Biomedical subjects
Publications and source records attributed to F Leroy.
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Recent studies have clearly demonstrated that preemptive renal transplantation is associated with better graft and patient survival. It improves the quality of life and is a cost-effective option compared to conventional transplantation. We report our experience with this concept and review the literature. We retrospectively analyzed all adult kidney transplantations performed in our center between March 1986 and May 2004: among 463 renal transplantations 44 were preemptive (9.5%). Mean follow-up was 45.7 +/- 6 months in preemptive versus 62.3 +/- 2.6 months in the other group. At the end of the study, graft survivals were 93.2% and 77.1%, respectively (P = .02). Patient survival rates were similar in both groups. In the preemptive group, grafts were more likely to come from living donors (P < .001) and cold ischemia time was shorter (P = .02). A subgroup case-control study showed that cost saving for dialysis in the preemptive group was about 119,000 Euros per patient. More preemptive patients had professional activity before (P = .0002) and after transplantation (P = .02). Our results and data from the literature support the place of preemptive transplantation as the optimal mode of renal replacement therapy for medical and socioeconomic reasons.
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Dialysis efficiency can be increased while shortening the duration of the treatment by the use of highly permeable dialysis membranes, larger surfaces, and higher blood and dialysate flows. However, vascular repletion of water and solutes, compared with the amount removed by rapid dialysis, is a limitation of short dialysis. This can be overcome by ultrashort daily dialyses, preferably performed by the patient alone. A safe, efficient, and user-friendly apparatus has been developed to permit Ultrashort Daily Auto Dialysis (UDAD).
To evaluate the potential of a new in vivo confocal Raman microprobe, we undertake a pilot study in human skin. A fiber optic probe is operated with a 633-nm laser and trials are conducted in healthy volunteers. We examine changes in molecular composition and structure of the stratum corneum, from different volunteers, from different anatomical sites and skin layers. Main spectral variations are detected in the following regions: 800 to 900 cm(-1) (amino acids); 1200 to 1290 cm(-1) (proteins); and 1030 to 1130 cm(-1), 1300 to 1450 cm(-1), and 2800 to 2900 cm(-1) (lipids). Curve fitting of the amide 1 region performs in detail protein secondary structural variations of the amide 1 band. Protein conformation is also found to vary depending on the anatomical site and volunteer. Similar analysis of the 730- to 1170-cm(-1) spectral window reveals a different organization of lamellar lipids: gel for forearm and palm, and liquid-crystalline phase for fingertips. All these variations result from changes in the stratum corneum components such as natural moisturizing factor (NMF), lipids (namely ceramides), and water. Hierarchical clustering classification is also performed to sort out Raman data obtained from different subjects. Further improvement of the confocal probe would be to adapt a 360-deg configuration enabling access to other anatomical sites.
A pathologic investigation was conducted on 100 placentas collected from pregnancies resulting from in vitro fertilization (IVF) and intrauterine embryo transfer (ET), including 70 singleton pregnancies, 20 twin pregnancies, and 10 multiple pregnancies complicated by the vanishing twin (VT) phenomenon (n = 5) or artificially reduced (n = 5). These results were compared with those for 70 spontaneous spontaneous singleton and 20 spontaneous twin pregnancies. In cases of singleton pregnancies, the incidence of abnormal placental shapes was significantly different (P < .025) in the IVF group compared to controls. A significant (P < .005) difference was also observed between these groups in terms of umbilical cord insertion. The mean distance between the cord insertion and the closest placental margin was significantly (P < .001) shorter among IVF singleton pregnancies (3.19 +/- 1.83 versus 4.62 +/- 2.23 cm). In cases of twin pregnancy, no difference was found between IVF and spontaneous pregnancy in the incidence of pregnancy complications and distribution of cord insertion. First-trimester bleeding was the only clinical sign of the disappearance of an embryo in multiple pregnancies complicated by the VT phenomenon and was not observed in multiple pregnancies artificially reduced. The present findings support the hypothesis that marginal cord insertion is secondary to oblique orientation of the blastocyst at the nidation. A larger trial is now required, analyzing the placental features from IVF pregnancies in relation to the etiology of infertility.
To determine the procedural variables associated with eventual long term angiographic success in patients with recurrent restenosis, we compared two successive PTCAs on the same segment, in the same 16 patients, where the first led to recurrent restenosis but the second to successful long term angiographic result. A long interval since previous PTCA and low inflation pressure are associated with long term success after repeated PTCA; other procedural variables are not linked with long term outcome. This study may help us to predict long term success after a repeated angioplasty procedure.
A new test developed to characterize the bending properties of treated or virgin hair fibers is described. The device consists of a pendulum that bends a sample made up of 39 parallel hair fibers at each swinging stroke. Hair bending stiffness can be assessed by the number of strokes observed until the pendulum stops. The mechanical behavior of natural hair fibers is related to their geometric characteristics. The effects of various hair treatments can be assessed by this method.
In recent years different types of micromanipulation have become available to improve human gametes interaction, particularly in cases of severe sperm defect. Direct injection of one spermatozoon into the cytoplasm of the egg has not been applied in man, not only because of technical difficulties and low efficacy, but also in view of the theoretical risk of chromosomal anomalies. However, subzonal sperm injection (SUZI) and partial zona dissection (PZD) are now used routinely by a number of IVF centers. In our hands this latter method has increased significantly the fertilization rate (21.6 vs 2.9 p.cent among intact oocytes) and has allowed to obtain 3 pregnancies (of which 2 ongoing) after 28 attempts. Our results and those of the literature are discussed with respect to the risks and advantages linked to these techniques.
As elsewhere in Europe, the origins of Belgian obstetrics are related to the double rivalry between medical doctors and surgeons on the one hand and between surgeons and midwives on the other hand. Extension of obstetrical teaching in our regions has been hampered because of political turmoil resulting from the successive territorial dominations by Spain, Austria, France and Holland. In this evolution, the organisational sanitary model emerging from the French revolution exerted a prominent influence namely through creation of the subordinate grade of "Health Officer" and the suppression of local medical colleges as well as of the sole existing university faculty of medicine. These factors explain the poor quality of obstetrics which has prevailed on our soil until 1815.
The Napolean defeat at Waterloo entailed drastic changes of health services in our regions. Under the new Dutch rule, many different medical grades were put in use making the pertinent legal rules very difficult to apply. At Belgian independence, the Free University of Brussels was founded including a Faculty of Medicine of which the clinical infrastructure was mainly the Saint-Pierre Hospital located at the Hal Gate. In 1880, provincial schools for midwives were established while operative obstetrics remained in the hands of general surgeons. At Brussels, medical students rightly complained about the poor training of general practitioners in obstetrics. Until the first third of the XXth century, the vast majority of deliveries took place at home under the supervision of a midwife. A consultant surgeon was called upon only if deemed indispensable.
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OBJECTIVE: To evaluate the effect of in vitro culture on zona pellucida resistance in mouse oocytes and embryos. METHOD: Zona pellucida resistance was assessed by comparing duration of zona lysis in the presence of alpha-chymotrypsin. The effects of artificial or physiological conditions of development were evaluated by comparing embryos in vitro with those left to reach the same stage of development in vivo. RESULTS: The time required for zona lysis of oocytes increased after 2, 24, and 48 hours in vitro (P < .001). The same observation holds true for oocytes left in vivo during 24 hours. Fertilization both in vivo and in vitro induced a major increase in zona resistance. At the two-cell stage, in vitro culture did not harden the zona pellucida. At the morula stage and beyond, enzymatic lysis was slightly longer in vitro as compared to that of similar stages recovered from the genital tract. CONCLUSIONS: Our data indicate that in vitro culture conditions do not modify zona hardening in oocytes and only slightly increased zona resistance from the morula stage on.
An IgG anti-F1 Enzyme linked immunosorbent assay (Elisa) has been developed for plague diagnosis in the Malagasy republic. The sensitivity of the test was 91.4% and the specificity 98.5%. This technique is cheap and the cross reaction with other infections diseases prevalent in Madagascar is very limited. During the urban plague outbreak (Mahajanga city, 1995), the positive predictive value and the negative predictive value were 95.2% and 97% respectively. During this outbreak, the usefulness of the Elisa test for retrospective individual serodiagnosis was confirmed. Furthermore, the test confirmed plague among suspect patients without bacteriological diagnosis. The test was used for a sero-epidemiological study. Eight villages in the endemic area were investigated and 900 persons were studied. The overall seroprevalence was 6 times the officially prevalence of plague, notified at the Central Plague Laboratory. A large disparity of the seroprevalence was observed in the endemic area, with variation from < 1.5% to 15.5%. A high incidence of asymptomatic infections due to Yersinia pestis was found.
OBJECTIVE: To characterize a subpopulation of complicated cases of ovarian hyperstimulation syndrome (OHSS). METHOD: Descriptive retrospective study. RESULTS: 0.75% of our IVF-ET population suffered from OHSS. Among this group, 33% did not exhibit any recognized risk criteria of OHSS in terms of infertility characteristics and ovarian response to exogenous gonadotrophins. Only severe (ascites) OHSS cases were considered (n = 5) in this study. Previous IVF-ET attempts had been uneventful and during the complicated trial, estradiol peak levels and numbers of oocytes retrieved remained below 2,500 pg/mL (conversion factor to SI unit, 3.671) and 10, respectively. In all cases, the luteal phase was supplemented by hCG and all patients became pregnant. A threshold level of exogenous and/or endogenous hCG seems to be responsible for the occurrence of OHSS. CONCLUSION: One-third of the patients developing an ovarian hyperstimulation syndrome after IVF-ET had not previously shown risk criteria. A causal role of exogenous and/or endogenous hCG is suggested.