[HELLP syndrome. Hepatic subcapsular hematoma and infarction. 2 cases reports]
Rodriguez Gonzalez D. Velarde Ibarra R. Cortez Alatorre E. Hernandez Camarena R.
Unidad de Cuidados Intensivos Nuevo Hospital Civil de Guadalajara.
Two patients with HELLP syndrome are presented and hepatic subcapsular haematoma and infarction were documented. The first clinical manifestation in both cases was hypotension. A surgical pregnancy interruption was required. These patients also presented leukocytosis, renal insufficiency, severe hepatic failure and the presence of hepatic encephalopathy (grade III-IV). One patient died in spite of medical intervention with multiple organ failure. The other patient is still alive but with minor liver dysfunction.
[Appendicitis during pregnancy]
Bonfante Ramirez E. Estrada Altamirano A. Bolanos Ancona R. Juarez Garcia L. Castelazo Morales E.
Instituto Nacional de Perinatologia, Mex., D.F. Clinica de Embarazo de alto riesgo.
Acute appendicitis es the most common cause of lapparotomy during pregnancy. The differential diagnosis in the pregnant woman becomes a challenge due to the anatomic changes that take place during the maternal adjustment to pregnancy. We have done a retrospective study between january 1989 and december 1994, at Instituto Nacional de Perinatologia. We found in that period of time 35,080 deliveries reported and 4 cases of acute appendicitis during pregnancy. The maternal age was between 16 and 42 years old, 26 years in average. Three patients were in the 3 trimester at the time of diagnosis, and the most important clinical sign was found to be diffuse abdominal pain. In 3 cases diagnosis was attributed to obstetric pathology rather than appendicitis in first place. Laparotomy and appendicectomy was done to all patients, with on block hysterectomy in only one case, having this particular patient an abscess as a postquirurgical complication. Just one case reported a healthy newborn delivered at term. It is obvious that early diagnosis and quirurgical treatment are important factors for the mother and the fetus prognosis. Appendicectomy as well as cholecystectomy are the two most common causes of laparotomy during pregnancy.
[Simultaneous repair of type IV rectovaginal fistula (cloaca) and ectopic anus deformity. Presentation of a case and review of the literature]
Saborio DV. Saborio GP. Aguirre Romero F. Noriega Ibarra A.
Harlem Hospital Center, College of Physicians & Surgeons of Columbia University, USA.
A 40-year-old woman presented with a 7-year-old type IV rectovaginal fistula (cloaca) and an associated "ectopic anus" deformity. The initial step of the operation was the creation of two v-shaped full-thickness skin flaps. Subsequently, a longitudinal repair was performed. The initial elevation of the flaps facilitates the identification of muscular structures needing repair. The overlap of the flaps as a final step of the operation corrects the "ectopic anus" deformity. Critical steps of the operation are described in detail and illustrated.
[Crohns disease and pregnancy. A case report]
Gudino Molina FJ. Jinich Brook H. Montiel-Jarquin A. Rodriguez Torres LF.
Gineco-Obstetra Certificado Clinica Londres.
The name "Inflammatory Bowel Disease", of Anglo-Saxon origin, has been worked wide used in the medical language to name two nosologic entities: "Ulcerative colitis" (CU) and "Crohn's Disease" (EC). Both affect primarily young people, with approximately equal male to female ratio, although there is slight preponderance of females. In early as 90's, the development of ulcerative colitis during pregnancy had been described as potentially fatal complication, based on this observation therapeutic abortion was frequently recommended; now a days five questions in these patients with Inflammatory Bowel Disease (EII) that want to become pregnant have to be made: 1. Will the patient have more trouble getting pregnant? 2. Will the same (EC) affect the prognosis of pregnancy? 3. Will pregnancy affect the disease? 4. Which will be the treatment of the (EC) in pregnant women? 5. Will the treatment affect the fetus of the pregnancy? The authors present a case of Crohn's disease of the colon, in a patient of 24 years old with her first pregnancy. This case offered the opportunity to discuss problems and questions that took place in this kind of circumstances as mentioned earlier.