Methylergometrine Maleate Research Articles

Spontaneous coronary artery dissection during oral administration of methylergometrine maleate for uterine blood retention after cesarean section : a case report

Spontaneous coronary artery dissection during oral administration of methylergometrine maleate for uterine blood retention after cesarean section : a case report

Emergency Peripartum Hysterectomy

Uterine atony is a major cause of postpartum hemorrhage (PPH), an emergency event that remains one of the leading causes of maternal morbidity and mortality worldwide. This study reviews a case of severe atonic PPH after a primary cesarean, which resulted in an emergency peripartum hysterectomy. In the United States, prevalence studies have revealed a peripartum hysterectomy rate of almost 1 per 1,000 births. Multidisciplinary collaboration using effective communication is needed when responding to the severity of Stage 3 PPH. A 28-year-old woman, gravida 3 para 0, at 40.0-weeks gestation arrived at the labor and delivery unit in active labor. During labor, she received oxytocin augmentation and an epidural. Cervical dilation progressed slowly, with the patient remaining at 9.5 cm for 5 hr. On complete dilation, the patient pushed for 1.5 hr before the decision was made to proceed with a cesarean due to failure of the fetus to descend and maternal exhaustion. After the successful birth of a 4,042-g newborn by cesarean, persistent uterine atony developed. Interventions were then enacted, guided by the California Maternal Quality Care Collaborative Obstetric Emergency Management Plan. Additional staff arrived in operating room to provide support. Multidisciplinary teamwork was achieved through use of effective communication techniques, including situation–background–assessment–recommendation and closed-loop communication. Pharmacologic interventions included the use of oxytocin, misoprostol, methylergometrine maleate (×2), and carboprost tromethamine (×2). Procedural interventions by the physician included bimanual uterine massage, uterine packing, B-Lynch suture, and intrauterine balloon tamponade. Maternal hypotension and tachycardia developed, leading to the initiation of the massive transfusion guidelines. Despite interventions, severe uterine atony and brisk vaginal bleeding continued, resulting in a total quantitative blood loss of 4 L. The decision was made to proceed with an emergency peripartum hysterectomy. Postpartum emotional support was provided by a multidisciplinary team that included nursing, physician, chaplain, and social services. The mother and her newborn were discharged home on Postoperative Day 4. This case study demonstrates the success of quickly initiated PPH protocol interventions that are necessary to prevent maternal mortality and knowing the current literature on risk identification, management, and treatment of severe PPH.

PREVENTION OF RETAINED FETAL MEMBRANE BY USING VARIOUS DRUGS IMMEDIATELY AFTER PARTURITION IN COWS

The aim of the study was to investigate for the effect of different drugs immediately after parturition on the reduction of retention of placenta in selected cows. One hundred pregnant cows from members of Community Based Dairy Veterinary Foundation, Shikalbaha, Potiya, Chittagong were included in this study belonged to two breeds viz, cross bred and local, aged 3-8 years, calved 1-5 times with BCS 2-3.5. The cows were divided into five groups; group L (n=20) treated with oxytocin 50 iu/intramuscular, group IL (n=20) treated with calcium 400 ml/intravenous, group III: (n=20) treated with methyl ergometrine maleate 20 mg/intramuscular, group IV: (n=20) treated with oxytocin 50 iu/ intramuscular plus calcium 400 ml/ intravenous and group V: (n=20) served as non-treated control. The incidence of retained fetal membrane was 35% in control group, while that of pooled treatment group had 15%. This reduction was significant (P<0.05). In the present study, there was no significant difference among the different treatment groups on the prevention of retention (P>0.05). The incidence of retained fetal membrane was affected by the age and breed of cows (P<0.05). However, this effect was override by treatment and injection of drugs immediately after parturition decreases the incidence of retention of placenta in cows.

Highly sensitive and selective determination of methylergometrine maleate using carbon nanofibers/silver nanoparticles composite modified carbon paste electrode

A highly sensitive and selective voltammetric method for determination of Methylergometrine maleate (MM) in pharmaceutical formulations, urine and blood serum samples has been developed based on enhanced electrochemical response of MM at carbon nanofibers and silver nanoparticles modified carbon paste electrode (CNF-AgNP-CPE). The electrode material was characterized by various techniques viz., X-ray diffraction, scanning electron microscopy and energy dispersive X-ray spectroscopy. The electrocatalytic response of MM at CNF-AgNP-CPE was studied by cyclic voltammetry (CV), differential pulse voltammetry (DPV) and electrochemical impedance spectroscopy (EIS). Under optimized conditions, the proposed sensor exhibits excellent electrochemical response towards MM. The DPV study shows greatly enhanced electrochemical signal for MM at CNF-AgNP-CPE lending high sensitivity to the proposed sensor for MM detection. The peak (Ip) current for MM is found to be rectilinear in the range 4.0×10−8–2.0×10−5M with a detection limit of 7.1×10−9M using DPV. The feasibility of the proposed sensor in analytical applications was investigated by conducting experiments on commercial pharmaceutical formulations, human urine and blood serum samples, which yielded satisfactory recoveries of MM. The proposed electrochemical sensor offers high sensitivity, selectivity, reproducibility and practical utility. We recommend it as an authentic and productive electrochemical sensor for successful determination of MM.

Sensitive anodic voltammetric determination of methylergometrine maleate in bulk and pharmaceutical dosage forms using differential pulse voltammetry

The voltammetric oxidation behavior of methylergometrine maleate (MM) was investigated applying differential pulse voltammetry (DPV) at three different electrodes; pencil graphite (PGE), carbon paste (CPE) and glassy carbon (GCE) electrodes. Cyclic voltammetric analyses were performed to optimize the voltammetric conditions. MM cyclic voltammogram showed a well-defined anodic peak at around 740–780mV using Britton Robinson buffer at pH 5.0 for PGE and GCE, and pH 6.0 for CPE. The oxidation process was shown to be completely irreversible and diffusion-controlled. Based on this study, a sensitive quantitative method was proposed for determination of MM in its pure and pharmaceutical dosage forms. Various experimental conditions were examined and optimized; including pH, type of supporting electrolyte, accumulation time, scan rate and electrode material. The results obtained were linear over the concentration ranges 0.10–1.00, 0.08–0.36 and 0.50–5.50μg/mL with a square of correlation coefficient (R2) 0.9996, 0.9995 and 0.9994 at PGE, CPE and GCE, respectively. The method showed a minimum detectability (LOD) of 0.02, 0.008 and 0.14μg/mL and a limit of quantitation (LOQ) of 0.06, 0.02 and 0.42μg/mL at PGE, CPE and GCE, respectively. The method was validated and compared with the reference valid method. It revealed good accuracy and reproducible results. The anticipated voltammetric procedure has the advantage of being simple, precise, inexpensive and highly sensitive.

Inadvertent oral administration of methylergometrine maleate to children in the first months of life: from surveillance to prevention.

Methylergometrine maleate is an ergot alkaloid frequently used in obstetrics for prevention and treatment of post partum haemorrhage. Accidental administration of this medicine to newborns can cause severe effects and should be carefully prevented. The present paper is aimed at describing the main characteristics of cases accidentally exposed to this medicine in Italy before and after Novartis, the manufacturer of Methergin®, a widely used methylergometrine maleate-containing gynecological medication, decided to withdraw the drop preparation from the European market. The study design is a case-series study. The database of the National Poison Control Centre of Milan was searched retrospectively (from 1 January 2005 to 31 December 2011) and prospectively (from 1 January 2012 to 31 December 2013) in order to provide a descriptive analysis of the main characteristics of cases unintentionally exposed to methylergometrine maleate and to document the impact of Novartis' decision. In the first period under study (2005-2011), a total of 642 cases of exposure to methylergometrine maleate were identified. Most of them were children aged <1 year (No. 483, 75%). Patients aged 1-2 and 3-5 years accounted for 13% (No. 85) and 9% (No. 56) of cases, respectively. Among children aged <1 year, about 76% (No. 368) were exposed during the first month of life, including 44% (No. 211) of cases exposed in the first week of life. The main cause of exposure was medication error (No. 432, 89%), mainly due to oral administration of methyltergometrine maleate in place of a paediatric preparation (No. 469, 97%). About 14% of these cases suffered clinical effects as a consequence of the exposure. Severity of poisoning was minor in 45 cases, moderate in 12, and severe in one case. The main cause of exposure among children aged 1-2 and 3-5 years was uncontrolled access to the medicine, accounting for 78% (No. 66) and 77% (No. 43) of cases, respectively. Some 9% (No. 8) of cases aged 1-2 years and 7% (No. 4) of those aged 3-5 years developed signs/symptoms possibly related to the exposure. For all of them, severity of clinical effects was low, but one case suffered moderate effects. Exposure to the medicine in drops was reported for 87% (No. 74) and 84% (No. 47) of cases aged 1-2 and 3-5 years, respectively. In 2012-2013 a total of 25 cases were observed. Among them, two patients were aged <1 year (8%). Both cases occurred in 2012 and were inadvertently administered the medicine in drops still available (present) in the home. Fourteen (56%) and 8 (32%) cases were aged 1-2 and 3-5 years, respectively. All of them were exposed to the tablet formulation following uncontrolled access to the medicine. The observations here reported indicate that having different formulations for methylergometrine maleate-containing products intended for the mother and paediatric medicines can successfully prevent medication error due to medicine exchange in the first months of life.

The eff ect of intracoronary administration of ergonovine on the contralateral coronary artery in a provocation test for the diagnosis of variant angina

Background Little is known about the effects of selective intracoronary administration of ergonovine into a coronary artery on the artery on the other side. This study aimed to evaluate the effect of intracoronarily administered ergonovine on the contralateral coronary artery.Subjects and methods From June 2011 to August 2013, coronary spasm provocation tests were performed in 85 consecutive patients using selective intracoronary administration of methylergometrine maleate (ER). The doses increased in a step-wise manner up to 60 μg for the left coronary artery (LCA) and up to 50 μg for the right coronary artery (RCA). The coronary artery diameters were measured and analysed by repeated-measures ANOVA.Results Twenty-four (28%) patients had a spasm-positive result. The mean diameter of the spasm segment in the contralateral artery decreased from 2.83 to 2.68 mm (5.1 ± 0.1% change, P< 0.001) in the negative spasm group and from 2.40 to 2.10 mm (11.1 ± 2.2% change, P= 0.001) in the positive spasm group. There were no serious procedure-related complications.Conclusions Intracoronary administration of ER resulted in a statistically significant decrease of lumen diameter of the contralateral coronary artery. However, from the clinical perspective, the extent of the decrease was relatively small and the test may be conducted safely unless there is a significant coronary artery luminal narrowing.

A case of treadmill-stress-induced vasospastic angina suggested by coronary angiography with methylergometrine maleate

A case of treadmill-stress-induced vasospastic angina suggested by coronary angiography with methylergometrine maleate

症例 子宮収縮薬による冠攣縮により急性心筋梗塞,stunned myocardiumをきたした若年女性の1例

症例 子宮収縮薬による冠攣縮により急性心筋梗塞,stunned myocardiumをきたした若年女性の1例

A Case Report of Acute Myocardial Infarction Induced by Coronary Spasm

A 53-year-old male complaining of chest pain was admitted to our hospital with suspected acute myocardial infarction (AMI). Emergent coronary angiography (CAG) determined a totally occluded middle right coronary artery (RCA). Thrombus aspiration was conducted, followed by intravascular ultrasound (IVUS) imaging. Diffuse intima plus media thickness was identified at the obstruction site and a thrombus was observed proximally to the occlusion site on IVUS. Following isosorbide dinitrate (ISDN) administration, dilatation of the RCA was confirmed. IVUS study indicated the luminal dilatation was achieved by the release of the diffuse intima plus media thickening. Of note, plaque volume showed no significant difference after administration of ISDN at any vessel site. These results clearly show that luminal dilatation and vessel dilatation were achieved from the redistribution of plaque volume (intima plus media). A follow-up CAG showed no significant stenosis in the RCA. After a provocation test using methylergometrine maleate, the RCA was totally occluded at the very site of the initial event. The involvement of vasospasm as a cause of AMI in the present case was doubly confirmed with characteristic IVUS images of vasospasm in the acute phase and with a provocation test at follow-up.

Exacerbation of acetazolamide-responsive sodium channel myotonia by uterotonic agents

The symptoms of myotonia can worsen during pregnancy and tocolysis with ritodrine has been associated with rhabdomyolysis. We describe a patient with myotonia who developed hypertonus immediately following the administration of uterotonic agents. A 24-year-old, G2P1 at 31 weeks of gestation with a history of acetazolamide-responsive myotonia presented with premature rupture of membranes. During cesarean delivery she experienced significant hypertonus of the upper limbs, shoulders, fingers, and mouth immediately after intravenous administration of oxytocin 5 IU and methylergometrine maleate 0.2 mg. The mechanism underlying increased muscle tone in response to these drugs remains unclear. Anesthesiologists should be especially attentive to the administration of uterotonic drugs during the management of pregnant myotonia patients.

Effects of Methyl Ergometrine Maleate on Bleeding Following Iud Insertion

A report of the double-blind study of the effects of oral methyl ergometrine maleate (Methergin) on bleeding post JUD insertion. The result of 38 cases receiving the Methergin and 46 cases receiving placebo tablets were compared. In general the use of methergin does not have any significant effect on the intensity or duration of bleeding or pain. However in case of heavy bleeding after insertion, the intensity and duration of bleeding may be reduced by this medication.

Methylergometrine maleate from synchrotron powder diffraction data

The title compound {systematic name: 9,10-didehydro-N-[1-(hydroxy­meth­yl)prop­yl]-d-lysergamide maleate}, C20H26N3O2 +·C4H3O4 −, contains a large rigid ergolene group. This group consists of an indole plane connected to a six-membered carbon ring adopting an envelope conformation and N-methyl­tetra­hydro­pyridine where the methyl group is in an equatorial position. In the crystal, inter­molecular N—H⋯O, O—H⋯N and O—H⋯O hydrogen bonds form an extensive three-dimensional hydrogen-bonding network, which holds the cations and anions together.

Ultrasonography Vs. Per Rectal Examination for Uterine Involution in Methyl Ergometrine and Other Supplements Treated Crossbred Cows

Normally calved 36 post-partum HF crossbred cows from first to seventh parity were selected from University Farm and divided randomly into 6 equal groups. In all treatment groups (T1 to T5), injections of methyl ergometrine maleate (Ergovet, 2 mg, i/m, OD) at 1/2 hr, 2nd and 3rd day post-partum were given. Additionally, in T2, calcium (Mifex, 50 mg/ml, @ 300 ml, i/v) and phosphorus (Tonophosphan, 0.2 gm/ml, @ 10 ml, i/m, OD) were injected on second day of calving; in T3, Vit. ADE (Intavita, @ 10 ml, i/m, OD) on the second day of calving; in T4, Ceftiofur sodium (Xyrofur, 1 gm, i/m, OD) for three days from the second day of calving, and in T5, Calcium, phosphorus, Vit. A D E and Ceftiofur sodium were given with same dosage. The sixth group (T6, control) was left untreated. Cervical and uterine (previously gravid; PG and non-gravid; NG horns) diameters and uterine involution were examined by USG and per rectal palpation, at 5 days interval from day 12 to day 40 post-partum, to observe the effect of methyl ergometrine with and without above combinations on uterine involution. The reduction was observed earlier in T1, T2, and T5, by per rectal palpation compared to USG examination, while in T3, T4 and C, both methods were at the same time. PG and NG horn diameters were reduced significantly (p less than 0.05) earlier in all treatment groups (T1 to T5) as compared to control. Uterine involution was found to be completed by per rectal palpation on day 32 post-partum in all treatment groups and on day 37 in control, whereas by USG examination, it was on day 32 in T1 and T5 and on day 37 in all other groups. Methyl ergometrine along with Ca, P, Vit. ADE and ceftiofur, enhanced uterine involution in CB cows. Further, the uterine and cervical assessment by per-rectal palpation revealed fast involution as compared to USG.

Xiong-gui-tiao-xue-yin (Kyuki-chouketsu-in), a Traditional Herbal Medicine, Stimulates Lactation with Increase in Secretion of Prolactin but not Oxytocin in the Postpartum Period

The aim of the present investigation was to evaluate the clinical efficacy of Xiong-gui-tiao-xue-yin, a traditional Japanese herbal medicine, in stimulating lactation in the postpartum period. We enrolled 82 women who had a normal delivery in Osaka Medical College Hospital, and randomly assigned them to the following two groups: a group of 41 women who received Xiong-gui-tiao-xue-yin at a dose of 6.0 g/day (Group X), and a group of 41 women who received ergometrine (methylergometrine maleate) at a dose of 0.375 mg/day (Group E). Volume of lactation was determined daily until Day 6 postpartum. Plasma prolactin and oxytocin concentration were measured at Days 1 and 6 postpartum. The results showed that volume of lactation was significantly higher in Group X than in Group E at Days 4 (p = 0.042), 5 (p = 0.038), and 6 (p = 0.046). Significant differences between Groups X and E were noted in plasma prolactin concentration at Days 1 (157.9 +/- 78.2 ng/ml and 129.1 +/- 64.8 ng/ml; p = 0.037) and 6 (167.5 +/- 95.4 ng/ml and 117.1 +/- 53.6 ng/ml; p = 0.0042) postpartum. On the other hand, at Day 1, oxytocin concentration was significantly higher in Group E than in Group X (p = 0.0024). No adverse effects were observed in this study. The results of our study demonstrate the beneficial effects of Xiong-gui-tiao-xue-yin on lactation, with increase in prolactin level without increase in oxytocin level in the postpartum period. Therefore, Xiong-gui-tiao-xue-yin can be expected to improve lactation in women in the postpartum period. Further detailed bio-pharmacological studies and clinical trials to investigate the properties of this drug are warranted.

Meta-analysis on the Usefulness in Postpartum Control by Kyukichoketsuin with Methylergometrine Maleate as Control

[Purposes] Evidence-based medicine (EBM) is now the established standard for selecting appropriate treatment, the basic ideas of which cannot be ignored even in the field of Kampo medicines. With this in mind, we conducted a meta-analysis (MA) for those Kampo medicines which had been administered in randomized clinical trials, as a method of establishing the evidence for Kampo medicines, and then examined the resulting data obtained for the present study. Here, we focused on the assessing the usefulness in postpartum control, using Kyukichoketsuin (KCI), with methylergometrine maleate (MME) as control.[Methods] We searched and collected articles published before September 2004 in Igaku Chuo Zasshi (Japana Centra Revuno Medicina) and Medline using keywords such as “Kyukichoketsuin”, etc. First we selected target articles for analysis in accordance with our inclusion criteria and examined the quality of those articles using a score system adopted by Chalmers, in 1981. Then we extracted target data from the articles in accordance with meta-analytic methods, integrated the resulting data using the DerSimonian-Laird method, and implemented sensitivity analysis to them.[Results and Discussion] We selected four articles for our target analysis. All four were of similar quality. When we set post-labor pains as an assessment item, and integrated three of the four articles, KCI showed that it more significantly decreased those pains compared to MME, with an integrated odds ratio of 0.32 (95%CI, 0.17-0.60). The one remaining independent article, however, in which KCI exerted statistically significant effect in height of day-five uterine fundus, indicated no higher significance through integration with the first three articles. Also, even integrating the height of the uterine fundus shown in the articles, on day four as well as the height before integration, had no significance. These results indicate that the effect of KCI for the involution of the uterus may be the same as that of MME. Regarding the volume of breast-milk lactation on day four in comparison between two test drugs, some articles showed more volume in both the KCI and MME. groups, despite reaching no significant decreases in volume, with an integrated odds ratio of -8.20 (95%CI, -16.17--0.23). However, contrary to this, results for the integration of day-five breast-milk lactation volume showed an increase in the KCI group, although without reaching significant difference. Therefore, the effectiveness of KCI for breast-milk lactation could not be generally categorized as less than that of MME.[Conclusion] MA demonstrated that KCI was more effective in decreasing post-labor pains than was MME. We could not implement the comparable study in safety at this time. Therefore, further analysis on KCI including safety may be required to argue total effectiveness on postpartum control.

Effect of estradiol 17β upon coronary artery vasoconstrictor response to methylergometrine maleate in female menopausal patients

Background Estrogens produce several beneficial effects upon the cardiovascular system. Amongst these, an endothelium-independent effect has been convincingly demonstrated only in vitro, while there is no evidence for such an effect in vivo. The aim of the present study was to evaluate the effect of acute administration of estradiol 17β upon coronary artery reactivity to methylergometrine in 16 menopausal patients with coronary artery disease. Methods Sixteen menopausal patients underwent coronary angiography at rest and after incremental doses of methylergometrine (intracoronary 2, 10, 30 μg) before and 20 min after either intracoronary estradiol 17β (20 ng/mL at 1 mL/min for 20 min; 8 patients) or placebo (Dextrose 5%, 1 mL/min; 8 patients). Results and conclusions No significant differences were observed in baseline coronary artery diameter or area between the 2 groups. No significant differences in the degree of coronary artery constriction were observed after either estradiol 17β or placebo at submaximal doses of methylergometrine. However, the degree of coronary artery constriction after maximal doses of methylergometrine was significantly attenuated by estradiol 17β compared to placebo (change in diameter: − 0.9 ± 4.5% vs. − 19 ± 6%, p < 0.001; change in area: − 3.2 ± 9% vs. − 32.2 ± 10%, p < 0.001). Estradiol 17β reduces coronary artery constriction following methylergometrine administration in menopausal patients with coronary artery disease. This effect may be related to the calcium-antagonist properties of the ovarian hormone. Condensed Abstract The effect of acute administration of estradiol 17β upon coronary artery reactivity to methylergometrine was evaluated by coronary angiography in 16menopausal women with CAD. The investigation was performed at rest and after incremental dose of methylergometrine before and 20 min after either intracoronary estradiol 17β or placebo. Significant differences were not observed either in the baseline coronary artery diameter or the area between the 2groups, or in the degree of coronary artery constriction after either estradiol 17β or placebo at submaximal doses of methylergometrine. Coronary artery constriction after maximal doses of methylergometrine resulted attenuated by estradiol 17β for its calcium-antagonist properties.

Successful pregnancy after the noninvasive management of uterine arteriovenous malformation

A 22-year-old woman, gravida 2, para 0, showed massive vaginal bleeding and was admitted to our institution. She had persistent vaginal bleeding for 4 weeks after a secondary artificial abortion at 14 weeks’ gestation. When she was presented to our hospital, evaluation included negative urine hCG, and hemoglobin of 10.7 g/dl. Vaginal examination showed no uterine enlargement and no adnexal mass, but vaginal bleeding and some bloody coagula was recognized. Transvaginal ultrasound showed multiple tubular anechoic spaces without mass effect in the myometrium from the left anterior wall to the fundus. As dysfunction of uterine contraction due to retained products of conception, or trauma following artificial abortion was suspected, she was administered 0.2 mg of intramuscular methylergometrine maleate and 0.5 mg/day of oral methylergometrine maleate for 5 days. Vaginal bleeding decreased soon after the intramuscular injection, and she was discharged the next day with no vaginal bleeding. One week later, she was admitted again to our hospital with massive vaginal bleeding. Her hemoglobin was 6.9 g/dl. She was given only 0.5 mg/day of methylergometrine maleate orally for 7 days, which stopped the vaginal bleeding immediately. Her hemoglobin value subsequently rose by oral administration of iron alone. Percutaneous transfemoral angiography showed a 3×2 cm hypervascular mass which looked like nidus in the left uterine wall (Fig. 1), and Color Doppler ultrasound revealed a mosaic pattern in the same area of the uterine wall, which was compatible with uterine AVM. Approximately one month later, angiography was performed again for embolization, but the procedure was not carried out because of an obvious reduction in the size of the lesion. Color Doppler ultrasonography also demonstrated the decreased size of the mosaic pattern area. After discharge, follow-up Color Doppler examinations showed no signs of abnormal findings, nor any abnormal bleeding. She conceived 8 months after her previous pregnancy. Her pregnancy progressed quite normally, and ultrasound evaluation showed normal fetal growth. At 38 weeks’ gestation, a normal male infant weighing 3504 g was born by cesarean section. During the operation, no abnormality was found in the uterine myometrium by ultrasound or macroscopy. Digital subtraction angiography of the internal iliac artery demonstrates irregular, hypervascular vessels of the left uterine artery. Uterine AVM is a very rare condition and hysterectomy or embolization has been applied in its treatment. Conservative management, such as embolization, is preferable for the preservation of reproductive capability. To our knowledge, there have been ten reported cases of pregnancies after embolization of uterine AVM and one case of the noninvasive management of uterine AVM with methylergometrine maleate in 1999. We report here on a case of successful management of uterine AVM with methylergometrine maleate which was followed by full term pregnancy. Uterine AVMs are either congenital or acquired. Congenital uterine AVMs are considered to be the result of anomalous differentiation or developmental arrest in the primitive capillary plexus. The causes of acquired uterine AVMs are usually secondary to uterine neoplasm such as choriocarcinoma, curettage, infection and so on. It is important to diagnose it correctly and to start appropriate treatment promptly, because uterine AVM often causes life-threatening massive and persistent vaginal bleeding. Although interventional radiology has been used to diagnose uterine AVM preoperatively, the use of noninvasive Color Doppler ultrasound has increased over the past few years. The mainstay for management of uterine AVM has been hysterectomy or the embolization of uterine arteries. A few years ago, however, Flynn and Levine reported on the successful noninvasive management of a uterine AVM using methylergonovine maleate (1). Our report is the second case where AVM has been managed with methylergometrine maleate. Recently, Timmerman and colleagues reported nine cases diagnosed as having uterine vascular malformations using color Doppler imaging, and some of these cases have shown spontaneous regressions (2). They advocated the possibility of a new pathological entity, named subinvolution of the placental bed that was different from true AVM. In order to determine whether methylergometrine maleate has therapeutic action on uterine AVM, more case data must be collected. The mechanism of disappearance of uterine screw arteries, after normal delivery, may hold the clue to explaining the course of our case. The possibility that we observed spontaneous regression of uterine AVM on its own still remains. It is not proven that methylergometrine maleate has definite effectiveness on uterine AVM. Trying methylergometrine maleate does seem worthwhile, however, when massive vaginal bleeding calms down. We are grateful to L. Saza for helpful advice on the manuscript.

Myocardial ischemia due to vasospasm of small coronary arteries detected by methylergometrine maleate stress myocardial scintigraphy.

Recently, several case reports have implicated vasospasm of small coronary arteries in vasospastic angina pectoris. Vasospasm of small coronary arteries was also considered from angiographic findings in patients with atypical chest pain. In Syrian hamster, vasospasm in small coronary arteries was considered to be the cause of dilated cardiomyopathy. This study was undertaken to determine whether vasospasm in small coronary arteries can be induced by methylergometrine maleate stress thallium-201 (201Tl) myocardial scintigraphy. Twenty-five patients with chest pain, all of whom had intact coronary arteries, were studied. After intracoronary methylergometrine maleate injection, coronary arteriograms also looked normal in all cases. Thallium-201 myocardial scintigraphy was carried out immediately after intracoronary methylergometrine maleate injection in four patients with chest pain. In the remaining 21 patients with chest pain, methylergometrine maleate was given intravenously within up to 2 weeks before 201Tl myocardial scintigraphy. In the intracoronary injection study, one patient had chest discomfort after methylergometrine maleate injection, and ST-segment elevation was observed on electrocardiogram (ECG). Of the 21 patients with chest pain, 11 patients felt angina-like chest pain after intravenous injection of methylergometrine maleate, but their ECGs showed no ischemic changes. Stress 201Tl myocardial scintigrams showed methylergometrine maleate-induced perfusion defects with complete redistribution in 3 of 4 patients in the intracoronary injection study and in 12 of 21 patients in the intravenous injection study. These findings suggest that vasospasm in small coronary arteries caused myocardial ischemia in 15 of 25 patients (60%) with chest pain. Vasospasm in small coronary arteries may be involved in the myocardial ischemia of some patients with chest pain who do not show any large coronary artery vasospasm.

49-Year-Old Woman With Chest Pain

49-Year-Old Woman With Chest Pain