The Trojan-horse mechanism: How networks reduce gender segregation.

The segregation of labor markets along ethnic and gender lines is socially highly consequential, and the social science literature has long viewed homophily and network-based job recruitments as some of its most crucial drivers. Here, we focus on a previously unidentified mechanism, the Trojan-horse mechanism, which, in contradiction to the main tenet of previous research, suggests that network-based recruitment reduce rather than increase segregation levels. We identify the conditions under which networks are desegregating, and using unique data on all individuals and all workplaces located in the Stockholm region during the years 2000-2017, we find strong empirical evidence for the Trojan-horse mechanism and its role in the gender segregation of labor markets.

Identification of factors influencing the decision-to-delivery interval in emergency caesarean sections.

BACKGROUND: In a life-threatening context, the American College of Obstetrics and Gynecology and the Royal College of Obstetrics and Gynaecology recommend a maximum delay of 30 min between the decision to perform an emergency caesarean and the infant's birth. Our objectives were to estimate the rate of prolonged intervals and identify the factors influencing the decision-to-delivery interval. METHODS: All women who had given birth at Saint-Etienne University Hospital by a non-prophylactic caesarean section between September 1 and November 1, 2007 were included in a prospective cohort study. A linear regression analysis was performed to identify the factors influencing the decision-to-delivery interval. RESULTS: 68 women were included in the study. Regardless of the degree of emergency, the decision-to-delivery interval exceeded the recommended interval in 50% of the cases. In extremely urgent caesarean sections, the optimal interval of 15 min was exceeded in 85.7% of cases. We found that two factors contributed to delayed patient care: urgent and extremely urgent caesareans and hospitalization in a pathological pregnancy unit. This delay leads to more paediatric reanimations. CONCLUSION: This study highlights the difficulty to reach the recommended target interval. One solution is to improve the identification of the degree of urgency and the communication between the various members of the healthcare team.

[Shoulder dystocia: a ten-year descriptive study in a level-III maternity unit]. / La dystocie des épaules: analyse descriptive sur dix années dans une maternité de niveau III.

OBJECTIVE: Shoulder dystocia is one of the most dreadful complications of vaginal deliveries. The aim of this observational study was to evaluate risk factors of dystocia, maternal and neonatal complications and recurrent risk factors. PATIENTS AND METHODS: Sixty-six cases of shoulder dystocia occurring between January 1998 and August 2008 in our university hospital were identified. Demographic data, labor management, management of the shoulder dystocia and neonatal outcome were recorded. RESULTS: The incidence of shoulder dystocia was 0.3%. Multiparity, weight gain greater than 12 kg, and post-term delivery were more present in our study group. McRoberts' manoeuver and symphyseal pressure were first realised. Brachial plexus injuries affected 9% of neonates with skeletal fractures in 7.5% of cases. Maternal morbidity was evaluated at about 8%. Twenty per cent had a recurrent shoulder dystocia. DISCUSSION AND CONCLUSION: Shoulder dystocia is an obstetric emergency which requires a prompt management of trained personnel. Despite the difficulty of being able to prevent shoulder dystocia, training the obstetric staff could probably improve management of shoulder dystocia.

[Massive haemoptysis associated with pulmonary Strongyloides stercoralis hyperinfestation]. / Hémoptysie massive associée à une hyperinfestation pulmonaire à Strongyloides stercoralis.

INTRODUCTION: Pulmonary infestation with Strongyloides stercoralis is an exceptionally rare cause of haemoptysis, the diagnosis being difficult and often delayed. CASE REPORT: We report the case of a retired coal miner suffering from pneumoconiosis who presented with acute respiratory insufficiency and massive haemoptysis, with a fatal outcome, associated with pulmonary stongyloidosis. The only identified source of infestation with Strongyloides stercoralis was his period in the coal mine and the only risk factors for the hyperinfestation were a short course of systemic corticosteroid therapy and the presence of a peritoneal-auricular valve. CONCLUSION: This observation illustrates the importance of a systematic search for anguillosis in ex coal miners prior to any immunosuppressant treatment in order to avoid the serious and frequently fatal form of hyperinfestation with Strongyloides stercoralis.

[Percutaneous aortic valvuloplasty by trans-septal approach]. / Valvuloplastie aortique percutanée par abord transseptal.

Aortic valvuloplasty has recently been introduced in the treatment of some cases of aortic stenosis. In the case reported here, the aortic orifice was so difficult to traverse by the retrograde route that the obstacle was approached by trans-septal catheterization. The aortic area, initially estimated at 0.25 cm2, increased to 0.82 cm2 at the end of the examination. However, additional dilatation by the retrograde route was necessary, using a catheter 25 mm in diameter.

[Cardioversion by internal electric shock of permanent atrial fibrillation]. / Cardioversion par choc électrique interne de la fibrillation auriculaire permanente.

A new technique for cardioversion of chronic atrial fibrillation was used in 17 patients whose arrhythmia had resisted all attempts at electrical and pharmacologycal cardioversion. Atrial fibrillation was badly tolerated by all patients despite digitalis administered alone (8 patients) or combined with amiodarone (9 patients). Twelve patients had left atrial dilatation at echocardiography. The 200, 300 or 400 joule electrical shock was delivered between the proximal pole of a quadripolar catheter (cathode) and a back plate (anode). The catheter was positioned at the His bundle recording site then withdrawn into the right atrium. The internal shock restored sinus rhythm in 15 patients (88 p. 100). Transient atrioventricular block (3-315 sec) was observed in 8 patients. Eleven patients were discharged in sinus rhythm. In 4 patients, the atrial fibrillation recurred on day 8 and after 2, 4 and 9 months. A second shock was attempted in two patients and succeeded in one. After a mean follow-up period of 14.8 +/- 8 months (range 2 to 25 months), 8 of the 11 patients successfully cardioverted (72 p. 100) or of the attempted reductions (47 p. 100) were in sinus rhythm. The remaining 9 patients were treated with antiarrhythmic drugs (n = 5) or by his bundle catheter ablation (n = 4). High energy internal shock therefore seems to be an interesting treatment in patients with permanent atrial fibrillation after failure of external electric shock. It enabled 13 of the 17 patients in this series to avoid His bundle catheter ablation indicated by the quasi-impossibility to control the atrial rate and associated symptoms.(ABSTRACT TRUNCATED AT 250 WORDS)

[Excimer laser assisted angioplasty. Immediate results in the treatment of complex coronary lesions]. / Angioplastie assistée par laser Excimer. Résultats immédiats dans le traitement des lésions coronaires complexes.

Transluminal coronary angioplasty (TCA) with pulsed excimer laser (CVX 300 Spectranetics) was performed in 89 patients (age 63.7 years); CCS I: 6; CCS II: 12; CCS III: 40; CCS IV: 31; instable: 58%. There was a previous history of myocardial infarction (MI) in 27 cases, TCA (9 restenoses) in 24 cases, 19 bypass graft procedures, 13 failures of TCA. The lesions (n = 90) affected the left main coronary artery: 1 case; the left anterior descending artery: 37 cases; the left circumflex: 8 cases; the right coronary: 28 cases and there were saphenous vein grafts in 16 cases. The lesions were classified B2 (ACC/AHA) in 56 cases and type C in 34 cases. There were 24 lesions > 10 mm, 15 > 20 mm; calcification in 49 cases; excentric in 65 cases; ostial in 9 cases; affecting bifurcations in 13 cases; affecting collateral vessels in 16 cases; chronic occlusions in 12 cases and restenoses of stents in 4 cases. Multifiber catheters: 1.4 mm (50), 1.7 mm (41) and 2 mm (3), were used to deliver energies of 43.3 mj/m2 (+/- 8.1 mj) with an average of 5.2 +/- 1.2 applications persite, and 2.7 +/- 1.1 passages. A balloon dilatation was performed after laser angioplasty in 96% of cases. The following results were observed: success of laser angioplasty (20% reduction of stenosis) in 95.5%, a successful procedure (residual stenosis less than 50% without major complications) in 95.5%, and a clinical success (no pathological Q wave or non-Q wave infarction, bypass graft, or repeat TCA): 92.1%. The following complications were observed: death = 0, non-Q wave infarction 2.2%, emergency bypass surgery in 1 case with Q wave infarction: 1.1%. The use of laser angioplasty may be proposed in the following indications: long, moderately calcified lesion, ostial lesions, complete occlusions, bypass graft disease, failure of angioplasty. In addition to these indications, we propose the treatment of restenosis on stents. The main disadvantage of the Excimer Laser is the poor cost/benefit ratio, given the relatively small number of indications.

[Post-traumatic fistula of the left anterior descending coronary artery and left ventricle. Apropos of a new case]. / Fistule post-traumatique entre l'interventriculaire antérieure et le ventricule gauche. A propos d'un nouveau cas.

The authors report the case of a 23 year old man who presented with a continuous murmur five years after closed chest trauma. The electrocardiographic and echocardiographic findings indicated previous apical myocardial infarction. The underlying diagnosis was first suggested by continuous wave Doppler which showed systolo-diastolic flow in the septo-apical region directed towards the left ventricle (LV) in diastole. Color Doppler flow studies showed a mosaic pattern opposite a dilated left anterior descending (LAD) artery. These signs of LAD-LV fistula with a single orific were confirmed at coronary arteriography. The patient's previous history was in favour of a traumatic etiology. In the absence of left ventricular failure and myocardial ischaemia by coronary steal, surgery was deferred; Doppler echocardiography would seem to be a good method of following up the fistula and its consequences on left ventricular function. A traumatic left coronary to left ventricular fistula is an extremely rare condition and merits publication. The authors review the literature and describe the physiopathology, diagnosis and therapeutic indications of these fistulae.

[Tricuspid endocarditis with right-left shunt in the atrium]. / Endocardite tricuspidienne avec shunt droite-gauche à l'étage auriculaire.

A case of tricuspid regurgitation due to endocarditis causing a right-to-left shunt through a patent foramen ovale is reported. Tricuspid valve endocarditis occurred after septic abortion and caused valvular regurgitation with dyspnea and cyanosis. The diagnosis was made by echocardiography and the finding of peripheral arterial desaturation, and it was confirmed at surgery. The physiopathology of these right-to-left shunts is the same as that already described during traumatic tricuspid regurgitation: reopening of the foramen ovale by the right atrial dilatation and ventricularisation of right atrial pressures. The presence of a shunt is an indication for surgery.

[Electro-mechanical dissociation concomitant with myocardial reperfusion in the acute phase of myocardial infarction]. / Dissociation électro-mécanique contemporaine de la reperfusion myocardique en phase aiguë d'infarctus du myocarde.

An unusual case of transient electro-mechanical dissociation concomitant with myocardial reperfusion is reported. The patient had myocardial infarction caused by occlusion of the middle anterior interventricular artery relieved by injection of urokinase and plasminogen in situ. The dissociation could be documented by simultaneous ECG recording on 3 leads and direct intravascular recording of femoral arterial pressure, the patency of that artery, and its maintenance, being demonstrated by angiography. This clinical case can be added to the list of events which occur during reperfusion of the myocardium after prolonged ischaemia. Its mechanisms, so far, are purely conjectural.

[Comparative effects of anti-arrhythmia agents on ventricular refractory period and prevention of ventricular tachycardia induced by stimulation]. / Effets comparés des antiarythmiques sur la période réfractaire ventriculaire et sur la prévention des tachycardies ventriculaires induites par stimulation.

The efficacy of antiarrhythmic drugs is attributed to their actions on the refractory periods or conduction velocity in the reentry circuit. The aim of this study was to determine the relationship between these factors and the prevention of electrically inducible ventricular tachycardia (VT). Twenty-seven patients with sustained monomorphic postinfarction VT underwent programmed stimulation under basal conditions and after administration of oral Class I antiarrhythmic drugs. The protocol of stimulation consisted of delivering one to three extrastimuli to the right ventricular apex on two basic cycle lengths. Sustained VT was induced in all patients. After the same protocol under antiarrhythmic therapy (1 to 5 tests, average 2.9 +/- 1) sustained VT could not be induced in 12 patients (44%). The effective right ventricular refractory period was significantly increased in patients without inducible VT under treatment (247 +/- 18 versus 302 +/- 26 ms). The increase in the right ventricular effective refractory period in patients with persistence of inducible VT was much less (from 270 +/- 28 to 287 +/- 30 ms). In all patients in whom several antiarrhythmic drugs were tested the right ventricular effective refractory period was higher when the treatment was judged to be effective (299 +/- 27 ms) than ineffective (272 +/- 27, p < 0.02). The prevention of inducible VT by class I antiarrhythmic agents seems therefore to be related to their effect on the ventricular refractory period.

[Septal rupture repaired in the acute stage of myocardial infarction. Clinical, hemodynamic and angio-coronarography findings in the evaluation of surgical risk]. / Ruptures septales opérées à la phase aiguë de l'infarctus du myocarde. Evaluation du risque opératoire par les données cliniques, hémodynamiques et angio-coronarographiques.

Between 1977 and 1987, 27 consecutive patients (16 men, 11 women, mean age 66 years, range 54 to 75 years) with ventricular septal rupture complicating acute myocardial infarction underwent surgical repair. The purpose of this retrospective study was to analyse the post-operative mortality factors from clinical, haemodynamic and operative data in all patients and also from coronary angiographic data in 23/27 patients whose haemodynamic status allowed this type of exploration. Seventeen patients (63 p. 100) died during the first post-operative month, 10 survived and were discharged. Factors that influenced the prognosis were: (1) inferiorly-located necrosis associated with a 75 p. 100 mortality rate (9 out of 12 patients), as opposed to 53 p. 100 (8 out of 15 patients) with anterior necrosis; (2) right ventricular dysfunction, observed in 83 p. 100 of patients with inferior necrosis and 53 p. 100 with anterior necrosis, which was responsible for 7 out of 9 deaths in the inferior necrosis subgroup and contributed to 3 out of 8 deaths in the anterior necrosis subgroup; this established a cause-effect relationship between right ventricular function and the overmortality of patients with inferior necrosis; (3) independently of the haemodynamic status, two- and three-vessel lesions (56 p. 100 of all lesions) which had an 84 p. 100 mortality rate as opposed to 40 p. 100 with one-vessel lesions; (4) the presence of a state of shock which was associated with a 78 p. 100 mortality rate as opposed to 55 p. 100 in patients without shock. We conclude that when permitted by the patient's haemodynamic status coronary angiography should be part of the pre-operative evaluation to assess the operative risk and guide the surgical procedure.

[Acute occlusion of the renal artery caused by an embolism of cardiac origin. Treatment by in situ thrombolysis]. / Occlusion aiguë de l'artère rénale par une embolie d'origine cardiaque. Traitement par thrombolyse in situ.

An intra-arterial infusion of streptokinase successfully dissolved a large thrombus of the renal artery in a 54-year old male patient with old-standing mitral stenosis. This case illustrates the effectiveness of fibrinolysis in situ. This method provides complete arterial recanalization and preserves the renal function, thus enabling surgical embolectomy to be performed.

[Coronary angioplasty in patients aged 70 and over. Immediate results and later outcome]. / L'angioplastie coronaire chez le sujet âgé de 70 ans et plus. Résultats immédiats et devenir à moyen terme.

One hundred and ninety one consecutive patients over 70 years of age (127 men and 64 women, average age 75.6 years) underwent percutaneous transluminal coronary angioplasty (PTCA) between January 1986 and February 1989. One hundred and sixty patients had severe angina (20 Class III and 140 Class IV), 72 patients had previous myocardial infarction, 36 of which were recent (less than 1 month), and 6 patients had previously undergone coronary bypass surgery. The coronary lesions affected one vessel in 67 patients and more than one vessel in 124 patients. The left ventricular ejection fraction was less than 50% in 15 patients. Angioplasty was attempted on 245 lesions (228 stenoses and 17 occlusions): 1 lesion in 141 patients, 2 lesions in 46 patients, 3 lesions in 4 patients, with a primary success rate of 81% in stenotic and 41% in occluded arteries. There were 9 deaths (4.7%) 6 of which occurred in patients with multivessel disease and unstable angina; there were 6 Q-wave infarctions (3.1%), 8 non Q-wave infarctions (4.2%) and 3 emergency coronary bypass operations (1.6%). The first 123 patients of this series were followed up for an average of 18.8 months (7 to 37 months). Follow-up of the 100 patients successfully dilated (4 lost to follow-up) showed that 55 remained improved (53 asymptomatic), 25 had recurrent angina after the initial improvement due to restenosis in 19, progression of coronary athero-sclerosis in 3, restenosis and an evolution of coronary atherosclerosis in 1 and a lesion which had been neglected in 2 cases.(ABSTRACT TRUNCATED AT 250 WORDS)

[Acute puerperal uterine inversion: two cases]. / Inversion utérine puerpérale aiguë: à propos de deux cas.

Acute puerperal inversion is both rare and serious (1/20000 deliveries in France) and may lead to significant morbidity and mortality. Outcome depends on the degree of uterine bleeding and the presence or not of a state of shock. Acute puerperal inversion occurs at the time of placental delivery. Four stages are usually described by degree of exteriorization of the uterus. The diagnosis is essentially clinical. The predisposing factors are hypotonic uterus, fundal implantation of the placenta and placental acretas. 60% of all cases are caused by precipitous manoeuvres including traction on the cord or improper fundal pressure. Once a diagnosis is made immediate measures must be undertaken to assure clinical stability of the mother. Manuel reinversion of the uterus must be done quickly to avoid a cervical stricture that may form within thirty minutes of the inversion making successful manipulation very difficult. Failure or reoccurrence requires surgical treatment either by abdominal or vaginal approach. We report on two cases: one of complete inversion leading to a hysterectomy in order to control bleeding and a second case of incomplete inversion where repositioning was successful.

[Evaluation of the prognosis of mitral valve prolapse]. / Evaluation du pronostic du prolapsus valvulaire mitral.

It is not easy to evaluate the prognosis of mitral valve prolapse. First of all, a positive diagnosis is difficult: the clinical insufficiencies are ill-compensated by sonocardiography as it is less reliable than expected; the very existence of the "mitral valve prolapse" described by Barlow is being challenged. Secondly, the most severe complications of mitral prolapse are rare, with respect to its frequency. Some complications are currently well defined. Thus, severe mitral insufficiency, leading to valve replacement, affects elderly men more than young women, although the pathological lesions correspond to the same disease. Endocarditis is rare and only occurs when there is an audible murmur. Rhythm disorders are varied, with however, frequent junction tachycardias and a marked influence of catecholamines, which may explain the clinical effectiveness of beta-blockers. Unfortunately, severe complications are not as well known. Thus, the risk of sudden death and cerebral vascular accident cannot be figured out from large statistical studies. Only studies of some so called "risk" sub-groups, should allow a better knowledge of these two complications and a more effective prevention.

[Usefulness of a collecting bag for the diagnosis of post-partum hemorrhage]. / Intérêt de l'utilisation d'un sac de recueil dans le diagnostic des hémorragies de la délivrance.

OBJECTIVE: Depending on the country and the publications, post-partum hemorrhage (PPH) is either the first or second cause of maternal death in the world, including in developed countries. It remains a significant source of morbidity, severe anemia, blood transfusion, transfusion complications, acquired coagulation disorders and hemostasis hysterectomy. Visual assessment underestimates the amount of blood loss in around 45% of cases. Emergency treatment is therefore sometimes undertaken with some delay, giving time for Disseminated Intravascular Coagulation (DIC) to occur, which worsens the prognosis. A collecting plastic bag put under the pelvis of the mother just after delivery is a quantitative and objective method of measuring blood loss. The objective was to assess sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), studying correlation between bag's volume and hemoglobin and hematocrit variation. MATERIALS AND METHODS: Included outpatients were women with unique pregnancy at term. Breech presentations were excluded. We measured serum hemoglobin and hematocrit just after admission for labor. A collecting bag, placed under the pelvis of each woman just after birth, was weighted after delivery. Serum hemoglobin and hematocrit were again assessed at three days. Post-partum hemorrhage was defined by a fall of hematocrit more than 10 points (delta Ht), or by a fall of hemoglobin more than 3g/dL (delta Hb). RESULTS: From January 2003 to May 2003, 272 patients were included. 8.9% of the results were unuseful (n=24). The mean volume of blood loss was 190 ml (5th p=29 ml, 10th p=48 ml, 90th p=610 ml, 95th p=824 ml). The mean delta Ht was 2.7 +/- 4 pts (16.5 / -4.8). The mean delta Hb was 1.2 +/- 1.4 g/dL (5.9 / -1.5). For a delta Ht=10 the calculated bag volume was 564 ml. With this cut off we noted 5.5% PPH (n=15) prevalence=0.06. Sensitivity=34.21%. Specificity=99%. PPV=86%. NPV=90.38%. For a delta Hb=3 the calculated bag volume was 486 ml. With this cut off we noted 10.7% PPH (n=24) prevalence of PPH=0.1. Sensitivity=38.77%. Specificity=95.96%, PPV=67. 85%. NPV=87.7%. CONCLUSION: The collecting pelvis bag is a rapid and precise procedure to diagnose PPH in the delivery room. It also enables a visual and quantitative non-subjective estimation of blood loss. Because of its simplicity and very low cost, the collecting pelvis bag should be used widely as a routine preventive measure.

[Behçet's disease and cardiovascular pathology]. / Maladie de Behçet et pathologie cardiovasculaire.

Behçet's syndrome appears in different localisations. Some of them were at the source of the initial description of the disease and are therefore well known. However, cardiovascular localisations were discovered later on and are worthy of detail. They may enable retrospective diagnosis and are an evolutive turning point in this still mysterious disease.

[Prenatal Bartter's syndrome. Report of two cases]. / Le syndrome de Bartter anténatal. A propos de deux cas.

Antenatal Bartter Syndrome (ABS) is a rare autosomic recessive tubulopathy characterized by idiopathic hydramnios, fetal polyuria and elevated levels of amniotic chloride. It is related to mutations affecting several transporters in the loop of Henle e.g. the Na-K-2Cl cotransporter, the chloride channel CLC-NKB and the potassium channel ROMK. We report two cases of ABS in siblings born to consanguineous parents (first cousins). The first pregnancy showed hydramnios of unknown etiology at week 23. Two amnio drains were performed at weeks 26 and 27. The baby was born in week 29 and developed polyuria with hyponatremia, hypokalemia and hyperaldosteronism. After eliminating diabetes insipidus and adrenal insufficiency, ABS was diagnosed. The baby was treated with 0.5 mg/kg/d indomethacine, which controlled the polyuria and the hydroelectrolytic disorder. The second pregnancy showed idiopathic hydramnios at week 24. The elevated amniotic chloride level (above 112 mmole/l) led to the antenatal diagnosis of ABS. The mother was treated with 1 mg/kg/d indomethacine until week 31 in order to stabilize the hydramnios. Two amnio drains at weeks 31 and 33 allowed the pregnancy to be prolonged until week 34. A genetic study of the family showed homozygosity of the NKCC2 gene marker suggesting its implication in the disease.

[Premature rupture of the membranes between 28 and 34 weeks of amenorrhea. Retrospective study apropos of 71 cases]. / Rupture prématurée des membranes entre 28 et 34 semaines d'aménorrhée. Etude rétrospective à propos de 71 cas.

OBJECTIVE: The aim of our study is to compare the outcome of infants born after preterm premature rupture of the membranes (PPROM) between 28 and 34 weeks gestation. We compare two groups of infants: group A, infants born in hospitals without neonatal intensive care unit, after PPROM with long tocolysis, no maternal prophylactic antibiotic therapy and no systematic maternal steroid therapy. Group B with systematic maternal steroid therapy, maternal prophylactic antibiotic therapy, short tocolysis and born in an hospital with neonatal intensive care unit. The latency period (time from rupture of membranes to the onset of labor) authorized was 15 days in the group B and not limited in the group A. RESULTS: Death (13.8% vs 0%; p=0.022), neonatal infection (66.6% vs 28.6%; p=0.0013), and respiratory distress (63.8% vs 34.3%; p=0.0144) were less frequent in the group B. The group A infants passed more than ten days in intensive care unit (61.1% vs 37.1%; p=0.043). Neonatal infection was not higher in the corticosteroïd therapy group (41.2% vs 70.3%; p=0.0135). There is more neonatal infection in the group A with long latency period (61.7% vs 24.3%; p=0.0014) and more chorioamnionitis (70.6% vs 24.3%; p<0.0001). CONCLUSION: The association maternal steroid and antibiotic therapy, short latency period, and hospitalization of the pregnant woman close to a neonatal intensive care unit reduce significantly the neonatal morbidity after preterm premature rupture of the membranes.