Wernicke’s encephalopathy complicating hyperemesis gravidarum: from the background to the present

Wernicke’s encephalopathy (WE) is a neuropsychiatric syndrome due to thiamine deficiency, which is potentially fatal but preventable. In Obstetrics, it can complicate hyperemesis gravidarum because of major daily requirement. Nowadays there is no consensus on early diagnosis, treatment and prevention of this disorder. We present a case report of hyperemesis gravidarum which degenerated into WE and Korsakoff’s syndrome. It highlights that the clinical suspicion is necessary to recognize signs and symptoms, to apply the available effective preventive measures in situations at risk and to begin urgent treatment in presence of characteristic clinical features.     

妊娠早期剧烈呕吐相关危险因素及其对妊娠结局的影响

目的:探讨妊娠早期剧烈呕吐的相关危险因素,分析妊娠剧烈呕吐与妊娠结局的关系,指导孕期妇女的预防保健工作。方法:采用队列研究的方法,分析孕早期妇女妊娠剧烈呕吐状况,追踪其妊娠结局,主要分析方法为卡方检验和Logistic回归分析。结果:妊娠早期剧烈呕吐的相关危险因素有孕周、噪音、睡眠不好、新近装修、咖啡和孕后食量减少,而孕后口味嗜酸辣、少吃蔬菜是剧烈呕吐的保护因素。孕早期剧烈呕吐不是不良妊娠结局的高危因素,对妊娠结局影响不大。结论:妊娠早期剧烈呕吐与妊娠结局关系不大,但应重视孕早期剧烈呕吐,减少噪音等不良因素的暴露,创造良好妊娠条件,注意均衡饮食,保证睡眠,以尽量减少高危妊娠的发生。     

Maternal serum cytokine levels in women with hyperemesis gravidarum in the first trimester of pregnancy

OBJECTIVE: To compare serum cytokine levels in patients with hyperemesis gravidarum with levels in healthy pregnant and nonpregnant women. DESIGN: Case-control study. SETTING: Clinical and academic research center. PATIENT(S): Thirty women with hyperemesis gravidarum, 30 healthy women in the first trimester of pregnancy, and 30 healthy nonpregnant women. MAIN OUTCOME MEASURE(S): Serum levels of interleukin-1beta, interleukin-2 receptor, interleukin-6, interleukin-8, and tumor necrosis factor (TNF)-alpha. RESULT(S): Median serum levels of interleukin-2 receptor and interleukin-8 did not differ significantly among the three groups. Serum levels of interleukin-1beta and interleukin-6 were significantly higher in healthy pregnant women than in healthy nonpregnant women. Median TNF-alpha levels were significantly higher in women with hyperemesis (25.8 pg/mL [range, 4.9-140 pg/mL]) than in healthy pregnant and nonpregnant women (10.85 pg/mL [range, 4.1-35.8 pg/mL] and 12 pg/mL [4.3-68.2 pg/mL], respectively). CONCLUSION(S): Levels of TNF-alpha were significantly higher in patients with hyperemesis gravidarum than in healthy pregnant and nonpregnant women. Thus, TNF-alpha may be involved in the etiology of hyperemesis gravidarum.     

A phase I study of oral uracil/ftorafur (UFT) plus leucovorin and bis-acetato-ammine-dichloro-cyclohexylamine-platinum IV (JM-216) each given over 14 days every 28 days

Purpose: To determine the feasibility, maximal tolerated doses, and response rates for a combined regimen of the platinum and 5-fluorouracil oral analogues bis-acetato-ammine-dichloro-cyclohexyl-amine platinum(IV) (JM-216) and uracil/ftorafur (UFT) coadministered as a 14 consecutive-day every 28-day schedule. Methods: Of 20 patients enrolled in this investigation, 17 on the following dose escalation scheme were evaluable for toxicity and/or response: I UFT 300 mg/day, JM-216 5 mg/day (three patients), II UFT 300 mg/day, JM-216 10 mg/day (four patients), III UFT 300 mg/day, JM-216 20 mg/day (ten patients). Results: All 17 evaluable patients were evaluable for toxicity. At dose level III, dose-limiting nausea and emesis were observed in one patient despite maximal antiemetic support. Importantly, neurotoxicity and nephrotoxicity were not observed at the JM-216 dose levels examined in this study. This observation is consistent with results seen with single agent JM-216. Conclusion: For JM-216 and UFT administered at 20 mg/day and 300 mg/day over 14 days, nausea and emesis were observed as the principal dose-limiting toxicities. These doses are considerably below the maximally tolerated doses of single agent JM-216 and UFT. Shorter administration schedules should be explored in an attempt to increase the dose intensity and minimize the toxicity of this combination oral regimen. Received: 5 March 1998 / Accepted: 3 September 1998     

Severe long esophageal stricture following hyperemesis gravidarum

We report a 32-year-old female patient with esophageal stricture thought to have been caused by hyperemesis gravidarum. Eleven months before admission she had been admitted to another hospital, because of hyperemesis gravidarum, at 26 weeks of gestation. Marked and recurrent vomiting occurred and her consciousness gradually worsened. Three weeks later, her baby was delivered by Cesarean section. Postpartum progress was uneventful except that she developed dysphagia 5 months after delivery. Esophagography and upper endoscopy demonstrated severe esophageal stricture. Endoscopic balloon dilatation was performed four times, but was unsuccessful. Blunt dissection of the esophagus was then performed. Histological examination demonstrated marked fibrosis in the submucosal layer and muscular hypertrophy. Esophageal glands were not identified. In this case, esophageal stricture might have been associated with severe esophagitis due to recurrent vomiting and reflux of gastric contents during hyperemesis gravidarum.     

Dystonia gravidarum: A new entity?

We describe cervical dystonia occurring in a 31-year-old, previously well, primigravid, primiparous Chinese woman at 4 weeks' amenorrhea, which was ameliorated with low-dose clonazepam and disappeared completely by the end of the second trimester without recurring despite her being tapered off benzodiazepine therapy. Investigations were unremarkable for structural and biochemical causes of dystonia. Chorea, paraballismus, and restless legs syndrome are known to occur during pregnancy, attributable to high estrogen levels. Dystonia, on the other hand, has not been described to occur de novo in pregnancy. This association should be considered in women of reproductive age who present with cervical dystonia.     

Relationship between hyperemesis gravidarum and Helicobacter pylori seropositivity

Early pregnancy is commonly characterized by the disturbance of digestive function,characteristically manifested by nausea and vomiting.     

针药结合治疗妊娠剧吐的临床研究

目的：探讨针药结合治疗妊娠剧吐的疗效。方法：妊娠剧吐的94例病人随机分为治疗组及对照组。治疗1疗程后专科复查,确定症状缓解与否。结果：治疗组及对照组均无明显副作用,治疗组疗效优于对照组。2组疗效比较有统计学意义（P〈0.05）。结论：针药结合治疗妊娠剧吐疗效确切,且操作简易、安全。     

Topical tretinoin 0.1% for pregnancy-related abdominal striae: An open-label, multicenter, prospective study

In an open-label, multicenter, prospective study, 20 women applied tretinoin (retinoic acid) cream 0.1% daily for 3 months to pregnancy-related stretch marks in the abdominal area. Efficacy was evaluated by analysis of one preselected target lesion, which was rated on a six-point scale (−1 = worse to 4 = cleared). At week 12, significant global improvement was noted from baseline in all stretch marks, and the target lesion decreased in length by 20% (P = .01). Erythema and scaling, the most common adverse events, occurred in 11 patients, decreased in severity after the first month of treatment, and were controlled with continued application of tretinoin and petroleum jelly ointment. In this small study, topical application of tretinoin significantly improved the clinical appearance of pregnancy-related stretch marks.