ABSTRACT
BACKGROUND: Adrenal oncocytomas are uncommon, nonfunctioning tumors occurring most often in endocrine organs. CASE: A 32-year-old woman presented at 25 weeks' gestation complaining of right flank pain. Abdominal ultrasonography and computed tomography revealed a 9 x 10-cm solid right-sided adrenal mass. Endocrine evaluation was normal. At 36 weeks' gestation, she underwent cesarean followed by resection of the adrenal mass. Histopathologic and ultrastructural studies revealed a benign adrenocortical oncocytoma. CONCLUSION: Although rare, adrenocortical oncocytomas should be included in the differential diagnosis of solid, nonfunctioning, adrenal tumors in pregnancy.
Subject(s)
Adenoma, Oxyphilic , Adrenal Cortex Neoplasms , Pregnancy Complications, Neoplastic , Adenoma, Oxyphilic/diagnosis , Adenoma, Oxyphilic/epidemiology , Adrenal Cortex Neoplasms/diagnosis , Adrenal Cortex Neoplasms/epidemiology , Adult , Female , Humans , Pregnancy , Pregnancy Complications, Neoplastic/diagnosis , Pregnancy Complications, Neoplastic/epidemiologyABSTRACT
OBJECTIVE: To study the funic thyroid hormone levels in cases were fetal distress during labor resulted in acidemia at birth. MATERIAL AND METHODS: Arterial and venous levels of TSH, total T4, free T4 and total T3 obtained from cord blood at birth of twelve acidemic fetuses were compared with normal controls. RESULTS: Acidemic fetuses had a significanly higher TSH levels than controls (16.5+/-2. 1 microI/dl vs. 9.6+/-1.4 microI/dl, P=0.01). Total T3 levels were significantly lower in acidemic fetuses (49.2+/-2.9 ng/dl vs. 63+/-5. 5 ng/dl, P=0.04). Total and free T4 levels were similar and there was no difference between arterial and venous levels of the hormones. CONCLUSIONS: Birth acidemia from fetal distress during labor is associated with higher TSH levels and lower T3 levels.
Subject(s)
Acidosis/blood , Fetal Distress/blood , Thyroid Hormones/blood , Female , Fetal Blood/chemistry , Humans , Hydrogen-Ion Concentration , Infant, Newborn , Oxygen/blood , Pregnancy , Thyrotropin/blood , Thyroxine/blood , Triiodothyronine/bloodABSTRACT
BACKGROUND: Intestinal intussusception is a rare event during pregnancy. The diagnosis of intestinal obstruction from any cause in pregnancy is made more difficult by the common overlapping complaints of nausea, vomiting and abdominal pain, which may persist during the second trimester. CASE: Intestinal obstruction occurred at 17 weeks' gestation. A preoperative diagnosis of intussusception was made by ultrasound by demonstrating multiple ecodense and ecolucent rings in the right lower quadrant of the abdomen. CONCLUSION: Ultrasonography may support the diagnosis of intussusception in pregnant women with intestinal obstruction.
Subject(s)
Abdominal Pain/etiology , Ileocecal Valve , Intussusception/diagnosis , Pregnancy Complications/diagnosis , Prenatal Care , Adult , Diagnosis, Differential , Female , Humans , Ileal Diseases/diagnosis , Intussusception/complications , Intussusception/diagnostic imaging , Intussusception/surgery , Pregnancy , Pregnancy Complications/diagnostic imaging , Pregnancy Complications/surgery , Pregnancy Trimester, Second , Preoperative Care , Ultrasonography, PrenatalABSTRACT
OBJECTIVE: To evaluate the incidence of ultrasonographically-diagnosed postcesarean hematomas and correlate their presence with febrile morbidity. METHODS: Prospective study of 111 consecutive patients who had a pelvic ultrasound 4-6 days post-operatively. Ultrasonographic findings were correlated with clinical data. RESULTS: Postoperative fever was diagnosed in 28 (25%) patients. Fifteen (13.5%) women had hematomas; 10 (9%) had bladder-flap and five (4.5%) had subfascial hematomas. Only subfascial hematomas were significantly associated with post-operative fever (P = 0.01). CONCLUSIONS: Postcesarean bladder-flap hematomas are not predictive of post-operative fever. The presence of subfascial hematomas should be specifically sought in the evaluation of a febrile postcesarean patient.
Subject(s)
Cesarean Section , Fever/etiology , Hematoma/diagnostic imaging , Pelvis/diagnostic imaging , Postoperative Hemorrhage/diagnostic imaging , Adult , Female , Hematoma/complications , Humans , Pregnancy , Prospective Studies , Ultrasonography , Urinary Bladder Diseases/complications , Urinary Bladder Diseases/diagnostic imagingABSTRACT
BACKGROUND: In the absence of hypertension and proteinuria, pregnant women with hemolysis, elevated liver enzymes and low platelet count (HELLP syndrome) present a diagnostic and therapeutic problem. CASES: Two atypical cases occurred of HELLP syndrome diagnosed by hemolysis, elevated liver enzymes and low platelet count. The patients presented early in the third trimester with epigastric pain and lacked the usual signs of preeclampsia, such as hypertension and proteinuria. The patients were managed expectantly; during this time they became hypertensive, but the thrombocytopenia resolved. CONCLUSION: Pregnant women with hemolysis, elevated liver enzymes and thrombocytopenia who do not have hypertension or proteinuria should undergo complete diagnostic evaluation. If other etiologies are ruled out, the patient should be managed as appropriate for severe preeclampsia complicated by the HELLP syndrome.
Subject(s)
HELLP Syndrome/diagnosis , Thrombocytopenia/complications , Adult , Diagnosis, Differential , Female , Humans , Platelet Count , Pregnancy , Pregnancy OutcomeSubject(s)
Antiemetics/adverse effects , Hyperemesis Gravidarum/complications , Hyperemesis Gravidarum/drug therapy , Metoclopramide/adverse effects , Porphyria, Acute Intermittent/etiology , Adult , Female , Glucose Solution, Hypertonic/therapeutic use , Hemin/therapeutic use , Humans , Porphyria, Acute Intermittent/diagnosis , Porphyria, Acute Intermittent/drug therapy , Precipitating Factors , PregnancyABSTRACT
A 27-year-old primipara with severe preeclampsia and primary antiphospholipid syndrome developed right upper quadrant pain, massive ascites, HELLP syndrome, and disseminated intravascular coagulation shortly following vaginal delivery. Computed tomography and color Doppler studies were compatible with complete thrombosis of the right hepatic veins, the Budd-Chiari syndrome. Anticoagulation was initiated, along with supportive measures, and the patient recovered completely. Imaging studies 6 months later were normal. This case demonstrates that nearly fatal forms of venous thrombosis may complicate preeclampsia in women with antiphospholipid syndrome; Doppler studies of the hepatic vein are of value in establishing the diagnosis.
Subject(s)
Antiphospholipid Syndrome/complications , Budd-Chiari Syndrome/etiology , Pre-Eclampsia/complications , Pregnancy Complications , Adult , Budd-Chiari Syndrome/diagnosis , Budd-Chiari Syndrome/therapy , Female , Humans , PregnancyABSTRACT
OBJECTIVE: To identify and quantify the anatomic sites of foot lesions resulting in amputation among patients suffering from peripheral arterial disease with and without diabetes mellitus. DESIGN: A retrospective study. SETTING: Department of Orthopaedic Rehabilitation. PATIENTS: A total of 212 recent lower limb amputees with diabetes mellitus (158) or peripheral arterial disease only (54) admitted for prosthetic rehabilitation. RESULTS: In 62.2% of all amputees the site of lesion that led to amputation was located in the digits. A lesion under the metatarsal heads was reported in 8.0%, along the mid-foot and heel in 8.5%, on the dorsum of the foot in 3.3%, around the ankle joint and lower leg in 5.7%. Finally, 12.3% reported multiple lesions or were unable to recall the exact anatomic location. CONCLUSIONS: Most foot lesions resulting in amputation are located around the digits. These high-risk sites, therefore, need the patient's and the health care team's special attention. The patient should be trained in self foot examination and meticulous daily care, whereas the role of the health care team is in foot evaluation and provision of protective foot wear.
