1/26. Leflunomide: new antirheumatic drug. Effect on pregnancy outcomes.QUESTION: I am treating a 34-year-old woman with rheumatoid arthritis. She began taking the new drug leflunomide (Arava) 6 months ago and had good clinical response. She is now planning her first pregnancy. What should she do? ANSWER: Leflunomide is a new and effective disease-modifying antirheumatic drug. Animal studies have shown an increased rate of malformations and fetal death in various species, but there are no data on pregnancy outcomes in humans treated with leflunomide. Since the drug has a prolonged and unpredictable elimination half-life, it should be stopped during pregnancy. The manufacturer recommends that patients who wish to become pregnant be treated with cholestyramine, which enhances elimination.- - - - - - - - - - ranking = 1keywords = life (Clic here for more details about this article) |
2/26. Impact of chemical warfare with agent orange on women's reproductive lives in vietnam: a pilot study.During the American war in vietnam, huge quantities of the highly toxic herbicide dioxin ('Agent Orange'), were sprayed over large areas of central and south vietnam. In addition to polluting the environment and causing cancers and other diseases in those directly exposed to it, dioxin has caused high rates of pregnancy loss, congenital birth defects and other health problems in their children. This paper reports the findings of a pilot study in the year 2000 among 30 Vietnamese women whose husbands and/or who themselves were exposed to Agent Orange. The aim was to develop research in order to explore the impact of chemical warfare on people's lives. Using the reproductive lifeline and semi-structured interviews, information was gathered on both partners' periods of exposure to Agent Orange, pregnancy outcomes, perceived health problems of children and experiences of living with handicapped children. The women had had a high number of miscarriages and premature births. About two-thirds of their children had congenital malformations or developed disabilities within the first years of life. Most of the families were poor, aggravated by impaired health in the men, the burden of caring for disabled children, and feelings of guilt and inferiority. The plight of 'Agent Orange families' is special and should be placed in its historical and political context.- - - - - - - - - - ranking = 2keywords = life (Clic here for more details about this article) |
3/26. Humeroradial synostosis, ulnar aplasia and oligodactyly, with contralateral amelia, in a child with prenatal cocaine exposure.Humeral "bifurcation" due to humeroradial synostosis, and amelia are both very rare limb anomalies. We report on a Canadian. Aboriginal boy with both these limb deficiencies. The family history was unremarkable, but he was exposed prenatally to cocaine at the time of limb development. Humeroradial synostosis with ulnar aplasia has been reported by several authors. The majority of cases are unilateral. When both upper limbs arms are involved, cases with oligodactyly often have asymmetrical limb deficiencies and have all been sporadic to date. Some appear to represent cases of the femur-fibula-ulna or FFU complex. Affected individuals with normal hands usually have symmetrical defects and show an autosomal recessive pattern of inheritance. Limb deficiencies have been reported in several infants exposed prenatally to cocaine and have been inducible in animal models. Most are terminal transverse defects or deficiencies of middle digits. When more than one limb is involved, the defects are usually asymmetric. Our case appears to be one of the most severely affected children reported to date.- - - - - - - - - - ranking = 58.058195585598keywords = family (Clic here for more details about this article) |
4/26. esophageal atresia and tracheoesophageal fistula in two infants born to hyperthyroid women receiving methimazole (Tapazol) during pregnancy.We report on 2 newborn infants with esophageal atresia and tracheoesophageal fistula (EA TEF) born to hyperthyroid mothers receiving methimazole (Tapazol) before and during their entire pregnancies. Both mothers were euthyroid during gestation and developed hydramnios diagnosed during weeks 34 and 33 of gestation. Premature delivery (36.2 weeks of gestation) occurred in one case, and both newborn infants were small for date with palpable goiter; one of them had other associated malformations. hypothyroidism was diagnosed by laboratory tests in both cases. Corrective surgery was undertaken, but both newborn infants developed septicemia and renal insufficiency and died in the first week of life. The EA TEF and a normally placed enlarged thyroid gland were confirmed at necropsy. These cases represent a previously unreported example of the association of maternal ingestion of methimazole during pregnancy and EA TEF.- - - - - - - - - - ranking = 1keywords = life (Clic here for more details about this article) |
5/26. Mobius sequence in children exposed in utero to misoprostol: neuropathological study of three cases.BACKGROUND: misoprostol exposure in the first trimester of pregnancy has been related to congenital malformations, particularly the Mobius sequence and terminal transverse limb defects. CASES: Neuropathological findings of three patients with Mobius sequence related to misoprostol are reported. No previous pathological studies have shown these abnormalities to be associated with misoprostol exposure in utero. The brain stem was cut serially, from the rostral mesencephalum to the caudal aspect of the medulla, and all fragments were stained with hematoxylin-eosin and cresyl violet. Old ischemic-anoxic foci of gliosis, with necrosis and calcification, dorsally situated, were present from the pons to the medulla, involving some cranial nerve nuclei (especially the IV, VII, and XII) that were partially or completely depopulated of neural cells. CONCLUSIONS: The findings suggest a circulatory mechanism to the Mobius sequence, with vascular disruption involving the territory of the subclavian artery, occurring in a critical period of embryonic life between six to eight weeks postconception. These cases add further evidence of the role of misoprostol as a teratogen.- - - - - - - - - - ranking = 1keywords = life (Clic here for more details about this article) |
6/26. Acute promyelocytic leukemia during pregnancy: report of 3 cases.Acute promyelocytic leukemia (APL) is characterized by onset at a young age and a life-threatening hemorrhagic diathesis, which is attributed to a disseminated intravascular coagulation (DIC)-like coagulopathy. The discovery of all-trans-retinoic acid has changed the course of APL treatment by reducing the onset of DIC and inducing a complete and durable remission in more than 90% of patients. The occurrence of APL during pregnancy is not a frequent event, but the management of these patients raises many therapeutic and ethical dilemmas and requires a careful clinical case evaluation of fetal and maternal risk, coagulation status, the parents' wishes, and therapeutic options. Here we describe 3 patients with APL diagnosed during pregnancy. Clinical data and the therapeutic approaches are presented. In the discussion, we analyze clinical decisions and therapeutic options and compare our cases with those found in the literature.- - - - - - - - - - ranking = 1keywords = life (Clic here for more details about this article) |
7/26. Valproate embryopathy: clinical and cognitive profile in 5 siblings.Valproate embryopathy is a well recognized syndrome caused by prenatal exposure to the anticonvulsant valproic acid (Depakote). We report five half-siblings with the same mother (four different fathers) who all have valproate embryopathy. valproic acid was the sole anticonvulsant in all five pregnancies, with doses ranging from 500 to 2,000 mg per day. All children were examined by a clinical geneticist and developmental pediatrician, and had formal developmental testing. Mean birth weight at term was 2,900 g (range: 2,400-3,400 g). Common features in the five children included: flat, broad nasal bridge (5/5), hypoplastic midface (4/5), apparent hypertelorism/telecanthus (4/5), smooth philtrum (4/5), thin upper lip (5/5), long thin tapering fingers (4/5), hypoplastic 5th toenails (2/5), and irregularly placed toes (2/5). Less frequent features were micro/brachycephaly (2/5), cleft palate (1/5), duplication cyst of small intestine (1/5), and hemangioma (1/5). None had neural tube defect. Neuropsychologic testing of the three children older than 4 years of age showed cognitive ability in the low normal or borderline range (mean IQ = 83; range: 75-86), with significantly lower scores in adaptive behavior and motor skills. Study of this family offers insight into the potentially high risk of valproate embryopathy in exposed pregnancies, and affords a unique opportunity to study the variability of expression and cognitive profile of the syndrome within one family.- - - - - - - - - - ranking = 116.1163911712keywords = family (Clic here for more details about this article) |
8/26. Renal tubular dysgenesis associated with in utero exposure to Nimuselide.Maternal ingestion of the selective cyclo-oxygenase-2 (COX-2) inhibitor Nimuselide has been reported to be associated with the development of oligohydramnios and neonatal renal failure in some cases. We report a case of neonatal renal failure associated with maternal ingestion of Nimuselide in the third trimester of pregnancy. The neonate presented with metabolic acidosis and non-oliguric renal failure on the second day of life. The renal histopathology showed evidence of renal tubular dysgenesis. The child continues to have elevated serum creatinine and hypertension at 10 months of age.- - - - - - - - - - ranking = 1keywords = life (Clic here for more details about this article) |
9/26. Foetal life and a legal duty of care.Until 1932 in england the right to sue for injuries caused by the fault of another was not recognised in the absence of contract. The law of negligence has expanded and developed as new facts are presented to the courts of their decision. One of the basic elements of the tort of negligence is proof that the defendant owed a duty of care to the plaintiff. The law with respect to those who suffer injury who are in being has been clearly defined. However, the law has now developed to hold that a child is born with injuries caused by the negligence of another whilst the child was in utero has a right to bring an action for compensation for those injuries provided the child is born alive. A further development in this area of law has been the legal recognition of a claim by a child who suffers injuries in utero caused by a negligent act committed against the mother at a time when the child was not even conceived provided the child can prove a duty of care was owed and that the injuries complained of were caused by the alleged negligent act. Thus midwives and other health professional who care for and advise pregnant women need to keep in mind that a duty of care may be owed to an unborn child or a future unborn child as well as to the pregnant women.- - - - - - - - - - ranking = 4keywords = life (Clic here for more details about this article) |
10/26. valproic acid prenatal exposure. association with lipomyelomeningocele.valproic acid is an anticonvulsant that has been associated with open neural tube defects. We report a family in which the maternal use of valproic acid, and other anticonvulsants, during pregnancy resulted in different malformations in two siblings, one of which had a lipomyelomeningocele. The association of valproic acid and closed neural tube defects has not previously been reported. A brief review of the teratogenic effects of valproic acid is included as well as the implications for early surgical management of lipomyelomeningocele.- - - - - - - - - - ranking = 58.058195585598keywords = family (Clic here for more details about this article) |
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