Background We present three cases of severe peripartum cardiomyopathy (PPCM) that required mechanical circulatory supports. Case presentation Case 1: A 33-year-old woman developed acute heart failure (AHF) after normal spontaneous delivery. Intra-aortic balloon pump (IABP) was inserted on postpartum day (PD) 10 with a peripartum cardiomyopathy (PPCM), which was withdrawn on PD 30 after medical treatment including anti-prolactin drugs. Case 2: A 44-year-old woman developed AHF 1 month after vaginal delivery. IABP or extra-corporeal membrane oxygenation (ECMO) was not effective and a biventricular assist device was inserted. It was withdrawn on PD 85 after improvement of left ventricular ejection fraction (LVEF). Case3: A 37-year-old woman was transferred with a diagnosis of PPCM. Cardiac function unimproved by IABP or ECMO, and a left ventricular assist device was implanted. It was withdrawn on PD 386 after recovery of LVEF. Conclusion All the cases with PPCM recovered after mechanical circulatory supports and resumed social lives.
AT, antithrombin; BUN, blood urea nitrogen; Cl, chloride; Cr, creatinine; D-bil, direct bilirubin; ESR, erythrocyte sedimentation rate; FDP, fibrinogen and fibrin degradation products; FT3, free triiodothyronine; γ-GTP, γ-glutamyl transpeptidase phosphatase; IL-6, interleukin-6; K, potassium; Na, sodium; Plt, platelet; PT, prothrombin time; PT-INR, prothrombin time-international normalized ratio; T-bil, total bilirubin; TNF-α, tumor necrosis factor-α ; TP, total protein; TSH, thyroid stimulating hormone; TSST-1, toxic shock syndrome toxin-1. A previously healthy 12-year-old boy was admitted to our hospital with distributive shock, liver failure, and non-oliguric renal failure. Initially, we suspected septic shock on the basis of laboratory studies, which showed high WBC, CRP, procalcitonin, and cytokine levels. However, echocardiography performed within 24 hr revealed decreased cardiac function, which led to the diagnosis of Kawasaki disease (KD). KD has been reported in all pediatric age groups, although 85% of patients were younger than 5 years. KD is a cytokine-associated disease, i.e., a systemic inflammatory response syndrome. The possibility of KD must be considered even when the patient's symptoms indicate distributive shock, as in this case.
Systemic mastocytosis is a life-threatening disease in which mast cell mediator release can lead to general symptoms. The most common triggers are stress and pain during labor and delivery. We report the management of labor and delivery in a case with severe systemic mastocytosis by epidural analgesia.
Materials and Methods:The PONV Intensity scale was formally translated and back-translated in accordance with available guidelines .2 To validate the translated PONV Intensity scale, an observational and cohort prospective study was conducted in a PACU. 157 adult patients were consecutively admitted and evaluated for the occurrence of PONV af ter elective surgery during three weeks. Patient pre-operative characteristics, intra-operative and postoperative data were collected. Measurements included nausea visual analogic scale (VAS) at 6 and 24 hours postoperatively. Descriptive statistics were used to present data and comparisons were made using the Mann-Whitney U-test to compare continuous variables and Chi-square or Fisher's. The correlation between PONV Intensity Scale and the nausea VAS score was made using Spearman rank correlation. Agreement was measured using interclass correlation (ICC). Results: 39 patients (23%) had PONV at 6 hours and 54 (34%) had PONV at 24 hours. 19 and 30 patients had vomiting or stretch at 6 and 24 hours respectively.36 and 54 patients experienced nausea at 6 and 24 hours respectively. Among patients with PONV, 6 patients (15%) and 9 patients (23%) had a clinically significant PONV intensity scale score at 6 and at 24 hours respectively. The median nausea visual analogic scale (VAS) scores at 6 and 24 hours were higher in patients with clinically significant PONV Intensity score (75 vs 30, p=0.022 at 6 hours and 70 versus 40, p=0.001 at 24 hours). Test-retest and inter-rater reliability were completed in 24 patients using PONV intensity scale and VAS for nausea. The reliability coef ficient was excellent for the PONV Intensity Scale [ICC 0.95 (95% CI 0.88-0.98),p< 0.001] and for VAS [ICC 0.99 (95% CI 0.97-1.00),p< 0.001]. Conclusions:The Portuguese version of the PONV Intensity Scale showed a good correlation with the original version. The PONV Intensity Scale appears to be an accurate and reliable assessment and monitoring instrument for PONV in the PACU set tings.
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