Chylomicronemia Syndrome in Pregnancy: a Case Report of an Acute Necrotizing Pancreatitis.

Introduction: Chylomicronemia syndrome (CS) is a rare disorder characterized by a high level of triglycerides in plasma. We present a case of a pregnant woman with a severe acute pancreatitis (AP) affected by a CS. Case: A 38-year-old gravida 2, para 0 with an uneventful course of pregnancy was referred with an AP at 37 0/7 weeks of gestation. This diagnosis was made from a nearby hospital where the chemical analysis showed elevated pancreatic enzymes with significant hypertriglyceridemia. Because of a pathological fetal heart tracing a caesarean delivery was performed. The APGAR score of the female newborn was 5/8/8 at 1, 5 and 10 minutes, respectively. The pH from the umbilical cord were 7.26 (artery) and 7.59 (vein). Once transferred to our intensive care unit a computer tomography scan confirmed an onset of a necrotizing AP. A conservative treatment was tried without success. For this reason a surgical debridement of the infected and necrosic parts was performed. After a long hospitalisation the patient could be dismissed after 2.5 months in good general condition. Discussion: Lipid profile changes in normal pregnancy are characterized by an elevation of total plasma cholesterol and triglyceride levels. This is normally caused by an increased liver synthesis of triglycerides in response to elevated estrogen levels. When a CS is diagnosed the main goal is to maintain fasting triglyceride levels at less than 500 mg/dL to reduce the risk for AP. Conclusion: Practitioners have an important role in evaluating chylomicronemic patients and implementing therapeutic lifestyle and pharmaceutic interventions aimed to reduce the risk for AP.

Symptom scores: mumbo jumbo or meaningful measures?

Instruments designed to assess the severity of lower urinary tract symptoms have become a routine component of the diagnostic evaluation of men with benign prostatic hyperplasia (BPH). Several validated tools have been developed to this end, including the International Prostate Symptom Score, which is used most commonly today. Despite attempts to correlate symptom score severity with commonly measured objective parameters of BPH, no clear relationships have been found. The reason for this is likely multifactorial and suggests a complex relationship among subjective and objective variables. However, symptom scores show a good correlation with the patient's perception of quality of life and degree of bother. This is critical because the decision to treat should be largely based on these subjective variables. Moreover, symptom scores have been shown to represent a meaningful endpoint in assessing treatment response in clinical studies.

Bilateral metastatic renal synovial sarcoma.

Synovial sarcoma is a malignant soft-tissue neoplasm, usually arising in close association with the joints and generally carrying a poor prognosis. We describe the first report of bilateral renal metastases from synovial sarcoma in a long-term survivor. Treatment consisted of systemic therapy with bilateral partial nephrectomies. The patient was disease free at 1 year of follow-up.

[Efficacy of troxerutin on the flow properties of blood under defined conditions of circulation. A double-blind study of patients with diabetic retinopathy and arteriosclerotic retinopathy]. / Wirksamkeit von Troxerutin auf die Fliesseigenschaften des Blutes unter definierten Strömungsbedingungen. Eine Doppelblindstudie an Patienten mit Retinopathia diabetica und Retinopathia arteriosclerotica.

In a clinically controlled double-blind study it was demonstrated that tri-(hydroxyethyl)-rutin is not capable of significantly improving blood viscosity or one of its constituent factors. On the basis of data from 58 patients, none of whom was under 43 years old, it was possible to show that the substance tested has no favorable influence on plasma viscosity, erythrocyte deformability and aggregation, or on the concentration of plasma proteins which promote aggregation. Thus, in the very group of patients for whom an improvement in blood flow properties by means of oral administration of tri-(hydroxyethyl)rutin had been hoped for, no therapeutic effect could be demonstrated.

[Effect of physical training on blood flow properties in patients with intermittent claudication]. / Einfluss von körperlichem Training auf die Blutfliesseigenschaften bei Claudicatio intermittens-Patienten.

Abnormal blood flow in patients with intermittent claudication can be normalized by physical training. We found a decrease in blood viscosity with a decrease in the erythrocyte-aggregation tendency and significant simultaneous improvement in erythrocyte filtrability. Improvement in these haemorheological properties led to a significant increase in physical performance after training. This positive result can be obtained by regular physical training; the application of rheologically effective medicaments is not necessary.

Low-dose cephradine prophylaxis in obstetric and gynecologic surgery.

A short-course, low-dose perioperative prophylactic regimen of cephradine was found to be highly effective in preventing serious postoperative infections (wound, vaginal cuff/pelvic and endometrial) in patients undergoing cesarean sections and vaginal hysterectomies. In patients undergoing abdominal hysterectomy no significant difference was observed in the prevalence of wound and pelvic infections in the antibiotic and placebo-treated groups. In all three operative procedures there was no significant reduction in urinary tract infections. The postoperative length of stay was significantly decreased in cesarean section patients, and a similar trend was observed in vaginal hysterectomy patients. An analysis of risk factors in cesarean section revealed that anemia and labor reduced the effectiveness of prophylaxis. Among vaginal hysterectomy patients those who were anemic and those who were premenopausal were at greater risk of infection. There was a low incidence of adverse drug reactions (less than 0.5%) and no evidence of the promotion of bacterial resistance in cephradine-treated patients.

The use of pelvic arteriography in assessing carcinoma of the cervix.

Twenty-nine patients underwent pelvic arteriography as a part of their pre-radical-hysterectomy evaluation for cervical carcinoma. False-positive studies were as common as false-negative studies, not only in the assessment of tumor extension locally, but also in determining the presence of pelvic lymph node involvement. Twenty-one patients underwent preoperative irradiation, but the lack of correlation was similar in 8 patients who were treated by primary radical surgery a few days after arteriography. The clinical estimate of tumor extension corresponded more closely to the pathologic findings than pelvic arteriography.

Familial male pseudohermaphroditism with incomplete virilization.

A 21-year-old 46 XY individual with familial male pseudohermaphroditism was investigated. Phenotype consisted of pseudovaginal perineoscrotal hypospadias with bilateral inguinal gonads and a masculine habitus without gynecomastia. Plasma testosterone, cortisol, follicle stimulating hormone, urinary 17-ketosteroids, and 17-ketogenic steroids were within the normal male range. Plasma dihydrotestosterone was at the lower limit of the normal male range. Plasma luteinizing hormone was three times and plasma estradiol was about one and a half times the upper limit of normal for men. These results are consistent with a partial defect in the mechanism of action of testosterone. The differential diagnosis of various forms of male pseudohermaphroditism is discussed.

Wound infection following cesarean section.

To investigate a high incidence of wound infections occurring in patients following cesarean section at a 650 bed charity hospital in Louisiana, a bacteriologic investigation was carried out. In this study, cultures were made at multiple sites prior to operation. An attempt was made to identify those bacteria that were predominately responsible for wound infection and their source, whether from the patient herself or from a nosocomial origin. The patients were divided into three groups depending on the degree of postoperative morbidity that followed. The bacterial flora in each group was relatively the same. Other factors were more significant in predicting those patients in whom postoperative morbidity occurred.

Thecomas and granulosa-theca cell tumors of the ovary: an analysis of 51 tumors,.

A retrospective study of 51 thecomas and granulosa-theca cell tumors of the ovary seen at Confederate Memorial Medical Center in Shreveport, Louisiana, is presented. Endometrial tissue was available for study in 38 of the 51 patients. The relation of these tumors to endometrial morphology suggests an excessive estrogenic stimulation in most cases. The microscopic pattern and degree of pleomorphism was of no value in predicting which tumors would behave in a malignant fashion. The incidence of endometrial malignancy associated with these tumors was only 7.8%, which was less than was anticipated. The addition of irradiation and/or chemotherapy is, in our opinion, difficult to evaluate since many of the women with these tumors die of unrelated causes before a recurrence is evident.

A retrospective study on the effectiveness of a screening effort to reduce the complications of gonorrhea.

In an effort to evaluate the effectiveness of a mass screening program for gonorrhea, a retrospective study was carried out on patients admitted to the hospital with the diagnosis of acute and chronic salpingitis. This study was done at the Confederate Memorial Medical Center in Shreveport, Louisiana. Admissions were reviewed for the year prior to the screening program, and compared to the numbers that were admitted after 2 years of screening. A 70% increase was found to have occurred despite extensive efforts to identify and treat asymptomatic women with gonorrhea, and their male contacts. This finding contrasts dramatically with the experience of others who have reported success in reducing the spread of gonorrhea by such a screening program.

Monitoring patients with tuberculosis for failure during and after treatment.

To assess the productivity and cost effectiveness of a traditional treatment monitoring protocol, the records of all 268 patients entered into the tuberculosis treatment program of Denver's municipal clinic during 1968 to 1972 inclusive were analyzed. Treatment failures were detected in 7 patients undergoing therapy, and disease reactivation was noted in 2 patients after treatment. Factors leading to the recognition of these failures were evaluated. It was observed that routine sputum cultures obtained only from selected, higher-risk patients would have detected all but one of the treatment failures occurring during therapy, whereas symptomatology would have identified both post-therapy reactivations. The cost effectiveness data presented suggest that substantial modifications of the methods for monitoring the outcome of tuberculosis chemotherapy should be made.