Simultaneous intrauterine and tubal pregnancy. A clinical case

The presence at the same time of intrauterine and ectopic (heterotopic) pregnancy is unusual. A case of acute abdomen by tubaric haemorrage in a patient with ectopic pregnancy and evolutive intrauterine pregnancy during first trimester is reported. After surgical therapy, the intrauterine pregnancy had a good evolution.     

Keeping the faith. Jewish traditions in pregnancy & child birth

3 groups are distinguished among 219 cases of the breast carcinoma with mucus formation: one-component colloid carcinoma, combined colloid carcinoma and signet ring cell carcinoma. Morphological features and prognosis for each group are listed. One-component colloid carcinoma has the most favourable prognosis: incidence of distant metastases 15% versus 27% and 33% in combined colloid and signet ring cell carcinoma, respectively. Signet ring cell carcinoma should obviously be regarded as a variant of invasive lobular carcinoma.     

Ectopic pregnancy associated with the intrauterine device: a study of seventy cases

Seventy cases of ectopic pregnancy associated with an IUD comprised 10% of all ectopics in a 9 year period. This increased to 15% in the last 19 months as more IUD's were in use. In two thirds of the ectopics the IUD had been in situ more than 1 year. Unusual bleeding and cramping attributed to the IUD obscured the diagnosis and resulted in removal or replacement of the IUD in over one half the cases 1 to 8 weeks before surgery. The episodic nature of the abdominal hemorrhage in two thirds of all ectopics resulted in surgery on day 44 average gestational age. The IUD is probably not causal in ectopic pregnancy but does not protect the predisposed patient from ectopic pregnancy which should be suspected in any patient with an IUD who has irregular bleeding and abdominal pain.     

Spontaneous conception and intrauterine pregnancy in a symptomatic missed abortion of ectopic pregnancy conceived in the previous cycle

We encountered a rare case of combined intrauterine and extrauterine pregnancy that occurred following separate spontaneous ovulations. A 33 year old woman visited our hospital with the chief complaint of abdominal pain on April 16, 1993. Her last menstruation was from March 23 for 6 days. However, the urinary human chorionic gonadotrophin (HCG) on April 19 was 1024 IU/l. Pelvic examination and ultrasonography indicated an extrauterine pregnancy, which was confirmed by laparotomy and histological identification of trophoblast cells. The urinary HCG concentration markedly decreased after the operation. However, the HCG level increased again on the fifth post-operative day, and a gestational sac (11 mm) was identified in the uterine cavity on the 11th post-operative day, indicating that this intrauterine pregnancy was established following spontaneous ovulation which occurred before the removal of the extrauterine pregnancy. This case indicates that a combined pregnancy can occur not only after simultaneous multiple ovulations but also after the separate spontaneous ovulations.     

Actively continued twin pregnancy with intrauterine death of one fetus

A case of twin pregnancy with intrauterine death of one fetus in the 28 th week of pregnancy been described. The pregnancy was actively continued. The following procedure was introduced: 1. Tocolysis, 2. Drugs accelerating lung maturation of the alive fetus, 3. Antinfectious and anticoagulopathy prophylaxis, 4. Special care of the mother and the alive fetus. In the 30 th week of pregnancy spontaneus labor occurred "per via naturales". The macerated dead fetus and the alive premature newborn were born. The baby was charged home in good condition in the 45 th day after delivery.     

Endometrial adenocarcinoma associated with intrauterine pregnancy. A report of five cases and a review of the literature

Endometrial adenocarcinoma associated with pregnancy is a rare lesion; only 14 acceptable examples have been reported in the literature. This study describes five additional examples with a critical review of the previously published cases. Four of the five women were nulliparous and three had sought medical intervention for infertility. The tumors were all well-differentiated endometrioid adenocarcinomas; three had a focal to extensive papillary pattern and three had focal to extensive squamous differentiation. Four were diagnosed at the time of dilatation and curettage and one at the time of cesarean section for a 28-week, live infant. Follow-up was available for four of the five women. Two women underwent hysterectomy with bilateral oophorectomy and were alive and well 12 and 48 months after diagnosis. The woman who had the live birth and the remaining woman were treated by repeat curettage with or without progesterone therapy, and each woman has had two subsequent full-term pregnancies with live births. These women are alive and well 57 and 58 months after diagnosis. Women with focal, well-differentiated carcinomas can successfully maintain their fertility if followed by repeat curettage with or without progesterone therapy.     

Continuous intrauterine pO2 determination in the fetus during birth

A study about continuous intrauterine pO2-measurement of the human fetus sub partu. It is reported about a continuous intrauterine unbloody pO2-measurement of the human fetus sub partu. There was found a good correlation in different cardiotocographic patterns between labour, fetal heart frequency and pO2-registration.     

Offspring birth weights after maternal intrauterine undernutrition: a comparison within sibships

The authors examined the effects of maternal intrauterine undernutrition on offspring birth weights in a cohort of women born between August 1944 and April 1946 in Amsterdam, The Netherlands. This period included the Dutch Hunger Winter, a war-induced famine. Undernutrition was defined separately for each trimester of pregnancy as an average supply of less than 1,000 calories per day from government food rations. For maximum control of potential maternal confounding factors related to offspring birth weight, the authors performed a within-family analysis, including 437 families with two siblings and 107 families with three siblings born between 1960 and 1985. As in other studies of the famine, maternal birth weight itself was decreased after third trimester intrauterine exposure but not after first trimester exposure. The expected increase in offspring birth weights with increasing birth order was not seen after maternal intrauterine exposure in the first trimester of pregnancy. In this group, second born infants weighed, on average, 252 g less at birth than their firstborn siblings (95% confidence interval (CI) -419 to -85), and thirdborn infants weighed 419 g less (95% CI -926 to 87), even after adjustment for trimester of maternal intrauterine exposure, maternal birth weight, smoking during pregnancy, and sex of infants in the sibling pairs. Additional adjustment for the birth weight of the elder sibling did not materially change this abnormal pattern. There were no abnormal patterns in offspring birth weights after maternal intrauterine exposure in the second or third trimester of pregnancy. The study outcomes could not be explained by other selected determinants of birth weight, by lack of control for socioeconomic status, or by loss to follow-up of the 1944-1946 birth cohort. This study suggests that there may be long-term biologic effects, even into the next generation, of maternal intrauterine undernutrition which do not correspond to the effects on the mothers' own birth weights.     

Sperm motility is a major determinant of pregnancy outcome following intrauterine insemination

The presence and the distribution of neuroendocrine cells in the gastrointestinal tract of adult wild boar were investigated. The endocrine cells have been identified by means of immunocytochemical techniques using antibodies against serotonin, gastrin, somatostatin, cholecystokinin (CCK), met-enkephalin (MET-ENK), gastric-inhibitory peptide (GIP) and glucagon. The number of positive cells for each antiserum in each region was evaluated. Results were compared with data present in the literature and obtained previously by us and other authors in swine and domestic mammals (Ceccarelli et al., 1985, 1987, 1990, 1991, 1995; Capella and Solcia, 1972; Domeneghini and Castaldo, 1981; Peranzi and Lehy, 1984; Krause et al., 1985).     

Delayed-interval delivery in a quadruplet pregnancy after intrauterine death of a partial molar pregnancy and preterm delivery. A case report

BACKGROUND: Delayed-interval delivery is infrequent in twin gestation and more rare in triplet and quadruplet gestation. Coexistence of a triploid pregnancy with a normal fetus has not previously been reported to have resulted in survival of the normal fetus. CASE: A 26-year-old woman, gravida 2, para 0-0-1-0, was diagnosed with a quadruplet pregnancy. At 16 1/2 weeks' gestation she developed preeclampsia and severe hyperemesis. Ultrasound was consistent with partial molar pregnancy in quadruplet D. Quadruplet D died in utero, and the preeclampsia and hyperemesis resolved. At 19 5/7 weeks, spontaneous rupture of the membranes and preterm labor occurred, and quadruplet A, stillborn female weighing 260 g, was delivered. With the use of antibiotic therapy, tocolysis and bed rest, the remaining two fetuses were maintained in utero until 32 6/7 weeks' gestation, when quadruplet B, a 1,470-g female, and quadruplet C, a 1,700-g female, were delivered. CONCLUSION: This was the first reported case of surviving fetuses coexisting with a partial molar pregnancy. This case was also complicated by preterm delivery and successful delayed-interval birth in a quadruplet pregnancy.     

Endogenous digoxin-like immunoreactivity during pregnancy and at birth

A typhoid fever outbreak affecting 54 school students occurred in a Public School of Móstoles, Madrid. The date of onset was 11 June 1991 and the last detected case was 8 July 1991. Salmonella typhi was cultured from blood and/or stool samples corresponding to 54 patients and one food-handler. There were no secondary cases detected. Epidemiological investigation suggested a salad or a custard as the common source. Patients and the food-handler were treated with ampicillin/amoxicillin for up to three weeks. There were seven relapses that were also treated with the same antibiotics with success. None were found to be excreting the organisms when tested after four months. All the Salmonella typhi isolated strains were phagetype 34, biotype Xylose +, Tetrationate Reductase + and harboured a similar 22 Mdal plasmid, they were also susceptible to the antibiotics tested.     

Characterization of medical activities of urban families in raising a healthy child

Ten statistically significant factors of risk of frequent diseases of children have been distinguished; four of them directly reflect medical activity of parents: late application for medical care when a child falls ill, neglect of prophylactic visits to doctors, neglect of child's health fortification, and refusal to take a sick leave when the child is ill. Poor medical activity of families as far as it concerns the upbringing of a healthy child results in a higher insurance risk, which should be taken into consideration when developing legal and economic aspects of medical insurance.     

Promoting healthy sexuality: guidelines for the school-age child and adolescent

The purpose of this article is to provide the clinician with practical information to promote the healthy sexuality of the school-age child through adolescence. Much of the current literature related to sexuality is problem-focused; this article focuses on sexuality from a health promotion viewpoint. The development of a healthy sexuality is a life-long process with different issues and problems pertaining to each age group. Issues common to the school-age child and adolescent include changing physical characteristics and body image concerns. A set of guidelines has been developed that can be used in the clinical setting. In order to follow a holistic approach to health promotion with these age groups, the clinician must address sexuality. These guidelines will provide the information the clinician will need to initiate a discussion about sexuality. Patient education guidelines are also presented that will help the parent, child, and adolescent in sexual issues and understanding. Suggested reading materials about sexuality are also presented.     

Occult pneumococcal septicemia and pneumococcal pneumonia complicating pneumatoceles in a previously healthy child

1. The effect of in vitro glycation on delta-aminolevulinic dehydratase (ALA-D) under several experimental conditions was investigated. When preincubated with 500 mM glucose at 37 degrees C for 20 hr, ALA-D was 80% inactivated and glycated hemoglobin levels were increased more than fourfold. 2. Thiobarbituric acid species were not modified during glycation; therefore ALA-D inactivation cannot be attributed to glucose autoxidation. 3. Acetyl salicylic acid was effective in preventing both hemoglobin glycation and ALA-D inactivation by glucose. 4. A method has been developed for measuring protein glycation in vitro, in a crude preparation of red blood cells, which can also be applied to sugars other than glucose.