ABSTRACT
A 22-year-old gravida II, para I, with a twin pregnancy was diagnosed with placenta praevia totalis et percreta in 25 GW. After consideration of various modes of delivery a C-section was performed with retention of the placenta percreta in situ when vaginal bleeding occured in 28 GW. Following 8 dosages of methotrexate given on an outpatient basis, the patient suddenly developed acute renal failure necessitating dialysis. This was due to a bilateral renal cortical necrosis after disseminated intravasal coagulation based on a massive accumulation of trophoblastic tissue.
ABSTRACT
OBJECTIVE: To assess the effects of chronic xerostomia on parameters of gastroesophageal reflux and esophagitis. DESIGN: Observational study of a cohort of male patients with xerostomia and age-matched control subjects. SETTING: Tertiary-care Veterans Affairs Medical Center. SUBJECTS: Sixteen male patients with chronic xerostomia secondary to radiation for head and neck cancers or medications. Nineteen age-matched male control subjects with comparable alcohol and smoking histories. MEASUREMENTS AND MAIN RESULTS: Esophageal motility was similar in patients with xerostomia and controls. Clearance of acid from the esophagus and 24-hour intraesophageal pH were markedly abnormal in patients with xerostomia. Symptoms and signs of esophagitis were significantly more frequent in subjects with xerostomia. CONCLUSIONS: Chronic xerostomia may predispose to esophageal injury, at least in part, by decreasing the clearance of acid from the esophagus and altering 24-hour intraesophageal pH. Esophageal injury is a previously unreported complication of long-term salivary deficiency.
Subject(s)
Esophageal Diseases/etiology , Gastroesophageal Reflux/etiology , Xerostomia/complications , Chronic Disease , Esophageal Diseases/physiopathology , Esophageal Motility Disorders/etiology , Esophagitis, Peptic/diagnosis , Esophagitis, Peptic/etiology , Esophagoscopy , Head and Neck Neoplasms/radiotherapy , Humans , Hydrogen-Ion Concentration , Male , Manometry , Middle Aged , Monitoring, Physiologic , Radiation Injuries/complications , Xerostomia/pathologyABSTRACT
Localizing active sites of bleeding within the small intestine remains a difficult task. Endoscopic, angiographic or scintigraphic studies may point to the small intestine as the site of blood loss, but at operation, without a palpable lesion, the exact site of bleeding remains elusive. Patients are managed at laparotomy with intraoperative endoscopy, angiography, multiple enterotomies, "blind" resections, or placement of an enterostomy. We describe two patients in whom intraoperative scintigraphy accurately identified active sites of bleeding in the small intestine when other modalities failed. Intraoperative scintigraphy is rapid, easy to perform and is an effective means of identifying active sites of bleeding within the small intestine.
Subject(s)
Gastrointestinal Hemorrhage/diagnostic imaging , Jejunal Diseases/diagnostic imaging , Aged , Erythrocytes , Female , Gastrointestinal Hemorrhage/etiology , Gastrointestinal Hemorrhage/surgery , Humans , Ileal Diseases/diagnostic imaging , Ileal Diseases/surgery , Intraoperative Period , Jejunal Diseases/surgery , Male , Radionuclide Imaging , TechnetiumABSTRACT
In a representative sample (n = 358) 18.4% of the children aged 3 to 14 were classified as having psychiatric disorders, mostly special symptoms (13.4%) (ICD 307). Using the multiaxial classification of child psychiatric disorders developed by Rutter et al. (1), connections between a psychiatric diagnosis on the one hand and developmental delays, medical conditions and abnormal psychosocial circumstances on the other are pointed out. Finally, the situation regarding help for children with psychiatric disorders is discussed. Only 2.0% of the children were receiving treatment for such conditions.
Subject(s)
Child Behavior Disorders/epidemiology , Mental Disorders/epidemiology , Rural Population , Adolescent , Child , Child Behavior Disorders/therapy , Child Development , Child, Preschool , Cross-Sectional Studies , Female , Germany, West , Humans , Male , Mental Disorders/therapy , Risk Factors , Social EnvironmentSubject(s)
Intelligence , Language Development , Social Class , Social Environment , Adolescent , Child , Child, Preschool , Humans , RiskABSTRACT
Published results from in vivo experiments carried out in Rhesus monkeys and from in vitro perfusions of human term placentas have indicated that placental estradiol (E2) is preferentially released towards the mother whereas estrone (E1) is about evenly distributed between fetal and maternal circulation. In order to examine the distribution of estriol, relative to that of E1 and E2, we have now prepared [3H]16-hydroxyandrostenedione by incubation of [6,7-3H]androstenedione with Streptomyces roseochromogenus and perfused placental cotyledons with mixtures of these two labeled precursors. Measurement of the concentrations of tritiated E1, E2 and E3 in the maternal and fetal perfusates, flowing at approx 10 and 5 ml/min, respectively, indicated that the distribution of E3 is different from that of E2 and resembles the distribution of E1. The simple perfusion system being used shows differences in the distribution of various estrogens between fetal and maternal perfusates which may reflect the in vivo situation and offers the opportunity for experimental examination of various explanations for these differences, e.g. existence of specific carrier systems in the syncytial membranes, specific binding of the estrogens to secreted placental proteins, and actions of placental and decidual 17 beta-hydroxysteroid dehydrogenases.
Subject(s)
Estradiol/metabolism , Estriol/metabolism , Estrone/metabolism , Placenta/metabolism , Androstenedione/analogs & derivatives , Androstenedione/metabolism , Ethinyl Estradiol/pharmacology , Female , Humans , In Vitro Techniques , Perfusion , Pregnancy , Time Factors , Tissue DistributionABSTRACT
The treatment of children and juveniles with psychiatric disorders is seen as a problem of case identification. Paediatricians and general practitioners can treat behavior disorders of best together with a child psychiatrist.
Subject(s)
Child Behavior Disorders/therapy , Mental Disorders/therapy , Pediatrics , Physicians, Family , Adolescent , Ambulatory Care , Child , Child Psychiatry , Child, Preschool , Humans , Interprofessional RelationsSubject(s)
Language Development , Speech Articulation Tests , Speech Production Measurement , Child , Child, Preschool , Female , Germany, West , Humans , MaleABSTRACT
The paper summarizes the most important findings of an epidemiological investigation in child psychiatry on the incidence of psychic disturbances and behavioral pecularities in patients aged from 3 to 14 years. Connections between psychic disturbances and behavioral peculiarities on the one hand and developmental residues, bodily symptoms and abnormal psychosocial circumstances on the other are pointed out. Finally the situation regarding provisions for psychically disturbed children and those with behavior peculiarities is discussed.
