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Unrecognized thrombocytopenia and regional anesthesia in parturients: A retrospective review
Citations from the Literature beginning of labour and before any analgesic. The mean temperature in the pethidine group remained constant during labour, whereas in the epidural analgesia group it showed a significant rise after only 6 hours of labour. This rise was not related to any clinical evidence of infection. Patients receiving epidural analgesia during labour are at increased risk of developing pyrexia. This pyrexia may be the result of vascular and thermoregulatory modification induced by epidural analgesia.
Cardiac output in women undergoing epidural or general anesthesia
cesarean section with
James CF; Banner T; Caton D Department of Aneathesiofogy, University of Florida College of Medicine, Gainesville, FL; USA American Journal of Obstetrics and Gynecology /160/5 (1178-1184)/1989/ Cardiac output during cesarean section and for 24 hours after delivery was estimated by using a noninvasive ultrasonic Doppler technique and was compared between term pregnant patients who underwent either epidural or general anesthesia. Cardiac output peaked by 36.7% and 26.3% of baseline values at 15 and 30 minutes after delivery, respectively, with epidural anesthesia and by 28% and 17.2%, respectively, with general anesthesia. From 60 minutes to 24 hours after delivery, cardiac output in both groups remained elevated at preoperative levels. This study demonstrates a similar pattern of increase in cardiac output with epidural and general anesthesia and a return by 60 minutes to preoperative levels, which persisted for up to 24 hours after delivery. The applicability of this noninvasive technique can be extended in various circumstances during pregnancy, labor, delivery, and the postpartum period to further define cardiac output in pregnancy.
Unrecognized thrombocytopenia and regional anesthesia parturients: A retrospective review
in
Rasmus KT; Rottman RL; Kotelko DM; Wright WC; Stone JJ; Rosenblatt RM Department of Anesthesiology, Cedars-Sinai Medical Center, Los Angeles, CA 90048; USA Obstetrics and Gynecology /73/6 (943-946)/1989/ Charts from 2,929 consecutive parturients were reviewed. Twenty-four had platelet counts less than lOO,OOO/~Lin the peripartum period. Seventeen of the 24 had predisposing causes for thrombocytopenia, including preeclampsia (nine), immune thrombocytopenia purpura (two), infection (three), placenta accreta (one), abruption (one), and excessive surgical bleeding (one). Seven and asymptomatic thrombocytopenia of unknown origin. Fourteen of the 24 thrombocytopenic patients received regional anesthesia, and none had permanent sequelae. Based upon this retrospective review, peripartal thrombocytopenia (15,000-99,000/r)) did not increase the risk of neurologic complications after a regional anesthetic. There have been no reports in the literature of spinal or epidural hematomas in parturients after regional anesthesia, except for one patient with a spinal ependymoma.
95
ONCOLOGY Prevention of ovarian cancer: A survey of the practice of prophylactic oopborectomy by fellows and members of the Royal College of Obstetricians and Gynaecologists
Jacobs I; Oram D Department of Obstetrics and Gynaecology, The London Hospital, London El IBB; United Kingdom British Journal of Obstetrics and Gynaecology /96/S (510515)/1989/ A questionnaire designed to investigate attitudes to prophylactic oophorectomy was sent to 2817 fellows and members of the Royal College of Obstetricians and Gynaecologists. A total of 1142 replies was received from those who performed regular sessions of gynaecological surgery. The number of respondents who said they would usually remove apparently normal ovaries at the time of abdominal hysterectomy from premenopausal women in age groups 35-39,40-44,45-49 and over 49 years was 4 (0.4%). 27 (Zcrlo),234 (20%) and 585 (51%) respectively, and from postmenopausal women 974 (85Oro).The majority of respondents said that (i) they would prescribe hormone replacement therapy in oophorectomized premenopausal women (82%); (ii) they did not consider unilateral oophorectomy to have a role in prevention of ovarian cancer (84’Yo);and (iii) they routinely discussed the question of prophylactic oophorectomy of with their patients before operation (65%). Only 128 (I 1070) the respondents believed that > = 10% of ovarian cancers in the UK could be prevented by prophylactic oophorectomy at the time of operation for benign disease, and 505 (44%) would perform prophylactic oophorectomy as a primary surgical procedure in women who had a strong family history of ovarian cancer.
DNA flow cytometry, clinical and morphological parameters as prognostic factors for advanced malignant and borderline ovarian tumors
Kuhn W; Kaufmann M; Feichter GE; Rummel HH; Schmid H; Heberling D Institute of Experimental Pathology, University Hospital, 69 Heidelberg; German Federal Republic Gynecologic Oncology /33/3 (360-367) /I 9891 Patients with malignant ovarian (n = 111)and borderline (n = 8) tumors (FIG0 stage Ill/IV) underwent surgery and chemotherapy and were analyzed clinically (age, residual tumor after surgery) and morphologically (type, grade, psammoma body content), and by means of flow cytometry (DNA ploidy, S-phase fraction). Follow-up was 12-72 months for investigation of survival. Patients under 60 years of age (n = 18) with malignant tumors showed longer survival than patients over 60 (n = 93) (P = 0.078). Residual tumor was relevant for prognosis in malignant tumors only if macroscopitally there was no residual disease (n = 13). There were no significant differences between residual tumors <2 cm (n = 61) and > 2 cm (n = 37). WHO typing was of little importance for survival analysis. Compared to borderline tumors (n = 8), serous (n = 65) endometrioid (n = 13), nonclassifiable (n = Inf J Gynecol Obstet 31
Cardiac output in women undergoing epidural or general anesthesia
cesarean section with
James CF; Banner T; Caton D Department of Aneathesiofogy, University of Florida College of Medicine, Gainesville, FL; USA American Journal of Obstetrics and Gynecology /160/5 (1178-1184)/1989/ Cardiac output during cesarean section and for 24 hours after delivery was estimated by using a noninvasive ultrasonic Doppler technique and was compared between term pregnant patients who underwent either epidural or general anesthesia. Cardiac output peaked by 36.7% and 26.3% of baseline values at 15 and 30 minutes after delivery, respectively, with epidural anesthesia and by 28% and 17.2%, respectively, with general anesthesia. From 60 minutes to 24 hours after delivery, cardiac output in both groups remained elevated at preoperative levels. This study demonstrates a similar pattern of increase in cardiac output with epidural and general anesthesia and a return by 60 minutes to preoperative levels, which persisted for up to 24 hours after delivery. The applicability of this noninvasive technique can be extended in various circumstances during pregnancy, labor, delivery, and the postpartum period to further define cardiac output in pregnancy.
Unrecognized thrombocytopenia and regional anesthesia parturients: A retrospective review
in
Rasmus KT; Rottman RL; Kotelko DM; Wright WC; Stone JJ; Rosenblatt RM Department of Anesthesiology, Cedars-Sinai Medical Center, Los Angeles, CA 90048; USA Obstetrics and Gynecology /73/6 (943-946)/1989/ Charts from 2,929 consecutive parturients were reviewed. Twenty-four had platelet counts less than lOO,OOO/~Lin the peripartum period. Seventeen of the 24 had predisposing causes for thrombocytopenia, including preeclampsia (nine), immune thrombocytopenia purpura (two), infection (three), placenta accreta (one), abruption (one), and excessive surgical bleeding (one). Seven and asymptomatic thrombocytopenia of unknown origin. Fourteen of the 24 thrombocytopenic patients received regional anesthesia, and none had permanent sequelae. Based upon this retrospective review, peripartal thrombocytopenia (15,000-99,000/r)) did not increase the risk of neurologic complications after a regional anesthetic. There have been no reports in the literature of spinal or epidural hematomas in parturients after regional anesthesia, except for one patient with a spinal ependymoma.
95
ONCOLOGY Prevention of ovarian cancer: A survey of the practice of prophylactic oopborectomy by fellows and members of the Royal College of Obstetricians and Gynaecologists
Jacobs I; Oram D Department of Obstetrics and Gynaecology, The London Hospital, London El IBB; United Kingdom British Journal of Obstetrics and Gynaecology /96/S (510515)/1989/ A questionnaire designed to investigate attitudes to prophylactic oophorectomy was sent to 2817 fellows and members of the Royal College of Obstetricians and Gynaecologists. A total of 1142 replies was received from those who performed regular sessions of gynaecological surgery. The number of respondents who said they would usually remove apparently normal ovaries at the time of abdominal hysterectomy from premenopausal women in age groups 35-39,40-44,45-49 and over 49 years was 4 (0.4%). 27 (Zcrlo),234 (20%) and 585 (51%) respectively, and from postmenopausal women 974 (85Oro).The majority of respondents said that (i) they would prescribe hormone replacement therapy in oophorectomized premenopausal women (82%); (ii) they did not consider unilateral oophorectomy to have a role in prevention of ovarian cancer (84’Yo);and (iii) they routinely discussed the question of prophylactic oophorectomy of with their patients before operation (65%). Only 128 (I 1070) the respondents believed that > = 10% of ovarian cancers in the UK could be prevented by prophylactic oophorectomy at the time of operation for benign disease, and 505 (44%) would perform prophylactic oophorectomy as a primary surgical procedure in women who had a strong family history of ovarian cancer.
DNA flow cytometry, clinical and morphological parameters as prognostic factors for advanced malignant and borderline ovarian tumors
Kuhn W; Kaufmann M; Feichter GE; Rummel HH; Schmid H; Heberling D Institute of Experimental Pathology, University Hospital, 69 Heidelberg; German Federal Republic Gynecologic Oncology /33/3 (360-367) /I 9891 Patients with malignant ovarian (n = 111)and borderline (n = 8) tumors (FIG0 stage Ill/IV) underwent surgery and chemotherapy and were analyzed clinically (age, residual tumor after surgery) and morphologically (type, grade, psammoma body content), and by means of flow cytometry (DNA ploidy, S-phase fraction). Follow-up was 12-72 months for investigation of survival. Patients under 60 years of age (n = 18) with malignant tumors showed longer survival than patients over 60 (n = 93) (P = 0.078). Residual tumor was relevant for prognosis in malignant tumors only if macroscopitally there was no residual disease (n = 13). There were no significant differences between residual tumors <2 cm (n = 61) and > 2 cm (n = 37). WHO typing was of little importance for survival analysis. Compared to borderline tumors (n = 8), serous (n = 65) endometrioid (n = 13), nonclassifiable (n = Inf J Gynecol Obstet 31