Recurrent heterotopic pregnancy after bilateral salpingectomy in an IVF patient: case report.

PURPOSE: To report a rare clinical case of recurrent heterotopic pregnancy in the same patient following bilateral salpingectomy and in-vitro fertilization (IVF) treatments. METHODS: A 35 year-old woman, suffering from mechanical infertility, was treated by IVF, resulting in two episodes of heterotopic pregnancies within 2 years. The first episode ended in bilateral salpingectomy due to unilateral tubal pregnancy and contralateral severely damaged tube. The intrauterine pregnancy ended in early missed abortion. The second heterotopic pregnancy presented as bleeding cornual pregnancy, managed by laparoscopic resection of the tubal stump, and ended in a term singleton delivery. CONCLUSION: The possibility of cornual heterotopic pregnancy following bilateral salpingectomy, though very rare, should be considered by every gynecologist treating IVF patient.

Down-up sequential separation of the placenta.

OBJECTIVE: To characterize the patterns of placental separation during the third stage of labor. METHODS: Continuous real-time ultrasound was performed during the third stage of labor in 101 normal deliveries. The sequence of placental separation was recorded for determining whether the process was multiphasic, the site from which separation commenced and the mode of its progression. RESULTS: Separation in 97 cases was multiphasic. Monophasic separation in which all parts of the placenta appeared to separate simultaneously occurred in two cases only. Pathological prolongation of the third stage precluded determination of separation in two cases. Ninety-two cases had a uterine wall placenta (anterior or posterior); the separation commenced at one pole and progressed sequentially towards the opposite side in 89 of them. The process started at the lower pole (down-up separation) in 83/92 cases (90.2%) and began from the upper pole (up-down separation) in only 6/92 cases (6.5%). Nine cases had a fundal placenta; of these the separation was also multiphasic but began sequentially from either the anterior or posterior pole, or simultaneously from both, in 8 (88.9%) cases so that the fundal part was separated last (bipolar separation). CONCLUSIONS: Placental separation is usually an orderly multiphasic phenomenon that begins mostly from the lower pole of the placenta and propagates sequentially upwards. Fundal placentae, however, separate first at their poles with the fundal part being separated last. Recognition of the sequence of events and understanding of the mechanism of placental separation may aid in detecting cases prone to third-stage complications and in managing pathological ones.

Does laparoscopic cholecystectomy influence peri-sinusoidal cell activity?

BACKGROUND/AIMS: To investigate the influence of laparoscopic procedures on perisinusoidal cell function. METHODOLOGY: In 31 patients who underwent laparoscopic cholecystectomy for symptomatic cholelithiasis, the serum levels of beta-N-acetyl hexosaminidase (beta-NAH) and hyaluronic acid (HA) were measured. Six female patients, who underwent other laparoscopic procedures, not involving the hepatobiliary system, served as controls. RESULTS: HA serum levels increased significantly in both study and control groups, while beta-NAH serum levels remained within normal values. Post-operative AST and ALT serum levels increased significantly only in the study group. No elevation of serum ALP was noted in any of our patients, and post-operative bilirubin levels did not increase in patients with normal pre-operative levels. CONCLUSIONS: Laparoscopic procedures caused detectable damage to Kupffer and endothelial cells as reflected by elevation of post-operative HA serum levels. The damage to the liver hepatocytes and perisinusoidal cells has no clinical significance and the laparoscopic procedure itself is the probable cause of the Kupffer and endothelial cells damage, while other mechanisms caused damage to the hepatocytes.