ABSTRACT
Adenocarcinoma of the endometrium with intrauterine pregnancy is extremely rare. We report the case of a 35-year-old woman with endometrial cancer discovered in the 7th gestational week. A therapeutic abortion was performed and because of bleeding and spotting dilatation and curettage was done 10 days later. Histology revealed adenocarcinoma in addition to products of conception. Hysterectomy and bilateral salpingo-oophorectomy was performed 3 weeks after intracavitary radiotherapy. Because of superficial myometrial infiltration demonstrated microscopically, the patient received intravaginal and external radiation postoperatively. She remains well 1 year after diagnosis.
Subject(s)
Adenocarcinoma/diagnosis , Endometrial Neoplasms/diagnosis , Pregnancy Complications, Neoplastic/diagnosis , Abortion, Therapeutic , Adenocarcinoma/pathology , Adenocarcinoma/therapy , Adult , Endometrial Neoplasms/pathology , Endometrial Neoplasms/therapy , Fallopian Tubes/surgery , Female , Humans , Hysterectomy , Ovariectomy , Pregnancy , Pregnancy Complications, Neoplastic/pathology , Pregnancy Complications, Neoplastic/therapy , RadiotherapyABSTRACT
In vivo platelet aggregation was determined in pregnant women at different gestational ages and nonpregnant women by a modification of a method. A higher platelet count ratio (PCR) was found in pregnant women after a gestational age of 13 weeks. At 16-30 and 31-41 weeks of gestation, in vivo platelet aggregation was significantly decreased. The PCR, meaning the ratio of non-aggregated platelets to all circulating platelets, correlated significantly with gestational age. It is suggested that the decrease in in vivo aggregation measured during pregnancy reflects a summarized effect of different factors during pregnancy connected to placenta and uteroplacental vessels.
Subject(s)
Platelet Aggregation , Pregnancy/blood , Adolescent , Adult , Female , Humans , Platelet Count , Pregnancy Trimester, First , Pregnancy Trimester, Second , Pregnancy Trimester, ThirdABSTRACT
Of 156 stroke patients prospectively and consecutively evaluated, one-third had a homonymous hemianopia. Of those 52 patients, 46% had a horizontal conjugate gaze paresis at the time of presentation. This gaze paresis was most commonly seen with large hemispheric stroke. The overall prognosis in patients with a gaze paresis was poor. The 30-day case fatality rate was 49% which was significantly higher than for stroke patients presenting with homonymous hemianopia without a gaze paresis.
Subject(s)
Brain Ischemia/complications , Hemianopsia/etiology , Aged , Female , Humans , Male , Middle Aged , PrognosisABSTRACT
Of 171 patients evaluated prospectively and consecutively for cerebral ischemia, 26 (15%) developed symptoms while hospitalized. Cerebral ischemia complicated operative procedures in 12 patients, unsuccessful cardioversion in one and coronary angiography in another. Twelve patients had apparent cerebral embolism and 14 patients had cerebral thrombosis as a mechanism of their symptoms. Hospitalized patients who suffered cerebral ischemia had one or more of the following: risk factors for stroke including cardiac source of embolus, previous stroke, diagnostic or therapeutic procedures for vascular disease, or chronic hypertension complicated by acute hypotension.
Subject(s)
Brain Ischemia/etiology , Hospitalization , Adult , Aged , Cerebral Infarction/complications , Cerebrovascular Disorders/etiology , Female , Heart Diseases/complications , Humans , Hypertension/complications , Iatrogenic Disease , Intracranial Embolism and Thrombosis/complications , Male , Middle Aged , Prospective Studies , Risk , Vascular Diseases/complicationsABSTRACT
The frequency of recurrent cerebral ischemia and death was determined prospectively in 36 patients who presented with ischemic stroke and had atrial fibrillation. Patients were followed an average of 2.3 months (range, 3 weeks to 9 months). The recurrence rate for cerebral ischemia was 33%, and the mortality rate was 22%. A beneficial effect of anticoagulation, given nonrandomly, was observed when we compared treated versus untreated patients followed for a similar length of time. Nine patients (25%), however, had CT evidence of hemorrhage associated with cerebral embolic infarction.
Subject(s)
Atrial Fibrillation/complications , Ischemic Attack, Transient/complications , Aged , Anticoagulants/adverse effects , Anticoagulants/therapeutic use , Atrial Fibrillation/drug therapy , Cerebral Hemorrhage/complications , Cerebral Infarction/complications , Female , Humans , Ischemic Attack, Transient/drug therapy , Ischemic Attack, Transient/etiology , Male , Middle Aged , Prospective Studies , RiskABSTRACT
Two patients with manifestations of cerebral ischemia were found to have a circulating coagulation inhibitor. This immunoglobulin, termed lupus anticoagulant, results in a prolonged partial thromboplastin time. Paradoxically, it is usually associated with a thrombotic tendency rather than a bleeding diathesis. It is most commonly found in systemic lupus erythematosus, which our patients did not have. These two patients represent the interesting phenomenon of cerebral ischemia in the presence of an endogenous inhibitor of coagulation.
Subject(s)
Blood Coagulation Factors/antagonists & inhibitors , Ischemic Attack, Transient/blood , Blood Coagulation Factors/blood , Humans , Lupus Coagulation Inhibitor , Male , Middle AgedABSTRACT
Downbeat nystagmus is generally the result of a structural lesion at the craniocervical junction. It has rarely been reported as a manifestation of metabolic disease or drug intoxication. We observed two patients with downbeat nystagmus secondary to phenytoin (Dilantin) intoxication. Both individuals had other features of phenytoin-induced central nervous system dysfunction with toxic blood levels of the drug (greater than 20 micrograms/ml). Complete resolution of the downbeat nystagmus followed the return of phenytoin levels to the therapeutic range.
