A pregnant patient with gallstone-induced pancreatitis initially responded to medical treatment, but the pancreatitis recurred. Endoscopic retrograde cholangiopancreatography and laparoscopic cholecystectomy were done at 28 weeks' gestation. The remainder of the pregnancy was unremarkable. Although 20 cases of laparoscopic cholecystectomy have been reported for cholecystitis during pregnancy, this is the ...

The two main conservative treatment alternatives for tubal pregnancy, methotrexate administration and laparoscopic salpingostomy are under constant review. Recently, expectant management of tubal pregnancy has become increasingly popular. In this review, we assess the outcome of conservative management modalities for extrauterine pregnancy and compare the results of treatment with methotrexate ...

Laparoscopic cholecystectomy has become the method of choice for symptomatic cholelithiasis. Laparoscopic cholecystectomy during pregnancy is also becoming more accepted, as illustrated by several recent publications on this subject. In the third trimester, however, laparoscopic cholecystectomy has been less commonly attempted, with only a few case reports. We present a ...

BACKGROUND: Medical treatment of ectopic pregnancy with methotrexate is an increasingly common alternative to surgical management. Initial reports of methotrexate therapy described a very low incidence of complications. We report our experience with two patients who developed profound toxicity following methotrexate treatment of ectopic pregnancy. CASE: The first patient received ...

We report four cases (three women, one man) having delusions of pregnancy seen over a four month period at a short - stay in-patient facility in a General Hospital Psychiatry Department. None had organic factors and all could be explained on the basis of psychological mechanisms. Delusions of pregnancy may ...

Medical therapy in ectopic and ovarian pregnancies in particular, can be a valid alternative to the surgical approach, since it can guarantee the reproductive function in a better way. More and more attempts with methotrexate, which can induce the death of both embryo and trophoblastic tissue, are being made. Both ...

OBJECTIVE: Our goal was to determine whether laparoscopic salpingostomy is preferable to laparoscopic methotrexate injection in the management of unruptured tubal gestation. STUDY DESIGN: Forty-eight patients with unruptured tubal pregnancy were prospectively randomized to either laparoscopic salpingostomy or laparoscopic local methotrexate injection in a university medical center. Operation time, duration ...

OBJECTIVE: To compare the economic costs between two strategies for management of the small unruptured ectopic pregnancy: initial treatment with methotrexate versus initial treatment with laparoscopic salpingostomy. METHODS: We assumed that both treatment strategies would result in identical clinical outcomes: resolution of the ectopic pregnancy without maternal mortality or long-term ...

Although diagnostic laparoscopy is still considered the standard reference in the diagnosis of ectopic pregnancy (EP), use of high-resolution endovaginal sonography, in conjunction with qualitative serum assays of the beta subunit of human chorionic gonadotropin (beta-hCG), allows detection of earlier and smaller EPs. The most common endovaginal sonographic finding of ...

We report four patients with internuclear ophthalmoplegia and torsional nystagmus, ipsiversive to the side of the medial longitudinal fasciculus (MLF) lesion. The MLF lesion could be responsible for an inactivation of the ipsilateral interstitial nucleus of Cajal inducing a contraversive slow phase. The presence of a corrective ipsiversive quick phase ...

OBJECTIVES: To review our experience with early ultrasonographic diagnosis and fertility-preserving complete medical treatment of cervical pregnancy. METHODS: From January 1989 to December 1994, 11 cases of cervical pregnancy diagnosed by ultrasonography and treated with methotrexate were evaluated. Patients were treated as follows: systemic administration of methotrexate with leucovorin rescue, ...

In a previous study, 30 pregnant women suffering from headaches were treated with physical therapy, relaxation training, and biofeedback. Eighty percent of these women experienced significant relief of headaches following treatment. Although this study demonstrated the effectiveness of nonmedical treatment during pregnancy, little is known about the influence of changing ...

OBJECTIVE: Our purpose was to evaluate the surgical management and outcome of laparoscopic removal of benign cystic teratomas during pregnancy. STUDY DESIGN: The records of women with benign cystic teratomas who were managed with operative laparoscopy during pregnancy were reviewed. RESULTS: Twelve women had laparoscopic removal of a benign cystic ...

Puncture and injection (usually by methotrexate) of ectopic pregnancies are relatively new modalities of treatment. Lately, these have been applied to cornual ectopic pregnancies. We describe here a proposed transvaginal ultrasound-guided puncture route, leading the needle into the cornual ectopic pregnancy, first traversing the myometrium and approaching the gestational sac ...

The aim of the present long-term follow-up study of orthodontically treated patients was to analyze postretention changes in arch width dimension and to isolate factors that may serve as predictors of long-term prognosis. Pretreatment, end-of-treatment, and postretention (at least 10 years) models of 226 cases with different malocclusions were used ...

OBJECTIVE: To evaluate tubal morphology, trophoblast proliferation, and inflammatory reaction in response to methotrexate (MTX) treatment of ectopic pregnancy (EP). DESIGN: Nonrandomized controlled study. SETTING: Academic hospital. PATIENTS: Archival specimens from 10 EP unsuccessfully treated with MTX and 10 cases primarily treated by surgery. INTERVENTIONS: Ki67/hCG and Ki67/human placental lactogen ...

The morphological plasticity of an identified population of synaptic boutons in the rat neostriatum was investigated 24 h (short-term treatment) or 14 days (long-term treatment) after administration of the depot neuroleptic, haloperidol decanoate. Specific methionine(5)-enkephalin antiserum was used to label bouton profiles in the dorsal neostriatum. The size and shape ...

Early diagnosis of ectopic pregnancy can provide women an alternative to surgical therapy. Nonsurgical treatment using methotrexate is cost-effective, restores subsequent fertility, and decreases the morbidity and morality intrinsic to traditional surgical procedures. This article reviews the risk factors, signs and symptoms, diagnostic techniques, and nursing care for medically treated ...

OBJECTIVE: To describe the use of methotrexate and misoprostol to induce abortion in pregnancies up to 8 weeks when uterine or cervical anomalies make suction curettage difficult or impossible. METHODS: Four consecutive women, 8 weeks pregnant or less and with failed suction curettage, were given methotrexate 50 mg per square ...

The incidence of carpal tunnel syndrome is increased during pregnancy. The common conventional therapeutic approach is conservative, as symptoms usually abate after delivery. We describe our experience with 65 hands (50 patients), who were treated initially by a conservative approach and later, when required, surgically. We found that all patients ...

Between November 1988 and December 1993, 100 patients with a common, unruptured ectopic pregnancy were treated with 1 mg/kg injection of intratubal methotrexate under transvaginal sonographic control. Patients were not excluded from this series on the basis of the size of the adnexal mass, the term of ectopic pregnancy or ...

Dr. Ellen R. Wiebe's study of the use of methotrexate and misoprostol in combination for early termination of intrauterine pregnancy (see pages 165 to 170 of this issue) is the first Canadian study of the use of this drug combination for medical abortion. The authors compare Wiebe's findings with those ...

OBJECTIVE: To evaluate the efficacy and safety of ureteric stone treatment by ureteroscopy and laser lithotripsy during pregnancy. PATIENTS AND METHODS: Four pregnant women (mean age 29.5 years, range 27-35) with five episodes of ureteric stones were treated by ureteroscopy and laser lithotripsy when the fetus was at 26-35 weeks ...

The purpose of this article is to evaluate the effectiveness, side effects, and complications of high dose methotrexate infusion with leucovorin rescue in select patients with ectopic pregnancy. Between January 1991 and November 1994, 28 patients with ectopic pregnancies were prospectively treated with methotrexate (100 mg/m2 intravenous bolus followed by ...

To compare the local injection of methotrexate (MTX) dissolved in saline and MTX suspensions for the laparoscopic treatment of ectopic pregnancy in terms of success rate and postoperative tubal patency. A total of 26 patients with unruptured ectopic pregnancies were selected from among 60 women with ectopic pregnancies admitted to ...

BACKGROUND: Medical therapy for ectopic pregnancy is successful in 86-100% of selected patients. Patients who conceive with an intrauterine device (IUD) in place have an increased risk of ectopic pregnancy (30% of conceptions); these patients have been treated routinely by surgery. CASE: A 33-year-old woman at 7 weeks' gestation with ...

BACKGROUND: Laparoscopy in pregnancy can endanger the fetus. It is now being reexamined because of our experience with complex operative procedures and new laparoscopic equipment. CASE: A decision was made to perform laparoscopy instead of laparotomy for a pelvic mass in a pregnant woman. The patient was admitted to the ...

Cisapride appears to be useful as therapy for chronic constipation that is not associated with underlying organic abnormalities or pregnancy and that is refractory to other treatments, such as increased dietary fiber intake or bulk laxatives. Dosages of cisapride that have demonstrated efficacy in chronic constipation range from 5 mg ...

BACKGROUND: Cholecystectomy represents the second most common nonobstetric operation during pregnancy. Published guidelines for laparoscopic cholecystectomy (LC) have considered it to be contraindicated in the gravid patient. Several cases of successful LCs in the gravid patient have been reported recently. This study reviews LC during pregnancy in my series and ...

OBJECTIVES: To measure and evaluate the in vitro release of MTX from suspensions of methotrexate (MTX) and lipiodol (LPD), and to investigate the MTX concentration and fertility rate using an animal model. METHODS: This study was divided into three components: a) An in vitro Release Study, b) Animal Study No. ...

Eight cases of heterotopic pregnancy following assisted reproductive techniques (ART) were reviewed. One cervical, three cornual and four tubal pregnancies were combined with intrauterine pregnancies. The cervical ectopy was successfully treated with a local injection of potassium chloride (KCl) into the gestational sac. A viable baby was produced from the ...

A successful myomectomy was performed in the second trimester of pregnancy to remove a 1500-g, symptomatic myoma that was refractory to conservative therapy. A laparoscopic single umbilical puncture technique was used. We suggest that laparoscopic myomectomy can be performed safely and effectively during pregnancy. If further studies confirm our experience, ...

BACKGROUND: Heterotopic pregnancy occurs in about 1% of pregnancies achieved with assisted reproductive technologies. The incidence of cornual pregnancy is approximately 1% of all ectopics. CASES: Two patients became pregnant after treatment with IVF-ET. Both presented during the first trimester with evidence of an acute abdomen and ultrasonographic suspicion for ...

A patient is presented with an advanced interstitial pregnancy, diagnosed by transvaginal ultrasound and confirmed by laparoscopy. Amenorrhoea at the time of diagnosis was 57 days. Methotrexate was given systemically (4 x 50 mg i.m.). Because of persisting viability of the fetus, systemic methotrexate treatment was followed by local instillation ...

BACKGROUND: Soft tissue augmentation is one of the most sought after cosmetic procedures around the world. It has been performed for centuries, but only in this decade or so have materials become available that allow effective therapy. OBJECTIVE: This review article discusses the use of materials for soft tissue augmentation ...

Until very recently cervical pregnancies have been treated with surgery, usually hysterectomy. The development of endovaginal ultrasound, which allows early diagnosis, and methotrexate chemotherapy have opened up new therapeutic options. A 45-year-old multigravida presented at 8 weeks' gestation with vaginal bleeding. Endovaginal ultrasound demonstrated a cervical pregnancy with a fetal ...

Laparoscopic cholecystectomy (LC) and laparoscopic appendectomy (LA) are well-established surgical procedures. Although pregnancy initially was considered a contraindication to laparoscopic surgical procedures, successful reports of LC and LA during pregnancy have appeared in the surgical literature. Two cases are presented in this report, one LC and one LA, both in ...

Recent reports affirm that ectopic pregnancy has become a medical rather than a surgical disease. Early diagnosis is the key to effective nonsurgical treatment. Diagnostic algorithms using serum progesterone, serial beta-human chorionic gonadotropin measurements, ultrasound, and office curettage now make definitive diagnosis possible without laparoscopy. Laparoscopic salpingostomy, the surgical gold ...

Laparoscopic treatment of tubal pregnancy is safe and effective. It permits performance of both radical and conservative procedures. Irrespective of the mode of access, conservative procedures carry the risk of retention of trophoblastic tissue. Systemic methotrexate administration is effective in the treatment of retained trophoblastic tissue, especially if the diagnosis ...

Cervical pregnancy was diagnosed in a nulliparous, 28-year-old woman who presented with intermittent vaginal spotting at 12 weeks of gestation. Sonographic evaluation revealed a cervical gestational sac with a fetus with cardiac activity. Methotrexate was instilled intraamniotically, followed by an intramuscular injection with folinic acid rescue. On the seventh day ...

Data on the efficacy and safety of pentavalent antimony in the treatment of visceral leishmaniasis during pregnancy are scanty. A case of visceral leishmaniasis in a 39-year-old woman in the second trimester of pregnancy is reported here. The patient was hospitalized in poor condition with high fever and pancytopenia which ...

Although laparoscopic cholecystectomy has become the surgical procedure of choice for most patients with cholecystitis, the safety of carbon dioxide (CO2) pneumoperitoneum during pregnancy has not been fully elucidated. Pregnancy causes many physiologic changes, resulting in compromised cardiac, pulmonary, and metabolic reserves. The use of CO2 pneumoperitoneum during laparoscopy may ...

Certain technical details are considered important to ease the laparoscopic performance of a Heller myotomy combined with a Dor antireflux procedure for esophageal achalasia. A special emphasis is given to intraoperative esophagoscopy combined with a mild balloon distension of the esophagogastric junction. These maneuvers prove helpful in identifying the esophagogastric ...

Ectopic pregnancy has become a surgical epidemic over the past two decades. To minimize the morbidity, mortality, and financial burden created by this rapidly growing health problem, nonsurgical alternatives have been investigated, including treatment with methotrexate. We reviewed current literature to evaluate the safety, efficacy, and costs associated with methotrexate ...

We report two cases with interstitial pregnancy, which showed completely different MR appearances. In case 1, a gestational sac was demonstrated and the diagnosis of ectopic pregnancy was straightforward. In case 2, a hypervascular mass was shown without demonstration of a gestational sac, the findings usually seen in gestational trophoblastic ...

The conventional treatment of interstitial pregnancy has been cornual resection of hysterectomy by laparotomy. We have used a laparoscopic approach to treatment of interstitial pregnancy, consisting of cornual excision in four patients and salpingotomy incision via the myometrium in another. In all five cases, the procedure was associated with minimal ...

The increasing frequency of pelvic inflammatory disease and use of ovulation-induction agents has resulted in a corresponding increase in the frequency of heterotopic pregnancy. In most reported cases the diagnosis was made retrospectively at the time of laparotomy. With improvements in ultrasonography and operative laparoscopy, the diagnosis can be made ...

Interstitial (cornual) pregnancies occur rarely, estimated at 1 for every 2500 to 5000 live births. Since the morbidity and mortality are high, the correct diagnosis must be made and treatment begun promptly. A number of management options have been described, including conservative treatments such as expectant management, methotrexate injections (local ...

The purpose of this study was to clarify the effect of lansoprazole on basic fibroblast growth factor (bFGF) during the healing of gastric ulcers in comparison with famotidine and rebamipide. Alteration of the localization and concentration of bFGF was examined in gastric mucosa obtained endoscopically from ulcer patients. The bFGF ...

BACKGROUND: Retinoic acid (RA) cream treatment alters epidermal proliferation and differentiation in photoaged skin. OBJECTIVE: To study the changes in the expression of markers of epidermal differentiation in photoaged skin following RA cream treatment. METHODS: Ten subjects with photoaged skin were examined before treatment and at regular intervals during 12 ...