The new eugenics and medicalized reproduction.
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Ethics, Medical↗
Biomedical subjects
J Testart
Publications and source records attributed to J Testart.
Towards an efficient medical eugenics: is the desirable always the feasible?
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Embryo Transfer↗
[Apropos of an inflammatory aneurysm of the abdominal aorta revealed by anuria].
Inflammatory aneurysms of the abdominal aorta raise particular problems, as they are often detected as a result of their complications. In the light of one case presenting with anuria, the authors discuss the various treatment options and the value of preoperative corticosteroids.
Aged↗
[Disunion of the stapling line 6 years after a tubulised gastroplasty].
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Bronchial Fistula↗
Ovarian production of IL6 and its potential inhibitory effect on progesterone secretion in Cynomolgus fascicularis.
We explored the potential relevance of interleukin-6 (IL6) to ovarian function in cynomolgus monkey females which were treated to induce multiple follicular growth. Present work gave evidences that IL6 was produced in the ovulatory follicle after hCG administration by using anti-IL6 monoclonal antibody and immunohistochemical techniques. IL6 was produced by granulosa cells in cultures. However, this production was not stimulated by adding to cultures FSH or Bt2cAMP, known to induce IL6 production in various cell types. IL6 was shown to antagonize luteinizing FSH effects. Inhibitory IL6 effect was probably mediated at a site distal to cAMP generation since it had no effect on progesterone production induced by dibutyryl cAMP treatment. The presence of IL6 in the ovulatory follicle show that inflammatory cytokines may play a role at ovulation. On the other hand, its inhibitory effect on progesterone production by granulosa cells could not likely affect the process of luteinization which is controlled by LH/hCG.
Animals↗
[Spontaneous regression of a sub-adventitial cyst of the popliteal artery].
We report a case of spontaneous regression of a cystic adventicial disease of a popliteal artery in a 37 years old man. The peroperative resection of the adventicia give us the histologic confirmation of the diagnostic. The cyst's content may have gone through either in the peri-arterial space or through a communication with the articulation of the knee. For us, it seems to confirm the embryologic theory for the pathogenic of this disease.
Adult↗
[A new case of arterial Listeria infection].
Listeria monocytogenes arterial infections are uncommon and usually occur on aneurysms of previously operated arteries, classically in very young and very old or immunodepressed subjects. Peroperative samples for bacteriology should always be taken as antibiotics generally used in vascular surgery are ineffective against listeria. We report a case of a patient who underwent emergency surgery. Bacteriologic analysis of the thrombus revealed listeria inoculation which was eradicated by adapted antibiotic treatment.
Aged↗
Resection of the aorta for leiomyosarcoma of the inferior vena cava.
Two cases of infra renal vena cava leiomyosarcoma are reported. Their locoregional extension resulted in a joint resection of the aorta and the vena cava. The follow-up of the two cases is of respectively 34 months and 32 months. We think that large resections are necessary, due to the microscopic characteristics of such tumors in order to try to improve the prognosis.
Adult↗
[Celioscopic cholecystectomy. 2 cases of infectious complications].
Despite the low morbidity and mortality of laparoscopic cholecystectomy, trauma and infection have been reported. Such complications can produce a misleading clinical picture, as in two cases we observed. Case 1. A symptomatic 56-year-old female patient underwent laparoscopic cholecystectomy. During the operation, the gall bladder ruptured and the contents had to be aspirated from the abdominal cavity. The patient complained of hepatalgia 2 weeks after the operation, then was not seen again for more than 1 year when fever and hepatalgia did not respond to symptomatic treatment. An inter-hepato-renal collection (6 cm in diameter) was punctured under echography. Aspirate culture yielded Pseudomonas aeruginosa. Adapted antibiotic therapy was unsuccessful and surgery was required to empty the abscess then remove a fibrous conjunctive tissue formation. Case 2. A 55-year-old female patient with a history of complete remission after mammectomy for breast cancer underwent laparoscopic cholecystectomy in 1991. Two days after the operation, fever (39 degrees C) was accompanied by abdominal defence. Biliary peritonitis due to imperfect suture of the bile duct was repaired followed by peritoneal lavage-drainage. Per-operative blood samples revealed type 6 Pseudomonas aeruginosa. Despite adapted parenteral antibiotics, fever persisted at 39 degrees C and intense jaundice was observed. A second laparoscopy 14 days later showed inflammatory narrowing of the main bile duct which was drained into a small bowel loop. Eight days later computed tomography revealed multiple abscess in the liver. Transparietal cholangiography was performed and showed that the contrast medium entered the abscesses via the biliary canals. The state of sepsis persisted, jaundice worsened and hepatic encephalopathy developed with obnubilation and flapping tremor. After 1 month of general antibiotherapy, no improvement was seen on computed tomography images and needle biopsy of an abscess led to the identification of resistant type 6 P. aeruginosa. Antibiotics were adapted and administered iv with no clinical improvement. Selective catheterism of the hepatic artery via the femoral access was performed to allow intra-hepatic antibiotic delivery. Three weeks later clinical situation remained unchanged when acute respiratory distress highly suggestive of pulmonary embolism led to death. Autopsy was not performed. In both of these rare cases of infectious complications due to P. aeruginosa after laparoscopic cholecystectomy, the source of contamination remained unknown. Nosocomial infection was suspected.
Anti-Bacterial Agents↗
[Endo-aortic calcification in young subjects, a complication of elastorrhexia].
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Adult↗
Should the vagus nerves be isolated from the fundoplication wrap? A prospective study.
OBJECTIVE: To assess whether careful dissection and isolation of vagus nerves from the three-quarter Nissen fundoplication wrap (a periesophageal posterior gastric wrap 270 degrees in circumference) could modify the postoperative outcome and reduce postoperative gastric emptying disturbances. DESIGN: Open randomized control trial. SETTING: University hospital. PATIENTS: Forty-two patients with proved esophageal reflux and indication for surgery, after informed consent. INTERVENTIONS: A three-quarter Nissen fundoplication with (21 cases) or without (21 cases) dissection and exclusion of vagus nerves from the wrap. MAIN OUTCOME MEASURES: Standard questionnaire, acid reflux test, and gastric emptying study before and 3 months after surgery. RESULTS: No difference was found between the groups. There was a correlation between preoperative and post-operative gastric emptying. CONCLUSION: Exclusion of the vagus nerves from the three-quarter Nissen fundoplication wrap provides no advantage on postoperative gastric emptying and does not affect outcome of reflux surgery.
Adult↗
[Rupture of the left bronchus during intubation by Carlens tube].
The authors report a case of left main bronchus rupture following endotracheal intubation with a Carlens double-lumen tube. The bronchus rupture occurred during a cure of gastro-oesophageal-reflux and resection of oesophageal diverticula through a left thoracotomy. The patient was a 65-year-old woman treated with corticosteroids for an Addison's disease. The weakness of the bronchial wall initiated by the steroid hormones was an important factor contributing to the perforation. There is also a higher risk of rupture during oesophageal surgery because of surgical dissection and stretch on the tracheobronchial airway. This case demonstrates that such a complication can occur without ventilatory failure. A rupture must be recognized and treated surgically very rapidly. Recommendations regarding the use of double-lumen endotracheal tubes are reviewed in order to decrease the occurrence of such a complication.
Addison Disease↗
Human oocyte activation after intracytoplasmic sperm injection.
Oocyte activation is a series of events triggered by the fertilizing spermatozoon and necessary for the beginning of the embryonic development. Calcium plays a pivotal role in this process. Here we used confocal laser scanning microscopy to examine the changes in the concentration of intracellular free calcium ([Ca2+]i) in human oocytes after intracytoplasmic sperm injection (ICSI). The first considerable but short (< 2 min) increase in [Ca2+]i was detected immediately after the penetration of the microinjection needle into the ooplasm. This rise by itself did not provoke oocyte activation and was also obtained after the injection of medium without spermatozoa. After a lag period of 4-12 h, oocytes that were subsequently activated initiated a second period of [Ca2+]i changes. These changes were sperm-dependent and followed one of two alternative patterns, a non-oscillatory one and an oscillatory one. The non-oscillatory pattern resembled the changes described previously during parthenogenetic activation of mammalian oocytes. The oscillatory pattern was similar to the changes accompanying normal fertilization in different mammalian species. It is concluded that the initial [Ca2+]i rise provoked by the ICSI procedure is not responsible for oocyte activation, and that a release of a sperm factor(s) is required to initiate this process.
Calcium↗
Treatment of sperm-injected human oocytes with Ca2+ ionophore supports the development of Ca2+ oscillations.
Oscillations of intracellular free Ca2+ concentration are an essential component of the oocyte response to the fertilizing spermatozoon. Ca2+ oscillations have also been observed in human oocytes fertilized by intracytoplasmic sperm injection (ICSI), but only after a considerable delay. The present study was performed to determine whether or not the development of Ca2+ oscillations in sperm-injected oocytes is influenced by exposure of the oocytes to Ca2+ ionophore. The treatment (5 min) of sperm-injected, but not sham-injected, oocytes with 10 microM ionophore A23187 augmented significantly the percentage of oocytes that developed Ca2+ oscillations and accelerated the onset of the oscillations as compared to the values for solvent-treated controls. However, the oscillations developed only after a lag period, which ranged between 25 min and 88 min after the removal of ionophore, during which intracellular Ca2+ levels returned nearly to the basal value. Each of the subsequent periodic Ca2+ rises was initiated from a focus in the oocyte cortex and spread throughout the ooplasm as a Ca2+ wave. These data suggest that ionophore treatment supports the physiological pattern of oocyte activation when applied after ICSI. This effect is probably indirect, implying the stimulation of an unknown process continuing during the lag period.
Calcimycin↗
Interleukin-6 biosynthesis in human preovulatory follicles: some of its potential roles at ovulation.
In the present work we explored cellular sites of interleukin-6 (IL-6) biosynthesis in human follicular aspirates from patients undergoing in vitro fertilization therapy and the effects of this cytokine on oocyte fertilization and granulosa cell (GC) steroidogenesis. Biological IL-6 activity from 20-40 IU/mL was present in follicular fluids from 22 patients; it was also detected in 10 of 22 supernatants of cultured oocyte-cumulus complexes and in cumulus cell and GC cultures. Biological IL-6 activity in oocyte-cumulus complex cultures was not related to fertilization rates. Total ribonucleic acid was isolated from follicular aspirates and GC-enriched preparations. After reverse transcriptase and polymerase chain reaction cycles using oligonucleotide primers corresponding to known cDNA sequences for IL-6, a 126-basepair band characterized the amplification product of IL-6 transcripts on gel electrophoresis. To localize IL-6 messenger ribonucleic acid, in situ hybridization analysis was performed using a [35S]IL-6 riboprobe. The distribution of transcripts was more dense (15% vs. 3% stained cells) in GC-enriched preparations, which contained more than 95% GCs, than in original follicular preparations, which contained 20-40% viable GCs; it was not significantly modified by the presence of macrophage contaminants. The expression of IL-6 protein was assessed by positive immunohistological stainings. Biological IL-6 activity was higher, and in situ hybridization signals were more dense and more intense in 24-h GC cultures than in 72-h GC cultures, suggesting that IL-6 biosynthesis was transiently induced. Under experimental conditions of low IL-6 endogenous levels in cultures, adding recombinant human IL-6 from 10-200 IU/mL had no effect on progesterone production or aromatase activity in GC cultures free of macrophages, whereas in GC cultures including macrophage contaminants, stimulatory effects on basal and hCG-stimulated progesterone production and on basal and FSH-stimulated aromatase activities were observed. The present study provides strong support for the view that IL-6 is produced by GCs in the preovulatory follicle at the time of ovulation. In addition, we showed that IL-6 might be an intraovarian regulatory factor concerned with steroidogenesis.
Adult↗
Human zona pellucida recognition associated with removal of sialic acid from human sperm surface.
The ability of human spermatozoa recovered from highly motile sperm fractions to bind wheat germ agglutinin (WGA) after discontinuous Percoll gradient centrifugation was studied. WGA could bind to almost all motile spermatozoa, whereas fewer than 25% of spermatozoa could bind peanut (PNA) and concanavalin A (Con A) agglutinin, two lectins that specifically bind acrosomal membranes. After removal of the plasma membrane with 0.04% Triton X100, WGA, PNA and Con A bound more than 80% of spermatozoa, but binding sites for WGA on the anterior acrosomal region were markedly reduced. The expression of sialic acid on human sperm plasma membrane was demonstrated, since WGA, which specifically recognizes both sialic acid (NeuNAc) and N-acetylglucosamine (GlcNAc), bound almost all intact motile spermatozoa, whereas succinylated WGA, which recognizes only GlcNAc, bound less than 10% of intact motile spermatozoa. Moreover, binding of WGA was compared with that of three other lectins (Sambucus nigra, SNA; Maackia amurensis, MAL and Limulus polyphemus, LPA) with specificity for different NeuNAc linkages. Only SNA, which requires the presence of the disaccharide structure NeuNAc alpha(2,6) Gal/GalNAc, showed a positive correlation with sperm motility as observed with WGA. Moreover, there was a strong inhibition of WGA binding on spermatozoa preincubated with bovine submaxillary mucin containing (2,6)-linked NeuNAc. These results demonstrate the presence of NeuNAc alpha(2,6) Gal/GalNAc glycoconjugate sequences on the plasma membrane of the motile human spermatozoon.(ABSTRACT TRUNCATED AT 250 WORDS)
Arachis↗
[Intraoperative pulmonary embolism of a hydatid membrane].
Only four cases of per-operative pulmonary embolus of parasites during surgery for hydatic cysts of the liver have been reported. Embolus usually occurs in patients who already have lung metastasis of hepatic cysts, suggesting a hepatic cyst in direct communication with the vena cava or suprahepatic vein. We report the first case which occurred in a patient in which there was no evidence of such communication.
Adult↗