1/94. Shaking, chills, and rigors with once-daily gentamicin. A patient receiving once-daily gentamicin experienced shaking, chills, and rigors. This adverse reaction has occurred in patients around the country at many different institutions. Although the etiology is thought to be mediated by higher than normal endotoxin levels in one product, other possibilities must be explored. ( info) |
| A young primigravid parturient had an uneventful labour under epidural analgesia and delivered a healthy male infant. She returned 48 hours later with fever, vomiting and severe headache, but was misdiagnosed as having endometritis. Further signs of meningitis appeared six hours later, however she succumbed to the infection and died four weeks later despite intensive care and high-dose antibiotic management. Causes of meningitis in the peripartum period are discussed. The possibility of a causal association between the patient's epidural analgesia and her infection are considered and preventive measures discussed. ( info) |
3/94. uterine hemorrhage in a menopausal female associated with an arteriovenous malformation and myometritis. A case is described of vaginal bleeding in a 67-year-old female as the first manifestation of a uterine arteriovenous malformation (AVM). Although bleeding is the commonest presentation of an AVM, this is the first case known to have been precipitated by florid myometritis associated with the long-standing presence of an intra-uterine contraceptive device (IUCD). Uterine imaging studies utilising ultrasound scan with color Doppler were instrumental in suggesting the source of bleeding in this case. Subsequently, the patient suffered a torrential hemorrhage which necessitated hysterectomy. ( info) |
4/94. Non-surgical management of post-cesarean endomyometritis associated with myometrial gas formation. We present a case of post-cesarean delivery, nonclostridial endomyometritis in which uterine (myometrial) gas formation raised concern for myonecrosis and need for hysterectomy. The patient fully recovered without surgery. Myometrial gas formation in this setting and in an otherwise stable patient may be an insufficient reason for hysterectomy. ( info) |
5/94. Deep-seated trichosporonosis in an immunocompetent patient: a case report of uterine trichosporonosis. We report an unusual case of endometritis caused by Trichosporon beigelii in an elderly woman who had no clinically obvious immunosuppression nor even clinically obvious skin disease. No evidence of predisposing factors for deep trichosporonosis was identified in this patient, who apparently is of normal immune status. ( info) |
| BACKGROUND: herpes simplex virus (HSV) can cause postpartum endometritis. The clinical diagnosis of HSV endometritis has been reported previously. The disease is responsive to acyclovir intravenously. CASE: A 22-year-old woman, gravida 2, para 1, status post primary cesarean section for a double footling breech presentation, developed a persistent postpartum fever. Simulating the febrile course of septic pelvic thrombophlebitis, the patient's condition was unresponsive to broad-spectrum antimicrobials and heparin therapy. Active herpetic lesions and a positive cervical culture for herpes simplex prompted the use of intravenous acyclovir. Rapid resolution of the fever and the similarity to previous case reports suggested the clinical diagnosis of herpes simplex endometritis. CONCLUSION: The diagnosis of postpartum herpes simplex endometritis should be considered when managing a persistent postpartum fever unresponsive to aggressive antimicrobial and heparin therapy. Immediate resolution of the fever should occur with the use of acyclovir. ( info) |
7/94. Recurrent bleeding from the lower segment scar--a late complication of Caesarean section. hysterectomy became necessary six months after Caesarean section because of recurrent severe haemorrhage from the uterine scar. ( info) |
| Extramedullary hematopoiesis (EMH) in the endometrium is an extremely rare occurrence. Four of the eight previously reported cases were related to an underlying hematological disorder, although the remainder had no such relationship. We describe a case of endometrial EMH associated with retained products of conception after termination of pregnancy. Routinely and immunohistochemically stained slides revealed several collections of normoblasts and granulocytic precursors in the endometrium with synchronous chronic endometritis. Retained chorionic villi were also identified. The patient had no known history of a hematological disorder or systemic disease and no such abnormality was detected after detailed hematological work-up. Local effects of growth factors on circulating stem cells may play a pathogenetic role in this process, although an association with recent pregnancy in this case suggests that implantation of fetal hematopoietic elements from the fetus or yolk sac may be more likely. ( info) |
9/94. Acute onset of hematometra associated with endometritis and cervical stenosis. A case report. The possible cause of hematometra is incomplete cervical stenosis which inhibits the passage of blood due to acute endometritis. ( info) |
10/94. Congenital tuberculosis associated with maternal asymptomatic endometrial tuberculosis. This is a report of a 4-month-old baby girl who presented with respiratory distress, bronchopneumonia, marasmus and hepatosplenomegaly and proved to have congenital tuberculosis on the basis of a strongly positive Mantoux test and liver biopsy findings. Endometrial biopsy in the asymptomatic mother confirmed the source of infection and the perinatal onset of illness. The age range of previously reported cases of congenital tuberculosis is 1-84 days and this case would appear to be the latest presentation of congenital tuberculosis in the literature. ( info) |