scholarly journals Successful Outcome of a Triplet Gestation in a Patient with a History of an Open Maternal-Fetal Surgery

2012 ◽  
Vol 2012 ◽  
pp. 1-2
Author(s):  
Kathleen A. Rivers ◽  
Paul W. Whitecar ◽  
Cristóbal S. Berry-Cabán
Keyword(s):  
Medical Literature ◽  
Fetal Surgery ◽  
Successful Outcome ◽  
Multiple Pregnancies ◽  
Reproductive Outcomes ◽  
History Of

Reproductive outcomes in women after pregnancy complicated by an open maternal-fetal surgery (OMFS) are limited. A review of the medical literature reveals only isolated cases of successful multiple pregnancies, and there are no prior documented cases of successful triplet gestations following OMFS. We report the delivery of a triplet gestation at 34-week gestation in a patient with a history of previous OMFS.

scholarly journals AB0444 THROMBOTIC MICROANGIOPATHY AND SJÖGREN SYNDROME, AN UNUSUAL ASSOCIATION. PRESENTATION OF CLINICAL CASE AND SYSTEMATIC REVIEW OF THE LITERATURE

2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 1521.2-1521
Author(s):  
Y. Santamaria ◽  
M. Galvis ◽  
A. Vanegas
Keyword(s):  
Hospital Admission ◽  
Plasma Exchange ◽  
Thrombotic Microangiopathy ◽  
Clinical Case ◽  
Medical Literature ◽  
Sjogren Syndrome ◽  
Plasma Exchange Therapy ◽  
History Of ◽  
The Mean ◽  
Intravenous Steroids

Background:Thrombotic microangiopathy (TMA) is a clinicopathologic diagnosis defined as microangiopathic hemolytic anemia (MAHA) with associated features of thrombocytopenia and end-organ ischemia. Systemic lupus erythematosus, antiphospholipid antibody syndrome, and scleroderma, are within the autoimmune diseases, the more commonly associated with TMA. It has been considered that the association with Sjögren Syndrome (SS) is rare.Objectives:To describe one patient with TMA and SS, and to review all cases reported in the literature.Methods:We notified a clinical case of a patient with Sjögren’s syndrome and TMA. Then, we searched the medical literature finding a total of 17 cases reported with this association until 2019. Before the data obtained were tabulated by trained staff and descriptive, comparing groups and bivariate analysis was performed. The outcome of interest was the death of the patient. Stata 12.0 software was used.Results:A 26-years-old Colombian female presented with a 6-week history of petechiae in lower limbs, gingivorrhagia, menorrhagia and jaundice; and previous history of arthritis and xerostomia. On admission, in the context of severe thrombocytopenia and MAHA, MAT diagnosis was made. During hospitalization we confirm the diagnosis of SS with ANA, antiRo and salivary gland biopsy. The patient was treated with steroids (methylprednisolone 500 mg/day, 3 days), plasma exchange therapy (PLEX) and Cyclophosphamide (750 mg), with recovery of hemoglobin and platelet levels; however, the patient died due to a complication of the PLEX catheter removal procedure.A total of 18 patients diagnosed with de novo or prevalent Sjögren’s syndrome who had hospital admission with a diagnosis of TMA were included. The mean age was 54.55 years (Standard deviation (SD): 12.45) and 83.33% of the patients corresponded to the female gender.At admission, the mean of hemoglobin was 8.45 g/dL (SD: 2.55) and median platelets of 27250/mm3 (interquartile range (IQR) 10500 - 102000) were found. The most frequent clinical manifestations were central nervous system alterations (50%), followed by bleeding in the skin and renal failure (44.44%) and fever (27.78%). The most frequent antibodies found were anti-Ro (100%), anti-nuclear antibodies (80%) and anti-La (75%). The most frequently prescribed treatment was plasma exchange therapy (83.33%), intravenous steroids (61.11%), oral steroids (61.11%) and cyclophosphamide (27.78%). Of the total patients, 38.89% died and 27.7% had some relapse of TMA.In the group comparison analysis, differences were found in intravenous steroid (81.82% in those who lived vs. 28.57% in those who died p=0.039), use of PLEX (100% in those who survived vs. 57.14% in those who died p = 0.043), fever (9.09% in those who survived and 57.14% in those who died, p = 0.047), admission hemoglobin (7.65 g/dL in those who lived vs. 10.22 g/dL in those who died, p = 0.05), final platelets (148,000 in which who lived and 39,000 in those who died p = 0.02). Then, in the logistic regression analysis, an association was found between mortality and use of intravenous steroids (OR: 0.08, 95% CI 0.009 - 0.83, p = 0.35) and fever at admission (OR: 13.33 95% CI: 1.04 - 169.55, p = 0.046).Conclusion:While the association between TMA and SS is uncommon, so far 18 cases have been reported in the world medical literature. It is typically a condition of women age close to 50 years. The most frequent manifestations are neurological. Among the variables evaluated, only the use of endovenous steroids was associated with a decrease in the probability of mortality; on the contrary, the presence of fever at hospital admission increased the probability of death. The results should be evaluated with caution, since, due to the limited availability of information, they may not be generalizable to clinical practice. More information on this should be obtained in the future.Disclosure of Interests:None declared

Carotid artery web with fetal posterior cerebral artery variant masquerading as recurrent ipsilateral cryptogenic ischaemic strokes

2021 ◽  
Vol 14 (12) ◽  
pp. e246421
Author(s):  
Rohit Mehra ◽  
Vikram Patra ◽  
Rishi Dhillan
Keyword(s):  
Carotid Artery ◽  
Cerebral Artery ◽  
Internal Carotid ◽  
Medical Literature ◽  
Posterior Cerebral Artery ◽  
Surgical Excision ◽  
Patch Angioplasty ◽  
History Of ◽  
Carotid Artery Endarterectomy ◽  
Multidisciplinary Teamwork

A 31-year-old woman was referred to vascular surgeons with the history of recurrent ischaemic strokes in two cerebral artery territories over a span of 1 year. On investigation, she was found to have a right internal carotid artery web, with thrombus and a fetal right posterior cerebral artery (PCA), which explained the ischaemic strokes in right middle cerebral and PCA territory. The rare association of these two infrequent entities makes the case a singular one in the medical literature. Successful surgical excision was done after multidisciplinary teamwork. The carotid web was excised as part of carotid artery endarterectomy and repaired with great saphenous vein patch angioplasty. The patient made a good recovery.

In iodine-induced thyrotoxicosis, steroid therapy today could keep the surgical knife at bay

2018 ◽  
Vol 31 (5) ◽  
pp. 585-588 ◽  
Author(s):  
Rohan K. Henry ◽  
Monika Chaudhari
Keyword(s):  
Steroid Therapy ◽  
Medical Literature ◽  
Urinary Iodine ◽  
Thyroid Stimulating Hormone ◽  
Thyroid Function Tests ◽  
Case Presentation ◽  
Total Triiodothyronine ◽  
History Of ◽  
Daily Allowance

Abstract Background: Amiodarone-induced thyrotoxicosis (AIT) type 2, characterized as a destructive thyroiditis, is well described in the medical literature; however, iodine-induced thyrotoxicosis (IIT) is not, though the latter has similar features and can be managed similarly. Case presentation: We present a 17-year-old female who presented with a history of an intermittent goiter with thyroid function tests (TFTs): thyroid-stimulating hormone (TSH)<0.015 (0.4–4 μU/mL), free thyroxine (T4)≥6 (0.7–2.1 ng/dL) and total triiodothyronine (T3) 651 (50–200 mg/dL). Thyroid antibodies were all negative. Despite methimazole therapy for 6 weeks, hyperthyroidism proved refractory to medical management. 123I scan uptake was suppressed. With hyperthyroidism being recalcitrant to therapy, a nutritional history revealed consumption of an iodine supplement containing at least 7 times the recommended daily allowance (RDA) for 5 years, contributing to the Jod-Basedow phenomenon. Urinary spot and 24-hour urinary iodine were both elevated. Though a surgical consult was obtained, surgery was cancelled once TFTs improved and then normalized with steroid therapy. The TFTs and urinary iodine levels remained normal post steroid therapy. Conclusions: We suggest that in addition to the need for a thorough nutritional history, a trial of corticosteroids should be utilized in the management of IIT which can present with findings similar to AIT type 2 which is recalcitrant to thionamide therapy. If successful, corticosteroids may delay or prevent surgical management thus avoiding possible complications with the latter approach.

scholarly journals Late-Term Complications of COVID-19: Retropharyngeal Infection and Myocarditis in a 26-Year-Old Patient

2021 ◽  
Author(s):  
Mohammad Yousef Mohammad Yousef ◽  
Basel Abdelazeem ◽  
Atefeh Kalantary ◽  
Rebecca Pratiti
Keyword(s):  
Ventricular Dysfunction ◽  
Medical Literature ◽  
Acute Myocarditis ◽  
Late Complication ◽  
Viral Myocarditis ◽  
Left Ventricular ◽  
Severe Left Ventricular Dysfunction ◽  
Clinical Challenge ◽  
History Of ◽  
Tomography Scan

Deep neck space infection and viral myocarditis related to coronavirus disease 2019 (COVID-19) have both been described in the medical literature. However, there are only three reported cases of retropharyngeal infection as a presenting pathology in the setting of COVID-19. A 26-year-old woman presented to the emergency room with fever and neck swelling and pain 1 month after COVID-19 infection. A computed tomography scan of the neck demonstrated tonsillitis with retropharyngeal infection. She was also found to have heart failure with an ejection fraction (EF) of <20% due to acute myocarditis. Her infection resolved and the EF improved to 40% prior to discharge. Our case is the first to describe retropharyngeal infection as a late complication in an adult with a history of COVID-19 several weeks previously. It also presented a clinical challenge in terms of tailoring goal-directed medical therapy to manage severe left ventricular dysfunction caused by myocarditis.

scholarly journals Congenital urethral dilatation in cattle calves: Diagnosis and surgical intervention

2020 ◽  
Vol 13 (2) ◽  
pp. 261-265
Author(s):  
Magda Mahmoud Ali ◽  
Kamal Hany Hussein ◽  
Ahmed Sadek ◽  
Abdelbaset Eweda Abdelbaset
Keyword(s):  
Successful Outcome ◽  
Biochemical Tests ◽  
Local Infiltration Analgesia ◽  
Radiographic Findings ◽  
Local Infiltration ◽  
Urethral Dilatation ◽  
Bull Calves ◽  
Normal Diameter ◽  
History Of ◽  
Perineal Region

Background and Aim: Congenital anomalies of the urinary system are common affections in ruminants. Dilatation of the pelvic urethra is one of these affections in which the pelvic urethra dilated than normal diameter. This study aimed to explain the diagnosis and surgical treatment of urethral dilatation in cattle calves. Materials and Methods: Twenty-three bull calves (2-7 months old) were presented with a history of stranguria, tenesmus, and straining. Diagnosis of urethral dilatation was relied on the case history and clinical examination and was confirmed using survey and contrast radiography, ultrasonography, and biochemical tests. Treatment was done by urethrostomy under the effect of local infiltration analgesia. Results: Physical examination revealed the presence of an oval, firm, and painless swelling at the perineal region, starting just below the anus and extended to the base of the scrotum. The owners reported that the initial swelling size and severity of symptoms increased with the progress of animal age. Biochemical findings revealed non-significant changes in blood urea nitrogen and creatinine levels. Radiographic findings showed an oval radiopaque mass. However, a well-demarcated structure with acoustic enhancement was detected on ultrasonographic examination. Urethrostomy resulted in a successful outcome of all cases. Conclusion: Depending on these findings, ultrasonography is the most reliable diagnostic tool and urethrostomy is the intervention of choice with acceptable results for diagnosis and treatment of urethral dilatation in cattle calves, respectively.

Pipes, Colanders, and Leaky Buckets: Reflections on the Futility Debate

1993 ◽  
Vol 2 (2) ◽  
pp. 147-149 ◽  
Author(s):  
John J. Paris
Keyword(s):  
Patient Autonomy ◽  
Medical Literature ◽  
Medical Futility ◽  
The Other ◽  
Moral Basis ◽  
History Of

The issue of physician refusal of requested treatment has fueled a two-pronged debate in our society-one on the meaning of futility and the other on the limits of patient autonomy. The latter is a genuinely philosophic dispute; the former, it seems, is a modern relapse into nominalism.It is not the meaning of a word, but the moral basis for the actions of the par-ticipants that should be the focus of our attention, Yet the medical literature distracts us with articles titled “Medical Futility: Its Meaning and Ethical Implica-tions” “The Problem with Futility” “Who Defines Futility?,” “The Illusion of Futility,” and even “Beyond Futility.”The history of the futility debate, which was launched by a 1983 study of Bedell and Delbanco that demonstrated the ineffectiveness of CPR for certain catego-ries of patients, has been documented elsewhere. Here we will inquire if the term, and its rapid intrusion into the medical lexicon, serves a useful purpose or if, as Truog suggested, we would all be better off if this new buzzword were jettisoned.

O-140 Uterine septum: clinical implications on fertility and obstterics outcomes. A systematic review and meta-analysis

2021 ◽  
Vol 36 (Supplement_1) ◽  
Author(s):  
G Spagnol ◽  
G Bonaldo ◽  
M Marchetti ◽  
A Vitagliano ◽  
A S Laganà ◽  
...  
Keyword(s):  
Systematic Review ◽  
Birth Rate ◽  
Recurrent Miscarriage ◽  
Meta Analysis ◽  
Live Birth Rate ◽  
Reproductive Outcomes ◽  
Septate Uterus ◽  
History Of ◽  
Uterine Septum ◽  
Infertile Patients

Abstract Study question How does the septate uterus and his metroplasty influence pregnancy rate (PR), live birth rate (LBR), spontaneous abortion rates (SA) and preterm labour rates (PL)? Summary answer Uterine septum is associated with a poor reproductive outcome. Metroplasty reduce the rate of SA but non-conclusive evidence can be extrapolated about PR and PL. What is known already Different studies evaluated the correlation between uterine septum and reproductive outcomes. On one hand, studies reported its association with poor obstetrics outcomes. On the other hand, recent studies raised doubts about the effectiveness of septum metroplasty to improve reproductive outcomes, although recent position papers continue to propose metroplasty in patients with a septate uterus and a history of infertility or miscarriages. Debate is still ongoing on reproductive outcomes of uterine septum on infertile patients and especially on patients with recurrent miscarriage, leading to an unanswered question whether or not these women should be treated. Study design, size, duration Systematic review and meta-analysis of published studies that evaluated the clinical impact of uterine septum and its metroplasty on reproductive and obstetrics outcomes. The meta-analysis included study with infertile patients or patients with a history of recurrent miscarriage. Searches were conducted using the following search terms: uterine septum, septate uterus, metroplasty, pregnancy rate, live birth rate, spontaneous miscarriage, infertility, preterm delivery. Primary outcomes were PR and LBR. Secondary outcomes were SA and PL. Participants/materials, setting, methods The meta-analysis was written following the PRISMA guidelines. Fifty-nine full-text articles were preselected based on title and abstract. Endpoints were evaluated in three subgroups: 1) infertile/recurrent miscarriage patients with septum versus no septum 2) infertile/recurrent miscarriage patients with treated versus untreated septum 3) infertile/recurrent miscarriage patients before-after septum removal. Odds-ratios (OR) with 95% confidence intervals (CI) were calculated for outcome measures. Random-effect meta-analysis was performed and a p-value less than 0.05 was considered statistically significant. Main results and the role of chance Data from 37 articles were extracted. In the first subgroup (10 studies), a lower PR and LBR were associated with septate uterus vs. controls, respectively (OR 0.39, 95% CI 0.26 to 0.58; p &lt; 0.000; low-heterogeneity and OR 0.21, 95% CI 0.12 to 0.39; p &lt; 0.0001; small-heterogeneity) and a higher proportion of SA and PL was associated with septate uterus vs. controls, respectively (OR 4.17, 95% CI 2.83 to 6.15; p &lt; 0.000; moderate-heterogeneity and OR 2.18, 95% CI 1.27 to 3.76; p = 0.005; low-heterogeneity). In the second subgroup (8 studies), PR and PL were not different in removed vs. unremoved septum, respectively (OR 1.10, 95% CI 0.49 to 2.49; p = 0.82; moderate heterogeneity and OR 0.44, 95% CI 0.18 to 1.08; p = 0.08;low-heterogeneity) and a lower proportion of SA was associated with removed vs. unremoved septum (OR 0.40, 95% CI 0.17 to 0.95; p = 0.001; substantial-heterogeneity). In the third subgroup (19 studies), the proportion of LBR was higher after the removal of septum (OR 49.58, 95% CI 29.93 to 82.13; p &lt; 0.0001; moderate-heterogeneity) and the proportion of SA and PL was lower after the removal of septum, respectively (OR 0.02, 95% CI 0.02 to 0.04; p &lt; 0.000; moderate-heterogeneity and OR 0.05, 95% CI 0.03 to 0.08; p = &lt;0.000; low-heterogeneity). Limitations, reasons for caution The present meta-analysis is limited by the observational design of included studies because, in literature, there are no prospective randomized controlled trials (RCTs). In the second and third subgroup of analysis clinical heterogeneity within and between studies represents another limitation. Wider implications of the findings The results of this meta-analysis confirm the detrimental effect of uterine septum on PR, LBR, SA and PL. Its treatment seems to reduce the rate of SA. Metroplasty should still be considered as good clinical practice in patients with a history of infertility and recurrent abortion. Trial registration number Not applicable © The Author(s) 2020. Published by Oxford University Press on behalf of the European Society of Human Reproduction and Embryology. All rights reserved. For permissions, please e-mail: [email protected].

Traumatic Deaths from Dog Attacks in the United States

PEDIATRICS ◽  
1982 ◽  
Vol 69 (2) ◽  
pp. 193-196
Author(s):  
Lee E. Pinckney ◽  
Leslie A. Kennedy
Keyword(s):  
United States ◽  
Medical Literature ◽  
Elderly Women ◽  
The United States ◽  
Pet Dogs ◽  
History Of

A newspaper survey and search of the medical literature identified 74 deaths from dog attacks, 51 of which occurred in a designated five-year study period. Most attacks were by single pet dogs without a preceding history of viciousness and without known provocation by the victim. The highest number of deaths (23) occurred in infants less than 1 year of age. Most of the remaining victims were children aged 1 through 8 years, and elderly women.

Leiomyoma of the Male Urethra

2000 ◽  
Vol 124 (2) ◽  
pp. 302-303 ◽  
Author(s):  
Jose L. Mira ◽  
Guang Fan
Keyword(s):  
Urethral Stricture ◽  
English Language ◽  
Medical Literature ◽  
Medical Center ◽  
Male Urethra ◽  
Surgical Specimen ◽  
Cord Injury ◽  
History Of ◽  
The University ◽  
Epithelioid Leiomyoma

Abstract We describe the case of a 48-year-old quadriplegic black man with history of C4-C5 cervical spine and cord injury secondary to a fall, who presented to the University of Cincinnati Medical Center Urology Service with obstructive symptoms at urination. A bulbous urethral stricture was diagnosed and subsequently resected with primary urethral reanastomosis. On pathologic examination, the surgical specimen contained an epithelioid leiomyoma at the site of the urethral stricture. Although leiomyomas of the female urethra are relatively common, we identified only 2 previously reported cases of leiomyomas of the male urethra in the English-language medical literature. To the best of our knowledge, we describe the third case of leiomyoma of the male urethra, the first of the epithelioid type.

scholarly journals Attempted Suicide Pact by Married couple: A Case Study

2017 ◽  
Vol 5 (1) ◽  
pp. 49-52
Author(s):  
A. Risal
Keyword(s):  
Case History ◽  
Attempted Suicide ◽  
Medical Literature ◽  
Married Couple ◽  
Psychiatric Case ◽  
Double Suicide ◽  
History Of

Suicide pact or a double suicide refers to the joint, actively induced death of two individuals at approximately the same time by mutual consent. News regarding these incidents is often found in media though scarcely published in medical literature. We report a psychiatric case history of a couple who attempted a suicide pact.  

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