Critical importance of in vivo amoxicillin and cefotaxime concentrations for synergy in treatment of experimental Enterococcus faecalis endocarditis

Although a higher incidence of ectopic pregnancy has been reported after in-vitro fertilization (IVF) and embryo transfer, three ectopic pregnancies in the same woman is very rare. A patient of 32 years underwent IVF-embryo transfer six times within 3 years. Three of four conceptions resulted in ectopic pregnancies. The first involved simultaneous intrauterine and left tubal pregnancy, the second was a right tubal pregnancy, and the third was a right interstitial pregnancy. In IVF-embryo transfer, bilateral salpingectomy does not remove the risk of interstitial or cornual pregnancy.     

The control of the radiochemical purity of compounds labelled with 113MIn using the method of thin-layer chromatography

A woman with two intrauterine pregnancies after two ectopic tubal pregnancies is presented. The first operation removed the left Fallopian tube (on 4 November 1970), while during the recurrent ectopic pregnancy, plastic surgery was applied in the remaining right tube (24 October 1972) with the enucleation of the fertilized egg after Prochownik's method. The patient became pregnant 3 months after the operation and had spontaneous abortion, with a fetus two-and-a half months old; the second time she became pregnant 17 months after the operation and gave birth to a female live-born, 26 days before the term, weighing 2,900 g and 49 cm high. The authors conclude that best results are obtained when the plastic surgery made in the fallopian tube is as small as possible and when postoperative instillation of the tubes is applied.     

Absence of upper limbs (amelia) in surviving intrauterine twin after salpingectomy for ectopic pregnancy

A patient is described who had simultaneous tubal and intrauterine pregnancies. The tubal pregnancy was treated by salpingectomy at 51 days after the onset of the last menstrual period. The surviving twin was born after 42 weeks gestation and had no upper limbs (amelia).     

Cornual pregnancies in patients with prior salpingectomy undergoing in vitro fertilization and embryo transfer

OBJECTIVE: To examine the frequency of cornual pregnancy in patients with prior salpingectomy undergoing IVF. DESIGN: Review. SETTING: Private fertility practice. PATIENTS: Women undergoing IVF. MAIN OUTCOME MEASURE: Cornual ectopic pregnancy. RESULTS: Of 26 ectopic pregnancies detected after ET during a 7-year period, 7 were located in the cornu or tubal stump after prior salpingectomy. CONCLUSIONS: Patients with prior salpingectomy undergoing IVF are at particular risk for cornual pregnancy.     

Early warning of new health care technologies in the United Kingdom

OBJECTIVE: To evaluate fertility after salpingectomy performed for ectopic pregnancies (EPs). DESIGN: Retrospective cohort study. SETTING: Tertiary care university hospital. PATIENT(S): Three hundred forty patients (213 with surgery by laparoscopy and 127 by laparotomy) between January 1985 and July 1994, with a mean follow-up period of 73 months (36-162 months). INTERVENTION(S): Salpingectomy performed either by laparotomy or by laparoscopy as indicated. MAIN OUTCOME MEASURE(S): Rate of intrauterine pregnancy (IUP), live births, and recurrent EP. RESULT(S): Forty-seven (13.8%) patients were lost to follow-up, and 68 (20%) did not want to become pregnant. The overall rate of spontaneous conception was 70.4% in the laparoscopy group and 53.2% in the laparotomy group. The rate of live births was 50% and 37%, respectively; the mean time until conception was 11 and 17.2 months; and the rate of recurrent EP, 10.6% and 9.6%. The multivariate analysis showed a rate of IUP of 82.1% among women younger than 30 years of age with a normal contralateral tube, laparoscopic surgery, and no history of infertility. CONCLUSIONS: In this study of fertility after salpingectomy for EP, laparoscopic treatment was superior to laparotomic treatment. Fertility was equivalent to that after conservative treatment in a subgroup of young patients treated with laparoscopy and with no history of tubal pathology.     

Intramesosalpingeal injection of oxytocin in conservative laparoscopic treatment for tubal pregnancy: preliminary results

The objective of this study was to evaluate the efficacy of the local use of oxytocin as adjuvant treatment in conservative surgery for tubal pregnancy. The patients were 25 women with laparoscopic diagnosis of tubal pregnancy who were candidates for salpingotomy. Before salpingotomy, each patient was randomly allocated to intramesosalpingeal injection of 20 IU oxytocin diluted to 20 ml with saline solution or 20 ml saline solution. The surgeon then proceeded with salpingotomy and removal of the pregnancy according to the usual technique. The main outcome measures were bleeding during salpingotomy, ease of removal of the pregnancy, bleeding at the site of the pregnancy, and need for recourse to salpingectomy. Twelve women were randomized to the oxytocin group and 13 to the control group. Examination of the surgeons' assessments of the difficulties encountered at the different stages of surgery revealed statistically significant differences between the oxytocin group and controls in each variable. In particular, the amount of endosalpingeal bleeding after removal of the pregnancy was less in the oxytocin group. In one control patient, persistent bleeding due to incomplete trophoblast removal forced the surgeon to perform salpingectomy. Our results indicate that intramesosalpingeal injection of oxytocin facilitates the performance of conservative laparoscopic treatment for tubal pregnancy.     

Successful laparoscopic management of primary abdominal pregnancy

Overall, approximately 1% of ectopic pregnancies are abdominal pregnancies, which can be life-threatening even when surgical intervention with laparotomy is performed. We present a case in which abdominal pregnancy was successfully managed by operative laparoscopy. A 25 year old Japanese woman presented 6 weeks after her last menstruation with elevated basal body temperature, lower abdominal pain, and light vaginal bleeding. The urinary human chorionic gonadotrophin (HCG) concentration was 2137 IU/I, and laparoscopic findings (i.e. the implantation site was the posterior serosa of the uterus with normal adnexae) established a diagnosis of primary abdominal pregnancy. The gestational product was completely removed by laparoscopic surgery with no uncontrollable loss of blood. The urinary concentration of HCG declined rapidly and the patient made an uneventful recovery. Operative laparoscopy is a safe alternative for the management of appropriately selected patients with early abdominal pregnancy.     

Combined intra-uterine and extra-uterine pregnancy associated with mild hyperstimulation syndrome after clomiphene ovulation induction

We report a combined intra-uterine and tubal pregnancy associated with mild ovarian hyperstimulation syndrome (OHSS) following ovulation induction by clomiphene. The diagnosis of ectopic pregnancy was originally missed until rupture occurred. OHSS confused the clinical picture, the important diagnostic feature being the fall in the haemoglobin concentration. The patient had a left partial salpingectomy and the uterine pregnancy progresses normally.     

Isolated torsion of the fallopian tube. A case report

BACKGROUND: While torsion of the adnexa is relatively common, isolated torsion of the fallopian tube alone remains a rare occurrence. Diagnosis and surgical intervention are often delayed. CASE: A 38-year-old woman presented with acute lower right abdominal pain initially managed as renal colic. She returned to the emergency department three days later. After surgical consultation, a computed tomography scan and ultrasound showed a cystic pelvic mass with normal ovarian flow studies. Ultimately, the gynecology team performed laparoscopy with the suspicion of intermittent adnexal torsion. A 6 x 8-cm, twisted, dusky purple right fallopian tube was noted. A laparoscopic salpingectomy was performed. CONCLUSION: In the differential diagnosis of acute lower abdominal pain, isolated torsion of the fallopian tube should be considered. A timely diagnosis and surgical intervention may allow preservation of the tube. Even when irreversible damage has occurred, laparoscopic management is recommended.     

Ectopic pregnancy in the stump of the uterine tube after in vitro fertilization

A rare case of ectopic pregnancy in stump of uterine tube after IVF, which was done after bilateral removal of uterine tubes, caused by uterine tube pregnancies was described. Diagnostic difficulties were shown in that case.     

Efficacy and safety of permanent cardiac DDD pacing with contemporaneous double spinal cord stimulation

A case of simultaneous bilateral tubal pregnancy resulting from in-vitro fertilization and embryo transfer is presented. Repeated transvaginal ultrasound examinations confirmed an intrauterine sac but no fetus. A diagnosis of early missed abortion was incorrectly made and a curettage was performed. The pathological examination showed the presence of decidua and Arias-Stella phenomenon but no chorionic villi. Diagnostic laparoscopy and laparotomy performed 40 days after embryo transfer (eighth week of gestation), revealed bilateral tubal pregnancy. Bilateral salpingectomy was performed.     

Intractable pelvic pain following Filshie clip application

Presented is the case of a 37-year-old South Australian woman who experienced intractable pelvic pain following laparoscopic sterilization with Filshie clips. The pelvic anatomy was normal and one Filshie clip was applied to each Fallopian tube. The patient stated she had experienced right-sided lower abdominal pain that radiated down the anterior part of her right thigh since regaining consciousness after general anesthesia. The pain had failed to resolve seven days after the procedure and the patient was unable to perform even simple tasks. Analgesics provided only temporary, partial relief. There were no signs of infection or any other exacerbating condition. At diagnostic laparoscopy, instillation of bupivacaine around the clip provided transient relief, but the pain returned the next day at the same level of severity. After one month of intractable pain, laparoscopic bilateral salpingectomy was performed to remove the clips and the pain disappeared. Although back pain has been reported in up to 14% of women undergoing laparoscopic sterilization, this is the first published case of long-term abdominal pain associated with the Filshie clip.     

The risk of ectopic pregnancy after tubal sterilization. U.S. Collaborative Review of Sterilization Working Group

BACKGROUND: Tubal sterilization is an increasingly common method of contraception in the United States. Although pregnancy after sterilization is uncommon, it can occur and may be ectopic. We used data from the U.S. Collaborative Review of Sterilization to estimate the risk of ectopic pregnancy in women who had undergone the common types of tubal sterilization. METHODS: A total of 10,685 women undergoing tubal sterilization were followed in a multicenter, prospective cohort study. We intended to follow all the women for 5 years by means of annual telephone interviews; for women enrolled early in the study, we attempted an additional follow-up telephone interview 8 to 14 years after sterilization. To assess the risk of ectopic pregnancy in these women, we used cumulative life-table probabilities and proportional-hazards analysis. RESULTS: There were 47 ectopic pregnancies in the 10,685 women; the 10-year cumulative probability of ectopic pregnancy for all methods of tubal sterilization combined was 7.3 per 1000 procedures. The cumulative probability varied substantially according to the method of sterilization and the woman's age at the time of sterilization. Women sterilized by bipolar tubal coagulation before the age of 30 years had a probability of ectopic pregnancy that was 27 times as high as that among women of similar age who underwent postpartum partial salpingectomy (31.9 vs. 1.2 ectopic pregnancies per 1000 procedures). The annual rate of ectopic pregnancy for all methods combined in the 4th through 10th years after sterilization was no lower than that in the first 3 years. CONCLUSIONS: A history of tubal sterilization does not rule out the possibility of ectopic pregnancy, even many years after the procedure.     

Discriminability in length of lines in the Müller-Lyer figure

OBJECTIVE: To compare patients' health-related quality of life after systemic methotrexate therapy versus laparoscopic salpingostomy for tubal pregnancy. DESIGN: Multicenter randomized clinical trial. SETTING: Departments of obstetrics and gynecology of six Dutch hospitals. PATIENT(S): Hemodynamically stable patients with a laparoscopically confirmed unruptured tubal pregnancy without signs of active bleeding, who were randomly assigned to undergo either systemic methotrexate therapy or laparoscopic salpingostomy. INTERVENTION(S): Standard health-related quality of life questionnaires administered before and 2 days, 2 weeks, 4 weeks. and 16 weeks after confirmative laparoscopy. MAIN OUTCOME MEASURE(S): Health-related quality of life. RESULT(S): Health-related quality of life was impaired most severely 2 days after confirmative laparoscopy in both treatment groups and improved during follow-up. Health-related quality of life was impaired more severely after systemic methotrexate therapy than after laparoscopic salpingostomy. Medically treated patients had more limitations in physical functioning, role functioning, and social functioning; had worse health perceptions, less energy, more pain, more physical symptoms, and a worse overall quality of life; and were more depressed than surgically treated patients. CONCLUSION(S): Systemic methotrexate therapy had a more negative impact on patients' health-related quality of life than did laparoscopic salpingostomy. This negative impact on patients' health-related quality of life of systemic methotrexate therapy should be taken into account when deciding on the appropriate therapy for tubal pregnancy.     

The Dall-Miles cable and plate system for periprosthetic femoral fractures

BACKGROUND: Spontaneous bilateral ectopic pregnancy is a rare event and difficult to diagnose preoperatively. CASE: A unique case occurred of bilateral ectopic pregnancy involving the left fallopian tube and right cornu, or interstitial segment. CONCLUSION: This case demonstrates the difficulty in diagnosing heterotopic pregnancies and in particular those pregnancies with an interstitial component and also demonstrates the limits of ultrasound and laparoscopy in making such a diagnosis.     

Gentamicin-resistant Staphylococcus aureus

The role of Arias-Stella reaction in diagnosis of ectopic pregnancy in a 35-year old woman who used a contraceptive coil in situ is described. The patient was seen with continuous uterine bleeding of almost 1 month duration. Histological examination of the curettage specimen showed multilayer endometrial epithelial cells with pyknotic apical nuclei and inflammatory infiltration of the stroma. These finding, trophoblastic growth and the absence of the chorion were indicative of the ectopic pregnancy. The patient was subjected to supravaginal hysterectomy. Examination of the surgery specimen confirmed diagnosis of tubal pregnancy.     

Case reports: unrecognized oviduct pregnancy and therapeutic abortion by uterine aspiration

2 cases of unrecognized oviduct pregnancy receiving therapeutic abortion by uterine aspiration are reported. A 29-year-old white female, gravida 4, para 2 with a Dalkon Shield in place for 2 1/2 years and with 6 weeks amenorrhea received a therapeutic abortion. 3 days later the patient complained of fever and severe suprapubic cramps. Minocycline was given in the belief that the patient was suffering from endometritis. 17 days after uterine aspiration the pain increased. At laparoscopy a corpus luteum was seen in the left ovary and blood was present in the pelvis. Histological examination of the oviducts revealed signs of an aborted oviduct pregnant. A 2nd case concerned a 26-year-old white female, gravida 2, para 2, using the Ogino-Knaus method of contraception and who had a normal menses 7 weeks previously. 12 days after uterine aspiration the patient complained of continued vaginal bleeding, lower abdominal cramps, and chills. After uterine aspiration was repeated minocycline therapy was initated. 20 days after the initial aspiration the patient reported a return of vaginal bleeding and lower abdominal pain. Laparotomy revealed a ruptured oviduct. Histology showed salpingitis and fusion of the right fimbria and a large blood clot and trophoblastic villi in the lumen of the right ampulla. In the future it is suggested that histological examination of the aspiration should be performed to aid in finding oviductal or ovarian pregnancies.     

Ectopic bone formation in a child with a head injury: complete regression after immobilisation

OBJECTIVE: To study the correlation between microsurgical tubal reversal after tubal sterilization and ectopic pregnancy. METHODS: 1029 women who underwent microsurgical tubal reversal were followed up. The causes of ectopic pregnancy were analysed and discussed. RESULTS: 960 intrauterine pregnanciess and 12 ectopic pregnancies occurred. The 12 ectopic pregnancies were all tubal ones, among which 2 had intrauterine pregnancies. The rate of ectopic pregnancy in the 1029 women was 1.17%, and in the pregnant cases was 1.23%. The ratio of intrauterine pregnancy to ectopic pregnancy was 1:80. The rates of ectopic pregnancy in the 1st, 2nd year and 2 years later after tubal reversal were not significantly different respectively among the tubal reversal and among the pregnant cases. The rates of ectopic pregnancy in the 1st and 2nd 6 months after tubal reversal were not statistically different. The early tubal hydrapertubation could only increase the chance of ectopic pregnancy. The sterilization method, reversal mode, and interval between sterilization and reversal were not related to the ectopic pegnancy. CONCLUSION: When the lesion in the sterilized position is completely removed, the sutures being through the tubal mucosa and the early tubal hydrapertubation not carried out, the chance of ectopic pregnancy can not be increased after tubal reversal. The contraception 6 months after tubal reversal is not related to ectopic pregnancy.     

Transient neurological deficits simulating transient ischemic attacks in a patient with meningioma--case report

The purpose of this study was to evaluate in vivo the changes in myometrial thickness throughout pregnancy. Myometrial thickness was measured in 25 singleton uncomplicated pregnancies. Ultrasonographic sagittal and transverse sections were used to measure uterine wall thickness from the low anterior wall (lower segment) and the anterior, posterior, right, and left walls of the upper segment and from the fundus. In each case four measurements were made in the second and third trimesters. Myometrial thickness of the upper uterine segment remains fairly constant in the first and second trimesters of pregnancy, whereas a significant linear trend was found between a decreasing thickness of the lower uterine segment and advancing gestational age. Myometrial thickness is significantly increased behind the placental insertion site as compared to other portions of the uterine wall. These data may serve as baseline reference values for further studies in the antepartum fetal surveillance of high-risk pregnancies.     

Hysterosalpingographic evaluation of tubal patency in women treated for anovulatory infertility

During therapy of anovulatory infertility, percentage of pregnancies is lower than the ovulation rate. Cause of this phenomenon is connected as well with the inadequate corpus luteum as others anomalies of the genital tract. Hysterosalpingography was performed in 120 infertile women in whom pregnancy did not occur in spite of effective induction of ovulation. Patency of both tubes was observed in 79 percent of patients. Occlusion of right tube has occurred in 8 percent, left tube in 5 percent, and both tubes in 8 percent of women. Authors suggest that laparoscopy should be obligatory as diagnostic and therapeutic procedure in woman with concomitant ovarian failure and abnormal HSG results.