BACKGROUND: Spontaneous heterotopic pregnancies are rare, but with assisted reproductive techniques the incidence may approach 1∶100. With the widespread use of transvaginal ultrasonography, physicians have attempted...BACKGROUND: Spontaneous heterotopic pregnancies are rare, but with assisted reproductive techniques the incidence may approach 1∶100. With the widespread use of transvaginal ultrasonography, physicians have attempted treatment of heterotopic pregnancies with minimally invasive procedures such as transvaginal guided potassium chloride(KCl) injection. However, there are few data on the success of this treatment. CASE: A 30-year-old primigravida presented with a desired pregnancy and was found to have a tubal pregnancy in addition to an intrauterine pregnancy. Ultrasound-guided KCl injection into the heterotopic pregnancy was complicated by abdominal pain, surgical abdomen, and hemoperitoneum requiring salpingectomy. CONCLUSION: A review of the literature revealed that 55%of tubal heterotopic pregnancies treated by KCl injection required subsequent salpingectomy. This raises concerns about the advisability of this treatment.展开更多
Objective. To determine the efficacy of secondary chemotherapy after failure o f initial treatment for high-risk gestational trophoblastic neoplasia. Methods. Twenty-six patients with high-risk gestational trophoblast...Objective. To determine the efficacy of secondary chemotherapy after failure o f initial treatment for high-risk gestational trophoblastic neoplasia. Methods. Twenty-six patients with high-risk gestational trophoblastic neoplasia based on WHO criteria who failed primary treatment or relapsed from remission and rece ived secondary chemotherapy were identified from the records of the Brewer Troph oblastic Disease Center. Initial chemotherapy consisted of etoposide, high-dose methotrexate with folinic acid, actinomycin D, cyclophosphamide and vincristine (EMA-CO) in 10 patients and methotrexate/actinomycin D-based chemotherapy wit hout etoposide in 16 patients. Secondary chemotherapy consisted mainly of platin um-etoposide combinations with methotrexate and actinomycin D (EMA-EP), bleomy cin (BEP), or ifosfamide (VIP, ICE). Adjuvant surgery and radiotherapy were used in selected patients. Clinical response and survival as well as factors affecti ng survival were analyzed retrospectively. Results. The overall survival has 61. 5%(16/26). Of the 10 patients who failed primary treatment with EMA-CO, 9 (90 %) had complete clinical responses to secondary chemotherapy with EMA-EP (3) o r BEP (6), and 6 (60%) were placed into lasting remission. Of the 16 patients w ho failed primary treatment with methotrexate/actinomycin D-based chemotherapy without etoposide, 10 (63%) had complete clinical responses to BEP (8), VIP (1) and ICE (1), and 10 (63%) achieved long-term remission. Adjuvant surgical pro cedures were performed on 15 patients as a component of their therapy; eight (73 %) of 11 patients who underwent hysterectomy, five (62%) of eight patients who had pulmonary resections, and one patient who had wedge resection of resistant choriocarcinoma from the uterus survived. Survival was significantly influenced by both hCG level at the start of secondary therapy and sites of metastases. Con clusion. Patients with persistent or recurrent high-risk gestational trophoblas tic neoplasia who develop resistance to methotrexate-containing treatment proto cols should be treated with drug combinations employing a platinum agent and eto poside with or without bleomycin or ifosfamide.展开更多
文摘BACKGROUND: Spontaneous heterotopic pregnancies are rare, but with assisted reproductive techniques the incidence may approach 1∶100. With the widespread use of transvaginal ultrasonography, physicians have attempted treatment of heterotopic pregnancies with minimally invasive procedures such as transvaginal guided potassium chloride(KCl) injection. However, there are few data on the success of this treatment. CASE: A 30-year-old primigravida presented with a desired pregnancy and was found to have a tubal pregnancy in addition to an intrauterine pregnancy. Ultrasound-guided KCl injection into the heterotopic pregnancy was complicated by abdominal pain, surgical abdomen, and hemoperitoneum requiring salpingectomy. CONCLUSION: A review of the literature revealed that 55%of tubal heterotopic pregnancies treated by KCl injection required subsequent salpingectomy. This raises concerns about the advisability of this treatment.
文摘Objective. To determine the efficacy of secondary chemotherapy after failure o f initial treatment for high-risk gestational trophoblastic neoplasia. Methods. Twenty-six patients with high-risk gestational trophoblastic neoplasia based on WHO criteria who failed primary treatment or relapsed from remission and rece ived secondary chemotherapy were identified from the records of the Brewer Troph oblastic Disease Center. Initial chemotherapy consisted of etoposide, high-dose methotrexate with folinic acid, actinomycin D, cyclophosphamide and vincristine (EMA-CO) in 10 patients and methotrexate/actinomycin D-based chemotherapy wit hout etoposide in 16 patients. Secondary chemotherapy consisted mainly of platin um-etoposide combinations with methotrexate and actinomycin D (EMA-EP), bleomy cin (BEP), or ifosfamide (VIP, ICE). Adjuvant surgery and radiotherapy were used in selected patients. Clinical response and survival as well as factors affecti ng survival were analyzed retrospectively. Results. The overall survival has 61. 5%(16/26). Of the 10 patients who failed primary treatment with EMA-CO, 9 (90 %) had complete clinical responses to secondary chemotherapy with EMA-EP (3) o r BEP (6), and 6 (60%) were placed into lasting remission. Of the 16 patients w ho failed primary treatment with methotrexate/actinomycin D-based chemotherapy without etoposide, 10 (63%) had complete clinical responses to BEP (8), VIP (1) and ICE (1), and 10 (63%) achieved long-term remission. Adjuvant surgical pro cedures were performed on 15 patients as a component of their therapy; eight (73 %) of 11 patients who underwent hysterectomy, five (62%) of eight patients who had pulmonary resections, and one patient who had wedge resection of resistant choriocarcinoma from the uterus survived. Survival was significantly influenced by both hCG level at the start of secondary therapy and sites of metastases. Con clusion. Patients with persistent or recurrent high-risk gestational trophoblas tic neoplasia who develop resistance to methotrexate-containing treatment proto cols should be treated with drug combinations employing a platinum agent and eto poside with or without bleomycin or ifosfamide.
