Intramural implantation is among the rarest forms of ectopic pregnancy.Since the first description by Perli, 21 cases were reported in worldwide literatures.The pathologic criteria required for intramural pregnancy is that the product of conception is completely surrounded by uterine musculature and is separated from the uterine cavity and the fallopian tube or round ligament.The previous history of uterine injury or adenomyosis is known as possible etiology of intramural implantation. Because the early diagnosis is very difficult, most cases is found after onset of complication such as a uterine rupture or hemoperitoneum. We have recently experienced a case of intramural pregnancy diagnosed and treated by laparoscopy in a 9 weeks gestation nulliparous woman without previous history of uterine injury or disease, and report with a brief review of literatures.
Adenomyosis ; Early Diagnosis ; Fallopian Tubes ; Female ; Fertilization ; Hemoperitoneum ; Humans ; Laparoscopy ; Pregnancy ; Pregnancy, Ectopic ; Uterine Rupture ; Round Ligaments

Airway management for patients who have suffered multiple facial fractures and skull base fractures is complicated. Nasal intubation can interfere with centralization and stabilization of nasal fractures and may lead to cranial intubation. Restoring the dental occlusion by means of intraoperative maxillo- mandibular fixation is a prerequisite to the corrrect anatomical reduction of multiple facial fractures. This fixation precludes oral endotracheal intubation. In the past, it has been overcome by a tracheostomy. Complications of a tracheostomy include infection, hemorrhage, subcutaneous emphysema, pneumothorax, pneumomediastinum, recurrent laryngeal nerve damage, tracheal stenosis, and tracheoesophageal fistula. The technique of submental intubation was originally described by Altemir. This technique provide secure airway, an unobstructed intraoral airway field. and allows maxillomandibular fixation while avoiding the drawbacks and complications of naso-endotracheal intubation or tracheostomy. With this technique, the multiple facial fractures were corrected successfully.
Airway Management ; Dental Occlusion ; Hemorrhage ; Humans ; Intubation* ; Intubation, Intratracheal ; Jaw Fixation Techniques ; Mediastinal Emphysema ; Pneumothorax ; Recurrent Laryngeal Nerve ; Skull Base ; Subcutaneous Emphysema ; Surgery, Oral* ; Tracheal Stenosis ; Tracheoesophageal Fistula ; Tracheostomy

Mitochondrial diseases are classified into the three major categories, defects of fatty acid oxidation, defects of pyruvate metabolism, and defects of the respiratory chain, and all of these cause severe neurologic dysfunction in the newborn period. Defects of the mitochondrial respiratory chain present as recurrent apnea, seizures, congenital lactic acidosis, hypotonia, hepatic dysfunction and hypertrophic cardiomyopathy in the neonatal period. Laboratory findings of hyperlactataemia(>2.5mM), elevated lactate/pyruvate(L/P) ratio(>20) and ketone body ratio(>2) suggest the diagnosis of mitochondrial respiratory chain defects. We report a case of mitochondrial respiratory chain defect diagnosed in the neonatal period presenting with multiorgan failure consisting of severe metabolic acidosis, comatous mental state, respiratory distress, hepatic dysfunction, renal failure with lactic acidosis(24mM), increased L/P ratois (55.6) and ketonuria (increased ratio of 3-hydroxybutyrate/acetoacetate).
Acidosis ; Acidosis, Lactic ; Apnea ; Cardiomyopathy, Hypertrophic ; Diagnosis ; Electron Transport* ; Humans ; Infant, Newborn ; Ketosis ; Metabolism ; Mitochondrial Diseases ; Muscle Hypotonia ; Neurologic Manifestations ; Pyruvic Acid ; Renal Insufficiency ; Seizures

Passive smoking is a major cause of respiratory morbidity, and is associated with increased bronchial responsiveness in children. To evaluate the effect of smoking by a parent on asthma symptoms, atopy, and airway hyperresponsiveness (AHR), we conducted a cross-sectional survey of 503 schoolchildren that involved questionnaires, spirometry, allergy testing, and a bronchial challenge test. If the PC20 methacholine was less than 16 mg/mL, the subject was considered to have AHR. The prevalence of a parent who smoked was 68.7%. The prevalence of AHR was 45.0%. The sensitization rate to common inhalant allergens was 32.6%. Nasal symptoms such as rhinorrhea, sneezing, nasal itching, and nasal obstruction were present in 42.7%. Asthma symptoms such as cough and wheezing were present in 55.4%. The asthma symptoms were significantly more prevalent in children who had a parent who smoked than in those whose parents did not. The nasal symptoms, atopy, and AHR did not differ according to whether a parent smoked. In a multiple logistic regression model, the asthma symptoms and atopy were independently associated with AHR, when adjusted for confounding variables. Passive smoking contributed to asthma symptoms in schoolchildren and was not an independent risk factor of airway hyperresponsiveness in an epidemiological survey.
Adult ; Asthma/*epidemiology/physiopathology ; Bronchial Hyperreactivity/*epidemiology/physiopathology ; Child ; Data Collection ; Female ; Human ; Hypersensitivity/*epidemiology/physiopathology ; Male ; Parents ; Prevalence ; Risk Factors ; Support, Non-U.S. Gov't ; Tobacco Smoke Pollution/*adverse effects/*statistics & numerical data