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Biomedical subjects

J P Brettes

Publications and source records attributed to J P Brettes.

At least 19 recordsLinked to original sources
PubMed2004

Peripartum bacteremias due to Leptotrichia amnionii and Sneathia sanguinegens, rare causes of fever during and after delivery.

We report three cases of delivery and postpartum bacteremia due to unusual anaerobic bacteria in healthy young women. Leptotrichia amnionii bacteremia occurred during delivery in two mothers and was associated with fetal distress during labor. Conversely, Sneathia sanguinegens bacteremia occurred postpartum, 2 days after delivery, without consequence for the neonate.

Adult↗
PubMed2002

[Peripartum dilated cardiomyopathies: is there a correlation with sexually transmitted diseases?].

A revue of litérature about peripartum cardiomyopathy; a disease of unknown pathogenesis. Some retrospective studies suggest a relation with sexually transmitted diseases. Other risk factors were observed. Diuretics and digoxin are used in the treatment. Cardiac transplantation is the final solution but the affection could appear again. A database must be started with epidemiologic information to understand this disorder and its correlation with sexually transmitted diseases.

Acquired Immunodeficiency Syndrome↗
PubMed2002

[Femoral neuropathy after transversal suspubic laparotomies. Etiopathological explanation on the basis of an anatomical study].

OBJECTIVES: Based on a case of transient troncular femoral neuropathy after the surgical treatment of a genital prolapse in a 46-year-old woman, a study was designed to better understand the mechanism of this postoperative complication. METHODS: The consequences of different varieties of transversal laparotomies were investigated in human cadavers. RESULTS: On the basis of the data from the anatomical evaluation, the most probable etiopathogenic explanation for the complication we observed is the compression of the femoral nerve, inside the psoas muscle, by the retractor lower edge. CONCLUSION: In the reported case, the outcome was simple with full sensory and motor recovery in the lower limb. The different mechanisms potentially involved in this kind of postoperative femoral neuropathies are reviewed and discussed.

Cadaver↗
PubMed2001

[Multidisciplinary management of aortic dissection complicating pregnancy].

BACKGROUND: Most cases of aortic dissection observed in women under 40 years of age occur as a complication of pregnancy in patients with other risk factors. Case report. We report a case of dissection of the ascending aorta in a young primigravida at 35 weeks gestation. The risk factor was aortic regurgitation. Multidisciplinary management enabled fetal extraction followed by repair of the aorta. Outcome was favorable for both mother and child. DISCUSSION: A review of the literature shows a variety of etiological factors leading to this disease. Emergency diagnosis and management is mandatory. Obstetricians should be aware that pregnancy can be a triggering factor in patients with a predisposition, e.g. connective tissue disease. A complete cardiovascular evaluation should be conducted before conception and a suitable surveillance planned for the entire pregnancy. The aim of this careful follow-up it to avoid surgery in an emergency setting that could compromise prognosis for both mother and child.

Adult↗
PubMed2000

[Laparoscopic surgery and "massive" obesity].

OBJECTIVE: Massive obesity is an important risk factor in gynecology surgery. The traumatic effect of traditional laparotomy on the parietal wall is responsible for important per and postoperative morbidity. We evaluated the feasibility and advantages of the laparoscopic approach in these patients, both in terms of surgical procedure and anesthesia. METHODS: To evaluate the technique, we reviewed four patients with massive obesity (BMI > or =40 kg/m(2)) who underwent laparoscopic surgery in our department. For each patient, we studied the cardiovascular risk factors, indications for operation, surgical technique, anesthesia conditions and follow-up. RESULTS: From the surgical point of view, certain technical difficulties were noted such as the problem of exposure and coagulation difficulties for the vascular pedicles enveloped in a layer of fatty tissue. No conversion to laparotomy was necessary. From the anesthesiology point of view, unlike what was previously feared, there was a reduction in the high operative risk due to obesity, especially due to postoperative benefits. Follow-up in these four patients was uneventful. CONCLUSION: Patients who suffer massive obesity are in a high risk category for surgery and anesthesia. This high risk group can benefit most from the advantages of laparoscopic surgery compared with open surgery.

Aged↗
PubMed1999

[Buprenorphine and pregnancy. Analysis of 24 cases].

BACKGROUND: Maintenance therapy of drug-addict mothers with medical and psychosocial support may reduce complications (prematurity, growth retardation, fetal distress and fetal death). Methadone has been widely used during pregnancy with beneficial effects. Buprenorphine (BUP) is used more and more and shows the same beneficial effects. PATIENTS AND METHOD: Twenty-four pregnant women received BUP and their infants were enrolled in the study. Thirteen retrospective (GI) and 11 prospective (GII) cases were studied. In the GII, the women were treated and followed up in an interdisciplinary manner. RESULTS: Complications in GII were less frequent than in GI: 9 vs 30% of prematurity, 9 vs 46% of fetal growth retardation and 0 vs 23% of acute fetal distress. However, the frequency of withdrawal syndrome was the same in both groups, 63 vs 69%, though improvements came more rapidly in GII. CONCLUSION: This study shows that the use of BUP during pregnancy, combined with medical and psychosocial support, may reduce addiction complications. This support has to be maintained after the birth.

Adult↗
PubMed1999

[Subareolar injection of 99m-Tc sulfur colloid for sentinel nodes identification in multifocal invasive breast cancer].

The objective were to study the relevance of the subareolar injection for sentinel node [SN] detection in multiple foci breast cancer. Seventy-nine patients with infiltrative breast carcinoma (diagnosed pre-operatively by core biopsy) and a mean age of 55 (31-78) years were enrolled. All patients were free of previous homolateral surgery, chemotherapy, locoregional radiotherapy or prevalent axillary lymph node. Using four 0.1 ml injections of 1.8 MBq, the technetium-99m 100 nm filtered sulfur colloid was injected by subareolar way (group I) in 16 cases of radiologically cancer with multiple invasive foci and 31 cases of radiologically unifocal cancer, and by peritumoral way (group II) in 32 cases of radiologically unifocal cancer. Scintigrams were obtained 2 to 4 hours after the injections and radioactive nodes were detected peroperatively 18 hours after the injection by intraoperative detection probe. Individual removal of all radioactive nodes was followed by axillary dissection at levels I and II of Berg including Rotter area control. All sentinel nodes were submitted to standard histopathological analysis on serial sections at 500 mu intervals completed by immunohistochemistry for cytokeratin on negative SN. SN were detected by scintigrams in 85% and 88% of the cases of group I and group II respectively, but in 98% and 97% of the cases of respectively both groups by intraoperative probe. Group I was composed of 69% ductal, 22% lobular and 9% tubular carcinomas, and group II of 87% ductal, 10% lobular and 3% tubular carcinomas. Seven and 5 radiologically unifocal tumors were in fact with multiple invasive foci at histology in groups I and II respectively. The complete scintigraphic procedure permitted the detection of a mean number of 2.7 (1-7) SN in group I and 2.3 (1-4) in group II (NS). In group I, the SN were metastatic in 22 patients (48%), 15 of them with the metastases being restricted to the SN, whereas in group II, the SN were metastatic in 9 patients (28%), 5 of them with the positivity restricted to the SN. No false negative result (SN negative and other axillary nodes positive) was observed in group I and only one false negative result in group II which was related to a cancer with histological multiple invasive foci. Sensitivities were 100% and 90%, and negative predictive values were 100% and 95%, for groups I and II respectively. Subareolar injection of radiocolloid allows identification of SN in cases of unifocal and multiple cancer. The mean number of SN detected by the subareolar method is not significantly different, although higher, to that detected by peritumoral injection.

Adenocarcinoma↗
PubMed1998

[Breast cancer: epidemiology, risk factors, screening].

Breast cancer is the most frequent cancer in women: more than 8 to 9% of women will develop a breast cancer during their life and the incidence rate is regularly increasing. Despite therapeutic improvements, breast cancer mortality still remains important and varying according to regions (five years survival: 62 to 80% for the last years). The risks factors analysis shows that a primary prevention of the major risks factors is not yet possible (genetic or endogenous hormonal risk). The chemoprevention is still is discussion and under investigation. For the moment, secondary prevention using screening is the only way to improve survival. The lead-time induced by the screening allows an earlier detection of breast cancers. The randomized trials have demonstrated a significant benefit on mortality and morbidity from breast cancer in women aged 50 to 69. So many countries started regional, pilot or national breast cancer screening programmes using mammography with a 2-year interval and specialized centers.

Adult↗
PubMed1997

[Urinary complications during laparoscopy: a urachal diverticula injury].

The authors report a bladder injury during laparoscopic procedure. A laparotomy is performed immediately and shows an urachal anomaly with the bladder reaching the umbilic. One of the accessory trocars perforates the bladder in its unusual position. Surgical repair is made and the patient discharged without sequelae 12 days later. Rate of bladder injury increases with development of advanced laparoscopy as Burch and hysterectomy. Careful drainage with folley catheter during all laparoscopic procedures present greater than morbidity. Previous laparotomy may change the usual position of the bladder. Care must be taken in case of wall anomalies as in our observation. Per-operative suspicion of bladder injury (hematuria, presence of gas in the urinary catheter collection bag) can be proved with the injection of methylene blue in the folley catheter. Laparoscopic repair is possible for an experienced surgeon, associated with 10 days continuous urinary drainage and quinolone antibiotherapy. Morbidity of unknown bladder injury is great with some death-case reports. All diagnosis technique possible must be used to light these clinical situations, urinary peritonitis symptomatology is often non specific.

Adult↗
PubMed1996

[Polycystic ovary and diazoxide. In vivo study].

The suppression of hyperinsulinism with diazoxide (300 mg/d during 30 days) in a young woman with PCOS and hirsutism, hyperinsulinism and insulinoresistance was followed by a modification of plasma androgens. Testosterone (T) and free testosterone (fT) were reduced after ten days and then increased but always remained below the baseline level. DHEAS had increased 200% by day 10, and 3 alpha-adiol G to three times its basal value by day 20. These modifications were constant during the treatment. fT decrease was secondary to reduction of hyperinsulinism which was followed by an increase of TeBG and a modest and transient reduction of androgen theca cells production. DHEAS increase was due to hyperinsulinism suppression which stimulated adrenal 17-20 lyase activity. 3 alpha-adiol G increase was concomittant, and can be considered as an index of adrenal androgen secretion.

Adolescent↗
PubMed1994

[Abdominal emergencies and pregnancy].

The authors report the principal abdominal surgical emergencies which may occur during pregnancy. Missed diagnosis of these acute abdomens forms the basis of their gravity in terms of both maternal and fetal prognosis.

Abdomen, Acute↗
PubMed1994

[Prenatal diagnosis of congenital cystic adenomatoid malformation of lung: perinatal management. Apropos of 4 cases].

BACKGROUND: Cystic adenomatoid malformation of the lung can be seen by ultrasonography during pregnancy. Surgical excision of the affected lobe is indicated during the first days of life. CASES REPORT: Four neonates were admitted to an intensive care unit from March 1988 to February 1992, due to cystic adenomatoid malformation of the lung, that had been diagnosed by ultrasonography at 19, 22, 34 and 37 weeks of gestational age, respectively. These malformations were not associated with other abnormalities and were type I (three cases) and II (one case) according to Stocker's classification. Only one patient became symptomatic, requiring intubation by 72 hours of age. Surgical excision of the affected lobe was performed in three patients at 4 hours, 2 and 7 days of life, respectively, with a normal long-term survival. A segmental resection was performed at 5 days of life in the remaining symptomatic patient but persistence of cystic lesions required lobectomy at 10 months. CONCLUSIONS: Early perinatal management of cystic adenomatoid malformations of the lung is necessary as surgical excision is indicated as soon as possible, even in asymptomatic patients.

Cystic Adenomatoid Malformation of Lung, Congenita↗
PubMed1993

Prenatal diagnosis of a fetus with partial monosomy 7(q34-->qter) and partial trisomy 18(q21-->qter).

Ultrasound examination of a 31-year-old woman at 27 weeks' gestation revealed fetal growth retardation, a bilateral cleft lip and palate, and the absence of median cerebral structures. Chromosome analysis after cordocentesis showed an abnormal karyotype with a structural abnormality of the long arm of chromosome 7: 46,XX,-7,+der(7),t(7;18) (q34;q21.3)mat. The pregnancy was terminated at week 29. The ultrasound findings were confirmed by post-mortem examination, which also revealed a semilobar holoprosencephaly.

Abnormalities, Multiple↗
PubMed1987

[Seroepidemiology of rubella in the Ivory Coast. Geographic distribution].

A total of 3,473 serum samples were collected from healthy subjects in five geographical areas of Côte-d'Ivoire, between July 1985 and August 1986, and were analysed for the presence of rubella haemagglutination inhibition antibodies. Rubella antibodies were present in 1,994 of the samples giving a prevalence of 57.4%. The distribution of this prevalence appeared to be influenced by the climatic conditions and the density of population. The areas of Korhogo and Sinematiali in the north with a hot and dry climate had high prevalences, while the areas of Bouake and Bondoukou in the Centre and Centre-east respectively had low prevalences. The prevalence of rubella antibodies increases with age until it reaches a relatively low level from the age of 15 onward. The analysis of the data by the chi 2 test indicates that there was a statistically significant variation in the prevalence of rubella antibodies between urban and rural communities (p less than 0.001). In the areas of Korhogo and Sinematiali the rubella virus appeared to be best circulate in the rural communities, while the reverse was observed in the areas of Bouake and Bondoukou. In this study, there was not a sex influence in immunity to rubella, because no difference immunity to the virus was observed between males and females. In women of child-bearing age (15 to 44 years) the rubella immunity was relatively low (61.2%).

Adolescent↗