Thrombotic thrombocytopenic purpura first seen as massive vaginal necrosis

Article Abstract:

Thrombotic thrombocytopenic purpura is a blood disorder characterized by fever, hemolytic anemia (a decrease in red blood cells due to their rupture), thrombocytopenia (a decrease in platelets, which are cells involved in blood clotting), nerve-related symptoms, and impaired kidney function. Purpura, a purplish discoloration resulting from bleeding into the skin, mucous membranes, organs, and tissues, is the initial symptom in more than 90 percent of cases of thrombotic thrombocytopenic purpura. Other symptoms include nosebleed, blood in the urine, gastrointestinal bleeding, heavy vaginal bleeding, and spitting up of blood. A case is described of a 38-year-old woman with vaginal necrosis (tissue death) as an initial sign of thrombotic thrombocytopenic purpura. The patient had fever, chills, abdominal pain, and vaginal bleeding and discharge. Laboratory tests revealed thrombocytopenia, anemia, impaired kidney function, and cocaine use. The patient was treated with blood transfusions and antibiotics. Although the uterus was enlarged, there was no evidence of bacterial infection. The patient began to vomit blood over the next two days. A pelvic examination revealed a lesions that extended throughout the vagina. Based on findings of thrombocytopenia, blood analysis, deteriorating mental function, impaired kidney function, and fever, the patient was diagnosed with thrombotic thrombocytopenia. Blood transfusions were started, but the patient died of a cardiopulmonary arrest two days after admission. Autopsy findings confirmed the diagnosis of thrombotic thrombocytopenic purpura. The patient's boyfriend had previously developed fever, blood coagulation abnormalities, and kidney failure, and died 24 hours after a cardiopulmonary arrest. In addition, the patient's mother had indicated that her daughter suspected that someone had tried to poison her. Cocaine or some contaminant in the cocaine may have triggered the development of thrombotic thrombocytopenic purpura in the patient and possibly her boyfriend. (Consumer Summary produced by Reliance Medical Information, Inc.)

Case studies, Evaluation, Causes of, Complications and side effects, Cocaine abuse, Vagina, Thrombocytopenic purpura, Blood diseases, Hematologic diseases, Poisoning, Necrosis, Vaginal bleeding

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A clinical-pathologic study of mixed muellerian tumors of the uterus over a 16-year period - The Medical College of Georgia experience

Article Abstract:

Mullerian tumors of the uterus were found to constitute 3.5 percent of all cancers of the female organs at the Medical College of Georgia. These tumors usually affect women who are over 65 and postmenopausal. About half (53 percent) of the tumors in the 40 patients studied between 1972 and 1987 were of mixed cell types, while the other half were of similar cell types. The survival rate for these patients was relatively low (32 percent) and the prognosis got worse the more the cancer was found in tissue outside of the uterus. Of the 24 patients diagnosed with stage I disease, 95 percent had distant metastases (cancer spreading to other parts of the body) and 14 patients died. Cisplatin, a chemotherapy drug, and radiation offered some minor improvement in four patients. Adjuvant radiation treatments alone did not offer improved survival rates and continuing research with combination chemotherapy with cisplatin-type drugs, both with and without radiation, is suggested. The authors also suggest that preoperative radiation treatment may in fact be detrimental to survival. (Consumer Summary produced by Reliance Medical Information, Inc.)

Physiological aspects, Cancer, Uterine cancer, Medical College of Georgia

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Gynecological surgery in octogenarians and nonagenarians

Article Abstract:

A study is conducted to analyze morbidity and mortality rates among octogenarian and nonagenarian patients who underwent operations for gynecologic indications. Successful gynecologic surgical outcomes with minimal morbidity are achievable in octogenarian patients and nonagenarian patients with optimization of co-medical conditions and careful perioperative treatment.

Science & research, Analysis, Gynecology, Operative, Gynecological surgery, Morbidity

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