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Biomedical subjects

J Bellver

Publications and source records attributed to J Bellver.

15 recordsLinked to original sources
PubMed2006

Examination of the fetal brain by transabdominal three-dimensional ultrasound: potential for routine neurosonographic studies.

OBJECTIVE: To evaluate the role of transabdominal three-dimensional (3D) ultrasound in the assessment of the fetal brain and its potential for routine neurosonographic studies. METHODS: We studied prospectively 202 consecutive fetuses between 16 and 24 weeks' gestation. A 3D ultrasound volume of the fetal head was acquired transabdominally. The entire brain anatomy was later analyzed using the multiplanar images by a sonologist who was expert in neonatal cranial sonography. The quality of the conventional planes obtained (coronal, sagittal and axial, at different levels) and the ability of the 3D multiplanar neuroscan to visualize properly the major anatomical structures of the brain were evaluated. RESULTS: Acceptable cerebral multiplanar images were obtained in 92% of the cases. The corpus callosum could be seen in 84% of the patients, the fourth ventricle in 78%, the lateral sulcus (Sylvian fissure) in 86%, the cingulate sulcus in 75%, the cerebellar hemispheres in 98%, the cerebellar vermis in 92%, the medulla oblongata in 97% and the cavum vergae in 9% of them. The thalami and the cerebellopontine cistern (cisterna magna) were identified in all cases. At or beyond 20 weeks, superior visualization (in > 90% of cases) was achieved of the cerebral fissures, the corpus callosum (97%), the supracerebellar cisterns (92%) and the third ventricle (93%). Some cerebral fissures were seen initially at 16-17 weeks. CONCLUSION: Multiplanar images obtained by transabdominal 3D ultrasound provide a simple and effective approach for detailed evaluation of the fetal brain anatomy. This technique has the potential to be used in the routine fetal anomaly scan.

Brain↗
PubMed2005

Similar endometrial development in oocyte donors treated with either high- or standard-dose GnRH antagonist compared to treatment with a GnRH agonist or in natural cycles.

BACKGROUND: This descriptive study evaluates the impact on endometrial development of standard and high doses of a GnRH antagonist in stimulated cycles compared with GnRH agonist and natural cycles. METHODS: Thirty-one oocyte donors were treated with a combination of rFSH and 0.25 mg/day ganirelix (standard dose), 2 mg/day ganirelix (high dose) or 0.6 mg/day buserelin (long protocol). Vaginal progesterone (200 mg/day) was administered in the luteal phase. Endometrial biopsies were performed 2 and 7 days after HCG administration. Additional biopsies were carried out in a subset of 12 subjects, 2 and 7 days following the LH peak of their previous natural cycle. Biopsies were evaluated histologically and by scanning electron microscopy. Gene expression profiles were also studied. RESULTS: At HCG +2, all the parameters studied were similar in all the groups and comparable to those observed in the natural cycle. At HCG +7, endometrial dating, steroid receptors and the presence of pinopodes were comparable in both GnRH antagonist groups and in the natural cycle. In buserelin group, endometrial dating and pinopode expression suggested an arrested endometrial development. For window of implantation genes, expression patterns were closer to those in the natural cycle following standard- or high-dose ganirelix than after buserelin administration. CONCLUSION: No relevant alteration was observed in the endometrial development in the early and mid-luteal phases in women undergoing controlled ovarian stimulation for oocyte donation following daily treatment with a standard- or high-dose GnRH antagonist. In addition, the endometrial development after GnRH antagonist mimics the natural endometrium more closely than after GnRH agonist.

Adolescent↗
PubMed2003

First-trimester reversed end-diastolic flow in the umbilical artery is not always an ominous sign.

We report five cases of first-trimester reversed end-diastolic flow in the umbilical artery. Diagnoses were performed between 8 and 12 gestational weeks. All but one case appeared as a transient early finding. Second-trimester fetal demise occurred in two cases. One case delivered at 32 weeks with severe growth restriction but recovered well. The other two cases had a good pregnancy outcome. Our experience suggests that this early Doppler finding is not always an ominous sign.

Adult↗
PubMed2000

Effects of prandial glycemic changes on objective fetal heart rate parameters.

BACKGROUND: There is confusion in the literature about the potential effect of maternal glucose levels on the fetal heart rate (FHR) cardiotocographic interpretation. METHODS STUDY DESIGN: prospective clinical descriptive study. SUBJECTS: 21 pregnant women with diabetes mellitus, 23 women with gestational diabetes and 18 healthy non-diabetic pregnant volunteers (control group). TREATMENT: maternal capillary glucose measurement and objective FHR analysis (Oxford System 8002) pre- and 1 h post-meal. STATISTICAL ANALYSIS: descriptive statistics. Student t-tests and Pearson correlation studies. RESULTS: Maternal capillary glucose levels ranged between 2.7-10.5 mmol/l pre-meal and 4.2 14.8 mmol/l post-meal. The differences between objective FHR parameters pre- and postmeal were not significant in any of the groups of women studied. No correlation was found between prandial glycemic and FHR changes. Women with optimal and suboptimal glycemic control exhibited similar objective FHR parameters pre- and post-meal. Women with gestational diabetes showed similar prandial cardiotocographic changes irrespective of whether they were on insulin therapy or on hypoglycemic diet only. CONCLUSIONS: Objective FHR parameters are unaffected by prandial glycemic changes over a wide range of maternal glucose levels. Timing the non-stress test in relation to the meals seems irrelevant in clinical practice.

Adult↗
PubMed1995

Continuous spinal anaesthesia versus single dosing. A comparative study.

Continuous and single dose spinal anaesthesia were compared in a prospective randomized fashion in 108 patients undergoing orthopaedic surgery. Continuous spinal anaesthesia was via a 20 gauge polyamide multiperforated catheter introduced through an 18 gauge Tuohy needle. Single-dose spinal anaesthesia was performed with a 24 guage x 103 mm Sprotte spinal needle. The mean local anaesthetic dose for the continuous technique was 38.4 (SD 16.5) mg as hyperbaric lignocaine 5%, and for the single-dose spinal anaesthesia 10.8 (SD 2.2) mg as hyperbaric bupivacaine 0.5%. Segmental levels reached with the initial dose did not differ significantly between the two groups. Mean time required to perform continuous spinal anaesthesia was 6.7 (SD 3.9) min, which was longer than for single dose 4.9 (SD 2.8) min (P < 0.05). The onset time and efficacy of anaesthesia, and the duration of the operation were similar in the two groups. Analgesia was inadequate in six patients who received continuous spinal anaesthesia (11%) and one patient who received single dose (2%) (P = 0.18). Hypotension was more frequent in those receiving single doses (P < 0.05). Caudal rotation of the outlet needle orifice to advance the catheter correlated with inadequate analgesia (P < 0.01, r = 0.38). There were no significant differences in the incidence of post-operative complications.

Aged↗
PubMed1994

Comparison of continuous spinal anaesthesia using a 32-gauge catheter with anaesthesia using a single-dose 24-gauge atraumatic needle in young patients.

One hundred and twenty-eight ASA I-III patients less than 40 yr of age, undergoing orthopaedic or trauma lower limb surgery, were allocated randomly to receive either continuous spinal anaesthesia (CSA) using a 32-gauge polyimide microcatheter with a permanent stylet (Rusch/TFX Medical, Duluth, GA, USA) or single-dose spinal anaesthesia (SDSA) with a 24-gauge x 103-mm Sprotte spinal needle (Pajunk, Germany). Plain bupivacaine (0.5%) was used as the local anaesthetic. The initial doses were 1 ml (5 mg) of CSA and 3 ml (15 mg) of SDSA, while the re-injection doses were 1 ml (5 mg) in the CSA group. SDSA was quicker to perform: mean 4.4 (SD 1.6) min compared with 6.2 (2.6) min for CSA (P < 0.01). Times to onset and surgical anaesthesia were also significantly greater in the CSA group (P < 0.01). The quality of the block was better in the SDSA group (P < 0.05), but was associated with greater haemodynamic instability (P < 0.05). The segmental level of analgesia was significantly lower in the CSA group (median T10 (range T12-T8)) than in the SDSA group (T9 (T11-T5)) (P < 0.05). There were no significant differences in the incidence of postoperative complications, with two mild spinal headaches in both groups. We conclude that CSA using a microcatheter in young patients is difficult to perform and affords no advantages over SDSA with a small gauge atraumatic needle.

Adult↗
PubMed1993

A comparative study of analgesia after knee surgery with intraarticular bupivacaine, intraarticular morphine, and lumbar plexus block.

Following arthroscopic surgery of the knee, 60 ASA I-II patients were randomly allocated to three different groups (n = 20 each) in an attempt to establish the best postoperative analgesic protocol: 20 ml of bupivacaine (0.25%; 50 mg) intra-articularly (IA) (Group 1); continuous three-in-one lumbar plexus block using a catheter to administer 0.25 ml/kg of bupivacaine (0.25%; single-shot) plus continuous pump infusion of the same drug (0.03 ml.kg-1 x h-1 of 0.25% bupivacaine for 24 h) (Group 2); or 1 mg of morphine with 20 ml of saline IA (Group 3). The results were appraised in a double-blind manner, and the degree of postoperative pain was evaluated by visual analog scale (VAS) at constant hourly intervals for the first 24 h, by the incidence of secondary effects, and by the need for complementary analgesia. Group 2 (three-in-one) VAS values were lower 16 and 24 h after surgery and also globally (P < 0.05), with respect to the other two groups. Five patients in Groups 1 and 3 required complementary analgesia, while three patients in Group 1 suffered nausea. No other secondary effects were observed. We conclude that all three analgesic methods proved efficient, as reflected by the scant requirements for additional analgesics and the degree of expressed patient satisfaction. However, lumbar plexus block (three-in-one) with continuous bupivacaine infusion was most effective, and, although it constitutes an added technique, its scant complications and easy performance make its use advisable.

Adolescent↗
PubMedDate not supplied

Continuous spinal anesthesia: a comparative study of standard microcatheter and Spinocath.

BACKGROUND AND OBJECTIVES: This prospective, randomized study evaluated the advantages and disadvantages of a new subarachnoid catheter. METHODS: Sixty ASA I-IV patients aged 40-70 years, scheduled for total knee arthroplasty, were randomly distributed into group 1 (Spinocath; Braun Melsungen, Germany) and group 2 (Intralong; Pajunk, Germany). The study tabulated details of subarachnoid catheter insertion, dural puncture, time to free cerebrospinal fluid (CSF) flow, anesthesia onset time, surgery anesthesia time, the upper level of sensory block reached, the anesthesiologist-evaluated degree of difficulty with the technique, and the quality of analgesia obtained and complications. At the end of surgery, all the catheters were removed, and their patency was checked. RESULTS: Spinocath insertion required 6.3 +/- 3.2 minutes in group 1 versus 3.9 +/- 1.2 minutes in group 2 (P < .01) with similar difficulties with catheter introduction. Perception of dural puncture was better in group 1 (P < .05). There were significant intergroup differences in time to free flow of CSF through the catheter. In group 2, correct catheter positioning had to be confirmed by aspiration in 80% of cases (P < .05). At the end of surgery, the catheters were removed, and there were no significant differences between groups. The anesthetic blocks were similar with both systems. Patient opinion of the technique did not differ between groups, and regression analysis did not show any differences between groups or correlation to any incident during performance of the technique. Globally, the anesthesiologists participating in the study considered both systems to be easy to use and adequate for continuous spinal anesthesia. With respect to the advantage afforded by a directional needle in orientating the catheter within the spinal canal, the Spinocath system-with a longer technique performance time than the standard approach-involves a success rate and incidence of technical problems similar to that of the conventional technique.

Adult↗
PubMedDate not supplied

[Antiemetic prophylaxis after laparoscopic cholecystectomy: comparative study of dehydrobenzperidol, metoclopramide, ondansetron and placebo].

OBJECTIVES: To compare the efficacy of ondansetron to that of metoclopramide, dehydrobenzperidol and placebo for the prevention of postoperative nausea and vomiting (PONV) after laparoscopic cholecystectomy in a double-blind random study. PATIENTS AND METHOD: A total of 100 ASA I, II and III patients undergoing scheduled laparoscopic cholecystectomy were divided into 4 groups according to whether they received one of the following intravenously just prior to anesthetic induction: 1.25 mg dehydrobenzperidol (group D), 10 mg metoclopramide (group M), 4 mg ondansetron (group O) or 2 ml of saline (group P). All received general anesthesia with induction by thiopental, analgesia with fentanyl, muscle relaxation with atracurium and maintenance with oxygen-air and isoflurane. Episodes of nausea and/or vomiting during the first 24 h after surgery were recorded. Treatment was considered effective if no episodes occurred during this period. RESULTS: Nine of the 100 patients were excluded from the study. There were no significant differences in demographic variables among the 4 groups. The incidence of PONV was significantly greater in group P than in any of the other groups. There were no significant differences in PONV among groups D, M and O. CONCLUSIONS: Ondansetron provides safe, effective prophylaxis for PONV after laparoscopic cholecystectomy, but it is not superior to the antiemetic drugs usually used. Its use may be justified in patients in whom dehydrobenzperidol or metoclopramide are contraindicated.

Adult↗