PubMed Health⌕ Search

Biomedical subjects

E Verspyck

Publications and source records attributed to E Verspyck.

18 recordsLinked to original sources
PubMed2000

Leuprorelin depot 3.75 mg versus lynestrenol in the preoperative treatment of symptomatic uterine myomas: a multicentre randomised trial.

OBJECTIVES: To compare the effect of the gonadotrophin-releasing hormone agonist leuprorelin and progestin lynestrenol, given prior to surgical treatment of symptomatic uterine myomas, on the pre-operative symptoms, tolerance, and operative blood loss. STUDY DESIGN: Fifty-six women were randomly selected to receive, during 16 weeks, either monthly subcutaneous injections of leuprorelin 3.75 mg sustained release (n=33) or lynestrenol 5 mg two tabs per day (5th to the 25th menstrual cycle) (n=23). RESULTS: Intent-to-treat analysis of the main efficacy criterion, namely ultrasonographic reduction of myoma(s) diameter, showed a significant difference in favour of leuprorelin (P=0.02) with a mean decrease of 26.5+/-4.5% (n=29) as opposed to 7.3+/-5% in the lynestrenol group (n=17). Clinical improvement was satisfactory in both groups. Hematocrit decrease between the preoperative value and the value measured 48 h postoperatively was significantly lower in the leuprorelin group than in the lynestrenol one (P=0.02) (for hemoglobin: P=0.07). CONCLUSION: Leuprorelin was more effective than lynestrenol because of its more intense antigonadotropic activity. The tolerance was good, reflecting each drug mechanism of action.

Adult↗
PubMed2000

[Newborn shoulder width: physiological variations and predictive value for shoulder dystocia].

OBJECTIVES: The purpose of this study was to determine maternal and infant characteristics affecting newborn shoulder width (NSW) and to evaluate the predictive value of NSW measurement in cases of shoulder dystocia. DESIGN: NSW was systematically measured at birth during a period of 18 months. SETTING: Department of Obstetrics and Gynaecology of Saint-Antoine University Hospital (Paris-France). POPULATION: A total of 2.222 NSW measurements were performed and 22 cases of true shoulder dystocia occurred during the study period. METHODS: NSW measurements were reviewed and correlated with maternal age, parity, nonpregnant weight, weight gain during pregnancy, height, race, fasting glucose and one hour glucose levels, gestational age, birthweight and sex of the neonate. A Receiver Operating Characteristics (ROC) curve was constructed to evaluate NSW as a test for predicting shoulder dystocia. RESULTS: The mean NSW was 122.06 mm +/-0.50 SD. Stepwise multiple regression showed that NSW was significantly associated with birthweight (p<0.001), parity (p = 0.04), and nonpregnant weight (p = 0.04). We estimated that the best cut-off for shoulder dystocia prediction was a NSW measurement with a low false positive rate (<10%) in association with a high sensitivity rate. Therefore, NSW measurement above or equal to 140 mm was selected. This measurement should have a low sensitivity of 27.27%, a specificity of 91.82%, a positive predictive value of 4.02%, and a predictive negative value of 99.01% for shoulder dystocia prediction. Nevertheless, birthweight above or equal to 4000 g should retrospectively have a better predictive value for shoulder dystocia. CONCLUSIONS: NSW measurement, which is strongly correlated with birth weight, still remains a poor predictor for shoulder dystocia, even when this evaluation is correct antenatally.

Anthropometry↗
PubMed2000

[Inherited thrombophilia and pregnancy].

Inherited thrombophilia include deficiences of antithrombin III, protein C and protein S, and the factor V Leiden mutation, the prothrombin gene variant, and homozygosity for the thermolabile variant of methylenetetrahydrofolate reductase (MTHFR). The incidence of thromboembolism events during pregnancy and postpartum period among women with thrombophilia is not well known and depends on the prethrombotic state resulting from the interaction of the underlying thrombophilic defect(s), history of congenital thrombophilia, and additional risk factors. In that way, many patients with congenital thrombophilia will require antenatal thromboprophylaxis, the timing of which will depend on the patient's history and thrombophilic disorders. Low molecular weight heparin appeared to be a safe alternative to unfractionated heparin for both the fetus and the mother during the pregnancy. Case-control studies have recently demonstrated that serious obstetrical complications i. e severe preeclampsia, abruptio placentae, intrauterine growth restriction, and stillbirth were frequently associated with inherited thrombophilia. Controlled trials are now urgently needed to determine the possible potential benefits of anticoagulant therapy in pregnancy outcome. Finally, there is no evidence to support routine screening for congenital thrombophilia during pregnancy.

Antithrombin III Deficiency↗
PubMed1999

[Management of cholestasis in pregnancy].

DIAGNOSIS: Pruritus in a pregnant women with healthy skin is suggestive of gravid cholestasis. The diagnosis can only be retained after ruling out viral or drug-induced hepatitis or gallbladder disease. The best markers are maternal serum transaminase and bile acid levels. FETAL RISK: The perinatal consequences of gravid cholestasis are minimal if reasonable premature delivery is accepted. THERAPEUTIC OPTIONS: Ursodesoxycholic acid is an interesting therapeutic option if pruritus is untolerable or if the diagnosis is made early in pregnancy. Injection of vitamin K prevents coagulation disorders.

Cholestasis↗
PubMed1999

Amniotic fluid alpha-fetoprotein is not a useful biological marker of pregnancy outcome.

The aim of our study was to determine if the amniotic fluid alpha-fetoprotein (AFP) level could be a useful predictive biochemical marker of pregnancy outcome. Amniotic fluid AFP measurement was prospectively carried out over a three-year period. After excluding factors susceptible to modifying AFP measurements, 587 subjects with gestational age between 14 and 20 weeks were selected to compare the amniotic fluid AFP mean levels depending on the occurrence of an adverse outcome. No significant associations between amniotic fluid AFP level and poor pregnancy outcome, i.e. pre-eclampsia, preterm delivery, premature rupture of fetal membranes, fetal growth retardation and placental abnormalities were observed. The routine measurement of amniotic fluid alpha-fetoprotein during an amniocentesis procedure was not considered useful in predicting pregnancy complications.

Adult↗
PubMed1999

Small for gestational age infant in association with maternal prothrombin gene variant (nt 20210A).

Most of disproportionate infants born small for gestational age (SGA) have an history of placental dysfunction with no explained cause. We report a case of an unexplained SGA infant with placental infarctions and thrombosis. Maternal thrombophilic disorder tests revealed that the patient was heterozygous for the A20210 prothrombin gene variant a newly identified thrombotic risk factor. It may be suggest that prothrombin gene variant, as factor V Leiden, could be a genetic risk factor for placental insufficiency.

Adult↗
PubMed1999

Newborn shoulder width: a prospective study of 2222 consecutive measurements.

OBJECTIVES: To relate maternal and infant characteristics to newborn shoulder width and to evaluate the predictive value of newborn shoulder width measurement in cases of shoulder dystocia. DESIGN: Newborn shoulder width was systematically measured at birth during a period of 18 months. SETTING: Department of Obstetrics and Gynaecology of Saint-Antoine University Hospital, Paris, France. POPULATION: A total of 2222 newborn shoulder width measurements were performed and 22 cases of true shoulder dystocia occurred during the study period. METHODS: Newborn shoulder width measurements were reviewed and correlated with maternal age, parity, nonpregnant weight, weight gain during pregnancy, height, race, fasting glucose and one hour glucose levels, gestational age, birthweight and sex of the neonate. A receiver-operating characteristics curve was constructed to evaluate newborn shoulder width as a test for predicting shoulder dystocia. RESULTS: The mean newborn shoulder width was 122.06 mm (10.50 SD). Stepwise multiple regression showed that newborn shoulder width was significantly associated with birthweight (P < 0.001), parity (P = 0.04), and nonpregnant weight (P = 0.04). We estimated that the best cut off for shoulder dystocia prediction was a newborn shoulder width measurement with a low false positive rate (< 10%) in association with a high sensitivity rate. Therefore, newborn shoulder width measurement > or = 140 mm was selected. This measurement should have a low sensitivity of 27.27%, a specificity of 91.82%, a positive predictive value of 4.02%, and a negative predictive value of 99.01% for shoulder dystocia prediction. Nevertheless, birthweight > or = 4000 g should have a better predictive value retrospectively for shoulder dystocia. CONCLUSIONS: Newborn shoulder width measurement, which is strongly correlated with birthweight, still remains a poor predictor for shoulder dystocia, even when this evaluation is correct antenatally.

Adult↗
PubMed1999

Fetal lactic dehydrogenase variation in normal pregnancy and in cases of severe intra-uterine growth restriction.

Physiological and pathological fetal levels of lactic dehydrogenase (LDH), including its five different iso-enzymes are still poorly known. Our objectives were to compare total LDH levels and its five iso-enzymes between a control group of healthy fetuses and a group of fetuses with severe intra-uterine growth restriction (IUGR), and to determine the biochemical associations and the prognostic value of elevated LDH activity in fetuses with IUGR. Total LDH levels, haematologic values and liver enzyme activities were measured in 108 healthy fetuses from 17 to 37 weeks of gestation and in 44 fetuses with severe IUGR. Total fetal LDH in plasma from the healthy fetuses were constant throughout pregnancy (mean (SD)= 305.09 (46.97)). Total LDH values in plasma significantly increased in cases of IUGR (p=0.003), and the degree of increase was significantly correlated with fetal erythroblastosis (n =44, r=0.80, p<0.001). LDH 5 significantly decreased in the IUGR group (p=0.03). Total LDH values strictly above 400 IU/l (a value equal to the mean+2 SD in the healthy fetus group) were found to be significantly associated with thrombocytopenia (p<0.001), erythroblastosis (p=0.008) and an increase in AST value (p=0.03). These results suggest that the fetal LDH value in plasma is a useful biological marker for severe chronic distress.

Case-Control Studies↗
PubMed1999

[Microdeletion of 22q11 and conotruncal cardiopathies: contribution of prenatal diagnosis].

OBJECTIVE: We report our experience on prenatal diagnosis of 22q11 deletion by fluorescent in situ hybridation (FISH). PATIENTS AND METHODS: From February 1997 to April 1998, prenatal diagnosis of 22q11 deletion was performed in 13 cases of congenital conotruncal heart defects. FISH was carried out using D22S75 DiGeorge's chromosome region probe. RESULTS: Microdeletions of 22q11 were detected in 4 fetuses with tetralogy of Fallot (3 cases) and pulmonary atresia with ventricular septal defect (1 case). Termination of pregnancy was performed in two cases for severe congenital heart defect. A third malformed fetus died immediately after a blood sampling procedure. The last fetus, with a tetralogy of Fallot malformation, was born and underwent corrective cardiac surgery. The dysmorphic features of this fetus was suggestive of DiGeorge's syndrome, and the development status was normal. CONCLUSION: Prenatal detection of 22q11 only played a minor role in the decision to terminate the pregnancy in our study.

Chromosomes, Human, Pair 22↗
PubMed1997

Treatment of bowel endometriosis: a report of six cases of colorectal endometriosis and a survey of the literature.

From October 1989 to September 1994, we performed six intestinal resections for rectal and sigmoidal endometriosis. The average age of the patients was 32 years old, and most had symptoms. In all cases coloscopy showed a normal mucosa. Patients had successfully been treated with hormones previously, but had relapsed when the treatment was stopped. Bowel resection was segmental, with immediate end to end anastomosis in five patients, and partial in one patient. Genital endometriosis was diagnosed in three cases and was then treated during the same procedure. A low colorectal anastomosis was complicated by a fistula, but no recurrence was observed after surgical treatment. Intestinal endometriosis tract is in 70% of cases located on the rectosigmoid. An association with genital endometriosis tract is observed in 80% of the cases. Deep rectosigmoidal endometriosis with symptoms is resistant to hormonal therapy and necessitates a surgical treatment by intestinal resection. The pelvis has always to be explored, with full evaluation and surgical treatment of genital endometriosis when necessary. Appendicular endometriosis should be removed surgically. Postoperative treatment can be additionally prescribed in cases of genital endometriosis and for leftover digestive location.

Adult↗
PubMed1997

[Diagnosis and treatment of rectal and sigmoid endometriosis].

From October 1989 to September 1994 six resections of the bowel were performed for colorectal endometriosis. Five of, the patients, with a mean age of 32 years, presented clinical features. In all cases, colonoscopy showed a normal mucosa. All patients treated by hormonetherapy relapsed. The resection was segmental with immediate end-to-end anastomosis in 5 cases and partial in 1 case. In three cases, endometriosis of the genital tract was associated and treated during the initial laparotomy. One low rectosigmoid anastomosis fistulised. Rectosigmoid endometriosis accounts for 70% of bowel localisations and genital endometriosis is associated in 80% of cases. Deep and clinical rectosigmoid endometriosis does not respond to hormonetherapy and requires bowel resection. The pelvis should be explored and genital tract endometriosis treated. Postoperative hormonetherapy should be considered after initial surgery.

Anastomosis, Surgical↗
PubMed1997

[Peritoneal tuberculosis. Value of laparoscopy].

We report 6 cases of tuberculous peritonitis, focusing on the contribution of laparoscopic exploration. The initial diagnosis was erroneus in all cases: the polymorphous clinical presentations suggested another infectious disease or cancer disease. Laparoscopy was performed in 5 patients who had ascitis and in 1 with plastic peritonitis. At laparoscopy, the peritoneum showed miliary granulations and inflammatory adherences on the visceral or parietal sheats. Bacteriological analyses of the ascitic fluid were positive in only one case. The diagnosis was confirmed after culture of biopsy specimens and identification of the Kock bacilli or on the basis of objective evidence of an epithelioid giant-cell granuloma with caseous necrosis. Outcome was favorable after appropriate antibiotic therapy.

Adult↗
PubMed1997

[Peritoneal tuberculosis].

Peritoneal tuberculosis remains a common problem in impoverished areas of the world. Immigrants and AIDS patients are two population groups at particular risk for abdominal tuberculosis in our country. The most common presenting symptoms of tuberculous peritonitis are abdominal pain, ascites and weight loss in more than 80% of cases. Results of sonographics studies are non specific and high serum CA 125 levels can be found. Pulmonary tuberculosis is concomitantly discovered in 50% of cases. Tuberculous peritonitis is of the exsudative type in 95% of cases and requires multiple studies of peritoneal fluid. Tuberculous peritonitis is suspected when exsudate and lymphocytes are present with no malignant cells, and high interferon gamma and adenosine desaminase activity. AFB is detected in the peritoneal fluid cultured conventionally in 80% of cases. Laparoscopy combined with peritoneal biopsy is effective for the diagnosis of tuberculous peritonitis in 75 to 85% of cases. Peritoneal tuberculosis is treated with antituberculous drugs for a period of nine months.

Antitubercular Agents↗
PubMed1993

Myasthenia gravis with polyhydramnios in the fetus of an asymptomatic mother.

Transient myasthenia gravis was observed in an infant whose mother had no signs of neuro-muscular disease. The case presented with severe polyhdramnios at 31 weeks. Sonographic and invasive work-up showed only an absence of fetal swallowing. At birth, the infant had severe muscle weakness and respiratory distress. He had high titres of anti-acetylcholine receptor (anti-AChR) antibodies of maternal origin. Anti-AChR antibodies were also found in stored samples of fetal serum and amniotic fluid. To our knowledge, this is the first case of neonatal myasthenia gravis for which neither past nor present evidence of disease could be obtained in the mother. Anti-AChR antibody testing should be considered in cases of unexplained polyhydramnios.

Abnormalities, Multiple↗
PubMed1993

[Laparoscopic myomectomy. 102 cases].

Myomectomy was performed by laparoscopy in 102 patients, according to a precise technique using the monopolar hook for the uterine incision and intraperitoneal sutures. Myomes were mostly removed through the suprapubic puncture site after fragmentation or by colpotomy. A laparotomy during the laparoscopic procedures was necessary in 2 cases. No complications were observed. A second-look laparoscopy or a cesarean section was performed in 24 cases. Post-operative adhesions were noted in 3 cases. In our experience, operative laparoscopy has several advantages over laparotomy and the risks of complications is low in selected cases.

Adult↗
PubMedDate not supplied

Transabdominal amnioinfusion for the management of nonlaboring postdates with severe oligohydramnios.

A retrospective study compared two comparable consecutive groups of nonlaboring primiparas beyond 41 weeks with severe oligohydromanios (no amniotic pocket more than 2 cm deep). Transabdominal amnioinfusions were not done in the historical control group (n = 14) but were done in the second group (n = 11). Fetal heart rate patterns and neonatal outcome were better in the group with amnioinfusion than in controls, and the rate of cesarean delivery was significantly lower (18 vs. 93%, p < 0.001). These results suggest that prepartum transabdominal amnioinfusion may have obstetrical and perinatal benefits for nonlaboring postdates with oligohydramnios, especially when the cervix is unripe.

Abdomen↗