ABSTRACT
OBJECTIVES: To evaluate the perineal morbidity of operative vaginal delivery using spatulas and vacuum. METHODS: From December 2008 to May 2010, 419 single pregnancies after 37 weeks of gestation in cephalic position were prospectively included: 226 spontaneous vaginal deliveries and 193 operative vaginal deliveries (126 spatulas and 67 vacuum). Each patient had rigorous clinical examination of the perineum. Perineal tears were classified in four different degrees depending on their severity: injury to skin only or episiotomy, injury to the perineum involving perineal muscles, anal sphincter rupture without and with anal epithelium tear, respectively. RESULTS: The rate of second degree or more perineal tear among patients who had spontaneous vaginal delivery, operative vaginal delivery using spatulas and vacuum was: 5.9%, 27% and 28.6%, respectively (p<0.001). If no significant difference was observed between the rate of perineal damages after spatulas and vacuum, compared to spontaneous vaginal delivery, only spatulas were significantly associated to the risk of third degree or more perineal damage: 2 (0.9%) vs. 6 (5.2%), respectively (p=0.022). Only operative vaginal delivery was identified as an independent risk factor for second degree or more perineal tear (AOR: 4.589; 95%CI: 2.012-10.467; p<0.001). Episiotomy had no independent significant impact on that risk (AOR: 0.690; 95%CI: 0.350-1.359; p=0.283). CONCLUSION: Operative vaginal delivery using spatulas and vacuum does significantly increase perineal morbidity. This risk appears to be independent of the practice of episiotomy.
Subject(s)
Delivery, Obstetric/adverse effects , Delivery, Obstetric/instrumentation , Obstetrical Forceps/adverse effects , Perineum/injuries , Adolescent , Adult , Female , Humans , Pregnancy , Prospective Studies , Risk Factors , Vacuum Extraction, Obstetrical/adverse effects , Young AdultABSTRACT
Standard treatment of locally advanced cervical carcinoma is actually represented by concomitant chemoradiotherapy followed by brachytherapy since several randomised study results in 1999. Surgical resection after concomitant chemoradiotherapy for locally advanced cervical carcinoma is discussed without evidence of benefice on survival and because morbidity. The aim of this study is to discuss surgery after chemoradiotherapy in terms of rate of morbidity and residual tumor, rate of pelvic disease control, overall survival and disease-free survival.
Subject(s)
Uterine Cervical Neoplasms/drug therapy , Uterine Cervical Neoplasms/surgery , Brachytherapy , Combined Modality Therapy , Disease-Free Survival , Female , Humans , Neoplasm Staging , Randomized Controlled Trials as Topic , Treatment Outcome , Uterine Cervical Neoplasms/pathology , Uterine Cervical Neoplasms/radiotherapyABSTRACT
OBJECTIVES: To describe the frequency of maternal and neonatal complications resulting from the use of Thierry's spatulas. MATERIALS AND METHODS: This retrospective study included 166 patients treated during a 17-month period. RESULTS: For 100% of the patients, the use of the spatulas allowed the extraction of the new born, in 68 cases (41%) the new born was engaged between one and two centimeters below the spines. A medio-lateral episiotomy was performed in 159 patients (96%). A serious perineal tear (Type 3) occurred for 6 of these patients (3.6%). A simple perineal tear (Type 1) or vaginal tear occurred in 24 (18%). Episiotomy was performed in 18 patients and was significantly protective. No case of serious neonatal complication were related to the use of the spatulas. CONCLUSION: We found that perineal tear rate is similar to that observed with other instruments used for fetal extraction. No case of fetal trauma could be related to the use of the spatulas; this was the goal of Thierry who creation the instrument. The use of Thierry's spatulas as a reference instrument is warranted, particularly for cases of prematurity, as these spatulas fulfil the modern obstetrics requirements of fetal protection, without maternal risk.
Subject(s)
Extraction, Obstetrical/adverse effects , Extraction, Obstetrical/instrumentation , Episiotomy , Extraction, Obstetrical/methods , Female , Humans , Infant, Newborn , Perineum/injuries , Pregnancy , Retrospective Studies , Risk Factors , Vagina/injuriesABSTRACT
BACKGROUND: The association of pancreatic diseases with panniculitis are rare. Various pancreatic diseases are described with panniculitis of which most frequent are pancreatitis and acinar cell carcinoma. We report a case of an acute nodular panniculitis whose etiologic assessment allow of discover an intraductal carcinoid tumour on a pancreas divisum. CASE REPORT: A 45 year-old woman without notable medico-surgical history had suddenly presented with multiple cutaneous erythematous nodules on the legs associated with moderates arthralgia in the wrists and the ankles. There were no other clinical manifestations. Results of laboratory tests and chest X-ray were normal. Histologic exploration showed a centrolobular fat necrosis and suggestive pancreatic disease was confirmed by an increase in serum pancreatic enzymes. Ultrasound study and computerized tomography of the abdomen was without notable anomaly. Endoscopic ultrasound study of the pancreas and magnetic resonance imaging showed moderate distention of the pancreatic duct. Endoscopic retrograde cholangiopancreatography highlighted a small tumor in the accessory duct orifice of the pancreas divisum. Immunohistological study of tumor's biopsy showed a carcinoid tumor. DISCUSSION: To our knowledge, this observation describes the first case of nodular panniculitis associated with carcinoid tumor of the pancreas. The detection of this tumor at an early stage, revealed by cutaneous fat necrosis, is probably due to the unusual anatomic site, on the accessory papilla of the pancreas divisum.
Subject(s)
Carcinoid Tumor/complications , Pancreas/abnormalities , Pancreatic Diseases/complications , Pancreatic Neoplasms/complications , Panniculitis/complications , Carcinoid Tumor/pathology , Female , Humans , Middle Aged , Pancreatic Diseases/pathology , Pancreatic Neoplasms/pathology , Panniculitis/pathologyABSTRACT
The aim of the article is to definite the important factors of decision-making in dental care for the elderly. However the medical situation of the patient is very important, most of all for the chronology of the treatment, virtually all dental care solutions are possible. The restricting factors for a dental treatment are the physical and mental abilities of the patient, concerning dental hygiene and adaptation.
Subject(s)
Dental Care for Aged , Mouth Diseases/therapy , Tooth Diseases/therapy , Activities of Daily Living , Adaptation, Physiological , Aged , Decision Making , Diet , Drug Therapy , Health Status , Humans , Mental Competency , Oral Hygiene , Patient Care Planning , Risk Factors , Social Environment , Time FactorsABSTRACT
In this case series, the problems encountered in the oral cavity of patients affected by the Parkinson syndrome are discussed. The major difficulties encountered are the poor oral hygiene and the evolution of the disease.
