Biomedical subjects
Publications and source records attributed to J Barrat.
The African population is a specific entity. It is younger, the women have more babies and the pelvis is frequently narrow. Caesarean section for a narrow pelvis should be considered very carefully in this population, while the idea of feto-pelvic disproportion has to be a clinical one. Radiological pelvimetry and the use of Magnin's diagram play no part in deciding which way to deliver the women.
The authors have made a growth cure of the bi-parietal diameter of the African infant using observations taken on 350 African women who were followed up and delivered in their department. Over all these curves of growth are smaller than the reference curves used in France. This study is a first contribution to the understanding of the mechanics of obstetrics in the African woman.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
It has long been known, because of the epidemiological criteria and because of the results of treating with hormones, that certain cancers of the breast and of the endometrium are hormone-dependent. This has been confirmed by the discovery of hormone receptors in these tumours. These are oestradiol receptors and progesterone receptors. The concentrations of these are variable so that some of these tumours can be classified as hormone-dependent and others as not hormone-dependent. Using these characteristics, we have attempted to select which cases will benefit from hormone therapy. All the same, the treatments that are suggested are mainly empirical, consisting in suppressing oestrogens by removal of the ovaries and the use of anti-oestrogens (progestogens) and also using drugs that compete for oestrogens such as Tamoxifen. The results, although they have not been negligible, have not fulfilled all hopes and a finer and more detailed analysis of the mechanism by which hormone therapy works should perhaps be considered, since there are so many failed treatments. We have tried to show that: suppressing oestrogens is not logical and may be damaging; for preference, progestogens should be prescribed in a sequential manner; doses of progestogens do not have to be very high, so that they are better tolerated; the classification of receptor values is perhaps less necessary, because that at first does not seem to be able to help to decide whether to give hormones or not. it may be it that is possible to avoid transforming a hormone-dependent tumour into a non-hormone dependent tumour by boosting the synthesis of receptors. These thoughts on the physiopathology lead to a suggestion that therapy should take much more account of the age of the woman, her hormone status and whether she has or does not have her ovaries. At the same time different types of hormone therapy can be combined with other therapies that have been proved useful, and in particular chemotherapy with which hormone therapy may be in competition. Properly worked out, these treatments need not oppose one another but could complement and potentiate one another.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
This work shows the effect of a policy of reducing the amounts of antibiotics prescribed, and reports on the effect on the rate of infection in a maternity unit where systematic antibiotic cover for patients with premature rupture of the membranes was stopped. Breaking of the waters with loss of liquor makes infection of the contents of the sac almost inevitable; but we have found over a period of five years that with the exception of certain strains of Group B streptococci infection with bacteria from vaginal flora rarely gives rise to severe infection in the infant. This balance sheet was drawn up: 350 infections of the liquor in 13.540 deliveries, which is 2.5%. Infection of the liquor by definition implies that the infant will be contaminated; but in fact the baby was infected in only 0.6% of births--which figure is no higher than in other series. Bacteria found in the vaginal flora: streptococci and anaerobes are responsible for 92% of amniotic infections, streptococcus B being first in frequency responsible for 41.36% of amniotic infections and 47.5% of neonatal infections. The low percentage, 5.4% of Gram negative Bacilli can be attributed to their absence when antibiotic cover is given. Neonatal infections usually improve quickly with a narrow-spectrum antibiotic and the one we gave most often was penicillin G. Careful watch on women with premature rupture of the membranes, accompanied by repeated bacteriological control makes it possible to avoid systematic antibiotic therapy and to allow the antibiotic sensitive bacteria to return to their primary role, if by chance infection of the amniotic contents, which is usually benign, occurs.
It is possible to induce labour in pathological pregnancies after artificial ripening of the cervix. The present study concerns 70 patients (45 primipara, 25 multipara). The main pathologies are hypertension of pregnancy and pregnancies past dates. Prostaglandin F2 alpha has been used with a Tylose gel containing 5 mg of PGF2 alpha introduced by the extra-amniotic route. The cervical change was noted using Bishop's score. The mean increase of the cervical score was 0.8 with the first PGF2 alpha gel. The total mean increase was 1.2. Two cases of hyperstimulation of the uterus were observed and they led to Caesarean section. Prostaglandin gel induced labour in 56% of the patients. The mean time between the introduction of the gel and the delivery was 14 h for primipara and 10 h for multipara. Other patients were induced with oxytocin on the following day. Epidural analgesia was widely used in this study (in 64% of cases). The mean duration of labour was 6 h 10 for primipara and 4 h 30 for multipara. 30% of the patients needed Caesarean section but there was a marked difference between primipara (36%) and multipara (4%). After a review of the literature the authors conclude that it is useful to ripen the cervix prostaglandin but, as foreign authors do, they think that PGE2 should be more efficient.
The use of prostaglandins is one of the best techniques for second trimester abortion. The authors present 40 patients aborted by a new two stage technique: First: ripening of the cervix a tylose gel containing 5 or 10 mg PGF2 alpha every 12 hours during 3 days. Then, if abortion is not obtained, previously published techniques are used: intra-amniotic injection (40 mg PGF2 alpha) or intra-cervical infusion (2 mg/hour). The mean duration of these abortions is 52 hours using 29 mg of PGF2 alpha. 22 patients aborted during ripening (mean = 27 hours), 12 patients needed an intracervical infusion (mean = 88 hours) and 6, an intra-amniotic injection (mean = 72 hours). It seems that abortion is easier when pregnancy is earlier, under 20 weeks of gestation. Few side effects were observed: only three cases of fever with a single case of endometritis. Failure of this technique occurred in five patients (4 aborted outside the time allowed for, and one needed instrumental extraction). With this technique, the mean duration is longer than those previously described in the literature but the efficiency is over 90%.
The authors have looked out the obstetric history of 13 young women who were suffering from ulcerative colitis or Crohn's disease between the years 1978 and 1982 and who had 25 pregnancies. This study made it possible to analyse the influence of these pathological conditions on the evolution of pregnancy as well as the effect of pregnancy on the evolution of the disease. The different therapeutic treatments that have to be given for these diseases, such as medical treatment using Sulphasalazine, enemata, corticosteroids and Azathioprin, or surgical treatments have been examined in their relationship with pregnancy. The results that have been obtained confirm those to be found in the literature in the sense that the two conditions are independent of one another and therapy for the pregnancy as well as for the bowel disease can be continued without too much consideration for the effect of the one condition on the other.
6.9% of women involved in accidents are pregnant. It is difficult to calculate all the fetal and maternal lesions that occur under these conditions. We are reporting a case of a 27-year-old primipara who had internal bleeding with shock without a precise aetiology. Very heavy vaginal bleeding occurred on the third day after admission so that a Caesarean had to be carried out in order to preserve the health of the mother and of the baby. Several complications can follow road traffic accidents in pregnant woman. The worst is usually fetal death and its mechanism is discussed. More frequently occurring, however, are fetal distress that threaten premature labour. Some lesions that are not lethal, such as bone fractures, can affect the long-term outlook for the pregnancy.
A study on dietary and smoking behavior during pregnancy was performed between January, 1976, and September, 1979, at the St. Antoine Maternity Hospital in Paris. In addition to the routine clinical examinations at the third, sixth, eight, and ninth months of pregnancy, the women were systematically questioned about their dietary and tobacco habits. No dietary advice was given by the dietitians at any time, nor was there special counseling against smoking. Among 534 women who were followed up, 200 (37%) were smokers before pregnancy. At the sixth month, half of them had stopped smoking and the others had reduced their consumption. The analysis showed that the mean caloric intake and the gain in weight were the highest in the women who continued to smoke and the lowest in nonsmokers. Intermediate results were found in smokers who stopped. Birth weight was, on the average, 70 gm lower among smokers throughout pregnancy, compared with the other two groups, but this difference was not significant. These findings are consistent with the hypothesis that the negative effects of smoking on the fetus could be compensated for, to a great extent, by extra food.
Explore the source record for details and available documents.
The effects of two galenic processes (micronisation and addition of oil) on the bioavailability of progesterone administrated orally were studied. After ingestion of progesterone (200 mg), mean plasma progesterone rapidly rises up to the 2nd hour and reaches levels of the normal luteal phase (12.6 +/- 2.6 ng/mg). It then decreases progressively up to the 8th hour. Daily administration of progesterone (300 mg) for 8 days significantly increases the endometrial concentration of the steroid (18.3 +/- 2.9 ng/ml) and efficiently corrects the tissular hormone deficiency. The breast tissue uptakes and concentrates equally progesterone. After oral administration of the natural hormone, progesterone concentrations are considerably increased in the three tissue compartments studied (normal glands: 25.0 +/- 9.7 ng/g; benign tumor: 38.0 +/- 9.1 ng/g; adipose tissue: 160.2 +/- 65.4 ng/g). These pharmaco-kinetic results correspond to the requirements of general substitutive hormone therapy. They justify the use of natural oral progesterone therapy, providing the amount given is modified according to immediate clinical tolerance.
The authors report a case of gonorrhoea occurring immediately after delivery, characterized by acute inflammatory polyarthritis. The diagnosis was made from swabs taken from the lochia that were cultured on enriched media. The outcome of the disease treated with penicillin was good after 48 hours. The new-born's state of health after swabs take from the nostrils were positive was satisfactory all the time. A review of the literature shows how rare these conditions are, how serious they can sometimes be, and the management that should be undertaken in order to prevent complications occurring.
Explore the source record for details and available documents.