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1.
J Gynecol Obstet Hum Reprod ; 53(7): 102792, 2024 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-38663686

RESUMEN

INTRODUCTION: Laparoscopic sacrocolpopexy (LSCP) is currently the gold standard surgical technique for treating pelvic prolapse. This study aimed to evaluate the feasibility of laparoscopic sacrocolpopexy in ambulatory care. PATIENTS AND METHODS: This prospective study was conducted to evaluate the feasibility of LSCP in women who visited the outpatient department of obstetrics and gynecology at the University Hospital of Strasbourg between July 2018 and December 2021. All women with indications for laparoscopic sacrocolpopexy for prolapse treatment who were willing to be treated as outpatients were included. The main criterion of the study was to evaluate the rate of re-hospitalization between discharge from the outpatient department after LSCP and postoperative follow-up consultations. RESULTS: Among the whole population (57/200, 28.5 %) included, 4 (7 %) were hospitalized. The quality of life was not altered with a preserved EuroQol (EQ-5D) quality of life score with a mean score of 73±18.4 standard deviation (SD) 95 % confidence interval (CI) (67.9; 78.1) on postoperative day 3 (D3) and 91.2 ± 16.3 SD 95 % CI (86.2-96) on D30. On D1, D2, D3, and D7, the anxiety rate evaluated by State-Trait Anxiety Inventory score (STAI Y-A) remained low, with mean scores of 24.8 ± 9.6 SD 95 % [23.4-26.5] on D30. All patients were satisfied or very satisfied with the procedure and outpatient management, with an average score of 9.6/10 (range: 8-10). CONCLUSION: This prospective, monocentric study evaluating the feasibility of outpatient LSCP reported demonstrated low rates of complications and re-hospitalization after outpatient management. Furthermore, the patients' quality of life was not altered, and they patients were satisfied with this type of management.


Asunto(s)
Procedimientos Quirúrgicos Ambulatorios , Estudios de Factibilidad , Laparoscopía , Prolapso de Órgano Pélvico , Calidad de Vida , Humanos , Femenino , Laparoscopía/métodos , Persona de Mediana Edad , Estudios Prospectivos , Prolapso de Órgano Pélvico/cirugía , Anciano , Procedimientos Quirúrgicos Ambulatorios/métodos , Procedimientos Quirúrgicos Ginecológicos/métodos , Readmisión del Paciente/estadística & datos numéricos
2.
Gynecol Obstet Fertil Senol ; 48(6): 491-499, 2020 06.
Artículo en Francés | MEDLINE | ID: mdl-32243912

RESUMEN

INTRODUCTION: The relevance of care is defined by the right act, for the right patient, at the right time. We were interested in the relevance of the management of presumed benign ovarian tumors before and after the release of the CNGOF guidelines 2013 (French guidelines). METHODS: This is a retrospective observational study conducted at the University Hospital in Strasburg France from 01/01/2013 to 31/12/2017 including all patients treated for a presumed benign ovarian cyst. We were interested in the diagnostic approach: relevance of the prescribed imaging and the use of CA 125 dosage, in the therapeutic approach: the relevance of the technique used as well as the relevance of the surgical indication. We compared our practices between 2013 and 2017 for these same items. RESULTS: We included 682 cysts for 621 patients, the imaging performed was relevant in 55% of cases, not relevant but justified in 25% and irrelevant in 20%. The CA 125 assay or its absence of assay was relevant in 84% of cases. The surgical technique was relevant in 67% of cases and not relevant but justified in 29%. With a significant improvement 7.1% in 2013 of irrelevant against 0.9% for the year 2017. The surgical indication was relevant in 72% of cases, not relevant but justified in 20% and irrelevant in 2.7%. CONCLUSIONS: The analysis of the relevance of care allows an evaluation of our practices. Professional recommendations can have an impact on the quality of care.


Asunto(s)
Neoplasias Ováricas/diagnóstico , Neoplasias Ováricas/terapia , Calidad de la Atención de Salud/estadística & datos numéricos , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Antígeno Ca-125/sangre , Femenino , Francia , Procedimientos Quirúrgicos Ginecológicos/estadística & datos numéricos , Humanos , Persona de Mediana Edad , Quistes Ováricos/diagnóstico , Quistes Ováricos/terapia , Guías de Práctica Clínica como Asunto , Estudios Retrospectivos
3.
Gynecol Obstet Fertil Senol ; 45(5): 262-268, 2017 May.
Artículo en Francés | MEDLINE | ID: mdl-28476591

RESUMEN

OBJECTIVES: To study the effects of laparoscopic repair of isthmoceles acquired after a cesarean section on symptoms and fertility. METHODS: This retrospective case series study included symptomatic women (abnormal uterine bleeding and/or pelvic pain and/or infertility) suffering from a large isthmocele and treated laparoscopically in our center. The surgical procedure consisted in resecting the pouch and suturing the scar in 2 layers. The patient follow-up has been realised through the postoperative control, the medical file and a survey, and concerned the evolution of the symptoms and fertility. RESULTS: Nine patients have been included, all suffering from large isthmoceles, diagnosed by transvaginal ultrasound associated with hysteroscopy, hysterosalpingography or MRI. Postoperatively, the symptoms disappeared in 78% of the patients. There have been 4 spontaneous pregnancies in 4 patients, 3 of them had been diagnosed with infertility. The median patient medical follow-up lasted 28 months. CONCLUSION: The diagnosis of a large isthmocele in patients suffering from invalidant symptoms and infertility should lead to consider a surgical treatment which is an efficient and surgically safe procedure.


Asunto(s)
Cesárea/efectos adversos , Cicatriz/cirugía , Laparoscopía/métodos , Adulto , Cicatriz/complicaciones , Cicatriz/diagnóstico , Femenino , Humanos , Infertilidad Femenina , Dolor Pélvico , Estudios Retrospectivos , Resultado del Tratamiento , Hemorragia Uterina
4.
Indoor Air ; 26(6): 880-891, 2016 12.
Artículo en Inglés | MEDLINE | ID: mdl-26643593

RESUMEN

Little is known about the health effects of school-related indoor dampness and microbial exposures. In this study, we investigated dampness and dampness-related agents in both homes and schools and their association with allergy and respiratory health effects in 330 Danish pupils. Classroom dampness was identified based on technical inspection and bedroom dampness on parents' self-report. Classroom and bedroom dust was analyzed for seven microbial components. Skin prick testing determined atopic sensitization. Lung function was expressed as z-scores for forced expiratory volume in one-second (zFEV1 ), forced vital capacity (zFVC) and the ratio zFEV1 /zFVC using GLI-2012 prediction equations. The parents reported children's allergies, airway symptoms, and doctor-diagnosed asthma. High classroom dampness, but not bedroom dampness, was negatively associated with zFEV1 (ß-coef. -0.71; 95% CI -1.17 to -0.23) and zFVC (ß-coef. -0.52; 95% CI -0.98 to -0.06) and positively with wheezing (OR 8.09; 95% CI 1.49 to 43.97). No consistent findings were found between any individual microbial components or combination of microbial components and health outcomes. Among other indoor risk factors, environmental tobacco smoke (ETS) decreased zFEV1 (ß-coef. -0.22; 95% CI -0.42 to -0.02) and zFEV1 /zFVCratio (ß-coef. -0.26; 95% CI -0.44 to -0.07) and increased upper airway symptoms (OR 1.66; 95% CI 1.03-2.66). In conclusion, dampness in classrooms may have adverse respiratory health effects in pupils, but microbial agents responsible for this effect remain unknown.


Asunto(s)
Contaminación del Aire Interior , Humedad/efectos adversos , Hipersensibilidad/etiología , Enfermedades Respiratorias/etiología , Niño , Estudios Transversales , Dinamarca , Femenino , Volumen Espiratorio Forzado , Vivienda , Humanos , Masculino , Pruebas de Función Respiratoria , Instituciones Académicas , Contaminación por Humo de Tabaco/efectos adversos
7.
Indoor Air ; 25(3): 245-59, 2015 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-25039673

RESUMEN

Little is known about the geographic variation and determinants of bacterial endotoxin and ß-(1,3)-D-glucan in Danish house dust. In a population of 317 children, we: (i) described loads and concentrations of floor dust, endotoxin, and ß-(1→3)-D-glucan and (ii) their correlations and (iii) assessed their determinants; (iv) Finally, we compared our findings with previous European studies. Bedroom floor dust was analyzed for endotoxin content by the kinetic limulus amoebocyte lysate assay and for ß-(1→3)-D-glucan by the inhibition enzyme immunoassay. The parents answered questions regarding potential determinants. We found: geometric means (geometric standard deviations) 186 mg/m(2) (4.3) for dust; 5.46 × 10(3) EU/m(2) (8.0) and 31.1 × 10(3) EU/g (2.6) for endotoxin; and 142 µg/m(2) (14.3) and 0.71 × 10(3) µg/g (7.3) for ß-(1→3)-D-glucan. High correlations (r > 0.75) were found between floor dust and endotoxin and ß-(1→3)-D-glucan loads, while endotoxin and ß-(1→3)-D-glucan concentrations were moderately correlated (r = 0.36-0.41) with the dust load. Having a carpet was positively associated with dust load and with endotoxin and ß-(1→3)-D-glucan concentrations. Pet keeping, dwelling type, and dwelling location were determinants of endotoxin concentrations. No other determinants were associated with ß-(1→3)-D-glucan concentrations. Compared with other European studies, we found lower ß-(1→3)-D-glucan loads and concentrations but higher endotoxin loads and concentrations suggesting a geographically determined different composition of Danish floor dust compared with other European regions.


Asunto(s)
Contaminación del Aire Interior/análisis , Polvo/análisis , Endotoxinas/análisis , Exposición a Riesgos Ambientales/análisis , beta-Glucanos/análisis , Animales , Lechos , Niño , Estudios Transversales , Dinamarca , Femenino , Pisos y Cubiertas de Piso , Vivienda , Humanos , Masculino , Mascotas , Proteoglicanos
9.
Allergy ; 69(8): 1008-25, 2014 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-24909706

RESUMEN

Food allergy can result in considerable morbidity, impact negatively on quality of life, and prove costly in terms of medical care. These guidelines have been prepared by the European Academy of Allergy and Clinical Immunology's (EAACI) Guidelines for Food Allergy and Anaphylaxis Group, building on previous EAACI position papers on adverse reaction to foods and three recent systematic reviews on the epidemiology, diagnosis, and management of food allergy, and provide evidence-based recommendations for the diagnosis and management of food allergy. While the primary audience is allergists, this document is relevant for all other healthcare professionals, including primary care physicians, and pediatric and adult specialists, dieticians, pharmacists and paramedics. Our current understanding of the manifestations of food allergy, the role of diagnostic tests, and the effective management of patients of all ages with food allergy is presented. The acute management of non-life-threatening reactions is covered in these guidelines, but for guidance on the emergency management of anaphylaxis, readers are referred to the related EAACI Anaphylaxis Guidelines.


Asunto(s)
Anafilaxia/diagnóstico , Anafilaxia/terapia , Hipersensibilidad a los Alimentos/diagnóstico , Hipersensibilidad a los Alimentos/terapia , Anafilaxia/epidemiología , Manejo de la Enfermedad , Hipersensibilidad a los Alimentos/epidemiología , Humanos
10.
Allergy ; 69(5): 581-9, 2014 May.
Artículo en Inglés | MEDLINE | ID: mdl-24433563

RESUMEN

BACKGROUND: Food allergies can have serious physical, social, and financial consequences. This systematic review examined ways to prevent the development of food allergy in children and adults. METHODS: Seven bibliographic databases were searched from their inception to September 30, 2012, for systematic reviews, randomized controlled trials, quasi-randomized controlled trials, controlled clinical trials, controlled before-and-after studies, interrupted time series studies, and prospective cohort studies. Experts were consulted for additional studies. There were no language or geographic restrictions. Two reviewers appraised the studies using appropriate tools. Data were not suitable for meta-analysis due to heterogeneity, so were narratively synthesized. RESULTS: Seventy-four studies were included, one-third of which were of high quality. There was no good evidence to recommend that pregnant or breastfeeding women should change their diet or take supplements to prevent allergies in infants at high or normal risk. There were mixed findings about the preventive benefits of breastfeeding for infants at high or normal risk, but there was evidence to recommend avoiding cow's milk and substituting with extensively or partially hydrolyzed whey or casein formulas for infants at high risk for the first 4 months. Soy milk and delaying the introduction of solid foods beyond 4 months did not have preventive benefits in those at high or normal risk. There was very little evidence about strategies for preventing food allergy in older children or adults. CONCLUSIONS: There is much to learn about preventing food allergy, and this is a priority given the high societal and healthcare costs involved.


Asunto(s)
Hipersensibilidad a los Alimentos/prevención & control , Prevención Primaria , Adulto , Lactancia Materna , Niño , Preescolar , Femenino , Humanos , Lactante , Fórmulas Infantiles , Recién Nacido , Masculino , Embarazo
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