We present a case of a 20 year old patient with twin pregnancy 25-26 weeks AOG on top of a reexisting mitral stenosis in congestive heart failure accompanied by comunity acquired pneumonia; questionable asthma and gestational diabetes mellitus. The physiologic changes associated with twin pregnancy such as increaased blood volume, cardiac output, heart rate and a decrease in systemic vascular resistance are conflicting with the requirements of mitral stenosis, thus down grading the mitral stenosis to NYHA class IVD. Anesthesia was provided with continuous lumber epidural anesthesia using isobaric bupivacaine 0.5% under vigilant and invasive monitoring. Central venous pressure was monitored and maintained to normal with judicious fluid administration and diuresis. Epidural morphine was given for postoperative pain control.
Human ; Female ; Young Adult ; PREGNANCY, TWIN ; ANESTHESIA ; MITRAL VALVE STENOSIS ; HEART FAILURE ; PREGNANCY ; PREGNANCY, HIGH-RISK

BACKGROUND: 8-92 percent of patients undergoing surgery may experience postoperative nausea and vomiting (PONV). This study was conducted to compare the efficacy of acupuncture and metoclopramide in preventing/decreasing the incidence and severity of postoperative nausea and vomiting METHODS: A Single-blinded randomized trial was conducted using 88 ASA I Filipino patients, 15-60 years of age scheduled for elective surgery under general anesthesia. Patients taking drugs with emetic or antiemetic properties or those with medical conditions associated with nausea and vomiting were excluded. Patients were divided into 4 groups. Groups I and II received acupuncture at P.6 meridian point followed by ear acupuncture while groups III and IV received metoclopramide 10mg/IV. Groups II and IV received opioids perioperatively while groups I and III did not. The medical clerk monitoring the patient was blinded as to what group the patient belonged to. The vital signs, duration and severity of postoperative nausea and vomiting were recorded until 24 hours postoperatively. Incidence and severity of postoperative nausea and vomiting in groups I, II, III and IV were recorded. RESULTS AND CONCLUSION: A total of 88 patients were enrolled in this study. Acupuncture was shown to be more effective than metoclopramide in preventing and decreasing the incidence and severity of postoperative nausea and vomiting. (Author)
Human ; Middle Aged ; Adult ; Young Adult ; ACUPUNCTURE ; POSTOPERATIVE NAUSEA AND VOMITING ; NAUSEA ; VOMITING ; SURGERY ; ANESTHESIA ; METOCLOPRAMIDE

INTRODUCTION: lgA pemphigus is a rare, chronic, relapsing, benign group of autoimmune intraepidermal blistering dermatosis with an unknown etiology. It is characterized by significantly pruritic, vesiculopustular lesions that occur mainly on the trunk and proximal extremities. Histopathologic and immunofluorescence studies show intraepidermal blisters and deposition of immunoglobulin A in the intercellular spaces of the epidermis, respectively. CASE REPORT To our knowledge, we present the first reported pediatric case of lgA pemphigus, intraepidermal neutrophilic type, in an 8-year old Filipino female with a 2-year history of generalized papules and flaccid pustules, some forming an annular pattern. Diagnosis was confirmed by histopathology and direct immunofluorescence. Enzyme-linked immunosorbent assay for Desmoglein 1 was negative. Complete clearance of lesions was achieved with dapsone, colchicine and prednisone.