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Biomedical subjects

J J Leng

Publications and source records attributed to J J Leng.

At least 19 recordsLinked to original sources
PubMed1998

Passage of S-(+)- and R-(-)-ketoprofen across the human isolated perfused placenta.

Ketoprofen is a chiral non-steroidal anti-inflammatory drug (NSAID) available as a racemic (rac) mixture of S-(+)- and R-(-)-isomers. Its inhibitory effect on prostaglandin biosynthesis resides virtually in the S-form. Interestingly, R-ketoprofen does not undergo substantial metabolic inversion in humans. Though contraindicated during the last trimester of pregnancy, NSAIDs, including ketoprofen, are used as tocolytic agents in some cases. The S/R plasma concentration ratio was reported to average 2.3 in premature neonates whose mothers were given rac-ketoprofen and to be close to 1 in the maternal plasma. Thus, we investigated the placental transfer of rac-ketoprofen in vitro using Schneider's perfused human cotyledon model. Glucosed Earle solutions with and without human serum albumin (HSA) were used. Several maternal perfusates were tested with different rac-ketoprofen concentrations together with 20 mg L-1 of antipyrine as a reference substance. Ketoprofen enantiomers were assayed by a specific HPLC method with derivatization procedure. HSA concentrations in maternal perfusate influenced the placental transfer of ketoprofen enantiomers. In the absence of HSA in the maternal perfusate, the S-(+)/R-(-) concentration ratio was close to 1 in the fetal perfusate. By contrast, this ratio averaged 1.44 after addition of HSA 10 g L-1 on the maternal side. Similar results were found for dialysis experiments using an inert Spectrapor 2 membrane suggesting that the S-(+)-free concentration is superior to the R-(-)-free concentration in the presence of HSA. Direct measurements of the free concentrations by centrifugal ultrafiltration confirmed this hypothesis. Accordingly, the data observed in vivo may result, at least in part, from the stereoselective protein binding of ketoprofen.

Anti-Inflammatory Agents, Non-Steroidal↗
PubMed1996

[Can the type of GnRH used during long in vitro fertilization protocols influence the pregnancy rate?].

Luteal defect is common during IVF cycles using GnRH agonist. It could be interesting to make up for this problem by using short acting GnRH agonist (effective for 24 hours), more handy at the end of the stimulation. 160 patients included in a long IVF protocol at the Bordeaux CHRU FIV center have been randomized, from September 1993 to August 1994, for the analog's choice (long or short) at the beginning of the stimulation. The stimulation's parameters, the hormonal dosages and the pregnancy rate are independent of the galenic form used. In close, the use of long-acting GnRH analog (sympler to use) sems preferable.

Adult↗
PubMed1995

[Transplacental passage of epirubicin].

We studied the transplacental transfer of epirubicin, an anthracycline used for the treatment of different neoplastic disorders, in particular breast cancers, by in vitro perfusion of term human placenta. Placenta from women with uncomplicated pregnancy were collected immediately after vaginal delivery and put into 37 degrees C thermostated hood. Perfusion of foetal surface of the placenta by modified Earle's solution was started immediately after catheterisation at a flow rate of 6 ml/min and then so was the perfusion of the intervillous space at the rate of 12 ml/min. Samples were collected at different times after the initiation of the perfusion from arterial inflow and venous outflow respective of the maternal and foetal compartment. The transplacental transfer of epirubicin was investigated for two doses: 5 and 9 micrograms/ml. The mean transfer value of epirubicin is low (3.66 +/- 1.07%) for the two tested doses and is only slightly higher than doxorubicin transfer, which drug has provided rare accidents in the clinical reports. These results are in favour of a low placental toxicity of epirubicin. Clinical data have to be collected from pregnant women to confirm the low foetal toxicity of epirubicin.

Dose-Response Relationship, Drug↗
PubMed1995

[Thromboembolism and ovarian hyperstimulation].

Three new cases of thromboembolic accidents involving the superior vena cave were associated with ovarian hyperstimulation and multiple pregnancy. On the basis of a review of the literature, three syndromes were individualized. First embolic arteries are infrequent and serious with an important morbidity; low doses of gonadotrophines is sufficient for causing this pathology. Second, thrombosis of the superior vena cava is late, during in vitro fertilization regimens with GnRH analogs complicated with serious hyperstimulation (degree III). Third, pregnancy is always present; pulmonary complications are very uncommon. Thrombosis of inferior vena cava is late, pregnancy is often present but women are frequently at risk of thromboembolic accident. Prevention of hyperstimulation is important. When present, HBPM is recommended for prevention of thromboembolism. Diagnostic of thrombosis is made with clinical examination and morphologic complementary exams such colour-vascular Doppler and magnetic resonance imaging. Curative treatment requires heparinization.

Adult↗
PubMed1994

[Evaluation of 3 diagnostic methods in premature rupture of membranes: diamine-oxidase assay, alpha-fetoprotein assay, colorimetric method evaluating the pH].

The authors set out to assess the three diagnostic methods available which can detect early breaking of the membranes: radio-enzymatic assay of diamine-oxidase (DAO), radioenzymatic assay of alpha-fetoprotein (AFP), colorimetric method for determining pH (Amnicator). Between June 1991 and March 1992, 114 samples of vaginal secretions were taken from 104 pregnant patients being followed up at Maternity Unit A, Bordeaux (France). The results of the assays were expressed in quantitative terms (microU/ml for DAO and ng/ml for AFP); ROC (Receiver Operating Characteristic) curves were used to determine the positivity threshold in terms of the sensitivity and specificity (20 microU/ml for DAO and 15 ng/ml for AFP). The sensitivity of the pH test was 97.5%, which was significantly better than that of DAO (90.2%) and even that of AFP (82.9%). However, there was no difference between the specificities of the pH, DAO and AFP tests (93.3%, 96.6% and 93.5% respectively). The data were compared with those in the literature. The problems in collecting the vaginal secretions probably accounts for the better results of the colorimetric test. This is a reliable, fast and easily reproducible test; these qualities make it the preferred test in EBM, and it can be completed using a radioenzymatic method (DAO) or immunoradiometric test (AFP).

Adult↗
PubMed1994

[Placental penetration of cefpirome (HR 810): study of fetal concentrations after in vitro infusions of human placenta at term].

Cefpirome (CPO) is a new parenteral cephalosporin with a wide antibacterial spectrum. In order to explore the possibility of using CPO in late pregnancy, we studied its placental transfer in vitro in a model of human placenta infusion. Mother-to-foetus in vitro transfer of CPO is high, similar to that of amoxicillin, with a placental clearance index of 0.20. A pharmacokinetic simulation based upon this result and data from literature suggests that CPO concentrations in foetal blood and amniotic fluid should be appropriate for the treatment of severe materno-foetal infections in late pregnancy. These preliminary results need to be confirmed by in vivo pharmacokinetic and clinical studies before recommending the use of CPO in late pregnancy.

Antipyrine↗
PubMed1993

Familial occurrence of hereditary renal adysplasia with müllerian anomalies.

We report on a family with unilateral or bilateral renal agenesis and Müllerian anomalies (vaginal atresia or minor anomalies). This family provides support for an autosomal dominant pattern of inheritance with incomplete penetrance and variable expressivity in hereditary renal adysplasia (HRA) associated with Müllerian defects.

Abnormalities, Multiple↗
PubMed1992

Isolation of genital mycoplasmas from blood of febrile obstetrical-gynecologic patients and neonates.

In a prospective study, 1156 blood specimens collected from hospitalized febrile obstetrical-gynecologic patients and neonates with suspected sepsis, were inoculated into a conventional biphasic culture medium, Castaneda S and cultures incubated aerobically. 15-24 h later the broth cultures were subcultured to specific media for detection of mycoplasmas. Genital mycoplasmas were isolated in 15 samples (taken from 8 women) and in 2 from 1 neonate. Mycoplasmas and members of the family Enterobacteriaceae were the most frequent significant bacteria isolated from adult specimens. Mycoplasma isolations were associated with either postpartum or postabortum febrile infections in women. Four of the neonates, whose mothers were infected, showed respiratory distress at birth; 1 of them had mycoplasmas in the blood. All febrile states in obstetrical or gynecological patients, and in neonates, should routinely lead to blood cultures for detection of mycoplasmas and ureaplasmas.

Adult↗
PubMed1992

[Induction in the scarred uterus].

Labor was induced in 41 women with uterine scarring and a fetus in the cephalic presentation and normal pelvis size. Due to various problems, these patients would have had to undergo cesarean section if this alternative had not been attempted. The use of prostaglandins E2 to increase maturation of the cervix, of Syntocinon and peridural analgesia made it possible to obtain delivery through the genital tract in 24 cases with the same level of fetal morbidity as for the babies delivered by cesarean.

Analgesia, Epidural↗
PubMed1991

[Use of etilefrin as local vasoconstrictor in lower gynecologic surgery ].

In this randomized prospective study the authors have compared the effectiveness and side-effects of two local vasoconstrictor agents, etilefrine (Effortil) and ornithine 8 vasopressin (Por 8) in vaginal gynaecological surgery. Thirty-three patients entered the trial and were divided into two groups: G1 (15 patients) received Effortil, and G2 (18 patients) received Por 8. The products, administered at random, were diluted in saline 40 ml and injected into the cervix through 6 points. A 3-minute interval was allowed between injection and incision. The results were assessed on the basis of trans- and postoperative haemorrhage and haemodynamic variations. Palor of the cervix was achieved after 3 minutes in both groups; moderate bleeding was observed in only one of the G1 patients. Postoperative renewal of packing was necessary in 2 patients in G1 and 4 patients in G2. No electrocardiographic anomaly was recorded in any of the two groups. Diastolic BP was significantly higher in G2 than in G1 (P less than 0.002, Fisher test). Systolic BP was also elevated in that group (P less than 0.03, chi 2 test). Moderate reduction in heart rate was observed in both groups (P less than 0.3, Fischer test), but severe (48 beats/min) bradycardia was noted in one G2 patient.

Adult↗
PubMed1991

Detection of Mycoplasma hominis antibodies by three different techniques, application to women with pelvic inflammatory disease.

Mycoplasma hominis, a mycoplasma potentially isolated from the genital tract of healthy women, seems to have some role in pelvic inflammatory diseases (PID). Three serologic techniques were developed to detect antibodies to M. hominis: ELISA (IgG, IgM), microimmunofluorescence (MIF) and Western blot. Rabbit and human control sera were used to establish the standard assay conditions. ELISA proved to be more sensitive but less specific than MIF. Cross-reactivity with antibodies to M. pneumoniae existed with ELISA but not with MIF. Twenty six and 60 kDa proteins were responsible for that cross-reactivity, as assessed by Western blot analysis. Among 33 patients with PID, 18 to 35 year old, 67% had antibodies to M. hominis by ELISA and 33% by MIF. Among 52 age comparable healthy women, 44 and 13% were positive for M. hominis by ELISA and MIF respectively. The Western blot analysis showed heterogeneity in the antibody response to M. hominis, but a 76 kDa protein reacted with half of the tested sera. Our study agrees with some role for M. hominis in PID. M. hominis was certainly the primary pathogen in one case, played a role that was probable in seven cases, and possible in three patients.

Adult↗
PubMed1991

[Fetus in fetu and acardiac monster: can the similar patterns of these 2 malformations be explained by a common morphogenic mechanism?].

Fetus in fetu and acardiac monster are two unusual malformations (estimated incidences: 1 in 500,000 and 1 in 34,600 deliveries respectively) which present very similar morphological patterns. The authors report two cases of acardiac monster and a case of fetus in fetu which emphasize this fact. These findings suggest that a single morphogenic mechanism leads to the defects observed in these two groups of malformations.

Abnormalities, Severe Teratoid↗
PubMed1990

[Thrombophlebitis of the ovarian veins. A case report. Review of the literature].

The authors report on one case of thrombophlebitis of the two ovarian veins complicated by thrombosis of the vena cava inferior after a septic abortion. The diagnosis suggested by the persistence of symptoms of a severe pelvic infection was confirmed using computerized axial tomography. Faced with a clot floating in the vena cava inferior, a Greenfield filter was placed subrenally and combined with antibiotic therapy and IV heparin therapy. Clinical symptoms resolved but the scanographic image of thrombosis of the vena cava persisted after 7 months of treatment. This is a rare disease which is currently easy to diagnose, thanks to computerized axial tomography and nuclear magnetic resonance.

Abortion, Septic↗
PubMed1990

[A randomized study of the treatment of threatened premature labor. Nifedipine versus ritodrine].

The authors compare the efficiency of two drugs in the treatment of threatened premature labour, the one being the calcium inhibitor (nifedipine) and the other a beta-mimetic drug (ritodrine). 62 patients after random selection were divided into two groups: 32 treated with ritodrine and 30 treated with nifedipine. The treatment was carried out over 7 days. The success rate was similar in both groups -72% for the ritodrine group and 63.33% for the nifedipine group. Women receiving nifedipine had slightly greater gain in weeks, six as against five for ritodrine. The side effects which were often found with nifedipine were; hot flushes (in 10 cases) and headaches (4 cases). These symptoms appeared 15-30 minutes after the first dose and were transitory. No neonatal complications were found. The ease with which a calcium inhibitor can be given suggests that it should be used more frequently in the treatment of threatened premature labour and particularly when there are contra-indications to the use of beta-mimetic drugs.

Adult↗
PubMed1989

[Vulvo-vaginal mycoses].

Vulvo-vaginal mycoses are extremely frequent and relatively easy to treat. Nevertheless, recurrent forms are extremely debilitating and there is no miracle treatment for them.

Antifungal Agents↗
PubMed1989

[Isolated necrotizing angiitis of the cervix uteri. Apropos of a case].

A necrotizing arteritis isolated to the uterine cervix without multisystem disease was fortuitously discovered in a 52-year old woman after hysterectomy for uterine leiomyomas. This rare lesion discovered by routine histopathological examination was cured by surgery. The aetiology and pathogenesis of this arteritis are unknown.

Female↗