ABSTRACT
Myotonic dystrophy is an autosomal-dominantly inherited neuromuscular disorder characterized by slowly progressive muscular dystrophy, muscle weakness and myotonia. The clinical features may vary from just cataracts to involvement of multiple organ systems such as various muscles, heart, lung and intestine. During pregnancy and delivery, serious maternal and obstetrical complications may occur. The myotonia is often aggravated during pregnancy and it leads to obstetrical complications such as fetal loss, preterm premature delivery, hydrops, in-utero fetal death, difficulties in fetal expulsion, postpartum hemorrhage and/or anesthetic accidents. The affected neonate may display severe hypotonia, facial displegia and respiratory distress. This report presents a woman with myotonic dystrophy complicated with congestive heart failure and preterm delivery during pregnancy.
Subject(s)
Female , Humans , Infant, Newborn , Pregnancy , Cataract , Edema , Estrogens, Conjugated (USP) , Fetal Death , Heart Failure , Intestines , Lung , Muscle Hypotonia , Muscle Weakness , Muscular Dystrophies , Myocardium , Myotonia , Myotonic Dystrophy , Obstetric Labor, Premature , Postpartum HemorrhageABSTRACT
OBJECTIVE: To evaluate the status of cone margins and severity of cervical neoplasia as predictors of residual lesions in the remaining cervices, and provide guideline for further treatment or close follow-up. METHOD: We performed a 3-year retrospective study and reviewed 95 patients who had undergone cervical conization followed by subsequent hysterectomy. RESULT: The prevalence rates of positive cone margins were 33, 50, 44, 71 and 88% respectively in patients with cervical intraepithelial neoplasia(CIN)II, CIN III, cervical cancer stage Ia1, Ia2 and Ib1. The prevalence rates of positive residual lesions in postcone hy-sterectomy specimens were 0, 31, 19, 29 and 59% respectively in patient with CIN II, CIN III, cervical cancer Ia1, Ia2 and Ib1. Residual lesions were significantly more frequently found in patients with positive cone margins(51%) than in those with negative margins(4.8%). Positive predictive values of margin status for the presence of residual lesions were 0, 56, 36, 40 and 67% respectively. Negative predictive values of margin status for the absence of residual lesions were 100, 94, 94, 100 and 100% respectively. CONCLUSIONS: (1) The prevalence of positive cone margin and residual lesion increased with more severe cervical neoplasia. (2) Positive cone margins had significantly higher risks of residual lesion than negative cone margins. (3) Positive cone margin does not invariably indicate the presence of residual lesion. (4) Negative cone margin does not ensure the absence of residual lesion. Subsequent hysterectomy may be reserved for the patient with CIN III or cervix cancer having positive cone margin or invasive lesion, or the patient who is not reliable for continuous follow-up.
Subject(s)
Humans , Conization , Follow-Up Studies , Hysterectomy , Prevalence , Retrospective Studies , Uterine Cervical NeoplasmsABSTRACT
A case of fetal supraventricular tachycardia which caused fetal hydrops was diagnosed at 29 weeks of gestation by fetal echocardiography. Transplacental fetal therapy with ma-ternal intravenous digoxin administration resulted in restoration of normal fetal sinus rhythm and disappearance of fetal hydrops on 7th day after initiation of treatment when the mat-ernal serum digoxin level was 2.11 ng/mL. The fetus showed normal sinus rhythm when evaluated by fetal echocardiography during the remainder of pregnancy with maternal oral digoxin maintenence. At birth, the infant did not show any cardiac arrhythmia and hydropic appearance.