RESUMEN
OBJECTIVE: The antenatal and intrapartum management of women with autoimmune thrombocytopenia is controversial. The current approach emphasizes an effort to identify maternal characteristics predictive of severe neonatal thrombocytopenia or to measure fetal platelet counts and perform cesarean section in patients considered to be at risk for neonatal intracranial hemorrhage. In the current study we review our experience with maternal autoimmune thrombocytopenia and neonatal outcome. STUDY DESIGN: Fifty-five pregnancies with autoimmune thrombocytopenia over a 10-year period in three major medical centers in San Diego, California, were evaluated. Maternal characteristics and neonatal outcomes were assessed and compared with those in other recent reports. Data were submitted to Fisher's exact (two-tailed), chi2, and Student t tests, with linear regression performed to analyze the association between variables. RESULTS: Maternal characteristics including platelet count, presence of antiplatelet antibody, antecedent history of autoimmune thrombocytopenia, and corticosteroid therapy were not predictive of severe neonatal thrombocytopenia. Maternal history of splenectomy was significantly correlated with fetal platelet counts <50 x 10(9)/L (odds ratio 5.63; 95% confidence interval 2.2 to 14.3). There were four neonates with severe neonatal thrombocytopenia (8%), and one who was delivered by cesarean section had intracranial hemorrhage. CONCLUSIONS: These findings, combined with others in the literature, confirm that severe neonatal thrombocytopenia is an infrequent complication of maternal autoimmune thrombocytopenia and is not reliably predicted by maternal characteristics. Intracranial hemorrhage is also a rare event and is not related to mode of delivery. Cesarean section should be reserved for obstetric indications only.
Asunto(s)
Enfermedades Autoinmunes/complicaciones , Enfermedades Autoinmunes/epidemiología , Hemorragia Cerebral/epidemiología , Bienestar Materno , Complicaciones Hematológicas del Embarazo/epidemiología , Trombocitopenia/complicaciones , Trombocitopenia/epidemiología , Adolescente , Adulto , Enfermedades Autoinmunes/etiología , California/epidemiología , Hemorragia Cerebral/etiología , Femenino , Sangre Fetal/citología , Humanos , Recién Nacido , Modelos Lineales , Estudios Longitudinales , Recuento de Plaquetas , Valor Predictivo de las Pruebas , Embarazo , Resultado del Embarazo , Factores de Riesgo , Índice de Severidad de la Enfermedad , Esplenectomía , Trombocitopenia/etiologíaAsunto(s)
Carbamazepina/uso terapéutico , Epilepsia del Lóbulo Temporal/tratamiento farmacológico , Trastornos Neurocognitivos/tratamiento farmacológico , Violencia , Diagnóstico Diferencial , Epilepsia del Lóbulo Temporal/diagnóstico , Epilepsia del Lóbulo Temporal/psicología , Humanos , Trastornos Neurocognitivos/diagnóstico , Trastornos Neurocognitivos/psicología , Escalas de Valoración PsiquiátricaAsunto(s)
Servicio de Urgencia en Hospital/estadística & datos numéricos , Mala Praxis/estadística & datos numéricos , Satisfacción del Paciente/estadística & datos numéricos , Anciano , Anciano de 80 o más Años , Recolección de Datos , Servicio de Urgencia en Hospital/normas , Inglaterra , Femenino , Relaciones Paciente-Hospital , Humanos , MasculinoRESUMEN
The instillation of diluted Bonney's blue into the bladder during gynaecological operations has been quite common practice over the last 50 years. Bonney's blue is composed of a 1:1 mixture of brilliant green and crystal violet dissolved in ethanol (90%) or industrial methylated spirit. Before insertion into the bladder this solution must be diluted with water to a 0.5% solution. Failure to do this will result in a severe inflammatory reaction within the bladder. The degree of resultant damage depends upon the duration of exposure. Persistent pain is a feature of this condition, although the other symptoms (frequency and urgency) may settle in time. Two cases of chemical cystitis resulting from the use of undiluted Bonney's blue are described to illustrate the possible consequences. Both patients were awarded 6-figure sums as compensation.
Asunto(s)
Cistitis/inducido químicamente , Violeta de Genciana/efectos adversos , Compuestos de Amonio Cuaternario/efectos adversos , Administración Intravesical , Adulto , Combinación de Medicamentos/administración & dosificación , Combinación de Medicamentos/efectos adversos , Femenino , Violeta de Genciana/administración & dosificación , Humanos , Compuestos de Amonio Cuaternario/administración & dosificaciónRESUMEN
An elderly man presented with progressive atelectasis of the left lung, a mediastinal mass, and dilatation of the thoracic aorta. Ventilation and perfusion radionuclide lung scans revealed the complete absence of ventilation in the left lung and near-complete absence of perfusion. Evaluation by MRI and angiography showed an obstructing mediastinal "mass" to be a saccular aortic aneurysm. A thoracic aortic aneurysm should be a consideration in the differential diagnosis for unilateral decrease or absence of ventilation and perfusion with a history or findings of mediastinal mass or aneurysm.