ABSTRACT
A spinal intradural hemorrhage due to a neurinoma is very rare and requires emergency surgery. We report the first case of a spinal intradural hemorrhage due to a neurinoma in an early puerperal woman. The patient had a history of intermittent episodes of lower back pain for 3 years. The antenatal course to that time had been uneventful. Two days after a normal vaginal delivery, she presented with sudden onset of spinal lesion with severe symptoms and an emergency laminectomy was performed to remove an intradural hemorrhagic lesion due to a neurinoma. In this case, we speculate that clots in the intratumoral vessels spontaneously occurred during pregnancy and obstructions of these vessels followed by necrosis and hemorrhage of distal tissues occurred in the early postpartum stage. Moreover, the change in posture caused by the change in the maternal center of gravity following delivery, as well as the frequent bending required for the care of the newborn, may have been contributing factors. Mild but repetitive traction force caused by the change in posture and frequent bending may have created exertion on the vascular attachment to the nerve roots, causing the intradural hemorrhage.
Subject(s)
Hemorrhage/etiology , Neurilemmoma/complications , Pregnancy Complications, Neoplastic/pathology , Puerperal Disorders/etiology , Spinal Cord Diseases/etiology , Spinal Cord Neoplasms/complications , Adult , Female , Humans , Neurilemmoma/surgery , Posture , Pregnancy , Pregnancy Complications, Neoplastic/surgery , Puerperal Disorders/pathology , Spinal Cord Neoplasms/surgeryABSTRACT
PROBLEM: There are few reports on the association between autoimmune hepatitis (AIH) and antiphospholipid syndrome; only five reports were found on a MEDLINE search between 1966 and 2001. Therefore, the etiology and the optimal treatment of them are not clear. METHOD OF STUDY: We encountered a case of AIH complicated by antiphospholipid syndrome in pregnancy. We present the clinical course and treatment of this case, and discuss some problems in managing such a patient. RESULTS: The patient received low-dose prednisolone and low-dose aspirin and delivered a live-born infant at term without any adverse effects. CONCLUSION: In this case, there was no relation between the variation of alanine aminotransferase (ALT) and the one of beta2-glycoprotein I (GPI)-dependent anticardiolipin antibody. It is supposed that there was no relation between the activity of AIH and the one of antiphospholipid syndrome, and it is also supposed that one is not secondary to the other.
Subject(s)
Antiphospholipid Syndrome/drug therapy , Hepatitis, Autoimmune/complications , Pregnancy Complications/drug therapy , Adrenal Cortex Hormones/therapeutic use , Adult , Antiphospholipid Syndrome/etiology , Female , Humans , Infant, Newborn , Male , Pregnancy , Pregnancy Complications/etiologyABSTRACT
A 76-year-old woman with stage IIb cervical cancer with a bulky tumor experienced aortitis during continuous intraarterial cisplatin-based chemotherapy. The chemotherapy was administered through a catheter tip placed in the aorta abdominalis, utilizing an external infusion pump. During the third course of chemotherapy, she complained of left-sided lower back pain and moderate fever was observed. Elevated white blood cell count (WBC) and C-reactive protein (CRP) level were noted, and an abdominal X-ray and urgent computed tomography (CT) were performed. The catheter tip was displaced against the arterial blood flow. At this level of the aortic wall, soft tissue density surrounded the aorta completely. Aortitis caused by the intraarterial chemotherapy, was strongly suspected. It was thought that the maldistribution of drugs and changes in the drug flow occurred due to the vertebral height movement of the catheter tip against the aortic blood flow, and there, flow to the vasa vasorum may have occurred. Chemical vasculitis of the vasa vasorum due to the anticancer drugs was strongly suspected as a contributing factor of the aortitis. Because of the long-term use of an intraarterial catheter, the maldistribution of drugs and changes in the drug flow occurred physically and biologically during the course of the chemotherapy. We recommend occasional monitoring of the location of the catheter tip and a repeat evaluation with contrast medium in regard to flow to the vasa vasorum.
Subject(s)
Antineoplastic Agents/administration & dosage , Aortitis/diagnosis , Carcinoma, Squamous Cell/drug therapy , Catheterization/adverse effects , Cisplatin/administration & dosage , Uterine Cervical Neoplasms/drug therapy , Aged , Antineoplastic Agents/adverse effects , Aortitis/chemically induced , Aortitis/diagnostic imaging , Carcinoma, Squamous Cell/diagnostic imaging , Carcinoma, Squamous Cell/pathology , Cisplatin/adverse effects , Diagnosis, Differential , Female , Humans , Infusions, Intra-Arterial/adverse effects , Magnetic Resonance Imaging , Neoplasm Staging , Tomography, X-Ray Computed , Uterine Cervical Neoplasms/diagnostic imaging , Uterine Cervical Neoplasms/pathologyABSTRACT
Large uterine myomas (compressed veins in the pelvis), and the resulting impaired blood flow have been associated with deep vein thrombosis and pulmonary embolism. Careful detection of the preoperatively formed thrombi and strict perioperative management, such as in the following cases we report, may reduce lethal pulmonary embolism and may positively affect patient prognosis.
