Spontaneous Rupture of the Liver during Pregnancy: A Case Report

Hepatic congestion resulting in hepatic rupture during pregnancy is a rare yet catastrophic event carrying a 60 to 70% maternal mortality rate. With preeclampsia and associated epigastric pain continuing to be a major problem confronting pregnant women, hepatic congestion may be more prevalent than believed. Current etiology, treatment, and characteristics of women who experience hepatic rupture are examined. A case report and nursing protocol are presented.     

Peer substance involvement modifies genetic influences on regular substance involvement in young women

Aims Peer substance involvement (PSI) is a robust correlate of adolescent substance use. A small number of genetically informative studies suggest that shared genetic and environmental factors contribute to this association. We examine mechanisms by which PSI influences the etiology of regular substance involvement (RSI), particularly in women. Design Population‐based cohort study of twin women from the US Midwest. Participants 2176 twin women. Measurements To examine the relationship between self‐reported PSI during adolescence and a composite RSI representing regular tobacco, alcohol and cannabis use during young adulthood, using genetically informative correlation, moderation and joint correlation‐moderation models. Findings There was evidence for a significant additive genetic X environment interaction. PSI was moderately heritable (h² = 0.25). Genetic, shared and non‐shared influences on RSI overlapped with influences on PSI (genetic correlation of 0.43). Even after controlling for these shared genetic influences, RSI was more heritable in those reporting greater PSI. Conclusions While young women may select peers based on certain dispositional traits (e.g. permissiveness towards substance use), the social milieu constructed by PSI does modify the architecture of increased RSI in those individuals with increasing levels of PSI being associated with stronger expression of heritable influences.     

Opioid overdose mortality in Australia, 1964-1997: birth-cohort trends.

OBJECTIVE: To examine trends in rates of opioid overdose deaths from 1964 to 1997 in different birth cohorts. DESIGN: Age-period-cohort analysis of national data from the Australian Bureau of Statistics. MAIN OUTCOME MEASURES: Annual population rates of death attributed to opioid dependence or accidental opioid poisoning in people aged 15-44 years, by sex and birth cohort (in five-year intervals, 1940-1944 to 1975-1979). RESULTS: The rate of opioid overdose deaths increased 55-fold between 1964 and 1997, from 1.3 to 71.5 per million population aged 15-44 years. The rate of opioid overdose deaths also increased substantially over the eight birth cohorts, with an incidence rate ratio of 20.70 (95% confidence interval, 13.60-31.46) in the 1975-1979 cohort compared with the 1940-1944 cohort. The age at which the cumulative rate of opioid overdose deaths reached 300 per million fell in successive cohorts (for men, from 28 years among those born 1955-1959 to 22 years among those born 1965-1974; for women, from 33 years among those born 1955-1959 to 27 years among those born 1965-1969). CONCLUSIONS: Heroin use in Australia largely began in the early 1970s and rates of heroin use have markedly increased in birth cohorts born since 1950.     

A technique to visualize wound bed microcirculation and the acute effect of negative pressure

Although previous studies have proved that subatmospheric pressure in vacuum assisted closure therapy increased blood flow at the wound edge, no reports have presented data on blood flow in the wound bed. This study examined a technique that visualized microcirculation of the wound bed and estimated the acute effect of negative pressure. The superficial stratum of the mouse gluteal skin was microsurgically excised preserving the subdermal vascular plexus. The preserved vessels were visualized as the wound bed microcirculation using an intravital microscope–video–computer system. Three levels of negative pressure (?125 mmHg [n=12], ?500 mmHg [n=12], 0 mmHg [n=8]) were applied to the wound. Our experimental model successfully and quantitatively visualized wound bed microcirculation under negative pressure application. A negative pressure of ?125 mmHg significantly increased wound bed blood flow immediately after pressure application, maintained for 1 minute after pressure release, whereas in the ?500 mmHg group blood flow decreased with time and reached a statistically significant level 5 minutes after pressure application. These findings reinforce the hypothesis that enhanced blood flow in the wound bed as well as at the wound edge may contribute to the beneficial effects of certain levels of negative pressure therapy for wound perfusion.     

Blue naevus with satellitosis mimicking malignant melanoma

Blue naevus is an acquired benign melanocytic naevus. It is a firm, sharply defined dark blue to grey-black papule or nodule, which is likely to arise from the arrested dermal melanocytes in the dermis. In the last few years, blue naevus has attracted much attention due to the recognition of new entities and to its confusion with malignant melanoma. We report a 69-year-old man who developed a blue-black nodular lesion with satellitosis on his scalp. Although clinically it was thought to be a malignant melanoma, histopathological investigation and conservative methods such as dermatoscopy and power Doppler ultrasonography did not confirm this diagnosis. Histopathological examination excluded malignant melanoma, as there were no cellular atypia and mitotic activity in either the nodular lesion or the satellitosis. Doppler ultrasonography confirmed the benign nature of the lesion. Dermatoscopic examination showed homogeneous steel-blue pigmentation with individual blue globules, dots and some brown veils, and confirmed the histopathological diagnosis. To the best of our knowledge, our case is the third reported case of a blue naevus with satellitosis mimicking malignant melanoma.     

Stevens–Johnson syndrome in two patients treated with cranial irradiation and phenytoin

Stevens-Johnson syndrome (SJS) is a severe cutaneous eruption that most often appears as an adverse reaction to medication. In this report, we present two patients diagnosed with SJS, which developed in patients with brain tumour, after receiving cranial irradiation and phenytoin. Concomitant application of these two therapies may play an important role in the occurrence of the disease.     

Disease duration and disability in dysfeRlinopathy can be described by muscle imaging using heatmaps and random forests

Introduction: The manner in which imaging patterns change over the disease course and with increasing disability in dysferlinopathy is not fully understood. Methods: Fibroadipose infiltration of 61 muscles was scored based on whole-body MRI of 33 patients with dysferlinopathy and represented in a heatmap. We trained random forests to predict disease duration, Motor Function Measure dimension 1 (MFM-D1), and modified Rankin scale (MRS) score based on muscle scoring and selected the most important muscle for predictions. Results: The heatmap delineated positive and negative fingerprints in dysferlinopathy. Disease duration was related to infiltration of infraspinatus, teres major–minor, and supraspinatus muscles. MFM-D1 decreased with higher infiltration of teres major–minor, triceps, and sartorius. MRS related to infiltration of vastus medialis, gracilis, infraspinatus, and sartorius. Discussion: Dysferlinopathy shows a recognizable muscle MRI pattern. Fibroadipose infiltration in specific muscles of the thigh and the upper limb appears to be an important marker for disease progression. Muscle Nerve 59:436–444, 2019