Biomedical subjects

H Fernandez

Publications and source records attributed to H Fernandez.

At least 55 records · Page 3Linked to original sources

PubMed2003

Successful management of a heterotopic Caesarean scar pregnancy: potassium chloride injection with preservation of the intrauterine gestation: case report.

Caesarean scar pregnancy (CSP), in which the pregnancy is located in the scar of a previous Caesarean section, is a rare situation that carries a high risk of uterine rupture. Improved ultrasound imaging allows early diagnosis of this condition, but there is no standard management. We report the first case of CSP associated with a normal intrauterine pregnancy. Potassium chloride administered under transvaginal ultrasonographic guidance terminated cardiac activity in the CSP. The CSP resolved, and a healthy infant was delivered at 36 weeks. When the diagnosis is early and the patient asymptomatic, surgery can be avoided, the CSP can be terminated selectively and the intrauterine pregnancy thereby preserved.

Adult↗

PubMed2003

Fertility and pregnancy outcomes following hypogastric artery ligation for severe post-partum haemorrhage.

BACKGROUND: Hypogastric artery ligation is a therapeutic option for severe post-partum haemorrhage. Little is known about the outcomes of subsequent fertility and pregnancy. We studied these parameters in women who required hypogastric artery ligation for severe post-partum haemorrhage in our institution over a 13-year period. METHODS: All patients who required hypogastric artery ligation for severe intractable post-partum haemorrhage from January, 1989 to April, 2001 were included. Data were retrieved from medical files and telephone interviews. RESULTS: A total of 68 patients required hypogastric artery ligation during the study period. Seventeen patients had 21 pregnancies with 13 term deliveries, two ectopic pregnancies, three miscarriages, and three abortions. Twenty-eight patients did not want a new pregnancy and one patient refused the interview. Twenty-three (34%) patients were lost to follow up. None of the patients suffered subsequent infertility and pregnancy was achieved in <12 months once planned. Pregnancy outcomes were normal. Fifty-four percent had vaginal deliveries. Three patients suffered a threatened post-partum haemorrhage that was easily treated medically. CONCLUSIONS: This is the largest reported series of pregnancies following hypogastric artery ligation. Hypogastric artery ligation for post-partum bleeding >1 l appears to be a safe procedure that does not impair subsequent fertility and pregnancy outcomes.

Adult↗

PubMed2003

Fertility and pregnancy outcome following pelvic arterial embolization for severe post-partum haemorrhage. A cohort study.

BACKGROUND: Pelvic arterial embolization is a safe, effective life-saving procedure in post-partum haemorrhage, but little information is yet available about its impact on menstruation and fertility. METHODS: A cohort of 28 women who underwent pelvic embolization for post-partum haemorrhage in our tertiary centre was studied. Patients were contacted by telephone to obtain long-term outcome for menstruation, clinical signs of estrogen insufficiency, desire for fertility and subsequent pregnancies. RESULTS: We found no menstrual abnormalities or signs of early menopause among the 17 patients we were able to reach. Six women expressed a clear desire for subsequent pregnancies. Five patients reported a total of six pregnancies (one biochemical pregnancy, one early miscarriage and four deliveries). The four patients with complete gestations gave birth to healthy babies, but post-partum haemorrhage recurred for all and led to two hysterectomies. No undesired pregnancies occurred. CONCLUSIONS: Embolization in post-partum haemorrhage appears to be a safe procedure that does not impair subsequent menstruation and fertility. Recurrence of severe post-partum haemorrhage may occur at subsequent deliveries.

Adult↗

PubMed2003

In vitro activities of ramoplanin, teicoplanin, vancomycin, linezolid, bacitracin, and four other antimicrobials against intestinal anaerobic bacteria.

By using an agar dilution method, the in vitro activities of ramoplanin, teicoplanin, vancomycin, linezolid, and five other agents were determined against 300 gram-positive and 54 gram-negative strains of intestinal anaerobes. Ramoplanin was active at or=256 microg/ml. Ramoplanin displays excellent activity against C. difficile and other gram-positive enteric anaerobes, including vancomycin-resistant strains; however, it has poor activity against most gram-negative anaerobes and thus potentially has a lesser effect on the ecological balance of normal fecal flora.

Acetamides↗

PubMed2003

[Sonographic diagnosis of ectopic pregnancy: optimal strategy?].

AIM AND METHODS: The diagnostic algorithms of ectopic pregnancy (EP) include sonographic procedures. Diagnostic sensitivity is low because the procedure is operator-dependent and each clinical aspect of EP is variable. We analyzed results of standardized ultrasound procedures performed within the framework of a detailed analysis of clinical findings. RESULTS: The sonographic procedure must be performed within the framework of an overall analysis including laboratory results (hCG level), examination of the decidua, localization of the corpus luteum, and careful detailed examination of adnexa. Hematosalpinx is pathognomonic of EP and is observed in 80% of cases. When diagnosis is doubtful, a second ultrasound procedure should be performed 48 hours later before undertaking laparoscopic diagnosis. CONCLUSION: The diagnostic sensitivity of ultrasonography has been consistently high in published series, undoubtedly because the studies were performed in referral centers highly experienced in diagnostic ultrasound.

Adnexa Uteri↗

PubMed2003

[Diagnosis of ectopic pregnancy: endometrial biopsy or diagnostic hysteroscopy].

OBJECTIVES: Define indications for endometrial biopsy and diagnostic hysteroscopy in ectopic pregnancy diagnosis. Define the indication of endometrial biopsy and diagnostic hysteroscopy in ectopic pregnancy diagnosis. MATERIALS AND METHODS: This prospective study included 15 women with a poorly localized pregnancy (ectopic or intrauterine localization not identified at ultrasound) who had an abnormal HCG curve and low progesteronemia. RESULTS: In 8 patients, an empty cavity was identified at diagnostic hysteroscopy and the endometrial biopsy was negative. In 2 patients hysteroscopy was non-contributive (pregnancy and intra uterine device with blood in the cavity) and the endometrial biopsy was negative. In 3 patients who had an early abortion hysteroscopy and endometrial biopsy demonstrated villosities. Finally, in 2 patients who had an early abortion hysteroscopy identified villosities and endometrial biopsy was non-contributive. The sensitivity and specificity of hysteroscopy for the diagnosis of EP was 100% but the sensitivity of endometrial biopsy was 50% with a specificity of 100%. CONCLUSION: If pregnancy cannot be correctly localized at ultrasonography, hysteroscopy appears to be better than endometrioal biopsy to discriminate between EP and early abortion.

Biopsy↗

PubMed2003

[Methotrexate administration in the treatment of unruptured tubal pregnancy. Prospective non-randomized study: intramuscular injection versus transvaginal sonography-guided injection].

OBJECTIVES: The aim of this study was to compare in a prospective non-randomized study, the efficacy of two methods of administering methotrexate (MTX) in the treatment of ectopic pregnancy (EP): transvaginal injection under sonographic control or intramuscular injection (IM). METHODS: Patients with EP who met specific inclusion criteria for medical treatment were treated by MTX: 73 patients (group 1) were treated by IM and 47 patients (group 2) by transvaginal local injection. MATERIALS AND METHODS: In group 1,50 mg/m(2) of MTX was injected intramuscularly; in group 2,1 mg/kg of MTX was injected transvaginally into the ectopic sac under sonographic guidance. Choice of the route depended on the physician's experience. RESULTS: The overall success rate, defined by a normal post-treatment hCG level (<10 mUI/mL) was 71.4% in group 1 versus 91.5% in group 2 (p<0.01); for patients with hCG levels<2,000 mUI/mL, 83% and 96% respectively (not significant); for patients with hCG 2,000 mUI/mL, 37.5% and 86.4% respectively (p<0.01). CONCLUSION: For medical treatment of EP, the efficacy of MTX is greater when administered by local transvaginal injection than by IM injection. We propose local treatment whenever the EP can be punctured, especially when hCG levels are 2,000 mUI/mL.

Abortifacient Agents, Nonsteroidal↗

PubMed2003

[Fertility after ectopic pregnancy: 10-year results in the Auvergne Registry].

OBJECTIVES: The purpose of this work was to study the fertility after ectopic pregnancy (EP) according to the type of contraception at the time of EP (none, IUD, other) and treatment (medical, conservative surgical, radical). MATERIAL AND METHODS: Ten-year Auvergne EP registry data were analyzed (1626 women, among whom 741 tried to become pregnant again). Fertility was characterized by the time to a new pregnancy and its outcome (EP recurrence, intrauterine pregnancy (IUP)). The censored data methodology was used. RESULTS: The rate of recurrence was much higher in women who had a IUD at the time of EP than in women without contraception. The opposite trend was observed for IUP (the rate of IUP was 1.7-fold higher in women who had a IUD at the time of EP). The rate of recurrence doubled in women treated medically. The rate of IUP was significantly lower in women given conservative treatment than in women given radical treatment. CONCLUSION: Contraception at the time of EP must be considered when studying subsequent fertility. The increase in rate of recurrence following medical treatment observed in the present study should be confirmed by others in search for an explanation. Our results point out the need for control trials on EP treatment, and provide data for planning such trials.

Adult↗

PubMed2003

[Quality of life instruments for women with pelvic organ prolapse].

OBJECTIVES: Our goal was to develop quality of life questionnaires in French for women with pelvic organ prolapse. MATERIAL AND METHOD: From two questionnaires previously developed for prolapse and validated in English, the Pelvic Floor Distress Inventory and the Pelvic Floor Impact Questionnaire, we have developed two questionnaires in French, the Inventaire des Symptômes de Prolapsus (ISP) and the Questionnaire sur l'Impact du Prolapsus (QIP). The ISP assesses symptom distress in women with pelvic floor disorders and measures how much these symptoms bother women. The QIP assesses life and emotional impact. These questionnaires were constructed after a double translation, a double expertise and patient interviews. A complete cross-validation into French is currently unfeasible due to cost considerations. RESULTS: The ISP and QIP questionnaires assess urinary, colorectal-anal and vaginal symptoms in relation to pelvic floor disorders. Both questionnaires significantly correlated with urinary and colorectal-anal symptoms. The main advantage of these instruments is the use of scales, with separate simple score for each scale. CONCLUSION: Based on two previously validated English questionnaires, the PFDI and the PFIQ, we have developed the first quality-of-life instruments in French for women with pelvic organ prolapse, the ISP and the QIP.

Fecal Incontinence↗

PubMed2003

[Myasthenia gravis and pregnancy. Report on 13 cases].

OBJECTIVES: To evaluate our experience of myasthenia during pregnancy. MATERIALS AND METHODS: Retrospective study in a tertiary care university hospital including pregnant women affected by myasthenia gravis and who delivered in the obstetrical tertiary center. Medical and delivery reports were analyzed. RESULTS: Between 1994 and 2002, 12 women, age 31 (25-36), delivered 14 children. One women delivered twice, and there was one twin pregnancy. Clinical symptoms of myasthenia worsened in five. One was admitted twice to the intensive care unit during her pregnancy. Two were admitted to intensive care unit during the first month of post-partum. Gestational age at birth was 39.3 weeks (38-40.6), all birth weights were normal: 3329 g (2660-4520). Six women delivered vaginally, two by instrumental extraction and five by cesarean section. Apgar score was normal for all infants: 9/10. The level of anti-acetylcholine receptor antibodies (anti AchR) was high: 36.4 nM/L (0-46.8) (normal below 0.6 nM/L), but was not related to neonatal outcome. Three children presented neonatal myasthenia. CONCLUSION: We recommend obstetrical monitoring in tertiary centers for pregnant women with myasthenia gravis because of the risk of neonatal myasthenia. Measurement of anti-acetylcholine receptor antibodies may be useful. Pediatric and maternal observation is necessary in the first days of post partum.

Adult↗

PubMed2003

[New concepts on pathophysiology, diagnosis and treatment of adenomyosis].

Adenomyosis is a relatively frequent disease, difficult to diagnose and which pathophysiology remains unknown. The treatment for the women which want to conserve or improve their fertility remains not well defined. Endovaginal ultrasonography seems to be as effective as MRI for the diagnosis of adenomyosis. Gn-RH agonist decreases symptoms and uterine volume; however, the symptoms reappear after discontinuation of agonist therapy, and side effects limit their prolonged use. Progestérone receptor modulators, anti-progestative and danazol or levonorgestrel-releasing intra-uterine system have been used as therapeutic modalities for adenomyosis, but the lack of controlled studies make their efficacy difficult to quantify. Some women with superficial adenomyosis may theoretically benefit from hysteroscopic myometrial or endometrial resection, but these procedures would be limited to women not wishing to conceive. Laparoscopic myometrial electrocoagulation or excision has proven to be effective but pregnancy following these techniques poses special problems, particularly the increased risk of uterine rupture. Transvaginal ultrasonography can successfully diagnose adenomyosis. Medical and conservative surgical treatments are already available.

Biopsy↗

PubMed2002

C-reactive protein should accelerate the diagnosis of bowel injury after gynecologic surgery.

STUDY OBJECTIVE: To search for a marker that could aid in earlier diagnosis of bowel injury after gynecologic surgery. DESIGN: Retrospective case study with prospective controls (Canadian Task Force classification II-2). SETTING: University hospital. PATIENTS: Fourteen women with bowel injuries and 50 controls with no postoperative complications. MEASUREMENTS AND MAIN RESULTS: Bowel injury occurred in 14 (2.4/1000) of 5901 gynecologic procedures. Of these, eight were recognized intraoperatively and treated immediately. In six women C-reactive protein levels were markedly increased (>100 mg/L) relative to control patients (p <0.0001). CONCLUSION: Systematic postoperative assessment of C-reactive protein in patients at high risk for bowel injury may help identify this complication earlier in the postoperative period.

Adult↗

PubMed2002

[Home birth: opinion of French women and perinatal risk. Results of the French overseas departments 2000 survey].

OBJECTIVES: This study has two objectives: firstly, to find out what are the women's views about home birth, and secondly to perform a review of the perinatal risk associated with home birth. PATIENTS AND METHODS: A questionnaire was sent to 121 women in three maternity hospitals and a Medline search was performed using the following keywords: home delivery, hospital delivery, risk factor, perinatal transfer. RESULTS: Fifty two percent of these women think that home delivery "should or could be offered" (group I), 22% think that it "should never be offered" (group II); finally 26% "do not know" whether it should or not be offered (group III). The level of maternity care, educational standards, nationality, parity, annual income, age, location of the place of residence, do not modify the rate of women belonging to group I. Thirty four percent of women who have heard about complications happening during delivery think that home delivery "should never be offered" while 13% of women who have never heard of complications during delivery stated that it should never be offered (p = 0.024). Even if it is not significant the number of women belonging to group II increases with educational standards and maternal age. Most women believed that hospital delivery is safer, more restful, that pain relief is better, but also stated that it is more impersonal than home delivery. CONCLUSION: In this study more than one out of two women believed that home delivery "should or could be offered". Nevertheless, 22% stated that home delivery "should never be offered". The level of opposition to home delivery seems to increase with the level of information about potential obstetrical complications. A study should be designed to confirm this statement. The analysis of perinatal risks related to home delivery shows that two conditions should be fulfilled in order to allow home delivery: a careful selection, with validated risk factor, to eliminate high risk pregnancies, and clear and complete information on the small but real risk of perinatal transfer.

Demography↗

PubMed2002

Sites of ectopic pregnancy: a 10 year population-based study of 1800 cases.

BACKGROUND: Several risk factors for ectopic pregnancy (EP) have been identified, but the site of implantation of EP has been little studied. METHODS: A total of 1800 surgically treated EP was registered between January 1992 and December 2001 in the Auvergne EP register and the women concerned were followed up. In this large population-based sample, we studied the distribution of EP sites, immediate complications, determining factors, and subsequent fertility. RESULTS: EP sites were interstitial (2.4%), isthmic (12.0%), ampullary (70.0%), fimbrial (11.1%), ovarian (3.2%) or abdominal (1.3%). No cervical pregnancies were observed. Complications and treatment depended on the site of EP. In multivariate analysis, the only risk factor associated with EP site was current use of an intrauterine device (IUD), which was more frequent in distal EP. The 2 year cumulative rate of subsequent spontaneous intrauterine pregnancy (IUP) increased progressively from interstitial to ovarian EP. Fair concordance (weighted kappa = 0.31) was observed between the sites of two successive EP if they were homolateral. CONCLUSION: In addition to providing an accurate description of the sites of implantation of EP, this study shows that current IUD use 'protects' against interstitial pregnancies, which are the most difficult to manage. It shows that subsequent fertility tends to be higher in women with distal EP.

Adult↗

PubMed2002

[Functional results of the TVT procedure: a postal questionnaire on 144 patients with a median follow-up of 20 months].

UNLABELLED: Introduction. The TVT procedure has been changed the surgical treatment of stress urinary incontinence (SUI). The aim of this study was to collect the patient's point of view. MATERIAL: and METHODS: The TVT procedure was performed to treat SUI on 144 consecutive women in our institution between May 1998 and December 2000. We have sent a postal questionnaire to all patients in order to determine subjective results on SUI and post-operative voiding difficulties. RESULTS: We have obtained 124 responses (86.1% of patients). The median follow-up was 20 months +/- 12 (range 8 to 38 months). The patients were "very satisfied" in 56.5% (n=70), "satisfied" in 34.6% (n=43) and "unsatisfied" in 8.9% of cases (n=11). The functional discomfort about SUI was, on a 0 to 10 visual analog scale, 7.5 +/- 2 preoperatively and 2.2 +/- 2.8 post-operatively. Only 13.7% of patients have SUI postoperatively, and then 86.3% are considered cured. Nevertheless, voiding difficulties are common after this procedure with 31.5% of patients complaining about dysuria. On 96 patients who had had mixed incontinence preoperatively, 45.8% (n=44) complaining about persistent urge symptoms. On 28 patients who had had pure SUI, 28.6% (n=8) complaining about de novo urge symptoms. CONCLUSION: The TVT procedure is an efficient treatment of stress urinary incontinence, but with numerous post-operative voiding difficulties. This conclusion justify a precise pre-operative information to the patients.

Female↗

PubMed2002

[Cystocele repair by the vaginal route with a tension-free sub-bladder prosthesis].

OBJECTIVE: To describe a new vaginal approach for the repair of cystoceles, reinforced with a tension-free polypropylene mesh. METHODS: The vaginal procedure consisted of a complete dissection of the cystocele and a thorough entry from the vesicovaginal space under the inferior pubic ramus into the retropubic space. The polypropylene mesh (GyneMesh(TM), Gynecare, Ethicon France) was placed from the retropubic space to the inferior part of the bladder in a tension-free fashion. RESULTS: Forty-eight consecutive women with grade 3-4 cystoceles underwent this procedure between October 1999 and September 2001. Mean age was 63.9 years (41-85). Mean follow-up is 18 months (8-32). The success rate was 97.9%. There were a total of four vaginal erosions of the mesh (8.3%). There were no postoperative infections of the mesh. CONCLUSION: The vaginal repair of severe cystocele reinforced with a tension-free polypropylene mesh is a simple and reproducible technique, with high success rate and low morbidity.

Adult↗

PubMed2002

[Peri-hepatitis abscess secondary to pelvic peritonitis].

OBJECTIVE: To report the case of a 42-year-old patient referred for exploration of a tumor of the right flank and evidence of inflammation. MATERIAL: and methods. Ultrasonography and computed tomography showed a liver mass associated with a heterogeneous adnexal mass. Serum CA-125 was elevated and ovarian cancer with liver metastasis was suspected. An alternative diagnosis was salpingitis complicated by Fitz-Hugh-Curtis syndrome in this patient wearing an intra-uterine contraceptive device. RESULTS: Exploratory laparoscopy was performed and confirmed the diagnosis of salpingitis complicated by an ovarian abscess and Fitz-Hugh-Curtis syndrome with rare abscess formation. Outcome was favorable after adapted antibiotic treatment. CONCLUSION: Fitz-Hugh-Curtis syndrome can take on an atypical aspect and should be entertained as a possible diagnosis in young women presenting pain of the right flank and fever.

Acute Disease↗

PubMed2001

[Hysteroscopic resection of submucous myomas: long term results].

STUDY AIM: To evaluate the follow-up after operative hysteroscopic resection of submucous leiomyomas. PATIENTS AND METHODS: Between January 1990 and December 1996, 200 patients underwent operative hysteroscopic resection of 289 uterine leiomyomas. Indications were: menometrorrhagia (n = 159), postmenopausal metrorrhagia (n = 22), infertility (n = 19) as sole etiology. Sixteen patients had infertility and menometrorrhagia. RESULTS: The mean follow-up was 33.4 +/- 19.2 months. Twenty-three patients were lost to follow-up. Due to the large size of the leiomyomas, 35 patients had 2 or 3 resections and a total of 241 hysteroscopic resections were performed. Twelve complications (5%) occurred without death or need for intensive care. An improvement of clinical symptoms was observed in 74% of patients. The predictive factors of failure were: size (> 5 cm), number of intracavitary leiomyomas (> 3), hysterometry (> 12 cm), intramural myoma class 2 and association of leiomyomas. Eight of the 35 infertile patients subsequently became pregnant, but with only two live births (5.8%). CONCLUSION: Hysteroscopic myomectomy appears to be safe, effective and reproducible for the treatment of menstrual disorders. Intramural class 2 and larger leiomyomas constitute the limits of the endoscopic technique.

Adult↗