ABSTRACT
Myositis ossificans progressiva is a rare autosomal dominant disorder characterized by a progressive ectopic ossification of the connective tissue of the voluntary muscles and ligaments with associated debilitation and characteristic skeletal malformations. There have been less than 600 cases in the literature. This is the first reported case of a viable pregnancy in a patient with myositis ossificans progressiva.
Subject(s)
Myositis Ossificans/physiopathology , Pregnancy Complications/physiopathology , Adult , Female , Humans , PregnancyABSTRACT
A case is reported of rupture of the uterus after intraamniotic injection of prostaglandin F2 alpha followed by intravenous oxytocin. The literature is reviewed and the management discussed.
PIP: A 34-year old Puerto Rican woman gravida 8, para 5, abortions 1, miscarriage 1, living children 4 admitted to the New York Hospital-Cornell Medical Center for prostaglandin abortion had a delayed diagnosis of rupture of the left uterine artery. The delay in diagnosis was attributed to the intraligamentous and retroperitoneal location of the hematoma. The bleeding was controlled by performing a supracervical hysterectomy and ligation of the left hypogastric artery. The patient recovered uneventfully. Rupture of the uterus is a less common occurence than cervical lacerations, which occur in 1% to 2% of 2nd trimester abortions and most frequently among young primigravidas. Uterine rupture occurs mostly in multiparous women and does not appear to be prevented by laminaria tents. Uterine rupture at term following oxytocin induction has been related with multiparous patients. Uterine rupture has also ben observed following induction of midtrimester abortion with intraamniotic hypertonic saline or prostaglandin analogs, and the dilatation and evacuation method. Of 12 documented cases of uterine ruptures after saline/prostaglandin-induced abortion, 11 necessitated hysterectomy and 2 patients died from blood loss. Management of oxytocin and prostaglandin-induced abortion is briefly discussed.
Subject(s)
Abortion, Induced/adverse effects , Prostaglandins F/administration & dosage , Uterus/injuries , Adult , Female , Humans , Oxytocin/administration & dosage , Oxytocin/adverse effects , Pregnancy , Pregnancy Trimester, Second , Prostaglandins F/adverse effects , RuptureABSTRACT
Sacral colpopexy has become the treatment of choice for post-hysterectomy vaginal vault prolapse at the New York Hospital--Cornell Medical Center. A review of the institutional experience with this technique since 1972 indicates that 20 of 21 patients obtained good vaginal support and preservation of functional capabilities with minimal complications.
Subject(s)
Postoperative Complications/surgery , Sacrum/surgery , Uterine Prolapse/surgery , Aged , Female , Humans , Hysterectomy , Methods , Middle Aged , Uterine Prolapse/etiologyABSTRACT
The association of unilateral tubo-ovarian abscess and the presence or use of an intrauterine contraceptive device (IUD) appears to be a definite clinical entity. Four cases of unilateral tubo-ovarian abscess in patients using the IUD are presented. Three patients had a Dalkon Shield IUD and one had a Lippes Loop. Two patients had unilateral salpingo-oophorectomy while the other 2 had total abdominal hysterectomy and bilateral salpingo-oophorectomy. The differential diagnosis, possible etiology, route and mode of infection, and management are discussed.
PIP: 4 cases of unilateral tuboovarian abscess in patients using an IUD are presented; 3 of the 4 patients had a Dalkon shield and 1 had a Lippes loop. These cases present the problem of diagnosis and treatment as the presence of pelvic mass in an IUD user may be due to an ectopic pregnancy, ovarian cyst, or a pelvic or tuboovarian abscess. Unruptured tuboovarian abscess requires conservative treatment with antibiotics initially and surgery if there is an unsatisfactory response. These patients display a high fever and purulent cervical discharge. An ascending infection is associated with IUD use and recent investigations implicate the tail, especially the compound variety. Trauma to the endometrium by the IUD may initiate the infection and the finlike projections of the IUD may cause further trauma. The connection of unilateral tubooovarian inflammatory mass with the IUD user should alert more clinicians to this possibility.
Subject(s)
Abscess/etiology , Fallopian Tubes , Genital Diseases, Female/etiology , Intrauterine Devices/adverse effects , Ovarian Diseases/etiology , Abscess/drug therapy , Abscess/surgery , Adult , Ampicillin/therapeutic use , Clindamycin/therapeutic use , Female , Genital Diseases, Female/drug therapy , Genital Diseases, Female/surgery , HumansABSTRACT
Four cases of water intoxication in connection with oxytocin administration during saline-induced abortions are described. The mechanism of water intoxication is discussed in regard to these cases. Oxytocin administration during midtrimester-induced abortions is advocated only if it can be carried out under careful observations of an alert nursing staff, aware of the symptoms of water intoxication and instructed to watch the diuresis and report such early signs of the syndrome as asthenia, muscular irritability, or headaches. The oxytocin should be given only in Ringers lactate or, alternately, in Ringers lactate and a 5 per cent dextrose and water solutions. The urinary output should be monitored and the oxytocin administration discontinued and the serum electrolytes checked if the urinary output decreases. The oxytocin should not be administered in excess of 36 hours. If the patient has not aborted by then the oxytocin should be discontinued for 10 to 12 hours in order to perform electrolyte determinations and correct any electrolyte imbalance.
