ABSTRACT
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.
Subject(s)
Embolism, Air/etiology , Hysteroscopy/adverse effects , Adult , Aged , Aged, 80 and over , Carbon Dioxide , Embolism, Air/epidemiology , Embolism, Air/therapy , France/epidemiology , Humans , Hyperbaric Oxygenation , Incidence , Laparoscopy/adverse effects , Population Surveillance , Prevalence , Prospective Studies , Retrospective StudiesABSTRACT
Interest for the psychopathological field of trauma has experienced a revival over the last fifteen years. Early and active treatment of victims is necessary to attenuate the psychopathological consequences of trauma. However, emergency psychiatry still rarely places a high value on it. This paper presents a case which contains in itself many aspects of psychological responses to psychologically traumatizing events. Trauma induced in this case, in particular, Dissociative Disorders (including a Dissociative Fugue), a Post-Traumatic Stress Disorder, Somatoform Disorders and Phobic Disorders. This case gives us the opportunity to situate the psychiatric emergency--"psychological trauma"--and to illustrate our talk with regard to the principles of mid-term and emergency treatment of victims.
Subject(s)
Crisis Intervention/methods , Dissociative Disorders/psychology , Dissociative Disorders/therapy , Emergency Services, Psychiatric/methods , Phobic Disorders/psychology , Phobic Disorders/therapy , Rape/psychology , Somatoform Disorders/psychology , Somatoform Disorders/therapy , Stress Disorders, Post-Traumatic/psychology , Stress Disorders, Post-Traumatic/therapy , Adult , Emergencies , Female , HumansSubject(s)
Ethics, Medical , Legislation, Medical , Prenatal Diagnosis , Reproductive Techniques , France , HumansSubject(s)
Gynecology/legislation & jurisprudence , Mass Screening/legislation & jurisprudence , Obstetrics/legislation & jurisprudence , Prenatal Diagnosis/adverse effects , Female , France , Gynecology/methods , Humans , Liability, Legal , Malpractice/legislation & jurisprudence , Mass Screening/methods , Obstetrics/methods , Prenatal Diagnosis/methodsSubject(s)
Insurance , Legislation, Medical , Sterilization, Tubal/economics , Female , France , HumansABSTRACT
In France, a law concerning biomedical research came into operation on 20 December 1988. This law is called loi Huriet after the senator who chaired the investigation committee. This law provides rules to be applied when research is conducted on incapacitated people. Different rules apply depending on whether the person concerned is an adult or not and whether he or she will benefit directly from the research. This law, and the law of 3 January 1968 concerning adult incapacitated persons, are discussed and their deficiencies are highlighted. Recommendations for improvements are made by the authors.