1/40. Acute adrenal insufficiency during pregnancy and puerperium: case report and literature review.Acute adrenal dysfunction during pregnancy is rare. Nevertheless, adrenal insufficiency can present as an adrenal crisis, and may be life threatening. There is a wide range of clinical symptoms and signs, and the differential diagnosis is challenging. A full adrenal and pituitary evaluation, both structural and hormonal, must be performed to reach the correct diagnosis, and appropriate treatment must not be delayed. A case is presented of acute adrenal insufficiency that occurred 24 hours after a cesarean delivery. The initial symptoms included hypoglycemic seizures and coma. The workup, both hormonal and structural, revealed isolated adrenocorticotrophic hormone deficiency. This considers this case and reviews the differential diagnosis, diagnostic workup, and the treatment of adrenal dysfunction in pregnancy and the puerperium, as well as the obstetric outcome in women suffering from this disorder. TARGET AUDIENCE: Obstetricians & Gynecologists, family physicians. learning OBJECTIVES: After completion of this article, the reader will be able to understand the various presentations of hypopituitarism, the various etiologies of this condition, and the appropriate work up and management of a patient with hypopituitarism.- - - - - - - - - - ranking = 1keywords = coma (Clic here for more details about this article) |
2/40. Obstructive sleep apnoea in a puerperal patient with Hallermann-Streiff syndrome.A 26 yr old puerperal female with Hallermann-Streiff syndrome developed serious obstructive sleep apnoea syndrome during pregnancy. She underwent an elective Caesarean section delivery, but ending the pregnancy did not improve her clinical symptoms. By treating her with nasal continuous positive airway pressure, a worsening of her headaches and glaucoma was prevented. The administration of acetazolamide controlled all of her symptoms. Treatment with nasal ventilation is the best initial approach. It is also important to assure normal oxygenation before pregnancy since the foetus may suffer from the severe deprivation that may occur in these patients.- - - - - - - - - - ranking = 1keywords = coma (Clic here for more details about this article) |
3/40. Granulocytic sarcoma: local presentation of a systemic disease.The case of a pregnant woman with a breast mass that proved to be a granulocytic sarcoma is presented. Her systemic therapy was initiated at a time when her tumor burden was possibly relatively low and a good response to the aggressive combination chemotherapy including Daunomycin was obtained. She was successfully carried through pregnancy and delivered a normal child despite combination chemotherapy. Factors relating to her case have been reviewed in the literature.- - - - - - - - - - ranking = 5keywords = coma (Clic here for more details about this article) |
4/40. Functional recovery despite prolonged bilateral loss of somatosensory evoked potentials: report on two patients.A bilateral loss of short latency somatosensory evoked potentials (SSEPs) after head trauma or non-traumatic brain damage is normally associated with a deleterious neurological outcome. An adequate recovery in reported in two deeply comatose patients with head trauma or severe hypertensive encephalopathy despite prolonged bilateral loss of SSEPs over days, found in repeated recordings. Hence, a bilateral loss of SSEPs should not be considered alone for prediction of outcome in cerebral injury.- - - - - - - - - - ranking = 1keywords = coma (Clic here for more details about this article) |
5/40. Management of glaucoma in pregnancy and lactation.A 30-year-old pregnant woman with glaucoma is presented. The management of her case is used as a basis for a discussion of the use of glaucoma medications, including newer formulations, during pregnancy and lactation.- - - - - - - - - - ranking = 6keywords = coma (Clic here for more details about this article) |
6/40. Acute barbiturate poisoning in the 39th week of pregnancy. Case report.A rare case of suicidal barbiturate poisoning in the 39th week of pregnancy is reported. Diagnostic difficulties and prolonged coma were the reason that the foetus was delivered by Caesarean section. The authors discuss the effect of barbiturates on the foetus and the possibilities of other ways of management.- - - - - - - - - - ranking = 1keywords = coma (Clic here for more details about this article) |
7/40. Living-related right lobe liver transplantation for a patient with fulminant hepatic failure during the second trimester of pregnancy: report of a case.A 28-year-old pregnant Japanese woman developed fulminant hepatic failure (FHF) with coma grade IV at 15 weeks' gestation and underwent emergency orthotopic living-related liver transplantation (LRLT) using the right hepatic lobe of her father. blood type was identical. On postoperative day 2, she regained consciousness and was extubated. For fear of possible negative effects of exposure to various drugs and from x-ray examinations on the fetus as well as the maternal burden of a continuing pregnant state on the patient, artificial abortion was a treatment choice in this woman on posttransplant day 31. The patient was discharged and is currently doing well. Until the present, 11 pregnant women were reported to have liver transplantation during the second trimester of pregnancy, including 2 pregnant women with LRLT. This is the third case of LRLT, and the first successful case in which the right hepatic lobe was used for graft.- - - - - - - - - - ranking = 1keywords = coma (Clic here for more details about this article) |
8/40. Successful jejunal nutrition therapy in a pregnant patient with apallic syndrome.A 41-year-old woman was admitted in the 8th pregnancy week as a consequence of a left-sided media infarction. After alloprothetic aortic valve replacement, she had discontinued deliberately the mandatory anticoagulation treatment. Following an initial clinical stabilisation, a second insult with right-sided media total infarction occurred 3 weeks after admission. In the further course, she developed an apallic syndrome and required respirator therapy. The initial enteral nutrition therapy via naso-gastric tube, was continued via percutaneous endoscopic gastrostomy (PEG). Due to recurrent vomiting from the 24th pregnancy week, the PEG was changed into a PEG with jejunal position of the tube (JET-PEG). Via this access and simultaneous body impedance analysis (BIA) control, the further nutrition therapy could be continued uneventfully. In the 27th pregnancy week, the patient gave birth to a female newborn (birth weight: 820 g) by Caesarean section in pre-eclampsia. The foetal development was in accordance with the gestational period and uncomplicated in the further course. The mother could be released into ambulatory care where the above nutrition therapy was continued.Reports on a successful nutrition therapy of pregnant comatose patients are rare. To the best of our knowledge, this is the first case where JET-PEG and monitoring by repeated BIA measurement were used for the control of the enteral nutrition.- - - - - - - - - - ranking = 1keywords = coma (Clic here for more details about this article) |
9/40. pregnancy in a persistent vegetative state: case report, comparison to brain death, and review of the literature.Severe maternal neurologic injury during pregnancy has the potential for fetal demise without advanced critical care support to the mother. brain death is the unequivocal and irreversible loss of total brain function, whereas patients in a vegetative state, by contrast, have preserved brain stem function but lack cerebral function. They can appear to be awake, have sleep-wake cycles, be capable of swallowing, and have normal respiratory control, but there are no purposeful interactions. These conditions have different maternal prognoses, but both have resulted in near-normal neonatal outcomes with long latencies from maternal injury to delivery in previously published cases. This article compares and contrasts the 11 cases of brain death with 15 cases of persistent vegetative state in pregnancy. We found that the mean latency between maternal brain injury and delivery was significantly shorter in the brain-dead patients as compared with those in a vegetative state (46 days vs. 124 days, P persistent vegetative state in pregnancy at our institution with both maternal and neonatal death in the context of previously published literature with a focus on obstetric and ethical management. We hope this information will help elucidate the issues for providers confronted with these unique and challenging cases. TARGET AUDIENCE: Obstetricians & Gynecologists, family physicians. learning OBJECTIVES: After completion of this article, the reader should be able to state the difference between coma, persistent vegetative state and brain death, to describe the neurologic aspects of a patient in a persistent vegetative state, and to list the fetal effects of maternal brain injury.- - - - - - - - - - ranking = 1keywords = coma (Clic here for more details about this article) |
10/40. pregnancy after limb-sparing hemipelvectomy for Ewing's sarcoma. A case report and review of the literature.Ewing's sarcoma of the bone is a malignant bone tumor occurring mostly in adolescence and was considered to have poor prognosis. With recent advances in multi-agent combined chemotherapy, prognosis has improved, and more patients with primary lesions in the pelvis opt for limb-saving surgeries. In the present case, Ewing's sarcoma in the left pelvis was diagnosed at the age of 11 and the patient underwent multi-agent chemotherapy combined with limb-sparing hemipelvectomy. She became pregnant at the age of 22. After an uneventful pregnancy, she delivered a healthy child at 37 weeks of gestation by cesarean section because of pelvic distortion. This is the first reported case of pregnancy and delivery after limb-sparing hemipelvectomy due to Ewing's sarcoma. Since the multi-modality treatment improves survival, the number of women with Ewing's sarcoma who desire pregnancy is expected to increase in the future. This is a valuable case that will provide useful information for such patients.- - - - - - - - - - ranking = 8keywords = coma (Clic here for more details about this article) |
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