The HELLP syndrome: Clinical issues and management. A Review

<p>Abstract</p> <p>Background</p> <p>The HELLP syndrome is a serious complication in pregnancy characterized by haemolysis, elevated liver enzymes and low platelet count occurring in 0.5 to 0.9% of all pregnancies and in 10–20% of cases with severe preeclampsia. The present review highlights occurrence, diagnosis, complications, surveillance, corticosteroid treatment, mode of delivery and risk of recurrence.</p> <p>Methods</p> <p>Clinical reports and reviews published between 2000 and 2008 were screened using Pub Med and Cochrane databases.</p> <p>Results and conclusion</p> <p>About 70% of the cases develop before delivery, the majority between the 27th and 37th gestational weeks; the remainder within 48 hours after delivery. The HELLP syndrome may be complete or incomplete. In the Tennessee Classification System diagnostic criteria for HELLP are haemolysis with increased LDH (> 600 U/L), AST (≥ 70 U/L), and platelets < 100·10⁹/L. The Mississippi Triple-class HELLP System further classifies the disorder by the nadir platelet counts. The syndrome is a progressive condition and serious complications are frequent. Conservative treatment (≥ 48 hours) is controversial but may be considered in selected cases < 34 weeks' gestation. Delivery is indicated if the HELLP syndrome occurs after the 34th gestational week or the foetal and/or maternal conditions deteriorate. Vaginal delivery is preferable. If the cervix is unfavourable, it is reasonable to induce cervical ripening and then labour. In gestational ages between 24 and 34 weeks most authors prefer a single course of corticosteroid therapy for foetal lung maturation, either 2 doses of 12 mg betamethasone 24 hours apart or 6 mg or dexamethasone 12 hours apart before delivery. Standard corticosteroid treatment is, however, of uncertain clinical value in the maternal HELLP syndrome. High-dose treatment and repeated doses should be avoided for fear of long-term adverse effects on the foetal brain. Before 34 weeks' gestation, delivery should be performed if the maternal condition worsens or signs of intrauterine foetal distress occur. Blood pressure should be kept below 155/105 mmHg. Close surveillance of the mother should be continued for at least 48 hours after delivery.</p

Obstructive sleep apnea secondary to cervical spine chordoma

We present a rare case of obstructive sleep apnea (OSA) secondary to chordoma involving cervical spine with confirmative histopathological diagnosis following the suggestive findings of computed tomography and magnetic resonance imaging. The patient underwent en bloc removal of the tumour involving the vertebral body of C4 with preservation of the nerve roots and vertebral arteries involved, associated with postoperative radiation therapy. Clinicians should be aware that this is a very rare secondary cause of OSA caused by chordoma involving the spine and imaging of the cervical spine may be necessary to avoid incorrect treatment approaches such as CPAP or BiPAP machine in such cases. Keywords: Chordoma, Radiotherapy, Surgery, Tumou

Effects of counseling on some care outcomes among patients with brain tumour: Pain, seizure, constipation, infection, dispatch conditions [Danişmanlik veri·len beyi·n tümörlü hastalarin bazi bakim sonuçlari: Agri, epi·lepti·k nöbet, konsti·pasyon, i·nfeksi·yon, sevk durumlari]

• Objective: The aim of this study was to determine effects of training on some care outcomes among patients with brain tumour. • Material and Method: There were 45 patients in both Group I and Group II (total, 90 people). Group I received training on a one-to-one basis and were given information .Group II were given a booklet for training. All patients were observed before operations and one, three and six months after operations. Data were collected with sociodemographic features, Pre-/Post-operative Symptom Diagnosis and Intervention Form. Data between two groups were tested Chi-squared test, variance analysis for repeated measurements, Cochran's Q. • Results: There was a significant difference among headache, infection, constipation (p0.05). Patients found to have such symptoms as being overweight, iron deficiency anemia, increased blood sugar levels, increased blood pressure, respiratory distress, neurological symptoms of difficulty in swallowing, alterations in consciousness, dizziness and loss of balance edema, wound infections, fear of brain tumours, sleeplessness, restlessness, lack of satisfaction with life and itching and increased SGPT due to the antiepileptic drug phenytoin sodium were referred to specialists during the follow-up. Patients have got anxiety, depression with physical symptoms. They give information about sexuality, alternative treatment, follow-up visits, fears. • Conclusion: This study was determined physical, psychological symptoms of patients with brain tumour . Care outcomes were significantly better in Group I than in Group II

Demonstrated rapid growth of a corpus callosum cavernous angioma within a short period of time

Cavernous angiomas are uncommon central nervous system vascular malformations. They occur in the corpus callosum very rarely. In this study we report a case of corpus callosum cavernous angioma which demonstrated rapid growth within a short period of time. Corpus callosum cavernous angiomas have distinct features regarding growth and should be treated more carefully by giving more importance to surgical removal rather than a conservative approach

Meningioma presented as subarachnoid haemorrhage: case report.

A case of parasagittal meningioma causing subarachnoidal haemorrhage (SAH) is reported. Computed tomography (CT) was found negative in the patient with acute severe headache and haemorrhage was observed on cerebrospinal fluid (CSF) examination. Digital subtraction angiography (DSA) showed an avascular space over the convexity and Magnetic resonance imaging (MRI) revealed the tumour. The importance of MRI for the detection of underlying pathology in SAH with unknown aetiology is emphasised

Surgical treatment of sacral perineural cysts. A case report.

Most of the perineural cysts (Tarlov's cysts) are asymptomatic. They are usually diagnosed incidentally, and a specific treatment is not necessary. They should be operated on, only if they produce progressive or disabling symptoms and/or sign clearly attributable to them. Several reports have been made regarding their sign and symptom, neurological and radiological features. This is a report emphasizing on their surgical indication and surgical treatment. We reported a 48 year-old woman who underwent surgery because of the symptomatic perineural cyst. It is concluded that the total excision of the perineural cyst is not necessary and a partial resection with a resultant reduction in the cyst size results in a favourable outcome

Ruptured distal middle cerebral artery aneurysm: Case report

INTRODUCTION This report describes a rare case of a distal middle cerebral artery (dMCA) aneurysm. PRESENTATION OF CASE That developed a right intracerebral haematoma and subarachnoid haemorrhage. It was treated by surgical exploration and clipping via pterional approach. DISCUSSION Clinical findings and surgical approaches of dMCA aneurysm are different from proximal middle cerebral artery (MCA) aneurysms. Microneurosurgical clipping is the most effective treatment of dMCA aneurysm. CONCLUSION We comprehensively review the literature related to these rare aneurysms within the temporal lobe, surgical anatomy of the dMCA aneurysm. © 2013 The Authors

Biomechanics of unilateral compared with bilateral lumbar pedicle screw fixation for stabilization of unilateral vertebral disease: Laboratory investigation

Object. An in vitro flexibility experiment was performed to compare the biomechanical stability of asymmetrical lumbar pedicle screw fixation (longer hardware attached ipsilaterally to a 1-sided lesion), short and long fixation, and fixation with and without interconnection to the involved vertebra. Methods. Seven human cadaveric specimens (T12-S1) were studied intact; after simulated unilateral lesions were created at L2-3 and L3-4, the segments were stabilized by 1) L2-4 unilateral fixation (L-3 excluded), 2) L2-4 bilateral fixation (L-3 included contralaterally), 3) L2-5 unilateral fixation (L-3 excluded), 4) L2-5 fixation ipsilateral (L-3 excluded) and L2-4 fixation contralateral (L-3 included), 5) L2-5 bilateral fixation (L-3 included contralaterally), and 6) L2-5 bilateral fixation (L-3 excluded). The testing order varied among specimens. Angular range of motion (ROM) and lax zone were recorded optically while loading to 6.0 Nm was created with nonconstraining pure moments. Results. Unilateral short fixation provided significantly worse stabilization than any other construct tested in all loading modes (p \u3c 0.05, repeated-measures analysis of variance). There was a mean 56% reduction in ROM across the lesion after adding 1 additional level rostrally and caudally. Asymmetrical long/short stabilization provided similar stability to symmetrical long stabilization. Minimal additional stability was gained by including L-3 in the long bilateral fixation construct. Conclusions. Unilateral fixation is inadequate for stabilizing a 2-level unilateral lesion. Bilateral fixation, whether symmetrical or asymmetrical, provides good stabilization for this injury. It is not important for stability to include the level of the lesion within the long construct contralaterally