ABSTRACT
Abdominal pregnancy is a rare localization of ectopic pregnancy. Early diagnosis and treatment are advised and the choice of treatment is crucial. A successful case of conservative treatment with combined systemic and intra-amniotic methotrexate is presented. This treatment option should be considered in the management of this potentially life-threatening condition.
Subject(s)
Abortifacient Agents, Nonsteroidal/administration & dosage , Abortion, Therapeutic/methods , Douglas' Pouch , Methotrexate/administration & dosage , Pregnancy, Abdominal/therapy , Adult , Female , Humans , Infusions, Parenteral , Injections, Intramuscular , Pregnancy , Pregnancy, Abdominal/diagnostic imaging , Ultrasonography, InterventionalSubject(s)
Abortifacient Agents, Nonsteroidal/therapeutic use , Methotrexate/therapeutic use , Placenta Accreta/drug therapy , Postpartum Hemorrhage/prevention & control , Abortifacient Agents, Nonsteroidal/administration & dosage , Adult , Female , Humans , Methotrexate/administration & dosage , Postpartum Period , Pregnancy , Treatment Outcome , Ultrasonography , Uterus/diagnostic imagingABSTRACT
OBJECTIVES: The aim of this study was to evaluate infantile cryptosporidiosis prevalence in central Tunisia. POPULATION AND METHODS: Stool samples from 34,020 immunocompetent children were investigated for oocysts through a 12-year study. RESULTS: Cryptotosporidia were detected in 0.32% (108) of samples. Ninety three per cent of children were less than five years old. Incidence was much higher in summer and autumn. Leading clinical symptoms were diarrhea, fever and vomiting. Symptoms spontaneously resolved in all patients. In three cases, infection was asymptomatic. CONCLUSION: Data analysis indicate that cryptosporidiosis is not uncommon in diarrheic central Tunisian children.
Subject(s)
Cryptosporidiosis/epidemiology , Adolescent , Child , Child, Preschool , Female , Humans , Incidence , Infant , Male , Prevalence , Retrospective Studies , Tunisia/epidemiologyABSTRACT
BACKGROUND/AIMS: The pathogenesis of thrombocytopenia associated with advanced liver disease is still controversial. To study the impact of portal decompression on this hematologic complication, we conducted a prospective, controlled study to compare the course of platelet counts in patients after implantation of a transjugular intrahepatic portosystemic shunt (TIPS) with matched controls without shunts. METHODS: Fifty-five TIPS patients and 110 controls matched for age, sex, Child-Pugh class, etiology of liver disease and baseline platelet count were included, and followed for 1 year. Follow-up visits were scheduled after 1 month, after 3 months, and at 3-month intervals thereafter. RESULTS: Nonparametric Mann-Whitney U-tests revealed significantly higher platelet counts for TIPS patients as compared to controls from the 1st through the 12th month (p<0.01). During the study period, the median platelet count of TIPS patients increased by 19.7%, from 104.0/nl (IR: 68.0) to 124.5/nl (IR: 41.0). In contrast, during the same period the median platelet count of controls decreased by 17.1%, from 102.5/nl (IR: 66.0) to 85.0/nl (IR: 67.5). In the group of cases with baseline platelet counts < or =100/nl, platelet counts had increased by at least 25% at month 12 in 65% of TIPS patients, but in only 5% of controls (p<0.001). However, normalization of platelet counts, i.e. > or =150/nl, was not achieved in any case. Neither the portosystemic pressure gradient after TIPS implantation, nor the percentage of portosystemic pressure gradient reduction during the procedure was predictive of platelet response. CONCLUSIONS: TIPS implantation increases platelet counts significantly. However, portal hypertension is clearly not the only mechanism contributing to thrombocytopenia in advanced liver disease.
Subject(s)
Liver Cirrhosis/blood , Liver Cirrhosis/surgery , Platelet Count , Portasystemic Shunt, Transjugular Intrahepatic , Adult , Aged , Blood Pressure/physiology , Female , Humans , Liver Cirrhosis/mortality , Liver Cirrhosis/physiopathology , Male , Middle Aged , Postoperative Period , Prospective StudiesABSTRACT
Implantation of a transjugular intrahepatic portosystemic shunt (TIPS) is associated with a broad spectrum of acute and chronic complications. Data concerning incidence and prognosis of these complications are conflicting but of great importance toward defining the role of TIPS relative to other therapeutic options. We conducted a prospective, uncontrolled cohort study in 53 patients to assess incidence, management and clinical outcome of complications occurring after TIPS procedure. Mean follow-up was 21.1 +/- 9.0 months. Technique-related mortality was 2%; 9% of patients died within 30 days after TIPS procedure. The overall survival rate after 18 months was 74%. The overall incidence of primary hepatic encephalopathy (HE) within the first year was 25%, and 77% of episodes could be managed successfully by medical treatment or implantation of a reducing stent. The rate of patients without rebleeding after 18 months was 84%. Rebleeding was associated with shunt abnormalities, and the bleeding was controlled by revision of the stent. Two patients died of variceal hemorrhage. The cumulative incidence of shunt stenosis or occlusion was 47% after 18 months. The technical success rate of shunt revision was 97%. TIPS implantation is associated with a considerable risk of HE and shunt stenosis or occlusion. Nevertheless most episodes of HE can be managed by medical treatment or implantation of a reducing stent. Angiographic revision of the stent is successful in nearly all cases of stenosis or occlusion. We therefore conclude that TIPS implantation in combination with careful follow-up examinations constitutes effective medium-term treatment of portal hypertension in a considerable proportion of patients.
