[Air embolism and exploratory hysteroscopy: myths or realities? Preliminary results]. / Embolie gazeuse et hystéroscopie exploratoire: mythes ou réalités? Note préliminaire.

OBJECTIVE: Authors tried to evaluate the prevalence of air embolism which is a severe complication of carbon dioxide hysteroscopy. DESIGN: On one hand, a retrospective inquiry with 18 hyperbaric oxygen therapy units over a 8 year period (1985 to 1992 included); and on the other hand, a prospective study with monthly survey to 84 public Gynaecology units during a 2 year period (January 1991 the 1st to December 1992 the 31st). RESULTS: From the 18 hyperbaric oxygen therapy units receiving iatrogenic air embolism, gynaecologic endoscopy represent 20% of the patients. Among these, 2/3 come from laparoscopy and 1/3 from hysteroscopy. In the prospective study, 42 public Gynaecology units made 5,140 carbon dioxide hysteroscopies. Three air embolism were declared in this population (i.e. 0.58/1000) with 1 death and 2 recoveries without sequelae after hyperbaric oxygen therapy. CONCLUSION: Analysis of these cases suggest that, for this risk, one should oppose ambulatory hysteroscopy without anaesthesia to hysteroscopy under general anaesthesia with frequent cervical dilatation, prolonged duration and different underlying pathology.

[Maternal behavior toward her newborn infant. Potential modification by peridural analgesia or childbirth preparation]. / Le comportement de la mère face à son enfant à la naissance. Ses modifications éventuelles par l'analgésie péridurale ou la préparation à la naissance.

The effects of sophrology and epidural analgesia on early relationship between the mother and her child were studied on a simple of 190 deliveries. The mothers were observed during and just after delivery. Mothers who had been separated from their child before the end of the observation were excluded from the study. The patients had the choice between epidural analgesia or prenatal care with sophrology. Participation to prenatal courses has statistically a positive effect on the relation between the mother and her child (p less than 0.01). Instead, epidural analgesia and posture have very limited effect on this factor. However, a trend to more interaction is found in multipari and patients who didn't choose epidural analgesia.

[Non-assistance or malicious avoidance of treating patients in obstetrics and neonatology. Analysis of its jurisprudence]. / La non-assistance ou abstention délictueuse en obstétrique et en néonatologie. Bilan de la jurisprudence.

1947 was the date of the first prosecution for failure to assist a person in danger at the time of delivery. Before coming back to it the authors define the constitutional elements of breaking the law as specified in article 63, paragraph 2 of the Penal Code in connection with applying articles 319 and 320 which concern homicide or involuntary bodily harm (or recklessness) which are the most often used in medicine. After that they present the court records of a number of cases which for the most part have not been published, from the Tribunals or the Appeal Courts of cases where prosecution could resulting up to 5 years of imprisonment or a fine of 20,000 F for general practitioners, specialists, gynaecologists and obstetricians or midwives who are indicted under these conditions. A series of 18 case histories which cover pregnancy, delivery and help for the newborn at risk in the first days of life, should lead to a good was of preventing this medico-legal risk, which is little known but very real. It requires great care by practitioners when called to urgent cases and a thorough and proper handling over to a colleague or to a team who are more able to give help, as well as good control of the conditions under which resuscitation is carried out and under which the newborn is monitored in the neonatal period. It is emphasized that the biggest risk run by the doctor who is responsible for the care of the pregnancy, of the delivery or resuscitation of the newborn is later not to be able to deny false information that may be given about the risks run by the victim, and to challenge the accusation that he was unwilling to give help. It is only by keeping good notes and by the evidence of witnesses that later provide indisputable proof against accusations of his failure, which characterize cases of failure to assist people in danger in medicine, can be fought. This risk is particularly strong in obstetrics and in neonatology.

[Endocrine aspects of Steinert's disease]. / Aspects endocriniens de la maladie de Steinert

The authors report a case of Steinert's disease in a woman and discuss the endocrine profile of this disease after giving an account of the criteria of diagnosis. Disorders of gonad function are mild in women, primary testicular atrophy is very frequent in man with reduction in 17-ketosteroids and testosterone. Thyroid function was normal but, in a few cases, a low fixation curve was found (our case) corrected by TSH stimulation. The frequency of cataract emphasizes the interest of this sign for detection. Diabetes, associated with hyperinsulinism, seemed more frequent than in a population without Steinert's disease. The pathogenesis of these endocrine disorders appears secondary and is ill explained if one considers it as a single disease. Better knowledge, no doubt linked to progress in biochemistry of normal and myopathic muscle, will help to explain the pathogenesis.