Multidosing Intramuscular Administration of Methotrexate in Interstitial Pregnancy With Very High Levels of β-hCG: A Case Report and Review of the Literature

Ectopic pregnancy (EP) is the implantation of an embryo outside the endometrial cavity of the uterus. Signs and symptoms of EP may arise between the 6th and the 8th week of gestation and include vaginal bleeding, lower abdominal and pelvic pain. Frequently EPs implant in the fallopian tubes. A rare EP is the interstitial pregnancy, a life-threatening condition being responsible for nearly 20% of all deaths caused by EPs. Because of its unique location, the diagnosis is difficult and based on signs and specific criteria together with measuring of serum β-hCG. Usually, EP is treated by surgical approach, which is associated with increased morbidity, decreased fertility and increased likelihood of hysterectomy and uterine rupture in a subsequent pregnancy. Early diagnosis is crucial to life saving and allowing alternative therapeutic interventions such as pharmacological treatments. Methotrexate (MTX) represents the mainstay therapy. There is no standard care for the interstitial pregnancy for what concerns either surgical or pharmacological approaches. We reported a case of a 36-year-old woman admitted to the Hospital of Salerno-Italy with a value of serum β-hCG of 35,993 IU/L. Transvaginal ultrasonography revealed an empty uterine cavity and a mass of 35.7 mm in diameter characterized by a hypoechoic central area. The patient was in stable haemodynamic condition and no haematologic, renal and hepatic impairments were recorded. Despite the high serum β-hCG levels, a pharmacological approach was preferred to a surgical one. The patient was treated with intramuscular administration of MTX in daily dose of 1 mg/Kg alternated with 0.1 mg/kg folinic acid for 5 days. The patient remained hospitalized for 20 days and no side effects were reported. The decrease of the serum β-hCG was monitored and more than 15% reduction was detected between the 4th and the 7th day after the beginning of the treatment. The serum β-hCG became undetectable 35 days after. A multidosing intramuscular administration of MTX was effective and safe even in the presence of very high serum β-hCG levels. Together with similar cases reported in literature, the present results can contribute to improve the decision making in the treatment of the interstitial pregnancy

In vivo characterization of doxycycline effects on tear metalloproteinases in patients with chronic blepharitis

Matrix metalloproteinases (MMPs) have a role in the pathogenesis of rosacea-associated chronic blepharitis. Doxycycline is largely used as a treatment for recalcitrant chronic blepharitis. It has been shown in vitro that doxycycline inhibits MMPs activation. The aim of this study was to investigate in vivo the effect of doxycycline in modulating MMPs in patients with chronic idiopathic blepharitis

Effects of soil pollutants, biogeochemistry and microbiology on the distribution and composition of enchytraeid communities in urbanand suburban holm oak stands

Holm oaks form typical urban woodlands in the Mediterranean region. We aimed at characterizing the enchytraeid communities in these environments and searching for possible correlations with soil parameters, including the traffic contamination. Samples of litter and topsoil were collected at different spatial scales and seasons in Naples and Siena cities and in two suburban stands. Only the co-variation between pollution and other soil chemico-physical factors showed significant effects, whereas no direct effect of soil microbiology was detected. Some thermophilous Fridericia and Achaeta tolerate high concentrations of heavy metals and PAHs and their abundance was mainly determined by Ca bioavailability. Central-European mesophilous species increased significantly under more temperate environmental conditions. Different combinations of soil cohesiveness, grain size composition and moisture regime seem to select species of certain body sizes

Effects of soil pollutants, biogeochemistry and microbiology on the distribution and composition of enchytraeid communities in urban and suburban holm oak stands

Holm oaks form typical urban woodlands in the Mediterranean region. We aimed at characterizing the enchytraeid communities in these environments and searching for possible correlations with soil parameters, including the traffic contamination. Samples of litter and topsoil were collected at different spatial scales and seasons in Naples and Siena cities and in two suburban stands. Only the co-variation between pollution and other soil chemico-physical factors showed significant effects, whereas no direct effect of soil microbiology was detected. Some thermophilous Fridericia and Achaeta tolerate high concentrations of heavy metals and PAHs and their abundance was mainly determined by Ca bioavailability. Central-European mesophilous species increased significantly under more temperate environmental conditions. Different combinations of soil cohesiveness, grain size composition and moisture regime seem to select species of certain body sizes

Office hysteroscopic treatment of a vanishing external uterine orifice in a postmenopausal woman with an obstetrical history of 44 abortions

Cervical stenosis, defined as cervical scarring of variable degree, represents a significant anatomical impediment to hysteroscopic procedures. Acquired cervical stenoses are more common than congenital forms and they are mainly associated with aging, estrogen–progesteron drugs, cervical trauma or carcinoma. The overcoming of cervical stenosis at office hysteroscopy is challenging and it often fails requiring the scheduling of the patient for an in-patient treatment under general anesthesia. We report the office hysteroscopy treatment of a vanishing external uterine orifice in a postmenopausal woman with an ultrasonographic report of a heterogeneous and thick endometrium suggestive of endometrial pathology, focusing on the main surgical steps to perform an adequate management