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H Fernandez

Publications and source records attributed to H Fernandez.

At least 127 records · Page 7Linked to original sources
PubMed1998

[Predicting the risk of extra-uterine pregnancy. Construction and validation of a French risk scale].

This paper reports the construction and validation of a composite measurement scale to predict the risk of ectopic pregnancy in France. The data from three case-control studies of ectopic pregnancy conducted in France were used. Fourteen potential factors were found to be associated to ectopic pregnancy, which were grouped by multiple correspondence analysis in four dimensions: infection, pelvic surgery, smoking and induced conception. Logistic regression was further used to model the relationship between candidate risk factors (single or grouped as suggested by multiple correspondence analysis) and ectopic pregnancy. The regression coefficients of the final model were scaled and rounded to integers so as to make the scoring system simpler to use. The resulting composite measurement scale was finally validated on two independent samples. It allows simple determination (with a nomogram) of the absolute risk of developing ectopic pregnancy, for a given level of risk factors. This indicator for the risk of ectopic pregnancy could be used by clinicians to predict occurrence and provide an indication as to which type of early pregnancy follow-up and information should be given to women planning a pregnancy. It could also be used to provide earlier diagnostic screening in case of mild symptoms.

Case-Control Studies↗
PubMed1998

[Contraceptive use in female transplant recipients].

The choice of a good contraception is difficult in allograft recipient woman. Even if patients recovered a normal menstruation and fertility, the oral and the intra-uterine devices contraceptives are contraindicated. If pregnancy occur too soon after the transplantation, the survival graft is in danger. According to the literature, 50% allograft recipient have begun a pregnancy without medical concentration. In this article, we wanted to find the contraceptive method effective and appropriate in recent allograft recipient female according to the organ grafted. We discuss the new contraceptive methods and advise to avoid, in first instance a tubal ligature.

Contraception↗
PubMed1997

High-dose donor bone marrow infusions to enhance allograft survival: the effect of timing.

BACKGROUND: The development of strategies to enhance survival of transplanted organs and to potentially lower or even discontinue immunosuppressive therapy would represent a significant advance in posttransplant patient care. The aim of this clinical trial was to determine the effect of timing and dose of peripheral donor bone marrow cell (DBMC) infusion on graft and patient survival after liver transplantation. METHODS: DBMC, obtained from vertebral bodies, were administered in 101 recipients of liver allografts (OLTX). There were 107 patients for whom DBMC could not be obtained; they received OLTX alone (controls). A total of 5 x 10(8)/kg DBMC were infused at day 0 (group 1; n=9); at days 0 and 11 (group 2; n=26); or at days 5 and 11 (group 3; n=26). In group 4 (n=40), patients received up to five infusions of 2 x 10(8)/kg DBMC at days 5, 14, 21, 28, and 90 after OLTX. RESULTS: When the results from patients receiving two or more DBMC infusions (groups 2, 3, and 4) are considered, both patient and graft survival were significantly improved compared with the control group (P=0.02 and P=0.01, respectively). In groups 3 and 4, 88.5% and 95% of patients were alive with mean follow-up of 536 and 265 days, respectively, compared with 77.6% of patients in the control group (average follow-up of 452 days) (P=0.02). Graft survival was also significantly improved in groups 3 (88.5%) and 4 (92.5%), compared with the controls (72%) (P=0.007). CONCLUSIONS: The results suggest that dose and timing of DBMC infusions may be important variables affecting allograft survival. A randomized prospective trial is now in progress to compare group 3 DBMC infusion protocol with controls receiving OLTX alone.

Adult↗
PubMed1997

Segregation of the G8993 mutant mitochondrial DNA through generations and embryonic tissues in a family at risk of Leigh syndrome.

We identified the T8993G mitochondrial mutation in a female infant who died of Leigh syndrome. The proportion of mutant mitochondrial DNA increased to near homoplasmy in three generations of the pedigree. A similarly high proportion of mutant mitochondrial DNA was found in the chorionic villi and in fetal tissues from a pregnancy interrupted because of the risk of Leigh syndrome. This study supports the concept that prenatal diagnosis can be used for Leigh syndrome with the T8993G mitochondrial DNA mutation.

Abortion, Therapeutic↗
PubMed1997

Safety and efficacy of Virend for topical treatment of genital and anal herpes simplex lesions in patients with AIDS.

Virend (SP-303), a new topical antiviral agent with activity against herpesvirus, was evaluated in a multicenter, double-blind, placebo-controlled Phase II study for safety and effectiveness against recurrent genital herpes lesions in patients with AIDS. The primary endpoints of this study were complete healing of lesions and time to healing. Patients had a history of recurrent genital or anogenital herpes with at least one lesion and positive HSV culture at enrollment. Participants received Virend (15% ointment; 24 patients) or matching placebo (21 patients) three times a day for 21 days. Excluding two patients in the Virend group who received an initial treatment but were lost to follow-up, 9 of 22 (41%) patients treated with Virend experienced complete healing of their lesions compared with three (14%) patients in the placebo group (P = 0.053). Viral culture revealed that 50% of Virend-treated patients and 19% of placebo-treated patients became culture-negative during treatment (P = 0.06). Based on these preliminary clinical findings, further evaluation of Virend for topical treatment of genital herpes in patients with AIDS is planned.

AIDS-Related Opportunistic Infections↗
PubMed1997

Rapid fetal fibronectin swab-test in preterm labor patients treated by betamimetics.

OBJECTIVE: A preliminary study to examine the value of a rapid fetal fibronectin swab-test used as a bedside test in the prognosis of preterm labor. STUDY DESIGN: Women presenting with preterm labor and intact membranes and less than 3 cm dilated were enrolled in a single referral center. Cervicovaginal swabs were assessed for the presence or absence of fetal fibronectin by means of a rapid monoclonal antibody assay the positivity of which was revealed by a colorimetric reaction. Results were compared with uterine contractions frequency, Bishop cervical score, duration of tocolysis and interval to delivery. The predictive value of fetal fibronectin test for delivery within 7, 14 or 21 days from sampling and before 32 and 37 weeks' of gestation was assessed in the two groups. RESULTS: Among 124 eligible patients, 19 presented with a positive fibronectin test and 105 with a negative one. Gestational age at sampling, Bishop cervical score and duration of tocolysis were identical in the two groups. The number of contractions was significantly lower and gestational age at delivery was significantly higher in the fibronectin negative group. Fetal fibronectin in cervicovaginal secretions has a high sensitivity (89%) for delivery within 7 days. Absence of fetal fibronectin in cervicovaginal secretions of patients presenting with uterine contractions could rule out preterm labor within 7 and 14 days with a predictive value of 99 and 95.2%, respectively. In negative fetal fibronectin patients, preterm delivery before 32 and 37 weeks' is unlikely to occur with a predictive value of 97 and 85%, respectively. CONCLUSION: Cervicovaginal fetal fibronectin detected by a rapid bedside swab-test in women with symptoms of preterm labor compares favourably with quantitative assays and could prove useful in the management of preterm labor. This should be confirmed in a longer prospective study.

Adrenergic beta-Agonists↗
PubMed1997

Uterine thermal balloon therapy under local anaesthesia for the treatment of menorrhagia: a pilot study.

This study evaluates the use of local anaesthesia in a subset of patients undergoing uterine thermal balloon endometrial ablation for the treatment of menorrhagia. Out of 51 patients with dysfunctional uterine bleeding, 18 were included for uterine balloon therapy under local anaesthesia. Inclusion criteria were dysfunctional bleeding with absence of organic lesions in the uterine cavity, adequate relaxation and pain control during physical examination and diagnostic hysteroscopy, and patient desire to avoid a general anaesthetic. Paracervical block was performed with 20 ml of dilute 1% lignocaine HCl with epinephrine 1:200,000. Success of the procedure was defined as amenorrhoea, hypomenorrhoea, or eumenorrhoea. The median follow-up period was 13.9 +/- 5 months and 11 patients (61%) had follow-up of >1 year. Treatment led to a significant decrease in menstrual flow, duration, and pad count in all patients (P < 0.0001). No intra-operative complications occurred. A pain scale (level 1-10) was used to evaluate the patients' tolerance of the procedure (mean 3.8 +/- 1.3). In light of these successful and well tolerated procedures, thermal balloon endometrial ablation, utilizing local anaesthesia, appears practical as an office-based therapy.

Adult↗
PubMed1997

[Intensive care of pregnant and puerperal women. Characteristics of patients and health management structures].

INTRODUCTION: In order to understand why maternal mortality is higher in France than in other comparable countries, an epidemiological survey was carried out concerning critical illness during pregnancy, delivery and post partum, to ascertain the frequency of critical illnesses, and describe the characteristics of the patients as well as of the obstetrical services caring for them. MATERIAL AND METHOD: The survey was carried out on all obstetric patients treated in intensive care units (ICU), in three French regions for one year. A detailed questionnaire was retrospectively filled out by a specialized investigator, according to the patient's medical file. RESULTS: The frequency of critical illness was estimated at 310 SD 36 per 100,000 live births. Hypertensive diseases (26%) are the most frequent diagnosis that motivated admission to ICU, followed by the hemorrhages (20%), and then the indirect obstetric causes (17%). A large part of these patients was affected by seriously poor conditions before the present pregnancy. Public hospitals were most often implicated in the care of these patients since the beginning of the pregnancy and still more at the moment of the delivery. There was no difference in prenatal care from one type of hospital to another. On the contrary, pathologies and hospitalisation during pregnancy then the causes and the time of admission to ICU as well as the seriousness of maternal conditions were statistically different from one type of hospital to much more frequently in such pregnancies. Letality did not differ according to the various classes of maternity ward but did differ according to the pathologies leading to the treatment in ICU. CONCLUSION: A large proportion of pregnant women experience seriously critical illness; the relationship between critical illness and maternal mortality according to health care must be studied in depth.

Critical Care↗
PubMed1997

[Surgical treatment of twin-to-twin transfusion syndrome: coagulation of anastomoses with a Nd:YAG laser, under endosonographic control. Forty four cases].

Twin to twin transfusion syndrome occurs in 15% of monozygotic twin pregnancies and is characterized by a hemodynamic imbalance between the two fetuses. Survival is about 10% with expectant management. Our aim is to coagulate the placental vascular anastomoses joining the two fetal circulations on the placenta in order to prevent the consequences on the survivor when one dies in utero. Between November 1993 and April 1996, 44 patients were referred with severe twin to twin transfusion syndrome at less than 28 weeks' gestation. Nd:YAG laser coagulation of the placental vessels crossing the interamniotic membrane was performed under sono-endoscopic control. Forty-one patients have completed their pregnancy and 3 are continuing uneventfully in the third trimester. Fifteen patients (36.5%) delivered 2 healthy infants who survived the neonatal period and are developing normally. Sixteen patients (41.5%) delivered one infant developing, normally after the death of the co-twin in the perinatal period. In ten cases (22%) both twins died in the perinatal period. Among the survivors, 3 (9%) present with neurological handicap at a median age of 9 months. Around 75% (31/41) pregnancies complicated by twin to twin transfusion and treated by fetoscopy delivered at least one healthy baby. These data confirm the feasibility of the technique and that morbidity in-the survivors is relatively low.

Endosonography↗