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PubMed1989

[Clinical study of ectopic eruption of permanent incisors and first molars].

UNLABELLED: Using the X-ray films, plastic models and pathological photograph of 4824 patients seen at the Department of Pedodontics of Iwate Medical University, the patterns of ectopic eruptions of permanent incisors and first molars (restricted to these teeth in this study) were classified into 4 groups (I-IV) to investigate the conditions of its incidence, size of the teeth and dental arch, and conditions at the stage of the mixed and permanent dentitions. RESULTS: 1. The total frequency of ectopic eruptions was 5.6%. No difference based on sex was found. 2. By classification, ectopic eruptions of the upper and lower permanent central incisors (Group I) amounted to more than half of the total frequency. The incidence of ectopic eruptions of the upper and lower permanent first molars (Group III) was very low and amounted to only 4.6% of the total frequency. 3. In Groups I and III, the incidence was higher in the maxilla than in the mandible. 4. Based on sex, the incidence was higher in boys in Group III and in girls in group II. 5. Ectopia of the permanent central incisors was frequently bilateral and those of the lower permanent lateral incisors and upper permanent first molars were frequently unilateral. 6. The mesiodistal width of the ectopically erupted permanent teeth tended to be somewhat enlarged, but showed no significant differences from Ono's mean value. 7. In ectopic eruptions at the area of the incisors, the C-C distance was narrowed with an increase in the ectopically erupted permanent teeth. 8. In patients in whom the permanent dentition was formed without occlusal guidance, the basal arch length and dental arch length were large and basal arch width and dental arch width were small. 9. In cases which were followed from the deciduous dentitions to permanent dentitions, the anterior tooth area at the stage of the mixed dentition was frequently crowded. Occlusal guidance was carried out in more than half of these cases.

Humans↗
PubMed1989

Increase of ectopic pregnancy in Finland--combination of time and cohort effects.

The marked increase of ectopic pregnancy in Finland was studied in 5-year age groups from 1968-1984. In the early 1970s, the overall increase was attributable to women under 30 years of age, and in the early 1980s to women aged 30 years or more. The increase in the incidence rate of ectopic pregnancy per 100,000 women has taken place somewhat successively since the late 1960s in women aged 20-24, 25-29, 30-34, and 35-39 years. The incidence of ectopic pregnancy per 100,000 women increased by every successive 5-year cohort born since the late 1930s up to the cohort born in 1954-1958; thereafter, the birth cohorts have experienced an equal or even lower risk of ectopic pregnancy. The findings suggest that the large "baby boom" cohort (born in 1945-1954), with its high risk of ectopic pregnancy, is mainly responsible for the overall increase in the number of ectopic pregnancies seen in the past decade. When these cohorts end their reproductive years, the marked increase in the number of ectopic pregnancies in Finland may decrease, but the incidence rates will probably stay stable.

Adolescent↗
PubMed1988

Ectopic pregnancy surveillance, United States, 1970-1985.

Ectopic pregnancy is now one of the leading causes of maternal death in the United States. In 1984 and 1985, both the numbers and rates of ectopic pregnancy increased. Since the rate of ectopic pregnancy remained unchanged for white women, the rate increase appears to be driven by the increasing rate among women of black and other races. Although ectopic pregnancies accounted for only 1.5% of the total pregnancies in 1984 and 1985, they accounted for 14% of the total maternal deaths in 1984 and for 11% of those deaths in 1985. However, the case-fatality rate for 1985 decreased to 4.2/10,000 ectopic pregnancies, down from the 35.5 deaths/10,000 ectopic pregnancies reported in 1970. Several factors may contribute to the increase in ectopic pregnancies, including heightened awareness of the condition, improved diagnostic technology, and possibly the higher prevalence of risk factors (e.g., acute and chronic salpingitis and sexually transmitted diseases) and the lower prevalence of protective factors (e.g., decreased use of oral contraceptives). Heightened awareness of the condition and improved technology may also be factors resulting in the decreased case-fatality rate.

Adolescent↗
PubMed1978

Ectopic pregnancy: a 15-year review of 160 cases.

Our review of the incidence of ectopic pregnancy in metropolitan Oklahoma City hospitals from 1960 through 1975 revealed an overall statistically significant increase. Review of the incidence of gonorrhea during the same period for the State of Oklahoma also showed a statistically significant increase. There was a significant correlation between the incidence of ectopic pregnancy and the incidence of gonorrhea. The 160 cases of ectopic pregnancy from University Hospital reviewed in detail included all ectopic pregnancies admitted from 1960 to 1975. Findings revealed 56% were white women with an average age of 26.8 years and average parity of 2.49. Pain (97.5%), amenorrhea (83%), and abnormal uterine bleeding (68%) were the most common presenting complaints, while abdominal tenderness (85%) and pelvic mass (54%) were the common physical findings. Culdocentesis was positive in 78% of the patients. Thirty-nine percent had a history of pelvic inflammatory disease and 8% a previous ectopic pregnancy. Admission diagnosis was correct in 67%. Unilateral adnexal procedure was the treatment in 81%. Fifty-seven percent of the ectopic pregnancies were right-sided, and hemoperitoneum averaged 950 ml. Postoperative complication rate was 55%. Follow-up pregnancy rate was 50%, and future ectopic pregnancies occurred in 6% of these.

Adolescent↗
PubMed1982

Risk of ectopic pregnancy following tubal sterilization.

To determine the impact of tubal sterilization on the overall incidence of ectopic pregnancy, the authors compared reported incidence rates of ectopic pregnancy after tubal sterilization with the rates associated with other contraceptive methods or no contraception. For each contraceptive method they then calculated the cumulative lifetime risk of ectopic pregnancy from the age at which a final contraceptive choice was made. Tubal sterilization was found to be associated with a lower cumulative lifetime risk of ectopic pregnancy than no contraception or use of an intrauterine contraceptive device. Tubal sterilization carries a somewhat higher risk of ectopic pregnancy than do barrier methods of contraception. Oral contraceptives are associated with a much lower ectopic pregnancy for most than any other contraceptive method or no contraception. Overall, however, the risk of an ectopic pregnancy for most women undergoing tubal sterilization in the United States is estimated to be lower than if they had not been sterilized and had continued their previous contraceptive practices.

Adult↗
PubMed1995

A 12-year survey of 681 ectopic pregnancies.

BACKGROUND: Since 1970, incidence of ectopic pregnancy has increased nearly three-fold worldwide. Ectopic gestation is the most common cause of mortality associated with pregnancy in the first trimester, and may adversely affect subsequent fertility. METHODS: A total of 681 patients with ectopic pregnancies seen during a 12-year span were analyzed for clinical evaluations including etiology, diagnosis and therapy. RESULTS: The ratio of ectopic pregnancies to deliveries was 1:52. The largest figure occurring in multiparous patients was in the 26 to 30 year age bracket. A previous abdominal operation or previous antibiotic therapy substantiating antecedent pelvic inflammatory disease is a prime etiologic factor in ectopic pregnancy. The most significant physical finding was abdominal or rebounding tenderness associated with adnexal or cul-de-sac fullness. The diagnosis was initiated by urine beta-hCG (ELISA) or serum beta-hCG (RIA) and ultrasonography in the majority of patients. Nighty-three percent of ectopic pregnancies were tubal pregnancies, and therapy consisted primarily of total salpingectomy. There were no maternal deaths in this series. CONCLUSIONS: Although newer diagnostic modalities are becoming more common, a correct diagnosis of ectopic pregnancy still relies heavily on clinical signs and symptoms. After a correct diagnosis is made, conservative surgical treatment or chemotherapy with preservation of the tube is the first choice for treatment. Thus to achieve a higher potential for a later pregnancy in the future for these women, routine salpingectomy should be the last resort.

Adolescent↗
PubMed1994

Prompt diagnosis of ectopic pregnancy in an emergency department setting.

OBJECTIVE: To evaluate quantitative hCG measurements and transvaginal ultrasound in the diagnosis of ectopic pregnancy in patients presenting to the emergency department. METHODS: A discriminatory zone for detecting the presence or absence of an intrauterine pregnancy by transvaginal ultrasound was established prospectively. Women presenting to the emergency department were evaluated prospectively using a diagnostic algorithm consisting of clinical examination, quantitative serum hCG, and transvaginal ultrasound. Finally, ectopic pregnancies diagnosed over a 22-month period were evaluated prospectively. RESULTS: All viable intrauterine pregnancies were identified in those subjects with hCG levels of 1500 mIU/mL (First International Reference) or greater. One thousand two hundred sixty-three subjects were evaluated prospectively; 59.8% were diagnosed with intrauterine pregnancy, 26.8% with spontaneous abortion, and 7.8% with ectopic pregnancy. At presentation, 13.2% of intrauterine pregnancies were diagnosed by clinical examination, whereas 82.9% were diagnosed by transvaginal ultrasound. Only 4% of normal intrauterine pregnancies were not confirmed on initial visit. Of 205 ectopic pregnancies diagnosed, 81.5% were hemodynamically stable; of these, 49.1% were diagnosed on initial presentation. Of all ectopics, 59% never reached an hCG level of 1500 mIU/mL and 35.8% had an hCG lower than the level at presentation. This protocol diagnosed ectopic pregnancies with a sensitivity of 100% and a specificity of 99.9%. CONCLUSION: A protocol of quantitative hCG levels (available within hours of presentation to an emergency department) combined with transvaginal ultrasound is effective in diagnosing ectopic pregnancy.

Chorionic Gonadotropin↗
PubMed1994

Transvaginal Doppler sonography for detecting ectopic pregnancy: is it really necessary.

In this prospective study we compared transvaginal duplex Doppler ultrasound with two-dimensional imaging for the diagnosis or exclusion of ectopic pregnancies. The study group comprised 76 stable patients with serum beta-human chorionic gonadotropin (hCG) levels > 100 mIU/ml in whom ectopic pregnancy was clinically suspected. Ectopic pregnancies were verified in 42 patients (60%), intrauterine pregnancies (normal and abnormal) in 19 (27%), and possible complete abortions, either intrauterine or extrauterine, in 9 patients (13%). Based on 2-D imaging alone, the appearance of an adnexal mass separated from the ovaries, and a lack of clear intrauterine gestational sac indicated ectopic pregnancy with a sensitivity of 95%. Intrauterine sac-like structures and absence of adnexal masses excluded ectopic pregnancies with a specificity of 89%. High velocity systolic flow, and low impedance diastolic flow which characterizes trophoblastic tissue when detected outside the uterus, had a sensitivity of 48%, while the presence of trophoblastic signals in the uterus or their absence outside the uterus excluded ectopic pregnancies with a specificity of 89%. The positive predictive values were 91% for Doppler and 95% for 2-D imaging, while the negative predictive values were 89% for imaging alone and 44% for Doppler. These data suggest that transvaginal Doppler ultrasound has significant lower sensitivity and negative predictive value and does not provide more useful diagnostic information than 2-D imaging alone for stable patients with suspected ectopic pregnancies.

Abortion, Spontaneous↗
PubMed1993

The value of ultrasonography in the diagnosis of ectopic pregnancy at the Kenyatta National Hospital, Nairobi.

Over a six-month-period, from 1st March 1988 to 30th September 1988, 127 patients suspected of having ectopic gestation at the Kenyatta National Hospital (KNH) were referred for sonographic examination, of whom 100 (78.7%) had enough data for a final diagnosis. During sonography, ectopic pregnancy was diagnosed in 31 (31%) patients, out of whom 15 (48.4%) were confirmed to have ectopic gestation at laparotomy. Of the 69 who were thought to have other gynaecological disorders at sonographic examination, 2 (2.9%) were later found to have other ectopic gestation at surgery. Of the 17 patients who had ectopic gestation finally, extrauterine gestational sac with a demonstrable foetal pole were observed in only 6 (35.3%) cases, thus allowing a confident diagnosis of ectopic pregnancy by sonography. An empty, bulky uterus, demonstrable adnexal mass, pseudo-gestational sac and fluid in the culde-sac, together improved the sonographic positive predictive value to 67.0%. This study has shown that sonography can be used in the diagnosis of ectopic pregnancy at the KNH. However, in order to improve its reliability, further studies are recommended involving a combination of pregnancy test and sonography.

Adolescent↗
PubMed1986

Prevention of ectopic bone formation by local application of ethane-1-hydroxy-1,1-diphosphonate (EHDP): an experimental study in rabbits.

This report shows that ectopic bone formation, a serious problem in orthopedic surgery, can be controlled in an animal model by local application of EHDP (disodium-ethane-1-hydroxy-1,1-diphosphonate). The results might be particularly pertinent to the clinical problem of preventing the recurrence of ectopic bone after surgical excision. Male New Zealand white rabbits were treated with immobilization and intermittent passive manipulation of the right knee. The treatment caused bone formation in the quadriceps muscle, which was visible on radiographs after 3 weeks. In this model, the effect of methacrylate implants containing EHDP was studied. A concentration of 16 g EHDP/100 g methacrylate inhibited bone formation in experimental cortical defects. Release of radiolabeled EHDP was studied in an in vitro system. The release of the drug was approximately 20 mg/day and implant initially, decreasing to about 0.1 mg/day/implant after 30 days. Standardized implants containing 16 g EHDP/100 g were then surgically attached to the femur, and the ectopic bone formation created by immobilization and intermittent manipulation was compared with that in rabbits treated with implants but without EHDP. The ectopic bone was measured from lateral and frontal radiograms and from radiograms of serial transverse sections of the thigh. We found that the EHDP implants were capable of preventing major ectopic bone formation in all cases, whereas all rabbits with an implant containing no EHDP had substantial ectopic bone formation at the end of the experiment. There was no difference between groups in the relative amount of cartilage, connective tissue, and normal bone. We conclude that local administration of EHDP may be a useful method for prevention of ectopic bone formation under the conditions and time employed.

Animals↗
PubMed2005

Temporary ectopic implantation for salvage of amputated lower extremities: case reports.

Two cases of temporary ectopic implantation of a complex amputated foot, followed by replantation to its anatomic position, are reported. Both cases of amputated foot were complicated by devastating soft-tissue injuries in the proximal stump of the amputation, fracture of the femur, and hemorrhagic shock, which ruled out the possibility of primary foot replantation. Both feet were temporarily ectopically implanted onto the contralateral legs, with microvascular anastomoses of the vessels to the recipient posterior tibial artery and saphenous vein. When the patient's general condition allowed, and the soft-tissue defects were repaired, the ectopic implanted feet were replanted to their anatomic positions. Both feet survived the temporary ectopic implantation and second-stage replantation. The length of the injured legs was maintained, and the feet regained their function in 4- and 6-month follow-ups. We conclude that temporary ectopic implantation of amputated parts provides an innovative procedure for the salvage of amputated extremities under special circumstances. A contralateral healthy extremity is an ideal recipient site for temporary ectopic implantation. The temporary ectopic implantation and second-stage replantation of an amputated foot and distal leg with indications can obtain satisfactory results.

Amputation, Traumatic↗
PubMed1990

The effects of ketanserin on ventricular ectopic activity in humans.

Ketanserin is a serotonin S2-receptor antagonist that lowers blood pressure and inhibits platelet aggregation. Ketanserin treatment is also associated with prolongation of the corrected QT interval. The recently reported Prevention of Atherosclerotic Complications with Ketanserin (PACK) trial confirmed this prolongation of QT and also revealed a significant excess of deaths in patients receiving ketanserin together with potassium-losing diuretics. The investigators suggested that this excess of deaths may have been attributable to exacerbation of hypokalemia-induced ventricular arrhythmias by the repolarization-prolonging effect of ketanserin. However, drugs that prolong the QT interval may affect ventricular ectopic activity beneficially, and our study was designed to evaluate the effects of ketanserin on ventricular ectopic activity. Twenty patients (18 male, 2 female) aged 42-73 years were studied, each having at least 15 ventricular ectopic beats/hour. The study design was a double-blind, crossover comparison of ketanserin, 40 mg twice daily, and placebo, both given for 1 week. Ventricular ectopic activity was assessed by 48-hour Holter electrocardiogram (ECG) tapes at the end of each treatment period. Ketanserin treatment was associated with prolongation of repolarization, as reflected by the significant mean increases in both QT interval (+30 ms; p less than 0.001) and corrected QT interval (+20 ms; p less than 0.05). The mean overall degree of ventricular ectopic activity, as represented by a score based on the Lown classification, was significantly reduced (p less than 0.05). This was associated with a concordant improvement in the individual indices of ectopic activity. Our results show that ketanserin significantly suppressed ventricular ectopic activity in our normokalemic patients.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1977

Ectopic neurones in the hippocampus of the postnatal rat exposed to methylazoxymethanol during foetal development.

Ectopic neurons have been detected in the hippocampus of postnatal hooded rats aged 5-24 days. These rats were exposed to methylazoxymethanol acetate (MAMac) during foetal development by injecting the mother rats with this neurotoxin. At birth, the hippocampus of rats exposed to MAMac showed a normal cytoarchitecture; ectopic neurones became prevalent from 5 days onwards. These ectopic neurones were restricted to subfields CA 1-2 of Ammon's horn, and evidence is presented which suggests that these ectopic sites are formed by neuronal emigration from stratum pyramidale. Ectopic neurones have been shown to occur in genetic abnormalities of man, and in the mutant mouse 'reeler'. MAMac is a powerful methylating agent especially for guanine which is present in DNA and RNA. It is postulated that viable cells with an altered DNA-RNA state may in some way be predisposed to the formation of ectopic cell clusters after a latent period. The movement of neurones from stratum pyramidale provides a convenient animal model for investigating the mechanisms by which ectopic neuronal sites are formed by abnormal migratory patterns.

Age Factors↗
PubMed1993

Neuronal ectopic masses induced by prenatal irradiation in the rat.

Ectopic neuronal masses below the subcortical white matter were seen in the brains of postnatal rats after 200 cGy irradiation at embryonic day 14. In contrast with the laminated organisation of the cortex located above the subcortical white matter, the ectopic masses were formed of confluent nodules composed of pyramidal and non-pyramidal neurons distributed at random, with no laminar organisation. Afferent and efferent fibres to/from the ectopic masses running together with fibres passing the subcortical white matter indicated that the ectopic masses were heavily connected to neighbouring structures. Examination of irradiated embryos revealed that the ectopic masses originated from ectopic periventricular rosettes, composed of germinal cells, which were formed shortly after irradiation. Neuronogenesis in these rosettes did not follow an inside-out gradient, as seen in the laminated cortex; however, early-generated neurons predominated in the external regions, whereas late-generated neurons were mainly located in the middle and internal regions of the ectopic masses.

Animals↗
PubMed1992

Ectopic ureter with complete ureteric duplication in the female child.

Twenty-two female children with complete ureteric duplication and ectopic ureter (two bilateral) were seen in a 15-year period. The most common clinical presentation was dribbling urinary incontinence with "normal" micturition. Other presentations included urinary infection and vaginal discharge. Four cases were diagnosed after antenatal recognition of ureterohydronephrosis. The clinical diagnosis was supported by various radiological investigations but ultrasonography (US) proved to be particularly reliable in diagnosing ectopic ureter. The most common sites of opening of the ectopic ureter were the urethral margin or the urethrovaginal septum, although in seven cases the site was not identified. Twenty-one kidneys were managed by upper pole heminephrectomy and three by ureteropyelostomy, removing as much of the ectopic ureter as possible via the renal approach. The distal ectopic ureter was removed via a separate suprapubic incision at the initial operation in four cases, and in two cases, delayed excision of the distal ectopic ureter was necessary. All surgical specimens were examined histologically and only two heminephrectomy specimens showed features of renal dysplasia. Dribbling urinary incontinence was cured in all cases, although in one patient the entire kidney was lost after heminephrectomy. Ectopic ureter should be suspected in girls with dribbling urinary incontinence. The diagnosis is best supported by US together with conventional radiology. The majority of cases can be managed by heminephrectomy, but when adequate function is demonstrated in the upper pole, ureteropyelostomy is recommended.

Child↗
PubMed1975

The effects of zinc on ectopic bone formation.

The effect of dietary zinc deficiency was studies in ectopic bone formation subsequent to Achilles tenotomy and also following the implantation of demineralized bone matrix in the muscle of rats. Three experiments were performed. The first was designed to investigate the relationship between zinc and calcium concentration during the formation of ectopic bone in rats fed a commercial laboratory ration, the second concerned the effects of dietary zinc deficiency on ectopic bone formation, and the third studies the subsequent effects of dietary zinc repletion on ectopic bone formation. The results indicated that, with the commercial ration, zinc increased concomitantly with calcium during ectopic bone formation in rats. Dietary zinc deficiency caused a retardation of ectopic bone formation and a significant reduction of in situ zinc and calcium concentration. Dietary zinc repletion to zinc-deficient animals restored the zinc concentration in ectopic bone to a level comparable to that of zinc-sufficient animals. Thus, these experiments present strong evidence that zinc plays an active role in bone metabolism.

Abdomen↗
PubMed1992

Anatomical origin of pressure-related ventricular ectopic rhythms.

In order to determine the origin of pressure-related ectopic rhythms, the main arteries were clamped in 11 anesthetized dogs, or the arteries or veins were transfused, while on or off metaraminol. The epicardial right atrial electrogram, the intracavity electrograms and the pressure of the two ventricles were recorded. Sinus rhythm was associated with 64/64 (100%) of the control periods off metaraminol, but only 19/50 (38%) of the clamping of the main arteries (P << 0.0005). In 14/27 aortic clampings ectopic beats appeared from the left ventricle and in 13/27 from the right one. In 4/23 clampings of the pulmonary artery ectopic beats appeared from the left ventricle and in 15/23 from the right one (P < 0.05). Sinus rhythm was associated with significantly lower left ventricular systolic pressure than any ventricular arrhythmia. The left ventricular systolic pressure associated with ectopic rhythms from the left ventricle was significantly (P < 0.005) higher than that associated with those from the right ventricle. The right ventricular systolic pressure during sinus rhythm was significantly (P < 0.005) lower than that during ectopic rhythm from any ventricle. It is concluded that a rise in the pressure of one ventricle tends to cause ventricular ectopic rhythms originating predominantly, but not exclusively, from this ventricle. The origin of ventricular ectopic rhythms from the right ventricle does not preclude that the arrhythmia may respond favorably to lowering of the systemic pressure.

Animals↗
PubMed2006

Incidence and location of ectopic abnormal parathyroid glands.

BACKGROUND: Ectopic parathyroid glands are a cause for failed parathyroid exploration. METHODS: Patients with hyperparathyroidism and ectopic parathyroid glands were identified from a parathyroid database. Laboratory data, gland weights, and surgical outcomes were obtained. The locations of the ectopic glands were correlated with results of technetium-99m-sestamibi imaging. RESULTS: Of 231 patients operated on for hyperparathyroidism, 37 (16%) had ectopic parathyroid glands. Ectopic inferior glands (N = 23 [62%]) were intrathymic, n = 7 (30%); anterosuperior mediastinal, n = 5 (22%); intrathyroidal, n = 5 (22%); within the thyrothymic ligament, n = 4 (17%); and submandibular, n = 2 (9%). Ectopic superior glands (N = 14 [38%]) were in the tracheoesophageal groove, n = 6 (43%); retroesophageal, n = 3 (22%); posterosuperior mediastinal, n = 2 (14%); intrathyroidal, n = 1 (7%); in the carotid sheath, n = 1 (7%); and paraesophageal, n = 1 (7%). Sestamibi scans were true-positive in 81%, identifying 13 of 16 retrosternal glands, and false-negative in 19%. CONCLUSIONS: A 16% incidence of ectopic parathyroid glands and a 100% positive predictive value of sestamibi scintigraphy underscore the importance of sestamibi imaging in patients with primary hyperparathyroidism.

Choristoma↗