Instructive case

Abstract: Case Report A 32-year-old primagravida first presented at 13 weeks' amenorrhoea with sudden onset of lower abdominal pain. She was found to be anaemic (haemoglobin value 9.3 g/dL, haematocrit 0.27) and a pelvic ultrasound examination reported a viable intrauterine gestation of size appropriate for dates. There was also a solid-cystic mass visualized adjacent to the uterus 'probable fibroid'. The pain settled and the patient was discharged on haematinics. At 16 weeks, a routine AFP estimation was found to be elevated (288 ug/L) and an amniocentesis was performed which excluded chromosomal abnormality or neural tube defect. The patient was seen regularly thereafter at the antenatal clinic and the pregnancy progressed without incident until 37 weeks, when the patient presented with severe preeclampsia. The decision was made to induce labour. A total of 10 mg of dinoprostone vaginal gel was administered in 7 doses over 4 days, without effect. Induction of labour was consequently considered to have failed and a Caesarean section was scheduled. At operation, the patient was found to have an abdominal pregnancy on the right side, with the placenta adherent to the broad ligament, caecum and small bowel. A live female, birth-weight 2,000 g, was delivered. The placenta was partly removed and its edge oversewn. The postoperative course was complicated by worsening preeclampsia, secondary haemorrhage and lobar pneumonia. The patient required admission to intensive care, and was treated with anticonvulsants, antihypertensives, antibiotics and a significant blood transfusion. Further laparotomy was considered, but precluded by the patient's grave condition. After a stormy postoperative course, the patient was eventually discharged with her baby on day 19. The patient was followed up in the outpatients department and was found to have a hard, tender abdominal mass. This showed no change in size for over 6 months, after which time it has been observed to be steadily diminishing in size. The patient is otherwise well. The infant remained well and has been discharged from hospital surveillance.

Abstract: (2001). An Instructive Case-study Hampered by Theoretical Puzzles: Critical Comments on Flyvbjerg's Rationality and Power. International Planning Studies: Vol. 6, No. 3, pp. 263-270.

Abstract: Excerpt The occurrence of gastric syphilis has been so well established that further proof of its existence is, in our opinion, not needed.1-31The instructive case herein reported is of interest be...