1/105. Transient osteoporosis during pregnancy: the perioperative nurse's role.Perioperative nurses are confronted with ever changing demands in their daily practice. Perhaps the greatest challenge, however, is in the care of patients with multi-faceted health problems. These patients require the coordination of many multi-disciplinary team members in attempting to achieve optimum health. This paper will describe the case study of a 28 year old, 26 week primip, who presented to a tertiary care centre with spontaneous bilateral hip fractures of unknown origin. It will further discuss the disease process known as Transient osteoporosis during pregnancy, the surgical approach, and finally, the role of the perioperative nurse in coordinating the patient's perioperative care.- - - - - - - - - - ranking = 1keywords = fracture (Clic here for more details about this article) |
2/105. Supine hypotensive syndrome caused by intra-abdominal mass: a case report.An obese woman who presented with 3 separate intra-abdominal masses developed a supine hypotensive syndrome following induction of general anesthesia. The hypotension was corrected by positioning the patient in a left lateral tilt and by releasing intra-abdominal pressure. Following decompression of the vena cava, arterial and central venous pressure rose and remained at a high level. urine output was poor until IV furosemide was administered.- - - - - - - - - - ranking = 0.13386759192206keywords = compression (Clic here for more details about this article) |
3/105. reflex sympathetic dystrophy in pregnancy: nine cases and a review of the literature.OBJECTIVE: To better understand the diagnosis of reflex sympathetic dystrophy of the lower extremities in pregnant women. SUBJECT: disease analysis using a retrospective series of nine cases and a review of the literature (57 patients and 159 sites of reflex sympathetic dystrophy). RESULTS: This disorder should be considered in any painful pelvic girdle syndrome or lower extremity pain. The hip is involved in 88% of cases. Symptoms develop in the third trimester of pregnancy, between the 26th and the 34th weeks. magnetic resonance imaging (MRI) provides an early, accurate, and very specific diagnosis, although standard radiography continues to be the first-line diagnostic tool. Fracture occurs in 19% of patients. The etiology and pathophysiology remain unclear, although pregnancy itself appears to play a significant role in this disease. Although locoregional mechanical factors partly explain reflex sympathetic dystrophy. hypertriglyceridemia appears to be a risk factor. This disorder develops independently, but the conclusion of pregnancy appears to be necessary for cure. reflex sympathetic dystrophy does not appear to affect the course of the pregnancy. Indications for cesarean delivery remain obstetrical and should be discussed when a fracture is involved. Simple therapeutic management using gentle physical therapy provides rapid and complete recovery in 2-3 months. CONCLUSION: reflex sympathetic dystrophy during pregnancy remains poorly understood and underestimated. Only joints of the inferior limbs are involved. MRI appears to be the best diagnostic tool. Pathogenesis remains unclear. Fractures are not rare. Treatment should be non-aggressive.- - - - - - - - - - ranking = 1keywords = fracture (Clic here for more details about this article) |
4/105. Bilateral fracture of the sacrum associated with pregnancy: a case report.We describe a 33-year-old woman with a bilateral fracture of the sacrum associated with pregnancy. Dual-energy X-ray absorptiometry of the lumbar spine and femoral neck showed normal bone mineral density, whereas bilateral osteopenic areas in the massae laterales were demonstrated by the initial CT-scan. The question remains whether the correct diagnosis is so-called insufficiency fracture due to transient osteoporosis of the sacrum associated with pregnancy or so-called fatigue fracture due to unaccustomed stress related to rapid and excessive weight gain in the last trimester of pregnancy.- - - - - - - - - - ranking = 7keywords = fracture (Clic here for more details about this article) |
5/105. Spinal lesions, paraplegia and the surgeon.Thirty-six patients with spinal cord lesions and varying degrees of paraplegia were seen by the surgical team at the Angau Memorial Hospital, Lae, over a thirty month period. Because the continued presence of a spinal lesion may lead to progressive cord destruction and ischaemic myelopathy, prompt treatment is advocated. The depressing results that have followed treatment of fracture dislocations of the cervical spine and secondary neoplasm with paraplegia is recorded and some suggestions are made that may improve the outlook in future cases. Early and major surgery is advocated in the treatment of spinal abscesses, tumours, Pott's paraplegia and unstable fracture dislocations of the lumbar spine.- - - - - - - - - - ranking = 2keywords = fracture (Clic here for more details about this article) |
6/105. Thoracolumbar distraction fractures in advanced pregnancy: a contribution of two case reports.Thoracolumbar trauma in pregnant women is an important topic, though rarely discussed in the pertinent literature. Two consecutive cases of thoracolumbar distraction injuries in advanced pregnancy are presented. Conservative treatment failed in both cases; surgical management was necessary on a delayed basis using compression instrumentation. The similar features of the pattern of injury in the two patients suggest a cushioning effect of the gravid uterus. A theoretical analysis of the pathomechanics is carried out in an attempt to explain the specificity of flexion-distraction injuries in victims in an advanced stage of pregnancy. The authors suggest that the spine pivots about the fetus, and so is injured more in tension than in compression. The damage is mainly to soft-tissue structures, while anterior column compression and axial loading are less important.- - - - - - - - - - ranking = 4.4016027757662keywords = fracture, compression (Clic here for more details about this article) |
7/105. Lymphocytic adenohypophysitis mimicking a pituitary macroadenoma.A 24-year-old woman developed headache and rapidly progressive visual disturbances during the last trimester of her first pregnancy. Magnetic resonance tomography (MRI) of the brain documented an intra- and suprasellar mass lesion. For preservation of vision, transsphenoidal microsurgical decompression was performed. Immediately postoperatively, visual acuity improved and hemianopia resolved. Histological examination yielded the diagnosis of primary lymphocytic adenohypophysitis. This is a rare inflammatory pituitary disease. There are no typical clinical, laboratory, or radiological findings that allow precise preoperative diagnosis. Even though this autoimmune disorder is principally steroid-responsive, an improvement of visual disturbances under steroid therapy cannot be predicted. Therefore, surgery is justified not only to establish the diagnosis, but also to restore vision by decompression of the optic nerves and the chiasm.- - - - - - - - - - ranking = 0.26773518384412keywords = compression (Clic here for more details about this article) |
8/105. osteoporosis with vertebral fractures associated with pregnancy and lactation.Three cases of young women who developed severe vertebral osteoporosis after pregnancy and during lactation are described. These patients shared several features: a low-calcium diet during most of their lives, very-low body weight in two patients, and a positive family history of osteoporosis in two patients. Initial studies disclosed vertebral fractures, severely diminished bone mineral density of the spine (Z score = -3.3 to -4.1), and a less severely affected bone mineral density of the hip (Z score = -1.6 to -2.3). During the prolonged follow-up of these patients, treated with oral biphosphonates, vitamin d, and calcium, an improved clinical response with a marked recovery of spine bone mineral density was observed. Poor general nutrition, low calcium intake, and a positive family history of osteoporosis appear to be strong risk factors for pregnancy- and lactation-associated osteoporosis. Although the mechanism of action is uncertain, calcium, vitamin d, and antiresorptive agents may have been beneficial in the treatment of this severe disorder.- - - - - - - - - - ranking = 5keywords = fracture (Clic here for more details about this article) |
9/105. Spontaneous rib fracture during pregnancy. A case report and review of the literature.No studies have demonstrated a direct relationship between pregnancy and rib fracture. A case of spontaneous rib fracture in the third trimester presents the opportunity to examine factors unique to pregnancy that may predispose the patient to stress fractures of the lower ribs. A 28-year old woman in week 31 of her pregnancy presented with the chief complaint of acute onset of right upper quadrant pain. A chest radiograph demonstrated a minimally displaced fracture of the right 10th rib. During pregnancy, the enlarging uterus causes certain opposing muscular forces to act on the ribs, making them more susceptible to fracture after minimal trauma or after repeated stresses such as a chronic cough.- - - - - - - - - - ranking = 9keywords = fracture (Clic here for more details about this article) |
10/105. A case report of primary hyperparathyroidism with severe bony involvement and nephrolithiasis.INTRODUCTION: Although the majority of patients with primary hyperparathyroidism have a relatively asymptomatic benign disorder, there are patients who have a more aggressive disorder. CLINICAL PICTURE: We report a case of primary hyperparathyroidism presenting during pregnancy complicated by antepartum haemorrhage and severe prematurity. The diagnosis was made postpartum, when her problems rapidly progressed to result in severe neuromuscular weakness, bilateral pathological hip fractures as well as nephrolithiasis. TREATMENT: Surgical parathyroidectomy was performed. The underlying lesion was a large solitary parathyroid adenoma with cystic elements. CONCLUSION: Primary hyperparathyroidism is not an innocuous disease and can result in severe morbidity if left untreated.- - - - - - - - - - ranking = 1keywords = fracture (Clic here for more details about this article) |
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