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Catastrophic uterine rupture
Abstracts
Cl DISABLING
79
POSITIONAL
VERTIGO.
Jannetta PJ, Moller MB, Moller AR. N Engl .I Med 1984; 310:1700-1705. A new balance disorder is described in nine patients, aged 31 to 57 years, who experienced constant positional vertigo or dysequilibrium, causing incapacitating disability unresponsive to medical treatment. Onset of symptoms was posttraumatic in two patients and spontaneous in seven. Six patients had tinnitus on the affected side and one had sensorineural hearing loss, indicating involvement of the auditory portion of the eighth cranial nerve. Extensive clinical testing was correlated with specific pathologic abnormality of the cerebellopontine-angle portion of the vestibular nerve. It was found to be compressed by blood vessels at the time of microsurgical decompression. All patients had progressive improvement following surgery with excellent long-term prognosis. [David A. Frommer, MD]
0
CATASTROPHIC
UTERINE RUPTURE.
Plauche WC, Von Almen W, Muller R. Obstet Gynecol 1984; 64~792-797. The authors review 23 cases of major rupture of the gravid uterus occurring at Charity Hospital in New Orleans between 1975 to 1983. Sixtyone percent of these cases involved rupture of a uterus scarred by a previous cesarean section. Rupture of the intact pregnant uterus occurred in 39% of the cases, and its causes included obstetric manipulation, oxytocic drug administration, labor disorders, and external trauma. There were no maternal deaths in the series; fetal mortality was 35%. Diagnosis of rupture of the pregnant uterus prior to delivery is difficult. Fetal distress and vaginal bleeding are variably present, and pain may be masked by labor or by anesthesia. Late signs of uterine rupture include cessation of labor, fetal death, intraperitoneal hemorrhage, vaginal bleeding, and shock. Management is confined to rapid fluid and blood administration, hysterectomy, or occasionally primary surgical closure of the uterus when the uterine tear is small. [Douglas Davenport, MD] Editor’s Note: Uterine rupture is a rare but a potentially catastrophic complication of pregnancy. The diagnosis should be considered in any woman in her second or, more typically, third trimester of pregnancy who has abdominal pain and evidence of intravascular volume loss.
Emergency treatment is supportive, with prompt surgical intervention.
0 PROPHYLACTIC ORAL ACYCLOVIR IN RECURRENT GENITAL HERPES. Minde1 A, Faherty A, Hindley D, et al. Lancer 1984; 8394157-59. In this randomized double-blind study 56 patients with frequently recurring genital herpes were treated with either oral acyclovir 200 mg qid or placebo for 12 weeks. Criteria for admission into the study were at least four recurrences per year with a culture positive recurrence during the 3-month period prior to admission into the study. Ninety-six percent of the placebotreated patients as opposed to 14% of the acyclovir-treated patients had a recurrence during the 12-week treatment period (P
0 DIAGNOSIS OF CHLAMYDIA TRACHOMATIS INFECTIONS BY DIRECT IMMUNOFLUORESCENCE STAINING OF GENITAL SECRETIONS. Stamm WE, Harrison HR, Alexander ER, et al. Ann of Intern Med 1984; 101:638-641. Although Chlamydia trachomatis is more common than Neisseria gonorrhea as a source
of genital infections, few clinicians have laboratories available which offer cell culture confirmation of chlamydial infection. In this blinded study the authors compared the results of direct immunofluorescence staining of 1,396 specimens of genital secretions to results obtained by chlamydial culture. Direct immunofluorescence is a simple, quick technique involving the addition of fluorescein-conjugated monoclonal antibody to a fixed slide of genital secretions. Following a 15-minute incubation period the slide is examined for the presence or absence of Chlumydia elementary bodies using an epifluorescent microscope. When compared with chlamydial culture in 576 men, most with signs and symptoms of urethritis, the direct smear had a sensitivity of
Cl DISABLING
79
POSITIONAL
VERTIGO.
Jannetta PJ, Moller MB, Moller AR. N Engl .I Med 1984; 310:1700-1705. A new balance disorder is described in nine patients, aged 31 to 57 years, who experienced constant positional vertigo or dysequilibrium, causing incapacitating disability unresponsive to medical treatment. Onset of symptoms was posttraumatic in two patients and spontaneous in seven. Six patients had tinnitus on the affected side and one had sensorineural hearing loss, indicating involvement of the auditory portion of the eighth cranial nerve. Extensive clinical testing was correlated with specific pathologic abnormality of the cerebellopontine-angle portion of the vestibular nerve. It was found to be compressed by blood vessels at the time of microsurgical decompression. All patients had progressive improvement following surgery with excellent long-term prognosis. [David A. Frommer, MD]
0
CATASTROPHIC
UTERINE RUPTURE.
Plauche WC, Von Almen W, Muller R. Obstet Gynecol 1984; 64~792-797. The authors review 23 cases of major rupture of the gravid uterus occurring at Charity Hospital in New Orleans between 1975 to 1983. Sixtyone percent of these cases involved rupture of a uterus scarred by a previous cesarean section. Rupture of the intact pregnant uterus occurred in 39% of the cases, and its causes included obstetric manipulation, oxytocic drug administration, labor disorders, and external trauma. There were no maternal deaths in the series; fetal mortality was 35%. Diagnosis of rupture of the pregnant uterus prior to delivery is difficult. Fetal distress and vaginal bleeding are variably present, and pain may be masked by labor or by anesthesia. Late signs of uterine rupture include cessation of labor, fetal death, intraperitoneal hemorrhage, vaginal bleeding, and shock. Management is confined to rapid fluid and blood administration, hysterectomy, or occasionally primary surgical closure of the uterus when the uterine tear is small. [Douglas Davenport, MD] Editor’s Note: Uterine rupture is a rare but a potentially catastrophic complication of pregnancy. The diagnosis should be considered in any woman in her second or, more typically, third trimester of pregnancy who has abdominal pain and evidence of intravascular volume loss.
Emergency treatment is supportive, with prompt surgical intervention.
0 PROPHYLACTIC ORAL ACYCLOVIR IN RECURRENT GENITAL HERPES. Minde1 A, Faherty A, Hindley D, et al. Lancer 1984; 8394157-59. In this randomized double-blind study 56 patients with frequently recurring genital herpes were treated with either oral acyclovir 200 mg qid or placebo for 12 weeks. Criteria for admission into the study were at least four recurrences per year with a culture positive recurrence during the 3-month period prior to admission into the study. Ninety-six percent of the placebotreated patients as opposed to 14% of the acyclovir-treated patients had a recurrence during the 12-week treatment period (P
0 DIAGNOSIS OF CHLAMYDIA TRACHOMATIS INFECTIONS BY DIRECT IMMUNOFLUORESCENCE STAINING OF GENITAL SECRETIONS. Stamm WE, Harrison HR, Alexander ER, et al. Ann of Intern Med 1984; 101:638-641. Although Chlamydia trachomatis is more common than Neisseria gonorrhea as a source
of genital infections, few clinicians have laboratories available which offer cell culture confirmation of chlamydial infection. In this blinded study the authors compared the results of direct immunofluorescence staining of 1,396 specimens of genital secretions to results obtained by chlamydial culture. Direct immunofluorescence is a simple, quick technique involving the addition of fluorescein-conjugated monoclonal antibody to a fixed slide of genital secretions. Following a 15-minute incubation period the slide is examined for the presence or absence of Chlumydia elementary bodies using an epifluorescent microscope. When compared with chlamydial culture in 576 men, most with signs and symptoms of urethritis, the direct smear had a sensitivity of