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Objectif : Le but de ce travail est d'effectuer une évaluation quantitative et un relevé des données relatives aux femmes consultant aux Urgences de gynécologie-obstétrique du DFME suite à une agression sexuelle, afin de décrire le parcours de soins précoces, et d'identifier les éléments pouvant influencer le déroulement de ce parcours. Il vise donc à vérifier si elles tirent le bénéfice souhaité des prestations proposées ainsi que du cadre mis en place, tout en cherchant à en identifier les difficultés. Méthode : L'étude projetée est une étude épidémiologique descriptive et rétrospective. La population étudiée est constituée des 50 premières patientes de plus de 18 ans, ayant consulté initialement aux Urgences de gynécologie-obstétrique du DFME du CHUV en 2017, et pour lesquelles une documentation spécifique a été établie en raison d'une révélation d'une agression sexuelle. Résultats : La moyenne d’âge des patientes de la cohorte est de 32.3 ans. Nos résultats montrent que 54% des patientes sont orientées aux urgences soit par elles-mêmes, soit par la police. Au moment des faits, 25% d’entre elles présentent des comorbidités psychiatriques et 46% ont des antécédents de violences sexuelles dans le passé. L’agresseur est connu de la victime dans 60% des cas, et l’agression a lieu au domicile de la victime dans 32% des cas. De la violence physique est rapportées dans 46% des agressions. Le délai entre l’agression sexuelle et la consultation aux urgences est court, avec 84% des patientes qui consultent dans les 7 jours. Concernant le suivi, 70% des patientes adhèrent à la première partie du suivi, contre seulement 22% lors de la seconde partie du suivi. Et seulement 39% sont présentes à la consultation d’infectiologie pour le suivi de la PEP. Aucun élément n’a montré une influence significative sur la probabilité d’adhérence au suivi de manière générale. Conclusion : Cette étude a démontré que les patientes faisant état d’une agression sexuelle, s’orientent plutôt bien dans le système de soins du CHUV, et adhèrent relativement bien au suivi mis en place, voire mieux que ce qui est décrit dans la littérature, et plus particulièrement à la première partie de ce dernier. Toutefois, les améliorations y sont toujours possibles, notamment pour la deuxième partie du suivi, ainsi que pour la prise en charge des patientes bénéficiant de la PEP.

Secondary elastic recoil after transluminal coronary angioplasty is a constant and immediate phenomenon after successful coronary angioplasty. It was studied by quantitative coronary angiography in 75 consecutive patients undergoing transluminal coronary angioplasty. This procedure was performed on lesions presumed to be responsible for the clinical presentation. The population was divided into 3 groups: stable angina (25 patients), unstable angina (25 patients) and recent post-infarction ischaemic syndromes (25 patients). There were 57 men and 18 women (mean age 59 +/- 11 years) with 31 left anterior descending (LA), 29 right coronary (RC) and 15 left circumflex (Cx) dilatations. The lesions dilated were eccentric in 29 cases and calcified in 37 cases whereas only one thrombus was detected at coronary angiography. The elastic recoil appreciated 10 mn after the last balloon inflation was 0.97 +/- 0.28 mm for the whole population. There was no significant difference between the 3 groups studies (respectively 0.94 +/- 0.24 mm; 0.96 +/- 0.26 mm; 0.99 +/- 0.33 mm). This appeared to be greater than the RC (1.06 +/- 0.30 mm) with respect to the Cx (0.86 +/- 0.23: p0.02) or LAD (0.92 +/- 0.25 mm: p0.04). Overall, a balloon to vessel diameter ratio1 and a lesion length10 mm were parameters predicting greater secondary elastic recoil (p0.07 and p0.001 respectively), whereas the degree of eccentricity only played a role in the post-infarction ischaemic syndromes and calcification only in unstable angina (p0.01 and p0.001 respectively).(ABSTRACT TRUNCATED AT 250 WORDS)

The Medtronic Intact is a recently commercialized porcine bioprosthesis. Its function and ultrasonic characteristics have not been widely studied. The authors performed a prospective Doppler echocardiographic study of 38 patients with Intact bioprosthesis (n. 19:1, n. 21:10, n. 23:9, n. 25:14, n. 27:3, n. 29:1) implanted in the aortic position and without clinical signs of dysfunction over a period of 8 +/- 5 months after surgery. The following parameters were measured: maximum and mean velocities, maximum and mean transprosthetic pressure gradients, permeability index (PI) or the ratio of subaortic to transprosthetic velocities, and the effective prosthetic surface area (S) calculated using the continuity equation. The PI and S were calculated by two methods, the first using the ratio of maximum velocities (PI1 and S1) and the second using the ratio of the velocity-time integrals (PI2 and S2). The global results were: Vmax 2.65 +/- 0.4 m/s range 1.9 to 3.7 m/s), maximum pressure gradient 29 +/- 9 mmHg (range 15-55 mmHg), mean pressure gradient 16.8 +/- 5.6 mmHg (range 9-32 mmHg), PI1 37.8 +/- 4.5 p. 100 (range 26-48%), PI2 39.1 +/- 5.5 p. 100, S1 1.25 +/- 0.19 cm2 (range 0.96-1.7 cm2) and S2 1.29 cm2 +/- 0.17 cm2. Minimal central prosthetic valve regurgitation was observed in 2 cases (5%). No correlations were found between the size of the prosthesis and blood flow velocities, pressure gradients or permeability indices. On the other hand, a correlation was observed between S and the size of the prosthesis (r = 0.88, p less than 1.10(-6) (S1); r = 0.80, p less than 1.10(-6) (S2)).(ABSTRACT TRUNCATED AT 250 WORDS)

Between February 1983 and June 1987, 140 patients underwent surgery for anterior interventricular revascularization using the left internal mammary artery (the right had been used once). Operative mortality was 3.5%, but this value decreased to 2.2% when the familiarization period for the technique was taken into account. 112 patients were monitored for at least 11 months, and 85 of these accepted an angiographic examination at the end of the follow-up period. No graft was occluded. Only two were thin due to an inadequate stenosis of the anterior interventricular septum. One graft was 90% stenosed at its anastomosis. Moderate competitive flux was noted in five cases. These results are in agreement with published findings, and comparison with literature reports confirms that the internal mammary artery is superior to the saphenous vein as graft material.

We have prospectively evaluated 6 patients admitted for a severe heart failure in alcoholic patients with dilated cardiomyopathy. We concluded that complete abstinence results in a short-term clinical improvement, associated to a significant increase in left ejection fraction.

The association of intraventricular or atrio-ventricular conductive disorders with a calcified aortic stenosis, is a classical notion demonstrated by the close anatomical relationships between aortic valve and conduction pathways. These conductive disorders have been, for quite some time, analyzed on standard electrocardiograms, but, since a few years, the recording of the bundle of His potential has become the technique of choice. However, studies regarding this subject are few, based on very small and sometimes heterogeneous groups of patients. Sixty six consecutive patients hospitalized for a narrow aortic stenosis have agreed to be subjected, before valve replacement, to a recording of the bundle of His potential. Thirteen of them (19.7%) show a HV interval exceeding 55 ms or a pathological H deflexion (twisted and lasting 35 ms). None of the pre-operative parameters that were analyzed (black-out, left ventricular function, ventriculo-aortic gradient, calculated valvular area, magnitude of valvular and ring calcifications), seem correlated with the increased HV interval. These results cross-check those reported in most of the literature.

Two groups of patients of comparable age, one comprising 12 subjects without detectable cardiac disease and the other comprising 38 patients with calcific aortic stenosis (CAS) underwent clinical, electrocardiographic, echocardiographic and haemodynamic studies to assess the degree and significance of left atrial hypertrophies in CAS. The volume of the left atrium (LA) was globally increased in CAS (maximum volume 68 per cent: 26/38) and LA ejection fraction was decreased in 60 per cent of patients (23/38). However, the maximum volume was only moderately greater than that of normal subjects (+38 per cent). The most specific non-invasive investigation for left atrial assessment is echocardiography. There was a linear relationship between LA angiographic volume and echocardiographic antero-posterior dimension (r = 0.43; p less than 1 x 10(-2)). The duration of the P wave in S2 was a specific (75 per cent) but relatively insensitive (27 per cent) sign of LA dilatation in pure CAS. On the other hand, the Morris index based on the surface of the P terminal force in V1 was quite sensitive (77 per cent) but not very specific (25 per cent). The maximum LA volume was not related to left ventricular volume, the severity of CAS, diastolic indices of compliance or left ventricular mass. However, the minimum LA volume (after atrial systole) was related to left ventricular end diastolic (r = 0.35, p less than 0.05) and end systolic volume (r = 0.34, p less than 0.05). The LA ejection fraction was inversely related to mean pulmonary capillary pressure (r = 0.34, p less than 5 x 10(-2).(ABSTRACT TRUNCATED AT 250 WORDS)