Respiratory syncytial virus associated hospitalizations in preterm infants of 29 to 32 weeks gestational age using a risk score tool for palivizumab prophylaxis.

To evaluate the efficacy of palivizumab in infants of 29 to 32 weeks of gestational age (GA) based on a risk score tool developed for Austria. Retrospective single-center cohort study including all preterm infants of 29 (+0) to 32 (+6) weeks of GA born between 2004 and 2012 at a tertiary care university hospital. Data on RSV-related hospitalizations over the first 2 years of life were analyzed and compared between those having received palivizumab and those without. The study population was comprised of 789 of 816 screened infants, of whom 262 (33%) had received palivizumab and 527 (67%) had not. Nine of 107 rehospitalizations (8.4%) in the palivizumab group compared to 32 of 156 rehospitalizations (20.5%) in the group without prophylaxis were tested RSV-positive (p = 0.004; OR 0.356 [CI 90% 0.184-0.689]). Proven and calculated RSV hospitalization rate was 3.1% (8/262) in the palivizumab group and 5.9% (31/527) in the group without (p = 0.042; OR 0.504 [CI 90% 0.259-0.981]). Increasing number of risk factors (up to three) increased the RSV hospitalization rate in infants with (6.1%) and without (9.0%) prophylaxis. RSV-associated hospitalizations did not differ between groups with regard to length of stay, severity of infection, age at hospitalization, demand of supplemental oxygen, need for mechanical ventilation, and admission rate to the ICU. A risk score tool developed for infants of 29 to 32 weeks of gestational age led to a reduction of RSV-associated hospitalizations without influencing the severity of disease.

Placebo Controlled Introduction of Prophylactic Supplementation of Probiotics to Decrease the Incidence of Necrotizing Enterocolitis at Dhulikhel Hospital in Nepal.

Background Although recent reports suggest that the use of probiotics may enhance intestinal functions in premature infants, the mechanisms are unclear, and open questions remain regarding the safety and its efficacy. Objective The objective of this study is to evaluate the efficacy of probiotics on prevention of necrotizing enterocolitis in preterm infants in Nepal. Method We conducted a randomized, double blind, placebo controlled study of 72 hospitalized preterm infants. They were randomly allocated to receive probiotics (lactobacillus rhamnosus 35) at a dose of 0.8 mg in infants >1500 gms and 0.4 mg in infants <1500 gms in 2 ml of expressed breast milk two times daily or the same amount of expressed breast milk as placebo (without probiotics). Result Seventy-two patients were studied. The probiotics group (n=37) and placebo group (n=35) showed similar clinical characteristics. The incidence of necrotizing enterocolitis was found less frequently in the probiotic group (6/37, 16.2%) compared to the control group (10/35, 28.6%), this difference was not significant (p=0.16). This is 12.35% reduction in the incidence of necrotizing enterocolitis. Among the risk factors for necrotizing enterocolitis, pregnancy risk factors and perinatal risk factors were not significant. However neonatal risk factors were more frequent in the probiotic group (59.3%, n=32) than in the placebo group (40.7%, n=22), the difference was significant (p=0.02). Conclusion In the western world probiotics have been shown to be preventive in regard to necrotizing enterocolitis incidence. The present randomized trial showed a trend towards necrotizing enterocolitis minimal reduction in Nepal too. Further studies in a larger cohort are warranted to prove this effect for preterm infants.

Respiratory syncytial virus-associated hospitalizations over three consecutive seasons in children with congenital heart disease.

The purpose of this investigation was to analyze the burden of respiratory syncytial virus (RSV)-related hospitalizations in infants and children with congenital heart disease (CHD) over three consecutive RSV seasons. Retrospectively, all children with hemodynamically significant (HS-CHD) and not significant (HNS-CHD) CHD born between 2004 and 2008 at a tertiary care university hospital and identified by ICD-10 diagnoses were included. Data on RSV-related hospitalizations over the first three years of life covering at least three RSV seasons (November-April) were analyzed. The overall incidence of RSV-related hospitalization was 9.6 % (58/602), without a statistically significant difference between HS-CHD and HNS-CHD (7.3 % vs. 10.4 %; p = 0.258). Recommendation of palivizumab prophylaxis did not influence the RSV hospitalization rates between groups. Patients with HS-CHD and early surgery were significantly less often hospitalized due to RSV compared to those with delayed surgery (1.3 % vs. 14.3 %; p = 0.003). The median duration of hospitalization was 8.5 days (HS-CHD: 14 vs. HNS-CHD: 7 days; p = 0.003). Thirteen patients (22.4 %) were admitted to the intensive care unit (ICU), for a median of 10 days. The median age at admission was 2 months, with a significant difference between HS-CHD and HNS-CHD (6 vs. 2 months; p = 0.001). The majority (97 %) of RSV-related hospitalizations occurred before 12 months of age. Patients with HS-CHD had a significantly more severe course of RSV disease and were older at the time of hospitalization. Early surgery seemed to significantly reduce the risk of RSV hospitalization during the first RSV season.

[Methods in neonatal abstinence syndrome (NAS): results of a nationwide survey in Austria]. / Vorgehen bei Neonatalem Abstinenzsyndrom (NAS): Ergebnisse einer nationalen Umfrage in Österreich.

BACKGROUND: Neonatal abstinence syndrome (NAS) occurs in neonates whose mothers have taken addictive drugs or were under substitution therapy during pregnancy. Incidence numbers of NAS are on the rise globally, even in Austria NAS is not rare anymore. The aim of our survey was to reveal the status quo of dealing with NAS in Austria. METHODS: A questionnaire was sent to 20 neonatology departments all over Austria, items included questions on scoring, therapy, breast-feeding and follow-up procedures. RESULTS: The response rate was 95%, of which 94.7% had written guidelines concerning NAS. The median number of children being treated per year for NAS was 4. Finnegan scoring system is used in 100% of the responding departments. Morphine is being used most often, in opiate abuse (100%) as well as in multiple substance abuse (44.4%). The most frequent forms of morphine preparation are morphine and diluted tincture of opium. Frequency as well as dosage of medication vary broadly. 61.1% of the departments supported breast-feeding, regulations concerned participation in a substitution programme and general contraindications (HIV, HCV, HBV). Our results revealed that there is a big west-east gradient in patients being treated per year. CONCLUSION: NAS is not a rare entity anymore in Austria (up to 50 cases per year in Vienna). Our survey showed that most neonatology departments in Austria treat their patients following written guidelines. Although all of them base these guidelines on international recommendations there is no national consensus.

Short-term morbidities in moderate and late preterm infants.

OBJECTIVE: To determine (1) the association between neonatal morbidity and gestational age and (2) the impact of pre-existing maternal medical conditions, pregnancy and birth complications on neonatal outcome in moderate and late preterm infants (32-36 completed weeks). METHODS: Retrospective single-centre cohort study including all moderate and late preterm infants without congenital anomalies born at the Children's and Maternity Hospital Linz, Austria, between January 2007 and June 2010. Stepwise regression analysis was used to determine significant associations between morbidities, maternal and perinatal complications and the gestational age. RESULTS: Of 870 infants included the incidence of neonatal morbidities increased from 24% at 36 weeks to 43% at 35 weeks', 55% at 34 weeks', 75% at 33 weeks' and 93% at 32 weeks' gestation. Infants at 32 weeks had a 4-fold (RR: 3.88; 95% CI: 1.87-8.06) increased risk compared with those at 36 weeks, and infants of 32 weeks were 16 times (RR: 16.01; 95% CI: 9.82-26.09) more likely to be admitted to the NICU than infants of 36 weeks'. Hyperbilirubinemia (29%) and respiratory morbidity (14.3%) were the most common neonatal diagnoses. Intrauterine growth restriction, preeclampsia, preterm premature rupture of the membranes, lack of antenatal steroid administration, antepartum hemorrhage, multiple pregnancy and male gender were all associated with any kind of neonatal morbidity, admission rate to the NICU and length of hospital stay (p<0.05). CONCLUSION: Nearly half of all infants suffered from any morbidity, and several risk factors were identified being significantly associated with NICU admission rate and length of hospitalization.

Meconium aspiration syndrome--a 21-years' experience from a tertiary care center and analysis of risk factors for predicting disease severity.

Aim of this study was to describe the course of perinatal factors in neonates with meconium aspiration syndrome (MAS) from 1990 to 2010 and to determine risk factors for a severe course of the disease.All neonates with MAS hospitalized in our level III neonatal intensive care unit from 1990 to 2010.Retrospective analysis of trends of perinatal factors in neonates with MAS over time and of the association of these factors with severe MAS (need for invasive mechanical ventilation for ≥7 days, or need for high frequency oscillation or need for extracorporeal membrane oxygenation).We included 205 neonates with MAS, 55 had severe MAS (27%). MAS incidence and absolute number of MAS cases per year decreased during the observation period (p=0.003 and 0.005, respectively) as well as rates of outborn deliveries (p=0.004), duration of invasive mechanical ventilation (p=0.004), and hospital stay (p=0.036). Incidence and absolute number of severe MAS cases per year decreased (p=0.008 and 0.006, respectively), though the percentage of severe MAS among all neonates with MAS did not change. Risk factors for severe MAS were acute tocolysis (odds ratio 18.2 (95% confidence interval 2.1-155.3), p<0.001) fetal distress (3.4 (1.8-6.4), p<0.001), and severe and moderate birth asphyxia (4.4 (2.0-9.7), p=0.001 and 2.9 (1.5-5.6), p=0.009).The incidence and absolute numbers of MAS and severe MAS cases changed during the study period as well as neonatal management. Acute tocolysis, fetal distress, and asphyxia were associated with severe MAS.

Borderline ovarian tumors diagnosed during pregnancy exhibit a high incidence of aggressive features: results of a French multicenter study.

BACKGROUND: The purpose of the current study was to evaluate the characteristics of borderline ovarian tumors (BOTs) diagnosed during pregnancy. PATIENTS AND METHODS: We conducted a retrospective multicenter study of 40 patients with BOTs diagnosed during pregnancy between 1997 and 2009 at five tertiary universitary departments of Gynecology and Obstetrics and one French cancer center. The medical records were reviewed to determine surgical procedure, histology, restaging surgery and recurrence. RESULTS: Mean patient age was 30.2 ± 5.4 years. Most BOTs were diagnosed during the first trimester of pregnancy (62%). Salpingo-oophorectomy (N = 24) was more frequently performed than cystectomy (N = 11) during pregnancy (P = 0.01). Only two patients had an initial complete staging. BOTs were mucinous, serous and mixed in 48%, 42% and 10% of patients, respectively. Twenty-one percent of mucinous BOTs exhibited intraepithelial carcinoma or microinvasion. Forty-seven percent of serous BOTs exhibited micropapillary features, noninvasive implants or microinvasion. Restaging surgery performed in 52% patients resulted in upstaging in 24% of cases. Recurrence rate in patients with serous BOT with micropapillary features or peritoneal implants was 7.5%. CONCLUSIONS: BOTs diagnosed during pregnancy exhibit a high incidence of aggressive features and are rarely completely staged initially. Given this setting, up-front salpingo-oophorectomy should be considered and restaging planned.

Prospective evaluation of clinical scoring systems in infants with bronchiolitis admitted to the intensive care unit.

The objective of this investigation was to compare different scoring systems to assess the severity of illness in infants with bronchiolitis admitted to a tertiary paediatric intensive care unit (PICU). Over an 18-year period (1990-2007), infants with bronchiolitis aged up to 12 months and admitted to the PICU were prospectively scored using the Pediatric Risk of Mortality III (PRISM III) score, the Organ System Failure (OSF) score and the Acute Physiologic Score for Children (APSC) within 24 h. Infants were compared as to whether or not bronchiolitis was associated with respiratory syncytial virus (RSV). There was no difference between 113 RSV-positive and 80 RSV-negative infants regarding gestational age, birth weight, rate of premature delivery or bronchopulmonary dysplasia (BPD). The PRISM III score differed significantly between RSV-positive and RSV-negative cases (3.27 ± 0.39 vs. 1.96 ± 0.44, p = 0.006), as did the OSF score (0.56 ± 0.05 vs. 0.35 ± 0.06, p = 0.049) and the APSC (5.16 ± 0.46 vs. 4.1 ± 0.53, p = 0.048). All scores were significantly higher in the subgroup with mechanical ventilation (p < 0.0001). The mean time of ventilation was significantly higher in the RSV-positive group compared to the RSV-negative group (6.39 ± 1.74 days vs. 2.4 ± 0.47 days, p < 0.001). Infants suffering from RSV-positive bronchiolitis had higher clinical scores corresponding with the severity of bronchiolitis.

Fertility and pregnancy following pelvic arterial embolisation for postpartum haemorrhage.

OBJECTIVES: To determine and compare the fertility and pregnancy outcomes following embolisation with or without uterine-sparing surgery for postpartum haemorrhage, and to attempt to identify specific risk factors associated with an increased likelihood of intrauterine synechia. DESIGN: Retrospective study. SETTING: University-affiliated tertiary referral centre. POPULATION: All consecutive women who had an embolisation with or without uterine-sparing surgery (vessel ligation and/or uterine compression) for postpartum haemorrhage between 1994 and 2007 were included. METHODS: Data were retrieved from medical files and telephone interviews. MAIN OUTCOME MEASURE(S): Fertility and pregnancy outcomes, synechia. RESULTS: Data were available for 68 of the 85 women (80%) included in the study. Among the 15 women who complained of amenorrhoea or decreased flow of menstruation, synechia was found in all those who decided to undergo an ambulatory hysteroscopy (n = 8). Seventeen women had 26 pregnancies with 19 term deliveries, one ectopic pregnancy, two abortions and four miscarriages. The clinical courses of the 19 complete gestations were uneventful, but postpartum haemorrhage recurred in six women (31.6%) (caused by placenta accreta in two women). Fertility and pregnancy outcomes did not differ between women who had undergone embolisation versus both embolisation and a uterine-sparing surgical procedure. The occurrence of synechia was significantly associated with a higher rate of placenta accreta/percreta (P < 0.001) and postpartum fever above 38.5 degrees C (P = 0.04). CONCLUSIONS: Embolisation, whether or not associated with a uterine-sparing surgical procedure, for postpartum haemorrhage does not appear to compromise a woman's subsequent fertility and obstetric outcome. Nevertheless, these women should be considered at high risk for postpartum haemorrhage during future deliveries.

[Recurrence of a rudimentary uterine horn rupture at 25 weeks of gestation: a case report]. / Récidive d'une rupture utérine sur corne rudimentaire d'un utérus pseudo-unicorne à 25 semaines d'aménorrhée : à propos d'un cas.

Pregnancy in a rudimentary uterine horn is a rare event which can be revealed by uterine rupture. Following the fetal extraction, some authors recommend the ablation of the rudimentary horn, in order to limit the risk of uterine rupture in case of subsequent pregnancy in the same horn. We report the obstetrical outcome of a patient with a history of rudimentary uterine horn rupture the treatment of which was conservative.

[Laparoscopic ovarian transposition and cryopreservation of ovarian tissue before chemo-radiotherapy for rectal cancer]. / Transposition ovarienne par coelioscopie et cryopréservation de tissu ovarien avant radiochimiothérapie d'un cancer du rectum.

We report a case of laparoscopic ovarian transposition and ovarian cryopreservation in a nulliparous 25-year-old woman with rectal cancer. The authors focus on the surgical technique and the importance of preserving ovarian function.

[Prosthetic repair of genito-urinary prolapses by the transobturateur infracoccygeal hammock technique: medium-term results]. / Correction prothétique des prolapsus génito-urinaires selon la technique du hamac transobturateur infracoccygien: résultats à moyen terme.

OBJECTIVES: The aim of this study was to evaluate the anatomical and functional medium-term efficacy and possible complications of vaginal prosthetic surgery with transobturator and infracoccygeal support to treat genital urinary prolapse. MATERIAL AND METHOD: A prospective and monocentre study was conducted, from February 2002 till February 2005. All the patients with or without stress urinary incontinence (SUI), who presented either a recurrent prolapse, either a voluminous genital prolapse of stage 3 or 4 notably a dominant cystocele, either a post-hysterectomy vaginal vault prolapse or even a prolapse of lesser importance but in a context of obesity, were operated according to the transobturator infracoccygeal sling technique. RESULTS: One hundred and three patients with a mean age of 65+/-11 years (41-84) were enrolled, with once on two SUI. Thirty percent of the patients had recurrent prolapse and 44% post-hysterectomy vaginal vault prolapse. With a mean follow-up of 32+/-13 months (12-53), the success rate of the technique was estimated to be 97% anatomically (three failures) and 89% in terms of urinary symptoms (69% of patients were cured, 20% were improved and 11% failed). Quality of life of the patients was sharply improved and their degree of satisfaction was high. Sexuality of the population which was limited here (44% of active patients) did not seem very modified by surgery. Complications were represented by a case of urinary retention observed with a secondarily pelvic haematoma, a low rectal injury without consequence, three blood transfusions. Three patients developed de novo overactive bladder. The prostheses exposure rate was 16%, once requiring on two one re-intervention. Prostheses were perceived during the postoperative evaluation by the examiner for 43% of the patients. But examination was painful only in 9,7% of the cases. CONCLUSION: Combined treatment of vaginal prolapse and associated urinary incontinence is possible by the use of a single transvaginal prosthesis. The medium-term anatomical and functional results are very good. The results on continence are good and a subsequent specific procedure is always possible in the case of failure or insufficient improvement. The prostheses exposure rate is similar to that observed with synthetic transvaginal prostheses. The exact tolerance of vaginal prosthetic repair of the prolapse of young women being this day an unknown, we remain careful on the extension of the indications of this technique in this category of population.

[Laparoscopic surgery of profund endometriosis with rectal affect]. / Chirurgia laparoscopica a endometriozei profunde cu atingere rectala.

OBJECTIVE: To present the principles of laparoscopic treatment for rectal endometriosis and to discuss possible postoperative outcomes. MATERIAL AND METHODS: Our series included women managed for rectal endometriosis during consecutive 20 months in the Department of Gynecology and Obstetrics, Rouen University Hospital, Rouen--France. Patient's characteristics, symptoms, imaging examination results, surgical treatment and postoperative outcomes were all evaluated retrospectively. RESULTS: Sixteen patients presenting with rectal endometriosis were managed surgically, (mean age was 35.9 +/- 6.5 years). All women presented at least one severe painful symptom which was typical of a digestive involvement in 12 cases. MRI results suggested a rectal involvement in 14 cases, and endorectal ultrasound examination clearly showed rectal wall infiltration in all patients. The gynaecological stage of surgical treatment was carried out laparoscopically in 13 cases, and the digestive surgical stage in 7 cases. Two limited and 14 segmental rectal resections were performed. Transitory stoma was carried out in 9 women. The length of the surgical procedure depended on the number of endometriosis localizations with a median value of 6 h 30 min. Postoperative complications occurred in 6 women: 2 anastomosis stenosis, 1 anastomosis fistula, 1 abscess of the parietal wall and 1 bladder atonia. Complains of pain were completely or significantly improved in all cases. CONCLUSION: Surgical treatment for rectal endometriosis may be carried out laparoscopically. It should be reserved for women presenting with severe painful condition and may contribute to significant improvement. However, the balance of benefit and risks must also be assessed on a case to case basis prior to any decision for or against surgical treatment.

Management of deep infiltrating endometriosis by laparoscopic route with robotic assistance: 3-year experience.

OBJECTIVE: To assess the feasibility of deep endometriosis surgery using robotic assistance, benefits and limits of this approach. METHOD: Case-series study enrolling patients managed for deep infiltrating endometriosis (DIE) using robotic assistance in our department between September 2011 and March 2014 (NCT02294825). Self-questionnaires including pain and digestive symptoms were filled in preoperatively and 1 year after surgery. RESULTS: Thirty-five patients were enrolled in the series. They represented 54% of patients managed for gynecological disease by laparoscopic route with robotic assistance during the study period, and 14% of patients managed for deep endometriosis in our department. Follow-up averaged 24±8 months, and no patient was lost to follow-up. Thirty-two patients had rectal involvement: rectal shaving was performed in 25 patients, disc excision in 3 and colorectal resection in 4. Three patients had bladder resection. Thirteen patients presented with deep endometriosis of the ureters: ureterolysis was performed in 11 of them, and resection of the ureter followed by reimplantation into the bladder in 2 patients. One major complication (Clavien IIIb) was recorded in a patient presenting with necrosis of the right ureter on postoperative day 5. Nine patients tried to conceive after surgery and 8 have already become pregnant (88.9%). One year after surgery, self-questionnaires revealed a significant decrease in pain symptoms and significant improvement in several item values of gastrointestinal standardized questionnaires. CONCLUSIONS: Surgical management of DIE is feasible using robotic assistance. However, data available in the literature and our own experience do not definitively support the hypothesis of the superiority of robotic assistance in the management of DIE.

[Cystocele and stress urinary incontinence: assessment of a total treatment by monoprosthesis]. / Cystocèle et incontinence urinaire d'effort: évaluation d'un traitement global par monoprothèse.

OBJECTIVES: The aim of this study is to evaluate the effectiveness and the potential complications in the short and medium terms of the transobturator and infracoccygeal hammock, a surgical technique suggested to treat in one sole operating time, by vaginal way, cystocele and stress urinary incontinence. PATIENTS AND METHODS: From February 2002 till August 2004, 45 patients aged 66+/-11 years on average, presenting a stage 3 or stage 4 cystocele associated with stress urinary incontinence (proven for 40 of them and masked by the prolapse itself for the other five) benefited from this new surgical procedure. RESULTS: With a mean follow-up of 31+/-9 months, the success rate of the technique is estimated at 98% on the anatomical aspect (one single failure) and at 91% on the urinary aspect (73% of the patients were cured, 18% improved and 9% in failure). No patient presented urinary retention except one with an infected pelvic hematoma requiring its evacuation and the partial ablation of the prosthesis. Postvoid residual volume at discharge was 83 ml. Two patients developed de novo bladder overactivity. Unfortunately we had to regret nearly 18% of exposed prosthesis. This result should be improved by the exclusive use of polypropylene monofilament prosthesis with broad meshes, weak weights and by reduced vaginal scars. DISCUSSION AND CONCLUSION: Total treatment by monoprosthesis of cystoceles with associated stress urinary incontinence constitutes an interesting prospect for some high-risk genital urinary prolapses for anatomical repetition or post-operative dysvoiding. Patients with recurrent failures of prolapse surgical cure, those with a large cystocele or by extension with a complete prolapse of the three floors, and even those with a post-hysterectomy prolapse have perhaps found a durable solution with their problem.

[Surgical management of intractable postpartum haemorrhages]. / Prise en charge chirurgicale des hémorragies sévères du post-partum.

Surgical management of an intractable postpartum haemorrhage after failure of medical and obstetric measures is not limited to the emergency peripartum hysterectomy. Uterine atony and abnormal placental insertions are the major causes of primary postpartum haemorrhages. Involving mostly young women, having few or no child, before with a healthy uterus, in first intention conservative option is recommended. The simplest methods must be known and be applied. It will be essentially progressive uterine arteries' ligation, which can be adapted to the majority of situations. Internal iliac arteries' ligation is a little less effective and technically more difficult to carry out. It remains interesting in obstetrical traumatic hurts, which do not concern the uterus. New and easier surgical methods, such as uterine compression or hemostatic suturing techniques have been described for which we lack experience. The quality of the result depends of the length of intervention and the cause of the bleeding. Nevertheless the main cause of failure with conservative treatments is placenta accreta. In case of failure of a conservative treatment, it would be dangerous to multiply techniques. Emergency peripartum hysterectomy then should remain the choice procedure.

[Posthysterectomy posterior compartment prolapse: Preliminary results of a novel transvaginal surgical procedure using polypropylene mesh via the low transobturator route]. / Prolapsus isolé de l'étage postérieur posthystérectomie: résultats préliminaires d'une technique utilisant les voies vaginales et transobturatrice basses.

OBJECTIVE: The aim of this study is the description and anatomical and functional outcome assessment of a novel surgical procedure, based on rectovaginal fascia defect repair with polypropylene mesh using the tension-free transobturator and infracoccygeal route based on the integral theory developed by Petros. MATERIALS AND METHOD: Prospective, consecutive and single centre study performed between February 2003 and April 2005. Inclusion criteria were symptomatic posthysterectomy stage three to four regarding posterior compartment prolapse according to the Baden and Walker classification, with no anterior and/or apical prolapse. Principles and description of this new surgical procedure are described. RESULTS: Fourteen patients, with a mean age of 63.5 years and a mean body mass index of 29.2, were included in the study. All the patients had previous hysterectomy, 64.3% reported at least one previous surgery for pelvic organ prolapse, 44.5% reported at least one reoperation. All patients complained of rectocele and/or enterocele stage three. No perioperative or postoperative complication occurred. With a median follow-up of 13 months (range 3-32.9), no recurrence and no anterior or apical compartment prolapse occurred. No vaginal erosion an infection of the mesh was observed. The mean level of subjective satisfaction was 9.23 on a visual analogical scale (0-very disappointed, 10-very satisfied). CONCLUSION: This new surgical procedure is effective and safe for the repair of posthysterectomy large posterior compartment prolapse. A long-term follow-up is required to confirm these promising results.

[Anatomic, functional and identity results after clitoris transposition]. / Évaluation des résultats anatomiques, fonctionnels et identitaires après transposition du clitoris chez 30 patientes.

OBJECTIVES: Every year 3 millions of young women had undergone female genital mutilation. The psychological, identical and sexual consequences, as well as the treatment were described only recently. After a sociodemographic and cultural reminder, we analyze the anatomical, psychological, identital, and functional results of the reconstructive surgery. PATIENTS AND METHODS: We conducted a retrospective monocentric study. Thirty women were included in our series. All the patients operated according to the technique of Pierre Foldes were contacted again, to estimate their motivations for this surgery and study the results on femininity, anatomy, psychology and functionality of this intervention. RESULTS: Twenty-six women were able to be estimated in the long term. Their main motivation was in 77% of the cases the research for a feminine identity. We compared the pre- and postoperative results, as well as different predefined under groups. The results shown a significant improvement between the pre- and the postoperative estimation for each of the items. The patients indicate an improvement: anatomical in 96% of the cases, for identity in 88% of the cases, psychological in 96% of the cases, and for sexuality in 88% of the cases. DISCUSSION AND CONCLUSION: This technique allows an improvement for anatomy and functionality but also for physical image, well-being and feminity.

Rehospitalisations for respiratory disease and respiratory syncytial virus infection in preterm infants of 29-36 weeks gestational age.

BACKGROUND: To evaluate rates of rehospitalisation due to respiratory illness in preterm infants of 29-36 weeks gestation without chronic lung disease. PATIENTS AND METHODS: Retrospective single centre cohort study including infants from 1998 to 1999 with follow-up over two respiratory syncytial virus (RSV) seasons. RESULTS: Of 435 infants included 61 infants (14%) experienced 78 rehospitalisations. The overall RSV attack rate was 4.4% over two consecutive RSV seasons for infants below 6 months of age at onset of RSV season (7.7 and 1.1%, respectively, p=0.015), with significant differences between infants of 29-32 and 33-36 weeks gestational age (10.5% vs. 2.3%, p=0.008). None of the infants needed mechanical ventilation or admission to the intensive care unit. Infants with RSV infection were younger of age (mean 4.2 vs. 8.2 months; p=0.015), had longer stays at the hospital (11.5 vs. 7.0 days; p=0.006), and more severe courses of disease (score 3.0 vs. 1.8; p<0.001). Additional risk factors for RSV infection were multiple gestation (OR 5.5; CI 95% 1.439-21.028) and congenital heart disease (OR 4.2; CI 95% 1.005-17.669). CONCLUSION: The total burden of respiratory disease and RSV infection in this population was low. A lower gestational age, multiple gestation, and congenital heart disease were associated with increased risk of RSV infection.