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At least 541 records · Page 30Linked to original sources
PubMed1997

Management of ectopic ureters: experience with the upper tract approach.

PURPOSE: The necessity of removing the ureteral stump after upper tract surgery for an ectopic ureter has been debated. We reviewed the records of patients initially treated at the kidney level to evaluate indications for later stump removal. MATERIALS AND METHODS: We reviewed the medical records of 32 patients with 33 ectopic ureters treated at the kidney level during the last 10 years. RESULTS: Ectopic ureters were associated with duplicated collecting systems in 31 cases and with single systems in 2. Upper pole heminephrectomy and partial ureterectomy were performed in 23 units and upper tract reconstruction was done in 8. Both patients with single systems underwent nephrectomy. Four patients (12%) required repeat surgery at the bladder level, including 1 who underwent ureteral reimplantation for persistent ipsilateral lower pole reflux and simultaneous upper pole stump removal. Preoperative voiding cystourethrography revealed reflux into the ectopic ureter in 1 patient with postoperative reflux and infections. The remaining 2 patients required a repeat operation to remove the stump due to recurrent urinary tract infections and newly detected reflux into the stump, respectively. CONCLUSIONS: The majority of patients with ectopic ureters can be treated by addressing only the upper urinary tract. No patient who presented with incontinence required ureteral stump removal. Whether noted preoperatively or postoperatively, reflux into the ectopic ureter necessitated ureteral stump removal. Three of the 6 patients (50%) who had reflux to the ipsilateral kidney required lower tract surgery.

Abnormalities, Multiple↗
PubMed1996

[Histologic examination and immunohistochemical analysis of estrogen and progesterone receptors of eutopic and ectopic endometrium in patients with endometriosis].

OBJECTIVE: To study the differences of histologic dating and steroid receptors between ectopic and eutopic endometrium in patients with endometriosis. METHODS: Histologic examinations were done on eutopic and ectopic endometrium in 28 patients with pelvic endometriosis, and estrogen and progestrone receptors concentrations were determined by immunochemical ABC method in 15 patients. All the ectopic tissues were biopsied from peritoneal lesions. RESULTS: In 67.9% patients, the ectopic endometrium development was retardated and 14.3% accelerated as compared with eutopic endometrium, and only 17.9% identical. The estrogen receptors (ER) and progesterone receptors (PR) contents of ectopic endometrium were significantly lower than those of eutopic endometrium in glandular cells (P < 0.01, P < 0.05 respectively), while differences were not significant in stroma cells. CONCLUSIONS: The advantage of the immunochemical technique is that it can definitely locate the site of receptors in the histologic section. The difference in histologic dating and ER and PR concentrations in the eutopic and ectopic endometrium may be accounted for by the different steroid environments and pathogenic theory of peritoneum metaplasia.

Endometriosis↗
PubMed1997

Characterization of transgenic tilapia lines with different ectopic expression of tilapia growth hormone.

The transfer of growth hormone (GH) genes has opened new possibilities for the manipulation of growth in economically important fish species. However, the ectopic GH levels to optimize growth acceleration in fish, and specially in tilapia, are not known and must be determined experimentally. The tilapia GH (tiGH) cDNA was used to construct chimeric genes expressing different levels of tiGH in vitro and in vivo. These constructs were used to generate four lines of transgenic tilapia by microinjection into one-cell embryos. Different patterns and levels of ectopic expression of tiGH and IGF were detected in organs of transgenic tilapia by RNA or protein analysis. The two lines with lower ectopic tiGH mRNA levels were the only ones showing growth acceleration, suggesting that the expression of ectopic tiGH promoted growth only at low expression levels. The effect of higher ectopic tiGH levels resembled the physiologic situation of low condition factor and permitted us to postulate a model for growth acceleration in transgenic tilapia expressing ectopic tiGH.

Animals↗
PubMed1976

Ventricular ectopic activity in chronic ischaemic heart disease.

Ventricular ectopic activity in 116 consecutive postmyocardial infarction patients was studied. The study extended over a period of 5 years and 700 periodic 6-7-hour Holter tape recordings were perfomred. A classification of ectopic activity is presented and it is suggested that patients be classified into group I with few, i.e. less than 8, and group II with multiple, i.e. 8 or more, ectopic beats per hour. It was found that the frequency of ventricular ectopic activity tends to remain constant over prolonged periods of time, and that repetitive firing as well as multiformity are functions of the absolute number of ventricular ectopic beats (VEB) present. A 6-7-hour sample of ventricular ectopic activity gives only marginally more information than a 1-hour recording, and the presence of VEB on a resting ECG correlates well with a frequency of more than 8 VEB per hour (group II) on extended monitoring.

Adult↗
PubMed1982

The frequency and clinical biology of the ectopic hormone syndromes of small cell carcinoma.

Eighty-four patients with small cell carcinoma of the lung were reviewed with respect to the frequency and biologic behavior of patients with a demonstrated ectopic hormone syndrome. This subgroup of 12 patients (14%) was compared with regard to stage of disease, distribution of metastases, response rate, and survival to those patients not demonstrating a clinical syndrome. Stage, distribution, and response rates are comparable in the two groups but differences were observed with regard to sites of metastases and survival. The ectopic hormone syndrome patients had an increased likelihood of liver metastasis and CNS metastasis. The frequency of CNS metastasis in patients without the ectopic hormone syndrome was 11/72 (15%) of which four of the 11 were present at initial presentation. In contrast, 5/12 (42%) of the patients with ectopic hormone syndromes developed CNS metastasis, and all five had clinically demonstrated SIADH. Survival was consistently inferior in those patients with the ectopic hormone syndrome.

ACTH Syndrome, Ectopic↗
PubMed1986

Ectopic pregnancy--an analysis of the etiology, diagnosis and treatment in 552 cases.

An analysis of the clinical data of 552 patients treated for ectopic pregnancy during 1973-82 in our hospital showed that the prevalence of this complication rose twofold (P less than 0.01) from an annual rate of 10.9 per thousand in 1973 to 20.9 per thousand in 1982. As regards parity distribution, the proportion of the 2-paras increased significantly (P less than 0.05) and this increase was significantly greater (P less than 0.001) than in the total population of parturients during this period. The increasing incidence of ectopic pregnancies had a significant positive correlation (P less than 0.05) with the use of an intrauterine device (IUD), but not with previous or present pelvic inflammatory disease or gynaecological or abdominal surgery. Because the 158 patients with an IUD in situ (34%) had a significantly less frequent past history of salpingitis, pelvic operation, infertility, ectopic pregnancy or spontaneous abortion and had less actual pelvic inflammatory changes than the 259 patients without contraception (57%), the IUD seemed to be directly involved with the increased risk of ectopic pregnancy. In the present study lower abdominal pain occurred in 97% of the patients and menstrual disorders in 93%; pelvic examination revealed adnexal mass in 63% and adnexal tenderness in 90% of the patients. Laparoscopy, a sensitive urinary pregnancy test (detection limit 75 IU/1) and culdocentesis were the most important factors in the diagnosis of ectopic pregnancy as evidenced by positive results in 97, 90 and 83% of the cases, respectively. Due to improved diagnostic procedures the annual rate of an unruptured tube at operation increased from 49% to 73% during the study period.

Adolescent↗
PubMed1987

The intrauterine device and ectopic pregnancy.

Based on data given by case-control and cohort studies the relationships between current and past IUD use, duration of IUD use and the type of IUD were evaluated to determine the risk of ectopic pregnancy among IUD users. The results of this review indicate that current and past IUD users do not have an increased risk of ectopic pregnancy. No relationship was found between the duration of IUD use, for either current or past IUD users, and the risk of ectopic pregnancy. Pooled data from clinical studies of different types of IUD showed that the lowest risk of ectopic pregnancy was for users of copper-bearing IUDs, and the highest risk was for users of progesterone-releasing IUDs. Further research is needed to evaluate the ectopic pregnancy risks to past IUD users, especially in view of recent studies which have shown that these women may be at a higher risk of infertility.

Female↗
PubMed1989

Serum IgG and IgA antibodies to Chlamydia in ectopic pregnancies.

The possible association of Chlamydia trachomatis with ectopic pregnancies was evaluated in a case-control study, comprising 35 women with ectopic pregnancy and 294 apparently healthy women who served as controls. Chlamydia-specific IgG and IgA antibodies were determined by single serovar (L2) inclusion immunoperoxidase assay (IPA). Socio-demographic characteristics, gynecological history and contraceptive methods were also evaluated. An inverse relationship was found between the educational levels and the prevalence of IgG and IgA antibodies to chlamydia. The prevalence rate of elevated IPA IgG (titer greater than or equal to 128) and IPA IgA (titer greater than or equal to 16) specific to chlamydia was significantly higher in women with ectopic pregnancy versus controls (32% vs 8%, respectively, for IgG: odds ratio = 4.9; and 26% vs 4% for IgA: odds ratio = 7.5). Chlamydia trachomatis was not isolated in cell cultures in 10 specimens available from fallopian tubes of women with ectopic pregnancy. Only 9% of the women recall having pelvic inflammatory disease (PID) indicating that most of the infections were asymptomatic. Women who did not use IUD had a higher proportion of chlamydia-specific IgG and IgA seropositives, though not statistically significant, as compared to IUD users. This study further supports the hypothesis that subclinical infection of the tube with C. trachomatis may underlie ectopic pregnancies.

Adolescent↗
PubMed1982

The rise in ectopic pregnancy--exploration of possible reasons.

The rate of ectopic pregnancies has been rising in the past decade and it is responsible for an increasing proportion of maternal deaths. A history of pelvic inflammatory disease is strongly associated with ectopic pregnancy. There is a higher rate of ectopic pregnancy among intrauterine device users than non-users. A history of abdominal surgery has been associated with ectopic pregnancy and there is some evidence that women taking certain hormonal preparations experience excess ectopic pregnancies. Through a critical review of the literature, the author explores the evidence for these associations. The paper closes with recommendations for future research.

Abdomen↗
PubMed1989

A ten year survey of 193 ectopic pregnancies.

During the period 1977-86, 193 women underwent surgery for ectopic pregnancy in the Medway Health District. 1 ectopic pregnancy was found for every 233 deliveries, an incidence of 0.43%, with a rising trend. The most common presenting symptom was abdominal pain (96%) and the most frequent physical finding was abdominal tenderness (91%). Past histories of appendicectomy (24%), infertility (19%), use of IUD (15%), and pelvic infection (13%) were elicited. In 95% of the cases, the pregnancy was tubal. 56% of the patients required blood transfusions and there were no maternal deaths. These findings confirm the rising incidence of ectopic pregnancy. During the study period, the diagnosis and management of ectopic pregnancy have changed significantly. The early use of plasma hCG, ultrasonography, and laparoscopy decreases the morbidity and mortality associated with ectopic pregnancy, allowing conservative tubal surgery when indicated.

Biology↗
PubMed1958

Ectopic pregnancy; early diagnosis, clinical errors and conservative operation.

This report of eight years' experience with extrauterine pregnancy by a single gynecologist is an exposition of how the diagnosis was made or why it was missed. Of 26 diagnoses of ectopic pregnancy, five were false (20 per cent); and in three cases (10 per cent) the diagnosis was not made promptly-a total error of 30 per cent. Ectopic pregnancy will be discovered earlier if obstetric patients are always examined shortly after missing the first menstrual period.A palpable adnexal mass was present in 19 of 21 ectopic pregnancies (90 per cent). A mass was palpable in only one of five cases erroneously diagnosed as ectopic pregnancy (20 per cent).Decidual casts were passed by four patients, two of whom did not have ectopic pregnancy. If two gynecologists do not agree on the question of extrauterine pregnancy, a third opinion should be sought or culdoscopy employed. Enucleation of the conceptus and salvage of the oviduct is advocated.

Culdoscopy↗
PubMed2002

Transvaginal sonographic diagnosis of live monochorionic twin ectopic pregnancy.

Ectopic pregnancy is a leading cause of pregnancy-related deaths; its incidence has progressively increased in recent years. Spontaneous twin ectopic pregnancy, however, is extremely rare. Among more than 100 reported cases of twin tubal pregnancies, only 5 cases in which fetal cardiac motion has been visualized in both embryos have been reported. We describe an additional case of a live monochorionic twin ectopic pregnancy in a patient with no predisposing factor. With transabdominal sonography, we initially diagnosed a single ectopic pregnancy, visualized as an ill-defined mass in the left adnexa. However, with transvaginal sonography, we determined the left adnexal mass to contain a single monochorionic gestational sac with 2 embryos, each with cardiac motion. These findings were confirmed with color Doppler sonography and at laparotomy. The introduction of high-resolution transvaginal sonography has resulted in the earlier diagnosis of ectopic pregnancy and has contributed to a recent decrease in the maternal mortality and morbidity associated with this condition.

Adult↗
PubMed2005

Diagnosis of early intramural ectopic pregnancy.

Intramural ectopic pregnancy is a very rare diagnosis. Establishing a diagnosis is difficult and is often made intraoperatively. Demonstration of a live extrauterine gestation is the only specific sign of such a pregnancy. A small number of ectopic pregnancies are interstitial or cornual pregnancies. Rupture of an intramural ectopic pregnancy is a serious clinical complication. Diagnosis of this ectopic pregnancy can sometimes be made using 2-dimensional transvaginal ultrasound (TVS), but it may also require 3-dimensional TVS. We present the case of a 25-year-old gravida 0, para 0 woman with amenorrhea lasting 6(+5) weeks. Previous surgery included a right adnexectomy for torsion of a right dermoid cyst. The patient's serum hCG was elevated. TVS provided a detailed view of the endometrial cavity. The results of 2-dimensional TVS suggested the presence of an ectopic pregnancy. The sonogram showed a gestational sac with an embryonic pole and a yolk sac, which was separated from the endometrium. Use of 3-dimensional TVS demonstrated a live embryo in a gestational sac surrounded by myometrium below the right cornu lying outside the endometrium. This finding was confirmed by laparotomy and the conceptus was excised. The patient had an uneventful postoperative course and was discharged 7 days after surgery. In our case, the previous adnexectomy was an identifiable risk factor. Nonetheless, making a diagnosis of an intramural pregnancy was challenging. Suspicion may arise when sonography has revealed an intramural gestational sac.

Adult↗
PubMed2006

The conservative management of cervical ectopic pregnancies.

OBJECTIVE: To evaluate the role of conservative management in the treatment of cervical ectopic pregnancies. METHODS: This was a retrospective analysis of all cervical ectopic pregnancies diagnosed in women attending our early pregnancy unit between April 1997 and September 2004 inclusive. The diagnosis of cervical ectopic pregnancy was made using transvaginal ultrasound. Clinical and demographic data were recorded in all cases. Serum human chorionic gonadotropin levels were measured at presentation and monitored subsequently to determine the rate of successful resolution. Conservative management was in the form of medical or expectant management. Medical management involved administration of systemic or intra-amniotic methotrexate, with or without intra-amniotic potassium chloride. Systemic methotrexate was either a single dose of 50 mg/m2 or an alternate-day regimen of methotrexate at 1 mg/kg (days 1,3,5) with folinic acid rescue (days 2,4,6). If intra-amniotic treatment was required, this was either 50 mg methotrexate or 5 mmol/L potassium chloride. RESULTS: Seven cervical ectopic pregnancies were diagnosed during the study period. Three cases were managed successfully with a single dose of methotrexate. One case was managed successfully using a multiple-dose methotrexate regimen. Another case failed medical management with both the single- and multiple-dose regimens but was successfully treated after potassium chloride was given intra-amniotically under ultrasound guidance. One case was successfully treated with intra-amniotic methotrexate and another was managed expectantly. There was no associated morbidity or mortality during the study period. We also performed a review of the current literature. CONCLUSION: The conservative management of cervical ectopic pregnancy is effective and safe.

Abortifacient Agents, Nonsteroidal↗
PubMed1986

The intrauterine device and ectopic pregnancy.

Based on data given by case-control and cohort studies the relationships between current and past IUD use, duration of IUD use and the type of IUD were evaluated to determine the risk of ectopic pregnancy among IUD users. The results of this review indicate that current and past IUD users do not have an increased risk of ectopic pregnancy. No relationship was found between the duration of IUD use, for either current or past IUD users, and the risk of ectopic pregnancy. Pooled data from clinical studies of different types of IUD showed that the lowest risk of ectopic pregnancy was for users of copper-bearing IUDs, and the highest risk was for users of progesterone-releasing IUDs. Further research is needed to evaluate the ectopic pregnancy risks to past IUD users, especially in view of recent studies which have shown that these women may be at a higher risk of infertility.

Female↗
PubMed2003

Acromegaly due to ectopic secretion of GHRH by bronchial carcinoid in a patient with empty sella.

GH hyperproduction due to ectopic secretion of GHRH is a rare cause of acromegaly. Since 1959, approximately 50 cases of ectopic GHRH production from extrapituitary tumors have been described. Here we report the clinical and biochemical features of a 47-yr-old Caucasian woman with ectopic GHRH syndrome sustained by a bronchial carcinoid. The criteria for the diagnosis of acromegaly due to ectopic GHRH secretion were satisfied in our patient (i.e. confirmation of active GH hypersecretion, unequivocal demonstration of GHRH production and secretion from an extrapituitary tumor and cure of acromegaly after neoplasm removal). The tumor was an atypical carcinoid and there was a familial history of lung and colorectal cancer. Acromegaly was slightly active (mean GH value: 7.4 ng/ml, IGF-I: 436 ng/ml) and after tumor removal there was a progressive decline of GH levels, consistent with remission of pituitary somatotroph hyperplasia. Pituitary radiology showed an empty sella demonstrating for the first time its association with ectopic GHRH syndrome.

Acromegaly↗
PubMed1998

Nine year survey of 138 ectopic pregnancies.

During the nine years (1986-1994), 138 women underwent surgery for ectopic pregnancies (One for every 213 deliveries). The commonest presenting symptom was abdominal pain (96%) followed by vaginal bleeding (83%). Four patients were asymptomatic and were diagnosed at a routine antenatal ultrasound scan. The most frequent physical findings were abdominal tenderness (87%) and followed by adnexal tenderness (57%). Histories of infertility in 17%, use of intrauterine contraceptive device (13%), and previous ectopic pregnancy in 11% were elicited. Eleven patients (8%) had a false negative urinary pregnancy test and subsequently required surgery. The ectopic pregnancies were tubal in 97% of the cases. There were 3 ovarian ectopics and one cervical ectopic.

Abdominal Pain↗
PubMed2000

Serial serum human chorionic gonadotropin (hCG) levels in ectopic pregnancy and first trimester miscarriage.

Serial serum hCG levels were measured in 50 patients with a tubal ectopic pregnancy and 50 patients with spontaneous miscarriage of an intrauterine pregnancy. Serum samples were obtained at intervals of 3-5 d and more frequently if clinically indicated. The final diagnosis was confirmed by laparoscopy and/or dilatation and curettage. Data were analyzed using a linear regression model. Initial hCG concentrations ranged from 91 to 3,050 mIU/mL. Eighty percent of ectopic pregnancies and 35% of miscarriages were associated with rising hCG concentrations and no significant differences were noted in daily increments of hCG in the two groups (210 +/- 30 mIU/mL/day for ectopic pregnancies versus 311 +/- 55 mIU/mL/d for miscarriages). Twenty percent of ectopic pregnancies and 65% of miscarriages had falling hCG concentrations and significant differences were noted in the daily decrements of hCG for EP and AB (270 +/- 52 mIU/mL/day for ectopic pregnancies versus 578 +/- 28 mIU/mL/d for miscarriages (P < or = 0.05).

Abortion, Spontaneous↗