Biomedical subjects
Publications and source records attributed to D Luton.
The decision of hysterectomy during the per- and postpartum period is difficult. After an historical evocation, we discuss the literature and we relate the series of our department. The last indications of this intervention are then exposed.
Flat heart rate recordings may be observed in different fetal states such as chronic distress and sleep. Their visual analysis do not allow the distinction between these two states. We used spectral analysis to study the heart rate patterns in 25 fetuses. Two significant (P < 5 x 10(-5)) groups were apparent from the determination of the position of the maximum energy peak (PMEP) in the high-frequency band (0.20-0.50 Hz): a PMEP at about 0.20 Hz (group 1), and another around 0.30 Hz (group 2). The two groups did not differ in spectral density (SD). The outcome of neonates showed that group 1 fetuses made good progress and produced healthy neonates; whereas group 2 comprised cases of chronic fetal distress, or even death in utero, and neonatal distress. The significance of this difference in PMEP between fetal heart rate patterns in chronic distress and sleep is unclear. Studies combining the assessment of fetal movements and the determination of PMEP are planned.
Spectral analysis of fetal heart rate variability allows quantitative determination of the main components that affect this variability. The physiological significance of these components is unclear; however, movements appear to contribute to variability. We studied six fetuses in which immobility required for in utero magnetic resonance or invasive fetal procedures was achieved by fetal intravascular injection of curare between 32 and 36 amenorrhea weeks. For each fetus, we compared spectral density parameters of heart rate variability. After curare administration, mean spectrum power was halved. We did not observe a larger significant decrease in any (very low, low, or high) frequency band. The other parameters of spectral analysis of variability were unaltered. Fetal movements accounted for a significant proportion of human fetal heart rate variability but did not constitute a unique frequency component.
Immunohistochemistry was used to detect markers of the vascular, stromal and hematopoietic cell compartments in the human embryo and early fetus, from 3 to 15 weeks of gestation. CD34 expression was consistently observed at the surface of vascular endothelial cells from off earliest stages tested, at the single exception of embryonic liver blood vessels. Yolk sac hematopoiesis was very transient and limited to primitive erythropoiesis. Clusters of erythroblasts, monocytes and granulocytes appeared from 4 to 5 weeks of gestation in the liver rudiment. The early development of the bone marrow was marked by the rapid invasion, at 8 weeks, of long bone cartilaginous rudiments by CD68+ osteoclast precursors, CD34+ endothelial cells and by preosteoblasts, leading to the development of large vascular sinuses between ossifying trabeculae. Endogenous erythro- and granulopoiesis developed from week 11 in primary logettes always organized around an arteriole, in a loose stromal mesenchymal network established between the media of these arterioles and the sinusal endothelium. Round, hematopoietic CD34+ cells were seen occasionally in yolk sac blood vessels. In the liver they were rare and intermingled as single cells in the hepatocyte cords; strikingly, CD34+ hematopoietic cells could seldom be detected in the developing bone marrow. In contrast, compact clusters of non-endothelial, round CD34+ CD45+ hematopoietic cells were detected, during the 5th week of development, in close association with the ventral wall of the dorsal aorta. These cells exhibit phenotypic and functional characteristics of very primitive hematopoietic progenitors. This observation is in striking correlation with the evidence accumulated in animal models that stem cells for the late embryonic and adult hematopoietic systems develop inside the embryo per se, in the vicinity of the dorsal aorta. We thus suggest that these aorta-associated CD34+ cells, that exhibit an anatomic localization similar to that of the intraembryonic stem cells identified in the avian and murine embryo, are the real stem of human hematopoiesis.
OBJECTIVES: To estimate the prevalence of Ureaplasma urealyticum (Uu) and Mycoplasma hominis (Mh) in the lower genital tract of pregnant women, their evolution during pregnancy, and the effect of these pathogens on the outcome of pregnancy in Equatorial Africa. STUDY DESIGN: 218 pregnant women were followed from before 20 weeks gestational age through delivery. Samples were taken from the cervix at every visit and from the newborn at delivery and tested for Uu and Mh. The data were analysed using Student's t-test, the Mann-Whitney, or the chi 2-test. RESULTS: The prevalence of cervical colonization by Ureaplasma urealyticum and Mycoplasma hominis in pregnant women was 79% and 41% respectively. Colonization with Uu and Mh increased significantly throughout pregnancy (P < 0.001). Their presence was associated with lower gestational age at delivery, lower birth weight and increased neonatal morbidity and mortality (P < 0.05). Erythromycin therapy did not have any effect on the evolution of Uu and Mh colonization during pregnancy. CONCLUSION: Uu and Mh are additional factors that might contribute to poor pregnancy outcome in a country where neonatal health is already impaired by many other microorganism.
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Contraception of two chimpanzees was considered necessary for clinical reasons. After failure of reversible methods of contraception (an intrauterine device and a long-acting progestagen), tubal ligation was successfully performed, using a technique similar to one used in women.
OBJECTIVE: Diagnosis of the Bart's hydrops fetalis [corrected]. METHOD: Bart's hydrops fetalis [corrected] was discovered by chance in the fetus of a female Chinese patient. Major intrauterine growth retardation, oligohydramnios, an immobile fetus, and cardiomegaly were the principal echographic signs. Cordocentesis showed fetal anemia, and electrophoresis of fetal hemoglobin revealed the presence of Bart's hemoglobin. RESULT: As there is no known effective treatment, termination of pregnancy was proposed to the patient. CONCLUSIONS: Bart's hydrops fetallis [corrected] is a lethal condition. Early echographic signs (cardiothoracic index >0.50, placental thickening) can be screened during weeks 17-18 or even during weeks 13-14 of gestation. These signs would permit a reduction of invasive examinations in couples at risk.
OBJECTIVE: Following recent data showing that an inflammatory response exists in the amniotic fluid of gastroschisis-affected fetuses, we hypothesized that amniotic fluid exchange or amnioinfusion would improve the prognosis of prenatally diagnosed gastroschisis. METHODS: We compared the outcome of prenatally amnioinfused fetuses with gastroschisis to non-amnioinfused fetuses with gastroschisis. 10 patients undergoing this procedure were matched with 10 patients of our previous study. Comparisons were done on data including surgical procedure, follow-up in the NICU and the gastro-pediatric unit. RESULTS: Our results show that gastroschisis-affected fetuses undergoing amnioinfusion had a lower duration of curarization after surgery (2.2 +/- 1.9 vs. 6.8 +/- 6.9 days, p = 0.019), a shorter delay before full oral feeding (49.7 +/- 21.5 vs. 72.3 +/- 56.6 days, NS), and a shorter overall length of hospitalization (59.5 +/- 19.7 vs. 88.5 +/- 73.6 days, NS). We confirmed our previous data showing that amniotic fluid displays a chronic inflammation profile. CONCLUSION: Our data suggest that amnioinfusion could improve the outcome of gastroschisis affected fetuses. The hypothesis by which this improvement could be due to a reduction of an inflammatory response remains to be proved.
OBJECTIVE: Recent studies on the management of human fetal gastroschisis have produced two major findings: (1) there is an inflammatory response in the amniotic fluid of these fetuses, and (2) amniotic fluid exchange designed to disrupt the inflammatory loop seems to have a favorable impact on the immediate and late outcome of these early operated neonates. To test this hypothesis, we used serial amniotic fluid exchanges in a model of gastroschisis developed in the ewe. METHODS: Gastroschisis was created at midgestation in 21 lamb fetuses by an in utero technique. Saline was amnioinfused in some fetuses every 10 days to term. Fetuses were sacrificed on day 145 by cesarean section. Extra-abdominal bowels with fibrous peel were processed for histologic examination. Comparisons were done between fetuses without gastroschisis (controls), fetuses with gastroschisis and amnioinfusion, and fetuses with gastroschisis without amnioinfusion. RESULTS: Of 21 fetuses operated, 8 died in utero or were stillborn; 5 were not amnioinfused, and 8 underwent amnioinfusion. Thickness of bowel muscularis (micrometer) was 92.6 +/- 20.2 for controls, 126.2 +/- 21 for the amnioinfused fetuses, and 182.8 +/- 58.3 for the nonamnioinfused fetuses (p = 0.001). The same significant results were obtained for thickness of serous fibrosis (p = 0.02) and plasma cell infiltration (p = 0.015). CONCLUSIONS: We have created a model of gastroschisis suitable for experimentation in the fetal sheep. Our amnioinfusion data in this model indicate a clear improvement of the deleterious process. This finding correlates well with recent data on amnioinfusion as a therapeutic approach to human gastroschisis.
BACKGROUND: Beckwith-Wiedemann syndrome is a rare serious condition with a high rate of malignant tumors. A relationship between Beckwith-Wiedemann syndrome and insulin-like growth factor (IGF) II gene located at the level of the 11p15 chromosomic region has been demonstrated. CASE: An acromegalic woman (elevated IGF I serum levels) undergoing pregnancy with a Beckwith-Wiedemann fetus is reported. We therefore reviewed data about this association and particularly fetal growth, and analyzed fetal blood samples for IGF I and II. CONCLUSION: We conclude that this association (i.e. Beckwith-Wiedemann syndrome and acromegaly) is independent, and point out that IGF I and II might be very high in the Beckwith-Wiedemann fetus.
OBJECTIVE: To evaluate the prognosis of prenatally diagnosed gastroschisis. STUDY DESIGN: In a retrospective study, we analyzed the clinical and echographic data of gastroschisis. These data were correlated with fetal outcome including delivery, surgical procedure, follow-up in the neonatal intensive-case unit and in the gastropediatric unit. RESULT: Twenty cases were analyzed. The overall survival rate was 85%. Classical criteria were analyzed (maximal bowel dilatation, thickening of bowel wall). Fetuses with both severe perivisceritis and meconium-stained amniotic fluid were born earlier than fetuses with mild perivisceritis and normal amniotic fluid (p < 0.01). CONCLUSION: Our data suggest that an inflammatory response could follow bowel exposure to amniotic fluid. This response could lead to perivisceritis and premature birth. This hypothesis is currently under investigation.
BACKGROUND: The association of hyperthyroidism and pregnancy is a rare but serious condition which can jeopardize fetal outcome. Classical follow-up relies on: serial clinical and echographic assessment; serial funipuncture to determine fetal thyroid status, and maternal propylthiouracil (PTU) treatment to treat fetal and/or maternal hyperthyroidism. CASE: We report the case of a euthyroid patient with Graves' disease who had already been delivered of two hyperthyroid fetuses; the present pregnancy revealed a hyperthyroid fetus diagnosed by funipuncture. Echography showed a fetal goiter at 28 weeks of gestation (WG) with important signal on colored Doppler echography. We observed an extinction of this signal as maternal PTU treatment was intensified. The patient was delivered of a mildly hyperthyroid newborn at 37 WG. Both newborn and patient are doing well. CONCLUSION: Fetal thyroid assessment by colored Doppler echography could help in the management of fetal thyroid dysfunction.
The authors report a case of ascaris lumbricoïdes located in the cervix uterus of a patient suffering from gonococcal salpingitis. Reviewing the literature, they conclude that the most likely way to the parts genitals was a transanal migration toward vagina.
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