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Biomedical subjects

M Camus

Publications and source records attributed to M Camus.

At least 127 records · Page 7Linked to original sources
PubMed1990

[Analysis of 10 cases of pregnancy after renal transplantation].

Renal transplantation has changed completely the fertility of women who had been dialysed. Our study is on 10 pregnancies which we followed up in 7 women who had had renal transplants in the University Hospital of Pitié Salpêtrière (Professor Y. Darbois) between 1979 and 1985. All patients were treated by the same technique and the same methods of prevention of rejection of the transplant. The mean interval between the transplant and pregnancy was 53 months. In 3 cases there was hypertension and raised creatinine levels (more than 150 in 3 cases). In 2 cases the two conditions were associated. The prognosis is bad when a raised blood pressure or a change in renal function occurs before pregnancy starts, leading to a real deterioration in renal function during the pregnancy when such function was abnormal before the pregnancy started. As far as the infants were concerned, the most common complication was IUGR (intrauterine growth retardation) which was found in half of all cases. Blood flow studies in these fetuses are particularity interesting. There were two cases of intra-uterine fetal death. The reasons for these were not necessarily connected with the deterioration in renal function. All the deliveries were by caesarean section, for medical reasons in 7 out of 10 cases. The average duration of the pregnancy was 35 weeks of amenorrhoea. As far as the mothers were concerned, they did not have more infections than other women in spite of being immuno-suppressed (this was excluding urinary tract infections).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1989

An 18-month survey of infertility treatment by in vitro fertilization, gamete and zygote intrafallopian transfer, and replacement of frozen-thawed embryos.

An 18-month survey of infertility treatment by in vitro fertilization (IVF) and related procedures at the Centre for Reproductive Medicine of the Vrije Universiteit Brussel is described. During this period, 1326 treatment cycles were started in patients with long-standing infertility and 1135 oocyte retrievals were performed in 771 different patients. IVF and embryo transfer (ET) after laparoscopic (N = 793) or ultrasonically guided (N = 342) ovum pickup, gamete intrafallopian transfer (GIFT; N = 284), or zygote intrafallopian transfer (ZIFT; N = 15) combined with IVF as well as the replacement of cryopreserved embryos yielded an overall pregnancy rate of 21.8% per started cycle. Echographic and laparoscopic oocyte retrieval gave similar results except for a higher fertilization rate after echographic-guided retrieval. For in vitro fertilization and embryo transfer an overall pregnancy rate of 26% per transfer was obtained. For GIFT and ZIFT the pregnancy rates were, respectively, 27.8 and 46.7% per replacement. For each procedure one-third of the pregnancies aborted. After the replacement of frozen and thawed embryos, during a natural cycle, a significantly lower fetal loss was observed.

Adult↗
PubMed1989

Splenic enlargement and Traube's space: how useful is percussion?

PURPOSE: The utility of Traube's space percussion in the bedside assessment of splenic enlargement was evaluated. The influence of meals and obesity on this sign were also assessed, because both are believed to interfere with the results of abdominal percussion. PATIENTS AND METHODS: The inpatient population of a tertiary care hospital was studied where cases and controls were selected according to the results of abdominal ultrasonographic examinations. RESULTS: Traube's space percussion exhibited a sensitivity of 0.62 (95% confidence interval [CI], 0.51 to 0.71) and a specificity of 0.72 (95% CI, 0.65 to 0.80) when classifying tympanitic examinations as negative. False-positive examinations were reduced by assessing patients more than two hours after mealtime. Obese patients were a source of false-negative examinations. CONCLUSION: Traube's space percussion compares favorably with other commonly used clinical maneuvers and diagnostic tests. When performed alone in a selected patient population, it adds useful clinical information but is not sufficiently sensitive or specific to obviate the need for further diagnostic testing.

Adult↗
PubMed1989

Human embryo viability after freezing with dimethylsulfoxide as a cryoprotectant.

This study concerns the effects of a slow freezing and thawing protocol using dimethylsulfoxide (DMSO) as a cryoprotectant on the survival and viability of 319 supernumerary human embryos produced after in vitro fertilization. One hundred twenty-one transfers were performed in a natural cycle and 18 pregnancies were achieved (15%), from which 14 were ongoing (12%). Overall, 52% of the thawed embryos retained at least 50% of their initial blastomeres intact after thawing, and were replaced. Survival was strongly correlated to prefreezing embryonic quality, as 78% of type I embryos, 55% of type II, 40% of type III, and none of type IV could be transferred. Implantations were obtained from type I embryos (21% per embryo replaced) and from type II (14.5%), whereas none of the type III embryos resulted in a pregnancy. In the authors' experience, using the DMSO protocol, the best pregnancy rates were achieved when replacing 8-cell embryos of high morphologic prefreezing quality. No statistically significant difference could be demonstrated, however, in implantation rates between 8-cell and 4-cell embryos, or between synchronously and asynchronously dividing concepti.

Blastomeres↗
PubMed1989

Performance of different embryo transfer catheters in a human in vitro fertilization program.

In a prospective and randomized study on 400 consecutive embryo transfers (ETs), the performance of three different transfer catheters was evaluated. In cases of difficult ET, the TDT catheter (Prodimed, Neuilly-en-Thelle, France) performed the best. However, the pregnancy rate with this catheter was the lowest (9.2%/ET). A better pregnancy rate (19.4%/ET) can be achieved when TDT catheter was used under ultrasound guidance. The Frydman catheter (Prodimed, Neuilly-en-Thelle, France) yielded the highest pregnancy rate (32.3%/ET) but also the highest frequency of difficult transfer procedures. The Wallace catheter (H.G. Wallace Limited, Colchester, England) showed similar performance, but the pregnancy rate was lower (19.2%/ET) compared with the Frydman catheter. Therefore, the Frydman catheter is used as the first choice, and for difficult transfers the TDT catheter under ultrasound guidance can be recommended.

Animals↗
PubMed1989

Zygote intrafallopian transfer as a successful treatment for unexplained infertility.

This study describes the zygote intrafallopian transfer treatment in patients with unexplained infertility. After retrieval, the oocytes were inseminated with 80,000 progressive motile sperm cells per milliliter. If fertilization occurred, a maximum of three zygotes were replaced by laparoscopy in the fimbrial end of one healthy fallopian tube. A pregnancy rate of 48.1% per zygote intrafallopian transfer replacement was obtained. Seventeen pregnancies are actually ongoing, two patients delivered, and seven patients miscarried. Even after replacing a maximum of three zygotes, there were 6 twin and 2 triplet pregnancies.

Adult↗
PubMed1989

Assisted procreation in the presence of a positive direct mixed antiglobulin reaction test.

Twenty-five infertile couples in which the male had antisperm antibodies were treated by in vitro fertilization (IVF), zygote intrafallopian transfer, or gamete intrafallopian transfer in 38 cycles. In 10 females a tubal pathology was present, and in the normal female patients repeated intrauterine insemination with husband sperm had failed. The presence of an andrological factor in 17 male patients did not influence the fertilization and the cleavage of the retrieved oocytes. Although the fertilization rate of 45.8% was significantly lower than in patients with tubal pathology, the pregnancy rate was 34.2% per started cycle and 44.8% per replacement. Furthermore, the embryos were of lesser quality than in couples with tubal and idiopathic infertility. This study suggests that IVF could be considered as a useful therapeutic approach for couples with a positive direct mixed antiglobulin reaction test before advising them the use of heterologous sperm.

Adult↗
PubMed1989

Synchronization of donor's and recipient's cycles with GnRH analogues in an oocyte donation programme.

In this oocyte donation programme nine female donors were stimulated using a combination of GnRH analogues and human menopausal gonadotrophins. A total of 149 oocytes were retrieved. Thirty fresh embryos were transferred in 14 uterine replacements, resulting in four pregnancies and 15 fertilized oocytes were placed in the Fallopian tube of six recipients, yielding two pregnancies. A mean number of 2.2 embryos was replaced. The implantation rate per embryo was 13%. Furthermore 36 embryos were cryopreserved for later use. Following 20 replacements, six pregnancies were established (30% per transfer); since two patients aborted, the ongoing pregnancy rate was 20%.

Adult↗
PubMed1989

The effect of pneumoperitoneum gases on fertilization, cleavage and pregnancy in human in-vitro fertilization and gamete intra-fallopian transfer.

A prospective, randomized study was carried out, creating a pneumoperitoneum with 100% CO2 or with 5% CO2 in air and evaluating the effect(s) of these gas phases on fertilization, cleavage and pregnancy outcome in this in-vitro fertilization and embryo transfer programme. There was no significant difference in the fertilization rate when either 100% CO2 or 5% CO2 in air was used for insufflation during laparoscopy. Further, embryonic development and pregnancy rates also indicated no significant differences between the two groups. Similarly, the oocytes which were retrieved and replaced with spermatozoa in the gamete intra-Fallopian transfer programme using either 100% or 5% CO2, gave similar pregnancy rates. Furthermore, the fertilization and cleavage rates of the supernumerary oocytes were not significantly different in both groups.

Carbon Dioxide↗
PubMed1989

Zygote intra-fallopian transfer as an alternative treatment for male infertility.

The results of 42 zygote intra-Fallopian transfer cycles in 37 couples with persistent male infertility are reported. Of 396 retrieved oocytes, 39.1% fertilized normally and 63 zygotes were replaced in 25 cycles. Twelve patients became pregnant, including two twin pregnancies. The pregnancy rate was 28.6% per started cycle and 48.0% per replacement. The implantation rate per replaced zygote was 22.2% (14 of 63 replaced zygotes implanted). Sixty-two supernumerary zygotes or embryos were cryopreserved for later use.

Embryo Transfer↗
PubMed1989

Effect of transuterine puncture during transvaginal oocyte retrieval on the results of human in-vitro fertilization.

In many in-vitro fertilization (IVF) programmes, the transvaginal approach is now the most widely used method for ultrasound-guided oocyte retrieval. Sometimes, however, the position of the ovaries is such that it might not be possible to aspirate the follicle transvaginally without puncturing the uterine wall. Between May and November 1988, we performed 518 transvaginal, ultrasound-guided oocyte retrievals for IVF or zygote intra-Fallopian transfer (ZIFT). During this period, 22 transuterine punctures (4.2%) were necessary to reach one of the ovaries. To investigate the effect of uterine laceration on the results of IVF/ZIFT treatment, the outcome of treatment was compared between patients who had a transuterine puncture and a control group of patients treated by IVF or ZIFT during the same period without transuterine puncture. Seven of 16 patients who had a transuterine puncture became pregnant after IVF, compared to 84 pregnancies out of 347 cases (24.2%) in the control group. After ZIFT, two pregnancies (2/6) were achieved in patients with uterine laceration, compared to 46 pregnancies out of 149 procedures (30.8%) in the control group. These differences were not statistically significant. Transuterine puncture during transvaginal oocyte retrieval does not seem to have an adverse effect on the results of human IVF and ZIFT treatment.

Female↗
PubMed1989

Time of insemination and its effect on in-vitro fertilization, cleavage and pregnancy rates in GnRH agonist/HMG-stimulated cycles.

In this prospective study, we compared the effect of delayed inseminations on fertilization, cleavage and pregnancy rates in two groups of patients. In one group, the ovarian stimulation was performed with a clomiphene citrate/human menopausal gonadotrophin/human chorionic gonadotrophin (CC/HMG/HCG) protocol. The other group was pre-treated with gonadotrophin-releasing hormone agonist (GnRHa) and ovarian stimulation was carried out with an HMG/HCG protocol. Under both protocols, a delay of 2, 4 or 6 h in insemination showed no significant differences in the fertilization, cleavage or pregnancy rates. To find out which type of oocyte has the potential for better fertilization, cleavage and implantation, a simple oocyte classification scheme is proposed. In the GnRHa/HMG group, 9% post-mature, 90% mature and only 1% immature oocytes were retrieved. The post-mature oocytes showed a tendency towards reduced fertilization when insemination was delayed. The mature and slightly immature oocytes fertilized equally well when spermatozoa were added 2, 4 or 6 h after retrieval. Similarly, no significant difference was observed in the cleavage (80%) or fragmentation (20%) rates of these oocytes. The pregnancy rates after inseminations delayed for 2, 4 and 6 h were 14, 27 and 26%, respectively. Though these figures were not statistically significant, the 4- and 6-h groups in both the IVF and zygote intra-Fallopian transfer treatments showed a slightly improved pregnancy rate compared to the 2-h group. An insemination delay of 4 h is advocated on a routine basis.

Adult↗
PubMed1989

Establishment of 22 pregnancies after oocyte and embryo donation.

Donated oocytes inseminated with partner's semen or donated embryos were transferred on 95 occasions in 28 women without ovarian function and in 21 with functional ovaries. Overall, 22 pregnancies were established, 13 after the transfer of fresh embryos and nine after the transfer of frozen-thawed embryos. Eleven of the pregnancies were established in women without ovarian function and 11 in women with functional ovaries. Nine of the pregnancies were established with donated oocytes inseminated with partner's semen and 13 with donated embryos. Fifteen healthy infants were born including one set of twins; three pregnancies are progressing normally and five miscarried.

Adult↗
PubMed1989

[Analysis of 42 membrane ruptures during the second pregnancy trimester].

65 cases of premature rupture of the membranes before the 28th week of amenorrhoea occurred during the 5 years between 1983 and 1987 in two maternity units in Paris. A retrospective study was carried out on 42 of these cases where conservative measures had been decided on. In two-thirds of the cases, of which 42% had had bleeding and 40% vaginal infection, the pregnancy had appeared to be progressing normally before the rupture of the membranes. 14% had had cerclage and 12% had had selective intrauterine fetal reduction or biopsy of the trophoblast or removal of an intrauterine device. Rupture of the membranes rarely happens in isolation because it is usually accompanied by uterine contraction or bleeding, which may occur separately or associated with one another in half the cases. In 21% of cases bacteriological examination was positive after the rupture. All patients were treated conservatively in this study. Antibiotics were prescribed in 35 cases and tocolysis in 13 cases. The membranes were ruptured on an average for 7 days. It was almost impossible to avoid infection except in two patients who delivered rapidly. The pregnancies resulted in 8 intrauterine deaths, 15 deliveries of babies that were not viable, 19 deliveries of live babies of which 7 were by caesarean section. 15 babies survived the neonatal period. This work makes it possible to judge whether it is really hazardous to try to be conservative before the 24th week of amenorrhea. Even if neonatal mortality is being lowered at term, overall in our series it was 25%. Finally, it does not seen that tocolytics or antibiotics help to lower this mortality significantly.

Adolescent↗
PubMed1989

[Epilepsy and pregnancy. Apropos of 50 cases].

This work is a report on the follow-up of 50 pregnant epileptic women who were looked after in the Gynaecological and Obstetric Service of La Pitié-Salpêtrière in Paris. These patients had a generalised form of the disease. Well controlled patients usually had simple pregnancies. On the other hand half of those who had frequent attacks were worse during the pregnancy. It is rare for complications to occur either in the mothers or the neonates. The element that is most serious is the risk of malformation, which is three times as great whatever treatment is used and it does seem to increase according to the number of attacks occurring during the pregnancy. It therefore seems important that all epileptics should be stabilised before each pregnancy and medication should be given and controlled. It is important all the same that these are at-risk pregnancies that require clinical and ultrasound supervision.

Abnormalities, Drug-Induced↗
PubMed1989

[Myasthenia and pregnancy. Apropos of 8 cases].

In 10 years we dealt with 8 cases of pregnancy in myasthenic women. Pregnancy does not seem to cause myasthenia to develop. Worsening of the condition, which we found in 40% of our cases, occurs particularly in the first trimester and nearly always regresses. Another critical period is after delivery. Deaths are not unusual in the literature but we did not have to record one in our study. Because myasthenia evolves in different ways it is important to watch these cases carefully and as soon as the diagnosis has been made stabilising treatment is needed. The patient has to be watched for at least two months after the delivery. During the pregnancy the first line of treatment is to use anticholinesterases which do not have any teratogenic effects. In our study all the women carried their pregnancies to term; although in the literature 10-40% of deliveries were premature. This fact makes one consider whether there is an oxytocic effect of anti-cholinesterases. If the mother becomes very tired she should have very little expulsive effort to carry out. Forceps delivery, which is often necessary, is helped if an epidural anaesthetic is given. Breast feeding by the mother can only be carried out if the myasthenia is stable and if there are weak levels of anti-receptor antibodies to acetylcholine. 50% of the newborn are often small for dates and show transitory myasthenia after delivery. The literature, however, shows only 10-20%. This finding is not always correlated with the levels of anti-receptor antibodies for acetylcholine. If they are present, they are useful to diagnose transitory myasthenia.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1989

[Cicatricial uteri. Vaginal delivery under peridural analgesia].

The results of 108 attempts to deliver women who had previously had caesarean sections vaginally under epidural analgesia are studied. 94 patients (87%) delivered vaginally taking the usual length of time for dilatation and delivery. These confirm that epidural analgesia does not alter the prognosis for this type of delivery. However, one uterus unfortunately ruptured with the rapid death of the baby. This study makes it possible to define certain rules that should be carried out to lessen or even get rid completely of the risk of these accidents. As far as the anaesthetic is concerned, epidural analgesia should be carried out and watched very carefully. Small doses of anesthetics should be used and those in low concentrations. Symmetry analgesia should be good. Medics should be aware of the cumulative effect of adding dose on dose. Finally, morphine or morphine-like substances should either be used carefully or forbidden altogether. These precautions will limit the quantities of epidural analgesics that are delivered and assure that there is symmetry so that it is easier to recognize the signs before rupture of the uterus. As far as the obstetrical side is concerned, although we did not use oxytocics very often (37%) we did not find that there was any risk attached to it. We recommend, however, that internal monitoring should be carried out very often whether oxytocics are used or not. Routinely, instruments should be used for the delivery to lessen the efforts required to expel the baby. Exploring the cavity of the uterus after the delivery does not seem to us to be necessary unless there are the usual obstetric indications for doing this.

Adult↗