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Biomedical subjects

C Stan

Publications and source records attributed to C Stan.

16 recordsLinked to original sources
PubMed2000

Stripping/sweeping the membranes for inducing labour or preventing post-term pregnancy.

BACKGROUND: Stripping or sweeping of the membranes aims to initiate labour through a cascade of physiological events. These may reduce pregnancy duration or pre-empt formal induction of labour with either oxytocin, prostaglandins or amniotomy. OBJECTIVES: The objective of this review was to assess the effects of membrane sweeping to promote or induce labour on maternal and perinatal outcomes. SEARCH STRATEGY: We searched the Cochrane Pregnancy and Childbirth Group trials register and the Cochrane Controlled Trials Register (last searched April 1998). SELECTION CRITERIA: Adequately controlled trials of digital separation of the membranes from the lower uterine segment for inducing labour or for preventing post-term pregnancy, compared to either no vaginal examination or vaginal examination for cervical assessment only without the intention to detach the membranes. DATA COLLECTION AND ANALYSIS: Two reviewers assessed trial quality and extracted data. MAIN RESULTS: Fourteen trials were included. Sweeping of the membranes, performed as a general policy in women at term, was associated with reduced duration of pregnancy and the frequency of pregnancy continuing beyond 41 weeks (relative risk 0.42, 95% confidence interval 0.19 to 0.93, random effects model) and 42 weeks. After sweeping of the membranes, there was a 17% risk reduction (confidence interval 6 to 29%, random effects model) in the use of more formal methods for labour induction. There was no difference in the mode of delivery or in the risk of infection. Discomfort during vaginal examination and other adverse effects (bleeding, irregular contractions) were more frequently reported by women allocated to sweeping. REVIEWER'S CONCLUSIONS: Routine use of sweeping of membranes from 38 weeks of pregnancy onwards does not seem to produce clinically important benefits. When used as a means for induction of labour, the reduction in the use of more formal methods of induction needs to be balanced against women's discomfort and other adverse effects.

Extraembryonic Membranes↗
PubMed2000

Elective delivery in diabetic pregnant women.

BACKGROUND: In pregnancies complicated by diabetes the major concerns during the third trimester are fetal distress and the potential for birth trauma associated with fetal macrosomia. OBJECTIVES: The objective of this review was to assess the effect of a policy of elective delivery, as compared to expectant management, in term diabetic pregnant women, on maternal and perinatal mortality and morbidity. SEARCH STRATEGY: We searched the Cochrane Pregnancy and Childbirth Group trials register and the Cochrane Controlled Trials Register (last searched July 1999). SELECTION CRITERIA: All available randomized controlled trials of elective delivery, either by induction of labour or by elective caesarean section, compared to expectant management in diabetic pregnant women at term. DATA COLLECTION AND ANALYSIS: The reports of the only available trial were analysed independently by the three co-reviewers to retrieve data on maternal and perinatal outcomes. Results are expressed as relative risks (RR) and 95% confidence intervals (CI). MAIN RESULTS: The participants in the one trial included in this review were 200 insulin-requiring diabetic women. Most had gestational diabetes, except 13 women with type 2 preexisting diabetes (class B). The trial compared a policy of active induction of labour at 38 completed weeks of pregnancy, to expectant management until 42 weeks. The risk of caesarean section was not statistically different between groups (RR 0.81, 95% CI 0.52 - 1.26). The risk of macrosomia was reduced in the active induction group (RR 0.56, 95%CI 0.32 - 0. 98) and 3 cases of mild shoulder dystocia were reported in the expectant management group. No other perinatal morbidity was reported. REVIEWER'S CONCLUSIONS: There is very little evidence to support either elective delivery or expectant management at term in pregnant women with insulin-requiring diabetes. Limited data from a single randomized controlled trial suggest that induction of labour in women with gestational diabetes treated with insulin reduces the risk of macrosomia. Although the small sample size does not permit one to draw conclusions, the risk of maternal or neonatal morbidity was not modified. Women's views on elective delivery and on prolonged surveillance and treatment with insulin should be assessed in future trials.

Cesarean Section↗
PubMed2000

Diagnosis of anal sphincter tears by postpartum endosonography to predict fecal incontinence.

OBJECTIVE: To determine whether anal endosonography immediately after vaginal delivery can predict subsequent fecal incontinence. METHODS: We studied nulliparas who delivered vaginally and had no anal sphincter tears (third- or fourth-degree perineal tears) diagnosed clinically by endosonography before any suture of the perineum. The sonographer was unaware of delivery details and the obstetrician and the women were not informed of endosonography results. Therefore, the suture of the perineum and the outcomes were not influenced by sonographer's diagnoses. Three months after delivery, we assessed fecal incontinence by self-administered questionnaires. RESULTS: Clinically undetected tears of the anal sphincter were diagnosed by anal endosonography in 42 of 150 women (28%). The external anal sphincter alone was involved in 30 women (20%), the internal anal sphincter alone in two (1.3%), and both in ten (7%). The postal questionnaire was returned by 144 women. Incontinence was reported by 22 (15%, 95% confidence interval [CI] 10%, 22%), consisting mainly of incontinence to flatus only (16 of 22, 73%, 95% CI 50%, 89%). Clinically undetected anal sphincter tears diagnosed by endosonography were associated with incontinence 3 months after delivery (odds ratio [OR] 8.8; 95% CI 2.9, 26.5). The sensitivity of anal endosonography was 68% (95% CI 49%, 88%) and the positive predictive value 37% (95% CI 22%, 51%). CONCLUSION: Anal endosonography immediately after vaginal delivery allows diagnosis of clinically undetected anal sphincter tears that might be associated with subsequent fecal incontinence.

Adult↗
PubMed2000

[The significance of points alpha and beta on the dark adaptogram of the normal eye].

PURPOSE: To determine the meaning of the points alpha and beta of the curve during dark adaptation. METHOD: In this paper I studied the curves during dark adaptation of the 48 normal eyes, examined at the Goldmann-Weekers adaptometer, for 30 minutes in standard conditions. The study had two stages: 1. To find out the mathematical low which defined the phenomenon; 2. To give a physiological explanation of the phenomenon. CONCLUSIONS: 1. Distribution in time of point alpha and point beta recognized mathematical low of normal log. 2. The cones adapted to the dark into two phases: from the beginning of the adaptation to the point alpha; after point alpha till before point beta. 3. The rods adapted in three phases: a) before point alpha to the point alpha; b) from point alpha to the point beta; c) after point beta to the terminal threshold. CONCLUSION: Point beta gained a new meaning: point beta represents the end of the cone's adaptation.

Adolescent↗
PubMed2000

[The influence of meteorological factors in wintertime on the incidence of the occurrence of acute endogenous iridocyclitis].

PURPOSE: I tried to establish if the atmospheric factors such as: temperature, pressure, humidity of the air, wind, had any influence on the onset of acute uveitis. METHOD: This study was made on 597 cases with acute uveitis hospitalized in the Eye Clinic--Cluj-Napoca, between 1983-1991. CONCLUSION: During winter, in the region of Cluj, acute uveitis occurred significantly more often: 1. When the weather was warmer or colder than the mean value of the season, and the temperature varied with more than 4 degrees C from the previous day; 2. When the humidity of the air was low (dry weather); 3. When the wind was more than 4 m/s. Correlating the physiological knowledge with the studies about weather and the living organisms, I draw some possible pathogenetic mechanisms to explain the influence of the meteorological factors on the onset of acute uveitis, in winter.

Acute Disease↗
PubMed2000

[The influence of meteorological factors for frequency of Herpes simplex keratitis].

HYPOTHESIS: The variation of the meteorological factors could be a stress for the organism, which could determine the start of some diseases. MATERIAL AND METHOD: We studied 252 cases of herpes simplex keratitis which had been hospitalized in Eye Clinic of Cluj between 1983-1991. The selection criteria were: known diagnosis; day of the rise could be exactly established; disease was taken place in Cluj or in region not longer than 30 km on Somes Valley. The meteorological parameters were collected by specialist from the Meteorological Station of the city and from the Cluj's Airport. The results were verified statistical and were guaranted by p = 0.05. RESULTS: The herpes simplex keratitis are more frequently in days with a temperature higher and an atmospheric pressure lower than the average value of the season. DISCUSSIONS: We drew a possible pathogenic mechanism to explained the reactivation of the virus under the influence of warm weather.

Adult↗
PubMed1999

[Diagnostic and prognostic evaluations of sterility and the Sierre Hospital. 389 cases].

AIM OF THE STUDY: The management of infertile couples at regional hospital level is rarely reported and is generally less known, whereas the activity of university infertility clinics is usually the reference. We evaluate the diagnostic approach to infertile couples at the Regional Hospital of Sierre. METHOD: The medical charts of 389 couples presenting with infertility between 1989 and 1996 were reviewed. The investigations and interpretation of results were always performed by the same investigator. RESULTS: A lower pregnancy rate was observed in the case of a pathological postcoital test and when proximal tubal occlusion or phimosis were diagnosed by hysterosalpingography or laparoscopy. In our population, age of the female partner > 40 years, duration of infertility of more than 36 months and multifactorial, male and female, aetiology of infertility were significantly associated with a poor prognosis (p < 0.001). For the assessment of tubal patency, hysterosalpingography and laparoscopy with chromopertubation showed an acceptable level of agreement (kappa coefficient = 0.58). Hysterosalpingography does not provide a precise diagnosis in peritoneal and ovarian pathology (72.9% sensitivity, 55.7% specificity). A third of pregnancies were obtained without treatment during the diagnostic study of the menstrual cycle, or after hysterosalpingography and laparoscopy with chromopertubation. CONCLUSION: Most diagnostic procedures for infertility can be performed in a regional hospital by an infertility specialist collaborating closely with a university centre. When infertile couples are transferred to a university centre their evaluation is simplified, as they have already completed an initial systematic investigation and treatment plan at the regional hospital. This two-step approach may be beneficial in selecting couples who need specific treatment not available in a regional hospital.

Adult↗
PubMed1999

[Immunoglobulins in the tear secretion in cases of herpetic keratitis].

The goal of this study is to analyse the immunoglobulins of patients with herpetic keratitis. Tears have been collected from 36 patients with herpetic keratitis (study group) and 20 healthy volunteers (control group). Quantitative determination of A, G, M immunoglobulins and secretor IgA has been performed by Mancini radial immunodiffusion method. Our study has revealed the following results: a decrease in IgM and IgA levels compared with control group (p < 0.01) and an increase in secretory IgA compared with fellow eye (p < 0.05) in patients with herpetic keratitis of the first manifestation; eyes with recidivant herpetic keratitis showed higher level of IgA than the control group (p < 0.01) and a higher level of IgG than the first disease manifestation group (p < 0.05); the IgA level in the healthy eye of the patients with herpetic keratitis appeared significantly lower than in the control group (p < 0.001).

Humans↗
PubMed1998

[Clinical effects of supplemental enteral nutrition solution in severe polytrauma].

Previous studies in critically ill patients have shown the beneficial effects of early enteral nutrition supplemented with arginine, omega-3 fatty acids and nucleotides (Impact) on immunological response, infection rate and length of stay in hospital. No specific data exist for patients with severe multiple injury, who represent a high risk group for systemic inflammatory response syndrome (SIRS), septic complications and multiple organ failure (MOF). In this prospective, randomized, double-blind controlled clinical study on patients after severe trauma (ISS ca. 40) the primary study endpoints were incidence of SIRS and MOF [definitions according to Am Soc Crit Care Med (5) and Goris (23), Sauaia (43)]. Thirty-two patients enrolled in the study, and 29 were eligible for analysis: test (Impact) (n = 16), control (n = 13). Both groups were comparable according to age, body mass index and severity of trauma (PTS-test: 38.8 +/- 12.5, PTS-control: 40.8 +/- 15.5, ISS-test: 39.6 +/- 11.4, ISS-control: 40.5 +/- 9.2). Patients were randomized to receive either Impact (test) or an isonitrogenous isocaloric diet (control). Feeding was started on the 2nd day after trauma via endoscopically placed nasoduodenal or jejunal feeding tubes. The experimental diet was safe and well tolerated. During the 1st week the enteral feeding amount was about 2000 ml without significant difference. Test-fed patients developed SIRS significantly less frequently between day 1 and day 28 (8 vs 13.3; P < 0.05) and especially between day 8 and day 14 (3 vs 6.2; P < 0.001). In the control group the Goris score was significantly worse (P < 0.05) on days 3, 4, 6, 7, 10, 11, 16 and 17 and the Sauaia score on days 8, 9, 10 and 11 (P < 0.05; P < 0.01). Mortality rate did not significantly differ (test 2/16, control 4/13), nor did length of ICU or hospital stay. With regard to the acute-phase response, C-reactive protein was significantly lower on day 4 in the test group (test: 131 +/- 67 mg/l, control: 221 +/- 110 mg/l) as was fibrinogen on day 12 (6.6 +/- 1.4 vs 7.5 +/- 1.4 g/l) and day 14 (7.1 +/- 1.3 vs 7.8 +/- 0.8 g/l). No significant difference could be observed for CD4/CD8 ratio, CD45 isotope on activated T-cells and lymphocytic interleukin (II)-2-receptor- and II-6 level. However, HLA-DR antigen presentation on peripheral monocytes was significantly elevated on day 7 in the test group (P < 0.05). According to the results, arginine, omega-3 fatty acids and nucleotides-enriched diet during early enteral feeding leads to reduction of SIRS after severe multiple injury. There is evidence for improvement of post-traumatic immunological response which helps to overcome the immunological depression after trauma.

Adolescent↗
PubMed1997

[Behçet's disease with a fatal evolution].

Behçet disease in an inflammatory systemic disease, of unknown etiology. Usually it is defined by a triad; buccal ulcerations, genital ulcerations and uveitis. Treatment is based on steroids and in difficult cases cyclosporina or cytotoxic agents could be used. We present a case of Behçet disease in a young male. The first symptoms were retrobulbar optic neuropathy, followed by buccal and genital ulcerations. For beginning the treatment was based on steroids, but the disease was more and more severe, so that the left eye lost its function because of an inflammatory maculopathy and new symptoms arose. We started treatment with cyclosporina (5 mg/kg/day), but we had to stopped it 3 months latter because of renal function's failure.

Acute Disease↗
PubMedDate not supplied

[Intermesenteric anastomoses].

This work is based on dissection and the analysis of the arteriographies of two mesenteric arteries and it analyses the type of intermesenteric anastomoses and their importance in surgical practice. The morphological varieties of Riolan's arcade depends on its pillars, as well as on the eventual presence, especially in the middle part of the transversal mesocolon, of the secondary arcades; it seems that the colic wall necrosis depends less upon the location of the lesion or the level of the suture of the arcade, but more so on the stretch of the destruction of the mesocolon. The intermesenteric trunk, a second way of intermesenteric anastomoses is a embryological remaining, non-functional in normal conditions, but capable to partially or completely replace the Riolan's arcade when the later is sutured or interrupted.

Angiography↗
PubMedDate not supplied

[The effect of atmospheric temperatures on eye diseases in the Cluj area].

The influence of the temperature of the air on the following ocular disease: acute glaucoma, uveitis and herpes keratitis, is studied in this paper through the X2 statistical method. Concerning the meteorological factor we studied five characteristics: medium temperature of the day, maximum temperature of the day, minimum temperature difference between maximum and minimum temperature of the day, difference of the temperature between the day before and the day when disease occurred. Concerning the ocular disease we studied the date of the first symptoms. The study has two distinct parts: a) study of the comparative action of seasons inside of a well definite step of temperature; b) study of the influence of the temperature inside of each season.

Acute Disease↗
PubMedDate not supplied

[The effect of meteorological factors on the body in general and on the eye in particular].

Some data of the literature concerning the action of the weather factors on the human body are presented. In the same time the knowledge about the modifications induced in the healthy organism by the atmospheric factors and the biotropical action of the weather factors and about some ocular diseases, whose evolutions in made worse by the weather factors, is summarized.

Eye Diseases↗
PubMedDate not supplied

[Penetrating orbital wounds with retention of the plant foreign bodies].

Here are presented the clinical observations of 5 patients with these diagnosis. We discussed the necessity of attentive exploration of the orbital injuries in the moment of urgency interventions because the foreign bodies can be multiplied. It is also important to suspect the retention of wood foreign bodies in the orbit in the presence of the patients: orbital fistula with an orbital injury in their antecedents.

Child↗
PubMedDate not supplied

Immune mechanisms in the process of hepatopathies chronicization. Contribution and role of lymphokines.

The study attempts to evaluate the role of interleukin-6 (IL-6) in the pathogenesis of chronic hepatitis. We have used EIA sensitive methods to determine the serum concentration in patients with chronic active hepatitis of HB (+) (CAH-HE Ag+) antigen, with chronic active hepatitis of HB(-) (CAH-HBAg-) antigen and in those with persistent chronic hepatitis of HB(+) (CPH-HBAg+) antigen, compared with a group of controls (blood donors) in whom HBAgs, antiHBs, HBAge, antiHBe and anti HBc were absent. Disease status diagnosis was given in accordance with international conventions, immunologic tests included. The fact that the T lymphocytes with a CD56 are present in the liver and that same marker is also encountered on the Kuppfer cells, but not on the T lymphocytes in circulation, shows that in the liver the interleukin 6 is produced by the activated T lymphocytes and by the Kuppfer cells. Therefore, in such conditions, LB stimulation and growth is performed rather by IL-6 and to a lesser extent by IL-8. This statement is also supported by the finding that in the lymphocyte cultures in the peripheral blood there is no difference in the response to polyclonal mitogens between patients with CAH-HBAg(+) and those with CAH-HBAg(-). Also, there are no significant differences in the total immunoglobulin concentrations, but there are differences in the IgM concentration (greater in CAH-HBAg(+). In our investigations, the serum level of IL-6 (40.1 +/- 6.8 pg/ml) was higher in those with higher immunoglobulin concentrations-both IgG, but more particularly IgM. The IgM increase was correlated with the presence of HBAg. Therefore, the highest IL-6 values were found in CAH with HBAg(+). Increases of serum IL-6 concentrations were found during intervals of severe hepatic aggression manifested in a cytolitic syndrome, with transaminase increase. In the case of determinations in dynamics, the values decreased as the enzyme titre decreased. We can state that the serum activity of IL-6 reflects the degree of liver inflammation and can be used as a parameter for monitoring the disease.

Adult↗