Early ovarian pregnancy diagnosed by ultrasound and successfully treated with multidose methotrexate. A case report.

A case report of a primary interstitial ovarian pregnancy is presented. A 37-year-old married woman with two children after two Cesarean sections and a spontaneous abortion, with a contraceptive intrauterine device (IUD) inserted three years before, presented at five weeks plus five days amenorrhea with a positive pregnancy test and lower abdominal pain but with no vaginal bleeding. Her previous menstrual cycles had been regular. She was hemodynamically stable. On bimanual examination, the uterus was of normal size, and there was an approximate four-cm tender right adnexal mass. Serum beta-human chorionic gonadotropin (b-hCG) was confirmed positive. Ultrasound revealed a well-positioned IUD in the uterus and a right adnexal mass with normal vascular flow on Doppler, that contained a well-defined gestational sac, well-distinct from the quiescent hemorrhagic corpus luteum. There was no fetal node or cardiac activity or free fluid. The patient received four injections of methotrexate intramuscularly using the multidose regimen that involves the administration of methotrexate calculated according to body weight, alternated with 0.1 mg/kg of leucovorin calcium per os after 30 hours until the values of 3-hCG had decreased by 15%. The patient's post-treatment period was uneventful with a full restoration of ovarian morphology and the complete absorption of the gestational sac. This case is the first where diagnosis was made by endovaginal sonography and treatment was made by multidose methotrexate. Spiegelberg criteria for the diagnosis of ovarian pregnancy are obsolete; new ultrasound and laboratory criteria are needed for a diagnosis as early as possible without the need of surgery.

Clinical significance and origin of artifacts in transesophageal echocardiography of the thoracic aorta.

OBJECTIVES: The aim of this study was to identify the mechanism and features of artifacts encountered during transesophageal echocardiography of the aorta. BACKGROUND: Artifacts are an important potential limitation of transesophageal echocardiography of the aorta. METHODS: The mechanism of the artifacts was examined by in vitro modeling. The frequency and clinical correlates of artifacts were examined by retrospective review of transesophageal echocardiograms in 36 patients with aortic pathologic lesions. RESULTS: Two classes of artifact were seen: linear artifacts in the ascending aorta, which may mimic intimal flaps, and mirror image artifacts in the transverse and descending thoracic aorta. Linear artifacts in the ascending aorta, seen in 44% of patients, were shown in vitro to be multiple path artifacts caused by reflection of ultrasound within the left atrium. Linear artifacts in the ascending aorta were associated with dilatation of the ascending aorta and were more frequent when the aortic diameter exceeded the left atrial diameter (p < 0.001). The mirror image artifacts of the transverse and descending thoracic aorta give the appearance of a double-barrel aorta and were shown in vitro to be caused by the aorta-lung interface, which acts as a total reflector of ultrasound. Mirror image artifacts were seen in > 80% of patients. Artifacts were equally frequent with the sagittal and transverse imaging planes when biplane transesophageal echocardiography was used. CONCLUSIONS: Artifacts occur frequently during transesophageal echocardiography of the aorta. An understanding of why they occur and the features that distinguish them from true abnormalities should enhance the diagnostic accuracy of transesophageal echocardiography for aortic disease.

[Apropos of a case of Dandy-Walker syndrome associated with chromosome abnormalities]. / A proposito di un caso di sindrome di Dandy-Walker associata ad anomalia cromosomica.

A case of Dandy-Walker syndrome associated with chromosome abnormalities (46,XX,-21, +der(13)t(13;21)(q22;q11), diagnosed during pregnancy is reported. This is a pathology characterized by malformations of the central nervous system, mainly of the cerebellum. Due to several aspects and different prognosis between classic Dandy-Walker and its variants, many clinical and therapeutic problems may raise.

[Diagnostic methods compared in neoplastic pathology of the endometrium]. / Metodiche diagnostiche a confronto nella patologia neoplastica dell'endometrio.

Preoperative staging is fundamentally important in endometrial carcinoma. The presence of lymph node metastasis and the risk of tumour recidivation are correlated to the degree of myometrial invasion by the tumour. The preoperative diagnosis of the absence of myometrial invasion may render pelvic lymphadenectomy superfluous. A group of 24 patients suffering from endometrial carcinoma underwent transvaginal ultrasonography and nuclear magnetic resonance prior to surgery in order to evaluate possible myometrial invasion. The study was integrated by computerised tomography (CT) to obtain a clearer image of the retroperitoneum. The authors aim to ascertain the accuracy, sensitivity and specificity of these methods in the preoperative evaluation other degree of myometrial infiltration.

[Transvaginal ultrasonography and nuclear magnetic resonance. Comparison of techniques in the evaluation of ovarian lesions]. / Ecografia transvaginale e risonanza magnetica nucleare. Tecniche a confronto nella valutazione delle lesioni ovariche.

A total of 53 patients were included in this study, aged between 21 and 72 years old and hospitalised with the diagnosis of ovarian tumour. All patients underwent a clinical examination, ultrasonography and NMR prior to surgery. The findings of ultrasonography and NMR were correlated with histological results in order to evaluate the value of these methods in the differential diagnosis of benign and malignant ovarian tumours. Histological tests revealed 46 benign tumours, 3 borderline cases and 4 malignant growths. Transvaginal ultrasonography revealed precisely 47 out of 53 ovarian tumours, and NMR 49 out of 53. The main limitation of both techniques was the tendency to overestimate ovarian lesions (specificity: ultrasonography 89%, NMR 93%). As far as concerns the identification of malignant lesions NMR does not appear to offer significant advantages in comparison to ultrasonography (sensitivity 85% ultrasonography = NMR).

Rise and fall of asthma-related mortality in Italy and sales of beta2-agonists, 1980-1994.

We performed this study with the aims of describing the trend of asthma-related mortality in Italy between 1980 and 1994, and to evaluate the relationship between sale estimates of beta2-agonists drugs and mortality from asthma. For asthma mortality we used data provided by National Institute of Statistics, for sale estimates of beta2-agonists we used data provided by IMS HEALTH. We calculated the gender specific age-standardized incidence rates of asthma-related deaths for all ages and for age classes. We found that estimates for asthma-related mortality steadily increased between 1980 and 1987 in both sexes, and thereafter decreased. In people, aged between 34 and 64 and over 64, death rates in males were significantly higher than in females while the rates in those aged less than 34, were mostly similar in both gender. The overall exposure to beta2-agonists (alone and in combination) increased from 1980 to 1990, remained stable between 1990 and 1993, and increased steeply in 1994. We conclude that asthma-related death rates have declined since the mid-1980's. This decline has been more pronounced in males and in the older ages, while the rates in younger patients of both genders have remained nearly unchanged. Our data do not substantiate the hypothesis of an increased risk of asthma-related mortality associated to the use of inhaled beta2-agonists in general nor fenoterol or salbutamol in particular.