Biomedical subjects
F Bargy
Publications and source records attributed to F Bargy.
Amniotic fluid digestive enzymes: diagnostic value in fetal gastrointestinal obstructions.
The diagnostic value of amniotic fluid gamma-glutamyl-transpeptidase (GGTP) and intestinal alkaline phosphatase (iALP) was evaluated in 55 patients who underwent amniocentesis for karyotyping because fetal gastric or small bowel dilatation had been detected by ultrasound. Gastrointestinal malformation was confirmed in 46 cases and there was no gastrointestinal anomaly in nine cases. Prenatal ultrasound was suggestive of gastroduodenal dilatation in 34 cases (group I) and small bowel dilatation in 21 cases (group II). In group I, amniotic fluid GGTP above the 99th percentile was 71 per cent sensitive and 100 per cent specific for a true anatomical defect of the digestive tract (mainly duodenal atresia). In group II, high levels of GGTP and/or iALP were 69 per cent sensitive and 83 per cent specific for a fetal digestive tract anomaly. In other words, when digestive tract dilatations were diagnosed by prenatal sonography, abnormal amniotic fluid enzyme activities were strongly suggestive of such an anomaly, the possibility of which was not precluded by normal amniotic fluid iALP and GGTP activities. But amniotic fluid digestive enzyme activities do not help in defining the prognosis.
Longus colli has a postural function on cervical curvature.
To determine the postural role of longus colli (LC) and dorsal neck muscles, we have studied the relationship between their cross-sectional areas related to their force of contraction and the lordosis and the length of the cervical spine. This study was carried out in 36 healthy subjects. Muscle cross-sectional areas were measured by computerized tomography. The index of lordosis and the length of the cervical spine were measured on an X-ray profile. The cross-sectional area of LC was correlated to the lordosis index (R = -0.432, p < 0.02) whereas all the other parameters were not correlated. The authors conclude that LC counteracts the lordosis increment related to the weight of the head and to the contraction of the dorsal neck muscles. Postural functions of LC and postcervical muscles are complementary. They form a sleeve which encloses and stabilizes the cervical spine in all positions of the head.
Management of ovarian cyst detected by prenatal ultrasounds.
As a result of refinements in Prenatal Ultrasonography (US), neonatal ovarian cysts are more frequently encountered than in the past. Between January 1981 and December 1990, 21 consecutive fetuses with ovarian cysts were followed up by ultrasonography. 23 ovarian cysts were diagnosed between 28 and 38 weeks gestation. 18 cysts were initially large cysts (more than 50 mm in diameter). In 9 cases, an anechoic cyst was observed and a US-guided needle aspiration of the cyst was performed (2 antenatally and 7 postnatally). Ultrasonographic patterns of complicated cyst were observed in 3 fetuses. After a postnatal ultrasound control, 11 infants were operated on: 8 surgical interventions were required for complicated cysts (torsion: 4, hemorrhage: 4), 3 cases irrespective of their sonographic appearance in our initial experience. In the remaining cases, spontaneous resolution was followed by repeated ultrasonographic examination. Prenatal ultrasonography today allows diagnosis of ovarian cysts and may suggest antenatal complications. To preserve as much ovarian tissue as possible, cysts greater than 50 mm in diameter should be candidates for percutaneous aspiration and complex cystic masses should be operated on.
Venous territories of the brain.
The venous return of the cerebral hemispheres is ensured by two systems. The first, superficial system, reaches the peripheral dural sinuses, i.e. the superior sagittal sinus, the lateral sinus and the cavernous sinus. The second, deep system, corresponds to Galen's vein. Anatomical and angiographic data from the literature enable the usual drainage territory to be defined for each of these collecting vessels. However, the variability of the superficial sylvian vein and the importance of cortical anastomotic vessels make impossible to delimit precisely the territory of each peripheral sinus. The functional role played by numerous centro-peripheral anastomoses is more difficult to assert in each individual. It is therefore probable that in the cerebral hemispheres there is a deep territory balancing the superficial territories.
[Evaluation of 5 years of experimental in utero surgery for the repair of diaphragmatic hernia].
The incidence of diaphragmatic hernia in he newborn is 1:2,500 to 5,000 births. An extensive American programme of foetal surgery for in utero repair of this defect has shown that the pulmonary hypoplasia was due to compression of lung tissue by the herniated organs. This process could be interrupted be repairing the diaphragmatic defect early enough in utero (before the 28th week). The results of five years of experimental surgery for in utero correction of diaphragmatic hernia are presented here. The experimental model used was the Macaca fascicularis monkey, the pregnant female of which having several gestational and endocrine characteristics similar to those of the pregnant woman. Three different experimental programmes were carried out successively. A first series including five animals was used to experiment both surgical and anaesthetic techniques; three foetuses died in utero. The second series (10 animals) was designed to find a suitable protocol for tocolysis. One female died after surgery, and seven other foetuses also died. The third group (13 animals) was the main study group. The diaphragmatic hernia was first created surgically, and then repaired. No foetus died from the surgery. One female died before giving birth, and one offspring died shortly after birth as its mother had no milk. After the encouraging results obtained with this last series of animals, the procedure was applied to human cases, with the Hospital Ethical Committee's approval. In the first case, the foetus died postoperatively as a result of the rupture of the diaphragmatic prosthesis.(ABSTRACT TRUNCATED AT 250 WORDS)
[Fetal surgery: for what purpose?].
Widespread use of prenatal ultrasonography allows accurate diagnosis of many fetal malformations. The natural history and pathophysiology of some fetal diseases will undoubtedly induce lethal issue. Prenatal ultrasounds allow to determine prognosis during the second trimester of pregnancy. Experimental model and clinical practice have shown that prenatal surgery could be proposed for some correctable malformations: congenital diaphragmatic hernia, cystic adenomatoid lung disease, sacrococcygeal teratoma, lower urinary tract obstruction. To purpose this fetal therapy, great attention has to be paid to maternal risk and her future fertility, keeping in mind the aim of such fetal surgery: a new hope for improved management of the fetus with life-threatening defect.
Method of quantitative anatomical study of the dorsal neck muscles. Preliminary study.
Biomechanical models of the cervical spine require knowledge of the position, size and orientation of the individual muscles that act on the cervical spine. We have developed a technique to stereometrically measure anatomical specimens. The apparatus is composed of three graduated metallic rods, which slide along a fixed support. This method is accurate to map the anatomy of individual muscles and provides quantitative data on their lines of action. Results are obtained from one specimen. The computer processing of the collected data allows formulation of a three-dimensional model of the neck muscles in man.
The anatomy of intersexuality.
A description of anatomical lesions in the intersexual states has been made based on clinical and anatomical observations. This study provides the anatomical basis which is necessary before surgical genital reconstruction can be carried out.
[Fetal surgery: future perspectives].
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[Meconium peritonitis. The value of prenatal diagnosis].
Over an eight year period (1980-1987), fifteen cases of meconium peritonitis have been studied. As it has been reported, this pathology is still very rare. Ten pregnancies have been followed on by multiple échographies and the prenatal diagnosis of meconium peritonitis, suspected as early as 24 weeks of amenorrhea, has been established in ten cases. Among these, eight infants have been operated on before twelve hours of life, and for the ninth, surgical treatment was not advocated. The most frequent cause of the pathology is a perforation above a bowel obstruction. Two had cystic fibrosis. Of the 15 infants with meconium peritonitis, nine survived, and among these, one with cystic fibrosis and the one that has not been operated. Prenatal diagnosis in meconium peritonitis is of major interest in taking care early infants that will need an urgent surgical operation in most cases.
Trifid pelvis and controlateral bifid ureter with bilateral ureteropelvic junction obstruction.
A 20-month-old boy with a trifid pelvis and ureteropelvic junction obstruction on one side and incomplete duplication of the ureter with ureteropelvic junction obstruction on the lower pole of the other kidney is described.
[Esophageal atresia in newborn infants weighing less than 2,000 grams. Apropos of 37 case reports].
In a consecutive series of 275 infants with esophageal atresia seen at Saint-Vincent-de-Paul's Hospital (Paris) between 1971 to 1987, the authors report the experience with 37 infants weighed under 2,000 g (13.45%). 19 had severe additional malformations (51.35%) and 10 (27%) had a respiratory distress syndrome. As Abrahamson in 1972 (3), Cozzi an Wilkinson in 1975 (4), Rickham in 1981 (5) reported, according to the criteria suggested in 1962 by Waterston (1), survival rate are related to additional congenital anomalies and initial respiratory distress (pulmonary dysmaturity or pneumonia) but seems more related to maturity (small-for-date babies) than to birth weight. The authors recommend to perform a primary division of the tracheo-esophageal fistula and end-to-end esophageal anastomosis whenever possible.
[Laparoschisis. Hypotrophy and intestinal lesions].
37 cases of gastroschisis were operated on at Saint-Vincent-de-Paul's Hospital from january 1983 to july 1987. They were more frequently premature by birth weights (70% below the 10 th percentile), than by period of gestation (40%). The comparison of their weights plotted on the centile charts with 28 neonates with omphaloceles and 25 neonates with upper intestinal atresia (esophageal atresia without tracheoesophageal fistula and complete duodenal and proximal jejunal atresia) shows that the 2 groups of laparoschisis and anomalies of the alimentary tract are quite similar. The authors suggest that the amniotic fluid may play a role in the fetal growth so that the alteration of the herniated bowel is responsible of the fetal growth retardation observed in gastroschisis.
[Congenital diaphragmatic hernia. 120 neonatal cases. Preliminary study].
120 newborns with a congenital diaphragmatic hernia (CDH) were treated during the first day after birth in the Department of Pediatric Surgery at Saint Vincent de Paul's Hospital from 1980 to 1987. The overall survival rate was 40%. The influence of prenatal diagnosis, clinical and anatomical aspects is analysed. The side and the size of the defect, the intra-thoracic liver, the intestinal malrotation and the abdominal hypoplasia are significant prognosis factors. This preliminary study suggests that the natural history of CDH may be responsible of two different diseases: a disease with an early visceral intra-thoracic growth, and a severe lung hypoplasia; another one with a secondary herniation of the intra-abdominal mass, and a better prognosis.
Diameter of the superior vena cava in the newborn: clinical applications in parenteral nutrition.
The authors measured the superior vena cava in the newborn by radiologic, anatomic and histologic methods and analysed the correlations between cross-sectional area and the biometric data. This method makes it possible to select the size of catheter for parenteral nutrition via the superior vena cava in relation to body-weight.
[Development and regression of the fetal adrenal cortex].
The adrenal glands from a series of 300 fetuses and infants which had died in the Hospital Saint-Vincent-de-Paul, Paris, were dissected, weighed and processed for routine histology. The development of the fetal cortex and its regression have been compared to the general development of the gland. Our results show that there is an important development of the fetal cortex up to birth, when the adrenal glands represent almost one third of the size of the kidneys and possess only very reduced permanent cortex and practically no medulla. The regression of the fetal cortex in the postnatal period is marked by a decrease in weight of the adrenal glands up to the 2nd or 3rd month, by the persistence of a few dispersed cells up to the fifth month and by the persistence of a few fibrous elements up to 2 years of age.
[In utero surgery of diaphragmatic hernia in Macaca fascicularis].
The aim of this study is to be able to perform on the animal (Macacus cynomolgus) a specific in utero surgical procedure for correcting congenital diaphragmatic hernia, in order to do the same on human fetuses. The surgical technique consist in operating in utero, and to put a silastic patch on the diaphragm. A good tocolysis is very necessary to prevent early abortion. Finally the fetuses' surviving is the main problem.