Search PubMed⌕ Search

Biomedical subjects

C Donner

Publications and source records attributed to C Donner.

At least 19 recordsLinked to original sources
PubMed2006

Evolution of fetal ultrasonography.

The authors wish to highlight the evolution that has occurred in fetal ultrasound in recent years. A first significant evolution lies in the increasing contribution of first trimester ultrasound for the detection of fetal anomalies. Malformations of several organs and systems have been diagnosed during the first trimester. Furthermore the systematic measurement of the fetal neck translucency has led to increasing rate of detection of aneuploidies and heart malformations. For several years now, three-dimensional (3D) and 4D ultrasound (US) have been used as a complementary tool to 2D US for the evaluation of fetal morphology. This brings an improved morphologic assessment of the fetus. Applications of the techniques are increasing, especially for the fetal face, heart and extremities. The third field where fetal US is continuously providing important information is the knowledge of the natural history of diseases. This has brought significant improvement in the postnatal management of several diseases, especially urinary tract dilatation and broncho-pulmonary malformation.

Congenital Abnormalities↗
PubMed2005

Should determination of the karyotype be systematic for all malformations detected by obstetrical ultrasound?

OBJECTIVE: The aim of this study was to determine whether karyotyping should be performed for every fetal malformation detected in low risk populations. METHODS: A karyotype was obtained from 428 fetuses examined over a 10-year period after fetal malformation was diagnosed using obstetrical ultrasound. These fetuses were separated into two groups, one with isolated malformations and the other with multiple malformations. The association between each type of malformation and the result of karyotype was evaluated. RESULTS: Forty-eight chromosomal abnormalities were encountered in 428 fetuses (11.2%). The karyotype was abnormal in 32/343 (9.3%) fetuses with isolated malformations and 16/85 (18.8%) fetuses with multiple malformations (p=0.022). The probability of an abnormal karyotype among the group of isolated malformation depended on the anatomical system involved (p<0.001). Our study demonstrated several isolated malformations without chromosomal abnormality (hydronephrosis with high obstruction, unilateral multicystic dysplastic kidney, gastroschisis, intestinal dilatation, meconium peritonitis, cystic adenomatoid malformation, pulmonary sequestration, tumor, vertebral anomaly). CONCLUSION: Each fetus with multiple malformations needs a chromosomal analysis. Within the group of isolated malformations, our study emphasizes that medical maternal history and the type of malformation need to be taken into account before performing a fetal karyotype.

Abnormalities, Multiple↗
PubMed2002

[The gynecology-obstetrics department].

The scientific and clinical activities of the Department of Obstetrics and Gynaecology have involved the three main subdivisions: the gynecological surgery, the obstetrics and fetal medicine, the endocrinology and the reproductive medicine. Minimal invasive surgery including laser assisted laparoscopy or robotic assisted surgery has been particularly developed. Endometriosis, a frequent and sometimes particularly invasive disease, and oncologic surgeries have been developed in collaboration with the digestive surgery department. The department has also contributed to the comprehension and treatment of prenatal pathologies such as premature labor and deliveries or the gestational diabetes. The department has supported the development of techniques to study the fetal well-being in utero: the prenatal echography, the chorionic villous sampling, the amniotic puncture or the cordocentesis for prenatal genetic diagnosis or fetal infectious contaminations, the CMV transmission more specifically. In endocrinology and reproductive medicine, the department has mainly developed the in vitro fertilization techniques. The prolonged embryo culture, the study of preimplantation embryo metabolism, the preimplantation genetic diagnosis and the cryopreservation of ovarian fragments to preserve fertility in women undergoing oncologic treatments represent the more recent developed topics. Finally, the security of viral transmission in assisted procreation and the treatment of these patients with chronic viral diseases (Hepatitis C or HIV) are another domain with important scientific activity.

Belgium↗
PubMed2000

Prenatal diagnosis of congenital cytomegalovirus infection: prospective study of 237 pregnancies at risk.

OBJECTIVE: To develop recommendations for prenatal diagnosis of congenital cytomegalovirus (CMV) infection and evaluate possible prognostic markers. METHODS: We studied 237 pregnant women who had suspected or confirmed primary CMV infections by amniocenteses with or without funipuncture. Diagnosis of CMV was based on culture and polymerase chain reaction (PCR) done on amniotic fluid (AF) samples; fetal blood tests for CMV immunoglobulin M antibodies, PCR, and nonspecific biologic markers; and repeated ultrasound examinations. In cases of pregnancy termination, viral and pathologic examinations of fetuses were done. At birth, CMV infections were sought in newborns. Pediatric follow-up was scheduled for at least 2 years. RESULTS: Of 210 fetuses and newborns correctly evaluated, 55 had CMV infections. Ten of 38 fetuses infected before 20 weeks' pregnancy had severe congenital disease. The global sensitivity of prenatal diagnosis was 80%. Best sensitivity and 100% specificity were achieved by PCR done on AF sampled after 21 weeks' gestation, respecting a mean interval of 7 weeks between diagnosis of maternal infection and prenatal diagnosis. Fetal thrombocytopenia was associated with severe fetal disease. Ultrasound follow-up missed two fetuses who presented with neurologic impairment due to CMV after birth. CONCLUSION: A reliable prenatal diagnosis of congenital CMV infection based on PCR on amniocentesis samples can be made after 21 weeks' pregnancy, after a 7-week interval between diagnosis of maternal infection and antenatal procedure. Ultrasound and nonspecific biologic parameters are not sufficient to identify all fetuses at risk of severe sequelae.

Biomarkers↗
PubMed1998

Fetal endocardial fibroelastosis: ultrasonographic findings in two cases.

EFE is a rare cardiac disorder with poor prognosis and uncertain cause. Primary and secondary forms have been described. Most authors consider that all EFE is secondary--a reactive process set off in the endocardium by stress on the myocardium. We report two cases representing the primary dilated form and the secondary contracted form. The dilated form was associated with intracavitary thrombus of the left ventricle. In both cases, an unusual presence of subendocardial calcifications was noted. The ultrasonographic findings are discussed.

Adult↗
PubMed1998

Accelerated lipoprotein uptake by transplantable hepatomas that express hepatic lipase.

To test the hypothesis that hepatic lipase plays a key role in lipoprotein removal in vivo, a novel system was used. Hepatoma cells (HTC 7288c) were transfected with a cDNA encoding hepatic lipase in culture and grown as solid tumors in vivo. In culture, transfected cells degraded chylomicron remnants and low density lipoprotein (LDL) somewhat more efficiently than untransfected cells. Tumors from the transplanted cells produced hepatic lipase localized to the surface of tumors from transfected cells but not tumors from non-transfected cells, grown in the same rat. The tumors from transfected cells removed, per gm of tissue, 34% (P < 0.001) more 125I-labeled LDL than tumors from non-transfected cells in the same animal. The uptake of chylomicron remnants (by tumors from transfected cells) was also modestly enhanced (15 +/- 6%, P < 0.005). There were no differences in the uptake of 125I-labeled albumin or 125I-labeled asialoglycoprotein. Compared to the liver, the untransfected tumors took up 12%, and the transfected tumors took up about 18% as much LDL per gram of tissue. The uptake of chylomicron remnants compared to liver was far lower. Both types of tumors had about twice as much LDL receptor related protein as the liver. Wild-type tumors had the highest level of LDL receptor, twice hepatic lipase-secreting tumors, and six times that of the liver. Using the novel approach of transfecting transplantable tumor cells with hepatic lipase, the ability of hepatic lipase to facilitate the removal of apoB-containing lipoproteins was demonstrated. The liver still removes low density lipoprotein and especially chylomicron remnants more rapidly than the tumors, suggesting factors in addition to hepatic lipase and LDL receptor level play a major role in hepatic lipoprotein removal.

Animals↗
PubMed1997

Monoamniotic twin cord entanglement. A case report with color flow Doppler Ultrasonography for antenatal diagnosis.

BACKGROUND: Monoamniotic twinning is a rare event with a high perinatal mortality rate from cord accidents. To date, only a few cases have been reported in which cord entanglement was diagnosed with Doppler ultrasonography. CASE: In a monoamniotic twin pregnancy, umbilical cord entanglement was diagnosed at 20 weeks' gestation by color flow Doppler ultrasonography. The entanglement was associated with growth discordance between the twins and subsequent death of the smaller fetus. CONCLUSION: The rarity of this condition hinders our understanding of the pathophysiology and development of management protocols.

Amnion↗
PubMed1997

Selective feticide by embolization in twin-twin transfusion syndrome. A report of two cases.

BACKGROUND: The early development of complications in twin-twin transfusion syndrome is a poor prognostic sign. For this reason, new techniques for intrauterine therapy are being developed: invasive options, such as selective feticide of one of the twins, have been reported. CASES: Two cases of twin-twin transfusion syndrome in the late second trimester were treated by selective feticide using vascular embolization to the more severely damaged fetus. In one case the embolized fetus was a hydropic recipient with a normal cotwin; in the other, the donor fetus was affected by bilateral hydrocephalus. These fetuses underwent ultrasound-guided embolization using a bolus of histoacryl injected into the umbilical vein and fetal heart. Both patients went on to deliver healthy singletons in the third trimester. CONCLUSION: In twin-twin transfusion syndrome of early onset, embolization may help one of the twins survive. This technique is neither time-consuming nor expensive and does not require a general anesthetic.

Adult↗
PubMed1997

Complete hydatidiform mole and coexisting normal fetuses. A report of two cases with contrasting outcomes.

BACKGROUND: Multiple pregnancies consisting of a complete hydatidiform mole and coexisting fetuses are relatively rare but may become more common due to the increasing use of ovulation-induction agents. CASES: We report on a twin and a triplet pregnancy, conceived using clomiphene citrate, with contrasting outcomes. The twin pregnancy resulted in a term delivery of a healthy singleton and the triplet pregnancy in a termination at 17 weeks followed by the development of choriocarcinoma. CONCLUSION: The few cases available suggest that a subgroup of complete moles follows a more benign course and can be managed conservatively, allowing the pregnancy to go to term with appropriate follow-up, whereas other cases follow a more aggressive course. Larger case series are needed to develop definitive protocols.

Adult↗
PubMed1996

Antenatal diagnosis of short-limb dwarfism: sonographic approach.

Based on the findings in 12 patients with skeletal dysplasia diagnosed antenatally, the authors propose a tailored approach to the evaluation of foetuses with shortened long bones, depending on the time of discovery, the degree of shortening and the associated findings. During the second trimester, a very short femur [2 standard deviations (SD) - 5 mm and less] most probably corresponds to a bone dysplasia, although the differential diagnosis is mainly early intra-uterine growth retardation, and the foetal skeleton should be surveyed completely in order to find supplementary features suggestive of dwarfism. Anomalies of long bones in their shape, thickness or contour, or spinal ossification disorders or undermineralisation (best evaluated at the level of calvarial bones) are most helpful in determining the type of dysplasia. A short femur (between 2 SD and 2 SD - 4 mm) may indicate growth retardation, a chromosomal anomaly or dwarfism. Follow-up examinations are mandatory in order to differentiate between them. During the third trimester a very short femur may indicate a bone dysplasia and the work-up should be the same as in the second trimester. A short femur may correspond to dwarfism of late development, a growth-retarded foetus or constitutional shortness. Various ratios, especially that of the femur/foot, are helpful in differentiating between them. In case of previous family history, a short or very short femur usually indicates recurrence of the dwarfism. In all cases of antenatal diagnosis, confirmation of the sonographic findings should be obtained either by foetal or neonatal radiographs. The approach proposed by the authors should provide sufficient information to counsel the family not only for the ongoing pregnancy but also for subsequent ones.

Bone and Bones↗
PubMed1996

Congenital bilateral perisylvian syndrome in a monozygotic twin with intra-uterine death of the co-twin.

Congenital bilateral perisylvian syndrome was diagnosed in a two-year- old boy with signs of pseudobulbar and diplegic cerebral palsy presenting on MRI a polymicrogyric appearance of the perisylvian regions. He was born from a monochorionic bi-amniotic twin pregnancy complicated by twin-twin transfusion syndrome and death of the co-twin between the 16th and 18th weeks of gestation. Ventricular enlargement and hepatic hyperechogenic lesions were seen during his sonographic intra-uterine follow-up. The authors suggest that ischaemic injury occurred in this patient as a consequence of acute haemodynamic changes induced by the death of his co-twin.

Cerebral Aqueduct↗
PubMed1995

Twin-twin transfusion syndrome--possible roles for Doppler ultrasound and amniocentesis.

A 29-year-old woman was referred for suspicion of twin-twin transfusion syndrome (TTTS). Several ultrasonographic and neonatal criteria of TTTS were encountered in this twin pregnancy. The peculiar observations in this case were, firstly, the demonstration of superficial anastomosis by Doppler ultrasound and, secondly, that one single therapeutic amniocentesis could have been sufficient to partially correct the progression of the syndrome, as after amniocentesis it was no longer possible to demonstrate the vascular communication. This observation suggests that superficial anastomoses could also have a role in the genesis of TTTS. Their effect could be monitored by Doppler ultrasound and could be more easily corrected by therapeutic amniocentesis.

Adult↗
PubMed1995

Experience with 1251 transcervical chorionic villus samplings performed in the first trimester by a single team of operators.

OBJECTIVE: We report our experience with 1251 chorionic villus samplings (CVS) performed by a single team of operators. STUDY DESIGN: From April 1984 through August 1993, 1251 CVS were performed in 1236 pregnancies. The transcervical route was used in the vast majority and the sampling was performed during the 9th through 13th weeks of gestation in 1193 cases (96%). Follow-up was ensured to tabulate the pregnancy-related complications and fetal loss rate until 28 weeks' gestation. Pregnancy outcome was documented for all but 36 women (3%). RESULTS: Most of the tests (72%-891/1236 pregnancies) were performed for advanced maternal age (> or = 35 years). The percentage of each indication remained relatively stable, around 90% for chromosomal indications and between 8 and 11% for DNA studies. Samples adequate for diagnosis were obtained in one or two sessions in 1179 pregnancies (95%). The rate of spontaneous abortion possibly related to CVS was 2.5% (28/1092). Mosaicism confined to the placenta was found in 23 cases (1.8%). The pregnancy outcome was known in 1098 pregnancies. There were 10 perinatal losses (0.9%) and nine congenital malformations (0.8%). No transverse limb defects were observed. The rate of premature deliveries (4.6%) and of small for gestational age were comparable to the general uninstrumented population. CONCLUSION: CVS is a safe and effective mode of antenatal diagnosis when performed by a single team of experienced operators.

Adult↗
PubMed1995

Management of the growth-restricted fetus: the role of noninvasive tests and fetal blood sampling.

OBJECTIVE: To assess the accuracy of two noninvasive tests, the nonstress test (NST) and Doppler velocimetry of the umbilical artery, in predicting fetal acidemia or hypoxia demonstrated by funipuncture, and to determine any association between acidemia or hypoxia and perinatal outcome. METHODS: The study included 112 consecutive growth-restricted fetuses diagnosed by ultrasonography between 26-39 weeks' gestation. For Doppler sonograms, the absence of end-diastolic flow was considered pathologic. Acidemia and hypoxia were defined as a pH and an oxygen pressure (PO2) below the fifth percentile at the given gestational age. The fetuses were classified according to the results obtained by the different tests (Doppler velocimetry, NST, cord blood gases). RESULTS: Fetuses with one or both noninvasive tests abnormal (group A, N = 32) had a significantly lower mean gestational age at sampling than those fetuses with both noninvasive tests normal (group B, N = 80). Mean pH and PO2 values for groups A and B were significantly different. Obstetric and perinatal data were collected, and a statistically significant difference was demonstrated between those with a pH and/or PO2 below the fifth percentile and those with a pH and PO2 above the fifth percentile for all indices except birth weight below the tenth percentile. CONCLUSION: Fetal growth restriction is a benign condition in physically normal fetuses if both noninvasive tests and pH and PO2 measured by funipuncture are normal in the absence of maternal pathology. One single fetal blood analysis for pH and PO2 helped separate groups having different obstetric and neonatal outcomes.

Female↗
PubMed1995

Areas of increased echogenicity in the fetal abdomen: diagnosis and significance.

Areas of increased echogenicity in the fetal abdomen are defined as abnormally bright areas with an echogenicity similar to that of surrounding bones. Such areas are encountered in various normal and abnormal processes. When increased echogenicity is discovered in the fetal abdomen, a careful search should be made for a potential cause. The causes to be considered depend on the location of the areas of increased echogenicity, which can be classified as intestinal, peritoneal, hepatic, retroperitoneal, and parietal. In each case, vascular, ischemic, infectious, tumoral, metabolic, and chromosomal abnormalities should be included in the differential diagnosis before considering the finding a normal variant. Therefore, in utero detection of fetal abdominal areas of increased echogenicity requires a complete sonographic survey of the fetus and placenta along with close sonographic follow-up, evaluation of familial factors, and testing for possible associated cystic fibrosis, infection, or a chromosomal anomaly. The prognosis depends more on the underlying disease than on the extent of the increased echogenicity.

Abdomen↗