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By Faye Kehler Family Physician and GP Anesthetist since 1987 interested in all aspects of Medicine
Etienne Laverse, Sarah Cader, Rajith de Silva, Sanjiv Chawda, Satish Kapoor, Olaleye Thompson
A 32-year-old woman presented with low pressure headache 3 days after delivery of her baby. An assessment of postdural puncture headache was made. This was initially treated with analgesia, caffeine, and fluids for the presumed cerebrospinal fluid (CSF) leak. The woman was readmitted two days after her hospital discharge with generalised seizures. A brain scan showed features of intracranial hypotension, and she was treated for CSF leak using an epidural blood patch. Her symptoms worsened and three days later, she developed a left homonymous quadrantanopia...
2013: Case Reports in Medicine
D Marfurt, P Lyrer, U Rüttimann, S Strebel, M C Schneider
There are many causes for headaches after childbirth. Even though postdural puncture headache (PDPH) has to be considered in a woman with a history of difficult epidural anaesthesia, pre-eclampsia should always be excluded as an important differential diagnosis. We report a case with signs of late-onset pre-eclampsia where administration of an epidural blood patch (EBP) was associated with eclampsia. A hypothetical causal relationship between the EBP and seizures was discarded on the basis of evidence presented in this report...
February 2003: British Journal of Anaesthesia
Susan C Modesitt
This month we focus on current research in endometrial hyperplasia. Dr. Modesitt discusses five recent publications, and each is concluded with a "bottom line" that is the take-home message. The complete reference for each can be found in on this page, along with direct links to the abstracts.
November 2014: Obstetrics and Gynecology
Sofiane Bendifallah, Geoffroy Canlorbe, Emilie Raimond, Delphine Hudry, Charles Coutant, Olivier Graesslin, Cyril Touboul, Florence Huguet, Annie Cortez, Emile Daraï, Marcos Ballester
OBJECTIVE: The objective of the study was to externally validate and assess the robustness of 2 nomograms designed to predict the probability of lymphatic dissemination (LD) for patients with early-stage endometrioid endometrial cancer. STUDY DESIGN: Using a prospective multicenter database, we assessed the discrimination, calibration, and clinical utility of 2 nomograms in patients with surgically treated early-stage endometrioid endometrial cancer. RESULTS: Among the 322 eligible patients identified, the overall LD rate was 9...
January 2015: American Journal of Obstetrics and Gynecology
Amir Qaseem, Linda L Humphrey, Russell Harris, Melissa Starkey, Thomas D Denberg
DESCRIPTION: The American College of Physicians (ACP) developed this guideline to present the evidence and provide clinical recommendations on the utility of screening pelvic examination for the detection of pathology in asymptomatic, nonpregnant, adult women. METHODS: This guideline is based on a systematic review of the published literature in the English language from 1946 through January 2014 identified using MEDLINE and hand-searching. Evaluated outcomes include morbidity; mortality; and harms, including overdiagnosis, overtreatment, diagnostic procedure-related harms, fear, anxiety, embarrassment, pain, and discomfort...
July 1, 2014: Annals of Internal Medicine
Amanda Tristram, Christopher N Hurt, Tracie Madden, Ned Powell, Stephen Man, Sam Hibbitts, Peter Dutton, Sadie Jones, Andrew J Nordin, Raj Naik, Alison Fiander, Gareth Griffiths
BACKGROUND: Vulval intraepithelial neoplasia is a skin disorder affecting the vulva that, if left untreated, can become cancerous. Currently, the standard treatment for patients with vulval intraepithelial neoplasia is surgery, but this approach does not guarantee cure and can be disfiguring, causing physical and psychological problems, particularly in women of reproductive age. We aimed to assess the activity, safety, and feasibility of two topical treatments--cidofovir and imiquimod--as an alternative to surgery in female patients with vulval intraepithelial neoplasia...
November 2014: Lancet Oncology
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