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PubMed1999

Ruptured tubal ectopic pregnancy: risk factors and reproductive outcome: results of a population-based study in France.

OBJECTIVE: The aim of this study was to investigate the determinants of tubal rupture and to describe its treatment and effect on subsequent fertility. STUDY DESIGN: The data were taken from a population-based register from Auvergne (France). All women aged between 15 and 45 years residing permanently in this area and treated for ectopic pregnancy by surgical or medical procedures have been registered since 1992. They are then followed up prospectively until the age of 45 years. This study is an analysis of 849 tubal ectopic pregnancies registered between January 1992 and December 1996. Women with tubal rupture were compared with those in whom no tubal rupture occurred. The risk factors for tubal rupture were identified by calculating crude and adjusted odds ratios. The effects of tubal rupture on subsequent fertility were assessed by calculating cumulative intrauterine pregnancy rates and were analyzed by log-rank tests and Cox regression. RESULTS: The rate of rupture for this population was 18%. Four factors were identified that increased the risk of rupture (results of the multivariate analysis): never having used contraception (odds ratio 1.7 [1.0 to 3. 3]), a history of tubal damage together with infertility (odds ratio 1.6 [0.9 to 2.7]), induction of ovulation (odds ratio 2.5 [1.1 to 5. 6]), and a high level of beta-human chorionic gonadotropin (at least 10,000 IU/L) when ectopic pregnancy was suspected (odds ratio 2.9 [1. 5 to 5.6]). The overall cumulative frequency of intrauterine pregnancy was not significantly lower after tubal rupture (adjusted risk ratio 0.85 [0.53 to 1.38]). CONCLUSION: Although tubal rupture seriously affects the immediate health of the women concerned, it seems to have no independent effect on subsequent fertility. Better knowledge of the risk factors should make it possible to identify those women who will not benefit from nonsurgical treatment.

Adolescent↗
PubMed2000

Ectopic noradrenergic hyperinnervation does not functionally compensate for neonatal forebrain acetylcholine lesion.

Adult rats who have undergone neonatal 192 IgG-saporin induced lesions of forebrain acetylcholine (ACH) neurons are normal on many behavioral tasks. In this study we determined whether ectopic hippocampal ingrowths, a documented consequence of these neonatal cholinergic lesions, functionally compensate for ACH denervation in these rats. Neonatal rats underwent systemic 6-hydroxydopamine (6-OHDA) injections on postnatal days (PND) 1-3 to prevent the ingrowths, and/or intraventricular 192 IgG-saporin injections on PND 7. The 192 IgG-saporin profoundly reduced basal forebrain p75 neurotrophin receptor (p75(NTR)) immunoreactive (IR) neurons. The 6-OHDA treatment abolished hippocampal and cortical dopamine-beta-hydroxylase (DBH) IR terminals, indicating the absence of normal norepinephrine (NE) innervation. Ectopic DBH IR and p75(NTR) IR varicosities which occurred in the hippocampus of 192 IgG-saporin treated rats were also eliminated by 6-OHDA treatment. Behavioral testing in adulthood indicated no effect of the treatments on the Morris water maze. 192 IgG-saporin treatment caused perseveration during delayed spatial alternation (DSA) and increased working but not reference memory errors on the radial arm maze (RAM). The 6-OHDA plus 192 IgG-saporin treated rats did not differ from the 192 IgG-saporin only rats on any task. These results indicate that ectopic hippocampal NE ingrowths do not functionally compensate for neonatal ACH lesions. Neonatal forebrain ACH lesion impairs working memory on the RAM but the absence of an effect on DSA contraindicates a basic dysfunction of short term memory. Despite severe combined neonatal loss of forebrain ACH and NE innervation, behavior is remarkably intact.

Acetylcholine↗
PubMed1987

Ectopic axon hillock-associated neurite growth is maintained in metabolically reversed swainsonine-induced neuronal storage disease.

An experimentally induced and reversible model of a neuronal storage disease, swainsonine-induced feline alpha-mannosidosis, has been used to study the modifiability of ectopic, axon hillock-associated neurites and their new synaptic contacts. Earlier studies have fully documented that a variety of neuronal storage disorders are characterized by such changes in neuronal geometry and connectivity. Swainsonine administration was ended after 6 months of continuous treatment which had resulted in characteristic signs of alpha-mannosidosis. Studies of this animal 6 months after reversal showed that even though neuronal vacuolation and other CNS changes essentially normalized, ectopic neurites and their synaptic connections were still present and appeared similar to those of another animal which had been treated with swainsonine for the entire 12-month period. These results suggest that once initiated during the disease process, ectopic axon hillock-associated dendrites become an integral part of the soma-dendritic domain of affected neurons and may not be reversible. These findings may have relevance for current attempts to devise therapies involving enzyme replacement for individuals with inherited neuronal storage disease.

Alkaloids↗
PubMed1996

A case report and review: the gross, histological and immunohistochemical characteristics of a carcinoma of ectopic thyroid in a dog.

Neoplasms of the canine thyroid gland represent 5-10% of heart base masses (Capen, 1978). Ectopic thyroid tissue is detected most commonly in the thorax, with 23-80% of all dogs having ectopic tissue at the base of the heart (Leav et al., 1976; Walsh & Diters, 1984). We describe here the gross and microscopic features of a rare ectopic thyroid carcinoma in a dog and the results of an immunohistochemical study of the tumour.

Adenocarcinoma↗
PubMed2003

Ectopic pregnancies following emergency levonorgestrel contraception.

There are little or no data on the risk of ectopic pregnancy following levonorgestrel treatment as an emergency contraception. We encountered three cases of ectopic pregnancy following the use of levonorgestrel administered peri- or postovulation. Here we report these cases and discuss the clinical and epidemiologic implications of this association. Health providers should be alert to the possibility of an ectopic pregnancy in women who become pregnant or complain of lower abdominal pain after taking levonorgestrel.

Adult↗
PubMed2001

Xanthine oxidase in eutopic and ectopic endometrium in endometriosis and adenomyosis.

OBJECTIVE: To investigate the expression of xanthine oxidase in eutopic and ectopic endometrium in endometriosis and adenomyosis. DESIGN: Immunohistochemical identification of xanthine oxidase in endometrial tissues by using polyclonal antibody. SETTING: University hospital. PATIENT(S): Thirty-four women with endometriosis, 34 women with adenomyosis, and 44 fertile control women. INTERVENTION(S): Biopsy samples were obtained from the endometrium throughout the menstrual cycle. MAIN OUTCOME MEASURE(S): Semiquantitative immunostaining (evaluation nomogram) score of endometrial cells. RESULT(S): The level of xanthine oxidase expression in the glandular epithelium of control varied according to menstrual phase, but no such variation in expression was seen in endometriosis. Variation in xanthine oxidase expression was observed during the menstrual cycle in patients with adenomyosis; this variation differed completely from that in controls. Xanthine oxidase expression was found in ectopic endometrial tissue in all cases. The mean evaluation nomogram levels in the glandular epithelium in adenomyosis tissue were as high as those in the early secretory phase in the eutopic endometrium. CONCLUSION(S): Aberrant expression of xanthine oxidase in eutopic and ectopic endometrium appears to play a pathologic role in endometriosis and adenomyosis.

Anemia, Iron-Deficiency↗
PubMed2002

Matrix metalloproteinase-2, membranous type 1 matrix metalloproteinase, and tissue inhibitor of metalloproteinase-2 expression in ectopic and eutopic endometrium.

OBJECTIVE: To investigate expression of matrix metalloproteinase-2 (MMP-2), membranous type 1 matrix metalloproteinase (MT1-MMP), and tissue inhibitor of metalloproteinase-2 (TIMP-2) in ectopic and eutopic endometrium from women with and without endometriosis throughout the menstrual cycle. DESIGN: Molecular studies in human tissue. SETTING: Reproductive immunology laboratory of a university medical center. PATIENT(S): Fifty-three premenopausal woman (23 with endometriosis and 30 without endometriosis) undergoing laparoscopic surgery. Endometrium and ectopic endometriosis tissue were obtained at the time of surgery. MAIN OUTCOME MEASURE(S): Messenger RNA and protein expression from eutopic and ectopic endometrium was analyzed by using quantitative competitive polymerase chain reaction, zymography, and Western blot assay. RESULT(S): Uterine endometrium from women with endometriosis expressed higher levels of MMP-2 and MT1-MMP and lower levels of TIMP-2 than did endometrium from normal women. CONCLUSION(S): Eutopic endometrium from patients with endometriosis may be more invasive and prone to peritoneal implantation because of greater expression of MMP-2 and MT1-MMP and lower expression of TIMP-2 messenger RNA, compared with endometrium from women without endometriosis. Thus, increased proteolytic activity may help to explain the invasive factors that result in endometriosis.

Adult↗
PubMed1985

Isthmic ectopic pregnancy: segmental resection as the treatment of choice.

We reviewed the records of 12 patients who were admitted to Yale-New Haven Hospital between February 1979 and January 1983 with the diagnosis of isthmic ectopic pregnancy. All pregnancies were unruptured. Two patients were managed by salpingectomy. Ten patients were treated conservatively. Of the women managed by conservative surgery, four had a linear salpingostomy and none of the four conceived. Three of these four patients demonstrated occlusion of the operated tube by hysterosalpingogram (HSG). The other six patients were managed by segmental resection and delayed microsurgical anastomosis. Four of the six patients conceived. Three pregnancies were intrauterine and one was an ectopic pregnancy in the conserved tube. Three patients conceived before an HSG could be done. The remaining three patients had HSGs 3 to 4 months after anastomosis, and the operated tube was patent in all three. From these data and a review of the literature, we conclude that segmental resection with either immediate or delayed anastomosis appears preferable to linear salpingostomy for the conservative management of unruptured isthmic ectopic pregnancy.

Adult↗
PubMedDate not supplied

Ectopic transcription and the possibility of RNA editing of the human arrestin gene.

PURPOSE: To investigate the ectopic transcription of arrestin in various human organs and tissues. METHODS: Reverse transcriptase-polymerase chain reaction was used to investigate the ectopic transcription of the arrestin gene in the retina, anterior capsule of the lens, iris, bulbar conjunctiva, muscle, skin, placenta, intestine, and human blood. In addition, we examined the expression of arrestin mRNA isolated from whole blood cells of patients with Oguchi disease who had the 1147delA mutation in the arrestin gene. RESULTS: Arrestin was expressed at the mRNA level in all our samples. The mRNA isolated from the blood cells of Oguchi patients was not associated with the same 1147delA mutation as was reported earlier in the arrestin gene but had the normal sequence. CONCLUSIONS: These results demonstrate the ectopic transcription of the arrestin gene in various tissues and also suggest the possibility of RNA editing in the blood cells of Oguchi patients.

Arrestin↗
PubMed1983

Ventricular ectopic beats with exit block: a retrospective Holter monitor study.

A retrospective study was conducted to define the incidence of ventricular ectopic beats with exit block (concealed extrasystoles). Of 904 Holter recordings, 92 were admitted for study on the basis of sufficient ventricular ectopic beats on rhythm strips. Concealed bigeminy conforming to the equation of S = 2n - 1 (where S = the interectopic sinus beat and N = any interger) was the most common and occurred in 42 of 92 (46%) Holters included in this study. Concealed trigeminy was observed in 12 of 92 (13%) studies. These Holters also showed ventricular ectopic beats strongly suggestive of parasystole with entrainment. Of 53 Holters reviewed for parasystole 12 were suggestive of, and five indicated this dysrhythmia. We conclude that: 1. Concealed extrasystoles are more common than previously appreciated. 2. Concealed bigeminy and trigeminy appear together and conversion may not always be associated with a change in heart rate. 3. Recognition of this dysrhythmia is uncommon mostly because of inadequate lengths of rhythm strips. 4. Parasystole with entrainment is suggested as a common dysrhythmia when frequent extrasystoles are present.

Cardiac Complexes, Premature↗
PubMed1985

Localization of cardiac ectopic activity in man by a single moving dipole. Comparison of different computation techniques.

The accuracy of different computation techniques for the non-invasive localization of cardiac ectopic activity was evaluated. Body surface potentials were recorded from 63 leads in 14 patients with implanted pacemakers. The location, orientation and magnitude of a single moving dipole (SMD) were computed from the first eight terms of a truncated multipole expansion estimated from the body surface potentials. The SMD trajectories obtained during the QRS complex were plotted along with the heart outlines and pacing leads obtained independently from chest x-rays. The origin of the SMD trajectories was compared to the position of the pacing lead to evaluate the accuracy of the SMD. The optimum computation technique used a least-squares (LS) estimation of the multipole expansion truncated at 15 multipoles, in conjunction with a torso model that included regions of lower conductivity representing the lungs. With this method, the SMD trajectories originated near the pacing lead (25 +/- 12 mm) and adequately represented the progression of the ectopic wavefront across the entire heart silhouette. With the LS techniques using 8 or 24 multipoles, the spans of the trajectories were respectively too short, or too long to cover the heart, and the average distance between the SMD at QRS onset and the pacing lead was larger. With a surface integration technique, the SMD-pacing lead distances were similar, both for a finite homogeneous torso model with a fixed geometry, as well as for torso models adapted to the torso geometry of each patient. The SMD was found adequate to represent the progression of an ectopic wavefront, and to localize its origin in man.

Aged↗
PubMed2003

Contractions and expansions of CAG/CTG trinucleotide repeats occur during ectopic gene conversion in yeast, by a MUS81-independent mechanism.

CAG/CTG trinucleotide repeat tracts expand and contract at a high rate during gene conversion in Saccharomyces cerevisiae. In order to characterize the mechanism responsible for such rearrangements, we built an experimental system based on the use of the rare cutter endonuclease I-SceI, to study the fate of trinucleotide repeat tracts during meiotic or mitotic (allelic or ectopic) gene conversion. After double-strand break (DSB) induced meiotic recombination, (CAG)(98) and (CAG)(255) are rearranged in 5% and 52% of the gene conversions, respectively, with similar proportions of contractions and expansions. No evidence of a meiotic hot spot activity associated with trinucleotide repeats could be found. When gene conversion is induced by a DSB during mitotic growth of the cells, no rearrangement of the repeat tracts is detected when the donor sequence is allelic to the recipient site of the DSB. However, when the donor sequence is at an ectopic location, frequent contractions and expansions of the repeat tract are found. No crossing-over associated with gene conversion could be detected. Mutants for the MUS81 gene, involved in the resolution of recombination intermediates, show a frequency of rearrangements identical with that of the wild-type strain. We concluded that trinucleotide repeat rearrangements occur frequently during ectopic but not during allelic recombination, by a mechanism that does not require crossover formation.

Alleles↗
PubMed1996

Ectopic ureter with complete ureteric duplication: conservative surgical management.

To assess the outcome of conservative procedures, the authors reviewed their experience in the management of 31 ectopic ureters with complete ureteric duplication. Twenty-eight girls and three boys (aged 19 days to 10 years; mean, 30 months) were operated on between 1968 and 1994. Twenty-four of the children presented for evaluation of dribbling urinary incontinence and/or febrile urinary tract infections; seven presented after prenatal ultrasonographic diagnosis of hydronephrosis. The location of the ectopic orifice was identified in 25 children: bladder neck (6), posterior urethra (6), vagina (7), and vestibule (6). Upper pole nephroureterectomy was performed in 16 children who had nonfunctioning renal segments. Ureterovesical reimplantation was performed in 10 children who had functioning segments. In five borderline cases, temporary cutaneous ureterostomy was performed, followed by ureteropyelostomy (2), ureterovesical reimplantation (2), and upper pole nephrectomy (1). Histological examination of the polar nephrectomy specimens showed lesions of dysplasia in only four cases (24%). The follow-up period ranged from 6 months to 20 years (mean, 66 months). All children who presented with incontinence became continent after polar nephrectomy or conservative surgery. One child required surgical revision of the ureteropyelostomy anastomosis. Of the 12 children who had ureterovesical reimplantation, none needed further procedures. Ectopic ureters in duplex systems with functioning renal segments should be conserved.

Biopsy↗
PubMed1996

A case of ectopic anus localized on the right gluteus.

A case of a gluteus-localized ectopic anus on the right side is described. A 5-month-old boy had a severe sacral anomaly with atrophy of the right lower extremity and a pes equinus deformity. Transcutaneous muscle stimulation showed a well-developed muscle complex, and parasagittal muscle fibers have been localized obliquely. Although he has severe sacral anomalies, the posterior sagittal anorectoplasty procedure could be performed. This unique case provides a good demonstration of not only the ectopically localized anus but also the ectopically localized muscle complex.

Abnormalities, Multiple↗
PubMed1997

Laparascopic excision of pelvic kidney with single vaginal ectopic ureter.

An ectopic vaginal ureter is an uncommon cause of urinary incontinence. Most cases are associated with a duplex kidney where the orthotopic lower moiety ureter enters the bladder. The authors present a case of chronic, continuous low-grade urinary incontinence caused by the rare combination of a pelvic kidney and a single ectopic ureter draining into the vagina. This ectopic kidney was successfully removed laparoscopically. A review of the English-language literature showed this to be only the second reported case treated by laparoscopic nephrectomy.

Child↗
PubMed1998

Endopyelotomy for horseshoe and ectopic kidneys.

PURPOSE: We report our experience with endopyelotomy for horseshoe and ectopic kidneys in the largest series to date to our knowledge, and discuss the technical modifications adopted to perform successfully percutaneous antegrade endopyelotomy. MATERIALS AND METHODS: From September 1987 to April 1996, 4 patients with horseshoe and 5 with ectopic kidney underwent percutaneous antegrade endopyelotomy for symptomatic ureteropelvic junction obstruction. The percutaneous puncture was made more posteromedial and the ureteropelvic junction was incised lateral. A retrograde percutaneous access tract was created under laparoscopic guidance in pelvic kidneys. RESULTS: The operative procedure was performed uneventfully in all patients with no major bleeding, pleural effusion or visceral perforation. The stents were removed at 6 weeks, and an excretory urogram was performed at 2 weeks, 6 months and yearly thereafter. In 2 patients (22%) with severe hydronephrosis, poor renal function and a long ureteral stricture surgical treatment failed immediately. The remaining 7 patients (78%) had long lasting clinical and radiographic success with a mean followup of 62 months. CONCLUSIONS: Percutaneous antegrade endopyelotomy, with a few technical modifications, is a safe and effective treatment for ureteropelvic junction obstruction associated with horseshoe and ectopic kidneys.

Adult↗
PubMed1999

Long-term outcome of transurethral puncture of ectopic ureteroceles: initial success and late problems.

PURPOSE: We studied the long-term outcome of transurethral puncture of ectopic ureteroceles specifically associated with duplex systems. MATERIALS AND METHODS: We retrospectively reviewed the records of patients who underwent transurethral puncture of an ectopic ureterocele. Study exclusion criteria were orthotopic, bilateral and prolapsing ureteroceles. RESULTS: We identified 19 girls and 2 boys, of whom 11 presented with prenatal hydronephrosis and 10 presented with urinary tract infection. Mean age at puncture was 5 months (range 0.5 to 60). Preoperatively voiding cystourethrography revealed no reflux in 7 patients, isolated ipsilateral lower pole reflux in 8, and bilateral and/or contralateral reflux in 6. Postoperatively studies initially showed no reflux in 8 cases but in 4 of the 8 reflux recurred up to 4 years after puncture. In 10 patients (48%) reflux developed into the ureterocele and upper pole segment. Repeat puncture was required 1 to 13 months after the initial procedure in 4 patients for persistent or recurrent upper pole hydroureteronephrosis. Subsequent open surgery was required in 15 of the 21 cases (71%), including ureterocele excision with ureteral reimplantation in 14. Of the children 10 and 4 underwent open surgery for recurrent urinary tract infection and progressive reflux, respectively, while 1 underwent ureteroureterostomy for progressive upper pole reflux. No patient underwent upper pole nephrectomy. Of the remaining 6 patients 4 have low grade reflux. CONCLUSIONS: Transurethral puncture of ectopic ureteroceles provides effective short-term correction of upper pole obstruction but it is not definitive therapy in the majority of cases. Most children still require open surgery. In patients without reflux after the puncture procedure new onset, recurrent or progressive reflux may later develop with extended followup. Repeat puncture may be required to ensure adequate decompression in a minority of cases, as in the 20% in our series.

Child, Preschool↗
PubMed2002

The mentor Alpha 1 penile prosthesis with reservoir lock-out valve: effective prevention of auto-inflation with improved capability for ectopic reservoir placement.

PURPOSE: Auto-inflation is a common and annoying complication of 3-piece penile prostheses. In the published literature the rate is approximately 11% with a 2% operative revision rate. We report the results of a review of 160 Alpha 1 and NB implants (Mentor Corp., Santa Barbara, California) with the new lock-out valve located on the reservoir to treat impotence. We compared it with 339 Alpha 1 implants with the standard reservoir. We also investigated the lock-out reservoir for ectopic nonretropubic implantation. MATERIALS AND METHODS: We compared 339 Alpha prostheses with the standard reservoir that were implanted between January 1, 1998 through December 31, 1999 and 160 with the new lock-out valve placed since January 2000 with at least 6 months of followup. Implants were further stratified as first time (virgin) or revision-replacement of a previous implant. In 8 patients with a scarred or obliterated retroperitoneal space the lock-out reservoir was placed superior to the transversalis fascia and beneath the abdominal musculature. RESULTS: Kaplan-Meier estimated 1-year survival was not significantly different in terms of mechanical failure (p = 0.57 and 0.85) revision for any cause (p = 0.92 and 0.92), patient dissatisfaction (p = 0.35 and 0.11) or infection (p = 0.64 and 0.94) for all implants and virgin implants only, respectively. Only 2 patients (1.3%) with a lock-out valve complained of auto-inflation initially and the problem resolved in each after instruction on how to operate the device. Of the patients in the earlier series 11% complained of auto-inflation and 2% required operative correction. None of the 8 patients with an ectopic reservoir location complained of auto-inflation. CONCLUSIONS: Our results indicate that the lock-out valve prevents early auto-inflation. Addition of the lock-out valve does not impact the revision rate compared with the same implant with a standard reservoir. In patients with a scarred retropubic space the lock-out valve offers the penile implant surgeon a decreased probability of auto-inflation with ectopic reservoir placement.

Cohort Studies↗