[Maternal fever. Relationship with maternal-fetal infection in full term newborn infants].
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Biomedical subjects
Publications and source records attributed to J Tricoire.
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In an attempt to evaluate the effects of pregnancy on HIV infection, the authors have studied the natural course of the disease in 128 female patients. A group of 64 pregnant women who were HIV seropositive and asymptomatic at the beginning of their survival was studied during childbearing and for three years thereafter. These women were compared with a control group of 64 non pregnant women who were also seropositive and asymptomatic at the beginning of the study. No statistically significant clinical or biological difference was observed between the two groups. The authors conclude that in their study pregnancy had little influence on the progression of HIV.
Human immunodeficiency virus infection is specific in children and related to their immune system. Recurrent bacterial and viral infections precede opportunistic infections. They are associated with non-specific manifestations (e.g. lymphadenopathy) and frequently reveal the HIV infection. Acute or chronic interstitial pneumonia is the main cause of morbidity and mortality (two-thirds of the cases); 34 to 90 p. 100 of children have neurological but also gastrointestinal and haematological involvement. All organs and systems can be directly or indirectly affected by the virus with immune and infectious consequences. The prognosis is very poor with an actuarial survival rate of 60 p. 100 at 5 years, so that strict clinical and laboratory monitoring is mandatory.
Over a period of 3 years (mean 16, extremes 3 and 36 months), we compared clinical and laboratory parameters of 128 female, human immunodeficiency virus (HIV)-infected patients, all in clinical stage II or III (CDC classification). 34 patients were pregnant and delivered a viable infant after at least 28 weeks of amenorrhea (group I), 29 patients were pregnant and had a spontaneous or induced abortion during the first or second trimester (group II), and 64 were non-pregnant female control patients (group III). The changes in the clinical stages over time were not statistically significant between the groups. The only laboratory parameters that were significantly higher in group I at the time of the delivery were: leucocyte count (p less than 0.001), lymphocyte count (p less than 0.05), and sedimentation rate (p less than 0.001). These changes are known to be related to pregnancy and not to HIV disease. All other laboratory parameters showed no significant differences within and between the groups. We conclude, that pregnancy--carried to term or interrupted--does not aggravate the natural evolution of HIV infection in clinical stage II and III patients.
In order to investigate the progression to AIDS, we studied 39 patients with hemophilia ranging presently in age from 8 to 20 years, who had been positive for HIV antibodies for a mean of 36 months. Every 3 to 6 months a clinical and laboratory examination was performed. The number of patients with AIDS increased from 2 to 6 and 2 patients died from opportunistic infections. The percentage of patients with less than 500 T4 cells increased from 28% to 41%. Increase in serum IgA concentrations above 2.5 gl/l ranged from 23% to 38% of patients. Seven subjects were found to be positive for HIV antigen and 11 of 15 had a loss of p24 antibody. Patients' distribution into two groups according to the results of T4 cells count at the beginning of the study have shown a significant difference on the basis of clinical and biological progression. The present investigation confirms the progression in this population and the importance of some markers.
Assessment of the risks of transmission of infection with human immunodeficiency virus type 1 (HIV-1) from mother to newborn is difficult, partly because of the persistence for up to a year of maternal antibodies transmitted passively to the infant. To determine the frequency of perinatal transmission of HIV infection, we studied from birth 308 infants born to seropositive women, 62 percent of whom were intravenous drug abusers. Of 117 infants evaluated 18 months after birth, 32 (27 percent) were seropositive for HIV or had died of the acquired immunodeficiency syndrome (AIDS) (n = 6); of the 32, only 2 remained asymptomatic. Another 76 infants (65 percent) were seronegative and free of symptoms, whereas 9 (8 percent) were seronegative but had symptoms suggestive of HIV-1 infection. The infants infected with HIV-1 did not differ from the others at birth with respect to weight, height, head circumference, or rate of malformations, but as compared with newborns who were seronegative at 18 months, their serum IgM levels were higher (78 +/- 81 mg per deciliter vs. 38 +/- 39 mg per deciliter; P less than 0.03) and their CD4 lymphocyte counts were lower (2054 +/- 1221 per cubic millimeter vs. 2901 +/- 1195 per cubic millimeter; P less than 0.006). Neither maternal risk factors nor the route of delivery was a predictor of seropositivity at 18 months; however, 5 of the 6 infants who were breast-fed became seropositive, as compared with 25 of 99 who were not (P less than 0.01). We conclude that approximately one third of the infants born to seropositive mothers will have evidence of HIV-1 infection or of AIDS by the age of 18 months, and that about one fifth of this group will have died.
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Prediction of risk of sequelae in 78 asphyxiated full-term newborns was evaluated during the 15 first days of life by clinical, electroencephalographic and cranial tomodensitometric (CT) data. The predictive value of CT hypodensity is poor (sensitivity: 87.7%; specificity: 63%), while its negative predictive value appears more interesting (97%). Combined evaluation of clinical, electroencephalographic and CT data allows the most accurate prognosis. These findings agree with other studies in the literature.
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The case of a 54-year-old man with a retroperitoneal seminoma and normal testes is reported. Diagnosis was established late, when the tumor had become large and inoperable and produced symptoms of subocclusion. Onset of gynecomastia, an uncommon occurrence, had been recorded two years earlier and should have given rise to suspicion. The tumor was a histologically unmixed seminoma with very significant beta-HCG secretion. A chemotherapy-radiotherapy combination produced dramatic improvement. From data from a review of the literature, pathogenesis, diagnosis and management of this uncommon type of seminoma are discussed.
Thirty-two women with breast cancer considered in active phase underwent, successively: internal mammary lymphoscintigraphy with 99m rhenium sulfide, chemotherapy and Pathey-type mastectomy with dissection of the axillary and internal mammary lymph nodes. Lymphoscintigraphy was successful in 97% of the cases, without complications. Its specificity was 0.88 (range: 0.76--0.99) and the sensitivity 0.6 (range: 0.19--0.92). Internal mammary lymph node dissection was technically successful in 87.5% of the cases; one patient developed chondritis. Thus, lymphoscintigraphy is usually successful, without morbidity and specific. However, it cannot pretend to provide a complete answer, as does internal mammary producing invaded lymph nodes.
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Following mastectomy for cancer, one hundred and sixty-two biopsy samples were examined to determine the frequency of tumoral lesions other than those of the main tumor. If tumoral remnants close to the excision zone or less than five cm from the main tumor are eliminated, 44.4 per cent of cases had other remote tumors. In the present series, the frequency of other tumoral lesions was far from negligible for small tumors, and increased when the main tumor had intraductal components and when four or more axillary lymph nodes were invaded. These results, which confirm those of other authors, have to be considered for effective treatment of breast cancers, even those of a small size.
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The preliminary study is concerned with 25 cases that have been examined using thermography in planes to check the conditions of temperature of the testes in normal and pathological states. Normal testicular thermography is characterised by a symmetrical and constant thermographic picture, the temperature staying between 32.5 and 34.5 degrees. In the pathological states of oligoasthenospermia plate thermography shows up a particular thermic picture associated with a varicocoele whether this is clinical or subclinical. The picture is one of hyperthermia and lack of symmetry in the case of a unilateral lesion. In these cases tyeing off the spermatic vein shows a rapid return to a normal thermographic picture. These positive results have led to a more extensive and deep study which is at present in progress.