Rate of hourly change in serum beta-human chorionic gonadotropin levels in ectopic pregnancy can predict the success of treatment with single-dose methotrexate: A retrospective observational study.

OBJECTIVE: To determine whether the success of treatment with single-dose methotrexate (SD MTX) for ectopic pregnancy can be predicted using the rate of change in serum ß-human chorionic gonadotropin (ß-hCG) level. STUDY DESIGN: This was a retrospective observational study conducted at a tertiary referral centre. The study population included women who underwent treatment with SD-MTX for ectopic pregnancy. We analysed data of 119 women treated with SD-MTX for ectopic pregnancy at the Galilee Medical Centre between 2012 and 2016. Success was defined as a <15% decrease in ß-hCG level between days 4 and 7, with no need for a second dose of MTX or surgical intervention. The dynamics of serum ß-hCG levels before treatment were considered as the main outcomes. RESULTS: SD-MTX administration was successful in 77 (65%) patients. The average baseline ß-hCG level was significantly lower in women with successful outcomes than in those without successful outcomes (763.1 vs. 1429.63 mIU/L, respectively, p < 0.0048). The hourly change in ß-hCG level was significantly lower in those with successful outcomes than in those without successful outcomes (0.38 vs. 5.73 mIU/mL, respectively, p < 0.0023). The percentage change in ß-hCG level was 13.1%, which was not significantly different between the groups (p < 0.133). At serum ß-hCG level < 946 mIU/mL and sac size < 2.55 cm, the treatment was successful in 88% of women. CONCLUSIONS: We propose a predictive model of hourly change in ß-hCG to achieve successful treatment using SD-MTX in ectopic pregnancy based on objective and measurable criteria.

Faecal carriage of extended-spectrum ß-lactamase-producing Enterobacteriaceae is common 12 months after infection and is related to strain factors.

We aimed to determine the duration of faecal carriage of extended-spectrum ß-lactamase (ESBL) -producing Enterobacteriaceae (EPE) in patients with clinical infection caused by an EPE, to study host strains during carriage, and to identify factors associated with prolonged carriage. Patients (n = 61) were followed with faecal samples and questionnaires about antimicrobial treatment and risk factors for EPE, 1, 3, 6 and 12 months after EPE infection. The EPE isolates were subjected to ESBL genotyping, epidemiological typing with pulsed-field gel electrophoresis and PCR-based replicon typing. Escherichia coli isolates were analysed with PCR for phylogrouping, detection of pabB (ST131) and virulence content. Patient-related and strain-related variables were compared for carriers and non-carriers at 12 months. Carriage of EPE was observed in 51 of 61 (84%) patients after 1 month, 36 of 61 (66%) after 3 months, 31 of 61 (55%) after 6 months and 26 of 61 (43%) after 12 months. Of the 26 carriers at 12 months, five had previous negative samples. In 17 of 61 patients, ESBL was found in a new bacterial species and/or strain during carriage. Among E. coli, 14 of 49 belonged to the international clone ST131. Phylogroup B2 and CTX-M-gr.-9 were associated with being carriers at 12 months (OR 4.3, 95% CI 1.1-16.3 and OR 6.4, 95% CI 1.3-30.9, respectively). In conclusion, EPE carriage is common 12 months after infection and persisting carriage may be associated with E. coli phylogroup B2 and CTX-M-gr.-9. The host strain frequently changes throughout carriage and negative samples do not imply eliminated carriage.

Three-dimensional endometrial volume and 3-dimensional power Doppler analysis in predicting endometrial carcinoma and hyperplasia.

OBJECTIVE: To evaluate the accuracy of endometrial volume measurement and 3-dimensional power Doppler analysis (3D-PDA) in the diagnosis of endometrial carcinoma and endometrial hyperplasia in women with post- and peri-menopausal bleeding. METHODS: 56 women with post-menopausal and 89 with peri-menopausal bleeding were enrolled. All were scheduled for hysteroscopy, dilatation and curettage, endometrial sampling or hysterectomy, and the ultrasound was performed within 24 h before the procedure. Endometrial thickness, endometrial volume, vascularity index (VI), flow index (FI) and vascularity flow index (VFI) were measured. These parameters were compared between the group of women with normal histology (including endometrial polyps) and the pathologic group (carcinoma and hyperplasia with or without atypia). RESULTS: Ninety women (62%) had normal histology, 26 (17.9%) had an endometrial polyp, 18 (12.5%) hyperplasia and 11 (7.6%) had endometrial carcinoma. Mean endometrial thickness was 11 mm and 15.5 mm in the normal and pathologic groups respectively (p<0.005). The mean endometrial volume was 6.87 cc and 15.5 cc in the two groups respectively (p<0.001). The VI was 2.27% and 2.95% in the two groups respectively (p=0.022). The FI was 18.6 and 23.6 in the two groups respectively (p=0.014). The VFI was 0.68 and 0.89 in the two groups respectively (p=0.018). Using ROC the area under the curve was 0.698, 0.728, 0.621, 0.631, and 0.625 for endometrial thickness, endometrial volume, VI, FI and VFI respectively. The best predictor of endometrial carcinoma was an endometrial volume of 3.56 cc or more (sensitivity 93.1%, specificity 36.2%). CONCLUSIONS: Endometrial volume and 3D-PDA are good diagnostic tools in predicting endometrial carcinoma and hyperplasia in women with post- and peri-menopausal bleeding.

A constricting ring structure within the wall of the inguinal hernia sac in infants and children and its role in the occurrence of incarceration.

The study aims to demonstrate the presence of a fibrous or fibromuscular ring structure within the wall of the sacs of inguinal hernia in children and its importance in the development of incarceration as a direct cause of this complication. A case series study of 784 children with unilateral inguinal hernias operated on over a period of 9 years (1992-2000) in two teaching hospitals (Mosul, Iraq). All underwent herniotomy. The sacs were examined for the presence of a ring structure, and the excised sacs containing the rings were studied histopathologically. The presence of the hernia sac ring (HSR) and its significance in the causation of incarceration was studied. Out of 784 cases, 660 were elective and 124 incarcerated hernias. In 56 sacs the hernia sac ring (HSR) was present - 36 rings in the elective and 20 rings in the sacs of incarcerated hernias. The histopathology of the hernia sac ring was fibrous or fibromuscular tissue. This ring has its significance in the development of incarceration. Hernias with the HSR are three times more liable to incarceration than those without the ring. Incarcerations of inguinal hernia in children are usually caused by the inguinal rings. Another cause for incarceration being studied is a fibrous or fibromuscular ring structure identified within the wall of the hernial sac, causing the incarceration in 5.6% of elective (nonincarcerated) hernias and 16% of incarcerated hernia patients. Patients with these hernia sac rings are three times more liable to incarceration than others.

Congenital prepubic sinus: an epispadiac variant of urethral duplication: case report and review of literature.

Urethral duplication is rare; the duplicated urethra is almost always dorsal to the normal urethra, which contains the sphincteric mechanism. It is very rare to present as a prepubic sinus. Urethral duplication does not represent a uniform entity making it difficult to find an unequivocul and comprehensive classification. A case of epispadiac variant of urethral duplication is reported in which the duplicated urethra presents as a prepubic sinus, with complete cure and normal urinary and sexual functions after maturity.

Perianal sinuses in neonates and infants.

OBJECTIVE: The aim of this study is to evaluate the etiology of perianal abscess or discharges in neonates and infants and some of them are perianal sinuses with blind inner end without connection to the anal canal, and some of these cases have a different histological pattern. Complete surgical excision and primary closure of their wounds can cure these patients. METHODS: Between January 1988 and December 2000, (81) neonates and infants (aged 2 weeks to 2 years) with perianal sinuses, fistula-in-ano abscess dealt in the Al-Zahrawi and Al-Khansa Teaching Hospitals, Mosul, Iraq, were studied. Fifty-one patients displayed an onset of symptoms during their first year of age, all cases had a gentle probing and proctoscopy under general anesthesia, and the discharge from abscess from the patients were sent for culture. Thirty patients with proper sinuses had excision of the sinus and primary closure; children with fistulae underwent fistulectomy; perianal abscesses drained. All the excised specimens were examined histopathologically. RESULTS: All children, except 3, were boys. Out of the 81 cases studied, 30 patients (37%) proved to have proper sinuses with blind inner end. Eight of these showed a different histological pattern, and in 2 cases, the histopathology was that of rectal duplication, the microbiology of the discharge from the proper sinuses was showing a predominance of non-gut derived organisms. All patients cured by excision of the sinuses and primary closure. CONCLUSION: Fistulae are the most common perianal discharging lesions in neonates and infants, blind sinuses are another cause in a considerable number. We propose a diagnostic strategy and treatment for those children presenting with discharging perianal lesions; for anticipation of these sinuses 3 points need to be considered before attempting surgery. 1) Blind sinus tract on gentle probing. 2) Normal anal and rectal mucosa on proctoscopy. 3) High bacterial yield of non-gut derived organisms on culture of the pus or discharge. Their treatment is by simple excision (coring) and primary closure; this method will shorten the healing and recovery time.