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PubMed1983

Direct diagnosis of unruptured ectopic pregnancy by real-time ultrasonography.

Real-time sonography was used in a prospective study of 32 patients as the sole diagnostic parameter for ectopic pregnancy. The minimal finding for diagnosis was an identifiable gestational sac with a circular pattern of echoes. Neither the presence or absence of an intrauterine sac nor the knowledge of either a positive or negative pregnancy test was used in the diagnosis. Among the 32 study patients, the diagnosis of ectopic pregnancy was made by sonography in nine (28.4%). Follow-up surgery confirmed the diagnosis in eight (89%). Among 23 patients with negative findings on sonography, only one was found on follow-up to have an ectopic pregnancy, for a 96% diagnostic accuracy for the negative group. Thus, of 32 patients with the potential diagnosis of ectopic pregnancy, 30 (94%) were correctly diagnosed using real-time sonography alone.

Female↗
PubMed1982

Chronic ectopic pregnancy.

Chronic ectopic pregnancy is often an enigma and a correct diagnosis is frequently not made until exploratory laparotomy. Hemodynamic stability, chronicity of symptoms, and a high incidence of false-negative pregnancy tests and culdocentesis results are clinical characteristics distinguishing it from the more common acute ectopic pregnancy. Dense adhesions and occasional abscess formation and surgical features that characterize the chronic ectopic pregnancy. Approximately 6% of ectopic pregnancies are chronic.

Adult↗
PubMed1982

Levels of human chorionic gonadotropin in unruptured and ruptured ectopic pregnancy.

Eighty-eight presenting with signs and symptoms that suggested ectopic pregnancy, all of whom had a positive radioreceptorassay (Biocept-G), were studied. Sixty-one patients (69%) were found to have intrauterine pregnancy. Twelve (14%) had unruptured tubal ectopic pregnancy with a mean (+/- SEM) human chorionic gonadotropin (hCG) level of 1190 +/- 320 mIU/ml, whereas 15 (17%) with ruptured ectopic pregnancies had a mean hCG level of 4160 +/- 400 mIU/ml. Among these 2 types of ectopic pregnancy, the mean hCG levels were statistically different (t = 5.0, P less than .001). Possible reasons for these differences are suggested, and the clinical implications of this finding are discussed.

Chorionic Gonadotropin↗
PubMed1981

Use of the radioreceptor assay for human chorionic gonadotropin in the diagnosis of ectopic pregnancy.

Since unrecognized ectopic pregnancy is a potentially lethal condition, there is a need for an accurate, rapid, sensitive and specific method for measuring low levels of human chorionic gonadotropin that may be observed in ectopic pregnancy. The Biocept-G test is a commercial modification of the radioreceptor assay for human chorionic gonadotropin. The test is performed in one hour and has a sensitivity of 200 milliinternational units of human chorionic gonadotropin per milliliter of serum. This study consisted of 15 patients with proved tubal ectopic pregnancies who were evaluated with the Biocept-G assay. All of the patients had a positive test result. By comparison, the two hour urine tube test result was positive in only eight and negative in seven patients. The two minute urine slide test result was positive in only six and negative in nine patients. The Biocept-G test was found to be simple to perform, quick and reliable, and the cost was comparable with that of the less accurate immunoassays. With the advent of the radioreceptor assay for human chorionic gonadotropin and the radioimmunoassays for the beta subunit of human chorionic gonadotropin, the presence of a positive pregnancy test result may be the most reliable diagnostic aid in helping to recognize early ectopic pregnancy.

Chorionic Gonadotropin↗
PubMedDate not supplied

Ectopic pregnancy: outcome of 152 cases.

Ectopic pregnancy is a common gynecological condition which usually presents with symptoms of acute abdomen. During the period 1976 to 1978, 152 cases of ectopic pregnancy were treated in our department. About one ectopic pregnancy was treated for every 100 infants delivered. Most of the cases were seen during summer time. Of the patients 43% were between 26 to 30 years of age. From their previous history, 47% reported one or more terminations of pregnancy and 33% recurrence of acute salpingitis. The majority of the ectopic pregnancies were located in the tube. Abdominal pregnancy was observed in three women, one of whom delivered, with the aid of laparotomy, a live infant. All the women reported pelvic pain, whereas shock appeared in only 23% of the cases. Culdocentesis gave false negative results in 14.15% of the cases. Preoperative diagnosis was based on laparoscopy in 28 cases. Dilatation and curettage (D and C) with endometrial biopsy disclosed decidual endometrium without chorionic villi in 37% and Arias-Stella cells in 68% of cases. Salpingectomy was performed in 52% of the cases, and plastic surgery of the tube in 16%.

Adolescent↗
PubMed1981

Discriminatory hCG zone: its use in the sonographic evaluation for ectopic pregnancy.

The most reliable ultrasonographic criteria for diagnosing ectopic pregnancy are based on the appearance of the uterus in the presence of a positive urine pregnancy test. The absence of an intrauterine sac signifies ectopic pregnancy, whereas its presence indicates intrauterine gestation. These criteria cannot be applied when serum pregnancy tests are used unless the serum human chorionic gonadotropin (hCG) level at which the sac of an intrauterine pregnancy becomes visible on ultrasound is known, because these tests are far more sensitive and identify pregnancy at an earlier stage than does sonar. In this study, the hCG level that distinguishes patients with intrauterine pregnancies in whom a gestational sac can be seen from those in whom it cannot be seen was determined and designated the discriminatory hCG zone. This zone lies between 6000 and 65000 mIU/ml. The absence of an intrauterine sac in conjunction with hCG values above this level signifies ectopic pregnancy; however, the absence of an intrauterine sac has no diagnostic significance when associated with hCG values below the discriminatory zone. An intrauterine sac associated with hCG levels above the discriminatory zone reliably indicates an intrauterine pregnancy, but at hCG values below the zone, it is suggestive of an abnormal pregnancy-either a missed abortion or an ectopic gestation.

Chorionic Gonadotropin↗
PubMed1994

[The role of serum beta-HCG levels for the diagnosis of ectopic pregnancy].

The study includes 56 cases of women admitted at Second gynaecology clinic of the University Maternity Hospital Sofia with evidence or suspicion of having an ectopic pregnancy who had their serum beta-HCG levels determined quantitatively. 27 of them showed no beta-HCG in their sera and none turned out to have pregnancy, neither intrauterine nor ectopic. All cases of ectopic pregnancies (a total of 20) were associated with detectable beta-HCG levels in the serum. The great diagnostic value of serum beta-HCG is emphasized in the cases of old disturbed ectopic pregnancies accompanied by mild and uncommon symptoms and very low beta-HCG levels. In case of unruptured pregnancies or tubal rupture the diagnosis is verified before the result is available by the clinical and sonographic data. On the other hand the high sensitivity of the method leads to an increased number of cases with elevated beta-HCG in which the location of the pregnancy cannot be proven. The precise quantitative evaluation of serum beta-HCG enables us to follow the tendency of beta-HCG which may according to the clinical manifestations warrant invasive diagnostic procedures or just observation without active interference.

Abortion, Spontaneous↗
PubMed1995

[Ectopic ovarian pregnancy].

Ovarian ectopic pregnancy is a rare form of ectopic pregnancy, with an estimated incidence ranging from 0.5% to 3% of the extrauterine pregnancies. For a correct diagnosis of the ovarian pregnancy, the traditional criteria proposed by Spiegelberg in 1878 must be fulfilled. This forced us sometimes to reject pregnancies which, despite being initially ovarian, during its evolution the adjacent tubal structures have been affected. Currently, the ectopic pregnancies are being diagnosed more early, mainly given the echographic advances, which have lead to very conservative treatments in order to avoid a reduced fertility. However, it is many times an intraoperative diagnosis. We present four new cases of ovarian ectopic pregnancy from our casuistry of the last three years with anatomoclinical study and literature review.

Adult↗
PubMed1995

[The evaluation of serum hormone levels (beta HCG, E2, P) and E2/P in diagnosis of early ectopic pregnancy].

27 cases of ectopic pregnancies (gestational period: 44 +/- 5d) and 33 cases of normal pregnancies (gestational period: 44 +/- 5d) as control groups were studied in our hospital from November, 1992 to May, 1994. The levels of serum hormone (beta HCG, E2, P) were measured in two groups by a radioimmunological method. The results were compared. The values of beta HCG, E2, and P in ectopic pregnancy group were significantly lower than in the control group (P < 0.01). The E2/P levels in ectopic pregnancy group were significantly higher than in the control group (P < 0.01). Our conclusion is that ectopic pregnancy may be due to the state of the higher E2 levels.

Adult↗
PubMed1994

Laparoscopic treatment of ectopic pregnancy. Residents' learning experience.

Although operative laparoscopy is a safe and effective method of treating ectopic pregnancy, its widespread acceptance requires appropriate operator training and experience. This retrospective study correlated operative results with experience of the resident performing surgery. Thirteen postgraduate year 3 and 4 gynecology residents treated 60 ectopic pregnancies by laparoscopy. There were four complications: two cases of atelectasis and two of persistent human chorionic gonadotropin titers. There were no blood transfusions. We found that the duration of surgery decreased as operator experience increased, and residents who had experience with five or more cases required a mean operative time of 74 minutes. We conclude from our results that the minimal amount of supervised training necessary for gynecology residents to safety and expeditiously treat ectopic pregnancy laparoscopically is five cases. Furthermore, the minimal morbidity in this study supports our continued recommendation that each resident have prior training experience of at least 10 laparoscopic sterilizations before attempting his or her first case of ectopic pregnancy.

Clinical Competence↗
PubMed1993

[New perspectives in the ablation of ectopic atrial tachycardia and atrial flutter].

The first experiences on non-pharmacological treatment of ectopic atrial tachycardia (EAT) and common atrial flutter (AFl) were performed by surgical techniques. The surgical abolition of EAT comprised the isolation, the excision or the cryoablation of the ectopic atrial foci using electromapping guide. The AFl was treated by extensive cryoablation of the slow conduction area responsible for the macroreentrant process located in the infero-posterior part of the right atrium (RA). Transcatheter ablation with DC-shock for the treatment of EAT was proposed in 1985 but the technique did not gain wide acceptance due to its risks. The same method was utilized for the treatment of AFl since 1987. Many preliminary studies reported on the use of transcatheter ablation with radiofrequency (RF) current as an energy source since 1992 and no major complications were encountered. According with our knowledge, 81 cases of permanent or iterative EAT were treated by RF in the world with a primary success rate superior than 90%. The low rates of recurrence are reported very early (within 24-48 hours) after the procedure; recurrencies are very easy to recognise and they are successfully ablated in a second session. Cases of EAT due to an ectopic focus localized in the RA are ablated from the superior or inferior vena cava approaches and cases of EAT related to a left atrial (LA) ectopic focus by a trans-septal approach (persistent foramen ovale or atrial septum puncture). On the basis of our personal experience regarding 7 cases (4 LA and 3 RA foci) the role of unipolar leads derived from the mapping catheter appears essential to select the target for RF applications.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1993

Ectopic pregnancy. Diagnostic and therapeutic algorithms minimizing surgical intervention.

Presented are the results of a diagnostic algorithm for ectopic pregnancy incorporating history, physical examination, quantitative human chorionic gonadotropin (hCG), serum progesterone, color-flow vaginal Doppler sonography and endometrial curettage as well as a treatment algorithm combining expectant, medical and surgical management. These algorithms resulted in: (1) earlier diagnosis of ectopic pregnancy, with fewer ruptured ectopic pregnancies; (2) virtual elimination of diagnostic laparoscopy; (3) elimination of culdocentesis; (4) greater use of methotrexate; and (5) increased use of expectant (i.e., nonsurgical and nonmedical) treatment. These algorithms are potentially applicable in other clinical settings and should be considered for use on at-risk populations or when the diagnosis of ectopic pregnancy is in question.

Algorithms↗
PubMed1993

Sudden death due to rupture of ectopic pregnancy concurrent with therapeutic abortion.

We report three cases of sudden death resulting from internal hemorrhage associated with the rupture of an ectopic pregnancy. In each case, the woman had undergone therapeutic abortion before death. The ectopic pregnancies, however, were not suspected or identified before the women left the treatment facility. Subsequently, all three women suffered fatal rupture of a tubal pregnancy and associated massive intraperitoneal hemorrhage during the postabortive period (range, 14 to 32 days). Our investigation of these cases has identified the lack of standardized procedures for the adequate monitoring of tissue recovered during therapeutic abortion. Such monitoring could have resulted in identification of the ectopic pregnancy and possibly led to successful intervention. We discuss the causes and risks of failure to diagnose ectopic pregnancy during the postabortive period.

Abortion, Therapeutic↗
PubMed1993

Ectopic pregnancy.

The incidence of ectopic pregnancy in the United States is increasing annually and is approaching epidemic proportions. Serum progesterone measurements show promise for the early detection of abnormal gestational development. Unfortunately, examination of serum progesterone levels does not allow discrimination between an ectopic pregnancy and an intrauterine abortion. Additionally, discriminatory levels of progesterone fail to include all abnormal gestations in the abnormal group (false-negative result) and classify some normal pregnancies to the abnormal group (false-positive result). As such, no discriminatory level of progesterone has been identified that can diagnose abnormal gestations. Instead, the value of progesterone appears to be its ability to predict a gestational complication, in much the same fashion as human chorionic gonadotropin doubling times. The advantage of progesterone appears to be that a single test of serum progesterone during the first 8 weeks of pregnancy is as predictive as serial human chorionic gonadotropin measurements. Clearly, future investigations into early gestational complications will focus on testing procedures that can discriminate between an intrauterine first-trimester demise and an ectopic pregnancy. Medical treatment for ectopic pregnancy is dependent on early diagnosis and is not yet widespread. Prostaglandin F2 alpha and methotrexate continue to be effective agents and demonstrate approximately 95% efficacy. Reproductive performance after medical therapy is comparable to reproductive performance after surgical therapy, but the duration of time until cure is longer in patients treated medically than in those treated surgically. Nomograms for human chorionic gonadotropin surveillance after surgical treatment have now been described, but not such data exists for surveillance after medical therapy.(ABSTRACT TRUNCATED AT 250 WORDS)

Chorionic Gonadotropin↗
PubMed1993

[Ectopic teeth in the area of the paranasal sinuses].

In contrast to dentogenious affections of the sinus maxillaris ectopic or supernumerary teeth in the paranasal sinuses are seldom. Ectopic teeth located at the ostium of the sinus maxillaris are rare, intranasal teeth are very rare and ectopic/supernumerary teeth in the sinus etmoidalis are a curiosity. We report about two patients with such ectopic teeth. A 55 year old woman had a rootless tooth in her right sinus ethmoidalis which had caused a "pseudopolyposis" with consecutive nasal airway obstruction and severe headache. A 59 year old man had ectopic teeth in both sinus maxillaris which obstructed the left ostium, causing dumbness of the left cheek and severe headache. Both patients have been cured by operation. However the presented patients demonstrate that even elaborated radiological efforts could not prove diagnosis. The etiology, diagnostical steps and treatment of these teeth are discussed. The surrounding soft tissue should be examined histologically after resection of such a tooth to prevent the development of a residual cyst and to notice the extremely rare development of malignancies deriving from the highly potential tissue of the dental follicle.

Diagnosis, Differential↗
PubMed1993

Ectopic corticotropin syndrome and small-cell carcinoma of the lung. Clinical features, outcome, and complications.

BACKGROUND: Ectopic corticotropin syndrome is a rare complication of small-cell lung cancer (SCLC). There is little information concerning this syndrome available in the literature. We therefore reviewed all cases of ectopic corticotropin syndrome seen at our institution during a 20-year period. METHODS: Cases were identified by searching a computerized database and reviewing the charts of all 840 patients with SCLC seen between 1971 and 1991. Patients were included if they met at least two of the following criteria: spontaneous hypokalemia (potassium level, < 3.2 mmol/L); plasma cortisol level greater than 600 nmol/L; 24-hour urinary free cortisol level greater than 400 nmol/d; and plasma corticotropin level greater than 22 pmol/L. Data were abstracted from the patients' medical records. RESULTS: Of 840 patients with SCLC, 14 (1.6%) had ectopic corticotropin production. This was diagnosed at the time of presentation with SCLC in seven patients and from 3 to 19 months later in the remainder. Five patients had limited disease and nine had extensive disease. One or more features of Cushing's syndrome were observed in 57% of patients, but the entire syndrome occurred rarely. Spontaneous hypokalemia was present in all patients, and 10 patients (71%) had hyperglycemia. There were two complete responses and one partial response to chemotherapy, giving an overall response rate of 21%, and the median survival was 5.5 months. Ten patients died of progressive growth of tumor, while three patients died of infections. In one other patient, infection probably contributed to death. A high rate of nonfatal infections was also seen. CONCLUSIONS: The occurrence of SCLC with ectopic corticotropin syndrome is associated with poor survival, and a high incidence of infective complications, in patients treated with chemotherapy.

ACTH Syndrome, Ectopic↗
PubMed1993

Reproductive outcome after 143 laparoscopic procedures for ectopic pregnancy.

OBJECTIVE: To analyze reproductive outcome after laparoscopic procedures for ectopic pregnancy, with particular attention to laparoscopic salpingectomy. METHODS: In a 260-physician multispecialty clinic in the rural upper midwestern United States, 143 patients were followed prospectively after undergoing laparoscopic procedures for ectopic pregnancy. Ninety-five who sought further pregnancies during the study period were analyzed for reproductive outcome. Intrauterine pregnancy rates were compared by age, parity, size of ectopic gestation, and evidence of prior tubal damage. Life table analysis was also performed. RESULTS: The overall intrauterine pregnancy rates for laparoscopic salpingostomy (60%) and laparoscopic salpingectomy (54%) were not significantly different from each other. However, intrauterine pregnancy rates differed significantly by history of prior tubal damage. The pregnancy rate was 79% among women without tubal damage and 42% among women with damage. CONCLUSIONS: Our intrauterine pregnancy rates after both laparoscopic salpingectomy and laparoscopic salpingostomy are similar to those reported in the literature for similar procedures performed at laparotomy. In predicting pregnancy outcome after laparoscopic procedures for ectopic pregnancy, the major variable seemed to be evidence of prior tubal damage. With no evidence of previous damage, we found similarly high pregnancy rates for laparoscopic salpingostomy and salpingectomy.

Adult↗
PubMed1977

Maternal mortality due to ectopic pregnancy. A review of 102 deaths.

Ectopic pregnancy represents an increasing proportion of direct maternal deaths which has reached 10%. Between 1950 and 1974 there were 102 deaths from early ectopic pregnancy reviewed by the Michigan Maternal Mortality Committee. These cases were analyzed by status on admission and compared to a control series treated at a medical center. Patients with ectopic pregnancy were older than women delivering live infants. There were no differences in age, gravidity, or parity between the study patients and controls. The study patients were slightly further advanced in pregnancy. Pain was the major presenting symptom. Marked delays occurred between first symptom, first consultation, and diagnosis. Seventy-five percent of the deaths were considered preventable. Hemorrhage was the leading cause of death. The estimated mortality of ectopic pregnancy is between 2 and 4/1000.

Adult↗