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Biomedical subjects

E Bertrand

Publications and source records attributed to E Bertrand.

At least 73 records · Page 4Linked to original sources
PubMed1996

Oocyte shortage for donation may be overcome in a programme with anonymous permutation of related donors.

Difficulty in recruiting donors plays a crucial role in oocyte donation programmes. We report here an original strategy to overcome this problem, consisting of sharing out anonymous oocytes between recipients, which has markedly improved treatment efficiency by avoiding freezing or destruction of supernumerary embryos. Each patient received part of the supply of oocytes from several donors in four successive cycles, while each donor underwent oocyte retrieval only once. This strategy led to one pregnancy per treated donor, increased treatment efficacy by 300%, and reduced dramatically the oocyte shortage at our centre. The system avoids wastage of the rare and precious donated oocytes, increases the chance of pregnancy for each related recipient and even permits the inclusion of some recipients without related donors.

Adult↗
PubMed1996

The long-acting gonadotropin-releasing hormone analogues impaired the implantation rate.

OBJECTIVES: To determine the efficacy and innocuousness of long-acting versus short-acting GnRH analogues (GnRH-a) in long protocol for in IVF-ET. DESIGN: Prospective randomized study. SETTING: The IVF unit at an academic hospital. PATIENTS: One hundred couples admitted for their first IVF-ET attempt. MAIN OUTCOME MEASURES: Serum concentrations of LH, E2, and P during the all cycles and duration of pituitary desensitization were assessed, as well as fertilization rate, embryo quality, and implantation and pregnancy rates. RESULTS: Significantly more days (10.8 +/- 1.8 versus 9.2 +/- 1.7 days) of stimulation and more ampules of hMG (47 +/- 22 versus 33 +/- 16) were necessary to obtain similar numbers of embryos of quality with the long-acting GnRH-a. Implantation and delivery rates were significantly lower with the long-acting GnRH-a (32.8% versus 21.1%; 48.9% versus 29.1%, respectively). CONCLUSIONS: As the long-acting GnRH-a might interfere with the luteal phase and embryo development, short-acting GnRH-a should be preferred for ovarian hyperstimulation in IVF-ET.

Adult↗
PubMed1996

Clinical parameters influencing human zona pellucida thickness.

OBJECTIVES: To assess which clinical parameters influence human oocyte zona pellucida (ZP) thickness. PATIENTS: Sixty-five couples undergoing 75 IVF-ET cycles. MAIN OUTCOME MEASURE: Zona pellucida thickness of 827 oocytes measured 16 to 20 hours after in vitro insemination under inverted light microscope. RESULTS: Zona pellucida thickness was 18.9 +/- 3.8 microns (mean +/- SD) for unfertilized, 16.4 +/- 3.1 microns for fertilized, and 15.1 +/- 2.4 microns for polyspermic oocytes (significantly different). Among our patients, a few underwent two (or even three) IVF-ET cycles, and the mean ZP thickness was, in most cases, not significantly different from one cycle to the other(s). Regression analyses were calculated between ZP thickness and available clinical parameters, i.e., the age of the women, the duration of stimulation, the cumulus maturity, the number of retrieved oocytes, the number of hMG doses, the maximum E2 level, and the follicular volume. A significant linear decreasing relationship exists between the mean ZP thickness of each patient and the maximum E2 level and an increasing one with the hMG dose. Relationships with the other parameters appeared to be nonsignificant. CONCLUSION: The ZP thickness is basically an individual feature that influences the fertilization rate. Nevertheless, it may be influenced slightly by the hormonal treatment during stimulation.

Adult↗
PubMed1996

Changes in dopaminergic neurons of the mesocorticolimbic system in Parkinson's disease.

The qualitative analysis of changes in major nuclei (n. paranigralis left and right, n. interfascicularis) of the mesocorticolimbic system (ventral tegmental area-VTA) was carried out on 25 cases with Parkinson's disease (PD). The cellular depletion with insignificant gliosis without the presence of macrophages was found. In addition, numerous extracellular melanin nodules being the remnants of broken dopaminergic neurons were found. The presence of Lewy bodies observed in all cases confirms the diagnosis of idiopathic Parkinson's disease. The morphometric analysis performed on selected long-lasting 7 PD cases and 6 controls showed that cellular depletion in n. paranigralis and in n. interfascicularis accounts for 42% and 62%, respectively in relation to controls. The number of melanin nodules grows with the age in the control group. While in the group of PD cases the number of nodules in VTA declines with the disease duration. It may indicate that the factor which damages melanin neurons also exerts a destructive effect on extracellular melanin.

Age Factors↗
PubMed1996

Mitochondrial encephalomyopathy of mixed MELAS type.

A 27-year-old man with slowly progressing symptoms of pigmentary retinal degeneration, cerebellar, pyramidal and extrapyramidal syndrome and atrophy of lower limb muscles, was admitted to the Department of Neurology. During the final stage of disease, generalized, tonic and clonic seizures, absence and myoclonic epilepsy as well as Jackson's motor seizures were observed. A computed tomographic (CT) scan showed a considerable atrophy of cerebellum and pons. A magnetic resonance imaging (MRI) revealed diffuse cortical and subcortical atrophy, especially in structures of posterior intracranial fossa and bilateral foci of increased signal intensity in cerebral cortex and subcortical gray structures. A morphological study of a biceps specimen revealed the presence of so called ragged-red fibers characterized by abnormal mitochondria with paracrystalline inclusions. A considerable atrophy of the central nervous system, especially of cerebral and cerebellar cortex was revealed by a macroscopic study of the brain. Numerous focal and so called pseudolaminar cortical necroses in the brain, regardless of vascular supply, with characteristic proliferation of capillary vessels were predominating in a microscopic study. The clinical data and especially histopathological features count for the diagnosis of mitochondrial encephalomyopathy of MELAS type. The presence of additional features such as pigmentary retinal degeneration, characteristic of Kearns-Sayre syndrome and myoclonic seizures typical of MERRF syndrome allows the classification of this case as mixed MELAS syndrome.

Adult↗
PubMed1995

Second polar body extrusion is highly predictive for oocyte fertilization as soon as 3 hr after intracytoplasmic sperm injection (ICSI).

OBJECTIVE: Our objective was to evaluate the time course and the predictive value of the extrusion of the second polar body after intracytoplasmic injection (ICSI) related to the fertilization rate, embryo cleavage and quality. SETTING: The setting was the in vitro fertilization program of a university hospital. PATIENTS: Twenty-one patients were treated with intracytoplasmic single sperm injection either for fertilization failure in IVF, low fertilization in IVF (< 5%), or severe male factors. DESIGN: One hundred thirty-five of 205 metaphase 2 oocytes treated with intracytoplasmic single sperm injection were observed 1, 2, and 3 hr after the assisted fertilization procedure. Extrusion of the second polar body was recorded. For each of these oocytes, fertilization was noted 18 hr after ICSI and cleavage and embryo quality were assessed 24 hr later. The 70 remaining oocytes were used to assess a possible negative effect of repeated exposure to light microscopy. RESULTS: The extrusion of the second polar body 3 hr after injection was an observation with a sensitivity of 0.87, a specificity of 0.58, and a high positive predictive value (0.90) toward oocyte fertilization. Twenty-nine and four-tenths percent of the oocytes extruded a second polar body within the first hour, 56.6% within the first 2 hr, and 78.3% had a second polar body 3 hr after injection. This time course was related neither to the speed of embryo cleavage nor to the embryo quality. Fertilization, cleavage, and embryo quality were not affected by repeated observation as deduced from comparison with the control group and confirmed by a high pregnancy (62% per oocyte retrieval) and implantation rate (22% per replaced embryo). CONCLUSION: Oocytes can be checked, in all safety, 3 hr after a single sperm injection for the presence of a second polar to predict oocyte fertilization with a high certainty.

Chorionic Gonadotropin↗
PubMed1995

Does zona pellucida thickness influence the fertilization rate?

In human in-vitro fertilization (IVF), the cumulus oophorus is routinely removed to assess fertilization and hence the thickness of the zona pellucida is measurable. This study aimed to measure the thickness of the zona pellucida and to assess its influence on fertilization rate in IVF programmes. The zona pellucida thickness varies from 10 to 31 microns with a mean of 17.5 microns. One-way analysis of variance revealed that in IVF trials performed with normal semen, the zona pellucida of fertilized oocytes (16.6 +/- 3.2 microns) was significantly thinner than the zona pellucida of unfertilized oocytes (18.9 +/- 4.0 microns; P < 0.001). As measured on micro-injected oocytes, the zona pellucida thickness did not change between ovulation and 16-20 h after fertilization. Zona pellucida thickness was not related to ooplasm diameter. In conclusion, zona pellucida thickness appears to be an additional factor that should be taken into account when interpreting the fertilization rate. Zona pellucida thickness influences sperm penetration, even when the spermatozoa are considered normal. From a clinical point of view, a thick zona pellucida (> or = 22 microns) could be an indicator for the use of micro-injection procedures.

Adult↗
PubMed1995

[Preclinical trials for mastering intracytoplasmic injection of a sole spermatozoid for the treatment of male infertility].

Before starting with the clinical application of ICS, aged unfertilized oocytes were gathered for training and were injected with a single sperm or without a spermatozoon as a control group for activation. Oocyte damage, initially as high as 40% was reduced to 15% after 60 oocytes. Normal fertilization (2PN) occurred in 18% of the injected oocytes. After this training period 1,488 metaphase II oocytes collected during 144 cycles were used for ICSI. Results were split up in 3 periods (n = 55, n = 24, n = 57) corresponding to the different improvements made in the technique. Results form ICSI in combination with MESA (n = 6) were analysed separately. Mean fertilization increased from 24% to 77%. Fertilization failures (18% of the cycles during the first period) vanished in the last period. Implantation rate improved from 7.4% to 11.4% and reached finally 26%. Pregnancy rate per oocyte retrieval was 16%, 25% and 54%. For the MESA group fertilization was 28%, implantation rate 17% and pregnancy rate 33% and only one fertilization failure was observed. A total of 50 pregnancies were obtained including 2 obtained after MESA and 2 with cryopreserved embryos. Four healthy children are born, 9 were early abortions, 37 pregnancies are still on-going. Preclinical practice on aged unfertilized oocytes seems useful before starting with clinical ICSI, as high initial oocyte damage could be reduced and subsequent clinical treatment successfully applied. Offering high fertilization and pregnancy rates in cases of infertility with severe male factor it is extremely worthwhile mastering this new technique.

Cytoplasm↗
PubMed1995

Coronary heart disease in black Africans: an overview.

Coronary heart disease is still rare representing only 6% of all cardiovascular diseases in black Africans despite its increased incidence in recent years. Myocardial infarction in black Africans shows similar characteristics as those seen in patients aged under 40 years in the west, particularly regarding the frequency of infarction as the first manifestation of the disease, low prevalence of coronary artery stenosis and relatively common finding of normal coronary arteriography. Risk factor profile is the same as in western countries, but the haemoglobin S or C trait could be a unique one. The long-term outcome of infarction is severe and influenced by myocardial sequelae of imprecise origin; delayed hospitalisation; absence of thrombolysis and angioplasty; and socio-economic and literacy problems.

Adult↗
PubMed1995

[Physical training and blood pressure].

The effects of exercise training on blood pressure (BP) are reviewed. BP rises during exercise and lowers in the post-exercise period. Regular physical training result in a significant lowering of BP at rest as long as the training is continued. Moreover exercise training result in a BP lowering during exercise which is greater in hypertensive patients than in normotensive subjects. A favourable effect is observed also on ambulatory blood pressure, but the night-time blood pressure is not lowered. The mechanisms of training-induced changes of BP are not sufficiently known. The exercise training seems act on systemic vascular resistance, plasma catecholamine, PGE2 and taurine levels, renin-angiotensin-aldosterone system. As adequate physical training can reduce BP, we can consider it is a non pharmacological treatment of hypertension: mainly for border lines, labile and mild hypertensives patients. For certain hypertensive patients, some sports can be permitted when no target organ is involved.

Adolescent↗
PubMed1995

Morphological changes in the corpus callosum in chronic alcoholism.

In a group of 66 patients (age 24 to 78 years) with the clinical diagnosis of chronic alcoholism the changes in the corpus callosum were evaluated. The period of alcohol abuse varied from 3 to over 30 years. In 57 cases atrophy of the corpus callosum was noted. The trunk was involved most frequently. Myelin sheaths exhibited abnormalities from slight pallor to total destruction. In 19 cases the damage of myelin sheaths was restricted to disseminated, perivascular, spongy degenerations. The vessels were sclerotic, especially periventricular ones exhibited degenerative changes. Perivascular gliosis was also seen. Conclusions from the present study indicate that the structural changes observed in the corpus callosum during chronic alcohol abuse are connected with CNS involution and with degenerative changes within vessels walls. The damage of myelin sheaths localized in our material similarly as Marchiafava-Bignami disease, differs from the later by less advanced changes, perivascular spreading of demyelination, and frequent destruction of axons.

Adult↗
PubMed1995

Rare vascular changes in the brain in a case of subacute cutaneous lupus erythematosus.

Histopathological changes in leptomeningeal and cerebral blood vessels in a case of subacute cutaneous lupus erythematosus (SCLE) with the involvement of the central nervous system are presented. A 46-year-old woman died because of cerebral stroke after a 19-year duration of the disease. The general autopsy showed changes in the kidneys, myocardium, spleen and pancreas, typical of systemic lupus erythematosus. The brain autopsy revealed large necrosis in the supply territory of the middle and posterior cerebral arteries in the left hemisphere. In addition, small focal necroses, partially hemorrhagic, were found in both cerebellar hemispheres. Small cortical necrosis was also visible in the right insular area. A diffuse damage of the blood vascular system in the form of fibrinoid necrosis of small sized cerebral blood vessels with inflammatory infiltrates of the vessel wall (necrotizing leukocytoclastic vasculitis) predominated in the microscopic examination of the brain. Vascular changes of vasculopathy type in the form of hyalinization of the vascular wall and fibrinoid necrosis with concomitant numerous, small necroses were observed. In the lumen of left internal carotid artery infiltrated by inflammatory cells, an organized thrombus was found. Giant cells were observed within vascular infiltration.

Arterioles↗
PubMed1995

[Post-partum cardiomyopathy: medical aspects, role of heart transplantation].

The incidence of post-partum cardiomyopathies (PPCM) represents 5% of all cardiomyopathies and 10-13% of cardiomyopathies in women. The outcome of PPCM may be: a) death in the acute phase, b) evolution to chronic myocardial disease or c) complete recovery, in which PPCM differs from dilated cardiomyopathy. Another difference is that PPCM may not recur in subsequent pregnancies. The aetiology and pathogenesis of PPCM are still unknown. Infectious diseases, nutritional disorders have been reported but they do not account for the majority of cases. Immune responses to the foreign tissue of the placenta and foetus may explain alteration of immune function associated with myocardial lesion. In the author's experience, the most common pathogenic mechanism is latent myocardial insufficiency observed in each woman in the normal post-partum period. The different noted "causes" could be factors which reveal this latent common condition. Recently, cardiac transplants for PPCM have been reported. As patients with PPCM may recover completely, we believe that PPCM is not a special priority for transplantation. Two recent studies have compared the outcome of women undergoing transplantation for PPCM and those for dilated cardiomyopathy. The risk of rejection and infection was greater in PPCM (but the difference was significant in only one report). The long-term survival was favourable in both groups.

Adult↗
PubMed1995

[Echocardiography and Jones criteria in the diagnosis of rheumatic heart diseases: 138 cases reviewed at the Cardiology Institute of Abidjan].

The files of 138 patients suffering from rheumatic heart disease were studied in order to confirm the value of modified Jones' criteria and heart damage and to evaluate the contribution of echocardiography findings. Only files containing complete clinical and laboratory findings were studied. Of the 138 cases reviewed there were 51 cases of carditis (36.6 percent) and 87 cases of heart damage (63.4 percent). Carditis was associated with arthritis in 35.3 percent of cases. Antistreptolysin O levels were elevated in 74.5% percent of cases. Regarding Jones' criteria, the presence of a minor clinical criteria such as fever, polyarthritis, and history of acute rheumatic joint inflammation and laboratory findings such as elevated erythrosedimentation and antistreptolysin O rates were associated with carditis significantly more often than with heart damage. Echocardiography played a determinant role in the diagnosis between rheumatic heart disease in 35.3 percent of cases. Only echocardiography allowed differential diagnosis between rheumatic heart damage and other tropical cardiovascular diseases.

Adolescent↗