Five cases of severe cardiac disease in pregnancy: outcomes and costs.

The obstetric, medical and anaesthetic management of five pregnant patients with a variety of significant cardiac problems is briefly reviewed. The duration of hospitalisation, and the use of high dependency and intensive care are documented. Financial costs are estimated and their implications for the care of such patients during and following pregnancy are discussed.

Cerebellar infarction as a cause of post-partum headache.

A 32-year-old multiparous patient requested epidural analgesia during labour. The epidural was sited, apparently without complication, but the patient proceeded to an emergency caesarean section due to fetal distress, shortly after the insertion. The severity of the fetal distress meant that surgery was necessary before the epidural could be extended sufficiently and a general anaesthetic was administered.

Refractory hypotension during caesarean section following pre-operative administration of anti-hypertensive agents.

Control of hypertension during pregnancy may require the use of more than one agent. Occasionally, the combined effect of these agents can cause acute hypotension. This report describes a patient who underwent emergency caesarean section for concealed antepartum haemorrhage but had persistent hypotension most probably due to a combination of labetalol and nifedipine given preoperatively.

Manoeuvres used to clear the airway during fibreoptic intubation.

Fibreoptic orotracheal endoscopy under general anaesthesia may be more difficult to perform if the upper airway cannot be fully cleared. We have studied the effectiveness of jaw thrust, lingual traction and the application of both manoeuvres simultaneously, in opening up the orolaryngeal airspace in 30 ASA group 1 or 2 patients aged between 16 and 70 yr undergoing elective general surgery requiring orotracheal intubation. Airway clearance was assessed fibreoptically at soft palate level by observing whether or not the uvula or soft palate was apposed to the base of the tongue, and at epiglottic level by observing whether or not the epiglottis was apposed to the posterior pharyngeal wall.

The sign of Leser-Trélat in a case of adenocarcinoma of the lung.

This is what we believe to be the first report of the sign of Leser-Trélat in association with occult adenocarcinoma of the lung. The sign of Leser-Trélat is proposed as a sign of possible occult malignancy, despite various suggestions to the contrary. Also, it is suggested that a tumor-produced humoral factor (eg, transforming growth factor-alpha [TGF-alpha]) could be responsible for both the acute eruption of the monomorphous seborrheic keratoses and the nearly concomitant development of acanthosis nigricans, which occurred in our case.