1/25. maintenance of serum calcium by parathyroid hormone-related peptide during lactation in a hypoparathyroid patient.We describe the changes in calcium homeostasis seen in a hypoparathyroid woman during the third trimester and with lactation following her second pregnancy. During lactation her need for supplemental calcium and calcitriol abated, and in fact she was transiently hypercalcemic and hypophosphatemic. This change was associated with a rise of serum parathyroid hormone-related peptide (PTHrP) released systemically during lactation. This is the first documentation of the time course of serum PTHrP levels from the late third trimester throughout lactation in a hypoparathyroid woman. In this context PTHrP may have sufficient biological activity to compensate for parathyroid hormone deficiency.- - - - - - - - - - ranking = 1keywords = lactation (Clic here for more details about this article) |
2/25. pregnancy in a patient with chronic intestinal pseudo-obstruction on long-term parenteral nutrition.parenteral nutrition support is provided in most instances for short intervals during pregnancy in conditions where oral/enteral intake is severely compromised. Few reports describe the use of parenteral nutrition from conception to delivery. We report the case of a 30-year-old woman suffering from a severe form of chronic intestinal pseudo-obstruction on long-term parenteral nutrition because of malabsorption and malnutrition. pregnancy and delivery developed uneventfully. The fetus grew normally throughout pregnancy. Our patient needed only slight modifications in her parenteral nutrition regimen during lactation. There were no metabolic complications during pregnancy. We conclude that female patients even with severe forms of gastrointestinal diseases, such as chronic intestinal pseudo-obstruction requiring long-term home parenteral nutrition, can conceive and carry successfully a pregnancy to term.- - - - - - - - - - ranking = 0.125keywords = lactation (Clic here for more details about this article) |
3/25. 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 = 0.75keywords = lactation (Clic here for more details about this article) |
4/25. 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 = 0.625keywords = lactation (Clic here for more details about this article) |
5/25. Granulomatous inflammation of the breast in a pregnant woman: report of a case with fine needle aspiration diagnosis.BACKGROUND: Granulomatous inflammation of the breast is an inflammatory process with multiple etiologies. It can accompany breast carcinoma or be idiopathic. It often presents clinically in a fashion mimicking carcinoma. Idiopathic granulomatous mastitis is strongly associated with lactation and is reported to occur in postpartum patients. This is the second fine needle aspiration (FNA) report of idiopathic granulomatous inflammation in the breast of a pregnant woman. CASE: A 27-year-old, 7-month-pregnant woman presented with a hard nodule in her right breast; on ultrasound examination it showed mixed echogenicity, suspicious for carcinoma. FNA showed granulomatous inflammation. The smears were highly cellular, with many clusters of and single epithelioid cells displaying moderate pleomorphism and prominent nucleoli in a background composed of neutrophils, plasma cells, lymphocytes and multinucleated cells. Core needle biopsy revealed a nonnecrotizing, granulomatous lesion. CONCLUSION: The diagnosis of granulomatous inflammation can be challenging, and the cytologic features can be difficult to separate from those of carcinoma. The relatively rare occurrence of this lesion and its cytologic features make it a potentially difficult diagnosis and diagnostic pitfall.- - - - - - - - - - ranking = 0.125keywords = lactation (Clic here for more details about this article) |
6/25. Treatment of perinatal delusional disorder: a case report.This article is a report on a complicated case of delusional disorder in pregnancy and lactation, and effective multidisciplinary treatment. Few reports in the literature concern delusional disorder in pregnancy, or regard olanzapine's safety in pregnancy and lactation. A gravid woman in her third trimester merited twin diagnoses of delusional disorder and borderline personality disorder, and was successfully treated with olanzapine and psychotherapy during pregnancy and lactation. Her infant was large for gestational age (LGA) and had Erb's palsy, which resolved, and remained healthy at six months, with continued breastfeeding. Her delusional beliefs did not recur, nor did she have postpartum depression or psychosis.- - - - - - - - - - ranking = 0.375keywords = lactation (Clic here for more details about this article) |
7/25. Intrauterine baclofen exposure: a multidisciplinary approach.Maternal use of the antispasmodic baclofen during pregnancy is an uncommon clinical scenario and leads to uncertainty regarding neonatal risks. We present a team-based, peripartum management plan designed for safe monitoring and minimizing the risk of neonatal withdrawal after unusual drug exposure. Incorporating the expertise of neonatology, nursing, pharmacy, neurology, and the lactation service, as well as parental input, this consensus approach was implemented in a case of maternal oral baclofen use with a successful outcome for the infant and family.- - - - - - - - - - ranking = 0.125keywords = lactation (Clic here for more details about this article) |
8/25. Bilateral oophorectomy in a pregnant woman: hormonal profile from late gestation to post-partum: case report.BACKGROUND: A 16 week pregnant woman presented with massive theca-lutein cysts requiring bilateral oophorectomy. pregnancy progressed uneventfully and spontaneous lactation ensued after delivery. methods: To study the role of the ovary on the hormonal profile at the end of gestation and in post-partum, we measured FSH, estradiol (E2), unconjugated estrone (E1), unconjugated estriol (E3), sex hormone-binding globulin, progesterone, dehydroepiandrosterone sulphate and prolactin at 37 weeks gestation and at 8 h, 4 days, 5 weeks, and 2 months post-partum. RESULTS: These hormones were within the range expected for ovary-intact pregnant and puerperal women until 4 days post-partum. At 5 weeks post-partum, FSH increased to a peri-menopausal range (31.4 IU/l) while estrogens remained within the normal puerperal range (E2=239 pmol/l; E1=102 pmol/l), contrasting with their rapid changes in non-pregnant women after bilateral oophorectomy. At 2 months, while partially breastfeeding, FSH, E2 and E1 were closer to menopausal range (68 IU/l, 136 and 70.2 pmol/l respectively), and hormone replacement was started. CONCLUSIONS: We conclude that the ovary is not required to maintain a normal hormonal profile in late pregnancy and early puerperium. However, the increase in FSH to peri-menopausal levels at 5 weeks post-partum, despite breastfeeding, suggests that the ovary is needed to maintain low FSH concentrations during lactation.- - - - - - - - - - ranking = 0.25keywords = lactation (Clic here for more details about this article) |
9/25. Unilateral gestational macromastia--a rare disorder.Macromastia is the massive enlargement of the breast, unilateral or bilateral, disproportionate to the growth of the rest of the body. It is called gravid macromastia or gigantomastia of pregnancy when it occurs during pregnancy. It may or may not regress following parturition. Gestational macromastia is exceptionally rare. We report a 28-year-old female with gigantomastia of the left breast. She presented at four months post-partum with painful massive enlargement of the left breast since the third month of pregnancy. The overlying skin was stretched out and showed multiple ulcers with foul smelling discharge. The nipple and areola were unremarkable. Simple mastectomy was done, as fine needle aspiration cytology was suggestive of phylloides tumour. The breast specimen measured 30 x 30 x 9 cm and was replaced totally by grey-white tissue involving all the resection margins. No normal breast tissue or fat was identified. Histopathology showed periductal as well as diffuse fibrosis, adenosis and lactational changes. No features of phylloides tumour or carcinoma were present and it was diagnosed as unilateral gestational macromastia.- - - - - - - - - - ranking = 0.125keywords = lactation (Clic here for more details about this article) |
10/25. pregnancy and breast cancer.breast cancer in association with pregnancy and lactation is rare, but presents a therapeutic problem of considerable magnitude. The outlook for such patients is less favorable than that of nonpregnant, nonlactating women, probably because the stage of the disease is more advanced when it is discovered. The most significant factor in the poorer prognosis is physician delay in diagnosis and therapy. When mastectomy is carried out early in pregnancy, the operation can be as effective as in nonpregnant women of the same age groups. It is emphasized that when pregnancy and breast cancer are found concurrently, prompt therapy for the cancer should be undertaken. Interruption of pregnancy in nondisseminated breast cancer is of little value. If pregnancy is near term when the diagnosis of disseminated breast cancer is made, the desire of the husband and wife for a child should be considered. A modest delay in therapy to allow for delivery probably has no deleterious effect. castration should be withheld and used only for the patient with metastatic disease. There may be a place for prophylactic castration in the treatment of disseminated disease, but its role is yet to be clearly defined. Subsequent pregnancies in a patient with axillary spread at the time of mastectomy are contraindicated, because of the high rate of treatment failure and decreased rate of survival. In patients desiring future pregnancies following mastectomy, a period of observation of at least 2 years seems wise. At the end of that period, if clinical evaluation, laboratory values, roentgenographic studies, and isotopic bone scanning are negative for disseminated disease, subsequent pregnancies seem safe. Prompt evaluation of any breast mass found during pregnancy and lactation should be carried out by needle or operative biopsies under local anesthesia. Although the prognosis of the pregnant or lactating woman with breast cancer is generally favorable, numerous long-term survivals are encountered in those women who undergo prompt mastectomy early in pregnancy. The former pessimistic outlook for such patients seems unjustified. With modern methods of diagnosis and treatment, therapy can be effective and successful.- - - - - - - - - - ranking = 0.25keywords = lactation (Clic here for more details about this article) |
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