Monomicrobial necrotizing fasciitis complicating pregnancy and puerperium.

BACKGROUND: Necrotizing fasciitis is an uncommon, rapidly progressive, life-threatening infection involving the subcutaneous tissue and fascia. Usually, it is a synergistic polymicrobic infection that occurs in patients with coexisting factors predisposing them to bacterial inoculation and the spread of infection. CASES: We report a monomicrobial variant of necrotizing fasciitis affecting three otherwise healthy pregnant or postpartum women. The necrotizing fasciitis involved either the lower extremity or the abdominal wall. The causative bacteria were Streptococcus pyogenes (two cases) and Staphylococcus aureus (one). All patients presented with an acute fulminant infection, including one woman who died from overwhelming sepsis. CONCLUSION: These cases raise a question about the possible role of increased bacterial virulence and the immunologic changes of pregnancy as potential predisposing factors in the development of necrotizing fasciitis.

Urethral stones in women. A case report.

Urethral stones are encountered rarely in the urethra in women. We report the clinical and urodynamic findings and the management of 17 stones in a urethral diverticulum.

Reproducibility of pressure transmission ratios in stress incontinent women.

Pressure transmission ratios (PTR) are obtained during cough pressure profiles (delta urethral pressure/delta bladder pressure x 100) and have been extensively used in pre and post operative evaluation of patients with stress urinary incontinence. Sixteen patients with genuine stress were studied to assess the magnitude of PTR variance in incontinent women and how changes in bladder pressure impact on PTR. A marked variation in PTR was seen in individual patients with the coefficient of variation averaging 19.8%. Using linear regression analysis, 5 patients demonstrated a statistically significant relationship between bladder pressure and PTR. Only one of the five patients showed a decrease in pressure transmission with increased cough strength. The differences seen in PTR within individual patients make comparisons of single recordings at different times difficult to interpret.

Surgical management of stress incontinence in patients with low urethral pressure.

Thirty-four women with genuine stress incontinence and low urethral closure pressure were studied pre- and postoperatively. A modified Burch retropubic urethropexy was performed in 29 patients with a cure rate of 78%, improvement in 7%, and failure in 15%. The modified Stamey procedure was performed in 5 patients with significant pelvic floor relaxation with a cure rate of 40% and improvement in 60%. If urethral mobility is present, traditional anti-incontinence procedures appear to be a reasonable alternative in patients with low urethral pressure.

A practical approach to the painful bladder syndrome.

The painful bladder syndrome (PBS) is a progressive and painful disease of the bladder that may lead to fibrosis, contracture and reduction of bladder capacity. The usual symptoms are urinary urgency, frequency, nocturia, chronic pelvic pain and lower abdominal pain upon filling of the bladder. A retrospective analysis was performed on 21 women with PBS between March 1987 and March 1988. The patients were treated weekly with a bladder pillar block, bladder distention and dimethyl sulfoxide instillation. Symptomatic relief was observed in 80% of the patients so treated. The maximum bladder volume increased from 185 to 475 mL (P less than .01). The side effects were minimal.

Prenatal diagnosis of and midtrimester pathology with karyotype 46,XY,del(4)(q22q26). A case report.

A prenatal diagnosis of an interstitial deletion with chromosome 4,46,XY,del(4)(q22q26) was obtained on amniotic fluid cells drawn at 19 weeks' gestation from a 35-year-old gravida. Counseling on the basis of unusual or tenuous data is always difficult, but comparisons with similar deletions in 4q suggested a substantial risk of anomalies. A comparison of the postabortal autopsy findings with those from other reported cases of interstitial deletions of chromosome 4q suggested different pathology with this area of deletion than previously reported for other areas of 4q.

Gonadotropin-releasing hormone agonist inhibits physiologic ovarian follicular loss in rats.

To study the effect of long-term use of GnRH agonists on the number and size distribution of ovarian follicles, two experiments were performed on adult female rats. Treatment was continued for 52 days in Experiment 1 and for 229 days in Experiment 2. Every sixteenth section from one ovary of each rat was examined using a light microscope attached to a BioQuant image analysis computer system. In Experiment 3, control and previously treated rats were mated with known male breeders and the number and normalcy of the offspring evaluated. The results indicate that in rats treated with GnRH agonist: 1) the total number of follicles, the number and percentage of follicles less than 35 microns in diameter were significantly higher than in the control group: 2) the number and percentage of follicles greater than 50 microns in diameter were significantly lower than control: and 3) the number of rats that got pregnant and the litter size were not significantly different from control. We conclude that GnRH agonists inhibit the physiologic process of follicle recruitment and loss and that fertility is preserved after long-treatment administration of GnRH agonists.

Endometrial carcinoma presenting as a large inguinal mass.

Patients with endometrial cancer usually present with vaginal bleeding. A case of endometrial cancer presenting as an asymptomatic, large, inguinal mass is reported. This unusual clinical picture and its management are discussed.

Sickle cell E hemoglobinopathy and pregnancy.

The incidence of E hemoglobinopathies has been increasing in the United States. This is the first known case report of hemoglobin S/E in pregnancy. Management was based on the similarities of the S/E and S/beta-thalassemia hemoglobinopathies, and included partial exchange transfusion. Complications included fetal distress, congenital hydrocephalus, and cleft lip and palate. It appears that S/E and E/beta-thalassemia hemoglobinopathies may entail increased perinatal risks, but that favorable pregnancy outcomes may be anticipated with homozygous hemoglobin E or hemoglobin E trait.