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O Irion

Publications and source records attributed to O Irion.

At least 19 recordsLinked to original sources
PubMed2006

Sphincter incontinence: is regenerative medicine the best alternative to restore urinary or anal sphincter function?

Incontinence is a major public health concern in aging societies. It is caused by age-dependent spontaneous apoptosis of muscle cells in the urinary and fecal sphincters, and is aggravated in women due to birth trauma. Compared to other currently employed invasive surgical management techniques associated with morbidity and recurrence, replacement or regeneration of dysfunctional sphincter through stem cell therapy and tissue engineering techniques hold great promise. This review focuses on the pathophysiological analysis of urinary incontinence and the possible application of muscle-derived-stem cells, satellite cells, chondrocytes and adipose-derived-stem cells in restoring sphincter functions.

Anal Canal↗
PubMed2006

Can we improve the diagnosis of rupture of membranes? The value of insulin-like growth factor binding protein-1.

Our objective was to assess the value of insulin-like growth factor binding protein-1 (IGFBP-1) and other tests for the diagnosis of rupture of the membranes (ROM). We included 49 women with suspected ROM. The gold standard for membranes status was defined based on clinical examination, ultrasonography, tests results (except IGFBP-1) and labour information. Sensitivity, specificity, positive predictive value and negative predictive value of each test were as follows, respectively: IGFBP-1 (86, 74, 73 and 87%); bromothymol (64, 100, 100 and 77%); fern test (62, 96, 93 and 75%) and ultrasonography (19, 100, 100 and 61%). The detection of IGFBP-1 in vaginal secretions has high sensitivity for the diagnosis of ROM.

False Positive Reactions↗
PubMed2006

Inter- and intraobserver variability in sonographic measurement of the lower uterine segment after a previous Cesarean section.

OBJECTIVE: To evaluate the reproducibility of sonographic measurement of the lower uterine segment in pregnant women at term. METHODS: Two independent observers performed transabdominal sonography on 129 women between 36 and 38 weeks of gestation who had had a previous Cesarean section. Sonography was performed when the patients had a full and a half-full bladder; in 100 patients, the measurements were also performed transvaginally, with the patients having an empty bladder. Agreement was quantified by the intraclass correlation coefficient and, using a cut-off of 3.5 mm, by the kappa coefficient. RESULTS: The intraobserver agreement was generally high (intraclass correlation coefficient > 0.90). The interobserver agreement was higher on transvaginal (intraclass correlation coefficient, 0.94) compared with transabdominal (0.70 and 0.84, with full and half-full bladder, respectively) ultrasound. The kappa coefficient was 0.75 transvaginally, compared with 0.34 and 0.54 using the transabdominal approach, with full and half-full bladder, respectively. CONCLUSION: The agreement between two observers for sonographic transvaginal measurement of the lower uterine segment can be considered good, compared with poor to moderate agreement using the transabdominal approach.

Adult↗
PubMed2005

[The epidemic of cesarean sections: a necessary evil?].

The proportion of cesarean deliveries has raised worldwide, to reach 29% in Switzerland, with important differences between public and private hospitals. There is no simple explanation to this. The emphasis on safety is no excuse, as cesarean sections have short and long-term risks. In this article, we try to understand the reason of this epidemic and we discuss the benefits and risks of cesarean section. This intervention should be performed for medical reasons only. Maternal demand is acceptable, only after a real informed consent. While simplification of surgical techniques and loco-regional anesthesia made cesarean safer, it should not become commonplace. To respect physiology is obstetrician's primary duty, corresponding to the wish of women. Hospitals and clinics have to publish their cesarean section rate.

Cesarean Section↗
PubMed2005

[Recent data on the physiopathology of preeclampsia and recommendations for treatment].

Maternal hypertension and proteinuria after 20 weeks gestation defines preeclampsia. Severe preeclampsia is defined by severe hypertension or massive proteinuria, with or without symptoms or altered laboratory tests. With an incidence of 4-7%, preeclampsia remains a major cause of maternal and neonatal morbidity and mortality. Admission into a hospital is crucial to monitor both mother and fetus. The only treatment is delivery. Management of blood pressure and prevention of eclampsia with magnesium sulfate is indicated in severe preeclampsia. Despite numerous studies attempting to elucidate the exact etiopathogenesis of this complex multifactorial disease, prediction or prevention of preeclampsia is not available. Preeclampsia has been named the "disease of theories" and remains to date a challenging enigma for the scientific community.

Calcium Channel Blockers↗
PubMed2005

[Changes in D-dimer levels during pregnancy and the postpartum period: results of two studies].

In outpatients D-dimer (DD) measurement is included in most algorithms to exclude venous thromboembolism (VTE). We have recently performed two studies to evaluate the evolution of DD during pregnancy and the postpartum. During pregnancy, DD increase progressively and are of poor value to exclude VTE after 20 weeks of gestation. During labour, DD are usually very high and decrease quickly during the first 3 days post-delivery. Many weeks are necessary to obtain their normalisation and therefore their utility to rule out VTE is very limited until 4 weeks postpartum. This increase of DD values until 4 to 6 weeks after delivery correlates with the length of antithrombotic prophylaxis recommended for women at high risk of VTE.

Adult↗
PubMed2005

Membrane sweeping for induction of labour.

BACKGROUND: Sweeping of the membranes, also named stripping of the membranes, is a relatively simple technique usually performed without admission to hospital. During vaginal examination, the clinician's finger is introduced into the cervical os. Then, the inferior pole of the membranes is detached from the lower uterine segment by a circular movement of the examining finger. This intervention has the potential to initiate labour by increasing local production of prostaglandins and, thus, reduce pregnancy duration or pre-empt formal induction of labour with either oxytocin, prostaglandins or amniotomy. This is one of a series of reviews of methods of cervical ripening and labour induction using standardised methodology. OBJECTIVES: To determine the effects of membrane sweeping for third trimester induction of labour. SEARCH STRATEGY: We searched the Cochrane Pregnancy and Childbirth Group trials register (6 July 2004) and bibliographies of relevant papers. SELECTION CRITERIA: Clinical trials comparing membrane sweeping used for third trimester cervical ripening or labour induction with placebo/no treatment or other methods listed above it on a predefined list of labour induction methods. DATA COLLECTION AND ANALYSIS: A strategy was developed to deal with the large volume and complexity of trial data relating to labour induction. This involved a two-stage method of data extraction. MAIN RESULTS: Twenty-two trials (2797 women) were included, 20 comparing sweeping of membranes with no treatment, three comparing sweeping with prostaglandins and one comparing sweeping with oxytocin (two studies reported more than one comparison). Risk of caesarean section was similar between groups (relative risk (RR) 0.90, 95% confidence interval (CI) 0.70 to 1.15). Sweeping of the membranes, performed as a general policy in women at term, was associated with reduced duration of pregnancy and reduced frequency of pregnancy continuing beyond 41 weeks (RR 0.59, 95% CI 0.46 to 0.74) and 42 weeks (RR 0.28, 95% CI 0.15 to 0.50). To avoid one formal induction of labour, sweeping of membranes must be performed in eight women (NNT = 8). There was no evidence of a difference in the risk of maternal or neonatal infection. Discomfort during vaginal examination and other adverse effects (bleeding, irregular contractions) were more frequently reported by women allocated to sweeping. Studies comparing sweeping with prostaglandin administration are of limited sample size and do not provide evidence of benefit. AUTHORS' CONCLUSIONS: Routine use of sweeping of membranes from 38 weeks of pregnancy onwards does not seem to produce clinically important benefits. When used as a means for induction of labour, the reduction in the use of more formal methods of induction needs to be balanced against women's discomfort and other adverse effects.

Extraembryonic Membranes↗
PubMed2005

[Gynaecology-obstetrics. Invasive prenatal diagnosis and in utero surgical treatments: what is new?].

Early ultrasonographic antenatal diagnosis permits to perform intrauterine treatment to improve the prognosis of the fetus. These interventions are, however, invasive and associated with risks. In 2004, the results of the randomized trial comparing treatment options in the case of twin-to-twin transfusion syndrome were published. We summarize in this article the current knowledge on invasive fetal therapy.

Female↗
PubMed2005

D-dimer levels during delivery and the postpartum.

BACKGROUND: D-dimer (DD) measurement has proved to be very useful to exclude venous thromboembolism (VTE) in outpatients. However, during pregnancy, the progressive increase as well as the interindividual variations of DD means that in this instance they are of poor value to rule out VTE. Only a few studies have reported measurements of DD levels in the postpartum. OBJECTIVES: To measure DD sequentially in the puerperium in order to determine when DD levels return to values obtained in non-pregnant women and can again be used in the exclusion of VTE. PATIENTS AND METHODS: After uncomplicated pregnancies, 150 women delivering at term either vaginally (n = 100) or by cesarean section (n = 50) were included. DD levels were measured immediately following delivery and next at days 1, 3, 10, 30 and 45. RESULTS: There was a marked elevation of DD at delivery, especially when instrumental. All DD measurements were above 500 ng mL(-1) at delivery, at day 1 and at day 3 postpartum. A sharp decrease in DD was observed between day 1 and day 3, followed by a slight increase at day 10. At day 30 and day 45, respectively, 79% and 93% of women in the vaginal delivery group and 70% and 83% in the cesarean group had levels below 500 ng mL(-1). Bleeding, breastfeeding and heparin prophylaxis did not modify DD levels significantly. CONCLUSION: Using the Vidas DD new assay, our study provides reference intervals for DD in the postpartum period. Using a cut-off at 500 ng mL(-1), DD measurement for ruling out VTE was found to be useful again 4 weeks after delivery.

Adult↗
PubMed2005

Cervical cancer in pregnant women: laparoscopic evaluation before delaying treatment.

BACKGROUND: Cervical carcinoma diagnosed during pregnancy generates conflicting concerns between control of malignancy and continuation of pregnancy. CASE: An invasive cervical carcinoma FIGO Stage IB2 was diagnosed in a 33-year-old primigravida during the first trimester of pregnancy. Because the patient strongly desired to preserve her pregnancy, laparoscopic lymphadenectomy was performed at 16 weeks of gestation to determine the extension of disease. Negative lymph node status was found and the patient was counseled about the possibility of proceeding until adequate fetal maturity had been achieved. An elective cesarean section and radical hysterectomy were performed at 36 weeks, followed by postoperative chemoradiation therapy. The clinical and Pap smear follow-up remain normal after four years. CONCLUSION: Pregnant women diagnosed with early stage cervical carcinoma should receive a complete evaluation including lymphadenectomy before considering delayed therapy. This strategy seems to be an acceptable option in well-defined conditions, and offers these patients the possibility of maternity.

Adult↗
PubMed2003

Intraobserver and interobserver agreement in the diagnosis of anal sphincter tears by postpartum endosonography.

OBJECTIVE: To evaluate intraobserver and interobserver agreement in the diagnosis of anal sphincter tears by endosonography when performed immediately postpartum by resident obstetricians. METHODS: Fifty-four primiparous women who delivered vaginally and had no anal sphincter tears (third- or fourth-degree perineal tears) diagnosed clinically were recruited. Four observers assessed photographic prints and video recordings of anal endosonography performed before the suture of the perineum. We calculated the intra- and interobserver agreement and the kappa coefficient to quantify the reliability of the diagnosis of clinically occult sphincter tears. RESULTS: The observers described sphincter tears in 13-28% of the prints, and in 7-32% of the video recordings. Intraobserver agreement was rated as substantial for prints (kappa, 0.63), and moderate for video recordings (kappa, 0.48). The interobserver agreement was fair for prints (kappa, 0.34) and moderate for video recordings (kappa, 0.42). CONCLUSION: Endosonography performed immediately postpartum to diagnose anal sphincter tears is of moderate reliability.

Anal Canal↗
PubMed2001

Mechanical methods for induction of labour.

BACKGROUND: Mechanical methods were the first methods developed to ripen the cervix or to induce labour. Devices which were used include various type of catheters and of laminaria tents, introduced into the cervical canal or into the extra-amniotic space. Mechanical methods were never completely abandoned, but were substituted by pharmacological methods during recent decades. Potential advantages of mechanical methods, compared with pharmacological methods, may include simplicity of preservation, lower cost and reduction of the side effects. However, special attention should be paid to contraindications (e.g. low-lying placenta), risk of infection and maternal discomfort when inserting these devices. This is one of a series of reviews of methods of cervical ripening and labour induction using standardised methodology. OBJECTIVES: To determine the effects of mechanical methods for third trimester cervical ripening or induction of labour in comparison with placebo/no treatment, prostaglandins (vaginal, intracervical, misoprostol) and oxytocin. SEARCH STRATEGY: The Cochrane Pregnancy and Childbirth Group Trials Register, the Cochrane Controlled Trials Register and bibliographies of relevant papers. Last searched April 2001. SELECTION CRITERIA: The criteria for inclusion were the following: (1) clinical trials comparing mechanical methods used for third trimester cervical ripening or labour induction with placebo/no treatment or other methods listed above it on a predefined list of labour induction methods; (2) random allocation to the treatment or control group; (3) adequate or unclear method for allocation concealment; (4) violations of allocated management not sufficient to materially affect conclusions; (5) clinically meaningful outcome measures reported; (6) data available for analysis according to the random allocation; (7) missing data insufficient to materially affect the conclusions. DATA COLLECTION AND ANALYSIS: A strategy has been developed to deal with the large volume and complexity of trial data relating to labour induction. This involved a two-stage method of data extraction. The initial data extraction was done centrally, and incorporated into a series of primary reviews arranged by methods of induction of labour, following a standardised methodology. The data will be extracted from the primary reviews into a series of secondary reviews, arranged by category of woman. MAIN RESULTS: In total, 58 studies were considered; 45 studies have been included and 13 were excluded. Studies generally included women with unfavourable cervix and intact membranes. Comparing mechanical methods with placebo/no treatment, only one study with 48 participants reported on vaginal delivery not achieved in 24 hours (69% with mechanical methods versus 77% with placebo/no treatment; relative risk (RR) 0.90; 95% confidence interval (CI): 0.64-1.26). Hyperstimulation with fetal heart rate changes was not reported. The risk of caesarean section, reported in six studies including 416 women, was similar between groups (34%; RR 1.00; 95% CI: 0.76-1.30). There were no reported cases of severe neonatal and maternal morbidity. Comparing mechanical methods with vaginal PGE2, only one trial (109 women) reported on vaginal delivery not achieved in 24 hours (73% versus 42%; relative risk (RR) 1.74; 95% CI: 1.21-2.49). Compared with intracervical PGE2, only one trial (100 women) reported on vaginal delivery not achieved in 24 hours (68% versus 40%; relative risk (RR) 1.70; 95% CI: 1.15-2.51). Compared with with misoprostol, the effectiveness of mechanical methods was similar (34% versus 30%; relative risk (RR) 1.15; 95% CI: 0.80-1.66). The use of mechanical method reduced the risk of hyperstimulation with fetal heart rate changes when compared with prostaglandins: vaginal PGE2 (0% versus 6%; RR 0.14; 95% CI: 0.04-0.53), intracervical PGE2 (0% versus 1%; RR 0.21; 95% CI: 0.04-1.20) and misoprostol (4% versus 9%; RR 0.41; 95% CI: 0.20-0.87). There was no difference in the risk of caesarean section between mechanical methods and prostaglandins. Serious neonatal (three cases) and maternal morbidity (one case) were infrequently reported. When compared with oxytocin, use of mechanical methods reduced the risk of caesarean section (4 trials; 198 women; 17% versus 32%; RR 0.55; 95% CI: 0.33-0.91). The likelihood of vaginal delivery in 24 hours and of hyperstimulation with fetal heart rate changes was not reported. There were no reported cases of serious maternal morbidity and severe neonatal morbidity was not reported. These results are similar whatever specific mechanical method was used, except with extra-amniotic infusion. When comparing extra-amniotic infusion with any prostaglandins, women were more likely to not achieve vaginal delivery within 24 hours (57% versus 42%; RR 1.33; 95% CI: 1.02-1.75), the risk of caesarean section was increased (31% versus 22%; RR 1.48; 95% CI: 1.14-1.90), without a reduction of the risk of hyperstimulation. REVIEWER'S CONCLUSIONS: There is insufficient evidence to evaluate the effectiveness, in terms of likelihood of vaginal delivery in 24 hours, of mechanical methods compared with placebo/no treatment or with prostaglandins. The risk of hyperstimulation was reduced when compared with prostaglandins (intracervical, intravaginal or misoprostol). Compared to oxytocin in women with unfavourable cervix, mechanical methods reduce the risk of caesarean section. There is no evidence to support the use of extra-amniotic infusion.

Catheterization↗
PubMed2001

CD34(+) cord blood cells expressing cutaneous lymphocyte-associated antigen are enriched in granulocyte-macrophage progenitors and support extensive amplification of dendritic cell progenitors.

OBJECTIVE: We evaluated the frequency of hematopoietic progenitor cells (HPC) in CD34(+)CLA(+) (cutaneous lymphocyte-associated antigen) and CD34(+)CLA(-) cord blood cells, and followed cellular growth and HPC production during cultures in Flt3 ligand, thrombopoietin, and stem cell factor (FTS). MATERIALS AND METHODS: Immunomagnetic bead-purified CD34(+) cells were sorted into CD34(+)CLA(+) or CD34(+)CLA(-) cells. HPC frequency was assessed by clonal assays in methylcellulose either ex vivo or after, 7, 14, or 21 days of culture with FTS. Dendritic cell (DC) progenitors were evaluated after induction of FTS-amplified cells into DC using secondary cultures containing granulocyte-macrophage colony-stimulating factor and interleukin-4. RESULTS: Ex vivo, granulocyte-macrophage progenitors were more frequent and erythroid progenitors were less frequent in the CLA(+) fraction. In FTS culture, CD34(+)CLA(+) cells produced greater absolute numbers of CD34(+) cells, granulocyte-macrophage-, erythroid-, and DC (including Langerhans cell-related) progenitors compared to CD34(+)CLA(-) cells. In CD34(+)CLA(+) cultures, CLA(+) cells steadily decreased with time, and CD34(+)CLA(-) cells appeared. In CD34(+)CLA(-) cultures, CLA(+) cells were generated, increased up to day 7, and decreased thereafter. CLA was expressed only on CD34(-) cells in these cultures. Ex vivo, CD34(+)CLA(+) cells could be subdivided further into CD38(low) and CD38(high) cells. Cord blood and growth factor-mobilized CD34(+) cells contained more CLA(+)CD38(low) cells than nonmobilized peripheral blood CD34(+) cells and proliferated more extensively with FTS than the latter cells. CONCLUSIONS: CD34(+)CLA(+) cells contain a rather immature progenitor capable of high proliferation and extensive amplification of HPC in vitro. This progenitor may be localized in the CD34(+)CLA(+)CD38(low) fraction. In addition, cultures of CD34(+)CLA(+) cells from cord blood produced CD34(+)CLA(-) cells, suggesting that these cells may derive directly from CD34(+)CLA(+) cells in vivo.

Antigens, CD↗
PubMed2001

Choosing a strategy to prevent neonatal early-onset group B streptococcal sepsis: economic evaluation.

OBJECTIVE: To determine the most appropriate strategy to prevent neonatal streptococcal sepsis in a setting with a low incidence of the disease. DESIGN: Decision analysis and economic evaluation. SETTING: Geneva University Hospitals, Switzerland. POPULATION: Pregnant women at 35-37 weeks of gestation and in labour. METHODS: Local data and data from the literature were used in a decision analysis to compare the current policy of antibiotic administration at Geneva University Hospitals with the recommended preventive strategies. MAIN OUTCOME MEASURES: Number of episodes of sepsis averted; cost and number needed to treat to prevent one episode of sepsis; and proportion of women receiving antibiotics during labour. RESULTS: Compared with the current policy, the risk factors strategy would prevent 69 streptococcal sepsis per million deliveries and the screening strategy would prevent 102 cases of sepsis per million deliveries. Cost per averted sepsis case would be 60 pounds, 700 and 473 pounds, 600, respectively. The number needed to treat to prevent one sepsis would be 1,087 with a risk factors strategy and 1,029 with a screening strategy. Preventive strategies would increase the proportion of women receiving antibiotics during labour from 6% with the current policy, to 13.5% and 16.5% respectively. CONCLUSIONS: Preventive strategies are more effective than the current policy, but imply increased hospital costs and a notable increase in the proportion of women receiving antibiotics during labour, which may be unjustified in a low incidence setting.

Antibiotic Prophylaxis↗
PubMed2000

Stripping/sweeping the membranes for inducing labour or preventing post-term pregnancy.

BACKGROUND: Stripping or sweeping of the membranes aims to initiate labour through a cascade of physiological events. These may reduce pregnancy duration or pre-empt formal induction of labour with either oxytocin, prostaglandins or amniotomy. OBJECTIVES: The objective of this review was to assess the effects of membrane sweeping to promote or induce labour on maternal and perinatal outcomes. SEARCH STRATEGY: We searched the Cochrane Pregnancy and Childbirth Group trials register and the Cochrane Controlled Trials Register (last searched April 1998). SELECTION CRITERIA: Adequately controlled trials of digital separation of the membranes from the lower uterine segment for inducing labour or for preventing post-term pregnancy, compared to either no vaginal examination or vaginal examination for cervical assessment only without the intention to detach the membranes. DATA COLLECTION AND ANALYSIS: Two reviewers assessed trial quality and extracted data. MAIN RESULTS: Fourteen trials were included. Sweeping of the membranes, performed as a general policy in women at term, was associated with reduced duration of pregnancy and the frequency of pregnancy continuing beyond 41 weeks (relative risk 0.42, 95% confidence interval 0.19 to 0.93, random effects model) and 42 weeks. After sweeping of the membranes, there was a 17% risk reduction (confidence interval 6 to 29%, random effects model) in the use of more formal methods for labour induction. There was no difference in the mode of delivery or in the risk of infection. Discomfort during vaginal examination and other adverse effects (bleeding, irregular contractions) were more frequently reported by women allocated to sweeping. REVIEWER'S CONCLUSIONS: Routine use of sweeping of membranes from 38 weeks of pregnancy onwards does not seem to produce clinically important benefits. When used as a means for induction of labour, the reduction in the use of more formal methods of induction needs to be balanced against women's discomfort and other adverse effects.

Extraembryonic Membranes↗