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Eight young women developed clinical manifestations of hyperprolactinemia after the application of bilateral methylpolixolosane mammary prostheses. Elevated serum levels of prolactin were present in all cases. Treatment with bromocriptine or methergoline corrected the excessive prolactin production and associated symptoms. The pathophysiology of this syndrome is unexplained as yet.
We describe seven patients with idiopathic facial (VII) nerve palsy commencing primarily in late pregnancy or in the immediate postpartum period. One patient had recurrent Bell's palsy in three consecutive pregnancies. Three women developed bilateral palsy. The occurrence of such otherwise rare manifestations of Bell's palsy supports the suggestion that physiologic changes occurring in late pregnancy or the immediate puerperium predispose to Bell's palsy.
A prospective study on 289 women with clinical stage I cutaneous melanoma was done to determine the relationship between estrogen administration, tumor characteristics, and survival. Eighty-two women took oral contraceptives (OC) and 44 took menopausal estrogens (MPE) prior to the diagnosis of melanoma. Users of OC presented with thinner primary tumors than nonusers of OC (P less than .01). A similar trend was observed in users of MPE. Women who used OC in the year prior to the diagnosis of melanoma had statistically thinner tumors than those who had discontinued use of OC more than 1 year prior to diagnosis (P less than .025). A statistically significant preponderance of truncal lesions was observed among users of OC (P less than .01). Other tumor characteristics were unaltered by estrogen administration. Duration of use and time in relation to diagnosis of melanoma did not affect survival. Women who took hormones had slightly better 5- and 9-year survival rates than nonusers. These results suggest that prior estrogen use and, particularly, use of OC in women developing melanoma have no deleterious effect.
Two women developed significant neurologic dysfunction, consistent with subacute combined degeneration of the spinal cord, within eight weeks of being anesthetized with nitrous oxide. Investigation revealed that each had preclinical or masked vitamin B12 deficiency. The first patient had two previous ileal resections for Crohn's disease and the other had pernicious anemia. It is postulated that nitrous oxide anesthesia may precipitate neurologic disease in people with unrecognized deficiency of vitamin B12.
Six women developed De Quervain's tenosynovitis during pregnancy. Onset was never before the fifth month. Two patients also had carpal tunnel syndrome. In two otherwise untreated patients, tendinitis resolved only after discontinuation of nursing. We discuss the possibility of association with hormonal changes occurring during pregnancy.
Two silver-blond young women developed green, tinted hair from exposure to tap water containing excessive amounts of copper. Results from analyses of tracemetal content of hair as an indication of excessive ingestion, systemic toxicity, or metabolic derangement should be interpreted with caution in view of the demonstrated ease of external contamination from common sources.
A 73-year-old women developed tight blisters exclusively on the legs. The histological and immunological examinations substantiated the diagnosis of localized pemphigoid. The disease had a chronic course and responded well to treatment with prednisolone.
The American Cancer Society estimates that more than a hundred thousand American women develop breast cancer every year. Mastectomy is the treatment of choice. While this surgery performs a gratifying service by saving a woman's life, her appreciation is muted by the price she must pay--the loss of a breast and permanent disfigurement. Within the value system of American culture, that price is a considerable one. This paper will attempt to interpret that cost.
To define the epidemiology of post-dysenteric Reiter's syndrome (RS), 1,162 persons were questioned about compatible symptoms soon after 3 separate outbreaks of shigellosis. We diagnosed RS for 3 women of 204 persons ill during an outbreak of Shigella flexneri 1b, for 3 women of 206 ill during an outbreak of S. flexneri 2a, and for none of 85 ill during an outbreak of S. sonnei. We found no RS among 667 persons without diarrhea. Prospective controlled investigations in defined populations documented that RS follows S. flexneri 1b as well as 2a infections in about 1.5% of white adults with dysentery and indicated that women develop post-dysenteric RS as often as men.
Familial occurrence of malignant melanoma is mostly due to a hereditary disposition which is phenotypically characterized by light complexion and multiple precursor nevi. The inheritance of this disposition is not monogenic but polygenic. The following arguments are in favor of polygenic inheritance: Lack of a uniform pattern of transmission, frequent sporadic occurrence of this phenotype, variable intensity of manifestation within the same family, evidence for polygenic inheritance of fair complexion, and demonstration of polygenic inheritance of melanoma in Xiphophorin fish. In melanoma families, children of affected women develop melanoma more frequently than children of affected men. The authors interpret this phenomenon as a manifestation of the Carter effect. This mechanism is proposed as a new argument in favor of a polygenic inheritance of familial malignant melanoma.
A 62-year-old diabetic women developed acute quadriparesis. Her first symptom was clumsiness of the right limbs, which was followed shortly after by quadriparesis with severe left-sided symptoms. Sensory examination showed pinprick and thermal sensation deficits below the left T6 and right T8 dermatomes. An intramedullary infarction in the cervical cord at C5 to C6 levels was demonstrated by serial magnetic resonance imaging (MRI) studies with Gadolinium-DTPA (Gd-DTPA) enhancement. Based on the findings from this patient and 20 patients with spinal cord infarction reported in the literature, it was concluded that spinal cord infarct lesions are characterized by negative Gd-DTPA enhancement at the acute and chronic stages and positive enhancement at the subacute stage, 1 to 4 weeks after the onset of infarction.
Cava-filters were implanted in 16 women suffering from acute thrombosis of the deep veins of the lower limbs in the third gestation trimester. Initial or relapsing thromboembolism of the pulmonary artery (TEPA) had place in 5 cases. Two types of filters were used, the REPTEPA ones being used more frequently. As a rule, a filter was implanted in the infrarenal segment of vena cava inferior. Complications occurred in two patients: perforation of right atrial wall and thrombosis of the filter. Pregnancy ended in delivery in all the cases, cesarean section was made in the majority of patients. No TEPA was recorded from the moment of cava-filter implantation. In remote period 15 women developed moderately expressed postthrombotic syndrome.
AIM: Assess the pregnancies of our female renal transplant recipients and to document long term maternal and fetal outcome. METHODS: Between 7 June 1972 and 31 December 1992 112 females had at least one renal transplant. Sixty-four of these 112 women were in the reproductive age and had a functioning graft. RESULTS: Nine women had 16 pregnancies which resulted in 11 live births and three first trimester abortions. Two unplanned pregnancies were terminated. Mean age at transplantation was 17.2 yr [range 16-22.5 yr] and mean interval from transplant to pregnancy was 6.8 yr [range 1.8-9.0 yr]. Prednisone and azathioprine were used in all patients and cyclosporin in five. For seven of the successful pregnancies plasma creatinine remained < or = 0.10 mmol/L. One of these women developed allograft nephropathy 5 years after delivery and returned to dialysis 9 years later. For the other four successful pregnancies the preconception plasma creatinine was 0.12-0.14 mmol/L. The woman with two successful pregnancies had a halving of glomerular filtration rate during the second pregnancy, but it has remained stable for 15 years; one was poorly compliant with her immunosuppressive regimen and reached endstage renal failure two years after delivery; one developed cyclosporin nephrotoxicity, but 18 months later renal function was stable after a dosage reduction. Ten infants were delivered by caesarean section, four of them urgently. Three babies were preterm and five growth retarded. One died of sudden infant death syndrome at four months. All other infants developed normally. CONCLUSION: There is no contraindication to pregnancy in female transplant recipients who have stable graft function and controlled blood pressure. Management of such pregnancies should be by shared obstetrical/nephrological/paediatric care.
A prospective randomized double blind study with processed rhubarb (low dose of 0.75g/day) was carried out in pregnant women at risk of pregnancy induced hypertension (PIH). Rhubarb (140 cases) or placebo (125 cases) was given to women at risk of PIH consecutively from the 28th week of gestation till delivery, and another 68 pregnant women as control. Results showed that 5.7% of rhubarb treated women developed PIH, a rate substantially lower than the 20.8% of the placebo group (P < 0.01). After 9-10 weeks of treatment, the plasma fibronectin (Fn) level and Plasminogen activator inhibiter (PAI) value were found significantly lower (P < 0.05) in the rhubarb treated group than in the placebo. Antithrombin III (ATIII) level also decreased significantly less in the rhubarb group as compared with the placebo (P < 0.05). It indicated that low dose of processed rhubarb has a good prophylactic effect on PIH. The mechanism may be related with the inhibition of PAI activity, reduced Fn synthesis and decreased damage to vascular endothelium.
One hundred fourteen cervical smears obtained from 18 women developing biopsy-proven high-grade squamous intraepithelial lesions and two with invasive squamous carcinomas were analyzed by two pathologists using the PAPNET neural network-based automated screening system (PAPNET Analyses A and B). The smears were originally reported as negative and had been previously rescreened and reclassified according to The Bethesda System. Using the PAPNET video displays of 128 potentially abnormal cellular images per smear, each reviewer (PAPNET A and B) determined whether a smear required conventional rescreening. Results of the PAPNET triage were compared with the reclassification diagnoses of the smears by conventional microscopy. PAPNET Analysis A selected eight (14%) smears reclassified as negative, 25 (69%) as atypical squamous cells of undetermined significance, and 15 (71%) as squamous intraepithelial lesions (SIL) for rescreening. In PAPNET Analysis A, two (10%) SILs were not selected for rescreening, and four (19%) were considered unsatisfactory for analysis. PAPNET Analysis B selected 21 (37%) smears reclassified as negative, 25 (69%) as atypical squamous cells of undetermined significance, and 18 (86%) as SIL for review. In PAPNET Analysis B, two (10%) SILs were missed, and one (5%) smear was unsatisfactory for analysis. Each PAPNET analysis selected smears for rescreening in 19 (95%) of 20 patients and detected SILs in 10 patients that were missed in the original screening. Using PAPNET, SILs would have been detected a median of 56 months (PAPNET A) and 62 months (PAPNET B) before their actual discovery. These preliminary data suggest that PAPNET may help detect SILs missed in routine cytologic screening.(ABSTRACT TRUNCATED AT 250 WORDS)
Headache is very common among women of childbearing age and can be influenced by hormonal fluctuations. When pregnant women develop headache, the cause is usually tension-type headache or migraine, but headache may be a symptom of a more serious neurologic or medical condition. This article discusses the differential diagnosis and management of major causes of headache during pregnancy.
Although it is generally believed that pregnancy is a time of emotional well-being, many women develop or have a recurrence of psychiatric illness during this time. The risks associated with leaving a woman untreated during pregnancy are potentially substantial and must be weighed against the risks of exposing the fetus to the potentially teratogenic medications. Large prospective and retrospective studies suggest a relative safety of use of tricyclic antidepressants during pregnancy. Data available for neuroleptics, lithium, benzodiazepines, and the anticonvulsants valproic acid and carbamazepine, although mixed, point to increased risks of congenital malformations in the children of mothers exposed to these agents in the first trimester of pregnancy. Very little is known about the behavioral abnormalities in offspring of mothers exposed to these agents. Animal studies suggest changes in brain receptor number and function in the offspring of mothers on a variety of psychotropic drugs studied to date. The few human studies do not suggest long term effects, but given the very limited data, no definitive conclusions can be drawn. Large epidemiologic follow-up studies of children exposed to medication in utero may help clarify questions relating to behavioral changes and thus help guide clinical decisions.
Sixteen patients (8 female, 8 male) with primary angiitis of the CNS (PACNS), were followed prospectively in a vasculitis clinic. Diagnosis was by angiography in patients without underlying disease. Median age at diagnosis was 36.5 years, and median duration of follow-up was 28 months. Onset was acute in 14 patients (88%), with 3.5 weeks (median) from onset symptoms to diagnosis. Three women developed symptoms within 3 weeks postpartum. The most frequent symptoms were severe headaches (12, 75%), stroke (6, 30%), transient ischaemic attack (TIA) (4, 28%), seizures (7, 44%), visual aberration (3, 19%), and cognitive impairment (5, 31%). Laboratory data included high ESR (2, 13%), leucocytosis (8, 80%), thrombocytosis (1, 6%), positive antinuclear antibody titre (3, 15%), and high levels of complement (5, 31%). Lumbar puncture was performed in 12 patients (75%). CSF analysis was abnormal in five patients (42%). EEG was abnormal in 5/9 patients. The major CT/MRI scan findings were cerebral haemorrhage (4, 25%), brain infarcts (5, 31%), brain atrophy (2, 13%) and non-specific lesions (2, 13%). Four patients had normal studies. All patients received corticosteroids (CS), and five were treated with oral cyclophosphamide. Two patients relapsed despite CS and cyclophosphamide therapy. All patients are alive, and at the last assessment, eight had a permanent neurological deficit, which included paresis (3, 19%), neurocognitive abnormalities (2, 13%), visual loss (2, 13%) and seizure activity (5, 31%). Our data suggest a non-progressive, non-fatal course in those PACNS patients diagnosed angiographically and treated with CS with or without cyclophosphamide.