Cases reported "Puerperal Disorders"

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11/25. Ischemic stroke in a postpartum patient: understanding the epidemiology, pathogenesis, and outcome of moyamoya disease.

    BACKGROUND: moyamoya disease (MMD), or spontaneous occlusion of blood vessels in the circle of willis, is a noninflammatory, nonatheromatous vasculopathy that often presents with ischemia or hemorrhage and has a tendency to affect young women. We discuss a case of a woman 7 days postpartum with new onset strokes, suspected initially to have benign angiopathy of the central nervous system (BACNS)/postpartum angiopathy versus primary CNS vasculitis. cerebral angiography was suspicious for MMD and the patient underwent surgical revascularization. OBJECTIVES: To review the epidemiology, presentation, diagnosis, differential diagnosis, treatment, prognosis, and postpartum maternal outcomes of MMD. methods: The authors reviewed the English-language literature published between 1996 and 2004 using medline databases. Additional articles were obtained from references described in literature obtained by the primary search. RESULTS: MMD is characterized by severe bilateral stenosis of the distal internal carotid arteries and their first branches, with prominent collateralization. autoantibodies relating to endothelial cell dysfunction have been studied as possible pathogenetic mechanisms. The gold standard for diagnosing MMD is digital subtraction contrast angiography (DSA). MMD-related findings on imaging studies may, at times, be mistaken for those of vasculitis. A surgical approach may need to be considered. Despite treatment, the overall prognosis of MMD is worse in adults compared with children. CONCLUSION: awareness of the specific features of MMD is crucial for clinical decision-making to avoid unnecessary exposure to aggressive immunosuppressive therapy. It is important for rheumatologists to consider MMD in the differential diagnosis of suspected CNS vasculitis.
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12/25. multiple myeloma in pregnancy: a case report.

    multiple myeloma, a generalized malignancy resulting from the proliferation of a single clone of neoplastic plasma cells, occurs rarely in pregnancy. This is the fifth documented case of pregnancy in a woman with this disorder. Clinical features of multiple myeloma include bone pain, pathologic fractures, neurologic deficits, and frequent bacterial infections. Laboratory evaluation often reveals hypercalcemia, anemia, and some degree of renal failure. Both radiation therapy and chemotherapy are used to treat multiple myeloma. Although the ultimate prognosis of a woman with this disease is poor, the offspring are apparently unaffected.
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13/25. multiple myeloma in two young postpartum women.

    multiple myeloma is an uncommon disease before age 30 years. We recently encountered two cases of myeloma in women, aged 29 and 30 years, respectively. Aside from their young age, another unusual feature of these cases was that each woman had been pregnant and had a normal delivery, three and four months prior to diagnosis. A literature search revealed only 35 reported cases of multiple myeloma at or before the age of 30 years. Of these, only 14 were thought to be clear-cut or highly suggestive of myeloma by the authors. The relationship of multiple myeloma and pregnancy is discussed. Although the number of cases is small, the occurrence of myeloma in the younger individual does not appear to impart a worse prognosis or survival.
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14/25. Postpartum femoral neuropathy.

    Two cases of postpartum femoral neuropathy occurred. The literature on this subject is reviewed, and possible etiologic mechanisms are discussed. Complete functional recovery is typical of the excellent prognosis of puerperal femoral neuropathy. The importance of recognizing this complication is to predict a favorable prognosis and thus eliminate anxiety for both patient and physician.
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15/25. Systemic lupus erythematosus with myocarditis complicating pregnancy.

    We report a patient with systemic lupus erythematosus and myocarditis complicating pregnancy. cardiomegaly and compensated congestive heart failure persisted postpartum and we had the therapeutic dilemma of a pregnancy six months later. The defined maternal prognosis of a similar disease, peripartum cardiomyopathy, suggested the need for termination of pregnancy.
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16/25. Puerperal renal vein thrombosis.

    A case of renal vein thrombosis occurring one week post partum with unknown etiology and excellent recovery is described. review of the literature reveals this disorder is rare in the nonpregnant woman and even rarer in pregnancy. survival has greatly improved with anticoagulant use. Diagnosis, prognosis, and treatment are discussed.
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17/25. Evaluation of lupus nephritis during pregnancy by renal biopsy.

    patients with lupus nephritis frequently exhibit increasing proteinuria, hypertension and deterioration of renal function due to either active lupus nephritis, chronic lupus nephritis and/or superimposed preeclampsia during pregnancy. Percutaneous renal biopsies were therefore performed in 3 women with systemic lupus erythematosus during pregnancy and immediately postpartum in a fourth woman to evaluate their renal disease during pregnancy. Mean serum creatinine at renal biopsy was 2.9 mg/dl, with a mean creatinine clearance of 66 ml/min and protein excretion of 5.3 g/day. All patients had grade IV lupus nephritis and received pulse methylprednisolone immediately; 3 received cyclophosphamide. All 3 patients with crescent formation developed endstage renal disease within 3 years. The fourth patient has normal renal function 3 years after biopsy. Percutaneous renal biopsies during pregnancy in women with lupus nephritis provide an accurate histopathologic diagnosis and are important in providing appropriate therapy, counseling and prognosis.
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18/25. Primary antiphospholipid antibody syndrome and microscopic polyarteritis in the puerperium: a case report.

    The primary antiphospholipid antibody syndrome (PAPS) and systemic lupus erythematosus (SLE) may occur in women of reproductive age, and both syndromes have been reported to exacerbate during periods of hormonal flux such as oral contraceptive administration, pregnancy, or the puerperium. These disorders have features which cause them to resemble other multisystem diseases. PAPS and SLE must be differentiated from preeclampsia with hellp syndrome and thrombotic thrombocytopenic purpura occurring during pregnancy. These four disorders differ in prognosis and required therapies. We report an instructive case of PAPS in a patient who developed microscopic polyarteritis with significant glomerulonephritis following prostaglandin-induced delivery of a stillborn fetus. We compare the manifestations of PAPs, SLE, HELLP, and thrombocytopenic purpura, and discuss the possible role of hormonal imbalance as a precipitating event.
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19/25. Postpartum emotional illness: recognition and management in primary care.

    Recognition and management of postpartum depression and other emotional illnesses in the primary care setting is both possible and desirable. Screening questionnaires and clinical interviews, education of the patient and her family, and appropriate use of medication and support will allow the primary care physician to manage the majority of these cases successfully. depression is the most common disorder seen in the postpartum period, but several other psychiatric illnesses are also more common in this period. Decisions about pharmacologic management as well as hospitalization must be made in the context of risks and benefits to the patient, her baby, and her family. Although untreated emotional illness in postpartum women can have longterm sequelae for the family, appropriately managed most of these disorders have an excellent prognosis.
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20/25. Septic pelvic thrombophlebitis: an unusual treatable postpartum complication.

    Septic pelvic thrombophlebitis is an uncommon but serious postpartum complication occurring in about 1 in 2,000 pregnancies, characterized by pain, antibiotic resistant fever and tachycardia. In about 50% of cases a pelvic mass is present which is usually right-sided (especially when the ovarian vein is involved). It is estimated to cause 18 maternal deaths per million pregnancies in the united states. Use of contrast enhanced CT scanning and a trial of heparin therapy increases the diagnostic certainty. It is particularly important because surgical management which may otherwise be suggested because of a spiking fever and a mass seems to be associated with a poorer prognosis than does conservative management.
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