Biomedical subjects
Publications and source records attributed to R Renaud.
The two large mature sacro-coccygeal teratomas reported seem to be responsible for the death of fetuses in the fifth and sixth months of pregnancy. A review of the literature shows that teratomas are exceptionally rare during this period. Their outcome depends upon the degree of maturity of the tumor, its size, whether its location is pelvic or not, the presence of any associated malformations and upon prematurity.
The authors present 11 cases of Krukenberg tumour and have reviewed the literature concerning this condition. They conclude that the expectation of cure is increased if the primary tumour is removed early and if chemotherapy, hormono-therapy when indicated and immunotherapy are carried out, preferably together. No treatment at present seems to be specific for this condition.
One hundred and twenty two fetal echocardiograms were performed during normal pregnancies between the 20th and 38th weeks of gestation. Freeze frame M mode and 2D imaging was used to perform the following measurements: right and left systolic and diastolic ventricular dimensions, dimensions of the two atria, aortic and pulmonary artery dimensions, fractional shortening of both ventricles, ratio of right ventricular to left ventricular end diastolic dimensions RVEDD/LVEDD, ratio of pulmonary artery to aortic dimensions PA/Ao. The causes of error or failure were analysed. The results classified by gestational age show progressive growth of all structures which double their size during the second half of the pregnancy; the "physiological" septal hypertrophy reported by some workers was not observed in this series; similarly, paradoxical septal motion was only present in 3% of the fetuses studied. The RVEDD/LVEDD ratio approached unity, which questions the classical but hypothetical concept of physiological right ventricular preponderance, a concept also queried by recent fetal Doppler intracardiac flow studies. The repertory of normal values is particularly useful for the detection of cardiac malformations and for the surveillance of some pregnancies with a high risk of cardiomyopathy, as in maternal diabetes.
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The authors report a diagnosis of trisomy 21 in the 11th week following the last menstrual period in a patient of 40 years of age. This was made by chorion villi aspiration and direct cytogenetic examination.
The follow-up of women treated for breast cancer rather varies according to school of thought. This follow-up is often too irregular, insufficient or unnecessarily exhaustive and costly. It depends on numerous factors such as the doctor-patient relationship, stage of disease, frequency and usual site of metastases, time lapsed since first treatment, and validity and reliability of tests. In early stages, attention must be paid to discovery of recurrence and metastasis, either in the opposite breast or in other organs. In advanced stages, the examination involves an evaluation of the degree of extension and ongoing disease activity with search for evidence of stability.
Chorionic villus biopsies made during the first trimester of pregnancy offer the advantage of earlier antenatal diagnoses than usual methods. This technic was introduced about 15 years ago but recently improved thanks to innovations in equipment and the contribution of echography. 75 biopsies were made using aspiration technic by echographic-guided catheter. These biopsies were carried out before elective abortion, 18 in an ambulatory setting one to three weeks before the abortion in order to test the social acceptability and tolerance of this method, as well as the inherent risks involved. The biopsy technic is described as well as preliminary results of chromosomic analyses of biopsied chorionic tissues. Drawing from a perspicacious review of the literature, the respective advantages of various biopsy technics and their uses (i.e. sex determination and chromosome analyses by culture and especially direct methods, study of fetal DNA, and enzyme assay) are examined. Finally, the risks of biopsy technic in the immediate and near future are discussed, and the indications today for this new technic are described.
A review of current literature concerning developments of new parameters in fetal biometry is presented. To be sure, these parameters are very useful for detection of fetal malformations but outside of femoral length they do not contribute more valuable information than the already accepted parameters for determination of gestational age or detection of disorders of fetal growth.
Ovarian carcinoma is the most severe gynecological cancer with an overall incidence of 12 per 1000 Americans or Europeans developing it over 40 years of age. Only 3 of the 12 cases will receive efficient care because the diagnosis will be made too late. This study reveals the principal risk factors i.e. upper socioeconomic echelon, ovarian function uninterrupted by a pregnancy or usage of oral contraceptives, anamnestic evidence of ovarian carcinoma in the family, some hereditary disorders, external insults (talcum powder). The synthesis of these various risk factors permits a comprehensive review of the hypotheses of pathogenesis concerning recurrence of tumors. But corollary epidemiologic studies are still needed to try to define better the high risk groups whose follow-up systematic detection and testing is a priority.
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The authors report a series of 25 operations using the Bologna technic in which 20 cases were examined with bladder function tests before and after surgery. This technic has curative results for vesical hernia or cystocele and urinary incontinence. In all but one case the abdominal pressure transmission defect to the upper urethra was corrected without deterioration of maximal urethral pressure.
Recording the fetal cardiac rhythm (FCR) is currently the technique most widely used to assess the well being of the fetus. In view of the importance of the decisions taken on the modifications of the FCR, the authors have recorded and analysed over 24 consecutive hours 10 resting women manifesting a strictly normal pregnancy. They observed no modification in the basal cardiac frequency, very few declarations and above all, never any signs of a flat or sinusoidal rhythm. Flattening of the FCR is invariably pathological. It must not be interpreted as "fetal sleep" period, but it should intensify the surveillance.
A total of 506 women at moderate risk of preterm delivery were randomly allocated to either cervical cerclage or a control group. Significantly more women in the group allocated to cerclage were admitted to hospital for reasons other than the operation and more received oral tocolytic drugs. There were also more caesarean sections and more preterm deliveries in the women allocated to cerclage although the differences between the two groups were small and not statistically significant.
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Urinary incontinence is a complication of pregnancy. Having carried out urodynamic studies in pregnancy and immediately after delivery in 27 primigravid women, the authors have been able to clarify the alterations that take place in narrowing and closing the neck of the bladder and urethra, and especially in the tone of the urethra and of the functional character of the organ, in connection with hormonal changes that occur in pregnancy. They also demonstrate an increasing instability of the bladder which is due to compression by the pregnant uterus and which makes the function of bladder neck closure more difficult. On the other hand no significant short-term effect of obstetrical trauma could be found.
Adding together the obstetric histories and the urodynamic investigations carried out on 178 incontinent women has made it possible for the authors to work out the role that obstetric trauma can play in urinary symptoms. They are able to demonstrate the effects of repeated normal deliveries and also the results of traumata over and above those that occur physiologically and are sometimes undergone by the perineum.
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