[The temporal and spatial position of "hallucinatory stories". A study of the spatial and temporal position in the narratives of schizophrenic patients hearing voices]. / La position temporelle et spatiale dans les "histoires hallucinées". Etude de la position spatiale et temporelle dans les discours de patients schizophrènes entendant des voix.

INTRODUCTION: Hallucinations are often defined as perceptions when there is no object to perceive. However, clinical practitioners only have access to what their patients tell them about their hallucinations. By cooperating in the construction of a meaning for the hallucination, practitioner and patient can reach a common ground. This "co-construction" produces "hallucinatory stories" that are narratives, which revolve around this phenomenon. This raises the question of where the voices are temporally and spatially in the structure of the narrative. METHODS: Fourteen patients meeting the DSM-IV schizophrenia criteria were included and took part in a filmed standardized interview. The markers of temporal and spatial localization were listed and their occurrence in the narrative calculated (Student t test and Wilcoxon test). RESULT: The results revealed that: a significant difference between the present perfect tenses. There is a distinction between what is happening now and what has happened in the past; a significant difference between the markers of temporal localization such as accomplishment and position. The hallucinatory phenomena repeat themselves. Furthermore, the subjects' judgements concerning the moment at which the hallucinatory phenomenon arises are objective and are accompanied by a temporal reference associated with their story; a significant difference between the markers of spatial localization, with relative positions being preferred. The voices constitute a distinct, autonomous spatial reference for hallucination subjects. CONCLUSION: The narrative makes it possible to give the hallucinatory voices a place in the subject's story. The "hallucinatory stories" represent a transition from the private to the intersubjective world, a way for subjects to appropriate these experiences. When articulated in words, this experience is a product distinct from the self. This distinction between self and non-self, the hallucinating patient and his/her voices, seems to be conveyed in part by the markers of temporal and spatial position.

[Chronic fatigue syndrome: A new disorder?] / Le syndrome de fatigue chronique : une nouvelle maladie ?

More than 30 years after its individualization, chronic fatigue syndrome (CFS) remains a debilitating condition for the patient and a confusing one to the physicians, both because of diagnostic difficulties and poorly codified management. Despite the numerous work carried out, its pathophysiology remains unclear, but a multifactorial origin is suggested with triggering (infections) and maintenance (psychological) factors as well as the persistence of inflammatory (low grade inflammation, microglial activation…), immunologic (decrease of NK cells, abnormal cytokine production, reactivity to a variety of allergens, role of estrogens…) and muscular (mitochondrial dysfunction and failure of bioenergetic performance) abnormalities at the origin of multiple dysfunctions (endocrine, neuromuscular, cardiovascular, digestive…). The complexity of the problem and the sometimes contradictory results of available studies performed so far are at the origin of different pathophysiological and diagnostic concepts. Based on a rigorous analysis of scientific data, the new American concept of Systemic Disease Exertion Intolerance proposed in 2015 simplifies the diagnostic approach and breaks with the past and terminologies (CFS and myalgic encephalomyelitis). It is still too early to distinguish a new disease, but this initiative is a strong signal to intensify the recognition and management of patients with CFS and stimulate research.

Antenatal predictors of the neurologic sequelae at 3 years of age: a multivariate analysis.

OBJECTIVE: To study the association between fetal blood flow abnormalities and the occurrence of long-term neurologic sequelae. STUDY DESIGN: Umbilical, aortic and middle cerebral artery blood flow parameters were obtained by Doppler examination and retrospectively analyzed in 128 high-risk singleton pregnancies, followed by neurologic examination of the surviving children at 3 years of age. Traditional parameters of neurologic outcome (Apgar scores, intrauterine growth retardation (IUGR), umbilical artery pH and base deficit, gestational age, birth weight, newborn encephalopathy, mode of delivery, fetal heart rate, neurosonographic examination) were included as possible confounding factors. Mann-Whitney U-test, Student's t-test, analysis of variance or Fisher's exact test, where applicable, were used for the univariate analysis. A stepwise logistic regression procedure was conducted to test the independent association of selected perinatal risk factors on neurological outcome. Statistical significance was assumed at P<0.05. RESULTS: Eighteen out of 114 surviving children suffered neurologic illness at 3 years of age. Four children had major neurologic dysfunction and the remaining 14 suffered minor or mild form of the disease. Although blood flow parameters and various perinatal parameters did not differ significantly between the group of children with major neurologic dysfunction and healthy children, aortic resistance index showed an independent association with occurrence of minor or mild neurologic disabilities. CONCLUSION: Antenatal evaluation of the aortic blood flow might be an important predictive variable for permanent neurologic disturbances.

Local estrogen treatment in patients with urogenital symptoms.

OBJECTIVES: Determination of the efficacy and safety of vaginally administered low dose (25 microg) micronized 17beta-estradiol in the management of patients with urogenital symptoms. METHODS: A total of 1612 patients with urogenital complaints were randomized to receive 25 microg of micronized 17beta-estradiol (n=828) or placebo (n=784) in a multicenter double-blind placebo-controlled study running for 12 months. Female patients were treated once a day over a period of 2 weeks, and then twice a week for the remaining of the 12 months with an active or placebo tablet. The assessment included full history-questionnaire, micturition diary, gynecologic and cystometric examination, transvaginal ultrasound, and serum 17beta-estradiol level determination. It was carried out at the beginning, and after 4 and 12 months of treatment. RESULTS: The overall success rate of micronized 17beta-estradiol and placebo on subjective and objective symptoms of postmenopausal women with vaginal atrophy was 85.5%, and 41.4%, respectively. A significant improvement of urinary atrophy symptoms was determined in vaginal ERT group as compared with the beginning of the study (51.9% vs. 15.5%, P=0.001). The maximal cystometric capacity (290 ml vs. 200 ml, P=0.023), the volume of the urinary bladder at which patients first felt urgency (180 vs. 140, P=0.048), and strong desire to void (170 ml vs. 130 ml, P=0.045) were significantly increased subsequent to the micronized 17beta-estradiol treatment. The number of patients with uninhibited bladder contractions significantly decreased following micronized 17beta-estradiol as compared with pretreatment values (17/30, P=0.013). Side effects were observed in 61 (7.8%) patients treated with low dose micronized 17beta-estradiol. Therapy with 25 microg of micronized 17beta-estradiol did not raise serum estrogen level nor stimulated endometrial growth. CONCLUSIONS: Local administration of 25 microg of micronized 17beta-estradiol is an effective and a safe treatment option in the management of women with urogenital complaints.

The effect of high birth weight (400 g or more) on the weight and height of adult men and women.

Three hundred and twenty eight examined adult men and 346 examined adult women were macrosomic at birth (4000 g or over). The control group consisted of 564 adult men and 749 adult women with birth weights of 2500 to 3999 g. Both male and female macrosomic babies achieve greater weights and heights in adulthood than those in the control group. There are more overweight and obese men in the macrosomic group than in the control group and the same is true of the women (p < 0.001). The mean values of the BMI (body mass index) for the macrosomic adults are greater than those for the control group (p < 0.001). Fetal macrosomia is a good predictor of the weight and height of adult men and women.

Perinatal outcome of pregnancies in women aged 40 and over.

Perinatal outcome of pregnancies at forty and over was analyzed starting from the diagnosis of pregnancy to seven days following delivery. Retrospectively, pre-gestational health and reproduction status were dealt with, as well as the course of pregnancy, deliveries, and newborn children (study group). The control group was composed of pregnant women aged 20 to 29, who were identical to study group in terms of parity. Statistical data processing was done by means of chi2-test, and contingency 2 x 2 tables. The difference was significant if p < 0.05. Out of 2,099 diagnosed wanted pregnancies at forty and over, 415 (19.8%) had a miscarriage, in 33 (1.6%) an artificial abortion was performed after determining the fetus karyotype and 1,651 (78.2%) of pregnant women delivered. In 66.2% of pregnancies the fetus karyotype was determined and in 33 (2.5%) fetuses chromosomal abnormalities were found Incidence of deliveries at 40 and over is 1.38%, which is a 35.6-percent increase in the last ten years. Nullipara and pluripara had an increase, and multipara had a decrease. Pre-gestational health and reproduction status in study group is lower than in control group. Complications during pregnancy: threatened abortion, EPH gestosis, placenta praevia, gestational diabetes, late fetal death are more frequent than in control group (p < 0.05). In intrapartal terms, more frequent were induction of delivery, meconium-stained amniotic fluid, fetal distress, operative vaginal deliveries, and Cesarean section (p < 0.05). In neonatal outcome there are more premature infant, there are more VLBW, LBW, SGA, newborn with low Apgar index values, and the total perinatal death is greater than in the control group (p < 0.05). In perinatal terms, (from the diagnosis to the seventh day following delivery) 1,617 children survived (77.0%), meaning that perinatal loss was 482 (23.0%). Authors conclude that pregnancy at 40 and over is a high-risk pregnancy. There is a high risk of pre-gestational and gestational complications, and perinatal loss is high. Therefore, those pregnancies are not desirable from the medical point of view.

[Prenatal diagnosis of coiling of the umbilical cord around the neck and its effect on early neonatal prognosis]. / Antenatalna dijagnoza omotane pupkovine oko vrata i utjecaj na ranu neonatalnu prognozu.

"Real time" ultrasonic equipment enables antenatal diagnosis of nuchal encirclement by the umbilical cord. One hundred cases of normal term pregnancies were sonographically examined immediately before programmed delivery induction with a purpose of finding the cord around fetal neck. During the delivery all the patients were CTG monitored, after delivery the blood was taken from the umbilical artery for the acid-base balance analysis and also the Apgar score was determined. One of a hundred examined cases falsely negative and one falsely positive result were found which indicates that the method is highly sensitive and specific (sensitivity 94.1%, specificity 98.8%). There was a statistically significant difference (P less than 0.005) between acid-base balance, CTG and Apgar score in a group of the newborns with nuchal cord. The active antenatal ultrasonic search for umbilical cord around the fetal neck can significantly reduce the frequency of intrapartal hypoxia as well as the perinatal mortality and morbidity.

Hepatitis B virus infection among pregnant women in Split region.

A seroepidemiologic survey of pregnant women in Split region was performed in order to determine a strategy for prenatal screening for HBsAg. Thirty (7.5%) of 400 women had the markers of past or current HBV infection, while 3/400 (0.75%) were carriers. According to demographic data and risk factors they represent low risk population. General prenatal screening for HBsAg is advisable.

Maintenance of labour.

In 160 women large but variable amounts of intravenous oxytocin were needed to induce labour within a reasonable time interval to 5 cm cervical dilatation. Thereafter 7 mU of oxytocin/min would maintain progress. Since large maintenance doses may cause obstetric problems it is recommended that a maintenance regimen should be used once labour has progressed to this stage.

[The breech partogram]. / Partogram zatka.

A partogram was made after analysis 383 spontaneous breech deliveries of primiparas and 343 of multiparas. The height of parturients was 160 cm or more, gestational age between 37 and 42 weeks and the newborn birthweight between 2500 and 3900 g. The newborns did not show any signs of fetal damage from the period of pregnancy or delivery. The duration of delivery was counted from the time of the cervical dilatation of 2 cm or more. A partogram was made after the statistical analysis of particular cervical dilatation phases; the duration of delivery in primiparas was up to 13 hours and 15 minutes and in multiparas up to 10 hours and 40 minutes. The second stage of delivery in primiparas was 1 hour and 20 minutes and in multiparas 40 minutes. The distribution of data concerning the duration of delivery demonstrated by the mean value and SD was symmetrical; the mean value of the duration of delivery with 99% of reliability was from 9 hours up to 10 hours and 54 minutes for primiparas and from 8 hours and 19 minutes up to 9 hours, and 18 minutes for multiparas. Breech delivery was accelerated in the earlier dilatation phase if compared to the later phase which was significantly slowed down.

The study of morphology and circulation of early embryo by three-dimensional ultrasound and power Doppler.

Three-dimensional (3-D) ultrasound plays an important role in obstetrics predominantly for assessing fetal anatomy. Presenting volume data in a standard anatomic orientation assists both ultrasonographers and pregnant patients to recognize anatomy more readily. Three-dimensional ultrasound is advantageous for the study of normal embryonic and/or fetal development, as well as providing information for families at risk for specific congenital anomalies by confirming normality. This method offers advantages in assessing the embryo in the first trimester as it is able to obtain multiplanar images through endovaginal volume acquisition. Rotation of the embryo and close scrutiny of the volume allow the systematic review of anatomic structures such as cord insertion, limb buds, cerebral cavities, stomach and bladder. Using this modality one can easily obtain the volumes of the gestational sac and yolk sac and can evaluate their relationship to prediction of pregnancy outcome. Three-dimensional power Doppler sonography has the potential to study process of placentation and evaluate the development of the embryonic and fetal cardiovascular systems. Three-dimensional ultrasound imaging in vivo compliments pathologic and histologic evaluation of the developing embryo, giving rise to a new term: 3-D sonoembryology. Rapid technological development will allow real-time 3-D ultrasound to provide improved and expanded patient care on the one side, and increased knowledge of developmental anatomy on the another.

Laparoscopic and laparotomic cholecystectomy: a randomized trial comparing postoperative respiratory function.

BACKGROUND: The fact that pulmonary complications occur in 20-60% of the patients subjected to abdominal operations clearly indicates that the lungs are the most endangered organ during the postoperative period. OBJECTIVE: The aim of this study was to demonstrate the impact of cholecystectomy on postoperative respiratory disturbances by comparing the laparotomic cholecystectomy with laparoscopic gallbladder removal. PATIENTS AND METHODS: A hundred cholecystectomized patients were included in the prospective randomized clinical trial. Half of the patients were operated on by the laparotomic procedure, whereas the other half underwent laparoscopic cholecystectomy. Spirometric parameters, arterial blood gases, and acid-base balance were determined before the operation, and at 6, 24, 72 and 144 h postoperatively. Abdominal distension was assessed by auscultating intestinal peristaltics, abdominal circumference measurement, and time interval to restitution of defecation. RESULTS: Six hours postoperatively, the values of ventilation parameters decreased on average by 40-50% from the baseline preoperative values in both groups of patients. The group of patients submitted to laparotomic cholecystectomy had significantly lower spirometric values and slower recovery of the ventilation parameters than the laparoscopic cholecystectomy group. Abdominal circumference was significantly greater and the time needed for restitution of peristaltics and defecation was significantly longer in the laparotomic cholecystectomy group compared to the group of laparoscopic cholecystectomy. CONCLUSIONS: Statistically significant impairments including hypoxia, hypocapnia and hyperventilation were observed in the patients submitted to laparotomic cholecystectomy, indicating the presence of objective respiratory risk, especially in elderly patients and patients with obstructive pulmonary diseases or cardiac insufficiency.