Biomedical subjects
Publications and source records attributed to C Colette.
This is a report on two cases of mesomelic dysplasia Langer type. This is a rare kind of dwarfism which combines severe dwarfism with predominant shortening of the forearms and lower legs and other morphological abnormalities. The diagnosis can be made by ultrasonography in the early second trimester of the pregnancy.
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The best indication for breech extraction, and undoubtedly the last, is for delivery of the second twin with a non-cephalic presentation. At the Besançon University Hospital, we have used this technique routinely and without delay in case of non-cephalic presentation of the second twin. In order to evaluate the results of this approach, we studied 56 patients files retrospectively in a continuous series of case over a 7-year period. The following data were noted: birthweights, APGAR score at 5 minutes, requirement for paediatric intensive care, hospitalization in paediatric ward, and death. Gestational age and rate of prematurity were calculated. We also recorded the rate and type of antalgisia used, as well as the frequency of episiotomy. Both the obstetrical and neonatal results indicated that breech extraction of the second twin is a reliable effective technique in terms of mortality and morbidity for the second twin. Using this technique should not raise any legal problems since the other techniques for delivering the second twin have not been shown to give better results. When planned and performed under precise conditions by an experimented physician, this route does not give any poorer results than cesarean. Breech extraction should be an exceptional technique all obstetricians can use, together with cesarean, for delivering the second twin.
The effects of simvastatin and pravastatin on cholesterol biosynthesis were compared in 26 hypercholesterolemic patients who were randomly allocated to either simvastatin or pravastatin treatment (20 mg once daily) for 6 weeks in a crossover trial. Serum total cholesterol (TC), low density lipoprotein cholesterol (LDL-C) lathosterol (latho) concentrations and lathosterol/cholesterol (latho/chol) ratios (the latter two are considered as reliable indices of whole body cholesterol synthesis) were evaluated at the beginning and end of each therapeutic sequence. Reductions in TC and LDL-C were more pronounced (P < 0.001) with simvastatin (TC = -28.0%, LDL-C = -35.6%) than with pravastatin (TC = -19.6%, LDL-C = -25.2%). These results were associated with concomitant decreases in both latho concentrations (-59.0% with simvastatin and -37.0% with pravastatin) and latho/chol ratios (-43.0% with simvastatin and -20.3% with pravastatin). Simvastatin resulted in more marked diminutions of latho concentrations (P < 0.01) and latho/chol ratios (P < 0.05) than pravastatin. These results suggest that the better efficacy of simvastatin on serum cholesterol and LDL cholesterol might result in part from a greater inhibitory action of simvastatin on cholesterol synthesis compared with that of pravastatin.
The effects of intensive insulin therapy on metabolic control, fatty acid metabolism and platelet function were studied in 18 non-obese non-insulin-dependent diabetics (NIDDs) with secondary failure to oral antidiabetic drugs (OAD). Patients were randomly allocated either to continue maximal OAD (Group I, n = 9) or to receive a multiple injection regimen of insulin therapy (Group II, n = 9) for a 6-month period. At baseline both groups were identical for clinical and biological parameters. At study day 180, fasting blood glucose (P < 0.01) and mean capillary blood glucose (P < 0.05) were reduced in group II but the difference between HbA1 percentages remained non-significant. At study day 60, in total plasma lipids, oleic acid was lower (P < 0.05), linoleic acid (P < 0.05) and the sum of polunsaturated fatty acids (PUFA) (P < 0.05) were higher in group II than I. In triglycerides, palmitic acid was lower in group II at study days 60 (P < 0.01) and 180 (P < 0.05), whereas gamma-linolenic acid was decreased (P < 0.05) at study day 180 only. A similar change was noted in cholesterol esters for gamma-linolenic acid at study day 60 (P < 0.05). No difference was noted between both groups for platelet agregation, insulin sensitivity and clinical parameters despite a significant increase in body weight in group II at study day 180. Positive correlations were obtained between the content of different lipid fractions in some PUFA and the glucose clearance. We conclude that optimized insulin therapy in NIDDs with secondary failure to OAD leads to a transient improvement in glucidic and lipidic metabolism but has no significant effect upon platelet aggregation and insulin sensitivity.
Cholesterol metabolism is altered in diabetic states. Three main mechanisms seem to be involved in these alterations: a) an increased glycation of cholesterol-rich lipoproteins, b) an insulin-resistant state which is mainly present in overweight type 2 diabetic patients, and c) changes in insulin secretion which depends on the clinical type of diabetes. Insulin per se exerts beneficial effects on the metabolism of cholesterol binding lipoproteins. Despite insulin has a stimulatory influence on the endogenous cholesterol synthesis from Acetyl-CoA, this hormone tends to decrease the LDL cholesterol concentrations through two additional effects: a diminution in the ApoB VLDL synthesis and an increase in the LDL catabolism. In well controlled diabetic patients, plasma concentrations of cholesterol binding lipoproteins are generally found within the normal range. These patients exhibit usually a normal sensitivity to insulin in the liver and peripheral tissues. In this case, the VLDL production is generally decreased, the LDL catabolism is either increased or normal, and therefore the endogenous cholesterol synthesis from Acetyl-CoA remains setted at a normal level. In poorly controlled and/or in insulin resistant diabetic patients, both VLDL cholesterol production and cholesterogenesis are increased, mainly as a consequence of the insulin-resistant state. The excessive glycation of LDL results in a diminution of their catabolism and therefore in an increase of their plasma concentrations. The reverse cholesterol transport pathway is also altered, the modifications being characterized by a diminution in HDL cholesterol concentrations, especially in the HDL2 subfraction. All these changes are certainly involved in the accelerated development of cardio-vascular complications encountered in diabetic patients.
This investigation includes 369 women-patients from the region served by the clinic during the period 1988-1992. Some particularities are observed in the course of the monoparental pregnancies, related with the social characteristics of the pregnant unmarried women. They are younger than the women, who get pregnant in biparental families. More than the half have no profession. They have no or only primary education in 39.5% of the cases. These women appear late and more rarely for medical examinations surveillance. Almost 30% of these pregnancies are lately declared or not registered at all. The premature deliveries occur three times more frequently than in the other female population. The delivery flows spontanously more seldom (69% against 76%), more often a section caesarean is applied (8.5% against 7.5%). Data concerning the pathology during the term of pregnancy and postdelivery complications, are presented. In this group of women the number of those who are breast-feeding their babies is smaller (55% against 68%). It is recommended to carry out a similar study in Bulgaria in order to plan better founded measures for education and social support of women.
UNLABELLED: Thirty-nine women, aged 20 to 40 years, suffering from endometriosis, were treated in three different ways before fertilization in vitro (FIV). Excluded from the trial were all cases of Seventy five stimulated cycles were carried out altogether for the purposes of FIV. The results of the three methods of treatment, in terms of number of pregnancies, obtained after FIV, are compared. RESULTS: First method: surgical treatment. It was applied to 4 patients, suffering from severe endometriosis. The FIV (6 stimulations) give rise only to one pregnancy, interrupted through spontaneous abortion, during the second month. Second method: therapeutic treatment. Applied to 17 patients (mild-7, moderate-7, and severe cases-3). The FIV (32 stimulations) brought 4 pregnancies, run normally to the term, and 2 pregnancies, interrupted through spontaneous abortions. Third method: combined (therapeutic surgical) treatment, applied to 18 patients (mild-3, moderate-9, and severe cases-6). In this group the FIV (37 stimulations) give best results: 9 pregnancies terminated successfully. Three false pregnancies were found (biochemically). No abortion. The possibilities and the restrictions of each method of treatment are discussed. These results are considered as an indication that combined (therapeutic-surgical) treatment is the most appropriate with a view to a successful following FIV.
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OBJECTIVE: To produce an index of lithogenic risk which identifies patients at risk of stone recurrence and facilitates the monitoring of prophylactic treatments. PATIENTS AND METHODS: The EQUIL2 program provides an evaluation of the state of urinary saturation, particularly of calcium oxalate, based on the pH and total concentrations (mmol/l) of sodium, potassium, calcium, magnesium, uric acid, chloride, ammonium, citrate, phosphate, sulphate, oxalate, pyrophosphate and carbon dioxide. The morning urinary calcium oxalate saturation coefficient was thus calculated for 30 stone-formers (Group 1) and 30 normal control subjects (Group 2). RESULTS: Urine from the majority of individuals was saturated, with no significant difference between the two groups. There appeared to be a correlation between the state of saturation and the urinary calcium oxalate molar product in both stone-formers (r = 0.931) and controls (r = 0.914). CONCLUSION: In future studies on urinary calcium oxalate saturation, it should be possible to supplement the sophisticated coefficient determined by the EQUIL2 program with the molar product, except in cases where monitoring therapies have little or no effect on urinary oxalate or urinary calcium levels.
In order to gain further insight into the mechanisms of calcium (Ca) homeostasis in hypercalciuria, we studied 32 lithiasic patients who were divided into three groups: normocalciuric patients (NC; n = 11), patients with absorptive hypercalciuria (AH; n = 12) and patients with renal hypercalciuria (RH; n = 9). The patients were investigated on 3 occasions: during a random diet, after a Ca-restricted diet and during a Ca tolerance test. The following determinations were made: Ca intake, Ca tubular reabsorption (Ca TR), plasma 1,25-dihydroxyvitamin D [1,25(OH)2D] and parathyroid hormone (PTH) levels, natriuresis and urinary protein-bound Gla. The latter was measured as a marker of urinary nephrocalcin excretion. Ca TR was decreased in hypercalciuric patients (HC). AH but not RH patients normalized their Ca TR during fasting. Plasma PTH and 1,25(OH)2D levels were similar in all the groups on the 3 occasions. Natriuresis was elevated in RH during the fasting period (p < 0.02 vs. AH). Compared with NC, protein-bound Gla urinary excretion rates (UER) were enhanced in AH after the Ca-restricted period (p < 0.02) and in RH during fasting (p < 0.02). In AH, a strong positive correlation was found between Ca TR and protein-bound Gla UER (r = 0.79, p = 0.002) following a Ca-restricted diet. In the HC group as a whole, fasting protein-bound Gla UER were correlated to plasma 1,25(OH)2D levels (r = 0.68, p < 0.001). In conclusion, the results suggest that PTH directly or indirectly through 1,25(OH)2D increases nephrocalcin synthesis.(ABSTRACT TRUNCATED AT 250 WORDS)
Unregistered and unmonitored pregnancies account for 0.2 to 0.6 p. cent of all pregnancies. They essentially concern young, single, primiparous mothers from disadvantaged social backgrounds. Labour and delivery are generally without difficulty but the neonatal prognosis is impaired by a high proportion of premature and underdeveloped infants, often requiring a long stay in a pediatric unit.
Ivemark Syndrome is a multiple organ syndrome associated with splenic abnormalities, complex cardiac pathology and an abnormality of the abdominal viscera. The incidence in our department is 1/6000 deliveries and the teratogenic effect seems to occur between the 30th and 40th days of intrauterine life, but the cause is unknown. The principal warning signal is bradycardia. Prenatal diagnosis can be made by ultrasound. The prognosis depends on the degree of malformation of the heart.
About 1% of all pregnancies in France are complicated by a primary infection with toxoplasmosis. The risk for the fetus being affected increases during the pregnancy but the seriousness of the effect on the fetus becomes less with more advanced pregnancies. Treatment of the mother using Spiramycin have been proven to be efficient, lessening the risk for the fetus being affected. The diagnosis of the fetus being affected rests on a whole bundle of presumptive evidence culled from non-invasive methods and invasive methods which are not without risk. (Direct or over-enthusiastic diagnostic techniques or none at all). We have studied a series of 101 primary infections with toxoplasmosis for which we have not carried out any invasive diagnostic techniques. The long term results in 77 infants show no difference in fetal morbidity and better results as far as mortality are concerned. We therefore propose simplifying the diagnostic approach in cases of primary infection with toxoplasmosis during pregnancy.
Nephrocalcin is a urinary gamma-carboxyglutamic acid (Gla) containing protein that may be a physiological inhibitor of calcium oxalate nephrolithiasis. Nephrocalcin isolated from urine of stone formers seems to be abnormal in lacking Gla that is required for inhibitory activity. In order to study this hypothesis, we compared the protein-bound urinary Gla contents in 32 calcium oxalate stone formers and in 24 controls. Protein-bound Gla was resolved by reversed-phase high-performance liquid chromatography after elimination of free Gla, alkaline hydrolysis and precolumn derivatization with o-phthalaldehyde and mercaptoethanol. Protein-bound urinary Gla concentrations were similar in stone formers (0.83 +/- 0.38 mumol/l, mean +/- SD) and controls (0.81 +/- 0.27) and were less than 5% of free urinary Gla. However, excretion rates of free and protein-bound Gla (nmol/min) were higher in stone formers (P = 0.006 and P = 0.002). Positive correlations (P = 0.000) were observed between free and protein-bound Gla both in controls and in stone formers. These results do not support the hypothesis of a lacking Gla nephrocalcin in stone formers.
Manual evaluation of uterine contractility through the abdominal wall performed twice a day for 1 hour and reported by telephone every other day keeps pregnant women at risk of premature labour in a state of continual attention. When the women are disciplined, the recommendations, prescriptions and encouragements they receive in return result in a statistically significant reduction in the number of premature deliveries. More generally, this new and relatively inexpensive method leads to substantial savings. Such were the results obtained by comparing the courses of 2 series of pregnancies after hospitalization for the indispensable intravenous tocolysis.
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There are more than 280 carriers of the hepatitis B virus worldwide. The risk of chronic carriers, and a fatal outcome due to hepatocarcinoma, is estimated to be about 50% in Asian children contaminated by materno-fetal transmission. Serovaccination of the neonatal infant born to a HBV carrying mother provides protection in nearly 100% of cases. Routine screening for HBV carriers at the Besançon teaching hospital maternity unit led to the vaccination of 1.12% of the babies born in 1990, which corresponds to the current national average.