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Biomedical subjects

A Proust

Publications and source records attributed to A Proust.

40 records · Page 3Linked to original sources

Cervical injury in head trauma.

Criteria for excluding cervical spine injury in patients who have sustained blunt head or neck trauma were prospectively studied at four hospitals in the Chicago area. The authors attempted to define a subset of these adult patients who, based on clinical criteria, could reliably be excluded from cervical spine radiography, thus avoiding unnecessary radiation and saving considerable time and money in their evaluation. Patients fell into four groups: (1) patients who were awake, alert, and had no complaint of neck pain or tenderness on physical examination; (2) patients who were awake, alert, but had complaint of neck pain or tenderness on physical examination laterally over the trapezius muscle only; (3) patients who were awake, alert, but had complaint of central neck pain or tenderness on physical examination over the cervical spine or center of the neck; and (4) patients who were not fully awake or alert, were clinically intoxicated, had other painful or distracting injuries, or had focal neurologic findings. Patients in group 4 had significantly more fractures (21/387) when compared with all other patients (7/478). Patients with central neck pain or tenderness (group 3) had significantly more fractures (7/237) than patients without pain or tenderness or with these findings limited to the trapezius area (0/236). It is clear that patients who have altered mental status, abnormal examination findings, distracting injury, or pain or tenderness over the cervical spine must have cervical spine radiographs.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗

Emergency cervical cerclage after 20 weeks' gestation: a retrospective study of 6 years' practice in 34 cases.

The aim of this study was to evaluate the outcome of late emergency cervical cerclage, after 20 weeks' gestational age (GA). This report describes a retrospective study from January 1, 1988 to December 31, 1993, of 34 patients with intact membranes who required emergency cervical cerclage after 20 weeks of GA, on observing significant cervical changes such as 'cervix dilated at least 2 cm and bulging membranes', in the Department of Obstetrics and Gynecology (Bichat-Claude Bernard Public Hospital, Paris, France). Eight patients were primigestae, and 3 had twin pregnancies. After 48 h resting under tocolysis infusion, emergency cervical cerclage (MacDonald technique) was performed with general anesthesia and prophylactic antibiotic administration. Out of 34 patients, 19 (73.1%) had a past history of one or more previous obstetrical events capable of causing cervical incompetence (CI). Mean duration of pregnancy at emergency cervical cerclage was 22.1 weeks of GA, and at delivery was 35.7 weeks of GA. The mean prolongation of pregnancy obtained was 13.9 weeks. There was a significant negative linear relationship between term at time of cerclage and the prolongation of pregnancy. In this series, 6 patients (17.6%) delivered before 28 weeks of GA, and 6 further patients (17.6%) delivered between 28 and 37 weeks of GA. Chorioamnionitis was observed in 5 cases (14.8%). Overall the neonatal survival rate was 86.5%, with 5 deaths among a total of 37 newborn. Two fetuses died in utero as a consequence of chorioamnionitis, 2 twins died shortly after birth at 24 weeks of GA, and 1 died after failure of emergency cervical cerclage (peroperative rupture of membrane). Out of 32 alive newborn, 7 were admitted to intensive care and were followed up at age 1 year with no signs of major handicap. On observing significant cervical changes with bulging membrane through an open cervix after 20 weeks of GA, an 'aggressive' multifactorial approach including cervical cerclage is legitimate and is associated with a satisfactory fetal survival rate with a minimum of maternal complications. However, in the absence of a controlled study and regardless of the major ethical problems this might entail, these beneficial effects described cannot be considered as proved.

Adult↗

[Iron and zinc supplementation during pregnancy: interactions and requirements].

The metabolism of iron and zinc during pregnancy is reported; their deficiency impairs foetal growth, and increases the rate of complications at delivery and of preterm births. Providing iron and zinc supplements must take into account their metabolic interactions which are likely to decrease their bioavailability. Supplementations should be prescribed only during at risk pregnancy and their dosage should be adapted to lessen these side effects and improve their efficiency.

Dietary Supplements↗