Biomedical subjects

A Vincelot

Publications and source records attributed to A Vincelot.

4 recordsLinked to original sources

PubMed2005

[Practicability of the vaginal prolapse surgery in the elderly woman].

OBJECTIVE: To evaluate the vaginal prolapse cure in the elderly woman. PATIENTS AND METHODS: A retrospective study is carried out on 38 patients of more than 80 years, operated for a vaginal genital prolapse cure between November 1997 and October 2004. The patients' general state of health, the type of analgesia, the operative type and time, the per- and postoperative complications and the evolution of the patients one month after the intervention, had been assessed. RESULTS: The average age of the patients was 84.2 (80-95). The patients' general state of health, according to the ASA classification was about 55.3% ASA II, and about 44.7% ASA III. The anaesthesia was general in 92.1% and spinal in 7.9%. The operating type was vaginal hysterectomy associated to a Marion-Kelly and a posterior perineorrhaphy in 68.4%; and a simple vaginal hysterectomy, associated more or less to the installation of a TVT in 13.1%; an intervention of Lefort, a case of Richter and a case of simple colpectomy in 10.5%. The average operative time is about 43 minutes. The peroperative complications can be summed up in a conversion in laparotomy due to haemorrhage, and a case of ligation of the right urethra. The transfer in an intensive care unit during 24 hours is necessary only for one case in 38. The postoperative complications are in one case death at eleventh day as a result of a pulmonary embolism, and a case of temporospatial disorientation and a prolapse relapse at 6 months. The duration of stay in hospital is about 7 days (2-18). The surgery did not affect the autonomy of the patients at one month. DISCUSSION AND CONCLUSION: Vaginal prolapse concerning the elderly woman is workable in quite common practice; it involves a good cooperation between anaesthetist and surgeon. The vital risk is really present but relative. This functional surgery must not be delayed by the installation of a pessary which must be used only for the inoperable patients.

Aged, 80 and over↗

PubMed2001

Platelet function during pregnancy: an evaluation using the PFA-100 analyser.

In clinical practice, the only tests of platelet function are bleeding time and platelet number. Bleeding time lacks sensitivity and specificity but the PFA-100, an in vitro analyser of platelet function may be of value. This study aimed to evaluate any correlation between platelet number and function using the PFA-100 in pregnant women. During a 21-month period, platelet function was evaluated in whole blood as part of the pre-anaesthetic coagulation testing screen with the PFA-100 using collagen and epinephrine (PFA-EPI) or ADP (PFA-ADP) as platelet agonists. Thrombocytopenia was defined as a platelet number less than 150 G litre(-1). The patients were divided into four groups: Group I (n=110) normal pregnancy; Group II (n=38) thrombocytopenia of pregnancy; Group III (n=13) women with pre-eclampsia without thrombocytopenia; Group IV (n=19) women with pre-eclampsia and thrombocytopenia. Results are expressed as mean (SD). Platelet count was not statistically different between Groups II and IV (111.1 (23.1) vs 99.5 (28.0) G litre(-1)). PFA-EPI was statistically increased in Group II (124.0 (26.3) s), Group III (128.3 (17.9) s), and Group IV (143.6 (47.7) s) compared with normal pregnant patients (114.6 (27.3) s, P<0.05, Mann-Whitney U-test). PFA-ADP was statistically increased only in Group II compared with normal pregnant patients (90.5 (18.9) vs 80.2 (11.2) s, P<0.05). PFA values were increased above normal laboratory values in (four of 38) Group II patients and (six of 19) Group IV patients but in no patients in Group III. PFA-ADP results were correlated with platelet count only in Group IV (r=-0.74, P=0.0003). The increased PFA values and the correlation between PFA-ADP and platelet number in hypertensive thrombocytopenic women confirms that platelet function may be decreased in such patients. In patients with pregnancy-induced thrombocytopenia, platelet function may be preserved when the platelet count is as low as 60 G litre(-1).

Adolescent↗

PubMed1993

[Pharmacokinetics of epidural or intrathecal bupivacaine in elective cesarean section].

Twenty ASA 1 pregnant women at term, undergoing elective Caesarean section were included in this study. They were randomly assigned to one of two groups, receiving either a spinal or an epidural anaesthesia. Before induction, in order to prevent hypotension, all patients were given an i.v. infusion of 1000 ml of Ringer-lactate and a subcutaneous injection of ephedrine 30 mg. They were positioned on the operating table with a 15 degrees left lateral tilt. Spinal anaesthesia was performed with hyperbaric bupivacaine 0.5 p. cent (0.08 mg.cm-1 of height). Epidural anaesthesia was obtained with a bolus dose of 0.5 p. cent plain bupivacaine, followed by a continuous infusion through the epidural catheter until the level of surgical block reached T6 bilaterally. Bupivacaine was assayed in plasma by high performance liquid chromatography (HPLC). Following pharmacokinetic parameters of bupivacaine were determined: Cmax (maximal concentration), Tmax (time to reach maximum), AUC (area under curve), Cl (total plasma clearance), Vz (volume of distribution during the elimination phase), T1/2 (elimination half-life). Bupivacaine concentration was also measured in samples obtained at birth from umbilical vein and umbilical artery. The mean dose of bupivacaine used was 12.8 +/- 0.6 mg in the spinal group and 118.6 +/- 17.8 mg in the epidural group. The time of onset of surgical anaesthesia was significantly shorter with spinal anaesthesia (7.6 +/- 4.4 vs 31 +/- 11.1 min; p < 0.01). The sensory block had a longer duration in epidural group (223.2 +/- 15 vs 291 +/- 13.8; p < 0.001).(ABSTRACT TRUNCATED AT 250 WORDS)

Anesthesia, Epidural↗

PubMedDate not supplied

[Peridural analgesia in labor. Comparison between bupivacaine and 2-chloroprocaine].

The purpose of this study was the comparison of the effects on the labor and neonates of epidural analgesia conducted either with bupivacaine or 2-chloroprocaine. Hundred and three parturients were included in the study. They were randomly divided in two groups. Sixty-three patients received bupivacaine in 0.25% solution and 40 received 2-chloroprocaine in 2% solution. Epinephrine was not added to local anesthetics. The first dose was 25 mg of bupivacaine (10 ml) or 200 mg of 2-chloroprocaine (10 ml). Reinjections occurred every 30 min for 2-chloroprocaine (80 mg) and every hour for bupivacaine (10 mg). The time of onset of cutaneous analgesia was similar in both bupivacaine (12.5 +/- 4.7 min) and 2-chloroprocaine (13.8 +/- 5.1 min) patients. The incidence of incomplete or insufficient analgesia was significantly higher with 2-chloroprocaine. The number of parturients who required forceps for conclusion of childbirth was not statistically different with bupivacaine (n = 25, 40%) or 2-chloroprocaine (n = 11, 28%) (CHI2 = 1.5971, p = 0.2063). The second stage of labour was significantly longer in parturients who required forceps extraction in both groups. These patients also received significantly more local anesthetics. All newborns had an Apgar score performed before the third minute following birth. All observed Apgar scores except one of bupivacaine group were over eight. Umbilical cord blood was drawn for pH determination. Cord blood pH was slightly but significantly lower in bupivacaine (7.314 +/- 0.106) than in 2-chloroprocaine (7.345 +/- 0.06) patients (t = 1.6968, p = 0.046). Newborns extracted with forceps after maternal bupivacaine epidural analgesia had a significantly lower umbilical blood pH (7.278 +/- 0.117) than newborns who did not required forceps in the bupivacaine group (7.337 +/- 0.093) (t = 2.1986, p = 0.0159).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗