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Antineoplastic Drugs during Pregnancy
Published in “Bert” Bertis Britt Little, Drugs and Pregnancy, 2022
Approximately 40 percent of lymphoma malignancies are the Hodgkin’s type, and are the most frequently encountered lymphoma among pregnant women. The incidence is estimated to be one in 6,000 pregnancies. Non-Hodgkin’s lymphoma is “very rare” in pregnancy (Lishner et al., 2016). Similar to breast carcinoma, pregnancy apparently does not change the prognosis for Hodgkin’s disease (Lishner et al., 2016). Leukemias and lymphomas can metastasize to the placenta, but the actual risk is unknown. Hodgkin’s lymphoma management during pregnancy depends on the disease stage and gestational age at which the disease is diagnosed, as with most other malignancies (Table 7.5). Staging is of utmost importance. Pregnancy may confound or limit types of diagnostic studies that can be safely performed. The majority of diagnostic procedures not involving the abdomen or fetus can be performed safely, if necessary, with minimal risk to the conceptus. Importantly, a single abdominal X-ray and computed tomography (CT) scan usually expose the fetus to less than 1 rad of actual radiation. An alternative to ionizing radiation is magnetic resonance imaging (MRI), and it may be useful in early to mid-pregnancy. Laparotomy lymphoma staging is somewhat controversial and difficult, if not impossible, to accomplish in the latter half of pregnancy because the large uterus obstructs the operating field (Bloss and Miller, 1995).
Case 15
Published in Andrew Solomon, Julia Anstey, Liora Wittner, Priti Dutta, Clinical Cases, 2021
Andrew Solomon, Julia Anstey, Liora Wittner, Priti Dutta
InvestigationsBlood tests to include: full blood count, urea and electrolytes, liver function tests, coagulation screen, group and save, blood culturesStool culturesAbdominal X-ray and erect chest X-ray
Malrotation
Published in Mark Davenport, James D. Geiger, Nigel J. Hall, Steven S. Rothenberg, Operative Pediatric Surgery, 2020
Simon Blackburn, Joseph I. Curry, Bhanumathi Lakshminarayanan
The features suggestive of a volvulus on the plain abdominal radiograph are an air-filled stomach and a paucity of gas in the rest of the intestine (Figure 35.1). The abdominal X-ray may, however, be normal. In the infant presenting in shock with features of acute strangulating obstruction, further radiologic investigations only delay definitive treatment.
Air under the diaphragm—perforation or Chilaiditi sign?
Published in Baylor University Medical Center Proceedings, 2022
Shobha Mandal, Sneha Singh, Barun Kumar Ray, Rahul Kumar Thakur, Anish Kumar Shah, Victor Kolade
Management depends on presentation. Patients with radiographic evidence of Chilaiditi sign without any symptoms do not require any further treatment. In symptomatic patients, an immediate meticulous abdominal examination is needed to rule out acute abdomen requiring surgical intervention. Initial management of patients includes conservative management like bowel rest, intravenous fluid, nausea, and pain control. An abdominal x-ray should be performed to look for signs of perforation. A CT scan of the abdomen can better visualize these signs in stable patients.11–13 For diagnosis, the patient must have the following findings on the abdominal x-ray or CT scan (erect position: abdomen): distended bowel, a depressed superior margin of the liver below the level of the left hemidiaphragm, and elevation of the right hemidiaphragm above the liver by the intestine in between.14 As it can easily be misdiagnosed as bowel perforation, patients are at high risk of unwarranted surgical interventions.1,13,15
The subway tunneling technique for distal shunt catheter insertion
Published in British Journal of Neurosurgery, 2020
Giuseppe R. Giammalva, Nello Grassi, Enrico Lo Bue, Lara Brunasso, Rosario Maugeri, Domenico G. Iacopino, Francesca Graziano
We read with interest the article by Osman et al. titled ‘Trocar assisted distal shunt tube insertion with intra-operative X-Ray confirmation’. The authors purpose their technique to place the peritoneal catheter during ventriculoperitoneal shunt (VPS) surgery1 as an alternative to laparoscopy and laparotomy. The trocar is inserted at the inverse McBurney point, after a small skin incision, and then it is directed at a 45° angle (to avoid the retroperitoneal vascular structures), until an abrupt feeling of release and a ‘pop’ sound indicate that the peritoneum is pierced. Then, they perform an intra-operative abdominal X-ray to confirm the positioning of a catheter. They report 58 patients having this surgical technique. There were six complications: 2 patients had shunt infection (3.4%), 2 patients had shunt obstruction (3.4%), 1 patient had bowel injury (1.7%) and 1 had disconnection (1.7%).1
Formulation, optimization, and evaluation of raft-forming formulations containing Nizatidine
Published in Drug Development and Industrial Pharmacy, 2019
Manal K. M. Darwish, Amal S. M. Abu El-Enin, Kamilia H. A. Mohammed
Six healthy volunteers participated in the study. All subjects were given their written consent for their participation in the study after having been informed of all aspects of the study. The study was approved by the ethical committee of Zi- diligence Research Laboratory, Cairo, Egypt. The study was conducted by administering two chewable tablets (equivalent to 150 mg) of Nizatidine to each subject in one session and was conducted in the fed state [31]. After overnight fasting, the volunteers were fed with a low-calorie food. Half an hour later, a BaSO4- loaded Nizatidine chewable tablets were administered orally to each volunteer. At different time intervals (0, 0.5, 1, 2, and 3 h post administration of tablet), in a standing position, the volunteers were exposed to abdominal X-ray imaging under the supervision of an expert radiologist. The source of X-rays and the subject was kept constant for all images. Thus the observations of the raft formation and movements could be easily noticed. The time elapsed before raft formation and the mean gastric residence time of raft were determined [32].