Ultrasonographic "endometrial three-layer" pattern: a unique finding in ectopic pregnancy

Although diagnostic ultrasonography is playing an increasing role in the investigation of the patient with suspected ectopic pregnancy (EP), it has significant limitations in the very early stages of pregnancy. By sonographically exploring the intrauterine echoes in 45 cases of documented EP, we demonstrated a unique pattern in 28 cases (62.2%). A well-defined spheric structure forming an endometrial three-layer (ETL) pattern was seen, probably formed by a midline echo between the two adjacent edematous proliferative layers of the endometrium, the latter resembling the late proliferative endometrium. In 17 patients with a proved EP (37.8%), the ETL pattern was not demonstrated. However, the ETL was not demonstrated in all 40 cases of early intrauterine pregnancy and all 50 cases of miscarriage. These findings suggest a 100% specificity and a sensitivity of 62.2% for the ETL pattern in the diagnosis of EP.

Renal cell carcinoma metastatic to the ovary. Ultrasound and CT appearance

Three years following nephrectomy for renal cell carcinoma, a 54-year-old woman presented with symptoms secondary to ascites, and a large left adnexal mass. A large predominantly cystic, partially solid, septated mass with thick irregular margins was found on ultrasound and computed tomography scans. Pathological examination revealed renal cell carcinoma identical to the original tumor. The etiology and appearance of metastatic disease to the ovary are discussed.

Early uterine prolapse following colponeedle suspension

The association of retropubic colposuspension for the treatment of urinary stress incontinence with genital prolapse has been reported previously. Described here is a case of an 83-year-old patient who had a colponeedle suspension and was readmitted because of genital prolapse 3 weeks after surgery. This case emphasizes the need for proper evaluation of the whole pelvic floor prior to any surgical treatment for urinary incontinence, and addition of appropriate surgical measures aimed to avoid later genital prolapse, if necessary.

Good fetal outcome following prolonged indomethacin induced anhydramnios. Case report

Indomethacin is a non steroidal anti-inflammatory agent widely employed in the treatment of premature contractions. Indomethycin induced oligohydramnios is a well described side-effect, and is considered an indication for treatment discontinuation. We present a case of prolonged anhydramnios, secondary to indomethacin therapy with no apparent ill-effect on the fetus or neonate.

Simultaneous detection of three common sexually transmitted agents by polymerase chain reaction

OBJECTIVE

Human papillomaviruses, herpes simplex viruses, and Chlamydia trachomatis are very common infections of the genital tract. The purpose of our study was to develop a polymerase chain reaction-based assay for the simultaneous detection of these organisms from a single genital swab.

STUDY DESIGN

To prove the technical feasibility of a simultaneous polymerase chain reaction assay for these organisms, a mixture of deoxyribonucleic acids extracted from cells infected by these three agents was amplified in the same tube with three different sets of primers corresponding to specific regions of the human papillomavirus genome, the herpes simplex virus 1 and 2 genomes, and the Chlamydia trachomatis plasmid, respectively. Then genital swabs from patients with suspected infection by one or more of these agents were assayed by polymerase chain reaction for the presence of herpes simplex virus, human papillomavirus, and Chlamydia trachomatis independently and simultaneously. Most of the samples were analyzed in parallel by other methods: herpes simplex virus by culture., Chlamydia trachomatis by culture and antigen staining, and human papillomavirus by the filter in situ hybridization method.

RESULTS

Analysis of the polymerase chain reaction products amplified from the deoxyribonucleic acid mixture revealed three bands corresponding to the respective amplified region of each microorganism. A total of 391 genital swabs were assayed independently by polymerase chain reaction for the presence of herpes simplex virus (113 samples), human papillomavirus (200 samples), and Chlamydia trachomatis (78 genital swabs and four urethral swabs). Forty-nine were herpes simplex virus positive (47 by culture), 45 were human papillomavirus positive (43 by filter in situ hybridization), and one sample was positive for Chlamydia trachomatis, both by polymerase chain reaction and by culture. Ninety-two of the 391 samples were analyzed simultaneously by polymerase chain reaction for the presence of the three agents. The correlation between the results obtained independently and simultaneously was of the order of 100%: 29 were positive for herpes simplex virus, 16 were positive for human papillomavirus, and one was positive for Chlamydia trachomatis, in one sample we could detect both human papillomavirus and herpes simplex virus.

CONCLUSIONS

The polymerase chain reaction simultaneous assay is a quick and efficient way of detecting herpes simplex virus, human papillomavirus, and Chlamydia trachomatis from a single genital swab. This method can greatly simplify the diagnostic procedures in the laboratory.

Intrapartum bimanual tocolytic-assisted reversal of face presentation: preliminary report

OBJECTIVE

To design and conduct a mode of vaginal delivery for mentoposterior-presenting fetuses when cesarean delivery is not possible.

METHODS

Eleven orthodox Jewish parturients who refused cesarean delivery had intrapartum bimanual conversion of mentoposterior to occipitoanterior presentation, concomitant with ritodrine infusion in ten.

RESULTS

Excluding the first case, in which ritodrine was not administered, the maneuver was successful and vaginal delivery was achieved.

CONCLUSION

This maneuver, performed with intravenous ritodrine tocolysis, might be an alternative mode of delivery in the presence of mentoposterior presentation when cesarean delivery is not possible. More experience is needed with this technique before it is performed routinely.

Conservative surgical management of acute abdomen caused by placenta percreta in the second trimester

Placenta percreta accompanied by intraabdominal hemorrhage and acute abdomen in the second trimester is described. Suturing the myometrial defect created by the protruding placenta prolonged the pregnancy and achieved a viable fetus. Successful achievement of hemostasis, prolongation of the pregnancy, and survival of mother and fetus should encourage "conservative" surgery.

Maternal serum creatine kinase: a possible predictor of tubal pregnancy

Tubal pregnancy remains a clinical challenge in spite of improvements in diagnostic tests and procedures. In a prospective study we evaluated the role of the serum creatine kinase as a possible marker for tubal pregnancy. Three groups of 17 patients each were included in the study: group A, documented tubal pregnancy; group B, spontaneous abortion; and group C, normal pregnancy. Serum was tested for creatine kinase in all of the patients. Creatine kinase level was > 45 IU/L in all patients with tubal pregnancy, significantly higher than the level in patients in either of the two other groups (p < 0.0001). We conclude that a high serum creatine kinase level can be an important diagnostic test in the evaluation of a suspected tubal pregnancy.

Prophylactic effect of the open vaginal vault method in reducing febrile morbidity in abdominal hysterectomy

In a randomized study, we evaluated the efficacy of the "open vaginal vault" method of abdominal hysterectomy, when cefonicid is administrated preoperatively, in reducing postoperative febrile morbidity. The vaginal vault was left open in 72 patients and closed in 65 patients in control groups. No significant difference in postoperative febrile morbidity was noticed in the two groups.

Risk factors for lateral ankle sprain: a prospective study among military recruits

In a prospective study of risk factors for lateral ankle sprain among 390 male Israeli infantry recruits, a 18% incidence of lateral ankle sprains was found in basic training. There was no statistically significant difference in the incidence of lateral ankle sprains between recruits who trained in modified basketball shoes or standard lightweight infantry boots. By multivariate stepwise logistic regression a statistically significant relationship was found between body weight x height (a magnitude which is proportional to the mass moment of inertia of the body around a horizontal axis through the ankle), a previous history of ankle sprain, and the incidence of lateral ankle sprains. Recruits who were taller and heavier and thus had larger mass moments of inertia (P = 0.004), and those with a prior history of ankle sprain (P = 0.01) had higher lateral ankle sprain morbidity in basic training.