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At least 1,369 records · Page 76Linked to original sources
PubMed1996

Is maternal serum creatine kinase actually a marker for early diagnosis of ectopic pregnancy?

OBJECTIVE: Our purpose was to investigate whether serum creatine kinase (CK) levels could be used as an early marker of ectopic pregnancy. Student's t-test was used for statistical analysis. STUDY DESIGN: In a prospective study we therefore measured serum progesterone, beta hCG and CK levels in 30 women with ectopic pregnancies, 30 women with ongoing pregnancies and 30 women with missed abortion. RESULTS: The mean serum CK concentration for patients with an ectopic pregnancy, ongoing pregnancy, and the women with missed abortion was 81.4 +/- 66.2, 81.5 +/- 40.3, 84.8 +/- 49.3, respectively. No relationship was found between CK level and the location of the pregnancy. CONCLUSION: Conversely to the first report of Lavie et al. (Am J Obstet Gynecol 1993; 169: 1149), our data suggest that serum CK level is not discriminative in the early diagnosis of tubal pregnancy.

Abortion, Missed↗
PubMed1980

Is the evidence for ectopic antidiuretic hormone watertight?

The clinical syndrome of inappropriate secretion of antidiuretic hormone (SIADH) associated with malignancy cannot be distinguished from a similar metabolic abnormality found in patients with non-malignant conditions. It is, nevertheless, widely accepted that SIADH associated with malignancy is due to the "ectopic" tumour production of arginine vasopressin (AVP). This view is challenged after scrutiny of available data. Since some malignant or non-malignant tissues may produce neurophysins, the presence of "ectopic" AVP in tumour tissue may be explained by active binding of AVP from the circulation by neurophysins. On the other hand, the absence of detectable AVP in tumour accompanied with SIADH suggests excess AVP secretion from the posterior pituitary or hyponatraemia due to other, as yet unidentified, antidiuretic factors. The concept of "ectopic" AVP may be false.

Arginine Vasopressin↗
PubMed1993

Ruptured ectopic pregnancy after medical management: current conservative management strategies.

A case of hypotension caused by hemorrhage in a patient receiving systemic methotrexate to treat a known ectopic pregnancy is presented. A primary goal of gynecologic practice in the 1990s is to conserve tubal patency and fertility. Consequently, ectopic pregnancy is more frequently being managed by conservative strategies. The emergency physician must be familiar with conservative methods for the management of ectopic pregnancy and the complications that may cause emergency presentations in these patients.

Adult↗
PubMed1987

The clinical management of ectopically erupting first permanent molars.

The literature on ectopically erupting first permanent molars is reviewed. The progression of the ectopic condition is discussed along with factors that will affect the practitioner's decision on a mode of treatment. The optimal treatment approach depends on the clinical eruption status of /6/, the change in position of /6/, the amount of enamel ledge of /E/ entrapping /6/, the mobility of /E/, and the presence of pain or infection. A variety of treatment approaches together with diagnostic rationale and clinical guidelines are presented. Overall aspects of the malocclusion must be considered when planning the management of ectopically erupting first permanent molars.

Child↗
PubMed1995

Colonic adenocarcinoma associated ectopic ACTH secretion: a case history.

A 57-year-old woman developed features of Cushing's syndrome after resection of a Duke's C adenocarcinoma of the sigmoid colon. Biochemical and endocrine investigation indicated ectopic production of adrenocorticotrophic hormone (ACTH) as the cause for her condition. Hepatic metastases were detected by computed tomography (CT) scan. Histology of the original tumour displayed neuroendocrine characteristics but no definite evidence of ACTH synthesis. Treatment was instituted to control her hypercortisolism, and chemotherapy initiated to reduce the production of ectopic hormone. A clinical, biochemical and radiological response was obtained with complete resolution of her Cushing's syndrome. The tumour relapsed after several months with distant metastases, but no further endocrine abnormality was noted. A review of ectopic ACTH producing adenocarcinoma is given along with a discussion of the major pathological and therapeutic features of the case.

ACTH Syndrome, Ectopic↗
PubMed2004

Leukemia inhibitory factor and homeobox a10 gene expression in an ectopic pregnancy model for implantation.

OBJECTIVE: We investigated the expression of leukemia inhibitory factor and homeobox a10 in endometrium that was derived from patients with concurrent ectopic pregnancies compared with nonpregnant luteal phase endometrium from the same patients. STUDY DESIGN: Endometrial biopsy specimens that were obtained from women (n=3) who underwent surgery for ectopic pregnancy were matched with biopsy specimens in a nonpregnant luteal phase from the same patients. Quantitative reverse transcription polymerase chain reaction for leukemia inhibitory factor and homeobox a10 was performed. Polymerase chain reaction products were assayed with laser detection of nanogram quantities of complementary deoxyribonucleic acid. Ratios of each implantation marker to glyceraldehyde-3-phosphate dehydrogenase as an internal standard were compared for quantification. RESULTS: Leukemia inhibitory factor expression is increased in endometrium from ectopic pregnancy; homeobox a10 is increased in luteal phase endometrium. CONCLUSION: Leukemia inhibitory factor appears to be regulated by human chorionic gonadotropin or other factors of pregnancy; homeobox a10 is regulated by ovarian steroids of the luteal phase.

Biomarkers↗
PubMedDate not supplied

Report of two cases of uterus didelphys and rare ectopic (cornual and cervical) pregnancies.

Two cases of rare ectopic pregnancies are presented, both with underlying uterine didelphys anomaly. Uterine anomalies are a well-known predisposing factor for ectopic pregnancies. Detection of the uterine anomaly is crucial in the choice of treatment of an ectopic pregnancy as well as planning of future pregnancies. Magnetic resonance is helpful in diagnosing and defining the uterine anomaly (Saleem S. MR imaging diagnosis of uterovaginal anomalies: current state of the art. Radiographics 2003; 23:e13) that should be suspected by ultrasound.

Adult↗
PubMed2005

Hyperadrenocorticism in a dog due to ectopic secretion of adrenocorticotropic hormone.

Spontaneous hyperadrenocorticism in dogs is known to be the result of excessive secretion of adrenocorticotropic hormone (ACTH) by the pituitary gland or excessive autonomous glucocorticoid secretion by an adrenocortical tumor. Here, we report on an 8-year-old German shepherd dog in which ACTH-dependent hyperadrenocorticism was a result of ectopic ACTH secretion and could be related to an abdominal neuroendocrine tumor. Hyperadrenocorticism was diagnosed on the basis of the history, clinical signs, and elevated urinary corticoid/creatinine ratios (UCCRs; 236 and 350 x 10(-6); reference range < 10 x 10(-6)). The UCCR remained elevated (226 x 10(-6)) after three oral doses of dexamethasone (0.1 mg/kg body weight) at 8-h intervals. Ultrasonography revealed two equivalently enlarged adrenal glands, consistent with adrenocortical hyperplasia. Plasma ACTH concentration was clearly elevated (159 and 188 ng/l; reference range 5-85 ng/l). Computed tomography (CT) revealed that the pituitary was not enlarged. These findings were interpreted as indicating dexamethasone-resistant pituitary-dependent hyperadrenocorticism. Transsphenoidal hypophysectomy was performed but within 2 weeks after surgery, there was exacerbation of the clinical signs of hyperadrenocorticism. Plasma ACTH concentration (281 ng/l) and UCCRs (1518 and 2176 x 10(-6)) were even higher than before surgery. Histological examination of the pituitary gland revealed no neoplasia. Stimulation of the pituitary with corticotropin-releasing hormone did not affect plasma ACTH and cortisol concentrations. Treatment with trilostane was started and restored normocorticism. CT of the pituitary fossa, 10 months after hypophysectomy, revealed an empty sella. Hence, it was presumed that there was ectopic secretion of ACTH. CT of the abdomen revealed a mass in the region of the pancreas and a few nodules in the liver. Partial pancreatectomy with adjacent lymph node extirpation was performed and the liver nodules were biopsied. Histological examination revealed a metastasized neuroendocrine tumor. Abdominal surgery was not curative and medical treatment with trilostane was continued. At 18 months after the abdominal surgery, the dog is still in good condition. In conclusion, the combination of (1) severe dexamethasone-resistant hyperadrenocorticism with elevated circulating ACTH levels, (2) definitive demonstration of the absence of pituitary neoplasia, and (3) an abdominal neuroendocrine tumor allowed the diagnosis of ectopic ACTH secretion.

ACTH Syndrome, Ectopic↗
PubMed2006

Prompt diagnosis of ectopic pregnancy with the human chorionic gonadotropin test using exuded extract from endometrial curettings.

Using saline solution including exuded extract from uterine curettings, hCG tests were performed in 63 women in whom there was a suspicion of ectopic pregnancy, and their results correlated highly with the microscopic existence of chorionic villi and trophoblasts. Ectopic pregnancy can be mostly excluded when the test is positive, and either ectopic pregnancy or complete abortion is probable when it is negative.

Adult↗
PubMed2006

Use of "2-dose" regimen of methotrexate to treat ectopic pregnancy.

OBJECTIVE: To evaluate the safety and acceptability of a novel dosing regimen of methotrexate to treat ectopic pregnancy. DESIGN: Prospective study. SETTING: Three academic medical centers. PATIENT(S): One hundred one patients with ectopic pregnancy who elected to have medical therapy. INTERVENTION(S): Intramuscular methotrexate 50 mg/m(2) was administered on days 0 and 4; additional doses of methotrexate were given on day 7 and/or day 11 if hCG levels did not decrease by 15% during the follow-up period. MAIN OUTCOME MEASURE(S): Adverse events, acceptability, and resolution of pregnancy without surgical treatment. RESULT(S): With this protocol, 87% of patients were treated successfully. Of those protocols that were considered failures, only 3% of patients experienced rupture of ectopic pregnancy. Treatment was well-tolerated; most side effects were reported as mild and transient. Ninety-one percent of the 61.5% of patients who responded to the satisfaction questionnaire reported satisfaction with this regimen. CONCLUSION(S): This "2-dose" protocol minimizes the number of injections and surveillance visits, compared with the "multiple dose" regimen, and methotrexate is administered more frequently than with the "single dose" regimen. The protocol may optimize the balance between convenience and efficacy. In a limited number of women, no safety concerns were noted with up to 4 doses of methotrexate in a 2-week period without leucovorin rescue.

Adult↗
PubMed2006

[Management of ectopic pregnancy in developing countries: example of a Nigerian reference maternity].

OBJECTIVE: We report 143 cases of ectopic pregnancy (EP) treated in the Issaka-Gazobi maternity of Niamey between January 1st, 1999 and April 30th, 2001 (28 months). The objective of this study was to estimate the epidemiological, diagnostic and therapeutic aspects to propose actions, which could lead to the improvement of the prognosis of EP. PATIENTS AND METHODS: The frequency of ectopic pregnancy was 2.32% in our study. The patients were young and pregnant for the second or third time. Frequently we observed previous sexually contagious infections and/or abortions. More than 70% of the patients were admitted for a complicated stage of EP. RESULTS: The culdocentesis allowed to evoke the diagnosis in more than 80% of the cases. It is a simple gesture, which makes it possible to make the diagnosis of EP and which should be taught and practised in maternities of the developing countries. The pelvic ultrasonography and the laparoscopy allowed the diagnosis in the other cases. The tubal localization was the most frequent, cervical and abdominal pregnancies were found. The surgical treatment conducted by laparotomy was conservative in 11.9% and radical in 87.4% of the cases. The mortality rate was still 0.70%. DISCUSSION AND CONCLUSION: Prevention of the sexually contagious infections and medical management of abortions are important to reduce the risks of ectopic pregnancies. Education of the patients, living far from the maternity, is also necessary to obtain more precocious consultation in case of pregnancy in order to improve the prognosis of EP.

Abortion, Induced↗
PubMedDate not supplied

Laparoscopic management of an ectopic pregnancy in a lower segment cesarean section scar: a review and case report.

Implantation of a pregnancy within the scar of a previous cesarean delivery is the rarest of ectopic pregnancy locations, with only 32 cases reported in the English-language medical literature. A 28-year-old woman was admitted to our institution with a suspected ectopic pregnancy located in the scar from a previous cesarean section. Ultrasound revealed a well-encapsulated, bulging mass with a gestational sac within the anterior uterine isthmus in the site of an old cesarean delivery scar. Laparoscopy was performed to confirm the diagnosis, and the gestational products also were removed laparoscopically. The defect in the uterus was then repaired by suturing. Total operative time was 120 minutes, blood loss was limited, and no transfusion was needed. Laparoscopy may be a reasonable alternative to laparotomy for an unruptured ectopic pregnancy in a cesarean scar.

Adult↗
PubMed2006

Ectopic adrenocorticotropic hormone syndrome in a case of small cell carcinoma of the bladder manifesting as severe muscle weakness.

Ectopic adrenocorticotropic hormone syndrome is a paraneoplastic syndrome associated with small cell carcinoma. However, ectopic adrenocorticotropic hormone syndrome is rare in association with small cell carcinoma of the bladder. We report what we believe to be the first case of ectopic adrenocorticotropic hormone syndrome associated with small cell carcinoma of the bladder that manifested as severe muscle weakness due to hypokalemia. An early diagnosis and aggressive potassium replacement is essential for retaining muscle strength. The patient died of pneumonia less than 2 months after the diagnosis. Severe immunosuppression by excess cortisol production was suspected. Control of cortisol levels before chemotherapy might be beneficial in preventing infective complications.

ACTH Syndrome, Ectopic↗
PubMed1996

Single-dose methotrexate for the treatment of ectopic pregnancy: Northwestern Memorial Hospital three-year experience.

OBJECTIVE: Our purpose was to evaluate the effectiveness of single-dose intramuscular methotrexate in the treatment of ectopic pregnancies by physicians in the Department of Obstetrics and Gynecology of Northwestern Memorial Hospital and to compare the results with those of previously published studies. STUDY DESIGN: A retrospective chart review was performed of 50 patients with ectopic pregnancies treated with single-dose methotrexate according to the protocol of Stovall et al. from January 1992 to February 1995. RESULTS: The mean pretreatment level of beta-human chorionic gonadotropin was 1896.4 +/- 2399 mlU/ml. Only 32 women (64%) were successfully treated with a single dose of methotrexate. An additional 7 women required a second or third injection. The combined success rate for medical management of ectopic pregnancy with one to three doses of methotrexate was 78% (39 women). Pretreatment beta-human chorionic gonadotropin levels were significantly lower in women who responded to single-dose therapy than in those who required either two or three doses or who had failure of medical management (p = 0.0011). The mean time to resolution of beta-human chorionic gonadotropin was 26.5 +/- 17 days. Higher pretreatment levels correlated with longer resolution time (r = 0.83, p < 0.001). Eleven women (22%) with failure of medical management required surgery. CONCLUSIONS: In our series single-dose methotrexate was only 64% successful. Women with a pretreatment beta-human chorionic gonadotropin level >5000 mlU/ml had a greater probability of requiring either surgical intervention or multiple doses of methotrexate. The potential for emergency surgery remains an important risk.

Adolescent↗
PubMed1996

Long-term effects of cesarean sections: ectopic pregnancies and placental problems.

OBJECTIVE: Few studies on the long-term effects of cesarean sections exist. The purpose of this study was to investigate the occurrence of three long-term effects, ectopic pregnancy, placenta previa, and abruptio placentae, in the subsequent pregnancy. STUDY DESIGN: This retrospective cohort study was based on two nationwide registers in Finland: the birth register and the hospital inpatient register. Women (n = 16,938) having had a cesarean section (exposed women) and a matched control group were identified from the birth register. The occurrence and outcome of the first subsequent pregnancy was determined from the 1987 to 1993 hospital inpatient register and the first subsequent birth from the 1987 to 1993 birth register. RESULTS: During the follow-up time in the hospital inpatient register, fewer exposed women had a completed pregnancy. Ectopic pregnancy was more common among the exposed women than among the controls (risk ratio 1.28). In the first subsequent birth abruptio placentae was more common among primiparous (at index the birth, risk ratios of 3.22 in hospital inpatient register and 2.41 in birth register) and multiparous women (4.52 in hospital inpatient register and 3.89 in birth register). Placenta previa was more common among primiparous exposed women than among control women (risk ratio 5.34 in hospital inpatient register and 3.78 in birth register). CONCLUSIONS: Cesarean section is a modest risk factor for ectopic pregnancy and an important risk factor for placental problems.

Abruptio Placentae↗
PubMed1997

Recurrent chlamydial infections increase the risks of hospitalization for ectopic pregnancy and pelvic inflammatory disease.

OBJECTIVE: We examined whether the risks of hospitalization for ectopic pregnancy and pelvic inflammatory disease increase with increasing numbers of chlamydial infections. STUDY DESIGN: A retrospective cohort design was used to evaluate the risks of hospitalization for ectopic pregnancy or pelvic inflammatory among 11,000 Wisconsin women who had one or more chlamydial infections between 1985 and 1992. Logistic regression was used to evaluate the strength of association between recurrent infection and sequelae. RESULTS: After adjustment in multivariate analyses, we observed elevated risks of ectopic pregnancy among women who had two (odds ratio 2.1, 95% confidence interval 1.3 to 3.4) and three or more chlamydial infections (odds ratio 4.5, 95% confidence interval 1.8 to 5.3). These groups were also at increased risk for pelvic inflammatory (two infections: odds ratio 4.0, 95% confidence interval 1.6 to 9.9; three or more infections: odds ratio 6.4, 95% confidence interval 2.2 to 18.4). CONCLUSIONS: A unique prevention opportunity occurs at the diagnosis of any chlamydial infection because women with subsequent recurrences are at increased risk for reproductive sequelae.

Adolescent↗
PubMed1998

Treating ectopic pregnancy with the combination of mifepristone and methotrexate: a phase II nonrandomized study.

OBJECTIVE: Our goal was to compare the use of a combination of methotrexate and mifepristone with methotrexate alone in the medical management of ectopic pregnancy. STUDY DESIGN: This was a preliminary nonrandomized phase II study. All patients with progressing ectopic pregnancy meeting criteria for medical management were included. Treatment consisted of 50 mg/m2 of methotrexate injected intramuscularly and 600 mg of mifepristone, administered orally, compared with a previous group who received only 50 mg/m2 of methotrexate injected intramuscularly. RESULTS: Of the 30 patients treated with the combination, there was only 1 failure, whereas medical treatment had failed for 11 of 42 patients treated with methotrexate alone. CONCLUSIONS: The combination of mifepristone and methotrexate decreased the risk of failure in medical treatment of ectopic pregnancy.

Abortifacient Agents, Steroidal↗
PubMed1993

The radiological investigation of occult ectopic ACTH-dependent Cushing's syndrome.

The radiological features of 14 patients with Cushing's syndrome due to 'occult' ectopic ACTH syndrome have been reviewed. In 11 of the 14 patients (79%), the ACTH-producing tumour was located in the thorax. Bronchial carcinoid tumours (eight patients) were the single most common source of 'occult' ectopic ACTH production with thymic carcinoid tumours (two patients) and mediastinal metastases from a medullary carcinoma of the thyroid gland (one patient) accounting for the other intrathoracic tumours. The tumours were usually small with five of the eight bronchial carcinoid tumours measuring between 4 and 10 mm in diameter. Since it remains difficult to distinguish between pituitary-dependent Cushing's disease and 'occult' ectopic ACTH-dependent Cushing's syndrome both clinically and biochemically, the role of radiology remains vital.

ACTH Syndrome, Ectopic↗