摘要:

BackgroundFetal chylothorax is associated with elevated perinatal mortality. Development of mediastinal shift with significant lung compression before 35 weeks' gestation needs treatment.CaseA 24-year-old gravida 2, para 0 presented at 26 weeks' gestation with a fetal pleural effusion with a mediastinal shift and abnormal Doppler velocimetry indices in several vessels. Thoracentesis was successful but 3 days later, the fetal effusion had reaccumulated. Because of fetal position, a pleuro-amniotic shunt was difficult technically, so maternal medical treatment was initiated with a low-fat, high medium-chain triglyceride diet. After initial mild decrease, the estimated volume of the fetal chylothorax remained stable until 36 weeks' gestation, at which time we delivered by cesarean an infant with good Apgar scores. After aspiration of the remaining thoracic fluid and administration of a similar diet, the infant did well, with normal growth and development.ConclusionMaternal dietary treatment might help delay the need for thoracentesis in cases of fetal chylothorax.

ISSN:0029-7844    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

BackgroundSplenic rupture in the newborn is a rare complication in erythroblastosis fetalis. There are no reports of splenic rupture in the fetus affected by hemolytic disease of the newborn.CaseA 41-year-old gravida 3, para 2-0-0-2 with severe rhesus alloimmunization was managed with serial intrauterine transfusions resulting in fetal death after the fourth procedure. Autopsy findings revealed intra-abdominal clotted blood and splenic capsular defects consistent with splenic rupture.ConclusionFetal splenic rupture might occur in hemolytic disease of the newborn associated with splenomegaly. Acute hemodynamic changes with increased intra-abdominal pressure from intrauterine transfusion might precipitate splenic rupture.

ISSN:0029-7844    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

BackgroundIntramural ectopic pregnancy is unusual, difficult to diagnose, and associated with a high rate of uterine rupture.CaseA 35-year-old, gravida 3, para 0-0-2-0 was diagnosed with intramural ectopic pregnancy by ultrasound showing a gestational sac surrounded completely by myometrium. It was confirmed by laparoscopy. With expectant management, the gestation resolved spontaneously.ConclusionEarly diagnosis by ultrasound of intramural ectopic pregnancy permits expectant management which, if successful, would aid in maintaining fertility.

ISSN:0029-7844    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

BackgroundStenosis of the neovagina is a late postoperative complication of male-to-female sex reassignment surgery when patients do not have frequent sexual intercourse or do not perform vaginal dilation.CaseA 39-year-old male-to-female transsexual who had sex reassignment surgery, in which a segment of sigmoid colon was used for neovagina construction, developed total introital stenosis and subsequent peritonitis caused by bowel perforation of the colon conduit.ConclusionTo avoid stenosis of the neovagina, an inflatable silicon vaginal stent should be used all day for 30 days, then for 3 months overnight or until sexual function is regular.

ISSN:0029-7844    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

BackgroundAcrocephalosyndactyly is a syndrome characterized by congenital malformation of the skull with craniosynostosis, midface hypoplasia, and symmetrical webbed fusion of the fingers and toes. We describe a possible pathophysiologic mechanism for chylous ascites that developed several months after menarche in a woman with acrocephalosyndactyly and congenital lymphatic dysplasia.CaseA 25-year-old nulligravid woman with acrocephalosyndactyly, at 18 months after menarche, developed persistent abdominal distension at age 18 years. Laparoscopy at age 25 years revealed chylous ascites with marked chronic peritoneal inflammation, and lymphatic dysplasia with lymphocysts. With hormone manipulation, the chylous ascites fluctuated.ConclusionAfter menarche in a woman with acrocephalosyndactyly, ovarian steroid hormones might have increased lymph production and hydrostatic pressure, causing rupture of congenitally dysplastic lymph vessels resulting in chylous ascites.

ISSN:0029-7844    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

BackgroundCompartment syndrome is a condition in which increased tissue pressure within a limited tissue space compromises the circulation and function of the contents of the space.CaseA 43-year-old black woman, para 3, had repair of a recurrent vesicovaginal fistula. She was placed in a low lithotomy position with thigh length sequential compression sleeves. The procedure lasted more than 5 hours. On postoperative day 1, she complained of pain in her right leg and foot. Compartment syndrome was diagnosed and emergency fasciotomy was done.ConclusionGynecologists should be aware of the possibility of compartment syndrome during prolonged procedures with patients in the lithotomy position. Concomitant intermittent compression sleeves might further increase the risk. Early diagnosis and treatment of compression syndrome are essential to minimize long-term neurovascular morbidity.

ISSN:0029-7844    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

BackgroundDiffuse uterine leiomyomatosis is a rare, benign entity and approximately 30 cases have been described previously.CaseA 42-year-old woman who complained of abdominal pain had a pelvic ultrasound scan showing a uterine mass. During the operation, the surgeon observed that both ovaries, the broad ligament, and the pelvis contained various nodules of striking size. On sectioning, uterus and ovaries contained multiple nodules of elastic consistency; microscopically, all consisted of benign smooth muscle tissue.ConclusionLeiomyomatosis may exhibit concomitant parametrial, pelvic, and bilateral ovarian involvement.

ISSN:0029-7844    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

BackgroundUterine sarcomas are rare malignancies that resemble benign uterine leiomyomata. Uterine artery embolization is offered increasingly for treatment of uterine leiomyomata, which might lead to embolization of undiagnosed uterine sarcoma.CaseA 52-year-old woman, gravida 7, para 6, with perimenopausal menometrorrhagia was diagnosed with uterine leiomyomata after physical examination and transvaginal ultrasound. An endometrial biopsy was negative for malignancy. After medical treatment was unsuccessful, she had uterine artery embolization. She then passed a piece of tissue from her vagina, the pathology report of which was necrotic high-grade sarcoma. During surgery we confirmed that the tumor was confined to the uterus.ConclusionUterine sarcoma cannot be diagnosed except by pathologic examination of a resected specimen. Women considering uterine artery embolization for treatment of apparent leiomyomata should be counseled on the risk of decreased survival by delaying diagnosis and treatment of uterine sarcoma.

ISSN:0029-7844    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

BackgroundEndometrial ablation is a surgical alternative to hysterectomy. Cases exist in the literature of endometrial adenocarcinoma found at endometrial ablation. If endometrial cancer is occultit might not be detected during ablation, especially if destructive techniques are used.CaseA 41-year-old woman had a history of menorrhagia. A previous D&C showed benign proliferative endometrium. Investigations for menorrhagia found no abnormalities. The diagnosis was dysfunctional uterine bleeding. Endometrial ablation was done and the pathologic examination of the resected endometrium found focal, well-differentiated adenocarcinoma of the endometrium.ConclusionThis case shows the importance of patient selection, evaluation, and surveillance after endometrial ablation. Resection of the endometrium is superior to destructive techniques because it provides tissue for pathologic evaluation. We recommend close postoperative surveillance in such cases.

ISSN:0029-7844    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

ObjectiveTo clarify the relative efficacy of nifedipine and beta-agonists for tocolysis.Data SourcesThe literature was searched in the following databases: MEDLINE 1965–1998, Embase 1988–1998, Current Contents 1997–1998, and the Cochrane Database for 1998. We also sought unpublished trials and abstracts submitted to major international congresses. Search terms were: “tocolysis,” “nifedipine,” “calcium channel blocker,” “ritodrine,” “terbutaline,” and “salbutamol.”Methods of Study SelectionRandomized controlled trials comparing tocolysis with nifedipine and beta-adrenergic agonists during preterm labor were reviewed. In cases with postrandomization exclusions, authors were contacted to obtain intent-to-treat results and to avoid analytical bias. We identified 11 published and two unpublished randomized trials.Tabulation, Integration, and ResultsData were extracted by two reviewers and analyzed by a blinded biostatistician with RevMan 3.1 software from the Cochrane Collaboration. We analyzed nine relevant randomized controlled trials that included 679 patients. Meta-analysis showed that nifedipine was more effective than the beta-agonists in delaying delivery at least 48 hours [odds ratio (OR) 1.52, 95% confidence interval (CI) 1.03, 2.24], or over 34 weeks (OR 1.87, 95% CI 1.11, 3.15). The agents did not differ as to the incidence of deliveries after 37 weeks (OR 1.29, 95% CI 0.85, 1.96) or the neonatal mortality rate (OR 1.51, 95% CI 0.63, 3.65). Treatment with nifedipine was interrupted significantly less often because of side effects (OR 0.12, 95% CI 0.05, 0.29) and led to better neonatal outcomes (fewer infants with respiratory distress syndrome: OR 0.57, 95% CI 0.37, 0.89) or transferred to neonatal intensive care units (OR 0.65, 95% CI 0.43, 0.97).ConclusionWith respect to neonatal outcome, nifedipine appears to be more effective than beta-agonists for tocolysis and should be considered for use as a first-line tocolytic agent.

ISSN:0029-7844    

出版商:OVID    

年代:2001

数据来源: OVID