Uncontrollable uterine atony after replacement of uterine inversion managed by hysterectomy: a case report.

Background:Uterine inversion may cause massive hemorrhage, resulting in maternal deterioration and death. Replacement of the inverted uterus must be performed as soon as possible. As time passes, the inverted uterus becomes atonic and necrotic, and a surgical approach may be required.Case presentation:A 27-year-old Japanese woman was admitted to our hospital 4 hours postpartum with increased hemorrhage after the replacement of an inverted uterus. Recurrent inversion was diagnosed, and though the atonic uterus was replaced again by the Johnson maneuver, hemorrhage persisted. Balloon tamponade was not successful in stopping the hemorrhage, and uterine artery embolization was performed. Bleeding resumed the next day on removal of the balloon, and hysterectomy was performed. Massive hemorrhage, coagulopathy, and uterine necrosis caused uterine atony, and the reperfused blood flow on replacement of the ischemic uterus increased hemorrhage.Conclusions:Cases of uterine inversion with coagulopathy lasting for more than 4 hours may require a surgical intervention, and uterine replacement may have to be delayed until the maternal hemodynamic condition is stabilized. Uterine replacement under laparotomy may be also be considered due to the risk of increased hemorrhage

A mixed Müllerian cystadenoma presenting as a paraurethral tumor.

•We report the first case of a paraurethral mixed Müllerian cystadenoma.•The cystic lesion was lined by a mixture of three different types of epithelium.•All epithelial cells were positive for estrogen receptor and PAX8

Three-dimensional Pseudo-continuous Arterial Spin-labeling Using Turbo-spin Echo with Pseudo-steady State Readout : A Comparison with Other Major Readout Methods

We evaluated 3D pseudo-continuous arterial spin labeling (pCASL) using turbo spin echo with a pseudo-steady-state (PSS) readout in comparison with the other major readout methods of 3D spiral and 2D echo-planar imaging (EPI). 3D-PSS produced cerebral blood flow (CBF) values well correlated to those of the 3D spiral readout. By visual evaluation, the image quality of 3D-PSS pCASL was superior to that of 2D-EPI. The 3D-PSS technique was suggested useful as pCASL readout

In Zucker Diabetic Fatty Rats, Subclinical Diabetic Neuropathy Increases In Vivo Lidocaine Block Duration But Not In Vitro Neurotoxicity

Background and Objectives: Application of local anesthetics may lead to nerve damage. Increasing evidence suggests that risk of neurotoxicity is higher in patients with diabetic peripheral neuropathy. In addition, block duration may be prolonged in neuropathy. We sought to investigate neurotoxicity in vitro and block duration in vivo in a genetic animal model of diabetes mellitus type 2. Methods: In the first experiments, neurons harvested from control Zucker diabetic fatty (ZDF) rats were exposed to acute (24 hours) or chronic (72 hours) hyperglycemia, followed by incubation with lidocaine 40 mM (approximately 1%). In a second experiment, neurons harvested from control ZDF rats, or diabetic ZDF rats, were incubated with lidocaine, with or without SB203580, an inhibitor of the p38 mitogen-activated protein kinase. Finally, we performed sciatic nerve block (lidocaine 2%, 0.2 mL) in control or diabetic ZDF rats and measured motor and nociceptive block duration. Results: In vitro, neither acute nor chronic hyperglycemia altered neurotoxic properties of lidocaine. In vitro, incubation of neurons with lidocaine resulted in a slightly decreased survival ratio when neurons were harvested from diabetic (57% +/- 19%) as compared with control (64% +/- 9%) rats. The addition of SB203580 partly reversed this enhanced neurotoxic effect and raised survival to 71% +/- 12% in diabetic neurons and 66% +/- 9% in control rats, respectively. In vivo, even though no difference was detected at baseline testing, motor block was significantly prolonged in diabetic as compared with control rats (137 +/- 16 vs 86 +/- 17 min). Conclusions: In vitro, local anesthetic neurotoxicity was more pronounced on neurons from diabetic animals, but the survival difference was small. In vivo, subclinical neuropathy leads to substantial prolongation of block duration. We conclude that early diabetic neuropathy increases block duration, whereas the observed increase in toxicity was smal

Coapplication of Lidocaine and the Permanently Charged Sodium Channel Blocker QX-314 Produces a Long-lasting Nociceptive Blockade in Rodents

Frontal view of both doors; In 1401 a competition was announced for a second set of bronze doors. The two finalists were Lorenzo Ghiberti and Filippo Brunelleschi; both entries, illustrating the Sacrifice of Isaac, are extant (Florence, Bargello). Ghiberti won the competition and was commissioned in 1403 to design doors with New Testament scenes. Installed in 1424 on the east side (later moved to the north side), these followed the scheme of the earlier doors, having twenty narratives and eight seated figures within quatrefoils. The enframing lattice is considerably richer than that of Pisano's doors, and the compositions are more closely coordinated with the quatrefoils. Source: Grove Art Online; http://www.groveart.com/ (accessed 2/10/2008