Case report of laparoscopic cholecystectomy in the third trimester of pregnancy

Article Abstract:

Gallstones are hard structures that may form in the gallbladder or bile duct. They can cause inflammation and distention of the gallbladder, and pain in the back and right shoulder, which usually occurs after eating and when the stomach is empty. The formation of gallstones with the development of symptoms during pregnancy is usually treated by conservative methods, such as pain-relieving drugs. If conservative treatment is ineffective, the gallbladder can be removed surgically. However, cutting of the upper midline area of the abdomen may be complicated by extreme discomfort in the final weeks of pregnancy, the formation of ventral hernias, and the need for narcotics to suppress pain from surgery. Narcotics can cause depression of lung function in the fetus, along with the mother. Cholecystectomy, the removal of the gallbladder, can also be performed during laparoscopy, a procedure in which a tube-like device with an optical system is inserted into the abdomen through a small incision. Laparoscopic cholecystectomy does not result in as much pain as extensive surgical incision. A case is described of a 27-year-old pregnant woman with gallstones at 31 weeks of pregnancy. She had pain in the upper right portion of her abdomen and experienced vomiting and nausea after eating. Conventional treatment was unsuccessful and the woman could not eat for four days. Laparoscopic cholecystectomy was performed after insertion of the laparoscope through a small cut beneath the navel. The patient was able to eat a normal diet the evening of the operation, and required only oral medication for pain. She was discharged two days after the cholecystectomy, and 10 weeks later gave birth to a healthy male infant, delivered by cesarean section. This case shows that laparoscopic cholecystectomy can be safely performed during pregnancy and is associated with rapid recovery and fewer complications compared with traditional cholecystectomy. (Consumer Summary produced by Reliance Medical Information, Inc.)

Methods, Evaluation, Gallstones, Cholecystectomy, Laparoscopy

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Acromegaly first diagnosed in pregnancy: the role of bromocriptine therapy

Article Abstract:

Acromegaly is a chronic disease usually beginning in middle age, and is characterized by elongation and enlargement of bones of the extremities, such as the arms, legs, feet and hands, and certain head bones, such as the jaw. These changes are accompanied by enlargement of the nose and lips, and thickening of the soft tissue of the face. This condition may also be associated with sleepiness, moodiness, and decreased libido. Acromegaly results from the increased secretion of growth hormone from the pituitary gland in the brain. Abnormal secretion of growth hormone is a criteria for diagnosing acromegaly. However, during pregnancy, growth hormone is less responsive to factors that stimulate its release, and this may complicate the diagnosis of acromegaly during pregnancy. A case is described of a 32-year-old pregnant woman who was diagnosed with acromegaly in the second trimester of her pregnancy. She had high blood pressure, increased foot growth, abnormal sweating, weakness and pain in the thumb muscles, and blurred vision. In addition, the patient had a coarse face, projected jaw, and sausage-shaped fingers. A tumor was detected in the pituitary that may have compressed the optic nerve to the eye, thereby causing her visual disorders. The drug bromocriptine was given to the patient, and her visual abnormalities resolved within two weeks. Bromocriptine also suppressed the release of the hormone prolactin but had no effect on growth hormone levels. These findings suggest that bromocriptine suppression of the cell overgrowth caused by excessive prolactin release may have potential as a noninvasive method for treating pituitary tumors in pregnancy. (Consumer Summary produced by Reliance Medical Information, Inc.)

Health aspects, Diagnosis, Physiological aspects, Somatotropin, Chemotherapy, Acromegaly, Pituitary gland tumors, Pituitary tumors, Bromocriptine

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Hepatic infarction during pregnancy complicated by antiphospholipid syndrome

Article Abstract:

Liver disease including antiphospholipid syndrome can make completing a pregnancy difficult. The case of a woman had a history of hepatic infarctions during her pregnancies. Hepatic infarctions are localized areas of tissue death in the liver which result from a lack of oxygen. Her three prior pregnancies complicated by symptoms such as high fevers, nausea, high blood pressure, one intrauterine fetal death and one spontaneous abortion. During her prior pregnancies, computed tomography scans had identified lesions on her liver, some of which resolved after delivery. She was admitted to the hospital during her fourth pregnancy. Placental infarcts had also been evident. Because of a high protein content in her urine, the patient was started on 10 milligrams of prednisolone per day. At 21 weeks' gestation the diagnosis of antiphospholipid syndrome was confirmed by a test for immunoglobulin G anticardiolipin antibodies. Treatment with 60 mg of aspirin per day was begun. The dose of prednisolone was increased at 26 and 32 weeks' gestation. The patient's blood pressure rose and was not able to be controlled by medication. A cesarean section was performed at 35 weeks, delivering a healthy infant.

Complications and side effects, Liver diseases, Antiphospholipid syndrome

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