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Ectopic expression of Msx-2 in posterior limb bud mesoderm impairs limb morphogenesis while inducing BMP-4 expression, inhibiting cell proliferation, and promoting apoptosis.

During early stages of chick limb development, the homeobox-containing gene Msx-2 is expressed in the mesoderm at the anterior margin of the limb bud and in a discrete group of mesodermal cells at the midproximal posterior margin. These domains of Msx-2 expression roughly demarcate the anterior and posterior boundaries of the progress zone, the highly proliferating posterior mesodermal cells underneath the apical ectodermal ridge (AER) that give rise to the skeletal elements of the limb and associated structures. Later in development as the AER loses its activity, Msx-2 expression expands into the distal mesoderm and subsequently into the interdigital mesenchyme which demarcates the developing digits. The domains of Msx-2 expression exhibit considerably less proliferation than the cells of the progress zone and also encompass several regions of programmed cell death including the anterior and posterior necrotic zones and interdigital mesenchyme. We have thus suggested that Msx-2 may be in a regulatory network that delimits the progress zone by suppressing the morphogenesis of the regions of the limb mesoderm in which it is highly expressed. In the present study we show that ectopic expression of Msx-2 via a retroviral expression vector in the posterior mesoderm of the progress zone from the time of initial formation of the limb bud severely impairs limb morphogenesis. Msx-2-infected limbs are typically very narrow along the anteroposterior axis, are occasionally truncated, and exhibit alterations in the pattern of formation of skeletal elements, indicating that as a consequence of ectopic Msx-2 expression the morphogenesis of large portions of the posterior mesoderm has been suppressed. We further show that Msx-2 impairs limb morphogenesis by reducing cell proliferation and promoting apoptosis in the regions of the posterior mesoderm in which it is ectopically expressed. The domains of ectopic Msx-2 expression in the posterior mesoderm also exhibit ectopic expression of BMP-4, a secreted signaling molecule that is coexpressed with Msx-2 during normal limb development in the anterior limb mesoderm, the posterior necrotic zone, and interdigital mesenchyme. This indicates that Msx-2 regulates BMP-4 expression and that the suppressive effects of Msx-2 on limb morphogenesis might be mediated in part by BMP-4. These studies indicate that during normal limb development Msx-2 is a key component of a regulatory network that delimits the boundaries of the progress zone by suppressing the morphogenesis of the regions of the limb mesoderm in which it is highly expressed, thus restricting the outgrowth and formation of skeletal elements and associated structures to the progress zone. We also report that rather large numbers of apoptotic cells as well as proliferating cells are present throughout the AER during all stages of normal limb development we have examined, indicating that many of the cells of the AER are continuously undergoing programmed cell death at the same time that new AER cells are being generated by cell proliferation. Thus, a balance between cell proliferation and programmed cell death may play a very important role in maintaining the activity of the AER.

Animals↗

Ectopic osteogenesis using adenoviral bone morphogenetic protein (BMP)-4 and BMP-6 gene transfer.

Bone morphogenetic proteins (BMPs) delivered on scaffolds can induce ectopic bone formation after subcutaneous injection. Adenoviral vectors (Ad) carrying BMP2, BMP7, and BMP9 cDNAs have been shown to produce bone through endochondral ossification. The present study was performed to elucidate the histological events leading to ectopic ossification for two novel first-generation adenoviral constructs encoding BMPs, AdBMP4 and AdBMP6. In vitro, the viral constructs produced and secreted the mature BMP4 and BMP6 proteins. In vivo, the calf muscles of athymic nude rats were injected with AdBMP4, AdBMP6, AdBMP2, or AdlacZ. Rats were sacrificed 3, 6, 9, 16, 21, 60, and 90 days postinjection. Whereas AdBMP4 produced ectopic bone through mechanisms similar to endochondral ossification, AdBMP6 seemed to induce bone by way of mechanisms similar to both intramembranous and endochondral ossification pathways. At the relatively low vector dose used in this study, AdBMP2 caused an initial recruitment of primitive mesenchymal cells, without further development to bone. From computed tomographic analysis, AdBMP6 produced the most rapid tissue calcification. The ultimate density of ectopic bone formed by AdBMP4 and AdBMP6 was comparable. The current study demonstrates that AdBMP4 and AdBMP6 are more potent than the prototypical osteogenic adenoviral vector AdBMP2 and seem to induce ectopic bone by different mechanisms.

Adenoviridae↗

Ectopic colonic mucosa in ulcerative colitis and in Crohn's disease of the colon.

Colectomy specimens from 62 patients (22 with ulcerative colitis, 20 with Crohn's disease of the colon, and 20 with invasive adenocarcinoma [without inflammatory bowel disease]) were reviewed for the presence of ectopic colonic mucosa. One or more foci of ectopic colonic mucosa were found in 16 of the 22 specimens (72 per cent) with ulcerative colitis and in 11 of the 20 specimens (55 per cent) with Crohn's disease of the colon. None of the 20 specimens having adenocarcinoma (without chronic inflammatory bowel disease) had ectopic colonic epithelium. The presence of ectopic colonic mucosa was found to be dependent on the age of the patients (more frequent among younger patients) and on the number of sections per specimen. One adenocarcinoma in a case of long-standing ulcerative colitis had apparently originated in ectopic colonic mucosa.

Adolescent↗

Prognostic value of exercise-induced ventricular ectopic activity for mortality after acute myocardial infarction.

To evaluate the importance of ventricular ectopic activity on the predischarge treadmill exercise test for predicting mortality in patients after acute myocardial infarction (AMI), 163 patients with uncomplicated AMI were studied using symptom limited low-level treadmill exercise testing and 24-hour ambulatory electrocardiographic monitoring before hospital discharge. All patients were followed for at least 2 years or until recurrent AMI, coronary artery bypass grafting or death. Seventeen patients (10%) died during the follow-up period, 15 patients (9%) had recurrent AMI and 45 patients (28%) underwent bypass surgery. Ventricular ectopic activity was the only single treadmill abnormality that predicted subsequent cardiac death; angina pectoris, electrocardiographic ST-segment depression and a hypotensive blood pressure response did not. The mortality rate in the 20 patients with exercise-induced ventricular ectopic activity was 25%, compared with 8% in those without (p less than 0.004). Furthermore, in this patient population, exercise-induced ventricular ectopic activity was a much better predictor of cardiac death than that detected by ambulatory monitoring. Thus, ventricular ectopic activity on the predischarge treadmill exercise test is an important risk factor for death after AMI.

Adult↗

Ectopic axonal firing in an epileptic cortical focus is not triggered by thalamocortical volleys during the interictal stage.

The triggering of ectopic action potentials (APs) at axon terminals in a chronic epileptic cobalt focus was investigated in thalamocortical (TC) neurons of rats under urethane anesthesia. TC cells which were in register with an active epileptic aggregate discharged bursts of 2-11 APs. According to the rules of the collision test, we ascertained that bursts contained APs of ectopic and/or somatic origin. During a transient blockage of TC orthodromic discharges produced by raising the extracellular concentration of Mg2+, ectopic bursts which were in close time relationship with the focal interictal electrocorticographic spikes persisted. These results demonstrate (i) the antidromic nature of identified ectopic APs and (ii) that, during the interictal stage, such axonal APs were not a consequence of TC discharges. The possible mechanisms for the triggering of ectopic axonal APs in the chronic cobalt focus are discussed.

Animals↗

Infected ectopic pregnancy presenting as unilateral tubo-ovarian abscess.

Ectopic pregnancy may be a dramatic occurrence, such as in the acutely ruptured extrauterine entity, or diagnosis may be delayed in the chronic ectopic gestation. Eight cases of infected ectopic pregnancy simulating tubo-ovarian abscess are reported; the diagnosis may be difficult and misleading. Symptoms and signs include abdominal pain and vaginal bleeding following a period of amenorrhea, usually accompanied by fever. All patients in our series presented with a picture of tubo-ovarian or pelvic abscess; however, the diagnosis of infected ectopic pregnancy was made preoperatively in all due to a positive beta-hCG test. Surgery in our cases included unilateral salpingo-oophorectomy in 7, and salpingectomy in one. Attention was drawn to the fact that, in the case of unilateral tubo-ovarian abscess, infected ectopic pregnancy should be suspected whenever preoperative beta-hCG is positive.

Abscess↗

Backpropagation of action potentials generated at ectopic axonal loci: hypothesis that axon terminals integrate local environmental signals.

This review deals with the fascinating complexity of presynaptic axon terminals that are characterized by a high degree of functional distinctiveness. In vertebrate and invertebrate neurons, all-or-none APs can take off not only from the axon hillock, but also from ectopic axonal loci including terminals. Invertebrate neurons display EAPs, for instance alternating with somatic APs, during survival functions. In vertebrate, EAPs have been recorded in the peripheral and central nervous systems in time relationship with physiological or pathological neuronal activities. In motor or sensory axon, EAP generation may be the cause of motor dysfunctioning or sensory perceptions and pain respectively. Locomotion is associated with rhythmic depolarizations of the presynaptic axonal membrane of primary afferents, which are ridden by robust EAP bursts. In central axons lying within an epileptic tissue EAP discharges, coinciding with paroxysmal ECoG waves, get longer as somatic discharges get shorter during seizure progression. Once invaded by an orthodromic burst, an ectopic axonal locus can display an EAP after discharge. Such loci can also fire during hyperpolarization or the postinhibitory excitatory period of the parent somata, but not during their tonic excitation. Neurons are thus endowed with electrophysiological intrinsic properties making possible the alternate discharges of somatic APs and EAPs. In invertebrate and vertebrate neurons, ectopic axonal loci fire while the parent somata stop firing, further suggesting that axon terminal networks are unique and individual functional entities. The functional importance of EAPs in the nervous systems is, however, not yet well understood. Ectopically generated axonal APs propagate backwards and forwards along the axon, thus acting as a retrograde and anterograde signal. In invertebrate neurons, somatically and ectopically generated APs cannot have the same effect on the postsynaptic membrane. As suggested by studies related to the dorsal root reflex, EAPs may not only be implied in the presynaptic modulation of transmitter release but also contribute significantly during their backpropagation to a powerful control (collision process) of incoming volleys. From experimental data related to epileptiform activities it is proposed that EAPs, once orthodromically conducted, might potentiate synapses, initiate, spread or maintain epileptic cellular processes. For instance, paroxysmal discharges of EAPs would exert, like a booster-driver, a powerful synchronizing synaptic drive upon a large number of excitatory and inhibitory postsynaptic neurons. We have proposed that, once backpropagated, EAPs are likewise capable of initiating (and anticipating) threshold and low-threshold somatodendritic depolarizations. Interestingly, an antidromic EAP can modulate the excitability of the parent soma.(ABSTRACT TRUNCATED AT 400 WORDS)

Action Potentials↗

Initiation and growth of ectopic neurites and meganeurites during postnatal cortical development in ganglioside storage disease.

The incidence of cortical pyramidal neurons displaying meganeurites or enlarged axon hillocks with ectopic spines and neurites was evaluated developmentally using feline models of GM1 and GM2 gangliosidosis. Results of these studies demonstrated that the onset of ectopic neurite growth occurred after the elaboration of dendrites on cortical pyramidal neurons, and that the time of onset of this renewed dendritogenesis was similar in the two diseases. Initiation and growth of ectopic neurites also correlated in a general way with onset and progression of clinical deterioration in both diseases. In GM1 gangliosidosis there was a greater tendency toward formation of meganeurites, whereas in cats with GM2 gangliosidosis the growth of ectopic axon hillock neurites without meganeurites predominated. At end-stage disease in GM2 gangliosidosis, nearly 90% of pyramidal cells displayed some degree of axon hillock neurite growth as opposed to less than half this number for GM1 gangliosidosis cats at the same age. These data are consistent with the hypothesis that there are two separate driving forces behind these somadendritic abnormalities of pyramidal neurons in the gangliosidoses. Excessive intraneuronal accumulation of storage vacuoles accounts for the formation of meganeurites, whereas some type of intrinsic metabolic defect results in axon hillock neurite growth which in turn offers new surface area for synaptic input. Currently available data indicate that GM2 or GM3 ganglioside, or a closely related metabolic product other than GM1 ganglioside, may be primarily associated with the growth of ectopic dendritic processes on morphologically mature neurons in storage diseases.

Animals↗

Neural control of ectopic filiform spines in adult tongue.

The tongue surface directly above a fungiform taste bud is flat, thinly keratinized, and free of filiform spines. We examined fungiform papillae in serial sections of rat and gerbil tongues after unilateral transection of the chorda-lingual nerve had caused many fungiform taste buds to degenerate. Such empty fungiform papillae often formed a solitary keratinized outgrowth that closely resembled the spine of an ordinary filiform papilla. By six months an ectopic spine was found on 61% of empty fungiform papillae, but never on fungiform papillae that contained a taste bud. Experimental innervation of the tongue reduced the incidence of ectopic filiform spines in proportion to the cross-sectional area of the trigeminal nerve branches tested (the mylohyoid nerve, the lingual nerve, lingual + mylohyoid or lingual + auriculotemporal nerves). The chorda tympani nerve was 60 times more effective than trigeminal nerves in preventing ectopic filiform spines. We suggest that positive and negative trophic actions are normal characteristics of taste axons, for they promote the formation of taste buds and prevent the expression of ectopic filiform spines. By preventing the outgrowth of ectopic spines on fungiform papillae, taste axons maintain a thinly keratinized apical surface that can be breached by the taste receptor cells.

Animals↗

Antidromic firing occurs spontaneously on thalamic relay neurons: triggering of ectopic action potentials by somatic intrinsic burst discharges.

Possible dynamic relationships between orthodromically conducted somatic bursts and antidromic impulses arising from presynaptic endings of thalamocortical neurons were explored. Evoked or spontaneous bursts were recorded from 125 identified thalamic relay neurons in 36 anesthetized rats using extracellular microelectrodes. Evoked bursts were obtained by electrical stimulation of either the neocortex or the peripheral activation field. Spontaneous antidromic firing appeared only during periods of (or an expected) rapid somatic intrinsic burst discharge. Ectopic axonal impulses occurred either separately, or clustered in doublets or triplets having relatively long-lasting intervals; these slow bursts represented a proportion of about 12% of evoked and 20% of spontaneous whole bursts. Separate ectopic action potentials could also appear several milliseconds after rapid bursts, producing peculiar long last-interval bursts; about 15% of the whole bursts were of this long interval type. The probability that an ectopic axonal impulse will occur after a rapid burst increases with the number of its action potentials, suggesting that the duration of orthodromic burst firing might contribute to the triggering of ectopic impulses. For 52% of the neurons tested, the activation threshold of their axon terminals decreased just before or immediately after rapid somatic bursts. Since no excitability changes were observed in thalamocortical axons of the white matter, the ectopic action potential generators were probably located on presynaptic endings. During a transient deafferentation of thalamic neurons induced by intrathalamic microinjection of a magnesium solution, neither burst activity nor spontaneous antidromic firing were observed, suggesting that thalamic orthodromic burst discharges are required for presynaptic impulse generation. In conclusion, somatic intrinsic bursts traveling orthodromically along thalamocortical axons might be involved in triggering presynaptic impulses on parent and possibly on nearby thalamic cells. Since a spontaneous antidromic action potential is able to trigger a rapid burst [Pinault (1988) Eur. J. Neurosci. Suppl. P. 246; Pinault and Pumain (1989) Neuroscience 31, 625-637], it is postulated that excitatory interactions between presynaptic endings might be involved in intrinsic burst synchronization processes.

Action Potentials↗

Indecainide for treatment of ventricular ectopic depolarizations: efficacy, pharmacokinetics, hemodynamic effects and safety.

Ten patients were treated with oral indecainide for frequent ventricular ectopic depolarizations during a short-term, dose-ranging, single blind inpatient trial followed by open label long-term therapy for 2 years. During dose ranging, patients received placebo followed by 50, 75 and 100 mg of indecainide three times daily. Eight of the 10 patients achieved greater than or equal to 80% reduction in ventricular ectopic depolarizations during inpatient therapy. Mean ventricular ectopic depolarizations decreased from 15,792/24 h to 2,357/24 h on optimal dosage (p less than 0.01). Nine patients had paired ventricular ectopic depolarizations; four of the nine had greater than or equal to 99% reduction of these beats. Among seven patients with nonsustained ventricular tachycardia, five had 100% elimination of these events with indecainide and all had greater than or equal to 90% reduction in these events. Indecainide prolonged the PR interval 44 +/- 27 ms (p less than 0.0001) and the QRS interval 11 +/- 9 ms (p less than 0.0001) from baseline without prolongation of the QTc or JTc interval. The mean trough plasma level of indecainide on optimal dosage was 409 +/- 173 ng/ml and the mean plasma elimination half-life was 10.3 +/- 2.3 h (range 7.1 to 14.2). No adverse hemodynamic effects of indecainide were detected. Side effects during short-term therapy were mild and did not require discontinuation of the drug. Efficacy was maintained for some patients during long-term therapy for 2 years, although five patients discontinued therapy because of loss of efficacy or side effects. Indecainide is a highly effective and well tolerated antiarrhythmic drug for suppression of frequent and repetitive ventricular ectopic depolarizations.

Administration, Oral↗

Radiofrequency catheter ablation of ectopic atrial tachycardia using paced activation sequence mapping.

OBJECTIVES: Although ectopic atrial tachycardia is infrequent, it can be an important clinical challenge. We sought to define an alternative therapeutic approach to this refractory problem. BACKGROUND: Radiofrequency energy catheter ablation has been used to treat a variety of ventricular and supraventricular arrhythmias but has not been proved efficacious in the management of ectopic atrial tachycardia. METHODS: Ten patients (14 to 47 years of age) referred with refractory ectopic atrial tachycardia were studied. Mapping techniques included identification of earliest atrial activation, confirmation of concordance of P wave configuration during spontaneous tachycardia and pacing from the ablation catheter, and paced activation sequence mapping. The paced activation sequence mapping compared the activation sequence at multiple atrial sites during spontaneous tachycardia with that recorded during pacing from the ablation catheter. The catheter was steered to a point where pacing reproduced the spontaneous activation sequence. RESULTS: Foci were right atrial in eight patients and left atrial in two. In 8 of 10 patients, 514 +/- 97 (SE) J and 5.7 +/- 2.3 (SD) J radiofrequency energy applications ablated the ectopic focus. Seven of these eight patients presented with one focus and one had two discrete and stable foci. Ablation was unsuccessful in two patients with multiple foci. No complications occurred. An arrhythmia focus recurred in two patients and one patient underwent successful repeat ablation. The other patient was managed medically. All seven patients with successful ablation are symptom free after 6.5 +/- 3.8 months. CONCLUSIONS: Our preliminary experience suggests that with the use of both paced activation sequence mapping and standard techniques, radiofrequency ablation of ectopic atrial tachycardia may be a safe and effective form of therapy.

Adolescent↗

Laparoscopic management of tubal ectopic pregnancy in obese women.

OBJECTIVE: To study the surgical morbidity associated with the laparoscopic management of tubal ectopic pregnancy in an overweight population compared with a lean population. DESIGN: Retrospective study. SETTING: An academic tertiary referral obstetrics and gynecology center. PATIENT(S): One hundred seventeen patients in two groups, lean (n = 90; body mass index 30) who had pathology-confirmed tubal ectopic pregnancies that were managed laparoscopically. Each group was subdivided into a laparoscopically managed group and a group in which laparoscopy was converted to laparotomy. INTERVENTION(S): None. Operative time, blood loss, and complications of laparoscopic surgery as well as causes of conversion from laparoscopy to laparotomy, in obese compared with lean women, with ectopic pregnancy. RESULT(S): There was no significant difference in gestational age; beta-hCG level; or history of previous surgeries, ectopic pregnancy, pelvic inflammatory disease, or endometriosis or in any of the studied outcomes (conversion rate, blood loss, and operative time) between the lean and obese groups or their respective subgroups except for operative time between obese women who underwent laparotomy, which was significantly longer when compared with the case of lean women who underwent laparotomy. Intraoperative and postoperative complications were comparable between the lean and obese groups, and all complications occurred in the completed-laparoscopy group. CONCLUSION(S): Laparoscopic management of tubal ectopic pregnancy does not appear to significantly increase surgical morbidity in obese patients.

Adolescent↗

Bleeding ectopic varices--treatment with transjugular intrahepatic porto-systemic shunt (TIPS) and embolisation.

BACKGROUND/AIMS: Bleeding ectopic varices due to cirrhosis can be difficult to manage. We report our experience of uncontrolled bleeding from ectopic varices treated with transjugular intrahepatic porto-systemic shunt (TIPS). METHODS: We selected the 21 cirrhotics who underwent TIPS for bleeding ectopic varices from our database: Child-Pugh grade A (2), B (11) and C (8). Site of bleeding was rectal (11), colonic (2), ileal 1, jejunal 1, duodenal 1, and stomal (5). RESULTS: TIPS was performed successfully in 19/21 (90%) patients. All except 1 had either a reduction in portosystemic pressure gradient < or = 12 mmHg (n=12) or reduction by 25-50% of baseline (n=6). TIPS alone was used in 12/19: 7 of these 12 had no further bleeding; 5 (42%) rebled within 48 h, and had embolisation, 4 without further bleeding. In 7 of 19, TIPS and embolisation were performed together: 2 patients (28%) rebled; further embolisation stopped the bleeding. CONCLUSIONS: Ectopic varices do rebleed despite a reduction of porto-systemic pressure gradient < or = 12 mmHg or by 25-50% of baseline, following TIPS. Embolisation stopped bleeding in all but 1 patient. We recommend performing embolisation at the time of the initial TIPS to control bleeding from ectopic varices.

Adult↗

Altered expression of interleukin-18 in the ectopic and eutopic endometrium of women with endometriosis.

OBJECTIVE: This study has investigated the expression of interleukin (IL)-18 in the eutopic and ectopic endometrium of women with endometriosis and the role of IL-18 on the pathogenesis of endometriosis. METHODS: Endometriotic tissue specimens and endometrium specimens were obtained from patients with endometriosis. IL-18 protein was determined by immunohistochemical analysis. Expression levels of IL-18 mRNA were analyzed by reverse transcriptase (RT)-PCR. RESULTS: IL-18 was detected in the glandular epithelial and stromal cells of eutopic and ectopic endometrium. RT-PCR analysis showed that endometrial IL-18 mRNA expression levels were significantly higher at the secretory phase than the proliferative phase in normal women, but not in patients with endometriosis. IL-18 mRNA expression levels were lower in the ectopic endometrium than in the eutopic endometrium of women with endometriosis. IL-18 mRNA levels in both ectopic and eutopic endometrium of patients with endometriosis were lower than in endometrium of women without endometriosis. CONCLUSION: Ectopic and eutopic endometrial IL-18 was down-regulated in women with endometriosis, suggesting that IL-18 might play a pathogenic role in the formation of endometriosis.

Adult↗

Surgical treatment of temporal lobe epilepsy associated with subcortical ectopic gray matter under the guidance of intraoperative electrocorticography.

We describe a dual pathology presenting as intractable temporal lobe epilepsy associated with subcortical ectopic gray matter. The patient was a 28-year-old male with a 12-year history of refractory temporal lobe epilepsy. Preoperative diagnostic imaging revealed right hippocampal sclerosis, in addition to subcortical ectopic gray matter extending from the posterior end of the inferior horn of the right lateral ventricle to the cerebral parenchyma in the temporoparietal lobe. As surgical therapy for epilepsy, right anterior temporal lobectomy with amygdalohippocampectomy was initially performed. Intraoperative electrocorticography (ECoG) was extremely useful at this point in determining the range of excision of ectopic gray matter after resection of mesial temporal lobe structures. Based on ECoG findings, about 50% of the ectopic gray matter was excised. As of 2 years postoperatively, the patient has remained seizure free with no medication. In cases concomitantly manifesting hippocampal sclerosis and subcortical ectopic gray matter, epilepsy may be associated with dual pathology. This case report raises the potentially important issue of the possible presence of areas of structural abnormality that are non-epileptogenic.

Adult↗

Chromosome analysis of ectopic human conceptuses.

Maternal factors (e.g. salpingitis) are known to be associated with ectopic gestations; however, few studies have considered the chromosomal complements or morphologic features of ectopic conceptuses. We studied 23 ectopic conceptuses removed from fallopian tubes during surgical resection. The chromosomal complements were normal (four with 46,XY; four with 46,XX) in all cases in which an intact embryo was identified, as well as in the single case characterized by disorganized embryonic tissue. Ten of the 14 ectopic conceptuses in which only a gestational sac and placental villi were identified also show normal chromosomal complements (seven with 46,XX; three with 46,XY); in the remaining four cases, variations from the normal chromosomal complement were found (46,XX/47,XX,+9; 45,X/46,XX; 46,XX/47,XX,+mar; and 92,XXXX). The former two probably signify underlying fetal abnormalities; however, the latter two could have reflected, respectively, in vitro aberrations or tetraploidy characteristic of normal amnion. Pooled data from this study and two previous reports indicate that ectopic conceptuses probable have no higher frequency of chromosomal abnormalities than in utero conceptuses of comparable embryonic ages.

Adolescent↗

Conservative surgical management of isthmic ectopic pregnancies.

During the 12-month study interval ending March 30, 1986, there were 203 ectopic pregnancies at Grady Memorial Hospital, a ratio of one ectopic gestation per 34 deliveries. Twenty patients with isthmic ectopic pregnancies were selected for treatment by one of three operative modalities. Seven patients with ruptured isthmic ectopic pregnancies underwent segmental tubal resection without reanastomosis. All four patients who underwent segmental tubal resection with primary microsurgical reanastomosis had postoperative hysterosalpingograms demonstrating bilateral tubal patency. One pregnancy has occurred in this group. Nine patients underwent linear salpingostomy. In five of the six patients who had postoperative hysterosalpingography, patency of the involved fallopian tube was demonstrated. Four of these nine patients, including one patient with contralateral tubal occlusion, have conceived. We conclude that linear salpingostomy for isthmic ectopic pregnancies is as effective as segmental tubal resection with primary microsurgical reanastomosis in achieving tubal patency.

Adult↗