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PubMed2002

[The first clinical experience and technical peculiarities of mitral valve homograft implantation].

INTRODUCTION: Surgical interventions because of mitral valve disease have been ascribed since 1951. Many changes within mitral valve replacement have passed including closed and open mitral commissurotomy, mitral valve repair operations implantation of mechanical, biological heart valve and finally use of mitral valve homograft. Despite changes in chirurgical tactics and medico-technical environment, mitral valve homograft implantation remains one of the most complex surgical interventions. Surgical and technical details of mitral valve homograft implantation are discussed. OBJECTIVE: to estimate technical difficulties and anatomical positioning of mitral valve homograft considering a spectrum of indications of mitral valve replacement. CASE REPORT: 62-year-old woman 26 years ago underwent mitral valve replacement with Starr-Edwards mitral valve prosthesis, because of rheumatic heart disease by homograft. Due to malfunction of the mitral valve prosthesis, and progressive left ventricular failure patient was reoperated on 26(th) of February 2002. Fresh antibiotic preserved mitral valve homograft was implanted. Surgical techniques were guided using left ventricle size measurement indicated by echocardiography. RESULTS: The technique described by Acar/Carpentier was used except of mitral valve annuloplasty ring implantation. Peri- and early postoperative period was free of homograft related complications. The left ventricle function was improving and the heart size decreased dramatically during first postoperative week. CONCLUSION: The most important peculiarities for mitral valve homograft implantation are echocardiography data and intraoperative left ventricle measurements. Homograft implantation techniques are rather demanding therefore indications for mitral valve replacement have to be selected carefully and should be based on the presence of severe mitral valve dysfunction in order to achieve best hemodynamic results and prevent patient from anticoagulation therapy.

Echocardiography↗
PubMed2006

East-west: does it make a difference to hospital efficiencies in Ukraine?

Ukraine's history has given it a split personality (e.g. divergent cultural influences on economic and managerial behavior), as was observed in the recent political developments both prior to and following the December 2004 elections. Eastern regions were heavily influenced by Russo-Soviet rule, while western regions have more of a European outlook. This study, which is largely exploratory, compares recent trends in hospital efficiency in Ukraine to see if this split personality manifests itself in differential rates of improvement. Given the inflexibility of Soviet-style planned economies, it is hypothesized that western regions will show greater improvement in economic efficiency that can be attributed to higher levels of managerial and medical entrepreneurship. Data for this study comes from three oblasts (i.e. geopolitical regions), one in the west and two in the east, spanning from 1997 to 2001. Data envelopment analysis (DEA) was used to estimate technical efficiency for the hospitals. After correcting for bias, a second-stage Tobit regression was estimated. Results indicate that hospitals in the west improved efficiencies, while those in the east stayed constant. These western areas of the nation, being more amenable to western management and medical 'business' practice, may be quicker to pick up on new techniques to increase healthcare delivery efficiencies. This may stem from the more limited effects of a shorter history of incorporation into a Soviet-style planned and controlled economy in which individual decision-making and entrepreneurship was suppressed in favor of central decision-making by the state.

Culture↗
PubMedDate not supplied

[Impact of 3 years of contract implementation on the quality of cataract surgery].

OBJECTIVE: To assess the adequacy to clinical practice of cataract procedures contracted in the Gipuzkoa Health Area (in public as well as concerted hospitals) from 1995. A second aim is to identify the achievements obtained three years after its implementation comparing the data with those of 1994, a year before. METHODS: Before its implementation a multidisciplinar team established the number of surgical procedures to be contracted each year by age and sex, as well as the technical and quality conditions (out-patient surgery, loco-regional anaesthetic, facoemulsification, etc.). Data used for the assessment: Cataracts Registry of the Ophthalmologic Unit, Patient Management Categories and surgical waiting lists. RESULTS: During the period studied, 8,073 cataract operations were performed, 9% higher than expected. The distribution by age and sex was as estimated. Technical and quality standards were fulfilled, except for the surgical waiting list, in at least 75% of the procedures. The surgical technique mainly used was facoenmulsification, increasing from 15% in 1994 to 76.5% in 1997. CONCLUSION: The contracting of cataract surgery has allowed the assessment, reordering, and establishment of standards of care for all the professionals involved in the process. There were improvements in clinical practice during the period studied. This has given raise to the homogenisation of care in all the units following technical and quality standards, meaning better equity for the patients in need of the procedure.

Aged↗
PubMed1994

Sexually low performing male rats die earlier than their high performing peers and (-)deprenyl treatment eliminates this difference.

Out of 1600 sexually inexperienced 28-week old Wistar-Logan male rats 94 sexually inactive ('low performing', LP) and 99 highly active ('high performing', HP) rats were selected. The rats were treated from the 8th month of their life three times a week, subcutaneously, with either 0.9% NaCl or 0.25 mg/kg (-)deprenyl until they died. Their copulatory activity was tested once a week and their learning performance was measured in the shuttle box once in three months. The salt treated LP rats (n = 44) never displayed ejaculation during their life time, they were extremely dull in the shuttle box and lived 134.58 +/- 2.29 weeks. Their (-)deprenyl-treated peers (n = 48) became sexually active, their mating performance was substantially increased and lived 152.54 +/- 1.36 weeks, significantly longer than their salt-treated peers and as long as the salt-treated HP rats. The salt treated HP rats (n = 49) displayed 14.04 +/- 0.56 ejaculations during the first 36-week testing period and due to aging they produced 2.47 +/- 0.23 ejaculations between the 73-108th week of testing. Their learning performance was high. They displayed 78.45 +/- 3.01 conditioned avoidance responses (CAR) during the first 36-week testing period and this dropped to 50.67 +/- 2.99 (p < 0.01) during the 73-108th week of testing. They lived 151.24 +/- 1.36 weeks, significantly (p < 0.001) longer than their LP peers. The (-)depre-nyl-treated HP rats (n = 50) were sexually much more active than their salt-treated peers. They displayed 30.04 +/- 0.85 ejaculations during the first 36-week testing period and 7.40 +/- 0.32 ejaculations between the 73-108th week of testing. Also their learning performance was substantially increased. They produced 113.98 +/- 3.23 CARs during the first 36-week-testing period and 81.68 +/- 2.14 CARs during the 73-108th week of testing. They lived 185.30 +/- 1.96 weeks, significantly more than their salt-treated peers and out of the 50 rats 17 lived longer than the estimated technical life span (TLS).

Animals↗
PubMed1996

[Chlamydia trachomatis infection: risk factors].

UNLABELLED: Genital Chlamydia Trachomatis (CT) infections are the most common cause of tubal infertility. Its prevalence is variable between the authors, but seems to be more frequent in the young population. OBJECTIVE: Evaluate the CT genital infection rate in a population consulting either in a sexually transmitted disease center (STD) or in a family planning unit (FPU). --Judge the interest of a routine screening, and by which technic. --Estimate the information level of population about STD and their prevention. METHODS: 270 men and 331 women were detected by uretral or endocervix sample with an immunofluorescence method (Syva Microtrack). CT serology were also realised. RESULTS: 18.5% of man samples, 20% of woman samples in the STD center and 17.9% of woman samples in the FPU were positive for CT. There is a strong correlation between CT positivity and cervical discharge or cervicitis (RR = 4.64, p < 0.01). Serology was positive in 45.5%, 32.5% and 21.2% respectively for STD center's men, STD center's women and PFU's women. The correlation between samples and serology was 62%. Positive samples were more frequent in the 15-30 years old population and positive serology in the over 30 years old population (RR = 3.57, p < 0.01). There is a correlation between CT positive samples and nulliparity, multiple sexual partner and history of genital infection. CONCLUSION: The high prevalence of CT genital infection observed in our centers justify a routine screening especially in the young population.

Adolescent↗
PubMedDate not supplied

Indirect estimation of cause of death structure in Africa and contemporary theories of mortality.

This paper is a critical assessment of techniques used for the estimation of cause of death structure in Africa in the light of contemporary theories of mortality. The technique mostly used for the indirect estimation of cause of death structure is based on the mortality experience in Western countries. With the marked differences in the epidemiologic transition experienced in Western countries and those being experienced in African countries, it is not very likely that an estimation of cause of death structure based on data from the former can accurately estimate cause of death structure in the latter. This argument is supported in the paper through a comparison of observed estimates of cause of death structure for some African populations with indirect estimates. It is proposed that a better approach is to use a residual method whereby one proceeds from nearly true estimates of cause of death rates to obtain estimates for unknown causes via the known general mortality.

Africa↗
PubMed1996

Child and maternal mortality during a period of conflict in Beira City, Mozambique.

BACKGROUND: Child mortality rates have been declining in most developing countries. We studied child and maternal mortality risk factors for child mortality in Beira city in July 1993, after a decade of conflict in Mozambique. METHODS: A community-based cluster sample survey of 4609 women of childbearing age was conducted. Indirect techniques were used to estimate child mortality ('children ever born' method and Preceding Birth Techniques (PBT) and maternal mortality (sisterhood method). Deaths among the most recent born child, born since July 1990, were classified as cases (n = 106), and two controls, matched by age and cluster, were selected per case. RESULTS: Indirect estimates of the probability of dying from birth to age 5 (deaths before age 5 years, (5)q(0) per 1000) decreased from 246 in 1977/8 to 212 in 1988/9. The PBT estimate of 1990/91 was 154 (95 percent confidence interval [CI]: 124-184), but recent deaths may have been underreported. Lack of beds in the household (odds ratio [OR] = 2.0, 95 percent CI: 1.1-3.8), absence of the father (OR = 2.4, 95 percent CI : 1.2-4.8), low paternal educational level (OR = 2.1, 95 percent CI: 0.8-5.4), young maternal age (OR = 2.0, 95 percent CI: 1.0-3.7), self-reported maternal illness (OR = 2.4, 95 percent CI : 1.2-4.9), and home delivery of the child (OR = 2.3, 95 percent CI : 1.2-4.5) were associated with increased mortality, but the sensitivity of risk factors was low. Estimated maternal mortality was 410/100 000 live births with a reference date of 1982. CONCLUSIONS: Child mortality decreased slowly over the 1980s in Beira despite poor living conditions caused by the indirect effects of the war. Coverage of health services increased over this period. The appropriateness of a risk approach to maternal-child-health care needs further evaluation.

Adult↗