Brief Summary of Abortion

 Gynaecology, Obstetrics  Comments Off
Nov 302011
 
Abortion is the spontaneous or induced (therapeutic) expulsion of the products of conception from the uterus before 20 weeks gestation (fetal weight less than 500 g [17½2 oz]). Up to 15% of all pregnancies and about 30% of all first pregnancies end in spontaneous abortion (miscarriage). At least 75% of miscarriages occur during the first trimester.
Causes
Spontaneous abortion may result from fetal, placental, or maternal factors. (See Types of spontaneous abortion.) Fetal factors usually cause abortions before the 12th week of gestation and include:
  • defective embryologic development resulting from abnormal chromosome division (most common cause of fetal death)
  • faulty implantation of the fertilized ovum
  • failure of the endometrium to accept the fertilized ovum.
Placental factors usually cause abortion around the 14th week of gestation, when the placenta takes over the hormone production necessary to maintain the pregnancy. These factors include:
  • premature separation of the normally implanted placenta
  • abnormal placental implantation.
Maternal factors usually cause abortion during the second trimester and include:
  • maternal infection, severe malnutrition, and abnormalities of the reproductive organs (especially an incompetent cervix, in which the cervix dilates painlessly and bloodlessly in the second trimester)
  • endocrine problems, such as thyroid dysfunction or a luteal phase defect
  • trauma, including any surgery that requires manipulation of the pelvic organs
  • phospholipid antibody disorder
  • blood group incompatibility
  • drug ingestion.
The goal of therapeutic abortion is to preserve the mother’s mental or physical health in cases of rape, unplanned pregnancy, or medical conditions, such as moderate or severe cardiac dysfunction.
Signs and symptoms
Prodromal signs of spontaneous abortion include a pink discharge for several days or a scant brown discharge for several weeks before the onset of cramps and increased vaginal bleeding. For a few Continue reading »
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Toxic shock syndrome

 General Medicine, Gynaecology  Comments Off
Nov 212011
 
An acute bacterial infection, toxic shock syndrome (TSS) is caused by toxin-producing, penicillin-resistant strains of Staphylococcus aureus, such as TSS toxin-1 and staphylococcal enterotoxins B and C. The disease primarily affects menstruating women younger than age 30 and is associated with continuous use of tampons during the menstrual period.
TSS incidence peaked in the mid-1980s and has since declined, probably because of the withdrawal of high-absorbency tampons from the market.
Causes
Although tampons are clearly implicated in TSS, their exact role is uncertain. Theoretically, tampons may contribute to development of TSS by:
  • introducing S. aureus into the vagina during insertion
  • absorbing toxin from the vagina
  • traumatizing the vaginal mucosa during insertion, thus leading to infection
  • providing a favorable environment for the growth of S. aureus.

When TSS isn’t related to menstruation, it seems to be linked to S. aureus infections, such as abscesses, osteomyelitis, and postsurgical infections.
Signs and symptoms
Typically, TSS produces intense myalgias, fever over 104° F (40° C), vomiting, diarrhea, headache, decreased level of consciousness, rigors, conjunctival hyperemia, and vaginal hyperemia and discharge. Severe hypotension occurs with hypovolemic shock. Within a few hours of onset, a deep red rash develops—especially on the palms and soles—and later desquamates.
Major complications include persistent neuropsychological abnormalities, mild renal failure, rash, and cyanotic arms and legs.
Diagnosis
A diagnosis of TSS is based on clinical findings and the presence of at least three of the following:
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Introduction to Lymphomas

 General Medicine  Comments Off
Nov 192011
 
Also known as non-Hodgkin’s lymphomas and lymphosarcomas, malignant lymphomas are a heterogeneous group of malignant diseases originating in lymph glands and other lymphoid tissue. Nodular lymphomas have a better prognosis than the diffuse form of the disease, but in both, the prognosis is worse than in Hodgkin’s disease.
Causes
The cause of malignant lymphomas is unknown, although some theories suggest a viral source. Up to 35,000 new cases appear annually in the United States. Malignant lymphomas are two to three times more common in males than in females and occur in all age-groups.
Although rare in children, these lymphomas occur one to three times more often and cause twice as many deaths as Hodgkin’s disease in children under age 15. Incidence rises with age (median age is 50). Malignant lymphomas seem linked to certain races and ethnic groups, with increased incidence in whites and people of Jewish ancestry.
Signs and symptoms
Usually, the first indication of malignant lymphoma is swelling of the lymph glands, enlarged tonsils and adenoids, and painless, rubbery nodes in the cervical or supraclavicular areas. In children, these nodes are usually in the cervical region, and the disease causes dyspnea and coughing.
As the lymphoma progresses, the patient develops symptoms specific to the area involved and systemic signs and symptoms, such as fatigue, malaise, weight loss, fever, and night sweats.
Diagnosis
A positive diagnosis requires histologic evaluation of biopsied lymph nodes of tonsils, bone marrow, liver, bowel, or skin or of tissue removed during exploratory laparotomy. A biopsy differentiates malignant lymphoma from Hodgkin’s disease.
Other tests include bone and chest X-rays, lymphangiography, a liver and spleen scan, computed tomography scan of the abdomen, and excretory urography. Laboratory tests include a complete Continue reading »
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