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[Comparison of the intensity of the effect of ethmozine and its diethylamine analog on the ectopic foci of excitation at the late stage of experimental myocardial infarct].

The atrioventricular block was produced in dogs 24 hours after the occlusion of the left descending coronary artery by formalin injection into the atrioventricular node or the bundle of His. The intensity and duration of the ectopic foci inhibition produced by ethmozine and by its diethylamine analogue (ethmozine DAA) were compared. It was shown that intravenous infusion of 3 mg/kg ethmozine reduced the frequency of the ectopic ventricular excitations by 28% (n = 6), 0.5 mg/kg ethmozine DAA - by 46% (n = 7), and 1 mg/kg ethmozine DAA - by 78% (n = 8). In 50% of the animals 1 mg/kg ethmozine DAA completely suppressed the ectopic activity. Duration of the drugs action was determined by the time necessary for the attainment of 50% of the maximal effect in the inhibition of ectopic exitation frequency (for 3 mg/kg ethmozine it was 32.7 +/- 2.5 min, for 0.5 mg/kg ethmozine DAA - 5.1 +/- 7.2 min, and for 1 mg/kg ethomozine DAA - 55.0 +/- 9.8 min). The results obtained suggest that the ethmozine DAA action is more intensive and of longer duration than ethmozine, and effective at the late stage of experimental myocardial infarction.

Animals↗

Anti-arrhythmic agents in ischemic heart disease: supraventricular arrhythmias, digitalis toxicity and chronic stable ventricular ectopic beats.

Digoxin remains a very useful agent for chronic atrial fibrillation or for the ectopic beats associated with heart failure. But when rapid control of the ventricular rate is required to arrhythmias such as atrial fibrillation, atrial flutter, or paroxysmal atrial tachycardia, a slow infusion of verapamil is the agent of choice. In general, verapamil may be added to digoxin or given intravenously while a digoxin effect is awaited, unless there is digitalis toxicity. In digitalis toxicity, lignocaine remains the agent of choice for ventricular arrhythmias, and is given in the same doses as for acute myocardial infarction; phenytoin is used for digitalis-arrhythmias with A-V block. Verapamil may be infused very cautiously for digitalis-induced supraventricular tachyarrhythmias. The use of oral agents such as quinidine, disopyramide and mexilitene for chronic prophylaxis of ventricular ectopic beats is of doubtful effectiveness, unless the ectopic activity is symptomatic. Serious ventricular arrhythmias may be induced by quinidine and disopyramide. Beta-blockade is especially useful for ectopic beats associated with anxiety, or when arrhythmias are associated with angina of effort or hypertension. As always, major contraindications to the use of beta-blockade include cardiomegaly, heart failure or asthma.

Aged↗

[Immediate reconstructive surgery in the treatment of ectopic pregnancy (author's transl)].

In cases of non ruptured tubal ectopic pregnancy, the first results of immediate reconstructive surgery demonstrate the need to give up classical salpingectomy, and the possibility of avoiding a second laparotomy. The technique used in this series of six unruptured ectopic pregnancies of the ampulla consisted in a subserous enucleation-excision of the ectopic ovum with end-to-end anastomosis on a polyethylene wire, followed by early hydrotubations. Hysterosalpingographic controls performed 3 months after the operation showed in all six cases bilateral passage and peritoneal spill of the contrast medium. Three patients have at the time of writing intrauterine pregnancy (16, 22 and 33 weeks old). Thus the anatomical integrity of the fallopian tubes could be restored in every case, as early as the emergency laparotomy for suspicion of unruptured ectopic pregnancy confirmed by laparoscopy. No early or late postoperative complications occurred in this series.

Adult↗

[Suprasellar ectopic pituitary adenoma: report of a case].

An extremely rare case of an ectopic pituitary adenoma in the suprasellar region is reported. A 57-year-old man was referred to us in March, 1993, because of bitemporal hemianopsia. Magnetic resonance imaging (MRI) and computed tomography (CT) revealed a well-circumscribed enhancing mass in the suprasellar region. Sagittal tomography of the skull showed normal-sized sella turcica. Endocrinological tests were almost within normal range. The tumor was totally removed by combined right subfrontal and interhemispheric approach. At the time of the operation, we confirmed that the tumor did not continue to the pituitary gland and that the diaphragma sellae was intact. Histological diagnosis of the tumor specimen was pituitary adenoma. Post-operative MRI showed a normal pituitary gland, thus supporting the diagnosis of ectopic pituitary adenoma. To our knowledge, only ten cases of suprasellar ectopic pituitary adenoma have been reported, including our case. Pathogenesis of ectopic pituitary adenoma was briefly discussed.

Adenoma↗

Ectopic thyroid gland simulating a thyroglossal duct cyst: a case report.

There have been many reports of the inadvertent removal of an ectopic thyroid gland that was mistaken for a thyroglossal duct cyst. The differentiation of these two conditions is extremely important, because inadvertent removal of an ectopic thyroid gland may result in profound hypothyroidism. The authors report the case of a 5-year-old girl with an ectopic thyroid gland in whom the preliminary diagnosis was a thyroglossal duct cyst. They review the embryologic features in the development of an ectopic thyroid gland and discuss an approach to the management of this congenital anomaly.

Child, Preschool↗

[Congenital midureteral stricture with ectopic ureter: a case report].

A 7-year-old girl was hospitalized with urinary incontinence. Intravenous pyelography showed the dilatation of upper segment of the right kidney, in which slight radioisotopic accumulation was detected on renal scintigraphy with 99mTc-DMSA. On computerized tomographic (CT) scan, a cystic mass shadow occupied the retroperitoneal space. During surgery, the right kidney was found to be completely duplicated and the ectopic ureter opened in Vestibule vaginae accompanied with midureteral stricture. The ectopic ureter was incised above the strictural site and anastomosed with the ureter of the lower segment. Although approximately 700 cases of ectopic ureter have been reported in Japan, congenital midureteral stricture accompanying ectopic ureter is extremely rare.

Child↗

Thyrotoxicosis complicated by ectopic pregnancy. First reported case.

The reported incidence of thyrotoxicosis during pregnancy ranges from 0.02% to 3.7%, with an average of 0.2%. Ectopic pregnancy occurs in 1 of 66 pregnancies in the United States. The signs and symptoms of thyrotoxicosis complicate the diagnosis and surgical management of an ectopic pregnancy. This is the first reported case of thyrotoxicosis complicated by an ectopic pregnancy. The patient presented with a surgical abdomen (in this case an ectopic pregnancy) coupled with thyrotoxicosis. The combination of prompt presurgical medical intervention and operative correction prevented the mortality associated with a ruptured tubal pregnancy and thyroid storm.

Adult↗

Ectopic pregnancy and first trimester abortion.

A total of 41,753 first-trimester abortions were done over a 4-year period at two Planned Parenthood centers, among which 11 verified cases of ectopic (tubal) pregnancy were discovered. Elective abortion provides an opportunity for the diagnosis of unruptured ectopic pregnancy. Pathologic examination of tissue specimens is important in suggesting the presence of an ectopic gestation. Patients who become pregnant with an intrauterine device in place are at higher risk for an ectopic pregnancy.

Abortion, Legal↗

The ambulatory patient with ectopic beats and episodic tachyarrhythmias.

Ventricular ectopic activity in a young person with an otherwise normal heart usually requires no treatment. In older patients, 10 or more ectopic beats per minute, multiform beats and ectopy occurring close to the preceding beat are indications for drug control. Exercise-induced ectopic beats may respond to physical training. Three or more consecutive ventricular ectopic beats constitute ventricular tachycardia, which requires prevention. Supraventricular tachyarrhythmias, when paroxysmal, may be aborted by maneuvers to enhance vagal tone. When they are frequent, treatment is required.

Adult↗

[Ectopic prostatic tissue in the bladder].

A 55-year-old man with a 5-year history of microhematuria had a whitish sessile tumor at the ureteric ridge containing benign prostatic glandular tissue. The presence of benign prostatic polyps in the prostatic urethra is a common finding, but ectopic prostatic tissue elsewhere is rare, it has been described previously in a few cases in the trigonum. The origin of prostatic glands in this unlikely location is not yet fully understood. Prostatic tissue at any ectopic location is benign, although local recurrence has been reported. We reviewed 43 cases of ectopic prostatic tissue, 7 of which occurred in bladder include our case, reported in the Japanese literature. Ectopic prostatic tissue should be considered in the differential diagnosis of hematuria in the male.

Choristoma↗

Technetium-99m-methoxyisobutylisonitrile in localization of ectopic parathyroid adenoma.

Preoperative localization of ectopic parathyroid lesions is crucial for the correct treatment of patients with primary hyperparathyroidism. Invasive and noninvasive procedures, including selective venography, ultrasound, CT and MRI provide limited sensitivity in the detection of ectopic lesions. We report three patients in whom 99mTc-MIBI scintigraphy accurately detected ectopic parathyroid adenomas and was instrumental in the cure for these patients. Technetium-99m-MIBI scintigraphy provides a simple and accurate noninvasive test for the detection of ectopic parathyroid adenomas.

Adenoma↗

Ectopic parathyroid adenoma with severe hungry bone syndrome: a case report.

The presentation rate of ectopic mediastinal parathyroid adenoma is about 5 approximately 22%. Ectopic parathyroid adenoma is a common etiology of failed parathyroid surgery as well as a diagnostic challenge to clinicians. We reported a case of ectopic mediastinal parathyroid adenoma. A 20-year-old girl presented with arthralgia for 2 years before hyperparathyroidism was diagnosed. Parathyroid ultrasonography failed to find the lesion, but a vivid uptake in the superior mediastinum was discovered by thallium-201 (Tl-201) and technetium-99m-sestamibi (Tc-99m-MIBI) images. Removal of the ectopic adenoma resulted in severe Hungry bone syndrome, which required a large amount of calcium and phosphorous supply. Later, the patient suffered from bilateral femoral neck fracture due to marked osteoporosis. Bone mineral density study revealed marked increase of fracture risk. Although bone disorder is rare in cases of hyperparathyroidism nowadays, it still should be considered in patients with arthritis of unknown etiology like our case. Early diagnosis and treatment can reduce the morbidity.

Adenoma↗

Ectopic G-CSF expression in human melanoma lines marks a trans-dominant pathway of tumor progression.

Using a human melanoma/Scid xenograft model with the C8161, M24-met, LD-1 and other human melanoma lines to investigate spontaneous metastasis, we made the observation of marked splenomegaly (up to five times normal weight and size) in only those xenografts exhibiting high degrees of spontaneous metastasis. Evaluation of this revealed the cause to be massive myelopoiesis due to ectopic granulocyte/ colony-stimulating factor (G-CSF) production by the melanoma cells. Because of these observations linking G-CSF expression with metastasis of human melanoma, we decided to investigate the mechanism of this ectopic production. No gross amplification or rearrangement of the G-CSF gene could be detected as the basis for the increased transcriptional activity in any of these lines. Human-human somatic cell hybridization studies carried out between the metastatic C8161 and several different nonmetastatic non-G-CSF-expressing lines revealed, in addition to metastatic dominance, 3- to 10-fold enhancement of G-CSF transcription and expression in the fusions compared with C8161 itself. The suggestion of a trans-dominant mechanism was further supported by transfection studies with a human G-CSF promoter-CAT-reporter construct, which revealed 3- to 5-fold increased reporter activity in only those melanoma lines and hybrids expressing G-CSF. Furthermore, no obvious autocrine or paracrine effects of this ectopic G-CSF expression on the melanoma lines' growth or metastasis were apparent, as all of the G-CSF-expressing lines lacked the G-CSF receptor and injections of purified recombinant G-CSF exerted no stimulatory effects on their tumorigenicity, latency, growth, or metastasis in Scid mice. Thus, we advance the hypothesis that G-CSF expression is serving as a marker of a more generalized trans-dominant pathway linked to tumor progression and metastasis. This hypothesis has direct relevance to many human cancers where ectopic hormone or growth factor production occurs with no obvious autocrine or paracrine benefit to the tumor.

Animals↗

[Ectopic thyroid and late-onset functional deficit of the thyroid gland].

PURPOSE: To evaluate retrospectively the incidence of ectopic thyroid gland causing hypothyroidism in patients referred to "Di Venere" Hospital, Bari. PATIENTS AND METHODS: Over a period of 14 years, ectopic thyroid gland has been detected by thyroid scan in 56 out of 122 patients with hypothyroidism due to congenital thyroid abnormalities. Of these 56 patients, 48 were < 1 year old, 2 were < 2 years old, while 8 with late onset of the disease were 7 to 35 years old. RESULTS: Among the eight patients with late onset hypothyroidism, 3 had normal serum levels of thyroid hormones at birth. Overall, an ectopic thyroid gland was observed in 6 out of 32 (18.7%) patients with hypothyroidism beginning between 2.5 and 14 years of age. CONCLUSIONS: Thyroid scan is a safe and effective procedure in the diagnosis of ectopic thyroid gland in neonatal patients. It should be recommended as neonatal screening in order to prevent irreversible damage to central nervous system.

Adolescent↗

Molar pregnancy--associated ectopic decidua: report of a case and review of the literature.

Ectopic or extrauterine decidual transformation is regularly associated with pregnancy. This phenomenon has been observed most often in the ovary and cervix. Sporadic reports have documented decidua formation of peritoneal surfaces, lymph nodes and other organs in pelvic and abdominal cavity. Molar pregnancy-associated ectopic decidua has never been documented. We report the case of ectopic decidua at posterior surface of uterus, near the cul de sac, in a 45-year-old woman with molar pregnancy. The article review reveals that it is the first report of molar pregnancy-associated ectopic decidua.

Decidua↗

Ectopic ureter draining into seminal vesicle cyst: usefulness of MRI.

Ectopic ureter draining into seminal vesicle cyst is very rare congenital anomaly, which is thought to be caused by ectopic ureteral bud arising on the mesonephric duct. It is often associated with ipsilateral renal agenesis. We experienced a case of ectopic ureter draining into seminal vesicle cyst that is associated with ipsilateral renal agenesis. Generally, an invasive modality, that is, cyst puncture, cystography, or seminal vesiculography, is essential in the confirmative diagnosis of ectopic ureter. However, we could establish a definitive diagnosis with magnetic resonance imaging.

Adult↗

Ectopic ossification after hip arthroplasty.

The incidence of radiographically visible ectopic ossification around the hip joint was redorded in 145 hip joints of 132 patients treated by endoprosthetic replacement. There were 56 total hip replacements with a McKee-Farrar and 39 with a Brunswik type of endoprosthesis; in a further 50 hips the femoral head was replaced with a Moore or Thompson prosthesis. An identical antero-lateral surgical approach was used in all, without detachment of the greater torchanter. The patients were re-examined 3, 6, and12 months after the operation. The extent of ectopic ossification was graded from 0 to III and correlated with pain and with the function and mobility of the operated hip. Ectopic ossification of varied extent was recorded in 37 % after total hip replacement and in 38 % after replacement of the femoral head. Of these ossifications 95 % were recognizable within 3 months; they did not increase in size, but often in density during the following months. One case of bony ankylosis was noted. Ectopic ossification of slight (grade I) to moderate (grade II) degree did not cause pain or affect the function of the operated hip, but reduced the mobility of the affected hip. The difference in mobility between grade I and grade II was significant (p less than 0.05), and between grade 0 and grade II highly significant (p less than 0.001).

Aged↗

[99mTc pertechnetate scintigraphy and premedication for the search for ectopic gastric mucosa in Meckel's diverticulum].

BACKGROUND: Meckel's diverticulum (MD) is the most common anomaly of the large intestinal tract (1-3%) and is more frequent in children (62% < 2 years) and in males (66%). It often involves ectopic gastric mucosa which manifests through gastrointestinal bleeding in 50% of cases. 99m-Technetium scintigraphy (99mTcO4) is one of the procedures available for the non-invasive diagnosis of ectopic gastric mucosa. METHODS: Twenty-eight patients (11 females, 17 males), including 16 children and 12 adults, aged 8 months-80 years old, were included in the study. The patients were admitted to hospital for hematochezia and melena (22) associated with abdominal pain (5): 3 patients repeatedly presented occult blood in their stools. Two patients only suffered from abdominal cramps and one only anemia. Patients were studied using plain abdominal radiographs and ultrasound; 10 underwent gastroscopy and colonoscopy; radiological contrast studies were performed in 5 patients. All tests were inconclusive. All the patients were premedicated with oral cimetidine (20 mg/kg in pediatric patients and 300 mg q.i.d. for adults, 48 hours before the test) or with ranitidine i.v. (1 mg/kg, max 50 mg, in 20 minutes, one hour before the test); barium meals and colonoscopy were deferred for 2-3 days after examination. An intravenous injection of 37-180 Mbq of 99mTcO4 was given followed by a dynamic study of the abdomen in anterior projection. Images were acquired for one hour or until the visualisation of abnormal foci of intake: in this case, lateral and oblique images were acquired for a better localisation of the suspicious area. Some patients were administered furosemide i.v. (0.75 mg/kg). All underwent a follow-up period of 12 months. RESULTS: Pertechnetate scintigraphy was positive in 10 cases and the presence of ectopic gastric mucosa was confirmed by surgery. The study was negative in 18 cases: 3 of them were discharged with a diagnosis of Salmonella infection, polyp of the small bowel or ulcer of the large bowel respectively; the other 15 patients did not show symptoms of onset during follow-up. CONCLUSIONS: These results confirm the high diagnostic accuracy of pertechnetate scintigraphy to detect ectopic gastric mucosa if associated with H2-receptor-blocking agent premedication.

Adolescent↗