[Computerized management of the obstetrical record].
Explore the source record for details and available documents.
Computer Systems↗
Biomedical subjects
F Pierre
Publications and source records attributed to F Pierre.
[Maternal behavior toward her newborn infant. Potential modification by peridural analgesia or childbirth preparation].
The effects of sophrology and epidural analgesia on early relationship between the mother and her child were studied on a simple of 190 deliveries. The mothers were observed during and just after delivery. Mothers who had been separated from their child before the end of the observation were excluded from the study. The patients had the choice between epidural analgesia or prenatal care with sophrology. Participation to prenatal courses has statistically a positive effect on the relation between the mother and her child (p less than 0.01). Instead, epidural analgesia and posture have very limited effect on this factor. However, a trend to more interaction is found in multipari and patients who didn't choose epidural analgesia.
Analgesia, Epidural↗
[Actinomycosis on an intra-uterine device: what is the cause?].
Explore the source record for details and available documents.
Actinomycosis↗
Respiratory symptoms and pulmonary function in 871 miners according to Pi phenotype: a longitudinal study.
Pi phenotype was determined and alpha 1 protease inhibitor (alpha 1 Pi) was measured in 871 iron-ore miners examined twice at five years interval. A questionnaire on respiratory symptoms was administered and lung function tests: spirometry (VC, FEV1.0), measurements of the residual volume (RV/TLC) and of the CO diffusion (FuCO), were carried out by the same medical and technical team, using the same apparatus. There were no differences in age, length of employment or smoking habits among the three Pi Phenotype groups: M (90.03%), MS (7.1%), MZ (2.8%). The prevalence of clinical symptoms at the initial survey and the incidence of symptoms between the 2 surveys were not related to Pi Phenotype groups. However a significantly steeper decline of FEV1.0/VC was observed in the alpha 1 Pi partially deficient groups MS and MZ (-3.9%) compared with the non-deficient group (-1.8%). No significant difference was observed for VC, RV/TLC and FuCO. This finding suggests that an intermediate deficiency of alpha 1 Pi may be related to a slight but statistically significant impairment of a lung function in occupational conditions.
Adult↗
Decreased serum ceruloplasmin concentration in aluminum welders exposed to ozone.
During an epidemiological survey on arc welders, serum copper and ceruloplasmin were determined in two groups of workers. One group consisted of aluminum welders who were divided into two groups: 13 welders working inside aluminum tanks (confined atmosphere) and 8 welders engaged in the production of vans for dump trucks (nonconfined atmosphere). The reference group consisted of 26 workers of the same plant who were not exposed to welding fumes. Ozone, the major pollutant in aluminum arc welding, was thought to be the principal factor in the significant decrease (P less than 0.01) of mean ceruloplasmin in confined welders. This decrease in the level of ceruloplasmin was still within the reference values and was not linked to age or to tobacco consumption. We found a linear relationship between ceruloplasmin concentration and the cumulated worktime along the week. This effect could be a sign in the serum of a lung reaction against oxidant activity in this type occupational exposure.
Adult↗
[Medicolegal risks of celioscopy. Analysis of 32 cases of complications].
An analysis of 200 case records of complications or undesired incidents that happened in the practice of gynaecological surgery and which often gave rise to legal actions either in the criminal or the civil courts, made it possible to extract from these case notes 32 cases where there were medico-legal consequences from laparoscopies that had become complicated. Above all, the relative seriousness of each case had to be considered. More than a third of these cases led to death directly linked to the gynaecological laparoscopy. This furthermore could be responsible for intestinal or vascular complications that had to be treated by intensive resuscitation and by further operative interference carried out as emergencies and by prolonged hospitalisation. After having reported these 32 case histories in detail, the authors analyse the medical consequences of these complications before going on the legal repercussions arising from them. The medico-legal practices that are so important are the ability of the laparoscopist, the standards of his technical equipment and of the anaesthetist, and his taking note of previous operations that have been carried out on the patient. It should not be forgotten, too, that there is a statistically demonstrated risk when laparoscopy sterilization is carried out, because this itself gives rise to claims. Finally, the preventive measures that can be undertaken in order to protect surgeons are outlined. These follow the discovery of an important series of complications which may help them to avoid trouble in their daily practice.
Adolescent↗
[Active management of labor in Dublin: what is it 15 years later?].
Every obstetrician, in his readings, must have come across a report of article by K. O'Driscoll, and could not remain indifferent (surprise, incredulity, even anger...) in front of astonishing results: 5% of caesarean sections, 5 to 6% of forceps deliveries, combined with a recruiting worthy of any large university center and creditable neonatal results which are accurately analysed. In view of the difficulty and understanding of the basis of "active management of labor", advocated by this team and described as the main reason of its success, the author tried to understand, while staying in this department, the highlights of its daily obstetrical practice. In this detailed report of the activities of this irish obstetrical team, the author wanted to put the results back in their context and broadly outline the organization of this department and the management of labor, in order to evaluate the significance of the figures reported in numerous international publications and too often not easy to analyse for uninformed readers.
Anesthesia, Obstetrical↗
[Levels of manganese in biological media: value, samplings, physiopathological variations. Bibliographic review].
The great diversity of methods for manganese analysis in biological materials (serum, plasma, whole blood, urine, spinal fluid and hair) reveals the difficulty in measuring extremely small quantities of this element. An examination of these methods demonstrate that the most used one is flameless atomic absorption spectrometry. This review offers a comparison of the different instrument settings. Authors' recommendations for the collecting of samples are reported in detail. A description of the preliminary steps, the handling of the specimen samples, the preparation of the standards, procedures used, analytical criteria and perturbations is also included. Normal values and their physiological and pathological variations are also described.
Body Fluids↗
[Pelvic and genital injuries in children. Sexual injuries of young girls. Management in a medico-legal context].
In the emergency care of a young girl presumed to be a victim of sexual assault and the treatment of the lesions discovered in the perineum and vulvo-vaginal tract, the paediatric surgeon must take into consideration the medico-legal aspects of the file right from the first approach to this young victim. It would actually be damaging to her if a paediatric surgeon reconstituted the perineal tissues, vulva and vagina "ad integrum" without carefully describing the lesions observed and without, whenever possible, taking good quality photographs to be kept in the case file to support the evidence of sexual assault, if a criminal procedure is filed. Similarly, as a complement to this assessment of the initial lesions, the surgeon must be able to establish an anatomical and functional assessment of the vulvo-vaginal tract after healing, to enable the experts appointed by the court to determine the basis for compensation of bodily damages related to the sexual assault and the expenses entailed by further plastic operations required by the sequelae of the genital lesions. The bases for a pretium doloris, future aesthetic, sexual and obstetric damages should also be indicated in any certificate given to the patient's family or to the court experts. Thus, if the surgeon participates indirectly in demonstrating evidence of the crime subject to penal sanction, he can help the victim in her parallel civil court action for compensation of her bodily damages before the repressive jurisdiction.
Child↗
[The obstetrical future of the post-fractured pelvis of the child. Medico-legal evaluation of obstetrical damages].
When the paediatric orthopaedic surgeon is required to treat a fracture of the pelvis in a young girl, by an orthopaedic method or by appropriate open reduction and fixation, he should evaluate the future obstetric sequelae in order to be able to answer the specific questions raised by the injured child's family and also by legal experts appointed by the court. The authors have classified the various fractures of the pelvis in children by analysing the elements of functional prognosis of these lesions based on the types of fractures and on the particular factors of vitiation reported in the literature, consisting of series which are too short to be truly demonstrative. It is obviously impossible to precisely determine the obstetric prognosis, as only trial of labour following induction will confirm the intact patency of the pelvic osteo-articular passage. However, the collaboration of the paediatric orthopaedic surgeon immediately after the accident will allow a prudent evaluation of the obstetric prognosis, allowing the court expert to allocate funds and to define the bases for compensation of bodily damages in the light of this prognosis.
Child↗
[Seasonal, weekly and lunar cycles of birth. Statistical study of 12,035,680 births].
The authors have studied the seasonal, weekly and lunar rhythms which could characterize deliveries, based on 12,035,680 french births, between January 1, 1968 and December 31, 1982. The seasonal rhythm is the most remarkable. It is characterized by a maximum of newborn in May and a minimum in November; there is an increased number of births during the month of September. The weekly rhythm is characterized by a drop in the number of births especially on Sundays, but also on Saturdays, with a maximum on Tuesday. The number of births also fluctuate according to the lunar cycle. Their amplitude is low. They are however significant. From that standpoint, these results confirm other studies already conducted in France and the USA, in a much smaller scale.
Circadian Rhythm↗
[Medical records in gynecology and obstetrics. Administrative and medico-legal aspects].
Explore the source record for details and available documents.
Female↗
[Importance of the initial examination after a rape in considering the criminal penalty and indemnification of the victim in a civil suit. Review of the documents from one Court of Assizes over 11 years].
The gynaecologist-obstetrician may be the medical witness who has to give evidence about the extent of the initial trauma after the presumption of a sexual assault on a victim who comes to consult him, or as an expert witness. The certificate that he gives at the time of the first consultation is an essential document for the examining magistrates who have to decide whether there has been an offence. It is also a very great help to support the brief for the lawyers in a civil action taken by the victim, who is claiming damages as compensation for physical or psychological damage resulting from the sexual abuse. The authors reported it useful to look through 64 case documents that were considered in 11 years. They studied the differences in the penalties that were awarded for criminal offences and the sums of money for indemnity that were awarded in civil cases. These were before the new law concerning rape was passed on the 23rd December 1980, and after this law had been applied. It tends to improve the position for the victim in civil cases and increases the sentences that can be passed for aggravated rape (as on a minor by an adult, or in particular somebody who has a position of responsibility to the child). The authors point out especially how important it is to take note of sexual precocity and to have a detailed account of the first investigations carried out after the sexual assault. These can be used to make the sentences differ and to make it possible to increase and widen the awards given to compensate the victims. As far as civil action is concerned, as there is usually a fixed scale for every regional Court of Assizes according to a definite formula, it is advisable according to the authors that the initial expert assessment presented by the magistrates should establish in its conclusions the details of the indemnity to be considered by professional judges of the Assize juries. They should take particular notice of added injuries that are not physical and are often not considered, such as pain and suffering, loss of pleasure and the aesthetic, the sexual, the obstetrical and the moral as well as the juvenile points of view. In certain cases ad full medical assessment presented before the end of the case will help the professional judges of the jury of Assizes who have to give judgment in a civil action by giving them information that will support the true interests of the victim.
Expert Testimony↗
[Refusal of blood because of being Jehovah's witnesses or for fear of AIDS. Deontologic and legal aspects].
Difficult new medical and professional ethical problems have arisen by an increase in the number of patients refusing blood transfusion or the use of blood derivatives because of religious convictions. In particular Jehovah's Witnesses and patients frightened of catching AIDS and other diseases transmitted by blood are involved. Because of this it is necessary to consider how to prevent legal actions which may be brought under the heading of "death by negligence or by failing to give correct treatment for a patient in danger", particularly when the case is of death that could be connected with failure to resuscitate a patient where the basic treatment would be giving blood. The authors have analysed article by article of the Code of Medical Deontology of 1975 and have found ambiguities, not to say apparent contradictions, in the recommendations given to doctors who find themselves confronted by patients who have refused in this way needed treatment for haemorrhagic shock, as can occur particularly in obstetrics and gynaecology. The law is extremely weak in this matter because the Appeal Court has never taken a clear position in regard to the responsibility the doctor has when he finds himself with a patient who has refused the correct treatment. The authors have been driven to research through a large bibliography of medico-legal works to find out what doctors should do when they are confronted by patients who refuse the correct treatment by they adults or infants or mentally incapacitated. The practical advice that ends this analysis should make it possible for the readers to adopt a compromise way of dealing with these situations that at the same time accords with the normal medical contract between patients and doctor and the dignity that should be afforded to the patient but also the safety of the patient. This is done by avoiding on the one hand total rejection of the legitimate personal convictions of the patient but also on the other hand not accepting too readily these convictions, which could lead to being held responsible for failure to carry out one's obligations to patients or to just leaving the patient to her circle, stepping aside from caring for her.(ABSTRACT TRUNCATED AT 400 WORDS)
Acquired Immunodeficiency Syndrome↗
Determination of manganese in biological materials by electrothermal atomic absorption spectrometry: a review.
The great diversity of methods for measuring manganese in biological materials (serum, plasma, whole blood, urine, spinal fluid, and hair) reflects the difficulty in measuring extremely small quantities of this element. Detailed examination of these methods demonstrates that the one most used is flameless atomic absorption spectrometry. In this review we report the different instrument settings for wavelength, slit width, protection gases, graphite furnaces, type of background correction, amounts measured, and thermal programs. We give detailed recommendations by various authors for collecting samples. A thorough description of the preliminary steps and the handling of the specimen samples is also included: direct determination with or without dilution, addition of a matrix modifier or determination after ashing, with or without chelation-extraction steps. The preparation of the standards, procedures used, analytical criteria (accuracy, precision, specificity, detection limit, linearity), problems (interferences, matrix effects), and reference values and their physiological variations are also described. We give a consensus of recommendations concerning the choice of a method.
Female↗
[The price of the breast. New jurisprudence establishing the amount of compensation for a breast removed by error].
Explore the source record for details and available documents.
Adolescent↗
[Non-assistance or malicious avoidance of treating patients in obstetrics and neonatology. Analysis of its jurisprudence].
1947 was the date of the first prosecution for failure to assist a person in danger at the time of delivery. Before coming back to it the authors define the constitutional elements of breaking the law as specified in article 63, paragraph 2 of the Penal Code in connection with applying articles 319 and 320 which concern homicide or involuntary bodily harm (or recklessness) which are the most often used in medicine. After that they present the court records of a number of cases which for the most part have not been published, from the Tribunals or the Appeal Courts of cases where prosecution could resulting up to 5 years of imprisonment or a fine of 20,000 F for general practitioners, specialists, gynaecologists and obstetricians or midwives who are indicted under these conditions. A series of 18 case histories which cover pregnancy, delivery and help for the newborn at risk in the first days of life, should lead to a good was of preventing this medico-legal risk, which is little known but very real. It requires great care by practitioners when called to urgent cases and a thorough and proper handling over to a colleague or to a team who are more able to give help, as well as good control of the conditions under which resuscitation is carried out and under which the newborn is monitored in the neonatal period. It is emphasized that the biggest risk run by the doctor who is responsible for the care of the pregnancy, of the delivery or resuscitation of the newborn is later not to be able to deny false information that may be given about the risks run by the victim, and to challenge the accusation that he was unwilling to give help. It is only by keeping good notes and by the evidence of witnesses that later provide indisputable proof against accusations of his failure, which characterize cases of failure to assist people in danger in medicine, can be fought. This risk is particularly strong in obstetrics and in neonatology.
Female↗
[The female breast as an object of liability complaints. Analysis of relative jurisprudence].
The authors analyse the incidence of medico-legal actions that can follow surgical and irradiation treatment of tumours in the female breast under French jurisprudence, which is now well established. Also involved are cosmetic surgery and all reconstructive procedures on the breast. Attention is drawn to errors that should be avoided in order to minimise the risks of being sued. There has been according to the files that have been inspected, a drop in legal actions for surgery of the breast for growths because radical surgery has become less frequent and less extensive. On the other hand there have been more complications from irradiation or from chemotherapy that has not been well controlled and where the risks had not been properly explained to the patients before treatment started. The article brings to attention how important it is to obtain informed consent about all details including very rare complications, particularly when the indication for the operation is cosmetic or for comfort and not in order to cure disease. Finally, the authors discuss the problem of cancer eventually developing in a tumour of the breast which appears after trauma received by the breast from seat-belt compression injuries. In spite of the unclear pathological causes so far discovered, there may be cause and effect between traumatism and a tumour discovered after an interval. It is suggested that immediately after the injury a careful examination of both breasts should be undertaken using mammography and ultrasound, including the anterior wall of the thorax, so that early diagnosis is made of possible signs suggesting that a tumour would be likely to develop. This should be done in spite of the presence of a haematoma in or around the breast.
Breast↗