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L Mandelbrot

Publications and source records attributed to L Mandelbrot.

At least 73 records · Page 4Linked to original sources
PubMed1995

Frequency of early in utero HIV-1 infection: a blind DNA polymerase chain reaction study on 100 fetal thymuses.

OBJECTIVE: To estimate the prevalence of in utero transmission of HIV-1 through the second trimester. MATERIAL AND METHODS: One hundred consecutive, unselected, intact fetuses, beyond 15 weeks gestational age (mean, 22.4 weeks) were studied. These were obtained following spontaneous intrauterine deaths (n = 4), miscarriages (n = 4), and elective mid-trimester terminations (n = 92), eight of which were fetuses with malformations from HIV-1-positive pregnancies. Coded DNA extracts from the fetal thymuses were tested blindly by polymerase chain reaction in three laboratories using a total of six different primer pairs. RESULTS: Two thymuses tested positive [95% confidence interval (Cl), 0.2-7]. Results from the three laboratories were consistent in all 100 cases. The two fetuses with HIV in the thymus both tested positive in other organs, demonstrating systemic HIV infection. The first fetus, whose mother had advanced AIDS, had died in utero and had diffuse toxoplasmosis. The second died following extremely premature delivery in a pregnancy complicated by repeated bleeding. HIV infection was observed in none of the 92 fetuses that resulted from elective mid-trimester terminations (95% Cl, 0-4). CONCLUSION: The frequency of early in utero HIV infection appears to be low, compared with transmission rates in infants born to HIV-1-infected mothers, suggesting that transmission occurs mostly later in pregnancy and/or at delivery. Specific risk factors may have implications in the occurrence of early as opposed to late transmission.

Adult↗
PubMed1994

Meckel-Gruber syndrome: prenatal diagnosis at 10 menstrual weeks using embryoscopy.

A case of Meckel-Gruber syndrome was diagnosed by embryoscopy at 10 menstrual weeks, allowing for early termination of pregnancy. Post-mortem examination confirmed the presence of polydactyly and bilateral cystic lesions of the mesonephros and metanephros. Both the forming nephrons and the collecting ducts were involved in the formation of renal cysts.

Adult↗
PubMed1994

Thrombocytopenia in pregnant women infected with human immunodeficiency virus: maternal and neonatal outcome.

OBJECTIVES: Our purpose was to evaluate the prevalence of thrombocytopenia related to human immunodeficiency virus among seropositive pregnant women and its impact on maternal and neonatal outcome. STUDY DESIGN: A retrospective survey of all deliveries of women infected with human immunodeficiency virus in 14 maternity units in France over a 6-year period collected data on mothers who had thrombocytopenia < 100.10(9)/ and their infants. RESULTS: Among 890 women, 29 were thrombocytopenic (3.2%, 95% confidence interval 2.1% to 4.3%). Thrombocytopenia appeared directly related to human immunodeficiency virus infection in 25 of these women. During pregnancy 16 patients were treated for thrombocytopenia with zidovudine, corticosteroids, or high-dose intravenous gamma globulin. Zidovudine was effective in five of seven cases, and intravenous gamma globulin was effective in five of 11 cases. Cesarean sections were performed in 13 of 29 women. Abnormal intrapartum or postpartum bleeding was recorded in five cases. Among 28 infants for whom neonatal platelet counts were available, only one had thrombocytopenia < 100.10(9)/L at birth; he went on to have early-onset acquired immunodeficiency syndrome. CONCLUSIONS: The incidence of fetal or neonatal thrombocytopenia appears low and may not justify invasive sampling or routine cesarean delivery. Therapy with zidovudine or intravenous gamma globulin should be considered for women with severe thrombocytopenia, because of the risk of maternal hemorrhage.

Adult↗
PubMed1993

Myasthenia gravis with polyhydramnios in the fetus of an asymptomatic mother.

Transient myasthenia gravis was observed in an infant whose mother had no signs of neuro-muscular disease. The case presented with severe polyhdramnios at 31 weeks. Sonographic and invasive work-up showed only an absence of fetal swallowing. At birth, the infant had severe muscle weakness and respiratory distress. He had high titres of anti-acetylcholine receptor (anti-AChR) antibodies of maternal origin. Anti-AChR antibodies were also found in stored samples of fetal serum and amniotic fluid. To our knowledge, this is the first case of neonatal myasthenia gravis for which neither past nor present evidence of disease could be obtained in the mother. Anti-AChR antibody testing should be considered in cases of unexplained polyhydramnios.

Abnormalities, Multiple↗
PubMed1993

Serum hCG assay: a method for detection of contamination of fetal blood samples.

Serum human chorionic gonadotrophin (hCG) can be assayed in specimens obtained by percutaneous fetal blood sampling to check for the absence of maternal blood or amniotic fluid contamination. In order to assess the accuracy of this approach, we measured serum hCG in 44 pure fetal blood samples obtained by intracardiac puncture. The mean fetal serum hCG concentration was 52 IU/l, and the ratio of maternal to fetal serum hCG concentration never exceeded 1.1 per cent, which represents the smallest contamination rate detectable by this method.

Chorionic Gonadotropin↗
PubMed1993

Congenital cystic adenomatoid malformation of the lung: prenatal management and prognosis.

Thirty-two cases of congenital cystic adenomatoid malformation of the lung diagnosed antenatally are reported. Antenatal diagnosis has made it possible to document the progress of the condition in utero and the postnatal prognosis. It has been possible to advise on termination and intrauterine intervention, to counsel the parents, and to plan arrangements for delivery and postnatal care among obstetricians, neonatologists, and pediatric surgeons. According to Stocker's classification there were 12 cases of type I, 15 of type II, and 5 of type III. Five pregnancies were terminated. Antenatal drainage of a cyst was performed in four patients with two survivors. Thirteen babies showed relative regression of the cyst as pregnancy progressed. After delivery the extent of the cystic malformation was assessed by chest x-rays and computed tomography scanning in 25 and angiography in 6. Treatment consisted of observation in 4, embolization in 2, operation as an emergency in 3, and electively around 4 months in 15.

Cystic Adenomatoid Malformation of Lung, Congenita↗
PubMed1993

Prenatal management of congenital cystic adenomatoid malformation of the lung.

In utero evolution and postnatal outcome were studied for 18 cases of congenital adenomatoid malformation (CAM) diagnosed by prenatal ultrasound. Five were macrocystic CAM, 9 were microcystic, and 4 were homogeneously hyperechogenic. Three fetuses presented with hydrops. Pulmonary amniotic shunting was performed in 3 patients. Outcome was the following: 4 were aborted, 1 died neonatally, and 13 survived. Four of these infants required no surgery in the neonatal or postneonatal period. In three of these, the size of the mass had decreased spontaneously in utero. Outcome did not appear to be related to the anatomic type of CAM nor to the presence of moderate polyhydramnios, but was related to the degree of mediastinal compression and to the existence of hydrops. A clearer understanding of the natural evolution of CAM is useful to determine the indications for in utero therapy.

Cystic Adenomatoid Malformation of Lung, Congenita↗
PubMed1993

[HIV seropositivity and desire for children].

Growing numbers of women and men who are HIV infected and aware of their serostatus, want to have children. Gynecologists are involved in the dilemmas of counseling those couples about reproductive decisions. For HIV infected women, pregnancy is contra-indicated, mostly because of the risk of transmission to the fetus/infant. However, no rational argument can abolish the desire of many young women to have children in the face of the life-threatening infection. The clinical and immune status of the would-be mothers, her partner's serostatus and the availability of family members to rear an orphaned child, must be considered. For seronegative women with HIV-infected partners, after confirming that seroconversion is not occurring, the partner's clinical and immune status must be evaluated. The risk of transmission through unprotected intercourse increases with the degree of immune suppression in the partner. The couple's stability and the woman's motivations for becoming pregnant must also be carefully evaluated. About one third of such discordant couples separate after the birth of their child. For selected couples who have clearly decided to attempt pregnancy, the objective of reproductive counseling is to reduce their risk of heterosexual transmission. The partner's sperm should not be used for insemination because techniques have not yet been established to eliminate HIV from sperm preparations. Insemination with HIV-negative donors' sperm can be considered. An alternative is the "natural" method, consisting in having unprotected intercourse only during ovulation. Administration of zidovudine to the man in order to reduce the amount of virus excreted has been discussed.(ABSTRACT TRUNCATED AT 250 WORDS)

Breast Feeding↗
PubMed1993

Fetal urinary biochemistry predicts postnatal renal function in children with bilateral obstructive uropathies.

OBJECTIVE: To investigate the ability of fetal urinalysis to predict in utero the renal function of children with bilateral uropathy who survive to the second year of life. METHODS: This was a prospective cohort study of 100 consecutive patients with prenatal diagnosis of bilateral uropathy who underwent fetal urine sampling. Fetal urinary concentrations of sodium, chloride, calcium, phosphorus, ammonium, urea, creatinine, glucose, proteins, and beta 2 microglobulin were measured. Prenatal findings were matched with renal function of survivors at 1-2 years. The single end point was serum creatinine, which was considered abnormal when greater than 50 mumol/L (0.56 mg/dL) during the second year of life. RESULTS: Elevated serum creatinine was found in 17 of 42 children with isolated uropathy who survived more than 1 year. For prediction of elevated serum creatinine during the second year of life, the fetal urinary concentration of beta 2 microglobulin was both specific (0.83) and sensitive (0.80); sodium, chloride, and urea levels were sensitive (0.70 or greater) but lacked specificity (less than 0.65); and fetal urinary glucose, phosphorus, calcium, ammonium, and total proteins were specific (0.70 or greater) but lacked sensitivity (0.65 or less). CONCLUSIONS: Our results provide a new approach to prenatal management of congenital obstructive uropathies by identifying those fetuses at risk for survival with suboptimal renal function. These fetuses might benefit from intrauterine therapy. In contrast, no attempt at prenatal uro-amniotic shunting should be made when a spontaneously good outcome is predicted by fetal urinalysis.

Adult↗
PubMed1993

Virus excretion in the cervicovaginal secretions of pregnant and nonpregnant HIV-infected women.

In order to estimate the prevalence of viral excretion in cervicovaginal secretions, we made a cross-sectional study of 55 HIV-infected women. The patient population was diverse, including pregnant and nonpregnant women in different disease stages from three centers. Virus replication was found in the cell-free supernatant from 12 of 55 cervicovaginal samples (21.8%) by coculture on the CD4-positive cell line CEM-C113. In addition, cell-associated virus was detected in five of a subgroup of 22 samples testing negatively on cell-free supernatant. The prevalence of HIV in the cell-free supernatant was not related to disease stage, zidovudine therapy, transmission group, or history of sexually transmitted diseases. Excretion of HIV was significantly higher in our population of pregnant women (eight of 21, 38%) compared with an unmatched group of nonpregnant women (four of 34, 11.8%; p = 0.04). These results provide evidence of cell-free virus shedding as well as the presence of cell-associated virus in the genital secretions of HIV-infected women.

Adolescent↗
PubMed1992

Reversal of fetal distress by emergency in utero decompression of hydrothorax.

OBJECTIVE: The purpose of our study was to determine whether in utero pleural decompression can improve abnormal cardiotocograms resulting from compressive fetal hydrothorax. STUDY DESIGN: We reviewed all cases of fetal hydrothorax referred to our level 3 fetal medicine unit. Highly pathologic cardiotocographic findings were observed in four third-trimester patients. All had mediastinal compression that resulted in skin edema on the upper part of the body. Prenatal therapy was performed on an emergency basis, two with thoracocentesis and two with pleuroamniotic catheters. RESULTS: One patient went into intractable bradycardia on arrival in the department and died in spite of immediate thoracocentesis. The other three recovered, with normal heart rate patterns after pleural decompression. CONCLUSION: Emergency prenatal therapy may reverse fetal distress in utero, allowing time for delivery of uncompromised infants if possible after a complete evaluation of nonimmune hydrops.

Adult↗
PubMed1992

Prepartum transabdominal amnio-infusion for severe oligohydramnios.

Transabdominal amnio-infusion preceding labor induction was evaluated as a means of avoiding fetal distress and cesarean delivery in patients with oligohydramnios. A preliminary study was performed in 8 consecutive term or post-term pregnancies complicated by severe oligohydramnios (amniotic fluid index less than or equal to 1 cm) with unripe cervices (Bishop's score less than or equal to 3). Warm saline was injected through a spinal needle under ultrasound control. Vaginal delivery occurred in 7 cases; cesarean section was performed in one patient for failure to progress. There was no meconium aspiration and no sign of fetal distress.

Abdomen↗
PubMed1992

Comparative value of polymerase chain reaction and conventional biological tests for the prenatal diagnosis of congenital toxoplasmosis.

When toxoplasmosis is acquired during pregnancy, there is a risk of severe congenital defect in the foetus. Maternal treatment with spiramycin limits the transplacental passage of the parasite to the foetus but does not prevent infection in all cases. Prenatal diagnosis should be based on specific and fast methods to prescribe the more potent combination of sulfadiazine and pyrimethamine. This study evaluates PCR in the prenatal diagnosis of toxoplasmosis; PCR was based on the detection of the gene coding for the P30 surface protein. Amniotic fluid from 44 women with suspected foetal infection was tested by PCR and results were compared to those of conventional diagnostic tests on foetal blood and amniotic fluid. PCR was positive in 7 out of 10 samples from proven congenital toxoplasmosis cases. Sensitivity of PCR was similar to cell culture and mouse inoculation of amniotic fluid but was superior to tests carried out on foetal blood (specific IgM, eosinophil and platelet counts, gamma glutamyl transferase, mouse inoculation). In two cases, PCR was positive with no detected infection of the foetus. In this study, the combination of fast detection methods, ie cell culture and PCR of amniotic fluid, eosinophil and platelet counts, GGT activity and specific IgM, enabled us to confirm 10/10 cases of congenital toxoplasmosis in less than a week. PCR therefore appears to be an additional test which improves early prenatal diagnosis of toxoplasmosis.

Amniotic Fluid↗
PubMed1992

Gonadotrophin-releasing hormone agonist and laparoscopic myomectomy.

The indications for operative laparoscopy have expanded greatly over the past decades, as its many advantages over laparotomy have been recognized. We report our techniques and short-term results concerning myomectomy by laparoscopy. From January 1, 1990 to October 1, 1991, 147 intraperitoneal myomectomies were performed in 70 patients: 46 of 70 were treated preoperatively with a depot gonadotrophin-releasing hormone agonist. No complications were observed. In selected cases, with the advantages of laparoscopic surgery, laparoscopic myomectomy appears to be a safe technique.

Anti-Bacterial Agents↗
PubMed1991

[Epidemiological study of 200 HIV infected pregnant women].

Demographic characteristics and lifestyle were studied among 200 HIV-seropositive women followed in a tertiary care obstetrics/gynecology center in Paris. Between 1985 and 1989, a detailed questionnaire was run by a specialized midwife. The study group, mostly comprised of pregnant women, was compared with the women delivering in the department and with the overall French pregnant population. The women's partners were also studied. There appeared to be a core group of women who are young, single, often unemployed, marginalized members of foreign-born minorities, heavy smokers, and past or present intravenous drug users. Among their partners, drug use was frequent; over half were born in sub-Saharan Africa or North Africa and one third were unemployed. Among women having a job, white collar employees and service workers were over represented, whereas blue collar workers were under represented. The epidemiological profile of HIV-infected women appears to be very different from that of the largely homosexual male population in France. These women are younger and often less intellectual, poorer, more socially marginalized and less receptive to campaigns for prevention. However, the majority of our patients are married or live maritally, work and do not (presently) use drugs.

Adult↗
PubMed1991

[Routes of HIV infection in a pregnant population in metropolitan France: evolution over a three year period].

Routes of HIV transmission among seropositive pregnant women were studied over a three year period in a nationwide multicenter study in France. A total of 2,346 cases were included: 666 in 1987, 809 in 1988 and 871 in 1989. The principal route of transmission was intravenous drug use (IVDU), however an increase in heterosexual transmission was observed. From 1987 to 1989, the proportion of cases related to IVDU decreased from 66.4 percent to 48.2 percent while sexually transmitted cases increased from 24.9 percent to 41.8 percent. The trend towards heterosexual transmission among pregnant women was more marked in the Paris region than in the rest of France. This tendency may be overestimated because of changes in population, such as an increase in women from sub Saharan Africa, the extension of serodiagnosis among IVDU and the extension of systematic testing of pregnant women over the study period. Heterosexual transmission of HIV does appear to be increasing in Europe as can be observed among female AIDS cases.

Adult↗