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Biomedical subjects

R Frydman

Publications and source records attributed to R Frydman.

At least 253 records · Page 14Linked to original sources
PubMed1993

[Clinical pharmacokinetics of ceftriaxone during the third trimester of pregnancy and study of its transplacental passage in two patients].

The purpose of this study was to determine ceftriaxone (CTX) pharmacokinetics during pregnancy. Six women (26 to 34 years of age) admitted for chorioamnionitis (n = 4) or pyelonephritis (n = 2) were included. Gestational age ranged from 29 1/7 to 40 5/7 weeks. Initial intravenous treatment was ceftriaxone (CTX) (2 g/d), tobramycin (3 mg/kd/d) and ornidazole (1 g/d). Blood specimens were collected during the first treatment day (D1) to determine the primary pharmacokinetic profile of CTX then at steady-state (D7) to look for systemic accumulation. In two patients, transplacental passage of CTX was evaluated by determining the ratio of fetal and maternal concentrations (F/M) at delivery. Plasma CTX levels were determined using high-performance liquid chromatography. A noncompartmental method was used for pharmacokinetic analysis. Each patient served as her own control. Data obtained on D1 and D7 were compared using Wilcoxon's test (values of p < or = 0.05 were considered significant). A group of healthy controls given a similar regimen was also used. 1) Tolerance was outstanding, recovery was achieved in every case, and there were no premature deliveries. 2) No evidence of accumulation of CTX was found and kinetic profiles on D1 and D7 were not significantly different. 3) Mean kinetic parameter values were closely similar to those found in healthy volunteers. 4) Residual levels of total CTX and free CTX determined after 24 hours were greater than the minimal inhibitory concentration (MICs) of susceptible organisms. 5) The usual recommended dosage of CTX (2 g/d) proved adequate during the third trimester of pregnancy.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1993

[Gestational age and fetal lung maturity].

In order to assess the lung maturity of the fetus, a biochemical analysis using two reliable, simple and rapid methods (FLM-TDX Abbott and determination of phosphatidylglycerol (PG) have been carried out on 166 amniotic fluids taken by amniocentesis. The patients were particularly pregnant women presenting disorders such as diabetes (n = 41), premature rupture of the membranes (n = 30), hypertension (n = 20), intra uterine growth retardation (n = 13) and gemellar pregnancies (n = 27). The lung maturity of the fetus has been considered as mature (no risk of any hyaline membrane disease: HMD) when the phospholipid rate is higher than 50 mg/g albumin (FLM-TDX Abbott), associated or not with the presence of PG (PG positive). The latter phospholipid was present only in women whose pregnancy was about 35 weeks. Besides, our results show a very large disparity of the phospholipid rates (FLM-TDX) in the amniotic samples for an identical gestational age. Values from 9 to 124 for pregnancies with term of 31 weeks, and from 21 to higher than 160 for those of 38 weeks. In infants born not later than 48 hours after the amniotic punction (n = 30), four of them presented an HMD. The FLM-TDX values were less than 30 for three cases and equal to 52 for the fourth. The term of these newborns was 37 weeks or more for three of them, and 31 weeks for the last one. Our study confirm that the TDX-FLM Abbott is useful to assess the fetal lung maturity and does not correlate with the gestational age.

Amniocentesis↗
PubMed1993

[The value of RU-486 (mifepristone) in medical indications of the induction of labor at term. Results of a double-blind randomized prospective study (RU-486 versus placebo)].

One hundred and twenty term women (> 37.5 weeks amenorrhea) with unripe cervixes (Bishop < 4) and with a clear clinical indication for labour induction were randomized to receive either mifepristone (RU 486) or placebo. The patients' regimens consisted of 200 mg of mifepristone on days 1 and 2 over an observation period of 4 days, with labour induction planned for day 4. Within 12 hours after taking the first tablet, fetal distress was diagnosed in 8 patients (3 in the Mifepristone group and 5 in the control group), who underwent immediate cesarean section. These 8 patients could not therefore participate in our survey and have been excluded from the final results. Forty one patients had spontaneous onset of labour, 31 in the mifepristone group and 10 in the control group (p < 0.001). Forty seven patients needed cervical maturation with prostaglandin, 32 from the control group and 13 from the mifepristone group (p < 0.001). Thirteen patients in each group had cervical maturation sufficient for classical labour induction. We noted that patients delivering vaginally needed significantly lower amount of oxytocin in the mefepristone group and that the mean time interval between day 1 and the onset of labour was also significantly shorter in this group. The high cesarean section rate (32%), which is equivalent in both the placebo and the treated groups, may be attributed to the fact most of the patients in this survey had high risk pregnancies. There was no difference in the occurrence of fetal distress during labour in the 2 groups. Neonatal parameters were similar in both groups. These results establish mifepristone as an induction agent for the initiation of labour in term women. Though more studies are needed, Mifepristone has shown itself to be safe and appropriate in situations where labor has to be induced in term women.

Adult↗
PubMed1992

First-trimester diagnosis of nuchal anomalies: significance and fetal outcome.

High-resolution real-time ultrasonography now permits the differentiation between nuchal translucencies and cystic hygromata of the neck in the first trimester. A series of 85 nuchal anomalies are presented that were diagnosed by ultrasonography at 9-14 weeks' gestation; their association with chromosomal defects and fetal outcome are also presented. Chromosomal anomalies were found in 8/29 nuchal translucencies and in 16/56 cystic hygromata of the neck. However, in fetuses with normal karyotype, additional defects were diagnosed in l0/40 fetuses with cystic hygromata and in none with nuchal translucency. These data may be important for the management of these conditions and for counselling the patients toward further pregnancy.

Journal Article↗
PubMed1992

[Sterility and medically assisted fertilization].

In vitro fertilization is now part of the treatment of infertility. Since 12 years, indication have been extended to male or female infertility factors. The successes have also been increased and the actual pregnancy rate is about 18% pregnancies by retrieval. Different methods are available such as GIFT, ZIFT, TET and progresses will certainly come from new techniques such as micro-manipulation, oocyte freezing and genetic procedures applied to assisted reproduction technologies.

Female↗
PubMed1992

Anonymous oocyte donation: a psychological study of recipients, donors and children.

The psychological features of anonymous, personalized oocyte donation are examined. The specific psychological profiles of recipients and donors are described, as well as the psychological experience of patients undergoing fertilization attempts. Preliminary data from an ongoing 3-year longitudinal study of children born by these medically assisted procreation techniques are reported.

Denial, Psychological↗
PubMed1992

Controlled preparation of the endometrium with exogenous oestradiol and progesterone: a novel regimen not using a gonadotrophin-releasing hormone agonist.

In women having inactive ovaries, controlled preparation of the endometrium has been achieved with exogenous oestradiol and progesterone. We report on the feasibility and practicality of using a similar regimen for timing transfers of cryopreserved embryos in women whose ovaries have not been suppressed. A total of 91 women having cryopreserved embryos from previous in-vitro fertilization (IVF) attempts received 4 mg/day of oestradiol valerate, starting on cycle day 1 of spontaneous (n = 85) or induced (n = 6) menstruation. A single blood sample was obtained on cycle day 14 for the measurement of plasma progesterone, oestradiol and luteinizing hormone (LH). Vaginal administration of micronized progesterone (300 mg/day) was started on day 15. Cryopreserved embryos were transferred on day 17 or 18 provided that day 14 plasma progesterone remained < or = 0.5 ng/ml, thereby confirming the absence of spontaneous ovulation prior to the administration of exogenous progesterone. Out of 91 cycles studied, plasma progesterone was found to be elevated (> 1 ng/ml) in only three (3.2%). Of the 88 scheduled transfers, 31 did not take place because no embryo survived thawing. In the remaining 57 cycles, 116 embryos were transferred resulting in 10 pregnancies, giving pregnancy and embryo implantation rates of 17.5 and 8.6% respectively. When a positive beta human chorionic gonadotrophin (HCG) titre was obtained, supplementation with oral oestradiol and vaginal progesterone was continued until placental autonomy was achieved. Of the 10 pregnancies, five (50%) were lost during the first trimester (biochemical, n = 1; miscarriage, n = 3; ectopic, n = 1).(ABSTRACT TRUNCATED AT 250 WORDS)

Abortion, Spontaneous↗
PubMed1992

Influence of sperm parameters on outcome of subzonal insemination in the case of previous IVF failure. off.

Subzonal insemination (SUZI) has been proposed for patients with sperm male factor infertility, and in cases of in-vitro fertilization (IVF) failures. However despite SUZI, there still remain couples with very low fertilization rates and even with fertilization failures. Since sperm parameters are known to influence the IVF fertilization rate, we investigated the relation between sperm parameters and the SUZI issue in cases of previous IVF failures with normal or subnormal sperm. Twenty-seven couples were included in the study and were split into two groups according to whether they had normal or subnormal sperm. In the first part of the study a randomized prospective trial comparing SUZI to classic IVF insemination was carried out (11 cycles). In the second part, all the oocytes had SUZI (35 cycles). None of the control inseminated oocytes fertilized. Including all the cases, the fertilization rate after SUZI was 29.8% with a pregnancy rate of 15.2% per cycle. We concluded that: (i) SUZI is efficient for achieving fertilization in cases of IVF failures; (ii) the post SUZI fertilization rate is inversely correlated to the percentage of acrosome defects in the semen (P < 0.001); and (iii) when the sperm is normal, the oocyte quality might be responsible for the previous IVF failures. In spite of a good fertilization rate for this indication, it seems that the chance of having a baby is low.

Adult↗
PubMed1992

Spontaneous luteinizing hormone surges can be reliably prevented by the timely administration of a gonadotrophin releasing hormone antagonist (Nal-Glu) during the late follicular phase.

A new gonadotrophin releasing hormone antagonist (Nal-Glu) was used during the late follicular phase of the natural cycle in order to prevent spontaneous surges of luteinizing hormone (LH). Eight regularly ovulating women (group 1) received two injections of Nal-Glu (5 mg) administered 48 h apart when plasma oestradiol levels exceeded 125 pg/ml. Human menopausal gonadotrophin (HMG, 225 IU) was administered simultaneously with Nal-Glu and repeated every 12 h thereafter until either a spontaneous LH surge occurred or human chorionic gonadotrophin (HCG, 5000 IU) was administered. HCG was arbitrarily administered 48 h after the second Nal-Glu injection. Six other women (group 2) receiving only HMG served as controls. In seven of the eight women in group 1, LH and progesterone remained low for 96 h following Nal-Glu, i.e. until HCG administration. In the remaining woman in this group, LH started to rise 12 h before HCG injection. In this group, Nal-Glu did not interfere with follicular development or the plasma profile of oestradiol. All women developed one single dominant follicle with the exception of one subject who had already spontaneously developed two dominant follicles prior to administration of Nal-Glu and HMG. In group 2, LH rose spontaneously in all women before the planned HCG injection. The luteal phase was apparently not altered by Nal-Glu. These results suggest that Nal-Glu administration during the late follicular phase of natural cycles supported by HMG, can prevent the spontaneous LH surge while not interfering with follicular growth.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1992

Effects of luteal estradiol on the secretory transformation of human endometrium and plasma gonadotropins.

To study the role of luteal estradiol (E2), we interrupted the supply of E2 during the luteal phase of E2 and progesterone (P) replacement cycles. Thirty-one women, aged 26-37 yr, with absent or inactive ovaries received three different treatment regimens: group I (n = 11) received transdermal E2 and vaginal P according to a protocol designed to approximate levels of estrone (E1), E2, and P seen during the menstrual cycle. Groups II (n = 11) and III (n = 9) received identical treatments, except that in group II no E2, and in group III no E2 or P, was administered after day 15. Endometrial biopsies were obtained on days 20 and 24 in groups I and II, and on days 14 and 20 in group III. In group I, plasma E1 and E2 reached menstrual cycle levels, whereas in groups II and III, discontinuation of the E2 supply on day 15 resulted in a prompt decrease to castrate levels of plasma E1 and E2. In groups I and II, menopausal FSH and LH levels decreased to 26 +/- 6 and 30 +/- 7 IU/L, respectively, on day 13 (mean +/- SEM). In group I, administration of E2 and P starting on day 15 further lowered plasma gonadotropin levels. In group II, administration of P only failed to induce a similar decrease in plasma FSH and LH. No uterine bleeding occurred before day 25 in women of groups I or II, while women of group III bled within 2 days of E2 withdrawal. Endometrial biopsies were similar in groups I and II. Histological features were characteristic of early and late luteal phases on days 20 and 24, respectively. Endometrial maturation assessed by estrogen and progesterone receptors identified by immunocytochemistry showed the typical distribution seen on day 24 of the menstrual cycle with no difference between groups I and II. We conclude that in women deprived of ovarian function, administration of P only after 14 days of E2 priming prevented uterine bleeding and induced normal secretory transformations of the endometrium, but failed to suppress plasma gonadotropins.

Administration, Cutaneous↗
PubMed1992

[Medical and ethical problems posed by the prenatal diagnosis of distal absence of a limb].

Eight cases of distal amputation of limb are reported. The diagnosis were made by ultrasound scans at 18-25 weeks of amenorrhea. In all cases, according to the French law, our team of fetal medicine refused the therapeutic terminations of pregnancy requested by the parents. The therapeutic terminations of pregnancy were achieved by another unit of fetal medicine in France, or in another country. These reported cases address many questions about the aim of fetal medicine (therapeutic terminations of pregnancy or treatment of infants), the place of the parents request in the decision, the different decision arguments, and the variations in the decision between different fetal medicine crew facing to similar prenatal diagnosis.

Abortion, Legal↗