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Biomedical subjects

J Y Grall

Publications and source records attributed to J Y Grall.

At least 55 records · Page 3Linked to original sources
PubMed1992

[Breast cancer associated with pregnancy. Nine case reports. Review of the literature and current update].

The authors report nine personal cases in a review of the literature concerning cancers of the breast associated with pregnancy and lactation (until a year post-partum). The diagnosis of the illness is reported to be difficult in pregnant women and it is necessary to use fully all the diagnostic procedures available and in particular cytology and histology. Surgery is urgent. It is classical practice to carry out a mastectomy with axillary clearance. Nevertheless more conservative treatments are now being suggested. The principal problem of therapy is linked to the effects of adjuvant therapy on the fetus be they radiotherapy or chemotherapy, particularly because it is very important that treatments should be thorough and start early in the pregnancy. The overall prognosis is bad because pregnancy seems above all to aggravate serious forms of the disease.

Adult↗
PubMed1992

[Pregnancy in the diabetic woman. Incidence of malformations, of macrosomia, update on obstetrical management].

Perinatal mortality for infants born to diabetic mothers has dropped in the years from the 1950's when it was 20% to less than 3% by the end of the 1980's. In spite of this considerable reduction which is due to careful observation and multidisciplinary management in this type of pregnancy, the congenital malformation rate is 4 times greater than with the general population (3%) and the rate of spontaneous abortions is double (13%). The caesarean section rate is 5 times higher (18%). In bringing out a retrospective study we have attempted to analyse the endocrinological and obstetrical features of the cases.

Cesarean Section↗
PubMed1992

[A complication of epidural anesthesia: cerebral pneumatocele. A case report].

Having had a case themselves the authors report a rare complication of epidural anaesthetic, namely pneumocephaly. When it occurs it is usually after a difficult puncture; and usually thought of if headaches are unusually severe of there is a picture of intracranial rise in pressure. Then a tomodensitometry will lead to the diagnosis. Literature shows that it can be a serious condition, sometimes fatal, which means that the case has to be followed up very carefully and tomodensitometry has to be repeated until complete cure has been obtained.

Adult↗
PubMed1991

[Intraductal carcinomas in situ. Retrospective study of 21 cases and review of the literature].

In situ canalicular carcinomas are defined as malignant, galactophoric epithelial cells, do not invade the basal membrane. The author saw 21 cases of in situ canalicular carcinomas which were treated surgically at the University Hospital of Rennes. It is possible from these cases to include certain themes: there is a pathology of an early carcinoma of the breast which will go on growing. It concerns patients in the menopausal age who 1 in 3 have a family history of neoplasia. Medical examination is important because in 1 out 2 cases leads to complimentary examinations which help to make the diagnosis. Mammography is essential because it leads to the diagnosis of a finding of suspicious microcalcifications as well as arranges an outline. The histology will indicate what the therapy should be. Comedocarcinomas (cellular proliferation with central necrosis) has to be considered as separate from other better differentiated types (solid, cribriform, papillary and clinging carcinomas). In fact comedocarcinomas often have a poor prognosis and the factors are: the size, the mitotic activity, the poor cellular differentiation, perigalactoriphic reaction, and stromal and multi centre micro-invasion. Treatment has to be adapted to features of this pathology. Mastectomy which used to be routine in these cases because of the high incidence of multiple centres, are to be reserved for cases with a poor prognosis. At present conservative treatment is being evaluated, but it seems logical to recommend it in non-invasive cancers with a good prognosis when a large lumpectomy followed up by radiotherapy to the whole breast can be used, particularly because this form of treatment is now given to invasive tumours. It is very important to follow-up these patients regularly and for a long time, clinically and with mammography if conservative treatment is carried out, in any case when the opposite breast is at risk. Conclusion. Now that treatments have become varied the improvement in prognosis will depend on early diagnosis. This means that mammography screening will proceed to an increasing number of non-invasive cancers of the breast that are discovered, and to a need to work out acceptable and effective treatment for these cancers.

Adult↗
PubMed1991

[Primary pure carcinoid tumor of the breast: a case report. Review of the literature].

The authors present a case of primary pure carcinoid tumour of the breast and point out how rare it is and how they made their diagnosis mainly by histology. A review of the literature makes it possible to assess the prognosis which should be good and they also describe the anatomo-pathological findings in these tumours. Finally these tumours show a strange histogenesis which if it is understood makes it possible to understand certain processes of cellular differentiation in breast tissue.

Aged↗
PubMed1991

[The treatment of obstetrical uterine inversion. Apropos of 3 cases].

Uterine inversion is exceptional and spectacular, although treatment is simple if diagnosed early. Three cases are reported with a review of possible obstetrical procedures for reduction. Manual repositioning by central pressure is emphasised. General anesthesia is generally needed because of associated state of shock. The three principal steps of manual reduction are: intra-abdominal repositioning of the uterus, removal of placenta, intramural injection of ocytocine to avoid immediate relapse. Ideally, obstetrical procedure should be carried out within one-half hour after inversion.

Adult↗
PubMed1991

[Autoimmune thrombocytopenic purpura and pregnancy: significance of fetal blood punction].

The authors report three cases of percutaneous fetal blood sampling at 38 weeks of pregnancies complicated by immunologic thrombocytopenia. In each case, the purity was perfect which is essential for using the examination with a view to the obstetrical management. The birth is programmed 24 or 48 hours later. In two cases, the neonatal control is in agree with the fetal blood sampling. In the third observation, the fetal platelet count in 142,000/mm3 and the newborn control 55,000/mm3: the only explanation is a very active process as usually state with newborns. There was no accident, and these samplings led to natural births. This approach seems to be the more effective for the evaluation of fetal platelet count and allow the choice of birth management. A cesarean section is decided in case of fetal thrombopenia lower than 50,000/mm3.

Adult↗
PubMed1991

[Hydranencephaly. Report of a new case].

Hydranencephaly is the total or virtually total absence of the cerebral hemispheres, which are reduced to a membranous sac of glial tissue, with no ependymal coating, in an intact skull. This is rare disorder (0.5 per thousand births). It is classified as a circulatory encephalopathy. Two opposing theories are generally advanced: the encephaloclastic or destructive theory and the theory of dysontogensis or malformation, due to early disruption of organogenesis. It has many causes (vascular, viral, parasitic, genetic, toxic, estrogenic...). It appears to be readily diagnosed by ultrasound, the neurological findings may be normal at birth, but transillumination of the skull remains a simple and reliable diagnostic test. Transfontanellar ultrasound, CT scanning and anatomical confirmation alone can establish the diagnosis. The prognosis is hopeless and there is no treatment.

Adolescent↗
PubMed1991

[Management of persistent posterior occipital presentation. 253 extractions by forceps].

A retrospective study of the notes of 253 deliveries was carried out in the two maternity units attached to the University of Rennes between 1980 and 1985. This followed a review of the literature on delivery of babies presenting with a persistent occipito posterior position. Tarnier's forceps were used in each case with full rotation of the presenting part carried out or else delivery in the occipito posterior position. There were five cases of failed forceps. We have not been able to show that there was a significant statistical difference as far as the neonatal state of the babies was, because to the methods of delivery. On the other hand, there was a greater frequency of urinary-vaginal lesions after full rotation. We therefore suggest that a trial of forceps delivery should be carried out in the operating theatre when the optimal obstetrical conditions have been fulfilled, so long as the manoeuvres are carried out technically easily and so long as Caesarean section is resorted to if all the obstetrical conditions are not fulfilled, or if it seems difficult to deliver the baby with a forceps.

Cesarean Section↗
PubMed1991

[Scarred uterus. Results and selection of patients for vaginal delivery. Apropos of 884 cases].

The authors present their results as far as successful vaginal delivery (in 39.9% of cases) carried out in 884 cases with a scar in the uterus. They also give the morbidity and maternal and fetal mortality as well as those that developed a rupture of the uterus. No mother died in their series and there was no fetal death that could be ascribed to a complete rupture or a uterine dehiscence. Both fetal and maternal mortality was considerably higher when the trial of scar failed or when a Caesarean section was carried out prophylactically, as compared with the results from vaginal delivery. 2.17% of all the 884 patients with a uterine scar had a complete or incomplete rupture of the scar. Finally the describe their criteria for selecting patients for attempts at vaginal delivery and they show that it is necessary to test the ability of the fetus to pass through the pelvis after looking very carefully at the partogram made for the previous Caesarean operation. In this way they were able to use a trial of labour in slightly contracted pelves or where the fetus was big in such a manner as to obtain a vaginal delivery in, respectively, 68 and 72% of cases.

Birth Weight↗
PubMed1990

[Fatal maternal streptococcus A infection after cesarean section].

A case is reported of an infection with Streptococcus pyogenes, occurring 24 hours after an elective Caesarean section in a 30 year old woman. She worsened during the first 48 h, with shock (Pasys less than 70 mmHg, pH 7.28) as well as abdominal tenderness and guarding. Laparotomy revealed peritonitis, and subtotal hysterectomy was carried out. Gram positive cocci were found in the peritoneal exudate, with bacterial cultures yielding Streptococcus pyogenes. Histopathological examination of the specimen revealed necrosing endomyometritis with septic thrombophlebitis. During the immediate post-operative period, there were several prolonged episodes of circulatory arrest treated with dobutamine, adrenaline, and noradrenaline. Multiple organ failure occurred during the next five days, despite antibiotic therapy (vancomycin, tienamycin, amikacin) and intensive care. It included jaundice, thrombocytopaenia (10 G.l(-1] adult respiratory distress syndrome (ARDS). A further laparotomy was carried out because of abdominal and thigh cellulitis, with completion of the hysterectomy and bilateral salpingo-oophorectomy. Streptococcus pyogenes was still present in the peritoneal cavity. There followed an improvement, with a return to normal of the platelet count, haemodynamic stability such that vasoactive drugs were no longer needed, and a decrease in the degree of jaundice. However, the ARDS worsened, and the patient died 15 days after the Caesarean section. There have been recent reports of similar cases, suggesting an increase in the virulence of group A streptococci linked to a re-emergence of exotoxin A.

Adult↗
PubMed1990

[Comparative use of analogs of prostaglandin by intravenous or vaginal administration in termination of pregnancy].

We made a prospective study using vaginal suppository of Géméprost (analogue of PGE1) and intravenous infusion of Sulprostone (analogue of PGE2) in thirty second- and third-trimesters pregnancy terminations. The efficacy was excellent for both procedures: only one failure, mean duration of abortion of 15 h 15 with Sulprostone, interval of 17 hours with Géméprost. In this case, the delay was shorter when vaginal administration was made every 6 hours. The evacuation of the uterus was very good, however one aspiration was made three days after abortion. Few side effects were observed with these two drugs: one case of fever, one case of vomiting, both with Sulprostone: two cases of nausea, one case of diarrhoea with Géméprost. We think that the effectiveness is marked and comparable, allowing the use of epidural anesthesia.

Abortifacient Agents↗
PubMed1990

[Treatment of autoimmune neonatal thrombocytopenia with high-dose intravenous immunoglobulins].

During the neonatal period, 6 infants born to mothers with auto-immune thrombocytopenia purpura were diagnosed as having severe thrombopenia (platelet counts below 30 X 10(9)/l). High doses of intravenous immunoglobulins (IVIG) (0.4 g/kg/injection for 2 infants and 1 g/kg/injection for 4 infants) were administered as of the first week of life. Short-term efficacy was good in all cases (platelet counts over 50 X 10(9)/l, 2-10 days after the first injection). During the second week of life, 5 newborns had relapses which were rapidly reversed by one or several IVIG injections. The thrombopenia was cured between days 19 (shortest) and 41 (longest) and, more over, no side effects were observed. High doses of IVIG seem to be an effective and well-tolerated treatment for neonatal auto-immune thrombopenia, and they can be recommended over classical treatments (corticotherapy, exchange transfusion, platelet transfusion) as a first line of attack.

Adult↗
PubMed1990

[The contemporary history of breech delivery].

After the last 50 years, the problems raised by breech presentation may be summarized as follows: during this period, foetal prognosis has been notably improved, the improvement is, nevertheless, considered to be insufficient in the present sociocultural context, the improvement has been brought about by various means and methods for which it is not easy to establish a ranking of values, too many differences remain concerning the significance of the presentation itself, as well as the results obtained with the various therapeutic approaches, these uncertainties prevent definition of the best management approach and, consequently, prevent fresh progress from being made, these uncertainties can only be removed by making an effort to integrate and summarize all that has been or will be published concerning the subject.

Breech Presentation↗
PubMed1989

[2 cases of the HELLP (Hemolysis Elevated Liver Low Platelet) syndrome].

Recently described by Weinstein, the "HELLP syndrome" is an entity of the pre-toxemic syndrome; its precise physiopathological mechanism, related to a thrombotic micro-angiopathy, is still not clearly established. Therefore, the treatment remains symptomatic, associated with the treatment of the toxemia. Two cases occurring in twin pregnancies are reported.

Adult↗
PubMed1989

[Selective interruption of pregnancy and embryonic malformations of the limbs].

The authors report 3 cases of fetal malformations consisting of amputation of the limbs. These were found in their cases of selective abortion carried out around the 10th week of amenorrhoea by injection under ultrasonic needle guidance of hypertonic saline into selected sacs. These malformations seem to be associated with either the existence of amniotic bands or with a toxic mechanism (direct contact of the limbs of the embryo with neighbouring hyperosmolar membranes). This technique is to be given up in favour of transcervical aspiration, or direct needling of the fetus. The different techniques for selective abortion have been reviewed as well as the so-called "alternative" techniques (such as follicular aspiration) which are preferable.

Abortion, Therapeutic↗