[Clinical value of hCG ratio of blood in peritoneal cavity versus venous blood in diagnosis of ectopic pregnancy].

OBJECTIVE: To study the value of hCG ratio of blood in peritoneal cavity versus venous blood (RPhCG/VhCG) in diagnosis of early ectopic pregnancy (EP). METHODS: From Mar. 2009 to Oct. 2012, 268 cases with EP (EP group) and 53 women with intrauterine pregnancy with haemoperitoneum (hIUP) (hIUP group) from International Peace Maternity and Child Health Hospital of Shanghai Jiaotong University School of Medicine, Shanghai 6th People Hospital and Shanghai Jiangwan Hospital were enrolled in this prospective study. The HCG of all subjective were measured in blood in peritonea cavity and venous blood, then calculate the ratio of RPhCG/VhCG. Scatter point analysis and ROC were used to differentiate EP, determine threshold of hIUP and evaluate the sensitivity, specificity and accuracy in diagnosis EP preoperatively. RESULTS: The mean RPhCG/VhCG of EP group was 4.35, which was significantly higher than 0.81 in hIUP group (P < 0.01). Scatter point analysis showed that the threshold value of RPhCG/VhCG between ectopic pregnancy and hIUP was 1.0. The overall sensitivity of RPhCG/VhCG in the diagnosis of EP was 98%, the specificity was 100%, the positive predictive value was 100% and the negtive predictive value was 93%. CONCLUSION: RPhCG/VhCG > 1.0 could be used to diagnose and differentiate EP from hIUP accurately.

[Effect of verapamil on production of anti-inflammatory cytokines by peritoneal mononuclears].

Effects ofverapamil, a slow calcium channel blocker, on the production of anti-inflammatory cytokines (TNF-alpha and IL-beta) by peritoneal mononuclears were studied using a rat model of aseptic intra-abdominal inflammation. Autohemoperitoneum was simulated by intraperitoneal administration of autoblood (group 1). The similarly treated animals of group 2 were additionally given verapamil. A statistically significant rise in the TNF-alpha and IL-beta levels was documented in the former case. In group 2, verapamil substantially modified functional activity of peritoneal macrophages in that TNF-alpha content in peritoneal exudate was twice lower than in group 1 while the IL-beta level remained unaltered. These findings suggest that slow calcium channels are involved in regulation of cytokine-producing function of mononuclear cells during intra-abdominal inflammation.

Assessment of the relationships among coagulopathy, hyperfibrinolysis, plasma lactate, and protein C in dogs with spontaneous hemoperitoneum.

OBJECTIVE: To relate coagulation and fibrinolysis derangements to shock severity as reflected by plasma lactate concentrations in dogs with spontaneous hemoperitoneum (SHP) and determine the impact on transfusions. DESIGN: Prospective, observational, case-control study. SETTING: Three veterinary teaching hospitals. ANIMALS: Twenty-eight client-owned dogs with SHP and 28 breed- and age-matched control dogs. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Blood samples for platelet counts, coagulation, and anticoagulant assays (prothrombin time, activated partial thromboplastin time, fibrinogen, antithrombin, and protein C, thromboelastography [TEG]), fibrinolysis testing (d-dimer and TEG lysis parameters with and without the addition of 50 U/mL of tissue plasminogen activator [TEG LY30 measured with the addition of 50 U/mL of tPA to the blood sample, LY3050 and TEG LY60 measured with the addition of 50 U/mL of tPA to the blood sample, LY6050 ; LY30 and LY60]), and plasma lactate as an indicator of severity of shock were collected from SHP dogs at the time of diagnosis. SHP dogs were hypocoagulable (prolonged prothrombin time and activated partial thromboplastin time, decreased TEG maximum amplitude) and hyperfibrinolytic (increased LY3050 and TEG LY6050 ) compared to controls. The severity of hypocoagulability was related to protein C activity, while the severity of hyperfibrinolysis was related to plasma lactate concentration. Among the 18 dogs discharged from the hospital, LY3050 was significantly associated with the dose of fresh frozen plasma administered, but none of the parameters were associated with the dose of red blood cells administered. CONCLUSIONS: Dogs with SHP have evidence of hypocoagulability, protein C deficiency, and hyperfibrinolysis. Parameters of hyperfibrinolysis were related to plasma lactate concentrations and volume of plasma transfused during hospitalization. These derangements resemble those found in people with acute coagulopathy of trauma and shock, and activation of protein C may be a common feature to both syndromes.

Hemoperitoneo secundario a tumor miofibroblástico inflamatorio perforado. Presentación de una complicación inusual / Hemoperitoneum secondary to perforated inflammatory myofibroblastic tumor: a case report of an unusual complication

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Hemoperitoneo por rotura espontánea de bazo no patológico en paciente fumador, simulando una perforación de ulcus duodenal: a propósito de un caso / Hemoperitoneum secondary to an spontaneous rupture of the spleen mimmicking a duodenal perforated ulcera: a case report

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Human chorionic gonadotropin ratio of hemoperitoneum versus venous serum improves early diagnosis of ectopic pregnancy.

OBJECTIVE: To analyze the value of the hCG ratio of peritoneal serum versus venous serum (R(P/V)) for early diagnosis and prognostic evaluation of ectopic pregnancy (EP). DESIGN: Retrospective clinical study. SETTING: University hospital. PATIENT(S): One hundred three women with hemoperitoneum and positive urine hCG tests underwent laparoscopy or laparotomy. INTERVENTION(S): Venous serum and peritoneal serum samples were obtained; ultrasound was performed in all the patients; dilatation and curettage was used in 28 patients. MAIN OUTCOME MEASURE(S): Quantitative hCG and R(P/V). RESULT(S): The R(P/V) in EP (5.55 +/- 4.32) is apparently greater than that in hemoperitoneum with intrauterine pregnancy (hIUP; 0.61 +/- 0.18). The median R(P/V) is 4.07 in the EP group versus 0.60 in the hIUP group, with a suggested threshold value of 1.0 for their differential diagnosis. Moreover, the R(P/V) of EP shows the dominant difference between the patients with active bleeding (8.03 +/- 3.29, n = 24) and the patients without active bleeding (4.59 +/- 3.88, n = 16) when the hCG level of venous serum is more than 1500 U/L. CONCLUSION(S): R(P/V) could instantly diagnose ectopic pregnancy and differentiate it from hIUP.