1/18. ED echocardiography for peripartum cardiomyopathy.Although peripartum cardiomyopathy is uncommon, emergency physicians should be knowledgeable of it because of its high morbidity and mortality. Emergency physicians should be alert to the fact that the clinical presentation of peripartum cardiomyopathy is nonspecific. Its clinical manifestations are found in other medical conditions that can present in the late prepartum or postpartum patient. We present a case of peripartum cardiomyopathy that illustrates how its nonspecific respiratory signs and symptoms led to an initial diagnosis of pulmonary embolism. The case also highlights the need for echocardiography in the evaluation of peripartum cardiomyopathy. We discuss the clinical presentation, diagnosis, and treatment of peripartum cardiomyopathy.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
2/18. Late postpartum eclampsia 16 days after delivery: case report with clinical, radiologic, and pathophysiologic correlations.BACKGROUND: Postpartum eclampsia is a rare, frightening, and potentially tragic complication of hypertensive pregnancies, usually developing within 48 hours of delivery. seizures occurring days to weeks after parturition are exceedingly uncommon and require rapid, precise clinical evaluation by multiple specialists. methods: A case presentation of delayed postpartum eclampsia illustrates unique features of the syndrome. Extensive review of the literature highlights pathogenesis, controversies, and dilemmas surrounding this enigmatic hypertensive disorder. RESULTS AND CONCLUSIONS: A 39-year-old hypertensive patient had an uneventful full-term delivery by her family physician only to develop headache, double vision, and recurrent tonic-clonic seizures 16 days later. Initial evaluation showed severe hypertension, diplopia, hyperreflexia, proteinuria, and hyperuricemia. She was given a magnesium sulfate infusion. magnetic resonance imaging (MRI) documented asymmetric ischemic foci within gray matter in the distribution of the posterior cerebral arteries. All symptoms, signs, and abnormal laboratory values resolved within 4 days. A follow-up MRI showed complete resolution of all cytotoxic cortical lesions. Based on human autopsy data, radiologic investigations, and animal studies, eclampsia is believed to result from explosive vasospasm, endothelial dysfunction, and cytotoxic edema of cerebral cortex. This central nervous system vasculopathy is most prominent in the posterior cerebral vasculature and is often rapidly reversible. Difficulties in differential diagnosis, typical findings on neuroimaging, and urgent management strategies are discussed. The time limit for postpartum eclampsia probably should be lengthened to 4 weeks, as indicated by our case and other clinical series.- - - - - - - - - - ranking = 0.5keywords = physician (Clic here for more details about this article) |
3/18. infectious mononucleosis presenting as postpartum fever.infectious mononucleosis and pregnancy are common conditions seen by obstetricians and family physicians. However, infectious mononucleosis in the postpartum period has not been reported in the literature. A 20 year-old woman presented with a four-day history of fever of 40 degrees C, and chills at her six-week postpartum visit, which prompted an evaluation of the cause of the fever. The atypical presentation of mononucleosis in this patient delayed the eventual diagnosis. Although infectious mononucleosis has not been mentioned in the literature as a cause of postpartum fever, it is likely more common than realized. For that reason the evaluation of infectious mononucleosis and postpartum fever are discussed.- - - - - - - - - - ranking = 0.5keywords = physician (Clic here for more details about this article) |
4/18. Aggressive management of recurrent ovarian cancer--the challenge of individualizing cancer therapy illustrated by a case report.BACKGROUND: In clinical practice, treatment recommendations and the patient's wishes often diverge, facing the physician with difficult choices. CASE REPORT: The clinical course of a 36-year-old patient with 'platinum-refractory' ovarian cancer is reported. The patient experienced a symptomatic relapse 7 months after debulking surgery and completion of platinum-based first-line chemotherapy. As she had given birth to a son 22 months before diagnosis, she fought with outmost determination against her disease. Her husband supported her, and both asked for maximal therapy, including intensive care treatment for recurrent respiratory tract infections and total parenteral nutrition (TPN). For the patient, it was of major importance to stay with her family and make sure that her son would be able to remember his mother. Problems related to TPN and progression of disease affected her individual perception of quality of life to a much lower extent than expected and perceived by her caretakers. All professional health care providers were more than once very reluctant to continue treatment and only after extensive counseling gave in to the demand of the patient for further treatment, considering the effort futile - only to be surprised by treatment response and recovery. After 3 years of palliation, the tumor was resistant to all cytotoxic regimens and the patient died 2 months after withdrawal of chemotherapy. CONCLUSION: This case report illustrates that also in the age of evidence-based medicine individualized treatment beyond proven strategies can offer patient benefit. Taking the child's development into account makes it impossible to determine the cost-benefit ratio.- - - - - - - - - - ranking = 0.5keywords = physician (Clic here for more details about this article) |
5/18. An uncommon cause of back pain in pregnancy.Back pain is a major cause of disability worldwide. A case of a 29 year old Caucasian woman with low back pain secondary to an uncommon benign condition called osteitis condensans ilii is presented and the literature is reviewed. Limited information in the literature combined with poor awareness across the specialty and among the primary care physicians leads to an extensive investigation and misdiagnosis of this benign condition. This report emphasis the salient features and the differential diagnosis in diagnosing and managing this rare condition.- - - - - - - - - - ranking = 0.5keywords = physician (Clic here for more details about this article) |
6/18. Cystic degeneration of a leiomyoma masquerading as a postoperative abscess.Leiomyomas are common tumors that usually have a typical sonographic appearance. With degeneration, however, the sonographic findings may be completely uncharacteristic. We report a case of a multicystic anterior uterine wall mass detected at antenatal sonography in an asymptomatic patient. Differential diagnosis included myoma, varicosity, hematoma, abscess, uterine anomaly, and pelvic neoplasm. At cesarean section, the mass was confirmed to be a myoma. Postoperatively, an ultrasound was performed by the radiology service during evaluation of suspected endometritis and the mass was interpreted as an endometrial abscess. This case illustrates that myomas can present with sonographic features consistent with a number of pathologic disorders. This variable pattern of echogenicity may sometimes create difficulty in establishing a correct diagnosis. The case also demonstrates the importance of communication between services and the need for not only antenatal but also postpartum and gynecologic ultrasound studies to be performed by physicians trained in sonographic findings of the abnormal uterus.- - - - - - - - - - ranking = 0.5keywords = physician (Clic here for more details about this article) |
7/18. Posterior reversible encephalopathy syndrome: a case study.A young woman 4 days postpartum was admitted after experiencing two seizures. Her mentation waxed and waned until, after several hours, staff were unable to arouse her with voice or touch. A computed tomography scan demonstrated considerable white-matter edema. The patient's condition declined to a coma. She remained comatose despite therapeutic interventions to control increased intracranial pressure. To her family, her condition was a source of anguish. To the physicians and nurses, she was a puzzle. The final diagnosis was posterior reversible encephalopathy syndrome, which was related to a preeclamptic condition and its associated hypertension. The collaboration of obstetricians and neurologists with vigilant care by neuroscience nurses resulted in a positive outcome for this challenging patient.- - - - - - - - - - ranking = 0.5keywords = physician (Clic here for more details about this article) |
8/18. Puerperal psychosis following ablaction with bromocriptine.Addiction in the context of drug abuse usually is perceived as habitual dependence on the part of the consumer of a potentially habit forming drug. attention is drawn to an alternative pattern of drug abuse, namely, unwarranted prescription of drugs on the part of physicians. An example of what the writers perceive is the habitual distribution of a potentially harmful drug in the absence of a clear-cut indication. attention is being drawn to the worldwide use of bromocriptine, an agent suspected of causing occasional vasospasm, hypertensive cerebral accident and myocardial infarction, for the purpose of ablactation. An additional observation is described where, following administration of bromocriptine in the puerperium manifestations consistent with ergotism developed. The clinical picture was also consistent with pure puerperal psychosis. attention is also drawn to the likelihood of a cause-effect relationship between the abovementioned drug (an ergot derivative) and the ensuing psychotic reaction.- - - - - - - - - - ranking = 0.5keywords = physician (Clic here for more details about this article) |
9/18. tuberculosis presenting as puerperal fever.Two cases of unusual postpartum fever in foreign nationals are presented. Prolonged work-up led to the diagnosis of pulmonary tuberculosis as a cause of postpartum fever that responded well to antituberculous drugs. The signs and symptoms illustrated by these cases should alert physicians to consider tuberculosis in their differential diagnosis when caring for pregnant immigrants. The changing patterns and diagnostic and therapeutic problems are discussed.- - - - - - - - - - ranking = 0.5keywords = physician (Clic here for more details about this article) |
10/18. cerebrovascular disorders associated with pregnancy.stroke is a leading cause of maternal death. Intracerebral hemorrhage may be associated with eclampsia, metastatic choriocarcinoma or ruptured arteriovenous malformations. Intracranial venous thrombosis may result from a hypercoagulable state or local intracranial vascular damage. subarachnoid hemorrhage is usually caused by the rupture of an intracranial aneurysm or arteriovenous malformation. signs and symptoms of stroke in pregnancy can be confusing. The physician must be aware of these signs to avoid mismanagement of the pregnant stroke patient.- - - - - - - - - - ranking = 0.5keywords = physician (Clic here for more details about this article) |
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