Impact of implementation of a breech clinic in a tertiary hospital.

BACKGROUND: The incidence of breech presentation in single pregnancies at term is between three to 5 %. In order to support eligible women in their choice of mode of delivery, a dedicated breech clinic with a care pathway was developed in December 2015 in a tertiary referral centre in Brussels. The primary objective of this study was to evaluate the vaginal birth rate before and after the introduction of a dedicated breech clinic. The secondary objective was to compare the early neonatal outcomes before and after the breech clinic was introduced. METHODS: This was a single centre retrospective and prospective study. The inclusion criteria were term (from 37 weeks), singleton fetus and breech presentation at delivery. The exclusion criteria were suspected intrauterine growth restriction, severe fetal malformations and intrauterine fetal demise. We used a composite outcome as an indicator of neonatal morbidity and mortality. RESULTS: After the introduction of the breech clinic, we observed a significant increase in planned vaginal delivery from 7.4% (12/162) to 53.0% (61/115) (OR: 13.5; 95% CI: 6.7-27.0). The effective vaginal breech delivery rate (planned and unexpected) significantly increased from 4.3% (7/162) pre-implementation of breech clinic to 43.5% (50/115) post-implementation (OR: 17.0; 95% CI: 7.3-39.6). Neonatal outcomes were not statistically different between the before and after periods. CONCLUSION: The introduction of a dedicated breech clinic has led to an increase in vaginal deliveries for breech babies without adversely affecting neonatal outcomes.

Carcinoma of the male breast. An update.

The majority of reports in the literature that have documented poor survival in men with breast cancer have originated from major cancer centers and military hospitals. In contrast, we reviewed 45 men with breast cancer from seven community-based medical centers. Of the patients who were seen, 55% had localized disease (stage I), 39% had disease that was confined to the axilla (stage II), and 6% had metastatic disease (stage III). The survival data was compared with that of 2,620 women treated during the same time interval. The comparison showed a survival advantage for the men. This variance in survival data obtained from previously published reports may be due to a generally early stage of disease seen in community hospitals as compared with major referral centers.

Improved method for intra-abdominal drainage.

It has been shown that, by the addition of both suction and sump to straight drainage, the efficiency of the drain can be improved. A drain is described herein which uses these principles by combining a Jackson-Pratt drain, urethral catheter and Penrose drain. The combination drain has been used clinically and has proved to be both efficient and safe.

Ruptured mycotic salmonella aortic aneurysm treated with combined cefotaxime antibiotic and staged surgical management.

A case of salmonella infrarenal aortic aneurysm that ruptured and was treated with staged operative procedures and a highly effective antibiotic is reported and analyzed. An emergency situation with a ruptured abdominal aortic aneurysm required prompt surgical intervention with an aortobifemoral graft insertion. In the immediate postoperative period it was realized that a prosthetic graft was placed in the bed of a mycotic aneurysm. The patient had significant arteriosclerotic occlusive disease limiting the distal anastomotic site to the common femorals. Interoperatively the superficial femorals were noted to be occluded chronically. Consequently, revascularization via an extra-anatomical bypass after aortobifemoral graft removal was more complex. This was managed in a staged delayed fashion, while suppressing the infecting organism with Cefotaxime. The details of this complex situation are described within.