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Biomedical subjects

H Fernandez

Publications and source records attributed to H Fernandez.

At least 271 records · Page 15Linked to original sources
PubMed1988

Pregnancy and paroxysmal nocturnal hemoglobinuria.

Our study concerns eight pregnancies, six of which were successful, in four patients with paroxysmal nocturnal hemoglobinuria (PNH). Several complications of PNH during pregnancy were prevented: chronic anemia, folate and iron deficiency, and deep-vein thrombosis. During puerperium, acute hemolytic crises, most probably triggered by delivery, were observed in two patients. Thrombotic complications could be prevented by early initiation of an anticoagulant therapy after delivery. The only neonatal complication, observed in two cases, was isoimmune hemolytic anemia related to the multiple blood transfusions received before and during pregnancy. These results show that successful pregnancies are possible in women with PNH provided that both the obstetricians and physicians in charge monitor the pregnancies closely.

Adult↗
PubMed1988

Internal iliac artery ligation in post-partum hemorrhage.

Between 1978 and 1986, internal iliac artery ligation was performed on eight patients undergoing treatment for severe post-partum hemorrhage, and disseminated intra-vascular coagulation (DIVC) combined with causal pathology was detected in five patients. This procedure was effective in controlling bleeding in eight patients and no hysterectomy was necessary. Post-operative follow-up was uncomplicated in six patients. One patient suffered from post-operative occlusion. Another patient suffered from renal failure, due to secondary cortical renal necrosis. Surgery is usually simple and does not pose any technical problems. This technique allows for the conservation of the reproductive functions, and two of the women became pregnant at a later stage. Obstetric hysterectomy can be avoided by using this technique. It is recommended in cases where DIVC does not respond to medical treatment and can furthermore be used by all surgeons.

Adult↗
PubMed1988

LHRH agonists in IVF: different methods of utilization and comparison with previous ovulation stimulation treatments.

LHRH agonists are being increasingly used in ovulation stimulation protocols in IVF programmes. We have compared the results of two methods of utilization of LHRH agonists. In the long protocol, gonadotrophin stimulation was only commenced after a preliminary period of pituitary desensitization with LHRH agonist. In the short protocol, exogenous gonadotrophins were administered shortly after the start of LHRH agonist therapy, benefiting from the gonadotrophin flare-up effect. One-hundred-and-eighty-six patients were divided equally between the two treatments. There was no difference in the ovarian response on the day of HCG or the number of mature oocytes recovered. The cleavage rate of mature oocytes was higher in the short protocol (70, versus 56, P less than 0.01). The ongoing pregnancy rate per treatment cycle was similar in both groups (18, in the long protocol and 16, in the short protocol). Analysis of the luteal phases revealed a trend for higher progesterone values in the long protocol although this was only significant on the second day following oocyte retrieval. As the clinical results were similar other factors should be taken into account when deciding therapy. These include patient convenience, cost and side-effects. Other schedules of ovulation stimulation using LHRH agonists are discussed.

Female↗
PubMed1988

Mifepristone (RU486) and therapeutic late pregnancy termination: a double-blind study of two different doses.

An antiprogesterone, mifepristone (RU486), was administered to 35 patients undergoing a therapeutic interruption of pregnancy during the second and third trimester for maternal or fetal indications. A randomized double-blind study test was performed using 150 and 450 mg of mifepristone as pretreatment prior to prostaglandins. No toxicity or maternal morbidity were recorded. In three patients the onset of labour occurred spontaneously before prostaglandin administration. Mifepristone produced a modification in the consistency of the cervix with a statistical improvement in cervical calibration in the two groups, but the cervical effect was independent of the dose.

Abortifacient Agents↗
PubMed1988

[Cancer of the bile ducts and pregnancy. Apropos of a case].

The authors report a case of successful pregnancy 8 years after surgery and chemotherapy for biliary cancer with secondaries in the liver. The authors, in considering this case, have analysed the sequelae of chemotherapy for cancer on fertility. They discuss the need to preserve the ability to produce oocytes in young women who need treatment for cancer.

Adult↗
PubMed1988

[Maternal mortality caused by hemorrhage in developing countries. What policy is proposed?].

Maternal mortality in the third world is fifty to two hundred times higher than in developed countries. Haemorrhage following birth or abortion is one of the leading causes of maternal mortality and a specific analysis of this can clarify the problems. The incidence of maternal death by haemorrhage is not clearly documented and fluctuates between 6 and 90 per cent. Patients predicted to be at high risk for haemorrhage in the third trimester should be automatically referred for a higher level of medical care. In fact, many cases of haemorrhage cannot be predicted and death depends on the rate of blood loss and on the pre-existing anaemia. Better nurses' and mid-wives' training, better ante natal care, and the treatment of anaemia should decrease maternal mortality.

Developing Countries↗
PubMed1988

Spontaneous resolution of ectopic pregnancy.

Fourteen patients with ampullary tubal pregnancy confirmed by laparoscopy were initially managed conservatively. Serum human chorionic gonadotropin (hCG) levels were measured daily and strict clinical monitoring performed. In nine patients (64%), the tubal pregnancy spontaneously resolved. In four cases (29%), surgery was ultimately necessary. One patient with a coexistent intra- and extrauterine pregnancy was also successfully managed conservatively. There was a high probability of spontaneous resolution of the pregnancy when the serum hCG level at diagnosis was less than 1000 mIU/mL. Hysterosalpingography was performed after the spontaneous resolution of the tubal pregnancies. Tubal patency was demonstrated in all six patients, and three are currently pregnant. We conclude that conservative therapy allows spontaneous resolution of certain types of ectopic pregnancy.

Abortion, Spontaneous↗
PubMed1987

Uterine evaluation by microhysteroscopy in IVF candidates.

Over an eight-month period, microhysteroscopy was performed on 180 women, candidates for in-vitro fertilization (IVF). One hundred and two of them were suspected of having uterocervical pathology (group I), and 78 were not (group II). Group I had microhysteroscopic abnormalities in 60.8% and group II in 21.8%. Microhysteroscopy showed 30.6% of 36 positive hysterographies to be false positive and 37.5% of 144 negative hysterographies to be false negative, producing a confirmation rate of 63.9%. Admission to the IVF programme depended on microhysteroscopic normality. One hundred and one women were accepted directly, and 20 refused ('primary decision'). Fifty-nine were deferred with treatable hysteroscopic abnormalities, pending medical (22) and surgical (37) treatment, 14 via the microhysteroscope. Of the 59 women deferred, 51 were finally admitted and 8 rejected after a microhysteroscopic check ('secondary decision'). Finally, 152 of the 180 candidates (84.4%) were admitted. Microhysteroscopy helped to determine the optimal route for embryo transfer in 23 women with cervical pathology. Term pregnancy rates per embryo transfer were similar with hysteroscopic findings primarily normal, or normal after successful treatment (11.2 and 10.8% respectively). Microhysteroscopy seems useful for selection of cases for IVF, accurately determining utero-cervical pathology or normality, aiding in surgical correction of abnormalities and facilitating the process of embryo transfer. We suggest that microhysteroscopy should be performed routinely on all IVF candidates.

Adult↗
PubMed1987

[Marchiafava-Micheli syndrome and pregnancy].

Paroxysmal nocturnal hemoglobinuria (PNH) is an acquired clonal disorder characterized by sensitive populations of erythrocytes, granulocytes and platelets. PNH is a disease of young adults with a slight female predominance. Several complications of PNH during pregnancy, could be prevented; chronic anemia, folate and iron deficiency, deep vein thrombosis. We report seven pregnancies, six of which were successful in four patients. One pregnancy was terminated after 25 weeks by a fetal death during an acute hemolytic crisis. Diagnosis of PNH was made in the four patients before the pregnancy by the acidified serum lysis assay and the sucrose lysis assay. During puerperium, acute hemolytic crisis, most probably triggered by delivery, were observed in two patients. Thrombotic complications could be prevented by early initiation of an anticoagulant therapy after delivery. The only neonatal complication, observed in two cases was iso immune hemolytic anemia related to the multiple blood transfusions received before and during pregnancy. These results show that successful pregnancies are possible in PNH women when monitoring is especially close. To allow optimal fetal development, patients were transfused with saline-washed or frozen-thawed packed red-cells to prevent the precipitation of hemolysis, so that the hemoglobin level remained higher than 10 g/dl. During the whole pregnancy, patients had to be given dietary supplementation with folic acid and iron therapy whenever deficiency was demonstrated, under close surveillance of hemolysis. To prevent thrombotic complications during pregnancy, anticoagulant therapy was used if the patients had to be bedridden, or within 8 hours following delivery.

Adult↗
PubMed1987

[Idiopathic autoimmune thrombopenic purpura and pregnancy].

Immune thrombocytopenic purpura can no longer be considered as incompatible with pregnancy provided that close surveillance is undertaken. However, the main risk (a possible intracranial hemorrhage) persists in the newborn when severe thrombocytopenia due to the placental transfer of maternal IgG has occurred. None of the maternal parameters is predictive of the fetal thrombocytopenia or of its magnitude. A platelet count on fetal blood obtained by in utero or scalp sampling allows the choice between vaginal delivery or cesarean section, to limit the risk of intracranial bleeding. In most cases i.v. IgG infusion allows rapid correction of severe thrombocytopenia in the newborn.

Autoimmune Diseases↗
PubMed1987

[Value of RU 486 in failed terminations of pregnancy].

One of the complications of therapeutic termination of pregnancy is the complete retention of the embryo. The authors present four cases of repeated failure to evacuate the uterus associated with multiple fibroids or a malformation of the uterus. The use of RU 486 to soften the cervix and to allow it to dilate spontaneously made it possible in each case to aspirate the products completely. This action on the cervix of RU 486 could be used to make it easier to terminate early pregnancies up to the 12th week and particularly when there is associated uterine pathology.

Abortifacient Agents↗
PubMed1986

Ribavirin: a clinical overview.

Ribavirin, a broad spectrum, non-interferon-inducing virustatic chemotherapeutic agent, demonstrates activity against a wide range of RNA and DNA viruses, including the retrovirus known to cause the acquired immune deficiency syndrome. The drug's proposed mechanism of action, as well as pharmacokinetics are discussed, and preclinical toxicity, safety and clinical efficacy studies are presented. To date, the best success has occurred in the use of ribavirin to treat respiratory syncytial virus infection in infants and young children and to treat influenza A and B virus infections in young adults. Viral infections, particularly viral pneumonia, are often life-threatening in infants with severe combined immunodeficiency disease (SCID), and ribavirin aerosol has been used successfully to treat respiratory syncytial virus and parainfluenza virus infection of immunodeficient children. Special note is taken of ribavirin's clinical benefit in treating severe and life-threatening infections caused by the Lassa fever virus and the significant improvement over either the use of immune plasma or supportive therapy alone. Indeed, ribavirin thus emerges as the first antiviral drug that is able to reduce mortality in a highly lethal systemic disease by more than 90%. Additional studies demonstrate the drug's efficacy in acute viral hepatitis, herpesvirus infections, and measles. Controlled clinical trials are underway to test the drug in patients infected with the AIDS virus.

Clinical Trials as Topic↗
PubMed1986

Programmed oocyte retrieval during routine laparoscopy and embryo cryopreservation for later transfer.

Fixed-schedule ovulation induction and cryopreservation of the obtained embryos was performed in women undergoing a preliminary laparoscopy for infertility investigation before possible inclusion in an in vitro fertilization program. The cycle before follicular stimulation was modified by a progestogen or an estrogen-progestogen contraceptive pill. Ovarian inaccessibility precluded follicular aspiration in four of 34 patients but at least one oocyte was obtained in 29 of the remaining 30. Although fewer oocytes were obtained in these patients than in a control group undergoing in vitro fertilization treatment, one or more embryos were obtained in 22 patients in the study group. All embryos were frozen and to date 25 embryos from 17 patients have been thawed. Embryos have been placed in 16 of the 17 patients and six pregnancies have been initiated. Three are currently ongoing, one ectopic pregnancy was recorded, and two pregnancies were classified as "chemical." Programmed oocyte retrieval and embryo cryopreservation resulted in an extra chance of pregnancy in patients undergoing a laparoscopy for infertility investigation.

Adult↗
PubMed1986

[Autoimmune thrombopenia and pregnancy. Value of counting scalp platelets].

Fetuses of mothers who have auto-immune thrombocytopenia are at risk in utero of having transitory thrombocytopenia. There is no maternal biological test that can predict the numbers of platelets in the fetus. This count of platelet numbers can be estimated from taking fetal blood from the scalp at the onset of labour, and if the count is less than 50 X 10(9) per litre a caesarean operation is indicated. The authors report a series of 23 pregnancies where the mother had auto-immune thrombocytopenia and where fetal scalp blood sampling was indicated. This series has been compared with a previous series of 14 pregnancies where scalp sampling was not carried out. There was no case of severe fetal thrombocytopenia after scalp sampling was carried out and where the best way of delivery could be predicted early enough in each case. The ease of taking the sample and the safety and reliability of it for estimating the degree of thrombocytopenia in the fetus and thus deciding the method of delivery makes us believe that this method should be used more frequently in cases of maternal thrombocytopenia that appear late in pregnancy.

Autoimmune Diseases↗
PubMed1985

Development of the mature distribution of synapses on fibres in the frog sartorius muscle.

Most of the fibres in mature frog sartorius muscle possess two or more synapses separated by up to one-third the length of the muscle. The aim of the present work was to determine how the relative distances between these synapses changes during development in the frog (Limnodynastes tasmaniansis), as the fibres increase in length from 2 mm (stage 56) to 20 mm (1 year postmetamorphosis). At the earliest stage investigated (fibres 2.0-4.0 mm in length; stages 56-57) about 80% of the fibres were innervated at two endplates. The percentage of fibres with two endplates then remained approximately constant with further development. The polyneuronal innervation of endplates was almost eliminated by stage 57. Muscle fibres with two endplates had each situated on average about one-third the length of the fibre from a tendinous insertion; these relative positions did not change throughout development. Thus the distance between endplates increased linearly with an increase in fibre length. The size of terminals and the complexity of their branching also increased continually throughout development, independently of the location of the terminals on the fibres. The observations suggest that the distance between terminals increases during development because of the intercalation of new plasma membrane and basal lamina associated with the increase in length and diameter of fibres.

Aging↗
PubMed1985

[Epiphyseal points of the fetal knee. The impact of growth disorders on bone maturation].

The radiological appearance of bone maturity can be used as a criterion for fetal maturity. This examination with limited irradiation to the fetus is an alternative to amniocentesis. The practice of the latter is not without risk. The authors carried out 194 examinations of the contents of the uterus to look at the epiphyses of the knee between the 34th and 40th week of amenorrhoea. The found three groups: 1) those with normal development; 2) those with delayed development and 3) those with more advanced development. They did not find significant correlation between small-for-dates growth and bony maturity. On the other hand, where there was increased growth of the fetus in cases where maternal diabetes was excluded there was demonstrated that bony maturity accelerated with the presence of Béclard's point from the 34th week onwards. With such great variation in the dates of the appearance of points of ossification the presence of epiphyseal points in the knee cannot be taken as a criterion to establish fetal maturity nor the minimum duration of the pregnancy.

Birth Weight↗
PubMed1982

[Prediction of ovulation].

Predicting ovulation is the basis on which the fertile period is determined. When we carried out observations on 60 spontaneous cycles it was possible to detect with precision the discharge of LH which would produce ovulation by taking series of plasma levels of LH. The start is defined as the time when the level of LH becomes 180% greater than the mean level observed in the previous 24 hours. Ovulation occurs between 37 and 39 hours after this threshold has been crossed. The discharge of LH is the most constant criterion and the most precise one, and it does make it possible to work out the chronology of the events that precede ovulation. Ultrasound and estimation of levels of oestradiol in the plasma or in the urine do allow one to appreciate how the follicle is maturing.

Body Temperature↗