RESUMEN
There is controversy on the preferred mode of delivery (vaginal delivery (VD) versus caesarean section (CS)) in preterm breech delivery in relation to neonatal outcome. While CS is supposed to be safer for the fetus, arguments against CS can be the increased risk of maternal morbidity, risks for future pregnancies, and costs. Moreover, neonatal respiratory distress syndrome occurs more frequently after CS compared to VD. In the past, several RCTs have been started on this subject, but they were all preliminary and stopped due to recruitment difficulties. As the Cochrane review of these RCT's reported on 116 women only, knowledge on the effectiveness of CS and VD can at present only be obtained from non-randomized studies. We performed a systematic review and meta-analysis of non-randomized studies that assessed the association between mode of delivery and neonatal mortality in women with preterm breech presentation. We searched Pubmed, Embase and the Cochrane library for articles comparing neonatal mortality after VD versus CS in preterm breech presentation (gestational age 25(+0) till 36(+6) weeks). Seven studies, involving a total of 3557 women, met the eligibility criteria and were included in this systematic review. The weighted risk of neonatal mortality was 3.8% in the CS group and 11.5% in the VD group (pooled RR 0.63 (95% CI 0.48-0.81)). We conclude that cohort studies indicate that CS reduces neonatal mortality as compared to VD.
Asunto(s)
Presentación de Nalgas/terapia , Parto Obstétrico/métodos , Nacimiento Prematuro , Cesárea/métodos , Femenino , Humanos , Mortalidad Infantil , Recien Nacido Extremadamente Prematuro , Recién Nacido , Recien Nacido Prematuro , Embarazo , Resultado del TratamientoRESUMEN
Extensive abdominal infections with Actinomyces were diagnosed in two women aged 35 and 33 years respectively, who suffered from the nonspecific symptoms fever and abdominal pain. These infections occur more often in women with an intrauterine device. Development of an abdominal mass with ureter or bowel obstruction may cause hydronephrosis and mechanical ileus. The patients underwent a laparotomy and a double-J catheter was inserted, which could be removed later on (temporary stoma). Treatment included high-dose penicillin i.v. followed by oral amoxicillin. Both patients recovered. It may be difficult to establish this diagnosis: the first patient was diagnosed by histopathological examination, in the second Actinomyces had been found in a routine cervical smear a few years earlier.
Asunto(s)
Actinomicosis/diagnóstico , Actinomicosis/cirugía , Dispositivos Intrauterinos/efectos adversos , Dolor Abdominal/microbiología , Actinomyces/aislamiento & purificación , Actinomicosis/tratamiento farmacológico , Adulto , Diagnóstico Diferencial , Femenino , Humanos , Laparotomía , Penicilinas/uso terapéutico , Tomografía Computarizada por Rayos X , Frotis VaginalRESUMEN
In a 57-year-old woman ovarian cancer spread lymphogenically to the groin and suprapubic skin.
Asunto(s)
Linfangitis/etiología , Neoplasias Ováricas/patología , Antineoplásicos/uso terapéutico , Femenino , Ingle , Humanos , Metástasis Linfática , Persona de Mediana Edad , Neoplasias Ováricas/radioterapia , Neoplasias Ováricas/cirugíaRESUMEN
Changes in subjective sensations due to xerostomia before and after administration of Xialine, a xanthan gum-based saliva substitute, were evaluated in 30 patients with radiation-induced xerostomia using the QLQ-H&N35. Xerostomia in general decreased with both Xialine and placebo to almost the same degree. A trend was seen for Xialine to improve problems with speech and senses.