J Reprod Med
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Randomized Controlled Trial Clinical Trial
Prochlorperazine and transdermal scopolamine added to a metoclopramide antiemetic regimen. A controlled comparison.
Cisplatin-induced nausea and vomiting occurs both acutely and over a prolonged period of time. These symptoms may be incapacitating and are frequently given as a reason to discontinue therapy. We compared prochlorperazine and transdermal scopolamine when added to a standardized metoclopramide antiemetic regimen. ⋯ Among similar treatment groups no differences were seen regarding the number of emetic events, level of nausea, degree of sedation or overall acceptability of one treatment arm or another. While not superior to prochlorperazine, transdermal scopolamine is a useful antiemetic agent and can be combined with metoclopramide in an attempt to reduce cisplatin-induced nausea and vomiting. Further evaluation of this approach is needed.
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Case Reports
Group A beta-hemolytic Streptococcus as a cause of toxic shock syndrome. A case report.
Group A beta-hemolytic Streptococcus (pyogenes) has been associated recently with toxic-shock-like syndrome similar to staphylococcal toxic shock as described originally in 1978. A group A beta-hemolytic streptococcal infection occurred in a recent postpartum patient and clinically resembled staphylococcal toxic shock.
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A pregnant woman sustained an abdominal gunshot wound during the second trimester; the bullet injured multiple loops of bowel and passed through the uterus, placenta and fetus. Although the stillborn fetus was delivered by cesarean section, a review of the literature indicated that operative delivery is not indicated when the fetus has died already. Labor and delivery are well tolerated, and an unnecessary hysterotomy is thus avoided. ⋯ Approximately 40% of fetuses will survive the initial injury. In past reviews the risk of prematurity often outweighed the benefits of delivery of those infants. Advances in neonatology now make survival routine after 28 weeks' gestation, and viable fetuses should be delivered promptly by cesarean section to decrease the risk of delayed death from fetal or placental injury.
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Halothane depresses uterine contractility and may increase cesarean blood loss during the use of general anesthesia. We retrospectively compared the medical records of 399 elective repeat cesarean section patients. We excluded medical and obstetric conditions that may predispose such patients to increased blood loss. ⋯ No patient received a blood transfusion. The incidence of low postoperative hematocrits (less than 32%) following surgery was similar with all the anesthetic methods. Low-dose halothane supplementation of general anesthesia for elective cesarean section did not increase blood loss.
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Salpingostomy is the preferred surgical method of managing ectopic gestation when patients desire future fertility. Problems with that technique stem principally from difficulties with hemostasis. While ligation of a single mesosalpingeal vessel has been described, blood to the site of the ectopic gestation is supplied primarily by the tubal branch of the ovarian artery. ⋯ Salpingostomy is thus possible, even in cases of large, actively bleeding or ruptured ectopic gestations. The need for partial salpingectomy, frequently utilized under those circumstances, is thus obviated. Salpingostomy may result in spontaneous recanalization; if anastomosis is needed subsequently, maximal tubal length is preserved.