Persistent ectopic syndrome

Persistent ectopic syndrome is a complication of conservative surgery for tubal pregnancy. This study is directed toward the escalating conservatism in the treatment of tubal ectopic pregnancy and its possible sequelae. Residual trophoblast propagation after initial surgery is becoming more frequent. Two cases are reported. The first woman was admitted with an acute abdomen; salpingectomy was performed to control hemorrhage from tubal rupture at the site of the previous salpingostomy. The second woman was treated by fimbrial expression. Because of the recurrence of pain, the beta human chorionic gonadotropin (BHCG) levels were measured; they indicated fresh trophoblastic activity. She was treated with methotrexate orally, 10 mg/d for 5 days. The need for BHCG surveillance of conservatively managed tubal ectopic pregnancy is stressed. The value of using methotrexate when tubal integrity persists is discussed in the light of its traditional role against trophoblastic tumours.     

Pregnancy-associated ectopic decidua

Extrauterine formation of decidua of stromal cells has been well described, particularly in the cervix and ovary. Sporadic reports have documented decidua formation of peritoneal surfaces and lymph nodes as well as ovarian ectopic decidua in pregnant patients. The apparent hormonal mechanism of this phenomenon suggests a relationship to endometriosis. Between 1983 and 1986, tissue from 10 pregnant patients (acquired from nine at cesarean section and from one at appendectomy) demonstrated submesothelial decidua formation in the form of microscopic nodules and diffuse cell arrangements in an edematous stroma. Some cases showed mild chronic inflammation. An intracytoplasmic lipofusin-type pigment was observed in one case. Four cases had diffuse omental involvement: two with small amounts of free peritoneal blood and two with peritoneal adhesions. Three cases were associated with paratubal cysts: two of these occurred in the uterine and appendiceal serosa, respectively, and one case showed involvement of a retroperitoneal lymph node associated with a pheochromocytoma. No specific gross observations were noted at surgery. There was no prior or subsequent evidence of endometriosis. A review of 958 elective tubal ligations performed between 1983 and 1985 demonstrated 52 examples (5.5%) of serosal decidua formation. Ectopic stromal decidua formation in pregnancy is: (a) a physiologic phenomenon related to the possible specialized sensitivity of the superficial coelomic stroma to progesterone; and (b) diffusely distributed in the peritoneum although it is a clinicopathologic process distinct from endometriosis.     

单一输尿管异位开口的诊治

目的 回顾分析了6例单一输尿管异位开口的患者的诊治.方法 所有患者都有正常分次排尿合并持续性滴尿,均行B超检查,2005年前4例患者行大剂量IVP延迟摄片联合增强CT检查,2005年后2例开始行增强CT及三维重建.所有患者均行手术治疗,4例患者肾发育不良,行肾输尿管切除,2例患者行输尿管膀胱吻合.结果 所有患者均痊愈出院.2例行输尿管膀胱吻合患者,1例随访1年,1例随访3年,未见尿路感染,肾积水程度明显减轻.结论 单一输尿管异位开口少见,增强CT及三维重建能清楚显示肾脏形态位置及输尿管走行.手术是治疗单一输尿管异位开口的唯一有效的办法.     

Intracardiac ectopic thyroid

Intracardiac ectopic thyroid is a rare lesion. We present a case of successful excision of thyroid tissue obstructing the right ventricular outflow tract and provide a literature review. In all cases reported to date, the ectopic tissue arose from the ventricular septum and extended to the outflow tract.     

Temporary ectopic implantation

Temporary ectopic implantation is a technique designed for extremity salvage in cases of devascularization or amputation of an essentially intact part in conjunction with extensive segmental proximal injury. A case of a traumatic midforearm amputation that survived by ectopic implantation in the abdominal wall, with subsequent replantation eleven weeks later, is presented.     

Extra-urethral ectopic prostate

Extra-urethral ectopic prostatic tissue is a distinct entity which has been identified in the bladder of seven patients and may be more common than previously thought. Such tissue probably derives from the subtrigonal glands of Lowsley.     

Perineal ectopic testis

The case of a 24-year-old patient is presented who was erroneously presumed to have unilateral testicular aplasia following inguinal exploration in early childhood. At the age of 24 years he underwent surgery for a soft perineal mass, which was found to be perineal testicular ectopia associated with a congenital hernia. Histological examination of the excised testicle revealed atrophy of the germinal epithelium. A survey of the literature yielded approximately 175 more cases of perineal testicular ectopia. This is the most frequent from of testicular ectopia with a relative incidence of less than 1% of all cases of undescended testes. Ectopic testes seem only to differ from undescended testes in terms of topography. Little difference can be observed in terms of histology or the incidence of concomitant hernias.     

Recurrent ectopic craniopharyngioma

A 66-year-old woman developed an asymptomatic mass in the right frontal lobe 5 years after undergoing a right frontal craniotomy and removal of a craniopharyngioma. The mass progressively enlarged over the next 3 years, during which time it became multiloculated and partially cystic. Repeat craniotomy was performed 8 years after the original operation, at which time the mass was found to be an ectopic craniopharyngioma. The lesion probably resulted from seeding of tumour cells along the surgical tract at the time of the initial surgery.     

The ectopic ureter

The different forms of ureteral ectopy can be explained embryologically. Ureteral ectopy is caused by the premature appearance of the ureteral bud on the Wolffian duct. We find this rare malformation more frequent in women. We have seen 19 patients with ureteral ectopy, 15 with duplicated ureters and 4 patients with single ectopy. The symptoms are variable and not typical. The diagnostic procedures are discussed in detail. Ultrasonography and antegrade pyelography have been approved in diagnosis of ureteral ectopy. The operative treatment is rarely reconstructive, but mostly ablative.     

Diagnosis and therapy of ectopic ureters and ectopic ureteroceles with double kidneys

Diagnosis and treatment of ectopic ureters and ectopic ureteroceles with renal duplication is a rewarding challenge for any urologist, requiring specific knowledge, awareness of the anomaly and good surgical technique. The diagnosis is primarily based on the correct interpretion of the medical history and the excretory urogram, irreplaceable by sonography. Confusing details can easily be interpreted when the anomaly is detected, or the patient will be left on a long and frustrating path of medical treatment, diagnostic interventions, possibly leading to psychotherapy. The classical triad: renal duplication, incontinence and normal micturition is rarely helpful in complicated cases, compared to the typical findings on the excretory urogram which sometimes are incomplete or only suggestive but still have the highest diagnostic value. Their recognition usually leads to correct diagnosis and treatment. Modern surgical and anesthesiological techniques allow a one stage approach to correct the anomaly and avoid further complications. However, if the risk is considered to be too high, a two stage approach is justified starting with a heminephrectomy. After this 20% will require further surgical treatment of the bladder, due to complications. Dysplastic and nonvisualizing renal segments should not be preserved nor should dilated, ectopically ending ureters. Minimal surgical interventions, reducing, but not solving the problem (incision of ureteroceles, interpelvic anastomosis) are not recommended in modern urological treatment.     

Bilateral single ectopic ureter

A case of successfully treated bilateral single ectopic ureter with a follow-up of 13 years is reported. The genesis of the incompetence of the vesical sphincter and its treatment are discussed.     

Bilateral single ectopic ureter

A case of single bilateral ureteral ectopia is presented. Patient underwent bilateral ureteral reimplantation with right ureteral tailoring, with a satisfactory result.     

Primary intraorbital ectopic meningioma

We report a case of intraorbital meningioma. Operative findings and histopathological examination revealed the tumoc to be meningothelial meningloma and to be located entirely outside the optic dura. This case demonstrates the occurrence of primary intraorbital ectopic meningioma, and the tumor was removed through a modified Dolenc approach. The primary intraorbital ectopic meningioma is discussed and the surgical approach to the orbital apex region is reviewed.