Background: Our aim was to present our experience in diagnosing and managing the ectopic pregnancy, developing in a previous Cesarean section scar. Methods and Results: Between 2005 and 2008, six patients were diagnosed with Cesarean scar pregnancy, with transvaginal and Color flow Doppler ultrasound. Five of them were diagnosed during routine scans for confirmation of pregnancy (5 + 2/7weeks, 6 + 1/7weeks, 6 + 4/7week, 7 + 3/7weeks, 5 + 4/7weeks), and one of them because of vaginal hemorrhage (8 + 4/7weeks). Ultrasound demonstrated gestational sac or viable embryo, in the region of the previous Cesarean scar. All the patients had at least one previous Cesarean section. Five of them, after diagnosis, underwent transcervical aspiration of the gestational sac under ultrasound guidance. One of them (5 + 4/7weeks GA) decided to undergo medical treatment and follow-up scans. Firstly, she had mifepriston + misoprostol treatment. She had normal bleeding pattern during six days. In the follow-up scan (day 7), ultrasound showed a viable embryo (6 + 5/7weeks). Then, she had methotrexhate + misoprostol treatment. On day 12, the scan showed again a viable embryo (7 + 4/7weeks). After that, the patient underwent transcervical aspiration under ultrasound guidance. From six patients, in four of them, termination of pregnancy needed no more interventions. In one of them, the patient went again through transcervical aspiration under ultrasound guidance because of residua. In one of them (6 + 2/7weeks), it ended with hysterectomy due to massive bleeding. Conclusions: Transvaginal ultrasound is a reliable tool for early diagnosis of ectopic pregnancy in Cesarean scar. We would advise termination of pregnancy during the first trimester, with aspiration under ultrasound guidance, better than tempting medical treatment.
The [W(CO)5]‐catalyzed cycloisomerization reaction of 1,1‐disubstituted 4‐pentyn‐1‐ol derivatives has been studied from both, an experimental and theoretical point of view. Three different catalytic systems have been evaluated {preformed [(thf)W(CO)5], [W(CO)6]/excess Et3N, and [W(CO)6]/2 mol % Et3N]. We have found that the reaction proceeds to give the formal endo‐ or exo‐cycloisomerization products depending on the amount of Et3N used and on the substitution along the alkyl chain of the starting alkynol. The theoretical study allowed us to find the mechanisms of the reactions which explain the formation of the formal endo‐ or exo‐cycloisomerization products.
Introduction: ACR has developed a BI-RADS lexicon of the breast sonography in order to standardize the characterization of sonographic breast lesions. Purpose: To analyze the accuracy of the categorization of sono-mammographic results according to the BI-RADS use criteria and breast cancer. Methods: In the period of 2002-2008, in our policlinic sonomammography was performed on 2719 patients. Sonographic findings are categorized according to respective criteria of BI-RADS sono-mammography. Every change has been described by use of these features and is classified in categories from 1 to 5, according to BI-RADS for sono-mammography. Categorization and biopsy results have been compared. Results: In 32 (1.2%) patients, sono-mammography could not be assessed due to the extreme tissue density. Categorization 1-normal was found in 758 (27.9%) patients. Simple cysts classified as category 2 are found in 988 (36.3%) women. In 567 (20.9%) patients suspicious benign solid masses have been found categorized as category 3. Local suspicious processes for the malignant process categorized as category 4 are found in 234 (8.6%) women and local processes suggest high malignity possibility categorized as category 5 is found in 140 (5.1%) patients. Histological results were possible in 37 (6.5%) masses that are classified by BI-RADS as category 3, in 102 (43.5%) of the category 4, and 129 (92.1%) of the category 5. The level of malignant findings was: 2.7% (n=1) in category 3, 17.6% (n=18) in category 4 and 92.2% (n=119) in category 5. For the category 4, OR=7.7, 95% CI 0.991-60.02. For the category 5 OR=428.4, 95% CI 53.0-3462.5.
Conclusion:The assessment of findings during malignity sonomammography based on criteria used by BI-RADS of the breast sonography, has high level accuracy comparable to those obtained by BI-RADS mammography.
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