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At least 217 records · Page 12Linked to original sources
PubMed1979

Therapeutical application of artificial beta-cell in surgery and obstetrics.

An artificial beta-cell (Biostator) was used to control blood glucose concentration in six insulin-dependent diabetics who underwent surgical procedures and in five diabetic women during both vaginal childbirth and Caesarian section. In all cases, an optimal glycometabolic control was achieved before, during, and after surgery and delivery.

Adult↗
PubMed1988

[Nicolas Puzos: an obstetrician of the 18th century. From military surgery to obstetrics and from milk fever to placenta praevia].

Nicolas Puzos (1686-1753) was a famous french obstetrician in Paris during the 18th century. When he was sixteen years old, his father sent him as aide-major to follow the armies of Louis XIV to learn military surgery. After this he became an obstetrician studying with his master, a friend of his father, Julien Clément, accoucheur to the Court. Puzos while working wrote many notes which were assembled in a book after his death by Morisot-Deslandes: "Traité des Accouchements de M. Puzos", published in 1759. Puzos was the first to advocate rupture and tearing of the membranes in the treatment of haemorrhage brought about by placenta praevia partialis or marginalis. This "Puzos' method" as it is even now sometimes called in France, was aimed to replace "accouchement forcé" followed by version and was discussed by Leroux of Dijon who advocated the vaginal pack or tamponade. The "Puzos' method" was adopted until the current use of cesarean section.

France↗
PubMed1997

Acute gastric aspiration: prevention and treatment.

Pulmonary aspiration of gastric contents is a leading cause of maternal morbidity and mortality for patients during labor. The risk is increased in those women who require obstetric surgery and general anesthesia. Furthermore, gastric aspiration is believed to be largely preventable. Care providers can reduce the risk by limiting oral intake during labor and assuming that all parturients have a full stomach. Conduction anesthesia should be encouraged over general anesthesia. Having a skilled anesthesiologist available is optimal. Prophylactic use of antacids, H2 receptor antagonists, and/or the use of dopamine antagonists should be administered before obstetric surgery to raise the pH and decrease the volume of gastric contents. Should aspiration occur, prompt recognition, treatment, and monitoring will improve outcome.

Anesthesia↗
PubMed2005

Case-mix adjustment of the CAHPS Hospital Survey.

OBJECTIVES: To develop a model for case-mix adjustment of Consumer Assessment of Healthcare Providers and Systems (CAHPS) Hospital survey responses, and to assess the impact of adjustment on comparisons of hospital quality. DATA SOURCES: Survey of 19,720 patients discharged from 132 hospitals. METHODS: We analyzed CAHPS Hospital survey data to assess the extent to which patient characteristics predict patient ratings ("predictive power") and the heterogeneity of the characteristics across hospitals. We combined the measures to estimate the impact of each predictor ("impact factor") and selected high impact variables for adjusting ratings from the CAHPS Hospital survey. PRINCIPLE FINDINGS: The most important case-mix variables are: hospital service (surgery, obstetric, medical), age, race (non-Hispanic black), education, general health status (GHS), speaking Spanish at home, having a circulatory disorder, and interactions of each of these variables with service. Adjustment for GHS and education affected scores in each of the three services, while age and being non-Hispanic black had important impacts for those receiving surgery or medical services. Circulatory disorder, Spanish language, and Hispanic affected scores for those treated on surgery, obstetrics, and medical services, respectively. Of the 20 medical conditions we tested, only circulatory problems had an important impact within any of the services. Results were consistent for the overall ratings of nurse, doctor, and hospital. Although the overall impact of case-mix adjustment is modest, the rankings of some hospitals may be substantially affected. CONCLUSIONS: Case-mix adjustment has a small impact on hospital ratings, but can lead to important reductions in the bias in comparisons between hospitals.

Adolescent↗
PubMed2006

[Antibiotic prophylaxis in cesarean section -- piperacillin versus piperacillin/tazobactam in 300 cesarean sections].

INTRODUCTION: Antibiotic prophylaxis is a standard procedure in obstetric surgery and has been discussed in various investigations. Use of treatment is judged by high efficacy and good tolerance. METHOD: In 300 patients undergoing cesarean sections we compared results of application of Piperacillin 4 g and Piperacillin/Tazobactam 4.5 g after cut of umbilical cord. Tazobactam/Piperacillin is a combination of a broad-spectrum penicillin and a beta-lactamase inhibitor with increased toxicity against staph. aureus, enterobacter, and other germs responsible for local and systemic infections in obstetric surgery. RESULTS: We did not observe any severe adverse effects. Rate of severe wound infections was 1.3 % (Tazobactam/Piperacillin) and 2 % (Piperacillin alone). The difference showed no statistic significance (p > 0.01). During postoperative course we found a higher increase of CRP (p < 0.01) in the Piperacillin group. CRP proved to be a useful objective parameter to distinguish between patients with or without postoperative infections. No differences were found in the number of leucocytes, time in hospital and other parameters.

Anti-Bacterial Agents↗
PubMed1999

Antimicrobial prophylaxis in obstetric and gynecological surgery.

A major problem in obstetric and gynecological surgery, especially following cesarean section in labor, total vaginal or abdominal hysterectomy, or myomectomy, is postoperative wound infection. Consequently, the use of antimicrobial prophylaxis for cesarean section and for gynecological surgery has been advocated and shown to be effective in reducing postoperative morbidity, costs and duration of hospitalization. We reviewed 1021 patients who underwent cesarean section (597 elective, 424 emergency) and 814 gynecological patients undergoing abdominal (373) or vaginal (248) hysterectomy and myomectomy (193) between 1997-98 in the Obstetrics and Gynecology Clinic of the University of Florence. Before surgery 83.6% of obstetric and 75.1% of gynecological patients received 1 or 2 g of a first or second generation cephalosporin i.v. as a single-dose regimen at induction of anesthesia and sometimes a second postoperative dose. 1.5% of obstetric surgical patients had wound infection, as did 2.8% of gynecological surgery patients, with a mean postoperative hospital stay of 8 days. The short-term perioperative antimicrobial prophylaxis with cephalosporins is useful and provides the benefit of minimal toxicity and risk of chemoresistance.

Adult↗
PubMedDate not supplied

[Use of remifentanil in ambulatory obstetric-gynecologic surgery. A dose-effect study].

BACKGROUND: Remifentanil, a recently commercialised opioid, is characterised by a predictable and non cumulative effect which vanishes rapidly without determining side effects in the long term. These characteristics make remifentanil an ideal opioid in continuous infusion for the ambulatory surgery setting. Aim of this study was to assess the ideal dose of remifentanil, administered in bolus before propofol, in patients undergoing uterine curettage and assisted by mask ventilation in 100% oxygen. METHODS: Sixty patients, ASA status I-II, scheduled for uterine curettage, were divided into three study groups according to the bolus dose of remifentanil received before the induction agent: group A (n = 20) 1 microgram/kg; group B (n = 20) 2 micrograms/kg; group C (n = 20) 2 micrograms/kg. All patients were assisted by 100% oxygen ventilation with facial mask. During surgery the following were recorded: time to spontaneous ventilation (in case of post induction apnea); incidence of somatic and autonomic responses to surgical stress (treated with remifentanil in bolus). At the end of surgery the times to response to simple verbal commands, to discharge from the recovery room (by Aldrete score every 5') and to discharge from hospital (by PADSS score every 30') were registered. RESULTS: All patients presented post-induction apnea with a significantly more rapid return to spontaneous ventilation in group A. Six patients of group A responded to surgical stress while in groups B and C there was no need for supplementary boluses (p < 0.05). Five patients of group C were treated with atropine for bradycardia, in four of group C it was necessary to administer succinylcholine for thoracic rigidity. No significant differences regarding the anesthesia recovery times were observed. All patients were discharged from the recovery room after 10' from the end of surgery. Overall, the qualification for discharge from hospital was obtained at the second PADSS score control, except for one group A patient who incurred in metrorrhagia. CONCLUSIONS: The administration in bolus of remifentanil, before the inducing agent, permits short-term surgery in ambulatory surgery settings thanks to the rapid recovery of vital functions. Compared to the other doses, the 1.5 micrograms/kg dose guaranteed a good control over surgical stress without influencing the speed of awakening and without determining uncomfortable side effects.

Adult↗
PubMed2003

[Use of antibiotics in prevention and therapy in obstetrics and gynaecologic surgery].

BACKGROUND: The antibiotic treatments employed in 1999 in cases of gynaecologic and obstetric surgery in the first clinic of the Gynaecology and Obstetrics Department of the University of Turin have been evaluated. METHODS: 1131 gynaecological operations (major interventions, minor interventions, laparoscopies) and 492 laparotomic operations in obstetrics (mostly Cesareans) were assessed. Modalities of administration of chemoantibiotics (CAB) both at the prophylaxis stage and during the therapy stage were evaluated. RESULTS: A great application of chemoantibiotic prophylaxis (CABP) was noted as regards the gynaecological interventions (57.4% of cases) and low resort to chemoantibiotic therapy (CABT) (9%), thus highlighting the effectiveness of prophylaxis in reducing the incidence of infectious complications in the postoperative course in gynaecological surgery. As for obstetrics, the low percentage resort to CABP (36%) and the high resort to CABT (26%) were noted. It is proposed to obviate this fact by increasing the number of cases of CABP for obstetrics so as to reduce the massive recourse to CABT. CONCLUSIONS: Finally, some pharmacoeconomic remarks are offered regarding the rationalisation of the use of CABs in hospital surgical obstetrics and gynaecology.

Antibiotic Prophylaxis↗
PubMed2001

[Uterine rupture in Senegal. Results of 2 surveys taken in 1992 and 1996].

OBJECTIVES: National prospective descriptive study on dystocia were conducted in Senegal in 1992 and 1996. We examined more closely the data on uterine rupture to determine trends between these two surveys. METHODS: Data were collected for all patients undergoing an obstetrical intervention between January 1st and December 31st in 1992 and in 1996 in one of the referral maternity-obstetrical surgery units in each of the 10 regions in Senegal. RESULTS: The rate of uterine rupture was 1 per 51 interventions in 1992 (1.87%) versus 1 per 53 interventions in 1996 (1.94%). This dramatic event was recurrent in 7 of the 10 regions. The patients involved were aged 25-35 years (68% in 1992 versus 70% in 1996), multiparous or grand multiparous (52% in 1992 versus 70% in 1996), illiterate (90%), with poor follow-up (less than 3 prenatal consultations in 56% of the cases), and were generally evacuated to the unit (80% in 1992 versus 97% in 1996) without medical care (55%). Maternal mortality was high (28% in 1992 versus 12% in 1996). Infant mortality was also very high (98% in 1992 versus 86.6% in 1996). Conservative treatment of uterine rupture was used increasingly: the rate of conservative suture rose from 3.3% in 1992 to 22% in 1996. CONCLUSION: Prevention is a challenge for healthcare workers, public authorities and the population in general. Health policy should be directed towards forming general practitioners in obstetrical surgery. Emergency surgery kits should be made available to improve the quality of care in all maternity units throughout the country.

Adult↗
PubMed1996

[Risk of contamination with blood during obstetric-gynecologic surgery].

To determine the risk of exposure to blood and body fluids potentially contaminated with infectious organisms, we instituted a prospective study of 100 gynecologic procedures performed at Hospital General Regional of Puebla, México. Accidental exposure to blood occurred during 8 procedures (8%). There were 8 glove tears (8%). Needlestick injuries occurred in 6% of the operations. The frequency of blood contamination, glove tears and percutaneous injuries is high; surgical personnel are at risk of contracting a blood-borne disease such as HIV infection or viral hepatitis. Implantation of universal blood and body fluids precautions is useful in preventing HIV exposures of which needlestick precautions are most important.

Acquired Immunodeficiency Syndrome↗
PubMed2005

[Prevention of venous thromboembolism in surgery and obstetrics].

The French Society of anaesthesiology and intensive care has chosen a high level methodology to issue professional Recommendations on perioperative and obstetrical venous thromboembolism prophylaxis. In addition with a short review on mechanical and pharmacological prophylaxis, all surgical and obstetrical settings have been studied. The initiation and duration of prophylaxis have been particularly debated in close relation with the level of surgical risk. A large group of experts has been involved in this process. More than 150 other experts have participated in the reading process. Didactic tables have been added to help the prescription.

Delivery, Obstetric↗
PubMed2006

Botulinum toxin as an adjunct to motor learning therapy and surgery for obstetrical brachial plexus injury.

Following obstetrical brachial plexus injury, infants are unable to learn specific patterns of movement due to the disruption of neural pathways. Even with successful reinnervation (spontaneously or post surgical reconstruction), function can be suboptimal due to overactivity in antagonist muscles preventing movement of reinnervated muscles. Botulinum toxin type A (BTX-A) was used to temporarily weaken antagonistic muscles early in the reinnervation process following brachial plexus injury, with the aim of facilitating functional improvement. A case series of eight children (five females, three males; mean age 12.5mo [SD 6.43]; range 5-22mo) with significant muscle imbalances but evidence of reinnervation were given BTX-A injections into the triceps, pectoralis major, and/or latissimus dorsi muscles. After a single injection, all parents reported improvement in function. Active Movement Scale total score changed significantly between pre BTX-A and 1 month (p=0.014), and 4 months (p=0.022) post BTX-A injection. It is proposed that BTX-A facilitated motor learning through improved voluntary relaxation of antagonist muscles while allowing increased activity in reinnervated muscles.

Biomechanical Phenomena↗