1/6. Peripartum cardiomyopathy and biventricular thrombi.Peripartum cardiomyopathy is a rare cardiac disorder characterized by the development of heart failure in the last month of pregnancy or up to 5 months postpartum in women without other determinable causes of cardiac failure. Intracardiac thrombi have been found at autopsy in some patients with this condition and have been demonstrated in the left or right ventricles on 2-dimensional echocardiography. A 23-year-old woman presented with peripartum cardiomyopathy and biventricular thrombi on echocardiography. The thrombi were spherical, pedunculate, shaggy and irregular in configuration, and freely mobile, suggesting that they were fresh. She was treated with conventional heart failure therapy and anticoagulants. Four days later, the apical thrombi within both ventricles had disappeared and there was no evidence of embolism on physical examination. The hypercoagulable state of the peripartum period and the severe biventricular dysfunction most likely led to the formation of biventricular thrombi.- - - - - - - - - - ranking = 1keywords = physical examination, physical (Clic here for more details about this article) |
2/6. Postpartum unilateral Horner's syndrome following lumbar epidural anesthesia after a Cesarean delivery.We report on a case demonstrating unilateral Horner's syndrome (HS) after lumbar epidural obstetric anesthesia. A healthy, 32-year-old woman with a breech presentation was scheduled for an elective cesarean section. The patient had normal vital signs throughout the surgical procedure. The operation lasted for 50 min. In the recovery room, she complained of left nasal stuffiness, left cheek numbness, and heaviness in her left eye. Meanwhile, left nipple sensory loss was noted during baby suckling training. On physical examination, her left eyelid was droopy along with left-side ptosis and facial flushing. Reduced sensation over the left hemifacial region and upper arm was also noted, which resolved completely over the next 110 min. A diagnosis of unilateral HS was then made. Although typically a benign side effect which often spontaneously resolves, HS is likely to cause anxiety in both the patient and the doctor. Prompt recognition of this syndrome and determination of its cause from lumbar epidural anesthesia can prevent unnecessary and potentially dangerous diagnostic workup and can reassure both patients and clinicians. The patient was discharged from the hospital 5 days after onset with a good outcome.- - - - - - - - - - ranking = 1keywords = physical examination, physical (Clic here for more details about this article) |
3/6. Spontaneous dissection of the internal carotid artery.Spontaneous dissection of the internal carotid artery is not well known in scandinavia. Several hundred cases have been reported world-wide, but none from finland. We presume the annual incidence in finland to be at least 20-30 cases, nearly all of which remain undiagnosed. Our experience of 12 cases indicates that the typical patient is a middle-aged man who after strenuous physical exertion suffers a transient ischemic attack or progressing stroke. Manifestations may include ipsilateral incomplete Horner's syndrome and facial or cervical pain. The diagnosis is based on angiography and verified from repeat angiograms. The most typical finding is an extracranial stenosis or occlusion of the internal carotid artery. Irregular expansion, double lumen and aneurysmal dilation are also fairly common. The stenotic area usually recanalizes in a few months. Nonsurgical management is recommended. Prompt diagnosis and adequate heparinization with simultaneous start of oral anticoagulation seem to give the best final result.- - - - - - - - - - ranking = 0.13037762230028keywords = physical (Clic here for more details about this article) |
4/6. Postpartum cervical myofascial pain syndrome: review of four patients.Four postpartum patients with complaints of headache and neck pain were examined. All had received epidural analgesia and had a long second stage associated with prolonged pushing. Many similarities to postdural puncture headache were noted. The headache started the day after delivery and involved the occipital region primarily, along with the neck and shoulder girdle areas. However, the pain did not change with positional changes and was associated with marked tenderness of muscles at specific anatomic points. A diagnosis of cervical myofascial pain was made. All patients responded quickly to physical therapy. The authors suggest that many patients initially considered to have postdural puncture headache may actually have postpartum cervical myofascial pain.- - - - - - - - - - ranking = 0.13037762230028keywords = physical (Clic here for more details about this article) |
5/6. lactation failure due to insufficient glandular development of the breast.With the present increased incidence of breast-feeding, clinicians need to be prepared to identify and manage problems in lactation. Most problems are related to insufficient knowledge, inappropriate routines, and lack of confidence and are easily managed or prevented by prenatal education, anticipatory guidance, and adequate support. Increasing evidence exists that primary causes of lactation failure also occur and can preclude successful lactation, even among highly motivated women. Three cases are presented in which lactation failure is believed to stem from insufficient glandular tissue within the breasts. Supportive history for this entity include absence of typical breast changes with pregnancy and failure of postpartum breast engorgement to occur. Associated physical findings included a unilateral underdeveloped breast in each woman and palpable patchy areas of glandular tissue in one case. breast diaphanography, or transillumination, substantiated clinical findings in the two cases in which it was performed. Both multiparous women had a previous unsuccessful breast-feeding experience, whereas the primiparous woman had immediate family members with a history of lactation failure. All three women benefited psychologically from the interpretation that lactation failure was not due to their breast-feeding performance, and each elected to continue nursing long-term despite the need for formula supplement. These cases are presented to emphasize that primary causes of lactation failure do exist and to alert clinicians to the historical and physical findings suggestive of inadequate glandular tissue as an etiology of previously unexplained lactation failure. Preserving the "every woman can nurse" myth contributes to perpetuating a simplistic view of lactation and does a disservice to the small percentage of women with primary causes of unsuccessful lactation.- - - - - - - - - - ranking = 0.26075524460056keywords = physical (Clic here for more details about this article) |
6/6. Puerperal febrile morbidity associated with the reverse transcriptase inhibitor stavudine.We report a case of postpartum drug fever associated with stavudine, a new reverse transcriptase inhibitor. A human immunodeficiency virus (hiv)-infected patient experienced fevers to 102.6 degrees F following vaginal delivery and bilateral partial salpingectomy. When history, physical, laboratory, and radiographic evaluations did not reveal a source of infection, discontinuation of the stavudine led to rapid defervescence within 28 hours. stavudine-associated fever may be a cause of puerperal febrile morbidity in the hiv-seropositive patient without a source of infection.- - - - - - - - - - ranking = 0.13037762230028keywords = physical (Clic here for more details about this article) |