Systemic methotrexate treatment of interstitial pregnancy--magnetic resonance imaging (MRI) as a valuable tool for monitoring treatment.

OBJECTIVE: Interstitial pregnancy occurs in 2-4% of ectopic pregnancies and is defined as implantation of the trophoblast in the interstitial part of the tuba uterina. Therefore the term intramural pregnancy can also be found in the literature. In 20% of the cases that progress beyond 12 weeks of amenorrhea a potentially life-threatening rupture of the uterus occurs, leading to a maternal mortality rate of 2.5%. According to the literature until a few years ago diagnosis was mainly made intraoperatively, and resulted in cornual resection or hysterectomy per laparotomy. Better methods of diagnosis and treatment of interstitial pregnancy can help to decrease morbidity and mortality associated with this condition. PATIENTS: We describe two cases of interstitial pregnancies that were eventually diagnosed and also monitored by magnetic resonance imaging (MRI) after systemic methotrexate treatment. Both patients were uniparous and experienced their second spontaneous pregnancy. METHODS: Treatment consisted of four doses (50 mg/m2 body surface area) of systemic intramuscular methotrexate alternating with four doses (6 mg) of intramuscular folic acid. When beta-hCG levels were undetectable, MRI results were compared with pre-therapeutic MRI findings. RESULTS: In patients A and B, beta-hCG levels were undetectable 64 and 88 days after initiation of methotrexate treatment, while magnetic resonance imaging revealed nearly equally persisting interstitial pregnancies. They initially presented as hyperintense lesions with hypointense zones and changed into a hypointense lesion with a central hyperintense area for patient A, and a completely hyperintense lesion for patient B at the time of negative beta-hCG levels in follow-up MRI. CONCLUSION: Systemic methotrexate treatment with an intramuscular regimen is effective in the treatment of interstitial pregnancy. MRI has the ability of correct tissue differentiation and objective three-dimensional measuring of interstitial pregnancy. We therefore propose this imaging modality as a valuable tool for monitoring systemic methotrexate treatment of interstitial pregnancy that should be used additionally to beta-hCG clearance curves.

[Reliability of ultrasound pregnancy screening]. / Die Verlässlichkeit des sonographischen Schwangerschaftsscreenings.

This study investigates the reliability of ultrasonographic screenings for detecting fetal malformations in pregnancy. The data from 1505 screening examinations of pregnant women who underwent routine checks at the Department of Obstetrics of the University of Vienna, were compared with the anomalies diagnosed in the newborn of the same collective. Fetal malformations were diagnosed in 28 screening cases. The statistical distribution of these anomalies is shown for the different organ systems. In 5 newborn malformations were found, which had not been diagnosed sonographically. Another 23 newborn had minor malformations in regions that are not included in the routine screening ultrasound. The results show a high accuracy of the sonographic screening examination, with the exception of the median facial region and the large vessels of the base of the heart. The fact that not all of the cardiac malformations were diagnosed prompts the performance of an extended sonographic inspection of the fetal heart within the framework of routine screening.

[Measuring amniochorionic membrane thickness with high frequency ultrasound]. / Die Messung der Eihautdicke mittels Hochfrequenzultraschall.

The postpartal thickness of the amniochorionic membrane was measured by means of 20 MHz ultrasound after 28 inconspicuous deliveries in the course of a prospective study. The aim of our investigation was to determine the thickness of the amniochorionic membrane using high frequency ultrasound and to evaluate the results for a statistical correlation with fetal and maternal parameters. The data obtained were compared with histological sections for measurement accuracy using a linear regression analysis method. Membrane thickness of the total study group was 0.83 +/- 0.11 mm (0.72-1.08 mm). Based on a statistical comparison with the histological sections, the high frequency ultrasonographic examination was shown to be highly reliable with a correlation coefficient of r = 0.96 (p < 0.0001). Results obtained by ultrasonography were correlated with maternal (gestational age, patient age, parity) and neonatal (size and weight at birth, sex, placental weight, Apgar 1/5/10) parameters by means of linear regression analysis. There was a statistically significant correlation between parity and membrane thickness (r = 0.485, p < 0.05). There was also a correlation of Apgar scores at 5 minutes post partum (r = 0.485, p < 0.05). We were able to demonstrate that the measurement of membrane thickness by ultrasound is an objective and reliable method and may be a gain to prenatal diagnostics when used in vivo.

A new mode of treatment of human papilloma virus associated anogenital lesions using a nonsteroid estrogen analogue.

Human papilloma virus (HPV)-induced condylomata acuminata in both sexes, as well as cervical dysplasias were treated locally with an ointment or a cream containing 25 mg clomiphene citrate per gram for a fortnight. The DNA of HPV 6, 11, HPV 16, 18, and HPV 31, 35, 51 was monitored pre- and post-therapeutically using an in situ hybridization assay. The therapeutic response to the drug was demonstrated by the disappearance of condylomata acuminata (100%), HPV DNA in cervical dysplasia (up to 80%), and penile genital warts (75%). Under this therapeutic regimen 78% of all cases treated became negative for the probed HPV. The pharmacological action of the drug was diminished in HPV 16, 18 positive lesions. Clomiphene is shown to be an effective anti-HPV drug.

[Imaging procedures in diagnosis of ovarian carcinoma]. / Bildgebende Verfahren in der Diagnostik des Ovarialkarzinoms.

Each of the 3 major imaging modalities, ultrasound, computed tomography, and magnetic resonance imaging, plays a specific role in the evaluation of the ovaries. Depending on the different diagnostic potential each imaging technique has its special operating areas. Ultrasound, and in particular transvaginal ultrasound, remains the examination of choice for screening and can detect a wide spectrum of ovarian pathology from simple ovarian cysts to complicated ovarian masses. Computed tomography is currently the recommended modality to stage ovarian carcinoma, but is also used in the follow-up and to judge the response to cytostatic therapy. Magnetic resonance imaging is a valuable tool to evaluate disorders of sexual differentiation and to localize ectopic gonads. Magnetic resonance imaging is also capable of depicting spread of ovarian carcinoma throughout the pelvis and the abdomen.

[Role of the cervix uteri at labor onset from ultrasound studies]. / Die Rolle der Cervix uteri im Geburtsbeginn aus sonografischen Untersuchungen.

The cervix uteri is of greatest importance for the environment of the fetus. The sonographic imaging of the cervix uteri can be done by transabdominal, perineal and transvaginal route. Each of these methods are associated with specific advantages and disadvantages. During the time of gestation the cervix uteri can be measured sonographically concerning the length, the thickness, the width of the cervical canal and in addition the diameter of the internal and the external os. At the beginning of labour the cervix shows a transformation: a shortening with an increase of thickness. The phase of contraction is followed by a phase of reformation. Individual formations of the cervix regarding the a premature opening of the internal os or the external os could be demonstrable without clinical symptoms. By W. Eppel a score-like formula "Incompetence-Factor" was described for a quantification of these measurements.

[Fetal ultrasound--retrospect and prospects]. / Fetale Sonographie--Rückblick und Ausblick.

In a historical review the situation in obstetrics was shown in the last 3 decades. Compound-scans and "real-time-scan" were the fundamental instruments for the first sonographical diagnosis and changes in clinical practice. The demonstration of the foetal body and organs allows numerous measurements of length, areas, and volumes. Signs of foetal vital functions were studied in different aspects. Doppler-flow-measurements in different parts of the foetal circulatory system had brought to light new information. In future especially colour-coded flow measurement will show signs of foetal life such as drinking, vomiting, and urinating and will enable us to study these functions of foetal life.

[A case of Patau syndrome. Fetal heart defect and lip-jaw-palate cleft as indicators]. / Ein Fall von Patau-Syndrom. Fetale Herzmissbildung und Lippen-Kiefer-Gaumenspalte als Hinweiszeichen.

Diagnosis of a malformation of the heart and a facial cleft and additionally other abnormalities by means of ultrasound. The result of karyotyping was trisomy 13.

[Vaginal sonography of the cervix in twin pregnancies]. / Die Vaginosonographie der Zervix bei Zwillingsschwangerschaften.

In a prospective study of 97 uncomplicated twin pregnancies, vaginosonographic cervix measurements of length, thickness and width of the internal os were performed. Furthermore, a group of 113 uncomplicated primipara was measured by vaginosonography. The twin pregnancies were examined sonographically at 4-5 week intervals between the 14th and 34th week of gestation. The results of the measurements were correlated between these two groups in accordance with duration of pregnancy and the number of deliveries. The results showed in general, that the cervical length of multipara-multiple pregnancy is longer than in the primipara-multiple pregnancy. Between the 13th and 17th week of gestation the cervix of primipara showed a length of 48.1 +/- 2.1 mm, the multipara twins showed a length of 52.3 +/- 3.4 mm. Between the 18th and 22nd gestational week, the primipara showed a cervical length of 49.4 +/- 3.6 mm and the multipara a length of 49.6 +/- 2.6 mm. In the 23rd to 27th week, the primipara had a cervical length of 39.4 +/- 2.4 mm, the multipara of 49.3 +/- 3.7 mm. From the 28th to 33rd week, cervical length was reduced in primipara to 31.2 +/- 2.9 mm, and in multipara to 42.7 +/- 5.1 mm. In the normal group of multipara, the cervical length was slightly longer. The assessment of cervical thickness showed the widest cervices in multipara gemini followed by the primipara gemini, the smallest cervices were found in primipara-single pregnancies.(ABSTRACT TRUNCATED AT 250 WORDS)

[Tuboscopy--new developments for accurate tubal diagnosis]. / Die Tuboskopie--Neue Entwicklungen für eine exakte Tubendiagnostik.

A specially developed linear everting catheter (LEC) in combination with a microendoscope, enables for the first time the visualisation of the complete tubal mucosa from a vaginal approach. Preliminary results in using this technique are described. Physiological and pathological results of tubal mucosa can be presented, which will influence the diagnostic and therapeutic part of subsequent sterility treatment.

[Blood flow measurements of neovascularization in tubal pregnancy]. / Blutflussmessungen von Neovaskularisationen bei Tubargravidität.

In a retrospective study the results of vagino- and colour flow Doppler sonography of 23 tubal pregnancies verified by surgery were documented. Due to the neovascularisation in the trophoblast tissue the vascular impedance was elevated in all cases. The mean value of all pulsatility indices was 0.85 +/- 0.2. The direct signs of tubal pregnancy were seen in only 20 cases with vaginosonography alone. The combination of vagino- and colour flow Doppler sonography offers the chance of an earlier detection (5th week of pregnancy) of a tubal pregnancy.

[Late complication of tubal pregnancy visualized with color Doppler ultrasound. A case report]. / Spätomplikation einer Tubargraviditt dargestellt mit der Farbdopplersonographie. Eine Kasuistik.

An invasive mole in an ectopic pregnancy was diagnosed in the 16th week post amenorrhoea by transvaginal colour flow mapping. Colour flow mapping was the only noninvasive method used to verify the diagnosis. In this case the serum level of human chorionic gonadotropin (HCG) was very low (0.196 IU/ml) and subjective symptoms and uterine bleeding were absent.

Beta-endorphin, steroids, and prolactin. Immunoassay in breast cysts and blood.

Circulating levels and cyst fluid concentrations of beta-endorphin (beta-EP), estradiol, progesterone, and prolactin were measured by radioimmunoassays in 10 premenopausal women with gross breast cysts. In addition, aspirates and frozen tissue sections from cystic lesions were investigated immunocytochemically for a possible beta-EP production. Epithelia of dilated ducts, smaller cysts, and hyperplastic lesions without atypia showed a strong positive reaction in the cytoplasm. In apocrine metaplasia, this staining was concentrated in the apical region. The staining intensity in atypical hyperplasia was diminished. Occasionally, normal duct and lobular epithelia exhibited positive beta-EP immunostaining. Levels of beta-EP, estradiol, and progesterone in the cyst fluid were significantly higher than in blood, but no significant differences were observed for prolactin. The ratios of progesterone to estradiol, estradiol to prolactin, and progesterone to prolactin in the cyst fluid were considerably higher than in blood. This suggests that beta-EP and steroid hormones are secreted from the lining epithelia into the breast cysts.

[Umbilical blood flow relations in pregnancy complications. Part 2. Pathologic index constellations]. / Umbilikale Strömungsverhältnisse bei Schwangerschaftskomplikationen. 2. Teil: Pathologische Indexkonstellationen.

In a study comprising a total of 700 pregnant women, umbilical resistance was examined. Measurements were taken at both sides of the cord. A decline in resistance was registered from the fetal abdominal wall to the placental insertion of the vessels. According to a collective of 500 patients with a normal development and outcome of their pregnancies a physiological constellation of the resistance indices could be confirmed. It was taken as a basis for the definition of pathological cases. Different pathologies were related quite clearly to a special (unphysiological) constellation of the indices.

Endovaginal Doppler flow measurements of the ovarian artery in patients with a normal menstrual cycle and with polycystic ovary syndrome during in vitro fertilization.

Women with a normal menstrual cycle (n = 21, controls), polycystic ovary syndrome (n = 10) and hypogonadotropic amenorrhea (n = 3) were stimulated with clomiphen-citrate (4th day to 8th day of the cycle) and with human menopausal gonadotropin (8th day to 11th day). The vascular impedance of the ovary carrying the dominant follicles was monitored by endovaginal pulsed Doppler flow measurement. Simultaneously, serum levels of LH, E2 and 17-OHP were assayed. Contrary to controls, women with polycystic ovary syndrome or hypogonadotropic amenorrhea showed decreased hormone levels and no lowering of the vascular impedance. In controls, the lower pulsatility index is caused by neovascularization around the dominant follicle and by E2-induced vasodilatation in the ovarian artery.