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Biomedical subjects

M Coppens

Publications and source records attributed to M Coppens.

At least 19 recordsLinked to original sources
PubMed2002

Treatment of postoperative pain after ophthalmic surgery.

For ophthalmic surgery we have to deal with a wide range of different patient characteristics. We treat young healthy children, in some cases even neonates, but on the other hand we have debilitated aging patients with multiple concomitant diseases. Treatment of postoperative pain is imperative for inpatients, but is even more important for patients who are treated on an outpatient basis. There also is a wide range of different types of ophthalmic surgical procedures. The postoperative care after a cataract extraction is only seldom complicated by severe pain and is completely different of that after a vitrectomy with scleral buckling. More aggressive surgery as enucleation or evisceration of an eye often is a very stressful and painful procedure. We certainly have some excellent strategies to cope with postoperative pain. We can use topical anesthetics or non-steroidal anti-inflammatory medication. Regional anesthesia of the globe is extremely useful for anticipating on postoperative pain, especially when long-acting agents are used. We can administer analgesics by mouth or parenterally. Acetaminophen or paracetamol is widely used and can be supplemented with NSAIDs or opioids. Especially for children one has to use optimal doses of minor analgesics by an adequate route of administration in order to achieve a timely and efficient analgesia.

Acetaminophen↗
PubMed2001

Computerized analysis of acute and chronic changes in fetal heart rate variation and fetal activity in association with maternal smoking.

OBJECTIVE: To investigate the acute and chronic changes in fetal heart rate and fetal activity in association with maternal smoking by means of a computerized fetal behavior assessment program. STUDY DESIGN: In 13 term nonsmokers and 13 term smokers, fetal behavior was analyzed for 2 consecutive periods of >60 minutes. In between these 2 periods, the smokers were allowed to smoke 1 cigarette, the nonsmokers were allowed a short break of comparable time span. Fetal heart rate variation and fetal activity were recorded by a single 1.5-MHZ ultrasound transducer. The percentage of time spent in low and high fetal heart rate variation and fetal activity were analyzed by computer before and after the short break for nonsmokers and before and after the smokers smoked the 1 cigarette. Smoking-induced changes in Doppler umbilical artery recordings were also investigated. Chronic exposure to cigarette smoke was objectively evaluated by measuring the carbon monoxide concentration in expired air in all participating women after breath holding. RESULTS: Fetuses chronically exposed to cigarette smoke spent significantly more time in a low fetal heart rate variation pattern, while fetal activity was decreased both in high and low fetal heart rate variation periods. After maternal smoking, no acute changes were observed in fetal heart rate variation, yet a reduction in fetal activity was noted; however, this only reached statistical significance in periods of high fetal heart rate variation. No significant change in mean fetal heart rate was observed, yet a significant reduction in the frequency of accelerations was noted. Smoking caused an acute and transient increase in the mean pulsatility index in the umbilical artery. CONCLUSION: The computer program was able to detect changes in fetal behavioral variables in association with acute and chronic smoking. These changes may be suggestive of altered neurodevelopmental maturation possibly resulting from chronic fetal hypoxemia. This computer program offers a real possibility that analysis of fetal behavioral variables can be brought into routine clinical practice. Incorporating an analysis of these behavioral variables into smoking cessation programs may render them more successful.

Adult↗
PubMed1997

Computerised analysis of behaviour in normal and growth-retarded fetuses.

Fetal behaviour [fetal heart rate (FHR) variation and movements (FA)] was studied in 27 normally grown fetuses and in 18 fetuses with intrauterine growth restriction (IUGR). FHR and FA were recorded using a single 1.5 MHz ultrasound transducer and analyzed by computer. The IUGR fetuses had significantly lower FA rates than the normally grown fetuses at all gestation times. They also spent a significantly lower proportion of time exhibiting high FHR variation at 28-31 weeks. Only two of the eighteen IUGR fetuses had abnormal biophysical profile scores (BPS) at the time of recording and yet all but one of them had either FHR or FA patterns that were outside the 10-90th centile range for the normally grown fetuses, suggesting that FHR and FA abnormalities predated BPS changes. More of the IUGR fetuses had abnormalities of FA than FHR. Finally, within the IUGR fetuses, those with small head circumferences (less than 3rd centile) had lower FA rates during periods of both low and high FHR variation, though this was only statistically significant for periods of low FHR variation (P < 0.05). This preliminary study offers the possibility that such objective evaluation of fetal behaviour could be used in a clinical setting and provide a more sensitive method of fetal assessment than the BPS.

Behavior↗
PubMed1997

Computerized analysis of behavior in fetuses with congenital abnormalities.

An observational study was undertaken to evaluate a computerized fetal behavior program in a clinical setting. Behavior of normal fetuses was compared with that of fetuses with a variety of congenital abnormalities. Forty-three fetuses were studied at 28-36 weeks; 26 were normal (49 recordings) and 16 had congenital abnormalities (26 recordings; ten had structural abnormalities of the central nervous system, one had Down's syndrome and five had other abnormalities). Behavior was recorded with the use of Doppler ultrasound. The duration of each recording was 60 min or more in all but two instances. The behavioral criteria studied were (1) the relative percentage of time spent in low and high fetal heart rate (FHR) variation; and (2) the percentage of time fetal activity was detected in low and high FHR variation. Fetuses with abnormalities exhibited varying patterns of behavior: only eight had patterns of FHR variation that were within the 10th and 90th centiles for normal fetuses and only one fetus exhibited a fetal activity pattern that was between the 10th and 90th centiles for the normal group. All the abnormal fetuses had a FHR pattern and/or fetal activity rate outside the 10th or 90th centiles. This study suggests that such a computerized behavioral analysis program may serve as a functional adjunct to the evaluation of a fetus with structural abnormalities.

Abnormalities, Multiple↗
PubMed1996

Blomstrand lethal osteochondrodysplasia.

We present the clinical, roentgenographic, and histologic abnormalities in a stillborn infant with Blomstrand osteochondrodysplasia. Parental consanguinity and multiplex occurrence in the patients' sibship confirm the hypothesis of autosomal recessive inheritance of this monogenic lethal entity. The unknown genetic defect interferes severely with skeletal growth through lack of chondrocyte multiplication and apparent uncoupling of the processes of enchondral ossification and skeletal growth.

Adult↗
PubMed1996

Longitudinal evaluation of uteroplacental and umbilical blood flow changes in normal early pregnancy.

The hemodynamic changes in the uteroplacental circulation and the umbilical artery were evaluated in normal pregnancy from 8 to 14 weeks' gestation. A 6-9-MHz broad-band transvaginal sonographic transducer combined with pulsed color Doppler was used to scan 37 healthy volunteer pregnant women at weekly intervals. Vascular impedance to blood flow in all examined vessels decreased significantly throughout the first gestational trimester. Resistance to flow was highest in the main uterine artery and decreased towards the spiral artery. When the flow velocity waveform patterns of the arteries under investigation were analyzed, specific changes were observed. The diastolic notch was present in the spiral artery flow velocity waveform in all cases until 10 weeks' gestation. From then, the diastolic notch disappeared progressively and was absent in 100% of cases at 13 weeks. The diastolic notch in the arcuate artery disappeared within 2 weeks of its disappearance in the spiral artery. We could not detect intervillous blood flow during the first 12 weeks. From then on, intervillous flow was observed in most pregnancies, reaching 100% at 14 weeks' gestation. These changes reflect the growth and development of the uteroplacental circulation. The absence of detectable intervillous flow during most of the first trimester confirms the concept that, during the first 3 months of gestation, blood flow to the intervillous space is inhibited by trophoblastic plugs.

Female↗
PubMed1995

Risk factors for mother-to-child transmission of human immunodeficiency virus-1 infection.

OBJECTIVE: Our aim was to examine maternal, obstetric, and infant characteristics of mother-to-child transmission of human immunodeficiency virus-1 in Nairobi, Kenya. STUDY DESIGN: Proviral human immunodeficiency virus-1 was detected by polymerase chain reaction in peripheral blood samples taken between 6 weeks and 3 months of age from 107 children born to human immunodeficiency virus-1 seropositive women. The association of maternal, infant, and obstetric variables with human immunodeficiency virus-1 transmission was examined. RESULTS: The mother-to-child transmission rate was 31% (95% confidence interval 21.6 to 40.2) as defined by the presence of proviral human immunodeficiency virus-1 in the infant. Variables associated with transmission in a univariate analysis included placental inflammation (7/12 in the transmitting group as compared with 2/22 in nontransmitters, p = 0.006), low maternal CD4 and high CD8 percentages (21% and 52%, respectively, in transmitting mothers and 32% and 40% in nontransmitting mothers; p = 0.001), and the gender of the neonate (20/29 infected neonates were female as compared with 26/65 noninfected children, p = 0.02). Sexually transmitted diseases were found more often in transmitting mothers but the differences were not significant. Birth weight and gestational age were not related to vertical transmission of human immunodeficiency virus-1. CONCLUSION: Risk factors for mother-to-child transmission of human immunodeficiency virus-1 included chorioamnionitis, an impaired maternal immune status, and female gender.

Adult↗
PubMed1994

Is there an increased risk for tumor dissemination using ultrasonic surgical aspiration in patients with vulvar carcinoma?

The ultrasonic surgical aspirator (USA) is a new surgical instrument that allows precise and selective tissue dissection. Ultrasonic cell destruction is combined with continuous irrigation causing a cloud of fine droplets, which sometimes contains viable tumor cells, hanging above the operative field. We present a patient who developed massive recurrent vulvar carcinoma in the subcutaneous tissue in the proximity of the incisions of the vulva and both groins 3.5 months after a USA-assisted radical vulvectomy and inguinal lymphadenectomy. The atypical pattern of recurrence in the entire operative field suggests that tumor cells might have been spread by the irrigation fluid of the USA. Further investigation is needed to assess the risk of tumor dissemination with USA before the instrument can be used safely in patients with early cancer.

Carcinoma, Squamous Cell↗
PubMed1994

Extramammary Paget's disease of the axilla.

A case of extramammary Paget's disease of the axilla in an 84-year-old patient is presented. No underlying carcinoma was found and the lesion was treated successfully by wide local excision. Immunohistochemical staining showed nuclear immunoreactivity for c-myc and cytoplasmic staining for CEA, EMA, CAM 5.2, EGRF, c-erbB-2 and pan-cytokeratin in all the Paget cells. No immunoreactivity of the lesion was observed for S-100 protein, pan-ras, H-ras, K-ras, and p53 oncoproteins. Further research is needed to establish whether oncoprotein overexpression plays a role in the pathogenesis of extramammary Paget's disease and can be used as a diagnostic or prognostic marker.

Aged↗
PubMed1994

Maternal human immunodeficiency virus-1 infection and pregnancy outcome.

OBJECTIVE: To study the impact of maternal human immunodeficiency virus type 1 (HIV-1) infection on pregnancy outcome. METHODS: Between January 1989 and December 1991, 406 HIV-1-seropositive and 407 HIV-1-seronegative age- and parity-matched pregnant women from Nairobi, Kenya, all at less than 28 weeks' gestation, were recruited into a prospective study of HIV-1 infection in pregnant women and their offspring. Both groups were followed until 6 weeks postpartum. RESULTS: Three hundred fifteen HIV-1-seropositive women and 311 HIV-1-seronegative controls were followed until delivery. Seropositive women were younger at sexual debut and reported more lifetime partners and more sexually transmitted diseases (STDs) than the seronegative controls. The seropositive women had higher rates of genital ulcer disease (4.7 versus 2.0%; P = .08), genital warts (4.9 versus 2.0%; P = .03), and positive syphilis serology (7.9 versus 3.2%; P < .001), but there were no differences between the groups in isolation rates of Neisseria gonorrhoeae (6.8 versus 7.1%) and Chlamydia trachomatis (11.5 versus 9.0%). Maternal HIV-1 infection was associated with significantly lower birth weight (2913 versus 3072 g; P = .0003) and with prematurity (21.1 versus 9.4%; P < .0001), but not with small for gestational age size (4.2 versus 3.2%; P = .7). The stillbirth rate was higher in seropositive women, yet not statistically significant (3.8 versus 1.9%; P = .2). Women with a CD4 count lower than 30% had a higher risk of preterm delivery (26.3 versus 10.1%; P < .001). Postpartum endometritis was more common in HIV-1-infected women than in seronegative controls (10.3 versus 4.2%; P = .01) and was inversely correlated with the CD4 percentage. No histopathologic placental abnormalities attributable to HIV-1 were detected. CONCLUSION: Maternal HIV-1 infection was significantly associated with prematurity and postpartum endometritis, but not with fetal growth retardation. There was a trend toward a higher stillbirth rate in HIV-1-seropositive mothers.

Acquired Immunodeficiency Syndrome↗
PubMed1993

Tubal hydatidiform mole.

We report a tubal hydatidiform mole, most likely resulting from dispermic fertilization. Early hatching of the embryo, because of a defective zona pellucida, may have favored tubal implantation.

Adult↗
PubMed1993

Merkel cell carcinoma of the eyelid. A clinicopathological case report.

Merkel cell carcinoma, a neuroendocrine tumor, is a highly invasive cutaneous neoplasm, which rarely affects the eyelids. This tumor must be treated aggressively to minimize the changes of local recurrence and regional or distant metastasis. In this paper, we describe a 78-year-old woman who had two recurrences of this neoplasm after consecutive local excisions. We describe the histopathological findings and emphasize the differential diagnosis with other neoplasms, as the therapeutic approach is different.

Aged↗
PubMed1992

The role of the gynecologist in the diagnosis and management of breast disease.

As women depend on their gynecologist for advice regarding their reproductive organs, including the breasts, it is mandatory for the gynecologist to obtain extensive experience in diagnostic and management procedures of breast disease. Postgraduate teaching in breast disease should be integrated in the basic training schemes for all resident gynecologists/obstetricians. These teaching programs should include all aspects of diagnosis, management and follow-up of breast disease.

Breast Diseases↗