ABSTRACT
In the original article publication, the authors given name and family name were interchanged.
Subject(s)
Pregnancy, Ectopic , Pregnancy, Tubal , Female , Humans , Methotrexate , Off-Label Use , Pregnancy , Progesterone , Treatment OutcomeSubject(s)
Pregnancy, Ectopic , Pregnancy, Tubal , Female , Humans , Methotrexate , Pregnancy , Progesterone , Treatment OutcomeABSTRACT
INTRODUCTION: We aimed to assess the prognostic significance of early ßhCG change and baseline progesterone level on treatment outcome among women receiving single dose Methotrexate protocol for tubal ectopic pregnancy (EP). MATERIAL AND METHODS: Retrospective study involving all consecutive patients diagnosed with EP and receiving Methotrexate therapy form January 2015 to December 2016. Patients were stratified into 2 groups according to treatment outcome: success group (n = 66) involved women who displayed complete resolution of serum ßhCG levels following a single course of Methotrexate; failure group (n = 55) included patients who required repeated Methotrexate administration and/or surgical management. Predictive performances of baseline progesterone and ratio"ßhCG level on day 4/ ßhCG level on day 1â³ (d4/d1) on treatment outcome were assessed using Receiving Operating Characteristics curves. RESULTS: The ratio d4/d1 displayed good performances in predicting treatment outcome (AUC = 0.826). A ratio ≤ 0.7 was associated with a success rate of 94% after 1 course of Methotrexate and 100% after 2 courses. In contrast, a ratio >1.7 was associated with a failure rate of 100%. Conversely, baseline progesterone showed poor performances (AUC = 0.611). CONCLUSIONS: Patients with extreme ßhCG changes (n = 33) on day 4 might benefit from a more personalized approach: simplified monitoring in those with a decline ≥30%, anticipated second course of treatment in those with an increase > 70%.
Subject(s)
Chorionic Gonadotropin, beta Subunit, Human/metabolism , Methotrexate/therapeutic use , Pregnancy, Ectopic/drug therapy , Progesterone/metabolism , Adolescent , Adult , Female , Humans , Methotrexate/pharmacology , Pregnancy , Prognosis , Retrospective Studies , Treatment Outcome , Young AdultSubject(s)
Coitus , Fusobacterium Infections/complications , Fusobacterium Infections/diagnosis , Fusobacterium necrophorum/isolation & purification , Iliac Vein/pathology , Thrombophlebitis/etiology , Thrombophlebitis/pathology , Adolescent , Female , Fusobacterium Infections/pathology , Humans , Lung Abscess/etiology , Lung Abscess/pathology , Pelvis/diagnostic imaging , Radiography, Thoracic , Thrombophlebitis/microbiology , Tomography, X-Ray ComputedABSTRACT
OBJECTIVES: Endoscopy is a key tool in the diagnosis and management planning of peritoneal carcinomatosis. The aim of this study was to determine which type of endoscope is the most efficient for comprehensive staging of the upper abdomen peritoneal surface. METHODS: From April 2010 to February 2011, endoscopies were performed on five human female fresh-frozen cadavers. Three endoscopes (rigid 0°, 30° and flexible) were used consecutively and compared. RESULTS: The diaphragmatic areas explored with the flexible endoscope were significantly larger than those with the other two. On average, 135 (range 66-225), 168 (range 96-306), and 201 (range 128-399)cm(2) were observed using the 0°, 30°, and flexible laparoscopes, respectively. The p value obtained using the exact Wilcoxon test for paired data was 0.0019 between the 0° and 30° endoscopes and between the 30° and flexible endoscopes. The 30° endoscope was consistently better than the 0° endoscope for the observation of the diaphragm and spleen undersurface. CONCLUSION: Flexible endoscopy seemed to be the most efficient for the evaluation of peritoneal carcinomatosis. However, due to a poorer image, the need for considerable practice, and the high equipment and maintenance cost of the flexible endoscope, the rigid 30° endoscope seems to be the best compromise.
