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L Boubli

Publications and source records attributed to L Boubli.

At least 37 records · Page 2Linked to original sources
PubMed2002

[Tocolysis: indications and contraindications. When to start and when to stop].

Clinical trials have demonstrated that most tocolytic agents such as beta mimetics, atosiban and indometacine -exception made for magnesium sulfate- extend the duration of pregnancy, when compared to placebo. They reduce the rate of delivery at 24 hours, 48 hours and at 7 days. There is no proof however for their beneficial effect on perinatal or neonatal outcomes. Usual obstetrical contraindications of tocolytic treatments (infection, genital haemorrhage, fetal distress and certain maternal conditions) are often determined on a case by case basis, rather than upon evidence based medicine. Tocolysis may be considered in case of maternal infection without chorioamniotitis or during moderate hemorrhage due to placenta preavia (NP 4). There is no objective argument to refute a tocolytic attempt due and in accordance with a low gestationnal age limit. The risk for neonatal respiratory distress syndrome is higher at 34 weeks compared to 35 and 36 weeks. The studies were however realized before the corticosteroid era of fetal lung maturation. There are no available randomized trials concerning the benefits of tocolysis after 34 weeks of amenorrhea. Furthermore, there are no satisfactory trials preconising a specific tocolytic agent based on amniotic liquid study of lung maturity. In case of advanced cervical dilatation, rare studies have concluded the usefulness of tocolysis to allow fetal lung maturation by corticosteroids. Most studies have evaluated the effectiveness of tocolytic treatment during 48 hours. There is no evidence for continuing tocolytic treatment after an effective tocolysis prescribed during the first 48 hours. For intermediate situations, between franc success or failure of tocolysis (such as reduction but persistent painful uterine contractions or major cervical modification at a low gestational age despite reduction of uterine contractile activity), literature guidelines are poorly contributive. The management of such patients is most often empirical.

Clinical Trials as Topic↗
PubMed2002

[Neonatal consequences of preterm premature rupture of membrane (PPROM) at 24-34 WG: 118 singleton pregnancies].

OBJECTIVES: To evaluate the outcome of preterm infants born after preterm premature rupture of membranes (PPROM) between 24 and 34 weeks gestation (WG). METHODS: One hundred and eighteen consecutive singleton infants were included in a prospective unicenter study during 3 years. A PPROM management had been instituted by the local obstetrician's board committee. In case of suspected chorioamniotitis defined by maternal or fetal criteria or in case of fetal heart rate abnormalities, a fetal extraction was decided. Diagnosis of chorioamnionitis was confirmed regarding the results of placenta culture and/or histology. Neonatal sepsis was defined by positive blood placenta culture or by the association of 2 positive bacterial cultures with a CRP>15 mg/l. RESULTS: The mean gestational age was 29.8 WG (24-34 SA) for PPROM and 30.4 WG for delivery. Mean latency period between PPROM and delivery was 119 hours +/- 208. The incidence of choriamnionitis was 31%. The overall incidence of neonatal sepsis was 15%. Neonatal mortality was 11.7%. Bronchopulmonary dysplasia occured in 8.4% of the liveborn cases and cranial ultrasound abnormalities (HIV III-IV, kystic LPV) in 11.7% of overall cases. Cerebral lesions were positively correlated with hypotension and negatively correlated with GA. Cerebral lesions seemed to occur more frequently in case of chorioamnionitis but it is not significant. CONCLUSION: In this study, in case of PPROM between 24-34 SA, gestational age and hypotension are correlated with neurologic injury.

Brain Diseases↗
PubMed2001

An experimental model of gastroschisis using fetoendoscopy: preliminary results and technical considerations.

BACKGROUND: The aim of this study was to show the feasibility of an experimental model of gastroschisis using fetoendoscopic surgery on sheep fetuses, and also to perform amnioinfusion until delivery using an in-dwelling intraamniotic catheter. METHODS: We analyzed the data from 18 pregnant ewes having 26 fetuses, which underwent surgery at 80 days of gestation (full term, 145 days). The fetendo technique was used to create a gastroschisis in 15 fetuses. The fetal abdominal wall was opened on the left side of the cord using scissors. The omentum and the intestinal loops were eviscerated using atraumatic forceps. Eleven fetuses were used as a control group. Twenty-one fetuses underwent amnioinfusion; a simple exteriorized catheter was used in seven cases and an intraamniotic catheter with an implantable port was used in the other 14. All ewes and fetuses were killed at the end of the experiment by an intravenous injection of pentotal; thereafter, the fetuses underwent necropsy. RESULTS: Twelve fetuses died and 14 survived (53.8%); seven of the 15 that underwent gastroschisis survived (46.7%). An amniotic infection occurred in nine fetuses (34.6%); of these, six died and three that were administered antibiotics survived. CONCLUSIONS: Our experience shows that this experimental model of gastroschisis is feasible and reproducible, and that a repeated amnioinfusion can be performed with an in-dwelling catheter in pregnant ewes. The use of an implantable port is safer than a simple exteriorized catheter.

Animals↗
PubMed2001

Maternal endothelial soluble cell adhesion molecules with isolated small for gestational age fetuses: comparison with pre-eclampsia.

OBJECTIVE: 1. To evaluate the activation profile of the endothelium in pregnancies complicated by small for gestational age fetuses compared with pre-eclampsia and normal pregnancy, by measuring the plasma levels of soluble adhesion molecules soluble E-selectin, intercellular cell adhesion molecule-1 and vascular cell adhesion molecule-1. 2. To determine whether soluble adhesion molecules were related to the severity of small for gestational age fetuses and pre-eclampsia. DESIGN: Observational study. PARTICIPANTS: Sixteen women with small for gestational age fetuses; 15 women with pre-eclampsia and 15 healthy primigravidae were recruited as controls. METHODS: Plasma levels of soluble E-selectin, intercellular cell adhesion molecule-1 and vascular cell adhesion molecule-1 were measured by ELISA. RESULTS: Compared with the healthy controls, soluble E-selectin was significantly increased in both small for gestational age fetuses and pre-eclampsia, whereas intercellular cell adhesion molecule-1 and vascular cell adhesion molecule-1 were increased only in pre-eclampsia. In the small for gestational age fetuses group, soluble E-selectin correlated inversely with the ratio between birthweight and the expected normal birthweight (r = -0.4, P = 0.007). In the pre-eclampsia group, a significant correlation was observed between vascular cell adhesion molecule-1 and blood pressure (r = 0.54, P = 0.039). CONCLUSIONS: Endothelial activation, reflected by raised levels of soluble E-selectin, is a feature of small for gestational age fetuses and is correlated with the severity of the disease. Differences in the profile of soluble cell adhesion molecules suggest variations in the degrees of endothelial activation between pre-eclampsia and small for gestational age fetuses.

Adult↗
PubMed2001

[Rectal administration of misoprostol for delivery induced hemorrhage. Preliminary study].

OBJECTIVE: Assess the efficacy of one misoprostol tablet (Cytotec) in severe delivery-induced hemorrhage on uterine atony after failure of syntocinon. PATIENTS AND METHODS: A descriptive study was conducted at the Djibouti Army Hospital from September to December 2000. Five patients with severe delivery-induced hemorrhage due to uterine atony unresponsive to syntocinon were give a tablet of misoprostol by rectal administration. RESULTS: The hemorrhage ceased in less than 5 minutes in all patients. No immediate side effect was observed. DISCUSSION: These preliminary findings are encouraging and suggest that further investigations would be useful to assess the beneficial effect of misoprostol by rectal administration for patients with severe delivery-induced hemorrhage due to uterine atony. Case-control studies with a sufficient number of cases should be undertaken to determine the real efficacy of misoprostol in this indication.

Administration, Rectal↗
PubMed2000

[Recurrence of Demons-Meigs' syndrome. A case report].

Meigs' syndrome includes ascites, hydrothorax and benign ovarian tumor. The aim of this study was to report a recurrence of Meigs' syndrome in a 71 year old woman, which occurred 30 years after the initial operation. It seems to be the first reported case of recurrence. The high level of CA125 was suggestive of malignancy. Resection of a peritoneal recurrence of the benign fibrothecoma was followed for the second time by improvement of all the symptoms.

Aged↗
PubMed2000

Neutrophil activation in preeclampsia and isolated intrauterine growth restriction.

OBJECTIVE: Neutrophils have been implicated in the pathogenesis of preeclampsia. Because preeclampsia and intrauterine growth restriction result from similar placental lesions, the aim of this study was to investigate neutrophil activation in isolated intrauterine growth restriction relative to preeclampsia and uncomplicated pregnancy. Polymorphonuclear neutrophil activation was analyzed by measuring cell surface and soluble cell adhesion molecule expressions. STUDY DESIGN: L -Selectin (CD62L ) and CD11b surface expressions on polymorphonuclear neutrophils were analyzed in 13 women with preeclampsia, 11 women with isolated intrauterine growth restriction, and 17 age- and gestation-matched control women by means of a standardized quantitative flow cytometry assay. Serum levels of soluble L -selectin were measured by enzyme-linked immunosorbent assay. RESULTS: Neutrophils from women with isolated intrauterine growth restriction and women with preeclampsia displayed higher levels of CD11b and lower levels of CD62L than did neutrophils from healthy pregnant women. Soluble L -selectin serum levels were significantly increased in the preeclampsia and intrauterine growth restriction groups relative to normal values. No significant difference in the levels of CD11b, CD62L, and soluble L -selectin were observed between women with isolated intrauterine growth restriction and those with preeclampsia. Leukocyte activation was not correlated with disease severity. CONCLUSION: The observed alteration in polymorphonuclear neutrophil adhesion molecule expressions and increased serum soluble L -selectin levels are consistent with activation of peripheral blood neutrophils occurring in isolated intrauterine growth restriction in a manner similar to that seen in preeclampsia. This evidence of neutrophil activation may help to advance our understanding of the disease process in isolated intrauterine growth restriction.

Adult↗
PubMed2000

Endometrial response to sexual steroids as assessed by prostaglandin F(2alpha) output in explant culture and hormone receptor expression.

The objective of this study was to evaluate the endometrial response to sexual steroids in organ culture using two means: prostaglandin (PG) F(2alpha) output in medium culture and steroid receptor immunoexpression in tissue. Human endometrium samples were classified in homogeneous and heterogeneous proliferative or secretory subsets. In proliferative endometrium explant culture, progesterone (10(-7) M) induced a significant decrease in PGF(2alpha) output, but this was not the case in secretory endometrium, whereas no significant effect of estradiol (10(-8) M) was observed. Before culture, homogeneous and heterogeneous proliferative endometrium presented the same pattern of estradiol receptor (ER) and progesterone receptor (PR) expression evaluated by quantitative immunocytochemistry. After culture, immunoreactive ER and PR were detected on the explant. PR immunoexpression rates after culture were lower than before culture in glands on homogeneous proliferative and in stroma on heterogeneous proliferative endometrium explants without in vitro steroid addition. In secretory endometrium, no significant difference was observed between ER or PR immunoexpression rates before culture and after culture. These results provided the hormonal receptivity status of endometrium after culture and will thus serve as a reference for evaluating in vitro steroid effects on endometrium explants. Our preliminary results suggest that cultures of endometrium explants are a valid model for studying the effects of hormonal treatment on homogeneous as well as heterogeneous endometrium. These data could be particularly relevant for evaluating the potential response to hormone stimulation and treatment of endometria sampled in perimenopausal patients.

Culture Techniques↗
PubMed2000

[Hormone replacement therapy in menopause and colorectal disease].

Colorectal disease is frequent. Accumulating evidence indicates that postmenopausal hormone replacement therapy may reduce the risk of this pathology in women. Through MEDLINE computer searches, we identified English-language articles with quantitative data on the relation of postmenopausal hormone replacement therapy to colorectal cancers and adenoma. Twenty-four studies about colorectal cancer and five studies about colorectal adenoma were reviewed. Epidemiological data suggest a 20 to 30% reduced risk of colorectal cancer and adenoma among women taking postmenopausal hormones. There is biological evidence to support this association.

Colorectal Neoplasms↗
PubMed1999

[Congenital toxoplasmosis and cerebral involvement inspite of prenatal treatment].

BACKGROUND: Maternal toxoplasmosis seroconversion during the first trimester of pregnancy raises an important risk of toxoplasmic fetopathy. CASE REPORT: Primary toxoplasmosis was identified between 9 and 17 weeks of gestation. PCR analysis of the amniotic fluid confirmed fetal infection. The mother was given a sulfadoxine-piremythamine combination and monthly ultrasonographic surveillance was initiated. At birth, the female infant was found to have diffuse cortical lesions and a chorioretinitis compatible with toxoplasmic fetopathy. She was given sulfadoxine-piremythamine. At 2 years, the clinical and neuroradiological course has been favorable. CONCLUSION: Despite antenatal and postnatal treatment and despite ultrasonographic surveillance, it is difficult to predict the course of congenital toxoplasmosis. This case illustrates the importance of informing parents of the risk and the requirement for careful follow-up after antenatal diagnosis of first-trimester toxoplasmosis.

Adult↗
PubMed1999

Evaluation of a disinfection procedure for hysteroscopes contaminated by hepatitis C virus.

We assessed the ability of a standard disinfection procedure to eliminate hepatitis C virus (HCV) from the air-water channel of hysteroscopes. The residual HCV RNA remaining after the disinfection procedure was measured by polymerase chain reaction. When correctly applied to hysteroscopes, the standard disinfection procedure was sufficient to eliminate the risk of HCV transmission.

Disinfection↗
PubMed1999

[Pelvic endometriosis with urologic involvement. Therapeutic principles: apropos of 2 cases].

The authors report 2 clinical cases of vesicopelvic endometriosis. The urinary symptoms and the radiological appearance of endometriosis of the bladder are nonspecific. The diagnosis was established by histological examination of the resection specimen. The authors describe the therapeutic approach based on radical surgery designed to eradicate the endometriosis, while remaining as conservative as possible in order to allow subsequent pregnancy, and the place of urological surgery combined with medical treatment with LHRH analogue.

Adult↗
PubMed1998

[Prenatal diagnosis of fetal goiter revealing iodine utilization defect].

We report on a case of fetal goitrous diagnosed on ultrasonogram done at 31 weeks of gestation. Thyroid maternal function was normal and no therapeutic was responsible. Hormonal test done on cord blood supported diagnosis of prenatal hypothyroidism. The infant was born prematurely at gestation age of 34 without antenatal treatment. He was eutrophic with clinical and biological signs of hypothyroidism and a large goiter. Therapy with thyroxine was instituted on the third day of life. At 9 months, growth and development are normal. Congenital hypothyroidism has an incidence of approximately 1 in every 4000-5000 live births. Rarely fetal goitrous hypothyroidism have been attributed to thyroid hormone dyshormonogenesis. When fetal goiter is diagnosed on ultrasonography, without maternal hypothyroidism or therapeutic and when hypothyroidism is confirmed on fetal blood, this diagnosis must be suspected.

Female↗