Needs for vitamins and micronutriments, enzyme cofactors in various metabolic processes, are notably increased during pregnancy in order to satisfy the requirements of fetal and placental growth. Limited maternal stores and an often inadequate dietary intake lead to deficiency, the materno-foetal consequences of which are beginning to be discerned: supplements thus appear to be useful. While there is hardly any discussion regarding iron and calcium, the authors feel that it should be broader, including water-soluble vitamins, magnesium and trace elements, in such a way as to deal with widely encountered microdeficiencies and with metabolic inter-relations. Recent studies appear to show that, rather than being selective and seeking out a "high risk" population, supplements should be given routinely to all pregnant women because of their low costs in relation to expected health benefits.

Deficiency Diseases↗

PubMed1993

Preparing cytotoxic agents in an isolator.

The design of an isolator and its use by an oncology satellite pharmacy for preparing cytotoxic drugs are described. The isolator (Iso Concept, Boulogne, France) is a totally enclosed ventilated biological-safety cabinet of class III polyvinyl chloride (PVC) with positive air pressure, a half-suit with a rotating seal, and attached neoprene gloves. There are three work-stations, one for the half-suit and two along one side of the isolator. The ventilation and air filtration system consists of one entry pipe with a full ventilation-filtration box fitted with one prefilter, one blower, one ball valve, one high-efficiency particulate air (HEPA) filter, one airtight nipple connected to an automatic sterilizer, alarms, and one exhaust pipe protected by a HEPA filter. The air lock consists of a rigid, transparent Plexiglas pass-through. The chamber is sterilized with heated compressed air mixed with 3.5% peracetic acid. Maintenance includes regular changing of gloves and HEPA filters; checking of the integrity of the PVC, half-suit, and gloves; and washing and decontamination procedures. Preparation of cytotoxics is planned in advance with prescription data and manufacturing sheets. In the half-suit, a pharmacy technician reads the label, supervises preparation of the sterile admixture, and writes a label. The operators on the side of the unit read the manufacturing sheet and prepare the dose identified by the label.(ABSTRACT TRUNCATED AT 250 WORDS)

Antineoplastic Agents↗

PubMed1993

[Complete and complicated tears of the perineum in spite of preventive incision. A study of the risk factors and the short-term consequences].

A retrospective study of case controls was carried out by postal enquiry to find out the risk factors for complete complicated tears (DCC) of the perineum occurring after prophylactic episiotomy. There were 33 such cases of DCC out of 8,039 vaginal deliveries which means 0.41% in the University Centre in Grenoble in the years 1985-1986-1987. A control group of 66 cases was paired according to parity and episiotomy. The risk factors were identified as large fetal weight, instrumental deliveries, mid-line episiotomy or perineotomy. The questionnaires could be analysed for faults after delivery in 26 cases and 52 controls (response rate of 90%). The sole significant problem of the cases was perineal and rectal pain lasting more than a month longer than in the control cases. There was no greater dyspareunia, stress incontinence with urine, nor anal incontinence which contradicts previous reports in the literature. The authors conclude there are no serious complications of DCC following perineotomy providing repair is carried out very carefully. The patients in this group show that is was acceptable because no more in this group than in the controls were frightened of a repeat pregnancy.

Anal Canal↗

PubMed1993

Zinc deficiency and dietary folate metabolism in pregnant rats.

Five groups of pregnant Wistar rats (zinc-deficient diet without folate supplementation; folinic acid, folate monoglutamate, folate polyglutamate-supplemented groups receiving zinc-deficient diet; pair-fed groups as controls) were fed from day one of fertilization with a semisynthetic zinc-deficient diet containing 0.2 mg/kg of Zn in the diet for the 4 deficient groups and 100 mg/kg for the pair-fed group. After 20 days, the zinc status (plasma, liver, femoral bone) was significantly decreased in the zinc-deficient groups. The liver and plasma folate levels were lower in the zinc-deficient groups compared to the pair-fed group. Moreover, the folinic acid and the polyglutamate folate supplementations (100 mg/kg diet) did not normalize the folate status of the animals. Only the supplementation with folate monoglutamate led to correct folate levels in the pregnant rats. Nevertheless, no form of folate supplementation prevented fetal growth retardation in any of the zinc-deficient groups. These results indicate that zinc deficiency in pregnant rats decreases folate bioavailability of folinic acid, folate polyglutamates and, to a lesser extent, that of folate monoglutamate. However, no form of folate supplementation (i.e., folate monoglutamate) prevents fetal growth defect and the incidence of malformation in zinc-deficient rats.

Animals↗

PubMed1990

[Antibiotic prophylaxis in cesarean sections without high risk of infection. Therapeutic trial of cefotetan versus placebo].

Caesarean sections are performed with an ever increasing frequency, and their morbidity rate due to infection varies between 35 and 40 per cent. The effectiveness of antibiotic prophylaxis has been demonstrated in caesarean sections with a high risk of infection, but few studies have been devoted to caesarean sections without this high risk. The purpose of our study was to evaluate the effectiveness of antibiotic therapy in this second type of caesarean section since its postoperative infection rate is not negligible (about 25 per cent). We therefore set up a two-centre randomized trial comparing two groups of 133 women without any particular risk of infection. At the moment of umbilical cord clamping, one group received cefotetan 1 g intravenously, while the other group received an intravenous injection of a placebo solution. The postoperative infection rate was 12.5 per cent in the treatment group and 26.9 per cent in the control group (P less than 0.05). The relative risk in the placebo-treated women was 2.15 (95 per cent confidence limits, 1.41 to 3.28). Antibiotic prophylaxis prevented 53.5 per cent of postoperative infections (95 per cent confidence limits, 29 to 69.5 per cent). Moreover, in the treatment group infections were less severe, resulting in a significant decrease in hospital stay and a lower overall cost. We conclude that antibiotic prophylaxis with cefotetan is effective in caesarean sections without a high risk of infection, as it significantly reduces the postoperative morbidity due to infection.

Abscess↗

PubMed1990

[Economic benefit of using antibiotics prophylactically in cesarean sections with little risk of infection].

A randomised double trial was carried out in 266 women who had Caesarean without any high risk of infection in order to study the efficacy of prophylactic antibiotics given during the operation. One group received 1 gram of cefotetan when the cord was being clamped and the other had an injection of placebo under the self-same conditions. Apart from studying the clinical efficacy, evaluation of the economics of the treatment was carried out using, as parameters, the length of stay in hospital and the cost of the antibiotics which were prescribed after the operation. The following results were obtained: 75% of the Caesarean operations carried out in the Maternity Units of the University Regional Hospital Centre were without high risk of infection. Prophylactic antibiotics are proficient because they reduce post Caesarean morbidity due to: endometritis, superficial and deep abscesses and septicaemia. 12.5% in the group who had antibiotics developed infections as against 26% in the placebo group. Post Caesarean infections which required antibiotics cost on an average for each Caesarean 16 francs in the groups who received antibiotics as against 52 francs in the groups that received the placebo. Even including the cost of the antibiotics given prophylactically the costs of antibiotics (prophylactic and curative) was higher in the antibiotic group than in the placebo group. The length of hospital stay was significantly reduced in the group that received prophylactic antibiotics.

Cefotetan↗

PubMed1990

[Effects of zinc deficiency in pregnancy on the mother and the newborn infant].

There seems to be a zinc deficiency during pregnancy in view of the low serum zinc levels, but especially low zinc levels in hair and leucocytes. The need for zinc supplements is still ill-defined but represents at least 5 mg per day which are not covered by the diet and taken from the maternal reserves. Therefore the risk of deficiency is real and its manifestations are numerous. There is a risk of spontaneous abortion, gravidic toxemia, treatment-resistant anemia, abnormally prolonged gestation and difficult delivery for the mother. As for the fetus, with zinc deficiency there is a risk of hypotrophism and malformations with potentialization of the teratogenic effect of alcohol and many medications. Besides, in animals, zinc deficiency during pregnancy results in late effects several months after birth: decrease immunity, learning or memory disorders. In view of all these consequences, administration of supplements is imperative and must be evaluated providing that it does not exceed 50 mg of zinc per day. Besides, it seems preferable to provide balanced multisupplements in minerals and vitamins, since supplement in iron alone results in zinc deficiency.

Congenital Abnormalities↗

PubMed1990

[Role of zinc deficiency in the etiology of neural tube malformations].

The authors study the hypothesis of zinc deficiency as an etiology of malformations of the neural tube. This hypothesis is based on several facts: decrease of maternal zinc levels in this disease found by many authors, malformations of the neural tube induced by experimental deficiency in several animal species, zinc membrane transfer disorders found in fibroblasts cultures in affected newborns. Numerous zinc related biochemical mechanisms could explain this effect. But the most interesting would a disturbance of folate metabolism. In fact, neither a strict isolated zinc deficiency nor a strict folate deficiency can clearly explain these malformations. On the contrary, an interaction, genetic as well as nutritional, between these nutrients would explain these anomalies.

Fetus↗

PubMed1990

[Acute idiopathic dilatation of the right colon or Ogilvie's syndrome. Apropos of a case encountered after cesarean section].

The syndrome of acute colectasia of the right colon following a caesarean section is a rare disease observed and described for the first time by Ogilvie in 1948. Many etiopathological hypotheses have been formulated but recent studies demonstrate the role of the neuro-vegetative nervous system, causing the functional obstacle responsible for the idiopathic right colon dilatation. The clinical picture of low obstruction is seldom typical, as in our case; however, the abdominal X-Ray easily confirms the diagnosis, since the caecal distention may exceed 10 cm in diameter. Most of the time, the prognosis is favorable after aspiration via colonoscopy; caecal perforation is always the spontaneous outcome, due to the "vicious cycle" perpetuating the functional obstruction.

Adult↗

PubMed1989

[Acute epididymitis and antibiotherapy. Measurement of the epididymal diffusion of pefloxacin].

Acute epididymitis is a common infection in the young sexually active adult. Etiologically, the organisms most frequently found are Chlamydia trachomatis, Neisseria gonorrhea and gram negative bacilli. Pefloxacin is a novel quinolone whose antibacterial spectrum and bactericidal activity allow it to be considered for use in the treatment of orchitis and epididymitis Prior to clinical study the authors investigated the degree of epididymal diffusion of Pefloxacin. Ten subjects underwent extraction of an epididymal sample by direct access to the epididymis through a transverse scrotal incision under peridural anesthesia. Three days before surgery, Pefloxacin was administrated at the rate of 400 mg every 12 hours by the oral route. On the day of the operation, the subject receive a 400 mg infusion over one hour, 2 hours before epididymal biopsy. Blood specimens were also extracted. Pefloxacin assays were performed by HPLC following a method derived from that of Montay. The trough concentration of Pefloxacin inhibiting 90% of sensitive strains (MIC 90) is less than or equal to 2 micro-g/ml. The majority of sensitive organisms have minimum bactericidal concentrations equal to twice the MIC 90. The epididymal concentrations that the authors measured are situated at values of 8.15 to 21.80 miro-g/g tissue (mean 13.44). These data allow the use of Pefloxacin to be considered an option in the treatment of epididymitis.

Acute Disease↗

PubMed1988

[Lutenyl and menstrual disorders. A hospital study].

The efficacy of nomegestrol acetate in the treatment of menstrual cycle disorders and dysfunctional uterine bleedings was confirmed on 66 cases in this study conducted by three hospital departments. The study also confirmed the perfect clinical tolerance of nomegestrol acetate. One knows that the same is not true with Nortestosterone derivatives which were used up to now in these indications.

Adult↗

PubMed1988

[Death in utero of a twin during the 2d and 3d trimester of pregnancy].

The study of a series of 9 cases of monofetal death during the last trimester of a twin pregnancy, permits to emphasize the relative frequency of this accident (7.14% in our series, markedly higher than those noted in the literature). An early diagnosis, essentially on ultrasonography, of monofetal death, enables monitoring of the mother and the surviving fetus for whom there is a non negligible risk. It is often necessary to deliver this fetus as soon as it is mature. Systematic and repeated clinical and ultrasonographic monitoring of any twin pregnancy during the third trimester ensures, in a large number of cases, prophylaxis of this accident.

Adult↗