Cases reported "Puerperal Disorders"

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1/92. Endovascular thrombolysis for symptomatic cerebral venous thrombosis.

    OBJECT: The authors sought to treat potentially catastrophic intracranial dural and deep cerebral venous thrombosis by using a multimodality endovascular approach. methods: Six patients aged 14 to 75 years presented with progressive symptoms of thrombotic intracranial venous occlusion. Five presented with neurological deficits, and one patient had a progressive and intractable headache. All six had known risk factors for venous thrombosis: inflammatory bowel disease (two patients), nephrotic syndrome (one), cancer (one), use of oral contraceptive pills (one), and puerperium (one). Four had combined dural and deep venous thrombosis, whereas clot formation was limited to the dural venous sinuses in two patients. All patients underwent diagnostic cerebral arteriograms followed by transvenous catheterization and selective sinus and deep venous microcatheterization. Urokinase was delivered at the proximal aspect of the thrombus in dosages of 200,000 to 1,000,000 IU. In two patients with thrombus refractory to pharmacological thrombolytic treatment, mechanical wire microsnare maceration of the thrombus resulted in sinus patency. Radiological studies obtained 24 hours after thrombolysis reconfirmed sinus/vein patency in all patients. All patients' symptoms and neurological deficits improved, and no procedural complications ensued. Follow-up periods ranged from 12 to 35 months, and all six patients remain free of any symptomatic venous reocclusion. Factors including patients' age, preexisting medical conditions, and duration of symptoms had no statistical bearing on the outcome. CONCLUSIONS: patients with both dural and deep cerebral venous thrombosis often have a variable clinical course and an unpredictable neurological outcome. With recent improvements in interventional techniques, endovascular therapy is warranted in symptomatic patients early in the disease course, prior to morbid and potentially fatal neurological deterioration.
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ranking = 1
keywords = thrombosis, venous thrombosis, vein, deep
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2/92. Idiopathic mesenteric thrombosis following caesarean section.

    Mesenteric venous thrombosis, "the great mimicker", is a very rare disorder in pregnancy and the puerperium, particularly when not associated with any pre-existing thrombophilia or autoimmune states. We describe a patient requiring a resection of 150 cm of gangrenous small bowel after uncomplicated elective Caesarean section. The only risk factor for thrombosis was recovery from an elective Caesarean section, a condition classified by the Royal College of Obstetricians and Gynaecologists as "low risk". death from thromboembolism is the leading cause of maternal mortality and should always be considered with unusual post partum symptoms. early diagnosis of mesenteric vascular occlusion is difficult and recent evidence suggests that elevated GST isoenzyme may be helpful. In all cases of MVT anti-coagulation is the basis of treatment. patients who are not anti-coagulated after surgery have a recurrence rate of 25 per cent compared with 13 per cent of heparinised post-operative patients. As no other pre-existing cause for MVT was found, management was with warfarin for 6 months, the oral contraceptive pill was contraindicated and heparin prophylaxis was recommended for future pregnancies.
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ranking = 0.6571034088769
keywords = thrombosis, venous thrombosis
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3/92. A case report of acute pelvic thrombophlebitis missed by magnetic resonance imaging of the pelvic veins.

    A 29-year-old woman presented post-natally with pulmonary hypertension. Peripheral venous thrombosis was not detected by duplex ultrasound or conventional MRI. Despite anticoagulation, the patient arrested. autopsy revealed right iliac vein thrombosis. The ability of conventional MRI to detect acute pelvic thrombophlebitis depends on obtaining appropriate views.
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ranking = 0.27113295810544
keywords = thrombosis, vein thrombosis, venous thrombosis, vein
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4/92. Postpartum ovarian vein thrombosis.

    OBJECTIVE: Ovarian vein thrombosis (OVT) is known as a rare but serious postpartum complication. The condition is often clinically not distinguishable from endometritis, appendicitis or pyelonephritis. OVT may cause sepsis, septic pulmonary thromboembolism, and thrombosis of the inferior vena cava and the renal veins, and is potentially fatal. The objective of this study was to report the clinical findings and outcome of two patients with diagnosed ovarian vein thrombosis after delivery managed at this institution. METHOD: Two patients fit the study criteria of documented ovarian vein thrombosis after delivery. An imaging diagnosis (CT) of ovarian vein thrombosis was required for final study inclusion. RESULTS: We present two patients with ovarian vein thrombosis. The symptoms of one patient disappeared two days after beginning heparin and antibiotic therapy. The control-CT 93 days after the diagnosis of POVT showed unsuspected ovarian veins. The other patient suffered from POVT 13 days after spontaneous delivery. Because of lethal embolisms she died during the operation for embolectomy. CONCLUSION: On the basis of our series and other recent series, OVT may likely be more common than previously thought and may become clinically apparent only when complicated by infection, expansion of the thrombus or pulmonary embolism. POVT is a potentially fatal condition most commonly seen as a complication of pelvic surgery or inflammatory disease.
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ranking = 1.3723759992852
keywords = thrombosis, vein thrombosis, vein
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5/92. Postpartum headache after epidural blood patch: investigation and diagnosis.

    Use of an epidural blood patch to treat spinal headache after accidental dural puncture is well recognized. The high success rate associated with this practice has been questioned and it is not uncommon for patients to suffer recurring headaches after a supposedly successful blood patch. We describe a patient in labour who suffered accidental dural puncture, and whose headache was treated twice with an epidural blood patch. Despite this, the headache persisted. The case highlights the difficulty in the diagnosis of headache in the postnatal period in patients who have had regional analgesia and the importance of considering an alternative pathology, even if epidural blood patching has been successful. In this case, a diagnosis of cortical vein thrombosis was made. The incidence, presentation, aetiology and treatment of this rare condition is described.
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ranking = 0.14032314669897
keywords = thrombosis, vein thrombosis, vein
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6/92. Late-onset puerperal ovarian vein thrombophlebitis treated laparoscopically.

    Puerperal ovarian vein thrombophlebitis is an uncommon condition that usually develops in the immediate postpartum period. Computed tomography, magnetic resonance imaging, Doppler ultrasound, and exploratory laparotomy may be performed to diagnose it. A woman developed worsening abdominal pain 6 weeks postpartum. Laparoscopic intervention allowed treatment of late-onset, left-sided puerperal ovarian vein thrombophlebitis. The disorder may develop much later after delivery than expected and can be successfully treated laparoscopically.
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ranking = 0.0090191989294548
keywords = vein
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7/92. Vena cava thrombosis associated with nephrotic syndrome in the puerperal gestational cycle.

    CONTEXT: The puerperal gestational cycle is accompanied by a state of physiological hypercoagulability. Thromboembolic phenomena may occur at this time. OBJECTIVE: To report on a clinic case involving a patient that presented a family history of thromboembolism and developed deep vein thrombosis in a lower limb and vena cava thrombosis during the puerperal gestational cycle, displaying nephrotic syndrome as the main complication. DESIGN: Case report.
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ranking = 0.67801681922689
keywords = thrombosis, vein thrombosis, deep vein, vein, deep
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8/92. Postpartum coronary artery dissection complicated by heparin-induced thrombocytopenia and thrombosis.

    A 32-year-old woman presented with an acute anterior-lateral myocardial infarction 7 days postpartum. coronary angiography revealed an occlusive left main coronary artery dissection. After coronary artery bypass surgery the patient's cardiac function improved and stabilized. thrombocytopenia and a femoral artery thrombosis after 9 days of heparin exposure marked the development of heparin-induced thrombocytopenia and thrombosis that was successfully managed with argatroban, a direct thrombin inhibitor anticoagulant.
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ranking = 0.63876767610808
keywords = thrombosis
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9/92. Post-partum ovarian vein thrombosis.

    Post-partum ovarian vein thrombosis (POVT) is uncommon, but the true incidence is not known. Ninety per cent of cases present as right iliac fossa pain within 10 days of delivery. Anti-coagulation and intravenous antibiotics are the mainstay of treatment. We report three cases that were referred to our unit. These cases illustrate the difficulty in the clinical diagnosis of POVT and highlight the importance of its inclusion in the differential diagnoses of an acute abdomen in post-partum patients. POVT can be accurately diagnosed by appropriate noninvasive investigations and a laparotomy avoided.
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ranking = 0.70161573349485
keywords = thrombosis, vein thrombosis, vein
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10/92. Two cases of postpartum cardiomyopathy initially misdiagnosed for pulmonary embolism.

    PURPOSE: To underline the crucial role of urgent echocardiography in the differential diagnosis of acute respiratory and/or circulatory failure in the postpartum period. CLINICAL FEATURES: A 24-yr-old woman was admitted to the intensive care unit (ICU) with a preliminary diagnosis of pulmonary embolism (PE) one week after cesarean section. Neither computerized tomography nor Doppler sonography showed any signs of deep venous thrombosis or PE. In the ICU she required intubation and ventilatory support for acute respiratory and circulatory failure. Bedside echocardiography revealed features of left ventricular failure. A diagnosis of postpartum cardiomyopathy (PPCM) was made, appropriate treatment instituted and the patient soon improved. A 29-yr-old, previously healthy primipara presented at the Maternity Clinic on the fourth postpartum day complaining of increasing dyspnea and fatigue. Within eight hours she required intubation, ventilatory support and subsequent defibrillation due to cardiac arrest. She was transferred to the ICU with a preliminary diagnosis of PE. She developed pulmonary edema followed by cardiac arrest with successful resuscitation. Bedside echocardiography revealed a left ventricular ejection fraction below 30% with an increased systolic diameter of the left ventricle, restrictive diastolic abnormalities and no signs of pulmonary hypertension. Peripartum cardiomyopathy was diagnosed and supportive treatment for heart failure was instituted. CONCLUSION: It is possible to misdiagnose postpartum cardiomyopathy for PE. An error in diagnosis is life-threatening for the patient. echocardiography is a valuable tool in the differential diagnosis. As a noninvasive procedure, it should be performed at the bedside as soon as possible to institute proper treatment and to avoid potentially fatal errors.
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ranking = 0.12482718792443
keywords = thrombosis, venous thrombosis, deep
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