[Severe congenital thoracic-lumbar scoliosis in pregnancy. A case report and review of the literature]. / Scoliosi toraco-lombare congenita grave in gravidanza. Case-report e review della letteratura.

The authors describe a case report of a patient affected by congenital thoraco-lumbar scoliosis of a severe degree, aged 32, para 0, gravida 1. She was submitted to orthopedic surgery in childhood. Cesarean section was performed at the 37th week of amenorrhoea. Pregnancy in severe defects of the spine, though becoming more and more uncommon, can still be encountered. Severe congenital scoliosis is a clinical problem; it affects not only the size and shape of the pelvis, but also sometimes results in significant maternal cardiovascular and respiratory complication. The authors, reviewing the literature, evaluate the anatomical and functional (from a biomechanical point of view) derangement of the pelvis, the problem of vaginal delivery and the clinical and radiological assessment of the problem, especially evaluating the cardio-pulmonary function. In conclusion, pregnancy in patients with severe scoliosis can be managed successfully by close monitoring especially of the respiratory function. The decision of the route of delivery is related to clinical assessment and obstetric indications.

Effects of cyclic therapy with intranasal carbocalcitonin in healthy spontaneous postmenopausal women.

Carbocalcitonin spray administered for 12 months at a daily dosage of 80 U MRC according to five schedules has been tested on 150 normal spontaneous postmenopausal women for its influence on bone mineral density (BMD), bone metabolism and osteoarticular pain. BMD was monitored before and at the end of treatment in comparison with BMD of untreated control women. Metabolic markers (serum alkaline phosphatase, serum osteocalcin and urinary hydroxyproline) were also evaluated before and during treatment (at the 9th or 10th month of treatment). Osteoarticular pain was assessed by an analogic visual scale. Intranasal carbocalcitonin, administered according to cyclic schedules at a high frequency dosage, was able to maintain bone mass only in the earlier postmenopausal women. BMD percent increase after 12 months of treatment was 1.10 and 1.31 in women with low (< 0.870 mg/cm2) and high baseline BMD (> or = 0.870 mg/cm2), respectively. In advanced menopause the maintaining effect of carbocalcitonin on BMD seemed evident only if the baseline bone mass was lower than the BMD of the age matched control group. At least six months of treatment/year is necessary for effective therapy. Both systemic and local tolerance were optimal. No significant side-effects were detected.

Cirrhosis and pregnancy. A case report and review of the literature.

A clinical case of a pregnant suffering from hepatic cirrhosis with ascites, splenomegaly and portal hypertension is described. The pregnancy carried on till the 31st week, even though with the repeated use of tocholytic agents. Cesarean section was performed because of the onset of serious jaundice and the decline of general maternal conditions. The infant, who had an Apgar score of 8 at the 1st and 5th minute, died on the 10th day because of accuse haemorrhagic interstitial pneumonitis in premature lungs and hepatopathy associated with widespread jaundice. The mother was discharged on the 25th day of the postpartum period, in light of the net improvement of her general metabolic condition, the sudden regression of the jaundice and the decrease of the cholestasis indices. A review of the literature discussing maternal complications fetal risks, management of pregnancy and delivery and outcome of the newborn are presented.