Thirty patients with unruptured ectopic pregnancy (4–10 weeks’ gestation) were treated locally with methotrexate (MTX) under sonographic guidance. The transvaginal puncture was performed under analgesic sedation using an automatic puncturing device. Local MTX therapy was successful in 25 patients (83.3%). Eighteen of these patients had received a single MTX instillation with a total dose of 10 mg, 7 patients had received a second instillation with 10 mg because of plateauing hCG levels after the first instillation. In 5 patients MTX therapy was unsuccessful. Surgical intervention was necessary within 4 h to 15 days after MTX treatment, due to severe tubal bleeding (n = 1) or the development of an increasing peritubal hematoma (n = 4). Patients with an outer trophoblast diameter < 1.5 cm could be treated successfully in all cases (25/25). In patients with hCG values > 5,000 mlU/ml the success rate was 70% (7/10) and in patients with demonstration of cardiac activity of the embryo 63% (5/8). The fluid aspirated from the ectopic cavity showed an average hCG concentration that was 53 times higher than in the serum. The decline in hCG to values below 10mlU/ml ranged between 7 and 75 days (mean 28 days). The hysterosalpingography performed 4–6 months after MTX therapy showed tubal patency on both sides in 85.7% of the patients examined. In the meantime 4 of these patients gave birth to healthy children.

Hemorrhagic shock developed in a 29-year-old nullipara without coagulopathy after emergency caesarean section. Treatment with uterotonic drugs, prostaglandins, and conservative procedures with transfusion of packed red cells and fresh-frozen plasma failed to control the diffuse vaginal and uterine bleeding. Finally an intravenous bolus injection of 90 microg/kg recombinant activated factor VII (rFVIIa, NovoSeven, Novo Nordisk A/S, Bagsvaerd, Denmark), was given and showed success within 20 minutes after administration, without any side effects.

In modern day health care, Sheehan's syndrome is a rare disorder affecting the postpartum period. We present a case of a 33-year-old woman with atonic hemorrhage developing a transient Sheehan's syndrome associated with hyponatremia six days postpartum. Evaluation of cranial computer tomography and magnetic resonance imaging of the pituitary demonstrated normal finding. Immediate replacement therapy using sodium, chloride, hydrocortisone, fludrocortisone and levothyroxine revealed regression of the Sheehan's syndrome to complete recovery. The present report shows that Sheehan's syndrome can be associated with hyponatremia and illustrates the need to include hyponatremia as an initial symptom in the differential diagnosis of Sheehan's syndrome.

A radioimmunoassay for extracted, N-acetylated human serum serotonin (5-hydroxytryptamine) is described. Antisera were raised in rabbits against a conjugate of bovine serum albumin with serotonin hemisuccinamide. Polyethylene glycol in combination with anti-rabbit immunoglobulins was used to separate bound and unbound ns \-Bolton Hunter-strolonin conjugate. Ethanol precipitation of serum proteins was used to extract serotonin, which was subsequently acetylated with acetic anhydride to N-acetyl serotonin. The average recovery was 66%. The minimal detectable concentration of N-acetyl serotonin was 0.012 μηιοΐ/ΐ serum (25 fmol per tube). The intra-assay precision (CV) was 6.8% (n = 20) at a level of 0.9 ± 0.06 μιηοΐ/ΐ. The inter-assay CV was 10% at a level of 0.49 ± 0.049 μπιοΐ/ΐ, and 25% (n = 10) at a level of 2.16 ± 0.53. Analytical recovery of serotonin, corrected for losses during extraction and acetylation, was 99 ± 13%. The only substance cross-reacting with the antibody was endogenous N-acetyl serotonin. This was detectable when the acetylation Step was omitted, and it can be removed by extraction before the acetylation. The observed r nge for the concentration of serotonin in serum was for 59 women 0.45 -3.46 (mean + SD: 1.37 ± 0.63 μπιοΐ/ΐ) aiid for 59 men 0.19 -2.8 (mean ± SD: 1.18 ± 0.56 μιηοΐ/ΐ). All values are corrected for endogenous N-acetyl serotonin: observed r nge 0 -0.18 (mean ± SD: 0.03 ± 0.03 μηιοΐ/ΐ). Radioimmunologische Bestimmung des Serotonins in HumanserumZusammenfassung: Wir beschreiben die radioimmunologische Bestimmung des extrahierten und N-acetylierten Serotoni s (5-Hydroxytryptamin) im Serum des Menschen. Antiseren wurden gegen das an Rinderserumalbumin gebundene Bernsteins uremonoamid-Derivat des Serotonins bei Kaninchen erzeugt. Polyethylenglycol und anti-Kaninchen Immimglobulin wurden zur Trennung des freien und gebundenen 125 I-markierten Serotonins verwendet. Serotonin wurde durch Ethanolfallung der Serumproteine extrahiert und anschlie end mit Essigs ureanhydrid zum N-Acetylserotonin acetyliert. Gesamtausbeute: 66%. Die Nachweisgrenze f r N-Acetylserotonin betr gt 0,012 μπιοΐ/ΐ Serum (25 fmol pro Assayr hrchen). Der Intra-Assay-Variationskoeffizient (VK> bei einer Serotoninkonzentrati n von 0,9 ± 0,06 μιηοΐ/ΐ betr gt 6,8% (n = 20), die InterAssay VK bei 0,49 ± 0,049 und 2,16 + 0,53 μηιοΐ/ΐ betragen 10 bzw. 25% (n = .10). K nstlich erh hte Serotoninkonzentrationen werden nach der Korrektur auf Extraktions-und Acetylierungsverluste zu 99 ± 13% wiedergefunden. Nur endogenes N-Acetylserotonin zeigt eine Kreuzreaktion mit dem Antik rper und kann durch Extraktion ohne Acetylierung nachgewiesen werden.

Preeclampsia/HELLP syndrome has been associated with a high incidence of defects in the protein C pathway and increased anticardiolipin-antibodies/lupus anticoagulants. It is also apparent that thrombophilia is responsible for other pregnancy complications, such as recurrent spontaneous abortion, fetal growth restriction, intrauterine fetal death, and abruptio placentae. ProC Global is a new global dotting assay designed to evaluate the abnormalities in the protein C anticoagulant pathway. It is based on the ability of endogenous activated protein C, generated by activation of protein C by Protac, to prolong an activated partial thromboplastin time. A total of 61 patients with a history of severe preeclampsia or HELLP syndrome and 61 normal pregnant women (controls) were evaluated, 15 of whom had factor V Leiden mutation, 12 had protein C/S deficiency, 30 had a repeated lupus anticoagulants, and 27 increased anticardiolipin antibodies (ACA). All carriers of factor V Leiden mutation (N=15) as well as all the patients with low activated protein C (APC) resistance ratio (N=15) had a ProC Global normalized ratio (NR) less than 0.80 (sensitivity 100%). Twenty-four patients positive for the lupus anticoagulants (LA) and 19 patients positive for ACA (>5.0 IgG U/mL) had a ProC Global NR less than 0.8, while six and eight, respectively, had a ProC Global NR greater than 0.8 (sensitivity, 70%-80%). The detection of a reduced protein C/protein S activity (<70%) was low (sensitivity, 33%-44%). In 25 cases with pathologic ProC Global results, a thrombophilic defect (protein S/LA/ACA without APC resistance) was diagnosed in 18 women; but in 7 cases, no known thrombophilic defect was present. ProC Global is a new screening test to identify patients with defects of the protein C system and an activated dotting system in preeclampsia but cannot correctly cover each thrombophilic component.