Pregnancy with myasthenia gravis.

Myasthenia gravis (MG) is an autoimmune disorder of the neuromuscular transmission, caused by auto antibodies against the nicotinic acetylcholine receptor. These antibodies of the IgG isotype are detected in 80-90% of generalized MG and in 50-70% of ocular MG. Seronegative MG is caused by humoral factors. Prevalence of MG lies between 1 in 10.000 and 1 in 50.000, with 2/3 of affected individuals being female. In the case of maternal myasthenia gravis, both the mother and the child may develop myasthenia symptoms with varying degrees of weakness and progressive fatigability of the skeletal muscles. Data for the case report were generated by reviewing labour, delivery, and postpartal records. We present a 26 years old lady who suffered from a generalized form of myasthenia gravis since the age of 15. She got herself admitted to a neurologic clinic for a myasthenic crisis when she was two and half months pregnant. The patient was treated with anticholinesterase medication, corticosteroids and intravenous immunoglobulin. Clinically, the patient's condition improved significantly during pregnancy. Delivery and the post delivery period were also normal for the patient. Myasthenia gravis especially when associated with pregnancy is a high-risk disease. As this disease predominantly occurs in women of reproductive age, it is important to be aware of this condition in obstetrics and its interdisciplinary diagnostic and therapeutic management is required.

Fatal sepsis due to Pseudomonas cepacia.

Pseudomonas cepacia is known as an opportunistic pathogen in the patients with altered host defence. We report a case of hospital-acquired fatal sepsis due to P. cepacia in a child with no known defect in immune system. Virulence of the organism was indicated by the high magnitude of septicaemia. The organism was successfully eliminated by ceftriaxone but the patient died of renal failure.

Maternal serum FDP and circulating fetal red cells throughout pregnancy. A longitudinal study.

The presence of fetal red cells in the maternal circulation and the serum FDP content of 73 women was followed serially throughout a normal pregnancy. There was a signigicant increase in the mean serum FDP levels in late pregnancy, which was due to episodic elevations occurring in approximately 65% of women. These transient elevations appeared to increase in frequency and severity as pregnancy progressed. There was also an increase in the number of occasions fetal red cells were detected in the maternal circulation in the later months of pregnancy, but his phenomenon did not appear to be associated in any way to the serum FDP elevations. It is concluded that the episodic rises in serum FDP occurring in normal pregnancy are not related to episodes of occult disseminated intravascular coagulation secondary to placental haemorrhage as was previously hypothesized. Their etiology and clinical significance remain unknown.

Urinary excretion of fibrinogen-related materials, complement, and immunoglobulins in proliferative glomerulonephritis and after renal transplantation.

Using a radial immunodiffusion technique we measured the urinary concentration of material related to complement (C3), IgM, and IgG along with fibrin-fibrinogen degradation products and heterophile (sheep) haemagglutinins in 15 patients with proliferative glomerulonephritis and in 10 patients after renal transplantation. There was a significant correlation between all variables measured, and serial studies showed that with the exception of IgG-related materials potentially useful information could be obtained on the detection of rejection and the response to treatment in both conditions. The significance of these observations is discussed.