RESUMO
PURPOSE OF THE STUDY: To assess the stress factors affecting operating theater nurses during the perioperative period. PATIENTS AND METHODS: The study was conducted as a cross-sectional survey by means of a specifically drawn-up questionnaire based on the data available in the literature. Stress was measured on a 0/100 visual analogue scale (VAS). RESULTS: Six hundred and twelve (612) persons responded. Stress associated with an operation amounted to 31.8; it was higher at the time of the procedure (49.6) and immediately beforehand (39.4), particularly among the least experienced nurses. The most widely represented stress factors were associated with the surgical team (perceived incompetence, lack of confidence), relational problems with regard to the surgeon, and team members' disruptive behavior. By contrast, familiarity with the team or the procedure seemed to shield the nurses from stress. Feelings of stress had a relatively frequent impact on quality of life (33%), family and personal life (26%), with chronic (recurrent or constant) stress symptoms reported among 20% of respondents. CONCLUSION: Among operating theater nurses, stress associated with an operation was particularly strong among the least experienced professionals, when the type of procedure or the other team members were unfamiliar, and in the event of disruptive behavior. Stress factor improvement should be a priority, the objective being to enhance professional and personal quality of life, while better ensuring patient safety.
Assuntos
Enfermeiras e Enfermeiros , Salas Cirúrgicas , Estresse Psicológico , Cirurgiões , Estudos Transversais , Humanos , Relações Interprofissionais , Enfermeiras e Enfermeiros/psicologia , Equipe de Assistência ao Paciente , Segurança do Paciente , Qualidade de Vida , Estresse Psicológico/psicologiaRESUMO
OBJECTIVES: To assess prenatal changes in the volume of congenital pulmonary malformations (CPM) and examine whether these changes differ in lesions that appear cystic on ultrasound compared with hyperechoic lesions, and to study the relationship between CPM volume and risk of fetal compression. METHODS: We conducted a nationally representative, multicenter, prospective cohort study, which included 579 ultrasound examinations in 176 pregnant women with a diagnosis of fetal CPM, between March 2015 and November 2016. Several ultrasound examinations were performed between diagnosis and delivery, including measurement of CPM volume. We modeled changes in CPM volume ratio (CVR) as a function of gestational age, overall and for cystic/mixed vs hyperechoic malformations, and examined the association between CVR and signs of compression during pregnancy. RESULTS: When modeling CVR changes over time, there was a statistically significant decrease in CVR with increasing gestational age (P < 0.001), but the pattern of change differed according to CPM phenotype at first ultrasound examination: cystic/mixed CPM were characterized by a monotonic decrease in CVR with increasing gestational age (P = 0.002), whereas hyperechoic CPM showed an initial increase in CVR up to 27 weeks of gestation, followed by a decrease thereafter (P < 0.001). Peak CVR values were predicted as early as 21-22 weeks for cystic/mixed CPMs compared with 25-26 weeks for hyperechoic malformations. Regardless of CPM phenotype, fetuses that showed no sign of compression at any point had substantially lower CVR at first CVR measurement, and the CVR remained relatively constant thereafter. Among the subpopulation of fetuses with no sign of compression at first CVR measurement, the odds of a subsequent compression was 7-fold higher (adjusted odds ratio, 7.0; 95% CI, 1.6-29.9) if initial CVR was > 0.4 vs CVR ≤ 0.4 cm2 . CONCLUSIONS: Predicted changes in CVR during pregnancy differ between cystic and hyperechoic malformations. This may be the result of different pathophysiological mechanisms or differences in the timing of occurrence of these different types of CPM. CVR measured at the initial diagnostic ultrasound examination was strongly associated with the odds of subsequent compression. Copyright © 2018 ISUOG. Published by John Wiley & Sons Ltd.
Assuntos
Malformação Adenomatoide Cística Congênita do Pulmão/diagnóstico , Doenças Fetais/diagnóstico , Cuidado Pré-Natal , Adulto , Feminino , Idade Gestacional , Humanos , Gravidez , Prognóstico , Estudos Prospectivos , Ultrassonografia Pré-NatalRESUMO
A MAJOR CONCERN: Hypertensive syndromes occur in approximately 10 to 15% of all pregnancies and are the cause of 30% of maternal deaths and 20% of fetal and neonatal deaths. Syndromes include gestational hypertension also called pregnancy-induced hypertension, chronic hypertension and preeclampsia. DEFINITION: In pregnant women, hypertension is defined as blood pressure levels above 140/90 mmHg at two successive measurements at a 4-hour interval. The primum movens is the development, at about 16 weeks gestation, of secondary placental ischemia due to a defect in the second trophoblastic invasion of the spiral arteries of the myometrium. This induces endothelial dysfunction leading to pro-coagulation activation and inhibited physiological vasodilatation. RISK FACTORS: The risk of vasculoplacental disease increases with age, body mass index, primiparity, stressful working conditions, and personal history of vascular events during pregnancy. MATERNAL RISKS: Maternal complications include preeclampsia-eclampsia, retroplacental hematoma, acute renal failure, and HELLP syndrome (hemolysis, elevated liver enzymes, low platelet count). FETAL RISKS: Hypotrophy, in utero death and prematurity may occur. The development of hypertension during pregnancy may also reveal a hypertensive background which could progress to persistent high blood pressure. Preeclampsia is an independent risk factor of cardiovascular disease requiring regular surveillance after delivery.
Assuntos
Hipertensão/diagnóstico , Complicações Cardiovasculares na Gravidez/diagnóstico , Feminino , Morte Fetal/prevenção & controle , Seguimentos , Síndrome HELLP/diagnóstico , Síndrome HELLP/mortalidade , Síndrome HELLP/fisiopatologia , Humanos , Hipertensão/mortalidade , Hipertensão/fisiopatologia , Mortalidade Infantil , Recém-Nascido , Troca Materno-Fetal , Gravidez , Complicações Cardiovasculares na Gravidez/mortalidade , Diagnóstico Pré-Natal , Fatores de RiscoRESUMO
UNLABELLED: ACHIEVE PRECISE DIAGNOSIS: Hypertensive syndromes during pregnancy secondary to placental ischemia still cause threatening matemofetal complications. A precise differential diagnosis between gestational hypertension, chronic hypertension and preeclampsia must be achieved as the management protocols are quite different. PATIENT MONITORING: Blood tests for urea, creatinine, platelet counts, coagulation, and liver enzymes are required. Fetal monitoring, urine protein and ambulatory blood pressure measurements are also helpful. Ultrasound-Duplex explorations allow an evaluation of the maternal vascular status and fetal development. THERAPEUTIC MANAGEMENT: These patients should be managed in specialized centers, limiting the minimum the number of hospitalizations. Unlike good rules of hygiene and dietetics, antihypertensive therapy has little effect on the progression of the pregnancy. An antihypertensive therapy is only warranted to avoid cardiovascular complications in the mother. In case of chronic hypertension, treatment should be tailored to the measured pressures. Prudent antihypertensive therapy may be useful for severe gestational hypertension and preeclampsia. Because of their safety profile and pharmacologic properties, antihypertension drugs with central action and alph-beta-blockers should be preferred over other drug classes. PREVENTIVE TREATMENT: Antiaggregates (aspirin 50-100 mg/d) starting at 16 weeks gestation should be reserved for high-risk pregnancies. Regular follow-up, both pre- and post-natally, is essential, especially in light of the large number of women who can be expected to progress to established hypertensive states.
Assuntos
Hipertensão/diagnóstico , Complicações Cardiovasculares na Gravidez/diagnóstico , Feminino , Humanos , Hipertensão/terapia , Recém-Nascido , Gravidez , Complicações Cardiovasculares na Gravidez/terapia , Fatores de TempoRESUMO
The pathophysiology of pre-eclampsia, disease of the endothelium, placental ischaemia, and its consequences on blood pressure and heart rate variations are described. The methods of evaluation of heart rate and blood pressure during pregnancy, outpatient visit clinical measurement, self-measurement, ambulatory measurement, "Finapres", electrocardiogram and Holter ECG are reviewed; the practical implications of the nocturnal fall of vagal tone with tachycardia, demonstrated during pre-eclampsia, are discussed.
Assuntos
Pressão Sanguínea , Frequência Cardíaca , Complicações Cardiovasculares na Gravidez/fisiopatologia , Feminino , Humanos , Pré-Eclâmpsia/diagnóstico , Pré-Eclâmpsia/fisiopatologia , Gravidez , Complicações Cardiovasculares na Gravidez/diagnósticoAssuntos
Transplante de Fígado , Gravidez , Adulto , Feminino , Humanos , Resultado da Gravidez , Fatores de RiscoRESUMO
Pregnancy is now a common, but high-risk event, in young women who have received transplants. Consequences to the fetus are known, but pregnancy may also interfere with graft function. We report the outcome of two successive and successful pregnancies in a 29-year-old woman with type 1 hyperoxaluria, who received a combined liver and kidney transplant. Two healthy children were born at 35 and 37 weeks of gestation, with low birth weight. Liver function remained normal before, during, and after pregnancies up to 52 months after transplantation. Renal function was impaired before the first conception, worsened during both pregnancies, and returned to the previous level in both immediate postpartum periods. However, renal function has declined 17 months after the last delivery. This report shows the feasibility of successive pregnancies in multiple organ transplant recipients, but raises the question of long-term maternal kidney graft survival.
Assuntos
Hiperoxalúria/cirurgia , Transplante de Rim , Transplante de Fígado , Complicações na Gravidez/fisiopatologia , Adulto , Feminino , Humanos , GravidezRESUMO
OBJECTIVES AND METHODS: We report 7 pregnancies which occurred from 1988 to 1995 in 5 women who underwent liver transplantation. The immunosuppression regimen associated cyclosporine, azathioprine and prednisone. RESULTS: Mean age at conception was 25. During pregnancy, cholestasis occurred in 2 women. None of the patients experienced rejection. An increase in serum creatinine was observed in 3 cases. Serum uric acid increased in the third trimester of pregnancy in 6 cases, associated with arterial hypertension in 3 cases. In 4 cases, toxemia led to premature delivery. Seven childbirths occurred between the 34th and 38th week of gestation, by vaginal delivery (n = 3) or caesarean section (n = 4). Newborn weights ranged from 1,350 g to 3,100 g. A favorable outcome was observed in all mothers, with a follow-up ranging from 2 months to 7 years after delivery. CONCLUSION: These results suggest that a successful pregnancy is possible after liver transplantation in young women with normal hepatic function and treated with cyclosporine. The risk of toxemia is mainly related to renal function before pregnancy.
Assuntos
Transplante de Fígado , Gravidez de Alto Risco , Adulto , Cesárea , Parto Obstétrico , Feminino , Retardo do Crescimento Fetal , Humanos , Imunossupressores/uso terapêutico , Rim/fisiopatologia , Fígado/fisiopatologia , Período Pós-Operatório , Gravidez , Resultado da Gravidez , Fatores de Risco , Fatores de TempoRESUMO
We present a case of prenatal diagnosis of severe metatropic dysplasia at 20 weeks' gestation. The characteristic prenatal features of this rare autosomal recessive chondrodysplasia appear to be significant dwarfism with an enlarged head and a narrow thorax associated with enlargement of the hands and feet, and the radiographic 'dumb-bell' appearance of the long bones.
Assuntos
Doenças do Desenvolvimento Ósseo/diagnóstico por imagem , Nanismo/diagnóstico por imagem , Ultrassonografia Pré-Natal , Adulto , Doenças do Desenvolvimento Ósseo/embriologia , Osso e Ossos/diagnóstico por imagem , Osso e Ossos/embriologia , Osso e Ossos/patologia , Cartilagem/patologia , Nanismo/embriologia , Feminino , Humanos , Masculino , Gravidez , RadiografiaRESUMO
BACKGROUND: Antenatal manifestation of glucose-6-phosphate dehydrogenase deficiency is uncommon. CASE REPORT: A male was born by caesarian section at 34 weeks of GA for hydrops fetalis (HF). Fetal ultrasonography showed hydrops fetalis for the first time at 24 weeks of GA. All investigations were normal, except moderate anemia (Hb: 11.5 g/dl) and important erythroblastosis (67%) in the fetal blood sampling at 25 weeks. HF spontaneously resolved, until caesarian section at 34 weeks for recurrence of HF. Hydrops and neonatal anemia were successfully treated with pleural and peritoneal aspiration and blood transfusion. At the age of 4 months, investigations showed low levels of G-6-PD activity. At the age of 12 months, the child's growth and development appeared to be appropriate. CONCLUSIONS: Diagnosis of G-6-PD deficiency must be suspected when HF due to anemia occurs in a population at risk; it could be confirmed by an enzyme study of fetal red blood cells.
Assuntos
Deficiência de Glucosefosfato Desidrogenase/complicações , Hidropisia Fetal/etiologia , Humanos , Recém-Nascido , MasculinoRESUMO
BACKGROUND: The role of Helicobacter pylori in chronic gastric and duodenal ulcer disease has now been proven in adults as well as in children. MATERIAL AND METHODS: H pylori has been looked for during endoscopy in 130 children suffering from recurrent abdominal pain (78 patients) or other symptoms (52 patients). Biopsy samples were taken from the antrum and the fundus, and were examined for histology and bacteriology (Gram staining, urease test, culture). RESULTS: H pylori was found in 30 cases (H pylori+ group, medium age: 12 years) and was absent in the 100 other cases (H pylori- group, medium age: 6 years). H pylori was present in 27% of children suffering from recurrent abdominal pain and 17% of children with other symptoms. Epigastric location of the pain and vomiting were equally frequent in both groups. Endoscopic gastritis, often nodular, was noted in 60% of the cases in the H pylori+ group and in 46% in the H pylori- group (NS). Chronic gastritis was noted in 90% of the cases in the H pylori+ group, and in 32% of the cases in the H pylori- group (p < 0.01). Culture was positive in 27 out of 28 cases (97%) in the H pylori+ group, including 3 cases with negative histologic examination. Twenty-two children in the H pylori+ group were treated with amoxicillin and metronidazole. Endoscopy performed about 2 months later showed eradication of H pylori in 63% of the cases, associated with disappearance of histologic lesions in 6 out of 14 cases and of symptoms in 5 out of 7 cases. CONCLUSIONS: H pylori is associated with some pediatric cases of antral gastritis. Further studies are needed to determine the influence of its eradication on symptoms and the interest to search this pathology (by serology) in children suffering from chronic abdominal pain.
Assuntos
Gastrite/complicações , Infecções por Helicobacter/complicações , Helicobacter pylori , Adolescente , Criança , Pré-Escolar , Endoscopia Gastrointestinal , Feminino , Gastrite/diagnóstico , Gastrite/microbiologia , Gastrite/patologia , Humanos , Lactente , MasculinoRESUMO
BACKGROUND: Brachial plexopathy is rare in children; it may follow a non-specific respiratory infection or occur after a specific viral disease or immunization. CASE REPORT: An 8 year-old girl was admitted suffering from presuppurative acute cervical adenitis. She was given penicillin V, netilmicin and corticosteroids. The adenitis gradually resolved over a period of ten days. There was no evidence of a specific bacterial infection. The patient suffered from pain localized to her right shoulder 15 days after admission; this pain was resolved within 3-4 days but was followed by paralysis affecting the upper brachial roots without sensory signs. EMG performed 15 days later showed signs of denervation. Amyotrophy set in rapidly but recovery under physiotherapy was complete 5 months later. CONCLUSION: This plexopathy resembling the Parsonage-Turner syndrome could be allergic in pathogenesis although similar cases after bacterial, possibly streptococcal, infection remain to be confirmed.
Assuntos
Neurite do Plexo Braquial/etiologia , Plexo Braquial , Linfadenite/complicações , Doenças do Sistema Nervoso Periférico/etiologia , Neurite do Plexo Braquial/reabilitação , Criança , Feminino , Humanos , Doenças do Sistema Nervoso Periférico/reabilitaçãoRESUMO
Despite a large body of literature or hypertension in pregnancy, there still is no recognized prognosis factor for this frequent and severe disease. Management still relies on clinical features (occasional blood pressure measurements, weight curve) and appropriate tests including fetal and maternal echodoppler, urinary uric acid, 24 h proteinuria and fetal heart rate monitoring. Recent developments including self measurement and ambulatory monitoring of blood pressure have helped improve follow-up and therapeutic management in high risk pregnancies. By repeating the measurements, these techniques require more intensive medical follow-up and an adapted therapy near the term of pregnancy. They do not however provide a means of predicting outcome or recurrence of preeclampsia. These techniques have effectively been shown to reduce the number and duration of hospitalizations.
Assuntos
Hipertensão/diagnóstico , Hipertensão/prevenção & controle , Programas de Rastreamento/métodos , Complicações Cardiovasculares na Gravidez/diagnóstico , Complicações Cardiovasculares na Gravidez/prevenção & controle , Cuidado Pré-Natal/métodos , Determinação da Pressão Arterial/métodos , Feminino , Monitorização Fetal , Hospitalização/estatística & dados numéricos , Humanos , Hipertensão/epidemiologia , Gravidez , Complicações Cardiovasculares na Gravidez/epidemiologia , Resultado da Gravidez , Segundo Trimestre da Gravidez , Prognóstico , Recidiva , Fatores de Risco , Autocuidado , Aumento de PesoRESUMO
Ambulatory blood pressure monitoring (ABPM) completes the diagnostic approach to hypertension of pregnancy, by providing a dynamic study of the blood pressure status of the pregnant woman. It corrects certain erroneous diagnoses of hypertension of pregnancy, in particular those related to the "White coat" effect, especially common in pregnant women. ABPM enables the study of nocturnal blood pressured figures, known for their prognostic value in hypertension of pregnancy. Finally, while loss or reversal of circadian rhythm appears to be of good predictive value regarding the onset of eclampsia, it is above all blood pressure load which appears to be harmful to fetal growth and maturity. ABPM also facilitates management by improving the compliance of pregnant women with regular monitoring and with treatment, by more accurately guiding the surveillance of drug treatment.
Assuntos
Determinação da Pressão Arterial , Hipertensão/fisiopatologia , Complicações Cardiovasculares na Gravidez/fisiopatologia , Assistência Ambulatorial , Determinação da Pressão Arterial/métodos , Ritmo Circadiano , Feminino , Humanos , Hipertensão/terapia , Monitorização Fisiológica , Gravidez , Complicações Cardiovasculares na Gravidez/terapia , Prognóstico , Valores de ReferênciaRESUMO
BACKGROUND: Mirror movements are a specific type of synkinesis. The pathogenesis is unknown. Three types have been identified: 1) a hereditary form, 2) a form associated with other neurological diseases, 3) a sporadic form, as is this case. CASE REPORT: A girl was born at term after cesarean section for fetal anoxia. Psychomotor development seemed normal, but mirror movements of fingers, hands, wrists and forearms were noticed when she was 8-9 months old. There were no other neurological manifestations and the imaging techniques were normal. Rehabilitation was begun when she was 20 months old. The girl is now 4 1/2 years old and writes, draws and cuts up normally. CONCLUSIONS: Mirror movements that are not associated with other neurological disorders usually remain unchanged and can be a professional handicap for adults. Prolonged rehabilitation offers a good functional prognosis.
Assuntos
Dominância Cerebral , Transtornos dos Movimentos/reabilitação , Feminino , Humanos , Lactente , Transtornos dos Movimentos/fisiopatologiaRESUMO
The anaesthetic management of pregnant women who suffered from systemic lupus erythematosus (SLE) was reviewed retrospectively. During the ten-year period studied, there were nineteen pregnancies in eighteen women (mean age 27 years) who had either SLE or an isolated lupus type anticoagulant (LAF). Four pregnancies were stopped before the third trimester, two spontaneously, and the other two because of the mother's condition. Of the fifteen remaining pregnancies, eight children were born with a weight less than 2,500 g. One child, birth weight 750 g, died after three days. None of the fourteen living children had neonatal lupus. Six epidural and twelve general anaesthetics were carried out for four abortions, nine Caesarian sections, and five deliveries. Epidural anaesthesia was often contraindicated by neurological and haemostatic complications of the SLE: recent meningitis, thrombocytopaenia, prolonged bleeding, anticoagulant therapy. In fact, management of SLE patients required extensive preanaesthetic clinical and paraclinical assessment, as all the systems may be involved in this condition; moreover, it may worsen during pregnancy (seven times in this series). The most frequent complications were cardiovascular, renal, and haematological. Possible intubation difficulties must also be looked for. A LAF was associated with a great number of venous thromboses. An isolated LAF does not contraindicate epidural anaesthesia, as long as there is no associated haemostatic defect, such as a thrombocytopaenia. Furthermore, the patient should not have had prolonged episodes of unexplained bleeding, or require anticoagulants. In the present series, epidural anaesthesia was contraindicated in three of the four patients with LAF. Finally, prevention of thromboembolism, postoperative infection and adrenal failure (in those patients with long-term steroid therapy) must be carried out.