Factor VII Deficiency and Second Trimester Abortion: A Case Report.

The prevalence of factor VII deficiency (F7D) is 1 in 500,000. Due to its rarity, the management of bleeding disorders in pregnancy is not well established. We examine a case of an 18-year-old (gravida 1, para 0) woman at approximately 19 weeks gestation with a known history of F7D who presents after a motor vehicle accident. Fetal demise was confirmed necessitating a medical induction. She also had multiple fractures requiring surgical intervention. A multidisciplinary team consisting of orthopedic surgery, obstetrics and gynecology, and hematology/oncology was consulted for optimal timing of factor VII replacement prior to procedures. The patient underwent successful left tibial intramedullary nailing with minimal bleeding. She received factor VII and tolerated an uncomplicated vaginal delivery. Her postpartum and postoperative courses were uncomplicated, requiring one unit of packed red blood cells. The patient was discharged on postpartum day three. Management of this second-trimester abortion with a history of F7D was possible with effective communication and the organization of a multidisciplinary team to account for the risk of thrombosis versus hemorrhage and the availability of factor VII replacement therapy.

Ipsilateral Facial Hyperhidrosis in a Patient With Squamous Cell Carcinoma of the Lung.

While anhidrosis in Horner's Syndrome is a well-documented result of apical lung malignancies impinging on the sympathetic pathway traveling through the upper lobe of the lung, its opposite effect, hyperhidrosis, is a seldom reported consequence. Hyperhidrosis occurs as a result of irritation of the sympathetic nervous system near the superior cervical ganglion. In this report, we examine a patient with known Stage IIIB squamous cell carcinoma of the lung presenting with right hemifacial hyperhidrosis, dyspnea, and right upper extremity swelling. Computed tomography angiography (CTA) of the chest re-demonstrated the intrathoracic neoplasm encroaching on his mediastinum. During admission, the patient had his first cycle with carboplatin and paclitaxel. His hyperhidrosis, as well as dyspnea and swelling improved post-treatment, and the patient was stable for discharge to follow up outpatient with oncology and radiation oncology to continue further treatment. As hemifacial hyperhidrosis is rarely reported, it becomes important to recognize this as a likely indicator of mediastinal invasion from malignancy.