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Biomedical subjects

Y Darbois

Publications and source records attributed to Y Darbois.

At least 37 records · Page 2Linked to original sources
PubMed1995

[Human papilloma virus infection and renal transplantation. Two personally observed cases and a review of the literature].

Two cases of recurrent genital infection due to human papilloma virus (HPV) infection with preneoplasic lesions were observed in kidney transplant recipients. The neoplasic component appears to be very frequent in this immunosuppressed population with a risk estimated at 7%. According to the different authors in the literature [correction of litterature], genital lesions due to HPV, with or without dysplasia are found in 15 to 30% of the transplant population. The factors of risk are not different from the general population and are a function of sexual activity. The clinical expression of the lesions, their clinical course and recurrence are probably related to the immunosuppressor treatment. All such patients should be carefully screened to allow prevention and treatment, which, as seen in these cases, may be insufficient to irradicate the lesions. New therapeutic approaches should be studied in this group of patients at risk.

Female↗
PubMed1994

How many embryos should be transferred in in vitro fertilization? A prospective randomized study.

OBJECTIVE: To maintain the rate of pregnancy, while suppressing high rank multiple pregnancies by limiting the number of fresh embryos transferred after IVF, in a population selected for potential success. DESIGN: A prospective, randomized study. SETTING: Département de Gynécologie Obstétrique, Centre Hospitalo Universitaire, Paris VI, France. PATIENTS: There were two groups of 28 couples. Women were < or = 35 years of age, with > or = 70% cleavage rate and at least four morphologically regular embryos. INTERVENTION: On the day of ET, either four fresh embryos were transferred (group 1) or two fresh embryos were transferred and two were frozen for later transfer (group 2). MAIN OUTCOME: Pregnancy rate and multiple pregnancy. RESULTS: The pregnancy rate was the same in the two groups with one-third of the high rank pregnancies in group 1 and no pregnancies in group 2. CONCLUSION: Only two fresh embryos need to be transferred in this selected population.

Adult↗
PubMed1994

[Diabetic pregnancy. Evaluation and prospects from the study of 212 diabetic pregnancies followed-up between 1985 and 1992].

A total of 212 diabetic pregnancies were studied prospectively over the period 1985 to 1986, included: 76 insulinodependent diabetics (IDD), 34 non insulinodependent diabetics (NIDD), and 102 gestational diabetes. The perinatal mortality rate for all diabetic pregnancies was 1.4% (n = 3); 3 congenital malformations were recorded (a therapeutic abortion was performed in 2 cases). These results are comparable with those of the non diabetic population. However, it is to be noticed that maternal as well as neonatal morbidity was important (hypoglycaemic comas: 18 in 9 IDD, preeclampsia: 7 IDD, 2 NIDD, 1 DG; caesarean delivery: 50% IDD, 50% NIDD, 25% DG; neonatal morbidity 20% of the new born. The main objectives must be targeted on the prevention of severe hypoglycaemia in IDD, the early diagnosis of DG and the development of pregnancy care in NIDD.

Adult↗
PubMed1994

[Pregnancy in patients with heart valve prosthesis. Retrospective study apropos of 40 pregnancies].

In order to be able to offer pregnant artificial heart valve patients a practical management approach enabling reduction of maternal and fetal risks, the authors evaluated 40 pregnancies in 24 women. Thirty one valves had been inserted prior to these pregnancies: 24 mechanical valves and 7 biological valves. Different types of anticoagulation regimens were used in 32 pregnancies, while 8 took place without the use of anticoagulants (biological valves in sinus rhythm). From a clinical standpoint, almost all these pregnancies brought to term took place without cardiac decompensation. They resulted in the birth of 26 live infants, including one premature. One child was born at term with a phocomelia-type malformation and two were stillborn. There were five therapeutic abortions and six spontaneous abortions. There were four cases of thromboses of the artificial valve, three of which occurred in patients on heparin (dose of 5,000 IU/12 h). Three massive thromboses required emergency valve replacement surgery. There were also three embolic accidents, including one which regressed totally in a few hours. Two hemorrhagic complications occurred with subcutaneous heparin during the post-partum period. In practice, we feel that: when a young woman wishing to become pregnant requires valve replacement, a biological device is preferable; oral anticoagulants are contra-indicated during the first three months of pregnancy; the dose of 5,000 IU/12 h of heparin is insufficient to prevent thrombo-embolic accidents; when a mechanical valve is already implanted, the sequential treatment protocol of subcutaneous heparin--oral anticoagulant--subcutaneous heparin, with an initial dose of heparin of 5,000 IU/12 h then adjusted on the basis of APTT, is the best choice.

Adult↗
PubMed1993

[The vaginal cesarean, a necessary review].

Having carried out four cases of vaginal caesarean section the authors describe the technique they used. The advantages of the operation are: it is simple and can be carried out quickly, future obstetric behaviour is not compromised. It is important to avoid two complications of the operation: haemorrhage and injury to the bladder. These are reduced if the vertical incision in the cervix is made in the midline and long enough. The ideal indications for the operation are absence of cervical dilatation, or the occurrence of severe maternal haemorrhage during the operation to terminate a pregnancy, or while the uterine contents are being expelled towards the end of the second trimester. It is disputable whether there is a place for vaginal caesarean operation when the fetus is alive, in view of the recent studies on fetal prognosis.

Adult↗
PubMed1992

[Laparoscopic surgery versus laparotomy. Comparative analysis of stress markers].

The place of laparoscopic surgery continues to increase in the field of surgery in our specialty. Although the advantages would seem to be obvious, it seemed to us interesting to quantify, if possible, the parameters of operative stress and compare laparoscopic surgery with conventional surgery. Markers studied are Prolactin, Cortisol, Adrenaline, Nor-Adrenaline, Dopamine and the Beta-Endorphins. The only marker that shows any difference in the two procedures in our study is Beta-Endorphin which is significantly less raised in laparoscopic surgery directly after the operation (p less than 0.01). This was very specific for pain, which is one of the benefits of this technique and shown in this parameter which confirms the clinical impression. The curves of the changes in the different markers have been analysed and discussed.

Adult↗
PubMed1992

[Pregnancy and obesity. A case control study of 140 cases].

A retrospective study of 70 fat women and 70 women of normal weight was carried out to compare their obstetric performance. The patients were assessed before pregnancy for corpulence by estimating the body mass index (IMC). Obesity was defined by having an index of 30 or above. The mean weight of the obese patients at delivery was 142 kgs and of the controls 65.4 kgs. The main risk in obese patients is a raised blood pressure (34%); and in spite of this no child showed intrauterine growth retardation. The mean weight of the newborn infants was 3.7 kgs against a mean weight of 3.2 kgs in the control group. Eighteen infants born to obese mothers were very heavy (25%). The increase in fetal weight explains why the caesarean section rate was three times as high in the obese patients as in the control due to disproportion (25%). These differences are statistically significant. Neonatal morbidity was similar in the two groups. It is debatable whether a slimming diet was worthwhile. All the same calorie intake reduced slightly to about 1.800 calories a day together with vitamin supplements is advisable. It does not have any ill effect on the fetus.

Adult↗
PubMed1992

[Hydatid cyst of the breast. Case report].

The rarity of mammary echinococcosis leads the authors to report the demonstrative case of a 45-year-old woman, para 9, gravida 9, who had always breast fed, undergoing surgery for a cyst of the right breast and which was found histologically to be a hydatid cyst. Progression of the tumour was particularly slow (approximately 10 years). Mammography forms an essential part of pre-treatment evaluation since it enables circumscription of the lesions and study of regional lymph nodes which are normal in all cases. At any event, cystectomy is the only effective method of treatment, recognised by all authors. Clinical and mammographic evaluation after 2 years of our patient was normal.

Biopsy, Needle↗
PubMed1991

[Celioscopy with peridural anesthesia. Techniques, indications, results in 220 cases].

The authors used epidural anaesthesia to carry out laparoscopy in 220 patients. The chief indications for the laparoscopies were GIFT (intratubal transfer of gametes) and tubal sterilization. The technique used was slightly different according to the indications for the use but they had to be sure of anaesthetising up to T4. In 90% of cases the patients tolerated the procedure well. No change in ventilation or in metabolic measurements. As far as fertilization was concerned studies carried out in various parameters failed to show any untoward side effects due to the use of local anaesthetics. Finally so long as the anaesthesia is only used for a short length of time this technique seems to be suitable for day cases.

Ambulatory Care↗
PubMed1991

[Heart transplantations: impact on female fertility].

Improvements in the management of patients with cardiac transplantation make it possible for these patients in the child-bearing age to expect a pregnancy. In fact, since 1987, several cases of pregnancy after cardiac transplantation have been reported. We report here two cases of successful pregnancy two years after cardiac transplantation. First Case. Pregnancy was uneventful until 36 weeks of gestation with no evidence of transplant rejection. At 38 weeks of gestation, a cesarean section was performed for increasing blood pressure, cholestatic pruritus and cephalopelvic disproportion. Cesarean section was performed under regional anesthesia and a healthy baby boy of 2680 gr was delivered. The patient was discharged one week after. Eighteen months after, both the mother and the baby are in good condition. Second case. Pregnancy was complicated by severe maternal anemia and fetal hypotrophia. Because of increasing renal insufficiency and pre eclampsia, a cesarean section was performed under regional anesthesia at 36 weeks of gestation. Delivery of a healthy baby girl of 1700 g. Five other cases have been reported. Cesarean section performed in september 1984 for a patient who underwent cardiac transplantation in 1980. Delivery of a healthy baby of 3280 gr. Death of the mother five months after following heart transplant rejection. Vaginal delivery performed in august 1986 for a patient who underwent cardiac transplantation in 1984. Delivery of a preterm baby at 31 weeks of gestation who survived without any sequelae. Vaginal delivery performed in august 1987 for a patient who underwent cardiac transplantation in april 1985. Delivery of a healthy baby of 2550 gr at 38 weeks of gestation. Vaginal delivery of twins (baby girl of 1200 and 1100 gr) in april 1988 of a patient who underwent cardiac transplantation in 1986. Vaginal delivery at 38 weeks of gestation performed in november 1990 for a patient who underwent cardiac transplantation in 1986. All the cases reported showed that: The foetus is not affected by the immuno-suppressive treatment of the mother. This was already known for pregnant patients with renal transplant. The cardiovascular changes associated with pregnancy are well tolerated by the heart transplant. Preexisting hypertension is increased, particularly during the third trimester of pregnancy and during labour. The incidence of preterm labor is increased in patients with heart transplant. Transplant rejection never occurred during pregnancy.

Adult↗
PubMed1990

[Analysis of 10 cases of pregnancy after renal transplantation].

Renal transplantation has changed completely the fertility of women who had been dialysed. Our study is on 10 pregnancies which we followed up in 7 women who had had renal transplants in the University Hospital of Pitié Salpêtrière (Professor Y. Darbois) between 1979 and 1985. All patients were treated by the same technique and the same methods of prevention of rejection of the transplant. The mean interval between the transplant and pregnancy was 53 months. In 3 cases there was hypertension and raised creatinine levels (more than 150 in 3 cases). In 2 cases the two conditions were associated. The prognosis is bad when a raised blood pressure or a change in renal function occurs before pregnancy starts, leading to a real deterioration in renal function during the pregnancy when such function was abnormal before the pregnancy started. As far as the infants were concerned, the most common complication was IUGR (intrauterine growth retardation) which was found in half of all cases. Blood flow studies in these fetuses are particularity interesting. There were two cases of intra-uterine fetal death. The reasons for these were not necessarily connected with the deterioration in renal function. All the deliveries were by caesarean section, for medical reasons in 7 out of 10 cases. The average duration of the pregnancy was 35 weeks of amenorrhoea. As far as the mothers were concerned, they did not have more infections than other women in spite of being immuno-suppressed (this was excluding urinary tract infections).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1990

[Are unexpected pregnancy over age 40 at high risk?].

A study concerning 5 years of activity at the Maternity of La Pitié, has shown differences in the population of pregnant women after the age of 40: decreased absolute number, relative increase of primiparous women, improvement of the socio-economic level, resulting in a decreased maternal and fetal pathology. The perinatal mortality remains almost 3 times higher than for the overall population.

Adult↗