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Secondary abdominal appendicular ectopic pregnancy.  


Although the case fatality rate for ectopic pregnancies has decreased to 0.08% in industrialized countries, it still represents 3.8% of maternal mortality in the United States alone. In developing countries, the case fatality rate varies from 3% to 27%. Laparoscopic management of tubal pregnancies is now the standard form of treatment where this technology is available. Abdominal pregnancies are rare, and secondary implantation of tubal ectopic pregnancies is the most common cause of abdominal gestations. We present an interesting case of secondary implantation of a tubal ectopic pregnancy to highlight the appendix as a possible secondary implantation site after a tubal ectopic pregnancy. PMID:17630175

Nama, Vivek; Gyampoh, Bright; Karoshi, Mahantesh; McRae, Reynold; Opemuyi, Isaac


Secondary abdominal appendicular ectopic pregnancy  

Microsoft Academic Search

Although the case fatality rate for ectopic pregnancies has decreased to 0.08% in industrialized countries, it still represents 3.8% of maternal mortality in the United States alone. In developing countries, the case fatality rate varies from 3% to 27%. Laparoscopic management of tubal pregnancies is now the standard form of treatment where this technology is available. Abdominal pregnancies are rare,

Vivek Nama; Bright Gyampoh; Mahantesh Karoshi; Reynold McRae; Isaac Opemuyi



Undiagnosed case of term heterotopic pregnancy with ectopic abdominal pregnancy.  


Heterotopic pregnancy involves coexisting intra-uterine and extra-uterine gestations. The incidence for natural uninduced pregnancy is 1 in 30,000 pregnancies. However the incidence is increasing with ovulation induction and artificial reproductive techniques. In more than 90% heterotopic pregnancies, the ectopic implantation is in the fallopian tube. A case of undiagnosed term heterotopic pregnancy in a 26-year-old primigravida is reported. She was referred from a practising obstetrician as a case of term twin pregnancy. Her regular antenatal records suggested intra-uterine growth restriction in one foetus of the twin. After confirmation of findings with ultrasound she was taken for emergency caesarean section. Heterotopic pregnancy was diagnosed on opening the abdomen. The term abdominal pregnancy was managed successfully. Although remained undiagnosed till term, good maternal and perinatal outcome was noted with survival of both the babies. PMID:22482330

Tripathi, Jagruti B; Patel, B S; Rawal, Smruti A; Garg, Shelza



Ectopic Pregnancy  


... to the uterus and implants somewhere else (see drawing below). An ectopic pregnancy most often occurs in the fallopian tube, causing a “tubal pregnancy.” It can also occur in the ovary, cervix or abdomen. It is important to find the ectopic pregnancy ...


Ectopic Pregnancy  

Microsoft Academic Search

\\u000a The incidence of ectopic pregnancies has risen significantly to 2% of all pregnancies. A thorough clinical evaluation for\\u000a surgical and gynecologic history and social risk factors can alert the clinician to patients at risk. Patients at risk or\\u000a high suspicion should be followed closely until their ?-hCG exceeds the discriminatory zone at which time ultrasound and dilation\\u000a and curettage can

Stephan Krotz; Sandra Carson


Ectopic/Tubal Pregnancy  


... egg continues to grow developing into a fetus. Ectopic pregnancy: An ectopic pregnancy happens when a fertilized egg implants itself outside of the uterus. An ectopic pregnancy can occur in the o vary, abdomen, cervix ...


Ectopic pregnancy (image)  


An ectopic pregnancy is one in which the fertilized egg implants in tissue outside of the uterus and the placenta ... common site is within a Fallopian tube, however, ectopic pregnancies can occur in the ovary, the abdomen, and ...


Spontaneous bilateral tubal ectopic pregnancy.  


A 28-year-old woman presented at eight weeks and four days of gestation, according to her menstrual dates, complaining of painless vaginal bleeding for three days. Her urinary pregnancy test was positive. Initial transvaginal ultrasound demonstrated an irregular complex structure with a fluid filled centre in the right adnexum. Despite the diagnosis of a possible underlying unruptured right tubal ectopic pregnancy, she declined surgical intervention and was managed expectantly as an inpatient. When she complained of increasing abdominal pain with haemodynamic instability, an emergency laparotomy was performed and a diagnosis of bilateral tubal ectopic pregnancy was made. PMID:19391453

Marasinghe, Jeevan P; Condous, George; Amarasinghe, W I



Ultrasound in the diagnosis of ectopic pregnancy.  


The majority of ectopic pregnancies can be diagnosed on transvaginal scan before treatment. Diagnosis should be based on positive visualization of an ectopic pregnancy rather the inability to visualize an intrauterine pregnancy. The majority of ectopic pregnancies will be visible on the initial transvaginal scan performed. Those who do not have their ectopic pregnancies visualized on the first examination will be initially classified as having a pregnancy of unknown location. They will then need follow-up until a diagnosis of ectopic pregnancy is confirmed. This review discusses the use of ultrasound in the diagnosis of ectopic pregnancy and the specific criteria for diagnosis of the different types of ectopic pregnancy. PMID:22510620

Kirk, Emma



Surgical treatment of ectopic pregnancy.  


Ectopic pregnancy remains the leading cause of death in the first trimester of pregnancy. Today, serial serum hCG measurements and transvaginal ultrasound examination can provide early detection of most ectopic pregnancies allowing medical treatment with methotrexate. In those who require surgery, the type of procedure depends on the clinical situation and the location of the pregnancy. Most of the cases can and should be performed by laparoscopy. Compared with laparotomy, the laparoscopic approach is associated with many advantages including short hospital stay, low cost and less adhesion formation. In addition, hemoperitoneum is not a contraindication for performing laparoscopy. Linear salpingostomy is the procedure of choice when unruptured tubal pregnancy is found in women who want to preserve their fertility; otherwise, salpingectomy is performed. Fertility performance after salpingostomy and salpingectomy is comparable. Similar to the case with tubal ectopic pregnancy in general, women with non-tubal ectopic pregnancy such as cervical, interstitial, or Caesarean scar pregnancy should be first treated medically with methotrexate. These types of ectopic pregnancies may be associated with massive bleeding during surgery. Precautionary procedures should be considered and these include the placement of an angiographic catheter for possible uterine artery embolization. These pregnancies can also be treated laparoscopically. PMID:19231293

Agdi, Mohammed; Tulandi, Togas



Ectopic pregnancy: the surgical epidemic.  

PubMed Central

Ectopic pregnancy has become a major health problem in terms of its morbidity and its impact on health care resources. In a case-control study involving 40 black patients, the odds ratio of developing ectopic pregnancy in current and former intrauterine device users is 11.7, which is statistically significant. The odds ratio for patients with a history of pelvic inflammatory disease is 4.4, which is statistically insignificant. A review of the current literature indicates Chlamydia salpingitis as the major cause of the ectopic epidemic. Prompt and effective treatment of this venereal disease may curtail health care expenses and prevent suffering of thousands of women each year.

Coupet, E.



MR features of ectopic pregnancy  

Microsoft Academic Search

Ectopic pregnancy (EP), in which a fertilized ovum implants outside the uterine cavity, is the leading cause of pregnancy-related\\u000a death in the first trimester. EP is usually suspected by a positive pregnancy test and an empty uterus on transvaginal sonography\\u000a (TVS). Although TVS is the initial modality of choice, it may occasionally fail to demonstrate the implantation site. When\\u000a TVS

Ken Tamai; Takashi Koyama; Kaori Togashi



Transvaginal sonographic findings of chronic ectopic pregnancy  

Microsoft Academic Search

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% (62305)

Cem Turan; Mustafa Ugur; Muammer Dogan; Eyüp Ekici; Kubilay Vicdan; Oya Gökmen




PubMed Central

Unless an ectopic pregnancy is visible by ultrasound, diagnosis can be a challenge. Differentiating ectopic pregnancies from intrauterine pregnancies can be impossible without intervention or follow-up. This poses a clinical dilemma to the practitioner given the inherent danger to the mother of tubal rupture of an ectopic pregnancy versus the fear of intervening in the case of a desired pregnancy without certainty of diagnosis. Early diagnostic modalities are clearly lacking, and serum biomarkers are currently being investigated as a solution to need for a rapid and accurate test for ectopic pregnancy.

Rausch, Mary E; Barnhart, Kurt



Ruptured ectopic pregnancy presenting 3 years after supracervical hysterectomy.  


An ectopic pregnancy after a hysterectomy is a rare event, with about 40 reported cases since it was first identified by Wendeler in 1895. There are even fewer cases reported of an ectopic pregnancy occurring years after a hysterectomy has been performed. This case illustrates the sonographic and computed tomographic (CT) findings in the setting of abdominal pain in a woman of childbearing age and highlights the need to obtain a urine pregnancy test as part of the workup for abdominal pain in women, even if a history of a hysterectomy has been given. Many providers may automatically exclude an ectopic pregnancy as a possibility in the aforementioned clinical scenario if the patient has a history of a hysterectomy. Such automatic exclusion may result in life-threatening consequences. PMID:18577674

Babikian, Sarkis; Thoma, David C; Berkey, Bryan D



Medical treatment of ectopic pregnancy.  


Background: The ectopic pregnancy (EP) is a public health problem and its frequency has doubled in most industrialized countries in 20 years. aim: To evaluate the effectiveness of medical treatment of ectopic pregnancy with methotrexate (MTX) intramuscularly (IM). methods: prospective study supported between October 2006 and December 2010. The selected patients received methotrexate IM (1 mg per kg). The monitoring was based on: the kinetics of plasma HCG, clinical examination and ultrasound. A second injection was performed if hCG on day 4 was increased by more than 25% or J7> the initial rate. Healing corresponded to obtain a zero rate of HCG in a stable manner. results:We used the first-line medical treatment in 122 patients. The average age of patients was 31.94 years. A haematosalpinx was found in 87.70% of cases. The initial rate of HCG plasma varied between 40 IU/ml and 4088 IU / ml, with an average of 805.88 m IU / ml. The primary success rate obtained after a single injection of intramuscular MTX was 67%. The high success rate obtained after two injections of MTX was 27%. The overall success rate after 1 or 2 injections of MTX was 82%. 17 patients underwent surgical treatment after a first injection of methotrexate. 5 patients underwent surgery after receiving two doses of methotrexate. The period of normalization of plasma levels of h CG was 24 days on average, with extremes ranging from 4 to 43 days for 67 patients cured after a single injection of MTX. This period was 33 days on average, with extremes ranging from 8 to 62 days for patients healed after two injections of MTX. Conclusion: Medical treatment applied to 38% of ectopic pregnancies diagnosed in our department is effective in 82% of cases if the inclusion criteria are strictly adhered to. Successful treatment is limited by patient compliance and demanding nature of monitoring. PMID:24008873

Mathlouthi, Nabil; Slimani, Olfa; Ferchichi, Amira; Ben Temime, Riadh; Makhlouf, Tahar; Attia, Leila; Chachia, Abdellatif



Tubal ectopic pregnancy: diagnosis and management  

Microsoft Academic Search

Ectopic pregnancy is the gynaecological emergency par excellence and remains the leading cause of pregnancy-related first\\u000a trimester deaths in the UK. Its prevalence continues to rise because of increases in the incidence of the risk factors predisposing\\u000a to ectopic pregnancy. Classically, the diagnosis is based on a history of pelvic pain associated with amenorrhoea, a positive\\u000a pregnancy test with or

Vivek Nama; Isaac Manyonda



Diagnosis and management of intramural ectopic pregnancy.  


Intramural pregnancy is a rare form of ectopic pregnancy, and little is known about its etiology, prevalence and natural history. There is no consensus regarding the ultrasound criteria necessary for the diagnosis of intramural pregnancy, and management strategies vary depending on the severity of clinical presentation, exact location of the pregnancy, viability and gestational age at diagnosis. We present four cases of intramural pregnancy diagnosed in a single institution that illustrate variability in their clinical presentation and difficulty in reaching the correct diagnosis. We also propose a set of ultrasound criteria to facilitate differential diagnosis between intramural and other types of uterine ectopic pregnancy. PMID:23417903

Memtsa, M; Jamil, A; Sebire, N; Jauniaux, E; Jurkovic, D



Ectopic pregnancy in Conakry, Guinea.  

PubMed Central

OBJECTIVE: To assess the incidence of ectopic pregnancy (EP) in hospitals in Conakry, the capital of Guinea, West Africa. Data on EP incidence in developing countries are rare and often out of date, particularly in Africa. METHODS: A retrospective study was carried out, examining all cases of EP registered in the medical files of two referral maternity units at the Donka and Ignace Deen university hospitals between 1995 and 1999. FINDINGS: The EP incidence at the two maternity units increased from 0.41% to 1.5% of annual deliveries over this period. Haemoperitoneum was observed in most women, with tubal rupture in 93%; only 6 women received conservative treatment. CONCLUSION: The results suggest that the hospital-based incidence of EP per delivery has increased over the last decade in this West African capital, and that health professionals and public health officials in developing countries, especially those in Africa, should consider EP as a major obstetric problem for maternal morbidity.

Thonneau, Patrick; Hijazi, Yolande; Goyaux, Nathalie; Calvez, Thierry; Keita, Namory



Ectopic pregnancy after infertility treatment  

PubMed Central

Early pregnancy complications are more common in women who conceive after infertility treatment. Most of these occur before 12 weeks of gestation and include miscarriage, vaginal bleeding, intrauterine hematoma, vanishing twin, and ectopic pregnancy (EP). The incidence of EPs following infertility treatment is much higher compared with that in spontaneous pregnancies. The occurrence of an EP is very distressing to an infertile couple, who has lots of hopes pinned on the treatment outcome, especially because of the cost incurred and the physical and mental trauma both have gone through during the treatment process. The association between infertility and EP is complex, as it can be a consequence of infertility as well as a cause. The two principal risk factors for an EP are genital tract infections and tubal surgeries. Though several etiologies are proposed, but patients with tubal factor infertility are at an increased risk of an EP. Earlier diagnosis of EP helps to improve prognosis and optimize subsequent fertility. It is pivotal to evaluate the likelihood of subsequent occurrence of an EP and be too vigilant when treating. The correct choice of the treatment modality should be made to prevent the recurrence. The early prediction of the pregnancy outcome therefore has great importance for both the couple and clinician. Today with the help of sensitive beta human chorionic gonadotropin (?-hCG) assays and transvaginal sonography, one can diagnose an EP prior to symptoms, and conservative treatment for the preservation of the fallopian tube is possible. Conservative management in the form of expectant and medical management should be considered as a first-line treatment modality, provided that the overall clinical picture suggests that it is safe to do so. If not, laparoscopic management of EPs appears to be the favored approach of management as compared to laparotomy.

Patil, Madhuri



Persistent Ectopic Pregnancy - A Case Report  

Microsoft Academic Search

The following case report describes a case of persistent ectopic pregnancy following laparoscopic segmental salpingectomy. The patient had an unusual presentation of acute abdomen and focal haemorrhage from omental implantation of the trophoblastic tissue.

N Shamini; B Chern


The ectopic pregnancy, a diagnostic and therapeutic challenge  

PubMed Central

The classic symptoms of ectopic pregnancy are secondary amenorrhoea, abdominal pain and vaginal haemorrhage, with a clinical picture of varying acuteness. It is among the commonest causes of maternal mortality during the first three months of pregnancy In the majority of cases (95%) the pregnancy is tubal, but other sites are possible (cervical, corneal, ovarian, peritoneal). In the treatment of sterility or medically assisted reproduction, the risk of ectopic pregnancy should be borne in mind. The individual risk factors may be cumulative, particularly with a previous history of extrauterine pregnancy or tubal surgery (including sterilisations), pelvic post–inflammatory status (adhesions proved by coelioscopy) or presence of an intrauterine device. Diagnosis is based on serum beta–hCG concentration and transvaginal ultrasound Laparoscopy is the treatment of choice for tubal pregnancies. The decision to perform salpingotomy depends on the presence/status of a contra lateral tube. In carefully selected cases local or intra–muscular administration of methotrexate allows conservative treatment, provided the patient does not present acute bleeding. It is also indicated where trophoblastic tissue persists after surgery, notably salpingostomy, and in non–tubal ectopic pregnancies. The latter are rare, however, and it is important to recognise them in view of the more serious complications.

Buss, J



An Ectopic Pregnancy in the Tubal Interstitium: Beware!  

PubMed Central

An interstitial ectopic pregnancy is a rare and a dangerous form of an ectopic pregnancy. It presents late clinically and it is difficult to be imaged radiographically. We are presenting a case of an interstitial pregnancy which was a surprise intra operative finding. As Assisted Reproductive Technology (ART) procedures are becoming popular, the incidence of ectopic pregnancies is likely to increase. The clinicians should be well equipped to diagnose and to treat this unusual form of ectopic pregnancies at the earliest.

Sharma, Nidhi; Rohini; Upasana



Diagnosis and management of ectopic pregnancy.  


Ectopic pregnancy remains to be an important cause of maternal morbidity and mortality worldwide, although the incidence has remained unchanged especially in developed countries over the last decade. Several factors are responsible for this, including misdiagnosis and failure to institute timely appropriate treatment aimed at preserving fertility and minimizing the associated morbidity. Recent advances in imaging and biomonitoring have reduced the number of women presenting with ruptured ectopic pregnancy. Any attempt to reduce the consequences of ectopic pregnancies must, therefore, focus on improving the diagnosis of the unruptured type and evidenced-based treatment, which is cost effective. In this review, the authors discuss the diagnosis and treatment of this complication in the light of the recent evidence highlighting how improvements can be made to reduce the consequences. PMID:23826778

Orazulike, Ngozi C; Konje, Justin C



Bilateral simultaneous isthmic ectopic pregnancy after clomiphene induction.  


A rare case of a 32-year-old patient with simultaneous bilateral isthmic tubal pregnancy. A 32-year-old woman with a 3-year history of primary infertility was admitted with light vaginal bleeding and mild abdominal pain. She was 41 days after her last menstruation and 23 day after intrauterine insemination with her husband's sperm. Clomiphene citrate (CC) was used for the induction of ovulation. In cases of ectopic pregnancy with ovulation induced by CC, doctors must be aware of the possibility of bilaterality. PMID:23441473

Pehlivanov, Blagovest K; Amaliev, Georgi I; Malinova, Maria L; Amaliev, Ilia G


Female Sterilization: Risk of Ectopic Pregnancy After Tubal Sterilization  


... Back to Female Sterilization Female Sterilization: Risk of Ectopic Pregnancy After Tubal Sterilization Fact Sheet Among 10,685 women studied, the risk of ectopic pregnancy within 10 years after sterilization was about 7 ...


Isolated fluid in the cul-de-sac: How well does it predict ectopic pregnancy?  

Microsoft Academic Search

We examined the risk of ectopic pregnancy among patients with isolated abnormal cul-de-sac fluid at transvaginal ultrasound. We conducted a retrospective cohort study of all ED patients presenting January 1995 to August 1999 with abdominal pain or vaginal bleeding and a positive [beta ]-hCG test. The risk of ectopic pregnancy in patients with a moderate volume of anechoic fluid was

Robert Dart; Samuel A. McLean; Linda Dart



Adnexal ring of ectopic pregnancy detected by contrast-enhanced CT  

Microsoft Academic Search

We present a case of a 37-year-old woman who presented with acute right lower quadrant abdominal pain. Work up with contrast\\u000a enhanced CT to rule out appendicitis revealed dramatic ring enhancing cystic structure in the right adnexa corresponding to\\u000a tubal ring sign of ectopic pregnancy seen on subsequent pelvic ultrasound. Right tubal ectopic pregnancy was confirmed at\\u000a surgery.

Hong Pham; Eugene C. Lin



A pragmatic and evidence-based management of ectopic pregnancy.  


The incidence of ectopic pregnancy is approximately 2% of all pregnancies, and it remains the leading cause of death in early pregnancy. Over 95% of ectopic pregnancies are tubal pregnancies, and the remainders are nontubal pregnancies. The highest risk factor for ectopic pregnancy is a previous tubal pregnancy followed by previous tubal surgery, tubal sterilization, tubal pathology, and current intrauterine device use. The apparent increase in the incidence of nontubal ectopic pregnancy including heterotopic pregnancy may be attributed to the increasing number of pregnancies because of in vitro fertilization treatment. In most cases, an ectopic pregnancy can be treated medically with a single dose of methotrexate. Surgical treatment is still needed in women who are hemodynamically unstable and in those who do not fulfill the criteria for methotrexate treatment. Usually surgical treatment can be performed by laparoscopy and in some cases by hysteroscopy. Laparotomy is rarely needed even in women with intraperitoneal bleeding. PMID:23587907

Oron, Galia; Tulandi, Togas



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


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

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



[Non surgical management of ectopic pregnancy].  


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

Kdous, Moez



The Paracrinology of Tubal Ectopic Pregnancy  

PubMed Central

As part of successful human reproduction, the Fallopian tube must provide a suitable environment for pre-implantation development of the embryo and for efficient transport of the embryo to the uterus for implantation. These functions are coordinated by paracrine interactions between tubal epithelial, smooth muscle and immune cells and the cells of the developing embryo. Alterations in these signals can lead to a tubal microenvironment encouraging of embryo implantation and to dysregulated tubal motility, ultimately resulting in inappropriate and early implantation of the embryo in the Fallopian tube. Here, we highlight novel and emerging concepts in tubal physiology and pathobiology, such as the induction of a receptive phenotype within the Fallopian tube, leading to ectopic implantation. Chlamydia trachomatis infection is a risk factor for tubal ectopic pregnancy. Activation of toll-like receptor 2 (TLR-2) in the Fallopian tube epithelium, by C. trachomatis has recently been demonstrated, leading to the dysregulation of factors involved in implantation and smooth muscle contractility, such as prokineticins (PROK), activin A and interleukin 1 (IL-1). The Fallopian tube has also recently been shown to harbour a unique population of immune cells, compared to the endometrium. In addition, the complement of immune cells in the Fallopian tube has been reported to be altered in Fallopian tube from women with ectopic pregnancy. There are increasing data suggesting that vascularisation of the Fallopian tube, by the embryo during ectopic pregnancy, differs from that initiated in the uterus during normal pregnancy. This too, is likely the result of paracrine signals between the embryo and the tubal microenvironment.

Shaw, Julie L. V.; Horne, Andrew W.



Diagnosis and management of intramural ectopic pregnancy.  


Intramural pregnancy, a gestation completely surrounded by the myometrium located within the uterine wall with separation from the uterine cavity, is an extremely unusual form of pregnancy. Complications resulting from intramural pregnancy include inevitable uterine rupture with resultant hemorrhage and possible hysterectomy if diagnosis is not made early and treatment is not initiated. An asymptomatic patient was initially diagnosed with a missed abortion at approximately 6 weeks of gestation after a routine ultrasound. Suction curettage was performed approximately 1 month after the initial diagnosis. The pathology specimen failed to reveal placental villi. Ultimately, the diagnosis of intramural pregnancy was made via ultrasound and a computed tomography scan. She was treated with a single dose of systemically administered methotrexate. Over a period of 4 months, ?-human chorionic gonadotropin levels trended downward; however, the intramural pregnancy failed to resolve completely, and a persistent mass remained. The intramural pregnancy was removed using the da Vinci laparoscopic procedure (Intuitive Surgical, Sunnyvale, CA). If the diagnosis of intramural ectopic pregnancy is made sufficiently early, conservative measures can be taken, which can preserve a patient's future fertility. PMID:24034539

Bannon, Kimberly; Fernandez, Carlos; Rojas, David; Levine, Elliot M; Locher, Stephen


Recurrent Ectopic Pregnancy in the Tubal Remnant after Salpingectomy  

PubMed Central

We present two cases of ectopic pregnancy located within the remnant tube following ipsilateral salpingectomy. This particular pathology is rare and yet has significant consequences for the patient, with mortality rates 10–15 times higher than other ectopic pregnancies. It demonstrates that salpingectomy does not exclude ectopic pregnancy on the ipsilateral side. We suggest careful clinical consideration and bring attention to the current surgical technique.

Samiei-Sarir, Bahareh; Diehm, Christopher



Cigarette smoking as a risk factor for ectopic pregnancy  

Microsoft Academic Search

Objective: Our purpose was to assess the risk of ectopic pregnancy among women who smoke cigarettes. Study Design: We used data from a case-control study of ectopic pregnancy conducted from October 1988 to August 1990 at an inner-city hospital in Georgia. Cases were 196 non-Hispanic black women with a surgically confirmed ectopic pregnancy. Controls were non-Hispanic black women who had

Mona Saraiya; Cynthia J. Berg; Juliette S. Kendrick; Lilo T. Strauss; Hani K. Atrash; Young W. Ahn



Full-term extrauterine abdominal pregnancy: a case report  

PubMed Central

Introduction Extrauterine abdominal pregnancy is extremely rare and is frequently missed during antenatal care. This is a report of a full-term extrauterine abdominal pregnancy in a primigravida who likely had a ruptured ectopic pregnancy with secondary implantation and subsequently delivered a healthy baby. Case presentation A 23-year-old, Middle Eastern, primigravida presented at 14 weeks gestation with intermittent suprapubic pain and dysuria. An abdominal ultrasound examination showed a single viable fetus with free fluid in her abdomen. A follow-up examination at term showed a breech presentation and the possibility of a bicornute uterus with the fetus present in the left horn of her uterus. Our patient underwent Cesarean delivery under general anesthesia and was found to have a small intact uterus with the fetus lying in her abdomen and surrounded by an amniotic fluid-filled sac. The baby was extracted uneventfully, but the placenta was implanted in the left broad ligament and its removal resulted in massive intraoperative bleeding that necessitated blood and blood products transfusion and the administration of Factor VII to control the bleeding. Both the mother and newborn were discharged home in good condition. Conclusions An extrauterine abdominal pregnancy secondary to a ruptured ectopic pregnancy with secondary implantation could be missed during antenatal care and continue to term with good maternal and fetal outcome. An advanced extrauterine pregnancy should not result in the automatic termination of the pregnancy.



Acute abdomen and abdominal pain in pregnancy  

Microsoft Academic Search

Abdominal pain in pregnancy may be due to the anatomical and physiological changes of the pregnant state or may be totally unrelated to pregnancy. Some conditions that are associated with the pregnant state, such as urinary tract infections, may present with abdominal pain. Acute abdomen refers to an intra-abdominal process that is characterized by abdominal pain, tenderness and muscular rigidity,

Edwin Chandraharan; Sabaratnam Arulkumaran



Ectopic pregnancy and emergency care: ethical and legal issues  

Microsoft Academic Search

Ectopic or tubal pregnancy presents a medical emergency that requires prompt treatment in order to contain risks of maternal death and morbidity, including loss of future fertility. Medical circumstances involving individual patients and resources of the prevailing health care system will determine the options and means of treatment. Termination of ectopic pregnancy does not constitute or directly implicate abortion. Any

B. M. Dickens; A. Faúndes; R. J. Cook




Microsoft Academic Search

Background Tubal sterilization is an increasingly common method of contraception in the United States. Although pregnancy after sterilization is un- common, it can occur and may be ectopic. We used data from the U.S. Collaborative Review of Steriliza- tion to estimate the risk of ectopic pregnancy in wom- en who had undergone the common types of tubal sterilization. Methods A




Randomized trial of conservative laparoscopic treatment and methotrexate administration in ectopic pregnancy and subsequent fertility.  


Methotrexate treatment was compared to laparoscopic salpingotomy for conservative management of ectopic pregnancy in a prospective randomized study. One hundred patients were randomized into two groups using random numbers. Inclusion criteria were an ectopic pregnancy visualized by ultrasound with a pre-therapeutic score <13 as assessed by the following six criteria, graded from 1 to 3: gestational age, human chorionic gonadotrophin (HCG) concentration, progesterone concentration, abdominal pain, haemoperitoneal volume and diameter of the haematosalpinx. The treatments were either 1 mg/kg of methotrexate injected transvaginally into the ectopic pregnancy without anaesthesia or administered i.m. when the pregnancy could not safely or easily be punctured (group 1), or laparoscopic salpingotomy (group 2). Success was defined as the return to normal (<10 mIU/ml) of HCG concentrations. Treatment was successful for 45 of 51 patients in group 1 (88.2%) and 47 of 49 in group 2 (95.9%). Medical treatment was significantly (P < 0.05) associated with shorter postoperative stay (24 compared with 46 h), but HCG returned to normal more quickly after laparoscopic treatment (13 compared with 29 days). Spontaneous reproductive performance was similar in both groups, but overall intrauterine pregnancy was higher, and repeat ectopic pregnancy lower, after methotrexate treatment. In selected cases of ectopic pregnancy, with a pre-therapeutic score <13, methotrexate treatment appeared as safe and efficient as conservative treatment by laparoscopy and was associated with improved subsequent fertility. PMID:9853887

Fernandez, H; Yves Vincent, S C; Pauthier, S; Audibert, F; Frydman, R



Methemoglobinemia misdiagnosed as ruptured ectopic pregnancy.  


A 22-year-old woman with an initial diagnosis of 'ruptured ectopic pregnancy' and 'hemorrhagic shock' was sent to the operation room for surgical treatment. The mucocutaneous color was deeply cyanosed and the pulse oximeter oxygen saturation (SpO2) was only 86% after tracheal intubation (100% O2). 'Chocolate-brown' blood was observed and methemoglobinemia was considered. Then the arterial blood gas (ABG) sample was obtained, an intravenous infusion of methylene blue and vitamin C followed. The patient recovered quickly, and later two other patients with similar symptoms were treated in the same way. The success was due to a correct diagnosis accompanied with prompt treatment and quick recognition of the etiology. PMID:15777313

Yang, J J; Lin, N; Lv, R; Sun, J; Zhao, F; Zhang, J; Xu, J G



Persistent trophoblastic tissue following salpingostomy for unruptured ectopic pregnancy  

SciTech Connect

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.

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



Ectopic pregnancies after infertility treatment: modern diagnosis and therapeutic strategy.  


Ectopic pregnancy (EP) is a major event in a woman's reproductive life. It complicates infertility treatment and must be recognized early to simplify the treatment strategy, which must always be directed towards optimizing subsequent fertility. Epidemiological findings indicate that tubal history and smoking are the principal risk factors of those EP that are considered reproductive (rather than contraceptive) failures. Adding together the attributable risks for EP allows the construction of a risk scale to determine its probability for any given patient. This risk calculation makes it easier to establish a diagnostic strategy that uses abdominal and transvaginal ultrasound and hCG assays. Progesterone assays are useful only for determining the activity of the pregnancy but do not help to identify its site. Conservative treatment is to be preferred unless the EP occurs on a known hydrosalpinx. All the treatment trials and the Cochrane database meta-analysis show that medical treatment with methotrexate, preferably multidose, is equivalent in efficacy to conservative treatment with laparoscopy in the populations studied. Heterotopic pregnancies, which occur most often after assisted reproduction technology (1-3%), should preferably be treated by salpingectomy except in interstitial sites. There is no consensus that IVF is indicated after EP. The patient's age is probably the determining factor: fertility treatment should not be delayed to an age where the results would be altered, especially with the risk of a recurrent EP. PMID:15388673

Fernandez, Herve; Gervaise, Amelie



A serum proteomics approach to the diagnosis of ectopic pregnancy.  


An ectopic pregnancy (EP) occurs when implantation of the embryo occurs outside of the uterus. If left untreated, the developing fetus will continue to grow, leading to life-threatening consequences for the mother. A major difficulty with the diagnosis of ectopic pregnancy is that methods of detection are limited, and some, such as ultrasound, are not very reliable in the earliest days of gestation. Currently, no effective serum test exists to distinguish an ectopic pregnancy from a normal intrauterine pregnancy. The incidence of ectopic pregnancy is increasing and has doubled in the last 20 years. It is now the second most common cause of maternal death in the first trimester of pregnancy. To address this issue, we initiated a project to identify serum markers of ectopic pregnancy. The subjects for these studies presented at the Hospital of the University of Pennsylvania. We obtained over 140 serum samples from women with suspected ectopic pregnancy: women presenting with pain and/or bleeding in the first trimester of pregnancy. The approximate racial breakdown of the subjects is as follows: African American, 36%; Caucasian, 3%; Asian, 2%; Hispanic, 1%; unknown, 58%. Serum samples from 139 women (62 with ectopic pregnancy and 77 with a normal intrauterine pregnancy) were applied to WCX2 (weak ion exchange) protein chip surfaces and analyzed for serum markers using surface-enhanced laser desorption/ionization time-of-flight mass spectrometry (SELDI-TOF-MS). Several proteins in the 7500-18,000 Da mass range were identified that may discriminate an ectopic pregnancy from an intrauterine pregnancy. The most promising markers were analyzed using classification and regression tree analysis (CART) with and without clinical variables (serum hCG value, length of amenorrhea). Two different algorithms were developed that classify the patients on the basis of sensitivity (number of EPs who screen positive/# of EPs) or specificity (# of healthy patients who screen negative/# of healthy). Our current approach is to refine these two "rule sets" to segregate patients into three groups: those who need immediate intervention for a probable ectopic pregnancy, those who appear to have a normal pregnancy, and those who need further monitoring for diagnosis. PMID:15251976

Gerton, G L; Fan, X J; Chittams, J; Sammel, M; Hummel, A; Strauss, J F; Barnhart, K



Late Occurring Ectopic Pregnancy in a Posthysterectomy Patient  

PubMed Central

The incidence of ectopic pregnancy after hysterectomy is extremely rare with only 56 cases reported in the medical literature. Due to its rare occurrence, this diagnosis may not be initially considered when such a patient presents with abdominopelvic pain. It is an important diagnosis to keep in mind since a delay in diagnosis may lead to death. The case presented below describes this extremely unusual diagnosis of an ectopic pregnancy which occurred six years after a supracervical hysterectomy.

Anis, Munazza; Irshad, Abid; Ackerman, Susan



What Is the Risk for a Second Ectopic Pregnancy?  


... Finding Affordable Health Care Eating Well & Staying Fit Flu Vaccine: How Many Doses? Connect With Us: Social Media Pregnant? Your Baby's Growth What Is the Risk for a Second Ectopic Pregnancy? KidsHealth > Parents > Q&A > Pregnancy and Infants > What ...


Morbidity and mortality following tubal ectopic pregnancies in Enugu, Nigeria.  


Our objective was to determine the current incidence, clinical pattern, surgical and medical management, maternal morbidity and mortality from tubal pregnancies in Enugu, Nigeria. The records of all patients treated for tubal pregnancy at the University of Nigeria Teaching Hospital, Enugu from 1 January 1997 to 31 December 2003 were reviewed. The number of tubal ectopic pregnancies was 136, while the total number of hospital deliveries was 6,003 giving a ratio of 1:44. There were four maternal deaths due to tubal pregnancy, out of a total of 126 maternal deaths that occurred during the same period. Ectopic pregnancy was prevalent in young single women with a previous history of induced abortion and resultant pelvic infection. The most common mode of treatment is salpingectomy. Most gynaecologists are not competent in operative laparoscopy and often do not use medical management of ectopic pregnancy. However, late presentation with haemoperitoneum limits the use of conservative treatment. Maternal morbidity and mortality due to tubal pregnancy is rising in Enugu, Nigeria. Preventive efforts should aim at health education and liberal contraceptive utilisation. Provision of more sophisticated equipment and tests in the management of ectopic pregnancies may in the long term be economically viable. Currently, autotransfusion is under utilised. PMID:16234149

Ikeme, A C C; Ezegwui, H U



Selective uterine artery embolization for management of interstitial ectopic pregnancy.  


Interstitial ectopic pregnancy is a rare condition of pregnancy and may be very dangerous if not identified and treated urgently. We report a case of successful treatment of an interstitial pregnancy using selective uterine artery embolization. A 27-year-old woman with interstitial pregnancy was treated by uterine artery embolization after failure of systemic methotrexate treatment. Her serum beta-human chorionic gonadotropin (beta-hCG) was undetectable one month after the therapeutic embolization and transvaginal sonography 31 days after embolization showed normal endometrium and cornu. The patient achieved a normal pregnancy eight months after embolization. PMID:17420637

Yang, Seung Boo; Lee, Sang Jin; Joe, Hwan Sung; Goo, Dong Erk; Chang, Yun Woo; Kim, Dong Hun


Selective Uterine Artery Embolization for Management of Interstitial Ectopic Pregnancy  

PubMed Central

Interstitial ectopic pregnancy is a rare condition of pregnancy and may be very dangerous if not identified and treated urgently. We report a case of successful treatment of an interstitial pregnancy using selective uterine artery embolization. A 27-year-old woman with interstitial pregnancy was treated by uterine artery embolization after failure of systemic methotrexate treatment. Her serum beta-human chorionic gonadotropin (?-hCG) was undetectable one month after the therapeutic embolization and transvaginal sonography 31 days after embolization showed normal endometrium and cornu. The patient achieved a normal pregnancy eight months after embolization.

Lee, Sang Jin; Joe, Hwan Sung; Goo, Dong Erk; Chang, Yun Woo; Kim, Dong Hun



Ruptured Ectopic Pregnancy in Caesarean Section Scar: A Case Report  

PubMed Central

Pregnancy implantation within previous caesarean scar is one of the rarest locations for an ectopic pregnancy. Incidence of caesarean section is increasing worldwide and with more liberal use of transvaginal sonography, more cases of caesarean scar pregnancy are being diagnosed in early pregnancy thus allowing preservation of uterus and fertility. However, a delay in either diagnosis or treatment can lead to uterine rupture, hysterectomy, and significant maternal morbidity. We are reporting a rare case of first trimester caesarean scar pregnancy with viable fetus in the process of rupture, where uterine repair could be done, thus preserving the future fertility.

Singh, Kamal; Soni, Anjali; Rana, Shelly



An extra-adrenal abdominal pheochromocytoma causing ectopic ACTH syndrome.  


We report a 55-year-old woman with ectopic adrenocorticotropin (ACTH) secretion caused by extra-adrenal pheochromocytoma. The patient presented with a 6-month history of hypertension and diabetes mellitus. Her serum and urinary cortisol levels were extremely high and dexamethasone failed to suppress the cortisol secretion. Her plasma ACTH levels were also elevated (>300 pg/mL) and irresponsive to corticotropin-releasing hormone (CRH) or metyrapone administration. Gel filtration analysis of the patient's plasma detected the existence of large molecular weight ACTH being eluted with a major peak of authentic 1-39 ACTH. Abdominal computed tomographic scan and magnetic resonance imaging revealed a 5-cm paraganglioma located underneath the left kidney, in which (123)I-MIBG tracer specifically accumulated. Bilateral adrenal glands were diffusely enlarged. After surgical removal of the paraganglioma, the patient's clinical symptoms improved and biochemistry normalized including plasma ACTH, urinary free cortisol, and urinary catecholamines. Subsequent histologic evaluation of the transected paranglioma tissue revealed ACTH, synaptin, and chromogranin-A histologically immunostaining. Culture of primary cells collected from the resected paraganglioma demonstrated of in vitro production of ACTH, noradrenaline, and adrenaline. This is the first report of ectopic ACTH syndrome induced by an extra-adrenal abdominal paraganglioma. PMID:16202863

Otsuka, Fumio; Miyoshi, Tomoko; Murakami, Kazutoshi; Inagaki, Kenichi; Takeda, Masaya; Ujike, Kazuhiro; Ogura, Toshio; Omori, Masako; Doihara, Hiroyoshi; Tanaka, Yasushi; Hashimoto, Kozo; Makino, Hirofumi



Ectopic pregnancy is again on the increase. Recent trends in the incidence of ectopic pregnancies in France (1992- 2002)  

Microsoft Academic Search

BACKGROUND: We aimed to assess the recent incidence trends of ectopic pregnancies (EP) in France (1992 - 2002). METHODS: A population-based register of all women aged 15 - 44 years with EP was set up in Auvergne (central France). We calculated rates of EP as a 'reproductive failure' or as a 'contraceptive failure', frequencies of exposure to the two main

Joel Coste; Jean Bouyer; Sylvie Ughetto; Laurent Gerbaud; Jean-Luc Pouly; Nadine Job-Spira



Heterotopic pregnancy: should we instrument the uterus at laparoscopy for ectopic pregnancy.  


The coexistence of intrauterine and ectopic pregnancy (heterotopic pregnancy) occurs in 1/30,000 of spontaneous pregnancies. However, it is getting more common at 1/900 in clomiphene citrate-induced pregnancies and rises to 1% in assisted reproduction. It is a potentially life-threatening condition with diagnostic and therapeutic complexities. Our patient is a 40-year-old who has been trying to get pregnant for 3 years. A planned non-instrumentation of the uterus at laparoscopy despite clear signs of a ruptured ectopic pregnancy has given her a chance of a continuing intrauterine pregnancy. With the increasing number of in vitro fertilisation-embryo transfers, the incidence of heterotopic pregnancies is also increasing, hence issues discussed here is whether the uterus should be instrumented at all during laparoscopy in early pregnancy and misdiagnosis with its sequel. PMID:23166166

Yamoah, Kofi Kwenu; Girn, Zeenie



Simultaneous presentation of tubal and primary abdominal pregnancies following clomiphene citrate treatment.  


Abdominal pregnancy is a rare condition that is potentially life-threatening for the mother. We present a case of simultaneous ectopic pregnancies (EPs) in the right fallopian tube and in the vesicouterine pouch. A 26-year-old woman had undergone prior ovulation induction with clomiphene citrate and human chorionic gonadotropin (hCG) at an outside hospital for unexplained infertility. The patient was referred to our hospital for a suspected ectopic pregnancy at 6 weeks gestation. Transvaginal ultrasonography detected a viable fetus at the anterior left side of the uterus; therefore, we suspected a left tubal pregnancy. However, laparoscopic surgery revealed that EPs were located in both the left vesicouterine pouch and in the right fallopian tube. Resection of the right salpinx and abdominal implant were performed. Histopathological examination confirmed the simultaneous presentation of a primary abdominal pregnancy and a right tubal pregnancy. After surgery, the patient's serum hCG level returned to normal. Concurrent EPs and abdominal pregnancy are very rare. However, it should be noted that reproductive technologies sometimes cause unusual clinical situations. A thorough abdominal inspection is needed. PMID:22454215

Baba, Tsuyoshi; Endo, Toshiaki; Ikeda, Keiko; Takenami, Naoko; Shimizu, Ayumi; Morishita, Miyuki; Honnma, Hiroyuki; Ikeda, Hideyuki; Saito, Tsuyoshi



[Is the treatment of ectopic pregnancy still exclusively surgical?].  


At the end of the 19th century, ectopic pregnancy became a surgical procedure. A century later, one third of ectopic pregnancies are treated medically. In the meantime, early detection of ectopic pregnancy became possible due to sensitive serum hCG and progesterone combined assays with transvaginal sonography and a knowledge of risk factors. Consequently, a nonsurgical approach appears to be an attractive alternative to surgery. Expectant management is recommended with a plateau or decreasing hCG and an initial level < or = 1.000 mIU/ml in asymptomatic women. Medical treatment by local or parenteral methotrexate is recommended in patients with clear evidence of an unruptured pregnancy in based on initial hCG and progesterone level, size of hemoperitoneum, ultrasound diameter of hematosalpinx and absence of clinical pain. Laparoscopy remains the gold standard but in prospective randomized trials between medical treatment and laparoscopy, in selected patients, the non-surgical approach appears to be equivalent with a similar reproductive performance. PMID:9297859

Fernandez, H; Pauthier, S; Capella-Allouc, S



An Appraisal of the Management of Ectopic Pregnancy in a Nigerian Tertiary Hospital  

PubMed Central

Background: Ectopic pregnancy has remained a significant cause of maternal morbidity and mortality especially in the sub Saharan Africa. A periodic appraisal of its management is paramount. Aim: To determine the incidence and associated risk factors, for ectopic pregnancy, review available treatment modalities and suggest interventions to reduce its prevalence, morbidity and mortality. Materials and Methods: A cross sectional study with retrolective data collection of all cases of ectopic pregnancy managed in Nnamdi Azikiwe University Teaching Hospital, Nnewi, south-east Nigeria between 1st January, 2002 and 31st December, 2011 was undertaken. Analysis was carried out using Epi-info 2008 version 3.5.1. Results: During the study period, there were a total 98 cases of ectopic pregnancies out of 8,811 deliveries and 1884 gynecological admissions, giving an incidence of 0.9% of all attendants or 1 in 90 deliveries and 5.2% of all gynecological admissions. Only 94.9% (93/98) case files were retrieved and were used in the final analysis. The mean age of the patients was 30.1 (0.7) years while the mean gestational age at presentations was 7.4 weeks. Previous induced abortion, 37.5% (36/93) was the commonest associated risk factor, followed by pelvic infections, 35.5% (33/93). The recurrence rate was 6.5% (6/93). Majority, 80.6% (75/93) presented with abdominal pain and 35.8% (33/93) presented with vaginal bleeding. Up to 88.2% (82/93) had salpingectomy while only 2.5% (2/93) were successfully managed medically with methotrexate therapy following diagnosis with transvaginal ultrasound Missed diagnosis of ectopic pregnancy occurred in 16.1% (15/93). There was no maternal death. Conclusion: Ectopic pregnancy has remained an important gynecological condition in our center. The common identifiable risk factors were induced abortion and pelvic infection. Early first trimester transvaginal ultrasound should be offered to all women for early diagnosis.

Igwegbe, AO; Eleje, GU; Okpala, BC



Early abdominal pregnancy with an unexpected and misleading location. The ultrasonographic interpretation.  


Abdominal pregnancy is a rare condition defined as an ectopic pregnancy that implants in the peritoneal cavity and is associated with important morbidity and mortality. We report a case of a 35-year-old woman with an ultrasonographic diagnosis of a left extrauterine pregnancy located proximally in the isthmus or distally in the interstitial region. In the exploratory laparotomy a gestational sac implanted anteriorly on the uterine serosa was found, with no signs of uterine perforation or tubal abortion. The pathologic examination confirmed the diagnosis of an early first trimester abdominal pregnancy. This case illustrates the importance of an early sonography in the diagnosis of an abdominal pregnancy as well as a high index of suspicion. PMID:22675969

Simões, M; Marques, C; Ribeiro, F; Guerreiro, C; Grilo, I; Rosa, D



Reliability of urinary pregnancy tests in the diagnosis of ectopic pregnancy.  


Recently a new generation of urinary pregnancy tests with increased sensitivity and specificity for beta-human chorionic gonadotropin (beta-HCG) was introduced. The clinical sensitivity of seven of these tests was evaluated in patients with surgically proven ectopic pregnancy. Two enzyme-linked immunosorbent assays (Tandem Visual, Hybritech; Mod C1, Monoclonal Antibodies), with a sensitivity of 50 mIU of beta-HCG, were positive in 90% of ectopic pregnancies. The three-tube tests (Sensitex, Roche; UCG Beta Stat, Wampole; beta-Neocept, Organon), with a sensitivity of 150-250 mIU of beta-HCG, were positive in 81-85% of ectopic pregnancies. Two slide tests (UCG Beta Slide, Wampole, and Sensislide, Roche), with a sensitivity of 500-800 mIU of beta-HCG, were positive in 51-61% of ectopic pregnancies. Both the immunosorbent assays and the tube tests were statistically more sensitive than the slide tests (P less than .001). There was no statistically significant increase in sensitivity between the tube tests and the immunosorbent assays. The sensitivities of these tube tests in ectopic pregnancy are similar to those of tube tests from other manufacturers previously reported on. PMID:3841157

Barnes, R B; Roy, S; Yee, B; Duda, M J; Mishell, D R



[Current state of conservative management of ectopic pregnancy].  


The ectopic pregnancy constitutes a disease that require the most diagnostic accuracy, not only for the biologic importance of its clinical manifestations, but for the sequelae of its treatment too, in relation with the fertility of a patient frequently affected with infertility so far. The increase in its frequency, by multiple factors, including treatment of infertility itself and Assisted Reproduction techniques, make the clinician must be alert and have availability of all diagnostic tools for the establishment of an oportune and conservative treatment, directed to prevent an acute alteration of the hemostasis and a shadowy reproductive future. The present review of the literature about the conservative management of the ectopic pregnancy let us have to know the criteria neccessary for giving the optimum treatment to our patients and offering them a better reproductive future. PMID:8729189

Marin Cantu, V A; Mondragon Alcocer, H; Cherem Cherem, B; Serviere Zaragoza, C



Placental Proteins in Peripheral Blood and Tissues of Ectopic Pregnancies  

Microsoft Academic Search

Circulating human chorionic gonadotrophin (hCG), Schwangerschaftsprotein 1 (SP-1) and pregnancy-associated plasma protein A (PAPP-A) were examined in 10 women with ectopic gestation in relation to distribution and intensity of staining for these molecules using immunohistochemical techniques applied to matched trophoblastic and decidualized endometrial tissues. All 10 women revealed strong staining for hCG and SP-1 in the syncytiotrophoblast, which was apparently

Ditte Tornehave; John Chemnitz; Jes G. Westergaard; Børge Teisner; Henning K. Poulsen; Anthony E. Bolton; Jurgis G. Grudzinskas



Prevalence of gestational trophoblastic disease in ectopic pregnancy  

PubMed Central

Objective: To describe the prevalence of gestational trophoblastic disease in ectopic pregnancy. Study design: Medical records of 105 patients from January 2007 to October 2009. We excluded of the study 5 cases (one case where the answer of the biopsy was not clear; 4 others with diagnosis of adhnexial mass where the pregnancy test had resulted positive but the answer of biopsy have been resulted ruptured ovary cyst and pyosalpingitis). So definitely the size of the sample was 100 patients. Results: 79 patients with EP underwent surgery due to a (diagnosis of EP with hem peritoneum and enraptured ectopic pregnancy) and in 18 of them the answer of the biopsy was GTD. 4 of 75 cases admitted in our hospital with diagnosis of EP, (pregnancy test was used instead of estimation of the level of ?-hCG because our hospital couldn?t offer estimation of the level of ?-hCG during 24 hours) have been not confirmed diagnosis of EP by biopsy, but ruptured ovary cyst with hem peritoneum, pyosalpingitis. 31 cases with EP (enraptured EP) underwent medical treatment with methotroxate. In 10 cases last management was failed and surgical intervention was institutionalized and histological analysis revealed GTD in 6 of them (partial mole). ?-hCG level was detected in 31 cases with enraptured fallopian pregnancy; in all cases where treatment with methotroxate has been failed and GTD was confirmed, the level of ?-hCG was > 10.234 mUI/ml. 21 cases with enraptured fallopian pregnancy were successfully treated, and at this point we never learned the answer of biopsy. We registered one case with cervical pregnancy and one cornual (interstitial portion) pregnancy. Conclusion: we found 18 cases of GTD in EP /11.500 deliveries (1,56 per 1,000 deliveries), prevalence of the GTD in EP was about 18%.

Tasha, Ilir; Kroi, Enriketa; Karameta, Anila; Shahinaj, Rozeta; Manoku, Nikita



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

Code of Federal Regulations, 2010 CFR

...termination of ectopic pregnancies. Federal funds are available for drugs or devices to prevent implantation of the fertilized ovum, and for medical procedures necessary for the termination of an ectopic...



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

Code of Federal Regulations, 2010 CFR

...termination of ectopic pregnancies. Federal funds are available for drugs or devices to prevent implantation of the fertilized ovum, and for medical procedures necessary for the termination of an ectopic...



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

Code of Federal Regulations, 2010 CFR

...termination of ectopic pregnancies. FFP is available in expenditures for drugs or devices to prevent implantation of the fertilized ovum and for medical procedures necessary for the termination of an ectopic...



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

Code of Federal Regulations, 2010 CFR

...termination of ectopic pregnancies. FFP is available in expenditures for drugs or devices to prevent implantation of the fertilized ovum and for medical procedures necessary for the termination of an ectopic...



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

Code of Federal Regulations, 2010 CFR

...termination of ectopic pregnancies. Federal funds are available for drugs or devices to prevent implantation of the fertilized ovum, and for medical procedures necessary for the termination of an ectopic...



Risk of ectopic pregnancy following day-5 embryo transfer compared with day-3 transfer.  


The incidence of ectopic pregnancy after IVF is increased approximately 2.5-5-fold compared with natural conceptions; however, the aetiology for this increased risk remains unclear. One proposed practice change to decrease the incidence of ectopic pregnancy is blastocyst embryo transfer on day 5 rather than cleavage-stage embryo transfer on day 3. A retrospective cohort study was conducted to compare the risk of ectopic pregnancy following fresh day-5 embryo transfer with day-3 embryo transfer among women who underwent IVF and achieved pregnancy from 1998 to 2011. There were 13,654 eligible pregnancies; 277 were ectopic. The incidence of ectopic pregnancy was 2.1% among day-3 pregnancies and 1.6% among day-5 pregnancies. The adjusted risk ratio for ectopic pregnancy from day-5 compared with day-3 transfer was 0.71 (95% confidence interval 0.46-1.10). Although this analysis included 13,654 cycles, with a two-sided significance level of 0.05, it had only 21.9% power to detect a difference between the low incidence of ectopic pregnancy among both day-3 and day-5 transfers. In conclusion, this study was not able to demonstrate a difference in the risk of ectopic pregnancy among day-3 compared with day-5 transfers. PMID:23953586

Smith, Laura P; Oskowitz, Selwyn P; Dodge, Laura E; Hacker, Michele R



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


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

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



Ectopic spleen presenting with anemia and an abdominal mass in a dog.  


An 11.5-year-old, neutered male, golden retriever dog that had previously had a splenectomy for benign disease 2 years prior to presentation was diagnosed with anemia and a large abdominal mass. Necropsy and histopathology identified the abdominal mass as ectopic splenic tissue. PMID:24179243

Prosser, Kirsten J; Webb, Jinelle A; Hanselman, Beth A



[Retrospective analysis of effectiveness of transvaginal ultrasound in the detection of ectopic pregnancy].  


Objective: To evaluate the effectiveness of transvaginal ultrasonographic (US) scan in own group of patients.Design: Retrospective analysis.Setting: Department of Gynaecology and Obstetrics, 3rd Faculty of Medicine, Charles University and Faculty Hospital Kralovské Vinohrady, Prague.Methods: We retrospectively evaluated the history, laboratory and ultrasound findings in a group of 115 patients, that have undergone a surgical procedure due to a positive diagnose or suspicion of ectopic pregnancy (EP). In all cases the diagnose of ectopic pregnancy was histologically confirmed. Results: 67% of our patients were nulliparous, 10% of patients had a positive personal history of previous ectopic pregnancy, only 5% of pacients had a record of pelvic inflammatory disease in the past. Histological examination confirmed 96.5% (111/115) tubal, 1.7% (2/115) interstitial, 0.9% (1/115) ovarian and 0.9% (1/115) cervical ectopic pregnancy. Our transvaginal ultrasonography (TVUS) scan was successful in 76.5% (88/115). A pathological adnexal mass was visualised in 67% (77/115) cases. A negative ultrasound finding was observed in 23.5% (27/115) cases. Conclusion: The US detection of ectopic pregnancy by a single TVUS examination was successful in 76.5% (88/115) cases. Early detection of ectopic pregnancy by TVUS decreases the risk of rupture of different types of EP, decreases the rate of surgical interventions and also promotes conservative management of ectopic pregnancies. Keywords: diagnosis - ectopic pregnancy - transvaginal ultrasound - blob sign - bagel sign. PMID:24040980

Kubešová, B; Líbalová, P; Simonová, V; Bucharová, J; Záhumenský, J



Recurrent ectopic pregnancy in a woman suffering from infertility due to male factor presented with heterotopic pregnancy.  


Heterotopic pregnancy is the simultaneous occurrence of intrauterine and extrauterine pregnancies. A 27-year-old third gravida with history of two ectopic pregnancies, presented with cramping pain in pelvis radiating to left side and bleeding from vagina. Ultrasonographic diagnosis of heterotopic pregnancy was put forward. Unfortunately intrauterine component of heterotopic pregnancy resulted in blighted ovum and linear salpingostomy was done for left-sided tubal pregnancy. PMID:22605872

Chaudhari, Hemang D; Gandhi, Viplav S; Banker, Hiral; Suri, Amar



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

PubMed Central

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.

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



Uterine artery embolization for management of interstitial twin ectopic pregnancy: case report.  


Interstitial pregnancy is rare and dangerous variation of ectopic pregnancy. We describe a case of unilateral interstitial viable twin pregnancy treated by selective uterine artery embolization. A 23-year-old women with clinical and ultrasonic diagnosis of viable twin interstitial pregnancy was treated by selective uterine artery embolization after failure of systemic methotrexate treatment. Her serum beta-HCG was undetectable 2 months after the procedure and the ultrasound scan 70 days after embolization showed only multiple echogenic spots in the right uterine cornua. This therapeutic modality seems to be effective for conservative management of interstitial ectopic pregnancy, and as a prophylactic measure before surgical intervention to prevent major bleeding. PMID:15218007

Ophir, E; Singer-Jordan, J; Oettinger, M; Odeh, M; Tendler, R; Feldman, Y; Fait, V; Bornstein, J



Abdominal pain in pregnancy: a rational approach to management  

Microsoft Academic Search

Abdominal pain during pregnancy is a relatively common symptom. It may reflect anatomical and physiological changes of the pregnant state, such as the ‘round ligament strain’ or may be due to an underlying pathological process. Various obstetric conditions such as placental abruption, clinical chorioamnionitis, threatened preterm labour and uterine rupture present with acute abdominal pain. Pregnancy also may predispose to

Sangeeta Devarajan; Edwin Chandraharan



Comparing the levels of ßHCG, progesterone and estradiol between ectopic pregnancy and normal intrauterine pregnancy  

Microsoft Academic Search

Background: The value of serial measurement of serum ß subunit of human chorionic gonadotropin (ßHCG) and ultrasonography in the early diagnosis of ectopic pregnancy has well established. Objective: The objective of this study was to explore the diagnostic value of raising level of serum ßHCG, single measurement of progesterone (P) and estradiol (E2) in early diagnosis of ectopic pregnancy. Materials

Parvin Gharabaghi; Manizheh Gharabaghi


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

Code of Federal Regulations, 2012 CFR

...INDIAN HEALTH Abortions and Related Medical Services in Indian Health Service...Programs § 136a.55 Drugs and devices and termination of ectopic pregnancies...of the fertilized ovum, and for medical procedures necessary for the...



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

Code of Federal Regulations, 2012 CFR

...APPLICABILITY Abortions and Related Medical Services in Federally Assisted Programs...Service § 50.308 Drugs and devices and termination of ectopic pregnancies...of the fertilized ovum, and for medical procedures necessary for the...



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

Code of Federal Regulations, 2012 CFR

...INDIAN HEALTH Abortions and Related Medical Services in Indian Health Service...Programs § 136.55 Drugs and devices and termination of ectopic pregnancies...of the fertilized ovum, and for medical procedures necessary for the...



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

Code of Federal Regulations, 2011 CFR

...APPLICABILITY Abortions and Related Medical Services in Federally Assisted Programs...Service § 50.308 Drugs and devices and termination of ectopic pregnancies...of the fertilized ovum, and for medical procedures necessary for the...



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

Code of Federal Regulations, 2011 CFR

...INDIAN HEALTH Abortions and Related Medical Services in Indian Health Service...Programs § 136a.55 Drugs and devices and termination of ectopic pregnancies...of the fertilized ovum, and for medical procedures necessary for the...



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

Code of Federal Regulations, 2011 CFR

...INDIAN HEALTH Abortions and Related Medical Services in Indian Health Service...Programs § 136.55 Drugs and devices and termination of ectopic pregnancies...of the fertilized ovum, and for medical procedures necessary for the...



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

Code of Federal Regulations, 2012 CFR

...AND HUMAN SERVICES (CONTINUED) MEDICAL ASSISTANCE PROGRAMS SERVICES...Abortions § 441.207 Drugs and devices and termination of ectopic pregnancies...implantation of the fertilized ovum and for medical procedures necessary for the...



Measurement of Intrauterine Human Decidua-Associated Protein 200 and Diagnosis of Ectopic Pregnancy  

Microsoft Academic Search

The aim of the current study was to examine whether the measurement of intrauterine human decidua-associated protein (hDP) 200 might be of clinical value in the diagnosis of ectopic pregnancy versus early missed abortion. Uterine fluid levels of hDP 200 were measured in two groups of patients: 20 women with ectopic pregnancy, diagnosed by laparoscopy, and 20 women diagnosed (after

Reuvit Halperin; Eran Hadas; Ian Bukovsky; David Schneider



Detection of Chromosome Abnormalities by Quantitative Fluorescent PCR in Ectopic Pregnancies  

Microsoft Academic Search

Objective: To evaluate the potential value of quantitative fluorescent polymerase chain reaction (QF-PCR) in the detection of chromosome abnormalities in ectopic pregnancies. Methods: Seventy chorionic villi samples of ectopic pregnancies were studied by QF-PCR. Primers for chromosomes 16, 21, X and Y in chorionic villi were evaluated. Fluorescence in situ hybridization (FISH) was performed when results of QF-PCR showed aneuploidy,

Mariette Goddijn; Marja van Stralen; Heleen Schuring-Blom; Bert Redeker; Liesbeth van Leeuwen; Sjoerd Repping; Nico Leschot; Fulco van der Veen



Clinical study of ectopic pregnancy treated with integrated traditional chinese and western medicine  

Microsoft Academic Search

Objective: To explore the therapeutic effect and mechanism of integrated traditional Chinese and western medicine (TCM-WM) in treating\\u000a ectopic pregnancy (EP).Methods: Seventy-eight patients suffering from unruptured EP were divided into two groups at random in proportion of roughly 2:1,\\u000a Group I (n= 50) was treated with methotrexate (MTX) plus Ectopic Pregnancy No. 2 (EP2), a Chinese medicinal decoction, Group\\u000a II

Wang Jianhua; Yu Zaiji; Zhang Aihua; Hao Haiyan



Uterine artery embolization for management of interstitial twin ectopic pregnancy: Case report  

Microsoft Academic Search

Interstitial pregnancy is rare and dangerous variation of ectopic pregnancy. We describe a case of unilateral inter- stitial viable twin pregnancy treated by selective uterine artery embolization. A 23-year-old women with clinical and ultrasonic diagnosis of viable twin interstitial pregnancy was treated by selective uterine artery embolization after failure of systemic methotrexate treatement. Her serum b-HCG was undetectable 2 months

E. Ophir; J. Singer-Jordan; M. Oettinger; M. Odeh; R. Tendler; Y. Feldman; V. Fait; J. Bornstein



The expression of IL-6R? and Gp130 in fallopian tubes bearing an ectopic pregnancy  

PubMed Central

Women with tubal ectopic pregnancies have high levels of circulating interleukin 6 (IL-6). IL-6 treatment in vitro significantly reduces the ciliary activity of tubal epithelium. The effects of IL-6 on target cells occur via the formation of a high-affinity complex with its receptors IL-6R? and glycoprotein 130 (Gp130). IL-6R? is specifically expressed in the cilia of the epithelial cells. In this study, we performed a quantitative reverse transcriptase polymerase chain reaction to determine the mRNA expression of IL-6R? and Gp130 in the fallopian tubes obtained from 12 women with ectopic pregnancies, 12 women with normal pregnancies, and 12 healthy nonpregnant women in the luteal phase of their menstrual cycle. Fallopian tubes were evaluated from specimens taken during tubal ligation in normal pregnancies and nonpregnant fertile women or during tubal surgery in ectopic pregnancies. We observed that IL-6R? mRNA expression in fallopian tubes was increased in ectopic pregnancy compared with that in the midluteal phase. We also found that the Gp130 mRNA expression was significantly lower in fallopian tubes from ectopic pregnancies than in those from nonpregnant women during the midluteal phase of their menstrual cycle, although its expression was noticeably high in fallopian tubes in the midluteal phase, which suggests that high Gp130 levels may possibly contribute to embryo transport into the uterus.

Yousefian, Elham; Fathabadi, Fateme Fadaei; Farahani, Reza Mastery; Kachouei, Emadeddin Yazdani



The expression of IL-6R? and Gp130 in fallopian tubes bearing an ectopic pregnancy.  


Women with tubal ectopic pregnancies have high levels of circulating interleukin 6 (IL-6). IL-6 treatment in vitro significantly reduces the ciliary activity of tubal epithelium. The effects of IL-6 on target cells occur via the formation of a high-affinity complex with its receptors IL-6R? and glycoprotein 130 (Gp130). IL-6R? is specifically expressed in the cilia of the epithelial cells. In this study, we performed a quantitative reverse transcriptase polymerase chain reaction to determine the mRNA expression of IL-6R? and Gp130 in the fallopian tubes obtained from 12 women with ectopic pregnancies, 12 women with normal pregnancies, and 12 healthy nonpregnant women in the luteal phase of their menstrual cycle. Fallopian tubes were evaluated from specimens taken during tubal ligation in normal pregnancies and nonpregnant fertile women or during tubal surgery in ectopic pregnancies. We observed that IL-6R? mRNA expression in fallopian tubes was increased in ectopic pregnancy compared with that in the midluteal phase. We also found that the Gp130 mRNA expression was significantly lower in fallopian tubes from ectopic pregnancies than in those from nonpregnant women during the midluteal phase of their menstrual cycle, although its expression was noticeably high in fallopian tubes in the midluteal phase, which suggests that high Gp130 levels may possibly contribute to embryo transport into the uterus. PMID:24179692

Yousefian, Elham; Novin, Marefat Ghaffari; Fathabadi, Fateme Fadaei; Farahani, Reza Mastery; Kachouei, Emadeddin Yazdani



Lactogenesis failure following successful delivery of advanced abdominal pregnancy.  


Abdominal pregnancy is a rare condition with significant risk of maternal and fetal morbidity and mortality. Because of the vascular involvement, the placenta is often left in situ. Prior reports have neglected to discuss the implications of leaving the placenta in situ on breastfeeding and lactation. We present a case of failure of lactogenesis II following the successful delivery of an advanced abdominal pregnancy in which the placenta was left in situ. This is the first report to discuss the effects on lactation of leaving the placenta in situ as a conservative management option in advanced abdominal pregnancy. PMID:22428571

Pieh-Holder, Kelly L; Scardo, James A; Costello, Deborah H



Intramyometrial ectopic pregnancy in an ICSI patient following uterine artery embolization  

Microsoft Academic Search

Myometrial pregnancy represents a rare subtype of ectopic pregnancy. A history of uterine artery embolization (UAE) because of symptomatic uterine fibroids, and assisted reproductive treatment may predispose to this unusual implantation site. A 40-year-old woman with a history of uterine fibroids underwent a transfer of two embryos after intracytoplasmic sperm injection treatment. The combined findings on transvaginal ultrasound scan, pelvic

M. Leyder; M. De Vos; B. Popovic-Todorovic; M. Dujardin; P. Devroey; H. M. Fatemi



Predictive score for the systemic treatment of unruptured ectopic pregnancy with a single dose of methotrexate  

Microsoft Academic Search

Objective: To evaluate the efficacy of a predictive score for the systemic treatment of unruptured ectopic pregnancy with a single dose of methotrexate in order to select the best cases for the medical treatment. Method: Our study included 40 patients. The inclusion criteria were: hemodynamic stability; adnexal mass ?3.5 cm; desire of future pregnancy; and a written permission to participate

J. Elito; A. P. Reichmann; M. N. Uchiyama; L. Camano



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

PubMed Central

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.

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



[Unruptured ectopic pregnancy: diagnosis and treatment. State of art].  


It is advisable to do the non-invasive diagnosis of ectopic pregnancy precociously, before there is the tube rupture, combining for that the transvaginal ultrasonography with the dosage of the b-fraction of the chorionic gonadotrophin. A range of treatment options may be used. Either a surgical intervention or a clinical treatment may be taken into consideration. Laparotomy is indicated in cases of hemodynamic instability. Laparoscopy is the preferential route for the treatment of tube pregnancy. Salpingectomy should be performed in patients having the desired number of children, while salpingostomy should be indicated in patients willing to have more children, when the b-hCG titers are under 5,000 mUI/mL and the surgical conditions are favorable. The use of methotrexate (MTX) is a consecrated clinical procedure and should be indicated as the first option of treatment. The main criteria for MTX indication are hemodynamic stability, b-hCG <5,000 mUI/mL, anexial mass <3,5 cm, and no alive embryo. It is preferable a single intramuscular dose of 50 mg/m(2), because it is easier, more practical and with less side effects. Protocol with multiple doses should be restricted for the cases with atypical localization (interstitial, cervical, caesarean section scar and ovarian) with values of b-hCG >5,000 mUI/mL and no alive embryo. Indication for local treatment with an injection of MTX (1 mg/kg) guided by transvaginal ultrasonography should occur in cases of alive embryos, but with an atypical localization. An expectant conduct should be indicated in cases of decrease in the b-hCG titers within 48 hours before the treatment, and when the initial titers are under 1,500 mUI/mL. There are controversies between salpingectomy and salpingostomy, concerning the reproductive future. Till we reach an agreement in the literature, the advice to patients who are looking forward to a future gestation, is to choose either surgical or clinical conservative conducts. PMID:19142485

Elito Junior, Julio; Montenegro, Nuno Aires Mota de Mendonça; Soares, Roberto da Costa; Camano, Luiz



Is adverse pregnancy outcome predictable after blunt abdominal trauma?  

Microsoft Academic Search

Objective: The aim of the study was to evaluate the following: (1) pregnancy outcome after blunt abdominal trauma and (2) factors that may predict preterm birth and adverse peripartum outcomes. Study Design: All women who had noncatastrophic abdominal trauma and came to the labor and delivery suite July 1994-August 1997 were prospectively evaluated and admitted for continuous uterine and fetal

Lisa Leone Pak; E. Albert Reece; Linda Chan



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

PubMed Central

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.

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



Angular ectopic pregnancy presenting as rupture of lateral wall of the uterus.  


This is a case report of a 32-year-old woman, being treated for secondary infertility, with history of previous ectopic pregnancy, who presented to the emergency obstetrical room in a state of hypovolemic shock. A diagnosis of ruptured ectopic pregnancy was confirmed in view of history of 14 weeks amenorrhea with a positive urine pregnancy test and positive colpopunture. She was immediately shifted for an emergency exploratory laparotomy. Intraoperatively, the authors were surprised to encounter a right lateral wall rupture uterus and ~14 weeks foetus with the placenta lying freely in the peritoneal cavity. That was suggestive of a right interstitial ectopic which had grown up to 14 weeks, invaded the uterine cavity thus forming an angular ectopic, which ended up as the catastrophic event. The authors here wish to highlight that angular pregnancy is rare but it has catastrophic consequences including maternal mortality. Had the patient presented early, in view of history of previous ectopic, an ultrasonography and color Doppler would have been useful in early detection. And a fertility conserving management in the form of Methotrexate therapy or Selective Uterine artery embolization could have been done. PMID:19562062

Ps, Baldawa; Hk, Chaudhari



Angular ectopic pregnancy presenting as rupture of lateral wall of the uterus  

PubMed Central

This is a case report of a 32-year-old woman, being treated for secondary infertility, with history of previous ectopic pregnancy, who presented to the emergency obstetrical room in a state of hypovolemic shock. A diagnosis of ruptured ectopic pregnancy was confirmed in view of history of 14 weeks amenorrhea with a positive urine pregnancy test and positive colpopunture. She was immediately shifted for an emergency exploratory laparotomy. Intraoperatively, the authors were surprised to encounter a right lateral wall rupture uterus and ~14 weeks foetus with the placenta lying freely in the peritoneal cavity. That was suggestive of a right interstitial ectopic which had grown up to 14 weeks, invaded the uterine cavity thus forming an angular ectopic, which ended up as the catastrophic event. The authors here wish to highlight that angular pregnancy is rare but it has catastrophic consequences including maternal mortality. Had the patient presented early, in view of history of previous ectopic, an ultrasonography and color Doppler would have been useful in early detection. And a fertility conserving management in the form of Methotrexate therapy or Selective Uterine artery embolization could have been done.

PS, Baldawa; HK, Chaudhari



Conservative Management of Ectopic Pregnancy with Fetal Cardiac Activity by Combined Local (Sonographically Guided) and Systemic Injection of Methotrexate  

Microsoft Academic Search

Objective: To evaluate the efficacy of conservative management of ectopic pregnancy with fetal cardiac activity by combined local sonographically guided and systemic injection of methotrexate. Study Design: The study group included 12 patients with ectopic pregnancy and fetal cardiac activity, treated by combined local and systemic injection of methotrexate in the period from January 1, 2000 to July 1, 2002.

Reuvit Halperin; Zvika Vaknin; David Schneider; Michal Yaron; Arie Herman



[Uterine artery embolisation in massive vaginal bleeding in ectopic pregnancy--case report].  


Implantation of the ovum within the scar after cesarean section is the rarest form of ectopic pregnancy. We present the case of 32-year-old patient with vaginal bleeding in 10th week of pregnancy. Missed abortion was diagnosed. Previous pregnancy was terminated by caesarean section. During hospitalization spontaneous abortion had place. The patient was qualified to curettage after which massive vaginal bleeding occurred. Ectopic pregnancy in the scar after cesarean section was diagnosed. Because of the patients age and desire to preserve fertility, embolization of the uterine artery was performed. Gelatine sponge, unstable embolic material was used. The procedure successfully stopped the bleeding. Six months after embolization patient feels well and menstruates regularly. Embolization could be a lifesaving procedure, moreover it could be an alternative for surgical treatment in young patients, who wants to save their fertility. PMID:23276048

Pyra, Krzysztof; Wo?niak, S?awomir; Szkodziak, Piotr; Paszkowski, Tomasz; Sojk, Micha?; Szczerbo-Trojanowska, Ma?gorzata



Utility of a single beta HCG measurement to evaluate for absence of ectopic pregnancy  

Microsoft Academic Search

The objectives of this study were to determine the optimal cutoff value (CV) and utility of a single serum beta human chorionic gonadotropin hormone (HCG) level in assessing the likelihood of ectopic pregnancy (ECP). A retrospective chart review was performed at an urban county hospital. The optimal CV was determined by comparing all available patients diagnosed with ECP and patients

Keith A Marill; Thomas E Ingmire; Brian K Nelson



Nonobstetric abdominal pain and surgical emergencies in pregnancy.  


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

Diegelmann, Laura



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


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

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



A case of splenic torsion and rupture presenting as ruptured ectopic pregnancy  

PubMed Central

Splenic torsion with rupture of spleen is an extremely rare phenomenon. The clinical picture mimics several common conditions which are causes of acute abdomen and so it is seldom detected pre-operatively. An 18 year old female patient was admitted with an acute abdomen and shock. The provisional diagnosis was of a ruptured ectopic pregnancy. Peri-operatively we found a spontaneous rupture of the spleen following torsion along with early intrauterine pregnancy. Splenectomy was carried out and patient recovered well. Our report confirms that this rare entity can present as an acute abdomen which is very difficult to diagnose preoperatively and can masquerade as ruptured ectopic pregnancy in women of childbearing age group.

Lahiri, Somdatta; Dasgupta, Nabanita; Mondal, Aftab-ud-din



Ectopic pregnancy, active component, U.S. Armed Forces, 2002-2011.  


Ectopic pregnancy (EP) is a rare adverse outcome in which a fertilized egg implants and develops outside of the uterus. Life-threatening cases of EP among deployed U.S. service members have been described. During 2002- 2011, among active component females younger than 49, 1,245 EPs were diagnosed and treated as indicated by diagnostic and procedure codes recorded in electronic medical records. Annual numbers of EPs ranged from 91 to 151. During the period EP affected 0.64 percent of all pregnancies, with higher proportions among servicewomen in their 30s and of black, non-Hispanic race/ ethnicity. As compared with civilians, service members had the same percentage of pregnancies that were ectopic but had lower proportions of EPs that were treated medically (with methotrexate) rather than surgically. PMID:22876802



The role of estrogen in the pathophysiology of tubal ectopic pregnancy  

PubMed Central

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.

Shao, Ruijin; Feng, Yi; Zou, Shien; Weijdegard, Birgitta; Wu, Gencheng; Brannstrom, Mats; Billig, Hakan



Successful laparoscopic management of primary omental pregnancy.  


Omental pregnancy is an extremely rare type of ectopic pregnancy. We present a case in which a 26-year-old woman was admitted to the emergency room with abdominal pain. She was diagnosed with a ruptured ectopic pregnancy after a positive urinary pregnancy test and transvaginal ultrasound. Laparoscopic surgery showed intact pelvic organs and an ectopic mass on the omentum. The patient was treated successfully with laparoscopic partial omentectomy, and pathologic examination confirmed an omental pregnancy. As evidenced by this case, laparoscopy can be useful to diagnose and treat unusually located ectopic pregnancies. PMID:19434418

Seol, Hyun-Joo; Kim, Tak; Lee, Seon-Kyung



Tubal patency and fertility outcome after expectant management of ectopic pregnancy  

Microsoft Academic Search

Objective: To study tubal patency and fertility outcome of patients with expectantly managed ectopic pregnancy (EP).Design: A prospective study.Setting: Department of Obstetrics and Gynecology, Turku University Central Hospital, Turku, Finland.Patient(s): Thirty patients who wanted to become pregnant again were treated successfully by expectant management of EP.Intervention(s): Patients were examined with posttreatment hysterosalpingography, and they filled out a questionnaire about their

Mika Rantala; Juha Mäkinen



Serum human chorionic gonadotropin measurement in the diagnosis of ectopic pregnancy when transvaginal sonography is inconclusive  

Microsoft Academic Search

Objective: To assess the accuracy of initial and repeated serum hCG measurements in the diagnosis of ectopic pregnancy (EP) in patients in whom transvaginal sonography is inconclusive and to evaluate whether patient characteristics influence the accuracy of serum hCG measurements.Design: Prospective study.Setting: Two large teaching hospitals in Amsterdam, the Netherlands.Patient(s): Three hundred fifty-four consecutively seen pregnant patients with suspected EP

Ben W. J Mol; Petra J Hajenius; Simone Engelsbel; Willem M Ankum; Fulco Van der Veen; Douwe J Hemrika; Patrick M. M Bossuyt



CB1 Expression Is Attenuated in Fallopian Tube and Decidua of Women with Ectopic Pregnancy  

Microsoft Academic Search

BackgroundEmbryo retention in the Fallopian tube (FT) is thought to lead to ectopic pregnancy (EP), a considerable cause of morbidity. In mice, genetic\\/pharmacological silencing of cannabinoid receptor Cnr1, encoding CB1, causes retention of embryos in the oviduct. The role of the endocannabinoids in tubal implantation in humans is not known.Methods and FindingsTimed FT biopsies (n = 18) were collected from

Andrew W. Horne; John A. Phillips; Nicole Kane; Paula C. Lourenco; Sarah E. McDonald; Alistair R. W. Williams; Carlos Simon; Sudhansu K. Dey; Hilary O. D. Critchley; Syed A. Aziz



The Evolution of Methotrexate as a Treatment for Ectopic Pregnancy and Gestational Trophoblastic Neoplasia: A Review  

PubMed Central

Methotrexate was developed in 1949 as a synthetic folic acid analogue to compete with folic acid and thus interfere with cell replication. While initially developed as a potential treatment for acute lymphoblastic leukaemia, a serendipitous observation led to methotrexate's use to effect the dramatic cure of a case of advanced choriocarcinoma. This prompted the exploration for the potential of methotrexate to treat other conditions involving disordered trophoblastic tissue. Methotrexate has subsequently revolutionized the treatment of two pregnancy-related conditions—gestational trophoblastic neoplasia and ectopic pregnancy. This article reviews the development of modern treatment protocols that use methotrexate to medically treat these two important gynaecological conditions.

Skubisz, Monika M.; Tong, Stephen



Use of FloSeal Sealant in the Surgical Management of Tubal Ectopic Pregnancy  

PubMed Central

Background. Surgery is sometimes required for the management of tubal ectopic pregnancies. Historically, surgeons used electrosurgery to obtain hemostasis. Topical hemostatic sealants, such as FloSeal, may decrease the reliance on electrosurgery and reduce thermal injury to the tissue. Case. A 33-year-old G1 P0 received methotrexate for a right tubal pregnancy. The patient became symptomatic six days later and underwent a laparoscopic right salpingotomy. After multiple unsuccessful attempts to obtain hemostasis with electrocoagulation, FloSeal was used and hemostasis was obtained. Six weeks later, a hysterosalpingogram (HSG) confirmed tubal patency. The patient subsequently had an intrauterine pregnancy. Conclusion. FloSeal helped to achieve hemostasis during a laparoscopic salpingotomy and preserve tubal patency. FloSeal is an effective alternative and adjunct to electrosurgery in the surgical management of tubal pregnancy.



Assessment of transvaginal hysterotomy combined with medication for cesarean scar ectopic pregnancy.  


The objective of this retrospective study was to explore a novel surgical technique, transvaginal hysterotomy combined with methotrexate injection, for treatment of cesarean scar ectopic pregnancy in 12 patients. All patients underwent the operation. Mean (SD; 95% CI) operative time was 21.6 (7.3; 17.0-26.2) minutes, and intraoperative blood loss was 90.8 (59.6; 52.9-128.7) mL. Postoperative ultrasonography confirmed removal of the pregnancy sac. The length of hospital stay was 7.4 (3.7; 5.0-9.8) days. The first normal postoperative menstrual period was at 28.3 (5.6; 24.7-31.9) days after surgery. The serum ?-human chorionic gonadotropin concentration returned to normal at 15.8 (6.3; 11.8-19.8) days. We conclude that surgical removal of the ectopic sac via transvaginal hysterotomy combined with methotrexate injection during the operation is a potentially good new approach to treatment of cesarean scar ectopic pregnancy. The efficacy and safety of the technique need further confirmation in future studies. PMID:22935305

Wang, Zhonghai; Le, Aiwen; Shan, Lili; Xiao, Tianhui; Zhuo, Rong; Xiong, Huijuan; Shen, Yi


Maternal Serum Macrophage Inhibitory Cytokine-1 as a Biomarker for Ectopic Pregnancy in Women with a Pregnancy of Unknown Location  

PubMed Central

Background Ectopic pregnancy (EP) occurs in 1–2% of pregnancies, but is over-represented as a leading cause of maternal death in early pregnancy. It remains a challenge to diagnose early and accurately. Women often present in early pregnancy with a ‘pregnancy of unknown location’ (PUL) and the diagnosis and exclusion of EP is difficult due to a lack of reliable biomarkers. A serum biomarker able to clearly distinguish between EP and other pregnancy outcomes would greatly assist clinicians in diagnosing and safely managing PULs. This study evaluates the ability of maternal serum macrophage inhibitory cytokine-1 (MIC-1) levels to differentiate between EP and other pregnancy outcomes in women with a PUL. Methods Sera were collected from 120 women with a PUL at first clinical presentation and assayed for MIC-1 by ELISA. Results were classified according to ultimate pregnancy outcome and the discriminatory ability of MIC-1 to diagnose EP was assessed. Results Serum MIC-1 levels were lower in women with histologically confirmed (definite) EP (dEP) (median 552 ng/mL; interquartile range (IQR) 414–693 ng/mL) compared to women with definite viable intra-uterine pregnancies (dVIUPs) (722 ng/mL; IQR 412–1122 ng/mL), and higher when compared to women with definite non-viable intra-uterine pregnancies (dNVIUPs) (465 ng/mL; IQR 341–675 ng/mL). MIC-1 levels were significantly higher in women with dEP compared to women whose PULs resolved without medical intervention (srPUL) (401 ng/mL; IQR 315–475 ng/mL) (p<0.003). There were no women with an ectopic pregnancy where serum MIC-1>1000 ng/mL. Conclusion Serum MIC-1 levels in PUL were not able to categorically diagnose EP, however, MIC-1 could distinguish women with an EP that required medical intervention and those women whose PULs spontaneously resolved. A single serum MIC-1 measurement also excluded EP at levels above 1000 ng/mL. MIC-1 may play a role in the development of a combined assay of biomarkers for the diagnosis of EP.

Skubisz, Monika M.; Brown, Jeremy K.; Tong, Stephen; Kaitu'u-Lino, Tu'uhevaha; Horne, Andrew W.



Clinical Effectiveness of Urinary Human Chorionic Gonadotropin Related Protein (hCGRP) Quantification for Diagnosis of Ectopic Pregnancy  

PubMed Central

We detected pregnancy related new molecule, human chorionic gonadotropin related protein (hCGRP) in the urine of a pregnant women by using a monoclonal antibody against the human chorionic gonadotropin (hCG). This study examined the effectiveness of urinary hCGRP quantification in diagnosing ectopic pregnancy. This study included 40 normal pregnant women and 25 patients with ectopic pregnancy. Patients' serum and urinary intact whole hCG (i-hCG) and hCGRP concentrations were measured using sandwich ELISA and the ratio of hCGRP to i-hCG was calculated. Statistical analysis was performed using statistical package for social sciences (SPSS) 10.0. Receiver operating characteristic (ROC) curve analysis was performed to evaluate the cut-off value to discriminate ectopic pregnancies from normal intrauterine pregnancies. Urinary hCGRP and hCGRP/i-hCG ratio in ectopic pregnancy group (14±6.6 ng/mL, 4.6±1.9%, respectively) were significantly lower than those of normal pregnancy group (149±10.2 ng/mL, 29.7±1.9%, respectively; p<0.001). Based on ROC curve analysis, a cut-off point of urinary hCGRP/i-hCG ratio <16.2% discriminated between ectopic pregnancy and normal pregnancy with a sensitivity, specificity, positive predictive value and negative predictive value of 92.0%, 90.0%, 32.6%, and 99.5%, respectively. Urinary hCGRP/i-hCG ratio measurement may be effective in diagnosing ectopic pregnancy.

Lee, Jae-Kwan; Shin, Joong-Sik; Lee, Kyung-Joo; Nam, Jung-Hyun; Cha, Jung-Hak; Chang, Jin-Dong; Cho, Dong-Hee; Kang, In-Soo; Lee, Paul I



Intra-abdominal pressure, intra-abdominal hypertension, and pregnancy: a review  

PubMed Central

The last several decades have seen many advances in the recognition and prevention of the abdominal compartment syndrome (ACS) and its precursor, intra-abdominal hypertension (IAH). There has also been a relative explosion of knowledge in the critical care, trauma, and surgical populations, and the inception of a society dedicated to its understanding, the World Society of the Abdominal Compartment Syndrome (WSACS). However, there has been almost no recognition or appreciation of the potential presence, influence, and management of intra-abdominal pressure (IAP), IAH, and ACS in pregnancy. This review highlights the importance and relevance of IAP in the critically ill parturient, the current lack of normative IAP values in pregnancy today, along with a review of the potential relationship between IAH and maternal diseases such as preeclampsia-eclampsia and its potential impact on fetal development. Finally, current IAP measurement guidelines are questioned, as they do not take into account the gravid uterus and its mechanical impact on intra-vesicular pressure.



Intra-abdominal pressure, intra-abdominal hypertension, and pregnancy: a review.  


The last several decades have seen many advances in the recognition and prevention of the abdominal compartment syndrome (ACS) and its precursor, intra-abdominal hypertension (IAH). There has also been a relative explosion of knowledge in the critical care, trauma, and surgical populations, and the inception of a society dedicated to its understanding, the World Society of the Abdominal Compartment Syndrome (WSACS). However, there has been almost no recognition or appreciation of the potential presence, influence, and management of intra-abdominal pressure (IAP), IAH, and ACS in pregnancy. This review highlights the importance and relevance of IAP in the critically ill parturient, the current lack of normative IAP values in pregnancy today, along with a review of the potential relationship between IAH and maternal diseases such as preeclampsia-eclampsia and its potential impact on fetal development. Finally, current IAP measurement guidelines are questioned, as they do not take into account the gravid uterus and its mechanical impact on intra-vesicular pressure. PMID:22873421

Chun, Rosaleen; Kirkpatrick, Andrew W



Full-Term Abdominal Pregnancy: A Case Report and Review of the Literature  

Microsoft Academic Search

Background: Abdominal pregnancy is a rare, life-threatening condition. Case: A 30-year-old pregnant, gravida 3, para 1, was presented to hospital at 38 weeks gestation. She suffered from abdominal pain at 16 weeks gestation. At admission, obstetrical examination and transabdominal ultrasonography revealed that it was uterine pregnancy with a single living fetus and oligohydramnios. The diagnosis of abdominal pregnancy was made

Jianping Zhang; Fen Li; Qiu Sheng



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

PubMed Central

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 2.58–2.95]) or after 6 years (AHR 1.57 [95% CI 1.29–1.91]) 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 0.50–0.56]). Compared to women with an initial termination, women with an EP had an increased chance of a second pregnancy (AHR 2.38 [95% CI 2.23–2.55]) 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 11.63–16.86]), miscarriage (AHR 6.07 [95% CI 4.83–7.62]), or termination (AHR 12.84 [95% CI 10.07–16.37]). 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

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



Can sonographic endometrial pattern be an early indicator for tubal ectopic pregnancy and related tubal rupture?  

Microsoft Academic Search

Purpose  The present study aims to determine whether sonographic endometrial pattern can be addressed as an early indicator for tubal\\u000a ectopic pregnancy and related tubal rupture in case ultrasonography reveals no adnexal mass and maternal serum beta human\\u000a chorionic gonadotropin (HCG) level is below the discriminatory zone (?1,000 mIU\\/mL).\\u000a \\u000a \\u000a \\u000a Methods  The study evaluated the endometrial features of 441 naturally conceived and asymptomatic first

Ilknur Col-Madendag; Yusuf Madendag; Mine Kanat-Pektas; Nuri Danisman



Ectopic pregnancy rates after in vitro fertilization: a look at the donor egg population.  


In an 8-year review of ectopic pregnancy (EP) rates in donor egg recipients and standard patients undergoing in vitro fertilization-embryo transfer (IVF-ET) at a large university-based program, we report an EP rate of 0.6% in donor egg recipients and 0.9% in standard IVF patients, a difference that is not statistically significant. Donor egg recipients were found to have a significantly lower incidence of tubal disease compared with standard IVF patients; however, tubal disease was not found to be an independent risk factor for EP in our practice, perhaps owing to aggressive management of tubal disease. PMID:19524897

Rosman, Elana R; Keegan, Debbra A; Krey, Lewis; Liu, Mengling; Licciardi, Frederick; Grifo, Jamie A



Ectopic Pregnancy  


... risk factors. For example, limit your number of sexual partners and use a condom when you have sex to help prevent sexually transmitted infections and reduce the risk of pelvic inflammatory disease. ...


The importance of gestational sac size of ectopic pregnancy in response to single-dose methotrexate.  


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/m(2)) 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 = 3.18-8.22) and baseline level ? -hCG (coefficient = 1.60, OR = 5.0, 95% confidence interval = 4.26-6.72) 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

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



Evaluation of ADAM-12 as a Diagnostic Biomarker of Ectopic Pregnancy in Women with a Pregnancy of Unknown Location  

PubMed Central

Background Ectopic pregnancy (EP) remains the most life-threatening acute condition in modern gynaecology. It remains difficult to diagnose early and accurately. Women often present at emergency departments in early pregnancy with a ‘pregnancy of unknown location’ (PUL) and diagnosis/exclusion of EP is challenging due to a lack of reliable biomarkers. Recent studies suggest that serum levels of a disintegrin and metalloprotease protein-12 (ADAM-12) can be used differentiate EP from viable intrauterine pregnancy (VIUP). Here we describe a prospective study evaluating the performance of ADAM-12 in differentiating EP from the full spectrum of alternative PUL outcomes in an independent patient cohort. Methodology/Principal Findings Sera were collected from 120 patients at their first clinical presentation with a PUL and assayed for ADAM-12 by ELISA. Patients were categorized according to final pregnancy outcomes. Serum ADAM-12 concentrations were increased in women with histologically-confirmed EP (median 442 pg/mL; 25%–75% percentile 232–783 pg/mL) compared to women with VIUP (256 pg/mL; 168–442 pg/mL) or miscarriage (192 pg/mL; 133–476 pg/mL). Serum ADAM-12 did not differentiate histologically-confirmed EP from spontaneously resolving PUL (srPUL) (416 pg/mL; 154–608 pg/mL). The diagnostic potential of ADAM-12 was only significant when ‘ambiguous’ PUL outcomes were excluded from the analysis (AROC?=?0.6633; P?=?0.03901). Conclusions/Significance When measured in isolation, ADAM-12 levels had limited value as a diagnostic biomarker for EP in our patient cohort. The development of a reliable serum biomarker-based test for EP remains an ongoing challenge.

Horne, Andrew W.; Brown, Jeremy K.; Tong, Stephen; Kaitu'u-Lino, Tu'uhevaha



Ectopic intramural pregnancy developing at the site of a cesarean section scar: a case report  

PubMed Central

Introduction Cesarean section scar pregnancy is a rare but serious complication. It occurs in women with previous uterine scar when implantation takes place at the site of this scar. If early diagnosis is missed the woman's future fertility and eve her life are at risk. Earlier reports on the condition suggesting different management approaches have been described. Case presentation A 37 year-old woman gravida 4, para 3, was referred to our emergency department, as a case of missed miscarriage following 14 weeks amenorrhea. Ultrasound examination revealed a picture suggestive of intramural pregnancy near the Cesarean section scar. The case was managed by laparotomy evacuation of products of conception and repair of the scar. Conclusion The diagnosis of ectopic intramural pregnancy in a cesarean section scar is possible with ultrasound and high level of suspicion. This serious complication must be suspected in a pregnant woman with previous uterine scar when early ultrasound show a gestational sac that is implanted anteriorly in the lower uterine segment, near the uterine scar. Ultrasound criteria for diagnosis include empty uterus, empty cervical canal and a discontinuity on the anterior wall of the uterus demonstrated on a sagittal plane of the uterus running through the amniotic sac. Early intervention is recommended to avoid serious consequences in such cases.



The impact of tubal ectopic pregnancy in Papua New Guinea - a retrospective case review  

PubMed Central

Background Ectopic pregnancy (EP) is an important cause of morbidity and mortality amongst women of reproductive age. Tubal EP is well described in industrialised countries, but less is known about its impact in low-resource countries, in particular in the South Pacific Region. Methods We undertook a retrospective review of women with tubal EP treated at a provincial referral hospital in coastal Papua New Guinea over a period of 56 months. Demographic and clinical variables were obtained from patients’ medical records and analysed. The institutional rate of tubal EP was calculated, and diagnosis and management reviewed. Potential risk factors for tubal EP were identified, and delays contributing to increased morbidity described. Results A total of 73 women had tubal EP. The institutional rate of tubal EP over the study period was 6.3 per 1,000 deliveries. There were no maternal deaths due to EP. The mean age of women was 31.5+/?5.7 years, 85% were parous, 67% were rural dwellers and 62% had a history of sub-fertility. The most commonly used diagnostic aid was culdocentesis. One third of women had clinical evidence of shock on arrival. All women with tubal EP were managed by open salpingectomy. Tubal rupture was confirmed for 48% of patients and was more common amongst rural dwellers. Forty-three percent of women had macroscopic evidence of pelvic infection. Two-thirds of patients received blood transfusions, and post-operative recovery lasted six days on average. Late presentation, lack of clinical suspicion, and delays with receiving appropriate treatments were observed. Conclusions Tubal EP is a common gynaecological emergency in a referral hospital in coastal PNG, and causes significant morbidity, in particular amongst women residing in rural areas. Sexually transmitted infections are likely to represent the most important risk factor for tubal EP in PNG. Interventions to reduce the morbidity due to tubal EP include the prevention, detection and treatment of sexually transmitted infections, identification and reduction of barriers to prompt presentation, increasing health workers’ awareness of ectopic pregnancy, providing pregnancy test kits to rural health centres, and strengthening hospital blood transfusion services, including facilities for autotransfusion.



Full-term abdominal extrauterine pregnancy complicated by post-operative ascites with successful outcome: a case report  

PubMed Central

Introduction Advanced abdominal (extrauterine) pregnancy is a rare condition with high maternal and fetal morbidity and mortality. Because the placentation in advanced abdominal pregnancy is presumed to be inadequate, advanced abdominal pregnancy can be complicated by pre-eclampsia, which is another condition with high maternal and perinatal morbidity and mortality. Diagnosis and management of advanced abdominal pregnancy is difficult. Case presentation We present the case of a 33-year-old African woman in her first pregnancy who had a full-term advanced abdominal pregnancy and developed gross ascites post-operatively. The patient was successfully managed; both the patient and her baby are apparently doing well. Conclusion Because most diagnoses of advanced abdominal pregnancy are missed pre-operatively, even with the use of sonography, the cornerstones of successful management seem to be quick intra-operative recognition, surgical skill, ready access to blood products, meticulous post-operative care and thorough assessment of the newborn.



Ultrasound availability in the evaluation of ectopic pregnancy in the ED: Comparison of quality and cost-effectiveness with different approaches  

Microsoft Academic Search

The liberal use of ultrasonography has been advocated in patients with first trimester cramping or bleeding to avoid misdiagnosis of ectopic pregnancy in the emergency department (ED). The cost-effectiveness of different approaches to ultrasound availability has not been previously reported. In this study, we investigated measures of quality and cost-effectiveness in detecting ectopic pregnancy in the ED over a 6-year

William E. Durston; Michael L. Carl; Wayne Guerra; Abigail Eaton; Lynn M. Ackerson



Ultrasound assessment of haemoperitoneum in ectopic pregnancy: derivation of a prediction model  

PubMed Central

Background To derive an ultrasound-based prediction model for the quantification of haemoperitoneum in ectopic pregnancy (EP). Methods Retrospective study of 89 patients operated upon EP between January 1999 and March 2003 in a French Gynaecology and Obstetrics department in a university hospital. Transvaginal sonograms, clinical and biological variables from patients with haemoperitoneum ? 300 ml at surgery were compared with those from patients with haemoperitoneum < 300 ml or no haemoperitoneum. Sensitivity, specificity, positive and negative likelihood ratios were calculated for each parameter after appropriate dichotomization. Multiple logistic regression analysis was used to select the best combination at predicting haemoperitoneum ? 300 ml. Results Three parameters predicted haemoperitoneum ? 300 ml independently: moderate to severe spontaneous pelvic pain, fluid above the uterine fundus or around the ovary at transvaginal ultrasound, and serum haemoglobin concentration < 10 g/dL. A woman with none of these three criteria would have a probability of 5.3% for haemoperitoneum ? 300 ml. When two or more criterias were present, the probability for haemoperitoneum ? 300 ml reached 92.6%. Conclusion The proposed model accurately predicted significant haemoperitoneum in patients diagnosed to have EP.

Fauconnier, Arnaud; Mabrouk, Ali; Salomon, Laurent J; Bernard, Jean-Pierre; Ville, Yves



Spontaneous resolution of ectopic pregnancy in a surrogate after oocyte donation and frozen embryo transfer.  


A case of tubal pregnancy in a young and healthy woman participating in a programme of in-vitro fertilization (IVF) gestational surrogacy is reported. The gestational surrogate was the 30 year old fertile sister of a 25 year old patient affected by stage 1 ovarian cancer. After mandatory oncological consultation, the donor was recommended to prospectively undergo controlled ovarian hyperstimulation cycles for embryo banking before being treated by total hysterectomy. Available embryos were cryopreserved and after adequate endometrial preparation using artificial cycles of hormone replacement therapy, three thawed frozen embryos were transferred to the surrogate. At 17 days following embryo transfer the surrogate was noted to have a negative beta-human chorionic gonadotrophin (HCG) serum concentration. All medication was suspended and a few days later normal menstrual bleeding occurred. After 2 weeks, the beta-HCG concentrations, performed as part of routine follow-up evaluation, were showing signs of trophoblast activity (236 mIU/ml). Taking into account the stable condition of the patient, a decision was made to undertake expectant management. At 43 days after embryo transfer, a complete tubal abortion was apparently seen in the posterior cul-de-sac by ultrasound associated with a subtle and short lasting pelvic pain. We stress that this ectopic gestation was able to maintain prolonged viability in conditions of absent corpus luteum and exogenous steroid supplementation. PMID:9021391

Bernardini, L; Asch, R H



Successful operative management of an intact second trimester abdominal pregnancy with additional preoperative selective catheter embolization and postoperative methotrexate therapy  

PubMed Central

Summary Background Abdominal pregnancy is a rare condition that may lead to severe complications. Case Report The authors report the case of a 17-week intact abdominal pregnancy diagnosed in the course of an investigation of lower abdominal pain. Ultrasonography and MR examination revealed an intact abdominal pregnancy. Subsequent angiography was performed to occlude the supportive artery of the pregnancy by selective embolization. The pregnancy was terminated safely by laparotomy a day later. The placenta was left in the abdominal cavity because of the high risk of massive and often uncontrollable bleeding, and treatment with methotrexate was applied postoperatively. Conclusions Preoperative embolization and the postoperative methotrexate therapy facilitate the safe surgical treatment of abdominal pregnancy.

Demendi, Csaba; Langmar, Zoltan; Banhidy, Ferenc; Borzsonyi, Balazs; Csatlos, Eva; Joo, Jozsef Gabor



Interleukin-15 (IL-15) and Anti-C1q Antibodies as Serum Biomarkers for Ectopic Pregnancy and Missed Abortion  

PubMed Central

Given the present lack of clinically useful tests for the accurate diagnosis of ectopic pregnancy (EP), there is a need to select out those immunological factors measured in the maternal serum, as potential biomarkers. Our assumption was that C1q/anti-C1q antibody complexes and serum levels of interleukin-15 (IL-15) may play a role in differentiating abortions (MAs) and EPs and normal pregnancies. We assessed whether their measurement could set the diagnosis in a case control study at 6–8 weeks consisting of 60 women with failed early pregnancy (30?EPs, 30?MAs) and 33 women with intrauterine pregnancies. Normal pregnancies contain anti-C1q antibodies more frequently compared to women with failed pregnancies, the lowest levels being found in EPs, but this lacked statistical significance and anti-C1q could not serve as a marker. However EP pregnancies had elevated IL-15 levels that could statistically significantly differentiate them from MAs and IUPs. Furthermore, when assessing IL-15 for the clinically important differentiation between IUP and EP, we found at a cut-off of 16?pg/mL a negative predictive value of 99 with a sensitivity for diagnosing an EP of 92%. According to these results, serum IL-15 is a promising marker differentiating an MA from an EP.

Daponte, Alexandros; Deligeoroglou, Efthimios; Pournaras, Spyros; Hadjichristodoulou, Christos; Garas, Antonios; Anastasiadou, Foteini; Messinis, Ioannis E.



Interleukin-15 (IL-15) and anti-C1q antibodies as serum biomarkers for ectopic pregnancy and missed abortion.  


Given the present lack of clinically useful tests for the accurate diagnosis of ectopic pregnancy (EP), there is a need to select out those immunological factors measured in the maternal serum, as potential biomarkers. Our assumption was that C1q/anti-C1q antibody complexes and serum levels of interleukin-15 (IL-15) may play a role in differentiating abortions (MAs) and EPs and normal pregnancies. We assessed whether their measurement could set the diagnosis in a case control study at 6-8 weeks consisting of 60 women with failed early pregnancy (30 EPs, 30 MAs) and 33 women with intrauterine pregnancies. Normal pregnancies contain anti-C1q antibodies more frequently compared to women with failed pregnancies, the lowest levels being found in EPs, but this lacked statistical significance and anti-C1q could not serve as a marker. However EP pregnancies had elevated IL-15 levels that could statistically significantly differentiate them from MAs and IUPs. Furthermore, when assessing IL-15 for the clinically important differentiation between IUP and EP, we found at a cut-off of 16 pg/mL a negative predictive value of 99 with a sensitivity for diagnosing an EP of 92%. According to these results, serum IL-15 is a promising marker differentiating an MA from an EP. PMID:23401701

Daponte, Alexandros; Deligeoroglou, Efthimios; Pournaras, Spyros; Hadjichristodoulou, Christos; Garas, Antonios; Anastasiadou, Foteini; Messinis, Ioannis E



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

PubMed Central

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.

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



Single dose methotrexate therapy: application to interstitial ectopic pregnancy 1 The views expressed herein do not necessarily represent the opinion of Planned Parenthood Federation of America. 1  

Microsoft Academic Search

A woman with a small (6-mm gestational sac) interstitial pregnancy had complete resolution after medical therapy alone. A single cycle of methotrexate 50 mg\\/m2 was used as outpatient treatment without any operative procedure either for diagnosis or intervention. The guidelines that have evolved for selection of women for single dose methotrexate treatment for both intrauterine and tubal ectopic pregnancies may

L Borgatta; M Burnhill; P Stubblefield



Pregnancy ultrasound  


... the baby's age Look for problems, such as ectopic pregnancies or the chances for a miscarriage Determine the ... to some of the following conditions: Birth defects Ectopic pregnancy Intrauterine growth restriction Multiple pregnancies Miscarriage Problems with ...


Magnetic resonance imaging for the evaluation of acute abdominal pain in pregnancy.  


The investigation of acute abdominal pain in pregnancy is challenging. The use of ultrasound may be limited due to the patient's change in body habitus and computed tomography is not desirable due to fetal irradiation. Magnetic resonance imaging (MRI) has thus become increasingly popular in the evaluation of such patients, due to its lack of ionizing radiation, multiplanar capability and high contrast resolution. This review will detail the MRI technique required to image the pregnant abdomen and describe the MRI features of common causes of acute abdominal pain in pregnancy. PMID:20974361

Beddy, Peter; Keogan, Mary T; Sala, Evis; Griffin, Nyree



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

Code of Federal Regulations, 2010 CFR

... Federal financial participation is available with respect to the cost of drugs or devices to prevent implantation of the fertilized ovum, and for medical procedures necessary for the termination of an ectopic...



Shotgun proteomics identifies serum fibronectin as a candidate diagnostic biomarker for inclusion in future multiplex tests for ectopic pregnancy.  


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

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



Abdominal circumference vs. estimated weight to predict large for gestational age birth weight in diabetic pregnancy  

Microsoft Academic Search

Early third trimester fetal abdominal circumference and sonographic fetal weight estimates were compared to predict large for gestational age birth weight in diabetic pregnancy. Both parameters have similar sensitivity, specificity, and predictive values. However, the optimal percentile cutoff values differ. Choice of birth weight standard significantly influences test characteristics. Negative prediction of large birth weight is more accurate than positive

William L Holcomb; Dorothea J Mostello; Diana L Gray



Increment in ?-hCG in the 48-h period prior to treatment: a new variable predictive of therapeutic success in the treatment of ectopic pregnancy with methotrexate  

Microsoft Academic Search

Background  To evaluate the increment in ?-hCG levels (%) in the 48-h interval prior to treatment as a predictor of therapeutic success\\u000a in the management of ectopic pregnancy with methotrexate.\\u000a \\u000a \\u000a \\u000a Methods  A prospective observational study was carried out between April 2002 and November 2006 at the Federal University of São Paulo\\u000a in 65 patients with an ectopic pregnancy treated with a single

Roberto da Costa Soares; Júlio Elito Junior; Luiz Camano



Performance of hCG curves in women at risk for ectopic pregnancy: exceptions to the rules  

PubMed Central

Objective To investigate the accuracy of serial hCG to predict outcome of a pregnancy of unknown location in an ethnically and geographically diverse setting. Design Multi-site cohort study Setting University hospital Patients Women with a pregnancy of unknown location Interventions None Main outcome measures Patients were followed until diagnosed with ectopic pregnancy (EP), intrauterine pregnancy (IUP), or miscarriage. To predict outcome, observed hCG was compared to recommended thresholds to assess deviation from defined normal curves. Predicted outcome was compared to standard of care. Sensitivity, specificity, predictive value, and accuracy were calculated, stratified by diagnosis. Results The final diagnosis 1,005 patients included 179 EPs, 259 IUPs, and 567 miscarriages. The optimal balance in sensitivity and specificity used the minimal expected two-day rise in hCG of 35%, and the minimal two-day decline in hCG of 36–47% (depending on the level) achieving 83.2% sensitivity, 70.8% specificity to predict EP. However 16.8% of EPs and 7.7% of IUPs would be misclassified solely using serial hCGs. Consideration of a third hCG and early ultrasound decreased IUP misclassification to 2.7%. Conclusion Solely using serial hCG values can result in misclassification. Clinical judgment should trump prediction rules and continued surveillance with a third hCG may be prudent, especially when initial values are low or when values are near suggested thresholds.

Morse, Christopher B.; Sammel, Mary D.; Shaunik, Alka; Allen-Taylor, Lynne; Oberfoell, Nicole L.; Takacs, Peter; Chung, Karine; Barnhart, Kurt T.



Systematic Discovery of Ectopic Pregnancy Serum Biomarkers Using 3-D Protein Profiling Coupled with Label-free Quantitation  

PubMed Central

Ectopic pregnancy (EP) and normal intrauterine pregnancy (IUP) serum proteomes were quantitatively compared to systematically identify candidate biomarkers. A 3-D biomarker discovery strategy consisting of abundant protein immunodepletion, SDS gels, LC-MS/MS, and label-free quantitation of MS signal intensities identified 70 candidate biomarkers with differences between groups greater than 2.5-fold. Further statistical analyses of peptide quantities were used to select the most promising 12 biomarkers for further study, which included known EP biomarkers, novel EP biomarkers (ADAM12 and ISM2), and five specific isoforms of the pregnancy specific beta-1-glycoprotein family. Technical replicates showed good reproducibility and protein intensities from the label-free discovery analysis compared favorably with reported abundance levels of several known reference serum proteins over at least three orders of magnitude. Similarly, relative abundances of candidate biomarkers from the label-free discovery analysis were consistent with relative abundances from pilot validation assays performed for five of the 12 most promising biomarkers using label-free multiple reaction monitoring of both the patient serum pools used for discovery and the individual samples that constituted these pools. These results demonstrate robust, reproducible, in-depth 3-D serum proteome discovery, and subsequent pilot-scale validation studies can be achieved readily using label-free quantitation strategies.

Beer, Lynn A.; Tang, Hsin-Yao; Sriswasdi, Sira; Barnhart, Kurt T.; Speicher, David W.



Superfetation after ovulation induction and intrauterine insemination performed during an unknown ectopic pregnancy  

Microsoft Academic Search

This report describes the first case of superfetation after ovarian stimulation with gonadotrophins and intrauterine insemination (IUI) that were performed in the presence of an undiagnosed tubal pregnancy. A 32-year-old woman who underwent repeated attempts of ovarian stimulation and IUI was hospitalized for severe pelvic pain and submitted to laparoscopic salpingectomy because of ruptured salpynx containing a 6-week pregnancy. Transvaginal

Teresa Lantieri; Alberto Revelli; Pietro Gaglioti; Guido Menato; Gianluca Gennarelli; Luisa Delle Piane; Marco Massobrio



Rupture of Ovarian Pregnancy in a Woman with Low Beta-hCG Levels  

PubMed Central

Background. Ovarian pregnancy is a rare form of ectopic pregnancy. It is often difficult to distinguish from tubal pregnancy, and diagnosis and management are frequently a challenge. Case. A 33-year-old nulligravida woman presented with light vaginal bleeding and bilateral lower quadrants abdominal pain. Beta-human chorionic gonadotropin (beta-hCG) level (592?mUI/mL) and clinical and ultrasound (US) findings were suspicious for tubal pregnancy. On the third day, despite beta-hCG decrease (364?mUI/mL), she complained of severe pain in the lower abdomen, and physical examination revealed abdominal rebound tenderness. US showed a large amount of fluid in the abdominal cavity. Because of the unstable clinical condition, emergency laparoscopy and resection of left ovarian ectopic pregnancy were performed. Histology confirmed ovarian gestation. Conclusion. This case shows that ectopic pregnancy rupture may occur despite low levels of beta-hCG. Hemoperitoneum is not contraindication to laparoscopy.

Resta, Serena; Fuggetta, Eliana; D'Itri, Federica; Evangelista, Simona; Ticino, Adele; Porpora, Maria Grazia



Role of serial MRI assessment in the management of an abdominal pregnancy.  


A 33-year-old woman was admitted to the hospital with an abdominal pregnancy at a gestational age of 20 weeks. An initial MRI mapping of fetal location and placental vascular invasion was obtained. The patient refused surgical intervention until fetal survival would be possible. Serial MRIs were essential in timing delivery and avoiding an emergency surgical situation. The baby was delivered at 24 weeks with the assistance of a multidisciplinary surgical team. The mother as well as the baby survived. This case report highlights the role of serial MRI evaluations in the diagnosis and expectant management of an abdominal pregnancy. It also highlights the importance of interdisciplinary communication for a successful outcome. PMID:24127374

Renfroe, Shyann; Dajani, Nafisa K; Pandey, Tarun; Magann, Everett F



Spontaneous bilateral tubal pregnancy  

Microsoft Academic Search

With the increase in incidence of ectopic pregnancy over the decades, bilateral ectopic pregnancy is also increasing. It is usually associated with assisted reproductive techniques (ART) but in recent years few cases of spontaneous bilateral ectopic pregnancy have been reported. Gynaecologists should be aware of this and that ultrasonography has limitations in diagnosis. In cases of ectopic pregnancy where contralateral

Aisha Syed Wali; Rozilla Sadia Khan



Management of extra-tubal and rare ectopic pregnancies: case series and review of current literature  

Microsoft Academic Search

Objective  Management of extra-tubal ectopic gestations remains an inadequately explored clinical field due to the rarity of the presentations.\\u000a We present a synopsis of the management highlighted by our personal case series.\\u000a \\u000a \\u000a \\u000a Method  A literature search was conducted through Pubmed and Medline databases. We reviewed all cases presenting with extra-tubal\\u000a nidations in our institute, including seven interstitial, two cervical, three ovarian and

R. Oliver; M. Malik; A. Coker; J. Morris



Ectopic pregnancy in southern Iran: a statistical review of 96 cases.  


A review is presented of 96 cases of ectopic pregnacy over a 7-year period. It is noted that in recent years the incidence of this problem has increased. Inadequately diagnosed and treated pelvic inflammatory disease has been found to be the main predisposing factor (40%). The rate of extra-uterine gestation was 1:336 deliveries. In this study, previous fertility was high, and primigravidae constituted only 10.4% of the total. The effect of previous pelvic operations and pelvic infection is discussed; a statistical review of signs and symptoms is tabulated, and the management of the patient and of concomitant problems is presented. PMID:15916

Javey, H




Microsoft Academic Search

SUMMARY Abdominal pregnancy is relatively frequent in countries with low socioeconomic level. The authors report 4 observations of abdominal pregnancies of which a forward with an alive newborn child and 3 pregnancies stopped in the second quarter. The met difficulties are in the first place of order diagnosis in front of the absence of obstetrical ultrasonography in the first quarter

P Guié; P Iovenitti; I Yao; E Bohoussou; JJ Dia; S Anongba



Quinacrine Sterilization: an Assessment of Risks for Ectopic Pregnancy, Birth Defects and Cancer  

Microsoft Academic Search

Quinacrine sterilization (QS) involves transcervical insertion of quinacrine pellets using a modified Copper T IUD inserter. Pellets are placed at the fundus in the proliferative phase of the menstrual cycle. Efficacy is presently estimated at 1 pregnancy failure per 100 women at 2 years. Early complications are lower for QS than surgical sterilization and this is also true for risk

E. Kessel



Quinacrine sterilization: an assessment of risks for ectopic pregnancy, birth defects and cancer  

Microsoft Academic Search

Quinacrine sterilization (QS) involves transcervical insertion of quinacrine pellets using a modi¢ed CopperT IUD inserter. Pellets are placed at the fundus in the proliferative phase of the menstrual cycle. E?cacy is presently estimated at 1 pregnancy failure per 100 women at 2 years. Early complications are lower for QS than surgical sterilization and this is also true for risk of




Vaginal bleeding in pregnancy  


... may be a sign of a miscarriage or ectopic pregnancy. See the doctor right away. During months 4 - ... during pregnancy: Cervical polyp Early labor (bloody show) Ectopic pregnancy Infection of the cervix Trauma to the cervix ...


Massive hemorrhage in a previously undiagnosed abdominal pregnancy presenting for elective Cesarean delivery  

Microsoft Academic Search

Purpose  To report a case of previously undiagnosed abdominal pregnancy diagnosed at the time of Cesarean section for persistent oblique\\u000a lie. Delivery of the fetus was followed by near catastrophic hemorrhage. The management of massive hemorrhage in the context\\u000a of the obstetric patient is discussed.\\u000a \\u000a \\u000a \\u000a Clinical features  A 32-yr-old, ASA l primigravida was scheduled for elective Cesarean delivery at 38 weeks gestation

Krishna Ramachandran; Paul Kirk



The response of Islamic jurisprudence to ectopic pregnancies, frozen embryo implantation and euthanasia.  


The opinions of the Jurisconsult of Egypt on Islamic law regarding test tube fertilization, embryo transfer and abortion are explained. Test tube babies, if not derived from the husband's sperm, are by definition, "zina" or the result of illicit sexual intercourse. This type of quasi-adultery is punishable by mere disgracing, rather than lapidation, or stoning to death. Such children cannot inherit even from the mother. Possibly, a female child may marry the husband, to be legitimized in terms of inheritance. Under Islamic law, embryo transfer is illegal insofar as it involves artificial insemination of the donor by the husband; temporary maternity by the donor is a jural concept that has no place in Islamic family law. The egg of the donor, not the surrogate mother, places the issue in the thorny area of multiple suckling. There have been no pronouncements by Islamic legal experts on euthanasia or pregnancy by in vitro fertilization of orphaned embryos. Abortion law "ijhad" in Kuwait was amended in 1982 to permit abortion where either grievous bodily harm to the mother is imminent or it is proved that the baby will suffer incurable brain damage or severe mental retardation. The decision must be approved unanimously by 3 Muslim consultant physicians presided over by an obstetrician or gynecologist, parental consent is required, and the hospital must have an obstetric-gynecological wing. There is precedent in Islamic law for saving the life of the mother where there is a clear choice of allowing either the fetus or the mother to survive. Similarly in case of miscarriage or attempted miscarriage, damages for a fetus or stillborn are less than those paid for a live birth. Penalties for therapeutic abortion, for example after exposure to German measles, have been viewed as less serious before 120 days of gestation, when the Prophet indicated that the embryo is given a soul. These ethical interpretations are worth considering for Western jurists as a source of ideas. PMID:3626801

Ghanem, I



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

SciTech Connect

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.

Sudour, Helene, E-mail: h.sudour@hotmail.f [Department of Paediatric Onco-Hematology, CHU Nancy, Vandoeuvre-les-Nancy (France); Chastagner, Pascal [Department of Paediatric Onco-Hematology, CHU Nancy, Vandoeuvre-les-Nancy (France); Claude, Line [Department of Radiotherapy, Centre Leon Berard, Lyon (France); Desandes, Emmanuel [Department of Statistics, Centre Alexis Vautrin, Vandoeuvre-les-Nancy (France); Klein, Marc [Department of Endocrinology, CHU Nancy, Vandoeuvre-les-Nancy (France); Carrie, Christian [Department of Radiotherapy, Centre Leon Berard, Lyon (France); Bernier, Valerie [Department of Radiotherapy, Centre Alexis Vautrin, Vandoeuvre-les-Nancy (France)



Sonography of Methotrexate for Ectopics  

NASA Astrophysics Data System (ADS)

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.

Urzic?, Denise; Dorohoi, Dana-Ortansa



Blood flow velocity in the fetal abdominal aorta and in the umbilical artery in uncomplicated pregnancies.  


The blood flow velocity waveform (BFWV) in fetal vessels depends on the stroke volume and the frequency of the fetal heart, the compliance of the vessel and the peripheral resistance of the fetal vascular bed. The objective of the present study was to establish the change of the BFVW throughout gestation and whether the change of the resistance indices are related to the peak flow velocity and/or the end-diastolic flow velocity. The BFVW of the fetal abdominal aorta and of the umbilical artery at 27th-30th week and at 37th-40th week of gestation were analysed in fifteen patients with uncomplicated pregnancies and subsequent normal outcome. The measurement was performed with a pulsed duplex scanner (Kranzbühler). The Doppler beam had a fixed angle of 50 degrees to the fetal vessel in all cases. The peak flow velocity in the fetal aorta remained constant from the 27th-30th week to the 37th-40th week of gestation: 1418 +/- 248 Hz vs. 1448 +/- 269 Hz. The end-diastolic flow, however, showed a significant increase during the respective periods: from 270 +/- 59 Hz to 325 +/- 69 Hz. The peak flow velocity in the umbilical artery was about 25% below that of the fetal aorta: 1028 +/- 149 Hz (27th-30th week) and 1106 +/- 196 Hz (37th-40th week). The end-diastolic flow, however, increased by about 41%: 292 +/- 86 Hz vs. 412 +/- 83 Hz demonstrating a tremendous change of the compliance and the peripheral resistance in the umbilical vascular system. These alterations are also exhibited by the resistance indices. The resistance indices S/D, PI and RI of both vessels were related to the EDF of the abdominal aorta and the umbilical artery at the respective gestational age. It demonstrated that the EDF is of major influence on the calculated resistance indices. The blood flow in the aorta and the umbilical artery was 135(+/- 18) ml/kg/min and 143 (+/- 21) ml/kg/min, respectively. In conclusion, the BFVW for fetal surveillance should be measured under a constant angle in the fetal abdominal aorta. It gives a good information concerning the peripheral resistance and compliance in the respective vascular areas. The EDFV has its lowest value at 200 Hz in the fetal aorta and in the umbilical artery under physiological conditions. PMID:1426509

Künzel, W; Jovanovic, V; Grüssner, S; Colling, T



[Conservative management of extra-uterine pregnancy].  


Expectant management was studied in 35 patients representing 4.9% of all ectopic pregnancies during an 8 year period. Laparoscopy was performed in a first period to define the inclusion criteria: hematosalpinx < or = 2 cm and hemoperitoneum < or = 50 ml. In a second period, inclusion criteria used a predictive pretherapeutic score < or = 11 with a sonographic visualization of the ectopic pregnancy. This score involved six criteria graded on a scale from 1 to 3: gestational age, hCG and P level, existence of abdominal pain, size of hemoperitoneum and diameter of hematosalpinx assessed sonographically. The patients were on out-patients basis. Success rate was 85.7% (30/35 patients). When the pretherapeutic score was < or = 11 and the initial hCG level < 1,000 mUl/ml the success rate increased to 96%. Thirteen patients (87%) had patent tubes evaluated by hysterosalpingography on the side of the ectopic pregnancy. Twelve patients delivered one miscarriage occurred and none ectopic pregnancy was observed. Expectant management is a useful form of treatment for ectopic pregnancy in selected cases. PMID:8075657

Fernandez, H; Frydman, R



Comparison of the diagnostic values of circulating steroid hormones, VEGF-A, PIGF, and ADAM12 in women with ectopic pregnancy  

PubMed Central

Background Several peripheral proteins that might be useful for detecting the presence of ectopic pregnancy (EP) have been evaluated, but none have been proven entirely useful in the clinic. We investigated the presence and the possible changes in circulating molecules that distinguish between normal intrauterine pregnancy (IUP) and tubal ectopic pregnancy. Methods Non-pregnant women during the menstrual cycle, women with IUP, and women with tubal EP after informed consent. Serum levels of 17?-estradiol (E2), progesterone (P4), testosterone (T), beta-human chorionic gonadotropin (?-hCG), vascular endothelial growth factor-A (VEGF-A), placental growth factor (PIGF), and a distintegrin and metalloprotease protein 12 (ADAM12) were analyzed. Receiver operating characteristic analysis was used to assess the diagnostic discrimination of EP and gestational age-matched IUP. Results E2, P4, PIGF, and ADAM12 levels increased and ?-hCG decreased throughout IUP. E2 and VEGF-A levels were significantly different between women with tubal EP and IUP. However, using a serum ?-hCG cut-off of less than 1000 mIU/mL, P4 was significantly lower in women with tubal EP compared to IUP. Although E2 was inversely correlated with VEGF-A in women in the early stages of IUP, E2 was not correlated with VEGF-A in women with EP prior to tubal surgery. There were no significant differences in either PIGF or ADAM12 alone between women with tubal EP or IUP. Although no significant correlations were seen between E2 and PIGF or P4 and ADAM12 in women in the early stages of IUP, E2 was positively correlated with PIGF and P4 was positively correlated with ADAM12 in women with EP prior to tubal surgery. Our studies defined associations but not causality. Conclusions Individual measurements of serum E2 or VEGF-A levels are strongly related to early pregnancy outcomes for women with IUP and EP, and pregnancy-associated E2 and VEGF-A levels provide diagnostic accuracy for the presence of tubal EP. This study demonstrates that correlation analysis of E2/VEGF-A and E2/PIGF serum levels may be able to distinguish a tubal EP from a normal IUP.



How and when human chorionic gonadotropin curves in women with an ectopic pregnancy mimic other outcomes: differences by race and ethnicity  

PubMed Central

Objective To investigate the hCG profiles in a diverse patient group with ectopic pregnancy (EP) and to understand when they may mimic the curves of an intrauterine pregnancy (IUP) or spontaneous abortion (SAB). Design Retrospective cohort study. Setting Three university hospitals. Patient(s) One hundred seventy-nine women with symptomatic pregnancy of unknown location. Intervention(s) None. Main Outcome Measure(s) Slope of log hCG; days and visits to final diagnosis. Result(s) Of women with an EP, 60% initially exhibited an increase in hCG values, with a median slope of 32% increase in 2 days; 40% of subjects initially had an hCG decrease, with the median slope calculated as a 15% decline in 2 days. In total, the hCG curves in 27% of women diagnosed with EP resembled that of a growing IUP or SAB. Of the EP hCG curves, 16% demonstrated a change in the direction of the slope of the curve. This was more common in African Americans and less evident in Hispanics. Furthermore, it was associated with more clinical visits and days until final diagnosis. Conclusion(s) The rate of change in serial hCG values can be used to distinguish EP from an IUP or SAB in only 73% of cases. The number of women who had a change in direction of serial hCG values was associated with race and ethnicity.

Dillon, Katherine E.; Sioulas, Vasileios D.; Sammel, Mary D.; Chung, Karine; Takacs, Peter; Shaunik, Alka; Barnhart, Kurt T.



Wnt-activation down-regulates Olfactomedin-1 (Olfm-1) in Fallopian tubal Epithelial cells: A Microenvironment Predisposed to Tubal Ectopic Pregnancy  

PubMed Central

Ectopic pregnancy occurs when the embryo failed to transits to the uterus and attached to the luminal epithelium of Fallopian tube. Tubal ectopic pregnancy (EP) is a common gynecological emergency and more than 95% of EP occurs in the ampullary region of the Fallopian tube (FT). In humans, Wnt-activation and down-regulation of Olfactomedin-1 (Olfm-1) occur in the receptive endometrium and coincided with embryo implantation in vivo. Whether similar molecular changes happen in the Fallopian tube leading to EP remains unclear. We hypothesized that activation of Wnt-signaling down-regulates 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)-Fallopian tube epithelial cell co-culture model (JAr and OE-E6/E7 cells) to study the role of Olfm-1 on spheroids attachment. Olfm-1 mRNA expression in the ampullary region of non-pregnant FT was higher (p<0.05) in the follicular than theluteal phase. Ampullary tubal Olfm-1 expression was lower in FT from women with EP compared to normal controls at the luteal phase (H-SCORE=1.3±0.2 vs 2.4±0.5; p<0.05). Treatment of OE-E6/E7 with recombinant Olfm-1 (0.2-5 ?g/ml) suppressed spheroids attachment to OE-E6/E7 cells; while activation of Wnt-signaling pathway by Wnt3a or LiCl, reduced endogenous Olfm-1 expression and increased spheroids attachment. Conversely, suppression of Olfm-1 expression by RNAi increased spheroids attachment to OE-E6/E7 cells. Taken together, Wnt-activation suppresses Olfm-1 expression and this may predispose a favourable microenvironment of the retained embryo in the Fallopian tube leading to EP in humans.

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



Methotrexate versus hyperosomolar glucose in the treatment of extrauterine pregnancy  

Microsoft Academic Search

The aim of this prospective, randomized, double blind study was to compare the efficacy of methotrexate and hyperosmolar glucose\\u000a injected directly into the extra-uterine gestational sac under laparoscopic vision. The study included twenty women with ectopic\\u000a pregnancy. Inclusion criteria were intact tubal pregnancy, not exceeding 4 cm in diameter, rising or plateauing ?hCG levels, and no evidence of intra-abdominal bleeding.

O. Sadan; S. Ginath; A. Debby; S. Rotmensch; A. Golan; H. Zakut; M. Glezerman



Indicators of potential for rupture for ectopics seen in the emergency department  

PubMed Central

Background: Emergency departments (ED) frequently evaluate patients with probable ectopic pregnancies who go home and may rupture. It would be beneficial to know which patient factors are associated with rupture and which are not. Objectives: The purpose of this study was to determine which ED patients with ectopic pregnancies are at risk for rupture. Materials and Methods: This study was a retrospective chart review of all women aged ?18 years during a 5-year period who were diagnosed with ectopic pregnancy to a level I ED. Data collected included basic demographic information, medical, surgical, obstetric and gynecologic history, social and sexual history, findings on physical examination, and laboratory values such as urine pregnancy test, ?-hCG, and complete blood count. Results: There was a significant difference using a multivariate regression analysis with 95% CI in history findings of abdominal pain, nausea, vomiting, and urinary tract symptoms. There was a significant difference in physical examination of pulse, diastolic pressure, abdominal tenderness, peritoneal signs, cervical motion tenderness, and adnexal tenderness. There was also a significant difference in ?-hCG, hemoglobin and hematocrit results and ultrasound findings of free peritoneal fluid, intrauterine pregnancy and cardiac findings between those who ruptured and those who did not. None of these tests was able to differentiate those that would go on to rupture. Conclusion: The result of the study did not find any single sign, symptom, or test that could reliably differentiate patients who have a ruptured ectopic from those who do not. However, ?-hCG over 1500 mIU was the best variable in explaining the variation between those who would or would not go on to rupture after their ED visit.

Downey, La Vonne A; Zun, Leslie S



An interesting case of intramyometrial pregnancy.  


A 27-year-old woman, gravida 3, para 1, at 9 weeks gestation, initially presented with clinical and ultrasonographic features suggestive of a missed spontaneous abortion for which surgical evacuation was performed. A diagnosis of ectopic pregnancy was made as on histological review no fetal or chorionic tissue was seen. Medical management for an ectopic pregnancy was initiated. Following methotrexate administration she was readmitted with severe abdominal pain. Findings on diagnostic laparoscopy revealed an asymmetrically enlarged swollen fundus. Hysteroscopy was performed concurrently demonstrating an empty uterine cavity. A diagnosis of intramyometrial pregnancy was made based on these findings. An MRI scan was performed postprocedure which supported the diagnosis. In view of her parity and future fertility medical management was adopted with methotrexate. She was followed up until hormone levels returned to baseline and serial scans showed a healed solid collection. PMID:22605595

Verghese, Tina; Wahba, Karim; Shah, Ahmar



Spontaneous bilateral tubal pregnancy.  


With the increase in incidence of ectopic pregnancy over the decades, bilateral ectopic pregnancy is also increasing. It is usually associated with assisted reproductive techniques (ART) but in recent years few cases of spontaneous bilateral ectopic pregnancy have been reported. Gynaecologists should be aware of this and that ultrasonography has limitations in diagnosis. In cases of ectopic pregnancy where contralateral adnexa is not clearly identified on ultrasound and fertility needs to be conserved, patient should be managed by experts in well equipped centres. A case of spontaneous bilateral tubal pregnancy that remained undiagnosed till laparotomy, is described. PMID:22313653

Wali, Aisha Syed; Khan, Rozilla Sadia



Ectopic Kidneys  


... topics for this letter X X-ray Y Yeast Infections Z no topics for this letter Ectopic ... An illness caused by harmful bacteria, viruses or yeast growing in the urinary tract. urine: Liquid waste ...


[Intact twin tubal pregnancy].  


A case of a unilateral eight-week twin ectopic pregnancy diagnosed with transvaginal sonography is presented here. This ectopic pregnancy was found in the right Fallopian tube of a 35-year old woman. After the surgical procedure conducted by the method of transversal laparotomy, we removed the right Fallopian tube with two gestational sacs So far only a hundred of such cases of ectopic twin pregnancy have been described worldwide. PMID:21258316

Hodzic, Jasmin; Granic, Abdulah; Hodzic, Nina; Idrizbegovic, Aida



Characterization of Tubal and Decidual Leukocyte Populations in Ectopic Pregnancy: Evidence That Endometrial Granulated Lymphocytes are Absent from the Tubal Implantation Site 1 1 Supported by grant 033166\\/Z\\/91 from the Wellcome Trust, London, United Kingdom, and by a European Community Junior Research Fellowship (grant no. BMH1CT94-6077), Brussels, Belgium  

Microsoft Academic Search

Objective: To compare and quantify leukocyte populations at the tubal implantation site, in the tubal mucosa away from the implantation site and in the intrauterine decidua in women who have had an ectopic tubal pregnancy with leukocyte populations in the decidualized endometrium in women who have had a normal intrauterine pregnancy.Design: Retrospective immunohistochemical study.Setting: Department of Pathology, University of Newcastle,

Neratzoula Vassiliadou; Judith N Bulmer



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

SciTech Connect

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.

Harris, G.J.; Al-Jurf, A.S.; Yuh, W.T.C.; Abu-Yousef, M.M. (Univ. of Iowa Hospitals and Clinics, Iowa City (USA))



Thickness of Rectus Abdominis Muscle and Abdominal Subcutaneous Fat Tissue in Adult Women: Correlation with Age, Pregnancy, Laparotomy, and Body Mass Index  

PubMed Central

Background Rectus abdominis muscle and abdominal subcutaneous fat tissue are useful for reconstruction of the chest wall, and abdominal, vaginal, and perianal defects. Thus, preoperative evaluation of rectus abdominis muscle and abdominal subcutaneous fat tissue is important. This is a retrospective study that measured the thickness of rectus abdominis muscle and abdominal subcutaneous fat tissue using computed tomography (CT) and analyzed the correlation with the patients' age, gestational history, history of laparotomy, and body mass index (BMI). Methods A total of 545 adult women were studied. Rectus abdominis muscle and abdominal subcutaneous fat thicknesses were measured with abdominopelvic CT. The results were analyzed to determine if the thickness of the rectus abdominis muscle or subcutaneous fat tissue was significantly correlated with age, number of pregnancies, history of laparotomy, and BMI. Results Rectus abdominis muscle thicknesses were 9.58 mm (right) and 9.73 mm (left) at the xiphoid level and 10.26 mm (right) and 10.26 mm (left) at the umbilicus level. Subcutaneous fat thicknesses were 24.31 mm (right) and 23.39 mm (left). Rectus abdominismuscle thickness decreased with age and pregnancy. History of laparotomy had a significant negative correlation with rectus abdominis muscle thickness at the xiphoid level. Abdominal subcutaneous fat thickness had no correlation with age, number of pregnancies, or history of laparotomy. Conclusions Age, gestational history, and history of laparotomy influenced rectus abdominis muscle thickness but did not influence abdominal subcutaneous fat thickness. These results are clinically valuable for planning a rectus abdominis muscle flap and safe elevation of muscle flap.

Kim, Jungmin; Lim, Hyoseob; Lee, Se Il



Atypical presentation of a large interstitial pregnancy.  


We report the case of a 20-year-old female who presented to the ER with a 1-week history of worsening abdominal pain and intermittent vaginal bleeding for the previous 5 days. Physical exam was notable for bilateral adnexal tenderness and a closed cervix without motion tenderness or discharge. Laboratory data demonstrated a beta HCG level of 7,787 IU/L, and pelvic ultrasound with transvaginal imaging was subsequently performed. Neither an adnexal mass nor a normal intrauterine pregnancy was demonstrable; however, a focal right fundal 7-cm area of heterogeneous echogenicity was observed. Initial findings were felt indeterminate with considerations including potential degenerating leiomyoma coexistent with a nonvisualized intrauterine pregnancy, ectopic pregnancy, or recent spontaneous abortion versus atypical interstitial ectopic pregnancy. The patient, initially declining further clinical intervention, returned within 24 h with continued pain. A repeat ultrasound demonstrated a relatively static and unchanged appearance with only a minimal concurrent interval increase in beta HCG levels. MRI was performed for further elucidation and demonstrated a heterogeneously hypervascular right fundal interstitial 6-cm mass, which, in the clinical context, was most suspicious for an ectopic pregnancy. Confirmatory laparoscopic cornual wedge resection and salpingectomy was subsequently performed. PMID:23250569

Rheinboldt, Matthew; Ibrahim, Sherif



Ectopic Intrapulmonary Thyroid: A Case Report  

PubMed Central

An ectopic thyroid is caused by abnormalities in migration of the thyroid during development and rarely occurs in the thoracic cavity or the abdominal cavity. We report the case of a 64-year-old female who had abnormal findings from a thyroid hormone test during follow-up after thyroid cancer surgery. Based on the radioisotope diagnostic test, an ectopic thyroid inside the thoracic cavity was suspected. Through surgical treatment, the patient was diagnosed with ectopic intrapulmonary thyroid. Ectopic intrapulmonary thyroid is reported to be very rare and the case is described along with a literature review.

Cho, Sung Woo; Lee, Hee Sung; Kim, Hyoung Soo; Nam, Eun Sook; Cho, Seong Jin



Vaginal bleeding in early pregnancy  


... An ectopic pregnancy, which may cause bleeding and cramping. A molar pregnancy, in which the pregnancy does ... you have: Heavy bleeding Bleeding with pain or cramping Dizziness and bleeding Pain in your belly or ...


Assessment of the Fetal Heart at 12-14 Weeks of Pregnancy Using B-Mode, Color Doppler, and Spatiotemporal Image Correlation via Abdominal and Vaginal Ultrasonography.  


This study aimed to evaluate the effect that combining multiple ultrasonographic imaging methods has on the proportion of tests with a satisfactory fetal heart assessment at 12-14 weeks of pregnancy using B-mode, color Doppler, and spatiotemporal image correlation software (STIC) via both the abdominal and vaginal routes. This cross-sectional prospective study involved healthy pregnant women at 12-14 weeks of pregnancy with a crown-rump length (CRL) of 84 mm or shorter. The following four cardiac views were assessed: four-chamber, left and right ventricular outflow tract, and aortic arch views. The same examiner sought to identify these four views using B-mode, color Doppler, and STIC via both the vaginal and abdominal routes. The study determined the proportion of cases and the respective 95 % confidence intervals (CIs) in which all four views were identified. The presence of significant differences in comparisons between methods was analyzed using McNemar's test. Although 57 pregnant women at 12-14 weeks of pregnancy agreed to participate in the study, 4 were not included because they presented with a CRL longer than 84 mm. Thus, 53 pregnant women were thoroughly assessed and included in the analysis. The combination of B-mode, color Doppler, and STIC via both the abdominal and vaginal routes enabled the highest proportion of identification of the four views (90.6 %; 95 % CI, 79.8-95.9 %). The lowest proportions were observed when B-mode was used alone via both the vaginal route (30.2 %; 95 % CI, 19.5-43.5 %) and the abdominal route (37.7 %; 95 % CI, 25.9-51.2 %). The abdominal route showed results slightly better than those of the vaginal route with all the methods, but the differences were not statistically significant. In the vast majority of the cases, the fetal hearts were properly assessed at 12-14 weeks of pregnancy when several methods were combined using both the abdominal and vaginal routes. However, only one-third of them would have had adequate heart assessment if the B-mode via either the abdominal or the vaginal route had been used alone. PMID:23479309

Lima, Angélia Iara Felipe; Araujo Júnior, Edward; Martins, Wellington P; Nardozza, Luciano Marcondes Machado; Moron, Antonio Fernandes; Pares, David Baptista Silva



Endometrium implantation and ectopic pregnancy  

Microsoft Academic Search

Embryo in uterine implantation is a complex and multifactor-related process and is a downstream and ideal point for woman\\u000a fertility control. Understanding the cellular and molecular mechanism of implantation is a prerequisite for development of\\u000a anti-implantation contraceptives. In spite of considerable accumulation of information from the laboratory animals that has\\u000a been achieved, it is difficult to generate such information in

Liu Yixun



Rapid method of diagnosing a normal pregnancy with high accuracy  

US Patent & Trademark Office Database

The present invention relates to a novel method of determining the existence of a normal pregnancy which has a high likelihood of culminating in a term pregnancy, by measuring hyperglycosylated hCG in a pregnant woman and comparing the concentration of measured hyperglycosylated hCG with a predetermined value. A measurement of hyperglycosylated hCG above the predetermined value, for example, about 13 ng/ml, is evidence of a high likelihood of a normal pregnancy. A measurement below the predetermined value is evidence of an abnormal pregnancy (ectopic pregnancy or miscarriage). Further analysis of the patient in the event that the measurement falls below the predetermined value is made by intravaginal or abdominal ultrasound to determine whether or not the pregnancy is ectopic or will likely result in a spontaneous abortion (miscarriage). This point-of-care (POC), over-the-counter (OTC) or professional laboratory application is unexpectedly rapid and highly predictive of pregnancy outcome in women exhibiting symptoms of pregnancy.




ERIC Educational Resources Information Center

|Reviews research on the response of normal women to a variety of aspects of pregnancy. Discusses motivation, physical aspects, emotional response, interpersonal changes, and relationships among response to pregnancy, postpartum reaction, and infant status. Presents a discussion of several theoretical phychological perspectives. (MK)|

Leifer, Myra



Extrauterine pregnancy: a historical review 3 3 Delivered as keynote address, Obstetrics and Gynecology Section, Society of Air Force Clinical Surgeons annual meeting, Biloxi, Mississippi, April 5, 2000. The opinions and assertions contained herein are the private views of the author and are not to be construed as official policy or position of the United States Government, the Department of Defense, or the Department of the Air Force  

Microsoft Academic Search

This article reviews historical developments in the recognition and management of abdominal and ectopic pregnancy since these entities were first recognized centuries ago. Contributions of the early anatomists who studied the female reproductive system and the courage of early surgeons who dared invade the abdomen cleared the path for the extraordinary success of today’s obstetricians and gynecologists in the treatment

Alvin M Cotlar



Ruptured extrauterine pregnancy  

Microsoft Academic Search

Extrauterine pregnancies contribute substantially to maternal mortality in all parts of the world. The most common cause of these deaths is massive bleeding after rupture of the ectopic pregnancy. The advent of transvaginal ultrasonography in early pregnancy and the use of quantitative measurement of the ?-unit of human chorionic gonadotropin have revolutionized the management of this condition. These diagnostic modalities

D. R. Slabbert; T. F. Kruger





... also be tired and need more rest. Your body will change as your baby grows during the nine months of your pregnancy. Don't hesitate to call your health care provider if you think you have a problem or something is bothering or worrying you.


Diagnosis and management of a ruptured rudimentary horn pregnancy in a low-resource setting.  


A 22-year-old woman presented with amenorrhoea, lower abdominal pain and brown vaginal discharge. She was noted to be in hypovolaemic shock with a distended and peritonitic abdomen. On bimanual examination, the uterus was not palpated, the posterior fornix was full and cervical excitation was present. A clinical diagnosis of a ruptured ectopic pregnancy was made. She was resuscitated and an emergency laparotomy was performed. Intraoperatively, a ruptured rudimentary horn with an ex utero pregnancy was discovered. The right horn and tube were removed, as was the non-viable fetus. There were no postoperative complications and the patient was discharged after 5 days of observation. PMID:23749832

Nathan, Hannah; Sornum, Alvin



Angular and interstitial pregnancy.  


Two cases of interstitial and one of angular pregnancy have been presented. Angular pregnancy occurs in the angle of the uterine cavity, while interstitial pregnancy is a true ectopic pregnancy. The outcome may therefore be different: the first may develop or abort into the cavity, while the second will almost always rupture. Because of the rich vascularization of this area, hemorrhage is usually profuse and may be catastrophic. Preoperative diagnosis is rare, but the triad of bleeding in pregnancy, no fetal remnants on dialation and curettage and an asymmetric uterus suggest angular or interstitial pregnancy. More liberal use of laparoscopy may increase the number of cases diagnosed before severe bleeding occurs. PMID:844965

Lancet, M; Bin-Nun, I; Kessler, I



Submyomatous Cornual Pregnancy  

PubMed Central

Cornual pregnancy constitutes an emergency while its diagnosis and management remain a challenge. Anatomical abnormalities in the uterus, such as fibroids in the cornual region, make the management even more difficult. A nulliparous patient presented with an ectopic pregnancy at the right cornua under a huge fibroid. Despite multiple doses of methotrexate for a cornual ectopic gestation, the serum beta human chorionic gonadotropin (?-hcG) levels doubled on the fifth day and a viable fetus was demonstrated on imaging. Thus surgical intervention in the form of laparoscopy followed by laparotomy, myomectomy of a large cornual fibroid and cornuostomy was performed. The serum beta human chorionic gonadotropin result was negative three weeks later. Surgical intervention in the form of myomectomy and cornuostomy was necessary to preserve fertility in this unusual presentation of cornual ectopic pregnancy.

Al-Kharusi, Lamya; Gowri, Vaidyanathan; Al-Sukaiti, Rashid; Al-Ghafri, Wadha; Rao, Kuntal



The ectopic ACTH syndrome  

Microsoft Academic Search

Ectopic Cushing’s syndrome usually relates to the ectopic ACTH syndrome (EAS) and represents ?20% of ACTH-dependent and ?10%\\u000a of all types of Cushing’s syndrome (CS). Nearly any neuroendocrine or non-endocrine tumours may be associated with EAS, but\\u000a the more prevalent tumours are bronchial carcinoids, small cell lung carcinomas, pancreatic carcinoids, thymic carcinoids,\\u000a medullary carcinomas of the thyroid, and phaeochromocytomas. Occult

Krystallenia I. Alexandraki; Ashley B. Grossman



Rh Factor: How It Can Affect Your Pregnancy  


... 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 ...


An Unexpected Near Term Pregnancy in a Rudimentary Uterine Horn  

PubMed Central

Unicornuate uterus occurs due to a complete or partial nondevelopment of one Mullerian duct; sometimes it is associated with a rudimentary horn, which can communicate or not with uterine cavity or contain functional endometrium. Pregnancy in a rudimentary horn is rare and the outcome almost always unfavorable, usually ending in rupture during the first or second trimester with significant morbidity and mortality. Despite the availability and advances on imagiologic procedures, recognition of this ectopic pregnancy is frequently made at laparotomy after abdominal pain and collapse. The authors describe a case of a primigravida with 34 weeks of gestation admitted with a preeclampsia with severity criteria. A cesarean for fetal malpresentation was done and, unexpectedly, a rudimentary horn pregnancy was found with a live newborn. In the literature, few reports of a horn pregnancy reaching the viability with a live newborn are described, enhancing the clinical importance of this case. A review of literature concerning the epidemics, clinical presentation, and appropriate management of uterine horn pregnancies is made.

Goncalves, Elisabete; Prata, Joao Pedro; Abreu, Rita; Mesquita, Jorge; Carvalho, Agostinho; Pinheiro, Paula



Ectopic localization of tungiasis.  


Tungiasis is caused by the penetration of the female sand flea Tunga penetrans into the epidermis. It is generally assumed that lesions are confined to the feet. To determine to what degree tungiasis occurs at other topographic sites, 1,184 inhabitants of a poor neighborhood in northeastern Brazil were examined; 33.6% were found to have tungiasis (95% confidence interval = 30.9-36.4%). Six percent presented lesions at locations other than the feet, with the hands being the most common ectopic site (5.5%). Other sites were the elbows, thighs, and gluteal region. Ectopic tungiasis was significantly associated with the total number of lesions (P < 0.001) and an age less than 15 years old (P = 0.02). In 86 patients actively recruited with lesions on their feet, ectopic localizations were observed in 25.6%. Since untreated sand flea lesions are prone to become superinfected, clinicians should be aware of not missing any ectopic localization of tungiasis. PMID:12389950

Heukelbach, Jörg; Wilcke, Thomas; Eisele, Margit; Feldmeier, Hermann



Ectopic Lacrimal Gland Tissue.  

National Technical Information Service (NTIS)

All of the cases coded as aberrant or ectopic lacrimal gland at the Armed Forces Institute of Pathology were reexamined, and observations on 35 are reported. The cornea was involved in ten of the 18 cases in which the choristomatous tissue was present in ...

W. R. Green L. Zimmerman



Heterotopic pregnancy: midtrimester management.  


A case of heterotopic pregnancy is presented. A search of the English literature reveals the present case to be the first instance in which a living second-trimester abdominal fetus has been extracted while its placenta remained undisturbed, and the intrauterine pregnancy progressed normally to term. PMID:514564

Wolf, G C; Kritzer, L; DeBold, C



Intra-Abdominal Bleeding during Pregnancy, Preterm Delivery, and Placental Polyp in a Long-Term Survivor of Neuroblastoma: A Case Report  

PubMed Central

Background. There are few reports of pregnancies in long-term survivors of pelvic neuroblastoma. Case. A 30-year-old Japanese woman with a history of pelvic neuroblastoma in her childhood, which was treated with surgical resection, chemotherapy, and radiation. Her pregnancy continued with conservative management, but she delivered a 510?g female infant at 23 weeks of gestation due to sudden onset of labor pain. She also had a placental polyp and developed massive postpartum bleeding. Conclusion. Cancer treatment, especially radiation therapy, in childhood may cause adverse outcomes during pregnancy in long-term survivors of neuroblastoma.

Watanabe, Noriyoshi; Tsutsui, Junna; Kakiuchi, Satsuki; Jwa, Seung Chik; Takahashi, Hironori; Kato, Naomi; Ozawa, Nobuaki; Sago, Haruhiko; Kitagawa, Michihiro



[Ectopic mediastinal parathyroid adenoma].  


We experienced 3 surgical cases with ectopic mediastinal parathyroid adenoma. All patients checked elevated serum calcium levels and parathyroid hormone levels above normal range so we diagnosed their illness as primary hyperparathyroidism. Two had treated urinary tract lithiasis for long time, and the other had no symptoms by hypercalcemia. To determine the location of abnormal parathyroid glands, 99mTc-methoxy-isobutyl-isonitrile (MIBI) scintigraphy, chest computed tomography (CT) scan and/or magnetic resonance imaging (MRI) were done, then posterior and anterior mediastinal tumors were revealed. Especially MIBI scintigraphy was very useful as diagnostic procedure for small ectopic parathyroid adenoma. It's considered that large tumor in the posterior mediastinum like case 1 is originated from upper parathyroid gland, and small tumor in the anterior mediastinum like case 2, 3 is originated from lower parathyroid gland. Tumors were resected via small thoracotomy with thoracoscope, cervical incision and partial median sternotomy respectively. Serum calcium and parathyroid hormone levels were normalized immediately. If we can detect the accurate location of small ectopic parathyroid adenoma using some intraoperative method, the tumor is resected by less invasive procedure. PMID:20715458

Sato, Nobuyuki; Nakagawa, Takayuki; Kanno, Masaaki; Nakamura, Yoshihiro; Kishimoto, Kouji; Imai, Tadashi



An unexpected spontaneous triplet heterotopic pregnancy.  


A heterotopic pregnancy is the coexistence of one or more ectopic pregnancies and a single or multiple eutopic pregnancies. This potentially fatal condition rarely occurs in spontaneous conception cycles. We report a case of spontaneous triplet heterotopic pregnancy in a multigravida with no known risk factors. Ultrasound imaging was the diagnostic tool used and left salpingectomy via laparotomy was performed in this case report. PMID:15756372

Alsunaidi, Mohammed I



Acinar Cell Carcinoma Arising from an Ectopic Pancreas  

Microsoft Academic Search

We herein report a rare case of ectopic pancreatic acinar cell carcinoma (ACC) which presented as a submucosal tumor of the\\u000a pylorus. A 73-year-old man came to our hospital presenting with epigastralgia. Esophago-gastroduodenal endoscopy showed no\\u000a mucosal lesions, but a submucosal tumor was observed around the pylorus. Abdominal computed tomography revealed two round\\u000a masses. One was located in the pylorus,

Yoshimasa Mizuno; Yasuhiro Sumi; Sho Nachi; Yoshihiro Ito; Tsutomu Marui; Shigetoyo Saji; Hirokazu Matsutomo



Heterotopic pregnancy in a large inner-city hospital: a report of two cases.  

PubMed Central

While ectopic pregnancy is a common occurrence, especially in the nonwhite female patient population, heterotopic pregnancy has traditionally been regarded as a rare clinical event until recently, especially with the advent of assisted reproductive procedures. We reported two cases, one in which an intrauterine pregnancy was discovered after a diagnosis of tubal abortion, another in which a patient underwent laparotomy for a tubal ectopic pregnancy with a concomitant previously diagnosed intrauterine pregnancy. The first patient subsequently delivered at term, while the second was lost to follow-up. In both cases, there was a delay in detecting the ectopic pregnancy component. These cases suggest that the clinician maintain a reasonable index of suspicion while evaluating a patient presenting with pelvic pain in the face of a documented intrauterine pregnancy. They also demonstrate the need for prompt and immediate action at the first sign indicating ectopic pregnancy to avoid missing this potentially life-threatening condition.

Perkins, James D.; Mitchell, Mark R.



Simultaneous bilateral tubal pregnancy after intracytoplasmic sperm injection.  


Since the advent of assisted reproductive technology, the concern about ectopic implantation of embryos has increased dramatically. Simultaneous bilateral tubal pregnancy is the least common type of ectopic implantation of two embryos. In this report we present the first case of simultaneous bilateral tubal pregnancy after intracytoplasmic sperm injection (ICSI) and embryo transfer treatment. The present case had no risk factor for ectopic pregnancy. Therefore, for early diagnosis and management of such cases, close clinical follow-up and routine ultrasonography following ICSI are necessary. PMID:8822467

Kahraman, S; Alatas, C; Tasdemir, M; Nuhoglu, A; Aksoy, S; Biberoglu, K



[Surgical treatment of a 5 month pregnancy in the rudimentary uterine cornu].  


Cornual ectopic pregnacy is rare clinical entity with high maternal mortality. In all cases surgical treatment is indicated, and taking care of most important complication--haemorrhagic shock. Therapeutic approach is individual and depending of simptomatplogy, gestational age of pregnancy and condition of the patient in time of diagnosis. Authors are presenting the case of cornual ectopic pregnancy of five months. PMID:17338208

Boskovi?, V; Vrzi?-Petronijevi?, S; Petronijevi?, M; Berisavac, M; Liki?-Ladjevi?, I



Ectopic lingual thyroid  

PubMed Central

Thyroid ectopy is characterized by the presence of thyroid tissue outside its normal position resulting from a defect of the thyroid diverticulum migration from the base of the tongue until its final pre-tracheal position. One case is presented in a 12-year-old girl patient who consults for a failure to thrive estimated at less than three standard deviations (SD). Bone age was estimated at 8 years late compared to chronological age. The hormonal assessment showed hypothyroidism with negative thyroid antibodies. Cervical ultrasound was revealed thyroid parenchyma pre-dominantly left in place while sweeping the area under chin showed a nodular formation of the base of the tongue. Thyroid scan with technetium 99 m showed a selective uptake of radiotracer in sublingual position. Cervical computed tomography revealed a posterior median sublingual mass spontaneously hyperdense and enhancing sharply after injection of contrast. Treatment with thyroxine allowed obtaining euthyroidism. This case asks us to be careful before aetiological diagnosis of hypothyroidism in children, because although this is rare, the presence of a thyroid parenchyma up to the cervical ultrasound does not eliminate the presence of ectopic tissue.

Amani, Mohammed El Amine; Benabadji, Nadjia; Benzian, Zakaria; Amani, Souad



Urolithiasis in pregnancy  

Microsoft Academic Search

Urolithiasis is the most common cause of urological-related abdominal pain in pregnant women after urinary tract infection.\\u000a The disease is not uncommon during pregnancy occurring in 1\\/200 to 1\\/2,000 women, which is not different from the incidence\\u000a reported in the nonpregnant female population of reproductive age. During pregnancy, the frequency of stone localization is\\u000a twice as higher in the ureter

Stavros Charalambous; Asterios Fotas; D. E. E. Rizk



Intervention to Decrease Risk for STDs and Unintended Pregnancies Among Navy Women Aboard Ships: A Biopsychosocial Approach.  

National Technical Information Service (NTIS)

Unintended pregnancies (UIPs) and STDs with their sequelae of ectopic pregnancy continue to be epidemic among active duty enlisted women. Such reproductive health problems result in major morbidity among affected women as well as posing a potential threat...

C. B. Boyer



Abdominal trauma  

Microsoft Academic Search

Summary  \\u000a While a great part of the Anglo-American medical literature addresses the topic of penetrating trauma the German spreaking\\u000a countries rather publish on blunt abdominal injury. The presented paper discusses the strategic principles of acute clinical\\u000a management of abdominal trauma on the combined basis of own research results and a comprehensive review of the literature.\\u000a \\u000a \\u000a \\u000a Blunt abdominal injuries in most

D. Nast-Kolb; A. Trupka; S. Ruchholtz; L. Schweiberer



The occurrence and outcome of 39 pregnancies after 1621 cases of transcervical resection of endometrium  

Microsoft Academic Search

BACKGROUND: To evaluate the outcomes and management of pregnancy after transcervical resection of the endometrium (TCRE). METHODS: Retrospective study of 39 pregnancies after 1621 procedures of TCRE. RESULTS: Among 1621 women who were successfully followed up after TCRE, there were 39 pregnancies in 32 women, including five ectopic pregnancies (12.8%) and 34 intrauterine pregnancies (87.2%). The majority of pregnancies (84.6%)

Enlan Xia; Tin-Chiu Li; Dan Yu; Xiaowu Huang; Jie Zheng; Yuhuan Liu; Mei Zhang


Accurate Preoperative Diagnosis of Ovarian Pregnancy with Transvaginal Scan  

PubMed Central

Ovarian pregnancy is a rare variant of ectopic pregnancy, and an accurate preoperative diagnosis is very challenging. Dr. Saint Monnissey described the first reported case of ovarian pregnancy in 17th century. Transvaginal ultrasonography is a valuable tool in identifying an ovarian pregnancy from other types of ectopic pregnancies. Management with laparoscopy or laparotomy is required in all cases, and in almost all cases, ovary can be preserved since implantation is usually superficial (Koo et al.; 2011). A single case of an ovarian pregnancy, consistent with Spiegelberg's criteria is presented here. This case history demonstrates the use of ultrasonography (USG) and surgery in the diagnosis and treatment, respectively, of the ovarian pregnancy. As we step into an era where in vitro fertilization rate is on its hike, one should be aware that incidence of ovarian pregnancy is also increasing, necessitating a high index of suspicion.

Gupta, Natasha; Gupta, Anu; Onyema, Godwin; Pantofel, Yelena; Ying, Shan-Ching; Garon, Jack E.; Lampley, Charles; Blankstein, Josef



Limiting the caesarean section rate in low risk pregnancies is key to lowering the trend of increased abdominal deliveries: an observational study  

PubMed Central

Background As the rate of Caesarean sections (CS) continues to rise in Western countries, it is important to analyze the reasons for this trend and to unravel the underlying motives to perform CS. This research aims to assess the incidence and trend of CS in a population-based birth register in order to identify patient groups with an increasing risk for CS. Methods Data from the Flemish birth register 'Study Centre for Perinatal Epidemiology' (SPE) were used for this historic control comparison. Caesarean sections (CS) from the year 2000 (N = 10540) were compared with those from the year 2008 (N = 14016). By means of the Robson classification, births by Caesarean section were ordered in 10 groups according to mother - and delivery characteristics. Results Over a period of eight years, the CS rise is most prominent in women with previous sections and in nulliparous women with a term cephalic in spontaneous labor. The proportion of inductions of labor decreases in favor of elective CS, while the ongoing inductions of labor more often end in non-elective CS. Conclusions In order to turn back the current CS trend, we should focus on low-risk primiparae. Avoiding unnecessary abdominal deliveries in this group will also have a long-term effect, in that the number of repeat CS will be reduced in the future. For the purpose of self-evaluation, peer discussion on the necessity of CS, as well as accurate registration of the main indication for CS are recommended.



Body art and pregnancy  

Microsoft Academic Search

Body art has gained tremendously in popularity over the past 20 years, and a substantial number of pregnant women may have tattoos or piercings. In most cases, pregnancy will be uneventful. However, on rare occasions, body art may become an issue or cause complications. Navel and abdominal surface piercing and microdermal implants may cause unsightly stretch marks from gravid distension.

Nicolas Kluger



Laparoscopic surgery in pregnancy  

Microsoft Academic Search

A 32-year-old white lady suffering from tubal infertility was referred to our institution in November 1992 because of low abdominal pain due to a heterotopic pregnancy (one intrauterine sac and the other in the right tube). The patient had undergone, 8 weeks before, her second successful attempt at in vitro fertilization and embryo transfer. We decided to perform a laparoscopic

V. Remorgida; C. Carrer; A. Ferraiolo; M. Natucci; P. Anserini



Intratubal methotrexate injection combined with Chinese herbal medicine for tubal pregnancy and following pregnancy prognosis  

Microsoft Academic Search

Objective: To compare the effects of treatment of tubal pregnancy (TP)and its following second pregnancy by intratubal methotrexate\\u000a injection (IMI) alone and combination of IMI with Chinese herbal medicine.Methods: Thirty-five patients suffering from unruptured TP were divided into two groups at random, to the 19 patients in the treated\\u000a group, the treatment of combined IMI with Ectopic Pregnancy decoction No.

Wang Yu-dong; Li Da-Jin; Lian Fang; Zhang Jian-wei



Spontaneous triplet, tubal ectopic gestation.  

PubMed Central

Only six cases of spontaneous, unilateral, triplet ectopic gestations have previously been reported. We now present a seventh case. The patient's prior obstetrical history was significant for a term stillbirth and a term cesarean section for breech. Quantitative betahCG was normal for gestational age; however, the increased trophoblastic mass of an inappropriately implanted multiple gestation may produce sufficient betahCG to mimic an intrauterine singleton gestation. Resolution was achieved via salpingostomy. This case is significant for being spontaneously conceived and not the result of assisted reproductive technologies. Furthermore, this case supports an association between prior cesarean section and ectopic gestation. Images Figure 1

Nwanodi, Oroma; Berry, Robert



Acinar cell carcinoma arising from an ectopic pancreas.  


We herein report a rare case of ectopic pancreatic acinar cell carcinoma (ACC) which presented as a submucosal tumor of the pylorus. A 73-year-old man came to our hospital presenting with epigastralgia. Esophago-gastroduodenal endoscopy showed no mucosal lesions, but a submucosal tumor was observed around the pylorus. Abdominal computed tomography revealed two round masses. One was located in the pylorus, while the other was found between the portal vein and the inferior vena cava. An examination of a biopsy specimen was inconclusive. We diagnosed a gastrointestinal stromal tumor or malignant lymphoma preoperatively, and decided to perform an operation in order to confirm the diagnosis and select the optimal treatment. Intraoperatively, the mass in the pylorus invaded the pancreatic head, and the lymph node in the hepatoduodenal ligament was swollen. We performed a pancreaticoduodenectomy as a radical excision. The resected specimen showed the 7.6 x 4.9-cm size tumor to mainly originate from the pylorus. Histopathologically, the tumor was identified as pancreatic ACC with lymph node metastasis. The tumor cells were labeled by immunohistochemical staining for alpha1-antitrypsin. Because of the tumor location, we considered the tumor to have originated from the ectopic pancreatic tissue in the stomach. This is only the second case of ACC originating from an ectopic pancreas reported in the literature. PMID:17643220

Mizuno, Yoshimasa; Sumi, Yasuhiro; Nachi, Sho; Ito, Yoshihiro; Marui, Tsutomu; Saji, Shigetoyo; Matsutomo, Hirokazu



[Seven-weeks cervical pregnancy treated successfully with methotrexate - a case report].  


The paper presents the case of a 7-weeks-cervical pregnancy treated successfully with methotrexate. A 16 years-old nullipara girl was admitted to the hospital, because of moderate bleeding from the vagina and mild lower abdominal pain. The last menstruation was 56 days before admission. The vaginal part of the cervix was bluish and thickened. 0 x 03B2-hCG concentration in blood serum was 2.65 IU/ml. In the endovaginal USG the pregnancy follicle was not seen in the uterine cavity, but the uterine cervix was expanded in the middle part by an echo negative follicle 10.5 mm in diameter. The foetal heart beat was not visible. Because of the patient's young age, 50mg of methotrexate (MTX) was applied intravenously. 0 x 03B2-hCG concentration decreased to 1.18 IU/ml on 4th day, but the follicle halo in USG was still visible so an additional dose of 25 mg methotrexate i.v. was applied. 0x03B2-hCG fell to 0,0485 IU/ml on the 10th day and USG showed, tissues of differentiated echogenicity and faint contour of the follicle in the cervical canal. Curettage of the cervix and uterus was made without any complications. Subsequent examinations showed decreasing concentration of 0 x 03B2-hCG. The patient, in good condition, was discharged from the hospital after five days. Methotrexate in treatment of cervical pregnancy is safe and allows to preserve the uterus and fertility in young nullipara adolescent women with cervical pregnancy. Few reports in the literature describe the use of methotrexate in ectopic pregnancy in teenagers, but no reported cases of cervical pregnancy treated with methotrexate have been found. PMID:19648659

Olejek, Anita; Horak, Stanis?aw; Zam?y?ski, Jacek; Bodzek, Piotr; Sto?tny, Piotr


[Spleen trauma during pregnancy (a case report)].  


Splenic injury during pregnancy after blunt abdominal trauma is rare. The physiological and anatomical changes during pregnancy modify the clinical, biological and radiological signs. The authors report a case of a 30-year-old-woman in the 32nd week of pregnancy, with an isolate splenic injury after a motor vehicle accident. Splenectomy was realised 4 days after an initial decision of abstaining from surgery. In pregnancy, the frequency of recurrent bleeding, the possibility of concomitant uterine injuries and the risk of foetal loss should modify the surgeon's attitude to splenic rupture after abdominal blunt trauma. PMID:14522395

Badaoui, R; El-Kettani, C; Radji, M; Samkaoui, M-A; Byhet, N; Ossart, M



Abdominal Pain  


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[Cervical pregnancy: a rare case of reimplantation after abortion. A case report].  


Cervical pregnancy is a rare form of ectopic pregnancy defined by the implantation of the blastocyst in the cervical canal. Most of the cervical pregnancies have been reported in patients with a history of vacuum curettage or caesarean section. The authors report a case of cervical pregnancy occurred after a failure of medical abortion. A literature review discusses the possibility of a cervical secondary implantation and describes the management of such pregnancies. PMID:22921158

Pizzoferrato, A C; Legendre, G; Demaria, F; Benifla, J-L



Radiation risks in pregnancy  

SciTech Connect

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.

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



Ovarian Pregnancy following Intracytoplasmic Sperm Injection and Embryo Transfer: A Case Report  

PubMed Central

Ovarian pregnancy is a rare form of ectopic pregnancy following ICSI-ET, and the diagnosis depends on the physicians suspicion and experience. Preservation of ovarian tissue during surgery is of utmost importance to preserve fertility. We present a case of ovarian pregnancy who had a successful treatment preserving the ovary.

Ramachandran, Amar; Sharma, Swati; Pratap, Kumar; Rajesh, Bhakta; Akhila, Vasudeva; Ramayapally, Akhila; Valiathan, Manna



Successful Management of Intrauterine Twin and Concomitant Cervical Pregnancy: A Case Report  

Microsoft Academic Search

Use of in vitro fertilization techniques increases the frequency of pathological implantation. However, simultaneous pregnancies are a rarity. Ectopic implantation of the embryo may occur in the cervical canal. This is the first case report, which describes successful management of an intrauterine twin pregnancy which occurred simultaneously with a cervical pregnancy. Diagnostic and therapeutic options are discussed along with the

E. Ujvari; F. Krizsa; A. Sebestyen; S. Varbiro; F. Paulin



Efficacy of transabdominal ultrasound examination in the diagnosis of early pregnancy complications in an emergency department  

Microsoft Academic Search

OBJECTIVE: To assess the value of ultrasound in an emergency department in the diagnosis of early pregnancy complications, the efficacy of a study protocol in identifying ectopic pregnancies, and the agreement on ultrasound findings among emergency department staff and gynaecologists. METHODS: All women presenting with early pregnancy complications had a transabdominal ultrasound scan performed by the attending doctor and checked

T W Wong; C C Lau; A Yeung; L Lo; C M Tai



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

Microsoft Academic Search

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

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



Explaining Pregnancy Loss: Parents' and Physicians' Attributions.  

ERIC Educational Resources Information Center

|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…

Dunn, Dana S.; And Others



Ovarian response to exogenous gonadotropins during pregnancy  

Microsoft Academic Search

Multiple ovarian follicles were successfully induced in a patient undergoing superovulation for a gamete intrafallopian transfer (GIFT) procedure despite, the presence of an undiagnosed ectopic pregnancy. Midluteal gonadotropin releasing hormone agonist (GnRH-a) treatment should be coupled with mechanical contraception in the previous cycle in patients with patent tubes.

Johnny S. Younis; Aby Lewin; AMNON BRZEZINSKI; Yehuda Schwartz; Joseph G. Schenker; Neri Laufer



Aftermath of abortion. Anniversary depression and abdominal pain.  


Two case histories of significant psychopathology resulting from theraputic abortion are presented. In both cases, pregnancy was motivated by restitution of a loss. One woman experienced psychogenic abdominal pain related to an unconscious pregnancy fantasy. The patient was a 23-year-old nurse's aide who developed cramping with occasional nausea and vomiting during the same month her pregnancy would have been delivered. A 40-year old married housewife also became symptomatic at the time of delivery of a pregnancy she had aborted. Both pregnancies, the physical and the psychosomatic, occurred after the death of the patient's father. Multiple factors, not just therapeutic abortion, led to neurotic depression. PMID:719214

Cavenar, J O; Maltbie, A A; Sullivan, J L



A ruputured left cornual pregnancy: a case report.  


A cornual gestation is one of the most hazardous types of ectopic gestations, which accounts for 2 - 4% of all the ectopic pregnancies and it has a mortality rate which is 6 - 7 times higher than that of the ectopics in general. The diagnosis and the treatment of such a pregnancy is challenging and it constitutes an urgent medical situation. Because of the myometrial stretch ability, they tend to present relatively late, at 7 - 12 weeks of gestation. A significant maternal haemorrhage which can lead to hypovolaemia and shock, can rapidly result from a cornual rupture. We are reporting a case of 28 year old woman who presented to the emergency obstetrical room in a state of hypovolaemic shock. The diagnosis of a ruptured ectopic pregnancy was confirmed in view of the history of 10 weeks of amenorrhoea, with a positive urine pregnancy test. She was shifted for emergency exploratory laparotomy. Intraoperatively, we encountered a left lateral wall ruptured uterus with a 10 week old foetus in the peritoneal cavity, which suggested a left cornual ectopic pregnancy which had ended up as a catastrophic event. A cornual resection and repair was done successfully. PMID:23998092

S M, Surekha; T, Chamaraja; Singh N, Nabakishore; Singh N, Bimolchandra; T S, Neeraja



A Ruputured Left Cornual Pregnancy: A Case Report  

PubMed Central

A cornual gestation is one of the most hazardous types of ectopic gestations, which accounts for 2 – 4% of all the ectopic pregnancies and it has a mortality rate which is 6 – 7 times higher than that of the ectopics in general. The diagnosis and the treatment of such a pregnancy is challenging and it constitutes an urgent medical situation. Because of the myometrial stretch ability, they tend to present relatively late, at 7 – 12 weeks of gestation. A significant maternal haemorrhage which can lead to hypovolaemia and shock, can rapidly result from a cornual rupture. We are reporting a case of 28 year old woman who presented to the emergency obstetrical room in a state of hypovolaemic shock. The diagnosis of a ruptured ectopic pregnancy was confirmed in view of the history of 10 weeks of amenorrhoea, with a positive urine pregnancy test. She was shifted for emergency exploratory laparotomy. Intraoperatively, we encountered a left lateral wall ruptured uterus with a 10 week old foetus in the peritoneal cavity, which suggested a left cornual ectopic pregnancy which had ended up as a catastrophic event. A cornual resection and repair was done successfully.

S M, Surekha; T, Chamaraja; Singh N, Nabakishore; Singh N, Bimolchandra; T S, Neeraja



Ectopic tooth in maxillary sinus: Case series  

PubMed Central

Ectopic eruption of a tooth within the dentate region of the jaws is often noticed in clinical practice and is well documented in the literature. But the ectopic eruption into the non dentate region is rare and scantly documented. The maxillary sinus is one such a non dentate region, apart from nasal septum, mandibular condyle, coronoid process and the palate, to accommodate such ectopic eruptions of teeth. Due to its rarity and lack of consensus over its management, the incidence deserves to be added to the literature and discussed. Early surgical intervention for removal of ectopic tooth along with enucleation of the associated cyst, if any, is the treatment of choice.

Ramanojam, Shandilya; Halli, Rajshekhar; Hebbale, Manjula; Bhardwaj, Smita



Effects of ovariohysterectomy on intra-abdominal pressure and abdominal perfusion pressure in cats.  


Intra-abdominal pressure (IAP) and abdominal perfusion pressure (APP) have shown clinical relevance in monitoring critically ill human beings submitted to abdominal surgery. Only a few studies have been performed in veterinary medicine. The aim of this study was to assess how pregnancy and abdominal surgery may affect IAP and APP in healthy cats. For this purpose, pregnant (n=10) and non-pregnant (n=11) queens undergoing elective spaying, and tomcats (n=20, used as controls) presented for neutering by scrotal orchidectomy were included in the study. IAP, mean arterial blood pressure (MAP), APP, heart rate and rectal temperature (RT) were determined before, immediately after, and four hours after surgery. IAP increased significantly immediately after abdominal surgery in both female groups when compared with baseline (P<0.05) and male (P<0.05) values, and returned to initial perioperative readings four hours after surgery. Tomcats and pregnant females (P<0.05) showed an increase in MAP and APP immediately after surgery decreasing back to initial perioperative values four hours later. A significant decrease in RT was appreciated immediately after laparotomy in both pregnant and non-pregnant queens. IAP was affected by abdominal surgery in this study, due likely to factors, such as postoperative pain and hypothermia. Pregnancy did not seem to affect IAP in this population of cats, possibly due to subjects being in early stages of pregnancy. PMID:23118052

Bosch, L; Rivera del Álamo, M M; Andaluz, A; Monreal, L; Torrente, C; García-Arnas, F; Fresno, L



Transvaginal fetal biometry in early pregnancy  

Microsoft Academic Search

Objective: To produce reference charts for fetal size with transvaginal sonography that are potentially helpful in evaluating normal and abnormal early pregnancies. Design: A prospective cross-sectional study. Subjects: 1081 normal singleton pregnancies with a normal fetal karyotype or normal healthy baby at delivery, at 9–16 weeks' gestation. Measurements included crown rump length, biparietal diameter, transverse cerebellar diameter, head and abdominal

Paolo Rosati; Lorenzo Guariglia



[Examples of emergency surgery. Ectopic pregnancy, biliary ileus, appendicitis].  


Surgery was practised at home for a long time during the first half of the XXth century. The improvement of anaesthesia and of the structures of cares provoked the progressive disappearing of these practices after the WWII. Although modern techniques were currently used in the Hospitals of the Universities the conditions of practising remained the same in some countries at the beginning of the century. At the beginning of the 50s before the growing transports surgical emergencies could be taken in charge at home in some areas uneasy to reach. PMID:19579550

Lebert, Raoul; Bonnichon, Philippe; Douard, Richard


Abdominal tuberculosis.  

PubMed Central

Tuberculosis has staged a global comeback and forms a dangerous combination with AIDS. The abdomen is one of the common sites of extrapulmonary involvement. Patients with abdominal tuberculosis have a wide range and spectrum of symptoms and signs; the disease is therefore a great mimic. Diagnosis, mainly radiological and supported by endoscopy, is difficult to make and laparotomy is required in a large number of patient. Management involves judicious combination of antitubercular therapy and surgery which may be required to treat complications such as intestinal obstruction and perforation. The disease, though potentially curable, carries a significant morbidity and mortality. Images Figure 1 Figure 2 Figure 3 Figure 4 Figure 5 Figure 6 Figure 7 Figure 8 Figure 9 Figure 10 Figure 11 Figure 12 Figure 13

Kapoor, V. K.



Pregnancy after hydrosalpinx treatment with Essure.  


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

Inocêncio, Gonçalo; Coutinho, Lúcia; Maciel, Raquel; Barreiro, Márcia



Successful pregnancy following medical management of heterotopic pregnancy  

PubMed Central

We present a case of sonographic demonstration of quadruplet heterotopic pregnancy consisting of twin intrauterine (IU) pregnancy and a twin adnexal pregnancy after ovulation induction (OI) with clomiphene citrate (CC) and timed intercourse (TI). Both heterotopic pregnancy and spontaneous twinning are frequent after OI, this combination although extremely rare must be kept in mind. The role of early transvaginal sonography and serum beta human chorionic gonadotrophin after missed periods helps in early diagnosis. It gives us an opportunity for medical management, saving the patient the agony of surgery along with loss of pregnancy. The management of heterotopic pregnancy is controversial. This patient did not have a viable IU pregnancy and both the sacs in the adnexa were small. Thus, we treated her successfully by medical management with systemic methotrexate, with regular follow-up. This patient successfully conceived after 6 months with OI and TI, with ovulation occurring from the same side of the previous ectopic. She had a viable IU gestation corresponding to 12 weeks.

Lavanya, R; Deepika, K; Patil, Madhuri



Heterotopic pregnancy following ovulation induction by Clomiphene and a healthy live birth: a case report  

Microsoft Academic Search

INTRODUCTION: A heterotopic pregnancy is defined as the presence of a combined intrauterine and ectopic pregnancy. Its estimated incidence is accepted as between 1\\/7000 and 1\\/30,000 pregnancies. It is also reported to be as high as 1% after the use of assisted reproductive technology, but Clomiphene Citrate which increases the rate of twinning, could be associated with a heterotopic pregnancy

Abbas Honarbakhsh; Elham Khoori; Simin Mousavi



Gerota's fascia over a pelvic ectopic kidney: Myth or reality?  

PubMed Central

Objective: To prospectively evaluate for the presence or absence of Gerota's fascia in a pelvic ectopic kidney, as this is not well documented. Materials and Methods: Between January 2007 and July 2011, all patients with normal renal functions presenting to the Urology Clinic with pelvic ectopic kidney were evaluated for the presence of fascia similar to Gerota's fascia. Specific evaluation included a contrast-enhanced computed tomography (CT) scan and open surgery where indicated. A literature search using PubMed was also done for the period between 1990 and May 2011 using the terms ‘Gerota's fascia’, ‘perirenal fascia,’ and ‘pelvic kidney’. Results: Eleven patients were evaluated. The mean age was 28.6 years (range 7 to 50). The presentation included stone disease in six, pelvi-ureteric obstruction in three, and as part of the evaluation for other causes of lower abdominal pain, it was found in two. A CT scan performed on eight patients did not show any evidence of fascia, while surgical exploration done on seven showed a well-defined fascial layer, at least on the ventral aspect of the kidney. A literature search also did not show any information about Gerota's fascia in the pelvic kidney. Conclusion: Further anatomical / radiological studies are needed to definitively document the presence of Gerota's fascia around a pelvic kidney. Our data is more in favor of the presence of such a perirenal fascia similar to Gerota's fascia.

Goel, Apul



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

SciTech Connect

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.

Macedo, Thanila A., E-mail:; Andrews, James C. [Mayo Clinic and Foundation, Department of Radiology (United States); Kamath, Patrick S. [Mayo Clinic and Foundation, Division of Gastroenterology and Hepatology (United States)



Pregnancy and outcome of uterine allotransplantation and assisted reproduction in sheep.  


This pilot study was performed from March 2008 through February 2010 to demonstrate that pregnancy can be achieved in a uterine allograft in the sheep model with the guidance of assisted reproductive technology. Uterine allotransplantation was performed in 12 sexually mature African sheep (Sudanese and Ethiopian). All animals underwent uterine transplantation via a minilaparotomy incision using a Mobius retractor device. A control group of pregnant Romney Marsh sheep with nontransplanted uteri were used to compare fetal development, uterine and placental histologic findings, and blood samples of progeny of the uterine transplant recipient sheep. Fetal size was obtained from ultrasound measurements during the early (crown-rump length) and late (biparietal diameter and abdominal circumference) gestational periods. The primary end point variables included preoperative and postoperative management, embryo transfer protocol, intraoperative assessments, and physiologic cardiopulmonary changes in the lamb during the first 5 hours of life. Four months after the initial uterine transplantation, 5 of 12 uterine allografts were considered candidates for the embryo transfer procedure. Fresh and frozen blastocyst donors were transferred accordingly to the remaining 5 uterine allografts via a minilaparotomy incision. Three of these resulted in pregnancies. One was an ectopic gestation, 1 sheep carried the pregnancy to 105 days, and 1 delivered a fully developed lamb from the transplanted uterus that was delivered via cesarean section. Neonatal lamb blood gas values and chemistry, gross organ examination, and ventilation and respiratory compliance studies yielded results normal for gestational age. This first reported case demonstrates that pregnancy can be carried in an allotransplanted uterus, with the end result a successful delivery. PMID:21354071

Ramirez, Edwin Ricardo; Ramirez Nessetti, Doris K; Nessetti, Matthew B R; Khatamee, Masood; Wolfson, Marla R; Shaffer, Thomas H; Ramirez, Viviana Zuluaga; Ramirez, Hugo A


Approach to the acute abdomen in pregnancy.  


Numerous physiologic changes in pregnancy may affect the presentation of abdominal pain in pregnancy. A high index of suspicion must be used when evaluating a pregnant patient with abdominal pain. General anesthesia is considered safe in pregnancy. Intraoperative monitoring and tocolytics should be individualized. Laparoscopic surgery should be performed in the second trimester when possible and appears as safe as laparotomy. If indicated, diagnostic imaging should not be withheld from the pregnant patient. Appendectomy and cholecystectomy appear to be safe in pregnancy. The reported incidence of adnexal masses and fibroids in pregnancy may increase with increasing use of first-trimester ultrasound. Conservative management, with surgical management postpartum, appears reasonable in most cases. PMID:17921006

Kilpatrick, Charlie C; Monga, Manju



Addiction in pregnancy.  


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

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



Ectopic cervical thymoma in a patient with Myasthenia gravis  

PubMed Central

Ectopic cervical thymoma is rare and is often misdiagnosed as a thyroid tumor or other malignancy. Ectopic thymic tissue can be found along the entire thymic descent path during embryogenesis. However, a thymoma arising from such ectopic thymic tissue is extremely rare. Herein we report a patient with ectopic cervical thymoma and myasthenia gravis (MG) and discuss the management.



Teaching NeuroImages: Ectopic posterior pituitary.  


Ectopic posterior pituitary results from incomplete caudal extension of the diencephalon during embryogenesis.(1) The portal circulation carrying hypothalamic-releasing hormones to the adenohypophysis is disrupted, resulting in growth hormone deficiency and more rarely panhypopituitarism. PMID:24127194

Grech, Rueben; Galvin, Leo; Looby, Seamus; O'Hare, Alan; Thornton, John; Brennan, Paul



Ectopic Axillary Breast during Systemic Lupus  

PubMed Central

Many breast changes may occur in systemic lupus erythematosus. We report a 41-year-old woman with lupus who presented three years after the onset of lupus an ectopic mammary gland confirmed by histological study.

Ben Dhaou, Besma; Boussema, Fatma; Aydi, Zohra; Baili, Lilia; Rokbani, Lilia



Gallbladder-associated ectopic liver: A rare finding during a laparoscopic cholecystectomy  

PubMed Central

INTRODUCTION Ectopic hepatic tissue is due to an uncommon failure of embryological liver development that is rarely described in the world medical literature. The incidence of ectopic liver (EL) has been reported to be anywhere from 0.24% to 0.47% as diagnosed at laparotomy or laparoscopy. We describe a case of EL adherent to the gallbladder, removed at laparoscopic cholecystectomy. PRESENTATION OF CASE A 37-year-old female was admitted for elective cholecystectomy having had an episode of acute cholecystitis provoked by gallstones. During the procedure, a 30 mm × 10 mm × 5 mm section of EL tissue attached to the anterior wall of the gallbladder was identified and removed by en-bloc excision during laparoscopic cholecystectomy. Histological examination confirmed the absence of malignant degeneration of the hepatic tissue. The patient recovered well postoperatively and was discharged the day after the operation. She was well when seen six months later. DISCUSSION EL has been reported in several sites, such as the gallbladder, gastrohepatic ligament, adrenal glands, esophagus, and thoracic cavity. EL is often clinically silent and discovered incidentally during abdominal surgical procedures or autopsies. Because patients with ectopic liver may suffer complications such as torsion, peritoneal bleeding, fatty change, and evolution to cirrhosis or malignant degeneration to hepatocellular carcinoma, any ectopic liver tissue needs to be correctly identified and removed. CONCLUSION Despite the rare occurrence of EL, it should be recognized and removed by the surgeon to prevent a higher risk of complications and malignant transformation.

Martinez, Carlos Augusto Real; de Resende, Herminio Cabral; Rodrigues, Murilo Rocha; Sato, Daniela Tiemi; Brunialti, Cyntia Viegas; Palma, Rogerio Tadeu



Locating Ectopic Foci on a Cylinder  

NASA Astrophysics Data System (ADS)

Arrhythmia is a condition in which an additional ectopic pacemaker is present in the tissue of the heart. Localization of ectopic foci is essential for successful radio-frequency ablation, an important surgical way of treating arrhythmia. In one of the possible mechanisms, arrhythmia induced by an ectopic foci located in one of the main blood vessels leading out or onto the heart. The therapeutic procedure in this case is usually ablation of the whole junction of the blood vessel with heart wall. In this way, whatever excitation occurs inside the vessel, it cannot penetrate the ventricles perturbing their contraction cycle. Such an ablation procedure is long and burdened with the risk of the perforation. A more safe method would involve the localization of the source of the excitation (i.e. the ectopic foci) and its ablation. The methods used in cardiology at present involve complicated localization systems and are time-consuming with the patient spending a long time on the operating table. Recently, Hall and Glass have developed numerical methods which allow to quickly to model the localization of the ectopic foci in a flat, square sample of an inhomogeneous medium. Here, we demonstrate an extension of this model for the case of a cylinder containing an ectopic foci, that can be a model of a blood vessel with the source of the ectopic beat inside it. Three methods of localization are implemented. Standard electrodes containing several active tips are used to stimulate the medium locally and locate the foci judging from the reaction of the system. The first one uses electrode activation times to compute the location of the ectopic site. The second one localizes it by measuring the resetting response of the foci, and the third one, uses wavefront curvature. Specifically for the cylindrical geometry of the blood vessel, we developed a localization procedure that allows to quickly localize the pacemaker.

Kuklik, Pawel; Zebrowski, Jan J.



Ectopic geographic tongue--a case report.  


This report describes a case of 'ectopic' geographic tongue where lesions, clinically and histologically similar to those normally confined to the tongue, presented on the floor of the mouth and cheek mucosa. The patient, a type II diabetic, had a history of thrombocytopaenia and, more recently, autoimmune haemolytic anaemia. Clinical Relevance: Geographic tongue is a common oral medicine condition and the purpose of this paper is to highlight the fact that it can present ectopically on the oral mucosa. PMID:17432777

Borrie, Felicity; Musthyala, Rajitha; Macintyre, David



Unilateral ectopic breast tissue on vulva in an adult female.  


Among the ectopic breasts, an ectopic breast tissue on vulva is an extremely rare case, especially in adult period. To our knowledge only 38 cases of ectopic breast tissue on vulva are documented in the world literature, out of which only 10 cases of unilateral ectopic breast tissue on vulva has been reported. Because of its rarity here we report a case of unilateral ectopic breast tissue on vulva in an adult female. PMID:23904730

Deshmukh, Santoshkumar Nagnath; Maske, Audumbar N; Deshpande, Akshay P; Shende, Shweta P



Ultrasonographic Endometrial Features in Tubal Pregnancy: Are They Predictive Factors of Successful Medical Treatment?  

Microsoft Academic Search

The aim of this study was to explain possible relationships in cases of ectopic pregnancy between sonographic endometrial features and treatment outcome following methotrexate (MTX) injection. A total of 157 cases of unruptured tubal pregnancy were diagnosed and treated systemically with MTX. The sonographic endometrial pattern, endometrial thickness and treatment outcome were retrospectively analyzed. There were four types of endometrial

Ji Eun Lim; Tak Kim; Nak-Woo Lee; Min-Jeong Oh; Hyun-Joo Seol; Nan-Hee Jung; Sung-Hoon Park; So-Eun Jung; Il-Hae Park; Hai-Joong Kim



Laparoscopic surgery in the treatment of nonruptured tubal pregnancy  

NASA Astrophysics Data System (ADS)

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.

Mutrynowski, Andrzej; Zabielska, Renata



Pregnancy testing and counseling.  


Pregnancy testing and counseling are increasingly accepted as necessary services for adolescents within the primary care setting. For teenagers in need of a pregnancy test, the easy-to-perform, highly sensitive and specific enzyme immunoassay analysis for measuring beta-human chorionic gonadotropin (beta-HCG) is ideal. However, no single beta-HCG analysis should be taken as absolute evidence for the presence or absence of pregnancy. Instead, an integrated approach using all of the health care professional's skills in adolescent health care should be taken. In some cases a careful history and physical examination will confirm the pregnancy. At other times serial quantitative serum HCG titers, pelvic ultrasonography, and culdocentesis may be necessary to rule out the possibility of ectopic pregnancy or threatened abortion. For more than three quarters of pregnant adolescents the pregnancy is unplanned and may represent a major conflict for themselves, their partner, and their families. When such an event occurs the health care professional will frequently be sought as a resource. Successful pregnancy counseling has many components. The adolescent will need to visualize the counselor as an available, sensitive, nonjudgmental individual who believes in the right of the pregnant teenager ultimately to progress to her own decision. The counseling process should be firmly based on an understanding of adolescent psychosocial and biologic development, crises intervention techniques, and family dynamics. The counselor needs to be a reliable information source. If the adolescent decides to go to term, programs offering comprehensive prenatal services to teenagers should be identified. Information concerning high-quality, low-cost abortion services also will need to be available for those who wish to terminate. It is important to monitor the quality of care given in prenatal and abortion service referrals. Few adolescents currently choose to place their babies for adoption. Counseling in this area is especially needed. Several types of adoption procedures are available and at appropriate times during a teenager's neonatal care adoption should be presented as a reasonable alternative to parenthood. Throughout this process, the health care professional will have opportunities to discuss a wide variety of health related topics with the adolescent and often her partner and their respective families. Ideally, whatever her final decision, it is the goal of the counselor to make the experience a positive and maturing influence on her life and the lives of other persons involved. PMID:2660091

Stephenson, J N



Costs of maternal conditions attributable to smoking during pregnancy  

Microsoft Academic Search

Context: Despite known adverse health effects, many women continue to smoke during pregnancy. Public attention has now focused on the economic as well as health effects of this behavior.Objective: To estimate health care costs associated with smoking-attributable cases of placenta previa, abruptio placenta, ectopic pregnancy, preterm premature rupture of the membrane (PPROM), pre-eclampsia, and spontaneous abortion.Design: Pooled odds ratios were

E. Kathleen Adams; Cathy L. Melvin



Impact Tolerance - Abdominal Injury.  

National Technical Information Service (NTIS)

In order to provide data on human tolerance to blunt abdominal impact a literature study and laboratory tests were carried out to determine the major causes of abdominal injury, injury mechanisms, a quantitative relationship between input and occurrence o...

D. L. Beckman J. H. McElhaney R. L. Stalnaker V. L. Roberts



Abdominal tuberculosis in children  

Microsoft Academic Search

Four boys with abdominal tuberculosis, one of whom had acquired immunodeficiency syndrome, are presented. Abdominal imaging findings on plain radiography, ultrasonography, computed tomography, and gastrointestinal contrast studies included tuberculous peritonitis and ascites in all patients, tuberculous adenopathy in two, gastrointestinal tuberculosis in two, and omental tuberculosis in two. The radiographic features particularly characteristic of abdominal tuberculosis were: (1) low attenuating

D. S. Ablin; K. A. Jain; E. M. Azouz



Unintended pregnancy  

Microsoft Academic Search

Unintended pregnancy is a worldwide problem that affects women, their families, and society. Unintended pregnancy can result from contraceptive failure, non-use of contraceptive services, and, less commonly, rape. Abortion is a frequent consequence of unintended pregnancy and, in the developing world, can result in serious, long-term negative health effects including infertility and maternal death. In many developing countries, poverty, malnutrition,

Carrie S Klima



Ectopic lingual thyroid with vascular anomalies  

PubMed Central

Background Lingual thyroid represents 90% of ectopic thyroid tissue localizations. The first case was described by Hickman in 1869. An ectopic thyroid is often asymptomatic, but pathological or physiological conditions inducing hyperproduction of thyroid-stimulating hormone can lead an ectopic thyroid to become symptomatic. Treatment of the symptomatic ectopic thyroid can be medical, with hormone-suppressing therapy, or surgical. Case presentation A 17-year-old female presented to our outpatient clinic complaining of a sensation of a lump in her throat. Ear, nose, and throat (ENT) examination identified a swelling of the base of the tongue in the glossoepiglottic area. Thyroid scintigraphy showed a single contrast enhancement in the sublingual region, instead of in the normal anatomical position of the thyroid. She was treated surgically after failed hormone-suppressing therapy. An arteriography performed before the surgery showed vascular anomalies and was useful in surgical planning. Conclusion Recognition of vascular anomalies in an ectopic thyroid is fundamental before surgical planning, therefore, accurate radiological study of the vasculature should always be planned before surgical treatment of this disease.

Bianco, Maria Rita; La Boria, Alessandro; Franco, Teresa; Ferrise, Pierpaolo; Allegra, Eugenia



Ectopic liver: Different manifestations, one solution.  


Developmental abnormalities are rare in the liver. This study presents two case reports of ectopic liver. The first case was a 31-year-old male with clinical indication for laparoscopic appendectomy. Laparoscopy identified a perforated appendix and an unknown tumorous lesion in the ligamentum hepato umbilicalis. The patient underwent a laparoscopic appendectomy, intraoperative lavage of the peritoneal cavity, and extirpation of the lesion in the ligamentum hepato umbilicalis. Histpathological examination of the excised tumor revealed that it comprised liver tissue with fibrinous changes. The tumor was completely separate from the liver with no connection. It was classified as an ectopic liver. No further therapy was required. The second case was a 59-year-old male with a tumor on the upper pole of the spleen, incidentally diagnosed in an ultrasound examination. The biopsy raised suspicion of hepatocellular carcinoma. A positron emission tomography-computed tomography examination revealed accumulation of F-18 fluorodeoxyglucose only in the tumor. The patient underwent a splenectomy with a resection and reconstruction of diaphragm. After the hepatocellular carcinoma was confirmed, adjuvant therapy (sorafenib) was initialized. The operations and postoperative recoveries were uncomplicated in both cases. Despite the low incidence of ectopic liver and rare complications, it is necessary to maintain awareness of this possibility. The potential malignancy risk for ectopic liver tissue is the basis for radical surgical removal. Therapy for hepatocellular carcinoma in an ectopic liver follows the same guidelines as those followed for treating the "mother" liver. PMID:24151369

Zonca, Pavel; Martinek, Lubomir; Ihnat, Peter; Fleege, Jan



Ectopic liver: Different manifestations, one solution  

PubMed Central

Developmental abnormalities are rare in the liver. This study presents two case reports of ectopic liver. The first case was a 31-year-old male with clinical indication for laparoscopic appendectomy. Laparoscopy identified a perforated appendix and an unknown tumorous lesion in the ligamentum hepato umbilicalis. The patient underwent a laparoscopic appendectomy, intraoperative lavage of the peritoneal cavity, and extirpation of the lesion in the ligamentum hepato umbilicalis. Histpathological examination of the excised tumor revealed that it comprised liver tissue with fibrinous changes. The tumor was completely separate from the liver with no connection. It was classified as an ectopic liver. No further therapy was required. The second case was a 59-year-old male with a tumor on the upper pole of the spleen, incidentally diagnosed in an ultrasound examination. The biopsy raised suspicion of hepatocellular carcinoma. A positron emission tomography-computed tomography examination revealed accumulation of F-18 fluorodeoxyglucose only in the tumor. The patient underwent a splenectomy with a resection and reconstruction of diaphragm. After the hepatocellular carcinoma was confirmed, adjuvant therapy (sorafenib) was initialized. The operations and postoperative recoveries were uncomplicated in both cases. Despite the low incidence of ectopic liver and rare complications, it is necessary to maintain awareness of this possibility. The potential malignancy risk for ectopic liver tissue is the basis for radical surgical removal. Therapy for hepatocellular carcinoma in an ectopic liver follows the same guidelines as those followed for treating the “mother” liver.

Zonca, Pavel; Martinek, Lubomir; Ihnat, Peter; Fleege, Jan



Satisfaction with Hospital Care and Interventions after Pregnancy Loss.  

ERIC Educational Resources Information Center

|Conducted longitudinal study of 194 women and men who experienced miscarriage, ectopic pregnancy, stillbirth, or newborn death to examine recommended interventions. Subjects were more satisfied if they had experienced intervention than if they had not, but having experienced more total interventions was not associated with lower grief or greater…

Lasker, Judith N.; Toedter, Lori J.



Gastroenterology Consultations in Pregnancy  

PubMed Central

Abstract Background Training in gastrointestinal (GI) disorders in pregnancy is required for all gastroenterology fellows. Nevertheless, the actual role of the gastroenterologist in the management of pregnant patients is unknown. Establishing the characteristics of GI consultations in pregnancy can help focus trainee education and prepare gastroenterologists for future practice. The purpose of this study was to determine the indications for consultations in pregnancy and the gastroenterologist's role in the evaluation and management of the pregnant patient. Methods A chart review was performed of all consecutive outpatient GI consultations for pregnant women at a high-volume obstetrics hospital over a 3-year period. Referring source, patient characteristics, indication(s) for consultation, diagnosis(es), change in management after consultation, and need for follow-up were recorded. Results We reviewed 370 charts. The mean age (±standard deviation [SD]) at referral was 28.7 years?±?6.5, and mean weeks of gestation (±SD) was 21.3?±?8.8. Obstetrician/gynecologists requested most consultations (70.1%). New GI symptoms arising in pregnancy comprised 35.4% of consultations, and worsening of a preexisting GI disorder comprised 24.4%. The most common indications for consultation were viral hepatitis (20.2%), nausea and vomiting (18.9%), and nonspecific abdominal pain (13.5%). The most common diagnoses were acute or chronic viral hepatitis (17.8%), hyperemesis gravidarum (15.1%), gastroesophageal reflux disease (14.3%), and constipation (13.0%). Consultation changed the diagnosis in 25.1% of patients and changed management in 78.6%. Follow-up was required in 77.3% of cases during pregnancy and 37.8% postpartum. Conclusions GI consultation in pregnancy is sought more frequently for the evaluation and management of GI disorders not unique to pregnancy than for pregnancy-unique disorders. Although GI consultation changed the diagnosis in a minority of cases, it changed management in the majority. Gastroenterologists should be familiar with the most common indications for consultation in pregnancy and be prepared to evaluate and manage pregnant women with GI disorders.

Manlolo, Joseph; McGowan, Christopher E.; Reinert, Steven; Esposti, Silvia Degli



Spontaneous Heterotopic Pregnancy, Simultaneous Ovarian, and Intrauterine: A Case Report  

PubMed Central

Spontaneous heterotopic pregnancy is a rare clinical condition in which intrauterine and extrauterine pregnancies occur at the same time. The occurrence of an ovarian heterotopic pregnancy is a singular event as it comprises only 2.3% of all heterotopic pregnancies, extremely rare among women who conceive naturally. A case of a 28-year old patient was treated for spontaneously conceived heterotopic pregnancy. The patient was admitted to our center with lower abdominal pain and amenorrhoea. A transvaginal ultrasound scan showed an ovarian and an intrauterine heterotopic pregnancy. This was managed laparoscopically. Considering spontaneous pregnancies, every physician treating women of reproductive age should be aware of the possibility of heterotopic pregnancy. It can occur in the absence of any predisposing risk factors; only with an early diagnosis and treatment the intrauterine pregnancies will reach viability with a great chance of a favorable obstetric outcome.

Basile, Francesca; Di Cesare, Cristina; Quagliozzi, Lorena; Donati, Laura; Bracaglia, Marina; Caruso, Alessandro; Paradisi, Giancarlo



Ectopic parathyroid adenoma--the hidden culprit.  


Primary Hyperparathyroidism is known to present with protean manifestations leading to misdiagnosis in the initial stages of the disease. Inability to locate the adenoma in an ectopic parathyroid gland may further delay the diagnosis of these cases. Aberrant migration during development may lead to intrathyroidal or other ectopic locations of parathyroid glands. This may lead to their misdiagnosis as a thyroid nodule or failure to locate parathyroids during surgery. Similarity in cytological picture between thyroids and parathyroids may further complicate diagnosis by fine needle aspiration cytology. Nuclear imaging scintigraphy accurately localizes the tumor in 90% of cases and simplifies the surgical management. We encountered three such cases with the parathyroid gland adenomas in ectopic locations in which pre-operative nuclear imaging played a major role. PMID:17907504

Muthukrishnan, J; Verma, A; Modi, K D; Kumaresan, K; Jha, Sangeeta



[Ectopic molar tooth in the maxillary sinus].  


The development of intranasal ectopic teeth is rare. Although they are more commonly seen in the palate and maxillary sinus, they can also be found in the mandibular condyle, coronoid process, and nasal cavity. A 30-year-old male patient presented with a complaint of headache. Computed tomography of the paranasal sinuses showed a bony mass in the right maxillary sinus wall, 1 cm in size. He did not have any history of maxillofacial trauma or operation. The mass was removed via a Caldwell-Luc procedure. It looked like a tooth. Histopathologic diagnosis was made as ectopic molar tooth. The patient was asymptomatic two weeks after the operation. PMID:18187979

Altun, Hüseyin; Teker, Ay?enur Meriç; Ceran, Murat; Gedikli, Orhan



Diagnostic potential for miRNAs as biomarkers for pregnancy-specific diseases.  


Discovery of circulating miRNAs in maternal blood has not only facilitated the understanding of their role in normal pregnancy, but also paved new avenues for biomarker discovery to detect pregnancy-associated complications, such as preeclampsia, ectopic pregnancy, gestational diabetes mellitus, fetal growth restriction, recurrent pregnancy loss, and preterm delivery. In this review, we summarize the studies to date of miRNAs in maternal circulation and placental tissue in human. This brief review does not cover all aspects of this intriguing field but focuses on some new and interesting findings of diagnostic potential for miRNAs as biomarkers for pregnancy-specific diseases. PMID:23396163

Zhao, Zhen; Moley, Kelle H; Gronowski, Ann M



Ruptured renal artery aneurysm during pregnancy, a clinical dilemma  

Microsoft Academic Search

BACKGROUND: Rupture of a renal artery aneurysm (RAA) during pregnancy is a rare event, with a high mortality rate for both mother and fetus. Increased blood flow and intra-abdominal pressure, and vascular changes secondary to increased steroid production are postulated as contributory to the increased risk of rupture during pregnancy. CASE PRESENTATION: We present here a case report of total

Khaled B Soliman; Yaser Shawky; Mohamed M Abbas; Mohamed Ammary; Allaa Shaaban



Abdominal epilepsy in chronic recurrent abdominal pain  

PubMed Central

Background: Abdominal epilepsy (AE) is an uncommon cause for chronic recurrent abdominal pain in children and adults. It is characterized by paroxysmal episode of abdominal pain, diverse abdominal complaints, definite electroencephalogram (EEG) abnormalities and favorable response to the introduction of anti-epileptic drugs (AED). We studied 150 children with chronic recurrent abdominal pain and after exclusion of more common etiologies for the presenting complaints; workup proceeded with an EEG. We found 111 (74%) children with an abnormal EEG and 39 (26%) children with normal EEG. All children were subjected to AED (Oxcarbazepine) and 139 (92%) children responded to AED out of which 111 (74%) children had an abnormal EEG and 27 (18%) had a normal EEG. On further follow-up the patients were symptom free, which helped us to confirm the clinical diagnosis. Context: Recurrent chronic abdominal pain is a common problem encountered by pediatricians. Variety of investigations are done to come to a diagnosis but a cause is rarely found. In such children diagnosis of AE should be considered and an EEG will confirm the diagnosis and treated with AED. Aims: To find the incidence of AE in children presenting with chronic recurrent abdominal pain and to correlate EEG findings and their clinical response to empirical AEDs in both cases and control. Settings and Design: Krishna Institute of Medical Sciences University, Karad, Maharashtra, India. Prospective analytical study. Materials and Methods: A total of 150 children with chronic recurrent abdominal pain were studied by investigations to rule out common causes of abdominal pain and an EEG. All children were then started with AED oxycarbamezepine and their response to the treatment was noted. Results: 111 (74%) of the total 150 children showed a positive EEG change suggestive of epileptogenic activity and of which 75 (67.56%) were females and 36 (32.43%) were male, majority of children were in the age of group of 9-12 years. Temporal wave discharges were 39 (35.13%) of the total abnormal EEG's. All the children were started on AEDs and those with abnormal EEG showed 100% response to treatment while 27 (18%) children with normal EEG also responded to treatment. Twelve (8%) children did not have any improvement in symptoms. Conclusions: A diagnosis of AE must be considered in children with chronic recurrent abdominal pain, especially in those with suggestive history, and an EEG can save a child from lot of unnecessary investigations and suffering.

Kshirsagar, V. Y.; Nagarsenkar, Suhel; Ahmed, Minhajuddin; Colaco, Sylvia; Wingkar, K. C.



Intermittent hepatic porphyria in pregnancy with good perinatal outcome.  


Porphyrias are rare metabolic diseases caused by enzymatic defects of the haeme biosynthesis. Association of pregnancy and acute porphyria is rare, but mortality rate among pregnant women from acute attack has been reported up to 42%. This paper presents a patient with pregnancy complicated by intermittent hepatic porphyria with good perinatal outcome. The pattern of the attack in pregnancy varies individually and it makes porphyric pregnancies a challenge. Previously diagnosed porphyria patients should be closely monitored during pregnancy and diagnosis of acute porphyria must be also considered in all pregnant women with unexplained abdominal pain. PMID:22634923

Vidosavljevi?, Domagoj; Sijanovi?, Siniša; Rubin, Mirjana; Košuta Petrovi?, Maja; Abi?i? Žuljevi?, Kristina; Simi?, Ivana



Abdominal decompression in children.  


Abdominal compartment syndrome (ACS) increases the risk for mortality in critically ill children. It occurs in association with a wide variety of medical and surgical diagnoses. Management of ACS involves recognizing the development of intra-abdominal hypertension (IAH) by intra-abdominal pressure (IAP) monitoring, treating the underlying cause, and preventing progression to ACS by lowering IAP. When ACS is already present, supporting dysfunctional organs and decreasing IAP to prevent new organ involvement become an additional focus of therapy. Medical management strategies to achieve these goals should be employed but when medical management fails, timely abdominal decompression is essential to reduce the risk of mortality. A literature review was performed to understand the role and outcomes of abdominal decompression among children with ACS. Abdominal decompression appears to have a positive effect on patient survival. However, prospective randomized studies are needed to fully understand the indications and impact of these therapies on survival in children. PMID:22482041

Ejike, J Chiaka; Mathur, Mudit



Ectopic subgaleal meningioma and familial neurofibromatosis.  


A 14-year-old male adolescent presented with progressive enlargement of the forehead and a history of familial neurofibromatosis. Plain x-ray films of the skull, computed tomography scanning, and carotid angiography were performed prior to removal of the tumor. Pathologic verification of an ectopic subgaleal meningioma prompted the report of this rare tumor. PMID:3919457

Guarnaschelli, J J; Dzenitis, A J; Ogden, L L



Symptomatic epidural lipomatosis in ectopic Cushing's syndrome  

Microsoft Academic Search

We report a case of spinal epidural lipomatosis (SEL) caused by ectopic Cushing's syndrome and give a review of the literature. The most common cause of SEL is prolonged therapy with glucocorticoids, only a very few cases are related to endogenous Cushing's syndrome. The pathophysiological mech- anism is not clear but there is a possible role for the autonomic nervous

Alexander G L Bodelier; Wim Groeneveld; Antonius N van der Linden; Harm R Haak



Widespread ectopic expression of olfactory receptor genes  

Microsoft Academic Search

BACKGROUND: Olfactory receptors (ORs) are the largest gene family in the human genome. Although they are expected to be expressed specifically in olfactory tissues, some ectopic expression has been reported, with special emphasis on sperm and testis. The present study systematically explores the expression patterns of OR genes in a large number of tissues and assesses the potential functional implication

Ester Feldmesser; Tsviya Olender; Miriam Khen; Itai Yanai; Ron Ophir; Doron Lancet



Abdominal compartment syndrome  

PubMed Central

Intra-abdominal hypertension (IAH) associated with organ dysfunction defines the abdominal compartment syndrome (ACS). Elevated intra-abdominal pressure (IAP) adversely impacts pulmonary, cardiovascular, renal, splanchnic, musculoskeletal/integumentary, and central nervous system physiology. The combination of IAH and disordered physiology results in a clinical syndrome with significant morbidity and mortality. The onset of the ACS requires prompt recognition and appropriately timed and staged intervention in order to optimize outcome. The history, pathophysiology, clinical presentation, and management of this disorder is outlined.

Bailey, Jeffrey; Shapiro, Marc J



Misdiagnosed Uterine Rupture of an Advanced Cornual Pregnancy  

PubMed Central

Cornual pregnancy is a diagnostic and therapeutic challenge with potential severe consequences if uterine rupture occurs with following massive intraabdominal bleeding. We report a case of a misdiagnosed ruptured cornual pregnancy occurring at 21 weeks of gestation. Ultrasound examination and computer tomography revealed no sign of abnormal pregnancy. The correct diagnosis was first made at emergency laparotomy. Uterine rupture should be considered in pregnant women presenting with abdominal pain and haemodynamic instability.

Sant, Christian Linus Hastrup; Andersen, Poul Erik



The fine structure of normal and ectopic (tubal) human placental villi as revealed by scanning and transmission electron microscopy.  


The aim of this study was to examine the development of chorionic villous trees during early periods of normal intrauterinal and ectopic (tubal) pregnancies, and to study the structural specializations on the free surface of mature placental villi by scanning and transmission electron microscope (SEM and TEM). In order to study the structures of placental villi between 28 and 34 days old (pc), early, 6-8 week normal and ectopic, and full term human placenta samples were obtained from legal curettage and hysterectomized cases, and spontaneous deliveries, and tissues samples were prepared for SEM and TEM. Three-dimensional configurations of the developing chorionic villous trees were observed as large main villus groups, covered with abundant microvilli of different size and diameters. It appeared that the chorionic villous trees which emerged from the chorionic plate divided gradually into branches of which ramifications originated as buds. These buds gradually grew and were transformed into shoots. The number of developing new villi appeared to increase gradually from 28 days to 9 weeks (pm) of gestation. From the 4th week onwards the massive trophoblastic sprouts were observed on the surface of main chorionic villi which transformed into primary, secondary and tertiary villous trees. When the placental villi formation in ectopic pregnancy was compared with the intra-uterinal pregnancy, an arrested development was remarkable. The configurations of ectopic placental villi seemed to be disparate, such as curved lines or compressed and wrinkled positions so that the three dimensional aspect had been wizened. The ramification and new villi formation seen as in the normal placenta were not only decreased but also infrequent. Some placental villi samples displayed a gradually thinning terminal region. Trophoblastic degenerations were frequently found on the surface of ectopic villi ultrastructurally. According to these results, we comment that in ectopic pregnancy the placental villi formation and development could have been delayed. At term, some specialized structural modifications were observed on the free surface of the mature placental villi. The presence of some dome-like balloonings and many crateriform hollows were the most striking features of the mature intermediate and terminal villi. According to the increasing physiological needs of the growing fetus, these special structures that are related to lung-like and kidney-like functions and named "nephropneumonic-like units", formed in the mature placental barrier. We have observed that these special units were showing a smooth surface similar to an inflated balloon.(ABSTRACT TRUNCATED AT 400 WORDS) PMID:7756246

Demir, R; Demir, N; Ustunel, I; Erbengi, T; Trak, I; Kaufmann, P



Kidney disease in pregnancy: (Women's Health Series).  


Kidney disease and pregnancy may exist in two general settings: acute kidney injury that develops during pregnancy, and chronic kidney disease that predates conception. In the first trimester of pregnancy, acute kidney injury is most often the result of hyperemesis gravidarum, ectopic pregnancy, or miscarriage. In the second and third trimesters, the common causes of acute kidney injury are severe preeclampsia, hemolysis-elevated liver enzymes-low platelets syndrome, acute fatty liver of pregnancy, and thrombotic microangiopathies, which may pose diagnostic challenges to the clinician. Cortical necrosis and obstructive uropathy are other conditions that may lead to acute kidney injury in these trimesters. Early recognition of these disorders is essential to timely treatment that can improve both maternal and fetal outcomes. In women with preexisting kidney disease, pregnancy-related outcomes depend upon the degree of renal impairment, the amount of proteinuria, and the severity of hypertension. Neonatal and maternal outcomes in pregnancies among renal transplant patients are generally good if the mother has normal baseline allograft function. Common renally active drugs and immunosuppressant medications must be prescribed, with special considerations in pregnant patients. PMID:24002558

Gyamlani, Geeta; Geraci, Stephen A



[Cervical pregnancy: conservative treatment with primary embolization of the uterine arteries. A case report. Review of the literature].  


Ectopic pregnancies are rarely located in the cervix. In most (50-70%) of the cases, haemostatic hysterectomy is usually performed. We attempted an original approach for ectopic pregnancies located in the cervix which allowed preservation of the uterus. The uterine arteries are embolized before evacuation of the pregnancy and haemostasis of the loge with a balloon probe. In the literature, the incidence has been reported at 1 cases/20,000 births. Past history of curetage is a favouring factor. Echography facilitates diagnosis. When possible, conservative treatment may involve surgery (arterial ligature, endocervical haemostasis), drug therapy (methotrexate) and radiography (arterial embolization). PMID:7730566

Lambert, P; Marpeau, L; Jannet, D; Jault, T; Truchet, F; Safar, E; Rotenberg, L; Pathier, D; Milliez, J



[Intestinal obstruction during pregnancy].  


This is a review of literature concerning intestinal obstruction in pregnant women. Approximately 50-90% and 30% of pregnant women, respectively suffer from nausea and vomiting, mostly during the first trimester. There is also increased risk of constipation. During the perioperative period, the administration of tocolytics should be considered only in women showing symptoms of a threatening premature delivery. Intensive hydration should be ordered to sustain uterine blood flow. The incidence of intestinal obstruction during pregnancy is estimated at 1:1500-1:66431 pregnancies and is diagnosed in II and III trimester in most cases. However, it can also occur in the I trimester (6%) or puerperium. Symptoms of intestinal obstruction in pregnancy include: abdominal pains (98%), vomiting (82%), constipation (30%). Abdominal tenderness on palpation is found in 71% and abnormal peristalsis in 55% of cases. The most common imaging examination in the diagnosis of intestinal obstruction is the abdominal X-ray. However ionizing radiation may have a harmful effect on the fetus, especially during the first trimester. X-ray is positive for intestinal obstruction in 82% of pregnant women. Ultrasonography and magnetic resonance imaging are considered safe and applicable during pregnancy. Intestinal obstruction in pregnant women is mostly caused by: adhesions (54.6%), intestinal torsion (25%), colorectal carcinoma (3.7%), hernia (1.4%), appendicitis (0.5%) and others (10%). Adhesive obstruction occurs more frequently in advanced pregnancy (6% - I trimester 28% - II trimester; 45% - III trimester 21% - puerperium). Treatment should begin with conservative procedures. Surgical treatment may be necessary in cases where the pain turns from recurrent into continuous, with tachycardia, pyrexia and a positive Blumberg sign. If symptoms of fetal anoxia are observed, a C-section should be carried out before surgical intervention. The extent of surgical intervention depends on the intraoperative evaluation. Intestinal torsion during pregnancy mostly occurs in the sigmoid colon and cecum. Small bowel torsion secondary to adhesions is diagnosed in 42% of pregnant women with intestinal obstruction. The risk of intestinal torsion is higher in the 16-20 and 32-36 weeks of pregnancy and during puerperium. Intestinal torsion results in vessel occlusion which induces more severe symptoms and makes urgent surgical intervention necessary. The overall prognosis is poor--during II and III trimester the fetal mortality rate reaches 36% and 64%, respectively while the risk of maternal death is 6%. Acute intestinal pseudoobstruction can be diagnosed during puerperium, especially following a C-section. Diagnosis is made on the basis of radiological confirmation of colon distension at the cecum as > 9cm, lack of air in the sigmoid colon and rectum, exclusion of mechanical obstruction. In most cases, the treatment is based on easing intestine gas evacuation and administering neostigmine. The authors point out the need for multi-specialty cooperation in the diagnostic-therapeutic process of pregnant women suspected with intestinal obstruction, since any delay in making a correct diagnosis increases the risk of severe complications, both for the woman and the fetus. PMID:23668061

Stukan, Maciej; Kruszewski Wies?aw, Janusz; Dudziak, Miros?aw; Kopiej?, Arkadiusz; Preis, Krzysztof



Bowel obstruction in pregnancy.  


Intestinal obstruction during pregnancy and in the puerperium is an uncommon complication, although cases are probably underreported. Fortunately, the mortality rate has improved over the decades. Overall, it was greater than 60% in 1900. By the 1930s, maternal mortality had dropped to 21% and fetal mortality decreased to 50%. Modern rates of maternal mortality have shown continued improvement, with Goldthorp reporting an incidence of 12% in 1966. Over the last 30 years the maternal mortality rate has decreased to approximately 6%, as noted in various series published in the English literature. Fetal mortality rates, however, have remained significantly high. They have remained constant at between 20% and 26%. Furthermore, only one third of patients with prenatal bowel obstruction complete term pregnancies after operative resolution of their obstruction. These findings emphasize the importance of remembering that two patients are at risk when intestinal obstruction complicates pregnancy. The delay from presentation to admission and from admission to definitive management continues to be a significant cause of morbidity and mortality. A high index of suspicion is mandated in this patient population, especially in those women presenting with a history of previous abdominal or pelvic surgery. The high incidence of necrotic bowel found in this subset of patients demonstrates the need for aggressive surgical intervention. Only through diligent and urgent intervention can the morbidity and mortality be decreased. The diagnosis and treatment of a pregnant patient suspected of having a bowel obstruction should be no different from those given to a nonpregnant one. PMID:7855712

Connolly, M M; Unti, J A; Nora, P F



Ectopic pancreas bleeding in the jejunum revealed by capsule endoscopy.  


Ectopic pancreas is defined as pancreatic tissue found outside the usual anatomic location. It is often found incidentally at different sites in the gastrointestinal (GI) tract. The incidence of ectopic pancreatic tissue in autopsy series is 1% to 2%, with 70% of the ectopic lesions found in the stomach, duodenum and jejunum. Although it is usually a silent anomaly, an ectopic pancreas may become clinically evident when complicated by inflammation, bleeding, obstruction or malignant transformation. We report a case of ectopic pancreas located in the jejunum and presenting as an obscure GI bleeding, which was diagnosed by capsule endoscopy. PMID:22977800

Lee, Mi-Jeong; Chang, Jae Hyuck; Maeng, Il Ho; Park, Jin Young; Im, Yun Sun; Kim, Tae Ho; Han, Sok-Won; Lee, Do Sang



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

PubMed Central

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.

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



Teenage Pregnancy.  

ERIC Educational Resources Information Center

|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)|

McClellan, Mary C.



Cervico-isthmic pregnancy successfully treated with bipolar resection following methotrexate administration: case report and literature review.  


Cervico-isthmic pregnancy is a rare form of ectopic pregnancy associated with a high morbidity and mortality rate. Recent advances in high-resolution ultrasound have made the diagnosis of early cervico-isthmic pregnancies easier. Early diagnosis allows a more conservative therapeutic approach that avoids hysterectomy and preserves fertility. Here is reported a case of viable cervico-isthmic pregnancy successfully treated with resectoscopy after failed systemic and local (hysteroscopic) methotrexate administration. The resectoscopic excision of the cervico-isthmic pregnancy was carried out with the technique of slicing, using a 27 bipolar resectoscope with a 4-mm loop. The procedure was successful with the complete removal of the ectopic pregnancy, while maintaining satisfactory haemostasis. A literature review shows that no consensus exists for the treatment of cervico-isthmic pregnancies. We report a case of viable cervico-isthmic pregnancy successfully treated with resectoscopy after failed systemic and local (hysteroscopical) methotrexate administration. The resectoscopic excision of cervico-isthmic pregnancy was carried out with the technique of slicing, using a 27 bipolar resectoscope with a 4-mm loop. The procedure was successful with the complete removal of the ectopic pregnancy, while maintaining satisfactory haemostasis. PMID:23177414

Di Spiezio Sardo, Attilio; Alviggi, Carlo; Zizolfi, Brunella; Spinelli, Marialuigia; De Rosa, Pasquale; De Placido, Giuseppe; Nappi, Carmine



The role of routine post-natal abdominal ultrasound for newborns in a resource-poor setting: a longitudinal study  

PubMed Central

Background- Neonatal abdominal ultrasound is usually performed in Nigeria to investigate neonatal symptoms rather than as a follow up to evaluate fetal abnormalities which were detected on prenatal ultrasound. The role of routine obstetric ultrasonography in the monitoring of pregnancy and identification of fetal malformations has partly contributed to lowering of fetal mortality rates. In Nigeria which has a high maternal and fetal mortality rate, many pregnant women do not have ante-natal care and not infrequently, women also deliver their babies at home and only bring the newborns to the clinics for immunization. Even when performed, most routine obstetric scans are not targeted towards the detection of fetal abnormalities. The aim of the present study is to evaluate the benefit of routinely performing abdominal scans on newborns with a view to detecting possible abnormalities which may have been missed ante-natally. Methods- This was a longitudinal study of 202 consecutive, apparently normal newborns. Routine clinical examination and abdominal ultrasound scans were performed on the babies by their mother's bedside, before discharge. Neonates with abnormal initial scans had follow-up scans. Results- There were 108 males and 94 females. There were 12 (5.9%) abnormal scans seen in five male and seven female neonates. Eleven of the twelve abnormalities were in the kidneys, six on the left and five on the right. Three of the four major renal anomalies- absent kidney, ectopic/pelvic kidney and two cases of severe hydronephrosis were however on the left side. There was one suprarenal abnormality on the right suspected to be a possible infected adrenal haemorrage. Nine of the abnormal cases reported for follow- up and of these, two cases had persistent severe abnormalities. Conclusions- This study demonstrated a 5.9% incidence of genito urinary anomalies on routine neonatal abdominal ultrasound in this small population. Routine obstetric USS is very useful but inadequate availability of skilled personnel and cost implications create great challenges in poor resource settings like Nigeria. However, awareness should be created so that parents who can afford such investigations can make informed decisions.



Recurrent Abdominal Pain  

ERIC Educational Resources Information Center

|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…

Banez, Gerard A.; Gallagher, Heather M.



The preoperative diagnosis of primary ovarian pregnancy.  

PubMed Central

BACKGROUND: Ovarian pregnancies comprise 0.15% of all pregnancies and 0.15-3% of ectopic gestations, with an incidence of up to 1/7,000 deliveries. CASE: A single case of an ovarian gestation consistent with Spieglberg's four criteria in a primigravida without prior gynecological, medical, or surgical history is presented. Presumptive diagnosis was by thorough clinical examination with a single, palpable, adnexal mass in a patient with BMI of 19, supported with serial ultrasound and quantitative betaHCG-enabled preoperative diagnosis. CONCLUSION: Primary ovarian pregnancy may occur without any classical antecedent risk factors. Ultrasonography can be a useful adjunct to clinical presentation and physical examination in allowing the preoperative diagnosis of ovarian gestation. Images Figure 1 Figure 2 Figure 3

Nwanodi, Oroma; Khulpateea, Neekiaund



Two Live Births following Robotic-Assisted Abdominal Cerclage in Nonpregnant Women  

PubMed Central

Introduction. To report the robotic-assisted abdominal cerclage performed in two nonpregnant women and the success of live birth outcomes. Presentation of Cases. A 36-year-old woman with a complaint of recurrent second trimester pregnancy losses and a 35-year-old patient with a complaint of preterm deliveries and cervical insufficiency underwent robotic assisted abdominal cervicoisthmic cerclage placement in nonpregnant period. The two patients had spontaneous pregnancy after the robotic-assisted abdominal cerclage and delivered healthy infants. Discussion. The limitations of traditional laparoscopic abdominal cerclage have been accomplished with robotic surgery advantages especially intuitive movements and increased range of motion. There are only a few studies in the literature including robotic assisted abdominal cerclage in nonpregnant women, and only five successful live birth outcomes were reported. In this paper, we reported the sixth and seventh cases of achieved live pregnancy after robotic assisted abdominal cerclage in the literature. Conclusion. Robotic assisted abdominal cerclage is a good alternative surgical method with successful pregnancy outcomes.

Gocmen, Ahmet; Sanl?kan, Fatih



[Desmoid tumours in the abdominal wall].  


Desmoid tumours are benign tumours originating from musculoaponeurotic structures and the fascia. They usually are slow-growing, without metastatic potential. However, their local behaviour can be infiltrative and aggressive, leading to damage of adjacent structures causing organ dysfunction. They carry a high risk of relapse. In this paper, three case studies of women aged 33, 35 and 42 years, respectively, illustrate the presentation, diagnostics and therapy of abdominal desmoid tumours. All three were surgically treated and recovered. Desmoid tumours occur most commonly in fertile women. Although the etiology is unknown, there is a correlation with scar tissue, pregnancy and radiotherapy. Abdominal desmoid tumours have the lowest relapse rate of all desmoid tumours. In toto resection is the treatment of choice. Radiotherapy in addition to surgery may be considered when risk of relapse is high. PMID:21262014

Eijsackers, Maaike F; Tijsterman, Jasper D; van de Linde, Pieter; van Rooden, Jan Kees; Merkus, Jos W S



Widespread ectopic expression of olfactory receptor genes  

PubMed Central

Background Olfactory receptors (ORs) are the largest gene family in the human genome. Although they are expected to be expressed specifically in olfactory tissues, some ectopic expression has been reported, with special emphasis on sperm and testis. The present study systematically explores the expression patterns of OR genes in a large number of tissues and assesses the potential functional implication of such ectopic expression. Results We analyzed the expression of hundreds of human and mouse OR transcripts, via EST and microarray data, in several dozens of human and mouse tissues. Different tissues had specific, relatively small OR gene subsets which had particularly high expression levels. In testis, average expression was not particularly high, and very few highly expressed genes were found, none corresponding to ORs previously implicated in sperm chemotaxis. Higher expression levels were more common for genes with a non-OR genomic neighbor. Importantly, no correlation in expression levels was detected for human-mouse orthologous pairs. Also, no significant difference in expression levels was seen between intact and pseudogenized ORs, except for the pseudogenes of subfamily 7E which has undergone a human-specific expansion. Conclusion The OR superfamily as a whole, show widespread, locus-dependent and heterogeneous expression, in agreement with a neutral or near neutral evolutionary model for transcription control. These results cannot reject the possibility that small OR subsets might play functional roles in different tissues, however considerable care should be exerted when offering a functional interpretation for ectopic OR expression based only on transcription information.

Feldmesser, Ester; Olender, Tsviya; Khen, Miriam; Yanai, Itai; Ophir, Ron; Lancet, Doron



[Ruptured abdominal aortic aneurysm].  


Rupture of the abdominal aortic aneurysm is a high lethal risk pathology, which requires precise diagnosis and urgent and efficient surgical treatment. Despite improved diagnostic capabilities (echoscopy, in specialized departments--angiography, computed tomography, magnetic nucleus resonance), mortality related to this pathology remains high in intensive care units. In the present article data concerning prevalence and clinical outcomes of the rupture of the abdominal aortic aneurysm for 1999-2001 is presented in detail. During this period 22 patients have undergone surgery due to abdominal aortic aneurysm rupture. Described are most prevalent complications, mortality rates and causes, analyzed are treatment strategy and tactics. PMID:12474751

Urbonavicius, Sigitas; Antusevas, Aleksandras



[Ultrasound for abdominal lymphadenopathy].  


This CME-review is about the clinical importance of the abdominal lymph node diagnostic with special attention to various ultrasound techniques. This includes innovative techniques like contrast enhanced ultrasound and elastography. The clinical importance of ultrasound in relation to cross sectional imaging will be the target of the article as well as anatomic- topographic aspects. The article deals as well with endosonographic techniques because of the upmost importance of the technique for diagnosing mediastinal and abdominal lymphnode swellings. In conclusion of the article different clinical scenarios and clinical algorithms are presented to help the reader to diagnose abdominal lymphadenopathy correctly in an efficient way. PMID:23633280

Dietrich, C F; Hocke, M; Jenssen, C



Mobilization of ectopic yolk in Gallus gallus domesticus: a novel reverse lipid transport process.  


In many oviparous animals, bursting type atresia of ovarian follicles occurs during the reproductive cycle, resulting in the escape of yolk into the extracellular compartment. In birds, this ectopic yolk is rapidly cleared by an unknown process that involves the appearance of yolk-engorged macrophage-like cells. To study this unique type of lipid transport, we injected young male chickens intra-abdominally with egg yolk. Absorption of egg yolk from the body cavity markedly increased the triacylglyceride-rich fraction (TRL) of plasma lipoproteins and was coincident with increased levels of plasma triacylglycerides (TAGs) but not non-esterified fatty acids (NEFAs). Thus, the transport of yolk lipids from the abdominal cavity appears to occur in lipoproteins and be more similar to the transport of hepatic TAGs to the periphery via lipoproteins than to transport of adipose TAGs to the periphery via NEFAs released by the action of lipases. When macrophages were exposed to yolk in vitro, they quickly phagocytized yolk; however, it is unclear whether this level of phagocytosis contributes significantly to total yolk clearance. Instead, the chicken macrophage may function more as a facilitator of yolk clearance through the modification of yolk lipoproteins and the regulation of the local and systemic immune response to ectopic yolk. Yolk appears to be anti-inflammatory in nature. Yolk did not increase levels of the inflammatory cytokines IL-1, IL-6 and IFN? either in vivo or in vitro; in fact, yolk dampened many inflammatory changes caused by lipopolysaccharide (LPS). Conversely, LPS-induced inflammation retarded yolk clearance from the abdominal cavity and plasma TAG levels. PMID:23348941

Cornax, Ingrid; Walzem, Rosemary L; Larner, Craig; Macfarlane, Ronald D; Klasing, Kirk C



Intra-abdominal hypertension and abdominal compartment syndrome  

Microsoft Academic Search

Background: The effects of increased intra-abdominal pressure in various organ systems have been noted over the past century. The concept of abdominal compartment syndrome has gained more attention in both trauma and general surgery in the last decade. This article reviews the current understanding and management of intra-abdominal hypertension and abdominal compartment syndrome. Methods: Relevant information was gathered from a

K.-M. Sieh; Kent-Man Chu; John Wong



Gastric adenocarcinoma associated with lymphangitis carcinomatosa, adrenal metastasis with ectopic ACTH syndrome and malignant common bile duct stricture.  


Ectopic adrenocorticotrophic hormone (ACTH) syndrome (EAS) commonly occurs secondary to neuroendocrine tumours and small cell carcinoma of lung. EAS has also been reported in association with gastric carcinoids. But, the occurrence of EAS secondary to gastric adenocarcinoma has rarely been reported. A 45-year-old male patient from Bangladesh presented with abdominal pain, jaundice and hyperpigmentation. Extensive work-up revealed poorly differentiating mucin-secreting adenocarcinoma of stomach with lymphangitis carcinomatosa of lung, bilateral adrenal metastasis and malignant common bile duct (CBD) stricture. Laboratory reports were suggestive for ectopic ACTH production. Most of these features are very rare in adenocarcinoma of stomach, and all these rare events occurring in a single patient is probably the rarest. PMID:22560823

Guha, Pradipta; Sahai, Shivesh Shankar; Sarkar, Debasis; Sardar, Partha; Mandal, Biplab; Das, Bidyut Kumar; Chatterjee, Sanjoy Kumar



Body art and pregnancy.  


Body art has gained tremendously in popularity over the past 20 years, and a substantial number of pregnant women may have tattoos or piercings. In most cases, pregnancy will be uneventful. However, on rare occasions, body art may become an issue or cause complications. Navel and abdominal surface piercing and microdermal implants may cause unsightly stretch marks from gravid distension. Nipple piercing could impair breastfeeding. In emergency situations, oral piercing may interfere with airway management and nasal jewelry can be inhaled or swallowed during orotracheal intubation. Tattoos may become distorted if placed on a distended area or they may cover surgical incision lines. The risk of introducing tattoo pigments during epidural analgesia, with the potential for tumor growth, is currently under debate, although the arguments are highly speculative and without solid basis. PMID:20557995

Kluger, Nicolas



Laparoscopic management of early primary peritoneal pregnancy: a case report  

PubMed Central

Peritoneal pregnancy is an implantation in the peritoneal cavity exclusive of tubal, ovarian, or intra-ligamentary implantations. This is a rare obstetric complication with high maternal mortality and even higher perinatal mortality, and secondary type was most common. Risk factors for peritoneal pregnancy are previous history of extrauterine pregnancy or tubal surgery pelvic post-inflammatory status or presence of an intra-uterine device. As it is a life-threatening condition, expectant management carries a risk of sudden life-threatening intra-abdominal bleeding and a generally poor fetal prognosis. So, when it is recognized, immediate termination of pregnancy is usually recommended. Early diagnosis of peritoneal pregnancy is difficult, but is important by their life threatening progress course to patients. Recently, we experienced primary peritoneal pregnancy which meets both the original and modified criteria. In this paper, we reported the case of early diagnosed and successfully treated peritoneal pregnancy despite of their diagnosis was incidentally.

Koo, Hwa Seon; Bae, Ju Youn; Kang, Inn Soo; Koong, Mi Kyoung; Kim, Hye Ok; Cha, Sun Hwa; Choi, Min Hye; Kim, Ji Young



Normal Abdominal CT  

NSDL National Science Digital Library

Set of normal abdominal CT images with various important anatomic structures outlined, for cine viewing to gain a 3D view of the structure and its relationship to adjacent organs.Annotated: trueDisease diagnosis: Normal

Shaffer, Kitt



Functional Abdominal Pain  

Microsoft Academic Search

Functional abdominal pain syndrome (FAPS) is a relatively less common functional gastrointestinal (GI) disorder defined by\\u000a the presence of constant or frequently recurring abdominal pain that is not associated with eating, change in bowel habits,\\u000a or menstrual periods (Drossman Gastroenterology 130:1377–1390, 2006), which points to a more centrally targeted (spinal and supraspinal) basis for the symptoms. However, FAPS is frequently

Madhusudan Grover; Douglas A. Drossman




PubMed Central

Nonpenetrating abdominal injuries are commonly seen in a general hospital. High speed traffic accidents are responsible for the majority of these injuries. The mortality rate is high. Deaths were from associated injuries, failure to recognize abdominal trauma, hemorrhage and from acute renal insufficiency. Careful observation of every severely injured person, vigorous treatment of hemorrhagic shock with whole blood, and prompt surgical intervention when indicated will improve the mortality figures.

Brock, William; Cusick, George



Imaging of abdominal abscesses.  


The aim of the study is presenting own experiences in using different diagnostic modalities in evaluating abdominal abscesses. Material comprises a group of nine patients with diagnosed abdominal abscess aged between 22 and 78 years. The plain abdominal radiograms, ultrasound examinations and computed tomography were performed in those patients. The CT examination was performed in 10-mm thick axial sections, before and after administering contrast agent. The perirenal abscesses were found in two patients. In US have showed various, inhomogeneous echogenicity, depending on the stage of the abscess. The contrast CT reveals enhancing septa, thick walls and oval, central area of lower density. The plane radiograms revealed abscesses in three cases. In two of them abscesses were complications of previouscholecystectomy. The large abscesses dislocated intestinal loops. CT was necessary to assess the extent, depth and shape of retroperitoneal fluid collections. Abdominal abscess is life threatening condition requiring quick diagnosis and proper management. The imaging methods are especially important in diagnosis of abscesses. Abscesses may by recognized on plain abdominal radiograms, but US and especially CT are much more sensitive and accurate. CT is imaging modality of choice in revealing abdominal abscess. CT and US are very useful in nonoperative therapies, including US and CT guided drainage. PMID:16146093

Pas?awski, Marek; Szafranek-Pyzel, Joanna; Z?omaniec, Janusz



[The abdominal compartment syndrome].  


In two patients, a man aged 67 and a woman aged 80, an abdominal compartment syndrome was diagnosed. The man had been treated surgically for an abdominal aortic aneurysm; he recovered after re-operation. The woman had been treated by sigmoidectomy because of ileus. A Bogota bag and a vacuum-assisted wound-closure system were applied to the abdominal wound. Her condition deteriorated, an intestinal perforation became apparent, of which she did not recover and died. An abdominal compartment syndrome should always be kept in mind when a patient at risk presents with increased intra-abdominal pressure and at least one of the following symptoms: oliguria, decreased cardiac output, increased pulmonary-artery pressure, hypotension and acidosis. Measurement of the bladder pressure remains the method of choice to establish the abdominal pressure level. However, there is a lack of correlation between the measured pressure and the clinical condition of the patient. Therefore, the combination of clinical findings and the observed trend in serial measurements of the bladder pressure is preferred to a single pressure measurement. PMID:16008031

Rozeboom, A L; Havekes, B; Steenvoorde, P; Arbous, M S; Elzo Kraemer, C V; van de Velde, C J H



Selective activation of ectopic grey matter during motor task.  


The role of ectopic grey matter in neuronal migration disorders is still a matter of debate. Using fMRI we studied the activation pattern of ectopic and regular cortical neurons in a female patient with subcortical bilateral laminar heterotopia (double cortex syndrome) performing a simple motor task. We demonstrate a synchronous activation pattern of the motor cortex and the adjacent subcortical ectopic grey matter layer during finger-tapping. We also observed activation in the cerebellum ipsilaterally and in the basal ganglia contralaterally. The present findings are consistent with the hypothesis that ectopic neurons may be functionally integrated in motor circuits during repetitive voluntary movements. PMID:15076746

Draganski, B; Winkler, J; Flügel, D; May, A



Abdominal compartment syndrome in children.  


Abdominal compartment syndrome is defined as sustained intra-abdominal pressure greater than 20 mm Hg (with or without abdominal perfusion pressure <60 mm Hg) associated with new organ failure or dysfunction. The syndrome is associated with 90% to 100% mortality if not recognized and treated in a timely manner. Nurses are responsible for accurately measuring intra-abdominal pressure in children with abdominal compartment syndrome and for alerting physicians about important changes. This article provides relevant definitions, outlines risk factors for abdominal compartment syndrome developing in children, and discusses an instructive case involving an adolescent with abdominal compartment syndrome. Techniques for measuring intra-abdominal pressure, normal ranges, and the importance of monitoring in the critical care setting for timely identification of intra-abdominal hypertension and abdominal compartment syndrome also are discussed. PMID:23203955

Newcombe, Jennifer; Mathur, Mudit; Ejike, J Chiaka



Unplanned pregnancy.  


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

Nuthall, J



Spontaneous heterotopic pregnancy with tubal rupture: a case report and review of the literature  

PubMed Central

Introduction Heterotopic pregnancy is diagnosed as the presence of two gestations simultaneously. This is a rare situation with a reported prevalence of 0.08% in normal conception. Case presentation We report a case of a 24-year-old primigravida of Indian origin who was seen in the emergency department with a diagnosis of a ruptured ectopic pregnancy. A careful ultrasound assessment led to the diagnosis of a heterotopic pregnancy. Immediate surgical intervention with supportive measures resulted in a successful outcome. Conclusion An obstetrician should keep in mind the occurrence of a heterotopic pregnancy while dealing with pregnant females. The ectopic gestation invariably ruptures over a period of time leaving the patient in an emergency situation. A quick assessment and careful handling of the normal gestation can lead the patient to term with gratifying results.



A case of abdominal aortic aneurysm associated with L-shaped crossed-fused renal ectopia.  


Genitourinary anomalies are a tremendous challenge for the vascular surgeon, especially when dealing with an abdominal aortic aneurysm. We report a case of crossed-fused renal ectopia, a rare anomaly accompanied by abdominal aortic aneurysm. Bilateral renal arteries and one aberrant artery from the right common iliac artery supply the ectopic kidney. Because renal ischemia during aortic reconstruction can be a serious problem, we reconstructed a temporary right axillo-left renal artery bypass graft first, then reimplanted the aberrant renal artery. When choosing the procedure for renal preservation, preoperative multidetector-row computed tomography was useful to plan the operative strategy. PMID:21035712

Iida, Yasunori; Obitsu, Yukio; Sugimoto, Tsutomu; Yamamoto, Kazuo; Yoshii, Shinpei; Shigematsu, Hiroshi



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


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

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



Pregnancy and Eating Disorders  


... Special Issues / Pregnancy and Eating Disorders Pregnancy and Eating Disorders Pregnancy and motherhood require a great deal of ... required for a healthy pregnancy, for women with eating disorders, having to gain this amount can be very ...


Ectopic bone formation in a subsegmental bronchus.  


A 48-year-old man with fever and dry cough was admitted to our hospital. Imaging examinations revealed a mass lesion with calcification in the right B(3)b bronchus and atelectasis in the distal lung area. Subsequently, right S(3) segmentectomy was performed. There was a hard polypoid mass completely obstructing the right B(3)b bronchus. Histopathological findings suggested a metaplastic bone formation with mature bone marrow tissue leading to the primary bronchial cartilage. A case of ectopic bone formation in subsegmental bronchus has never been reported thus far. The resident fibroblasts might transform into osteoblasts under appropriate environmental conditions and induce bone formation. PMID:22692702

Tsukioka, Takuma; Yamamoto, Rhoji; Takahama, Makoto; Nakajima, Ryu; Tada, Hirohito



Teenage pregnancy.  


Pregnancy among women under age 15 years is unusual, but not rare. About one third of the approximately 3 million total pregnancies which occur each year in the US are to teenagers. However, only about 30% of all pregnant adolescents receive adequate prenatal care, even though it is women in that age group who most need such care. Teen mothers have a higher rate of anemia and pregnancy-induced hypertension, most probably related to diet. Infants born to teen mothers are more likely to be premature and of low birth weight. Infants born to teen mothers are also more predisposed to mental retardation, brain damage, and birth injuries. Teen mothers are more likely to have poor weight gain, premature labor, abruptio placentae, and preeclampsia. The psychosocial reasons why teenage women become pregnant are considered, as well as the relevant media influences. While teenage pregnancy remains a major problem in the US, 1996 statistics indicate an overall 4% decline to 54.7 births/1000 among women aged 15-19 years. Teenage women need to be taught that there are many options in life other than pregnancy. PMID:9549975

Murdock, N H



Successful management of interstitial pregnancy with fetal cardiac activity by laparoscopic-assisted cornual resection with preoperative transcatheter uterine artery embolization  

Microsoft Academic Search

Introduction  Interstitial pregnancy is a rare but dangerous form of ectopic pregnancy. Although various forms of minimally invasive management\\u000a for this disorder have been previously reported, optimal treatment regimen has not been yet unknown due to its rarity.\\u000a \\u000a \\u000a \\u000a Case report  A 29-year-old married woman with no previous disease history was referred under suspicion of ectopic pregnancy. Serum hCG\\u000a value was 95,365 mIU\\/mL. On

Akihiro Takeda; Kazuyuki Koyama; Sanae Imoto; Masahiko Mori; Kotaro Sakai; Hiromi Nakamura



Teenage pregnancy.  


Teen pregnancy is a social problem not resolved in developing and some developed countries. Adolescent fecundity has become the most exact bio-demographic and health indicator of development. In developing countries that are expected to follow the sexual behaviour patterns of developed countries, without offering the levels of education and services for adolescents, the consequences will be adolescent fecundity and STI prevalence increase. The ignorance about sexuality and reproduction both in parents, teachers and adolescents increases the early initiation of coital relations and of unwanted pregnancies. Extreme poverty and being the son or daughter of an adolescent mother are risk factors of repeating the early pregnancy model. The application of predictive risk criteria in pregnant adolescents to facilitate the rational use of Health Services to diminish the maternal and perinatal mortality is discussed as well as the social factors associated with adolescent pregnancy as socioeconomic levels, structure - types and characteristics of the family, early leaving school, schooling after delivery, female employment, lack of sexual education, parental and family attitudes in different periods of adolescent pregnancy, adolescent decisions on pregnancy and children, unstable partner relationship and adoption as an option. Social consequences are analyzed as: incomplete education, more numerous families, difficulties in maternal role, abandonment by the partner, fewer possibilities of having a stable, qualified and well-paid job, greater difficulty in improving their socioeconomic level and less probability of social advancement, lack of protection of the recognition of the child. Finally, based on evidence, some measures that can reduce adverse consequences on adolescent mothers, fathers and their children are suggested. PMID:22846537

Molina Cartes, Ramiro; González Araya, Electra



Traumatic abdominal wall hernia  

PubMed Central

INTRODUCTION Traumatic abdominal wall hernia (TAWH) is a rare entity. Most cases occur in children, following an injury from the bicycle handle bar. In adults, it usually results from road traffic accidents (RTA). We present one of the largest reported cases of TAWH following RTA managed by delayed mesh repair. PRESENTATION OF CASE A 35 yr old obese male with RTA was diagnosed with TAWH with 19 cm × 15 cm defect in left flank. As there were no intra abdominal injuries and overlying skin was abraded, he was planned for elective repair after 6 months. On exploration a defect of 30 cm × 45 cm was found extending from midline anteriorly to 8 cm short of midline posteriorly in transverse axis and costal margin to iliac crest in craniocaudal axis. After restoration of bowel into abdominal cavity, primary closure or even approximation of muscular defect was not possible thus a mesh closure using 60 cm × 60 cm prolene mesh in subcutaneous plane was done. After 4 months follow up, patient is healthy and has no recurrence. DISCUSSION Emergent surgical management of TAWH is usually favoured due to high incidence of associated intra abdominal injuries. Delayed repair may be undertaken in selected cases. CONCLUSION TAWH, although rare, should be suspected in cases of RTA with abdominal wall swellings. With time, the hernia defect may enlarge and muscles may undergo atrophy making delayed repair difficult.

Yadav, Siddharth; Jain, Sunil K.; Arora, Jainendra K.; Sharma, Piyush; Sharma, Abhinav; Bhagwan, Jai; Goyal, Kaushal; Sahoo, Bhabani S.



Abdominal wall desmoid tumors: A case report  

PubMed Central

Desmoid tumors (DTs) are rare lesions that do not possess any metastatic potential. However, they have a strong tendency to invade locally and recur. They constitute 3% of all soft tissue tumors and 0.03% of all neoplasms. Abdominal DTs occur sporadically or are associated with certain familial syndromes, such as familial adenomatous polyposis (FAP). The single form of this neoplasm most frequently occurs in females of reproductive age and during pregnancy. A female patient with a DT of the abdominal wall who had no relevant family history was admitted to hospital. The patient, who presented with a painless mass in the left anterolateral abdomen, had no history of trauma, surgery or childbearing. According to the medical history, physical examination and CT report, the patient was diagnosed with DT. Radical resection of the affected abdominal wall musculature was performed, and the defect was replaced with a polypropylene mesh. The histological diagnosis was of DT. The patient remains in good health and complete remission without any other treatment following surgery. DTs exhibit aggressive growth and have a high rate of recurrence. Surgery is the optimal treatment, and subsequent radiotherapy may decrease the local recurrence rate. Further research into their aetiology is required combined with multicentre clinical trials of new treatments in order to improve management of this disease. This case report provides general knowledge of DT, and may be used as a guidance for diagnosis and treatment.




Damage control surgery by keeping the abdomen open during pregnancy: favorable outcome, a case report  

Microsoft Academic Search

BACKGROUND: Acute abdomen in advanced pregnancy is one of the most challenging surgical situations. In life-threatening situations, despite optimal management, foetus distress and preterm delivery may occur. Although laparostomy is a useful treatment of abdominal sepsis, its successful management has not been reported previously in pregnant women. CASE: 30-year-old woman at 23 week of pregnancy was investigated for non-specific abdominal

Wojciech Staszewicz; Michel Christodoulou; François Marty; Vincent Bettschart



Abdominal compartment syndrome.  


Intra-abdominal hypertension (IAH) and abdominal compartment syndrome (ACS) are frequently encountered in critically ill patients and carry a high morbidity and mortality risk. Despite these facts, IAH/ACS are still overlooked by many physicians and therefore timely diagnosis is not made and treatment is often inadequate. All clinicians should be aware of the risk factors predicting IAH/ACS, the profound implications and derangements on all organ systems, the clinical presentation, the appropriate measurement of intra-abdominal pressure to detect IAH/ACS and the current treatment options for these detrimental syndromes. This comprehensive review provides knowledge about known facts, unresolved issues and future directions for research to improve patient survival and long-term outcome. PMID:20668421

Mayer, D; Veith, F J; Lachat, M; Pfammatter, T; Hechelhammer, L; Rancic, Z



Isolated tubal torsion in pregnancy.  


Adnexal torsion is an uncommon cause of acute abdomen in pregnancy and isolated fallopian tube twisting accounts for a very small number of these cases. These conditions, either in pregnancy or in non-gestational circumstances, are known to be due to both genital and non-genital causes and, in most cases, predisposing factors can be identified. We reviewed the literature and retrieved only 19 cases of isolated fallopian tube torsion in pregnancy treated surgically from 1936 to today, including one recently published case from our experience. The clinical presentation was lower quadrant abdominal pain in all cases. The right side was involved in 90% of the cases. Tenderness was usually present but peritoneal irritation with guarding or rebound was exceptional. Symptoms were nausea and vomiting, scanty vaginal bleeding and dysuria. Signs suggestive of necrosis such as leucocytosis, increased CRP and mild hyperpyrexia were uncommon. Preoperative ultrasound evaluation was performed in eight patients and in all cases an adnexal cyst was detected on the ipsilateral side of the abdominal pain. The case we recently published was carefully investigated preoperatively by Doppler flow ultrasound techniques which allowed for a precise differential diagnosis with total adnexal torsion. This aspect has never been previously considered. The surgical approach showed acute isolated fallopian tube torsion in all the cases and a predisposing factor was identified in 75% of the patients. Foetal and maternal outcome were always excellent. In cases of acute abdomen in pregnancy, with detailed Doppler flow ultrasound evidence of normal ovaries and of a pelvic cyst, an isolated tubal-paratubal cyst torsion should be considered and appropriate ovary-sparing surgical treatment foreseen. PMID:19493607

Origoni, Massimo; Cavoretto, Paolo; Conti, Enrico; Ferrari, Augusto



Ectopic internal carotid artery presenting as an oropharyngeal mass  

Microsoft Academic Search

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

Emmanuel P Prokopakis; Constantinos A Bourolias; Argyro J Bizaki; Spyros K Karampekios; George A Velegrakis; John G Bizakis



Diagnostic localization of ectopic parathyroid lesions: developmental consideration.  


Parathyroid glands arise from the third and fourth pharyngeal pouches. Parathyroid lesions sometimes develop ectopically. The aim of this article is to illustrate the knowledge of pharyngeal apparatus development to assist with diagnostic localization of ectopic parathyroid lesions. We retrospectively reviewed charts of 23 patients who received a diagnosis of ectopic parathyroid lesions. The ectopic lesions were widely distributed; cranially lesions were located on the carotid bifurcation, caudally in the right paraaortic region, ventrally on the surface of the sternohyoid muscle, and dorsally in the paraesophageal region. In most cases, parathyroid tissues were associated with structures related to the third or fourth pharyngeal pouches that traveled to regions where the ectopic lesions ultimately developed. In a few cases, lesions were not associated with these pouches and might have developed from parathyroid tissue that migrated due to an anomalous pathway of parathyroid travel. When patients present without entopic lesions, the presence of ectopic lesions should be evaluated based on an understanding of the developmental mechanisms of parathyroid glands and the frequency with which ectopic lesions have been found in specific locations. Systematic diagnosis can minimize the frequency with which ectopic lesions are missed during clinical care and maximize their accurate localization. PMID:21191734

Okuda, Itsuko; Nakajima, Yasuo; Miura, Daishu; Maruno, Hirotaka; Kohno, Tadasu; Hirata, Kazuaki



Parents' Grief Following Pregnancy Loss: A Comparison of Mothers and Fathers.  

ERIC Educational Resources Information Center

|Examined gender differences in bereavement following miscarriage, ectopic pregnancy, stillbirth, and neonatal death. Interviewed 56 couples using Perinatal Grief Scale. Women scored significantly higher than men on most dimensions of grief at two months, one year, and two years postloss, except on dimension indicating most serious consequences of…

Stinson, Kandi M.; And Others



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

SciTech Connect

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.

Vidal, V. [CHUM - Saint-Luc Hospital, Department of Radiology (Canada); Joly, L. [CHUM - Saint-Luc Hospital, Clinical Research Center, Liver Unit (Canada); Perreault, P.; Bouchard, L.; Lafortune, M. [CHUM - Saint-Luc Hospital, Department of Radiology (Canada); Pomier-Layrargues, G. [CHUM - Saint-Luc Hospital, Clinical Research Center, Liver Unit (Canada)], E-mail:



Heterotopic pregnancy with successful pregnancy outcome.  


A heterotopic pregnancy is a rare complication of pregnancy, in which both extra-uterine and intrauterine gestation occur simultaneously. We hereby report a case of ruptured heterotopic pregnancy presenting at 6weeks of gestation and was managed with immediate laparatomy. The intrauterine pregnancy course was uneventful with delivery of a healthy baby at term by Caesarean section. PMID:23162362

Noor, Nasreen; Bano, Imam; Parveen, Shazia



Heterotopic pregnancy with successful pregnancy outcome  

PubMed Central

A heterotopic pregnancy is a rare complication of pregnancy, in which both extra-uterine and intrauterine gestation occur simultaneously. We hereby report a case of ruptured heterotopic pregnancy presenting at 6weeks of gestation and was managed with immediate laparatomy. The intrauterine pregnancy course was uneventful with delivery of a healthy baby at term by Caesarean section.

Noor, Nasreen; Bano, Imam; Parveen, Shazia



Laparoscopic total abdominal colectomy  

Microsoft Academic Search

The aim of this study was to prospectively assess the impact of laparoscopy upon the outcome of total abdominal colectomy (TAC). Specifically, patients underwent standard laparotomy with TAC and ileoproctostomy (TAC + IP), TAC and ileoanal reservoir (TAC + IAR), laparoscopically assisted TAC + IP (L-TAC + IP), or laparoscopically assisted TAC + IAR (L-TAC + IAR). Parameters studied included

Steven D. Wexner; Olaf B. Johansen; Juan J. Nogueras; David G. Jagelman



Lateral Abdominal Wall Reconstruction  

PubMed Central

Lateral abdominal wall (LAW) defects can manifest as a flank hernias, myofascial laxity/bulges, or full-thickness defects. These defects are quite different from those in the anterior abdominal wall defects and the complexity and limited surgical options make repairing the LAW a challenge for the reconstructive surgeon. LAW reconstruction requires an understanding of the anatomy, physiologic forces, and the impact of deinnervation injury to design and perform successful reconstructions of hernia, bulge, and full-thickness defects. Reconstructive strategies must be tailored to address the inguinal ligament, retroperitoneum, chest wall, and diaphragm. Operative technique must focus on stabilization of the LAW to nonyielding points of fixation at the anatomic borders of the LAW far beyond the musculofascial borders of the defect itself. Thus, hernias, bulges, and full-thickness defects are approached in a similar fashion. Mesh reinforcement is uniformly required in lateral abdominal wall reconstruction. Inlay mesh placement with overlying myofascial coverage is preferred as a first-line option as is the case in anterior abdominal wall reconstruction. However, interposition bridging repairs are often performed as the surrounding myofascial tissue precludes a dual layered closure. The decision to place bioprosthetic or prosthetic mesh depends on surgeon preference, patient comorbidities, and clinical factors of the repair. Regardless of mesh type, the overlying soft tissue must provide stable cutaneous coverage and obliteration of dead space. In cases where the fasciocutaneous flaps surrounding the defect are inadequate for closure, regional pedicled flaps or free flaps are recruited to achieve stable soft tissue coverage.

Baumann, Donald P.; Butler, Charles E.



Operative laparoscopy; is it a safe option in pregnancy?  

Microsoft Academic Search

We report a case of an ovarian cyst in pregnancy complicated by torsion of the cyst requiring urgent surgical intervention\\u000a at 13 weeks of gestation. The case was successfully managed by laparoscopic ovarian cystectomy without any maternal or fetal\\u000a complications. Thus proving that operative laparoscopy in pregnancy is a safe and feasible option. Approximately 0.2% of pregnant\\u000a women require intra-abdominal general

A. Rauf; P. Suraweera; S. De Silva



Abdominal Complications after Severe Burns.  

National Technical Information Service (NTIS)

Abdominal catastrophe in the severely burned patient without abdominal injury has been described. We perceived an alarming recent incidence of this complication in our burn center, both during acute resuscitation and later in the hospital course. We sough...

C. E. White E. M. Renz K. W. Markell L. H. Blackbourne M. E. Albrecht



Abdominal Aortic Aneurysm (AAA) Screening  


... covered? Search 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 ...


Incision for abdominal laparoscopy (image)  


Abdominal laparoscopy is a useful aid in diagnosing disease or trauma in the abdominal cavity with less scarring than ... as liver and pancreatic resections may begin with laparoscopy to exclude the presence of additional tumors (metastatic ...


[Ectopic testicular parenchyma in albugineal tunic].  


We introduce a male patient with bilateral chryptorchidism submitted to surgery; during the intervention, macroscopically round macules were seen in the outer surface of both testes. In the round macules histological study, groups of seminiferous tubules were observed, including stroma and Leydig's intestitial cells surrounded of tunica albuginea, isolated from the rest of testicular parenchymal tissue; the diagnosis "Ectopic testicular parenchyma tissue" was confirmed by histopathological study. Due to the seminiferous tubules are surrounded by the tunica albuginea, with no apparent connection to the rest of the testicular parenchyma, a long-term assessment is required, both during puberty as well as in adulthood; owing to that can mislead and make unnecessary laparotomies and orchiectomies in the future. PMID:23659025

Sanjuán Rodríguez, S; Catalina Fernández, I; Reyes Mondragón, A L; Moreno Hurtado, C; Torres de Aguirre, A



[Laparoscopic management of extrauterine pregnancy].  


The radioimmunologic assay of human chorionic gonadotropin and ultrasound have contributed to an earlier diagnosis of ectopic tubal pregnancy. Laparoscopy has modified not only diagnostic, but even therapeutic approach. In fact laparoscopic approach and medical treatment with methotrexate have proved to be safe and effective. Between October 1991 and December 1993 by the Department of Obstetric and Gynecology of the Hospital Felice Villa (Mariano Comense -- CO) all patients (14) with suspected extra-uterine pregnancy were submitted to laparoscopy. Of these 12 were treated by laparoscopic salpingostomy or aspiration. Five cases in which trophoblastic tissue was not present at histologic specimen were submitted to medical treatment with methotrexate. In 2 cases in which the tube was ruptured we performed a salpingectomy after laparotomy. We didn't have any early or late complication. After laparoscopy betahCG levels were monitored every 2 days. We didn't have any case of trophoblastic persistency or any recurrence. Recent studies have demonstrated lower morbidity and higher fertility rate in women treated laparoscopically for GEU. However data from literature show some discrepancy. As a matter of fact it is not so evident that fertility is better preserved by operative laparoscopy than laparotomy. Anyway laparoscopy presents a better outcome for the patient and requires less days of hospitalization. PMID:8820391

Borsellino, G; Danile, G



Spontaneous Hemoperitoneum from a Ruptured Superficial Uterine Vessel in Third Trimester of Pregnancy  

Microsoft Academic Search

Summary: Spontaneous hemoperitoneum in third trimester of pregnancy is a very rare but lethal condition which demands prompt diagnosis and management for the survival of both mother and fetus. A 30 years old multipara woman presented at 34 weeks of pregnancy with acute abdominal pain and hypovolemic shock. Emergency exploratory laparotomy was done; an asphyxiated baby was born by cesarean




Adolescent Pregnancy  

Microsoft Academic Search

\\u000a Over the past several decades, there has been considerable debate over youthful sexual onset, pregnancy, and childbearing.\\u000a In the course of these debates, as in most issues of demographic significance, issues arise of ethics and morality, of health\\u000a and medicine, of politics and economics, of family and the social order. Each area of concern has implications from the most\\u000a personal

Laurie Schwab Zabin; Kathleen M. Cardona


Adolescent pregnancy.  


Infants born to young teenage mothers are more likely to be of low birthweight; stillborn, or to die in the neonatal period than other infants. However, these risks were not increased in 1 study that controlled for the effects of parity, marital status, and social class. If is is accepted that higher risk noted in adolescent pregnancy stems from avoidable social and environmental conditions, rather than biological factors, then adolescent pregnancy programs may be effective in improving adolescents' reproductive outcomes. The National Health and Medical Research Council has made a number of recommendations relating to adolescents and pregnancy, including the promotion of access to family planning information and advice for sexually active teenagers, the promotion of postgraduate health education training programs, and hospital antenatal department review of their approach to pregnant teenagers. Comprehensive medical, social, and educational services before and after birth for young mothers and their infants have been demonstrated to be cost effective, resulting in a decreased incidence of pernatal problems, fewer postnatal clinic and hospital visits, and markedly fewer pregancies in the subsequent 1-2 years. Adequate social and emotional support is also needed to help young mothers manage the concurrent psychological task of adolescence and parenthood. PMID:6749027

Stanley, F; Robertson, S



Liver Disease in Pregnancy  

Microsoft Academic Search

Liver dysfunction during pregnancy can be caused by conditions that are specific to pregnancy or by liver diseases that are not related to pregnancy itself. This review attempts to summarize the epidemiology, pathophysiology, and management of the different pregnancy-related liver diseases, and to review different liver diseases not related to pregnancy and how they may affect or be effected by

Fabiana S. Benjaminov; Jenny Heathcote



[Giant ectopic peritoneal and omental deciduosis mimicking a peritoneal carcinomatosis.  


Ectopic decidual reaction of the peritoneum and the omentum is rare. It is usually an incidental finding during caesarean section and it could mimick macroscopically peritoneal carcinomatosis or tuberculosis. Histology is very important to make diagnosis. Ectopic decidual reaction is physiological, with an excellent prognosis and spontaneous resolution. We report one case of ectopic peritoneal and omental deciduosis of the peritoneum and discovered incidently during caesarian section. Definitive diagnosis was done by immunohistological examination. A laparoscopy four months later showed complete and spontaneous regression of all lesions. PMID:22766047

Abramowicz, S; Kouteich, K; Grémain, J; Sabourin, J-C; Marpeau, L; Sergent, F



Ectopic fat: the true culprit linking obesity and cardiovascular disease?  


Obesity is a major risk factor for cardiovascular disease and its complications. However, not all fat depots share the same characteristics. Recent studies have found that ectopic rather than subcutaneous fat accumulation is associated with increased cardiometabolic risk. However, ectopic fat accumulation can be seen initially as a protective mechanism against lipotoxicity. Subsequently the adipose tissue becomes dysfunctional, thus inducing systemic metabolic alterations (through release of cytokines) or specific organ dysfunctions. The purpose of this review is to summarise the current available data on the impact of excess adiposity vs ectopic fat in the development of cardio-metabolic diseases. PMID:23884194

Morelli, M; Gaggini, M; Daniele, G; Marraccini, P; Sicari, R; Gastaldelli, A



Papillary carcinoma in ectopic thyroid detected by Tl-201 scintigraphy  

SciTech Connect

A 37-year-old man with papillary carcinoma in an ectopic thyroid is presented. Excisional biopsy revealed the cervical mass to be a metastasis from thyroid cancer. X-ray, ultrasonography, and computed tomography, however, failed to identify the primary tumor in the thyroid. Incidental TI-201 uptake was noted in the midline of the anterior neck, and a palpable nodule was discovered in this area. Fine needle aspiration cytology demonstrated Class V papillary adenocarcinoma, and subsequent surgery confirmed a papillary carcinoma in the ectopic thyroid. This case suggests the usefulness of TI-201 scintigraphy for the detection of ectopic thyroid malignancy.

Michigishi, T.; Mizukami, Y.; Mura, T.; Nomura, T.; Watanabe, K.; Tonami, N.; Hisada, K. (Kanazawa Univ. Hospital (Japan))



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

NASA Astrophysics Data System (ADS)

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.

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



Mysterious Abdominal Pain  

PubMed Central

A man presented to the emergency room with recurrent episodes of abdominal pain. He had a history of coronary artery bypass grafting of the left internal mammary artery (LIMA) to the left anterior descending (LAD) artery and the right gastroepiploic artery to the posterior descending artery. After numerous gastrointestinal evaluations, a stress test was performed, which was positive. Coronary angiography showed a proximal occlusion of the LAD and right coronary artery and a normal functioning LIMA bypass. Aortography showed a 95% stenosis of the celiac trunk. Angioplasty and stent implantation of the celiac trunk was successfully performed. Six months later the patient was completely asymptomatic with a negative stress test. In conclusion, abdominal pain in patients who have undergone coronary artery bypass surgery using the right gastroepiploic artery should raise suspicion not only of a stenosis of the arterial conduit but also of a potential stenosis of the celiac trunk.

Cappelletti, Alberto; Cristell, Nicole; Mazzavillani, Monica; Margonato, Alberto



[Abdominal compartment syndrome: current view].  


In the last few years, physiological changes, symptoms, diagnostic tools, and treatment of abdominal compartment syndrome interest surgeons, trauma surgeons and anaesthetists. Sudden, dangerous basic vital function deterioration in patients managed in the intensive care unit, may be results of abdominal compartment syndrome. Abdominal compartment syndrome is secondary to massive intraabdominal haemorrhages, hepatic or retroperitoneal space "packing", fluid collection in tissues, including abdominal organs. Circulatory, respiratory and kidney dysfunction occur, when intraabdominal pressure measured in urinary bladder is 25 H2O or higher. In this condition, rapid surgical decompression is necessary. During decompression abdominal organs reperfusion may produce arterial hypotension and asystole. Abdominal closure must prevent abdominal hypertension. Temporary plastic patch, simple and cheap is the most popular technique. PMID:11603185

Wysocki, A



Obesity-Associated Abdominal Elephantiasis  

PubMed Central

Abdominal elephantiasis is a rare entity. Abdominal elephantiasis is an uncommon, but deformative and progressive cutaneous disease caused by chronic lymphedema and recurrent streptococcal or Staphylococcus infections of the abdominal wall. We present 3 cases of patients with morbid obesity who presented to our hospital with abdominal wall swelling, thickening, erythema, and pain. The abdominal wall and legs were edematous, with cobblestone-like, thickened, hyperpigmented, and fissured plaques on the abdomen. Two patients had localised areas of skin erythema, tenderness, and increased warmth. There was purulent drainage from the abdominal wall in one patient. They were managed with antibiotics with some initial improvement. Meticulous skin care and local keratolytic treatment for the lesions were initiated with limited success due to their late presentation. All three patients refused surgical therapy. Conclusion. Early diagnosis is important for the treatment of abdominal elephantiasis and prevention of complications.

Kohli, Ritesh; Argento, Vivian; Amoateng-Adjepong, Yaw



Prevalence of ectopic thymic tissue in myasthenia gravis and its clinical significance  

Microsoft Academic Search

Forty patients with myasthenia gravis underwent maximal thymectomy. Complete histologic study findings were available for 38 patients. The prevalence of ectopic thymic tissue was 39.5% (15 of 38). On the basis of the presence or absence of ectopic thymic tissue, patients were divided into two groups: group I had ectopic thymic tissue and group II had no ectopic thymic tissue.

M. Ashour



Cervico-isthmic pregnancy: an extremely rare case diagnosed during labour  

Microsoft Academic Search

This case report describes a cervico-isthmic pregnancy ending in a live vaginal birth at 37+2 weeks’ gestation. The case remained undiagnosed throughout pregnancy when after a fairly normal labour a massive haemorrhage occurred. After an unsuccessful effort to control the bleeding conservatively, a total abdominal hysterectomy was carried out. During the operation the diagnosis of cervico-isthmic pregnancy was confirmed, which

Spryros A. Mesogitis; George J. Daskalakis; Dimitrios G. Doublis; Aristides J. Antsaklis; Nikolaos E. Papantoniou; Stylianos P. Michalas



The Abdominal Circulatory Pump  

PubMed Central

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.

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



Robotic abdominal surgery  

Microsoft Academic Search

As a whole, abdominal surgeons possess excellent videoendoscopic surgical skills. However, the limitations of laparoscopy—such as reduced range of motion and instrument dexterity and 2-dimensional view of the operative field—have inspired even the most accomplished laparoscopists to investigate the potential of surgical robotics to broaden their application of the minimally invasive surgery paradigm. This review discusses data obtained from articles

Eric J. Hanly; Mark A. Talamini



Functional abdominal pain  

PubMed Central

Functional abdominal pain or functional abdominal pain syndrome (FAPS) is an uncommon functional gut disorder characterised by chronic or recurrent abdominal pain attributed to the gut but poorly related to gut function. It is associated with abnormal illness behaviour and patients show psychological morbidity that is often minimised or denied in an attempt to discover an organic cause for symptoms. Thus the conventional biomedical approach to the management of such patients is unhelpful and a person's symptom experience is more usefully investigated using a biopsychosocial evaluation, which necessarily entails a multidisciplinary system of healthcare provision. Currently the pathophysiology of the disorder is poorly understood but is most likely to involve a dysfunction of central pain mechanisms either in terms of attentional bias, for example, hypervigilance or a failure of central pain modulation/inhibition. Although modern neurophysiological investigation of patients is promising and may provide important insights into the pathophysiology of FAPS, current clinical management relies on an effective physician-patient relationship in which limits on clinical investigation are set and achievable treatment goals tailored to the patient's needs are pursued.

Matthews, P; Aziz, Q



Sex during Pregnancy  


... satisfying and safe sexual relationship during pregnancy. Is Sex During Pregnancy Safe? Sex is considered safe during ... frequently asked questions about sex during pregnancy. Can sex harm my baby? No, not directly. Your baby ...


Ending a Pregnancy  


... Ending a Pregnancy Ending a Pregnancy What is abortion? Abortion means ending a pregnancy early. In some cases, ... This is called a miscarriage, or a spontaneous abortion. In other cases, a woman chooses to end ...


Travel during Pregnancy  


... time. What should I know about planning long car trips during pregnancy? During a car trip, make ... pregnancy? • What should I know about planning long car trips during pregnancy? • What should I know about ...


Giant Desmoid Tumor of the Anterior Abdominal Wall in a Young Female: A Case Report  

PubMed Central

Desmoid tumors (also called desmoids fibromatosis) are rare slow growing benign and musculoaponeurotic tumors. Although these tumors have a propensity to invade surrounding tissues, they are not malignant. These tumors are associated with women of fertile age, especially during and after pregnancy. We report a young female patient with a giant desmoid tumor of the anterior abdominal wall who underwent primary resection. The patient had no history of an earlier abdominal surgery. Preoperative evaluation included abdominal ultrasound, computed tomography, and magnetic resonance imaging. The histology revealed a desmoid tumor. Primary surgical resection with immediate reconstruction of abdominal defect is the best management of this rarity. To the best of our knowledge and PubMed search, this is the first case ever reported in the medical literature of such a giant desmoid tumor arising from anterior abdominal wall weighing 6.5?kg treated surgically with successful outcome.

Koshariya, Mahim; Shukla, Samir; Khan, Zuber; Vikas, Vaibhav; Pratap Singh, Avinash; Baghel, Puspendra; Pendro, Varun; Kirti Jain, Vishal; Jagdish Jai, Shrikant; Kumar, Sanjeev; Songra, M. C.



Giant desmoid tumor of the anterior abdominal wall in a young female: a case report.  


Desmoid tumors (also called desmoids fibromatosis) are rare slow growing benign and musculoaponeurotic tumors. Although these tumors have a propensity to invade surrounding tissues, they are not malignant. These tumors are associated with women of fertile age, especially during and after pregnancy. We report a young female patient with a giant desmoid tumor of the anterior abdominal wall who underwent primary resection. The patient had no history of an earlier abdominal surgery. Preoperative evaluation included abdominal ultrasound, computed tomography, and magnetic resonance imaging. The histology revealed a desmoid tumor. Primary surgical resection with immediate reconstruction of abdominal defect is the best management of this rarity. To the best of our knowledge and PubMed search, this is the first case ever reported in the medical literature of such a giant desmoid tumor arising from anterior abdominal wall weighing 6.5?kg treated surgically with successful outcome. PMID:23710408

Koshariya, Mahim; Shukla, Samir; Khan, Zuber; Vikas, Vaibhav; Pratap Singh, Avinash; Baghel, Puspendra; Pendro, Varun; Kirti Jain, Vishal; Jagdish Jai, Shrikant; Kumar, Sanjeev; Songra, M C



Ectopic parotid gland as an unusual cause of cheek swelling.  


There are numerous causes for chronic cheek swelling, including masseteric hypertrophy, lymphadenopathy, diffuse inflammatory changes and neoplasia. We report an unusual case where the swelling was the result of ectopic parotid tissue. PMID:11420634

Boyd, D; Bates, C; Macleod, R I



Complications of misdiagnosis of maxillary canine ectopic eruption.  


Ectopic eruption of maxillary canines can be associated with root resorption of adjacent teeth. This case report describes and discusses an interesting case of a 15-year-old girl with a Class III malocclusion and an impacted maxillary canine. Because of the unfavorable position of the ectopic canine and the severe root resorption of the maxillary left central and lateral incisors, the treatment options included extraction of the maxillary permanent canines. The mandibular first premolars were extracted to compensate for the Class III malocclusion. A panoramic radiograph taken earlier in the mixed dentition already indicated a possible eruption disturbance of the maxillary left permanent canine. The importance of early diagnosis of maxillary canine ectopic eruption is highlighted in this case report. The early identification of radiographic signs of an ectopic pathway of eruption should be followed by deciduous canine extraction to prevent canine retention and maxillary incisor root resorption. PMID:22858336

Garib, Daniela Gamba; Janson, Guilherme; Baldo, Taiana de Oliveira; dos Santos, Patrícia Bittencourt Dutra



Live birth after laparotomy for concurrent heterotopic pregnancy and appendicitis in a 6 weeks IVF pregnancy  

Microsoft Academic Search

Backround  A term delivery after concurrent appendectomy and salpingectomy at 6 weeks in an appendicitis coexisting with a heterotopic\\u000a pregnancy after in vitro fertilization (IVF) treatment is reported.\\u000a \\u000a \\u000a \\u000a Methods  Case report.\\u000a \\u000a \\u000a \\u000a Results  The patient presented with severe low abdominal pain at 6 weeks of pregnancy after IVF and had explorative laparotomy for\\u000a appendicitis, during which she had appendectomy and salpingectomy for an undiagnosed concurrent heterotopic

Alexandros Daponte; Mihail Spyridakis; Maria Ioannou; Polyxeni Vanakara; Georgios Tzovaras; Konstantine Hatzitheofilou; Ioannis E. Messinis



Adolescent pregnancy desire and pregnancy incidence  

PubMed Central

Background Research has suggested the importance of pregnancy desire in explaining pregnancy risk behavior among adolescent females. Much of the literature, however, uses cross-sectional study designs to examine this relationship. Because bias may strongly influence these results, more prospective studies are needed to confirm the relationship between pregnancy desire and pregnancy incidence over time. Methods Non-pregnant adolescents aged 14-19 years (N=208) completed baseline interviews and interviews every 6 months thereafter for 18 months. Logistic regression was used to examine demographic and psychosocial correlates of pregnancy desire. Cox regression analysis was used to determine if pregnancy desire predicted pregnancy incidence over time after controlling for potential confounders. Results Twenty-four percent of participants either desired pregnancy or were ambivalent towards pregnancy in the next year. Pregnancy desire was associated with older age, relationship duration of less than 6 months, and higher perceived stress. After accounting for potential confounders, pregnancy desire doubled the risk of becoming pregnant over the 18 month follow-up period (RR=2.00, 95% CI=0.99-4.02). Additionally, a heightened risk for pregnancy was found among those who expressed some desire for pregnancy and who were not in school compared to those who expressed no desire for pregnancy and who were in school (RR=4.84, 95% CI=1.21-19.31). Conclusion Our analysis reinforces the importance of evaluating pregnancy desire among sexually active adolescent females. Interventions should target young women in new romantic relationships and who are not in school to improve pregnancy prevention efforts. Additionally, improving coping abilities may help reduce feelings of pregnancy desire among adolescent females.

Sipsma, Heather L.; Ickovics, Jeannette R.; Lewis, Jessica B.; Ethier, Kathleen A.; Kershaw, Trace S.



Extra-abdominal Periosteal Desmoid Tumor of the Third Toe.  


Extra-abdominal periosteal desmoid tumors are uncommon nonmetastatic tumors of the extremities with a propensity for local recurrence. Lesions in the distal extremities are rare; a majority of extra-abdominal lesions occur in more proximal portions of the upper and lower extremities. This article reports a patient with an extra-abdominal periosteal desmoid tumor in the toe. A 37-year-old woman had a mass in her left third distal phalanx that was originally noted 3 years prior to presenting to the authors' institution. She reported the mass expanded during pregnancy. The toe was red and elongated and had expanded to approximately the same size as her great toe. The plantar aspect of the toe was thick and callused, and the toenail was slightly elevated. Marginal excision with retention of the nail was performed without complication. The mass was determined to be an extra-abdominal periosteal desmoid tumor and was successfully removed without recurrence. To date, the patient remains asymptomatic, with no pain and complete sensation in her third toe. Although extra-abdominal periosteal desmoid tumors have been identified in the extremities, to the authors' knowledge none have been reported as far distal as the toe. Identifying this lesion in the distal extremity will allow a hasty diagnosis and treatment in future cases of similar presentation. Knowledge of the existence of this type of tumor in the distal extremity may also assist in narrowing differential diagnoses. PMID:24025015

Saleem, Omar; Sayres, Stephanie; O'Malley, Martin



Unusual anatomic variation of bilateral ectopic ureters in a dog.  


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

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



Successful unilateral thoracoscopy for bilateral ectopic mediastinal parathyroidectomy.  


Ectopic parathyroid glands are frequently located in the thymus and may become hyperplasic in patients with secondary hyperparathyroidism. When medical management fails, surgical removal is required, using either a traditional open sternotomy approach or video-assisted thoracic surgery (VATS). We were able to excise large, bilateral, mediastinal parathyroid glands using only left VATS. To the authors' knowledge, this is the first reported case of the use of unilateral thoracoscopic subtotal thymectomy for the excision of bilateral ectopic mediastinal parathyroid glands. PMID:20376735

Fama', F; Berry, M G; Linard, C; Gioffre'-Florio, M; Metois, D



Robot-assisted excision of ectopic mediastinal parathyroid adenoma.  


Robot-assisted excision of an ectopic parathyroid adenoma in the superior mediastinum was performed in a 57-year-old man. The mass was located by methoxyisobutylisonitrile scan and computed tomography. Identification of the ectopic parathyroid adenoma was facilitated by the 3-dimensional images of the da Vinci robotic system, and resection was achieved using EndoWrist instruments. Robot-assisted excision of parathyroid adenoma located in the relatively inaccessible superior mediastinum proved to be feasible. PMID:20124300

Chan, Alexander P H; Wan, Innes Y P; Wong, Randolph H L; Hsin, Michael K Y; Underwood, Malcolm J



Video-assisted mediastinoscopic resection of ectopic parathyroid adenoma.  


Hyperparathyroidism can induce fatal complications in long-term hemodialysis patients. Approximately 20% of patients with hyperparathyroidism have ectopic mediastinal parathyroid glands, and the locations of 2% require a median sternotomy or thoracotomy. A 68-year-old man with an ectopic parathyroid gland in the thymus, underwent total resection via a video-assisted mediastinoscopic approach, which provides a less invasive surgical approach. PMID:23284123

Yutaka, Yojiro; Omasa, Mitsugu; Shikuma, Kei; Taki, Toshihiko



Pregnancy rhinitis.  


Pregnancy rhinitis has gained attention as a defined clinical entity that is recognized increasingly by medical professionals and by the public. It affects one in five pregnant women, and as far as we know, it is not caused by one single factor. Pregnant women should be informed about this cause of nasal congestion, and how to handle it. There is no cure known, but symptomatic treatment may be needed, because impaired nasal breathing can reduce quality of life and possibly affect the fetus. Simple measures, such as elevated head end of the bed, physical exercise, nasal saline washings, and nasal alar dilation can improve nasal breathing. PMID:16443147

Ellegård, Eva K



Mother-daughter in vitro fertilization triplet surrogate pregnancy  

Microsoft Academic Search

A successful triplet pregnancy has been established in a surrogate gestational mother following the transfer of five embryos fertilized in vitro. The oocytes were donated by her biological daughter, and the sperm obtained from the daughter's husband. The daughter's infertility followed a total abdominal hysterectomy performed for a postpartum hemorrhage as a result of a placenta accreta. Synchronization of both

M. C. Michelow; J. Bernstein; M. J. Jacobson; J. L. McLoughlin; D. Rubenstein; A. I. Hacking; S. Preddy; I. J. Van der Wat



Spontaneous rupture of the uterine artery in pregnancy.  


A case of spontaneous rupture of the uterine artery in the third trimester of pregnancy is described. Review of the literature reveals only three similar cases. Clinical signs are sudden abdominal pain with hemodynamic collapse and a decrease in the level of hemoglobin. Treatment consists in performing a laparotomy with suturing of the ruptured artery. PMID:9447366

Swaegers, M C; Hauspy, J J; Buytaert, P M; De Maeseneer, M G



A challenging case of an ectopic parathyroid adenoma  

PubMed Central

The occurrence of ectopic parathyroid adenomas is not uncommon (3-4% of all parathyroid adenomas). A 42-year-old female diagnosed as having GH secreting pituitary adenoma presented with an ectopic mediastinal parathyroid adenoma located between left (Lt) pulmonary artery and Lt main bronchus. The aim of presenting this case is not to appreciate the rarity of the condition but to rather discuss some of the vital practical problems faced during its management. Patient presenting in endocrine OPD with nausea, vomiting, drowsiness and chronic constipation was investigated biochemically and with various imaging modalities and accordingly managed. Patient was also investigated from the perspective of MEN 1 syndrome. Results: Baseline routine investigations revealed hypercalcemia (corrected S. Ca- 16.9 mg/dl) due to primary hyperparathyroidism (PHP, PTH-1190 ng/L) with adenoma located between Lt main bronchus and Lt pulmonary artery. Patient was medically managed and after proper preoperative preparation, surgical excision by open thoracotomy was planned but two days before surgery she developed pulmonary embolism and was shifted to ICU where she died after 20 days. An accurate preoperative localization by various imaging procedures plays a decisive role in case of ectopic adenomas in the chest. Ectopic parathyroid adenomas are frequent cause of failed initial surgery. The best surgical approach to these ectopic adenomas is still controversial. Equally effective newer medical treatment modalities are also required in patients who are awaiting or are unfit for surgery. Lastly combination of MEN 1 with ectopic parathyroid adenoma is rare.

Panchani, Roopal; Varma, Tarun; Goyal, Ashutosh; Gupta, Nitinranjan; Saini, Ashish; Tripathi, Sudhir



Abdominal imaging: An introduction  

SciTech Connect

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.

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



Pediatric abdominal wall defects.  


This article reviews the incidence, presentation, anatomy, and surgical management of abdominal wall defects found in the pediatric population. Defects such as inguinal hernia and umbilical hernia are common and are encountered frequently by the pediatric surgeon. Recently developed techniques for repairing these hernias are aimed at improving cosmesis and decreasing pain while maintaining acceptably low recurrence rates. Less common conditions such as femoral hernia, Spigelian hernia, epigastric hernia, lumbar hernia, gastroschisis, and omphalocele are also discussed. The surgical treatment of gastroschisis and omphalocele has undergone some advancement with the use of various silos and meshes. PMID:24035087

Kelly, Katherine B; Ponsky, Todd A



[Abdominal penetrating trauma].  


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

Kring, Søren; Helligsøe, Per; Kåg, Lise



[Rehabilitation after abdominal surgery].  


A combined strategy of anesthetic and surgical care defines postoperative rehabilitation, which aims to accelerate recovery from surgery, shorten convalescence, and reduce postoperative morbidity. Preoperative and early postoperative oral feeding, a relatively "dry" fluid regimen, and the avoidance of or early removal of drains, gastric tubes and bladder catheters all contribute to decreasing postoperative morbidity after abdominal surgery. Postoperative pain control, prevention of nausea and vomiting, shortening the duration of postoperative ileus, and early ambulation can also help to decrease postoperative morbidity. The use of multimodal fast-track clinical rehabilitation programs should improve outcomes and quality of life, reduce hospital stays, and save money. PMID:16783266

Bonnet, Francis; Szymkiewicz, Olga; Marret, Emmanuel; Houry, Sidney



VHDL modeling of FECG extraction from the composite abdominal ECG using Atificial Intelligence  

Microsoft Academic Search

FECG (Fetal ECG) signal contains potentially precise information that could assist clinicians in making more appropriate and timely decisions during pregnancy and labour. The extraction and detection of the FECG signal from composite abdominal signals with powerful and advance methodologies is becoming a very important requirement in fetal monitoring. The purpose of this paper is to model the developed algorithms

Muhammad A. Hasan; Muhammad I. Ibrahimy; Mamun B. I. Reaz; M. J. Uddin; Mohammed S. Hussain



Acute traumatic abdominal wall hernia.  


Although blunt abdominal trauma is frequent, traumatic abdominal wall hernias (TAWH) are rare. We describe a large TAWH with associated intra-abdominal lesions that were caused by high-energy trauma. The diagnosis was missed by clinical examination but was subsequently revealed by a computed tomography (CT) scan. Repair consisted of an open anatomical reconstruction of the abdominal wall layers with reinforcement by an intraperitoneal composite mesh. The patient recovered well and the results of a post-operative CT scan are presented. PMID:20440527

den Hartog, D; Tuinebreijer, W E; Oprel, P P; Patka, P



Hypnosis for functional abdominal pain.  


Chronic abdominal pain is a common pediatric condition affecting 20% of the pediatric population worldwide. Most children with this disorder are found to have no specific organic etiology and are given the diagnosis of functional abdominal pain. Well-designed clinical trials have found hypnotherapy and guided imagery to be the most efficacious treatments for this condition. Hypnotic techniques used for other somatic symptoms are easily adaptable for use with functional abdominal pain. The author discusses 2 contrasting hypnotic approaches to functional abdominal pain and provides implications for further research. These approaches may provide new insights into this common and complex disorder. PMID:21922712

Gottsegen, David



Adrenal Disorders in Pregnancy  

Microsoft Academic Search

Like other conditions, adrenal disorders may manifest in the course of pregnancy in three basic ways: (1) an adrenal disorder clearly developing de novo during the pregnancy, e.g., adrenal hemorrhage; (2) an adrenal disorder present but undiagnosed prior to pregnancy; and (3) an adrenal disorder diagnosed and treated prior to pregnancy where the issue is continued management. Naturally the distinction

Dima Abdelmannan; David C. Aron


Nutrition and Multifetal Pregnancy  

Microsoft Academic Search

Largely because of assisted reproduction, the rate of multifetal pregnancy is rising rapidly in the United States. Accordingly, dietitians are increasingly being called upon to provide nutrition services for these high-risk pregnancies. This article gives an overview of the incidence of and risks associated with multifetal pregnancy and reviews studies that contribute to our knowledge of nutrition and multifetal pregnancy.




Pulmonary physiology in pregnancy.  


This section reviews anatomic and functional changes of the respiratory system during pregnancy. Pulmonary function during exercise in pregnancy and in the obese gravida, sleep-disordered breathing during pregnancy, and pulmonary changes in the pregnant woman living at altitude are discussed in detail. Assessment of pulmonary function and interpretation of the arterial blood gas during pregnancy are also discussed. PMID:20436304

Bobrowski, Renee A



[Pathophysiology of abdominal pain].  


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

Curatolo, Michele



Teenage Pregnancy  

PubMed Central

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.

Wolfish, Martin G.



Hypertensive Disorders of Pregnancy  

PubMed Central

Hypertension is the most common medical problem encountered during pregnancy, complicating 2-3% of pregnancies. Hypertensive disorders during pregnancy are classified into 4 categories, as recommended by the National High Blood Pressure Education Program Working Group on High Blood Pressure in Pregnancy: 1) chronic hypertension, 2) preeclampsia-eclampsia, 3) preeclampsia superimposed on chronic hypertension, and 4) gestational hypertension (transient hypertension of pregnancy or chronic hypertension identified in the latter half of pregnancy) (1). This terminology is preferred over the older but widely used term pregnancy-induced hypertension (PIH) because it is more precise.

Mammaro, Alessia; Carrara, Sabina; Cavaliere, Alessandro; Ermito, Santina; Dinatale, Angela; Pappalardo, Elisa Maria; Militello, Mariapia; Pedata, Rosa



Imaging of gastrointestinal and abdominal tuberculosis  

Microsoft Academic Search

This article discusses the range of manifestations of tuberculosis (TB) of the abdomen, including involvement of the gastrointestinal tract, the peritoneum, mesentery, omentum, abdominal lymph nodes, solid abdominal organs, the genital system and the abdominal aorta. Abdominal TB is a diagnostic challenge, particularly when pulmonary TB is absent. It may mimic many other abdominal diseases, both clinically and radiologically. An

F. M. Vanhoenacker; A. I. De Backer; B. Op de Beeck; M. Maes; R. Van Altena; D. Van Beckevoort; P. Kersemans; A. M. De Schepper



Alpha 1-antitrypsin retention in an ectopic liver  

PubMed Central

Ectopic livers are infrequently reported in the literature. The reported size for ectopic livers range from a few millimeters up to several centimeters. They are often clinically silent and incidentally discovered during imaging of the hepatobiliary tract, regional surgical procedures or autopsy. They are predestined for benign liver diseases otherwise observed in normal livers like fatty change or develop malignancies such as hepatocellular carcinoma, in a manner analogous to the parent orthotopic liver. The presence of abnormal alpha 1-antitrypsin retention in an ectopic liver has, to our knowledge, not been reported in the literature. Hereby, we present the first reported case featuring alpha 1-antitrypsin retention in an ectopic liver attached to the fundus of the gallbladder and present the clinical, radiological and pathological findings in a caucasian woman undergoing cholecystectomy for acute cholecystitis. Special liver stains showed an alpha 1-antitrypsin retention which was confirmed immunohistochemically. Although ectopic livers are rare and usually an incidental finding, the radiologist and the surgeon should take this into the differential diagnosis of a mass attached to the gall bladder. A secondary disease should be considered by the pathologist in such a specimen and alpha 1-antitrypsin retention should be ruled out by special liver stains. Finally, such a finding should prompt the managing clinician to exclude systemic alpha-1 antitrypsin deficiency in the patient through further appropriate tests.



Alpha 1-antitrypsin retention in an ectopic liver.  


Ectopic livers are infrequently reported in the literature. The reported size for ectopic livers range from a few millimeters up to several centimeters. They are often clinically silent and incidentally discovered during imaging of the hepatobiliary tract, regional surgical procedures or autopsy. They are predestined for benign liver diseases otherwise observed in normal livers like fatty change or develop malignancies such as hepatocellular carcinoma, in a manner analogous to the parent orthotopic liver. The presence of abnormal alpha 1-antitrypsin retention in an ectopic liver has, to our knowledge, not been reported in the literature. Hereby, we present the first reported case featuring alpha 1-antitrypsin retention in an ectopic liver attached to the fundus of the gallbladder and present the clinical, radiological and pathological findings in a caucasian woman undergoing cholecystectomy for acute cholecystitis. Special liver stains showed an alpha 1-antitrypsin retention which was confirmed immunohistochemically. Although ectopic livers are rare and usually an incidental finding, the radiologist and the surgeon should take this into the differential diagnosis of a mass attached to the gall bladder. A secondary disease should be considered by the pathologist in such a specimen and alpha 1-antitrypsin retention should be ruled out by special liver stains. Finally, such a finding should prompt the managing clinician to exclude systemic alpha-1 antitrypsin deficiency in the patient through further appropriate tests. PMID:21356114

Dettmer, Matthias; Cathomas, Gieri; Willi, Niels



Ectopic parathyroid glands and their anatomical, clinical and surgical implications.  


Ectopic parathyroid glands result from aberrant migration during early stages of development and lack of successful identification may lead to lack of success in parathyroid surgery. They constitute a common etiology of persistent or recurrent hyperparathyroidism, when they are missed at initial diagnosis. Their prevalence is about 2-43% in anatomical series and up to 16% and 14% in patients with primary and secondary hyperparathyroidism, respectively. Ectopic inferior parathyroids are most frequently found in the anterior mediastinum, in association with the thymus or the thyroid gland, while the most common position for ectopic superior parathyroids is the tracheoesophageal groove and retroesophageal region. Neck ultrasound and 99mTc Sestamibi scan are first-line imaging modalities, although with low sensitivity and specificity. However, their combination with modern techniques, such as single photon emission computed tomography (SPECT) alone or in combination with CT (SPECT/CT) increases their diagnostic accuracy. Fine needle-aspiration cytology of a lesion suspicious for parathyroid tissue and measurement of parathyroid hormone (PTH) in the aspired material further assist to the successful preoperative localization of ectopic glands. Common sites for surgical investigation are the upper thyroid pole and the upper vascular thyroid stalk behind the hypopharynx and cervical esophagus for the superior parathyroids, and the carotid artery bifurcation and the thymic tongue, for the inferior parathyroids. Radioguided minimally invasive parathyroidectomy after successful localization, assisted by rapid PTH measurement postoperatively, significantly improves surgical outcomes in patients with ectopic parathyroid adenomas. PMID:23174995

Noussios, G; Anagnostis, P; Natsis, K



Ovarian dysgerminoma and synchronic contralateral tubal pregnancy followed by normal intra-uterine gestation: a case report  

PubMed Central

Introduction We report that the coincidence of ovarian tumor and pregnancy poses significant challenges that are more pronounced if the pregnancy is ectopic. Case presentation Here, we report a rare and interesting case of a 24-year-old nulliparous Spanish woman who experienced the coincidental occurrence of left tubal pregnancy and dysgerminoma in the right ovary. The corpus luteum settled in the right ovary. A right adnexectomy and left linear salpingostomy were performed. Remarkably, our patient became pregnant spontaneously after surgery. The pregnancy occurred prior to starting chemotherapy, and the intra-uterine pregnancy was carried to term; later, she also had another normal pregnancy. Our patient has done well without chemotherapy. Conclusions Our report on the challenges of diagnosis and treatment faced in this case can help clinicians better understand and manage these pathologies. We have not found any similar cases in the literature.



How I Manage Abdominal Injuries.  

ERIC Educational Resources Information Center

|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)|

Haycock, Christine E.



Hypnosis for Functional Abdominal Pain  

Microsoft Academic Search

Chronic abdominal pain is a common pediatric condition affecting 20% of the pediatric population worldwide. Most children with this disorder are found to have no specific organic etiology and are given the diagnosis of functional abdominal pain. Well-designed clinical trials have found hypnotherapy and guided imagery to be the most efficacious treatments for this condition. Hypnotic techniques used for other

David Gottsegen



Thirty years of abdominal pain  

Microsoft Academic Search

In this paper, the author describes a brief psychotherapy with a man who has struggled with abdominal symptoms for most of his adult life. After an unhappy childhood, the patient (Mr A) married and then was witness to the birth of his stillborn child, in a foreign country. Soon after his abdominal symptoms started, and plagued him for the following



Updates on abdominal desmoid tumors  

Microsoft Academic Search

Desmoid tumor is a monoclonal, fi broblastic proliferation arising in musculoaponeurotic structures. This connective tissue hyperplasia infi ltrates locally, recurs frequently after resection but does not metastasize. Abdominal desmoid occurs sporadically, in association with some familial syndromes and often represents a clinical dilemma for surgeons. The enigmatic biology and anatomical location of abdominal desmoids make treatment recommendations diffi cult. This

Bernardino Rampone; Corrado Pedrazzani; Daniele Marrelli; Enrico Pinto; Franco Roviello



Urgent Abdominal Re-Explorations  

Microsoft Academic Search

BACKGROUND: Treatment of a number of complications that occur after abdominal surgeries may require that Urgent Abdominal Re-explorations (UARs), the life-saving and obligatory operations, are performed. The objectives of this study were to evaluate the reasons for performing UARs, outcomes of relaparotomies (RLs) and factors that affect mortality. METHODS: Demographic characteristics; initial diagnoses; information from and complications of the first

Haluk Recai Unalp; Erdinc Kamer; Haldun Kar; Ahmet Bal; Mustafa Peskersoy; Mehmet Ali Onal



Natural expansion of artificial dermal template by successful full-term pregnancy.  


Extensive postburn scars of the trunk may cause breathing difficulty and, in female patients of reproductive age, render future pregnancy a serious reconstructive goal. Scar excision and skin grafting with or without artificial dermal templates is the current preferred management. A patient who underwent staged extensive grafting of the abdominal wall by dermal regeneration template and completed a full-term successful pregnancy is presented here. Although tissue expanders have been used to expand artificial dermal templates, natural expansion by pregnancy has not been previously documented. A 30-year-old woman with extensive chest and abdominal wall, bilateral gluteal and breast scars after burns sustained at childhood presented with difficulty in deep breathing. Abdominal scar tissue was excised and the abdominal wall was reconstructed by dermal regeneration template and autologous thin split-thickness skin graft in two stages. Six months postoperatively, spirometric values were improved by 15%, while 1 year later the patient completed successfully a full-term pregnancy. Reconstruction of extensive abdominal postburn scars by dermal regeneration template improves breathing by increasing elasticity and compliance of the reconstructed area. In female patients, the template can be extensively and naturally expanded by the gradually growing uterus, allowing for full-term pregnancy. PMID:22210074

Kakagia, Despoina; Kyriopoulos, Eugenia; Zapandioti, Polyxeni; Tsoutsos, Dimosthenis


Abdominal wall gossypiboma.  


A 71-year-old woman, one year following a fleur-de-lis abdominoplasty and incisional hernia repair, presented with two chronic, draining peri-umbilical sinuses. Her immediate postoperative course was complicated by a superficial surgical site infection with central skin breakdown that was treated with vacuum assisted closure (VAC). After the wound had closed completely, two midline sinus tracts developed. A CT scan demonstrated an 8x3x1.6cm thick-walled collection along the anterior abdominal wall containing numerous air bubbles. Surgical debridement revealed a cavity containing an 8x3x1.6cm block of well incorporated VAC foam. With the increasing clinical use of VAC wound therapy, this image serves as an important reminder to include gossypiboma in the differential diagnosis for patients with chronic wound problems who have previously received VAC treatment. PMID:19683975

Huston, Tara L; Grant, Robert T



CT of abdominal tuberculosis  

SciTech Connect

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.

Epstein, B.M. (Univ. of the Witwatersrand, Johannesburg, South Africa); Mann, J.H.



Total and subtotal abdominal hysterectomy.  


Hysterectomy is one of the most frequently performed operations in the world, accounting for 500,000-600,000 procedures annually in the USA; the abdominal route for hysterectomy is the preferred route in 60-80% of these operations. Although the number of total abdominal hysterectomies performed annually has decreased, the number of subtotal abdominal hysterectomies increased by >400%. The major indications for abdominal hysterectomy include abnormal uterine bleeding, myomata uteri, adenomyosis, endometriosis, neoplasia, and chronic salpingitis. The basis for selection for subtotal versus total hysterectomy has little in the way of factual data to support it and may actually present some significant disadvantages, such as continued menstruation and cervical prolapse. The detailed technique for performing intrafascial abdominal hysterectomy relies heavily on precise knowledge of pelvic anatomy and compulsive detail to tissue handling. The consistent and correct usage of prophylactic antimicrobials, measures to prevent thromboemboli, and procedures to avoid urinary retention are key to the overall success of the surgery. PMID:15985251

Baggish, Michael S



Abdominal wall desmoid tumor mimicking a subserosal uterine leiomyoma  

PubMed Central

Desmoid tumors are cytologically bland fibrous neoplasms originating from musculoaponeurotic structures throughout the body. The cause of desmoid tumors is uncertain, but may be related to trauma or hormonal factors, or may have a genetic association. These tumors can be found in some young women during pregnancy or just after giving birth. We report herein a case of desmoid tumor on the inner aspect of the abdominal wall that mimicked a large subserosal uterine leiomyoma. Initial clinical examination of the patient suggested a large abdominal wall tumor, while the imaging techniques including transabdominal ultrasound and magnetic resonance imaging suggested a large subserosal uterine leiomyoma as the initial diagnosis. This case emphasizes the importance of clinical examination during the diagnostic process.

Al-Jefout, Moamar; Walid, Alabed; Esam, Abomayale; Amin, Alqaisi; Nather, Hawa; Sultan, Nawayse; Maysa, Khadra



Ectopic papilla of Vater in the pylorus.  


The major papilla of Vater is usually located in the second portion of the duodenum, to the posterior medial wall. Sometimes the mouth of the biliary duct is located in other areas. Drainage of the common bile duct into the pylorus is extremely rare. A 73-year old man, with a history of duodenal ulcer, was admitted to hospital with the diagnosis of cholangitis. Dilatation of the extrahepatic biliary duct was observed by abdominal ultrasonography, and endoscopic retrograde cholangiopancreatography (ERCP) was performed. No area suggesting the presence of the papilla of Vater was found within the second duodenal portion. Finally the major papilla was located in the theoretical pyloric duct. Cholangiography was performed and choledocholithiasis was found in the biliary tree. The patient underwent dilatation of the papilla with a balloon tyre and removal of a 7 mm stone using a Dormia basket, which solved the problem without further complications. This anomaly increased the difficulty of performing therapeutic interventions during ERCP. This alteration in anatomy may increase the risk of complications during papillotomy, with a theoretically higher risk of perforation. Dilatation using a balloon was the chosen therapeutic technique both in our case and in the literature, due to its low rate of complications. PMID:19891024

Guerra, Iván; Rábago, Luis-Ramón; Bermejo, Fernando; Quintanilla, Elvira; García-Garzón, Silvia



Interstitial pregnancy management and subsequent pregnancy outcome.  


We report on management and subsequent fertility outcome of interstitial pregnancy in a retrospective cohort study (Canadian Task Force classification II-3) at a university affiliated teaching hospital. Of 706 women with extrauterine pregnancy, 14 consecutive women with interstitial pregnancy were treated by methotrexate, laparotomy or laparoscopy between 1997 and 2007. The first four women, with significant hemoperitoneum, were treated by laparotomy. Of the next 10 women, four were selected for medical treatment with methotrexate. Only one case was treated successfully. The other six women had laparoscopic treatment. Of nine laparoscopies, one was converted to laparotomy due to excessive blood loss during the procedure. Of nine women desiring a child, three were infertile, whereas six conceived with an intrauterine pregnancy. A change from diagnosis later in pregnancy and laparotomy to more conservative treatment, mainly by laparoscopy, suggests a possibly better subsequent pregnancy rate. PMID:23962257

Sagiv, Ron; Debby, Abraham; Keidar, Ran; Kerner, Ram; Golan, Abraham



Successful Conservative Treatment of a Cesarean Scar Pregnancy with Systemically Administered Methotrexate and Subsequent Dilatation and Curettage: A Case Report  

PubMed Central

Cesarean scar pregnancy is a rare type of ectopic pregnancy associated with severe complications such as uterine rupture, uncontrollable bleeding which may lead to hysterectomy, and definitive infertility. Many therapeutic options are available such as Dilatation & Curetage, excision of trophoblastic tissues using either laparotomy or laparoscopy, systemically administered Methotrexate, and more recently uterine artery embolization. The use of Methotrexate sometimes required laparotomy later because of severe hemorrhage. Through this paper, we demonstrated that viable cesarean scar pregnancy can be managed safely by systemically delivered Methotrexate at the cost of a prolonged followup.

Fadhlaoui, Anis; Khrouf, Mohamed; Khemiri, Khaled; Nouira, Kais; Chaker, Anis; Zhioua, Fethi



Pregnancy and epilepsy: Update on pregnancy registries  

Microsoft Academic Search

Opinion statement  In the United States, about 1 million women of childbearing age have epilepsy. Estimates vary as to the percentage of these\\u000a women who consider pregnancy, but epilepsy is the most common neurologic condition encountered in pregnancy. Women with epilepsy\\u000a express significant interest in receiving guidance about pregnancy and the effects of seizures and anticonvulsant treatments\\u000a on the developing fetus,

Kaarkuzhali B. Krishnamurthy



MDCT Findings of Right Circumaortic Renal Vein with Ectopic Kidney  

PubMed Central

Anomalies of renal vasculature combined with ectopic kidneys were found on a multi-detector CT scan. Knowledge of renal vascular variation is very important for surgical exploration, radiologic intervention and staging for urologic cancer. We present an extremely rare case of a right circumaortic renal vein combined with a right ectopic kidney. The right kidney was located at the level between the third and fifth lumbar vertebra. The right circumaortic renal vein crossed the aorta and returned to the inferior vena cava behind the aorta.

Kim, Min-Kyun; Ku, Young Mi; Chun, Chang Woo



Pelvic Nephroureterectomy for Renal Cell Carcinoma in an Ectopic Kidney  

PubMed Central

We present a case of an ectopic renal tumor in a 61-year-old morbidly obese man with a pelvic kidney found after presenting with hematuria and irritative voiding symptoms. The mass, along with the ectopic kidney and ureter, was radically resected through an open operation that involved removing both them and the renal vessels from the underlying iliac vessels. Pathological analysis demonstrated an 8.3?cm papillary renal cell carcinoma (RCC) with oncocytic features, Fuhrman nuclear grade 3, with angiolymphatic invasion and negative margins. The patient has been recurrence-free for over four years since tumor resection.

Baldie, Kevin G.; Al-Qassab, Usama A.; Ritenour, Chad W.; Issa, Muta M.; Osunkoya, Adeboye O.; Petros, John A.



The ectopic adrenocorticotropic hormone syndrome in carcinoid tumors  

PubMed Central

Ectopic production of adrenocorticotropic hormone by carcinoid tumors is relatively uncommon and may not be recognized by physicians. This report describes a woman who had Cushing syndrome from the ectopic secretion of adrenocorticotropic hormone by a carcinoid tumor. Her cause of death was a pneumonia that may have been secondary to her untreated hypercortisolism. There are threeinstructive elements of this case: 1) the recognition of Cushing syndrome, 2) the association of Cushing syndrome with low-grade (carcinoid tumors) as well as with high-grade (small cell carcinoma) neuroendocrine tumors, and 3) the need to treat the hypercortisolism as well as the tumor.

Fazel, Poorya; Mennel, Robert G.; Austin, Ned A.



The M26 hotspot of Schizosaccharomyces pombe stimulates meiotic ectopic recombination and chromosomal rearrangements.  

PubMed Central

Homologous recombination is increased during meiosis between DNA sequences at the same chromosomal position (allelic recombination) and at different chromosomal positions (ectopic recombination). Recombination hotspots are important elements in controlling meiotic allelic recombination. We have used artificially dispersed copies of the ade6 gene in Schizosaccharomyces pombe to study hotspot activity in meiotic ectopic recombination. Ectopic recombination was reduced 10-1000-fold relative to allelic recombination, and was similar to the low frequency of ectopic recombination between naturally repeated sequences in S. pombe. The M26 hotspot was active in ectopic recombination in some, but not all, integration sites, with the same pattern of activity and inactivity in ectopic and allelic recombination. Crossing over in ectopic recombination, resulting in chromosomal rearrangements, was associated with 35-60% of recombination events and was stimulated 12-fold by M26. These results suggest overlap in the mechanisms of ectopic and allelic recombination and indicate that hotspots can stimulate chromosomal rearrangements.

Virgin, J B; Bailey, J P



The impact of previous perinatal loss on subsequent pregnancy and parenting.  


The loss of any pregnancy through miscarriage, ectopic pregnancy, stillbirth, or neonatal death presents as a significant life crisis for any woman and has far-reaching implications into a couple's future aspirations. Planning another pregnancy after dealing with a perinatal loss is difficult and plagued by ambivalence, doubts, and insecurities. Despite this ambivalence, a majority of women do become pregnant within a year following a perinatal loss. Four recurring issues surrounding perinatal loss and subsequent pregnancy have been identified in this literature review: the effect of the grief process on the subsequent pregnancy; parental coping mechanisms during the subsequent pregnancy; replacement or vulnerable child syndrome; and parenting issues with the subsequent live-born child. Issues surrounding anxiety as a coping mechanism during a pregnancy following a perinatal loss are documented consistently in the literature; however, less is known about the impact that a loss has on parenting behaviors with subsequent children. Further research is imperative to examine these issues in more detail so that evidence-based practices can be established and updated. Health care providers are in a unique position to assist these couples in dealing with the issues that a perinatal loss may place on subsequent pregnancies. By providing a reassuring and supportive environment, women can achieve a positive pregnancy outcome with the correct tools to decrease anxiety and enhance attachment to the subsequent healthy child. PMID:17273295

Lamb, Elizabeth H



Hemoperitoneum caused by a bleeding myoma in pregnancy.  


The prevalence of uterine myomas during pregnancy is estimated to range from 0.3% to 2.6%. Although leiomyomas usually remain asymptomatic, in one often cases they may be complicated. The management of uterine fibroids during pregnancy is largely conservative and surgical removal is generally delayed until post partum. A 37-year-old pregnant woman (15 weeks) with a history of gynecologic examination several hours before presented with lower abdominal pain and signs of acute abdomen. She was para-2, as she had delivered a healthy child 12 years before, and current pregnancy was uncomplicated until presentation. Intra-abdominal hemorrhage was suspected and she underwent immediate exploratory laparotomy, which revealed massive hemoperitoneum. A subserous uterine leiomyoma of 8.5x6.5 cm was found in the fundus area, with an actively bleeding ruptured vessel on its dome. Myomectomy was successfully performed and 1.5 liter of blood and blood clots were evacuated from the peritoneal cavity. The histology report showed sections of interlacing bundles of smooth muscles with areas of bleeding and necrotic degeneration. The postoperative course and subsequent antenatal period were uneventful. The woman went into spontaneous labor at 38 weeks and delivered vaginally a healthy male baby. This rare case ofintra-abdominal hemorrhage due to bleeding myoma supports other recent studies, which have demonstrated that myomectomy may be successfully performed during pregnancy in selected circumstances. PMID:21086740

Kasum, Miro



Limits to sustained energy intake. XVI. Body temperature and physical activity of female mice during pregnancy.  


Lactation is the most energy-demanding phase of mammalian reproduction, and lactation performance may be affected by events during pregnancy. For example, food intake may be limited in late pregnancy by competition for space in the abdomen between the alimentary tract and fetuses. Hence, females may need to compensate their energy budgets during pregnancy by reducing activity and lowering body temperature. We explored the relationships between energy intake, body mass, body temperature and physical activity throughout pregnancy in the MF1 mouse. Food intake and body mass of 26 females were recorded daily throughout pregnancy. Body temperature and physical activity were monitored every minute for 23 h a day by implanted transmitters. Body temperature and physical activity declined as pregnancy advanced, while energy intake and body mass increased. Compared with a pre-mating baseline period, mice increased energy intake by 56% in late pregnancy. Although body temperature declined as pregnancy progressed, this served mostly to reverse an increase between baseline and early pregnancy. Reduced physical activity may compensate the energy budget of pregnant mice but body temperature changes do not. Over the last 3 days of pregnancy, food intake declined. Individual variation in energy intake in the last phase of pregnancy was positively related to litter size at birth. As there was no association between the increase in body mass and the decline in intake, we suggest the decline was not caused by competition for abdominal space. These data suggest overall reproductive performance is probably not constrained by events during pregnancy. PMID:23720802

Gamo, Yuko; Bernard, Amelie; Mitchell, Sharon E; Hambly, Catherine; Al Jothery, Aqeel; Vaanholt, Lobke M; Król, Elzbieta; Speakman, John R



Economics of abdominal wall reconstruction.  


The economic aspects of abdominal wall reconstruction are frequently overlooked, although understandings of the financial implications are essential in providing cost-efficient health care. Ventral hernia repairs are frequently performed surgical procedures with significant economic ramifications for employers, insurers, providers, and patients because of the volume of procedures, complication rates, the significant rate of recurrence, and escalating costs. Because biological mesh materials add significant expense to the costs of treating complex abdominal wall hernias, the role of such costly materials needs to be better defined to ensure the most cost-efficient and effective treatments for ventral abdominal wall hernias. PMID:24035086

Bower, Curtis; Roth, J Scott



Intra-abdominal hypertension and abdominal compartment syndrome.  


Abdominal compartment syndrome (ACS) is seen with increasing frequency in the critically-ill. Elevated intraabdominal pressures interfere with vital organ function and contribute to mortality. Prevention, when possible and early recognition of occurrence with timely therapy will improve survival. Measurement of bladder pressures plays a critical role in diagnosis and guiding therapy. Treatment includes non-invasive and invasive methodologies designed to decrease the volume of abdominal contents and invasive methods to increase the compartment dimensions. PMID:23097942

Early, Gerald L; Wesp, Julie; Augustin, Stanley M


Evisceration through multiple abdominal wall defects following blunt abdominal injury.  


We report an unusual case of a posttraumatic evisceration of small and large bowel through 2 holes in the anterior abdominal wall after a motor vehicle accident. Prompt adequate management consists of reestablishing the perfusion of the eviscerated organ if the blood supply is compromised, performing a full laparotomy to exclude intra-abdominal organ injury and meticulous cleaning of the eviscerated organs before reducing them in the abdomen and closing the abdomen in layers. PMID:14578838

van As, A B; Rode, H



Micromanaging Abdominal Aortic Aneurysms  

PubMed Central

The contribution of abdominal aortic aneurysm (AAA) disease to human morbidity and mortality has increased in the aging, industrialized world. In response, extraordinary efforts have been launched to determine the molecular and pathophysiological characteristics of the diseased aorta. This work aims to develop novel diagnostic and therapeutic strategies to limit AAA expansion and, ultimately, rupture. Contributions from multiple research groups have uncovered a complex transcriptional and post-transcriptional regulatory milieu, which is believed to be essential for maintaining aortic vascular homeostasis. Recently, novel small noncoding RNAs, called microRNAs, have been identified as important transcriptional and post-transcriptional inhibitors of gene expression. MicroRNAs are thought to “fine tune” the translational output of their target messenger RNAs (mRNAs) by promoting mRNA degradation or inhibiting translation. With the discovery that microRNAs act as powerful regulators in the context of a wide variety of diseases, it is only logical that microRNAs be thoroughly explored as potential therapeutic entities. This current review summarizes interesting findings regarding the intriguing roles and benefits of microRNA expression modulation during AAA initiation and propagation. These studies utilize disease-relevant murine models, as well as human tissue from patients undergoing surgical aortic aneurysm repair. Furthermore, we critically examine future therapeutic strategies with regard to their clinical and translational feasibility.

Maegdefessel, Lars; Spin, Joshua M.; Adam, Matti; Raaz, Uwe; Toh, Ryuji; Nakagami, Futoshi; Tsao, Philip S.



Tetracycline and Pregnancy  


... or visit us online at: . Tetracycline and Pregnancy In every pregnancy, a woman starts ... advice from your health care professional. What is tetracycline? Tetracycline is an antibiotic used to treat conditions ...


Isotretinoin (Accutane) and Pregnancy  


... early pregnancy. Can taking isotretinoin during pregnancy cause birth defects? YES. Isotretinoin causes a pattern of birth defects in more than ... used by women of childbearing age and can cause birth defects similar to isotretinoin. August 2010. Copyright by OTIS. ...


Yeast Infection during Pregnancy  


... may be reprinted for personal, noncommercial use only. Yeast infection during pregnancy: Are over-the-counter treatments ... share your e-mail address Sign up Question Yeast infection during pregnancy: Are over-the-counter treatments ...


Salmeterol and Pregnancy  


... your asthma during pregnancy. Does salmeterol cross the placenta and get to the baby? When salmeterol is ... pregnancy because unlike the mother, (who shares the placenta with the baby) the father does not share ...


Valproic Acid and Pregnancy  


... valproic acid and then had a relapse of bipolar disorder during my pregnancy? Recurrence of depression or mania ... 7. Yonkers KA et al. 2004. Management of bipolar disorders during pregnancy and the postpartum period. Am J ...


Diabetes and Pregnancy Project.  

National Technical Information Service (NTIS)

In order to enhance the state's Diabetes and Pregnancy program, the project developed, tested, and implemented a model regional perinatal data system which collected, analyzed, and reviewed information on pregnancies complicated by diabetes, and developed...

L. Headley



American Pregnancy Association  


... About Contact Online Advertising Corporate Sponsor Info Pregnancy Week-By-Week Sign up for our newsletter to track your ... Your Ovulation Ovulation Calendar Pregnancy Calculator Baby Names Week By Week Video Library Ovulation Calculator Education Sponsored ...


Damage control surgery by keeping the abdomen open during pregnancy: favorable outcome, a case report  

PubMed Central

Background Acute abdomen in advanced pregnancy is one of the most challenging surgical situations. In life-threatening situations, despite optimal management, foetus distress and preterm delivery may occur. Although laparostomy is a useful treatment of abdominal sepsis, its successful management has not been reported previously in pregnant women. Case 30-year-old woman at 23 week of pregnancy was investigated for non-specific abdominal pain. Surgical exploration revealed extensive ischemic bowel necrosis. Multiple segmental resections were performed and abdomen was left open with vacuum assisted dressing, maintained for 48 hours. At the third surgical look the continuity was restored and abdominal wall closed. The foetal condition stayed unperturbed under pharmacologic tocolysis. Pregnancy was carried to full term delivery. Conclusion Open abdomen strategy can be successfully applied in pregnant woman.

Staszewicz, Wojciech; Christodoulou, Michel; Marty, Francois; Bettschart, Vincent



Thymic Neuroendocrine Carcinoma Producing Ectopic Adrenocorticotropic Hormone and Cushing's Syndrome.  


Neuroendocrine carcinoma of the thymus, previously termed thymic carcinoid, is a rare clinical entity. Rarer still are such cases presenting with endocrinopathies. We report a case of thymic neuroendocrine carcinoma presenting with ectopic adrenocorticotroic hormone production and resultant Cushing's syndrome. PMID:24088497

Dixon, Jennifer L; Borgaonkar, Sanket P; Patel, Anupa K; Reznik, Scott I; Smythe, W Roy; Rascoe, Philip A



Brief review of models of ectopic bone formation.  


Ectopic bone formation is a unique biologic entity--distinct from other areas of skeletal biology. Animal research models of ectopic bone formation most often employ rodent models and have unique advantages over orthotopic (bone) environments, including a relative lack of bone cytokine stimulation and cell-to-cell interaction with endogenous (host) bone-forming cells. This allows for relatively controlled in vivo experimental bone formation. A wide variety of ectopic locations have been used for experimentation, including subcutaneous, intramuscular, and kidney capsule transplantation. The method, benefits and detractions of each method are summarized in the following review. Briefly, subcutaneous implantation is the simplest method. However, the most pertinent concern is the relative paucity of bone formation in comparison to other models. Intramuscular implantation is also widely used and relatively simple, however intramuscular implants are exposed to skeletal muscle satellite progenitor cells. Thus, distinguishing host from donor osteogenesis becomes challenging without cell-tracking studies. The kidney capsule (perirenal or renal capsule) method is less widely used and more technically challenging. It allows for supraphysiologic blood and nutrient resource, promoting robust bone growth. In summary, ectopic bone models are extremely useful in the evaluation of bone-forming stem cells, new osteoinductive biomaterials, and growth factors; an appropriate choice of model, however, will greatly increase experimental success. PMID:22085228

Scott, Michelle A; Levi, Benjamin; Askarinam, Asal; Nguyen, Alan; Rackohn, Todd; Ting, Kang; Soo, Chia; James, Aaron W



An Ectopic Breast Tissue Presenting with Fibroadenoma in Axilla  

PubMed Central

Introduction. The congenital anomalies of breast, especially the polymastia (supernumerary breast) and polythelia (supernumerary nipple), always do not fail to amuse the clinicians because of their varied presentations, associated renal anomalies, and pathologies arising from them. The axillary polymastia is a variant of ectopic breast tissue (EBT). Ectopic breast tissue can undergo the same physiological and pathological processes as the normally located breast. The incidence of fibroadenoma developing in ectopic breast is reported as a rare entity, the most common being the carcinoma. Case Presentation. A 31-year-old Dravidian female presented with a lump of 4?cm in the right axilla for the past year which gradually increased in size, giving discomfort. Our initial differential diagnosis was fibroadenoma, lipoma, and lymphadenopathy. Further investigation and histopathological report of excision biopsy confirmed it as a fibroadenoma on ectopic breast tissue in the axilla. Patient has no associated urological or cardiac anomaly. Conclusion. This case has been reported for its rarity and to reemphasise the importance of screening of EBT for any pathology during routine screening of breast.

Amaranathan, Anandhi; Balaguruswamy, Kanchana; Bhat, Ramachandra V.; Bora, Manash Kumar



Orbital dermoid cyst with sinus tract mimicking ectopic cilia.  


Dermoid cysts are the most common periorbital masses presenting in childhood. We describe an unusual case of a dermoid cyst presenting with black hairs emerging from a sinus tract on the upper eyelid and mimicking the appearance of ectopic cilia. Our case highlights the value of radiologic examinations in such cases. PMID:21168077

Wang, Yi; Su, Fan; Li, Yueyue; Xiao, Lihua



Klippel-Trenaunay syndrome and pregnancy.  


General recommendations on how to deal with pregnancy in patients with Klippel-Trenaunay syndrome (KTS) are rare. We describe the case of a 32-year-old female with KTS, involving the head and the left arm and leg, delivering a healthy female child, and are reviewing the recent literature. The risk to deliver an ill child is low in women with KTS. At the end of the 1st trimester a sonographic investigation can exclude angiodysplastic alterations of the fetus. If the fetus shows changes compatible with KTS, a termination can be discussed because the risk of fatal complications after delivery is high. During pregnancy the careful monitoring of coagulopathic disorders is necessary. Prior to delivery an MR-scan may be useful to detect angiodysplastic vascular structures next to the spinal cord, pelvic structures or the lower abdominal wall, which might complicate peridural anesthesia or caesarean section. PMID:12865887

Hergesell, K; Kröger, K; Petruschkat, S; Santosa, F; Herborn, C; Rudofsky, G



Anxiety disorders in pregnancy  

Microsoft Academic Search

There is now growing realization that many women suffer from new onset or worsening of anxiety disorders during pregnancy.\\u000a Studies of anxiety symptoms in pregnancy show that a significant portion of women are affected. Anxiety symptoms in pregnancy\\u000a have been associated with adverse fetal and infant outcomes. Furthermore, having an anxiety disorder during pregnancy is one\\u000a of the strongest risk

Bavanisha Vythilingum



[Antithrombotic therapy and pregnancy].  


The incidence of venous thromboembolism (VTE) during pregnancy is about one event per 1000 pregnancies and placenta-mediated pregnancy complications (PC) occurred in 15%. Knowing the biological combined with clinical risk factors would help to prevent problems during the pregnancy. Several antithrombotic therapies exist, including very recent ones but LMWH and aspirin are still molecules of choice. The women should be assessed for VTE and PC risk in order to improve the outcome. PMID:23855993

Chauleur, Céline; Raia, Tiphaine; Gris, Jean-Christophe



Diabetes and Pregnancy  

Microsoft Academic Search

Diabetes mellitus is the most common complication in pregnancy, affecting nearly 8% of all pregnancies. Nearly 90% of women\\u000a with diabetes develop the condition during pregnancy; diabetes in the other 10% antedated the pregnancy. Since the discovery\\u000a of insulin, perinatal mortality rates for women with diabetes have decreased, however, infant morbidity remains higher than\\u000a in the nondiabetes pregnant population.\\u000a \\u000a Diabetes

Alyce M. Thomas


Immunologic tests for pregnancy. A comparison.  


A study was undertaken to determine the most reliable immunologic pregnancy test or tests and to determine which factors unrelated to pregnancy influence test results. 1 direct latex aggutination test using both serum and uterine. 4 latex inhibition-agglutination slide tests, and 3 hemagglutination-inhibition tube tests were used. These tests were compared in pregnant and nonpregnant patients in the following categories: patients with proteinuria, those receiving psychotropic drugs, women taking oral progestins, postmenopausal females, and hyperthyroid patients. Also evaluated were patients with a known acute ectopic gestation. In all, 1661 tests were performed on urine and serum samples from 206 patients. patients. Results indicated that there is a difference not only in the sensitivities of the various reagents, but in the degree to which factors other than the presence of chorionic gonadotropin may influence the tests. In general, the hemagglutination-inhibition tube tests are more sensitive than the latex agglutination-inhibition slide tests, and they are, therefore, able to detect lower levels of chorionic gonadotropin. Slide tests, however, can be completed in several minutes while tube tests may take as long as 2 hours to complete. The data of this study indicate that some of the psychotropic drugs, proteinuria, the postmenopausal state, and possibly, hyperthyroidism may cause falsely positive reactions with some of the reagents. The oral estrogen-progestins do not appear to affect the test results. As a general all-purpose office pregnancy screening test, the Pregnosticon Slide test appears to offer the greatest number of advantages and the fewest disadvantages. If increased sensitivity or quantitative studies are desired, the tube tests (UCG, Pregnosticon Tube and Pregnosticon Accuspheres) should be used for problem pregnancies. PMID:4912253

Kerber, I J; Inclan, A P; Fowler, E A; Davis, K; Fish, S A



Pregnancy outcome with removal of intrauterine device.  


Of 201 women who became pregnant with an IUD in situ, 120 had the device left inserted and 81 had it removed. Patients excluded from the study were those who showed evidence of threatened or incomplete abortion, those in whom the thread was not visible and the IUD not recovered during or after termination of pregnancy, and those known to have had attempts at induced abortions. The IUDs were removed only when the thread was still visible at the cervical os, when pregnancy was within the first trimester, and when the 1st attempt at pulling the thread offered no undue resistance. 12 weeks gestation was taken as the cut-off period for attempted removal since the conceptus does not fully occupy the uterine cavity until the 4th month. In the group in which the devices, mostly Lippes loops, had been left in situ there were 5 cesarean sections for obstetric indications including 1 case of placenta previa. 2 of the premature infants died during the neonatal period. Among those with the devices left in situ 48.44% aborted, compared wtih 29.62% in the removal group (p less than .02 greater than .01). When the incidence of abortion and prematurity were combined, the in situ group showed a significant increase (p less than .01). The incidence of ectopic pregnancy in this series also confirms previous reports of the relative increase (5%) among women who become pregnant with the IUD in situ. In this series of incidence was 6%. These data suggest that when continuation of pregnancy is desired, the IUD should be removed if possible. PMID:4708484

Alvior, G T



Abdominal actinomycosis: a case report.  


Actinomycosis is an anaerobic infection caused by actinomycetes, which are part of the normal flora in the intestinal, anal and genital tracts. Although the infection is often cured medically with appropriate antimicrobial therapy, diagnosis is usually made surgically. We report the case of a 41 year-old woman with intra-abdominal mass secondary to extensive actinomycosis involving the hepatic flexura. She required emergency surgery during which the mass was excised. A review of the literature on abdominal actinomycosis during the last 20 years is reported. Emergency surgery has been rarely described in this condition. Although the incidence of actinomycosis has decreased, the abdominal form has been observed with increasing frequency: it could be the result of prolonged use of intra-uterine device. Abdominal actinomycosis is an extremely rare infection that can mimic multiple disease processes and requires accurate diagnosis for successful therapy. PMID:14653043

Coban, A; Yetkin, G; Kebudi, A



Disseminated Intra-Abdominal Hydatidosis  

PubMed Central

We present the case of a 26-year-old male Peruvian patient who presented with disseminated intra-abdominal hydatidosis. The patient was treated with surgical removal of the cysts and prolonged medical treatment with albendazole.

Concha, Fatima; Maguina, Ciro; Seas, Carlos



Abdominal ultrasonography, 2nd Ed  

SciTech Connect

This volume is a new and updated edition of an extensively illustrated text and reference on the capabilities and imaging of gray scale ultrasonography for each major abdominal organ. Each major organ system is treated separately, including liver, gallbladder and bile ducts, pancreas, kidney, retroperitoneum, abdominal vasculature, and more. There are over 500 illustrations and ten pages of full color plates for cross sectional anatomy.

Goldberg, B.B.



Functional Abdominal Pain in Children  

Microsoft Academic Search

\\u000a Approximately 50 years ago, Apley and Naish described children who presented with repeated episodes of abdominal pain for\\u000a at least 3 months without any identifiable cause under the term recurrent abdominal pain (Apley and Naish 1958). Later studies\\u000a showed that this term was a “waste basket” encompassing functional and organic conditions. More recent symptom-based criteria,\\u000a known as Rome criteria, exclusively

Miguel Saps; Gati Dhroove


Management of functional abdominal pain  

Microsoft Academic Search

Opinion statement  The diagnosis of functional abdominal pain should be made based on the Rome II symptom criteria with only limited testing\\u000a to exclude other disease. During physical examination the clinician may look for evidence of pain behavior which would be\\u000a supportive of the diagnosis. Reassurance and proper education regarding the clinical entity of functional abdominal pain is\\u000a critical for successful

Yuri A. Saito; Jean C. Fox



Therapeutic laparoscopy for abdominal trauma  

Microsoft Academic Search

  Background: Instead of open laparotomy, laparoscopy can be used safely and effectively for the diagnosis and treatment of\\u000a traumatic abdominal injuries. Methods: Between February 1998 and January 2002, 78 hemodynamically stable patients (49 males\\u000a and 29 females) with suspicious abdominal injuries underwent diagnostic or therapeutic laparoscopy. The patients ranged in\\u000a age from 15 to 79 years (median, 40.9 years). Of

Y. B. Chol; K. S. Lim



Pericardial Disease in Pregnancy  

Microsoft Academic Search

Background: There is no evidence that pregnancy affects susceptibility to pericardial disease. However, when such a condition occurs, its proper diagnosis and management may be crucial for the outcome of the pregnancy. Incidence and Diagnosis: Hydropericardium is the most frequent form of pericardial involvement in pregnancy. It is typically a small, clinically silent pericardial effusion present in the third trimester

Arsen D. Risti?; Petar M. Seferovi?; Aleksandar Ljubi?; Ida Jovanovi?; Gorica Risti?; Sabine Pankuweit; Miodrag Ostoji?; Bernhard Maisch



Malignancy in pregnancy  

Microsoft Academic Search

Malignant disease in pregnancy represents a complex situation with medical and ethical issues. Delayed diagnosis occurs when symptoms are attributed to pregnancy. Once malignancy is diagnosed, gestational age becomes important in further management. Magnetic resonance imaging is safe in pregnancy and can be used for staging purposes. Maternal counselling is of paramount importance in decision-making.

Saadiya Aziz Karim; Mahmood I. Shafi



Addiction in Pregnancy  

Microsoft Academic Search

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

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



Depression during pregnancy  

Microsoft Academic Search

OBJECTIVE To review existing literature on depression during pregnancy and to provide information for family physicians in order to promote early detection and treatment. QUALITY OF EVIDENCE MEDLINE was searched from January 1989 through August 2004 using the key words depression, pregnancy, prenatal, and antenatal. Articles focusing on depression during pregnancy were chosen for review; these articles were based on

Deirdre Ryan; Lisa Milis; Nicholas Misri



Intrahepatic cholestasis of pregnancy  

Microsoft Academic Search

Intrahepatic cholestasis of pregnancy (ICP) is a cholestatic disorder characterized by (i) pruritus with onset in the second or third trimester of pregnancy, (ii) elevated serum aminotransferases and bile acid levels, and (iii) spontaneous relief of signs and symptoms within two to three weeks after delivery. ICP is observed in 0.4–1% of pregnancies in most areas of Central and Western

Thomas Pusl; Ulrich Beuers



Vanishing tumor in pregnancy  

PubMed Central

A patient with microprolactinoma, who had two successful pregnancies, is described for management issues. First pregnancy was uneventful. During the second pregnancy, the tumor enlarged to macroprolactinoma with headache and blurring of vision which was managed successfully with bromocriptine. Post delivery, complete disappearance of the tumor was documented.

Vimal, M. V.; Budyal, Sweta; Kasliwal, Rajeev; Jagtap, Varsha S.; Lila, Anurag R.; Bandgar, Tushar; Menon, Padmavathy; Shah, Nalini S.



Adolescents’ pregnancy intentions  

Microsoft Academic Search

Purpose: This study explores if and how adolescents’ pregnancy intentions relate to life situations and health-related behaviors prenatally and up to 2 years postpartum.Methods: Adolescent girls who reported that they had “wanted a baby” (n = 75) as their reason for pregnancy were compared with those who reported that the pregnancy “just happened” (n = 79) at four separate time

Valerie Rubin; Patricia L East



Vaccinations and Pregnancy  


... couldn't see my baby at my 7 week ultrasound. Why? At the 7th week of pregnancy, your baby is about ½ an ... 1 in 120 pregnancies at 15 to 20 weeks gestation. Most disappear during pregnancy or within several ...


Hyperthermia and Pregnancy  


... fever in pregnancy. I have been using the hot tub and sauna. Is this a risk during my pregnancy? Hot tub or sauna use during pregnancy should be ... take only 10 to 20 minutes in a hot tub or sauna to raise your body temperature ...


Outcome of pregnancy in survivors of Wilms' tumor  

SciTech Connect

Outcome of pregnancy was reported by 99 patients who were cured of childhood Wilms' tumor at seven pediatric cancer centers during 1931 to 1979. These patients carried or sired 191 singleton pregnancies of at least 20 weeks in duration. Among the 114 pregnancies in women who had received abdominal radiotherapy for Wilms' tumor, an adverse outcome occurred in 34 (30%). There were 17 perinatal deaths (five in premature low-birth-weight infants) and 17 other low-birth-weight infants. Compared with white women in the United States, the irradiated women had an increased perinatal mortality rate (relative risk, 7.9) and an excess of low-birth-weight infants (relative risk, 4.0). In contrast, an adverse outcome was found in two (3%) of the 77 pregnancies in nonirradiated female patients with Wilms' tumor and wives of male patients. The high risk of adverse pregnancy outcome should be considered in the counseling and prenatal care of women who have received abdominal radiotherapy for Wilms' tumor.

Li, F.P.; Gimbrere, K.; Gelber, R.D.; Sallan, S.E.; Flamant, F.; Green, D.M.; Heyn, R.M.; Meadows, A.T.



A case of buccal abscess; originating from an ectopic accessory parotid gland?  


We report a case of an abscess from an 'ectopic' accessory parotid gland in the cheek demonstrated by sialography and computed tomography (CT). The accessory parotid gland was ectopically located anterolateral to the masseter muscle and isolated from the main parotid gland. The orifice and ductal system of the ectopic accessory parotid gland were separated from those of Stensen's duct. The abscess developed from this ectopic accessory gland, and the main parotid gland was free of inflammation. Using sialography and CT, we confirmed the presence of this ectopic accessory gland. PMID:11945200

Lee, Dong-Hee



Clinical Therapeutics in Pregnancy  

PubMed Central

Most drugs are not tested for use during pregnancy, consequently, labeling, which may include information about fetal safety, includes nothing about dosing, efficacy, or maternal safety. Yet these are concerns of health care providers considering treatment of disease during pregnancy. Therefore, the practitioner treats the pregnant woman with the same dose recommended for use in adults (typically men) or may decide not to treat the disease at all. However, is the choice of not treating a woman during pregnancy better than dealing with the challenges which accompany treatment? This paper, which summarizes metabolic and physiologic changes induced by pregnancy, illustrates that standard adult dosing is likely to be incorrect during pregnancy.

Feghali, Maisa N.; Mattison, Donald R.



Adrenal disorders in pregnancy.  


Adrenal disorders may manifest during pregnancy de novo, or before pregnancy undiagnosed or diagnosed and treated. Adrenal disorders may present as hormonal hypofunction or hyperfunction, or with mass effects or other nonendocrine effects. Pregnancy presents special problems in the evaluation of the hypothalamic-pituitary-adrenal axis in addition to the usual considerations. The renin-angiotensin-aldosterone axis undergoes major changes during pregnancy. Nevertheless, the common adrenal disorders are associated with morbidity during pregnancy and their management is more complicated. A high index of suspicion must be maintained for these disorders lest they go unrecognized and untreated. PMID:22108280

Abdelmannan, Dima; Aron, David C



[Endocrine emergencies during pregnancy].  


Endocrine emergencies during pregnancy can become life-threatening for both mother and fetus. In addition to some pregnancy-linked endocrine disorders, several pre-existing forms of endocrinopathy, such as Grave's disease, type 1 diabetes and adrenal insufficiency might deteriorate acutely during pregnancy. Early diagnosis and management are challenging because the classical symptoms are often modified by pregnancy. Laboratory tests are subject to altered physiological ranges and pharmacological options are limited while therapeutic goals are stricter than in the non-pregnant patient. This article focuses on endocrine emergencies complicating pregnancy. PMID:22349529

Harbeck, B; Schütt, M; Sayk, F



Adolescent pregnancy options.  


The range of pregnancy options available to adolescents each have significant ramifications for future educational and economic achievement. The changing societal context of adolescent pregnancy decision-making are described, and the characteristics of adolescents who choose to terminate their pregnancy, parent their child, or place for adoption are examined. The role of significant others in decision-making and the implications of mandatory parental involvement in pregnancy decision-making is discussed, as well as the roles of schools in promoting the well-being and potential of adolescents considering pregnancy decisions. PMID:1434557

Resnick, M D



Pregnancy and delivery after cone biopsy of the cervix.  


Seventy-seven women had 98 pregnancies after a cone biopsy of the cervix. There were 62 deliveries, 26 legal abortions, 9 spontaneous abortions and 1 ectopic pregnancy. Cervical cerclage was done for 22 out of 62 conized parturients (35.4%) and for none in the matched control group. There were 4 (6.4%) preterm deliveries in the cone biopsy group and 1 in the control group. The perinatal mortalities were 3.2% and 0% respectively. The mean duration of labour was 2.4 h shorter in the conized parturients than in the controls (P less than 0.05) but there were no difference in the mode of delivery in the two groups. PMID:3954449

Kuoppala, T; Saarikoski, S



Cesarean section scar pregnancy treatment--case report.  


This is a case report of a 36-year-old patient with an ectopic pregnancy located in the previous cesarean section scar following in vitro fertilization (IVF). The patient was treated by 50 mg of intrasacular methotrexate locally under ultrasound guidance. Transvaginal ultrasound (TVUS) confirmed that the pregnancy was no longer vital within 24 hours, dilatation and aspiration of the ovular tissue were performed after seven days and it was sent for pathohistological analysis. Eight hours after the procedure, the patient began bleeding abundantly and was consequently treated locally by 1 ml of Beriplast P Combi set, human fibrinogen, and human thrombin set (CSL Behring). After the treatment, the patient was discharged in good health, with normal laboratory values. Her menstrual period resumed 35 days after the procedure. PMID:23971267

Nejkovi?, L; Pazin, V; Filimonovi?, D



Electromyographic response of the abdominal musculature to varying abdominal exercises.  


This study examined the electromyographic (EMG) response of the upper rectus abdominis (URA), lower rectus abdominis (LRA), internal obliques (IOs), external obliques (EOs), and the rectus femoris (RF) during various abdominal exercises (crunch, supine V-up, prone V-up on ball, prone V-up on slide board, prone V-up on TRX, and prone V-up on Power Wheel). The subjects (n = 21) performed an isometric contraction of the abdominal musculature while performing these exercises. Testing revealed no statistically significant differences between any of the exercises with respect to the EOs, the URA, or the LRA. However, when examining the IO muscle, the supine V-up exercise displayed significantly greater muscle activity than did the slide exercise. In addition, EMG activity of the RF during the crunch was significantly less than in any of the other 5 exercises. These results indicate that when performing isometric abdominal exercises, non-equipment-based exercises stressed the abdominal muscles similarly to equipment-based exercises. Based on the findings of the current study, the benefit of training the abdominal musculature in an isometric fashion using commercial equipment could be called into question. PMID:21088553

Schoffstall, James E; Titcomb, David A; Kilbourne, Brianne F



ACR Appropriateness Criteria® pulsatile abdominal mass, suspected abdominal aortic aneurysm.  


Clinical palpation of a pulsating abdominal mass alerts the clinician to the presence of a possible abdominal aortic aneurysm (AAA). Generally an arterial aneurysm is defined as a localized arterial dilatation ?50% greater than the normal diameter. Imaging studies are important in diagnosing the cause of a pulsatile abdominal mass and, if an AAA is found, in determining its size and involvement of abdominal branches. Ultrasound (US) is the initial imaging modality of choice when a pulsatile abdominal mass is present. Noncontrast computed tomography (CT) may be substituted in patients for whom US is not suitable. When aneurysms have reached the size threshold for intervention or are clinically symptomatic, contrast-enhanced multidetector CT angiography (CTA) is the best diagnostic and preintervention planning study, accurately delineating the location, size, and extent of aneurysm and the involvement of branch vessels. Magnetic resonance angiography (MRA) may be substituted if CT cannot be performed. Catheter arteriography has some utility in patients with significant contraindications to both CTA and MRA. The American College of Radiology Appropriateness Criteria(®) are evidence-based guidelines for specific clinical conditions that are reviewed every 2 years by a multidisciplinary expert panel. The guideline development and review include an extensive analysis of current medical literature from peer reviewed journals and the application of a well-established consensus methodology (modified Delphi) to rate the appropriateness of imaging and treatment procedures by the panel. In those instances where evidence is lacking or not definitive, expert opinion may be used to recommend imaging or treatment. PMID:22644671

Desjardins, Benoit; Dill, Karin E; Flamm, Scott D; Francois, Christopher J; Gerhard-Herman, Marie D; Kalva, Sanjeeva P; Mansour, M Ashraf; Mohler, Emile R; Oliva, Isabel B; Schenker, Matthew P; Weiss, Clifford; Rybicki, Frank J



Neuromyelitis optica and pregnancy.  


Less than a hundred cases of pregnancies in women with neuromyelitis optica (NMO) have been published in the world. The aim of the present study was to add the Brazilian experience to this subject. Cases of women with NMO who became pregnant, or who developed NMO soon after pregnancy, were included. Retrospective analysis of medical data from these patients was carried out by the neurologist responsible for the case. Seventeen cases of pregnancies (16 full-term pregnancies, one miscarriage) were identified. The relapse rate of demyelinating events in the first trimester after pregnancy was significantly higher than at any other time. Disability progression was significantly worse 1 year after delivery. Pregnancy negatively influenced the disease course of NMO in these women. These results are similar to those of other authors, although the total number of cases so far described is still small. Obstetricians must be aware of the potential complications of a pregnancy in a woman who has NMO. PMID:23835638

Fragoso, Yára Dadalti; Adoni, Tarso; Bichuetti, Denis Bernardi; Brooks, Joseph Bruno Bidin; Ferreira, Maria Lucia Brito; Oliveira, Enedina Maria Lobato; Oliveira, Celso Luis Silva; Ribeiro, Sonia Beatriz Felix; Silva, Alex Eduardo; Siquineli, Fabio



Early Parental and Child Predictors of Recurrent Abdominal Pain at School Age: Results of a Large Population-Based Study  

ERIC Educational Resources Information Center

|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…

Ramchandani, Paul G.; Stein, Alan; Hotopf, Matthew; Wiles, Nicola J.



A functional ectopic vaginal anus: a rare clinical entity.  


A case of functional ectopic vaginal anus is presented in a 20 years old girl. Patient complained of passage of stool through her vagina. She was continent and had no complaint of constipation. Her examination revealed imperforated anus with functional ectopic vaginal anus. Her surgery was performed in two stages. In first stage, anoplasty was performed at midpoint between the vulval and anal opening. The posterior vaginal wall was repaired in two layers and protective loop colostomy was made. In the second stage, after a period of 3 months loop colostomy was closed. Patient's recovery was smooth, she is not constipated and continent with Wexner score of 3. She was advised pelvic floor rehabilitation exercises.She improved within a month with Wexner score of zero. PMID:23058153

Mehboob, Mukhtar; Naz, Samina; Tabassum, Shahina; Khan, Jamil Ahmed



Thymic hyperplasia as a source of ectopic ACTH production.  


A 26 year-old man with suspected Cushing's disease underwent transsphenoidal exploration of the pituitary without any evidence of microadenoma or hyperplasia. Progressive hypercortisolism necessitated bilateral adrenalectomy. Postoperatively, skin pigmentation gradually developed with a marked elevation of plasma ACTH levels, and CT scanning uncovered a thymic mass. Following removal of the thymic mass, skin pigmentation disappeared and plasma ACTH levels fell to normal. The excised mass was found to be a benign thymic hyperplasia without epithelial or carcinoid tumor cells. However, gel chromatography showed that the thymic tissue extract contained high ACTH content comparable to that of ectopic ACTH-producing tumors with a major component corresponding to ACTH(1-39). Northern blot analysis and in situ hybridization revealed the expression of proopiomelanocortin transcripts in lymphocytes of thymic hyperplasia. This report suggests that lymphocytes in thymic hyperplasia are the most likely site of deregulated ACTH expression causing ectopic ACTH syndrome. PMID:11075732

Ohta, K; Shichiri, M; Kameya, T; Matsubara, O; Imai, T; Marumo, F; Hirata, Y



Abdominal trauma: never underestimate it.  


Introduction. We present a case of a sports injury. The initial presentation and clinical examination belied serious intra-abdominal injuries. Case Presentation. A 16-year-old male patient came to emergency department after a sports-related blunt abdominal injury. Though on clinical examination the injury did not seem to be serious, FAST revealed an obscured splenorenal window. The CT scan revealed a large left renal laceration and a splenic laceration that were managed with Cook coil embolization. Patient remained tachycardic though and had to undergo splenectomy, left nephrectomy, and a repair of left diaphragmatic rent. Patient had no complication and had normal renal function at 6-month followup. Conclusion. The case report indicates that management of blunt intra-abdominal injury is complicated and there is a role for minimally invasive procedures in management of certain patients. A great deal of caution is required in monitoring these patients, and surgical intervention is inevitable in deteriorating patients. PMID:23326699

Bodhit, Aakash N; Bhagra, Anjali; Stead, Latha Ganti



Abdominal radiation causes bacterial translocation  

SciTech Connect

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.

Guzman-Stein, G.; Bonsack, M.; Liberty, J.; Delaney, J.P.



Lap Pak for Abdominal Retraction  

PubMed Central

Retraction of the bowels during abdominal surgery is generally facilitated by the