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Biomedical subjects

P Hohlfeld

Publications and source records attributed to P Hohlfeld.

At least 37 records · Page 2Linked to original sources
PubMed2000

Cardiotoxic transplacental effect of idarubicin administered during the second trimester of pregnancy.

Polychemotherapy including idarubicin was administered during the second trimester to treat acute lymphoblastic leukemia. The infant delivered at 28 weeks' gestation had acute cardiac failure attributed to the cardiotoxic effect of idarubicin. Cardiotoxicity may be caused by idarubicin's biophysical properties that facilitate its transplacental passage. Idarubicin should be used with extreme caution during pregnancy.

Adult↗
PubMed2000

Birth trauma: short and long term effects of forceps delivery compared with spontaneous delivery on various pelvic floor parameters.

OBJECTIVE: To compare the effects of forceps delivery and spontaneous delivery on pelvic floor functions in nulliparous women. DESIGN: A longitudinal prospective study with investigations during the first pregnancy, 10 weeks and 10 months after delivery. SETTING: Antenatal clinic in a teaching hospital. POPULATION: One hundred and seven patients aged 28 +/- 4 years, divided into those with forceps (n = 25) or spontaneous (n = 82) delivery. METHODS: Investigations with a questionnaire, clinical examination, assessment of bladder neck behaviour, urethral sphincter function, intra-vaginal/intra-anal pressures during pelvic floor contractions. RESULTS: The incidence of stress urinary incontinence was similar in both groups at 9 weeks (32% vs 21%, P = 0.3) and 10 months (20% vs 15%, P = 0.6) after delivery, as was the incidence of faecal incontinence (9 weeks: 8% vs 4%, P = 0.9; 10 months: 4% vs 5%, P = 1) and the decreased sexual response at 10 months (12% vs 18%, P = 0.6). Bladder neck behaviour, urethral sphincter function and intra-vaginal and intra-anal pressures were also similar in the two groups. However, 10 months after delivery, the incidence of a weak pelvic floor (20% vs 6%, P = 0.05) and the decrease in intra-anal pressure between the pre- and post-delivery values (-17 +/- 28 cm H2O vs 3 +/- 31 cm H2O, P = 0.04) were significantly greater in the forceps-delivered women. CONCLUSIONS: Forceps delivery is not responsible for a higher incidence of pelvic floor complaints or greater changes in bladder neck behaviour or urethral sphincter functions. However, patients with forceps delivery have a significantly greater decrease in intra-anal pressure and a greater incidence of a weak pelvic floor.

Adult↗
PubMed2000

Placental transfer of pyrimethamine studied in an ex vivo placental perfusion model.

Pyrimethamine is used as and anti-infectious agent because of its antifolate properties. Its action is synergistic with that of dapsone and sulfamides on Toxoplasma gondii. The goal of the present study was to evaluate the placental transfer of pyrimethamine in an ex vivo model of perfused human placental cotyledon at term. Human placentas were perfused according to the slightly modified method of Schneider. The pyrimethamine fetal transfer rate was approximately 30%, while cotyledon clearance was about 1.8 ml/min. The placental transfer of pyrimethamine seems to be independent of the maternal concentrations of pyrimethamine, suggesting passive diffusion mechanisms or a nonsaturable active transport at the tested concentrations.

Female↗
PubMed2000

Induction of the putative protective protein ferritin by infrared radiation: implications in skin repair.

The modification of ferritin in human skin cells in vitro and in vivo following infrared-A irradiation by immunohistochemical analysis and ELISA were evaluated. In addition, we observed that IR-A is not capable of inducing frank damage to DNA (pyrimidine dimers, p53), induction of oxidative stress proteins (heme oxygenase, nitric oxide, superoxide dismutase, heat shock proteins) or proteases (collagenase, stromelysin, gelatinase) involved in carcinogenesis and photoaging of the skin. in vivo, basal levels of ferritin were heterogeneous for all individuals tested but all showed ferritin to stain precisely in the basal layer of unirradiated epidermis. Following IR-A radiation, the ferritin increase was localized to epidermal tissue and showed an increase from 120 to 220%. Parallel to the in vivo analysis, dermal fibroblasts were cultured from six individuals. Quantitative analysis for ferritin in cultured fibroblasts was assessed by ELISA and increases were seen to be dose-dependent and up to 130% of basal levels of ferritin following infrared-A. Our findings indicate that the putative defense system of ferritin that exists in human skin in vivo can be induced by infrared-A radiation and that these wavelengths may prove to be beneficial for human skin. Importantly, following the same doses of IR-A that induced ferritin levels, there was no alteration seen for nuclear DNA type damage, oxidative stress proteins or proteases involved in the degradation of skin. The increased concentrations of this antioxidant in human skin following acute UV radiation could afford increased protection against subsequent oxidative stress.

Adult↗
PubMed2000

[Diagnosis of materno-fetal toxoplasmosis].

The antenatal diagnosis of congenital toxoplasmosis represents today an important application of molecular diagnostic methods such as PCR. Done directly in amniotic fluid, the PCR for T. gondii is able to detect in utero infected foetus with high probability. Doing so, it precludes to obtain foetal blood and to use more cumbersome and lengthy procedures such as inoculation to cell lines or to mice. Although it is use today in many centres, the molecular diagnosis of T. gondii by PCR is neither commercialized nor standardised. The objective of this report is to present the methodology used in our institution and to establish its degree of validation.

Female↗
PubMed1999

[Intrauterine death in twin pregnancies].

The loss of a fetus in a multiple pregnancy is relatively frequent. The main risk factor is a monochorionic twin pregnancy. If fetal loss occurs after 16 weeks of pregnancy, the survivor is also at increased risk of intrauterine death. In monochorionic twins, the risk of neurological sequelae can be as high as 25%. These lesions are due to acute episodes of hypoperfusion immediately following the death of the co-twin. Maternal complications including coagulation disorders are rare. The management will vary according to the type of placenta, the gestational age and the condition of the surviving twin. When the last trimenon has been reached, rapid delivery is probably the safest management. In monochorinoic biamniotic twins, the risk to the survivor often justifies the induction of delivery between 28 and 32 weeks of gestation after steroids have been administered. In most cases, before the 28th week of gestation, a conservative management will be proposed. In monochorionic monoamniotic twins, immediate delivery should be considered as soon as fetal viability is reached.

Female↗
PubMed1999

Long-term effects of neonatal hypoglycemia on brain growth and psychomotor development in small-for-gestational-age preterm infants.

OBJECTIVE: To investigate the effects of neonatal hypoglycemia on physical growth and neurocognitive function. STUDY DESIGN: A systematic detection of hypoglycemia (<2.6 mmol/L or 47 mg/dL) was carried out in 85 small-for-gestational-age preterm neonates. Prospective serial evaluations of physical growth and psychomotor development were performed. Retrospectively, infants were grouped according to their glycemic status. RESULTS: The incidence of hypoglycemia was 72.9%. Infants with repeated episodes of hypoglycemia had significantly reduced head circumferences and lower scores in specific psychometric tests at 3.5 years of age. Hypoglycemia also caused reduced head circumferences at 18 months and lower psychometric scores at 5 years of age. Infants with moderate recurrent hypoglycemia had lower scores at 3.5 and 5 years of age compared with the group of infants who had 1 single severe hypoglycemic episode. CONCLUSION: Recurrent episodes of hypoglycemia were strongly correlated with persistent neurodevelopmental and physical growth deficits until 5 years of age. Recurrent hypoglycemia also was a more predictable factor for long-term effects than the severity of a single hypoglycemic episode. Therefore repetitive blood glucose monitoring and rapid treatment even for mild hypoglycemia are recommended for small-for-gestational-age infants in the neonatal period.

Blood Glucose↗
PubMed1999

Maternal antiplatelet antibodies in predicting risk of neonatal thrombocytopenia.

OBJECTIVE: To determine the incidence of maternal antiplatelet antibodies in cases of thrombocytopenia during pregnancy, using the monoclonal antibody-specific immobilization of platelet antigens assay; and to assess the usefulness of this assay for predicting risk of neonatal thrombocytopenia. METHODS: A total of 6770 pregnant women were included in the study, and the monoclonal antibody-specific immobilization of platelet antigens assay was done when platelet counts were less than 150 x 10(9)/L. Platelet counts were determined in 6103 newborns. RESULTS: The incidence of maternal thrombocytopenia was 11.6% (95% confidence interval [CI] 10.8, 12.4). Among newborns, 1.3% (95% CI 0.5, 2.7) born to thrombocytopenic mothers were thrombocytopenic, compared with 0.4% (95% CI 0.2, 0.6) born to nonthrombocytopenic women. Antiplatelet antibodies were detected in 37 (8.6%) of 430 thrombocytopenic women; autoantibodies were detected in 28 cases (circulating or bound to platelets), alloantibodies in eight cases, and an association of alloantibodies and autoantibodies in one case. The positive and negative likelihood ratios for predicting neonatal thrombocytopenia were 4.6 and 0.7, respectively. CONCLUSION: The monoclonal antibody-specific immobilization of platelet antigens assay did not predict the risk of neonatal thrombocytopenia in an unselected population of thrombocytopenic pregnant women.

Adult↗
PubMed1999

[Toxoplasmosis].

Explore the source record for details and available documents.

Female↗
PubMed1999

Haematological parameters of parvovirus B19 infection in 13 fetuses with hydrops foetalis.

Thirteen cases of fetal parvovirus B19 infection with hydrops foetalis are reported. Viral DNA was identified by polymerase chain reaction (PCR) of amniotic fluid sampled between the 19th and the 29th week of gestation. Haematological examination revealed severe anaemia in all cases and thrombocytopenia in 11/13 cases, which was severe in two cases. Six fetuses died in utero; two after intrauterine transfusion. Complete recovery was observed in seven fetuses; five cases were treated by intrauterine transfusions, and in two cases spontaneous recovery occurred. Upon follow-up, no case of congenital anaemia was observed.

Anemia↗
PubMed1999

Value of the comparative enzyme-linked immunofiltration assay for early neonatal diagnosis of congenital Toxoplasma infection.

BACKGROUND: The transplacental transfer of specific maternal IgG antibodies makes the diagnosis of congenital Toxoplasma infection quite difficult in the neonate. The enzyme-linked immunofiltration assay (ELIFA), comparing at delivery the immunologic profile of the mother's antibody response and that of her child, allows discrimination between IgG antibodies of maternal origin and IgGs synthesized by the fetus. OBJECTIVE: To evaluate the diagnostic reliability of the comparative ELIFA for diagnosing congenital Toxoplasma infection as well as the reliability of testing for IgM- and IgA-specific antibodies in cord blood. METHODS: From November, 1991, to December, 1995, an ELIFA was prospectively performed at delivery on blood samples obtained from 227 women with primary Toxoplasma infection during pregnancy and from their infants. For each child the ELIFA result was evaluated in relation to the serologic follow-up: disappearance of specific anti-Toxoplasma gondii IgG antibodies in the absence of treatment before 12 months of age indicating an uninfected child, as opposed to persistence beyond 12 months of age indicative of a congenital infection. RESULTS: Of 227 children 139 were lost to follow-up. Among the 88 children available for follow up, the ELIFA was negative in 70 infants, 69 of whom were confirmed to be uninfected. Thirteen of these 69 cord blood ELIFA-negative samples were positive for anti-T. gondii IgM and/or IgA detected by means of a conventional immunosorbent agglutination assay. Of the remaining 18 children (representing 75% of all new cases of congenital toxoplasmosis diagnosed during the study period at our institution), the ELIFA was positive in 16, negative in 1 and inconclusive in 1. CONCLUSIONS: The ELIFA test is a valuable tool for diagnosing congenital T. gondii infection and in differentiating between true neonatal infection and cord blood contamination. In our experience the diagnostic sensitivity of the ELIFA test was 94.1% and the specificity was 98.6%. The cord blood was contaminated by specific maternal anti-T. gondii IgA and/or IgM in as many as 20% of the cases.

Animals↗
PubMed1999

[Maternal and neonatal prognosis after a prolonged second stage of labor].

The purpose of this study was to evaluate the neonatal and maternal outcome after a prolonged second stage of labor. We compared a study group of 751 women, who delivered after a prolonged second stage (mean: 189 minutes) with a control group of 5241 women, who delivered spontaneously after a short second stage (mean: 19 minutes). In the study group different factors were significantly associated with a prolonged second stage: primiparity, higher birth weight and occiput posterior position. If no arbitrary limit for the second stage of labor is used, the presentation will progress in 70% of cases and 90% of women will delivery vaginally. The high rate forceps delivery slightly increases maternal morbidity. In spite of lower umbilical pH and five-minute Apgar scores, neonatal morbidity and mortality were not increased.

Adult↗
PubMed1999

[Menorrhagia, hypermenorrhea and disorders of hemostasis].

Menorrhagia is a common clinical problem. About 10% of women aged between 30 and 49 take medical advice for abnormal uterine bleeding. Underlying bleeding disorders are found in about 20% of women, once pelvic abnormalities are excluded. It is important to characterize a bleeding disorder since specific treatments can be provided. Moreover, these women are susceptible to present other haemorrhagic complications, particularly in case of invasive procedures. This review aims at drawing the attention a) on the importance of a careful medical history to assess menorrhagia and a possible bleeding disorder, b) on von Willebrand disease, the main coagulation disorder involved in case of menorrhagia and c) on several therapeutic possibilities.

Blood Coagulation Disorders↗
PubMed1999

[Current aspects of symphysiotomy. Apropos of 1 case and review of the literature].

Symphysiotomy is regularly performed in developing countries where cesarean section can be a source of significant short-term and long-term morbidity. However, this method can be useful in some rare occasions and should be taught in our countries, at least theoretically. Such a case is presented with a review describing the present surgical technique, its indications and limits with special reference to its possible complications.

Adult↗
PubMed1998

[The prognosis of premature infants: from the viewpoint of gynecologists-obstetricians and results from Lausanne].

AIM OF THE STUDY: To assess the views of obstetricians concerning the survival rate in neonates on the basis of gestational age and birth-weight, rate of severe handicap, and minimum gestational age for preventive and curative measures (steroids for foetal lung maturation and caesarean section in the event of acute foetal distress). Then, to compare these results with the outcomes observed in the referral centre for these obstetricians. METHOD: We circulated an anonymous questionnaire (two mailings between October 1995 and February 1996) to obstetricians in the Lausanne area. The replies were compared with prospective data from the Lausanne obstetric unit (1989-1995) and neonatal intensive care unit (1982-1993) backed by the neurodevelopmental outcome assessed by regular follow-up until the age of 8 1/2 years. RESULTS: We obtained 116 replies from the 270 specialists questioned (43% participation). The mortality rates in Lausanne are described by gestational age and birthweight, as is the rate of severe handicap. We observed significant overestimation of the mortality rate for premature infants between 25 and 31 weeks and for birthweights over 600 grams. The rate of severe handicap was widely overestimated for a gestational age below 28 weeks at delivery or a birthweight below 1500 g (prognosis 31.2% and 21.5% respectively, compared with actual figures of 7.4% and 6.8%). Moreover, distribution of replies showed marked heterogeneity between 26 and 29 weeks and between 600 and 1000 grams. The estimated minimum gestational age was 26 weeks (mean) for starting steroid therapy and 27 weeks for caesarean section for acute foetal distress. CONCLUSION: Assessment of prognosis by obstetricians did not correlate with our results and reflected the disparity of data found in the literature. Nevertheless, the implications of this discrepancy may be slight. The study stresses the efficacy of the regionalisation of perinatal care in the Lausanne area, where we observed only 6% of outborn weighting less than 1500 grams in the 18 maternity departments covered. The rate of completed antenatal steroid therapy (41% for infants below 1500 grams) appears to be favourable in our population compared with the literature. We advocate permanent information on local results regarding perinatal outcome, to enable individual obstetricians to consider the desirability of treating, transferring or even counselling or reassuring their patients.

Birth Weight↗
PubMed1998

The effects of birth on urinary continence mechanisms and other pelvic-floor characteristics.

OBJECTIVE: To determine the effects of delivery on bladder and anorectal functions. METHODS: One hundred forty-nine nulliparas were studied once during pregnancy and again about 9 weeks after delivery by means of questionnaire, clinical examination, perineal sonography, urethral pressure profiles, and recording of intravaginal and intra-anal pressures during pelvic-floor contraction. RESULTS: Stress urinary incontinence was present in 46 patients (31%) during pregnancy and persisted in ten of them after delivery. After vaginal delivery, urinary and fecal incontinence were present in 36% and 4% of forceps-delivered women, respectively, and in 21% and 5.5% of spontaneously delivered women. Bladder neck mobility was increased significantly after all vaginal births, whereas bladder neck position at rest was lowered only in forceps-delivered women. Functional urethral length was decreased in the supine and standing positions after spontaneous and forceps deliveries. Otherwise, indices of urethral sphincter function were unchanged or improved after vaginal delivery. A significant decrease in intravaginal pressure and in intra-anal pressure was observed in all vaginally delivered women. The intra-anal pressure decrease correlated significantly with infant weight (r=0.24, P=.01). Women who underwent cesarean had no specific complaints and only slight modifications of these measurements. CONCLUSION: After spontaneous and instrumental deliveries, 21% and 34% of women complained of stress urinary incontinence and 5.5% and 4% reported fecal incontinence, respectively. Substantial bladder neck hypermobility was present together with diminished functional urethral length and intravaginal and intra-anal pressures. Only 22% of patients with stress urinary incontinence during pregnancy had such incontinence after delivery.

Adult↗
PubMed1998

Management of fetal and neonatal alloimmune thrombocytopenia.

Fetal and neonatal thrombocytopenia can be induced by a maternal alloimmunization against fetal platelet antigens. Alloimmune thrombocytopenia occurs with an incidence of 1/1,000 livebirths and may present either with evidence of damage from a prenatal hemorrhage such as porencephaly or intrauterine death, or with active life-threatening bleeding during the neonatal period. It is due to the destruction of fetal platelets by alloantibodies reacting on specific antigenic sites. In Caucasians, the human platelet antigen 1a (HPA-1a) is the most frequently involved in alloimmune thrombocytopenias, accounting for 80-90% of the cases. Anti-HPA-5b is responsible for a further 5-15% of the cases. This article reviews the clinical aspects, the biological diagnosis and the management, including prenatal sampling and maternal therapy.

Antigens, Human Platelet↗