The use of topical nitroglycerin ointment to treat peripheral tissue ischemia secondary to arterial line complications in neonates.

Catheterization of the aorta through the umbilical artery and/or of peripheral arteries in neonates may be accompanied by a number of complications, of which thrombotic phenomena and peripheral vasospasm are the most common. Two neonates with peripheral ischemia caused by vasospasm from indwelling umbilical artery catheterization and one infant with left hand ischemia due to a left radial artery line were successfully treated with 2% nitroglycerin ointment. No adverse effects were noted.     

Diphenhydramine toxicity in a newborn: a case report.

Maternal drug intake before delivery may influence the clinical behavior of the newborn. The effects of anesthetic agents and narcotics may cause symptoms of depression in the infant. Infants of substance-abusing mothers may also have altered clinical states. This is a case report of a newborn, very depressed at birth, who apparently was sedated by diphenhydramine (Benadryl) ingested by the mother before delivery. The importance of complete history of drug ingestion by mother before delivery is important in evaluating the behavior of a neonate.     

Aspergillosis in a 24-week newborn: a case report.

Aspergillosis is an uncommon neonatal infection, diagnosed with an increasing frequency over the last two decades. We report a premature neonate who developed aspergillosis while receiving amphotericin B and fluconazole for candidiasis. Despite early recognition and diagnosis, the infant died. We review the clinical appearance of Aspergillus species, the distinctions between primary cutaneous aspergillosis and invasive aspergillosis, and advances in diagnosis and treatment.     

Resolution of endometrial hyperplasia with adjuvant anastrozole treatment in postmenopausal breast cancer: a case report

BACKGROUND: Endometrial hyperplasia in patients with a history of breast cancer presents a therapeutic dilemma. The standard conservative therapy for hyperplasia, high-dose progestins, is contraindicated in breast cancer. Anastrozole, an aromatase inhibitor, is becoming first-line adjuvant therapy for breast cancer in postmenopausal women and may have protective effects on the endometrium. CASE: A 51-year-old, obese woman with a history of breast cancer presented with a 2-day history of heavy postmenopausal bleeding. Endometrial biopsy demonstrated simple hyperplasia without cellular atypia. After consultation with the patient's oncologist, the patient received adjuvant anastrozole therapy for the breast cancer; it led to resolution of the endometrial hyperplasia. CONCLUSION: Adjuvant therapy with anastrozole may be beneficial in resolving endometrial hyperplasia in patients with breast cancer.     

Subgaleal abscess and E. coli septicemia following scalp electrode in a preterm newborn: A case report

Escherichia coli as a causative agent for neonatal sepsis is well established. However, there is paucity of reports in the medical literature of E. coli sepsis following scalp electrode placement.

We report a preterm infant who developed scalp abscess and E. coli sepsis following a scalp electrode.

We recommend a careful examination of babies with a history of fetal electrode monitoring as this could be a nidus for local and generalised infection.     

Acute pseudo-obstruction of the colon following partial splenic artery embolization: report of a case.

This is a case of a 45-year-old woman suffering from liver cirrhosis with hypersplenism who received a partial splenic artery embolization with gelfoam pieces. Thrombocytopenia and leukopenia improved immediately after treatment. Marked abdominal distention, metallic bowel sounds and combined small and large bowel distension with air-fluid levels as shown on a plain abdominal X ray were noted on the fifth day after the embolization procedure. Laparotomy was performed. No mechanical obstruction was found during surgery. Acute pseudo-obstruction of the colon (Ogilvie's syndrome) was diagnosed. This condition was considered to be a complication of the partial splenic artery embolization and has not hitherto been reported.     

Patent ductus arteriosus after prolonged treatment with indomethacin during pregnancy: case report

Indomethacin was administered to suppress premature uterine contractions in a twin pregnancy from the 27th until the 32nd week of pregnancy. Patent ductus arteriosus was diagnosed after delivery in one twin and persisted patent for a period of 4 weeks. A hypothesis of the constrictive influence of prostaglandin synthetase inhibitors on the fetal ductus arteriosus during intrauterine and neonatal periods is suggested.     

Lupus-like syndrome in a mother and newborn following administration of hydralazine; a case report

A very-low-birth-weight infant died from pericardial effusion and cardiac tamponade confirmed by the post-mortem findings. The mother suffered from lupus-like syndrome consequent to hydralazine treatment for pregnancy-induced hypertension. The possible relationship between mother-infant pathology and hydralazine administration is discussed.     

Resolution of cerebral white matter lesions following long-term penicillamine therapy for Wilson's disease: report of a case.

Although lenticular gray matter lesions in Wilson's disease (WD) may resolve following long-term decoppering therapy, response of cerebral white matter lesions to such a treatment has not been reported. A patient with WD developed dystonia of the left hand and focal seizures involving the left upper limb with occasional generalization. CT disclosed a low density area in the right frontal white matter. Initiation of penicillamine therapy resulted in worsening of clinical manifestations, further extension of the right frontal lesion, and development of a new left parietal lesion. However, after five years of continued penicillamine therapy, clinical improvements were noted, including disappearance of the left parietal lesion and almost complete resolution of the right frontal lesion. The present case suggests that cerebral white matter lesions in WD may also respond to long-term chelating therapy.     

Ectopic pregnancy following emergency contraception with ethinyloestradiol-levonorgestrel: a case report.

BACKGROUND: Emergency contraception with ethinyloestradiol-levonorgestrel is effective, and ectopic pregnancy following its failure is rare. CASE: A 21-year-old nulligravid Japanese woman with regular menstrual periods took ethinyloestradiol-levonorgestrel pills for emergency contraception (EC) 36 and 48 hours after a coitus complicated by retention of the condom in the vagina. She started bleeding vaginally 24 days after that intercourse. As the bleeding continued for three weeks she consulted a gynaecologist. The pregnancy test was positive. Two weeks later she complained of lower abdominal pain, and transvaginal ultrasonography suggested a pelvic blood collection. At emergency surgery, she was found to have a left tubal pregnancy. CONCLUSION: Although ectopic pregnancy after failure of EC is rare, one should be alert to its possible occurrence.     

Transverse myelitis following methotrexate treatment of ectopic pregnancy: a case report

Objective: Ectopic pregnancy is a common condition in the field of gynaecology, often treated with methotrexate. Adverse effects are common and usually mild. Severe adverse events are rare amongst patients treated with MTX for this condition.

Case: A 26-year-old healthy woman was admitted and treated medically with MTX for an ectopic pregnancy. The patient was treated in the standard drug labelled protocol with an intramuscular injection of 78?mg of MTX according to body surface area. Soon after, the patient presented to the emergency department with symptoms of bilateral paresthesia of the lower limbs which ascended to the pelvis. After a thorough work up and imaging via MRI a diagnosis of transverse myelitis was made. Treatment was successful with corticosteroids and symptoms subsided.

Conclusions: We propose that MTX should be used with caution and severe toxicity should be kept in mind with high index of awareness for any symptom development following treatment, especially neurological one.     

Successful management of vulvar adhesions with potent topical corticosteroids: a case report

BACKGROUND: Vulvar adhesions are a rarely reported but clinically recognized complication of severe ulcerations following herpes genitalis. The condition is avoidable with adequate pharmacologic treatment, hygiene, separation of the labia and topical application of skin emollients. CASE: Vulvar agglutination was diagnosed in a 23-year-old woman following hospitalization for severe herpetic vulvar ulcerations. Manual attempts to separate the labia under local anesthesia were unsuccessful. Topical application of a potent cortico- steroid led to separation with no residual effects. CONCLUSION: Preventive and proactive management of extensive herpetic vulvar ulcerations should be the first line of care. There will always be patients who will present at a later stage of the disease, with established vulvar agglutination; there potent topical corticosteriods could prove valuable. There is no literature on the use of topical corticosteroids as the primary treatment for vulvar adhesions, and further studies are essential.     

Arterio-enteric fistula following pelvic radiation: a case report.

Two cases of arterial perforation into the small bowel are reported. Etiology was not determined in one case, but surgical trauma leading to localized infection in the irradiated tissue seemed responsible in the other. After the initial episode of hemorrhage, there was a symptom-free interval before its reappearance and vascular collapse. This is believed to be due to the distensibility of the large bowel. The site of arterial perforation was determined pre-operatively in one case by selective arteriography. Review of the recent literature relevant to transcatheter arterial embolization suggests that it may have potential in management of the arterio-enteric fistula as an alternative to or an aid in surgical correction by stabilizing the patient in a favorable condition.     

Maternal death after spontaneous rupture of a uterine artery immediately following delivery: a case report

We report the case of a maternal death occurring after spontaneous rupture of a uterine artery immediately following delivery. The patient presented abdominal pain and a collapsus one hour after a normal delivery. Laparotomy revealed massive haemoperitoneum and intraperitoneal bleeding from the right uterine artery. Ligature of the uterine artery and hemostasis hysterectomy were performed but the patient died of multivisceral failure 18 h after the delivery. This is the first case report of maternal death occurring after spontaneous rupture of a uterine artery.     

Branchial-cleft sinus presenting with a retropharyngeal abscess for a newborn: a case report

A retropharyngeal abscess rarely occurs in the neonate. We report a neonate without apparent trauma who presented with a left neck mass and respiratory distress at the fourth day of age. A lateral neck X-ray revealed a widened retropharyngeal space. A neck computed tomography (CT) scan revealed a space-occupying lesion with air content in the left retropharyngeal area, although direct laryngoscopy, endoscopy, and a pharyngoesophagogram did not demonstrate the presence of any fistula tract. Due to the high index of suspicion for an aero-digestive tract fistula, diluted contrast medium was injected into the cyst while performing a CT-guided aspiration, and opacification was found in the oropharynx, thus a branchial-cleft sinus appeared to be most likely. The follow-up neck CT scan revealed no evidence of any recurrence. We suggest that CT-guided aspiration and cystography are useful for the diagnosis and treatment of some neonatal neck cystic lesions.     

Internal mammary artery to pulmonary artery fistula associated with sick sinus syndrome: report of a case.

A 77-year-old woman presented with general weakness, dizziness and slow, irregular heart beats. An electrophysiologic study revealed a markedly prolonged sinus node recovery time of up to 5,900 msec, accompanied with dizziness. A permanent pacemaker with an AAIR mode was implanted. An abnormal shadow in the right lower lung field was found on chest x-ray. Selective arteriography revealed a right internal mammary to right pulmonary artery fistula. No significant hemodynamic abnormalities were found. This anomaly is extremely rare. Our patient is the oldest among 20 cases reported in the literature, and is the first one associated with sick sinus syndrome. Most reported cases have involved surgical ligation and excision, due to the risk of rupture of the malformation, endarteritis and congestive heart failure. Our patient refused surgical intervention and has done well during the past year.