ABSTRACT
OBJECTIVE: To compare the efficacy and side effects of 0.2 mg methyl-ergometrine IM, 400 microg misoprostol sublingual and 125 microg 15 methyl PGF2alpha IM in active management of third stage of labor. METHOD: Two hundred low risk pregnant women with induced or spontaneous labor were randomized to receive either 400 microg misoprostol sublingually or 0.2 mg methyl-ergometrine intramuscularly or 125 microg 15-methyl PGF2alpha intramuscularly, after the delivery of anterior shoulder of baby. The main outcome measures were: blood loss more than 500 ml, need for additional oxytoxic drug, change in hemoglobin level and side effects due to drugs. RESULTS: The median estimated blood loss, blood loss more than 500 ml, need for additional oxytocic drug and change in hemoglobin levels were similar in all three groups. The significant side effects in the misoprostol group were shivering, pyrexia (temperature > 38 degrees C) and vomiting, which were self-limiting. Diarrhea was significantly more in the 15 methyl PGF2alpha group. Three women in methyl-ergometrine group underwent manual removal of placenta. One woman in misoprostol group received blood transfusion. CONCLUSION: Sublingual misoprostol appears to be as effective as intramuscular methyl-ergometrine and intramuscular 15-methyl PGF2alpha in the prevention of postpartum hemorrhage. It can be a good alternative in resource poor setting.
Subject(s)
Carboprost/administration & dosage , Ergonovine/administration & dosage , Labor Stage, Third/drug effects , Misoprostol/administration & dosage , Oxytocics/administration & dosage , Postpartum Hemorrhage/prevention & control , Administration, Sublingual , Adult , Birth Weight , Carboprost/adverse effects , Ergonovine/adverse effects , Female , Humans , Infant, Newborn , Injections, Intramuscular , Misoprostol/adverse effects , Oxytocics/adverse effects , Pilot Projects , Pregnancy , Prospective StudiesABSTRACT
BACKGROUND: Malignant degeneration of benign cystic teratoma of the ovary is rare. Occurrence of melanoma in an ovarian cystic primary teratoma in the absence of a demonstrable extraovarian primary is even rarer. We describe here one such case. CASE: A 42-year-old nulliparous woman underwent laparotomy for a cyst in the right ovary. Histopathological examination of the specimen revealed malignant cystic teratoma with the presence of a melanoma component. There was no evidence of extraovarian primary melanoma on clinical examination. Two years later, she presented with lung metastasis and underwent left pneumonectomy. Histopathology confirmed metastatic melanoma. Postoperatively, she received combination chemotherapy using cisplatin and dacarbazine. She is on regular follow-up and continues to be disease-free, 18 months after treatment. CONCLUSION: Primary malignant melanoma in cystic teratoma of the ovary is extremely rare. We could find only 19 such cases on review of the literature. Clinical presentation is similar to that of primary epithelial ovarian cancer. Surgery remains the mainstay of treatment. Use of cisplatin and dacarbazine may be considered in a patient with metastatic disease.
Subject(s)
Melanoma/pathology , Ovarian Neoplasms/pathology , Teratoma/pathology , Adult , Female , Humans , Lung Neoplasms/secondary , Melanoma/drug therapy , Melanoma/surgery , Ovarian Neoplasms/drug therapy , Ovarian Neoplasms/surgery , Teratoma/drug therapy , Teratoma/surgeryABSTRACT
Persistent sciatic artery is a rare anomaly, only 33 cases having been reported to date. A 34th case is described in this report., The patient, a 45-year-old man, had bilaterally persistent sciatic arteries with bilateral aneurysms and acute ischemia due to distal embolization. The literature regarding the embryology, incidence and the problems of diagnosis and management of this rare condition is reviewed. The authors emphasize that in cases of aneurysm formation if the sciatic nerve adheres to the aneurysm no attempt should be made to excise the aneurysmal sac.
