Amniotic fluid embolism-apropos two consecutive cases.

Amniotic fluid embolism (AFE) is a sporadic, unpredictable, and usual fatal obstetric complication. The paper deals with two cases of maternal deaths because of AFE verified by medicolegal autopsy. In both the cases, several known risk factors associated with AFE, such as increased maternal age (41 and 35 years), diabetes, augmented labor, and cesarean delivery, were identified. Clinical features were typical, including sudden onset of cardiovascular and respiratory symptoms. In the patient who survived longer, both clinical and autopsy signs of disseminated intravascular coagulopathy were present, while they were absent in the case where death occurred rapidly. This paper describes briefly the particular features to look for at autopsy and stresses the importance of histology examination and staining techniques.

[Did we forget tetanus?]. / Da li smo zaboravili tetanus?

INTRODUCTION: Currently, in our country (Republic of Serbia) tetanus is a rarely occurring disease, mainly affecting people older than 65 years of age. A small number of reported cases is mainly due to appropriate immunization. Therefore, each case of tetanus may be considered as failure of health care system to provide adequate immunization. CASE OUTLINE: A 71-year-old woman was injured in her garden. She sustained laceration in the left coccygeal region. The next day the wound was treated by a surgeon, but tetanus postexposure prophylaxis was not administrated. On the fifth day following the incident, the symptoms and signs of tetanus became apparent, and the patient died two days later. Postmortem examination revealed the wound that was not adequately treated, since there was a foreign body and a dressing inserted in the wound. Signs of acute (aerobic) infection were also present. CONCLUSION: Tetanus is a severe, potentially lethal disease that is absolutely preventable. Mistakes in immunization and surgical treatment of the wound can be considered as medical malpractice.

[Vascular gastric anomalies as a cause of relapsing bleeding].

BACKGROUND: Although relatively rare, gastric vascular anomalies can be recognized as a source of both chronic and acute blood loss, most often presenting as long term iron deficiency anemia, rarely as severe acute gastrointestinal bleeding. CASE REPORT: We present five patients with various gastric vascular anomalies, diagnosed during the year of 2003. in the Clinical Hospital Center Zemun. The diagnosis was based on endoscopic appearances, clinical history and characteristic histological findings. Gastric vascular anomalies presented in our review were: portal hypertensive gastropathy, gastric antral vascular ectasia, angiodysplasia, hereditary hemorrhagic telangiectasia and Dieulafoy lesion. The used treatment modalities included surgery and various endoscopic techniques (schlerotherapy, argon plasma coagulation). CONCLUSION: Patients presented with chronic iron deficiency anemia or acute and recurrent gastrointestinal hemorrhage should be considered as having one of gastric vascular anomalies.

[Leiomyomas and massive digestive hemorrhages--case reports of patients diagnosed in 2004].

INTRODUCTION: During 2004, there were 6 patients with leiomyomas diagnosed and treated at the Department of Gastroenterology and Clinical Pathology of the Zemun Clinical Center. The most common location of these benign submucosal tumors is stomach, followed by small intestine and large intestine. CASE REPORT: The most common symptoms of these patients were massive intestinal hemorrhage, with haematemesis and melaena. Hemorrhages resulted from superficial lesions, caused by pressure of the tumour on the intestinal blood vessels. A significant contribution in reaching the final diagnosis and selecting appropriate therapeutic approach was provided by CT and arteriography. Most patients underwent surgical treatment, which provided precise diagnosis (based on histopathologicalfindings), and at the same time a definite therapeutic procedure. DISCUSSION AND CONCLUSION: According to the literature data, gastrointestinal leiomyomas account for 20%-30% of all types of gastrointestinal tumors. Our research revealed that the incidence of leiomyomas was significantly lower within our group of patients, accounting for 12% of all benign gastrointestinal tumors. They were also the main cause of hemodynamic instability in our patients having massive and recurrent intestinal hemorrhages, which is not often seen in practice. All of them originated either from muscularis propria or muscularis mucosae. These tumors are often an accidental finding at autopsy, especially if they are smaller than 3 centimeters and not followed by consequential complications. Presently, endoscopic ultrasonography is considered to be the the most accurate procedure in the diagnosis of leiomyoma, with a diagnostic specificity that is superior to other imaging techniques.