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Biomedical subjects

H Fernandez

Publications and source records attributed to H Fernandez.

At least 73 records · Page 4Linked to original sources
PubMed2001

Operative transvaginal hydrolaparoscopy for treatment of polycystic ovary syndrome: a new minimally invasive surgery.

OBJECTIVE: To evaluate a new minimally invasive surgery for treatment of the polycystic ovary syndrome (PCOS) in clomiphene-resistant infertile women. DESIGN: Prospective study. SETTING: University teaching hospital. PATIENT(S): Thirteen clomiphene citrate-resistant anovulatory women with PCOS. INTERVENTION(S): Operative transvaginal hydrolaparoscopy (THL) using a coaxial bipolar electrode. MAIN OUTCOME MEASURE(S): Feasability, ovulation rate, and pregnancy rate. RESULT(S): Ovarian drilling was performed by THL in all patients; no surgical complications occurred. Mean (+/-SD) duration of follow-up time was 6.3 +/- 3.3 months. Six patients recovered to have regular ovulatory cycles. Six pregnancies occurred; three were spontaneous, two occurred after stimulation and intrauterine insemination, and one occurred after IVF. The cumulative pregnancy rate was 33% at 3 months after THL and 71% at 6 months after THL. No miscarriages occurred. CONCLUSION(S): Transvaginal hydrolaparoscopy with ovarian drilling using bipolar electrosurgery appears to be an alternative minimally invasive in patients with PCOS who are resistant to clomiphene therapy.

Adult↗
PubMed2001

Balloon replacement of fetal membranes to facilitate emergency cervical cerclage.

BACKGROUND: Emergency cerclage can be used in cases of cervical incompetence, even when fetal membranes bulge through the dilated cervix. To facilitate the procedure we used a balloon device to replace the fetal membranes. TECHNIQUE: With the patient in a steep Trendelenburg position, after epidural anesthesia, the fetal membranes were replaced into the uterine cavity with an inflated balloon of the type used for endoscopic preperitoneal dissection. Cervical cerclage was done by the McDonald technique. EXPERIENCE: We have done 25 emergency cerclages with this technique. The following maternal and perinatal outcomes were assessed retrospectively: age, medical history, gestational age at inclusion and delivery, cervical dilatation at admission, preterm rupture of membranes, clinical or histologic chorioamnionitis, birth weight, admission to the neonatal intensive care unit, neonatal death, and postnatal course. CONCLUSION: Replacing prolapsed fetal membranes with an inflated balloon is a convenient technique that allows gestation to be prolonged for an average of 31 days. Cerclage was feasible when the cervix was widely dilated (more than 4 cm); it was associated with prolongation of gestation by a median of 9 days.

Emergencies↗
PubMed2001

Simultaneous bilateral tubal pregnancy after intracytoplasmic sperm injection treated by conservative medical treatment. Interest of sonographic follow-up.

We describe a case of early bilateral tubal pregnancy diagnosed by transvaginal ultrasonography after intracytoplasmic sperm injection (ICSI) and embryo transfer (ET). A follow-up by transvaginal sonography was done with a systematic second scan (5 days) after the first diagnosis of left tubal ectopic pregnancy in case of assisted conception procedure. This follow-up sonographic strategy permitted us to perform a conservative treatment for this case of spontaneous bilateral tubal pregnancy by two consecutive (left then right) in-situ methotrexate injections under vaginal ultrasonographic guidance without any complications.

Adult↗
PubMed2001

Neonatal group B streptococcal infection. Results of 33 months of universal maternal screening and antibioprophylaxis.

OBJECTIVE: To assess the efficacy and pitfalls of a protocol of generalized screening for group B Streptococcus (GBS) and intra-partum treatment of all carriers in a clinical setting. DESIGN: A descriptive study and comparison with an historical group. SETTING: A tertiary perinatal center. POPULATION: All women attending prenatal care in our center and delivered after 37 weeks were eligible. Study period ranged from January 1994 to September 1996. Comparison group consisted in deliveries of years 1992 and 1993. METHODS: Vaginal cultures were performed at 36 weeks on non-selective medium followed by intra-partum treatment of all carrier mothers. Rate of carriage, incidence of neonatal GBS sepsis, influence of risk factors and the reasons for failures were analysed. Comparison was made with an historical group. Statistical analysis was performed using a Chi-square test. RESULTS: There were 5374 term deliveries during the study. 3906 were screened (72.7%) and 559 of them found positive for GBS (14.3%). We observed 46 early-onset GBS diseases (0.86% of term-births). 43.5% of infections occurred in babies born from mothers without risks factors at delivery. Negative GBS cultures at sampling accounted for 43.5% of protocol failures. Comparison of the incidence of early-onset GBS disease with the previous two years showed a significant drop (1.45-0.86%, P<0.05). CONCLUSIONS: Our protocol revealed feasible and effective in reducing the incidence of early-onset GBS disease. Improvements must be studied particularly as to the predictive value of screening cultures.

Amoxicillin↗
PubMed2001

Management in intractable obstetric haemorrhage: an audit study on 61 cases.

OBJECTIVE: To refine the indications of bilateral hypogastric artery ligation (BHAL) and angiographic selective embolisation (ASE) in intractable obstetric haemorrhage. DESIGN: an audit study. SETTING: Tertiary care university hospital. POPULATION AND METHODS: Retrospective analysis of 61 cases of obstetric intractable post partum haemorrhage (PPH) initially managed either by hysterectomy or a conservative approach in a tertiary referral centre between 1983 and 1998. Procedures were reviewed as a primary (P) or secondary (S) attempt to arrest the haemorrhagic process. RESULTS: Ten hysterectomies (5 P, 5 S), 49 BHAL (48 P, 1 S) and 9 ASE (8 P, 1S) were successfully performed in arresting the haemorrhagic process. There were 7 maternal deaths, 5 following hysterectomy and 2 following a conservative approach. Atony of the uterus was the main cause of haemorrhage (n=21) and genital tract laceration was associated with the worst prognosis. Time-elapse between delivery and surgery appears to be the main prognostic factor. Nine patients became pregnant 1 to 4 years later following a conservative approach. CONCLUSIONS: ASE seems to be indicated in haemodynamically stable patients with birth canal trauma or uterine atony and clotting anomalies. BHAL is indicated when haemorrhage occurs after a cesarean section or when the patient is haemodynamically unstable. BHAL should be taught to Junior doctors in an attempt to decrease the number of patients transferred in tertiary referral centers for intractable PPH. This might also decrease the number of hysterectomies in intractable PPH.

Adult↗
PubMed2001

Pneumothorax complicating laparoscopic-assisted vaginal hysterectomy.

Right pneumothorax occurred 2 days after laparoscopic-assisted vaginal hysterectomy. The mechanism was most likely CO2 diffusion from pneumoperitoneum through a diaphragmatic defect. It is essential to be aware of this rare complication because of its late onset after the surgical procedure.

Adult↗
PubMed2001

[Hysteroplasty for enlargement: apropos of the results].

The DiethylstilBbestrol (DES) is a synthetic estrogen which was prescribed from 1941 onwards for the prevention of miscarriage. As well as a possible risk of cancer, another side effect of this treatment was the possible of abnormality of the genitalia in the female issue of the prescribed user. Apart from possibly having a hypoplasic uterus, the patient is also prone, in the case where she has an undersized uterus, to having a much narrower than normal cavity. Consequently there is a tendency for an excess of muscle tissue on the uterus walls. This can be observed on an RMN. The most significant characteristics of this abnormality are: constriction rings around the proximal uterine segment, a T shaped uterus, uterus with an arched based. The idea of the plastic enlargement operation is to widen the cavity by making careful incisions on the excess muscle tissue located on the uterus wall. The objective of this is to obtain a triangular shaped cavity taking care though not to weaken the walls themselves. 51 patients were treated. We observed 31 pregnancies (49%) after 16 months with 25 ungoing pregnancies. Generally the anatomic results are excellent but it's difficult to measure the functional results or the success rate in future pregnancies. The reason for this is the enlarging of the cavity alone does not guarantee successful fertility. There are other problems to take in to account e.g. implantation, miscarriage and premature labor. There are risks with this operation: placenta percreta, a possible rupture of the uterus, though this can happen at any time with DES patients. This operation can only be recommended once a thorough examination of the patient has been made. It is not advisable with a patient who has a hypoplasic cavity in a hypoplasic uterus (hysterometry < 4 cm). This operation should never be done as a first course of action but it can be recommended above all if the patient has a constriction ring: as a sole reason for infertility; where infertility has been diagnosed and unsuccessfully treated; and an unexplained failure of ART, and where the patient has unexplained repeated miscarriages.

Abnormalities, Drug-Induced↗
PubMed2001

Haemodynamic changes and vasopressin release are not consistently associated with carbon dioxide pneumoperitoneum in humans.

BACKGROUND: Conflicting haemodynamic changes, suggested to be caused by vasopressin release, have been reported during carbon dioxide (CO2) pneumoperitoneum. However, peritoneal stimulations including open surgery cause both a systemic vasopressor response and a vasopressin release, which are suppressed by opiate administration. Also, a decreased venous return of blood to the heart causes vasopressin release. Furthermore, previous haemodynamic assessments of laparoscopic surgery have been conducted using various anaesthetic regimens, which are likely to have caused various haemodynamic effects. We hypothesised that intraoperative haemodynamic and/or humoral changes would not be observed in association with laparoscopic surgery provided that, (a) normovolaemia is continuously maintained using transoesophageal echocardiographic (TEE) assessment, and (b) adequate depth of general anaesthesia is continuously maintained by bispectral index (BIS) monitoring and high plasma Ievel opiate administration. METHODS: Twenty ASA 1 women undergoing laparoscopic surgery received 10 ml. kg-1 lactated Ringer's solution and thereafter were randomly allocated to receive intraoperatively either 8 ng. ml-1 or 4 ng. ml-1 plasma remifentanil concentrations while BIS was maintained at 50+/-5 by isoflurane alteration. The group receiving 4 ng. ml-1 remifentanil was used as control. Expired CO2 was maintained within a 32-38 kPa range throughout the investigation. Complete TEE haemodynamic investigation was performed before pneumoperitoneum (PP) (T1), and during PP horizontal (T2), with a head-up tilt (T3), with a head-down tilt (T4), horizontal (T5), and PP released (T6). Plasma vasopressin, epinephrine and norepinephrine levels were measured at T1, T3, and T6. ANOVA, Student's t-test and Mann-Whitney U-test were used for statistical analysis. RESULTS: Haemodynamic indices and humoral values did not change significantly within and between remifentanil groups throughout the investigation (all P<0.05). CONCLUSION: Continuous adequate depth of anaesthesia and normovolaemia may have prevented both a humoral and a haemodynamic response, initiated in the peritoneum by the contact with CO2 in previous investigations.

Adult↗
PubMed2001

Tubal curettage: a new conservative treatment for haemorrhagic interstitial pregnancies.

Haemorrhagic interstitial pregnancies are commonly treated by cornual resection. This invasive procedure may increase the risk of uterine rupture in subsequent pregnancies. We report here a case of a haemorrhagic interstitial pregnancy, associated with a viable intrauterine pregnancy in a salpingectomized woman, which was treated successfully by curettage of the uterine cornu.

Adult↗
PubMed2001

Hysteroscopic resection of submucosal myomas in patients with infertility.

BACKGROUND: Submucosal myomas are associated with infertility, and may be treated by hysteroscopic resection. Improvement of the menstrual pattern after surgery has been examined and compared with pregnancy rate in a group of menorrhagic women with primary (n = 24) and secondary (n = 35) infertility. METHODS: The entire patient group (n = 59) was managed between January 1990 and September 1998. The submucosal myomas were intracavitary (n = 15), intramural class 1 (n = 34) and intramural class 2 (n = 10), and none was multiple submucosal myoma. The mean (+/- SD) age was 36.6 +/- 4.6 years; mean myoma size was 24.5 +/- 13.3 mm; mean duration of the procedure was 40 +/- 23 min; and mean follow-up was 26 +/- 18.8 months. Thirty-five patients had one or more associated infertility factors. RESULTS: An improvement in clinical symptoms was observed in 62% of patients. Sixteen patients (27%) conceived, and of these only six (10%) delivered at term. The pregnancy rate was significantly better when myoma was the exclusive aetiology of infertility (41.6%), and when the lesion was >/=50 mm in size (57.1%). CONCLUSIONS: Hysteroscopic myomectomy appears safe, and is effective in the control of menstrual disorders. However, the effect on infertility seems limited, particularly in terms of delivery rate. The advanced age of the patients may partly explain these results.

Abortion, Spontaneous↗
PubMed2001

Comparative in vitro activity of ertapenem and 11 other antimicrobial agents against aerobic and anaerobic pathogens isolated from skin and soft tissue animal and human bite wound infections.

We studied the comparative in vitro activity of ertapenem, a new carbapenem, against 240 aerobic and 180 anaerobic recent clinical bite isolates using an agar dilution method and an inoculum of 10(4) cfu/spot for aerobes and 10(5) cfu/spot for anaerobes. Ertapenem inhibited 410/420 (98%) of the isolates tested at < or = 4 mg/L with only 4/5 Campylobacter gracilis and 1/3 Campylobacter rectus strains requiring . or = 16 mg/L for inhibition. Ertapenem was only moderately active (MIC 8 mg/L) against 4/6 Enterococcus faecalis and 1/11 Staphylococcus epidermidis strains. All Pasteurella multocida, Pasteurella septica, Pasteurella canis, Pasteurella dagmatis, Moraxella spp. and EF-4 isolates were inhibited at < or = 0.015 mg/L. MIC(90)s for other aerobic genera and species were as follows: Corynebacterium spp., 4 mg/L; Staphylococcus aureus, 0.25 mg/L; Staphylococcus epidermidis, 4 mg/L; other coagulasenegative staphylococci, 0.25 mg/L; Streptococcus milleri group, 0.5 mg/L; Eikenella corrodens, 0.03 mg/L; and Bergeyella zoohelcum, 0.5 mg/L. For anaerobes the range of MICs and MIC(90)s were: Prevotella ssp., < or = 0.015-0.5, 0.125 mg/L; Porphyromonas spp., < or = 0.015-0.03, 0.015 mg/L; Fusobacterium spp., 0.015-0.125, 0.03 mg/L; Bacteroides tectum, 0.03-0.125, 0.125 mg/L; and Peptostreptococcus spp., 0.01-2, 1 mg/L. Ertapenem showed excellent potency against the full range of animal and human bite wound pathogens.

Animals↗
PubMed2001

Evaluation of the quality of care for severe obstetrical haemorrhage in three French regions.

OBJECTIVE: To determine what factors related to health services in France might explain substandard care of severe morbidity due to obstetric haemorrhage. DESIGN: Retrospective questionnaire survey. SETTING: Three administrative regions of France. POPULATION: All women who were pregnant or had recently given birth during the year before the survey. METHODS: A European survey (MOMS-B) defined severe haemorrhages as blood loss > or = 1500mL. A specific questionnaire was added in France to analyse the quality of care of these haemorrhages. The survey was carried out in three different administrative regions: Champagne-Ardenne, the Centre and Lorraine. An expert committee was appointed and began by establishing a framework for qualitative assessment. One hundred and sixty-five cases of severe haemorrhage were reviewed and classified into one of three levels of care: appropriate, inadequate or mixed. Inadequate care and 'mixed' care were both considered substandard. The 165 cases were coded and then studied with uni- and multivariate analysis (logistic regression with SAS and SPSS software). RESULTS: Of the 165 cases identified, 51% (85/165) were vaginal, 19% (31/165) operative vaginal, and 30% (49/165) caesarean. The leading cause of haemorrhage was uterine atony. Overall, 62% of the cases received appropriate care, 24% received totally inadequate care and 14% mixed care. After adjustment for sociodemographic factors, antenatal care and organisational aspects, the lack of a 24-hour on-site anaesthetist at the hospital and a low volume of deliveries (<500 births per year) were the factors associated with substandard care. CONCLUSION: Organisational features are so important that application of good clinical practices for safer motherhood reinforce the need for new organisation of obstetric services. For the first time, the presence of an anaesthetist is shown to have a measurable effect on the quality of care for women giving birth. These results need to be confirmed by others.

Adult↗