The role of antepartum transabdominal amnioinfusion in the management of oligohydramnios in pregnancy.

OBJECTIVE: The purpose of this study was to evaluate the role of transabdominal amnioinfusion in the management of oligohydramnios with the view to improving pregnancy outcome. METHODS: The study consisted of a retrospective analysis of 17 pregnant women presenting with oligohydramnios who were treated with amnioinfusion during pregnancy in a period from 2003 to 2006. RESULTS: The mean gestational age at first treatment was 24 weeks. The mean pre-procedure deepest pool of amniotic fluid was 1.8 cm and post-procedure was 3.8 cm. The mean number of infusions was 1.05. The mean first infusion to delivery interval was 31 days. Perinatal mortality was 88% and neonatal mortality was 35%, with only one baby surviving the neonatal period. There were three cases of chorioamnionitis, with one of these cases presenting with premature rupture of the membranes at the time of amnioinfusion. CONCLUSIONS: Transabdominal amnioinfusion is a useful procedure to reduce complications that result from oligohydramnios. Although the results show a high perinatal mortality, it must be borne in mind that most of these pregnancies had multiple fetal abnormalities with an already predicted poor outcome. Importantly, as this procedure increases the latency period, it may be useful in preterm pregnancies where prolonging the duration of the pregnancy may result in better perinatal outcome by improving important factors that influence survival including increased birthweight.

Upfront intraperitoneal chemotherapy for patients with epithelial ovarian cancer: long-term follow-up of a previously published trial.

OBJECTIVE: To update previously published work on the long-term survivorship of patients with surgically debulked epithelial ovarian cancer who were treated with intraperitoneal cisplatin-based chemotherapy after initial debulking surgery during the pretaxane era. METHODS: The records of 15 ovarian cancer patients treated with i.p. cisplatin (CDDP) and either i.v. doxorubicin or i.v. cyclophosphamide from 1985-1993 were reviewed. Data on long-term survivorship, toxicity and ultimate cause of death were updated. RESULTS: Recurrence-free survival rates for all subjects were 67% at two years, 47% at five years and 40% at 10 years. Five of the 15 (33%) original patients are alive with no evidence of disease (NED) at 180, 183, 205, 228 and 228 months respectively with a median of 205 months since last treatment. Toxicity was present yet posed no long-term threat. CONCLUSION: As presented in the original paper, i.p. chemotherapy can be safely utilized in a community hospital setting. Long-term survival is possible even with suboptimal regimens of chemotherapy as compared with today's standard treatments.

An unusual suicide with parenteral copper sulphate poisoning: a case report.

A 22-year-old unmarried, male painter was found by neighbouring shopkeepers to be rolling on the ground inside his shop due to severe abdominal pain. The man had tried to commit suicide by intravenously injecting a solution of copper sulphate, used as an antifouling agent in paints. He was taken to the local hospital with severe epigastric pain, vomiting and diarrhoea. His condition worsened after three days and he was transferred to the All India Institute of Medical Sciences, New Delhi, but the victim died on his way to the hospital. His relatives and neighbours confirmed that he had recently been suffering from depression.

Morbidity and mortality associated with intraperitoneal chemotherapy for Pseudomyxoma peritonei.

BACKGROUND: Many centers include intraperitoneal chemotherapy for treatment of pseudomyxoma peritonei. This study documented the morbidity of intraperitoneal chemotherapy in a single institution. METHODS: A retrospective review of pseudomyxoma peritonei over a 6-year period was undertaken. Treatment, morbidity, and outcome were documented. RESULTS: Eleven patients were identified with an average of 1.9 debulking procedures and 0.8 chemotherapy courses (0.3 complete). Intraperitoneal chemotherapy was not completed in 5 patients because of complications (56%): severe abdominal pain, seizure, neutropenia, and thrombocytopenia (the latter resulted in 1 patient's death). There was no association between incomplete chemotherapy and recurrence. Recurrence was 64% in those without chemotherapy and 44% in those with. Follow-up averaged 26 months and actual 3-year survival was 60%. CONCLUSIONS: Intraperitoneal chemotherapeutic morbidity and mortality were 56% and 11%, respectively. Chemotherapy was associated with decreased recurrence. To optimize outcomes, multicenter prospective trials will likely be required to further refine intraperitoneal chemotherapy protocols.

[Transfusion- and infusion-related iatrogenesis]. / Transfuzionno-infuzionnye iatrogenii.

Posttransfusion and postinfusion side effects and complications resulting occasionally in lethal outcomes are still available in clinical practice in spite of apparent safety and high efficiency of blood transfusions and infusions. These may be caused by the donor-recipient erythrocytic incompatibility, poor quality of the transfusion medium, disregard of contraindications to transfusion. Pathologic features of complications emerging in response to transfusion of incompatible blood or its substitutes are indicated as well as morphologic characteristics specific for posttransfusion shock and consequent acute hepatorenal insufficiency. For the substitutes there are occasional observations of the shock similar in its development to an anaphylactic one. Wide introduction of transfusion and infusion therapy into clinical practice dictates the necessity of adequate evaluation of the above therapy role in combined treatment of varying-type patients, in thanatogenesis basing on the initial patient status and previous treatment.

[Infusion therapy complications in newborn and nursing infants]. / Oslozhneniia infuzionnoi terapii u novorozhdennykh i detei grudnogo vozrasta.

The case histories of 306 babies dying at the age under 6 months were analysed. All the babies were given medicinal and nutrient solutions mainly via the subclavical veins for different diseases. In the process of the infusion therapy complications were observed which were distributed into 5 groups: 1--traumatic injuries, 2--air embolism, 3--thrombosis, 4--diffuse hyalin thrombi predominantly in the lung vessels, 5--acute renal insufficiency (ARI). Formation of the hyalin thrombi appeared to be due to the damaging effect of the administered solutions on the vascular endothelium and changes in the properties of erythrocytes and blood plasma. In the development of ARI some importance is ascribed to infusion overloading of the structurally and functionally immature kidneys of young infants.