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Biomedical subjects

F Puech

Publications and source records attributed to F Puech.

At least 91 records · Page 5Linked to original sources
PubMed1996

[Myasthenia and pregnancy. Two case reports].

OBJECTIVE: Assess obstetrical care in rare cases of pregnant women with myasthenia. METHOD: Two personal cases led to a brief recall of the disease process and the literature and an assessment of proposed optimal care. RESULTS: Both pregnancies were carried to term without aggravation of the myasthenia. According to the data in the literature, pregnancy has a variable effect on myasthenia (1/3 stability, 1/3 improvement, 1/3 aggravation). The risk of decompensation during expulsion is great and the patient's efforts should be limited, although cesarian section is not required (excepting classical surgical indications). Peridural anaesthesia is not required (excepting classical surgical indications). Peridural anaesthesia is recommended because it reduces patient fatigue and facilitates instrumental extraction. Nursing is authorized except in case of severe episodes with a major rise in antibody levels. Pre-eclampsia was reported in only 5 cases: both maternal and fetal risk is high in such cases requiring intensive care. Fetal risks include rare neuro-muscular disease in which prognosis is poor and in 15 to 20% of the cases, neonatal myasthenia. CONCLUSION: Myasthenia is an autoimmune disease rarely occurring in young women of childbearing age. Care for pregnant women with myasthenia requires close collaboration between the different specialists.

Adult↗
PubMed1996

[Pregnancy after hepatic transplantation: what is the maternal risk?].

OBJECTIVES AND METHODS: We report 7 pregnancies which occurred from 1988 to 1995 in 5 women who underwent liver transplantation. The immunosuppression regimen associated cyclosporine, azathioprine and prednisone. RESULTS: Mean age at conception was 25. During pregnancy, cholestasis occurred in 2 women. None of the patients experienced rejection. An increase in serum creatinine was observed in 3 cases. Serum uric acid increased in the third trimester of pregnancy in 6 cases, associated with arterial hypertension in 3 cases. In 4 cases, toxemia led to premature delivery. Seven childbirths occurred between the 34th and 38th week of gestation, by vaginal delivery (n = 3) or caesarean section (n = 4). Newborn weights ranged from 1,350 g to 3,100 g. A favorable outcome was observed in all mothers, with a follow-up ranging from 2 months to 7 years after delivery. CONCLUSION: These results suggest that a successful pregnancy is possible after liver transplantation in young women with normal hepatic function and treated with cyclosporine. The risk of toxemia is mainly related to renal function before pregnancy.

Adult↗
PubMed1996

[Intestinal obstruction and pregnancy].

Occlusion, a rare condition during pregnancy, occurred at 38 weeks gestation in a 26-year-old patient due to volvulous of the sigmoid on a dolichomegacolon. The diagnosis was made on the basis of the clinical manifestations and coloscopy evidence. Prognosis depends more on severity to the occlusion than on its association with pregnancy.

Adult↗
PubMed1996

[Prenatal diagnosis of three caudal regression syndromes associated with maternal diabetes].

We report three cases of caudal regression syndrome diagnosed in utero. Caudal regression syndrome (CRS) is a rare condition associating vertebral agenesia and urinary and digestive tract malformations. Pathogenesis is not clear but, as in our three cases, the CRS is often associated with poorly controlled maternal diabetes. Antenatal ultrasound examinations may reveal the disease in major forms with a non-viable foetus. In our 3 cases, a femoral "V" was associated with sudden interruption of the spine. Minor forms may not be recognized until childhood. Prognosis depends essentially on the extent of spinal involvement and associated malformations. Sirenomelus was considered for many years to be the most severe form of caudal regression, but recently acquired evidence suggests that these two conditions are separate entities.

Adolescent↗
PubMed1996

[Appendicitis and pregnancy. Seven case reports].

OBJECTIVES: Determiner optimal diagnosis and therapeutic management of pregnant women with suspected appendicitis. METHOD: Among over 9,000 patients who delivered in our obstetrics ward over a 4-year period, 7 (1/1, 285) underwent appendectomy during their pregnancy. Based on these observations and a review of the literature, an attempt was made to determine the best diagnostic approach in this rare situation. RESULTS: The frequency observed here was in agreement with data reported in the literature (1/1,000 to 1/2,000). Premature delivery occurred eight days after appendectomy at 29 months gestation in one woman. There was no complication in the 6 other pregnancies. Positive diagnosis, difficult during pregnancy, was based on clinical, biological and echographic findings. Laparoscopy improved not only diagnosis but also treatment and prognosis before 20 weeks gestation. CONCLUSION: Clinical presentation of appendicitis is modified during pregnancy rendering diagnosis difficult. The gravity of the appendicitis as well early diagnosis and management influence the maternal and fetal prognosis more than its association with pregnancy.

Adult↗
PubMed1996

[In utero fetal death in multiple pregnancies during the second and third trimesters. A series of 21 cases].

OBJECTIVE: Recall the maternal and fetal risks in multiple pregnancies with in utero death during the second and third trimester. METHODS: From january 1, 1984 through December 31, 1994 21 cases of in utero death occurred among 405 multiple pregnancies followed in our unit. The frequency and circumstances of maternal and fetal complications were established according to type of placenta implantation, etiology, term at death of the twin and delay from death to delivery. RESULTS: The rate of in utero death was 5.2%. Various etiologies were observed, but the main cause was intra-uterine growth retardation. Maternal complications were marked by moderate asymptomatic disorders in hemostasis which resolved rapidly. Fetal complications included premature delivery (20/25 infants) and multicystic encephalopathy in one surviving twin. In monochorial pregnancies there is either tromboplastin release or hypotension-hypoxia phenomena which lead to neurological lesions. CONCLUSION: Fetal prognosis depends essentially on the type of placenta implantation. The most severe fetal complications are caused by neurological damage occurring in monochorial pregnancies. Screening for this anomaly is difficult, limiting the antenatal evaluation to the prognosis of the surviving twin. In bichorial pregnancies, and even more so in monochorial pregnancies. It is important to prevent premature delivery and maintain regular obstetrical care. The ultrasound-Doppler examination is the key to follow-up in pregnancy.

Adult↗
PubMed1996

[Internal version and breech extraction of the second twin. A series of 35 cases].

OBJECTIVES: Identify indications and assess results of internal version followed by breech extraction. Evaluate fetal and maternal prognosis. METHODS: A retrospective study of 35 cases of ionternal versions followed by primary breech extraction of the second twin performed between 1 January 1986 and 31 December 1994, were analysed and compared with data in the literature. RESULTS: There were 2 failures requiring cesarean extraction of the second twin. There were no maternal complications other than minor bleeding at deliver in 3 who did not require transfusion. Obstetrical trauma was observed in 3 cases with no sequelae. Five infants were referred to the prematurity unit and 9 to the infant intensive care unit due to consequences of prematurity. In six cases nitroglycerin used as a uterine relaxing agent was associated with spinal analgesia thus avoiding general anesthesia. CONCLUSION: Internal version is the only alternative (together with external version) to cesarean, allowing rapid delivery of the second twin in breech position. Maternal prognosis is excellent and fetal prognosis is good if contraindications are avoided.

Breech Presentation↗
PubMed1996

[Uterine leiomyosarcomas: a surprising pathology. Review of the literature. Six case reports].

OBJECTIVE: The aim of this study was to determine the clinical features and laboratory tests which define a population with a high risk of leiomyosarcoma. METHOD: A retrospective analysis of 660 hysterectomies performed between 1989 and 1994 was conducted. There were 414 cases of leiomyoma and 6 leiomyosarcomas (1.4%). RESULTS: The indication for hysterectomy was complication of fibromyomatous uterus in all cases. Diagnosis of leiomyosarcoma was never suspected before surgery and the pathology examination. Complimentary radiotherapy was given in 2 patients among the 6 with leiomyosarcoma. Mean survival was 35 months. There were no cases of recurrence or metastasis. None of the laboratory tests performed provided clues to diagnosis. CONCLUSION: Physicians should be aware of possible misdiagnosis of a leiomyosarcoma when proposing medical treatment of uterine fibroma.

Adult↗
PubMed1996

[Infarction and pregnancy. Review of the literature. A case report].

UNLABELLED: BUT: Assess risk factors and pathogenesis of myocardial infarction in young women and evaluate cardiologic and obstetrical management of myocardial infarction during pregnancy as well as assess the prognosis of pregnancy in patients with a prior myocardial infarction. METHODS: Fra a personal observation of pregnancy after myocardial infarction, we reviewed the literature on two distinct themes: myocardial infarction during pregnancy and pregnancy after myocardial infarction. RESULTS: Pregnancy was deliberately authorized in a 21-year-old who had myocardial infarction 3 years earlier. The pregnancy was uneventful and cesarean section with epirual analgesia at 37 weeks gestation delivered a healthy 2,350 g boy. Unfortunately the patient died at her home 18 month later. Acardiac cause was retained although death due to ventricular rhythm disorder or recurrent myocardial infarction could not be confirmed due to lack of an autopsy. The prognosis of pregnancies after myocardial infarction would not appear to be catastrophic although this case raises some doubts as to whether pregnancy should be authorized in these patients. The major difference in mortality according to whether the infarction occurs before or during pregnancy would suggest that risk might be reduced by a haling period after the infarction. CONCLUSION: It appears that pregnancy in women with a prior myocardial infarction would be possible if sufficient precautions are taken. All situations increasing cardiac work should be avoided. Stress and pain must be avoided during delivery and the post-partum period. Intensive cardiological and obstetrical supervision supervision are required for correct management of the pregnancy.

Adult↗
PubMed1996

[Gamstorp's disease and pregnancy. A case report].

Gamstorp's disease or hyperkaliemic periodic paralysis is a rare pathology leading to spells of generalized hypotonia due to hyperkaliema. It is hard to say how far pregnancy affects the course of the disease and what is the impact of the disease on pregnancy. We report a case of Gamstorp's disease during pregnancy and we insist on the fact that because it can be crippling during its acute phases, close surveillance is needed during pregnancy. Screening for malignant hyperthermia should be carried out. During labour, kaliemia level should be monitored repeatedly and the expulsion phase kept as short as possible if necessary by forceps delivery.

Adult↗
PubMed1996

[May-Heggelin anomaly and pregnancy. A case report, review of the literature].

The May-Hegglin anomaly is a rare autosomal dominant platelet disorder characterized by thrombocytopenia, giant platelets and existence of crescent-shaped inclusions within the cytoplasm of granulocytes, eosinophils and monocytes (Döhle body). We report a case of May-Hegglin anomaly associated with a pregnancy. The pregnancy and delivery were uneventful. The child is not a carrier of this hematologic anomaly. Nine cases of complicated pregnancies with this anomaly have been reported in the literature. The risks of maternal hemorrhagic accident during pregnancy and during delivery are weak due to the fact that platelets functions are preserved. The same applies to the fetus. Nevertheless, as in the case of maternal autoimmune thrombocytopenic purpura, most reports advice performing a fetal platelet count on fetal blood sampling before birth to decide upon the mode of delivery. The risk of the cordonal approach to perform fetal blood sampling must be balanced against the small fetal hemorrhagic risk and most authors propose to allow normal delivery whilst avoiding all traumatic instrumental extraction, especially the use of vacuum extractor.

Adult↗
PubMed1996

[Cord prolapse. Review of the literature. A series of 50 cases].

OBJECTIVES: Identify the role of cord prolapse in modern obstetrics by estimating the frequency of this obstetrical accident, its conditions, prognosis and treatment and by analyzing factors favoring development of cord prolapse. METHOD: From a retrospective study of 50 observations of cord prolapse occurring in the department of obstetrics from January 1985 to June 1994. Results were compared with those reported in the literature. RESULTS: The frequency of cord prolapse was 0.21% over the 10-year period. Cesarean section was required in 72% of the cases, and obstetrical manoeuvers were used in some of the vaginal deliveries (28%). Neonatal mortality was 20/1000. Predisposing factors were breech presentation, prematurity, twin pregnancy and multiparity. CONCLUSION: Despite much progress in obstetrics, the frequency of cord prolapse has not changed over time. The consequences are not as lethal as in the past, because of progress in diagnosis and neonatal resuscitation. Fetal prognosis remains however severe.

Adult↗
PubMed1995

Prenatal diagnosis of metatropic dwarfism.

We present a case of prenatal diagnosis of severe metatropic dysplasia at 20 weeks' gestation. The characteristic prenatal features of this rare autosomal recessive chondrodysplasia appear to be significant dwarfism with an enlarged head and a narrow thorax associated with enlargement of the hands and feet, and the radiographic 'dumb-bell' appearance of the long bones.

Adult↗
PubMed1994

SCID-Hu mouse as a model for human lung HIV-1 infection.

HIV induces a multi-organ infection with a dual tropism for both lymphocytes and monocytes/macrophages. The lung is a target both for HIV infection and HIV-related opportunistic infections. The SCID mouse has provided the opportunity to develop a small animal model for HIV infection. However, HIV-1 infection of the human fetal thymus and liver (SCID Liv/Thy) implanted in these mice occurred only after direct intraimplant injection of HIV-1 and the resultant HIV-1 infection was restricted to the human thymus. Here we report that human foetal lung can develop in SCID Liv/Thy mice resulting in the development of normal human alveolar and bronchiolar lung compartments which can be productively infected with cell-free HIV-1 virus, leading to a systemic and bifocal infection. This SCID-Hu model should be useful for studying AIDS physiopathology, human viruses with lung tropism and for helping to define gene therapy protocols in lung human cells in vivo.

Acquired Immunodeficiency Syndrome↗
PubMed1994

[Evaluation and surveillance of blood pressure during pregnancy].

Despite a large body of literature or hypertension in pregnancy, there still is no recognized prognosis factor for this frequent and severe disease. Management still relies on clinical features (occasional blood pressure measurements, weight curve) and appropriate tests including fetal and maternal echodoppler, urinary uric acid, 24 h proteinuria and fetal heart rate monitoring. Recent developments including self measurement and ambulatory monitoring of blood pressure have helped improve follow-up and therapeutic management in high risk pregnancies. By repeating the measurements, these techniques require more intensive medical follow-up and an adapted therapy near the term of pregnancy. They do not however provide a means of predicting outcome or recurrence of preeclampsia. These techniques have effectively been shown to reduce the number and duration of hospitalizations.

Blood Pressure Determination↗