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D Vinatier

Publications and source records attributed to D Vinatier.

At least 109 records · Page 6Linked to original sources
PubMed1993

[Laparoscopic treatment of extra-uterine pregnancy. Results apropos of a series of 109 cases].

We report our experience concerning the laparoscopic treatment of ectopic pregnancy (EP). One-hundred and nine women with EP were treated in our department over a 4 year period, between February 1988 (date of our first laparoscopic surgery for EP) and December 1991. Twenty-two of these women underwent laparotomy and the remaining 87 laparoscopic surgery alone. Four therapeutic failures were noted in women treated by laparoscopy. Our results are compared with those of other series and the indications, as well as the modalities of laparoscopic treatment are detailed. It is concluded that laparoscopic surgery of EP is a reliable method which must always be considered, except for a few rare indications.

Abortion, Spontaneous↗
PubMed1993

[Cerebral tumors and pregnancy. Apropos of 8 cases].

Pregnancy is an aggravating factor for brain tumours on which it acts by three mechanism: acceleration of tumour growth, increase of peritumoral oedema and the immunotolerance to foreign tissue antigens that is proper to pregnancy. Histologically, the brain tumour most frequently encountered is glioma, usually revealed during the third trimester. Brain tumours is pregnant women have no special clinical features, and their diagnosis rests on computerized tomography or nuclear magnetic resonance completed, if required, by stereotactic biopsy. Following a review of the literature, the authors present an updated description of the neurological and obstetrical actions to be taken, illustrated by a report of eight personal cases. The indications for surgery depend on the site and histological nature of the tumour. As regards obstetrical measures, induced therapeutic abortion and caesarean section, no longer routinely performed, are now being replaced by vaginal delivery with systematic instrumental extraction. In both mother and foetus the prognosis has improved over the last ten year, but it remains very sombre.

Adult↗
PubMed1992

Decreased expression of eosinophil peroxidase and major basic protein messenger RNAs during eosinophil maturation.

We evaluated the levels of mRNAs encoding cationic proteins in peripheral blood eosinophils (PBE) purified from patients with eosinophilia and in eosinophils differentiated from cord blood cells (CBC) by culture with recombinant human interleukin-3 (rhIL-3), rhGM-CSF, and rhIL-5. Messenger RNAs encoding eosinophil peroxidase (EPO), major basic protein (MBP), eosinophil-derived neurotoxin (EDN), and eosinophil cationic protein (ECP) were detected by Northern blot hybridization with the respective specific oligonucleotide probes. In mature PBE, MBP mRNA appeared to be absent, whereas EPO mRNA was barely detectable in only 5 of the 19 patients. In contrast, EDN and ECP mRNAs were observed in the PBE of all patients. In CE, EPO, and MBP, mRNAs were abundant in immature eosinophils and their amounts decreased after differentiation toward eosinophils. ECP and EDN mRNAs followed the same patterns, but mRNAs were less abundant at all timepoints studied. Study of mRNA t1/2 during the time course of differentiation indicated that changes in the stability of the different mRNAs were not responsible for the variations observed in the steady-state levels. Together, these results suggest that regulation of expression differs among EPO, MBP, EDN, and ECP mRNAs during the time course of eosinophil differentiation.

Actins↗
PubMed1992

Anti-P30 IgA antibodies as prenatal markers of congenital toxoplasma infection.

This study extends a previous study and confirms that the detection of anti-P30 IgA antibodies is very helpful in the diagnosis of acute acquired or congenital toxoplasmosis. Moreover, we demonstrate that an anti-P30 IgA response can be mounted in the fetuses infected by Toxoplasma gondii during their intra-uterine life as early as week 23 of gestation. A double-sandwich ELISA described in our previous work was used to detect anti-P30 IgA antibodies in 1378 human serum samples collected from 551 patients, including 162 fetuses whose mothers had been infected by T. gondii during pregnancy, 46 congenitally infected and 90 uninfected newborns and 253 women suspected of having been infected during pregnancy, including the mothers of fetuses and newborns previously described. Anti-P30 IgA antibodies were detected in all cases of acute toxoplasmosis but in no case of chronic toxoplasmosis: in the majority of cases, the IgA antibody titre fell below cut-off in 3-9 months. Among the 46 congenitally infected newborns, anti-P30 IgA antibodies were detected in sera of 41 infected newborns (38 at birth, two in the first months of life, one in the seventh month of life), while anti-P30 IgM antibodies were detected in only 30 cases at birth and in one case during the first month of life. Among 162 fetuses, anti-P30 IgA response was observed in five infected fetuses, but was not detected in either 152 uninfected fetuses or in five fetuses considered as infected. The absence or presence of anti-P30 IgA antibodies in the fetus is discussed in relation to the date of maternal infection and collection of the fetal blood. It clearly appears from our study that the combined testing of both IgM and IgA in the fetus and the newborn is essential for a more efficient diagnosis of infection.

Acute Disease↗
PubMed1992

[Cytokines and pregnancy: physiology].

Several biological systems originating in the fetus and in the mother are involved in embryo implantation, maintenance of the pregnancy, protection of the fetus against outside influences and the start of labour (these are the immune system, endocrine system, and the endothelial system). In order to work efficiently there has to be some co-ordination. Cytokines which were first described by immunologists make it possible for information between the systems to be exchanged. The authors, referring to recent publications, show that there are several cytokines with specific receptors at the feto-placental interface. The place and the physiological role of these molecules in co-ordinating the links are discussed. These cytokines can be involved in many pathological situations.

Colony-Stimulating Factors↗
PubMed1992

[Turner's syndrome and pregnancy in donor oocytes and in vitro fertilization. Three case reports].

It is extremely rare for pregnancy to occur spontaneously in a woman with a mosaic or non-mosaic karyotype 45 x 0. (Till now only 13 patients with a homogeneous x 0 karyotype have been reported out of 62 patients who between them have had 138 pregnancies). Furthermore these pregnancies have been plagued by a number of important complications or fetal malformations (21% have had chromosome anomalies). It is therefore clear that in vitro fertilization with donor oocytes is a tempting solution for these women. The authors having three personal cases try and point out the conditions under which this technique can be used. It is important to realise that from the age of 10 or 12 years these patients have to have hormone treatment in order to avoid hypoplasia and hypovascularization of the uterus. Those conditions explain why so many these women had premature labours and also suffer from pre-eclampsia. Caesarean section was often found to be necessary because of feto-pelvic disproportion.

Adult↗
PubMed1992

[Outcome of pregnancies obtained by fertilization in vitro. Experience at the V. Olivier Ward (department of Professor Monnier, Lille University Hospital Center) and review of the literature].

The outcome of 87 pregnancies obtained by fertilisation in vitro and progressing beyond 20 weeks of amenorrhea monitored in the Victor-Olivier Ward (Prof. Monnier, Lille Teaching Hospital Group) was analysed. Results were compared with those in the literature. The group was characterised by three features: age, the number of primipara and above all the multiple pregnancy rate. One quarter of FIV pregnancies are multiple pregnancies and almost two newborn out of live are the result of multiple pregnancies. Almost 70 per cent of clinical pregnancies progressed beyond six months. Pregnancy pathology was represented by a marked worsening of the prematurity rate and by a slightly increased risk of fetal under-development. The cesarean section rate was very markedly increased. Sex ratio, and perinatal mortality, malformation and chromosomal aberration rates were similar to those for spontaneous pregnancies. Results are reassuring overall, the pathology being encountered in pregnancies of this type being only partially explained by age, the number of primipara and the multiple pregnancy rate. This pathology could possibly be explained by the underlying situation in which sterility occurred.

Abortion, Spontaneous↗
PubMed1992

[Immunologic aspects of endometriosis].

Endometriosis is thought to result from implantation of endometrial tissue swept back into the pelvic cavity during menstruation, or from coelomic metaplasia of the peritoneum. Yet not all women with menstrual reflux develop endometriosis. The authors present and analyse the arguments in favour of immune system involvement in the physiopathology of this frequent disease. A knowledge of the antigens that have been recognized and of the operative mechanisms will probably make it possible to understand better the repercussions of endometriosis on fertility, to develop diagnostic methods less traumatic than those available at present and to modulate treatments and improve their effectiveness.

Antibody Formation↗
PubMed1991

Prenatal diagnosis of PIBIDS.

In a well-documented PIBIDS family, two investigations of DNA excision repair showed a severe defect in lymphocytes from the index case (residual repair activities were 10.6-12.1 per cent). The values for the mother, father, and sister were within the normal range when compared with a healthy control. In the pregnant mother, a prenatal diagnosis of PIBIDS was made by measuring UV-induced unscheduled DNA synthesis in cultivated amniotic fluid cells. Results ranged between 12.5 and 26.1 per cent depending on the UV doses applied and were consistent with an affected fetus. The parents opted for a termination of pregnancy. Following a therapeutic abortion, fetal skin fibroblasts were tested and showed a severe DNA excision-repair defect of 9.2-13.5 per cent of residual activity.

Adolescent↗
PubMed1991

[Severe fetomaternal anti-Duffy allo-immunization].

The authors report a case of severe post-transfusion anti-Duffy (Fya) allo-immunization which required a treatment of four intrauterine exchange transfusions. The child was born at 32 weeks of amenorrhoea and he benefited from an exchange perfusion at birth. The outcome was fully satisfactory. On the basis of this case, the authors present a review of immuno-haematology concerning the Duffy system. This system holds fourth rank, after the ABO, rhesus and Kell systems, on the clinical importance scale of group systems. It concerns two alleles, Fya and Fyb, located on the first chromosome. The anti-Duffy antibodies are IgG immune antibodies; they may be responsible for haemolytic accidents, sometimes lethal, during transfusions, and they are an occasional cause of haemolytic disease of the newborn. A review of the literature yielded only 25 cases of haemolytic disease of the newborn, thereby showing that this allo-immunization is very rare, and it demonstrated its potential danger. Finally, the authors present the therapeutic methods used to treat the haemolytic disease of the newborn caused by anti-Duffy antibodies. Plasmapheresis and intrauterine exchange perfusion have dramatically improved the prognosis of this disease.

Adult↗
PubMed1990

[Multiple pregnancies. II. Epidemiology, clinical aspects].

It used to be rare for multiple pregnancies to occur but we have seen a spectacular rise in them in France between 1970 and 1986. Triplet deliveries increased threefold. The authors analyse a personal series of 23 pregnancies (19 triplets, 3 quadruplets and 1 quintuplet pregnancy). Sixteen of these 23 were medically induced. The main complications that have been observed were: threatened premature delivery in 86%, high blood pressure in 34.7%, anaemia in 50%, and urinary tract infections in 30.4%, 6.8% of the babies had congenital malformations. Reviewing the literature has made it possible to discern the epidemiological factors causing multi-fetal pregnancies: family history, high female fertility, maternal age, ethnic factors, hormonal contraception etc... At present it is medically assisted reproduction that is the big supplier of multi-fetal pregnancies in developed countries. We have reviews of several maternal as well as fetal complications: the ovarian hyperstimulation syndrome, extra-uterine pregnancy, hypertension, anaemia, spontaneous abortion, prematurity, intra-uterine growth retardation and malformations.

Adult↗
PubMed1990

[Meta-analysis as a synthesis of clinical and epidemiologic information. Its application to treatments in gynecology and obstetrics].

Multiple clinical studies require a structured synthesis of their results, especially where heterogeneous results are reported. Meta-analysis is a method that does just that. Such an epidemiological study of results across studies replaces the traditional narrative review of literature, and its study completes, but does not replace medical record linkage. Diuretics in pre-eclampsia, progestational agents in the control of major failures of pregnancy and fetal monitoring as a possible trigger for more frequent caesarean sections are given as examples of interest in gynaecology and obstetrics.

Female↗
PubMed1990

[Magnetic resonance imaging in the evaluation in utero of Siamese twins].

The authors report a case of twins conjoined at the umbilicus and diagnosed by ultrasound after 19 weeks of amenorrhoea in whom an assessment in utero was carried out using magnetic resonance imaging after the patient had been curarized. A review of the literature on this very difficult problem of conjoined twins has given us the possibility to assess the diagnostic measures as well as the prognosis of this pathology. In particular we point out the results that can be obtained using MRI in utero during the second and third trimesters of the pregnancy.

Abdomen↗
PubMed1990

[Multiple pregnancies. III. Therapeutic, psychologic and social aspects].

The authors analyse a series of 23 multiple pregnancies (19 triplet pregnancies, 3 quadruplets and 1 quintuplet). The first objective is to fight prematurity. Over and above all use of drugs as tocolytics (beta-mimetic drugs and progesterone) should routinely be advised and as soon as there is any threat of premature labour hospitalisation is needed. Twenty one of the 23 patients had prophylactic cerclage (Shirodkar's stitch). In 77% of the cases respiratory distress in the newborn was avoided by using cortico-therapy. Vaginal delivery can be carried out under certain conditions in triplet pregnancies. If certain precautions are taken there does not seem to be any immediate difference in the post delivery period of these children if they are born vaginally or by caesarean. Perinatal mortality is raised (at 5.6% for triplets and 58.3% for quadruplets). The psychological implications of these pregnancies are important. Problems appear as soon as the diagnosis is made and continue for years afterwards. On the social level, help given by the social services are usually inadequate. If the couples belong to the National Association for Mutual Aid of Parents of Children of Multiple Births, a system of mutual support is available. We recommend that these pregnancies should be looked after by several disciplines. These consist not only of obstetricians, paediatricians, anaesthetists, those who resuscitate together, but also psychologists, dietitians, social workers, community workers and physiotherapists.

Clinical Protocols↗
PubMed1990

[The fetal-maternal interface. Description of its elements from an immunologic perspective].

The authors describe the different elements that can change the immunological response at the feto-maternal interface having studied the increasingly large literature on the subject. They consider first the nature of the interface and how trophoblastic antigens occur and then they point out the type and the role played by the different numerous decidual cells that take part in recognising, activating and regulating the immune system there. This general review is justified because local immunological phenomena seem to be important for the survival and the development of the feto-placental unit. They are also for immuno-suppressant mechanisms and immuno-tropic mechanisms. These phenomena, however important they may be, make it necessary to recognise one or more embryonic or trophoblastic antigens acting on the maternal immunological system.

Female↗
PubMed1989

[Thyroid cancer and pregnancy].

Thyroid cancer is very rare during pregnancy, but a thyroid nodule is more likely to be cancerous if discovered during pregnancy (43 p. cent versus 15 p. cent). The diagnosis is more difficult. Tests using radioactive substances are contraindicated during pregnancy. Ultrasonography does not permit to specify the nature of the nodule and aspiration biopsy with cytological examination becomes the examination of choice. One should not hesitate to operate on these nodules, during pregnancy, if the diagnosis is made. It is difficult to assert that the prognosis is aggravated by pregnancy since there are so few cases, but several authors report a few cases with an abnormally fast progression during pregnancy. Forms which are properly treated and occurred before the age of 40, are not a contraindication to subsequent pregnancies, if they are not anaplastic or metastatic forms. However, a reasonable delay of the surgery is advised in order to stabilize the hormonal treatment and the calcium-phosphorus balance.

Adult↗