Ectopic pregnancy accounts for approximately 2% of all pregnancies and is the most common cause of pregnancy-related mortality in the first trimester. Initial evaluation consists of hormonal assays and pelvic ultrasonography (US). A history of pelvic pain along with an abnormal beta human chorionic gonadotropin level should trigger an evaluation for an ectopic pregnancy. The fallopian tube is the most common location for an ectopic pregnancy. An adnexal mass that is separate from the ovary and the tubal ring sign are the most common findings of a tubal pregnancy. Other types of ectopic pregnancy include interstitial, cornual, ovarian, cervical, scar, intraabdominal, and heterotopic pregnancy. Interstitial pregnancy occurs when the gestational sac implants in the myometrial segment of the fallopian tube. Cornual pregnancy refers to the implantation of a blastocyst within the cornua of a bicornuate or septate uterus. An ovarian pregnancy occurs when an ovum is fertilized and is retained within the ovary. Cervical pregnancy results from an implantation within the endocervical canal. In a scar pregnancy, implantation takes place within the scar of a prior cesarean section. In an intraabdominal pregnancy, implantation occurs within the intraperitoneal cavity. Heterotopic pregnancy occurs when an intrauterine and an extrauterine pregnancy occur simultaneously. A spectrum of intra- and extrauterine findings may be seen on US images. Although many of the US findings are nonspecific by themselves, when several of them are seen, the specificity of US in depicting an ectopic pregnancy substantially improves.

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Previous studies have shown that a pessimistic explanatory style is a risk factor for illness, but the factors linking explanatory style and illness are unknown. One's characteristic response to poor health may mediate this relationship. Perhaps pessimistic individuals act helplessly in the face of their symptoms, thereby exacerbating disease. In the present study, we investigated this possibility by asking 96 young adults to complete measures of explanatory style, habitual response to illness, and ways of coping during their most recent episode of illness. Subjects who explain bad events pessimistically (with internal, stable, and global causes) reported more frequent illnesses during the past year and rated their overall health more poorly than those who habitually favor external, unstable, and specific explanations. When ill, the pessimistic subjects were less likely than their optimistic counterparts to take active steps to combat their illness. Our results suggest that one pathway leading from pessimistic explanatory style to poor health is mundane: passivity in the face of disease.

This report investigates the role of compressive stress on ovarian cancer in a 3D custom built bioreactor. Cells within the ovarian tumor microenvironment experience a range of compressive stimuli that contribute to mechanotransduction. As the ovarian tumor expands, cells are exposed to chronic load from hydrostatic pressure, displacement of surrounding cells, and growth induced stress. External dynamic stimuli have been correlated with an increase in metastasis, cancer stem cell marker expression, chemoresistance, and proliferation in a variety of cancers. However, how these compressive stimuli contribute to ovarian cancer progression is not fully understood. In this report, high grade serous ovarian cancer cell lines were encapsulated within an ECM mimicking hydrogel comprising of agarose and collagen type I, and stimulated with confined cyclic or static compressive stresses for 24 and 72 h. Compression stimulation resulted in a significant increase in proliferation, invasive morphology, and chemoresistance. Additionally, CDC42 was upregulated in compression stimulated conditions, and was necessary to drive increased proliferation and chemoresistance. Inhibition of CDC42 lead to significant decrease in proliferation, survival, and increased chemosensitivity. In summary, the dynamic in vitro 3D platform developed in this report, is ideal for understanding the influence of compressive stimuli, and can be widely applicable to any epithelial cancers. This work reinforces the critical need to consider compressive stimulation in basic cancer biology and therapeutic developments.

There is evidence to support the use of pins over ORIF with plates and screws in the treatment of metacarpal fractures. This may have practical advantages, including minimal dissection, easier insertion and availability of the pins. The limitations of this study include the small number of eligible studies, lack of reporting of standard deviation value, and the lack of DASH score assessments at follow up. Further randomized controlled trials that include a larger patient numbers with longer follow up are needed to substantiate the superiority of one fixation method over another.

The newer techniques of cementing aim to improve interlock between cement and bone around a femoral stem by combining high pressure and reduced viscosity. This may produce increased embolisation of fat and marrow leading to hypotension, impaired pulmonary gas exchange and death. For this reason the use of high pressures has been questioned. We compared finger-packing with the use of a cement gun by measuring intramedullary pressures during the cementing of 31 total hip replacements and measuring physiological changes in 19 patients. We also measured pressure in more detail in a laboratory model. In the clinical series the higher pressures were produced by using a gun, but this caused less physiological disturbance than finger-packing. The laboratory studies showed more consistent results with the gun technique, but for both methods of cementing the highest pressures were generated during the insertion of the stem of the prosthesis.

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Objective. The purpose of this study was to assess the importance of monophasic waveforms encountered in the common femoral vein during deep venous thrombosis evaluation by a retrospective review of lower extremity venous Doppler (VD) sonography and correlative studies, such as computed tomography (CT) and magnetic resonance imaging. Methods. A retrospective review was conducted of lower extremity VD studies performed from September 1, 2000, through September 1, 2005. All satisfactory VD studies, which were in compliance with the Intersocietal Commission for the Accreditation of Vascular Laboratories standard protocol, were evaluated for the presence of monophasic waveforms and correlated with CT of the abdomen and pelvis. Studies were evaluated for the causes of monophasic waveforms. Patients younger than 18 years were excluded. Results. A total of 2963 VD examinations were reviewed. One hundred twenty-four of 2963 showed monophasic waveforms. Eighty-nine of the 124 had additional CT examinations within 1 week; 19 had CT within 2 months; and 16 had no additional examinations. Forty-seven of 124 cases revealed deep venous thrombosis extending into the iliac veins, of which 23 were identified by VD sonography; 26 were due to extrinsic compression; 6 showed a hypoplastic or stenosed common iliac vein; and the remaining 45 had no apparent causes for the monophasic waveforms. Conclusions. Monophasic waveforms in the common femoral veins are reliable indicators of proximal venous obstruction. Because iliac vein thrombosis is clinically important, we recommend routine sonographic evaluation of external iliac veins in the presence of monophasic waveforms and CT or magnetic resonance imaging, if necessary, to determine the cause of the monophasic waveforms. Key words: color flow Doppler sonography; deep venous thrombosis; monophasic waveforms; sonography.Received February 20, 2007, he normal common femoral venous waveform shows phasicity on spectral Doppler analysis. Phasic variation results from increasing and decreasing intrathoracic pressures secondary to respiration and is sometimes referred to as respirophasic. This rise and fall in pressure are transmitted from the central to peripheral veins and manifest as a cyclic change in blood flow velocity, which can be detected by spectral Doppler sonography. Loss of this phasic variation results in a monophasic waveform. Monophasic waveforms in the common femoral vein occur when the transmission of respiratory pressure to the vein is dampened or disrupted by extrinsic compression, proximal deep venous thrombosis (DVT), or intrinsic luminal narrowing of a more proximal vein.