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At least 919 records · Page 51Linked to original sources
PubMed1994

Rapid diagnosis of early ectopic pregnancy in an emergency gynaecology service--are measurements of progesterone, intact and free beta human chorionic gonadotrophin helpful?

The clinical usefulness of measuring serum concentrations of progesterone, human chorionic gonadotrophin (HCG) and the free beta-subunit of HCG in distinguishing between early viable and non-viable pregnancy, before an accurate ultrasound diagnosis is possible, was evaluated in a prospective study of patients presenting to our emergency gynaecology service with a clinical suspicion of ectopic pregnancy. Patients were selected on the basis of initial HCG concentrations; samples with HCG 25-10,000 IU/l were later analysed for progesterone and free beta HCG. Of the 181 patients studied, 38 (21%) had an ectopic pregnancy, 108 (60%) had a spontaneous abortion and 35 (19%) had a viable intra-uterine pregnancy. Concentrations of HCG and free beta HCG in the group with viable pregnancies were significantly higher than in the group with ectopic pregnancy (P < 0.001) and than those destined to miscarry (P < 0.01). Progesterone concentrations were also significantly higher in the viable versus the ectopic and the spontaneous abortion groups (P < 0.001 in each case). Despite these highly significant differences there was a degree of overlap such that it was impossible to devise a cut-off level for any hormone analysed, either singly or in combination, which would offer a clinically useful predictor of outcome.

Chorionic Gonadotropin↗
PubMed2006

Two adolescents with ectopic pregnancies: experience with methotrexate.

An ectopic pregnancy is a life-threatening form of pregnancy that is increasing in frequency especially in adolescents. Whenever a woman of childbearing age, including adolescents, presents with abdominal pain, the diagnosis of ectopic pregnancy must be considered as a possibility because if it is not diagnosed and treated expediously and appropriately, there will be considerable morbidity and mortality. Methotrexate has been shown to be effective in the management of ectopic pregnancy, but few reports are described in the literature regarding its use in teenagers. We report the cases of 2 adolescents with ectopic pregnancies who were treated successfully with methotrexate.

Abortifacient Agents, Nonsteroidal↗
PubMed2005

Frozen section examination of endometrial curettings in the diagnosis of ectopic pregnancy.

BACKGROUND: The aim of our study was to determine the accuracy and validity of frozen section analysis of endometrial curettings in differentiating between abnormal intrauterine and ectopic pregnancies. METHODS: A retrospective analysis of the database of the Department of Obstetrics and Gynecology in our institute was performed from January 1998 to September 1999. In 70 women with a suspected ectopic pregnancy a diagnostic curettage was sent for frozen section examination because products of conception could not be identified macroscopically in the curettings. Routine paraffin fixation specimens were also prepared from the endometrial curettings. A frozen section diagnosis was considered correct if it concurred with the final pathologic diagnosis, and incorrect if it differed. The sensitivity, specificity, positive predictive value and negative predictive value of a frozen section in identification of conception products were calculated. RESULTS: Of the 70 frozen section studies the diagnosis was correct in 63 (90%), and incorrect in 7 (10%) cases. Of 50 specimens interpreted as negative on frozen sections (no products of conception noted), 6 (12%) were found to contain conception products on final pathologic review. One of the 20 (5%) specimens interpreted as positive by a frozen section failed to demonstrate products of conception on a final pathologic section. The sensitivity of frozen sections in the diagnosis of ectopic pregnancy was 76%, specificity 97.8%; positive predictive value 95%; negative predictive value 88% and accuracy 90%. CONCLUSIONS: Frozen section examination is a rapid and accurate method for identifying products of conception in endometrial curettings, and may reduce delay in the diagnosis of an ectopic pregnancy and in the institution of therapy.

Curettage↗
PubMedDate not supplied

Pro-opiomelanocortin expression in a metastatic breast carcinoma with ectopic ACTH secretion.

Cushing's syndrome secondary to ectopic adrenocorticotropic hormone (ACTH) secretion is rarely observed in breast carcinoma and only four cases have been previously published. We report here the case of a 50-year-old woman who presented with a history of diffuse bone pain associated with multiple hepatic, pulmonary, and bone metastases. A core needle biopsy specimen revealed an invasive ductal carcinoma in the right breast. The patient subsequently developed an ACTH-dependent paraneoplastic Cushing's syndrome and she died of arrhythmia and heart failure, despite treatment. At autopsy, immunohistochemical staining showed chromogranin A and ACTH positivity in the breast tumor and a lung metastasis. The mRNA expression of the pro-opiomelanocortin (POMC) gene was detected in tumoral cells by reverse transcriptase polymerase chain reaction (RT-PCR). This is the first case of Cushing's syndrome secondary to ectopic ACTH secretion where the presence of ACTH by immunohistochemistry and the expression of the POMC gene by RT-PCR have both been demonstrated in a breast carcinoma with metastases. The clinical history and the pathologic findings are presented with the methods and results of the molecular analysis. This case illustrates an example of ectopic ACTH syndrome in a breast carcinoma with neuroendocrine (NE) differentiation. This NE phenotype is directly related to the synthesis of ACTH by the tumoral cells. It should be kept in mind that an ectopic ACTH syndrome may be produced not only by small cell carcinoma or endocrine tumors but also by breast cancer. No relationship has been established between NE features and prognostic factors or patient outcome for this peculiar type of breast carcinoma. The demonstration of mRNA POMC in breast carcinoma with NE features suggests a depression and/or an activation of the POMC gene linked to the NE differentiation.

ACTH Syndrome, Ectopic↗
PubMed1983

Pro-opiocortin related peptides in human pituitary and ectopic ACTH secreting tumours.

Basal and stimulated secretion of N-terminal pro-opiocortin (Pro-gamma-MSH), ACTH and LPH from seven pituitary and three ectopic ACTH secreting tumours have been studied in vitro using a perfused isolated cell system. The peptides were shown to be released concomitantly and in equimolar amounts. The pituitary tumours responded to stimulation with rat stalk median eminence extracts (SME) and synthetic AVP. However, peptide release from the ectopic tumours, although pulsatile, remained autonomous. Prior to surgery, gel-chromatographic profiles of plasma immunoreactive ACTH showed only one peak, which eluted in the position of 1-39 ACTH, in patients with the pituitary tumours, but there was a second peak of large molecular weight ACTH present in the plasma from those with the ectopic ACTH syndrome. This second form of ACTH could not be detected in any of the tumour cell column effluents. An eighth pituitary tumour was atypical, in its unusually large size, clinically aggressive nature and spectrum of peptide release. Although peptide release in response to stimulation with SME was similar to that observed with the other pituitary tumours, the chromatography of the plasma ACTH resembled the ectopic plasma pattern, showing two peaks of immunoreactivity.

ACTH Syndrome, Ectopic↗
PubMed1991

Use of ketoconazole in the treatment of Cushing's disease and ectopic ACTH syndrome.

Ketoconazole, an imidazole derivative which inhibits adrenal steroidogenesis, has been used with success for the metabolic control of Cushing's disease. Few data are available about the use of ketoconazole in the management of the ectopic ACTH syndrome. We have used ketoconazole in eight patients: four patients with Cushing's disease, two patients with overt and two with occult ectopic ACTH syndrome. Among patients with Cushing's disease, reversible hypoadrenalism occurred once. All had full clinical and biochemical regression of the disease for more than 6 months with 400-1200 mg ketoconazole per day. Patients with ectopic ACTH syndrome received 1200 mg ketoconazole per day for at least 2 months. Partial biochemical regression was observed in two and a secondary escape to adrenal blockade in two others. These findings further indicate that ketoconazole is a valuable tool for the metabolic control of Cushing's disease. On the contrary, in ectopic ACTH syndrome, this aim can be impossible to reach with ketoconazole although the reasons for its ineffectiveness remain to be determined.

ACTH Syndrome, Ectopic↗
PubMed1992

Mineralocorticoid excess and inhibition of 11 beta-hydroxysteroid dehydrogenase in patients with ectopic ACTH syndrome.

OBJECTIVE: 11 beta-Hydroxysteroid dehydrogenase protects renal mineralocorticoid receptors from cortisol by converting cortisol to inactive cortisone. We hypothesize that 11 beta-dehydrogenase is inhibited by ACTH, providing a mechanism whereby cortisol induces hypokalaemic alkalosis in ectopic ACTH syndrome. DESIGN/MEASUREMENTS: The principal sources of plasma cortisone were assessed by selective venous catheterization with measurement of cortisol and cortisone by radioimmunoassays. The effect of ACTH on peripheral plasma cortisol/cortisone ratio was assessed in healthy volunteers during circadian rhythm, insulin induced hypoglycaemia, and infusions with exogenous ACTH or cortisol. In patients with Cushing's syndrome plasma cortisol/cortisone ratios were related to plasma potassium, corticosterone, and 11-deoxycorticosterone concentrations. PATIENTS: Catheterization was performed in 24 patients with valvular or ischaemic heart disease. Cushing's syndrome patients included: 15 with pituitary adenoma; two with adrenal adenoma; and nine with ectopic ACTH secretion. RESULTS: Plasma cortisol/cortisone ratios were low in renal vein and high in hepatic vein. In healthy volunteers plasma cortisone increased during cortisol infusion but did not change with increases in endogenous or exogenous ACTH. Plasma cortisol/cortisone ratios were higher in ectopic ACTH syndrome than in other forms of Cushing's syndrome. However, the cortisol/cortisone ratio was no better a predictor of hypokalaemia than the levels of 11-deoxycorticosterone or corticosterone. CONCLUSIONS: Peripheral conversion of cortisol to cortisone occurs mainly in the kidney and is inhibited by ACTH. In ectopic ACTH syndrome the characteristic mineralocorticoid excess can be accounted for by a combination of increased secretion of cortisol, corticosterone and of 11-deoxycorticosterone and decreased inactivation of cortisol and corticosterone by 11 beta-dehydrogenase.

11-beta-Hydroxysteroid Dehydrogenases↗
PubMed1980

An unexpectedly high rate of ectopic pregnancy following the induction of ovulation with human pituitary and chorionic gonadotrophin.

Six tubal ectopic pregnancies occurred in a series of 193 pregnancies following ovulation induced with human pituitary gonadotropin (hPG) and human chorionic gonadotrophin (hCG). The ectopic pregnancy rate of 3.1 per cent is higher than quoted incidences in the general population and occurred in the absence of predisposing factors. There was an association between ectopic pregnancy and elevated urinary oestrogen excretion in the peri-ovulatory phases of the induced ovulatory cycles. A urinary oestrogen excretion of greater than 200 microgram/24 hours on day 0 (the day after hCG was given) was associated with a 10 per cent chance of ectopic pregnancy (P less than 0.05).

Anovulation↗
PubMed1987

Time trends of ectopic pregnancies.

Whether the increase of ectopic pregnancies could be explained by methodological problems or by changing age structure was examined in data from one hospital (Tampere, Finland) between 1972 and 1984. Numbers of ectopic pregnancies, births, and induced and spontaneous abortions were obtained by 5-year age-groups and county of residence from the hospital discharge register. Introduction of a more sensitive pregnancy test in 1979 was coincident with the most rapid increase in the role of ectopic pregnancies. Use of incomplete denominators and varying catchment areas and correction of changing age-distribution of pregnant women did not markedly influence the time trends. Our analysis suggests that the observed increase in ectopic pregnancies in this area was partly real and partly due to better diagnosis.

Age Factors↗
PubMed1988

Gonococcal and chlamydial antibodies in ectopic and intrauterine pregnancy.

Sera from 50 women with ectopic pregnancy and 50 age-matched control women with intrauterine pregnancy were tested by enzyme-linked immunosorbent assay (ELISA) using C. trachomatis and N. gonorrhoeae pili as antigens. In the ectopic pregnancy group 76% had IgG antibodies to C. trachomatis compared with 38% in the controls. The prevalence of gonococcal IgG antibody was 32% in the ectopic pregnancy group and 4% in the controls. The prevalences of IgA antibodies to the two organisms ranged from 2 to 12% and were similar in the two groups; cultures for C. trachomatis from cervical swabs from the ectopic pregnancy group were negative. Chlamydial antigen was detected (by ELISA) in exfoliated cervical cells of only one patient in this group.

Antibodies, Bacterial↗
PubMed1988

Ectopic pregnancy in Aberdeen 1950-1985.

The reported incidence of ectopic pregnancy in Aberdeen City and suburbs (1950-1985), using as denominators maternities, pregnancies and women aged 15-44 years, has increased threefold since 1970 to 6.4/1000 pregnancies. This increased incidence persisted after the exclusion of previously sterilized women. A total of 11,128 women were sterilized in Aberdeen City and suburbs between 1960 and 1982; 36 ectopic pregnancies occurred in this sterilized population. The prevalence of ectopic pregnancy was 3.55/1000 sterilizations. This did not alter significantly over the period of study despite changes in the method of sterilization. However, due to the increased popularity of sterilization, the proportion of ectopic pregnancies in women who had been sterilized increased from 0% in the 1950s to 21% in the quinquennium 1975-1979.

Adolescent↗
PubMed1988

Demonstration of ectopic pregnancy by transvaginal ultrasound.

Transvaginal ultrasound was used in the assessment of 148 patients clinically suspected of having an ectopic pregnancy. Transvaginal ultrasound allowed earlier demonstration of an intrauterine pregnancy without confusion with a pseudosac. Of the 36 patients with an ectopic pregnancy, this was strongly suspected in 29 (81%). A live extrauterine fetus was seen in 8 (22%), ectopic trophoblast or a gestation-sac-like structure in 19 (53%), and a pelvic haematoma in 2 (6%). Transvaginal ultrasound is advocated as the technique of choice in patients suspected of having an ectopic pregnancy.

Adnexal Diseases↗
PubMed1991

Prospective comparison of videopelviscopy with laparotomy for ectopic pregnancy.

OBJECTIVE: To compare operative laparoscopy with laparotomy for the management of ectopic pregnancy in haemodynamically stable women. DESIGN: Non-randomized prospective cohort study, treatment allocation depending on the surgical preference and experience of the on-call medical team. SETTING: Provincial undergraduate teaching hospital. SUBJECTS: 87 consecutive and unselected haemodynamically stable women treated for ectopic pregnancy between 1 March 1988 and 31 August 1989. INTERVENTIONS: Salpingotomy, salpingectomy, salpingo-oophorectomy or simple extraction of the ectopic pregnancy depending on its site, size and nature performed under laparoscopic control or laparotomy. MAIN OUTCOME MEASURES: Operative outcome, duration of surgery, intra- and post-operative complications, post-operative hospital stay, return to normal domestic activities, return to work, changes in plasma beta-hCG concentrations, health and social service costs. RESULTS: 60 women were treated by videopelviscopy on 65 occasions and the other 27 were treated by laparotomy. The two groups were similar for age, parity and gestation at presentation. Of the 65 operative laparoscopies 61 (94%) were successful and all 27 laparotomies were completed uneventfully. Whereas the operating time was similar in the two groups, 55.3 and 51.1 min for videopelviscopy and laparotomy respectively, operative laparoscopy was associated with significantly shorter post-operative hospital stay (1.7 vs 5.2 days), faster return to domestic activities (1.5 vs 3.3 weeks) and work (2.5 vs 5.7 weeks) (P less than 0.001 for all). In economic terms, successful videopelviscopy was associated with a reduction in hospital accommodation costs by 69% (248 pounds vs 808 pounds), drug costs by 52% (8.38 pounds vs 17.57 pounds) and statutory sickness payment by 51% (130.25 pounds vs 266.51 pounds), that is an overall saving to the health and social services of 701.47 pounds or 50% per ectopic pregnancy (P less than 0.001). CONCLUSIONS: Operative laparoscopy can be used to successfully treat most cases of extrauterine pregnancy with advantages over laparoscopy in terms of reduced hospitalization, faster recovery and lower health service costs.

Cost-Benefit Analysis↗
PubMed1993

Stereomicroscopic demonstration of chorionic villi: differentiation between miscarriage and ectopic pregnancy.

OBJECTIVE: To evaluate direct peroperative stereomicroscopic examination of endometrial curettings in the differentiation between miscarriage and ectopic pregnancy. DESIGN: A prospective consecutive controlled study. SETTING: Odense University Hospital, Odense, Denmark. SUBJECTS: One hundred and fifty-nine women with vaginal bleeding and/or abdominal pain in early pregnancy and no fetus seen on ultrasound. MAIN OUTCOME MEASURES: The results of stereomicroscopy were compared with the histological diagnoses. RESULTS: There was 90% (95% CI, 84-94%) agreement between the stereomicroscopic and histological examinations. Fifteen per cent had an ectopic pregnancy. The sensitivity of stereomicroscopy as a marker of ectopic pregnancy was 92% (73-99%), the specificity 94% (88-97%). The predictive value of a positive test was 73% (54-88%) and that of a negative test 98% (94-100%). CONCLUSION: Direct peroperative stereomicroscopy of endometrial curettings is a valuable diagnostic tool for immediate differentiation between miscarriage and ectopic pregnancy.

Abdominal Pain↗
PubMed2006

Virtual reality simulation training can improve technical skills during laparoscopic salpingectomy for ectopic pregnancy.

OBJECTIVES: To assess the first commercially available virtual reality (VR) simulator to incorporate procedural modules for training of inexperienced gynaecological surgeons to perform laparoscopic salpingectomy for ectopic pregnancy. DESIGN: Prospective cohort study. SETTING: Departments of surgery and gynaecology in central London teaching hospitals. SAMPLE: Thirty gynaecological surgeons were recruited to the study, and were divided into novice (<10 laparoscopic procedures), intermediate (20-50) and experienced (>100) groups. METHODS: All subjects were orientated to the VR simulator with a basic skills task, followed by performing ten repetitions of the virtual ectopic pregnancy module, in a distributed manner. MAIN OUTCOME MEASURES: Operative performance was assessed by the time taken to perform surgery, blood loss and total instrument path length. RESULTS: There were significant differences between the groups at the second repetition of the ectopic module for time taken (median 551.1 versus 401.2 versus 249.2 seconds, P = 0.001), total blood loss (median 304.2 versus 187.4 versus 123.3 ml, P = 0.031) and total instrument path length (median 17.8 versus 8.3 versus 6.8 m, P = 0.023). The learning curves of the experienced operators plateaued at the second session, although greater numbers of sessions were necessary for intermediate (seven) and novice (nine) surgeons to achieve similar levels of skill. CONCLUSIONS: Gynaecological surgeons with minimal laparoscopic experience can improve their skills during short-phase training on a VR procedural module. In contrast, experienced operators showed nonsignificant improvements. Thus, VR simulation may be useful for the early part of the learning curve for surgeons who wish to learn to perform laparoscopic salpingectomy for ectopic pregnancy.

Clinical Competence↗
PubMed1980

A review of ectopic pregnancies in Southern Tasmania.

Over the 10-year period 1968-1977, 131 patients with ectopic pregnancy were treated at the Royal Hobart Hospital. The clinical features of these patients are discussed. Using data on the number of ectopic pregnancies confirmed in Southern Tasmania in the period 1973-1977, it was shown that in terms of the ratio of ectopic pregnancies to total births, the incidence of ectopic gestation in the essentially stable population has risen from 1:130 to 1:72; possible reasons for this increase are discussed. The difficulty in diagnosis of the condition is emphasised.

Adult↗
PubMed1980

Problems in the diagnosis of ectopic pregnancy.

Problems in the diagnosis of ectopic pregnancy have been assessed over a 4-month period at King Edward Memorial Hospital. Twenty-three of thirty women (77%) were sent home after their initial presentation with symptoms of their ectopic pregnancy. Thirteen were sent home from major teaching hospitals and the remaining 10 by their general practitioners. In 76 patients, laparoscopy was performed to exclude ectopic pregnancy; the diagnosis was confirmed in only 30. Plasma beta HCG values were elevated in all patients with an ectopic pregnancy within the Fallopian tube. The finding of a beta HCG value of less than 2.5 i.u./l could have allowed 36 of these patients to avoid diagnostic laparoscopy. Nine patients with intrauterine pregnancies (5 continuing and 4 aborting) might have avoided laparoscopy if ultrasonography had been used. Careful application of these tests, together with good history taking, will minimise the number of patients in whom an incorrect diagnosis is made.

Chorionic Gonadotropin↗
PubMedDate not supplied

Support for the woman with an ectopic pregnancy.

Increased knowledge and awareness among health-care providers as well as technologic advances have decreased the risk of death from ectopic pregnancies. More sensitive pregnancy tests and improved diagnostic procedures have contributed to earlier and more rapid diagnosis of ectopic pregnancy. Also, women in the childbearing years have become more aware of ectopic pregnancy. This has probably contributed to earlier diagnoses and interventions; however, data are not available to substantiate this hypothesis. Research is needed in this area, particularly to study trends in number, causes, and characteristics of women with ectopic pregnancy among reproductive age women (15 to 45 years of age).

Adult↗