Women prefer hospital births.
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Biomedical subjects
Publications and source records attributed to S Haddad.
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A case of gunshot trauma to the common carotid artery which presented with a juxtaclavicular pulsating hematoma is presented. After precise diagnosis was established by angiography, reconstruction by interposing and autologous saphenous vein graft was successful. Aspects of this highly lethal type of trauma include the need for close observation of the asymptomatic patient, indications for exploring penetrating neck trauma, the need for routine angiography and reconstructive arterial surgery in the presence of central neurological damage, relevant surgical techniques, and the availability of parasurgical facilities. The current consensus is to perform reconstructive arterial surgery when feasible, regardless of preoperative neurological status. Preoperative angiography is definitely recommended in any hemodynamically stable patient who is not suffocating. An aggressive approach, surgical expertise and perioperative support might reverse the poor prognosis in these otherwise fatal cases.
Intrauterine fluid collections were demonstrated by transvaginal ultrasound in 19 of 21 patients, 4-6 hours after first-trimester termination of pregnancy. Similar but lesser findings were seen 3 days later in some of the cases. Five days postoperatively, the endometrium appeared normal in all patients. Appreciation of the normal sonographic appearance of the uterine cavity following abortion is important for detecting pseudosac of ectopic pregnancy or the possibility of inappropriate curettage of an intrauterine pregnancy.
Sixty-eight dogs from four African countries and Reunion Island were tested for antibodies against Ehrlichia canis. Twenty-six dogs (50%) in Tunisia, Senegal and Chad were found positive using the indirect fluorescence antibody test. Dogs from both the Central African Republic and Reunion Island were all negative. Thus, this preliminary report confirms the presence of E. canis in Africa. Larger studies will be necessary to evaluate the current epidemiologic situation of canine ehrlichiosis in these countries.
The testes of prepubertal male rats (N = 12) aged 21 days were stimulated with low-intensity pulsed ultrasound (1.5-MHz frequency, 1-KHz repetition pulse rate, 200-microseconds pulse width, 30-V peak-to-peak amplitude and 20-mW/cm2 intensity) applied to the skin for 20 min/day for 7 days. Control rats (N = 8) were manipulated in the same manner but not submitted to ultrasound. Ultrasound stimulation promoted a significant increase in plasma testosterone (62%) leading to a significant increase in seminal vesicle relative weight (35%) as well as an increase in the fructose (92%) and DNA (200%) contents of the gland. No differences were detected between ultrasound-treated and control animals in terms of body weight and the relative weights of testis, cauda epididymidis, testis DNA and mitosis.
The authors reviewed 200 cases of operated lumbar disk hernias. Hernias of the L4-L5 disk were twice as frequent as those of the L5-S1 disk. When clinical examination revealed simultaneous involvement of the L5 and S1 nerve roots, the L4-L5 disk was more frequently responsible (75%). Clinical examination alone was not sufficient to localize the level of the disk hernia and CT scan used for this purpose had a sensitivity of 93.2%. In 20% of cases, the CT scan demonstrated a second asymptomatic lesion. The results of surgical treatment were assessed as 83% good and very good results and 50% complete cures. The authors propose the following recommendations: Look for involvement of the L5 and S1 nerve roots which is suggestive of an L4-L5 hernia; only operate after radiological demonstration of the level of the herniated disk; do not operate on asymptomatic lesions detected by CT scan.
Bromocriptine was given in a controlled trial to 86 parkinsonian patients. Eight of 30 previously untreated patients with early and mild disease showed sustained benefit for two years and did not develop "on-off" effects or dyskinesias. Only two of 23 patients unable to tolerate or failing to respond to levodopa benefited from bromocriptine. Thirty-three patients with residual disabilities despite maximum tolerated doses of levodopa were also given bromocriptine: although benefit accrued, treatment was abandoned because of unacceptable side effects, and there was no improvement in the 11 with severe "on-off" disabilities. Although it was found that benefit from 70 mg daily of bromocriptine was comparable to that from 750 mg of levodopa with carbidopa, bromocriptine seems to offer no advantage to the majority of patients who have received or are receiving levodopa and/or carbidopa.
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One hundred arteriographies were performed in emergency in 87 patients with penetrating trauma of the lower limbs caused by high- or medium-velocity projectiles (bullet or shell fragment). Thirteen patients had bilateral wounds. In 79 cases, the arteriogram was abnormal and led to surgical exploration. In 76 cases, an arterial lesion was found and treated (positive predictive value = 76/79 = 96%). In three cases, no arterial lesion was detected (3 false-positive findings). Among the 21 patients with normal arteriograms, 10 had surgical exploration because of clinical suspicion. An arterial lesion was found in 2 cases (2 false-negative findings). In the other 11 cases, the clinical and Doppler sonographic observations were normal (negative predictive value = 19/21 = 90%). The sensitivity rate was 97%, specificity 86% and accuracy 95%. In 8 cases, arteriography led to modifying the surgical procedure. These results show that preoperative arteriography, performed as an emergent examination in hemodynamically stable patients, allows avoiding surgery in some cases, and modifying the procedure in others.