Cases reported "Pregnancy Complications"

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1/115. spinal cord injury in a fetus.

    In her eighth month of pregnancy a woman was stabbed in the abdomen with a barbecue fork. Upon delivery one week later, the child was noted to have two scars in the thoracic region on the back. The legs were flaccid. Surgical exploration at the age of seven months revealed marked, dense scarring of spinal cord and arachnoid membrane. No similar case was found in the literature.
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2/115. prenatal diagnosis of dyssegmental dysplasia. A case report.

    BACKGROUND: Since the first use of sonography, most fetal dwarfism has been detectable prenatally. The correct differentiation of the subtype of dwarfism is difficult at times. Dyssegmental dysplasia is probably an exception to these subtypes because the vertebral disorganization and occipital encephalocele at times permits prenatal diagnosis. CASE: A 34-year-old woman, gravida 3, para 1, elective abortion 1 for dwarfism, was referred at 27 weeks' gestation for cystic hygroma. Further sonographic findings included: cystic hygroma with massive ascites, micromelia, occipital encephalocele, spinal disorganization and hydramnios. The fetus and both parents appeared to have a normal karyotype. Later the pregnancy was terminated with vaginal delivery. The fetus had micromelia, camptomelia, cystic hygroma, a flat face, short neck, short trunk, narrow thorax with protuberant abdomen, scoliosis and clubfeet. CONCLUSION: Sonography is effective in prenatal diagnosis of dyssegmental dysplasia. With sonography, diagnosis of dyssegmental dysplasia becomes possible as early as the first trimester.
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3/115. Anaesthetic management of a woman who became paraplegic at 22 weeks' gestation after a spontaneous spinal cord haemorrhage secondary to a presumed arteriovenous malformation.

    A 19-yr-old woman developed a paraplegia with a T10 sensory level at 22 weeks' gestation. The spinal injury was caused by spontaneous bleed of a presumed arteriovenous malformation in the spinal cord. She presented for Caesarean section at term because of the breech position of her fetus. The successful use of a combined spinal epidural-regional anaesthetic is described and the risks of general and regional anaesthesia are discussed.
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keywords = spinal
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4/115. Devic's neuromyelitis optica during pregnancy in a patient with systemic lupus erythematosus.

    Neuropsychiatric forms of systemic lupus erythematosus (SLE) vary, most commonly consisting of seizures, psychiatric disturbances, or focal central nervous deficits. This is a new case of neuromyelitis optica or Devic's syndrome during the course of SLE. Few reports of this association exist in the literature. Our objective is to report this unique case of Devic's neuromyelitis optica during pregnancy in a patient with systemic lupus erythematosus. A 28-year-old woman had been diagnosed as having SLE with cutaneous and articular involvement in 1987 when she was 17 years old. She was treated with a synthetic antimalarial agent associated with corticosteroids. In 1994, during the fourth month of pregnancy, she had signs of transverse myelitis with a sensory level at T6 associated with an optic neuropathy suggesting a Devic's syndrome. The patient was managed by plasmapheresis sessions and intravenous corticosteroids. Transverse myelitis recurred postpartum and three years later at the same thoracic level. Management by bolus administration of a steroid and cyclophosphamide resulted in remission again. There have only been around a dozen reports in the literature of patients who had both Devic's neuromyelitis optica and SLE. magnetic resonance imaging is contributive to diagnosis and therapeutic follow-up, showing spinal cord lesions with increased intensity on T2-weighted sequences. Although the clinical course of the present patient has been favourable so far, the prognosis of this neurologic disease is generally considered to be poor with elevated mortality.
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5/115. Spinal anaesthesia for caesarean section in a patient with systemic sclerosis.

    We describe the management of a diabetic primigravid woman with systemic sclerosis and thrombocytopaenia who required Caesarean section for pre-eclampsia. This was performed successfully under spinal anaesthesia.
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6/115. Caesarean section in a patient with paramyotonia congenita.

    This case report details spinal anaesthesia for an elective caesarean section in a patient with the rare condition of paramyotonia congenita. There are few case reports of anaesthesia in this condition and none in the Australian anaesthetic literature. This case highlights the need for the avoidance of hypothermia and depolarizing muscle relaxants, the safety of spinal anaesthesia and a conservative approach to the management of plasma potassium concentration. The subsequent review outlines the current literature and discusses other issues involved in the anaesthetic management of this disorder.
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ranking = 2
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7/115. 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.
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ranking = 3
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8/115. Combined spinal-epidural in the obstetric patient with Harrington rods assisted by ultrasonography.

    We describe a patient with severe scoliosis, which had been corrected partially with Harrington rods, who requested epidural analgesia for labour. With no palpable landmarks, the use of ultrasound enabled identification of the vertebral midline and allowed provision of regional anaesthesia.
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ranking = 4
keywords = spinal
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9/115. Anaesthetic management of a parturient with a colloid cyst of the third ventricle.

    A colloid cyst in the third ventricle near the foramen of Monroe can obstruct cerebrospinal fluid (CSF) flow from the lateral ventricles. Any change in the CSF pressure on either side of the cyst can lead to displacement and thus precipitate acute hydrocephalus. Management of the confinement of a patient with a colloid cyst must therefore aim to minimize changes in CSF pressure. We describe our management of a patient with a small colloid cyst who was permitted to labour with the assistance of patient-controlled epidural analgesia. The available alternatives are discussed.
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10/115. Endodermal cyst of septum pellucidum and pregnancy: a case report.

    BACKGROUND: Endodermal or Neurenteric cysts are commonly found in spine. Their intracranial occurrence is rare and such a cyst in the septum pellucidum is exceptional.METHOD: We report a woman, with 33 week pregnancy, presenting in a semiconscious state due to raised intracranial pressure (ICP) due to hydrocephalus caused by a large lesion in the septum pellucidum. Computed tomography (CT) revealed the lesion which was better characterised by the magnetic resonance imaging (MRI). First baby was delivered by LSCS and bilateral ventriculo-peritoneal shunts were inserted; and later on the cyst was excised.RESULT: There was full neurological recovery following the insertion of VP shunt. After excision of cyst cerebrospinal fluid (CSF) pathway was established and shunts could be removed. Post-operative period was complicated by septic ventriculitis. Eventually patient was discharged home in excellent condition. CONCLUSION: Endodermal cyst of septum pellucidum is an uncommon condition. Such lesions may be large when revealed, good outcome is expected after surgical excision.
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