Causes of failure of antireflux surgery.

The multiple advantages of the laparoscopic techniques were the main reason for the explosion of laparoscopic antireflux surgery. As a result, laparoscopic Nissen fundoplication has become one of the most commonly performed laparoscopic procedures. Achieving consistently successful results is difficult with any form of therapy, and laparoscopic fundoplication is no exception. The definition of failure of antireflux surgery is unclear and is usually based on the patient's symptoms. In this report, we analyze the different types of failure and discuss the diagnostic and therapeutic options that are available to manage this challenging clinical problem.

Fetal death after trauma in pregnancy.

Trauma in pregnancy places the mother and fetus at risk. The objective of this study is to identify risk factors independently associated with acute termination of pregnancy and/or fetal mortality after trauma. The medical and trauma registry records of 80 injured pregnant patients were reviewed. Data were collected and then analyzed by univariate and multivariate analysis. Three patients died (3.7%), 23 had the pregnancy acutely terminated (30%), and 14 suffered fetal death (17.5%). The only independent risk factors for fetal mortality were an Injury Severity Score (ISS) > or =9 and a nonviable pregnancy (<23 weeks). The combination of both risk factors increased the likelihood of fetal mortality by fivefold over that of patients without either risk factor. Maternal hemodynamic parameters did not predict fetal loss. Two patients lost their fetuses despite insignificant trauma (ISS = 1) and normal hemodynamic parameters, whereas eight delivered normal babies despite major trauma (ISS > or = 16). Hemodynamic stability on admission does not predict fetal mortality. Although the presence of moderate to severe injuries (ISS > or = 9) increases the likelihood of fetal mortality, this complication may occur even with insignificant trauma. Close maternal and fetal monitoring is justified, regardless of maternal hemodynamic presentation or severity of injury.