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Biomedical subjects

P Merviel

Publications and source records attributed to P Merviel.

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

Ursodeoxycholic acid in intrahepatic cholestasis of pregnancy. A retrospective study of 19 cases.

OBJECTIVE: We studied the clinical and biological effects and safety of ursodeoxycholic acid in patients with intrahepatic cholestasis of pregnancy (ICP). METHODS: All cases of ICP treated with ursodeoxycholic acid in our department from January 1st, 1991 to May 31st, 1997 were reviewed. RESULTS: Forty-three patients had ICP, of whom 19 received ursodeoxycholic acid. The first symptoms appeared after a mean of 29.7 weeks of pregnancy (WP). Treatment was started after a mean of 32 WP, and lasted a mean of 28.5 days. Fourteen patients showed a clinical improvement on UDCA, and 11 showed a biological improvement. Two had a biological deterioration with increased liver enzyme concentrations. CONCLUSIONS: Ursodeoxycholic acid appears to be an effective treatment for ICP, but further studies are needed to confirm its safety in pregnancy.

Adult↗
PubMed1999

[Risk factors in pre-eclampsia].

PATIENT-RELATED FACTORS: Multiparous patients with a past history of severe pre-eclampsia are a high risk population which should be identified early in pregnancy. Selection on this criterion alone is however insufficient for large scale screening and prevention because most of the susceptible women are nulliparous. Search for a particular familial or personal history of vascular disorders can be helpful. The usefulness of blood pressure measurements during the second trimester has not been proven. MARKERS: There is a significant association between pre-eclampsia and a large number of biological markers. No one assay can however fulfill the requirements for effective early screening because sensitivity is too low or the rate of false positives is too high, or because the examination is too invasive or costly. DOPPLER ANOMALIES: Doppler exploration of the uterine arteries at 20 to 24 weeks gestation offers satisfactory sensitivity and specificity but the positive predictive value is low. Persistence of a bilateral notch beyond 24 weeks considerably limits the number of false positives. More than half of the patients with this anomaly will develop hypertension during pregnancy. While no one marker fulfills all the prerequisites for effective screening, a combination of several tests may be useful. hCG assay during the second trimester in association with Doppler exploration of the uterine arteries appears to be a promising combination. PREVENTION: Starting with these markers or risk factors, the goal is to develop a prevention scheme using low-dose aspirin, the only evidence-based preventive treatment to date. Further trials are required to test simultaneously the predictive value and impact (versus placebo) of proposed strategies.

Aspirin↗
PubMed1998

Lone hyperuricemia during pregnancy: maternal and fetal outcomes.

OBJECTIVE: Study of maternal and fetal consequences of lone hyperuricemia during pregnancy and demonstration that lone hyperuricemia is not a risk factor regarding the onset of preeclampsia. STUDY DESIGN: Retrospective study of two groups of women, one found to have lone hyperuricemia during pregnancy (n=102) and the others with normal serum uric acid levels (n=100). RESULTS: The only consequence identified of the lone hyperuricemia was a lower birth weight of children born to mothers found to have lone hyperuricemia for more than 2 weeks (P<0.05). CONCLUSIONS: Lone hyperuricemia is not a risk factor regarding the onset of preeclampsia. It is therefore unnecessary to measure serum uric acid level during a normal pregnancy.

Adult↗
PubMed1997

Influence of co-culture with established human endometrial epithelial and stromal cell lines on sperm movement characteristics.

The effects of co-culture of human spermatozoa with human immortalized endometrial cells - epithelial or stromal - on sperm movement characteristics, including hyperactivation, were studied using computer-assisted sperm analysis (CASA). Epithelial and stromal cell types could be separated following 8-10 days of culture of endometrial cells originating from human biopsies. Both cell types were immortalized by the SV 40 large T antigen. Co-incubation of sperm with epithelial and stromal monolayers enhanced the rate of hyperactivation: 24.9% (P <0.05) and 17.8% (P = 0.05) versus 9.5% as control, respectively, whereas the majority of motility parameters remained unchanged. Conditioned media had no effect upon sperm parameters, including hyperactivation. Co-incubation with either monolayer was able to maintain sperm motility over a longer period than incubation in control medium alone. In four patients whose spermatozoa did not exhibit hyperactivation, co-incubation with epithelial cells, but not conditioned medium, allowed normal rates of hyperactivation (range: 6.9-15.6%).

Antigens, Polyomavirus Transforming↗
PubMed1997

[Clinical use of recombinant gonadotropins (FSH, LH, hCG)].

The production of recombinant gonadotropins is independent of urine collection. They have a high specific activity and a better batch to batch consistency than urinary gonadotropins. In our IVF programme 62 normo-ovulatory patients less than 38 years old, with tubal or idiopathic infertility and normal sperm, were treated by r-FSH and randomized into four groups : with or without LHRH agonist, step-up or step-down stimulation. The overall results were higher in the agonist groups, but did not reveal any significant difference between step-up and step-down stimulation.

Adult↗
PubMed1997

[Severe preeclampsia: management. Is conservative treatment justified?].

Severe preeclampsia is a major contributor to maternal and perinatal morbidity and mortality. This review was performed to assess the fetal and maternal benefits of allowing women presenting with severe preeclampsia between 24 and 32-34 weeks of amenorrhea to continue their pregnancy following antihypertensive treatment. After ultrasound scanning to assess growth and biophysical state of the fetus, patients without deteriorating maternal conditions, were managed with volume expansion, antihypertensive drugs (as hydralazine, labetalol, nifedipine), anticonvulsants and prophylactic steroids to promote fetal pulmonary maturity. Previous studies have indicated that this conservative management is also possible with the HELLP syndrome, without an increase in maternal morbidity.

Anticonvulsants↗
PubMed1997

[Stereotactic core biopsy of breast microcalcifications. Aid to diagnosis?].

We assessed the accuracy with which stereotactic core biopsy of breast microcalcifications helps to justify follow-up or indicate required surgical planning. Eighty-nine patients underwent stereotactic breast biopsy performed with large core needles. Histopathologic findings of microbiopsies were correlated with radiological findings, with follow up and with surgical findings. Agreement between radiological and histopathologic findings on biopsies was obtained in 86% for benign results. Even in the case of benign radiological findings, the histological results of microbiopsies required a surgical biopsy justified in 10% of cases. Radiologically suspicious or malignant microcalcifications were correlated with 35% benign and 65% malignant histologies on biopsies. The positive predictive value, negative predictive value and accuracy were respectively 93%, 86% and 95%. Invasive lesions were found on microbiopsies in 39% of excised malignant lesions. Multifocal lesions were proved on microbiopsies in 50% of all excised carcinomas. Microbiopsies help to disclose malignant lesions undetected on radiological analysis, and may obviate diagnostic surgical biopsy in many cases.

Adult↗
PubMed1996

Isolated axillary recurrences after conservative treatment of breast cancer.

This retrospective study presents the diagnostic, prognostic and therapeutic problems raised by axillary recurrences (AR). 1589 cases of breast cancer measuring less than 3 cm, treated at the Institut Curie between 1981 and 1987, were studied by a combination of surgery and radiotherapy. Treatment of the breast always included wide local excision associated with irradiation. The axilla was treated either by dissection (865 cases) or by irradiation (724 cases) and 159 patients received chemotherapy. 26 patients (2%) developed AR, confirmed by fine needle aspiration cytology in 92% of cases. None of these 26 patients had initially received chemotherapy. The treatment of the AR was variable, adapted to the initial treatment. 22 patients retained their breast during treatment of the AR and none subsequently developed a local recurrence. 4 mastectomies were performed and histological examination revealed a subclinical local recurrence in 2 cases. The TNM classification, menopausal status, size of the tumour and hormonal receptor status were not risk factors for AR. Young age (P = 0.01) and high histological grade (P = 0.03) were significant risk factors for AR. The AR rate was similar whether axillary dissection or axillary irradiation had been performed. The overall 5-year survival after initial treatment was 85% for AR and 95% for the reference population. The overall 4-year survival after recurrence was 69% and the incidence of metastasis was markedly increased (P = 0.002). 2 of the 26 patients developed lymphoedema of the arm after treatment of AR. We confirm that AR worsens the prognosis, but not significantly more than local recurrence. Young age and the modified histological grading of Scarff Bloom and Richardson were risk factors for AR. Although excision of the AR is necessary to ensure local control, mastectomy is unnecessary when clinical examination and mammography are normal.

Age Factors↗
PubMed1996

[Influence of infertility etiology and follicular stimulation protocols on pregnancy outcomes by in vitro fertilization].

During a retrospective study on 152 singles pregnancies obtained by in vitro fecondation at Tenon hospital, and followed in this department between January 1990 and December 1994, we have studied the influence of the IVF (tubal origin, masculine or idiopathic) and the type of stimulation (human menopausal gonadotrophin: hMG or follicle stimulating hormone: FSH) on the weight of the newborn and the pathologies that occurred during the pregnancy. No difference in the antecedents has been found in the different group of patients. This study shows a significative difference (p < 0.001) of the newborn's weight when the indication of IVF is tubal origin or masculine. Also, in all IVF indications, the weight is significantly (p < 0.01) higher after a follicular stimulation by FSH versus hMG. For the pregnancy pathologies, no significative difference has been noted, although arterial hypertension, fetal growth retardation and gestational diabetes appear to be more frequent in the group of women who had stimulation by hMG.

Adult↗
PubMed1996

[Breast cancer during pregnancy].

Breast cancer during pregnancy is a rare eventuality. The mean age of women is 34 years. The same histological types (essentially ductal) are found, but there are more inflammatory forms and/or node involvement and general metastasis. The hormonal receptors are usually negative. The clinical diagnosis is often difficult and delayed. The mammography is perturbed because of breast congestion, giving reason for histological verification. The treatment must consider the fetus as much as possible. The traditional mastectomy associated to axillary nodes dissection is replaced most of the time by a large tumorectomy with axillary node dissection with the condition not to delay the complementary radiotherapy fore more than three months and to take in consideration the toxicity in relation to the gestational age, the site of impact and the doses given. Also, chemotherapy, if indicated, must begin in the month following the diagnosis. The pronostic is not as good in general as that in the non pregnant woman, because of the delayed diagnosis, the ganglionic metastasis, and the aggravation of the forms accelerated by pregnancy. The prevention consists of a clinical examination of the breast early in pregnancy (particularly after 30 years) and by histologic verification in cases where there is the slightest doubt.

Adult↗
PubMed1996

[Physiological review of the mammary gland development during pregnancy].

The mammary gland underwent during pregnancy morphological, histological and physiological modifications that ensure the lactation in the post-partum. On the morpho-histological side, the epithelial growth and the milk synthesis during pregnancy allow secondary the lactation. The physiological modifications, beside the endocrines factors such as prolactin, estrogens, progesterone or growth hormone, lead to an auto-paracrines interactions involving the growth factors and the molecules synthetized by the extracellular matrix.

Breast↗