[Heterotopic pregnancy following in vitro fertilization with excision of ruptured cornual pregnancy and eventually caesarean section close to term].

We describe a rare case of heterotopic pregnancy following in vitro fertilization with transferring of two embryos in a 39-year-old woman with previous bilateral salpingectomy. An ultrasound examination was performed on the day before admission showing a vital intrauterine pregnancy and no ectopic pregnancy. The woman was admitted with a ruptured cornual pregnancy at ten weeks of gestation. Laparotomy was performed on vital indication with excision of the ruptured haemorrhagic cornual pregnancy. The intrauterine pregnancy continued uneventfully with obstetric and fetal medicine specialist monitoring. A healthy boy was delivered by elective caesarean section.

Nocturia and associated morbidity in a Danish population of men and women aged 60-80 years.

OBJECTIVE: To evaluate the association between nocturia and medical diseases, medication, urinary incontinence (UI), recurrent cystitis, smoking, alcohol, parity, hysterectomy, pelvic organ prolapse surgery, UI surgery, and prostate surgery. SUBJECTS AND METHODS: The previously validated questionnaire the Nocturia, Nocturnal Enuresis and Sleep-interruption Questionnaire was sent to 2000 women and 2000 men aged 60, 65, 70, 75, and 80 years. The population was selected at random from The Danish Civil Registration System. RESULTS: Using multiple logistic regressions UI and age were significantly associated with nocturia irrespective of severity. Nocturia of > or =1 voids was significantly associated with body mass index (BMI), hypertension, and smoking; and nocturia of > or =2 voids with gender, BMI, diabetes and recurrent cystitis, as well as between nocturia of > or =3 voids and gender, lung disease, diabetes, use of diuretics and recurrent cystitis. Summarising the associations in an ordinal regression analysis UI (odds ratio (OR) 2.17, 95% CI 1.76-2.68), recurrent cystitis (OR 1.97, 95% CI 1.30-2.97) and diabetes (OR 1.89, 95% CI 1.32-1.65) had the strongest associations with nocturia. CONCLUSIONS: Our results show that various disorders are associated with nocturia. However, the associations are strongly dependent on the severity of the nocturia.

Prevalence and bother of nocturia, and causes of sleep interruption in a Danish population of men and women aged 60-80 years.

OBJECTIVE: To study the prevalence and bother of nocturia, and sleep interruptions in an unselected population of Danish men and women aged 60-80 years. SUBJECTS AND METHODS: A postal questionnaire was sent to 2000 women and 2000 men aged 60, 65, 70, 75, and 80 years. The population was selected at random from The Danish Civil Registration System, in which every person living in Denmark is identified. The Nocturia, Nocturnal Enuresis and Sleep-interruption Questionnaire (NNES-Q) was used to evaluate nocturia and bother, and sleep interruptions. Nocturia was defined as waking at night to void, according to the International Continence Society definition. RESULTS: In all, 92% (3664) subjects returned the questionnaire; 71% completed the questionnaire satisfactorily and were included in the study. The prevalence of nocturia increased with age. The overall prevalence of nocturia was 77% and there was no difference between men and women (P = 0.11), but men had slightly more severe nocturia than women. The bother caused by nocturia in men and women increased with the severity of nocturia, and women were slightly more bothered than men when the degree of nocturia was >2 voids/night. Nocturia was the most frequent self-reported reason for waking at night, followed by thirst. CONCLUSION: The prevalence of nocturia increased with age. There was no difference between the genders in the overall prevalence of nocturia, but nocturia of > or = 2 voids/night was more frequent in men. The degree of bother increased with the severity of nocturia, even after correcting for generic quality of life, and the younger groups were the most bothered. Nocturia was the major reason for waking at night, followed by thirst.

[Local thrombolysis in proximal deep venous thrombosis of the lower extremity]. / Lokal trombolyse ved proksimal dyb venetrombose i underekstremiteten.

INTRODUCTION: Deep venous thrombosis (DVT) often leads to chronic venous insufficiency and the present study was conducted in order to investigate the effectiveness of catheter-directed thrombolysis in patients with proximal DVT of the lower extremity (iliac vein involved), with respect to recanalisation and maintenance of venous valve function. MATERIAL AND METHODS: A prospective clinical investigation was carried out with puncture of the popliteal vein for continuous infusion of r-alteplase. Twelve patients suffering from recent proximal DVT were treated: In 10 patients the left extremity was affected, in two the right. Three of the 12 patients had factor V Leiden mutation in the heterozygote form, one of whom also had prothrombin mutation in heterozygote form. RESULTS: Ten of the 12 had their venous thrombosis successfully lysed and were discharged with an open venous system in the affected limb. The lysed venous segments remained patent in all ten, with normal venous valve function, as evaluated by Doppler reflux testing. The median follow-up time was five months (range 0-9 months). In one patient, the proximal thrombus (iliac) was lysed successfully, but the femoral vein could not be opened, probably because of an old thrombus remaining from a previous DVT episode. In the other patient, the venous thrombus was lysed successfully, but the vein rethrombosed after one day. DISCUSSION: Catheter-directed thrombolysis appears feasible in patients with recent proximal DVT and the short-term results are good in terms of venous patency and valve function. A randomised trial is necessary to test whether this treatment modality is superior to conventional anticoagulation therapy.