Cases of coexisting ovarian hyperstimulation and ectopic pregnancy are rare, and pose a difficult diagnostic problem. The routine attempts at laparoscopic diagnosis and treatment of these pregnancies may prove to be hazardous. Such cases may be better managed nonsurgically either by methotrexate or, in selected cases, by expectant management while ...

Administration of the long-acting beta 2-adrenoceptor agonist salmeterol from a new, easy-to-operate, multidose powder inhaler (Diskus) containing 60 sealed doses in a foil strip has been compared with administration from a Diskhaler inhaler in a multicenter, double-blind, double-dummy, parallel-group study. Asthmatic patients taking anti-inflammatory treatment, with baseline FEV1 > or ...

OBJECTIVE: Our purpose was to evaluate the efficacy of single-dose methotrexate as a treatment option for ectopic pregnancies. STUDY DESIGN: Patients were recruited from a tertiary teaching hospital setting. They had (1) a gestational sac < 3.5 cm, (2) no fetal cardiac activity, and (3) no significant pelvic pain or ...

The rationale for the conservative management of ectopic pregnancy is the preservation of reproductive potential. Removal of trophoblast through a linear incision (salpingotomy) can be easily performed by endoscopy. The injection of vasopressin into the broad ligament is required in less than 10% of cases and its routine use is ...

By combining diagnostic modalities such as serial human chorionic gonadotropin titers, transvaginal sonography, and suction curettage, most unruptured ectopic pregnancies can be diagnosed without laparoscopy. When the diagnosis can be made in this manner, methotrexate may be the treatment of choice. It certainly should be considered as an alternative form ...

In a review of 96 consecutive perinatal autopsies (42 nonautolyzed stillborn and 54 liveborn infants 12 h or less of age) with histologic sections of placental tissues and an undistended lung, we were impressed by the frequent occurrence of lymphocytic infiltrates in the interstitium of the lung. To study this ...

The last decade has witnessed an increasing number of reports indicating that ectopic pregnancy (EP) can be successfully and safely treated with methotrexate (MTX). This review summarizes the results. In large series, as many as 45% of a population of women with EP has been treated with MTX. Success rates ...

Methotrexate (MTX, 100 mg) was administered to 36 patients with early ectopic pregnancy locally, either under laparoscopic control into the distended fallopian tube (group A, n = 16), or transvaginally into the gestational sac directly, under ultrasound guidance (group B, n = 20). In cases with persistent beta-hCG levels (n ...

OBJECTIVE: To evaluate the safety and efficacy of single-dose systemic methotrexate (MTX) in the treatment of ectopic pregnancy (EP). DESIGN: A database was started and continued prospectively for 35 patients meeting criteria for MTX therapy from June 1991 to October 1993. Follow-up was performed retrospectively on all patients with EPs ...

Interstitial pregnancy is a rare and extremely dangerous form of ectopic pregnancy. Preoperative diagnosis of this condition prior to rupture is difficult, and early detection is essential to avoid a fatal outcome. Six cases in our series were diagnosed as interstitial pregnancy. Their clinical features were missed period, positive pregnancy ...

Until now, the traditional management of interstitial pregnancy has been surgical. Lately, we have advocated conservative treatment with methotrexate as an option for infertility patients. This is the first publication of a rupture with abundant intra-abdominal bleeding during systemic treatment with methotrexate of a patient with an interstitial pregnancy. Signs ...

Laparoscopic cholecystectomy had been considered contraindicated during pregnancy. A few brief clinical reports have appeared in the literature, but no trials attesting to the safety to the fetus (and mother) have been published. Laparoscopic cholecystectomy during pregnancy has advantages for the mother in that it speeds her recovery, giving her ...

A case of interstitial pregnancy is described. Transvaginal ultrasound examination, performed at 8 weeks' gestation, revealed an empty endometrial cavity with an eccentric gestational sac in the left uterine corner, with a clear separation between the uterine cavity (endometrium) and the gestational sac. Expectant management, consisting of repeated sonographic examinations ...

Laparoscopic removal of the products of conception remains the treatment of choice for ectopic pregnancy (EP). Systemic administration of methotrexate (MTX) is a promising new treatment; however, its efficacy has to be established in clinical trials. Local treatment by laparoscopy with MTX, prostaglandin, or other substances is not as effective ...

Acute calculus cholecystitis during pregnancy can be a difficult management problem. Two pregnant patients with cholecystitis refractory to conservative management underwent laparoscopic cholecystectomy at a community hospital. One patient was treated under epidural anesthesia. Pregnancy should not be an absolute contraindication to laparoscopic cholecystectomy, and epidural anesthesia should be considered.

We evaluated the feasibility of transvaginal methotrexate injection of viable cervical pregnancies to avoid complications of the "classic" surgical procedures in use and to preserve future fertility. Five viable cervical pregnancies, at 6 to 8 weeks, were treated. In three patients a spring-loaded automated puncture device and in two a ...

Antegrade sclerotherapy has been used since 1987 to treat patients with varicocele. The method has proved to be easy to perform, safe, economical and effective. The treatment results in 285 patients who had undergone sclerotherapy for a total of 317 varicoceles are presented and discussed. This followup study revealed that ...

Laparoscopic cholecystectomy has gained great popularity during the last few years. This procedure has advantages over the traditional open operation, thus making it the standard method for removal of the gallbladder at present. Only a few cases of laparoscopic cholecystectomy during pregnancy have been reported. On the other hand, some ...

We report on two cases of peritoneal trophoblastic tissue implants, one after salpingostomy, and one after salpingectomy for ectopic pregnancy. During each secondary laparoscopy, simple excision of implants with laparoscopic biopsy forceps resulted in persistent elevated beta-human chorionic gonadotrophin (beta-HCG) levels. Methotrexate therapy was used. Removal of all trophoblastic tissues ...

OBJECTIVE: To determine whether a single outpatient methotrexate injection successfully treats persistent ectopic pregnancy. METHODS: Nineteen consecutive patients with increasing beta-hCG titers after conservative surgery for ectopic pregnancy were treated with a single intramuscular methotrexate (50 mg/m2) injection. RESULTS: All 19 patients had resolution of their beta-hCG titers without subsequent ...

Methotrexate is cytotoxic to trophoblast and, in low doses, has minimal side effects. It is used to treat gestational trophoblastic neoplasia and ectopic pregnancy and has recently been shown to have similar effects on intrauterine trophoblast. A prior study suggested that methotrexate may successfully cause abortion of an early pregnancy ...

Pancreatic arteriovenous malformation is a rare condition that may cause gastrointestinal bleeding. A 66-year-old man with large arteriovenous malformation at the pancreatobiliary region is described. The patient had recurrent episodes of hemobilia after cholecystectomy performed for the treatment of cholelithiasis. Enlargement of the arteriovenous malformation was documented by angiography performed ...

Methotrexate is cytotoxic to trophoblast and, in low doses, has minimal side effects. It is used to treat both gestational trophoblastic neoplasia and ectopic pregnancy. The cytotoxic effects of methotrexate on intrauterine trophoblast should be equivalent. To test this hypothesis, ten pregnant women, < 8 weeks' gestation were treated with ...

PURPOSE: To evaluate the relationship of the endometrial canal and decidua vera to the interstitial gestational sac and to determine if this relationship can be used to increase the predictive value of ultrasound (US) in the diagnosis of interstitial ectopic pregnancy. MATERIALS AND METHODS: The US findings in 12 patients ...

A 30-year-old, white woman, gravida 4, para 2, abortus 1, was hospitalized at 21 weeks' gestation because of a symptomatic pericardial effusion. Extensive evaluation including pericardial biopsy failed to reveal a specific cause. Treatment with pericardiotomy and intrapericardial hydrocortisone was followed by relief of symptoms. The remainder of the pregnancy ...

OBJECTIVE: To evaluate reproductive outcome after laparoscopic local methotrexate (MTX) injection for tubal pregnancy. DESIGN: Follow-up was performed after 77 women were treated with local MTX injection between January 1, 1987 and December 31, 1990. SETTING: Department of Obstetrics and Gynecology in a university medical center. MAIN OUTCOME MEASURES: Concise ...

OBJECTIVE: Our purpose was to report an expanded clinical trial with a nonlaparoscopic approach to ectopic pregnancy diagnosis combined with single-dose intramuscular methotrexate treatment. STUDY DESIGN: A prospective cohort of 120 women with an ectopic pregnancy < or = 3.5 cm in greatest dimension was enrolled. RESULTS: Patients had a ...

The risk of operation during pregnancy is a concern to both patients and surgeons. Operative treatment for gallstone disease during pregnancy is therefore performed only when the severity of symptoms exceeds the tolerance of the patient. The insufflation of the abdomen during laparoscopy and the concerns regarding adequate exposure are ...

Reports of successful treatment of ectopic pregnancies by administration of methotrexate have recently attracted a great deal of attention. This review summarizes the results of therapy with methotrexate in tubal pregnancy. Different technical approaches and pharmacological doses have been reported. These methods, however, present various problems, including the occurrence of ...

It has been stated that pregnancy is an absolute contraindication to laparoscopic cholecystectomy. After failed medical management, five gravid patients underwent successful laparoscopic cholecystectomy with single-film intraoperative cholangiography. One patient was in the first trimester, three were in the second trimester, and one was in the third trimester. All carried ...

Although cervical pregnancies account for a very small number of the ectopic pregnancies, they sometimes result in a tragic outcome due to the difficulty of surgical treatment and subsequent intractable hemorrhage. We report our experience with four cases of cervical pregnancy which were treated successfully with methotrexate. All four patients ...

Two cases of interstitial pregnancy (one singleton, one heterotopic twins) were confirmed 31 and 34 days after in-vitro fertilization. Serum human chorionic gonadotrophin concentrations were 35,000 and 86,000 mlU/ml, respectively. They were treated conservatively with transvaginal ultrasonically guided intra-ovular injection of either methotrexate in the singleton pregnancy, or potassium chloride ...

As with laparotomy, laparoscopic treatment of ectopic pregnancy (EP) can be either conservative or radical. After conservative laparoscopic treatment by salpingotomy the risk of failure (between 4 and 6%) is comparable with that observed after similar treatment by laparotomy. The fertility results after laparoscopic treatment of EP are comparable if ...

Laparoscopic management is now the gold standard treatment of ectopic pregnancy. It can be performed using different procedures such as salpingotomy and salpingectomy, or it can be combined with methotrexate injection. On the other hand, nonsurgical treatment is available. The authors discuss technique results and indications of these various therapeutic ...

Pregnancy has generally been considered a contraindication to laparoscopic cholecystectomy. The authors present a case of laparoscopic cholecystectomy in a 37-year-old patient who was 18 weeks pregnant. Laparoscopic cholecystectomy can be safely accomplished during pregnancy, provided that the open technique of insertion of the first cannula is used, and all ...

Since the introduction of laparoscopic cholecystectomy in 1989, surgeons worldwide have become familiar with the basic techniques involved. Pregnancy has previously been considered an absolute contraindication to laparoscopic cholecystectomy; however, we present three cases of laparoscopic cholecystectomy in pregnancy. If conservative management fails, this method, far from being absolutely contraindicated, ...

We describe a patient with multicentric reticulohistiocytosis who presented, during the second trimester of pregnancy, with symmetric polyarthritis, marked erythematous, pulsatile synovial swelling of the distal interphalangeal joints of both hands, and widespread telangiectasias. She did not have the typical skin manifestations of multicentric reticulohistiocytosis. The erythema and pulsatility of ...

Two cases with ectopic pregnancy were successfully treated by laparoscopic injection of methotrexate (MTX). Case 1: A 29 year-old housewife was laparoscopically treated with a 15 mg MTX injection to the left Fallopian tube. After the laparoscopy, the human chorionic gonadotropin (HCG) was reduced to the normal range. Case 2: ...

This report describes a woman with a cornual pregnancy, documented by laparoscopy and ultrasonography, who was successfully treated with a 1-day high-dose methotrexate regimen and folinic acid rescue. The serum beta-hCG level was 2,260 and increased to 3,060 IU/l on the 5th day after treatment before it fell precipitously to ...

Morphological features of the craniofacial complex during orthopedic chin cup therapy were investigated in growing patients with mandibular prognathism. Lateral cephalograms of 30 subjects (15 boys and 15 girls, mean age: 9.04 +/- 1.29 years), taken at four different stages during treatment, were analyzed for 14 measurements. These measured values ...

Trocar-assisted transvaginal colpotomy was performed in 17 patients to remove large pathologic specimens during laparoscopic operations when the specimen could not be extirpated through the laparoscopic ports. Under direct laparoscopic visualization, colpotomy was performed using a 10- or 11-mm disposable trocar without the sleeve. The trocar was removed, a ring ...

We present a case in which treatment of interstitial pregnancy with local MTX administration was performed successfully through hysteroscopic vision, without the need to operate. Decreased gestational sac dimension and increased or low beta-hCG level ( < 1,400 mIU/mL) facilitates the success rate. The follow-up showed disappearance of the gestational ...

In a prospective study 69 carpal and digital ganglions were aspirated, multiply punctured, and digitally ruptured. Fifty percent of the wrists and digits were immobilized for 3 weeks and 50% were mobilized early. Follow-up was 1 year. Immobilization in our study did not significantly improve the results of treatment. During ...

We report a case of a woman with ectopic pregnancy with fetal cardiac activity after ovulation induction and transvaginal intratubal insemination by tactile sensation. The patient was successfully treated by single-dose methotrexate (MTX) (77 mg or 50 mg/m2 given intramuscularly). Control hysterosalpingograms showed no tubal patency on the involved side. ...

Interstitial tubal pregnancy occurs in about 5% of ectopic tubal pregnancies and is associated with an increased risk of severe haemorrhage (1). Diagnosis prior to rupture of the pregnancy into the peritoneal cavity is very important to avoid haemorrhage. Its presence has been considered to be a contraindication to laparoscopic ...

Two cases with unsuccessful local and systemic methotrexate (MTX) therapy of tubal pregnancy with fetal heart rate activity are reported. The three modes of therapy, the first with local potassium chloride solution injection, the second with local MTX injection, and the third with systemic MTX injection, failed in the resolution ...

We describe a case of pneumonitis following local administration of methotrexate for nonsurgical termination of an ectopic pregnancy. The signs and symptoms were similar to those seen with systemic use of the drug for other ailments. We believe that methotrexate represents a relatively effective alternative to surgery in patients with ...

Five patients with vital, unruptured interstitial pregnancies of less than 3 cm maximum diameter were treated successfully with methotrexate and leucovorin rescue. Four pregnancies showed cardiac activity. Diagnosis was established with transvaginal ultrasonography in all patients. The human chorionic gonadotrophin serum levels were measured to monitor the effectiveness of therapy. ...

Vivida when used orally has been previously shown to be effective in treating degenerated skin of women. In the present study, 30 women with moderate to severe sun-damaged facial skin applied Vivida cream twice daily for 120 days on one side of the face and placebo to the other. Vivida ...

This case report describes the treatment of tubal pregnancy by aspiration of the gestational sac content and injection of methotrexate by transvaginal sonographic guidance. The confirmation of the embryo aspiration as indicated by disappearance of the embryo with its heart beat and the resulting 46,XY karyotype, raises the question whether ...