Toksyczna nekroliza naskórka wikłająca antybiotykoterapię połogowego zapalenia endometrium: opis przypadku

The aim of the study is to describe a case report of Lyell syndrome (toxic epidermal necrolysis) involving 63% of body surface which has been associated with antibiotic therapy of mild peurperal endometritis in woman 3 weeks postpartum. Lyell syndrome is a severe life-threatening condition developing due to idiosyncrazy (alergic reaction type IV), most commonly after administration of drugs. Incidence quoted in literature is around 1:1-2000000. Illness severity can be assessed using a SCORTEN scoring system, which predicts patient mortality based on seven independent factors. Lyell syndrome is a very rare but potentially lethal complication of antibiotic treatment.Celem pracy jest opis przypadku zespołu Lyell’a (toksyczna nekroliza naskórka) obejmująca 63% powierzchni ciała, który był związany z antybiotykoterapią łagodnego zapalenia endometrium u kobiety 3 tygodnie po porodzie. Zespół Lyell’a jest ciężkim zagrażającym życiu stanem wywołanym idiosynkrazją (reakcja alergiczna typu IV), najczęściej po podaniu leków. Częstość występowania szacowana jest na około 1:1-2000000. Ciężkość choroby może być określona przy pomocy systemu punktowego SCORTEN, który przewiduje ryzyko zgonu pacjenta w oparciu o siedem niezależnych czynników. Zespół Lyell’a jest bardzo rzadkim ale potencjalnie śmiertelnym powikłaniem antybiotykoterapii

Vacuum-assisted vaginal delivery and levator ani avulsion in primiparous women

Objective: We compared the incidence and type of levator ani avulsion diagnosed by translabial ultrasound evaluation in primiparous women six months after vacuum-assisted or spontaneous vaginal delivery. Material and methods: This retrospective observational study was performed between January 2011 and December 2013. Primiparous women six months after vacuum-assisted vaginal delivery and after spontaneous vaginal delivery underwent translabial ultrasound evaluation. The distance between the urethra and fibers of the musculus levator ani puborectalis (levator–urethra gap) was measured. A levator-urethra gap >25 mm was considered a musculus levator ani avulsion. Results: In total, 184 women participated in the study. Among them, 92 had vacuum extraction and 92 had uncomplicated spontaneous delivery. A longer levator–urethra gap on both sides of the pubic bone was found in women after vacuum-assisted vaginal delivery (p < 0.0001 for both sides). Musculus levator ani avulsion was identified in 20 women (unilateral in 16 cases and bilateral in four cases). No difference in an incidence of musculus levator ani avulsion was identified in women after vacuum-assisted vaginal delivery [11/92 (12%)] compared to spontaneous delivery [9/92 (10%); p = 0.81]. Conclusion: Vacuum-assisted vaginal delivery in primiparous women is associated with a longer levator–urethra gap but not with a higher frequency of avulsion of the musculus levator ani.Web of Science29162718271