Search PubMed⌕ Search

Biomedical subjects

V Tsatsaris

Publications and source records attributed to V Tsatsaris.

16 recordsLinked to original sources
PubMed2002

Prenatal diagnosis of bilateral isolated fetal hyperechogenic kidneys. Is it possible to predict long term outcome?

OBJECTIVE: To study perinatal and long term outcome following prenatal diagnosis of hyperechogenic kidneys. DESIGN: Prospective observational cohort study. SETTING: The Maternité Port-Royal Hôpital Cochin and at the Departments of Obstetrics and Paediatric Nephrology, Necker Enfants Malades in Paris, France. POPULATION: Forty-three fetuses with isolated bilateral hyperechogenic kidneys. METHODS: All patients referred with isolated bilateral hyperechogenic fetal kidneys were followed up prospectively up to 34-132 months. The following prenatal items were analysed: fetal kidney size, amniotic fluid volume, gestational age at diagnosis, family history and renal ultrasound in parents. Postmortem examination was carried out in cases with perinatal death. Postnatal follow up of survivors included postnatal ultrasound, blood pressure, serum creatinine, proteinuria, need for restricted diet, weight and height and renal biopsy when available. MAIN OUTCOME MEASURES: Aetiology of hyperechogenicity, perinatal mortality and renal function in survivors. RESULTS: The aetiology could be established by family history, postmortem or postnatal data, but not by prenatal ultrasound. There were 20 autosomal recessive, 8 autosomal dominant polycystic kidney diseases, 9 other renal disorders and 6 symptom-free survivors without aetiological diagnosis. There were 19 terminations of pregnancy, 5 neonatal deaths and 19 survivors, of whom 14 had normal renal function three had mild and two had end stage renal failure. None of those with severe oligohydramnios and fetal kidneys > 4 SD survived (n = 14, 10 terminations and 4 neonatal deaths), whereas of the 17 with normal amniotic fluid volume and kidneys < 4 SD, 14 survived, of whom 9 were symptom-free. CONCLUSION: Aetiology could not be established prenatally in the absence of familial data. Kidney size and amniotic fluid volume were the best prenatal predictors of outcome.

Cohort Studies↗
PubMed2002

[Which tocolytic drugs in case of preterm labor?].

Because criteria used for the prediction of preterm labor are poorly effective, many patients receive tocolytic therapy in excess during pregnancy. Beta-mimetic agonists are the reference tocolytic drugs in most countries. Their efficacy in prolonging pregnancy compared to a placebo is proven although no benefit in neonatal morbidity or mortality has been demonstrated. Beta-mimetics have many contraindications, and side-effects are frequent. Serious complications such as pulmonary edema and maternal deaths, though rare, have been reported. Recent research has focused on tocolytic drugs with similar efficacy to beta-mimetics but with less side effects. Calcium-channel-blockers and oxytocin antagonists have been compared with beta-agonists in randomized trials. Both have demonstrated similar efficacy in the prolongation of pregnancy for at least 48 hours. Contrary to beta-mimetics, very few interruptions of treatment have been observed with these treatments. Other tocolytic drugs such as cyclooxygenase inhibitors, although effective in prolonging pregnancy, have unacceptable fetal side effects. Progesterone, antispasmodic drugs and magnesium sulfate have been widely used but their efficacy has not been demonstrated. More recent treatments such as NO-donors and cyclooxygenase-II specific antagonists are not sufficiently evaluated. In conclusion, three main classes may be used as first line tocolytic therapy, beta-adrenergic agonists, calcium-channel-blockers, and oxytocin antagonists. The choice among these treatments may be based on contraindications to beta-mimetics, side-effects of the treatment, or even economic reasons.

Clinical Trials as Topic↗
PubMed2001

Balloon replacement of fetal membranes to facilitate emergency cervical cerclage.

BACKGROUND: Emergency cerclage can be used in cases of cervical incompetence, even when fetal membranes bulge through the dilated cervix. To facilitate the procedure we used a balloon device to replace the fetal membranes. TECHNIQUE: With the patient in a steep Trendelenburg position, after epidural anesthesia, the fetal membranes were replaced into the uterine cavity with an inflated balloon of the type used for endoscopic preperitoneal dissection. Cervical cerclage was done by the McDonald technique. EXPERIENCE: We have done 25 emergency cerclages with this technique. The following maternal and perinatal outcomes were assessed retrospectively: age, medical history, gestational age at inclusion and delivery, cervical dilatation at admission, preterm rupture of membranes, clinical or histologic chorioamnionitis, birth weight, admission to the neonatal intensive care unit, neonatal death, and postnatal course. CONCLUSION: Replacing prolapsed fetal membranes with an inflated balloon is a convenient technique that allows gestation to be prolonged for an average of 31 days. Cerclage was feasible when the cervix was widely dilated (more than 4 cm); it was associated with prolongation of gestation by a median of 9 days.

Emergencies↗
PubMed2001

Tocolysis with nifedipine or beta-adrenergic agonists: a meta-analysis.

OBJECTIVE: To clarify the relative efficacy of nifedipine and beta-agonists for tocolysis. DATA SOURCES: The literature was searched in the following databases: MEDLINE 1965-1998, Embase 1988-1998, Current Contents 1997-1998, and the Cochrane Database for 1998. We also sought unpublished trials and abstracts submitted to major international congresses. Search terms were: "tocolysis," "nifedipine," "calcium channel blocker," "ritodrine," "terbutaline," and "salbutamol." METHODS OF STUDY SELECTION: Randomized controlled trials comparing tocolysis with nifedipine and beta-adrenergic agonists during preterm labor were reviewed. In cases with postrandomization exclusions, authors were contacted to obtain intent-to-treat results and to avoid analytical bias. We identified 11 published and two unpublished randomized trials. TABULATION, INTEGRATION, AND RESULTS: Data were extracted by two reviewers and analyzed by a blinded biostatistician with RevMan 3.1 software from the Cochrane Collaboration. We analyzed nine relevant randomized controlled trials that included 679 patients. Meta-analysis showed that nifedipine was more effective than the beta-agonists in delaying delivery at least 48 hours [odds ratio (OR) 1.52, 95% confidence interval (CI) 1.03, 2.24], or over 34 weeks (OR 1.87, 95% CI 1.11, 3.15). The agents did not differ as to the incidence of deliveries after 37 weeks (OR 1.29, 95% CI 0.85, 1.96) or the neonatal mortality rate (OR 1.51, 95% CI 0.63, 3.65). Treatment with nifedipine was interrupted significantly less often because of side effects (OR 0.12, 95% CI 0.05, 0.29) and led to better neonatal outcomes (fewer infants with respiratory distress syndrome: OR 0.57, 95% CI 0.37, 0.89) or transferred to neonatal intensive care units (OR 0.65, 95% CI 0.43, 0.97). CONCLUSION: With respect to neonatal outcome, nifedipine appears to be more effective than beta-agonists for tocolysis and should be considered for use as a first-line tocolytic agent.

Adrenergic beta-Agonists↗
PubMed2001

[The new tocolytics].

Explore the source record for details and available documents.

Calcium Channel Blockers↗
PubMed2001

[Which tocolytics should be used in 2001?].

Beta-mimetics are the gold standard tocolytic treatment but raise several problems. Despite their recognized efficacy in prolonging pregnancy, the neonatal benefit remains to be proven. There are several contraindications and frequent adverse effects, with a risk of fatal maternal accidents. The lack of reliable criteria for the prediction of preterm birth leads to giving unnecessary treatments to two-thirds of the patients. In this context, obstetrical practices have tended to prefer tocolytics which, with the same efficacy, would have fewer side effects than beta-mimetics and which would not raise a risk of severe complications. Calcium-channel blockers belonging to the dihydropyridin family and ocytocin antagonists would appear to meet the new requirements. In randomized trials versus beta-mimetics, they have been found to have a comparable effect in prolonging pregnancy by 48 hours. Tolerance is better than with beta-mimetics and treatment interruption due to side effects can be avoided. Finally, a meta-analysis of trials comparing calcium inhibitors versus beta-mimetics demonstrated a decrease in respiratory distress syndrome in the neonates and a reduction in the number of transfers to neonatal intensive care. The data accumulated on these new compounds would appear to suggest that they should be used as the first line treatment and not as an alternative to beta-mimetics. Other compounds including NO donors and cyclo-oxygenase 2 inhibitors are under evaluation.

Adrenergic beta-Agonists↗
PubMed2001

[Tocolysis with calcium-channel-blockers].

OBJECTIVE: To evaluate the use of calcium-channel-blockers (CCBs) for tocolysis. METHODS: We reviewed the literature retrieved from the Medline database from 1967 to 200 dealing with fetal toxicity and efficacy of CCBs compared with beta-adrenergic agonists. RESULTS: Data on fetal toxicity in animals were inconsistent. A teratologic effect has been observed during early pregnancy at supratherapeutic dosage. At usual therapeutic dosage, no fetal abnormalities have been observed. The efficacy of CBs for tocolysis is superior to that of beta-adrenergic drugs and allows a reduction of neonatal morbidity. Calcium channel blockers are better tolerated than beta-adrenergic agonists. CONCLUSION: Published data suggest that CCBs could be used a first line tocolytic agents. Although use of CCBs is extremely simple, they should not be prescribed in low-risk outpatients.

Adrenergic beta-Agonists↗
PubMed2000

Place of amniocentesis in the assessment of preterm labour.

OBJECTIVE: To evaluate the benefits and indications for amniocentesis in cases of preterm labor with or without preterm rupture of membranes. METHOD: A review of the literature on amniocentesis in cases of intra-amniotic infection. RESULTS: Amniocentesis is an invasive method that allows the diagnosis of intra-amniotic infection. However, no randomized trials have been performed from which we can assess the benefits and complications of amniocentesis in preterm labor. CONCLUSION: The published data do not justify the routine practice of amniocentesis in preterm labor. More data are needed to evaluate the benefits and complications of this practice. Only randomized trials of patients in preterm labor, comparing those who undergo amniocentesis with those who do not, will clarify the indications for this procedure.

Amniocentesis↗
PubMed1998

Changes in plasma and amniotic fluid endothelin levels during pregnancy: facts or artefacts?

OBJECTIVE: To describe the evolution of immunoreactive endothelins (irETs) in maternal peripheral plasma and in amniotic fluid at different stages of pregnancy using two different radioimmunoassays. STUDY DESIGN: Peripheral blood samples were obtained from ten non-pregnant and eighty-four pregnant patients at different stages of pregnancy, but not in labor. Amniotic fluid samples were obtained in ten patients during the second trimester of pregnancy and in twenty-two patients at term. Endothelin concentrations were assayed using two different kits: by antigenic cross-reactions, the RPA 545 assay allowed the detection of ET-1, ET-2 and big ET-1; the RPA 555 assay allowed the detection of ET-1, ET-2 and ET-3. RESULTS: Using the RPA 555 kit, no differences were observed in irET plasma levels between non-pregnant and pregnant patients whatever the gestational age. With the RPA 545 kit, the irET levels were significantly lower in pregnant patients during the first and second trimesters of pregnancy when compared to non-pregnant patients. Immunoreactive ET levels then increased significantly in the last month of pregnancy when compared to mid-pregnancy levels. In amniotic fluid, irET levels were significantly higher at term than during the early second trimester, without any difference between the two RIA kits. CONCLUSION: Our results are indicative of a differential evolution in ET isoforms during pregnancy in maternal peripheral blood. The increase in irET observed towards the end of pregnancy in maternal plasma and in amniotic fluid suggests that ET could play a role in the onset of parturition.

Amniotic Fluid↗
PubMed1998

Is conservative treatment of HELLP syndrome safe?

HELLP syndrome is associated with a high rate of maternal and perinatal morbidity and mortality, and often leads to immediate fetal extraction. However, this condition may occur very early in pregnancy and conservative approaches have been recently proposed. The limits of this approach are discussed with two cases of conservative management of HELLP syndrome complicated by abruptio placentae.

Abruptio Placentae↗
PubMed1997

[Autosomal dominant polycystic kidney. Apropos of 2 cases. Review of the literature].

Autosomal dominant polycystic kidney disease (ADPKD) is the most common hereditary disease. Genetic molecular methods can make the diagnosis of at least three different types of ADPKD. ADPKD concerns young people and complications such as hypertension and decreased renal function occur more frequently if onset is early, if it is a type 1, and if the patient is a woman. The pregnant woman with autosomal dominant cystic disease is at particular high risk of obstetrical complications. Prenatal diagnosis is possible.

Adult↗
PubMed1996

[Microangiopathic hemolytic anemia associated with uterine sarcoma: report of a case. Review of the literature].

Microangiopathic hemolytic anemia (MAHA) is a rare but severe complication of neoplastic disease. The diagnosis of thrombotic microangiopathy is based on a triad of a hemolytic anemia with schistocytes, thrombocytopenia, and renal failure. Carcinoma-associated MAHA and chemotherapeutic-induced MAHA have been described. Because of differences concerning prognosis and treatment it is important for the clinician to distinguish these two syndromes. However, to our knowledge, this is the first case of a sarcoma-associated thrombotic microangiopathy.

Anemia, Hemolytic↗
PubMed1996

[Umbilical metastasis of an endometrial adenocarcinoma: "Sister (Mary) Joseph's nodule". Review of the literature].

In the beginning of the XXth century, Sir Hamilton Bailey proposed the name "Sister Joseph's nodule" for the umbilical metastasis of an abdominal cancer. This unusual pathology has multiple primitive etiologies. We report here the 27th case of an umbilical metastasis of an endometrial adenocarcinoma. In case of a malignant umbilical tumor, 75% correspond to a "Sister Joseph's nodule". Their clinical manifestations are quite similar. This secondary localisation could appear before, during or after the diagnosis of the primitive tumor. Adenocarcinoma is the frequently diagnosed histological type. The endometrial origin represents only 1.4% of the cases. Multiple routes of spread exist. Prognosis remains poor. Medico-surgical treatment, in a curative target, will be aggressive and should be adapted at every case. Our case-report recalls a new patho-physiological approach. The extended follow-up of this patient, without further medical treatment, is an additional argument.

Adenocarcinoma↗
PubMedDate not supplied

[Uteroplacental vascularization].

The intervillous space is considered as receiving the most important part of the uterine flow input (> 90%), reaching the placenta through the modified spiral arteries network. The low vascular resistance detected on the uterine arteries is thought to be due to the presence of the placental shunt. Using a 3D Colour Doppler technology (ATL 5000), a complex anastomotic and intra-myometrial network has been detected. This vascular network is always detected during the first 48 hours of after delivery. During this time, the placenta has been removed, the uterine muscle is contracted, a low resistance of the uterine flow is systematically detected. A extraplacental vascular component must be considered as taking a functional part in the foeto-maternal exchanges.

Female↗