Jahir Sama

Expectant management of presumed ectopic pregnancies

Thirteen patients with presumed diagnosis of unruptured ectopic pregnancy underwent expectant management. The diagnosis was based on the criteria of clinical stability, no intrauterine gestation sac by sonogram, and falling beta subunit human chorionic gonadotropin titer. The diagnosis also was based on no gross evidence of trophoblastic tissue on sharp curettage and alteration in uterotubal anatomy at laparoscopy. In these 13 patients, titers continued to drop and were below assay detectability (1.5 miu/ml) by 1 to 5 weeks. Only one patient required a laparotomy. Hysterosalpingograms in ten of the patients showed normal, patent tubes in seven. One patient had cornual occlusion and two showed a hydrosalpinx with spillage. A second laparoscopy in seven patients demonstrated normal tubes in all but one. At present, three patients have delivered term infants and two have had first trimester spontaneous abortions. These observations suggest that expectant management of tubal pregnancies is appropriate under rigidly controlled conditions.

Endometriosis presenting as bloody pleural effusion and ascites-report of a case and review of the literature

Abstract A 34 year-old female presented with blood-stained pleural effusion and ascites. Investigation revealed a pelvic mass. She underwent exploratory laparotomy, and was found to have endometriosis. Total abdominal hysterectomy and right salpingo-oophorectomy was performed.

Prenatal diagnosis of dicephalous conjoined twins in a triplet pregnancy

Abstract Prenatal diagnosis of dicephalous conjoined twins in a triplet pregnancy and their management are presented.

Epithelioid sarcoma of the uterine cervix.

BACKGROUND Epithelioid sarcoma is a rare, yet aggressive soft tissue neoplasm that has not previously been reported to originate in the cervix. CASE A 29-year-old woman was seen in consultation at our institution after having been diagnosed with a poorly differentiated carcinoma of the cervix, which was treated with radiation and chemotherapy. Examination of the original biopsy material with additional studies led to a diagnosis of epithelioid sarcoma of the cervix. CONCLUSION Epithelioid sarcoma can occur in the cervix and should be included in the differential diagnosis of cervical neoplasms. Additional cases are needed to develop optimum treatment strategies and predict prognosis.

Diagnosis of trisomy 21 by chorionic villus biopsy

Chorionic villus biopsy for first-trimester diagnosis is gradually being popularized in the United States. It is still experimental and being done under the strict and rigid guidance of a research protocol. First prenatal diagnosis of trisomy 21 was described by Brambati and Simoni,! of Milan, Italy, in a letter to the editor, on March 12, 1983. We present here the second case of trisomy 21 diagnosed by chorionic villus biopsy in a 38-year-old black patient.