A Case Report of Massive Intraperitoneal Hemorrhage from Rare Cornual Pregnancy.

INTRODUCTION: A cornual pregnancy describes a rare ectopic location positioned within the myometrium next to the fallopian tube, which can be difficult to find on traditional ultrasound imaging. Given its location and the stretch within the uterine wall, cornual pregnancies can progress for weeks prior to diagnosis. Ruptures can, therefore, be catastrophic with disproportionally high maternal mortality rates compared to other ectopic pregnancies. CASE REPORT: A 34-year-old female recently treated with methotrexate for ectopic pregnancy presented to the emergency department (ED) for acute onset of lower abdominal cramping without vaginal bleeding. She arrived clinically stable and quickly decompensated with witnessed syncope in the ED, prompting point-of-care ultrasound showing free fluid in the abdomen. The patient was taken for emergent surgery by obstetrics while receiving transfusion of blood products for suspected ruptured ectopic pregnancy. A fetus estimated to be 10 weeks of age was discovered in the left cornual region. Approximately two liters of intraperitoneal blood were drained without complication. CONCLUSION: Cornual pregnancy is a difficult to diagnose but potentially disastrous type of ectopic pregnancy due to massive hemorrhage. Emergency clinicians should be aware of this condition given its rare occurrence but potentially catastrophic outcomes.

In vivo Mn-enhanced MRI for early tumor detection and growth rate analysis in a mouse medulloblastoma model.

Mouse models have increased our understanding of the pathogenesis of medulloblastoma (MB), the most common malignant pediatric brain tumor that often forms in the cerebellum. A major goal of ongoing research is to better understand the early stages of tumorigenesis and to establish the genetic and environmental changes that underlie MB initiation and growth. However, studies of MB progression in mouse models are difficult due to the heterogeneity of tumor onset times and growth patterns and the lack of clinical symptoms at early stages. Magnetic resonance imaging (MRI) is critical for noninvasive, longitudinal, three-dimensional (3D) brain tumor imaging in the clinic but is limited in resolution and sensitivity for imaging early MBs in mice. In this study, high-resolution (100 µm in 2 hours) and high-throughput (150 µm in 15 minutes) manganese-enhanced MRI (MEMRI) protocols were optimized for early detection and monitoring of MBs in a Patched-1 (Ptch1) conditional knockout (CKO) model. The high tissue contrast obtained with MEMRI revealed detailed cerebellar morphology and enabled detection of MBs over a wide range of stages including pretumoral lesions as early as 2 to 3 weeks postnatal with volumes close to 0.1 mm(3). Furthermore, longitudinal MEMRI allowed noninvasive monitoring of tumors and demonstrated that lesions within and between individuals have different tumorigenic potentials. 3D volumetric studies allowed quantitative analysis of MB tumor morphology and growth rates in individual Ptch1-CKO mice. These results show that MEMRI provides a powerful method for early in vivo detection and longitudinal imaging of MB progression in the mouse brain.

MRI analysis of cerebellar and vestibular developmental phenotypes in Gbx2 conditional knockout mice.

PURPOSE: Our aim in this study was to apply three-dimensional MRI methods to analyze early postnatal morphological phenotypes in a Gbx2 conditional knockout (Gbx2-CKO) mouse that has variable midline deletions in the central cerebellum, reminiscent of many human cerebellar hypoplasia syndromes. METHODS: In vivo three-dimensional manganese-enhanced MRI at 100-µm isotropic resolution was used to visualize mouse brains between postnatal days 3 and 11, when cerebellum morphology undergoes dramatic changes. Deformation-based morphometry and volumetric analysis of manganese-enhanced MRI images were used to, respectively, detect and quantify morphological phenotypes in Gbx2-CKO mice. Ex vivo micro-MRI was performed after perfusion-fixation with supplemented gadolinium for higher resolution (50-µm) analysis. RESULTS: In vivo manganese-enhanced MRI and deformation-based morphometry correctly identified known cerebellar defects in Gbx2-CKO mice, and novel phenotypes were discovered in the deep cerebellar nuclei and the vestibulo-cerebellum, both validated using histology. Ex vivo micro-MRI revealed subtle phenotypes in both the vestibulo-cerebellum and the vestibulo-cochlear organ, providing an interesting example of complementary phenotypes in a sensory organ and its associated brain region. CONCLUSION: These results show the potential of three-dimensional MRI for detecting and analyzing developmental defects in mouse models of neurodevelopmental diseases.

Lethal activity of nonthermal plasma sterilization against microorganisms.

OBJECTIVE: To determine the range and the mode of germicidal activity of sterilants generated by a nonthermal plasma sterilization system for microorganisms. METHODS: Representative bacteria, spores, viruses, bacteriophages, and fungi were exposed to the plasma cycle and the residual viability was measured in vitro. To assess the mode of lethal injury, Escherichia coli, Staphylococcus aureus, Bacillus atrophaeus, and bacteriophages were exposed to the plasma cycle, and the effects of the plasma-generated sterilants on the biological parameters were determined. RESULTS: There were at least 4-6 log reductions in viability for all microorganisms after 10 minutes of exposure to the plasma cycle. Electron micrographs and studies of the inhibition of bacteriophage infectivity suggested that the primary injury is to the organisms' cell envelopes. The plasma cycle also denatured isolated bacterial proteins and inactivated bacteriophages, but it had no effect on isolated DNA and bacterial proteins within exposed bacteria. CONCLUSION: Nonthermal plasma, which is produced at atmospheric temperature and pressure, generates sterilants that kill high concentrations of microorganisms and inactivate viruses during a 10-minute exposure. The primary injury appears to be at the surface structures of the organisms. This suggests that nonthermal plasma has utility for sterilization of heat-sensitive medical materials and devices.