ABSTRACT
Intramural pregnancy implanting in the previous cesarean section scar is one of the rarest form of an ectopic pregnancy and probably the most dangerous form because of its risk of rupture and hemorrhage. For its sonographic diagnosis, the gestational sac should be in the anterior wall of uterine isthmic portion, there should be no myometrium between bladder and gestational sac, and it should be verified that uterine cavity and cervix should be isolated from gestational sac. For young patients who wish to maintain their fertility, an earlier diagnosis and more conservative treatment are desirable. We have recently experienced a case of intramural pregnancy implanting in the scar of cesarean section, treated with systemic methotrexate injection. So, we report this case with a brief review of the literature.
Subject(s)
Animals , Female , Humans , Mice , Pregnancy , Cervix Uteri , Cesarean Section , Cicatrix , Diagnosis , Fertility , Gestational Sac , Hemorrhage , Methotrexate , Myometrium , Pregnancy, Ectopic , Rupture , Ultrasonography , Urinary BladderABSTRACT
Patients with chronic renal failure(CRF) suffer from muscular dysfunction of varying degrees. 31P-nuclear magnetic resonance(NMR) spectroscopic studies of skeletal muscle have shown that these patients have less energy reservoir. Chronic metabolic acidosis has been known to decrease intracellular pH in rat muscle. We investigated the effect of correction of metabolic acidosis with sodium bicarbonate on muscle energy metabolism. Eight patients(6M, 2F) with CRF(creatinine clearance <20ml/min/1.73m2) who were clinically stable and had serum bicarbonate level less than 18mEq/L were included. The median age was 48 years (range; 29-56 years). The patients were treated with daily doses of 3 gram sodium bicarbonate for 3 months. Phosphocreatine to inorganic phosphate ratio(PCr/Pi) and intracellular pH were measured with 31P-NMR spectroscopy, at resting, nadir and maximum recovery state after all-out exercise, before and after correction of acidosis. Plasma bicarbonate level increased from 16.2+/-0.9 to 21.9+/-1.1mmol/L(p<0.05). Creatinine clearance, hematocrit and serum albumin did not change during the study period. The exercise capacity, as measured by the time holding the weight, did not improve with sodium bicarbonate treatment. PCr/Pi ratio at resting state was 7.0+/-1.9 before treatment, which did not change after treatment, 6.2+/-0.8, although plasma bicarbonate level increased significantly. The ratio reached bottom immediately after the all-out exercise(the nadir state) and then recovered toward preexercise value. The PCr/Pi ratio at nadir and maximum recovery state were not different between before and after treatment. The intracellular pH became more acidotic immediately after exercise, but no difference was found between before and after sodium bicarbonate treatment in resting state, nadir or maximum recovery state. With our results, we conclude that the partial correction of acidosis does not improve energy reserve and serum albumin in CRF patients.
Subject(s)
Animals , Humans , Rats , Acidosis , Creatinine , Energy Metabolism , Hematocrit , Hydrogen-Ion Concentration , Kidney Failure, Chronic , Muscle, Skeletal , Phosphocreatine , Plasma , Serum Albumin , Sodium Bicarbonate , Spectrum AnalysisABSTRACT
No abstract available.