OBJECTIVE: To examine the therapeutic outcomes of methotrexate (MTX) in the treatment of unruptured interstitial pregnancy. METHODS: We reviewed the medical records of patients who were diagnosed with interstitial pregnancy and received MTX as first-line treatment between January 2003 and July 2014 at CHA Gangnam Medical Center. The treatment success rates and subsequent pregnancy outcomes were examined. RESULTS: Ninety-seven patients were diagnosed with interstitial pregnancy between January 2003 and July 2014. Of them, 38 initially received MTX treatment. The diagnosis was made at a median of 6+3 weeks (5+0 to 11+3 weeks). Thirty patients received a systemic MTX injection, while the other 8 received a local MTX injection. Systemic treatment composed of an 8-day alternating MTX regimen, single-dose regimen, or high-dose regimen (100 mg/m2 + 200 mg/m2 intravenously over 12 hours). The local injection consisted of a direct MTX injection into the gestational sac with or without systemic MTX injection. Twenty-one patients (55.3%) were successfully treated with MTX. However, MTX therapy failed in 17 patients (44.7%), who required surgery. Mode of MTX treatment was the only predictive variable of MTX treatment success (P=0.039). Treatment success was seen in 7 of 8 patients (87.5%) in the local MTX group vs. 14 of 30 patients (46.7%) in the systemic MTX group. After treatment, 13 patients attempted a successive pregnancy; of them, 10 patients had a confirmed clinical pregnancy and healthy live birth. CONCLUSION: Combined MTX treatment including a local injection might be an initial approach to the treatment of interstitial pregnancy.
Diagnosis ; Female ; Gestational Sac ; Humans ; Live Birth ; Medical Records ; Methotrexate* ; Pregnancy ; Pregnancy Complications ; Pregnancy Outcome ; Pregnancy, Interstitial*

Chronic intestinal pseudo-obstruction is a rare clinical syndrome which is characterized by intestinal obstruction without occluding lesions in the intestinal lumen and pregnancy is one of the important aggravating factors. Here, we report a case of a woman with intractable intestinal pseudo-obstruction that was precipitated by pregnancy. She could not make any stool passage for more than 4 weeks until a fetal gestational age of 17 weeks was reached. However, the patient could be maintained by repetitive colonoscopic decompressions and finally total colectomy could be performed successfully at a fetal gestational age of 21 weeks.
Colectomy ; Decompression ; Female ; Gestational Age ; Humans ; Interstitial Cells of Cajal ; Intestinal Obstruction ; Intestinal Pseudo-Obstruction ; Pregnancy

Interstitial pregnancy is a form of ectopic pregnancy in an unusual location, implanting on the intramural part of the fallopian tube. Because the myometrium is highly distensible, it may allow an interstitial pregnancy to advance up to 16 weeks where it usually presents with rupture. Its late diagnosis and severe hemorrhagic complication accounts for a higher mortality rate compared to other ectopics. On the other hand, interstitial pregnancies that progress to term or near term are extremely rare. From the 10 cases published in literature reporting the delivery of a live term or near term fetus, only 1 of these cases has antenatally diagnosed the presence of interstitial pregnancy prior to rupture by investigating a probable placenta accreta found on ultrasound. This report discusses a case of a ruptured full term interstitial pregnancy diagnosed intraoperatively which resulted to a live mother and baby, and describes retrospectively the similar ultrasound findings of placenta accreta which was realized after rupture.

Human ; Female ; Adult ; Pregnancy ; Pregnancy, Interstitial ; Fallopian Tubes ; Placenta Accreta ; Myometrium ; Mothers ; Delayed Diagnosis ; Term Birth ; Fetus

Systemic sclerosis or scleroderma is a rare autoimmune disorder characterized by excessive fibrosis and, vasculopathy, with multiorgan involvement. Anesthetic considerations in patients with systemic sclerosis must take into account the degree of organ dysfunction as well as airway management. Regional anesthesia is a preferable alternative to general anesthesia despite the reports of prolonged sensory block. Spinal anesthesia in patients with systemic sclerosis has been reported for only one patients undergoing cesarean section. Concurrent systemic sclerosis and pregnancy raise many obstetric and anesthetic considerations. We describe the case of a pregnant patient with systemic sclerosis who had a history of dyspnea and interstitial lung disease. The cesarean section was performed uneventfully under spinal anesthesia.
Airway Management ; Anesthesia, Conduction ; Anesthesia, General ; Anesthesia, Spinal* ; Cesarean Section* ; Dyspnea ; Female ; Fibrosis ; Humans ; Lung Diseases, Interstitial* ; Pregnancy ; Scleroderma, Systemic*

The interstitial cells of Cajal are the pacemakers in the gastrointestinal tract that modulate gastrointestinal motility. A case of a neonate with intestinal pseudo-obstruction caused by a decreased number of the interstitial cells of Cajal is presented. A premature male infant born at 32 weeks of gestation showed progressive abdominal distention beginning 3 days after initiation of enteral feeding at 15 days of life. No etiologic factors were identified on radiologic studies, a gastrographin enema, and an intestinal biopsy other than a markedly decreased number of the intestinal cells of Cajal. An ileostomy, followed by repair of the ileostomy was done, which resulted in but a limited improvement of the abdominal gas pattern. Respiratory distress, pancytopenia, and abdominal distention persisted, and the infant expired on 142 days of life.
Biopsy ; Diatrizoate Meglumine ; Enema ; Enteral Nutrition ; Gastrointestinal Motility ; Gastrointestinal Tract ; Humans ; Ileostomy ; Infant ; Infant, Newborn ; Infant, Premature ; Interstitial Cells of Cajal ; Intestinal Pseudo-Obstruction ; Male ; Pancytopenia ; Pregnancy

Ectopic pregnancies are unsuccessful pregnancies that result from implantation of fertilized ovum occurring inan aberrant area. Aside from an emergency case, the early diagnosis of ectopic pregnancy is very difficultparticularly in a case with insidious onset and mild clinical manifestations. Early diagnosis not only reduces thedanger, but also simplifies the management of ectopic pregnancy. Ultrasonography has been an indispensablediagnostic tool in obstetrics and Gynecology. In the authors' experience, clinical suspected ectopic pregnancy wasone of the common indications for performing ultrasonography. Since Kobayashi et al. reported the appearances ofextopic preganancy utilizing bistable B-scan ultrasonography, the ultrasonic findings of ectopic pregnancy havebeen reported by many authors. But, its accuracy and reliablity in the diagnosis of ectopic pregancy are stillopen to controversy. The authors studied 65 cases of clinically suspected ectopic pregnancy with Picker 80 L grayscale ultrasonography from Aug. 1982 to Jun. 1983. There were 29 confirmed cases, of which 15 were proved to haveextopic pregnancy and 14 were proved to have disease other than ectopic pregnancy by surgical andhistopathological study or by laparoscopy and histopatholoigcal study or by laparoscopy and follow up study. 29confirmed cases were reviewed. The resuls were as follows; 1. Among 15 ectopic pregnancies, there were 12ampullary pregnancies, 2 isthmic pregnancies and 1 interstitial pregancy. Among 14 cases of no ectopic pregnancy,there were 5 intrauterine pregnancies, 3 myoma uteri, 2 P.I.D., and 1 case of dermoid cyst, cystic teratoma,h-mole and tubal hematoma due to previous tubal ligation, respectively. 2. The age distribution of ectopicpregnancy was from 22 to 41 years. The common clinical manifestations of extopic pregnancy were lower abdominalpain (73.3%), vaginal spotting or bleeding (73.3%) and amenorrhea(66.7%). 3. Positive results of urine immunologicpregnancy test was 28.6% in ectopic pregnancy. 4. Ultrasonic findings of ectopic preganncy were as follows; 1) Nointrauterine gestational sac was observed in all cases except 1 interstitial pregnancy. Intrauterine fluidcollection was observed in 3 cases. Uterine displacement was observed in 10 cases. 2) Among 5 cases of rupturedtubal pregnancy, we observed predominantly cystic adnexal mass in 3 cases, mixed echogenic adnexal mass in 2cases, and cul-de-sac fluid in all cases. Among 9 cases of unruptured tubal pregnancy, we observed predominantlycystic adnexal mass in 2 cases, mixed echogenic adnexal mass in 7 cases, and cul-de- sac fluid in 3 cases. 3) Anechodense ring like structure was observed outside the uterus in 9 cases of tubal pregnancy. 4) In the case ofinterstitial pregnancy, eccentrically located gestational sac with overlying thin myometrium was observed withinthe uterus. 5) Fetal heart activity was noted outside the uterus with real time scanning in only 1 case of ectoicpregnancy. 5. Of 19 sonographically ectopic pregnancies, a correct positive ultrasonic diagnosis was made n 14cases (73.7%). Of 29 confirmed cases, overall diagnostic accuracy of ultrasound was 79.3%. 6. By demonstrationintrauterine pregnancy or disease other than ectopic pregnancy such as myoma uteri, homole or ovarian cyst,ectopic pregnancy was ultrasonically excluded in 10 cases. Among above 10 cases, 1 case of ultasonically bilateralovarian cyst was proved to have ruptured tubal pregnancy combined with ovarian cyst. The accuracy of ultrasonicexclusion of ectopic pregnancy was 90%. In the authors'experience, ultrasonography was very helpful in theexclusion of extopic pregnancy.
Age Distribution ; Animals ; Dermoid Cyst ; Diagnosis ; Early Diagnosis ; Emergencies ; Female ; Fetal Heart ; Follow-Up Studies ; Gestational Sac ; Gynecology ; Hematoma ; Hemorrhage ; Laparoscopy ; Metrorrhagia ; Mice ; Myoma ; Myometrium ; Obstetrics ; Ovarian Cysts ; Pregnancy ; Pregnancy ; Pregnancy, Ectopic ; Pregnancy, Interstitial ; Pregnancy, Tubal ; Sterilization, Tubal ; Ultrasonics ; Ultrasonography ; Uterus ; Zygote

BACKGROUND AND PURPOSE: The wnt/β-catenin signaling pathway plays a critical role in embryonic development and adult-tissue homeostasis. Recent investigations implicate the importance of wnt/β-catenin signaling in normal wound healing and its sustained activation being associated with fibrogenesis. We investigated the immunolocalization and activation of wnt/β-catenin in polymyositis (PM), dermatomyositis (DM), and Duchenne muscular dystrophy (DMD). METHODS: Immunofluorescence staining and Western blot analysis of β-catenin were performed in muscle specimens from 6 PM, 8 DM, and 6 DMD subjects. The β-catenin/Tcf4 DNA-binding activity in muscle was studied using an electrophoretic mobility shift assay (EMSA), and serum wnt/β-catenin/Tcf transcriptional activity was measured using a luciferase reporter gene assay. RESULTS: Immunoreactivity for β-catenin was found in the cytoplasm and nuclei of muscle fibers in PM, DM, and DMD. The protein level of β-catenin was elevated, and EMSA analysis confirmed the activation of wnt/β-catenin signaling. The transcriptional activities of β-catenin/Tcf in the circulation were increased in patients with PM, DM, and DMD, especially in those with interstitial lung disease, and these transcriptional activities decreased when PM or DM patients exhibited obvious clinical improvements. CONCLUSIONS: Our findings indicate that wnt/β-catenin signaling is activated in PM, DM, and DMD. Its activation in muscle tissue and the circulation may play a role in modulating muscle regeneration and be at least partly involved in the process of muscle and pulmonary fibrosis.
Blotting, Western ; Cytoplasm ; Dermatomyositis* ; Electrophoretic Mobility Shift Assay ; Embryonic Development ; Female ; Fluorescent Antibody Technique ; Genes, Reporter ; Homeostasis ; Humans ; Luciferases ; Lung Diseases, Interstitial ; Muscular Dystrophy, Duchenne* ; Polymyositis* ; Pregnancy ; Pulmonary Fibrosis ; Regeneration ; Wound Healing

We present two cases of acute interstitial pneumonia (AIP) during the second trimester of pregnancy managed by mechanical ventilation, high dose corticosteroids. We described clinical course, laboratory data and imaging studies. Case 1) A 29-year-old woman, G1P1, was referred for aggravated continuous coughing, sputum and dyspnea, pleuritic chest pain and mild fever for 3 weeks at 24(+3) weeks of gestation. There were coarse breathing sounds with crackles on the both lung field. Her chest X-ray showed diffuse haziness in both lungs with suspicious nodular opacities and suggested pneumonia. HRCT showed diffuse ground glass opacities with interstitial thickening and suspicious fine nodular infiltration in both lungs suggesting acute interstitial pneumonia combined with ARDS. Because her symptoms were more aggravated, she was performed mechanical ventilation treatment. After that, she was performed cesarean hysterotomy and delivered a dead male 850grams. After her symptoms were much more improved. All antibiotics were stopped and reduced the doses of steroids, she was discharged with t-tube capped state. Case 2) A 33-year-old woman, G1P1, was referred for continuous coughing, sputum and dyspnea for 3 months and low abdominal discomfort at 24(+4) weeks of gestation. There were coarse breathing sounds with rales on the both lung field. Her chest X-ray showed diffuse haziness in both lungs with suspicious nodular opacities and suggested interstitial pneumonia. HRCT showed diffuse ground glass opacities with some intralobular and interlobular interstitial thickening and suspicious fine nodular infiltration in both lungs suggesting acute interstitial pneumonia or miliary TBc combined with ARDS. She was treated with antibiotics, oxygen, high dose corticosteroids, and tocolytics. There was no evidence of TBc in the bronchoscopy. She showed decreased mentality and decreased O2 saturation below 90% in spite of mechanical ventilation, high dose steroids and IVGV therapy. She delivered a boy of 870 g (Apgar score 1/5). After delivery, she was expired due to combined aggravating DIC. Her baby was expired at the next day, too. The outcome of AIP is fatal, reporting 59~100% mortality rate. The clinical course, laboratory data and treatment are not well established due to rarity of this disease entity. Chest X-ray and HRCT may be helpful in diagnosis and high dose steroid and immunosuppressive agents usually used but the efficacy is not guaranteed.
Adrenal Cortex Hormones ; Adult ; Anti-Bacterial Agents ; Bronchoscopy ; Chest Pain ; Cough ; Dacarbazine ; Diagnosis ; Dyspnea ; Female ; Fever ; Glass ; Humans ; Hysterotomy ; Immunosuppressive Agents ; Lung ; Lung Diseases, Interstitial* ; Male ; Mortality ; Oxygen ; Pneumonia ; Pregnancy ; Pregnancy Trimester, Second* ; Pregnancy* ; Respiration, Artificial ; Respiratory Sounds ; Sputum ; Steroids ; Thorax ; Tocolytic Agents