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Biomedical subjects

J M Thoulon

Publications and source records attributed to J M Thoulon.

At least 19 recordsLinked to original sources
PubMed1992

Home uterine activity monitoring in France: a randomized, controlled trial.

OBJECTIVES: We assessed the effectiveness of ambulatory tocodynamometry in reducing the preterm delivery rate in women at risk of preterm delivery such as women with risk factors and women previously hospitalized and discharged. STUDY DESIGN: In four public maternity units these women were randomly allocated to two groups: 84 had home uterine activity monitoring and daily midwife contact and 84 were given the standard care for high-risk women, which generally includes home visits by community midwives. RESULTS: The proportion of deliveries before 37 weeks' gestation was slightly higher in the monitored group than in the control group (32% vs 22%). The corresponding odds ratio was 1.7 (95% confidence interval: 0.9 to 3.5). CONCLUSION: Although the sample was small, these results suggest that home uterine activity monitoring was probably not beneficial to the population studied, or at least that any benefit would have been too small to justify extending this monitoring in this high-risk population.

Cardiotocography↗
PubMed1992

[Microalbuminuria and pregnancy. Is microalbuminuria predictive of pregnancy toxemia?].

Several authors have suggested that estimating the levels of microalbuminuria will help in early screening for pre-eclampsia. The purpose of this work has been to look for the absence of microalbuminuria in normal pregnancies and to work out its predictive value for the risk of toxaemia of pregnancy when it does appear. The study was carried out on 257 women of whom 43 were controls and 214 women who were pregnant and had neither diabetes nor hypertension and had no kidney infections. The samples of urine were gathered in a 12 hour period of night and those that gave a positive reaction for albumin were rejected. RIA techniques were used to work out the levels of albuminuria and these were confirmed by immunoassay. We have compared microalbuminuria, the relationship between urine albumin and creatinine and the clearance of albumin in relationship to albuminuria (as defined by the relationship of albumin and creatinine clearance). We have calculated the sensitivity and the specificity and the prognostic value both positive and negative for these four parameters. Our results show that in a normal pregnancy there should not be any microalbuminuria, and on the other hand that if microalbuminuria does appear according to the four parameters studied, they are all equally sensitive for predicting pre-eclampsia. The relative clearance of albumin from the urine seems to be the most interesting parameter as far as we are concerned, and it could lead to early screening for toxaemia.

Adolescent↗
PubMed1991

[Effects of sunlight exposure on vitamin D status in pregnant women in France].

The concentration of 25-(OH)D in the blood were measured in 61 pregnant women between the ages of 16 and 45 who were living in three towns that had different amounts of sun (Lyon, Chambery, Nice). The reason for doing this was to find out the influence of exposure or non-exposure to sun on the vitamin D status of these women. A subclinical lack of vitamin D was found in a number of women where ever they lived, seemingly linked to too little exposure to sun (5% of women exposed to sunshine and 59% of women who were not exposed to sunshine had concentrations of 25-(OH)D (less than 10 ng/ml). In the women who were not exposed to sunshine there was a higher frequency of low concentrations of 25-hydroxy vitamin D (less than 10 ng/ml) in Lyon in winter and in women who came from South Europe, Africa or the Middle East. But 39% of the caucasian women who did not go out into the sun, also had low levels of 25-(OH)D (less than 10 ng/ml). There was a positive correlation between the concentrations of 25-(OH)D in the mothers and in the new born (p less than 0.001) which confirmed the dependence of the infant on his mother to build up reserves of vitamin D. Vitamin D supplements should be given to all women in the last trimester of pregnancy who cannot have enough sunshine, where ever they are living in France, in order to avoid the repercussions of low maternal vitamin D levels for the mother and her new-born infant.

Adolescent↗
PubMed1990

Induction of labor with mifepristone (RU 486) in intrauterine fetal death.

In a double-blind controlled multicentric study involving 94 patients with an intrauterine fetal death, we investigated the efficacy and tolerance of mifepristone (RU 486), a steroid compound that antagonizes progesterone action at the receptor level. Success of treatment was defined as the occurrence of fetal expulsion within 72 hours after the first drug intake. Mifepristone treatment (600 mg per day for 2 days) was considered to be effective in 29 of 46 patients (63%). There were only eight successes in 48 patients (17.4%) in the placebo group (p = 0.001, chi 2 test). Tolerance was good in the mifepristone group. In the placebo group, disseminated intravascular coagulation occurred in one woman for whom the investigator waited several weeks for spontaneous expulsion. This large double-blind controlled study provides evidence that mifepristone is of interest in the management of intrauterine fetal death. It could provide a pharmacologic alternative to the use of prostaglandins in this indication.

Adult↗
PubMed1990

[Amniocentesis versus choriocentesis (chorionic villi sampling) and cordocentesis (fetal blood sampling)].

Opinions are still divergent regarding the respective place of amniocentesis and choriocentesis in the scheduled prenatal diagnosis. Amniocentesis (PLA) is the oldest method. This technique is perfectly mastered as well as its results, complications; its follow-up is 17-18 years in the world and over 16 years in Lyon. The rate of technical failures is inferior to 0.5 p. cent under ultrasonographic control. Its results are quite reliable (one error in 4 to 5,000 amniocentesis for the karyotype). The culture failures are under 1 p. cent. The titration of tracers, such as alpha-feto-protein or acetyl-cholinesterase is possible, favoring PLA over choriocentesis when there is a risk of neural dysraphias. PLA may be performed at any time during the pregnancy. Its main drawback seems to be its lateness: currently, the ideal time is 15-16 weeks. PLA performed earlier may result in more technical and culture failures. When performed at 12-13 weeks, it enters in competition with the choriocentesis although its theoretical risk of abortion is lower. Therefore, PLA and choriocentesis may be competitors, according to the risk factors and the indications, especially regarding cytogenetics.

Amniocentesis↗
PubMed1989

[Diagnosis and surveillance of multiple pregnancies by echography].

Twin pregnancies are high-risk pregnancies requiring a particularly close supervision in which ultrasonography plays a major role from the beginning to the end. At the beginning, ultrasonography shows the presence of a twin pregnancy and provides an indication of its anatomical type. It may also detect early complications, notably lysis of the ovum. From the second trimester of pregnancy onwards, ultrasounds diagnose complications that are not readily accessible to physical examination, such as growth retardation of one foetus or both, foetal malformations or death in utero of one of the twins. At the end of pregnancy, ultrasounds also plays a role in the choice of the mode of delivery.

Female↗
PubMed1989

Study of the vaginal mucous membrane following tampon utilisation; aspect on colposcopy, scanning electron microscopy and transmission electron microscopy.

The effect of periodic tampons was studied in 17 young women during the menstrual and inter-menstrual cycle. Biopsies (n = 19) were analysed on scanning electron microscopy (SEM) and transmission electron microscopy (TEM). The effect of medium absorbant tampons was compared with that of super-absorbant tampons. On colposcopy, dryness was noted in 89% cases, peeling in 47% cases. Microulcerations were observed only once (5%). Dryness and peeling was most often encountered with the super-absorbant tampons and during the inter-menstrual phase. TEM revealed cellular destruction affecting all layers of the epithelium: lysis of superficial and intermediate cells, destruction of desmosomes accompanied by the creation of inter-cellular spaces, lipidic vacuoles in the lysed cells. SEM revealed epithelial peeling with cleavage and severe cellular desquamation. Cellular anomalies were common at the level of the cytoplasmic membrane, which presented either defects, a porous aspect, or appeared swollen by air-bubbles.

Adult↗
PubMed1989

[Results of pregnancies characterized by a decrease in the level of alpha-fetoprotein in the maternal blood].

Pregnancy outcome was followed in 123 women showing maternal serum alpha-fetoprotein, less than or equal to 0.50 MOM. In 28 cases AFP was secondarily considered as normal either after ultrasonography and correction of gestation age or after a second sample normal result. In 95 cases AFP level was confirmed lowered; perinatal outcome was normal in 70 cases and abnormal in 25. Among these 25 cases, 3 autosomal trisomies occurred, 2 trisomies 18 and 1 trisomy 21; in the 22 other cases, we observed antepartum risk factors (10 cases with impending premature labor or premature labor, 9 cases with chronic hypertension, 2 cases with Ag HBs hepatitis and 1 case with diabetes).

Female↗
PubMed1988

[Biochemical markers of neural tube closure defects during the second half of pregnancy].

Increasing number of amniocentesis done during the second half of gestation with indication "signe d'appel" made necessary for authors to study amniotic fluid markers in late pregnancy. Normal evolution curve must be established with samples obtained after 20 weeks gestation. Study reveals more false-negative results with AFP than before 20 weeks. AChE remains constantly positive in cases with NTD, band aspect being specific. For other malformations, AChE positivity seems inconstant, with a different aspect. Some normal gestation cases can be associated with faint AChE band.

Acetylcholinesterase↗
PubMed1988

[Alpha-fetoprotein and trisomy 21].

In 31 affected pregnancies with Down syndrome, the median maternal serum alpha-fetoprotein value was lower than normal, 0.76 MoM, and median amniotic fluid value was quite normal, 0.98 MoM. Selecting an arbitrary cutoff-point of 0.5 MoM, 4.1 percent of normal gestations show values less than 0.5 MoM. Authors discuss problems about screening for fetal Down's syndrome by measuring maternal serum AFP levels.

Amniotic Fluid↗