Ovarian ectopic pregnancy: diagnosis, treatment, correlation to Carnegie stage 16 and review based on a clinical case.

OBJECTIVE: To present a case of a vital ectopic pregnancy after 8 weeks that was located in the right ovary. DESIGN: Case study and literature review. SETTING: Hospital outpatient clinic. PATIENT(S): A 29-year-old primigravida presented with lower abdominal pain and mild vaginal bleeding at 8 weeks after her last menstrual period. INTERVENTION(S): Wedge resection of the ovary which did not affect subsequent fertility. MAIN OUTCOME MEASURE(S): Conservative treatment options and preservation of patient's reproductive capacity. RESULT(S): The embryo was laparoscopically removed in toto and visualized. Therefore, macroscopic correlation to Carnegie stage 16 of development was possible. CONCLUSION(S): Approximately 3% of all ectopic pregnancies are located in the ovaries. Preoperative diagnosis of this extremely rare condition is challenging, because the ectopic tumor often resembles cysts of the corpus luteum. At surgery, the trophoblast tissue or the embryo can rarely be visualized completely.

Twenty-six triplet pregnancies: a retrospective analysis.

METHODS: Twenty-six triplet pregnancies were delivered over 6 years. RESULTS: Over 80% of pregnancies resulted after infertility treatment (21/26). Mean maternal age was 32. On average, the infants were delivered after 32 + 0 weeks; in 4 cases delivery was at <28 weeks. In 1 case, the leading triplet was delivered spontaneously, the remaining babies by Caesarean. Main indications for Caesarean were: premature membrane rupture, premature contractions, maternal hospitalisation for foetal lung maturation/tocolysis/antibiotics. Mean birth weights were (triplet I-III): 1,730, 1,630 and 1,550 g. Hydrops fetalis and renal agenesis resulted in IUFD of the leading triplet in two cases. All newborns were cared for by neonatology. CONCLUSIONS: Triplet pregnancies are challenging for all specialities involved. They should be managed from an early stage in cooperation with an experienced centre, allowing outpatient care for as long as possible if there are no complications. This also has a cost-reducing impact.

A successful pregnancy in a patient with Takayasu's arteritis.

Takayasu's arteritis is a chronic, idiopathic, inflammatory disease of the arteries, which primarily involves the aorta, its main branches such as the brachiocephalic, carotid, subclavian, vertebral, and renal arteries, as well as the coronary and pulmonary arteries. It has been suggested that pregnancy, although not usually associated with an exacerbation of inflammatory vascular lesions, should only be considered during a phase of remission. The increased intravascular volume seen during pregnancy may impair circulation and exacerbate aortic regurgitation, hypertension, and congestive heart failure. Hypertension is probably the most serious major complication that can develop, possibly leading to intrauterine growth retardation, maternal heart failure, and fetal haemorrhage. We describe the case of a patient with a 7-year history of Takayasu's arteritis who conceived against medical advice. She continued to take her prescribed medication throughout the pregnancy, including adalimumab, leflunomide (until 8 weeks' gestation), and prednisolone. She underwent a planned cesarean section under spinal anesthesia at 37 + 2 weeks' gestation, and a healthy baby boy weighing 2550 g was delivered. There were no postpartum complications.

Comparison of possible carcinogenic estradiol metabolites: effects on proliferation, apoptosis and metastasis of human breast cancer cells.

OBJECTIVES: Certain estradiol metabolites may play a pivotal role in breast carcinogenesis. Of special interest are the metabolites 2-hydroxyestradiol (2-OHE2), which can react anti-carcinogenically, and 4-hydroxyestradiol (4-OHE1) and 16a-hydroxyestrone (16-OHE1), which may have procarcinogenic potential. In the present study, we have compared for the first time the effect of these metabolites and their parent substance 17beta-estradiol (E2) on proliferation, apoptosis, apoptosis markers and markers of metastatic property of human breast cancer cells. METHODS: MCF-7 cells (human estrogen-receptor positive metastatic breast cancer cell line) were incubated with the estrogens at concentrations of 0.1-100 nM. Cell proliferation rate was measured by the ATP-assay. Apoptosis was measured by cell death assay and the apoptosis markers cytochrome C, Bcl-2, Fasl and p53 were determined in cell lysates by ELISAs. The markers of metastatic property of the cell line, VEGF and MCP-1 were measured in the cell supernatant by ELISAs. RESULTS: The estrogens E2, 4-OHE2 and 16-OHE1 display a proliferative effect on MCF-7 cells which is accompanied by a down-regulation of apoptosis. Various markers of apoptosis such as Bcl-2, cytochrome C and p53 appear to be involved. No significant effect was found for the metabolite 2-OHE2. VEGF and MCP-1 were up-regulated by E2 and 16-OHE1, whereas 2-OHE2 and 4-OHE2 did not show any effect. CONCLUSIONS: The most potent estrogen regarding proliferation, apoptosis and metastasis of breast cancer cells seems to be estradiol. However, the estradiol metabolites 4-OHE2 and 16-OHE1 elicit similar properties on cell proliferation, apoptosis and metastasis as compared to estradiol but only at higher concentrations. In contrast 2-OHE2 did not show any significant effect on these parameters. Thus, intracellular estradiol metabolism may determine an individual's risk for breast carcinogenesis.