Genital Autoinoculation with Vaccinia: A Look at Two Cases.

Introduction: Smallpox, or vaccinia, has been eradicated worldwide as a disease; however, it may be weaponized and is thus a required immunization when military members deploy to certain parts of the world. Materials and Methods: We report two unusual cases of genital autoinoculation following smallpox vaccination. Results: Both patients' lesions resolved without sequelae within 20 d. Conclusions: We advocate for thorough education on this potential vaccination adverse event. These cases highlight the importance of a broad differential diagnosis when dealing with vulvar lesions, particularly in our military population.

A difficult airway in a patient with nephrogenic sclerosing fibrosis.

Nephrogenic sclerosing fibrosis (dermopathy) is a relatively rare complication of long-term renal dialysis. The syndrome includes marked thickening of the skin and diffuse fibrosis of fascia, muscle, heart, and lungs, leading to contractures of the joints and limbs and cardiopulmonary compromise. We present the case of a 29-year-old woman who required emergent intubation because of respiratory compromise, and who had had normal airway examinations and intubations before the onset of nephrogenic sclerosing fibrosis symptoms.

Amniotic fluid embolism.

Amniotic fluid embolism is one of the most catastrophic complications of pregnancy. First described in 1941, the condition is exceedingly rare and the exact pathophysiology is still unknown. The etiology was thought to be embolic in nature, but more recent evidence suggests an immunologic basis. Common presenting symptoms include dyspnea, nonreassuring fetal status, hypotension, seizures, and disseminated intravascular coagulation. Early recognition of amniotic fluid embolism is critical to a successful outcome. However, despite intensive resuscitation, outcomes are frequently poor for both infant and mother. Recently, aggressive and successful management of amniotic fluid embolism with recombinant factor VIIa and a ventricular assist device, inhaled nitric oxide, cardiopulmonary bypass and intraaortic balloon pump with extracorporeal membrane oxygenation have been reported and should be considered in select cases.

Laparoscopic pomeroy tubal ligation: a comparison with tubal cauterization in a teaching hospital.

OBJECTIVE: To compare laparoscopic Pomeroy tubal ligation to standard bipolar tubal cauterization for the outcome measures of failure rate, complication rate and procedure duration, with an analysis of the effect of resident experience on procedure duration. STUDY DESIGN: Retrospective study of patients presenting for interval sterilization between August 1998 and June 2000. RESULTS: The characteristics of the laparoscopic Pomeroy (n = 99) and bipolar cautery (n = 62) patients were comparable. The mean procedure duration was 40.8 +/- 14.6 minutes for laparoscopic Pomeroy and 39.6 +/- 18.8 minutes for bipolar cautery (p < 0.68). Multiple regression analysis revealed that procedure duration was a function of both months in residency (R2 = .098, p < 0.007) and number of laparoscopic Pomeroy procedures performed (R2 = .082, p < 0.01). One complication occurred with each procedure (p < 0.576). Two sterilization failures occurred after bipolar cautery and 1 after laparoscopic Pomeroy (p < 0.33). The laparoscopic Pomeroy failure occurred in the shortest tubal segment obtained, 0.7 cm, versus the average segment length, 2.07 +/- .79 cm. CONCLUSION: Laparoscopic Pomeroy did not differ from bipolar cautery for the outcome measures studied. Both time in residency and procedure-specific experience affect the duration of laparoscopic Pomeroy. A tubal segment length of 1 cm should be removed to limit sterilization failures.

Knowledge of neonatal car seat location in a predominantly disadvantaged prenatal population.

In order to assess knowledge of correct car seat location in prenatal patients of predominant lower socioeconomic status, an anonymous survey was performed at 2 inner city obstetric clinics. The survey participants (n = 688) were asked to select from among 3 drawings the correct location of a neonatal car seat. The choices showed an infant facing backward in the rear seat, forward in the rear seat, and backward in the front seat. The correct location of the car seat was selected by 61% of the participating subjects. Knowledge of correct location was related to age (p = 0.047), race (p = 0.002), and parity (p = 0.001) on univariate analysis. Education, survey site, and attendance at prenatal classes did not significantly correlate with car seat knowledge. Multiple regression analysis revealed that Caucasian race compared to African-American race predicted correct knowledge of car seat location with an Odds Ratio of 2.11 (CI 1.38-3.24). Multiparous women were more likely to know where to install a car seat relative to nulliparous women with an Odds Ratio of 1.63 (CI 1.12-2.38). Age was not significantly correlated with car seat knowledge on multivariate analysis. Knowledge of neonatal car seat location was suboptimal in our predominantly disadvantaged population, particularly in nulliparous, African-American women. Further prenatal education is needed during pregnancy or before hospital discharge to address this knowledge deficit.