Inexperienced sonographers can successfully visualize and assess a three-dimensional image of the fetal face using a standardized ultrasound protocol.

INTRODUCTION: A standardized three-dimensional ultrasonographic (3DUS) protocol is described that allows fetal face reconstruction. Ability to identify cleft lip with 3DUS using this protocol was assessed by operators with minimal 3DUS experience. MATERIAL AND METHODS: 260 stored volumes of fetal face were analyzed using a standardized protocol by operators with different levels of competence in 3DUS. The outcomes studied were: (1) the performance of post-processing 3D face volumes for the detection of facial clefts; (2) the ability of a resident with minimal 3DUS experience to reconstruct the acquired facial volumes, and (3) the time needed to reconstruct each plane to allow proper diagnosis of a cleft. RESULTS: The three orthogonal planes of the fetal face (axial, sagittal and coronal) were adequately reconstructed with similar performance when acquired by a maternal-fetal medicine specialist or by residents with minimal experience (72 vs. 76%, p = 0.629). The learning curve for manipulation of 3DUS volumes of the fetal face corresponds to 30 cases and is independent of the operator's level of experience. DISCUSSION: The learning curve for the standardized protocol we describe is short, even for inexperienced sonographers. This technique might decrease the length of anatomy ultrasounds and improve the ability to visualize fetal face anomalies.

[Comparison of the individual deprivation index of the French Health Examination Centres and the administrative definition of deprivation]. / Comparaison du score individuel de précarité des centres d'examens de santé, EPICES, à la définition socio- administrative de la précarité.

In French Health Examination Centres, populations in deprived situation were usually defined by administrative criteria The aim of the study was to investigate whether EPICES, a new individual index of deprivation, was more strongly related to health status than an administrative classification. The EPICES score was calculated on the basis of 11 weighted questions related to material and social deprivation. Participants were 197, 389 men and women, aged over 18, encountered in 2002 in French Health Examination Centres. Relationships between health status, health-related behaviours, access to health care, EPICES and the administrative classification of deprivation were analyzed by logistic regression. The associations between EPICES and the study variables were stronger than those observed for the administrative definition. The comparison also showed socially disadvantaged people with poor health identified by the EPICES score who were not by the administrative classification. These results showed that the EPICES score can be a useful tool to improve the identification of deprived people having health problems associated to deprivation.

[Intestinal barotrauma after diving--mechanical ileus in incarceration of the last loop of the small intestine between a mobile cecum and sigmoid]. / Barotraumatisme intestinal après plongée sous-marine--iléus mécanique sur incarcération de la dernière anse du grêle entre un caecum mobile et le sigmoïde.

A few hours after a self-contained underwater breathing apparatus (SCUBA) dive at 30 meters depth, a 49 years-old man complained of diffuse abdominal pain with nausea and vomitus. A laparotomy was performed 36 hours after a conservative treatment because of persistent mechanical small bowel obstruction. The last ileal loop was strangulated between a mobile ceacum and a long sigmoid loop. The man never had previous abdominal surgery. In absence of intestinal necrosis, a caecopexy was done and there was no post-operative complications. The gas distension during the ascension following the Boyle-Mariotte law and its distribution induced in this man with a special anatomy a mechanical small bowel obstruction. The treatment of mobile caecum and the literature of abdominal barotrauma is reviewed.

[Recovery following anesthesia with diazepam-ketamine and fentanyl-methohexital]. / Réveil après anesthésie par diazépam-kétamine et fentanyl-méthohexital.

The quality of recovery from general anaesthesia for day-case surgery is assessed by the Trailmaking test in a randomized study of 100 women scheduled for termination of pregnancy on an outpatients basis. All patients are in ASA group I or II. Recovery following diazepam-ketamine based anaesthesia is compared to that following fentanyl-methohexital based anaesthesia. In group A, 5 min after intravenous injection of diazepam (0,2 mg.kg-1), anaesthesia is induced with ketamine (1 mg.kg-1). If necessary, in response to spontaneous movement, for maintenance of anaesthesia, 1 or 2 supplementary doses of ketamine (0,5 mg.kg-1) are administered. In group B, 5 min after intravenous injection of fentanyl (1 microgram.kg-1), anaesthesia is induced with methohexital (2 mg.kg-1). If necessary, in response to spontaneous movement, for maintenance of anaesthesia, 1 or 2 supplementary doses of methohexital (0,7 mg.kg-1) are administered. The quality of recovery is assessed by Trailmaking test 1/2 h and 1 h after surgery and compared with pre-anaesthetic score. The two groups are comparable with regard to age, weight, educational level and average duration of anaesthesia. In group A, the mean score for the two parts of the test is not significantly different 1 h after surgery from the pre-anaesthetic score. In group B, the mean score for the two parts of the test is not significantly different 1/2 h after surgery than the pre-anaesthetic score. This better post-anesthetic score is explained by a learning effect of the test when used several times.(ABSTRACT TRUNCATED AT 250 WORDS)