Peterssonsmidt0372

To compare intrapartum- and neonatal mortality and intervention rates in term women starting labour in primary midwife-led versus secondary obstetrician-led care.

Retrospective cohort study.

Amsterdam region of the Netherlands.

Women with singleton pregnancies who gave birth beyond 37+0 weeks gestation in the years 2005 up to 2008 and lived in the catchment area of the neonatal intensive care units of both academic hospitals in Amsterdam. Women with a primary caesarean section or a pregnancy complicated by antepartum death or major congenital anomalies were excluded. For women in the midwife-led care group, a home or hospital birth could be planned.

Analysis of linked data from the national perinatal register, and hospital- and midwifery record data. We assessed (unadjusted) relative risks with confidence intervals. Main outcome measures were incidences of intrapartum and neonatal (<28 days) mortality. Secondary outcomes included incidences of caesarean section and vaginal instrumental delivery.

complications that can start labour in primary care and have low rates of medical interventions whereas perinatal mortality is low.For scientific claims to be reliable and productive they have to be justified. However, on the one hand little is known on what justification precisely means to scientists, and on the other the position held by philosophers of science on what it entails is rather limited; for justifications customarily refer to the written form (textual expressions) of scientific claims, leaving aside images, which, as many cases from the history of science show are relevant to this process. The fact that images can visually express scientific claims independently from text, plus their vast variety and origins, requires an assessment of the way they are currently justified and in turn used as sources to justify scientific claims in the case of particular scientific fields. Similarly, in view of the different nature of images, analysis is required to determine on what side of the philosophical distinction between data and phenomena these different kinds of images fall. This paper historicizes and documents a particular aspect ages as sources of training and knowledge production in scientific disciplines.A description of a case is presented of an isolated hypofibrinogenaemia acquired in relation to taking topiramate used as concomitant treatment of a drug resistant epilepsy. The hypofibrinogenaemia developed in the course of a month after the introduction of the drug, and was diagnosed in the perioperative period.

The purpose of our study is to present the socioeconomic aspects of the management of primary open angle glaucoma in Benin.

The study was a multicentric descriptive, record review from January 1st, 2011 to June 30th, 2013 and prospective from May 1st to July 31st, 2013. It included patients over 15 years of age, and treated for a diagnosis of primary open angle glaucoma during the study period.

Of 15,592 patients, 227 were diagnosed with glaucoma, for a 1.5% hospital prevalence with male predominance (64%). Medical treatment was the rule, with an average duration of 7.4 ± 7.4 months. A total of 10.6% of the patients were followed regularly. The average monthly cost of medications was 17.8 ± 10.8 euros. That of the consultations and diagnostic tests was an average of 79.5 ± 59.9 euros. The average cost of transportation to each visit was 1.6 euros. Stable glaucoma was more costly. A total of 17.6% of the patients were accompanied to visits for which the waiting time was always longer than one hour. The monthly average income of the patients was 187.7 euros. Loss of income associated with waiting was not evaluated. A total of 72.7% of the patients were self-insured, corresponding to 58.3% of their average monthly income.

Patients cannot logically afford their medication. Practitioners should rely more on lower-cost surgical treatments.

Patients cannot logically afford their medication. Practitioners should rely more on lower-cost surgical treatments.

To determine the epidemiologic and clinical characteristics of ocular trauma after evaluation with the ocular trauma score at the Army Teaching Hospital in Yaoundé, Cameroon.

A descriptive and retrospective monocentric hospital study was carried out from January 2008 to December 2010. Our sample included all patients with ocular trauma. Each traumatized eye was evaluated using the ocular trauma score after measurement of visual acuity. The most severe diagnoses observed were classified according to the Birmingham Eye Trauma Terminology system.

The frequency out of 364 eyes was 3.56%. There were 204 men (61.44%) with a male/female ratio of 1.59. read more The mean age was 32.95 years with predominance of 21-30 years. The most affected groups were laborers and craftsmen (28.61%), followed closely by students (23.80%), then armed forces personnel (19.58%). Fights were noted as the most common cause in 31.02% of cases. Punches predominated in 21.39% of cases. In 37.34% of cases, patients were seen within 72 hours of the trauma. Three hundred (90.36%) traumas were unilateral vs. 32 (9.64%) bilateral. The mean visual acuity at the first consultation was 0.3 logMAR. Grading after evaluation was as follows, 13 eyes were grade 1, 19 grade 2, 25 grade 3, 54 grade 4 and 253 grade 5. Fragile and exposed anatomical structures were the most commonly injured. Seventeen eyes exhibited elevated IOP (22 to 45) vs. 7 which were hypotonous. Two hundred and one (55.22%) oculo-palpebral contusions were noted, followed by 110 (30.22%) lacerations. Visual loss was reported in 16.20% and blindness in 8.79% of cases.

In the emergent setting, a good, timely clinical evaluation of each case according to the ocular trauma score may lead to effective management.

In the emergent setting, a good, timely clinical evaluation of each case according to the ocular trauma score may lead to effective management.Coronary artery interventions in the setting of Immune Thrombocytopaenic Purpura (ITP) carry the twin risks of bleeding and thrombosis related to the mandatory dual anti-platelet therapy. This condition therefore may require a splenectomy prior to the coronary intervention. Surgical splenectomy in the presence of high-grade coronary stenosis carries greater morbidity and mortality. We report here a unique solution to this therapeutic dilemma, which was splenic artery embolisation followed by percutaneous coronary intervention (PCI).

The goal of this study was to present open surgical conversion with graft salvage or "semiconversion" as a definitive and safe treatment for untreatable and persistent type II endoleaks causing sac enlargement after endovascular aneurysm repair.

Between January 2001 and December 2014, 25 of 1623 endovascular aortic repair (EVAR) patients were selected as candidates for open semiconversion. The indication was persistent type II endoleak in 13 patients (12 of whom received previous attempts of embolization), type I and II endoleak in 2 patients, and sac growth without imaging evidence of endoleak in the other 10. After the infrarenal aorta was prepared (via a retroperitoneal access, whenever possible), the technique consisted of performing a banding of the neck with Teflon (DuPont, Wilmington, Del), a sacotomy to remove the thrombus or the hygroma, or both, and then suturing all of the feeding vessels that were found. Proximal and distal fenestrations were performed to avoid sac repressurization.

The semiies shows that semiconversion is a safe and effective treatment for otherwise untreatable type II endoleak.

Isolated renal artery aneurysms are rare, and controversy remains about indications for surgical repair. Little is known about the impact of endovascular therapy on selection of patients and outcomes of renal artery aneurysms.

We identified all patients undergoing open or endovascular repair of isolated renal artery aneurysms in the Nationwide Inpatient Sample from 1988 to 2011 for epidemiologic analysis. Elective cases were selected from the period 2000 to 2011 to create comparable cohorts for outcome comparison. We identified all patients with a primary diagnosis of renal artery aneurysms undergoing open surgery (reconstruction or nephrectomy) or endovascular repair (coil or stent). Patients with concomitant aortic aneurysms or dissections were excluded. We evaluated patient characteristics, management, and in-hospital outcomes for open and endovascular repair, and we examined changes in management and outcomes over time.

We identified 6234 renal artery aneurysm repairs between 1988 and 2011. Total recations (0.6% vs 0.0%; P = .014) with open repair. Open repair had a longer length of stay (6.0 vs 4.6 days; P < .001). After adjustment for other predictors of mortality, including age (odds ratio [OR], 1.05 per decade; 95% confidence interval [CI], 1.0-1.1; P = .001), heart failure (OR, 7.0; 95% CI, 3.1-16.0; P < .001), and dysrhythmia (OR, 5.9; 95% CI, 2.0-16.8; P = .005), endovascular repair was still not protective (OR, 1.6; 95% CI, 0.8-3.2; P = .145).

More renal artery aneurysms are being treated with the advent of endovascular techniques, without a reduction in operative mortality or a reduction in open surgery. Indications for repair of renal artery aneurysms should be re-evaluated.

More renal artery aneurysms are being treated with the advent of endovascular techniques, without a reduction in operative mortality or a reduction in open surgery. Indications for repair of renal artery aneurysms should be re-evaluated.

Interruption of the hypogastric artery by ligation, embolization, or coverage frequently results in ischemic complications. The aim of this study was to compare the rate and risk factors for the development of ischemic complications after interruption of the hypogastric artery in obstetrics and gynecology (OBG), vascular surgery, oncology, and trauma patients.

MEDLINE, Ovid, and Scopus were searched for articles containing data of patients who underwent interruption of the hypogastric artery. Based on the indication, details of the procedure, and complications developed, data were categorized and a systematic review was done to evaluate any significant differences.

A total of 394 patients (median age, 48.5 years) from 124 papers were included in the study; 31% of the study population was male and 69% was female. Indication for interruption was OBG related in 53.3%, vascular surgery related in 25.1%, oncology related in 17.5%, and trauma related in 4.1% of patients. Overall ischemic complication rate wasis relatively safe in young and OBG patients compared with vascular surgery and oncology patients. Ligation of the hypogastric arteries is preferred to embolization, and proximal embolization should be preferred to distal embolization to decrease the risk of ischemic complications. Randomized controlled trials with larger sample size are needed to definitively elucidate clear risk factors for development of complications after hypogastric artery interruption.We describe a novel surgical technique to facilitate the second-stage elevation of the basilic or brachial vein in patients with first-stage brachial-basilic or autogenous brachial-brachial arteriovenous fistula by axial splitting of the medial antebrachial cutaneous nerve (MABCN). Filaments of the MABCN typically traverse the anterior aspect of the basilic and brachial veins. The second-stage elevation/shelf superficialization of the basilic or brachial vein, so as not to cause an injury to the MABCN, requires division of these veins with transposition over the nerve branches and subsequent reanastomosis. Our method of axial splitting of the MABCN enables elevation and shelf superficialization of the basilic or brachial vein without the division and reanastomosis of the vein. Twenty-eight patients underwent this simplified elevation. The nerve perineurium was incised longitudinally, nerve fibers were divided intrafascicularly, and cutaneous nerve branches were retracted aside. The vein was elevated between the divided nerves.