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At least 973 records · Page 54Linked to original sources
PubMed1999

[Initial experience with a minidose of methotrexate in the management of unruptured ectopic pregnancy].

Methotrexate has been used in the conservative management of ectopic pregnancy with good results. Due to its great afinity for the trophoblast it was decided to try unique doses of 50 mg i.m. independently of the body surface. Fifteen patients were studied with ectopic pregnancy by ultrasound and hCG in series that didn't require confirmatory laparoscopy. The ectopic pregnancies broken and/or decompensated were discarded. Average gestational age was 6.1 weeks; the maximal dimention of the sacs was 36.8 mm average; the values for hCG average were 6440 mU/ml and the maximal time of negativization was 52 days. One patient required laparoscopy and salpingostomy, lineal, for inminent rupture 24 hour after methotrexate, the other 14 presented with complete remission. There were no colateral effects. From the 15 patients, in 6 tubal permeability was confirmed by laparoscopy or HSG, being positive in 6 patients, it has not been evaluated, two patients with resolved pregnancy, and other on course (two of them with one salpinx). The proposed management seems to be useful in ectopic pregnancy with success, equivalent to surgical management, and other programs of medical management, with out side effects and with greater easiness of administration.

Chorionic Gonadotropin↗
PubMed1999

[Cushing syndrome due to ectopic ACTH secretion: an uncommon case presentation, diagnosis and therapy].

Ectopic ACTH secretion due to malignant tumours is the most frequently underdiagnosed form of Cushing's syndrome. The majority of neoplasms causing ectopic ACTH syndrome are small-cell cancers of the lung or carcinoids. Other well-documented cases include adenocarcinoma of the lung, medullary thyroid carcinoma, pancreatic islet tumours and malignant thymoma. We report a rare case of metastatic colonic adenocarcinoma with ectopic ACTH syndrome. Clinical features such as proximal muscle weakness, peripheral oedema, hypertension or hirsutism in women, or the presence of unexplained hyperglycaemia, hypokalaemia or metabolic alkalosis in patients with known malignancy strongly suggest ectopic ACTH syndrome. Removal of the source of ACTH is the treatment of first choice, but often not feasible. Most often, treatment modalities are only palliative, with drugs directed against hypercortisolism such as aminoglutethimide, metyrapone, ketoconazole or mifepristone.

ACTH Syndrome, Ectopic↗
PubMed1976

[Ectopic pregnancy near term (case-report) (author's transl)].

Description of a case of ectopic pregnancy during the last 3 months with a living, malformed and underdeveloped neonate. Possible treatment is discussed: where as in our case there is a secondary ectopic pregnancy (i.e.a pregnancy started primarily in the tube and still in vascular contact with it but secondarily ectopic) removal of placenta following ligation of the main vessels arising from the tube is possible and recommended. In the much rarer primary ectopic pregnancy with primary nidus in the abdomen, removal of the placenta is dangerous and not advised because of the danger of diffuse hemorrhage.

Cesarean Section↗
PubMed2000

[Spontaneous bilateral ectopic pregnancy--an rare and dangerous occurrence].

Bilateral, spontaneous ectopic pregnancy is rare (1 in 125-1580 ectopic pregnancies). We describe a 30-year-old, unmarried woman with no predisposing factors for ectopic pregnancy who presented in hypovolemic shock, in the 7th week of gestation, complaining of abdominal pain. On immediate laparoscopy there were found blood and clots in the abdominal cavity, a left ampullar pregnancy (5 cm in diameter), and there was active bleeding from the fimbria of the right tube. Bilateral salpingectomy was performed and she received 3 units of packed red cells. She was discharged in good condition 3 days later. The pathologic diagnosis was pregnancy in each tube. This case emphasizes the need for thorough sonographic and laparoscopic observation in order not to miss the presence of bilateral ectopic pregnancy.

Adult↗
PubMedDate not supplied

[Dilated cardiomyopathy induced by ectopic atrial tachycardia].

The deleterious effect of chronic or incessant supraventricular tachycardia on ventricular function is well-known and it has been demonstrated than can ultimately lead to dilated cardiomyopathy if unrecognized. Any variety of supraventricular tachycardia with chronic evolution may lead to left ventricular dysfunction, ectopic atrial tachycardia because of its persistent nature, often incessant and poorly responsive to antiarrhythmic drugs is a frequent cause of reversible congestive heart failure in patients without other demonstrable organic heart disease. Five patients (aged 14 to 52 years) were referred with symptoms of heart failure, NYHA functional class II (one patient), class III (one patient) and class IV (3 patients) associated with an incessant ectopic atrial tachycardia. Four patients underwent radiofrequency catheter ablation of the ectopic focus and one patient was treated with amiodarone. All patients were successfully treated and the echocardiographic assessment of left ventricular function indicated regression of the cardiomyopathy picture with recovery of systolic function, (mean left ventricular ejection fraction 39.2 +/- 6.1% before vs mean 62.4 +/- 4.8% after (p < 0.01). The clinical and echocardiographic picture of cardiomyopathy induced by incessant ectopic atrial tachycardia is reversible after successful treatment. This stresses the necessity of recognizing such arrhythmia as cause of primary heart failure.

Adolescent↗
PubMed2002

Concurrent appendicitis and ectopic pregnancy. A case report.

BACKGROUND: Ectopic pregnancy is infrequently encountered together with appendicitis. Since 1960, 21 such cases have been reported. CASE: A 32-year-old, Hispanic woman presented with signs and symptoms of an acute surgical abdomen. Preoperatively, the diagnoses of both ectopic pregnancy and acute appendicitis were entertained. On surgical exploration, a ruptured appendix and an unruptured left-sided ectopic pregnancy were found. CONCLUSION: The possibility of multiple pathologic disorders should always be considered in a patient with an acute surgical abdomen, especially during pregnancy. Evidence exists of a possible association between ectopic pregnancy and appendicitis in terms of a common pathogenic mechanism.

Abdominal Pain↗
PubMedDate not supplied

[Ectopic pregnancy in Senegal].

The objective of this prospective study was to analyse the epidemiology and prognosis of ectopic pregnancy in Senegal. From January 1 to December 31, 1996, 255 ectopic pregnancies were registered. The national rate of ectopic pregnancy was 0.6%. of expected pregnancies. However, rates differed greatly between areas in Senegal, with extremes ranging from 0.85%. in Dakar to 0.32%. in Thiès. The epidemiological profile was that of a young woman-mean age: 23 years old, mean parity=3, admitted with broken ectopic pregnancy (95%). A salpingectomy was performed in all cases. The maternal mortality rate was 1.20%, while morbidity, mainly due to post-operative infection, was found in 2.7% of the cases.

Adult↗
PubMed2002

Cervical fluid oncofetal fibronectin as a predictor of early ectopic pregnancy. Is it affected by blood contamination?

OBJECTIVE: To evaluate (1) the diagnostic usefulness of oncofetal fibronectin (fFN) in the cervical fluid in unruptured ectopic pregnancy, and (2) the contribution of maternal blood contamination of the specimen to the test results. STUDY DESIGN: A total of 111 cases in the first trimester of pregnancy, including 12 cases of ectopic pregnancy, 26 of spontaneous abortion and 73 of viable intrauterine pregnancy, were studied. fFN was determined with a commercial enzyme-linked immunosorbent assay kit with a threshold of 50 ng/mL in cervical fluid. To determine the effect of blood contamination on the fFN assay, the positive rate of the fFN test was examined when maternal blood in the first trimester was mixed with the dilution buffer. RESULTS: Eighty-three percent (10/12), 38% (10/26) and 12% (9/73) of cases with ectopic pregnancy, miscarriage and normal pregnancy, respectively, were positive for fFN. The positive rate in ectopic pregnancy was significantly higher than in normal pregnancy and spontaneous abortion. The test was positive for fFN in 8% with 0.5% of blood contamination, 67% with 1% contamination and 100% with 10% contamination.

Adult↗
PubMed2002

Seventy-five ectopic pregnancies. Medical and surgical management.

BACKGROUND: The aim of this study was to evaluate the treatment options of ectopic pregnancy. METHODS: Retrospective analysis performed on 75 patients diagnosed and hospitalised with ectopic pregnancy from January 1996 to May 2001. The medical records of each patient were evaluated. RESULTS: Treatment options: immediate surgical treatment (44%), methotrexate (MTX) therapy (43%) and expectant management (13%). MTX therapy success rate was 78.1%. Laparotomy was performed in 52.5% of surgically treated women. Over time there was an increase in the use of laparoscopic surgery: 75% of women underwent laparoscopy in the period 2000-2001. The rate of laparotomy still remains higher than the rate previously reported in other studies; the reason is that in our hospital no equipment for laparoscopy is available for emergency condition. Expectant management was effective when there was no pain and serum hCG levels were constantly low or were decreasing. CONCLUSIONS: Technological advances allow diagnosis of ectopic pregnancy before severe clinical symptoms arise. Although early diagnosis may contribute to higher incidence, it has also contributed to a decline in morbidity, deaths, and treatment costs. Timely and early diagnosis has made this disorder amenable to medical therapy, with success rates similar to those of traditional surgical treatment. Surgery is preferred when there are tubal ruptures or a high potential for rupture, hypotension, anaemia or ectopic pregnancy which is larger than 3 cm in diameter.

Female↗
PubMed2002

Ectopic pregnancy risk when contraception fails. A review.

OBJECTIVE: To alert clinicians to the risk of ectopic pregnancy when certain contraceptive methods fail by summarizing data from trials reviewed by the U.S. Food and Drug Administration (FDA). STUDY DESIGN: The review focuses on 7 contraceptive drug products with an increased risk of ectopic pregnancy when the method fails. Data were extracted from reviews of clinical trials submitted to the FDA to support marketing applications and from the medical literature. Data on 6 other contraceptive drug products and published data for tubal ligations are used for comparison. This review does not include medroxyprogesterone acetate injections because the FDA reviews for this method did not include any pregnancy outcome information. RESULTS: The results are presented in a table and are compared to postmarketing surveillance reports and published literature, when available. The proportion of ectopic pregnancies among all pregnancies ranged from 1:2 to 1:21 for intrauterine devices, tubal ligations, progestin-only implants and progestin-only oral contraceptives. Although the confidence intervals for the proportions were large in trials with few pregnancies, both postmarketing surveillance reports and published literature support proportions calculated from clinical trial data. CONCLUSION: Pregnancies in women using progestin-only oral contraceptives, progestin-only implants, intrauterine devices and tubal ligations are more likely to be ectopic than pregnancies in the general population.

Clinical Trials as Topic↗
PubMed1992

[Effectiveness of propafenone in congenital ectopic junctional tachycardia--a case report].

Junctional ectopic tachycardia is associated with a poor prognosis when it occurs in newborns and young infants. Like other automatic tachyarrhythmias, junctional ectopic tachycardia has been shown to be very resistant to medical treatment. Successful therapy with propafenone in a newborn with congenital junctional ectopic tachycardia is presented. Due to its high effectiveness, safety, and lack of side-effects, propafenone appears to be a valuable drug in the treatment of young patients with congenital junctional ectopic tachycardia.

Child, Preschool↗
PubMed2003

A randomized controlled comparison of minialpartomy and lapartomy in ectopic pregnancy cases.

BACKGROUND: As ectopic pregnancy is associated with significant maternal mortality and morbidity it may be worthwhile to find alternative surgical method to traditional laparotomy. AIMS: To compare the efficacy, safety and cost effectiveness of minilaparotomy surgery for ectopic pregnancy cases with standard laparotomy method. SETTING AND DESIGN: A total of 60 patients of ectopic pregnancy were randomized for minilaparotomy and laparotomy (30 cases each) for three years from January. 1998 to March 2001 in a medical college hospital. MATERIAL AND METHODS: Patients history, clinical examination, intraoperative, preoperative and postoperative data were recorded and compared in minilaparotomy and laparotomy groups. STATISTICAL ANALYSIS USED: Chi-square and Fischer chi-square test is used using P value of less than 0.05 as level of significance. RESULTS: Mean operative time was significantly less in minilaparotomy (38 minutes) than in laparotomy group (54 minutes). Postoperative complications were fever in 4(13.33%) and 6(20%) cases, paralytic ileus in 3(10%) and 8(26.66%) cases, urinary tract infection in 2(6.66%) and 3(10%) cases and wound infection in 1(3.33%) and 5(16.66%) cases respectively in the two groups and were significantly less in the minilaparotomy cases. Mean day of mobility, starting normal diet and discharge from the hospital were 10 hours and 24 hours, 1.5 days and 3.1 days and 3.4 days and 6.9 days respectively in the two groups and were significantly less in the minilaparotomy group than the laparotomy group. CONCLUSIONS: Surgery by minilaparotomy technique in ectopic pregnancy cases appears to be a safe and feasible method and is superior to conventional laparotomy as there are minimum perioperative and postoperative complications and patients can be discharged early from the hospital without the need of expensive equipment.

Adult↗
PubMed2003

[Ectopic pregnancy: criteria to decide between medical and conservative surgical treatment?].

OBJECTIVE: To search for criteria which should be used to decide between medical treatment and conservative laparoscopic treatment of ectopic pregnancy. METHOD: A Medline search was conducted via Pubmed and in the Cochrane Library. Other studies were selected from the references used in recent randomized trials. RESULTS: Results of medical and of conservative laparoscopic treatment have been similar in patients selected for prospective randomized trials. The criteria used to include patients in these studies were determined arbitrarily. Two scores were evaluated prospectively, they included criteria which may be difficult to use in clinical practice. CONCLUSION: The treatment should performed surgically if the patient is hemodynamically unstable, ss-hCG is >10,000 mUI/mL, the ectopic pregnancy is > or =4 cm in diameter, if there is a medical contraindication to methotrexate, and if the patient may not be followed adequately after treatment. Medical treatment should be preferred if the patient has undergone surgery many times previously, has extensive pelvic adhesion, a contraindication for general anesthesia, a cornual pregnancy, and after failure of a conservative laparoscopic treatment. Medical treatment is possible: if ss-hCG is below 5,000 or 10,000 mUI/mL, if the ectopic pregnancy is less than 4 cm in diameter or if the score is adequate when a scoring system prospectively evaluated can be used. Medical treatment should be preferred: if ss-hCG<1000 mUI/mL, if the patient has no pain and if the ectopic pregnancy cannot be visualized at ultrasound.

Abortifacient Agents, Nonsteroidal↗
PubMed2003

[Management of non-surgical treatment of ectopic pregnancy].

OBJECTIVE: To define non-surgical management of ectopic pregnancy using expectant management or medical treatment. METHODS: We reviewed French and English reports on Pubmed using to the following key words: "ectopic pregnancy, medical treatment, methotrexate, expectant management". RESULTS: Expectant management is possible for patients if they are selected according to precise criteria. It avoids therapeutic escalation, if there is a doubt as to whether it is a miscarriage or an ectopic pregnancy or for asymptomatic patients with spontaneous decreased hCG levels. Methotrexate is the medical treatment of choice. Side effects appear more rarely after one injection than multiple injections. Therefore, after multiple injections, it seems to be good to associate folinic acid. Local administration under sonographic control and mifepritone seem to be more efficient than intramuscular injection in case of active ectopic pregnancy (progesterone level and hCG level high). Two treatment protocols, the single dose and the multidose, have been reported and results are comparable when the success rate is defined as a negative hCG level associated with non-surgical intervention. This management can be handled on an outpatient basis but the patient's acceptance must be complete. Decreased hCG level is controlled in comparison with a standard curve. An additional dose of methotrexate is necessary when hCG levels are above the value of the curve on day 2, day 4, day 7 or day 10. Surgical management is necessary in case of tubal rupture. The occurrence of pain following methotrexate therapy should not be the sole indication for surgical intervention.

Abortifacient Agents, Nonsteroidal↗
PubMed1992

Mortality following unilateral twin interstitial ectopic pregnancy. A case report.

Twin ectopic pregnancy is an uncommon event, usually occurring as simultaneous intrauterine and tubal gestations. Interstitial implantation of an ectopic pregnancy is also a rare event, associated with a high mortality rate. Twin interstitial pregnancy has been previously reported only three times in the English literature. We report a recent case of unilateral twin interstitial ectopic pregnancy that resulted in maternal death and review the literature with regard to both ectopic pregnancy and factors associated with mortality from interstitial implantation.

Female↗
PubMed2004

[Ectopic ACTH syndrome].

Although the clinical and biochemical discrimination of true Cushing syndrome from the Cushing phenotype is sometime difficult, four diagnostic studies are currently used: late-night serum and salivary cortisol level, urine free cortisol level, low-dose dexamethasone suppression, and the dexamethasone-CRH test. Using these tests, 90% of patients with Cushing syndrome are diagnosed. Once the diagnosis of the Cushing syndrome is firmly established, the next step is differential diagnosis of the subtype. Furthermore, the differentiation of pituitary and ectopic ACTH-dependent Cushing syndrome should be carried out using measurement of ACTH. Finally, bilateral petrosal sinus sampling for ACTH with CRH administration might be a powerful tool for a diagnosis for ectopic ACTH syndrome. A variety of benign and malignant tumors of non-pituitary tissues have been associated with the ectopic ACTH syndrome. The tumors most commonly associated with ACTH syndrome arise from neuroendocrine tissues, however, the pathogenesis of the ectopic ACTH syndrome remains unknown.

ACTH Syndrome, Ectopic↗
PubMed2004

Relationship of high pretreatment folic acid level and failure of methotrexate in ectopic pregnancy: a pilot study.

OBJECTIVE: To test the hypothesis that high (> or =20.7 ng/mL) pretreatment serum folic acid level increases the failure of single-dose methotrexate for ectopic pregnancy. STUDY DESIGN: Twenty patients with ectopic pregnancy and measured pretreatment folic acid levels were divided into 2 groups based on pretreatment serum folic acid level (< or > or =20.7 ng/mL). All patients were candidates for single-dose methotrexate treatment. Variables analyzed in the 2 groups were pretreatment folic acid level, initial P-human chorionic gonadotropin (hCG) level, size of the ectopic mass, presence of fetal heart tones and clinical outcomes. RESULTS: Eleven patients had serum folic acid levels < and 9 > or =20.7 ng/mL. The mean (+/- SD) folic acid level was 13.4 ng/mL (+/- 3.2) in the group with folic acid levels <20.7 ng/mL, significantly lower than in the group with folic acid levels >20.7 ng/mL (p <0.001). The 2 groups were similar in initial hCG level, size of the ectopic mass and presence of fetal heart tones. The failure rate was significantly higher in the group with pretreatment serum folic acid levels > or = 20.7 ng/mL as compared to the group below (n = 4, 44%, vs. n = 0, 0%; p = 0.02). CONCLUSION: High pretreatment folic acid levels increase the risk of treatment failure with single-dose methotrexate.

Abortifacient Agents, Nonsteroidal↗