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Biomedical subjects

B J Paniel

Publications and source records attributed to B J Paniel.

52 records · Page 3Linked to original sources
PubMed1987

[Autoimmune thrombocytopenia and pregnancy].

Idiopathic thrombocytopenic purpura is an auto-immune disease that carries a risk of haemorrhage when the number of platelets drops to lower than 50 X 10(9)/l and particularly when the bleeding time is prolonged. Thrombocytopenic purpura and pregnancy can be associated with one another and the frequency of that is about 1/5000. Maternal mortality and morbidity are, however, practically nil when proper therapeutic measures are taken. Since 1981 IG IV, which is expensive but rapidly effective, is available to overcome corticotherapeutic failures and to avoid splenectomy in acute cases. Since the maternal anti-platelet factor can cross the placenta, the fetus may become thrombocytopenic like the mother and at risk of the complications of haemorrhage and particularly intra-cranial haemorrhage during delivery vaginally. Screening for fetuses that are affected (52% of the cases) is now possible, not by relying on the maternal platelet count, which is without any prognostic value for the fetus, nor on the levels of anti-platelet antibodies but on the use of examining fetal scalp capillary blood at the onset of labour. This test may make it possible to carry out a vaginal delivery safely when the fetal platelet count is higher than 50 X 10(9)l, whereas if it is lower than this figure a prophylactic caesarean operation should be carried out. There is much promise in the possibility of sampling blood in the fetal cord using ultrasound techniques. In a small number of cases that has already made it possible to diagnose the condition of thrombocytopenia in the fetus even before labour has started. It may in the future even make it possible to carry out treatment of the fetus in utero followed by a normal delivery, whether the treatment is carried out by treating the mother or directing platelets or better still IG IV directly into the fetal circulation.

Adrenal Cortex Hormones↗
PubMed1985

[110 cases of longitudinal septa of the vagina].

A retrospective analysis of 110 longitudinal septa ov the vagina which were seen at the Hotel-Dieu in Paris, demonstrated the following features: They were well tolerated and were discovered by chance in nearly 60% of cases, causing symptoms in 40% of cases. These symptoms were: dyspareunia, apareunia, haemorrhage at the first act of intercourse and more recently signs connected with the increasing use of tampons for the periods. They were complete in 49% of cases and incomplete in 51% of cases mainly in the upper part of the vagina. They were associated: in 26% of cases with a bicornuate-bicervical uterus, in 64% of cases with a septate uterus, the septum being total in 54% of the cases, in almost 10% of cases there was either a normal uterus or communicating uteri. There were fewer than 1% of normal uteri above septa that included the cervix and the vaginal vault. Clinical study of these malformations of the uterus and the vagina lead one to be able to make a hypothesis about the embryology: the fusion of the Müllerian canals and then the absorption of the septum where they join starts at the level of the isthmus. All morphological abnormalities of the uterus occur between the 55th and the 68th day of fetal life. The treatment is surgical, which is simple but has to be carried out very carefully. It consists of division or removal of the septum and should be done when the symptoms make it necessary, or during delivery when it gives rise to a dystocia or to a tear, which occurs but rarely.

Abnormalities, Multiple↗
PubMed1985

[Rectocolic endometriosis].

The authors distinguish two major varieties of rectocolonic endometriosis: the isolated benign sigmoid endometrioma which is difficult to distinguish from malignant lesions of the mucosa; the tendency to progressive stenosis is an indication for surgical excision of this lesion. Genital endometriosis which has spread to the intestinal tract. The genital and peritoneal lesions facilitate the diagnosis of the recto-sigmoid lesion. On the other hand, the intestinal involvement complicates the therapeutic. Low rectal involvement usually consists of endometriosis grafted to a perineal scar.

Endometriosis↗
PubMed1984

[Vulvoperineoplasty].

Vulvoperineoplasty is a surgical operation consisting of: (1) wide cleavage of the posterior vaginal wall, as in posterior colpoperineorrhaphy; (2) excision of a triangular segment of perineal skin, the summit of which touches the margin of the anus; (3) full exposure of the perineal central fibrous core and reduction of its relief by radial incisions and digital dissection; (4) lowering and eversion of a posterior vaginal flap with good blood supply in order to reconstruct the fourchette of the enlarged vaginal opening. This technique is applicable not only to congenital or acquired vulvar stenosis but also to the treatment of sclerous or dystrophic lesions of the fourchette. It was used on 43 occasions between 1978 and 1983, viz. in 6 patients after surgical treatment of prolapse, in 14 patients after obstetrical injury, in 17 cases of lichen sclerosus of the vulva and in 6 cases of Bowen's disease. The results were anatomically perfect in all cases, cosmetically good in 40 cases and functionally satisfactory in 40.

Adult↗
PubMed1984

[Vulvo-perineal surgery].

Vulvo- perineoplasty consists of: Splitting the posterior vaginal wall widely as is done for a posterior colpoperineorrhaphy operation. Excising a triangle of perineal skin the apex of which coincides with the margin of the anus. Thinning down the central fibrous nodule of the perineum which is completely exposed by radial incisions and digital dissection. Bringing down a well vascularised flap of the posterior vaginal wall so as to reconstitute an enlarged vaginal opening. This technique can not only be used to cure congenital and, especially, acquired narrowing of the vulva but also sclerotic and dystrophic conditions of the fourchette .

Adolescent↗
PubMed1984

[Surgical treatment of congenital transverse septum below the cervix of the vagina].

Transverse septa underneath the cervix are thick and have above them a funnel-shaped vault covered by pathological mucous membranes. The surgical procedures that are normally used to try to treat the condition and to avoid soft tissue dystocia by carrying out V-Y plasties using Garcia's technique or Z-plasties, or even radial incisions followed by the insertion of a pack, are all somewhat unsatisfactory. The authors, confronted with a similar case, decided to cut out the dome of the vagina and the diaphragm and followed that by a small amputation of the cervix, with anastomosis of the uterus and the remaining vagina.

Cervix Uteri↗
PubMed1978

[Diagnosis and treatment of intra-epithelial carcinoma of the uterine cervix. About 124 cases (author's transl)].

The means for diagnosis, treatment and long follow-up of intra epithelial carcinomas of the uterine cervix are assessed by the authors, about 124 cases seen at the Hotel-Dieu de Paris. The diagnosis is given by cytologic means and mostly by colposcopic examination. When the cylindro-pavimental junction (usual initial focus) is seen in totality, direct biopsies always gave an accurate diagnosis. When the junction is not seen, only a diagnostic--conisation can allow a definitive answer. Two types of surgical treatment were applied: amputation of the cervix conservative of menstrual and/or reproductive functions and, hysterectomy led by vaginal or abdominal route. The patients were followed from 1 to 16 years by the triple cytologic, Schiller test and colposcopic examination: none of them showed any recurrence either of intra-epithelial or of invasive type.

Biopsy↗
PubMed1978

[Haemangiopericytomas of the uterus. 4 case histories (author's transl)].

The authors report four cases of uterine haemangiopericytoma. These vascular tumours develop at the expense of the pericytes of Zimmermann. They are very rare since only 64 cases have been reported. The haemangiopericytomas of the uterus are clear cut histologically and as far as their ultrastructure is concerned. They therefore can be clearly distinguished from other connective tissue tumours which develop in the uterus and especially in the stroma of the endometrium. They should be considered as slow growing sarcomata of the myometrium as a study of the embryogenesis of the genital tract shows. Their prognosis is guarded.

Adult↗
PubMedDate not supplied

The congenital mesoblastic nephroma: a case report of prenatal diagnosis.

The congenital mesoblastic nephroma is a very rare benign congenital renal tumor. It is the most common renal tumor before the age of 6 months (50%) and it constitutes only 5% of renal tumors before 15 years. The authors report a case of prenatal diagnosis of congenital mesoblastic nephroma revealed by an acute polyhydramnios at 33 weeks of pregnancy. After a preterm labor, the patient delivered at 35 weeks. The newborn underwent a radical nephrectomy. No recurrence was noticed at 10 months. This case of prenatal diagnosis is compared to the 12 cases previously reported. The prognosis of CMN depends on histologic findings, but also on the severity of prematurity induced by the polyhydramnios. The main treatment of this pathology if diagnosed during pregnancy remains the prevention of preterm labor, and after birth the removal of the kidney.

Adult↗
PubMedDate not supplied

[An original and effective technic for trachelorrhaphy. Preliminary note].

Extensive commissural tears in the region of the isthmus accompanied by incompetence of the cervix can be easily and successfully treated by an original procedure carried out through the vagina. The technique uses at the same time the general ideas and advantages of the freshening of the surfaces technique uses at the same time the general ideas and advantages of the freshening of the surfaces technique of Emmet, the repair of the isthmus technique of Lash and of Palmer and Shirodkar's cerclage technique for stitching the isthmus of the uterus.

Adult↗