Laparoscopic cholecystectomy during pregnancy is safe for both mother and fetus

The use of laparoscopic cholecystectomy in pregnant women has been slow to gain wide acceptance for two reasons: one is the potential for mechanical problems related to the pregnant uterus and the other is fear of fetal injury resulting from instrumentation or the pneumoperitoneum. To assess the effects of laparoscopic cholecystectomy on both the mother and the unborn fetus, we reviewed our surgical experience over a 5-year period analyzing indications for the procedure along with complications and outcome. During this 5-year period, 22 patients ranging in age from 17 to 31 years underwent laparoscopic cholecystectomy during pregnancy. Gestational ages ranged from 5 to 31 weeks with two patients being in the first trimester, 16 in the second, and four in the third. The primary indications for surgical intervention were persistent nausea, vomiting, pain, and inability to eat in 17 patients, acute cholecystitis in three and choledocholithiasis in two. In all patients a pneumoperitoneum was established by means of a closed technique starting in the right upper quadrant of the abdomen. Two of the 22 patients also underwent successful transcystic common bile duct exploration with removal of common duct stones. All 22 patients survived the surgical procedure without complications, and there were no fetal deaths or premature births related to the procedure. Based on the preceding results, it would appear that laparoscopic cholecystectomy during pregnancy is safe for both the mother and the unborn fetus. Indications for this procedure should include stringent criteria such as unrelenting biliary tract symptoms or the complications of cholelithiasis. If at all possible, when laparoscopic cholecystectomy is indicated, it should be performed either in the second trimester or early in the third.     

Esclerosis múltiple,maternidad y cuestiones relacionadas con el género

Background

The course of multiple sclerosis (MS) is influenced by sex, pregnancy and hormonal factors.

Oat-cell carcinoma of the esophagus: presentation of two cases and literature review]

OBJECTIVE: Our objective is to contribute an updated view on a condition as rare as oat-cell carcinoma of the esophagus by reviewing the literature and reporting two recent patients seen in our department. MATERIAL AND METHOD: A retrospective study with a review of all medical records of patients seen in our ward and diagnosed with esophageal neoplasm for 6 years (January 2000 to December 2006). RESULTS: 249 cases of esophageal neoplasms were found, of them 106 were of squamous ancestry (42.6%), 141 were adenocarcinomas (56.6%), and 2 were oat-cell carcinomas (0.8%). Only in 45 (18%) was surgical resection feasible, 23 underwent palliative surgery (endoprostheses, gastrostomies, and jejunostomies not included) (9.3%), and the rest (181 cases, 72.7%) received derivative surgery or no surgery at all. CONCLUSIONS: We can affirm that this neoplasm is highly aggressive, displaying in practically all cases dissemination to other sites; this is a rare cancer that mainly affects men and whose clinical picture is similar to that of other malignancies involving the esophagus.     

Lupus eritematoso sistémico y púrpura trombótica trombocitopénica: un caso refractario sin actividad lúpica asociada

The association between systemic lupus erythematosus (SLE) and thrombotic thrombocytopenic purpura (TTP) has been infrequently reported. Usually, patients with TTP have more SLE activity and frequent renal involvement. Here we present a case of TTP associated to low-activity SLE. The absence of renal and major organ involvement increased the difficulty in making the initial diagnosis. ADAMTS13 activity in plasma in this patient was very low, as seen in other similar cases. The evolution of the patient was poor, needing plasma exchanges and immunosuppressive therapy, including the use of rituximab.     

Normal Breastfeeding after Breast Reconstruction in a Patient with Poland's Syndrome

BACKGROUND: Poland's syndrome is a rare congenital non-inherited anomaly that usually manifests itself during adolescence and is characterized by absence or deficient development of one of the breasts. To our knowledge, no case of breastfeeding after reconstruction surgery in patients with Poland's syndrome has been described. CASE REPORT: A 22-year-old female patient with Poland's syndrome underwent breast reconstruction. The procedure performed consisted of rotation of a myocutaneous flap harvested from the ipsilateral latissimus dorsi muscle, which was subsequently attached to the anterior thoracic wall to create a pouch and place a 300-ml round textured cohesive silicone gel-filled breast implant. 5 years later the patient got pregnant, and 1 year after delivery she is still breastfeeding normally with both breasts. CONCLUSION: Reconstruction surgery with the latissimus dorsi muscle and a prosthesis was shown to be a potential and safe solution to achieve improvement of breast symmetry and to provide confidence and comfort in relation to self-image and, moreover, the ability to breastfeed.     

Gigantomastia gravídica asociada a tejido mamario ectópico vulvar

We report the case of a primigravida who had previously undergone breast reduction and who developed gigantomastia associated with a vulvar adenoma, diagnosed as an ectopic mammary adenoma. Despite its low frequency, physicians should be familiar with this entity due to its major effects on the patient and health team, requiring decisions with important repercussions on the health – and sometimes life – of the woman and fetus.     

Use of ziprasidone in parkinsonian patients with psychosis

Twelve patients with Parkinson disease and psychosis were included in an open-label 12-week trial of ziprasidone. Two patients withdrew from the treatment because of adverse effects. The remaining 10 patients reported a significant improvement in psychiatric symptoms. Altogether, there was no deterioration of motor symptoms (UPDRS III score: basal 40.4 +/- 11.1, first month 41.1 +/- 10.8; final visit, 37.7 +/- 13.3). Two patients (20%) suffered a slight deterioration in motor symptoms and another patient suffered deterioration of gait. No analytic alterations or serious adverse effects that could limit the use of ziprasidone were observed. Although controlled trials are needed, the findings suggest that ziprasidone may be effective in parkinsonian patients with psychosis.     

Developmental cysts in the presacral space in adults

Localization of primitive neoplasms the retrorectal or presacral space is rare in adults as most of these tumors are congenital. Developmental cysts are included within the group of retrorectal congenital cystic neoplasms and are slowly-progressive cystic neoplasms. Because of their localization, their manifestation is delayed, despite their congenital nature. Their form of presentation is varied and is caused by compression of the surrounding organs or infectious complications of the cyst.We describe two cases of presacral developmental cysts (one epidermoid cyst and one dermoid cyst) that presented in adulthood. Special attention is paid to the classification, and diagnostic and therapeutic problems of these tumors.     

Quantification of angiogenesis in cervical cancer: a comparison among three endothelial cell markers

OBJECTIVES: The aim of this study was to evaluate the quantification of angiogenesis by assessing microvessel density in cervical cancer, comparing the performance of three monoclonal antibodies: anti-CD34 and BNH9, which are still little known markers in cervical neoplasia, and anti-CD31. METHODS: Fifty-four consecutive patients diagnosed with stages I and II invasive cervical cancer undergoing radical hysterectomy and bilateral pelvic lymphadenectomy were evaluated. The monoclonal primary antibodies used were anti-CD34, anti-CD31 and BNH9 antibody. The areas of highest microvessel density were used for counting microvessels in 10 high-power fields. Microvessel density was the mean vessel number counted in 10 high-power fields. RESULTS: The mean of microvessel density was 10.3, 9.7 and 5.8 for anti-CD34, BNH9 and anti-CD31, respectively. According to the Kruskal-Wallis nonparametric test, microvessel density estimated by anti-CD34 and BNH9 was significantly higher than the microvessel density estimated by anti-CD31. The difference between microvessel density measured by anti-CD34 and BNH9 was not statistically significant. There was diagnostic agreement in 44 out of 54 cases for anti-CD34 and BNH9 monoclonal antibodies, kappa coefficient being 0.63. The kappa coefficient was 0.41 between anti-CD34 and anti-CD31 and 0.26 between anti-CD31 and BNH9. CONCLUSIONS: The anti-CD34 and BNH9 seem to have higher sensitivity than anti-CD31. The agreement to quantify microvessel density between anti-CD34 and BNH9 is higher than between them and anti-CD31. Additionally, considering that the BNH9 is much less unknown than anti-CD34 and that they showed very similar performance, the BNH9 clinical significance should be test in different neoplasms.     

Baroreflex failure after chemodectoma resection

Baroreflex failure after chemodectoma resection We present a case of baroreflex failure secondary to a unilateral injury of the glossopharyngeal nerve. The patient was operated for a left-sided chemodectoma in the carotid body. Some months after surgery she started to report presyncopal episodes exacerbated by mental stress and when standing up. During these episodes, the patient presented hypertensive crises and tachycardia. However, blood pressure was below normal ranges at rest. The diagnosis was baroreflex failure secondary to unilateral injury of the glossopharyngeal nerve. The case reported herein illustrates the fact that the presence of a bilateral injury is not essential for the occurrence of this disorder.