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Biomedical subjects

F Puech

Publications and source records attributed to F Puech.

At least 73 records · Page 4Linked to original sources
PubMed1997

Consecutive successful pregnancies in a combined liver and kidney transplant recipient with type 1 primary hyperoxaluria.

Pregnancy is now a common, but high-risk event, in young women who have received transplants. Consequences to the fetus are known, but pregnancy may also interfere with graft function. We report the outcome of two successive and successful pregnancies in a 29-year-old woman with type 1 hyperoxaluria, who received a combined liver and kidney transplant. Two healthy children were born at 35 and 37 weeks of gestation, with low birth weight. Liver function remained normal before, during, and after pregnancies up to 52 months after transplantation. Renal function was impaired before the first conception, worsened during both pregnancies, and returned to the previous level in both immediate postpartum periods. However, renal function has declined 17 months after the last delivery. This report shows the feasibility of successive pregnancies in multiple organ transplant recipients, but raises the question of long-term maternal kidney graft survival.

Adult↗
PubMed1997

Pregnancy after myocardial infarction and a coronary artery bypass graft.

The authors report a pregnancy in a 34 year old patient who previously experienced a myocardial infarction. The pregnancy ended at 39 weeks in the birth of a healthy girl weighting 3040 g, by cesarean section under epidural anesthesia. A review of the literature revealed 33 similar cases, 16 of which were adequately documented.

Adult↗
PubMed1997

Recombinant tissue type plasminogen activator treatment of thrombosed mitral valve prosthesis during pregnancy.

PURPOSE: Prosthetic heart valve thrombosis occurring during pregnancy is a life-threatening complication. Surgical treatment requires clot removal under cardiopulmonary bypass (CPB) and carries a high mortality. We describe the successful use of thrombolytic therapy for recurrent thrombosed valve prosthesis in a pregnant patient. CLINICAL FEATURES: A 32-yr-old patient whose pregnancy was complicated by two episodes of a thrombosed St Jude mitral prosthesis is reported. The first episode occurred at 20 wk of pregnancy during the change of oral anticoagulant therapy (acenocoumarol 4 mg a day) to sc heparin. As the patient was in cardiogenic shock, the valve thrombus was treated by clot removal under CPB., with a cross clamp time of 32 min, a perfusion pressure above 70 mmHG. There was no fetal cardiac rhythm during CPB which lasted < 45 min. The second episode occurred at the 28th gestational week in a patient in cardiogenic shock and because reoperation was thought to carry too high a risk, the thrombus was successfully treated with 50 mg recombinant tissue plasminogen activators (rtPA) i.v. Following this, the course of pregnancy was uneventful and carried to term and the patient delivered vaginally. Pain relief was achieved with intravenous patient-controlled analgesia with alfentanil (bolus 100 mug; lock out = five minutes). Although rtPA has been used before, this is the first report in which pregnancy was carried to term and standard vaginal delivery performed. CONCLUSION: This case provides evidence for the efficacy and relative safety of rtPA as thrombolytic therapy in the treatment of haemodynamically compromised valve heart thrombosis in pregnancy.

Acenocoumarol↗
PubMed1997

The use of intravenous nitroglycerin for cervico-uterine relaxation: a review of the literature.

The safety, predictability, and ease of intravenous administration of nitroglycerin (NTG) have been firmly documented. In recent years, intravenous NTG has come to the attention of the obstetrician as a potent uterine relaxant. Intravenous nitroglycerin has been used to relax the uterus during manual extraction of retained placenta and to permit replacement of a contracted, completely prolapsed, inverted uterus. The use of this agent as a tocolytic has previously been reported in cesarean delivery of twins, in cases of intra partum external cephalic version, and for internal intrapartum podalic version of the second twin. This new procedure was also used for fetal head entrapment after vaginal breech delivery. The authors report a review of the literature about this subject.

Breech Presentation↗
PubMed1997

Myotonic dystrophy and pregnancy. A report of two cases and a review of the literature.

Myotonic dystrophy is a rare disease (1/8000), that is rarely associated with pregnancy, due to the fact that parents carrying the disease often encounter hypogonadism. Myotonic dystrophy is a neuro-endocrinian 'heredo-degenerative' dystrophy, with dominant autosomic transmission. Its association with pregnancy can lead to several problems. The myotony is often aggravated which leads to obstetrical complications turning into fetal loss, premature term delivery, hydrops, in-utero death, difficulties in expulsion, haemorrhage during delivery and/or anaesthetic accidents. The following signs during the pregnancy can diagnose fetal damage: presence of a hydrops, rare active fetal movements, and low fetal cardiac rhythm. They signify serious fetal damage leading to a diagnosis of myotonic dystrophy. Personal and family antecedents as well as an important hypotony and respiratory distress discovered in the new born are equally evocative elements. In congenital cases (6-30% of the time) the prognosis of the child is pessimistic. For all of the above elements, transmission is of maternal origin. The diagnosis of the congenital form is difficult because the disease is often unknown by the mother. The appearance of molecular tools permits a diagnosis to be formed much more rapidly in a new-born suspected to carry the illness of neonatal Steinert. Two observations illustrate this pathology. The occurrence of congenital myotonic dystrophy in a new-born allows us to diagnose the disease within the mother.

Adult↗
PubMed1997

[Panorama of uropathies discovered during the prenatal period. 147 cases].

OBJECTIVES: The aim of this study was to establish the panorama of uropathies discovered during the antenatal period and to analyze the explorations performed. Pregnancy outcome and infant prognosis was also recorded. METHOD: Ultrasonographic imaging revealed dilatation in 62.5% of the cases, parenchymal anomalies in 26.3% and unilateral or bilateral agenesia in 11.2%. The percentage of abnormal karyotypes was 4.76% for all urorenal symptomatologies. These abnormal karyotypes corresponded to 10% of those performed in 17 fetuses, urine puncture was used in order to assess in utero renal function. There were 113 live births, 31 medically termined pregnancies and 3 spontaneous abortions. Among the 113 live infants, 12 died during the post-natal period. Thirty-two infants were considered to be normal and 69 had an urorenal malformation, including 2 infants with pre-end-stage renal failure at 4 and 3 years. CONCLUSION: It is uncommon to discover an urorenal malformation at prenatal ultrasonography. The main problem is antenatal management and evaluation of prognosis. Urine puncture and in utero derivation are discussed. When no other reliable factors affecting fetal prognosis are available, puncture of fetal urine provides useful information for management although the technique remains under debate.

Abortion, Therapeutic↗
PubMed1997

[Pregnancy in women with a mechanical heart valve. Review of the literature].

AIM: To define therapeutic ways to manage obstetrics at an optimal level for a patient carrying a mechanical prosthetic heart valve. METHOD: From a review of literature and documented cases, we propose an obstetrical and cardiological management scheme for pregnant patients carrying a mechanical prosthetic heart valve. We deal successively with the preventive (anticoagulation) and curative treatment (surgery and thrombolytic therapy) of valvular thrombosis, in fact, a severe -but unfortunately frequent- complication of these pregnancies. RESULTS: Pregnancy concerning patients with mechanical prosthetic heart valves is a high-risk pregnancy. In fact, the risk of thrombo-embolic accidents even with a closely followed anticoagulant treatment seems to come from the existence of the prothese, the state of physiological hypercoagulation and peri-partum hemorrhages. Naturally, multidisciplinary follow-up is indispensable. The prescription of anticoagulant treatments must respect the main principals and the normal counter-indications in order to minimise maternal and fetal complications. CONCLUSION: Pregnancy amongst patients carrying mechanical prosthetic heart valves should be considered rare and highly exceptional cases, from a cardio-vascular surgeon's point of view. For obstetricians, it is sometimes difficult to forbid pregnancy to a nullipara. The discussion whether to authorize a pregnancy will be treated case-by-case, holding into account the socio-cultural environment of the patient, as the principles of an anticoagulant treatment and the underlying risks must be well understood.

Anticoagulants↗
PubMed1996

Brachmann-de Lange syndrome: pre- and postnatal findings.

Brachmann-de Lange syndrome (BDLS) is a well-delineated and relatively common syndrome. However, prenatal diagnosis has never been reported, even if in some cases ultrasonography demonstrated one or more manifestations of the syndrome. We report on 3 cases: in the first 2 cases, prenatal ultrasonography demonstrated some signs of the condition. The third represents, to our knowledge, the first prenatal diagnosis of BDLS. We also present a review of the literature concerning pre- and postnatal findings in this syndrome.

Abortion, Spontaneous↗
PubMed1996

Obstetric patients treated in intensive care units and maternal mortality. Regional Teams for the Survey.

OBJECTIVE: To ascertain the frequency of serious diseases in pregnant women. STUDY DESIGN: A population based survey was performed in France. The cases were all the women admitted for treatment in intensive care unit (ICU). The severity of the cases was measured with the simplified acute physiology score (SAPS) the lethality and the rate of still birth. RESULTS: 435 obstetric patients were included. The estimated frequency of severe diseases was 310 S.D.36 per 100,000 live births. The most frequent diagnose that motived admission in ICU was hypertensive diseases. The lethality rates differed greatly between specific disorders. The lethality rate was lower when scheduled maternity was located in a teaching hospital. CONCLUSION: Regarding these results it appears that the majority of obstetric patients with severe diseases are referred to suitable care, but a small proportion of women who had to change their type of care registered a significant higher lethality.

Female↗
PubMed1996

Intravenous nitroglycerin for intrapartum internal podalic version of the second non-vertex twin.

OBJECTIVE: Authors report their experience of intravenous nitroglycerin as uterine relaxing agent for managing successfully internal podalic version of the second twin. METHODS: From a retrospective study including nine observations of internal podalic version of the second non vertex twin performed with administration of intravenous nitroglycerin, between August 1994 and February 1996, authors compare their results with those reported elsewhere. RESULTS: Two failures of internal podalic version with nitroglycerin have been observed. But one failure is not considered to be due to the NTG: it was a patient, who had a panic attack necessitating a general anesthesia for sedative purpose. The internal podalic version succeeded. The true failure of NTG needed an emergency cesarean due to acute fetal distress and a non relaxing uterus. One internal podalic version was complicated by hemorrhage. The intravenous NTG used to induce uterine atonia associated with epidural-analgesia to relief pain avoiding general anesthesia makes internal podalic version easier. CONCLUSION: Our results confirmed those already reported. That intravenous nitroglycerin (NTG) injection induces a transient and prompt uterine relaxation required for internal podalic version without affecting maternal and fetal prognosis.

Female↗
PubMed1996

Thymocyte and thymic microenvironment alterations during a systemic HIV infection in a severe combined immunodeficient mouse model.

OBJECTIVE: A new model for systemic and multifocal HIV-1 infection was developed in severe combined immunodeficient (SCID) mice to study the alterations of thymocytes and of the thymic microenvironment that occur during a disseminated HIV infection. DESIGN AND METHODS: We grafted SCID mice with the classical human fetal thymus/liver co-implants together with fragments of autologous lungs (SCID-huLLT). These organs achieved normal differentiation and were productively infected after an intraperitoneal inoculation of two HIV-1 primary isolates. At time of sacrifice, thymic biopsies and thymic cell suspensions were analysed by immunohistochemistry, flow cytometry and lymphocyte function assays. RESULTS: At weeks 2-4 post-inoculation we observed the following thymocyte abnormalities: a minor to severe depletion of the immature CD1+CD4+CD8+ T cells (range, 0-73% thymocytes), compared with the persistence of mature CD4+ cells (11-50%) and amplification of CD8+ T cells (6-92%). The immature subset depletion was inversely related to the thymic HIV-1 viral load, suggesting the preferential infection of this subset. The residual mature thymocytes were functional as assessed by their sustained proliferative responses to CD3-triggering which contrasted with the lack of HIV-specific cytotoxic activity. A quantitative analysis of immunostained thymic sections revealed a disorganization and a densification of the thymic epithelial cells (TEC) network which occurred in all HIV-infected SCID-hu mice independently of the thymic CD1+CD4+CD8+ T-cell depletion. CONCLUSION: These results suggest that a systemic HIV infection induces in human thymuses from SCID-huLLT mice a preferential depletion of the immature thymocytes in the absence of mature CD4+ T-cell depletion, HIV-specific cytotoxic T-lymphocyte activity or thymic epithelial cell death, but is associated with dysplasia of the thymic microenvironment, and is therefore opening new perspectives for studying immune cell reconstitution strategies in HIV infection.

Animals↗