RESUMEN
BACKGROUND: Inadvertent vaginal entry is a rare intraoperative complication that may occur during cesarean deliveries performed in advanced labor or during emergency cesarean deliveries. CASE: We report two cases of inadvertent vaginal entry complicating cesarean delivre eries. The first cesarean delivery was performed after prolonged second stage of labor, complete cervical dilation, and failed trial of vacuum-assisted delivery. The second cesarean delivery was performed emergently for fetal bradycardia. In both cases unintentional vaginal entry via transverse vaginal incisions occurred. After we recognized the complication, we repaired the vaginal defect and ensured bladder integrity by retrograde filling in both cases. Both patients had uncomplicated postoperative courses and were discharged on the third postoperative day. CONCLUSION: Once accidental vaginal entry occurs, prompt recognition and repair are imperative to prevent potentially life-threatening complications.
Asunto(s)
Cesárea/efectos adversos , Complicaciones Intraoperatorias , Vagina/lesiones , Adulto , Bradicardia/complicaciones , Femenino , Enfermedades Fetales , Humanos , Complicaciones del Trabajo de Parto , Embarazo , Vagina/cirugíaRESUMEN
OBJECTIVE: This study aimed to report the case of a patient who developed an iliopsoas abscess after a dilation and evacuation for a midtrimester fetal demise. MATERIALS AND METHODS: This is a case report of a 35-year-old woman who underwent a dilation and evacuation at 17 weeks' gestation because of a preterm premature rupture of membranes and fetal demise. Four days later, she presented with fevers, chills, malaise, and right lower back, hip, and thigh pain. Magnetic resonance imaging of the abdomen and pelvis revealed a 2.3 × 1.6-cm right iliopsoas abscess. RESULTS: The patient underwent computed tomography-guided drainage of the abscess and made an uneventful recovery after completion of an antibiotic course and physical therapy. CONCLUSIONS: An iliopsoas abscess should be considered in the differential diagnosis of any woman presenting with fevers, chills, and unilateral lower back, hip, and thigh pain in a radicular pattern after a recent dilation and evacuation.
Asunto(s)
Dilatación y Legrado Uterino/efectos adversos , Rotura Prematura de Membranas Fetales/terapia , Absceso del Psoas/diagnóstico , Absceso del Psoas/patología , Adulto , Drenaje , Femenino , Humanos , Imagen por Resonancia Magnética , Pelvis/diagnóstico por imagen , Embarazo , Absceso del Psoas/etiología , Absceso del Psoas/cirugía , Radiografía Abdominal , Resultado del TratamientoRESUMEN
BACKGROUND: Trauma increases the enzyme arginase, thus depleting arginine necessary for producing nitric oxide. Arginine and omega-3 fatty acids are components in immune-enhancing diets. These diets decrease infections in surgical patients, perhaps by preventing arginine deficiency. This study examines whether omega-3 fatty acids alter the metabolic fate of arginine. Thus, we hypothesized there could be differential effects of varying prostaglandins on regulation of arginase. METHODS: Prostaglandins PGE1, PGE2, and PGE3 were tested using RAW 264.7 cells cultured in the presence of these prostaglandins for 24 hours. IL-13 (10 ng/mL) was added 24 hours later to induce arginase I. NO production was induced by adding LPS (2 microg/mL) to the cultures after another 24 hours. RESULTS: Arginase activity (nmol/min/mg) was induced by all prostaglandins but significantly more by PGE1 (466.05+/-30.25) and PGE2 (248.45+/-15.05) than PGE3 (139.87+/-19.88; p < .002) when co-cultured with IL-13. Western blots correlated the increase in arginase I expression. Nitrate levels (microM) were inversely proportional to activity with PGE3 having the highest production (3.89+/-0.19) and PGE2 and PGE1 with the lowest (2.75+/-0.49 and 1.54+/-0.19, respectively). Inhibition of arginase I using nor-hydroxyarginine increased and equalized nitrate levels. CONCLUSIONS: Different prostaglandins significantly alter the metabolism of arginine. Prostaglandins from omega-6 fatty acids increases arginase I expression. By decreasing arginase I expression, prostaglandins from omega-3 fatty acids may increase available arginine. The specific combinations of dietary fatty acids and arginine should be considered when tailoring dietary regimens.