Biomedical subjects
Publications and source records attributed to M Gamerre.
The transposition of an ovary or of a tube is a simple procedure and it is valuable in certain kinds of tubal pathology. In the four cases here presented this technique allowed three pregnancies to occur. It can however only be used in certain types of lesions.
Copper superoxide dismutase (Cu-SOD or SOD-1) was measured by radioimmunoassay (RIA) in amniotic cells and fluid as well as in fetal trisomy 21 fibroblasts. The significant increase of the SOD-1 activity observed in amniotic cells and fetal trisomy 21 fibroblasts demonstrates the early physiopathogenic expression of the supernumerary chromosome 21 in affected patients.
The value of the assay of the sub-units of human chorionic gonadotrophin in the diagnosis and follow-up of trophoblastic disease is generally recognised. The authors stress that this follow-up allows a maximal preservation of the genital tract of the patients and an evaluation of the real effectiveness of treatment.
In connection with a prospective study of 200 expectant mothers, the authors discuss the disorders of the lower urinary tract in the course, and at the end, of pregnancy, which are reversible in the vast majority of cases. They also describe the physiopathological mechanisms of lasting sequelae and the precautions to be taken at the time of childbirth in women identified as high-risk vesico-urethral cases.
In this article, the authors study the real obstetrical and neonatal effects of urinary infection in pregnant women. Basing themselves on 225 cases of gravidic urinary infection, the authors discuss asymptomatic bacteriuria, the need of early diagnosis in risk patients, and the use of regular post-treatment monitoring, in view of the fact that, even when well-treated, this complaint is apt to recur.
From the analysis of 190 case histories of elderly primiparas, the following conclusions were drawn concerning their pregnancy and delivery. Frequency = 0.6%. The high frequency of spontaneous abortion (26.8%) and infertility treatment (20.5%) should be stressed. Age-related obstetric pathology in the sample group is dominated by the high frequency of toxaemia (32.4%), premature delivery (14.3%) and uterine fibromata (17.3%). Dystocia is frequent: normal, unassisted vaginal deliveries: 32%; forceps: 33.2%; Caesarean section: 34.2%. Neonatal mortality remains high: 5.2% as does morbidity (Apgar less than 7: 29.6%).
Idiopathic thrombocytopenic purpura occurring in pregnancy has a risk for the fetus of severe thrombocytopenia. The handling of these cases obstetrically is controversial. Our experience and that derived from reading the literature suggests that counting the number of maternal platelets does not reflect on the risk for the fetus and the neonate. On the other hand it does seem that estimating the levels of circulating platelet antibodies in the maternal plasma does give an indication of platelet destruction in the fetus. Corticosteroid treatment improves greatly the number of maternal platelets and is probably good treatment for the fetus in utero. Giving gamma-globulins intravenously to the pregnant woman or to the newborn is an interesting therapeutic measure seeing how it is free of danger. How useful this treatment is in pregnancy has yet to be determined.
A binovular triplet pregnancy with a normal fetus and bicephalic monster was diagnosed by ultrasound after 19 weeks of amenorrhoea. After selective amniocentesis and genetic studies the diagnosis led us to kill the double monster in utero by injecting hypertonic saline into its aorta. The healthy twin went on growing normally in the following weeks. Premature vaginal delivery resulted in the expulsion of a macerated double monster and the birth of a baby weighing 1,650 g in blood health. This case history leads us to discuss the value of ultrasound in multiple pregnancies and the ability to carry out intra-uterine procedures in these special cases.
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In the last 110 cases of genital prolapse examined, IVU formed part of the prior urological investigation. 14 cases of ureteropelvic distension were thus discovered (13.6% of cases). In ten cases the prolapse was sufficiently largee as to exterioris the uterus or bring it to of the vulva. In 13 cases out of 15 a larg cystocoele was visible at the vulva with a full bladder. The precise urological consequences of these prolapses was greater than had been expected: 13 cases of incomplete vesical retention, 4 of unilateral ureteropelvic distension and 10 bilateral, including 3 only symmetrical. Bilateral high distension was in general associated with a large cystocoele. Severe renal insufficiency was seen in only one case, and 5 moderate elevations in blood urea, in 5 cases. The mechanism of such ureteropelvicalyceal distension is not clear, but the prolapse is directly responsible, since mechanical (insertion of a pessary) or surgical reduction of the prolapse restores the upper excretory tract to normal. Renal function recovered all the more rapidly when the prolapse had been present for a shorter time.
Three children with thrombopenia and radial aplasia were examined at the Centre de Génétique Médicale of Marsielles from 1974 to 1976. In each case the genetic basis of the anomaly was discussed with the family at genetic counseling underlining the high risk of recurrence related to the autosomal recessive transmission. Each proband was the only child of the couple. In the first case the father and mother, each having one child from a previous marriage, decided to have no more children. In the second case, the use of fetoscopy and its limitations were discussed as another pregnancy was desired. However, the parents finally refused the procedure during pregnancy which yielded a second child with phocomelia who did not survive. In the third and most recent case the proband died. Since the young couple strongly desired another child, ultrasonic monitoring of pregnancy was cautiously suggested and its limitations clearly exposed. Echography was regularly repeated from the third month of pregnancy. The forearms were never detected on echography, nor on fetal radiography. Pregnancy was thus interrupted with prostaglandins at 21 weeks gestational age. On examination the fetus presented bilateral aplasia of the forearm. Based on these observations, the authors discuss the problems raised by prenatal diagnosis of upper limb malformations.
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The authors studied the effects on the child of 196 caesarian sections performed in the absence of foetal distress. The following were noted for each child: the time before the first cry, the Apgar score, pH and the need or not for resuscitation techniques. Each feature was studied in terms of different factors: foetal, obstetric, anaesthetic and surgical. The conclusions were as follows: caesarian section, which remains the best means of preventing obstetric trauma, has its own direct complications which are linked to the conditions in which the operation takes place. These can be reduced to a minimum or even completely suppressed if the caesarian section is performed under ideal conditions: few or no depressant drugs before the operation (the use of diazepam for induction should be abandoned); inclined position of 15 degrees, even of the mother has never suffered from utero-caval syndrome and if possible on a heated mattress; extraction of the infant between the 5th and 15th minutes; finally, and above all, prior labour is desirable whenever obstetric conditions permit.
The authors report on their experience using prostaglandins E2 and F2alpha in obstetrics. 70 cases are involved: 30 inductions of labour, 33 abortions and 7 hydatidiform moles. The results as far as induction of labour is concerned are encouraging (76.6 p 100 success), but in the doses used no better than those achieved with synthetic posterior-pituitary oxytocins. On the other hand, as far as abortions are concerned, prostaglandins, whether given intravenously, intra-amniotically or extra-amniotically, are the method of choice because they are practically free of danger in the second trimester of pregnancy (93.9 p. 100 success). Side effects are common but are usually not severe and do not interfere with the treatment.
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