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Biomedical subjects

D Vinatier

Publications and source records attributed to D Vinatier.

At least 127 records · Page 7Linked to original sources
PubMed1988

[Bourneville's tuberous sclerosis. Prenatal diagnosis of a case].

The discovery of a tumour of the heart on fetal ultrasound is a rare event. 60% of heart tumours in the fetus are rhabdomyomas. 50% of rhabdomyomas are associated with Bourneville's tuberous sclerosis. The inherited element of the effect of the gene is variable but often severe (75% of patients die before the age of 25 and 60-80% are disabled). Tuberous sclerosis Bourneville is a multifocal pathological condition of which only the presence of rhabdomyomata in the heart make it possible to diagnose the condition antenatally. Monitoring the fetus consists of looking carefully for the complications that can occur and of planning the health care of the newborn including the need to consider surgical intervention at birth.

Female↗
PubMed1988

[Non-specific immune defenses present in pregnancy].

The state of pregnancy changes the immune system by allowing the trophoblast to go on developing without letting the mother's body be invaded by it, and by keeping intact immune defences against the usual assaults. The non specific immune system is the first bulwark against invaders. The elements of this system, which do not depend on immunological memory, are: the macrophage-monocyte system, Natural Killer cells (NK), the complement component and other bactericidal substances such as lysozyme, fibronectin and interferon. Pregnancy improves the working of the monocyte-macrophage system. In fact, the macrophages of th reticulo-endothelial system, which can be found in different strategic places in the body, phagocytose abnormal particles more intensely. The monocytes in the circulation are more aggressive in pregnancy. They are drawn to the feto-placental interface where they are activated by different lymphokines and cytokines which can be found in quantity at this site. The role of these local active monocytes is not limited only to phagocytosis because among the hundred substances that they can elaborate are some that will regulate trophoblastic proliferation. The activity of the Natural Killer cells that are circulating and which can control tumour cell growth and cells infected by viruses is lowered in pregnancy. The serum taken from pregnant women seems to have a substance that counters the maturation of the Natural Killer cell lines. The complement system of protein synthesis, which normally acts to lyse bacteria in the chemotaxis during opsonisation, is raised in pregnancy. At the feto-placental interface it does seem to activate this system but not elsewhere in the general circulation. Interferon, which is a molecule that normally activates NK cells, has been found at the feto-placental site, without seeming to have a particular role. Pregnancy changes the quantity and the distribution of other elements in the non specific immune system such as transferrin , fibronectin and beta-lysin.

Female↗
PubMed1988

[Evaluation of the defense mechanisms of the body during pregnancy. Clinical and experimental aspects].

The authors, in clinical, epidemiological and experimental studies, point to the extent to which defence mechanisms are depressed during pregnancy. Viral, parasitic and bacterial infections are more common and more serious in pregnancy; but it does not seem to be possible to speak of an immunodeficient syndrome that is acquired in pregnancy. The nutritional and hormonal status as well as racial and geographical factors have their effects on numbers of defense mechanisms. The immune system cannot be relied on in these changes of the defences entirely, insofar as the arrival of antibiotics has had a big effect on the consequences of pregnancy.

Female↗
PubMed1988

[Receiver operating curve, an aid in decision making. Principles and applications illustrated with some examples].

The practitioner has many difficult questions to resolve when he has placed in front of him more and more diagnostic and screening tests. Which is, in a given situation, the best test, by which is meant useful, least costly and most acceptable by the patient? Having chosen the test, at what level is the result to be considered positive or negative? The authors, having explained the principles and having taken some examples out of the literature of gynaecology and obstetrics, present a technique that shows on a receiver operating characteristic curve sensitivity and specificity sharing as a function of the possible levels for making decisions according to the test. The curve inordinate shows the sensitivity of the test or the number of true positives and on the abscissa the complement of specificity or the rate of false positives ford each decision threshold of the test. A simple glance gives the practitioner a view of the characteristics of the test over the whole band that this test can use. Using these curves it is possible to adopt more elaborate techniques to select the best threshold and to compare different tests.

Decision Making↗
PubMed1988

[Specific immune relationships among the mother, the fetus and the trophoblast. Present-day aspects].

Studying the literature, which is becoming larger and larger, the authors note that there is increasing understanding about the immune response that allows a harmonious development of the feto-placental unit. After the recognition of certain trophoblastic antigens there followed the activation of lymphocytes which synthesize substances favourable to trophoblastic growth. At the same time protective mechanisms which inhibit the generation and activation of immunological factors which are normally found when allografts are rejected, were recognized. Also recognized were other systems able to suppress aggressive features that can become active during pregnancy.

Female↗
PubMed1987

[Twin pregnancy combining a hydatidiform mole and a normal ovum].

It is rare for a twin pregnancy to consist of a normally growing fetus and a hydatidiform mole. A differential diagnosis between a partial mole and a degenerating fibroid together with a normal pregnancy has to be made. This can be made using ultrasound pictures but also using cultures from trophoblast samples, or cultures from amniotic cells obtained by amniocentesis. These will eliminate the possibility of the triploidy by showing that there is a normal caryotype present. The complications and the risk of degeneration are the same as with a plain hydatiform mole. The uterus has to be evacuated and a follow-up has to be carried out to screen for trophoblastic proliferation.

Adult↗
PubMed1987

[Is it necessary to specify the HELLP syndrome?].

In 1982 Weinstein described the Hellp-Syndrome in pre-eclampsia. Two personal case histories have led the authors to discuss the need to specify this syndrome. Apart from the classical elements of pre-eclampsia, which are: arterial hypertension, proteinuria and oedema, there are bowel symptoms in 86% of cases and on the biological level there is thrombocytopenia and a rise in the transaminases as well as a haemolytic anaemia. Some cases of rupture of the liver have been described. Treatment is that of pre-eclampsia. This involves treatment with cortisone and sometimes with heparin. Delivery of the fetus is, however, the only really effective treatment. The characteristic three elements of the Hellp-Syndrome seem to be linked to disseminated intravascular coagulation and have long been considered very serious factors in pre-eclampsia. On the other hand it does seem to be useful for the clinician to know about the Hellp-syndrome in order to estimate the seriousness of a case where there are vasculo-renal elements in the syndrome and in order to avoid diagnosis mistakes in cases where the symptoms are often deceptive.

Adult↗
PubMed1987

[Value of amiodarone in the treatment of fetal supraventricular tachycardia. Apropos of a case].

Description of a case of supraventricular tachycardia at 33 1/2 weeks of pregnancy following a treatment with salbutamol. After failure of digoxin alone then in association with propranolol, amiodarone allowed control of this tachycardia. A baby was born at 36 weeks, his cardiac and thyrodial assessment were normal. Different problems are discussed: the part of salbutamol on the onset of the tachycardia, the limits of fetal monitoring, the use of echocardiography and the various treatments available.

Amiodarone↗
PubMed1987

[Use of prostaglandin E1 ovules in the therapeutic interruption of pregnancy in the 2d and 3d trimesters. Apropos of 46 cases].

46 late interruptions of pregnancy (16 to 33 weeks of amenorrhea) were performed with the use of prostaglandins E1 ovules, of 1 mg, placed in the posterior vaginal cul-de-sac every 12 hours. It concerned 13 deaths in utero or extremely premature rupture of the membranes, 25 fetal indications (9 chromosomal abnormalities and 16 severe malformations), and 8 maternal indications. The efficacy was good either with ovules alone (84.7%) or associated with a balloon probe (5.3%). Expulsion is faster in the case of fetal deaths (average = 8 hours), than in therapeutic interruptions of pregnancy (average = 20 hours). The necessary doses did not exceed 3 mg of PgE1. There were very few side effects, essentially gastro-intestinal in nature and the course was simple. No obstetrical complication was noted. This method is therefore particularly effective with minimal side effects. Easy to use, it must be reserved for very precise indications.

Abortion, Therapeutic↗
PubMed1986

[Mucoviscidosis and pregnancy].

We have seen a patient who became pregnant. She was suffering from cystic fibrosis diagnosed late in life at the age of 26 years. Her case has allowed the authors to make some observations on this association of pregnancy with cystic fibrosis which will become increasingly common. 5% of individuals are heterozygous for this condition. The prospect for these patients surviving gets better and better. Although their fertility seems to be lowered it is possible for them to become pregnant. They are caught in the web of almost constant episodes of broncho-pulmonary infection with lasting effects on their respiratory capacities in 50% of cases. About 83% of these patients will deliver prematurely because of the respiratory distress they suffer. It is difficult to predict the long-term effects of pregnancy on the survival of these patients since the mortality rate anyhow is about 10% per year. According to the literature pregnancy will cause a permanent deterioration in respiratory function in about 37% of cases. The history of this particular case should be able to give new hope to some women suffering from this condition. All the same, there are a large number of problems that still have to be dealt with.

Adult↗
PubMed1986

[Fibroma and pregnancy. Apropos of 51 case reports surveyed from April 1976 to December 1984].

The study is based on 51 observations of fibromas of diameter 3 cm or more associated with pregnancy. The authors report the characteristics of this pathology, which occurs at a frequency of one in two in women over 35 years of age, half of whom are primiparae. The frequency varies with the size of the fibroma and falls between 0.3 and 2%. The circumstances of detection vary but echography both improves detection and allows the development of the fibroma to be monitored. The only frequent complication is aseptic necrobiosis (25% of cases), but it is usually latent or moderate. Abortions, low insertions of the placenta and faulty presentations are more frequent, especially where large fibromas are involved, but nonetheless 3/4 of such pregnancies come to term without any serious problems. Fetal prognosis is, therefore, excellent and perinatal mortality is close to that of a control population. The proportion of cesarean sections is high (30 to 75%) and depends on the circumstances, the size of the fibroma and the occurrence of dystocias. Myomectomy should remain exceptional during pregnancy but will be frequently used towards the end of a cesarean section; indications for hysterectomy on the other hand remain very limited.

Abortion, Spontaneous↗
PubMed1985

[Extrauterine pregnancy: epidemiologic, diagnostic, therapeutic and prognostic aspects. Apropos of 117 cases reviewed between April 1976 and September 1976].

This is a retrospective study carried out on 117 cases of extra-uterine pregnancy that occurred between 1976 and 1983. The authors review the different aspects of the pathological aetiology, the diagnoses, the treatments and the prognoses for this condition. Over all the incidence was 1 in 105 deliveries but this incidence had increased greatly to 1 in 68 in the last two years. The most frequent cause that was found was pelvic inflammatory disease in 42% of cases. 32% were recurrent cases of inflammatory disease and there is a correlation between ectopic pregnancy on the right side and previous appendicectomy. About a quarter of all the patients could have conservative surgery which the follow-up shows does increase the likelihood of fertility but also 37% of these had recurrent ectopic pregnancies. The discussion, which is supported by a review of the recent literature, points out that there is a recrudescence of extra-uterine pregnancy. It also shows how important it is to look out for this condition and what the risks are of conservative surgery. The indication for the latter should take into account many factors including the age, the general condition, the parity, the fertility, the wish for a pregnancy and the state and condition of the tube on each side.

Adult↗
PubMed1985

[Problems caused by the therapeutic interruption of pregnancy. Apropos of 120 cases observed from 1976 to 1983].

The authors present statistical data on 120 medical abortions performed at "Pavillon Victor Olivier" between April, 1976 and June, 1983. A precise study was performed on the maternal and fetal indications, the different techniques employed according to gestational age, and their follow-up since 1976. The principal purpose of this article is to arouse reflexion on the consequences of the law of 1975, as well as the appropriateness of the maternal and especially of the fetal indications. A major portion of these could be avoidable with prophylactic measures and adequate contraception.

Abortion, Legal↗
PubMed1984

[Steinert disease and pregnancy].

Steinert's syndrome and pregnancy with delivery are rarely associated. It is a dominant autosome disease. Certain signs in pregnancy may suggest that the fetus is affected. One case made it possible to demonstrate these facts. Hydramnios with infrequent fetal movements and a slow fetal heart rate may lead to a suspicion of fetal involvement. This is always serious. The presence of the disease in the mother should be sought if it is not already known. If there is already a known family history the patient should see a geneticist so long as early amniocentesis has not yet been performed.

Adult↗
PubMed1984

[Diagnostic and therapeutic problems in anencephaly].

The authors report on 18 cases of anencephalus, studied from April, 1976 to December, 1982. Possible etiologies, morphological characteristics, circumstances leading to its discovery, and diagnostic tools are presented. Emphasis is placed on the usefulness of ultrasonography to diagnose this condition as early as the 13th to 14th week of gestation. Evacuation of the uterus is always difficult as it involves a second trimester abortion, but is one of the best indications for the use of prostaglandins. In a woman with a previous history of an anencephalic child, careful monitoring of subsequent pregnancies is necessary as the recurrence rate is approximately 4 p. 100 (13 p. 100 in the case of a second anencephalic child). Dosing of alpha-fetoprotein and acetylcholinesterase in amniotic fluid and repeated sonograms are indispensable.

Anencephaly↗
PubMed1983

[Immunological aspects of pregnancy].

The authors undertake a review of the literature so that they can point out present knowledge of the immunological relationship between mother and fetus. The fetus is a true allograft since it carries paternal antigens. Total harmony occurs so that immunisation of the mother against the feto-placental unit is recognised. This immunological reaction must occur to allow smooth development of the fetus with, at the same time, protection of the mother against trophoblastic invasion. Many regulatory mechanisms are summoned up to bring about this immunological response. While the progress in immunological knowledge has enabled us to glimpse this immunological relationship, it seems strongly probable that knowledge of these mechanisms can have applications outside gynaecology and obstetrics and be of equal value in the interpretation of immunological reactions which are found on oncology and parasitology.

Antibody Formation↗
PubMedDate not supplied

Dose-dependent systemic human immunodeficiency virus infection of SCID-hu mice after intraperitoneal virus injection.

SCID mice were engrafted with human foetal liver, thymus and lung. Human cells were subsequently detected among peripheral blood leukocytes for 81% of tested animals and in tissue implants for 100% of tested animals. SCID-hu mice received intraperitoneal injections of human immunodeficiency virus type 1 (HIV1) at from 20 up to 20,000 median tissue culture infectious doses (TCID5). HIV1 infection was detected by means of cell culture and polymerase chain reaction both in blood and implants, up to 58 days after infection. The rate of infection was dependent upon the inoculated dose: the frequency of thymus infection ranged from 14% with 20-500 TCID50 up to 100% with 20,000 TCID50. HIV1 infection was detected less frequently in blood leukocytes than in thymus. Thymus virus load ranged from 40 to 50,000 HIV1 provirus copies per million cells and was not correlated with either infectious dose or viraemia. Thymus T-cell depletion was observed mainly in the CD1+4+8+ immature thymocyte compartment. The same rate of SCID-hu mouse infection was obtained using three different primary HIV1 isolates, suggesting that infection was not restricted to a few particular virus strains. The systemic infection of SCID-hu mice following intraperitoneal virus injection mimics some traits of human HIV infection and provides a promising, novel approach for future investigations in this field.

Animals↗