Successful conservative treatment of a cervical ectopic pregnancy at 13 weeks.

BACKGROUND: Cervical ectopic pregnancy is a potentially life-threatening condition due to the unexpected occurrence of uncontrollable bleeding from the cervix. CASE REPORT: A 39-year-old secundigravida was admitted with amenorrhea of 12 weeks and four days due to suspected cervical pregnancy, without bleeding. The ultrasonography revealed a gestational sac at the anterior wall of the isthmic-cervical part with a single viable fetus, with crown-rump length (CRL) of 59 mm and regular heart rate. The serum ß-human chorionic gonadotropin (ß-hCG) level on admission was 143.416 mIU/l. Two possible therapeutic options were considered, (1) systemic methotrexate treatment and (2) uterine artery embolization with gelatine sponge. The first was rejected due to gestational age, viable fetus, high ß-hCG level, and CRL, and the later was rejected by the vascular surgeons due to lack of experience. The curettage was performed. After the evacuation, prostin was administered into cervix accompanied with tamponade. On the next day ß-hCG level was 44.342 mIU/l and the following day ultrasonography revealed the oval non-homogenous formation in the cervical cavity (blood clots or residual trophoblastic tissue); ß-hCG level was 36.501 mIU/l. The reintervention was performed on the fifth day after the curettage and 200 ml of coagulated blood was aspirated; ß-hCG level was 16.432 mlU/l. Since the isthmic-cervical part was slightly dilated (23 mm) seven days after the curettage, systemic methotrexate treatment (100 mg intramuscular) was initiated. Serum ß-hCG level on the second and fourth day after methotrexate were 12.553 mIU/l and 8.900 mIU/l, respectively. The second dose of 100 mg of methotrexate was administered intramuscular seven days after the first dose. Three days after, ß-hCG level was 2.329 U/l and ultrasound scan revealed normal isthmic-cervical finding. CONCLUSION: The present case report showed efficient fertility sparing conservative treatment, dilatation and curettage, of 13 week cervical pregnancy followed by systemic methotrexate.

Measurements of alkyllead compounds in the gas and aerosol phase in urban and rural atmospheres.

Alkyllead compounds in the gas and aerosol phase were determined simultaneously in urban and rural atmospheres using gas chromatography--atomic absorption spectroscopy and wet chemical (iodine monochloride) methods. The difference in results between the two methods suggests the presence of vapour-phase tri- (and/or di-)alkyllead in both urban and rural air. Concentrations of 0.06-1.6 and 16-205 ng Pb m-3 were found for vapour-phase organolead compounds other than tetraalkyllead in rural and kerbside urban air, respectively. Tetraalkyllead and trialkyllead compounds were identified in atmospheric aerosols at both sites, but these were found to be present at concentrations less than 1.2% of the total gas-phase alkyllead.

Epidemiology of end-stage renal disease and current status of hemodialysis in Yugoslavia.

Maintenance hemodialysis (HD) in Yugoslavia started in the sixties and followed the dialysis trends in the Western Europe. However, in the last decade the development of renal replacement therapy (RRT) slowed down. In this report the epidemiology of ESRD from 1997-1999 and the survey of the status of HD treatment in Yugoslavia in 1999 are presented. Epidemiological data are obtained by the annual center questionnaires (response rate: 92.6 -94.2%). The survey of HD status is based on a specific questionnaire and covered 2108 patients (65%). At the end of 1999 there were 56 RRT centers in Yugoslavia treating 3939 patients: 3232 (82%) patients by HD, 248 (6.3%) by peritoneal dialysis, and 459 (11.7%) living with transplanted kidney. In a three year period, incidence of ESRD ranged from 108-128 pmp, point prevalence from 435-463 pmp and mortality rate from 20.7-17.9. Numerous refugee patients were treated over the last 10 years. Main causes of ESRD were glomerulonephritis (30%); Balkan nephropathy represented 11% and diabetic nephropathy 7% of all primary renal diseases. Cardiovascular and cerebrovascular diseases were the most common causes of death of RRT patients. Most centers are overcrowded and HD machines are worn out. Mean Kt/V was 1.19+/-0.08, mean URR% 58.8+/-7.4. The shortage of drugs prevented adequate management: 83% of HD patients had hemoglobin level less than 100 g/L but only 10.3 -17.8% were treated with rHuEpo; 64.5% of patients had phosphate levels higher than 1.7 mmol/L but only 33.5% used phosphate binders; 47% of patients had hypertension despite the antihypertensive therapy. The prevalence of hepatitis B remained unchanged (about 14%) in HD population during the last three years, but the prevalence of anti-HCV positive patients decreased (31-23%). In conclusion, there is a well developed dialysis service in Yugoslavia but insufficient conditions for adequate treatment.

Multivariate and Geoaccumulation Index evaluation in mangrove surface sediment of Mengkabong lagoon, Sabah.

Spatial variations in estuarine intertidal sediment have been often related to such environmental variables as salinity, sediment types, heavy metals and base cations. However, there have been few attempts to investigate the difference condition between high and low tides relationships and to predict their likely responses in an estuarine environment. This paper investigates the linkages between environmental variables and tides of estuarine intertidal sediment in order to provide a basis for describing the effect of tides in the Mengkabong lagoon, Sabah. Multivariate statistical technique, principal components analysis (PCA) was employed to better interpret information about the sediment and its controlling factors in the intertidal zone. The calculation of Geoaccumulation Index (I(geo)) suggests the Mengkabong mangrove sediments are having background concentrations for Al, Cu, Fe, and Zn and unpolluted for Pb. Extra efforts should therefore pay attention to understand the mechanisms and quantification of different pathways of exchange within and between intertidal zones.

Mental representations of attachment among prospective Australian fathers.

Research into security or otherwise of infant attachment and its correlates is well established. Research into adult internal representations of attachment is still in its infancy. This emergent area of investigation is facilitated by a new measurement instrument, the Adult Attachment Interview (AAI). This paper presents the first Australian report of the distribution of adult attachment classifications in a group of 62 men, prior to the transition to parenthood. Using the AAI, 35.4% of these men were classified as secure. This proportion is congruent with those reported by other investigators. Validity of the AAI is discussed and some theoretical questions related to the findings are raised.

[Cysts of the choledochus. Report of a case]. / Ciste duktusa choledochusa. Povodom jednog naseg slucaja

Cysts of the common bile duct, (also known as common bile coeles, or as common bile cysts) are quite rare. Those of the ampulla of Vater are a curious phenomena. Cysts of the extrahepatic part of the common bile duct can be quite large, excentrically located, and produce a triad of symptoms: pain, tumor and jaundice. These symptoms are intermittent, however, due to the periodic emptying of the cysts' contents into the duodenum. Cysts of the ampulla of Vater are those which occur in the intraduodenal part of the bile duct, and almost always found projecting into the lumen of the duodenum--imitating a tumor as it was in our case. Preoperative diagnosis of these cysts is extremely difficult, especially if the cyst is situated on the ampullar part of the common bile duct, and they are usually discovered during the operation. Possible compression of the ampulla of Vater, and the pancreatic duct can result in recidivating pancreatitis. The operative approach is dependent on the size of the cyst, and its location. The best is the complete removal of the cyst, and a correction of bile flow.

[Serum levels of beta 2-microglobulin in various types of hemodialysis]. / Serumska koncentracija beta 2-mikroglobulina u razlicitim vrstama hemodijalize.

beta 2-microglobulin (beta 2 m) is the major constituent of amyloid fibrils in dialysis-related amyloidosis (DRA), which is considered to be one of the most severe adverse effect of long-term dialysis. In this study we evaluated the efficiency of beta 2 m removal during different dialysis procedures. A total of 45 patients undergoing hemodialysis were divided in five groups: cuprophane dialysis (n = 10), high-flux polysulphone dialysis (n = 10), postdilutional hemodiafiltration (n = 10), conventional postdilutional hemofiltration (n = 10) and predilutional on-line hemofiltration (n = 5). Serum level of beta 2 m was determined before and after different procedures using ELISA. In the group of patients on cuprophane dialysis was registered an elevation of beta 2 m and of 16.8 +/- 11.4% on the average. Serum level of beta 2 m was decreased following all other procedures on the average of 40.7 +/- 16.4% after high-flux polysulphone dialysis, 42.0 +/- 13.7% after conventional hemofiltration, 64.7 +/- 9% after hemodiafiltration and 67.9 +/- 10.1% after predilutional hemofiltration. The best removal of serum beta 2 m was realized by predilutional hemofiltration. Also, we have noticed that patients treated with high-flux synthetic membranes in the longer time-period have lower predyalisis value of beta 2 m compared to patients treated with cuprophane membrane. Further long-term studies will be necessary to conclude whether these procedures could be successful prophylactic and/or therapeutic regimen for dialysis-related amyloidosis.