mice. These responses could be elicited at light intensities within the physiological range and substantially below those required by other optogenetic strategies. Mice with rod opsin expression driven by the ON-bipolar specific promoter displayed behavioral responses to increases in luminance, flicker, coarse spatial patterns, and elements of a natural movie at levels of contrast and illuminance (≈50–100 lux) typical of natural indoor environments. These data reveal that virally mediated ectopic expression of human rod opsin can restore vision under natural viewing conditions and at moderate light intensities. Given the inherent advantages in employing a human protein, the simplicity of this intervention, and the quality of vision restored, we suggest that rod opsin merits consideration as an optogenetic actuator for treating patients with advanced retinal degeneration. PMID:26234216

  15. Warfarin Accelerates Ectopic Mineralization in Abcc6?/? Mice

    PubMed Central

    Li, Qiaoli; Guo, Haitao; Chou, David W.; Harrington, Dominic J.; Schurgers, Leon J.; Terry, Sharon F.; Uitto, Jouni

    2014-01-01

    Pseudoxanthoma elasticum (PXE) is a multisystem ectopic mineralization disorder caused by mutations in the ABCC6 gene. Warfarin, a commonly used anticoagulant, is associated with increased mineralization of the arterial blood vessels and cardiac valves. We hypothesized that warfarin may accelerate ectopic tissue mineralization in PXE, with clinical consequences. To test this hypothesis, we developed a model in which Abcc6?/? mice, which recapitulate features of PXE, were fed a diet supplemented with warfarin and vitamin K1. Warfarin action was confirmed by significantly increased serum levels of oxidized vitamin K. For mice placed on a warfarin-containing diet, quantitative chemical and morphometric analyses revealed massive accumulation of mineral deposits in a number of tissues. Mice fed a warfarin-containing diet were also shown to have abundant uncarboxylated form of matrix Gla protein, which allowed progressive tissue mineralization to ensue. To explore the clinical relevance of these findings, 1747 patients with PXE from the approximately 4000 patients in the PXE International database were surveyed about the use of warfarin. Of the 539 respondents, 2.6% reported past orpresent use of warfarin. Based on the prevalence of PXE (approximately 1:50,000), thousands of patients with PXE worldwide may be at risk for worsening of PXE as a result of warfarin therapy. PMID:23415960

  16. Ectopic apudocarcinomas and associated endocrine hyperplasias of the foregut.

    PubMed Central

    Friesen, S R; McGuigan, J E

    1975-01-01

    Foregut endocrine polypeptide-secreting APUD cells (Amine-Precursor-Uptake and Decarboxylation), in their embryologic migration from neural crest to foregut may become "arrested" in the mesoderm or in other ectopic locations. They may become hyperplastic, adenomatous or malignant. Eight illustrative patients are reported. One patient had "pancreatic hyperparathyroidism" with hypercalcemic crises, pancreatic apudocarcinoma, normal parathyroids, biologically active parathormone, but inert immunochemically to the usual parathyroid antisera. Two had gastrin-secreting malignancies in the mesoderm. Remission after excision, but eventual recurrence of the syndrome due to islet cell hyperplasia required total gastrectomy. One patient had a gastric corpus apudocarcinoma found prospectively with hypergastrinemia which required excision of the tumor. One patient had acromegaly with hypergastrinemia and antral gastrinosis treated by pituitary irradiation, One patient had the antral or intermediary type of the Zollinger-Ellison syndrome with moderate hypergastrinemia, duodenal ulcer and antral gastrinosis, treated by vagotomy and antrectomy. One patient had hyperparathyroidism with antral gastrinosis, treated by parathyroidectomy. One patient had malignant Zollinger-Ellison syndrome and developed associated thyroid parafollicular cell hyperplasia and parathyroid chief cell hyperplasia, treated by total gastrectomy and multiple endocrine excisions. These investigative observations demonstrate ectopic loci and associated hyperplasias which support the concept of migration and bizarre potentiality of polypeptide-secreting cells of the foregut. Images Fig. 2. Fig. 3. Fig. 4. Fig. 5. Fig. 6. Fig. 7. Fig. 8. Fig. 9. Fig. 10. Fig. 11. PMID:241302

  17. Surgical management of colonic perforation due to ulcerative colitis during pregnancy: Report of a case

    PubMed Central

    Overbey, Douglas; Govekar, Henry; Gajdos, Csaba

    2014-01-01

    This report describes a young female in her second trimester of pregnancy with known ulcerative colitis on maintenance medical therapy. She was admitted for abdominal pain, and workup revealed a colonic stricture and ulceration with contained perforation. After multidisciplinary discussion she was managed with colectomy and end ileostomy. She delivered a healthy newborn 18 wk after surgery. Only a few prior reports described surgical management of inflammatory bowel disease during pregnancy, with recent results indicating low risk of adverse outcomes. PMID:25346802

  18. Abdominal Compartment Syndrome: pathophysiology and definitions

    PubMed Central

    Cheatham, Michael L

    2009-01-01

    "Intra-abdominal hypertension", the presence of elevated intra-abdominal pressure, and "abdominal compartment syndrome", the development of pressure-induced organ-dysfunction and failure, have been increasingly recognized over the past decade as causes of significant morbidity and mortality among critically ill surgical and medical patients. Elevated intra-abdominal pressure can cause significant impairment of cardiac, pulmonary, renal, gastrointestinal, hepatic, and central nervous system function. The significant prognostic value of elevated intra-abdominal pressure has prompted many intensive care units to adopt measurement of this physiologic parameter as a routine vital sign in patients at risk. A thorough understanding of the pathophysiologic implications of elevated intra-abdominal pressure is fundamental to 1) recognizing the presence of intra-abdominal hypertension and abdominal compartment syndrome, 2) effectively resuscitating patients afflicted by these potentially life-threatening diseases, and 3) preventing the development of intra-abdominal pressure-induced end-organ dysfunction and failure. The currently accepted consensus definitions surrounding the diagnosis and treatment of intra-abdominal hypertension and abdominal compartment syndrome are presented. PMID:19254364

  19. Immunology of normal pregnancy.

    PubMed

    Aagaard-Tillery, Kjersti M; Silver, Robert; Dalton, Jess

    2006-10-01

    Since Medawar's initial contemplations in 1953 on the mechanisms of immune evasion allowing for the survival of the allogeneic conceptus in an immunologically competent mother, physicians and immunologists alike have struggled to understand the immunological paradox of pregnancy. Ultimately, our attempts to define the immunology of normal pregnancy have broadened our appreciation of the myriad mechanisms at play that enable the promotion of implantation and maintenance of pregnancy. In this review, we summarise what is known regarding the immunology of normal pregnancy, with special emphasis on the relation to common disorders of pregnancy. PMID:16784908

  20. Skin disease in pregnancy.

    PubMed

    Soutou, Boutros; Aractingi, Slim

    2015-07-01

    Skin manifestations during pregnancy are common and diversified. This review will focus on the most important entities to be recognized by obstetricians. These are, on the one hand, physiological changes, where unnecessary investigations should be avoided, and on the other, the specific dermatoses of pregnancy. These develop electively in pregnancy, and they are currently grouped into three disorders: polymorphic eruption of pregnancy, atopic eczema of pregnancy, and pemphigoid gestationis. Arguments for recognition of these are presented including detection of anti-BP180 antibodies. Follow-up and treatment depend on the precise diagnosis. Risks in fetal prognosis may occur in rare pemphigoid gestationis cases. PMID:25862358

  1. [Visceral leishmaniasis and pregnancy in renal transplanted patient: case report].

    PubMed

    Silva, Jaqueline de Almeida; Arajo, Ivan de Melo; Pavanetti, Luiz Carlos; Okamoto, Liene Shigaki; Dias, Mnica

    2015-01-01

    Visceral leishmaniasis (VL) is a severe and potentially fatal disease caused by different Leishmania species, Leishmania chagasi prevailing in Brazil. Main symptoms include fever, malaise, anorexia, weight loss and abdominal enlargement with typically occurring hepatosplenomegaly Currently, VL is considered an opportunistic infection in immunocompromised hosts, including solid organ transplanted patients. The present study reports a case of VL associated to pregnancy after renal transplantation. PMID:26154649

  2. Pulmonary mechanics during pregnancy.

    PubMed

    Gee, J B; Packer, B S; Millen, J E; Robin, E D

    1967-06-01

    Previously reported changes in static lung volumes during pregnancy have been confirmed. Measurements of lung compliance (C(L)) and total pulmonary resistance (R(L)) were made in 10 women in the last trimester of pregnancy and 2 months postpartum, employing an esophageal balloon and recording spirometer. C(L) was unaffected by pregnancy, but R(L) was 50% below normal during pregnancy. Measurements of airway conductance (C(A)) were made, employing the constant pressure body plethysmograph on 14 nonpregnant and 13 pregnant women. Specific airway conductance was increased during pregnancy. Serial measurements of C(A) indicated a progressive increase beginning at about 6 months of gestation and a return to normal by 2 months postpartum. The mechanism of the increased C(A) during pregnancy is not known. It may be related to changes in bronchial smooth muscle tone and conceivably explains the tolerance of certain patients with lung resections to pregnancy. PMID:6026099

  3. Invasive Mucinous Carcinoma Arising in Ectopic Axillary Breast Tissue: A Case Report and Literature Review

    PubMed Central

    Nardello, Salvatore M.; Kulkarni, Nandini; Aggon, Allison; Boraas, Marcia; Sigurdson, Elin R.; Bleicher, Richard J.

    2015-01-01

    Patient: Female, 70 Final Diagnosis: Primary invasive mucinous carcinoma arising from ectopic breast tissue Symptoms: Axillary mass Medication: Adjuvant hormonal therapy and irradiation to the ipsilateral axilla Clinical Procedure: Wide local excision of ectopic breast carcinoma with lymphatic mapping and sentinel lymphadenectomy Specialty: Surgery Objective: Rare disease Background: Invasive mucinous carcinoma arising in ectopic axillary breast tissue is an uncommon diagnosis. While some published medical literature makes recommendations regarding the management of ectopic primaries, many of these recommendations are outdated. We therefore hope to provide general guidance with the management of this rare entity. Case Report: We report a case of a 70-year-old woman with primary invasive mucinous carcinoma of ectopic breast tissue. A literature study was performed on primary ectopic breast carcinoma. This case report with review of the literature was performed to provide rationales for a more conservative treatment based upon current data and treatment paradigms. Although the diagnosis of primary ectopic breast carcinoma is uncommon, the presence of a suspicious nodule along the mammary ridge should alert the clinician to consider the possibility of this diagnosis. A mammogram and ultrasound of the nodule were performed and the suspicious nodule was biopsied, confirming the diagnosis. Breast conservation was performed with standard nodal evaluation. Conclusions: The management of primary ectopic breast carcinoma should be based upon current breast conservation techniques of orthotopic breast cancer. Current data suggest that standard treatment paradigms remain applicable to this rare clinical entity. PMID:25770309

  4. Efficacy of landiolol for the treatment of junctional ectopic tachycardia resulting from sepsis.

    PubMed

    Oka, Hideharu; Sugimoto, Masaya; Azuma, Hiroshi

    2016-01-01

    Junctional ectopic tachycardia, after surgery for CHD, is a serious arrhythmia that can cause increased morbidity and mortality. We report a case of junctional ectopic tachycardia, preceded by sepsis, in a 4-year-old girl, 31 months after open-heart surgery. She was successfully treated using low-dose landiolol hydrochloride. PMID:25785611

  5. Gynecomastia-Like Hyperplasia of Axillary Ectopic Breast Tissue in a Young Female

    PubMed Central

    Shatzel, Joseph; Khoury, Thaer; Milligan, Janine; Skitzki, Joseph J.

    2013-01-01

    Gynecomastia-like hyperplasia of orthotopic female breast tissue is a rare entity. We present the singularly unique case of a 22-year-old female who presented with a small axillary mass subsequently discovered to be a discrete deposit of ectopic breast tissue with gynecomastia-like hyperplasia. This case highlights the etiology, variable presentation, and evaluation of ectopic breast tissue. PMID:23984148

  6. Familial Mediterranean Fever With Complete Symptomatic Remission During Pregnancy

    PubMed Central

    Kim, Kwang Taek; Lee, Jae Eun; Kim, Mi Kang; Yoo, Jun Jae; Lee, Gye Yeon; Kae, Sea Hyub; Lee, Jin

    2015-01-01

    Familial Mediterranean fever (FMF) is an inherited autosomal recessive disorder, ethnically restricted and commonly found among populations surrounding the Mediterranean Sea. FMF is the most prevalent autoinflammatory disease; is characterized by recurrent, self-limited episodes of fever with serositis; and is caused by Mediterranean fever gene (MEFV) mutations on chromosome 16. We describe a case of adult-onset FMF with complete symptomatic remission during pregnancy, without the use of colchicine. A 25-year-old woman had presented with periodic fever, abdominal pain, and vomiting since she was 21. Her abdominal computed tomography scan showed intestinal nonrotation. She underwent exploratory laparotomy and appendectomy for her symptoms 1 year prior. She had a symptom-free pregnancy period, but abdominal pain and fever recurred after delivery. Mutation analysis of the MEFV gene revealed two point mutations (p.Leu110Pro and p.Glu148Gln). We report an adult female patient with FMF in Korea with complete symptomatic remission during pregnancy. PMID:26131005

  7. Relation between single serum progesterone assay and viability of the first trimester pregnancy

    PubMed Central

    Abdelazim, Ibrahim Anwar; Belal, Maha Mohmed; Makhlouf, Hanan Hassan

    2013-01-01

    Objective: This study was designed to detect the relation between serum progesterone and viability of pregnancy during the first trimester. Material and Methods: Two hundred and sixty women during the first trimester of their pregnancies were hospitalised due to vaginal bleeding and/or abdominal pain and were included in this study. Criteria for inclusion in this study were: certain dates, foetus conceived spontaneously with no history of infertility and a positive serum pregnancy test. Blood samples were taken from women included in this study for serum progesterone assay; the patients were followed by ultrasound until the end of the first trimester for the viability of the pregnancy and the outcome of their pregnancy was recorded. Results: By the end of the first trimester, women included in this study were classified into: viable pregnancy group (n=178; 68.5%) and non-viable pregnancy group (ended by miscarriage) (n=82; 31.5%). The mean serum progesterone of the studied population was significantly higher in the viable pregnancy group (46.57.4 ng/mL) compared to non-viable pregnancy group (9.94.8 ng/mL; p<0.05). The serum progesterone cut-off level of 10 ng/mL was 79.3% sensitive for diagnosing non-viable pregnancy and 93.3% specific for the diagnosis of viable pregnancy, while a cut-off level of 20 ng/mL was 95.1% sensitive for the diagnosis of non-viable pregnancy and 98.9% specific for diagnosing viable pregnancy. Conclusion: Serum progesterone is a reliable marker for early pregnancy failure and a single assay of its serum level can differentiate between viable and non-viable pregnancies. PMID:24592077

  8. Ectopic ureter in the horse: Three cases and a review of the literature

    PubMed Central

    Pringle, John K.; Ducharme, Normand G.; Baird, John D.

    1990-01-01

    Ureterovesicular anastomosis resulted in resolution of the clinical signs of urinary incontinence in three horses with unilateral ectopic ureter. Follow-up of two of the horses ten months and three years later indicated no further urinary tract problems; the third horse died four days after surgery from intestinal infarction. Diagnosis can be readily confirmed by antegrade or retrograde ureterography, or endoscopic visualization of the ectopic ureteral openings. Nephrectomy appears indicated in cases of unilateral ectopic ureter with associated ipsilateral urinary tract infection or hydronephrosis, providing the contralateral kidney has normal function. Ureterovesicular anastomosis appears to be indicated in the management of unilateral ectopic ureters in the absence of ascending urinary tract infection or hydronephrosis, and in cases of bilateral ectopic ureters. ImagesFigure 1. PMID:17423490

  9. [Unplanned pregnancy in Portugal].

    PubMed

    Tavares, M; Barros, H

    1997-05-01

    This study was to determine the prevalence of unplanned pregnancy in a national sample of Portuguese puerperae and to define a risk profile for women with unplanned pregnancy. We also evaluated the independent effect of unplanned pregnancy in prenatal care utilisation and in the prevalence of preterm birth, low birth weight, and small for gestational age birth. Data was collected through a national survey proposed to the 50 major public Portuguese hospitals and answers were obtained from 41 hospitals, resulting in a sample of 1582 deliveries. Participants were classified as having a planned or unplanned pregnancy and were compared according to socio-demographic, behavioural, clinical, obstetric, and anthropometric characteristics. The prevalence of unplanned pregnancy was 39.4%. In the unplanned pregnancy group, single women aged less than 19 years and more than 34 years, those with one or more previous pregnancies, with 25% or less of the expected education for their age, and with the National Health Service as the source of were significantly more frequent. These characteristics, except the health provision, were significant and independently associated with an increased risk of unplanned pregnancy. Women with unplanned pregnancy were more likely to be unaware of prenatal care system, to have no prenatal care, late or inadequate prenatal care. Unplanned pregnancy was significantly associated with the risk of inadequate prenatal care (Odds ratio (OR) = 2.5; 95% Confidence interval (CI): 1.7-3.0), after adjusting for the effect of the confounding variables. Planning pregnancy was not significantly related with the prevalence of low birth weight or small for gestational age birth. However there was a significant relationship between unplanned pregnancy and preterm birth (Adjusted OR = 1.7; 95% CI:1.0-2.9). This study showed a high prevalence of unplanned pregnancy and that it was related with an under utilisation of prenatal care and with an independently increased risk of preterm birth, a major issue in perinatal health. PMID:9312979

  10. The Association Between Prepregnancy Parental Support and Control and Adolescent Girls Pregnancy Resolution Decisions

    PubMed Central

    Madkour, Aubrey Spriggs; Xie, Yiqiong; Harville, Emily W.

    2013-01-01

    Purpose To examine the influence of prepregnancy parental support and control on adolescent girls pregnancy resolution decisions. Methods Data from the National Longitudinal Study of Adolescent Health were analyzed. Girls whose first pregnancy reported in wave IV occurred after wave I and before age 20 were included (n = 1,107). Participants self-reported pregnancy disposition (abortion, ectopic or tubal pregnancy, miscarriage, stillbirth, live birth) for each pregnancy; responses were dichotomized as abortion versus other. Girls perceptions of parental support and control were measured at wave I. Controls were included for wave I age, age at pregnancy, year at the end of pregnancy, race/ethnicity, and parent characteristics (i.e., education, religious affiliation, age at first marriage, and educational expectations). Weighted multivariable logistic regression models were performed. Results Approximately 18% of girls reporting a teen pregnancy reported having an abortion. In crude analyses, parental support was marginally negatively related to abortion (odds ratio [OR] =.83, p =.06) and parental control was significantly negatively related to abortion (OR = .78, p = .02). In multivariable analyses, higher parental control was significantly negatively related to abortion versus other pregnancy outcomes (adjusted OR .80, 95% confidence interval .66.98). Perceived parental support was unassociated with pregnancy resolution decisions. The only other factor associated with abortion decisions was parent education: odds of choosing abortion versus other pregnancy outcomes were significantly higher for adolescent girls whose parents had a bachelors degree or greater versus those with lower educational attainment. Conclusions Pregnant adolescents with less educated parents or parents exercising greater control were less likely to have an abortion. PMID:23763966

  11. Sensory transduction in peripheral nerve axons elicits ectopic action potentials.

    PubMed

    Hoffmann, Tal; Sauer, Susanne K; Horch, Raymund E; Reeh, Peter W

    2008-06-11

    Sensory properties of unmyelinated axons in the isolated rat sciatic nerve have been revealed previously by measuring stimulated neuropeptide release in response to noxious stimuli. In addition, axonal sensitization by inflammatory mediators has been demonstrated and shown to depend on the heat- and proton-activated ion channel transient receptor potential vanilloid receptor-1. It was unclear whether this responsiveness is accompanied by ectopic generation of action potentials, which may play a crucial role in painful neuropathies. We explored this hypothesis using the isolated mouse skin-nerve preparation. This method enabled us to directly compare the sensory properties of axons in the peripheral nerve with their characterized cutaneous terminals in the receptive field using propagated action potentials as an index of axonal activation. Single-fiber recordings from 51 mechanosensitive mouse C-fibers revealed that a majority of the polymodal nociceptors responded with an encoding discharge rate to graded heating of the cutaneous receptive field (n = 38) as well as of the saphenous nerve carrying the fiber under investigation (n = 25; 66%). Axonal heat responses paralleled those of the receptive fields with regard to thresholds and discharge rates (41.5 +/- 4.3 degrees C; 7.7 +/- 9.6 spikes in a 20 s 32-48 degrees C ranged stimulation). In contrast, axonal mechanosensitivity was poor and noxious cold sensitivity more rarely encountered. In conclusion, peripheral nerve axons exhibit sensory transduction capacities similar to their nociceptive terminals in the skin with respect to noxious heat, although not to mechanical and cold sensitivity. This may become a source of ectopic discharge and pain if axonal heat threshold drops to body temperature, as may be the case during inflammation-like processes in peripheral nerves. PMID:18550771

  12. Regeneration of Leydig cells in ectopically autografted adult mouse testes.

    PubMed

    Makala, Himesh; Pothana, Lavanya; Sonam, Surabhi; Malla, Ashwini; Goel, Sandeep

    2015-03-01

    Ectopic autografting of testis tissue is a promising approach for studying testicular development, male germline preservation and restoration of male fertility. In this study, we examined the fate of various testicular cells in adult mouse testes following ectopic autografting at 1, 2, 4 and 8 weeks post grafting. Histological examination showed no evidence of re-establishment of spermatogenesis in autografts, and progressive degeneration of seminiferous tubules was detected. Expression of germ cell-specific proteins such as POU5F1, DAZL, TNP1, TNP2, PRM1 and PRM2 revealed that, although proliferating and differentiating spermatogenic germ cells such as spermatogonia, spermatocytes and spermatids could survive in autografts until 4 weeks, only terminally differentiated germ cells such as sperm persisted in autografts until 8 weeks. The presence of Sertoli and peritubular myoid cells, as indicated by expression of WT1 and ACTA2 proteins, respectively, was evident in the autografts until 8 weeks. Interestingly, seminal vesicle weight and serum testosterone level were restored in autografted mice by 8 weeks post grafting. The expression of Leydig cell-specific proteins such as CYP11A1, HSD3B2 and LHCGR showed revival of Leydig cell (LC) populations in autografts over time since grafting. Elevated expression of PDGFRA, LIF, DHH and NEFH in autografts indicated de novo regeneration of LC populations. Autografted adult testis can be used as a model for investigating Leydig cell regeneration, steroidogenesis and regulation of the intrinsic factors involved in Leydig cell development. The success of this rodent model can have therapeutic applications for adult human males undergoing sterilizing cancer therapy. PMID:25516990

  13. Dermatological Diseases Associated with Pregnancy: Pemphigoid Gestationis, Polymorphic Eruption of Pregnancy, Intrahepatic Cholestasis of Pregnancy, and Atopic Eruption of Pregnancy

    PubMed Central

    Svervall, Christine; Sand, Freja Lrke; Thomsen, Simon Francis

    2015-01-01

    Dermatoses unique to pregnancy are important to recognize for the clinician as they carry considerable morbidity for pregnant mothers and in some instances constitute a risk to the fetus. These diseases include pemphigoid gestationis, polymorphic eruption of pregnancy, intrahepatic cholestasis of pregnancy, and atopic eruption of pregnancy. This review discusses the pathogenesis, clinical importance, and management of the dermatoses of pregnancy. PMID:26609305

  14. Hepatobiliary diseases during pregnancy and their management: An update

    PubMed Central

    Lata, Indu

    2013-01-01

    Liver diseases in pregnancy although rare but they can seriously affect mother and fetus. Signs and symptoms are often not specific and consist of jaundice, nausea, vomiting, and abdominal pain. Although any type of liver disease can develop during pregnancy or pregnancy may occur in a patient already having chronic liver disease. All liver diseases with pregnancy can lead to increased maternal and fetal morbidity and mortality. It is difficult to identify features of liver disease in pregnant women because of physiological changes. Physiological changes of normal pregnancy can be confounding with that of sign and symptoms of liver diseases. Telangiectasia or spider angiomas, palmar erythema, increased alkaline phosphatase due to placental secretion, hypoalbuminemia due to hemodilution. These normal alterations mimic physiological changes in patients with decompensated chronic liver disease. Besides all these pathological changes however, blood flow to the liver remains constant and the liver usually remains impalpable during pregnancy. The diagnosis of liver disease in pregnancy is challenging and relies on laboratory investigations. The underlying disorder can have a significant effect on morbidity and mortality in both mother and fetus, and a diagnostic workup should be initiated promptly. If we see the spectrum of liver disease in pregnancy, in mild form there occur increase in liver enzymes to severe form, where liver failure affecting the entire system or maternal mortality and morbidity. It can not only complicate mother's life but also poses burden of life of fetus to growth restriction. Most of the times termination is only answer to save life of mother but sometimes early detection of diseases, preventive measures and available active treatment is helpful for both of the life. Extreme vigilance in recognizing physical and laboratory abnormalities in pregnancy is a prerequisite for an accurate diagnosis. This could lead to a timely intervention and successful outcome. PMID:24404454

  15. Screening for abdominal aortic aneurysm.

    PubMed

    Mussa, Firas F

    2015-09-01

    Guidelines are systematically developed statements to assist patients and providers in choosing appropriate health care for specific clinical conditions. Consensus exists across guidelines on one-time screening of elderly men to detect and treat abdominal aortic aneurysm (AAA) ≥5.5 cm. However, the recommendations regarding other age groups, imaging intervals for small AAAs, inclusion of women, and cost-effectiveness have not been universally adopted. As many countries are considering the initiation of an AAA screening program, this is an overview on the current status of such programs. PMID:26169012

  16. SIMPLE Technique of Laparoscopic Nephrectomy for Ectopic Nonfunctioning Pelvic Kidney Secondary to Pelviureteric Junction Obstruction: A Feasible and Safe Technique

    PubMed Central

    Parmar, Kalpesh Mahesh; Shankaregowda Ajjoor, Sriharsha; Jayant, Kumar; Singh, Shrawan Kumar

    2014-01-01

    Ectopic kidneys are rare developmental anomalies. Anomalous blood supply of the pelvic ectopic kidneys poses a problem for a minimally invasive surgery. Although laparoscopic nephrectomies have been described for symptomatic nonfunctioning pelvic ectopic kidney, this is the first case report that highlights the safety and feasibility of SIMPLE technique of laparoscopic nephrectomy in a pelvic kidney. PMID:25140271

  17. Gynecologic malignancy in pregnancy

    PubMed Central

    Ji, Yong Il

    2013-01-01

    Gynecologic malignancy during pregnancy is a stressful problem. For the diagnosis and treatment of malignancy during pregnancy, a multidisciplinary approach is needed. Patients should be advised about the benefits and risk of treatment. When selecting a treatment for malignancy during pregnancy, the physiologic changes that occur with the pregnancy should be considered. Various diagnostic procedures that do not harm the fetus can be used. Laparoscopic surgery or laparotomy may be safely performed. The staging approach and treatment should be standard. Systemic chemotherapy during the first trimester should be delayed if possible. Radiation therapy should preferably start postpartum. Although delivery should be delayed preferably until after 35 weeks of gestation, termination of pregnancy may be considered when immediate treatment is required. Subsequent pregnancies do not increase the risk of malignancy recurrence. PMID:24328018

  18. Ectopic Leydig cells of testis An immunohistochemical study on tissue microarray.

    PubMed

    Jun, Sun-Young; Ro, Jae Y; Park, Yong W; Kim, Kyu-Rae; Ayala, Alberto G

    2008-02-01

    The incidence of ectopic Leydig cells (LCs) has been reported to be 40% to 90%. Several theories have been proposed to account for ectopic LCs, including in situ differentiation, migration from testicular interstitium, and trapping of peritubular LCs in the tunica propria of the seminiferous tubule during its thickening. To document the nature of ectopic LCs and to compare them with interstitial LCs, Sertoli cells, epididymal cells, mesothelial cells, and epithelial cells in rete testis, immunostainings with calretinin, CD10, inhibin, CK7, and CK20 were performed in 40 cases of orchiectomy specimens using tissue microarray sections. In addition, the frequency of ectopic LCs was evaluated. Of the 40 orchiectomy specimens, 14 cases demonstrated ectopic LCs with an incidence of 35%. Inhibin was positive in more than half of ectopic LCs (9/14, 64.3%) and in almost all interstitial LCs. Calretinin was positive in most of ectopic LCs (12/14, 85.7%) as well as in most of normally located interstitial LCs and mesothelial cells and some of rete testis epithelial cells. The ectopic and interstitial LCs as well as Sertoli cells were negative for CK7, CK20, and CD10. CK7 was positive in all epididymal cells and in most mesothelial cells and epithelial cells in rete testis. CD10 was positive in some of epididymal cells and epithelial cells in rete testis. CK20 was negative in all cells in the testis and epididymis. Ectopic LCs showed similar staining patterns to interstitial LCs with positive immunoreactivity for calretinin and inhibin. In this study, the frequency of ectopic LCs was 35%. The lower incidence in this study was most likely because of the limited sampling. Immunohistochemically, ectopic LCs showed identical immunohistochemical patterns with those of interstitial LCs. Calretinin appeared to be more sensitive but less specific than inhibin for LCs. Because calretinin is frequently positive in cells other than ectopic or interstitial LCs, a precaution is required to differentiate LCs from mesothelial cells and rete testis epithelial cells. Based on our study, we could not add anything else of what is known in regard to the histogenesis of ectopic LCs. The current theories including in situ differentiation, migration from testicular interstitium, and trapping of peritubular LCs in the tunica propria of the seminiferous tubules during its thickening seem to be valid histogenetic theories. PMID:18164412

  19. [FUNCTIONAL PLASTIC OF ANTERIOR ABDOMINAL WALL HERNIAS].

    PubMed

    Grubnik, V V; Parfentyeva, N D; Parfentyev, R S

    2015-07-01

    In order to improve the treatment efficacy of postoperative anterior abdominal wall hernias the method of plastic with restoration of anatomical and physiological properties of the muscles of the anterior abdominal wall was used. After the intervention by the improved method, regardless of the location of the hernia defect yielded promising results for the conservation of anterior abdominal wall muscle function in 75% of cases completely restored functional ability of muscles recti abdomini. PMID:26591212

  20. [Pregnancy and enterostomy].

    PubMed

    Delaini, G G; Signori, E; Cattani, P; Tosadori, U; Dagradi, V; Piccinelli, D; Lolli, P; Iacono, C; Tenchini, P

    1985-10-01

    The authors describe the difficulties and possible complications of pregnancy in colonostomized women. In the neoplastic forms, generally appearing in advanced age, the knowledge of the basic disease discourages any possible attempt at pregnancy. In the chronic inflammatory diseases (ulcerous rectocolitis and Crohn's disease), typical of young age, pregnancy, if opportunely followed and programmed, can get an absolutely favourable course. The authors report their own experiences and some other authors' ones. PMID:4092309

  1. [Pregnancy, contraception and epilepsy].

    PubMed

    Leppert, D; Wieser, H G

    1993-08-01

    Epilepsy is the most common neurological disease of females in reproductive age. Problems concerning contraception, reproduction, teratogenicity and antiepileptic therapy preceding and during pregnancy are discussed and recommendations made. We underline the advantages of a planned pregnancy with optimal adjustment of antiepileptic drug therapy and recommend prophylactic treatment with folic acid before and during, and with vitamin K towards the end of pregnancy. PMID:8413747

  2. Lipotoxicity in obese pregnancy and its potential role in adverse pregnancy outcome and obesity in the offspring

    PubMed Central

    Jarvie, Eleanor; Hauguel-de-Mouzon, Sylvie; Nelson, ScottM.; Sattar, Naveed; Catalano, PatrickM.; Freeman, DilysJ.

    2010-01-01

    Increasing maternal obesity is a challenge that has an impact on all aspects of female reproduction. Lean and obese pregnant women gain similar fat mass, but lean women store fat in the lower-body compartment and obese women in central compartments. In the non-pregnant, central storage of fat is associated with adipocyte hypertrophy and represents a failure to adequately store excess fatty acids, resulting in metabolic dysregulation and ectopic fat accumulation (lipotoxicity). Obese pregnancy is associated with exaggerated metabolic adaptation, endothelial dysfunction and increased risk of adverse pregnancy outcome. We hypothesize that the preferential storage of fat in central rather than safer lower-body depots in obese pregnancy leads to lipotoxicity. The combination of excess fatty acids and oxidative stress leads to the production of oxidized lipids, which can be cytotoxic and influence gene expression by acting as ligands for nuclear receptors. Lipid excess and oxidative stress provoke endothelial dysfunction. Oxidized lipids can inhibit trophoblast invasion and influence placental development, lipid metabolism and transport and can also affect fetal developmental pathways. As lipotoxicity has the capability of influencing both maternal endothelial function and placental function, it may link maternal obesity and placentally related adverse pregnancy outcomes such as miscarriage and pre-eclampsia. The combination of excess/altered lipid nutrient supply, suboptimal in utero metabolic environment and alterations in placental gene expression, inflammation and metabolism may also induce obesity in the offspring. PMID:20443782

  3. Two pregnancy cases of uterine scar dehiscence after laparoscopic myomectomy

    PubMed Central

    Song, Soo-Youn; Yoo, Hee-Jun; Kang, Byung-Hun; Ko, Young-Bok; Lee, Ki-Hwan

    2015-01-01

    Uterine scar dehiscence following laparoscopic myomectomy rarely occurs but can compromise both maternal and fetal well-being in subsequent pregnancy. We here present two cases of pregnancy complicated by preterm birth that resulted from uterine scar dehiscence following laparoscopic myomectomy. First case was a nulligravida who had scar dehiscence at 26 weeks of gestation after having a laparoscopic myomectomy 3 months prior to conception. Two weeks later, we observed her fetal leg protruding through the defect. The other case was a primigravida with a history of prior cesarean delivery, whose sonography revealed myomectomy scar dehiscence at 31 weeks of gestation. Within a few hours after observing, the patient complained of abdominal pain that was aggravating as fetal leg protruded through the defect. In both cases, babies were born by emergency cesarean section. Conservative management can be one of treatment options for myomectomy scar dehiscence in preterm pregnancy. However, clinicians should always be aware of the possibility of obstetric emergencies. PMID:26623418

  4. Two pregnancy cases of uterine scar dehiscence after laparoscopic myomectomy.

    PubMed

    Song, Soo-Youn; Yoo, Hee-Jun; Kang, Byung-Hun; Ko, Young-Bok; Lee, Ki-Hwan; Lee, Mina

    2015-11-01

    Uterine scar dehiscence following laparoscopic myomectomy rarely occurs but can compromise both maternal and fetal well-being in subsequent pregnancy. We here present two cases of pregnancy complicated by preterm birth that resulted from uterine scar dehiscence following laparoscopic myomectomy. First case was a nulligravida who had scar dehiscence at 26 weeks of gestation after having a laparoscopic myomectomy 3 months prior to conception. Two weeks later, we observed her fetal leg protruding through the defect. The other case was a primigravida with a history of prior cesarean delivery, whose sonography revealed myomectomy scar dehiscence at 31 weeks of gestation. Within a few hours after observing, the patient complained of abdominal pain that was aggravating as fetal leg protruded through the defect. In both cases, babies were born by emergency cesarean section. Conservative management can be one of treatment options for myomectomy scar dehiscence in preterm pregnancy. However, clinicians should always be aware of the possibility of obstetric emergencies. PMID:26623418

  5. An unusual presentation of recurrent uterine rupture during pregnancy

    PubMed Central

    Tan, Shu Qi; Thia, Edwin Wee Hong; Tee, Chee Seng John; Yeo, George Seow Heong

    2015-01-01

    We describe a case of recurrent uterine rupture at the site of a previous rupture. Our patient had a history of right interstitial pregnancy with spontaneous uterine fundal rupture at 18 weeks of pregnancy. During her subsequent pregnancy, she was monitored closely by a senior consultant obstetrician. The patient presented at 34 weeks with right hypochondriac pain. She was clinically stable and fetal monitoring showed no signs of fetal distress. Ultrasonography revealed protrusion of the intact amniotic membranes in the abdominal cavity at the uterine fundus. Uterine rupture is a rare but hazardous obstetric complication. High levels of caution should be exercised in patients with a history of prior uterine rupture, as they may present with atypical symptoms. Ultrasonography could provide valuable information in such cases where there is an elevated risk of uterine rupture at the previous rupture site. PMID:26106245

  6. Cervical pregnancy with massive bleeding after treatment with methotrexate

    PubMed Central

    Saeng-anan, Ubol; Sreshthaputra, Opas; Sukpan, Kornkanok; Tongsong, Theera

    2013-01-01

    This report describes a catastrophic bleeding following methotrexate treatment of cervical pregnancy and dramatic response to Bakri surgical obstetric silicone (SOS) balloon tamponade in controlling massive bleeding. A 42-year-old woman was diagnosed for cervical pregnancy with a viable fetus at 12 weeks by transvaginal ultrasound. Conservative treatment with intrafetal potassium chloride injection and systemic methotrexate were instituted. On the sixth day of therapy, catastrophic bleeding lead to hypovolemic shock. After resuscitation and blood transfusion, we attempt to control the bleeding with evacuation and curettage but was unsuccessful. Bakri SOS balloon tamponade was applied with immediate and effective response. Nevertheless, total abdominal hysterectomy was performed. In conclusion, conservative treatment of cervical pregnancy with systemic methotrexate could be catastrophic in some patients. Control of active bleeding with Bakri SOS balloon tamponade may possibly be helpful in case of uncontrolled bleeding in selected cases. PMID:23929636

  7. Efficacy of Transcerebellar Diameter/Abdominal Circumference Versus Head Circumference/Abdominal Circumference in Predicting Asymmetric Intrauterine Growth Retardation

    PubMed Central

    Bhimarao; Bhat, Venkataramana; Gowda, Puttanna VN

    2015-01-01

    Background The high incidence of IUGR and its low recognition lead to increasing perinatal morbidity and mortality for which prediction of IUGR with timely management decisions is of paramount importance. Many studies have compared the efficacy of several gestational age independent parameters and found that TCD/AC is a better predictor of asymmetric IUGR. Aim To compare the accuracy of transcerebellar diameter/abdominal circumference with head circumference/abdominal circumference in predicting asymmetric intrauterine growth retardation after 20 weeks of gestation. Materials and Methods The prospective study was conducted over a period of one year on 50 clinically suspected IUGR pregnancies who were evaluated with 3.5 MHz frequency ultrasound scanner by a single sonologist. BPD, HC, AC and FL along with TCD were measured for assessing the sonological gestational age. Two morphometric ratios- TCD/AC and HC/AC were calculated. Estimated fetal weight was calculated for all these pregnancies and its percentile was determined. Statistical Methods The TCD/AC and HC/AC ratios were correlated with advancing gestational age to know if these were related to GA. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and diagnostic accuracy (DA) for TCD/AC and HC/AC ratios in evaluating IUGR fetuses were calculated. Results In the present study, linear relation of TCD and HC in IUGR fetuses with gestation was noted. The sensitivity, specificity, PPV, NPV & DA were 88%, 93.5%, 77.1%, 96.3% & 92.4% respectively for TCD/AC ratio versus 84%, 92%, 72.4%, 95.8% & 90.4% respectively for HC/AC ratio in predicting IUGR. Conclusion Both ratios were gestational age independent and can be used in detecting IUGR with good diagnostic accuracy. However, TCD/AC ratio had a better diagnostic validity and accuracy compared to HC/AC ratio in predicting asymmetric IUGR. PMID:26557588

  8. [Breast cancer in pregnancy].

    PubMed

    Maranghi, V; Di Meo, G; Carillo, C

    1994-01-01

    Breast cancer in pregnancy is a very rare condition. At present this doesn't seem a condition with a particularly grim prognosis. It's often only an underestimate of the mammalian masses in pregnancy which produces a delay in the diagnosis and the consequent grim prognosis. The authors recommend on the basis of their experience a careful control of mammalian masses in pregnancy and an opportune diagnosis that allows to operate as soon as possible. It's likewise underlined that interruption of the pregnancy don't seem to improve the prognosis. PMID:8177461

  9. Iron supplementation in pregnancy.

    PubMed

    Mngen, Ercment

    2003-01-01

    Iron deficiency is the most common nutritional disorder in the world. Pregnant women are at especially high risk for iron deficiency and iron deficiency anemia. A considerable proportion of pregnant women in both developing and industrialized countries become anemic during pregnancy. The prevalence of anemia in pregnant women has remained unacceptably high worldwide despite the fact that routine iron supplementation during pregnancy has been almost universally recommended to prevent maternal anemia, especially in developing countries over the past 30 years. The major problem with iron supplementation during pregnancy is compliance. Despite many studies, the relationship between maternal anemia and adverse pregnancy outcome is unclear. However, there is now sufficient evidence that iron supplements increase hemoglobin and serum ferritin levels during pregnancy and also improve the maternal iron status in the puerperium, even in women who enter pregnancy with adequate iron stores. Recent information also suggests an association between maternal iron status in pregnancy and the iron status of infants postpartum. The necessity of routine iron supplementation during pregnancy has been debated in industrialized countries and routine supplementation is not universally practiced in all these countries. In view of existing data, however, routine iron supplementation during pregnancy seems to be a safe strategy to prevent maternal anemia in developing countries, where traditional diets provide inadequate iron and where malaria and other infections causing increased losses are endemic. PMID:14601265

  10. Pituitary gland and pregnancy.

    PubMed

    Foyouzi, Nastaran; Frisbaek, Yr; Norwitz, Errol R

    2004-12-01

    The hypothalamic-pituitary-adrenal axis is central to mammalian reproductive function, including conception, pregnancy maintenance, parturition, and breastfeeding. Pregnancy is associated with substantial physiologic changes within this endocrine axis to meet the demands of pregnancy, which include support of the fetus (volume support, nutritional and oxygen supply, clearance of fetal waste), protection of the fetus (from starvation, drugs, toxins), preparation of the uterus for labor, and protection of the mother from potential cardiovascular injury at delivery. This article reviews the anatomy, embryology, and physiology of the pituitary. The effect of pregnancy on pituitary structure and function, in health and disease, also is discussed. PMID:15550340

  11. Hypoparathyroidism in pregnancy.

    PubMed

    Shah, Krupa Hitesh; Bhat, Shashikala; Shetty, Seema; Umakanth, Shashikiran

    2015-01-01

    Hypoparathyroidism is an uncommon endocrine deficiency characterised by low serum calcium, absent or inappropriately low parathyroid hormone and normal or high serum phosphorus levels. Parathyroid hormone is essential for calcium homoeostasis. Pregnancy and lactation are known for increased calcium requirement. They cause calcium stress as well as alter its metabolism. Hence, many abnormalities are expected in hypoparathyroidism during pregnancy and lactation. We report a case of pregnancy in postsurgical hypoparathyroidism, which is rarely encountered in antenatal clinics. We describe our clinical, biochemical and therapeutic experience of pregnancy and lactation in this patient with hypoparathyroidism. PMID:26178001

  12. Hyperthyroidism and pregnancy.

    PubMed

    Gargallo Fernández, Manuel

    2013-11-01

    Association of hyperthyroidism and pregnancy is not an unusual event, and has an impact on both the mother and fetus. After delivery, it may also affect the newborn and the nursing mother. Clinical management of this situation is quite different from that required by non-pregnant hyperthyroid women and poses significant diagnostic and therapeutic challenges. This review addresses aspects related to the unique characteristics of biochemical assessment of thyroid function in pregnancy, the potential causes of hyperthyroidism in pregnancy, and the clinical and therapeutic approach in each case. Special attention is paid to pregnancy complicated with Graves' disease and its different the maternal, fetal, neonatal, and postnatal consequences. PMID:23477757

  13. Why battering during pregnancy?

    PubMed

    Campbell, J C; Oliver, C; Bullock, L

    1993-01-01

    This exploratory study was designed to determine the reasons men might beat their female partners during pregnancy from the perspectives of women who had experienced this form of violence. Seventy-nine battered women were recruited by newspaper advertisement and bulletin board postings to take part in a larger study of women's responses to relationship problems. Women battered in their relationships were asked if they had ever been beaten during pregnancy. The 27 (34%) women who had a pregnancy with the abusive partner as the father and had experienced physical abuse during the pregnancy were compared with 24 (30%) women who also had been pregnant by the abuser but had not been abused during pregnancy. The only significant difference between the two groups was that the women battered during pregnancy were more frequently and severely beaten throughout the course of the relationship. Those abused during pregnancy were asked why they thought that had happened. Their answers were thematically analyzed into the categories: (1) jealousy of the unborn child; (2) anger toward the unborn child; (3) pregnancy-specific violence not directed toward the unborn child; and (d) "business as usual." Implications for nursing assessment and interventions for abuse during pregnancy are derived from this analysis. PMID:8369762

  14. [Liver diseases and pregnancy].

    PubMed

    Guettrot-Imbert, G; Plessier, A; Hillaire, S; Delluc, C; Leroux, G; Le Guern, V; Costedoat-Chalumeau, N

    2015-03-01

    Liver disease can be observed in pregnant women whether or not related to pregnancy. Liver disorders can be revealed by pruritus, vomiting, jaundice or abnormal liver blood tests during pregnancy. These liver manifestations can lead to the diagnosis of liver disease specifically associated to pregnancy as intrahepatic pregnancy, intrahepatic cholestasis of pregnancy, Hyperemesis gravidarum, acute fatty liver of pregnancy and preeclampsia-induced liver injury. Pregnancy may also be a risk factor for other liver diseases coincident with pregnancy as viral hepatitis, thrombosis, drug toxicity or gallstone. Finally, pre-existing liver disease must be taken into account given the risk of fto-maternal transmission risk as well as the risk of decompensation of underlying cirrhosis secondary to the hemodynamic changes caused by pregnancy. The aim of this revue is to perform an update on the various situations that can be observed, the principles of management of these liver diseases, in order to reduce the risk of complications and to ensure the best maternal and fetal prognosis. PMID:25591870

  15. Abdominal aortic aneurysm and diastasis recti.

    PubMed

    McPhail, Ian

    Midline abdominal incisional hernias are common following open repair of abdominal aortic aneurysms. These may be caused by the weakness of connective tissue. This study sought to determine the prevalence of diastasis recti among unoperated Caucasian males with abdominal aortic aneurysm compared to a control group with atherosclerotic lower extremity peripheral arterial disease. Forty-two consecutive white males referred for evaluation of abdominal aortic aneurysm (n = 18) or peripheral arterial disease (n = 24) were examined by a single examiner at the Mayo Clinic. Both groups were similar in terms of age and smoking history, 2 major risk factors for both abdominal aortic aneurysm and peripheral arterial disease. Abdominal aortic aneurysm patients ranged in age from 59 to 89 (mean, 73.2) years. Seventeen of 18 (94.4%) had a history of smoking. Peripheral arterial disease patients ranged in age from 52 to 93 (mean, 70.8) years. Twenty-one of 24 (87.5%) had a history of smoking. Diastasis recti were present in 12 of 18 (66.7%) subjects with abdominal aortic aneurysm versus 4 of 24 (16.7%) subjects with peripheral arterial disease (P = .001, 2-tailed Fisher exact test). Diastasis recti are significantly more common in males with abdominal aortic aneurysm than peripheral arterial disease and may provide an important clue to screen for abdominal aortic aneurysm in those at risk. PMID:18550558

  16. Reclosure of disrupted abdominal incisions.

    PubMed

    Walters, M D; Dombroski, R A; Davidson, S A; Mandel, P C; Gibbs, R S

    1990-10-01

    We evaluated prospectively a technique of delayed reclosure of disrupted abdominal incisions. Forty-one consecutive postoperative obstetric and gynecologic patients with abdominal incisions that had opened because of infection, hematoma, or seroma and had intact fascia participated in the study. All wounds were first managed identically, with surgical drainage and debridement, for a minimum of 4 days. The patients then were randomized to either wound reclosure by a standardized en bloc technique (35) or healing by second intention (six). Reclosure was successful in 30 of 35 cases (85.7%). The mean time to complete healing was 15.8 days in successful cases, 67.2 days in failed cases, and 23.2 days for all patients who were reclosed. Failure to heal after reclosure was due to subcutaneous infection in two patients and seroma in three; these women were significantly heavier than those in whom reclosure was successful. There were no other major complications of wound reclosure. Patients randomized to healing by second intention required a mean of 71.8 days of wound care. The time to complete healing in the wound-reclosure group was significantly shorter compared with the group that healed by second intention (P = .002, log rank test). We conclude that en bloc reclosure of disrupted surgical incisions, compared with nonsurgical treatment, significantly decreases the time required for wound healing and has minimal morbidity. PMID:2216186

  17. Advanced techniques in abdominal surgery.

    PubMed Central

    Monson, J R

    1993-01-01

    Almost every abdominal organ is now amenable to laparoscopic surgery. Laparoscopic appendicectomy is a routine procedure which also permits identification of other conditions initially confused with an inflamed appendix. However, assessment of appendiceal inflammation is more difficult. Almost all colonic procedures can be performed laparoscopically, at least partly, though resection for colonic cancer is still controversial. For simple patch repair of perforated duodenal ulcers laparoscopy is ideal, and inguinal groin hernia can be repaired satisfactorily with a patch of synthetic mesh. Many upper abdominal procedures, however, still take more time than the open operations. These techniques reduce postoperative pain and the incidence of wound infections and allow a much earlier return to normal activity compared with open surgery. They have also brought new disciplines: surgeons must learn different hand-eye coordination, meticulous haemostasis is needed to maintain picture quality, and delivery of specimens may be problematic. The widespread introduction of laparoscopic techniques has emphasised the need for adequate training (operations that were straight-forward open procedures may require considerable laparoscopic expertise) and has raised questions about trainee surgeons acquiring adequate experience of open procedures. Images FIG 9 p1347-a p1347-b p1349-a p1350-a p1350-b PMID:8257893

  18. Ectopic Atoh1 expression drives Merkel cell production in embryonic, postnatal and adult mouse epidermis.

    PubMed

    Ostrowski, Stephen M; Wright, Margaret C; Bolock, Alexa M; Geng, Xuehui; Maricich, Stephen M

    2015-07-15

    Merkel cells are mechanosensitive skin cells whose production requires the basic helix-loop-helix transcription factor Atoh1. We induced ectopic Atoh1 expression in the skin of transgenic mice to determine whether Atoh1 was sufficient to create additional Merkel cells. In embryos, ectopic Atoh1 expression drove ectopic expression of the Merkel cell marker keratin 8 (K8) throughout the epidermis. Epidermal Atoh1 induction in adolescent mice similarly drove widespread K8 expression in glabrous skin of the paws, but in the whisker pads and body skin ectopic K8+ cells were confined to hair follicles and absent from interfollicular regions. Ectopic K8+ cells acquired several characteristics of mature Merkel cells in a time frame similar to that seen during postnatal development of normal Merkel cells. Although ectopic K8+ cell numbers decreased over time, small numbers of these cells remained in deep regions of body skin hair follicles at 3 months post-induction. In adult mice, greater numbers of ectopic K8+ cells were created by Atoh1 induction during anagen versus telogen and following disruption of Notch signaling by conditional deletion of Rbpj in the epidermis. Our data demonstrate that Atoh1 expression is sufficient to produce new Merkel cells in the epidermis, that epidermal cell competency to respond to Atoh1 varies by skin location, developmental age and hair cycle stage, and that the Notch pathway plays a key role in limiting epidermal cell competency to respond to Atoh1 expression. PMID:26138479

  19. Vaginal bleeding in early pregnancy

    MedlinePLUS

    Vaginal bleeding during pregnancy is any discharge of blood from the vagina. It can happen any time from conception (when ... to the end of pregnancy. Some women have vaginal bleeding during their first 20 weeks of pregnancy.

  20. Depression During and After Pregnancy

    MedlinePLUS

    ... Depression during and after pregnancy fact sheet ePublications Depression during and after pregnancy fact sheet This information in Spanish (en español) Print this fact sheet Depression during and after pregnancy fact sheet (PDF, 260 ...

  1. Pregnancy and Irritable Bowel Syndrome

    MedlinePLUS

    ... menstrual cycle influences IBS symptom. This suggests that ovarian hormones, which are elevated in pregnancy, may contribute to ... in stool frequency during pregnancy. Changes in the ovarian hormones, which are elevated during pregnancy, and the physical ...

  2. Combined laparoscopy and hysteroscopy vs. uterine curettage in the uterine artery embolization-based management of cesarean scar pregnancy: a cohort study

    PubMed Central

    Wu, Xin; Xue, Xiaohong; Wu, Xuezhe; Lin, Ru; Yuan, Ying; Wang, Qing; Xu, Congjian; He, Yifeng; Hu, Weiguo

    2014-01-01

    Aim: To evaluate the efficacy of combined laparoscopy and hysteroscopy compared with traditional uterine curettage in removing the ectopic conceptus and repairing the tissue defect following uterine artery embolization (UAE) management of cesarean scar pregnancy (CSP). Design: A prospective cohort study. Setting: Three large obstetrics and gynecology centers in Shanghai, China. Sample: CSP patients diagnosed between March 2009 and August 2010 who had received no prior treatments, were hemodynamically stable, and had no contraindications for UAE were enrolled. Methods: Patients were divided into two cohorts to undergo the intra-arterial methotrexate (MTX), UAE, and one of the following treatments: combined laparoscopy and hysteroscopy (research group, 25 cases) and uterine curettage (control group, 33 cases). Main Outcome Measures: The conceptus removal rate, the severity of intra- and postoperative complications, surgical time, and duration of hospital stay. Results: The single-surgery conceptus removal rate reached 100% in the research group, which was significantly higher than the 82% (P=0.024) observed in the control group (with one hysterectomy). The average volume of intraoperative blood loss was 78.0 mL in the research group, which was much less than the 258.5 mL (P=0.004) in the control group. Moreover, the research group had significantly shorter hospital stays and ?-hCG regression times, as well as lower rates of postoperative abdominal pain, uterine bleeding and menstruation abnormalities. Conclusions: Combined laparoscopy and hysteroscopy is much safer and more effective than uterine curettage as a supplementary measure following UAE. PMID:25356141

  3. Abdominal signals: denoising by application of the event synchronuous canceller.

    PubMed

    Tar?lung?, D; Wolf, W; Strungaru, R; Ungureanu, G M

    2007-01-01

    The electrical activity recorded on the abdomen during pregnancy and labor (abdominal signals, ADS) contains vital information about the health state of both mother and fetus. The most important signal related with the health of fetus, extensively studied by now, is the fetal ECG (fECG) which allows physicians to examine the evolution of the fetus and to identify possible heart diseases of fetus. The movement of the fetus which shows up in the electrohysterogram (EHG), extracted from ADS, indicates a normal pregnancy. This paper presents a method of removing the maternal ECG (mECG) from ADS in order extract the EHG and to obtain information about the uterine contractions and fetal movements. After removing the mECG and the fECG, the ADS, filtered in the frequency range of the uterine activity, is further used to predict labor or preterm labor. The ADS, cleaned from the mECG allows also the analysis of the fECG for fetal monitoring. PMID:18002019

  4. Acute fatty liver of pregnancy associated with severe acute pancreatitis: A case report

    PubMed Central

    de Oliveira, Cássio Vieira; Moreira, Alecsandro; Baima, Julio P; Franzoni, Leticia de C; Lima, Talles B; Yamashiro, Fabio da S; Coelho, Kunie Yabuki Rabelo; Sassaki, Ligia Y; Caramori, Carlos Antonio; Romeiro, Fernando G; Silva, Giovanni F

    2014-01-01

    Acute fatty liver of pregnancy is a rare disease that affects women in the third trimester of pregnancy. Although infrequent, the disease can cause maternal mortality. The diagnosis is not always clear until the pregnancy is terminated, and significant complications, such as acute pancreatitis, can occur. Pancreatic involvement typically only occurs in severe cases after the development of hepatic and renal impairment. To date, little knowledge is available regarding how the disease causes pancreatitis. Treatment involves supportive measures and pregnancy interruption. In this report, we describe a case of a previously healthy 26-year-old woman at a gestational age of 27 wk and 6 d who was admitted with severe abdominal pain and vomiting. This case illustrates the clinical and laboratory overlap between acute fatty liver of pregnancy and pancreatitis, highlighting the difficulties in differentiating each disease. Furthermore, the hypothesis for this overlapping is presented, and the therapeutic options are discussed. PMID:25068005

  5. Management of an Iatrogenic Injury in a Crossed Ectopic Kidney Without Fusion

    PubMed Central

    Kamal, Mir Reza; Mukherjee, Satyadip; Mandal, Soumendra Nath; Karmakar, Dilip

    2014-01-01

    Crossed renal ectopia is a condition in which a kidney is located on the side opposite of its ureteral insertion. Ninety percent of crossed ectopic kidneys are fused to their ipsilateral uncrossed renal unit. Crossed renal ectopia without fusion is rare, with only 62 patients reported in the literature to date. These kidneys may suffer iatrogenic injury during an unrelated surgical intervention. The injury, unless self-limiting, may necessitate the removal of the ectopic kidney. We present a unique case of a dual injury, renal as well as ureteric, in a crossed ectopic kidney without fusion that was successfully managed without surgical excision. PMID:25132952

  6. Severe Hypokalaemia, Hypertension, and Intestinal Perforation in Ectopic Adrenocorticotropic Hormone Syndrome

    PubMed Central

    Karacaer, Cengiz; Açikgöz, Seyyid Bilal; Aydemir, Yusuf; Tamer, Ali

    2016-01-01

    Ectopic adrenocorticotropic hormone (ACTH) syndrome is a rare cause of the Cushing’s syndrome. The occurrence of the ectopic ACTH syndrome presenting with severe hypokalaemia, metabolic alkalosis, and hypertension has been highlighted in case reports. However, presentation with lower gastrointestinal perforation is not known. We report the case of a 70-year-old male patient with severe hypokalaemia, metabolic alkalosis, hypertension, and colonic perforation as manifestations of an ACTH-secreting small cell lung carcinoma. Ectopic ACTH syndrome should be kept in mind as a cause of hypokalaemia, hypertension, and intestinal perforation in patients with lung carcinoma. PMID:26894113

  7. Fibroadenoma in an ectopic vulvar breast gland: a common neoplasm in an uncommon site.

    PubMed

    Ayadi-Kaddour, A; Khadhar, A; Mlika, M; Braham, E; Ismail, O; Zegal, D; El Mezni, F

    2014-03-01

    Ectopic breast tissue is defined as glands located outside of the breast. It can be found anywhere along the milk line extending from the axilla to the groin, and can occur in the vulva. Ectopic breast tissue should be excised because it may develop benign or malignant pathologic processes. Less than 40 cases of fibroadenoma in the vulva have been reported in the literature. We report a case of a 37-year-old woman presenting a solitary vulvar mass. The mass was excised completely, and histology demonstrated an ectopic breast fibroadenoma. This is one of the few reports on the benign pathologies of vulvar mammary glands. PMID:24897780

  8. Mediastinal ectopic parathyroid adenoma: report of two cases successfully treated by VATS approach.

    PubMed

    Akin, H; Gunluoglu, Z; Kara, V; Melek, H; Dincer, I

    2008-02-01

    Ectopic parathyroid adenomas are the cause of approximately one in four cases of primary hyperparathyroidism (pHPT). Most ectopic parathyroid adenomas are located adjacent to the upper thymus gland and can be resected with a collar incision. In rare cases, however, adenomas located in the chest require a transsternalor transthoracic approach. Due to the high rate of morbidity with a sternotomy or thoracotomy, minimally invasive methods such as video-assisted thoracoscopic surgery (VATS) or video-assisted mediastinoscopic surgery (VAMS) are becoming increasingly popular. We present two cases with primary hyperparathyroidism due to mediastinal ectopic parathyroid adenoma that were successfully treated by VATS approach. PMID:18200473

  9. Primary Ectopic Mediastinal Goiter in a Patient With Crohn's Disease Presenting as Myasthenia Gravis.

    PubMed

    Kumar, Sunil; Sultania, Mahesh; Vatsal, Shivam; Sharma, M C

    2015-12-01

    Mediastinum is an uncommon location for ectopic goiter. Primary ectopic mediastinal goiter has been reported to present mostly with compressive symptoms. We report a case of a 62-year-old man with history of Crohn's disease, who presented with symptoms of myasthenia gravis and was found to have an anterior mediastinal mass. The mass was resected completely with successful outcome. On histopathologic examination this mass turned out to be colloid goiter. This is an extremely rare presentation of a primary ectopic mediastinal goiter. PMID:26652525

  10. Impact of caesarean section on future pregnancy--a review of cohort studies.

    PubMed

    Hemminki, E

    1996-10-01

    Use of Caesarean sections has notably increased in many countries. This article reviews existing cohort type studies to compare subsequent reproduction after Caesarean section with a comparable control group, with exposure at the earliest in the 1960s. Eight studies were found. They suggested that a Caesarean section is a risk factor for lowered fertility, for uncompleted pregnancy (ectopic pregnancy and possibly miscarriage), for complications in the next pregnancy and birth (including placental complications) and for health problems in the next infant. The review was impeded by the lack of relevant research, and all studies to date potentially suffer from selection bias by indication. Trials and other studies on the long-term outcomes of Caesarean sections are needed, especially in populations with a high risk for reproductive problems. PMID:8931052

  11. Novel Medical Therapy of Cesarean Scar Pregnancy With a Viable Embryo Combining Multidose Methotrexate and Mifepristone

    PubMed Central

    Kalampokas, Emmanouil; Boutas, Ioannis; Panoulis, Konstantinos; Kalampokas, Theodoros

    2015-01-01

    Abstract An ectopic pregnancy is defined as cesarean scar pregnancy (CSP) when the products of conception are implanted within the myometrium in the area of a cesarean section scar. CSP can be a life-threatening condition and to date there is no clear consensus for CSP management. A medical approach joining high treatment rates with fertility preservation could be a safer and less invasive method of therapy. We present a case of CSP with a viable embryo that was successfully treated with a novel medical therapy combining multidose methotrexate (MTX) and mifepristone. No further additional invasive procedure was required since pregnancy products were dissolved and no major complications were experienced. Multidose MTX and mifepristone can be considered a safe and effective treatment for CSP. PMID:26469907

  12. Pseudoephedrine, Phenylephrine and Pregnancy

    MedlinePLUS

    ... related to an increase in the risk of gastroschisis, which is an opening in the baby’s abdominal ... chance that you could have a child with gastroschisis because you took pseudoephedrine is very small, with ...

  13. Thyrotoxicosis of Pregnancy

    PubMed Central

    Labadzhyan, Artak; Brent, Gregory A.; Hershman, Jerome M.; Leung, Angela M.

    2014-01-01

    Thyrotoxicosis presenting during pregnancy is a common clinical problem and can be challenging to differentiate between physiologic patterns of thyroid dysfunction during gestation and intrinsic hyperthyroidism. This review provides a summary of the differential diagnosis, clinical presentation, diagnostic options, potential adverse effects of maternal thyrotoxicosis to the fetus, and treatment recommendations for thyrotoxicosis arising in pregnancy. PMID:25243108

  14. Prevent Infections in Pregnancy

    MedlinePLUS

    ... Arrives Trouble Getting Pregnant Avoiding Pregnancy Articles Preventing Infections in Pregnancy Language: English Español (Spanish) Recommend on Facebook Tweet Share Compartir You can prevent infections and help keep your unborn baby safe. Here’s ...

  15. Sleeping during Pregnancy

    MedlinePLUS

    ... 30% to 50% more than you had before pregnancy) moving through your body, and this filtering process results in more urine. Also, as your baby grows and the uterus gets bigger, the pressure on your bladder increases. This ... heart rate increases during pregnancy to pump more blood, and as more of ...

  16. Cardiac Physiology of Pregnancy.

    PubMed

    May, Linda

    2015-07-01

    Although the physiology of the heart and vascular system has not changed, there are many things we have learned and are still learning today. Research related to heart adaptations during pregnancy has been performed since the 1930s. Since the mid-1950s, researchers began to look at changes in the maternal cardiovascular system during exercise while pregnant. Research related to exercise during pregnancy and offspring heart development began and has continued since the 1970s. We will review the normal female cardiovascular system adaptations to pregnancy in general. Additionally, topics related to maternal cardiac adaptations to pregnancy during acute exercise, as well as the chronic conditioning response from exercise training will be explored. Since physical activity during pregnancy influences fetal development, the fetal cardiac development will be discussed in regards to acute and chronic maternal exercise. Similarly, the influence of various types of maternal exercise on acute and chronic fetal heart responses will be described. Briefly, the topics related to how and if there is maternal-fetal synchrony will be explained. Lastly, the developmental changes of the fetal cardiovascular system that persist after birth will be explored. Overall, the article will discuss maternal cardiac physiology related to changes with normal pregnancy, and exercise during pregnancy, as well as fetal cardiac physiology related to changes with normal development, and exercise during pregnancy as well as developmental changes in offspring after birth. PMID:26140720

  17. Moclobemide in pregnancy.

    PubMed

    Rybakowski, J K

    2001-03-01

    We report on the case of female patient with chronic dysthymia, who took moclobemide at 300 mg/day throughout her first pregnancy. The course of pregnancy was healthy, and natural delivery was uneventful. The psychomotoric and somatic development of the child within first 14 months of life has been normal. PMID:11302569

  18. Smoking and Pregnancy

    MedlinePLUS

    Smoking and Pregnancy Smoking can cause problems for a woman trying to become pregnant or who is already pregnant, and for her baby ... too early • Pregnancy occurs outside of the womb Smoking causes these health effects. Smoking could cause these ...

  19. Metastatic pancreatic neuroendocrine tumor with ectopic adrenocorticotropic hormone production

    PubMed Central

    Nagarur, Amulya; Kerr, Darcy A.; Lauter, Kelly B.; Padmanabhan, Arun; Raghavan, Srivatsan; Pallais, Juan C.; Fenves, Andrew Z.

    2015-01-01

    We describe a 71-year-old man who presented with abdominal pain, lower-extremity edema, recent unintentional weight loss, hypertension, hyperglycemia, hypokalemia, and metabolic alkalosis. Serum cortisol levels remained elevated after overnight high-dose dexamethasone suppression. Magnetic resonance imaging revealed a small mass in the head of the pancreas with scattered liver metastases. Both endoscopic ultrasound-guided pancreatic biopsy and liver biopsy revealed a well-differentiated neuroendocrine tumor. These lesions did not show significant uptake on octreotide scan. Medical management and hepatic artery chemoembolization were attempted. Ultimately, the patient underwent bilateral adrenalectomy, but died within 4 months of symptom onset secondary to postoperative complications. PMID:25552797

  20. Abdominal aortic pseudoaneurysm secondary to melioidosis.

    PubMed

    Rao, Jaideepraj; Kaushal, A S; Hoong, Chia Kok

    2009-01-01

    Melioidosis is an infective condition which is common in South East Asia. It can present in various forms like cutaneous abscess, pneumonia and severe septicaemia. However, melioidosis causing abdominal aortic pseudoaneurysms is extremely rare and a difficult condition to diagnose and treat. We present our management of two cases of abdominal aortic pseudoaneurysms secondary to melioidosis and their subsequent outcomes. PMID:19321406