[Total parenteral nutrition during pregnancy].
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Biomedical subjects
Publications and source records attributed to F Laffargue.
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In the last 110 cases of genital prolapse examined, IVU formed part of the prior urological investigation. 14 cases of ureteropelvic distension were thus discovered (13.6% of cases). In ten cases the prolapse was sufficiently largee as to exterioris the uterus or bring it to of the vulva. In 13 cases out of 15 a larg cystocoele was visible at the vulva with a full bladder. The precise urological consequences of these prolapses was greater than had been expected: 13 cases of incomplete vesical retention, 4 of unilateral ureteropelvic distension and 10 bilateral, including 3 only symmetrical. Bilateral high distension was in general associated with a large cystocoele. Severe renal insufficiency was seen in only one case, and 5 moderate elevations in blood urea, in 5 cases. The mechanism of such ureteropelvicalyceal distension is not clear, but the prolapse is directly responsible, since mechanical (insertion of a pessary) or surgical reduction of the prolapse restores the upper excretory tract to normal. Renal function recovered all the more rapidly when the prolapse had been present for a shorter time.
The ultrastructure of normal ovarian hilar cells, both during the reproductive era and after the menopause, shows evidence of steroid hormone synthesis. In this respect these cells are very similar to Leydig cells in that they contain mitochondria with a dense matrix, a highly developed smooth endoplasmic reticulum, Reinke crystals, and microcystalline inclusions. The latter are much more numerous than in the normal testis. Their enzymatic activities are quite similar to those of Leydig cells. Ovarian hilar cells seem to originate from progressive metamorphosis of fibroblastic cells under the induction of sympathetic nervous structures. Their relations with hilar nerves are of three types: simple direct membrane contact without a Schwann cell sheath, intimate intracytoplasmic relationships, and specialized contacts, which are comparable to a synapse.
The authors report on their experience using prostaglandins E2 and F2alpha in obstetrics. 70 cases are involved: 30 inductions of labour, 33 abortions and 7 hydatidiform moles. The results as far as induction of labour is concerned are encouraging (76.6 p 100 success), but in the doses used no better than those achieved with synthetic posterior-pituitary oxytocins. On the other hand, as far as abortions are concerned, prostaglandins, whether given intravenously, intra-amniotically or extra-amniotically, are the method of choice because they are practically free of danger in the second trimester of pregnancy (93.9 p. 100 success). Side effects are common but are usually not severe and do not interfere with the treatment.
This study is about hormone receptivity carried out on 84 fibroadenomata of the breast. In displaying the intracellular receptors for oestradiol and progesterone it shows that hormone receptivity was maximum in benign conditions as they were starting in young women with a short clinical history and with most marked cellular density on anatomo-pathological examination. We compare our results with those that were obtained in cases of cancer of the breast and show in parallel the plasma steroid levels that were obtained in women with benign pathological conditions of the breast.
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A case-report of arrhenoblastoma is presented where the endocrine profile has been determined before, during and after removal of the tumor. Sex steroids, cortisol, corticosteroid binding globulin (CBG) and sex steroid binding protein (SBP) were measured in fluid from 2 cysts, tumor vein and peripheral plasma. Hormones were measures by specific RIAs after stepwise chromatography on celite support according to a new elution pattern allowing the resolution of 8 sex steroid in a single chromatographic system. Excessive amounts of androgen, the most prominent being testosterone, and 17-OH-progesterone, but low levels of estrogens and progesterone were found in preoperative plasma. Due to an androgen-directed rise of CBG, large amounts of plasma cortisol were detected. However, preoperative SBP capacity was found to be reduced. The steroid profile of cyst fluids was found to be similar to that of peripheral plasma. Neoplastic cells were found capable of producing an androgen binding protein. These results correlated well with Sertoli-Leydig cell tumors histology, i.e. a testis-like endocrine structure. From the endocrine profile, the steroid biosynthetic pathways are discussed with respect to the possibility that biosynthesis, once the 17-OH-pregnenolone structure was reached, was active along both the delta 5 and delta 4-steroid pathways. The steroid levels in tumor vein and their corresponding gradients to the periphery are discussed with respect to: i) the possibility of metabolic and biosynthetic capacities of cancer cells bearing an undifferentiated steroidogenic appearance, ii) the possibility for tumor steroid secretion by others means than by venous blood and iii) the possibility that both point i) and ii) could be the cause of inconsistent diagnosis significant of endocrine profile as observed in some patients.
Fetal blood values were evaluated from 541 cordocenteses. Simple regressions were used to find a correlation between blood values and gestational age. We found a linear increase in hemoglobin concentration and hematocrit throughout gestation; a linear decrease of the mean corpuscular volume with the gestation was evidenced as a regular decrease in mean corpuscular hemoglobin. Lastly, the mean corpuscular hemoglobin concentration was constant during the gestation; a linear increase of the platelet count and the nucleated cells was also evidenced. We suggest that each fetal medicine unit should have its own reference ranges. It will permit to accurately diagnose fetal infection, fetal anemia, or any fetal disease where alterations of hematopoiesis have been described.
Hemangiolymphangioma is a malformation of both lymphatic and blood vessels. We present a case of fetal abdominal hemolymphangioma diagnosed by ultrasound at 27 weeks of gestation. The extensive fetal involvement, and the diagnosis before fetal viability led us to propose medical termination of pregnancy. This represents the second reported case of prenatal diagnosis of this malformation.
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The combined oral contraceptive pill is an efficient means of contraception. It acts at different levels of the genital tract. Despite its efficiency, it is universally suggested that patients take the pill at regular daily intervals. Little attention has been given to the question of what happens if you miss the pill one day or more. A study was undertaken to evaluate the consequences of pill misses at different times of the cycle. Forty-seven young, healthy, normally menstruating patients voluntarily enrolled. All were given Cilest (ethinyl estradiol 35 micrograms and norgestimate 250 mg, Cilag France) for 21 days without any misses. Then, after a 7-day interval, they were prescribed one (group 1), two (group 2), three (group 3) or four days of pill misses, to occur respectively on day 1 (group a), 6 (group b), 12 (group c) or 18 (group d) of a new 21 day cycle; supplementary contraceptive means were recommended. Four patients had no miss prescribed and served as controls. Ovarian function was evaluated with daily estrogen measurements (E1 + E2 enzymatic dosage, BioMérieux, France) and ultrasound examinations. When required, because of significant increase in estrogen or because of follicular growth detected on ultrasound, LH and progesterone were measured. None of the patients experienced a normal ovulation. Four patients (1 control, 1 from group 2a, and 2 from group 3a) had a significant increase in estrogen levels and had a follicular image on ultrasounds. One of them (group 3a) had a follicular rupture, but none had a LH surge or increase in progesterone.(ABSTRACT TRUNCATED AT 250 WORDS)
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The fetus and his environment which had remained, for so long, inaccessible to our exploratory techniques, is becoming every day, more and more accessible because of the various examinations now available. The biopsy of trophoblast which, after 10 weeks of amenorrhea, enable to obtain embryonic material and the tap of the umbilical chord under sonogram, permitting to obtain pure fetal blood after 18 weeks of amenorrhea, are an example of the new techniques which have completely modified the classical data of prenatal diagnosis. Now, the knowledge of parameters such as fetal haemostasis, immune status, metabolism and fetal karyotype, enabled the rapid development of fetal studies and already leads up to therapeutic procedures in utero.
A comparison of our results with those in the literature confirms that Bret's plastic operation on the uterus is valuable in the cure of septate uterus with two cavities in infertile patients who have had several spontaneous abortions. In spite of this it is advisable to take care to select cases and to be guided by the classical indications for plastic operation on the uterus. The number of abortions (more than 2) is the major criterion but it is often difficult to confirm that the infertility which results is due to the malformation and not to associated pathology. The problem is even more complex when it is a question of sterility rather than repeated abortions.
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