Biomedical subjects

M Thiery

Publications and source records attributed to M Thiery.

At least 19 recordsLinked to original sources

PubMed2002

Mortality and early neonatal morbidity in vaginal and abdominal deliveries in breech presentation.

From January 1984 to June 1986, 268 consecutive breech presentations in two university hospitals were studied prospectively. Vaginal delivery was attempted in all cases, under expert supervision and electronic monitoring, except in the presence of clear-cut contraindications. For most of the examined parameters no statistically significant differences were found in mortality and morbidity between the vaginally delivered group and the caesarean section group in three birth weight categories. Regarding mortality a relation with the mode of delivery was demonstrable in two cases in the vaginal group and one case in the caesarean section group in the low and very low birth weight category. In the 500-1499 g birth weight category, underestimation of the birth weight during pregnancies led to iatrogenic neonatal death in two cases. Our study shows that the management of breech presentation can be modified in order to stop the increase in caesarean section rate and diminish the degree of variation in operative delivery without affecting the perinatal outcome.

Belgium↗

PubMed2000

Intrauterine contraception: from silver ring to intrauterine contraceptive implant.

Gräfenberg introduced his silver ring in 1928 and by his classic paper, published in 1931, provided intrauterine contraception with a scientific basis. For largely non-medical reasons, the Gräfenberg ring vanished from the scene a few years later, and it took almost 30 years before the method was rehabilitated as a result of a change in mental attitude toward birth control, the awareness of world population explosion, and the introduction of improved intrauterine devices (IUDs). The United States became the epicenter of IUD research in the 1960s but, due to adverse publicity and the threat of litigation, the pendulum swung and European investigators took over the job of improving the IUD. Proceeding from Dr Gräfenberg's classic paper, the major steps in the evolution of the intrauterine devices are retraced with focus on the scientists who were innovative in the field.

Germany↗

PubMed2000

Intrauterine contraception in the year 2001: can intrauterine device use be revived with new improved contraceptive technology?

Intrauterine contraception is the most cost-effective reversible method of contraception today. The method is becoming increasingly attractive to women due to the development of new technologies that not only enhance the performance of the intrauterine device (i.e. efficacy is now close to 100%), but also reduce the rate of expulsion (in the case of the 'frameless' GyneFix intrauterine device (IUD)) and the number of removals for medical reasons. This is important, since the demand for intrauterine devices is likely to increase drastically in the coming years. The size of the intrauterine foreign body with the mini GyneFix has been reduced six-fold since the development of the Lippes Loop, resulting in an almost total absence of incompatibility problems. Furthermore, intrauterine contraception is entering a new phase with the development of intrauterine systems (IUSs) that deliver potent progestins. The Mirena intrauterine system, which releases levonorgestrel, has been shown to drastically reduce menstrual bleeding. The FibroPlant levonorgestrel IUS has been clinically developed since 1997 and is a further development of the 'frameless' anchoring IUD concept. The majority of women presenting with excessive bleeding can be treated by insertion of the IUS, resulting in greatly reduced menstrual blood loss. This is a very important result from both a health and a quality-of-life point of view. The fact that the IUS is also a potent contraceptive is extremely interesting. We believe, therefore, that these new technologies will lead to a re-appraisal of the IUD and could revive the use of intrauterine contraception in all parts of the world, including those regions where IUD use is presently very low.

Female↗

PubMed1999

GyneFix-LNG: preliminary clinical experience with a copper and levonorgestrel-releasing intrauterine system.

A novel intrauterine contraceptive drug delivery system derived from the conventional GyneFix intrauterine implant system is described and the preliminary results in 22 women are discussed. The first objective of the development of the GyneFix-levonorgestrel system was to reduce menstrual bleeding, whether or not related to the effect of copper, by combining a shortened version of the standard GyneFix implant, having a copper surface area of 200 mm2, with a system for the sustained intrauterine delivery of levonorgestrel. The results of this initial observational study indicate that the GyneFix-levonorgestrel system, apart from being well tolerated, is safe and effective. The levonorgestrel component appears to have a beneficial effect on the amount of bleeding. A study on menstrual blood loss will be carried out to substantiate this assumption.

Adolescent↗

PubMed1998

Indications for caesarean section in breech presentation.

OBJECTIVE: The study was conducted because of the still considerable controversies about the variation in obstetric management in breech presentation, in combination with the still increasing caesarean section rate for this type of presentation, as well as doubt concerning the assumed improvement in neonatal and maternal morbidity and mortality obtained by increasing section rate in breeches. STUDY DESIGN: Two hundred and sixty eight consecutive breech presentations in two university hospitals were studied longitudinally and prospectively. In principle, vaginal delivery was attempted in all cases, under expert supervision and electronic monitoring, except in the presence of clear-cut contraindications. X-ray pelvimetry was not used. RESULTS: The incidence of caesarean section was 34%. The trial of vaginal delivery succeeded in 64% of the nulliparas and in 60% of the non-frank breeches, without statistically significant differences in outcome measures compared with the multiparous women and the frank group, respectively. Hyperextension of the foetal head rarely occurred. CONCLUSION: Several classic obstetric factors have a lower discriminating value for the route of delivery than is currently assumed. Progress of labour was an important factor in determining the route of delivery.

Birth Weight↗

PubMed1998

Battey's operation: an exercise in surgical frustration.

Robert Battey (1828-1895) introduced bilateral oophorectomy for the treatment of non-ovarian conditions in 1872, coining the term "normal ovariotomy" for the operation. Normal ovariotomy - a contradictio in terminis - was practised widely for several decades. Alfred Hegar (1830-1914), among many other gynaecologists, extended the indications of Battey's operation to include the treatment of various ovarian conditions as well, e.g., small tumors. Better insight into female physiology and ovarian function finally pushed the sinister operation of Robert Battey from the scene.

Female↗

PubMed1998

[Transformation of left bundle branch block into simulated bundle branch block after ablation of the right bundle in a patient with branch-to-branch reentry ventricular tachycardia].

Masquerading bundle branch block associates left bundle branch block in the standard lead and right bundle branch block in the precordial leads. Mr R., 67 year old, was referred for investigation of syncope. He had a history of idiopathic dilated cardiomyopathy (normal coronary arteries; EF: 14%, CI: 2.2 l/min/m2 at later investigations). The ECG showed LBBB with left axis deviation, a PR interval at the upper limits of normal and ventricular premature beats. During observation, he had another syncopal episode and the ECG showed wide complex tachycardia (160 bpm) reduced by external cardioversion. Electrophysiological investigations showed inducible VT due to bundle branch reentry. The HV interval in sinus rhythm was 80 ms. Radiofrequency ablation of the right bundle led to first degree AVB with masquerading bundle branch block with an increased HV interval of 120 ms. The usual facility of ablation of the right bundle branch block is an argument in favour of the hypothesis whereby masquerading bundle branch block is a variety of RBBB with severe conduction defects of the two branches.

Aged↗

PubMed1997

Intrauterine contraception in adolescent women. The GyneFix intrauterine implant.

Pregnancy rates among adolescents have not decreased over the last 10 years, despite numerous efforts. To solve this important health problem, the major strategy recommended is to encourage contraceptive use among sexually active teenagers. An important means of obtaining this is by promoting methods that are not dependent on daily administration in order to avoid noncompliance. One such method (Norplant) has already shown to be much more effective than the combination pill in preventing pregnancy in adolescent women. The frameless intrauterine implant system (fixed, frameless, and completely flexible) has been studied since 1985 in women between 14 and 50 years of age. The results in young nulligravid women confirm its very high effectiveness (cumulative pregnancy rate at 36 months: 1.4%), its low expulsion rate (cumulative rate at 36 months: 0.9%) and its optimal tolerance (cumulative removal rate for medical reasons at 36 months: 2.4%), resulting in a high acceptance of the implant and a high continued use. The system (GyneFix) offers long-term protection (5 years), and its insertion, with or without anesthetic, is easily accomplished in the office. The GyneFix should therefore be recommended as an excellent alternative for birth control pills for young women with low risk for STDs, especially when compliance is a problem, without an increased risk for complications and without systemic side effects. Removal of the device is accomplished by traction on the tail. It can also be used for emergency contraception and for insertion immediately after termination of pregnancy.

Adolescent↗

PubMed1997

The GyneFix implant systems for interval, postabortal and postpartum contraception: a significant advance in long-term reversible contraception. International Study Group on Intrauterine Drug Delivery.

Intrauterine contraception has a number of important advantages over other forms of contraception and remains, therefore, an important method of birth control. However, side-effects and other drawbacks have reduced its overall acceptance. Also misconceptions and lack of updated scientific knowledge among the potential users and providers are major obstacles to the widespread use of intrauterine contraception. Ideally, an intrauterine device (IUD) should prevent pregnancy effectively, be well tolerated, not become displaced or expelled over time, cause a minimum of side-effects, be long-lasting, have a strictly local effect, and be easy to insert and remove. A group at the University of Ghent, Belgium, the International Study Group on Intrauterine Drug Delivery, has developed, since 1985, a totally new concept in order to improve current intrauterine contraceptive efficacy and enhance tolerance, by creating a harmonious relationship between the uterine cavity and the contraceptive 'foreign body'. The new concept (GyneFix) consists of a non-biodegradable suture thread made of surgical 00 monofilament polypropylene on which six copper tubes are threaded, providing a total surface area of 330 mm2. The upper and lower tubes are crimped onto the thread to keep the tubes in place. The upper extremity of the thread is provided with a knot which serves as an anchor. The knot is implanted in the myometrium of the uterine fundus with a specially designed insertion instrument, thereby permanently securing the device in the uterine cavity. Since the initial clinical investigations, over 10,000 woman years of experience and up to 10 years' follow-up in international multicenter, non-comparative and comparative clinical trials have been collected. The clinical material also included a large number of nulligravid and nulliparous women. Due to the design characteristics of the GyneFix and its anchoring in the uterine fundus, an optimal tolerance and almost complete absence of expulsion were obtained. The constant release of copper ions in the upper part of the uterine cavity results in the high effectiveness of the anchored device. The effectiveness is higher than in the high-load conventional copper IUDs which have a risk of becoming displaced, partially or totally expelled in 10% or more (nulliparous women), resulting in a significant number of accidental pregnancies. The absence of frame and, as a consequence, its flexibility, explain the low incidence of side-effects and the very low incidence of complications, such as pelvic inflammatory disease and ectopic pregnancies. This new concept could be a major step forward in the acceptance of intrauterine contraception worldwide and increase its popularity. This article reviews the experience with the new concept for interval, postabortal and postpartum contraception.

Abortion, Induced↗

PubMed1997

Pioneers of the intrauterine device.

The history of the intrauterine device is remarkably short and its survival has been jeopardized several times from the beginning when Gräfenberg introduced the intrauterine ring in 1928, and later when product liability claims in the USA forced companies to withdraw the IUD from the market. However, a revival is happening, and one of the withdrawn copper IUDs has been re-introduced in the USA. In the 1980s, pessimism about the future of the IUD was based on the fact that there are still two major imperfections inherent in intrauterine contraception: its lack of protection against both 'gyne' and sexually transmitted disease. That IUDs, in contrast with some other methods, do not protect the wearer against microbiological invasion from the lower genital tract is correct, and will probably remain so notwithstanding the prophylactic use of antibiotics at the time of insertion. However, the solution to this imperfection is quite simple: clinicians must learn once and for all to adhere to the principle that bilateral monogamy is the first prerequisite for the safe use of this method of contraception. The second drawback of the IUD is the absence of so-called 'gyne' protection. Although seldom threatening women's health, menorrhagia, occasionally accompanied by pain, is a nuisance, and bleeding problems remain the most frequent single reason for the removal of an IUD. Consequently, research should concentrate on the alleviation of abnormal vaginal bleeding. Prevention is difficult, mainly because the etiopathology of abnormal bleeding is insufficiently understood. Menstrual hemostasis is a complex phenomenon and attempts at etiological treatment give poor results. However, because bleeding is, in all probability, related to an endometrial trauma caused by the geometric incompatibility between the frame of the IUD and the uterine cavity, it was logical for research to concentrate on correcting this factor. This review provides some historical notes about the pioneers who contributed to the improvement of intrauterine contraception since the introduction of the intrauterine ring by Gräfenberg in 1928 until the invention of the frameless device by Wildemeersch in 1984.

Consumer Product Safety↗

PubMed1997

[Vaginal speculum: the developmental history of a gynecologic instrument].

The vaginal speculum (katopter) was known in Antiquity. The instrument fell in disuse during the Middle-ages notwithstanding the fact that Abulcasis had conceived improved speculae in the 10th century. Obstetrical use (embryotomy) of the speculum matricis was deleted from the 17th century on. The speculum vaginae was "rediscovered" in 1801.

Equipment Design↗

PubMed1996

Willughby's observations in midwifery: the Dutch translation.

The Dutch translation of the manuscript of "Observations in Midwifery" (ca. 1672) by the English man-midwife Percival Willughby (1596-1685) - pupil and friend of William Harvey - was printed in The Netherlands in 1754 and antedated the English edition (1863) by more than a century. This delay may explain why this valuable 17th-century text had no impact on obstetrical practice in Willughby's native country.

History, 17th Century↗

PubMed1996

[Not Available].

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Arab World↗

PubMed1996

[Not Available].

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Europe↗

PubMed1996

[Intrauterine copper contraceptive implants].

GyneFix, conceived in 1985, was developed to minimize three major problems frequently associated with discontinuation of IUD use: expulsion, bleeding and pain. Since the initial clinical investigations, over 10,000 women years of experience and up to 8 years of follow-up in international, multicenter, non-comparative and comparative clinical trials, including a large proportion of nulligravid/nulliparous women, have been collected. The following conclusions were reached: 1. The unique design characteristics of GyneFix (frameless, flexible and fixed to the fundus of the uterus) have resulted in optimal tolerance and almost complete absence of expulsion. The result is enhanced effectiveness (comparable to OCs and male/female sterilization) and a high rate of continued use. GyneFix reduces the IUD-failure rate to a minimum and is, therefore, a welcome reversible alternative to OCs and female surgical contraception. 2. Frameless and flexibility explain the absence of side-effects and adverse events caused by dimensional incompatibility between the frame of conventional IUDs and the uterine cavity and may also explain the absence of PID and ectopic pregnancies in any of the clinical studies. 3. Insertion of GyneFix, with or without local anaesthesia, is easily accomplished in the office of a few minutes. Removal is easy, quick and painless. 4. GyneFix is an equally effective and well accepted method fro nulliparous women.

Equipment Design↗

PubMed1995

A randomized comparative study of the TCu380A and Cu-Safe 300 IUDs.

The Cu-Safe 300 is one of the latest additions to the array of available IUDs. It was specifically designed to decrease unwanted side-effects (e.g. bleeding, pain and expulsion) while providing simplicity of insertion, ease of removal and fair contraceptive protection. For comparison, the TCu380A was chosen. Both types were inserted at random in 600 recipients by a group of independent physicians with a long standing experience in intrauterine contraception. Life table analysis was used for comparison over a period of three years. The Cu-Safe 300 produced a slightly but not statistically significant higher pregnancy rate and more expulsions. Removals for bleeding and pain, however, were significantly less frequent. All inserting physicians agreed that insertion and removal of this new device was remarkably easy.

Adolescent↗

PubMed1995

[Not Available].

Explore the source record for details and available documents.

History, Ancient↗

PubMed1995

[Obstetrical study of the pelvis: a historical overview].

The female pelvis is fundamental to life itself, but it took ages to grasp this truism. During Antiquity, physicians had no need for the concepts of pelvic dystocia and cephalopelvic disproportion. When Aranzo (16th century), a practising physician, stated that a disproportion between the size of the fetus and that of the bony pelvis was the main culprit of difficult labor, his suggestion was overlooked, so much so that it was Hendrik van Deventer (1701) who came to be coined "father of the pelvic theory". The need for an accurate knowledge of the dimensions of the maternal pelvis and of the fetal skull became imperative in the middle of the 18th century, when forceps extraction had become popular. Levret, but above all William Smellie, made valuable contributions to the pelvic theory, which, however, were weakened by Baudelocque's fallacies concerning the intrinsic value of external pelvimetry. After the first quarter of the 19th century, the epicenter of scientific obstetrics moved to Germany and Austria, and German-speaking practitioners, e.g. Michaelis, Litzmann, and the Naegele, deepened our insight in the mechanism of labor. After the discovery of the X-rays (1895), the use of instrumental pelvimetry declined, but the clinical breakthrough of radiopelvimetry was delayed until the twenties of this century. Radiopelvimetry, a very valuable technique indeed, dispensed a large number of mothers from undergoing abdominal delivery. However, awareness of the hazards of fetal-maternal exposure to ionizing radiation pushed ante- and intrapartum radiopelvimetry from the scene. Thanks to the progress of chemistry, pharmacology and electronics, "dynamic pelvimetry" became the fad, heralded by what is called "active management of labour". The fetus now assumed the role of "dynamic pelvimeter". The historical circle was closed.

Dystocia↗