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A Picaud

Publications and source records attributed to A Picaud.

35 records · Page 2Linked to original sources
PubMed1990

[Diagnostic echography of extrauterine pregnancy (EUP). Apropos of 228 EUP confirmed by laparotomy].

The department of gynaecology and obstetrics of the University Hospital in Libreville carried out in the five years between 1984 and 1988 8,688 ultrasound examinations of which 1,234 (14.2%) were performed because an ectopic pregnancy was considered possible. 213 correct diagnoses (32.8%) were confirmed by laparotomy. 649 surgical procedures for ectopic pregnancy were carried out of which 228 (35%) were helped by the ultrasound examination. The diagnosis was made 138 times (60.5%) accurately and suspected 75 times (32.9%). On the other hand, diagnosis was wrong 15 times (6.6%). These false negatives are worrying: in 4 cases there was an intra-uterine pregnancy as well and in these cases the intra-uterine zygote gave a false sense of security for the diagnosis. The 11 other cases were false diagnoses of adnexal infections which were diagnosed correctly by laparoscopy or culdocentesis. There were also 27 false positive diagnoses mainly in tubo-ovarian infectious and rarely where an ovarian cyst or pedunculated fibroid had twisted or the pregnancy was developing in a blind hemi-uterus. The assessment of the results makes its possible to show that in 88.75% the procedure was valuable in making the diagnosis and in 98.5% was valuable for excluding the diagnosis. Since the sensitivity of the test is 93.4% and its specificity is 97.3% it follows that ultrasound examination should have a very important place in the diagnosis of ectopic pregnancy particularly because in our unit we cannot at present carry out biological tests (beta HCG estimations). The test is rapid, cheap and easy to perform (as long as one avoids the traps).(ABSTRACT TRUNCATED AT 250 WORDS)

False Negative Reactions↗
PubMed1990

[Fallopian tube bilharziasis caused by Schistosoma intercalatum disclosed by hemoperitoneum].

Schistosomiasis due to Schistosoma intercalatumis common in Gabon and, since 1971, Schistosoma haematobium has been found in the south of the country. Genital involvement is infrequent: 0.8 per cent of gynecologic specimens sent to the pathology laboratory and ten of 622 fallopian tube specimens (1.5 per cent). We report an unusual clinical case with hemoperitoneum as the first manifestation: the schistosomal lesion was developed within the tubal serosa, and caused a breach in an arteriole responsible for a 2500 cc hemoperitoneum. Genital lesions preferentially involve the vulva, vagina, and cervix. Involvement of the tubes and ovaries is less common and seems to have an incidence on fertility only if bacterial superinfections cause adhesions around the tubes and ovaries. Genital schistosomiasis is usually asymptomatic. Ectopic pregnancies and infertility may occur.

Adult↗
PubMed1990

[Fatal toxic hepatitis in pregnancy. A discussion of the role of methyldopa].

The authors report a case of toxic hepatitis in a woman of 22 years of age in the third trimester of her first pregnancy treated by methyldopa for hypertension of pregnancy which was diagnosed at 33 weeks of amenorrhoea. The prodromal symptoms were mild and consisted of nausea, vomiting and rise in temperature and this phase was associated with febrile jaundice without pruritus and it was only associated with coagulation disorders in the third stage of labour. This was a case of mixed cytolytic hepatitis (ASAT x 3N) and cholestasis (x 1.5N). The outcome was fatal. The patient died three days after delivery following haematemesis and renal failure as well as hepatic encephalopathy. The main diagnostic feature was acute hepatic stasis in spite of the absence of pruritus and the presence of a raised temperature after hematolytic, viral and obstructive causes had been eliminated. Histology confirmed that there was toxic hepatitis. This aetiology was suggested by the timing of the symptoms after MD (methyldopa) had been taken. Elkington described methyldopa hepato-toxicity in 1969. Fatal cases in the literature were in patients who were over 40 years of age. Methyldopa is used in pregnant women because of its safety as far as the fetus is concerned. Mechanism by which it causes toxic hepatitis is a combination of abnormal metabolism (the cytochrome P450 chain produces an antigen) and an immune reaction in response to this antigen and these explain why such severe and potentially fatal forms of the condition exist.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1990

[Unusual causes of hemoperitoneum of genital origin].

Extra-uterine pregnancy is the most common emergency in gynaecology and obstetrics in the Hospital Centre of Libreville, and the diagnosis of blood in the peritoneal cavity is synonymous with extra-uterine pregnancy. All the same, when the authors reviewed 429 cases of haemoperitoneum 17 were shown not to be due to ectopic pregnancy. Ruptures of ovarian cysts and uterine perforation from illegal abortions are often found but more rarely, have been rupture in the blind horn of a bicornuate uterus, choriocarcinoma in the tube, tubal bilharzia and thrombopenia due to AIDS. It is essential to carry out histological examination for the differential diagnosis between an ovarian pregnancy and a ruptured cyst as well as choriocarcinoma or bilharzia. If it is not possible to find the site of the bleeding even after looking underneath the mesocolon, a search must be made for coagulation disorders due to a virus such as HIV.

Choriocarcinoma↗
PubMed1990

[The sequela of peri-hepatitis due to Chlamydia trachomatis (Fitz-Hugh-Curtis syndrome) seen during an ectopic pregnancy].

Between January 1st and May 31 1989, there were 31 cases of perihepatic adhesions (Fitz-Hugh-Curtis syndrome) about 90 ectopic pregnancies (rate: 34 p. cent). The Chlamydia's serology is positive at 1/64 level in 97 p. cent of cases and at 1/256 level in 72 p. cent. Only three cases are not allied with pelvic disease. Peri-splenitis accompanies severe hepatitis (3 cases) and no perinephritis was observed in this study. The authors emphasize the wish to explore perihepatic space in all pelvic surgery. In the department of Gynecology and Obstetrics at the University Hospital of Libreville, increased the rate of ectopic pregnancy (1 for 44 deliveries), this coincides with the increased prevalence to Chlamydia trachomatis infection (81 p. cent ectopic pregnancies and 63 p. cent deliveries). This situation creates a new and greater problem of health in sub-Saharan Africa.

Abortion, Spontaneous↗
PubMed1990

[Büschke-Loewenstein tumor during pregnancy. Apropos of 2 cases].

The authors report two cases of Büschke-Loewenstein tumors during pregnancy. The considerable development of this giant condyloma requires a caesarean section, to prevent a possible neonatal contamination of the newborn. The course is complicated with recurrences and the treatments are disappointing during the pregnancy. After birth, regression may be spontaneous (case no. 2). Most of the time, after a surgical biopsy is performed, for an accurate pathological examination, electrocoagulation, cryotherapy or CO2 laser result in the cure of the patient. Monitoring must be long-lasting because of the risk of spinocellular degeneration and node metastases. The papillomavirus in cause is the type HPV 6 or 16 and a few cases are described with types 16, 18, 32. The high frequency of accumulated condylomas and the possibility of rapid spread make this disease very current: the human immunodeficiency virus is one of the cofactors of transformations into verrucous carcinoma.

Adult↗
PubMed1990

[Delivery in the scarred uterus. Apropos of 606 cases in 62,193 deliveries].

Scarred uterus represent 1 p. cent of the deliveries in our department (n = 606). Delivery is performed vaginally in 61 p. cent of the cases and by caesarean section in 39 p. cent of the cases. During two 4-year periods (1981-1984 and 1985-1988), the rate of repeated caesarean sections increases from 36 to 41 p. cent with decrease of the number of uterine ruptures which however, persists (almost 5 p. cent of scarred uteruses). The type of scarring is the major risk factor with: segmental scarring (1.5 p. cent of ruptures), gynecological (5 p. cent), segmento-corporeal (26 p. cent) and corporeal (33 p. cent). Strict obstetrical monitoring permits to control this risk (25 p. cent of ruptures occur at home). It is the uterine rupture that determines the maternal risk (3 death scarred uteruses represent almost 40 p. cent of uterine ruptures 11) and result in 3 p. cent of the maternal mortality in the department. The perinatal mortality is 63.6 for 1,000. A dynamic test of the uterus requires an obstetrical decision taking into consideration the scar, essentially segmental transverse, the head delivery with favorable cephalo-pelvic comparison and a well-trained team. This choice is dictated by the maternal risk of caesarean section, 2 for 1,000 in Europe (14) and for 1,000 in the department and a persistent high mortality in children (97 for 1,000 in Gabon).

Cesarean Section↗
PubMed1989

[Extra-uterine pregnancy. Study of 509 cases surgically treated at the University Hospital Center of Libreville].

Extra-uterine pregnancy is the principal emergency procedure undertaken in the University Department of Libreville. We study 509 cases treated surgically between 1984 and 1987, which is a level of 16/1,000 deliveries. The incidence of rupture of the tube has driven us to search for the best possible means to diagnose the condition earlier. Ultrasound gives the best results, dropping the level of ruptured tubes from 83% in 1984 to 50% in 1987. Extra-uterine pregnancy in nulliparous patients (25% of the group) presented a third of recurrent ectopics. The anatomopathological examination of the tissues emphasizes how common acute or chronic infections of the tubes are (25%) and salpingitis isthmica nodosa (31% of cases). If sexually transmitted diseases can be prevented the incidence of ectopic pregnancies will drop. We have tried since 1986 to be conservative in our surgery hoping that a secondary plastic operation will improve the fertility of these young patients. Mortality was high (13.75/1,000 ectopics). The principal factor responsible for this high figure is the absence of blood transfusion banks which delayed resuscitation and exposed the patients to the risk of coagulation defects when surgery is practised on these patients who are still shocked.

Adolescent↗
PubMed1989

[Perinatal mortality at the Hospital Center of Libreville (Gabon)].

A study of the work carried out in the obstetrical department during the years 1985, 1986 and 1987 shows there was a corrected perinatal mortality of 32.61 per 1,000. This involved 776 deaths out of 23,980 births of babies weighing 1,000 g. or more. Research as to the causes showed that the largest reasons for these deaths were maternal and fetal infections (28.9% of the aetiology of perinatal mortality). In 35.1% of cases there was obstetrical trauma leading to intrapartum anoxia and prematurity was responsible for 63.7% of deaths associated with other causes. These figures can be reduced if there is better antenatal care in Maternity and Paediatric Centres with teams that are competent and that are properly trained, and on the other hand the delivery rooms are rebuilt in such a way as to make it possible to supervise labours and deliveries and to look after the newborn children immediately problems involving newborn care are found.

Cause of Death↗
PubMed1989

[Perinatal and maternal risks in multiple pregnancies].

The perinatal risk in multiple pregnancies is part of the traditional gabonese culture. The authors study the perinatal mortality of twins which is four times higher than in single pregnancies. Prematurity represents the main etiology: 30 p. cent of twin deliveries occur before 32 weeks. The fetal prognosis improves from 2,000 g but deteriorates beyond 2,500 g, emphasizing the role of intra-uterine hypoxia aggravated by the obstetrical trauma. The increased mortality of the second twin, which was demonstrated by all, and the birth delay, become harmful beyond 30 minutes. The maternal pathology consists in frequent hypertensive complications and severe gravidic anemias. The maternal mortality is three times higher than in single deliveries and is related to delivery haemorrhages. The authors propose to improve the prognosis with early ultrasonographic diagnosis and pregnancy monitoring, along with social measures covering a number of prenatal tests, with hospital delivery supervised by obstetrical and neonatal teams. On the contrary, they do not believe that caesarean section is a determining factor in the improvement of fetal prognosis.

Female↗
PubMed1989

[Uterine rupture. Apropos of 31 cases seen at the Hospital Center of Libreville (Gabon)].

The authors report 31 cases of rupture of the uterus at the Hospital of Libreville-Gabon. The frequency is 1.4/1,000 deliveries. The usual etiological factors are found: malformations of the uterus, obstetrical maneuvers, mechanical dystocias, use of oxytocics, scars of caesarean section. The clinical characteristics are those previously described. There were two maternal deaths and 17 fetal deaths. These figures emphasize the progress accomplished and to come.

Adult↗
PubMed1989

[Maternal mortality at the Hospital Center of Libreville (1984-1987)].

Maternal mortality at the University Hospital of Libreville was 152.5 for every 100,000 live births. There were 48 maternal deaths out of 31,799 deliveries carried out between 1984 and 1987. The principal causes were: haemorrhage in 45.8%, infections in 20.8%, intercurrent diseases in 20.8%, vasculo-renal syndromes in 10.4% and thromboses in 2%. The main differences between this country and developed countries were the large number of haemorrhages and the rarity of thrombosis. Poor prognostic factors were SS sickle-cell disease in 10.4% of the cases who died and in deaths due to anaemias, of which 25% were due to haemorrhage connected with the afterbirth. Complications occurring in the 1st trimester of pregnancy caused nearly a third of all maternal deaths. Complications of abortion occurred in 16.6% and of extra-uterine pregnancies in 14.6%. If the maternal mortality rate is to be reduced it is important to have a proper blood bank. The risks of caesarean section are ten times greater than of vaginal delivery, although it is a good way out for difficult situations. The indications for the operation have to be carefully considered. Comparing the statistics reported from Cotonou, the University Hospital in Libreville has a lower incidence of maternal mortality but it is too high and requires real progress to be made.

Abortion, Induced↗
PubMed1976

[Photosynthetic activity in the absence of CPl and CP2 pigmentary complexes (author's transl)].

Various photochemical activities were tested on chloroplasts of Zea mays that received 4 s of light every 4 h during the culture period. Photosystem I and Photosystem II were functioning, as well as the photosynthetic electron transport. These chloroplasts exhibited upon sodium dodecyl sulphate gel electrophoresis neither Complex 1 (Mr 70 000) generally associated with Photosystem I nor Complex 2 Mr 25 000) generally associated with Photosystem II. Chlorophyll is indeed attached to polypeptides of molecular weight 21 000 and 29 000. These results lead us to question the functional role of chloroplast protein-pigment complexes observed by sodium dodecyl sulphate gel electrophoresis.

Chloroplasts↗
PubMedDate not supplied

[Eclampsia at the Hospital Center of Libreville. 53 cases among 41,285 deliveries from 1985 to 1989].

Eclampsia is a serious complication at the end of pregnancy. This retrospective study over a 5-year period at the Libreville CHU hospital shows that the incidence of 0.12 p. cent is comparable to the incidence fond in other countries at a similar level of development. Promoting causes include youth of the patients, twin births, the "cold" season, the lack of follow-up after prenatal consultations. The consequences are increased maternal and perinatal death. Cesarean section remains the best way of dealing with an attack of eclampsia and improves both maternal and fetal prognosis. It is possible to eliminate, or at least reduce, the number of cases by developing conscientious and regular prenatal consultations.

Adolescent↗