Late presentation of a heterotopic pregnancy at 19 weeks of gestation leading to maternal collapse: A case report.

BACKGROUND: Heterotopic pregnancy is a rare form of pregnancy that involves implantation of simultaneous pregnancies at two sites. They are normally identified in early gestation when patients become symptomatic with vaginal bleeding or abdominal pain. CASE PRESENTATION: A 35-year-old woman (para 0, gravida 2) presented to the emergency department in haemorrhagic shock at 19 weeks and 5 days of gestation. On assessment she was hemodynamically unstable and was found to have a large hemoperitoneum on ultrasound. She subsequently underwent an exploratory laparotomy and right salpingectomy for a suspected ectopic pregnancy. The postoperative period was uneventful, and the intrauterine pregnancy continued to term. CONCLUSION: Heterotopic pregnancy should be included in the differential diagnosis for women presenting with hemoperitoneum even beyond the first trimester.

Rupture of a caesarean scar ectopic pregnancy: A case report.

BACKGROUND: Caesarean scar pregnancy is an uncommon form of ectopic pregnancy characterized by implantation into the site of a caesarean scar. Common clinical features include vaginal bleeding and abdominal pain; however, a significant proportion of cases are asymptomatic. The primary diagnostic modality is transvaginal ultrasound. There is no current consensus on best-practice management. CASE PRESENTATION: A 36-year-old woman, G7P2, presented to an early-pregnancy service with vaginal spotting and an ultrasound scan demonstrating a live caesarean scar ectopic pregnancy at 8 + 5 weeks' gestation. On examination she was hemodynamically stable with a soft abdomen. She was advised to have dilation and curettage (D&C) under ultrasound guidance; however, she was concerned that she might require more extensive surgery, such as a hysterectomy and so requested non-surgical management. On day 1 she underwent ultrasound-guided embryocide with lignocaine followed by inpatient multi-dose systemic methotrexate. Her beta-human gonadotrophic hormone level decreased. Repeat ultrasound on day 18 demonstrated a persistent caesarean scar ectopic pregnancy with increased vascularity, and so uterine artery embolization (UAE) was performed with a view to D&C the following day. This plan was altered to expectant management with ongoing follow-up by a different clinician who had had previous success with UAE alone. On day 35 the patient presented with life-threatening vaginal bleeding that required an emergency total abdominal hysterectomy. CONCLUSIONS: Caesarean scar pregnancies are uncommon. Multiple treatment strategies have been employed, with variable degrees of success. Further research into risk stratification and management are needed to guide clinician and patient decision making.

Sequential advanced pharmacy practice experiences at one institution for students from three pharmacy schools.

PURPOSE: The structure and implementation of an advanced pharmacy practice experience (APPE) that was sequential in nature are described. SUMMARY: In early 2008, the pharmacy department of the Cleveland Clinic began conversations with three partner pharmacy schools in the surrounding area to accommodate rotations for advanced practice experiences pharmacy students. The resulting sequential APPE (SAE) program is offered at each school for four or five months and incorporates a longitudinal student project component to be completed over the SAE's duration. Program coordination and scheduling are unique to this program, where rotations are set up outside of the typical rotation selection. Since 2009, 23 students have completed the program, and 10 are currently enrolled. The SAE program was implemented in 2009 and continues to provide a depth of experience for pharmacy students. Preceptors have reported that SAE students are more motivated, have goals that fit with the institution, and offer decreased orientation burden compared with traditional APPE students. Students report a maximum of 19 hours gained per month in decreased orientation time to the computer system and site, allowing them to focus more time on patient care. Over a five-month period, a student could gain 76 hours in clinical experience over the traditional APPE student due to the decreased orientation burden. CONCLUSION: SAEs at one institution have proven advantageous to preceptors, students, and the site. SAEs have provided enriching student rotations while increasing site efficiencies, allowing longitudinal projects, and enhancing the site's exposure to students as potential residency candidates.

Curcumin for inflammatory bowel disease: a review of human studies.

OBJECTIVE: To evaluate the use of curcumin in inflammatory bowel disease. DATA SOURCES: ALTMEDEX, Comprehensive Database of Natural Medicines, MEDLINE/PubMed were searched from January 1980 through May 2009 using the terms curcumin, turmeric, ulcerative colitis, Crohn's disease, Curcuma longa, Curcuma domestica, Indian saffron, inflammatory bowel disease. Data was limited to human trials. References of identified articles were reviewed. DATA SYNTHESIS: Data evaluating the use of curcumin in inflammatory bowel disease (including ulcerative colitis and Crohn's disease) is limited to two studies comprising data for only 99 patients. Curcumin in conjunction with mainstream therapy, consisting of sulfasalazine (SZ) or mesalamine (5-aminosalicylic acid [5-ASA] derivatives) or corticosteroids was shown to improve patient symptoms and allow for a decrease in the dosage of corticosteroids or 5-ASA derivatives. In one small study of 10 patients, some patients even stopped taking corticosteroids or 5-ASA. CONCLUSIONS: Although two small studies have shown promising results, all authors conclude that larger-scale, double-blind trials need to be conducted to establish a role for curcumin in the treatment of ulcerative colitis. In addition to improving results when used in conjunction with conventional medications for UC, curcumin may pose a less-expensive alternative.

Vesicular stomatitis virus: a potential therapeutic virus for the treatment of hematologic malignancy.

Certain strains of vesicular stomatitis virus (VSV) have been shown to be oncolytic in a wide variety of solid tumors. In the present study, we tested the leukemolytic properties of VSV using established leukemia cell lines and primary patient material. VSV efficiently killed essentially all leukemic cell lines. In contrast, however, normal clonogenic bone marrow progenitor cells and peripheral blood cells were remarkably refractory to infection by VSV. By exploiting this large difference in susceptibility to infection we successfully purged contaminating leukemic cells from cultures of peripheral blood progenitor cells (PBPC) using VSV. VSV was also able to infect and kill leukemic cells in primary samples taken from patients with multiple myeloma (MM). This study demonstrates the potential utility of VSV in the treatment, both ex vivo and in vivo, of hematologic malignancies.