Retropharyngeal abscess complicated by Prevotella buccae sepsis during pregnancy. A case report.

BACKGROUND: Retropharyngeal abscess is extremely uncommon in adults and rare in pregnancy. A MEDLINE search yielded only 1 reported case during pregnancy. Likewise, sepsis caused by prevotella buccae, a bacteria associated with more benign conditions such as bacterial vaginosis or dental infections, is also rare, with no reported cases during pregnancy. CASE: We report a case of retropharyngeal abscess complicated by Prevotella buccae septicemia during pregnancy. CONCLUSION: Retropharyngeal abscess should be suspected in a pregnant patient who presents with sore throat, dyspnea, and dysphagia, especially when preceded by dental treatment or symptoms. If confirmed, antibiotic treatment should cover the usual pathogens associated with retropharyngeal abscess, including Pre- votella species.

Recurrent duodenal atresia: a case report.

BACKGROUND: Duodenal atresia is a rare disorder occurring in 1 in 10,000 live births. Duodenal atresia is associated with trisomy 21: 5-15% of trisomy 21 cases have duodenal atresia and 30% of duodenal atresia cases are associated with trisomy 21. Some cases of duodenal atresia may be recurrent. CASE: Two siblings were born with duodenal atresia but no other anomalies. The father of the siblings also had isolated congenital duodenal atresia. CONCLUSION: Recurrent duodenal atresia should be considered when the condition is discovered prenatally. The etiology may be autosomal dominant inheritance, as with Feingold syndrome, or autosomal recessive inheritance.

Eating disorders during pregnancy.

UNLABELLED: Eating disorders during pregnancy, once thought to be rare, occur in a significant number of women. The incidences of the major eating disorders-anorexia nervosa and bulimia nervosa-are increasing because of cultural pressures on the drive for thinness. Because the age range for these major eating disorders overlaps with the age range for reproductive function, it is not unusual for a clinician to encounter a pregnant patient with a major eating disorder. Eating disorders attributable to the pregnant state include pregnancy sickness, pica, and ptyalism. The diagnostic criteria, etiology, nutritional behavioral influences, evolutionary psychological considerations where elucidated, and treatment of these disorders will be presented. TARGET AUDIENCE: Obstetricians and gynecologists, family physicians LEARNING OBJECTIVES: After completing this CME activity, physicians should be better able to review how the major eating disorders impact pregnancy, to diagnose eating disorders during pregnancy using the diagnostic criteria, and to treat eating disorders during pregnancy.

Locked-in syndrome.

Locked-in syndrome is a rare neuropsychological disorder. Its primary features are quadriplegia and paralysis of the cranial nerves except for those responsible for vertical eye movements. The differential diagnosis includes persistent vegetative state, brain death, minimally conscious states, C3 transection of the spinal cord, and conversion locked-in syndrome. Etiologies of locked-in syndrome include hemorrhagic and thrombotic events, tumors affecting the ventral pons, infectious agents, iatrogenic causes, trauma, metabolic abnormalities, and other miscellaneous causes. The clinical manifestations, differential diagnosis, neuropsychological assessment, rehabilitation, and prognosis of patients with locked-in syndrome are discussed.

Stress: pregnancy considerations.

UNLABELLED: Stress-induced pregnancy complications represent a significant cause of maternal and perinatal morbidity and mortality due to preterm labor, low-birth-weight babies, pregnancy-induced hypertension, and neuropsychological developmental delays of affected offspring. Psychosocial factors such as socioeconomic status, work status, marital status, level of education, access to prenatal care, substance abuse, ethnicity, cultural background, and quality of relationships with partners and parents have been identified as determinants of stress during pregnancy. The biopsychosocial model of health and disease aptly explains the interactions of these psychosocial factors in the genesis of stress-induced pregnancy complications. Prenatal screening and intervention for relevant biopsychosocial risk factors may be useful in preventing stress-related perinatal complications. TARGET AUDIENCE: Obstetricians and gynecologists, family physicians. LEARNING OBJECTIVES: After completing this CME activity, physicians should be better able to describe how stress is manifested biologically, discuss stress and its impact from the biopsychosocial model of health and disease, recognize how stress may lead to pregnancy complications such as preterm labor, preeclampsia, and low-birth-weight infants, explain how stress may impact the neuropsychological development of children whose mothers experienced perinatal stress, and demonstrate how prenatal screening and appropriate interventions may reduce perinatal stress and associated pregnancy complications.

Pregnancy sickness: a biopsychological perspective.

Pregnancy sickness is a universal phenomenon, affecting 70% to 85% of all pregnant women. The primary symptoms of pregnancy sickness are nausea, vomiting, and food aversions. In the past, pregnancy sickness was attributed to psychological disturbances of the pregnant woman. However, recent evolutionary psychological and biopsychological studies have reconsidered pregnancy sickness as an embryo-protective mechanism, an evolutionary adaptation to protect the embryo from phytotoxins and other environmental hazards. The biopsychological perspective of pregnancy sickness as an embryo-protective mechanism is presented.