Inpatient rehabilitation outcomes for patients receiving left ventricular assist device.

Objective: The aim of this study was to evaluate outcomes of patients participating in inpatient rehabilitation program after left ventricular assist device (LVAD) implantation.

Design: Medical records of 94 patients who received LVADs between January 1, 2008, and June 30, 2010, at the Mayo Clinic in Rochester, MN, were retrospectively reviewed for demographic data, and inpatient rehabilitation functional outcomes were measured by the Functional Independence Measure scale.

Results: After successful implantation of LVAD, the patients were either discharged directly home from acute care (44%) or admitted to inpatient rehabilitation (56%).

[Treatment of stress urinary incontinence. Experience at the Gynecology-Obstetrics Center of Amiens].

The authors report their experience of the surgical treatment of stress urinary incontinence. They underline the value of urodynamic tests in the examinations for urinary continence and prolapses. In the presence of a transmission defect, three different techniques are used: indirect colpopexy by strips (Loffredo) in the absence of prolapse, mixed route using vaginal strips (Bologna) in case of cystocele, sub-urethral plication reserved for elderly patients presenting a prolapse with stress urinary incontinence revealed by the urodynamic tests.

[Changing management of breech presentation in a primipara].

The authors investigate the changing management based on a score including the prognostic items in a primiparous woman with a breach presentation. The study involved two series: one from 1970 to 1975, including 185 breach position primiparous women before the score was established, and the other, dating from 1982 to 1988, consisting of 145 breach position primiparous women after this score came into use. The use of the score has tripled the number of cesareans but reduced neonatal morbidity.

[Report on threatened premature labor: etiology, management, results].

The studies on the aetiological factors of a premature delivery constitute an old fear of obstetricians and epidemiologists. However, they remain confused and the very definition of prematurity is among the first sources of confusion. There are many therapeutic methods considered as preventive.

[Spontaneous abortion. Etiologic survey. Results].

The definition of repeated spontaneous abortions is subject to caution. For some, it corresponds to at least three repeated spontaneous abortions with no normal previous pregnancy; for others, it comprises the repeated spontaneous abortions occurring after a normal pregnancy. It is a frequent problem, especially if one tries to give a wider definition.

A comparison of butoconazole nitrate cream with econazole nitrate cream for the treatment of vulvovaginal candidiasis.

In a randomized, single-blind, parallel study the safety and efficacy of 2% butoconazole nitrate cream used for 3 days were compared with those of 1% econazole nitrate cream used for 7 days at night in patients with vulvovaginal candidiasis. Patients in both treatment groups had positive potassium hydroxide smears and fungal cultures, and were similar in age, disease duration and history, obstetric history and contraceptive use. Of the 75 patients enrolled, 63 with a Candida albicans infection were included in the efficacy analyses.

[Proposal for a new therapeutic strategy in high genital infections].

78 cases of acute salpingitis were treated with the association Oflocet-Augmentin in a multicenter study. An accurate clinical and bacteriological evaluation was carried out prior to the treatment and a control laparoscopy was performed in 31 cases. A Chlamydia infection was responsible in 56 p.

[Role of the thyroid in first-trimester miscarriage].

In case of maternal hypothyroidism, the number of miscarriages is higher and reaches 50% in this multicenter study. Several hypotheses are advocated in order to explain this frequent occurrence: the most remarkable is that as substitute treatment is very effective and decreases noticeably the risk of abortion. In case of maternal hypothyroidism, the frequency of abortions in this study reaches 35% before the disease is diagnosed and this figure is not modified (35%) after the diagnosis is made and the treatment initiated.

[Contribution of urodynamic tests in gynecology. Apropos of 700 cases].

Basic urodynamic tests (cystomanometry-sphincterometry) are absolutely necessary for evaluation of urinary incontinence, urination disorders and prolapses, and are useful in the evaluation following treatment. In a retrospective study including 700 cases, the authors analyze the urodynamic results according to the clinical symptomatology since the clinical diagnosis often is misleading. Then, they study the different treatments advocated and their clinical and urodynamic results: medical treatment: 75 per cent of good results; pelvi-perineal physical therapy: 82 per cent of good results; Loffredo's procedure: 98.

[Electro-conization of the cervix uteri].

After having reported various opposite techniques for the treatment of dysplasia and in situ carcinomas of the uterine cervix, the authors present their experience with 125 cases of conisation, performed between 1984 and 1988. The electroconisation technique, performed in 88 cases, is compared with other conisation techniques: conisation with a cold scalpel, laser conisation. The use of a cold scalpel is simple and effective, but presents the disadvantage of peroperative (22.

[Practical problems posed by toxoplasmosis during pregnancy].

The occurrence of toxoplasmosis during pregnancy raises numerous problems. Determination of the time of the maternal infection is the first problem since we know that the frequency and gravity of fetal involvement vary according to the term of the pregnancy. Then, with information obtained from prenatal diagnostic tests (sonogram, amniocentesis, fetal blood sampling), it is important to recognize infected fetuses and advocate a management which goes beyond therapeutic abortion.

[Evaluation of ultrasonography. Apropos of a continuous series of 1,000 pregnancies].

2,648 sonograms were performed in a continuous series of 1,000 patients, all of whom had delivered in the department between March 1, 1988 and September 1, 1988; pregnancies resulting in a spontaneous miscarriage, extra-uterine pregnancy, therapeutic abortion as well as invasive sonographies, are excluded. Most patients underwent two or three sonograms during their pregnancy. 74 per cent of the requests come from specialists.

[Evolution of the parietal incision in cesarean sections].

This concerns a multicenter study including 51 centers of the North, Picardy and Champagne areas, 35 public institutions and 16 private institutions. This study was carried out on 7,216 records of Caesarean sections, collected between 1978 and 1983. The objective of this study was to specify maternal and fetal morbidity in Caesarean sections.

[Preliminary study of the use of intranasal buserelin in the long-term protocol of ovarian stimulation with the view toward fertilization in vitro].

A study conducted in 22 patients who used intranasal buserelin, in a long-term protocol for IVF, showed that pituitary desensitization is obtained between 14 days and 1 month. Analysis of the trials in this series, where the results were not satisfactory, suggests that the bioavailability of the product used intranasally, may be in question. A better distribution of nasal sprays causes more discomfort than when used subcutaneously.

[Prevention of the risk of infection and thromboembolism following cesarean section. 2. Results of a multicenter study].

The amount of infection following caesarean operations changes according to the indication for the caesarean and the length of time the membranes have been ruptured. Antibiotics should be prescribed according to these parameters. It does not seem that the numbers of thrombo-embolic complications in this series were reduced by using heparin prophylactically in the usual doses.

[Maternal complications of cesarean section. Results of a multicenter study. I].

The authors report a study they have made of 7,216 case histories designed to show the type and the number of the various maternal complications of the caesarean operation and compare these results with those found in the literature and those that occur after vaginal delivery. The maternal mortality rate directly associated with the operation is 1.38/000, which is between 5 and 25 times greater than those for vaginal delivery.

[Our experience in the serodetection of Chlamydia infections in tubal pathology].

Chlamydia appears to be an increasingly frequent cause of salpingitis and its complications (sterility, extra-uterine pregnancy). The difficulty of isolating Chlamydia in cell cultures has led us to study the value of serology in the form of immunofluorescence and ELISA. This study is based on 475 cases (206 controls and 269 women with tubal disease).

[Physiopathology of pregnancy-induced hypertension].

Even though multiple factors are involved in arterial blood pressure elevation, during pregnancy-induced hypertension normal physiologic processes are occurring in the uteroplacental unit. These appear probably very early in pregnancy. Treatment of pregnancy-induced hypertension at the present time is directed simply at lowering the blood pressure.

[Comparative study of the treatment of cervical dysplasias with the CO2 laser and electroresection with the diathermy loop].

The authors compared CO2 laser and the diathermy loop in the ambulatory treatment of 192 cases of cervical dysplasia. Clinical results were essentially equivalent (94.7% and 94.

[The extemporaneous examination: the decisive step in the surgical strategy in breast lesions].

Research into breast diseases is developing in all directions. In particular, there has been great progress in the fields of cytology, radiology, isotope studies, thermography and ultrasonography. The diversity of these methods reflects the complexity of the diagnosis.

[The effects of bromocriptine in normoprolactinemic anovulation and dysovulation: followed by pregnancy in 11 cases].

The authors report the results of a study of 40 patients with normal serum prolactin levels who were treated with bromocriptine for sterility secondary to ovulatory disturbances. This therapy restored normal ovulatory cycling in 62.5% of cases with subsequent pregnancy in 27.

[Study of fertility after extrauterine pregnancy].

Out of a total of 139 cases of extra-uterine pregnancy operated between 1979 and 1983, 78 patients were regularly followed. In 47 women wanting to become pregnant, 18 remained sterile, 8 had a further extra-uterine pregnancy and 21 obtained an intra-uterine pregnancy. The results are analysed in terms of the past history and the treatment of the first extra-uterine pregnancy.

[Study of a new fetal blood gas parameter: oxygen saturation].

The oxygen saturation, together with the other parameters of the acid-base balance, was studied in the umbilical vessels of 60 neonates born by vaginal delivery. These assays were used to define the normal range, which is 28 to 38% in the umbilical artery and 62 to 74% in the umbilical vein. The umbilical arterio-venous gradient was always negative.

[Our experience of the detection of latent pericardial effusions in the 3d trimester of pregnancy].

Following the paper published by Haiat, in which he reported the ultrasonographic detection of latent pericardial effusions in the third trimester of pregnancy, the authors conducted a study of 129 cases: 99 hospitalized patients (series I) and 30 patients seen in the consulting rooms (series II). Pericardial effusions were detected in 15% of cases in series I and in 20% of cases in series II, despite a more sophisticated apparatus. In general, these effusions were quite small.

[Prognosis of decidual hematomas or ovular detachments discovered by echography during the 1st trimester of pregnancy].

A prospective study conducted over a period of 20 months revealed 76 cases of ovular detachment during the first trimester (0.9% of the obstetric ultrasound examinations performed during this period). In the 57 cases which were followed up, a poor outcome was observed essentially in the group of patients with a past gynaeco-obstetrical history (endometrial infection, intra-uterine operations).