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Biomedical subjects

B Hedon

Publications and source records attributed to B Hedon.

At least 73 records · Page 4Linked to original sources
PubMed1990

Pure fetal blood samples obtained by cordocentesis: technical aspects of 322 cases.

Three hundred and twenty-two percutaneous umbilical blood samplings were performed over 4 years in our prenatal diagnostic centre. A 3.5 MHz sector ultrasound transducer was used to guide a 22.5-gauge needle under local anaesthesia. Sampling was performed for rapid fetal karyotyping (within 72 h) in 120 cases, for diagnosis of fetal toxoplasmosis in 133 cases, for determination of the severity of Rh immunization in 15 cases, and for diagnosis of congenital rubella in 4 cases. Pure fetal blood was obtained in 98.7 per cent of the cases after two attempts. The approach to the cord was either transamniotic or transplacental. Puncturing was preferentially done at the placental insertion of the cord (72.2 per cent of the cases) and the mean blood sample volume was 3.5 ml. The rate of fetal death in utero was 1.9 per cent, including two cases of amnionitis, one trisomy 18, and one severe bradycardia. The failures were due to sampling at an early stage of pregnancy (before gestation week 18), to maternal obesity, oligohydramnios, and the inexperience of the operator.

Anemia, Sickle Cell↗
PubMed1990

Early or late monitoring of stimulation of ovulation for in-vitro fertilization? A methodological discussion of a randomized study.

Two GnRH agonist long-stimulation protocols, in association with HMG, are compared on a random basis. Group A (n = 53) was monitored daily from the 6th day of stimulation, whereas monitoring in group B (n = 55) began on the 11th day of stimulation. There was no significant difference in the numbers of follicles which matured, the numbers of collected oocytes, the numbers of embryos obtained in vitro and the clinical pregnancy rate. But the power of such a study is very weak (6%). It would have been necessary to include greater than 1000 patients in each group to obtain a bioequivalence test. Such a study is unrealistic for a single centre and multicentric studies are very difficult to achieve because of practical difficulties. A pooled analysis is perhaps the methodological answer.

Chorionic Gonadotropin↗
PubMed1990

Obstetrical results after embryonic reductions performed on 34 multiple pregnancies.

Thirty-four women with multiple pregnancies (three or more fetuses) underwent embryonic reduction in order to reduce abortions, premature births or fetal growth-retardation by obtention of twins. Four early abortions occurred. Thirty pregnancies reached term and out of 60 fetuses, 58 infants were born alive. Fetal death in utero of one twin occurred in two pregnancies. The mean term until delivery was 36 +/- 2.8 weeks gestation and the prematurity rate was 51.7%. Of 55 neonates, 25 were underweight within the 10th percentile and 10 out of 55 neonates were underweight below the 3rd percentile. There were three deaths in the early neonatal period. The rate of perinatal mortality was 8.3%. Fifty-four children are currently healthy and one child has a mild axial hypotonia. A reduction in prematurity was observed with a gain of 2 weeks on reported data concerning triplet pregnancies. The rate of low-birth-weight infants was high, 63.5% being underweight at birth.

Abortion, Incomplete↗
PubMed1990

The evolution of oral contraceptives. Maximizing efficacy, minimizing risks.

No single pharmacologic agent has been more widely studied than the oral contraceptive (OC). Scientific efforts have been directed primarily toward maximizing the benefits of OCs--which remain the most effective, reversible form of birth control--while minimizing their potential risks, specifically thromboembolic disorders and cardiovascular disease. Decreases in the dose of estrogen from the 100 micrograms--150 micrograms levels of the 1960s to the 30 micrograms--50 micrograms formulations of today have been accompanied by dramatic reductions in the risk of thromboembolic events. In healthy women not predisposed to these conditions, the risk of thromboembolism is now considered very small. Similar reductions in the doses of progestin have also resulted in decreases in the incidence of stroke and myocardial infarction. Evidence suggests that not only dose but androgenic activity of a progestin may negatively impact on risk of cardiovascular disease. Thus development of OCs containing a progestin with the least potential for androgenically mediated side effects appears to be advisable.

Cardiovascular Diseases↗
PubMed1990

[Hazards of ultrasonography of the hip].

We studied the value of ultrasound examination combined with conventional clinical evaluation in screening for congenital defects of the hip in a study including more than 3,000 neonates. We used two kinds of ultrasound methods, i.e. the morphological method, that is highly standardized and seeks to identify several well-defined anatomic landmarks (Graf's technique), and the dynamic method, that uses transverse flexion, frontal flexion or medial sections to determine the degree of stability of the hip. We describe these sections in detail so that pediatricians may correctly appreciate the images obtained. The respective indications of each section depend on the findings made as the investigation advances. Rigorous adherence to precise rules is now possible and is the only means for ensuring that these techniques will be used rationally in a way that can be expected to significantly reduce the still considerable number of dislocations and dysplasias of the hip discovered beyond three months of age.

Evaluation Studies as Topic↗
PubMed1990

[Hormone therapy in the 40-year-old woman].

Hormone replacement therapy is frequently prescribed in 40-year old women because of the hormonal changes which start to occur at this age. A progestogen-only treatment is often prescribed to restore the oestrogen/progestogen balance. This treatment alone can be sufficient on the therapeutic level as well as on the contraceptive level. However, in order to minimize the risks of such a treatment, a non-androgenic derivative must be chosen. There are no contra-indications for oral contraceptives in women who are over 40 years old on condition that the risk factors are not cumulated. Here also, it is advisable to use the lowest possible dose of steroids which has an adequate contraceptive action and enables a good cycle control. As for oestrogens, the minimum ethinyloestradiol dose must be sought. For the progesterone dose, a non-androgenic derivative should be chosen. The GnRH agonists may have some indications, but their exact place is yet to be defined.

Adult↗
PubMed1990

[An association of Werdnig-Hoffman disease and pregnancy: apropos of an unusual case].

The authors describe the first case in the literature of pregnancy in a twenty year old patient suffering from Werdnig Hoffman's disease. This is pure progressive spinal muscular atrophy which involves respiratory and locomotor functions. It brings into consideration several problems of respiration and in particular of genetics to be considered in this case, and we report that pregnancy was well tolerated in the patient who had a severe physical handicap.

Adult↗
PubMed1989

[Dissociation of maternal and fetal platelet levels in maternal idiopathic thrombocytopenic purpura. Diagnosis of fetal thrombocytopenia by cord ultrasound-guided puncture].

Severe foetal thrombocytopenia (24,000 platelets per cubic mm) was diagnosed in a 37-week pregnant woman. The primigravida, primipara mother had been affected with idiopathic thrombocytopenic purpura at the age of 6 years, in remission since the age of 8 years (after splenectomy). The prenatal diagnosis was made by foetal blood sampling performed when the mother's platelet count was normal. The expected haemorrhagic complications of vaginal delivery were avoided by a caesarean section.

Adult↗
PubMed1989

[Pulsatile administration of LH-RH: diagnostic and therapeutic applications].

Hypothalamic hypogonadotropic hypogonadism (HHH), a disorder occurring in both sexes, is characterized by a partial or complete inability to synthesize and/or release LH-RH from the hypothalamus which result in absence or defects of amplitude and frequency of gonadotropin secretion. Long term substitution by pulsatile exogenous LH-RH usually result in complete normalization of both pituitary and gonadic hormones. Such a treatment allows differentiation between hypothalamic and pituitary causes of hypogonadotrophic hypogonadism. Ovulation and fertility can be achieved in most of women with hypothalamic amenorrhea treated with pulsatile LH-RH using i.v. bolus doses of 25-100 ng/kg at 1-2 h intervals. In opposite LH-RH therapy yields inferior results to human menopausal gonadotropin (hMG) in chronic anovulatory patients with persistent LH secretion or polycystic ovary syndrome (PCOS) as shown by one randomized and several non-controlled studies. Successful pulsatile LH-RH treatment following a 2 months LH-RH analog suppression in PCOS previously refractory to LH-RH alone represents a new promising approach. The majority of men with complete HHH begin to produce sperm only after 1 year of therapy. Both the testicular volume and the mean sperm concentrations were below the normal values after 2 years of treatment in spite of normalization of testosterone, LH and FSH levels. Pulsatile LH-RH does not seem significantly improve the treatment of infertile HHH men compared to hMH/hCG.

Amenorrhea↗
PubMed1989

Results of IVF attempts in patients with unexplained infertility.

From January 1986 to July 1987, 143 patients with unexplained infertility (UI) following 217 IVF attempts were studied and randomly assigned for statistical analysis to be compared with 434 tubal infertility (TI) patients undergoing 748 IVF attempts. The age of patients, previous pregnancy history and stimulation protocols were identical in both groups. In comparison with tubal patients, IVF attempts on the UI group were characterized by the same rates of cycle failure, mean number of oocytes retrieved per cycle, a lower fertilization rate (45.7% UI/59.8% TI) (P less than 0.01) and no difference in cleavage and nidation rates. However, a decrease in the pregnancy rate/attempt (13.8% UI/19.5% TI) tended towards a significant value (P = 0.06). Although the semen parameters were found to be in the normal range during the previous fertility screening in both groups, the incidence of at least one abnormality (count less than 20 X 10(6)/ml, and/or total motility less than 30% and/or abnormal forms greater than 75%) on the day of insemination was found to be significantly higher in UI (20%) than in TI (11%) patients. Moreover, 25% of UI patients did not fertilize any oocytes inseminated, whatever the number of oocytes retrieved. This rate of failed fertilization was significantly lower (9%) in tubal patients. The oestrogen response profiles were similar in both groups, analyzed according to the stimulation protocols.(ABSTRACT TRUNCATED AT 250 WORDS)

Buserelin↗
PubMed1989

[Use of a technic of bioluminescence for determining estrogens and LH during static and dynamic study of the ovary].

Estrogens and LH are necessary among other assays for ovulation diagnostic and ovarian monitoring during stimulations. They can be both measured with a method based on a bioluminescent reaction. This method measures, with a standard luminometer, the reduced NAD produced and accumulated by the reaction of two dehydrogenase enzymes: the estradiol dehydrogenase for direct assay of estrogens (estrone + estradiol), the glucose-6-phosphate dehydrogenase for gonadotrophin determination. These techniques can be applied to all biological fluids. They are simple and straightforward, do not need extraction and can be automated. Urinary assays are very useful in clinical practice to appreciate ovarian function, either during a spontaneous cycle or under stimulation, and are mandatory to decide the timing of hCG injection. The reported studies can be listed as follows: determination of preovulatory LH rise (LH greater than 10 Ul/g of creatinine) prior to embryo transfer after cryopreservation and thawing, detection of LH surges during ovarian stimulation, either premature surges causing premature luteinization, either normal surges when follicular maturation is adequate (296 cycles), confirmation of pituitary desensitization when using GnRH agonists (43 cycles), study of the initial stimulatory effect of GnRH agonists (13 patients). This effect can be responsible for the inadequate results obtained with the so-called "short protocol" in this experience when compared with the "long protocol" in the author's experience with compared with the "long protocol" (8 p. cent pregnancy rate per stimulation cycle versus 20 p. cent respectively, intrafollicular LH in 129 follicular fluids (86 with GnRH agonists and 43 without) has no correlation with the fecundability of the ovum. These results lead to extend bioluminescent techniques to the study of other parameters, and in particular FSH.

Buserelin↗
PubMed1989

[Congenital mesoblastic nephroma (Bolande's tumor). Prenatal diagnosis].

The authors report a new case of the antenatal ultrasound diagnosis of a congenital mesoblastic nephroma (also called Bolande's tumor) at 33 weeks of amenorrhea. This tumor was found to be associated with acute hydramnios involving premature labor and fetal death by respiratory embarrassment. Congenital mesoblastic nephroma is a very rare entity but is the predominant renal neoplasm in the immediate neonate period. The differential diagnosis between Bolande's tumor and nephroblastoma (Wilm's tumor) is now clear since histopathological features have been precisely described by Bolande. Clinical and pathological features of the renal disease are discussed. The prognosis is excellent for most cases requiring only surgical treatment (nephrectomy).

Acute Disease↗
PubMed1989

[Fetal blood sampling for karyotype using echoguided puncture of the cord. Study of 103 pregnancies].

Subcutaneous ultrasound guided puncture of the umbilical cord was carried out in order to obtain samples of blood in 103 fetuses. This was done to get the result of the karyotype quickly, i.e. in 72 hours. The indications were for diagnosis, particularly of malformations (63 cases) or intra-uterine growth retardation (24 cases). A small proportion of the indications were those for failures to carry out amniocentesis early or for checking on mosaics that were obtained after the culture of amniotic fluid cells. In 88% of the cases it was possible to obtain a karyotype and the results were checked with the sex of the fetus and the karyotype that had been obtained from amniocentesis. There were 11 abnormalities diagnosed. The chief indication of chromosome abnormality is fetal malformation. Because the result are obtained so quickly cordocentesis should replace late amniocentesis, at present when looking for fetal abnormalities.

Adolescent↗