Cases reported "Pregnancy Complications"

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1/21. 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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2/21. Acute asthma. Emergency management in the community.

    BACKGROUND: The prevalence of asthma in australia is one of the highest in the world. statistics suggest that two million or more Australians across all age groups have the disease. It is one of the top five medical problems referred to hospital and one of the commonest presentations seen in emergency departments. asthma was the cause of death of 685 Australians in 1998. All general practitioners will have a cohort of asthmatics in their practice and consequently must be prepared to manage these people at any time, but especially at times of acute exacerbation. OBJECTIVE: To outline the features of acute asthma and its management in the community setting. DISCUSSION: general practitioners have a crucial role to play in the community and prehospital management of asthma. An awareness of the features and treatment of acute exacerbations will help them reduce an enormous burden on the health system and contribute to a reduction in morbidity and mortality in their patients.
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3/21. A case report of neonatal thyrotoxicosis due to maternal autoimmune hyperthyroidism.

    A case of neonatal thyrotoxicosis secondary to maternal autoimmune hyperthyroidism is reported in an infant born at 34 weeks gestation who presented with tachycardia, jitteriness, diarrhea, and a small goiter. propranolol and oxygen were used to treat high-output cardiac failure and transient persistent pulmonary hypertension. The infant's response to propylthiouracil therapy, gradual resolution of cardiac and systemic symptoms, and normaliziation of thyroid studies are described. Thyroid physiology and function and the special considerations in a premature infant are reviewed. An overview of maternal autoimmune hyperthyroidism and the implications for the developing fetus and neonate are presented. The risk factors for, and clinical presentation of, hyperthyroidism are outlined and treatment strategies highlighted. The nursing care of infants with hyperthyroidism is carefully described with an emphasis on the surveillance for and management of multisystem manifestations.
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4/21. Massive extravasation of traumatically ruptured buttock silicone prosthesis.

    Although requests for gluteal implants are unusual in the united states, the use of silicone implants for buttock cosmesis has been described. Complications of this procedure have rarely been reported. There are no reports of long-term follow-up in these patients. This report describes the traumatic rupture of a silicone buttock implant nine years after initial surgical placement. Massive silicone extravasation and migration, along with silicone granuloma formation, occurred. The contralateral implant remained intact, functional, and cosmetically acceptable. The surgical approach and repair of this injury is outlined and discussed. We conclude that early surgical treatment of extravasation injuries is needed and that buttock reconstruction with implants can be useful, but close follow-up is needed. We also suggest there is a need to evaluate alternative materials for use in this procedure.
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5/21. pancreatitis related to severe acute hypertriglyceridemia during pregnancy: treatment with lipoprotein apheresis.

    We report a clinical observation of acute pancreatitis due to severe hypertriglyceridemia in a pregnant woman. In order to decrease the serum triglyceride level rapidly, two lipaphereses were undertaken using the double-filtration technique. This lipoprotein apheresis technique is briefly described and the efficacy in reducing rapidly hypertriglyceridemia is outlined. Like in 3 previously published reports, the patient had a rapid recovery, confirming that lipoprotein apheresis should be an adequate and a well-tolerated treatment in such a condition.
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6/21. Systemic lupus erythematosus during pregnancy.

    Today, more women with systemic lupus erythematosus are opting for pregnancy than in the past. nurses need to be familiar with maternal, fetal, and neonatal manifestations of the disease, as well as antenatal surveillance and treatment options. A review of the literature outlines current pharmacologic management and provides the basis for both medical and nursing considerations.
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7/21. Drug dependence and pregnancy: antenatal and intrapartum problems.

    The last decade has seen an increase in the use of illicit drugs and alcohol in the community including an increase in the use of these agents by women in the reproductive age group. With this in mind, health-care workers need to avoid being complacent in caring for these women--they are a high-risk obstetric population with a significant incidence of medical, obstetric and paediatric complications. This paper concentrates on the antenatal and intrapartum problems, and outlines their management. An overview of the problem is presented as well as an illustrative case report.
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8/21. asthma and pregnancy: responsibility of physicians and patients.

    The successful management of asthma during pregnancy requires a cooperative approach between the obstetrician, the physician managing the asthma, and the patient. This is emphasized by a case report describing a patient with uncontrolled asthma subsequently managed with appropriate medical and obstetrical care. Concern for maternal and fetal health and reassurance of patients are primary concerns. Guidelines for physicians and patients are outlined as are the safety of drugs and therapy in pregnant patients. physicians must have knowledge of appropriate use of medications during pregnancy.
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9/21. Emergence and resolution of ambivalence in expectant mothers.

    Little has been written about the perceptions of expectant mothers with previous histories of psychiatric disturbance and their affective oscillations during pregnancy. This paper discusses the case of a 22-year-old primigravida with a history of schizoaffective disorder who was referred to our mother-infant psychotherapy service. Despite the patient's initial defensive style, she was asked to discuss several dreams that she had had since learning about her pregnancy. A wealth of information about the patient's unconscious ambivalence and destructive wishes toward her unborn infant emerged. The patient was also unable to engage in any predictive imagery about the future of her infant or to anticipate intuitively what the experience of mothering would be like. This paper reveals that pregnant women with a history of psychological disturbances often have highly aberrational fantasies and ambivalent impulses toward their unborn infant, and some of these fantasies threaten to manifest in the form of abusive behavior after the birth. Techniques for predicting how new mothers with previous psychiatric histories will interact with their infants after birth are outlined. It is hoped that this treatment may avert child abuse.
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10/21. diagnosis and management of susceptibility to malignant hyperthermia in pregnancy.

    A case of susceptibility to malignant hyperthermia, diagnosed by muscle biopsy during the first trimester of pregnancy, is presented. Pertinent medical history that might raise this suspicion is reviewed. The pathophysiology of malignant hyperthermia is discussed. Recent reports documenting the placental transfer of dantrolene and complications associated with dantrolene administration during labor are described. The pharmacology of dantrolene sodium is presented. Guidelines regarding the management of labor and delivery in patients susceptible to malignant hyperthermia are outlined. Suggestions for counseling patients and their children with this syndrome are reviewed.
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