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Biomedical subjects

L Mandelbrot

Publications and source records attributed to L Mandelbrot.

At least 91 records · Page 5Linked to original sources
PubMed1991

[HIV-infected women's decision to continue or terminate pregnancy].

Our purpose was to determine how women's knowledge of HIV seropositivity influenced their decision on whether to continue pregnancy. The study included 2,023 pregnant women from 220 maternities through France, 595 in 1987, 691 in 1988 and 737 in 1989. Approximately one half decided to continue pregnancy. This proportion was higher in the Paris region (58.9 percent) than in the other regions of France (38.2 percent). Motivations for continuing pregnancy included a visceral desire to have a child, a means of transcending one's mortality, a gift to the partner, a means of rehabilitation, a denial of the pathologic state or the conviction that the infant will be unaffected. Motivations for terminating pregnancy included fear of contaminating the infant, fear that pregnancy could accelerate their own disease progression and fear that the infant will become orphaned. The attitude of physicians towards pregnancy in HIV infected women is discussed. The discovery of an effective treatment decreasing materno-fetal transmission and/or an approach to prenatal diagnosis could offer solutions to this difficult dilemma.

Abortion, Induced↗
PubMed1991

First-trimester prenatal diagnosis in quintuplets: a practical approach using step-by-step embryo reduction.

A multiple pregnancy of high rank may occur in a couple at risk for a Mendelian disorder. Prenatal diagnosis is hampered by the difficulty of (1) obtaining chorionic villi from each zygote and (2) unequivocally relating each sample to the corresponding embryo. The calculation of the genetic risk according to the number of zygotes led us to propose a diagnostic strategy based on embryo reduction, a technique initially designed to improve the perinatal outcome of multiple pregnancies with normal embryos. We report a case in which this approach allowed rational use of first-trimester chorionic villus sampling in a quintuplet pregnancy at risk for non-ketotic hyperglycinaemia, resulting in the selective birth of unaffected twins.

Abortion, Therapeutic↗
PubMed1991

Embryo reduction in multifetal pregnancies after infertility therapy: obstetrical risks and perinatal benefits are related to operative strategy.

To assess the benefits that can be expected from embryo reduction of multiple pregnancies after infertility therapy, we report 58 consecutive cases of selective termination using either a transcervical or a transabdominal approach. The initial number of embryos was five or more in 13 patients, four in 29 patients, and three in 15 patients. The miscarriage rate after transabdominal procedures (23%) was one half of that after transcervical aspiration. Forty pregnancies resulted in the live birth of one child or more. The rate of prematurity was strongly related to the number of embryos left. Mean gestational age at birth was 35.5 weeks but reached 37.7 weeks when only one embryo was left. A reduction in premature birth after selective termination appeared clear for pregnancies with four or more embryos but was less significant for triplets.

Abortion, Induced↗
PubMed1991

Risk factors for ectopic pregnancy in 556 pregnancies after in vitro fertilization: implications for preventive management.

OBJECTIVE: To analyze risk factors for ectopic pregnancy (EP) after in vitro fertilization (IVF). DESIGN: A retrospective study of IVF pregnancies was performed between November 1983 and December 1989. SETTING: This study was conducted in a tertiary care center, the Port-Royal University Hospital. PATIENTS: Patients' records were reviewed for 48 EP and 508 intrauterine pregnancies obtained by IVF. INTERVENTIONS: Forty-six salpingectomies were performed for EP after IVF. MAIN OUTCOME MEASURE: We evaluated the impact on the ectopic rate of tubal status, the type of ovarian stimulation and luteal phase support, and the number of embryos transferred. RESULTS: Forty-three of 48 EP occurred in patients with tubal infertility. The rate of EP was significantly higher when the indication was tubal (11.1%) than when it was endometriosis (2.1%) or unexplained infertility (3.4%). Pathological findings revealed tubal lesions in all 46 salpingectomies. CONCLUSIONS: Ectopic pregnancy after IVF appears related to pre-existing tubal pathology. However, routine prophylactic salpingectomy to prevent the risk of EP does not appear justified.

Adult↗
PubMed1991

Myomectomy by laparoscopy: a preliminary report of 43 cases.

OBJECTIVE: To evaluate the technique and short-term results of intraperitoneal (IP) myomectomies. DESIGN: From January 1, 1990, to March 1, 1991, IP myomectomies were performed in all cases in which it appeared feasible. SETTING: This study was conducted in a tertiary care center, the Port-Royal University Hospital. PATIENTS, PARTICIPANTS: Among 49 consecutive patients with interstitial or subserous myomas, 6 patients with voluminous, multiple myomas had laparotomies. Intraperitoneal myomectomy was performed in 43 patients. The indication for laparoscopy was a pelvic mass in 29 cases, infertility in 13, and severe endometriosis in 1 case. INTERVENTIONS: Thermocoagulation or monopolar coagulation was used for the uterine incision. Myometrium and serosa were sutured in 23 of 43 patients. Myomas were removed through the suprapubic puncture site after fragmentation of large myomas. MAIN OUTCOME MEASURE(S): We evaluated the length of the procedures, blood loss, and postoperative course. RESULTS: Ninety-two myomas were removed laparoscopically. No complication was observed. CONCLUSIONS: In selected cases, IP myomectomy appears to be a safe technique with the advantages of laparoscopic surgery.

Adult↗
PubMed1991

Thyroid function in fetus and mother during the second half of normal pregnancy.

Thyroid hormones, thyroxine-binding globulin (TBG) and thryrotropin (TSH) concentrations were measured in 46 paired fetal and maternal blood samples collected between 17 and 36 weeks of gestation. The samples were selected retrospectively from fetuses that had undergone cordocentesis for prenatal diagnosis, had been found to be unaffected and confirmed healthy at birth. In maternal serum, total thyroxine (TT4) and triiodothyronine (TT3) concentrations were high, but free thyroxine (FT4) and free triiodothyronine (FT3) were within normal adult ranges; reverse T3 (RT3) increased and TSH levels decreased towards term. Fetal TT4, FT4, TT3, FT3, TBG and TSH levels significantly increased whereas RT3 sharply decreased with gestational age. The ratio of fetal TSH/FT4 significantly decreased, suggesting that the set point for negative feedback of pituitary TSH secretion is changing while the sensitivity of the thyroid gland to TSH increases throughout gestation. There was no significant correlation between the maternal and fetal TBG, TSH, TT4 and FT4, whereas maternal TT3 was positively correlated with fetal TT4, FT4, TT3 and FT3. Normal reference values for maternal and fetal iodothyronines, TBG and TSH throughout the second half of gestation provide insight into fetal thyroid development and may be useful for prenatal diagnosis.

Adult↗
PubMed1990

Reproductive outcome after laparoscopic salpingectomy for tubal pregnancy.

Since 1983, we have performed laparoscopic salpingectomy as a routine procedure for ectopic pregnancy (EP) in cases where conservative management is impossible or contraindicated. The main indications are a ruptured tubal gestation, a pathological tube, a history of tuboplasty, and an ipsilateral recurrence. This technique is simple, quick, and safe. Reproductive outcome after laparoscopic total salpingectomy for EP was evaluated in 125 cases between January 1983 and December 1987. The pregnancy rate was 33.6%. In our population, there was a high proportion of patients with a pathological or absent contralateral tube (74.4%). In patients with a normal contralateral tube (32 cases), the live birth rate (46.9%) was greater but not significantly than in patients (39 cases) with a patent but pathological tube (25.6%). In vitro fertilization (IVF) was performed in 59 patients; clinical pregnancy was obtained in 40.7% of cases. These encouraging results lead us rapidly to consider IVF in patients with a pathological contralateral tube.

Fallopian Tubes↗
PubMed1990

Treatment of unruptured tubal pregnancy by local injection of methotrexate under transvaginal sonographic control.

Seventeen unruptured tubal gestations were managed on an outpatient basis using local methotrexate (MTX) injection. A single 50-mg dose of MTX was injected into the gestational sac under transvaginal sonographic control. Follow-up included serial assays of the beta-subunit of human chorionic gonadotropin (beta-hCG), clinical and sonographic evaluation. Resolution was obtained in 13 out of 17 patients. The regression curve between days after treatment versus beta-hCG (y = 82.2 - 10.8x + 0.37x2) demonstrated a significant negative correlation (R2 = 0.77; R = 0.88; P less than or equal to 0.02). The mean beta-hCG level on day 15 was 3.2% +/- 3.1% of the initial value. Laparoscopy was performed in 4 patients. Pathological findings suggested that resolution was underway in these four cases despite a slow decline in beta-hCG. No systemic side effects were observed in any of the 17 patients. Long-term follow-up is needed to evaluate tubal patency and reproductive outcome. Our experience suggests that local injection of MTX may be an effective alternative for the treatment of unruptured ectopic pregnancy.

Chorionic Gonadotropin↗
PubMed1990

Terminal tuboplasties by laparoscopy: 65 consecutive cases.

A series of 65 consecutive laparoscopic distal tuboplasties, performed from May 1986 to May 1988 is reported. Thirty-one were fimbrioplasties and 34 were neosalpingostomies. Outcome was evaluated at 18 months postoperatively. Twenty-two patients obtained pregnancies (33.8%), of which 18 were intrauterine (27.7%). The intrauterine pregnancy rate was 25.8% after fimbrioplasty and 29.4% after neosalpingostomy. These results are comparable with those obtained after microsurgery. Progress in operative laparoscopy may be attributed to the development of an appropriate atraumatic instrumentation and the CO2 laser. The major advantage of laparoscopic techniques is their availability at the time of diagnostic laparoscopy. Immediate opening of hydrosalpinges allows for precise evaluation of the tubal mucosa, thereby establishing prognosis. In cases with a severely altered mucosa, in vitro fertilization may be considered immediately. When the mucosa is satisfactory, laparoscopic fimbrioplasty or neosalpingostomy may be performed. Within 1 year after one of these procedures, a pregnancy is generally achieved in 1 of 3 patients.

Adult↗
PubMed1990

[The socioeconomic consequences of HIV infection in women and children].

The impact of AIDS is expected to shift dramatically towards women and children during the next decade. By the year 2000, millions of women and children in Africa will have AIDS or be orphan. In Europe and America, HIV infection is also spreading most rapidly among these populations. In the Paris hospitals, 0.9% of pregnant women were HIV infected in 1989. Women in the HIV seropositive population are predominantly young, unmarried, smoke, are foreign-born or have used drugs. In France, there is a clear trend towards infection of pregnant women through heterosexual transmission, 24.7% in 1987 to 41.8% in 1989. Women are increasingly choosing to continue pregnancy despite counseling on the risk of HIV transmission to the fetus. Today, over 50% of infected women in Paris continue pregnancy. In the developed countries, 20 to 25% of the infant of HIV seropositive mothers are infected perinatally and 60% die within the first 5 years. The outlook for many of the uninfected children is also quite break. They may be abandoned or orphaned and/or maintained in various institutions. Medical care for infected children is more expensive than for mothers. The cost of HIV infection includes not only diagnosis and treatment but the social cost as well. In maternities, the strain on personnel and facilities can be considerable. Services attending a high proportion of seropositive women and children must be reorganized. Screening, which is accepted by nearly all pregnant women, must be emphasized. Further emphasis must be placed on the prevention of heterosexual transmission.

Child↗
PubMed1990

[Male genital lesions caused by papillomavirus. Results and reflections apropos of 256 examinations].

The authors report 256 male genital examinations to determine papillomavirus lesions (HPV) in men whose female partners presented HPV cervical lesions. 46 p. cent of the examinations performed with a colposcope were abnormal. Histologically, anomalies are present in 62 p. cent of the samples and, overall, 39 p. cent of the men presented, most of the time, infraclinical lesions. Knowing that males are probably safe from malignant degeneration, it is most likely that the treatment of male lesions decreases the frequency of recurrences in women and represent a factor in limiting the extension of the epidemic. The approach of the couple in consultation is discussed.

Biopsy↗
PubMed1989

Prenatal diagnosis of HIV infection: two attempts using fetal blood sampling.

Blood samples were studied, prior to medical terminations of pregnancy, in two second trimester fetuses with HIV-positive mothers. Fetal blood was obtained from the umbilical vein under ultrasound guidance. No evidence of infection was found in either fetus. In particular, lymphocyte subpopulations were at normal levels and cultures yielded no reverse transcriptase activity. Postmortem findings were normal. Reliable means for prenatal diagnosis of HIV infection, with a minimal risk of false-negative results, have yet to be developed. However, further studies using fetal blood sampling should be useful for the management of HIV-positive pregnancies.

Acquired Immunodeficiency Syndrome↗
PubMed1988

Placental transfer of vitamin K1 and its implications in fetal hemostasis.

Vitamin K status was evaluated using coagulation studies and/or vitamin K1 assays in a total of 53 normal fetuses and 47 neonates. Second trimester fetal blood samples were obtained for prenatal diagnosis under ultrasound guidance. Endogenous vitamin K1 concentrations (determined by high performance liquid chromatography) were substantially lower than maternal levels. The mean maternal-fetal gradient was 14-fold at mid trimester and 18-fold at birth. Despite low vitamin K levels, descarboxy prothrombin, detected by a staphylocoagulase assay, was elevated in only a single fetus and a single neonate. After maternal oral supplementation with vitamin K1, cord vitamin K1 levels were boosted 30-fold at mid trimester and 60-fold at term, demonstrating placental transfer. However, these levels were substantially lower than corresponding supplemented maternal levels. Despite elevated vitamin K1 concentrations, supplemented fetuses and neonates showed no increase in total or coagulant prothrombin activity. These results suggest that the low prothrombin levels found during intrauterine life are not due to vitamin K deficiency.

Female↗
PubMed1988

Fetal curarization for prenatal magnetic resonance imaging.

Fetal magnetic resonance (MR) imaging was performed at 33 weeks of gestation for investigation of a posterior fossa abnormality found at ultrasound screening. Fetal movements were abolished by vecuronium injected under ultrasound guidance into the umbilical vein. MR images showed atrophy of the left cerebellar lobe with cisternal dilatation. These were confirmed postnatally by CT scan.

Adult↗