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Biomedical subjects

D Jacob

Publications and source records attributed to D Jacob.

At least 19 recordsLinked to original sources
PubMed2000

[Treatment of parathyroid adenomas with ethanol injection under ultrasonographic guidance].

STUDY OBJECTIVE: The objective of this retrospective study was to report the results of ethanol injection in parathyroid adenomas. PATIENTS AND METHOD: Since 1988, 31 patients with inoperable primary hyperthyroidism have been treated by ultrasound-guided percutaneous ethanol injection into the adenoma. The main surgical contraindications were heart failure (n = 12) and age over 85 years (n = 11). Plasma calcium and PTH were measured 48 hours after ethanol injection and during subsequent follow-up. RESULTS: Patients had one to three ethanol injections. With a mean 5-year follow-up, total success with normal plasma calcium and PTH levels was achieved in 20 patients (64.5%), 4 of whom underwent another ethanol injection after 1 to 3 years. Partial success with correction of plasma calcium only was achieved in 9 patients (29%) resulting in an obvious clinical benefit. Failure was observed in 2 patients (6.5%) with nodular goiter, probably due to incorrect localization of the adenoma. Treatment was always well tolerated and no major side effect was observed. CONCLUSION: Ultrasound-guided percutaneous ethanol injection of parathyroid adenoma is effective in most cases of hyperparathyroidism and very useful in patients with a high surgical risk. The need for precise ultrasound localization of the adenoma is the main limitation of this treatment.

Adenoma↗
PubMed2000

Six-month daily administration of parathyroid hormone and parathyroid hormone-related protein peptides to adult ovariectomized rats markedly enhances bone mass and biomechanical properties: a comparison of human parathyroid hormone 1-34, parathyroid hormone-related protein 1-36, and SDZ-parathyroid hormone 893.

Daily administration of parathyroid hormone (PTH) and PTH-related protein (PTHrP) peptides has been shown to increase bone mass and strength in animals and, for PTH, to increase bone mass in humans. Long-term direct comparison of multiple members of the PTH/PTHrP family in vivo has not been reported. We therefore selected three PTH/PTHrP molecules for direct comparison in vivo in an adult rat model of postmenopausal osteoporosis: PTH(1-34), PTHrP(1-36), and the PTH analog, SDZ-PTH 893 ¿Leu8, Asp10, Lys11, Ala16, Gln18, Thr33, Ala34 human PTH 1-34 [hPTH(1-34)]¿. A 6-month study was performed in which adult (6-month-old) vehicle-treated ovariectomized (OVX) and sham OVX rats were compared with OVX rats receiving 40 micrograms/kg per day of either PTH(1-34), PTHrP(1-36), or PTH-SDZ-893. Bone mass, as assessed by ash weight and densitometry, bone histomorphometry, biomechanical properties at trabecular and cortical sites, and indices of bone formation markedly increased in all three PTH/PTHrP peptide-treated groups as compared with controls. In general, this improvement followed a rank order of SDZ-PTH-893 > PTH > PTHrP. The adverse effect profile also was greatest with SDZ-PTH-893; these rats developed moderate hypercalcemia, marked renal calcium accumulation, and displayed a 13% mortality. These studies show that PTH(1-34), PTHrP(1-36), and PTH-SDZ-893 significantly and progressively increase bone mass and bone strength in this rat model of postmenopausal osteoporosis. The adverse effect profile correlates in general terms with efficacy. All three peptides show promise as skeletal anabolic agents. Further studies in humans will be required to define optimal efficacy-to-adverse effect ratios and relative efficacy for each peptide in human osteoporosis.

Animals↗
PubMed2000

[Uterine artery embolization: anatomical and technical considerations, indications, results, and complications].

The first reported use of transcatheter arterial embolization in the management of intractable bleeding related to pelvic trauma appeared in the literature in 1973. Other indications for pelvic embolization in women include postoperative and postpartum hemorrhage and bleeding related to gynecologic malignancy. Recently, the use of uterine artery embolization in the management of symptomatic leiomyoma has been reported as an alternative to surgery. The widespread acceptance of this procedure necessitates greater knowledge of the arterial anatomy of the female genital tract. In this paper, main arterial variations in uterine vascularization and procedure-relevant technical considerations will be discussed. Indications, results and potential complications of uterine artery embolization will be listed and explained.

Angiography↗
PubMed1999

Unique checkpoints during the first cell cycle of fertilization after intracytoplasmic sperm injection in rhesus monkeys.

Intracytoplasmic sperm injection has begun an era of considerable improvements in treating male infertility. Despite its success, questions remain about the dangers of transmitting traits responsible for male infertility, sex and autosomal chromosome aberrations and possible mental, physical and reproductive abnormalities. We report here the first births of rhesus monkeys produced by intracytoplasmic sperm injection at rates greater or equal to those reported by clinics. Essential assumptions about this process are flawed, as shown by results with the preclinical, nonhuman primate model and with clinically discarded specimens. Dynamic imaging demonstrated the variable position of the second meiotic spindle in relation to the first polar body; consequently, microinjection targeting is imprecise and potentially lethal. Intracytoplasmic sperm injection resulted in abnormal sperm decondensation, with the unusual retention of vesicle-associated membrane protein and the perinuclear theca, and the exclusion of the nuclear mitotic apparatus from the decondensing sperm nuclear apex. Male pronuclear remodeling in the injected oocytes was required before replication of either parental genome, indicating a unique G1-to-S transition checkpoint during zygotic interphase (the first cell cycle). These irregularities indicate that the intracytoplasmic sperm injection itself might lead to the observed increased chromosome anomalies.

Animals↗
PubMed1999

Secondary postpartum hemorrhage: treatment with selective arterial embolization.

PURPOSE: To evaluate the efficacy and safety of selective arterial embolization of the uterine arteries in the management of intractable delayed postpartum hemorrhage. MATERIALS AND METHODS: Fourteen consecutive women with secondary postpartum hemorrhage were treated with selective embolization of the uterine arteries. In all cases, hemostatic embolization was performed because of intractable hemorrhage that could not be controlled with the administration of uterotonic drugs or with uterine curettage. RESULTS: The causes of bleeding included genital tract tears in four women and endometritis in eight women; the endometritis was associated with proved, retained portions of placenta in four women. In two women, no evident cause of bleeding was found before angiography. Angiography revealed extravasation in three women. A false aneurysm of the uterine artery was found in two women. In one patient, an arteriovenous fistula was observed. Immediate resolution of external bleeding was observed in all women. No complication related to embolization was found. Normal menstruation resumed in all women. CONCLUSION: Selective arterial embolization of the uterine arteries is a safe and effective means of controlling secondary postpartum hemorrhage.

Adult↗
PubMed1999

[Management of severe post-partum hemorrhage using selective arterial embolization].

OBJECTIVES: To evaluate the efficacy and safety of uterine embolization in the management of intractable post-partum hemorrhage. MATERIALS AND METHODS: From July 1994 to December 1997, 51 patients with severe primary (n = 37) or secondary (n = 14) post-partum hemorrhage were treated by arterial uterine embolization. In all cases, hemostatic uterine embolization was performed because of persistent hemorrhage despite adapted obstetrical measures and early introduction of uterotonic drugs. RESULTS: In case of immediate post-partum hemorrhage, primary and secondary success rates were 89% et 97% respectively. In one patient with placenta accreta, delayed hysterectomy was necessary. One patient died of associated cerebral hemorrhage while vaginal bleeding had stopped. The success rate reached 100% in case of secondary post-partum hemorrhage. CONCLUSION: Emergency arterial embolization is a safe and effective means of controlling severe post-partum hemorrhage after failure with medical treatment.

Adult↗
PubMed1999

[Action of SERM and SAS (tibolone) on breast tissue].

SERMs are developed in HRT in order to provide the beneficial effects of estradiol on bone and the cardiovascular system. SERMs are antiestrogens and their properties depend upon the pharmacological class they belong to. Tibolone is a progestin with mixed properties. Our studies on breast cells in vitro demonstrated that it behaves as a progestin in these cells. The clinical data obtained with these various therapies on breast are presented.

Antineoplastic Agents, Hormonal↗
PubMed1999

Selective arterial embolization of the uterine arteries in the management of intractable post-partum hemorrhage.

BACKGROUND: To evaluate the efficacy and safety of selective arterial embolization in the management of intractable post-partum hemorrhage. METHODS: Thirty-five consecutive women with severe post-partum hemorrhage (primary, n=25; secondary, n=10) were treated by selective embolization of the uterine arteries. The main cause of immediate post-partum hemorrhage was atonic uterus. Retained placental fragments with endometritis was the main cause of delayed hemorrhage. In all cases, hemostatic embolization was performed because of intractable hemorrhage. Hysterectomy had been performed in two cases before embolization but it had also failed to stop the bleeding. RESULTS: Angiography revealed extravasation in ten cases, spasm of the internal iliac artery in four cases, false aneurysm in two cases and arteriovenous fistula in one case. After embolization, immediate cessation or dramatic diminution of bleeding was observed in all cases. Two patients required repeated embolization the following day. No major complication related to embolization was found. In one patient with placenta accreta, delayed hysterectomy was necessary. Normal menstruation resumed in all women but two who had hysterectomy. One woman became pregnant after embolization. CONCLUSION: Selective emergency arterial embolization is an effective means of controlling severe post-partum hemorrhage. This procedure avoids high risk surgery and maintains reproductive ability.

Adult↗
PubMed1998

Percutaneous ethanol injection into parathyroid adenomas: mid- and long-term results.

The aim of this study was to evaluate mid- and long-term results of ultrasonically guided ethanol injection into parathyroid adenomas. From 1988 to 1996, 27 patients (mean age 77 +/- 13 years) were treated for parathyroid adenomas by percutaneous ethanol injection. The survey included clinical information, plasma calcium, phosphorus and PTH (1-84) evaluation. Follow-up lasted 22.6 +/- 10 months. No major complications were observed for 63 ethanol injections. Biochemical recovery was 58%, biochemical improvement at 3 months was 33%, and failure was 7%. Four of 15 cured patients presented a recurrence of the disease 1 or 2 years after the first treatment. Ultrasonically guided ethanol injection can be useful in the treatment of parathyroid adenomas when surgery is not possible. The immediate results are interesting but not as good as those obtained with surgery. A regular biochemical survey is necessary so that recurrences can be recognized and treated at an early stage.

Adenoma↗
PubMed1998

Life-threatening primary postpartum hemorrhage: treatment with emergency selective arterial embolization.

PURPOSE: To prospectively evaluate the efficacy and safety of emergency selective arterial embolization in the management of intractable primary postpartum hemorrhage. MATERIALS AND METHODS: Twenty-seven consecutively seen women with life-threatening primary postpartum hemorrhage underwent uterine embolization. In all cases, hemostatic embolization was performed because of intractable hemorrhage that could not be controlled with vaginal packing and administration of uterotonic drugs. The mean hemoglobin level before embolization was 7.48 g/dL +/- 2.39 (74.8 g/L +/- 23.9) (1 standard deviation). Hysterectomy performed in two patients before embolization failed to stop the bleeding. RESULTS: Angiography revealed extravasation in nine patients and spasm of the branches of the internal iliac artery in five. The procedure consisted of embolization of uterine (n = 46), vaginal (n = 5), or ovarian (n = 2) arteries or anterior division of internal iliac arteries (n = 8). Immediate disappearance or dramatic diminution of external bleeding was observed in all cases. Two patients needed repeated embolization the next day. No major complication related to embolization was found. In one patient with placenta accreta, delayed hysterectomy was necessary. Normal menstruation resumed in all women except the two who underwent hysterectomy. One woman became pregnant after embolization. CONCLUSION: Emergency arterial embolization is a safe and effective means of control of primary postpartum hemorrhage. The procedure obviates high-risk surgery and allows maintenance of reproductive ability.

Adult↗
PubMed1997

[Comparative validation of manual and automated methods for mixing and volume control of total blood samples].

During blood collection, agitation and volume limitations are critical to ensure thorough mixing of the blood with the anticoagulant and obtention of the predetermined volume. These 2 factors are essential to prevent blood activation and to obtain well standardized blood products. The objective of this study was to compare the quality of the blood collected using 2 types of collection method: tripping of a scale at a predetermined volume limit of 450 mL in the presence of manual agitation, and the 3 blood collection monitors currently available in France. A minimum of 100 collection procedures was performed for each of the 4 methods tested. Results were found to be equivalent using either the manual or the automated procedures with regard to both the accuracy and reproducibility of the blood volumes obtained and the collection times and flow rates. The characteristics of the red blood cell concentrates, platelet concentrates and plasma units prepared from the first 30 collections of each group were assessed and compared to regulatory requirements. The quality of all these products was found to be comparable to that currently observed at quality control and no product was rejected at the release control for reasons of poor collection. An assessment of the practicability of the different methods showed that the automated devices are subject to practical difficulties involving transport and battery loading. In addition, the cost of this equipment is approximately 5 times higher than that of the scales. In conclusion, the results of this study show that in our hands, no significant advantage could be expected from the use of automated blood collection monitors as compared to simple scales with manual mixing. These results further raise the question of the applicability to labile blood products of the comparative validations currently accepted in the pharmaceutical industry, in order to allow the use of correctly validated alternative methods.

Automation↗
PubMed1997

A simple monoclonal antibody based ELISA for free protein S. Comparison with PEG precipitation.

A simple monoclonal antibody based ELISA for free Protein S, compatible with out existing ELISA for total Protein S has been developed, and its performance compared with the conventional PEG precipitation method of free Protein S assay. The normal range (mean +/- 2 SD) was 0.19-0.54 iu/ml free Protein S. The mean intra assay variation was 5.24% and the mean inter assay variation was 5.50%. A total of 102 routine diagnostic samples from patients referred for prothrombotic investigation (six assays for each method) were assayed by PEG precipitation (mean 0.32 iu/ml, SD 10.60), and the monoclonal ELISA (mean 0.34, SD 0.9). Paired t-test analysis of the two data sets indicated no significant difference between them (P < 0.001). In this sample population, there was no significant difference in free Protein S values when assayed by monoclonal based ELISA or by PEG precipitation. The monoclonal assay has proved to be reliable, accurate and precise. The monoclonal ELISA is simpler, quicker and easier to perform in routine use. Data generated is directly comparable to that generated by PEG precipitation. This methodology would be suitable for laboratories currently measuring Protein S by ELISA.

Analysis of Variance↗