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PubMed1995

Assessment of the laparoscopic treatment of ectopic pregnancy.

AIMS: To assess the first 2 years experience of the laparoscopic surgical treatment of ectopic pregnancy in a regional referral centre. METHODS: All cases of ectopic pregnancy in a 2 year period from August 1991 were evaluated to assess the impact on the routine management of this condition. RESULTS: In the first year 14 cases were managed by laparoscopic means and took an average operating time of mean 73.8 (SD 17.2) minutes compared to mean 69.1 (17.9) minutes in the 26 cases managed this way in the second year. The 40 patients were hospitalised for an average of 1.4 days and 24 stayed one night only. There was no difference in operating time between registrars and consultants. The only major complication was a patient who required an emergency laparotomy because of continued bleeding. When all cases of ectopic surgery were evaluated in the second year, six of the 32 cases required laparotomy to complete the operation. CONCLUSION: The benefits of laparoscopic surgical treatment of ectopic pregnancy dictate that this should be employed as first line treatment for all cases of tubal ectopic gestation. Our experience suggests that achieving such a service, whilst not without pitfalls, should be possible in all gynaecology units provided that staff are motivated and that laparoscopic equipment is available.

Evaluation Studies as Topic↗
PubMed1995

Ectopic pregnancy--United States, 1990-1992.

Ectopic pregnancy is the leading cause of pregnancy-related death during the first trimester (1). Women who have one ectopic pregnancy are at increased risk for another such pregnancy and for future infertility (2). In the United States, the reported number of hospitalizations for ectopic pregnancy increased from 17,800 in 1970 to 88,400 in 1989 (1). This report summarizes trends in hospitalizations for ectopic pregnancy in the United States during 1990-1992 and presents the incidence of ectopic pregnancy in 1992, based on aggregated inpatient and outpatient data.

Female↗
PubMed1994

[Clinical and ultrasonographic data in ectopic pregnancy].

In order to evaluate the clinical and sonographic findings in 60 patients with ectopic pregnancy confirmed at laparotomy, we carried out a prospective study at the Hospital de Gineco-Obstetricia del Centro Médico León, Instituto Mexicano del Seguro Social. The patients were 28.17 years old, average. The ectopic pregnancy was more common in multiparous women (80%) than in nuliparous ones. The obstetric risk factors more frequent were abortion (26.6%) and use of intrauterine device (23.3%). The clinical sign reported most common was pelvic pain, referred in 48 patients (80%). Hemodynamic changes were detected in 21.6% of the cases. The ultrasound findings were seen in most of the patients and heterogeneous adnexal mass was observed in 91.6% of them, moreover intraperitoneal fluid was reported in 61.6% of the patients with ectopic pregnancy. The heterogeneous adnexal mass had a direct relationship with the diagnosis of ectopic pregnancy and had a correlation coefficient value R = 0.99 (P < 0.01). The ultrasonographic findings seen with transvaginal technique were similar than those obtained through transabdominal procedure. We conclude that ultrasonography has a definite role in improving the diagnosis of ectopic pregnancy.

Abortion, Induced↗
PubMed1993

Ectopic pregnancy in the United States: economic consequences and payment source trends.

OBJECTIVE: To estimate the annual direct and indirect costs of ectopic pregnancy in the United States and to examine trends in payment source. METHODS: We analyzed hospital discharge data for 1982-1989 from a San Francisco hospital and California statewide data for 1983-1987 to estimate direct medical care costs and to determine payment sources. Examination of national labor data was used to compute indirect cost. RESULTS: The total cost of ectopic pregnancy in 1990 was estimated to be nearly $1.1 billion. Direct costs of hospitalization and other medical treatment contributed 77% of the total costs, with average hospital costs estimated to be $6079, hospitalization-related physician fees $3254, and average outpatient costs $149, for a total direct cost-per-case of $9482. Of the total indirect costs ($250.5 million), 67% was attributed to the value of lost wages and the remainder to the lost value of household management. Public payment sources covered the largest portion of ectopic pregnancy-related direct costs among women aged 19 and younger (35%), but private insurance covered the largest portion among women aged 20-29 (32%) and women aged 30 and older (43%). In general, the proportion of payments made by private insurance has decreased, while the proportion of payments made by public pay sources and health maintenance organizations and preferred provider organizations has increased. CONCLUSIONS: Ectopic pregnancy results in a substantial economic burden, with an increasing share of direct costs being borne by public pay sources. Appropriate use of cost-effective management approaches can reduce costs, while preventive measures that decrease the risk of ectopic pregnancy can both save resources and, more important, spare human suffering.

Adolescent↗
PubMed1995

[Ectopic pregnancy. The "epidemic" seems to be over].

Since decades the incidence of ectopic pregnancy has risen in most western countries including four to five folded increased rates, suggesting an "epidemic". Increasing incidences of ectopic pregnancy was reported in Sweden until 1988 and 1989 when a peak of 17.3 cases of ectopic pregnancy/10,000 women in fertile age was registered. Between 1990 and 1991 the incidence decreased from 16.8 to 14.9 cases of ectopic pregnancy/10,000 women. The mortality in Sweden 1985-1991 was 0.15/1000 (3 deaths in 20,486 cases of ectopic pregnancy), the lowest case-fatality rate ever reported.

Female↗
PubMed1996

Risk factors for ectopic pregnancy in a rural population.

BACKGROUND AND OBJECTIVES: The study determined the frequency of common risk factors in patients with ectopic pregnancy in a rural-based population (communities with a population less than 60,000). METHODS: The complete medical records were reviewed of all patients with ectopic pregnancy who presented from 1986 through 1992 to the emergency department of a large, rural referral hospital with 65,000 annual visits. RESULTS: Among 126 patients with ectopic pregnancy, the predominant risk factors were a history of infertility in 35% and prior tubal operation in 38%. Pelvic inflammatory disease was a risk factor in 17%, a prior ectopic pregnancy in 16%, and a prior appendectomy or pelvic operation in 13%. No risk factor was identified in 47% of the patients. CONCLUSION: In rural populations, the frequency of common risk factors for ectopic pregnancy is different from that cited in studies of urban populations. Frequently, patients in rural populations have no risk factors whatsoever.

Adult↗
PubMed1977

A rapid modification of the beta-hCG radioimmunoassay. Use as an aid in the diagnosis of ectopic pregnancy.

Over half the patients with proven ectopic pregnancies have negative urinary slide or tube pregnancy tests at the time they present with symptoms. Because of the morbidity and mortality associated with unrecognized ectopic pregnancy, the need for an accurate, rapid, sensitive, and specific method for measuring low levels of human chorionic gonadotropin (hCG) is apparent. A three-hour radioimmunoassay (RIA) for serum hCG with a sensitivity of 5 mlU/ml was developed which utilizes an antiserum generated against the beta subunit of hCG, 125I-hCG for tracer purposes, a highly purified hCG standard, and dioxane for separation of bound from free hormone. Blood samples were obtained from 52 patients with suspected ectopic pregnancies. Twenty-four of these patients had a surgically proven ectopic gestation. The blood samples were analyzed in the above described RIA, and in the standard (24-hour) double antibody beta-hCG RIA. There were no false positive or false negative results by either assay. These results indicate that the dioxane modification of the beta-hCG RIA is an accurate and rapid method for confirming the diagnosis of ectopic pregnancy.

Antibodies↗
PubMed1996

[Intrauterine pregnancy complicated by coexisting ectopic pregnancy].

Authors have presented the case of coexisting 11 week intrauterine and ectopic pregnancies in the 25 years old woman, which had earlier been operated on the left ovary dermoid cyst. That operation could be regarded as an ectopic pregnancy risk factor, but the suspicion of an ectopic pregnancy has been suggested only by physical examination, and sonography and laparoscopy were most important in final diagnosis. Ectopic pregnancy has been removed by laparotomy according to the progression of the disease. The case has drawn the attention to the necessity of thorough diagnosis in pregnant women particularly in those ones with lower abdominal pain in early pregnancy and with unfavorable gynaecological and obstetric past, for example appendages operation such as in our case. It was also been emphasized, that the complex diagnosing of patients with already recognized ectopic pregnancy should be proceeded. Sonography, especially the one equipped with the endovaginal probe, plays the most important part in diagnosing. In some questionable cases laparoscopy, along with diagnostical significance, also makes the surgical treatment possible.

Abdominal Pain↗
PubMed1997

A five-year review of ectopic pregnancy.

During the five years from 1990-1994, 98 women underwent surgery for ectopic pregnancy. For every 167 deliveries, one patient underwent surgery for ectopic pregnancy. The incidence is 0.59 per cent with a rising trend. The commonest presenting symptom was abdominal pain (97%) followed by vaginal bleeding (79%). Four patients were asymptomatic and were diagnosed at routine antenatal ultrasound scan. The most frequent physical findings were abdominal tenderness (91%), followed by adnexal tenderness (54%). Histories of infertility (15%), use of intrauterine contraceptive devices (14%), and previous ectopic pregnancy (11%) were elicited. Five patients had a false negative urinary pregnancy test and subsequently required surgery. The ectopic pregnancies were tubal in 98 per cent of the cases. The diagnosis and management of ectopic pregnancy has changed significantly over the last decade. The increasing use of quantitative BHCG assay and vaginal ultrasonography have made early diagnosis possible, allowing conservative tubal surgery when indicated.

Female↗
PubMed2000

Interventions for tubal ectopic pregnancy.

BACKGROUND: The diagnosis of ectopic pregnancy can now often be made by non-invasive methods due to sensitive pregnancy tests (in urine and serum) and high resolution transvaginal sonography, which have been integrated in diagnostic algorithms. These algorithms, in combination with the increased awareness and knowledge of risk factors among both clinicians and patients, have enabled an early and accurate diagnosis of ectopic pregnancy. As a consequence, the clinical presentation of ectopic pregnancy has changed from a life threatening disease to a more benign condition. This in turn has resulted in major changes in the options available for therapeutic management. Many treatment options are now available to the clinician in the treatment of tubal pregnancy: surgical treatment, which can be performed radically or conservatively, either laparoscopically or by an open surgical procedure; medical treatment, with a variety of drugs, that can be administered systemically and/or locally by different routes (transvaginally under sonographic guidance or under laparoscopic guidance); expectant management. The choice of a treatment modality should be based on short-term outcome measures (primary treatment success and reinterventions for clinical symptoms or persistent trophoblast) and on long-term outcome measures (tubal patency and future fertility). OBJECTIVES: In the treatment of tubal pregnancy various types of treatments are available: surgical treatment, medical treatment and expectant management. In this review the effects of various treatments are summarized in terms of treatment success, need for reinterventions, tubal patency and future fertility. SEARCH STRATEGY: The Cochrane Menstrual Disorders and Subfertility Group trials register and MEDLINE were searched. SELECTION CRITERIA: Randomized controlled trials comparing treatments in women with ectopic pregnancy. DATA COLLECTION AND ANALYSIS: Trial quality was assessed and data extracted independently by two reviewers. Differences were resolved by discussion with all reviewers. MAIN RESULTS: Laparoscopic conservative surgery is significantly less successful than the open surgical approach in the elimination of tubal pregnancy due to a higher persistent trophoblast rate of laparoscopic surgery. Long term follow-up shows similar tubal patency rates, whereas the number of subsequent intrauterine pregnancies is comparable, and the number of repeat ectopic pregnancies lower, although these differences are not statistically significant. The laparoscopic approach is less costly as a result of significantly less blood loss and analgesic requirement, and a shorter duration of operation time, hospital stay, and convalescence time. Compared to laparoscopic conservative surgery (salpingostomy) local methotrexate is not a treatment option. Injection of this drug, both under laparoscopic guidance and under ultrasound guidance, is significantly less successful in the elimination of tubal pregnancy. Systemic methotrexate in a single dose intramuscular regimen is not effective enough in eliminating the tubal pregnancy compared to laparoscopic salpingostomy. This as a result of inadequately declining serum hCG concentrations after one single dose of methotrexate necessitating additional methotrexate injections or surgical interventions. If methotrexate primarily given in a multiple dose intramuscular regimen is compared with laparoscopic salpingostomy no large differences are found in medical outcomes, both short term and long term. However, this treatment regimen is associated with a greater impairment of health related quality of life and is more expensive, due to surgical interventions for clinical signs of tubal rupture, generating additional direct costs due to prolonged hospital stay. Furthermore, indirect costs due to productivity loss are higher. Only in patients with low initial serum hCG concentrations systemic methotrexate leads to costs savings compared to laparoscopic salpingostomy.

Female↗
PubMed2003

Ring 21 chromosome and a satellited 1p in the same patient: novel origin for an ectopic NOR.

Nucleolus organizer regions (NORs) are present on the satellite stalks located on the short arms of the acrocentric chromosomes. NORs present on non-acrocentric chromosomes (ectopic NORs) are rare and were reported in both phenotypically normal and abnormal individuals. We describe a patient, ascertained prenatally, with an ectopic NOR on 1p and a ring 21 chromosomes. Amniocentesis was performed at 27-weeks gestation on a 19-year-old woman after identification of intrauterine growth retardation (IUGR) by ultrasound. Cytogenetic analysis of amniocytes from the fetus showed a mos 46,XX,1ps,r(21) (p11.2q22.3)[44]/45,XX,1ps,-21[6] karyotype. Parental karyotypes were normal, indicating a de novo origin for these rearrangements in the fetus. Molecular cytogenetic characterization of the 1ps showed no loss of euchromatin and retention of the telomeric repeats. Characterization of the r(21) using array comparative genomic hybridization (CGH) identified that the deletion was approximately 5 Mb encompassing most of chromosome band 21q22.3. The ectopic NOR (1ps) was most likely derived from the acentric 21p fragment generated by the chromosome breakage event that lead to formation of the r(21) chromosome. This represents a novel mechanism for the origin of ectopic NORs. In addition, this study illustrates the importance of FISH analysis with telomeric and subtelomeric probes for characterization of chromosomes with ectopic NORs.

Chromosomes, Human, Pair 1↗
PubMed2002

Efficient ectopic gene expression targeting chick mesoderm.

The chick model has been instrumental in illuminating genes that regulate early vertebrate development and pattern formation. Targeted ectopic gene expression is critical to dissect further the complicated gene interactions that are involved. In an effort to develop a consistent method to ectopically introduce and focally express genes in chick mesoderm, we evaluated and optimized several gene delivery methods, including implantation of 293 cells laden with viral vectors, direct adenoviral injection, and electroporation (EP). We targeted the mesoderm of chick wing buds between stages 19 and 21 (Hamburger and Hamilton stages) and used beta-galactosidase and green fluorescent protein (GFP) to document gene transfer. Expression constructs using the cytomegalovirus (CMV) promoter, the beta-actin promoter, and vectors with an internal ribosomal entry sequence linked to GFP (IRES-GFP) were also compared. After gene transfer, we monitored expression for up to 3 days. The functionality of ectopic expression was demonstrated with constructs containing the coding sequences for Shh, a secreted signaling protein, or Hoxb-8, a transcription factor, both of which can induce digit duplication when ectopically expressed in anterior limb mesoderm. We identified several factors that enhance mesodermal gene transfer. First, the use of a vector with the beta-actin promoter coupled to the 69% fragment of the bovine papilloma virus yielded superior mesodermal expression both by markers and functional results when compared with several CMV-driven vectors. Second, we found the use of mineral oil to be an important adjuvant for EP and direct viral injection to localize and contain vector within the mesoderm at the injection site. Lastly, although ectopic expression could be achieved with all three methods, we favored EP confined to the mesoderm with insulated microelectrodes (confined microelectroporation- CMEP), because vector construction is rapid, the method is efficient, and results were consistent and reproducible.

Actins↗
PubMedDate not supplied

Scintigraphic localization of ectopic parathyroid lesions with thallium-201.

Six consecutive patients with ectopic parathyroid lesions were studied by preoperative thallium-technetium scintigraphy. Ectopic lesions were accurately localized in 5 of 6 patients. Four of five lesions deep in the superior mediastinum, and 1 in the superior carotid sheath, were correctly identified. Ectopic lesions in 4 of 5 patients, who had previously undergone unsuccessful exploration, were correctly localized. In 1 previously unoperated patient, a mediastinal lesion was identified by preoperative scintigraphy. In 2 patients, deep mediastinal exploration via manubriotomy was successfully conducted without confirmation by "invasive" intravascular procedures. There were no false-positive studies. Lesions identified weighed from 185 mg to 9 g and were from 1.1 to 3.0 cm in size. Scintigraphy is particularly effective for demonstration of ectopic parathyroid tissue, because the absence of thyroid tissue in the mediastinum or superior cervical region permits appreciation of areas of abnormal thallium uptake unobscured by uptake in adjacent thyroid tissue. We conclude that ectopic parathyroid tissue may be accurately identified by thallium-technetium scintigraphy without confirmation by invasive intravascular studies.

Adult↗
PubMedDate not supplied

Ectopic soft tissue calcium deposition following liver transplantation.

We observed ectopic soft tissue calcification affecting seven patients following orthotopic liver transplantation. The cause of such calcification is unknown, but potential pathogenetic factors include hyperparathyroidism, calcium administered during and following surgery, renal failure, acid-base changes and citrate in fresh frozen plasma. To investigate some of the mechanisms underlying ectopic calcification following liver transplantation, we determined preoperative levels of ionized serum calcium, phosphate, magnesium, parathyroid hormone (midmolecule assay) and 1,25-(OH)2 vitamin D in 20 patients who underwent 24 liver transplants. In addition, these parameters were measured weekly in 15 patients during the first month after liver transplantation. Preoperatively, 5 of the 20 patients had elevated serum levels of parathyroid hormone, and 9 others had low levels of 1,25-(OH)2 vitamin D. After liver transplantation, ectopic calcification was found in seven patients (47%). The organs affected in order of frequency were lungs, liver graft, colon, vascular walls, kidneys, adrenal glands and gastric mucosa. One patient with ectopic calcification of both lungs had markedly restricted pulmonary function as well as radiologic evidence of osteopenia and pathologic fractures of three vertebrae. Postoperatively, increased parathyroid hormone levels were found in all patients who developed soft tissue calcification. Parathyroid hormone levels peaked during the second week after transplantation and were higher at all times compared to subjects without calcification. Five of the seven patients with ectopic calcification had associated renal failure. Individuals who developed calcification had received significantly more fresh frozen plasma, red blood cells and elemental calcium postoperatively, but showed no difference in serum levels of calcium, magnesium, vitamin D, total plasma CO2 or phosphate levels when compared to patients without calcification.(ABSTRACT TRUNCATED AT 250 WORDS)

Biopsy↗
PubMed1993

Infidelity in the structure of ectopic transcripts: a novel exon in lymphocyte dystrophin transcripts.

Ectopic (or "illegitimate") transcripts have recently become popular as a means of facilitating the study of transcripts normally considered to have a pattern of expression restricted to one or a few tissues. It has been generally assumed that the structure of an ectopic transcript faithfully represents that of its tissue-specific counterpart. We describe here the inclusion of a novel exon in 50% of ectopic dystrophin transcripts from human peripheral blood lymphocytes. The novel sequence resembles a conserved region in the 3' untranslated region of members of the carcinoembryonic antigen gene family and lies within the first intron of the human dystrophin gene. This constitutes a significant departure from the expected in vivo splicing behaviour in an ectopic transcript and suggests that there may be exceptions to the assumption that ectopic transcripts are processed in a similar way to their tissue-specific counterparts.

Amino Acid Sequence↗
PubMed1985

Differentiation of mouse ectopic germinal cells in intra- and perigonadal locations.

Four hundred and thirteen ectopic germinal cells in the testicular and extratesticular stroma and in the rete testis of mouse fetuses from day 13 of uterine development to term were studied together with 161 ectopic germinal cells in the rete ovarii and periovarian stroma of female fetuses at days 17 and 18 of intrauterine life. The morphology and the differentiation of these ectopic germinal cells were compared to those of germinal cells within seminiferous and ovigerous cords. While the ectopic germinal cells in the testis and in the rete testis followed patterns of differentiation identical with those in the seminiferous cords throughout the period included in the study, those in the extratesticular stroma behaved like entopic germinal cells only through day 17, since at days 18 and 19 many of them entered meiotic prophase just like XX germinal cells in the ovigerous cords. No differences were noted between ectopic and entopic ovarian germinal cells. The results of this study show that the factors responsible for the male differentiation of XY germinal cells are not limited to the seminiferous cords but operate throughout the testicular territory, and confirm that outside the testis, XY germinal cells differentiate as female; our study also corroborates the thesis that the differentiation of XX germinal cells is an autonomous and ubiquitous process.

Animals↗
PubMed2006

Serum biochemistry correlates with the size of tubal ectopic pregnancy on sonography.

OBJECTIVE: To investigate whether there is a correlation between serum biochemistry (human chorionic gonadotropin (hCG), CA 125, progesterone and estradiol) and the common sonographic findings (blob sign, bagel sign or extrauterine gestational sac with cardiac activity) or size of a tubal ectopic pregnancy, and whether there is a difference in serum biochemistry between women with a tubal ectopic pregnancy who are hemodynamically unstable (tachycardia, hypotension, falling hemoglobin levels and/or acute severe abdominal pain) and those who are hemodynamically stable. METHODS: This was a prospective cohort study of 106 women with a tubal ectopic pregnancy. We noted transvaginal ultrasound examination findings including adnexal mass size, and the serum levels of hCG, CA 125, progesterone and estradiol. The data were analyzed retrospectively. RESULTS: The mean maternal and gestational ages were 30.7+/-5.7 years and 44+/-4.2 days, respectively. There was no correlation between serum markers and common sonographic findings. However, in the presence of the bagel sign on ultrasound, hemodynamic stability was more common (P=0.03). The mean serum hCG concentrations in tubal ectopic pregnancies<20 mm, 20-40 mm and >40 mm in size were 2225.3+/-3166.9, 4124.8+/-6121.4, and 11 011.8+/-12 670.1 IU/mL, respectively (P<0.001). Serum hCG, CA 125 and estradiol values were well correlated with adnexal mass size; for CA 125 this correlation was linear. There was no difference in serum biochemistry between hemodynamically stable and hemodynamically unstable women. CONCLUSION: Common sonographic findings of tubal ectopic pregnancy do not correlate with serum biochemistry. High levels of CA 125, hCG or estradiol may suggest a larger adnexal mass in women with uncomplicated tubal pregnancies. Hemodynamically stable and hemodynamically unstable women do not differ in their serum biochemistry.

Adolescent↗
PubMed1995

Characterization of two populations of ectopic cells isolated from the hearts of NGF transgenic mice.

We have observed sympathetic hyperinnervation and hyperplasia of an unknown cell population within the base of the hearts from transgenic mice in which nerve growth factor (NGF) expression was targeted to cardiac tissue (Hassankhani et al., 1993, 1995). To characterize this ectopic cell population, cells from the base of hearts of 3- to 4-week-old transgenic mice were dissociated and established in tissue culture, and their properties were analyzed using morphological, immunocytochemical, and physiological techniques. Morphological studies of the ectopic cells revealed the temporal expression of two different cellular phenotypes: (i) a spindle-shaped cell type, present by 1 to 2 days in vitro (DIV) and (ii) cells with a fiber-like morphology, detected by 7 DIV. In contrast to transgenic cardiac myocytes that express immunoreactivity to antibodies against sarcomeric myosin, beat spontaneously (approximately 60/min), and are electrically excitable, the ectopic cell types did not stain with an antibody against sarcomeric myosin, never showed contractile activity, and did not manifest membrane excitability. Moreover, these two types of ectopic cells demonstrated other distinctive characteristics. The spindle-shaped subpopulation typically formed small clusters of cells that were immunostained by antibodies to GFAP, vimentin, and low-affinity NGF receptor (LNGFR) and demonstrated a low incidence of dye coupling (30%), whereas the fiber-like cells aligned themselves along their long axes, immunostained for gp140trkA, LNGFR, and anti alpha-smooth muscle actin and showed extensive (100%) and diffuse dye spread to numerous other contiguous fiber-like cells. Dye spread was not observed between the adjacent fiber-like and the spindle-shaped cells and was reversibly blocked between homologous cells after treatment with halothane, a gap junction channel blocking agent. In comparison to cardiac myocytes, macroscopic junctional conductance of the spindle-shaped cells was more voltage-sensitive. At the single channel level, unitary junctional conductances of approximately 60 pS were predominant. Overall, these results indicate that these ectopic cells are likely derived from neural crest. The spindle-shaped cells appear to be immature Schwann cells, whereas the fiber-like cells may be related to the ectomesenchymal cells contributing to the morphogenesis of the cardiac outflow tract.

Animals↗