Thirty-two patients with lobar hematoma were encountered during a period of six and a half years. Of these patients, 13 had arterial hypertension, 7 had other etiologies, and the remaining 12 were without apparent etiology. In 5 of these patients, cryptic angiomas were suspected from angiograms and CT scans. In one young patient, there was a later recurrence of hemorrhage that resulted in death. Our experience in this series and a review of the literature have led us to conclude that, in young normotensive patients with lobar hematoma, surgical intervention may be a reasonable consideration so that evacuation of the hematoma may be accomplished and a detailed search for small angiomatous malformations may be carried out with a view to preventing recurrences.
Reversible posterior leukoencephalopathy syndrome (RPLS) is characterized by clinical symptoms such as seizures, visual disturbance, and altered mental status. It also presents abnormal findings on computed tomography (CT) and magnetic resonance imaging (MRI) indicating cerebral edema in the white matter of the occipital, temporal, and parietal lobes. Both the clinical symptoms and abnormal imaging findings can be reversed by controlling blood pressure or treating the underlying condition including infection. This report describes a patient with RPLS that occurred secondary to eclampsia. A 26-year-old female, gravida 0 para 0, developed weakness and pain in her upper and lower extremities and gait disturbance during the 34th week of pregnancy, and severe pregnancy-induced hypertension near the end of the 37th week. On the first day of the 38th week, she developed constricted visual fields and complained of visual illusions. MRI revealed a high-signal-intensity area in the right occipital lobe. Immediately after MRI, the patient had a 10-sec tonic convulsion. Diagnosed with eclampsia, she underwent emergency cesarean section. MRI on the 2nd postoperative day showed that the high-signal-intensity area was slightly improved. Her visual illusions were diminished by the 4th postoperative day, and almost all subjective symptoms disappeared by the 7th postoperative day. The patient was discharged at 12th postoperative day. We recommend MRI not only for symptomatic patients with suspected RPLS, but also for asymptomatic patients with severe pregnancy-induced hypertension. If findings such as cerebral edema are observed on MRI, immediate delivery should be considered before eclamptic seizures or exacerbation of neurological symptoms.
Although moderate gastrointestinal toxicity was observed, oral CPA therapy contributed to improving the survival of heavily pretreated patients with recurrent epithelial ovarian cancer. A well-designed phase II trial in this regard is awaited.
Absolute configurations of the gastric antisecretory compound P371A1 (1) and its congener P371A2 (2) from Streptomyces sp. P371 were determined on the basis of identification of the methyl glycosides 9, 10, and 11 obtained by the acid degradation of 1 and 2, as well as application of the modified Mosher method to the P371A2 C-glycoside MTPA esters 7 and 8 and observation of the excitation chiralities in the P371A2 C-glycoside benzoate derivatives 5 and 6.
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