Rupture of pregnancy in the communicating rudimentary uterine horn at 34 weeks

Pregnancy in the rudimentary horn is rare and represents a form of ectopic gestation. Despite advances in ultrasound, prenatal diagnosis remains elusive, with confirmatory diagnosis being made at laparotomy. Because of variable muscular constitution of the wall of the rudimentary horn, pregnancy can be accommodated until late in pregnancy, when rupture occurs manifesting commonly as acute abdomen with high risk of maternal mortality. The rudimentary horn may or may not communicate with the uterine cavity with majority of cases being non-communicating. We present a case of pregnancy in the communicating horn that was difficult to diagnose which ruptured at 34 weeks and a review of literature.     

Laparoscopic management of rudimentary horn pregnancy

A unicornuate uterus with rudimentary horn is a rare Müllerian abnormality. This uterine anomaly may cause many gynaecological and obstetric complications, including infertility, recurrent abortions, preterm deliveries and rupture of the uterus, especially when the pregnancy implants in the rudimentary horn. To date, laparotomy has been the treatment of choice when resection of a rudimentary horn was indicated. We report on the case of a woman who benefited from laparoscopic surgery of a rudimentary horn pregnancy. Laparoscopy, in these exceptional cases, is the most accurate diagnostic tool that carries significant advantages in effective surgical management, thereby avoiding laparotomy.     

Influence of the IUD on ovarian activitiy in the hamster and rat

The efects of an unilaterally placed IUD on the maintenance of pregnancy in the contralateral horn was studied in rats and hamsters. Implantation and the number of corpora lutea were clearly affected by the IUD, but there was no effect on the number of eggs shed. There were no fetuses found in either horn in hamsters receiving a unilateral silk IUD. However, in rats, fetuses were found in the contralateral horn, though not in the IUD-bearing horn. Thus, the IUD has a different effect on ovarian function in rats and hamsters. The results suggest that the IUD causes regression of the corpus luteum in hamsters, and alters the uterine environment in rats.     

Uterine position and presentation of minipig-fetuses and their order and presentation at birth

Uterine position and presentation of fetuses in 17 minipigs during pregnancy were compared with their order and presentation at birth. Fetuses from 1 or both uterine horns were marked between day 80 and day 105 of gestation by 1 or more transuterine injections of either a 2.5% solution of dianil blue (3 animals) or a radiopaque substance (14 animals). Roentgenograms of the newborn pigs, which were ear-notched immediately after birth, enabled making individual identification. Pigs seemed to be delivered randomly from the 2 uterine horns. They either followed a neighbor from the same horn (n = 42) or followed a pig from the contralateral horn (n = 52). Only in 3 dams did 1 uterine horn become empty before delivery from the other horn started. In 4 dams, 1 pig passed its neighbor from the same horn, thereby being born earlier than expected. Moreover, passing of pigs could have occurred and gone undetected in those dams from which the pigs of only 1 horn were marked. This passing might have taken place within the uterine body. From 18 of 95 pigs (19%) , the presentation at birth differed from the one observed at laparotomy.     

Effects of feeder cells (human cancer cell lines) on the development of mouse embryos by co-culture

The participation of apical membranes of uterine epithelial cells in the process of blastocyst adhesion makes them an interesting object in the study of changes occurring during early pregnancy. In the study of these changes alkaline phosphatase (AIP), a typical brush border enzyme, was chosen for demonstration with the scanning electron microscope (SEM) by means of a backscatter detector. Thus the temporal and spatial pattern of enzyme activity on the uterine luminal surface was made visible with lead salt procedures. AIP activity was shown to be located on apical membranes and microvilli of endometrial epithelial cells with high activity on day 2 of pregnancy decreasing to virtually no activity on day 5. This decrease in overall AIP activity was shown to be asymmetrical with respect to the uterine cavity. It begins on the antimesometrial half of the uterine lining on day 2. A distribution pattern demarcating a presumptive implantation site along the uterine horn was not found. However, on day 5 of pregnancy, a characteristic pattern of surface folds was found, dividing the uterine horn into 'implantation segments'. In addition, SEM investigation revealed a marked variation of AIP activity from one individual cell to the next on day 2 of pregnancy resulting in a mosaic-like pattern. This pattern is lost with the decrease of AIP activity on day 5. Thus heterogeneity of uterine epithelial cells in AIP activity is apparently a feature of nonreceptive epithelium in contrast to the homogeneous epithelium on day 5. It is proposed that epithelial cell homogeneity could be a marker for uterine receptivity.     

Tumor resistance to antimetabolites

Histological variations of canine deciduoma which was induced in the non pregnant horn at several stages of unilateral pregnancy were examined. In the first half of the unilateral pregnancy, deciduoma was characterized by the cystic glandular hyperplasia corresponding to each of the stages in normal early placentation. In the second half, deciduoma could not be induced and few histological reactions were recognized. The endometrium looked normal for late diestrus with no growth of the uterine glands. These differences might reflect the latent strength of the uterine glands to proliferate and dilate in the stimulated periods.     

Increasing isoflurane from 0.9 to 1.1 minimum alveolar concentration minimally affects dorsal horn cell responses to noxious stimulation

BACKGROUND: The spinal cord appears to be the site at which isoflurane suppresses movement that occurs in response to a noxious stimulus. In an attempt to localize its site of suppressant action, the authors determined the effect of isoflurane on dorsal horn neuronal responses to supramaximal noxious stimulation at end-tidal concentrations that just permitted and just prevented movement. METHODS: Rats (n = 14) were anesthetized with isoflurane, and after lumbar laminectomy, the minimum alveolar concentration (MAC) for each rat was determined using a supramaximal mechanical stimulus. In these same rats, after extracellular microelectrode placement in the lumbar spinal cord, dorsal horn neuronal responses to the supramaximal stimulus were determined at the concentrations of isoflurane that bracketed each rat's MAC (0.1% higher and lower than MAC). The MAC of isoflurane was then re-determined. RESULTS: Dorsal horn neuronal response was 1,757+/-892 impulses/min at 0.9 MAC and 1,508+/-988 impulses/min at 1.1 MAC, a 14% decrease (P < 0.05). Cell responses varied, with some cells increasing their response at the higher concentration of isoflurane. The MAC of isoflurane was 1.38+/-0.2% before and 1.34+/-0.2% after determination of dorsal horn neuronal responses. CONCLUSIONS: Isoflurane, at concentrations that bracket MAC, has a variable and minimal depressant effect on dorsal horn cell responses to noxious mechanical stimulation. These data suggest that the major action of isoflurane to suppress movement evoked by a noxious stimulus might occur primarily at a site other than the dorsal horn.     

A new technique for arthroscopic resection of a bucket handle tear

The authors present a previously undescribed technique for excision of a bucket handle tear. The technique uses a Caspari suture punch to pass a suture through the meniscus and use the suture as a tool to maneuver the meniscus so that its posterior horn attachment can be cut. The technique is noteworthy in that it eliminates the need for establishing an additional portal.     

Aesthetic dentistry systems: positioning advanced materials in a modern dental practice

The pregnancy and delivery in multifetal pregnancy most often are accompanied by complications and by a high degree of risk both for the mother and the foetus. The successful and of the delivery depends on the condition of the mother, the good obstetric status, the gestation age of the foetuses and their presentation. The authors have followed the characteristic of the delivery in multifetal pregnancy over 10-years material in 137 cases of pregnancy. After strict indications, in 26 cases the delivery has been completed though caesarean section. In 111 cases the delivery has been vaginal. A characteristic of the delivery has been made and it has been expressed in diagrams. The authors have been successful in the vaginal deliveries in multifetal pregnancy. They emphasize the active observation of the patient, especially in the first stage, and the monitoring of the foetus.     

EUROPOP--European Programme of Occupational Risks and Pregnancy Outcome--part II

As continuation of their previous paper the authors submit the results of the European study EUROPOP pertaining to the effect of occupation on the course and outcome of pregnancy. The paper contains the first part of results where the authors compare groups of women with premature deliveries (22nd-36th week of pregnancy) with control groups 1/10 deliveries in term (> or = 37 weeks). The groups of abortions in the second trimester which were studied by the authors were relatively small (Czech Republic 49 and in the all-European study 229). To keep the study within a reasonable limits the tables are not presented. Comparison of results describing home work, living conditions of pregnant women, prenatal care and medical problems as well as data on the outcome of pregnancy are presented in part III.     

Pleural invasion by peripheral bronchogenic carcinoma: assessment with three-dimensional helical CT

Cystic endometrial hyperplasia resembling that of normal early pregnancy was induced by the insertion of a silk suture into diestrous bitches. Intraluminal trauma (wire scratching) induced a similar but moderate change. Intraluminal olive oil and saline had little or no effect. Maternal decidual response in rodentia produced by mechanical means in progesterone-stimulated uteri in the absence little or no effect. Maternal decidual response in rodentia produced by mechanical means in progesterone-stimulated uteri in the absence of fertilized ova is termed Loeb's deciduoma. A similar response was created in progesterone-stimulated canine uteri by various physical means when compared to the pregnant contralateral horn.     

Pregnancy in the presence of an intrauterine contraceptive loop (IUD) in the uterine cavity

One of the most important questions, raised after the occurrence of intrauterine contraceptive loop, is the problem about the fate of pregnancy. The authors describe the attitude of the obstetrician toward pregnancy and a loop during the 3 trimesters of gestation. They give some practical important rules for roentgenological control and diagnosis and for treatment of women. To illustrate the seriousness of the problems which could arise, the authors present 2 cases--1 with interrupted pregnancy and another with full term pregnancy and normal delivery. Typical roentgenological pictures illustrate the difficulties which the physician should overcome frequently in order to establish the correct diagnosis and eventually to begin the proper treatment.     

Young people with spina bifida: transfer from paediatric to adult health care

INTRODUCTION: The method used to terminate pregnancy on medical grounds during the second trimester must be safe, rapid, psychologically feasible and associated with a minimal risk of long-term sequelae. The objective of the present work was a critical analysis of the author's standard protocol of termination of pregnancy during the second trimester. MATERIAL AND METHODS: For induction of abortion during the second trimester the authors used a synthetic prostaglandin analogue (PG) F2 alpha-Dinoprost which was administered in a single dose of 30 mg by the intraamniotic route. At the time of onset of uterine contractions the authors administered peridural anaesthesia. The authors investigated indications, mean period of induction, correlation between the period of induction of abortion and the indications for termination of pregnancy, the week of pregnancy and parity of the mother. They recorded also the type and number of complications. RESULTS: From January 1991 till June 1997 179 pregnancies were terminated by intraamniotic PG administration. After a single intraamniotic PG administration 72% women aborted within 24 hours. In 26% women the intraamniotic administration was repeated twice and in 2% women three times. The mean induction period, i.e. the interval between the administration and abortion of the foetus was 22.6 hours. The interval was significantly longer (28 hours) in foetuses where pregnancy was terminated because of a neural tube defect (p < 0.01). The authors did not detect a correlation between the period of induction and the indication, week of gestation and parity of the mother. COMPLICATIONS: once a general reaction to intraamniotic administration, in three patients a major blood loss replaced by transfusion of erythrocyte mass, no uterine rupture. CONCLUSION: In all instances the therapeutic effect was achieved and there was no need to perform section minor. The disadvantage of the method is the high price of the preparation and need of repeated intraamniotic administration of PG in 29% of the patients.     

Brain neoplasms in pregnancy. Two case histories

The diagnosis of brain tumor in a pregnant women is a dramatic event. The nature and timing of therapy at intracranial neoplasm are affected by the existence of the pregnancy. The authors report a two cases of cerebral neoplasm in pregnancy. Clinical syndromes, diagnosis, neurosurgical and obstetrical management are discussed.     

Non-Hodgkin lymphoma during pregnancy

The authors report a case of a pregnancy with a Non-Hodgkin lymphoma. A histological association of high-grade B-cell and a MALT type lymphoma was found which, to their best knowledge, is described for the first time in pregnancy.     

Effect of "in vitro" cultivation time on the infectivity of Toxocara canis eggs

Retroperitoneal space is an exceptional location of extrauterine pregnancy (four cases have been previously reported). The authors report a case of retroperitoneal ectopic pregnancy. Pathogenesis is discussed.     

Pregnancy and colorectal cancer]

Among 1761 patients operated on for colorectal malignancies by the authors in a period of 20 years, four cases were diagnosed during pregnancy. Beside analyzing the case-histories they present the relevant literature data: the incidence of colorectal tumors during pregnancy is 4-5 cases/100,000 pregnancies, and most frequently they are situated in the rectum. The prognosis of primary colorectal malignancies diagnosed during pregnancy is unfavourable, and their biological behavior is more aggressive. Authors review the advised diagnostic and therapeutic approaches in different periods of pregnancy.     

Simultaneous extra- and intrauterine pregnancy with the birth of a healthy child

Report on the occurrence of a simultaneous intra- and extrauterine pregnancy. A live, mature infant was born at term. At the time of the operation of the ectopic pregnancy there was diagnosed the intrauterine pregnancy. The possible cause of a simultaneous intra- and extrauterine pregnancy are analysed and the clinic and diagnosis emphasized. In case of not having a child-wish the authors take into consideration a routine curettage of the uterus at the time of the operation of the ectopic pregnancy.     

Hypertension in pregnancy--chaos in terminology of literature world-wide

The authors submit an account of the terminology of toxemia of pregnancy and hypertension during pregnancy which are used in the world literature. They draw attention to the lack of uniformity which leads to a distortion of statistics. Differences in the nomenclature and incorrect enlistment of hypertension may lead also to an inadequate type of treatment and conduction of delivery. The authors recommend the use of nomenclature based on the pathogenesis and on their own experience. They emphasize the difference in the pathogenesis, therapy, prognosis and prevention of different types of hypertension.     

A plant transformation vector with a minimal T-DNA II. Irregular integration patterns of the T-DNA in the plant genome

Except for villous hypertrophy of the choroid plexus that may not be true tumors, multiple choroid plexus papillomas are extremely rare. The authors report a case involving multiple choroid plexus papillomas that were distinct from villous hypertrophy. These lesions were localized, one in the atrium of the right lateral ventricle and the other in the inferior horn of the left lateral ventricle. A review of the literature revealed that this case represented the first reported case of true multiple choroid plexus papillomas documented by findings on magnetic resonance imaging.