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Biomedical subjects

C D'Ercole

Publications and source records attributed to C D'Ercole.

At least 19 recordsLinked to original sources
PubMed2006

Fetal magnetic resonance hydrography: evaluation of a single-shot thick-slab RARE (rapid acquisition with relaxation enhancement) sequence in fetal thoracoabdominal pathology.

OBJECTIVES: To evaluate the potential of a single-shot thick-slab RARE (rapid acquisition with relaxation enhancement) sequence in fetal thoracoabdominal magnetic resonance (MR) examinations compared with multislice T2-weighted sequence and postnatal imaging. METHODS: RARE sequence is rapid and provides very heavily T2-weighted images. Twenty-seven fetal thoracoabdominal MR imaging examinations were performed at 23-38 weeks using our conventional protocol. This included thin multislice T2-weighted half-Fourier acquired single-shot turbo spin-echo (HASTE) sequence and thin-slice GE (gradient echo) T1-weighted images with a 1.5-T MR unit. A single-shot thick-slab (60 mm) RARE sequence was added to all MR examinations. The acquisitions were obtained with the mother breath-holding. The thick-slab heavily T2-weighted images were compared with HASTE sequence images and with postnatal imaging in all cases. RESULTS: The thick-slab RARE sequence did not show additional abnormalities compared with the conventional protocol but displayed an overall view of the urinary tract, tracheobronchial tract and small bowel. It gave information that was highly correlated with postnatal imaging, such as abdominal plain films, chest film or cystography. The quality of the thick-slab RARE images was considered as good in 13 cases (48%), moderate in 12 cases (45%) and poor in two cases (7%). CONCLUSION: Although thick-slab RARE sequence does not show additional abnormalities compared with the conventional protocol, it illustrates very nicely static fluids such as those in urinary dilatation, the esophagus and small bowel (normal or dilated) and thoracic cystic masses. It is very rapid (5 s) to perform, allows fetal hydrography, and correlates well with postnatal imaging.

Adult↗
PubMed2004

[Prenatal MRI diagnosis of esophageal atresia].

The diagnosis of esophageal atresia may be suspected on prenatal ultrasonography in fetuses with absent or small stomach, upper esophageal dilatation and unexplained polyhydramnios. However, the diagnostic value of these findings is relatively poor. Two cases are reported where MRI appeared to be accurate for establishing the diagnosis of this congenital anomaly.

Adult↗
PubMed2003

[Prenatal screening of kidney pelvis ectasia, frequently caused by vesico-ureteral reflux detected after birth. Analysis of a series of 159 cases in 4 years at a maternal-child unit].

UNLABELLED: To describe the pre- and post-natal management of vesico-ureteric reflux in a prospective study of babies presenting with vesico-ureteric reflux suspected from pre-natal ultrasonography in a tertiary paediatric center. PATIENTS AND METHODS: Between 1997 and 2001, 35 children (25 boys and 10 girls) with were vesico-ureteric reflux followed for 12 to 36 months after the pre-natal detection of urinary tract anomalies. Ultrasound examination was realized at the 5th of life, retrograde cystography at the 15th if the renal pelvic dilatation measured at least 10 mm of diameter. In 11 the reflux was bilateral and 46 refluxing units were reviewed. RESULTS: According to the international classification of, 7% vesico-ureteric reflux were grade I, 20.5% were grade II, 32% were grade III, 18% were grade IV, 22.5% were grade V. Fourteen patients (17 refluxing units) underwent ureteric-reimplantation. Four total and two partial nephrectomics were carried out in patients < 2 years old; in 8 patients the VUR resolved spontaneously. Of the latter, 7 patients (ten refluxing grade III-IV units) are still being followed and awaiting a decision on treatment. CONCLUSION: This study confirms the predominance of boys in those with antenatally suspected vesico-ureteric reflux. The spontaneous resolution or improvement during the first 3 years of life was apparent in most cases, even in those with severe reflux (grade III-V).

Dilatation, Pathologic↗
PubMed2003

Pregnancies after ICSI using sperm with abnormal head-tail junction from two brothers: case report.

We report ICSI pregnancies in two couples with a history of long standing primary infertility in which the sperm of the male partner were either acephalic or had abnormal head-midpiece attachments. The two couples, in which the men are brothers, underwent ICSI. Sperm were analysed by transmission electron microscopy and immunocytochemistry with an anti-MPM2 monoclonal antibody. The first couple underwent two ICSI cycles, each consisting of the injection of two mature oocytes and the transfer of two embryos. A successful pregnancy occurred after the second transfer and led to the birth to a healthy girl. The second couple underwent three ICSI cycles, each consisting of the injection of 18 oocytes and the transfer of two embryos; the last of these led to a triple ongoing pregnancy which included two identical twins. Caesarean section led to the birth of three fetal-growth restricted children. This case report demonstrates that ongoing pregnancies can be achieved in cases of abnormal development of the head-neck attachment. The genetic origin of this syndrome is generally accepted, but the phenotypic heterogeneity observed by light and electron microscopy among published cases suggests that there are a variety of genetic causes of this syndrome.

Adult↗
PubMed2002

Ultrasonographic evaluation of cervical length in pregnancies complicated by preterm premature rupture of membranes.

OBJECTIVE: To evaluate the usefulness of transvaginal ultrasonography in the determination of the risk of preterm delivery and chorioamnionitis in pregnancies affected by preterm premature rupture of membranes preterm premature rupture of membranes. DESIGN: One hundred and one singleton pregnancies with preterm premature rupture of membranes were included in this prospective study over a 3-year period. Patients underwent cervical length measurement by transvaginal ultrasonography at admission and thereafter, in the absence of chorioamnionitis, were managed expectantly. RESULTS: The median time interval between admission and delivery (latency period) was 48 h. A cervical length of less than 20 mm was associated with a significant risk of early delivery (mean latency period was 59.44 +/- 159.93 h vs. 240.94 +/- 364.67; P < 0.05). There was no relation between cervical length and occurrence of chorioamnionitis or neonatal sepsis. CONCLUSIONS: These data suggest that the use of transvaginal ultrasonography for cervical length measurement during preterm premature rupture of membranes may predict an early delivery but cannot anticipate the risk of chorioamnionitis or neonatal sepsis.

Adult↗
PubMed2002

Scintigraphy with 99mTc-MIBI and echography in the study of primitive hyperparathyroidism.

BACKGROUND: The authors analyse the value of the exams preoperative for the identification of the pathological parathyroid glands. METHODS: The authors examined 58 patients affected by primitive hyperparathyroidism (HPTp) who had undergone surgical treatment for primary hyperparathyroidism at the Third Surgical Department of University "La Sapienza" of Rome, in 175 patients affected by primitive hyperparathyroidism observed between January 1970 and June 2000; all patients had undergone echotomography of the neck and 99mTc-MIBI scintigraphy in the diagnostic phase. The histological valuation confirmed the diagnosis by I.P. RESULTS: 99mTc-MIBI scintigraphy demonstrated the pathological glands in 56 cases (96.6%), the echography in 57 cases (98.2%). The comparison of the two exams demonstrated the pathological glands in 100% of the cases. In 45 cases the scintigraphy localized the side (77.6%), and the echography in 41 cases (70.7%). In one case demonstrated I.P. persistent (1.7%) and never one case demonstrated relapsed. CONCLUSIONS: The authors think that the scintigraphy together with the echography show high sensibility to identification the pathological glands. Neck surgical exploration can still give the side good when the diameter of the parathyroids is inferior to 5 mm.

Female↗
PubMed2001

An experimental model of gastroschisis using fetoendoscopy: preliminary results and technical considerations.

BACKGROUND: The aim of this study was to show the feasibility of an experimental model of gastroschisis using fetoendoscopic surgery on sheep fetuses, and also to perform amnioinfusion until delivery using an in-dwelling intraamniotic catheter. METHODS: We analyzed the data from 18 pregnant ewes having 26 fetuses, which underwent surgery at 80 days of gestation (full term, 145 days). The fetendo technique was used to create a gastroschisis in 15 fetuses. The fetal abdominal wall was opened on the left side of the cord using scissors. The omentum and the intestinal loops were eviscerated using atraumatic forceps. Eleven fetuses were used as a control group. Twenty-one fetuses underwent amnioinfusion; a simple exteriorized catheter was used in seven cases and an intraamniotic catheter with an implantable port was used in the other 14. All ewes and fetuses were killed at the end of the experiment by an intravenous injection of pentotal; thereafter, the fetuses underwent necropsy. RESULTS: Twelve fetuses died and 14 survived (53.8%); seven of the 15 that underwent gastroschisis survived (46.7%). An amniotic infection occurred in nine fetuses (34.6%); of these, six died and three that were administered antibiotics survived. CONCLUSIONS: Our experience shows that this experimental model of gastroschisis is feasible and reproducible, and that a repeated amnioinfusion can be performed with an in-dwelling catheter in pregnant ewes. The use of an implantable port is safer than a simple exteriorized catheter.

Animals↗
PubMed2001

Maternal endothelial soluble cell adhesion molecules with isolated small for gestational age fetuses: comparison with pre-eclampsia.

OBJECTIVE: 1. To evaluate the activation profile of the endothelium in pregnancies complicated by small for gestational age fetuses compared with pre-eclampsia and normal pregnancy, by measuring the plasma levels of soluble adhesion molecules soluble E-selectin, intercellular cell adhesion molecule-1 and vascular cell adhesion molecule-1. 2. To determine whether soluble adhesion molecules were related to the severity of small for gestational age fetuses and pre-eclampsia. DESIGN: Observational study. PARTICIPANTS: Sixteen women with small for gestational age fetuses; 15 women with pre-eclampsia and 15 healthy primigravidae were recruited as controls. METHODS: Plasma levels of soluble E-selectin, intercellular cell adhesion molecule-1 and vascular cell adhesion molecule-1 were measured by ELISA. RESULTS: Compared with the healthy controls, soluble E-selectin was significantly increased in both small for gestational age fetuses and pre-eclampsia, whereas intercellular cell adhesion molecule-1 and vascular cell adhesion molecule-1 were increased only in pre-eclampsia. In the small for gestational age fetuses group, soluble E-selectin correlated inversely with the ratio between birthweight and the expected normal birthweight (r = -0.4, P = 0.007). In the pre-eclampsia group, a significant correlation was observed between vascular cell adhesion molecule-1 and blood pressure (r = 0.54, P = 0.039). CONCLUSIONS: Endothelial activation, reflected by raised levels of soluble E-selectin, is a feature of small for gestational age fetuses and is correlated with the severity of the disease. Differences in the profile of soluble cell adhesion molecules suggest variations in the degrees of endothelial activation between pre-eclampsia and small for gestational age fetuses.

Adult↗
PubMed2000

Hysteroscopic metroplasty for septate uterus and repetitive abortions: reproductive outcome.

OBJECTIVES: The aim of this study is to assess fertility outcome and obstetrical prognosis of 63 patients after hysteroscopic section of uterine septa. MATERIALS AND METHODS: This is a retrospective study about 63 patients consulting for septate uterus and repeated pregnancy loss or abnormal fetal presentation between January 1988 and December 1996 in La Conception hospital in Marseille. Septal lysis was performed with microscissors or resectoscope. Statistical analysis was performed using the CHI2-test. RESULTS: The anatomical result was considered satisfactory in 57.1% of cases. Forty-five pregnancies were obtained, two after an IVF-program in 56 patients. Twenty-eight living children were born: twenty-six at term. Twenty patients delivered normally. Two women are still pregnant. Obstetrical prognosis of these patients is statistically improved by the treatment (P=0.001). CONCLUSION: Obstetrical prognosis of patients presenting repeated pregnancy loss and septate uterus is statistically improved by hysteroscopic metroplasty.

Abortion, Habitual↗
PubMed1999

[Danger of anti-erythrocyte antibodies during pregnancy].

INTRODUCTION: Red cell autoantibodies are very rarely observed in pregnant women. We report one case related to the presence of a lupus anticoagulant. EXEGESIS: A 32-year-old woman had a history of two intrauterine deaths that had occurred at weeks 32 and 33, respectively. Due to the presence of a lupus anticoagulant, prednisone (20 mg/day) and subcutaneous calcium heparin were administered during her third pregnancy. The direct antiglobulin test remained positive throughout the pregnancy; however, hemolysis could not be detected. Caesarean section was done in emergency at week 29, due to fetal bradycardia related to severe fetal hemolysis. CONCLUSION: When autoimmune hemolysis occurs during pregnancy, risks for the fetus increase with the severity of hemolysis in the mother. It is thought that child mortality reflects the existence of anemia, rather than the existence of hemolysis. Our observation suggests that severe fetal hemolysis may occur, despite the absence of hemolysis in the mother.

Adult↗
PubMed1999

Laparoscopic surgery in gynecology: randomized prospective study comparing pneumoperitoneum and abdominal wall suspension.

OBJECTIVE: To compare laparoscopic surgery using insufflation of carbon dioxide gas with laparoscopic surgery using abdominal wall retractor in gynecology. SETTING: University hospital. DESIGN: Prospective randomized study. MATERIAL AND METHODS: Fifty-one patients were assigned to the gasless laparoscopy group, and 52 patients were assigned to the laparoscopy group with pneumoperitoneum. Patients presented with ovarian cyst, endometriosis, acute salpingitis, hydrosalpinx and extra-uterine pregnancy. RESULTS: No severe complications were noted. One conversion to laparotomy was performed in each group. Eight gasless laparoscopic procedures were converted into laparoscopy with pneumoperitoneum; difficulties appeared in patients with adhesions following laparotomy and in cases of unsatisfactory exposure of the pelvis. No differences appeared between the two groups in terms of complications, quality of the operative sequelae, and duration of hospitalization. CONCLUSION: Gasless surgery is a recent technique and progress in modifying the equipment is necessary to reduce conversions.

Abdominal Muscles↗
PubMed1999

[Ontogeny of the immune system].

The newborn immune system differs quantitatively and functionally from adults. At birth, the immune system is partially immature, resulting in deficiency in cell-mediated cytolysis, immunoglobulin synthesis and cytokine production. The most clearly defined deficit in neonatal phagocytosis defenses is diminished neutrophil storage. T cell function is diminished, including T cell-mediated cytotoxicity and T cell help for B cell differentiation. Selective decreases in cytokine production by T cells may contribute to all of these deficits. One of the fundamental differences between adults and newborns for T cell functions resides in whether or not the patient had prior exposure to antigens. Significant immune responses to antigens can be obtained in the neonatal period. These responses are qualitatively different from those induced in adults with a predominance of TH2 pattern.

Adult↗
PubMed1998

Intertwin disparity in fetal size in monochorionic and dichorionic pregnancies.

OBJECTIVE: To compare monochorionic and dichorionic pregnancies for intertwin disparities in fetal size. METHODS: Monochorionic and dichorionic pregnancies, recruited from an ultrasound screening study at 10-14 weeks' gestation, were compared for intertwin disparities in crown-rump length and birth weight. The disparities were expressed as a percentage of the values of the larger twin. RESULTS: The study population was 123 monochorionic and 416 dichorionic twin pregnancies. In the 104 monochorionic and 381 dichorionic pregnancies resulting in two live births, there were no significant differences in median (range) intertwin disparity in crown-rump length (4.3% [0-18.8%] and 3.4% [0-25.5%]) or birth weight (10.2% [0-37.0%] and 9.3% [0-49.2%]). To determine that the observed 0.9% intertwin differences in crown-rump length and birth weight between the two groups were significant at alpha = .05 with 80% power, we would have had to examine a minimum of 984 and 926 twin pregnancies, respectively, assuming that the proportion of monochorionic to dichorionic twins remained the same as in the current study. In addition, there was no significant correlation between intertwin disparities in crown-rump length and intertwin disparities in birth weight in either the monochorionic (P = .40, Rho = 0.02, 95% confidence interval [CI] -0.17, 0.22) or dichorionic group (P = .44, Rho = 0.01, 95% CI -0.11, 0.09). The median (range) intertwin disparity in crown-rump length in 15 dichorionic pregnancies with chromosomally abnormal fetuses (6.6% [0-24.0%]) and in 20 dichorionic pregnancies that ended in miscarriage or intrauterine death of one or both fetuses (7.7% [0-43.9%]) was significantly higher than in dichorionic pregnancies resulting in two live births (Z = 2.49 and 3.26, respectively, and P = .01 and .001, respectively). However, in 19 monochorionic twins with adverse pregnancy outcome there was no significant difference in median (range) intertwin disparity in crown-rump length (4.5% [0-20.0%]) from monochorionic pregnancies resulting in two live births (4.3% [0-18.8%]). To determine that the observed 0.2% difference in intertwin difference in crown-rump length between the two groups was significant at alpha = .05 with 80% power we would have had to examine a minimum of 5652 monochorionic twin pregnancies, assuming that the proportion in each group remained the same as in the current study. CONCLUSION: The findings of this study demonstrate that monochorionic and dichorionic twin pregnancies do not differ significantly in intertwin disparity in fetal size, either in early pregnancy or at birth.

Crown-Rump Length↗
PubMed1998

Inter-twin membrane folding in monochorionic pregnancies.

This study examines the value of assessing inter-twin membrane folding in monochorionic twin pregnancies in the prediction of twin-to-twin transfusion syndrome. In 83 monochorionic twin pregnancies ultrasound scans were carried out at 10-14, 15-17 and 19-21 weeks to investigate folding of the inter-twin membrane as an early sonographic feature of inter-twin discrepancy in amniotic fluid volume. There were 23 (28%) cases of membrane folding, which was first observed in one case at 10-14 weeks, in 21 cases at 15-17 weeks and in another case at 24 weeks. In 12 (52%) of the 23 cases the pregnancy progressed to severe twin-to-twin transfusion syndrome and 10 of these were treated by endoscopic laser coagulation of the placental vascular anastomoses. In the other 11 cases there was a moderate syndrome with large discrepancies in amniotic fluid volume and fetal size, persisting throughout pregnancy. In the severe group, five pregnancies resulted in live birth of both babies, three in live birth of one and intrauterine death of the other twin and in four cases there were no survivors. In the moderate group, all babies survived and the inter-twin disparity in birth weight was more than 20%. Similarly, all 60 pregnancies with no membrane folding resulted in live births. In all three groups there was an increase in inter-twin disparity in fetal size with gestation and the greatest inter-twin disparities were in those with moderate twin-to-twin transfusion syndrome from as early as the 10-14 week scan. These findings demonstrate that folding of the inter-twin membrane occurs in about one-quarter of monochorionic twins and in about half of these there is subsequent development of severe twin-to-twin transfusion syndrome.

Extraembryonic Membranes↗