Complete hydatidiform mole and normal live birth: a novel case of confined placental mosaicism: case report.

Hydatidiform molar change, characterized by abnormal fetoplacental development and placental villous trophoblast hyperplasia, results from genetically abnormal conception, in which there is an excess of paternally derived genetic material. The majority of pregnancies in which molar change has been reported in association with a live fetus represent dizygotic twin pregnancies in which one fertilization results in a complete hydatidiform mole (CM) and the other a normal co-twin. In such cases, there is usually a clear distinction, both sonographically and pathologically, between the molar and non-molar regions of the placenta. We present a singleton pregnancy, with diffuse placental molar change detected prenatally, which resulted in a chromosomally and phenotypically normal female infant at term. Pathological examination revealed the presence of intermixed populations of morphologically normal chorionic villi and villi with the characteristics of CM. Studies of genetic polymorphisms demonstrated that the CM, normal villi and fetus were all derived from the same sperm; the fetus was diploid and biparental whereas the areas of pathological CM were androgenetic and monospermic. We believe this represents the first well-documented case of apparent confined placental mosaicism involving CM and a coexisting normal fetus, which has presumably arisen following mitotic abnormalities in the early post-fertilization period.

Differential diagnosis of infective endocarditis.

Infective endocarditis (IE) is a deadly disease if left untreated. Early detection and treatment of IE reduces the high mortality rate. Mitral valve prolapse is now the leading risk factor for development of IE. The Duke (1994) criteria includes echocardiography as a diagnostic tool. Outclient i.v. therapy is increasing due to once-daily dosing regimens, which reduces the cost of treatment. Identifying at risk clients and educating them is vital to the prevention of IE. This article familiarizes the primary care provider with the pathophysiology, clinical presentation, diagnostic testing, complications, medical treatment, prophylactic management, and client education of IE.

Thinking about thinking.

BACKGROUND: The nursing leadership at a 900-bed tertiary-care facility in the southeast believed an opportunity existed to improve the critical thinking abilities of the professional nursing staff. METHOD: A team, consisting of a diversified group of nurse educators and managers, had the opportunity to gain understanding of the critical thinking process of the nursing staff as well as to develop a plan designed to improve critical thinking skills. RESULTS: Outputs of the team included development of a critical thinking model and process as well as an action plan that specifically outlined how it would implement the model within the organization using a preceptor-based educational process. CONCLUSION: Nursing leadership within this facility believes that nurturing critical thinking in the staff will have a positive impact on care delivery outcomes. Creating shared visions through the assumptions that the staff and organization hold is important to improving care provided. Assisting staff with using a critical thinking process in order to construct, tear down, and then reconstruct clinical incidents as encouraged by this model is one key to problem-solving.