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Biomedical subjects

B Hedon

Publications and source records attributed to B Hedon.

At least 55 records · Page 3Linked to original sources
PubMed1993

Factors involved in catheter obstruction during long-term peritoneal insulin infusion.

OBJECTIVE: To analyze the efficacy of ECPII and the factors responsible for technical problems often encountered. This treatment has been in use with IDDM patients since 1980. RESEARCH DESIGN AND METHODS: Forty-four IDDM patients were treated by ECPII for 42-78 mo (mean, 53 mo). RESULTS: Glycemic equilibrium was improved during treatment (mean plasma glucose level, 7.6 mM; mean GHb level, 8%). Catheter blockage was the main reason for ECPII failure (74%). Mean catheter survival of each catheter, determined by actuarial analysis, was 11.7 mo and significantly decreased with subsequent implantation. SEM of the catheter tips showed deposits composed of fibrin and cells occluding the inner lumen. Factors such as age, sex, local infection, and low insulin basal rate were not found to have any incidence on the catheter survival. Placement of the catheter in the upper part of the peritoneum, however, increased catheter survival. Anti-insulin antibodies did not seem to be directly involved in blockage. CONCLUSIONS: We conclude from this long-term experience that during ECPII, catheter blockage remains the major recurring complication, probably involving a local immune-inflammatory response in the peritoneum.

Adult↗
PubMed1993

Plasma fibrinolytic activators and their inhibitors in women suffering from early recurrent abortion of unknown etiology.

The fibrinolytic response to a venous occlusion test was evaluated in 116 consecutive patients who had each had early recurrent miscarriages of unknown origin. A normal response to venous occlusion was defined from the statistical analysis of data obtained in a matched group of 90 women with no past abortion. Seventy-four patients had at least one abnormal fibrinolysis-related test, whereas no member of the control group had any (p < 10(-6)). Fifty-six of the patients had a stasis-induced shortening of the euglobulin clot lysis time that was less than normal (median decrement 3.5% [normal > or = 28%] [p < 10(-6)]). In this subgroup, 17 women also had a poor tissue-type plasminogen activator (tPA) response (median increment 18% [normal > or = 34%] [p < 0.001]). Twenty-one of the 56 had high plasma levels of type 1 plasminogen activator inactivator (PAI-1) as well as a high PAI activity level (p < 0.001 for comparison with normal controls). Sixteen patients had both abnormalities (tPA response blunted and high PAI values). When retested in the same patients, the patterns persisted over time. Nine other habitual aborters had abnormally high type 2 plasminogen activator inhibitor plasma levels (> 4.2 ng/ml). Six other patients had a poor urokinase-type plasminogen activator reactivity to venous occlusion (post-stasis levels lower than 0.18 ng/ml). Thus activators and inhibitors of the fibrinolytic system are frequently abnormal in primary habitual aborters. The current pathogeneses of high PAI-1 concentrations and of impaired tPA reactivity to venous occlusion were not found in these patients. The role of the fibrinolytic components in trophoblast invasiveness has been suspected in animals, and an impaired plasmin-dependent proteolysis in women might favor recurrent abortion by promoting fibrin deposition in early placental circulation or by limiting trophoblast development, or both.

Abortion, Habitual↗
PubMed1992

Favourable outcome in 33 triplet pregnancies managed between 1985-1990.

In this paper, we describe the outcome of 33 triplet pregnancies referred to us between 1985 and 1990. They were managed as follows: management at home as soon as the diagnosis was made, then hospitalization at 28 weeks' gestation. Progesterone and beta-mimetics were administered daily, a cesarean section was always performed. One late abortion occurred at 21 weeks. The rate of prematurity was 90.6%, mean gestational age at delivery was 34.1 +/- 3 weeks, and 62.5% of deliveries occurred between 34 and 37 weeks. Ninety-four fetuses were delivered alive. Mean birth weight was 1880 +/- 410 g. Fetal growth retardation rate was 61.8%, including 28 infants under the third centile and 31 under the 10th centile. Perinatal death rate was 4.16% including 2 in utero deaths and 2 neonate deaths. All infants are healthy except for one child with severe mental retardation. These results show that triplet pregnancies can be safely managed, and that selective first-trimester reduction in triplet pregnancies does not appear to be necessary.

Adult↗
PubMed1992

[Fetal growth retardation: prevention. Review of the literature].

The principle underlying preventive treatment of fetal intrauterine growth retardation can only be considered after defining various groups that are at risk and early screening based on the obstetric history, biological tests, and recently using flow rates with Doppler techniques. The use of aspirin in preventive treatment of growth retardation originates in the pharmacological properties of its molecule which allow the re-establishment of a balance of the prostoglandins. Numerous authors have studied clinical effects, its harmlessness as well as the true indications for its use. As there have been no control studies the theoretical possibilities of using Beta-Mimetic drugs has not been tested. The use of ultrasound has made it possible to try to see whether there is an improvement in the fetal state of well-being when oxygen therapy is used by the mother as it is in certain extremes to see what effect it has on placental function. Its use as an effective prophylactic has not yet been demonstrated. Promising lines of research could be assessing the effects of immunological treatments that have already been suggested (especially gammaglobulin transfusions). They have been used prophylactically with success but the series are small for well defined immunological indications.

Adrenergic beta-Agonists↗
PubMed1992

Ovarian consequences of the transient interruption of combined oral contraceptives.

The combined oral contraceptive pill is an efficient means of contraception. It acts at different levels of the genital tract. Despite its efficiency, it is universally suggested that patients take the pill at regular daily intervals. Little attention has been given to the question of what happens if you miss the pill one day or more. A study was undertaken to evaluate the consequences of pill misses at different times of the cycle. Forty-seven young, healthy, normally menstruating patients voluntarily enrolled. All were given Cilest (ethinyl estradiol 35 micrograms and norgestimate 250 mg, Cilag France) for 21 days without any misses. Then, after a 7-day interval, they were prescribed one (group 1), two (group 2), three (group 3) or four days of pill misses, to occur respectively on day 1 (group a), 6 (group b), 12 (group c) or 18 (group d) of a new 21 day cycle; supplementary contraceptive means were recommended. Four patients had no miss prescribed and served as controls. Ovarian function was evaluated with daily estrogen measurements (E1 + E2 enzymatic dosage, BioMérieux, France) and ultrasound examinations. When required, because of significant increase in estrogen or because of follicular growth detected on ultrasound, LH and progesterone were measured. None of the patients experienced a normal ovulation. Four patients (1 control, 1 from group 2a, and 2 from group 3a) had a significant increase in estrogen levels and had a follicular image on ultrasounds. One of them (group 3a) had a follicular rupture, but none had a LH surge or increase in progesterone.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1992

[Fetal growth retardation: physiopathology. Review of the literature].

Fetal hypotrophy or intrauterine growth retardation is an important cause of fetal and neonatal mortality and a real cause of iatrogenic prematurity. When pregnancy is progressing normally there are histological changes in the spiral arteries with an equilibrium between the endothelial prostacyclin and platelet thromboxane on the one part and peroxides and Vitamin E on the other part. This allows uteroplacental circulation to flow rapidly and at a low pressure. Furthermore immunological tolerance of the mother's system in the relationship to her embryo plays a part in bringing about this special haemodynamic state. The physiopathology of retarded growth stemming from the blood vessels brings into play multiple mechanisms. The first cause is a defect in placentation which is shown up as insufficient trophoblastic invasion in the second stage. This brings about endothelial dysfunction with disappearance of the normal equilibrium of the prostaglandins and an alteration in the physiological equilibrium between the peroxides and a natural antagonist, which is vitamin E. Immunological disturbances have also been considered following studies on the immunohistochemistry and with the frequent association of obstetrical vascular complications together with phospholipid specific autoantibodies.

Fetal Growth Retardation↗
PubMed1992

Cordocentesis versus amniocentesis for rapid fetal karyotyping in cases of late referral of women.

Eighteen women were referred for fetal karyotyping because of advanced maternal age (over 38 years) later than 23 weeks' gestation. In order to obtain more rapid karyotypes, cordocentesis rather than amniocentesis was performed. All procedures were successful, leading to the obtention of normal karyotypes in all cases. No fetal incidents occurred and results were obtained more rapidly than by amniocentesis. We suggest the use of cordocentesis rather than amniocentesis in cases of late referral of women.

Adult↗
PubMed1991

Early prenatal diagnosis of congenital cystic adenomatoid malformation of the lung (Stocker's type I); a case report.

A congenital cystic adenomatoid malformation was diagnosed by ultrasound examination at 20 week's gestation. The entire right lung was cystic and elements of poor prognosis such as hydrops fetalis and polyhydramnios were present. After verification of the karyotype, abortion was performed and autopsy confirmed prenatal findings and Stocker's type I. Cystic congenital adenomatoid malformation of the lung is a rare form of congenital pulmonary disease. Our case shows that this malformation can be accurately diagnosed during the midtrimester of pregnancy by ultrasound examination. Ultrasound examination permits an evaluation of the three types described by Stocker and may reveal certain lesions associated with poor prognosis, such as anasarca or polyhydramnios. Also, it offers the possibility to save some fetuses by surgical decompression in the immediate postnatal period, or to terminate earlier pregnancies by abortion.

Adult↗
PubMed1991

Prenatal diagnosis of an abdomino-pelvic hydrometrocolpos; a case report.

The authors describe a case of prenatal diagnosis of hydrometrocolpos performed at 35 weeks of ammenorhea. Diagnosis was based on fetal images of a rounded, solid, pelvic mass increasing rapidly, which evoked vaginal and uterine distension. No associated anomaly was found. This very unusual genital malformation required treatment at birth. This case shows that hydrometrocolpos can be evidenced by prenatal ultra-sonography allowing early treatment and prevention of complications.

Adult↗
PubMed1991

[The use of LHRH analogs in ovulation induction].

The use of LH-RH agonists is appropriate for the stimulation of ovulation. In contrast, in the case of induction of ovulation in a patient with deficient ovulation, suppression of influences of the hypothalamo-pituitary axis does not modify the pathological condition responsible for the ovulatory anomaly.

Clinical Protocols↗
PubMed1991

[Multicentric clinical trial of a combination of 35 micrograms of ethinylestradiol and 2 mg of cyproterone acetate].

The authors report the results of an open multicentric study of 136 women treated by a combination of 35 micrograms ethinylestradiol and 2 mg cyproterone acetate for cutaneous manifestation of hyperandrogenism. No pregnancy occurred during the treatment of 12 months. Comparison between the last treated and non treated cycle showed a significant difference (p less than 0.001) in the severity of acne lesions regardless of their sites. General and gynaecological tolerance were excellent.

Acne Vulgaris↗
PubMed1991

[Techniques, results and indications of embryonic reductions in multiple pregnancies. Review of the literature].

The authors report, after a review of the literature, the evolution of ideas concerning first-trimester terminations in multiple pregnancies. Different techniques are performed including transabdominal approach or transvaginal approach at the mean gestational age of 9 or 11 weeks of amenorrhea. Analysis of obstetrical results obtained after these procedures (rates of early or late abortions, preterm labor or in utero growth retardation) shows a high rate of abortions and demonstrate also that reductions are unable to prevent premature births. Indications are discussed: concerning pregnancies of high order (four or more), most part of authors agree with the procedure and also when a triplet pregnancy occurs on a scarred or malformed uterus. Concerning triplet pregnancies, the procedure remains considered by some teams as an unethical approach of theses gestations, specially when considering the recent advances in perinatal medicine. In all cases, a clear and complete information about the risks of these procedures should be given to couples faced with multiple pregnancies.

Abortion, Induced↗
PubMed1991

[Spontaneous rupture of the liver during triplet pregnancy following in vitro fertilization].

The authors present an observation of a spontaneous rupture of the liver happening during the 8th month of gestation of a triple pregnancy obtained by in-vitro fertilization. The diagnosis was done with some delay but evolution was successful for the mother and all her children. It is elective ligation of the right branch of the hepatic artery which produced the hemostasis.

Adult↗
PubMed1990

[Influence of abnormal weight and imbalanced diet on female fertility].

The cult of a slim body without the slightest bit of adipose tissue and the food restriction or selection habits it creates are extremely common in our society. Their influence on menstrual cycle and female infertility is not negligible. A vegetarian low calorie diet may induce cycle disorders and a short luteal phase. Disturbances in the pulsatility of gonadotropic hormones are responsible for anovulation, and they occur when slimness with excessive reduction of the body fat mass is associated with psycho-socio-professional stress factors or with intensive sporting activities. The greater frequency of dysovulation in obese women, notably those who put on weight rapidly, is accompanied by numerous hormonal changes, including reduced sex hormone-binding globulin, increased ovarian and adrenal androgen production, increased peripheral aromatization of androgens to oestrogens, and altered gonadotropin pulsatile secretion. The hyperinsulinism consecutive to insulin resistance in obese subjects might act as co-factor of the luteinizing hormone and as such participate in abnormalities of follicular maturation by stimulating the insulin-like growth factor and the ovarian androgens. However, the relative importance of these various factors in the physiopathology of abnormal ovulation remains to be determined. Overweight reduces the effectiveness of clomiphene citrate, menopausal gonadotropins and gonadotropin-releasing hormone in stimulating the follicles. Weight loss reduces hormonal disturbances and facilitates follicular maturation and ovulation in spontaneous or induced cycles.

Androgens↗