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Biomedical subjects

H Grandjean

Publications and source records attributed to H Grandjean.

At least 55 records · Page 3Linked to original sources
PubMed1996

[Outcome of blood gas parameters during the first 24 years after Exosurf administration].

BACKGROUND: There is now good evidence that the clinical course of infants with respiratory distress syndrome can be improved by treatment with exogenous surfactant. However, optimal methods of giving such a treatment are still debated. POPULATION AND METHODS: The arterial blood gases and the arterial/alveolar oxygen tension ratio (a/A) were recorded during the 24 hours following artificial surfactant (Exosurf) treatment in 400 newborns aged 25 to 42 gestational weeks. A positive response was defined by an a/A ratio > 0.22 or an increase in a/A ratio up to 25%. RESULTS: After administration of the first dose, a positive response was obtained in 63% of cases during the first 6 hours and 11% during the 6 following hours. The response after the second dose was favourable in 75% of cases. At 24 hours after treatment, 36% of the infants had obtained an a/A ratio > 0.22. CONCLUSION: Because of the 18% of infants who responded positively only after the second dose, administration of this dose seems justifiable even in case of non-response to the first dose. The quality of the response is related to the severity of the pulmonary illness but is independent of the gestational age.

Analysis of Variance↗
PubMed1996

Prevalence, aetiology, and care of severe and profound hearing loss.

Severe and profound hearing loss (> 70 dB) were analysed in a retrospective study of 226 children, born between 1976 and 1985, and recruited from three French administrative departments. The prevalence was 0.54 per 1000 children under 9 years old, with no decrease over the study period. A hereditary origin was identified in 20.8% of cases and an infectious origin in 11.5%. Perinatal risk factors were present in 11.5%, while the aetiology was undetermined in more than half the cases. In 85.8% of the children there was no other severe impairment. Marked learning difficulties were observed: 36% of the children were two years behind their age group and 28% were more than two years behind. The age of initial care decreased over the study period but is still too advanced. Systematic neonatal screening would enable earlier care, which should limit the social and educational impact of hearing loss.

Adolescent↗
PubMed1996

[Fetal growth from the AUDIPOG study. I. Establishment of reference curves].

The collection of nearly 100,000 births from 22 maternity hospitals in various French regions permitted to establish foetal growth curves for weight, height and head circumference. The 50th percentiles of weight at term obtained in this sample are not different from those given by Leroy and Lefort in the Paris region in 1971. However below 38 weeks of gestation, we found that 50th percentiles are 100 or 150 g less than those given by Leroy and Lefort. The discussion from international papers show large variations of the 10th percentile for weight in according to gestational age and sex, these variations are often related to the choice of different target populations.

Birth Weight↗
PubMed1996

[Fetal growth from the AUDIPOG study. II. Application for the diagnosis of intrauterine growth retardation].

The identification of intrauterine growth retarded infants remains a problem. It is useful to distinguish between small for date which uses the reference of a statistical birthweight limit and intrauterine growth retardation. A study comprising nearly 100,000 births from many French regions allowed a definition of the limits of birthweights taking into account gestational age, sex, birth rank, maternal height and pregravid maternal weight. This new approach distinguished two groups of newborns, the "constitutionaly small" and those who are newly called "growth retarded". The validity of this new classification is discussed.

Adult↗
PubMed1995

Femur/foot length ratio for detection of Down syndrome: results of a multicenter prospective study. The Association Française pour le Dépistage et la Prévention des Handicaps de l'Enfant Study Group.

OBJECTIVE: The aim was to determine the sensitivity and specificity of a short femur for detection of trisomy 21 in the second trimester. STUDY DESIGN: Thirty-six investigators in 12 centers measured biparietal diameter and femur and foot lengths in 3582 14- to 24-week-old fetuses in mothers undergoing amniocentesis for age, history of genetic disorder, or laboratory signs. RESULTS: Among the various ratios for evaluating femur shortening the femur/foot ratio appeared to be the most discriminatory. At an upper cutoff level of 0.88 a sensitivity of 35% was obtained for 4.6% false positives in normal infants. However, to only obtain 2.3% false positives, the cutoff limit had to be set at 0.85, giving a sensitivity of no more than 15%. CONCLUSION: Determination of the femur/foot ratio improves ultrasonographic detection of trisomy 21 in the second trimester, although for systematic use it would lead to an unacceptable number of unnecessary amniocenteses.

Amniocentesis↗
PubMed1995

Sonographic measurement of nuchal skinfold thickness for detection of Down syndrome in the second-trimester fetus: a multicenter prospective study. The AFDPHE Study Group. Association Française pour le Dépistage et la Prévention des Handicaps de l'Enfant.

OBJECTIVE: To determine the sensitivity and specificity of soft-tissue nuchal-fold measurement in the second-trimester fetus for the detection of trisomy 21. METHOD: Thirty-six investigators in 12 centers measured nuchal skinfold thickness in 3308 fetuses of 14-24 weeks' gestation. All mothers were referred for amniocentesis because of age, history of genetic disorder, or laboratory findings. Those referred with an ultrasound indication for amniocentesis, including nuchal-fold thickening, were excluded. RESULTS: Overall, nuchal skinfold was 6 mm or more in 8.5% of chromosomally normal fetuses and in 38% of those with trisomy 21. A false-positive rate below 5% was obtained by 81% of the investigators. Raising the cutoff of normality to 7 mm after 18 weeks' gestation improved specificity. CONCLUSION: Although the diagnostic value of this sign in skilled hands could allow its use as an indication for genetic amniocentesis at the second trimester, the method does not appear suitable for population screening because of the high variability in the results among the investigators.

Analysis of Variance↗
PubMed1995

Effect of adrenaline on plasma concentrations of fentanyl during epidural anaesthesia for caesarean section.

The present study was designed to assess the effect of adrenaline on the plasma concentrations of fentanyl in mothers and umbilical vessels after epidural administration for caesarean section. Thirty patients undergoing elective caesarean section were allocated randomly into two groups. Group 1 (n = 16) received 100 microg fentanyl, 10 ml of 0.5% bupivacaine and 10 ml 2% lidocaine, while group II (n = 14) received 100 microg fentanyl, 10 ml of 0.5% bupivacaine with adrenaline 1:200 000, and 10 ml of 2% lidocaine with adrenaline 1:80 000. Blood samples were obtained from the maternal antecubital vein (MV) at various times up to 6 hours after epidural injection, and from umbilical vein (UV) and arteries (UA) at birth for determination of plasma fentanyl by radioimmunoassay. Fentanyl Cmax and Tmax in MV did not differ significantly between the two groups. In umbilical vessels, plasma fentanyl concentrations were comparable in the two groups: (0.12 +/- 0.08 ng ml(-1) and 0.13 +/- 0.08 ng ml(-1) in UV and 0.08 +/- 0.07 ng ml(-1) and 0.06 +/- 0.05 ng ml(1) in UA of groups I and II respectively). The maximum plasma concentration in UV was 0.24 ng ml(-1) in group I and 0.25 ng ml(-1) in group II. There was no significant correlation between umbilical vessel (vein or artery):MV ratio and dose to delivery interval and no difference between the two groups in Apgar score or umbilical cord pH.

Journal Article↗
PubMed1995

Did preterm deliveries continue to decrease in France in the 1980s?

To study the trends in gestational age and birthweight in France, we compared data from three surveys that were based on representative samples of births in 10 French regions and were conducted in 1972, 1981 and 1988-89. Only single livebirths were considered in the analysis. The rate of preterm births decreased from 7.9% in 1972 to 5.8% in 1981 and 4.0% in 1988-89. The corresponding rates of children with a birthweight below 2500 g were 5.4, 4.3 and 4.7%. The mean birthweight of preterm babies born in 1988-89 was lower than the mean birthweight of those born in 1972 and 1981. The reduction in preterm births cannot be attributed to the improved accuracy of gestational age determination, but the general use of ultrasound may have played a major role in the apparent reduction of the mean birthweight of preterm babies.

Birth Weight↗
PubMed1995

[Cesarean section trends at the Toulouse University Hospital, from 1983 to 1993. Determinants and consequences].

OBJECTIVE: To examine the factors accounting for the increase in rate of cesarean section, between 1983 and 1993 (from 13.0% to 19.5%) in Toulouse University Hospital, a tertiary level center. DESIGN: Retrospective study of all single deliveries, excluding deaths in utero, between 1983 and 1993. RESULTS: Half the increase in overall rate was due to the numerical increase in women with a cesarean section history. The percentage of cesarean sections in these patients remained constant at 79% over this period. For the other patients, the increase in rate was due partly to an increase in risk factors, but mainly to a change in obstetric practice with a marked increase in elective cesarean section (70% of all cesarean sections in 1993). Major complications in the mothers were relatively rare, albeit significantly more frequent in the cesarean cases. Over the study period the percentage of infants requiring intensive care remained constant for the vaginal deliveries but declined for the cesarean sections. CONCLUSION: The increased rate of cesarean sections has not led to any increase in maternal complications, and appears to have had a small favorable influence on infant morbidity.

Adult↗
PubMed1994

[Short and mid-term outcome of a cohort of 1157 newborn infants with respiratory distress syndrome].

BACKGROUND: Data concerning neonates with acute respiratory distress syndrome (RDS) are still scarce. The characteristics and follow-up of a French cohort which has participated in an international trial concerning the efficacy of artificial surfactant have been studied. POPULATION AND METHODS: One thousand one hundred and fifty-seven neonates admitted from October 1990 to December 1991 in 27 French intensive care units because of RDS due to hyaline membrane disease were included in the study, whatever their birthweight and gestational age (GA). RESULTS: Three hundred and sixteen neonates (27.3%) were born from twin or multiple pregnancies. Fourty-five (5.5%) of the mothers had been given corticosteroids for the week preceding delivery. 55.5% were delivered by cesarean section. Mean GA was 31.0 +/- 2.9 weeks and mean birth-weight was 1,603 +/- 625 g. Two hundred and sixty-six neonates (23%) were small for GA. Two hundred and twenty-three died after a mean survival of 4.2 days (63% before the end of the first week and 80% before the end of the third week). Fifty percent of these deaths were due to respiratory distress, 28% to severe brain disorders and 9% to infections. The bronchopulmonary dysplasia rate was 21.7%. Early ultrasound scan of the brain showed major injuries in 19.5% of cases; the second scan performed in 822 infants was normal in 84.3%. CONCLUSIONS: Taking into account GA, mortality and morbidity rates were similar to those of the other non-French participating centres.

Birth Weight↗
PubMed1993

Comparison between fluorescent peanut agglutinin lectin and GB24 antibody techniques for the assessment of acrosomal status.

In order to compare fluorescent peanut (Arachis hypogaea) agglutinin lectin and GB24 antibody (specific for the inner acrosomal membrane) techniques for the assessment of acrosome reaction, both methods were applied on semen specimens obtained from patients undergoing in-vitro fertilization (IVF). The acrosome status was evaluated after a 4 h incubation in B2 medium with and without calcium ionophore A23187. Results obtained with both techniques were compared and studied as a function of IVF outcome. The percentage of spontaneous acrosome-reacted spermatozoa was higher when assessed by lectin than by GB24 (19 +/- 2% versus 11 +/- 1%; P < 0.001). The difference between the two methods (lectins minus GB24) was significantly higher in abnormal than in normal spermatozoa (10 +/- 2% versus 4 +/- 2%; P < 0.05), but did not significantly correlate with the percentage of acrosomes with abnormal morphology (r = 0.28; NS). When studied in relation to the IVF results, the response to A23187 was higher in successes than in failures (45 +/- 2% versus 34 +/- 4%; P < 0.05) but there was no significant difference between methods. Thus the assessment of acrosome reaction is strongly influenced by the method used, particularly in abnormal spermatozoa. Since the results obtained with lectins were higher in abnormal spermatozoa, GB24 seems to be more effective for assessment of true acrosome reaction.

Acrosome↗
PubMed1993

Evaluation of six markers of haemostatic system in normal pregnancy and pregnancy complicated by hypertension or pre-eclampsia.

OBJECTIVE: To establish the plasma evolution of prothrombin fragments 1+2 (F 1+2), thrombin-antithrombin III complexes (TAT), fibrin fragment D-Dimers (DD), von Willebrand factor antigen (vWf), Type 1 plasminogen activator inhibitor antigen (PAI) and blood platelet count during normal pregnancy and to compare these values with those obtained in hypertensive or pre-eclamptic pregnancies. DESIGN: Cross-sectional study. SUBJECTS: Forty-seven healthy pregnant women with gestational age ranging between 5 and 40 weeks, and fourteen women with gestational age ranging between 25 and 38 weeks presenting with either gestational hypertension (n = 4) or pre-eclampsia (n = 10). Numbers of nulliparous women in the control, hypertension and pre-eclampsia groups were 13/47 (28%), 1/4 (25%) and 9/10 (90%), respectively. RESULTS: All six markers increased with gestational age in normal pregnant women (P < 0.01). Using the upper limit of 95% prediction interval obtained from regression curves as normality threshold, TAT showed the best sensitivity (71% vs < 30% for F1+2, DD, vWf, PAI and platelet count). CONCLUSION: TAT appears to be an interesting marker for detecting haemostatic system alterations in pregnancies complicated by hypertension or pre-eclampsia. A large prospective study to determine its clinical usefulness for such complicated pregnancies is currently in progress.

Adult↗
PubMed1991

Placental transfer of glycosaminoglycans in the human perfused placental cotyledon model.

Placental transfer of unfractionated heparin (UH), of low molecular weight heparin CY 216 (LMWH) and of Dermatan sulphate (DS) was studied using the human perfused placental cotyledon model. Two different techniques were used to assess the transfer: labelled molecules and biological activities as measured by antifactor Xa or antifactor IIa activities. No biological activity was present in the fetal circulation, for any of the drugs used; however, very low fractions of the perfused radioactivity were recorded, 0.76% +/- 0.36%, 1.46% +/- 1.44% and 2.37% +/- 0.89% for DS, UH and LMWH, respectively.

Dermatan Sulfate↗
PubMed1991

Maternal and umbilical cord concentrations of fentanyl after epidural analgesia for cesarean section.

The maternal and umbilical concentrations of fentanyl were measured after epidural analgesia for cesarean section, using a highly sensitive radioimmunoassay method. Sixteen parturients were anesthetized with a single epidural injection of a mixture of 85 mg bupivacaine 0.5%, 60 mg etidocaine 1%, and 100 micrograms fentanyl with epinephrine 1:200,000. Apparent maternal individual maximum peak concentration (Cmax) of fentanyl was 0.38 +/- 0.16 ng/ml (mean +/- SD) (range 0.12-0.59 ng/ml) and the time to reach Cmax (Tmax) was 24 +/- 14 min (range 5-60 min). Infants were born 19 to 42 min after epidural administration of fentanyl (mean 27 min). Fentanyl concentrations in neonates was 0.13 +/- 0.04 ng/ml for the umbilical vein and 0.06 +/- 0.03 ng/ml for the artery. The fetus extraction ratio was 53 +/- 19% (range 20-83%). The large difference between arterial and venous concentrations of fentanyl may be due to a metabolization by the fetus and/or an uptake of the drug in the fetal tissues. Thus, even if fentanyl levels reaching the fetus after cesarean section under epidural anesthesia, using local anesthetics with 100 micrograms of fentanyl, are within safe range values, the likelihood of fentanyl uptake by fetal tissues calls for a cautious use of repeated fentanyl administration.

Analgesia, Epidural↗