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Query: UMLS:C0018801 (heart failure)
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Twenty-eight women with severe pre-eclampsia were misdiagnosed and initially thought to have disorders unrelated to pregnancy. Their chief complaints included failing vision, liver or gallbladder dysfunction, renal failure, hemorrhage, seizures, and heart failure. Laboratory studies usually demonstrated thrombocytopenia and high hematocrit values. The development of these symptoms appears to begin with failure of the primigravida to appropriately increase her blood volume commensurate with the increase in size of her uterus. Expanding the severly pre-eclamptic patient's blood volume with intravenous albumin appears to be an effective and appropriate therapy.
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PMID:Severe pre-eclampsia: another great imitator. 94 95

In the course of a sterilization by tubal electrocoagulation, the patient suffered perforation of the abdominal aorta, causing a large hematoma and danger of bleeding to death. The aorta was repaired with a Teflon patch and the patient recovered, but the potentially fatal incident occasioned a review of the legal status of sterilization and of its complications. In the Dohrn case (1964), the Federal Court of Justice determined that voluntary sterilization is nonpunishable under German law. However, sterilization has increased less in Germany than, e.g., in England or Japan, and in 1969 the German Doctors' Conference declared sterilization permissible only for medical, genetic-eugenic, or pressing social reasons. As for complications, electrocoagulation of the tubes - involving anesthesia, inhibition of respiration by means of Trendelenburg's position, introduction of carbon dioxide into the abdomen, and manipulation of instruments through incisions - must be considered a complex procedure. Among 11,956 published cases described by 29 authors between 1969-1974, the complication rate was 1.71%; probably the actual rate is higher. 3 fatalities - from heart failure, peritonitis, and suffocation - were reported. In addition, there were 117 hemorrhages (.98% of the cases reported), 22 burns or mechanical injuries of the gastrointestinal tract (.19%), 26 perforations of the uterus (.22%), 44 infections (.37%), 25 skin burns (.21%), and 24 cases of skin or organ emphysema (.2%). Mechanical injuries carry the danger of perforation of organs over time, and the injuries reported included 13 perforations of colon, ileum, or stomach, requiring laparotomy and excision. Complications under electrocoagulation are reported to be less severe than in conventional operations; nevertheless, electrocoagulation should never be performed as an outpatient operation, and follow-up to check for delayed complications is advisable. Contraindications are poor general health, severely reduced respiration, and such conditions as anatomical anomalies, tumors, endometriosis, and obesity.
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PMID:[Aortic perforation following electrocoagulation of the tubes]. 126 30

The authors report eight cases of antenatal diagnosis of sacro-coccygeal teratoma (SCT) in five girls and three boys in whom the diagnosis was made between the 19th and 34th week of amenorrhea (mean = 27 weeks). The ultrasound pictures taken antenatally of the SCT assist in the discovery of a mass that is usually heterogenous, attached to the distal end of the sacrum, and the discovery is usually made fortuitously or because the height of the uterus is too great. A different series of antenatal diagnoses for SCT have made it possible to work out certain criteria of seriousness to be able to predict intra-uterine death: the presence of anasarca or of hydramnios, the discovery of the lesion before the 30th week of amenorrhoea, the relative weight of the teratoma as against the weight of the fetus being above 50%. We think from our experience that it is important to add the scale of the antenatal growth of the teratoma. A rapid growth of the SCT will lead to a tumour mass which is great as compared to the size of the fetus. Similarly in certain cases the vascular bed will increase in size, and intratumour haemorrhages can occur and give rise to fetal heart failure and also to fetal anaemia, hypoproteinaemia and the appearance of anasarca or of hydramnios. The child dies in utero or immediately after birth because of prematurity from the haemorrhagic state or from cardiac insufficiency. Furthermore accelerated growth of the tumour is nearly always in the immature tumour cells and that means that the child, if it is born alive, should be followed up for a long time because there is a risk of it becoming locally malignant. In practice the monitoring of SCT and the antenatal discovery of the condition should be carried out very seriously in order, in some cases, if it is viable to produce a living child in conditions where the rapid growth of tumour would make it likely that the child would die in utero.
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PMID:[Sacrococcygeal teratomas in antenatal diagnosis]. 195 58

Septic shock in obstetrics is a major cause of mortality. Postpartum endometritis is often the first step of bacterial colonization inside the uterus which becomes the nidus of infection. Rapid spread into general circulation is favoured by hemodynamics patterns of pregnancy. Bacteremia would result in cardiovascular collapse and a myocardial depressant factor has been proposed to explain the fall in cardiac output. Later, endotoxin activates the substances of malignant intravascular inflammation and multiple systems organ failure may be observed in uncontrolled sepsis. Eight cases are reported hospitalized at Morelia's General Hospital, SSA, with septic shock and MSOF. Presumably because of aggressive acute resuscitation nobody succumbed during acute cardiac failure and hypotensive episode but two patients died later with multiple system organ failure. The mortality was 25%. Fluid, resuscitation, and vasoactive drugs are the most effective way to reduce mortality. Antibiotics, specific treatment of MSOF and taking away the nidus of infection are critical components of therapy.
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PMID:[Septic shock in obstetrics]. 207 37

2 studies have been done in China: 1) a longitudinal study on maternal mortality in Beijing from 1949 to 1983; and 2) a cross-sectional study on maternal mortality in the year 1984 in 21 of 29 provinces, municipalities, and autonomous regions. A maternal and child health network for care and referral of abnormal cases was set up with ambulances and transfusion facilities in place and training for traditional birth attendants. Aseptic delivery reduced the number of deaths due to sepsis from 213/100,000 live births to 4.2 in 5 years and to 0 in 9 years. Deaths from hemorrhage (including ruptured uterus) dropped by 86% in 5 years. With legalized abortion came a dramatic fall in maternal mortality from 685,100/000 live births to 15, a decrease of 98%. In 1949, 27% of women who died in childbirth had received hospital care; another 27% had no cure. In 1958, however, 80% of the fetal cases had obtained hospital care; the remaining 20% had been seen by a traditional practitioner or health worker. From 1959-68, the total maternal mortality was 1.3-28.1/1 00,000. From 69-78, the turmoil of the cultural revolution had "ill effects" on maternal and child health but by 1979, order was brought back again. The cross-sectional study covered a population of about 177 million. About 2.5 million live births occurred. 1211 maternal deaths were registered for a maternal mortality rate of 48.4/100,000. Maternal mortality varied a good deal in different parts of the country--from 17.7 in Shanghai to 108.2 in the region of the Hai people in Ningxia in northwest China. Maternal mortality rates correspond roughly to the level of economic development. The 5 main causes of death were hemorrhage, heart failure, pregnancy- induced hypertension (including eclampsia), postpartum infection and liver failure.
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PMID:Maternal mortality in China. 263 3

We describe the anaesthetic management of a 20 years old female with a Friedreich's ataxia for curettage of the uterus. After the premedication with thalamonal, diazepam and atropine the anaesthesia was induced with thiopental. Isoflurane and nitrous oxide were used for maintenance. We review the literature about this disease and its implications in anaesthesia. Anesthetic hazards to the patient with Friedreich's ataxia include potential risk of cardiac dysrhythmias and heart failure and also marked sensitivity to muscle relaxants. Respiratory complications and diabetes mellitus are other main problems in postoperative period. We conclude that this patients should be careful monitored specially cardiovascular function and neuromuscular transmission during and after anaesthesia.
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PMID:[Anesthetic management in a case of Friedreich's ataxia]. 268 72

Intravenous leiomyomatosis (IVL) is a rare neoplastic disease which is defined as the extension into venous channels of histologically benign smooth muscle tumors arising either from a uterine myoma or from the walls of a uterine vessel. We report a case of IVL originating from the uterus, growing up in the inferior vena cava, and extending into the right pulmonary artery. The patient was a 42-year-old woman, who was admitted to our hospital with clinical signs of right-side heart failure and syncope in December 1987. Her medical history included a total hysterectomy in August 1986. On examination, two dimensional echocardiography showed a freely floating tumor in the right atrium and right ventricle, which protruded via the inferior vena cava. Cavography confirmed the above findings. Because of the clinical disability caused by the tumor localized in the right heart, emergency operation was performed, extracorporeal circulation was instituted through the femoral vein, the superior vena cava, and the femoral artery. Opening the right atrium confirmed that a white sausage-like mass quite free from the wall extended into the right ventricle, and the head of the tumor was adherent to the right pulmonary artery. After detaching the head of the tumor from the right pulmonary artery, the remaining tumor in the inferior vena cava was also successfully pulled out. The operative specimen was measured 55 cm in length, but the basal end of the tumor was supposed to be left in place. Two months later, the second-stage operation for the remaining tumor was carried out through a median laparotomy.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[A case report of intravenous leiomyomatosis of the uterus with extension into the right pulmonary artery]. 269 64

Maternal endoxin (digoxinlike substance) is proposed as arising in the fetal area of the fetal adrenal cortex. Its function may be to sensitize the uterus for labor, much as does cortisol in the sheep fetus. Because endoxin is a sodium-potassium-adenosine triphosphatase inhibitor, however, it may also induce maternal vasoconstriction. On our service, normal pregnant women have detectable endoxin after 35 weeks with increasing amounts at term. Specimens of cord blood often have "digoxin" in the therapeutic range. We find that about 40% of women in premature labor and 65% of pregnant women with hypertension have elevated levels of serum endoxin. Postdate gravid women sometimes have very low endoxin levels. Pregnant women with complications and elevated digoxin (endoxin) levels could have specific antidigoxin therapy if endoxin proves to be a modulator of their symptoms. Digoxinlike substances are also sometimes elevated in ill nonpregnant persons, such as those with renal, liver, or heart failure, or hypertension.
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PMID:Fetal endoxins and complications of pregnancy. 284 75

Tubal ligation was initially proposed to prevent serious and foreseeable accidents related to pregnancy. The techniques and indications for tubal ligation have subsequently multiplied. Physicians must assess their own attitudes toward sterilization seekers, taking into account the moral and legal aspects, the risks of all surgery, and the uncertain prospects for reversal. Surgical sterilization should remain an exceptional procedure, reserved for women who have exhausted other medical resources. No law in France specifically addresses the legality of male or female sterilization, but physicians performing sterilizations have some risk of being charged with assault and battery. Laparotomy and minilaparotomy, except in postpartum sterilization, are usually done in France only when there are contraindications to laparoscopic sterilization. Among laparoscopic techniques, electrocoagulation and thermocoagulation are not often used because of the risk of serious complications. Yoon rings and Hulka-Clemens clips are preferred because of the lessened risk of accidents and improved potential reversibility. Laparoscopic sterilization is the technique of choice except during the postpartum or in very obese women, women who have undergone repeated abdominal surgery, or with cardiorespiratory complications. Vaginal techniques are another alternative in case of contraindications to laparoscopy, but they are contraindicated in case of a large uterus, infection, or endometriosis. The medical indications for surgical sterilization are becoming rare because of progress in preventive medicine, nutrition, and hygiene, and the appearance of new treatments and methods of prenatal surveillance. The principal indication at present is a scarred uterus following several cesareans. Other medical indications are neoplasia, severe cardiac insufficiency, and serious psychiatric disorders. Genetic indications are also exceptional. The greatest demand for sterilization is among women desiring contraceptive convenience, but some 10-20% of women sterilized in the absence of specific medical indications experience regret and 1-5% request reversal. Risk factors for reversal include young age of the woman, marital problems, sterilization during an obstetrical event, low parity, poor information on contraception, no previous contraceptive usage, incomplete information on sterilization and its consequences, and intrusion of the physician in the sterilization decision.
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PMID:[Surgical sterilization in women]. 343 98

Single agent activity of aclacinomycin A or aclarubicin (ACR) for acute leukaemia in adults was as follows: complete remission was achieved in 8 of 21 (38%) with untreated patients and 7 of 41 (17%) with prior chemotherapy; thus the overall complete remission rate was 24%. The optimal dose schedule was 14 mg/m2/d daily i.v. administration, and a median total dose of 200 mg/m2 and 16 days were necessary for induction of complete remission. In combination, with behenoyl ara-C, ACR, 6-mercaptopurine and prednisolone, complete remission was achieved in 40 of 60 (67%) previously untreated patients, and 41 of 65 (63%) with prior chemotherapy; thus the overall rate was 65%. In a phase II study of ACR for solid tumours, response was achieved in carcinoma of oesophagus (1/3), stomach (12/84, 14%), gall bladder (1/4), pancreas (1/8), lung (4/30, 13%), breast (6/33, 18%), uterus (1/4), ovary (3/9, 33%), head and neck (1/5) and sarcoma (1/5). Side-effects of ACR most frequently observed were nausea and vomiting (around 30%) and a moderate grade marrow suppression was noted. An ECG change was observed in 7%, but there were no cases of chronic heart failure.
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PMID:Clinical review of aclacinomycin A in Japan. 386


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