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 ...

We present a case of an intact interstitial pregnancy at 6 postmenstrual weeks and 4 days, which was successfully treated by combined local and systemic methotrexate administration. The embryonic cardiac activity stopped within 1 min after uneventful ultrasound-guided puncture and methotrexate instillation of the chorionic sac. While the beta-hCG serum ...

BACKGROUND: Data concerning medical treatment of interstitial ectopic pregnancies are scarce. These pregnancies are characterized by late and serious clinical manifestations. We report a case of advanced interstitial pregnancy treated successfully by combining methotrexate (MTX) and hysteroscopy. CASE: A routine ultrasonic evaluation of a 10-week pregnancy revealed a right interstitial ...

OBJECTIVE: To describe the monitoring of an unsuccessful case of methotrexate treatment of cervical pregnancy. DESIGN: Case report. SETTING: University hospital. PATIENT(S): A 27-year-old woman, gravida 3, para 1, with a vital cervical pregnancy. INTERVENTION(S): Feticide and methotrexate administered both locally and systemically. MAIN OUTCOME MEASURE(S): Treatment success, defined as ...

OBJECTIVE: Our aim was to assess the efficiency of methotrexate therapy for unruptured ectopic pregnancy. STUDY DESIGN: From November 1990 to December 1996, 60 patients diagnosed with unruptured ectopic pregnancies were treated by the Departamento de Ginecología y Obstetricia at the Hospital Virgen Macarena of Seville. Of these, 14 patients ...

To review the effect of non-gynecologic laparoscopic procedures performed during the second and third trimesters of pregnancy on pregnancy outcome. A review of the patient log for the antenatal obstetrical unit was used to identify the patients in this series from January 1, 1997 to December 31, 1997. Medical records ...

In the search for a more potent alternative to a single i.m. injection of methotrexate for ectopic pregnancy, a randomized trial was organized. The efficacy of a combination of methotrexate and mifepristone was compared with methotrexate alone in the treatment of unruptured tubal pregnancies. The diagnosis of an unruptured tubal ...

Recent reports describe successful treatment of interstitial ectopic pregnancies using methotrexate. While the number of reported cases is increasing, no consensus exists regarding the management of this complication of pregnancy. We present the successful use of combined systemic and direct intrasac injection of methotrexate for an interstitial pregnancy with the ...

Cornual pregnancy traditionally has been treated with laparotomy and either cornual resection or hysterectomy. Recently, more conservative operations have been developed, and operative laparoscopy has provided yet another management option. This report describes the conservative management of a large cornual ectopic pregnancy and reviews the techniques and outcomes of conservative ...

We evaluated the role of transvaginal color Doppler ultrasound in the treatment and follow-up after transvaginal instillation of methotrexate in ectopic pregnancy. Three patients diagnosed with ectopic pregnancies were treated with a single 50 mg dose of methotrexate, transvaginally instilled, under direct color sonographic guidance. Inclusion criteria required a gestational ...

PURPOSE: Satellite dark dots (SDD) seen by indocyanine green angiography (ICGA) around the main retinochoroiditis focus are described in 75% of cases. Whether SDDs represent subclinical infectious foci or just a perilesional inflammatory reaction is not known. The purpose here was to report a case giving additional information on this ...

In selected patients who are hemodynamically stable with an unruptured tubal pregnancy, systemic methotrexate has success rates comparable to laparoscopic salpingostomy. Larger randomized studies are necessary to adequately assess subsequent fertility. Local injection of methotrexate or other agents requires a sonographically visible ectopic as well as technical skills, and has ...

Symptomatic biliary disease during pregnancy may have serious consequences for both the mother and the fetus. Laparoscopic cholecystectomy was felt initially to be contraindicated in pregnancy, but clinical experience accumulated since 1991 has been extremely favorable. Specialists in the areas of anesthesiology, obstetrics and laparoscopic surgery should continue to carefully ...

Transvaginal colour and angio Doppler blood flow analysis combined with serial measurement of human chorionic gonadotrophin (HCG) concentration is reported here for the first time to study the local vascularity of a cornual pregnancy and to monitor the effectiveness of medical therapy. Interestingly, a strong relationship between morphological changes of ...

OBJECTIVES: The objective of this study was to review the largest single series of ectopic pregnancies treated with single-dose methotrexate reported to date. STUDY DESIGN: A review of 315 patients with unruptured ectopic pregnancies treated with single-dose methotrexate 50 mg/m2 from March 21, 1990, to March 1, 1997, was performed. ...

The use of single-dose intramuscular methotrexate for the primary treatment of ectopic pregnancy is increasing in frequency in many countries. We performed a systematic review of all available studies and case reports of intramuscular methotrexate to examine the therapeutic efficacy, side-effects and complication rates of this new treatment approach. The ...

Methotrexate is a folic acid analogue that has been used successfully for the treatment of ectopic pregnancy and, in conjunction with misoprostol, for medical abortions of early intrauterine pregnancies. To administer the most efficacious treatment requires knowledge of the mechanism underlying the induction of methotrexate-induced abortion. This study was designed ...

BACKGROUND: Ectopic pregnancy is a well-known complication of in vitro fertilization/embryo transfer (IVF-ET). Although ectopic pregnancy after IVF-ET in patients with prior bilateral salpingectomy is uncommon, it can occur and may be a cornual implantation. Because of the possibility of early rupture with severe hemorrhage, special attention to cornual pregnancy ...

Between 1979 and 1995 we have treated 272 consecutive women with high-risk (GTT including 121 previously treated patients who were treated with the weekly EMA/CO (etoposide, methotrexate, actinomycin D alternating with cyclophosphamide and vincristine). The median follow-up is 4.5 years (range 1-16 years). The cumulative 5 year survival is 86.2% ...

A woman with a small (6-mm gestational sac) interstitial pregnancy had complete resolution after medical therapy alone. A single cycle of methotrexate 50 mg/m2 was used as outpatient treatment without any operative procedure either for diagnosis or intervention. The guidelines that have evolved for selection of women for single dose ...

PURPOSE: Respiratory acidosis during carbon dioxide (CO2) insufflation has been suggested as a cause of spontaneous abortion and preterm labour following laparoscopic cholecystectomy during pregnancy. Capnography may not be adequate as a guide to adjust pulmonary ventilation during laparoscopic surgery and hence arterial carbon dioxide (PaCO2) monitoring has been recommended. ...

OBJECTIVE: To evaluate a laparoscopic technique of cornual resection using the harmonic scalpel. METHODS: Four patients with unruptured interstitial pregnancies were treated laparoscopically using the harmonic scalpel at Ioannina University Hospital. RESULTS: There were no failures in the technique in any of our patients. CONCLUSION: Our study suggests that interstitial ...

Pregnancy was once considered a contraindication to laparoscopic cholecystectomy and appendectomy. The progression of laparoscopic techniques has resulted in a continued reassessment of laparoscopic procedures during pregnancy. There still exists some controversy as to the safety of laparoscopic procedures during pregnancy. This paper reviews our series of six pregnant patients ...

A case of vaginal bleeding occurring in a patient with a cervico-isthmic pregnancy located in a previous caesarean section scar was treated with curettage and systemic methotrexate. Metrorrhagia and uterine rupture are severe complications of this kind of ectopic pregnancy and sometimes require demolitive surgery, still today. Early ultrasonographic diagnosis ...

The aim of this study was to compare direct and indirect costs of single-dose methotrexate and laparoscopy in the treatment of unruptured ectopic pregnancy. We conducted a prospective study between 1 January 1995 and 31 May 1997 and recorded costs accrued from outpatient and inpatient treatment with methotrexate (group I) ...

Management of ectopic pregnancy remains traditionally surgical. Early detection of unruptured ectopic pregnancies, using both ultrasound techniques and beta-human chorionic gonadotropin (beta-hCG) assays, allows a more conservative treatment. Twenty-six tubal pregnancies, which were managed with local methotrexate (MTX) injection, are presented. A single dose of 10-12.5 mg of MTX was ...

OBJECTIVE: To evaluate subsequent pregnancy outcomes in women who have been treated with methotrexate for tubal pregnancies. METHODS: Descriptive study of subsequent pregnancy outcomes in 170 women who were treated with methotrexate for tubal pregnancy at Brigham and Women's Hospital during 1989-1994. Patients who agreed to participate were administered a ...

BACKGROUND: The 4-S modification of the Roeder knot may be tied laparoscopically as a single-throw knot. TECHNIQUE: It is tied by adding a fourth wrap around the suture loop and securing the loop in place with a square knot rather than a single half-hitch. EXPERIENCE: We have used this knot ...

We present a case in which a viable cervical pregnancy was successfully treated with preservation of the uterus. A 26 year old female presented with a 6 week cervical pregnancy with acute moderate bleeding. On the day of admission the patient underwent embolization of the descending uterine artery to decrease ...

BACKGROUND: Conventionally, cornual pregnancy has been treated by cornual resection or hysterectomy at laparotomy because it is usually hard to achieve hemostasis of the myometrial wound. We describe laparoscopic treatment with fibrin glue hemostasis in a woman with cornual pregnancy following salpingectomy. CASE: A 39-year-old woman who had a history ...

During endodontic treatment of any tooth, aesthetics must be considered in the same manner as during any other dental treatment. The most common aesthetic challenge associated with endodontics is the discoloration of natural tooth structure. The discoloration may be a result of pulp pathosis, especially pulpal hemorrhage prior to or ...

PURPOSE: To suggest an explanation for the satellite dark dots seen by indocyanine green angiography (ICGA) around the main focus of a toxoplasmic retinochoroiditis. METHODS: The authors analysed the evolution of ICG satellite dark dots in two cases of recurrent toxoplasmic retinochoroiditis receiving anti-toxoplasmic treatment not including corticosteroids. RESULTS: Both ...

Using microdialysis of human melanoma transplants in athymic mice we have shown that interstitial glutathione levels decreased during treatment with buthionine sulphoximine (BSO) and recovered after cessation of treatment. The cysteine concentrations also decreased, while 5-S-cysteinyldopa tended to increase during BSO treatment. Restoration of the glutathione levels was not seen ...

BACKGROUND: Medical management of ectopic pregnancy is effective in selected cases and is recommended to treat interstitial pregnancy to avoid surgery that may limit future fertility. Although successful medical management of interstitial pregnancy has been reported, evidence does not support success rates equal to that in other ectopic locations. CASES: ...

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 ...

With use of transvaginal ultrasonographic guidance, cardiac activity in an interstitial heterotopic pregnancy at 7 weeks' gestation was terminated. The interstitial pregnancy resolved, and a healthy term infant was delivered. If an early diagnosis of an interstitial heterotopic pregnancy is made, selective reduction may allow preservation of the intrauterine gestation ...

BACKGROUND: The interstitial gestation prevalence ranges from 1 in 2,500-5,000 live births, with a mortality rate of 2-2.5%. Total abdominal hysterectomy is usually offered to clinically stable patients over 35 years old. For younger women who desire to preserve their child-bearing capacity, interstitial pregnancy excision with a salpingo-oopherectomy is offered. ...

This report describes an infant with multiple congenital anomalies born to a 20-year-old mother with juvenile rheumatoid arthritis who had been taking weekly low-dose methotrexate (MTX) during the first trimester of pregnancy. The abnormalities found were consistent with those associated with maternal ingestion of MTX at dosage levels used to ...

BACKGROUND: Interstitial pregnancies are often associated with significant morbidity. The surgical treatment of such ectopic gestations often requires laparotomy and cornual resection, thus obliterating tubal and uterine continuity. Methotrexate has been shown to be 94% successful in the management of tubally implanted ectopic gestations, but few reports describe its use ...

The object of this report is to discuss diagnosis and treatment of heterotopic pregnancies. Thirteen consecutive cases referred to our institution are reviewed. In 54% of cases the heterotopic pregnancy was asymptomatic. The ectopic pregnancy was visualized prior to surgery in 69% of the cases. The treatment was surgical in ...

Recently, various conservative regimens for the treatment of cervical pregnancy have been introduced to preserve fertility in young women, with methotrexate being one of the most widely used drugs. The success of conservative treatment depends on early preoperative diagnosis. We report three cases of first trimester cervical pregnancy, successfully treated ...

Pneumonitis is an infrequent complication of methotrexate therapy. Described is a case of pneumonitis after treatment of an ectopic pregnancy. A 20-year-old white woman, gravida 3, para 0, ectopic pregnancy 2, was treated for her third ectopic pregnancy with 88 mg (50 mg/m2) of intramuscular methotrexate. Four days later acute ...

From March 1989 to December 1995, 194 cases of ectopic pregnancy were diagnosed in our centre and treated following a strict laparoscopic protocol. A total of 193 cases was treated surgically and only one case was treated medically, because general anaesthesia was contraindicated. Altogether, eight laparotomies (4.1%) had to be ...

BACKGROUND: To assess the use of laparoscopy in the management of persistent adnexal mass during the second trimester of pregnancy. SUBJECTS: Six consecutive pregnant women undergoing laparoscopic surgery for persistent adnexal masses in the second trimester. RESULTS: Laparoscopic removal of an adnexal mass was successfully performed in all patients. The ...

STUDY OBJECTIVE: To compare three treatment options for ectopic pregnancy-laparotomy, laparoscopy, and methotrexate-including clinical aspects, costs, and reproductive outcomes. DESIGN: Retrospective review of outpatient and inpatient records of all patients with a diagnosis of ectopic pregnancy insured by Fallon Community Health from 1990 to 1995. SETTING: Multispecialty group practice and ...

There is a widespread belief that salpingostomy is the treatment of choice for ectopic pregnancy. The ability to treat most ectopic pregnancies via a laparoscopic approach has been a major advance in gynaecological surgery. Despite the well publicized benefits of laparoscopy over laparotomy only 50% of patients with ectopic pregnancies ...

This report describes a woman with cornual pregnancy, documented by ultrasonography and laparoscopy, who was successfully treated with two doses of methotrexate under laparoscopic and ultrasonographic guidance. The serum beta human chorionic gonadotropin level was 20,000 mIU/ml and increased to 43,800 mIU/ml after the first methotrexate injection and to 44,400 ...

The feasibility of ultrasound-guided transvaginal interstitial laser treatment of the ovary (TILT) and its efficacy for ovulation induction was investigated in 3 hormone-therapy-resistant patients with chronic hyperandrogenic anovulation. TILT was performed at powers of 1-2 W and exposures of 75-600 s. Clear-cut hyperechogenic zones developed during laser irradiation with diameters ...

To review the literature regarding the role of laparoscopy during pregnancy, particularly adnexal mass and non-obstetric surgery, incorporating the results of a series of 9 cases of laparoscopy during pregnancy at our centers. A Medline search was performed to review the literature, and the reference lists provided by those articles ...

OBJECTIVE: To investigate whether the incidence of persistent ectopic pregnancy after linear salpingostomy can be reduced by prophylactic administration of a single dose of methotrexate postoperatively. METHODS: Women who underwent linear salpingostomy for treatment of unruptured ectopic pregnancy and who agreed to participate in the study (n = 129) were ...