Conservative treatment of cervical pregnancy.
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The association between clinical findings and the occurrence of spermagglutinating antibodies was investigated in serum from women in 326 consecutive infertile couples. No relationship was found between unexplained infertility and the occurrence of sperm antibodies as detected by the tray agglutination technique. The occurrence of pregnancy at follow-up was the same in women with and without circulating sperm antibodies. However, the cumulative probability of conception per year was significantly lower in women with spermagglutinating antibodies than in women without such activity (0.005 greater than 2 P greater than 0.001), and the results showed a positive correlation between the duration of infertility and the occurrence of sperm antibodies. The latter findings may either reflect a fertility-reducing effect of the sperm antibodies or represent a time-related increasing tendency to develop sperm antibodies secondarily to the infertility.
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From January 1973 to December 1975, 26 018 women were delivered at Edendale Hospital. During the same period, 4 478 patients aborted there. Maternal deaths during this period numbered 118, a mortality of 4,5/1 000 total births. Avoidable factors influencing the mortality may have been present in 28 (2387%).
Two cases of interstitial and one of angular pregnancy have been presented. Angular pregnancy occurs in the angle of the uterine cavity, while interstitial pregnancy is a true ectopic pregnancy. The outcome may therefore be different: the first may develop or abort into the cavity, while the second will almost always rupture. Because of the rich vascularization of this area, hemorrhage is usually profuse and may be catastrophic. Preoperative diagnosis is rare, but the triad of bleeding in pregnancy, no fetal remnants on dialation and curettage and an asymmetric uterus suggest angular or interstitial pregnancy. More liberal use of laparoscopy may increase the number of cases diagnosed before severe bleeding occurs.
The differential diagnosis between abortion and ectopic pregnancy has important clinical implications. In this report we have tested the accuracy of frozen sections in uterine curettings to identify intrauterine pregnancy. Uterine curettings with a diagnosis of products of gestation, from 104 patients were studied. In all of them plasmatic levels of B Gonadotrophin were measured. The curetting material was fixed and studied on frozen sections and on paraffin embedded tissue. A high positive relationship between frozen and embedded material was observed. The sensibility, specificity, positive and negative predictive value of the frozen section to detect chorionic villi were 90.6; 100; 100 and 74% for each of them.
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We report the case of a 27-year-old woman with a history of Kearns-Sayre syndrome and a double mitral lesion who underwent surgery without complications. Anesthetic induction was achieved with propofol and fentanyl, and maintenance was with nitrous oxide and oxygen through a face mask. There were no instances of O2 desaturation or hemodynamic alterations. The postoperative period transpired without adverse events and the patient was released 24 h after surgery. The management of anesthesia in this rare mitochondrial disease is described, and anesthetic alternatives are discussed as depending on clinical findings that can occur in the context of these syndromes.
The authors describe one case of quadruplet pregnancy create difficulties in diagnosis and conclude with unfavourable outcome. One of fetuses have hydrops foetus generalisatus, another foetus is malformative and the rest two fetuses are normal anatomy. Multifetal pregnancies require very early and exactly diagnosis and make up behaviour with goal is favour able outcome. In the end the authors recommended this cases must be turn to hospitals which are better possibilities for antenatal and intensive neonatal care.
OBJECTIVE: To describe our experience with selective removal of residual intrauterine trophoblastic tissue via hysteroscopy. METHODS: This is a descriptive report. Eighteen patients, 16 postabortion and 2 postpartum, underwent a hysteroscopic procedure for removal of residual trophoblastic tissue causing continuous bleeding. At hysteroscopy, a cutting loop was used as a curette for selective removal of the adherent residual tissue, while interference with the rest of the endometrial surface was avoided. RESULTS: Complete removal of the suspected residual tissue was achieved in all patients. Histology confirmed the curettings as trophoblastic remnants. No complications were reported during or immediately after the procedure. The median operative time was 10 minutes (range, 8-20). In all cases the bleeding stopped shortly after the procedure. In each patient, postoperative ultrasonography revealed a uterine cavity free of residual tissue. Five of the patients underwent second-look hysteroscopy several weeks later, and no signs of further residual tissue were observed. CONCLUSION: Selective curettage of residual trophoblastic tissue directed by hysteroscopy is an easy and short procedure and might be preferable to conventional, nonselective, blind curettage.
Genes coding for CD66a (biliary glycoprotein), carcinoembryonic antigen (CEA) group member 2 (CGM2), and nonspecific cross-reacting antigen (NCA) are members of the human CEA gene subgroup. We investigated a series of 11 colorectal carcinomas by Northern blot and isotopic in situ hybridization (ISH), demonstrating underexpression of CD66a and CGM2 in the majority of the carcinomas as compared with the normal mucosa, whereas NCA was overexpressed. ISH for CD66a and CGM2 mRNA revealed that large areas of the carcinomas remained without or with only faint hybridization signals. However, in every carcinoma, at least some positive foci were observed, indicating remaining cell populations that actively transcribe CD66a and CGM2. In contrast, ISH for NCA displayed strong and extensive autoradiographic signals. By analysis of step sections, foci of CD66a and CGM2 expression were shown to co-localize. Furthermore, these foci contained relatively few nuclei immunohistochemically positive for the proliferation-associated nuclear antigen Ki-67. Our data indicate a dysregulation of the three genes possibly with a common transcriptional control for CD66a and CGM2 and a different control for NCA. The focal expression of CD66a and CGM2 could be interpreted as due to a focal, incomplete, and abortive differentiation or, alternatively, as a consequence of genetic heterogeneity with foci of slow-proliferating subclones.
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One thousand radioreceptorassays for human chorionic gonadotropin (hCG) for the diagnosis of pregnancy were analyzed under eight categories. The high sensitivity (50 pg/ml) and specificity, coupled with performance time of the assay (1 hour), provided a new modality for the early diagnosis and management of normal and abnormal pregnancy in the first trimester. The radioreceptorassay becomes positive 1 week after conception. In the normal pregnancy this assay has been 100% correct at the time of the first missed menses. All ectopic pregnancies demonstrated positive tests, and no false negatives occurred. On the other hand, a negative assay excluded ectopic pregnancy.
Climacterium is characterized by symptoms that occur as a result of the differentiation of hormonal equilibrium. It begins around the age of 40 and continues up to the age of 60. In this period cycles are usually anovulatory. This paper presents a case which may be diagnosed as abortus incompletus despite the patient being in menopause for five years previously.
We have presented a patient who followed abortion went on to develop septicemia, right-sided endocarditis and septic pulomonary emboil. Such potentially fatal condition should be prevented and diagnosed early to prevent morbidity and mortality.
Leiomyosarcoma are malignant tumors showing smooth muscle differentiation, they are rare, representing only about 25 percent of all uterine sarcomas and mixed malignant tumors and slightly more than 1 percent of all corporeal malignant tumors. Usually they arise in postmenopausal women and are not known to be related to the known risk factors for endometrial carcinoma (nulliparity, obesity, diabetes mellitus, hypertension, etc.) or carcinosarcoma (prior radiation therapy). They may occur in uteri that also bear typical benign leiomyomas, but leiomyosarcoma rarely can be proven to have arisen in or from benign leiomyomas. We report on two premenopausal women with leiomyosarcoma--out of totally 31 cases in our clinic from 1975-1995 who got pregnant after surgical treatment preserving the uterus. The patients are alive without evidence of disease 3 and 6 years after surgical resection.