Platelet antigen HPA-5b (Bra) in an Algerian population.
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Adult↗
Biomedical subjects
M Gamerre
Publications and source records attributed to M Gamerre.
[Home delivery].
Home delivery, although unconventional, has not totally disappeared. It sometimes results from the desire to "demedicalise" an event deemed natural and is sometimes the consequence of government policy and hence approved by medical authorities. This is the unique situation of Holland, where a highly efficient home delivery system has been created, with the possibility of transfer of the mother at any time to rapidly available emergency medical teams. In fact the large majority of home deliveries are accidental, unprepared and take place in the absence of any medical or paramedical assistance. All available studies show that perinatal and maternal morbidity associated with these accidental deliveries is greater than that of hospital deliveries, and this despite the setting up of emergency services responding as soon as a distress call is received. Home delivery should remain the exception at present since it is unable to guarantee a birth as undangerous as possible.
Emergencies↗
[Alternatives to hospitalization in gynecology-obstetrics].
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Ambulatory Care↗
Fetal karyotype from cystic hygroma fluid: diploid/tetraploid mosaicism.
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Adult↗
In vivo MRI of the fetal brain.
We report MRI of the brain in 45 fetuses; the findings were confirmed by pathological examination or postnatal neuroradiological studies. MRI necessitates medication to eliminate fetal motion; curare was injected into the umbilical cord, and MRI is therefore limited to cases in which umbilical cord puncture is indicated. T1-weighted images were obtained in axial, sagittal and coronal planes; the last of these were generally as the most useful as regards morphology. We demonstrated cerebral malformations (n = 13), brain haemorrhage (n = 1), a facial angioma (n = 1), a facial mass (n = 1), hydrocephalus (n = 5), unilateral ventricular enlargement (n = 1), atrophy (n = 4), a porencephalic cyst (n = 1) and normal appearances of the brain in 18 cases. Twenty-two of the fetuses were born alive, and the clinical and/or neuroradiological examination confirmed the antenatal findings. The diagnosis was also confirmed in 8 cases in which a neuropathological examination was possible.
Agenesis of Corpus Callosum↗
[Simultaneous radiotherapy and chemotherapy in the treatment of advanced cancer of the cervix uteri].
The pelvis is a major site of failure in patients with advanced carcinoma of the cervix. Attempting to improve local disease control, 40 patients were treated between February 1988 and July 1992 with concurrent chemoradiation (CCR). Thirty three patients (group A) with bulky cervical tumors (> 5 cm) received this CCR as the first part of their treatment (stages IB: 4; IIB with distal parametrial involvement: 14; IV: 15). CCR was followed by brachytherapy and a parametrial boost if indicated, then by surgery. CCR was also given, as a postoperative treatment, in seven patients (group B) with a bulky nodal involvement on a previous hysterectomy with lymphadenectomy performed for an early stage. CCR was a pelvic radiation therapy (RT): 45 Gy/25 F/33 d (two fractions per day in the last 14 patients) and a chemotherapy delivering: CDDP 60 mg/m2 on days 1 and 21, followed by 5-FU 600 mg/m2 i.v. continuous infusion for 96 hours (respectively 40 and 400 mg/m2 in the 16 last patients). Median follow-up is 35 months (range 10-63 m). Acute toxicities were grade 3-4 diarrhea in 16 patients and another patient died from a septic episode without leucopenia after CCR. Five post-operative complications required a second surgical procedure. Among these five patients, one died and two other developed small bowel late complications. No post-operative or late complication were observed in patients treated with a bi-fractionated RT. Sites of failure were: pelvic: four; metastases: five, both: three. Thirty months survival and DFS rates were 67.5% and 58.4% in the whole series and respectively 64% and 52.5% in stages IB-IIB patients and 63% and 59% in stage IV patients. Surgery is an important factor of the treatment and a CCR with a bi-fractionated RT allows such a surgical procedure. These encouraging results must be confirmed by a prospective study to determine whether a CCR is able to improve local control and survival.
Adult↗
[Fetal supraventricular tachycardia. Management].
We report two cases of fetal supraventricular tachycardia with hydrops fetalis. The transplacental therapy with digoxin, sotalol and amiodarone, using combination of both of this drugs, has given in one case a partial conversion, total in the second case. Ultrasounds allow diagnosis of SVT, evaluate the gravity when it is associated with fetal hydrops secondary to a congestive heart failure, research a cause and follow the evolution during the treatment. The treatment must begin when diagnosis of SVT is done, by digoxin; other drugs as sotalol, amiodarone or flecainide acetate are described and also direct fetal therapy by intramuscular or into the umbilical vein injections.
Adrenergic beta-Antagonists↗
[Chorionic villus needle sampling by the transabdominal route or by placental centesis. A series of 930 cases].
The authors report on a series of 930 chorion villus sampling diagnoses made with a needle by the transabdominal route, from January 1991 to October 1992 at the Prenatal Diagnosis Center in Marseille. Indications for prenatal diagnosis were: raised maternal age in 75% of cases (N:698); ultrasound findings in 11% (N:106), chromosome abnormalities in the family in 6% cases (N:53), raised human chorionic gonadotrophin in 4% cases (N:38), parental rearrangement in 2% cases (N:20), and sex linked disease in 1% (N:15). The success rate was 97% with 29 failures; the number of needle insertions was one in 97% cases and two in 3% cases. The average gestational age at sampling was related to the indications; 16 weeks of amenorrhoea for raised maternal age, and 22 weeks of amenorrhoea for ultrasound findings. Thirty one abnormalities were observed, four balanced translocations, and seven placental mosaicisms. Forty eight pregnancies terminated in abortion. The rate of fetal loss was 3.5% (7 cases) for the 200 first cases and 1% (8 cases) for the 730 following cases. Choriocentesis through the transabdominal route provides a diagnosis within a few days and the rate of fetal loss is close to that of amniocentesis. These arguments are in favour of an extension of this method of sampling.
Abortion, Therapeutic↗
[Contribution of Doppler in fetal prognosis].
Uteroplacental and cerebral artery velocimetry is a predictive factor in the outcome of many high-risk pregnancies. Positive predictive value is good for intrauterine growth retardation (complications due to preeclampsia, diabetes or twin pregnancy). Velocimetry is also a predictor of adverse outcome in small for gestational age fetuses and for oligohydramnios but not for anemic fetuses of isoimmune pregnancies or post-term pregnancies.
Cerebral Arteries↗
[Neonatal consequences of premature rupture of membranes (more than five days) before the 34th week of gestation].
Twenty-six cases of premature braking of the membranes which occurred before week 34 of amenorrhea and lasted for more than 5 days are assessed retrospectively. The mean age when the membranes broke was 26.6 weeks of amenorrhea. Delivery occurred on average at 31.5 +/- 2 WA, with an interval of between 6 and 91 days (mean 35 +/- 23 days). In 4 cases, chorioamniotitis complicated the premature breaking of the membranes. The perinatal mortality rate was 5 out of 27, including 2 still births. Nine of the neonates showed respiratory distress which required artificial ventilation. Four cases of pulmonary hypoplasia were confirmed by pathological examination. In all cases, this was associated with a reduction in the volume of the amniotic fluid, reduced fetal mobility and delayed intrauterine growth. In contrast, when these three factors were absent the prognosis was always good, regardless of the date at which the membranes broke. In the long term, the surviving children showed no neurological sequelae.
Birth Weight↗
Influence of the morphological aspect of embryos obtained by in vitro fertilization on their implantation rate.
In a series of 500 transfers of embryos obtained by in vitro fertilization, we examined the implantation rate of 1356 embryos transferred in utero. The average implantation rate per embryo was 15.1% and remained relatively constant, regardless of the number of transferred embryos per patient. The implantation rate per embryo, in relation to its morphology, was clearly lower when irregular blastomeres and fragments were present in the perivitelline area. Other embryos, regardless of their morphology, had an identical development potential. Analysis of the results of this series demonstrates the difficulty of determining the development potential of all the embryos on the basis of morphological criteria.
Embryo Implantation↗
Epididymal sperm aspiration in conjunction with in-vitro fertilization and embryo transfer in cases of obstructive azoospermia.
Epididymal sperm aspiration is a new treatment for vasal agenesis. In previous reports, epididymal spermatozoa resulted in pregnancy by utilizing in-vitro fertilization (IVF) or gamete intra-Fallopian transfer (GIFT). We sought to investigate the efficacy of epididymal sperm aspiration in conjunction with IVF in patients with congenital absence of the vas deferens or with secondary extended obstruction of spermatic ducts. Fifty-eight attempts were performed in 23 patients (25-50 years). Eight patients (34.7%) had vasal agenesis and 14 (60.8%) presented with vasal secondary extended obstruction. The sperm count was adequate (greater than or equal 20 x 10(6)/ml) in 13.8% of sperm retrievals and sperm motility of 20% was obtained in 15.5% of sperm retrievals. Fourteen attempts at IVF were performed with epididymal sperm counts of 2-44 x 10(6)/ml and motilities of 0-45%. A mean of six mature oocytes (0-13) were inseminated in each case. Five embryo transfers were performed in five patients' wives (35.7%) and two couples had an early pregnancy loss (14.2%). Epididymal sperm aspiration is an advance in treating such patients, as an adequate number of mature spermatozoa can be obtained and used for IVF. However, spermatozoa directly aspirated from the proximal epididymis and with fertilizing capacity in vitro, gave a high rate of embryo degeneration (greater than 50%) after embryo transfer.
Adult↗
Nucleolar changes in human embryo during the pre-implantation stage. Activation of ribosomal genes during the nucleologenesis.
We studied the structural and functional organization of human embryo nucleoli during the pre-implantation stage from spare embryos obtained by in vitro fertilization. In human embryo nucleoli, structural modifications occur during the first cleavages. They lead to the constitution of a reticulated nucleolus from an initial structure called primary nucleolus. They appear during the third cleavage and correspond to the nucleogenesis. Autoradiography shows no transcription in the primary nucleolus. Transcription of rDNA starts on the periphery of the initial structure after the 4-cell stage. It corresponds to the beginning of the embryonic gene expression. The entire nucleolus will be progressively concerned by this transcription during the reticulation. Silver staining at the ultrastructural level shows that Ag-NOR proteins are missing in the primary nucleolus. In the beginning of nucleogenesis, Ag-NOR proteins are first located on the nucleolar periphery. Their following distribution corresponds to the structures containing rDNA in the nucleolus. Nucleologenesis in the human embryo during the pre-implantation stage first requires an association of rDNA with a primary structure, then an activation of ribosomal genes.
Autoradiography↗
The relation between seborrheic keratoses and malignant solid tumours. A case-control study.
In order to establish whether or not here is an association between cancer and intense growth of seborrheic keratosis, the so-called Leser-Trelat sign, we conducted a case control study in which the number and features of seborrheic keratosis in 82 patients with recent solid tumours, were compared with 82 age- and sex-matched controls. Neither numbers nor features of seborrheic keratosis differed significantly in patients and controls. Eruptive seborrheic keratosis was noted in only one patient and one control. This study showed that solid malignancies are not generally associated with an increase in the number or size of seborrheic keratosis lesions, thus suggesting that they are not controlled by a hypothetical secretion of growth factors by tumours. Our results suggest that Leser-Trelat is either a coincidence, or at most a very rare sign of unusual types of cancer. We also showed that multiple cherry angiomas, previously reported to be a paraneoplastic sign, are not regularly associated with solid tumours.
Adult↗
[Leukorrhea. Diagnostic orientation and management].
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Endometritis↗
[The usefulness of the level of alpha-fetoprotein (AFP) and electrophoresis of amniotic acetylcholinesterase for the detection of selected congenital malformations].
We report the experience of a prenatal diagnosis center for routine amniotic alpha-fetoprotein and acetylcholinesterase analysis during the second trimester of pregnancy in 4,411 pregnant women. The identification of neural tube defects, for a population with a low prevalence, and of other major birth defects was studied. The pertinence of practising a fetal karyotype when these tests were abnormal was also estimated. For amniotic acetylcholinesterase, 262 electrophoreses were done. Sensitivity, specificity and positive predictive values of the tests were calculated. One fetus out of 4 carries an unbalanced chromosomal anomaly if amniotic alpha-fetoprotein is higher than the mean plus 2 standard deviations. This result shows the need for a fetal karyotype for all these cases.
Acetylcholinesterase↗
[Epidemiology of cancer of the endometrium].
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Estrogens↗
The effects of oral administration of progesterone for premature labor.
The potential tocolytic effect of natural progesterone administration on premature labor was investigated in a double-blind study. An oral progesterone formulation was used because its ability to increase both plasma and myometrial concentration of progesterone in pregnant women had been previously demonstrated. Furthermore, no commercial intravenous or intramuscular natural progesterone formulation is currently available in France. Fifty-seven patients in two obstetric clinics, admitted because of the risk of premature delivery, were included in the study, and uterine contractility and fetal cardiac rhythm were monitored in all of them. At random and after 30 minutes' rest, 29 women absorbed four capsules of 100 mg of progesterone each and 28 women absorbed four capsules of a placebo. Plasma progesterone levels were evaluated in all cases after 30 minutes' rest and 1 hour after absorption of the capsules. The results showed that bed rest and placebo administration decrease uterine activity in 42% of the cases and oral progesterone decreases activity in 75% to 88% of cases, depending on the initial severity of the menace of premature delivery. The difference between the effects of progesterone and of placebo is significant. The tocolytic effect of oral progesterone is not as intense or as rapid as the effect of intravenous beta-mimetics but is sufficient in 80% of cases, on the average, to stop the premature labor without any detectable side effects. This tocolytic effect of oral progesterone is related not just to an increase in plasma progesterone levels but probably to an increase in myometrial progesterone concentration.
Administration, Oral↗