RESUMO
Seizures are a rare, but documented, consequence of accidental dural puncture and epidural blood patch. They are also the cardinal feature of eclampsia. We present a postpartum patient who suffered a tonic-clonic seizure within 1 hour of an epidural blood patch procedure for a suspected post-dural puncture headache. Investigations also revealed hypertension, proteinuria and subdural collections. This case demonstrates the diagnostic dilemma associated with postpartum headache and late postpartum eclampsia. We illustrate the importance of a thorough clinical assessment of postpartum patients presenting with headache, highlighting the possibility of more than one underlying pathological cause. We also consider the role of epidural blood patch in both precipitating, and preventing, complications of accidental dural puncture.
RESUMO
Iatrogenic injury accounts for the second most common cause of acquired diaphragmatic hernias after penetrating trauma. An increased incidence of these hernias has been observed with the widespread use of laparoscopic surgery. We present the case of a 65-year-old woman who initially underwent sigmoid resection for an adenocarcinoma and a subsequent liver resection for metastasis. She was noted to have a left lower lobe pulmonary nodule on surveillance computed tomography, for which she underwent a mini-thoracotomy for a planned resection. At the time of surgery, the pulmonary nodule was discovered to be a diaphragmatic hernia, most probably of iatrogenic origin. We discuss the difficulty in diagnosis given her history and the location of such a lesion.
Assuntos
Hérnia Diafragmática/diagnóstico , Hérnia Diafragmática/etiologia , Doença Iatrogênica , Adenocarcinoma/patologia , Adenocarcinoma/secundário , Adenocarcinoma/cirurgia , Idoso , Diagnóstico Diferencial , Feminino , Humanos , Neoplasias Hepáticas/secundário , Neoplasias Hepáticas/cirurgia , Neoplasias Pulmonares/diagnóstico , Neoplasias do Colo Sigmoide/patologia , Neoplasias do Colo Sigmoide/cirurgiaAssuntos
Síndrome da Imunodeficiência Adquirida , Infecções por HIV , Preconceito , Síndrome da Imunodeficiência Adquirida/epidemiologia , Síndrome da Imunodeficiência Adquirida/psicologia , Síndrome da Imunodeficiência Adquirida/transmissão , Atitude Frente a Saúde , Gâmbia/epidemiologia , Gâmbia/etnologia , Infecções por HIV/epidemiologia , Infecções por HIV/psicologia , Infecções por HIV/transmissão , Humanos , Masculino , Noruega/epidemiologiaRESUMO
In an acute model of skin infection with Dermatophilus congolensis in the mouse, lesions can be prevented by simultaneous application of staphylococci which produce antibiotics; non-producer staphylococci fail to inhibit lesion formation.