Résumé
Strongyloides stercoralis is a soil transmitted intestinal nematode that is endemic in the tropical and subtropical regions. In most individuals who are infected, chronic, usually asymptomatic, gastrointestinal infection persists. But, in immunocompromized hosts or in patients receiving immunosuppressive therapy, autoinfection of S. stercoralis may result in the dissemination of larvae, leading to fatal hyperinfection and increased rate of complications. We report a case of hyperinfective strongyloidiasis with bacterial meningitis in a patient receiving steroid therapy. Strongyloidiasis was diagnosed by the presence of filariform larvae of S. stercoralis in the bronchoalveolar lavage cytology and upper gastrointestinal endoscopic biopsy specimen. Her clinical symptoms had progressively aggravated and developed bacterial meningitis during treatment. She died despite aggressive antibiotic and antihelminthic therapy.
Sujets)
Sujet âgé , Animaux , Femelle , Humains , Insuffisance surrénale/traitement médicamenteux , Liquide de lavage bronchoalvéolaire/parasitologie , Endoscopie gastrointestinale , Enterococcus faecium/isolement et purification , Sujet immunodéprimé , Muqueuse intestinale/anatomopathologie , Larve/physiologie , Imagerie par résonance magnétique , Méningite bactérienne/complications , Stéroïdes/effets indésirables , Strongyloides stercoralis/croissance et développement , Strongyloïdose/complicationsRésumé
A 33-year-old-woman with twin pregnancy underwent genetic amniocentesis in our hospital at 16 weeks of gestation. Fetal chromosomal analysis showed 46,XY,inv(9) and 47,XX,+21. The affected twin was terminated by ultrasonographically guided intracardiac injection of 3 ml potassium chloride solution at 19 weeks of gestation. A healthy 2570 g male infant was born by cesarean section with Apgar scores of 8 and 9 at one and five minutes, respectively.
Sujets)
Femelle , Humains , Nourrisson , Mâle , Grossesse , Grossesse , Amniocentèse , Césarienne , Syndrome de Down , Chlorure de potassium , Deuxième trimestre de grossesse , Grossesse gémellaire , Jumeaux dizygotesRésumé
OBJECTIVES: Estimation of the anterior lower uterine segment (LUS) thickness difference who underwent prior cesarean delivery measured with transvaginal sonography at or after 36 gestational weeks (sonographic thickness) and a ruler during elective cesarean section (operation thickness) Methods: One hundred sixty women who underwent prior cesarean delivery had the thickness of their LUS measured with transvaginal sonography at or after 36 gestational weeks. The LUS thickness was measured with a ruler during elective cesarean section. We compared group I whose LUS was fairly well visualized 4 cm or more from the uterine cervix to group II which had less than 4 cm. RESULTS: The mean sonographic thickness of LUS was 1.7 0.8 mm and that of operation thickness was 1.9 0.5 mm. The mean difference of the two (thickness difference) was 0.5 0.5 mm. In 31.3% the sonographic thickness was same as the operation thickness and in 70.7% of the total with 0.5 mm or less difference, the sonographic thickness could be regarded as accurate. The thickness difference with the sonographic thickness with 2 mm or more was smaller than those with 1 mm or less (0.4 0.5; 0.6 0.6) and that of group I was smaller than that of group II (0.4 0.4; 0.9 0.6) (p< .05). CONCLUSION: The thickness difference was 0.5 0.5 mm and it was smaller when the LUS thickness is 2 mm or over, clearly visible 4 cm or over from the cervix.
Sujets)
Femelle , Humains , Grossesse , Col de l'utérus , Césarienne , Cicatrice , ÉchographieRésumé
OBJECTIVE: Some vaginal procedures may be safer, easier and more successful if they could be done under direct sonographic vision of the object. METHODS: All the procedures were done under the guidance of transrectal sonography. Suction curettage, after using curved plastic Karman's cannula, additional curettage was done only when there was probable remaining conceptal tissue seen on sonography. If additional curettage was needed curved metal cannula made in the same form as plastic Karman's cannula is used first and then usual metal curette if the former did not work. A high frequency cautery unit was used for myolysis. Insertion of the flexible curved cautery tip into the myoma mass was done through the uterine cavity and coagulation of the myoma tissue was performed. Myoma biopsies were done with thin loop high frequency cautery tip through laparoscopy and the vagina. RESULTS: Suction curettage in 156 cases of early pregnancy and 2 cases of previous cesarean incision site pregnancy, D&C in 11 cases, chorionic villus sampling in 13 cases, polypectomy in 1 case, myolysis in 1 case and myoma biopsy in 2 cases were done. CONCLUSION: Performing some vaginal procedures under the guidance of transrectal sonography may be better.
Sujets)
Femelle , Grossesse , Biopsie , Cathéters , Cautérisation , Prélèvement de villosités choriales , Curetage , Dilatation et curetage , Laparoscopie , Myome , Matières plastiques , Échographie , Curetage aspiratif , VaginRésumé
Correct discrimination of the first and the second twin is important. Case: (1) The first fetus, whose amnionic cavity was closest to the cervix at 19 weeks, even though its body was higher than the second fetus, was found to be closer to the cervix by 23 gestational weeks than its twin. (2) The result of the chromosomal study of dichorionic twins at 17 gestational weeks was male with 9 inversion of the presumed first, and female with trisomy 21 of the presumed second. AT 19 gestational weeks, the sex and order of the two were found to be reversed at sonography for selective termination. In diamnionic twins, the fetus in the amnionic sac closest to the cervix is nominated as the first.