Manejo expectante de gestación ectópica abdominal tras fecundación in vitro en paciente con salpinguectomía bilateral: reporte de un caso / Expectant management of abdominal ectopic pregnancy following in vitro fertilization in a patient with previous bilateral salpinguectomy: a case report

ANTECEDENTES El embarazo ectópico abdominal es el menos habitual de los embarazos ectópicos, con una prevalencia situada entre el 0.9 - 1.4%. La mortalidad materna es elevada, alcanzando un 20% y la viabilidad fetal mínima. El manejo médico en estas situaciones es complicado ya que no está bien establecido debido a su baja frecuencia. CASO CLÍNICO Mujer de 35 años, con antecedente de esterilidad por endometriosis y salpinguectomía bilateral. Tras 5 fecundaciones in vitro (FIV) consigue una primera gestación, con finalización mediante cesárea por no progresión de parto. Acude a urgencias en su segundo embarazo, logrado tras 3 (FIV), con edad gestacional de 7 semanas. Presenta sangrado vaginal escaso y la ecografía demuestra a nivel de Douglas y hacia fosa iliaca izquierda un saco gestacional de 3 cm con embrión sin latido cardiaco de 5 mm. El nivel de β-hcg es de 1477 mUI/ml. Se diagnostica de gestación ectópica abdominal y se opta por actitud expectante dada la estabilidad clínica de la paciente. En un control a las 48h la β-Hcg es de 464 mUI/ml y la paciente se mantiene estable. En controles posteriores se observan niveles descendentes de β-Hcg y tras un mes la resolución es completa. CONCLUSIÓN El embarazo ectópico abdominal es una entidad poco frecuente pero con una alta tasa de mortalidad. Aunque lo más común es optar por un abordaje quirúrgico es necesario individualizar cada caso y basarse en la clínica y las diferentes pruebas diagnósticas para seleccionar aquellos casos que se pueden beneficiar de un manejo conservador.

BACKGROUND Abdominal ectopic pregnancy accounts for only 0.9-1.4% of all ectopic pregnancies. The maternal mortality rate is high (up to 20%) and fetal viability mínimum. The managment, specially the conservatory management of these cases is difficult because of our limited experiencie due to its low frecuency. CASE PRESENTATION 35-year-old woman, with history of sterility due to endometriosis that required bilateral laparoscopic salpinguectomy. Her first pregnancy (after 5 in vitro fertilization cicles (IVF)) finalized with a caesarean section because of to the lack of labour progresion. She was admitted to our emergency department during her second pregnancy (after 3 IVF cicles), with 7 weeks of gestational age. She had a little vaginal bleeding. Ultrasound scan showed a 5mm gestational sac with a 3mm embryo without cardiac activity in the pouch of Douglas. The β-Hcg level was 1477mUI/ml. The final diagnosis was ectopic abdominal pregnancy and it was decided to undertake an expectant management because she was clinically stable. The β-Hcg level after 48 hours was 464 mUI/ml. In subsequent examinations β-Hcg showed descending levels and after one month the resolution was completed. CONCLUSION Abdominal ectopic pregnancy is very infrequent but it has a high mortality rate. The most common approach is surgical but it is necessary to study all signs and diagnostic tests to select patients that could get profit from a conservatory management.

Testicular mixed germ cell tumor presenting with seizure as the initial symptom: a case report and literature review

Abstract Most patients with testicular germ cell tumor present with a painless scrotal mass. We report a 19-year-old patient who presented with neurological complains. Rapid clinical progression to coma was noted during the staging work up. A diagnosis of testicular mixed germ cell tumor with multiorgan metastasis (lymph node, lung, liver and brain) was made. Patients with brain metastasis should receive chemotherapy alone or combined with surgery or radiotherapy. Because the clinical symptoms deteriorated quickly, surgery was used upfront followed by chemotherapy and radiotherapy for the brain tumor. After the first stage of treatment, the clinical symptoms, tumor markers and imaging findings were improved. The residual brain tumor was eliminated by chemotherapy, and only sparse degenerated tumor cells were noted in the brain tissue. Longer follow up is required to assess the impact of our treatment strategy.

Supposed pituitary-production of human chorionic Gonadotropin induced by androgen deprivation therapy

ABSTRACT Introduction: The main cause of slightly elevated human chorionic gonadotropin (HCG) after successful treatment of male germ cell tumors is considered to be pituitary-derived HCG. It is well known that pituitary-derived HCG is frequently detected in postmenopausal women. We evaluated the status of serum HCG in men with elevated gonadotropins, which were induced by androgen deprivation therapy, using commercially available assays. Materials and Methods: We enrolled 44 patients with prostate cancer, who underwent luteinizing-hormone releasing hormone agonist treatment. We measured serum follicle-stimulating hormone (FSH), serum luteinizing hormone (LH), serum total HCG, serum free HCG-β subunit, and urine total HCG 3 times per patient, on the day of treatment initiation, the next day, and 3 months after. Results: On the day after treatment initiation, serum and urine HCG was detected in 61% and 73% of patients, respectively. Markedly strong correlations were observed between serum/urine HCG and FSH/LH. In particular, receiver operating characteristic curve analysis indicated excellent area under the curve (0.977, 95% confidence interval 0.951-1.003)) for serum HCG-detectable LH. At the cutoff value of 21.07 mIU/mL for serum HCG-detectable LH, the sensitivity and specificity were 96.7% and 95.3%, respectively. Serum HCG-β was not detectable at any times in any patients. Conclusions: Suggested pituitary-derived HCG can be frequently detected in patients with elevated gonadotropins, and there is a firm association between HCG detection and gonadotropin levels.

CA125, progesterone & ß-hCG in prediction of first trimester abortion / CA125, progesterona e ß-hCG na previsão de aborto no primeiro trimestre

Introduction: Pregnancy loss is a common medical problem in reproductive-age as more than fifty percent of human pregnancies are aborted before term. The majority are unrecognized occurring before or with the expected next menses. About 10­12 percent of all clinically diagnosed pregnancies are lost as first-trimester or early second trimester. The rate of fetal death after 14 weeks' gestation is much lower than the rate of pre-embryonic and embryonic loss. CA125 is a member of the mucin family glycoproteins. CA125 has found application as a tumor marker or biomarker that its level may be increased in the serum of some patients with specific types of cancers. Some studies detected that the abortion risk is increased in pregnant women with higher CA125 levels. Progesterone belongs to the C21 group of progestogen. Its main source in humans is the corpus luteum. Human chorionic gonadotropin (HCG) is a glycoprotein produced by syncytiotrophoblast. Aim of the work: The aim of this study was to determine the effectiveness of measuring maternal serum -HCG, progesterone, CA125 in prediction of first trimester abortion. Patients: The study included 90 pregnant women attending the ANC clinic in El-Shatby Maternity University Hospital. Patients were divided equally into two groups: Group I: 45 women with threatened abortion, subdivided into 2 subgroups: Subgroup A ­ Cases ended in abortion; Subgroup B ­ Cases continued as normal pregnancies. Group II: 45 pregnant women with normal pregnancy and were further subdivided into two subgroups: Subgroup C ­ Cases ended in abortion; Subgroup D ­ Cases continued as normal pregnancies. Exclusion criteria: (1) Multiple pregnancies; (2) Anembryonic pregnancy; (3) Pregnant women with prior treatment with progesterone; (4) History of endometriosis; (5) Fibromyoma with pregnancy. Methods: After clinical and sonographic examination, 3 mL venous blood have been taken once for estimation of serum level of -hCG, progesterone and CA125 by quantitative ELISA. Results: This is a case­control study. Out of the 90 pregnancies, 15 cases (16.6%) had aborted during follow-up, 9 cases (60%) of them had history of threatened abortion while 6 cases (40%) had no history of threatened abortion. Regarding Serum Progesterone level between studied groups, the calculated p value was <0.001. For Serum HCG, the calculated p value was <0.001. In Serum CA125 the calculated p value was <0.001.(AU)

Introdução: A perda da gravidez é problema clínico comum em mulheres em idade fértil, pois em mais de 50% das gestações humanas ocorre aborto antes do termo. Em sua maioria, tais abortos passam despercebidos; ocorrem antes da próxima menstruação ou juntamente com a próxima menstruação. Cerca de 10-12% de todos os abortos clinicamente diagnosticados ocorrem no primeiro trimestre ou no início do segundo trimestre. O percentual de mortes fetais após 14 semanas de gestação é muito mais baixo do que o percentual de abortos pré-embrionários ou embrionários. Foi constatado que CA125 tem aplicação como marcador tumoral ou como biomarcador, pois seu nível pode aumentar no soro de alguns pacientes portadores de tipos específicos de neoplasias. CA125 é um membro da família das glicoproteínas mucinas. Alguns estudos observaram que o risco de aborto aumenta em gestantes com níveis mais elevados de CA125. Progesterona pertence ao grupo C21 dos progestágenos. Em seres humanos, sua principal fonte é o corpo lúteo. Gonadotrofina coriônica humana (HCG) é uma glicoproteína produzida pelo sinciciotrofoblasto. Objetivo: Determinar a eficácia da determinação, no soro materno, de -HCG, progesterona e CA125 na previsão do aborto no primeiro trimestre. Pacientes: O estudo abrangeu 90 gestantes atendidas na clínica ANC na Maternidade do Hospital Universitário El-Shatby. As pacientes foram divididas equitativamente em dois grupos. Grupo I: 45 gestantes com ameaça de aborto, subdivididas em dois subgrupos: Subgrupo A ­ Casos que terminaram em aborto; Subgrupo B ­ Casos que tiveram continuidade como gestações normais. Grupo II: 45 gestantes com gestação normal, subdivididas em dois subgrupos: Subgrupo C ­ Casos que terminaram em aborto; Subgrupo D ­ Casos que tiveram continuidade como gestações normais. Critérios de exclusão: 1. Gestações múltiplas; 2. Gestação anembriônica; 3. Gestantes previamente tratadas com progesterona; 4. História de endometriose; 5. Fibromioma com gestação. Métodos: Após exame clínico e ultrassonográfico, 3 mL de sangue venoso foram coletados uma vez para estimar o nível sérico de -hCG, progesterona e CA125 por Elisa quantitativo. Resultados: Este é um estudo de casos-controle. Das 90 gestações, durante o seguimento ocorreram 15 (16,6%) casos de aborto; nove (60%) tinham história de ameaça de aborto, seis (40%) não tinham história de ameaça de aborto. Com relação ao nível sérico de progesterona entre os grupos estudados, calculamos p < 0,001. Para o nível sérico de CA125, calculamos p < 0,001.(AU)

Previsão de gravidez pós-fertilização in vitro de acordo com valor de ß-hCG e progesterona / Prediction of pregnancy after in vitro fertilization according ß-hCG and progesterone levels

Introdução: Múltiplos estudos sugerem que os valores de ß-hCG e de progesterona podem ser bons preditores de gravidez. Objetivo: Investigar o potencial dos valores de ß-hCG e progesterona na previsão de gravidez evolutiva e de gravidez gemelar, 14 dias após punção ovocitária em ciclos FIV/ICSI, e estabelecer um modelo de previsão. Métodos: Estudo retrospetivo de ciclos com punção e transferência de embriões a fresco entre maio/2011 e setembro/2015. Os grupos definidos foram: sem gravidez; gravidez não evolutiva; gravidez evolutiva (única ou gemelar). A análise estatística considerou = 5%. Para avaliar a capacidade de prever gravidez evolutiva e gravidez gemelar recorreu-se a um modelo de análise multivariada e usou-se um processo de regressão logística binária. Recorreu-se às curvas ROC para avaliar a capacidade do valor de ß-hCG e progesterona na distinção entre gravidez não evolutiva e evolutiva. Resultados: Verificaram-se 149 casos: sem gravidez 11,4%, gravidez não evolutiva 24,8%, gravidez evolutiva 63,8% (83 única, 12 gemelares). Com exceção dos valores de progesterona e ß-hCG, não se verificaram diferenças estatisticamente significativas entre as variáveis do grupo gravidez não evolutiva e evolutiva (ß-HCG: 38,9 vs 159 UI/L; progesterona: 20,4 vs 60 ng/mL). Na comparac¸ão entre gravidez única e gemelar, apenas o valor de ß-hCG foi estatisticamente significativo (ß-HCG: 147 vs 331 UI/L). Quando o valor de progesterona é ≥ 25, a probabilidade de gravidez é 5,4 vezes superior (IC95%, 1,18-24,8). Na regressão logística para gravidez gemelar apenas o valor de ß-hCG foi estatisticamente significativo. Conclusão: Uma avaliação única de progesterona e ß-hCG, 14 dias após punção, tem um bom valor preditivo de gravidez evolutiva, porém com capacidade limitada para discriminar entre gravidez única e gemelar.(AU)

Introduction: Multiple studies suggest that the amount of ß-hCG and progesterone can be good predictors of pregnancy. Objective: To investigate the potential of ß-hCG and progesterone values in predicting evolutive pregnancy and twin pregnancy, 14 days after oocyte puncture in IVF/ICSI cycles, establishing a predictive model. Methods: A retrospective study of cycles with the use of a puncture and fresh embryo transfer between May/2011 and September/2015. The defined groups were: with no pregnancy; without evolutive pregnancy; and with evolutive (single or twin) pregnancy. Statistical analysis considered = 5%. To assess the ability to predict evolutive pregnancy and twin pregnancy, a multivariate analysis model was carried out, with the use of a binary logistic regression process. ROC curves were used to evaluate the ability of ß-hCG and progesterone values in differentiating between non-evolutive and evolutive pregnancy. Results: 149 cases were found: no pregnancy 11.4%, without evolutive pregnancy 24.8%, with evolutive pregnancy 63.8% (83 single, 12 twins). Excluding progesterone and ß-hCG values, there were no statistically significant differences between the variables of non-evolutive and evolutive pregnancy groups (ß-HCG: 38.9 vs. 159 IU/L, progesterone: 20.4 vs. 60ng/mL). In a comparison between single and twin pregnancies, only the amount of ß-hCG was statistically significant (ß-HCG: 147 vs. 331 IU/L). When progesterone value is >25, the probability of pregnancy is 5.4 times greater (95% CI, 1.18-24.8). In a logistic regression for twin pregnancies, only ß-hCG value was statistically significant. Conclusion: A single assessment of progesterone and ß-hCG values 14 days after the puncture has a good predictive value of evolutive pregnancy, but with limited ability to discriminate between single and twin pregnancies.(AU)

Expression of human chorionic gonadotropin (ßhCG) in pre-eclamptic placenta / Expresión de gonadotropina coriónica humana (ßhCG) en placenta preeclámptica

This study aimed to assess association between preeclampsia with trophoblast cells and serum level of b-human chorionic gonadotropin (ß-hCG). Were compared 20 patients with preeclampsia and 20 control patients with respect to demographics, hematological parameters and the presence of trophopblast in placental samples. Patchy necrosis with loss of microvilli and gross thinning of the syncytium with distorted microvilli were seen in terminal villi of placentae of women with pre-eclampsia Syncytial cells at the molecular level crossings, especially at the level of ßhCG in conjunction with the changes in the preeclampsia was made on the histopathological changes to clarify the villi.

El objetivo fue evaluar la asociación entre la preeclampsia con células trofoblásticas y concentración sérica de la gonadotropina coriónica humana b (ß-hCG). Se compararon 20 pacientes con preeclampsia y 20 pacientes de control con respecto a datos demográficos, parámetros hematológicos y la presencia de trofoblasto en muestras de placenta. Se observaron áreas dispersadas de necrosis, con pérdida de microvellosidades y adelgazamiento del sincitio con microvellosidades distorsionadas en las vellosidades terminales de placentas en mujeres con células sincitiales preeclámticas a nivel molecular, junto a altos niveles de ßhCG asociados a los cambios generados por la preeclampsia sobre los parámetros histopatológicos.

Hypotensive Response Magnitude and Duration in Hypertensives: Continuous and Interval Exercise / Magnitude e Duração da Resposta Hipotensora em Hipertensos: Exercício Contínuo e Intervalado

Background: Although exercise training is known to promote post-exercise hypotension, there is currently no consistent argument about the effects of manipulating its various components (intensity, duration, rest periods, types of exercise, training methods) on the magnitude and duration of hypotensive response. Objective: To compare the effect of continuous and interval exercises on hypotensive response magnitude and duration in hypertensive patients by using ambulatory blood pressure monitoring (ABPM). Methods: The sample consisted of 20 elderly hypertensives. Each participant underwent three ABPM sessions: one control ABPM, without exercise; one ABPM after continuous exercise; and one ABPM after interval exercise. Systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MAP), heart rate (HR) and double product (DP) were monitored to check post-exercise hypotension and for comparison between each ABPM. Results: ABPM after continuous exercise and after interval exercise showed post-exercise hypotension and a significant reduction (p < 0.05) in SBP, DBP, MAP and DP for 20 hours as compared with control ABPM. Comparing ABPM after continuous and ABPM after interval exercise, a significant reduction (p < 0.05) in SBP, DBP, MAP and DP was observed in the latter. Conclusion: Continuous and interval exercise trainings promote post-exercise hypotension with reduction in SBP, DBP, MAP and DP in the 20 hours following exercise. Interval exercise training causes greater post-exercise hypotension and lower cardiovascular overload as compared with continuous exercise. .

Fundamento: Embora se saiba que o exercício promova hipotensão pós-exercício, até o momento não há argumentações consistentes sobre os efeitos da manipulação de seus diversos componentes (intensidade, duração, intervalos de descanso, tipos de exercício, métodos de treinamento) na magnitude e duração da resposta hipotensora. Objetivo: Comparar os efeitos dos exercícios dinâmicos, contínuo e intervalado, sobre a magnitude e duração da resposta hipotensora em hipertensos por meio da monitorização ambulatorial da pressão arterial (MAPA). Métodos: A amostra foi composta por 20 idosos hipertensos. Cada participante realizou três sessões de MAPA, sendo uma controle (sem exercício), uma após exercício contínuo e uma após exercício intervalado. O monitoramento de pressão arterial sistólica (PAS), pressão arterial diastólica (PAD), pressão arterial média (PAM), frequência cardíaca (FC) e duplo produto (DP) foi realizado para verificação da hipotensão pós-exercício e comparação entre cada MAPA. Resultados: As MAPAs após exercício contínuo e intervalado demonstraram hipotensão pós-exercício e redução significativa (p < 0,05) de PAS, PAD, PAM e DP por 20 horas, na comparação com a MAPA controle. Na comparação entre as MAPAs após exercício contínuo e intervalado, verificou-se redução significativa (p < 0,05) de PAS, PAD, PAM e DP após exercício intervalado. Conclusão: Os exercícios contínuo e intervalado promovem hipotensão pós-exercício, com redução significativa de PAS, PAD, PAM e DP ao longo das 20 horas subsequentes à atividade. O exercício intervalado gera maior magnitude de hipotensão pós-exercício e menor sobrecarga cardiovascular, medida por menor DP. .

Primary Adenocarcinoma with Focal Choriocarcinomatous Differentiation in the Sigmoid Colon / 대한소화기학회지

Primary colorectal choriocarcinoma is a rare neoplasm. Only 19 cases have been reported worldwide, most of which involved adenocarcinomas. The prognosis is usually poor, and the standard therapy for this tumor has not been established. A 61-year-old woman presented with constipation and lower abdominal discomfort. She was diagnosed with primary adenocarcinoma with focal choriocarcinomatous differentiation in the sigmoid colon and liver metastasis. Because the serum beta-human chorionic gonadotropin level was not significantly elevated, and because only focal choriocarcinomatous differentiation was diagnosed, we selected the chemotherapy regimen that is used for the treatment of metastatic colorectal adenocarcinoma. The patient survived for 13 months after the initial diagnosis. This is the first case in Korea to assess the suppressive effects of the standard chemotherapy for colorectal adenocarcinoma against coexisting colorectal choriocarcinoma and adenocarcinoma.

Twin pregnancy with a complete hydatidiform mole and surviving co-existent fetus: a case report

A 27-year-old woman conceived following six cycles of ovulation induction with clomiphene citrate. Successive ultrasound [US] examinations documented a normally growing live fetus with a normal placenta and an additional intrauterine echogenic mass with features of molar pregnancy. Follow-up serum beta-hCG estimation and genetic amniocentesis was done. Fetus revealed normal female 46XX karyotype. The pregnancy was continued till 28[th] weeks. Labor was induced at 28 week gestation due to vaginal bleeding, which resulted in the delivery of a live normal female infant and two adjoining placentas. One placenta was normal and the other placenta was composed of vesicles of various sizes. Microscopic examination of the abnormal placenta documented complete hydatidiform mole [[HM]. The baby was well and serial maternal serum beta-hCG levels showed a declining trend and were undetectable by 8 weeks after delivery. The prenatal diagnosis of twin pregnancy with complete HM and coexistent fetus was based on US findings, abnormally elevated beta-hCG levels and normal fetal karyotype [46XX]. The pregnancy should be continued with close follow-up to detect potential maternal and fetal complications

values of CA-125, progesterone, beta-HCG and estradiol in the early prediction of ectopic pregnancy

To explore the diagnostic value and measurement of serum CA-125, the single measurement of progesterone [P], beta-HCG, and estradiol [E2] in the early diagnosis of ectopic pregnancy. Serum levels of CA-125, progesterone, beta-HCG and estradiol were measured by Enzyme Linked Immuno Sorbent Assay [ELISA] techniques in 40 symptomatic women with ectopic pregnancy and 24 women with normal intrauterine pregnancy during gestational age of 4-10 weeks at Al-Kadhmiya Teaching Hospital, Baghdad, Iraq, between November 2010 and June 2011. The mean +/- SEM serum levels of CA-125, progesterone, beta-HCG, and estradiol in patients with ectopic pregnancies [16.51 +/- 2.39U/ml; 2.54 +/- 0.47ng/ml; 72.75 +/- 12.27mIU/ml; 13.4 +/- 2.14pg/ml; respectively] were significantly lower than the levels in normal intrauterine pregnancies [74.25 +/- 18.5U/ ml; 28.36 +/- 3.7ng/ml; 249.54 +/- 18.0mIU/ml; 112.7 +/- 23.6pg/ml; respectively]. When using a CA-125 concentration of 20.5 U/ml as a cut-off value for the diagnosis of ectopic pregnancy, sensitivity was 75.7%, specificity 100%, the positive predictive value was 100% and the negative predictive value 71.4%. The measurement of CA-125 and progesterone levels is useful in discriminating ectopic from normal gestations

Embarazo ectópico ovárico: experiencia en 10 años del Hospital Universitario La Paz, Madrid, España / Ovarian ectopic pregnancy: 10-year experience at Hospital Universitario La Paz, Madrid, Spain

La gestación ectópica ovárica es muy infrecuente, presentando una incidencia de 1/2100-7000 gestaciones (0,5-3% de todos los ectópicos). Su diagnóstico es difícil y dada la poca experiencia, no está claro el tratamiento más adecuado. Se presentan seis casos clínicos, recogidos en nuestro hospital desde 2001 hasta 2011, destacando el difícil diagnóstico prequirúrgico así como el tratamiento realizado.

Ectopic ovarian pregnancy is very infrequent, with an incidence of 1/2100-7000 pregnancies (0.5-3% of all ectopic pregnancies). Diagnosis is difficult and due to few cases presented in the literature there is no consensus on the appropriate treatment. Here we review six clinical cases of ovarian ectopic pregnancy that presented to our hospital between 2001 and 2011, highlighting the difficult presurgical diagnosis and appropriate course of treatment.

Submyomatous cornual pregnancy managed surgically after failed medical management

Cornual pregnancy constitutes an emergency while its diagnosis and management remain a challenge. Anatomical abnormalities in the uterus, such as fibroids in the cornual region, make the management even more difficult. A nulliparous patient presented with an ectopic pregnancy at the right cornua under a huge fibroid. Despite multiple doses of methotrexate for a cornual ectopic gestation, the serum beta human chorionic gonadotropin [beta-hcG] levels doubled on the fifth day and a viable fetus was demonstrated on imaging. Thus surgical intervention in the form of laparoscopy followed by laparotomy, myomectomy of a large cornual fibroid and cornuostomy was performed. The serum beta human chorionic gonadotropin result was negative three weeks later. Surgical intervention in the form of myomectomy and cornuostomy was necessary to preserve fertility in this unusual presentation of cornual ectopic pregnancy

[ report about a case of gestational trophoblastic tumor associated with ectopic pregnancy]

Gestational trophoblastic tumor associated with ectopic pregnancy is a very rare event. This paper reports a case of an invasive mole arising from a tubal pregnancy. Patient is a 26-year-old G2L1Ep1 who was referred to Isfahan Beheshti Hospital due to rise in BHCG level after surgery of ectopic pregnancy [EP]. The patient had initially been treated with salpingectomy. The pathologic study of specimen was invasive mole. The patient underwent two period of MTX treatment. Because of sonographic report of adnexal mass, the patient underwent laparotomy. The result of laparotomy was invasive mole. The patient underwent EMACO regimen and was released when the BHCG was 1. Appropriate monitoring of BHCG titers following surgery of EP is important not only to diagnose persistent EP, but also for rejecting the presence of GTT. In addition, follow up of the pathologic report is also important, although the clinical diagnose seems to be correct

Pleomorphic Carcinoma of the Lung with High Serum Beta-human Chorionic Gonadotropin Level and Gynecomastia

Although gynecomastia is a well-defined paraneoplastic syndrome in patients with non-small cell lung cancer, the association with pleomorphic carcinoma has not been reported. A 50-yr-old man presented with bilateral gynecomastia and elevated serum beta-human chorionic gonadotropin (beta hCG) level. Chest tomography showed a mass in the right middle lobe. Right middle lobectomy and mediastinal lymph node dissection were performed. beta hCG levels decreased rapidly after surgery. Histological examination revealed pleomorphic carcinoma with positive immunostaining for beta hCG. Serum beta hCG levels began to increase gradually on postoperatively 4th month. Computed tomography detected recurrence and chemotherapy was started. After second cycle of chemotherapy, beta hCG levels decreased dramatically again and tomography showed regression in mass. Patient died 6 months later due to brain metastasis. beta hCG expression may be associated with aggressive clinical course and increased risk of recurrence, also beta hCG levels may be used to evaluate therapy response in patients with pleomorphic carcinoma.

Diagnostic value of beta-HCG, estradiol, and progesterone in ectopic pregnancy versus normal-intrauterine pregnancy

To evaluate the diagnostic value of rising level of serum beta subunit human chorionic genadotrophin, single measurement of progesterone, and estradiol in early diagnosis of ectopic pregnancy. A case control study was conducted on 40 women with ectopic pregnancy and 40 women with normal intrauterine pregnancy from Shatby University Maternity Hospital. Blood samples for the measurement of beta subunit human chorionic genadotrophin [beta-hCG], estradiol [E2], and progesterone were drawn in all the women upon admission. Extra blood sample was drawn for measurement of beta-hCG 24 hours after admission. The mean serum levels of beta-hCG, progesterone, and estradiol in patients with ectopic pregnancies [969.0 +/- 302.1, 7.9 +/- 2.83, 621.9 +/- 131.4 respectively] were significantly lower than these levels in normal intrauterine pregnancies [3186.8 +/- 649.2, 23.5 +/- 5.3, 1853.6 +/- 508.4 respectively]. The average rate of beta-hCG rising was [8%] for 24 hours in patients with ectopic pregnancy and [31%] in normal intrauterine pregnancies. Single measurement of serum progesterone level has the greatest sensitivity [97%] and specificity [90%] in the diagnosis of early ectopic pregnancy

Unruptured tubal pregnancy: different treatments for early and late diagnosis

CONTEXT AND OBJECTIVE: There is evidence that ectopic pregnancies present different behavioral patterns. These distinct evolutions of ectopic pregnancies represent two different natural histories. To evaluate these evolution patterns, we compared patients undergoing medical treatment and expectant management according to their gestational age and initial beta-hCG levels. DESIGN AND SETTING: Prospective study at the Department of Obstetrics of Universidade Federal de São Paulo, a tertiary center. METHODS: Among 119 cases of unruptured ectopic pregnancies diagnosed from April 1999 to February 2004, 57 received systemic treatment with methotrexate 50 mg/m² (body surface area) intramuscularly and 62 were managed expectantly. In this study we evaluated the beta-hCG levels at presentation and amenorrhea duration. RESULTS: There was a significant difference between the two groups regarding amenorrhea duration and initial beta-hCG levels (p < 0.001). The group with decreasing beta-hCG levels (managed expectantly) had longer amenorrhea (mean: 8.87 ± 1.71 weeks) and lower initial beta-hCG levels (mean: 648.8 ± 754.7 mIU/ml). On the other hand, the group treated with methotrexate had shorter amenorrhea (mean: 6.81 ± 1.88 weeks) and higher beta-hCG levels at presentation (2642.7 ± 2315.1 mIU/ml). CONCLUSIONS: The data suggest that ectopic pregnancies can be categorized into two groups: those with early diagnosis and shorter amenorrhea, increasing or maintained beta-hCG levels over 24 and 48-hour intervals and higher beta-hCG levels requiring medical treatment; and those with late diagnosis and longer amenorrhea, decreased beta-hCG levels over 24 and 48-hour intervals and lower beta-hCG levels requiring expectant management.

CONTEXTO E OBJETIVO: A gravidez ectópica apresenta comportamentos diferentes. Para avaliar as diferentes evoluções da gravidez ectópica, nós comparamos as pacientes submetidas ao tratamento medicamentoso e à conduta expectante de acordo com a idade gestacional e os valores iniciais de beta-hCG. TIPO DE ESTUDO E LOCAL: Estudo prospectivo, realizado no Departamento de Obstetrícia da Universidade Federal de São Paulo, hospital terciário. MÉTODOS: Foram diagnosticados 119 casos de gravidez ectópica íntegra no período de abril de 1999 a fevereiro de 2004. O tratamento com metotrexato 50 mg/m² de superfície corpórea intramuscular foi realizado em 57 casos e a conduta expectante, em 62 casos. Neste estudo, nós avaliamos os valores iniciais de beta-hCG e o período de amenorréia. RESULTADOS: Houve diferença estatística significante entre os dois grupos com relação ao período de amenorréia e os valores iniciais de beta-hCG (p < 0,001). O grupo com títulos de beta-hCG em regressão (conduta expectante) apresentaram período de amenorréia mais longo (média:8,87 ± 1,71 semanas) e valores iniciais de beta-hCG mais baixos (648,8 + 754,7 mUI/ml). Por outro lado, o grupo tratado com metotrexato teve período menor de amenorréia (média 6,81 + 1,88 semanas) e valores de beta-hCG mais altos (2642,7 +2315,1 mUI/ml). CONCLUSÕES: Os resultados deste estudo sugerem que a gravidez ectópica pode ser categorizada em dois grupos: aquelas com diagnóstico precoce com período curto de amenorréia e valores elevados de beta-hCG que requerem tratamento com metotrexato, e aquelas com diagnóstico tardio com período longo de amenorréia e valores baixos de beta-hCG que requerem a conduta expectante.

[Relationship between the serum B-HCG and preeclampsia and its severity]

Preeclampsia as the most common complication of pregnancies has unknown physiopathology. Because the role of serum Beta-human Chorionic Gonadotropin [B-hCG] in pathophysiology of preeclampsia is not well known, we decided to determine the correlation between serum concentration of B-HCG and preeclampsia. This case-control study performed on two groups of 40 preeclamptic nulliparous and 40 healthy term pregnant women at obstetrics and gynecology ward of Sh. Yahyanejhad Hospital in Babol during 2003-4. Serum B- hCG concentration was measured in all patients. Patients with chronic hyprtension, diabetes, multiple pregnancies or medial diseases were excluded. The data were analyzed using Chi-square, T-Test and ANOVA, Mann-Whitney and Kruskall-Wallis tests. The maternal serum Beta hCG levels in patients with preeclampsia were [39840 +/- 24630] IU/L which is higher in comparison with healthy ones [27460 +/- 25862] IU/L [P=0.031]. The mean of serum beta hCG levels were 31991 +/- 16758 and 84312 +/- 9257 in mild and severe preeclampsia [P<0/0001]. Serum Beta hCG level is higher in preeclamptic women than normal pregnancies. It is also noticed that the higher the levels of serum Beta hCG the more severe the preeclampsia. This finding, in turn, reinforces the association between elevated HCG concentrations and placental damage

Predictors of Success of Repeated Injections of Single-dose Methotrexate Regimen for Tubal Ectopic Pregnancy

The purpose of this study is to evaluate predictors of success of repeated injections of methotrexate in the single-dose regimen for the treatment of tubal ectopic pregnancy. All patients who had ectopic tubal pregnancy and were treated with a single dose regimen were retrospectively identified. 126 patients were treated with methotrexate. Among them, 39 patients were adequate for this study. 33 were treated with the 2nd dose and 27 were successfully cured. Additionally, 6 who were injected with the 3rd dose were all cured as well. Therefore, in our study, the success rate for the repeated injections of methotrexate was found to be 84.6% (33/39). The mean initial beta-hCG level was significantly lower in patients who were successfully treated than in patients who failed (3915.3+/-3281.3 vs. 8379.7+/-2604.4 IU/mL, p<0.05). The success rate is 96% when the beta-hCG level is less than 6,000 IU/mL and is 58% when beta-hCG is greater than 6,000 IU/mL (OR=18.57, 95% CI 1.86-185.89). The initial beta-hCG level is the only factor that has significant meaning as predictor of success of repeated injections of methotrexate in the single-dose regimen. Repeated injections of methotrexate may be particularly effective when the initial beta-hCG level is below 6,000 IU/mL.