Southern medical journal
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Southern medical journal · Jun 1990
ReviewMaternal paraparesis after epidural anesthesia and cesarean section.
Continuous epidural infusion of local anesthetics containing epinephrine has become increasingly popular. This technique has been associated with few, if any, complications. We have presented a case of anterior spinal artery syndrome with paraparesis after continuous lumbar epidural infusion of an anesthetic during labor and subsequent emergency cesarean section.
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We have presented the case of an elderly woman with severe kyphoscoliosis, osteoarthritis and left knee effusion who had symptoms and signs of intermittent intestinal obstruction. Operation showed a left-sided obturator hernia. In any elderly, debilitated, chronically ill woman, symptoms and signs of recurrent small-bowel obstruction (without a history of abdominal surgery or external hernias) and pain along the ipsilateral thigh and knee (Howship-Romberg sign) should raise suspicion for an obturator hernia. If the hernia is not palpable by physical examination, a CT scan of the pelvis and upper aspect of the thigh would confirm the diagnosis before operation and allow prompt treatment and better chance of patient survival.
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Southern medical journal · May 1990
Patterns of multiple substance abuse during pregnancy: implications for mother and fetus.
This paper describes patterns of drug use such as choice of drug, other substances abused, and route of administration in 174 women who reported methamphetamine, cocaine, heroin, or "Ts and blues" abuse during pregnancy. Seventy-five percent (130/174) reported using more than one drug. Other than tobacco, alcohol and cocaine were the drugs most frequently used in combination with other drugs (7% to 53% and 12% to 54% of the time, respectively). The extent of polydrug use observed in this study emphasizes (1) the difficulty in ascribing adverse maternal or fetal health effects to single substances, and (2) the potential for interaction effects due to multiple substance abuse.
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Rapid, extreme expansion of the extracellular fluid with solutions devoid of acid or alkali theoretically can produce a metabolic acidosis, due to buffer dilution. This phenomenon has previously been demonstrated only in experimental animal studies. We have reported what we believe to be the first documented case of hypobicarbonatemia and metabolic acidosis consequent to massive saline infusion, other causes having been excluded.