Medical evacuations from the region of former Yugoslavia: The experience of 2 years

In September 1992, the International Organization for Migration(IOM), an intergovernmental humanitarian organization basedin Geneva, Switzerland, implemented the special medical programme(SMP) for the medical evacuation of war victims in former Yugoslavia.For inclusion into the SMP, patients must be victims of war,suffer from a serious medical condition with a favourable prognosis,not treatable locally, be stable enough to survive air traveland withstand delay between medical documentation and actualevacuation. As of August 1994,1,484 patients In need of secondarytreatment not locally available were evacuated to hospitalsin 31 countries. Most patients suffered from fractures, amputationsand nerve injuries. Seventy-two per cent originated from Bosnia-Herzegovina.This paper discusses various problems encountered, such as bureaucraticobstacles, ongoing armed conflict hampering humanitarian activities,lack of funding and the effects of the sustained media attention.     

Transesophageal Color Flow Echocardiographic Evaluation of Supravalve Mitral Ring in an Adult Patient

Supravalve mitral ring (SVMR) is an extremely rare form of congenital left ventricular inflow obstruction in which a left atrial membrane causes an obstruction keeping the left atrium from emptying into the left ventricle. Cardiac catheterization and angiography are not reliable means to diagnose this lesion. Transthoracic echocardiography (TTE) has proved to be the most sensitive tool for diagnosis of this form of left ventricular inflow obstruction; however, its diagnostic accuracy has been recently questioned. We report the complementary roles of TTE and transesophageal echocardiography in a case of SVMR in an adult patient. (ECHOCARDIOGRAPHY, Volume 11, May 1994)     

Diagnostic accuracy of anesthesiology evaluation timing: the 'One-Stop Anesthesia' in pediatric day-surgery

Objective:  Assessing timing efficacy of anesthetic evaluation in pediatric day-surgery by a diagnostic accuracy study.
Aim:  Lowering hospital visits in patients with negative medical history.
Background:  Pediatric patients scheduled for day-surgery procedures can be categorized, according to their history, in two groups. One, the largest, includes healthy patients and the other includes those with medical conditions that necessitate further evaluation.
Materials and methods:  Clinical data are collected by the pediatric surgeons of our department and reviewed by an anesthetist who then selects the timing of anesthesiology evaluation, which will take place in the same day of the procedure (One-Stop Anesthesia), or some days before it, in a dedicated setting (Pre-Admission Clinic). In 2008, 332 children, older than 12 months, screened by that method, underwent surgical procedures in general anesthesia.
Results:  Our data were examined using Bayesian Statistical Analysis. In the 'One-Stop Anesthesia' group, true positive were 290 (87.4%) and false positive 4 (1.2%). Of the 38 patients assessed by our Pre-Admission Clinic, true negative were 30 (9%) and false negative 8 (2.4%). Sensibility (97.3%), specificity (88.2%), positive predictive value (98.6%), negative predictive value (78.9%), diagnostic accuracy (96.4%), likelihood positive (8.3), and likelihood negative (0.03) were calculated.
Conclusions:  Timing the preoperative anesthesiologist's evaluation avoided 88% of hospital visits, usually to the Pre-Admission Clinic, and thus, it was cost effective, reducing direct and indirect costs of healthcare providers.     

Short-term reproductive prognosis when no cause can be found for recurrent miscarriage

Summary. The short-term reproductive prognosis of recurrent miscarriage for which no cause was found has been evaluated in 95 couples investigated between 1980 and 1986 at the First Obstetric and Gynaecological Clinic of the University of Milan. The actuarial overall 3-year livebirth delivery rate was 64%, increasing constantly with time. The reproductive success rate decreased with the number of previous miscarriages from 80% in women with two, to 60% with three and 46% with four or more miscarriages. No effect of age and socio-economic status emerged. There was a positive association between the number of previous miscarriages and the risk of miscarriage in the next pregnancy. Compared with women with two miscarriages the relative risk of another miscarriage was 2·3 for those with three previous miscarriages and 5·0 for those with four or more (χ²₁ for trend adjusted for age = 5·2, P = 0·02).