Anti-coagulation complications in pregnancies with severe pulmonary arterial hypertension

Background: Epoprostenol, a potent vasodilator, is the treatment of choice for severe pulmonary arterial hypertension (PAH) in pregnancy. However, its inhibition of platelet aggregation increases the risk of coagulation complications with conjunctive use of anti-coagulants for thromboprophylaxis.

Cases: Case 1 demonstrates a pregnancy complicated by thrombocytopenia. Case 2 describes a pregnancy with newly diagnosed PAH at 35?weeks who delivered by repeat cesarean delivery complicated by a wound hematoma. Case 3 describes a patient who delivered at 32?weeks. She required extracorporeal membrane oxygenation and a heart–lung transplant. Her care was further complicated by severe thrombocytopenia with postpartum hemorrhage refractory to usual conservative measures.

Conclusions: This case series describes three patients with severe PAH in pregnancy and the range of different complications that arose from anticoagulation in the setting of epoprostenol.     

Visual object naming in patients with small lesions centered at the left temporopolar region

Naming is considered a left hemisphere function that operates according to a posterior–anterior specificity gradient, with more fine-grained information processed in most anterior regions of the temporal lobe (ATL), including the temporal pole (TP). Word finding difficulties are typically assessed using visual confrontation naming tasks, and have been associated with selective damage to ATL resulting from different aetiologies. Nonetheless, the role of the ATL and, more specifically, of the TP in the naming network is not completely established. Most of the accumulated evidence is based on studies on patients with extensive lesions, often bilateral. Furthermore, there is a considerable variability in the anatomical definition of ATL. To better understand the specific involvement of the left TP in visual object naming, we assessed a group of patients with an epileptogenic lesion centered at the TP, and compared their performance with that of a strictly matched control group. We also administered a battery of verbal and non-verbal semantic tasks that was used as a semantic memory baseline. Patients showed an impaired naming ability, manifesting in a certain degree of anomia and semantically related naming errors, which was influenced by concept familiarity. This pattern took place in a context of mild semantic dysfunction that was evident in different types and modalities of semantic tasks. Therefore, current findings demonstrate that a restricted lesion to the left TP can cause a significant deficit in object naming. Of importance, the observed semantic impairment was far from the devastating degradation observed in semantic dementia and other bilateral conditions.     

Penetration of Ciprofloxacin into Human Peritoneal Tissue Following a Single Oral Dose of 750 Milligrams

The penetration of ciprofloxacin into the peritoneal tissue was studied in 10 patients after a single oral dose of 750 mg given 5.6 hours (mean) before elective laparotomy. The mean tissue level was 0.29 μg/ml (range, 0.082 to 0.96 μg/ml) while the mean concomitant serum level was 1.3 μg/g (range, 0.52 to 2.57 μg/g). The achieved concentrations are above the minimum inhibitory concentrations (MICs) of ciprofloxacin for most gram-negative bacteria commonly involved in intra-abdominal infections.     

„No-puncture-Laparoskopie“ während der Hernienversorgung im Kindesalter – sinnvolle Ergänzung eines bewährten Therapiekonzepts

Zusammenfassung. Aus epidemiologischen Untersuchungen ist bekannt, da? bei ca. 50 % der Kinder mit einseitiger Leistenhernie auf der Gegenseite ebenfalls ein offener Processus vaginalis vorliegt. 10–25 % dieser Kinder entwickeln in der Folge eine kontralaterale Hernie. Seit 1996 wird in unserer Klinik bei S?uglingen und Kindern mit klinisch unilateraler Leistenhernie mittels intraoperativer Laparoskopie durch den er?ffneten Bruchsack der kontralaterale innere Leistenring inspiziert. Vorgehen: Bisher wurden 112 Kinder untersucht (Alter: 6 Monate bis 7 Jahre; 78 Jungen, 34 M?dchen). Nach Freipr?paration des Bruchsacks wurde dieser er?ffnet und ein 5,5-mm-Trokar durch den inneren Leistenring eingebracht. Nach Anlage des Pneumoperitoneums erfolgte mit einer 5-mm-(30 °)-Optik zun?chst die orientierende Laparoskopie, anschlie?end mit der 70 °-Optik die Inspektion des kontralateralen inneren Leistenrings. Ergaben sich Hinweise für einen breit offenen Processus vaginalis (Typ III nach Chin), wurde in gleicher Narkose diese Seite ebenfalls offen chirurgisch exploriert. Ergebnisse: Laparoskopisch fand sich bei 19 Patienten (17 %) ein nach oben genannten Kriterien pathologischer Befund (6 M?dchen, 13 Jungen). Diese wurden auf der Gegenseite operiert und die laparoskopische Diagnose in allen F?llen best?tigt. Verfahrensbedingte Komplikationen traten nicht auf. Die Eingriffe erfolgten im Rahmen der Eintageschirurgie. Die Operationsdauer erh?hte sich durch die intraoperative Laparoskopie um im Median 6 min (3–11 min). Deutlich h?ufiger fanden sich pathologische Befunde bei Patienten unter 2 Jahren (14 von 19 Patienten). Schlu?folgerungen: Das beschriebene Verfahren erlaubt ohne nennenswerten zus?tzlichen Zeitbedarf, Patienten zu selektionieren, die von einer einzeitigen offenen Exploration der gegenseitigen Leistenregion profitieren. Somit k?nnen Zweitoperationen mit erneuter Narkose und Hospitalisierung vermieden werden. Zus?tzlich erlaubt die intraoperative Laparoskopie die allgemeine Beurteilung der Abdominalorgane sowie Kl?rung spezieller Fragen wie, z. B. die Vitalit?t reponierter Darmschlingen.      

Lack of association between ACE gene polymorphism and left ventricular hypertrophy in essential hypertension

The possible association between the insertion/deletion (I/D) polymorphism of the angiotensin I converting enzyme (ACE) gene and left ventricular hypertrophy (LVH) was investigated in a group of essential hypertensive patients. Seventy-one essential hypertensive patients (35 men and 36 women), aged 51 +/- 1 years, were genotyped by PCR for the I/D polymorphism of the ACE gene. Cardiac morphology and function were assessed by means of M-mode echocardiography. The relative frequencies of the three genotypes, DD, DI, and II, were respectively: 24%, 55%, and 21%. Mean values of left ventricular mass index were 145, 144, and 150 g/m2 for DD, DI, and II genotypes, without significant differences among them (P = 0.82). Likewise, the prevalence of LVH (76%, 64%, and 87%) was not significantly different among the three genotypes (P = 0.23). We conclude that the ACE gene I/D polymorphism is not associated with LVH in essential hypertension. Journal of Human Hypertension (2000) 14, 47-49.     

Concentration and bactericidal activity of fusidic acid and cloxacillin in serum and synovial fluid.

Fusidic acid and cloxacillin were studied in patients who underwent joint aspiration for noninfectious disorders. Nine patients were given oral 500 mg fusidic acid tid for 72 h, the last dose being given 4, 8 or 12 h before the joint aspiration. Cloxacillin was administered in a single 2 g iv dose to 9 patients, 0.5, 4 or 8 h before the aspiration. Bactericidal activity was determined against five isolates each of methicillin-susceptible and methicillin-resistant Staphylococcus aureus. Satisfactory activity (> or = 1:3) was detected in the serum in patients who received fusidic acid, while in the synovial fluids titres reflected borderline effectiveness (c. 1:2). Despite drug concentrations and excellent MICs, fusidic acid demonstrated markedly lower inhibitory and bactericidal activity against S. aureus than did cloxacillin.     

Duodenum-preserving pancreatic head resection leads to relief of common bile duct stenosis

BACKGROUND: Common bile duct stenosis (CBDS) is one of the most frequent complications in chronic pancreatitis with inflammatory mass in the head of the pancreas (IMH). METHODS: A total of 474 patients who underwent duodenum-preserving pancreatic head resection (DPPHR) between 1982 and 1998 were reevaluated; 219 patients (46%) with a mean duration of the disease of 45 months had a radiologically proven CBDS. RESULTS: One patient (0.5%) died of septic complications in the early postoperative course, 15 patients (6.8%) had to be reoperated on for complications. A follow-up investigation of 143 patients (92%) revealed a late mortality of 12%; no patient died of biliary complications. Seventy-five percent of the patients were completely free of pain, and 85% of the patients had a constant or even increasing body weight. CONCLUSIONS: The high percentage of pain-free patients with improved physical status and economical rehabilitation demonstrates the improvement of the quality of life after DPPHR for complicated chronic pancreatitis.