Rudimentary uterine horn pregnancy. The 20th-century worldwide experience of 588 cases

OBJECTIVE: To investigate the outcomes of rudimentary uterine horn pregnancies and to identify trends and opportunities for improvement in patient care. STUDY DESIGN: During the period 1900-1999, 588 cases of rudimentary uterine horn pregnancy were identified using both manual and computerized searches of Index Medicus, Excerpta Medica and the Index-Catalogue of the Library of the Surgeon-General's Office of the United States Army as well as standard reference tracing. Nine characteristics of each case were evaluated: (1) fetal status at birth, (2) maternal survival, (3) neonatal survival, (4) gestational age at delivery, (5) whether the rudimentary horn ruptured, (6) communication status of the horn with the contralateral hemiuterus, (7) gravidity and parity, (8) side of the horn, and (9) order of the gestation. RESULTS: Newborn survival ranged from 0-13% by decade and trended upward. Eighty-five percent of pregnancies occupied noncommunicating horns. Thirty percent of gestations progressed to term or beyond. Fifty percent of pregnant uterine horns ruptured, with 80% of these events occurring before the third trimester. There was no trend in either the incidence or timing of uterine horn rupture during the century. Maternal mortality decreased from 6% to 23% during the first half of the century to < 0.5% currently. Twin pregnancies consisted of 5.3% of cases. CONCLUSION: Neonatal survival has improved greatly for rudimentary horn pregnancies, and maternal mortality has decreased significantly. Such pregnancies are now identifiable early in gestation by obstetric imaging studies, and there can be guarded optimism that favorable trends in outcomes will continue into the 21st century.     

Adrenomyeloneuropathy--report on a family.

A family is reported in which there is one case of adrenomyeloneuropathy, one case of Addison's disease and at least three heterozygous females with spastic paraparesis and peripheral neuropathy. Adrenomyeloneuropathy has not been reported previously in Scandinavia. The differences in the clinical picture between the sexes and at different ages are emphasized. Elevation of the levels of very-long-chain fatty acids in plasma is a characteristic feature of the disease and confirms the diagnosis. Some recent reports in the literature seem to provide some hope that the clinical manifestations of adrenomyeloneuropathy/adrenoleukodystrophy may be prevented.     

Nosocomial infections caused by methicillin-resistant Staphylococcus aureus in a pediatric intensive care unit

We performed an epidemiological investigation owing to the appearance between February and March 1988, of subsequent MRSA infections in our ICU; we also started a checking scheme. At the same time we performed a retrospective-perspective study of 701 patients (310 newborns 391 not newborns) admitted into ICU from 1-1-1987 to 30-6-1988. This study allowed us to settle the presence of MRSA in ICU and the manner in which they become infected. From our study the 4.9% of our patients contracted hospital infections and the 34.2% of these were MRSA infections. The 39.7% of our colonized patients were MRSA. It is really significant the frequency of MRSA colonization (p less than 0.0005) among newborn patients compared with other age patients; in the meantime there is not statistical significance in the frequency of MRSA hospital infections among the two groups. The results of our study show that infections were probably transmitted by the hands of the members of staff and that the reservoir of MRSA are tracheostomized hosts or long term ventilated patients.     

EVALUATION OF THE EFFECTIVENESS OF TREATMENT ON ADULT HEIGHT PROGNOSIS IN DISORDERS WITH ADVANCED AND RETARDED BONE AGE Height and Height Velocity related to Chronological or to Bone Age

Different growth parameters and their graphical presentation in disorders with advanced and retarded bone age are discussed. Their usefulness for the evaluation of the effect of treatment on growth and maturation is compared. In precocious puberty, more information is obtained when height is plotted against bone age instead of chronological age. It is more reasonable from a physiological standpoint to plot height velocity against bone age rather than chronological age. For the evaluation of the efficiency of treatment on adult height prognosis in precocious puberty, two possibilities are proposed: height velocity expressed as height increment per bone age year, or the quotient height age increment/bone age increment. However, where skeletal maturation is severely retarded, as in hypopituitary growth retardation, these growth parameters should be related in the conventional way to chronological age, rather than to bone age.     

Changes in femur dimensions in asymptomatic non-cemented hip arthroplasties: 20 cases followed for 5-8 years

We assessed changes in proximal femur diameter during 5-8 years follow-up of 20 clinically successful press-fit cementless isoelastic implants. Total bone diameter, medullary diameter and cortical thickness were measured over the distal half of the prosthesis and just beyond the prosthesis tip. During the follow-up period total bone diameter did not change. However, cortical thickness declined by an average of 1 mm, while the size of the medullary canal increased by the same amount. As the patients remained asymptomatic during this period, the phenomenon observed did not appear to be related to loosening. We concluded that age-related changes in bone diameter can lead to widening of the tight interface between the stem and the femur.     

Unsuccessful rescrewing of a dislodged screw-in atrial lead

We report a case of unsuccessful rescrewing of an atrial lead after its early dislodgment in a 64 years old patient because of entrapped endocardial tissue in the screw-in system. (PACE 2004; 27:692)     

Infectious mononucleosis hepatitis: a case-report

46-year-old Mexican-born who lived in Mexico City was admitted to the hospital for evaluation with a two-week history of fever, jaundice, and malaise. Physical examination he had cardiac murmurs. The liver was palpable 2 cm below the costal margins. Liver-function tests showed hypertransaminasemia. The patient had a high titer of anti-EBV IgM antibodies, but tests for all other antiviral antibodies were negative. The liver biopsy shows EBV latent membrane protein.