Successful transvaginal aspiration of interstitial pregnancy after failed methotrexate treatment.

Interstitial pregnancy is an uncommon condition that is challenging, not only in making an accurate diagnosis, but also in the choice of treatment. Systemic methotrexate (MTX) treatment has been favored to prevent scarring of the uterus. Nevertheless, surgery is generally indicated when this treatment fails. Transvaginal aspiration of the gestational tissue has been proposed as an alternative to surgery. The authors present a case of interstitial pregnancy in which the patient failed to respond to multidose MTX treatment and was successfully treated with transvaginal sonography-guided transvaginal aspiration of the gestational tissue, thereby bypassing the risk associated with undergoing major surgery. Transvaginal aspiration of conceptive tissue may be a novel treatment for patients with unruptured interstitial pregnancy.

Automatic optimum order selection of parametric modelling for the evaluation of abnormal intra-QRS signals in signal-averaged electrocardiograms.

Abnormal intra-QRS potentials (AIOPs) in signal-averaged electrocardiograms have been proposed as a risk evaluation index for ventricular arrhythmias. The purpose of the paper was to develop an automatic algorithm for selecting the optimum parametric model order in the analysis of AIOPs to make the modelling approach clinically more feasible. A total of 130 normal Taiwanese subjects and 87 patients with ventricular premature contractions and 23 with sustained ventricular tachycardia were recruited. The unpredictable AIQP signal was estimated from the modelling residual. The cross-correlation coefficient between the original signal and the ORS estimate was employed to evaluate the accuracy of the estimate. A pre-selected threshold cross-correlation coefficient of 0.9999 was used to determine the optimum order. The mean AIQP in lead Y for ventricular tachycardia patients was 3.9 microV, which was significantly smaller than 4.9 microV for ventricular premature contraction patients (p < 0.01) and 6.3 microV for normal subjects (p < 0.001). The linear combination of AIQP in lead Y and the time-domain parameter RMS40 provided the best global performance (the area under the receiver operating characteristic curve was 89.1%). A higher risk of ventricular arrhythmias was associated with lower AIQP in lead Y, and the automatic modelling algorithm improved the clinical feasibility of AIQP analysis.

Acute esophageal ulcer with massive bleeding: an unusual complication of uremic patient during hemodialysis.

Inflammatory mucosal changes of upper gastrointestinal (GI) tract including stomach and duodenum are well documented in uremic patients and assumed to be the major source of upper GI bleeding. However, acute esophageal ulcer which causes massive bleeding on hemodialysis is rare. Herewith a case is reported. A 28-year-old male uremic patient had a sudden onset of hematemesis on hemodialysis. Urgent endoscopy revealed an acute mucosal lesion with bleeding at the upper and middle third esophagus. It was demonstrated by esophageal biopsy. The patient had taken some pepper one day before and was choked during hemodialysis. This special condition is suggested to induce the acute esophageal ulcer and bleeding.