Biomedical subjects
Publications and source records attributed to B Ducot.
25 pathologists have used an analytical assessment-form in order to study 78 orchidectomies. An histological pattern of more than 50% embryonal carcinoma appears to be in accordance with the rate of embols, which are the main risk factor even if exclusively intratesticular. This form might be useful for multicentric studies.
Embryo cryopreservation does not induce clear-cut anomalies at detectable rates, but several mechanisms exist for nonlethal damage during the freeze-thaw process, and the risk of moderate or delayed consequences has not been extensively investigated. In a long-term study including senescence, we compared cryopreserved and control mice for several quantitative traits. Significant differences were seen in morphophysiological and behavioral features, some of them appearing in elderly subjects. Thus, apart from its immediate toxicity, embryo cryopreservation, without being severely detrimental, may have delayed effects. These results, consistent with other findings, question the neutrality of artificial reproductive technologies and draw attention to the preimplantation stages in developmental toxicology.
BACKGROUND: The ambulatory twenty-four hour esophageal pHmetry is nowadays a common mode of assessment of gastro-esophageal reflux in children. The aim of this study was to evaluate the impact of the test on child and family's ordinary daily life. MATERIAL AND METHODS: One-hundred children (64 boys, 36 girls) were included in this study during a 10-month period from August 1992 until May 1993. Mean age was 2 years 9 months (range: 22 days--12 years). Forms with a list of questions concerning parental understanding of the test, child's reaction after introduction of the pH-electrode, general reactions in the household, and eventual disturbance of the child's temper and appetite, were given to the parents. Six months later, 81 families were contacted by telephone and asked the same questions. Children were divided into three groups: those under 1 year of age (n = 38), from 1 to 4 years (n = 35), and more than 4 years (n = 27). RESULTS: One child aged 2 months had to be admitted to hospital due to the mother's overanxiety. The majority of parents (80%) assumed they knew about the principles of the test, with little change once the test was over. Those whose child had previously been submitted to the test were less apprehensive. When the test was first initiated, 81% of parents feared it would cause some discomfort, either due to pain (69%), or to poor acceptance at home (25%) with the risk of having the catheter accidently removed. Once the catheter had been positioned with the parents close to the child at that time, its presence was judged by them tolerable in 88.9% of cases. Once at home, 84.8% of the parents were not worried, as the child was calm (83.8%) and also due to the possibility for them to get in touch with the physician if necessary (86.9%). No change in routine daily life was reported by 80.8% of the families; in only 19.2% was the child reported to be overwhelmed with the test. When asked if the test should be undertaken another time, 91.9% would still prefer it as a home procedure, the only families requesting it be done in hospital being those with a history of sudden death syndrome. CONCLUSION: pHmetry test as a 24-hour procedure done at home may be the source of some discomfort and anxiety both to the child and parents; yet it appears to be generally well-accepted, both for its non-aggressive and diagnostic value.
In order to improve our knowledge of post partum headache, during a two-year period we studied a large population of pregnant patients of our institution using a four-stage process including two questionnaires (the first at 12-15 weeks' gestation and the second in the first week after delivery), a pre-anesthetic visit at 36 +/- 2 weeks' gestation and a computer printout obtained at delivery. Of 1058 patients for whom records were complete and who had epidural analgesia during labor not complicated by dural puncture, 128 (12.1%) complained of post partum headache. In patients who did not receive epidural analgesia, the incidence of post partum headache tended to be higher (15.2%). However, because of the low response rate (27.1%) and the low absolute number of patients with headache (27) in the non-epidural group, statistical comparison was not possible. Data from the medical history or from the current pregnancy as well as data obtained during delivery (maternal and fetal-neonatal) were not significantly different between those patients free of pain and those presenting with headache, except for a history of migraine and pregnancy-induced hypertension which were both associated with an increased risk of post partum headache. These risk factors should be considered in both clinical studies and obstetric malpractice claims.
OBJECTIVE: To investigate the impact of sperm-associated antibodies in the fertilization process beyond the zona pellucida in human oocytes. DESIGN: Subzonal insemination (SUZI) was performed with antibody-coated spermatozoa from patients with autoimmune infertility. Sperm parameters and antibody binding were analyzed after Percoll selection and were compared with SUZI outcome. PATIENTS: Patients (n = 29) with an immunobead test higher than 60% for immunoglobulin (Ig)G, IgA, or both classes were included in the study (38 attempts). Twenty-six patients had previous IVF failures, and the semen characteristics for three were unsuitable for IVF. RESULTS: Diploid fertilization occurred in 52.6% of cycles and 16.0% of oocytes (n = 263). The fertilization rate was inversely correlated to the proportion of spermatozoa coated with IgG in the Percoll-selected sperm suspension. Three of the 16 attempts in which > 90% of the spermatozoa were coated with IgG resulted in a low diploid rate of 4.1%. Fertilization was obtained in 18 of the 22 attempts in which < 90% of spermatozoa were IgG coated, with a diploid fertilization rate of 22.8%. Association of both classes of antibodies (IgG and IgA) further impaired the fertilization rate. Twenty ETs gave four pregnancies: one biochemical, one ongoing, and two giving birth to healty babies (1 singleton and 2 twins). CONCLUSIONS: Subzonal insemination is a potential solution for achieving fertilization in cases of IVF failure because of sperm autoimmunity. However, IgG inhibits in a dose-dependent manner the fusion of gametes' membranes. Though the level of IgA antibodies does not appear as critical as that of IgG antibodies, association of both classes of Igs impairs the probability of fertilization.
From March 1990 to September 1993, 20 women underwent a total of 89 cycles of intracervical inseminations with donor semen (ICI) and 23 women underwent 67 cycles of intrauterine inseminations with donor semen (IUI). The women were assigned to the two groups randomly, but ensuring that the ages of the women and pathologies of the male partner (azoospermia or severe oligozoospermia) were similar in the two groups. There was no significant difference between the characteristics of the two groups and the method used to induce ovulation (HMG/HCG) was identical. Two semen straws were used for each insemination cycle. Semen was prepared for IUI on a Percoll gradient. Thirteen clinical pregnancies were obtained in the IUI group (19.4% of the attempts) and six in the ICI group (6.75%). After six cycles of insemination, 75.4% of the women of the IUI group obtained a pregnancy, as compared to 35% in the ICI group. These good results may be due to the method of induction of ovulation, but also to the technique itself, increasing the number of motile spermatozoa at the site of fertilization. The time taken to obtain a pregnancy is thus shorter with IUI than with ICI, and the number of semen straws required is smaller. In-vitro fertilization (IVF) should be proposed after six failures by IUI.
OBJECTIVE: The authors report on the experience of orthotopic liver transplantation in fulminant hepatitis at Paul Brousse Hospital. SUMMARY BACKGROUND DATA: Liver transplantation is a breakthrough in the treatment of patients with fulminant hepatitis. However, the indications, the timing for transplantation, the type of transplantation, and the use of ABO incompatible grafts in this setting still are debated. METHODS: Transplantation was indicated in patients with confusion or coma and factor V less than 20%, younger than 30 years of age, and confusion or coma and factor V less than 30% older than 30 years of age. RESULTS: Among 139 patients who met the aforementioned criteria for transplantation, 1 recovered, 22 died before transplantation, and 116 underwent transplants with a 1-year survival of 68%. Survival was 83% in patients with grade 1 and 2 comas at transplantation versus 56% (p < 0.001) in those with grade 3 comas; it was 51% versus 81% (p < 0.001) in those transplanted with high risk (ABO-incompatible, split, or steatotic) and low-risk grafts, respectively. In a multivariate analysis, steatotic and partial grafts were predictive of poorer patient survival, and ABO incompatibility was predictive of poorer graft survival. CONCLUSIONS: Orthotopic liver transplantation is an effective treatment in fulminant hepatitis. Use of high-risk grafts permitted transplantation of 83% of patients, but was responsible for higher mortality.
Flagellar dyskinesia is characterized by abnormal sperm movement parameters and a negative sperm mucus penetration test. It is associated with structural pathologies of the axonemal complex (lack of outer dynein arms), of the periaxonemal complex (sliding spermatozoa and periaxonemal dyskinesia), or of both structures (short flagella). Even during in vitro fertilization, dyskinesia prevents the spermatozoon from getting through the egg vestment. However, in some cases, fertilization has been achieved using subzonal insemination. Flagellar dyskinesia is therefore an interesting model for investigating the role of sperm movement in the fusion process between the spermatozoon and the oolemma. Thirty-one patients requiring assisted fertilization were included in the study. Fifteen had spermatozoa in which the flagellum lacked outer dynein arms, 11 had anomalies of the periaxonemal complex (five with sliding spermatozoa and six with periaxonemal dyskinesia) and five had spermatozoa with short flagella. Seven men who produced spermatozoa with normal movement were selected as controls. Movement was evaluated using a computer-assisted analyser, and penetration was assessed using zona-free hamster eggs. At 37 degrees C, in semen, the dyskinetic spermatozoa had reduced straight line and curvilinear velocity and lateral head displacement compared with controls (P < 0.01). In the Percoll-selected sperm suspension, the only difference was that spermatozoa with periaxonemal anomalies maintained a narrow lateral head displacement compared with the controls (P < 0.001). After 3 h of incubation at 37 degrees C, the lateral head displacement of dyskinetic spermatozoa had not changed, while that of the controls showed a significant increase (4.5 to 5.6 microns; P < 0.05). The results from the sperm penetration assay for the spermatozoa lacking outer dynein arms were lower than those of the controls (47% versus 77%; P < 0.05) and the results for sliding spermatozoa and spermatozoa with periaxonemal dyskinesia were even lower (25% and 34%, respectively; P < 0.01). The fertilization rates after subzonal insemination were 46.5% for spermatozoa lacking outer dynein arms, 36.1% for spermatozoa with short flagella, 24.8% for sliding spermatozoa and 17.3% for spermatozoa with periaxonemal dyskinesia. There was a significant correlation between the curvilinear velocity of the Percoll-selected sperm suspensions and their fertilization rates after subzonal insemination (r = 0.5; P < 0.05) and their sperm penetration assays (r = 0.7; P < 0.001). The data provide evidence that sperm velocity is correlated with the ability to fuse with the oolemma.
OBJECTIVE: France and Britain have similar size populations, yet the incidence of AIDS is threefold higher in France. The objective of this study was to compare data from two surveys recently performed in the two countries, in order to determine whether differences in sexual and drug-use behaviour could explain the different epidemiological patterns. DESIGN: Cross-sectional random sample surveys of France and Britain. RESPONDENTS: In France, 20,055 persons aged 18-69 years and in Britain, 18,876 persons aged 16-59 years were interviewed in 1990-1991. The following indicators were compared in the respondents aged 18-59 years: prevalence of homosexual experience and injecting drug use, number of sexual partners, prevalence of sexual practices, condom use and sex with prostitutes, age of sexual partners. RESULTS: Very similar results were found for the prevalence of male homosexual partnerships. Slightly higher numbers of lifetime partners were reported by French than British men, but no difference was found for recent periods. Anal intercourse and sex with prostitutes was more frequent among heterosexual French people than British people. Condom use was more systematic in Britain than in France. CONCLUSION: Only small differences were found between the two countries, although prevalence of risk indicators were higher in France. These differences combined with early development of prevention policies in Britain, together with the timing of virus introduction, may contribute to differences between the epidemics in the two countries.
PURPOSE: Intermediate uveitis presents a characteristic clinical picture with inflammation in the vitreous and peripheral retina. From a physiological point of view, the disease is characterised by a rupture of blood-ocular barriers. To determine the sites involved, a vitreous fluorophotometry was performed in patients with intermediate uveitis and in a group of healthy patients. METHODS: Seventy-one patients with an intermediate uveitis were studied by vitreous fluorophotometry. Anterior chamber and posterior segment fluorophotometric findings were measured 5 and 60 minutes after injection of fluorescein. Results were compared to a group of healthy patients. RESULTS: Vitreous fluorophotometry demonstrated abnormal leakage of fluorescein in all vitreous sectors of the patients suffering from uveitis compared with the control group (p < 0.001). In the anterior chamber, leakage of fluorescein was not significantly different between the two groups (p > 0.05). CONCLUSION: Results obtained suggest that intermediate uveitis involves a generalized permeability disturbance of the posterior segment secondary to a diffuse vasculitis. However, in the anterior segment this disturbance is not found.
MRI has now been recognized as the best technique for exploration of spinal tumours and, in particular, tumours within the spinal cord. Based on a retrospective study of 74 operated glial tumours, we are trying to define a specific semiology for intramedullary astrocytomas and ependymomas. Thirty-four cases were selected including 17 astrocytomas (7 low-grade, 10 high-grade) and 17 ependymomas (1 of which was grade III) for whom the pre-operative MRI examination was complete, with T1-weighted sequences without, then with gadolinium, and T2-weighted sequences. The examination was performed using a high-field and in most cases 1.5 Tesla machine. Analysis, correlated with operative data and pathology results, comprised on the one hand patients' distribution by age, sex and location of the tumour on the spinal cord, and on the other hand the MRI semiology concerning the sagittal and axial localization of the fleshy portion after gadolinium injection, the limits of the tumour, the homo- or heterogeneous character of its enhancement, the possible existence of stigmas of intra- or peritumoral chronic bleeding, and finally the presence or absence of associated cysts in the 34 exploitable cases. Some semiological differences were elicited between astrocytomas and ependymomas: the patient's age at the time of diagnosis was predominantly 0 to 20 for astrocytomas (astrocytomas 39%, ependymomas 4%), and the well-limited character of the fleshy portion of the tumour after gadolinium injection was found in 70% of ependymomas, 40% of high-grade astrocytomas and 14% of low-grade astrocytomas. The homogeneity of contrast enhancement in ependymomas has been classically defined, but it did not show in our series. Finally, it seems that high-grade astrocytomas are characterized by the rare presence of hemosiderin deposits (high-grade 20%, low-grade 57%, ependymomas 58%) and by the absence or reduced extension of overlying and underlying cysts.
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BACKGROUND: The role of liver transplantation in patients positive for the hepatitis B surface antigen (HBsAg) is controversial because of the high rate of recurrent hepatitis B virus (HBV) infection. It has not been determined whether this risk is greater for certain patients and whether the administration of anti-hepatitis B surface antigen (anti-HBs) immune globulin is beneficial. METHODS: We conducted a retrospective study at 17 European centers of 372 consecutive HBsAg-positive patients who underwent liver transplantation between 1977 and 1990. Recurrence of HBV infection was defined as the reappearance of HBsAg in serum. RESULTS: For all 334 patients with follow-up data, the mean (+/- SE) three-year actuarial risk of recurrence of HBV was 50 +/- 3 percent. The risk was 67 +/- 4 percent among 163 patients with HBV-related cirrhosis, 32 +/- 5 percent among 110 patients with cirrhosis related to hepatitis delta virus, 40 +/- 16 percent among 14 patients with fulminant hepatitis delta infection, and 17 +/- 7 percent among 39 patients with fulminant HBV infection (P < 0.001). Among the patients with HBV-related cirrhosis, the risk of HBV recurrence was greatest (83 +/- 6 percent) in those who were seropositive for HBV DNA at the transplantation and lowest (58 +/- 7 percent) in those with neither HBV DNA nor hepatitis B e antigen detectable in serum. With respect to the use of passive prophylaxis with anti-HBs immune globulin, the risk of HBV recurrence was 75 +/- 6 percent among the 67 patients given no immunoprophylaxis, 74 +/- 5 percent among the 83 treated for two months, and 36 +/- 4 percent among the 209 treated for six months or longer (P < 0.001). In a multivariate analysis the predictors of a lower risk of HBV recurrence were the long-term administration of the immune globulin, hepatitis delta virus superinfection, and acute liver disease. For the entire study cohort, survival was 75 percent at one year and 63 percent at three years, but for those in whom HBV infection recurred, survival was 68 percent at one year and 44 percent at three years. CONCLUSIONS: In this retrospective study of HBsAg-positive patients, liver transplantation had better results in those who had fulminant hepatitis or delta virus superinfection. An absence of viral replication at the time of transplantation and long-term immunoprophylaxis were associated with a reduced risk of recurrent HBV infection and reduced mortality.
Studies in animals on the use of UW solution in liver transplantation have shown an inverse relation between cold ischaemia time (CIT) and graft function. There are few clinical data on this relation in human beings. We have investigated the effect of extended cold ischaemia in a prospective study. We assessed early graft function and subsequent outcome for 306 consecutive elective liver transplantations; for analyses, grafts were grouped according to CIT (< 12 h group A, > or = 12 h group B), since a preliminary study identified 12 h as a significant cut-off point. Initial graft function was better in group A than group B, as shown by maximum alanine aminotransferase activity (mean 623 [805] vs 946 [1148], p = 0.02), bile production on days 1-3 (p < 0.05), maximum serum bilirubin by day 10 (206 [166] vs 244 [163] mumol/l, p = 0.04), and frequencies of primary non-function (1 [0.4%] vs 4 [7%], p = 0.006) and hepatocyte necrosis on routine biopsy sample after reperfusion (18% vs 31%, p = 0.04). Long-term outcome was also better in group A than group B; graft and patient survival rates were higher and fewer retransplantations were needed. These findings suggest that cold ischaemia in UW solution for longer than 12 h is a risk factor for graft function and patient survival. We recommend that the limit of the safe CIT be reconsidered.
In order to evaluate male and female risk factors for infertility in a case-control study, we have compared all couples in a French administrative region consulting for primary or secondary infertility (of more than one year's duration) with couples in which the woman had given birth during the year of the study. For any one couple, a history of varicocele, male genital infections or testis damage multiplies the risk of primary infertility by a factor of 28, 3 and 4 respectively, and previous female infections (salpingitis) multiply the risk by 45. Similarly, a history of ectopic pregnancy, sexually transmitted diseases or salpingitis multiplies the risk of secondary infertility by a factor of 5, 4 and 7 respectively, and a history of varicocele multiplies this risk by 4.
Subzonal insemination (SUZI) has been proposed for patients with sperm male factor infertility, and in cases of in-vitro fertilization (IVF) failures. However despite SUZI, there still remain couples with very low fertilization rates and even with fertilization failures. Since sperm parameters are known to influence the IVF fertilization rate, we investigated the relation between sperm parameters and the SUZI issue in cases of previous IVF failures with normal or subnormal sperm. Twenty-seven couples were included in the study and were split into two groups according to whether they had normal or subnormal sperm. In the first part of the study a randomized prospective trial comparing SUZI to classic IVF insemination was carried out (11 cycles). In the second part, all the oocytes had SUZI (35 cycles). None of the control inseminated oocytes fertilized. Including all the cases, the fertilization rate after SUZI was 29.8% with a pregnancy rate of 15.2% per cycle. We concluded that: (i) SUZI is efficient for achieving fertilization in cases of IVF failures; (ii) the post SUZI fertilization rate is inversely correlated to the percentage of acrosome defects in the semen (P < 0.001); and (iii) when the sperm is normal, the oocyte quality might be responsible for the previous IVF failures. In spite of a good fertilization rate for this indication, it seems that the chance of having a baby is low.