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D Vinatier

Publications and source records attributed to D Vinatier.

At least 91 records · Page 5Linked to original sources
PubMed1995

[Physiopathology of pre-eclampsia: the role of immunology].

Preeclampsia complicating 3% of all births is an important cause of maternal death and is associated with an increased risks of neonatal morbidity and mortality. Among the numerous theories proposed to explain this syndrome, the concept of placental ischaemia resulting in a generalized disturbance of endothelial physiology is receiving increasing support. Maternal immunological systems is often solicited during normal pregnancy. Most likely the immunological system is implicated in preeclampsia. Its responsibility is protean. Trophoblastic antigens may not be properly recognized by maternal immunologic system, resulting in a defect of trophoblastic invasion of the myometrial segment of the spiral arteries. Preeclampsia does not seem to be accompanied with trophoblast immunological rejection by the mother. Some cases of preeclampsia are associated with autoimmune phenomena. The autoantibodies could be directed against phospholipids or/and trophoblastic membrane components. Activated neutrophils release a variety of substances, capable of mediating vascular damage. An imbalance between the protective antioxidant activity and aggressive oxidant mechanisms could initiate the endothelial lesions. Preeclampsia could be one presentation of immunodystrophism with local excess of harmful cytokines. The immunologic system is probably not the initiator of preeclampsia, but its role is ambiguous: either the protective immunologic mechanisms usually operating during pregnancy can be surpassed, or immunologic responses are inadequate and directly aggressive. A better understanding of the underlying immunologic anomalies will improve the nosologic classification of preeclampsia syndrome.

Autoimmune Diseases↗
PubMed1995

[Obstetrical prognosis of the post-cesarean uterus. 641 cases].

OBJECTIVES: A retrospective study of decisions made in a gynaecology department between January 1990 and December 1993 were analyzed in order to assess management of the post-cesarean uterus. METHOD: Among 9092 women who delivered in the department during the study period, there were 641 patients with a post-cesarean uterus, due to a single prior cesarean section in 451. Results were analyzed and compared with those reported in the literature. RESULTS: Among the 451 patients with a single scar, 184 (41%) delivered by elective cesarean section and in 267 (59%) a decision was made during labour. In this group of 267 patients with a single cicatrix who underwent a labour tests, 227 (85%) had a vaginal delivery compared with 40 (15%) in which the decision for cesarean section was made during labour. CONCLUSION: The results observed were comparable with those found in the literature. Management of pregnancy with post-cesarean uterus is now quite similar to that of a normal uterus. Epidural anaesthesia and ocytotin therapy as well as epidural labour triggering have had an important effect.

Extraction, Obstetrical↗
PubMed1995

[Are there still indications for cerclage in 1995?].

AIM: In order to assess their undertook a retrospective study in their department over a 4 year period: from January 1991 to December 1994. METHOD: the study concerned 129 patients who were treated by cerclage. This procedure was performed prophylactically in the great majority of them (97), while it was carried out as an emergency in 32 (25%). RESULTS: the authors drew a distinction between two groups (prophylactic and emergency suture) when analyzing the various results: complications due to suture, mean age of pregnancy at delivery, threatened premature labor, mean length of prolongation obtained. These personal data formed the basis of a review of the literature, in order to specify the indications for suture adopted by various authors at the present time. CONCLUSION: the authors found themselves to be in agreement with data from the literature, considering a history of at least two obstetric accidents (late abortions) and/or the existence of a severe uterine malformation to be the principal indication for prophylactic suture. "Emergency" suture should be performed whenever there is a serious threat of early premature labor in the presence of cervical changes such that suture offers the only chance of prolonging the pregnancy.

Emergencies↗
PubMed1995

[Intrauterine growth retardation associated with a mosaic trisomy 20 limited to the placenta. A case report].

When an amniocentesis was performed to determine fetal age, the karyotype was found to be a trisomy-20 mosaic, which could not be confirmed at birth on peripheral blood but which was confirmed at the cytogenetic examination of the placenta. Fetal growth impairment occurred. Mosaic trisomy in the placenta alone is known to affect fetal development. Normally, lethal, mosaic trisomy found during antenatal diagnosis in a viable fetus with no detectable malformation suggests an extra-embryo anomaly. The risk of spontaneous abortion and fetal growth retardation is however increased making strict echographic surveillance essential in these pregnancies.

Adult↗
PubMed1994

Pregnancy after myocardial infarction.

UNLABELLED: The occurrence of pregnancy in a patient after myocardial infarction remains a dilemma for both the cardiologist and the obstetrician. The majority of obstetricians and cardiologists are very reticent about pregnancy in a woman suffering from coronary disease. AIMS: The aims of this study are to evaluate the risks, the prognosis of pregnancy for women who had suffered from myocardial infarction and to propose guidelines for pre-pregnancy counselling and medical supervision of the pregnancy and delivery. METHODS: A review of literature has revealed 30 cases, 14 of which are sufficiently documented. Only one of these patients requested pre-pregnancy counselling. We add to this experience the case of a patient who, having had an infarction, was authorized to begin pregnancy. RESULTS: Most of the pregnancies in these patients evolve satisfactorily if the more frequent cardiovascular complications are diagnosed and treated rapidly. During the pregnancy, rest is the rule and any situation which risks to increase the myocardial work-load should be avoided. Normal vaginal delivery with epidural anesthesia is the preferred method. CONCLUSION: The maternal and fetal prognosis is good on condition of performing a pre-pregnancy examination and of setting up a multi-discipline surveillance of the pregnancy. The review of the literature does not confirm the surrounding pessimism concerning the patients becoming pregnant after myocardial infarction.

Adult↗
PubMed1994

[Laparoscopically-prepared vaginal hysterectomy. Our personal experiences (apropos of 35 cases)].

We report our personal experience with 35 laparoscopically prepared vaginal hysterectomies performed over a 3 year period, for January 1990 to January 1993. We give our indications for this new technique present our results. We compared our results with those reported in the literature evaluating indications, technique and complications and demonstrate the numerous advantages of this new technique. Finally, a decision protocol has been prepared in order to chose the optimal approach according to the preoperative work-up.

Decision Support Techniques↗
PubMed1994

[Prenatal diagnosis of hepatic hemangioendothelioma. Apropos of a case].

An antenatal echography performed at 32 weeks of amenorrhoea revealed a formation in the liver. Other tests during the antenatal period were unable to provide an exact diagnosis which was only established after exploratory laparotomy after birth. A review of the literature showed that this hepatic tumour has been diagnosed in 3 reported cases antenatally. Haemangioendothelioma occurring during the antenatal period is difficult to diagnose and the severe forms discovered by echography have a poor prognosis.

Adult↗
PubMed1993

[Chronic idiopathic enterocolitis and pregnancy. Reciprocal repercussions and treatment].

The authors having studied retrospectively 23 pregnancies that were complicated by haemorrhagic proctocolitis or Crohn's disease, try to define by following the literature as well, how these diseases react on fertility and on pregnancy, and how pregnancy reacts on the diseases and the treatments that are available during pregnancy. As far as we know at present, the patients are sub-fertile in cases on ulcerative colitis and normally fertile in cases of Crohn's disease. These illnesses are not exacerbated by pregnancy, but pregnancies are affected by flare-ups of the condition, and therefore should be planned if possible for when the illness is in remission. Previous bowel resection does not alter the course of the pregnancy nor change the methods of delivery. These is no abnormal effect on the fetus or infant due to the treatment, but it is wiser to avoid using Azathioprine during embryogenesis.

Abortion, Spontaneous↗
PubMed1993

[Medullary aplasia during treatment for congenital toxoplasmosis in a twin pregnancy].

The authors report a case of a patient who in the 24th week of a twin pregnancy became sero-positive for toxoplasmosis. This was diagnosed by cordocentesis as being infected, and the treatment was therefore started with pyrimethamine and sulfadiazine and folic acid at the 28th week of pregnancy. At 35 weeks, the patient had an acute medullary aplasia due to the absence of the folates. The mother's state was improved rapidly by giving her folinic acid and the twins were normal haematologically. In this case, the authors point out how important the folates are in a pregnancy, especially in twin pregnancies, and point out the precautions that have to be taken when treatment with pyrimethamine and sulfadiazine is started for congenital toxoplasmosis.

Adult↗
PubMed1993

[Diabetes insipidus and postpartum anterior hypophyseal insufficiency].

There have only been thirty cases of total post-partum hypopituitarism published in the literature and these have nearly all been secondary to Sheehan's syndrome. The authors report a case of partial anterior hypopituitarism associated with diabetes insipidus which arose after an uneventful Caesarean operation and the origin of which seems to lie in auto-immune hypophysitis. The authors first describe the morphological and endocrine changes that the hypophysis undergoes during pregnancy and then point out that auto-immune hypophysitis seems to have been only recently recognised. This can be used to explain some cases of post-partum hypophyseal insufficiency occurring almost silently without any history of third haemorrhage. Research has been made systematically for anti-hypophyseal antibodies and for specific antibodies of the organ, but has not always been positive. So the diagnosis of auto-immune hypophysitis is often made only after eliminating other reasons for it. A brief review of the physiopathological mechanisms of diabetes insipidus makes it possible to suggest that vasopressinase coming from the placenta together with prostaglandins could play a role.

Adult↗
PubMed1993

[The ovaries, the immune system, cytokines: physiology].

Sevellar cellular types are involved together in the cyclical functioning of the ovary. Regulating this co-operation between cells are intercellular systems of communication both autocrine and paracrine. The immune system that is present in the ovary seems to have an important role among the regulatory factors. Cytokines are the vectors of intercellular communication. The authors after studying the recent literature show how the immune system elements undergo cyclical variations corresponding to the ovulatory cycle. Reciprocal co-operation between the different cells is brought in to play at all stages of growth and of atrophy of the follicle. The knowledge of these networks for regulation make it possible to understand what is going on better and to work out a more appropriate treatment for certain pathologies such as premature menopause and unforeseen responses to certain forms of stimulation of ovulation.

Cytokines↗
PubMed1993

[Partial 12q trisomy and chylothorax].

The authors present a case of partial trisomy 12q associated with chylothorax, diagnosed at 30 weeks of pregnancy. Cordocentesis for the karyotype as well as thoracocentesis were carried out. In spite of the administration of tocolytic drugs the patient delivered a girl with multiple clinical abnormalities, who died at 7 days of age. From this case, the authors report 6 other cases of partial trisomy 12q in the literature, and, in the discussion they suggest the management after the diagnosis of hydrothorax has been made by ultrasound.

Abnormalities, Multiple↗
PubMed1993

[Risks related to chronic arterial hypertension: strategy before pregnancy].

.5% to 3% of pregnancies are complicated by chronic hypertension. These pregnancies are at increased risk for the development of superimposed pre-eclampsia, abruptio placentae, and poor perinatal outcome. The risk of development of adverse outcomes are not identical for all the patients. Several questions must be solved during the pre-pregnancy visit: What is the seriousness of the chronic hypertension? Is the chronic hypertension essential or secondary? Are there any organic repercussions of chronic hypertension? Why and how organize a special survey for such pregnancies? This complete pre-pregnancy cheek up permit to identify the high risk patients and to inform them of necessity of adjusted monitoring of the future pregnancy.

Antihypertensive Agents↗
PubMed1993

[Immunological recognition in pregnancy: physiology].

In the last decade works on the responses of the mother's immune system to the presence of the feto-placental unit have burgeoned. The antigens that are presented to the mother are special because the trophoblast does not show classical transplantation antigens which are classically implicated in graft rejection. A class I antigen, antigen HLA-G is present in the extra-villous cytotrophoblast, different from classical antigens by virtue of its molecular weight and its reduced antigenic polymorphism. Many functions have been attributed to this antigen; most of them are still being evaluated. The most important immunological phenomena are found at the feto-placental interface. Several events occur simultaneously or successively. Recognition of the trophoblast brings about an inflammatory reaction which is the initial phase of graft rejection. The numerous cytokines that are produced in this initial phase allow decidualization to occur and for the embryo to implant when it has reached an adequate stage of evolution. Rapidly, immunosuppressant mechanisms stop this rejection reaction which if not stopped can cause the pregnancy to end. There is a delicate equilibrium between the different cytokines, those favourable to pregnancy and those damaging to pregnancy. The trophoblast which is resistant to factors which would cause rejection protects the fetus particularly if its growth is helped along by certain cytokines. On the other hand, other cytokines are prejudicial to the growth of the trophoblast and activate certain cytotoxic cells which become aggressive. The maternal immune system and the endocrine system work together to maintain this cytokine network which if destabilized leads to certain pathological situations. Disturbances can be due to poor maternal recognition particularly if the trophoblast does not give out good antigens, or if the mother is genetically programmed not to respond although the disturbance can come from external factors such as certain infections.

Antibody Formation↗
PubMed1993

[Ovarian cysts. Diagnostic and therapeutic aspects].

The methods used to carry out exeresis of ovarian cysts by celioscopy are now familiar. Today, the main concern is the selection of annexial tumors appropriate for celiosurgical treatment in order to limit their use to benign organic cysts only. By comparing the results of a sery of 200 cysts which were treated surgically with cases in the literature, the authors conclude that the three-pronged use of clinical, ultrasound and macroscopic data in the diagnosis of malignant tumors is reliable. Progress remains to be made however in identifying functional cysts which are sometimes mistaken for an organic structure and all too often are still dealt with surgically. In order to reduce the incidence of such errors, new perspectives are envisaged, knowing that diagnostic error is often related to change in their ultrasound structure or their persistence despite conventional estro-progestogen treatment.

Adult↗
PubMed1993

[Abortions of immunologic origin. A trial of etiologic classifications and therapeutic consequences].

Repeated unintentional abortions are an agonizing problems for many couples. When the cause is unexplained an immunological reason is often invoked. There have been many theories, but none have been able to be proven. Progress in immunology makes it possible to predict that these mechanisms will become better understood. At the present time the most recent work presented by the authors underlines the fact that there are probably several different immunological mechanisms causing abortion. When the mechanisms can be identified using current techniques, it may be possible to suggest the treatment suited to each one of these situations and to abandon empirical treatment as is at present used in these repeated abortions.

Abortion, Spontaneous↗
PubMed1993

[Anti-Tja (PP1Pk) isoimmunization. A case, a review of the literature].

AIM: A review of the literature concerning the very rare anti-PP1Pk isoimmunisation with a personal case. CLINICAL MATERIAL: Anti-PP1k antibody gives rise to the high risk of abortion in the first and the second trimester (in a different series the risk is 50-70%). A 19-year-old patient who had this antibody was helped by a plasmaphoresis repeatedly between the 6th and the 25th week of pregnancy. Cordocentesis was carried out to estimate fetal haemoglobin from the 25th week onwards. A set caesarean section was carried out at 36 weeks because of intrauterine growth retardation and the development of fetal anaemia. DISCUSSION: The authors suggest research based on the known immunohaematological factors concerned with this isoimmunisation and on the main treatments available (plasmaphoresis, cordocentesis, and delivery at a set time). CONCLUSION: Until now there have been very few cases and only four similar cases to ours have been reported in the literature. That is why it is so difficult to suggest a well defined strategy for treating these patients.

Adult↗