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Query: UMLS:C0002453 (amenorrhea)
 6,245 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

This report documents the danger of the gravid uterus fixing a large ovarian cyst in a position disadvantageous to diaphragmatic excursion and thereby obstructing ventilation. A 34-year-old pregnant patient presented at 18 weeks amenorrhoea with a large ovarian cyst. She gave a history of exertional dyspnoea and orthopnoea. Clinical examination revealed a grossly enlarged abdomen and a respiratory rate of 28 breaths.min-1. Intraoperatively, ventilation was markedly impaired resulting in cyanosis and bradycardia. This was relieved by drainage of the ovarian cyst. A left lateral tilt with manual traction on the tumour may have avoided this problem. Should the above measures be inadequate, immediate drainage of the cyst is essential. Severe respiratory distress may require ultrasound-guided, percutaneous, aspiration of the cyst preoperatively. However, as in this patient, the absence of gross signs of respiratory failure does not preclude acute ventilatory failure after induction of anaesthesia.
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PMID:Mechanical obstruction to ventilation from an ovarian cyst during pregnancy. 206 17

Prescription of oral contraceptives is reviewed by giving practical tips on the absolute contraindications, timing of the first dose, dose of estrogen, choice of type of progestin, reasons for changing the combination, and a list of benefits of oral contraceptives. The major risk in taking orals is cardiovascular disease, but actual risks are clustered in subsets of women. Those at high risk are women over 45, smokers over 35, and smokers of any age with cardiovascular risk factors. Generally women should start with a 30 or 35 mcg estrogen combined pill, and perhaps consider taking a higher estrogen dose if they experience breakthrough bleeding or amenorrhea. The 1st cycle can be started at any time up to 6 days after Cycle Day 1 or after spontaneous or induced abortion. Women taking bromocriptine should also begin contraception soon after delivery. Signs of potential major complications are abdominal pain, chest pain or dyspnea, headache or neurologic symptoms, visual or speech problems, or leg pain or weakness. Benefits of oral contraception include menstrual regulation, decreased menstrual flow, prevention of functional ovarian cysts, protection against ovarian and endometrial cancer by half, against benign breast disease, and possibly against pelvic inflammatory disease.
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PMID:Oral contraceptives. Who, which, when, and why? 362 38

We report a case of pulmonary embolus which is presumed to have been of trophoblastic tissue in a woman in her second pregnancy who had a hyperactive hydatidiform mole. (The size of the uterus was 27 cm after thirteen weeks of amenorrhoea. The level of urinary H.C.G. was greater than 2 million international units per litre.) One hour after the uterus had been evacuated under chemotherapy a picture of acute dyspnoea appeared, and this made it necessary to transfer the patient to an intensive care unit and to incubate her and ventilate her. The analysis of the blood gas showed desaturation and hypoxaemia leading to a diagnosis of massive pulmonary embolus. These complications were resolved in 72 hours and the levels of H.C.G. went down later under the influence of chemotherapy which was started one month after the evacuation and continued for fourteen weeks (for six weeks after the plasma H.C.G. levels had become negative).
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PMID:[Trophoblastic tissue pulmonary embolus in a molar pregnancy (author's transl)]. 745 14

A 21-year-old female was admitted to Tamono City Hospital with chief complaint of dyspnea due to spontaneous pneumothorax. The patient was transferred to our clinic for further examination of abnormal chest X-ray findings together with skin lesions and other symptoms of polyuria, amenorrhea and narrowed visual fields. Histochemical and electron microscopic examination of lung tissue obtained by open lung biopsy led to the diagnosis of eosinophilic granuloma. Furthermore, enhanced computed tomography and magnetic resonance images showed the existence of an intracranial tumor in the supra-hypophyseal region which was interpreted as the cause of hormonal and visual disturbances. Because of dyspnea and enlargement of intracranial tumor, treatment with steroid hormone was commerced followed by tapering of the dose. Chest X-ray findings and skin lesions improved markedly and the intracranial tumor regressed significantly with this steroid therapy, indicating that the intracranial tumor represented involvement with eosinophilic granuloma.
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PMID:[A case of pulmonary eosinophilic granuloma with extrapulmonary involvement treated effectively with steroid hormone]. 811 77

Hereditary hemochromatosis is an autosomal recessive disorder, the gene for which occurs in approximately 10% of Americans, most of whom are unaffected heterozygotes. Approximately 5/1000 white Americans are homozygous and at risk of developing severe and potentially lethal hemochromatosis. The disorder affects numerous organ systems, but the most common symptoms are fatigue, palpitations, joint pains, and impotence; the most common signs are those that relate to hypothalamic, cardiac, hepatic or pancreatic dysfunction, including poor cold tolerance, impotence in males, amenorrhea in females, cardiac arrhythmias, dyspnea, edema, hepatosplenomegaly, spider telangiectases, ascites, deformity, swelling or limitation of motion of joints, weight loss, hyperpigmentation. Characteristic abnormalities of laboratory tests include elevated serum iron concentration, high transferrin saturation, elevated serum ferritin concentration, elevated serum transaminases, hyperglycemia and low values for thyroid-stimulating hormone (TSH) and gonadotropins. Death may be the result of cardiac arrhythmia, congestive heart failure, liver failure or liver cancer. Since many of these complications cannot be reversed once they have developed, early diagnosis and treatment are essential. In view of the high prevalence in the American population (prevalence varies with ethnic background), the low cost of diagnosis and treatment, the efficacy of treatment if begun early, and, on the other hand, high costs and low success rate of late diagnosis and treatment, systematic screening for hemochromatosis is warranted for all persons over the age of 20 years. The initial screening should be by measurement of serum iron concentration and transferrin saturation. The practice guideline provides a diagnostic algorithm for cases in which the serum transferrin saturation is 60% or greater. It also provides guidelines for clinical management.
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PMID:Practice guideline development task force of the College of American Pathologists. Hereditary hemochromatosis. 886 84

In this 4-year open-label, noncomparative, single-center pilot efficacy study, the contraceptive efficacy, safety, bleeding pattern and acceptability of Implanon was studied in 200 sexually active women of proven fertility in Indonesia. All subjects received the single-rod subdermal implant Implanon, which contains 68 mg etonogestrel (3-keto-desogestrel), with an initial release rate of 67 micrograms etonogestrel/day. Contraceptive efficacy was analyzed by calculation of the pregnancy rate, bleeding patterns were determined by the 90-day reference period method, and acceptability by the discontinuation rate. No in-treatment pregnancies were reported during 658.4 women-years of exposure, resulting in a Pearl Index of 0.0 (95% CI 0.0-0.6). The overall bleeding pattern was acceptable, with no discontinuations because of irregular bleeding. Incidence of irregular bleeding was highest during the first two reference periods and decreased thereafter. Amenorrhea was experienced by 7%-12% of subjects during years 1 and 2, by 5%-7% during year 3, and by 2%-5% during year 4, with one discontinuation because of amenorrhea. No clinically significant changes were reported for systolic and diastolic blood pressure, body mass index, and hemoglobin level. Three adverse experiences were related to treatment and resulted in discontinuation (two headaches and one dyspnea). One difficult implant removal was reported. In conclusion, this pilot efficacy study indicates that Implanon provides excellent contraceptive reliability and an acceptable bleeding pattern. Overall safety and acceptability are good, as suggested by the low incidence of adverse experiences and the low discontinuation rate.
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PMID:A pilot efficacy study with a single-rod contraceptive implant (Implanon) in 200 Indonesian women treated for < or = 4 years. 1550 85

Several disease-modifying agents (DMAs) are approved for the treatment of multiple sclerosis, including three interferon (IFN)-beta products, glatiramer acetate and mitoxantrone. This article reviews the adverse event profiles of these DMAs based on the pivotal phase III trials, and provides practical guidelines for managing adverse effects. In general, the most common adverse events associated with IFN beta therapy are flu-like symptoms, including fever, chills and myalgias, and headache. The flu-like symptoms typically resolve within 24 hours and may be mitigated by over-the-counter anti-inflammatory agents. Adverse events related to glatiramer acetate therapy include injection-site reactions and a systemic reaction consisting of flushing, chest tightness, palpitation, anxiety or dyspnoea. The systemic reaction is transient (30 seconds to 30 minutes) and self-limited. Mitoxantrone may cause nausea, vomiting, alopecia, amenorrhoea and myelosuppression; isolated cases of acute leukaemia and dose-related cardiotoxicity have been reported in the literature. Longer-term tolerability data on mitoxantrone as a treatment for multiple sclerosis are needed. It is important for physicians to counsel patients on DMA-related adverse effects, most of which are transient and of mild-to-moderate severity. Various strategies that can be employed to prevent or manage these adverse effects and lessen their impact on the patient are discussed.
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PMID:US FDA-approved disease-modifying treatments for multiple sclerosis: review of adverse effect profiles. 1574 Jan 78

Two pregnant women aged 32 and 34, both of whom had mechanical prosthetic mitral valves, for which they were using low molecular weight heparin. One developed orthopnoea and dyspnoea at 36 weeks amenorrhoea, and the other suffered an acute myocardial infarction at 18 weeks. Both had valvular thrombosis. Following effective treatment, both women delivered at term and one week later after an uncomplicated course, were discharged home from hospital. Clinicians caring for pregnantwomen with mechanical prosthetic valves are faced with a dilemma when trying to provide optimal treatment. Inadequate anticoagulant therapy can result in thrombosis of the mechanical prosthetic valve while, on the other hand, anticoagulant therapy is associated with foetal and maternal bleeding and teratogenic effects. Pregnant women with mechanical prosthetic valves should be thoroughly counselled before or shortly after the confirmation of pregnancy regarding the risks associated with available anticoagulant options, allowing them to make an informed decision concerning the best management plan. This is an algorithm for optimal care of these patients.
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PMID:[Pregnancy and the mechanical prosthetic valve: dilemmas about the choice of antithrombotic prophylaxis]. 1734 36

Pregnancy is a common decompensation factor for women with post-rheumatic mitral disease. However, valvular heart diseases causing severe acute respiratory distress are rare. Use of extracorporeal membrane oxygenation (ECMO) early in the event of cardiorespiratory failure after cardiac surgery may be of benefit. Indeed, ECMO cardiopulmonary bypass (CPB) support could help pulmonary recovery if the mitral pathology is involved. A 31-year-old female patient at 30 weeks of amenorrhea was admitted to the obstetrics department with 40 degrees C hyperthermia and New York Heart Association (NYHA) class 4 dyspnea. The patient's medical history included a post-rheumatic mitral stenosis. Blood gases showed severe hypoxemia associated with hypocapnia. The patient needed to be rapidly intubated and was placed on ventilatory support because of acute respiratory failure. Transesophageal echocardiography showed a severe mitral stenosis, mild mitral insufficiency, and diminished left ventricular function, hypokinetic, dilated right ventricle, and a severe tricuspid regurgitation. An urgent cesarean section was performed. Because of the persistent hemodynamic instability, a mitral valvular replacement and tricuspid valve annuloplasty were performed. In view of the preoperative acute respiratory distress, we decided, at the beginning of the operation, to carry on circulatory support with oxygenation through an ECMO-type CPB at the end of the operation. This decision was totally justified by the unfeasible CPB weaning off. ECMO use led to an efficient hemodynamic state without inotropic drug support. The surgical post-operative course was uneventful. Early use of cardiorespiratory support with veno-arterial ECMO allows pulmonary and right heart recovery after cardiac surgery, thus avoiding the use of inotropic drugs and complex ventilatory support.
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PMID:Extracorporeal membrane oxygenation in severe acute respiratory failure in postpartum woman with rheumatic mitral valve disease: benefit, factors furthering the success of this procedure, and review of the literature. 1767 95

We report three cases of acute pulmonary edema that occurred during treatment by intravenous tocolysis using nicardipine in twin pregnancy patients with no previous heart problems. The three patients were admitted into our unit on account of the risk of premature birth after 29 to 32 weeks of amenorrhea. The treatment by intravenous tocolysis using nicardipine combined with glucocorticoids therapy had been undertaken in the previous maternity ward. The three patients presented symptoms of acute dyspnea 48 hours after the beginning of the treatment. Paraclinical examinations eliminated the diagnosis of pulmonary embolism. The patients'condition improved rapidly with appropriate diuretic treatment and by modifying the tocolysis. There are currently few studies proving the benefits of nicardipine in tocolysis treatment. Few similar cases of acute pulmonary edema have been noted in twin pregnancy patients treated with nicardipine. Haemodynamic modifications specific to twin pregnancy, intravenous hydratation and glucocorticoid maturation may explain a part of this complication. Therefore, it is appropriated to limit the use of intravenous nicardipine in the sole indication of tocolysis in twin pregnancy, and to prefer the use of nifedipine and atosiban, that have proven their effectiveness in this indication.
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PMID:[Acute pulmonary edema occurred during tocolytic treatment using nicardipine in a twin pregnancy. Report of three cases]. 1895 44


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